In Consultation Mar/Apr - Page 2

 

AA's famous Twelve Steps outline a program of personal development and spiritual growth that addresses the changes in attitude, lifestyle, relationships, and behavior necessary to maintain sobriety. Only the first step refers to alcohol, but all of them emphasize individual self-examination, building interpersonal connections, and service to others. Members are encouraged to "work" each of these steps in sequence, but with no particular timetable or set of expectations. Usually a sponsor or a senior member of AA guides a newcomer through his or her personal development in the fellowship.

A client who begins therapy with an untreated addiction problem may benefit from a referral to a local AA meeting after the need for medical intervention has been assessed. This referral should be, according to AA tradition, a suggestion, not a requirement. Clinicians should be aware of local meetings or have a published meeting list, which they can get at any AA meeting, by calling the local AA office listed in the phone book, or by looking online at www.aa.org.

Many clients will resist attending meetings, and clinicians may use the therapeutic relationship to defuse resistance. Typically, clients are worried about having other members of their community know they've attended a meeting, wary of the spiritual aspects of the program, and uncomfortable with the open group discussions in meetings. Everyone attending an AA meeting has privacy concerns, and though "leaks" may occur, they're highly unlikely. It's helpful to remind newcomers to the AA experience that they only need to give a first name in introducing themselves. Concerns about the spiritual aspects of the program can be defused by asking for open-mindedness and reminding clients that they can interpret this as freely as they choose. Social discomforts can be allayed by reassurance that AA members are free to "pass" their turns to speak and are encouraged only to attend and listen with a goal of "comparing" their problems with those of others.

A common misconception about AA is that by viewing the addiction as a disease, you're creating an excuse for continuing to drink. In practice, this is the opposite of what happens. By acknowledging that alcoholism is a disease, alcoholics take responsibility for their recovery. Diabetics and hypertensives face a similar dilemma: the disease isn't one that they caused, but by adhering to certain principles, they can reclaim their health, restore their ability to manage their lives, and remain fully functional. AA members don't coddle each other; taking stock of one's misdeeds, assuming full responsibility for one's own behavior, making amends, and relinquishing self-pity are integral to the program.

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