Treatment, self-help and other responses to addiction or dependence, changing consumption patterns, detox, residential treatment, self-help programs, pharmacotherapy, talking therapies

Self-help programs

NOTE: Quotes are presented word for word apart from minor editing for readability and clarity. Identifying details have been removed. Square brackets show text that has been added, e.g. ‘I want to maintain [my current level of drug use]’. Ellipses within square brackets […] show where text has been removed, e.g. ‘Counselling was good but […] I would have liked more information about other treatment options’.

Taking part in self-help programs is one of the ways people interviewed for this website talk about changing their patterns of consumption. Self-help programs include Narcotics Anonymous (NA), Alcoholics Anonymous (AA) and Self Management and Recovery Training (SMART). NA and AA are 12-step abstinence-based groups that meet regularly to help members give up alcohol and other drugs and remain abstinent. Sometimes called ‘fellowships’, these groups are made up of people who identify as having an alcohol and other drug addiction, dependence or problem. Although the format of meetings varies, they often include testimonials in which people share their experiences. They may also include readings that illustrate the 12 steps of change on which the programs are based. These programs are generally perceived to be religious because references to a ‘higher power’ are interpreted as relating to God (although some participants and literature note that the ‘higher power’ can refer to a range of phenomena). By contrast, SMART Recovery is an explicitly secular support group that uses strategies from cognitive behaviour therapy (a type of psychotherapy aimed at changing unwanted patterns of behaviour) and self-help tools to encourage self-directed change. Groups meet face to face or online and are guided by trained peers and facilitators. In addition to 12-step programs and SMART Recovery, there are a range of other self-help programs for those concerned about their alcohol and other drug use. Some are focussed on the needs of minority groups or those with mental health issues. Whatever their particular focus, self-help programs all use support from people with similar experiences (‘peer support’) to promote change.

Those who have participated in self-help programs say their benefits include fellowship, support to remain abstinent and the opportunity to learn from others and develop coping strategies. Several mention that regularly attending a self-help group enabled them to connect with others and made them feel less isolated. Taking part in a self-help group prompted a few of our participants to realise that they had a problem and needed to cut down or stop consuming alcohol and other drugs.

Some describe unhelpful or negative experiences and identify a number of drawbacks of self-help programs. These include the references to a ‘higher power’ in 12-step programs, the emphasis on abstinence in some programs and the expectation to share private experiences in a group setting. Some say the groups can be exclusive or ‘cliquey’, making it hard for a newcomer to fit in. A few have experiences of different kinds of self-help programs and compare their benefits and drawbacks.

12-step programs

The benefits of 12-step programs that our participants identify include support from others, fellowship and encouragement to remain abstinent. A few say that taking part in a 12-step program helped them to realise they had an ‘addiction’ and needed to give up alcohol and other drugs altogether. Others say attending 12-step groups has helped them to change unwanted behaviours and learn to manage their desire to consume alcohol or other drugs.

Tiffany (F, 33, works in hospitality, ice) says that taking part in 12-step meetings gives her a ‘sense of belonging’ and helps her to address ‘behaviours that […] need to change’. (Played by an actor)

[So, like, by] attending meetings I found a sense of belonging […] Like, you know, I share at meetings and say, ‘I’m grateful that I […] can share my [experiences with others who’ve got similar experiences …] I’m grateful that […] I’m attending [these meetings]. And that keeps me clean and I know it helps me’. [And I value] the fellowship as well. That’s all I needed, you know, a new whole set of friends from the fellowship […] and a sponsor. I got myself a sponsor as well. Not only does it help you address your addiction […] but also your behaviours […] that you need to change.

After attending one AA meeting, Bill (M, 43, works in retail, alcohol) says he realised he ‘did have a problem’ and needed to cut down and eventually stop drinking.

Part 1

I only actually ever went to one [AA meeting] but as I said, I sort of got the information. I realised that I was an alcoholic at that point and yeah, that I did have a problem.

Part 2

Then I […] did calm down a little bit.

Part 3

Sometimes I think I should go back to AA, just to talk to people about it […] I think talking about these situations and addictions […] is important so I’m sort of still in the process of trying to get there. But the main goal initially for me is just to not do it and I’m doing well at the moment with that, so I’m really proud of myself. And I still do think about going to AA or some other sort of Drugs Anonymous or something as well, just to share my story and to talk to other people and to gain strength from, you know, a group situation.

While Ben (M, 29, works in hospitality, alcohol) values hearing people’s stories in AA meetings, he suggests the program could include other activities to help members to ‘bond’.

Going to AA meetings and just listening; just hearing the similarities to my problems that I’ve had in the past [is helpful…] So I sort of don’t isolate myself thinking that I’m the only one out there that’s been through all this [… But] maybe aside from going in and sharing your story at a meeting, maybe [the group could be] more of a social group [allowing] alcoholics or narcotic users to go and actually do something together and bond that way. To get you out of that head space, rather than listening to the stories of using because I’ve been in [a meeting] in the past hearing those stories and [I found that was] a trigger. Whereas if you’re able to go out and just do something completely different, maybe people might […] see the better side to getting to know other users.

Some people describe negative or mixed experiences of 12-step programs and comment on their drawbacks. These include the focus on past experiences, the references to a ‘higher power’, the requirement to be abstinent and the expectation that members share their personal stories. For Emma (F, 42, works in retail, alcohol) talking about past experiences and what she ‘used to be like’ made her feel like she ‘was going backwards’, rather than focusing on the future. Others, such as Ben, say that discussions focused on alcohol and other drug use can sometimes act as a ‘trigger’ (a memory or situation that prompts a desire to engage in conduct that a person is otherwise trying to avoid, e.g. drug use). Some say the groups are exclusive or ‘cliquey’, making it hard for a newcomer to establish relationships with other members. While some people enjoyed sharing their experiences in a group setting, others found this confronting or invasive. As George (M, 58, not working due to illness, alcohol) explains, ‘Everybody goes around and blurts out personal experiences, which may or may not be relevant […] and I just found it personally invasive’.

Rachel (F, 50, works in the health sector, heroin) says that while she met a lot of ‘interesting people’ in NA, the program ‘didn’t hold her interest’ so she eventually stopped attending. (Played by an actor)

I met someone who was going to NA and so I went to a meeting, and then I met some other people […And I just decided] that I would kind of pursue the NA thing for a while. It was actually quite interesting. There were a lot of really interesting people in NA at that time, artists and musicians, famous people. And you know, in a way, it was as much for me about discovering […] a different ethnographic situation as [it was about] getting straight. And, you know […] I sort of enjoyed it for a little bit but […] it just didn’t hold my interest.

Jason (M, 34, studying, ice) likes the ‘camaraderie’ of 12-step groups but says their emphasis on abstinence doesn’t work for him.

Part 1

I felt that NA [Narcotics Anonymous and] AA [Alcoholics Anonymous] were great in the fact of having other people experiencing the same thing. However, I couldn’t say with any certainty that I would never use again and that’s a big part of what the recovery is for NA, AA.

Part 2

So I went to an NA meeting a couple of weeks ago now and […] I enjoy the camaraderie around it, the family aspect and now I’ve relaxed a lot into it. I used to be very shameful when I used and then I wouldn’t go until I got some ‘clean time’ up again before going back.

Part 3

I don’t like the abstinence model in the fact that whenever I say, ‘I can’t use again, I shouldn’t use any more’, that’s exactly when I want to use […] So yeah, abstinence doesn’t work for me.

Amy (F, 52, studying, heroin) questions references to a ‘higher power’ in 12-step programs and adds that in her experience, they can be exclusive or ‘cliquey’.

I don’t like the God stuff. Like […] the higher power stuff […] I met some people in there that I really didn’t like and who didn’t actually live what was coming out of their mouths. And also the big thing about NA [and] AA is the newest person is meant to be the most important member and I didn’t feel that. I felt like it was a cliquey group and the older ones just wanted to hear the sound of their own voice. There are some really great people in there but to be a real NA [member], it’s like 90 meetings in 90 days. You’ve got to do like three, four, five, six, seven meetings a week. Like, I don’t think I can make that sort of commitment where I live. There’s only one meeting a week out there, for an hour and a half. So I just felt it was a bit too cliquey. NA people only hang out with NA [people].

Other self-help programs

A few people interviewed for this website have experiences of other self-help programs, such as SMART Recovery and other peer support groups focussed on alcohol and other drug use. Those who have participated in SMART Recovery groups say their advantages include fairly unstructured meetings, non-judgemental facilitators and peers, an emphasis on self-reliance and tailoring to individual needs. The fact that SMART Recovery supports harm reduction as well as abstinence was also seen as part of its appeal. As Jason (M, 34, studying, ice) puts it, ‘SMART [Recovery] is about choosing a level of risk or harm minimisation for you at the time. Having a list of pros and cons of using, pros and cons of not using’.

Luke (M, 44, works in retail, alcohol) takes part in a SMART Recovery group that is supportive and non-judgmental, offering members the chance to learn from each other.

SMART Recovery is amazing […] It’s just a really, really chilled out group […] The only rule is you’re not allowed to turn up intoxicated. But everyone can ask questions and they feed off each other and say, ‘Well, how do you deal with this? How do you deal with that?’ And no one tells each other what their addiction is or anything like that. It’s just really, really chilled out and […] everyone [gives advice saying] ‘Well, I’ve done this and you might be able to do that’ […] And you feel kind of nice when you come out of there […] In SMART Recovery, you can sit there and say nothing […] You don’t have to do anything […] It’s totally how you are, whether you want to not drink, whether you want to cut down. But in the end it’s like people who might just […] want to cut down but then they realise after maybe a week or two […] they’re going, ‘Ooh, I think I might need to stop completely’ [But…] no one’s judgmental. You’re not allowed to be judgmental with anyone […] Yeah, it’s nice.

Those who have taken part in other self-help groups are generally positive about their experiences and describe their benefits. These include providing support to initiate and maintain change, and an opportunity to discuss difficult experiences and develop strategies to manage consumption.

Renee (F, 35, works in hospitality, ice) says that going to a self-help group for Aboriginal women gave her a support network and an opportunity to learn about issues that were relevant to her.

These women’s groups that I used to go on used to make me feel so normal because it’s the same girls going through the same stuff. It didn’t matter what your poison was, you know. They were all just very supportive of each other and things like that, you know […] One week we would be talking about foetal alcohol syndrome. Another week we would be talking about hep C, you know […] Just all health issues that Aboriginal-identified women were having trouble with. Anything to do with alcohol and drugs that we’d be sort of open to hear. There was about twenty of us who would go every week […] with our drug and alcohol worker. She was great. She didn’t care whether you were or weren’t clean, you know.

Matthew (M, 49, not working due to illness, cannabis) says that taking part in a peer support group helped him cut down his cannabis consumption.

I do a peer support group […] but a lot of them don’t smoke [cannabis]. One of them [takes crystal] meth and one of them is an alcoholic and I smoke. So we’ve all got different addictions and they’ve got medication for theirs. Apparently with alcohol […] you [can] get tablets to take [away] the cravings. Where[as] you can’t get anything for marijuana apparently, so they seem to be doing it a lot easier than me. But I think in general it was a good idea. I’ve cut down because I was smoking, at the end, probably half an ounce a week and now I, like, smoke probably two grams a week.