Therapies & Interventions for Addiction: Self-Management Programmes (AQA GCSE Psychology): Revision Note
Exam code: 8182
12-step recovery programmes
Self-management programmes require no specialist leader, leaving individuals to organise their own treatment
One type of self-management therapy is the 12-step recovery programme
12-step recovery programmes involve an individual taking charge of their journey to beating their addiction
The 12-step programme was devised over 65 years ago by Alcoholics Anonymous (AA), and is still based on the same spiritual principles today; the only requirement for membership is a desire to stop drinking alcohol
The 'higher power'
The addict surrenders control to a higher power (see steps 2, 3, 6 and 7)
Even though this is a religious concept, many non-religious people have found the programme helpful — the key is letting go of your own will
Admitting and sharing guilt
A number of the steps (4, 5, 6, 7, 8 and 9) involve the person coming to terms with things they've done wrong
Members of the group, and the higher power, hear these confessions and agree to accept the person despite them
Lifelong process
Recovery is treated as a lifelong process; members support each other, keep a book of names/numbers to call if they feel the urge to drink, and this offers a safe harbour against relapse (steps 10, 11 and 12)
Members see addiction as never fully "cured," but held in check through continued attendance and this lifelong process
The 12 Steps:
Admit that you have no power to stop or control the addictive behaviour
Gain hope that a higher (spiritual) power can help you
Give control over to that higher power
Take a personal inventory, focusing on the wrongs you've done
Share this inventory with the higher power and one other person, admitting wrongs done
Be prepared for the higher power to correct any shortcomings in your character
Ask the higher power to take away your faults, mistakes and wrongdoing
Make a list of people you have hurt or harmed because of your addiction
Make amends to those people if possible
Continue to be alert to and mindful of your faults, recognising wrongs immediately
Use prayer and meditation to continue your connection with the higher power
Carry the message of the 12 Steps to others in need
Self-help groups
Self-help groups are made up of people who share the same problems and regard each other as equals ("peers")
The 12-step programme is essentially a peer-sharing model, which is why it's a "self-help" approach as it is not led by an expert or professional therapist
Examples include:
Alcoholics Anonymous
Narcotics Anonymous (drug addiction)
Gamblers Anonymous
Overeaters Anonymous
These are separate organisations that have each adapted AA's 12 steps, rather than sub-programmes "within" AA
Other programmes adapt the 12-step model to avoid its religious element or engage local cultural values
E.g. the Native American method for alcoholics, which combines the 12 Steps with the Native American concept of the Medicine Wheel
SMART (Self-Management and Recovery Training) is a key adaptation that drops the "higher power" and focuses on internal control instead — self-empowerment and self-reliance
Meetings are led by a trained facilitator who is themselves a recovering addict, so it remains peer-led
Evaluation of self-management programmes
Strengths
Self-management programmes take a holistic approach to treating addiction, with their emphasis on the whole person and how addiction impacts their life and those around them
This can be contrasted with more reductionist approaches, such as aversion therapy, which targets stimulus-response links rather than the person as a whole
Weaknesses
Lack of clear evidence: the Cochrane Review (Ferri et al. 2006) found no significant difference in effectiveness between AA and other treatments
AA's own data claims 33% of 8,000 North American members stayed sober for 10+ years, but doesn't report how many left the programme unsuccessfully
This makes it hard to get clear data on the programme's overall effectiveness
Individual differences: the dropout rates above suggest self-help is demanding as continued attendance requires high motivation, and some people don't want to share their experiences and emotions with a group
This means it may only suit a particular type of person
Examiner Tips and Tricks
Examiners report that students often fall short when writing about therapies and intervention for addiction as follows:
They tend to describe self-management programmes without explaining how they are holistic
They compare the two therapies but not in terms of their reductionist and holistic perspectives
They misunderstand the terms ‘reductionist’ and ’holistic’ (e.g. they think that reductionist means reducing an addictive behaviour)
Worked Example
Here is an example of a question you might be asked on this topic - for AO1 and AO3.
AO1: You need to demonstrate knowledge and understanding of key concepts, ideas, theories and research.
AO3: You need to analyse and evaluate key concepts, ideas, theories and research.
Question: Aversion therapy and self-management programmes are both used as interventions for addiction.
Explain how aversion therapy is used as an intervention for addiction.
Use your knowledge of both the reductionist and the holistic perspectives to compare aversion therapy with self-management programmes. [9]
Model answer:
AO1:
Aversion therapy aims to stop addicts from using the substance by causing them to experience something unpleasant when they carry out the unwanted behaviour e.g. vomiting whenever they drink alcohol.
This use of aversive stimulus results in a link being made between the unwanted behaviour and the unpleasant experience as it is based on the mechanisms of classical conditioning.
Electrical aversion therapy may also be used, particularly with gambling addicts.
AO3:
The reductionist perspective is the idea that a phenomenon such as addiction can only be understood by simplifying it to its most basic constituents.
The holistic perspective is the idea that all the aspects of a phenomenon such as addiction are connected and are only fully able to be understood by looking at the ‘bigger picture’ or referring to the whole.
By itself, aversion therapy is reductionist because it only focuses on changing the link between unwanted behaviour and pleasure.
However if aversion therapy is combined with other treatments or therapies (such as CBT), it becomes more holistic.
Self-management programmes can be viewed as holistic because they help people to work on the ‘bigger picture’ which is achieved by not only dealing with someone’s urge to use a substance but also by addressing other factors that are often linked to addiction, such as environmental or social factors.
Self-management programmes also help people to address events or experiences from their past such as trauma or loss.
Self-management programmes tend to be more holistic than aversion therapy.
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