UWS SCHOOL OF EDUCATION COMPULSION ...

i

UWS

SCHOOL OF EDUCATION

COMPULSION

&

RECOVERY

(C & R)

RESEARCH

I will keep pure and holy

both my life and my art

(Hippocrates)

PhD 2007

Affie Adagio

ii

ACKNOWLEDGEMENTS

Dedication: Originally my need to achieve academically was fuelled by my father,

George Polimeris, and my cousin and mentor, Chris Polimeris. Although they are

not alive now to share my achievement I dedicate this work to the inspiration they

gave me. The Polimeris motto from my grandmother’s side was “give strength and

inspiration” and this indeed they have done. I like to carry this message wherever I

go. Admittedly, at times the obstacles I have lived through have almost stopped me

from reaching my goals. To my children Paul and Tina and their partners Nella and

Bill who have supported me throughout, especially for the financial support as

needed. To my grandchildren Gaby (13), Sabrina (8) and Nicholas (9) who have

patiently waited for Nana to spend more time with them after she finishes her “uni

school work”. The latest addition Talia (4), my daughter’s child, has learnt that what

I am doing is called ‘grown ups’ school’ as she attended the UWS Bankstown

Campus Library on several occasions when I was babysitting her on Wednesdays.

This dedication would not be complete without including another mentor Nick

Cassimatis, who has been the sounding board both for my inner and outer worlds.

Thankyou: After spending many years in the mother and wife roles, at 47 my next

role involved the life of academia. Before then I had upgraded my skills through

TAFE courses and private organisations such as UNIFAM, where I obtained my

Marriage and Family Therapist qualification. I thank Eric Stevenson (UNIFAM) for

also being my mentor through that time and inspiring my journey to UWS

Hawkesbury when I became ready for university. I commenced my relationship with

social ecology in 1991. My heroes from UWS Hawkesbury, Social Ecology &

Lifelong Learning, are: Viki Vivian who inspired my ‘artist within’ to become the

catalyst for my research project; Judy Pinn; David Russell; Graham Bird; Vladmir

Dimitrov; Stuart Hill; Virginia Kaufman Hall; Judy Davis; Robert Woog; Hilary

Armstrong; Peter Meltser; and too many others to mention here. I thank Brenda

Dobia and John Cameron for challenging me. Above all is my gratitude to Debbie

Horsfall whose approach nurtured my creativity giving me the strength to go on.

Finally my appreciation to Neil Davidson whose gentle, meticulous manner

continued the effect on my personal, professional and community development, as

that of my previous consultants - Viki Vivian, David Russell and Debbie Horsfall.

My thanks to the pioneers of Social Ecology. Over the past 14 years without

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belonging to this learning community I would not have survived my university

journey to the PhD. Thanks to UWS, the Wayside Chapel (through QANTAS) and

the Humanist Society of NSW for funding my research trips to Europe and the USA.

Thanks also to financial sponsors Judy Langton and Viki Potempa.

Throughout this C&R Research I have gained friends and sometimes made enemies

out of some of my employers, perhaps because of my curiosity and openness (or so I

like to believe). Nevertheless, I thank the Wayside Chapel and Barnardos for the

opportunity to research and hone my skills. Especially I thank the youthworkers and

counsellors who were eager to participate in the learning process and who I

acknowledge in another piece of work (Affie 1998). My gratitude to co-researcher,

Toola Andrianopoulos, whose dedication was immeasurable. To Andy Campbell

who along with Nick Cassimatis, as psychiatrists familiar with addictions, provided

my ethics collaboration.

Most importantly my gratitude to all the interviewees led by Leroy Bishop, Andy

Campbell, Nick Cassimatis, Nick Heather, Stephen Jurd, Jean Lennane, Michael

MacAvoy, James Maclaine, Andrea Mant, Kate Stewart, Pia Mellody and Pat

Mellody, who I considered not only collaborators but also measurers of the validity

and ethics of this research. Nick Cassimatis, Dean Dowling, Ian Ellis-Jones, Stephen

Jurd, and Alex Wodak contributed to my inquiry through the Australis2000

Humanist Congress. Stephen Jurd was often accessible to answer questions even

during the final editing in 2007. Also recently Richard Mattick (NDARC) and Kellie

Fixter (Health Dept Ageing Drug and Alcohol and Indigenous Programs Drug

Strategy Branch) were also invaluable with recent information (2007).

For brevity I have not used their titles here.

To Angela Drury for helping with the bibliography and the proof-reading, I am truly

grateful. Also many thanks to John August for proof-reading.

iv

CERTIFICATE OF ORIGINALITY

THE COMPULSIONS & RECOVERY (C&R) RESEARCH

To the best of my knowledge and belief this thesis is entirely original research which has not been submitted for any other degree at any place of learning.

Every effort has been made to ensure that writings and ideas delivered in any medium, have been acknowledged and referenced.

Affie Adagio

v

CONTENTS

Contents ......................................................................................................... v List of Figures .............................................................................................viii Contents Mind Map ...................................................................................... ix Abstract .......................................................................................................... x Chapter 1: Introduction

1 The D&A Debate ............................................................................... 1 1.1 The D&A Debate Becomes Public .............................................. 5

2 Personal Context ................................................................................ 6 3 Overview of Thesis .......................................................................... 11

Chapter 2: Methodology .............................................................................. 13 Philosophy & Values of The Research Relationship: 1 Major Influences on Methodology................................................... 13

1.1 Social Ecology ........................................................................... 13 1.2 Action Research ......................................................................... 15 1.3 Ecofeminism .............................................................................. 18

2 Dialectic as both Methodology & Research Method ....................... 20 3 Narrative Approach.......................................................................... 23

3.1 Narrative Theory ........................................................................ 23 3.2 Narrative Field ........................................................................... 27 3.3 Field Texts.................................................................................. 30 3.4 Research Text............................................................................. 31 3.5 Writing Research Text ............................................................... 32

4 Stages in the Research...................................................................... 33 5 Addiction Stories & My Praxis........................................................ 35 6 How Interviewees were Chosen....................................................... 37 7 Persons Interviewed ......................................................................... 40 8 Sample Group .................................................................................. 41 9 How Data was Analysed .................................................................. 42 10 Mind Mapping.................................................................................. 43 11 Summary .......................................................................................... 50

Chapter 3: Interviews ................................................................................... 52

Introduction ............................................................................................ 52

1 Stephen Jurd.................................................................................... 55 2 Andy Campbell ............................................................................... 61 3 Jean Lennane................................................................................... 65 4 Andrea Mant.................................................................................... 70 5 Michael MacAvoy ........................................................................... 73 6 Nick Heather ................................................................................... 78 7 Nick Cassimatis .............................................................................. 84 8 Jim Maclaine ................................................................................... 88 9 Pat Mellody...................................................................................... 91 10 Pia Mellody...................................................................................... 91 11 Leroy Bishop ................................................................................... 98 12 Kate Stewart .................................................................................. 101 13 Findings from these interviews ...................................................... 109

vi

CONTENTS (continued)

Chapter 4: Thesis – Case for Abstinence with the AA 12 Steps ............... 112

Literature Review................................................................................. 112 Summary ........................................................................................ 121

1 Abstinence and AA 12Steps Program............................................ 122 2 Medical/Genetic Model of Addiction & Recovery Methods......... 129

2.1 “It’s a Disease”......................................................................... 132 2.2 Identifying & Isolating the Problem ........................................ 134

3 Project MATCH from the TSF Perspective ................................... 135 4 George E Valiant – AA Research .................................................. 136 5 There’s Agreement – it’s Multigenerational .................................. 137

5.1 Australian High Youth Suicide Rate........................................ 139 CASE STUDY A ........................................................................... 142 CASE STUDY B ........................................................................... 144

6 Addiction – Genetic and/or Societal Influences............................. 145 6.1 Serials, Soap Operas & Dysfunctional

Behaviour/Codependence ........................................................ 145 7 Codependence ................................................................................ 147

7.1 The Swing Against Codependence .......................................... 152 7.2 Codependence: A Biblical View.............................................. 154 7.3 Codependence: A Psychologist’s View ................................... 155 7.4 Conduct Disorder or Codependence ........................................ 156 7.5 Society – The Addictive System & Codependence ................. 158 7.6 Addiction to Perfection – A Symptom of Codependence........ 159 7.7 The Demon of Perfection ......................................................... 160

8 Addiction Recovery – To the Doors of Death & Back to Life……161 9 Reflection………………………………………………………….161

10 Summary…………………………………………………………..163

Chapter 5: Antithesis: Case for Controlled Drinking (CD)/Use (Harm Minimisation) ................................................................................. 164

Literature Review................................................................................. 164 Summary ........................................................................................ 174 1 National Drug Strategy (1985): Harm Minimisation Policy.......... 174 2 Controlled Drinking ....................................................................... 176 3 “It’s Not Genetic!” ......................................................................... 176 4 “It’s Not A Disease”....................................................................... 178 5 Harm Minimisation (Harm Reduction).......................................... 180 6 Project MATCH from the Harm Minimisation Perspective .......... 183 7 Cognitive Behavioural Therapy (CBT).......................................... 185 8 Motivational Interviewing.............................................................. 186 9 Medically Supervised Injecting Centres ........................................ 187

9.1 Berne Switzerland .................................................................... 187 9.2 Kings Cross .............................................................................. 187 9.3 Netherlands Approach.............................................................. 187

10 Wodak’s paper .............................................................................. 188 11 Dowling’s paper............................................................................. 192 12 Reflection ....................................................................................... 194 13 Summary ........................................................................................ 195

vii

CONTENTS (continued) Chapter 6: Synthesis: Treatment Matching – A Diversity of Approaches……….196

Introduction.....................................................................................................196 1 Project MATCH from the Synthesis Perspective.....................................199 2 Assessing Stages of Change in Dependencies..........................................200 3 Motivational Interviewing & Stages of Change.......................................202 4 Stages of Compulsions and Recovery ......................................................204 5 Addiction Why & What?..........................................................................209 Important Aspects of Compulsions and Recovery ...................................210 My Praxis – A Synthesis of 26 Approaches.............................................211

5.1 Cognitive Behavioural Therapy (CBT) ..........................................213 5.2 Motivational Interviewing (MI)......................................................213 5.3 Gestalt.............................................................................................214 Gestalt Exercise A ..........................................................................215 5.4 Hippocrates Personality Types .......................................................216 5.5 Jung.................................................................................................217 Jung Exercise B ..............................................................................218 5.6 Neuro Linguistic Programming (NLP)...........................................218 NLP Exercise C ..............................................................................218 5.7 Process Oriented Psychology (Process Work) ...............................220 Process Work Exercise D ...............................................................220 5.8 Psychodrama...................................................................................220 Psychodrama Exercise E ................................................................221 5.9 Psychotherapy/Family of Origin Work ..........................................222 5.10 Rational Recovery (RR) .................................................................222 5.11 Rational Emotive Behavioural Therapy (REBT/RET)...................223 REB/RET Exercise F......................................................................224 5.12 SOS.................................................................................................225 5.13 SMART Recovery ..........................................................................225 5.14 Transactional Analysis (TA) ..........................................................226 TA Exercises G and H....................................................................228 5.15 AA and 12 Steps Program ..............................................................229 12 Steps Program Exercise I...........................................................230 5.16 Twelve Step Facilitation (TSF) ......................................................231 5.17 Visualisation/Hypnosis/Mindpower ...............................................233 5.18 Yoga/Meditation/Relaxation/Exercise............................................234 5.19 Medically Superv. Inject. Centre (MSIC) Kings Cross..................234 5.20 Berne (Switzerland) MSIC .............................................................235 5.21 Stockholm (Sweden) Drug Free Society Program..........................236 5.22 Amsterdam (Holland) Progressive Drug Program .........................236 5.23 Life Education Australia.................................................................237 5.24 Whatever Works.............................................................................238 Harm Minimisation Exercise J .......................................................238 5.25 Client Self-Responsibility & Self Determination ...........................240 5.26 Life Coaching Website ...................................................................242

6 Reflection .................................................................................................243 7 Summary ..................................................................................................243

Chapter 7: Conclusion and Recommendations......................................................245 BIBLIOGRAPHY .................................................................................................261 APPENDICES.......................................................................................................320

Appendix A – Newspaper clipping ..........................................................321 Appendix B – Newspaper clipping ..........................................................322 Appendix C – List of Interviews ..............................................................325

Appendix D – Course Feedback Form................................................ 328

viii

List of Figures

Fig.1 Jurd .................................................................................................... 46

Fig.2 Heather .............................................................................................. 48

Fig.3 SCOPE Book – Definitions .............................................................. 125

Fig.4 Stages of Addiction........................................................................... 127

Fig.5 Genogram ......................................................................................... 142

Fig.6 CEIDA Pamphlet .............................................................................. 241

ix

ABSTRACT

ABSTRACT

CONTENTS Mind Map

1

Compulsions

&

Recovery Research

Project PhD Thesis

Adagio 2005

2

ABSTRACT p (x)

CHAPTER 1

INTRODUCTION

p1

CHAPTER 2 p13

METHODOLOGY 1 Major Influences on Methodology p13 1.1. Social Ecology p13 1.2 Action Research p15 1.3 Ecofeminism p18 2 Dialectic p20 3 Narrative Approach p23 4 Stages in Research p33 5 Addiction Stories & My Praxis p35 6 How Interviewees were Chosen p37 7 Persons Interviewed p40 8 Sample Group p41 9 How Data was Analysed p42 10 Mind Mapping p43 Fig.1 Jurd p46, Fig.2 Heather p48 11 Summary p50

CHAPTER 4 p112

THESIS: Case for

ABSTINENCE

with AA 12 Steps

Program

CHAPTER 5 p164

ANTITHESIS:

Case for

CONTROLLED

DRINKING

(CD)/USE

CHAPTER 6 p196

SYNTHESIS:

TREATMENT

MATCHING –

A DIVERSITY OF

APPROACHES

CHAPTER 7 p245

CONCLUSION and

RECOMMENDATIONS

BIBLIOGRAPHY p261

APPENDICES p320 App A p321 App B p322 Newspaper clippings App C – List of Interviewees p325

App D Course Feedback p328

4

7

6

5

8

1. The D&A Debate p1 1.1. The D&A Debate Becomes Public p5 2. Personal Context p6 3. Overview of Thesis p11

Literature Review p164 NDS (1985) Harm Min p174 Controlled Drinking p176 It’s Not Genetic! p176 Harm Minimisation Policy p180 Project MATCH p.183 CBT p185 Motivational Interviewing p186 MSIC Kings Cross & Berne p187 Wodak’s paper p188 Dowling’s paper p192 Reflection p194

Project MATCH p199 Assessing Stages of Change p200 Stages of Compulsion p202 My Praxis – A Synthesis p211 CBT p213 MI p213 Gestalt p214 Exerc. A p215 Hippocrates Personality Types p216 Jung p217 Exerc. B p218 NLP p218 Exerc. C p218 Process Work p220 Exer. D p220 Psychodrama p220 Exerc E p221 Psychotherapy/F.O.W. p222 RR p222 REBT/RET p223 Exer. F p224 SOS p225, SMART Recovery p225 TA p226 Exerc. G & H p228- 12 Steps p229 Exerc. I p230 TSF p231 Visualis’n/Hypnosis/Mindpower p233 Yoga/Meditation/Relax/Exercise p234 MSIC Kings Cross p234 Life Education Australia p236 Whatever Works p238 Harm Minimisation Exerc. J p238 CEIDA Pamphlet Fig.6 241 Life Coaching Website p242

Jurd 55 Campbell 61 Lennane 65 Mant 70 MacAvoy 73 Heather 78 Cassimatis 84

Maclaine 88 Mellody P&P 91 Bishop 98 Stewart 101

3

CHAPTER 3 p52 INTERVIEWS

1. Introduction p52

Literature Review 112 AA 12 Steps p122 Fig.3 SCOPE book p125 Fig.4 Stages of Addiction p127 It’s Genetic! p129 Multigenerational p137 Project MATCH p135 Valiant AA Research p136 Australian Youth Suicide p139 Fig.5 Genogram p142 Case Study A p142 Case Study B p144 Codependence p147 Reflection p161

x

ABSTRACT

When I began the Compulsion & Recovery Research Project in 1992 I did so in

response to the schism between professionals who were leaders in the addictions

recovery field. Known as The D&A Debate, this schism resulted in changes in

government policy, funding and service provision, causing great confusion to people

suffering with addictions. It was described by the media as ‘addiction treatment now

a battleground’. The battle was between professionals favouring controlled drinking

as a treatment option compared to those who were convinced that abstinence and the

Alcoholics Anonymous 12 Steps program was the successful treatment. Before the

conflict, government funded bodies ran detox units which included an abstinence

program and attendance at AA meetings on the premises. During the conflict,

government funded service providers supporting the harm minimisation concept,

began negating the abstinence and AA method of recovery. A person making a

commitment to reduce their drug intake now appeared to have succeeded in the

program more so than one who had been committed to abstinence and perhaps risked

relapse. So, detox units could show a higher success rate with the harm minimisation

policy (National Drug Strategy 1985), although it was argued by some that this was a

life threatening risk.

As a family therapist specialising in addictions recovery, I became concerned about

this battle between leaders in the recovery field and its impact on the community. I

had experience in running halfway houses for people recovering from addictions and

knew that abstinence with AA worked. I was confused about professionals negating

this recovery program which worked but I was curious about their rationale for

controlled drinking/harm minimisation. I embarked on a research project which used

a dialectic/narrative inquiry method, interviewing leaders in the conflict and others

who contributed progressive ideas to recovery. This inquiry was influenced by my

experience and the information gained from the previous interview to the next,

growing and evolving into a structure which I called the thesis – case for abstinence,

antithesis – case for controlled drinking/harm minimisation, and synthesis – case for

diversity of approaches to recovery. This process aimed at ensuring that there was

validity, rigour and ethics in the research process.

The interviews took place within Australia and overseas in Europe and USA where

people from different countries participated. Finally, on a panel with some of the

xi

protagonists in The Debate I presented my findings so far, in the Addictions Session

of the Australis2000 Humanist Congress in Sydney which was attended by scientists

from here and overseas.

Through the interviews the protagonists of the conflict clarified their stance whilst

remaining committed to their own worldview. The majority agreed that there was not

only one way to deal with compulsions, something that the media and service

providers had neglected to acknowledge.

As a result of this research I have developed a praxis that involves a client centred

modality involving a diversity of approaches (synthesis) informed by the 26 methods

mentioned in this thesis. This diversity of approaches is aimed at personal

development and recovery from compulsion.

As can be seen in more detail in Chapter 6, these are:

1. Cognitive Behavioural Therapies (CBT) 2. Motivational Interviewing (MI) 3. Rational Emotive Behavioural Therapy (REBT aka RET) 4. Rational Recovery (RR) 5. Secular Organisation for Sobriety – Save Our Selves (SOS) 6. SMART Recovery Groups 7. Hippocrates Personality Types (Typology) 8. Jung 9. Gestalt 10. Neuro Linguistic Programming (NLP) 11. Process Oriented Psychology (Process Work) 12. Psychodrama 13. Transactional Analysis (TA) 14. Psychotherapy/Family of Origin Work 15. Twelve Step Facilitation (TSF) 16. 12 Steps Program/Model 17. Visualisation, Affirmations, Hypnosis, Self-Hypnosis, Mindpower 18. Yoga, Relaxation, Breath Awareness (Rebirthing), Meditation 19. Life Education 20. Kings Cross Medically Supervised Injecting Centre (MSIC) 21. Berne (Switzerland) Medically Supervised Injecting Centre (MSIC) 22. Stockholm (Sweden) Drug Free Society Program 23. Amsterdam (Holland) Progressive Drug Programs 24. Client Centred - Whatever Works (Krivanek) 25. Client Responsibility & Self Determination (Available Choices) 26. Life Coaching Website

This praxis provides interested persons with an education process to enable them to

assess their own situation and to identify which method they would find more useful

xii

in achieving their required outcome. As a practitioner my responsibility is to ensure

that they are aware of the risks they are facing in making those choices or not

chosing certain options. Furthermore, my aim is to provide an efficient and effective

service to such persons.

Importantly as a result of this inquiry I came to believe that The Drug & Alcohol

Debate (The D&A Debate) protagonists need not dogmatically defend their own

model to the point of being in conflict, as all their treatments work, and it was valid

to concede that different models work for different people in different stages of their

recovery - “whatever works works, and not to be judged by others” (Nicotine

Anonymous The Book 1992:113).

1

CHAPTER 1

INTRODUCTION

The final word is about power – ours, and the power of alcohol. Most of us start drinking because it gives us an intoxicating feeling of confidence, and brief glimpses of omnipotence. Some of us then get into difficulties with dependence. It gradually becomes clear that there has been a radical shift, and far from being in control and more powerful, we are now powerless to handle the drug that has taken over our lives. Most of us don’t become dependent, but as part of society, perhaps we too are now in the grip of

something that is too powerful for us to control. (Lennane1 1992:186)

1. The Drug & Alcohol Debate

Our society is being affected by addiction more than ever before and it is getting

worse, as confirmed by Wodak, Director of the St. Vincent’s Alcohol and Drug

Service. As Australia’s international spokesperson for harm minimisation/reduction,

Wodak spoke on this topic at the Australis2000 Humanist Congress. Problems

stemming from alcohol and other drugs use are widespread in many societies

(Penrose-Wall, Copeland, & Harris, 2000). More frightening is that our children

(Peele & Brodsky 1991:345, ABS 2000, Lennane2 1992) are being sucked into this

destructive whirlpool, so as to escape and get that intoxicating feeling of confidence

and omnipotence.

In the late eighties, professionals disagreed about the solution to this problem and

were in conflict about treatments. From this schism The D&A (Drug and Alcohol)

Debate was born and became my area of interest for research. Cassimatis,

psychiatrist, in his second interview with me (1993) confirmed that the conflict

between the professionals occurs because the treatment for addiction is not

definitive, therefore, no one method is the answer. Heather, Director of National

Drug & Alcohol Research Centre (NDARC in 1993) and proponent of controlled

drinking, in his interview with me (1993) said “we won” when he summarised the

events of The D&A Debate meeting in the late 1980s. Jurd, Director of the Drug and

Alcohol Services at Royal North Shore Hospital and a protagonist for the abstinence

AA model, in his first interview with me in 1992, passionately expressed concern

about what life threatening consequences would occur due to the controlled drinking

1 For the sake of brevity only surnames are shown throughout this documentation 2 Names shown in bold are those of people I have interviewed or had some contact with, for the purposes of this research project

Chapter 1: Introduction

2

concept of the harm minimisation policy (NDS 1985). The Harm

Minimisation/Reduction Policy was the commonly used term for the National Drug

Strategy (NDS 1985) which in turn had come about from the campaign document of

the National Campaign Against Drug Abuse (NCADA) Special Premiers’

Conference in Canberra (1985). As a marriage and family therapist, specialising in

recovery from addiction, I could not understand the polemic so I embarked on a

research process and called it the Compulsion and Recovery Research Project. My

choice of the word ‘compulsion’, as mentioned by Blake and Stephens (1987), is one

of many used in the field. These are: addictions, compulsions, dependencies, misuse,

abuse, and excessive use. In this thesis these terms can refer to substance or process

abuse and are used interchangeably, with the more commonly known terms

alcoholism and addiction more often used as the heterogeneous term for compulsions

in order to describe the effect, process and recovery approach. In the 1960s Jellinek

had defined the concept of alcoholism as a disease. The following summary also

covers the age-old problem…

The theory that addictive behaviour, alcoholism specifically, is a progressive disease is about two hundred years old. Its chief symptom is loss of control over the use of substance; its only remedy is abstinence. Before this time, it was assumed people drank because they wanted to, not because they couldn’t stop themselves. (Ruden, Byalick 2000:74)

On the other hand from the other end of the continuum, the worldview expressed by

behaviourists who do not believe in the disease model and AA…

Certain central features of the received wisdom about drug addicts and addiction have to be challenged. The idea that addiction is a state in which the driving force for autonomous action becomes lost to the individual, and is taken over by craving, an irresistible psychological force fuelled by inevitable and excruciating withdrawal symptoms, is untenable since these concepts do not in fact possess the monolithic properties that they would require in order to assume the roles assigned to them. In their place, we require a conception of drug use which restores the user to centre stage, and within which his/her motives and intentions within particular contexts become the focus for attention and future theoretical development. (Davies 1997)

Which term is used depends on which model we support. However, whichever

theoretical approach is taken the effects of addiction are the same, involving

predictable stages of compulsion to use whatever will help us to enjoy, or cope with,

life (Chegwidden 1968, Affie 1998). These stages are also called levels of

dependence (Edwards and Gross in Jarvis, Tebbutt and Mattick 2001:16). Using a

mood changing substance or process gives a feeling of bliss with a quick fix that


3

euphoric state which for some can be followed by eventual loss of control over the

use of the substance or the process.

MacAvoy, psychologist, was Director of the Drug and Alcohol Directorate which

provided the funding for recovery and prevention programs in 1993. When I

interviewed him (1993) he reminded me that as long as there are human beings there

will always be addiction and it is unrealistic to expect otherwise. Why bother then?

Because it affects society – our children, road safety and everyone’s health, which

then costs the State and the taxpayer.

Substance abuse is a common presentation in general practice. Approximately 13% of adults abuse alcohol at some time in their lives with between three and five per cent of men and one percent of women becoming alcohol dependent. Alcohol is a contributing factor in around 50% of homicides and 25% of suicides. Illicit drug use is most prevalent among young people, especially young men. The assessment of substance abuse is complicated by the fact that few sufferers will present with the problem directly. (Davies 2000:163)

We cannot ignore these factors but more importantly when those affected by

addiction reach out to health care workers, pleading for help and freedom from its

slavery, we are accountable for the services we provide. This duty of care is ours, as

heath care workers, individuals, and society as a whole. Their lives are at risk - many

have died from alcoholism and its impact on their bodies - liver damage,

amputations, brain damage, suicide (Jurd 2000, Lennane 1992, ABS 2000).

Furthermore, there is also the danger to the community because alcohol and other

drug abuse is considered a major cause in road accidents, homicide and suicide (Elvy

1989).

Drug and alcohol misuse and addiction play a major role in offending behaviour. Statistics presented at the New South Wales Drug Summit reveal that about 70% of inmates in New South Wales prisons were under the influence of alcohol or other drugs at the time of their most serious offence. (Swain 1999)

This can also be seen by the more stringent policing of traffic, especially on

weekends and holidays when drivers are more inclined to ‘party hard’. The cost to

individuals and the community is confirmed by the following sources:

In the shared care review (2000:1):

Managing illicit drug use and dependence is costly, involving treatment and preventive public health agencies, social welfare and education sectors as well as law enforcement and correction services. These are conditions that pose significant


4

health threats to individuals with drug use problems and high costs to their

communities. (Penrose-Wall , Copeland, & Harris, 2000)

Also in an overview presented by Elvy, Executive Director, Australian Alcohol and

Drug Foundation Canberra, ACT, at the 1989 Conference on Australia’s Health

Policy on Alcohol by the Institute of Criminology:

Drink driving

It is of no surprise to find that drink driving as a crime is probably the best researched and most reviewed area of the alcohol-crime relationship. Undoubtedly, random breath testing has changed the nature of public drinking in Australia. Various programs have been described to reduce drink driving crime, including the Victorian countermeasures (South 1989), liquor industry campaigns (Broderick 1989), legislation for zero-blood alcohol limits for learner drivers and that reducing the BAL from 0.08 per cent to 0.05 per cent will significantly reduce injury accidents (Smith 1989). In addition, there is an indication that severe intervention programs should be given a higher policy priority by government, as a means of limiting alcohol availability (Smith 1989).

In MJA (1998; 168: 6-7) - Collateral damage from alcohol abuse: the enormous costs to Australia - Curtailing the rippling effect of irresponsible drinking

Past studies have found that alcohol abuse plays a significant role in violent crime. It is estimated that about 13% of Australians aged 14 years and over (well over one million people) have been physically abused at least once by someone affected by alcohol, while 16% have had their property damaged at least once. Alcohol has also been implicated in about one-third of sexual assault cases. In 1992, 294 people died from alcohol-related assaults in Australia. Drunk drivers put not only their own lives in peril, but also pose a significant risk to other road users. In NSW in 1995, of the 620 people killed in road accidents, 141 (including 37 passengers and pedestrians) died in alcohol-related accidents. In addition, 298 non-drivers were seriously injured. Even more dramatic examples of alcohol-related transport accidents have been recorded internationally, such as the tragic Exxon Valdez oil spill in Alaska in 1989.

At least 1% of the population (about 180,000 people) have a close family member with a serious alcohol problem. Isolation, neglect, aggression and disruption within the family, particularly spouse abuse, are frequent. Sexual and financial problems, stress, verbal and physical abuse, separations and divorce are also common between couples where at least one partner abuses alcohol. A Victorian report in 1988 found that alcohol was definitely or possibly involved in 53% of several thousand reported incidents of family violence. Children are particularly affected by having an alcoholic parent and they are more likely to become depressed, have lower IQ, and be alcohol dependent themselves in the future. [References in MJA article]

So, what are we as a society to do with this problem? What works best? What are the

professionals fighting about? Who is right? What happened to them? How did The

D&A Debate become so destructive to the point that some effective recovery

programs were ridiculed and their effectiveness thrown into doubt? Why is it

necessary to discredit recovery programs which work? In The D&A Debate (late 80s

early 90s) there were clashes between professionals from treatment models based on


5

opposite sides of the recovery continuum - one side adhered to the alcoholism is a

disease and AA abstinence model and the other believes the non-disease controlled

drinking/using behaviour modification concept or the related non-disease you'll grow

out of it (Peele, Brodsky, 1991) concept. This conflict was exacerbated by the new

Health Department Harm Minimisation Policy (NDS 1985) which was influenced by

the Heather et al (1981, 1989) research outcomes favouring education/harm

reduction/home detoxification strategies against the existing inpatient

detoxification/abstinence programs, and this affected government funding criteria for

services.

1.1 The D&A Debate Becomes Public

These clashes were spiced up with a vengeance by the media with headings such as

“addiction treatment now a battleground”, showing reputable specialist pioneers

such as Lennane and Gelhaar having been forced to leave their jobs (Appendices A

and B). Lennane maintained that this trend in media coverage was as a result of the

high incidence of denied alcoholism in Australia creating public interest especially

from people wanting to be vindicated by calling their habit 'social drinking/recreation

drugging' (Lennane 1992).

Drug and Alcohol issues were known in the field under the abbreviation of D&A up

until recently. Now the more acceptable wording is AOD (Alcohol and Other Drugs).

I shall use The D&A Debate because at the time of the flare up, in the late 80s,

between professionals in the alcohol and other drugs field, the conflict was known as

The D&A Debate or The Debate, also as written about in newspaper articles

mentioned earlier. In most cases I will also refer to addiction issues under the word

alcoholism (often used in the recovery field as a generic term) metaphorically for all

addictions perhaps because it is a drug addiction with a long history.

My curiosity and passion became aroused. In spite of my knowledge and skills as an

addictions counsellor, this clash between experts began to confuse me too.

Consequently, I became curious as to what each of these experts had as a rationale

for their stance. My curiosity ultimately led to planning a process of inquiry which

would enable the sharing of knowledge. This sharing would be with the disputing

parties through interviews, a dialectic/narrative method, and the community through

my training programs and counselling (also perhaps in the form of a book). My


6

passion fired up at the thought of such research giving all sides a voice to inform

each other more effectively than the unproductive public hostility expressed so far. I

became excited about the heuristic nature of the project (Kaufman Hall 1995), that is,

the unknown outcome. This approach left me feeling empowered. I had faith that this

process of its own accord could unfold into personal, professional and community

development - social ecology as described by Bookchin (1990) - since the focus

would not be solely on our inquiry to come up with the 'right answer'.

I chose a dialectic/narrative method for the interviews. Dialectic derived from the

Greek meaning to converse, to discourse or as Socrates defined as being a

“conversational method of argument involving question and answer”(Flew l984:94).

In other words, a polemic regarding addiction treatment could contribute to the

"notion of dialectic...a view that development depends on the clash of contradictions

and the creation of a new, more advanced synthesis out of these clashes". This

notion, can be described in terms of three stages which I have named three chapters -

'thesis, antithesis and synthesis' (Abercrombie, Hill, & Turner 1988:70). Narrative

inquiry was also my choice because it is a method of understanding the thinking

behind choices and actions regarding human experiences. Because of its storytelling

perspective, people are more relaxed about sharing their experiences. This method

also has a conflict transformation and/or problem-solving nature.

2. Personal Context

For me, understanding and explaining the process of recovery from addiction, is

exhilarating and is part of the training I provide both in my private practice, and in

facilitating courses wherever I work such as TAFE (2003) and more recently the Life

Strategies Workshop (2007). In other words, that recovery process that frees us from

the obsession and compulsion to get the ‘high’ and ‘quick fix’ - the instant

gratification in order to avoid feeling the discomfort of our feelings. My own

recovery journey from nicotine and food addiction gave me the impetus and tenacity

to develop this competency, and it is as though the quest for recovery and

personal/professional/community development has become my new positive

addiction (Glasser 1976). In this self-disclosure I become vulnerable. Nevertheless, it

is not possible for me to document the research process without telling my story too.

Self disclosure involves how much to disclose and its relevance to the point being

made.


7

Quite often in my work I came across clients already in, or coming into, a recovery

program. These people became confused about the effectiveness of programs upon

learning from the media and word of mouth about such a public controversy between

reputable leaders. This marred the chances for the success of these programs. I heard

from several colleagues, who had been at meetings between professionals from both

sides of the abstinence versus harm minimisation continuum, how volatile and

unprofessional the disagreements had been. I had the experience of two supervisors

in different workplaces trying to influence me into supporting the controlled usage

model only, which they wrongly understood to be the only harm minimisation

model. Abstinence through 12 Steps program is also harm minimisation as perceived

by those of that approach.

By 1991, as a qualified marriage and family therapist specialising in recovery from

addictions, I had attended 12 Step meetings at the rate of nine per week and listened

to over 20,000 stories of people struggling with addictions and how they became

successful, or not. This was as a result of attending the necessary meetings with

members of the halfway houses of which I was the coordinator. Over a period of

eleven years, as the coordinator of the Metropolitan Addictions Referral Service

(MARS) and SCOPE Stress Anonymous 12 Step Group (SCOPE) - halfway houses

for people recovering from drug and alcohol problems, I had become trained in, and

witnessed the effectiveness of the disease model which relied on detoxification,

abstinence and maintenance through the AA 12 Steps model.

In 1991 I was employed by a multicultural education centre and one of my projects

was to mount an addictions education project for people of non-English speaking

background. In the process I was collecting pamphlets on different methods of

recovery and spoke with the director about also including pamphlets in different

languages from Alcoholics Anonymous, Al Anon (relatives of alcoholics), and other

similar 12 Step Programs of recovery. She frowned and firmly instructed me not to

use these as it was, according to her, against the new Health Department Harm

Minimisation Policy (NDS 1985). I was stunned and quite taken aback. As a social

ecologist, a diversity of approaches was important to my worldview and her belief

appeared to be blatantly opposed to that concept and terribly one-sided. In other

words, controlled drinking/usage was to be promoted regardless of the consequences

to the individual. Earlier that same year I had experienced a similar incident in


8

another agency. This confirmed for me that this was not a ‘one off’ incident and that

The Debate was doing damage in the recovery field.

RESEARCH QUESTION

What rationale do the professionals in the Alcohol and Other

Drug recovery field have for maintaining their oppositional

stance to each other’s models at cost to the community?

So began my journey to find out the ‘why, what and how?’ of this change in attitude

in the addictions recovery field, which emphasized controlled drinking/using as the

only appropriate model. This journey took me through more than eighty interviews

recorded on audio and videotapes here and overseas, covering many different

countries. These interviews involved people who had experienced impaired control,

dependencies, and/or what is commonly known as ‘full-on addiction’. I interviewed

leaders in the community on all sides of The D&A Debate – abstinence, harm

minimisation/reduction, health/lifestyle alternatives such as nutrition, personal

development and so on. Using a dialectic/narrative method enabled conversations

and storytelling, informed by previous experiences and interviewees, to suit the

overall project, which was influenced by a social ecology/action

research/ecofeminism way of thinking. Furthermore, it was a proactive theoretical

dialogue where participants could bring about change (Kaufman Hall 1995) and

where I was not interpreting others’ experiences, but rather involving the storytellers

in the theory and knowledge production (Horsfall 1999) through feedback of my

understanding of what they had said, and through relaying information gained from

these conversations.

As presenters at the PRIDE Youth Drug Conference (1993) in Ohio USA, Toola

Andrianopoulos (youthworker/co-researcher) and I interviewed people from

different countries. At this conference the emphasis was on “saying no to drugs” and

abstinence was considered a vital path to a healthy lifestyle. Yet we presented the

harm minimisation perspective of providing free syringes and education on safe

sex/condom use to homeless young people, in order to decrease the spread of

HIV/AIDS infection, which Australia had managed to do. Over 10,000 people were

present and it was reassuring to know that we had been invited to present this


9

perspective, otherwise I would have been concerned about our safety. The large

majority of people there were certainly extremely enthusiastic about their stance on

having a drug free society, applauding loudly at the music and dance performances

by schoolchildren clearly “saying no to drugs”. While our perspective of harm

minimisation with homeless young people conflicted with such a worldview,

nevertheless, we were well received.

Interestingly, back in Australia having interviewed people from the harm

minimisation side of the continuum such as Heather, Mant, MacAvoy, I also knew

that service providers, such as the two I had experienced had actually misrepresented

their findings. For example, Heather in his interview with me (1993) stated that he

was not against the AA model but rather that it was available voluntarily in the

community, and therefore should not be funded by government in detoxification

units as had been done previously. He also maintained that the controlled drinking

model was aimed at those people who found it impossible to benefit from the AA

model. This in fact was not contradicted by Jurd and Lennane, from the abstinence

end of the continuum, because the AA model does state that it does not work for

everyone and in such cases a person should search for something else more effective.

Nevertheless, how The D&A Debate was perceived and how the Harm Minimisation

Policy (NDS 1985) was being implemented was causing major problems in health

service provision for recovery from addiction, and clients were confused. I was

carrying that message to those I interviewed in order to raise their awareness.

So our research continued, it is the nature of this research, it had a life of its own.

Just when it seemed as though enough had been done, then another opportunity

presented itself or someone else came along with a way of thinking that created

another outcome. This led to our journey continuing on to ten more cities in the

USA, as we interviewed more people, leaders in the personal development/recovery

field. At one stage I had to promise Toola, who videotaped the interviews, that I

would not arrange any more interviews because it seemed as though I had gotten us

onto a treadmill that would not end. However, in 1999 having attended a gathering

organised in the Eastern Suburbs I asked panellist Wodak, Australia’s international

spokesperson for harm minimisation/reduction, for his opinion on the method used

by Sweden which I had heard to be effective at the PRIDE Conference (1993). His

response was that Sweden’s method had failed and that Switzerland had made


10

inroads but had still not provided the answer. I could not avoid exploring such a

statement in person. Therefore, I applied to UWS (and was successful) for funding to

go over to Europe and find out for myself as Wodak was going to be in the

Addictions Session of the Australis2000 Humanist Congress (November 2000). I was

the convener of Australis2000 and a fellow panellist was presenting my research

findings in this session. This congress was an international event (venue: UTS,

Faculty of Law, Haymarket) and the audience would consist of Humanists from all

over Australia and overseas, who were mostly scientists and professionals.

In October 2000, three weeks prior to the Congress, I flew to Switzerland, Sweden

and Holland where, in a whirlwind nine days, I interviewed more leaders in the field

of recovery. It was such an exciting time and yet I was nervous because I was alone,

handling a video camera and unnecessarily feeling as though I was neglecting my

responsibilities as convener in the final days of the organisation of the Congress,

when people on the steering committee needed my leadership and support. The

interviews were most informative; the Congress was a success – Paul Kurtz, author

of the Humanist Manifesto I and II, was full of praise; the Addictions Session was

considered inspiring. Inspiring to the extent that the conversations were carried out

amicably and an edited version was prepared by Ann Young for Channel 31

community television and played at a Humanist Viewpoints Afternoon Tea on 13th

October 2002 where I spoke on my findings again and answered questions from

those present. To date, I have as the primary researcher conducted Life Strategies

Workshops and part time TAFE Courses sharing the research outcomes.

By 1994 some changes had taken place. The prescribed text for the AOD

Intervention course showed CBT (Cognitive Behavioural Therapies), Motivational

Interviewing (stages of change), and Self Help Groups (AA/NA 12 Steps Model) as

useful modalities in recovery from dependencies. A large research project called

Project MATCH (1993) had taken place which researched and showed the

effectiveness of Twelve Step Facilitation (TSF), Cognitive Behavioural Therapy

(CBT), and Motivational Enhance Therapy (MET) later known as Motivation

Interviewing (MI). The findings claimed that there was little difference between the

three modalities and that they were considered “state of the art behavioural

treatments” (Gordis 1996) useful for the recovery process.


11

3. Overview of Thesis

CHAPTER 1: Introduction. How the Compulsions & Recovery (C&R) Research

Project came about and progressed (1991-2007) – the historical background to this

research inquiry

CHAPTER 2 Methodology. This chapter shows the research relationship between

social ecology; action research and ecofeminist/feminist action research - the

theoretical underpinnings of the research. I cover my journey both from the

perspective of my praxis and how I came across, chose and interviewed the people in

this project showing the 12 sample group. I show the basic questions used as a

catalyst for the conversations in the interviews and how questions were informed by

the previous interviews – a dialectic and narrative inquiry. This chapter shows

everyone’s stand on addictions/dependencies/compulsions recovery and more of the

historical background of The D&A Debate (Drug & Alcohol Debate or The Debate,

as it was known then).

CHAPTER 3 Interviews. In this chapter in my voice, I use the interview

conversations to show how I analysed the data for documentation in this thesis.

CHAPTER 4 Thesis: the case for abstinence. Recovery treatments involving

abstinence; what works and what doesn’t. In this chapter I begin with a literature

review and elaborate on this area of focus and what people’s perceptions are.

Emphasis is shown on abstinence and the 12 Steps model, however, I also show

some disagreement to this stance.

CHAPTER 5 Antithesis: the case for controlled drinking. Recovery treatments

involving cognitive behavioural therapies and motivational interviewing feature in

this chapter after another literature review. Also information on models used

overseas. In presenting my research findings to date in this chapter I also show the

perspectives of some of the protagonists in The D&A Debate and the summaries of

two members of the panel in the Addictions Session of the Australis2000 Humanist

Congress in Sydney (2000) – Dowling and Wodak.


12

CHAPTER 6 Synthesis: treatment matching – a combination of all treatments

which I use in my praxis as a result of The D&A Debate and the Health Department

Harm Minimisation Policy (NDS 1985). I also cover more about Project Match

(1993) which involved 1,726 participants and is another perspective of treatment

matching. As a social ecologist, diversity is important to my worldview, and this

comes together in this chapter. This chapter shows the findings of my research

including my experience with interviews in Europe in 2000 (funded by UWS) and

my being the convener of the international Australis2000 Humanist Congress in

November 2000, when some protagonists in The Drug & Alcohol Debate met and

gave their viewpoints on addictive behaviours and treatments. Furthermore, the value

to this research of having the opportunity to express my own say on that panel.

CHAPTER 7 Conclusion. My final thoughts on this work and the impact it has had

on me and those I have come in contact with. This chapter is one of reflection.

13

CHAPTER 2

METHODOLOGY

THE PHILOSOPHY & VALUES OF THE RESEARCH RELATIONSHIP

Social Ecology, Action Research, Ecofeminism, Dialectic and Narrative

The praxis of social ecology is action for change. Ecofeminism is a transformative politic which attempts to reduce the alienation between the inner and outer acting to preserve the harmony and integrity of the self, the community, and the self within the community. Therefore, ecofeminist perspectives within the discipline of social ecology, together with transformative emancipatory action research has the potential to create a dynamically stable, organically sustainable human ecological system which provides the basis for ongoing development (Davis 1993:48).

Throughout the Compulsions & Recovery (C&R) Research Project the philosophy

and values influencing my work has been a strong research relationship between

social ecology, action research and ecofeminism. This theoretical base has evolved

into a paradigm fertilised by a dialectic and narrative method, which is covered more

fully later in this chapter, through the interviews and conversations with others in the

field. I have distinguished between methodology and research methods because the

former is the theoretical framework which shaped the choice and use of particular

methods (Crotty 1998) and the latter is not only the methods used for the research

process but also how participants formed those outcomes (Kaufman Hall 1995,

Horsfall 1999). At times I refer to research outcomes also as findings because the

word ‘findings’ represents for me a process of describing and interpreting events as

they evolve and this helps me to keep clear, as far as possible, the boundaries

between my assumptions and the outcomes.

This chapter shows the merging of social ecology, action research and ecofeminism

as the methodology influencing my way of thinking throughout the Compulsion &

Recovery (C&R) Research Project, and the use of dialectic and narrative as the

method for the interviews .

1. Major Influences on Methodology

1.1 Social Ecology

Social ecology places emphasis on personal, professional and community

development (Bookchin 1990) as the basis for research and development

relationships, thereby enabling outcomes of situation improvement. Working for over

twenty five years in the social welfare field as an ethnic community worker, with the

Chapter 2: Methodology

14

last twenty years specialising in recovery from drug and alcohol addictions and

relationship counselling, enabled me to sharpen my knowledge and skills in

community work. At UWS Hawkesbury in 1991 I discovered that the approach I had

developed experientially was in fact called social ecology. That is, a process that

involved identifying an area requiring action for change; collaborating with the

stakeholders to design a plan of action; becoming personally active in the learning

process; enabling community education through the sharing of knowledge and skills

gained from the research process which thereby created situation improvement. This

process always aimed at sensitising people to the entitlement of women to have

freedom from the oppression created by patriarchal systems in our society, an

ongoing battle. This emancipation process also involved persons from such minority

groups as immigrants, Aboriginal persons, people with disabilities, children and

aging people. Furthermore, the sensitising process was also aimed at reducing

vandalism, violence and harm to our planet as a whole. This to me describes a

relationship between social ecology, ecofeminism and action research. There are

many interpretations of social ecology, ecofeminism and action research, however,

for me the common characteristics are personal, professional and community

development with the indisputable outcome of situation improvement from within

the individual and the outer – society, environment, and the planet.

When I began my studies at UWS (1991) I would ask “what is social ecology, what

does it mean?” and would get the response of “what does it mean for you?” At first

Russell’s definition of the ‘the marriage between science, art and religion’ (1992)

and that it was influenced by ‘imagination in action’ (1993 Pinn elective) satisfied

my curiosity. However, I became more excited about the words that social ecology is

a science that “draws from any ‘body of knowledge’ in its pursuit of designing

activities that result in self respecting, sensitive and social behaviours which show an

awareness of social and ecological responsibilities”(Russell 1994:148). I then came

across the Davis thesis (1993), a substantial piece of work on social ecology and its

relationship with feminism, ecofeminism and action research and the way they

overlap in the aim for situation improvement, emancipation, and collaboration. Other

social ecology characteristics are experiential learning, reflexivity, freedom and

autonomy through equality between nature and humanity, and humans and humans

(Bookchin 1990). Throughout my work of collaboratively setting up projects in the

community I have in this way been doing science and social ecology experientially


15

(Russell 1993 elective). So, when I am asked what is social ecology I say personal,

professional and community development (Bookchin 1990).

1.2 Action Research

Action research was first coined by Lewin (1948) and used by several

interdisciplinary schools such as organisational behaviour and education. This term

was also referred to by Grundy and Kemmis (1981), Kemmis & McTaggart (1988)

Reason and Rowan (1981), Bawden (1985), Packham (1993) and Davis (1993), to

name a few. An important characteristic is that research which does not have

situation improvement is not action research. Participants become the stakeholders of

the situation improvement so it is research with people rather than on people (Reason

& Rowan 1981). Another important factor is that it is also qualitative research that

has rigour without numbers (Dick 1992). Rigour is ensured through strict standards

and accountability for the inquiry and its outcomes and through critical subjectivity

(Reason and Rowan 1981). Validity and ethics were ensured through (i)

collaboration about the research process, (ii) accurate data analysis and (iv)

appropriate documentation of this process. Because of the polemic nature of The

Debate, ethical issues came up regularly in the research both in the interviews and in

the final stage such as

questions regarding how much to disclose in the final report and how much to keep out of the final report are ever present. The researcher and participants in the project – or research assistant, decide how to present the information that best captures the social setting yet will not compromise or harm any members in the study. (Janesick in Denzin, Lincoln, (Eds.), 2000:385)

In my research project, the documentation was by video/audio taping and

transcription of interviews in Mind Map form (p.46) followed by collaboration

whilst analysing the information gained. In this way the research process was

monitored strictly as is described more fully in the next few paragraphs. The

collaboration was not only with resource people close to the research such as

Andrianopoulos, Campbell, and Cassimatis, but also in the dialectic and narrative

process with interviewees – a cross referencing, cross-cultural validity with those

involved here and overseas.

The Compulsion & Recovery (C&R) Research took place through a spiral of steps

(Bawden 1985) of planning, acting, observing, and reflecting (Reason & Rowan

1981, Grundy 1981, Davis 1993) as well as collaboration with those working in this


16

research, especially Andrianopoulos and Cassimatis, together with those being

interviewed. Although this research quite often felt as though it had a life of its own,

my role as the primary researcher was to monitor the process that would unfold, yet

keeping control so that it was not just a case study (Maxwell 1984). It also involved

reflexivity: what was discovered through the research process needed to be

emphasised with those who could affect change (Armstrong 1990, Davis 1993), as in

the case of Heather being made aware that people in positions of power were using

his findings to denigrate a successful recovery program, and his response being that

he would appreciate being advised when that happens. I understood that to mean that

it was unacceptable to him, and that he would take action when advised about it. The

reflection involved critical subjectivity which included my own internal dialectic as

can be seen throughout this thesis as part of the dialectic process.

It can be seen here how the project was influenced by the action research way of

thinking by looking at the format in more detail. The interviewing was not a certain

number of questions and counting the number of times answers matched. Although

there were a considerable number of people interviewed, (over 80), this was not

research that was assessed in terms of quantitative measurement but rather

conversations that were short, to the point, posing questions that opened the

interaction – a dialectic/narrative, which in fact was research with rigour (Rowan &

Reason 1981). As mentioned earlier, to ensure rigour I had the responsibility as the

primary researcher for the validity of the information being gathered and analysed.

All interviews were either audio taped or video taped for accuracy. When processing

the information I made mind maps as can be seen on pages 46 and 48 where I also

document the value of this communication tool (p.45). Then information gained in

one interview was relayed to other interviewees and processed this way.

The questions to prompt conversations were:

what is your field of work? what has your experience been in the area of addiction? what have you heard about the cyclical schism? what have you heard of The Debate over abstinence vs. controlled drinking? what would you recommend for treatment of addiction? is it genetic? Is it dysfunctional family of origin stuff? is it learned behaviour, psychological or physiological? is it the sick spirit, stress, or what we eat and drink? how do you know what you know? now that we have come to the end is there anything you would like to say?


17

Sometimes, not all these questions were asked, that is, it was not appropriate to ask

the protagonists of The D&A Debate if they had heard of it. Quite often there were

questions not needing to be asked because the information came up spontaneously

and other questions were asked that were not on this list because they needed to be

asked as a result of the conversation process. As mentioned in the previous chapter

and earlier in this chapter, having sat through over 20,000 stories over ten years at 12

Step meetings and working in the field running halfway houses and being a

counsellor, I felt qualified to carry out these interviews in a dialectic and narrative

method. I elaborate on the method later in this chapter, but I am mentioning some of

this here as part of the spiral of steps for action research: planning, acting, observing,

and reflecting influenced by collaboration, critical subjectivity and reflexivity. I also

mention my assumptions here because they affected this spiral of steps and also show

how the method evolved, informed by action research.

At the beginning of the research my assumptions were that (i) government funding

(or lack of) was the underlying cause of the change in Health Department harm

minimisation policy (National Drug Strategy 1985) which favoured controlled

drinking/use, (ii) the most effective method of recovery was abstinence, (iii) addicts

would die whilst experimenting with controlled drinking/use treatment, (iv)

protagonists in The Debate have the wellbeing of clients’ recovery as a priority, (v)

as the primary researcher/interviewer I would be able to mediate some conflict

resolution, (vi) research findings will be of help to the recovery community.

Unfortunately government seemed to be quite influential in the dispute (Lennane

interview 1993). In my experience, government is eager to support whatever works

out cheapest and not necessarily the most beneficial, as can be seen in the Swedish

model and some of the panel summaries from the talks at Australis2000 Congress

Addictions Session (2000) in Chapter 5. However as I conducted these interviews I

became more informed on this area of focus and confirmed that there is definitely a

place for abstinence - as in the case of someone who is out of control with their

addiction, and a place for harm minimisation/controlled usage – as in the case of

homeless young people who need to learn to use clean syringes for those who are

unable to be abstinent (as specified by Mant, MacAvoy, Heather in interviews

1993). This can also be seen in the prescribed text for teaching the AOD TAFE

Course – Treatment Approaches for Alcohol and Drug Dependence (Jarvis, Tebbutt

and Mattick 2001) which was incidentally first published in 1995 and had six


18

reprints with the last being in 2001. I also designed an AOD (Alcohol and Other

Drugs) Interventions Course for TAFE which I taught for 18 weeks in 2003 and

which incorporated a diversity of these models (See Chapter 6 – Synthesis herein).

More recently, in 2007, I have become familiar with SMART Recovery at St.

Vincent’s Hospital which is based on CBT and REBT strategies, and made myself

available to facilitate meetings.

I have shown how action research and social ecology overlap and now I would like

to show the other aspect influencing my research – ecofeminism.

1.3 Ecofeminism

As I see it, the common thread of ecofeminism is a collective ecological vision of

working together towards a lifestyle that is based on respecting each other, equality

and taking care of the planet and all its occupants – similar to the social ecology

worldview. It is also focused strongly on the freedom for women from oppression

caused by the patriarchal system. In the addiction field this can be seen in the victim

role that women feel forced to take because of issues such as financial insecurity and

responsibilities that can come from being the carers in their families, whilst family

members are involved with drugs or gambling (Mellody 1989, Bradshaw 1988).

Sharp's (1984) 'middle ground' feminist concept represents for me the value of

respecting different approaches to achieving the collective ecological vision of

ecofeminism. As the primary researcher, I have an feminist worldview in the sense

that I am committed to the process of continuous social change through being freed

of a limited traditional vision by “loosening theoretical frameworks and methods,

allowing them to be antipositivist, antipatriarchal, and open-ended” (Bologh in

Reinharz 1992:178). This for me is the creative use of methods to empower

humanistic relations i.e. enabling people to interact at a level of mutual respect and

trust (Cox 1995); equality and commitment to peaceful coexistence. Being a feminist

in the sense as described by Kaufman Hall as having developed my own authority

(1995:34) and one who rejects notions of dominance and power, who prefers to

understand rather than judge (1995:35) gave me the courage to approach men and

women in positions of power and challenge their stance. This led me to diversity as a

strength, which is one of those recognised distinctive feminine characteristics (Mies

& Shiva 1988). When I use the term ‘feminine characteristics’ I do so in the Jungian


19

archetype sense that can be held by both men and women and involves creative

problem-solving (Kaufman Hall 1995).

I particularly like the strong workable relationship between social ecology,

ecofeminism and action research as they overlap and merge with the common

characteristics being change agents; addressing the inner and outer influences on self

and the planet; with a promised outcome of transformation and emancipation through

collaboration. Mills (1995), Mies and Shiva (1988) first drew my attention to the

term ‘ecofeminism’ which until then I knew as my lived experience. Another

identifying feminist characteristic has been the change in me as the researcher. This

research process began with my belief that there was one effective way for recovery

from addiction - abstinence. This inquiry has contributed to my personal,

professional and community development - an inquiry influenced by social ecology

and ecofeminist action research affecting my role as a change agent and the

dissemination of information from the findings of this research. The following

statement expresses this well:

the researcher would learn about herself, about the subject matter under study, and about how to conduct research. Many feminist researchers report being profoundly changed by what they learn about themselves. Changes may involve completely conceptualising a phenomenon and completely revising one’s worldview.”(Reinharz 1992:194)

As a social ecologist committed to ecofeminist principles of working together

towards a lifestyle based on respecting each other and taking care of the planet and

its occupants, I felt a passion about doing action research with The D&A Debate

controversy, when the protagonists were seen to be arguing bitterly and affecting the

community. Apart from three or four introductory questions, each interview had a

character of its own. I had heard from some AA members that this conflict was one

that occurred every 10 or so years where there was a swing away from the AA

recovery program and then back again – what I called a cyclical schism. My intent

was to speak to the leaders involved in the conflict and find out what their rationale

was for the stance they were taking. One of my assumptions was that surely it was

everyone’s agenda to provide recovery services for tormented addicts, so why was

there conflict? The interview method was a dialectic and narrative inquiry which I

elaborate on now.


20

2. Dialectic as both Methodology & Research Method

“Dialectic: development not only change, derivation not only motion, mediation not

only process, cumulative not only continuous” (Bookchin 1990). As a research

method I chose dialectic – The Socratic definition as derived from the Greek word

‘to converse’ or ‘to discourse’ meaning a conversational method of argument

involving question and answer (Flew 1984:94). Others who expanded on that

concept were Kant, Hegel, Marx, and Engels (in Honderich, 1995:198), to name a

few and which is not the aim of this thesis to elaborate on. My use of dialectic is a

more practical definition, not a philosophy. The notion of “a view that development

depends on the clash of contradictions and the creation of a new, more advanced

synthesis out of these clashes” (Abercrombie, Hill, & Turner 1984:70) appealed to

me. This was because it was a choice that came about through the character of The

Debate – professionals who disagreed about recovery options and who were quite

passionate about expressing their views which affected government funding and the

community. The words thesis, antithesis, synthesis, stood out for me as the

foundation of this process and not so much in the Helgian sense but rather in the

Greek Socratic meaning which I expand on in the relevant chapters (Philosophy

Pages website 2007). I anticipated I could obtain the different perspectives (thesis

and antithesis) and through the process there would be a transformation where an

appropriate diversity of approaches (synthesis) would become clearer, in this way

explaining the stances of those in The Debate to inform the community. This

outcome would not necessarily rely on the protagonist agreeing with it, although the

ideal would be that such an agreement could take place. What was important was that

the information gained would be accurate and of assistance to the community.

Murphy (1972) in looking at the works of those such as Marx, Freud, Durkheim,

Weber, Kant, Hegel and more, in his book theDialectics of Social Life (1972) stated

that contradictions are existential to humanity and show that humans are both the

shapers and the victims of their society. Dialectics are not symptoms of rebellion but

rather expressions of viewpoints contributing to evolution of thought and actions. So

in that sense, dialectic as a research method for this C&R Research Project became

the vehicle for evolution of thought and actions of protagonists on The Debate

continuum, as well as those who were not involved in the dispute. Interviews were

dialectic because they consisted of conversations carrying information from the

previous interviewee and/or my knowledge as a professional in the addictions


21

recovery field. In this way information was exchanged, and disseminated to others -

“the power of the dialectical interaction”(Guba 1990:234).

There were others who were not only protagonists on the continuum of abstinence

vs. controlled drinking, professionals who used both methods of recovery, but also

those who were searching for information about what to do and how to go about it.

For example, those who focused on what the role of nutrition and spirituality or

enlightenment is in being free of addiction and even preventing addiction. So some

interviews focused on persons who had expertise in those areas. There were also

interviews that had to do with the influences on the methodology as in the case of the

interview with Woog (1993) regarding social ecology at UWS Hawkesbury.

However, for this thesis I concentrated on transcribing and analysing conversations

involving twelve of the eighty people I had interviewed as well as using the

summaries of two of the protagonists Dowling and Wodak who participated in the

Addictions Session panel of the Australis2000 Humanist Congress which also

included Cassimatis, Jurd and myself presenting my findings (I was also the

convener of this international Humanist congress). This sample group were those I

considered to be representative of leaders in The Debate. I used Mind Mapping

during the inquiry, summarising the outcomes of each video/audio taped interview

thereby informing the process for the next interview. I then used the transcribed

interviews of the twelve professionals, my experience and literature review for

documentation of this research. In analysing the data (Chapter 3) I identified the

interviewees’ stance in the recovery field and the key issues in our conversation

which contributed to the argument. I also discussed my thoughts on their statements,

pointing out some moments of agreement between them. This process also showed

how when I gave each one the information I had received from another interviewee,

the recipient was more willing to clarify or become more mellow about their stance.

This sometimes created an “Ahaa” moment for the participants in the research. As

can be seen, I elaborate on this in the next paragraphs and more so in Chapter 3.

The dialectic method created personal, professional and community development as

can be seen in the next few paragraphs – the evolving development at these three

levels. With each interview the data gathered was analysed, discussed, some

agreement reached and then presented to those concerned and further discussed for


22

the next interview, and in that interview. This agreement reached could be seen at

times in interviews with me, when people conceded agreement about certain aspects

of recovery, even if they were on opposite sides of The Debate. For example,

Heather (interview 1993) stated that he became interested in 1975 upon “reading an

article about some alcoholics return to controlled drinking…some people not all

people” and yet if a man with long term sobriety in AA came and asked to try

controlled drinking he would tell him he was crazy to give up something that

worked. He said “we need alternatives to AA, we don’t want to eliminate it”

(interview 1993). This is an example of how I had information gained from this

interview to develop the approach for the next interview. Another interviewee from

the abstinence side, Jurd, reached agreement by conceding that AA and abstinence

did not work for all and that it was an accepted fact in the AA movement. In fact he

said that the AA Big Book (1938) mentions those who can control their drinking, and

felt that AA first coined the term controlled drinking as such. Mant mentioned in her

interview with me (1993) that AA worked but controlled drinking as a harm

minimisation program was a good alternative for those who resisted AA. Should

harm minimisation not work then she referred them to AA.

I could relate to these comments because I had clients in my private practice who

needed to try controlled drinking in order to convince themselves of their impaired

control, or otherwise. Once they discovered that they had impaired control they were

eager to explore AA. Others discovered that they were able to take control of their

drinking and did not need to attend AA. The latter involved counselling that was

focused on social learning theory (Morris 1988) cognitive behavioural therapy

(Kendall & Hollon 1979; Geldard & Geldard 2001; Jarvis, Tebbutt & Mattick

1995), and motivational interviewing (ibid; Miller & Rollnick 2002).

Initially I had hoped that through me as the ‘messenger’ or ‘mediator’, the dialectic

format would enable the interviewees to reach an agreement, a synthesis, even if only

to agree to disagree. How effective would it be if this dialectic took place through a

mediator in individual interviews and not all coming together in one meeting place?

Actually that was more than the intent of the research and it did hook in my

imagination. As mentioned throughout this thesis, disputing professionals was most

confusing to the community and my intent was to clarify the thinking behind the

dispute for my benefit as a therapist and, in turn, the benefit of the community - if


23

some conflict resolution was achieved, then even better. The dialectic could also be

the vehicle for ethics and evaluation of the research process through these

conversations, and supporting the rigour required.

There was my internal dialectic, a meta communication, a self reflexivity – the “why

the ruckus?” and “what really works?” “how do we avoid the dogma of appearing to

think there is only one solution?” and “what am I doing about it?” These questions

helped me to fuel the dialectic – putting on paper the chatter in my head, taking these

and new questions onto the next interview. The internal dialectic also served as the

evaluation of the ethical process – “how are my biases and assumptions affecting the

conversations?” “how is this affecting me?” “how is their personal ecology being

affected?” and more. These questions are addressed.

As the research process unfolded, through my internal dialectic and the interviewing

dialectic, I sensed as though my role was evolving into a mediator subtly

contributing to the transformation of the conflict through these interviews. This

transformation was taking place as conversations informed the topic that was so

volatile previously that it had caused a polemic between leaders in the addictions

field. Lennane, a strong protagonist for the abstinence side, admitted in her

interview with me (1993) that youth drinking education projects were vital. Heather,

Mant and MacAvoy from the harm minimisation/controlled drinking side confirmed

that they are definitely not against AA and abstinence. This meant that I had the

evidence on videotape and service providers could not misrepresent information

from leaders such as Heather, Mant and MacAvoy.

3. Narrative Approach

3.1 Narrative Theory: why I chose narrative approach? I used a narrative approach to

enhance the dialectic method. As mentioned previously, the dialectic method is a

process of thinking by means of questioning, discussion, debate, or argument, in

conversation, which was demonstrated as early as ancient Greece by Socrates

(Philosophy Pages website 2007). This dialogue is complemented by the storytelling

nature of the narrative approach. That is why I chose this method, which is

furthermore identified as a natural observation and documentation of human

experience, as perceived by protagonists of the behaviour patterns that have

manifested. More so, my choice has been because it is a method of understanding the


24

thinking behind choices and action that involve and affect individuals and the

community at large. Through narrative inquiry such findings are made possible more

easily because individuals are more relaxed about telling their stories and when

documented reliably, invaluable information is forthcoming. An added benefit is that

the natural result of narratives has the promise of conflict transformation and/or

problem-solving, which was also the secondary aim of this research. There is a

difference in narrative research between (i) narrative inquiry theory, (ii) narrative in

the field, (iii) field text and (iv) research text which I elaborate on in this section. I

show the difficult transition which can happen when moving from field text to

research text.

When Chase (in Denzin & Lincoln 2005:651) stated that the “narrative inquiry in the

social sciences is flourishing” I agreed wholeheartedly and at the same time whirling

around in my mind was the question “wasn’t it always flourishing?” Indeed, even

before Dewey (1922, 1929, 1938) highlighted experiential learning and narrative,

researching human experience was explained often by narrative. Gergen and Gergen

(1986) who argued for narrative to link and explain observed events of development,

highlighting how this was demonstrated by Piaget, Freud and the learning theorists

when they constructed a narrative around the plot of the expected life course

(Kirkman 2002). However, Dewey’s way of thinking was more of a major influence

in the work of more recent researchers and educators such as Clandinin, Connelly

and Michael (2000) who remind us of the multi-disciplinary character of narrative

research. Their view was drawn from researching the forms of inquiry of Geertz

(1988, 1995) and Bateson (1994) in anthropology, Polkinghorne (1988) in

psychology, Coles (1989) in psychotherapy, and Czarmiawska (1997) in

organizational theory. These protagonists of the narrative, storytelling, experiential

method of research prefer this way of thinking and working. Narrative therapy is an

effective approach for relationship therapy (White & Epston 1990, White 1995) and

contributes to talking therapy which is also useful for addiction recovery and which

is an approach I favour in my private practice. I believe it is also the approach which

creates the therapeutic process in the 12 Step model where people are given the

opportunity to share their stories without interruption or advice giving, enabling them

to hear themselves tell their stories and even discover solutions to their problematic

behaviour. Because I have a preference for the narrative therapy approach this

enables me to be more comfortable with narrative research.


25

Nevertheless, my drawing attention to how old this approach is may have been due to

my preference for the narrative storyteller method of gathering and disseminating

information. This preference is, I am certain, also influenced culturally by my Greek,

Austrian, Hungarian and Russian background (immediate grandparents), peppered

with the fact that I was born in Romania and came to Australia, with my family as

refugees, when I was six. For me narrative and storytelling has been, and still is, an

effective cultural communication style. I believe culture and language is of

uppermost importance to any form of research. Culture and language in the sense

that we need to use language and norms understandable and relevant to those

involved in the research. For example, in research with young people of ethnic

background, it is vital to be empathic to the influences and language expressed by

them. Furthermore, it is important to keep narrative distinct from discourse, both of

which relate to language. To do this, the unit of analysis needs to emphasise the

individual actor (narrative) rather than the language (discourse) used in the

storytelling. Another clear distinction is that plot and time are inherent in narrative

but not discourse (Wetherell, Stiven & Potter 1987). For someone bi-lingual like me,

clarifying this aspect means that narrative has clearer disciplinary boundaries which

can at times become blurring (Kirkman 2002).

Then again, one might say that the influencing factor of whether a researcher prefers

narrative and storytelling depends primarily on their personality type. Hippocrates

(circa 400 BC) in ancient Greece, Jung (1921), Myers-Briggs (1958), and more

recently Littauer (1997) are among those who studied the communication styles of

people, and their findings showed that those more likely to enjoy narrative and

storytelling are primarily Sanguine and Choleric personality types. Nonetheless, all

personality types can learn to develop the knowledge and skills to research and

communicate through narrative and storytelling. As a Sanguine Choleric personality

type, I can also justify my preference for narrative and storytelling methods of

research. Finally, as mentioned previously, as a therapist, I also use narrative therapy

effectively (Epston & White 1990, White 1995) and this has especially influenced

my choice in research method greatly.

I have been more successful with community education when using a dialectic with a

narrative storytelling approach about experiences and information gained. Added to

this combination I have an insatiable curiosity, which has fuelled my research


26

journey, spurring me on to speak with numerous people influencing The D&A

Debate in order to get their perspective on their choices causing the dispute - choices

which had affected funding and in turn the recovery community as a whole.

Dewey emphasised that “experience is both personal and social” (in Clandinin,

Connelly & Michael 2000:2). This can be seen in the context of individual

experiences in relation to community and culture, which is vital for developing

workable life strategies. More importantly is the relationship between narrative

inquiry at the personal level and its affect on the community and social change. I

believe that Dewey is a storyteller of narrative inquiry outcomes. Whenever I read

his work it was not only thought provoking but extremely ‘reader friendly’ - easy to

read and understand, also to apply in practice. Learning strategies such as

Imagination in Action, (Pinn UWS Elective, 1993) contributed to accelerated

learning experiences for all participants. Such experiential learning I believe was

greatly influenced by the Dewey paradigm.

In this way Dewey has also greatly influenced my way of thinking, especially

because as an educator and ethnic community worker or social ecologist, I related to

his notion that experiences grow out of experiences and lead to further experiences,

and this has been the basis of my life’s work – my praxis. Apart from passing on

knowledge and skills on a one to one basis, as we experience learning we discover

other experiences which lead us to new experiences.

In looking at narrative I am mindful that there are many different types of narrative

inquiries, “oral or written, and may be elicited or heard during fieldwork, an

interview, or a naturally occurring conversation” (Chase 2005:652). In my research

the narrative used was one that elicited oral interviews, purposefully involving

naturally occurring conversations. I did not have a lengthy questionnaire but rather a

few questions that were relevant to that person’s field and aimed at stimulating

conversation so as to get their viewpoint on The Drug & Alcohol Debate and

recovery choices. This also gave me the opportunity to inform each interviewee

about how their position or choice was perceived by the community at large, which

was a method of conflict resolution because not only was the D&A Debate conflict

creating confusion in the recovery field but it was also causing a lack of respect for

the professionals and agencies involved. When I challenged an interviewee I used a


27

respectful ‘fact finding’ approach even if I did not agree with their stance

completely. This enabled me to establish rapport with them in order to give them

another perspective that may be opposite to their stance. Quite often interviewees

admitted that they were not aware of the information, situation, or development,

which I told them about. At times such as those, I felt as though I was making a

difference in the conflict, and proving to myself and the community that dealing with

different worldviews need not be conflicting, but instead a sharing of knowledge and

skills resulting in developing a diversity of approaches. Such an outcome is achieved

more efficiently through a dialectic and narrative method. People can relate more

effectively through conversations and information sharing, becoming educated by

experiencing such a process. An example of the effectiveness of this process can be

seen when people attend meetings where the speakers self disclose about how they

experienced personal and professional development in recovery.

Another perspective of narrative is that of Mancuso & Sarbin, (1983:233) which

states when “the narrative principle” is seen as “a fundamental guide to human

thought and action” psychologists can consider the reasons given by people for their

acts, including the context of time and place in which these acts and the narration

take place. In anthropology, illness narrative is largely used to understand how

people deal with the experience of chronic illness. Anthropologist, Good (1994),

argued that narratives locate the illness in relation to the subject, events, and people

associated with the sick person such as family members, which is vital to

understanding the experience. I mention these different perspectives of narrative

because narrative theory, or mode of thought, is interdisciplinary which at times is a

blurring of disciplinary boundaries as well as having imprecise boundaries between

data, method and theory as pointed out by Kirkman (2002) when she also mentioned

Carr (Carr, Taylor & Ricoeur, 1991) stating that narrative is “fast becoming a

discipline in its own right”.

I have used references from a variety of fields to show how narrative inquiry as a

research method complements the dialectic method which together aptly suit my area

of research about compulsions and recovery.

3.2 Narrative Field: In narratives the researcher needs to have a balanced approach of

becoming comfortable with the intimacy of being a part of the group, as well as the


28

ability to be distanced when necessary, so as to not take over (Clandanin, Connelly &

Michael 2000). In my case, I felt part of the group from the beginning and became

more informed with each interview, yet I was constantly sensitive to the fact that I

was the researcher, whether I was sharing as a professional or as a person with the

experience of recovery (food and nicotine addiction). I also consciously paced

myself so that the focus was on the person or persons I was interviewing and that the

process was a narrative as they shared their stories. I participated by bringing stories

from other interviews to the table and when appropriate my own personal

experiences. This was the tension I experienced through the whole period of the

narrative where I was constantly attempting to balance being fully involved yet

respectfully holding back, so as to keep an acceptable distance without alienating

anyone. There were people I felt at ease with and there were others who I felt

threatened by before I met with them. Once we began the discussion all was well as

my thirst for information and learning meant that hearing their stories was usually

exciting.

For nearly two years I had a co-researcher, Toola Andrianopoulos, who was a

youthworker working with me at the Wayside Chapel and later the Stansfield Project

and who joined me for the trip to USA. During that period the interviewing was so

much more enjoyable because not having to handle the equipment made it less

stressful for me. Then discussing what had taken place in an interview afterwards

was rewarding and we made audiotapes of those discussions. Also during interviews

Andrianopoulos would fuel the narrative by asking questions and making comments

and the interviewees’ responses have been included in the outcomes shown in this

thesis. This process contributed to developing the relationships to a level of trust as

in the case of Cassimatis asking Andrianopoulos whether she felt her question had

been answered. Comparing each others interpretations, which were all valid, was an

enriching experience and is known as the narrative relativism which complements

the narrative truth as we each perceived it and which enhanced our individual values.

With each person I met, some stories were retold as I passed messages from one to

another and video taped these. Then I discussed these conversations with other

professionals such as my external consultants Cassimatis and, to a lesser degree,

Campbell and Jurd – all three are psychiatrists experienced in the recovery field

who were often available to be consulted by me. This reconstruction of experience

from the narrative inquiry, as Dewey referred to it, also happened when I taught


29

alcohol and other drug interventions courses such as those at TAFE (2003). Over

time this meant the information I provided had evolved from all the stories of those

people I had spoken to, with and without Andrianopoulos. As I shared my findings

from interviews with those people who spoke the addictions language, my

knowledge of this area evolved. I did not keep copious field notes because I lived

this research, in conversations with others, sharing stories, exchanging knowledge

and skills, and formulating policies for the organisations I worked in and for the

personal and professional development courses I conducted for training counsellors,

youthworkers and individuals who participated in Life Strategies Workshops which I

facilitated. In designing these courses the research process was documented.

Even though narrative is looked upon favourably by such renowned researchers as

Clandinin, Connelly and Michael (2000), I had been challenged in the scientific

community by some who still did not consider narrative to be a “serious” method of

research. Their reasoning had focused on the issue of “fact versus fiction” in

narrative inquiry (ibid). Another reason given for this positivist outlook was that

narrative does not have such formal systems and rigour measurements as that of

quantitative research. However, qualitative research provides reliability through the

dependability of the data (Polkinghorne 1988); validity (as it is an interpretive

concept) when the analysis is accepted as plausible and credible (Bruner 1990); and

generalisability depends on the recognition of outcomes (Grieve 1992) and is

established on theoretical not statistical principles (Hollway 1989). For these

purposes I had video taped my interviews so that I could not only hear the

interviewee stories but also that I could see the body language accompanying their

words and thoughts. This method was extremely helpful because my interpretation of

their comments was either confirmed, or sometimes modified when I played back the

taped interview and realised how my assumptions had influenced what I had

understood. In other words, in playing the tapes I became certain of the accuracy of

what I was analysing and documenting, that is, discovering how people made sense

of their choices and how they accepted other perspectives. Not only did I document

this information into Mind Maps but also personally typed transcriptions of the

interviews.

Working in a three-dimensional inquiry space emphasises the importance of those

involved in the inquiry having the ability and the opportunity to go backwards and


30

forwards in time in their stories. Equally important is being able to look inwards and

outwards and being in the present. In other words remembering stories contributes to

the narrative inquiry, which also includes the experiences of the inquirer. As I spoke

to the research protagonists, quite often I found myself remembering my journey in

recovery from food and nicotine addiction as well as that of the clients I worked with

and this enabled me to maintain an active role in the inquiry, fuelling the

conversations. This can especially be seen in my interview with Mellody and

Mellody where I introduce my own personal story with food addiction.

3.3 Field Texts - Conversations, Taped Interviews, Courses: My experience with

narrative field text was when I began my interviews with the people involved with

The Drug & Alcohol Debate. At that time the dispute they were involved in was not

only causing members of the community confusion but also to me, as an experienced

professional in the field. I needed to understand how they made sense of their stance

as leaders in the recovery field and as professionals. This was because their

behaviour was considered unprofessional (Pollard interview 1993) and I was eager

to have conversations with them – a narrative inquiry, where I could hear their

answers to the confusion they were creating in the community. I suspected that each

had their story and it could be of value to know their way of thinking. I could not

believe that professionals would make public claims that were not factually based

and, therefore, was eager to hear their reasoning. Some thought it naïve of me,

nevertheless, that did not dissuade me from my inquiry. I first met with Jurd, one of

the protagonists who was known to me, as I felt less threatened by that thought. I

experienced the shifts and changes that researchers face when they enter the field and

with that process negotiating and re-evaluating the course. This meant being flexible,

open to changes but also proactive in arranging interviews with the actors in this

drama (Clandinin, Connelly & Michael 2000). Some were leaders on opposite sides

of The D&A Debate, powerful positions in the conflict, whilst others were open to

providing service that allowed for client’s choice, and some were clients who had

mixed experiences in recovery (Con interview 1993).

Field texts are all those processes and tools which capture the inquiry experience in

order to remember what took place for the analysis and for the final documentation

phase. As Clandinin, Connelly & Michael (2000:83) remarked “Field notes,

photographs, students’ written work, teachers’ planning notes are all field texts that


31

help us step out into cool observation of events remembered within a loving glow”.

Also shown as field text are research interviews. My field texts consisted of video

tapes, mind maps on comments by each interviewee, course notes for training

counsellors and their learning outcomes (both in role plays in the class and written),

feedback forms and comments from participants in Life Strategies Workshops, taped

conversations about the research - between other researchers, my supervisors and

myself. Another form of field texts that I used were the genograms (family trees and

information) of clients. Listening to over 20,000 stories in the 12 Step Program

meetings was the most informative example of field texts for me. The sheer number

of stories repeating the same types of experiences made them unforgettable, which

was fortunate because the information is not permitted to be written about or taped,

at these meetings. My mind feels like a huge blotting paper and the strength of my

curiosity has enabled me to recall the landmark stories immediately. This can also

come under the category of life experience as a source of field texts. It is interesting

to note that this is another amazing example of the power of storytelling – how it

captures our attention; gives us a method of developing life skills through role

modelling; provides a reliable method to remember the lessons (without writing it

down); and trains us to pass these on to other students of life.

“Relationship is the key to what it is that narrative inquirers do” (Clandinin,

Connelly & Michael 2000.189) and I believe that the ability to develop research

relationships is valuable for researchers. I often honed my relationship skills to gain

interviews with people who were vital for this research. I focused on developing

rapport so that they would not feel threatened to share their stories with me as

honestly and willingly as possible. Having dependable relationship skills also meant

being able to make a difference to the conflict, by being a part of the information

exchange from one interviewee to the other. Information about the issue contributes

to resolving a conflict or problem and I was certain that when I made public all

perspectives of the conflict in a rational way, then the solution would become more

apparent. Importantly, I would understand how they made sense of their stance as I

was convinced that something worthwhile would evolve from such an inquiry.

3.4 Research Text: In narrative inquiry we move from theory to field, to field text,

and then the transition to research text. This is when we shift from dialectic,

conversations with participants, to retelling their stories through research texts, and


32

this transition can be difficult. This is the interpretive analytical phase in which we

need to “fight against our desire to let field texts speak for themselves” (ibid:130). At

this stage research material file management is vital. In a narrative method we are

tempted to let the field texts speak for themselves and that is a potent pull whereas

findings need to be in the voice of the researcher.

As a researcher it is the dialectic, narrative method and this way of thinking that

enhanced my research journey and without this method I am certain I would not have

undertaken nor completed my research. This is a workable method because

“narrative inquiry is a form of living” (ibid:89) and I was living and sleeping the

process as well as feeling personally connected to the stories of each interviewee as

they lived their mode of thought (Kirkman 2002). As a result, my way of thinking

changed by the end of the research from leaning more to one side of addiction

recovery, to reaching a stance of supporting a diversity of approaches which I

elaborate on in Chapter 6 – Synthesis, showing how the afflicted person can have

options to choose from, whatever works for them in gaining and maintaining their

recovery.

Narratives have influenced various areas of knowledge such as anthropology,

psychology, historical fact finding, biographies, fiction writing, research, therapy,

community education, legal action, philosophy, and so on. This shows how

widespread this approach has become.

3.5 Writing Research Text: In order to avoid taking what a few may say as fact, I

made a commitment to interviewing as many leaders in the recovery field so that I

had many perspectives from several points on the The D&A Debate continuum –

several from the medical-abstinence model, several from the behaviourists-controlled

drinking model and several from synthesis-diversity of approaches model. In this

manner consistent patterns immerged from interviews which supported each group’s

stance.

I chose a narrative inquiry approach with a dialectic method because it involved not

only collecting and analysing stories but also living and telling of the experiences

(Clandanin, Connelly & Michael 2000) so that there could be an understanding of


33

what took place with The D&A Debate polemic and what choices there can be for

those in the community seeking recovery.

4. Stages in the Research

The Compulsions & Recovery Research Project comprised four stages. Stages 1, 2, 3

and 4. (Stage 1) the project action plan, (Stage 2) the interviews and (Stage 4)

convening the Australis2000 International Humanist Congress which had an

Addictions Session and more interviews overseas (Europe). Stage 3 was the

Stansfield Program Action Research which involved setting up a program for Wards

of the State who had been affected by addictions and who benefited from a

synthesised recovery program. In other words, a program which was a combination

of education on drug abuse, controlled usage (harm minimisation) and abstinence. As

the coordinator/primary researcher I influenced the design to be a stand alone

ecofeminist action research project which has been fully documented elsewhere

(Affie 1998) and which I will not elaborate on in this thesis.

In the late 1980s because of the conflict between professionals in the addictions

recovery field which was coined The Drug & Alcohol (D&A) Debate, interviewing

began as part of the Action Plan in Stage 1 of the Compulsions & Recovery (C&R)

Research Project in 1992 with Jurd (full interview transcript in Affie 1992).

Then as part of Stage 2 I interviewed people through my work as the Director of

Social Services at the Wayside Chapel during 1992 and 1993. For example, Basten

was a consultant for the Wayside Chapel training course, and he advised me that the

person whose work had influenced the Health Department Harm Minimisation

Policy (NDS 1985) was Heather. I interviewed Basten twice, once audiotape and

then on video, when I also attended one session of his Psychology of Addiction

Course, Centre for Continuing Education, Sydney University. Later I interviewed

Heather who had extensively researched this topic and co-authored works such as

Controlled Drinking (1981). An extensive amount of the interviews took place at the

PRIDE Youth Drug World Conference in Ohio, with delegates from all over the

world. Furthermore, Andrianopoulos, my co-researcher/youthworker, and I took the

opportunity to continue throughout several cities in the USA (1993) to speak with

more leaders in the field. Interviewing would take place whenever we came across

someone who we thought had an interesting perspective on addiction. At first, in


34

Sydney, I used a cassette recorder. Later when Andrianopoulos became a co-

researcher, at her suggestion, she filmed the interviews with a video camera unless

they needed to be audiotaped for confidentiality purposes i.e. people struggling with

addiction.

Stage 3 of the C&R Action Research Project involved interviews with the Wards of

the State through our work at Stansfield Program, their stories about addictions in

their families, and their own drug use which I audiotaped. In this stage there was a

separate stand alone action research project (Stansfield Action Research 1998) to do

with Wards of the State who had been faced with addiction issues and is not covered

in this thesis because it has been documented elsewhere (Affie 1998).

Stage 4: I videotaped people I interviewed in Switzerland, Sweden and Holland on a

trip in October 2000 funded by UWS Hawkesbury. Previously in 1999 I became the

volunteer convener of the Australis2000 Humanist International Congress. Wodak

was invited as a protagonist of the harm minimisation group, to participate and he

accepted and chose the topic – a more effective response to illicit drugs. So, as the

convenor, I invited people with various perspectives to form a balanced panel (harm

minimisation through to abstinence) as part of an Addictions Session. On this panel

were Wodak with his topic A more effective response to illicit drugs; Jurd

presenting an abstinence model – No half measures in addiction recovery;

Cassimatis – Society’s solution to the drug problem (through community

responsibility); Dowling, Humanist physicist – Illegal Drugs Law – (disclosing the

truth about drugs); Ellis-Jones who chaired the Addictions Session – spoke on SOS

(Secular Organisation for Sobriety – Save Our Selves) a secular version of AA; and I

presented some of my research findings including an update of the recent interviews

in Europe – Diversity in alcohol & other drug treatments.


35

5. Addiction Stories & My Praxis

At this point it is also important to elaborate on what I mentioned earlier, that as a

drug and alcohol worker since 1983, when I was the founding co-ordinator of MARS

(Metropolitan Addiction Referral Service) and SCOPE, I ran halfway houses for

people recovering from alcohol and other drug problems. Subsequently, I have

listened to over 20,000 stories about addictions. My role, in some cases, was to

attend 12 Step3 meetings with residents who were new to the halfway houses. As a

person recovering from nicotine and food addiction myself, I also attended such

meetings for my own benefit. As a community worker I facilitated 12 Step meetings

in community centres such as the Wayside Chapel (1992-94) where I successfully set

up Overeaters Anonymous (OA); SCOPE (Stress Anonymous); Nicotine

Anonymous (NicA); Co dependence Anonymous (CoDA) - women only meeting;

Sex & Love Addicts Anonymous (SLAA) - women only meeting. Alcoholics

Anonymous (AA) was already existing in the Wayside Chapel. I set up the CoDA

and SLAA meetings for women only because there appeared to be a need for such

closed meetings apart from the mixed men and women meetings already in existence.

This proved to be a successful choice as there were record attendances of 30-40

women at each meeting in the early days, as was attendance for NicA. More recently

in 2007 I have assisted in the setting up of an OA meeting at the Wayside Chapel.

Through my work from 1983 to 1994 I attended at least five (sometimes nine) 12

Step meetings a week at which at least seven (sometimes 10) people shared, making

at least 35 stories per week (sometimes 40-90) resulting in a minimum of 1,820

stories per year over 11 years, all in all a total of over 20,000 stories. The meetings I

attended were Alcoholics Anonymous (AA); Alanon (family and friends of

alcoholics); Narcotics Anonymous (NA); Naranon (family and friends of addicts),

Overeaters Anonymous (OA); Nicotine Anonymous (NicA); Sex & Love Addicts

Anonymous (SLAA); Co-dependents Anonymous (CoDA); SCOPE (Stress

Anonymous), Debtors Anonymous (DA). Whilst in the USA Toola and I also

attended a SLAA Convention which was extremely well organised. The 12 Step

meetings I have not yet attended are Gamblers Anonymous (GA); Prescribed Pills

Anonymous (PA); Alateen; Adult Children of Alcoholics (ACoA); and the off-shoots

GROW and SOS (Secular Organisations for Sobriety), although in 2007 I have

attended SMART Recovery which is a secular CBT based model and am becoming a

3 Commonly known as Alcoholics Anonymous 12 Step Program et al


36

facilitator for this group (Chapter 6). In this period of time I also trained with Unifam

Marriage and Family Counselling Service and in 1987-91 became their “roving”

Marriage and Family Therapist for Petersham, Parramatta, City, Kogarah, and

Gosford branches. Also, through my part time private practice, together with the

members of the SCOPE Board, I ran the SCOPE Halfway Houses for people

recovering from addictions. The recovery model we used in SCOPE was the 12 Steps

model which I was trained in when I worked with the Metropolitan Addictions

Referral Service (MARS) Halfway Houses in 1983-86. Also when I worked in 1992-

94 at the Wayside Chapel, as the Director of Social Services, I was involved as

course trainer and supervisor for the Crisis Centre and the Shepherd of the Street

Youthwork Programs. In this role I use a diversity of approaches in the training

course.

In 1993 I was sent by the Wayside Chapel to present a paper on addictions at the

PRIDE Youth Drug World Conference in Ohio, USA, attended by 10,000 young

people and some adults. Andrianopoulos, who also worked for the Wayside Chapel

was a qualified Youthworker/Welfare Worker, who joined the C&R Research Project

and filmed the majority of interviews in 1993. She also became the co-presenter at

the PRIDE Conference in Ohio where we presented a paper called Addictions –

Abstinence and Harm minimisation OHIO PRIDE Conference Paper. As the

Conference theme was “say no to drugs” our presentation in itself needed to be very

sensitive to the USA organisers’ worldview, making sure they got the perspective

that we supported the supply of syringes to, and education on condom use for,

homeless young people in order to reduce the spread of HIV/AIDS infection in

Australia and not that we condoned addiction or promiscuity. At the PRIDE Youth

Drug World Conference in Ohio, USA, we seized the opportunity to interview

people from all over the world. As mentioned earlier Andrianopoulos and I took our

holidays so as to make a quick tour from Ohio around through Boston, Washington,

New York, Minneapolis, Portland, San Francisco to Los Angeles where we caught

the airplane back to Sydney. This was in order to interview leaders in the personal

development/recovery field whilst in the USA.

I summarised my background and introduced Andrianopoulos, my co-researcher, in

more detail here, to show what experience she and I brought to this research. I chose

to interview people outside Australia’s The D&A Debate because what they had to


37

say contributed to the history of the polemic taking place as a result of the harm

minimisation/reduction movement worldwide – Bishop, Campbell, Cassimatis,

Mant, MacAvoy, Heather, Jurd, Lennane, Maclaine, Mellody and Mellody, and

Stewart, (interviews 1993); those interviewed in USA and at PRIDE Youth Drug

World Conference in Ohio, USA; Wodak, Dowling, Ellis-Jones 2000;

Kerssmakers, Marxer, and Haemmig interviews in Europe 2000)

6. How the Interviewees were Chosen

Who we planned to interview was a combination of my experience and knowledge of

the subject, complemented by consultation with Andrianopoulos, the co-researcher

and suggestions from previous interviewees, peppered with spontaneity and

serendipity, as can be seen throughout this thesis. As a worker in this field, apart

from my knowledge of leaders in the field such as Jurd, Lennane, Mant, MacAvoy,

Maclaine, there were those personally known to me such as psychiatrists, Campbell

and Cassimatis with whom I collaborated as I became more informed on the subject,

and when I wanted to check out ethical issues as well as Jurd. Also Dowling,

Wodak, and Ellis-Jones I had not interviewed but spoke with them in person at

different times, nevertheless, they gave their perspectives at the Australis2000

Humanist Congress as part of the panel I was a participant on with Cassimatis and

Jurd. I specifically met with Mattick (NDARC) in 2007 to gain an update. At the

same time (2007) I gained updates from Fixter (Health Dept. Drug Strategy Branch),

Jurd and Cassimatis along with seven detox/rehab services which are mentioned

in Chapter 7 - Conclusion.

At the beginning of the research, I knew that I needed to maintain a balance between

interviewing those on the abstinence and harm minimisation continuum and so I

made sure that on my list were such names as Heather, MacAvoy, Marxer (Low

Threshold Safe Injecting Centre – Berne, Switzerland), Mant, and Kerssmakers

(Jellinek Prevention Team, Amsterdam); as well as those who were leaders in the

abstinence 12 Steps field such as Jurd, Lennane, Mellody and Mellody; and a few

people who had benefited from recovery in both abstinence and harm minimisation.

The research mostly focused on the leaders in the field rather than consumers or

clients because my intent was to clarify the conflict between the leaders (The D&A

Debate as it became known). Campbell, Cassimatis and Stewart I chose as part of


38

my sample group because at that time they were the professionals in a position to

speak about a diversity of approaches, the approach I have named the ‘synthesis’.

There were those who agreed to be interviewed confidentially (audio tapes),

members of the 12 Steps programs such as Alcoholics Anonymous, Overeaters

Anonymous, Sex & Love Addicts Anonymous, Narcotics Anonymous and so on.

These people praised the twelve step program for their recovery. Some interviews

were with those who claimed to have benefited from harm minimisation. For

example homeless young people who through contact with the Wayside Chapel

Shepherd of the Streets youthworkers learned about using clean syringes. Some of

these told us how they had then moved onto abstinence when they were ready.

Others I interviewed spoke about being career people and having either reduced their

intake of drugs or gained abstinence through harm minimisation methods. Also there

were interviewees who found relief from addiction by changing their environment

and doing what they felt passionate about such as PJ who was a cab driver and a

committed Christian after spending a prison term for drug dealing. There is strong

anecdotal evidence that belonging to a church group has proven to produce good

results for those struggling with addiction who have not wanted to join a 12 Step

group nor succeeded in harm minimisation programs. I have known many people

who have benefited in this way. Therefore, even though I have a secular humanist

worldview I have encouraged addicts, who need abstinence and are not willing to

attend a 12 Step program, to join a church group which is committed to abstinence.

Then there were those interviewed who spoke on Hypoglycaemia, Nutrition,

Spirituality, Biology, Social Ecology, other models such as Transactional Analysis,

Rational Emotive Therapy, Neuro Linguistic Programming, Gestalt, Jungian

Psychology, and Solution Focus, which I show under the harm minimisation

heading.

As mentioned earlier, who I interviewed next depended on what I experienced in the

now (Perls 1969). For example, when I attended a community event in Waverley in

the late 90s, Wodak (St. Vincent’s Hospital and part of the harm minimisation

group) was on a panel and spoke on addictions. At question time I asked if he had

looked into the Swedish abstinence model which I was told, at the PRIDE Youth

Drug World Conference in Ohio, USA, 1993, that it had been successful. Wodak

dismissed it as a failure but mentioned the Swiss model. This hooked in my curiosity


39

and I successfully applied for UWS Hawkesbury funding to visit Europe particularly

Switzerland, Sweden and Holland to interview people and see for myself. At that

stage I had no idea that Wodak would eventually be invited to speak at the

Australis2000 International Humanist Congress or that I would be its convener and

one of the Addictions Session panel members. This is how the research process often

had a life of its own – at the final stage of the inquiry I became interested in

Wodak’s thoughts which took me to Europe to find out for myself for the purpose of

the research, then even better the opportunity presented itself to have Wodak and

others on the same panel where I presented my findings too.

For my trip to Europe I enlisted the help of my friend, John Dalzell, who is a

computer expert, to track down people to interview in Switzerland, Sweden and

Holland. My first visit was to meet with Marxer, the Manager of The Low

Threshold Centre in Berne, Switzerland, which was featured on Australian television.

As well I was introduced by email to Haemmig, the head of the Integrated Drug

Service, University Psychiatric Services, and the Dept. of Social & Community

Psychiatry, Murtenstr, Berne. Arrangements were also made through Haemmig to

meet the person responsible for the heroin injections in prison program.

Unfortunately I had to cancel the prison program interview as I ran out of time. We

tried to track down Dahl and Danielson who I had interviewed at the PRIDE Youth

Drug World Conference in Ohio, as I remembered that they had advised us that

Sweden had tried the liberal model and found it had not worked. Dahl and Danielson

claimed that in 1993 Sweden had moved onto a model involving community support

for a drug free society and that it was proving successful.

Dalzell discovered that Danielson had moved onto a political career, but found Dahl

(who lived too far for me to reach in the time available) and arranged through him

for me to meet with Johansson (Secretary General – Swedish National Association

for a Drug Free Society) who was in Stockholm. Johansson showed immense

hospitality and introduced me to Hallberg (European Cities Against Drugs) who I

also interviewed. After the interviews in Sweden I went to Amsterdam and found my

way to the YHA (Youth Hostel Association). None of the Dutch email contacts

responded before I left Sydney but I had the name of a service, so on phoning them

they referred me to the Jellinek Centre and on reaching them the only person


40

available on that day to speak with me was the Manager of the Jellinek4 Prevention

Team, Kerssmakers, who turned out to be a good choice to interview because he

gave a good overview of the services provided in Amsterdam – (i) education on

prevention in schools, (ii) safe use, and (iii) rehabilitation. This again was the nature

of the research process having a life of its own. I had a good balance of models over

the three countries. Their opinions are covered later in this thesis.

7. Persons Interviewed

In Appendix C I show a list of the total number of people I interviewed. However,

these are not all the people interviewed because due to technical difficulties a small

number of interviews did not turn out, for example, I audiotaped a confidential

interview with a public servant who attended the Premiers’ meetings on drug reform

and the tape did not turn out. All the people interviewed knew that it was for a

university research project and agreed to be interviewed for it. However, in the case

of Albert Ellis, RET founder, it was not an interview as such but rather I participated

in an exercise with him, at a seminar in Sydney (1992), regarding my own food

addiction patterns and these were not recorded by me but by his own staff. Later I

videotaped an interview with RET (now called REBT) representative for Australia –

Kidman and we further discussed my exercise.

The list of those I interviewed (Appendix C) also shows the dates of the positions

held as some have moved on. I have interviewed others more than once such as

Basten, Jurd, Cassimatis and Campbell as part of the collaboration process

together with recording my conversations with Andrianopoulos. I have shown them

in different categories to identify roughly their stance but it is not entirely so, as for

example, there are those who believe in the abstinence recovery model but admit that

for some this does not work, and there are those who believe in the harm

minimisation or controlled usage model, but admit that for some abstinence is

necessary. Those in the either/or category have been known to me to support both

abstinence and harm minimisation models working side by side in a treatment centre.

This is just to show that there is a wide variety of opinions and that they lean more

one way or the other. Some were interviewed because of my interest in their

spirituality knowledge or nutritional information, others because of their knowledge

4Dr. Jellinek first identified alcoholism as a disease


41

of the methodology. So, not all were considered to be protagonists in The Debate but

rather contributors to this research process and its documentation.

8. Sample Group

I chose to make the analysis of this inquiry from twelve of the 80 interviews and two

of the talks presented by Dowling and Wodak at the Addictions Session in the

Australis2000 Humanist International Congress of which Jurd, Cassimatis and

myself were also panellists and of which I was convener. The summaries of Wodak

and Dowling appear in chapter 5. My own personal and professional experience as a

marriage and family therapist specialising in addictions and including an extensive

literature review conducted by me, also contributed to this inquiry and its findings.

The identified protagonists in The D&A Debate as shown in Appendices A and B are

Heather, Jurd, Lennane, MacAvoy, Maclaine, Mant, and Wodak. I chose this

sample group so that it comprised of the seven protagonists in The D&A Debate here

in Australia; then Bishop, Pia and Pat Mellody because they are leaders in the

abstinence 12 Steps field overseas and here; also Campbell, Cassimatis and

Stewart because they were more representative of the synthesis – a diversity of

approaches worldview. Dowling’s worldview (Chapter 5) was important to this

group because as a Humanist physicist he provided a scientific perspective not easily

made available to the public. The mind maps analysing the interviews took place as I

went along and after each interview. Examples of the mind map process are shown

on pages 46 and 48. It is important to see how the conversations evolved in this

research so in the next chapter I show the dialogue I had in the sample group

interviews with Bishop, Campbell, Cassimatis, Heather, Jurd, Lennane,

MacAvoy, Maclaine, Mant, Mellody and Mellody, and Stewart.

Throughout this process I kept reminding myself of the research question which was

the reason for this inquiry. What rationale do the professionals in the Alcohol and

Other Drug recovery field have for maintaining their oppositional stance to each

other’s models at cost to the community? It is important to note that my aim with this

research was not to prove which model of recovery worked better or why people

chose to support or use it. I was only interested in why leaders in the field, the

protagonists in The Debate, and their supporters were denigrating each other’s

models and causing a public polemic. Nevertheless, I do show an overview of the

different worldviews as the foundation to this documentation.


42

9. How the Data was Analysed

As I lived and “became” the C&R Project it was an ongoing, evolving, transforming

process of conversations with those willing to exchange information and life

experiences relevant to the research. Lewin’s action research process influenced my

thinking in that there was a spiral of steps (Bawden 1985): planning, acting,

observing, reflecting (Reason & Rowan 1981, Grundy 1982, Davis 1993) and the

collaboration involved those working on the research as well as those being

interviewed. Also there was cross-referencing and cross-cultural validity.

Collaboration was used for the planning when I would work out who to interview

and what I wanted to find out from them. For example, at the beginning when

interviewing Basten, he advised that Heather was primarily involved in the research

influencing the Health Dept. Harm Minimisation policy (NDS 1985), so I needed to

include Heather in the interview list and make sure that I would question him on this

area of focus. Cross-referencing took place when I disseminated information gained

to the different interviewees and obtained their comments. The cross-cultural validity

happened when I interviewed people from Switzerland, Sweden, Holland, Greece,

USA, UK, Germany, South America and these people were experts in their recovery

field. Also it wascovered by those such as Jurd and Heather who spoke about the

facts of cross-cultural recovery and harm minimisation. In analysing the data, key

issues were discussed by those who were from both ends of the recovery continuum

– on one side the behaviourists who supported the controlled drinking/use/harm

minimisation and on the other side those who believed in the abstinence and AA 12

Steps program.

Regardless of the issues, they all expressed the belief that there needs to be more

than one method of recovery to choose from. As previously mentioned, this research

process quite often felt as though it had a life of its own and my role as the primary

researcher was to hold on for the ride and watch where it would go and what would

be discovered, yet keeping control of the process so that it was not just a case study

(Maxwell 1984). It also involved reflexivity in that what was discovered through the

research process needed to be emphasised with those who could affect change

(Armstrong 1990, Davis 1993), as in the case of Heather being made aware that

people in positions of power were using his findings to denigrate a successful

recovery program, and his response to take action if he is advised about it.


43

Adagio: …Are you aware though that there are professionals out there in

positions of power who are interpreting the Health Harm Reduction

Policy that 12 Steps and abstinence is a ‘no no’ and basing it on your

research?

Heather: I’m not aware of that and I’d be grateful to you for letting me

know where my work is being misinterpreted that way. I would certainly

say to those people that they should read more carefully what I and

others have to say on this issue.

And similarly, reflexivity was used with MacAvoy (1993 Director of Drug and

Alcohol Directorate and policy advisor to the Minister for Health – Collins)

Adagio: I had experienced in a position that involved the ethnic

communities whereby we were preparing translations for a quit for life

smoking campaign and when we had arranged the translations for

different aspects of that then I said to the person in charge of this project

“OK now we need to get pamphlets in different languages about meetings

for the 12 Step program” and this person said “the Health Department is

against 12 Steps so we’re not going to do that”. Are you aware that these

are some of the comments that are going around about the Harm

Reduction [policy}?

MacAvoy: Harm Reduction approach really allows any method, any

approach, any style of thinking to assist people to manage their life better.

So from our point of view, from the Department’s point of view, we do

not remove isolate or ignore any particular model of treatment approach

and therefore it would be quite wrong of us to say that we are opposed to

the 12 Steps approach. The 12 Steps approach in fact is by our reckoning

a type of approach to managing their life better.

Going through this inquiry I felt the ‘high’ of positive addiction (Glasser 1976). This

gave me the courage to go where I would not otherwise dare, both geographically

and in my questions, giving me the energy to go on. Others joined me on the journey

such as Toola Andrianopoulos who became a part of the research process.

10. Mind Mapping

When I participated in Vladmir Dimitrov’s workshop on Mind Mapping in 1991,

through UWS Hawkesbury, I was enlightened as to the scope of this method for

documenting and analysing data and have since that time been a strong supporter of

this medium, especially with my students.


44

Buzan (1988) was the pioneer of mind mapping with the first edition of his book

Make the Most of Your Mind (1977). Others followed such as that written by

Margulies (1992) showing different styles of mind mapping. Mind Maps have been

accredited by schools and colleges as effective communication methods as shown in

Bankstown TAFE English Communication teaching resources for 2003 (Presenting

Information 1994). Buzan wrote about how the brain has limitless power and abilities

such as memory and motivation. This also means that the way we record what we

learn can be made more efficient and effective by the use of mind maps because note

taking is linear and we can absorb and recall information ten times easier if it is

through a mind map. Here Buzan describes the process further:

In conjunction with listening for ideas, your comprehension, understanding, retention, and recall will be far greater if you take highly efficient Mind Map notes rather than standard lineal or list notes. Mind Map notes involve your entire left and right brains, and consequently improve overall listening performance dramatically. (1988:71)

Therefore, it was naturally my choice of documentation and analysis for the

video/audio taped interviews. I drew mind maps of all the information which we

gained from the audio and video taped interviews, then typed up summaries of these,

examples of which appear on pages 46 and 48. The Heather interview summary was

longer because I had only one interview with him whereas I was familiar with Jurd’s

stance from my experience in the field.

These conversations shaped my perception and I shared this knowledge with each

person I spoke to – this in turn fuelled that person’s perspective, a sharing of

knowledge gained in the research process. This process informed me as a change

agent and I sensed at times a professional development taking place – an

acknowledgement of the necessity to recognise the facts regarding the impact of The

Debate on the community. For example, Heather stating that they were not against

AA and abstinence as a recovery program and Jurd confirming that even AA states

that for those who are not alcoholics controlled drinking could work. Then I would

discuss findings with collaborators such as initially Godfrey (1992), then

Adrianopoulos (1992-1996) and her partner Hamilton (1995-1996) both Stansfield

Program Youthworkers, other Stansfield Program Youthworkers, Wayside Chapel

Shepherd of the Streets Youthworkers, management and my work supervisors such

as Rev. Richmond (Wayside Chapel) and Dixon (Stansfield Program), and external

consultants Campbell (1987-1995), with input from Jurd and Cassimatis being


45

ongoing as I need it. More importantly, I considered the majority of the interviewees

as collaborators because their opinions influenced the flow of the project, that is,

where I went, who I interviewed, what I learnt and what I said to the next

interviewee – experiential learning, experiences grow out of experiences and lead to

further experiences (Dewey 1922, 1929, 1938).

I will now show mind maps and summaries of two interviews – Figure 1 (Jurd) and

Figure 2 (Heather). This mind mapping process enabled me to, in between

interviews, document and analyse the data gained from each interview, informing my

inquiry efficiently and effectively, helping it to evolve. It also identifies how video

tapings and typed transcriptions served as narrative field texts which recorded the

dialectic conversations. Then the mind maps formed part of the narrative research

texts showing my summarised interpretation of what was expressed by the

interviewees. These mind maps (summarised research texts) contributed to the final

documentation in this thesis – the final narrative research text.


46

Fig 1

MIND MAP AUDIO TAPED INTERVIEW – JURD (1992)

Dr. Stephen Jurd, (Psychiatrist, Royal North Shore Hospital & Manly Hospital – Phoenix Unit). Supporter of the abstinence and AA 12 Steps Model, and TSF (Twelve Step Facilitation) model of recovery. When The Debate was born, Heather was asked to write an article on “Is Alcoholism a Disease?” and, according to Jurd, he refused and instead wrote the article “Why Alcoholism is not a Disease” for the Medical Journal of Australia. Which led to them commissioning Jurd to write an article called “Is Alcoholism a Disease” (1992). Jurd would have preferred to write an article about the pros and cons but because Heather had refused to look at the balanced evidence then Jurd wrote on the disease model. Jurd found it easy to show this because as a psychiatrist he had treated other diseases such as schizophrenia and manic depressive illnesses and he said that the disease of alcoholism similarly has a clinical syndrome that is fairly typical regardless of the cultural background – “Greek alcoholics, Australian alcoholics, German alcoholics, Scandinavian alcoholics”, i.e. all shiver and shake in the mornings and have the same sort of obsessions about their drinking with other similar behaviour like hiding their drinks in the toilet. The same applies with heroin addicts. He also believes that it has been scientifically proven that alcoholism can also be genetic. Although we can develop alcoholism without it being genetic. He quoted studies of adopted children of alcoholics. He also mentioned the work of Blum and Noble who have identified the alcoholic gene. He pointed out that controlled drinking is not a new concept as even in The AA Big Book (1938) there is mention of those who can control their drinking, actually he felt it was AA who first coined the term controlled drinking. In our conversation I brought up other addictions such as food and love and Jurd was not as convinced about these being a disease although he did describe gambling as possibly so.


47

In 1992 when I decided to interview protagonists in The D&A Debate I chose to

begin the interviews with psychiatrist, Jurd, because he was not only the addictions

recovery specialist at Royal North Shore Hospital and Manly Hospital Phoenix Unit,

but was also known to me through my work in the recovery field. This choice to

interview Jurd first allayed my anxiety about entering into an imagined ring of fire

where fighting protagonists from opposite ends of the continuum were allegedly

aggressively denigrating each other’s methods of recovery - abstinence vs. controlled

drinking (Appendices A and B). I was on familiar ground speaking to Jurd and

could pose questions about which I was knowledgeable. This experience I knew

would give me the impetus to move onto other interviews, especially with people

who were unknown to me. This indeed was so.

Jurd reinforced his stance, one which was held by those in the field, that abstinence

and belonging to a 12 Steps program (Alcoholics Anonymous, Narcotics Anonymous

etc.) was the most effective recovery method for addiction. In speaking with Jurd I

came away convinced that what I had learnt whilst running halfway houses was in

fact accurate – what worked for addiction was abstinence and AA/NA. Even so,

Jurd did admit that there are some people who would not benefit from an abstinence

model and the controlled drinking (harm minimisation) model would be possible for

them. So, through that interview these two views were expressed by Jurd:

1. that the abstinence model is the most effective

addictions recovery model

and

2. that there could be an area of agreement with the

other side that controlled drinking can work for some

This left me with the discovery that there may not be such a huge difference in the

belief systems between the two sides as had been described by those involved,

especially in the media. In other words, there is a middle ground in both camps that

could result in each one ceasing to denigrate the other model, thus ending the clash

incurred by The Debate.


48

Fig. 2 MIND MAP VIDEO INTERVIEW – HEATHER (1993)

Professor Nick Heather (Director, National Drug and Alcohol Research Centre 1993) whose research had influenced the Health Department Harm Minimisation Policy (NDS 1985). Heather became interested in 1975 after “reading an article about some alcoholics’ return to controlled drinking…some people not all people.” The 1980s brought world commitment to harm reduction. Heather became involved in more research as a result of the National Campaign Against Drug Abuse. In answer to the question about how he would respond to a person with long term sobriety in AA who came and asked to try controlled drinking, he would say to him that he was crazy if he gave up what had worked. He was not interested in attracting people into a social drinking program if what they were doing worked. I asked Heather if he was aware that some professionals in positions of power were using his research outcomes to negate AA and the abstinence approach, and he said that he was not aware of that and that he would be grateful for letting him know where his work was being misinterpreted that way. He pointed out that total abstinence is also harm reduction. Controlled drinking is for people with less serious problems, saying “someone who has achieved some stable way of life through abstinence, the last thing I would want to do is to sway, to endanger that, in any way….it’s not that I’m opposed to abstinence”. Heather said that for people with less serious problems “if you approach them and tell them to be totally abstinent for the rest of their lives it is a bit radical and extreme”. He also said that many people find that the spiritual approach is unacceptable to them - there are many people who take to AA and many who don’t. “We need alternatives to AA, we don’t want to eliminate it.” However, “there is also the question of public funding - AA is a fellowship and does not cost society, but when you go a step further and fund it by government” as was done as part of programs in detox units this is not necessary. His comments on The D&A Debate were that “we won” the motion that the 12 Steps approach was not the only approach for alcoholism. Heather praised Australians for their achievements as a result of the harm reduction policy for HIV, (methadone and needle exchange) among injecting drug users.


49

Before I interviewed Heather I interviewed, apart from Jurd, several others from

both sides of the continuum such as MacAvoy and Mant, protagonists from the

CD/harm minimisation side, and Lennane and Maclaine from the abstinence side.

This also helped me prepare for meeting Heather, whose model up until then caused

me some concern. I had been more afraid of how I would respond to his controlled

drinking method than anything else. Fortunately my curiosity far outweighed any

bias and this enabled me to have an informative conversation which contributed to

the research dialectic as can be seen with Heather’s response when I asked if there

was anything he wanted to cover at the end of our interview – [smiling] “Ah no, I

don’t think so you’ve had a wide range in discussion and I’m quite happy with

what’s been covered”. Heather repeated the thoughts Jurd, MacAvoy and Mant

had shared that there are some who cannot benefit from abstinence and AA/NA, and

therefore controlled drinking/harm minimisation was a more effective alternative for

them. Put into such a perspective it sounded sensible. Of course, there are numbers of

people who cannot commit to abstinence and AA/NA for help to be free of their

addiction and this would result in failure. However, in the abstinence field it was

considered that in order to save lives it was important to persevere with the push for

abstinence with AA/NA, whereas in the controlled drinking/harm minimisation field

achieving some measure of reduction in usage was considered a success.

Heather was firm in his stance confirming this belief system and clarifying that even

though he was convinced that alcoholics could return to controlled drinking the harm

reduction model was aimed at those who were not so seriously affected by addiction

and who could achieve success by reducing their intake of drugs. This made sense to

me and changed my attitude about controlled drinking and harm minimisation when

presented in this manner. Furthermore, it was reasonable to have an alternative for

those who did not wish to enter a spiritual program and who wanted to remain social

drinkers/users. I was surprised to hear Heather be supportive about AA and, as

MacAvoy and Mant had stated, did not wish to eliminate it. He believed in

abstinence for some. I was also pleased when he reassured me that if anyone was

using his research to denigrate abstinence and AA he would like to be told about it. I

became convinced that there was a place for both abstinence and controlled

drinking/harm minimisation and that there was a middle ground between the two. By

now I was more interested in the concept of diversity of approaches for different

people with different needs and treatment preferences.


50

With the interviews involving Jurd, Heather, MacAvoy, Mant and Maclaine I had

interviewed the main protagonists in The Debate (Appendices A and B) and although

they maintained their stance they also admitted there was a place for the other model.

With this information in hand I looked forward to other interviews – my curiosity

was the fuel for this inquiry.

11. Summary

In this chapter I have written about the research relationship between social ecology,

ecofeminism, action research and the dialectic, narrative method - how they merge

and complement each other with the outcome of situation improvement and how this

influenced my way of thinking throughout this inquiry. Over 80 interviews were

conducted as listed in Appendix C, of which I analysed a sample group of 12 plus the

talks presented by Dowling (2000) and Wodak (2000) at the Australis2000

Humanist Congress, whose interviews are analysed Chapter 3.

It is important to discuss how I ensured that there was rigour, validity and ethics for

this research. Rigour involved using video tapes when interviewing the protagonists

in The D&A Debate, then making mind maps and typing transcriptions of the sample

group of interviews for the data analysis which is discussed in Chapter 3. Validity

was ensured by disseminating and comparing information face to face in interviews

with those experts who were the protagonists and carrying that information to other

interviewees, consultants and collaborators. Ethics were ensured through constantly

consulting with professionals and management, who could monitor the progress of

the research and my findings. Apart from the interviewees there were those such as

psychiatrists Jurd (Royal North Shore and Manly Hospitals) who at the time was an

expert in the abstinence and AA 12 Steps program, and Campbell (Rozelle Hospital)

and Cassimatis (Evesham Hospital) - the latter two were more supportive of a

diversity of approaches. This thesis describes and explains my social, philosophical,

and physical location in the study, my biases and the strict documentation of the

interview dialectic, narrative inquiry and data analysis. Also shown is the personal,

professional and community development which has taken place as part of this

research. I have chosen a narrative approach to write this thesis which suits the

methodology – a storytelling approach that documents the dialectic, analysis,

critique, collaboration, reanalysis, reflexivity and the birth of my concept of

synthesis – a diversity of approaches, which is the situation improvement as a result


51

of the process. Through this narrative process it can be seen how my own internal

dialectic and personal, professional development contributes to the data source. This

reflection also makes clear the critical subjectivity that takes place on my part and

the part of the collaborators including those who were interviewees. Hence, this

thesis is more than a presentation of data gathered, I have used a dialectic, narrative

approach - in the form of conversations - to analyse, organise and present the work

carried out. This is central to the method as can be seen over the next few chapters

when the process unfolds. To distinguish from everyone else in the field, the

information provided by those I interviewed, or spoke with in passing, have their

names in bold font. Furthermore, I show the different perspectives and the tension

created by separating the findings into Chapters called Thesis meaning the original

stance of recovery – abstinence and the AA 12 Steps program, Antithesis -the new

social drinking/use/harm minimisation methods and Synthesis – a diversity of

approaches which can include these both and other models.

52

CHAPTER 3

INTERVIEWS

In this chapter I show the information I collected from the interviews by using

narrative, dialectic methods. This storytelling, conversational method meant the

interviews were part of an inquiry that gathered information regarding the conflict

between people disputing on The Drug & Alcohol (D&A) Debate continuum. This

was also indirectly aimed at exchanging worldviews in an effort to transform the

conflict through me as the messenger.

I alternate the terms Harm Reduction or Harm Minimisation Policy because at the

time of the research the meanings were the same but the terms were interchangeable

and better known then the originating policy which was the National Campaign

Against Drug Abuse (NCADA) Campaign Document (1985) which launched the

National Drug Strategy (NDS) of 1985 (Fixter 2007). Also interchangeable were the

terms for the same conflict - The D&A Debate or The Debate. Furthermore, I refer to

TSF (Twelve Step Facilitation), the term for the clinical model of recovery, based on

abstinence and the AA 12 Steps program, which was designed for Project MATCH

(1993). There were three models in Project MATCH (1993) research - TSF,

Cognitive Behavioural Therapy (CBT) and Motivational Enhancement (ME) later

known as Motivational Interviewing (MI), and which I elaborate on in the next

chapters.

My assumption about this conflict was that according to some AA elders every 10-

12 years there is a swing away from abstinence and AA 12 Steps model to controlled

drinking (CD) programs; then back again to the abstinence and AA 12 Steps model –

what I named a cyclical schism. So I asked that question of interviewees from the

abstinence field. I noticed that even if they remembered a swing they would not

recognise the term cyclical schism and I was convinced that was because it was a

term I had invented, even though it was self-explanatory. Another assumption, on

my part, was that the 12 Steps model was the most effective method of addiction

recovery. This belief was because I am a family therapist specialising in addictions

and had also experienced running halfway houses for people recovering from alcohol

and other drug problems using the 12 Steps model. More so, after hearing over

20,000 stories at 12 Steps meetings I became convinced about the success of the 12

Chapter 3 – Interviews

53

Steps fellowship for recovery. My research journey into the ‘controlled usage’ side

of the recovery field gave me another perspective - when the 12 Steps model was not

successful. This was an insightful discovery for me, and one that confirmed what

was already part of my praxis when dealing with people who refused to use the 12

Steps model or who were not afflicted with an addiction.

A major difficulty in documenting narrative inquiry can be how potent the need is to

relate the outcome of the interview (research text) in the interviewee voice rather

than the researcher voice. Nevertheless, as can be seen in literature on narrative this

is the interpretive analytical phase in which we need to “fight against our desire to let

field texts speak for themselves” (Candinin, Connelly, Michael 2000:130). As a

common temptation it had caused me internal conflict in the transition from the field

texts to the research text. Especially given the status of the interviewees who were

leaders in the recovery field and my temptation to want to show exactly what they

had said for the record, rather than in my words. I consider that to have been the

most difficult part of documenting this research.

I chose twelve interviewees for the sample group, forming the field texts providing

data for the research text of the narrative (Candinin, Connelly, Michael 2000). This

sample group consisted of the protagonists in The D&A Debate who had been

identified in the media; those who I believed would contribute another important

perspective; and those who brought in something from overseas that would influence

programs here. Their full names and positions are listed as part of the 80 interviews

in Appendices A and B. For the purpose of brevity I only use surnames in this thesis.

On the 12 Steps model side (Chapter 4: thesis) were Jurd, Lennane, and Maclaine.

On the Harm Minimisation/controlled drinking (CD) side (Chapter 5: antithesis)

were Heather, MacAvoy, and Mant. Then Stewart, Campbell, and Cassimatis all

worked in hospitals that supported harm reduction/minimisation and whose personal

leanings were towards a diversity of approaches (Chapter 6: synthesis). From the

USA, Pia Mellody, Pat Mellody and Bishop I chose to interview because they were

here to influence the setting up of a new rehabilitation program at South Pacific

Private Hospital (1993) in Sydney, using the Pia Mellody model and developed in

the USA. I treated all interviewees as collaborators for this research and I took

information to them from other interviews to discuss with them, fuelling the

dialectic, narrative method.


54

The key points of the interviews in this chapter are:-

• critical parts of each interview

• where the interviewee sits in terms of The D&A Debate

• sequential order of the interviews

• interviewees are known leaders in the field of addictions and recovery

• interviewees’ professions are psychiatrists, behaviourists and service

providers

• whether they had heard of the cyclical schism – the swing every 10-12 years

where the trend swings from abstinence and AA 12 Steps model to controlled

drinking (CD) programs

• my feedback as a result of the interviews, to ensure I have understood them

• their feedback/comments as a result of the interviews

With each interviewee I shared information, some of which I gained from the

previous interviews, that I thought would clarify the misunderstanding that caused

the conflict in The D&A Debate – an attempt by me at conflict resolution. For

example, the notion of labelling which was a primary tool in the AA and abstinence

program, and which was a strategy rejected by most behaviourists as being negative

and counterproductive (MacAvoy interview 1993, Brigham & Gentle interview

1996). It should be noted that although interviewees had not heard of my term - the

cyclical schism, interestingly enough some did confirm that there was an ongoing

schism resulting in swings between AA abstinence model and controlled drinking

(CD) models.

There were questions put specifically in one interview and not in another, because of

the interviewee’s area of expertise and my personal interest such as food addiction

(Mellody interview) and family therapy (Stewart interview 1993). Nevertheless,

these issues all related to the recovery worldview of various protagonists on The

D&A Debate continuum. This is because family therapy is important to recovery and

all addictions have similar symptoms to alcoholism. For that reason the AA 12 Steps

Program has been adopted, and adapted accordingly, for the recovery program of

other addictions such as NA (Narcotics Anonymous), NicA (Nicotine Anonymous),

OA (Overeaters Anonymous) which also includes under-eaters and bulimics, GA

(Gamblers Anonymous), SCOPE (Stress Anonymous), SLAA (Sex & Love Addicts


55

Anonymous), and CoDA (Codependents Anonymous) which is considered by some

to be the primary level of dysfunctional behaviour from which all other addictions

are secondary (Mellody 1992). They are all life threatening addictions which can

make a person’s life unmanageable.

As mentioned in the previous chapter I made a mind map after each interview from

the video of that interview in order to absorb more clearly what had taken place,

discussed the outcome with co-researcher Andrianopoulos and other collaborators

such as Cassimatis and other interviewees, and I researched more literature to

prepare me for future interviews. The previous interviews determined who I

interviewed in the future. In this chapter, following transcription of the interviews, is

the research text, documentation of the sample group (12 people) out of 80

interviews, which with my knowledge and experience has informed my research

findings. The questions I asked were relevant to the area of expertise of the

interviewees, the model they were supporting and what would reinforce and broaden

my knowledge of recovery as the primary researcher. In turn I disseminated this

information to the community through training programs such as those carried out at

TAFE, Wayside Chapel, and Stansfield Program. I also spoke at gatherings such as

Australis2000 Humanist Congress; Humanist Society of NSW; and Friends and

Families for Drug Law and Reform (ACT) Inc. in Canberra (2004).

1. Jurd 2nd

Interview (1993) Sydney. 1st Interview took place in 1992 as part of

the Action Plan for the C&R Research Project and was documented as part of my

GDSE at UWS (1992)

Jurd at this time was the Director of the Drug & Alcohol Unit at Royal North

Shore Hospital and the Director of the Phoenix Unit at the Manly Hospital

Sydney and a supporter of the worldview that there is a biology of alcoholism.

Jurd is a leader in the medical model using abstinence with the AA 12 Steps

program, and was a protagonist in The Drug & Alcohol (D&A) Debate. As

mentioned earlier, I worked in that model and Jurd was known to me, so I felt

more comfortable to begin with him as the first interview. Jurd also advised

me, in a later interview, about the Twelve Step Facilitation (TSF) clinical

model (from Project MATCH research) being identified as an efficient part of

recovery.

I asked Jurd the question about his knowledge of a cyclical schism where

treatment shifted from disease model with AA and abstinence to non-disease

model and controlled drinking (CD). Jurd had not heard of the cyclical schism,


56

however, he had given some thought to the notion that “the less the society drinks

the more there’s a split between the very moderate drinkers and the more extreme

drinkers and then alcoholism becomes to look very obvious”. However that was

not what I was meaning about the cyclical schism and now in 2007 I have noticed

that we have come around to being less anti 12 Steps model as could be seen in the

TAFE (2003) Alcohol and Other Drug Interventions Course text book (Jarvis,

Tebbutt, & Mattick, 1st edn. 1993, 7th edn. 2001) in which self help groups such

as AA were recommended for those who wished assistance with their abstinence.

During the height of The D&A Debate in the eighties to early nineties any such

suggestions were avoided or frowned upon.

One of the problems I faced often in my work in the recovery field was from

behaviourists, who were against the 12 Steps model, who objected to my

supporting the use of problem identification in order to gain recovery.

Behaviourists from the harm minimisation side of The D&A Debate called this

negative labelling whilst practitioners from the disease abstinence field fully

supported this terminology. Such conflicting information triggered my curiosity

greatly. At every opportunity I tentatively broached the subject to determine

which school of thought the interviewee supported. I say tentatively because as a

worker in government funded agencies I had learned very quickly to avoid using

terminology connected with the abstinence and 12 Steps model concept in order

to stay employed. Jurd’s explanation was interesting when he said “the notion of

diagnosis is far from the notion of a label”, going on to explain that not only is

this a way of understanding people, but also a necessary procedure for identifying

any level of dysfunction.

As I introduced the outcome of a lecture I had attended where the disease model of

alcoholism was denigrated, Jurd responded to this in a way that brought in

scientific proof. He began by qualifying what I suspected, which was that the

organisers and participants must have been from the worldview which did not

support the disease model, and thereby chose not to cover information on the allele

dopamine receptor (Blum & Noble, 1990). Further supporting that theory Jurd

cited eight studies which found that “that gene is over-represented in alcoholic

populations” through testing the DNA out of the blood cells of these patients

(Jurd interview 1993). This confirmed what I knew from my experiences as a


57

worker in the alcohol and other drugs field and documented by Ruden (2000) with

his scientific findings. Yet Peele and Brodsky (1991) strongly dispute this and I

elaborate on this in the literature review of Chapter 5: Antithesis – The Case for

Controlled Drinking (CD)/Use (Harm Minimisation).

(This interview had to be continued at a later date due to time constraints)

Jurd 3rd

Interview (1993) Sydney

The Harm Reduction/Minimisation Policy (NDS 1985) was becoming more

influential in the service provision field and Jurd’s comments confirmed that this

policy was aimed at reaching more people needing care in the community.

However, in an effort to achieve the outcomes of Harm Minimisation (NDS 1985),

which are less than the optimal outcomes of abstinence programs, the quality of

services provided is considered inferior by some professionals, as confirmed by

Jurd “so to use an alternate catch phrase – sometimes Harm Reduction is an

enemy of quality assurance”.

People completing a Harm Minimisation program can choose to lower their drug

intake and this is considered to be a successful outcome, or use methadone instead

of heroin, thereby showing positive statistics especially for funding purposes.

Providers of the abstinence 12 Steps model do not consider this to be the optimal

outcome, because attempted controlled usage can have life threatening results for

the addict who needs to abstain and develop a new lifestyle without that threat.

This was my opportunity to express my belief system about the diversity of

approaches (synthesis), so I asked why there needs to be either or? Why cannot

there be harm reduction for some and abstinence for others? Jurd’s viewpoint was

that it was political – “divide and rule” which meant that services were competing

for the government dollar in order to cut funding. Furthermore, existing services

have their funding divided to allow for introduction of new projects such as for

HIV and hepatitis services. This political influence is also a strong point made by

Lennane in our interview later in this chapter. His answer, although logical, was

not hopeful for me as a worker in the recovery field.

We discussed the benefits of the rationale for the Harm Minimisation/Reduction

policy (NDS) which was lowering the HIV infection in Australia and becoming a


58

world leader, and that we spent a lot of money towards this achievement. Jurd

pointed out that a similar effort should be put into dealing with youth and lowering

of alcohol damage. Again another powerful point made by Lennane in our

interview and in her book (1992). Jurd’s statement regarding this is worth quoting

here which showed that although Australia’s progress in lowering the AIDS

infection is noteworthy, nevertheless, it almost equals the deaths of young people

from alcohol related incidents.

Jurd: AIDS is a terrible scourge an epidemic 1400 people have died in

Australia of AIDS, however, every year for the last ten years and more

1000 young Australians between the ages of 15-34 have died as a result

of alcohol and I don’t see the same sort of effort being put into drink

driving at a health level, being put into binge drinking…I’ve put it in

perspective that I am very glad that we’ve come to a 1 in 20 chance of

having HIV, still despite the enormous mortality there’s a grave

disparity between the response to it and the response to alcohol.

I covered the concept of disease vs. non-disease model debate by saying the World

Health Organisation has accepted that alcoholism is a disease, yet reputable

professionals dispute this. Jurd explained this by saying that alcohol use is confused

with alcohol dependence and negators do not see that there is a point “where people

step over the line and go from being users to dependent individuals”.

Regarding scientific evidence that alcoholism is a disease, I asked why reputable

practitioners who are against the disease model of alcoholism passionately claim

that the evidence is inconclusive? In his answer he maintained that perhaps if

behaviourists agree that it is a disease then it would invalidate behavioural

treatment and affect funding. Jurd compared that disbelief to being like people

who “say that it is not absolutely proven that smoking causes lung cancer”. He

described it as being a power game with the winner gaining funding. This can be

seen as having happened with the Harm Minimisation Policy (NDS 1985) where

funding has been redistributed to support politically popular concepts such as

controlled drinking (CD) and pushing afflicted persons into the community for

support rather than funding programs which included this. That is, having AA

meetings on the premises as was once a part of detoxification and rehabilitation

programs.


59

Again when I reminded Jurd of the strong viewpoint held by behaviourists, from

the harm minimisation side of The D&A Debate, that to put the alcoholic in that

disease model means that it’s labelling them in a negative way from which they

cannot achieve recovery. Jurd again put forward the therapeutic benefit of

diagnosis and also how it alleviates the guilt and then gives them the ability to take

responsibility for their recovery. His response encapsulates the worldview of the

12 Steps model as held by practitioners and clients whose stories I heard over 9

years of attending 12 Steps meetings (over 20,000 stories).

Jurd: So, some people still suggest controlled drinking goals for even

severely dependent drinkers. Some people are predisposed genetically,

environmentally, personally, constitutionally predisposed to alcohol

dependence….my patients receiving a diagnosis of alcohol dependence

is generally a relief, it is generally explanatory. It gets down to the

notion of diagnosis of alcoholism or drug dependence does explain

much of the behaviour, much of the experience, of many of my

clientele and generally they find that great consolation. It alleviates the

guilt. They are able to say “oh I did that because of my sickness” but it

doesn’t alleviate them of the responsibility to do something about it.

The primary thing being to avoid using the substances as much as

possible that they are unable to deal with appropriately.

I believed that people who were not alcoholics or addicts could handle controlled

drinking (CD)/use and in response Jurd confirmed my suspicions that it would

work for people who had low levels of dependence or who were able to control

their drinking to begin with but who somehow had developed a problem. These

people could be successful in a controlled drinking (CD) program. It was helpful

to be reminded that when “alcohol consumption is at a high level in a society there

will be a lot of people who don’t satisfy criteria for alcohol dependence” but who

have problems with drinking and for such people reducing alcohol consumption

“is the appropriate intervention”. This statement confirmed that professionals from

the abstinence and 12 Steps side of The Debate do actually believe in controlled

drinking (CD) for some people.

I think it is a grey area between those who can control their dependency and those

who cannot. At the personal level of narrative inquiry my thoughts went to how as

a nicotine addict in recovery, an ex chain smoker, at end of last year I celebrated

eighteen years abstinence. However, previously I had twice been abstinent for six

years each time. Believing I could control my smoking, after the six years I tried

each time to smoke three cigarettes a day instead of the four packets a day I used


60

to smoke. Unfortunately, within three days I was smoking four packets a day once

more. I proved to myself conclusively through experiencing twice that had I been

just a heavy smoker and abstained then I could perhaps begin again with a

moderate number and keep it to a minimum, but as an nicotine addict with a

progressive disease, each time I started it was as though I had not stopped. After

eighteen years of abstinence, I am happy to be free of being driven to light up

another life threatening cigarette and am not needing to test this. The same applied

to thousands of addicts whose similar stories I have heard at 12 Steps meetings.

Therefore, I firmly believe through my experience, and that of thousands of others,

that it is not possible for an addict to revert to minimised usage of any drug. The

only people who can revert to controlled drinking (CD)/usage are those who are

not addicts.

In response to my question about how to identify alcoholism, Jurd advised that

the best way was to talk to someone from AA or to attempt controlled drinking

(CD), a suggestion made by AA in the 30s. Also to be honest about how much

alcohol is costing them, and that a strong emotional attachment is also a reliable

indicator. He added an important point which is that client satisfaction is used as a

lever by the controlled drinking (CD) lobby. Jurd’s passion against the controlled

drinking (CD) lobby was equally strong as those on the opposite end of The D&A

Debate.

Jurd confirmed the compulsion continuum notion of Blake and Stephens (1987),

which spoke to me as a plausible concept and which influenced the title of my

research. He pointed out that all other conditions can have sub problem levels too.

Reflection: Jurd was faced with the reality of implementing Harm

Minimisation policies at both institutions he managed, and yet it was clear that

he was committed to the 12 Steps model and he gave convincing arguments for

that stance which were both medical and behavioural. His worldview supported

the genetic, biology of alcoholism and that abstinence is vital to the recovery of

this diseased condition. This confirmed what I had been taught, and experienced,

as a coordinator running halfway houses for people recovering from drug and

alcohol problems and a model which I have used as a therapist/trainer/researcher

in that field. Strengthening my resolve for the 12 Steps model, I looked forward


61

to meeting with other protagonists from the same side and especially Heather,

MacAvoy and Mant from the controlled drinking (CD) side of The Debate to

see how those interviews would effect my thinking.

2. Campbell 1st (1993) Sydney

Campbell, psychiatrist, Director of Clinical Services, Rozelle Hospital (1993) where one of the oldest and renowned services - McKinnon Detox Unit, was

located. I had read that Lennane had been sacked as a result of her resistance

to the implementation of the Harm Minimisation Policy (NDS 1985) at

Rozelle Hospital. Therefore, interviewing Campbell and Lennane was

important. I first met Campbell who was a guest facilitator at an advanced

weekend workshop for family therapists for the Unifam course (1987).

Therefore, as a resource person for my work as a family therapist, Campbell

became one of the consultant/collaborators for my C&R research project

along with Cassimatis. Campbell supported the implementation of the Harm

Minimisation Policy (NDS 1985), however, he maintained that people being

admitted to the Detox Unit needed to be committed to abstinence.

Nevertheless, cigarette smoking was permitted outside the building. He

believed the 12 Steps model worked and it was useless for people to argue

about it.

I began the interview by mentioning the belief by some senior AA members who

explained The D&A Debate raging in the community, as something that happened

every ten or twelve years. In his answer Campbell clarified this and several issues

that others had not. He confirmed that because we don’t know the underlying

pathology of addiction we periodically try out different solutions and that

competing therapies cause schisms in the professional ranks.

Campbell: Well I think it’s not unusual for any problem where we

haven’t got complete understanding what the issues are about – what

the underlying pathology is, the nature of the beast, that we will

periodically try out different theoretical solutions and models and that

we commonly find ourselves reinventing the wheel and that is perhaps

symptomatic of the collective memory of the system. Various

treatments we’ll adopt have a fashion and come and go or will have

some efficacy, I guess the problem with that sort of cycle is some

things that are good don’t get a fair go but that the good things that we

do come back to, there’s a grain of truth in everything and eventually

we come back. You get competing therapies where no one therapy is

clearly superior, you get these competing therapies and then schisms

in the ranks ‘cause people start saying this is the only true way of

doing it and [indicating the opposite side with his hands] people saying

this is the only true way of doing it.


62

Campbell stated that AA was one of those models which could not be analysed for

efficacy due to the confidential nature of the program. At the time of this interview

Project MATCH 1993 was taking place which was able to research TSF (Twelve

Step Facilitation model), CBT (Cognitive Behavioural Therapies) and MET

(Motivational Enhancement Therapy) later known as MI (Motivational

Interviewing). This was considered to be the first time that the efficacy of the AA 12

Steps program was scientifically researched. I elaborate about these findings in

Chapters 4, 5 and 6. Given his position at Rozelle Hospital, I wanted to know what

Campbell thought of the harm minimisation or harm reduction policy (NDS 1985).

Campbell: Well harm reduction has been brought in recognising the

inherent failings of the abstinence models. For any service that’s

trying to provide for care for all the people that they’re responsible

for, if the abstinence model will only allow for “x” percentage of care

and the rest have to be in the gutter then you’re trying to minimize the

damage of being in the gutter until something else works. I think it is a

perfectly legitimate necessary program, it doesn’t exclude other

models of care but it recognises that people shouldn’t be damaged by

their not responding to other forms of treatment.

Here Campbell verbalised what many believe to be one of the fundamental

reasons for the harm minimisation policy (NDS 1985). In other words, with harm

minimisation programs there are larger numbers of successful outcomes, therefore,

government funding appears to get better results for less effort and resources. On

the other hand, the abstinence model is believed to be harder to achieve and

fraught with relapsing. Before harm minimisation, the programs based on detox

with the AA 12 Steps abstinence permitted smoking in the recovery process but

now with the advent of smoking being illegal in hospitals and such institutions, I

wanted to know how Campbell’s service handled this issue. He agreed that it was

important to handle one addiction at a time and that those who smoked were

expected to do that outside the hospital building.

At this point I brought up the notion that recovery programs have now generally

changed from confrontation about the dependency in order to chip away at the

afflicted person’s denial of the problem, to giving the person a choice over which

personal issue they wanted to work on. Campbell agreed that “good therapy is

best conducted in a sort of therapeutic alliance where people often bring up the

issues that really concern them when they feel safe and comfortable”. Also saying

“it’s unrealistic to expect that this is going to happen in a brief admission or even


63

brief contact in an outpatient centre”, but he added that his service would be

needing staff training to get to that stage. In the meantime he stated…

Campbell: As far as this hospital goes our abstinence programs are

run by people who are trained in delivering this one form of care and

they’re very focused on that. They’re not necessarily skilled in having

counselling type relationships with someone or don’t necessarily have

the contact to allow issues to emerge over a period of time. So

inpatient programs are by necessity very focused on the problem at

hand which is their immediate addiction.

This sounded efficient and effective but I wondered whether the aim is how to

provide a service that could achieve outcomes in a short period, which would

appear successful in larger numbers? I gave an example of one of my clients who

had 31 admissions to a detox centre and who was told that he could fit well into

one of the halfway houses they were running now, with the harm reduction

controlled drinking (CD) model. This program allowed the residents to drink in

the evenings if they had not drunk all day, so I asked how that could work with an

alcoholic? Campbell confirmed that “the successful rate of an abstinence program

is in the minority, most people present again. We desire services to deal with

recidivism”. That was the rationale for the Harm Minimisation Policy (NDS 1985)

in a nutshell – the recovery statistics needed to show a majority outcome which

reduced recidivism. Yet the fact that recidivism was camouflaged because it was

not obvious did not count. Nevertheless, it was important that harm minimisation

strategies reached people that were not reached with the abstinence programs,

such as homeless street people and ‘skid row’ alcoholics.

I asked him how a ‘skid row’ alcoholic could possibly drink only at a certain part

of the day because in my experience that was not possible. He agreed that those

afflicted by addiction would be advised to embark on an abstinence model.

However, if they are not going to, then the next step is to attempt to reduce the

harm to them by giving them the opportunity to pace themselves, by setting such

limits as provided by government funded houses where they could drink at certain

times of the day and not at others. These types of programs worked for heavy

drinkers but rarely worked for ‘skid row’ alcoholics, he added that at least this

type of program prevented them from living on the streets and drinking

methylated spirits. This conversation made it obvious to me that harm

minimisation benefited many, but at least we needed to be honest about who it


64

helped – those people who could not manage to motivate themselves to enter

abstinence programs.

I asked Campbell to comment on process dependencies such as gambling and

love addiction and codependence, explaining that some professionals such as

behaviourists, from the harm minimisation side of The D&A Debate, claimed

these were just labels. With his response he showed that these are conditions

needing therapy, although in his answer he alluded to these not being diseases.

This is disputed by those suffering from these process addictions because to them

treating their condition as a disease is the first step to recovery using the 12 Steps

model. Campbell stated that the difference between these conditions and

substance addiction was that “essentially most addictions are some external

substance modifying our internal chemistry so we need to take more – we get a

tolerance. And we maintain the addiction essentially to feel normal.” Yet he said

that “gambling to get some satisfaction and challenges, that life isn’t otherwise

offering them. It’s not necessarily, if you like, a disease, inasmuch an attempt to

be normal in an abnormal unstimulating world”. That certainly sounded the same

to me whether you take a substance to modify the internal chemistry to feel

normal or a process which will make us feel normal in an abnormal world still

involves serotonin release.

Because Campbell was a supporter of the synthesis concept (diversity of

approaches) and I had attended a workshop where he spoke of Transactional

Analysis as a strategy for personal development, I mentioned another perspective

to gambling addiction, the TA concept of gambling being a ‘loser’s script’ which

gamblers are hooked into playing. His answer was important to my research as it

supported my synthesis concept in Chapter 6. Campbell confirmed the TA

viewpoint that being a loser enables the gambler to feel “I know how to cope with

being a loser, I don’t know how to cope with winning” and so that gives them a

feeling of normalcy. This statement took me back to when Campbell although a

psychiatrist operating in the medical model, was a co-facilitator in the advanced

enlightenment weekend for my marriage and family therapist’s course (Unifam)

when Transactional Analysis and other similar modalities were used. For me, this

experience placed Campbell as one of the professionals who supported a diversity

of approaches – my notion of synthesis as covered in Chapter 6.


65

Finally, I asked Campbell what difference harm reduction/harm minimisation had

brought to his hospital. He claimed that there was none because they always had

selective detox and clients could choose to give up their drinking but not, for

example, smoking. Furthermore, because of their circumstances and the cost of

admission, abstinence rather than harm reduction still applied.

Reflection: Campbell has always given me explanations which made sense - a

balanced overview of the recovery process. He also respected modalities that were

workable yet perhaps not acceptable in traditional medicine, for example

Transactional Analysis and the AA program. When I was faced with objections

from the controlled drinking (CD) supporters about choosing 12 Steps model as a

recovery program for the SCOPE Halfway Houses, I asked Campbell what he

would say and he replied “tell them you use that model because it works!” His

stance supported a variety of approaches and that for an alcoholic - controlled

drinking (CD) is too difficult, but harm minimisation has its place in recovery.

3. Lennane Interview (1993) Sydney

A psychiatrist, in private practice (Sydney) Lennane for many years was

involved with one of the oldest detox units – McKinnon at Rozelle Hospital.

As covered in the media at the time that The D&A Debate developed,

Lennane was sacked from her position due to her stance against the Harm

Minimisation Policy (NDS 1985) at Rozelle Hospital. Lennane is also an

author of a book regarding Australian drinking patterns (1992). Lennane is

on of the protagonists in The D&A Debate whose stance was firmly in the

medical abstinence with the 12 Steps model. In her term at Rozelle Hospital,

and during mine as co-ordinator of the Metropolitan Addictions Referral

Service (MARS), I had been involved in a project on alcohol related brain

damage accommodation in the hospital grounds which she was responsible

for. So, I knew her from that project, specifically.

I asked Lennane about the cyclical schism that happens every 10 or 12 years

where professionals are supportive of the disease model and then the non disease

model and how now there is the battle between professionals about harm

minimisation, and she maintained that it was an ongoing debate which goes in

cycles. That sounds to me another way of saying a cyclical schism. Lennane was

also convinced that it was not only a debate between medical profession and the

behaviourists from the harm minimisation side of The D&A Debate, but also that

it was political and professional competition. Political in the sense that less

funding would be needed to provide services. This is because it is cheaper to

provide a weekly outpatient treatment with a psychologist rather than to have a


66

service provided by a doctor. Another concern is whether a weekly outpatient

service is as effective as an intensive detoxification inpatient treatment. From my

experience with people in halfway houses, who came from detox units, I knew

how hard it was for them to maintain recovery when they had the support of

living in a ‘safe house’ so, living out in the community as outpatients would be

even more difficult, unless they were not severely addicted to begin with.

Lennane’s response to my question about what she covered in her book Alcohol –

the National Hangover (1992) showed the need for concern for not only the

alcoholic or addict, but also the heavy drinker, and how that affects youth in

Australia. Lennane also supported an outpatient controlled drinking (CD)

program for heavy drinkers and those who are not habitual drinkers but have

gotten into trouble with alcohol abuse. This of course applies often to young

people who have serious accidents and “other sorts of terrible complications just

from what is accepted in their circle as normal social use of alcohol”. What stood

out for me was when she said that because “there is a wide range of alcohol

problems” then there needs to be different approaches”.

Lennane: What you tend to get is competition between the people

whose empires cover only part of that spectrum to say that their

particular patch is “the one” and the one that should get the

funding and the one that should be followed by everybody.

Interestingly, Heather from the control drinking side of The Debate claimed that

the medical abstinence side were promoting their model as the only model of

recovery. When I gave her feedback that it sounded as though she thought that

there is room for different models of treatment or therapy or living, she agreed

strongly. Yet in showing her comments here it can be seen how passionate this

side of The D&A Debate is about how behaviourists from the harm minimisation

side of The D&A Debate misunderstand alcoholism.

Lennane: Very much so, and I think a major difficulty is the obvious

ignorance of the behavioural school of the very seriously alcohol

dependent alcoholic type of problem. They just never see it, they’re

usually not clinicians, they haven’t dealt with the seriously alcoholic

person and they just have no concept of that kind of thing and yet

they’re quite happy to say “oh there’s no such thing” or “we can deal

with it all by a particular method” or whatever. And I think you

would find that most of the people who recognise and practice with the

disease model do recognise that there are other areas of the alcohol


67

problems that aren’t appropriately dealt with by the 12 Steps

programs or by intensive inpatient detoxification and therapy but I

don’t find that same broad knowledge among the behavioural harm

reduction school.

Her comments drew attention to the situation where there are people with co-

morbidity - experiencing other mental illnesses together with alcoholism such as is

often found in people with schizophrenia or bi-polar disorder who self medicate

with alcohol.

Lennane pointed out that it is important to reduce the overall consumption of

alcohol in Australia as it is far too high and the way to achieve that is to have a lot

more people not drinking at all in order to get more people drinking at safe levels.

This concept is also supported by Cassimatis who has stated that society needs to

take responsibility for reducing the role of alcohol in social events such as

weddings, as has been done at sports venues and with smoking in restaurants.

I mention that it is my interpretation from behaviourists I have spoken to that the

Harm Reduction policy (NDS 1985) is aimed at the whole Australian community,

which is one of the world’s highest drinking populations and any decrease will be

an improvement whereas abstinence is too hard. Lennane disagreed with this

concept because she maintained that living with alcohol is a choice not a

necessity. We talked about cultures and communities, such as the Muslim

community, where total abstinence is an expected and accepted way of life. It is

getting easier in Australia to choose not to drink rather than to drink, because

community education such as drink driving laws sensitise people to the negative

effects of drinking, so it does not appear as attractive.

I was interested in getting Lennane’s opinion regarding the compulsion

continuum concept I had read in Blake & Stevens (1987) and which influenced the

name of my research project. Lennane agreed with the continuum concept

confirming the theory that at one end of the continuum is habit with compulsion

evolving from heavy usage to impaired control at varying points from there on.

This resulted in her covering her belief that alcoholism can be threefold – genetic,

social learning, and situational circumstances when a person uses alcohol to cope

with a particular stress such as bereavement. This is what can lead to problem

drinking or addiction if it is not reduced after a certain time, and in this case, the


68

person becomes physically and emotionally dependent. It is much easier to correct

this excess when the person is not genetically predisposed to becoming addicted.

This belief is held throughout the 12 Steps fellowship and it is believed that

knowing when a person is genetically predisposed is both a preventative and

recovery measure. Nevertheless, as Lennane confirmed, compulsion can occur

with anyone who abuses something even if they are not genetically predisposed.

This is what confuses people because someone without a genetic predisposition

may have developed a compulsion and then by abstaining for a long period of time

they are introduced to controlled usage, such as Heather has documented, and

they find they revert to being successful social drinkers/users. It is considered that

they were not true addicts in the first place so the return to controlled usage is

possible for someone such as that (Jurd interview 1992)

So I broached a volatile issue presented by behaviourists from the harm

minimisation side of The D&A Debate, that genetic predisposition is inconclusive

and she passionately disagrees with them?

Lennane: Oh, that’s rubbish! That is absolute rubbish and that really

makes me very angry when people say that. The evidence is very clear

now and there is no argument, in my view, about it at all. The only

people who will say that are the behaviourists and they simply have

not adequately studied the evidence – that’s not to say that inheritance

is the only aspect, obviously it isn’t. If you have terrible genes for

alcoholism and you’re born in a Muslim country you don’t get into

trouble. So there are definitely other factors, but genetics is very

important and this is again something that annoys me very much that

because of the influence of the behaviourists school in policy making

where they’ve really managed to take the whole thing over – because

they don’t recognise the genetic aspect they’re not doing what I think

is one of the most important things that we should be doing and that is

warning people, running an education campaign to people that “if you

have alcoholism in your family you may have a genetic predisposition

yourself and you have to be very very careful about using alcohol”.

This further supports my belief that community education is the solution to

improving our situation with excessive drinking and other drug usage in our

country. Funding for this should be plentiful so that the emphasis is on prevention

through community education.


69

We spoke about behaviourists claiming that to identify as an alcoholic is labelling.

Her strong statement, similar to those who support the AA abstinence model, was

“there is nothing whatever wrong with a label that’s appropriate and it tells you

then what to do”. Just as Jurd had said that it is a diagnostic measure. Lennane

also commented on how valuable AA is as a support system that is available 24hrs

a day, 365 days a year with its many meetings, which of course is an amazing

community resource.

I wanted to know what Lennane remembered of The D&A Debate meeting and

she informed me that it took place at the Prince of Wales Hospital in 1990 and was

organised by NDARC (National Drug and Alcohol Research Centre). As I was

told it had been a disgracefully unprofessional meeting (Pollard interview 1993) I

asked her what she thought of that meeting and she believed it was a “set up”.

Lennane: I think the statement being debated was Alcoholics

Anonymous or the disease model is the only method for treating

people with severe alcohol dependence – some statement like that

which I personally really wouldn’t agree with because of course it’s

not the only method and there are people who can be dealt with

differently and each case is indeed different but I would say a

statement like it is the best in most cases or is the most cost effective or

whatever, that sort of statement.

It is worth noting that Heather’s interpretation of the meeting was that the other

side (Lennane’s) was voting for there being only one way of recovery the AA and

abstinence model, whereas Lennane disputes this in her interview.

In as far as those behaviourists being against people being directed to the AA self

help fellowship, Lennane confirmed that this was so and this was my experience

too. This is unfortunately the negative aspect of some professionals discouraging

people with dependence problems to belong to such a supportive fellowship as

AA.

There is disagreement between professionals and service providers as to what is

considered an addiction, some claiming that addiction applies to substances not

processes such as gambling and love. So I asked Lennane to comment on

codependence and other dependencies such as love and sex addiction, and stress

addiction and she stated that these too were compulsions. Lennane added that the

12 Steps program was in fact a character building program which is therefore


70

beneficial to non alcoholics too - a way of life which results in self help, personal

and professional development. This showed that her knowledge of the program is

exceptional.

Lennane was quite well informed as to the history of codependence in response to

my probe on that subject. I had found that even in the AA fellowship there were

elders who did not accept codependence as a compulsion. However, her answer

showed me that she did not come from the school of thought that codependence is

the primary level of addiction with addictions being secondary to that (Mellody

1993). As a primary addiction, codependence is the inability to deal with life

stresses appropriately which results in self medicating with addictive substances or

processes in order to gain normalcy.

Reflection: Lennane showed that she had experience with all aspects of recovery

and even the progressive aspects of codependence, which few people are informed

about. It was refreshing to hear that she believed not one method was the ideal and

in a sense she agreed with MacAvoy from the opposite side of The Debate, that

there are afflicted people who need a variety of approaches to choose from. That

does not mean that the protagonists give up their stance but rather as the

researcher I was pleased to find that they were not as intractable as had been

represented.

4. Mant Interview (1993) Sydney

Mant, medical practitioner, was the Clinical Director of the Drug and Alcohol

Program, Eastern Area Health Service (1993). Her stance was on the Harm

Minimisation/Controlled Drinking side of The D&A Debate. Mant was known

to me from working briefly on a project which she headed and I had been on

the committee. Therefore, I felt comfortable about meeting with her for the

interview.

I asked Mant about the cyclical schism that happens in the drug and alcohol field

every ten or twelve years where it’s either a pro disease model or anti disease

model? She confirmed that at present the behavioural model was in favour – the

non-disease model. It was interesting to me that some leaders in the recovery field

easily identified a cyclical schism whilst others could not. Mant confirmed that at

the moment there was a “decline in the view that the disease model is correct” and

that there has been a growth in the view that a learning model of behaviour “is


71

maybe a more productive way to design services, effective services, for many drug

and alcohol dependent persons” and for those who are only problem drinkers and

who do not see themselves as diseased. Even so, she showed a balanced outlook

by stating that the disease model only works for some.

Mant: So from a very practical point of view I’d say that there’s a

large group of people for whom the disease model is not very useful

and then there’s a small group of people for whom I’m also aware of

as a doctor over the years for whom the disease model has been I

would say a lifesaver.

In other words, Mant explained that for people who are early on in drug

dependency, they could benefit from a harm minimisation/reduction program and

those who are more dependent and admit they have a problem and are willing to

go to AA, could benefit from abstinence and the AA model. Her opinion was very

important to me as she was a protagonist in The Debate, a medical practitioner, a

spokesperson for Australia in the harm reduction worldview who attended several

international conferences and who was not against AA. This was something I also

discovered later about others on the Harm Minimisation end of The Debate

continuum.

As Mant continued to clarify the harm reduction philosophy, it was enlightening

to hear her perspective. She emphasised that it originated to prevent the spread of

HIV/AIDS infection “through loosening up on drugs” and as she put it “being kind

to drug users, being less restrictive” creating a way of thinking that “really it is

quite reasonable for people to have substitution – be it methadone or other

appropriate things”. This I knew also included supplying clean syringes on

demand in order to lessen HIV/AIDS infection which in fact did happen with

Australia becoming one of the leaders in the world.

Being close to those who were responsible for the establishment of the policy, I

asked Mant to tell me the difference between the terms harm reduction and harm

minimisation and she said that she didn’t believe there was any and that it was

confusing as such. Mant described making sure heavy drug users are sheltered

and have nutrition is harm reduction and that harm minimisation can include

abstinence as well as controlled usage.


72

In answering my question about whether she was aware that professionals in

powerful positions were against the AA model because of the Health Harm

Minimisation Policy (National Drug Strategy 1985), Mant agreed. She also

mentioned an important point that in medicine, many treatments which were “the

vogue” and found effective had never been subject to randomised control trials

and this was also the argument behaviourists from the harm minimisation side of

The D&A Debate had against AA - that it had not had randomised control trials to

prove it works. However at the same time of this interview, Project MATCH

(1993) was taking place and later the findings showed that it had included Twelve

Step Facilitation (TSF) in the treatment research sample, which made it the first

scientific research for the effectiveness of the AA 12 Steps model. Nevertheless,

Mant went on to confirm that testimonials from those who had benefited from AA

program showed that it was a great social support system, a network for people

who wanted to maintain a new way of living.

Mant’s next comments made good sense and this is why I had embarked on this

inquiry in the first place, so as to make sense out of the stance of the conflicting

professionals and the government stance.

Mant: There are very few doctors who don’t know that AA exists, or

who don’t have patients who have benefited by, or don’t refer people

to it. What we’ve got to be sure about is that there are other options,

because we do know that there are a lot of people who will never go to

AA and not only not go to AA but will never go to a detox centre

either. So we must look to alternatives for effective treatments.

We discussed those who participated in excessive drinking and who would refuse

to go to AA but needed to become informed on harm reduction. Furthermore,

another form of harm minimisation was having advertisements showing the

negative consequences of what excessive drinking can do, for the benefit of young

people to see. This type of harm minimisation I thought was important and

effective, as is supplying clean syringes on demand and free of charge. Having

community education on how important it was to reduce the amount of alcohol

intake is just as useful.

When I asked Mant about codependence and love addiction, she made it clear

that she did not support that concept because the process blamed the victim who

was usually a woman. This showed me that Mant did not have a good


73

understanding of the concept of codependence. I tried to inform Mant about the

concept as she had not been to a Codependents Anonymous meeting. I told her

about the CoDA Meeting at the Wayside Chapel and that people benefited from

the program as it was a supportive process with others being there and helping

each other to lower the shame of their experiences, and helping them to become

more assertive. Mant attempted to normalise codependence by laughingly

comparing it to the obsessional need that medical students can have about

succeeding as medical practitioners. This confirmed that she was not comfortable

with the notion of codependence.

I introduced the notion of compulsion being on a continuum and she agreed.

However, she turned the focus back onto how it was important to not “become

obsessed with the concept of compulsive behaviour” but rather support harm

reduction so as to decrease the alcohol induced road accident deaths. Although

Mant tried to have a balanced viewpoint, it was obvious to me that Mant was

strongly committed to the rationale of the Harm Reduction side of The Debate.

Reflection: Mant made it clear that she is a staunch supporter of the Harm

Reduction model and as a GP is very experienced with the benefit of AA and

abstinence for alcoholics. She is convincing in her arguments for harm reduction

as an education option for young people and a workable method of regulating

excessive drug use for those who refuse to use AA and abstinence methods. She

also supports the use of more than one model, although she strongly leans towards

the harm reduction model. Although she supports sending people to AA meetings

when they are willing, I do not believe Mant has any understanding of how the 12

Steps program actually works.

5. MacAvoy Interview (1993) Sydney

MacAvoy, a psychologist and Director of the Health Department Drug &

Alcohol Directorate (DAD), and chief policy adviser to the Minister for

Health, Collins (1993). His stance as a behaviourist fully supported the Harm

Reduction Policy (NDS 1985) the implementation of which he was responsible

to, and was one of the protagonists in The D&A Debate. MacAvoy promoted

the methadone program and was responsible for his department funding the

production of Methadone Maintenance Treatment (Ward, Mattick, & Hall,

1992). MacAvoy was known to me as his department funded the Wayside

Chapel of which I was then the Director of Social Services. Andrianopoulos,

co-researcher and camera operator for the interviews, was a Shepherd of the

Streets Youthworker at the Wayside Chapel. Later, Andrianopoulos and I


74

worked together at the Stansfield Program in Shellharbour, where she was

one of the youthworkers and I was one of the co-ordinators.

I asked MacAvoy what he knew of the cyclical schism in the drug and alcohol

field that happens every ten to twelve years – the disease model vs. the non-

disease model. He answered that he was only aware of a debate which has arisen

and became stronger over the years rather than something cyclical.

I then asked about the Harm Reduction Policy (NDS 1985). He was the

appropriate person to provide this information as he was in charge of

implementing this policy. In his answer which was articulate and which I show

here because it came from the Health Minister’s adviser at the time of the Harm

Minimisation Policy ((NDS 1985) inception, MacAvoy pointed out the important

aspects. This felt like I was present for a press release.

MacAvoy: The Harm Reduction Health Policy that is operated by all

Australian Governments really says that we want to reduce the harm

associated with drug use and that harm may be social, physical,

economic, criminal – a whole range of facets of people’s lives which

they may get into difficulties as a result of their drug taking. The

underlying principle is that the prospect of achieving a drug free

society is zero and therefore what we need to do is to try and make the

use of drugs for those who persist in using them as safe as possible.

Now such a policy does not in any way condone the use of drugs for

which we have clear evidence there is harm. For example there is no

safe level of tobacco consumption and therefore the only way to

minimise harm is for people not to smoke. That is not so in the case of

alcohol where it is possible to define a safe level of consumption and it

is certainly possible to define safe levels and methods of administration

for many of the other illegal drugs as well.

As was done by Lennane in particular, MacAvoy pointed out that achieving a

drug free society was an improbability and therefore it was essential to reduce

harm whenever possible. Another vital outcome from this statement was that

cigarette smoking cannot have a safe level of consumption and people need to stop

smoking.

The next point was equally vital as it was one of the main reasons I began my

research and I thought that his opinion would clarify many misunderstandings. I

shared with MacAvoy that a service provider had said that “the Health

Department is against 12 Steps” and was he aware that these are some of the


75

comments about the Harm Reduction policy (NDS)? With his answer MacAvoy

made it perfectly clear that Harm Reduction is “any method, any approach, any

style of thinking to assist people to manage their life better”

MacAvoy: So from our point of view, from the Department’s point of

view, we do not remove isolate or ignore any particular model of

treatment approach and therefore it would be quite wrong of us to say

that we are opposed to the 12 Steps approach. The 12 Steps approach

in fact is by our reckoning a type of approach to managing people’s

drug problems which has shown to be quite effective for some people.

That statement protected the Department’s reputation in the eyes of the

community and it satisfied in me the need for balance and justice. However, as he

continued, much like Mant, his commitment to the same behaviourists’

worldview became apparent. He did clarify the Department’s rationalisation

regarding reduction of funding for programs using 12 Steps as part of their

rehabilitation services, by stating that as such programs “involved residential

placement of people for long periods of time” which could be carried out just as

effectively on an outpatient basis after a short in-stay period. MacAvoy felt that

12 Steps approach was available in the community free of charge and did not

justify government spending. This sounded quite logical when the aim of the

treatment provided is one based on the Harm Minimisation Policy (NDS 1985)

and therefore a reduction in usage is considered a successful outcome for the

afflicted person. However it is definitely not of any use to an addict or alcoholic

who needs all the support of a residential treatment program to gain abstinence

and the opportunity to learn how to tap into AA - one of the largest recovery

networks available.

Nevertheless this was proving to be a productive interview as it was important to

have a variety of approaches for people to choose from and confirmation of this by

a government representative was a relief. I tackled the next volatile issue by

asking him what he thought of the idea of controlled drinking (CD) for alcoholics?

MacAvoy expressed his belief that there is continuum for alcoholics whereby

some cannot control drink because they are too physically and mentally damaged

and have a record of uncontrollable consumption. On the other hand, MacAvoy

quoted the statistics of “14% of people so called alcoholics are known to

spontaneously remit to normal drinking” and he used this evidence to justify

controlled drinking (CD) programs. This left me wondering at what risk would an


76

alcoholic be prepared to go to in order to find out if they were one of the 14% and

why?

In my effort to get MacAvoy’s thoughts on the continuum concept it was

enlightening to hear him disclose that those at the ordinary social drinking end of

the continuum get into more difficulty than those who drink heavily. This

information meant that people at the habit end of the continuum who are in larger

numbers are part of the at risk group because of drink driving deaths than those

who are alcoholics and as a smaller portion of the community did not pose as

much threat to others. So it sounded that the government dollar needed to go

towards programs for the greater good and to not bother about the minority

alcoholic group.

A stigma had arisen to do with certain terminology which did not exist before, so I

questioned him next about this. In response to my question about the terms

addiction, misuse and abuse he explained that they had been dropped out of the

diagnostic categories because they were imprecise and derogatory terms and that

the acceptable expressions now were chemically dependent, safe levels and

harmful levels or potentially harmful levels. When I mentioned that someone who

abuses a substance would not be able to return to social use again he confirmed

that it was the AA 12 Steps concept and added that it depended on the individual

and their ability to return to controlling the substance or not. His explanation was

helpful because it clarified the thinking behind this trend from people from his end

of The Debate.

In response to my query on what he thought about the term codependence he

dismissed it as a term which can be applied to “a multitude of situations” and was

labelling something that is a “normal human adaptation”. I was not surprised at his

comments considering they came from a behaviourist as this is their way of

thinking.

The same applied when I broached the concept of identifying problem behaviour

by naming it. It showed the rationale which behaviourists, from the harm

minimisation side of The D&A Debate, call labelling in the sense that it is negative

rather than therapeutic. His thoughts on that topic were profound because they

were quite the opposite to explanations given by Jurd and Lennane.


77

MacAvoy: Well if people think that by solving something all you need

to do is make a diagnosis then I think that has been the problem of

medicine and psychiatry right down the line. There is nothing about

putting a name to something to suggest that you have a treatment or

resolved it…By labelling you ostracise people, you marginalize them,

you place them as ‘second class’ people – it’s like talking about

addicts. If you want to do that then call everybody, who’s married or

lived with a drug addict, a codependent.

This is quite a strong statement about the medical profession and perhaps warrants

a whole separate research project. The last section showed that he did not

understand the process of codependence and or addiction recovery because

addicts and alcoholics in recovery do not complain of feeling ostracised or

marginalised but rather “happy joyous and free” in their newfound serenity once

they understand what their condition is called.

As I came to the end of the interview, I asked MacAvoy if there was anything

else he would like to comment on. His response showed that he had a positive

outlook regarding drug dependency and hoped to have constructive debates about

solutions, although he did admit that this would be difficult because of the strong

emotions and beliefs of people involved. He wanted it to be understood that he

was a strong supporter of “a variety of approaches and a variety of solutions to

drug taking behaviour”. Yet he went on to say that he thought it was not necessary

to have a person “removed from the presence of all alcohol or taken out of society

for a long period of time as it has not shown to be more effective than holding

them in society and perhaps have them live on substitute drugs or drugs used in a

safer fashion for a good part of their life”. This meant perhaps people who use

methadone to enable them to carry on with their jobs and their lives. This is an

option for those who are able to control their drug use and need to use methadone

to stay off the hard drug of choice until they do not need the methadone anymore

but it is not, in my experience, something that a totally addicted person can do to

normalise their life. I’ve known addicts who were given methadone and used

heroin at the same time.

I posed the question about how he would respond to a person of 35 years sobriety

wanting to use controlled drinking (CD) and he advised that person should not

change what they were doing that worked. But he put a slant on the answer that


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was different in suggesting that some other option should be considered if the

person was not happy with his life as it was.

MacAvoy: All I can say is that we have to accept that there are other

points of view and other approaches – no one would deny a person of

35 years sobriety if that’s what keeps him sane, if that’s what keeps his

life in order so that he can get some enjoyment out of it and those

around him can, then who would deny him access to AA? But if you

said to me “there’s this person with 35 years of sobriety out of AA

whose life has become a rigid adherence to a religion which he’s so

dependent on that religion that he’s really no better than when he was

on the drink, in terms of his ability to enjoy his life and people to

relate to him” then one would have to seriously question whether that

person has achieved a great deal. Now I’m not suggesting for a

moment that the answer is to go back on the booze but then maybe

[there are] other approaches which that person could look at.

MacAvoy’s answer certainly showed that he did not have a correct

understanding of AA, because it is definitely not a religion and he used that in

his example, nevertheless, his point was accurate that should a person have 35

years of unhappiness then perhaps they should try something else.

Reflection: MacAvoy’s comments confirmed his commitment as a behaviourist

to those principles shared by his colleagues and he put up a convincing argument

for his worldview. Nevertheless, as those committed to abstinence, he too

supported a variety of choices for recovery and not ‘one to the exclusion of all’

and this was positive. I was pleased that I got the opportunity to personally

mention the misrepresentation about the Health Department opposing the 12

Steps model and hearing him deny that, because having a representative who

was adviser to the Minister saying that, I believe raised his awareness of what

was being said in the community.

6. Heather Interview (1993) Sydney

Heather at that time was the Director of the National Drug and Alcohol

Research Centre (NDARC) (1993) also co-author of a book Controlled

Drinking (1983, Rev. edn.) and similar other literature. Heather, a

protagonist in The D&A Debate, was obviously a major supporter of the

controlled drinking (CD) side, whose research was primarily responsible for

influencing the inception of the Health Harm Minimisation Policy (NDS

1985).


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In response to my question of what fired his interest in Harm Reduction, Heather

answered that it made sense and was relevant to his previous research interests as

he had been reading an article in 1975 about controlled drinking (CD) and how

some people with alcohol problems could return to a safe level of drinking. It is

important to note that he qualified his comments by adding…

Heather: I stress ‘some people’ not all people and a lot of my research

and writing since then has been on that issue and specially more

recently in the area of brief interventions for people with less serious

problems who are picked up by general practitioners and general

hospital wards and so on. So when during the 1980s arose a lot of

interest at the time about Harm Reduction it was all fairly familiar –

the notion that abstinence was not always necessary and that there was

sometimes very good reasons for at least accepting a non-abstinent

outcome of treatment, of regarding that in some circumstances as a

good outcome and also to go further than that actually aiming at a

non-abstinent outcome across a range of drug problems – not only

alcohol but obviously other drugs as well. So that really was the

motivation for my interest.

It was important to show his thoughts verbatim here because it shows his way of

thinking and I find it explains his stance, making it a reasonable rationale for his

research. It shows that this model can reach a larger portion of the community and

therefore justifies funding, whereas he had been attributed with supporting only

the controlled drinking (CD) model.

I broached my notion of a cyclical schism where there is a swing from abstinence

in recovery to a controlled drinking (CD) model. His response indicated that he

thought there had not been a cyclical schism but rather conflict between

professionals with scientific background and “recovering people who are already

in the field”. This conflict he thought was due to the National Campaign Against

Drug Abuse which launched the National Drug Strategy (1985). Heather said that

eventually both groups would “find a way of working together” as had happened

more in the United Kingdom, although he qualified that statement by saying that

there were problems there too. In praising Australia’s progress to do with

“increasing professionalisation in the discipline” he did not think the same applied

to the United States because their dominant treatment response is based on the 12

Steps model which is worth quoting here as it shows his bias.


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Heather: I’m sure you know that although there are a lot of very able

scientists and people producing a lot of very good work in the United

States the dominant treatment response is still based on the 12 Steps

model and the kinds of people involved in treatments are still

primarily recovering people themselves.

He informed me that abstinence is also a form of Harm Reduction and clarified

that “people with relatively less serious problems or less serious levels of

dependence” should be directed to controlled drinking (CD). This was something

both sides of The Debate were in agreement with, yet some service providers

were not giving that message. The message given by those people was that

abstinence was not an option rather harm minimisation was expected by

government, and this was not accurate. This realisation meant a lot to me as a

community worker, trainer, and researcher.

At this point I wanted reassurance that he believed what he stated so I asked what

Heather would say to an alcoholic who was in AA for 35 years, and he was

thinking of trying controlled drinking (CD)?

Heather: He’d be crazy. I mean somebody who’s achieved a contented

stable way of life through abstinence the last thing one wants to do is

to try and persuade them to endanger that in any kind of way. It’s not

a question of being opposed to abstinence, you must understand, I

think this is a misunderstanding that many people have. It’s more a

question of the role that moderation or controlled drinking can play

in the range of services.

His response convinced me that as a protagonist on the controlled drinking (CD)

side of The Debate he was focused on the wellbeing of the recovering alcoholic

and not what had been claimed, he was not totally against AA and abstinence.

However, he did explain that as there are more people with early stages of

drinking problems or people with less serious problems than those who are highly

dependent, then there needed to be an approach that did not involve abstinence

which these people who did not have a serious problem could not accept. An

approach that would enable them to not give up drinking completely but rather

reduce the harm.

Here too he is in agreement with the abstinence and AA 12 Steps side of the

continuum about levels of dependence, and I too expressed agreement with his

statement, however, I added that there are professionals in positions of power who


81

are interpreting the Health Dept. Harm Minimisation Policy (NDS 1985) in a way

that denigrates the 12 Steps and abstinence model and are basing that on his

research. This was my way of passing information about personal experiences to

one of the protagonists to give him the opportunity to become informed and

attempt to transform conflict. So, I asked if he was aware of that?

Heather: I’m not aware of that and I’d be grateful to you for letting

me know where my work is being misinterpreted that way. I would

certainly say to those people that they should read more carefully what

I and others have to say on this issue.

I related my experience when I had prepared a smoking cessation package in

different languages and recommended that we also include Nicotine Anonymous

literature in different languages but this was refused by the director of the project

saying that “the Health Policy is against the 12 Steps model at the moment”. I

commented that I believed this to be a serious statement and it was the reason I

wanted to interview him and get his response in person. He maintained that he was

not convinced there was a need for a 12 Steps approach in the area of smoking

cessation but that needed to be discussed separately but he did elaborate on the

argument which had been created in the community – The D&A Debate, and he

advised that he was against the notion that the AA 12 Steps approach was the

exclusive approach to alcohol problems. Which in turn was not what the other side

were maintaining – that there was an exclusive approach. I show his rendition here

because it described a historic event relevant to my research.

Heather: Interestingly there was a debate [The D&A Debate] here

about a year ago – probably a bit longer than that when the motion

under discussion, I can’t remember the exact wording, but the effect of

it was that the 12 Steps approach was the only approach to alcoholism

and three people were found to support that motion. So, there are

faults on both sides, there are people who are dogmatic about the 12

Steps Program and won’t accept any alternative including abstinence

oriented alternatives. It’s simply not just 12 Steps versus controlled

drinking, of course there are other ways of getting abstinence and of

course there are many people, and I think this is the most important

point to make, there are many people who find that the spiritual

approach embodied in the 12 Steps principles is unacceptable to them.

There are many people who take to AA but there are also a lot of

people who don’t take to AA and are turned off by AA and these

people have serious problems and we’ve got to find a way around it.

But what some people are saying is we need alternatives to the 12

Steps approach we don’t want to eliminate it.


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Heather objected to government funding being allocated to the 12 Steps model

when AA is a cost effective self help fellowship out in the community, which

people can avail themselves of without costing government. At the time of the

interview the Project MATCH (1993) research evidence had not come to light so

Heather added to his argument that the 12 Steps model was not an approach that

had been scientifically proven. He mentioned that he attended a conference in

Albuquerque where consideration was being given to a large research project

being conducted to ascertain the effectiveness of the 12 Steps approach, CBT

(cognitive behavioural treatments) and other forms of treatment [probably Project

MATCH 1993] - “research that would satisfy academic criteria which hasn’t been

the case so far”, he stressed. He spoke of a distinction between the AA self help

fellowship and a private program involving the 12 Steps approach. The later could

attract government funds and which participants could pay for. That sounds like

the TSF clinical model which was designed for Project MATCH (1993) research

along with CBT and MET (later known as MI).

I asked Heather to comment on process dependencies such as codependence, sex

and love addiction. His thoughts on this were ambivalent because although he

admitted there could be a “lot of things in common from a psychological point of

view and certainly from a behavioural point of view” he believed “that’s been

overdone a bit”. He felt strongly about chemical dependencies being in “a class on

their own and involve much more compulsion”. I respected that he did finish that

whole statement with “I could be wrong” because he had heard people who

claimed “that compulsive gambling is a highly obsessive compulsive disorder”,

nevertheless, he still leaned toward “those similarities are a bit overdone”. His

opinion on codependence was strongly against giving the condition any credibility

to the extent that he supported that it was perhaps a notion that came out of people

running out of clients in the United States in the 1980s because services for

alcoholics were plentiful so they dreamed up this condition which initially was

attributable to their spouses. This indicated to me that Heather was not familiar

with the definition of the condition because it is now defined as being ‘neurotic’ as

written about in Mellody’s Facing Codependence (1989). I have heard about this

in countless stories shared in the 12 Steps fellowship and yet there are

professionals in the field like Heather who are not informed accurately on the

meaning and yet who make strong oppositional comments.


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I informed Heather that I was going to a Conference in America where I’ll be

talking about Australia using Harm Reduction techniques such as the free syringe

deliveries and would he like to make any comments about that? His pride about

Australia being a leader in reduction of HIV infection shone through as he spoke

highly of “the deliberate policy in the National Campaign 1986-87…by Dr Neil

Blewett and his advisors” (interview 1993) generously funding the use of

methadone and needle exchange programs - the harm reduction measures

primarily responsible for containing the spread of HIV among injecting drug users

in Australia.

Heather: Australia very quickly learnt that lesson and very

courageously I think at the time, because there was a lot of opposition,

invested in this approach to HIV, about which we know is a mistake to

be too complacent and one must be constantly aware of the possibility

of the epidemic growing if we’re not careful and that is why one is

opposed to any efforts to reduce the methadone or close needle

exchange programs but providing we don’t, that’s a considerable

achievement.

Reflection: Heather made it clear that controlled drinking (CD) is for those who

are not seriously affected by alcohol problems and that this approach could be

used for other drug problems and for those who were not open to an abstinence

approach. Although he expressed a more open viewpoint than what he had been

credited with, he admitted that there are some areas that he was not convinced

about such as a 12 Steps approach for smoking cessation and other dependencies. I

did not mention to him that I had given up smoking four packets a day on the

Nicotine Anonymous program where other approaches had failed because he was

elaborating on The D&A Debate, which at that time did not place cigarette

smoking in the same category. My primary area of focus was The Debate, so I did

not want to influence the conversation away from that. It was also important for

my research project to get his perspective. At the risk of repeating myself here,

given that I promised to make the interview short and succinct, when I asked him

if he wanted to say anything before we ended the interview he answered “Ah no, I

don’t think so, you’ve had a wide range in discussion and I’m quite happy with

what’s been covered”. As the primary researcher, I was pleased with his response

even though as a therapist I may not agree with some of his comments.


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7. Cassimatis Interview (1993) Sydney

Cassimatis a psychiatrist in private practice was also based at Evesham Clinic

at the time of the interview. Furthermore, he was the external medical

consultant for this research project. Initially Cassimatis was trained at

Morisset Hospital Alcohol Unit in the early 1970s and later worked in Ryde

Psychiatric Centre Alcohol Unit as it was known then, and in the mid eighties

with Allanbrook Private Hospital specialising in alcohol and other drug

addiction. Although he is a registered methadone prescriber he has not

practiced this in the last ten years. Cassimatis also had worked with a

practitioner who specialised in overeating and obesity. His experience in the

dependency field made him an excellent consultant to the progress of the

Compulsion and Recovery (C&R) Research Project throughout its several

stages over more than a decade. As a mentor and medical consultant to my

private practice Cassimatis served as the main ethics and medical advisor for

my research. His stance in The D&A Debate has been clearly one supporting

the diversity of approaches (synthesis), having a full understanding of the

abstinence and 12 Steps model and being well informed in CBT. He believes

that when addiction becomes marginalised instead of central to our society

then we will be free of its cost.

To document the balanced way of thinking of Cassimatis, which is client centred,

I began by enquiring about why the AA model was preferred at Morisset Hospital

when he worked there, Cassimatis advised that the Unit director, a psychologist,

believed that program was the best, it had good support from the AA programs, a

good reputation and it worked. He also mentioned how Allanbrook being a private

hospital because of its high profile public life clientele needing a more secluded

up-market environment had also primarily an AA program with regular AA

meetings and group therapy which was psychodynamically based. This meant to

me that he had personal experience about the 12 Steps model as a recovery

program.

When I probed Cassimatis about the obesity program at Allanbrook he spoke

about medically based programs with drugs such as appetite suppressants, health

farms, diet, diuretics, thyroid hormones and whatever was in vogue at the time. I

mention this here because it showed me that Cassimatis had a well informed

knowledge base regarding different conditions and remedies. He did add that these

remedies lasted usually for the month the people were there, which did not

surprise me because it is well known that no matter which addiction we struggle

with in order to be free we need to belong to a support network that keeps up the

new lifestyle.


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I asked Cassimatis if he has heard of a cyclical schism where abstinence and AA

is popular and then it is not. He said he had not heard of it as clearly as that but he

knew that AA had in its sixty years “remained fairly consistently the true and

responsible program with its 12 Steps and other such activities” as a non

professional self help program. Its basis is in psychotherapy – “make an admission

that you have a fault and looking for the causes, understanding the reasons,

altering the self and continually working through this”, a self awareness process.

In the preamble of SCOPE (Stress Anonymous) 12 Steps Group the program is

described as being based on Eastern and Western philosophy, and psychology.

Cassimatis, however, explained that “the best result of any new therapy is at the

beginning” and as that wears off then AA and the 12 Steps model, which has been

in existence longer, is found to be more successful, but even AA is not for

everyone. In saying that, he supported other therapies that are useful to people

who do not benefit from the 12 Steps model and need something else. Another

strong reason for a schism was as Cassimatis said that addiction is not definitive

and we are searching for the magic solution.

It’s important to mention here that Cassimatis is a psychiatrist who works in the

medical model but who also is familiar and supportive (as Campbell) of such

models as Transactional Analysis. I have found that a large number of traditional

medical practitioners discredit these models.

At this point I introduced Nobel’s concept of the Allele 2 gene contributing to

addiction. In responding Cassimatis again showed the balance in his way of

thinking which I find more effective as a counsellor in the field and which is worth

quoting here.

Cassimatis: I’m sure that we are all predisposed to something through

our constitution, our heredity…but I think that it’s like everything else

it’s multi-factorial - there’s a lot of behaviour there, and learned

behaviour - people’s character comes into it and that’s not inherited

that’s learned.

When I asked about Jurd citing studies done with twins that support the

genetic/hereditary concept, Cassimatis also confirmed this worldview about the

susceptibility to inherited alcoholism. This, for me, was important information

expressed by someone from a medical background. Even more importantly, he


86

also spoke about the effect of the environment and learned behaviour which can

inform and motivate a person to protect themselves from destructive inherited

susceptibility, something Lennane had also mentioned in her book (1992).

So I asked him how to deal with the scepticism of those who do not believe in

hereditary or genetic dependency when they say the evidence is “inconclusive”,

which was a statement I was constantly bombarded with from behaviourists who

were against the 12 Steps model. His response was so simple – to refer objectors

to research scientific material for more information.

I probed about his knowledge of experiments with alcoholics and controlled

drinking (CD), and the success of such people. Cassimatis spoke about the type of

people who possibly could return to controlled drinking (CD) but he was emphatic

about alcoholics being unable to control drink by saying “No, I don’t believe that”.

Even though he is a therapist who uses a variety of methods, his next comment

confirmed for me what those from the abstinence end of The Debate continuum

believe, which is that alcoholism is a progressive disease. I’ve heard how

alcoholism is a disease and is progressive, in more than 20,000 stories shared at

the 12 Steps meetings that I attended and it is referred to often in literature from

that model (AA Big Book 2002).

On the subject of motivation, Cassimatis maintained that it is the “be all and end

all of any recovery”. So I prompted him to elaborate on how can someone

motivate themselves to become motivated or ‘become willing’ as the 12 Step

program states? Our discussion led to a well known notion that an addict needs to

reach their rockbottom in order to find the motivation to get into recovery. This

made me remember that there are some strategies that a therapist or someone close

can use to facilitate an addict’s entry into recovery. The main two I am familiar

with are based on information giving 1. bringing up the rockbottom through

focusing on what can happen at worst, 2. someone close can arrange an

“intervention” where those in the addict’s life hold a surprise meeting and lovingly

confront him or her about the addiction and the need for recovery. Cassimatis

made a strong point that everybody’s rockbottom is different, some worse than

others.


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I brought in the concept of harm reduction/minimisation and how it affected his

work. Cassimatis advised that he was seeing people in the early phases of

substance and process abuse which affected their relationships, therefore, harm

minimisation was their focus. He felt that this is because they were not at the

rockbottom stage where they were willing to look at AA and its changed lifestyle.

Here he was confirming that a harm minimisation concept works at the early

stages of habit forming behaviour where people are motivated to change. In

answer to my question as to whether Evesham Clinic has a detox unit, although he

confirmed that one existed it was mainly aimed at an individual treatment whereas

the sister hospital, Northside Clinic, is where they refer the majority requiring a

detox program. In fact Evesham and Northside Clinics are owned by the same

person. As depression is thought to be major contribution to addiction I asked

Cassimatis to comment on that. He confirmed that depression exists as a

condition of addiction and that co-morbidity involves someone who suffers from

depression and addiction, which is not treated.

He asked Toola Andrianopoulos (co-researcher handling the camera) if there was

something she was interested in. She asked him what did he mean in a previous

statement that there are people who drink and are just drunker versions of

themselves and there are people who drink and are completely different people?

This I thought was an important question. Cassimatis claimed that an alcoholic is

someone who pursues the ‘high’ and it biologically makes them a different person,

“a true drug affect in which they become somebody else”. Eventually they drink

too much and it backfires, destroying their life. On the other hand, there are those

who drink and “become drunker versions of themselves”. In his words here, there

are two types of addiction that describes why it is easier for some to move into

controlled usage after excess use. People who have behaviour that reinforces a

persona they choose, find it more difficult to give up the substance or process that

helps them achieve this and they are genetically susceptible, whereas those whose

behaviour is an embarrassment to them can move into controlled usage as they

probably do not have the hereditary component to their condition.

Cassimatis: The second group is probably not the hereditary alcoholic.

I think they’re people who have learnt to use alcohol for their

depression, coping with life, and so on. Whereas the first group is

biologically driven because they get this change in them. I think you

hear the same with gambling, food and so on – people can eat


88

something and just feel terrific, get this amazing feeling and if you get

that, you’ve got to chase it because you can’t get it anywhere else. And

I think that’s the hard one – they’ve got a lot to give up, their

rockbottom has to be way down. Whereas the person whose becoming

a drunker version of themselves they’ll give it up [because] they’re

saying “what am I doing here falling asleep at parties and

embarrassing myself”, and some feedback will get them to stop.

Reflection: I covered several perspectives in this interview with Cassimatis. He

would deal with alcoholism by using the abstinence and AA 12 Step program, and

medication as required. Then he confirmed that although the Health Dept. Harm

Minimisation Policy (NDS 1985) did not officially affect his practice it had

impacted clients who were educated to use a harm minimisation method. Finally

he confirmed that he was the type of therapist who used a synthesis – a diversity

of approaches as required by the client whether it was abstinence, cognitive

behavioural therapy/treatments or medical treatments such as anti-depressants, and

psychotherapy. Cassimatis believed that society should take responsibility for

addiction problems through community education. This could eventually evolve

into a cultural norm where functions will have water on the tables and only

provide alcohol when specifically requested, rather than guests being

automatically asked by waiters which alcoholic drink they would prefer.

Nevertheless, more guests are already preferring water and soft drinks nowadays.

8. Maclaine Interview (1993) Sydney

Jim Maclaine, psychologist, director of the recovery unit, St. Edmonds

Hospital, and author (2001 rev. edn.), is considered a forerunner in the AA

and abstinence dependency recovery field. Maclaine made recovery inroads

in Sydney because not only was he a protagonist on the abstinence AA side of

The D&A Debate continuum but also he had been responsible for programs

that facilitated addicts exploring emotional problems that manifested once

the alcohol or drug had been stopped. Maclaine strongly criticised the

controlled drinking (CD) side of The Debate and articulated his knowledge

and experience with recovery from addictions with the abstinence and AA 12

Steps model.

I had heard about Maclaine in stories of recovery at 12 Steps meetings and

therefore when his name appeared as one of the protagonists in The Debate

(Appendices A and B). I particularly wanted to find out his perspective. I had also

heard about his clinic running programs for anorexics, one of which was my

client. I had also heard that the recovery model was influenced by the John

Bradshaw approach, another leader in the 12 Steps recovery field.


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Maclaine spoke of how “dependence is locked into the personality at the deep

level of the self” and how he believed that the emotional problems had a

connection with damaged childhood usually through the alcoholism of their

parents (Maclaine 2001, Bradshaw 1988, Mellody and Miller 1992). In his own

words he describes here St. Edmond’s program as it was in 1993.

Maclaine: We have a program that’s able to address the need of

people who are experiencing adult difficulties, serious adult

difficulties, through the damage that they encountered as children –

emotional, physical, sexual or whatever. It works very successfully

with that group of people…we have a medical detox and a full

complement of hospital staff to care for people who might be going

through difficult emotional difficulties when they come in or difficult

detox, or whatever. There’s a full range of services that way,

psychologist, psychiatrists, medical doctors…Codependency would

generally need about three weeks because there’s a lot to absorb.

I posed the question about the cyclical schism between disease vs. non-disease

models every 10 or 12 years where now the emphasis is on the non-disease model

concept. Maclaine put another perspective which made sense and which Heather

had also mentioned (interview 1993). That is, initially it had been a “lay

alcoholism movement” and professional services had grown around that, but that

as a result it provided career paths which “became an industry in its own right for

professionals”. So, this industry increasingly evolved into an academically driven

field with the competition that process brings, somewhat losing “its contact with

the base that made it meaningful and successful for the people with the problem in

the first place”. As can be seen in his statement he felt very strongly about the

opposite side of the continuum.

Maclaine: the model that’s sort of the academic ‘flavour of the

month’ through behaviourism is the continuing model that denies

there’s any difference in the quality of processes between, say, your

addicted drinker drinking himself to death and your normal

drinker – it’s explicit in their literature which is academic nonsense.

I brought up the controlled drinking (CD) program which existed with the

Haymarket Foundation and asked him how he thought that could possible work?

In his response he was again emphatic that it was nonsense but that such a

program could be established for those who have some control over their

drinking and thus could be a “holding operation” to minimise the harm they


90

would experience so as to not end up on the streets. Maclaine stressed that we

should be informed on the different types or levels of problem drinkers so as to

assess appropriately what program to provide for them.

Maclaine elaborated on the point that controlled drinking (CD) would not be

necessary if a person was capable of controlling their drinking in the first place -

“So there is no need for them to control it, all they need is to moderate it” and,

therefore, they would be a compulsive drinker if they could not control their

drinking. This showed he was committed to the inappropriateness of using a

controlled drinking (CD) program for an alcoholic.

In supporting the claim of Blum and Noble (1990) Maclaine firmly claimed that it

can be seen in “all the literature on genetic predisposition” that there is not the

slightest doubt that there is a significant genetic element to addicted drinkers. He

also attributed the role of lifestyle and personality disorder as being a contributor

to the person becoming addicted.

Before I asked about process addiction and codependence I hesitated because

some therapists treating alcoholism have been against these terms. However, in his

answer he showed that he came from that school of therapists who believed in

process addiction and codependence, as can be seen here.

Maclaine: Ah well, I see alcoholism and other drug dependencies as

being disorders that arise from the deeper parts of the personality

which is why that’s so difficult for the person to get over. The deeper

parts of their self carry the disorder and that leaves no part of their

self free to take things in hand. And the alcohol in certain people has a

chemical pathway to those deeper parts of the personality through its

affect on whatever areas of the brain function are involved. And the

kind of difficulties that arise from abuse in childhood also implant on

the deeper parts of the personality and in those areas which self help

therapy has been found uniquely useful because it provides a way for

change to happen in the deeper parts of the self.

Maclaine agreed that naming and identification was a powerful tool in recovery

and to call it labelling as those behaviourists do, was counterproductive.

Reflection: Maclaine, a strong supporter of abstinence with the AA 12 Step

program of recovery, had been outspoken and it was apparent that he was

committed and passionate about this. He was informative in his explanations of


91

the recovery process and its history. In his description of the program used at this

hospital, many strategies were shown to be important to recovery.

9. Mellody Pia Interview (1993) Sydney

and

10. Mellody Pat Interview (1993) Sydney

Both counsellors from The Meadows, Arizona (1993). Pat is a senior

counsellor/trainer together with Pia, who is also an author (1989, 1989, 1992)

on codependence and love addiction. As Pat stated, it is a broad based

treatment program centre with a lot of conditions being treated there –drug

and alcohol, basic depression and eating disorders and the whole broad genre

that’s now called codependency, “which is really what neurosis used to be

called”. This program is based on family of origin issues as well as the first

five steps of the 12 Steps model. There is a whole week embedded workshop,

which Pia calls Survivors Week, that all the patients go through in which they

look at early childhood issues and how they impact the present. They carry

out an integrated process that works both with the early childhood issues and

the present addiction model. Because of Pia and Pat’s area of expertise it was

important for me to interview both, which I had the opportunity to do whilst

they were out here consulting on the establishment of South Pacific Private

Hospital at Harbord/Curl Curl (1993) based on the Mellody program. As Pia

had a higher public profile due to her books and tapes on codependence, at

the time, she also presented a seminar at Sydney University where I managed

to interview both Pia and Pat Mellody at lunch time. In the next year (1994) I

participated in that residential program for four weeks at the beginning of

the year for my food addiction, so as to give me a first hand experience in that

rehabilitation program. This was in order to benefit my research as well as

my recovery from food addiction. Bishop (whose interview is next) and his

partner Elaine Alexander, a food disorder expert, were brought out to set up

and run the South Pacific Private Hospital program. They were familiar with

the Mellody program.

In the interview with Pat and Pia, I began by summarising the Australian Health

Department Harm Reduction/Minimisation policy (NDS 1985) where the message

is being incorrectly interpreted and misrepresented as alcoholics being able to

return to controlled drinking (CD). I also presented my notion of a cyclical schism

which Pat Mellody although he stated that he wasn’t aware of it happening in

cycles proceeded to give the evidence about the last trend 15 years ago for

controlled drinking (CD) with the Sobell Sobell studies which were mentioned by

Jurd (interview 1993) as a failure and Peele and Brodsky (1991) as a success. His

information showed that those who succeeded in the Sobell Sobell had done so

with AA and he insisted that he had not heard of any alcoholics who had

succeeded with a controlled drinking (CD) program, just as Cassimatis had stated.


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Pat: I don’t know that it happens in cycles. I know that we went

through a big furore 15 years ago in the United States about the Sobell

Sobell and the Rand Report, which purported to say that controlled

drinking would work. The problem with further research into the

Sobell work was that it was all spurious work. Out of the 12 people

they actually tracked only two survived and they’re ones who got into

an abstinence model with AA. Although I believe that the controlled

drinking model sounds logical I don’t know anybody it’s worked for,

I’ve not heard of anybody it’s worked for, I’ve not even heard of

anybody who’s heard of anybody it has worked for and our belief is

anybody who’s tried controlled drinking ends up dying from it.

Further to my summary about the Harm Minimisation Policy (NDS 1985) and its

ramifications for alcoholics Pia Mellody contributed an interesting slant which

informed that the United States was also having a similar backlash against

abstinence and AA. In her comment she also refers to a 15 year peak which was

now being attacked. I show this interaction between them here because their

comments are significant to The D&A Debate which had also sprouted in their

country too.

Pia: But in terms of AA being caught in a bad light as a model of

recovery, we’re actually going through that ourselves right now [in the United States] where there is kind of a backlash in the “recovery

movement” and people are coming out with books that really make

some really spurious remarks about the recovery community without

really understanding the recovery community; giving talks and

writing papers about how 12 Steps meetings really promote unhealthy

thinking and are full of a lot of sick people, and so 12 Steps programs

have really enjoyed what would you call a peak…they’ve been in the

limelight for about 15 years and now are getting attacked by certain

health providers.

Pat: I think it’s more the whole codependency movement that’s being

attacked more than 12 Steps meetings.

Pia: That’s true.

Although Pat Mellody corrected her that it had been more to do with

codependence, which she agreed to, nevertheless, the codependence movement

uses an adapted AA 12 Steps program. Therefore, it sounds as though the trend

against the AA program has some impact in the USA too where zero tolerance is

a government policy. That is not to say that controlled drinking (CD) will become

as influential as it is here in Australia, however, it is worth noting and possibly it

could be the area of focus for another research inquiry.


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Pia stated that behaviourists attacking the AA strategy of identification of the

problem by “calling yourself and alcoholic” comes from ignorance about what

makes the program a recovery lifestyle. It is a vital part of the AA recovery

program and allows the alcoholic to do whatever it takes to achieve recovery from

alcoholism or any other addiction.

Pia: The 12 Steps works because the essence of any spiritual process

like that teaches people how to love self and others which is a very

healing process for self and for relationships with others that certainly

do impact on somebody’s need to drink or to use drugs or sex or

gambling or anything else to alter who they are.

I broached the subject of codependence and addiction and, as there is

disagreement between professionals as to which happens first, I asked them to

clarify this. They both agreed in their answer. Pat Mellody first commented

saying “codependence results out of a childhood that was abusive and less than

nurturing, and the addictions are generated out of the pain of the childhood”. He

reinforced the belief that alcoholism is hereditary, although it doesn’t need to

develop when the family is functional and that happens when they are informed on

what predisposition exists. In other words when people know that there is

alcoholism in the family they can take the necessary measures to develop

character strengths and avoid the type of drinking that can only lead to excess and

addiction. The same applies to other feelgoods such as addictive substances and

processes. Here Pia Mellody affirms that belief and adds another slant about

people maintaining their addiction and ignoring the harmful consequences, an

obsessive compulsive behaviour, in order to replay the trauma they had

experienced in childhood in an effort to find help. Here, Pia expands on the

answer to my questions about which comes first - codependence or other

addictions.

Pia: Actually when I think about addictions and the issue of

codependence – I think addictions are connected to codependence in 2

ways. One is that when you’re a codependent what’s going on is that

you’re basically enamoured to a person and lack certain constructs

within your personality that allow you to be centred and feel good

within and so we reach into obsessive compulsive process or addictive

issues to medicate the stress created by our own lack of proper

personality structure. So in that way I see issues of addiction as a

secondary symptom to the underlying primary issues of codependence.

However, in years and years and years of dealing with addiction issues

I really believe that some issues of addiction are obsessive compulsive


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processes done in the face of harmful consequences that are ignored -

that sometimes the addiction process is really a reflection of early

trauma and actually a way in which people are trying to tell how they

were traumatised by engaging in the addiction issue. You’ll especially

see that in eating disorders and you’ll see it in sexual addiction, and

you’ll most certainly see it in what we call love addiction which is that

book I finally wrote.

Addictions become clearer if we remember that the primary issue is codependence

and we pick up other addictions to deal with the stress of that state. When I added

“which addiction takes place depends on the individual” Pia agreed by sharing an

example of her own experience with alcohol “I’m genetically alcoholic and it’s

throughout my whole family”. Therefore, when she first drank she became out of

control whereas 15 years later when she started drinking again she was needing to

medicate the pain. In that story she showed that she experienced both types of

alcoholism – genetic predisposition and in response to the pain of codependence.

This is certainly a different way of seeing alcoholism and I have heard it shared

similarly in stories at 12 Steps meetings. As she told her story I became absorbed

in her experience.

Pia: The first time I ever drank I got drunk because I’m genetically

alcoholic and it’s throughout my whole family. There’s a bunch of us

that have it and when I first drank I was out of control and I wasn’t

drinking to medicate – I didn’t know what it would do, I was just

trying to drink socially so I stopped drinking because I knew I was out

of control and I didn’t want that experience. The next time I drank

basically was about 15 years later and I purposely started to drink in

order to medicate the pain I was in so you see I have it on two levels as

the secondary level of the underlying codependence which created a

lot of pain and I also had it genetically which is a primary illness.

My own struggle with food over years caused me to take the opportunity to ask an

important question for me. I choose to show the interaction here because it was

about me and how both Pia and Pat dealt with it from the 12 Steps perspective.

Adagio: So what would you say in my case, for example, I work the

program – I’m a nicotine and food addict in recovery and all the other

things that go with it in codependency – but the one part that is

difficult for me is the food [both Pia and Pat nodded knowingly as I spoke] – I get it to a manageable level, the eating but the weight is still

there…I was beating up on myself saying “well I’m not being spiritual

enough or I’m not working the program” but to hear you talk about

some family of origin issues that are probably coming up that I’m not

dealing with and I need to look at which could be the reason…


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Her response to this, was a summary of what she had spoken about at the seminar

previous to this interview, before lunch. A narrative inquiry is both personal and

social, and this research also involved personal, professional and community

development. For those reasons I wanted to record this conversation here in her

own words because it is so personal to me.

Pia: Let me talk about those for a minute.

First, what I said in the lecture is that we believe that there are certain

phases of treatment for people, or phases of recovery:

• phase one: dealing with real powerful addictions that

medicate

• phase two: working on the first three symptoms of

codependence

• phase three: working on your family of origin

and

• phase four: going into looking at taking better care of

yourself being moderate and becoming more sober

[abstinent] – picking up other issues of addiction.

And what I told you is that eating disorders for many people are a

stage four or a phase four issue of treatment in that trying to arrest

them and get a person sober [abstinent] at phase one phase two and

phase three is not very effective.

They can have some sort of sobriety in terms of awareness but in

terms of it going into powerful resolution it won’t happen and I believe

that’s because eating disorders are with us for many different reasons.

Eating really medicates, eating really numbs our feelings. Eating in a

certain way can make us high so we can use it to medicate essentially

or mask a depression because we can raise our energy levels and raise

it out of a depression so we can eat to medicate anger, fear, pain.

We can use it to relieve a depression, we can use it, and this is where I

think the family of origin gets in there, we can use it to literally

nurture ourselves when we’re not getting enough contact and

nurturing from others around us – as a way to kind of medicate the

experience of not getting enough support in our life today.

I believe that comes from having to use food as a child as a way to feel

nurtured because your parents were too immature to nurture you and

so sometimes what I think needs to precede really getting your eating

sorted out has to be work done on the abandonment issues in


96

childhood that supported a child using food to get a sense of nurturing

and until you do that work on the family of origin around that lack of

nurturing, stopping using food to nurture is going to be very difficult.

I was enlightened by this interpretation and support of my experience, being

reminded that I use food to nurture myself at times of anxiety or to medicate

emotions that I dislike or imagine I will lose control of. Food is believed by some

to be an acceptable drug for such a purpose. Pat made a statement too which

reminded me that I am accountable for how I use food and that I need to deal with

this impaired control myself. As the 12 Steps program states – I am not

responsible for my disease but I am responsible for my recovery. His statement

contradicts that of behaviourists who persist in saying that the 12 Steps program is

about making victims. Here it can be seen by someone experienced in the program

that it is totally the opposite.

Pat: I think another important point to make here is part of the

backlash against the 12 Steps movement and the whole recovery

movement, that is, people hear what we say about these things and

think we’re excusing people’s behaviour based on their childhood and

the reality is that recovery entails saying “I am accountable for my

behaviour”. So we believe in holding people fully accountable for their

behaviour and looking at their childhood for a possible reason or part

of the reason for why it may happen yet still people holding the

individual responsible for recovery and accountable for the behaviour

they’re involved in.

I understood that to say that I need to stop using food addiction to medicate my

feelings. Behaviour modification is also a tool in the 12 Steps model.

I asked what they thought about (i) the compulsion continuum (Blake, Stephens

1987) and (ii) whether a person who has stopped excessive drinking can become a

social drinker again, because at the time we were educating young people to drink

less. So I wanted the opinion of leaders in the abstinence field about this type of

harm minimisation. Pat Mellody saw the societal expectation that people need to

drink alcohol to socialise as being obligatory. He stated that if people drank with

harmful consequences then they needed to learn from that and avoid doing it

again. That sounded logical but in my experience it is impractical when it comes

to youth. They are inexperienced and fool themselves into thinking that the

harmful consequences of drinking is normal for all drinkers and they are not

aware of the serverity until it is often too late. It is far better to educate them about


97

the harm alcohol can cause and show how ridiculous they appear if they

overindulge. This is what our community education is aimed at now with TV

advertisements regarding drink driving. However, for people who are committed

to recovery, then Pat’s strategies are beneficial. He advises them that when

people wish to recover from childhood issues and get in touch with their feelings

they cannot drink at any level because it affects their feelings. It doesn’t matter

whether they call themselves alcoholic or not they need to avoid drinking during

the program. Another indicator is that when it is easy to not drink for that period

then they should not, but if it is hard to not drink then probably they have a

problem.

Pat: Another thing, someone who has long term sobriety like I do, I

have 22 years, statistically people who start drinking and get back into

it after long term sobriety don’t ever get well again and don’t stop

again.

Pia: But on the other hand like Pat was saying once your drinking

becomes suspect it’s very risky to fiddle around with it but on the

other hand people don’t like to hear that they can never do something

again and so when they read things like that, it has a propensity to be

very seductive to them. On the other hand when you put out a rule like

that, that you can never drink again, it’s really operating in the

extreme…

Pat: The problem is that the people who are most likely to have the

problem are the ones more willing to take the risk.

I posed the notion of codependence being called a disease which is again what

behaviourists call negative labelling when they say “it’s a label”. Pia Mellody

articulated her response spontaneously - how a disease has a series of symptoms

with are of a pathological nature and that can be predicted in advance as in the

case of codependence. She went on to describe the five primary symptoms of

codependence.

Pia: We believe that codependence has five primary symptoms to it.

that are predictable that are ever present in the codependent, that you

can see, that you can deal with and you can also treat and that are

pathological.

• it’s pathological not to love the self

• it’s pathological not to defend the self

• it’s pathological to avoid knowing who you are

• it’s pathological not to take care of yourself


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• it’s pathological to operate in the extremes cause it

creates chaos

These are all pathological symptoms of distress that we happen to call

a disease because they are pathological and predictable. I don’t know

how you can dispute that.

I shared my understanding of the importance of having appropriate ego boundaries

to be in recovery from this condition and Pia agreed. She had confirmed that

codependence is considered a disease, a mental illness, with the symptomotology

of the absence of healthy ego boundaries and the emotional maturity, thereby

preventing the individual from asserting their needs. As I understand it,

codependence is about not being able to take care of our needs either through

lacking the skills to assert ourselves appropriately or avoiding any negotiation for

fear of confrontation. Therefore, having strong ego boundaries allows us to

develop the skills necessary to assert ourselves and to have improved self esteem

which provides us with emotional maturity that is age appropriate, as well as

serenity.

Reflection: Pia and Pat Mellody presented a convincing argument for the disease

model of addiction, with medical research and practice to back it up. They

answered questions that I am personally familiar with and which have caused me

concern until I was reminded about my own resources. I understood from Pia and

Pat in this interview, that they were not supportive of any other models of

recovery. This was because they have helped so many desperate people who

through this model found recovery and a changed lifstyle. Another important

reason was that they also found their own recovery through this model and had not

heard of similar success with any other program.

11. Bishop Interview (1993) Sydney

Bishop had been brought out from the U.S.A. to take on the position of the

Executive Director of South Pacific Private Hospital Harbord/Curl Curl (1993)

which was beginning in September with the Pia Mellody model. Bishop was

originally from the Sierra Tucson treatment centre in USA where in 1986 he

said he “cemented the program” so that the facility grew from a 54 bed to a 350

bed facility. That model was based on abstinence and the AA 12 Steps program

which he said was used for other issues too and that there were approximately

60-70 groups that were using 12 Steps programs that had originated from the

AA program. He had also worked at the Meadows where Pat and Pia Mellody

worked and came highly recommended by them. Bishop said that the program

would “integrate psychiatry by doing feelings work” through looking at


99

unresolved ‘family of origin trauma’. He emphasised that the outcome of this

work would be that people after the treatment could continue to get support

from a 12 Steps fellowship such as CoDA or AA.

As I was the Director of Social Services at the Wayside Chapel at the time and

trained crisis intervention counsellors and youthworkers, I asked if the program for

counsellor training would be the five weeks required of those seeking recovery?

Bishop advised that for counselling staff it could be a week where they could come

in when the family members attended so that they could “see it from the inside”. I

did try their program for four weeks (my holidays in January 1994) in an attempt to

experience a rehabilitation program for my PhD research and for my recovery from

food addiction. I was content in recovery from codependence and nicotine addiction

so my area of focus for the four weeks in South Pacific Private Hospital was

depression with food addiction as its manifestation. Bishop was the facilitator of

some of my group meetings and I appreciated learning from his approach, both from

the personal and professional levels. I cannot imagine the usefulness of research that

is not experiential in nature.

Another reason for this experiential research was to determine the professional

requirements for this model as others interviewed from both sides of The Debate had

claimed that some of the conflict was due to the different levels of qualifications, or

lack of, in the field. Also as I trained Crisis Intervention Counsellors at the Wayside

Chapel I wanted to know what they needed to do to become counsellors in this

model, which is what I had done with many other modalities. Maclaine and

Heather had mentioned that the conflict between the professionals was due to

workers in the 12 Steps model being lay people who did not have the appropriate

qualifications. Subsequently, my experience with the service providers of this

hospital proved otherwise.

Bishop: We had a training program at Sierra Tucson…it was a nine

months to a one year long program where people got an opportunity to

experience all aspects of treatment from spending time with the nurses

and seeing what the medical end of it looked like to doing intakes and

eventually working their way up into group where they were doing co-

facilitation in group and then eventually running groups on their own.

In his comments Bishop shows that this model relies on a “framework of working

with a person’s feelings and looking at their family of origin” issues which falls

under the category of psychotherapy. This model is favoured in the character


100

building aspect of the AA program which is one side of The Debate whereas the

behaviourists on the other end of The Debate favour cognitive behavioural therapies

and not dealing with family of origin issues. I clarify this difference in the Antithesis

and Synthesis Chapters in this thesis. I broached the notion of cognitive behavioural

methods to deal with alcoholism and he spoke about his professional knowledge of

controlled drinking (CD) as well as his experience as a recovering alcoholic. Bishop

mentioned the Sorbell group experiment and he recalled that there were some who

had died later as a result of the controlled drinking (CD) experience. With reference

to the possibility that an alcoholic could return to controlled drinking (CD), Bishop

stated that as an alcoholic in recovery he felt it was too risky to test.

I mentioned the concept of alcoholism or addiction being on a continuum and that

when a person reaches the abuse stage and their life becomes unmanageable it is

believed that they cannot go back to social drinking and he explained why he agreed

with this mentioning the progressive notion of alcoholism which is firmly part of the

AA worldview. It is worth showing his explanation here of how this condition is

progressive, because it is detailed both from the viewpoint of a professional and an

alcoholic in recovery.

Bishop: I totally agree with that and I think it even goes beyond that

from the experience that I’ve had working with people in treatment,

which is that I think that once you’ve stopped drinking the cycle

continues in your body anyway. Because I’ve seen people who have been

sober for a number of years started drinking again and their body

reacted as though they’d never quit. So they may have been off for ten or

twenty years, I may start drinking now and end up with a body that

would have been similar had I have been drinking the last thirteen

years…it progresses in your body whether you’re drinking or not once

you have been afflicted…at some point in time the tolerance is going to

go away. I could drink a fifth a day and function reasonably well, I

might still be able to drink a fifth a day and function reasonably well, I

might also drink one can of beer and be totally wasted so…[shrugging his shoulders] I think the cycle continues in my body as if I had kept

drinking all these years.

I asked Bishop what he thought of the Health Department Harm Minimisation

Policy (NDS 1985) that enabled kids to carry on drugging and drinking on the streets

but using safer methods such as clean syringes and reducing the amount of alcohol

they drink? His viewpoint was important as those who use the abstinence model

maintain that anything else is life threatening. He spoke of instances in the States

where young people experiment and then as they are not genetically predisposed can


101

stop. The problem was that people are not informed and or they do not want to

believe that they are susceptible to addiction so they risk it.

When I asked which he thought comes first codependency or alcoholism he

responded firmly “codependency”. Behaviourists from the harm minimisation side

of The D&A Debate do not believe in codependency as a condition.

Then to my question as to what has come up for him through this interview he gave a

strong answer:

Bishop: Controlled drinking doesn’t work.

Reflection: For me the AA abstinence model was confirmed with this interview

especially when Bishop stated he would not risk social drinking. Also there appeared

to be some agreement between this AA protagonist and behaviourists from the harm

minimisation side of The D&A Debate, as in the case of his comments on young

people in the streets using as a result of the Harm Minimisation Policy (NDS 1985).

12. Stewart Interview (1993) Sydney

Kate Stewart, family therapist, had been for two years heading the recovery

program located with Langton Centre Sydney replacing Gehlhaar who was

the protagonist (Appendix A) from this agency when The D&A Debate began

and had been forced to resign because she did not agree with the

implementation of the Harm Minimisation Policy (NDS 1985). Stewart as a

result of a review of Langton Centre was responsible for a complete overhaul

of the service provided - from the 12 Steps model to one based on a Brief

Interactional Solution Focus model with 12 Steps supportive follow-up. It is

influenced by Narrative Therapy of Michael White and Michael Durant and

is customer centred. Her worldview is informed by the Humanistic notion

that “people are not pathological, they have a problem, they don’t want this

problem and they have the resources to change this problem”.

I put to Stewart the question of whether she was familiar with the cyclical schism

concept where every ten years there’s a disease model vs. the non disease model

swing from one to the other? Her response covered the 30 year history of Langton

Centre and its recent review. Originally this agency used a humanistic

unconditional positive regard model which sounded very much like one based on

Eriksson and Maslow’s Humanistic Psychology. Then 20 years ago the cognitive

confrontational approach was introduced by psychologist, Gehlhaar who was well


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known throughout the recovery field because her technique was used by other

professionals too. At the beginning of The D&A Debate it was reported in the

media that Gehlhaar had been forced to resign along with the sacking of Lennane

from McKinnon (Appendices A and B). When I ran halfway houses for people

recovering from alcohol and other drug problems, people coming from the

Langton Centre detox unit spoke of how they respected Gehlhaar tearing down

their denial with that confrontation model which, at the time, I believed as many

other professionals did, was too denigrating for the human psyche.

Stewart advised that they chose to change the model because it would then give

clients the choice of treatments that suited them. This impressed me because of my

own preferences - that individuals be empowered to choose so that they are more

motivated for recovery. Subsequently, her answer confirmed my initial claim that

there is a cyclical schism which happens every ten or so years because she

mentioned that the “interest in drug and alcohol has been moving out of a medical

model and seems to be more of a psychological model”. So although this agency

had been primarily using the 12 Steps model and then looked as if it was heading

towards controlled drinking (CD), Stewart was now describing a diversity of

approaches which were client focused (synthesis). Consumer choice and treatment

matching were the catch phrases in her response.

Stewart: To have more consumer choice and certainly treatment

matching is seen in the literature as being very very valuable - that we

look at our clients and we ask them what is going to fit for them. The

other thing that we discovered in many treatments, is that programs

were based not so much on research but were based on intuition and

personal experience and we felt that was fine for their programs but

we needed to go back and look at the literature and really see over

time what types of interventions had gotten some significant

information as far as changing behaviour in a positive direction and at

the end of the day I decided to choose the model that not only was

helpful for clients but also helpful for the team and everyone that

worked here. A model that supported us and supported the clients for

what kind of changes they need to make.

As Stewart spoke the model she had chosen sounded promising and she advised

that not only were the clients using this model but also the staff were also trained

and encouraged to use it. Stewart focused on how as the client has found their

way to the service this “means they want to make a difference in their lives” and

the process of Solution Focus is looking at how they managed to stand up to their


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problem before it took over and therefore assisting them to use those skills once

more. Her words identified a less serious level of compulsion which can be

successfully treated with controlled usage. The empowering nature of Solution

Focus as a therapy can be seen in her statement here.

Stewart: We’ll say “well there’s no failures only feedback” and the

problem’s the problem the person’s not the problem, so we separate

the problem from the person and attempt to assist them to find

solutions to that problem, of course there’s a variety of techniques that

we use. And we also use that philosophy with us in our work, we feel

that change can occur anywhere in this environment, change within

the culture of the clients, or change with the housekeeper. So we

believe that change can occur at any time, in fact we believe that

sometimes change can occur when a client makes a decision to come

into this Centre and it’s our job to maybe remind clients that change is

possible.

So I added to her interpretation of their model that the client is encouraged to

focus on the skills they had in the past and what has worked for them before and

putting them back in touch with that experience. To which she responded…

Stewart: Yes, some of it is called competency based rather than deficit

based. We feel that if we only concentrate on the deficit then they’ll

never learn how to be competent.

Stewart shared some examples of well known people who had experienced

moving from hopelessness to competency by remembering how they had done it

before. This too was inspiring and this was how they teased good memories out of

clients who had reached a stage of helplessness and needed to become empowered

from within.

Stewart: We also talk about failed attempts and we look for

information in those failed attempts to give to the clients and

sometimes we tell clients that it may not be advisable to come back

here at Langton because we may have become a part of the problem

and they need to look at how to do it differently.

However, in her saying how they dealt with failures, I wondered whether the

solution was not one that was of benefit to the agency rather than the

client/customer? This is because seriously addicted persons may need to have

several attempts before they finally cross over the line into reliable long term

recovery. But in the meantime each failure is not good for service’s statistics, as it

needs to show a high proportion of successful outcomes for funding purposes.


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We discussed how they evaluate their program and that is why Stewart said that

not only the clients used their model but also the staff practised it and worked at

not being tempted by the traditional models to “fix the client” but rather that the

client can fix themselves if staff reminded them to stay “on the path of fixing

themselves”. As part of the evaluation program they are constantly improving it

through their staff meetings – an ongoing evaluation model.

Stewart reported that there were approx 300 inpatients who are encouraged to

come back as outpatients which is a good supportive program and it also makes

positive outcomes for government funding. In response to my question about

whether they still have 12 Steps meetings at Langton Centre as they had done in

the past, Stewart emphatically said that it was part of introducing clients to a

variety of interventions and that a huge number choose to attend 12 Steps

meetings.

Stewart: The 12 Steps philosophy is not incompatible with Solution

Focus and the traditions of 12 Steps model. I think what happens is

that people interpret the 12 Steps model their own way and then

distort it and take on different meanings that aren’t very helpful. But

certainly if you follow a 12 Steps program it works very well and so we

feel “well OK it fits with them, it makes sense to them, it works for

them and if the disease model really makes sense for why they’re the

way they are, then we don’t discourage, we encourage any

understanding that they can gather about themselves that can solve

their problems and we have no opinion on why or what they choose to

explain who they are”.

I thought that her answer was well put and fair which fit in with my diversity of

approaches (synthesis) concept and that pleased me because I was tired from

hearing the hostility of certain service providers who were all for controlled

drinking (CD) and against the 12 Steps model.

Responding to my interest in regular attendance at 12 Steps meetings where

people go through the naming and identifying the problem and learning from

others as a follow-up to recovery, Stewart advised that they have a huge

outpatient program and that some had been coming back for over two years and

also using their therapeutic groups. Her comments show this.

Stewart: I think we do offer the biggest outpatient program in the

whole of Australia. A lot of people choose to come back and do our


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program during the day and keep up with our program. I’m finding

that a lot of people mix different types of interventions – like they go to

12 Steps - NA, AA, also do private therapy, and also do different types

of lifestyle groups like Bourke Street and they have counsellors, there

are certainly lots of counsellors around, some clients go to private

therapy where they pay, some clients go to family therapy, some

clients go to long-term rehab, our welfare officers are really the ones

that assist clients to develop aftercare plans – and they are just

excellent they work so hard, they love this model.

As an addictions therapist it was reassuring to hear that people come through this

treatment followed by a supportive follow-up therapy process afterwards and then

once the therapy is no longer needed then they are back in the community like

anyone else and do not need an ongoing fellowship unless as Stewart explained

she knows of people in the community who need some sort of support in life to

maintain a healthy lifestyle. My thoughts, however, focused for a moment on how

addicts need to be a part of a fellowship otherwise they can relapse. Whether they

join a church group or 12 Steps fellowship, recovering addicts need to be around

people in the community who can socialise without addictive substances or

processes. I mentioned that people need to be affirmed and validated and she

agreed with me saying that she did not think that was necessarily indicative of

people with problems with chemical dependency only, adding that people “need

those passages and those rituals and those supports” which they try to create at

Langton in the form of building cultures by introducing newcomers to each other

and doing exercises to get to know each other and to practise new behaviours such

as expressing gratitude. Some of these community rituals, Stewart advised,

developed out of the Solution Focus model.

In response to my question on the naming and identification issue Stewart’s

answer was unique. This was that the clients already determine what they want to

admit to and there are medical doctors on staff who examine them physically as

well as psychiatrists in order to diagnose their condition. Furthermore, the clients

are considered to be “the experts in their problems” and in that way the staff do

not try to guess what their problems are. This is an important approach to

recovery because it empowers the client to choose and maintain a program of

recovery. The difficulty is that when a client is in denial about their addiction they

will choose a softer remedy which may be life threatening because it delays their

abstinence and/or recovery.


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Stewart: I mean a client may come in with an alcohol problem but

what he feels is most important in his life is getting his family back and

that would be the problem that he would need to work on and we may

talk very little about alcohol except as part of the solution to getting

his family back so clients tell us what they need to work on and what

they need assistance with.

At this point we discussed Langton Centre’s harm minimisation role where

Stewart confirmed that they have a syringe exchange and methadone service.

I asked Stewart to comment on codependence. She answered that she was

somewhat amused because she is an American family therapist and the term was

coined in America and also she worked for Shirley Smith who is a codependency

expert in Australia. She mentioned that the term came out of family therapy and as

she was trained in family therapy she used it in that context, but it seemed that in

this interview she was avoiding actually committing to the concept because she

said that some people felt the term blamed women. So she described the repetitive

nature of codependence or any neurotic behaviour in relationships by reframing

the term codependence, which showed the effect of The Debate, or perhaps a

‘hiccup’ in her relationship with Shirley Smith.

Stewart: I think that a lot of people have problems with inter-personal

relationships and I think that our clients are in the habit of doing

unhelpful behaviour in relationships over and over again but putting

aside the codependency label I think that when you have problems

with figuring out who you want to be you are going to have problems

figuring out how you are going to relate with other people and

sometimes in trying to solve a problem some of our clients solve them

in a way that’s not very helpful and keep getting involved in situations

over and over and over again. And some of that involves getting in

relationships that are not helpful, not supportive or which supports

their change.

As I heard Stewart describe their process, I understood her to say they assisted

clients to see the patterns in both their successful and unsuccessful behaviour and

then choosing the appropriate patterns. She agreed that was the way people could

be competent in relationships whereas if they “only looked at the times they were

codependent then it wouldn’t be very helpful”. This once more showed me that

although I liked the Langton Centre model, Stewart was leaving out a very

important part of the Codependence (CoDA) recovery concept which was that

codependents do look at what has gone wrong as a result of their codependent

behaviour but that is only to help them choose a more functional alternative as


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learnt from others’ stories of success. The preamble for CoDA (as all other 12

Steps groups) is that members share their stories highlighting not only the pain but

also the strength and hope they obtained from the 12 Steps and the loving

fellowship which is their community, and which can be interpreted in this sense as

spirituality. This is a program that provides a learning curve for recovery.

We discussed the difference between the family systems approach in the

codependency field and that of the non-codependency field and Stewart said that

the “difference was in technique, in approach and language”. She added that from

the family therapy perspective, the codependency model was not supported, and I

knew thatto be the case as I discovered in my training as a marriage and family

therapist, which was based on the systemic and strategic Minuchin model. The

codependency perspective would involve a Codependents Anonymous 12 Steps

(CoDA) challenging counselling model such as the one of Shirley Smith here in

Sydney and this model was not acceptable to the systemic marriage and family

therapy approach. However, Stewart agreed with my point that the Smith model

differed from the Codependents Anonymous model because Smith maintained that

once a person reached emotional maturity they were recovered from

codependency whereas the CoDA belief is that recovery is ongoing.

We discussed the various models and techniques that can come out of a theory

such as family systems and she had a good point about how there was “very little

therapeutic value in having a range of models under the one roof”. I agreed with

this and yet it aroused my curiosity as to my notion of a diversity of approaches. I

agree that there is a possibility of confusing the team of service providers yet as

she spoke of using a technique such as psychodrama or sociodrama with their

model it convinced me that it depends on appropriate staff training so that a

diversity of approaches can be used successfully.

Stewart: If you have a therapist that’s doing confrontational, if you

have a therapist that’s doing psychoanalytical, if you have a therapist

that’s doing Gestalt, if you have a therapist that’s doing rebirthing

with their own beliefs about the clients it will horribly confusing for

the clients and is absolutely, according to the literature, a waste of

time. Your team really has to believe in the philosophy of the model

that you’re using now, that does not mean you can’t mix up

techniques, like psychodrama goes very well with solution focus, well

we use more sociodrama.


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I asked Stewart if they use any techniques from NLP (Neurolinguistic

Programming) or TA (Transactional Analysis) as I use different techniques as

required. In her answer she showed that they use what I call a synthesis of some

approaches which have been customized to create their specific model.

Stewart: Ah, no we haven’t used TA we haven’t used NLP although

Milton Erickson was for NLP…a big foundation for that type of

therapy, because it’s a seven day program and it’s only so many hours

in a day we have to kind of choose what techniques blend best. We’ve

certainly experimented with different types of techniques along with

solution focus techniques and we’ve chopped and changed and right

now along with solution focus we’ve used psychodrama particularly

with people going through the course with solution focus questionnaire

attached…that’s important. We use family therapy…we do relaxation

and visualisation, which fits very nicely, experientially answering

questions of the clients as they pick up the program, we have didactic

groups that talk about a variety of topics from family, spirituality, a

sense of yourself.

We spoke about the training and support system they have for the counsellors and

workers in her organisation and it confirmed that they attempted to use the same

program for their staff that they had for their clients – a humanistic and family

systems model highlighting unconditional positive regard.

Stewart: client counsellor relationship - if the counsellor possesses

counselling characteristics of unconditional positive regard, genuine

respect and empathy that is a huge factor in positive change. And what

I think we are mirroring here is counsellor characteristics that have

been embraced in a way that psychologists have always wanted it to

be, and to be normal of counsellors.

Reflection: I found Stewart’s comments educational from both sides of the

abstinence vs. harm reduction models as she was supporting a program that gave

the clients more of a choice at determining what their problem was and how they

wanted to deal with it, which meant that they were empowered and motivated to

have more successful outcomes. I was also interested in her comments as a family

therapist working in the addictions field, as that is my background, considering

that she was the primary influence for changing the program from a

confrontational disease one to a harm minimisation one. I understand that the

team would be more competent in their work if there is a clear philosophy and

one primary model – that is keeping it simple. However, I found that when there

is an effective professional training program then there can be strategies from


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other models that can complement the primary philosophy and/or model, making

it more interesting for developing life strategies with the clients.

13. Findings from these Interviews

Having interviewed leaders in the addictions recovery field I was relieved to find

out that they didn’t all believe that the one method was the only successful

method as can be seen from the sample interviews. The difference was that those

in one model believed their own was the most appropriate for their target group

although they did agree that some clients would not benefit if they could not relate

with the program. As in the case of Jurd who stated that AA and abstinence may

not be for all and that controlled drinking (CD) was coined first by AA in the

1930s. Lennane, who supported the abstinence and AA model primarily also

agreed that one model was not possible as did the controlled drinking (CD) side

Heather, MacAvoy, Mant who supported the concept of the AA fellowship

existing in the community for those willing to avail themselves of it. Bishop, Pat

and Pia Mellody who spoke of their own experience with alcoholism, running

recovery programs and establishing a new program in Sydney were committed to

an abstinence program which also necessitated family of origin psychotherapy.

Maclaine in his program is also committed to this psychotherapy model in

conjunction with abstinence in the AA fellowship program. This is not the case

with cognitive behavioural therapy programs operated by behaviourists who avoid

exploring childhood trauma and although they support abstinence if required by

the client, they also support controlled usage. In supporting controlled usage

Heather, MacAvoy and Mant promoted their concept strongly. Campbell,

Cassimatis and Stewart appear to favour both family of origin work and

cognitive behavioural therapies for addiction recovery.

It was clear that those who understood the effectiveness of psychotherapy, family

of origin issues and abstinence with the AA program were supportive of the use of

language involving codependency, dependencies, the naming and identification

process, as well as abstinence being essential to recovery. Whereas those who

believed in controlled usage found this process as labelling and

counterproductive. Although some did believe in abstinence for those who were

seriously dependent.


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I also realised that whichever side of The D&A Debate continuum people were

on, their programs had been misrepresented by some service providers who were

more intent on promoting their own perspective instead of creating informed

choices from which persons approaching them for help could make. As I had

believed initially, in doing so they were misrepresenting the meaning and aim of

the Health Department Harm Reduction Policy (National Drug Strategy 1985),

and this had caused extensive confusion in the recovery community. Even as

current as 2007, I phoned seven detox/rehabilitation units and several government

departments, to obtain an update on what recovery models were operating, Harm

Minimisation/Reduction/CD/CBT/MI or the 12 Steps model/TSF, and felt an

amazing tension and defensiveness with most. Some intake officers/receptionists

referred me to people with the authority to comment and when I left messages

usually they did not return my calls. Stewart was no longer with Langton Centre,

which is now solely an outpatient service. Only a few were informative and polite

such as Mattick - Director NDARC, Dore - Manager, Herbert Street Clinic

(Royal North Shore Hospital), Duty Nurse - McKinnon Unit (Rozelle Hospital).

Fixter - Assistant Director, Department Health and Ageing, Drug Strategy Branch

(Canberra) and Jurd – Assoc. Prof (Macquarie Hospital). I cover this in more

detail in Chapter 7 – Conclusion.

This narrative dialectic inquiry through interviews meant that I gained the

opportunity to disseminate information between the conflicting parties, drawing

attention to problems created by The D&A Debate, and their stance. At times

there seemed to be an agreement between the majority of those interviewed that

there is room for a choice of approaches.

The interview findings strengthened my resolve as a practitioner and community

educator, in other words a social ecologist, that a synthesis which could come

about from a diversity of approaches, is the most appropriate approach to

recovery. The method will work much more effectively if the person finds out

which suits them most to live their life to the fullest. This may mean that a

person’s choice will not gain the approval of another, but so be it because no one

can design another’s lifestyle successfully. We can only provide ideas for choices

and give individuals the opportunity to make the final choice. The diversity of

approaches needs to have models from the whole continuum, from habit to severe


111

dependencies. In this way individuals will be able to choose from state of the art

treatment options such as CBT, TSF and MI, as well as others such as NLP, TA,

GESTALT, SMART Recovery, 12 Steps Models, Exercise, Meditation, Yoga,

Relaxation, and anything they believe will create a healthy lifestyle for them.

The next Chapter explores the concept of thesis – the case for abstinence which

was the method used in many government and non-government detox units until

the advent of the Health Department Harm Minimisation Policy (NDS 1985)

when funding for controlled drinking (CD) programs (the antithesis) was

introduced.

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CHAPTER 4

THESIS – THE CASE FOR ABSTINENCE WITH THE AA 12 STEPS

No half measures in addiction recovery (Jurd interview 2000)

My research was aimed at finding out why leaders in the recovery field were involved in

such a heated polemic, The D&A Debate, which resulted in some professionals losing

their jobs and the recovery community becoming confused (Appendices A and B).

In order to find out why the protagonists were maintaining their oppositional stance, the

inquiry also involved exploring and documenting an overview of their models. This

included viewpoints of other leaders too, who were perhaps not directly involved in The

Debate but who were influential in that modality such as Mellody and Chick. Pia

Mellody spoke of conflict rising up in the USA regarding the CoDA 12 Steps model,

after reaching its peak following years of growth. A growth that she had contributed to

with her work and the books she co-authored on codependence and love addiction

(1989, 1989, 1992).

Abstinence and the AA 12 Steps program had, for many years, been the chosen recovery

program in detox units and rehabilitation programs often funded by government, both

here and all over the world especially in USA where it was founded. This was at least

until 1994 when SMART Recovery, a secular abstinence self help model based on CBT,

came about from the Albert Ellis REBT model and Rational Recovery (RR) in USA,

reaching Australia five years ago (2002) and which I expand on in Chapter 6 (synthesis

– a diversity of approaches). However, I named this chapter: Thesis – the case for

abstinence with the AA 12 Steps, because the word thesis means position or stance in

Greek. Indeed, this was the stance before The D&A Debate and until the Special

Premiers’ Conference in Canberra (April 1985) which issued the document from the

National Campaign Against Drug Abuse (NCADA) resulting in the National Drug

Strategy (1985) being established (Fixter 2007). This introduced Australia to drug

solutions commonly known as the Harm Minimisation policies/ principles and for which

controlled drinking/drug use (and needle exchange) became favoured for funding by

governments, rather than abstinence with AA 12 Steps model. This did not exclude

abstinence as an aim, but the government funding was focused on programs that aimed

Chapter 4: Thesis – The case for abstinence

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at reducing usage. This was the beginning of The D&A Debate rising out of the clash

between the abstinence AA 12 Steps program/model and the Controlled Drinking/use

approach.

Another term that has emerged in connection with abstinence and the AA 12 Steps

model was Twelve-Step Facilitation (TSF) as designed for Project MATCH (1993)

research, which was initiated by the National Institute on Alcohol Abuse and

Alcoholism (NIAAA) involving 1,726 patients (NIAAA 1996). TSF was designed to be

used as a clinical model carried out by qualified facilitators in outpatient programs. TSF

is aimed at encouraging people with alcohol or other drug problems to commit to

abstinence through joining the relevant 12 Steps fellowship and commit to working the

program of recovery. Furthermore, the change agent is the 12 Steps fellowship and not

the facilitator whose role is to guide the afflicted person to commit themselves to

achieving and maintaining their sobriety/clean time/abstinence from the dependency of

choice. The TSF model is elaborated on in Chapter 6: synthesis – a diversity of

approaches.

Comparing the three therapeutic approaches: TSF, Cognitive Behavioural Therapy

(CBT) and Motivational Enhancement Therapy - later known as Motivational

Interviewing (MI), enabled Project MATCH research outcomes to identify that all three

were “state of the art in behavioural treatments” (Gordis 1996). This was helpful to the

AA 12 Steps model, as it had not been possible for the efficacy of the AA program to be

scientifically researched previously due to the confidential nature of AA. Subsequently,

Project MATCH research enabled the AA model to become a recognised recovery

method at a clinical level as part of TSF. The TSF definition here was supplied by Jurd

in slide form (2007), to which I added the last paragraph gained from online.


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TSF Definition

TSF focuses on three objectives:

• AA attendance

• Getting active in AA – [personal change is achieved via 12

Steps]

• Getting and using a sponsor in AA [who guides you through

using the12 Steps]

It is important to take whatever time is necessary to explore resistances, to make suggestions, and to elicit a commitment to any reasonable progress in these areas.

TSF seeks to facilitate two general goals in individuals with alcohol or other drug problems: acceptance (of the need for abstinence from alcohol or other drug use) and surrender, or the willingness to participate actively in 12-step fellowships as a means of sustaining sobriety. These goals are in turn broken down into a series of cognitive, emotional, relationship, behavioral, social, and spiritual objectives. (Nowinski, NIDA 2007)

Blake and Stephens (1987) influenced my research considerably because I agreed with

their concept of a continuum, where at one end is habit and at the other end is obsessive

compulsive disorder requiring twenty four hour care and somewhere in the middle is

compulsion. Those I interviewed also agreed with the concept of a continuum,

regardless of where they were placed on the continuum of The Debate. 12 Steps model

supporters also refer to addictive behaviours as obsessive compulsive behaviours

(Mellody and Mellody, interview 1993)

Throughout my C&R Research, supporters of both abstinence and controlled drinking

have confirmed that when dealing with severe dependency, abstinence is the most

effective recovery method. Abstinence on its own is a difficult achievement, so a

structured supportive program is needed. Alcoholics Anonymous is a twelve steps

program of personal development which has a supportive network of regular meetings.

The program is documented in Alcoholics Anonymous (AA) (1939, 1991, 2002),

commonly known in AA as The Big Book, a manual for abstinent recovery and the basis


115

for the AA self-help movement. This AA program is made up of eastern and western

philosophy, psychology and the Bible, creating a program for character building set out

in 12 Steps and 12 Traditions.

As there are AA members who are atheists, agnostics or members of different religions,

the program is considered a spiritual program and not an organised religion. AA

members maintain their own religions if they so desire or believe that their Higher

Power is the AA program and/or fellowship, and in so doing this is a form of spirituality.

The Big Book is not only important to the historical background of AA but also for what

is needed to gain and maintain sobriety through an education process. AA meetings are

vital to the success of recovery and it is recommended that the interested parties read and

re-read the Big Book in order to refresh knowledge of, and commitment to, recovery

from alcoholism or any other addiction through adopting the AA program. The founders

of AA, Bill W. and Dr. Bob S. (surnames are anonymous), were themselves afflicted by

alcoholism and were able to find sobriety and maintain recovery through the program

and its fellowship. Added to this program is the emphasis of spirituality as

recommended by Jung, the Swiss psychiatrist. When approached in therapy by an

alcoholic struggling with his sobriety, Jung advised him that it was vital to experience

spirituality, not through organised religion but through surrendering to a power greater

than himself. This advice is recorded in The Big Book (2001:26) and in the chapter for

agnostics (ibid:44). This enlightenment is referred to in the AA 12th Step as a spiritual

awakening, achieved through “striving for authenticity” rather than perfection as

required by religious dogma (Thyer 2004:14).

My experience with the 12 Steps model confirmed for me the efficacy of the program –

the functional behaviour was obvious when the individual was using the model. When I

ran halfway houses for people recovering from alcohol and other drug problems, it was

apparent by their functional behaviour, which residents were attending meetings and

those who were not. This was as obvious as when a person suffering from mental illness

is taking their medication or not. The behaviour of those residents attending meetings

was functional in the sense that, they were serene with a good sense of humour,

improved assertiveness, and the ability to negotiate their needs. Whereas, those who

were not attending meetings, exhibited dysfunctional behaviour which was fidgety,


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aggressive and defensive. This was quite an amazing phenomenon and could be detected

by all experienced staff and subsequently also confirmed by the resident in question.

Those who believe in the medical model of addiction and the necessity for abstinence

and the 12 Steps model for recovery, also believe that the disorder is genetic and that it

can sometimes skip a generation. This was confirmed by Noble at a seminar I attended

in Sydney where he spoke about the discovery of an alcoholic gene called allele 2 (Blum

& Noble 1990). It was maintained that this alcoholic gene makes such people

susceptible to alcoholism and when they are aware of their condition they can take

preventive action. Although confirmed by Jurd and Lennane (interviews 1993), the

Blum and Noble discovery has been viciously attacked by Peele and Brodsky (1991)

who did not believe in the genetic concept. Instead Peele and Brodsky believe that

people with dependency problems can control these and can even grow out of them with

age. Peele and Brodsky also criticised the validity of the Blum and Noble research. As

can be seen later here in this chapter, the genetic factor for addiction appears in

multigenerational patterns which show the recurrence of addiction in families. All

interviewees, who support the disease model of addiction, believe in this genetic aspect

too.

For more than fifty years the efficacy of AA had been experientially proven throughout

the world, yet behaviourists have criticised it because they claim that it had not been

scientifically proven. Subsequently, the findings of Project MATCH 1993 gave TSF

(with the AA program), CBT, and MET/MI scientific recognition in the recovery of

dependencies. The findings showed that these three modalities were equally effective,

yet each group maintained that their modality was found to be more effective. For

example, the TSF efficacy outcome from Project Match research was highly praised by

its supporter Chick in the journal ALCOSCOPE (2001). Chick, at the time, a consultant

psychiatrist at Royal Edinburgh Hospital and senior lecturer in psychiatry Edinburgh

University, had been an adviser to government bodies in UK, Brazil, Australia, Canada,

and USA on public health and treatment issues to do with alcohol, health, and social

problems. Furthermore, his research in early detection and intervention for problem

drinkers and relapse prevention treatments for alcohol dependence is recognised

internationally. Also his study on counselling for problem drinkers in the general

hospital system is the third most cited paper in the field of alcoholism treatment research


117

in world literature. He spoke highly of the findings of Project MATCH (1993) which

showed the efficacy of the Twelve-Step Facilitation (TSF) method, and because of his

reputation his claims added to the value of the findings. However, Heather, based here

in Sydney (1993) as the Director of the National Drug and Alcohol Research Centre

(NDARC), and who co-authored with Robertson books and papers on controlled

drinking (1983, 1989), negated the outcome of the Project MATCH (1993) research

because he stated that it was conducted with people who were primarily seeking

abstinence (see Chapter 5).

Cassimatis and Wilson Schaef (1987), both supporters of the 12 Steps model, believe

that addiction is a societal responsibility and I believe that eventually society will evolve

to a more responsible lifestyle for its members. This notion I also expand on later in this

thesis. Furthermore, Schaef (2000) highlights recovery as an empowering human

capability when using the appropriate resources. A notion shared by Wegsheider-Cruise

(1989), who strongly favours family of origin work. This method involves revisiting the

trauma experienced in childhood which has remained unresolved. In this process the

afflicted person can experience becoming free of resentments which prevent them from

gaining emotional maturity relevant to their age as adults.

When I taught Alcohol and Other Drug Interventions at TAFE (2003), I designed a

course based on the course text Treatment Approaches for Alcohol and Drug

Dependence (Jarvis, Tebbutt & Mattick 2001). This text introduced students to CBT, MI

with emphasis on controlled drinking (with a possible aim of abstinence), and to a lesser

degree abstinence and the AA/NA 12 Steps model through self help groups. In 2007 I

met with Mattick, who is now the head of NDARC, and I mentioned that I found his

book very informative and also useful as a text for AOD Interventions students.

Nevertheless, I added that although I was pleased to see a 12 Steps component, 8 pages

out of 225 was hardly sufficient considering that AA and its related groups is such a vast

fellowship benefiting addicts worldwide. In 2001, there were 100,000 AA groups

worldwide (AA Wikipedia 2007). The first edition of the AOD Interventions course text

book was 1995, so it is obvious that during that period the 12 Steps model was not

encouraged as a modality, even though its efficacy had been known for decades. Mattick

admitted that at that time the 12 Steps model was unpopular with those policy makers


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who made decisions for funding education and recovery services. The difficulty, as I

see, is that traditional text books do not show the 12 Steps model. Also the books that do

explain AA and the 12 Step model are not considered “serious academic” books by

academics. Yet it is these books that OAD Interventions workers depend on to develop

competencies in the abstinence and 12 Steps model needed for severe alcoholics and

addicts. For that reason I have included self help/personal development books as part of

my knowledge base and in my bibliography which has sometimes raised eyebrows from

those who are ignorant about the lack of resources for abstinence and 12 Steps model

academic texts. Furthermore, as can be seen in Chapter 6, I have attended numerous

introduction courses to different modalities so that my learning has been extensively

experiential too.

This type of limited information on the 12 Steps model means that training AOD

Interventions workers in the abstinence field is reliant on information gained from older

12 Step model texts such as that of Johnson (1980) which is one of the original recovery

books and although recommended reading is out of print today. Apart from detailed

information about addiction in I’ll Quit Tomorrow (Johnson 1980), the ‘intervention’

strategy is outlined and this is still commonly used in helping afflicted people to

voluntarily admit themselves into rehabilitation programs. The ‘intervention’ involves

family members and or friends getting together as a group and surprising the afflicted

person with their feedback on how they have been affected by his or her behaviour. The

works of more recent authors such as Ruden with Byalick (1997) have a scientific

approach to alcoholism, also shared by Christopher of the movement SOS - Secular

Organizations for Sobriety (1988, 1992) and claiming that there is a biological

explanation to alcoholism involving the limbic system. Also Ruden and Byalick remind

us of Jellinek (1960) who coined the concept of alcoholism as a disease and which

strongly influenced the recovery field from then onwards. On my visit to Amsterdam in

2000 I interviewed the Manager of the Prevention Team at Jellinek Centre, which was a

very informative experience. In Chapter 6 I write in more detail of the Netherlands

system which is progressive as it has provision for preventive, educational, recreational

and rehabilitation services for drug use in the community. Furthermore, since 1994 a

secular CBT recovery model has been formed called SMART Recovery initially

Rational Recovery (RR), which had been influenced by Secular Organizations for


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Sobriety (SOS) and the RET/REBT model founded by Albert Ellis. SMART Recovery

was brought to Australia in 2002 by St. Vincent’s Hospital and REBT strategies are

primarily used in this model along with other CBT techniques. I elaborate on this model

too, in Chapter 6.

Other authors of abstinence and 12 Steps model literature, show the painful origins of

addiction and the struggle involved in becoming free from the clutches of compulsion.

Whether it involves youth, individuals, or community as a whole we need to take

recovery seriously for the sake of future generations (Lennane 1992). It is vital to have

a qualified person experienced in family of origin therapy for this type of psychotherapy

which assists the person to remember their childhood in an effort to resolve issues that

have affected their sanity causing them to self medicate with addictive substances and

processes (Maclaine 2001). Another supporter of family of origin therapy is renowned

therapist/author Ann Miller (1993) and although her notion of working through

childhood trauma is promoted through the recovery movement, it is important to note

that Miller has not wanted to be seen as officially supporting 12 Step programs or any

other particular therapy. Through family of origin work, character building, or personal

development, takes place resulting in appropriate emotional maturity, which is relevant

to the age of the person in question, that is, recovery from co dependence, or ‘neurosis’

as it was previously known (Pat Mellody, Pia Mellody interview 1993). Codependence

is considered to be an addiction and also the primary state from which other addictions

spring making them secondary to codependence. (Mellody (Pia), Miller & Miller 2001,

Mellody (Pia & Pat) in my interview 1993).

Yet, Heather, from the controlled drinking end of the continuum, has been totally

opposed to the notion of codependence, as are behaviourists from the controlled drinking

worldview who also do not believe the genetic perspective of addiction. Katz (1991) - a

noted secular psychologist, wrote about what he coined the “codependency conspiracy”,

also showing a contempt for the concept of codependency and its treatment.

Westermeyer (2002), a psychologist, was against the notion of codependency and

strongly objected to the impact it has had on the reputation of women, because he

believed this labels and blames them. This is fascinating, considering that globally this

model has helped thousands of women who have been faced with potential suicide and


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have come through to live healthy fulfilling lives. This has taken place as a result of

therapy for codependence complemented with such programs as the self help group

Codependents Anonymous (CoDA).

Other opposers to the 12 Steps model are sceptics, agnostics and atheists who object to

the recommended spirituality aspect of the 12 Steps model which is used to help

codependents and addicts find and maintain recovery (Cline 2002). Opposition to the

term codependence also comes from some religious groups, perhaps because they feel

threatened by the competition of a worldwide spiritual fellowship. An example of this

worldview is that of Pastor Gilley who stated that “The psychological world (including

“Christian” psychologists) errs, because it has a faulty anthropology (view of man)

based upon human wisdom, rather than upon the Word of God.”(2002). There is more

on this worldview later in this chapter.

There are professionals who maintain that our young people, on the whole, are relatively

well adjusted Rey (1995). I strongly disagree with this claim because the opposite is

shown by statistics on youth suicide in Australia and by the increase in services being

funded by government to reduce youth suicide. (World Health Organisation (WHO),

World Health Statistics Annual, 1994, Australia Bureau of Statistics, 1994 and 2002,

Dudley, Kelk, Florio, Howard, and Waters, 1964-1993). Addiction plays a huge role in

youth deaths as documented by these organisations in order to justify their funding. I

elaborate on this, later in the chapter, so as to show that large numbers of young people

are dangerously affected and we need to take notice (Lennane 1992, Affie 1998).

Another weakness in the worldview of those who want to believe that our young people

are so well adjusted, is the tendency to overlook how children are affected by addiction

in their families of origin. When I worked on the Stansfield Substitute Care Project

(1994-1996) although the records showed that all the Wards of the State had excessive

dysfunctional behaviours in their families, this was not identified as dependencies and

did not feature in the method used to correct the young people’s behaviour before they

came to our program. Such excessive behaviours and dependencies were: heavy

drinking, marijuana, gambling, violence (in jail for attempting to kill his wife with an

axe), cocaine, heroin, prescribed pills. As Toola Andrianopoulos and I were in a

position to influence the development of our program in a way that dealt with these


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problems, we had positive results (Affie 1998). This could be seen by the number of

times which professionals from other similar agencies visited us to observe our system,

sometimes even from interstate. Our young people stopped breaking windows, punching

holes in the walls, beating each other and unlike other projects our staff was not faced

with life threatening situations. Youthworkers at other similar agencies had even lost

their lives in altercations with their young Wards of the State (Affie 1998). Sher (1997)

highlighted similar psychological characteristics of COAs (children of alcoholics) and

showed alcoholism from the perspective of children of alcoholics, with its impact on

their lives and for generations to follow. This worldview is the same for children of

families who are affected by alcoholism, narcotics, violence, jealousy, gambling and any

other addiction. Cigarette smoking is a serious addiction not only because it role models

addictive behaviours but because it is so dangerous to the health of the smoker and

others near them – passive smoking.

To explore the effects of addiction there is a need to look at dysfunctional behaviour,

genetic predisposition (Mellody, Miller & Miller 1989, Bradshaw 1988),

multigenerational patterns (Scarf 1987, Marlin 1989), societal norms (Burton & Young

1961, Nichols & Everett 1986, Minuchin 1981, Epson & White 1989) codependence

(Mellody & Miller 1989), substance and process abuse (Blake & Stephens 1987, Ruden

& Buyalick 1997). The issues of family of origin, multigenerational patterns and genetic

predisposition feature strongly in the worldview of the abstinence and AA 12 Steps

model of recovery. Furthermore, behaviourists who are on the opposite end of The D&A

Debate continuum strongly oppose these concepts.

Summary

When reading literature supporting the disease model and abstinence 12 Steps recovery

program (AA 1939), it is clear that certain authors/professionals such as Bill W. and Dr.

Bob (1938), Blake and Stephens (1987), Blum and Noble (1990), Bradshaw (1988,

1988, 1990, 1992), Chick (2001), Jellinek (1960), Johnson (1980), Lennane (1992),

Mellody, Miller and Miller (1989, 1989, 1992), Maclaine (2001), Ruden and Buyalick

(1997), Sher (1997), Schierse Leonard (1989), Wegsheider-Cruise (1989), Wilson

Schaef (1987, 2000), Woodman (1987), are all very committed to expressing the dangers

involved in treating addiction as anything other than a disease which needs a strong


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commitment to using the 12 Steps model comprising primarily of abstinence and the

twelve steps program, family of origin psychotherapy and character development based

on spirituality.

1. Abstinence and AA 12 Steps Program

The case for abstinence and the Alcoholics Anonymous (AA) 12 Steps program is also

known as the medical model or disease model, which considers addiction as a

progressive life threatening illness knowing no boundaries - race, socio-economic or

gender, all sharing the identical symptomatology. Jurd, in his interview with me (1993),

pointed out that “people who favour behavioural treatments are the ones least able to

accept that it’s a disease” because they believe that in accepting the disease model would

invalidate behavioural treatments. His belief that there was a power game between the

different groups which had to do with retaining the power and getting extra funding and

kudos is a belief shared just as strongly by Lennane and Maclaine when I interviewed

them (1993). I had wanted to know his thoughts on the disease model and how he dealt

with behaviourists who claimed that to admit to being alcoholic was being negatively

labelled and handing over responsibility for gaining recovery. His words confirmed my

understanding.

Jurd: Some people are predisposed - genetically, environmentally,

personally, constitutionally predisposed to alcohol dependence…Simply it’s

a ‘no fault’ disease, people have got it. People are responsible for the

treatment but not for the disease. Once the diagnosis is made people are

responsible for the treatment. Another important element of this worldview

is that admitting to being an alcoholic is not negative labelling but rather

accepting a diagnosis which then makes recovery possible.

Jurd and other supporters of the 12 Steps model all believe that this strategy is a vital

part of recovery, whereas opposers call it negative labelling.

Although the focus throughout this documentation has been on alcohol and other drugs,

I believe it is pertinent, at this point, to mention other addictions. At the beginning of

this inquiry I discovered that many AA members did not agree with the notion that other

addictions such as codependence and food addiction are true addictions equal to alcohol

and other drugs, although, with time many have changed their opinions. However, it is


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my experience that the symptomatology is the same and just as life threatening.

Compulsive eating, whether overeating, bulimia or undereating are on the same

continuum and dangerous – obesity, vomiting, anorexia are life threatening and can

result in severe depression with suicidal tendencies, as can any dependency including

codependence. Many a lovelorn victim has killed themselves. Compulsion is a mental

illness and to think otherwise is to be in denial about the condition and not see it as a

disease.

Another area of concern between CoDA and AA is that the AA fellowship encourages

members to reach out to potential newcomers and take them to meetings and contact

them frequently until they are strong enough in their recovery to do so themselves. Some

of the behaviours displayed by AA members towards new members, are perceived by

members of Codependents Anonymous as a fine line between outreach and

codependence. Another fellowship which has had to adapt the AA approach is Sex and

Love Addicts Anonymous (SLAA) who have been given approval by AA to change the

wording of the 12th Step from using the phrase “to practice these principles in all our

affairs” to “practice these principles in all areas of our lives”. These are adjustments

made to the original AA12 Steps program to suit the different compulsions and their

programs. The difference between AA and Overeaters Anonymous is that AA places

importance on ‘the meeting after the meeting’ which involves serving tea, coffee and

food in abundance, so members can socialise and develop friendships. This is not

possible for OA as only tea and coffee can be served and with artificial sweeteners –

sugar can be a binge/trigger food for many. After a few years absence, upon returning to

OA I discovered that a 3rd Step Prayer had been introduced at the end of some meetings

instead of AA’s Serenity Prayer (although some meetings still use that). For me this

sounds too religious, whereas the Serenity Prayer (originally by Reinhold Niebuhr circa

1934) which became officially adopted and modififed by AA in 1950, is more

acceptable:

God grant me the…

Serenity to accept the things I cannot change

Courage to change the things I can and

Wisdom to know the difference


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Subsequently although the AA program began as being spiritual and left organised

religion to other groups, I am wondering whether it is transforming with its growth. It is

important to remember that as the 12 Steps movement grows, it faces certain problems,

which is why the organisation is so cautious about approving changes to the basic

format. Nevertheless, at a seminar I attended in Sydney (1992), in his response to our

question, Scott Peck said that he thought the 12 Steps approach was the best self help

movement on the planet, but like all movements once it becomes very large then it risks

becoming an institution with all the difficulties that transformation brings.

SCOPE (Stress Anonymous) 12 Steps Family Group was based on the AA Steps and

Traditions and was created here in Sydney in 1983. It was aimed at helping people deal

with stress which was considered to be the cause of many addictive behaviours including

codependence. The group prepared a weekly readings book and in Figure 3 I am

including the those description of addictions here because I believe it is an accurate

documentation of these (1991:4).


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Fig. 3

Definitions (Scope Weekly Readings 1991)

Setting Myself Free from Addictions Weekly Readings

Jan 15-21

Addictions are symptoms of how poorly we express ourselves and our

needs, also how poorly we cope with our mood swings and emotions. If I

suppress my need for love, then I will feed my insufficiency with whatever

makes me feel good. This only results in me wanting more and more of

that ‘feel good’ for I am not dealing with, the true need which is

simmering inside me. That ‘feel good’ becomes an addiction as I need

more and more to keep feeling good. Some addictions are:

Co-Dependency – relying on others to feel good

Love Addiction – using love to raise self-esteem

Alcoholism – using alcohol to drown the pain

Drug addiction – needing drugs to get the buzz

Cigarettes – helping us get through the day

Food – medicating our feelings

Work – only feeling good when we produce

Gambling – getting high on taking risks

Spending – pampering ourselves to cope

Sleeping – withdrawing from life’s pressures

Stress – needing the drama to avoid boredom

Rage – an excuse for violence and drama

Thought for today: When I promise to stop doing something because it’s causing me

unhealthy stress and find I cannot no matter how hard I try, then I am addicted. I know

I have to admit I am powerless – that my life has become unmanageable. Only then,

with the help of the program, can I begin to set myself free.

Understanding the addiction, involves being familiar with its stages. This also enables

the appropriate treatment to be offered according to the intensity of the dependence.

Michael Chegwidden, the psychiatrist who set up the McKinnon Detox Unit (Rozelle

Hospital) in 1975, believed that there were stages to the addictive process (in Lennane,

1992). In 1993 I asked Chegwidden for an interview and he refused because he felt he

was at a stage in his life that he had said it all before and had nothing more to say. From

my perspective, as a therapist specialising in alcohol and other drug problems, over a


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period of twenty years and listening to over 20,000 stories in Alcoholics Anonymous

and other 12 Steps meetings, I observed these stages as shown in Figure 4 (updated by

me in 2003), which are similar to those listed by Chegwidden (1968) and levels of

dependence by Edwards and Gross (1976) in Jarvis, Tebbutt & Mattick (2001).

Although some symptoms are representative of other medical conditions such as certain

mental disorders (Davies 2000), the difference is that when a person abstains from the

drug being abused, then the symptoms disappear. In the course of my work, I have heard

countless people share at 12 Steps meetings about how they had been diagnosed with

schizophrenia or manic depression whilst they were abusing drugs and upon coming into

recovery and abstinence, the symptoms were alleviated without any medication.

Furthermore, it is my experience that untreated depression is a contributing factor to the

compulsion to use drugs, as confirmed by the statement “serious mental disorder

predisposes one to the onset of substance use disorder” in an attempt to self-medicate

(Penrose-Wall, Copeland & Harris 2000:12). Those who suffer from both mental

disorders and substance use disorder (ibid), otherwise known as co-morbidity, have

symptoms that overlap.

Here, in Fig. 4, I show my understanding of the stages of addiction starting with Habit

Stage which although manageable can lead to more severe dependence.


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Fig. 4

(Adagio 2003)

STAGES OF THE ADDICTIVE PROCESS

HABIT STAGE - "IT'S JUST HARMLESS FUN!"

harmless habit/ritual that is so enjoyable, threat of disappointment without it the search for that buzz/high which is missing - the instant 'fix' anxiety at the thought of having to give up a fun social activity striving to relieve stress, numbing of pain, light impaired control STAGE 1: DENIAL - "I CAN STOP ANYTIME!"

loss of awareness, blackouts, broken promises, personality changes loss of motivation, depression, fear denial, defensiveness, aggression, lies, deceit, blaming others, compulsion, obsession, feeling driven for the 'instant fix', hyperactive STAGE 2: LOSS OF CONTROL - "WHY CAN'T I STOP?!"

loss of control, shame, guilt, self hate, loud about next drink paranoia, looking for the magic solution, feeling sex starved and unloved, desperation about how to stop the compulsion threat of deprivation without the 'fix', stashing supplies for later mood swings, remorseful, defiant, violent victim role (inferiority) loss of libido STAGE 3: UNMANAGEABILITY - "I CAN'T GO ON LIKE THIS!"

unmanageability with life tasks and relationships, fatigue, helplessness, benders, loses tolerance for alcohol suicidal thoughts, the pits, black hole, rockbottom

(More details in Chapter 6)

Not all people suffering from addictions reach the rockbottom of the derelict alcoholic or

drug addict. Rockbottom is the term which came about from William James original


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term ‘calamity and collapse’. Nevertheless, the unhappiness caused to them by impaired

control is often a rockbottom, as unpleasant as the one experienced by those who have

reached life threatening proportions (Cassimatis 1993) and in his interview with me

(1993) he spoke about rockbottom in this way:

Cassimatis: Everyone’s rockbottom is different. Someone’s rockbottom is

that if he’s only drinking on Friday nights and the wife says “I’m not

prepared to live with you and the Friday night drinking with all the lies

and the lateness and that” and he will weigh up whether his marriage is

worth keeping at that simplistic level. Whereas another wife may be very

happy to have her husband drunk fairly often because life’s OK that way.

But when he gets to the point where he’s losing his job she may decide “no

it’s not worth living with you then” so he decides whether it’s worth being

where he is. So I think the consequence of rockbottom motivates us and

that’s the pain in life where we finally get to where we don’t want to be.

Many addicts, food, alcohol and all the rest of them and gamblers, enjoy

being addicts they just don’t like the consequences of being addicts.

Subsequently, addiction qualifies as such when the person is faced with unmanageability

for themselves or for those around them. Unmanageability can be loss of job, family

breakup, poor health, accidents, overwhelming bills, and inertia. People who have

abused alcohol and have reached that out-of-control and compelled stage can find great

relief by being in a loving fellowship which has in common an abstinent lifestyle. This

abstinence can be through something like a religious program or AA, some of whose

members may declare themselves to be against organised religion, but in fact choose to

be in a spiritual program. Some people at this stage of their addiction cannot detox alone

and need to admit themselves voluntarily to a detox unit of a hospital or clinic where

they will undergo anywhere from seven days to five weeks of an initial abstinence

program involving the AA 12 Steps model. After this they can go home, or to a halfway

house, or to a rehabilitation program/farm, or a Therapeutic Community (TC) program.

Examples of TCs are WHO or Odyssey House, which have a longer program based on

the therapeutic communities model – people helping people.

In the past, a major part of the detox unit program has been mandatory attendance of AA

meetings which were run in the detox unit as part of the recovery program. Since the

advent of the Harm Minimisation Policy (National Drug Strategy 1985) inpatients, who

choose abstinence as their recovery goal, are encouraged to attend AA or relevant 12


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Steps meetings out in the community (MacAvoy) when such meetings are no longer

available in the government funded treatment centres.

2. Medical/Genetic Model of Addiction

There are several theories on addiction and here I elaborate on the medical/genetic

model and abstinence with the AA 12 Steps model as the recovery method -.

2.1 “It’s Genetic” – The Alcoholism Gene

In 1993 I attended a talk by Professor Noble at the Wesley Mission Auditorium where

he heralded the findings of a research project (Blum & Noble JAMA Study, Journal of

American Medical Association 263 (1990): 2055-60) which identified the allele

dopamine receptor gene, otherwise known as the alcoholism gene (also referred to as A1

allele of the D2 dopamine receptor gene). Noble spoke of research outcomes showing

the multi-generational genetic incidence of alcoholism in families. Even though

alcoholism can appear to skip a generation, Noble explained that this is more the case

due to offspring becoming so repulsed by their parent(s) compulsion that they have a

strong aversion to any substance use that may cause them the same embarrassing

behaviour. That is why we find teetotallers who have alcoholic parent(s) and alcoholic

children. In the case of the children's children, they are not familiar with the genetic

predisposition to addiction in the families of their teetotaller parent(s) and, therefore,

they abuse alcohol which then turns into alcoholism.

This school of thought has also been shared by renowned leaders in the 12 Steps field

such as Bill Wilson and Dr. Bob (AA Big Book 1939), Bradshaw (The Family 1988),

Mellody Miller and Miller (1992), Miller (1993), Wegsheider-Cruse (1989), Jurd

(interview 1992), Maclaine (interview 1993). Jurd drew attention to the studies carried

out on twins, and cross cultural experiments which proved beyond a doubt that

alcoholism is genetic (Jurd interview 1992, Lennane 1992:30). Maclaine and

Cassimatis (interviews 1993) pointed out that there is ample documented evidence

showing that alcoholism is genetic. Others like Lenane also take that stand and here I

show how it appeared in the dialogue I had with Lennane, Maclaine, Cassimatis and

Jurd in our respective interviews (1993).


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In response to my question regarding comments made that the genetic predisposition is

inconclusive, the 12 Steps model supporters have been passionate in their objections to

that notion and strongly affirming the existence of genetic predisposition. Lennane

refers to the twin studies in her book (1992) where she also announced the study “in

Australia which is looking at the drinking habits of some 3,000 twins” and how not only

pathological drinking patterns are shown to be inherited but also that what they call

normal drinking patterns are also “significantly determined by heredity” (Lennane

1992:32).

Furthermore, repeating their comments from Chapter 3 here, is important because it

shows how emphatic they are about this evidence.

Lennane: Oh, that’s rubbish! That is absolute rubbish and that really makes

me very angry when people say that. The evidence is very clear now and there

is no argument, in my view, about it at all. The only people who will say that

are the behaviourists and they simply have not adequately studied the evidence

– that’s not to say that inheritance is the only aspect, obviously it isn’t. If you

have terrible genes for alcoholism and you’re born in a Muslim country you

don’t get into trouble. So there are definitely other factors, but genetics is very

important and this is again something that annoys me very much that because

of the influence of the behaviourists school in policy making where they’ve

really managed to take the whole thing over – because they don’t recognize the

genetic aspect they’re not doing what I think is one of the most important

things that we should be doing and that is warning people, running an

education campaign to people saying that “if you have alcoholism in your

family you may have a genetic predisposition yourself and you have to be very

very careful about using alcohol”.

and in my interview with Maclaine…

Maclaine: If you look at all the literature on the genetic predisposition there’s

not the slightest doubt that a significant genetic element…component…to

people becoming addicted drinkers, so there’s no doubt about that and the

question is what way does that play out in people and it would seem that [in]

some people the alcohol acts on brain centres that produce a much deeper

psychological response than other people? That, in and of itself, would not

mean they would become alcoholic or certainly alcohol dependent, but it could

amount to a strong predisposition to, given whatever might be there in the

personality.


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Although Cassimatis does not solely use the 12 Steps model, he emphatically supports

the theory that alcoholism is genetic as seen in twin studies (Cassimatis 1993, Jurd

1993).

In response to my question Cassimatis also takes it further by advising what we can say

to those who insist otherwise.

Cassimatis:…twin studies have shown that in many illnesses, and alcohol is

no exception in that identical twins despite the environment that they’re

reared will be susceptible to alcoholism, and that proves that there is a

hereditary factor. What the environment does though will teach us how

motivated we are and how much insight we have and so what the outcome

will be we don’t know. Twin A and Twin B may have alcohol problems but

Twin A may have little insight into his problem or less motivation or

whatever it is because of the environment he grew up in and be a much more

difficult customer to deal with, whereas Twin B may not. And so what we

find is that the environment brings out the expression…and I think AA deals

with this because it talks about defects in our personality…[doubters should]

go and read the science books and the articles. I don’t think it’s worth

fighting with them if they’ve got a fixed idea, if it’s due to lack of information

they should get further information.

Likewise, answering the claims that the evidence is inconclusive Jurd becomes

emphatic too.

Jurd: No, because something like eight studies have found that that gene is

over represented in alcoholic populations…the allele dopamine

receptor…These are not studies that say the sons of alcoholic fathers are

more likely to have alcoholism than sons of non alcoholic fathers. No, this is

studies that identified a single gene that is over represented amongst

alcoholics they take the DNA out of the blood cells of these patients and

identified the gene. No there’s no suggestion that it’s the only gene that

confers risk for alcoholism but as far as you can know scientific fact it is a

gene that does confer risk for alcoholism.

Although Peele and Brodsky have attempted to negate the Blum and Noble findings

about the existence of an allele dopamine receptor, Ruden in his book The Craving Brain

(2000) identifies the relationship between dopamine and serotonin in the brain’s

addictive terrain that can predispose a person to addiction.


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Although the complexity of human behaviour precludes the straightforward analysis of the influences that lead to addictive behaviour, laboratory rats have been bred to self-administer virtually all the drugs that are abused by humans. In these experiments, the animal is free to drink from two bottles, one containing the drug and the other containing water. Alcohol-preferring (P) rats could be bred for voluntary alcohol consumption simply by mating high-alcohol-consuming rats until there was a clear distinction between those bred to prefer alcohol and those bred not to prefer alcohol (NP)…if an individual is born with this terrain, the risk for addiction is great. (2000:28-29)

Jurd takes it further in our interview and I show this here in the next paragraph on the

subject of addiction.

2.2 “It’s a Disease”

The Alcoholics Anonymous solution is to see alcoholism as an illness which has been

also shown as a “progressive disease” on its website. In 1960, Bill Wilson, one of the

founders of AA gave a speech on alcoholism. In explaining why he did not use the word

disease he said:

We AA's have never called alcoholism a disease because, technically speaking it is not a disease entity. For example there is no such thing as heart disease. Instead there are many separate heart ailments, or combinations of them. It is something like that with alcoholism. Therefore we do not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore we always call it an illness, or a malady, -- a far safer term for us to use. (AA website 2007)

However, although it is preferred that alcoholism be called an illness instead of a disease

this is quite often not done, so at different times throughout this thesis the terms are used

interchangeably by me and those I am quoting. Alcoholism as an illness/disease needs to

be treated through abstinence from alcohol and working the AA program (AA Big Book

1988) to maintain the recovery. Alcoholism is seen as similar to diabetes which can be

stabilised with abstinence from sugar and fats, and by having the appropriate treatment

(Jurd 1993). AA members have shared at the meetings I attended that it is a progressive

disease and the notion that “the illness progresses” is a belief also supported in books

such as I’ll Quit Tomorrow (Johnson 1980:112) and The Craving Brain (Ruden

2000:127). The term “progressive disease” is also mentioned in the AA website

(copyrighted in 2007 by Alcoholics Anonymous World Services, Inc).

Remember that alcoholism is a progressive disease. Take it seriously, even if you feel you are only in the early stages of the illness. Alcoholism kills people. If you are an alcoholic, and if you continue to drink, in time you will get worse. (alcoholics-anonymous.org)


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A “progressive disease” also means that should the intake of alcohol be ceased, then the

symptom of ill health is alleviated but the disease is still there, and should alcohol be

picked up again, even many years later, the extent of the tolerance will be as though

drinking had continued (Jurd interview 1993, Bradshaw 1988, Lennane interview

1993, Mellody 1992). Mellody also elaborates on the belief that alcoholism is a disease.

there is a biology of alcoholism absolutely! no question about it! The only

question is how relative is it, how much does it contribute and insofar as

understanding the disease itself. I think it contributes significantly because it

helps people to understand their own experience of the terrible loss of control

of their own behaviour of their own lives and it helps them to understand

that some people react in one way and other people react in another way then

they realize that there’s a reason for them to be abstinent whereas other

people can control their drinking. The notion of it being a no fault disease,

people are not responsible for their disease they are responsible for their

recovery and that’s the way it is with any other disease.

Referring to the craving brain, Ruden pointed out that biobalance to mindfitness is vital

in order to treat addictive behaviour, which is also a response to stress (2000:110). In an

interview with me (1993) Larsen, Training Supervisor, Haselden Rehabilitation Centre,

Minneapolis, USA said “people that have crossed the line into addiction need to

abstain”. Once that behaviour has reached such extreme proportion it is a struggle to

maintain usage at a harm minimised level - as confirmed by Pat and Pia Mellody in

their interview with me (1993). This is evidence from not only professionals who were

brought out here to assist in the setting up of a rehabilitation service but also from

people who had personal experience with addiction. This evidence cannot be treated

lightly – controlled drinking or usage is an unrealistic expectation which is very risky.

Pat Mellody: To me it’s a risk factor that if someone has been drinking in

the face of harmful consequences and stops drinking it’s much safer for

them to assume that drinking again will bring them back into harmful

consequences than it is to take the risk. I often double bind people and say

first of all if you want to recover from your childhood issues and get in

touch with your feelings you can’t drink at any level because it affects your

feelings. I don’t care if you call yourself alcoholic or not just don’t

drink…So I look on it that it’s more a self-protection thing to look on

myself as not ever being able to drink again than take the risk and go down

the tubes like a lot of people do. Another thing someone who has long term

sobriety like I do, I have 22 years, statistically people who start drinking


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and get back into it after long term sobriety don’t ever get well again and

don’t stop again.

Pia Mellody: It’s a huge risk.

2.3 Identifying & Isolating the Problem

A common strategy for recovery from any dysfunctional behaviour or illness involves

identifying and naming the problem, then separating the person from the problem so that

the person can be recruited to make the appropriate therapeutic choices for problem-

solving and recovery. Therapeutic interventions; counselling and mediation training

techniques; and personal development tools appearing in books such as The Skilled

Helper (Egan 1982), Getting to Yes (Fisher & Ury 1986), to name a few, refer to this

strategy in different ways. It is a strategy which is aimed at goal setting and problem-

solving and this is also a strategy heavily emphasised in AA recovery literature. Perhaps

this is also how a person develops a coping skill. In my experience, from attending

workshops in different modalities, the terminology used in describing this strategy is -

identifying, naming, articulating, describing, owning, clarification of the problem, and/or

isolating the problem. As Wilson Schaef writes (1987):

We cannot recover from an addiction unless we first admit that we have it. Naming our reality is essential to recovery ...Once we name something, we own it. Once we own it, it becomes ours, as does the power we formerly relinquished to it. Once we reclaim that personal power, we can begin to recover and not until then...to name the system as addict is not to condemn it: it is to offer it the possibility of recovery. (1987:144)

Brigham and Gentle, psychologists (and social activists), Wollongong Eating Disorders

Clinic (1993), share the worldview of many psychologists such as Peele (1989), that to

call alcoholism, eating disorders or any other disorder a disease is to label the person in a

way that is not freeing but in fact limiting. In an interview with Brigham (interview

1996) I focused on his strategy of calling an eating disorder the “bitch” which the

afflicted persons need to rid themselves of permanently. He did not agree that there is a

parallel between his “the bitch” concept and naming it a disease from which to recover

concept. To me, both sound very much like the problem naming and identification

strategy aimed at isolating the problem so that a solution can be found.


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Furthermore, another interpretation of this concept is when Peele & Brodsky wrote that

when referring to an alcoholic parent "to distinguish between the parent as a person and

the parent's "disease," so that they can blame the parent's hurtful behaviour on the latter"

is a misguided technique (1991:342). This refers to a technique used to help a person in

recovery from all sorts of stress caused by an alcoholic parent or living with an alcoholic

person or being an alcoholic and wanting to be free of the disorder. If it is for the reason

of laying blame, then I agree that it is a misguided technique but this is not the intention

of such a technique. That parent's "disease" is separated from the parent as a person, so

as to work together against the "disease" and not to lay blame, which is quite a useless

action. From another perspective, according to Fisher and Ury (1986), negotiation

experts, separating the people from the problem enables all those concerned to "jointly

face a common task" (ibid:40) which in this case is to deal with the problem behaviour

and the impact it has made on those having to live with it. It is believed that when this is

done the problem is not laden with stress as would happen if personalities came into the

picture. I found that this is confirmed by the AA slogan I saw at various meetings: place

principles before personalities. Another example of how AA discourages ‘victim’ and

‘blaming’ labels is in often used sayings such as “I am not responsible for the disease

but I am responsible for my recovery from it” which I heard shared over and over at AA

meetings. I found recovery more easily achievable when a person admitted their

powerlessness over their addiction and then took the necessary steps to become free of it

through abstinence as the disease model supports, rather than relying on willpower to

control it as fostered by non-disease models. The process of separating me from my

nicotine addiction made it clearer what the problem was and how to be released from it.

3. Project Match from the TSF Perspective

Chick, consultant psychiatrist Royal Edinburgh Hospital and senior lecturer in

psychiatry Edinburgh University, has advised government bodies in UK, Brazil,

Australia, Canada, and USA on public health and treatment issues related to alcohol,

health, and social problems. His research in early detection and intervention for problem

drinkers and relapse prevention treatments for alcohol dependence is recognised

internationally. His study on counselling for problem drinkers in the general hospital

system is the third most cited paper in the field of alcoholism treatment research in

world literature (ALCOSCOPE 2001 – International Review of Alcoholism


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Management). Here he mentions the benefit of Twelve-Step Facilitation (TSF) and some

of the Project MATCH outcomes. Though lengthy, I feel it is necessary to include the

whole quote as it is important to this chapter.

Naturalistic, non-randomised, studies have shown that treatment programmes using the AA approach are associated with outcomes in drinking and overall functioning similar to those of programmes using the cognitive-behavioural approach. Patients in AA-based programmes (‘12-step programmes’) show improvements in self-efficacy and coping

skills in line with patients treated by sophisticated cognitive behaviour therapy12. A large

US government study, Project MATCH [1993] randomly allocated patients to either cognitive behaviour therapy, motivational enhancement therapy, or a treatment called 12-step facilitation (TSF), which instructed patients in the tenets of AA and assisted and

encouraged them to attend AA meetings.13 TSF was associated with the best outcomes after 1 year, for those who had been relatively free of psychiatric problems at entry to the study. After 3 years, patients who came from backgrounds where their family, social or work environments brought them into frequent contact with drinking did significantly better with TSF and going to AA than with the other treatments offered by specialist psychologists. Alcohol dependent patients whose physicians help them to start attending AA meetings are often profoundly grateful. The key to getting the patient to try his or her first AA meeting, to follow any abstinence-oriented therapy such as taking relapse-prevention medication, or to go for specialist therapy, is the motivational ambiance and

empathy14 of the early meeting that took place at primary care.” (ALCOSCOPE 2001 Vol.4: Issue 1:10)

It is important to note here that the Project MATCH (1993) involved people who made a

commitment to abstinence and not those who wished to control drink/use (Heather 1999

94(1), p36).

4. George E. Vaillant - AA Research

As a result of “a vast collaborative effort which started with two studies in the late 1930s

and was still running after 60 years” Vaillant, a Harvard psychiatric professor wrote in

his book (1995) “…research during the last 15 years has revealed growing indirect

evidence that AA is an effective treatment for alcohol abuse. This was even though it

was difficult to obtain direct evidence by statistical methods, nevertheless through

personal experiences this information was gathered. He stated that “AA is the most

effective means of long-term relapse prevention in the physician’s armamentarium”.

Vaillant in his paper (2005) produced an extensive study of AA efficacy and safety, in

12 Oiumette PC, Finney JW, Moos RH, Twelve-Step and cognitive-behavioural treatment for substance

abuse: a comparison of treatment effectiveness, J Consult Clin Psycol 1997; 65:23-40 13 Longabough R, Wirtz PW, Zweben A, et al. Network support for drinking, Alcoholics Anonymous and longterm matching effects. Addiction 1998; 93: 1313-34 14 Connors GJ, Carroll KM, DiClemente CC, et al. The therapeutic alliance and its relationship to

alcoholism treatment participation and outcome. J Consult Clin Psychol 10997; 65: 588-98


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the treatment of alcoholism through reviewing literature published from 1940 to now.

However, this showed that AA was not the answer for all alcoholics but his overall

observation is that

multiple studies that collectively involved a thousand or more individuals, suggest that good clinical outcomes are significantly correlated with frequency of AA attendance, with having a sponsor, with engaging in a Twelve-Step work and with chairing meetings. (ibid 2005)

Vaillant’s conclusion is that

Alcoholics Anonymous appears equal to or superior to conventional treatments for alcoholism, and the skepticism of some professionals regarding AA as a first rank treatment for alcoholism would appear to be unwarranted. (ibid)

5. There’s Agreement – it’s Multigenerational

Those who believe that addiction is a disease and genetic also believe it is

multigenerational with multigenerational patterns being passed down to the next

generation – especially dysfunctionality – and sometimes skipping generations (Noble

1992, Mellody 1989).

Even though there are so many who have conflicting views about addiction, the fact that

dysfunctional behaviour is multigenerational is not disputed, as indicated by leaders in

both the 'abstinence' and 'controlled drinking' and behavioural fields such as Bradshaw,

Rey (1995), Mellody (1989), Burton & Young (1961), Nichols & Everett (1986), Peele

& Brodsky (1991:341) to name a few. In order to understand what constitutes

dysfunctional behaviour we need to first consider functional behaviour.

As a trained professional in personal development, I have devised a list representing

functional behaviour which is included in the manuals provided at the Life Strategies

Workshops which I facilitate.

Functional Behaviour emanates from such characteristics as...

good self esteem, healthy self love, emotional maturity

being positive and maintaining clear ego boundaries

a balance between being autonomous yet interdependent

being able to give and receive unconditional positive regard (loving/caring)


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ability to admit when wrong and admitting our mistakes

being non-critical, nurturing and yet firm in setting limits

ability to express and release emotions appropriately

ability to be passionate and creative about life choices

respect for equality, peace, spirituality, and other people’s life choices

commitment to living a healthy life and having fun

giving service to humanity and the planet.

Dysfunctional behaviour is the absence of those listed under functional behaviour, and

having a compulsive nature. Compulsive behaviour includes feeling driven to do things

repeatedly, as written about by Johnson (1980:172) and Blake and Stephens (1987:2).

Examples of such behaviour are:

the need for power and control to feel secure

using abusive, violent methods of achieving this and 'acting out'

fear of intimacy

self-righteous, feelings of superiority, blaming, manipulative

being possessive, argumentative, needy, clinging

being elusive, anti-social, selfish

afflicted with a compulsion/addictive system

unmanageability, unreliable, irresponsible

self-centred, narcissistic, emotionally immature

compliant, dishonest, approval seeking

resentful, full of hate for self and others

Another way of describing dysfunctionality is with the term co-dependence which came

about initially as a description of the behaviour of spouses of people who were substance

dependent. Such people were seen to be drawn to sharing lives with addictive persons

(Bradshaw 1988, 1992). Bradshaw pointed out that if people experience that ‘locking

of eyes across the room’ and the ‘in love’ feeling when they know nothing about each

other, then it is certain that at a subconscious level they know there is a need for a

codependent and dysfunctional relationship and they can either avoid it or not.


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Another definition of codependence is by an expert in the 12 Steps model, Mellody,

who writes that "the experience of abuse in childhood is the root of the illness of

codependence" and she believes that "the recovery process begins by looking at the

beginning of the disease - which is in childhood"(1989:3).

Mellody also defines codependence as the inability to have emotional maturity relevant

to one's age. In other words people who are codependent become so at a young age and

search for relationships that will feed and maintain that way of being. Addiction fuels

codependence. The addicted person needs a rescuer (codependent) to keep them

excessively using a ‘feelgood’ such as alcohol, narcotics, cigarettes, pot, food (sugar,

fat), gambling, work, rage, stress, love, sex, spending and so on, and the codependent is

addicted to rescuing the addict. This is a dysfunctional relationship and many of us grow

up in one. This can be seen by the distressed lives some of our youth experience which

results in suicide. The major causes of suicide in youth are mental illness, substance

abuse and isolation. So I cover this topic here briefly because of its relationship to

dysfunctional behaviour (codependence) and substance abuse.

5.1 Australia's High Youth Suicide Rate

As stated by WHO (World Health Organisation), World Health Statistics Annual, 1994

(Australia Bureau of Statistics, 1994) Australia’s youth suicide was at a high rate

worldwide then. Multigenerational patterns can play a significant role in the family

system. I want to mention youth suicide statistics because it shows the state of affairs of

our young people who are affected by the dysfunctional behaviour they are being

brought up in, and living with, as well as the impact drug taking is having on their lives.

The statistics are as recent as is possible, given that we rely on the Australian Bureau of

Statistics for such information. Rey, Director of Adolescent Unit, Sydney (1995) and

who has spent many years working with adolescents, states in his book (1995) that "the

majority of teenagers are caring, intelligent, idealistic and stable people who love and

appreciate their families and their country" 1995:9).

Even so, it is a well known fact that “Australia’s youth suicide rate is among the highest

in the Western world” as per the Australian Christian Lobby report (2000) showing

research statistics including that each week 10 young Australians kill themselves, each


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week more than 1000 make unsuccessful suicide attempts and up to 60,000 youths try to

suicide per year (Australian Bureau of Statistics 1994). Also as reported in April, 2000,

by Lisa Clausen in Time Magazine under the heading “A Nation’s Long Misery…Last

week the Australian Bureau of Statistics released just such a batch of numbers, in its

most comprehensive outline yet of the national blight of suicide…Australia now has one

of the highest youth suicide rates in the world.” More specifically - if the 1995

Australian youth suicide figures were used for comparison to other industrialised

countries, Australia would rank as 11th highest for young men and 10th for young

women. (Patton et al, and Zubrick et al regarding World Health Statistics and Australian

Bureau of Statistics on youth suicide death rates in various countries - Youth Suicide in

Australia 2000). According to the Australian Bureau of Statistics (2000) the following

statistics show a serious picture:

The biggest increase in deaths from suicide between 1921-1998 has been in the 15-24 years age group for men (rising from 8.6 deaths per 100,000 men in 1921-25 to 27.7 in 1996-98...[and as per graph] Women rising from 3.0 in 1921-25 to 5.9 in 1995-98. (ABS 2002)

Although the statistics show males to have higher suicide rates in the age group 15-24 it

is noted that females have the highest attempted suicide rates.

According to results from the 1997 Survey of Mental Health and Wellbeing of Adults, women were about twice as likely as men to have attempted suicide in the 12 months prior to the interview. (ibid)

Why is this happening?

In 1997 The Australian Bureau of Statistics began tabulating all causes and conditions reported on death certificates. The process of recording multiple causes of death was introduced to give more detailed information about the underlying cause of death...In 1998, 15% of men and 18% of women who committed suicide also had an associated or contributory diagnosis of mental disorder, including 9% of men and 5% of women for whom substance use (usually abuse of alcohol or other drugs) was a factor. A further 4% of men and 9% of women who committed suicide were classified as having a depressive disorder.”(ibid)

However, as shown in an article published by The Medical Journal of Australia (Dudley,

Kelk, Florio, Howard, and Waters. Suicide among young Australians, 1964-1993: an

interstate comparison of metropolitan and rural trends, The Medical Journal of Australia

1998 169:77-80) “Suicide rates for 15-24 year old Australian men have trebled since the

early 1960s.” Whereas, the report claims that suicide rates for women in that period of


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time have not increased, which is unlike The Australian Bureau of Statistics information.

Youth Suicide’s major contributing factors are mental illness, depression and substance

abuse; isolation being a lesser contributor. As shown in the Canterbury Suicide Project’s

Bulletin No. 7 August 1995, whose representatives presented papers at the XVIIIth

Congress of International Association for Suicide Prevention, some suicide prevention

strategies at present are: (i) Mental Health Education; (ii) Mental Health Care; (iii)

Curriculum based prevention programs; (iv) Crisis Intervention/“Hotline” Centres; (v)

Restriction of access to methods of suicide; (vi) Family Support Programs; and (vii)

Postvention – for those who knew the victim and are faced with the impact of the

suicide. Projects such as this show that the problem of youth suicide is so extensive that

social welfare programs are being created to address the situation.

When we look at the model that takes into consideration family of origin issues (12

Steps model) we need to understand multigenerational patterns. Again, whether it's

addictions, any other neurosis or learnt dysfunctional behaviour, there is agreement that

dysfunctional relationship patterns repeat across generations. Rey goes on to say that

when teenagers with serious problems come in for assessment and help, "knowing what

happened in one generation may help to understand the problems in the next" (1995:46).

This phenomenon sometimes skips a generation (Mellody, Miller & Miller 1989, Noble

1993). As mentioned earlier, when a pattern appears in one generation and skips over the

next only to return, it is thought that this is due to the adverse reaction from the children

to their parents' mode of relating. The use of the word adverse here, has positive and

negative connotations. That is, adverse for the sake of doing the opposite to their parents

non drinking and/or adverse as an outcome of education to avoid abuse.

On the other hand, Noble (JAMA December1990) and those from the disease/medical

model school of thought agree with the multigenerational pattern notion but add a

genetic component, I give an example (Fig. 5) here of multigenerational patterns as I

have experienced them in counselling.


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For confidentiality purposes the genogram and all Case Studies shown in this

thesis are not exact but similar and I use substitute names for the clients

whose presenting problem is addiction, be it substance or process addiction

e.g. drugs or violence and/or dysfunctional behaviour (codependence).

Fig.5

Genogram

The genogram is mainly used in marriage and family therapy in the documentation of

casework (Marlin 1989, Scarf 1987). Symbolises deceased – Female Male

CASE STUDY A

died: suicide death unknown died: heart died: cancer died: heart died alcoholism stroke diabetes heavy drinker workaholic overeater heavy drinker non drinker heavy drinkers

painkillers heavy drinker fitness fanatic alcoholic violent

Hank’s sister: fit

previous relationship non drinker non drinker previous marriage defacto depression gambler/violent heavy drinker

SISSY (60) HANK (61) Musician

FITNESS TRAINER GYM INSTRUCTOR anorexic heavy drinker

Fitness experts, religious teenager Fitness fanatic died: drug overdose

CASE STUDY A

In this situation Sissy and Hank came to me with the presenting problem of Sissy’s depression which was aggravated by their son’s heavy drinking which was out of control and the loss of their other son’s daughter as a result of a drug overdose. Also of great concern to them is Hank’s musician daughter by a previous marriage who has anorexia. Hank as a gym instructor and Sissy a fitness trainer are both very self disciplined and health conscious but were finding the situation of their offspring and the death of their granddaughter unnerving, making their life unbearable. I spoke about multi-generational patterns of addiction which they could see on their genogram and praised them on their commitment to fitness and a healthy lifestyle. I recommended that they attended a meeting of Al Anon (relatives and friends of alcoholics) to understand which


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would be the best approach in dealing with their heavy drinking son. I reassured them that this was not because I thought he was an alcoholic but rather that there are ways to express their concerns to him without perhaps making it worse. I also recommended that they attend an Overeaters Anonymous meeting to help them with how they express their concerns to the anorexic daughter – I had heard many an anorexic person’s recovery story in OA, which I thought would be useful for them to hear. Both recommendations involved what they would need to do themselves rather than trying to take the offspring to these meetings. When they came back to see me they were both relieved and feeling more relaxed about what was expected of them as parents because the program with its members is a supportive fellowship and can give people some guidance as to what is helpful and what is not – that takes the pressure off. They also told me that they were going to continue attending the group and that some members had offered to be available by phone any time of day or night should they need to turn to them. I had also recommended that apart from material supplied by Al Anon and OA that they also read some literature by Mellody and Bradshaw. I have seen people who take on this course of action creating an unintentional positive effect on the members of their families who are experiencing the problems. The program states that if you change your own behaviour it will be of benefit to the person afflicted with the problem too, although it is recommended that you do not have that as the intention for your becoming a member of the fellowship.

I use this case study, involving a genogram, which is very different to the study in Case

Study B to show how such knowledge helps me as a counsellor assess which treatment

and tasks to use for the situation of the client – treatment matching techniques. I

understand that there is a level of accuracy/inaccuracy that is dependent on the

information provided by the client, which in turn can affect the design of the genogram.

However, generally a picture can be drawn that is sufficiently reliable to make an

assessment – one which the client finds relevant and for which a plan of action can be

designed.

In this example, it can be seen how a pattern skips a generation when a person whose

parent is a heavy drinker/alcoholic may chose to abstain from drinking because they

were perhaps repulsed by their parent's behaviour and were afraid of being the same if

they drank (Lennane 1992:31). This person marries a non drinker for the same reasons

and they bring up their child in a non-drinking household. When their child grows up

(s)he thinks that the parent(s) are square and, as (s)he is unaware of the effect that

alcohol had on the grandparents, abuses alcohol and is overcome by addiction.

Consequently, if you are from the Alcoholics Anonymous recovery movement you will

not be surprised about this story and will say "of course, it's genetic!" However, when


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you believe as behaviourists do, that addiction is learned behaviour and can be unlearned

(as were a variety of research findings by Peele & Brodsky 1991, Heather & Robertson

1981, et al) then you will agree with Maturana’s (interview 1993) statement that it is

not genetic.

Nevertheless, this pattern has repeated itself in the example family over three

generations and, it quite possibly has a long history spanning over other generations.

Patterns show up over and over in genograms. When I have had someone presenting

with problem drinking or a compulsion of some sort and I draw up their genogram, if

there is no trace of addiction or emotional disorders in their background I provide social

learning tasks as part of their therapy (cognitive behavioural therapy). Their motivation

level is usually high and the outcome is promising.

Here is an example in CASE STUDY B of one such client, whose name and certain

circumstances I have changed for confidentiality purposes.

CASE STUDY B

Peter came to me feeling despondent and worried that there is something wrong with him and that he is addicted to alcohol because he had been getting drunk on weekends for a few weeks. I drew his genogram and there was no noticeable addiction or emotional disorder in his background. He comes from a supportive family and he did very well with his studies. He has a good fulfilling job and fell in love with a woman who did not feel the same for him and with this rejection he withdrew. Taking an extended leave he came to Sydney to clarify his thinking but he feels it is not getting better. His employer has offered to keep the job open for him no matter how long he takes, which shows that he is productive and appreciated. I suggested that he attempt to reduce his drinking before it gets out of hand and he will not be able to control it anymore (an intervention which brings up the rockbottom). He felt that was possible and didn’t seem fussed at the notion. We processed the situational depression that he seemed to be experiencing because of the loss of his love, and as a result of normalising his situation, he said he was relieved and it gave him hope. I also pointed out that it was early days – it was only two weeks since the rejection and it would probably take at least two months to process the hurt. I also suggested he take Vitamin B as this may help his physical health as he has been drinking a lot. I have seen Peter since and he is back to his normal healthy self with the ability to have the occasional beer or two with work mates and then stop.


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The above example is much simpler to deal with than the one shown in Figure 5 CASE

STUDY A where the background indicates patterns of serious compulsion. So this

involved a harm minimization plan of action which worked for him.

6. Addiction – Genetic and/or Societal Influences

There is a third group of people, from both sides of The D&A Debate and too many to

mention, who believe as I do that addiction can be a combination - a physiological

susceptibility to dependency and a learned dysfunctional behaviour from their families

and peers, who do not know any other way to cope with stress. That is, having for a role

model dysfunctional behaviour/codependence as an appropriate interactive response.

This type of behaviour is reinforced mostly by societal trends, which differ from culture

to culture, and is perpetuated and inflated by multi-media, our movies and soap

operas/serials especially.

6.1 Serials, Soap Operas & Dysfunctional Behaviour/Codependence.

Even now, to watch a soap opera can be very enlightening about today's attitudes and

values, which I might add causes me great concern. In these serials, dysfunctional

behaviour/codependence is presented as the only way to survive life's traumas and again

is all centred around the dominance and submission romanticism, by either gender. This

modelled behaviour is depicted in work relationships, love relationships and so on.

Before I began expanding my mind, I too was one of these women who experienced a

compulsion for watching the serials - swinging from being delighted with the myth and

then to frustration about the ridiculous. Nevertheless, when I occasionally come across

such a show nowadays, and am temporarily mesmerised by one of these mating ritual

myths, I feel some amount of shameful discomfort. I observe my conditioned responses

of becoming momentarily titillated by behaviours which I now call “codependent drivel”

and which is role modelled by these actors reinforcing the fantasy that dominance and

submission is love, or as Firestone (1970) describes it as the unequal power struggle

known as romantic love and also known as fantasies that socialise us into maintaining

societal addictive systems of inequality, dominance, submission, and everything else

they represent as the ideal.


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This is better described in Datye's words presented at a feminists meeting in Vadstena,

Sweden 1989 (in Mies & Shiva 1993:15) relaying what was said by Sicilian women

when they protested against nuclear missiles being stationed in their country. They

defended their 'no' to war as also being a part of their 'struggle for liberation' and

stressed the "connection between nuclear escalation and the culture of musclemen,

between the violence of war and the violence of rape". Furthermore, these women

claimed, this is how women remember war and it is considered a daily experience in

"peacetime" when women feel that they are still at war and that...“It is no coincidence

that the gruesome game of war - in which the greater part of the male sex seems to

delight - passes through the same stages as the traditional sexual relationship:

aggression, conquest, possession, control. Of a woman or a land, it makes little

difference.”(ibid)

Dysfunctional/codependent relationships are cultivated, reinforced and encouraged by

the media and this is what the public pays to see and mimic, being indicative of how

addicted we are to relating in this way. This is further reinforced by our patriarchal

society with its romanticised male dominance/female submission relationship role

models which, we convince ourselves, are the ideal and longingly seek for our happiness

even though dysfunctional and damaging to our personal ecology. Only recently I saw

advertisements for two TV shows which showed role model females using violence to

solve disputes. The first one advertised was the sitcom Friends in which the audience

was screeching with laughter when role model, Rachel who is in her twenties, was

having a disagreement with her TV sister and they slapped each other furiously, to the

audience’s delight. What example does that give to younger people about dispute

resolution? Then in The Practice another TV show, the role model, a lawyer, punched

another woman. This is truly unjustifiable, yet what can be done about such poor

examples of conflict resolution which especially our young people think is ‘cool’ and

mimic. Or the lead actor (female) in another popular action weekly story – The

Pretender - shown smoking in a deliberate fashion – this indeed will provide a role

model for women to smoke, especially young women who are influenced by such role

models.


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7. Codependence, the Springboard for Addictions

Co-dependence – once called ‘neurotic’ (Pat Mellody interview 1993) but coined by

addiction counsellors in the beginning for spouses of alcoholics, is a common term now

for dysfunctional behaviour and covers a spectrum of compulsive behaviours (wording

used in the 12 Steps fellowship). Wilson Schaeff (1987) states that the majority of

people are codependent and very few are autonomous and self-actualising. The extremes

of codependence are: rescuing others to the extent of placing one's own wellbeing at risk

at one end of the spectrum and at the other end is avoidance to the extent of withdrawal,

isolation, and/or passive aggression in order to manipulate the other person.

Pia Mellody and Pat Mellody in their interview with me in 1993 described their

organisation called The Meadows in Arizona. A broad based treatment program centre

means they treat drug and alcohol problems, basic depression and eating disorders, as

well as codependence. Pat pointed out that ‘codependence’ is now the term for “what

neurosis used to be”.

The model is based on family of origin issues and the 12 Steps model. Importantly, there

is a whole Survivors Week workshop which gives the participants the opportunity to

look at early childhood issues and how they impact on the present. They are encouraged

to concentrate on the first 5 steps of the 12 Steps of the program. In doing so, they have

an integrated process that works both with early childhood issues and the present

addiction model. They confirmed that they believe that “codependence results out of a

childhood that was abusive and less than nurturing” and that “addictions are generated

out of the pain of childhood”. Pat Mellody was not only a senior therapist at The

Meadows but also a self disclosed alcoholic in recovery for many years. Pia Mellody

had discovered her own codependence through her recovery from alcoholism and as a

therapist at The Meadows had co-authored with Miller and Miller a forerunner in

codependence recovery together with its manual (1989). They also pioneered literature

on love addiction (1992).

This was the confirmation that codependence is the primary addiction and other

addictions are secondary and which are used to self medicate the pain experienced

through codependence. This is supported by Pat’s statement here.


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Pat: Of course, you know in alcoholism there is a very strong

hereditary aspect but you don’t find people from an alcoholic family

classically that come out of a functional habitat…I think the

codependency issues generate the pain and we get into addictions to

try to not feel the pain.

Speaking about Pia Mellody’s area of expertise brought her into the discussion and I

was mesmerised by her comments. I had attended her seminar that weekend (1993) and

at the beginning of the morning break I had gone up to the stage and asked if I could

interview her at lunch. To my surprise she agreed. Andrianopoulos, my co-researcher at

the time and who was there too, filmed the interview. Pia put an important slant on

codependence and addictions. First, codependence can as a result of childhood trauma

result in low self esteem and lacking appropriate emotional maturity we depend on a

person we are “basically enamoured” with to provide what is missing. Second, because

of this insecurity our needs cannot be met and then we “reach into obsessive

compulsive” behaviour (addictions) to medicate the stress created by our own lack of

personality structure.

Pia: So in that way I see issues of addiction as a secondary symptom

to the underlying primary issues of codependence. However, in years

and years and years of dealing with addiction issues I really believe

that some issues of addiction are obsessive compulsive processes

done in the face of harmful consequences that are ignored that

sometimes the addiction process is really a reflection of early trauma

and actually a way in which people are trying to tell how they were

traumatised by engaging in the addiction issue. You’ll especially see

that I think in eating disorders and you’ll see it in sexual addiction

OK? And you’ll most certainly see it in what we call love addiction

which is that book I finally wrote.

Pia then highlighted a perspective that needed to be documented as a separate point

because of its profound insight and its relevance to the genetic issue.

Pia: On the other hand I think some addiction issues stand on their

own as a primary illness such as genetically determined alcoholism

and they’re now understanding that some issues of eating and sex

and other obsessive compulsive behaviour actually is physiologically

based. So actually I believe, when you talk about how does addiction

fit into this – it fits into it at two different levels and on a third level

it doesn’t fit in it at all – it will stand on its own as a primary illness.


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Then Pia self disclosed about her own addiction as it manifested into alcoholism and the

role her codependence played. This is interesting because it shows how compulsion can

change character.

Pia: …it depends on the individual, for example, the first time I ever

drank I got drunk because I’m genetically alcoholic and it’s

throughout my whole family. There’s a bunch of us that have it and

when I first drank I was out of control and I wasn’t drinking to

medicate – I didn’t know what it would do, I was just trying to drink

socially so I stopped drinking because I knew I was out of control

and I didn’t want that experience. The next time I drank basically

was about 15 years later and I purposely started to drink in order to

medicate the pain I was in so you see…I have it on two levels as the

secondary level of the underlying codependence which created a lot

of pain and I also had it genetically which is a primary illness.

As I see it, codependence is when we expect others to ‘make us happy’ or blame our

unhappiness on others and external factors solely, therefore, relinquishing our

responsibility for how we can feel. One person could in a lifetime swing from the

characteristics of one compulsion to the characteristics of the opposite one. This is

considered codependent behaviour in that there is an addictive process of repetition

taking place which they cannot resist. For example a person who is a love addict

(Mellody 1992) in one relationship can become an avoidance/sexual anorexic when not

in a relationship. Or, the teetotaller partner of an alcoholic leaves the relationship and

becomes a heavy drinker themselves in the next relationship. This happens when one

partner acts out the addiction and the other codependently enables the addiction by self-

righteously refraining from drinking and creating a shaming process (Bradshaw 1988a)

which the other uses as an excuse to drown in drink. Then when the non-drinking

partner enters a new relationship having had so much self-control they give themselves

permission to be out of control thereby opening the floodgates to drink/drug abuse. This

role switching is not necessarily a conscious process.

In the next few paragraphs I mention those who are authorities on this topic as they are

responsible for developing the definition of the condition and educating the global

community, beginning in the USA. As the founders, their literature is of the timeframe

when they coined the term codependence and although of the period 1988-93, I believe


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it is important to show here as it documents why it was necessary to define the

condition.

Cermak (1988) defined Co-dependence as warranting the diagnosis of Mixed

Personality Disorder according to its definition in DSMIII and yet DSM lV (Diagnostic

Criteria American Psychiatric Assoc 1994:286) shows...

Personality Disorder Not Otherwise Specified and not to be confused with Multiple Personalities Disorder. (ibid)

Bradshaw, a leader in codependence and alcoholism field writes in his book

Homecoming…

I define co-dependence as a dis-ease characterized by a loss of identity. To be co-dependent is to be out of touch with one’s feeling, needs and desires.”(1990:8)

Pia Mellody elaborates on Cermak’s quotes by saying...

According to Cermak the essential features of codependency include (1) consensual investment of self-esteem in the ability to influence/control feelings and behaviour in self and others in the face of obvious adverse consequences; (2) assumption of responsibility for meeting other's needs to the exclusion of acknowledging one's own needs; (3) anxiety and boundary distortions in situations of intimacy and separation; (4) enmeshment in relationships with personality disordered, drug dependent and impulse disordered individuals; and (5) exhibits (in any combinations of three or more) constriction or emotions with or without dramatic outbursts, depression, hypervigilance, compulsions, anxiety, excessive reliance on denial, substance abuse, recurrent physical or sexual abuse, stress-related medical illness, and/or a primary relationship with an active substance abuser for at least two years without seeking outside support. Cermak takes each criterion and points out how it relates to established DSM diseases (e.g., Dependent Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder). Cermak alone in the psychological literature searched has tried to describe codependence and present a case for its deserving serious consideration as a disease. (Timmen Cermak (1986) Journal of Psychoactive Drugs)

Pia Mellody discovered she was suffering from codependence in her work at The

Meadows, Wickenburg, Arizona – a treatment centre for alcoholism, drug abuse, and

related problems. She was faced with outbursts of her own rage and the threat of losing

her job due to her behaviour. This led to identifying the disease of codependence as

being “the result of dysfunctional parenting that abuses the normal characteristics of

children by harmful actions or by neglect.”(1989:117) Pia had been an abused child and

her theory is that codependence also leads to addictions in order to cope with the


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symptoms it manifests. That is, “low or non-existent self-esteem; impaired boundaries;

owning your reality; meeting your own needs and wants; and operating in

extremes”(1989:205). I mentioned earlier that as this is a well known term in the disease

model of addiction and has its own twelve steps group – CoDA 12 Steps Group – it is

important to cover as much as possible here about not only the term but also those who

have defined the condition and have been effective in educating the global community

on the topic.

Another definition by Pia Mellody is:

I define codependence as the lack of those functional internal habit patterns regarding the body, thinking, feeling, and behaviour that are necessary to be a mature adult capable of having healthy relationships and finding a reasonable level of comfort in life. (Pia Mellody & Andrea Wells Miller, 1989:vii)

In my search for literature on codependence the most important was that mentioned by

Bradshaw, Mellody, Wells Miller, Miller and Beattie during the mid 1980s. This is due

to the fact that they are among the founders identifying this term and have published

several books between them. Therefore I chose to show their research first.

To prepare for writing their book (which is still very popular), Facing Codependence

one of the authors, Mellody searched the data base of the psychological abstracts on a

compact disk. These abstracts included articles from all sorts of psychological journals

representing psychological research and new developments. Since codependence was a

new phenomenon, having surfaced by name only in the past few years, they checked all

the abstracts and pertinent articles from January 1983 to September 1988 (inclusive)

which was when interest in the term arose. This led to the discovery that traditional

psychological literature contains only a few references to the disease of codependence,

at least by that name (1989:209). There were only eight articles in 1985 pertaining to

“codependence or codependency”. All in all these were as follows:-

Lesater et al (1985) wrote about research outcomes which concluded that “chemical use and associated problems such as codependence are significant factors affecting families.” (Journal of Drug Education. 15(2):171-185, (1985) Identifying chemical use problems in a community clinic)


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Walter (1986) shows a case of codependence where the wife of an alcoholic learned to detach from her husband’s drinking. (Journal of Strategic and Systems Therapies. 5(3):1-3 Putting the codependent in charge: A compression approach to an alcoholic system.)

Caldwell (1986) emphasises that challenging dysfunctional behaviour in an alcoholic is only successful when supporting his healthy behaviour as well. (Journal of Psychoactive

Drugs. 18(1):57-59 Preparing a family for intervention)

Rothberg (1986) in a family systems approach to alcoholism shows that both spouses are contributors to the alcoholic problem and both are affected by it. (Alcoholism

Treatment Quarterly 3(1):73-86. The alcoholic spouse and the dynamics of codependency)

Gierymski and Williams (1986) although agreed that wives and family members of alcoholics more likely suffered emotional problems than those of non-alcoholic they expressed scepticism regarding the concept of codependence. (Journal of Psychoactive

Drugs 18(1):7-13. Codependency) Smalley (1987) discusses dependency issues in lesbian relationships. Prezioso (1987) discusses spirituality as it relates to the treatment of chemically dependent and codependent people. (Journal of Substance Abuse Treatment, 4(3-4):233-238. (1987) Spirituality in the recovery process) Horney, the psychiatrist who wrote Human Growth (1950), was credited with coining the “dependency (personality)” definition which is similar to Pia Mellody’s definition of codependence. Horne saw healthy adults as autonomous but believed that ultimately all people find survival difficult without the physical and emotional support and caring of others enabling us to gain individuality.

7.1 The Swing Against Codependence

There is a movement of behavioural scientists against the concept of codependency.

From the link - Frequently Asked Questions - psychological literature – codependency

edited by Cline (2002), was an article which showed a strong criticism to the claims of

Mellody, Miller & Miller(1989,1992), Bradshaw(1990,), Beattie (1987,1989),

Wegscheider-Cruise (1989), and Wilson Schaef (1987,1992), a few of the leaders in the

codependence field and quoted names which I included in this chapter. Although

lengthy, I use the information of this article here because I have come across these

frequent claims in my work and research…

“It is unsurprising that the origins of codependency are asserted to be in childhood - specifically childhood abuse. Therapy for codependency usually includes taking an inventory of all "less than nurturing" experiences from childhood. Although specific physical and sexual abuse is included in this, those horrors are cheapened by not distinguishing between them and any event in which are parents were seen as harsh or unfair. Abuse counts as pretty much anything which isn't optimal and perfect parenting. And thus is born a dysfunctional family. Anne Wilson Schaef and John Bradshaw, two of the leading authors in the codependency movement, argue that 96


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percent of all Americans are involved in dysfunctional families and relationships - and, naturally, in need of help from therapists such as themselves. Dysfunctional families in which there is insufficient nurturing creates codependent and addicted adults later in life. Then, their acts of nurturing and caring are diagnosed as pathological and the cause of yet more dysfunctional relationships. Unfortunately for the codependency movement, empirical data supporting most of their broad claims is completely lacking. In one review of recent studies, Edith Gomberg [Gomberg, E.L. 1989, On terms used and abused: The concept of codependecy. Drugs and Society, 3, 113-132.], a psychologist at the Alcohol Research Centre of the University of Michigan, unequivocally states that there is "...no data at all" justifying the automatic diagnosis of all family members of a substance abuser as being "codependent" - which is to say, as having a predictable, pathological personality disorder merely due to a particular family relationship. As Gomberg so directly puts it, "Where are the data? There are no surveys, no clinical research, no evaluations; only descriptive, impressionistic statements." In fact, Ofshe and Watters report that studies have shown that simply going through a long interview and being put on a waiting list can produce a 75% improvement rate among patients. Thus, even interviews can be perceived and therapeutic and that perception becomes reality. Just two words can describe this: placebo effect. There is little sympathy in the codependency movement for such observations. Unfortunately, any expression of criticism or skepticism can itself become a symptom of a mental disorder. Anne Wilson Schaef has written that "Your judgmentalism is a characteristic of the disease."

As well as Wilson Schaef’s comments, further criticism of the previous claims of Ofshe

and Watters (1996) in a book review carried out by Butler for Los Angeles Times

(February 1995) “The tale is an embellished reconstitution of the court records, and

discrepancies in the details do not inspire confidence in Ofshe and Watters' contention

that Crook's memories were caused by reckless therapy and the reading of self-help

books. The authors have fiddled with the timeline, making it appear that Crook read and

positively reviewed The Courage to Heal before, rather than after, she recovered

memories of abuse.”

The Agnostics/Atheists/Skeptics website also claims that “The language and therapy of

codependency and dysfunctionality certainly makes people feel better. It gives them

categories and explanations for their vague feelings of frustration, anxiety and

inadequacy. They suddenly belong to something larger than themselves and they find

answers - at least temporarily - to their questions. They also become victims - victims of

their past, of their parents, and of their own relationships, relieving them of a certain

amount of responsibility in improving their own lives from within”. This statement

shows a great deal of ignorance about the codependence recovery program which says

that the doorway to a new life is that we learn about the disease and then take

responsibility for our own recovery (Mellody, Miller & Miller 1989:193).


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The author of this article further claims that “Codependency may give people a renewed

feeling of control and relief, but it fails fundamentally in addressing their problems. It

places inordinate emphasis on inner feelings and Higher Powers in the attempt to deal

with women's problems instead of the two factors which social scientists have repeatedly

stated have the biggest impact upon women's self esteem: children and finances”. To

finish off he makes the profound discovery that I have heard others believe in, that it

causes “Dysfunctional Feminism…In this way perhaps codependency functions as an

unconscious compromise for women trapped in difficult relationships and impoverished

circumstances. In the therapist's office, they are given permission to think about their

personal needs and aspirations - but once outside, they aren't faced with the difficult task

of challenging the social and economic status quo…Codependency appears to be a

combination of both issues. In adopting the label "codependent" or being in a

"dysfunctional" family, women become able to say "I am a recovering addict; the

problem is in me" rather than directly confronting the social institutions which have

imposed particular social roles on women for so many decades. There is no longer a

drive to create financial or social independence. By defining their problems in medical

rather than political terms, they get an audience and sympathy.”

It fascinates me that people who know so little about the philosophy of the program, set

themselves up as not just critical thinkers but actual authorities on its effectiveness.

7.2 Codependence: A Biblical View

The previous comments are not dissimilar to others such as Pastor Gilley. I show these

because they are representative of the belief system of many religious people I have

come across, who are against the twelve steps movement. Gilley’s disapproving tone in

summarising his understanding of codependence is quite surprising given that his work,

in my understanding, is supposedly one of tolerance and forgiveness.

As a summation, the adherents of codependency would say: "Codependents carry distorted messages about their own sense of worth and such messages originate in dysfunctional families. Those messages must be erased through regressive therapy and replaced with positive, self-enhancing messages" (Bobgan, p. 46). The Scriptures teach a very different method of change and growth. This method is outlined in places such as Eph. 4:22-24, where we are told to put off the old self, put on the new self, and be renewed in the spirit of our mind. Specific application of this principle will depend upon the problem that we face. The psychological world (including “Christian” psychologists) errs, because it has a faulty anthropology (view of man) based upon human wisdom, rather than upon the Word of God.


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Psychologists believe that people behave poorly, and develop emotional and psychological problems, because their love tanks are empty. If they can get their “significant others,” or even God, to fill up their “love tanks”, their problems will be resolved. The end result is everyone living for themselves. The Bible says, however, that we behave poorly because we are totally depraved, having been born with a sin nature. As a result, we react sinfully to our problems. The solution offered by God is to live Biblically. Progressive sanctification is our goal as we live our lives to please God.” (October 1966 issue of Southern View Chapel (since renamed Think On These Things).

Katz, a noted secular psychologist, in his controversial book The Codependency

Conspiracy (1991) makes the following charge:

"By creating so many different disease characteristics, the codependency leaders offer a slot for everyone. We all must be codependent because we all fit at least one of the descriptions. This tactic is very good for book sales and lecture attendance. ... But the tactic is also irresponsible. Most of the feelings and behaviour listed as codependence traits are perfectly normal. They do not indicate that we came from dysfunctional families or are in one now. They do not prove we are addicts. ... All they prove is that the authors of these lists have conceived a theory so broad, so multifaceted that it is virtually meaningless."

7.3 Codependence: A Psychologist’s View

Westermeyer is a licensed psychologist in San Diego specialising in the treatment of

depression and addictive behaviour from a cognitive behavioural perspective. Most of

his clinical work is in hospital settings, and he has been instrumental in creating psycho-

education modules for cognitively driven programs. Passionate about Harm Reduction,

Westermeyer maintains the HabitSmart and Push Harm Reduction websites as a public

service (Habit Smart 2002)...

Most disturbing is the fact that codependency authors are unaware of the volumes of empirical data backing up non-12-step methods of change for the symptoms delineated in codependency books (anger control problems, depression, anxiety, communication problems, to name but a few of those symptoms listed in Beatties's book). Also behaviorally oriented family therapists have developed methods for helping families in which addiction occurs without the use of 12-step mentality (e.g. O'Farrell, et. al.) The bottom line is that it is quite unlikely that you must do "grief work" in order to become more assertive or less depressed. Adult functioning is not linked to events in our past, but how those events have been assigned meaning. Instead of separating the "precious child" from the harsh cruel world, assign new meaning to events from the perspective of a coping adult who has survived. Do an inventory of the events which you overcame. Consider adult qualities which were related to surpassing and having insight into difficult times in the past. Victimhood, though stylish these days, creates a historical distraction for incoming information that is not healthy. (ibid)

Alice Miller, who taught and practised psychoanalysis, writes in one of her many books,

Breaking Down The Wall of Silence

People whose only experience has been the wall of silence cling to the wall, seeing in it the solution to all their fears. But if they have once glimpsed an opening in it, they will not endure its illusory protection…Now they wish to save others from the same fate, as far as is possible. They


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wish to share their knowledge of the causes of their suffering and how it can be resolved. They want to let others know that life, every life, is far too precious to be ruined, squandered, or thrown away. And they want to say that it is worth feeling the old pain, never felt before, in order to be free of it -free for life. (1993:9)

It is important to note that Miller does not officially support 12 Steps programs or any

other therapy. I use her thoughts here to show that they balance the previous author’s

comments.

Then again I have spoken to an elder of AA who surprised me by his disapproval of

Codependents Anonymous (which uses an adaptation of the AA program) because he

maintained that the AA program is based on a loving caring fellowship and this is seen

as codependent. His mistake was his ignorance on the difference between a loving

caring fellowship and codependence which is dysfunctional manipulative rescuing

behaviour.

Sher (1997:7) with reference to codependence concludes that to date, existing research

indicates that care should be taken when making generalisations about the psychological

characteristics of COA's (Children of Alcoholics). Clearly, evidence indicates that as a

group, COA's are at higher risk than non-COA's for a number of psychological disorders

in both childhood and adulthood and that they seem to be more impulsive and possibly

more neurotic than people without alcoholic parents. With the exception of the risk for

substance use disorders, however, the proportion of COA's affected by these other

psychological disorders does not appear to be large.

7.4 Conduct Disorder or Codependence

When we look at what Rey, a specialist psychiatrist who has worked for many years

with adolescents, says in his book (1995) which aims at being a parent's guide to serious

adolescent problems, the following are identifying characteristics of Conduct Disorder.

Symptoms of Conduct Disorder...

Bullying, victimisation and intimidation of others Cruelty to other people or to animals Starting physical fights Using weapons in fights (e.g. knife, bat) Stealing, shoplifting or breaking and entering


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Setting fires to cause damage Vandalism or destroying the property of others Lying or cheating (to con others) Running away from home overnight Staying out at night without parents' permission Repeated truancy Forcing others to perform sexual acts against their will (1995:196)

Although these behaviours can be exhibited by anyone in their lifetime, the determining

factor of when these become a problem is when they occur more often than not and

drive the person, and those around them, to despair with which they are unable to cope

and which results in their life becoming unmanageable, in AA terms.

If I were to list the symptoms of the other behavioural disorders which Rey covers in his

book, they would be all applicable in occurrence and intensity to those behaviours

exhibited by the young people in the Stansfield Program (Stage 3 of the C&R Action

Research Project – Affie 1998) and even others who are not identified as having

behavioural disorders. However, as an addictions counsellor, I have listened to over

20,000 stories (over a period of 11 years) at 12 Steps meetings covering addictions. The

dysfunctional behaviours, people shared about, fit more reliably the problem behaviours

of the 6 young people in the Stansfield Program, and are now known in the CoDA 12

Steps fellowship as codependence, the basis of an addict’s behaviour.

In other words, conduct disorder, dysfunctional behaviour, codependence and addiction

have similarities that are obvious, especially in our youth. According to Lennane

(1992), youth alcoholism is increasing yet Rey chose to only touch up on “drug and

alcohol problems" in his last short chapter called Other Disorders, briefly covering

"post-traumatic stress disorders, personality disorders, tics (Tourette's disorder) and

bedwetting" because "to describe each one of them.....would become an unwieldy

volume and would overwhelm even the most avid reader....all these conditions are

important in their own way" (1992:259)! My disappointment is about how writers and

helping professionals like Rey, who can appropriately clarify human dysfunction in the

traditional sense, are so ignorant about the current realities. As Bradshaw puts it one

such reality is...


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Codependence is the most common family illness because it is what happens to anyone in any kind of a dysfunctional family. In every family there is a primary stressor...anyone who becomes controlling in the family to the point of being experienced as a threat by the other members, initiates the dysfunction . This member becomes the primary stressor. Each member of the family adapts to this stress in an attempt to control it. Each becomes outerdirected and lives adapting to the stressor for as long as the stress exists. Each becomes co-dependent on the stressor (1988:164)

7.5 Society – The Addictive System & Codependence

In my work (1994-96) with the Barnardos Stanfield Program (Stage 3 of Compulsions &

Recovery Action Research – Affie 1998) when my questions, about the addictive

patterns in our young people’s families of origin, were met by other professionals with

indifference, I sensed disapproval for bringing up the notion. Now, it makes more sense

to me. If society is the Addictive System that Anne Wilson Schaef writes about in When

Society Becomes An Addict (1987) , then aggression underlying the denial, a well

known characteristic of addiction, was sensed by me. I then became outerdirected and

adapted to the stressor, making sure I didn't do anything that may rock the boat and risk

disapproval. So I did not persist with my questioning but instead I went about finding

out for myself and acted upon what I found out - customising the program accordingly.

Lennane, psychiatrist (originally of the McKinnon Detox Unit Rozelle Hospital), writes

about the "social and personal costs of drinking in Australia" and the role of the

academics and/or professionals:

When so many people see alcoholism only in dirty raincoats on park benches, how can you say someone near and dear to you is one of those? How can you openly talk about something so many people see as a disgrace? Or that some learned academics scoff at, and say does not exist? How can you address the problem of your increased risk sensibly, and avoid inflicting it on your own children in turn, if those same academics are preventing you even being told about it? (1992:55).

In the same paragraph, Lennane also stresses that not just the parents but we too, as a

society, are contributing to our children's problems by encouraging drinking as a social

activity and thereby teenagers who have the genetic susceptibility, cannot say "My Dad's

an alcoholic and I'm more likely to become one too, I've decided not to drink at all" and

neither can they "rely on friends and family to support that decision"(ibid).

Those helping professionals who only see healing through traditional methods need to

become creative, lateral thinkers about codependence. Family members can learn to


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function in an open system instead of a closed system where every family member

codependently plays their role to keep the system dysfunctional in order to cope with

stressor. The more each plays his or her role the more unchangeable the dysfunctional

family system. Although not all families are dysfunctional, when we are enablers of

dysfunctional family systems...

Society itself thus becomes the ultimate dysfunctional family system. (Bradshaw

1988:167)

7.6 Addiction to Perfection – A Symptom of Codependence

Tolerance & Ambiguity. Perhaps the answer lies in society's attitude to being human and

the level of tolerance to ambiguity that is necessary for humans to find happiness in just

'being', instead of addiction to perfection. Could it be that at the bottom of all this

codependence and addiction lies the compulsion to perfection rather than intolerance to

ambiguity?

Essentially I am suggesting that many of us - men and women - are addicted in one way or another because our patriarchal culture emphasizes specialization and perfection. Driven to do our best at school, on the job, in our relationships - in every corner of our lives - we try to make ourselves into works of art. Working so hard to create our own perfection we forget that we are human beings (Woodman, Jungian Analyst, 1982:10).

The universal struggle - humanity’s constant aim is the mastery of what we do. In that

search we discover that we do some things better than others. We are encouraged by

society to reach excellence in what we do well, sometimes making it our vocation, and

to at least improve in what we are not good at, in other words, our strengths and

weaknesses. But somewhere in there we step over the fine line between excellence (as in

very good) and perfection (as in faultless). To become faultless is a stressful, unrealistic

process which gives birth to addictions.

Behind the masks of these successful lives, there lurks disillusionment and terror. One common factor appears repeatedly. Consciously the individuals are being driven to do better and better within the rigid framework they have created for themselves; they unconsciously cannot control their behavior. There are countless individual and collective reasons for the outbreak of chaos as soon as the daily routine is completed. Will power can only last so long. If that will power has been maintained at the cost of everything else in the personality, then nothingness gapes raw. When in the evening it's time to come back to oneself, the mask and the inner Being do not communicate.....Compulsions narrow life down until there is no living - existence perhaps, but no living (ibid:12).


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This I how there is a sense of a void inside. So, as the distance between our conscious

and unconscious becomes greater, we experience the fear that is fuelled by separateness

(Buber 1973). This anxious void we attempt to fill compulsively through alcohol, drugs,

gambling, food, work, jealousy, violence, sex, which enable us to run away from our

inner conflicts and that void.

Bradshaw (1988) writes about perfectionism as the need to always be "right" in

everything we do which I believe goes hand in hand with the need to control and have it

done our way or it's wrong. In this way our children feel squashed (oppressed), and fear

making their own mistakes or finding their own way, that is, finding their own identity.

This tyranny of being right can be about any norms the multigenerational family system has preserved. The norm may be about intellectual achievement or moral self righteousness or being upper class and rich, etc. The perfectionistic rule always involves a measurement that is being imposed. There is a competitive aspect to this rule. There is a one-up, better-than-others aspect to this rule that covers the shame.....The members in the system anxiously avoid what is bad, wrong or inferior. The fear and avoidance of the negative is the organizing principle of life. The members live according to an externalized image of life (Bradshaw 1988:80)

This externalised image of life is our mask, fostering the dissociation from self, creating

self-deception and denial, leading us to maintaining that status quo through addictions

instead of accepting that "we are not able to be perfect" (Schierse Leonard 1989:35).

7.7 The Demon of Perfection

Recovery is Developing a Relationship with Self. What Marion Woodman (1982) calls

'the wolf syndrome', 'the demon of perfection', was once for me a howling dog, inside

that big black hole in my inner world. No matter how fulfilling my life felt nor how

nurturing I was towards myself, most of the time I would feel as though there was a dog

howling inside, inconsolable. So, as well as psychotherapy and undergoing a residential

program in South Pacific Hospital as part of my Compulsions & Recovery Action

Research Project, I then did my grief work5. Then I focused on developing a relationship

with myself, bridging the gap between my conflicting selves. I did this internal dialogue

5 my griefwork paradigm: For two weeks at midnight (the only time I had free) I would dance to soulful music in the dark watching my shadow on the walls and tears would flood out about memories which I had not mourned before. I believe that this physical movement shifted the blocked energy I had suppressed for a long time.


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through a written question and answer log, and not long after I became free of that

howling dog inside.

8. Addiction Recovery – To the Doors of Death and Back to Life

I found this quote to be quite profound in describing what I have covered in these pages

about addiction. Schierse Leonard, Jungian Analyst/recovering alcoholic in the AA

movement writes about her experience in her journey through the depths of addiction...

every addict who recovers chooses life and makes this existential choice daily. The addict's recovery depends upon an acknowledgment of his [or her] powerlessness over the unmanageable depths to which he [or she] has fallen through his [or her] disease, upon his [or her] surrender to allow a higher creative power to guide his [or her] life, and on a daily commitment to work to lead a creative life and to give to others. This process of recognition, surrender, work, and choice is the basis of the twelve-step program of recovery and parallels the experience of a creative artist such as Dostoevsky, who was also addicted to gambling (Witness to the Fire, 1989:xv).

9. Reflection:

Dysfunctional Behaviours. I have covered several aspects of dysfunctional behaviours

from those considered to be multigenerational patterns through either genetic

predispositions such as mental illness or learned behaviour passed down through family

lines…to those aggravated by or leading to addictions and compulsions...to the role our

patriarchal capitalist society has in promoting dysfunctional behaviours that romanticise

dominance and submission as the ideal role model for loving relationships...to how we

treat our children and the effect this has on them and how, in turn, they treat others and

the planet. Which comes first is dependent on the worldview held. So, in this chapter, in

my documentation of the case for abstinence and the 12 Steps model in The D&A

Debate regarding addiction recovery, I have also balanced this stance by showing some

argument from the behaviourists perspective regarding this treatment approach.

Empowering Relationships instead of Dysfunctional Relationships. In the Stansfield

Paradigm (Affie 96)6 my vision was that we could show young people how to relate

differently, thereby empowering them to have a better chance at asserting their needs

and having these met. In this way they could break the dysfunctional cycle and find

6 I call it a paradigm here because it involves not only the therapeutic model but also the action research process.


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freedom from the oppression that they had learnt to rebel against, quite unsuccessfully as

it resulted in their being ostracised by their families and by society. This meant that there

was a way out, so, through our role modelling a nurturing, non-violent, non-punitive,

caring, creative way of relating, showed how it could be possible for them to do this.

This took a great deal of self-awareness on the part of workers as, in my opinion, we

were constantly struggling to free ourselves from dysfunctional behaviours that we

inherit from our societal script.

In other words, some of us may understand the changes that need to take place to rid

ourselves of behaviours which foster dominance/submission relationships and

oppression, however, when we are faced with a perceived threat to our personal space

we are tempted to resort to those punishing and punitive measures that are the norm in

our society. This vigilance and ability for adults to avoid regressing to such

dysfunctional behaviours, at times of stress with disturbed young people, takes an

amazing amount of energy and personal commitment to the vision of breaking the

dysfunctional cycle. Nevertheless, in my work with the Stansfield Program (1994-1996)

young people showed me that it was, indeed, possible and, therefore, strongly advisable

to role model functional behaviour (Affie 1998). Though the dysfunctional behaviour of

young people made it difficult for some to see the progress easily, when youth workers

persevered then the progress became obvious. By this I mean there was some

improvement, but when the young people’s behaviour reverted to dysfunction (breaking

a window or kicking a hole in the wall due to a temper tantrum) it lasted for a shorter

period with perhaps less intensity and less damage than before. So using the slogan ‘two

steps forward and one back’ gave hope that there was some improvement and for the

adults to think in positive terms, remembering to continue role modelling functional

behaviour.

10. Summary

This chapter addressed the case for abstinence in recovery from addictions. It is the

perspective maintained by the 12 Steps model and the Twelve-Step Facilitation (TSF)

model from Project MATCH (1993). The information shown here is that which has been

supported by those I interviewed and the literature review conducted throughout this ten


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year action research project called The Compulsions & Recovery Action Research,

instigated by The D&A Debate in the late eighties.

In the next chapter (Chapter 5) I cover the case for Controlled Drinking/use as focused

on through Cognitive Behavioural Therapies (CBT) and Motivational Interviewing (MI).

From this perspective family of origin work and childhood experiences are not of vital

consideration. Rather the more workable part of this theory is that behaviour can be

modified in the here and now. This involves accurate assessment of the individual’s

stage of change (their readiness on the motivational ruler) and that empowerment of the

individual is possible, so that they can change the dysfunctional behaviour accordingly.

The third school of thought including a mixture of psychotherapy (Family of Origin

Work and Gestalt group work), Cognitive Behavioural Therapies (CBT), and abstinence

with Twelve-Step Facilitation (TSF), and Codependence, is covered more fully in

Chapter 6 Synthesis – treatment matching: a diversity of approaches.

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CHAPTER 5

ANTITHESIS – THE CASE FOR CONTROLLED DRINKING (CD)/USE

(HARM MINIMISATION)

Everything in moderation (Greek axiom)

I called this chapter antithesis because the Harm Minimisation Policy (1985), as it

was commonly known then and referred to in the interviews in 1993, encouraged

controlled drinking/other drug use. This was anti (Greek: opposite to) the original

thesis (Greek: stance) of abstinence and the AA 12 Step program. Actually, the

correct name of this policy is the National Drug Strategy (NDS), which came after its

forerunner - the National Campaign Against Drug Abuse (NCADA), and has been

operating since 1985 based on harm minimisation principles, (Fixter 2007). Both

NCADA and NDS were created with strong bipartisan political support and involve a

cooperative venture between the Commonwealth and State/Territory governments as

well as the non-government sector (NDS website 2007). I refer to the National Drug

Strategy as Harm Minimisation (NDS 1985) in this Thesis.

Controlled drinking (CD) is the term for people who are able to drink/use (other

drugs) in moderation and it is believed that when they are drinking/using (other

drugs) excessively they are able to reduce usage to a less harmful level. Social

drinking or drinking in moderation is a popular social activity. Drinking one or two

glasses of red wine per day is also recommended by some professionals as being

healthy for nonproblem drinkers – this is claimed also as a result of a study in

Northern California that followed 128,934 adults from 1978-1990, (Klatsky &

Friedman 2003). However, others such as Jackson and his team from University of

Auckland say “any coronary protection from light to moderate drinking will be very

small and unlikely to outweigh the harm, and the other health risks definitely

outweigh the benefits” (University of Auckland website).

Cognitive Behavioural Therapy (CBT) is a therapeutic approach to achieve

controlled drinking (CD), so the terms are interchangeably used throughout this

documentation. There are other harm minimisation strategies such as learning to use

clean syringes; safe sex through condom use; using methadone: and using a

medically supervised injecting centre. However, unlike Australian behaviourists,

there are some American behaviourists who are not supportive of CD (Marlatt 1973).

Chapter 5: Antithesis – The Case for Controlled Drinking/Use (Harm Minimisation)

165

Furthermore, although many behavioural approaches have been successful for

controlled drinking goals, these have also been effective for abstinence goals. This

can be seen with some of the 12 Step model strategies which in fact are behavioural

strategies – ceasing drinking/other drug usage, attending meetings regularly,

committing to changes in behaviour, writing, reading and talking therapy. This is

also applicable to the CBT based abstinence model SMART Recovery, which has

many REBT (Ellis) strategies and which has been introduced to Australia by St.

Vincent’s Hospital in 2005. I elaborate on this model in Chapter 6.

Again it is important to note, that it is not the role of this research to show evidence

of how each protagonist’s therapeutic approach was established and to prove its

efficacy. Rather, by outlining each protagonist’s therapeutic model, I am showing

what they believe in - their worldview. In this way, when I have explored their way

of thinking through interviews or attending their seminars, there can be a clearer

perspective of what is influencing their stance.

For decades controlled drinking (CD) strategies have been recommended for, and

attempted by, those whose drinking had caused problems. This can be seen in

treatment evaluation literature (Heather & Robertson 1983, Pattison, Sobell &

Sobell 1977, Sobell, Brochu, Sobell, Roy & Stevens 1987).

A well known study into controlled drinking carried out in the United States, was the

1976 Rand Report. The National Institute on Alcohol Abuse and Alcoholism

(NIAAA) commissioned the Rand Corporation to analyse data collected from 2,339

male alcoholics from their NIAAA treatment centres. This included a follow-up of

597 of these participants 18 months later. The participants were not being taught to

drink moderately as was in the Sobell Sobell research. When following up, the Rand

researchers found 22 percent had abstained for a substantial period compared to 22

percent who were drinking normally. However, when the report was released, the

National Council on Alcoholism denounced it as being ‘dangerous, misleading, and

not scientific.’ Consequently, the Rand researchers conducted an extensive four year

follow-up study, broadening their sample, scrutinising their definitions, analysing

subgroups of subjects, and extending the period over which subjects were examined.

Their findings confirmed the viability of controlled drinking for all types of

alcoholics. Yet again its own funding body, NIAAA, reinterpreted the findings by


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announcing that ‘those who were dependent on alcohol cannot go back to normal

drinking’ (Peele 2006). This NIAAA interpretation is also firmly maintained by the

12 Steps model worldview (Jurd, Mellody & Mellody, Bishop, Maclaine,

Lennane, Larsen, interviews 1993)

The Rand study was even larger than the Project MATCH (1993) which had 1,726

participants and which was also initiated by NIAAA. I elaborate on Project MATCH

from a controlled drinking perspective later in this chapter.

The study carried out by the Sobells (Linda and Mark) began in 1970, when they

were students at University of California, and involved 20 patients at Patton State

Hospital on a behaviour modification program aimed at producing moderate

drinking. These patients were compared to another 20 who received standard hospital

treatment aimed at abstinence. There were one and two year follow-ups and the

findings indicated that participants in the abstinence group did not function as well as

those who were in the controlled drinking group. The Sobell study on controlled

drinking was attacked and even accused of being fraudulent by Pendery, Maltzman,

and West (1982). Later the Sobells were completely vindicated of wrongdoing, and

their results were accepted as legitimate outcomes, by the committee appointed by

the Addiction Research Foundation (ARF) which found no indication of fraud (Peele

2006) and which also gave them employment. The Pendery Group charges were also

investigated by the Addiction Research Foundation of Ontario and although the

Sobells’ study was exonerated by that agency in their 1982 report, it received little

attention by the recovery community.

There are still many accusations of deaths attributed to the Sobells’ controlled

drinking group (Bishop, Mellody, ibid) whilst other claims were made that there

were deaths within the abstinent group too (Peele 2006). Yet there are still

investigations in progress about the efficacy of controlled drinking for alcoholics in

the United States. I write about it here because although my documentation is

primarily concerned with The D&A Debate in Australia, the USA experience is

relevant and affects our attitude about compulsions and recovery. It is interesting to

note that “the controlled drinking approach is considered a dead issue in the United

States” (Peele ibid) yet in our country we are facing a time that we encourage this

method. Controlled drinking is a harm minimisation option, here in Australia, for


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alcoholics who have no intention of committing to abstinence and who therefore are

encouraged to reduce the harm to themselves and the community by attempting a

controlled drinking program such as that of the Haymarket Foundation and Matthew

Talbot Hostel. The same applies to drug use with such programs as the Medically

Supervised Injection Centre in Kings Cross which again has been well funded to

provide a safe environment for addicts who need to safely inject.

Peele when focussing on the Rand Report and the Sobells’ Study, which is still being

debated so many years later, makes a poignant remark here.

Other investigations are in progress, but whatever their results, it is clear that the controlled-drinking approach is a dead issue in the United States. The question is whether its demise was based on reasoned evidence and scientific scrutiny, or on superficial reporting arising from popular conceptions about alcoholism and alcoholics. (ibid 2006)

When drinking is such a major part of our social life, it stands to reason that it is

unrealistic to expect abstinence, even if that is a less risky option. Nevertheless, we

can aim at community education to encourage ‘drinking in moderation’, as the

preferred option in cultures where drinking is an expected social activity.

Experimenting with drugs has also been an accepted social activity for younger

people, especially adolescents. Our government has funded educational

advertisements as to safe drinking levels and other drug usage such as recreational

drugs (Mant interview 1993). The government has even supplied on demand, free of

charge, clean syringes for drug use (MacAvoy interview 1993). When I was the

Director of the Wayside Chapel (1992), our training for youth workers was aimed at

making young homeless people aware of this service. This did not mean we

condoned drug usage, rather, we were accepting the reality that it would take place

and in educating young homeless people about safe usage this helped Australia to

become a global leader in the reduction of the AIDS infection (1993). Another

government supported harm minimisation strategy was the methadone program. In

our interview (1993) MacAvoy spoke highly of the methadone program, as a

substitute for heroin addiction, and how his department, the Drug and Alcohol

Directorate (DAD), had funded the publication of a book on methadone treatment

(Ward, Mattick & Hall, 1992).

Cognitive Behavioural Therapy CBT was one of the three recovery treatment models

studied by Project MATCH (1993), which was initiated by the National Institute on


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Alcohol Abuse and Alcoholism (NIAAA) and involved 1,726 patients (NIAAA

website 2007). The second was Motivational Enhancement Therapy (MET) which

launched the strategy Motivational Interviewing (MI). The third, TSF involved the

AA 12 Step program and belonging to its fellowship for ongoing support. I will

primarily refer to MI instead of MET. Project MATCH findings may not have shown

that alcoholism is a biological condition and that treatment matching is not as useful

to recovery as was thought by the medical and behavioural professions, but the

NIAAA Director, Gordis M.D. (1996), reassured the recovery community that “any

one of these treatments, if well-delivered, represents the state of the art in

behavioural treatments”. Arguably, these treatments were not made “state of the art”

by this research, because they existed before Project MATCH. However, the 12

Steps model had not been scientifically studied before Project MATCH because of

the confidential nature of AA. Subsequently, as mentioned in the previous chapter,

TSF was designed for Project MATCH research and has enabled the 12 Steps model

through TSF to gain recognition as a therapeutic approach for addiction.

As I highlight the Controlled Drinking (CD)/Harm Minimisation worldview of The

D&A Debate, I also show some of the 12 Steps model arguments against the

CD/CBT way of thinking. I also use arguments from those of us who support the

worldview of Diversity of Approaches (DoA), which is the term I have given to

provision of choices for people suffering with dependencies.

At the Australis2000 Humanist Congress (2000), of which I was convenor, and also a

panel member of the Addictions Session, I (Affie 1992, 1994, 1998) was

representing a Diversity of Approaches (DoA) and at that time had personal

experience with such protagonists as Dowling (1994, 1995) (CD) - a retired

Humanist Physics Lecturer, Wodak (1996, 1989) (CD) – one of Australia’s Harm

Minimisation/Reduction spokespersons and the Director of The Drug and Alcohol

Service of St. Vincent’s Hospital, Jurd (12 Steps model) – Psychiatrist and head of

Drug and Alcohol Division of Royal North Shore Hospital and Phoenix Unit of

Manly Hospital (2000), Cassimatis (DoA) – Psychiatrist and Deputy Director of

Evesham Clinic, Ellis-Jones (SOS, 12 Steps model) – President of Humanist Society

of NSW (2000), Senior Lecturer Law Faculty UTS, and chairperson of this

Addictions Session panel. The panel consisted of a balance of CD, 12 Steps model

and DoA supporters.


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Professionals from the Controlled Drinking/Harm Minimisation end of The D&A

Debate such as Heather, MacAvoy and Mant passionately believed at that time,

that everyone is able to participate in controlled drinking and also justified their

stance because by 1993 Australia had become a leader in the world in reducing the

spread of HIV/AIDS and hepatitis infections (Heather, MacAvoy and Mant

interviews 1993). Such supporters of this worldview are known worldwide (Heather

& Robertson 1983, 1987, 1989, Heather, Richmond, Webster, Wodak, Hardie &

Polkinghorne 1989, Heather, Batey, Saunders & Wodak 1989). Other international

supporters of controlled drinking such as Peele and Brodsky (1991) have been

extremely outspoken and this has influenced our professionals and educators in

Australia. Their way of thinking has especially affected our AOD Interventions

Course requirements (Sobell, Breslin & Sobell 1998, Prochaska & DiClemente 1992,

Miller & Rollnik 2000, Peele & Brodsky 1991, Jarvis, Tebbutt & Mattick 2001).

The recommended reading for TAFE (2003) AOD Interventions Course did have

several pages on 12 Steps in the self help groups section, which was extremely

helpful yet unusual (Jarvis, Tebbutt & Mattick 2001). This inclusion was vital for

educators in the training of alcoholics to achieve abstinence when they could not

manage controlled drinking. It is worth mentioning again, that when I met with

Mattick, Director of NDARC, this year, I gave him positive feedback on his book

regarding its ‘user friendly’ format. My students found it easy to use, and I added

that although the CBT and MI strategies were well represented, only a few pages on

the self help aspect of the AA approach were hardly enough. Mattick agreed that at

that time, when the book was being prepared (1995), the 12 Steps model was not a

favoured approach with professionals in Australia who were attempting to fit in with

the Harm Minimisation aspect of the National Drug Strategy (1985).

This is a clear example of how the policy negatively affected government funded

agencies, especially education. The same applied to information supplied by the

Centre for Education and Information on Drugs and Alcohol (CEIDA) which

produced the naltrexone pamphlet and which showed supports for afflicted people

but eliminated the 12 Steps model or any other self help options (Chapter 6). Then,

similarly, as a project officer for a multicultural centre in Burwood in 1991, whilst I

prepared a recovery package in different languages, the director told me to exclude

12 Steps information as the Health Department objected to our using any 12 Steps


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program information. This was a misrepresentation as I found out later, through my

research journey (MacAvoy, Heather interviews 1993). My C&R research program

owes its beginnings to that particular misrepresentation of the Health Policy.

For decades, in the USA, the preferred method of recovery has been abstinence and

the AA 12 Steps Program which has spawned adaptations for other dependencies –

even codependence. Therefore, cognitive behaviourists have been seen to be

supporting controlled drinking therapy, and then against, as has taken place through

the rise and decline of controlled drinking therapy from the 1970s to now. An

example of this is Nathan’s career. Nathan was the first behaviourist/clinician to

become the head of Rutgers Center of Alcohol Studies (1983-1989), the pioneer of

academic alcohol studies (Marlatt 1973, 1985). Nathan's early research observed

alcoholics' drinking in the laboratory setting (Nathan & O'Brien, 1971). Although

this work resulted in crucial insights into the nature of alcoholism, it also drew a

great deal of criticism because of moral issues regarding testing alcohol on

alcoholics.

Today, such work is not supported by the NIAAA because of the idea of providing

alcohol to alcoholics and this is perceived as unethical and hazardous for research

participants. Nevertheless, Nathan’s work along with other researchers such as

Mellow made inroads into drinking behaviour and were against terms such as “loss

of control” and “craving” because they believed that this prevented alcoholics from

becoming re-educated in being social drinkers by behaviourally oriented strategies.

This way of thinking supports the social learning approach which in turn supports the

controlled drinking outcomes and strategies, especially when alcoholics believe this

is possible. Nathan moved on to oppose CD therapy for chronic alcoholics but has a

private practice where he only accepts clients who are willing and able to learn

controlled drinking strategies. This indicates a level of motivation in the afflicted

person that enables them to have the willingness to succeed in reducing the level of

harm in their drinking.

This is quite the opposite in Australia where supporters of the 12 Steps program

believe that behaviourists are supportive of CD/CBT and against the abstinence and

AA program (Lennane, Jurd, Maclaine interviews 1993). This is when the ongoing

conflict becomes so apparent and clearly shows how it exists worldwide. There


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seems to be a need to have opposing camps to treating the debilitating condition of

compulsion.

At the Australis2000 Humanist Congress, Dowling used his expertise, as a retired

physics lecturer (University of Ballarat) to show that illicit drugs when pure are not

the problem, rather what the drugs are mixed with and the quantity consumed cause

the risk to life. To prove his point he spoke about how drinking too much water at

one time can be fatal (2000). Dowling who had “been fighting the cause for Truth

and Justice in our Drug Laws since 1970” (Atheist Foundation of Australia Inc

article, 1994), has created much controversy in his opposition to government and

community misinformation which he claims creates the fallacy about drugs and drug

use. His arguments sounded plausible, especially given his professional background.

He maintained that his stance against government practices in this area, made it more

difficult for him to have accurate information published.

Wodak (St. Vincent’s Alcohol and Other Drug Service) was one of the protagonists

in The Debate and as a panellist on the Addictions Session of the Australis2000

Humanist Congress. I show his name in bold letters, throughout this documentation,

as I have done with those interviewed by me, because although I did not interview

him fully, I had questioned him on different occasions and his answers resulted in

major turning points for my research. For example, at a seminar, in response to my

questions he mentioned that the Swiss model was worth noting, and this resulted in

my obtaining a grant from UWS Hawkesbury to travel to Europe and interview

service providers in Berne, Stockholm and Amsterdam. This enabled me to have

updated information for my C&R research in time for my participation on the

Addictions Panel at the Australis2000 Humanist Congress. He provided the summary

of his paper which informed this Thesis as I elaborate on later in this chapter.

Wodak is outspoken about his belief that there is no change for the better in the

situation with illicit drugs in Australia. I also attended a panel discussion at the

Wayside Chapel on Tuesday 24th April, 2007, involving Wodak, Plibersek and

Rhiannon on the subject of illicit drugs, which is also mentioned in more detail later.

CBT is based on the belief that alcoholism (or addiction) is not a disease and cannot

be treated as such. This was reinforced by the findings published in Monograph

Series No. 11 which the Task Force on Evaluation of the National Campaign Against


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Drug Abuse (1989) commissioned the National Drug and Alcohol Research Centre

(NDARC) to show the effectiveness of treatment for drug and alcohol problems.

Heather (Director NDARC 1993), Wodak (St. Vincent’s Hospital), Batey

(Westmead Hospital), and Saunders (Royal Prince Alfred Hospital) prepared the

report together with contributions by Digiusto, Greeley, Richmond, Tebbutt and

Mattick. I interviewed Mattick in 2007 in the position previously held by Heather

with NDARC and this interview together with the book he co-authored (Jarvis,

Tebbutt and Mattick, 1995) has informed this documentation too. On the CBT side

of The Debate Heather has authored countless books and literature together with

other authors such as Batey, Saunders, and Wodak (1989), Jarvis, Tebbutt and

Mattick (2001), Richmond, Webster, Wodak, Hardie, and Polkinghorne (1989),

Robertson (1983, 1987, 1989).

Nonetheless, although Heather (interview 1993) admitted to me that if an alcoholic

is sober for a long time he would be crazy to try CD, Heather has shown in his

written works that he is very passionate about alcoholics being able to handle

controlled drinking (Heather & Robertson 1983). Their 26 studies of controlled

drinking methods used with clinical populations showed that seriously dependent

alcoholics were able to successfully control their drinking. In Australia, controlled

drinking is encouraged and an example of this is alcoholics who live in government

funded hostels which allow them to drink when outside the premises. As Campbell

(interview 1993) pointed out, this was indeed harm reduction rather than these people

sleeping in the streets and drinking methylated spirits. In this sense CD for severe

alcoholics is especially preferable. The Heather studies, with Robertson and other

researchers such as Miller, Rollnik and Winton, have been cited frequently regarding

this topic.

In this chapter another area that needs to be addressed is the stages of dependence as

perceived by the CD/CBT side of the continuum. Edwards and Gross, (1976)

reinforces the concept of stages of dependence which are progressive and debilitating

if not checked. This model of stages in addiction is the one used in motivational

interviewing and is reinforced by the controlled drinking/harm minimisation

movement professionals.


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It should not be overlooked that Egan (1982) has influenced all models of

counselling which is used in addiction recovery whether in CD/harm minimisation or

abstinence programs. In CD/harm minimisation and especially motivational

interviewing these skills are required and similarly in the family of origin

psychotherapy. The same applies to Rogers (1951) which is the basis for counselling

in any model. The skills attributable to Egan and Rogers, to engage with clients for

their therapy, are not disputed by professionals on either side of the schism.

Another concept not in dispute is that there are AA members who agree that there are

those who can control their drinking as shown in the Alcoholics Anonymous (AA)

book (1938, 1988). Jurd (interview 1993) confirmed that AA members believe that

those who can control their drinking are not alcoholics and do not need to abstain and

belong to the AA fellowship. It was also considered that if they have been abstinent

for a long period and then are able to return to controlled drinking then they were not

alcoholics to begin with.

When looking at the question of genetics, Maturana (interview 1992), renowned

biologist, was clear in his belief that alcoholism is not genetic. Even more passionate

about this notion have been Peele and Brodsky (1991) carrying out a heated criticism

of the research project by Blum and Noble (1990) about their discovery of the allele

alcoholism gene.

A promising possibility was the concept that home detox and treatment maintenance

for illicit drug use could be provided by local general practitioners. (Penrose-Wall,

Copeland, and Harris 2000). The general practitioner, who is usually the first contact

point, does not have the stigma of other addiction professionals and services and,

therefore, this would be the ideal service to begin funding. A trained support worker

would be required to deal with the intake level of a GP’s office. People could be

assessed by the GP and then the support person could carry out the groupwork for the

education aspect. Then an intense recovery program could be planned and followed

up. This could involve recommendation to attend 12 Step Meetings/SMART

Recovery Meetings/Therapy.


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Summary

In looking at the literature for controlled drinking (CD)/harm minimisation Heather,

Batey, Saunders, Wodak, Digiusto, Greeley, Mattick Richmond, and Tebbutt

(1989); Jarvis, Mattick and Tebbutt (2001); Heather, Richmond, Webster, Wodak,

Hardie, and Polkinghorne (1989); Heather and Robertson (1983, 1987, 1989); Peele

and Brodsky (1991, 2007); Penrose-Wall, Copeland and Harris (2000); Dowling

(2000), Edwards and Gross (1976); Ward, Mattick and Hall (1992); Wodak and

Owens (1996); Miller and Rollnick (2002); Pattison, Sobell & Sobell (1977); Sobell,

Brochu, Sobell, Roy & Stevens (1987); Foreyt (1987); Heather, Winton and

Rollnick. (1982); Marlatt, Demming and Reid (1973); Mello & Mendelson (1971);

Miller and Hester (1986); Nathan (1984); Nathan and McCrady (1987); Nathan &

Niaura (1985); Nathan & O'Brien (1971), have contributed extensively and are just

as committed to their concept that addiction can be controlled with CD/harm

minimisation programs even though it has been in and out of favour in the United

States.

This literature review and background information has informed this chapter on

controlled drinking (CD)/harm minimisation. The following points are an elaboration

of this way of thinking.

1. National Drug Strategy (1985) – Harm Minimisation Policy

The National Drug Strategy is a cooperative venture between Australian, State and

Territory Governments and the non-government sector, and is aimed at improving

health, social and economic outcomes for Australians by preventing the uptake of

harmful drug use and reducing the harmful effects of licit and illicit drugs in our

society (NDS website 2007). Although interviewees (1993) referred to the Strategy

as the Health Dept. Harm Minimisation Policy, when I contacted the Health

Department in May 2007 to obtain ‘scholarly documentation’ for my Thesis, no one

had heard of it as such. Finally following calls to different departments (state and

national), I found Fixter, Assistant Director, Drug Strategy Branch, Alcohol and

Indigenous Programs, Health and Ageing Dept. (Canberra). She was very helpful and

her efforts clarified the confusion about the Harm Minimisation Policy of 1985. The

National Campaign Against Drug Abuse (NCADA, 1985) identified its strategies for

harm minimisation/reduction which became the National Drug Strategy (NDS,

1985). This involved programs which had a “wide range of integrated approaches


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involving a balance between demand reduction, supply reduction and harm

reduction” (Fixter email to me 2007). Australia became recognised worldwide as a

leader in progressive, respected drug strategies, which contributed greatly to harm

reduction such as a decrease in the spread of HIV infection through supply of clean

syringes and the establishment of a medically supervised injecting centre (MSIC

Kings Cross). The harm minimisation approach underpinning the NCADA report and

the National Drug Strategy is considered to be fundamental to its ongoing success.

Here is a summary of the basic aims of the National Drug Strategy:

• Supply reduction strategies to disrupt the production and supply of illicit drugs and the control and regulation of licit substances.

• Demand reduction strategies to prevent the uptake of harmful drug use including abstinence oriented strategies and treatment to reduce drug use.

• Harm reduction strategies to directly reduce drug related harm to individuals and communities.

Harm minimisation aims to improve health, social and economic outcomes for both the community and individuals. Harm minimisation does not condone illegal behaviours such as injecting drug use, but acknowledges that these behaviours occur despite vigorous efforts to reduce supply and demand. Consequently, authorities have a responsibility to develop and implement public health and law enforcement measures that contribute to reducing the harm to individuals and the community. The current National Drug Strategy, Australia’s Integrated Framework, achieves its objectives by adopting:

• The principle of harm minimisation, including a balanced approach between supply reduction, demand reduction and harm reduction strategies, between preventing use and harm, and facilitating access to treatment

• A comprehensive approach, which includes all drugs and other mood altering substances

• A partnership between Commonwealth, State and Territory Governments, health, law enforcement and education agencies, community based organisations and industry in tackling drug related harm

• An emphasis on rigorous research, evidence based practice and evaluation and assessment of interventions.

(National Drug Strategy 2004-09)

The harm minimisation policies mentioned in the interviews, and in other

documentations, are the principles that underpin the actual strategy as further

outlined on the website of Divert – Assessor Training, The Police Drug Diversion

Initiative (Divert 2007). Prime Minister Howard has spoken of a zero tolerance

approach to drugs (FFDLR April 2007:1) which is seen as not fitting in with the

National Drug Strategy. Yet the zero tolerance was explained to me by the Health

Dept. as being the focus and relating to those who are involved with supplying

drugs.


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2. Controlled Drinking

Controlled drinking or usage is nothing new - it’s what people do when they eat,

drink, and experience social activities in moderation. In other words, they are in

control of what they are doing and how they are enjoying life. So for such people,

when they increase usage to the point that it becomes excessive, they can embark

either on their own, or on a program which enables them, to regain control over

usage and restore the balance in their life. As the Greeks say “everything in

moderation” and many people are quite capable of moderation and when excess is

experienced, a return to moderation can be achieved. Controlled drinking is a term

used in Alcoholics Anonymous (The Big Book 1988 3rd edn.) for those who have the

ability to control their drinking. As mentioned at the beginning of this chapter, there

have been many books written on the subject of controlled drinking/use. Heather in

his interview with me (1993) shared that his interest in the field came about when as

far back as 1975 he read about alcoholics who had managed controlled drinking. But

he did stress that only “some people not all people” were able to return to safe

drinking levels. He supports the use of brief interventions for people with less serious

drinking problems who are usually seen by general practitioners and hospitals. These

people have another identifiable characteristic which is they do not want to abstain.

This would apply to those people who are able to control their drinking or are so

seriously addicted that to train them to drink/use less would be good harm reduction.

Jurd in his interview (1993) supported the concept that those people who controlled

drinking could work for, were those who were not deemed alcoholics. This clarifies

the notion that those who were categorised as alcoholics and who have been able to

become controlled drinkers were not alcoholics to begin with. Instead they had come

to enjoy the freedom abstinence gave them through AA and then succeeded in

controlled drinking when they tried that. AA members with long term sobriety

(Bishop, Mellody interview 1993) told me it is a huge risk to attempt to find this out

and this was also supported by Heather in his interview (1993).

3. “It’s Not Genetic”

Peele & Brodsky (1991) who opposed the Blum & Noble JAMA study (Journal of

American Medical Association 1990) showing that there is a pleasure seeking gene

that makes alcoholism genetic, also claim that eight months after the Blum & Noble

JAMA Study (1990) another study as printed in JAMA disproved the link between a


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gene and alcoholism. In their book they take a strong stand against any arguments for

"inherited disease" with the statement "it is essential that we firmly refute this

science fiction"(1991:61). Peele & Brodsky also emphasize that many expressed

scepticism. They stated that Donald Goodwin, the psychiatrist whose research first

pointed to the inheritance of alcoholism, noted that "the history of this kind of work

so far has been a failure to replicate" (ibid). Yet Jurd in his comments about the

allele dopamine receptor disputes this in the previous chapter in his interview with

me (1993) stating that “8 studies have found that that gene is over represented in

alcoholic populations”. Behaviourists hold a firm stance on the notion that addiction

is not genetic but rather behavioural, which can be changed with behaviour

modification programs such as CBT.

Further work on the genetics of alcoholism will provide more understanding of the

physiology of alcoholism and other neurophysiologic and neuropsychiatric

abnormalities, however, those who are from the CD behaviourism end of the The

D&A Debate continuum are not convinced that alcoholism/addiction is genetic. Their

claim that believing in loss of control over alcohol consumption is a self fulfilling

prophecy and that a genetic early warning notion is likely to produce more problem

drinking than it prevents. (Peele 2006, Nathan and McCrady 1987)

Maturana, biologist/scientist/author (Tree of Knowledge 1992), along with other

well known names such as Heather (SMH 13/71991:21) disagree with the genetic

notion of alcoholism. In an interview Maturana (1993) told me that he believes

alcoholism is not genetic because if it were, then everyone would have it. I use it

here to show that influential people can have strong opposing viewpoints which,

when explored further with them, can hold validity in their own paradigm and are not

necessarily in total disagreement with that of others - diversity by another name.

For example, behaviourists criticise that believers of the genetic/disease concept

(Alcoholics Anonymous 12 Step Program) create a negative label by calling

themselves alcoholics/addicts all their lives. Yet, one of the primary goals of the 12

Step Program is to help addicts identify their problem and learn better coping skills

so as to be free of the need to medicate the pain of living. On the other hand,

believers in the 12 Step Program criticise behaviourists/psychologists for promoting


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unsuccessful recovery programs for addicts by promising successful controlled

drinking outcomes.

4. “It’s Not A Disease”

National Campaign Against Drug Abuse (NCADA) which was launched in 1985

commissioned the National Drug and Alcohol Research Centre (NDARC) to produce

a report on the current situation. The result was Monograph Series No. 11:

Effectiveness of Treatment for Drug and Alcohol Problems. Heather (National Drug

& Alcohol Research Centre), Wodak (St. Vincent’s Hospital), Batey (Westmead

Hospital), and Saunders (Royal Prince Alfred Hospital) et al, claimed that addiction

is not considered to be “legitimately compared with specific medical syndromes” and

treatment thereof can be quite different to “the treatment of a medical condition.”

(1989:4). Whereas protagonists in the abstinence side of the continuum such as Jurd

and Lennane believe it is a medical condition because it is life threatening and

creates health problems such as damage to brain cells, liver, kidneys and so on,

resulting in death if not ceased.

Heather, Director - National Drug & Alcohol Research Centre (NDARC 1993), and

others from the controlled drinking side of the continuum have carried out studies

and written much on the behavioural aspects of alcoholism, and how it can be

modified to the extent that alcoholics can become social drinkers (Controlled

Drinking 1981). One of the protagonists in The Debate (1993) who believed in

abstinence and AA as the most effective treatment for alcoholism, asked me to put a

question to Heather when I interviewed him, about what he would say to a person

who had sobriety through AA for over thirty years and wanted to try controlled

drinking. When I did put that question to Heather he replied…

Heather: He’d be crazy I mean somebody who’s achieved a contented

stable way of life through abstinence the last thing one wants to do is to

try and persuade them to endanger that in any kind of way. It’s not a

question of being opposed to abstinence, you must understand, I think this

is a misunderstanding that many people have. It’s more a question of the

role that moderation or controlled drinking can play in the range of

services.

I posed the same concept to MacAvoy, Director of the Drug & Alcohol Directorate –

Health Department and chief policy adviser to the Minister for Health, Mr. Collins

(1993) and he responded in this way:


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MacAvoy: All I can say is that we have to accept that there are other

points of view and other approaches – no one would deny a person of 35

years sobriety if that what keeps him sane, if that what keeps his life in

order so that he can get some enjoyment out of it and those around him

can, then who would deny him access to AA?

Both Heather and MacAvoy went on to explain that their stance was more to do

with those who either have less serious drinking problems and can learn to modify

their behaviour through controlled drinking or who have serious problems but do not

want to abstain. For those types who do not want to abstain, a program to lessen the

harm to themselves and the community is preferable. MacAvoy even commented on

those alcoholics who had long term recovery but their life “has become a rigid

adherence to a religion” and they cannot enjoy life, in which case a controlled

drinking program may work better. In becoming familiar with Heather’s work, I

have also realised that controlled drinking is aimed at the seriously addicted

alcoholic who benefits from reduced drinking even slightly if not abstaining, because

they are not willing to abstain.

As can be seen, the outlook of Heather and MacAoy, along with others who support

the CD/harm minimisation model of recovery, is that they are not against the 12

Steps model and abstinence but rather that there should be government funded

programs that suit those who wish to use different programs of recovery other than

abstinence programs which exist in the community at no cost to government. This

convinced me that there is a level at which all agree.

Mant (Clinical Director of the Drug and Alcohol Program, Eastern Area Health

Service, and Associate Professor at NSW University) from the 'controlled drinking

side' of The D&A Debate, in an interview with me (1993) threw some light on her

stance by saying that AA works for some but not for all and that the Harm

Minimisation Policy (NDS 1985) came about because of, and is aimed at, those

people in the community who are unable to benefit from abstinence and the AA 12

Steps model. As a GP she knew the benefit of AA but the harm minimisation

programs, she was sure, benefited those who did not see themselves as having a

disease. She confirms this by saying:

Mant: I’d say that there’s a large group of people for whom the disease

model is not very useful and then there’s a small group of people for


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whom I’m also aware of as a doctor over the years for whom the disease

model has been I would say a lifesaver.

Campbell (psychiatrist, Director Clinical Services, Rozelle Hospital, McKinnon

Detox Unit (1993) and consultant for this C&R Project) along with Mant agreed that

harm minimisation has a place in dealing with one addiction at a time, say,

methadone (approved replacement for heroin) is permissible when abstinence from

all other drugs is undertaken, but he added that it cannot be overlooked that AA

works for a large number of people. When treating alcohol/other drug dependent

people with a harm minimisation program this means that those who must abstain

will be expected to do so by abstaining from one dependency at a time. For example

when they are in a detox unit and they are being treated for alcoholism they need to

abstain from that and not from smoking cigarettes which they can do outside of the

hospital premises. Patients who are addicted to benzodiazepines and want some help

to withdraw from ‘benzos’ do so but that they can continue their methadone use.

Campbell called this “selective detox” enabling the patient to choose which addiction

they wish to work with and maintain the other. In this way everyone becomes aware

“that people also have other addictions”. With this attitude then the program is aimed

at a social learning approach with emphasis being on the patient taking responsibility

for how they recover from their addiction or addictions. This perhaps reinforces the

worldview that addiction is not a disease but rather behaviour that can be changed.

The AA model also supports the concept of giving up one addiction at a time, but

that only refers to working on recovery from alcohol and putting off recovery from

addiction to nicotine and food until long term abstinence from alcohol is achieved.

However, that abstinence is also expected to include other drugs such as pot,

narcotics, pills and even methadone. Harm minimisation professionals support the

use of methadone under medical supervision for addicts, as a replacement to heroin

and other narcotics, and I cover this in the next paragraph in more detail.

5. Harm Minimisation/Harm Reduction (National Drug Strategy 1985)

Psychologist, MacAvoy (Director of Drug & Alcohol Directorate 1993), who was

responsible for the implementation of the National Drug Strategy (1985) and funding

grants in the alcohol and other drugs field, supported the use of methadone. As a

synthetic substitute for heroin, methadone is supplied by the Health Dept. to addicts

under strict supervision, as a workable option in recovery from heroin. As mentioned


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earlier MacAvoy was anti the disease concept, as he stated in his interview with me

(1993) and he totally supported the concept of minimising harm and allowing people

to stay in society on a substitute drug.

MacAvoy: …on a controlled and regulated supply of methadone which

enables them to enjoy their lives and their physical health, relationships,

their jobs and so forth. I find that quite acceptable that they may need to

take another drug for a very long period of time.

MacAvoy's agency funded the Wayside Chapel Shepherd of the Streets Program, a

homeless youth project. As the Director/Trainer for this project, I introduced our

youthworkers to the relatively new and controversial concept of harm minimisation.

New and controversial because up until then recovery from addiction was primarily

abstinence and now the emphasis was not on abstinence but rather harm

minimisation, that is, reduced and safe usage of the substance. This was became a

more effective approach with young people on the streets of Kings Cross who found

it more enticing to reduce the drug taking, and become educated in safety measures,

than the thought of abstaining.

This was the most realistic approach, given the target group's circumstances, and

Australia's commitment to lowering the level of HIV/AIDS infection. As a result of

this harm minimisation/reduction campaign, Australia has become one of the global

forerunners in slowing the infection of AIDS (MacAvoy 1993, Wodak 1993 and

2000). The success of our program led to youthworker, Toola Andrianopoulos and

myself representing the Wayside Chapel at the PRIDE Drug Youth Conference in

Ohio in 1993 which was attended by approximately 10,000 people (mostly youth)

from all over the world. The focus of the conference was an abstinence policy of

‘saying no to drugs’, yet our presentation promoting ‘harm minimisation usage with

homeless young people’ was well received.

Initially the AA program was part of most detox unit programs but once the harm

minimisation policy (NDS) was adopted by the Health Department in 1985 (Wodak

2000) it was primarily replaced with brief interventions or solution focus therapy

(Stewart interview 1993) and people were just encouraged to go to AA meetings

outside (MacAvoy, Heather interviews 1963). The rationale was that AA is a

voluntary organisation and should not be government funded, as was the case when a

meeting was organised in detox units by staff. This meant that costs were cut and


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outcome evaluation changed. However, certain staff misinterpreted the intention to

mean that the AA program was ineffective and had no part in the harm minimisation

policy, as was expressed to me by the director of a migrant education centre and

other professionals working in government funded services. This attitude contributed

to my wanting to embark on this research project, as I could not believe that such an

attitude was supported by the Health Department. This was further confirmed when

speaking to MacAvoy, the Director of the Drug and Alcohol Directorate, who said

that the problem with the abstinence program was that AA would not tolerate harm

minimisation such as the methadone program and that is an important element of

recovery for some. Whereas when AA was a part of a detox program in most cases

the detox was drug free and totally abstinent. MacAvoy in his interview confirmed

that AA was available in the community and therefore a person could choose to

attend. The funding encouraged detox units to use harm minimisation methods. This

change, MacAvoy felt, was due to the belief that a harm reduction approach allows

different methods to be used to “assist people to manage their life better” whereas

previously the 12 Steps program approach used was effective but involved long

residential periods which proved to be costly and hard to justify.

MacAvoy: What we have said however is that the style of managing a 12

Steps program which normally and previously involved the residential

placement of people for long periods of time, upwards of three months

and longer, is extremely hard to justify and that such programs can just

as effectively be carried out on an outpatient basis although admittedly

after sometimes a short in-stay period. So the way the program has been

delivered in the past has been changed as a result of understanding the

efficacy of that treatment approach.

One of the obvious benefits of the harm minimisation policy is that more people

were perceived to have successful outcomes. That is to say, a person could be on

methadone who otherwise would fail an abstinence detox. In the case of Langton

Centre (1993) which moved from an abstinence and the 12 Steps model to solution

focus and narrative therapy, the role of staff then was to facilitate a client’s personal

resources to minimise the harm of the impaired control in order to live a lifestyle

where they were more in control of their choices. In my interview with her, Stewart

in 1993 who was the team leader of Langton Centre describes their model and how

they have in increase in outpatient participation.

Stewart: We’ve had a huge increase in outpatient participation, off the top

of my head I think 300 inpatients are being serviced, so people will want


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to come back as outpatients. The evaluation is ongoing so we really don’t

know statistically how it’s going to turn out. From perceptions we have,

intuition, we’re feeling all very positive about it, there’s a very good

atmosphere this model generates within the team. I suspect even if the

outcome isn’t that good we’ll say there’s no failure there’s feedback.

Along with brief therapy, solution focus is another cognitive behavioural therapy.

Supplying the community with clean syringes on demand and free of charge also

ensured that the spread of HIV (Human Immune Deficiency Virus) and HCV

(Hepatitis C Virus) infection was significantly reduced as confirmed by Wodak.

The harm minimisation policy had also affected a proposed change in service

provision. In 2000 a shared care review conducted by School of Community

Medicine UNSW Sydney encouraged home detox and treatment maintenance for

illicit drug use supported by local general practitioners. However, in (August 2003) I

interviewed my local general practitioner, Ikegame, and psychiatrist, Cassimatis

(Evesham Private Clinic), who had not yet been approached by any government

authority to provide any type of shared care service which would enable home detox

and treatment maintenance. Nor had they heard of such a program prior to my

mentioning it.

6. Project MATCH (1993) from the Harm Minimisation Perspective

With studies showing that some treatment approaches were more effective than

others for patients with certain characteristics, the National Institute on Alcohol

Abuse and Alcoholism (NIAAA) initiated Project MATCH. This research, Project

MATCH (Matching Alcoholism Treatment to Client Heterogeneity), was designed to

build on earlier studies but with a large sample size of 1,726 throughout the United

States (Lucas CSAC, CADAC April 1999), it was far more ambitious. The goal of

Project MATCH was to learn whether different types of alcoholics respond

selectively to particular treatments. Project MATCH was not as successful as

anticipated. Commenting about the research, NIAA Director Enoch Gordis, MD said

that, "The major finding from Project MATCH—that matching patients to treatments

added little benefit to treatment results—was a surprise to clinical investigators and

to service providers alike. However, it certainly is not the first time that reasonable

hypotheses, when rigorously investigated in a large population, failed to yield an

expected result." (Lucas 1999). The Project MATCH patients probably did well

because the treatments were of high quality and well delivered, according to Thomas

F. Babor, Ph.D., Department of Psychiatry, University of Connecticut Health Center


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and principal investigator for the Project MATCH Coordinating Center: "The

striking differences in drinking from pretreatment levels to all followup points

suggest that participation in any of the MATCH treatments would be associated with

marked positive change." Gerard Connors, Ph.D., chairperson of the Project MATCH

Steering Committee and principal investigator at the Research Institute on

Addictions in Buffalo, New York, noted that today's findings do not rule out the

possibility that other patient-treatment matching effects may be clinically important.

"The MATCH data do not speak at all to matching patients types to different

treatment settings, therapists, psychotherapies other than those studied, or

pharmacological treatments," he said. "A logical next step for alcoholism treatment

research is to test our quite excellent behavioral treatments in conjunction with

promising pharmacological treatments for alcoholism," said Richard K. Fuller, M.D.,

Director of NIAAA's Division of Clinical and Prevention Research, which oversaw

Project MATCH (1996).

Heather (1999 Addiction 1999, 94(1), p36) agreed that Project MATCH has shown

the failure of treatment matching, of the kind studied, to substantially improve the

overall effectiveness of treatment for alcohol problems. His comments showed what

he thought may have helped the research:

Among MATCH researchers a favoured explanation for the lack of matching is that the theories available to be tested were too simplistic. MATCH generally tried to match treatments to uni-dimensional, standard client attributes, but real-world therapists make multi-dimensional assessments combining objective and intuited client attributes. Multidimensional (or ‘thick’) matching might have proved more effective. (ibid:3)

Glaser (1999:94:34) had a more positive perspective seeing Project MATCH like the

Titanic i.e. although it sank taking several lives with it there was a beginning of

bigger and better things to come in the nautical history of seaworthiness. The editor

of Addictions (1999, 94(1), 31-36), in the conclusion stated that although Project

MATCH is not considered the treatment success as previously believed the matches

found are, however, reasonable considerations for clinicians to use as starting points

in planning treatments.

The three approaches used in Project MATCH (CBT, MET and TSF) are in fact

useful in the work of AOD recovery, as documented in the work of Jarvis, Tebbutt

and Mattick (2001), and Miller and Rollnick (2002).


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7. Cognitive Behavioural Therapies (CBT) In Alcohol & Other Drugs (AOD)

Field

As the name implies this is the process of the person’s perception (thought) of an

event and their performance (behaviour) as a result of that understanding. A major

goal of this theory is to change the way one thinks about the world and where one fits

into it. Because people generate ideas and thoughts about the world to explain

themselves and reality, they can have what is called ‘faulty thinking’ or ‘irrational

ideas’, which may lead to counter-productive behaviours (TAFE Learner Resource

2000:20).

The cognitive behavioural (CBT) therapist assists clients to eliminate self-defeating

thinking and develop a more rational and tolerant view of self and others. The client

can be assisted in examining their thinking patterns and reframing these into a new

way of thinking. This is called ‘cognitive restructuring’ (Jarvis, Tebbutt, and

Mattick 2001) which means assisting the person to turn around negative self talk

into positive self talk and also being able to catch themselves when they revert to

‘faulty thinking’. In the AOD field the main cognitive behavioural therapies involve:

• Early intervention (questioning and clear advice about what is excessive use and medical examinations and treatments)

• Brief intervention techniques (controlled use or behavioural self management program as created with client)

• Applications in assessment process and case management (Stages of Change)

• Motivational Interviewing

• Applications in relapse prevention

Examples of CBT exercises and techniques are:-

• Making a decisional balance sheet (pros, cons about usage and giving up)

• Keeping a daily diary of the amount of alcohol consumed and circumstances when it was increased or reduced.

• Setting limits on the days and amount consumed.

• Keeping a thought monitoring sheet to reframe negative thinking to positive thinking.

• Keeping a diary that lists positive things about a person in someone’s life.

Such exercises are aimed at changing a person’s perspective and enabling more

control of what happens in their life.

Some other CBT models are Solution Focus, Social Learning, Rational Emotive

Behaviour Therapy (REBT), Brief Therapy, Neurolinguistic Programming Therapy


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(NLP) and Transactional Analysis (TA). In the next chapter I will elaborate on these

approaches which I have experienced as successful for those who have been affected

by excessive drinking/use and who either were not prepared to abstain with AA or

who chose controlled drinking/usage as an option.

8. Motivational Interviewing (MI)

This model, formerly from Motivational Enhancement Therapy MET (Miller W.R. &

Rollnick S., 2002) as seen in Project MATCH 1993, is facilitated by assessing where

the person is in the six Stages of Change:-

1. Precontemplative

2. Contemplative

3. Determination

4. Action

5. Implementation

6. Maintenance

7. Relapse

Through this process the facilitator maintains a positive position and ensures that the

interviewing aims at empowering the client to identify the changes they wish to make

and how they will go about it. The facilitator can provide information when the client

is ready to receive it and can assist in planning suitable tasks together with the client.

The client needs to feel in control of the interview process. Some of the techniques

used are:

• asking what are “good things and less good things” (about using)

• exploring concerns

• giving information (when client is ready to receive this)

This method is not as confronting as some methods used with the 12 Steps method

and more directive than the traditional non-directive counselling methods

demonstrated by the Rogers (1951) and Egan (1982) schools of thought. It is

essential that the person feels in control of the process and makes the decisions about

what is to take place. The counsellor on the other hand needs to have a repertoire of

information, exercises and techniques for when the client is ready to avail themselves

of these. Timing, in presenting these options, is vital.


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9. Medically Supervised Injecting Centres and the Netherlands Approach

What needs to be addressed, under harm minimisation, is also the usefulness of the

medically supervised injecting centres as can be seen in Kings Cross, Berne and

Amsterdam to name a few places. These centres are not about providing state-of-the-

arts premises for people to come and inject drugs but rather a decent place for people

who would otherwise inject on the streets and cause risk to themselves and the

public.

9.1 The Low Threshold Centre, Berne Switzerland (2000) - Marxer, Manager, stated

that the intention and outcome of the Centre had not been to provide an attraction for

increased usage but rather an improvement in the living conditions of people who

injected in the streets. This was in the hope that these people experiencing such an

improvement would wish to take it a step further and enter recovery programs.

Marxer confirmed that the Centre did not create an increase in usage from the

community at large but rather, as anticipated, from street people.

9.2 Medically Supervised Injecting Centre (MSIC) Kings Cross. In August 2003 I

attended two public meetings in Kings Cross about the Medically Supervised

Injecting Centre (MSIC) situated in Darlinghurst Road, Kings Cross. The Kings

Cross Chamber of Commerce had convened these two meeting because their

interpretation of the report produced by MSIC showed that it had not been a success.

On the other hand, the medical director and several residents present (including

myself as a resident) contradicted that interpretation, maintaining that lives had been

saved and people injecting and overdosing in the streets were not as frequent as had

been in the past. I also interviewed a local general practitioner, Ikegame, and other

residents who confirmed that since the MSIC there were fewer overdoses and people

injecting in back lanes and stairwells. The Premier, Carr, also announced that MSIC

was being given a further four year trial period to continue their work and the

funding was available through confiscated drug monies.

9.3 The Netherlands Approach - Amsterdam Drug Programs. In Amsterdam in 2000

when I spoke with the Manager of the Jellinek Prevention Team, I found out that

their approach is multi pronged. There is an education program for schools where

children are informed about the dangers of drug taking (this includes alcohol and

nicotine). Then there is an acceptance of the right for people to use recreational drugs


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and legislation enables the use of and growth of marijuana. People can smoke pot in

certain cafes, however, the onus is on the proprietor that they are not permitted to

purchase or sell this on the premises and should this take place the café is shut down.

This can happen three times after which the café is permanently shut down, so it is

within the owner's interests that the café is purely a place for a person to smoke pot

socially but not do business with it. People using designer drugs such as ecstasy have

the opportunity to have their drugs tested at a voluntary program. Doing this

ascertains the purity, and death can be avoided from impure drugs. Even so their

statistics of deaths from ecstasy were much higher than ours in Sydney in 2000. One

reason being that recently ecstasy users have found that by drinking water when

using ecstasy, death from dehydration, the main cause, can be avoided. Then, of

course, there are safe injecting and rehabilitation programs for those who have full-

blown addiction and need professional care. He also said that heroin injecting was

considered to be an old person's drug and so the demand is minimal, with most

young people going for designer/recreational drugs.

10. Wodak Paper – What Does Australia Do About Illicit Drugs?

Although Amsterdam and Berne seem to have a more workable model it does not

mean that Stockholm has not. According to community attitude in Sweden, although

theirs is more suitable for them, their model is being hampered due to the change in

funding and resources provided by the government. This is much like Australia

where we have committed to a harm minimisation model and yet the government has

not been forthcoming with the funds required which means that what we are doing is

being obstructed (Wodak, a presenter at the Australis2000 Humanist Congress and

one of the original protagonists in The Debate). So whichever model is used, it needs

to be fully supported by the community and the government and resourced well in

order for it to be effective. Nevertheless, the method needs to be progressive. Again

this is information I include in my talks.

Wodak (from St. Vincent’s Hospital Drug & Alcohol Department and a protagonist

in The D&A Debate presented a paper at the Australis2000 International Humanist

Congress held in Sydney), was on the Addictions panel consisting of Jurd,

Cassimatis, Dowling, Ellis-Jones and myself. Wodak is also Australia’s

spokesperson for harm minimisation. From an audiotape of his presentation, and a


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printed summary provided by Wodak, here are some of the important points he

made.

The commonwealth and state governments officially adopted harm minimisation on

2nd April 1985. Harm minimisation strategies encompassed supply reduction,

demand reduction and harm reduction. Harm reduction refers to programs aimed at

primarily reducing the adverse health, social and economic consequences of mood

altering drugs rather than on reduction of drug use. Australia has reconfirmed its

commitment to harm reduction several times since 1985. Although since 1997 the

Australian government adopted a ‘Tough on Drugs’ policy (1997), funding for

needle syringe programs has increased and there is more emphasis on programs

aimed at diverting drug users away from criminal justice to drug treatment instead.

Wodak used Switzerland as an example for treating the drug problem in a nation. He

pointed out that Switzerland had experienced out of control HIV infection among

injecting drug users, resulting in drug overdose deaths climbing steeply. The

increased expenditure on prevention, treatment and harm reduction made it possible

for the health and social interventions to equal expenditure on law enforcement. This

resulted in HIV deaths falling from 419 in 1992 to 209 in 1998 and 181 in 1999.

Wodak made the following convincing statement about Switzerland’s progress:

Crime is falling, HIV infection is under control, city centres are no longer controlled by drug traffickers, and the number of drug injectors is falling (Australis2000 Congress 2000)

When speaking about the Netherlands, Wodak added another positive perspective

about harm reduction in saying that in a population of 14 million there have been

about 60 drug overdose deaths a year, and HIV infection among injecting drug users

is back under control. I remember my interview with the Jellinek Prevention Centre

manager who told me about a government funded voluntary program that enables

recreation drug users to have their drugs tested for purity, and Dowling who claimed

that it was the impurity of drugs that kills.

Wodak then spoke of the negative outcomes of the zero tolerance worldview of

Sweden and the USA. Sweden has high and increasing deaths due to overdose (250

deaths out of a population of 8 million) and drug use in that country is on the

increase (2000). The USA has a high and increasing number of deaths due to

overdose (15,000 out of 289 million population) with HIV infection among injecting


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drug users spreading. Government spending in the USA for zero tolerance programs

is seen as not effective and there is a mainstream opposition to the war on drugs now

(2000).

He showed with these statistics that countries with progressive drug laws are

achieving better outcomes whereas those committed to a war against drugs are

suffering terrible outcomes.

For Australia, there is a strong recommendation which we cannot afford to ignore:

Wodak: policy based on punishment has been an expensive and

resounding failure. Australia has rapidly increasing deaths,

disease, crime, corruption and drug use

He strongly points out that we need to accept that:

• We can only marginally reduce demand

• We can only marginally reduce supply

• Intensification of supply reduction redistributes illicit drugs: geographic, demographic and pharmacological

• While there is demand there will always be a supply - legal or otherwise

• Illicit drugs are primarily a health and social issue rather than a law enforcement issue

• Cannabis distributed by criminals and corrupt police is even worse than cannabis controlled by taxation and regulation

Accordingly we should:

• Increase funding for health and social interventions to the level of law enforcement

• Adopt evidence based strategies

• Adopt an outcomes approach

• Need research to be able to compare medical prescription of heroin and amphetamine with availability through criminals

This confirms that deaths, disease, crime and corruption could be reduced

substantially when we accept that illicit drugs are primarily a health and social issue.

Statistical evidence of the state of Australia’s mood altering drugs situation is:

alcohol $13 billion; illicit drugs $7 billion (cannabis $5 billion); tobacco $6 billion;

pharmaceutical drugs $4 billion.


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Important points to consider are:

• Cannabis cultivation and consumption illegal in all jurisdictions 1. No reported deaths from cannabis 2. Cannabis not harmless but morbidity is dwarfed by alcohol and tobacco 3. Substantial demand met entirely by criminals and corrupt police 4. Reputable bodies now accept a small role for medicinal use of cannabis 5. Demand from treatment agencies for help stopping cannabis growing

• Amphetamine use increasing worldwide and in Australia 1. Heroin users often started with amphetamine 2. Little demand for treatment from amphetamine users 3. Limited success with non-pharmacological treatment 4. Prescription dexamphetamine used to treat amphetamine dependence in

UK for decades but limited research evaluation

In conclusion Wodak reminds us of how communities can best respond to illicit drug

problems.

Recognising that:

• Illicit drugs are an important issue

• Australia’s main response to illicit drugs has been law enforcement

• Australia prohibited cannabis and heroin because of international pressure and without careful review

• The success of harm reduction in controlling HIV infection among injecting drug users

• Australia’s drug policy has been an expensive resounding failure with increasing deaths, disease, crime, corruption and drug use

• Countries with modern approaches, such as Switzerland and the Netherlands, are getting better results

• Countries waging a war on drugs, such as the US and Sweden, are getting terrible results

• Australia could get better results by redefining illicit drugs as primarily a health and social issue

• Unless we undermine the profitability of the criminal supply system we will never make progress

• Where there is a demand for drugs, there will always be a supply

His closing remark was “What would happen if it were not a crime to use drugs?”

and he answered this by pointing out that perhaps “Decriminalisation is a better

option as can be seen by historical events when prohibition has been lifted” and as

can be seen in the case of the Netherlands.

In looking at the Medical Journal of Australia website in 2003, the most recent

statistics were still these quoted by Wodak in 2000. So, I believe, that Wodak is

saying for Australia to progress in our fight against drugs we need to become

progressive with our legislation and aim at decriminalisation where addicts are not

penalised for using drugs but rather the dealers, the suppliers, the criminals, are


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punished. Then more funding would be made available by government for

prevention and recovery programs rather than being wasted on imprisoning victims.

Australia would then keep its place as a leader in global harm

minimisation/reduction.

11. Dowling Paper – Illegal Drug Laws

Dowling, retired Humanist physicist ex Adelaide University, another of the members

of the Addictions Panel at the international Australis2000 Humanist Congress

presented a perspective aimed at demystifying drugs. He also supplied this

information in writing which I am using here.

Dowling has been so outspoken that he says that he often cannot have his

contributions published. He believes that drug prohibition causes the growth of the

mafia, house breaking, violence, fraud, police corruption, that is, real crime (S.A.

Humanist Post August 1994:6). “But what about the dangers of having narcotics

available freely on the market?” he asks. In answering, as physicist, what he has to

say is notable. Marihuana and heroin, if pure, are safer than alcohol because 98% of

drug deaths in Australia are due to alcohol and tobacco. He justified this statement

with the following evidence in his own words:

In 1980 (the year of the Justice E.S. Williams Royal Commission on Drugs) the Federal Department of Health figures on death due to drugs were: Narcotics 90, barbiturates 280, alcohol 3600, alcohol related 1829, road alcohol 3478, (total alcohol 8907), tobacco 16,200. Similar figures have occurred every year since. Even in the drug ravaged USA in 1985 in the deaths due to alcohol/tobacco were 400,000 relative to only 3562 due to ALL the illegal drugs COMBINED.

I have mentioned earlier that Dowling reminds us that everything can be toxic in

sufficient quantities. For example death can result from drinking 14 litres of pure

water, 10 grams of caffeine, or eating 4lbs of sugar. Addiction rates have been

grossly exaggerated for personal benefit as in the case of Vietnam War veterans who

wanted to claim disability pensions for becoming addicted whilst on service.

Dowling claimed that only 1% remained addicted when they returned. Furthermore,

he maintains that “the addiction rate for social alcohol drinkers is 10% with another

5% at risk.”

When considering withdrawal it is useful to remember that heroin withdrawal takes

48 hours and is like a bad cold, making it the easiest to treat. For alcohol it takes 6-7


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days to withdraw with convulsions and seizures, toxic psychosis resulting in

hallucinations (“pink elephants”) or worse – persecutory delusions, cardio-vascular

impairment, D.T.’s (delirium tremors) and death. The hardest to treat is withdrawal

from benzodiazepines (valium, serepax, mogadon, euphnos and so on) because these

are very addictive (44% on the normal therapeutic dose after 4 weeks), brain damage

is similar to that of alcohol abuse, and depression is a side effect, even though they

can be prescribed for people with pre existing depression. Dowling claims that the

Federal Department of Health do not warn the public about benzodiazepines because

it is not politically convenient to do so.

Dowling also draws attention to overdoses, which is another area to consider. As a

result of heroin, when pure, there is a relatively slow death (12 hours or more) by

respiratory depression but recovery can be prompt (within one minute) with antidotes

such as nalorphine or naloxone. He maintains that “most heroin deaths are due to the

unknown concentration and/or the junk impurities, which lead to blood clots or

pulmonary oedema, not the heroin itself”. For overdose with alcohol, a stomach

pump is used.

When considering the destruction of body/brain cells, Dowling advised that for

heroin, if pure, there is none; but for alcohol, as is well documented, there is serious

damage to the nervous system, heart, brain, liver, circulation, kidneys, foetus and

more. He also claimed that behaviour changes in heroin and marihuana users tend

towards passive and peaceful behaviour, whereas with alcohol excess behaviours are

more likely to be boorish and aggressive. Then again, I wonder, how do we justify

the term “happy drunk” for some who have been drinking too much. An example, of

how the risks Dowling highlights can be avoided, is that in Amsterdam there is a

government funded service which enables people using drugs to have them tested for

impurities so that they are safe for use.

Dowling strongly states that there are myths about the danger of drugs which harm

the population by not providing people with accurate information for informed

decisions. In this way politicians make policy by keeping the community in the dark.

He has been quite outspoken on this topic but quite often thwarted in his efforts by

the media.


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I have shown Wodak and Dowling’s perspectives here because many scientists see

drugs to be harmful only due to the illegal status of drugs such as heroin and

cannabis, and people lacking in education about appropriate usage. Harm

minimisation is a workable perspective as can be seen in this chapter. The cognitive

behavioural therapies trend in dealing with excessive drinking and other drug usage

appear to have better results with the part of the community that will not consider

abstinence as an option. As relapse is part and parcel of the Stages of Change, and is

not considered a failure, it is not considered so hopeless to relapse as appears to be

for those in the abstinence recovery program. So recovery statistics in harm

minimisation programs show a better picture than can those of abstinence and the 12

Steps programs, and overall appear easier to achieve. In other words, a person can

leave a detox unit having achieved a commitment to a reduced usage program and it

is considered successful.

Committing to a controlled narcotics usage with clean syringes is considered to be a

success. Another success is lowering HIV/AIDS infection through the free

distribution of clean syringes program. So with the CD/harm minimisation policy,

statistics appear positive for those trying to lower their usage in government funded

programs.

This approach can be successful to those in the community who will not consider an

abstinence approach, providing it is an educated decision. Furthermore that need not

be to the exclusion of abstinence, if required, through CBT such as Motivational

Interviewing which can lead to a decision to abstain, and through the spiritual 12

Steps model or the secular SMART Recovery program (CBT).

12. Reflection

When looking at the case for controlled drinking/use there is, from those in that

worldview, a strong emphasis against any notion of abstinence, perhaps showing

disdain as though it is a temperance or prohibition stance which is considered quite

outdated or counterproductive. Nevertheless there are many parts of the community

which do enjoy such an abstinent lifestyle quite effectively. Also there are those in

the community who are quite productive and have a fulfilling lifestyle whilst using

drugs socially, this does not include smoking as it has been scientifically proven to


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be harmful to health at any level of use (MacAvoy 1993). However, programs in the

community do not encourage abstinence unless the individual specifically requests it.

13. Summary

It can be seen in this chapter that there are behaviourists and scientists from this

worldview who find controlled drinking/use an effective strategy for harm

minimisation/reduction. They believe that persons who have used drugs to excess,

can reduce the harm to themselves and to the community and live improved lifestyles

(Heather, MacAvoy, Mant interviews 1993). In doing so, a more positive outcome

can be documented in detox units/rehabilitation programs than that of persons who

attempt to get recovery through abstinence and the 12 Steps model in a government

funded organisation. The abstinence and 12 Steps method is considered harder to

achieve and relapse occurs more often making a higher rate of recidivism (Lennane,

Jurd, Campbell, Cassimatis interview 1993). However, behaviourists do agree that

those persons seriously afflicted need to resort to recovery through abstinence and

the 12 Steps model or SMART Recovery. This is unless they are so badly affected

that any reduction in drinking/use, no matter how slight, would be an improvement

for them, and unless they are determined not to use an abstinence approach.

In the next chapter the case for synthesis – a diversity of approaches is explored.

There is always a place for diversity of treatments which are relevant to the different

needs of people and their type of dependencies.

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CHAPTER 6

SYNTHESIS: TREATMENT MATCHING – A DIVERSITY OF APPROACHES

…you start with the person’s experience and you work with the person to find the door and walk through it to experience life.(Russell interview 1994)

When I named this chapter synthesis, it was to indicate an integration of treatments

and self help processes or the availability of a diversity of approaches that persons

can choose from for their own recovery and personal enlightenment, according to

their own needs. This is instead of the conflict that The D&A Debate created which I

named in earlier chapters as the thesis for abstinence and AA 12 Step program, and

the antithesis for controlled drinking(CD)/use (CD/Harm Minimisation).

So now that I have come to the end of the research process my question presents

itself once more - what rationale did the professionals in the Alcohol and Other Drug

recovery field have for maintaining their oppositional stance to each other’s models

at cost to the community? Although initially it was not my intention to prove what

works and what does not in recovery from addiction, my findings about compulsions,

addictions, dependencies, and obsessive compulsive behaviours unfolded explaining

why the leaders in the recovery field and the protagonists in The D&A Debate were

in conflict and why each maintained their stance. In this chapter I highlight these

different approaches which form the diversity of approaches I have come to believe

are important to the compulsions and recovery field.

During the past ten years, speaking to over 80 people, protagonists in the D&A

Debate and those concerned in this area of focus, I have come to believe that there is

a vital need for treatment matching and therefore an awareness about the

stages/levels/severity of compulsions/addictions/dependencies (Chegwidden 1968,

Blake & Stephens 1987, Affie 1998, Edwards and Gross 1976 in Jarvis, Tebbutt &

Mattick 2001). The treatment matching I am referring to is related to these stages or

severity of dependencies, sometimes known as stepped care “which is an alternative

approach that has gained currency in the smoking field but is relatively new to the

alcohol field” (Drummond, 1999). In other words, synthesis involves matching the

treatment approach to the severity of the condition and offering a choice for the

afflicted person to make an educated decision, as opposed to an attempt at matching

Chapter 6: Synthesis: Treatment Matching – A Diversity in Approaches

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the condition to a treatment. Another perspective on this approach was made by

Stewart, head of the Langton Centre recovery unit and replacement for Gehlhaar

who was forced to resign as a result of the harm minimisation (Appendix A).

Stewart:…if we were going to start supporting the idea of treatment

matching which meant that clients would find the program that best fit

for them to help them change or deal with their problems then we needed

to offer a variety of programs…for the clients to have more consumer

choice and certainly treatment matching is seen in the literature as being

very, very valuable that we look at our clients and we ask them what is

going to fit for them.

As can be seen throughout this thesis, protagonists from both sides of The Debate

have at some stage supported the concept that individuals may need a different

approach to the one espoused by the protagonists in question. In this chapter I show

how a synthesis, or diversity of approaches, can be offered. As indicated in their

interviews with me Bishop, Campbell, Cassimatis, Heather, Jurd, Lennane,

MacAvoy, Maclaine, Mant, Mellody, and Stewart (1993) – supported a synthesis

of approaches in one way or another even when it meant the opposite to their

modality.

For example, 12 Step supporters strongly believe that there is a ‘duty of care’ to

challenge the denial of an afflicted person so as to ‘bring the bottom up’ (Addiction

Love to Know Intervention 2007) in order that they can realise how life threatening

their addiction is. Yet the protagonists of The Debate who are committed to the 12

Step model have admitted to me, in their interviews (1993), that sometimes

controlled drinking/use or another treatment approach is appropriate. Such people are

those who can control their drinking/using (Jurd interview 1993) or those who are

aware of their genetic predisposition and knowing this can be “very careful about

using alcohol” (Lennane interview 1993). Furthermore, it is important to establish

the level of involvement in the drug/process causing the problem because “there is a

very clear distinction to be made between people who are compulsively or

obsessively involved in drinking or drug abuse and those who are not so involved”,

in other words ‘the intensity’ (Maclaine interview 1993). Not everyone will take

advantage of what is offered to them, as Bishop (interview 1993) said “it’s not

something that fits for everyone”. Another perspective was that of Mellody (Pia)

(interview 1993) who spoke of becoming free of compulsive behaviour by using

treatments outside the 12 Step approach, explaining that when a person explores how


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they were traumatised as a child this helps them to do “detoxification work from

their original trauma” and the addictive behaviour as a result of this “goes into

resolution” and “they no longer feel compelled to keep acting out that way”.

From the other side of the continuum, supporters of CD/Harm Minimisation believe

that 12 Step model is for a small portion of the community who are willing to

undertake that approach to recovery. These protagonists maintain that there should

be an approach that can suit the majority who are prepared to deal with their

problems of excess through behaviour modification because it is not a medical

condition. Nevertheless, these protagonists have admitted to me in their interviews

(1993) that they are not against abstinence and AA 12 Step model but rather that this

program is available in the community, as required. As confirmed by the statement

made by MacAvoy (interview 1993), who was adviser to the Health Minister on the

implementation of the Harm Minimisation Policy (National Drug Strategy 1985) “we

have to accept that there are other points of view and other approaches – no one

would deny a person of 35 years sobriety if that is what keeps him sane, if that is

what keeps his life in order so that he can get some enjoyment out of it and those

around him, then who would deny him access to AA?” This example was in response

to my question about a man of 35 years sobriety asking about controlled drinking.

Mant, general practitioner and Harm Minimisation supporter, admitted she was

aware as a doctor, that there was a small group of people “for whom the disease

model has been a lifesaver”. Heather, Director of NDARC (1993) whose research

was one of the major influences on the introduction of the Harm Minimisation Policy

(NDS 1985), said “It’s not a question of being opposed to abstinence, you must

understand, I think this is a misunderstanding that many people have. It’s more a

question of the role that moderation or controlled drinking can play in the range of

services”. Again these statements were made in the interviews with me in 1993, and

Heather wanted to be advised whenever this misunderstanding was being attributed

to him.

Then when noting the worldview of those who are supporters of the diversity of

approaches, the conflict of The D&A Debate is made clearer. Campbell, psychiatrist

and Director of Clinical Services at Rozelle Hospital (1993), stated that there are

“competing therapies where no one therapy is clearly superior, so you get these

competing therapies and then schisms in the ranks” adding that because practitioners


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argue that their way is the true way “no-one can be proved wrong”. Cassimatis

psychiatrist with Evesham Clinic, explained that from time to time there is “a new

idea that appears – whether it’s psychotherapeutic or whether it’s another type of self

help group or whether it’s drugs or a behaviour modification program” which is as a

result of people searching for a solution to the problem of addiction.

These quotes from the previously mentioned interviewees emphasise the importance

of the availability of diversity of approaches for people to choose from, making it

more workable for them. This also means that such a choice will take into

consideration the level (severity) of dependence each person perceives themselves to

be at, making it more effective for treatment matching. Consequently, the interviews

admitted that regardless of their own approach, others are needed.

1. Project MATCH from the Synthesis Perspective

Project MATCH (1993) explored treatment matching, and the target group

comprised those who wanted abstinence (Heather 1999). The outcome of Project

MATCH showed that Twelve Step Facilitation (TSF), Cognitive Behavioural

Therapies (CBT) and Motivational Enhancement Therapy (MET) which spawned

Motivational Interviewing (MI) were ‘state of the art behavioural treatments’ (Gordis

NIAAA 1996) and the outcomes showed they were close in as far as their efficacy

although those who were using the TSF approach and attending 12 Steps meetings

were found to still be abstinent in the one year follow-up (ibid). Nevertheless, this

research scientifically documented these three approaches, one of which had never

been researched previously – 12 Steps as part of the TSF model. Chick (2001)

provided an information update on treatment matching, stating that the “US

government study, Project MATCH (1993) randomly allocated patients to either

cognitive behaviour therapy, motivational enhancement therapy, or TSF, the latter

instructed patients in the tenets of AA and assisted and encouraged them to attend

AA 12 Step meetings.” (ALCOSCOPE 2001)

When speaking with Jurd in 2000, he mentioned research showed that TSF is vital

to the recovery program and should not be omitted. As mentioned earlier it is

important to note that the Project MATCH involved those whose agenda was

abstinence only (Heather 1999), and not necessarily matching people with

treatments relevant to their stage of dependency nor including moderation use. Yet


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when considering treatment matching to mean giving the afflicted person the choice

of which treatment suits them, thereby having a better chance at the desired outcome,

then it is a valuable recovery approach.

Since The D&A Debate in the late 1980s there has been a more accepted synthesis of

approaches for recovery as can be seen from the prescribed text book (Jarvis, Tebbutt

and Mattick 2001) used in the Alcohol and Other Drugs (AOD) Interventions

Course taught at Loftus TAFE. When I designed an updated course in 2003 and

taught it part time for eighteen weeks, I used this book, other TAFE resource

materials, my experience and research findings. In the process I noted how important

it was when showing Cognitive Behavioural Therapies (CBT) as part of the course,

to also ensure the inclusion in the course of the role of 12 Steps model in recovery. In

looking at the various approaches to recovery it is possible to choose a combination

of some, or techniques of one in conjunction with those of another. However, it is

also important to consider the person and their stage of dependency and match the

recovery approach to suit (Chick on Project MATCH, 2000, Heather, Batey,

Saunders and Wodak1989:viii). For example, there is no point sending a person who

is experiencing heavy drinking to AA when they could use a CD method (CBT) and

they do not want to go to AA, as can be seen by the comments from Heather,

Wodak, Batey, Saunders et al in the NDARC report (1989). Likewise it is too risky

to send a person who considers themselves to be an alcoholic, and is drinking

uncontrollably, to a controlled drinking program instead of detox followed by AA

meetings (Jurd, Lennane, Maclaine interviews 1993).

Accurate assessment of drug and alcohol problems is essential. It is believed that

accurate matching of individuals to optimal treatment methods and goals could result

in an overall improvement in success rates. (Heather, Batey, Saunders and Wodak

1989)

2. Assessing Stages of Change in Dependencies

Recognising that addictive disorders exist on a continuum of change from 'denial' of

the need to change, to maintaining the change resulting from actions taken to alter

one's behaviour, is an important position from which to consider "a drug problem."

(Chapman, 84, 508-518, and 9, 185-188.) As confirmed by Chapman, accurately

identifying the stage of dependency and what would suit the person is vital to the


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successful outcome of the recovery approach used. As a result of my literature

review I came to realise that not much has been documented recently showing the

symptomatology of the stages of addiction in layperson terminology as identified by

Chegwidden 1968, Blake & Stephens 1987, Affie 1998. However, much has been

written over the past two decades about the Transtheoretical Model stages of change

(Prochaska, J.O., DiClemente 1986) and there is mention of the seven elements of the

dependence syndrome by Edwards and Gross (1976) in Jarvis, Tebbutt & Mattick

(2001:16), nevertheless, the latter is in jargon more easily understood by

professionals.

The seven elements of the dependence syndrome (Edwards and Gross 1976 in Jarvis

& Mattick 2001:16) are:

Narrowing of the behavioural repertoire: A person who is not dependent will vary

the amount and type of substance use, depending upon the situation. With increasing

dependence, the person will tend to consume or use the same amount each day.

Salience of drinking or drug use: With increasing dependence, the substance use will

be given greater priority in the person’s life, to the detriment of dietary, health,

financial and social factors.

Subjective awareness of compulsion: The person’s subjective experience of

dependence is characterised by a loss of control over the substance use, an irresistible

impulse to keep using the substance, an inability to stop using at certain times or

constant cravings when not using.

Increased tolerance: Heavy use leads to an adaptation to higher amounts of

substance. This is known as tolerance and is evident when amounts that previously

had mind-altering effects now produce fewer obvious effects. The dependent person

responds to tolerance by using larger amounts in order to achieve the desire effect.

Repeated withdrawal symptoms: As dependence increases, the frequency and

severity of withdrawal symptoms also increases. For alcohol users these may include

perspiration, tremor, anxiety, agitation, a rise in body temperature, hallucination,

disorientation and/or nausea; for opiate users they may include goosebumps


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(especially on the chest), perspiration, dilated pupils, runny nose or eyes, excessive

yawing, vomiting, diarrhoea or nausea, reported loss of appetite, sneezing, aching or

cramped muscles, heart pounding or high blood pressure, feelings of coldness,

problems in sleeping, stomach cramps, restlessness, and muscle spasm or twitching.

Withdrawal from psychostimulants, such as amphetamines and cocaine, can be

associated with depression. Benzodiazepine withdrawal may lead to anxiety reactions

and, infrequently, has been know to cause seizures. Withdrawal from other drugs is

not typically associated with physical reactions but may be associated with agitation,

mood swings or behavioural change.

Relief from or avoidance of withdrawal symptoms: The person seeks relief from

withdrawal symptoms through further substance use (e.g. morning drinking) or

maintains a steady level of substance use in order to avoid withdrawal.

Post-abstinence reinstatement: A return to substance use after a period of abstinence

will be characterized by a rapid return to the pre-abstinence level of substance use

and dependence symptomatology.

3. Motivational Interviewing & Stages of Change

For those who are practitioners in cognitive behavioural therapies and motivational

interviewing (Miller & Rollnick 2002) then it is important to be aware of the

Prochaska and DiClemente stages of change which have been conceptualised for a

variety of problem behaviours. The six stages of change as shown in the motivational

interviewing modality (Prochaska, DiClemente, (1992). 47, 1102-1114 in Jarvis,

Tebbutt & Mattick 2001, 7th ed.) are-

1. Precontemplative stage – Resistance and the four ‘Rs’…reluctance,

rebellion, resignation, and rationalisation

People in this stage may not see their behaviour as a problem and are not

even interested in changing but they may be open to being given information

about the dangerous levels of drug using. Usually others see their behaviour

as problematic. Considering the four ‘Rs’ can clarify their state.


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Reluctance: due to lack of knowledge or inertia there is no desire to

change

Rebellion: don’t like being told what to do and want to make their own

decisions

Resignation: they feel out of control, it is too late for them

Rationalisation: convinced it is not a problem and debates the facts

Pitfalls: Precontemplators may not be rationalising but rather making a life

choice and they have every right to do so even if it is life threatening. If it is

a well informed and conscious decision, it is their choice. Another pitfall is

to assume that the problem means the same to them as it does to us. Also

with precontemplators it is not useful to have high-intensity programs or

approaches.

2. Contemplation stage – A Risk-Reward Analysis

Clients are open to information and decisional balance considerations.

However, they are usually wanting something that will compel them to

change – the magic answer. They are hoping for the problem to be fixed for

them. Using CBT and Motivational Interviewing can be helpful.

Pitfalls: Contemplators can be faced with chronic ambivalence making it

frustrating. Confusion of this stage with commitment, which it is not.

3. Determination (Preparation) stage: Commitment to Action

Persons in this stage make a commitment to a plan of action. This is a calm

dedication to the plan. There is also a willingness to heed warnings on

pitfalls and to develop good coping skills. This is when a decision as to

abstinence of controlled usage is important for the action plan.

Pitfalls: There still can be ambivalence interfering with the process. An

adamant stance can also undermine progress.

4. Action stage: Implementing the Plan

People in the action stage often have the plan and need to use therapy as a

public commitment to action; to get external confirmation and reinforcement

for the purpose of external monitors of their activity. This enhances self-


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efficacy and provides support. If abstinence is chosen then AA or NA 12

Step meetings is advisable.

Pitfalls: Action people may only use therapy to monitor their process and not

to strengthen their learning process. A tendency to create a ‘guru’ reputation

of their therapists. Some therapists who need to be needed may experience

problems with action people not needing them further.

5. Maintenance & Relapse Prevention stage

To reach this stage can involve years of long-term sustained change which

becomes firmly established. The risk of relapse becomes less frequent and

intense. If abstinence is chosen then AA or NA 12 Step meetings is advisable.

Relapse prevention needs to be considered at every stage.

Pitfalls: Over-confidence in the new patterns of behaviour. Testing temptation.

Persons in this stage experience an overwhelming, unexpected urge or

temptation which they fail to cope with successfully and causes a weakened

self-efficacy.

6. Termination stage

This is when the person is confident that their changed lifestyle is secure and

they are confident that they will not relapse.

4. Stages of Compulsion & Treatments (Adagio 2007)

In running several Halfway Houses (MARS and SCOPE) for people recovering from

addictions and from my training I noticed that people afflicted with impaired control

could be set on a continuum, similar to that written about in the book Compulsion,

and exhibit certain stages of addiction as mentioned by Chegwidden (1968) and by

Jarvis, Tebbutt and Mattick (2001:16).

Below are the stages and treatment approaches as I have come to know them best,

and in my choice of words. I believe these stages are identified in a way more easily

understood. I show the Habit Stage and three stages of addiction.


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Habit Stage “it’s just harmless fun!”

harmless habit/ritual that is so enjoyable – ‘the high’

threat of disappointment without it

the search for that buzz which is missing - that instant 'fix'

anxiety of having to give up a fun social activity – ‘chasing the high’

striving to relieve stress, numbing of pain,

mild impaired control,

apologetically boasting and joking about this state

At this stage quite often people do not want to cease the activity, as they see no harm

in it and in many cases, there is minimum harm to themselves and to those near to

them in their private lives and at work. These are social alcoholics who maintain

their jobs and ability to produce whilst being heavy drinkers doing some damage to

their health. They also manage to have a reasonable lifestyle. Of course, if they can

maintain that level of use, it is mild impaired control, and this stage is not seen to be

a true stage of addiction but it can be the catalyst. However, what is not easily

apparent is that they are killing themselves. For example, cigarette smoking is not

only a health hazard but also a killer and yet people have been brainwashed by the

tobacco companies (advertisements) into considering it a cool recreational drug.

Alcohol in small regular doses is considered healthy but our socialisation promotes

heavy drinking as depicted by Lennane in her book (1992). “Alcohol advertising

helps to foster the image of drinking being not only respectable, but highly desirable”

(ibid:47).

Furthermore, community education is required such as is taking place with the signs

on packets of cigarettes i.e. SMOKING IS A HEALTH HAZARD or SMOKING

KILLS. Legislation for a change in the formula of cigarettes is vital because tobacco

companies use addiction enhancement additives such as strychnine (Nicotine

Anonymous literature 1996). When community education enables people to know

what is being sold to them, their choices can be more sensible.

In cases when a person knows the dangers and still continues to use, risking their

lives for the instant gratification, then these are some of the methods that can

facilitate that change:


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• advertising showing the possible harm

• counselling

• Smoke Enders, Government Quit Program

• Zyband (prescription pill)

• harm reduction such as nicotine patches, nicotine chewing gum, nicablok

• programs such as TA, NLP, Psychodrama, CBT, Motivational Interviewing

• avoiding after work drinks with workmates/making new friends/new hobbies

• belonging to a group committed to having fun without using unhealthy

methods

At the Habit Stage a person has more control over what their lifestyle choice is and

how to go about changing something that is not healthy such as cigarette smoking,

junk food eating, heavy social drinking, designer/recreational drug using. Although it

can be difficult for a person to attempt to avoid participating in some of these

unhealthy activities it can be done with the help of any of the previously mentioned

aids. Otherwise, they need to break away from the kind of friends who persist in

socialising in a manner that involves using life threatening activities. Sometimes at

this stage a heavy drinker attending an AA meeting can get a picture in their minds

of how they will end up and this can give them the motivation to do something about

the habit. This is called an intervention that brings the rockbottom up (Johnson

1986).

Stage 1 – Denial “I can stop anytime I want!”

Loss of awareness, blackouts, broken promises

loss of motivation,

depression

denial, defensiveness, aggression

lies, deceit, stealing,

blaming others

compulsion

obsession

feeling driven to get the 'instant fix'

hyperactivity and short concentration span


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By this stage a person is in serious trouble. There needs to be a focus on where this

pain is coming from which the person is trying to numb with the use of substance or

process abuse. Examples of such substances are drinking, smoking, designer drugs

and food. Some of the processes used are gambling, love and sex, work, and

violence.

Quite often there is stress or an underlying ailment such as untreated depression

and/or another emotional illness which the person is unaware of and is self

medicating. What is serious is that at this stage they still think they do not have a

problem and that if they want to they can stop the harmful behaviour whenever they

want to. Except that they tell themselves that they do not want to. They are aware,

however, that there is perhaps something wrong. An important treatment at this stage

is one called the Intervention where family members and/or close friends surprise the

person together, preferably with a professional, and lovingly confront him or her

with whatever behaviour has taken place as a result of the problem and how it has

affected them all. Then choices are presented and the person in question can commit

to some sort of action (Intervention 2007, Johnson 1986). Other methods are CBT or

Motivational Interviewing for the precontemplative stage.

Stage 2 – Loss of Control “Why can’t I stop?!”

shame, guilt, self hate,

loss of control, paranoia

looking for the magic solution

feeling sex starved and unloved

desperation to find the easy way to get off the treadmill

threat of deprivation without the 'fix', mood swings

victim role (inferiority)

loss of libido.

By this stage the person is usually aware of the helplessness of their condition and

lifestyle. This does not necessarily mean that it is an easy decision for some to do

anything constructive about their condition because it means giving up the perceived

source of the ‘high’. Nevertheless, many have reached the end of their tether and

turned to such successful treatments as:


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• Yoga (relaxation and meditation)

• other programs such as CBT, Motivational Interviewing, TA, NLP etc

• self/home detox: a new food plan which eliminates alcohol, other drugs etc

• exercise

• rest

• joining a spiritual group/church

• attending 12 Step meetings, Smart Recovery or any other program

• psychotherapy including family of origin work

• medical treatment for depression or for any other emotional illness

Obviously there needs to be an attempt at replacing the artificial method of achieving

that ‘high’ with one that deals with the reason that such a need exists and with a

method that can meet that need more healthily.

Stage 3 – Unmanageability “I can’t go on like this!”

unmanageability,

compelled to use the substance/process to excess

disregarding personal safety and that of others

fatigue

helplessness

suicidal thoughts

‘the pits’, black hole, rockbottom

At this stage very few people can detox at home although it has been known to

happen with support. A person who loses their job, their family and/or their health

can be faced with the harsh reality of the compulsion and make a decision to stop the

self destructive behaviour. It is unlikely to succeed if a person does it on their own.

Far more likely is when they join a religious group where the members do not drink,

gamble or smoke and it is expected that sex takes place only after marriage. The

other options are detox units or Therapeutic Communities such as Odessey/WHO.

Another workable method is joining AA (Alcoholics Anonymous) or another 12 Step

Program which is not only a fellowship of ex heavy drinkers/users but also a loving

and caring fellowship which has a character building program enabling the addicted

person to identify the reason or reasons they picked up a drink in the first place.


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Another option is abstinence through SMART Recovery which is a secular program

based on CBT.

I find that these different models indicating stages of change for dependence and

recovery are similar in that there is a process that takes place for a condition which

shows certain symptomology which cannot be disputed. The differences are in the

language used to describe the process which is often only understood by trained

professionals. For that reason I created a description of the stages in language more

easily understood as shown in this section.

.

5. Addiction/Dependence/Obsessive Compulsive Behaviour/Compulsion/Excess:

The Why and What?

Having looked at the stages we need to understand the problem behaviour which is

called many names and is extremely powerful - this means the afflicted person even

repeats life threatening behaviour in order to gain a ‘high’. Once that ‘high’ is

achieved then there is a compulsion to get more. With each repetition the tolerance

level (Johnson 1980, 1986) is affected resulting in being compelled to use even more

to gain the level reached previously. This stage of being insatiable cannot be treated

effectively with cognitive behaviour therapies alone. Motivational Interviewing (MI)

and other cognitive behavioural therapies (CBT) such as SMART Recovery, can

compliment the 12 Steps model and vice versa.

The most effective treatment is abstinence and belonging to a self help movement

such as AA or a religious group where all members are required to abstain from the

offending behaviour. For those who do not want a spiritual fellowship then SOS

(Secular Organizations for Sobriety 2007), RR (Rational Recovery 2007) or SMART

Recovery (2007) are other options.

Behavioural models such as CBT, Motivational Interviewing, TA, NLP, etc are

doomed to fail on afflicted people at this stage of compulsion, when they are

insatiable, unless the agenda is abstinence. Also required is a complete medical

check-up to identify and treat depression/hypoglycaemia/OCD/diabetes or any other

underlying organic contribution to the need for self medication.


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6. Important aspects of compulsions and recovery

This list identifies various contributing factors for compulsion and some appropriate

treatments.

• stress is an important factor in disease and we live a stressful lifestyle

• a percentage of people will search for feelgoods to avoid stress, oblivious to

the risk

• people with untreated depression or psychotic illness and conditions such as diabetes, tend to self-medicate with alcohol and other drugs

• it is easy for human beings to enter into denial about life-threatening behaviour in order to experience the ‘highs’

• relapse has a high occurrence record (recidivism)

• what works for one person may not work for another

• once an afflicted person reaches a rockbottom they can become motivated to enter recovery

• treatment that is relevant to the correct diagnosis is paramount

• the afflicted person needs to believe in the treatment

• the afflicted person needs to be committed to undertake and maintain the

treatment

There are many effective treatment models such as Cognitive Behavioural

Therapies (CBT), Motivational Interviewing (MI), Brief Therapy, Rational

Emotive Behavioural Therapy (REBT), Neuro Linguistic Programing (NLP),

Transactional Analysis (TA), Gestalt Therapy. Furthermore the 12 Step model is

now also supported by Twelve Step Facilitation (TSF), Family of Origin Work

(Bradshaw, Mellody et al). Other models and support groups are: Psychotherapy

(Jung), Yoga, church groups, other self help groups such as SMART Recovery

(based on CBT).

It is important to remember that given that treatments need to be relevant to the

correct diagnosis, different modalities of treatment for compulsive behaviour are

more suitable for the different stages on the continuum or severity mentioned

previously.


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7. My Praxis – A Synthesis of 26 Approaches

I began this research because service providers were interpreting the Health

Department Harm Minimisation Policy (NDS 1985) as negating the abstinence and

AA program of recovery, which had been the preferred method before this change in

policy. The D&A Debate exposed heated accusations from both sides of the

continuum – the abstinence and AA 12 Step program; and the controlled

drinking/use (CD/harm minimisation) supporters. Each stated that the other claimed

their model worked best. Nevertheless, funding was made available to services which

showed they provided harm minimisation programs.

Importantly as a result of this inquiry I came to believe that The D&A

Debate protagonists do not need to dogmatically defend their own model

to the point of being in conflict, as all their treatments work, and it was

valid to concede that different models work for different people in

different stages of their recovery - “whatever works works, and not to be

judged by others” (Nicotine Anonymous The Book 1992:113).

Based on my experience, my research and my commitment to a synthesis – diversity

of approaches (DoA), in this chapter I summarise twenty-six personal and

professional development strategies, AOD interventions and treatment approaches,

which I have chosen and customised for my praxis. From this repertoire I have

designed courses such as TAFE AOD Interventions, Crisis Intervention and

Youthwork Training – a synthesis of client centred approaches. This DoA was the

approach I built my praxis on, before, during and after the C&R Research process – a

praxis that has been complemented by a diversity of approaches which became even

more informed through the research inquiry.

I attended training workshops for each model, where I learned basic introductory

exercises and I also use these in my Life Strategies Workshops, which I have

designed and facilitated. Such personal and professional development is important

for prevention and/or recovery from compulsive behaviour and for self-actualisation.

However, clients/participants of the Life Strategies Workshops and Training Courses

not only need to have had previous personal development experience but also a


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medical check-up because sometimes difficulties develop due to medical reasons and

need to be addressed appropriately. According to feedback received these exercises

have been very helpful for the participants in their learning process.

IMPORTANT NOTE

When I facilitate a Life Strategies Workshop or personal/professional

development course, participants need to have had previous self-

awareness/personal development experiences, as it is not a therapy

group.

Introductions to these various modalities provided enjoyable learning

outcomes for me, which I was willing to share with others. Also as part

of my work and personal life I have experienced different approaches

that were more than introductory workshops – ways of thinking and

living.

Examples of various modalities I have experienced are: AOD (Alcohol

& Other Drugs) Interventions/Recovery, Art (a therapy), Art of

Breathing (Rebirthing), CBT, Dance (as therapy), Dreamwork, Family

of Origin Work (Bradshaw and Mellody Workshops/Programs),

Hippocrates/Littauer Personality Types (Typology), Gestalt, Hypnosis,

In Depth Interviewing, Jung, Life Strategies/Self Awareness, Mediation

(Conflict Resolution), Meditation, Music (as therapy), Neurolinguistic

Programming (NLP), Play (as therapy), Poetry/Prose (as therapy),

Process Oriented Psychology (Process Work), Psychodrama,

Psychotherapy, Reading (as therapy), Relaxation, Research Methods,

REBT, Storytelling (as therapy), Talk Therapy, Transactional Analysis

(TA), 12 Steps Program, Twelve Steps Facilitation (TSF), SMART

Recovery, Visualisation, Writing (as therapy), and Yoga. When

participants wish to become more familiar with these modalities as a

result of what they have experienced with me, then they are encouraged

to explore the original source for further training.


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In this section I have included some of the modalities/research I have experienced in

my life, These have had an influence on my praxis and in some cases I show

examples of exercises from the various modalities which I use. (The names of

exercises are not necessarily those used by the originators).

7.1 Cognitive Behavioural Therapies (CBT)

These consist of any exercises that enable the mind (cognitive) to affect performance

(behaviour). This school of thought maintains that a person can change behaviour

through programming their thinking to make these changes. It is a here-and-now

approach and does not support the benefit of exploring childhood events or family of

origin issues. The aim is behaviour modification through conscious effort. I introduce

exercises such as making a diary of usage, a relapse drill (a checklist of what to do to

avoid relapse), a thought monitoring sheet. REBT, brief therapy, social learning

theory, solution focus, motivational interviewing and SMART Recovery are some of

the therapies associated with this approach. I use these techniques when I assess that

a person favours this approach and therefore can benefit more from such a method.

7.2 Motivational Interviewing (MI)

This approach was created by Miller and Rollnick and consists of six stages of

change which need to be identified and treated accordingly with techniques such as

“good things less good things”, “exploring concerns”, and “information giving”.

Other cognitive behavioural exercises are used as required and the therapist needs to

have a repertoire of such activities to use at different stages of change (Prochaska

and DiClemente in Jarvis, Tebbutt & Mattick 2001): I have also trained counsellors

in this process.

This is a summary of the stages of this method:

Precontemplative stage – I provide information because education is a large part of recovery, and put good things, less good things questions

Contemplation stage – I concentrate on exploring the good things, less good things, and exploring concerns

Determination (Preparation) stage – (just before action) I focus on exploring setting goals and discussing strategies.


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Action Stage – I again facilitate setting goals and discuss strategies

Maintenance & Relapse Prevention - relapse prevention should be on the counsellor’s agenda right from the beginning so I explore this with them

Termination - when the person is confident that their changed lifestyle is secure and they are confident that they will not relapse we discuss the termination of treatment and the possible follow up process if required.

7.3 Gestalt

Gestalt is a school of psychology that interprets phenomena as organized wholes

rather than as aggregates of distinct parts, maintaining that the whole is greater than

the sum of its parts (as cited from website on Gestalt 2005). The term Gestalt was

coined by the philosopher Christian von Ehrenfels in 1890, to denote experiences

that require more than the basic sensory capacities to comprehend. In 1912, the

movement was given impetus in psychology by German theorists Wertheimer,

Kohler, and Koffka as a protest against the prevailing atomistic, analytical

psychological thought. It was also a departure from the general intellectual climate,

which emphasized a scientific approach characterized by a detachment from basic

human concerns. According to the school, understanding of psychological

phenomena such as perceptual illusions could not be derived by merely isolating the

elementary parts for analysis, because human perception may organize sensory

stimuli in any number of ways, making the whole different from the sum of the parts.

Gestalt psychologists suggest that the events in the brain bear a structural

correspondence to psychological events; indeed, it has been shown that steady

electric currents in the brain correspond to structured perceptual events.

The Gestalt school has made substantial contributions to the study of learning, recall,

and the nature of associations, as well as important contributions to personality and

social psychology. Gestalt therapy, developed after World War II by Frederick Perls,

maintains that a person's inability to successfully integrate the parts of his/her

personality into a healthy whole may lie at the root of psychological disturbance. In

therapy, the analyst encourages clients to release their emotions, and to recognize

these emotions for what they are – owning these emotions as having a valid

contribution to their own identity. Gestalt psychology has been thought of as

analogous to field physics.


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Yet at the end of a paper called Gestalt Psychology and Gestalt Therapy, the

presenter, Henle, made this critique:

From the material already discussed, it is not difficult to reach a conclusion. What Perls has done has been to take a few terms from Gestalt psychology, stretch their meaning beyond recognition, mix them with notions - often unclear and often incompatible - from the depth psychologies, existentialism, and common sense, and he has called the whole mixture gestalt therapy. His work has no substantive relation to scientific Gestalt psychology. To use his own language, Fritz Perls has done 'his thing'; whatever it is, it is not Gestalt psychology. (Henle 1975, 1986)

This shows that different people perceive meanings differently and polemics can

arise between reputable professionals and/or scientists, because of this clash in

schools of thought. Nevertheless, Gestalt therapy has had a remarkable impact in

addictions recovery and is used in many rehabilitation programs whether AA

inspired or not, disease model or not. According to Perls, when a person is not

willing to integrate their fragmented parts so as to become whole, then that person is

neurotic. This model is known for being able to relate to the other person in the here-

and-now - immediacy. In most gestalt work we find the parts in us that are in

conflict, or are fragmented, and using a technique enable those parts to communicate

until agreement is reached - integration. Favoured techniques are empty chair

(conversing with frustrations) and dreamwork (by placing ourselves in every part of

the dream to understand our discomforts) (Stevens 1975:73). This concept is also

used in NLP, which I elaborate on under a separate heading in this chapter.

Many years ago I attended a Gestalt introduction workshop where these strategies

were used and now I use the dreamwork strategy in counselling when a client has

problems with certain dreams, and the empty chair exercise in personal and

professional training courses as shown in Case Example C.

Exercise A

Gestalt Empty Chair

In one of the Life Strategies Workshops, which I facilitated, there were ten participants who were previously experienced with personal development work. One person was a successful actor by profession and at this time shared that his aim was to work on the frustration he had experienced with people misunderstanding him. Previously, in the Psychodrama group work exercise, when it became obvious that the way he was communicating was not as he thought, and perhaps he needed to change the messages he was giving to people I suggested we deal with this internal conflict using the Gestalt Empty Chair method and which he agreed to. So on two chairs he put out two parts of himself – the one being responsible for the double messages


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and the other being that representing the self-critic. As he shared his concern as the self-critic facing the empty chair I then said “change” which was our code for him to change chairs. Having changed chairs he took on the role of the part that is giving the double messages who defended its position and at an appropriate time I said “change” and he changed chairs taking on the self-critic part to continue the dialogue. This continued for a few times (probably twenty minutes) until I heard the words change from “you” (blaming) and “I” (defending) to “what are we going to do?” (integration of conflicting parts) and this usually means the process has reached some resolution through integration of the conflicting parts that had caused the confusion and miscommunication to begin with. Such a resolution enabled the person in question to become aware of the mixed messages he was giving and stop thinking people were misunderstanding him but rather that he was empowered to express himself more clearly. (Another exercise to resolve such a mixed message is the TA sweatshirt exercise as seen later in this chapter). Physically experiencing this insight can be faster and more effective than other methods.

7.4 Hippocrates Temperaments/Personality Types (Typology).

These four temperaments, which have been further expanded on by professionals

such as Jung, Myers-Briggs and Littauer are the basis of scientific personality studies

used in the work environment primarily, and now for improving communication in

personal relationships. I use this as an exercise for participants to become more

aware of their own characteristics and how these relate with those of others. This is a

useful tool for conflict resolution and an icebreaker helping to bring a group together

before they enter into more serious personal/professional development. The four

Hippocrates temperaments are called personality types by Littauer (1997) and

described by her as summarised here:

1. Popular Sanguine - those whose obvious traits are fun-loving, entertaining, loud, optimistic, natural storytellers they are usually the centre of attention and enjoy making the most out of life. They can be chaotic and often late.

2. Powerful Choleric - those who love to be the leaders of the pack, good organisers, creative and also enjoy being teachers. They can have an attitude of “my way is the way” and appear bossy.

3. Peaceful Phlegmatics – are those who prefer to watch and could easily go in any direction as long as someone else is leading, they are easy to get on with because they are the quiet ones. They will usually do whatever they choose even if they seem to agree with the initial instructions.

4. Perfect Melancholic – those who are preoccupied with attention to detail and order, therefore making excellent musicians. They are moodier than


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the others and maybe appear pessimistic – ‘the glass is half empty’ way of thinking.

It is believed that each person has a combination of any two of these temperaments, with one of the two being dominant.

There is a full questionnaire by Littauer (1997) which can identify the main two

personalities of a person. However, at a training session I use this summary to keep

the exercise as an icebreaker. I write on the board the simplified descriptions of the

four temperaments and then go around the room asking each participant to choose

those two that more accurately describe their own personality. To begin with I also

share about mine, which is a combination of a Sanguine/Choleric. This is usually an

enjoyable exercise and provides group cohesion through laughter and self awareness.

There are always a few who doubt the process but who are more agreeable when

reminded that these temperaments are the basis of workplace personality studies for

effective teamwork. In dealing with relationship therapy I encourage the couple or

family to read Littauer’s book and carry out the questionnaire together. This assists

with understanding that the conflict is quite natural, given that they think and behave

differently, as identified by the Hippocrates temperaments. Therefore, this helps

transform their conflict more effectively and without apportioning blame.

7.5 Jung

Jung, a pioneer of psychiatry along with Freud and other colleagues of that time,

claimed that he would have loathed to be known as a ‘Jungian’. Jung was also

credited with influencing, among other modalities, the development of the AA

program. Jung maintained that finding recovery from alcoholism could not be

possible without spiritual conversion. This recommendation was passed on to Bill

Wilson one of the founders of AA.

Some Jungians do not believe that alcoholism is a disease. San Roque

psychologist/Jungian Analyist who was planning the setting up of the Jung School in

Australia said in his interview (1993) that rather it is the Dionysian journey which

enables us to grow as we proceed through the experience. In Greek mythology,

Dionysus was the god of wine, and as a result of an awesome journey of self-

discovery he established that wine and wild dancing induced an state of ecstasy

enabling “a heightened awareness and a temporary release from the inhibitions


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necessitated by society” (Dictionary of Mythology 1994:52). This process in turn

enabled the worshipper to feel born anew. Dionysus is the patron of an annual

national celebration in Greece when people participate in drinking, dancing, eating

and having fun often a cathartic experience of feeling reborn. The Jungian worldview

also influences Process Work. There are many Jungian exercises involving music,

dreamwork and art which can help a person explore their innerworld. Here I give an

example of one I have modified and use at my Life Strategies Workshops and

Professional Developoment sessions, which works very well.

Exercise B

Jung Drawing

At a Life Strategies Workshops the group (10 participants) drew free flowing stream of consciousness designs and once everyone had completed their drawings (usually all finish around the same time) each person showed their art and as the facilitator I assisted in working out together with the artist and other group members what the relevance of the drawing was to each individual. Douglas, who had resisted commitment with his girlfriend, discovered through this exercise that he had wanted to go on a trip and settle in the country which is what he did. Two years later he returned and shared that his journey was most rewarding but that he felt ready to come back and resume his trade and consider settling down and having children which he had avoided strongly before. His girlfriend was still free and they got back together.

7.6 Neuro Linguistic Programming (NLP)

The founders of NLP, Bandler and Grinder support the non disease concept and lay

claims to curing addictions and phobias through practical exercises, in a short

timespan. The therapy is based on the premise that we have many sides to our

personality and when a person has their sober and alcohol sides dissociated this

causes internal conflict and results in impaired control over their compulsion. To

resolve this situwation a technique may be used to create communication between

the dissociated parts and can result in integration of those parts, enabling the person

to gain control over their compulsion. “This is a precondition for establishing an

effective channel of communication through the sober part and the alcoholic part

which knows about the drinking problem and what needs it satisfies.” (Bandler,

Grinder 1982:183). An anchoring strategy is established such as touching the knee or

wearing an elastic band on the wrist to snap when needed to remind themselves of

their ability to integrate their dissociated parts and maintain control. Described by


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NLP trainer Bolstad on his website - Research on Neuro Linguistic Programming A

Summary (1997):

Research on NLP is in its infancy. The term NLP was first coined in 1976 by Richard Bandler and John Grinder, so that the entire field is currently only 20 years old, and some of the most significant techniques were developed within the last decade. Most NLP Practitioners trust the empirical evidence that what they are doing works, but the following article collects some of the scant research data currently available to support their experience. Some NLP techniques are simply “modelled” on techniques used and researched in other fields (Ericksonian Hypnosis and Classical Conditioning being the two main examples) and in these fields NLP is an accelerated methodology for learning these techniques, rather than the originator of them. In other cases research from the field of Psychology supports the theoretical basis of NLP techniques which in themselves have not been fully researched yet (a key example being the phenomenon called “Submodalities” in NLP). Finally some specific research on NLP’s own developed techniques does exist.

I have attended separate sessions, introducing NLP strategies, originally with Helen

Whitmont (1990) and more recently with Antony Robbins. This NLP exercise which

I learnt in an NLP introduction workshop (Whitmont 1988), I use to show

participants how they can integrate different conflicting parts of themselves in order

to resolve internal conflicts more easily.

Exercise C

NLP - Integration of Selves

In a personal/professional development course I asked the participants to think of an issue troubling them (they don’t need to disclose it to the rest of the group). Then access the part of them that is responsible for that issue and upon connecting with that part thank it for taking care of that issue and ask it what is the good intention of hanging on to that issue. Once the answer is provided then thanking the responsible part and asking if it would agree to choosing another method to maintain that good intention and as it accepts the possibility excuse yourself and search for the creative part of self. Then on finding that creative part welcome it and thank it for being responsible for the creativity of self then ask it if it could come up with three other suggested methods of taking care of the positive intention of that existing issue. Having obtained three suggestions, thank it and go back to the initial part responsible for the positive intention of the issue previously causing concern and present the suggested three options to choose from in order to replace the problem one. Once the responsible part agrees to try one of these new options ask it to set a reality check, that is, what will it do if the next time there is a need to use this option and if it doesn’t work what will it do? Having reached an agreement ask the self if there is any part that does not agree with this solution – if there is then deal with the objection in a similar manner as has been done so far until agreement is reached by all parts of the self. At the end of this exercise there usually is a feeling of inner peace as a resolution is reached that has a better chance of lasting.


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7.7 Process Oriented Psychology (Process Work)

This explanation is a succinct outline of Process Oriented Psychology as shown on

the Process Work Institute website (2005) showing its relationship with Jungian

psychology:

About Process: Work Process Oriented Psychology, or Process Work, developed by Drs. Amy and Arnold Mindell and their colleagues [Max Schuepbach], is an innovative and comprehensive psychotherapeutic modality designed for working with the entire spectrum of human consciousness. This dynamic approach to the unity of mind, body, spirit and the world has its roots in Jungian psychology, Taoism, shamanism and modern physics. It integrates dream work, bodywork, relationship work, meditation and large group work into a single theoretical framework…The Journal of Process Oriented Psychology: Each issue of The Journal has a central topic which most of the articles address. It is a great way to discover cutting-edge ideas and developments in process work worldwide. This twice-yearly collection includes theory, technique, case examples and personal perspectives which will stimulate creativity in both lay people and advanced practitioners. It includes interviews with Arny Mindell and Max Schuepbach, articles by Joseph Goodbread, Leslie Heizer, Jytte Vilkkelsoe, Jan Dworkin, Julie Diamond, Kate Jobe, Amy Mindell, Dawn Menken, Sara Halprin, Mosses Ikiugu, Kay Ross, Salome Schwarz, Gary Reiss, Reini Hauser and Arlene and Jean-Claude Audergon to name a few. Every issue includes artwork and some feature a single artist.

Co-founder Schuepbach, in an interview with Toola Andrianopoulos and me in the

USA (1993) and later whilst running an addictions workshop spoke of the positive

benefits of experiencing addiction in a person’s growth process…“Whatever happens

is meaningful and needs to be supported” he said and Process Work has specific

tools to unfold this, that is, addiction shouldn’t be overcome but that the deeper

process behind the addiction should be found.

Exercise D

Process Work Communication Exercise

As had been demonstrated by Schuepbach at one of his workshops, I facilitated an exercise involving myself and one other group member (10 participants) carrying on a conversation in front of the rest about something not including the others. It was only a short conversation with the desired outcome demonstrating how people can feel excluded when an interaction held separately between two people in a group can result in the others feeling alienated/excluded. This is often experienced in a family, school or work environment and results in conflict which is acted out sometimes violently by those who feel excluded and alienated.

7.8 Psychodrama

Psychodrama was created by Moreno in Vienna 1921. It is a method of physically

enacting one’s problems in a group setting enabling a deep release of tension with

group support. As a person’s awareness about a problem increases, the tension


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regarding this is released and a solution becomes more apparent. The psychodrama

was described by the British Medical Journal in a series of articles (1999):

Conceived and developed by Jacob L. Moreno, MD, psychodrama employs guided dramatic action to examine problems or issues raised by an individual. Using experiential methods, sociometry, role theory, and group dynamics, psychodrama facilitates insight, personal growth, and integration on cognitive, affective, and behavioral levels. It clarifies issues, increases physical and emotional well being, enhances learning and develops new skills…The word 'Psychodrama' is often used as a generic term when talking about the range of action methods that J L Moreno developed. Action methods are used to enable past, present and future life events to be explored. Issues or problems and their possible solutions are enacted rather than just talked about. Psychodrama offers the opportunity to practise new roles safely, see oneself from outside, gain insight and change. There is a director, an action area and group members. The director supports groups to explore new solutions to old problems, group members participate in the drama as significant others and share how they personally relate to and can learn from the presenting issue at the end of the session. Whether we are seen as stereotypes or as individuals depends upon our language and perspective. The art of psychodrama includes the recognition of a person's private and metaphorical language and the use of multiple perspectives to elicit the subjective experiences of the protagonist, the director and the group members. Psychodrama can be used in a group or individually for therapy and persona growth. It can also be applied to family and couples therapy. Psychodrama is practised and taught extensively through the world.

The technique of a psychodrama statue is preferable and does not require an expert to

facilitate, resulting in a learning outcome. I have facilitated in-service Professional

Development and Life Strategies Workshops at which I have used a psychodrama

human statue exercise which I learned at a psychodrama introduction workshop. It

has been very well received and successful, making it extremely popular as shown in

‘feedback’ sheets:

Exercise E

Psychodrama Exercise – Human Statue

At the same Life Strategies Workshop shown in Case Study C where there were ten participants, each having their own issue which remained unknown to everyone else at the beginning of the session, therefore, I asked for a volunteer to share their issue with us and one person who we will call Peskas for the purpose of confidentiality agreed. I asked for a volunteer to be the director of this psychodrama and Gene (a businessman) offered, though a little reluctant because he was not familiar with what to do. I reassured him that he would soon understand the process and to relax. I advised the group that the director would need their individual participation as requested. Peska shared about his issue which was that he felt concerned about his life and where he was heading and briefed us on some happenings both at home and work. Peska is a successful finance broker dealing in millions of dollars and has been committed to personal development as part of his life. I had him sit next to me to observe the process. Gene (the director) chose Hector (a management consultant)) to play the role of Peska and stood him in the centre of the room. Gene then asked Rose (a counsellor) to stand up and as his wife to take hold of


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Peska’s hand and look as though she is pulling him to one side. Then Gene asked Bill (actor) to play the role of Peska’s feeling of confusion and place him standing behind Hector (playing Peska) supposedly looking confused. Manuel (grief counsellor) was to represent Peska’s work and pull him by the other hand in the opposite direction. Lucy (retired teacher) was to represent a white horse which was Peska’s favourite hobby (horse-riding) which he had not had time to do in a long time. Sue (market researcher)) and Gerry (IT networker) were called to kneel and hang onto Peska’s knees, being his two children demanding attention. Daisy (retired sociologist) was asked to be Peska’s feeling of anxiety and stand wherever she felt was appropriate to do this. Once the players where chosen they were all asked to freeze into a human statue for a few seconds depicting their different roles. Peska sitting next to me, took this in then I asked him to change everyone’s positions in a way that he would like to see the scenario and this he did removing everybody’s hold on him and embracing his wife and children whilst putting his work a little further out. Everyone then was asked to sit down and Peska was asked to give feedback on the experience which he found amazing as Gene did not know all the details that he had interpreted and depicted yet were so accurate and so Peska felt understood more than ever. Peska also felt empowered to make the necessary changes and not feel so helpless. Every member shared about the relevance of the role they each enacted to how their life was at the moment and what was necessary to do to improve it. Bill (actor) discovered that although he was to represent confusion, his body language was perceived by all present to be that of indifference, which surprised him, as ‘being misunderstood’ was his recent problem with people. As a result Peska felt he knew what action he needed to take to improve his life and this self awareness enabled others to plan likewise. (Three days later Peska phoned me and told me that he quit his job and started his own consultancy and years later this gives him less stress and more time to spend with his family.) This led us to a Gestalt Empty Chair exercise for Bill (actor) to deal with his problem of miscommunication (see Exercise A).

7.9 Psychotherapy/Family of Origin Work

This is an effective method for achieving and maintaining recovery. Jungian therapy,

Gestalt, Bradshaw, and Mellody all involve using this method. As needed, it is better

to research for appropriate available practitioners to choose from. Therefore,

someone who is recommended can be a better choice. I also find this approach

effective for personal development in order to raise self esteem. This model enables

the individual to explore his or her childhood events guided by a professional so as to

process unresolved issues.

7.10. Rational Recovery (RR)/AVRT

Founder Jack Trimpey established Rational Recovery (RR) in 1985, a rational

thinking approach for addiction recovery based on the model created by psychologist

Albert Ellis - Rational Emotive Therapy (RET), now known as Rational Emotive


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Behavioural Therapy (REBT). In the early days it was believed that Rational

Recovery members could still drink, were required to attend meetings only once or

twice a week and expected to become well enough to not need to belong after six

months (Ruden & Byalik 2000). In exploring the RR website recently (2007) there

seems to be a marked transformation of this model to the point that individuals are

now encouraged to use the website and find their cure to addiction online (Rational

Recovery 2007). There are no support groups and RR is still anti the AA model. RR

claims to ensure a cure for addiction based on abstinence and also using the

Addictive Voice Recognition Technique (AVRT). SMART Recovery has come outof

this model and I elaborate on this model later.

7.11 Rational Emotive Behavioural Therapy (REBT aka RET)

In 1953 Ellis established one of the first Cognitive Behavioural Therapies which

enabled individuals to change their ways of thinking and feeling. This took replacing

irrational beliefs with rational thinking.

REBT helps people to reduce their own neediness and specifically their need to prove themselves to others. To discourage selfishness, REBT teaches what Albert Ellis calls the value of rational self-acceptance. According to Ellis, healthy people are usually glad to be alive and accept themselves just because they are alive and have some capacity to enjoy themselves. They refuse to measure their intrinsic worth by their extrinsic accomplishments, materialistic possessions and by what others think of them. They frankly choose to accept themselves unconditionally; and then try to completely avoid globally rating themselves—meaning their totality or their "essence." They attempt to enjoy rather than prove themselves. Thus, rather than acting out of selfishness, they learn to operate from responsible self-interest. (REBT website 2007)

Kidman who lived and worked here in Sydney in 1993 when I interviewed him, was

then the Australian representative for RET, now known as REBT. In 1993 Kidman

was a RET practitioner/research scientist/author and Chairman of Foundation of Life

Sciences and had stated in his book Tactics of Change (1986) that...

the idea of substance dependent people that they lose all restraint after the first drink, the first slice of cake, the first inhale, the first shot of heroin is often a cognitive distortion. (p.106)

This statement showed that he did not believe in the disease concept because those

who believe in the disease model such as Johnson, Jurd, Bradshaw, Mellody, and

members of AA, state that addiction is life threatening and alcoholics need to abstain

from the first drink or they will relapse. As mentioned earlier, in an interview with

Kidman (1993) I reminded him about my experience with Ellis, the founder of

RET/REBT, at a workshop here, and which had been organised by Kidman, where I


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was one of a few invited to participate with the master. In front of hundreds of

conference attendees, I put forward to Ellis the problem of the constant relapse from

my overeating recovery. Ellis then guided me through a cognitive process of penalty

and reward which I was to use whenever I became tempted to overeat. It worked

admirably for three days and then, like every other cognitive behavioural model I had

tried, failed to prevent my relapsing. In answer to my dilemma, Kidman

recommended that this strategy's sustainability could have been enhanced by

working closely with a counsellor. Such a professional would have paced me through

a process of recording my food intake (a behavioural diary), and other exercises, so

as to achieve and sustain my recovery. This is one of the cognitive-behavioural

approaches to recovery which is obviously not concerned with the disease concept,

multigenerational patterns, or exploring childhood past experiences in order to

process the effect of trauma, grief and shame. Instead, this method focuses on

immediacy, the here-and-now of addiction, using behaviour modification techniques

which deal with the facts and reality. The AA model also has a behavioural

component to it, in that it is necessary to cease and desist the substance use, undergo

detoxification, attend meetings and work the program. I show here an exercise I use

that I associate with the REBT model. Although this can be identified with other

CBT modalities I show it as a REBT exercise because Kidman suggested it as a

strategy:

Exercise F

REBT – Food Diary

Carlos had come to me about a problem which was annoying him to do with breaking his diet. I asked him to first tell me what had happened and what he had planned as a solution (empowering him to take control of the situation). He has chosen a particular regime which sounded reasonable to achieve this and also included modest exercise. I asked him if he was keeping a diary of his planned eating for the next day and recording what he had eaten. He was not so I asked him if he was willing to do that and he agreed. I also suggested that he record his weight and the number of steps he was carrying out each day (he had a pedometer as it was a part of this program he had begun previously). I also suggested that he plan how to handle the temptation to cheat before it comes up. Then I also suggested that he chose an affirmation that he could repeat when he felt he needed the strength and to write what he was feeling when he was tempted to eat. He could telephone preferably someone who knew the program for support as he needed it and I would see him in one week to assess his progress. I reminded him to keep his appointment regardless of his progress as we could find a solution if needed. Carlos came back the next week and he was back on track – he came to see me five more times in order


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to make a habit of his commitment to the regime and then we ended the contract to see me with an option to come back should he need to.

7.12 Secular Organizations for Sobriety –Save Our Selves (SOS)

(SOS) is a secular movement influenced by Rational Recovery (RR/REBT) and

focusing on abstinence, human support and its effective self-empowerment method

for achieving and maintaining a lasting sobriety: the Sobriety Priority Program.

Author/founder, Christopher (1988, 1992), maintained that “Anyone who drinks

alcohol comes, to some degree, ‘under the influence’. The majority, however, don’t

become alcoholics.” Christopher believes that it has to do with our limbic system

imprints of ‘fire-pain’ control. And for those of us who continue to ‘thrust our hands

into a roaring fire’, we have a polluted primitive limbic system or “lizard brain”

which contains countless thousands of “alcohol = pleasure” imprints. Through SOS

the awareness of alcohol/drugs = pain can be maintained to reach sobriety = survival.

(1992:9).

Although this is a worthwhile program it has ceased operating in Sydney (2005),

however, there are members who have benefited and who I refer clients to for

support. Such clients are those who do not want a spiritual recovery program. It is

also another model that predated the birth of SMART Recovery.

7.13 SMART Recovery

The letters in SMART stand for:

• Self

• Management

• And

• Recovery

• Training

The originators of this approach claim it to be an educational organisation based on

scientific methods and run by volunteers offering their service to the community. A

group broke away from Rational Recovery (RR) in 1994 and called itself SMART

Recovery becoming a non profit self-help abstinence program based on CBT. This

includes REBT, Stages of Change (Prochaska, DiClement & Norcross 1994), and

other CBT techniques such as Cost/Benefit Analysis aimed at building and

maintaining motivation to abstain.


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SMART Recovery is open to people with different addictive behaviours who are

wanting to abstain, and the focus is on teaching how to:

• enhance and maintain motivation to abstain

• cope with urges

• manage thoughts, feelings and behaviour

• balance momentary and enduring satisfactions

Participants can attend other programs such as 12 Steps groups and are requested not

to denigrate other such approaches. Cross talk and advice giving is encouraged from

others present and the group meetings are monitored by a facilitator(s).

Confidentiality is an important requirement of this model. SMART Recovery is not a

spiritual model and was brought out by St. Vincent’s Hospital to Australia in 2002,

having over 80 meetings, some of which take place in correctional facilities. Having

attended several meetings I found it quite useful in making a plan to cope with urges

in relation to my food addiction, which is something I had overlooked before. The

only difficulty I experienced with this model is that some participants offer advice

and yet they do not have a handle on their own recovery. On the other hand, advice

given from those who have experienced the worst, and have found a strong recovery,

is valuable. I have now become a facilitator for this program at St. Vincent’s

Hospital as I am familiar with CBT and REBT strategies, having taught these in a

variety of courses.

7.14 Transactional Analysis (TA)

The founder of TA, Berne in Games People Play (1977) and Harris the author of the

TA book I'm OK You're OK (1970) call alcoholism a game not a disease and state

that there are many players involved including AA members in the rescuer roles

whose aim is to keep the game going if the person keeps relapsing hopelessly. I show

here an extract from the Transaction Analysis Journal website as part of the critique

for this model.

Transactional analysis (TA) is a form of therapy, which was developed by psychologists with

strong humanist leanings (see the section on humanistic views of personality), amongst whom

the best known is probably Eric Berne, author of Games People Play and What Do You

Say After You Say Hello? Transactional analysis generally seems to be glossed over in

psychology textbooks, both as a form of therapy and as a personality theory…TA offers

plausible explanations of interpersonal communication, especially of communication


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breakdowns, and [it is] particularly useful in analysing interactions involved in the

development of practical work [for counsellors especially]. Ego states: Fundamental to TA is

the notion that our personality consists of three 'ego states': In a 'transaction' (an interaction

with one or more other people), one or other of these ego states will predominate in us and

other people in the transaction. Particular communicative behaviours are associated with each

of these ego states, but it is important to understand that they are not necessarily associated

with chronological stages of psychological development. An adult can exhibit child-like

communicative behaviour and a child can exhibit adult-like behaviour (Cultsock 2005).

James & James, authors and practitioners of TA, were both inspiring in the

interview which Andrianopoulos and I had with them in 1993 in the home of

Muriel James in San Francisco. They claim that a person can enter recovery by

reparenting themselves and finding the appropriate recovery support network which

could be AA to stay sober. Muriel James, who trained with Berne co-authored

Passion for Life (1992) with her son John James and they have taken the TA model

further by developing a philosophy which embraces seven urges which if neglected

lead to addiction but if fulfilled lead to a Passion for Life (1992). John James

summarised this book by saying that to feel full with excitement of life is having the

energy that comes from seven basic urges:

urge to live with meaning urge for freedom - from political oppression, addiction etc. urge to understand - yearning for knowledge urge to create and to be productive urge to enjoy life at a deep level urge to connect in ways that we feel loved urge to transcend beyond the normal

Students in the TAFE AOD Interventions Course (2003) found the explanation of the

concept of these seven basic urges as enlightening both personally and

professionally.

Another method I use is one gained from the TA introduction course I attended. This

exercise gives participants the opportunity to experience empathy, and this is

especially valuable in professional development courses.


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Here is an example of this:

Exercise G

TA – How Does It Feel?

Youth workers in a professional development session were split up into groups of three and each took on the role of A, B or C. A (playing critical parent ego state) was to be a critical autocratic adult issuing orders to the adolescent. B (playing adult ego state) was to be a professional whose aim was to mediate the conflict peacefully. C (playing adapted child ego state) was the troubled adolescent who was to lash out using dysfunctional behaviour and obscene language (this can be very difficult for professionals who pride themselves on the ability to communicate functionally). Once each participant of the group experienced their role to the fullest for approximately four minutes then I as the facilitator asked them to change and they carried out the next role again for four minutes. Finally they rotated to the last role until each had experienced the three different roles. Feedback on this exercise usually showed an insight into the frustrations of conflict and which communication was perceived to be more effective.

Another TA example which is very useful is when I use the TA sweatshirt exercise to

give people the opportunity to have an indication of the persona they present to

others and whether they wish to change that or not. This is shown in this case study

here:

Exercise H

TA -Sweatshirt

Following a course of personal/professional development we go around the group and each participant good-naturedly chooses an animal, actor or famous identity to describe each individual, as they perceive them, and the reason why that choice was made. Each group member will receive the opportunity to have the group’s choices which can present a particular pattern. When that pattern emerges the individual can make the decision whether they agree with it and whether they are happy with the perception or wish to change it in the future. For example, in one group I was seen as a fat cuddly black cat which inspired me to perhaps lose some weight but otherwise I felt flattered as I love cuddly cats (although it should be noted that cats do not suffer fools lightly) and enjoyed the message I was sending about myself to the group. Another time much to my surprise I was perceived as a stubborn dog and chose to treat this perception as something I should change, which was relatively easy to do as a result of this feedback.

I believe TA provides a light-hearted and non-threatening method of personal and

professional development and usually the feedback from participants regarding this

model is usually positive.


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7.15 AA & 12 Steps Program

Alcoholics Anonymous (AA) model which was founded by Dr. Bob and Bill Wilson

in the USA in 1934. It is a twelve steps and twelve traditions program which is aimed

at abstinence and character building with spirituality, in a loving fellowship of non

drinkers who have found freedom from alcoholism. The twelve steps are made up

from eastern and western philosophy, psychology and the Bible. Although it is not a

religion because believing in ‘a God of our understanding’ (AA 12 Steps) enables

members of different religions to continue to believe in their own God, or atheists to

be spiritual without being religious. For some agnostics/atheists making the 12 Steps

program their Higher Power is a workable source of spirituality. One of the

definitions of spirituality can be belonging to a loving fellowship. It is a loving

fellowship and participants are encouraged to attend as many meetings as possible

per week in the beginning and until they find a home meeting that suits them. This is

a self-help program that is free of charge.

There are 8 tools of recovery which include: (i) abstaining from drinking

alcohol/using; (ii) attending meetings; (iii) anonymity (not disclosing outside the

fellowship who is seen or what is heard there); (iv) getting a sponsor who guides the

person through understanding and using the program; (v) reading the 12 Step

literature; (vi) writing; (vii) telephoning their sponsor and other members; (viii)

giving service such as setting up and clearing the meeting room. Following each

meeting there is a social gathering where food and tea/coffee is served and for which

donations are accepted. This part of the meeting is considered just as important as the

first half. There are alcoholics who have been sober for over thirty years and still

attend meetings in order to maintain their sobriety and to ‘give back’ what they have

gained. There are those who take on the role of sponsor who share their success with

another. All members are encouraged to have sponsors. Accepting the powerlessness

of this condition enables the individual to stay real about how unmanageable denial

can make their situation and what measures they need to take to gain and maintain

abstinence/sobriety/recovery.

It is clear to me, that the twelve steps involve some strategies from cognitive

behavioural theory and RET (Larsen interview 1993). For example, the 4th Step

involves ‘made a searching and fearless moral inventory of ourselves’ which is then

shared in great detail with, preferably, a sponsor (5th Step). This later becomes a way


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of life for looking at problem situations, in other words a decisional balance sheet,

pros and cons list in order to make decisions, a Cost/Benefit Analysis (CBA). I have

heard the questions posed “have you done a 4th step on that issue” (12 Step model)

and “have you done a CBA on that?” (SMART Recovery) showing that they are

similar strategies. Another invaluable 12 Step strategy is the sharing circle which I

have also seen in New Age groups, who have copied that ritual from the Native

American culture, as they pass around a ‘talking stick’. In the 12 Step model a

speaker gets the opportunity to speak uninterrupted without being given advice or

questioned. This process is a learning curve in that people learn from each other’s

experiences as a result of storytelling – talking therapy. Furthermore, as members of

the audience they experience that to talk too long can be boring and to show ‘strength

and hope’ is far more insightful than to sound a ‘victim’ – in that manner role

modelling is the experiential phenomenon taking place. Here is an example of how I

used the 12 Step model sharing circle in professional development as training, stress

management and peer assessment methods.

: Exercise I

12 Step Model

Training, Stress Management & Peer Assessment

As the coordinator/trainer of counsellors/youthworkers I introduced to the staff professional development meetings the 12 Step model where at the beginning (usually involving 10-15 staff) we individually spent five minutes sharing without interruption the experiences each one had for the week. This meant giving examples of problem behaviour from clients and/or Wards of the State in our care, and how each of us resolved this. No one was to ask questions of the person sharing even for clarification purposes until they had completed their story. Many a laugh was had by all and through this process each person learned very quickly the model being used and creative solutions to the problems faced. This also empowered each worker to be creative and transparent about the methods they had used – there was trust. This process also relieved the high level of stress that can be experienced in such work. Our unit involving the Wards of the State (Stansfield Program) was so successful that people from other organisations here and interstate visited us to see what we were doing that resulted in the good work morale and decreased violence from our youth. In this model participants operated at a trust level through feeling safe because criticism was not acceptable, it was not seen as constructive. Therefore, everyone learned from each other’s experiences, using the agreed model and through peer assessment which was aimed at being encouraging. (Affie 1998)

RET (REBT) which I elaborated on earlier, was also included with 12 Step Model at

The Hazelden Private Treatment Center (Minnesota USA). In 1993 when I visited


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the Hazelden Centre, whose addiction recovery program was influenced heavily by

the AA epistemology, there was a practitioner on site who wrote RET literature for

the participants of this program. So for that to be taking place, RET would need to be

enhancing the Hazelden paradigm which supported the notion that addiction is a

disease. When I interviewed the head of the professionals' training course at

Hazelden, Larsen (interview 1993), he mentioned that they were open to utilising

other therapeutic interventions for learning coping skills such as those of the RET

(REBT) paradigm which, although not identical, were compatible with the Hazelden

program. Therefore, the RET (REBT) methodology although not strictly identical to

that of the host treatment, was able to complement the Hazelden recovery program.

This Minnesota Model was originally part of most AA treatment programs such as

Hazelden Foundation, Betty Ford Foundation, Sierra Tucson Centre.

7.16 Twelve Step Facilitation (TSF)

TSF was designed specifically for Project MATCH (1993) so that it could be one of

the three approaches researched in MATCH.

TSF Definition

TSF focuses on three objectives:

• AA attendance

• Getting active in AA [personal change is achieved via 12 Steps]

• Getting and using a sponsor in AA [guide for using the12 Steps]

It is important to take whatever time is necessary to explore resistances, to make suggestions, and to elicit a commitment to any reasonable progress in these areas. [Twelve Step Facilitation in Action 2007]

TSF seeks to facilitate two general goals in individuals with alcohol or other drug problems: acceptance (of the need for abstinence from alcohol or other drug use) and surrender, or the willingness to participate actively in 12-step fellowships as a means of sustaining sobriety. These goals are in turn broken down into a series of cognitive, emotional, relationship, behavioral, social, and spiritual objectives. (Nowinski, NIDA 2007)

As a result of Project MATCH (1993) TSF, CBT and MET (which spawned MI)

were declared “state of the art in behavioural treatments” (Gordis 1996). I have

shown the CBT and MI treatments earlier, and now I elaborate on the TSF approach


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from information provided by Jurd (TSF slides 2007) and Nowinski (NIDA 2007) as

adapted by me.

TSF facilitators are trained in the model which supports that addiction can be

arrested but not cured and that recovery comes from abstinence and working the AA

12 Step program (also the basis of other programs such as Narcotics Anonymous).

Abstinence together with character building is the desired goal. The 12 Steps model

is a spiritual program which is documented in the AA Big Book (1988 3rd edn) and

the related literature for recommended reading, and is to be followed in detail, in

order to gain and maintain recovery. Attendance at 12 Step meetings is a primary

requirement, providing talk therapy whilst people share their stories of experience,

strength and hope.

Another important aspect of this program is using the 8 tools of the 12 Steps

program, as shown previously.

Twelve-Step Facilitation (TSF) consists of a brief, structured, and manual-driven approach to facilitating early recovery from alcohol abuse/alcoholism and other drug abuse/addiction. It is intended to be implemented on an individual basis in 12 to 15 sessions and is based in behavioral, spiritual, and cognitive principles that form the core of 12-step fellowships such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). It is suitable for problem drinkers and other drug users and for those who are alcohol or other drug dependent. (Nowinski, NIDA 2007)

As part of the 12 to 15 sessions 2 conjoint sessions shall involve the significant

other (SO), providing there is one, and the focus is on recovery issues such as

detaching vs enabling and not marital or job issues which can be dealt with no

sooner than 6 months following recovery having been achieved and maintained.

Given that the TSF theoretical rationale is based on the 12 Steps and 12 Traditions

of AA, TSF accepts that willpower alone is not sufficient to achieve recovery.

Furthermore, it supports that alcoholism and other drug addiction are illnesses which

affect the person mentally, physically and spiritually affecting their ability to control

usage. Surrendering to this condition and accepting that there is a loss of control

enables the person to follow the 12 Steps in order to become free of the obsession

and compulsion (Blake & Stephens 1987). It is accepted also that there is no cure

but rather that the disease is arrested as long as abstinence is maintained, therefore,

for that reason it is not compatible with a controlled drinking (CD) model. Another

important point regarding the need for spirituality in recovery is clarified here:


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that self-centeredness must be replaced by surrender to the group conscience, and that long-term recovery consists of a process of spiritual renewal. The primary mechanism action is active participation and a willingness to accept a higher power as the locus of change in one's life. (ibid)

TSF facilitators are facilitators of change whereas the agent of change is the 12 Step

fellowship, therefore, TSF facilitators encourage the individuals to attend and

become committed to the 12 Step fellowship and to follow its program. The TSF

facilitator’s role involves providing “education and advocacy, guidance and advice,

and empathy and motivation” (ibid) in a directive but non-punitive manner, showing

unconditional positive regard. The TSF facilitator monitors the recovery tasks such

as client’s ability to be abstinent, dealing with the client’s inability to maintain

abstinence if needed, client attending 12 Step Meetings (possibly 90 in the first 90

days), obtaining a sponsor, clarification of a moral inventory. TSF facilitators need to

have minimum credentials of a master’s degree (or equivalent) in a counselling field

so as to have the required clinical skill to implement the TSF manual. Furthermore,

they need to be able to stay focussed and in control of the session establishing a

collaborative relationship with the client, utilising confrontation in a constructive

non-punitive manner. The Session involves the client sharing about their recovery

journey during the week regardless of whether they have had success or not and their

ability to get active in AA or NA. This is followed by reading and/or didactic

processes to ensure they understand concepts. Then there is a discussion about what

the client understood out of what tasks they had undertaken and then fresh tasks are

set (ibid).

Finally, another strength of the 12 Step fellowship is the peer support gained from

those who have experienced the problem before, have found freedom from the

obsession through recovery and are willing to share this with anyone needing to

learn. This job description is very similar to that of the work usually carried out in

the past by drug and alcohol counsellors, except that they did not usually have

minimum credentials of a master’s degree.

7.17 Visualisation, Affirmations, Hypnosis, Self Hypnosis, Mindpower

The use of exercises and strategies which are aimed at utilising the power of the

mind, has been documented extensively as an indisputable method of

personal/professional development and self-actualisation, for the purpose of

developing good self-esteem. This process enables people to rely on their own


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resources and not to depend on drugs or addictive destructive processes to achieve

their desired goals. Such exercises are used even in preparing persons to win sporting

events. So I will not elaborate here about that except to mention experts such as

Anthony Robbins – I attended one of his weekend events and found it impressive

and useful (Unlimited Power 1988); likewise Maxwell’s weekend seminar (1997);

DeBono (1990); Maslow (1954); Gallwey (1983); Powers (1961); Reid (1989). I’ve

even walked on fire eleven times at Judsta’s firewalks and one more time at the

Robbins event, which was indeed an awesome, empowering experience. This gave

me first hand experience of the power of the mind and that we can do many things

that can be considered impossible. Such power of the mind exercises also fit into the

synthesis – diversity of approaches concept because personal empowerment develops

good self esteem to handle life’s ups and downs functionally.

7.18 Yoga, Relaxation, Breath Awareness (Rebirthing), Meditation, Exercise

All these forms of stress release and personal/professional development are well

known and documented as important to personal development and/or maintaining

recovery. Some examples of yoga, meditation, relaxation, and breathing exercises

can be found in Davies (2000) and Kent (1998). Exercise such as aerobics,

hydrotherapy, pilates and/or sport are also extremely therapeutic e.g. tennis, tenpin

bowling, squash etc., and attending a gym for aerobics or pilates or using exercise

videos and equipment in the privacy of the home. I have experienced ten rebirthing

sessions which extremely improved my breathing/relaxation and when I have

difficulty falling asleep I can correct the shallow breathing and fall asleep

immediately. I have often seen successful results when recommending the

mindpower and breathing exercises for people who suffer insomnia. These methods

was especially helpful with people coming out of detox into the MARS or SCOPE

Halfway Houses who found it difficult to sleep, as they no longer used alcohol and

other drugs for that purpose.

7.19 Kings Cross Medically Supervised Injecting Centre (MSIC)

The State Government has approved funding for another four years for MSIC in

Kings Cross ($2 million per year running costs not including management fee paid to

the Uniting Church). Kings Cross Police Supt. Darcy, Moore (Mayor - City of

Sydney Council), local GP Ikegame, Wayside Chapel senior duty counsellor Jim

George, and other residents such as Hopkins, all confirmed that there are less


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overdoses and less syringes thrown about nowadays. For that reason this project is

supported. The Kings Cross Chamber of Commerce and some other residents are

against this centre because of its present location, which is in Darlinghurst Rd., the

heart of Kings Cross business centre and opposite the railway station. MSIC

Director, van Beek at a public meeting (August 2003) which I attended, stated that

the role of the facility was to provide a medically supervised injecting environment

for those who would otherwise be on the streets. This is the same aim as that of the

centre in Berne, Switzerland. van Beek reported that MSIC had saved lives – by

April 2003 the Centre had seen 88,322 injecting episodes, averaging 226 visits per

day with the most frequent clients being sex workers. She added that the dignified

and respectful treatment they received ‘hopefully increased their sense of self-worth,

essential to effecting personal change at an individual level’ as printed in The King’s

Cross Times, (July16, 2003).

7.20 Berne (Switzerland) Medically Supervised Injecting Centre

Marxer, Manager of the medically supervised self injecting Centre – Low Threshold

Agency (Contact Netz) in Berne, Switzerland, in an interview with me (October

2000) stressed that it does not mean that people will run to use the Centre just

because it exists but rather it is used by people who were previously homeless and

using in the streets. As I sat in the lounge area I could agree with her as it was a

modestly furnished area and could not be described as plush. Therefore, it could be

imagined that it was certainly a cut above the lifestyle of living in the streets, but not

one that the average recreational drug user would favour. Furthermore, it would

enable the participants to be reminded of how life could be better if it were not for

their addiction (Stewart interview 1963). This then means that it can be a step up

towards a rehabilitation program. The important thing to remember is that in this

type of agency, people are to bring their own drugs, as these are not provided on the

premises, and neither can they be purchased from others there or immediately

outside. Speaking with Haemmig, the head of the Integrated Drug Service, Berne,

Switzerland, he described the benefit of the prison program which does supply the

heroin for injecting, and that this was important so that inmates would not spread

HIV and hepatitis within the prison.


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7.21 Stockholm (Sweden) Drug Free Society Program

On my trip to Stockholm (2000), interviewing Johansson, the Secretary General of

the Swedish National Association for a Drug Free Society, I found out that their zero

tolerance program had worked brilliantly when the government supplied the funds

and resources. The police, social workers and schools all worked in together as soon

as a young person presented with drug problems. The team then worked with the

young person and their family to rectify the reason for the young person’s straying

into a life- threatening direction. In other words it was treated as a social problem

and remedied with the assistance of the team. As everyone became over-confident

with the good results, the government cut the funding and it became a bleak situation

- the team could only focus on very young victims and had to ignore the needs of the

older ones, leaving them at risk. National drug taking was on the increase and so

were the problems that go with it. This model contributed to information I shared at

seminars such as the international Humanist Australis2000 Congress and the

Families & Friends for Drug Law Reform Association (2004) in Canberra.

7.22 Amsterdam (Nederlands) Progressive Drug Programs.

In Amsterdam in 2000 when I spoke with the Manager of the Jellinek Prevention

Team I found out that their approach is multi pronged. There is an education

program for schools where children are informed about the dangers of drug taking

(this includes alcohol and nicotine). Then there is an acceptance of the right for

people to use recreational drugs and legislation enables the use of and growth of

marijuana. People can smoke pot in certain cafes, however, the onus is on the

proprietor that they cannot purchase or sell this on the premises and should this take

place the café is shut down. This can happen three times after which the café is

permanently shut down, so it is within the owner's interests that the café is purely a

place for a person to smoke pot socially but not do business with it. People using

designer drugs such as ecstasy have the opportunity to have their drugs tested at a

voluntary program. Doing this ascertains the purity and death can be avoided from

impure drugs. Even so their statistics of deaths from ecstasy were much higher than

ours in Sydney in 2000. One reason being that recently ecstasy users have found that

by drinking water when using ecstasy death from dehydration, the main cause, could

be avoided. Then, of course, there are safe injecting and rehabilitation programs for

those who have full-blown addiction and need professional care. He also said that

heroin injecting was considered to be an old person's drug and so the demand is


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minimal, with most young people going for designer/recreational drugs. Although

Amsterdam and Berne seem to have a more workable model it does not mean that

Stockholm has not. According to community attitude in Sweden, although theirs is

more suitable for them, their model is being hampered due to the change in funding

and resources provided by the government. Much like Australia where we have

committed to a harm minimisation model and yet the government here has not been

forthcoming with the funds required which means that what we are doing is being

obstructed (Wodak Australis2000). Subsequently, whichever model is used, it needs

to be fully supported by the community and the government and resourced well in

order for it to be effective. Nevertheless, the method needs to be progressive. Again

this is information I include in my talks.

7.23 Life Education Australia

A registered charity, this service was originated by Ted Noffs in 1979, with support

from the Hon. Bob Ellicott who was on the founding management committee, and

delivers school-based drug education to over 750,000 pre-school, primary and high

school students per year (Life Education 2007). Its mission is to teach young people

about health, about things that can harm them – legal and illegal drugs, as well as

equipping and encouraging them to make choices that will keep them safe and drug

free. Life Education Australia believes that prevention is better than cure. Each

State/Territory office is responsible for the employment of Educators and the

delivery of programs and resources in its own State/Territory. The programs and

resources are based on latest research into effective drug education. They provide

high quality drug education demonstrated by role-play; social skills training;

correction of common myths; and varied, fast moving and interactive activities using

the latest multi-media technology, including Virtual Classroom and other current

online programs. “These curriculum outcomes based programs can be used with

school-based drug education, to assist young people develop the social skills and

knowledge necessary for effective decision-making, communication, negotiation,

peer resistance and refusal in drug-related situations.” (Drugsafe 2007). The schools

are visited with mobile Life Education classrooms and after the visit they are

encouraged to log in for their online resources such as videos and cartoons which had

been shown on the Life Education visits.


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7.24 Whatever Works

Whether addiction is considered a disease or not, whether it is considered genetic or

not, whether AA or behavioural models should be used or not, most importantly the

individual needs to find the recovery model that works best for him or her. Clearly

put by Krivanek, the founder and former Director of Clinical Drug Dependence

Studies at Macquarie University and at the University of Newcastle and more

recently Professor of International Relations at the Technical University of Ostrava

in the Czech Republic in her book Understanding Drug Use: The Key Issues (2000),

there is little hard evidence to either validate or disprove the three principal models

of addiction – disease, moral and psychosocial.

They have operated more or less as rivals, yet all of them are productive – each

permitting us to assist some of the people some of the time. We can choose the

model that best agrees with our worldview. But if we are concerned with the

management of an actual drug addiction in an individual the choice between the

model used is ultimately guided not by our view but by the addict’s own personal

conception of what addiction is.

As Krivanek confirms…

[This conception] will significantly influence the addict’s behaviour and it will determine the form of therapy to which he or she will best respond. Therapists do not heal people. Clients heal themselves. One way or another, with professional help or without, the individual, sensitized to the need for a new solution, must make the crucial decision to change on his or her own…the solution selected must be one that feels right for that individual.” (2000:55)

Therefore, people need to find their way through recovery. Sometimes they need to

try one method in order to come out of denial about what will work for them. I agree

totally with Krivanek’s comments as can be seen in the section on my praxis, and

below is an example of how I deal with such a situation.

Exercise J

Harm Minimisation Through Research & Trial Exercise

A client was a heavy drinker to the point that he was at risk of becoming violent. His wife was about to leave him so they came to relationship counselling. I intuited that he perhaps was not an alcoholic so I asked him if he was willing to try and find out for himself what hold the alcohol had on him. He agreed and I asked him to chose a timeframe that he would not drink and therefore test himself. He agreed and I also asked him to attend with his wife an AA meeting for the experience, and as an intervention used for ‘bringing up the rockbottom’. That is, showing him how bad it


239

could get if he does not modify his behaviour. I saw the couple for 5-6 times and they found a solution to the problem drinking. Needless to say, in that process we also covered enhancing communication skills which lessened the abusive behaviour between them. Both attending one AA meeting together meant that they shared the fact-finding exercise and had they needed to go back they were now informed. It is an awesome self-help support movement for people recovering from alcoholism. Although he did not need the program, because the behaviour modification strategies we used were effective, should he find later that he relapses to that behaviour, at least he would know where to go for a more intense supportive program.

When a person is not convinced that they have a problem we can be of no help by

telling them they do. Yes, there is a risk that the person is toying with death. But

surely that is their choice and the best we can do is provide the information for them

to make that choice? As ‘duty of care’ there are times when we need to be more

confrontational in the assessment of their condition, however, they are still

responsible for that choice. It is totally codependent for us to think that it is up to us

to make them do what they must do to save themselves. Even so, some members of

AA would perhaps disagree, as they believe that an alcoholic needs all the help they

can get in the early stages by having someone to get them to meetings as they are in

denial about their condition (Johnson 1980). However in the codependence recovery

field, that is called becoming their conscience instead of providing the platform for

them to reclaim their conscience, which has been taken hostage by the caretakers in

their lives. So there is a fine line between one and the other and it is important to

have the skills to provide the appropriate decision-making information competently.

However when someone comes to me and presents with the symptoms of alcoholism,

admitting that he/she is out of control and cannot stop themselves and that they feel

their life is unmanageable (car accidents, loss of job etc), I do not waste time with

this life threatening condition and after providing them with the information about

alcohol abuse I then immediately urge them to attend several AA meetings before the

next consultation with me. Of course, there needs to also be evidence presenting

itself from their genogram that indicates this would be the best strategy at that

moment. I also tell them that this does not necessarily mean they are alcoholics but

that becoming informed is an important life saving option. It’s not about who is right

or wrong, but rather what stage of impaired control the afflicted person is at, their

awareness about their affliction, their willingness to get into recovery from it and the

method that mostly suits them. This latter point determines which modality will work


240

for them. Although sometimes their denial may make it difficult to chose the

appropriate method of recovery at first. In some cases their addiction is so severe that

just having access to harm minimisation programs is a good beginning to a better

lifestyle. My experience in this area gives me the confidence to present emergency

options for someone in such a situation. Whereas with another person, who has a less

severe dependence, we have more time to explore their awareness and preferences,

giving them the time to make a firm commitment to recovery.

7.25 Client Self-Responsibility & Self Determination – Available Choices

Diversity in treatment methods is vital for people to make choices of what to use, and

therefore ensuring a more successful outcome. Client self-responsibility, first coined

by Socrates, and self-determination has been shown to be a more powerful catalyst in

recovery of any illness or disorder. As William Oslo maintained in 1905 you get the

best results from any therapy when it is new (Cassimatis interview 1993). The

placebo effect can be very powerful.

Government funded services should provide a fair balance of available services both

for controlled drinking(CD)/use and abstinence/12 Steps/TSF programs so that client

self-determination can take place. A CEIDA pamphlet is an example when this has

not taken place. CEIDA (Centre for Education and Information on Drug and

Alcohol) is a government funded organisation providing information and training

regarding alcohol and other drug problems. The pamphlet is Figure 6 on the next

page.


241

Fig. 6

CEIDA PAMPHLET

(Centre for Education and Information on Drug and Alcohol) literature

Naltrexone – A guide for Carers, [information is imparted on Naltrexone

which is a treatment for drug and other alcohol dependencies and on the last

page is the statement.]

Choosing the right treatment

Naltrexone is one of a range of treatment options for opioid dependence. Other

treatment options include:

Methadone maintenance

Detox, rehabilitation

Counselling.

Adagio: ��

��

��

Deciding to undergo naltrexone treatment requires careful consideration.

The important thing to remember is that the patient must detox first.

Naltrexone is not a euphoric alternative to heroin or other opioids. It’s a

drug which blocks euphoric effects and helps maintain the patient’s

abstinence.

As a carer, let the person know that you will support and care for them and

that they will not be undergoing the naltrexone treatment alone. Establish the

fact that you may be supervising their dosage. Explain to them that it is not

because you don’t trust them but because you are their care and support

person. If this is a role that you have both agreed to then let the doctor know as

early as possible.

(2000:7 http://www.ceida.net.au/drugs/naltrexone2)

What irritates me, as an addictions counsellor and member of the community, is that

a government funded information organisation can make recommendations of


242

“choosing the right treatment” and showing options that completely ignore

successful community self-help groups that are available and free. This does not

mean that the AA fellowship and church groups are to be promoted by government

but rather that people should also be informed of alternatives that are available to

them. As a humanist my thinking is secular and I do support the separation between

Church and State, however, I have seen how such groups (and AA is not a church

group) have had successful outcomes in freeing people from the torment of addiction

by belonging to such fellowships (100,000 AA groups worldwide). Yet much

government funded literature omits the existence of such successful resources as an

option.

However, “A Manual of Mental Health Care in General Practice”, by John Davies,

a national mental health strategy does show under the self-help groups heading the

12 step options for recovery. One could say that there is a risk of government being

responsible for referring people to organisations that may perhaps do damage, but so

could referring them to counselling turn out to be the same if some counsellors were

incompetent. Nevertheless, I have seen hundreds of people who have been hopelessly

addicted who upon joining religious groups have gone on to live clean and sober,

fulfilling lives.

To be fair, some AA members have also been biased and accused cognitive

behavioural therapies of not working. A few AA members have also ridiculed the

codependence movement because the AA fellowship relies on members taking a

close active role with newcomers and this could be interpreted as codependent

behaviour by some.

7.26 Life Coaching Website

I have established a website http://www.affie.com.au (created by Paul Zagoridis, my

son, October 2005) which shows simplified life strategies for personal/professional

development and addiction recovery, as well as other links of possible interest. I

make blogs (web logs) at least three times a week. As it is new I still need to refresh

the overall presentation of my website. By 2006, there have been over 2,000 hits to

the website daily and I have responded to many enquiries about addictions.


243

8. Reflection

In this chapter in showing the synthesis: treatment matching – diversity of

approaches, it can be seen that there is a place for both abstinence and controlled

drinking recovery programs and the use of a combination of both – a total of twenty

two in all. However, the importance that service providers give appropriate

information, without excluding vital aspects, can make the difference between a

person’s successful recovery or not. Also shown was the importance of treatment

matching to suit the severity of a person’s compulsion and their worldview, to ensure

the success rate of their recovery.

10. Summary

As a result of this research, my praxis has evolved into a client centred model

consisting of a diversity of approaches informed by the twenty six (26) points in this

chapter. In other words, I use a client centred approach together with any of these

twenty two tools to provide information to the client about their condition and what

options they have available to them for recovery. This assessment needs to be

accurate and also requires my skills to motivate the client to make a wise choice as to

what is workable for them. Feedback from these clients has shown that my approach

facilitates their recovery and they also recommend my service to others. To be more

specific when a client approaches me for assistance, I assess how they perceive their

problem, what they know about the risk to their health, and what they are prepared to

do to improve their situation. This is when I provide information about their

condition, as I see it, and what is available for them to do. The stage they are in will

determine which strategy I will use. For example, if they are in denial about how

serious their problem is then I will set an exercise for them to test it through harm

minimisation and as they realise that they need something more structured we will

then discuss what they are willing to try. Empowering someone to make such

decisions usually results in more effective recovery choices. Another person may not

be so seriously affected and can find out through such a process that they are able to

lessen their dependency through self-awareness.

In the Life Strategies Workshops which I facilitate, the aim is for participants to

become aware of, through one or two of the exercises I have shown in this chapter,

what measures need to be taken to improve the situation in their life. This self-

awareness may be blocked by the busy lifestyles they have and once they experience


244

one of these exercises, which I facilitate, it becomes an enlightening experience for

them, making it possible to make the necessary changes. The benefit of this method

is that the process is experiential, enlightening and empowering. Feedback from

these Life Strategies Workshops has been also positive, as it is not only obvious

during the process but I provide feedback sheets which are duplicates and one comes

to me as the facilitator and they keep the copy to refresh their memories, as needed,

of what has taken place for them (Appendix D).

I have also used information from these twenty-six approaches in my private practice

as a therapist, and as part of professional development courses which I have

facilitated:

• TAFE Aboriginal Communication and NESB Social & Work Environment

Courses and Animal Care Communication Course (Bankstown)

• TAFE CGVE Youth Courses (St George)

• TAFE Alcohol & Other Drugs Interventions Course (Loftus)

• Wayside Chapel Crisis Intervention Counsellors & Youthworkers Training

Courses

• Barnardos Youthworkers Courses

• Ethnic Child Development Unit Courses

• Life Strategies Workshops

For me, this synthesis has come about as a result of the polemic between the two

major sides of The D&A Debate, making a diversity of approaches which includes

both those elements rather than creating a new theoretical position, as in the Hegelian

sense.

The next chapter brings together the information documented in this Thesis and

highlights the outcomes of this research carried out over a ten year period when The

D&A Debate began showing a strong split between professionals from the disease

model and those from the non-disease model, then moving through to an admission

from both sides of the continuum that it is important to cater to those people who

could not benefit from the one model.

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CHAPTER 7

CONCLUSION AND RECOMMENDATIONS

When I began the Compulsion & Recovery (C&R) Research Project in 1992 I did so

in response to the schism, known as The D&A Debate, between professionals who

were leaders in the addictions recovery field. This schism resulted from changes in

government policy as a result of the National Drug Strategy 1985 with its

underpinnings in harm minimisation/reduction. As government funding influenced a

change in service provision away from the 12 Steps model towards Harm

Minimisation models, great confusion was caused to people suffering with

addictions and service providers/therapists trained in the 12 Steps model, such as

myself.

I was trained and experienced in abstinence with the Alcoholics Anonymous 12

Steps model, which up until this polemic was easily recognised as the most effective

method of recovery for alcoholism and other addictions. In running halfway houses

for people recovering from alcohol and other drug problems I found it amazing that

there was such a swing away from what had worked and that the AA 12 Steps

program became stigmatised. It had become necessary to be careful when and where

the AA word was used and 14 years later I found that the same tension applies. I

discovered this tension when in 2007 I phoned several services to get an update

regarding which model they were using.

AA refused to comment, as it is their policy to not enter into public controversy – at

the beginning of this research in 1992 some AA elders told me this trend towards

social drinking (Harm Minimisation as it was called then) occurred every 10-12

years. Perhaps a cyclical schism as I called it, and yet most interviewees had not

confirmed that term but did admit that there had been cycles to and from what was in

vogue (Maclaine interview 1993). AA was there for those who found it worked for

them, and those who did not, could go elsewhere. It did not seem to matter to the AA

Central Office (1993) that their program was being referred to as one creating a

‘labelling’ process (negatively branding a person) or encouraging people to live a

‘victim/loser’s script’, by admitting they are alcoholics. AA Central Office knew the

program worked and they went about their business providing a supportive

Chapter 7: Conclusion

246

fellowship. Neither did government bureaucrats appear worried about the effect on

AA with the Harm Minimisation/Reduction Policy (NDS 1985), because AA is a

voluntary organisation and it would continue to exist (McAvoy interview with me

1993).

Lennane (1992), in an interview with me in 1993, claimed that government policy

was favouring services that would save money and gain votes, ‘enabling’ the

community to get into denial regarding heavy drinking. Heather (1983) in an

interview with me in 1993 believed that controlled drinking worked and he had been

involved in studies which showed this. Such research findings had influenced the

Health Department’s National Drug Strategy (1985) to be based on harm

minimisation policies. Jurd made it clear in newspaper articles (Appendix B) and

interviews with me (1992, 1993, 1994, 2000, 2007) that abstinence and the AA 12

Steps model, and more currently the Twelve-Step Facilitation (TSF) clinical

approach (designed for Project MATCH 1993), was the recovery program that

worked with severely dependent persons.

The AA 12 Steps model supports (i) abstinence; (ii) regular attendance at AA

meetings; (iii) anonymity; (iv) getting a sponsor for guidance on how to use the

program; (iv) giving service such as helping to set up and/or pack up meeting gear

(chairs etc); (vi) reading AA literature; (vii) writing; and (viii) telephoning other

members and the sponsor in order to avoid isolation. The 12 Steps are a character

strengthening process – the steps are based on eastern and western philosophy,

psychology and the practical aspects of the Bible. It is not an organised religion, as

members can have their own beliefs including agnosticism and atheism,

nevertheless, it does support developing a connection to a Higher Power of one’s

own understanding to experience spirituality. The HP can be the 12 Steps Program

itself, for atheists or agnostics. For others the HP/Spirituality can involve meditation,

music, belonging to a loving fellowship or, for those who prefer, it can mean a God

of their choosing, and/or a religion which they belong to outside the 12 Steps

fellowship. Furthermore, belonging to the 12 Steps fellowship, where people have a

common goal of abstaining and being committed to a way of thinking that involves

being ‘up front, honest and open’ about themselves, especially avoiding gossip and

ill-will towards others, provides the serenity required to live in awareness of the

authentic self. This serenity can help a person avoid picking up drinking


247

alcohol/other drugs/addictive processes (according to the program they join). The Al

Anon 12 Steps program is used by family and friends of alcoholics where they learn

how to detach and avoid being enablers of alcoholism. The AA 12 Steps has been

adopted by Narcotics Anonymous (NA) and many other groups wanting freedom

from compulsion such as Codependents Anonymous (CoDA), Overeaters

Anonymous (OA), Nicotine Anonymous (NicA), and Gamblers Anonymous (GA).

Twelve-Step Facilitation (TSF) was independently designed as a clinic approach

comparable to CBT and MET (later known as MI) which were the other two

modalities researched in Project MATCH (1993) and which differed from each

other. Facilitators of TSF are professionals trained to motivate individuals seeking

abstinence from alcohol or other drug use to commit to the 12 Steps program by

attending regular AA meetings and working that program through the eight tools

shown in the previous paragraph. There are 12-15 sessions where the goals are

broken down into a series of cognitive, emotional, relationship, behavioural, social,

and spiritual objectives (Nowinski 2007). Out of those sessions 2 can be with the

significant other (SO) where strategies are considered as to detachment from

enabling behaviour. Project MATCH (1993) has provided recognition for an

approach involving the 12 Steps model which until then could not be researched due

to the anonymous nature of AA. The outcome showed that TSF along with the other

two modalities, CBT and MET, are ‘state of the art’ approaches (Gordis NIAAA

1996) and similar to each other in efficacy, although TSF participants were more

likely to be found abstinent in the one year follow-up because they belonged to the

12 Steps fellowship (ibid).

Mant (interview with me 1993) believed that although AA did work for a minority

group, something was needed for those who could not benefit from AA, and that was

the rationale behind the Harm Minimisation/Harm Reduction (NDS) policy for

detox/rehabilitation units and outpatient programs.

Harm Minimisation/Harm Reduction is the basis of the National Drug Strategy

(1985) which came out of the ‘National Campaign Against Drug Abuse [NCADA],

Campaign document issued following the Special Premiers’ Conference Canberra

April 2 1985 (Fixter 2007). Harm Minimisation/Harm Reduction as was explained

to me by Heather, MacAvoy, and Mant (interviews 1993), refers to such programs


248

as needle/syringe exchange; education regarding careless drug use, excessive

drinking/using and promotion of safe driving. Another service under the HM/HR

umbrella was established in the late 1990s - the Sydney Medically Supervised

Injecting Centre (MSIC) in Kings Cross. As a resident of Kings Cross I have seen a

vast improvement since its inception. There are fewer visible overdosed people lying

in the streets and fewer used syringes too, although the latter can also be due to the

appropriate syringe disposal systems available nowadays. Harm

Minimisation/Reduction (NDS) supports behavioural and medical models for

treating people experiencing difficulties with excessive alcohol/other drug use

(including cigarette smoking).

Examples of such models which can be carried out with the guidance of a

professional are (i) Cognitive Behavioural Therapy (CBT is based on social learning

theory) which assists the person to take control of the undesired behaviour using

certain strategies such as a log documenting usage and enabling them to reduce the

harm; (ii) Motivational Interviewing, born of Motivational Enhancement Therapy

(based on motivational psychology) which enables the person to identify their level

of motivation to change and mobilise personal resources to achieve the outcome they

desire (NIAAA 1996); (iii) Narrative Therapy which enables persons to share their

stories with others and find strategies that can work for them; (iv) Medically assisted

harm reduction such as methadone, naltrexone, and medically assisted

detoxification; (v) Smart Recovery groups (based on CBT) with meetings held in

Australia (approximately 39 in NSW); (vi) harm reduction education through the

media such as the ‘quit smoking’ campaign (Quit); (vii) Controlled Drinking (CD)

programs which have tapered off recently (Mattick meeting 2007). Other CD

programs such as TV advertisements aimed at youth drinking which promoted harm

reduction - the message was to reduce the amount of alcohol consumed.

Furthermore, the police random checks have resulted in people reducing their

drinking for fear of losing their licenses. It was not the aim of this research to show

how successful that is and perhaps can be the area of focus for further research.

Although abstinence and the 12 Steps model is harm reduction this does not appear

to be recognised as such by the HM/HR section of the professional community.

Project MATCH (USA) research involved 1,726 participants who were alcohol and

other drug dependent and was “the largest and most statistically powerful clinical


249

trial of psychotherapies ever undertaken” (NIAAA 1996). Not only did this research

identify three ‘state of the art’ approaches but participants “showed significant and

sustained improvement in increased percentage of abstinent days and decreased

number of drinks per drinking days, with few clinically significant outcome

differences among the three treatments in either treatment arm” (ibid). This means

that in the aftercare arm there was no difference in sustained abstinence between the

treatment approaches. “However, outpatients who received 12-step facilitation were

more likely to remain completely abstinent in the year following treatment than

outpatients who received the other treatments” (ibid). Furthermore, participants who

had low psychiatric severity had more abstinent days with Twelve-Step Facilitation

Therapy than those treated with Cognitive Behavioural Therapy (ibid).

Given these findings, there is strong evidence that these three different approaches

have efficacy in the area of recovery, yet CBT and MET - later known as

Motivational Interviewing (Jarvis, Tebbutt & Mattick 2001 7th edn) have more

recognition in Sydney services than the 12 Steps model or TSF from the same

research. There is tension still from services based on Harm Minimisation/Harm

Reduction. This tension became apparent to me recently when I phoned

detox/rehabilitation units in an attempt to find out whether the 12 Steps model and/or

TSF exists in Sydney services. This recent experience reminded me of the tension

during The D&A Debate, in the late 1980s and early 1990s. Why was it necessary

for these professionals to clash in public about their differing opinions? Pollard

(interview with me 1993) described the meeting of The D&A Debate (1990) between

the protagonists, saying that it was a disappointment because of the unprofessional

behaviour exhibited by some members of the panel and some of the audience.

As a Family Therapist specialising in addiction recovery, having listened to over

20,000 stories at AA and related meetings, I became familiar with what worked and

what did not. How could scientists and leaders in the field, rationalise methods that

did not work? The D&A Debate was enough to fuel my passion for the journey of

inquiry I undertook. This journey took 15 years, my curiosity was my passion and in

turn the courage to ask people to participate in the research process. In an attempt to

check out the most recent effect of the National Drug Strategy on

detox/rehabilitation services, this year I contacted seven of these and explained that I

was in the final stages of a PhD research into Compulsions and Recovery and


250

wanted to confirm the model they were using. Those who were using a Harm

Minimisation/Harm Reduction model were guarded and referred me to staff

members who had ‘the authority’ to release such information but who were not

present. These were the responses I received after repeated attempts. (i) Langton

Centre (HM/HR model) – I am still waiting for ‘the authority’ person to respond, but

had been advised that they were using Narrative Therapy by a person who refused to

give their name; (ii) Gorman House (HM/HR model) - I am still waiting for ‘the

authority’ person to respond to my message. (iii) McKinnon Unit (Rozelle Hospital),

the ward manager was more helpful as he informed me that they use Harm

Minimisation/Reduction methods and AA/NA run 12 Steps meetings at the hospital.

When I mentioned that this was different to when I brought clients from our halfway

houses in 1984-1989, he was unable to confirm that their program was different to

then. (iv) Odyssey House, the representative was adamant that they are a Therapeutic

Community model – “people helping people”, and do not have a 12 Steps model,

saying that Christian units tended to use the 12 Steps model. I was left with the

impression that further discussion was not to be entered into; (v) Phoenix Unit

(Manly Hospital) reassured me that they were a rehabilitation service and had

qualified D&A counsellors using different models, but I was unable to ascertain

much more as the D&A counsellor was too busy to continue the discussion. (vi)

South Pacific Private Hospital director was too busy to speak with me but I managed

to find out that their model is still based on the Pia Mellody model which involves,

as part of the therapy, a commitment to the 12 Steps model; (vii) Herbert Street

Clinic (Royal North Shore Hospital) director, Dore, was cooperative and

professional in her attitude to my contact, as was the staff I spoke to before my

conversation with her. Their program is committed to harm minimisation/reduction

through programs such as medicated detoxification, and pharmacological therapy for

depression and psychosis; CBT, and other models where people are assisted to

identify triggers for stress and anxiety. Also available are other options to choose

from such as attendance at meetings run by the Smart Recovery group (based on

CBT model), and the 12 Steps model.

I attended Smart Recovery meetings to make sure that I had not overlooked a model

which is relevant to my research. Smart Recovery is based on CBT and started in

1994 born out of REBT (Albert Ellis), SOS and finally RR. It came to Australia in

2002 through St. Vincent’s Hospital which was funded to facilitate the creation of 39


251

groups in NSW, 50 groups in correctional facilities and 1 group in Brisbane. The

program has a Handbook which can be purchased by the participants. They can learn

the way of thinking of the model, which has such strategies for personal

development as a cost benefit analysis to assist with staying abstinent and avoiding

recidivism. The groups are small (approximately 10-12 members) and discussions

take place where members assist each other to understand the way the program

works using rational thinking. There are qualified facilitators who ensure that the

participation is kept relevant to the program. As I have taught CBT and REBT

techniques in courses, I am familiar with the model and was impressed with the

process which appeared to be useful to the participants. This model relies on rational

thinking and does not support spirituality which should suit those participants who

object to the 12 Steps model on that condition.

I contacted Jurd too, who is now Director of Postgraduate Training in Psychiatry,

Northern Sydney Central Coast Network and Clinical Associate Professor,

Discipline of Psychiatry, Faculty of Medicine, University of Sydney, and is also

shown as addiction psychiatrist at Macquarie Hospital, NSW in the ABC Four

Corners 19th February 2007 interview on alcoholism (Cohen 2007). Jurd (initially

connected with Herbert Street Clinic and Phoenix Unit 1993) confirmed the tension I

was experiencing in trying to find out where 12 Steps model and/or TSF was being

practiced in Sydney, if at all, and which Harm Minimisation/Reduction methods

were used at well known detox/rehabilitation services.

It is important to mention here that in my recent interactions with Jurd, Dore

(Herbert Street Clinic), Mattick (NDARC) and Fixter (Dept. Health & Ageing,

Alcohol and Indigenous Programs, Drug Strategy Branch, Canberra), they were all

professional and informative in their responses to me. This is what I had expected

from everyone else I was attempting to obtain information from and yet who

surprised me with the tension. An important piece of information I gained in my

contact with Fixter had to do with Prime Minister Howard’s statements on zero

tolerance (FFDLR 2007). How could we be considering zero tolerance when the

National Drug Strategy is committed to Harm Minimisation/Reduction principles?

She assured me that Howard’s zero tolerance comments refer to drug trafficking –

importing, supply and demand. I would like to believe that, time will tell and this

could be a future area of research.


252

From the beginning in 1992, there were those who ocollaborated with me only in

the early days of the C&R Research Project, and those who shared their experience

and knowledge right through to the end, such as Cassimatis and Jurd. Now that it

is over, I wonder how I managed not to lose interest or give up the inquiry which

was informed by the action research process – perhaps my passion and curiosity

was the positive addiction that kept me going. Moreso, my own recovery from

nicotine and food compulsion provided a strong momentum.

Serendipity was another contributing factor, in that some opportunity would present

itself which was “an offer I could not refuse”. For example, attending seminars

conducted by James, Shuepbach, Peavey, Maturana, Mellody, Noble, the PRIDE

Youth Conference in Ohio, and finding the courage to ask for interviews for my

research project. Then after attending a Law Society Festival and wanting to find out

more about Wodak’s answer to my question about the Swedish model I applied to

UWS for funding to ‘whisk’ over to Europe and conduct some more interviews in

time for the Australis2000 Humanist Congress of which I was the convenor. At

Australis2000 I was able participate in a panel with Wodak, Jurd, Cassimatis,

Dowling, and Ellis-Jones. Being the Convenor of this congress ensured the

opportunity for me to participate in, and organise, such a balanced panel which

covered the continuum of abstinence/12 Steps model to Controlled Drinking/Harm

Minimisation. Initially in 1999, the last thing I had wanted to do was become the

volunteer convenor of this congress but the need to save the situation took over and

led to the opportunity to create something very relevant to my research process. This

is the approach I call feminist action research because it means a woman researching

who becomes creative, proactive, and original (Reinharz 1992) and doing it her way

instead of being bogged down by traditional research methods (Graziano & Raulin

1993).

Ecofeminist action research played a major role in the Compulsions & Recovery

(C&R) Research Project (Affie 1998) when as the full time Co-ordinator of the

Stansfield Program I was able to influence the design and implementation of a

training program for the youthworkers and young Wards of the State in our care.

This program, although initially a social ecology seed, bloomed and evolved from

the creative process of myself and the staff, as well as creative input from the youth

in our care. The young people came from families afflicted with addictive


253

behaviours, which were not identified as that (again because of the stigma that

HM/HR era placed on the concept of addiction). These young people until then used

vandalism and violence, especially against women, to express themselves. Using an

approach that befriended them and trained them to negotiate for their needs, within

two years everyone lived and worked in a lifestyle based on a more nurturing,

caring, creative, non-punitive, non-punishing, non-restraining approach. The young

people showed an improvement in how they treated each other, women, and the

environment. Professionals came from other agencies, even interstate, to see why

our model worked so well. Our young people, in Stansfield House, did not run away

and they did not attack staff. In time their behaviour mellowed from the violent type

they exhibited originally when they became Wards of the State to that shown in our

care. Youthworkers were encouraged to live and role-model ecofeminist behaviours

(Mies & Shiva 1988) so as to counteract the damage the patriarchal childrearing

model had created for these young people.

This was a stand alone ecofeminist, action research project documented elsewhere

(Affie 1998). I show this outcome here because the approach was influenced by the

12 Steps program of character building through a loving fellowship (which the

youthworkers created). Yet there was an element of Harm Minimisation/Reduction

where it was unrealistic to expect these young people to be clean and sober but

rather they were given incentives to not use drugs or smoke in the house. They could

smoke cigarettes outside. We educated them on the importance of avoiding

becoming addicted. When they were found to be smoking marihuana, we took them

to Narcotics Anonymous for a meeting so they could hear firsthand how marihuana

affected young people and how it contributed to more severe drug use. Campbell

who, when I interviewed him, was the Director of Clinical Services, Rozelle

Hospital (1993) has more recently confirmed how cannabis can seriously damage a

young person’s brain (ABC Four Corners interview with Cohen 2005).

I shared my dream about the final stage of The D&A Debate with my UWS

consultant, Russell (Social Ecology 1992), that at the end of this research I would

like to bring together some of the protagonists. At such a meeting, I planned to ask

them what differences there were in their attitudes about addiction recovery

compared to how they felt at the beginning of The D&A Debate. Russell chuckled

(probably at my audacity) and said that if I could get some of these people to attend


254

a ‘book launch’ lunch, that would in itself be quite an achievement, never mind a

discussion. As it turned out, in the Addictions Session of the international

Australis2000 Humanist Congress, I spoke on my findings together with four

protagonists of The Drug & Alcohol Debate Cassimatis, Dowling, Jurd and

Wodak, to an international audience. This was rewarding to me as the primary

researcher.

We desperately need, as a society, to accept the importance of diversity in

approaches to treating addiction, and to make appropriate recommendations as to

what could help best at the different stages. We need professionals all working

together, respecting the differences and empowering the individual to make the

appropriate choice (Krivanek 2000), and especially not criticising and making value

judgements which tarnish our professionalism and confuse the recipients of the

information process. Live and let live (AA slogan in SCOPE 1991)

Over a fifteen year period of research, as I spoke to all concerned I found that there

was more agreement between them than had appeared. As in the case of Jurd

(interview 1993) who pointed out that AA coined the term ‘controlled drinking’

when they referred to those who were not alcoholics and did not have impaired

control. Then again, Heather (interview 1993) affirmed that he was not against the

AA program and those who found success in that program should stay with it.

MacAvoy (interview 1993) also confirmed that although AA was useful it was

already available in the community and should not be funded by government in

detox/rehabilitation programs. Mant (interview 1993) stated that she supported

Harm Minimisation being available for those who did not wish to use AA 12 Steps

model and needed an alternative. Wodak (Australis2000 Humanist Congress)

rightfully sang the praises of Australia’s reduction of HIV/AIDS infection as a result

of Harm Minimisation policies (NDS 1985) but he complained that not enough

funding was being made available for the appropriate services. As can be seen later

in this chapter their different approaches can belong in a synthesis - diversity of

approaches.

The clash settled down and at the international Australis2000 Humanist Congress in

the Addictions Session, Jurd, Wodak, Cassimatis, Dowling, Ellis-Jones and

myself shared our knowledge with the audience, consisting of members of the


255

community, professionals and scientists from here and overseas. This took place in

conversations in a civil manner, unlike that of The D&A Debate a decade ago.

Interviewing over eighty (80) persons here and overseas, for the Compulsions &

Recovery (C&R) Research, has given me a repertoire of approaches involving

abstinence models (AA and SMART) and Harm Minimisation/Reduction models.

Some I was already familiar with and used as part of my praxis before I embarked on

this inquiry. I have disseminated the information gained, as well as trained/facilitated

AOD (alcohol and other drugs) workers/counsellors and participants of Life

Strategies Workshops, using a diversity of approaches. This repertoice consists of

abstinence with the 12 Steps model and/or with the SMART Recovery model, CBT

(Cognitive Behavioural Therapies), MI (Motivational Interviewing from

Motivational Enhancement Therapy) as well as other modalities and have become

the recommendations I make as listed here:

• participation in the AA self help 12 Steps program (and other

dependencies)

• information about Twelve-Step Facilitation (TSF)

• cognitive behavioural therapies

• participation in SMART Recovery (abstinence through CBT/REBT)

• motivational interviewing

• using other relevant literature such as Grief Counselling (McKissock),

TSF, AA 12 Steps model, NLP (Bandler & Grinder), TA (James &

James), Gestalt (Perls), Psychodrama (Moreno)

• relaxation through yoga, music and art

• outpatient and inpatient detox/recovery programs

• supplying kits (clean syringes) free to the community (Harm

Minimisation)

• medically supervised injecting rooms (MSIC Kings Cross and Berne)

• increase in community lobbying for decriminalisation (FFDLR, ACT)

• increase in community education in appropriate drug use (social

drinking)

• drug education specifically for school children and parents (Life

Education)


256

• tighter harm reduction policies such as lowering of alcohol levels for

drivers

• awareness of drug policies of different countries

• facilitating willingness for the protagonists in The D&A Debate to take

responsibility for ensuring that service providers do not denigrate

recovery programs through misinformation (Heather 1993)

• using prescribed text from the TAFE Alcohol and Other Drugs Course

(Jarvis, Tebbutt & Mattick 2001) showing a diversity of treatment

approaches

• Typology – increasing awareness of personalities and behavioural

patterns for personal and professional development

Using a diversity of approaches can create the possibility of a clear swing from a

polemic between the polarities of AA 12 Steps model/TSF and CD/Harm

Minimisation/CBT modalities to a matching of treatments according to the person’s

needs, motivational stage, stage of addiction, and resources available.

Confrontational methods are not as popular as ten years ago. Although a somewhat

directive style has replaced the confrontational method, which is more empowering

for the client so as to take responsibility for their recovery and in the process

exploring either controlled drinking or abstinence, whichever they choose. It is not

so much a case of being pushed into either controlled drinking or abstinence but

rather a conscious decision of which is most appropriate for the individual - a choice

made by the individual, even if that choice is to only reduce usage and risk their

lives in the process. This sounds more sensible and Humanistic – empowering the

individual to make their own informed lifestyle choices.

I remember one person I had previously interviewed (1993), Con, who was known

to me sitting on a milk crate in the middle of the walkway one night under the Kings

Cross lights and the stars. I knew him as a homeless person who was always slightly

intoxicated. When things deteriorated he was hospitalised and then sober again

would return to his milk crate and life on the streets. He suffered from abscesses on

his ankles that were also deteriorating. This particular evening as I passed by with

my shopping we exchanged pleasantries and in the process I asked him whether he

wanted any help with organising Housing Department accommodation and he

responded in a shocked tone. His attitude was that once he had lived a life of seven


257

years sobriety in AA and having his own Housing Department unit, which he found

extremely boring and nowhere near the enjoyment that he was experiencing with the

hustle and bustle of Kings Cross and the “stars as his ceiling”. This was his choice

and I could see the joy in his tipsy eyes. He spent his last days in the manner he

chose and which he knew very well would cost him his life, sooner rather than later.

He had experienced both abstinence and Harm Minimisation, his choice was an

informed one, and it was his to make, which cost him his life. This story reminds me

of how hard it can be at times for me as a social ecologist to accept a person’s choice

when it means their death, even though I have a Humanistic worldview which means

that I believe such a choice is theirs to make. Nevertheless, after 15 years of research

in this area of focus I am able to see that such decisions represent a freedom of sorts,

similar in fact to euthanasia which should also be the individual’s choice and not that

of anyone else.

So, compulsions and recovery need to be in the realm of the individual’s lifestyle

choice – having the ability to reverse the confused limbic system (Ruden 2000)

which is involved with the regulation of states of arousal, desire, and motivation, and

which is described as the ‘lizard brain’ by Christopher (1992) the founder of SOS

(Secular Organization for Sobriety; Save Our Selves). If the task is too daunting to

control drink/use then the individual has the choice of abstinence or death. The latter

does not seem to have become of problematic proportions in countries such as the

Netherlands or Switzerland, in 1993, whose drug policies are progressive and allow

for the individual to make educated lifestyle choices.

Abstinence with 12 Steps model/TSF, however, has also proven to be a relief from

addictions for many, regardless of the drug policies of the country they are living in.

Those people who cannot recover from impaired control and who need to be free of

the compulsion have found this freedom through abstinence and AA 12 Steps

program. As Project Match (1993) showed that out of TSF, CBT and MET the most

successful outcomes for those in abstinence recovery was TSF, even if only slightly.

This now provides the scientific information that could not be obtained earlier from

the AA method because of its anonymous format. Have we come full circle from

Harm Minimisation/Reduction to abstinence and AA being the best option? Chick

(2001) reported that the TSF method has been proven scientifically to be the most

effective method for abstinence, is that a biased perspective? Furthermore, in Project


258

MATCH (1993) “many patients in the three treatments also participated in

community meetings of Alcoholics Anonymous, a mutual support fellowship rather

than a formal treatment” (NIAAA 1996).

Nevertheless, when considering the whole population, the ultimate solution is to

have diversity in treatments/approaches and relevance to the individual’s needs and

condition (stage of addiction, motivational stage of change) and/or resources.

Controlled drinking/use in moderation with CBT is appropriate for those who can

stop the behaviour when they want. Otherwise if the person cannot stop themselves

the compulsion takes over and abstinence through 12 Steps program and/or SMART

Recovery is the only way out. Not to be overlooked is the resource that abstinence

can also be gained through a religious group which promotes a lifestyle without

drugs (not even social drinking/use). Anyone who claims that abstinence is not

essential for severe addiction, has not experienced addiction. That is, the good

intention to not overdo it for the sake of health, and then succumbing to the

craving/urge, giving in to the compulsion, for whatever the reason, and risking the

consequences. Usually, that is the outcome when relying on a controlled use or

moderation use program, perhaps another area of research for a separate inquiry.

Again, what a person is capable of doing depends on the person, the condition and

the resources available. Perhaps we need to look at the success of the no alcohol and

no smoking rule here at the Olympic Games (2000) and any other sports held. The

community is getting used to, and appreciating, no smoking and no excessive

drinking norms in our society (legal limits for driving). When addiction becomes

marginalised instead of central to our society then we will be free of its cost

(Cassimatis 2000).

My assumptions at the beginning of this research were that for severe dependencies

there needed to be abstinence and the 12 Steps yet there needed to be a diversity of

approaches where individuals needed to be given informed choices so that they

could be empowered to make the appropriate decisions. Subsequently, as mentioned

earlier in this chapter my praxis has expanded with the information about

addiction/dependencies/compulsions and the 12 Steps model/SMART Recovery for

those requiring abstinence, as well as a diversity of approaches such as Life

Strategies, CBT, Motivational Interviewing, NLP, TA, Psychodrama, Gestalt, Art,

Poetry, Music, Dance, Bushwalking, and anything an individual may find workable


259

in their healing and recovery process. My role was that of a facilitator who at times

was more directive as needed, providing options to choose from. I have been

overwhelmed with the tension created by the polemic/schism as a result of The D&A

Debate. Having interviewed leaders in the field and at times those at the grassroots

level – the people affected by the compulsions, I am even more convinced that there

is a place for a diversity of approaches as shown by Project MATCH (1993) with the

three different models used. Such findings should be treated with respect and utilised

to provide resources to the whole community in an ethical manner, as was exhibited

by those who imparted knowledge in an informative way.

By the end of this research project I have come to believe even more strongly in the

AA abstinence recovery program as the most effective method for serious addiction.

Now I also appreciate the SMART Recovery method too. This is because both the

TSF/12 Steps model/SMART Recovery and the CBT and/or MI models have

abstinence as the recommended approach for those who have severe dependence and

who want to become abstinent. Whereas the Controlled Drinking (CD) model for

those with severe dependencies has not held its ground, although this could be

another area of focus for future research. Those who have denigrated the AA

abstinence 12 Steps program/TSF in support of CD/Harm Minimisation/Reduction,

have done so from an uninformed position and for political reasons, often

misrepresenting the work of the originators such as Heather who influenced Harm

Minimisation/Harm Reduction (interview 1993). However, I have also come to

believe that there are those who cannot benefit from an abstinence recovery program

for various reasons and that there is a place for Harm Minimisation programs too.

From this research it is apparent that there is some agreement from both sides of the

continuum – abstinence 12 Steps model/TSF/SMART Recovery and CD/CBT/Harm

Minimisation; that there is a place for diversity of treatment methods. Subsequently,

the method needs to be relevant to the stage of impaired control or severity of

dependency of the person (Heather, Wodak, Batey, and Saunders et al 1989, AA

‘Big Book’ 1988). In other words the severity of the dependency needs to determine

the choice of method/approach. Furthermore, although each group supporting a

particular approach does admit there is a place for a different approach, they are

passionate about their own method and are not eager to totally support the other

modalities. Therefore there is a need to find the solution for treating addiction


260

because as long as the treatment is not definitive then there will continue to be a

polemic/schism (Cassimatis interview 1993). Government needs to make funding

available for such research.

To reiterate my recommendations - it is important that research be funded and

undertaken in such areas as the controlled drinking/moderation vs abstinence

programs; success of police random breath tests; zero tolerance vs harm

minimisation; Also funding needs to be made available for programs which have

scientifically proven abstinence modalities (Project MATCH). When the National

Drug Strategy (2004-9) highlights that it supports “A partnership between

Commonwealth, State and Territory Governments, health, law enforcement and

education agencies, community based organisations and industry in tackling drug

related harm” then what will it take to make funding available for training and

service provision of Twelve-Step Facilitation (TSF) which has earned its place next

to CBT and Motivational Interviewing and which will then encourage respect for

another model that works? Keeping in mind the Project MATCH statement that

“many patients in the three treatments also participated in community meetings of

Alcoholics Anonymous, a mutual support fellowship rather than a formal treatment”

(NIAAA 1996), this shows that the resources of differing models can be shared

harmoniously.

This is a powerful lesson for us here in Australia where there is still tension, due to

issues of cost effectiveness and political agendas. TSF is essential, as is CBT and

MI, to individuals with severe dependencies ensuring that they can learn how to

avail themselves of the AA 12 Steps model as well as SMART Recovery (which has

people referred by professionals trained in CBT). Therefore, funding needs to be

made available for training and employment of TSF facilitators, a service which has

been scientifically researched through Project MATCH (1993) and which can, in the

long run, save the government money and protect the community by reduction in

drink driving, criminal activities and violence.

261

BIBLIOGRAPHY

262

BIBLIOGRAPHY

12 Step and cognitive-behavioural treatment for substance abuse: a comparison of treatment effectiveness, J Consult Clin. Psychol. 1997: 65:23-40 (author unknown)

A Manual of Mental Health Care in General Practice, 2000,Commonwealth Department of Health and Aged Care, Queensland Divisions of General Practice Association, and Queensland Health

AA also see Alcoholics Anonymous

AA Wikipedia, 2007, http://en.wikipedia.org/wiki/Alcoholics_Anonymous, also see Alcoholics Anonymous

AA World Services Inc, 1979, Living Sober, New York, AA World Services

AA World Services Inc., [1938 1st edn.], 1939,[1988 3rd edn.], 1991, 2001, Alcoholics

Anonymous: The Big Book, New York, AA World Services

AA World Services Inc. Alcoholics Anonymous: The Big Book, 2002, [pocket book edn.], New York, AA World Services

AA World Services Inc., 1989, Came To Believe, New York, AA World Services Inc.

AADAC [ed], 1998, Overview of Addictions. AADAC: Edmonton, Health Canada

AADAC, 1994, Straight Facts About Drugs and Drug Abuse. Edmonton, Health Canada

AADAC, 1994a, Exploring the Gambling Experience, Edmonton, Health Canada

AADAC, 1994b, Addressing Problem Gambling in Alberta. Edmonton, Health Canada

Abercrombie N., Hill S., Turner B.S., 1988, Dictionary of Sociology, UK, Penguin Books

ABS – Australian Social Trends 1994 and 2000 Health – Mortality and Morbidity:

Suicide, Retrieved February 19, 2001 from http://www.abs.gov.wu/ausstats/ab

ABS – Youth Suicide 1994 and 2002, Retrieved April 17, 2002 from

http://www.abs.gov.wu/ausstats/ab

Adair J., 1983, Effective Leadership, London, Pan Books Ltd.

Addiction Love to Know Intervention, Retrieved April 29, 2007 from http://addiction.lovetoknow.com/wiki/Intervention)

Addiction Research Foundation, Retrieved February 19, 2001, from http://www.arf.org/

263

Addiction Research Foundation of Ontario, 1994, Canadian Profile on Alcohol,

Tobacco and Other Drugs, Toronto, A.R.F.

Affie (no surname then), 1992, A Heart Full of Tears, Sydney, Community First Editions

Affie, 1992 (no surname then), GDSE, UWS Hawkesbury, Sydney

Affie (no surname then) & Andrianopoulos T., 1993, Addictions – Abstinence and

Harm Minimisation PRIDE Conference Paper, Sydney, Wayside Chapel

Affie (no surname then), 1994, M. App. Sci. UWS, UWS Hawkesbury, Sydney

Affie (no surname then), 1998, for our children happiness is healthy relationships,

democracy, equality and peace, M.Sc. (Hons), UWS Hawkesbury, Sydney

Airola P., 1971, Are you confused? USA, Health Plus Publishers

Alberto P., Troutman A., 1986, Applied Behaviour Analysis for Teachers, USA, Merrill Pub. Co.

Alcoholics Anonymous, Retrieved on June 21 2007, from http://en.wikipedia.org/wiki/Alcoholics_Anonymous

Alcoholics-anonymous “progressive disease” AA website (copyrighted in 2007 by Alcoholics Anonymous World Services, Inc), Retrieved on April 6, 2007 from http://www.alcoholics-anonymous.org/en_is_aa_for_you.cfm?PageID=14

Alcoholism Treatment Quarterly 3[1]. 73-86. The alcoholic spouse and the dynamics of codependency (author unknown)

ALCOSCOPE – International review of alcoholism management 2001 Vol.4:1:10

Alexander F.M., 1985, The Use of the Self, London, Victor Gallance Ltd.

Alexander P., 1990, It Could Be Allergy and Can Be Cured, Australia, Ethicare P/L

Alexander, R., 1991, Recovery Plus: Freedom from Co-dependency, Florida, Health Communications

Allaby M., 1986, Ecology Facts, England, Hamlyn Middlesex

Allen J.P., ProjectMATCH: a clarification. Behavioural Health Management 1998:18[4]:42-43. [ADAI jl]

American Academy of Addiction Psychiatry: Retrieved November 11, 2002 from http://www.aaap.org/

American Journal of Psychiatry, 150[11]:1707-1711 (author and paper title unknown)

American Journal of Public Health, 85[8]:1149-1152 (author and paper title unknown)

264

American Journal on Drug and Alcohol Abuse, 22[3]:313-333 (author and paper title unknown)

American Heart Association Inc., 2005, Circulation. 2005;111:e10-e11. (author and paper title unknown)

American Psychiatric Association. Diagnostic and Statistical Manual of Mental

Disorders, Fourth Edition, Washington, DC, the Association, 1994

American Society of Addiction Medicine: Retrieved November 11, 2002 from http://www.asam.org/

anonymous, 1993, Sex & Love Addicts Anonymous, The Augustine Fellowship, Sex & Love Addicts Anon, Mass., Fellowship-Wide Services Inc.

anonymous, 1995, Nicotine Anonymous: The Book, USA, Nic. Anon World Services Inc.

Arco Publishing, 1985, Human Relationships, NY, Arco Publishing

Arent R.P., 1984, Stress and Your Child, USA, Prentice-Hall Inc.

Argyle M., 1972, The Social Psychology of Work, NY, Taplinger Publishing Co.

Armstrong D., 1990, An Outline of Sociology as Applied to Medicine, London, Wright

Armstrong H., 1990, Reflexivity In Action, MSc [Hons] Thesis, Australia, UWS Hawkesbury

Arndt B., 1985, The Australian Way of Sex, Australia, Horwitz & Grahame

Arndt B., 1986, Private Lives, Australlia Penguin Books

Arnold J.S., 1988, Writing with Style 2, VIC., Heinemann Education

Ashton M. Project MATCH: unseen colossus. Drug Alcohol Findings 1999:1:15-21. [ADAI rp 08705]

Aspin L., 1992, The Family: an Australian Focus, Melbourne, Longman Cheshire

Association for Medical Education & Research in Substance Abuse: Retrieved November 11, 2002 from http://www.amersa.org/

Atheist Foundation of Australia Inc., article, 1994, Dowling D.

Australian Bureau of Statistics Retrieved February 19, 2001 from http://www.abs.gov.au/

Australian Christian Lobby report, 2000, Youth Suicide

Australian Drug Law Reform Foundation, 1994, Harm minimisation, Canberra, A.D.L.R.F., [author unknown] Comments on Project MATCH : matching alcohol

treatments to client heterogeneity. Addiction 1999:94[1]:31-34. [ADAI jl]

265

author unknown, 1991, Scope 12 Steps Family Group Readings, Sydney, Community First Editions

author unknown, 1994, Dictionary of Mythology, Melbourne, Chancellor Press

Avery G., Baker E., 1984, Psychology at Work, Australia, Prentice-Hall

Babor TF. The fickle Inglefinger of fate: observations on embargo policies and the timely release of scientific findings. The Project MATCH Research Group [editorial]

Addiction 1997 Oct:92[10]:1237-9. [ADAI jl]

Babor T.F. & Del Boca F.K., Treatment Matching in Alcoholism, UK, Cambridge University Press

Bair D., 1990, Simone de Beauvoir, NY, Summit Books

Baker Miller J., 1976, Toward a New Psychology of Women, USA, Pelican Books

Baldwin A., 1967, Theories of Child Development, Sydney, John Wiley & Sons

Baldwin R., 1979, Special Delivery, California, Les Femmes Publishing

Bandler C., 1978, They Lived Happily Ever After, USA, Meta Publications

Bandler R., Grinder J., 1979, Frogs & Princes, Utah, Real People Press

Bandler R., Grinder J., 1982, Reframing, Utah, Real People Press

Banks G., 1985, Your Guide to Successful Living, Vic., Dove Communications

Barbeau C., 1987, How to raise parents, California, Ikon Press

Babor, T.F., Grant, M., Acuda, W., Burns, F.H., Campillo, C., Delboca, F.K., Hodgson, R., Ivanets, N.N., Lukomskya, M., Machona, M., Rollnick, S., Resnick, R., Saunders, J.B., Skultle, A., Connor, K., Ernberg, G., Kranzler, H., Lauerman, R., & Mcree, B., 1994, “A randomized clinical trial of brief interventions in primary health care: Summary of a WHO project”, Addiction, 89, 657-660.

Barker Woolger J., Woolger R., 1988, The Goddess Within, Australia, Random Century

Barlow W., 1973, The Alexander Principle, UK, Arrow Books

Barrett M., 1985, Women’s Oppression Today, UK, Verso

Bateson G., 1973, Steps to an Ecology of Mind, London, Granada Publishing

Bateson M.C., 1994, Peripheral Visions: Learning Along the Way, NY, HarperCollins

Batten R., Weeks W., Wilson J. [Ed], 1991, Issues Facing Australian Families,

Australia, Longman Cheshire

Baum J. 1985, One Step Over the Line, San Francisco, Harper & Row

266

Bawden R., 1988 Essays in Sabbatical Reflection, NSW, Hawkesbury Agricultural College

Bawden, Ison, Packham, Macadam & Valentine 1985, A Research Paradigm for

Systems Agriculture, in “Farming Systems Research: Australian Expertise for Third World Agriculture.” [Chapter 2], J.V. Reminyi [ed], Canberra, ACIAR

Bearpark H., 1994, Overcoming Insomnia, Sydney, Gore & Osment

Beattie, M., 1987, Codependent No More, USA, Hazelden Book

Beattie, M., 1989, Beyond Codependency. USA, Hazelden

Beattie, M., 1990a, Codependents' Guide to the Twelve Steps, USA, Prentice Hall

Beattie, M., 1990b, The Language of Letting Go. USA, Prentice Hall

Beavis W., 1999, Become the person you dream of being, USA, Powerborn

Beer M., 1995, Make Winning a Habit, VIC., Wrightbooks

Beisler F., Scheeres H., Pinner D., 1997 [2nd ed. 3rd reprint], Communication Skills,

Australia, Addison Wesley Longman

Belson W., 1979, Television Violence and the Adolescent Boy, Farnbrough UK, Saxon House

Bennett B., Cowan P. & Hay J. [Ed.], 1985, Perspectives One, Melbourne, Longman Cheshire P/L

Benson H., 1996, Timeless Healing, NSW, Hodder & Staughton

Benson, Bruce L., and Rasmussen, David W., [1996] Independent Policy Report: Illicit Drugs and Crime, Oakland CA: The Independent Institute

Berger P. & B., 1983, Sociology: A Biographical Approach, VIC., Penguin Books

Berger S., 1988, What your doctor didn’t learn in medical school, Sydney, Bantam/Schwartz

Berkowitz B., 1977, How to Take Charge of Your Life, USA, Bantam Books

Berkowitz B., 1988, How to be Your Own Best Friend, London, Cedar

Berne E., 1977, Games People Play, Great Britain, Penguin Books

Berne E., 1983, Sex in Human Loving, USA, Penguin Books

Berne E., 1986, A Layman's Guide to Psychiatry & Psychoanalysis, UK, Pengiun Books

Berry C.R., 1991, How To Escape The Messiah Trap, NY, Harper Collins

267

Beverly C. [Ed], 1994, The Book of 1001 Home Health Remedies, USA, F C & A Publishing

Biddulph S., 1984, The Secret of Happy Children, Sydney, Bay Books

Biestek F.P., 1973, The Casework Relationship, London, Unwin University Books

Bill B., 1981, Compulsive Overeater, Minnesota, CompCare Publishers

Bill B., 1986, Maintenance for Compulsive Overeaters, Minnesotta, CompCare Publishers

Blake R., Stephens E., 1987, Compulsion, Great Britain, Thames Television PLC

Blanchard K., Bowles S., 1998, Gung Ho, NY, William Morrow & Co. Inc.

Blanchard K., Johnson S., 1983, The One Minute Manager, Glasgow, William Collins Sons & Co.

Blanchard K., Onchen Jnr. W., Burrows H., 1990, The One Minute Manager Meets

the Monkey, Glasgow, William Collins Sons & Co.

Bliss S. [Ed], 1985, The New Holistic Health Handbook, NY, Penguin

Bloomfield H.H., 1983, Making Peace with Your Parents, USA, Ballantine Books

Blum & Noble, 1990, Nat. Inst. on Alcohol Abuse and Alcoholism Study in JAMA, Journal of American Medical Association 263 (1990): 2055-60

Bly R., 1990, Iron John, USA, Houghton Miffin Reading Mass.

Bolt M., 1996, Social Psychology, USA, McGraw-Hill

Bolstad R., 1997, Research on Neuro Linguistic Programming A Summary - Bolstad, NLP Trainer, 1997. Retrieved on October 16, 2004, from www.stant-1.demon.co.uk/artcl007.htm Research on Neuro-Linguistic Programming:

Bommersbach, M.., Cowan G., & Curtis, S.R. [1995]. Codependency, Loss of Self,

and Power, Psychology of Women Quarterly, 19, 221-236.

Bookchin M., 1982, The Ecology of Freedom, California, Cheshire Books

Bookchin M., 1987, Social Ecology Versus Deep Ecology, USA, Socialist Review 18, 3

Bookchin M., 1990, Remaking Society, Canada, Black Rose Books

Booth, P.G., Dale, B., Slade, P.D., and Dewey, M.E. [1992]. A follow-up study of problem drinkers offered a goal choice option. Journal of Studies on Alcohol, 53, 594-600

Borneman E., 1994, Childhood Phases of Maturity, USA, Prometheus Books

268

Boud D., Keogh R., Walker D. [Ed.], 1985, Reflection: Turning Experience into

Learning, London, Kogan Page Ltd.

Boud D., Pascoe J., 1986, What is Experiential Learning, Sydney, NSW University

Bower, B. [1997, January 25]. Alcoholics synonymous: Heavy drinkers of all stripes may get comparable help from a variety of therapies. Science News, 151, 62-63

Bowlby J., 1984, Attachment, Middlesex, Penguin Books

Bradley D., 1992, Hyper-Ventilation Syndrome, NZ, Tandem Press

Bradshaw J., 1988a, Healing The Shame That Binds You, Florida, Health Communications Inc.

Bradshaw, J. 1988b, Bradshaw on the family, Pompano Beach USA, Health Communications Inc.

Bradshaw J., 1988c, The Family, Florida, Health Communications Inc.

Bradshaw J., 1990, Homecoming, USA, Bantam Books

Bradshaw J., 1992, Creating Love, USA, Bantam Books

Bradshaw J., 1996, Family Secrets, USA, Bantam Books

Branden N., 1988, How to Raise Your Self-Esteem, USA, Bantam Books

Brasch R., 1975, How did sex begin, London, Pan Books

Brecher R. & E. [Ed.], 1966, An Analysis of Human Sexual Response, NY, Signet Books

Bridging Clinical and Public Health Strategies, New York: Guilford Press, 1999, pp. 45-66. [ADAI bk] RC 564 C468 1999

British Medical Journal 1999, Psychodrama, Retrieved April 20, 2005 from http://www.patient.co.uk/showdoc/6/ - 28k

Bristol C.M., 1969, The Magic of Believing, NY, Prentice Hall

Brown H., Smith H. [Ed.], 1992, Normalisation: A Reader for the Nineties, London, Routledge

Brown J.A.C., 1974, Freud and the Post-Freudians, Auckland, Pelican Books

Brown S., Beletsis S., Cermak T., 1989, Adult Children of Alcoholics In Treatment, Florida, Health Communications

Brownmiller S., 1984, Femininity, London, Grafton Books

Bruner J., 1990, Acts of Meaning,

269

Buber M., 1973, Meetings, Illonios, Open Court Publishing Co.

Bullough V.L. & B., 1995, Sexual Attitudes, USA, Prometheus Books

Bundey C., Cullen J., Denshire L., Grant J., Norfore J., Nove T., 1991, Group

Leadership, Westmead, Western Sydney Area Health Promotion Unit

Burnley I.H., 1976, The Social Environment, Sydney, McGraw-Hill

Burton C., 1985, Subordination, Australia, George Allen & Unwin

Buscaglia L., 1972, Love, USA, Souvenir Press

Buzan T., 1977 and 1988, Making the Most of Your Mind, London Pan Books

Byham W., 1993, Zapp! Empowerment in Health Care, NY, Fawcett Colombian

Cabot S., 1987, Women's Health, Australia, Pan Books

Cabot S., 1993, The Body Shaping Diet, NSW, Women’s Health Advisory Service

Callan, L., [1996] Prevention in AADAC: A Vision for Success. Calgary, AADAC

Camm E.P., Camm J.C.R., & Gordon M., 1998, Society & Culture, Melbourne, Longman

Campbell A. [Ed.], 1989, The Opposite Sex, Sydney, Doubleday

Campbell R., 1987, How to really love your child, UK, Scripture Press Foundation

Canadian Centre on Substance Abuse, [1999], The Costs of Substance Abuse in

Canada, Toronto, Canadian Centre on Substance Abuse

Canadian Society of Addiction Medicine: Retrieved November 11, 2002 from http://www.csam.org/

Canterbury Suicide Project’s Bulletin No. 7 August 1995, Canterbury Suicide Project

Caplan G., 1966, Principles of Preventative Psychiatry, London, Tavestock Publications

Capra Fritjof, 1982, Turning Point: Science, Society and the Rising Culture UK, Harper Collins

Carbonari JP: DiClemente CC. Using transtheoretical model profiles to differentiate levels of alcohol abstinence success. J Consult Clin Psychol 2000: 68[5]:810-817. [ADAI jl]

Carbonari JP: Wirtz PW : Muenz LR : Stout RL. Alternative analytical methods for detecting matching effects in treatment outcomes. J Stud Alcohol 1994:Suppl. 12:83-90. [ADAI jl]

270

Carkhuff R., 1983, The Art of Helping IV. Massachusetts, Human Resource Development Press

Carr D., Taylor C. & Ricoeur P., 1991, Discussion: Ricoeur on narrative. In D. Wood (Ed.), On Paul Ricoeur: Narrative and and interpretation (pp. 160-187), in Kirkman M., March 2002, Australian Psychologist, 37 (1), pp.3038

Carr W., Kemmis S., 1983, Becoming Critical Knowing through Action Research,

Australia, Deakin University Press

Carr, J., 1995, "Stages of Change". Paper presented at Breaking through the Smoke Screen USA Conference

Carroll KM: Cooney NL : Donovan DM : Longabaugh RL : Wirtz PW : Connors GJ : DiClemente CC : Kadden RR : Rounsaville BJ : Zweben A. Internal validity of Project MATCH treatments : Discriminability and integrity. J Consult Clin Psychol

1998:66[2]:290-303. [ADAI rp 07993]

Carroll KM : Kadden RM : Donovan DM : Zweben A : et al. Implementing treatment and protecting the validity of the independent variable in treatment matching studies. J Stud Alcohol 1994:Suppl. 12: 149-155. [ADAI jl]

Carroll, Kathleen M. [ed.]. Improving compliance with alcoholism treatment. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism, 1997. [ADAI bk] HV 5278 P76 v. 6

Carter S., Sokol J., 1989, Men Who Can’t Love, UK, Bantam Books

Cassimatis, 2000, Australis2000 Humanist Congress paper, Sydney

CEIDA Naltrexone Pamphlet: Retrieved November 11, 2002 from http://www.ceida.net.au/drugs/naltrexone2

Cermak T., (1988) Diagnostic Criteria, USA, American Psychiatric Assoc.

Cermak T., [1986] Journal of Psychoactive Drugs (title unknown)

Cermak T., (1994) Diagnostic Criteria, USA, American Psychiatric Assoc.

Chapman R.J., Ph.D. Counseling Center La Salle University Philadelphia, PA., Journal of Abnormal Psychology, 84, 508- 518., Journal of Addictive Behaviors, 9, 185-188

Chapman Y.B., 1994, The Lived Experience of Nursing Dying or Dead People MSc [Hons] Thesis Social Ecology, NSW, UWS Hawkesbury

Chapman, R.J., Ph.D. Counseling Center La Salle University Philadelphia, PA., Journal of Abnormal Psychology, 84, 508- 518., Journal of Addictive Behaviors, 9, 185-188

Charbet J., 1982, Feminism, London, J.M. Dent & Sons Ltd.

271

Charles C., 1981, Building Classroom Disciplines, NY, Longman

Chase S.E., 2005, Chapter 25, in Denzin, N.K. & Lincoln Y.S. (eds.), Handbook of

Qualitative Research (3rd Ed.), CA, Sage

Chaudron, C. and D. Wilkinson [eds.], [1988] Theories on Alcoholism, Toronto

Cheaskin E., Ringsdorf W., Clark J., 1977, Diet & Disease, USA, Keats Publishing

Checkland P. [undated] Framework through Experience to Learning the Essential

Nature of Action Research, Lanc. Uni.

Chegwidden M, 1968, The Disease of Alcoholism, in Lennane J., 1992:129, Alcohol

the National Hangover, Sydney, Allen & Unwin

Chesser E., 1983, Love Without Fear, London, Arrow Books

Chiauzzi, E. and S. Liljegren, 1993, "Taboo Topics in Addiction Treatment", USA, Journal of Substance Abuse

Chick J., 2001, ALCOSCOPE, Vol.4: Issue 1.10

Christopher J., 1988, How to Stay Sober, USA, Prometheus Books

Christopher J., 1992, SOS Sobriety, USA, Prometheus Books

Cisler R : Holder HD : Longabaugh R : Stout RL : Zweben A. Actual and estimated replication costs for alcohol treatment modalities: case study from Project MATCH, J

Stud Alcohol 1998 Sep:59[5]:503-12. [ADAI jl]

Clandinin D., Connelly J. & Michael F., 2000, Narrative Inquiry: Experience and

Story in Qualitative Research, CA., Jossey-Bass Publishers

Lisa Clausen April 2000 in Time Magazine A Nation’s Long Misery

Cleary T. [Translated by], 1989, Zen Lessons: The Art of Leadership, USA Boston, Shambhala

Cleese J., Skynner R., 1983, Families and How To Survive Them, GB, Methuen London Ltd.

Clements A., 1986, Infant and Family Health in Australia, Melbourne, Churchill Livingstone

Cline, Agnostics/Atheists/Skeptics [2002]: Retrieved November 11, 2002 from http://www.atheism.about.com/library/FAQs/skepticism/blfaq_newage_codependency.htm

Coates I., 1984, Don’t panic – paint!! NSW, Black Lightening Press

Cohen J., 2007, ABC Four Corners Interview – Dr. Andrew Campbell 02/03/05, Retrieved on May 24, 2007 from http://www.abc.net.au/4corners/content/2005/s1314465.htm

272

Cohen J., 2007, ABC Four Corners Interview – Dr. Stephen Jurd 19/02/07, Retrieved on May 24, 2007 from http://www.abc.net.au/4corners/content/2006/s1850987.htm

Cohen P., 1990, Drugs as a Social Construct, Amsterdam, Universiteit van Amsterdam

Coleman C., Perrin P, 1990, Marilyn Ferguson's Book of PragMagic, USA, Pocket Books

Coleman V., 1988, Know Yourself, London, Penguin Books

Coles R., 1989, The Call of Stories: Teaching and the Moral Imagination, Boston, Houghton Mifflin

Colgrove, Bloomfield, & McWilliams, 1983, How To Survive the Loss of a Love,

Sydney, Bantam

Colling T., 1984, Relationships, Galsgow, ABC Sydney Collins & Sons

Community First Additions, 1991, SCOPE Weekly Readings & Members Stories,

SCOPE (Stress Anonymous) 12 Steps Group, Sydney, Community First Additions

Comparison of Processes of Change, in Journal of Consulting and Clinical Psychology". 64[1]:130-138.

Conger J., 1979, Adolescence: generation under pressure, London, Harper & Row

Conley R., 1991, Metabolism Booster Diet, London, Arrow Books

Connel R.W. with Dowsett G.W., 1992, Rethinking Sex, VIC., Melbourne University Press

Connell R.W., 1987, Gender & Power, NSW, Allen & Unwin

Connors G.J., Toscova R.T., and Tonigan J.S., [1999] Integrating spirituality into

treatment: Resources for practitioners. In W. R. Miller [Ed Abstracted from.], [pp. 235-250]. Washington, DC: American Psychological Association

Connors GJ : Allen JP : Cooney NL : DiClemente CC : et al. Assessment issues and strategies in alcoholism treatment matching research. J Stud Alcohol 1994: Suppl.

12:92-100. [ADAI jl]

Connors GJ, Carroll KM, DiClemente CC, et al. The therapeutic alliance and its relationship to alcoholism treatment participation and outcome. J Consult Clin

Psychol 10997:65: 588-98

Connors GJ, Tonigan JS, Miller WR. A longitudinal model of intake symptomatology, AA participation and outcome: retrospective study of the Project MATCH outpatient and aftercare samples. J Stud Alcohol 2001 Nov:62[6]:817-25. [ADAI jl]

Conolly J., 1983, Step-families, Balmain, NSW, Corgi Books

273

Conran S., 1978, Superwoman, Australia, Penguin Books

Cook, C. The Minnesota Model, British Journal of Addiction, 1988, 83: 625-634

Cooper P.J., 1993, Bulimia Nervosa, UK, Robinson Publishers

Corkille Briggs D., 1975, Your Child’s Self-Esteem, NSW, Dolphin Books

Cottler, L.B.: Schuckit, M.A.: Helzer, J.E.: Crowley, T.: Woody, G.: Nathan, P.: & Hughes, J. The DSM-IV field trial for substance use disorders: Major results. Drug and Alcohol Dependence 38:59-69, 1995

Coupe S.M., with Driscole W.P., & Elphick E.S., 1974, Search for Identity, Australia, Rigby Ltd.

Cowan C., Kinder M., 1986, Smart Women, Foolish Choices, London, Bantam Books,

Cowan C., Kinder M., 1988, Women men love, women men leave, London, Bantam Books

Cox E., 1995, A Truly Civil Society, Sydney, ABC Books

Cranwell B., 1983, Action Learning in the Community, UK, Gower Publishing Co.

Crosby J., 1989, When One Wants Out And The Other Doesn't, NY, Brunner Mazel

Crotty M., 1998, The Foundations of Social Research Sage Publications London, in Book of Readings UWS Hawkesbury Researching [post-graduate students], Australia, Faculty of Social Inquiry Social Ecology Academic Group1996

Crumm T., 1987, The Magic of Conflict, USA, Touchstone Books

Cruse, J., & Wegscheider-Cruse, S. [1990]. Understanding Codependency, Deerfield Beach Florida, Health Communications Inc.,

Cuff E.C., Payne G.C. [Eds.], 1981, Perspectives in Sociology, UK, George Allen & Unwin

Culligan M., Sedlacek K., 1979, How to avoid stress before it kills you, NY, Gramercy Publishing. Co.

Cultsock: CCMS Infobase - psychology: Transactional Analysis Journal . Retrieved April 20, 2005 from http://www.cultsock.ndirect.co.uk/MUHome/cshtml/ta/ta.html

Curthoys A., 1988, For & Against Feminism, Sydney, Allen & Unwin

Curtin M.E., 1973, Symposium on Love, USA, Behavioral Communications

Czarmiawska B., 1997, Narrating the Organization: Dramas of Institutional Identity,

Chicago, University of Chicago Press

Daly M., 1984, Pure Lust – Elemental Feminist Philosophy, London, Women’s Press

274

Dariaux G.A., 1968, The Men In Your Life, London, Frederick Muller Ltd.

Darvill W. with Powell K., 1995, The Puberty Book, Australia, Hodder & Stoughton

Darwin C., 1965, The Expression of Emotions in Man and Animals, Chicago, Uni of Chicago Press

Davidson, R., S. Rollnick and I. MacEwan [eds.], [1991] Counseling Problem

Drinkers, NY, Guildford Press

Davies J., 2000, A Manual of Mental Health Care in General Practice, Australia, Govt. Publishing Service

National Mental Health Strategy, Australia, Commonwealth Dept of Health & Aged Care

Davies J.B. & Baker, R, The impact of self-presentation and interviewer bias effects on self-reported heroin use, British Journal of Addiction, 82, 907912,1987.

Davies J.B. Drinking in England and Wales: the latest news from OCPS. British

Journal of Addiction, 84, 957-959, 1989

Davies J.B., & Coggans N., 1991, The Facts about Adolescent Drug Abuse. London, Cassell

Davies J.B., & Stacey B., 1972, Teenagers and Alcohol. London, HMSO

Davies J.B., 1997, "Drugspeak": The Analysis of Drug Discourse, Reading, Harwood Academic Publishers

Davies J.B., 1997, The Myth of Addiction. Second edition, Amsterdam B.V., OPA [Overseas Publishers Association]

Davies J.B., Alcoholism, social policy and intervention. In Eiser, J.R. [ed.], 1982, Social Psychology and Behavioural Medicine, Chichester, Wiley

Davies J.B., Life stress and the use of illicit drugs, alcohol and tobacco: empirical

findings, methodological problems and attributions. In Warburton, D. [Ed.], 1990, Addiction Controversies, London, Harwood Academic Publishers

Davies J.B., Questions and answers in addiction research, British Journal of

Addiction, 82, 1273-1276, 1987

Davies K., 1994, When Innocence Trembles, Pymble, Angus & Robertson Publications

Davis J., 1993, Finding Voice, Being Heard And Living In the Tension, MSc [Hons]

Thesis, Social Ecology, UWS Hawkesbury

Davis J., 1994, Older Australians, Sydney, Harcourt Brace & Co.

275

Davis P., 1976, How to Cope With the Problem Drinker, Australia, Paul Hamlyn

Davy J., Parker R., Patterson J., 1997, Health Moves 2, Victoria, Heinemann

Dawson, D.A. [1996]. Correlates of past-year status among treated and untreated persons with former alcohol dependence: United States, 1992. Alcoholism: Clinical

and Experimental Research, 20, 771-779

De Angelis B., 1992, Are you the One for Me, UK, HarperCollinsPublishers

de Beauvoir S., 1985, The Second Sex, UK, Penguin

de Shazer S., 1985, Keys to Solution in Brief Therapy, USA, WW Norton & Co. Inc.

Dean H., 1998, Broken Bangles, Australia, Anchor Australia & NZ

DeBono E., 1975, PO: Beyond Yes & No, NY, Simon & Schuster

DeBono E., 1990, Lateral Thinking, UK, Penguin Books

Del Boca FK : Brown JM. Issues in the development of reliable measures in addictions research: Introduction to Project MATCH assessment strategies. Psychol

Addict Behav 1996:10[2]:67-74. [ADAI jl]

Del Boca F.K., Mattson M.E., Developments in alcoholism treatment research : patient-treatment matching. Alcohol 1994:11[6]:471-475. [ADAI jl]

Demetrakopoulos S., 1983, Listening to our bodies, Boston US, Beacon Press

Deming, W., [1986] Out of the Crisis, Cambridge, M.I.T

Dendy A., 1924, Biological Foundations of Society, London, Constable & Co. Ltd.

Denholtz E., 1981, Having it Both Ways, NY, Stein and Day

Denzin N.K., Lincoln Y.S., [eds.], 2000, Handbook of Qualitative Research, [2nd Edn.] USA, Sage Publications

Denzin, N.K. & Lincoln Y.S. (eds.), 2005, Handbook of Qualitative Research (3rd Ed.), CA, Sage

Dependency: An Emerging Issue, pp. 31-44. Dept of Health and Human Services, 1992, Florida, Health Communications

Dewey J., 1922, Human Nature and Conduct, New York, Hart, Holt and Company

Dewey J., 1929, The Quest for Certainty: A Study of the Relation of Knowledge and

Action, New York, Paragon Books

Dewey J., 1938, Experience and Education, New York, Collier Books

Dewhurst-Maddock O., 1993, The Book of Sound Therapy, Australia, Simon & Schuster

276

Diamond H. & M., 1991, Fit for Life II, GB, Bantam Books

Dick B., 1992, Qualitative Action Research: Improving the Rigour and Economy,

Brisbane, Queensland. University

DiClemente C. Motivational Interviewing and the Stages of Change. In:Miller W. R., Rollnick S., op.cit., p. 91-201

DiClemente CC : Carroll KM: Connors GJ: Kadden RM. Process assessment in

treatment matching research. J Stud Alcohol 1994: Suppl. 12:156-162. [ADAI jl]

DiClemente CC.: Bellino LE: Neavins TM. Motivation for change and alcoholism

treatment [Project MATCH : MET]. Alcohol Res Health 1999:23[2]:86-92. [ADAI jl]

Dictionary of Mythology, 1994, London, Chancellor Press

Ditton, J. The Scottish Cocaine Research Group. Scottish Cocaine Users: Yuppie Snorters or Ghetto Smokers? University of Glasgow: Update 6. Internal

Memorandum, September 1990

Divert Assessor Training - The Police Drug Diversion Initiative (PDDI), 2007, Drug

Information, Harm Minimisation Retrieved April 27, 2007, from http://www.divert.sa.edu.au/drugs/harm_minimisation.htm

Dobson J., 1982, Dr. Dobson Answers Your Questions, NSW, ANZEA Publishers

Dobson J., 1993, The Strong Willed Child, USA, Tyndale House Publishers

Dobson J., Bouer G., 1990, Children at risk, USA, Word Publishing

Dominian J., 1986, An Introduction to Marital Problems, Glasgow, William Collins Sons & Co.

Donovan DM : Kadden RM : DiClemente CC : Carroll KM: et al. Issues in the

selection and development of therapies in alcoholism treatment matching research. J Stud Alcohol 1994: Suppl. 12:138-148. [ADAI jl]

Donovan DM. Efficacy and effectiveness : complementary findings from two multisite

trials evaluating outcomes of alcohol treatments differing in theoretical orientations [Dept. of Veterans Affairs effectiveness study: Project MATCH]. Alcoh Clin Exp Res 1999:23[3]:564-572. [ADAI jl]

Dowling C., 1985, The Cinderella Complex – Women’s Hidden Fear of

Independence, UK, Fontana

Dowling C., 1993, You Mean I Don’t Have To Feel This Way, USA, Bantam Books

Dowling D., 1994, The Jurisprudence of the Illegal Drug Laws, Why the Draconian Penalties and Criminogenesis, Submission to Parliamentary Standing Committee on

Family and Community Affairs, in Atheist Foundation of Australia Inc., Articles, Social Issues, Drug Laws, Retrieved March 21 2007, from http://www.atheistfoundation.org.au/drugs.htm

277

Dowling D., 1994, S.A. Humanist Post August 1994:6

Dowling D., 2000, Australis2000 Humanist Congress paper, Sydney

Draganov P., 2001, ALCOSCOPE International ReviewVol.4 Issue 1, UK, Adis International

Dreikurs R., 1970, Happy Children, UK, Souvenir Press

Drug Education Network Inc. Tasmania, RHSET Commonwealth Department of DrugWise: A harm reduction resource for rural workers. Taking on Prevention, 1997 Health and Family Services

DRUG LORE: the questioning of our current drug law, 1997, Australian Parliamentary Group For Drug Law Reform, Canberra, Australian Drug Law Reform Foundation

Drummond DC. Treatment research in the wake of Project MATCH, Addiction

1999:94[1]:39-42. [ADAI jl]

Drydon W., 1991, A Dialogue With Albert Ellis Against Dogma, Bristol, Arrowsmith

DSM-IV, 1994, American Psychiatric Association. USA, American Psychiatric Publishing, Inc.

Dudley M.J., Kelk N.J., Florio T.M., Howard J.P. and Waters B.G.H., 1998, Suicide among young Australians, an interstate comparison of metropolitan and rural trends, Medical Journal of Australia 1998; 169: 77-80

Dufty W., 1975, Sugar Blues, NY, Warner Books

Dumbrell L., 1989, Becoming a Writer, NSW, Allen & Unwin Australia

Dunn J., 1994, Think Like a Shrink and Keep Yourself Sane, Australia, Collins Dove Public

Drugsafe 2007, Life Education Australia, Retrieved on April 29, 2007 from http://www.drugsafe.org.au/resources.htm

Drummond, 1999 94(1):41, Stepped Care, [extensive search unable to locate original]

Dyer W.W., 1977, Pulling Your Own Strings, USA, Avon Books

Dyer W.W., 1981, The Sky’s the Limit, London, Granada Publishing

Dyer W.W., 1985, What do you really want for your children? London, Transworld Publishers

Eagleton M. [Ed.], 1990, Feminist Literary Theory, UK, Basil Blackwell

Eales C., 1983, Raising your talented child, Melbourne, Angus & Robertson

278

Edelman H., 1995, Motherless Daughters: the legacy of loss, Australia, Hodder & Stoughton

Edwards & Gross, 1976, in Jarvis J.J. Tebbutt J., & Mattick R.P., (2001:16), Treatment Approaches for Alcohol and Drug Dependence, UK, J. Wiley & Sons

Edwards G., & Gross M., Alcohol Dependence: provisional description of a clinical syndrome, British Medical journal, 1, 1976, 1058-1061

Edwards G., The Alcohol Dependence Syndrome, In Edwards and Grant [eds.], 1977, Alcoholism: Addiction, 1999:94[1], p36 New Knowledge and New Responses. London, Croom-Helm

Edwards, G. In Psychotherapy, Psychological Treatments and the Addictions, Cambridge, Cambridge, MIT

Egan G., 1982, The Skilled Helper, California, Wadsworth Inc.

Eichenbaum L., Orbach S., 1987, What Do Women Want? GB, Fotana Books

Eimers R., Aitchison R., 1977, Effective Parents Responsible Children, USA, McGraw Hill

Eisler R., 1987, The Chalice & the Blade – Our history our future, San Francisco, Harper Collins

Elisabeth L., 1988, Twelve Steps For Overeaters, San Francisco, Harper/Hazelden

Ellis A., 1957, How to live with a neurotic, USA, General Publishing Co. Ltd.

Ellis A., 1969, The Art and Science of Love, NY, Bantam Books

Ellis A., 1971, Growth Through Reason, California, Hal Leighton Printing Co.

Ellis A., 1977, Anger - How to live with and without it, Melbourne, Sun Books

Ellis A., Harper R., 1975, A Guide to Rational Living, UK, Prentice-Hall International Inc.

Elvy G., 1989, Retrieved June 13, 2007, from http://aic.gov.au/publications/proceedings/01/Elvy.pdf

Encyclopedia Britannica, 2007, Retrieved June 22, 2007 from http://www.britannica.com/eb/article-9005515/Alcoholics-Anonymous

Epston D., White M., 1990, Literature Means to Therapeutic Ends, SA, Dulwich Centre

Eriksson E., 1987, Childhood and Society, UK, Pallidin

Ernst K., 1976, Pre-Scription A TA Look at Child Development, California, Celestial Arts

279

Estes C.P., 1993, Women Who Run With The Wolves, London, Random House

Exiner J., Lloyd P., 1987, Learning Through Dance, Melbourne, Oxford University Press

Eysench H.J., 1966, Sense and Nonsense in Psychology, Middlesex UK, Penguin Books

Faber A., Mazilsh E., 1996, How To Talk So Kids Can Learn, USA, Fireside Books

Faludi S., 1991, Backlash, London, Chatto & Windus

Families & Friends of Drug Reform Law see FFDLR

Farber M., Wilson R.H.L., [Ed.], 1963, The Potential of Woman, USA, McGraw-Hill Book Co.

Farnsworth M.W., 1978, Genetics, NY, Harper & Row

Feelgood, 1984, Thoughts on Sex & Relationships, Australia, Wilkinsons Books

Feighner, J.P.: Robins, E.: Guze, S.B.: Woodruff, R.A., Jr.: Winokur, G.: & Munoz, R. Diagnostic criteria for use in psychiatric research, Archives of General Psychiatry

26[1]:57-63, 1972

Fell L., Russell D., 1994, The Dance of Understanding, School of Social Ecology Occupational Papers Vol 2 1995, Australia, UWS Hawkesbury

Fell L., Russell D., Stewart A., [Eds.], 1994, Seized by Agreement, Swamped by

Understanding, Australia, UWS Hawkesbury

Fensterheim H., Bayer J., 1983, Don't Say Yes When You Want to Say No, London, Futura Publishers

FFDLR Newsletter, April 2007 - Families and Friends for Drug Law Reform (ACT) Inc.

Filiberti Moglia R., Knowles J. [Eds.], 1980, All about sex, NY, Three Rivers Press

Finney JW. Some treatment implications of Project MATCH. Addiction 1999:94[1]:42-45[ADAI jl]

Firestone S., 1970, The Dialectic of Sex, UK, The Women’s Press Ltd.

Fishbein, D. and S. Pease, [1996] The Dynamics of Drug Abuse, Toronto, Allyn & Bacon

Fisher R., Ury W., 1984 and 1986, Getting To Yes, England, Hutchinson

Fixter K., 2007, Assistant Director, Alcohol and Indigenous Programs Drug Strategy Branch, Health & Ageing Dept. as per email report on NDARC and NDS, Received May 15, 2007, [email protected]

280

Flew A. [Ed. Consult.], 1984, A Dictionary of Philosophy, London, Pan Books

Fonow M., Cook J., 1991, Beyond Methodology – Feminist Scholarship as Lived

Research, Bloomington Indiana

Foot, D., 1996 Boom Bust and Echo: How to Profit from the Coming Demographic

Shift, Toronto, Macfarlane Walter & Ross

Foreyt, J.P. 1987, The addictive disorders. In G.T. Wilson, C.M. Franks, P.C. Kendall, & J.P. Foreyt (Eds.), Review of behavior therapy (Vol. 11, pp. 187-223). New York: Guilford.

Foucault M., 1990, The History of Sexuality, USA, Vintage Books

Foucault M., 1990, The Use of Pleasure, USA, Vintage Books

Fox W., 1992, Towards a Transpersonal Ecology, USA, Shambhala

Foy, D.W., Nunn, L.B., & Rychtarik, R.G. 1984, Broad-spectrum behavioral treatment for chronic alcoholics: Effects of training controlled drinking skills. Journal

of Consulting and Clinical Psychology, 52, 218-230.

Freeman E.A., 1987, The Catastrophe of Comas, Australia, David Bateman

Freire P., 1970, The Pedagogy of the Oppressed, NY, Seabury Press

Freudenberger H., 1985, Burnout, London, Arrow Books

Friday N., 1986, My Mother Myself, USA, Fontana Books

Friedan B., 1963, The Feminine Mystique, UK, Penguin

Friel J. & L., 1988, Adult Children, USA, Health Communications Inc.

Friel, J. and L. Friel, [1990] An Adult Child's Guide to What's Normal, USA, Health Communications Inc.

Frisch O., 1972, The Nature of Matter, London, Thames and Hudson

Fromm E., 1988, The Art of Loving, London, Unwin Hyman Ltd.

Fuhrman J., 1997, Reject me – I love it, Pennsylvania, Success Publishers

Fuller R.K : Allen JP. Patient-to-treatment matching. In: Zernig G: Saria A: Kurz M: O'Malley SS [eds.]. Handbook of Alcoholism, Boca Raton, FL : CRC Press, 2000, pp. 363-368. [ADAI bk]

Fuller R.K., Project MATCH, Dec 17 1996, Retrieved on April 21, 2007 from http://www.niaaa.nih.gov/

281

Fuller R.K: Hiller-Sturmhoefel S. Alcoholism treatment in the United States : an

overview. Alcohol Res Health 1999:23[2]:69-77. [ADAI jl]

Furth G.M., 1988, The Secret World of Drawings, USA, Sigo Press

Galke E.H., 1975, You Can Have A Family Where Everybody Wins, Adelaide, The Lutheran Publishing House

Gallwey W.T., 1983, The Inner Game of Tennis, GB, Redwood Burn

Gardner H. [Ed.], 1995, The Politics of Health, Melbourne, Churchill Livingstone

Gaylin W., MD, 1994, The Rage Within, NY, Simon & Schuster

Geertz C., (1988), The Anthropologist as Author, Stanford, Stanford University Press

Geertz C., (1995), After the Fact: Two Countries, Four Decades, One Anthropologist, Cambridge, Mass., Harvard University Press

Geldard G. & K., 2001, Basic Personal Counselling, Australia, Prentice Hall

Gendlin E.T., 1982, Focusing, USA, Bantam Books

Geoff Elvy, Executive Director, Australian Alcohol and Drug Foundation Canberra, ACT Drink driving,1989, Conference on Australia’s Health Policy on Alcohol by the Institute of Criminology

Gergen K.J & Gergen M.M., (1986), Narrative form and the construction of psychological science, in T.R. Sarbin (Ed.), Narrative psychology: The storied nature

of human conduct (pp.22-44) NY, Praeger

Gestalt 2005, The Columbia Electronic Encyclopaedia, 6th ed. Columbia University Press. Retrieved April 20, 2005 from http://www.answers.com/topic/gestalt-psychology: Gething L., Hatchard D., Papalia D. E., Wendkos Olds S., 1991, Life Span

Development, USA, McGraw Hill

Gilley see Pastor Gilley

Gladding, S., [1998] Family Therapy: History, Theory and Practice, [2nd ed.], Ohio, Prentice Hall

Glaser FB et al. Project MATCH Research Group. Comments on Project MATCH :

matching alcohol treatments to client heterogeneity. Addiction 1999:94[1]:31-69. [ADAI rp 08792]

Glaser FB. The unsinkable Project MATCH. Addiction 1999:94[1]:34-36. [ADAI jl]-

Glass L., 1993, He Says She Says, NSW, Transworld Publishers Australia P/L

Glasser W., 1976, Positive Addiction, New York, Harper & Row

282

Glatt M.M., Marks J., [Eds.] 1982 The Dependence Phenomenon, UK, MTP Press

Glickman R., 1993, Daughters of Feminists, NY, St. Martin’s Press

Godby G., 1990, Leisure in your life, USA, Venture Publishing

Godfrey C. The "value" of Project MATCH for service provision. Addiction 1999:94[1]:54-55. [ADAI jl]

Goffman E., 1982, Asylums, Auckland, Pelican Books

Goicoechea D. [Ed.], 1995, The Nature & Pursuit of Love, USA, Prometheus Books

Goleman D., 1995, Emotional Intelligence, London, Bloomsbury

Gomberg, E.L. [1989]. On terms used and abused: The concept of codependecy. Drugs and Society, 3, 113-132

Gomez J. Dr., 1988, A Dictionary of Symptoms, GB, Paladin

Good B.J., 1994, Medicine, rationality and experience: An anthropological

perspective, UK, Cambridge University Press

Goodbey G., 1990, Leisure in Your LIfe, USA, Venture Publishing

Goodrich T.J., Rampage C., Ellman B., Halstead K., 1988, Feminist Family Therapy, Canada, Penguin Books

Gordis E., NIAAA, 1996, Project MATCH, Retrieved on May 23, 2007, from http://www.niaaa.nih.gov/NewsEvents/NewsReleases/match.htm

Gordis E: Fuller R. Project MATCH. Addiction 1999:94[1]:57-59. [ADAI jl]

Gordon, T., 1975, P.E.T. Parent Effectiveness Training, NY, Plume

Gordon T., 1982, P.E.T. in Action, USA, Bantam Books

Gornick V., Moran V.K., 1971, Woman in Sexist Society, USA, Basic Books Inc.

Gossop M. & Eiser J.R., The addicts perceptions of their own drug-taking:

implications for the treatment of drug dependence. Addictive Behaviours, 7, 189-194, 1982

Gossop M., Compulsion, craving and conflict, In Warburton D.M., 1990, Addiction

Controversies, London: Harwood

Gottheil, E., Murphy, B.F., Skoloda, T.E., & Corbett, L.O., 1972, Fixed-interval drinking decisions: II. Drinking and discomfort in 25 alcoholics. Journal of Studies on

Alcohol, 11, 325-340.

Goulding M., Goulding R., 1975, Changing Lives Through Redecision Therapy, NY, Brunner/Mazel Inc.

283

Goulds S., 1985, The Role of Women, UK, A MacDonald Book

Goyen M., 1994, The Australian Guide to Prescription Drugs, Australia, The Watermark Press

Graham R., 1987, Surviving Childhood, Australia, Methuen Haynes

Grant, B.F. DSM III-R and ICD 10 classifications of alcohol use disorders and associated disabilities: A structural analysis. International Review of Psychiatry 1:21-39, 1989

Gray J., 1992, Men are from Mars Women are from Venus, NY, Harper Collins Publishers Inc.

Gray J., 1995, Mars and Venus in the Bedroom, NSW, Hodder Headline Australia P/L

Graziano A., Rowlan M., 1989, Research Methods A Process of Inquiry NY, Harper & Row

Greer G., 1970, The Female Eunuch, London, McGibbon & Kee

Greer G., 1984, Sex & Destiny, VIC., Seker & Warburg

Greer G., 2000, the whole woman, UK, Anchor

Grieve N., 1992, Reflections on being a feminist psychologist: Disciplinary and interdisciplinary issues, in Grimshaw P., Fincher R. & Campbell M. (Eds.), Studies in

gender: Essays in honour of Norma Grieve (pp. 297-307, Melbourne, University of Melbourne Equal Opportunity Unit

Griffiths S., 1987, Allergy Overload, Sydney, Fontana Books

Grundy S., Kemmis S., 1981, Educational Action Research in Australia: The State of

the Art in Kemmis, S. and McTaggart R., 1988, The Action Research Reader, Vic.Deakin Uni. Press

Guba E.G., Lincoln Y.S., 1989, Fourth Generation Evaluation, California, Sage

Guba, E. [ed.], [1990] The Paradigm Dialog, London, Sage

Guerney B.G., 1982, Relationship Enhancement, California, Jossey-Bass Behaviorial Science Series

Gurley Brown H., 1982, Having it all, NY, Simon & Schuster

Habermas J., 1974, Theory and Practice, tr. John Viertel, London, Heinemann

Habit Smart 2002, Retrieved November 11, 2002 from http://www.habitsmart.com/bw.htm

Hadley, R. and L. Mitchell, [1995] Counseling Research and Program Evaluation, Toronto, Brooks/Cole

284

Hafner J., 1993, The End of Marriage, London, Arrow Books Ltd.

Hagan, K. 1989, Codependency and the myth of recovery: A feminist scrutiny, Atlanta, Escapadia Press

Haley J., 1980, Leaving Home: the therapy of disturbed young people, USA, McGraw Hill

Hall D., 1986, What's Wrong With You? How Natural Therapies Can Help, Australia, Thomas Nelson

Hall W. Patient matching in treatment for alcohol dependence : is the null hypothesis

still alive and well? [Project MATCH]. Addiction 1999:94[1]:52-54. [ADAI jl]

Hanna S., 1995 Person to Person: Positive Relationships Just Don't Happen, New Jersey, Prentice Hall

Hansen, J., & Emrick, C.D. (1983). Whom are we calling "alcoholic"? Bulletin of the

Society of Psychologists in the Addictive Behaviors, 2, 164-178.

Hanson P., 1988, The Joy of Stress, London, Pan Books

Harding D.E., 1990, Head Off Stress, Suffolk, Arkana

Harding S., 1987, Feminism And Methodology, UK, Open University Press Milton Keynes

Harm Minimisation 2007, Divert Assessor Training - The Police Drug Diversion

Initiative (PDDI), Drug Information, Harm Minimisation Retrieved April 27, 2007, from http://www.divert.sa.edu.au/drugs/harm_minimisation.htm

Harris A., Harris T., 1985, Staying OK, SA, Griffin Press Ltd.

Harris C.C., 1972, The Family, GB, Redwood Press Ltd.

Harris T., 1970, I'm OK - You're OK, Great Britain, Pan Books

Harrison J., 1987, Love Your Disease, London, Angus & Robertson

Hartin W. 1980, Staying Married, Australia, Content Publishing Co. P/L

Hartin W., 1988, Why Did I Marry You, Melbourne, Hill of Content Publishing P/L

Hasin, D.S.: Grant. B.: & Endicott, J. The natural history of alcohol abuse: Implications for definitions of alcohol use disorders. American Journal of Psychiatry

147[11]:1537-1541, 1990

Haye L., 1988 You Can Heal Your Life, Australia, Specialty Publications

Hays P., 1964, New Horizons in Psychiatry, UK, Penguin Books

285

Health Library Ebsco, 2005, Retrieved April 21, 2005, http://healthlibrary.epnet.com/GetContent.aspx?token=dce59228-1023-4705-b1c7-b407be7b4fc6&chunkiid=156987

Health Services Division Commonwealth Department of Health and Aged Care Mental Health Branch Youth Suicide in Australia, Health Services Division Webmaster 2000 Retrieved March 21, 2000 from http://www.aifs.gov.au/ysp/ysplinks.html

Heater S.H., 1983, Am I still visible? USA, White Hall Books

Heather, N., Winton, M., & Rollnick, S., 1982, An empirical test of "a cultural delusion of alcoholics." Psychological Reports, 50, 379-382.

Heather N., Robertson I., 1981 and 1983 [Rev. edn.], Controlled Drinking, NY, Methuen Inc.

Heather, N., 1986, Change without therapists: The use of self-help manuals by problem drinkers. In W.R. Miller & N.K. Heather (Eds.), Treating addictive

behaviors: Processes of change (pp. 331-359). New York: Plenum.

Heather N., Robertson I., 1987, Let’s Drink to Your Health, Ryde, Angus & Robertson

Heather N., Richmond R., Webster I., Wodak A., Hardie M., & Polkinghorne H., 1989, A Guide to Healthier Drinking: A Self-help Manual, Sydney, Clarendon Printing

Heather N., Batey R., Saunders J.B., Wodak A.D., 1989, Monograph Series No. 11: The Effectiveness of Treatment for Drug and Alcohol Problem: an overview edited by Heather N., Tebbutt J., [contributions by Digiusto E., Greeley J.D., Mattick R.P., Richmond R.L., Tebbutt J.S.], Australian Govt. Publishing Service Canberra (title unknown)

Heather N., Robertson I., 1989, Problem Drinking Oxford, University Press Oxford

Heather, N. 1995 Brief Interventions Strategies, in Hester R.K., & Miller W.R. [Eds.] Handbook of Alcoholism Treatment Approaches: Effective Alternatives [pp.93-116], NY, Pergamon Press

Heather N. Waiting for a match: the future of psychosocial treatment for alcohol problems [Project MATCH]. Addiction 1996:91[4]:469-472. [ADAI jl]

Heather N., Comments on Project MATCH: matching alcohol treatments to client heterogeneity, Addiction 1999:94[1], 31-69:36

Heather N. Some common methodological criticisms of Project MATCH : are they justified? Addiction 1999:94[1]:36-39. [ADAI jl]

286

Heather N. Clinical responses. Psychosocial treatment approaches and the findings of Project MATCH. In: Plant M : Cameron D [eds.]. The Alcohol Report. New York:

Free Association Books, 2000, pp.154-178. [ADAI bk] HV 5035 P59 2000

Heesh J.: Harm Minimisation and Responsible Service of Alcohol. Retrieved November 11, 2002 from http://www.cybersydney.com.au/emc/news/alcohol.html

Hegel G.W.F., 1991, Elements of the Philosophy of Right, UK, Cambridge University Press

Hegeler I. & S., 1971, The XYZ of Love, London, MacGibbon & Kee

Heilpern D. and Bolt S., [1998] Rough Deal: your guide to drug laws, Sydney, Redfern Legal Centre Publishing

Henderson R., 1998, Department for Women 1997-1998 Annual Report, NSW, Dept. for Women

Henle M., 1975 [republished 1986], 1879 and All That, Essays in the Theory and

History of Psychology, Columbia University Press, New York 1986, pp 22-35.

Henriques F., 1968, Love in Action, GB, Panther Books

Hertz R., 1986, More Equal Than Others, USA, University of California Press

Hewlett S.A., 1987, A Lesser Life: The Myth of Women’s Liberation, London, Michael Joseph Ltd.

Hickson F., 1991, Psychosocial and Sociological Factors, Aust. Catholic Uni. Nth Syd. Hill Book Co., Australia

Hill S. [Ed. Consult.], 1998, Book of Readings Researching, Australia, Faculty of Social Inquiry UWS Hawkesbury

Hill S. [Ed. Consult.], 1999, Introductory Reader 2 Social Ecology Working With

Change, Australia, Faculty of Social Inquiry UWS Hawkesbury

Hillman J., Ventura M., 1990, We've Had a Hundred of Psychotherapy and The

World's Getting Worse, USA, Harper Collins

Hilts E., 1994, Getting In Touch With Your Inner Bitch, London, Harper Collins

Hippocrates, 400, Robbie Hatley website, Retrieved June 2, 2007, from http://www.well.com/~lonewolf/essays/personality-types.html

Hirsch P.L., 1996, Living with Passion, Va., MLM Publishing Inc.

Hirst D., 1979, Heroin in Australia, VIC., Quartet Books Aust. P/L

Hite S., 1994, The Hite Reports: Sexuality, Love and Emotion, GB, Sceptre

Hoff, L., [1978], People in Crisis: Understanding and Helping, Ontario, Addison-Wesley

287

Holder HD, Cisler RA, Longabaugh R, Stout RL, Treno AJ, Zweben A. Alcoholism treatment and medical care costs from Project MATCH. Addiction 2000

Jul:95[7]:999-1013. [ADAI jl]

Hollway W., 1989, Subjectivity and method in psychology: Gender, meaning and

science, London, Sage

Honderich, T., 1995, The Oxford Companion To Philosophy, GB, Oxford Uni Press

Hordern A., 1976, Tranquility Denied: stress and its impact today, Australia, Rigby

Horne D., 2001, Looking for Leadership, Australia, Penguin Books

Horne R., 1988, Improving on Pritikin, Sydney, Happy Landings P/L

Horne R., 1992, Health & Survival in the 21st Century, Sydney, Margaret Gee

Publishing

Horsfall D., 1999, The Subalterns Speak: A Collaborative inquiry into community

participation in community health care, PhD Thesis, Faculty of Social Ecology, Richmond, NSW, UWS Hawkesbury

Houston J., 1982, The Possible Human, USA, Tarcher St. Martin's Press

Howard R.W., 1984, Coping & Adapting, NSW, Angus & Robertson

Hudson A., Griffin, N., Ed., 1980, Behaviour Analysis And The Problems of

Childhood, Vic., Pitt Publishing

Hulse S., Egeth H. & Deese J., 1958, The Psychology of Learning, Kouga, McGraw-Hill

Hutchinson F. Dr., 1995, Research Methods & Critique Faculty of Health Humanities & Social Ecology, NSW, UWS Hawkesbury

Hutchinson F., 1994, Educating Beyond Violent Futures in Children's Media, Futures 26[1] in School of Social Ecology Occasional Papers Vol 2 1995, NSW, UWS Hawkesbury

Hutchinson F., 1995, Course Readings Peace Sustainability & World Futures SE103

& SE305A Faculty of Health Humanities & Social Ecology, NSW, UWS Hawkesbury

Ingram A., O’Donnell P., 2002, My Money Myself, Sydney, Choice Book

Inkeles A., 1964, What is Sociology?, New Jersey, Prentice-Hall

International Society of Addiction Medicine Retrieved on October 16, 2004 from http://www.sympatico.ca/pmdoc/ISAM/

Intervention, 2007, Retrieved April 29, 2007 from http://addiction.lovetoknow.com/wiki/Intervention

288

“J”, 1971, The Sensuous Woman, UK, Mayflower Books Hert

Jackson D., Soothill R., 1988, Is the medicine making you ill? Sydney, Angus & Robertson

Jackson R., Dr., University of Auckland, Retrieved on April 23, 2007 from http://www.news-medical.net/?id=14846

James L., 1998, Life Skills, Michigan, Sage Creek Press

James M., 1981, Breaking Free, Philippines, Addison-Wesley Publishing Co.

James M., 1981, Transactional Analysis for Moms & Dads, Philippines, Addison-Wesley Publishing Co.

James M., 1985, It's Never Too Late To Be Happy, Philippines, Addison-Wesley Publishing Co.

James M., James J., 1992, Passion for Life, USA, Penguin Books

James M., Jogeward D., 1978, Born to Win, USA, Penguin Books

James M., Savary, L.1980, A New Self, Philippines, Addison-Wesley Publishing Co.

James W., 2002, The Varieties of Religious Experience: A Study in Human Nature

Centenary Edition, Routledge Retrieved on June 21 2007, from http://en.wikipedia.org/wiki/Varieties_of_Religious_Experience

Jamieson K.G., 1979, A First Notebook of Head Injury, London, Butterworths

Jampolsky G.G., 1983, Teach Only Love, NY, Bantam Books

Jampolsky G.G., 1985, Love is Letting Go of Fear, USA, Bantam Books

Janesick V.J., 2000, The Choreography of Qualitative Research Design. In Densin N.K., Lincoln Y.S., [eds.], 2000 Handbook of Qualitative Research [2

nd Edn.],

Thousand Oaks, CA, Sage Publications, Inc.

Jansen D., Newman M., 1989, Really Relating, Sydney, Century Hutchinson Aust. P/L

Jarman C., 1970, Evolution of Life, London, Hamlyn Publishing

Jarvis J.J., Tebbutt J., & Mattick R. P., 1993 [1st ed] and 2001 [7th Edition], Treatment

Approaches for Alcohol and Drug Dependence, UK, J. Wiley & Sons

Jarvis W., 1980, Discover Yourself And...Live!, Melbourne, Sphere

Jay M., 1973, The Dialectical Imagination: The History of the Institute for Social

Research and the Frankfurt School, 1923-50, Boston, Little Brown and Co.

Jeffers S., 1987, Feel the Fear and Do It Anyway, London, Arrow Books Ltd.

289

Jellinek, E.M. 1952, Phases of Alcohol Addiction, Quarterly Journal of Studies on

Alcohol, 13,673-684

Jellinek, E.M., 1960, The Disease Concept of Alcoholism. New Brunswick, Hillhouse Press

Johnson R.A., 1983, The Fisher King & The Handless Maiden, USA, HarperCollins

Johnson R.A., 1983, We - The Psychology of Joy, USA, HarperCollins

Johnson R.A., 1986, Inner Work, NY, Harper & Row

Johnson R.A., 1989, Ecstasy - The Psychology of Joy, USA, HarperCollins

Johnson R.A., 1989, He, NY, Harper & Row

Johnson R.A., 1989, She, NY, Harper & Row

Johnson R.A., 1991, Owning Your Own Shadow, NY, Harper & Row

Johnson S., 1983, One Minute Father, UK, Columbus Books Kent

Johnson S., 1983, One Minute Mother, UK, Columbus Books Kent

Johnson S., 1996, Women Love Sex, NSW, Random House Australia P/L

Johnson S., 1998, Who Moved My Cheese, Random House UK Ltd., London

Johnson V. E., 1980, I’ll Quit Tomorrow, San Francisco, Harper & Row

Johnson V.E., 1986, Intervention, USA, Johnson Inst. Books

Jones B.T., Treatment match, Addict Res 1998:6[6]:469-472 [ADAI jl]

Jones C., 1989, The search for meaning, Sydney, ABC Enterprises

Jones R. N., 1968, Human Relationship Skills, London, Harcourt Brace Jovanovich

Jongeward D. & Scott D., 1985, Women as Winners, Philippines, Addison Wesley Publishing Co.

Jongeward D., James M., 1980, Winning With People, Philippines, Addison-Wesley Publishing Co.

Journal of Consulting and Clinical Psychology, 56:520-528, applications to the cessation of smoking

Journal of Drug Education. 15[2]:171-185, [1985] Lesater et al, Identifying chemical use problems in a community clinic

Journal of Drug Issues, 20[1]:37-65 (author and title unknown)

Journal of Drug Issues, 26[1]:45-61 (author and title unknown)

290

Journal of Family Therapy, vol. 5, no. 4, pp. 249-58 (author and title unknown)

Journal of Psychoactive Drugs, 18[1]:7-13. Codependency (author and title unknown)

Journal of Psychoactive Drugs, 18[1]:57-59 Preparing a family for intervention (author unknown)

Journal of Strategic and Systems Therapies, 5[3]:1-3 Putting the codependent in charge: A compression approach to an alcoholic system (author unknown)

Journal of Substance AbuseTreatment, 4[3-4]:233-238. [1987] Spirituality in the recovery process (title unknown)

Journal on Addictions, 5[3]:259-261 (author and title unknown)

Jung C., 1921, Psychological Types, Robbie Hatley website, Retrieved on June 2, 2007 from http://www.well.com/~lonewolf/essays/personality-types.html

Jung C, 2007, in Alcoholics Anonymous, Retrieved on June 21 2007, from http://en.wikipedia.org/wiki/Alcoholics_Anonymous

Jurd S., 2000, No Half Measures in Addiction Recovery, paper, Australis2000

Humanist Congress Sydney

Kadden RM. Project MATCH: treatment main effects and matching results. Alcohol

Clin Exp Res 1996 Nov:20 [8 Suppl]:196A-197A. [ADAI jl]

Kadden, Ronald : Carroll, Kathleen : Donovan, Dennis M. : Cooney, Ned : Monti, Peter : Abrams, David : Litt, Mark [eds.]. Cognitive-behavioral coping skills therapy

manual : a clinical research guide for therapists treating individuals with alcohol

abuse and dependence. Rockville : National Institute on Alcohol Abuse and Alcoholism. [ADAI bk] HV 5278 P76 v.3

Kaplan C., 1989, There’s a Lipstick in my Briefcase, NSW, Godiva Pub. P/L

Katz S.J., 1991, Codependency Conspiracy, NY, Warner Books Inc.

Kaufman Hall V., 1995, Women Transforming The Workplace, Ph.D. Thesis, UWS

Kearns K., 1997, Psychoanalysis, Historiography & Feminist Theory, Cambridge, Cambridge Uni. Press

Keen S., 1991, Fire in the Belly, USA, Bantam Books

Keller, M., & Doria, J. On defining alcoholism. Alcohol Health & Research World 15[4]:253-259, 1991

Kemmis S., McTaggart R., 1988, The Action Research Reader, Australia, Deakin Uni Press

291

Kendall P.C. and Hollon S.D., 1979, Cognitive-Behavioural Interventions, New York, Academic Press Inc.

Kent H., 1998, Breathe better Feel better, London, Apple Press

Kenton L., 1985, Ageless Ageing, London, Arrow Books

Kenton L., 1986, The Biogenic Diet, London, Century Arrow

Kersey C., 1998, Unstoppable, Illinois, Sourcebooks Inc.

Kidman A, 1985, Tactics for Change, Sydney, UTS Neurobiology Unit

Kidman A., 1985, Risk Taking, Sydney, UTS Neurobiology Unit

King D.B., Wertheimer M., Max Wertheimer & Gestalt Theory, USA Transaction Publishers

Kirkman M., 2002, What’s the Plot? Applying Narrative Theory to Research in Psychology, Australian Psychologist, March 2002; 37 (1), 30-38

Kiley D., 1984, The Wendy Dilemma – do you mother your man, London, Arrow Books

Klatsky A.L., 2003, Drink to your health? Scientific American. 2003; 288:74–81.

Klatsky AL, Friedman GD, Armstrong MA, et al., 2003, Wine, liquor, beer, and mortality. Am J Epidemiol. 2003;158(6):585-95.

Klein J., 1970, Working with Groups, Arizona, Hutchinson & Co.

Knepfer G., 1984, Sex in Australia, Sydney, J & G Publishing

Knight P., 1983, Positively No: the book of rejections, London, Elm Tree Books

Koffka K., 1963, The Principles of Gestalt Psychology, USA, Harcourt, Brace & World Inc.

W. Köhler, 1969, The Task of Gestalt Psychology, Princeton, Princeton University Press

Kolb D.A., 1984, Experiential Learning: Experience as the Source of Learning and

Development, New Jersey, Prentice-Hall Inc.

Kopp S., 1988, If You Meet the Budha on the Road Kill Him, California, Sheldon Press

Kovel J., 1986, A Complete Guide to Therapy, England, Penguin Books

Kritsberg, W., [1993] The Invisible Wound, NY, Bantam

Krivanek J., 2000, Understanding Drug Use, Australia, WEF Associates

292

Kubler-Ross E., 1975, Death the Final Stage of Growth. London Prentice Hall International

Kubler-Ross E., 1986, On Death & Dying, London, Tavistock Publications

Kuhn, T., [1974] The Structure of Scientific Revolutions. Chicago, The Uni of Chicago Press

Kurtz I., 1995, Ten-Points for an Untroubled Life, London, Fourth Estate

Kurtz P., 1988, Forbidden Fruit, USA, Prometheus Books

Kurtz P., 2000, Humanist Manifesto 2000, USA, Prometheus Books

Kushner H.S., 1981, When Bad Things Happen to Good People, London, Pan Books

Kushner H.S., 1986, When All You've Ever Wanted Isn't Enough, USA, Pan Books

L. Moreno J.L., 1946, Psychodrama, New York, Beacon House

Laing R.D. with Esterson A., 1964, Sanity Madness and the Family, GB, Penguin Books

Lather P., 1991, Getting Smart – Feminist Research & Pedagogy within the

Postmodern, London, Routledge

Lazarus, R.S. & Folkman, S. 1984, Stress, Appraisal and Coping, NY, Springer

Leach E. [Ed], 1983, The Arts: A Way of Knowing, Oxford, Pergamon Press

Lederach J.P., 1996, Preparing for Peace, NY, Syracuse University Press

Lender, M.E., & Martin, J.K., 1982, Drinking in America, New York: MacMillan.

Lennane J., 1992, Alcohol the National Hangover, Nth. Sydney, Allen & Unwin

Lesater et al, Journal of Drug Education. 15[2]:171-185, [1985] Identifying chemical use problems in a community clinic

Lessin R., 1982, Spanking why, when, how? USA, Bethany Fellowship Inc.

Lester G., 1981, When it’s time to talk about sex, USA, Abbey Press

Leunig M., 1992, Everyday Devils and Angels, VIC., Penguin Books

Lever C., 1997, If you can’t climb the wall, build a door, Florida, Inti Publishing

Levinthal, C., [1999: 2nd ed.] Drugs, Behavior, and Modern Society, Toronto, Allyn & Bacon

Levison A., 1986, An Addict in the Family, Auckland, Penguin Books

293

Lewin K., 1948, Action Research, in Reason & Rowan 1981:xvii, Richmond, UWS Hawkesbury

Life Education 2007, Retrieved June 23, 2007, from http://www.life-educationaustralia.com.au/main/newsitem.asp?NewsID=6 Lindstrom L. Life is short, the art long [Project MATCH]. Addiction 1999:94[1]:45-47. [ADAI jl]

Lindstrom, L., [1992] Managing Alcoholism: Matching Clients to Treatments. Oxford Uni Press

Lisansky Gomberg, E. and T. Nirenberg, [eds.] [1993] Women and Substance Abuse, New Jersey, Ablex

Littauer F., 1986, Your Personality Tree, USA, Word Publishing

Littauer F., 1989, Rising the Curtain on Raising Children, Texas, Word Inc.

Littauer F., 1991, Dare to Dream, USA, Word Publishing

Littauer F., 1997, Personality Plus, USA, Fleming H. Revell

Llewellyn-Jones D., 1985, Understanding Sexuality, VIC., Oxford Uni. Press

Llewllyn-Jones D., 1993, Everybody – the healthy eating handbook, Oxford, Oxford Uni Press

Loads A. [Ed], 1990, Feminist Theology - a reader, USA, Westminster/John Knox Press

Lofquist, W., [1983] Discovering the Meaning of Prevention: A Practical Approach

to Positive Change, London, Sage Publications

Long J., [1993] The Essential Guide to Prescription Drugs, U.S.A, Harper

Longabaugh R : Mattson ME : Connors GJ : Cooney NL. Quality of life as an outcome variable in alcoholism treatment research [Project MATCH]. J Stud Alcohol

1994:Suppl. 12: 119-129. [ADAI jl]

Longabaugh, Richard : Wirtz, Philip W. [eds.]. Project MATCH hypotheses : Results and causal chain analyses. [Project MATCH Monograph 8 : NIH Publication No. 01-4238] Bethesda : National Institute on Alcohol Abuse and Alcoholism, 2001. xii, 330 p. [HV 5278 P76 v.8 [REF HND]

Lucas K.A., 1999, Idyll Abor Inc., Chemical Dependency Counselor Journal, Illinois, Chestnut Health.Implications

Lucas K.A., CSAC, CADAC April 1999, Idyll Arbor’s Journals of Practice [IAJP], Retrieved November 11, 2002 from http://www.idyllarbor.com

Luckmann T. [Ed], 1978, Phenomenology & Sociology, UK, Penguin Books

294

Lukes A., Barbato J., You are what you drink, VIC., S. & W. Information Guide

Lundin R.W., 1965, Personality – and experimental approach, NY, The Macmillan Co.

Mace C.A., 1962, The Psychology of Study, GB, Pelican Books

Mace D.R., 1985, Getting Ready For Marriage, Tennessee, Parthenon Press

Macksey J. & K., 1975, Feminine Achievements, London, Guinness Superlatives Ltd.

Maclaine J., 2001, When Someone You Love Is Addicted to Alcohol or Drugs, Sydney, Random House Transworld Publishers

Madanes C., 1981, Strategic Family Therapy, USA, Jossey-Bass Inc.

Mahan, S. [1996]. Crack, Cocaine and Women: Legal, Social and Treatment Issues, Thousand Oaks, Sage Publications

Maisto, S., M. Galizio and G. Connors, [1995] Drug Use and Abuse, Toronto, Harcourt Brace

Malone T. & P., 1987, The Art of Intimacy, London, Simon & Schuster

Maltz M., 1974, Psycho-Cybernetic Principles for Creative Living, NY, Pocket Books

Man J., 1979, Walk: it could change your life, USA, Paddington Press Ltd.

Mancuso J.C & Sarbin T.R, 1983, The self-narrative in the enactment of roles, in T.R. Sarin & K.E. Sheibe (Eds.), Studies in social identity (pp. 233-253), NY, Praeger

Mandel B., 1984, Open Heart Therapy, CA, Celestial Arts

Mandel B., 1986, Two Hearts Are Better Than One, CA, Celestial Arts

Mandel B., 1989, Heart Over Heels, CA, Celestial Arts

Mandell M., Waller Scanlon L., 1980, 5-Day Allergy Relief System, NY, Pocket Books

Mander J., 1978, Four Arguments for the Elimination of Television, USA, Quill Books

Mandino O., 1994, The Twelfth Angle, USA, Ballantine Books

Maple T., Matheson D.W. [Eds], 1973, Aggression, Hostility & Violence, Australia, Holt Rinehart & Winston

Margulies N., 1992 [2nd reprint], Mapping Inner Space, Australia, Hawker Brownlow Education

Marlatt, G. and J. Gordon, 1985, Relapse Prevention: Maintenance Strategies in the

Treatment of Addictive Behaviours, New York, Guilford Press

295

Marlatt, G.A., Demming, B., & Reid, J.B. (1973). Loss of control drinking in alcoholics: An experimental analogue. Journal of Abnormal Psychology, 81, 233-241.

Marlatt,G.A.,:Tucker, J.A.,:Donovan, D.M.:and Vuchinich, R.E., 1996, Help-Seeking

by Substance Abusers: The role of harm reduction and behavioural-economic

approaches to facilitate treatment entry and retention., USA, University of Washington

Marlin E., [1989] Genograms: The New Tool for Exploring the Personality, Career,

and Love Patterns You Inherit, USA, McGraw-Hill/Contemporary Books

Marr D., 1999, The High Price of Heaven, NSW, Allen & Unwin

Martin G., Pear J., 1988, Behavior Modification, USA, Prentice Hall

Martin P. [Ed.], 1987, Psychiatric Nursing, London, Macmillan

Martin, A.L., & Piazza, N.J. [1995]. Codependency In Women: Personality Disorder or Popular Descriptive Term? Journal of Mental Health Counseling, 17[4], 428-440

Marlatt, G.A., Demming, B., & Reid, J.B. (1973). Loss of control drinking in alcoholics: An experimental analogue. Journal of Abnormal Psychology, 81, 233-241 Maslow A.H., 1954, Motivation & Personality, NY, Harper & Row

Massey A., Long R., Horton J., 1989, Financial Affairs for Women, Vic., Wrightbooks

Masson J. M., 1984, The Assault on Truth, USA, Farrar, Strauss Giroux

Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH posttreatment drinking outcomes. J Stud Alcohol 1997 Jan:58[1]:7-29. [ADAI jl]

Matching alcoholism treatments to client heterogeneity: Project MATCH three-year drinking outcomes. Alcohol Clin Exp Res 1998 Sep:22[6]:1300-11. [ADAI jl]

Matching alcoholism treatments to client heterogeneity: treatment main effects and matching effects on drinking during treatment. Project MATCH Research Group. J

Stud Alcohol 1998 Nov: 59[6]:631-9. [ADAI jl]

Matthew A., 1997, Follow Your Heart, Australia, Seashell Publishers

Matthews A., 1989, Being Happy, Singapore, In Books

Matthews A., 1990, Making Friends, Singapore, In Books

Mattson M.E. Patient-treatment matching. Alcohol Health Res World

1995:18[4]:287-295. [ADAI jl]

Mattson ME : Del Boca FK : Carroll KM : Cooney NL : DiClemente CC : Donovan D: Kadden RM: McRee B : Rice C : Rycharik RG : Zweben A. Alcohol Clin Exp Res

296

1998 Compliance with treatment and follow-up protocols in Project MATCH: predictors and relationship to outcome, Sep:22[6]:1328-39. [ADAI jl]

Maturana H., Varela F.J., 1987 and 1992, The Tree of Knowledge, Mass., Shambhala

Mausner B., 1979, A Citizen's Guide to Social Sciences, USA, Nelson Hall

Maxwell J.C. 1997, The Success Journey, Tennessee, Thomas Nelson Inc.

Maxwell J.C., 1998, Laws of Leadership, Tennessee, Thomas Nelson Inc.

May WW. Findings from Project MATCH: Fact or artifact? Behav Health Manage

1998:18[1]:38-39. [ADAI jl]

Maynard Smith J., 1966, The Theory of Evolution, UK, A Pelican Book

McBride W., 1994, Killing the messenger, NSW, Eldorado

McCabe, R.J.R., 1986, Alcohol-dependent individuals sixteen years on. Alcohol &

Alcoholism, 21, 85-91.

McCamy J. & Presley J., 1975, Human Life Styling, NY, Harper & Row

McCarthy W., 1983, Teaching About Sex, The Australian Experience, Australia, George Allen & Unwin Australia P/L

McClure V., 1991, The Tao of Motherhood, USA, Nucleus Publications

McCullough M., 1997, I Can. You Can Too, Okalahoma, Honor Books Inc.

McCutcheon M., 1993 Writing Ecologically, Australia, Social Ecology UWS Hawkesbury

McCutcheon M., 1994, Social Ecologising Through Purposeful Conversation, School of Social Ecology Occasional Papers Vol 2, 1995, Australia, UWS Hawkesbury

McGoldrick M., Gerson R., Shellenberger S., [2nd Edition] [1999],�Genograms:

Assessment and Intervention, USA, W.W. Norton & Company

McGregor J., 1992, The Tao of Recovery, USA, Bantam Books

McIntyre-Palmer F., 1995, Two Sides of the Coin, Canada, McIntyre-Palmer F.

McKeon P., 1986, Coping with Depression & Elation, UK, Sheldon Press

McKissock M., 1993, Coping With Grief, Sydney, ABC Books

McMahon J. Is it time for a change of direction in treatment research? [Complementary Therapies, Project MATCH]. Addict Res 1998:6[5]:379-384. [ADAI jl]

McMahon L., 1990, Fatigue and how to beat it, Australia, Sun Books

297

McMullin R.E., Gehlhaar P., 1990, Thinking & Drinking, VIC., Marlin Publications

McNamara I., Morrison J., 1988, Separation Divorce & After, Australia, University of Qld Press

McNeece, C. and D. DiNitto, [1998] Chemical Dependence: A Systems Approach. Toronto, Allyn and Bacon

McRee B. Project MATCH -- a case study. The role of a coordinating center in

facilitating research compliance in a multisite clinical trial. In: Zweben A : Barrett D: Carty K : McRee B : Morse P : Rice C [eds.] Strategies for Facilitating Protocol

Compliance in Alcoholism Treatment Research, Bethesda: National Institute on Alcohol Abuse and Alcoholism, 1998, pp.93-110. [ADAI bk] HV 5278 P76 v.7 [REF HND]

Mead M., 1970, Culture & Commitment, USA, The Natural History Press

Meares A., 1977, Relief Without Drugs, UK, William Collins Sons & Co.

Medically Supervised Injecting Centre [MSIC], 2003, Face Up, Sydney, MSIC Sydney

Melara J., 1997, Time for Success, Oaklahoma, Global Support Network

Melara J., 1998, It Only Takes Everything You’ve Got, USA, Moran Printing

Mellody P., Miller A.W., & Miller J.K., 1989, Facing Codependence, San Francisco

Harper & Row

Mellody P., Miller A., 1989, Breaking Free, San Francisco, Harper & Row

Mellody P., Miller A.W., & Miller J.K., 1992, Facing Love Addiction, San Francisco

HarperCollinsPublishers

Mello, N.K., & Mendelson, J.H. (1971). A quantitative analysis of drinking patterns in

alcoholics. Archives of General Psychiatry, 25, 527-539.

Mesiti P., 1997, Attitudes & Altitudes, Fyshwick Canberra, Perie Printers P/L

Messner, B. [1996]. Sizing Up Codependency Recovery. Western Journal of

Communication, 60[2], 101-123

Meyer, W.R. (1981). Discussion of papers by Ludwig, Mello, and Nathan. In Evaluation of the alcoholic: Implications for research, theory, and treatment (DHHS Publication No. ADM 81-1033, pp. 243-248). Washington, DC: U.S. GPO. Miedzian M., 1992, Boys Will Be Boys: Breaking the Link Between Masculinity and

Violence, London, Virago

Mies M., Shiva V., 1988, Ecofeminism, Nth Melb., Spinifex Press

298

Mies M., Shiva V., 1993, Preliminary report submitted by the Special Rapporteur on violence against women, its causes and consequences, Retieved April 27 1993 from http://www.unhchr.ch/Huridocda/Huridoca.nsf/0/75ccfd797b0712d08025670b005c9a7d?Opendocument

Miller A., 1993, Breaking Down the Walls of Silence, London, Virago Press

Miller P.H., 1989, Shortcomings of the Theories in the Theories of Development, NY, W.H. Freeman

Miller W. R. Motivational Interviewing with Problem Drinkers. In Behavioural

Psychotherapy, 1983, 11, p.147-172

Miller W. R., Principles of Motivational Interviewing. In:Miller W. R., Rollnick S., Motivational Interviewing, New York, London: Guilford Press, 1991, p. 51-63

Miller, Nunnally and Wackman, 1985, Talking Together, USA, Interpersonal Communication

Miller, W., Zweben A., DiClemente C., Rychtarik R., Motivational enhancement

therapy manual,. Rockville : National Institute on Alcohol Abuse and Alcoholism, 1992. [ADAI bk]HV 5278 p76 v.2

Miller, W. and Rollnick S., [2002] Motivational Interviewing: Preparing People to

Change Addictive Behaviour, NY, Guilford Press

Miller, W., Form 90 : A structured assessment interview for drinking and related

behaviors : Test manual. Rockville : National Institute on Alcohol Abuse and Alcoholism, 1996. [ADAI bk] HV 5278 p76 v. 5 [REF HAND]

Miller, W: Tonigan J. S.: Longabaugh, R., The Drinker Inventory of Consequences

[DrInC] : An instrument for assessing adverse consequences of alcohol abuse : Test

manual. Rockville : National Institute on Alcohol Abuse and Alcoholism, 1995. [ADAI bk] HV 5278 p76 v.4 [REF HAND]

Millett K., 1981, Sexual Politics, UK, Virago Press Ltd.

Mills I., 1995, When Our Lips Speak Together Part II Faculty of Health Humanities & Social Ecology, Australia, UWS Hawkesbury

Milne Smith D. & Leicester S., 1996, Hug the Monster, Sydney, Random House

Mindell A. & A., 1992, Riding the Horse Backwards, London, Penguin

Mindell A., 1987, The Dreambody in Relationships, London, Penguin

Mindell E., 1994, Food is Medicine, Melbourne, Bookman Press

Miners S., 1984, A Spiritual Approach to Male Female Relations, Illinois, The Theosophical Publishing House

299

Minichiello V., Aroni R., Timewell E., Alexander L., 1990, In-Depth Interviewing,

Cheshire, Longman

Minuchin S., Fishman H.C., 1981, Family Therapy Techniques, USA, Harvard

Mitchell J., 1972, Woman’s Estate, UK, Penguin Books

Mitchell S., 1984, Tall Poppies, Australia, Penguin Books

MJA 1998 see Medical Journal of Australia (MJA)

Medical Journal of Australia (MJA), Retrieved June 13, 2007 http://www.mja.com.au/public/issues/jan5/tai/tai.html

Monograph Series No. 11 which the Task Force on Evaluation of the National Campaign Against Drug Abuse (1989) see Heather

Montagu A., 1986, Touching, USA, Harper & Row

Montgomery B., Morris L., 1988, Getting on With the Oldies, Melbourne, A Lothian Book

Montgomery B., Morris L., 1992, Living with Anxiety, Melbourne, A Lothian Book

Monti, P.M., Abrams, D.B., Kadden, R.M., & Cooney, N.L. (1989). Treating alcohol

dependence. NY, Guilford

Moreno J.L., 1946, Psychodrama, New York, Beacon House

Morris C.G. 1988, Psychology: An Introduction, (6th edn.),USA, Prentice Hall

Munro, G., 1995, A Critique of Codependence as a Movement and Clinical Tool in

Saskatchewanm, Edmonton, AADAC

Munro, G., 1998, Trends, Issues and Challenges, [September], Edmonton, AADAC

Munro, G., G. McBeth and A. Aubry, 1994, Treating Men Experiencing Alcohol and

Drug Addiction, Edmonton, AADAC

Munro, Geoff, June 1997, School-based drug education: realistic aims or certain

failure, Australia, Australian Drug Foundation

Murphy J., 1985, The Power of Your Subconscious Mind, USA, Bantam Books

Murphy R F., 1972, The Dialectics of Social Life, UK, George Allen & Unwin Ltd.

Murphy-O’Connor J., 1978, Becoming Human Together, Dublin, Veritas Publications

Myers I. & Briggs, 1958, Myers-Briggs Type Indicator, Robbie Hatley website, Retrieved on June 2, 2007 from http://www.well.com/~lonewolf/essays/personality-types.html

300

Nakken, C., [1988] The Addictive Personality: Roots, Rituals, and Recovery. Minnesota, Hazelden

Naltrexone – A guide for Carers, 1999, CEIDA [Centre for Education and Information on Drug and Alcohol], Australia, Commonwealth Department of Health and Aged Care

Marlatt, G.A., Demming, B., & Reid, J.B. (1973). Loss of control drinking in alcoholics: An experimental analogue. Journal of Abnormal Psychology, 81, 233-241.

McCabe, R.J.R. (1986) Alcohol-dependent individuals sixteen years on. Alcohol &

Alcoholism, 21, 85-91.

Mello, N.K., & Mendelson, J.H. (1971). A quantitative analysis of drinking patterns in alcoholics. Archives of General Psychiatry, 25, 527-539. Meyer, W.R. (1981). Discussion of papers by Ludwig, Mello, and Nathan. In Evaluation of the alcoholic: Implications for research, theory, and treatment (DHHS Publication No. ADM 81-1033, pp. 243-248). Washington, DC: U.S. GPO.

Miller, W.R. (1989). Increasing motivation for change. In R.K. Hester & W.R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives (pp. 67-80). New York: Pergamon.

Miller, W.R., & Hester, R.K. (1986). The effectiveness of alcoholism treatment: What research reveals. In W.R. Miller & N.K. Heather (Eds.), Treating addictive behaviors:

Processes of change (pp. 121-173). New York: Plenum.

Minetree, H. (1986, May). Alcoholism's sober philanthropist. Town & Country, pp. 184-186, 238-243.

Monti, P.M., Abrams, D.B., Kadden, R.M., & Cooney, N.L. (1989). Treating alcohol

dependence. New York: Guilford.

Murphy R F., 1972, The Dialectics of Social Life, UK, George Allen & Unwin Ltd.

Nathan, P.E., & O'Brien, J.S. 1971, An experimental analysis of the behavior of alcoholics and nonalcoholics during prolonged experimental drinking: A necessary precursor of behavior therapy? Behavior Therapy, 2, 455-476

Nathan, P.E. 1980, Ideal mental health services for alcoholics and problem drinkers: An exercise in pragmatics. In P.O. Davidson & S.M. Davidson (Eds.), Behavioral

medicine: Changing health lifestyles (pp. 279-298). New York: Brunner/Mazel.

Nathan, P.E. 1982. Louise: The real and the ideal. In W.M. Hay & P.E. Nathan (Eds.), Clinical case studies in the behavioral treatment of alcoholism (pp. 107-125). New York: Plenum.

Nathan, P.E. (1984). The length and breadth of alcoholism. (Review of G.E. Vaillant, 1983, The natural history of alcoholism.) Contemporary Psychology, 29, 101-103.

301

Nathan, P.E. 1986. Outcome of treatment for alcoholism: Current data. Annals of

Behavioral Medicine, 8, 40-46.

Nathan, P.E., & Niaura, R.S. 1985. Behavioral assessment and treatment of alcoholism. In J.H. Mendelson & N.K. Mello (Eds.), The diagnosis and treatment of

alcoholism (2nd. ed., pp. 391-455). New York: McGraw-Hill.

Nathan, P.E., & McCrady, B.S. 1987. Bases for use of abstinence as a goal in the behavioral treatment of alcohol abusers. Drugs & Society, 1, 109-131.

Nathan PE. 1998, Would a pill placebo have redeemed Project MATCH? Prevention Treat 1998:1:np. Retrieved November 11, 2002 from http://www.journals.apa.org/treatment/vol1/97_c3-97_a1.html]

Nathan, P.E. Substance use disorders in the DSM-IV. Journal of Abnormal Psychology 100[3]:356-361, 1991

Nathanson P., 1991, Over the Rainbow, USA, State University of NY Press

National Association of Alcoholism and Drug Abuse Counselors: Retrieved February 19, 2001 from http://www.naadac.org/

National Campaign Against Drug Abuse [NCADA], Campaign document issued

following the Special Premiers’ Conference Canberra April 2 1985, Canberra, Australian Government Publishing Service National Clearing House for Drug and Alcohol Information: Retrieved February 19, 2001 from http://www.health.org/ (author and title unknown)

National Council for International Year of the Family, 1994, The Heart of the Matter

Families at the Centre of Public Policy, Australia, Aust. Govt. Publishing Service

National Council on Alcoholism and Drug Dependence: Retrieved February 19, 2001 from http://www.ncadd.org/

National Drug Strategy (NDS), 1985, Retrieved May 15, 2007 from http://www.nationaldrugstrategy.gov.au/ National Institute on Alcohol Abuse and Alcoholism [NIAAA]: Retrieved February 19, 2001 from http://www.niaaa.nih.gov/

National Institute on Drug Abuse [NIDA]: Retrieved February 19, 2001 from http://www.nida.nih.gov/

(NDS) National Drug Strategy, 1985, Retrieved May 15, 2007 from http://www.nationaldrugstrategy.gov.au/

Nowinski J., 2003, Twelve-Step Facilitation, National Institute on Drug Abuse [NIDA], Retrieved on May 15 2007 from http://www.nida.nih.gov/ADAC/ADAC10.html

302

Negrete JC. A contrast in treatment philosophies [comments on Project MATCH], Addiction 1999:94[1]:59-62. [ADAI jl]

Nelson-Jones R., 1991, Human Relationship Skills, Holt Rinehart & Winston Australia New York Times, p. A17

Newman M., Berkowitz B., 1988, How To Be Your Own Best Friend, London Cedar Books

Newman M., Berkowitz, B., 1981, How to Take Charge of Your Life, USA, Bantam Books

NIAAA Report, Project MATCH (1993), Retrieved April 21, 2005 from http://www.niaaa.nih.gov/

Nichols W.C., Everett C.A., 1986, Systemic Family Therapy, USA, The Guilford Press

Nichols, M. and R. Schartz, [1995] Family Therapy: Concepts and Methods, Ma., Allyn & Bacon

Nicotine Anonymous The Book, 1992, USA, Nicotine Anonymous World Services, Inc.

Nicotine Anonymous, 1996, NicA Nicotine, USA, Nicotine Anonymous World Services, Inc

NLP Trainer Bolstad R., 1997, Retrieved on October 16, 2004, from http://www.stant-

1.demon.co.uk/artcl007.htm Research on Neuro-Linguistic Programming

Noble Professor, National Institute on Alcohol Abuse and Alcoholism Study, Journal

of American Medical Association, 1990 Dec.

Norwood R., 1989, Women Who Love Too Much, London, Arrow Books Ltd.

Norwinski J., 2003, Twelve-Step Facilitation [TSF], Retrieved on May 18, 2007 from http://www.nida.nih.gov/ADAC/ADAC10.html

Nowinski, Joseph Baker, Stuart : Carroll, Kathleen. Twelve step facilitation therapy

manual: a clinical research guide for therapists treating individuals with alcohol

abuse and dependence. Rockville : National Institute on Alcohol Abuse and Alcoholism, 1992. [ADAI bk] HV 5278 p76

O’Connor P., 1981, Understanding the Mid-Life Crisis, VIC., Sun Books

O’Donnell C., 1984, The Basis of the Bargain: gender schooling and jobs, Australia, George Allen & Unwin

O’Neill N. & G., 1984, Open Marriage, NY, M. Evans & Co.

Oakley A., 1977, Sex Gender & Society, London, Temple Smith

303

O'Farrell, T. [ed.], [1993] Treating Alcohol Problems: Marital and Family

Interventions. NY, Guilford

Oiumette PC, Finney JW, Moos RH, Twelve Ofshe R., and Watters R., 1996, Making

Monsters: False Memories, Psychotherapy, and Sexual Hysteria, California, Univ California Press

Oliver-Diaz P., O'Gorman P.A., 1948, Twelve Steps to Self Parenting, NY, Health Communications Inc.

O'Malley S.S., Current strategies for the treatment of alcohol dependence in the United States [Project MATCH]. Drug Alcohol Depend 1995:39[suppl 1]:S3-S7. [ADAI jl]

Oppedisano R., 1993, How to stop fatigue, VIC., Rocco Oppedisano Enterprises

Orback S., 1988, Fat Is A Feminist Issue, Sydney, Random House

Orlick T., Bottreill C., 1977, Every Kid Can Win, USA, Nelson & Hall

Ortner S.B., Whitehead H., 1992, Sexual Meanings, Cambridge, Cambridge Uni. Press, Allen & Unwin

Oswald I, 1970, Sleep, UK, Penguin Books

Otto J.H., Towle A. & Bradley J.V., 1982, Modern Biology, Canada, Holt Rinehart & Winston

Overeaters Anonymous, 1980, USA, Overeaters Anonymous

Owen PL : Slaymaker V : Torigan JS : McCrady BS : Epstein EE : Kaskutas LA : Humphreys K : Miller WR. Participation in Alcoholics Anonymous : Intended and unintended change mechanisms. [Presentations given at 2001 RSA Meeting, including "Changing AA practices and outcomes: Project MATCH 3-year follow-up" by J. Scott Tonigan]. Alcohol Clin Exp Res 2003:27[3]:524-532 [ADAI jl]

Packham R., 1993 Research Methods Elective Package, Australia, Social Ecology UWS Hawkesbury

Parkes C., 1987, Bereavement, New Edition, London, Penguin

Parkin P., [1995] A Needs Assessment of the Drug prevention Issues of Young People

in the Derwent Valley. The Drug Education Network.

Passmore J., 1974, Man's Responsibility for Nature, Surrey, UK, Unwin Bros. Ltd.

Pastor Gilley, Retrieved November 11, 2002 from http://www.cuttingedge.org

Pateman C. & Gross E. [Ed.], 1986, Feminist Challenges, NSW, Allen & Unwin

Patterson M., 1986, Hooked, London, Faber & Faber

304

Pattison, E. M., Sobell, M. B., & Sobell, L. C., (eds.) (1977), Emerging concepts of

alcohol dependence, NY, Springer.

Patton F.H., 1986, Force of Persuasion, NY, Simon & Schuster Inc.

Patton et al, and Zubrick et al regarding World Health Statistics and Australian Bureau of Statistics on youth suicide death rates in various countries - Youth Suicide in Australia 2000

Paul J. & M., 1987, If You Really Loved Me, USA, CrompCare Publishers

Pearce J., 1987, The Kids Work Out, UK, GP Publishing

Pease A. & B., 2000, Why men don’t listen & women can’t read maps, UK, The Orion Publishing Group

Peavey F., 1986 Heart Politics, USA, New Society Publishers

Peck M.S., 1990, People of the Lie, London, Arrow Books

Peck M.S., 1994 The Road Less Travelled, London, Arrowbooks Ltd.

Peel R., 1988, Spiritual Healing in a Scientific Age, USA, Harper & Row

Peele S., 1976, Love and Addiction, USA, Signet

Peele S., Brodsky A., 1991, The Truth About Addiction & Recovery, USA, Fireside Books

Peele, S., 1989, Diseasing of USA, Boston, Houghton Mifflin

Peele, S., 2006, Retrieved on April 23, 2006 from http://www.peele.net/lib/glass.html

Peine H., Howarth R., 1976, Children & Parents, USA, Pelican Books

Penrose-Wall J, Copeland J., Harris M., 2000, Shared care of illicit drug problems by

general practitioners and primary health care providers: A literature review, Sydney, NDARC Sydney & Community Medicine UNSW

Pepper D., 1984, The Roots of Modern Environmentalism, USA, Crown Helm

Perls, F., 1969, Gestalt Therapy Verbatim, Utah, Real People Press

Peters T., 1987, Thriving on Chaos, London, Pan Books

Petersen E., Petersen J., [Eds], 1974, For Women Only, USA, Tyndale House

Phillips J., 1983, Mothers Matter Too, Australia, Penguin Books

Phillips S., 1979, Young Australians The Attitudes of Our Children, Sydney, Harper & Row

Pilger J., 1989, A Secret Country, London, Jonathan Cape

305

Philosophy Pages, (n.d.), Britannica Internet Guide Selection, Retrieved February 25, 2007 from http://www.philosophypages.com/ph/socr.htm (author unknown)

Pinn J. & Russell D., 1989, Master in Science – course proposal, Australia, UWS Hawkesbury

Pinn J., 1988, The Emergence of Social Ecology, Australia, UWS Hawkesbury

Pinn J., Wieneke C., Kuhn-White L., 1994, Why would anyone want to talk to women

about the environment? Australia, UWS Hawkesbury

Pitino R., Reynolds B., 1998, Success is a Choice, NY, Broadway Books

Plesman J., 1986, Getting Off The Hook, Sydney, Plesman

Polkinghorne D.E., 1988, Narrative Knowing and the Human Sciences, Albany, State University of New York Press

Polley M., 1981, Dance Aerobics, California, Anderson World

Popovich D., 1987, Effective, Educational & Behavioral Programming for Severely &

Profoundly Handicapped, Sydney, Aust. Cath. Univ & DOCS North

Posavac E., and Carey R., [1997] Program Evaluation Methods and Case Studies. [5th edn.], NJ, Prentice Hall

Powell J., 1974, The secret of staying in love, USA, Argus Communications

Powers M., 1961, A Practical Guide to Self Hypnosis, California, Wilshire Book Company

Pratt V., 1978, The Philosophy of Social Sciences, NY, Methuen & Co.

Presenting Information National Communication Modules, 1994, Open Training & Education Network: for the Minister of Education, Training and Youth Affairs Redfern

Process Oriented Psychology [Process Work], 2005, Retrieved on April 20, 2005 from http://www.processwork.org

Prochaska, J. and C. DiClemente, [1992a] "Stages of Change in the Modification of

Problem Behaviors", in Miller W.R. & Rollnik S. [2000] Motivational Interviewing,

Preparing People to Change Addictive Behavior, Guilford Press New York

Prochaska, J. O., DiClemente, C. C., [1992b]. In search of how people change, American Psychologist, 47, 1102-1114

Prochaska J.O., DiClement C.C., & Norcross J.C., 1994, Changing for Good, NY, Avon

Project MATCH (1993), National Institute on Alcohol Abuse and Alcoholism (NIAAA) Report, 1996, Retrieved April 21, 2005 from http://www.niaaa.nih.gov/

306

Project MATCH [Matching Alcoholism Treatment to Client Heterogeneity]: rationale and methods for a multisite clinical trial matching patients to alcoholism treatment. Alcohol Clin Exp Res 1993 Dec: 17[6]:1130-45. [ADAI jl]

Project MATCH, Gordis E., NIAAA, 1996, Retrieved on May 23, 2007, from http://www.niaaa.nih.gov/NewsEvents/NewsReleases/match.htm

Project MATCH Research Group. Comments on Project MATCH : matching alcohol treatments to client heterogeneity. Addiction 1999:94[1]:31-69. [ADAI rp 08792]

Project MATCH Research Group. Matching patients with alcohol disorders to treatments : clinical implications from Project MATCH. J Mental Health UK

1998:7[6]:589-602

Project MATCH Research Group. Project MATCH secondary a priori hypotheses. Addiction 1997:92[12]:1671-1698. [ADAI jl]

Project MATCH Research Group. Project MATCH: Rationale and methods for a multisite clinical trial matching patients to alcoholism treatment. Alcohol Clin Exp

Res 1993:17[6]:1130-1145. [ADAI rp 06250]

Project MATCH (2003)"MATCH Book", Treatment Matching in Alcoholism, Babor T.F. & Del Boca F.K., USA, Cambridge University Press

Psychodrama British Medical Journal 1999, Retrieved April 20, 2005 from http://www.patient.co.uk/showdoc/6/ - 28k

Queensland Domestic Violence Task Force 1988, Beyond These Walls, Q, Queensland Press

Rational Recovery (RR), 2007, Retrieved June 23, 2007 from http://www.rational.org/faq.html

Ray S., 1980, Loving Relationships, California, Celestial Arts

Rayners, C., 1984, Marriage Guide, London, MacMillan London Ltd.

Reanney D., 1991, The death of forever, Melbourne, Longman Cheshire

Reason P., 1990, Human Inquiry in Action, London, Sage Publications

Reason P., Rowan J., 1981, Human Inquiry – a sourcebook of new paradigm

research, NY, Wiley

Reber A. S., 1986, The Dictionary of Psychology, England, Penguin Books

REBT wbsite 2007, Retrieved on June 24, 2007 from http://www.rebt.org/WhatisREBT.htm

Reed W., 1985, Positive Listening, USA, Watts

Reid D., 1989, The Tao of Sex, Health & Longevity, Australia, Positive Paperbacks

307

Reik T., 1948, Listening with the Third Ear, NY, Grove Press

Reinharz S., 1992, Feminist Methods in Social Research, USA, Oxford University Press

Reinhold M., 1991, How to Survive in Spite of Your Parents, UK, Mandarin Paperback

Reinhold Niebuhr, (circa 1934), Serenity Prayer, Retrieved on June 21 2007 from

http://en.wikipedia.org/wiki/Serenity_Prayer

Reit S., 1988, Sibling Rivalry, USA, The Bank Street College of Education

Report on the Establishment or Trial of Safe Injecting Rooms, 1998, Joint Select Committee NSW State Parliament, Sydney, Govt. Printing

Rey J., 1995, Is My Teenager In Trouble?, Australia, Simon & Schuster

Ricci I., 1980, Mom's House, Dad's House, USA, MacMillan

Rice C: Mohr CD : Del Boca FK : Mattson ME : Young L : Brady K : Nickless C. Self-reports of physical, sexual and emotional abuse in an alcoholism treatment sample [Project MATCH]. J Stud Alcohol 2001:62[1]:114-123. [ADAI jl]

Richardson D., 1986, Sexual Therapy, Sydney, Fontana Books

Riddle R., 1987, Family Studies, Melbourne, Lonman Cheshire

Robbins A., 1988, Unlimited Power, London, Simon & Schuster

Roberston N., 1988, Getting Better, USA, William Morrow & Co. Inc.

Robertons J with Montey T., 1997, Natural Prozac, USA, HarperSanFrancisco

Robinson R., 1992, When Women Choose to be Single, USA, A Newcastle Book

Rodale J., 1967, Smoke and Die – Quit and Live! Pens., Rodale Books

Rogers C. R., 1951, Client-centered therapy, Boston, Houghton Mifflin

Rogers C.R., 1982, A Therapists View of Psychotherapy on Becoming a Person, UK, Constable & Co. Ltd.

Roman, P.M., and Blum, T.C. [1997]. National treatment center study, Athens, GA: Institute of Behavioral Research, University of Georgia

Rose C., 1987, Negotiate & Win Melbourne, Lothian Publishing Port

Rosenbaum J.V., 1977, Stepparenting, California, Chandler & Sharp

Ross A.O., 1981, Child Behavior Therapy, USA, J Wiley & Sons

Ross E., 1971, On Death & Dying, NY, Tavistock Publications

308

Roth G., 1992, When Food is Love, GB, Piatkus

Rothberg, N.M. 1986, ‘The alcoholic spouse and the dynamics of co-dependency’, London, Routledge & Kegan Hall

Rounsaville, B.J.: Bryant, K.: Babor, T.: Kranzler, H.: & Kadden, R. Cross system agreement for substance use disorders: DSM-III-R, DSM-IV and ICD-10. Addiction

88[3]:337-348, 1993

Rowe D., 1996, Dorothy Rowe’s Guide to Life, UK, HarperCollinsPublishers

RR (Rational Recovery), 2007, Retrieved June 23, 2007 from http://www.rational.org/faq.html

Ruden R. with Byalick M., 2000, The Craving Brain, USA, Perennial

Russell B., 1963, Unarmed Victory, London, Penguin Books Middlesex

Russell C., 1981, The Aging Experience, Australia, George Allen & Unwin

Russell D., 1988, Social Ecology: Communicating for the Commonweal, Australia, UWS Hawkesbury

Russell D., 1989, Social Ecology…An Appropriate Epistemology for the Social

Sciences, in Readings and 'Learning Tree' in Social Ecology Course Notes, Australia, UWS Hawkesbury

Russell D., 1990, Social Ecology and the Greening of the Australian Mind, keynote

paper presented at Inaugural Green Seminars, Sydney February, 1990

Russell D., 1994, Public Participation in Decision Making: A social ecology in action, Occasional Papers Volume One, Australia, UWS Hawkesbury

Russell D., Dimitrov V., Fell L., 1994, Ancient Wisdom and Contemporary

Ecological Problems in Seized by Agreement, Swamped by Understanding, Australia, UWS Hawkesbury

Russell G., 1983, The Changing Role of Fathers, Q, University of Queensland Press

Rutherford Trunball III, [Ed.], 1981, The Least Restrictive Alternative Principles &

Practices, The USA Assoc. on Mental Deficiency USA, NY, Rutledge

S.A. Humanist Post August 1994:6 (see Dowling D.)

Salleh A.K., 1984, Feminism to Ecology, Social Alternative Magazine Vol 4, No 3

SAMHSA [1997, February]. National admissions to substance abuse treatment

services, San Francisco, Harper

San L. Future research directions and the impact of the MATCH project on research technology in the addictions. Addiction 1999:94[1]:55-57. [ADAI jl]

Sanders D., 1985, The Woman Book of Love & Sex, London, Sphere Books Ltd.

309

Sargent W.E., 1971, Psychology, London, Teach Yourself Books

Satir V., 1967, Conjoint Family Therapy, California, Science & Behaviour Books

Satir V., 1976, Making Contact, California, Celestial Arts

Satir V., 1976, Peoplemaking, USA, Science & Behavior Books Inc.

Saunders J., 1994, How to Write Realistic Dialogue I, London, Allison & Busby

Scarf M., 1980, Unfinished Business, UK, Fontana/Collins

Scarf M., 1987, Intimate Partners: patterns in love and marriage, UK, Century Hutchinson Ltd.

Schaef, A.W. 1986, Co-Dependence: Misunderstood and Mistreated, San Francisco, Harper & Row

Schierse Leonard L., 1989, Witness to the Fire, Mass., Shambhala Publications

Schuckit, M.A. DSM-IV: Was it worth all the fuss? Alcohol and Alcoholism. [Supp.

2]:459-469, 1994

Schuckit, M.A. Familial alcoholism. In: Widiger, T.: Frances, A.: Pincus, H.: First, M.: Ross, R.: & Davis, W., eds. DSM-IV Sourcebook. Vol. 1. Washington, D.C.: American Psychiatric Association, 1994. pp. 159-167

Schwartz D.J., 1987, The Magic of Thinking Big, NY, Simon & Schuster

Schwarz J., 1988, It's Not What You Eat But What Eats You, California, Celestial Arts

SCOPE Weekly Readings & Members Stories, SCOPE (Stress Anonymous) 12 Steps Group, Sydney, 1991, Community First Additions

Secular Organizations for Sobriety (SOS), 2007, Retrieved June 23, 2007, from http://www.secularsobriety.org/

Segal L., 1994, Straight Sex, London, Virago Press

Senge, P., 1990, The Fifth Discipline. NY, Doubleday

Serenity Prayer see Reinhold Niebuhr, (circa 1934)

Shakti Gawain, 1985, Creative Visualization, USA, Bantam Books

Shakti Gawian, 1986, Living in the Light, California, Whatever Publishing Inc.

Shapiro A., 1994, Feminists Revision History, Press, New Jersey USA, Rutgers Uni.

Shapiro B., 1989, Separate Houses, USA, Bookmakers Guild

Shared Care Review (2000) in Penrose-Wall J, Copeland J., Harris M., 2000, Shared

care of illicit drug problems by general practitioners and primary health care

310

providers: A literature review, Sydney, NDARC Sydney & Community Medicine UNSW

Sharp P., 1984, A Radical Feminist Perspective of the Middle Ground, Faculty of Health Humanities & Social Ecology, Australia, UWS Hawkesbury

Sharvet J., 1982, Feminism, UK, Dent & Sons Ltd.

Shaykh Hakin Moinuddin Schishti, 1991, The Book of Sufi Healing, USA, Inner Traditions International

Sheehan D.V., 1990, The Anxiety Disease NY, Bantam Books

Sher K., American Alcohol Health & Research World Vol. 21 No. 3 Psychological characteristics of COAs [1997:7], Retrieved February 19, 2001 from http://www.niaaa.nih.gov/publications

Silva J., 1977, The Silva Mind Control Method, NY, Simone Schuster

Singer J., 1980, The Crises That Shape Your Marriage, USA, Library of Congress

Singer P., 1993, How are we to live, Melbourne, Text Publishing Co.

Sisely D., Halliday H.M., [undated] Do It Yourself Social Research, VIC., ACOSS

Skinner B. F., 1971, Beyond Freedom & Dignity, Middlesex UK, Penguin Books

Slavik, W. and R. Faist, [1993] Alcohol and Drugs in Alberta, Alberta, AADAC

Small G. & Trent J., 1989, Love is a Decision, USA, Word Inc.

Smart Recovery FAQ about Smart Recovery Groups, Retrieved on May 26, 2007 from http://www.smartrecovery.org/resources/faq.htm

SMART Recovery Handbook (2nd edn.) see Steinberger H., Ed.

SMART Recovery [Meetings List] Retrieved May 24, 2007 from http://www.smartrecovery.org/meetings_db/view/show_countryau.php

Smith K., 1985, How to get closer to your children, NSW, Waratah Press

Smith L., 1976, Improving your child’s behaviour chemistry, USA, Simon & Schuster

Smith M., 1987, When I Say No I Feel Guilty, London, Bantam Books

Smith V., 1995, On The Level, NSW, Family Planning

Smokers: A Literature Review, Ottawa, Health Canada

Sobell M. B: Breslin FC : Sobell LC. Project MATCH: the time has come .to talk of many things [letter: comment] J Stud Alcohol 1998 Jan:59[1]:124-5. [ADAI jl]

311

Sobell, M. B., Brochu, S., Sobell, L. C., Roy, J., & Stevens, J. (1987) Alcohol treatment outcome evaluation methodology: State of the art 1980-1984 Addictive

Behaviours, 12, 113-128.

Social Ecology Learning Package, 1994, Curriculum Perspectives Vol. 2. No. 3, 1982, Australia, UWS Hawkesbury

Social Ecology Package, 1995, Part Two A Book of Readings UWS 1995

Ecofeminism, Australia, UWS Hawkesbury

Somekh E., 1979, The complete guide to children’s allergies, USA, Pinnacle Books

SOS (Secular Organizations for Sobriety), 2007, Retrieved June 23, 2007, from http://www.secularsobriety.org/

Soyka M. Efficacy of outpatient alcoholism treatment. Addiction 1999:94[1]:48-50. [ADAI jl]

Spencer R., 1986, The A-Z of Australian Family Medicines, Sydney, Butterworths

Spender D., 1982, Women of Ideas & What Men Have Done To Them, USA, Routledge & Kegan Hall

Spender D., 1983, There’s always been a women’s movement this century, London, Pandora Press

Sperling A., 1984, Psychology made simple, London, Heinemann

Spock B., 1958, Baby & Child Care, London, The Bodley Head Ltd.

Spock B., Rothenberg M.B., 1990, Dr Spock’s Baby & Child Care, UK, W.H. Allen Publishers

Stacey M., Price M., 1981, Women Power & Politics, UK, Tavistock Publishing

Standing Committee on Law, Crime Prevention Through Social Support Report No.

11, 1998, NSW Parliament

Standing Committee on Law, Crime Prevention Through Social Support Report No.

12, 1999, NSW Parliament

Stanton H.E., 1983, The Stress Factor, Sydney, Fontana Books

Steinberger H., ( Ed.), 2004, Smart Recovery Handbook (2nd edn.)

Steinem G., 1983, Outrageous Acts and Everyday Rebellions, NY, Holt, Rinehart And Winston

Steinem G., 1992, Revolution from Within, London, Corgi

Steinem G., 1994, Moving Beyond Words, London, Bloomsbury Publishing Ltd.

Steiner C., 1982, Scripts People Live, USA, Bantam Books

312

Stevens B., 1970, Don't Push The River [It Flows By Itself], California, Celestial Arts

Stevens J., 1975, gestalt is, USA, Real People Press Utah

Stills P., 1995, Get A Life, Virginia USA, Upline Press

Stockwell T. Should a few hours of therapy change behaviour 3 years later? [Project MATCH]. Addiction 1999:94[1]:50-52. [ADAI jl]

Stone G., 1958, A Marriage Manual, Sydney, Halstead Press

Strachan J. G., [1968], Alcoholism: Treatable Illness, Vancouver, Mitchell Press

Strasser S., 1988, Working It Out: Sanity and Success in the Workplace, USA, Prentice-Hall

Strategy to Prevent the Abuse of Alcohol and Other Drugs, Toronto, Allyn and Bacon

Stuart R.B., Jacobson B., 1988, Weight, Sex & Marriage, NSW, Compass Pub. Co. P/L

Students Handbook, 1995, Social Ecology, NSW, UWS Hawkesbury

Style Manual Committee, 1988, Style Manual: for authors, editors and printers,

Canberra, Aust. Govt. Printing Service

Subby, R., 1987 Lost in the Shuffle: The Co-dependent Reality, USA, Florida: Health Communications

Sullivan B., 1997, The Politics of Sex, UK, Cambridge Uni. Press

Suter K., 1986, Alternative to War, Sydney, WILPF

Sutton S., Project MATCH and the stages of change. Addiction 1999:94[1]:47-48. [ADAI jl]

Suzuki D., 1992, Inventing The Future, Australia, Allen & Unwin

Swain M., 1999, The New South Wales Drug Summit: Issues and Outcomes NSW Parliament Library Research Service, in First Report of the Inquiry into Crime

Prevention Through Social Support,1999:46, Standing Committee on Law & Justice, NSW Parliament.

TAFE English Communication Teaching Resource Presenting Information 1994, NSW, Bankstown TAFE

TAFE Learner Resource 2000:20, NSW, TAFE

Tallent N., 1978, Psychology of Adjustment, NY, D. Van Nostrand Co.

Taylor J. [Ed], 1989, Readings and “Learning Tree” in Social Ecology, NSW, UWS Hawkesbury

313

Tebo B. & T. 1994, Free To Be Me, Moorebank, N.S.W, Bantam Books

Thatcher V.S., McQueen A., [Ed.], 1971, The New Webster Encyclopedic Dictionary

USA, Processing & Books Inc.

The Australian Bureau of Statistics [1994], Retrieved February 19, 2001 from

http://www.abs.gov.wu/ausstats/ab

The Columbia Electronic Encyclopaedia, 6th ed. Columbia University Press. Retrieved on October 16, 2004, from http://www.answers.com/topic/gestalt-psychology:

The Framework of drug education, Harm minimisation: The policy framework. Drug-Ed Net, Australian Drug Foundation 1997, Retrieved November 11, 2002 from http://www.adf.org.au

The Gestalt Archives: C Retrieved on October 16, 2004 from http://www.gestalttheory.net/archive/

The journal of drug and alcohol issues. Connexions 2 issues: February/March 1998, April/May 1998 Sydney

The King’s Cross Times, Vol.2, 2003. July 16

The Medical Journal of Australia: Retrieved November 11, 2002 from http://www.mja.com.au Suicide among young Australians, 1964-1993: an interstate comparison of metropolitan and rural trends, The Medical Journal of Australia 1998: 169:77-80

The National Council for the International Year of the Family, 1994, The Heart of the

Matter, Australia, The Australian Govt. Publishing Service

Theiring B., 1973, Created Second? Aspects of Women’s Liberation in Australia, Australia, The Griffin Press

Thyer J., 2004, Steps to Life, Adelaide, Griffin Press

Tickell J., 1995, Laughter, Sex, Vegetables & Fish, Australia, Vic., Bookman Press

Tiefer L., 1979, Human Sexuality, Curacao, Multimedia Publications

Tober G. Evidence based practice -- Still a bridge too far for addiction counsellors? [re: Project MATCH] Drugs Educ Prev Policy 2002:9[1]:17-20. [ADAI jl]

Tober G. Motivational Interviewing with Young People. In:Miller W. R., Rollnick S., op.cit., p.248-259

Todd P.B., 1992, Aids: A Pilgrimage To Healing, United States, Millennium Books

Toft D., 1994, Hazelden News: The Paradox of Giving & Receiving, Minn, Hazelden Book

314

Tonigan J.S : Miller WR : Schermer C. Atheists, agnostics and Alcoholics Anonymous [study of Project MATCH outpatient and aftercare samples]. J Stud

Alcohol 2002:63[5]:534-541. [ADAI jl]

Tonigan J.S. Benefits of Alcoholics Anonymous attendance : replication of findings between clinical research sites in Project MATCH. Alcohol Treat Q 2001:19[1]:67-77. [ADAI jl]

Tonigan JS : Connors GJ : Miller WR. Special populations in Alcoholics Anonymous [Project MATCH]. Alcohol Health Res World 1998:22[4]:281-285. [ADAI jl]

Tonigan JS : Miller WR : Conners GJ. Project MATCH client impressions about Alcoholics Anonymous: Measurement issues and relationship to treatment outcome. Alcohol Treat Q 2000:18[1]:25-41. [ADAI jl]

Tracey N., 1993, Mothers & Fathers Speak, NSW, Apollo Books

Transactional Analysis Journal Retrieved April 20, 2005 from http://www.cultsock.ndirect.co.uk/MUHome/cshtml/ta/ta.html

Trimingham C., 1991, Book of Readings: Human Growth & Development, NY, Harper & Row

Trimpey J., 1988, Rational recovery from alcoholism: The small book. Lotus, CA, Lotus Press.

TSF, 2007, Twelve Step Facilitation in Action.ppt supplied by Jurd S., 2007

Turnbull R., 1981, The Least Restrictive Alternative, Washington DC, AAMD

Turner L., Sizer F., Whitney E., Wilks B., 1992, Life Choices, USA, West Publishing

Twelve Step Facilitation in Action.ppt supplied by Jurd S., 2007

Twentier J.D., 1994, The Positive Power of Praising People, Nashville, Twentier

Twerski A, 1990, Addictive Thinking: Understanding Self-Deception. San Francisco, Harper & Row

University of Auckland, Retrieved on April 23, 2007 from http://www.news-medical.net/?id=14846

Vaillant G.E., 1995, The Natural History of Alcoholism Revisited, Cambridge, Harvard University Press

Valliant G.E., 2005, Alcoholics Anonymous: cult or cure? Australian & New Zealand

Journal of Psychiatry, Jun2005, Vol. 39 Issue 6, p431-436

Valliant G.E., 2007, Alcoholics Anonymous Wikipedia Free Encyclopedia, Retrieved

June 21 200, from http://en.wikipedia.org/wiki/Alcoholics_Anonymous

315

Valnet J., 1986, Aromatherapy, Essex, C.W. Daniel

Van Bilsen H., Van Emst A. Motivating Heroin Users for Change. In: Bennet G. ed. Treating drug abusers. London, New York: Tavistock/Routledge, 1989, p. 29-47

Van Bilsen H., Whitehead B. From Addiction to Control. In:Druglink, 1991, 6 [2], p. 8-10

Van Bilsen H., Whitehead B., Motivating Selfcontrol, In:Conference Report of the

British Assoc. for Behav. Psychoth., Oxford, 1991, p. 1-7

Vander A.J. Sherman J.H. & Luciano D.S., 1975, Human Physiology, USA, McGraw-Hill

Vander Zanden J. & Pace A., 1984, Educational Psychology, NY, Random House

Vanier J., 1970, Tears of Silence, Canada, Griffin Press

Velasquez MM, DiClemente CC, Addy RC. Generalizability of Project MATCH: a comparison of clients enrolled to those not enrolled in the study at one aftercare site. Drug Alcohol Depend 2000 May 1:59[2]:177-82. [ADAI jl]

Vernon E. Johnson, 1980, I’ll Quit Tomorrow, San Francisco, Harper Row

Vernon M.D., 1963, The Psychology of Perception, London, Penguin Books,

Vogel H.C.A., 1995, The Nature Doctor, Melbourne, Bookman Press

Volin M. & Phelan N., 1971, Essence of Yoga, Sydney, Dymocks Book

Wadsworth Y., 1991, Everyday Evaluation on the Run: Action Research Issues, Melbourne, Assoc. Wadsworth

Waitley D., 1983, Seeds of Greatness, USA, First USA Pocket Books

Waitley D., 1984, The Psychology of Winning, NY, The Berkley Publishing Group

Walford R.L., 1983, Maximum Life Span, London, Norton

Walker K., 1948, Human Physiology, London, Pelican Books

Walker K., Fletcher P., 1955 Sex & Society, UK, Penguin

Ward J., Mattick R., Hall W., 1992, Methadone Maintenance Treatment, Australia, NSW Uni. Press

Warren A., 1997, The Great Connection, Florida, Pallium Books

Waters B., 1994, Ever Toddler, Sydney, Margaret Gee

Waters M. & Crook R., 1990, Sociology One, Melbourne, Longman Cheshire

Watson M., 1992, How’s Your Love Life?, Sydney, Hale & Iremonger

316

Watson R. [ed.], [1994], Addictive Behaviors in Women, New Jersey, Humana Press

Weber M. & D., 1988, Macrobiotics and Beyond, NSW, Nature & Health Books

Webster's Concise Encyclopedia, 1992, Great Britain, Cresset Press

Weekes C., 1987, Agoraphobia, UK, Angus & Robertson

Weekes C., 1989, Self Help for your Nerves, Australia, Angus & Robertson

Wegscheider-Cruise S., 1988, Coupleship: how to build a relationship, Florida, Health Communications

Wegsheider-Cruise S., 1989, The Miracle of Recovery, Florida, Health Communications

Wegscheider-Cruise, S. and J. Cruse, [1990] Understanding Co-dependency, Florida, Health Communications

Weiss A., 1986, Seers And Scientists, NY, Harcourt Brace Jovanich

Weiss L., Weiss J. 1989, Recovery from Codependency, USA, Health Communications Inc.

Wenck D., 1981, Supermarket Nutrition, USA, Prentice-Hall

Wertheimer see King D.B., Wertheimer M.,

Westermeyer – HabitSmart, Retrieved November 11, 2002 from http://www.habitsmart.com/bw.htm

Whetherell M., Stiven H. & Potter J., 1987, Unequal egalitarianism: A preliminary study of discourses concerning gender and opportunites, British Journal of Social

Psychology, 26, 59-71

White M., 1993, Lovers Guide, Sydney, Herst/ACP

White M., 1995, Re-authoring Lives: Interviews and Essays, SA, Dulwich Centre Publications

White M. & Epston D., 1990, Narrative Means to Therapeutic Ends, N.Y. Norton

Whitehead B. Motivational Interviewing. In Executive Summary, The Centre for Research on Drugs and Health Behav., 1992, Nr. 17

Whitfield C.L., 1989, Healing the Child Within, USA, Health Communications Inc.

Whitfield, C.L. [1991]. Co-dependence: Healing the Human Condition. Deerfield Beach, Florida, Health Communications Inc.

WHO [World Health Organisation], World Health Statistics Annual, 1994 in Australian Bureau of Statistics, 1994 - Australian Bureau of Statistics Retrieved November 11, 2002 from http://www.abs.gov.au/

317

Wieneke C., Power A., Bevington L., Sullivan L., 1995, Creating older women, NSW,

UWS Hawkesbury

Wilson B., Dr. Bob, 1990, Alcoholics Anonymous, USA, AA World Services

Wilson J., 1965, Logic & Sexual Morality, UK, Penguin Books

Wilson P. [Ed], 1977, Delinquency in Australia, Queensland, University of Queensland Press

Wilson-Schaef, A. [1986]. Codependence: Misunderstood-Mistreated, California, Harper & Row

Wilson Schaef A., 1987, When Society Becomes An Addict, NY, Harper & Row

Wilson Schaef A., 2000, Beyond Therapy, Beyond Science, USA, iUniverse.com., Inc.

Wittgenstein L., 1969, On Certainty, Oxford, Blackwell

Wodak A., 2000, Australis2000 Humanist Congress paper, Sydney

Wodak, A. and Owens, R., 1996, Drug Prohibition: A Call For Change, Sydney, University of N.S.W. Press

Woititz J.G., 1983, Adult Children of Alcoholics, Florida, Health Communications Inc.

Wolf N., 1991, The Beauty Myth, UK, Vintage

Wolf N., 1993, Fire With Fire, UK, Vintage

Wolpe J. & D., 1988, Life Without Fear, California, New Harbinger Publications

Woodman M., 1982, Addiction to Perfection, Toronto, Inner City Books

Woog R., Dimitrov J. Bihl, 1994 Social Ecology: a Post-Modernist Neo-Positivist

Methodology, NSW, UWS Hawkesbury

Woog R., Dimitrov J., Dimitrov V., Parker F., Bird G., Cameron J., Russell D., Stewart B., Parker, Kuhn-White L., 1994, Occasional Papers Volume One, Health Humanities & Social Ecology, NSW, UWS Hawkesbury

World Health Organization. Statistics Annual, 1994, Youth Suicide, Geneva: World Health Organization, 1967

World Health Organization. Manual of the International Statistical Classification of

Diseases, Injuries, and Causes of Death, Eighth Revision. Geneva: World Health Organization, 1967


Diseases, Injuries, and Causes of Death, Ninth Revision. Vol. 1. Geneva: World Health Organization, 1977

318


Diseases, Injuries, and Causes of Death, Ninth Revision. Vol. 2. Geneva: World Health Organization, 1978

World Health Organization. The ICD-10 Classification of Mental and Behavioural

Disorders: Clinical Descriptions and Diagnostic Guidelines, Tenth Revision. Geneva: World Health Organization, 1992

World Services USA [Alcoholics Anonymous literature]

Worsley P., 1982, Marx & Marxism, NY, Travistock Publications

Wright J., 1981, Successful Slimming, Sydney, Golden Press

Wright J., 1982, Alternative Medicine, Sydney, Golden Press

Wurtman & Danbrot, 1988, Managing Your Mind and Mood Through Food, UK, Grafton Books

Wykes A., 1964, Gambling, UK, Aldus Books

XVIIIth Congress of International Association for Suicide Prevention 1995, XVIIIth Congress of International Association for Suicide Prevention

Yellowlees H., 1955, To Define True Madness, London, Penguin Books

Yen F Tai Medical Student, University of Sydney, NSW, John B Saunders Head, Department of Alcohol and Drug Studies University of Queensland, Brisbane, QLD, David S Celermajer Associate Professor of Medicine, University of Sydney NSW, Collateral damage from alcohol abuse: the enormous costs to Australia In MJA 1998: 168: 6-7

Yeomans W. N., 1996, 7 Survival Skills for a Reengineered World, NY, Penguin Group

Yoder B., 1990, The Recovery Resource Book, USA, Fireside

Young, E. 1987, ‘Co-Alcoholism as a disease: implications for psychotherapy’, Journal of Psychoactive Drugs, vol. 19, no. 3, pp. 257-68

Youth Suicide in Australia, [Health Services Division Webmaster 2000 Health Services Division Commonwealth Department of Health and Aged Care Mental Health Branch

Zigler Z., 1989, Raising Positive Kids in a Negative World, NY, Ballantine Books

Zigler Z., 1998, Success for Dumbies, California, IDG Books Worldwide Inc.

Zinsser W., 1980, On Writing Well, NY, Harper & Row

319

Patton et al, and Zubrick et al regarding World Health Statistics and Australian Bureau of Statistics on youth suicide death rates in various countries - Youth Suicide in Australia 2000

Zweben, Allen: Barrett, David: Carty, Kathleen: McRee, Bonnie: Morse, Priscilla: Rice, Christopher [eds.]. Strategies for facilitating protocol compliance in alcoholism

treatment research. Bethesda, MD : National Institute on Alcohol Abuse and Alcoholism, 1998. [ADAI bk] HV 5278 P76 v.7

320

APPENDICES

321

APPENDIX A

322

APPENDIX B

325

APPENDIX C

List of Total Interviewees

Pro abstinence (although also supportive of harm minimisation as required)

Pat Mellody – D&A Counsellor Meadows Rehabilitation Centre USA

Pia Mellody – author Love Addiction

Dr. Stephen Jurd – Director D&A Service, Royal North Shore Hospital

Dr. Jean Lennane – Psychiatrist, author - Alcohol: The National Hangover (1992)

Jim Maclaine – Psychologist, St. Edmunds Hospital (1993) (now Wentworth Clinic)

Dr. Leroy Bishop – Exec. Direct. South Pacific Private Hosp., Harbord (1993)

Elaine Alexander – Eating Disorders Expert, South Pacific Hospital (1993)

Bruce Larsen – Training Supervisor Hazelden Rehabilitation Centre, Minneapolis

Holly McCartney – D&A Counsellor Sierra Tucson USA

Susan Skyvvington –Psychologist – Pia Mellody model/Gestalt

Dr. Jamie W. – Physician, SLAA member and founder of Create and Love Program

Dr. Karen Moore – Mollecular Biologist, “a fellow”, Agency for Internat. Dev. USA

Antonio Gadso – Senior Advisor for Social Services, U.S. Agency for Internl. Dev.

Per Johansson – Sec. Gen. Swedish Nat. Assoc. for a Drug Free Society (Stockholm)

Peter Stoker UK – Positive Prevention Group Plus, Drug Prevention (1992)

Ann Stoker UK - Positive Prevention Group Plus

Johan Danielson – Sec. Gen. Nat. Swedish Parents Org. Against Drugs (1993)

Thomas Hallberg – ECAD (European Cities Against Drugs) (2000)

Margeurite Oaklands – Executive Board, Europe Against Drugs (1993)

Johan Dahl – Counsellor Swedish National Assoc. for a Drug Free Society (1993)

Nick Koropoulis – Hellenic Drug Committee (Greece)

Rebecca Froga - Germany – Advertising Anti Drug Campaign for Government

Pro Harm Minimisation (although also supportive of abstinence as required)

Prof. Nick Heather – Nat. Drug & Al. Res. Centre (1993) (Controlled Drinking 1981)

Dr. Mike MacAvoy, Director, Drug & Alcohol Directorate (1993)

Assoc. Prof. Andrea Mant - Clinical Dir., D&A Program, East. Area Health Service

Chris Basten MA – Psychology of Addiction, Centre for Cont. Ed., Sydney Uni.

Anita Marxer, Manager, Low Threshold Safe Injecting Centre, Berne, Switzerland

Dr. Robert Haemmig - Intergrated Drug Service, Uni. Psych. Services, Switzerland

Roel Kerssmakers - Jellinek Prevention Team, Amsterdam

Kate Gentle (Barnardos) & Pyschologist/Wollongong Eating Disorders Centre

Steve Brigham – Social Activist/Wollongong Eating Disorders Centre Specialist

326

APPENDIX C contd.

Kate Stewart – Langton Centre, Shirley Smith trained/Solution Focus model (1993)

Prof. Albert Ellis – RET Rational Emotional Behaviour Therapy Founder/Author

Prof. Dr. Antony Kidman, RET Clinical Psychologist/School of Biology UTS (1993)

Pro CBT and 12 Steps Model

Dr. Andy Campbell, Psychiatrist, Director Clinical Services, Rozelle Hospital (1993)

Dr. Nick Cassimatis – Psychiatrist, Evesham Private Clinic

Lt. Cdr. Joe Pollard – Training Officer, Drug & Alc. Unit, Royal Aust. Navy (1993)

Max Schuepbach – Co-founder of Process Oriented Psychology, Portland

Fran Peavey – Activist/Author - Heart Politics (1986)

Tova Green – Addictions Counsellor, Gestalt/psychoanalytic approach/group work

Marjorie Ball (aka Katie Bell) – Psychotherapist/Music Therapist

Valerie Orton – NLP Practitioner, Conflict Resolution Workshops

Pro Nutrition (these represented the role of nutrition in recovery)

Ken McLean – Macrobiotics Practitioner, Aiki Institute

Geoff Ritchie – Macrobiotics/Shiatsu Practitioner

Jur Plesman – Psychologist/Author - Getting off the Hook

Pro Spirituality (these represented the spiritual role in recovery)

Craig San Roque – Jungian Analyst

Muriel James – Transactional Analysis author Born to Win6 (Also CBT & TSF)

John James – Transactional Analysis author - Passion for Life (Also CBT & TSF)

Gillian and Tony (Zen Centre)

Assoc. Prof. David Russell – Co-founder Social Ecology UWS Hawkesbury (1993)

Dr. John Cameron – Lecturer UWS Hawkesbury, interview on Buddhism

John Seed – Activist/Ecologist/Musician/Author

Other

Humberto Maturana, Scientist/Biologist, interview genetic nature of addiction (1993)

Robert Woog – UWS Head of School/Soc. Ec. (1993) – on the future of Soc. Ec. which influenced the research methodology for this project.

6I have only shown a few book titles in this list – the rest are in the Bibliography

327

APPENDIX C contd. Consumers/Clients CBT and/or TSF

Sean (Wine and Narcotics)

Jane (Codependence)

Lara (Alcohol)

Lisa (Codependence)

Alan (Nicotine)

Gary (Cocaine)

Ben (Gambling/Love Addiction)

Craig (Alcohol)

David (Narcotics)

Dora (Narcotics/Sex & Love)

Fred (Narcotics)

Jimmie (heroin) (now deceased)

John. (Cocaine)

Maggie (Heroin and Anorexia)

Sasha (Eating Disorder)

Susie (Eating Disorder/Narcotics) (now deceased)

Hock (Homeless Young Person, Kings Cross – Narcotics)

Con (Homeless Person Kings Cross/Alcoholic) (now deceased)

Graham “dreadlocks” (Homeless Person, Kings Cross/Alcohol)

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APPENDIX D

COURSE FEEDBACK FORM

What has been the highlight of this course for you? What has been the least useful for you? Which would you like to experience more? How would something been more helpful for you? Comments: Name: Date: Email address: Tel. No.:

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