COUC 691 Week 4 DB Forum 2 (AA) Example

Discussion Board Forum 2 (AA): Thread and Two Replies

COUC 691 Substance Abuse: Diagnosis, Treatment and Prevention, Discussion Board Forum 2, AA (thread and two replies)

Thread by [Student Name]

The prompt, the writer's observations and the classmates' posts are composites standing in for the course's own forum, and no AA member is described in identifying detail; the textbooks, Scripture and published studies are real; COUC 691 shares its course guide with CEFS 691, and the requirements follow that public guide.

Thread

After the Tuesday step meeting I attended for our first paper, I expected people to leave. Instead, a dozen members stood in the parking lot for almost an hour, talking about jobs, children and a softball game that weekend. One man was being given a ride to work for the week. Someone told a newcomer which coffee shop the group used after Saturday meetings. It looked less like a treatment program and more like a neighborhood, and I began to wonder whether that was the point. Inside, the meeting had been about the fourth step; outside, it was about rides, jobs and Saturday plans. For a newcomer whose old friends all drink, the second conversation may matter as much as the first.

Research suggests it may be. Litt et al. (2009) tested whether treatment could help clients change a social network that supports drinking into one that supports sobriety. They randomly assigned 210 alcohol-dependent adults to network support, network support plus contingency management, or case management. Two years after treatment, the network support condition produced up to 20% more days abstinent than the others, along with greater increases in network support for abstinence, AA attendance and AA involvement. Changes in the network were accompanied by gains in self-efficacy and coping, which in turn strongly predicted long-term drinking outcomes.

If recovery depends partly on who a person spends Friday night with, then counseling has to ask about that, not only about cravings and triggers. Miller and Rollnick (2013) describe evoking a client's own reasons for change, and a question such as "Who in your life would be glad to see you sober?" can open that conversation. It may also uncover the opposite: friends, relatives or coworkers whose lives are built around drinking. Capuzzi and Stauffer (2016) treat family and social context as central to treatment planning, and the parking lot showed me what a new context can look like. For my own clients at the recovery residence, I now plan to map their networks on paper during intake, marking who drinks, who supports sobriety and who could be asked for help, and to revisit that map as they attend meetings.

Hebrews 10:24-25 calls believers to stir one another toward love and good works and not to give up meeting together (English Standard Version Bible, 2001/2016). The members I watched were living out a version of that call.

Classmates: what did you see at your meetings that suggested how members support one another outside the room?

Reply to Jasmine

Jasmine, you raised an honest concern: several clients at your internship site are atheists or simply uncomfortable with talk of God, and you wondered whether referring them to AA sets them up to fail. I heard similar language at both of my meetings, along with one member who said the group itself was his higher power, so I share the question. It is a real concern, and some clients will leave a meeting feeling preached at.

Kelly et al. (2006) offer some reassurance. They followed 227 alcohol-dependent outpatients for three years after intensive outpatient treatment, testing whether mutual-help participation in one year predicted outcomes in the next. Participation was linked with more abstinence and fewer drinks per drinking day, and that relationship did not depend on religious preference, gender, psychiatric diagnosis or prior mutual-help experience. Most participants attended AA, so the finding speaks directly to the program your clients would be offered. The study also found that even small amounts of participation helped with abstinence, while higher doses seemed necessary to reduce the intensity of relapses.

That suggests we can present AA to nonreligious clients honestly, as a group many people with varied beliefs find useful, while also offering alternatives such as secular mutual-help groups or a different AA meeting with a less religious tone, since groups vary widely. Could you see yourself walking a client through how to approach the spiritual language before a first meeting?

Reply to Daniel

Daniel, you described a resident at your agency who went to AA every day for two months and then drank after his father's funeral, and you asked whether that means the program did not work for him. I understand the discouragement, but I think the relapse research gives us a better way to see it.

Witkiewitz and Marlatt (2004) review evidence for relapse prevention and propose a reconceptualized cognitive behavioral model in which relapse emerges from dynamic interactions among risk factors and the situation of the moment. Background factors, such as years of drinking, family history and coping style, combine with immediate ones, such as grief, a craving, a drink offered at the reception and the absence of usual supports. In that model, a small change in one factor can tip a person toward or away from drinking.

Seen that way, the resident's two months of meetings were not wasted; they may be part of why he called someone afterward instead of drinking for a week. The funeral combined high stress with a break in his routine. A counselor could help him map that situation and plan for the next high-risk event, such as the anniversary of the death or the holidays. The relapse also gives his sponsor and his counselor important information about which supports need strengthening. What supports do you think he lacked that day, and which of them could be arranged before the next anniversary?

References

Capuzzi, D., & Stauffer, M. D. (2016). Foundations of addictions counseling (3rd ed.). Pearson.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Kelly, J. F., Stout, R., Zywiak, W., & Schneider, R. (2006). A 3-year study of addiction mutual-help group participation following intensive outpatient treatment. Alcoholism: Clinical and Experimental Research, 30(8), 1381-1392. https://doi.org/10.1111/j.1530-0277.2006.00165.x

Litt, M. D., Kadden, R. M., Kabela-Cormier, E., & Petry, N. M. (2009). Changing network support for drinking: Network Support Project 2-year follow-up. Journal of Consulting and Clinical Psychology, 77(2), 229-242. https://doi.org/10.1037/a0015252

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.

Witkiewitz, K., & Marlatt, G. A. (2004). Relapse prevention for alcohol and drug problems: That was Zen, this is Tao. American Psychologist, 59(4), 224-235. https://doi.org/10.1037/0003-066X.59.4.224