1. Will the Real AA Please Stand Up! CAADAC Annual Conference 2008 Dee-Dee Stout, MA, CADC II; MINT member Responsible Recovery Project Pride/City College of San Francisco

2. Gallows Humor “What’s the difference between a sponsor and a vulture? A vulture waits until you’re dead to peck your eyes out.” Heard in an AA meeting, Pacifica, CA; circa 1988

3. How did AA become so anti-HR? What did Dr. Bob and Bill W. think about AA, treatment, & those who still used?

4. Moderate drinkers/not alcoholic “… our hats are off to them! ” (p) “… have little trouble in giving up liquor entirely if they have good reason for it. They can take it or leave it alone. ” (p20) Mandated AA is against the Traditions –Unless they have a desire to stop drinking

5. Working with alcoholics “… one must be approachable, understand what the drinker is talking about, that there is no attitude of Holier than Thou, just the sincere desire to be helpful; no people to please, no lectures …” (p20) –Client-centered counseling –MI

6. AA was intended: To work with “ low-bottom ” alcoholics To be tried when “ all else failed ” As one way of “ solving the drink problem ” For white, upper-middle class men only As a fellowship, not treatment

7. Myth #1: Harm reduction is the opposite of abstinence/AA is all about abstinence

8. Myth #1: Reality Abstinence always part of HR Abstinence is the ultimate HR AA does not address abstinence –“The only requirement for membership is a desire to stop drinking,” not to quit forever

9. Myth #2: Clinicians should be in charge of treatment, not clients/A client’s best thinking got them here!

10. Myth #2: Reality Client's ‘best thinking’ got them into your office/agency Different drugs interact with each individual user differently; tx needs are different w/each person Building rapport most important aspect of any practice –research shows most important factor in behavior change We do share opinions/thoughts – with permission Expert in room on client's life is the client – so ask them!

11. Myth #3: Harm reduction just gives people permission to use.

12. Myth #3: Reality Have you ever known anyone to ask permission to use anything?? We can neither give permission to nor take permission from a client, even when mandated –Leverage v ‘permission’ HR helps uncover internal motivations; supports natural human instinct towards healthier behavior

13. Myth#4: Harm reduction means anything goes/You can’t mix harm reduction and abstinence goals in treatment/AA is treatment

14. Myth#4: Reality 12-Step meetings include many folks including some under the influence “Keep Coming Back!” Don’t punish folks for showing symptoms of their illness(es) but structure is necessary (tx plans!) Stages of Change AA is a self-help fellowship NOT treatment –Bill W’s testimony to Congress

15. Myth #5 : AA is not religious but spiritual

16. Myth #5: Reality Defining religion : 1) the service or worship of God 2)commitment or devotion to observance 3) system of beliefs held w/ardor & faith Defining spiritual : 1) connectedness 2) a supernatural being 3) the essential element influencing a person 4) sentient part of a person Use of prayers: The Lord ’ s Prayer, St. Francis of Assisi prayer, and more –“ But there is One who has all power – that one is God. May you find Him now. ” (AA,p59) Why do we argue about this?

17. Summary AA is originally HR! –“ Keep Coming Back ” Original AA does not subscribe to the disease concept/medical model –AA states drinking is merely a “symptom of a greater underlying spiritual problem” AA believes in the use of medications and therapy –“ We are not doctors, we are not psychiatrists but we work closely with them. ” (See pamphlet)

18. Bottom Line … What do we care how people change? Why do we feel the need to “ protect ” AA? What are we so afraid of? People change in a variety of ways – research shows all ways are equally good/bad. Motivational Interviewing : the bridge? CDOI the ultimate answer?

19. No other medical/psychiatric condition … … uses only one type of treatment for everyone. That would be unethical. Why should AOD treatment be any different?

20. For more … “ Coming to Harm Reduction Kicking and Screaming: Looking for Harm Reduction in a 12-Step World ” by Dee-Dee Stout. Due early 2009.

21. THANK YOU!! Dee-Dee Stout ddstoutrps@aol.com sensiblerecovery@aol.com www.responsiblerecovery.org