| What Does A.A.
1. A.A. members share their experience with
anyone seeking help with a drinking problem; they give person-to-person service
or "sponsorship" to the alcoholic coming to A.A. from any source.
2. The A.A. program, set forth in our Twelve
Steps, offers the alcoholic a way to develop a satisfying life without alcohol.
3. This program is discussed at A.A. group
a. Open speaker meetings
open to alcoholics and non-alcoholics. (Attendance at an open A.A. meeting is
the best way to learn what A.A. is, what it does, and what it does not do.) At
speaker meetings, A.A. members tell their stories. They describe
their experiences with alcohol, how they came to A.A., and how their lives have
changed as a result of Alcoholics Anonymous.What Does A.A. Not
Do?What A.A. Does
b. Open discussion
meetings one member speaks briefly about his or her drinking experience,
and then leads a discussion on A.A. recovery or any drinking-related problem
anyone brings up. (Closed meetings are for A.A.s or anyone who may have a
c. Closed discussion meetings conducted
just as open discussions are, but for alcoholics or prospective A.A.s
d. Step meetings (usually closed) discussion of one of the
e. A.A. members also take meetings into correctional and
f. A.A. members may be asked to conduct the
informational meetings about A.A. as a part of A.S.A.P. (Alcohol Safety Action
Project) and D.W.I. (Driving While Intoxicated) programs. These meetings
about A.A. are not regular A.A. group meetings.
A.A. does not:
initial motivation for alcoholics to recover
2. Solicit members
3. Engage in or sponsor research
4. Keep attendance records or case
5. Join councils of social
6. Follow up or try to control its members
7. Make medical or psychological diagnoses or
8. Provide drying-out or nursing services,
hospitalization, drugs, or any medical or psychiatric treatment
9. Offer religious services
10. Engage in education about alcohol
11. Provide housing, food, clothing, jobs,
money, or any other welfare or social services
12. Provide domestic or vocational
13. Accept any money for its services, or any
contributions from non-A.A. sources
14. Provide letters of reference to parole
boards, lawyers, court officials, social agencies, employers, etc.
Relapse Prevention, a cognitive-behavioral
therapy, was developed for the treatment of problem drinking and adapted later
for cocaine addicts. Cognitive-behavioral strategies are based on the theory
that learning processes play a critical role in the development of maladaptive
behavioral patterns. Individuals learn to identify and correct problematic
behaviors. Relapse prevention encompasses several cognitive-behavioral
strategies that facilitate abstinence as well as provide help for people who
The relapse prevention approach to the
treatment of cocaine addiction consists of a collection of strategies intended
to enhance self-control. Specific techniques include exploring the positive and
negative consequences of continued use, self-monitoring to recognize drug
cravings early on and to identify high-risk situations for use, and developing
strategies for coping with and avoiding high-risk situations and the desire to
use. A central element of this treatment is anticipating the problems patients
are likely to meet and helping them develop effective coping strategies.
Research indicates that the skills individuals
learn through relapse prevention therapy remain after the completion of
treatment. In one study, most people receiving this cognitive-behavioral
approach maintained the gains they made in treatment throughout the year
Model provides a framework for engaging stimulant abusers in
treatment and helping them achieve abstinence. Patients learn about issues
critical to addiction and relapse, receive direction and support from a trained
therapist, become familiar with self-help programs, and are monitored for drug
use by urine testing. The program includes education for family members
affected by the addiction.
The therapist functions simultaneously as
teacher and coach, fostering a positive, encouraging relationship with the
patient and using that relationship to reinforce positive behavior change. The
interaction between the therapist and the patient is realistic and direct but
not confrontational or parental. Therapists are trained to conduct treatment
sessions in a way that promotes the patient's self-esteem, dignity, and
self-worth. A positive relationship between patient and therapist is a critical
element for patient retention.
Treatment materials draw heavily on other
tested treatment approaches. Thus, this approach includes elements pertaining
to the areas of relapse prevention, family and group therapies, drug education,
and self-help participation. Detailed treatment manuals contain work sheets for
individual sessions; other components include family educational groups, early
recovery skills groups, relapse prevention groups, conjoint sessions, urine
tests, 12-step programs, relapse analysis, and social support groups.
A number of projects have demonstrated that
participants treated with the Matrix model demonstrate statistically
significant reductions in drug and alcohol use, improvements in psychological
indicators, and reduced risky sexual behaviors associated with HIV
transmission. These reports, along with evidence suggesting comparable
treatment response for methamphetamine users and cocaine users and demonstrated
efficacy in enhancing naltrexone treatment of opiate addicts, provide a body of
empirical support for the use of the model.
Supportive-Expressive Psychotherapy is a
time-limited, focused psychotherapy that has been adapted for heroin- and
cocaine-addicted individuals. The therapy has two main components:
- Supportive techniques to help patients feel
comfortable in discussing their personal experiences.
- Expressive techniques to help patients
identify and work through interpersonal relationship issues.
Special attention is paid to the role of drugs
in relation to problem feelings and behaviors, and how problems may be solved
without recourse to drugs.
The efficacy of individual
supportive-expressive psychotherapy has been tested with patients in methadone
maintenance treatment who had psychiatric problems. In a comparison with
patients receiving only drug counseling, both groups fared similarly with
regard to opiate use, but the supportive-expressive psychotherapy group had
lower cocaine use and required less methadone. Also, the patients who received
supportive-expressive psychotherapy maintained many of the gains they had made.
In an earlier study, supportive-expressive psychotherapy, when added to drug
counseling, improved outcomes for opiate addicts in methadone treatment with
moderately severe psychiatric problems.
Individualized Drug Counseling focuses directly on
reducing or stopping the addict's illicit drug use. It also addresses related
areas of impaired functioning such as employment status, illegal activity,
family/social relations as well as the content and structure of the patient's
recovery program. Through its emphasis on short-term behavioral goals,
individualized drug counseling helps the patient develop coping strategies and
tools for abstaining from drug use and then maintaining abstinence. The
addiction counselor encourages 12-step participation and makes referrals for
needed supplemental medical, psychiatric, employment, and other services.
Individuals are encouraged to attend sessions one or two times per week.
In a study that compared opiate addicts
receiving only methadone to those receiving methadone coupled with counseling,
individuals who received only methadone showed minimal improvement in reducing
opiate use. The addition of counseling produced significantly more improvement.
The addition of on site medical/psychiatric, employment, and family services
further improved outcomes.
In another study with cocaine addicts,
individualized drug counseling, together with group drug counseling, was quite
effective in reducing cocaine use. Thus, it appears that this approach has
great utility with both heroin and cocaine addicts in outpatient treatment.
Enhancement Therapy is a client-centered counseling approach for
initiating behavior change by helping clients to resolve ambivalence about
engaging in treatment and stopping drug use. This approach employs strategies
to evoke rapid and internally motivated change in the client, rather than
guiding the client step by step through the recovery process. This therapy
consists of an initial assessment battery session, followed by two to four
individual treatment sessions with a therapist. The first treatment session
focuses on providing feedback generated from the initial assessment battery to
stimulate discussion regarding personal substance use and to elicit
self-motivational statements. Motivational interviewing principles are used to
strengthen motivation and build a plan for change. Coping strategies for
high-risk situations are suggested and discussed with the client. In subsequent
sessions, the therapist monitors change, reviews cessation strategies being
used, and continues to encourage commitment to change or sustained abstinence.
Clients are sometimes encouraged to bring a significant other to sessions. This
approach has been used successfully with alcoholics and with
Therapy for Adolescents incorporates the principle that unwanted
behavior can be changed by clear demonstration of the desired behavior and
consistent reward of incremental steps toward achieving it. Therapeutic
activities include fulfilling specific assignments, rehearsing desired
behaviors, and recording and reviewing progress, with praise and privileges
given for meeting assigned goals. Urine samples are collected regularly to
monitor drug use. The therapy aims to equip the patient to gain three types of
Stimulus Control helps patients avoid
situations associated with drug use and learn to spend more time in activities
incompatible with drug use.
Urge Control helps patients recognize
and change thoughts, feelings, and plans that lead to drug use.
Social Control involves family members
and other people important in helping patients avoid drugs. A parent or
significant other attends treatment sessions when possible and assists with
therapy assignments and reinforcing desired behavior.
According to research studies, this therapy
helps adolescents become drug free and increases their ability to remain drug
free after treatment ends. Adolescents also show improvement in several other
areas of /school attendance, family relationships, depression,
institutionalization, and alcohol use. Such favorable results are attributed
largely to including family members in therapy and rewarding drug abstinence as
verified by urinalysis.