For professional health providers
The most popular self-help groups are the 12-step groups, including Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Cocaine Anonymous (CA). The addiction counselor must be familiar with the general philosophy and the 12 steps and be able to review them, and the principles involved, with each patient.
Reviewing these concepts will serve to familiarize the patient with the 12 steps in a very general way and help the patient to apply the 12-step approach to specific aspects of his or her recovery program. As the patient attends counseling sessions, the counselor will want to monitor the patient’s participation in self-help groups. The counselor should inquire about the patient’s participation in, and thoughts and feelings about, 12-step groups and follow up by providing whatever further information or encouragement the patient needs about self-help groups and the 12-step philosophy
12-Steps Programs in Primary Care Meeting scheduled by patients or staff with good sobriety take newcomers to a meeting. Staff encourage relatives to attend Alanon if addicted patients are difficult. Negative attitudes and remarks to addicted patients are not tolerated.
Twelve Step groups are normative organizations that: help members experience, express and manage feelings. Prevent negative feedback from others. Help capacity for self-regulation. Increase self efficacy and self care. Improve relationship to others. Find purpose and meaning. Increase ability to listen to others.
Unlike other countries such as Australia and most of WesternEurope, the US have adopted an abstinence-based response to drug dependence, making 12-step recovery an ideal resource and after care modality. Note however that even in countries that have adopted a harm minimization paradigm such as Australia, the majority of individuals with a chronic history of poly-substance use choose total abstinence from all mind altering substance as their personal recovery goal and report 12-step utilization patterns that do not significantly differ from that of their US counterparts.
Behavior in an Active 12-Step Program of Recovery: Thoughtful, Honest, Open to learning and change, Humility, Gratitude, Common defense mechanisms, Altruism, Humor, Anticipation, Suppression, Sublimation, Hope.
Negative attitudes in AA about psychiatrists/psychotherapy comment that they are: Insensitive; Dangerous (anti-aa); Arrogant; Drug-oriented; Ignorant about addiction; Abusive; Non-spiritual; Minimize impact of alcohol; Money-grubbing; Competitive; Contemptuous; Threatening.
In a softer way it is to recognize limitations of current drugs:
- Partial efficacy: Many existing drugs are characterized by only partial efficacy: not everybody responds, residual symptoms are frequent and full benefit takes several weeks to emerge. Crucially, more efficacious drugs are unlikely to be developed until there is a better understanding of the molecular and cognitive mechanisms of disease. Furthermore, very little is known about why some patients respond and others do not. In principle, it should be possible to identify neurobiological and genetic differences between responders and non-responders. However, the necessary studies require information on substantial numbers of treated patients.
- Side effects and poor treatment adherence: Many psychiatric drugs are poorly tolerated because of side effects, which commonly include weight gain, sexual dysfunction, sedation and nausea. This reduces adherence to treatment and so increases the likelihood of relapse and recurrence. In addition, most people do not want to take psychiatric drugs and their adherence to prescribed treatment is poor. This is due to a complex combination of factors.
- Sub-optimal diagnosis and drug dosing: Many patients receive inappropriate doses of drugs for an insufficient period. Not only are sub-optimal treatments regimes less cost effective, but incorrect dosing can prevent recovery and can be mistakenly construed as inefficacy or resistance to treatment. These erroneous conclusions might result in unnecessarily changing the treatment, or administering another drug (polypharmacy), and so may be disruptive (or possibly hazardous in the latter case) to the patient.
For Fellowship Carers
Negative attitudes of psychiatry towards AA Substitute dependency insist on that: AA is “adjunctive”; A folk movement; Religious bible thumping; A cult; Fosters dependency in members; No follow-up; No controlled research; Efficacy not proved; Disorganized; Hostile to psychiatry; Lacks accountability; Uncooperative; "They smoke and drink coffee”; Non-intellectual; Free.
Parts of explanations are with: anonymity (that could be seen as a decent right to privacy and share of common problem); not so scientific way to assess result (meanwhile there have been since 2 decades assessment that put in "scientific evidence" the effectiveness of AA groups and ATS (Minnesota's model) approach.
AA Changes Brain Function and Behavior: Alcoholic/Addicted Behavior: Impulsive, Antisocial, Immature, Painful to self and others, Common defense mechanisms, Denial, Minimization, Projection, Grandiosity, Acting ou.t.
Working a 12-Step program of recovery is not easy. It requires help from others, especially a sponsor and a home group costs time and energy. When refered to a 12-Step program two benefits can be expected: 1) Sobriety, which sets the stage for improved health, relationships, finances, and learning. 2) Mature Growth and Development Tasks of adult growth and development.
Other goals are: intimacy, the ability to be genuine and open with others; (re)generativity; the ability to pass on what one has learned to others; integrity, a sense of wholeness and acceptance of one’s self goes, beyond the usual goals of medical treatment, but one which any physician can support.
"The main features of the positive future with Addictions' care are:
- There should be no stigma attached to mental health problems, drug use or addiction.
- Research has led to the development of drugs for mental illness that have minimal side effects and are prescribed only when necessary.
- Health, rather than punishment, is the framework for supporting those whose drug use becomes a problem, and the services are widely available and of high quality.
- Primary care and community health workers are experienced in working with addicts and people with mental health problems.
- All children receive age-appropriate, effective drugs education.
- Doctors and patients should work together, with families and carers where necessary and beneficial, to work out the best course to take".
Historically, recovered and recovering people brought great passion and energy to the treatment milieu. They brought a focus on direct service to the still suffering addict and a deep faith in the potential for recovery derived from their own transformed lives and their participation in a community of recovered and recovering people. It is that contagious spirit of hope that must not be lost.