Millions of people have been finding freedom from addiction through participation in self-help groups.
In these groups they can share their experiences, learn social and coping skills, and gain strength from other people who have been-there-done-that.
Self-help programs call upon the individual addict or alcoholic to take responsibility for his or her lifestyle and at the same time encourage self-acceptance and
Most experts in the field of
view substance abuse as a medical problem because of its effects on both the brain and body. Others see it as a behavioral problem to be solved through the development of self-knowledge, behavioral changes, and coping techniques.
There are self-help groups that embrace both views and others that lean toward the behavioral model. Each type of program encourages the individual to abstain from drugs and alcohol as well as encourages them to search for the underlying emotional causes of his or her addiction.
12 Step Program
The most prominent self-help group for drug and alcohol addiction is the
12 Step program,
based on the principles for living originated by Alcoholics Anonymous (AA).
About The Meetings
12 Step programs
are always FREE and are NOT facilitated by professional health or social workers. Fellow addicts and alcoholics who share their experience, strength and hope chair the meetings.
The 12 Step approach has a spiritual component in that the steps include admitting powerlessness over the addiction and surrendering to a "higher power," which they can interpret according to their individual beliefs.
Research, including studies conducted over many years, indicates that these programs are effective, especially as a continuing follow-up to medical treatment for drug and alcohol addiction.
Recognizing their success, many different kinds of
drug and alcohol treatment
settings, including jails and walk-in clinics, have begun to incorporate 12 Step programs on site, and professionals in the field have made a point of being able to refer clients to self-help programs.
Self Help Programs Are Important Before, During And After Treatment
Self-help groups have recently assumed greater importance in substance abuse treatment, especially with the decreases in the intensity and duration of treatment.
Studies indicate that self-help programs can help achieve positive results for people with substance abuse problems before, during and after treatment.
Treatment centers can greatly influence the success rate of a patient’s sobriety if they refer them to a self-help group after rehab.
However, self-help and
specifically the 12 Step program
of recovery are often misunderstood. The lack of information and understanding has been identified as the most important factor in a treatment provider's reluctance to refer clients to SH groups.
A Crucial Part Of Any Recovery Program
The American Psychiatric Association (APA) has addressed the role of SH groups, and in addition to treatment for substance abuse, the APA has included referral to 12 Step programs ("a crucial part of any recovery program") in its recommendations concerning the role of psychologists in alcohol and drug treatment.
The APA also discussed the importance of SH as a lifelong resource for recovery after treatment.
Currently in the US, there are more visits for substance abuse and psychiatric problems to self-help groups than to all addictive and mental health specialties combined.
Also, SH groups often engage members more intensely and for longer periods than do professional treatment programs.
Today, most treatment professionals look at SH programs as "the cake rather than the icing" for long-term recovery. Clinicians are interested in SH because of the possibilities of coordinating formal treatment and SH to achieve better outcomes.
Evidence suggests that involvement in SH groups promote longer-term periods of recovery from drug and alcohol abuse.
The APA also suggests that in addition to treatment, "referral is appropriate at all stages in the treatment process, even for patients who are still substance abusers."
Survey data collected by the APA found that in treatment centers; 79% were referred to Alcoholics Anonymous and 45% were referred to Narcotics Anonymous.
It is very important that clinicians' and treatment facilities know how to engage clients in SH groups.
If they don’t properly present the SH program and the benefits derived from them, this could negatively influence the clients decision and participation in these programs.
Treatment provider’s that link clients with community recovery resources, in particular
12 Step programs,
can and should be regarded as a model for other forms of substance abuse treatment.
When the treatment system provides clients with education and information about SH and exposure to these groups, many clients find them to be a logical and comfortable extension of what they learned in treatment.
Experience With Self-Help Groups
Clinicians should ask the client about their past experiences with SH programs and identify or correct any inaccurate beliefs.
Clinicians can also build on areas where their experiences and belief systems have been favorable with the 12 Step recovery program and continue to encourage participation.
Clinicians can also help decrease client drop out of
SH groups after they begin attending. The drop out rate from self-help groups is estimated to be high, particularly in the first few months.
Alcoholics Anonymous estimates that 50% of alcoholics drop out in the first 3 months.
Some of the reasons for drop out are because the client was not ready to embrace important aspects of the program. Part of this problem could be because the clinician failed to provide the client with minimal understanding and preparation.
Widely Misunderstood And Misinterpreted
Self-help programs, especially the Anonymous groups based on the 12 Step program are widely misunderstood and misinterpreted.
This is largely because the 12-step program contradicts the normal attitudes of self-reliance, and instead is based on spiritual principles emphasizing powerlessness and the reliance on a higher power.
The concept of powerlessness is both the foundation of recovery and a stumbling block for many clinicians.
It should be noted that 12 Step fellowships base their public relations policy on attraction rather than promotion,
Tradition 11 (AA),
and do not advertise, recruit, respond to criticism or address widely held misunderstandings about their program of recovery or about the fellowships.
Beliefs rest largely on what is learned and experienced. For clinicians to educate clients about SH, they need to know and understand the SH processes.
One study found that only half (56%) of 120-treatment provider’s referred clients to available self-help groups. The most common reason for not referring clients was a lack of awareness of either the groups’ existence or their programs.
It Works If You Work It!
Abstinence-based treatment with Alcoholics Anonymous or Narcotic Anonymous has been found to work for every race, color and creed.
Misconceptions Of 12 Step Programs
Misconceptions about 12-step programs include the belief that the programs are a religion or cult and that they lack professionalism.
Many think that their effectiveness lacks practical support and that members become overly dependent on the group.
Other misconceptions are that members get bad advice from the group and that the usefulness of these groups is short-term.
Others believe that people only need them early in recovery or that the SH group only deals with one substance while many people have multiple issues. These beliefs are simply not true.
Treatment Providers Approach - Questions Should Include:
- Is self-help participation discussed with new clients as part of an initial assessment?
- Are specific experiences, concerns and misgivings identified and addressed? If so, how?
- How well equipped are clinicians to address misinformed clients who may say:
How people perceive a treatment provider’s referral to SH is extremely important.
- I went once and I didn’t like it.
- That group is all heroin addicts, I use crack.
- I don’t want to hear about God.
- I know someone who went for years and they relapsed. It doesn’t work.
Clients can sense how well informed the provider is or how much they believe in SH groups. This perception could be the difference as to whether a person will go again or never go at all.
Conclusions And Future Directions
Substance abuse treatment can enhance the effectiveness of SH groups.
The question should be, "How can I engagement a client in SH groups and reduce any barriers?"
Most importantly, treatment clinicians can provide the necessary information that will lead to more self-help referrals, and will result in more people achieving long-term sobriety.
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