Alcoholics, Narcotics and Cocaine Anonymous
Twelve step programs, such as Alcoholics Anonymous (AA), have become so well known that most of us do not realize that their origin dates back less than 100 years ago. AA started with only a few members in 1935 and dramatically increased its membership over the next 50 years to more than 1.7 million members in 94,000 AA groups worldwide1. Programs based on the same philosophy as AA soon began to develop to deal with more diverse issues of addiction. These programs include Narcotics Anonymous (NA) for narcotic drug addiction and Al Anon for family members and loved ones of addicts and alcoholics. Today, there are more than 250 organizations that either use the word “Anonymous” as part of their name, or are based on a 12 step program philosophy of recovery.
12 step program and Rehab, Drug Addiction Treatment
Twelve step programs are often confused with formal addiction treatment or rehab drug treatment since both programs generally espouse abstinence from drugs and alcohol as a means of recovery. However a 12 Step Program differs significantly from formal treatment or drug rehab. An Addiction treatment program will focus mainly on the negative consequences of addictive behaviors through specific medical, psychological and social interventions. A 12 Step Program on the other hand, will view the addictive behavior as a symptom of an underlying spiritual crisis. In order to recover from the addiction, the individual must address these larger issues of spirituality and character development. Thus, the addictive behavior, or one’s powerlessness over drugs and/or alcohol, is only mentioned in the first step. The other eleven steps focus on spiritual awakening and character development.
Addiction Treatment rehab drug centres tend to concentrate on interventions geared to individuals; a twelve step program is based in community involvement. Participation in the fellowship meetings and sponsorship are essential parts of a 12 Step Program. An important goal of membership is the awareness of the consequences of one’s addiction, especially the social consequences of addictive behaviours. In fact, AA appears to be very helpful to individuals who have destructive social networks that are supportive of their drinking, as it introduces them to new constructive social networks or people who support each other’s sobriety. Individuals with heavy alcohol use and psychiatric problems have been found to benefit from AA involvement, possibly because the 12 Step social network provides external supports to compensate for poor internal resources. In addition, rehab drug addiction treatment utilizes professionals to help people with addictions. The “experts” in a 12 Step Program are its members. Twelve ( 12 ) step groups are not lead by professional therapists or counsellors; they are lead by the addicts themselves who came in search of help. Thus, unlike the costs of operating a treatment program, a 12 Step group program uses the knowledge of its members. Addiction treatment also is finite. Patients are expected to learn new behaviours while in treatment and to continue using them when treatment is completed. Twelve-step programs do not end. Recovery from addiction is seen as a lifelong process and involvement in 12 Step Programs are a lifetime commitment to recovery. Given the differences between 12 Step programs and addiction treatment, one would not expect a high level of cooperation between the two. However, over 95% of addiction treatment centers in the United States follow a model of care based on the 12 Step philosophy. Treatment programs are responsible for introducing almost 35% of the current members of AA to the
program. A study of employed alcoholics who were referred to inpatient treatment, mandated to AA, or given a choice between the two programs found that the individuals who completed inpatient treatment and followed it with voluntary AA involvement had the lowest rates of relapse of the three groups.
Effectiveness of 12-Step Programs
Alcoholics Anonymous has been conducting triennial anonymous scientific surveys of its members since 1968.
• According to a survey completed in 19985, the average length of sobriety for its members is more than 7 years, with almost half of the members sober for more than 5 years.
• Project MATCH, a major national research trial of three treatments for alcoholism, found that AA involvement is related to positive treatment outcomes regardless of the type of treatment.
• A survey of NA (narcotics anonymous) members in Great Britain found a positive relationship between length of membership in NA, abstinence from drugs and healthy levels of self-esteem and anxiety.
• In addition, two large-scale analyses of many research studies on AA found that participation in AA is related to improved psychosocial functioning and decreased drinking. Many people wonder about the effectiveness of 12 Step programs for different types of people. Although AA began mainly as a white, middle-aged male-dominated program, the most recent membership survey revealed a much more diverse membership. The percentage of female members rose to 34% in 1998 from 22% in 1968. Members aged 30 years or younger currently comprise 9% of the membership. Research has found that AA and NA participation is not influenced by employment status, education or race. Active involvement in 12 Step programs repeatedly is found to be a better predictor of long-term recovery than attendance at meetings. Involvement in AA following addiction treatment is related to increased positive ways of coping, high commitment to continued abstinence and an increased sense of self-efficacy. However, a major impediment to the effectiveness of 12 Step programs is the high dropout rate. It has been estimated that 50% of AA members drop out within the first 3 months and that only 20% of alcoholics referred to AA attend meetings on a regular basis. In order to determine why people do not become actively involved in or drop out of 12 Step programs researchers have examined the attributes of individuals who successfully use these programs. Self-identification as an alcoholic or addict appears important for successful 12 Step program affiliation. A study of AA affiliation following discharge from treatment found that individuals who remained involved in AA were more accepting of all aspects of the 12 Step program than were individuals who rejected the program or who thought their alcohol drinking was not very serious.
It appears that 12 Step programs are as effective as one wants them to be. Research has not yet proven that 12 Step involvement causes recovery or that a 12 step program is more effective than other paths to recovery. However, active long-term involvement in a 12 Step program is strongly related to recovery and improved psychosocial functioning. Involvement in these programs is more demanding than simple cessation of alcohol or drug use and requires a greater level of participation than mere attendance at meetings. The research on 12 Step rehab drug programs strongly indicates that the effectiveness of a program is intertwined with acceptance of the philosophy, spirituality and personal growth inherent in the 12 Step's.