Hello everyone and welcome back. In our past sections we have been talking about a variety of different treatment models and approaches. In this section we are going to begin talking about twelve step approaches. So let's begin by going to slide two.

In general, as you can see here there are a wide variety of twelve step programs and there is a whole lot more listed in your text. The most common one that you probably know about is Alcoholics Anonymous or Narcotics Anonymous; however there are many others such as Prostitutes Anonymous, Self-Mutilators Anonymous, and on, and on, and on.

AA or Alcoholics Anonymous was developed by Bill W. and Bob S. Basically since its inception has spread across the world. We have meetings in every city and there are no dues for membership or for any other aspect of the program. The only requirement to participate is to desire to stop drinking. It is also not aligned with any other group. It crosses all religious, racial, and other types of barriers as well. For those reasons it has become very popular.

In many ways twelve step programs act like pseudo-therapy groups. As we can see in slide four there is a mutual sharing of experiences by members. There is support for each individual. And, one of the big aspects related to substance abuse treatment is that it provides a structure to help the person get through their day. This structure is extremely important in the early stages of recovery. AA and other types of twelve step approaches can be used as an adjunct to a wide variety of other treatment models. As a consequence it is often required by a wide variety of treatment agencies. It is also required by probation and parole, Department of Health Services, etc regardless of whether the client's opinion on whether they want to go or not.

There are a lot of positive aspects about twelve step programs and AA in particular. One of the major ones as we see in slide five is that it provides structure for individuals. That structure as we have seen and talked about a second ago is very, very important because it keeps the person in a model where they do not have a lot of free time in their day to go out and drink. It is also free. The other thing that it does is that it provides goals for the individual to achieve. That is very, very important in relation to treatment.

Now other twelve step programs are out there as well. These are not designed specifically for the user. These are designed for other people such as spouses, children or others. And, a couple of ones you might know of are Al-Anon and Narcanon. However, regardless of the approach the system it all works kind of the same.

What are some of the advantages of twelve step programs? As we can see in slide seven some problems include a lack of research. The reason for that is because these programs are anonymous so there has been a lot of resistance to even allow researchers in to talk with people. There is also a wide variety of mixed results. Some individuals in some programs show improvement by using twelve step programs, others do not. There is also major resistance to twelve step programs by a wide variety of folks especially individuals who are users. Many individuals have problems with the higher power concept. There is also a lack of tolerance to other treatment modalities by many 12 step members. Finally, some individuals are just uncomfortable going to groups and individuals that have dual diagnosis’s issues especially with phobias really have problems attending twelve step meetings.

The key for twelve step programs is, as you see in slide eight, that you need to buy into the concepts. If you do not buy into the concepts you are going to have a very problematic time with success with this kind of a model. You also need to attend the meetings. In initial stages you may have to meet more than once a night. As you go longer you may not have to go as often. You also need to do and work on a wide variety of issues in relation to your substance abuse and this is called step work. The step work that one undergoes can be very difficult especially because the members are not usually therapists and have a lot of training to help you walk through that stuff.

Consequently there are issues that occur with twelve step programs. However, there are also a wide variety of advantages of twelve step programs and some of these are shown in slide nine. First of all they can be very useful in providing support. They can also help users find non-using friends because the former using friends are no longer around. The big advantage that I keep alluding to is that it provides structures for users that they can relate to and it provides alternatives instead of paying for treatment. Twelve step programs also help to provide a lot of inspiration for users and demonstrate to new individuals coming into the group that recovery is possible. However, the best results occur when one uses twelve step programs in combination with other treatment approaches.

So in general as we see in slide ten, twelve step programs can be very effective in addictions treatment and they are best when combined with other models. But they can also be detrimental when they are not done well. Despite all the issues that go along with twelve step programs are very popular with the judges, the popular press, and the members who actually have buy-in to particular treatment models. That does not necessarily mean that all twelve step models programs are very good and like other treatment models some have good aspects and some have bad aspects.

Well that concludes this section. In our next section we're going to talk about family treatment models. So until then we hope you have a good day and we look forward to talking with you soon.

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