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The Philosophies and Practices of Alcoholics Anonymous from a Psychodynamic Perspective University of Pennsylvania ScholarlyCommons Doctorate in Social Work (DSW) Dissertations School of Social Policy and Practice Winter 12-18-2015 The Philosophies and Practices of Alcoholics Anonymous From a Psychodynamic Perspective Noah Kass University of Pennsylvania, [email protected] Follow this and additional works at: https://repository.upenn.edu/edissertations_sp2 Part of the Social Work Commons Recommended Citation Kass, Noah, "The Philosophies and Practices of Alcoholics Anonymous From a Psychodynamic Perspective" (2015). Doctorate in Social Work (DSW) Dissertations. 73. https://repository.upenn.edu/edissertations_sp2/73 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/edissertations_sp2/73 For more information, please contact [email protected]. The Philosophies and Practices of Alcoholics Anonymous From a Psychodynamic Perspective Abstract Although predominantly ignored in the existing literature, psychodynamic perspectives on addiction are relevant to understanding the twelve-step program known as Alcoholics Anonymous (AA). This dissertation analyzes specific psychodynamic perspectives on addiction including ego psychology, object relations theory, self-psychology, and attachment theory, as well as their derivations and the philosophies and practices of AA outlined in AA literature. These literatures are integrated to inform the findings and recommendations section, justifying certain AA practices while offering recommendations to improve the overall effectiveness of AA. Findings concentrate on AA helping members transition from utilizing primitive to mature defense mechanisms; manage volatile emotions in early recovery; increase humility in addressing alcoholism; establish consistency in the recovery program; participate in a nurturing holding environment; strengthen object permanence; establish transitional objects and address unmet selfobject needs, including helping members feel valued (mirroring); merge with an admirable object (idealizing); and experience alikeness with others. Recommendations are made to AA leaders and include pronouncing the value of joining a home group in AA literature and having members state whether they attend a home group during meeting introductions, stressing respect for boundaries members should not cross, and maintaining consistency in where and when meetings take place and how they function. Newcomers are suggested to attend 90 meetings in their first 90 days of AA; have family and friends attend open anniversary meetings; choose sponsors whom they have the potential to emulate; receive treatment from mental health professionals when necessary; and discuss with their sponsors and peers regarding decreasing weekly meeting attendance. Members are encouraged to receive treatment from mental health professionals when warranted and promote collaboration between their sponsors and treatment providers. Mental health/addiction treatment professionals are advised to recommend AA meetings to their clients where they are most likely to form attachments with those in attendance. Degree Type Dissertation Degree Name Doctor of Social Work (DSW) Department Counseling and Human Services First Advisor Ram A. Cnaan, Ph.D. Second Advisor Marni Rosner, DSW Keywords addiction, alcoholics anonymous, psychodynamic theory Subject Categories Social and Behavioral Sciences | Social Work This dissertation is available at ScholarlyCommons: https://repository.upenn.edu/edissertations_sp2/73 THE PHILOSOPHIES AND PRACTICES OF ALCOHOLICS ANONYMOUS FROM A PSYCHODYNAMIC PERSPECTIVE Noah Kass A DISSERTATION in Social Work Presented to the Faculties of the University of Pennsylvania in Partial Fulfillment of the Requirements for the Degree of Doctor of Social Work 2015 __________________________ Ram A. Cnaan, Ph.D. Dissertation Chair John Jackson, Ph.D. Dean, School of Social Policy and Practice Dissertation Committee Marni Rosner, DSW ii Dedication This dissertation is dedicated to Jessie Kass and Ava Kass. I love you both so much. iii Acknowledgments I would like to thank my dissertation chair, Ram Cnaan, Ph.D., for his unwavering support and guidance in the writing of this dissertation. In the dictionary, under the word patience, there should be a picture of Ram reading my frantic emails. I owe an additional debt of gratitude to my other committee member, Marni Rosner, DSW. Marni represents everything great about the Penn DSW. I take such pride in knowing we have graduated from the same doctorate program. It is important that I thank Lina Hartocollis, Ph.D. Lina was incredibly supportive of me throughout my time at Penn and is an inspiring leader. To Jeffrey, Phyllis, Andrea, and Leslie: Thanks for challenging me during the first year … you are all amazing teachers. To the dedicated and talented professionals that made up this cohort: I am so happy to have been on this journey with all of you. To my dad and mom: Thank you for those big hearts. To my brother: Thank you for being such a great friend. iv Abstract Although predominantly ignored in the existing literature, psychodynamic perspectives on addiction are relevant to understanding the twelve-step program known as Alcoholics Anonymous (AA). This dissertation analyzes specific psychodynamic perspectives on addiction including ego psychology, object relations theory, self-psychology, and attachment theory, as well as their derivations and the philosophies and practices of AA outlined in AA literature. These literatures are integrated to inform the findings and recommendations section, justifying certain AA practices while offering recommendations to improve the overall effectiveness of AA. Findings concentrate on AA helping members transition from utilizing primitive to mature defense mechanisms; manage volatile emotions in early recovery; increase humility in addressing alcoholism; establish consistency in the recovery program; participate in a nurturing holding environment; strengthen object permanence; establish transitional objects and address unmet selfobject needs, including helping members feel valued (mirroring); merge with an admirable object (idealizing); and experience alikeness with others. Recommendations are made to AA leaders and include pronouncing the value of joining a home group in AA literature and having members state whether they attend a home group during meeting introductions, stressing respect for boundaries members should not cross, and maintaining consistency in where and when meetings take place and how they function. Newcomers are suggested to attend 90 meetings in their first 90 days of AA; have family and friends attend open anniversary meetings; choose sponsors whom they have the potential to emulate; receive treatment from mental health professionals when necessary; and discuss with their sponsors and peers regarding decreasing weekly meeting attendance. Members are encouraged to receive treatment from mental health professionals when warranted and promote v collaboration between their sponsors and treatment providers. Mental health/addiction treatment professionals are advised to recommend AA meetings to their clients where they are most likely to form attachments with those in attendance. vi Table of Contents Dedication ii Acknowledgments iii Abstract iv Introduction 1 Chapter 1: Early Psychodynamic Perspectives on Addiction 4 Chapter 2: Modern and Contemporary Psychodynamic Perspectives on Addiction 29 Chapter 3: The Origins of Alcoholics Anonymous 50 Chapter 4: What Is Alcoholics Anonymous? 66 Chapter 5: Findings and Recommendations 86 References 103 1 Introduction This dissertation aims to understand how psychodynamic theories and their many derivations are relevant to the twelve-step program known as Alcoholics Anonymous (AA). Through this intellectual journey, I will identify and elicit the key classic and modern/contemporary psychodynamic writings on the etiology and treatment of addiction and substance abuse, and juxtapose them with the key essentials of the twelve-step program. I intend to review AA components in light of this psychodynamic literature. I will identify how psychodynamic literature justifies certain existing AA protocols while offering recommendations to improve the overall effectiveness of Alcoholics Anonymous. The focus of this dissertation is alcoholism. Most early and modern psychodynamic theorists discuss addictions from a generalist perspective. These theorists focus on behavioral addictions as well as substances; within substances, they address alcohol, among other drugs. I will include these theorists’ observations on a range of addictions; however, I will narrow my focus on alcohol and alcoholism in the findings section. Central to this dissertation’s mission is to understand why people use and become addicted to narcotics or alcohol, and what can be done to assist their recovery. While the addiction treatment community (largely consisting of AA supporters) has principally ignored psychoanalytic literature, I propose this rich body of work has more in common with AA’s philosophies and practices than previously conceived. Charles Goldberg (2011), author of Freud Meets Bill W.: A Model for the Dynamics of Alcoholism, supported this position: “Historically there has been a lamentably wide gap between Alcoholics Anonymous (AA) and psychodynamic psychotherapy. Although each has a distinct language, they actually utilize parallel principles” (p. 141). In Pragmatic Convergence in the 2 Programs of Psychoanalysis and Alcoholics Anonymous, psychoanalyst David W. Mann
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