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An Existential Approach: an Alternative to the AA Model of Recovery

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An Existential Approach: an Alternative to the AA Model of Recovery An Existential Approach: An Alternative To The AA Model of Recovery Maria A. Rogers Debra Cobia Auburn University schizophrenia, for example, they have a 47% lifetime history of substance abuse Abstract or dependence (Regier,et al. 1990). Alcoholics Anonymous (AA) is the most In the past, it has been noted that mental widely used organization for the health professionals have not performed treatment of alcoholism. AA’s well in their treatment of substance philosophy has changed how many abuse disorders (Brown, 1985; people view themselves and their Khantzian, 1985; Vaillant, 1995). substance use. The majority of Professionals argued that the spread of substance abuse programs in the United self-help groups such as Alcoholics States use the 12 steps, either by making Anonymous (AA) occurred because of them the basis of their treatment the ineffective responses by mental program, or by introducing AA to clients health professionals to substance abuse as a means of recovery. Research is not problems (Khantzian, 1985). According clear, however, as to whether working to Shaffer (1986), professionals were the AA program is helpful in achieving confronted with an array of treatment sobriety. Based on a review of the models, professional and self help, for literature, this article examines substance abuse problems, and none of differences between AA and them appeared to demonstrate a high professional counseling, and explores degree of effectiveness. Additionally, AA’s philosophy. An existential some reviews of the history of the approach to therapy is reviewed with treatment of substance abuse have regard to case conceptualization, argued that the traditional assessment and interventions in treating psychodynamic approach to treating individuals suffering with alcohol- individuals with substance abuse issues related issues. as a symptom of an underlying psychiatric disorder has been especially Regardless of their area of expertise, ineffective (Polcin, 1997). According to counseling professionals will most Velleman (1989), there is no single certainly be faced with clients who approach or one agency that can help present with substance use disorders those individuals who suffer with (Polcin, 2000). Numerous studies substance abuse problems, and he suggest a lifetime prevalence rate of 8%- indicates that accurate assessment of 14% for alcohol dependence (American individuals is essential; professionals Psychiatric Association, 1994), and it must match the client with the best appears that at least 29% of clients who possible service. Beck, Wright, present with a current mental health Newman and Liese (1993) stated there is problem are also plagued with a history no conclusive evidence about the most of substance use disorder, and in such effective treatment for all people with populations as clients with a diagnosis of alcohol problems, and concluded that ExistentialExistential Approach Approach 60 treatment outcomes for individuals with less clearly codified. These entities alcohol-related problems are determined seem to be increasingly defined by by a number of aspects that include: the professional and commercial interests process of treatment; post-treatment and not by clinical science (White, adjustment; the characteristics of those 1998). individuals seeking treatment; the nature of the presenting problem, and the In a review of self-help and support interactions between these variables. It is groups, Kurtz (1997) highlights the recognized that in the United States, a distinctions between treatment and majority of professional programs for mutual-aid groups. Kurtz explains that substance abuse use the 12 steps, either self-help and support groups focus on by making them the basis of their the mobilization of resources within the treatment programs or by introducing self, within the family, and the wider them to clients as a means of recovery community. These groups are personal, (Bradley, 1988). The use of AA by egalitarian, and anti-bureaucratic and professional treatment programs is seen shun expert advice in lieu of personal as beneficial to the clients (Hulbert, and collective experience. According to 1992; Irwin & Stoner, 1991; Miller & Kurtz, many practitioners in the field Mahler, 1991). have some difficulty in distinguishing among self-help, support, or The purpose of this article is to provide psychotherapy groups, and she explains an overview of the fundamental that the most distinct difference between differences between Alcoholics self-help and support groups is that self- Anonymous (AA) model of recovery help groups aim at effecting change. and professional substance abuse Since both self-help groups and treatment, and also to examine the psychotherapy groups help their philosophy of AA. Additionally, an members achieve personal change, they existential approach to substance abuse differ by the inclusion of a professional treatment as an alternative to the AA therapist and not relying on the group. model of recovery for treatment of alcohol abuse will be investigated as a White (1998) offers elaborations on the process for helping addicted clients sort points made by Kurtz (1997) and adds out and clarify ways in which they additional reflections on the differences construct meaning in their lives. between AA and professional treatment in numerous areas. According to White, An Overview of the Differences between professional treatment services take AA and Professional Treatment place within the context of a business environment; AA-directed recovery The differences between AA and takes place within a voluntary social and substance abuse treatment could easily spiritual community. The field of be drawn if the boundaries of both of professional treatment is tied together by these separate units were clearly defined. professional and institutional self- While AA’s boundaries are defined by interest; AA is bound together by what the Twelve Steps and the Twelve White has called a “kinship of common Traditions, the professional boundaries suffering.” Theories underlying of what makes up “treatment” are much alcoholism treatment begin with The Alabama Counseling Association Journal, Volume 34, Number 1, Spring 2008 61ExistentialExistential Approach Approach different conceptions of the etiology of relationship in which the professional is alcoholism and proceed from these obliged to take on special ethical and conceptions to numerous derived legal duties and obligations for the care treatment strategies; AA simply says to of the client. The treatment relationship the alcoholic, “Stop drinking and here is is hierarchical whereby it is assumed that how to avoid taking the next drink.” control resides in the therapist and the Professional treatment asserts that it is institution. On the other hand, AA rooted in psychology and medicine, relationships are equal and have a sense while AA claims to come from medicine of reciprocity, and assume that strengths and religion. The focus of treatment is and vulnerabilities are shared by all characterized as a process of “getting members, and that the members are there into oneself”, self-exploration and self- because they need to be there. healing. AA is about the individual Treatment relationships are time-limited; getting outside oneself and focusing on relationships in AA are open-ended, and resources and relationships beyond the have the potential of being life-enduring. self. Treatment involves self- In substance abuse treatment, clients development; AA is about self- receive a service; in AA one receives transcendence. Treatment involves membership in a recovering community. discovery or initiating sobriety while the In treatment a diagnosis is made by one goal of AA is recovery or sustaining or more trained professionals of the sobriety. With respect to locus of nature of the problems presented by the control in addiction treatment, it is often person seeking help. The professionals difficult for the client to have control are aware that errors in diagnosis can over the degree of intimacy in the client- result in harm done to the clients, and therapist relationship, because of the the professional possesses substantial inherent inequality of this relationship; power, and the client who is being in contrast, AA members, every day, diagnosed brings significant decide if, when, where, how long, and at vulnerability to the diagnostic event. what level of intensity contact with AA The emphasis in AA is on self-diagnosis. will occur. In addiction treatment the “experts” credentials are measured in the degrees, The degree of invasiveness is reduced in licenses, and certifications awarded by AA through such mechanisms as the governmental and private authorities. It discouragement of cross-talk and is assumed that the professional avoiding taking other people’s possesses special knowledge and skill “inventories.” In treatment a high level that the client lacks. In AA, the experts of personal self-disclosure is are measured by the credentials of encouraged. Treatment seeks specific personal experience and the experience details related to the problem; AA asks is based on one’s sobriety today, one’s for conclusions. The story model of AA sobriety date, and one’s degree of is a life summary; the story model of actualization of the values of AA. When treatment is an expression of the participating in AA, members with particular aspects of how one came to be professional credentials must take off wounded. Relationships in substance their professional “hats.” Because abuse treatment are
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