-IBIS-1.5.0-
rx
issues and approaches
precautions with AA programs
psychospiritual approaches
definition
"One of the most successful drug therapies is Alcoholics Anonymous. However, without understanding and following a given process structure, special methods such as AA are not necessarily successful, because simply forbidding alcoholism uses only one part of the personality. Part of the program is for the AA member to claim, 'I am and always will be an alcoholic.' The somewhat evangelistic tone of AA works with many because it picks up on the alcoholic's secondary discipline and courage. There are many people with complicated processes who require more than escalating and accessing the courage and militarism in their secondary processes. They also need to find the meaning and the teleology in their drinking. Many alcoholics will not be satisfied and will want to learn to follow their life process as a whole." (Mindell, 1988, p. 132)
"No one treatment modality is superior to others statistically. Claimed recovery rate seldom goes above 30% for any type of treatment (AA, alcoholism clinic, psychiatric treatment, hospitalization), and is frequently lower. AA, however may have the edge, since it is by far the best known approach and access can be immediate. No matter the personality make-up of a particular alcoholic, AA is always worth a try; but the AA approach may not be congenial to the personality, nor a suitable answer to that person's particular set of problems."
Step one is an admission of powerlessness, of the alcoholic's helplessness to exert control over himself or his life. "For some alcoholics, this humbling acknowledgement is purging; it sets them free to begin again. But for others whose lifelong struggle with dependency needs has necessitated an insistent self-reliance, it can be deeply threatening. It can also be dangerously threatening to those alcoholics who are fighting to stave off imminent personality disintegration". The last thing some alcoholics can afford is to give up the shreds of strength they are clinging to. They must hold onto their self-esteem, not because it is intact but because it is so close to fragmentation that they sense catastrophe if they abandon the pretense that they are in control of their destiny. For this person, AA is not not a help but a danger.
Step two and three suggest that the alcoholic substitute belief in a higher power for his belief in himself; that he turn his life and his will to God. If God is not dead for the alcoholic, this is a constructive measure. But too many alcoholics have absent fathers, or frightening and indifferent ones, to envision entrusting themselves to a faith they cannot feel. AA has attempted to minimize this by turning themselves over 'to God as we understood Him,' thus encouraging any interpretation, such as a Higher Power. "But such latitude of definition still does not solve the problem of faith for many alcoholics and they are doubly threatened: by the requirement of submission and then by the question of submission to what? To something they cannot convince themselves exists." It can cause further splitting in the psyche if it contradicts an existing belief system.
Four more of the Steps specifically mention God, making six of the twelve steps religious in tone. For the alcoholic without formal faith, struggling to hold onto the vestiges of faith he has, the AA tenets may disconcert and disaffect him. The religious nature may be so unpalatable, he cannot bring himself to make use of those parts of the program which might be useful to him. "Like all converts, AA members are fervent; they have seen the light and they wish to bring it to others, and this cannot help but lend an evangelical tone to the meetings."
"Another objection raised is the confessional character of the meetings. Some people consider it indecent exposure and are appalled; others quickly grow bored by the repetitive nature of the accounts; and others suspect a secret vying among alcoholics, each to paint himself, and the details of the long descent to their personal 'bottom', worse than the other so that it is clear their rehabilitation is an awesome achievement.
"Perhaps a degree of extroversion is required to become a successful member of AA. In my observation (meetings in NY, NJ, and Miami areas), alcoholics who embrace AA are people who are by temperament outgoing, friendly, warm, and non-introspective. They tend to work in the occupations which bring them more in contact with people than ideas. Accustomed to repeated and easy encounters with people in bars and lounges, they welcome the quick and unstinting friendship proffered at AA meetings. AA meetings provide the ready companionship they can scarcely do without; they immerse themselves in AA as they once immersed themselves in liquor.
"The evenings of talk, the acceptance of their peers, the support and encouragement and release of pent-up feelings, the endless cups of coffee provide much the same outlet for oral-dependency needs as drinking formerly did, while the group itself, the nurturing ambiance, quite possibly acts as a mother substitute. Dependency is encouraged and fostered. Identification with the group, the sinking of self into oneness with it, with undemanding acceptance offered in return, recapitulates, as well as substitutes for, the original tie to the mother. The indivisible oneness of mother and child, never renounced by the alcoholic and repeatedly sought again in alcohol, is replaced by the 'we-ness' of AA. For the alcoholic who can find it there, and accept it there, AA is a replacement for a drink.
"AA does not so much cure an alcoholic's addiction as provide him with another to take its place, as evidenced by the fact that recovered members continue to attend meetings indefinitely. AA meetings and 12-step work with other alcoholics are their maintenance dose. Since the symptom is a devastatingly destructive one, addiction to AA is infinitely preferable to addiction to alcohol. But the symptom, alcoholism, has not been cured but suppressed."
(Coudert, p. 210-214)
see:
addiction: psychosocial approach
hologram of an alcoholic
process paradigm
recovery: stages of treatment
recovery: twelve step programs
state-dependent learning
search for god
subjective inquiry approach
the shadow and physical symptoms
footnotes