The Alcoholics Anonymous (AA) program requires an act of surrender—an acknowledgment of being an alcoholic and of the destructiveness that results—a bearing of witness, and an acknowledgement of a higher power.
As in Protestant revival meetings, the alcoholic/sinner seeks salvation through personal testimony, public contrition, and submission to a higher authority. Courts have ruled that Alcoholics Anonymous is a religion for purposes of separation of church and state, thus rendering what transpires at AA meetings subject to the same protection as clergy-parishioner exchanges. AA also provides “an important social network through which members learn appropriate behavior and coping skills in drinking situations and become involved in various (nondrinking) leisure activities with other recovering alcoholics”.
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Therapeutic community (TC) is a generic term for residential, self-help, drug-free treatment programs that have some common characteristics, including concepts adopted from Alcoholics Anonymous (AA): “There is no such thing as an exaddict, only an addict who is not using at the moment; the emphasis on mutual support and aid; the distrust of mental-health professionals; and the concept of continual confession and catharsis.
The rehabilitative approach, therefore, requires multidimensional influences and training that, for most clients, can only occur after an extended period of living in a 24-hour residential setting.
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Symptoms of neurotic behavior, such as drug abuse, are tied to repressed material from early life. In this view, the symptoms will disappear when the repressed material is exposed under psychoanalytic treatment. Therefore, the psychoanalyst seeks to make unconscious affect and memories available to the patient’s consciousness.
Psychoanalysis and the therapies based on it aim “at inducing the patient to give up the repressions belonging to his early life and to replace them by reactions of a sort that could correspond better to a psychically mature condition.
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In 1964 Doctors Dole and Nyswander gave twenty two hospitalized heroin addicts increasing doses of methadone until they reached a “stabilized state,” meaning that they had neither withdrawal symptoms nor a craving for further increases in the dosage: With repeated administration of a fixed dose, methadone loses its sedative and analgesic powers. The subject becomes tolerant.
The patients were then released, but they returned each day for an oral dose of methadone. The following year a research report by Dole and Nyswander (1965) revealed extraordinary results from this approach, which they ascribed to methadone’s ability to provide a “pharmacological block” against heroin. Furthermore, it was theorized, heroin abuse in certain addicts results in a metabolic disorder that requires the continued ingestion of narcotics if the person is to remain homeostatic. With such disorders methadone acts like any prescribed medicine, normalizing the patient’s functioning.
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