Treatment options for drug and alcohol problems include Alcoholics Anonymous (AA) (Timko, Moos, Finney & Lesar, 2000; Weiss et al. , 2000), and therapeutic communities (TCs) (Hall, Chen & Evans, 1995; De Leon, 1994; Nielsen & Scarpitti, 1997). Given the lack of consensus on the etiology of drug and alcohol problems (Craig, 1995), proponents of AA, and TCs tend to highlight the benefits of adopting their particular treatment intervention.
However, a review of drug and alcohol literature indicates that although these two treatment interventions differ somewhat in their perspectives on drug addiction and their approach to alcohol and drug problems (Inaba & Cohen, 2000), they not only share similarities but are often used in conjunction with each other (e. g. , Minnasota Model) (Winters et al. , 2000; McKay et al. , 1998). The disease model of drug addiction … “acknowledges biological predisposition, pharmacological reinforcement of behaviour, accumulating organic damage, entrenched cognitive patterns, [and] family and developmental influences” (Jurd, 1996, pp.
5-6). The disease model assumes that addiction to alcohol and drugs, especially narcotics (Drummond, 1991), is caused by a physical defect, the problem is within the person rather then the drug (Clarke & Saunders, 19 ). Although AA is based on the disease model of addiction (Jurd, 1996) they do not “take any particular medical point of view (AA, 1976, p. xx), and are fundamentally spiritual, as opposed to religious, programs (Gaudry, 1994; Miller & Kurtz, 1994).
Alcoholics Anonymous (AA) and similar groups (NA) are referred to as 12-Step programs because there are twelve defined steps in the program for recovery (Yalisove, 1998), and the focus of treatment is holistic in that it incorporates the physical, mental and spiritual aspects of the person (Goold, 2001). The treatment intervention advocates abstinence, (physical), adherence to the 12-Steps, the 12-Traditions and other collective wisdom (mental), and the belief in a higher power and support from the sponsor/group (spiritual) (Goold, 2001).
The 12-Steps incorporates important cognitive (Steps 1, 2, 3, 6,and 11), behavioural (Steps 4, 5, 8, 9, 10, and 12) (McCullough, 1995) and social (fellowship) (Miller & Kurtz, 1994) components founded on reinforcement, social learning, and reference group theory (Wallace, 1993). Individual character defects are viewed as the primary cause of using drugs and failure in life (Gaudry, 1994), and a fundamental premise of this approach is that the disease is progressive and controlled use of alcohol (or other drugs) is not possible (Watson, 1991).
Twelve step programs are free, usually voluntary (Rivers, 1994), peer based, and employ confrontational approaches (Yalisove, 1998) within a group format (Monras & Gual, 2000). The only requirement for membership is a desire to stop the addiction (Rivers, 1994). Gaudry (1994) posits that the recovery program helps to build self-concept through a process that engages addicts at their level of addiction, breaks down their isolation, guilt, and pain, and shows them they are not alone.
Meetings are conducted by reformed addicts, and provide a forum in which members acquire new skills to maintain abstinence and enhance their quality of life (Gaudry, 1994). The telling of life histories (a narrative approach) has been the cornerstone of AA practices (Major, 2000), and the individual may, through attending meetings, develop a sense of acceptance, social affinity, and an opportunity for re-socialisation (Pisani, Fawcett, Clark & McGuire, 1993).
In addition to providing a sense of belonging, AA programs are not time-framed (Weiss et al., 2000) but focus on “one day at a time” (Wallace, 1993), and stress the importance of a lifelong commitment (McCrady, Epstein & Hirsch, 1996) towards maintaining abstinence and dealing with all of life’s problems (Snow, Prochaska & Rossi, 1994). Although AA programs recommend daily attendance for the first 90 days (McCrady, Epstein & Hirsch, 1996) it has been suggested that it is the extent of participation in the program, as opposed to attendance at meetings, that is associated with more positive outcomes (Montgomery, Miller & Tonigan, 1995; Fiorentine, 1999).
While the majority of AA and similar (NA) programs are conducted on an outpatient basis (Inaba & Cohen, 2000), alcoholic recovery homes such as Hazelden, and Synanon, the forerunner of American TCs, all grew out of the practices and philosophy of AA (Dodd, 1997). Although recovery homes have remained in the culture of AA, TCs have developed their own distinct culture of values, language, rituals, and traditions (Bassin, 1984, cited in Dodd, 1997).
The social model (White, 1991; Dodd, 1997) provides the TC with a consistent framework for environmentally focused recovery that employs cognitive, and behavioural training methods and techniques founded on reinforcement, social learning (Wexler, Falkin & Lipton, 1990; De Leon, 1991) and, given that the peer encounter is the cornerstone of group processes in the TC (Nielsen & Scarpitti, 1997), self-control theory.
In addition there is an unusual mix of street idiom and language borrowed from various psychotherapeutic schools including psychoanalysis, gestalt therapy, and existential psychotherapy (De Leon, 1991). The TC views drug abuse as over-determined behaviour (De Leon, 1991) and does not perceive drug abuse as being the individual’s main disorder. Rather, drug abuse is viewed as a symptom of deviant behaviour, reflecting impeded personality development or chronic deficits in social, educational, and economic skills (De Leon, 1994).