By: Valerie J.
Slaymaker, Kirk J. Brower and Mike Crawford
Founded in 1935 in Akron, Ohio by Dr. Robert Smith and Bill Wilson, Alcoholics Anonymous (A.A.) is an extensive mutual-help organization that spans the globe. By 2002, over 100 000 groups were meeting in 150 countries (Alcoholics Anonymous World Services, 2004). As a result of A.A.’s growth and popularity, additional groups have been developed for those struggling with addiction to specific substances, including Narcotics Anonymous, Cocaine Anonymous, and Marijuana Anonymous, among others.
A.A. aims to help members with maintaining total abstinence
from alcohol and drugs by living in accordance with the Twelve Steps. The
Steps encompass the basic principles of the A.A. philosophy and emphasize
recognition of problem drinking and
alcoholism, development of hope for recovery, conducting a thorough self-inventory of
personal shortcomings, implementing a behavioral plan of action to address the
consequences of alcoholism, making restitution for harmful actions, engaging in regular
behavior intended to maintain recovery, developing spirituality and serenity, and helping
other alcoholics. Regular attendance at meetings is strongly encouraged and
newcomers are
advised to attend 90 meetings in 90 days whenever possible. In addition, the
program philosophy encourages modification of maladaptive cognitions (referred to as
‘‘stinkin’ thinkin’’),
behavioral changes (e.g. avoidance of drinking events, drinking friends, or relatives), and
the development
of adaptive coping skills (e.g. calling a sponsor for support when needed).
This multifaceted approach combines elements of cognitive and behavioral change,
social support
(fellowship), and spiritual growth and defines A.A. as a complex intervention.
Frequently misunderstood as a religious organization, A.A.’s spiritual principles
are broad and consistent with many religious
orientations. Whereas religions generally define the nature of God or
some other unifying force and prescribe specific,
ritualistic practices for relating to God, A.A. encourages members to
define a ‘Higher Power’ for themselves and to find their own way of relating to
that Higher
Power. For example, members may choose to use the words, ‘God,’ ‘Higher
Power,’ or ‘Power greater than ourselves’ to refer to a source of strength that
assists them in
maintaining recovery. The idea is that when alcoholics rely primarily on their
individual selves for recovery, they are in danger of relapsing to drinking. Therefore,
they need to
seek a power greater than themselves for recovery.
Nevertheless, some patients are unable to affiliate with A.A. because of its spiritual
connotations (Walters, 2002). A.A. is one of the most
commonly sought after sources of help for alcoholism in the U.S. (Weisner et
al., 1995; Workgroup on Substance
Abuse Self-Help Organizations, 2003), with membership estimated at over 2 000 000
people worldwide (Alcoholics Anonymous World Services, 2004). It is free, available
to anyone with a desire to stop drinking, omnipresent, and compatible with
professional interventions.
Because A.A. participation is related to improved substance use and psychosocial outcomes, a
number of national
organizations recommend referral to A.A. and other Twelve
Step related groups.
The most recent public policy statement written by the American Society of Addiction
Medicine (ASAM, 2001) recommends the inclusion
of self-help groups as an adjunct to professional treatment. Similarly, the
National Institute on Alcohol
Abuse and Alcoholism (NIAAA) includes A.A. in a discussion of advances in addiction treatment, noting the
efficacy of A.A. in improving outcomes (NIAAA, 2000a). The Department of
Veterans Affairs, perhaps one of
the largest providers of substance abuse treatment in the USA, also recommends referral
to self-help groups in
their clinical practice guidelines, with specific strategies included for promoting meeting
attendance among substance dependent patients (Veterans Health Administration Office
of Quality & Performance, 2001). The American Psychiatric Association (APA)
published its second edition of practice guidelines for substance use disorders
in 2006, which recommend attendance and participation in meetings of A.A. or
other similar
self-help groups in the light of higher abstinent rates among those who
participate. Acknowledging that individual patient needs and concerns must be
considered when
recommending A.A., the practice guideline maintains that most patients should
be encouraged to attend at least some A.A. meetings on a trial basis (APA, 2006,
p. 65). The Substance
Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse
Treatment has published
a series of practice guidelines in addictions treatment titled, Treatment
Improvement Protocols (TIP). These
guidelines recommend referral to A.A. and related groups for alcohol and drug addicted
people including
adolescents, adults, older adults, pregnant women, and those with co-occurring
mental health disorders
(US Department of Health and Human Services, 1993, 1994a, 1994b, 1994c, 1998,
1999). SAMHSA and the US Department of Veterans Affairs convened a group of
experts to discuss
mutual-help groups in the treatment of substance abuse and dependence. In a white paper
outlining their clinical and policy recommendations, the resulting Workgroup on
Substance Abuse Self-Help Organizations (2003) urges clinicians and program
directors to implement procedures to facilitate mutual help participation, such as that
offered in A.A. and related groups, among substance dependent people.
In addition to governmental agencies, groups of addiction
researchers recommend referral to A.A. as part of a comprehensive treatment
program. A group at the George Washington University Medical Center works to promote
public knowledge,
improve access to treatment, and reduce the social consequences of alcohol abuse and alcoholism through their
organization, Ensuring Solutions to Alcohol Problems. To this end, the group
publishes a series of
primers that are summaries of research addressing specific topics related to alcohol
abuse and alcoholism. In
Primer 4,
The Active Ingredients of Effective Treatment for Alcohol
Problems (Ensuring Solutions to Alcohol Problems,
2003), the group identifies participation in A.A. as an important component of
positive treatment outcome. Most recently, a group of nationally recognized
addiction researchers published an expert consensus statement outlining
policies for facilitating mutual-help group involvement (Humphreys et
al., 2004). Specifically, this expert panel recommended
that mutual-help
group attendance be viewed as an extension of professional treatment, not
a substitute for it. The workgroup further specified the use of empirically
validated methods to facilitate mutual-help group involvement including Twelve
Step facilitation counseling, having a menu of mutual-help group options available,
and encouraging clinical
staff to facilitate self-help group attendance, among others.
References
Peter
Tyrer and Kenneth R. Silk, Cambridge Textbook of Effective Treatments in
Psychiatry, Cambridge University Press 2008.
Read Also
Evidence-based cognitive-behavioral and behavioral treatments for drug dependence
Complex interventions for alcohol use disorders
The Minnesota model of care for alcohol use disorders
Therapeutic communities for alcohol use disorders
Combined pharmacotherapy and psychotherapy for alcohol use disorders
An Introduction to Pharmacotherapy of alcohol misuse, dependence and withdrawal
Treatment of co-occurring psychiatric and substance use disorders
The Minnesota model of care for alcohol use disorders
Therapeutic communities for alcohol use disorders
Combined pharmacotherapy and psychotherapy for alcohol use disorders
An Introduction to Pharmacotherapy of alcohol misuse, dependence and withdrawal
Treatment of co-occurring psychiatric and substance use disorders
No comments:
Post a Comment