Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

23. Group Therapy, Self-Help Groups, and Network Therapy 511SELF-HELP, 12-STEP GROUPS, AND 12-STEP FACILITATIONRole of Self-Help Groups in Addiction TreatmentSelf-help groups represent a widely available resource for the treatment of alcoholism,as well as other forms of chemical dependence. AA and other 12-steporganizations such as NA and Cocaine Anonymous (CA) have not only provideda large population of addicts with support and guidance but also havecontributed conceptually to the field of understanding and treating substanceabuse. However, important questions for the clinician and the researcher needto be answered before the proper role of 12-step programs in the treatment ofaddicts can be established. In what ways are such self-help programs compatiblewith professional care? In what ways do these groups achieve their effects? Forwhich patients are they most useful? Familiarity with self-help groups is essentialboth for the clinician providing care for substance abusers and for theresearcher attempting to understand psychosocial factors involved in the outcomeof addictions.History of Self-Help ProgramsSelf-help groups can be understood as a grassroots response to a perceived needfor services and support (Levy, 1976; Tracy & Gussow, 1976). In this sense, AAis the prototypical organization; it provided a model for the other successfulgroups such as NA and CA, as well as for its more closely related offspring suchas Al-Anon, Alateen, and Children of Alcoholics. Levy (1976) proposed arough division of self-help groups in two types of organizations: type I groups,which are truly mutual help organizations and include all 12-step programs, andtype II groups, which more frequently operate as foundations and place moreemphasis on promoting biomedical research, fundraising, public education, andlegislative and lobbying activities. Type I and type II groups are by no meanstotally exclusive, because type I associations promote public education, andtype II groups sometimes provide direct services.The development of AA has exerted a major influence on the self-helpmovement in general. The next section is concerned only with the developmentof AA and related 12-step programs for addictions, which are clearlydefined as type I associations.Origins and Growth of Alcoholics AnonymousAA’s principal founder, “Bill W,” in accordance with the AA tradition of anonymity,was himself an alcoholic. Bill was spiritually influenced by a drinkingfriend, Edwin Thatcher, who belonged to the Oxford Group, an evangelical religioussect (Kurtz, 1982). Thatcher, usually referred to as Ebby, attributed hisabstinence to his involvement with the Oxford Group, which displayed many of