Alcoholics Anonymous: Warts and All

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Notes

¹ The reader is asked to consider that the term “recovery” is an overloaded container concept, catch-all-code, in the substance use–misuse intervention field, which is bounded by culture, time, place, stakeholder values, agendas, interests, and influences. Although there is no consensualized definition by a range of involved deliverers of care and services for its targeted populations, recent definitions include the US: (1)Recovery from substance dependence is a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship. Sobriety refers to abstinence from alcohol and all other nonprescribed drugs. The Betty Ford Institute Consensus Panel, Journal of Substance Abuse Treatment 33 (2007) 221–228; and (2) the UK Drug Policy Commission: “Recovery is a process, characterized by voluntarily maintained control over substance use, leading towards health and well-being and participation in the responsibilities and benefits of society” The UK Drug Policy Commission, Recovery Consensus Group Policy Report, July 2008; www.ukpc.org.uk, “Recovery” is most often associated with abstinence. Its dimensions, and the necessary internal and external, micro and macro level conditions for its achievement and sustainment, and the person's necessary enabling resources as well as interfering flaws and limitations, have yet to be delineated in treatment ideologies such as harm reduction, quality-of-life, and conflict resolution. Editor's note.

² Treatment can be briefly and usefully defined as a unique, planned, goal directed, temporally structured, multi-dimensional change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.), associated with a range of stakeholders with agendas, and can be categorized into professional-based, tradition-based, mutual-help based (AA,NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which aren't also used with nonsubstance users. Whether or not a treatment technique is indicated or contra-indicated, and what are its selection underpinnings (theory-based, empirically-based, “principle of faith-based, tradition-based,” etc.) continues to be a generic and key treatment issue. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) and wellbeing treatment-driven models, there are now new sets of goals in addition to those derived from/associated with the older tradition of abstinence driven models. Conflict-resolution models may stimulate an additional option for intervention. Each ideological model has its own criteria for success as well as failure as well as iatrogenic-related harms. Treatment is implemented in a range of environments; ambulatory as well as within institutions which can include controlled environments. Treatment includes a spectrum of clinician–caregiver–patient relationships representing various forms of decision-making traditions/models; (1). the hierarchical model in which the clinician-treatment agent makes the decision(s) and the recipient is compliant and relatively passive, (2) shared decision-making which facilitates the collaboration between clinician and patient(s) in which both are active, and (3) the “informed model” in which the patient makes the decision(s). Editor's note.

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Notes on contributors

Shelly A. Wiechelt

Shelly A. Wiechelt, Ph.D., LCSW-C is an Associate Professor at the University of Maryland, Baltimore County, School of Social Work. She conducts research on the intersection between trauma and substance use. She engages in translational research, and develops collaborations between researchers and practitioners. Her research is primarily community based and includes studies on the provision of trauma-informed services in substance abuse and mental health treatment settings with vulnerable groups including women, women in prostitution, urban American Indians and individuals with severe mental illness. Dr. Wiechelt is an Associate Editor for Substance Use and Misuse. She serves on the editorial board for the Journal of Loss and Trauma and is a member of the review board for the Journal of Social Work Practice in the Addictions. She is a faculty member of the Middle Eastern Summer Institute on Drug Use and has participated in the institute's projects in Italy, Spain, and Israel. She has worked extensively as a clinician in both substance abuse and mental health treatment settings and has taught numerous continuing education workshops to practitioners. She has multiple peer-reviewed publications as well as national and international presentations on her research and practice interests.