This essay has a total of 3015 words and 16 pages.



In our rapidly growing world there are increasing demands on time for traditional client
counselling and therapy. Consequently it necessitates therapists finding other methods and
tools for helping clients to manage their problems.

There are a large number of 12 step programs available that can give this ongoing support
and lifelong maintenance. They can assist people to find a spiritual centre from which to
grow as individuals and help others.

These 12 step programs can act as a useful tool along with medication, support and
treatment when available, helping clients to work towards new significance and achievement
in their lives.

The original 12-step program, Alcoholics Anonymous (AA) was started in 1935 and has
developed to be the most widely used organization for the treatment of alcoholism and
substance abuse. There are over 2,000,000 members in 134 countries worldwide (Alcoholics
Anonymous World Services, 1990). AA has had a major impact in shaping western society's
view of addiction.

The treatment philosophy of AA has changed how many people view themselves, their
substance use and abuse, and the roles played by the people around them.

The success of AA has led to the establishment of a range of 12-step support groups for
other dependencies such as gambling, drug addiction, eating disorders, etc, and for people
having problems coping with these people as partners, relatives or friends.

Hester & Miller (1995) state that with the plethora of self help groups styled on the 12
step model, a practitioner treating a person with an addiction problem would benefit from
information to guide the selection of a 12 step group that is most likely to be of benefit
to a particular client. As researchers they acknowledge evaluation studies positive
findings and benefits of 12-step attendance.

AA provides the individual with a setting in which experiences of like-minded people can
be shared and trust can be established. Members exchange stories of what is was like, what
happened and what it is like now. This allows for identification of the problem, an
acknowledgement that a change is needed and what usually promotes this change. It also
gives a person listening, hope that they too can make similar positive changes. The proof
of this is seen in the person who is sharing their story. It is not just an hypothetical
proposition being put forward by a therapist. AA members are there for their own
recognition of a need for support; and at the same time are available for the support of
newer and other members who may be experiencing difficulties. All of this support is
offered in an unconditional sense, which may be the first time in their life that a person
has actually experienced unconditional positive regard.

AA meetings are easily accessible; there is no screening of members, the service is free
and the only basic requirement for membership is for a "desire to stop drinking". AA
assists in diminishing feelings of isolation (Talbott, 1990).

The idea of assistance in AA originated with it's founding members Bill Wilson and Bob
Smith. Out of their friendship and support for each other came the AA philosophy that one
member can be of aid to another during periods of stress (Kurtz, 1988). AA provides
support to its members in distress by direct support through sponsors. Each member has the
opportunity of seeking a "sponsor" member, who is usually some person who has made
progress through the program and can offer support and assistance. Sponsors have been
found to be a great help in the recovery process, especially in the initial stages.
(Fagan, 1986).

AA supports a model of alcoholism known as a disease model although some members refer to
it as a "dis-ease" model. Throughout the "big-book" of AA (Alcoholics Anonymous, 1976),
reference is continually made to alcoholism as being a three-fold disease, physical,
mental and spiritual. This is consistent with the World Heath Organisations model of
alcoholism as being a bio-psycho-social syndrome.

In so doing AA is addressing a holistic - eclectic model of the problem, which allows for
its members to see the need for personal acknowledgement and the requirement for change,
in all these areas.

In addressing the biological/physical aspects of the problem AA states that some people
suffer an "allergic reaction to alcohol, in that they process it differently than the rest
of the population, and are unable to use the substance in any form. This supports
Jellinek's (1960) disease concept of alcoholism. AA presents alcoholism as a progressive
illness that can be arrested but not cured (AAWS, 1984).

This model has unfortunately met with a large number of challengers to its validity by the
likes of Erickson, (1992), Miller, (1991) and Peele, (1990, 1992). These detractors cite
lack of scientific evidence and contradictory definitions of what a disease is, as their
major premises. In spite of continual challenge from some academic quarters, there is
plentiful evidence available in any AA meeting, in any town, worldwide that AA's view has
assisted in reducing the stigma attached to their problem. It has helped reduce feelings
of guilt and shame for its members and it has clarified for them the cause of their desire
to drink. It moves people away from the concept of "I am a bad person" to "I have a bad
problem". Once this stigma is removed, most people then can concentrate on doing something
about their problems.

AA's philosophy includes addressing social, emotional and spiritual elements also. The
basis for treatment lies in the 12 steps, which were adapted originally from the Oxford
Group, a Christian based organisation.

The 12 steps are:

1.We admitted we were powerless over alcohol - that our lives had become unmanageable.

2.Came to believe that a Power greater than ourselves could restore us to sanity.

3.Made a decision to turn our will and our lives over to the care of God, as we understood Him.

4.Made a searching and fearless moral inventory of ourselves.

5.Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6.Were entirely ready to have God remove all these defects of character.

7.Humbly asked Him to remove our shortcomings.

8.Made a list of all persons we had harmed, and became willing to make amends to them all.

9.Made direct amends to such people wherever possible, except when to do so would injure them or others.

10.Continued to take personal inventory and when we were wrong promptly admitted it.

11.Sought through prayer and meditation to improve our conscious contact with God as we
understood Him, praying only for knowledge of His will for

us and the power to carry that out.

12.Having had a spiritual awakening as the result of these steps, we tried to carry this
message to alcoholics, and to practice these principles in all our

affairs. (AAWS, 1976)

How each of these steps is interpreted and acted upon is up to the individual member. Each
12 step member also has the advantage, when listening to other members speak, of hearing
how effective that members own interpretation and action for that step have been for them.
In effect the new member has the choice of a various number of proven effective methods at
his disposal to choose to replicate, if he wishes to so do.

Each of the steps has it's own unique contribution to therapeutic change.

Step 1 is about coming out a denial and the acceptance at depth that there is a problem
that needs to be dealt with. It requires an acknowledgement by the member that their
attempts at managing their problem have not been successful.

Step 2 is about admitting to the self, the total "insanity" of their entire problem. For
example, when looked upon rationally by an outsider, an alcoholics continuing to drink,
knowing it causes problems is indeed insane. An AA allegory for this is, that "if a person
puts his hand on a hot stove and it gets burned; and he then continues to put his hand
back on the stove again after that, then this particular action would indeed be seen as
"insane." So it is for the drinker who continues to drink knowing he has a problem. This
step 2 also encourages a seeking for a "higher power" to assist with the problem. This
challenges the alcoholic's self-centred thinking style. It is a cognitive challenge needed
for change. Most members initially see that the "power" of the AA group, as a precursor
for change, is indeed a powerful force and greater than they themselves as an individual
are. As they have not been able to bring about their own change to date.

Step 3 is an overt Christian based philosophical tool and is a challenge for most
alcoholics who have spent a lifetime with a need for self-control. Previously for most
alcoholics' their God has been their alcohol - the thing that helps them feel good and
helps them cope. This step helps the drinker address the concept of spirituality and also
the possibility that he does not have control and does not need so much control in his
life to be able to deal with it. On a purely rational level it has been suggested that 92%
of what we think is going to happen, does not occur. Ellis (1975,1961) states that about
98% of anxiety arises as peoples over-concern for what they think others think about them.
This step assists members to put things in their true cognitive and behavioural

Continues for 8 more pages >>