12Step Programs: History, Philosophy and Politics

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12-Step Programs History, Philosophy and
Politics

• Group 3 Lori Barr, Mariah Davis, Roy Huggins,
  Molly Maynard and Eric Snow

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History of 12-Step Programs

• The first 12-step program, Alcoholics Anonymous,
  created in 1935 by two men known as Bill W., a
  stockbroker, and Dr. Bob, a surgeon. Both
  alcoholics.
• Started by these to men forming a relationship
  based on a shared problem and desire to get
  sober.
• The first group consisted of 3 men. By 1939,
  three groups had emerged 2 in New York, 1 in
  Cleveland, OH. These 3 groups produced 100 sober
  alcoholics within four years.

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History (cont.)

• In 1939 the basic textbook, Alcoholics Anonymous,
  was published. This explained the philosophy,
  methods and core of AA which is the 12-steps.
• After the publication of this text, commonly
  referred to as The Big Book, the development
  and expansion of AA was rapid.
• Today AA reports about 2 million recovering
  alcoholics and more than 103,000 groups worldwide.

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Philosophy

• The philosophy of Alcoholics Anonymous was
  influenced by Carl Jung and William James.
• Both believed in the healing power of spiritual
  faith and religious experience as necessary for
  sobriety.
• As well as being influenced by the spiritual
  model of addiction, AA is also based in the
  disease model of addiction.
• All 12-step programs create a support system for
  anyone who has the desire to stop engaging in the
  destructive behavior.

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The 12-Steps

• Admit I am powerless over alcohol that my life
  has become unmanageable.
• Come to believe that a Power greater than myself
  could restore me to sanity.
• Make a decision to turn my will and my life over
  to the care of God as I understand Him.
• Make a searching and fearless moral inventory of
  myself.
• Admit to God, to ourselves and to another human
  being the exact nature of my wrongs.
• Be entirely ready to have God remove all these
  defects of character.
• Humbly asked HIM to remove my shortcomings.

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• 8. Make a list of all persons I have harmed, and
  become willing to make amends to them all.
• Make direct amends to such people wherever
  possible, except when to do so would injure them
  or others.
• Continue to take personal inventory and when I am
  wrong promptly admitted it.
• Seek through prayer and meditation to improve my
  conscious contact with God as I understand HIM,
  praying only for knowledge of HIS will for me and
  the power to carry that out.
• Having had a spiritual awakening as the result of
  these steps, try to carry this message to
  alcoholics, and to practice these principles in
  all my affairs.

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Structure of 12-Step Programs

• There is very little structure in a 12-step
  program. No hierarchy and no formal control.
• Each group is considered a self-supporting and
  self-governing entity.
• The group conscience is a board of individuals
  who decide how the meeting will be structured
  ie. Are there weekly topics? Can you share more
  than once per meeting?
• New members are encouraged to have sponsors for
  mentorship and support. However, it is an
  informal process and is not mandatory.
• Groups can be open or closed there may also be
  groups that are held for certain populations
  (age, gender, sexual orientation, etc.).

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Elements included in most 12-step meetings

• Meeting may open with preamble, reading of the 12
  traditions and the Serenity Prayer.
• There are no last names used in order to preserve
  anonymity.
• No cross talk is allowed during meetings
  individuals are able to speak freely without
  commentary or judgment from group.
• Individuals are encouraged to give a donation at
  each meeting but it is not required.
• Meeting closes with the Serenity Prayer.

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Preamble

• "Alcoholics Anonymous is a fellowship of men and
  women who share their experience, strength and
  hope with each other, that they may solve their
  common problem, and help others to recover from
  alcoholism.
• The only requirement for membership is a desire
  to stop drinking.
• There are no dues or fees for A.A. membership -
  we are self supporting through our own
  contributions.
• A.A. is not allied with any sect, denomination,
  politics, organization or institution, does not
  wish to engage in any controversy, neither
  endorses or opposes any causes.
• Our primary purpose is to stay sober and help
  other alcoholics to achieve sobriety."

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The Serenity Prayer

• God, grant me the serenityTo accept the things I
  cannot change,Courage to change the things I
  can,and wisdom to know the difference.

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The 12 Traditions

• The foundation of AA and other 12 step programs
  are based on the 12 steps as well as the 12
  Traditions.
• The 12 Traditions of AA serve the group as a
  whole, while the 12 Steps serve the individual.
  They are based on attitudes and principles that
  were determined to be valuable in the survival of
  the informal structure of AA meetings.
• The 12 Traditions are not required for any group,
  however the majority have adopted them.

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The 12 Traditions

• Our common welfare should come first personal
  recovery depends upon AA unity.
• For our group purpose there is but one ultimate
  authority a loving God as He may express
  Himself in our group conscience. Our leaders are
  but trusted servants they do not govern.
• The only requirement of AA is a desire to stop
  drinking.
• Each group should be autonomous except in matters
  affecting other groups or AA as a whole.
• Each group has but one primary purpose to carry
  its message to the alcoholic who still suffers.
• An AA group ought never endorse, finance or lend
  the A.A. name to any related facility or outside
  enterprise, lest problems of money, property,
  prestige divert us from our primary purpose.

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• 7. Every AA group ought to be fully
  self-supporting, declining outside contributions.
• 8. Alcoholics Anonymous should remain forever
  nonprofessional, but our service centers may
  employ special workers.
• 9. AA, as such, ought never be organized but we
  may create service boards or committees directly
  responsible to those they serve.
• 10. Alcoholics Anonymous has no opinion on
  outside issues hence the AA name ought never be
  drawn into public controversy.
• 11. Our public relations policy is based on
  attraction rather than promotion we need always
  maintain personal anonymity at the level of press
  radio and films.
• 12. Anonymity is the spiritual foundation of all
  traditions, ever reminding us to place principles
  before personalities.

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The 12 Promises

• The 12 Promises of AA are discussed throughout
  the Big Book and are promises that will come to
  you when you practice abstinence.
• 1. If we are painstaking about this phase of our
  development, we will be amazed before we are
  half way through.
• 2. We are going to know a new freedom and a new
  happiness.
• 3. We will not regret the past, nor wish to shut
  the door on it.
• 4. We will comprehend the word serenity, and we
  will know peace.
• 5. No matter how far down the scale we have
  gone, we will see how our experience can benefit
  others.
• 6. That feeling of uselessness and self-pity
  will disappear.

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• 7. We will lose interest in selfish things
  and gain interest in our fellows.
• 8. Self-seeking will slip away.
• 9. Our whole attitude and outlook upon life will
  change.
• 10. Fear of people and of economic insecurity
  will leave us.
• 11. We will intuitively know how to handle
  situations which used to baffle us.
• 12. We will suddenly realize that God is doing
  for us what we could not do for ourselves.

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Other 12 Step Programs

• Since the creation of Alcoholics Anonymous, many
  other 12 Step programs have emerged.
• There are close to 100 different 12 Step programs
  globally, including Narcotics Anonymous, Alanon,
  CoDA, Gamblers Anonymous and Overeaters
  Anonymous.
• Each program uses the foundation of the
  Alcoholics Anonymous 12 Step model.

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Current Policy regarding 12 Step Programs for
Courts and Corrections

• Courts and jails wish to reduce recidivism
• Criminal offenders with drug abuse problems tend
  to be recidivists
• Many outcome studies indicate that,
  dollar-for-dollar, drug treatment programs for
  inmates, parolees and probationers with
  addictions problems save money on future law
  enforcement costs.
• Courts and jails want to use treatments that are
  proven to work. 12-step programs have proven to
  work for many decades.
• 12-step programs are controversial in courts and
  corrections because of the spiritual component.

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Drug Court

• Drug Court is an opportunity for defendants
  whove been charged with drug-related crimes to
  avoid imprisonment
• Some offenses can result in mandatory drug court
  attendance. I.e. Multiple DUIIs in Multnomah
  County will result in mandatory attendance at
  Clean Court.
• Drug court attendees typically have to plead
  guilty or no contest to their alleged crimes
• Drug court graduates may eliminate their
  sentences completely, have them reduced or limit
  their sentence to probation only.

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12-Step Programs and Drug Court

• Drug courts require ongoing addictions treatment
  according to a treatment plan set out by court
  staff. In many counties, these plans include
  12-step programs.
• Virginia Beach, VA requires 12-step group
  attendance for all phases of their drug court
  program, which can last as long as a year.
• Jackson County, FL has the same requirement.
  Also, they require continuing attendance after
  graduation from the program.
• In cases where group attendance is mandatory,
  judges are kept abreast of attendance and may
  mete out punishment to those who fail to attend.
• Portland-area drug courts do not seem to mandate
  12-step attendance.
• Clackamas County drug courts require group
  attendance but it does not have to be a 12-step
  group.

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Inmates/Parolees

• Many counties run transition programs for inmates
  re-entering the community either at the ends of
  their sentences or as parolees
• For inmates with addictions problems, these
  transition programs include addictions treatment.
• Many prisons will also require participation in
  treatment programs in order to receive rewards
  such as family visits.

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12-Step Programs and Inmates/Parolees in Portland
Metro

• Multnomah County corrections has IJIP (In-Jail
  Prevention Program), a residential treatment
  program for inmates re-entering the community
• Program participants may volunteer for attendance
  or be referred by a corrections professional.
• Participation in this program looks good for
  parolees and may help them maintain good standing
  with the courts.
• Participation includes mandatory 12-step
  orientation attendance
• Washington County has its own transition program
  the Recovery Mentor Program
• Helps former inmates find housing, employment and
  drug treatment.
• Mentors help keep participants on drug treatment
  plan.
• Treatment plan includes 12-step programs.

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Mandating 12-step Programs May Be Illegal

• 12-step programs have a spiritual component. When
  the government mandates participation in such a
  program, it may be a violation of the
  Establishment Clause.

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Case Studies

• Supreme Court 1944 United States v. Ballard
  created the Establishment Clause.
• Judges and juries cannot interpret any church
  doctrine or decide if one doctrine is more
  appropriate than another.
• AAs success does not mean that courts can
  single out its spiritual orientation as
  acceptable for mandate.

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• Griffin v. Coughlin 88 N.Y. 2d (June 11, 1996).
  Challenged the State of New York (regarding AA
  mandate) using the Establishment Clause.
• Supreme Court decision
• An Inmates expanded visitation privileges may
  not be conditioned upon his mandatory
  participation in a substance abuse rehabilitation
  program that is based upon the religiously
  oriented practices of Alcoholics Anonymous.

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• The Court advanced two approaches
• First The State could continue the current
  Alcohol Substance Abuse Treatment (ASAT) Program
  if its conducted on a voluntary basis.
• Second The State could condition special
  privileges on a mandatory participation in the
  ASAT Program provided it offered a secular
  alternative.

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• Where the judiciary has bounded themselves by
  previous rulings and many debates have taken
  themselves out of the arena to judge faith-based
  issues, the executive branch has no prior
  restrictions placed upon itself.
• What does this mean???
• Faith Based Initiatives

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• In 2004, the President set up a faith-based
  office in the White House creating a cabinet on
  how to answer questions about starting
  faith-base programs and how to obtain grants in
  aid.
• The President signed an executive order
  increasing the amount that Housing and Urban
  Development (HUD) and Health and Human Services
  (HHS) grant to faith-based organizations by 144
  million dollars.
• People forming AA groups can receive these funds.

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What if Im not religious?

• More alcoholics have been rehabilitated through
  AA than through the efforts of medicine,
  psychology and psychiatry combined (Madsen, 1974,
  as cited in Finlay, 2000).
• The ability of atheists to accept AA once they
  understand the need to acknowledge something
  other than themselves and AAs compatibility
  with every known religion (Chappel, 1990).
• There is a chapter in The Big Book called We
  Agnostics aimed at this issue.

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Alternative to 12-Step Programs

• Smart Recovery
• LifeRing
• Moderation Management

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Smart Recovery

• Stands for Self Management and Recovery Training.
  
• A set of tools and free meetings to help addicts
• 1.Become motivated to abstain
• 2. Cope with urges
• 3. Problem solve
• 4. Balance a new lifestyle

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Smart Recovery cont.

• Main difference from a 12 step program is a
  spiritual belief is not required and is not a
  focus of SMART.
• Reason and scientific knowledge is the final
  authority for SMART.
• Problem Solving Tools
• 1 ABC Model
• 2 Journaling
• 3 Relaxation
• 4 Planning

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ABC Model

• A process to identify and dispute ones irrational
  beliefs, thoughts, and feelings.
• A - Activating Event
• B - Beliefs about Activating Event
• C - Consequences
• And later
• D - Disputing Irrational Beliefs - used to
  clarify how and what the belief will do for the
  person

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Irrational Vs. Rational Beliefs Diagram
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SMART cont.

• Using REBT (Rational Emotive Behavior Therapy)
  SMART participants do not label themselves as
  alcoholics or addicts but instead create
  within themselves self-responsibility,
  self-motivation, and self-discipline as the
  primary means of stopping substance abuse.

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LifeRing

• Objective abstinence and the group process
• Difference from 12 step Programs
• Believes the power for people to change lies
  within themselves.
• Through their own desire and efforts as well as
  group support the person will realize their own
  capabilities for overcoming their problem
• Higher Powers or God are redundant to the
  recovery process.

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LifeRing Cont.

• No steps involved with LifeRing, other than do
  not drink or use no matter what.
• Each participant is supported in creating their
  own tailor-made recovery programs.

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Moderation Management

• A program designed to serve the needs of problem
  drinkers
• Meetings and online chat rooms are the source of
  communication.

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Who is MM for???

• It is NOT for
• Alcoholics, chronic drinkers, or those who have
  experienced significant withdrawal symptoms. It
  is also not intended for former dependent
  drinkers who are now abstaining.

• It is for
• People who want to reduce their drinking because
  they have encountered moderate to mild
  alcohol-related problems and would like to make
  positive lifestyle changes.