individualized treatment plans, and aftercare (Chappel & DuPont, 1999). This new model of treatment, subsequently known as the Minnesota Model, was adopted by Hazelden in 1961 and spread so rapidly that by 1989, 95% of the treatment programs in the United States were basing their programs on the Twelve-Step AA program. In actuality, the practice of AA in the community differs in fundamental ways from the Twelve-Step facilitation that is practiced in professional treatment centers. AA in the community is not “treatment.” It is a spiritually based fellowship that supports the development and maintenance of abstinence for those who want it and offers steps for sobriety and lifelong character development. AA could hardly be more different in its structure than a typical public or private addiction treatment program. AA groups in the community are self-supporting, led by fellow alcoholics, and are free of charge. There is no federal or state funding, no licensing or monitoring by any regulatory
agency, no records of attendance, and no case records. In contrast, Twelve- Step facilitation models implemented in treatment programs have paid professionals teach AA assumptions (powerlessness over alcohol, spirituality, Twelve Steps to recovery); require people to admit they are alcoholics, complete the work on the initial steps in a specific time frame, and go to a certain number of AA meetings; charge money for the treatment program; and are monitored by state and federal regulators (Travis, 2010 ; Fisher & Harrison, 2008 ). A fundamental difference between the writings of cofounder Bill Wilson, the philosophy of The Big Book of AA, and professional treatment programs that practice Twelve-Step facilitation is around the issue of compliance. As noted by LaFave and Echols ( 1999 ), “Twelve-Step self-help programs stress the voluntary nature of attendance and offer their ideas as suggestions. ... The highly directive nature of Twelve-Step treatment models is, therefore, a departure from the approach used in Twelve-Step self-help programs” (p. 348). AA and other Twelve-Step groups do a delicate dance of keeping alive the voluntary nature of the mutual-help program, in spite of pressures from treatment centers and probation and parole officers on clients to bring back attendance slips signed by the chairperson of the particular group. As noted on the official AA website, “Proof of attendance at meetings is not part of AA’s procedure. Each group is autonomous and has the right to choose whether or not to sign court slips. In some areas the attendees report on themselves, at the request of the referring agency, and thus alleviate breaking AA members’ anonymity.” T WELVE -S TEP P ROGRAMS AND H ARM R EDUCTION It may surprise some readers that the authors of this text consider Twelve- Step mutual-help organizations such as Alcoholics Anonymous and Narcotics Anonymous to be compatible with a harm reduction philosophy. In addition to the voluntary nature of the programs, there are other principles of Twelve- Step programs as practiced in the community that are consistent with harm reduction practices. A fundamental concept of the AA program is the need
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- Fall '16
- Microeconomics, Twelve-step program