Integrating the 12 Steps into Addiction Therapy: A Resource Collection and Guide for Promoting Recovery with CD-ROM

Overview

All the resources needed to fully integrate a 12-step approach as part of your overall treatment program

Millions of Americans have at some time in their lives participated in a 12-step program for treatment of a chemical or non-chemical addiction. Clinicians recognize that these grass-roots efforts have a very high cure rate. However, little has been written on how to integrate these programs into a traditional therapy setting.

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Overview

All the resources needed to fully integrate a 12-step approach as part of your overall treatment program

Millions of Americans have at some time in their lives participated in a 12-step program for treatment of a chemical or non-chemical addiction. Clinicians recognize that these grass-roots efforts have a very high cure rate. However, little has been written on how to integrate these programs into a traditional therapy setting.

Integrating the 12 Steps into Addiction Therapy serves as an indispensable resource for clinicians treating addiction patients who are simultaneously enrolled in 12-step programs. This valuable text:
* Contains eight lesson plans and twenty-seven assignments
* Integrates in-depth discussion of 12-step programs with hands-on resources like homework assignments, treatment plan examples, and patient handouts
* Will also benefit 12-step program peer counselors
* Includes companion CD-ROM with fully customizable homework assignments, lesson plans, and presentations

Treating addictions-whether chemical or non-chemical-can be one of the most difficult challenges faced by mental health professionals. For many people, 12-step programs have played a critical role in helping them to manage their addictive behaviors. Integrating the 12 Steps into Addiction Therapy gives psychologists, therapists, counselors, social workers, and clinicians the tools and resources they need to fully utilize these peer therapy program techniques in treating a wide variety of addictions.

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Product Details

  • ISBN-13: 9780471599807
  • Publisher: Wiley
  • Publication date: 9/28/2004
  • Edition description: Book with CD-ROM
  • Edition number: 1
  • Pages: 269
  • Product dimensions: 7.03 (w) x 10.12 (h) x 0.63 (d)

Meet the Author

James R. Finley, MA, is a seasoned therapist, educator, and manager, specializing in addictions and group family therapy. He is coauthor of Addiction Treatment Homework Planner, Second Edition and The Chemical Dependence Treatment Documentation Sourcebook, both from Wiley.

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Table of Contents

Preface.

SECTION I—What to Do and Expect (and What Not to Do).

Why Integrate 12-Step Work into Addiction Treatment?

Anonymity and Confidentiality.

Ensuring That Clients Are Participating Effectively in 12-Step Activities.

Helping Clients Benefit from Their 12-Step Programs.

Positions of 12-Step Programs on Psychotherapy and Medications.

Things 12-Step Programs Can and Can’t Do for Clients.

Incorporating 12-Step Work into Treatment Planning.

SECTION II—Homework Assignments.

Exercise II.A Understanding Spirituality in 12-Step Programs.

Exercise II.B Finding a Home Group.

Exercise II.C Learning from Recovery Role Models.

Exercise II.D Finding and Working with a 12-Step Sponsor.

Exercise II.E 12-Step Meeting Review/Critique Form.

Exercise II.F Step 1: Understanding Powerlessness.

Exercise II.G Step 2: Finding Hope.

Exercise II.H Step 3: Deciding to Turn It Over.

Exercise II.I Step 4: Personal Inventory.

Exercise II.J Step 5: Sharing the Step-4 Inventory.

Exercise II.K Step 6: Becoming Willing to Change.

Exercise II.L Step 7: Asking for Change.

Exercise II.M Step 8: Listing People Harmed.

Exercise II.N Step 9: Making Amends.

Exercise II.O Step 10: Continued Inventory.

Exercise II.P Step 11: Improving Conscious Contact.

Exercise II.Q Step 12: Carrying the Message.

Exercise II.R Special-Occasion Relapse Prevention in 12-Step Recovery.

Exercise II.S Using 12-Step Literature.

Exercise II.T 12-Step Recovery Issues for Young People.

Exercise II.U 12-Step Recovery Issues for Women.

Exercise II.V 12-Step Recovery Issues for Gay-Lesbian-Bisexual-Transgendered People.

Exercise II.W 12-Step Recovery Issues for People of Non-Christian Faiths.

Exercise II.X 12-Step Recovery Issues for Members of Minorities.

Exercise II.Y 12-Step Recovery Issues in Jail or Prison.

Exercise II.Z 12-Step Recovery Issues for People with Co-Occurring Mental/Emotional and/or Physical Illnesses.

Exercise II.AA Understanding 12-Step Recovery for Loved Ones of People with Addictions 174

Section III—Lesson Plans.

Lesson Plan III.A What to Expect in a 12-Step Group.

Lesson Plan III.B 12-Step Meeting Review and Analysis.

Lesson Plan III.C Problems and Solutions in Early 12-Step Recovery.

Lesson Plan III.D The 12 Steps, Relationships, and Work.

Lesson Plan III.E The 12 Steps and Financial Self-Management.

Lesson Plan III.F The 12 Steps and Emotional and Mental Problems.

Lesson Plan III.G The 12 Steps and Social Life.

Lesson Plan III.H 12-Step Relapse-Prevention Tools.

APPENDIX A: Useful Books and Films Related to 12-Step Work.

APPENDIX B: The 12 Steps and 12 Traditions.

Index.

About the CD-ROM.

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First Chapter

Integrating the 12 Steps into Addiction Therapy

A Resource Collection and Guide for Promoting Recovery
By James R. Finley

John Wiley & Sons

ISBN: 0-471-59980-8


Chapter One

WHAT TO DO AND EXPECT (AND WHAT NOT TO DO)

WHY INTEGRATE 12-STEP WORK INTO ADDICTION TREATMENT? For decades, clinicians have argued both for and against the integration of 12-step work into addiction treatment. Here are some of the pros and cons of using the 12-step model in combination with other approaches.

Cons The role and efficacy of Alcoholics Anonymous (AA) and other 12-step addiction recovery programs have always been controversial in the addiction treatment community. Many clinicians have criticized these programs for several reasons, including:

Lack of Scientific Rigor

The 12-step model was created by nonprofessionals, who worked out their methodology by trial and error. The only element based on any medical or psychological theory was their insistence that alcoholism (and later other addictions) resulted from a disease process rather than being a matter of character or will power. When AA formed, this theory was held by a few pioneering physicians but still 20 years away from popular acceptance and was, in fact, rejected at the time by the American Medical Association.

Further, since its origins, the structure and principles of the 12-step model have not easily lent themselves to research. The insistence on lack of affiliation withother organizations or institutions and the staunch protection of individual anonymity have made it very difficult for researchers to study the results of participation in these 12-step programs without the active support or involvement of the programs themselves.

Spiritual Orientation The 12-step model explicitly states that recovery from addiction requires a relationship with a God or some type of Higher Power (i.e., an intangible and supernatural entity or force). It also insists that there is no one correct version of this God or Higher Power and that each member is responsible for coming to his or her own individual understanding of this being or power. This is very difficult to accept, both for those who see no place for the mystical in modern medicine and therapy and for those who hold to a specific set of religious beliefs and reject the lack of a definitive doctrine regarding God. Some object to the fact that although the 12-step model insists that it does not prescribe any particular brand of faith, much of the early literature frames its discussion of a Higher Power in terms of a masculine and Christian God, and many groups use specifically Christian prayers such as the Lord's Prayer as part of their meeting format.

Lack of Cooperation with Treatment Providers AA and the other 12-step programs have a long-standing tradition of refraining from endorsing or affiliating themselves with outside organizations and/or institutions. As a result of this tradition, 12-step programs only offer partial treatment support. This support is usually limited to the following:

12-step groups welcome people who are undergoing addiction treatment;

Meeting chairpersons will usually sign attendance sheets; 12-step programs will bring meetings into treatment facilities; and

The 12-step programs provide information to professionals, through literature and in many communities via a 12-step program member designated as the Cooperation with the Professional Community (CPC) liaison. The programs will not assist with other treatment program activities or policies.

Further, many members of the various 12-step programs have the mistaken belief that 12-step work and treatment don't mix. Many individuals in 12-step programs disparage outside treatment, although the official stance of the 12-step programs is that treatment and psychiatry are also valuable and sometimes necessary for recovery. Many other 12-step members express gratitude for the outside treatment programs through which they first got clean and sober.

Pros Why is it a good idea for addiction treatment providers and programs to integrate participation in 12-step work with the services they offer their clients or patients? There are several compelling reasons, including:

Proven Effectiveness Alcoholics Anonymous was founded in 1935, and in the decades since, many other recovery programs based on the AA model have been formed. More people have succeeded in achieving long-term recovery through AA and the other 12-step programs than by any other means. Many succeed in these programs after repeatedly failing to sustain recovery any other way, a common enough phenomenon that a 12-step program is typically referred to as "the last house on the street," meaning that all other options have failed.

Although the majority of people who try AA do relapse and drift away, the long-term success rate of the 12-step programs still appears to be the best available. Also, when 12-step participation is sustained over a period of months as part of integration with treatment or relapse prevention programs, the proportion of people who continue to participate in the 12-step program and stay clean and sober rises significantly.

Knowledgeable Peer Role Modeling and Feedback People who are new to recovery, or trying to begin recovery, find more positive examples and mentors in AA and other 12-step programs than in any other milieu. At each meeting, in sponsorship and in informal conversations outside of meetings, the new person is able to watch and listen as experienced peers use the tools of 12-step recovery to stay clean and sober and cope with life's challenges. Sponsors and others experienced in recovery offer valuable feedback and suggestions regarding the newcomer's interpretation and use of the 12 steps and the principles of these recovery programs.

Availability of Meetings between Treatment Sessions Particularly with larger programs such as AA, Narcotics Anonymous (NA), and Overeaters Anonymous (OA), newly recovering people can attend several meetings per week in many communities. This provides an opportunity for the recently clean and sober person to receive frequent reinforcement and maintain recovery as a priority in daily life, more so than if he/she is seeing a clinician only once or twice a week.

Healthy and Supportive Social Environment One of the greatest risk factors for relapse in people completing treatment is the negative influence of returning to an unchanged social environment where substance abuse may be a norm. In a 12-step program, the newly recovering person finds an alternative social network and often a calendar of addiction-free recreational activities such as sober dances, picnics, and parties. On a daily basis, he or she is surrounded by other recovering people in a subculture where sobriety is the standard.

Lifelong Aftercare A 12-step program also offers a framework for lifelong aftercare that is otherwise sorely lacking in many programs. Research has shown the importance of long-term interventions in bringing about long-term abstinence from addictive behaviors, but most treatment programs are limited to a few months at most. By integrating 12-step participation during that treatment period and getting the client or patient "rooted" in AA, NA, or another related program, the clinician can lay the groundwork for a life-long self-managed program of aftercare. Many members of 12-step groups achieve decades of recovery and die sober.

Availability of Books, Workshops, and Tapes Literature is one of the primary tools used by 12-step programs since the inception of AA. These books are often found in main-stream bookstores. Larger communities often have recovery-oriented bookstores. Other vendors offer these products via the Internet. Most meetings sell the primary books used by their programs at wholesale prices without any markup, and often more experienced members buy books for newcomers who can't afford them. A trip to a bookstore will yield a variety of books and workbooks for going through the steps.

In most parts of the country there are frequent workshops, conventions, and other events centered on 12-step recovery in various programs. Many meeting places post information about these events on bulletin boards.

Both in recovery bookstores and at workshops and conventions, audiotapes and sometimes videotapes are available, usually recordings of speakers making presentations on various topics at previous gatherings. There are many Internet web sites devoted to 12-step recovery, offering online literature, chat room meetings, and directories and calendars of events. Many recovery-oriented bookstores have web sites where people can buy literature and even jewelry, T-shirts, and similar items.

All of these resources can be effective adjuncts to treatment through bibliotherapy assignments between sessions, in guided discussions in treatment groups, and as useful background reading for clinicians seeking to improve their own expertise.

Holistic Approach Although the design of the 12-step model and the traditional practices of groups using this model were developed through trial and error, they have evolved to effectively model multiple therapeutic approaches to both addictions and other life problems.

The sharing that takes place in meetings and between individuals can be a powerful psychodynamic intervention, as people relive formative experiences to gain insight, express previously withheld emotions, and find validation and acceptance from others with similar experiences.

The process of working through the steps themselves involves intense cognitive work as the recovering person reviews past and current patterns of thought and behavior, identifies errors and distortions in his or her thinking, replaces them with more functional patterns of cognition, and establishes a daily routine to maintain self-awareness and self-correction when distortion creeps back into thought patterns. The many actions included in the steps and in the norms and common practices in 12-step groups act as effective behavioral interventions, replacing self-destructive habits and coping strategies with healthier ones. Finally, the acceptance and encouragement 12-step groups provide their members is a potent source of the unconditional positive regard emphasized in humanistic approaches to treatment.

Specialized 12-Step Programs for Many Problems Any clinician is likely to encounter clients with addictive problems for which no specialized treatment program is accessible. In many situations, there may be no way to get clients into psychotherapeutic programs even for chemical dependencies. Often, a 12-step group that can fill this gap will be available to the client or patient, either locally or via electronic chat room meetings on the Internet. These can provide vital adjuncts to individual therapy or counseling. Where the specialized treatment programs needed are available, the corresponding 12-step programs can be useful to reinforce those programs and provide aftercare.

No Cost or Time Limitations Finally, at a time when funding for treatment is stretched more every year and clients or patients may be in more and more difficult financial situations, the 12-step programs are free of any cost. In each meeting, a collection is taken up, but contribution is completely voluntary, and many members are indeed unable to chip in. No distinctions are made between those who can afford to put money in the basket and those who can't. Even those who can afford to do more usually contribute only a dollar or two per meeting.

Conclusion

Twelve-step groups can be a valuable tool for clinicians by augmenting the work done in treatment and by filling gaps to meet particular client needs, such as daily reinforcement, a positive peer culture, and long-term aftercare, when there may be no other way to provide these things. For clinicians using an informed approach, the inclusion of this valuable and widely available set of resources in treatment planning and delivery offers benefits that far outweigh the liabilities. Counselors, therapists, social workers, psychologists, and physicians working with addictions can become more effective by learning about 12-step programs and integrating their use into their array of other treatment modalities.

Many clinicians approach 12-step programs with trepidation because they are concerned about making mistakes relative to the traditions and practices of these programs that might reduce their credibility or alienate clients. The simple guidelines in this book help avoid errors in working with clients who are participating in 12-step programs as part of their treatment regimen.

ANONYMITY AND CONFIDENTIALITY

As implied by the word "anonymous" in the name of every 12-step program, the framework of the 12-step program includes a strong tradition of mutual protection of identity. The tradition of anonymity also means that members are expected to refrain from identifying themselves as belonging to any 12-step program in any medium likely to be exposed to a mass audience. No member of a 12-step program should identify any other member without the other member's specific consent. Regardless of consent, no 12-step program participant should ever be identified in the mass media. This applies to both members' names and any identifiable images and includes print and electronic media.

The tradition of anonymity also extends to the confidences revealed by others in 12-step meetings. This anonymity is critical to using the 12-step approach.

In practical terms, this means that no clinician should ever ask a client to:

1. Identify another member of a 12-step program.

2. Publicly identify himself or herself as a program participant.

3.

Continues...


Excerpted from Integrating the 12 Steps into Addiction Therapy by James R. Finley Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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