418 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
involve health professionals. Alcoholics Anonymous
(AA) was founded in the 1930s by alcoholics. This self-
help group developed the 12-step programmodel for
recovery (Box 17-3), which is based on the philosophy
that total abstinence is essential and that alcoholics
need the help and support of others to maintain so-
briety. Key slogans reflect the ideas in the 12 steps
such as “one day at a time” (approach sobriety one day
at a time), “easy does it” (don’t get frenzied about
daily life and problems), and “let go and let God” (turn
your life over to a higher power). Each new member
has a sponsor who helps him or her. Once sober, a
member can be a sponsor for another person.
Regular attendance at meetings is emphasized.
Meetings are available daily in large cities and at least
weekly in smaller towns or rural areas. AA meetings
may be “closed” (only those who are pursuing recovery
can attend) or “open” (anyone can attend). Meetings
may be educational with a featured speaker; other
meetings simply offer the opportunity for members to
relate their battles with alcohol and to ask the others
for help staying sober.
Many treatment programs, regardless of setting,
use the 12-step approach and emphasize participation
in AA. They also include individual counseling and a
wide variety of groups. Group experiences involve
education about substances and their use, problem-
solving techniques, and cognitive techniques to iden-
tify and to modify faulty ways of thinking. An overall
theme is coping with life, stress, and other people
without the use of substances.
Although traditional treatment programs and
AA have been successful for many people, they are
not effective for everyone. Some object to the empha-
sis on God and spirituality; others do not respond well
to the confrontational approach and to being labeled
an alcoholic or an addict. Women and minorities have
reported feeling overlooked or ignored by an essen-
tially “white, male, middle-class” organization. Treat-
ment programs have developed to meet these needs
such as Women for Sobriety (exclusively for women)
and Rational Recovery (treatment program that does
not include AA or its tenets). Self-help support groups
exist for gay, lesbian, and non-Christian members.
The 12-step concept of recovery has been used for
other drugs as well. Such groups include Narcotics
Anonymous; Al-Anon, a support group for spouses,
partners, and friends of alcoholics; and AlaTeen, a
group for children of parents with substance prob-
lems. This same model has been used in self-help
groups for people with gambling problems and eating
disorders. National addresses for these groups are
listed in Box 17-4.Treatment Settings and Programs
Clients being treated for intoxication and withdrawal
or detoxification are encountered in a wide variety of
medical settings from the emergency department to
the outpatient clinic. Clients needing medically su-
pervised detoxification often are treated on medical
units in the hospital setting and then referred to an
appropriate outpatient treatment setting when they
are medically stable.
Health professionals provide extended or outpa-
tient treatment in various settings including clinics
or centers offering day and evening programs, half-
way houses, residential settings, or special chemical
dependency units in hospitals. Generally the type of
treatment setting selected is based on the client’s
needs as well as his or her insurance coverage. For ex-
ample, for someone who has limited insurance cover-
age, is working, and has a supportive family, the out-
patient setting may be chosen first because it is lessBox 17-3
➤ TWELVESTEPS OFALCOHOLICSANONYMOUS
- We admitted that we were powerless over alcohol, that our lives had become unmanageable.
- Came to believe that a Power greater than ourselves could restore us to sanity.
- Made a decision to turn our wills and lives over to the care of God as we understood Him.
- Made a searching and fearless moral inventory of ourselves.
- Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
- Were entirely ready to have God remove all these defects of character.
- Humbly asked Him to remove our shortcomings.
- Made a list of all persons we had harmed, and became willing to make amends to them all.
- Made direct amends to such people whenever possible, except when to do so would injure them or others.
- Continued to take personal inventory and when we were wrong promptly admitted it.
- Sought through prayer and meditation to improve our conscious contact with God as we understood Him,
praying only for knowledge of His will for us and the power to carry that out. - Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics and
to practice these principles in all our affairs.