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 51336 countries, with a probable membership of 250,000. According to the NAWorld Service Office, which publishes NA literature and centralizes informationwithin NA, the growth rate of the organization’s membership has been 30–40% a year (Wells, 1987). The growth of NA and other 12-2tep programs demonstratesthe organizational strength and appeal of the AA model.How 12-Step Programs WorkParticipation in a 12-step program can start at the moment the addict meets amember of an organization, reads its literature, or simply attends meetings (e.g.,an open meeting or an institutional meeting run by AA or NA speakers)(Galanter, 1989). A desire to stop drinking and/or abusing other drugs is theonly requirement for membership. Total abstinence becomes a goal from theoutset of the participation in the fellowship. Initial participation turns into aninduction period, which, in the case of AA, for instance, lasts 90 days andencourages daily attendance at meetings. The member is exposed to the 12-stepapproach to recovery; the first step consists of admitting powerlessness over theaddiction, and consequently breaking with denial. Seeking sponsorship fromanother member who has been sober for months (preferably more than a year)is also encouraged. Sponsors are usually of the same sex if the group is largeenough, so that emotional entanglements can be avoided to keep from distractingmembers from the purpose of attaining and maintaining sobriety. Openmeetings usually consist of talks by a leader and two or three speakers who sharetheir experiences of how the 12-step program related to their recovery.The 12-step program is an attempt to effect changes in addicts’ lives thatgo beyond just stopping the use of substances—changes in personal values andinterpersonal behavior, as well as continued participation in the fellowship.The 12 steps are studied and followed with the guidance of a sponsor and participationin meetings focused on each step. Each step involves changes inbehavior and attitudes that may profoundly affect the addict’s life. To achievethe ninth step, for instance, the addict makes amends to people formerlyharmed by his or her behavior. These amends may result in changes in the waythe person relates to others and interprets the problems that have affected pastand present relationships. For instance, an alcoholic man may “talk” to adeceased father whom he formerly hated and attempt a “conciliation” with hisimage of his dead father. The 12th step encourages propagation of the group’sphilosophy and consequently fosters the individual’s recovery by providingopportunities to others to recover and expand the fellowship.Traditionally, 12-step meetings are open to all members, but they may bedirected to special-interest groups (e.g., gays, women, minority groups, and physicians).Meetings can be of different types, such as discussions, 12-step study,and testimonials; some may be open to nonmembers, and others may be formembers only. If the recovery progresses, the member will learn strategies to