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The 12 Step Approach To Alcohol Abuse-Dependency,

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In our rapidly growing world there are increasing demands on time for traditional client counselling and therapy. Consequently it necessitates therapists finding other methods and tools for helping clients to manage their problems.

There are a large number of 12 step programs available that can give this ongoing support and lifelong maintenance. They can assist people to find a spiritual centre from which to grow as individuals and help others.

These 12 step programs can act as a useful tool along with medication, support and treatment when available, helping clients to work towards new significance and achievement in their lives.

The original 12-step program, Alcoholics Anonymous (AA) was started in 1935 and has developed to be the most widely used organization for the treatment of alcoholism and substance abuse. There are over 2,000,000 members in 134 countries worldwide (Alcoholics Anonymous World Services, 1990). AA has had a major impact in shaping western society's view of addiction.

The treatment philosophy of AA has changed how many people view themselves, their substance use and abuse, and the roles played by the people around them.

The success of AA has led to the establishment of a range of 12-step support groups for other dependencies such as gambling, drug addiction, eating disorders, etc, and for people having problems coping with these people as partners, relatives or friends.

Hester & Miller (1995) state that with the plethora of self help groups styled on the 12 step model, a practitioner treating a person with an addiction problem would benefit from information to guide the selection of a 12 step group that is most likely to be of benefit to a particular client. As researchers they acknowledge evaluation studies positive findings and benefits of 12-step attendance.

AA provides the individual with a setting in which experiences of like-minded people can be shared and trust can be established. Members exchange stories of what is was like, what happened and what it is like now. This allows for identification of the problem, an acknowledgement that a change is needed and what usually promotes this change. It also gives a person listening, hope that they too can make similar positive changes. The proof of this is seen in the person who is sharing their story. It is not just an hypothetical proposition being put forward by a therapist. AA members are there for their own recognition of a need for support; and at the same time are available for the support of newer and other members who may be experiencing difficulties. All of this support is offered in an unconditional sense, which may be the first time in their life that a person has actually experienced unconditional positive regard.

AA meetings are easily accessible; there is no screening of members, the service is free and the only basic requirement for membership is for a "desire to stop drinking". AA assists in diminishing feelings of isolation (Talbott, 1990).

The idea of assistance in AA originated with it's founding members Bill Wilson and Bob Smith. Out of their friendship and support for each other came the AA philosophy that one member can be of aid to another during periods of stress (Kurtz, 1988). AA provides support to its members in distress by direct support through sponsors. Each member has the opportunity of seeking a "sponsor" member, who is usually some person who has made progress through the program and can offer support and assistance. Sponsors have been found to be a great help in the recovery process, especially in the initial stages. (Fagan, 1986).

AA supports a model of alcoholism known as a disease model although some members refer to it as a "dis-ease" model. Throughout the "big-book" of AA (Alcoholics Anonymous, 1976), reference is continually made to alcoholism as being a three-fold disease, physical, mental and spiritual. This is consistent with the World Heath Organisations model of alcoholism as being a bio-psycho-social syndrome.

In so doing AA is addressing a holistic - eclectic model of the problem, which allows for its members to see the need for personal acknowledgement and the requirement for change, in all these areas.

In addressing the biological/physical aspects of the problem AA states that some people suffer an "allergic reaction to alcohol, in that they process it differently than the rest of the population, and are unable to use the substance in any form. This supports Jellinek's (1960) disease concept of alcoholism. AA presents alcoholism as a progressive illness that can be arrested but not cured (AAWS, 1984).

This model has unfortunately met with a large number of challengers to its validity by the likes of Erickson, (1992), Miller, (1991) and Peele, (1990, 1992). These detractors cite lack of scientific evidence and contradictory definitions of what a disease is, as their major premises. In spite of continual challenge from some academic quarters, there is plentiful evidence available in any AA meeting, in any town, worldwide that AA's view has assisted in reducing the stigma attached to their problem. It has helped reduce feelings of guilt and shame for its members and it has clarified for them the cause of their desire to drink. It moves people away from the concept of "I am a bad person" to "I have a bad problem". Once this stigma is removed, most people then can concentrate on doing something about their problems.

AA's philosophy includes addressing social, emotional and spiritual elements also. The basis for treatment lies in the 12 steps, which were adapted originally from the Oxford Group, a Christian based organisation.

The 12 steps are:

1.We admitted we were powerless over alcohol - that our lives had become unmanageable.

2.Came to believe that a Power greater than ourselves could restore us to sanity.

3.Made a decision to turn our will and our lives over to the care of God, as we understood Him.

4.Made a searching and fearless moral inventory of ourselves.

5.Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6.Were entirely ready to have God remove all



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