Debating theories would oppose at primary level 2 models:
- AA's model use: abstinence, spirituality, accountability, service; higher power as a spiritual concept, faith and big book authority, sponsorship, group conscience, 12-step recovery as a way of life;
- Psychiatrics' model would include: dual diagnosis, personal identity as psychiatric patient, medical authority, prescription authority, science & psychotherapy, psychopharmacology.
But practically cooperation with the Professional Community (CPC) Committee grew out of desire to help suffering alcoholics. Research in 1980’s and 1990’s observed AA most effective way for alcoholics to maintain long term sobriety. AA/NA compatible with treatment of all medical and mental disorders. Meanwhile the debate over socio-biology and complexity of new methods in brain functional exploration put science in less dialectical registers and change of paradigmas not perfectly in the registers of traditional scientist meanwhile epidemiological studies could have supported the results of improved and adapted empirical practices.
Minnesota's 12 steps
Historically, the principles of Alcoholics Anonymous (AA) and other 12step organizations have been an integral part of the development of drug abuse treatment. Substance abuse treatments utilizing a 12step approach evolved to meet the needs of patients who are not successful at establishing recovery solely through 12step organizations.
When AA first became interrelated with treatment for alcoholics,it was through the Minnesota Model, as developed at Hazelden center in Minnesota. Minnesota's model of treatment for substance dependence is a group-based psychosocial intervention program that rests on the 12 Steps principles of Alcoholics Anonymous.
On the basis of their contents, 12 steps may be grouped into decision steps (1-3), involve the recognition of powerlessness and a decision to put oneself in the hands of God of personal understanding (Gpu). The action steps (4-9) involve the writting of a moral inventory, share it with another person and turning to a Gpu. Making amend to harmed people. The maintenance steps (10-12) entail an ongoing and continuous self-examination, self-correction and deepening of relationships through prayer and meditation as well as carrying of the AA message to other alcoholics.
Between 1948 and 1950 three treatment centres in the state of Minnesota (Pioneer House, Hazelden and Wilmar State Hospital) put the method into practice. Hazelden was incorporated on 1949, as "a sanatorium for curable alcoholics of the professional class." Late 1970s and early 1980s model disseminate in the USA then overseas.
Over time, the sophistication and comprehensiveness of treatments have increased with developments in medication and behavioral therapies and with more complex views of the barriers to establishing and maintaining recovery. Today, there is great diversity among treatment programs using a 12step related approach. Commonly they often have a 3-6weeks initial treatment episode and residential; then followed by 6-24 months of program aftercare.
Staff may include medical doctors, social workers, nurses, clergy, psychologists and counselors often AA or NA recovered. Therapy group is considered the main therapeutic tool providing a place for identification with others in a similar situation. Written assignments, "life story", substance-related negative consequences are common tools.
Treatment goals are to assist patients in establishing abstinence, affiliation with 12step organizations, and stability or improvement in a full range of mind, body, and behavioral functions. Basic assumptions:
- Abstinence from alcohol and illicit drug use is essential to establishing recovery from alcohol or drug dependence.
- Involvement with 12step organizations is the most readily available and, for most individuals, the best way to achieve and maintain recovery.
- Alcohol and other drug (AOD) dependence is a chronic illness. Immersion in the 12step fellowships and program beginning in treatment is the best way to achieve 12step organization affiliation after treatment.
During treatment all patients become knowledgeable about both the 12step program and fellowships. All receive encouragement to begin attending 12step meetings immediately.
Assisted twelve steps is a counsellors' method that is employing recovered patients, more or less trained to drive consumers out. The counselor should create a sense of participating in a collaboration and partnership. This goal is best accomplished through three main avenues of approach. First, the counselor should possess a thorough knowledge of addiction and the lifestyles of addicts. Second, no matter how expert the counselor is, he or she must acknowledge that the patient is the true expert in discussing his or her own life. The counselor must listen accurately, empathize effectively, and avoid passing judgment. Third, the counselor should convey to the patient that he or she has an ally in the difficult progress toward recovery.
Traditional values of AA could have been seen contradicting cultural values. Adaptation to programs have been considered. For example for African-american an alternative list of ten “Terms of Resistance” meetings just as the Twelve Steps are at traditional meetingve been suggested (meanwhile any are free to entry in any common 12Steps AA group): 1) I will gain control over my life. 2) I will stop lying. 3) I will be honest with myself. 4) I will accept who I am. 5) I will feel my real feelings. 6) I will feel my pain 7)I will forgive myself and forgive others. 8) I will rebirth a new life. 9) I will live my spirituality. 10) I will support and love my brothers and sisters. Although the words may be different, echoes of the Twelve Steps can be heard throughout the Terms of Resistance.
Research in the 1990’s Project MATCH (n = 1726) in the USA, assess and qualified TSF (twelve steps support: Minnesota's model). It examined 10 sites experience, 12 weeks programs, manual guided, individually delivered treatments in the 3 kinds of: CBT - Cognitive Behavioral coping skills; MET - Motivational Enhancement Therapy; TSF - Twelve Step Facilitation and evidence compared favorably TSF.
Recovery process are also addressed, including the perception that 12-Step fellowships are exclusive and confused with religion, confusion over surrender versus powerlessness, and concerns about low self-esteem, dysfunctional family structure, communication difficulties, and institutionalized and internalized misunderstanding.
Out traditionally first and past criticism, many questions about 12-step approaches remain to be investigated:
- What is the optimum duration of 12step involvement?
- What is the best way to maintain involvement?
- Should patients receive annual addiction checkups? Semiannual? More often?
- If checkups and booster sessions are indicated, how should they be structured?
Twelve steps oriented providers are dedicated to this approach and are not looking to research for replacements of the 12steps approach. While these treatments are effective at achieving their primary goals of 12step organization affiliation and alcohol or drug abstinence, there is little understanding of the processes active in these programs. Some patients do not have an optimal response to current practices, and empirical investigation into improving these programs is lacking.