Rinse dirty water

Using Imagery and Storytelling to Educate Outpatients about 12-Step Programs and Improve Their Participation in Community-based Programs

The longer a patient remains engaged in recovery activities the greater the success of long-term abstinence.

Self-help community programs that use the 12-steps such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are known in the addictions field to contribute to sustained abstinence. Connecting patients to 12-step programs in early stages of recovery increases the chance of prolonged involvement.

A nurse working in an outpatient substance abuse clinic developed a unique method to inform and educate patients about the 12-step process.

A story and image metaphorically describe this journey. The cleaning of a vessel and subsequent discovery of tools along the way provide an uncomplicated look at the 12-steps.

Nurses can use the image and story to develop the necessary tools of honesty, open-mindedness, and willingness for patients to embrace the 12-step journey.

Dennis E. Hagarty, and Deborah J. Clark. Journal of Addictions Nursing, 2009, Vol. 20, No. 2, Pages 86-92. Using Imagery and Storytelling to Educate Outpatients about 12-Step Programs and Improve Their Participation in Community-based Programs

The twelve-step recovery model of AA: a voluntary mutual help association

Alcoholism treatment has evolved to mean professionalized, scientifically based rehabilitation.

Alcoholics Anonymous (AA) is not a treatment method; it is far better understood as a Twelve-Step Recovery Program within a voluntary self-help/mutual aid organization of self-defined alcoholics.

The Twelve-Step Recovery Model is elaborated in three sections, patterned on the AA logo (a triangle within a circle): The triangle’s legs represent recovery, service, and unity;

• The circle represents the reinforcing effect of the three legs upon each other as well as the “technology” of the sharing circle and the fellowship.
• The first leg of the triangle, recovery, refers to the journey of individuals to abstinence and a new “way of living.”
• The second leg, service, refers to helping other alcoholics which also connects the participants into a fellowship.
• The third leg, unity, refers to the fellowship of recovering alcoholics, their groups, and organizations.

The distinctive AA organizational structure of an inverted pyramid is one in which the members in autonomous local groups direct input to the national service bodies creating a democratic, egalitarian organization maximizing recovery.

Analysts describe the AA recovery program as complex, implicitly grounded in sound psychological principles, and more sophisticated than is typically understood.

AA provides a nonmedicalized and anonymous “way of living” in the community and should probably be referred to as the Twelve-Step/Twelve Tradition Recovery Model in order to clearly differentiate it from professionally based twelve-step treatments.

From; Borkman T. The twelve-step recovery model of AA: a voluntary mutual help association. Recent Dev Alcohol. 2008;18:9-35.

• See also;
• Twelve Step Facilitation
• Brief-TSF Description
• Alcoholics Anonymous

Brief Intervention as a Bridge to AA

Brief Intervention Is Insufficient for Medical Inpatients With Unhealthy Drinking

Data show that brief intervention reduces consumption and consequences among outpatients with unhealthy, but not dependent, alcohol use. To assess whether brief interventions work among medical inpatients with unhealthy drinking,* researchers randomized 341 of such patients to a 30-minute session of motivational counseling in the hospital or to usual care.

Most subjects had alcohol dependence, were unemployed during the previous 3 months, used other drugs, and had substantial psychiatric symptoms. Almost half were hospitalized for an alcohol-related medical diagnosis.

At 3 months among subjects with alcohol dependence, similar proportions of the intervention and control groups received alcohol assistance (e.g., specialty treatment) (49% and 44%, respectively).

At 12 months among all subjects, decreases in alcohol consumption did not significantly differ between the groups (e.g., adjusted mean decreases in drinks per day, 1.5 for intervention subjects and 3.1 for usual care subjects).

Comments:

Unlike most brief intervention studies in outpatients, this study enrolled a predominantly alcohol-dependent sample with major comorbidities—a group reflective of the treatment-resistant population identified when screening occurs in inpatient settings. The study suggests that screening, assessment, and brief counseling are necessary but not sufficient to change alcohol consumption in this population. Although the findings are disappointing, this study underscores that alcoholism—like cancer, atherosclerosis and other complex diseases—will not succumb to simple solutions.

References: Saitz R, Palfai TP, Cheng DM, et al. Brief intervention for medical inpatients with unhealthy alcohol use: a randomized controlled trial. Ann Intern Med. 2007;146(3):167–176.

• Brief-TSF extends brief intervention to lifelong recovery.