Alcohol Drug Counseling and the 12 Steps of Alcoholics Anonymous

By Chris Fajardo

Alcohol/drug counseling is not the application of general counseling theories and treatment methods adapted to specific alcohol/drug theory and research. The indiscriminate application of these theories and methods is just as ineffective today as ever. The professional field of alcohol and drug counseling was born of the experience of recovering alcoholics and of committed professionals and paraprofessionals.

Society has attempted to "treat" or control alcohol and drug problems since recorded history, with notable efforts such as the Washingtonians in 1840 and Prohibition in 1919. The most important development in this century pertaining to the treatment of alcohol and drug problems occurred in 1935, as the program of Alcoholics Anonymous (AA) was begun and developed. This program has its origin in the religious movement called the Oxford Groups. Bill Wilson (co-founder of AA) himself was quick to acknowledge that the principles of the Twelve Steps are the common property of all mankind.

Nonetheless, AA gave the world the 12 Steps, which have been and are continuing to be the foundation of recovery for millions of alcoholics and addicts – and others – worldwide. In an article published in 1939 in the medical journal The Lancet ("A New Approach to Psychotherapy in Chronic Alcoholism"), Dr. William Silkworth describes the process and principles of recovery from alcoholism. He states, "Once the patient agrees that he is powerless, he finds himself in a serious dilemma." This is, of course, Step One of the 12 Steps of Alcoholics Anonymous.

With courage, Silkworth goes on to describe the solution to this powerlessness as being spiritual in nature. He explains that when following directions given him by fellow alcoholics, "The patient experiences the profound mental and emotional change necessary for a complete recovery from alcoholism."

Citing the book Alcoholics Anonymous, Silkworth states that "the first half of the book is aimed to show an alcoholic the attitude he ought to take and precisely the steps he may follow to affect his own recovery." The word "precisely" is clear, strong and direct; it means that if we change the formula, we change the outcome. The 12 Steps are a proven formula for recovery and are certainly necessary for good treatment outcomes.

In 1996, the American Society of Addiction Medicine (ASAM) devoted five chapters to the 12 Steps – one full section of its manual. The 12 Steps have demonstrated effectively the ability to:

1) identify the problem;

2) define the solution; and

3) design a program of actions necessary to bring about recovery.

As the effectiveness of these 12 Steps demonstrated their ability to identify the problem, define the solution, and design a program of actions necessary to bring about recovery, professionals began to take note.

The first person to have taken the title of "alcoholism counselor" was Courtney Baylor in 1913. His influence on the development of the profession is evident to this day. The Common Sense of Drinking, a book that influenced both Dr. William Silkworth and Bill Wilson, was dedicated to Courtney Baylor by its author, Richard Peabody. The idea that complete surrender had to precede getting sober (AA’s First Step) came directly from Peabody’s work. Early efforts in Akron, Ohio (1935) by Dr. Bob Smith and in Wilmar, Minn. (1951) by Dr. Nelson Bradley began to teach the principles of recovery recorded in the textbook Alcoholics Anonymous.

The "Minnesota Model" was directly born out of the work of Bradley and Dr. Dan Anderson (Hazelden) when they began to mold a "team" of people that included alcoholics and non-alcoholics.

Many people in social work, medicine, psychology and theology began to realize the immense power of the 12-Step recovery program outlined in AA’s Big Book. The vast majority of hospitals and treatment centers in this country today call themselves "AA-oriented." This has come to mean in most cases that AA meetings happen on-site and/or patients may be transported to meetings off-site, or the staff may lecture occasionally or even frequently about the steps.

Counselors may talk to clients/patients about the steps. Some programs endeavor to "take" the client/patient through the first five steps (or less, or more). Certainly most treatment professionals in the alcohol and drug field today acknowledge that the steps are important. But, during these uncertain times of managed care, HMOs, PPOs, DRGs, health care crises, and reduced federal funding, many of us seem to be running for cover and forgetting what works.

We want to redefine our profession as somehow different and yet the same as those other professions. We are not the same as any profession in this century. We were born out of a "self-help" movement, although for some today, the self-help movements are new. Indeed, we have spawned many important new fields.

We have been responsible for the advent of adult children of alcoholics, and countless other worthwhile movements. Alcohol and drug counseling is intended to teach, counsel, guide, instruct, mentor, show the alcohol and drug client/patient what he/she must know in order to recover from alcoholism and drug problems.

Certainly some understanding of pharmacology, etiology, individual counseling, family systems, family counseling, and psychiatric conditions and disorders are important, but the principles outlined in the 12 Steps of recovery have been and remain a foundation of the alcohol and drug field.

In a recent conversation with Dr. Robert Straus, a pioneer in this field, I mentioned the apparent aversion to the conspicuous mention of 12 Steps in such documents as the Scope of Practice from NAADAC, The Association for Addiction Professionals. Straus’s response was, "It would be like a program for political science not mentioning the Declaration of Independence."

Alcohol and drug counselors now more than ever do not need to apologize for practicing a discipline that was born out of an effort to teach 12-Step principles.

It is time that we recognize that our effort to look just like other professionals (we all have our place in relieving human suffering) is not the answer. It is part of the problem!

As we distance ourselves from the 12 Steps, because they were first identified by "drunks in a self-help program," we forget that these are principles for all mankind, and they work!

We will lose our entire focus as well as our profession if we continue to be fearful that our fellow professionals won’t accept alcohol and drug counseling as a profession because we have "self-help" roots.

The founding fathers were not all well-educated men when the Declaration of Independence was written, but it is the foundation of our country. Certainly, the 12 Steps of Alcoholics Anonymous are the foundation of our profession.

Chris Fajardo has worked in the chemical dependency field since 1966. He is a licensed professional counselor in Virginia and is certified as an alcohol and drug counselor in Kentucky. He is CEO of Silkworth in Shelbyville, Ky., and has consulted with national and state organizations and the private sector.

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