12 Step program for working in rehab clinics
12 step program in rehabs for drug counselling is not the application of general counselling theories and treatment methods adapted to specific alcoholism issues. The indiscriminate application of these theories and methods is just as ineffective today as ever. The professional field of alcohol and drug counselling was born of the experience of recovering alcoholics and of committed professionals and paraprofessionals. Society has attempted to “treat” or control alcohol and drug problems since recorded history, with notable efforts such as the Washingtonians in 1840, and Prohibition in 1919. The most important development in this century pertaining to the treatment of alcohol and drug problems occurred in 1935, as the program of Alcoholics was begun and developed.
This program has its origin in the religious movement called the Oxford Groups. Bill Wilson (co-founder of AA) himself, was quick to acknowledge that the principles of the Twelve Steps are the common propertyof all mankind. Nonetheless, Alcoholics Anonymous gave the world the Twelve Steps that have been and are continuing to be the foundation of recovery for millions of alcoholics and addicts – and others – worldwide. In an article published in 1939 in the medical journal Lancett , (“A New Approach to Psychotherapy in Chronic Alcoholism”), Dr. William Silkworth describes the process and principles of recovery from alcoholism.He states: “Once the patient agrees that he is powerless, he finds himself in a serious dilemma.” This is, of course, Step One of the Twelve Steps of Alcoholics Anonymous. With courage, he goes on to describe the solution to this powerlessness as being spiritual in nature; he explains that when following directions given him by fellow alcoholics, “the patient experiences the profound mental and emotional change necessary for a complete recovery from alcoholism”.
Citing the book “Alcoholics Anonymous”, Dr. Silkworth states that “the first half of the book is aimed to show an alcoholic the attitude he ought to take and precisely the steps he may follow to affect his own recovery.” The word “precisely” is clear, strong and direct; it means that if we change the formula, we change the outcome. The Twelve Steps are a proven formula for recovery and are certainly necessary for good treatment outcomes. In 1996,the American Society of Addiction Medicine devoted five chapters to the Twelve Steps – one full section of their Manual.
The 12 Step Treatment Program – Twelve Steps have demonstrated effectively the ability to:
1) identify the problem;
2) define the solution, and
3) demonstrate a program of actions necessary to bring about recovery.
As the effectiveness of these Twelve Steps demonstrated their ability to identify the problem, define the solution, and design a program of actions necessary to bring about recovery, professionals began to take note. The first person to have taken the title of alcoholism counsellor was Courtney Baylor in 1913. His influence on the development of the profession is evident to this day. “The Common Sense of Drinking”, a book that influenced both Dr. William Silkworth and Bill Wilson, was dedicated to Courtney Baylor by its author, Richard Peabody.
The idea that complete surrender had to precede getting sober (AA’s 1st Step)came directly from Peabody’s work. Early efforts in Akron, Ohio (1935) by Dr. Bob Smith and in Wilmar, Minnesota (1951) by Dr. Nelson Bradley began to teach the principles of recovery recorded in the textbook “Alcoholics Anonymous”. The Minnesota Model was directly born out of the work of Dr. Bradley and Dr. Dan Anderson (Hazelden) when they began to mold a “team” of people which included alcoholics and non alcoholics. Many people in Social Work, Medicine, Psychology and Theology began to realize the immense power of the Twelve Step recovery program outlined in the AA Book. The vast majority of hospitals and treatment centers in this country today call themselves “AA oriented”. This has come to mean in most cases that AA meetings happen on site and/or patients may be transported to meetings off site, or the staff may lecture occasionally or even frequently about the steps.
Counsellors may talk to clients/patients about the steps. Some programs endeavour to “take” the client/patient through the first five steps (or less, or more). Certainly most treatment professionals in the alcohol and drug field today acknowledge that the steps are important, but… During these uncertain times of managed care, HMO’s, PPO’s, DRG’s, Health Care Crisis, and reduced federal funding, many of us seem to be running for cover and forgetting what works. We want to redefine our profession as somehow different and yet the same as those other professions. We are not the same as any profession in this century. We were born out of a “self help” movement, although for some today, the self help movements are new. Indeed, we have spawned many important new fields. We have been responsible for the advent of Adult children of Alcoholics, and countless other worthwhile movements.
Alcohol and Drug Counselling is intended to teach, counsel, guide, instruct, mentor, show the alcohol and drug client/patient what they must know in order to recover from alcoholism and drug problems. Certainly some understanding of Pharmacology, etiology, individual counselling, family systems, family counselling, psychiatric conditions and disorders are important but, the principles outlined in the Twelve Steps of recovery have been and remain a FOUNDATION of the alcohol and drug field. In a recent conversation with Dr. Robert Straus, a pioneer in this field, I mentioned the apparent aversion to the conspicuous mention of twelve steps in such NAADAC documents as the Scope of Practice.
The Doctor’s response was, “It would be like a program for Political Science not mentioning the Declaration of Independence”. Alcohol and Drug Counsellors now more than ever do not need to apologize for practising a discipline that was born out of an effort to teach Twelve Step principles. It is time that we recognize that our efforts to look just like other professionals, (we all have our place in relieving human suffering) is not the answer. It is part of the problem ! As we distance ourselves from the Twelve Steps, because they were first identified by “drunks in a self help program”, we forget these are principles for all mankind and they work ! We will lose our entire focus as well as our profession, if we continue to be fearful that our fellow professionals won’t accept Alcohol and Drug Counselling as a profession because we have “self help” roots. The founding fathers were not all well educated men when the Declaration of Independence was written but it is the foundation of our country. Certainly, the Twelve Steps at Alcoholics Anonymous are the foundation of our Profession.
Step 1 : We admitted we were powerless over alcohol – that our lives had become unmanageable.
Step 2 : Came to believe that a Power greater than ourselves could restore us to sanity.
Step 3 : Made a decision to turn our will and our lives over to the care of God as we understood Him.
Step 4 : Made a searching and fearless moral inventory of ourselves.
Step 5 : Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
Step 6 : Were entirely ready to have God remove all these defects of character.
Step 7 : Humbly asked Him to remove our shortcomings.
Step 8 : Made a list of all persons we had harmed, and became willing to make amends to them all.
Step 9 : Made direct amends to such people wherever possible, except when to do so would injure them or others.
Step 10 : Continued to take personal inventory and when we were wrong promptly admitted it.
Step 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.
Step 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
As used in 12 Step Treatment programs Worldwide