Wednesday, August 31, 2011

Outcomes of A.A. for Special Populations

So... I was directed to this little PDF here.

I'd like to hear your views on it.  It's written by Christine Timko and talks about why A.A. outcomes should be studied in  special populations... such as outcomes of A.A. for women, youth, older people, racial and ethnic groups... such as for African-Americans, American Indians, Hispanics, outcomes for Disabled Groups, Cognitive impairment, individuals with Dual Substance use and psychiatric disorders...

In the reference section, there's a reference to White Bison Inc., The Red Road to Wellbriety: In the Native American Way, Colorado Springs.  This may be run by our friend Don C?

In any case, I've not looked it through much yet.  I'd like to check it out more and see what's good/bad about it.

It's a 30 page PDF that you can download if you'd like.



  1. First, a couple of general observations: (1), Ms. Timko apparently isn’t a member of AA. (2), she takes the approach towards AA that seems to be prevalent among Psychiatrists, Psychologists, researchers, et. al. AA and other 12 step programs are places where they can refer their patients and (3), somehow the program is then responsible for getting them well.

    I don’t have any big problems with the first 10 or so pages of her paper. Other than perhaps that many African-Americans do not accept the premise that alcoholism is a disease. That’s a new one for me.

    But generally speaking, I agree that people are apt to be more comfortable sitting in groups that are homogeneous - above and beyond the alcoholism issue. This is particularly true of young people. Hence there are a number of groups (at least in my area) that are directed to teenagers. And we all recognize that we feel more comfortable sitting in some meetings than in others, and this is a simple matter of personalities.

    Race/religion/sexual orientation preferences are best left for another day. But they do play a part in attendance at meetings.

    Where I begin to have problems is with statements like “AA has been criticized as inappropriate for American Indian populations because it entails the confession-like disclosure of personal problems, has a Western religious emphasis, and excludes non-alcoholics.” Well, excuse me. If “…the AA approach could be highly offensive to a Native American…” then perhaps that individual should examine another program when seeking sobriety.

    I fully appreciate the conflicts various cultures may have with the AA program, and I empathize with them. This, however, is not AA’s problem. We cannot be all things to all people, nor should we try.

    Additional issues arise when addressing Disabled Groups. The perception that AA isn’t tailored to their needs is something that’s for the most part beyond the control of the individual groups. We’re at the mercy of finding spaces to hold meetings, and very few have handicap-accessible facilities, sign language interpreters, etc.

    And getting into dual addiction/psychiatric disorders is a giant can of worms. Again, I get the impression that she views AA as a program should be designed to solve the issues of PTSD, psychosis, schizophrenia, and dual substance abuse issues concurrently. And the fact that we focus our discussions on our problems relating to alcohol rather than allowing discussions of psychological problems only increases the distress of the patients and accounts for the high drop out rate. Indeed.

    So, to accommodate some of these problems, “Some of the 12 steps may need to be reframed; for example, making amends need not involve a formal apology but may entail an internal process of absolution.” Oh?

    I’m not gonna ramble on much longer. There are a lot of good points in the paper, but I suggest that Ms.Timko read the Big Book, familiarize herself with the AA program and then revisit her arguments.

    AA isn’t a generic therapy program where one “refers” patients. It’s a problem for people who have hit bottom, who’s lives suck so badly they’ll do anything to eliminate the pain and suffering. It for people who want to be there. I don’t think the author takes any of this into consideration in her discussion.

    Granted, she makes some great points about the efficacy of AA for Special Populations, but changing AA isn’t necessarily the solution. I think it would really behoove her and the entire publication this is a chapter to if she understood AA as well as she understands the special needs of the Special Populations.

  2. Good breakdown Joe. I don't know what it's like being an African American in A.A. But last year, I was out in Louisville Kentucky for some work with my brother and while there, I hit a couple of meetings... one over in Ohio and one there in Louisville.

    The pics above are from a huge and old historic building and meeting place for A.A. I can't remember the name of the meeting place, but I was very much in the minority there. There were many many black folks at this speaker meeting there, maybe 200+, and I was made to be very welcome there. Those folks loved their A.A. They read from the same book I do and do the same steps. None of them were complaining that the Big Book was written by elder white men and for elderly white men. This is the feedback I got from the person who brought this article/pdf to my attention.

    As far as hispanics in A.A., I've got that one covered from Southern Colorado... aka Pueblo, and even parts of New Mexico. A.A. works just great for hispanics... who are alcoholics who want to do A.A. One of my sponsors is Hispanic and has moved down to New Mexico... but we keep in touch.

    Native Americans? We've got that covered here in Colorado too. There's Don C who got his start in A.A. and does something... perhaps different than A.A., yet similar, with the Red Road thing in Colorado Springs. Then there's a medicine man friend of mine, Gary C, who helped me get my Harley Sportster. We have a guy named Rafa who is a staunch A.A. supporter here, while also doing his Native American commitments. Maybe Jim can weigh in on some of this.

    We've got a Gay and Lesbian and transgendered?? meeting here and luckily, some of those folks partake in some strong step working meetings here in town as well.

    Our young people's meetings are very well represented as they splintered off of the Thursday closed A.A. meeting. The only complaint some may have of it is that some consider them to be more of a "recovery" type meeting as it's listed as open A.A., but addicts go there too and can share, but they seem to confine their talks to alcohol only. What I'm saying is that there are some step working folks in those meetings. I personally know this for a fact, as I've done steps with many of them. They seem to be aligned with the CCYPAA. But for CCYPAA, they are a good thing because the program of action comes first and foremost to these young folks.

    Women in A.A. I guess they have their own meetings if they need. What do those women talk about in those womens' meetings? Men?

  3. I sort of get the feeling that this article is a solution in search of a problem. She Lists four "key ingredients" to the success of AA on pg. 23, all of which are psychbabble. Nowhere is there any mention of the steps, spiritual awakenings, sponsorship, fellowship, or working with others. Uh, Christine, read the Big Book.

    And in the last paragraph she bemoans the fact that studies to date have focused on alcohol or drug related outcomes. Well. Isn't that the whole purpose of the program - to stay sober and help others achieve sobriety?

    It sounds like she's fishing for funding in claiming that there's a need for further studies related to employment, school, coping strategies, legal outcomes, etc.

  4. I read it, wasn't much impressed. She'll do what she does, analyze the white off of rice.

    We'll do what we do, help drunks recover.

    Hope everyone is having a decent Labor day weekend.