The twelve-step recovery model of Alcoholics Anonymous

AA logo 2 The twelve-step recovery model of AA: a voluntary mutual help association

Alcoholism treatment has evolved to mean professionalized, scientifically based rehabilitation.

Alcoholics Anonymous (AA) is not a treatment method; it is far better understood as a Twelve-Step Recovery Program within a voluntary self-help/mutual aid organization of self-defined alcoholics.

The Twelve-Step Recovery Model is elaborated in three sections, patterned on the AA logo (a triangle within a circle): The triangle’s legs represent recovery, service, and unity;

  • The circle represents the reinforcing effect of the three legs upon each other as well as the "technology" of the sharing circle and the fellowship.
  • The first leg of the triangle, recovery, refers to the journey of individuals to abstinence and a new "way of living."
  • The second leg, service, refers to helping other alcoholics which also connects the participants into a fellowship.
  • The third leg, unity, refers to the fellowship of recovering alcoholics, their groups, and organizations.

The distinctive AA organizational structure of an inverted pyramid is one in which the members in autonomous local groups direct input to the national service bodies creating a democratic, egalitarian organization maximizing recovery.

Analysts describe the AA recovery program as complex, implicitly grounded in sound psychological principles, and more sophisticated than is typically understood.

AA provides a nonmedicalized and anonymous "way of living" in the community and should probably be referred to as the Twelve-Step/Twelve Tradition Recovery Model in order to clearly differentiate it from professionally based twelve-step treatments.

From; Borkman T. The twelve-step recovery model of AA: a voluntary mutual help association. Recent Dev Alcohol. 2008;18:9-35.

See also;

Alcohol Guidance for UK Doctors

Doctor drink mug of coffee in her office uid 1271749 UK Guidance for GP alcohol Directed Enhanced Service

A United Kingdom guidance document has been released to support the delivery of clinical directed enhanced services, alcohol being one of the five key health and service priorities.

The DES allows specific funding for GP’s to deliver Screening and Brief Interventions (SBIs) to newly registered patients. The DES’s began in April 2008 and are scheduled to run for 2 years backed by UK£50 million funding proposed earlier in the year, with an annual UK£8 million alcohol allocation.

According to the guidance, practices are required to screen newly registered patients using a shortened screening tool such as FAST. Those identified as positive will be given the full AUDIT test to determine if they are drinking at hazardous or harmful levels, and then offered the recommended intervention of 5 minutes brief advice in line with University of Newcastle’s primary care guidance ‘How Much is too much?’.

Dependant drinkers should be referred to local treatment services.

Full story at Alcohol Policy UK.

See also;

10 Steps to Happiness

Happiness is; Small waterfall into stream Ten Keys to Happiness By Deepak Chopra

Physical well being is inseparable from emotional well being. Happy people are healthy people. The wisdom traditions of the world tell us that happiness does not depend on what you have, but on who you are. Let’s take a moment to reflect on what really creates happiness in us.

The following ten keys, gleaned from the wisdom traditions, may give us some insight.

  1. Listen to your body’s wisdom, which expresses itself through signals of comfort and discomfort. When choosing a certain behavior, ask your body, ‘How do you feel about this?’ If your body sends a signal of physical or emotional distress, watch out. If your body sends a signal of comfort and eagerness, proceed.
  2. Live in the present, for it is the only moment you have. Keep your attention on what is here and now; look for the fullness in every moment. Accept what comes to you totally and completely so that you can appreciate it, learn from it, and then let it go. The present is as it should be. It reflects infinite laws of Nature that have brought you this exact thought, this exact physical response. This moment is as it is because the universe is as it is. Don’t struggle against the infinite scheme of things; instead, be at one with it.
  3. Take time to be silent, to meditate, to quiet the internal dialogue. In moments of silence, realize that you are recontacting your source of pure awareness. Pay attention to your inner life so that you can be guided by intuition rather than externally imposed interpretations of what is or isn’t good for you.
  4. Relinquish your need for external approval. You alone are the judge of your worth, and your goal is to discover infinite worth in yourself, no matter what anyone else thinks. There is great freedom in this realization.
  5. When you find yourself reacting with anger or opposition to any person or circumstance, realize that you are only struggling with yourself. Putting up resistance is the response of defenses created by old hurts. When you relinquish this anger, you will be healing yourself and cooperating with the flow of the universe.
  6. Know that the world ‘out there’ reflects your reality ‘in here.’ The people you react to most strongly, whether with love or hate, are projections of your inner world. What you most hate is what you most deny in yourself. What you most love is what you most wish for in yourself. Use the mirror of relationships to guide your evolution. The goal is total self-knowledge. When you achieve that, what you most want will automatically be there, and what you most dislike will disappear.
  7. Shed the burden of judgment you will feel much lighter. Judgment imposes right and wrong on situations that just are. Everything can be understood and forgiven, but when you judge, you cut off understanding and shut down the process of learning to love. In judging others, you reflect your lack of self-acceptance. Remember that every person you forgive adds to your self love.
  8. Don’t contaminate your body with toxins, either through food, drink, or toxic emotions. Your body is more than a life-support system. It is the vehicle that will carry you on the journey of your evolution. The health of every cell directly contributes to your state of well being, because every cell is a point of awareness within the field of awareness that is you.
  9. Replace fear-motivated behavior with love-motivated behavior. Fear is the product of memory, which dwells in the past. Remembering what hurt us before, we direct our energies toward making certain that an old hurt will not repeat itself. But trying to impose the past on the present will never wipe out the threat of being hurt. That happens only when you find the security of your own being, which is love. Motivated by the truth inside you, you can face any threat because your inner strength is invulnerable to fear.
  10. Understand that the physical world is just a mirror of a deeper intelligence. Intelligence is the invisible organizer of all matter and energy, and since a portion of this intelligence resides in you, you share in the organizing power of the cosmos. Because you are inseparably linked to everything, you cannot afford to foul the planet’s air and water. But at a deeper level, you cannot afford to live with a toxic mind, because every thought makes an impression on the whole field of intelligence. Living in balance and purity is the highest good for you and the Earth.

Deepak Chopra

See also;

Do You Love an Alcoholic?

Alcoholic couple arguing on street There Is Help for Families and Friends of Alcoholics

Do you know, care about, or love someone who suffers from the disease of alcoholism? If the answer is yes, you are not alone. For every alcoholic out there, there can be dozens, perhaps hundreds of people who have been or are affected by his or her disease as well. Family members, relatives, friends, and co-workers can all suffer as a result of loving, caring about, or depending on the alcoholic in some way.

The good news is that there is help for us, too. While most people realize there are rehabilitation and 12-step programs available for those suffering from the disease, not everyone knows about the programs designed to help those suffering from the effects of alcoholism in a relative or friend. Among these is Al-Anon, which was adapted from the 12-step program of Alcoholics Anonymous (AA).

Al-Anon was founded in 1951 by two women who were married to alcoholics. One was the wife of Bill W. who co-founded AA. Today there are nearly 25,000 Al-Anon groups (of untold sizes) in 131 countries and its literature is translated into over 32 different languages. In its 2006 U.S. and Canada Member Survey, 94 percent of its members said they would definitely recommend Al-Anon to others and 81 percent said that their lives were “much improved” by attendance at Al-Anon meetings. Why is Al-Anon so popular?

The behaviors we develop as a way of coping with the disease of alcoholism in a loved one can ultimately threaten our own well-being. When we care about an alcoholic, our good intentions can lead to caretaking, sometimes called “enabling.” This detrimental process often results in our attempts to spare the alcoholic from having to face the consequences of his or her behaviors. Even though our actions come from a place of love or goodwill, they can in fact prevent the alcoholic from experiencing that which may ultimately lead to his or her decision to get help.

Full story at Anchor Web

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Parents Urged to Act on Underage Drinking

under age drinking The prestigious medical journal the Lancet urges parents to act on underage drinking

Parents should take the greatest share of responsibility for steering teenagers away from binge drinking, according to an editorial in the Lancet. It said underage drinking had risen substantially during the past 10 years, and nearly one-third of teenagers were now binge drinkers.

Early abuse of alcohol increased the risk of serious health problems for teenagers, with more falling prey to fatal accidents, self-harm, suicide, violent behaviour, unprotected sex, alcohol dependence and liver disease, the journal said. Learning to enjoy alcohol, in moderation, was “an important part of growing up” in many societies, but it was a lesson not being taught in the UK.

In Britain and Ireland, young people are drinking more than ever before – and often substantially more than in the US, France and Mediterranean countries. According to the Lancet, 27% of British 15-year-olds admit to having had at least five alcoholic drinks in a row in the past month, up from 22% in 1995, and 29% of teenage girls binge drink. Nearly half of the alcohol drunk by young people comes from the family home, with the rest from supermarkets, shops, off-licences and bars.

Full story at; the Guardian, UK.

8,000 Doctors in Addiction Treatment in USA

Rehab Programs for Doctors Face Scrutiny

Recent publicity has led to increased scrutiny of confidential, state-run rehabilitation programs for physicians, the Associated Press reported Dec. 19.

An estimated 8,000 doctors with addiction problems are enrolled in treatment programs; most states have them, and California’s medical board made headlines last year when it voted to abolish its physician-assistance program after a review found that it didn’t help doctors recover and could put patients at risk.

“Patients have no way to protect themselves from these doctors,”

said Julie Fellmeth, head of the University of San Diego’s Center for Public Interest Law and an opponent of the California program.

Supporters say that the programs need to be confidential to get doctors to participate, and that botched procedures involving doctors undergoing treatment are rare. In fact, critics have been unable to cite a single case where a participating doctor erred in the operating room, although detractors say the secrecy surrounding the rehab programs makes such investigations difficult. Some doctors who took part in addiction treatment programs have been involved in unethical or incompetent practices, but no causal link has been made to alcohol or drug problems.

Addiction experts worry that, without a confidential treatment program, doctors with addiction problems simply won’t get help, possibly putting more lives at risk.

Without the assurance of confidentiality, some say, addicted doctors will go underground and continue to practice without getting any treatment at all. “I was never intoxicated taking care of patients,” said Jason Giles, a California physician who grappled with addiction problems. “It didn’t get to that — but would have if I didn’t avail myself of that rope dropped from the helicopter,” he said, referring to the confidential treatment program that helped him get sober. 

From; Join Together Online

See also; The loneliness of an alcoholic doctor

Recognizing Co-Dependency


Alcoholism may be a disease of isolation, but it is rarely an individual problem.

Understanding how “enabling” works is the first step in helping both the alcoholic and the co-dependent seek help.

Enabling is any action by another person or an institution that intentionally or unintentionally has the effect of facilitating the continuation of an individual’s addictive process.

Who Is An Enabler?

  • Most often, enablers are persons who genuinely care about the alcoholic — family, friends, co-workers, clergy.
  • Their love and concern, unfortunately, often leads them to do things that actually help the alcoholic stay that way.
  • They “cover” for the alcoholic, inventing excuses for absenteeism, tardiness, or inappropriate behavior.
  • They “save” the alcoholic by taking on the alcoholic’s responsibilities or sharing in the denial of the problem.

Yet, in their attempts to “help,” they are in fact encouraging alcoholic behavior by shielding the alcoholic from the consequences of his or her drinking.

Games Enablers Play

There are Many Ways to Enable an Alcoholic

As the saying goes, you are not the cause of someone else’s drinking problem, you cannot cure it and you can’t control it.

But there are ways that you may be contributing to the problem.

Before placing the blame for all the problems in your family or your relationship on his (or her) drinking, it might be wise to examine how the other person’s drinking may have affected you, and how you have reacted to it. For example, does the following statement sound familiar?

I don’t have a problem with my drinking! The only problem is your attitude. If you would quit complaining about it, there wouldn’t be a problem!

Well, obviously that statement is not completely accurate; after all denial of the problem is one of the more frustrating parts of the problem. On the other hand the statement may not be completely false either.

How do you react to the alcoholic’s drinking? Could your reaction be a part of the overall problem? Have you fallen into “role playing” in the family? Is there anything that you can do to improve the situation?

The following describes an incident that could be an example of alcoholic behavoir, and some examples of reactions to the incident. Does any of these sound familiar?

The alcoholic comes home late and he is drunk, too drunk in fact to get the key into the front door lock. After several futile attempts, he decides that it is a lost cause. Since he does not want anyone in the house to know that he is too drunk to unlock his own door, he makes a brilliant decision that solves his problem. He goes to sleep in the front yard!

How would you react?

The Rescuer

The “rescuer” doesn’t let the incident become a “problem.” Since she has been waiting up for him anyway, she goes out in the yard, gets the alcoholic up, cleans him up, and puts him into bed. That way the neighbors never see him passed out in the flower bed!

She never mentions the incident to him or anybody else. If anyone else mentions it, she denies there is a problem. She lies for him, covers up for his mistakes, and protects him from the world.

As the problems increase and his drinking gets worse, she takes on responsibilities that were once his. She may get a job or work extra hours to pay the bills. And if he gets in trouble with the law, she will move heaven and earth to come up with his bail.

The Provoker

The “provoker” reacts by punishing the drunk for his actions. She either waits for him to wake up the next morning and gives it to him with both barrels, or she goes out and turns the water sprinklers on!

She scolds, ridicules, and belittles. She nags. She screams insults at him loud enough for everyone to hear. She gets on the telephone and tells all her friends he’s a loser. She is angry and she makes sure that the alcoholic and everybody else knows it. Or she gives him the cold shoulder and doesn’t speak to him. She threatens to leave.

She doesn’t let it go, either. The anger and resentment continue to build as these incidents become more frequent. She never lets him forget his transgressions. She holds it against him and uses it as a weapon in future arguments — even months or years later.

The Martyr

The “martyr” is ashamed of the alcoholic’s behavoir and she lets him know it by her actions or words. She cries and tells him, “You’ve embarrassed us again in front of the whole neighborhood!”

She sulks, pouts, and isolates. She gets on the telephone with her friends and tearfully describes the misery that he has caused her this time! Or she is so ashamed of it she avoids her friends and any mention of the incident.

Slowly she becomes more withdrawn and depressed. She may not say much about it to the alcoholic, but she lets him know with her actions that she is ashamed of him. Quietly she tries to make him feel guilty for his behavoir.

Which is the Enabler?

The above examples may be somewhat of an exaggeration, but then again they may be very typical of what goes on in an alcoholic home. The “roles” the nonalcoholic spouse plays in the family may not be as well defined, as they are outlined here. Depending upon the circumstances, the spouse may fall into one of these roles, or may switch back and forth between them all.

So which of the spouses described above is an enabler? Which one is actually helping the alcoholic progress in his disease? Which one, although they are trying to make things better, are actually contributing to the problem?

All of them.

Al-Anon may be of help for you

New Life for Families of Alcoholics

Al-Anon offers new life to families of alcoholics

Alcoholism touched every aspect of Brenda’s family life. She lost a father to alcoholism, and her brother developed the disease. She also married a problem drinker. They had a large family, and her husband left the job of parenting to her.

"I had out-of-control children at home," she says. "There was no structure–no rules, no bedtime schedules. It was just chaos." Brenda tried to structure the household but found that she couldn’t do it alone. Some of her children developed behavior problems at school and eventually abused alcohol themselves.

For nearly a decade, Brenda searched for support. She went to parent meetings at school. She went to marriage counseling. She went to churches and Bible study groups. Finally, a therapist suggested Al-Anon.

"I remember listening to people at my very first Al-Anon meeting and thinking, this is where I belong," Brenda recalls. "The stories I was hearing there were about the very kinds of things happening in my life."

Al-Anon offers free and confidential support for anyone affected by an alcoholic or problem drinker. This includes parents, grandparents, spouses, partners, coworkers, and friends. Alateen, a part of Al-Anon, is a recovery program for young people impacted by a loved one’s alcoholism.

Founded in 1951 by the wives of two Alcoholics Anonymous members, Al-Anon is based on AA’s Twelve Steps. There are no dues and no fees. Rather than relying on mental health professionals, members lead self-help meetings in a spirit of mutual help. The purpose is to share their hope, strength, and experience in dealing with an alcoholic loved one.

It works. Today more than 26,000 Al-Anon groups exist in 115 countries.

Al-Anon begins with the principle that alcoholism is a family disease. And those who care most about the alcoholic are affected the most.

Al-Anon literature compares life with an alcoholic to a drama where people develop stereotyped, almost scripted, roles. Their behaviors center on the alcoholic and are dominated by:

Obsession–going to great lengths to stop the alcoholic’s drinking, such as searching the house for hidden stashes of liquor, secretly pouring drinks down the drain, or listening continually for the sound of opening beer cans.

  • Anxiety–worrying constantly about the effects of the alcoholic’s drinking on the children, the bills, and the family’s future.
  • Anger–feelings of resentment that result from being repeatedly deceived and hurt by the alcoholic.
  • Denial–ignoring, making excuses for, or actively hiding the facts about the alcoholic’s behavior.
  • Guilt–family members’ belief that they are somehow to blame for the alcoholic’s behavior.
  • Insanity–defined in Al-Anon as "doing the same thing over and over and expecting different results."

With help from their peers, Al-Anon members learn an alternative–detachment with love. This happens when family members admit that they did not cause their loved one’s alcoholism; nor can they control or cure it. Sanity returns to family life when members focus on taking care of themselves, changing the things that they can, and letting go of the rest.

As a result, alcoholic family members are no longer shielded from the consequences of their own behavior. This, more than anything else, can help them face the facts about their addiction and admit their need for help.

"Since I’ve been in Al-Anon, my life has totally changed," says Brenda. "I filed for divorce and set up my own household. Now my children are getting a lot more of their needs met with a lot more stability in their lives, and I’m a much happier parent. Since I moved out, my son has been on the honor roll at school and my daughter has had the best two years of her life."

To learn more about Al-Anon go online to, or send an e-mail message to A basic text, "How Al-Anon Works for Families and Friends of Alcoholics," explains the Al-Anon program in detail.

Alive & Free is a health column that provides information to help prevent substance abuse problems and address such problems. It is created by Hazelden, a nonprofit agency based in Center City, Minn., that offers a wide range of information and services on addiction.

Addiction in the Family

Addiction is a complex issue. It affects every member of the family and can have a lasting impact on their lives. The effect on family members varies from person to person and family to family.

How Does an Addiction Develop?

Addiction is a process rather than an event. In the beginning, people often don’t experience any difficulties. As their use continues, they may begin to focus more on the alcohol, drugs or gambling than they do on the other areas of their lives. This process is often influenced by a number of factors, including the culture they live in, life events, their biological makeup and their relationships with family and friends.

Researchers have looked at genetics, environment, and the combination of these two to explain how dependence develops. Right now, it’s believed that some people are genetically susceptible to becoming dependent. But this by itself is not enough to develop an addiction. A person’s life circumstances play an important role in determining whether or not a person becomes dependent.

How Does an Addiction Affect the Family?

When a family member has a dependency, the whole family usually develops ways of coping with the problems associated with the dependency. Often, there is less communication: the family avoids talking about the issue, avoids expressing emotions, and may keep the addiction secret from the community. Some family members may take on some of the responsibilities abandoned by the addicted person.

While these coping strategies may help the family to operate more smoothly and get along better, they may also allow the dependency to continue. Unfortunately, family members may also use alcohol, drugs or gambling themselves as a way of coping with the problems in their family.

Members of an addicted family often experience loneliness, frustration, fear, anger and shame. They may also feel a sense of hopelessness about the situation. It’s important for them to realize that the addiction is not their fault. Often, seeking outside help from a support group or professional counselor can help them cope with what is going on in their family.

How Does an Addiction Affect the Children?

Addiction often creates an unstable family environment. Parents may not effectively discipline their children or provide them with training in basic life skills. Children may feel insecure or unloved. They may also begin to take on adult responsibilities that are not appropriate to their age. Children in families where an addiction is present are more likely to show anti-social behavior and have problems such as skipping school, aggressiveness, hyperactivity and eating disorders.

Is There Any Good News?

Living with an addicted person is not easy, but most children are resilient. This means that they can overcome these difficult circumstances and become strong, healthy adults. They build on their own and others’ strengths. For those who may have resulting problems, help is available. 

A good starting point is to talk to people who have experienced a family addiction or alcoholism. Contact Al-anon or Adult Children of Alcoholics/Addiction. Look in your local phone book or go to Al-anon.