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RECOVERY: THE IMPORTANCE & PARALLEL OF AA
BY JOANNE L. BARIAN, MSW, LCSW, SAC-IT
FLO HILLIARD
21 N. PARK STREET, 7TH FLOOR
MADISON, WI 53715
(608) 265-2679
fhilliard@dcs.wisc.edu
PART ONE: INVESTIGATION OF ONE OF THE FOLLOWING WEBSITES – NATIONAL
INSTITUTE ON DRUG ABUSE (NIDA)
According to the National Institute on Drug Abuse, the definition of drug addiction is as
follows: “a chronic, relapsing brain disease that is characterized by compulsive drug seeking and
use, despite harmful consequences. It is considered a brain disease because drugs change the
brain-its structure and how it works”. “These brain changes can be long-lasting, and can lead to
the harmful behaviors seen in people who abuse drugs”. Addiction is a primary, chronic disease
of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to
biological, psychological, social and spiritual manifestations. In the dictionary, the definition is
described as follows: “the state of being enslaved to a habit or practice or to something
psychologically or physically habit forming”. A strong and harmful need to regularly have
something or do something.
Recovery by definition, as stated in the dictionary consists of 4 components:
“The act, process, duration, or an instance of recovering”.
“A return to a normal or healthy condition”.
“The act of obtaining usable substances from unusable sources”.
“The regaining of something lost”.
I will be discussing my opinions and thoughts on how I believe, and how it has been shown
throughout history, that AA has proven to be the most effective means of maintaining sobriety,
and adhering to longevity in a healthy recovery program. Thus, it will be demonstrated as to the
importance and parallel of recovery, and AA or 12 step programs.
AA has been around since 1935, started by the founders, Bill W. and Dr. Bob in Akron,
Ohio. The structure and format of AA has been assisting people, struggling w/ alcoholism
and/or addiction issues, by providing comfort, serenity, and a peace of mind, while focusing on
the “we” of the program, not on an “I” orientation. AA’s philosophy is simple: Offering a single
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path to recovery, abstinence, surrendering one’s ego and accepting one’s “powerlessness” over
alcohol, as the very first step reads: “We admitted we were powerless over alcohol and that our
lives have become unmanageable. AA offers a healthy way of living, from a like-minded group
of non-drinkers. Step 2 discusses that “we came to believe that a power greater than ourselves
could restore us to sanity”. The Betty Ford Center talks about addiction also being a disease, as
most would not argue, and that “when referring to making a moral inventory”, it is not to say that
poor morals cause addiction, it’s simply an example of a key step of the 12 steps, which helps a
person retain or regain honesty, in their quest to stay sober. In adhering to a life in recovery, it
isn’t to simply put down the bottle, or put the cap back on the bottle of pills, which keeps
someone sober and healthy. To maintain the act of sobriety, and to sustain a strong, healthy, and
happy recovery program, are two very different things. One may decide to practice abstinence
by not using drugs or alcohol or “picking up”, however, it does not mean that the negative or
dysfunctional, unhealthy behaviors, which typically run alongside a “practicing addict”
disappears. One can certainly be seen as a person in “active addiction”, w/o physically using, by
adopting new and more unhealthy ways of behaving badly, or engaging in addictive behavior
patterns.
Addiction is a disease, chronic, progressive, and deadly, when left unattended. Poor
morals or bad character are usually the result of addiction, not the reverse. AA and a healthy,
solid recovery program, in which a person really works the program, in fact adheres to 3 major
principles: HOW, which includes Honesty, Open-mindedness, and Willingness. Addictions can
manifest in so many different ways, not only w/ alcohol and drug abuse, but also, gambling,
overeating, compulsive shopping, spending habits, or hoarding, exercising, and eating disorders.
AA is also not affiliated w/ any religious affiliation. The premise is to maintain a belief system
around something, which one considers to be a “Higher Power” that helps someone realize their
own vision of recovery. For example, AA’s premise is not based on religious beliefs, therefore,
someone who considers himself/herself to be “agnostic or atheist”, may not believe in the
popular perception of God, but they have been able to find a power greater than themselves,
which helps them to remain sober. Again, when practicing true, healthy recovery, AA focuses
on “we”, not on “I”; because it has been proven that simply “white knuckling” it is not effective,
when suffering from addiction. The program of AA offers group support, w/ like-minded
people, joining together w/ a common problem, w/ the goal remaining the same: Achieving a
life that is happy, joyous, and free, refraining from the use of drugs or alcohol, or other unhealthy
behavior patterns.
The founder of AA, Bill Wilson, wrote that the cure for alcoholism would be “a spiritual
one, a power equal to the power of alcohol”. That spiritual remedy has been found to be AA.
The outline of the AA program is described as “a spiritual process of surrender of the ego to the
unconscious, or a higher power, and very much resemble the process of transformation in a
psychological premise, in Jungian therapy”. Letting go of the ego and surrendering to a Higher
Power, who either one calls God, or something higher than himself is the basis of the journey
toward maintaining sobriety and recovery. The first step in any recovery program is
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acknowledging the problem. Then, having the courage, the willingness, and open-mindedness to
go outside of oneself for the help, and finally developing the beginning of trust in something
beyond oneself, such as a therapist, sponsor, or the program. Opening up to others from a closed
system, when in “active addiction”, thus, upon acknowledging that there is a problem, and when
one has discovered he/she is powerless, the problem lies in one’s own attitudes and behavior.
This is what is considered, “taking ownership”, “holding oneself accountable” and “taking
responsibility” for one’s actions. The beginning of what can be seen as the first step, toward the
journey of a lifetime, is to “surrender”. A person begins to take that acquired trust and develop a
certain willingness to “turn to a power beyond oneself”. This is the premise of believing in a
Higher Power. Reality itself becomes a kind of teacher, as one is asked to continually “turn it
over” (to that power), and the ego gradually lessens, and the growth and development process
begins in life itself.
Awareness becomes stronger, new attitudes and behaviors surface, and one’s ego begins
to be challenged. The group support in AA is so important, in reinforcing new and healthy
behaviors. One begins to turn the anxiety often felt by an addict into the desire to “let go” and
“let God” or “turn it over”, where faith in the program emerges, the ability to let go becomes
easier, and there is a move toward functional behavior, and a happy, healthy lifestyle.
PART 2: HOW I WILL BEGIN USING THIS CERTIFICATE PROGRAM IN MY WORK
I have always felt that we are all born into the world w/ gifts and talents, which our “Wise
Creator” has provided each of us that allows all of us, to make a worthwhile contribution to the
world. What we make of those gifts and talents is up to us. We can choose to use them for the
positive, or ignore them, which will damage our innate interests and abilities. By pursuing our
gifts and talents, we can learn to enjoy life to the fullest. My goal and mission in this lifetime, is
to take all of my dedication, perseverance, and motivation, and utilize my gifts and talents to the
best of my ability. I then can ask myself this question: Am I using my God given talent to the
best of my ability today? And, if so….will I achieve a sense of inner peace, inner satisfaction,
and serenity? I have made the decision, to assist clients in pursuing their innate interests and
abilities, w/ the goal of living life to the fullest. This six part series in substance abuse will be
used in my psychotherapy practice, and also toward my efforts in pursuing the SAC-IT
certification and licensure in the state of Wisconsin.
One of first things I have learned is the ABC’s of therapeutic connection. Awareness,
Balance, and Connection, which help in establishing a rapport w/ a client. It’s important to be as
connected w/ yourself first and foremost, before connecting w/ a client. I have learned to check
in w/ myself at least twice daily, once in the morning and then before bedtime. In the morning, I
set an intention for the day when waking up, during a brief meditation period. Then, in the
evening, I do something similar, where I will do a day’s review, including a relationship review,
to discuss the highlights of the day, and the challenges. This daily and evening practice keeps
me fresh as a human being, working toward my true life potential, my professional self, as well
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as w/ the “we” of my relationship w/ my life partner. Goals set for oneself and each other allow
for individual and paired growth and development. I will also be using some of the screening
and assessment samples, when I am working w/ a client, and the information provided suggests,
a need to identify whether or not there is a substance abuse issue. One example would be the
(MAST), which correctly identifies 95% of alcoholics when used as an assessment. The DAST,
Drug Abuse Screening Test, a 20 question self test, can be helpful to gain additional detailed
information about potential use or abuse of substances.
The third example is the CAGE, which includes: C-history of trying to cut down or
control your drinking or using, A-annoyance over criticism about alcohol, G-guilt about drinking
or using behavior, and E-someone ever taking a morning eye opener to relieve stress or anxiety.
All of these examples are strategies which I plan to use w/ clients in my practice or have already
used previously. Other examples include the POSIT (Problem Oriented Screening Instrument
for Teenagers), used primarily for adolescents. The GAIN-SS, which is a short screener for
adolescents and adults and the BAM, Brief Addiction Monitor, would work particularly well in
dealing w/ my adult clients, as it examines the last 30 days of the client’s usage. It is composed
of 3 reliable factors: Substance use, Risk factors for use, and Prorecovery behaviors. I found it
to be extremely important to realize that approximately 84 million adults suffer from co-
occurring disorders, not merely depression or substance abuse as an isolated issue or diagnosis.
In past employment positions, and currently in my practice now, I have been able to keep
in mind, what would entail a substance abuse diagnosis. Defining substance abuse as a
maladaptive pattern of substance use leading to clinically significant impairment or distress, as
manifested by one (or more) of the following occurring within a 12 month period. A typical
question as a therapist, I might ask a client would be to describe what types of things they do
while under the influence, to help gauge what is considered hazardous or dysfunctional while
using. The examples listed in the DSM V-2013, would discuss the following when determining
a diagnosis of substance abuse: 1) “Significant change to substance use”, 2) “Diagnostic
category, including both substance use and non-substance use disorders”, 3) “The use of the
word addiction or dependence”, 4) “Added craving criteria and the removal of substance related
legal problems”, 5) “Removed abuse and dependence, w/ mild, moderate and severe”. When
working on establishing a treatment contract w/ a client, I adhere to the SOAP criteria: Status,
Orientation, Assessment, and Plan. Along w/ this outline, the ASAM.org placement criteria
including the 6 dimensions have proven to explore all necessary areas needed to determine the
best level of care, in the least restrictive setting. The dimensions include: 1)
Intoxication/Withdrawal, 2) Physical Health Issues, 3) Behavioral/Cognitive/Mental Health
Issues, 4) Readiness For Change, 5) Recovery Environment, and 6) Relapse Control. This 6
course training has reinforced clearly, as to the most effective treatment models to use, when
working w/ substance abuse, which include: 1) Motivational Interviewing, 2) Brief Therapy
(Solution Focused Model), 3) Cognitive Behavioral Theory, 4) Dialectical Behavior Therapy, 5)
Multidimensional Family Therapy, 6) Relapse Prevention Therapy, 7) Self Help Groups, and 8)
Medication Management (performed by Psychiatrists/MDs).
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I felt the class on cultural awareness, focused on a variety of different perspectives that
were strongly reinforced. I tend to balance my client case load to allow for a vast array of clients
adhering to diversity, including race, ethnicity, sexual orientation, spirituality, and religion. As a
therapist, it is imperative to develop openness and sensitivity, and also an understanding of
another cultural group. Learning to manage my prejudices, as a therapist, is important, as we all
do have prejudices. It begins w/ being honest w/ yourself, learn to manage our feelings and put it
all aside, to allow for cultural awareness. Similarly, it is important to not ever make assumptions
about people their culture, or their belief system. Another example includes paying attention to
gender, defined as how you see yourself socially. The opposite of gender is sex, which has to do
w/ how you see yourself physically. In working w/ gender related issues, I have always focused
on the 4 identifying characteristics: Gender, sex, masculine and feminine, and sexual
orientation. I believe that in working for so many years on myself, it has also created a profound
sensitivity, and concentration on such awareness. I identify as a recovering addict, first and
foremost, as well as a lesbian, who as one can imagine, has created its own set of challenges
through the years, both personally and professionally.
I hope to utilize all of the information learned from the training sessions, in very specific
ways. I have been a therapist before going into recovery, and now, as an addict in recovery. I
stand tall and strong, w/ great confidence, in stating that all has been reinforced as a result,
including my morals, values, beliefs, integrity and character. I am able to help clients w/ not
only my education and work experience, through the past 24 years in practice, but also from life
experience, which I believe has given me the ability to be sensitive, emphathetic, and kind
toward those struggling w/ the disease of addiction. Another method I have used is
“Motivational Interviewing” (change talk), having a conversation about behavioral change.
It is the language of change, which helps clients, I have found, to be more present, in
what they are doing. Such approaches would include talking to clients about “pro-using
thinking” and “pro-using behaviors”. Discussing and defining what “small victories” look like.
Help to change a person’s environment and social circle of friends. Introduce “pro-recovery”
people, and helping the client to identify triggers, and to construct other alternatives that would
be healthy. It has clearly been reinforced vividly, that all fundamental skills used for long term
recovery, involve “changing brain wiring”. The more the brain repeats a behavior positively or
negatively, the more efficiently and powerful patterns becomes. A helpful strategy would be in
using a cognitive/behavioral approach, where the focus is on teaching the client a new skill….not
on developing a close rapport w/ the client. I have also used the “attention training” model of
ten, where the focus is mindful awareness, which is defined as “what is happening in any given
moment”. Examples are thoughts, feelings and sensations, remembering that “addiction is a
brain disease”, and the brain has been “hijacked”.
There is still hope for change which is important to emphasize in treating clients w/
addiction, despite being a chronic progressive disease. In conclusion, I hope to use all of the
newly gained knowledge and information, to work toward approaching addiction w/ clients, in
an intelligent, empathetic, constructive approach to therapy,w/ love, compassion and kindness..
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It is my dream to achieve my SAC-IT certification, and any additional substance abuse
credentials available down the line, which would further my career. I hope to use my personal
and professional experiences, to provide guidance and support to those who suffer from
addiction. It is my mission during my career as a Psychotherapist/Marriage and Family
Therapist and Addictions Counselor, to “Pay It Forward”, sharing all of God’s gifts and
blessings, which I have acquired in my lifetime, w/ those in need. I believe that everything in
life happens for very specific reasons. On some occasions, we may not know all of the reasons
why something may occur in life, at the moment that it happens. However, in time, if we look at
challenging and difficult times, as life’s greatest teacher………..we may begin to see that what
in fact may appear to be the worst of times, may turn out to be the most significant gifts. My
addiction represents one of the greatest gifts of all, which not only has proven to be an incredible
life lesson in and of itself………….but it will continue to viewed as one of the most profound
examples of gratitude, I could ever have imagined. I can finally state, after attending many,
many 12 step meetings……….something that I could not even fathom taking ownership of in a
million years………….I can openly and honestly report: “ I am a grateful recovering addict”.
This program works, if we work it, and as I have heard so often, in so many meetings, life can be
horrendous and so unfulfilling if you don’t. I now can honestly say, w/o any reservation, and w/
great confidence……that “I can live life on life’s terms”, “Try to practice these principles in all
of my affairs”, and “Continue to take one day at a time”, and most of all, I have found my
“magic formula” to live “happy, joyous, and free”!!!!
By Joanne L. Barian, MSW, LCSW, SAC-IT
(414) 412-3657
Malteses12@gmail.com
