Alcoholics Anonymous Model Research Articles

The politics of belonging in Alcoholics Anonymous: A qualitative interview study.

A prevalent critique of Alcoholics Anonymous (AA) is that members must adopt an inflexible illness narrative, taking on an "alcoholic" identity and performing a set of practices to address this condition. Conversely, a small body of research suggests that, rather than comprising the uniform adoption of a rigid narrative, integration into AA is achieved by negotiating individual beliefs, values, and preferences with the AA model. To investigate such processes of negotiation, the current study aimed to explore the politics of belonging in AA. The study involved semi-structured interviews with 15 AA members recruited from meetings across Sydney, Australia, and data were analyzed thematically. Findings illustrated how participants navigated the politics of inclusion/exclusion within AA. While some aspects of AA were found to be negotiable by participants, a non-negotiable aspect of AA ideology that emerged was the axiom that "alcoholics" have no control over alcohol and therefore should maintain abstinence. Findings raise questions about how the politics of belonging in AA may shift over time following broader patterns of societal change.

Community Effect of Alcoholism: A Photovoice Study in Saint Vincent and the Grenadines.

The Icahn School of Medicine at Mount Sinai and the Saint Vincent/Grenadines Ministry of Health, Wellness and the Environment have been collaborating since 2012 in addressing the plight of alcoholism in Saint Vincent and the Grenadines (SVG). SVG is a middle-income country with few resources available for those who suffer from alcohol use disorders, and these efforts have centered on establishing and monitoring alcohol self-help groups based on the "Alcoholics Anonymous model" (AA model) in several communities in Saint Vincent and the Grenadines. In the summer of 2014, the efforts evolved to include an in-depth investigation of the experience of members of self-help group members via the qualitative research method known as Photovoice. Photovoice is a community based participatory research method in which a set of research questions are explored qualitatively through photographs, interviews, and focus groups. In June 2014, a Photovoice project was established with the longest running self-help group on the island of Saint Vincent in the fishing community of Barrouallie. This project consisted of three rounds of photo-taking, individual interviews, and focus groups, and analysis of the data revealed a number of broad themes relevant to perceptions about the impact of problematic drinking and about drinkers themselves; about the applicability of the AA model in SVG; and about factors that may perpetuate or mitigate problem drinking. It was evident that current and recovering alcoholics believed that there were different types of drinkers who because of their gender, public drinking or tendency for violence could be labeled as "irresponsible." These findings suggest areas for future interventions and research in SVG.

Addictions as Emotional Illness: The Testimonies of Anonymous Recovery Groups

ABSTRACTParticipants in recovery groups from a variety of addictions, following the Alcoholics Anonymous model, identify with each other as suffering from a common “illness of the emotions.” This study analyzes metaphors used to describe the patterns and dynamics of this emotional illness and recovery, derived from the personal writings and testimonials of group participants. Ways in which the participants discover alternate ways to deal with their emotional illness other than manipulating it to an active addiction are also explored.

Buddhist Mindfulness as an Influence in Recent Empirical CBT Approaches to Addiction: Convergence with the Alcoholics Anonymous Model

This article explores the convergence of the Alcoholics Anonymous (AA) model for addictions with recent advances in empirically supported cognitive-behavioral therapy (CBT) for addictions. This convergence stems from CBT entering its “third wave,” which incorporates techniques associated with mindfulness, meditation, and Buddhist philosophy and practice. Research findings associated with various third-wave CBT treatment programs on substance abuse outcome will be reviewed. Implications for research on 12-Step interventions based on areas of convergence of these psychotherapeutic approaches are also discussed.

The Heart of Addiction

Back to table of contents Previous article Next article Book ReviewsFull AccessThe Heart of AddictionBert Pepper, M.D.Bert PepperSearch for more papers by this author, M.D.Published Online:1 May 2003https://doi.org/10.1176/appi.ps.54.5.754AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The Heart of Addiction claims to be "a new way of thinking" about addictions. However, rediscovery of an old, important, but little used perspective for treating the addicted patient might be a more accurate description.Lance M. Dodes, the author, is a psychoanalytically trained psychiatrist who has been treating addicted patients in a variety of settings for many years. To this reviewer, who began treating addictions during psychiatric training in the late 1950s, this book exemplifies the idea that "what goes around comes around." Fortunately, this update of a historic psychiatric-psychoanalytic perspective on addictions—that the addiction represents an attempt to deal with an unresolved neurotic conflict—has value for our times. It tilts against "just say no" foolishness and argues against the reductionism of the one-size-fits-all approach used by some Alcoholics Anonymous (AA) groups and other 12-step groups.Dodes argues that every true addiction represents an attempt on the part of the patient to regain lost control. The addictive process—substance use, gambling, shoplifting—is used as a substitute for mastery over the unsolvable problem. The problem might be rooted in the present—perhaps in an unhappy marriage or career—but most often has its roots in an unresolved childhood conflict. The approach proposed, and exemplified in a number of useful case vignettes, is to develop a therapeutic alliance, to explore conflicted areas in the patient's life, to find the source of the sense of helplessness that the addictive process solves for the moment, and to help the person move on. Would Freud argue with this formulation?The Heart of Addiction never proposes psychoanalytic treatment. Indeed, it never mentions it. Rather, the book describes a method of psychotherapy that is readily recognizable by practitioners of psychodynamically oriented psychotherapy.Dodes argues that all "true addiction" is psychological; it is displaced helplessness and is separate from and independent of physical dependence. He sees physical dependence as more easily treated than psychological addiction. In pursuing this line of reasoning, Dodes minimizes the role of genetics and dependence. In reviewing the evidence for such a role, he concludes that such evidence is scant and finds the psychological dimension of helplessness to be controlling.Dodes analyzes the AA model and finds it wanting. A bit of history might be helpful here. When AA was created in the 1930s it acknowledged that psychiatric disorders often co-occurred with alcohol abuse. It respected the role of medicine and psychiatry. It added the self-help group and a set of rules for recovery to provide social and spiritual support. However, over the next 50 years AA narrowed from the broad base created by its founders. It tended to become a one-size-fits-all group support structure and shunned all psychiatric medications on the grounds that they were addictive. This is the AA that Dodes rightly criticizes.We cannot leave it at that; another point must be added. AA groups are essentially autonomous, and in the past decade or two many of them have broadened their approach. Some AA groups welcome medications and psychiatric treatment, as long as the doctor does not tell the patient to stop attending AA meetings. In sum, AA and other 12-step groups, such as Narcotics Anonymous (NA), help some people but not others, and the fit between a patient and a specific group must be considered.Dr. Dodes addresses his book to people who believe they may have an addictive disorder, or to family members who are trying to understand a relative who is in trouble. He provides a rich series of examples of individuals whose addiction was closely tied to issues of psychological conflict, and it is likely that many readers will benefit from the case examples. The book might be particularly useful for someone who has not been helped by the 12-step approach or who finds that approach to be personally unacceptable. For these reasons, The Heart of Addiction may be a useful book for many people who need help. However, it is regrettable that, in order to make his legitimate case about the importance of psychodynamics in understanding how unresolved conflict and helplessness can lead to an addiction, the author has excessively deemphasized the important role of physical addiction and of genetic risk factors.Dr. Pepper is executive director of The Information Exchange, Inc., in New City, New York.by Lance M. Dodes, M.D.; New York, HarperCollins Publishers, 2002, 257 pages, $24.95 FiguresReferencesCited byDetailsCited byNone Volume 54Issue 5 May 2003Pages 754-754 Metrics History Published online 1 May 2003 Published in print 1 May 2003

Coping and medication adherence in bipolar disorder

Background: Effective treatment of bipolar disorder depends on medication adherence, yet few correlates of adherence have been identified. The pleasure experienced during some manic episodes may render some individuals reluctant to adhere to medications that reduce these ‘highs’. Clinical observers identify denial of the severity or existence of illness as common to both bipolar disorder and addiction. The Alcoholics Anonymous model promotes acceptance as a pathway to abstinence adherence. This report hypothesized that acceptance coping would correlate positively and denial coping would correlate inversely with adherence to mood-stabilizing medication among individuals with bipolar disorder. Methods: Thirty-two participants diagnosed with bipolar I disorder were administered scales from the Brief COPE and an adherence self-report measure. Results: Consistent with hypotheses, curvilinear relationships between acceptance and denial with adherence were detected, suggesting that low levels of acceptance and high levels of denial undermine medication adherence. Limitations: Given the cross-sectional, naturalistic design of the study, no causal inferences can be made. Conclusions: The results uncover links between coping styles and adherence in a psychiatric population. The link between acceptance–denial coping, and mature, self-supportive behavior may point the way towards more effective psychosocial interventions.

The origins and evolution of the disease concept of treatment.

The disease concept of treatment (DCT) has been the dominant treatment model for alcoholism in the United States for the last 30 years. This article sheds light on this treatment model by tracing its historical origins and its evolution in institutions. Accounts from the published literature on Alcoholics Anonymous (AA) and early alcoholism treatment programs were culled for insights regarding the development of DCT. Early examples of AA facilities, state mental hospital alcoholism units, detoxification units, and outpatient alcoholism clinics are described as they evolved. The important role of AA in this process is detailed. Accounts are given of the interaction between professionals and alcoholism counselors during the period in which DCT was developed in these institutions. It was found that all of the current types of alcoholism treatment programs had their origins in early, informal AA facilities except for outpatient alcoholism clinics. DCT evolved concurrently in AA facilities, state mental hospitals and detoxification units. The historical accounts summarized here suggest that DCT was primarily a structured and didactic presentation of AA principles that incorporated some additional treatment elements, notably, the confrontation group. Thus, it can be argued that most alcoholism treatment today (i.e., DCT) derives from the original AA model. It is suggested that studies be undertaken to distinguish the degree to which AA recovery principles are different from DCT methods by researching the clinical beliefs and practices of alcoholism counselors and comparing them with those of AA members.

Mutual Help Movements for Alcohol Problems in an International Perspective

Mutual-help groups in the alcohol field were first organized 150 years ago, and some European groups continue from the late 19th century. After the Second World War, Alcoholics Anonymous (AA) began to spread internationally, and new national mutual help movements were founded, to some extent drawing on or reacting to the AA model. While AA is dominant in North America and many English-speaking countries, other mutual-help movements are stronger in such countries as France, Germany, Italy, Sweden and Japan. Several dimensions of differentiation between the movements are discussed, including: professional or institutional sponsorship vs. autonomous organization; the movement's religious, spiritual or secular basis; whether family members and others are members as well as alcoholics; whether there are external affiliations and activities; and patterns of internal organization and functioning.

Life stories and shared experience

Illness narratives have become a central issue in medical anthropology. Many researchers have made use of narratives as data in a meaning-centered approach, analysing personal illness accounts as a kind of coping strategy by which human beings ascribe cultural meaning to suffering. Often such narratives are being presented as clinical case stories or as patients' accounts told in interviews to a researcher. But apart from being methodologically created data personal stories also have their own life. They are a way of expressing experience, and as reality manifests itself as experience in us, stories are fundamental to human understanding. In many therapeutic groups personal stories are told as a way of sharing experience in order to solve common problems. This article focuses on the social and processual nature of personal narratives as they are presented in Alcoholics Anonymous (AA) groups. The article is based on a study of AA and Minnesota Model treatment of alcoholism in Denmark from 1990 to 1993. Various genres of personal narratives told at AA meetings are identified and analysed referring to individual as well as social and cultural levels. By focusing on interpersonal relationships and the creation of a shared identity in the groups, the article suggests that the ongoing telling of personal narratives in Alcoholics Anonymous takes place in a continuum between autobiography and myth. Thus, individual and collective experience are merged into the same therapeutic process.

Afrocentric Treatment of African American Women and Their Children in a Residential Chemical Dependency Program

Since the late 1970s and early 1980s when the so-called war was declared on drugs in America, little attention to treatment has been focused on African American women. Even less attention has been given to their children in treatment. Even when the National Institute on Drug Abuse (NIDA) made an attempt to refocus attention by awarding more funding to research and treatment (Rosenbaum & Murphy, 1981), these funds focused on women, but did not specify treatment and research with their children. Current drug treatment programs continue to make attempts to measure treatment outcomes based on an Alcoholics Anonymous (AA) model of treatment. It is possible that this model alone produces barriers to treatment of African American women and their children rather than yielding success. It is widely known that African American women are disproportionately represented among the ranks of those who suffer from the abuse of alcohol or other drugs. Consequently, many African American women eventually find themselves in some form of treatment because of these problems and the added fear of losing their children. Professionals are increasingly realizing that many substance abuse treatment programs may not serve the needs of their female African American clients because (a) there is a focus on the AA model only, (b) there are few agencies that provide

How to recognize the signs of sexual addiction

The sexual addiction model enables physicians to understand the self-destructive behavior of patients whose actions may otherwise appear inexplicable. When a person is preoccupied with sex and continues to engage in compulsive sexual activity despite adverse consequences (eg, loss of marriage, job, health, freedom), he or she is a sex addict. Treatment allows sex addicts to stop their compulsive behavior and improve their relationships. Preferred treatment includes professional counseling and attendance at self-help programs based on the Alcoholics Anonymous model. Partners of sex addicts, whose coaddiction may manifest itself through various physical symptoms, depression, or compulsions, can benefit from the same treatment approach.

Dance/movement therapy: Its use in a 28-day substance abuse program

Substance abuse is a major issue and its treatment is a high priority in contemporary society. Hundreds of thousands of men and women in the United States and throughout the world have begun, and continue, their recovery not only from alcoholism, but a variety of problems with chemical dependence, through the support of Twelve-Step programs (Scott, 1989). The Twelve-Step program was initiated by Alcoholics Anonymous (AA) and has been proved successful in dealing with numerous addictions including cocaine, marijuana, narcotics, and others. The overall effectiveness of this approach has been widely accepted and is in use in a majority of treatment centers, inpatient hospital programs, and groups/meetings all over the world. The fact is, therefore, that if one is to consider working in the treatment of substance abuse in the 1990s one must also consider working in conjunction with the AA model. The Twelve-Step AA model is a process of recovery that includes twelve principles to be practiced as a way of life. The initial steps involve an admission of powerlessness, an acceptance of life as unmanageable, the belief in a Power greater than self and turning oneself over to that Power. There is a commitment to an ongoing personal inventory, a sharing of those discoveries and the making of amends. There is a spiritual pledge to make a conscious contact with a Higher Power, knowing that this has a different meaning for each person. In the final step there is a commitment to carry the message to others. Questions have been raised with respect to AA’s disease-oriented philosophy of alcoholism (Herman, 1988; Khantzian, 1980; Szasz in Vataz & Weinberg, 1983). Those who question this model do not challenge the success of the AA program, but generally feel a meaningful and complete approach to alcoholism must ultimately include considerations of cause and effect relationships between alcohol and social, biological, andpsychologicalfactors (Khantzian, 1980). Though the ego impairments and other psychopathology that relate to substance abuse and addiction must be dealt with, it is clear this work requires one to be in a sober state. As it has been proved that sobriety can be accomplished through the AA Twelve-Step program, it is the focus of the work done in early treatment (Brown, 1985; FitzGerald, 1988). With the above in mind it is useful to improve patients’ capacities to perform the AA steps (Anderson & Gilbert, 1989). This paper will focus on how to support treatment of the chemically dependent in a 28-day inpatient hospital program through the use of dance/movement therapy.

Adapting the Alcoholics Anonymous model in adolescent alcohol treatment.

Instructor, Psychiatric Nursing Frankford Hospital School of Nursing Philadelphia, Pennsylvania Head Nurse, Adolescent Unit Charter Fairmount Institute Philadelphia, Pennsylvania