Thomas is a twenty-six-year-old drug and alcohol addict. He is currently struggling with drugs and is undergoing treatment at the Valley Forge Medical center. The main aim of this study is to acquire 12-step techniques to better the quality of life by maintaining ongoing abstinence from all drugs. The twelve steps to convalescence were developed by a self-help group “Alcoholics Anonymous” ("How Alcoholics Anonymous Works", 2019) . This strategy is more than just quitting alcohol. It is more of a decision. A guide to living a new and better social life.
The 12-step strategy aims at accepting that there is a problem, admitting the complexity in solving it, accepting external help in conquering it, and seeking to live and maintain a drug-free life. Therefore, this goal, when adhered to, plays a critical role in not only bringing addicts to sobriety but also leading them towards a productive life. This goal also corresponds to semi-structured interviews and questioning - the qualitative design methods selected for this study. Thomas, the client from the case study would be questioned and interviewed on his understanding of and the impact of the 12-step strategy.
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Qualitative Design
Semi-structured interviews would be conducted on the substance abuse addict to establish his experience, understanding, and view of the 12-step skills to recovery. Thomas, the client, will also be questioned on the various aspects of his social life, his experience with drugs and his feeling on the aim to abstain and achieving sobriety. Utilizing interviews and questioning proved to be the crucial and beneficial methods in getting first-hand information from the client. Data obtained from these methods are often free from bias and if the need arises, subsequent questions can be asked to superimpose those planned before. These methods were, therefore, perfect for this case study and the client (Félix ‐ Ortiz, Salazar, González, Sorensen & Plock, 2000) .
Methods of Initial Data Collection
A scheduled interview with Thomas, consisting of questions about his past experience with substances, was essential in initial data collection. Interviewing was decided as the perfect way of gathering data as it would provide accurate results. A case study done prior, discussions, and case histories also played a greater role in obtaining pre-intervention data. A study on his bank statement was also done to study how his money was spent on drinks and other substances.
In order to assess and emphasize the effectiveness of the 12-step recovery program, Thomas was referred to the Alcoholics Anonymous group in Valley Forge Medical Center, Pennsylvania. The existing client condition before being referred to the group was noted. After twelve months at the facility attending Alcoholics Anonymous’ meetings, Thomas was interviewed and questioned on various aspects. This was done to establish the effectiveness of the 12-step skills in not only curbing drug addiction but also aiding addicts to live a proper life.
Post-intervention data would be collected once the client has lived and integrated normally with society. This would enable a perfect environment to establish and evaluate the outcome of the 12-step strategy. Thomas will be given a short notice -12 hours- prior to our visit. This aims at eliminating client pretention as well as ensuring he does not experience any anxiety before the visit.
The aim of this post-intervention study is to establish the effectiveness of Alcohol Anonymous therapy. Face-to-face interviews with Thomas would help us understand him more as well as get more information on his experience with the group. Key points noted include; The period the client had been sober, the description of the feeling of experiencing craving and then overcoming it, how he overcomes craving, what exactly made him stop drinking, the exact time he stopped drinking, and he managed to stay sober.
The fact that the interview came on a short notice enabled the researcher to fully understand the client. The presence of beer bottles, opioids, or cigars would tell that the client has not fully recovered from the addiction. Behaviors such as lack of respect, poor hygiene and grooming would also suggest existing dependency on substances. Behavior and body language when answering questions helps in establishing the correctness and preciseness of the answered questions. This would ensure the post-intervention data is accurate and the successfulness of the research.
Filling the semi-structured interviews, prepared prior to the interview, played a critical role in recording the client’s responses. Field notes and the Client’s notes were also essential in capturing of data. Additional information, questions, and client behaviors during interviews were jotted down in a notebook. Upon the client’s approval, video recording was also done in formal face-to-face interviews.
Evidence-Based Selection of Intervention
Given the client’s history of struggle with drugs, Brief Interventions (BI) was prescribed as the best Evidence-Based intervention that would help him. This is because, despite several other interventions, his addiction to alcohol and other drugs had persisted for ages. Thomas has not responded to other forms of treatment to substance abuse (Jack et al., 2011) .
This method is deemed successful because many problems with substances have been found not related to extreme dependence. This enables BI to be used efficaciously in a wide range of patients including high-risk alcohol abusers. BI was also put in place gradually, starting with less intensive actions and increasing intensity only when necessary. Brief interventions can be applied by carrying out intensive counseling of the substance abusers as well as intra-treatment social support. These interventions go a long way towards ensuring the rates of subsistence are increased.
Fidelity check is achieved by providing BIs continuously for a period of time, say once daily for a week. We then create feedback paths to check the progress of the client and how they are affected by the intervention. This may include; a face-to-face meeting, a call, or a mail conversation. These channels will help establish if the interventions are working well in our aim to achieve and maintain abstinence.
Results and Data Analysis
Prior to the client being exposed to the 12-step strategy of attaining abstinence, the following behaviors were noted. Thomas was a high-level abuser of alcohol, marijuana, cocaine and other related drugs. He has been drinking right from his teenage years. He has overdosed and has been treated severally over the past three years. Thomas is unapologetic over the death of a friend who died of an overdose after he introduced her to drugs in a hotel. He neither has respect for others nor for himself.
After a 12-month social treatment via Alcoholic Autonomous, Thomas is able to fully recover from drug addiction. This can be ascertained from the interview and questioning conducted. Thomas has been sober for 6 months now and is extremely proud to have taken part in the life-changing exercise of Alcoholics Anonymous. He describes the event, six months ago, as a turning point in his life. Thomas is proud to overcome the craving. He acknowledges the self-help group he joined for their support during the exercise. The group, together with their pillars; the 12-point strategy ensured he quit drinking. He points out honesty, maintenance, acceptance and surrender as key factors that contributed to his ability to overcome the craving (Mendola & Gibson, 2019) . Thomas feels tempted when he experiences craving but feels strong and proud whenever he eventually overcomes it.
These results were broken down using content analysis. Notes and results from the interview concerning abstention and their previous addiction character were subjected to analysis and categorization.
With the consent of Thomas, we also studied his credit card usage one year before sticking to the 12-step skills and one year after the intervention. This was necessary to establish his spending on alcohol and other drinks he was addicted to. The results are shown below.
Figure 1. A graph showing Thomas’ spending on substance before and after intervention.
From the graph, we notice a rising amount of money spent on Drugs during the first 12 months. When the intervention starts, the spending significantly reduces before getting to zero. We note an effect of AA’s 12-skills in the addiction history of Thomas. The data coincides with his report that he stopped drinking after 6 months of starting the sessions.
Evidently, there was a huge and positive improvement by Thomas after sticking to the 12-step strategy. Not only did he stopped drinking and misusing drugs but his life also improved socially. He developed respect both for himself and others. The client, therefore, improved upon exposure to the 12-step strategy and this method is highly recommended for the treatment of substance abuse conditions.
Discussion, Limitations, and Next steps
From the interview with Thomas, it was evident that there are factors that influence one’s decision to quit drinking. These found include; external temptation and the battle against physical or psychological dependence. The 12-step strategy proved worthwhile in the fight against addiction. In fact, this technique worked well for our client, Thomas as a long-term substance abuser. After 12-months of dedicated attendance to Alcoholics Anonymous sessions, Thomas was able to obtain abstinence. It is important to note that abstinence is an ongoing process that involves self-help, assisting others and constant self-motivation.
The study was focused only on one individual. More and a variety of participants ought to have been included to obtain more conclusive results (Yeh, Che & Wu, 2009) . The next steps, therefore, are aiming at maintaining this abstinence. This may prove to be a challenging task but with determination and discipline, a healthy and substance-free lifestyle can be achieved.
References
Félix ‐ Ortiz, M., Salazar, M., González, J., Sorensen, J., & Plock, D. (2000). Community Mental Health Journal , 36 (4), 339-350. doi: 10.1023/a:1001983527309
How Alcoholics Anonymous Works. (2019). Retrieved 23 October 2019, from https://www.verywellmind.com/what-is-alcoholics-anonymous-62612
Jack, S., Dobbins, M., Sword, W., Novotna, G., Brooks, S., Lipman, E., & Niccols, A. (2011). Evidence-informed decision-making by professionals working in addiction agencies serving women: a descriptive qualitative study. Substance Abuse Treatment, Prevention, And Policy , 6 (1). doi: 10.1186/1747-597x-6-29
Mendola, A., & Gibson, R. (2019). Addiction, 12-Step Programs, and Evidentiary Standards for Ethically and Clinically Sound Treatment Recommendations: What Should Clinicians Do?. Retrieved 23 October 2019, from https://journalofethics.ama-assn.org/article/addiction-12-step-programs-and-evidentiary-standards-ethically-and-clinically-sound-treatment/2016-06
Yeh, M., Che, H., & Wu, S. (2009). An ongoing process: A qualitative study of how the alcohol-dependent free themselves of addiction through progressive abstinence. BMC Psychiatry , 9 (1). doi: 10.1186/1471-244x-9-76
