- Mental Health»
Review of “Adlerian Group Therapy With Substance Abusers”
This article doesn’t so much describe an empirical study as it discusses an Adlerian approach to ameliorating substance abuse at the, “Crossroads,” outpatient program in Denver, Colorado.
This program was run as an alternative to the Minnesota-model based program which invariably utilizes the twelve step approach as outlined in the 1939 book Alcoholics Anonymous by bill Wilson with significant contributions from others in the AA movement.
One of the main tenets of the, “Crossroads,” program was that Substance abusers could be treated, once sober, like any other neurotic. This was asserted by Dreikurs in a 1932 article. The interesting connection made between Adlerian Theory and Substance abuse is the hypothesis that the mistaken goals and expectations of radically ill-behaved children, as outlined by Dreikurs, are also the primary causes in adult substance abusers for shirking Adlerian life tasks and abdicating responsibility for these tasks by engaging in active alcoholism and substance abuse.
The four mistaken assumptive categories that were first outlined by Dreikurs (and in this treatment program assumed as a cause for substance abuse) are a need for pleasing, a need for controlling, a need to be superior, and stress avoidance. Rather playfully each of these was represented in, “Crossroads,” therapy by an animal: a chameleon, an eagle, a lion, and a turtle, respectively. The therapy entails listing the traits of an animal that the clients would like to be and then a forced choice between the four representative animals based on which is most compatible with their personalities at present.
The working theory was that avoiders of stress drank and used in order to escape problems, that people with a need to please drank and used to fit in and as a result of peer pressure, users in need of controller did so to avoid the control of others and as an attempt to control their families, and people with a need to be superior used in an attempt to buttress their confidence in intimidating situations.
Notable Differences and Similarities between the, “Crossroads,” Model and the Twelve Step Model
The importance of, “mutual aid, self-understanding, and encouragement,” (Prinz and Arkin, p.350) are views both of the, “Crossroads,” program and the twelve step approaches. Also, “The concepts of holism, goal-directedness, and movement are colorfully conveyed in the frequently heard expression, ‘make sure the tongue in your mouth and the tongue in your shoe are moving in the same direction,’” (Prinz and Arkin, p.350) which is an expression remarkably similar to the AA/NA mantra of, “Walk the walk, don’t just talk the talk.”
One notable technique used by this group is the, “Behind the Back Technique.” In this exercise a speaker talks about him/herself for 15-20 minutes and then removes them self and turns their back on the group and listens to them discuss what was said without the option of interruption. This parallels the feedback element utilized in AA/NA meetings and in AA/NA sponsorship
Some differences in this program is a lack of admission to being powerless over alcohol, not identifying oneself as an alcoholic, or closing out groups with the serenity prayer or lord’s prayer. It was thought such rituals might detract from a problem solving orientation, also from autonomous choice and self-determination, and further serve to pigeon-hole clients into a place where they could not fully use their creativity to determine how to interact with the world. What was considered a more useful message was, “I am a self-determined individual who is free to make choice and decisions.” (Prinz and Arkin, p.351) Another of the primary differences seemed to be the absence of the Chronic Disease Model. The group lasted for only 6 months at most and a need for any further maintenance work or continued engagement with a program wasn’t articulated in the article.
I have no doubt that people abusing substances as a result of personality disorder tendencies and developmental transitions would be helped by this program. They may after the, “Crossroads,” program learn to temper their use and engage recreationally in substance use. But I don’t think this program would have long term abstinence efficacy for true Addicts and Alcoholics. As predicted by the Chronic Disease model, without continuing care and support people who will never be able to use substances safely will invariably convince themselves after a certain period of abstinence and introspection (and self-deception) that they can do so.
I also think that acceptance of one’s status as an Alcoholic or Addict is a crucial part of lasting recovery. These labels are by no means meant to denigrate, in fact someone who can unashamedly apply one or both of these labels to themselves and simultaneously claim long term sobriety, I believe, has accomplished one of the more difficult trials in life.
I further believe that acceptance of one’s own powerless over substances is the only way to gain power over them. Paradoxical as this may seem, it is only when true Addicts and Alcoholics realize that substances will always dominate their best efforts at moderation will they stop engaging in a futile struggle with them and through this non-engagement no longer be subject to the destructive forces of chemicals in their lives.
While I do think Dreikurs hypothesizes as to why people begin drinking and using are accurate in most cases. I also believe that Alcoholism and Addiction can irrevocably develop, given enough time of chemical abuse with impunity, whatever the initial reasons. And so once a pattern of dependence has been established, I don’t think simply removing the original mistaken assumption or character defect that led to initial substance experimentation is enough to either maintain abstinence or transform a problem substance user into a social substance user. (Though I’m not sue this later claim was being made, the theoretical framework seemed to imply it.)