Good OldTimers: Treatment Staff Referrals, Participation Expectations, and Perceived Benefits and Barriers to Adolescent Involvement in Twelve-Step Groups

Monday, 22 September 2008

Treatment Staff Referrals, Participation Expectations, and Perceived Benefits and Barriers to Adolescent Involvement in Twelve-Step Groups

Treatment Staff Referrals, Participation Expectations, and Perceived Benefits and Barriers to Adolescent Involvement in Twelve-Step Groups
Alcoholism Treatment Quarterly: Volume: 26 Issue: 4. pp. 427 - 449
Adolescents treated for substance use disorders (SUDs) appear to benefit from participation in Alcoholics Anonymous/Narcotics Anonymous (AA/NA). However, as compared with adults, fewer adolescents attend, and those who do attend do so less intensively and discontinue sooner.
It is unknown whether this disparity is due to a lowered expectation for youth participation by the clinicians treating them, as they may adapt the adult-based model to fit a less-dependent cohort, or whether recommendations are similar to those of clinicians who work with adults and other factors are responsible.
All clinical staff (N= 114) at 5 adolescent programs (3 residential, 2 outpatient) were surveyed anonymously about referral practices and other beliefs about 12-step groups. Staff rated AA/NA participation as very important and helpful to adolescent recovery and referral rates were uniformly high (M= 86%, SD= 28%). Desired participation frequency was over 3 times per week. The theoretical orientation and level of care of the programs influenced some results.

Findings suggest lower adolescent participation in 12-step groups is not due to a lack of clinician enthusiasm or referrals, but appears to be due to other factors.

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Bill “Bill W.” Wilson was born November 26th, 1895 in Vermont, the scion of a long line of granite quarry workers and mine bosses. He was educated at the prestigious Burton and Burr academy before joining the Army at the onset of US involvement in W.W. I. It was in the military (where Wilson had a desk job and never saw combat) that he took his very first drink and discovered that he didn’t just like it, he loved it. He quickly graduated to a full-bore drunkard, and a violent one at that. Which wasn’t too much of a problem at first. Wilson possessed a fine mind, he was logical and scientific, one of those guys who can fix a broken machine by taking it apart and studying how it works. When he got out of the military, he turned his natural genius toward the world of high finance, where it meshed nicely with his almost pathological need to make money and to be esteemed as a Great Man. It wasn’t long before the ambitious and talented Wilson was a force to be reckoned with on the Wall Street of the rollicking 1920s. He would learn all he could about the inner workings of a publicly-traded company then make recommendations to buyers based on his unique understanding. Today Wilson would be considered a common, albeit gifted, stock analyst, but back then he was one of the few people doing that sort of thing. Savvy investors soon flocked to Wilson and it didn’t take long before he realized he could use his influence and advice to artificially inflate the price of a company’s stock, including those in which he had a financial stake. These days that sort of behavior is a crime called insider trading, but in the ‘20s it was called playing the game and no one cared that much. Wilson certainly didn’t. He raked in the cash with both hands. He spent that money, too. The best of everything was never quite good enough for Bill. He had to have more, he had to have better. While he justified his lavish lifestyle to acquaintances by explaining that he had grown up poor, this was hardly the case. Only he and his wife, Lois, knew otherwise, and he perpetuated the myth for decades. Apart from occasionally drinking himself catatonic, Wilson’s life rolled along swimmingly, right up until October 24th, 1929. On the day that will be forever be known as Black Thursday, the stock market crashed (due in large part to just the sort of insider shenanigans that had made Wilson fabulously wealthy) and he lost everything. Overnight, he went, like so many other Americans, from white spats and hot jazz to starved for button thread or a decent meal. The only part of his life that remained the same was his obsession with getting loaded. Wilson used his keen intellect to discover inventive new ways to get a hold of drinking money, such as not paying the rent. Then, on December 11th, 1934, after five years on the bum, something happened. No one, and especially not Wilson himself, was ever able to adequately articulate what occurred, but according to the standard tale it went something like this: After repeatedly failing to get his drinking under control, Wilson, trembling on the brink of insanity, called up into the sky, “If there be a God, let Him show Himself now!” Suddenly, a warm bright light filled the room and Wilson found himself standing atop a mighty mountain. A wind came to him, surrounding his body and moving through it. With its departure, Wilson fell back into himself and never touched another drop of alcohol. A life-long agnostic who sometimes espoused atheism, Wilson took pains to avoid terming the event supernatural. He likened it instead to a “heat flash,” as if he’d been visited by premature and off-gendered menopause. Refusing to call what had happened an other-worldly event began Wilson’s (and AA’s) weird and oftentimes contradictory relationship with faith and the occult, denying that AA was a Christian organization while simultaneously rooting their entire philosophy firmly in the Christian sphere. (Wilson would, later in life, come to embrace all manner of occult beliefs, but more on that later.) No matter what name he chose to call his conversion event, it contained the birth of Alcoholics Anonymous. Bill Wilson set about creating AA with his usual laser-like focus. He understood immediately that the fledgling organization needed money, and he’d always been good at convincing rich men to give him theirs. He beseeched America’s surviving moneyed elite, those who’d escaped largely unscathed from the Crash, to lend financial support to his cause. Eventually, he landed the biggest fish in the pond: Nelson Rockefeller. With Rockefeller’s help, the Alcoholics Foundation sprang into being and would fund AA for the better part of the next decade. AA swiftly grew from a simple idea in Bill Wilson’s mind to a nationwide organization with membership rolls in the thousands. Though AA was doing well, the Wilsons continued to live rather destitute lives. It’s strange that Wilson lived worse sober than he did as a hopeless lush. AA folklore casts his situation in a romantic light, using it to demonstrate that Wilson gave up everything for the cause, but this doesn’t fly. As a drunk, Wilson lived like his patron, Nelson Rockefeller, but when sober he and Lois used fruit boxes as furniture, and he continually bemoaned his tough financial situation. Wilson was no martyr, so his inability to earn a livable wage while sober is decidedly strange, especially from a man with such a finely-tuned financial mind. Wilson’s poverty was a boon to him, however, when the Cleveland chapter of AA accused him of embezzling funds from the Foundation and from royalties earned from the publication of the Big Book. The accusations were neither proved nor disproved, and most AA members seemed willing to cut Wilson some slack. In any event, Cleveland eventually got over their problem, and AA continued to flourish, even in the face of further controversy. From the time he was a young man, Wilson and the ladies were never far separated. He was an attractive fellow and women were drawn to his smarts and passion. His womanizing continued after his marriage to Lois and for the majority of his life. Though he had “cured” his addiction to alcohol, Wilson never lost his addiction to women. Late in her life, Lois claimed that, despite abundant evidence, she was never aware of any impropriety on the part of her husband. But she must’ve known. The AA hierarchy in those days was rife with tattletales. There is even some evidence to suggest that Wilson’s womanizing accelerated after his conversion to sobriety, which begs the question: Did Bill Wilson prey upon vulnerable and needy women who came to him for help with their drinking? We will probably never know the answer, but the fact remains that on at least one occasion Wilson hired one of his mistresses to an administrative position in AA, only to have the Foundation board fire her to avoid a public scandal. Wilson was also quite the publicity hound. For the first twenty years of AA’s existence, his name and face were synonymous with the group. Even as he denied that AA was his own personal fiefdom, he continued to front the group, sitting for every reporter or photographer and glad-handing every wealthy potential benefactor who came his way. The outlying memberships eventually rebelled. They stridently reminded Wilson that one of the two words in the group’s name is anonymous, and Wilson’s behavior was anything but. Wilson proposed that AA needed a public face, someone to whom donors and members could relate, but by the mid 1950s he relented. From that point forward, all public photographs of Wilson showed him in silhouette or with his back turned to the camera. This seems to have placated the membership, but did nothing to quell Wilson’s need to be seen as a Great Man. By all appearances, Wilson felt terribly guilty for both his philandering and his obsession with being viewed as a step above the common run. He lapsed into a series of depressions that lasted, off and on, for the better part of his adult life. At their height he was known to pace his AA office muttering about how he’d done all this work to help alcoholics get well but nobody cared about him. He felt friendless and lonely, bereft of direction, to the point he eventually sought out psychoanalytic therapy. When word got out to the members that Wilson was seeing a shrink, they seethed with fear and rancor. If the founder of AA himself, the man who’d developed the sacred 12 Steps, was seeing a therapist, didn’t that mean the Steps were suspect? An honest, logical question, to be sure. Wilson scrambled to reassure frightened members that the Steps were solid and effective, though he would continue receiving personal therapy for many years to come. One of his therapeutic journeys lead him to Trabuco College in California, and the friendship of the college’s founder, Aldous Huxley. The author of Brave New World and The Doors of Perception introduced Wilson to LSD-25. The drug rocked Wilson’s world. He thought of it as something of a miracle substance and continued taking it well into the ‘60s. As he approached his 70th birthday, he developed a plan to have LSD distributed at all AA meetings nationwide. The plan was eventually quashed by more rational voices, and a few years later the Federal government made the point moot by making the drug illegal. (That Wilson’s plan was shot down is probably fortunate. LSD is a beautiful thing, but nothing sounds more horrifying to me than a roomful of chain-smoking, frightened, needy drunks tripping their heads off in the basement of the local Y.) In his never-ending quest to find a substitute for his drinking, Wilson, the self-declared agnostic, delved heavily in the occult. He and Lois set aside a special room at their home, called Stepping Stones (“stepping,” get it?) for their outré games. Seances were a regular feature at the Wilson’s. Lois would later tell skeptical friends that she and her husband, with the help of their invisible spirit friends, levitated the table on several occasions and performed numerous other feats that would make Agent Mulder’s heart get all fluttery. Wilson’s primary substitute for drinking, however, was much less exotic: smoking. Though he smoked several packs a day, he was never very good at it. He burned holes in his clothes (even, strangely, his hat) and was continually smudged with ash. His fingers became yellowed by nicotine and even after being diagnosed with emphysema in the early 1960s, Wilson continued to smoke. He told friends he quit, but squirreled cigarettes away in his car. For as long as his health permitted him to drive, Wilson would escape in his car and smoke one cigarette after another. As his health worsened, he would intersperse hits off his oxygen tank with cigarettes. Late in the 1960s Wilson’s emphysema lead to repeated bouts of bronchitis, then to cases of pneumonia that confined him to his bed for long stretches of time. As his various illnesses deepened, so did his hallucinations. Though none were as singular as his “heat flash,” they ran the gamut from pleasurable scenes of youth and happiness, to demented and hostile visions of unseen things stalking him in the dark. His ravings drove the Wilson’s maid from the house in fear for her safety. The possibility exists that Wilson was suffering from Alzheimer’s, but that disease was largely unknown in those days. Rumor has it that at the very end of his life, Wilson angrily begged for a drink. Begged and was denied. Bill Wilson died of pneumonia on January 24th, 1971.

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Meetings for the week beginning Sept. 18-28

.La CrescentPrince of Peace Church Council: Thurs, Sept. 18, 7 pm, at the church.La Crescent Lions Club Board: Thurs, Sept. 18, Prince of Peace Church.Tri-State Two-Cylinder Club: Thurs, Sept. 18, 7:30 pm, La Crescent Community Bldg.La Crescent Cub Scout Pack #98: Thurs, Sept. 18, 6:30 pm, American Legion clubroom.La Crescent Healthy Community Partnership Board: Thurs, Sept. 18, 8:30-11 am, Kistler Memorial Park.La Crescent City Council: Mon, Sept. 22, 5:30 pm, city hall.La Crescent City Council Public Hearing: Mon, Sept. 22, 6 pm, Council Chambers, City Hall. Re: Vacating segments of Sycamore & Lancaster streets.Gopher State Sportsman’s Club: Thurs, Sept. 25, 7 pm, clubroom, Sportsman Valley Rd.Alcoholics Anonymous: every Thursday, 7 pm at Fitzgerald Center, 1380 Lancer Blvd., 895-6666.La Crescent Rotary Club: every Friday, 7 am at American Legion.FFF Dancing: every Monday, 10-10:30 am at Kistler Park, Healthy Community Partnership building. For all adults, 895-5150.Chapter Club with Mr. Petersilie: every Wednesday, 4-5 pm, Public Library.Faithfully Fit Forever: every Wednesday, 10-11 am at Kistler Park, Healthy Community Partnership building. For all adults, exercise group. 895-5150.BrownsvilleBrownsville Fire Dept. & First Responders: Mon, Sept. 22, 7 pm, fire station.Brownsville Senior Citizens: every Tuesday, 12:30-3 pm cards, Community Center.HokahLazy Lopers 4-H Club: Mon, Sept. 22, 6:30 pm, Hokah City Hall.Senior Citizens: 1st and 3rd Wednesdays, 1 pm, Fire Station meeting room.Alcoholics Anonymous: every Sunday, 7 pm, St. Peter Church, upstairs library.NodineNo meetings reported.Dresbach/DakotaDakota Area Community School: Sun, Sept. 21, 6 pm, at the school.Dakota Senior Citizens: Wed, Sept. 24, noon potluck, Community Center.HoustonHouston Chamber of Commerce: Thurs, Sept. 18, 6 pm, Houston Nature Center.Friends of Houston Public Library: Tues, Sept. 23, 7 pm, library.Friends of the Houston Nature Center: Wed, Sept. 24, 7 pm, Nature Center.Houston Public Library Board: Thurs, Sept. 25, 5:30 pm, library.Houston CountyHouston County Board of Adjustment: Thurs, Sept. 25, 7 pm, Commissioner’s Room, Courthouse, Caledonia.Houston County Planning Commission: Thurs, Sept. 25, 7:30 pm, Commissioner’s Room, Courthouse, Caledonia.Houston County Board of Commissioners: the first four Tuesdays of the month, 9 am. Standing committees meet at 8:30 am. Commissioner’s Room, Courthouse, Caledonia.Winona CountyWinona County Board of Adjustment: Thurs, Sept. 18, 1 pm, Government Center, 177 Main St., Winona.Winona County Planning Commission: Thurs, Sept. 18, 7 pm, Government Center, 177 Main St., Winona.Winona County Board of Commissioners: 1st and 2nd Tuesdays of month, 9 am; 4th Tuesday 7 pm, Winona County Government Center, 177 Main St., Winona.OtherSE MN Historic Bluff Country Board: Thurs, Sept. 18, 5:30 pm, Harmony Visitor Center.SE MN Area Agency on Aging (SEMAAA): Wed, Sept. 24, 9:30 am, Rochester Public Utilities, 4000 NE East River Rd., Rochester.Depressed Anonymous: every Monday, 5:30-6:30 pm at Franciscan Spirituality Center, La Crosse. 608-791-5295.

an intense feeling of pleasure known as a "high." Cocaine physical side effects that accompany that high, combined with the powerful psychological dependence it creates, makes it an extremely dangerous drug to take. As a very powerful stimulant, cocaine not only gives users more energy, it makes them feel confident and even euphoric, meaning they are extremely elated or happy, usually for no reason. This feeling of elation and power makes users believe they can do anything, yet when this high wears off, they usually feel upset, depressed, tired, and even paranoid. Cocaine has a very interesting history: It has gone from being considered a mild stimulant and then a wonder drug, to a harmless "recreational" drug, and finally to a powerfully addictive and very dangerous illegal drug. Although cocaine has, in fact, been all of these things at one time or another, we know it today to be an addictive drug that can wreck a person physically, mentally, and socially. It can also easily kill people.
Cocaine is extracted from the leaves of the coca shrub (Erythroxylum coca), which grows in the tropical forests on the slopes of the Andes Mountains of Peru. A second species, Erythroxylum novagranatense, grows naturally in the drier mountainous regions of Columbia. For thousands of years, the native populations of those areas chewed the leaves of these plants to help them cope with the difficulty of living at such a high altitude. Chewing raw coca leaves (usually combined with ashes or lime) reduced their fatigue and suppressed their hunger, making them better able to handle the hard work they had to do to live so high up in the mountains. The coca leaves were also used during religious ceremonies and for rituals such as burials. The feelings that the leaves gave to their chewers made them consider the coca plant to be a gift from the gods.
Once European explorers started coming to the Americas in the late fifteenth century, it was only a matter of time until invaders, such as the Spanish, came to the New World seeking riches. By the time the Spanish arrived in what is now Peru, the people of that land, known as the Incas, were already a civilization in decline, and they were easily subdued and conquered. The Spaniards eventually learned that giving coca leaves to native workers enabled them to force the workers to do enormous amounts of work in the gold and silver mines that were located in high altitudes. For the next two hundred years, although some coca plants were taken back to Europe, they were not popular or well-known since they did not travel well and were useless if dried out. Further, the Europeans did not like all the chewing and spitting required to get at the plant's active ingredient, and until this part of the plant could be isolated, coca leaves were not very much in demand.
All of this changed by the middle of the nineteenth century when German physician Albert Niemann perfected the process of isolating the active part of the drug and improved the process of making it. Niemann extracted a purified form of cocaine from the coca leaves, and wrote about the anesthetic or numbing feeling obtained when he put it on his tongue. Cocaine then began its inevitable introduction into medicine, drink, and finally drug abuse. First it was considered by many doctors to be a wonder drug, and they began prescribing it for all sorts of physical and mental problems. By the 1880s, cocaine was even added to a very popular "medicinal" wine called Vin Mariani. The famous Austrian physician Sigmund Freud, who would become the founder of psychoanalysis, published a paper in 1884 that made many wrong medical claims for cocaine. Although he would later withdraw his claims, Freud did write at the time, "The use of coca in moderation is more likely to promote health than to impair it."
In 1888, a soft drink named "Coca-Cola" was developed in America that contained cocaine and advertised itself as "the drink that relieves exhaustion." By 1908, however, the makers of Coca-Cola realized their mistake and removed all the cocaine from it, using only caffeine as a stimulant. By then, the initial enthusiasm for cocaine was seen to be undeserved, and many cases of overuse and dependence eventually forced lawmakers to take action against it. Consequently, in 1914 the United States introduced the Harrison Narcotic Act, which made cocaine illegal. After that, cocaine use was popular only with a fairly small number of artists, musicians, and the very rich, until the 1970s. In that decade, cocaine use skyrocketed as many young people who had earlier smoked marijuana took to cocaine as a drug they believed had no side effects, was safe, and was not addictive.
All of these beliefs were eventually seen to be terribly untrue, as a cocaine epidemic in the 1980s claimed many lives, such as that of comedian John Belushi, and wrecked numerous other lives, such as that of the comedian Richard Pryor. Once it is understood what happens to a person's nervous system when he or she ingests or takes in cocaine, it is not surprising that the results are often bad and sometimes tragic. The cocaine sold on the streets is usually a white crystalline powder or an off-white chunky material. It is usually diluted with other substances, like sugar, and is introduced into a person's body by sniffing, swallowing, or injecting it. Most people "snort" the powder or inhale it through their nose, since any of the body's mucous membranes will absorb it into the bloodstream. Injecting the drug means that it must first be turned into a liquid. Both ways create an immediate effect. Smoking "crack" cocaine delivers a more potent high, since crack is distilled cocaine. In its "rock" form it cannot be snorted, but is smoked in pipes. The name "crack" comes from the crackling sound these rock crystals make when heated and burned.
However the active part of the drug gets into the body, it delivers the same effect to the person's central nervous system, depending on the amount taken and the user's past drug experience. Usually within seconds, it travels to the brain and produces a sort of overall anesthetic effect because it interferes with the transmission of information from one nerve cell to another. Since this interference is going on within the reward centers of the brain, the user experiences a fairly short-term high that is extremely pleasurable. Physically, the user's heart is racing, and his blood pressure, respiration, and body temperature also increase. The user feels temporarily more alert and energetic. The problem is that these feelings do not last very long, and the user must do more cocaine to recapture them.
In tests with experimental animals, cocaine is the only drug that the animals will repeatedly and continuously demand on their own to the point of killing themselves. Although cocaine is not physically addictive the way heroin is (meaning that the user physically craves the drug and suffers withdrawal when off it), it nonetheless creates a profound psychological dependence in which the mind craves the ecstasy that comes with the drug. Further, since the user experiences fatigue and depression when he or she stops, there is little reason to want to quit. Over time, these cravings get stronger and stronger, and the user can only think of how to get another "hit." This obviously makes them unable to live a normal life without the drug, which has by now taken over their lives.
Severe and heavy overuse can make the abuser suffer dizziness, headache, anxiety, insomnia, depression, hallucinations, and have problems moving about. The increase in blood pressure can cause bleeding in the brain as well as breathing problems, both of which have killed many a user. Often, even physically fit people like Len Bias, the All-American basketball star from the University of Maryland, can suddenly die from ingesting cocaine. The medical risks associated with this drug are great, especially since there is no antidote for an overdose. Taking cocaine also has legal consequences, and besides the disorder and dysfunction it brings to a person's life, it can also land them in jail. Many American schools also have a zero-tolerance policy, as do many companies and other organizations. Overall, despite the glamour that some people see in the drug, the disadvantages far outweigh the temporary advantages, and rather than improving a person's life, it can only do the opposite.

Like a gaunt prospector, belt drawn in over the last ounce of food, our pick struck gold. Joy at our release from a lifetime of frustration knew no bounds. Father feels he has struck something better than gold. For a time he may try to hug the new treasure to himself. He may not see at once that he has barely scratched a limitless lode which will pay dividends only if he mines it for the rest of his life and insist on giving away the entire product. Alcoholics Anonymous Pages 128 & 129ÂWhen I talk with a newcomer to A.A., my past looks me straight in the face. I see the pain in those hopeful eyes, I extend my hand, and then the miracle happens: I become healed. My problems vanish as I reach out to this trembling soul.

Ten—Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy.

10.—No A.A. group or member should ever, in such a way as to implicate A.A., express any opinion on outside controversial issues—particularly those of politics, alcohol reform, or sectarian religion. The Alcoholics Anonymous groups oppose no one. Concerning such matters they can express no views whatever.

Nowhere in the Big Book of Alcoholics Anonymous are the words “outside issues” further mentioned together in the same context other than in our tenth tradition; yet, this remains one of the largest arguments or separations of empathy among many a recovering alcoholic, cross-addicted or otherwise. The *article below and its implications of, or to, our churches separation from state and the suggested treatments rendered to an alcoholic in the court system today should be our foremost personal battle of concern. Confusion arises at the religious or spiritual definition of a power greater than ourselves again. Condemners of AA have either call it a cult, or a religious program and cannot understand a spiritual program in the sense we have found. Continued pressures from the “non-believing” clinical sector are trying to take the soul from recovery into their own hands by administering “alternative” recourse to addiction. I would be willing to bet that a very low percentage, if any, of these clinics are comprised of recovering alcoholics as administers. Where do they get there internship/experience from? I personally never experienced any recovery from alcoholism through any of the doctors or psychologist trying to teach me this. Additional guidance of this variety I can see of great value, but taking AA completely out of the remedy is just plain scary. I suppose this goes back to “AA should never be organized” and this is case in point. AA will survive and “be there” just as the people wanting and needing its help will always be there, they will just have to seek it as we all have to seek our recovery on a daily basis leaving outside issues as just that, outside.
Thanks for being there I say.
BonesXXX

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Monday, 22 September 2008

Treatment Staff Referrals, Participation Expectations, and Perceived Benefits and Barriers to Adolescent Involvement in Twelve-Step Groups

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