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Professional counselors' perceptions of the role of Alcoholics Anonymous (AA) in substance abuse treatment: A qualitative narrative

ProQuest Dissertations and Theses, 2009
Dissertation
Author: Maria Dawson Rogers
Abstract:
Participation in Alcoholics Anonymous (AA) is an accepted, widely used practice in substance abuse treatment as a stand-alone method and as an adjunct to more traditional therapeutic models. The absence of overwhelming support for the AA model as a successful or curative approach in the treatment of substance abuse coupled with the far ranging use of this approach by professional counselors and treatment centers appears counterintuitive. The present study examines professional counselors' perceptions of the perceived benefits of AA, how and under what circumstances they would identify participation in AA as the best treatment option, and their assessment of the circumstances under which AA should be used. Results may contribute to the development of protocols for determining which clients might be referred by professionals to AA, which might be treated solely with more counseling-based models, and which might benefit most from some combination of the two approaches. Findings may also have implications for alcohol and drug treatment programs.

Table of Contents

Abstract ......................................................................................................................................... ii Acknowledgments........................................................................................................................ iii Chapter I. Introduction .................................................................................................................. 1 Statement of the Problem ..................................................................................................5 Purpose of the Study .........................................................................................................5 Definition of Terms...........................................................................................................6 Chapter II. Literature Review .......................................................................................................9 Substance Abuse Treatment ..............................................................................................9 Alcoholics Anonymous (AA) ...........................................................................................9 Brief History of Alcoholics Anonymous ............................................................10 AA in Context of Substance Abuse Treatment ...................................................13 Philosophy of Alcoholics Anonymous (AA) ..........................................15 AA and Substance Abuse Treatment ......................................................18 Research on12-Step Programs ................................................................22 Research on Counseling-Based Interventions ........................................24 Chapter III. Design and Methodology ....................................................................................... 29 Theoretical Foundations..................................................................................................29 Counseling Theory ..............................................................................................29 Critical Theory ....................................................................................................30

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Qualitative Research Design ...........................................................................................31 Naturalistic Observation .....................................................................................34 Role of the Researcher and Observer Bias .........................................................34 Interpretive Case Study ...................................................................................................35 Multi-Site Case Design .......................................................................................36 Site Selection ......................................................................................................36 Sample.................................................................................................................39 Summary of Experiences of Participants ............................................................39 Observations as Data Sources .................................................................40 Interviews as Data Sources .....................................................................41 Interview Questions ................................................................................43 Chapter IV. Results and Data Analysis....................................................................................... 47 Introduction .....................................................................................................................47 Exploratory Qualitative Case Design..............................................................................48 Participants and Data Collection .........................................................................49 Within-Case Analysis (Site One) ........................................................................52 Semi-Structured Interview Themes ....................................................................52 Substance Abuse is a Disease; It is Genetically Based, It is Learned Behavior ........................................................................52 Assessment and Diagnosis of Substance Abuse is not an Exact Science ..............................................................................54 An Eclectic Approach Appears to be Most Effective in Treating Substance Misuse/Abuse ..............................................58

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Participation in AA will Aid the Client in Remaining Clean and Sober ..........................................................................62 Practical Research is Needed to Help Counselors do Their Jobs ...........65 Within-Case Analysis (Site Two) .......................................................................68 Semi-Structured Interview Themes ....................................................................68 Knowledge of the Etiology of Substance Abuse Misuse/Abuse ............68 Assessment and Diagnosis Involves a Number of Variables..................69 Evidence-Based Practices to Form the Basis of Substance Abuse Programs in the Future .....................................................71 Participation in AA is seen as a Positive Aspect of Recovery ................73 We Need to Know that the Strategies and Interventions We Use are Effective ..................................................................76 Cross-Case Analysis ...........................................................................................78 Chapter V. Discussion ................................................................................................................82 Introduction .....................................................................................................................82 Summary of Thematic Findings......................................................................................82 Thematic Findings from Semi-Structured Interviews .....................................................83 Implications for Theory, Practice and Research ...........................................................106 Limitations of the Study................................................................................................109 Recommendations for Future Research ........................................................................111 References .................................................................................................................................112 Appendix 1: Site Authorizations/Cooperation Letters ............................................................126 Appendix 2: Recruitment Script ..............................................................................................129

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Appendix 3: Information Letter ..............................................................................................130 Appendix 4: Demographics Sheet ...........................................................................................132 Appendix 5: Observation Protocol ..........................................................................................133 Appendix 6: Interview Protocol ..............................................................................................134

CHAPTER I. INTRODUCTION

Substance abuse ranks as one of the major public health issues in today‘s society. At any given time in the United States, substance abuse is either directly or indirectly related to up to 50% of emergency room admissions and 25% of completed suicides (Stevens & Smith, 2001). As well, half of all homicides, one-third of psychiatric emergencies, 25% of completed suicide attempts of people addicted to alcohol, adolescents‘ psychiatric conditions, more than half of all domestic violence cases, and ischemic stroke primarily due to illicit drug use (Cohen, 1995; Evans & Sullivan, 1990; Gentillelo, Donovan, Dunn & Rivera, 1995; Hyman & Cassem, 1995; Martin, Enevoldson, & Humphrey, 1997; National Foundation for Brain Research, 1992). Regardless of their area of expertise, counseling professionals will certainly be faced with clients who present with substance use disorders (Polcin, 2000). Numerous studies suggest a lifetime prevalence rate of 8%–14% for alcohol dependence (American Psychiatric Association, 1994), and it appears that at least 19% of clients who present with a current mental health problem are also plagued with a history of substance use disorder, and in such populations such as clients with a diagnosis of schizophrenia, for example, there is a 47% lifetime history of substance abuse or dependence (Regier et al., 1990). Substance abuse almost always occurs within the context of other problems. Common presenting problems that are related to substance abuse are marital and family conflicts, child abuse, unemployment, financial problems, depression, suicide, multiple medical problems, as well as problems with aggression and violence. In assessing the role of substance abuse within

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the context of other problems, the clinician needs to understand the dynamics of other behavioral problems and how they may be exacerbated by substance abuse (Stevens, 2001). Unfortunately, the literature indicates that mental health professionals have not performed well in their treatment of substance abuse disorders (Brown, 1985; Khantzian, 1985; Vaillant, 1995). According to Shaffer (1986), although addictions professionals choose from an array of treatment models, including professional and self-help approaches, no single method appears to demonstrate a high degree of effectiveness. Some reviews of the history of the treatment of substance abuse have argued that the traditional psychodynamic approach to treating individuals with substance abuse issues as a symptom of an underlying psychiatric disorder have been especially ineffective (Polcin, 1997). Vellerman (1989) indicates that there is no single approach or one agency that can help those individuals who suffer with substance abuse problems. He indicates that accurate assessment of individuals is essential in order to match the client with the best possible service. Beck, Wright, Newman and Liese (1993) stated that there is no conclusive evidence about the most effective treatment for all people with alcohol problems. They concluded that treatment outcomes for individuals with alcohol problems are determined by a number of aspects that include the process of treatment, post-treatment adjustment, the characteristics of those individuals seeking treatment, the nature of the presenting problem, and the interactions between these variables. Professionals have speculated that the popularity of self-help groups such as Alcoholics Anonymous (AA) occurred because of the ineffective response by mental health professionals to substance abuse problems (Khantzian, 1985). AA is described as a self-help program based on the attraction of its members to the program‘s philosophy rather than on program promotion (Alcoholics Anonymous World Services [AAWS], 1990). The relationship between AA and professionally directed addiction

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treatment is an enduring theme in the modern history of alcoholism treatment. AA is viewed by many professionals and recovering individuals as the single most important component of maintaining a clean and healthy lifestyle (White, 1998). Proponents of AA quickly point out that participation provides the individual with an environment in which experiences can be shared and trust can be established. AA‘s philosophy has changed how many people view themselves, their substance use and abuse, and the roles played by the people around them. AA meetings are accessible, open to all prospective members, and free with no time limit for participation (Le, Ingarson, & Page, 1995). The broad influence of AA is reflected in slogans AA has made famous. ―It‘s the first drink that gets you drunk‖; this slogan tells members to aim for abstinence. ―One day at a time‖ warns members not to be discouraged by relapses. ―Think through the drink‖ encourages members to consider the long-term consequences of their actions. As in behavior therapy, individuals are warned to stay away from ―people, places, and things‖ associated with alcohol, and to be especially conscious of the risk when they are ―angry, hungry, tired, or lonely‖ (Harvard Mental Health Letter, July 2007). There is also a strong reliance on spirituality. AA professes to be spiritual rather than religious. Bill Wilson, AA‘s founder, explains the distinction in a chapter of Alcoholics Anonymous entitled, ―We Agnostics‖: As soon as we were able to lay aside prejudice and express even a willingness to believe in a Power greater than ourselves, we commenced to get results, even though it was impossible for any of us to fully define or comprehend that Power, which is God. Much to our relief, we discovered we did not need to consider another‘s conception of God. Our own conception, however inadequate, was sufficient to make the approach and to affect a contact with Him. As soon as we admitted the possible existence of a Creative Intelligence, a Spirit of the Universe underlying the totality of things, we began to be

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possessed of a new sense of power and direction…. [L]ay aside prejudice, even against organized religion. We have learned that whatever the human frailties of various faiths may be; those faiths have given purpose and direction to millions. Some counselors are uncomfortable with the spiritual qualities of AA (Bristow-Braitman, 1995), and prefer to use cognitive-behavioral or humanistic approaches to treatment. Rational emotive behavior therapy (REBT) has led the way in setting up recovery groups that are non- spiritual in nature. In a comprehensive review of research on alcoholism treatment outcomes Miller and Hester (1986) identified social skills training, stress management, and the community reinforcement approach as receiving sound support from controlled studies that have been replicated. The Institute of Medicine (1990) cited social skills training, marital and family therapy, stress management training, and the community reinforcement approach as showing ―promise for promoting and prolonging sobriety‖ (p. 538). If a healthy relationship between AA and professional counseling is to be achieved, then a clarification of boundaries is needed. These boundaries must be solid enough that both clients and counselors are aware of the important differences between AA philosophy and other substance abuse treatment programs, and flexible enough that clients may be referred to AA if desired. The use of the AA model of recovery as an adjunct, or, in some instances, as a replacement for therapy models bears further investigation. The focus of the present study is on the perceptions of professional counselors about the treatment of substance abuse disorders and the role of AA in the treatment of such disorders. Further understanding of the reasons counselors integrate AA philosophy into counseling treatment will be explored. The study attempts to identify and examine professional counselors‘ perceptions regarding the effectiveness

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of the AA model of recovery as both a stand- alone model for the treatment of substance abuse and as part of a counseling-based approach to treatment. Statement of the Problem Most people, whether or not they have used or abused substances themselves, have an abuser in the family, or have a close friend who has abused, or at least know someone or heard of someone in their community who uses alcohol or other drugs inappropriately. According to Stevens (2001), alcoholism continues to be a major problem among adolescents and is a major contributor to fatal automobile accidents and domestic violence situations. Smoking has increased in children ages 12 to 13. The United States has waged a ―war on drugs,‖ and carried out hundreds and possibly thousands of drug busts to stop the explosion of substance use, but to no avail. For helping professionals, drug abuse and dependence continue to be a major mental health challenge. Anecdotally, counseling professionals believe that substance use/abuse is intertwined with the majority of other problems that clients present in therapy; statistics support that belief. Purpose of the Study Participation in AA is a well-accepted and widely used practice in substance abuse treatment as an adjunct to more traditional therapeutic models and as a stand-alone treatment. The absence of overwhelming support for the AA model as a successful, or curative, approach in the treatment of substance abuse coupled with the far-ranging use of this approach by professional counselors and treatment centers seems counterintuitive. Therefore, an in-depth examination of professional counselors‘ perceptions of the perceived benefits of AA, how and under what circumstances participation in AA is identified as the best treatment option, and the circumstances under which AA is not used may aid in the development of protocols for

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determining which clients might be referred to AA, which might be treated with more counseling-based models, and which might benefit most from some combination of the two approaches. Also, these findings may suggest additional content and instructional strategies for alcohol-related treatment intervention courses. This qualitative case study was designed to generate a description of substance abuse counselors‘ perceptions of the role of AA in treatment. . In the following chapters, a review of the literature regarding the current status of substance treatment and AA will be presented, an explanation of the qualitative design for the present study, and finally the results, analyses, and conclusions of the study. Definition of Terms Alcoholics Anonymous (AA) – Alcoholics Anonymous describes itself as a mutual self- help group and a fellowship of recovering individuals, not as a treatment modality. Membership is based on attraction rather than promotion. It is free of charge. It does not have any opinion on any outside issues. It makes no effort to study its effectiveness to justify its existence other than periodic surveys to see what percentage of its members remain abstinent (Alcoholic Anonymous, 1976). Counseling-Based Interventions – The term, Counseling-Based interventions, refers to the application of mental health, psychological, or human development principles, through cognitive, affective, behavioral or systemic intervention strategies that address wellness, personal growth, career development, or pathology. Counseling-based interventions may range from a few brief interventions, such as classroom discussions, or longer-term one-on-one or small group counseling interventions for individuals with more substantial needs. Counseling may be delivered by a single counselor, two counselors working collaboratively, or a single counselor

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with brief assistance from another counselor who has specialized expertise that is needed by the client (Gladding, 2004). Professional Counselor – Individuals who wish to practice counseling or who wish to use the title, professional counselor, must be licensed as a professional counselor or hold a temporary license or professional counselor training certificate. According to the American Counseling Association (ACA), professional counselors apply mental health, psychological or human development principles, through cognitive affective, behavioral or systemic interventions, strategies that address wellness, personal growth or career development, as well as pathology. Self-Help Model – Since the 1970s, self-help groups have grown in prominence. Self-help groups usually develop spontaneously on a single topic, and are typically led by a layperson with little, if any, formal group training; however, the individual usually has experience in the stressful event that brought the group together. Over 10 million people are involved in approximately 500,000 such groups in the United States, and the number continues to increase (Gladding, 2004). Self-help groups aim to fill some of the needs of populations who can best be served through groups, and those who might otherwise not receive services. Groups meet in churches, recreation centers, schools, and other community buildings, as well as in mental health facilities. Lieberman (1994) sees self-help and support groups as healthy for the general public, and Corey (2001) thinks such groups are complementary to other mental health services. Like other group experiences, however, ―cohesion is always a vital characteristic for success,‖ and proper guidelines must be set up to ensure the group will be a positive, not a destructive, event (Riordan & Beggs, 1987). Substance Abuse (Diagnosis) – One of the primary difficulties encountered in diagnosing alcohol and drug problems may lie in the inadequate definitions commonly used. In an attempt to

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provide more comprehensive, specific, symptom-related criteria for diagnosis, the American Psychiatric Association (1994) developed categories for ―Substance-Related Disorders‖ in the Diagnostic and Statistic Manual IV (DSM-IV). The term substance is used to refer to a drug of abuse, a medication, or a toxin. Substances are grouped into 11 classes: alcohol; amphetamines; caffeine; cannabis; cocaine; hallucinogens, inhalants; nicotine; opiods; phencyclidine (PCP),; and sedatives, hypnotics, or anxiolytics (anti-anxiety drugs). The Substance-Related Disorders are divided into two basic groups: the Substance Use Disorders (Substance Dependence and Substance Abuse) and Substance-Induced Disorders (including Substance Intoxication and Substance Withdrawal) (Chamberlain & Jew, 2001).

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CHAPTER II. LITERATURE REVIEW

The review of the literature examines the differences between Alcoholics Anonymous (AA) and substance abuse treatment. Also, this review will examine the differences between treatment programs based on the 12-step model of recovery and counseling-based treatment programs. Substance Abuse Treatment Substance misuse, abuse, and addiction are multifaceted problems that vary across cultures and families as well as with individuals. Each problem is an issue that affects everyone, and the costs are staggering. The complexity of the problem has resulted in no single treatment method evolving as most effective for health-distressed individuals experiencing the consequences of substance abuse; however, current research does find that some approaches are more effective than others. Counselors, whether they work in the field of substance abuse counseling or in the general field of psychotherapy, encounter issues of substance abuse with many of their clients. Therefore, it is essential that all mental health professionals understand the process of abuse and addiction, the etiology of addiction, the individual, family, and societal costs, and available treatment modalities such as Alcoholics Anonymous (AA) and counseling- based interventions (Stevens, 2009). Alcoholics Anonymous (AA) Alcoholics Anonymous (AA) was founded late in the spring of 1935 when two middle- aged, middle-class men met in Akron, Ohio and formed an alliance to obtain and maintain

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sobriety. Both men, known now to AA as Bill W. and Dr. Bob, had been through years of compulsive, heavy drinking and had tried to stay sober with the aid of the Oxford Group, an evangelical non-denominational Christian organization. From those beginnings, AA has grown into a worldwide social organization consisting of autonomous local groups. An unusual institution, the only membership requirement is a desire to stop drinking. AA charges no dues or fees from members and keeps no membership lists. AA exists in and through local meetings and the interpersonal relationship between members. AA in the United States and Canada has a formal organizational structure based in New York City, but that structure has a minimal relationship with AA at large (Swora, 2004). Since its conception in 1935, AA has grown to be the most widely used organization for the treatment of alcoholism and substance abuse. Currently consisting of an estimated 1,800,000 members in 134 countries and more than 87,000 local groups, AA has become a major force in shaping the views of addiction (Alcoholics Anonymous World Services [AAWS), 1990]. AA‘s treatment philosophy has changed how many people view themselves, their substance use and abuse, and the roles played by the people around them. The influence of AA is seen not only in the treatment of alcoholics, but also in the range of support groups for varying concerns of eating disorders, drug addiction, and gambling (Browne, 1991; Gifford, 1989; Yeary, 1987). AA can provide the individual with an environment in which experiences can be shared and trust can be established (Flores, 1988). Brief History of Alcoholics Anonymous By 1934 alcoholic Bill Wilson had ruined a promising Wall Street career with his persistent drunkenness. He was introduced to the idea of a spiritual cure by an old drinking buddy, Ebby Thacher, who had become a member of a Christian movement called the Oxford

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Group. The Oxford Group believed in the practice of meditation, a belief in God of the believers‘ understanding, and following the six tenets: 1. Men are sinners; 2. Men can be changed; 3. Confession is a prerequisite of change; 4. The changed soul had direct access to God; 5. The age of miracles has returned; and 6. Those who have been changed must change others. At some point, Wilson was treated at Charles B. Towns Hospital by Dr. William Silkworth who promoted a disease concept of alcoholism. While in the hospital, Wilson underwent what he believed to be a spiritual experience and, convinced of the existence of a healing higher power, he was able to stop drinking (White, 1998). On a 1935 business trip to Akron, Ohio, Wilson felt the urge to drink again and in an effort to stay sober, he sought another alcoholic to help. Wilson was introduced to Dr. Bob Smith. Wilson and Smith co-founded AA with a word-of-mouth program to help alcoholics. Bob Smith took his last drink on June 10, 1935, and this date is considered by members to be the founding date of AA. By 1937, Wilson and Smith determined that they had helped 40 alcoholics get sober, and two years later, with the first 100 members, Wilson expanded the program by writing a book entitled, Alcoholics Anonymous, which the organization also adopted as its name. The book, informally referred to by members as ―The Big Book,‖ described a twelve-step program involving admission of powerlessness, a moral inventory, and asking for help from a higher power. In 1944, book sales and membership increased after radio interviews and favorable articles in national magazines, particularly by Jack Alexander in The Saturday Evening Post. According to White (1998), there were a wide range of ways in which AA as an institution and AA members related to alcoholism in the years between 1935 and 1960. AA made plans and then abandoned their plans to create ―AA hospitals‖ and ―AA Rest Homes‖ as well as

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plans to send out ―field missionaries‖ to carry the AA message to the far corners of the earth. AA members served as advocates for the creation of local alcoholism treatment programs, and served on national, state, and local alcoholism treatment advisory boards. Many states and national alcoholism efforts were pioneered almost exclusively by AA members. By 1946, as membership grew, confusion and disputes within groups over practices, finances, and publicity led Wilson to write the guidelines for non-coercive group management that eventually became known as the Twelve Traditions. AA came of age at the 1955 St. Louis convention when Wilson turned over the stewardship of AA to the General Service Board. In this era, AA also began its international expansion, and by 2006 there were a reported 1,867,212 AA members in 106,202 AA groups worldwide. The Twelve Traditions informally guide how AA groups function, and the Twelve Concepts for World Service guide how AA is structured globally. AA groups are self-supporting and are not charities, and they have no dues or membership fees. Groups rely on member donations, typically $1 collected per meeting in America, to pay for expenses like room rental, refreshments, and literature. No one is turned away for lack of funds. AA receives proceeds from books and literature that constitute more than 50% of the income for the General Service Office (GSO), which unlike individual groups, is not self-supporting and also maintains a small salaried staff. Additionally, it also maintains service centers which coordinate activities like printing literature, responding to public inquiries, and organizing conferences. They are funded by local members and responsible to the AA groups they represent. The AA-suggested program of recovery for alcoholics includes abstaining from alcohol one day at a time and having a spiritual awakening through following the Twelve Steps, helping with duties and service work in AA, and regular AA meeting attendance or contact with AA

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members. Members are encouraged to find an experienced fellow alcoholic called a sponsor to help them follow the AA program. The program of action has the goal of producing an identity change sufficient to recover from alcoholism. AA promotes the idea that recovery from alcoholism entails more than not drinking. Most AA meetings begin with socializing. Formats vary between meetings; for example, a beginner‘s meeting might include a talk by a long-time sober member about his or her personal experience of drinking, coming to AA and what was learned there about sobriety. A group discussion on topics related to alcoholism and the AA program might follow. A survey conducted by AA in 2004 indicates that over 7500 members in Canada and the United States concluded that AA is composed of 89.1% White, 65% male, and 35% female members. Average member sobriety is eight years with 36% sober more than ten years, 14% sober from five to ten years, 14% sober from one to five years, and 26% sober less than one year. Before coming to AA, 64% of members received some type of treatment or counseling, such as medical, psychological, or spiritual. After coming to AA, 65% received outside treatment tor counseling and 84% of those members said that outside help played an important part in their recovery. A survey conducted in 2004 showed that AA received 11% of its membership from court ordered attendance (AA World Services, 2004). AA in the Context of Substance Abuse Treatment Since 1949, when the Hazelden Treatment Center was founded by members of Alcoholics Anonymous, some alcoholic rehabilitation clinics have frequently incorporated precepts of the AA program into their own treatment programs. A reciprocal influence has also occurred with AA receiving 31% of its membership from treatment center referrals. Alcoholics

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Anonymous, however, does not endorse and is not allied with any rehabilitation center or outside facility. With the passing of many years, AA emerged as a primary source of referral of alcoholics to treatment programs. There were also many alcoholism treatment programs in the 40s and early 50s in which AA sponsorship was a requirement for admission. AA members served as volunteers within alcoholism treatment programs — often in education and co-therapist roles. AA members transported patients from hospitals, asylums, sanitariums, rest homes and prisons to AA meetings, and facilitated AA meetings inside these institutions. In the 40s, AA members — acting as individuals rather than as representatives of AA — began organizing and working as paid staff within alcoholism education and treatment programs, a practice that forced AA and treatment institutions to begin a dialogue about the distinctions between AA and treatment. As treatment programs developed formal patient-education programs, AA members were increasingly called upon to speak to patients about alcoholism, recovery, and AA. The Basic Text of AA regards alcoholism as an illness. While discussing the term ―disease,‖ Bill Wilson once stated that alcoholism was more comparable to an illness or malady, and uses the concept to challenge the belief of chronic, compulsive drinkers that they can stay sober by willpower alone. Dr. Silkworth introduced to Wilson and to AA the idea that alcoholism is an illness consisting of an obsession to drink alcohol and an ―allergy‖ which was the compulsion to continue drinking once the first drink had even been taken. What is perhaps most significant is that AA became the primary sobriety-based support structure to which most alcoholic patients were referred upon their discharge from treatment. What has been called the ―modern alcoholism movement‖ rose in the 1940s to redefine America‘s view of alcoholism and the alcoholic. One of the legacies of this movement was a

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professionally directed model of alcoholism treatment that integrated AA‘s philosophy and professionalized AA members within the new role of alcoholism counselor. Beginning with this movement, and ending with a model that, more than any preceding it makes the boundary between mutual-aid and alcoholism treatment extremely difficult to draw (White, 1998). Philosophy of Alcoholics Anonymous (AA). Kurtz (1979) describes AA as both a fellowship of alcoholics and a program of recovery from alcoholism. Participation and its principles are considered an effective treatment for alcoholism; however, AA itself is not considered therapy. AA‘s program for recovery as outlined in the Twelve Steps is a set of spiritual concepts and practices that have the purpose not of curing alcoholism, but of transforming the alcoholic, and the key term here is spiritual. The AA model of recovery explains alcoholism as incurable and a progressive disease of the body, mind and spirit. The fellowship and program focus on the spiritual aspect. Miller and Kurtz (1994) suggest that the cornerstone of the AA model of recovery is the paradoxical belief that to gain control of one‘s life, the individual must give up control to a Higher Power. Although God is spoken about in AA, members believe that one‘s Higher Power can be many things or beings. AA does distinguish between spirituality and religion. Addiction is believed to be a spiritual disease as well as a physical one. By embracing spirituality and not a specific religious dogma, AA allows all individuals to embrace a Higher Power of their own choosing. AA is described as a ―spiritual program of living.‖ As emphasized by Marion and Coleman (1991), the belief that abstinence from substance use is not enough is fundamental in AA philosophy. Individuals must be willing to make fundamental changes in their lifestyle with respect to attitudes and behaviors. The model is designed to allow individuals to address every aspect of their lives to include the physical,

Full document contains 145 pages
Abstract: Participation in Alcoholics Anonymous (AA) is an accepted, widely used practice in substance abuse treatment as a stand-alone method and as an adjunct to more traditional therapeutic models. The absence of overwhelming support for the AA model as a successful or curative approach in the treatment of substance abuse coupled with the far ranging use of this approach by professional counselors and treatment centers appears counterintuitive. The present study examines professional counselors' perceptions of the perceived benefits of AA, how and under what circumstances they would identify participation in AA as the best treatment option, and their assessment of the circumstances under which AA should be used. Results may contribute to the development of protocols for determining which clients might be referred by professionals to AA, which might be treated solely with more counseling-based models, and which might benefit most from some combination of the two approaches. Findings may also have implications for alcohol and drug treatment programs.