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RF_MH_2_B_PART_1_SUDHA
Harmony
of
Life
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T.T. Ranganathan Clinical Research Foundation
Chennai, India
THE NARASIMHANS
They Made It Possible
This vision of giving a new life to thousands of individuals affected by addiction
and rebuilding their broken families, would not have become a reality but for the
generosity and support of Smt Padma and Sri TT Narasimhan.
Sri TTN was steering the TTK group of companies founded by his illustrious
father Sri TT Krishnamachari who later became one of India's most able Finance
Ministers. When their eldest son, Ranganathan fell a victim to alcoholism in the
prime of youth, the Narasimhans turned their grief into action. They encouraged
his bereaved wife, Shanthi to train at the Hazelden Institute, a world-class
institution in the USA and a pioneer in the treatment of addiction. It was at
Hazelden that a determined Shanthi prepared herself for the purposeful task
ahead - establishing a mission bom of compassion and personal experience.
Narasimhans gave away their residence on the sea shore at Santhome to start a
day care centre for treating the patients. From that time onwards, they have been
providing support in many ways. With a financial contribution of 11 million
rupees from the TTK group of companies and the commitment of TT
Jagannathan, the spacious 60-bed TTK Hospital was built in 1987, with every
modem amenity. TT Jagannathan’s invaluable help continues, his support being
enriched by the involvement of his brother, TT Raghunathan.
Two Decades
of Care
and
Concern
God! Give me the harmony of life;
Caring friends, a good night's sleep...
A pleasant morning and a worthwhile day...!
Chamakaprasna
By the time an alcoholic or drug addict accepts his
problem and agrees to undergo treatment, the lines
of the Vedic prayer above have become meaningless
to him. He has fallen out of tune with life, and has
suffered several losses in every sphere of life - the
loss of personal dignity, of family relationships, of
friends and of finances. He knows no difference
between day and night. He does not even know
what he can expect from a good day.
The Genesis
In 1979, T T Ranganathan, in the prime of life,
died of alcoholism. Treatment services were
not available in India at that time. His young
wife, Shanthi was shattered; but did not lose
faith. She committed herself to making
treatment possible for people suffering from
addiction and helping their families recover
from the painful trauma.
A non-profit welfare organisation was bom of
Shanthi Ranganathan's personal experience
and determination. The T T Ranganathan
Clinical Research Foundation, as it was
named, is a pioneering institution in the
T T Ranganathan
treatment of addiction to alcohol. It had its
beginnings in 1980 in a house in Santhome,
Madras and began to function with a small
group of committed professionals as an
outpatient facility. In 1985, the therapeutic
services were extended to drug dependent
persons as well.
Addiction management, however, is essentially
a group programme. As patients began to
arrive from different parts of India, Shanthi
Ranganathan felt the need to change it to an
in-patient programme, thus increasing the
effectiveness of treatment. In 1987, the TTK
Hospital was established, a 60 bed treatment
and rehabilitation centre offering a month
long residential programme. Its ambience is
one of unconditional support and hope for the
patients, its charm, an abundance of empathy
and compassion.
Shanthi Ranganathan
Treating Addiction
- A Demanding Mission
The Problem of addiction
Addiction, a chronic disease, is characterised by excessive and
inappropriate use of alcohol or drugs. It leads to loss of control, which
affects a person physically, psychologically, socially and spiritually.
Treatment can help in arresting this problem and setting right the damage
it has caused.
Who is an addict?
An addict is a person whose drinking or drug-taking leads to continuing
problems in one or more areas of life - health, family relationships,
employment, finances - and who, despite these problems, continues to
drink or take drugs as he feels completely helpless. He becomes
dependent on alcohol or drugs both physically and psychologically.
Discontinuation leads to withdrawal symptoms ranging from stomach
cramps to delirium tremens.
Treating an addict is virtually rebuilding the man. He has to be
reconstructed, mind and body, brick by brick.
Goals of Treatment
• Total abstinence from alcohol and other mood-altering drugs.
• Improvements in lifestyle - effecting positive changes in
attitude and behaviour.
“About 55% of our patients treated so far have been able to lead sober
lives”, says Mrs. Ranganathan, the Founder-Director of the Institution
and the kinetic energy behind the mission. “The rest do have problems
in recovery. A good number stays on the borderline, alternating between
relapse and recovery. We do not wish to claim that a patient has recovered,
unless he is able to maintain a certain quality of life apart from leading a
drug-free life.”
Comprehensive Care
The hospital is surrounded by trees and is clean and airy within, an atmosphere
conducive to recovery.
The hospital has 43,000 sq.ft, of
floor space, and houses six
general wards which offer a
group environment for recovery.
There are seven special rooms
which can be occupied by
patients and their families. There
is also a family ward exclusively
for the families of those
admitted.
A 24-hour ‘on-call’ service is
provided at the detoxification
unit. There is also an emergency
ward which accommodates
patients who develop delirium
tremens and those who turn
violent.
An in-house pharmacy provides
medicines required by patients.
Apart from separate therapy
centres for patients and families
and a number of counselling
units, the hospital also has a
prayer hall and a recreation
room. Nutritious food is served
at subsidised rates in the
canteen.
Patient Care
Enhancing motivation
The treatment process begins with an
initial assessment of the patient by an
intake counsellor. The problem of
addiction is confirmed and the level of
motivation of the patient and the
support available to him are gauged.
Patients usually deny their problem
when they come for treatment, so
creating awareness of the problem is
the first step. The patient is then
admitted into the primary residential
treatment programme.
Medical management
Medical management or detoxification is
necessary to make the withdrawal process
from alcohol or drugs safe and comfortable.
It is carried out under the supervision of the
Director, Medical Services. Acute and
chronic physical problems associated with
abuse are also treated.
Psychological support
Once the patient stabilises physically, he
moves to the psychological therapy wing
where he participates in a highly structured
programme. The programme includes
community meetings, individual
counselling, re-educative lectures, group
therapy, art therapy and exposure to self
help programmes.
Internalising values
The day begins with a community meeting in which the counsellor narrates a value-based
story. Patients relate this story to their personal experiences. This helps them to think
meaningfully and make plans for the future.
Sharing personal problems
Each patient and the family member
who accompanies him are assigned a
counsellor. The opportunity to talk to
a supportive professional about their
most intimate problems and
experiences helps patients to accept
reality, take on the responsibility for
their own lives and develop renewed
hope and confidence.
Experiencing a feeling
of relief
During group therapy, patients talk
about their painful past and express
fears and hopes about the future. They
are comfortable sharing their
experiences with the others in the
group who have also faced similar
problems. The frank and constructive
feedback from other group members
breaks down denial and helps patients
to recognise and acknowledge critical
issues.
Art therapy gives patients an
opportunity to express themselves
through drawings. Even those who are
not articulate find a way to express
themselves effectively.
Practical management techniques
Re-educative lectures provide information about addiction - the disease concept, medical
complications and denial. Methods of making positive changes are offered. These include
ways to strengthen self-esteem, understand values and manage anger. The focus is on
recovery issues such as relapse, dry drunk syndrome and methods to stay sober. The lectures
have a practical rather than a theoretical orientation and each is followed by an activity which
helps patients to assimilate what they have learnt.
Help for the Family An Integral Part of Treatment
Addiction leaves its impact not only on the patient but on every member of his
family. Living with an addicted individual can be a painful experience and the
family is deeply hurt and feels desperate. Therefore, the family also needs help.
Healing the hurts and improving the patient's relationship with the family are
essential elements in treatment.
At the TTK Hospital, family participation is a mandatory condition for treatment.
This is a group programme with emphasis on fellowship. Re-educative lectures,
group therapy, counselling and self-help meetings constitute the recovery
programme for the family.
Viewing addiction as a disease helps family members to accept the patient better.
Family members are also given directions to deal with their problems and improve
the quality of their lives, even if the patient's addiction continues.
Making use of social support
Identifying and strengthening essential support for the recovering person, will help the
patient in sustaining recovery after the primary treatment. At the Hospital, the support
persons (parents, siblings, employer, friends) are met individually by the counsellor and are
appraised of the various aspects of addiction. They are also made aware of the need for
regular follow-up, the warning signs and management of relapse.
Planning for Relapse Prevention
One of the major problems during recovery from addiction is relapse. The
patient must be helped to lower the risk of relapse through structured
exercises. Programmes for the planning of relapse prevention are held once a
month at the hospital. These programmes help the patients to identify
relapse symptoms and plan methods to prevent them. If the relapse has
already occurred, the programme helps the patient to track and identify the
symptoms he overlooked, and to equip himself better for the future.
Free ongoing support
Recovery from addiction is not just the cessation of drug use. It also
demands adjustment to a new way of life. This new lifestyle can impose new
stresses which require new skills to cope. During the initial stages of
recovery, the patient thus needs more than mere grit - he also needs guidance
and support.
To ensure this, the hospital offers all patients free follow-up services for a
minimum of five years. Records of progress are periodically updated.
Correspondence, telephone conversations and home visits are carried out to
maintain contact.
Patients who have recovered celebrate their sobriety years as this date every
year marks when and how a new life for them began.
From the Hospital
to the Community
-----------------------------
It was in Manjakkudi, a village in Tamil Nadu that Shanthi Ranganathan’s
attention was drawn to the distressing problem of dropouts from the local schools.
The fathers of many of the students drank excessively. As a result, several of these
students dropped out of school.
It was the intense concern voiced by a teacher of the school that made
Mrs. Ranganathan think of extending the activities of the hospital to rural areas.
The idea of conducting rural camps for treating alcoholics was thus conceived.
Reaching the unreached
- free treatment for the rural poor
The Objectives
Providing treatment at the doorsteps of the villagers, specifically tailoring the
programme to suit the needs of the rural population.
Creating awareness about the problems associated with drinking among the
rural public, and transforming the community into an enabling force to
combat alcoholism.
Utilising the Infinite Power of the Community
Alcoholism is not the problem of a single individual. If it is not dealt with, it
soon becomes a problem affecting the entire community, as it leads to
violence, theft, insecurity and economic loss. For a rural community to live in
a secure environment, the entire village has to be involved in tackling
alcoholism. The empowered community has infinite powers to reform itself, a
power which no treatment centre can ever match.
Camps in the last decade
ITK Hospital has in the last decade conducted over 50 camps in the villages
of Tamil Nadu. At each of these camps, 25-30 patients have received
treatment.
Visible life style changes
After treatment and rehabilitation, many patients are able to get back to work and
contribute to the welfare of the family.
With every recovery, five or six other dependents - spouse, children and parents are
relieved of tension and anxiety.
* Children who have dropped out of school start returning to their studies.
❖ Awareness is created and many people who have not experimented, decide not to touch
alcohol. With the knowledge gained, several occasional drinkers have given up alcohol on
their own. (This information has been shared by many village leaders).
❖ There is also a reduction in the demand for alcohol. (In a village near Manjakkudi, the
'Panchayath' or local governing body has banned the sale of alcohol).
Community Rehabilitation
Addiction to alcohol and drugs is a major problem in urban slums also. The TTK Hospital
provides free treatment to urban slum dwellers. The hospital has adopted the neighbouring
Ranganathapuram community in the Indira Nagar locality. Two camps have been conducted
at which 45 patients have received treatment. The community leaders were also made aware
of the need to make the community drug-free.
Extended Care at the
After Care Centre
By 1986, drug addiction had become an issue of concern. The majority of drug users were
young and lacked family support. They also did not have the vocational skills required for
productive employment. So, the one-month primaiy treatment was not adequate for them.
What they needed was extended care and support.
To cater to this need, after-care services commenced
in 1989. A new building was constructed in 1997 to
house the After Care Centre. It offers
accommodation for
20 patients. The
Support from
programme is
industries
residential and
involves a threemonth stay. The
therapy aims at
resolving blocks in
recovery and helps
in vocational
rehabilitation.
Industrial houses have
been a great source of
support in many ways.
The vision of an After
Care Centre became a
reality, thanks to
financial contributions
from many sources
including the TTK
Group, the TVS Group
and the Birla Group of
companies.
Maya Varadharajan
Maya Varadharajan, the co-ordinator of the centre explains,
“Treatment provided here includes medical help,
psychological therapy and follow-up for five years. Yoga is
taught to improve the patient's concentration and memory.
It also helps in relaxation and toning up of muscles”.
Creating Alcohol-Free Workplaces
Alcoholism has been a major problem affecting the industries. Excessive drinking has been on
the increase among employees. It presents a major threat to the safety, security, productivity
and health of the work force. It leads to unpredictable absenteeism, accidents, deteriorating
discipline and causes constant worry over product quality. When addressed as a 'health and
safety1 issue, it can save social drinkers from becoming problem drinkers, and problem
drinkers to accept help and become productive employees.
To enable industries to deal
with this problem among
their employees and
improve their quality of
work performance, TTK
Hospital has developed a
comprehensive package.
As part of the package, the
management and union
members are encouraged
to develop a policy towards
creating an alcohol free
environment in their
workplace.
Apart from conducting effective prevention programmes, TTK Hospital provides methods to
supervisors and managers to identify early phase problem drinkers through poor job
performance. In addition, it helps in offering treatment, rehabilitation and follow-up services.
The Gains
□ Focusses attention on how alcohol affects productivity and personal safety7
□ Creates an ambience wherein peer pressure can prevent people from drinking
□ Motivates non-drinkers to feel proud of their abstinence
□ Helps to motivate social drinkers to give up alcohol completely
□ Enables problem drinkers to become productive employees
Education and Training
- The Need of the Hour
Alcohol is freely available today and restraints concerning its sale and use have
become far too lax. Youngsters experiment with drugs like marijuana and brown
sugar to complement what they think is a ‘modern’ lifestyle. The problem is
widespread and has penetrated every stratum of society.
One of the vital reasons behind this is the lack of proper information. The TTK
Hospital organises lectures in educational institutions, industries, welfare
organisations, villages and urban slums to provide accurate information about
alcohol and drugs so that people can make sensible, informed choices. Education
programmes are conducted in English or Tamil. Prevention programmes are
targetted at every section of society and different modes of communication are
employed for each section.
The TTK Hospital has printed several posters drawing the public’s attention to the
impact of addiction, and exhibitions on the subject are held regularly.
Mode of
Communication
Number of
Events
Number of
People Attended
Lectures
1061
74500
Exhibitions
257
51400
Video Shows
521
103000
Equipping Professionals
The TTK Hospital has been continuously providing specialised training
in three areas of addiction management.
□ early identification
□ treatment methodologies and
□ education and prevention strategies
Training programmes lasting from a single day to a week have been
conducted regularly at the hospital for trainees from the grassroots
level like the animators to medical, paramedical and industrial
personnel apart from parents and teachers.
Students of psychology, social work, criminology, medicine and nursing
usually confront addiction in their working lives, but are not equipped
to handle it. To overcome this handicap and fill the gap in the
curriculum, these students undergo compulsoiy training for a day at the
TTK Hospital as part of their post-graduate course.
These training programmes have proved to be highly beneficial to society. In
1987, there were only a couple of treatment centres in India, but today there
are more than four hundred. The majority of the staff in the treatment
centres in Tamil Nadu, Kerala, Karnataka, Andhra Pradesh and Pondicherry
have been trained at the TTK Hospital.
Addiction is a major problem in the North-East of India. The TTK Hospital
has been identified by the Central Bureau of Narcotics and Ministry of
Social Justice and Empowerment as an institution where their staff can
undergo regular training.
This Hospital has also been recognised by several international agencies like
the World Health Organisation, the Colombo Plan and the International
Labour Organisation as a specialised training centre.
The Benefits
□
People have direct access to
'hands on' experience
□ The role of counsellors in
addiction management is
recognised and understood.
□
Neighbouring countries with
similar cultures like Sri
Lanka, Bangladesh and
Nepal also find the
programme extremely
relevant.
Addressing Current Needs
Campaign against
Drinking and Driving
Prevention of
HIV-AIDS
On a certain New Year’s eve, ten
teenagers died in three road accidents.
The reason: drunken driving. The TTK
Hospital enlisted the support of the
insurance sector and began a campaign
against ‘Drinking and Driving’ in
Chennai for the first time in 1986. Such
campaigns are now a regular part of the
hospital's activities.
Another large scale social problem in
Tamil Nadu is the spread of the HIV
virus. At a treatment camp in Namakkal,
a number of lorry drivers (who formed
the majority of the patients) said they
often had casual sexual relationships.
This accounted for their forming a high
risk group for HIV, but they were
unaware of the danger they were exposed
to. The TTK Hospital conducted several
DRINKING AND DRIVING IS
DANGEROUS
programmes for local health workers,
teachers and the general public at
Namakkal, Manjakkudi and Ranipet in
Tamil Nadu. HIV awareness programmes
have become a part of the centre's
regular activities.
- It kills, hurts and damages property
Addiction Research Centre
The Addiction Research Centre at the TTK
Hospital has been recognised by the
department of Science and Technology and
enjoys 100% exemption from income tax.
Several papers have been presented at
international conferences and workshops.
The research findings are used by the
hospital mainly for therapy modifications.
There is at the hospital, a documentation
centre and a library with a large collection
of research papers, periodicals, technical
journals and books from all over the world.
Publications
The TTK Hospital shares its valuable
experience in addiction management
by publishing a number of
professional manuals and books.
These are culture specific and written
in the Indian context. They address
different target groups professionals in the field, other
service providers, patients, their
families and the general public - and
provide valuable practical guidelines.
Their latest publication addresses the
school children and their teachers.
‘Give me facts... Let me decide' shows
the teenager how to build self
confidence and handle his choices
sensibly.
‘Give them facts... Help them decide’
provides the teacher with powerful
tools to create a new value based,
well informed generation capable of
making responsible choices.
Free Services at a glance
Free services are a part of the TTK Hospital from the
day it was established and form the very basis of its
philosophy. No one who comes for treatment is turned
away because he cannot afford to pay. At the TTK
Hospital, the same standard of patient care is offered
to paying patients and those treated free of charge. The
following are the services offered free.
Follow-up services for five years after
primary treatment at the hospital
Treatment and follow-up services for
all patients at the After Care Centre
___________
Professional Expertise
At the TTK Hospital, a team of 56 committed professionals
provide medical and psychological support to the patients. This
dedicated team has treated over 10,000 patients over the last
twenty years.
L to R : Jacqueline David - Senior Counsellor, Dr. Anita Rao Director - Medical services, Shanthi Ranganathan - Hon. Secretary,
Dr. RR Cherian - Director - Research and treatment programme,
V Thirumagal - Director - Patient care and quality assurance.
The team includes a consultant psychiatrist, a physician, nurses,
counsellors and administrative staff. The counsellors are
psychologists, social workers or recovered addicts with qualitative
sobriety who have undergone training in this field. The After Care
Centre is managed by a coordinator, three counsellors, a resident
warden, a physician, a yoga therapist and other supporting staff.
To remain updated in the professional practice, continuous in
house staff development programmes are conducted. Specialists
of international repute from various institutions in allied fields,
are invited to deliver lectures. A number of staff members have
presented research papers and participated in international
seminars in the USA, UK, Canada, Australia, Malaysia, Italy,
Hong Kong and Thailand.
Volunteers in main stream activities
This institution has been singularly fortunate in its voluntary staff
who contribute to mainstream activities.
Rukmani Jayaraman has over
the last 12 years developed a
number of publications for
professionals, counsellors,
recovering patients and their
families. Her Master Guide on
addiction treatment is used as
a reference book by practicing
professionals in the SAARC
countries. Two of her books
are being used by leading
schools to impart Value
Education.
K. Ramdas Nayak retired from
a senior corporate position in a
bank to devote his time to
organising and administering all
the training programmes.
Jaya Sadasivam conducts group
sessions for family members on a
regular basis.
Vasantha Balasubramanian
helps in administration.
Jaya Sadasivam
Yoga Chandrasekaran looks
after the information manage
ment function.
Collaboration with
International Agencies
World Health Organisation
Consultants from WHO who visited one of the
treatment camps found rural camps a viable
approach for developing countries. Workshops
were organised by WHO in Geneva, London
and Colombo at which Shanthi Ranganathan was
the resource person. The TTK Hospital has been
chosen to train professionals from neighbouring
countries like Myanmar and Sri Lanka under the
sponsorship of WHO.
United Nations
Drug Control Programme
UNDCP identified a few organisations in the
country and equipped them to carry out their
mission against drug use. In the year 1995,
under the umbrella scheme, the Hospital
received a van and some hospital equipment.
International Labour
Organisation
The Hospital has been working on a few
Community Rehabilitation projects in
collaboration with the ILO. With their technical
assistance, the hospital has undertaken projects
to make two industries alcohol and drug free.
One of the hospital's counsellors was sent to
Delhi, Hong Kong and Bangkok to receive
training on the ILO's community based
rehabilitation reference model.
Colombo Plan
The TTK Hospital has been recognised as an
ideal training ground for women counsellors, as
most of the hospital’s counsellors happen to be
women. Also the family and community oriented
treatment methodology at the Hospital is
relevant to all the SAARC and ASEAN
countries. The Hospital organised three training
programmes for 46 women counsellors from
these countries in 1997 and 1998.
European Commission
The EC provided grant to continue with the
hospital's mission of providing after care
services. With partial financial assistance from
the EC, the 20-bed centre was built in 1998.
The EC also understood the hospital's need to
train its staff. Under its sponsorship, the medical
officer, the co-ordinator and a few counsellors
underwent training at Kaleidoscope, London and
at Centro Italiano Di Soliderata in Italy.
The Mission and the Vision
"What is it that has brought the TTK Hospital from its humble
beginnings to what it is today?’ ‘The grace of God’ says Shanthi
Ranganathan. She continues, ‘The team of committed professionals
and the patients from different parts of the country who have
continued to repose their faith in the hospital have been responsible
for its growth’.
The quest does not stop with providing a beacon of light to those
suffering in darkness. Shanthi looks ahead in her battle against
addiction. ‘Anyone in any part of India who wants to get out of the
clutches of addiction, should have access to quality care. We will
continue to share skills, knowledge and expertise, and equip the
professionals to spread the concepts of care. ’
"We will also continue with our mission of creating awareness so
that more and more people make sensible choices. The number of
new drug users should come down, and this positive change should
be felt at the family, peer and the community levels. ’
‘Service is our motto and we will continue to provide it with utmost
dedication, commitment and care’.
3FTT:
Wg I
May everyone be blessed with
Happiness and contentment
The T T Ranganathan
Clinical Research Foundation Committee
T T Narasimhan
President
Meena Muthiah Vice-President
G. Kasturi
Vice President
T T Jagannathan
Vice President
Ajay I Thakore
Vice President
Shanthi Ranganathan
Hon. Secretary
J. Srinivasan
Hon. Treasurer
Dr. Latha Jagannathan
Member
TT RANGANATHAN
CLINICAL RESEARCH FOUNDATION
(TTK HOSPITAL)
17, IV Main Road, Indira Nagar,
Chennai - 600020. India.
Tel : 91-44-4918461/4912948
E-mail: ttrcrf@md2.vsnl.net.in
MH - 2-b.
AFTER-CARE CENTRE AND ITS DEVELOPMENT
PREPARED BY
MRS. MAYA VARADARAJAN
MRS. ARUNA
MS. KANAKAM
CONTENTS
1.
Introduction
2.
Therapeutic Benefits
3.
Programme Time Table
4.
Therapeutic Activities
Lecture Topics
Group Therapy
Activities
5.
Review of Progress (Recovery)
6,
Conclusion
WEEKLY TIME-TABLE
FORE-NOON
06.00
WEEK DAYS
Monday
Rising
to'
time
Saturday
06.^0 .06.45,
06.45 07.00
07.00 07.30
07.30 09.30
10.00 10.30
Exercises
or
Yoga
(Wednesday
and
Saturday)
Prayer
(Thought
•for the
Day)
Therapeu
tic
Duties
Break
fast.
Commun i ty
meeting
02.0003.30
03.3005.00'
05.0006.00
07.0008.00
Group
Therapy
Counse11 ing
Recreat
ional
activities
A.A.
meeting
and
Counse11 ing
AFTER-NOON
WEEK DAYS
Monday
to
Saturday
11.0012.30
01.0002.00
Lecture/
Lunch
Assignment/
Therapeutic
Games
.
I PHASE
I MONTH
I - WEEK
Morning
i
Evening
After-noon
(Group Therapy)
Monday
Disease Concept
(Lecture)
Physical Damages
A>Au Meeting
Tuesday
Assignments
Occupational /
Damages
•
Financial
Wednesday
Psyc hosoc i a1
Factors
(Lecture)
Damages in the Family
(Re1at ion s h i ps)
Thursday
Assignments
'Feelings'
Friday
Surrender Vs
Compliance
(Lecture)
'Va1ues'
N.A. Meeting
I PHASE
I MONTH
II - WEEK
Morning
After-noon
Evening
(Group Therapy)
Monday
Human Needs
(Lecture)
Spi r i tua 1 Dec: 1 ine
A., A. Meeting
Social/Legal
Damages
Stress
Management
(Lecture)
Tuesday
Assignments
Wednesday
Assignments
Emotional Damages
Assertiveness
(Lecture)
'Feelings'
N.A. Meeting
Thursday
Values
(Lecture)
Friday
Assignments
'Values'
I PHASE - I MONTH
III - WEEK
Morning
After-noon
Evening
(Group Therapy)
Monday
Problems in
Sobriety
(Lecture)
Powerlessness
A. A.
Meeting
Tuesday
Assignments
Accidents due to
Intoxication
Wednesday
Denial
(Lecture)
Denial
Thursday
Assignments
'Feelings
Friday
Relapse
(Lecture)
■-
"'values'
hl.. A.
Meeting
I PHASE - I MONTH
IV - WEEK
Morning
After—noon
Evening
(Group Therapy)
Monday
Self-esteem
(Lecture)
Substitution of alcohol
with drugs -- vice versa
A. A,. Meeting
Roles played by
Family members
Anger
(Lecture)
Tuesday
Self-esteem
(Game)
Wednesday
Overcoming Grief
Cost of addiction
in all areas of life
Thursday
Assignments
'Feelings'
Friday
Role Play
'Values'
M.A. Meeting
II PHASE - II MONTH
■ r
Evening
After-noon
Morning
(Group Therapy)
Monday
IE
1ft
Personality Defects
(Lecture)
a)
b)
Symptoms
Preoccupation with
drinking
A.A. Meeting
Black outs
•
Tuesday
a|
Assignments
l|
Assignments
Increased Tolerance
Loss of Control
Dry-drunk
Syndrome
(Lecture)
Wednesday
Grandiose Behaviour
Insane / Aggressive
Behaviour
Thursday
Chalk Game
'Feelings'
N.A.
'Va1ues'
Group
Friday
Smoking
Meeting
II PHASE
Ungame
'Values'
II MONTH
Group
II PHASE
II MONTH
III - WEEK
Morning
Evening
After-noon
(Group Therapy)
Monday
Facing Challenges
of life
Destructive Be ha v i o u r
against oneself and
others
A.A.
Meeting
Tuesday
Assignments'
Methods used by family
members to control
addiction
,
Effects of
addiction on
sexuality
(Lecture)
Wednesday
'Values'
Game
Grief over death of
a1coho1 / drugs
Thursday
'Trust Walk'
Game
'Feelings'
1
N.A.
Friday
Assignments
Self-esteem
Evaluation
Progress Chart
'Vaiues'
Group
Meeting
II PHASE - II MONTH
IV - WEEK
After-noon
,
Evening
(Group Therapy)
j
Monday
B Looking at self
I
Secret Guilt feelings
A.A. Meeting
Loss of other interests
Warning signs
(Group)
(Assignment)
B ^Tuesday
^Quality of life
IB (Lecture)
I Wednesday
I
IB Talents Time
[
Past adverse life style
Thursday
I Memory Game
'Feelings'
Friday
Role Play
'Values'
N.A. Meeting
Ill PHASE - III MONTH
I - WEEK
Morning
Evening
After-noon
(Group Therapy)
Monday
Stamp Game
Life History
A.A.
Meeting
Tuesday
Inventory of Harmful
Consequences
'Hurt Feelings'
Wednesday
Developmental Task
(Lecture)
‘Guxlt Feelings'
Group
Thursday
Warning Signs
(Assignments)
Friday
Snakes & Ladders
Game
‘ Feelings'
N.A. Meeting
Ill PHASE
III MONTH
II - WEEK
Morning
Evening
After-noon
(G r ou p T he r a py )
Monday
Defining personal
goals and objectives
- Assignment
Developmental tasks
A.A. Meeting
Tuesday
24 hour programme
— Debate.
Deve1opmen ta1
task s
Wednesday
Clay modeling
— Activity
Deve1opmen ta1 tasks
Thursday
Re-appraisal of an
'upset situation'
- Assignment
'Feelings'
Friday
Conceptualise 'self'
- Self-esteem
"Values'
M.A.
Meeting
III PHASE - III MONTH
III - WEEK
Morning
.After—noon
Monday
Self disclosure
- Activity
Pleasure
A.A. Meeting
Tuesday
A.A. Step - I
— Assignment
Wednesday
"T"
- Puzzle
Thursday
Living Sober
- Lecture
Friday
Dumb Charade
- Game
A.A. Step - II
.. Assignment
Wednesday
g
f
Inside/Outside
Self drawing activity
•
A. A. Step IV
Ideal qualities of a
f a t her/brather/son/
husband — Our Deviation
Group
Thursday
r
'
'Feelings’
' Friday
Role Flay
'Values'
N.A. Meeting
LECTURE TOPICS
The lecture topics covered by the? Counsel lore are listed beloi*
1.
Disease concept
2.
Psychological
3.
Denial
factors
4.
Dry Drunk Syndrome
5.
Values
6.
Assertiveness
7.
Relapse Prevention
8.
Human needs
9.
Overcoming Grief
10.
Stress Management
11.
Living Sober
12.
Anger
1'3'.'' Personality Defects
14.
Problems in sobriety
15.
Self-esteem
16.
Surrender Vs. Compliance
17.
Emotional cost of dependency.
1
SPECIAL LECTURES
1.
Facing challenges of life
2.
Quality of life
<
3.
i Myths and misconceptions of Esperal
4.
Effect of addiction on sexuality
5.
Feelings
6.
Time Management
7.
Developmental tasks
8.
Smoking
■9.
Communication
GROUP THERAPY
Group
therapy
treatment
the
is a therapeutic, mode used in
The therapy helps the patients to interact,
addiction.
of
share and
discuss their problems with cd-patients.
A
group
Patients
45
therapy is held at the centre every day
2.00
p.m.
are in a closed group and each session lasts for
about
minutes
Counsellor
to one hour which is conducted
is
never authoritative,
member by monitoring,
by
rather she /
at
the
Counsellor.
he
helps
the
initiating and focusing on the topic.
Each
Group therapy is
also
Counsellor conducts the group for a week,,
held everyday in the evening between 7.00 and 8.00 p.m.
During the First phase of the programme the following topics
handled in the group.
They essentially deal with damages
various stages of life due to addiction,
family's attitude.
Sharing
1.
on physical damages.
2.
on occupational damage:
3.
on financial damages.
4.
on social damages.
5.
on emotional damages.
6.
on legal problems.
7.
on damages in the fam.<. J
are
during
reaction towards it
and
8.
effects of addiction on sexuality — damages due to addiction
9.
effects of addiction on person's spirituality.
from minor discomfort to major .complication,
10.
accidents (minor to major) due to addiction.
11.
substitution of alcohol with drug and vice versa.
played
role
12.
by
family members
our
towards
addiction
-
enabler, blamer, controller and protector, and its impact on
us.
13.
the cost of addiction.
14.
loss
other interests due to
of
hobbies,
recreation,
conversations,
During
focus
understand
symptoms and stages of addiction,
the
intellectual
political/discussions, etc.
Second Phase of treatment, programme
the
on
socialising,
addiction
reading paper/magazines,
to
mainly
topics
enable
them
to
disease concept and to break, the denial
of
the
of
individual.
1.
Powerlessness
a)
Preoccupation
powerlessness.
stinking
with
-
is
one
kind
thinking abilities
are
marred
drinking
Normal
this
think .ng - pre planning," hiding and
getting
by
high
with the plan.
b)
to
control chemical
use - self
attempts
towards
abstinence, making rules to abstain but breaking it,
trying
ways to abstain and go back to addiction.
These
Attempts
religious
methods also prove powerlessness towards addiction.
c)
List the times an addict has lost control over his behaviour
-
black outs, getting into arguments / fights,
complete
a
change of personality.
d)
- increase in tolerance level
about
^Sharing
and
of
loss
■ ,,control
2.
Grandiose
/
insane
behaviour,
on
behaviour
aggressive
intoxication.
6.
Relief drinking situation - where one person feels
or
addiction helps
relieved
him to decrease the pfiin caused by
the
situation.
Conclusion
—
addiction never gave
a
solution,
permanent
rather taught inadequate coping mechanisms by escaping
from
the reality.
4.
Values
lying,
violated and displayed due to addiction -
begging,
stealing,
cheating,
irregularity,
dishonesty,
irresponsibi1ity and indiscipline.
Conclusion
-
how addiction made one behave in
a
negative
harming
others,
manner - immoral and antisocial.
5.
Worst
drinking
episode
indulging in violence,
-
accidents,
hurting others, stealing articles
of
expensive value etc.
6.
7.
Destructive behaviour towards self q,nd others.
Secret guilty feelings
- never shared with any one,
embarrassing even now to think.
s.
Methods
used by family member:s to control add iction
beating,
house arrest, strict
mai1ing,
traditional
pleading,
begging,
with money,
avoiding
religious methods etc.
emotional
friend's
-
eg
b 1 ac 1
visit
Conclusion
to
ignorant family members
how
-
concept;
disease
how tolerant they were?
are
the
about,
attempt
The last
control addiction will be this treatment and hence
what
should be done?
Denial
Denying
a)
use
to
associated
the existence of any problem
of alcohol / drug.,
the problems are quite
but the addict, denies the
others,
with
obvious
his
that
fact
addiction has produced such adverse consequences.
Relate incidents of minimising - eg.,
b)
"I accept that
I
drank and it led to some problems but the problems were
as
not
much
In
as others thought,.
we
process
the
convince ourselves that it is not very serious."
c)
the
How
addict,
blames others
for
his
blaming others for his own short comings,
responsibility
Tor
many
of
his
addiction
Denying
addiction
related
problems and shifting him responsibility to others.
drink
because
my wife doesn't respect me
or
the
"I
because
people are unfair to me at work.," etc.
> ■ d)
Rationalising or giving excuses.
.e)
Justifying addiction.
Grief over death of alcohol / drug - whether we could accept
the fact that addiction cannot or should not reappear in our
Whether we feel ,a vacuum or gap due to this?
Or
can
we feel that we have escaped from that addiction which
will
life?
end
our
towards
life.
Hence we have to do
Feelings
something."
this grief - shock, denial, unhappiness
/
sadness
and acceptance.
,11.
Past
style
adverse life style -• relate about a past adverse
- spending excessively,
constant tension in the family,
the
grandiosity, guilty
lack of organised,system
and self, not taking care of
family
life
feelings
personal
in
hygiene
health etc.
12.
Previous
describe
relapses
external
/
internal
temptation.
16.
Fast
craving
experience
drugs
thoughts
towards
triggered
the cravings,
and
factors
involved
external
about possible
--internal
situations
craving
which
situation
and methods to deal with them.
In
third or final phase of our programme, topics
the
making
moral
inventory
of
self,
handling
(guilt, resentment, depression or anxiety)
focus
negative
on
feelings
of
creating awareness
self’.towards reality, reviewing their stay and their future plan.
1.
Identifying personality defects which maintained addiction group
confronts
defects,-
and
and helps the individual
to
motivates him to change whidh
strengthen his sobriety.
his
identify
will
in
turn
Need for improvement of quality of
life.
2.
What
does the addict think about "The ideal qualities of
son / father / brother..
Have I had these qualities?
a
Can
I
admit that I did not conduct my life in the right way and
I
have been irresponsible."
3.
Narrate positive (personality) qualities of family members -
How do I differ from my family members and become deviant in
the
in
How do they tolerate my traits
family?
order
to
maintain the unity of the family™
4.
The
addict names the persons he? dislikes / hates the
and
describes their personality traits - "can
same
traits
our
in
addiction
days
and
most,
we
identify
during
initial
recovery? Do we hqve patience to wait till the family member
society accepts Lis,
/
as they needed time to
their
change
attitudes."
,5.
Developmental Tasks.
Robert Havinghust proposed the possibility that there are
series of developmental
A
task is (one) which arises at or
developmental
certain
period
"tasks" appropriate to life
of the life of
the
individual
about
tasks,
individual,
while
failure leads to
disapproval
a
successful
achievement of which leads to happiness and to success
later
a
stages.
with
in
unhappiness
by the society and difficulty
the
with
later tasks.
Description of the group -
the
patients
are
divided
In the beginning of the
into
3
groups.
session,
The
groups
comprises patients between 1.8 and 26 years, 26 and 38
and 38 years and above.
the board writes developmental
groups.
years
The Counsellor then writes down
tasks for the respective
on
age
Task for the age group IB - 26 years ares
a)
Completion of school education and entering college,
b)
Completing college education.
c)
Selecting and preparing for an occupation.
d)
Developing
intellectual skills and concepts
necessary
for civic competence.
e)
Achieving socially responsible behaviour.
f)
Building conscious values and morals.
g)
Preparing for marriage and family life.
The tasks for the age group 26 -38 years are
a)
Selecting a mate.
b)
Learning to live with a marriage partner.
c)
Starting a family.
d)
Rearing children.
e)
Managing a home.
f)
Getting started in an occupation.
g)
Guiding a congenial social group.
The tasks for the age group 38 years and above are
a)
Achieving adult and civic responsibility.
b)
Maintaining an economic standard of living.
c)
Assisting children to responsible happy adults.
d)
Relating oneself to ones spouse as a person.
e)
Planning and saving for the future.
f)
Establishing
arrangements.
ft-
a
satisfactory
residential
living
from the first group has to sit' facing the
Patient
entire
group and the patients from each group ask him questions
the
of the task mentioned on the board.
basis
confront each about their achievement
members
and
on
group
The
failure
which is due to their addiction,.
Conclusion - Finding out disparity between chronological age
As mental age and its growth depends
and
mental age.
the
achievements,
accomplishments and
approval
upon
the
from
society which stagnates / deteriorates due to addiction.
6.
Anger
an
/ resentment / remorse
addict
guilt.
was
"Has
- Before coming for
carrying a load of
the
resentment,
programme helped
me
treatment
shame
relieve
to
and
these
feelings?”
Conclusion -- whether sharing of these helped addicts analyze
the
reasons, situations in a better way, and assess
turn
to
improve communication,
expressing,
it.
in
understanding
others and relieving tension,,
What are the advantages of staying sober today?
Pleasure Vs. Pain - In this group members were asked to give
the period when they suffered due to withdrawals / turkey
i.e. craving,
hang
over
joint
pains,
depression
minimal
were
/
days,
hours,
stomach
tremors,
/
ache,
no money unable to get drug /
drink
due
peddlars
them,
extreme
discomfort
physical
physical
or
anxiety / panic etc.
weeks,
cheated
They have
months or years which
give
in
be
very
Then
they
to
will
as no one could tolerate these stress,’
to
asked to give the period of pleasure they had
due
to
i.e.,
addiction,
high,
kick, not feeling pain / ache,
world wKich helps them to escape
in , fantasy
enjoyed with friends, going for picnics
problems,
living
worldly
from
/
tours
give
the
period of social drinking years which will be more than
the
and
spending
In this,
lavishly.
patients
will
pain / sufferings they had.
The
they
Counsellor would, ask the group,
gave
the
the period of
family during their
pleasure
days,
addiction
presenting / gifting the family members, grandiose
(buying
flowers, sweets,
spending
time
tours
and
clothes and delicious foods
with them happily,
outings,
to
them
taking
etc.)
movies,
creating
laughing with them and
In this, patients will be giving a very
atmosphere.
i.e.
spending
happy
little
account of days they gave them pleasure.
find finally they were asked to give the period of sufferings
/ pain caused to the family on addiction i.e.,
depressive
anxious
/
biological
feelings, suicidal
dysfunctions
(no
and
sleep
physically
hurting and verbally abusing,
children
were
backwardness,
faced
family
ideas
no
constant
/
plans,
appetite)
tension,
showed
academic
limited socialization due to stigma,
debts and
emotionally
upset
and
deprival of basic needs etc.
numerically the period,
the
group
Conclusion
-
regarding
their own pleasurable days will
equivalent
to the period of family members'
be more
mentioned
or
less
sufferings
due
to addiction whereas the period of their sufferings will
be
equivalent to the period of family's pleasurable days during
addiction days.
Generally
the
topics
of
deviance
tasks and pleasure Vs.
developmental
in
the
family,
pain will go on for
a
week.
9.
Share about the incidents of past crisis situation and
what
was the coping mechanism used?
- .
of
awareness
our
inadequate
/
negative
coping
mechanisms
-
misconception
/ belief that alcohol
/ drug
helped
to
come out from crisis or helped in minimising grief
realisation of how drinking / taking drug aggravated or
worsened
shame.
the situation which in turn produced guilt
/
in the
a
Example
position
-
death
not
family,
to help others in rituals nor
could
in
express
our own feelings towards it.
10.
Share about the feelings which are easiest / most
difficult
to express.
,
Conclusion
-
sadness
unhappiness,
/
disappointments
express.
proves
negative
and
feelings like
hurt,
frustration,
anger
depression
/
guilt were the difficult
feelings
"Hence kje seek the help of alcohol ■/
our inadequate personality and how we are
express these in a normal way."
/
resentment,
drug
to
which
going
to
11.
Review
of
discharged
our
stay
- the patie.hi
who
is
going
will share his experience at After-care
to
be
Centre,
what he has learnt and benefits, changes / improvements, and
his
future
observations,
plans.
Then
suggestions
the
group
will
give
towards his behaviour
help him towards planning 24 hour day programme..
and
their
also
ACTIVITIES
Introduction
Since
a growing need to supplement lectures and assignments
deeply
felt by the staff of the centre.,
The advantages of group activity include
to the programme.
peer
support,
was
added
'activities' were
pressure,
the
opportunity
to
practice
peer
social
interaction and learning that others also face similar problems.
Many activities were added with the experience and growth of
the
These activities were modified to suit
the
The activities are introduced to the
group
After-
care Centre.
needs of the Centre.
in the second and third'month of members'
Energizers
/'Shakes 'and Ladders
Guess what is the word
Talent's Time
Gardening
Memory Games (a,
Clap together
Dumb charade
Gelf—Esteem
Warm Fuzzy
Cold Prick ley
Feelings
I Feel
-
b ?< c)
stay at the Centre.
Ungame
Stamp Game
Inside / Outside / Self drawing
Debate
Values
24-Hr-a-day
Positive Growth
Values
Trust Walk
'T'
Puzzle
Chalk Balance
Role Play
Self Disclosure
Group Art work
Clay Modelling
Review
Review of the week
Review of the weekend
Review of Patient's stay by other members,.
* I FEEL'
Purpose
1.
To
make
the
patient
aware
of
various
foulings
experiences.
2.
To make him express his fueling^
•< v -
.
he
cut the association between drinking / taking drugs
To
and
expression of positive and negative feelings.
Materials
None
Instructions
This
is
an
,
to
activity where we learn
express.
addiction days whenever we were angry we had a
a
'joint.'
our
smoked
When the accounts did not tally at the
office we drank/smoked to forget it.
We had always used
drugs to express our feelings of sadness,
happiness,
alcohol
tension,
We thought that emotional outlet was only
irritation or anxiety.
through
During
of brandy or
When we were happy at a wedding, we drank or
for expressing happiness.
/
'peg'
alcohol / drug.
After we realised that alcohol
had become a problem to us, we are now
/
drug
taking treatment for
it.
Now while on the path to recovery, we should give up our old ways
of expressing our feelings with alcohol
activity we will
this
' drug.
With the help of
learn to express our feelings in a
normal
way.
Procedure
The
members start the first round of any particular
not feel happy says "I do not feel
case
feeling
"I feel happy" and gives the reason for it or if he
saying
happy” and gives reasons.
he does not want to assign any reason,
happy",
"I
simply- says "I
do not feel happy for no reason."
Thus,
the
by
does
In
feel
first
B B
Note
■ I
The Counsel lor also participates in the group.
II
his feeling he / she can be a role model for patients to
1
genuinely and honestly.
5<y sharing her
/
express
VALUES
Purpose
1.
To
pick
up
behaviours
that
are
adaptive
and
behaviours that are nonadaptive
2.
To set a creative mood and practice it sincerely.
Materials
A sheet of paper, pen.
give
up
/
drugs
were
alcohol.
We did not care about personal
hygiene.
We
not dressed properly, or shaved or brushed or washed.
Our
and sleeping patterns were also very irregular.
eating
for the treatment and
disease
and
improvement
of
a
the way out of it was by
life style.
changing
ourselves,
week.
t-he
week
and
us
to
The first step
in
pick
up
So, now each of you are going to select
value (behaviour) which you would either learn or give
this
came
abstinence
is to drop unnecessary habits and
good and healthy habits.
a
total
So it becomes necessary for
and commit ourselves for that change.
change
We
learnt that alcoholism / drug addiction was
I would like you to work on the values
up
through
(7 days) and we shall review as to how much
you
in
out
were
able to accomplish by next week.
Procedure
The patient is asked to select a value.
identify,
the
In case he is unable
group is invited to suggest some;
values
member
who accepts th'? necessary ones lie likes and
values
with
which
he
is not
comfortable
to
rejects
with..
He
to
the
the
is
not
sheet
of
compelled any further.
Time Frame
45 to 60 minutes.
Note
|The
value selected by each patient is noted down on a
|paper by the Counsellor.
This sheet is then put up on the Notice
At the next 'value activity' class, each patient is asked
Board.
to
also
share on,
how he was able to practise the value.
reviews his behaviour.
If he has not been
continues with the same value.
encouraged
to
The
If he has been successful,
take on another value.
group
successful,
During the
value
he
he
is
class,
patients are also encouraged to write letters of amends.
SELF-ESTEEM - WARM FUSSY
Purpose
1.
To boost up self-esteem of the group members.
2.
To help members identify positive qualities in
Materials
Paper, Pen.
Instructions
Pl.ease write your name on the paper
the
next member on your'right.
(right corner) and pass it to
Now read the name of the
person
I hen
write
('□n the paper) and think what good qualities he has.
down'2 or 3 such qualities in the paper.
the member oh' your right.
in your hand.
Again pass the paper to
This continues till you get your paper
Then stop.
Procedure
Patients sit. in a circle and write down the positive qualities of
the patient concerned on the sheet of paper.
to go through the list whenever they feel
Patients are
low or depressed.
asked
Time Frame
minutes.
30 to 40
COLD PRICKLEY
Purpose
1.
2.
To be aware of one's negative qualities or liabilities.
To
member
help
learn
to
others'
confront
negative
habits/behaviours in a healthy way.
, Materials
Paper,
pen.
Instructions
Please
your name on the top right corner
write
Pass the paper to the person on your right.
of
the
person
(on
the paper)
think of
of
paper.
the
As you read the name
his
or
her
negative
qualities i.e. qualities1 which are of negative influence for
adjustment
with others and write one such quality on the
.‘iThep. . pass the paper to the person on your right.
all' the members'
papers are passed.
Continue
his
paper.
till
Then stop.
Procedure
The
members
sit
in a circle and
start
qualities after the Instructions are given.
Time Frame
30 to 35 minutes.
writing
the
negative
Note
The Counsellor also participates in the activity.
MEMORY GAME (a)
Purpose
1.
To get each person involved in the group.
2.
To
make
the
patient aware of /
learn
about
his
memo,
process.
Materials
None
Instructions
Each
of you would start naming a city and
one
is
ne,-.
would mention the first one and call out his own choice.
continues in a circle.
Procedure
Example:
1st. Participant
Bombay
2nd Participant
Bombay, Delhi
3rd Participant
Bombay, Delhi-, Madras.
The patient who makes
Time Frame
30 to 40 minutes.
TP
Note
Counsellor also participates in this game mainly to get
The
ends on the memory process, covering definition, the
property
of
memory,
associative
the organisation on memory, the
factor off anxiety or memory
the
attention,
the
The Counsellor can give a talk when the activity
group involved.
etc.,
factor
of
would
which
bring awareness to the members about the same.,
MEMORY GAME (b)
sam^
The
same
the
the above game (a)
as
vegetables,
flowers, etc.
can be
played
The instruction,
in place of name of a city,
except
with
names
of
procedure etc.,
the
are
of
name
a
flower/vegetable is to be used.
MEMORY GAME (c)
Purpose
To bring an exact awareness of memory process. .
Materials
25
different objects of different categories ranging from
to medium size.
(Blade, chalk,
(2), flower,
vegetables
pen,
small
rubber, screw,
pin,
key,
spoon,
length of wire, stapler,
thread,
leaf, seed,
ball, coin, stone, small
small
needle, small cover,
pencil,
inland letter,
tatflet, token,
papers,
pen, etc.
Instruction
You
now
close
see different things kept on the table. Please
look
at
it
for 5 minutes,
after
which
these
have
will
a
be
Take a paper and pen and write down the things you have
removed.
just now seen.
Procedure
The. Counsel lor has to arrange on the table the different
objects
in a manner that they do not easily associate one object with the
other.
After
removed ,from
the
patients .have a close look,
the
the table and kept away from sight.
patient
After
then would be required to write the names of objects seen.
everyone
completes,
the right items in the answer sheet
ticked while wrong items scratched.
are
items
The
can
The number of correct
be
items
is totalled.
the
end
of the activity,
similar
to
that of last activity.
factors
as selectivity of attention, motivation- and
At
the Counsellor
information processing in the talk.
can
She can also
give
include
Time Frame
Note
The Counsellor does not participate in the activity.
talk
other
methods
This would help the
to learn more about the memory process.
a
of
patient
SNAKES AND LADDERS
Purpose
1.
To get the members involved in a group.
2.
As a part of light recreational group activity.
3.
To acquaint members about the 12 steps and key points
about
recovery.
Materials
The specially made Snake and Ladder Board, Dice and colour
chips
for participants.
Instructions
Choose your colour chip.
You have to roll out a
on dice to
'six'
Then you can continue in your turn and move that many
start off.
squares.
Your turn will end unless you roll out a six again
on
the dice.
If your chip reaches a square with a ladder, you
jump
ahead by climbing it.
square
of
On the other hand,
if your chip reaches
with a mouth of snake, you slide downwards to the
the snake.
The first one to reach 100, Happy Sober
the Winner.
When you reach a square where something is
please
care
take
to read it.
This is what
this
a
bottom
Life
is
written,
is
all
Snake
and
game
about.
Procedure
The
members
Ladder
are seated around a table on which
Board is set.
the
The colour chip for each person is
and dice rolled in turns.
The chips are moved that, many
as the numbers rolled on dice.
chosen
squares
Time Frame
35 to 60 minutes.
Note
The
Counsellor
Counsellor
does
not participate
in
this
activity.
each square aloud and give one sentence explanation.
This
should not be discontinued once a member emerges a
Other
members
reaching
feel
happy when they also
finish
in
would
that all of them listen and understand the message.
ensure
game
The
should take care to read out the written messages
The
winner.
the
game
by
'Happy Sober Life.'
REVIEW OF THE WEEK
Purpose
1.
To cultivate the habit of taking inventory of events of
the
day/s.
2.
To develop communication by sharing experiences.
Materials
Nond L
There
many events that happened over last week.
were
I
would
like you to think back what had happened during the week and
you
would
from
moved
through each day
(Monday to Friday)>of the
like you to share those experiences in the
Monday.
Go through the experiences of the
group..
day
how
week.
I
Start
event
by
Explain if any thing happened out of the usual,
event.
felt
like your
Share what you
getting a good news or you getting tensed up etc.
Similarly go through day
and how if affected you.
by
day
till Friday.
Procedure
The members share the week's experience.
Time Frame
35 to 45 minutes.
Note
In
case
any
member
finds it. difficult to
experience
in a positive way,
the
to
member
suggestions.
find
a
share
of
the
the Counsellor can probe and
help
better
way
with
the
any
help
The Counsellor too shares her experience
of
in
group
this
activity to bring about, genuine sharing on the part of members.
REVIEW OF THE WEEK END
Purpose
1.
To cultivate the habit, of taking inventory of events of
weekend.
2.
To.develop communication by sharing experiences.
Materials
iNone,
the
•*.
Instructions
jK
You have come here after spending your week end at home.
W
like you to think back what had happened during the week end
1 E how
m
you
your
spent
Saturday
E, experience of the week end,
HE. unusual experiences,
HI which
you
Sunday,.
event by event..
and
through
the
Share with us
those
Go
may be mother having a tete-et.. tete with you
expected or a friend
(sober
of
one
course!)
in or your people suspecting you having had a drink
dropping
smoke.
never
and
I would
or
Tell us how you felt and how it affected you.
Procedure
The members share the week end’s experience.
Time Frame
25 to 35 minutes.
J E Note
IL
The Counsellor too participates in the activity.
I E, finds
;|| j:
the
Counsellor
can
Ef (support, suggestion,
help the member seeking
confrontation, etc..,
E also by the group).
. W
When any member
himself unable to tackle the experience of the
STAMP GAME
I Purpose
help members to identify,
4.4
c
the
week
end,
group's
help
by the Counsellor
and
Materials
'stamp game'
The stamps from
by Claudia Black.
Instructions
Here
are
cards of different
some
colours.
Red Stamp
s
Any
Blue St^nip .
:
called
are
:
Fear
Orange Stamp
:
Gui 11
Green Stamp
s
Embarrassment
:
Any
Yellow Stamp
Light Brown Stamp
:
■■■
such
as
loss, etc.
as
joy,
but
the
such
as
i
love, etc.
Confusion
Any
■White Stamp
(Wild Card)
rage,
disgust, etc.
of happiness r such
form
warmth,
as
such
sadness
of
disappointment,
Black .Stamp
-
irritation,
form
Any
anger
of
form
frustration,
feeling not 1 isted .above,
member
wants
loneliness,
Please
They
Each of these stamps represent feelings.
coloured stamps.
to
identify
-
helplessness, anxiety, etc.
think back and try to remember wha£.’ it. was like when
you
were
a young child or a growing up teenager in your family.
As
these
stamps
pick
up
stamps
which
youngster
and
are
only feelings,
I would
represent the feelings you had
adolescent even if you were / were not
fethese
feelings
like you
then.
as
to
aware of yourself
You should select
a
number
of
irepresenting the intensity of each feeling - for example,
having
stamps
if
any
I Ione of you had experienced a great deal
I K5 to 10 red stamps,
of anger, you might
take
compared to feeling of small amount of
fear,
E Kwhere you might take 2 to 3 black stamps.
You can take 5
■ 8 ....
B K to identify with a particular
feeling and not required to pick up
.1 £ 'any,particular stamp colour(s)
immediately.
I ;
(Pause). '
HI Have y°u: all
selected your stamps'?
Now' arrange the stamps in
an
1
order beginning with the feelings expressed the most as a
child,
•1 |
to
feelings, shown next to the most, to those shown
least.
■
For
■E
it easier to show sadness and position his blue stamps
1
before
his red
(anger)
shewed that fear will
(guilt)
one
the
example, a member who knows that he hid his anger,
stamps,
correct
Most expressed
Cl
Cl
ci
Least expressed
Most expressed
Cl
E1
no
Thee
Typical arrangement of stamps could be
Cl
and
have his black stamp in front of his orange
way to position stamps. Arrangement is left
each one of you.
find
(sadness)
The person who was afraid
if he seldom or never showed guilt.
Example one:
Example two:
stamp(s).
can
up
to
Now talk about your stamps with the group.
you had expressed less and so on. 1
feeling
than
us,
telling
than
please tell us the source of your
appropriate
sharing
the
you
When
would be the Blues are just for
card stamps for the loneliness I
wild
lot
of
because
more
are
felt being left
my
Another
a
mother and father were out a lot of time, and here
my
are
rather
with
this is my anger (Red).
but I know some of this blue is for feeling sad
sadness
most,
feelings
Example - this anger is
simply identifying them.
mother for all her screaming Vs.
you
It is easier for
begin by talking about the -feelings you expressed
to
alone
so
often.
Procedure
The group can either sit on floor or around a large table.
completing
Encourage
shares,
be
them
to share honestly and openly.
originally .. thought
how
cards.
each
member
As
While the
and may add to his pile.
As
the
he can further be asked to
the stamps are different today as an adult.
He
collection and / or repositioning the order.
As the
is
than
first
reflect
can
asked to represent that change by adding to or substracting
his
may
member
he may become aware of having more of one feeling
member has shared his stamps,
on
After
arrange
other members may become aware of more feelings and
allowed to quietly add to their piles.
sharing,
he
the instructions, ask the members to
be
from
member
changes
his stamps,
he can tell the group why he is
making
the
changes.
When completed, next person takes his turn.
After
the
Counsellor
may
last
member has shared and if time permits.,
the
want
ask if the first would like to say
to
Efirst member is often more inhibited.
because
the
Thank all the members
for
more,
their sharing and attentiveness.
It
is
better if the group end with a quick
self-image
exercise.
self-reflection
Ask the group to express
or
each
quickly to
other
a)
What it is that you are particularly glad you shared?
b)
What did you learn about yourself during the game?
c)
What did you learn that would be helpful
for you to work on?
Thank participants again for being honest..
Time Frame
60 to 90 minutes.
Note
The,
Counsellor
does
not
participate
in
playing
this
game.
VARIATION OF GAME (b)
With Adolescents
The stamp game can be used with individuals or in a group format.
While it is not feasible to ask a teenager* how his feelings
changed
in
adulthood,
he can be asked to show(
any
stamps that would specifically reflect the past year.
change
have
in
ABBREVIATED TOPICS (c)
The stamp game can be used as an integral
-
groups
part of ongoing
The member may be asked to
or individual sessions.
pick up stamps that: represent feelings you had this week.
-
pick up stamps that represent feelings you had today.
-
pick up stamps that represent feelings you had at school.
-
up
pick
that represent feelings
stamps
you
with
had
a
particular person.
—
up
pick
stamps that represent feelings you would
like
to
discuss.
EXTENDED PLAY (d)
When
play
working with a group or person over time, members may
the game more than once.
For the first time it is played without
feed back component but later feed back can be included.
Feed
back is given after each member has completed
feelings
on childhood.
sharing
To give feedback, other members
on what feelings they think the member had or presently has
he did not identify or share.
of offering stamps.
from
stamp
To give feedback, other members take
must be specific,
without
analysing
or
limited to 2
intellectualising.
listens without verbally 1 responding,
picking
feedback
up
new
cannot
The
refuted.
In
3
The
sentences
member
sharing
and acknowledges feedback by
stamps and bringing them into
be
to
stamps
member's
and briefly explain to the member their perceptions.
given
that
Feedback is given only in the form
the community pile and place them in front of the
feedback
his
reflect
case
the
his
pile.
n^ember
is
The
not
comfortable
with feedback he can leave it in front of
indicating
willingness
refuse feedback.
his
pile
he
cannot
There is no dialogue regarding feedback.
Thus,
to reflect and consider,
but
it continues with other members and the feedback is ended with
a
self-image or self-reflection exercise.
The members should know that feedback is optional,
not
required.
Time and member's familiarity with each other are the key factors
to
consider
whether or not this aspect of the
game
should
be
included.
UNGAME
Purpose
1.
2.
To enhance self expression through the structured game.
To
begin to establish a norm of sharing and risk-taking
in
the group.
Materials
The
ungame board,
playing piece, dice and ungame cards.
Papers
and pens.
Instructions
This
of
Each
is a self expression game full of light-hearted fun.
you select a playing piece and place it
space nearest, to you.
on
question/comment
each
After determining who will go first.,
one will roll
the dice and move in the clock wise direction
many
the dice indicates;.
spaces
would draw a card from the deck,
Any one landing uii.
an
that
ungame
read it. aloud and answer in 2 or
3
sentences.
Deck—2
or
The Deck-1 is used in first round
can be jotted down on a scrap paper
ideas
on
landing
and
None of the members can comment.
is used.
question/ zomment space.,
and
on
later
thoughts
The
shared
when
in
this
When any one land
that member can ask any other member a question or comment
space,
regarding
noted
something
on
the
paper.,
scrap
something
previously shared or anything that comes to his mind or refer
has been noted on scrap paper.
what
Others will
listen
to
without
responding.
To help you play the game each of you should have
pencil
a
and
respond
ask
other
thoughts
an
"If
and
moving to corresponding "emotion” if it
applies
to
by
your ' reasons.
any
members.
When you
land
You should share
card,,
the member in
lands on choice space,
ask
expression
during
On next turn,
'Emotion'
each
Since this is
the group should agree to remain silent
one's
turn.
Similarly,
group
understand others when they share and not
will
When
draw
he may choose either to
a question or make a comment.
game,
area
arrow.
his move on the space indicated by the EXIT
one
on
a
or
aloud
to
you, or stay on the space if it does not apply.
start
/
and
space, the member should read the statement
questions,
you...."
to jot down personal
paper
will
a
a
self
except
listen
and
probe or challenge.
Procedure
The members sit around a large table or on floor.
in charge of moving the playing piece.
instructions are given.
the
members
One member
is
The game is started after
The Deck and cards are passed around
when they take turn to roll dice so that
they
to
can
1 out a card when
Frame
Note
the
Since: ..thxs is a non-competitive game v
end can be chosen when there i
be
and half hours
experience
wound up into asking each membei
in the game.
GUESS WHAT IS THE WORD
Purpose
1.
To introduce structured exercise activities in the group.
2.
To,raise the energy level of the group.
3,
To
motivate
exercises.
members
to
participate
in
group
activity
the
Group A would choose a word by group concensus
to themselves.
hold
and
One can choose any word under
the
While Group B would ask questions generally at
sun
them down to find what Group A
funnel
answering.
Group
A would only say
'Yes'
word
or 'No'
Group uB - can only ask one question at a time,.
and
or
Thus
When
'May
the
be' .
groups
alternate turns.
Procedure
I
The
groups
are formed and the game starts
after
instructions.
When the questioning group is able to find out the word,
If it is not able to do so,
point.
word,
the
will reveal it to the other group.
answering
group.
Thus
award
the group which chooses
Then award 1 point
6-8 chances for
each
given and points totalled finally.
Time Frame
30 to 40 minutes.
Note
The Counsellor does not. participate in this, activity.
is.
GARDENING
Purpose
ho distract the group with a different activity.
group
1
the
to
are
members are given directions by the Counsellor to work as
The
a
group to work in the limited garden space? available.
Time Frame
20 to 30 minutes.
TALENT'S TIME
Purpose
1.
To bring out the hidden talents of the group members.
2.
To give group members an opportunity to develop and
exhibit
talents.
Purpose
A ■ date is announced to the group and they are asked
their talents in music,
painting,
to
exhibit
mimicry,
during that time. -The hesitant members can be
etc.,
to
drama, drawing,
craft,
encouraged
participate on the day, as members might be inhibited
during
the start.
Time Frame
,45? to 60 minutes.
INSIDE / OUTSIDE - A DRAWING OF SELF
Purpose
1.
.To'
help members to be aware about their
perceptions
about
themselves.
2.
To express and communicte their perception's to other members
of the group.
Materials
Paper, colour pencils, colour pens, cellotape/board pins.
Instructions
I would like you all
to fold the paper given into two so that
Now (demonstrate)
a sheet-
becomes
I would like you to draw the outside of you,
inside.
sort of a person you are to others.
he
say
is good,
the
down
inside of you.
inside
you.
i.e.
Thus
we
how
do
On the inside paper I want you
The sort of person that you
You can be open,, spontaneous
feelings regarding yourself in the paper.
and
to
deep
are
put
the
This is no competition
and so do not expect any one to be artistic and what is
is
is
what
When we look at some one
he is friendly, etc.
find you as a person.
others
draw
he is bad,
it
this is outside and this
only your feelings put in paper as drawings.
expected
you
To give
a
clue how to proceed, you can draw through represented pictures of
animals,
to
trees,
things, etc., or abstractions you can add
give more depth,
even
but primarily drawing is expected.
carricature or scribble.
It is entirely left to you.
of you concentrate on your self and drawing.
words
You
You can take
can
All
about
20 -- 25 minutes to do that.
After
25 minutes are Over, the Counsellor says "Now let
together
(with
in a semi-circle."
us
Please put your works on the
either cellotape or board pin) so that we are able to
both inside and outside drawings.
I would
like you to share
feelings that you have put in the paper to the group.
sit
board
see
the
This would
help us to understand what exactly you have mteant.
Purpose
The
members
disperse after the first set
When they finish drawing,,
over.
of
instructions
the work is exhibited on
the group sits in semi-circle in front of the
Now
member is encouraged to share.
Each
baord.
The minor details of the
are
board.
drawing
are
probed into a
non-threatening manner by the Counsellor
and
the
group members.
Thank the members for participating and
for
being honest.
End the activity with quick check on the questions
of self-image exercise.
Time Frame
50 to 60 minutes.
Note
this is an
Since
emotionally charged activity,
the
Counsel lor
must be warm, understanding and empathetic.,.
VALUE DEBATE
Purpose
1.
To
clarify
the
values, necessary'to
continue
sober
and
needed
for
qualitative life.
2.
To
emphasise
that
maintaining sobriety.
4'
many positive
values
are
Materials
foolscap
papers
RESPONSIBILITY,
HONESTY,
Four
with
DISCIPLINE
ALCOHOL / DRUG FREE
SELFCONTROL,
or
LIFE
written
on
them, cellotape / board pins.
Instructions
You can see four different papers stuck on the wall.
1.
Please read
Also listen when I read what is written on board.
them.
Please
choose the value(s) that you consider necessary
for
maintaining sobriety and qualitative life.,
2.
Explain why you feel that a particular value(s) is necessary
to maintain sobriety .
3.
Debate with others on your position and try to convince them.
Now
you
can
split and sit around
the
you
value(s)
consider
necessary.
Procedure
As soon as they get into groups they are asked to settle down and
questioned if they feel comfortable with their position regarding
values.
In case a member expresses that he would
more than a value,
he is taking an
member
explains
'in-between'
position on the values.
why he’ considers his position1 right,
group is thrown open for discussion and debate.
Time Frame
45 to 60 minutes.
like to take up
he is asked to sit in between to indicate that
After
then
each
the
Note
During debating, the Counsellor guides the group members to argue
meaningfully
to
found
the particular
issue
The Counsellor also intervenes when the atmosphere gets
at hand.
heated
without
If .. . ai tJcular
issues.
he is confronted and focussed to
do so,
topic
member is
dwell on issues related to the
and
lingering on irrelevant
During
to the debate among the group,.
due
■ members
debate,
feel that they ,have to change their positions,
are
At
the
allowed to do so after explaining why they are changing.
end.of the debate,
if
they
the Counsellor winds up by giving a talk about
..itpe need to follow all values,, apart from the mentioned ones too,
and
only
that
Counsellor
necessary
by
priorities
about
values
shall
misconception that only
the
dispels
differ.
one
for.maintaining sobriety and qualitative life or
following
one
value the other
values
shpll
The
value
is
that
automatically
The Counsellor finally convinces those members who
follow.
are
not yet convinced about the necessity to acquire other values.
24 - HOUR - A - DAY DEBATE
Purpose
1.
2.
To clarify the concept of 24-hour-a--day to the group.
To
explain
the
advantages
ofollowing
programme to the group.
Materials
Three
foolscap
possible.
papers
with
'24-hour-a-day'
’24- hour-a-day’
24- hour-a-day
not.
hour—a-day'
necessary
and not possible
them,
on
cellotape / board pin.
Instructions
Now you see three different papers stuck up.
I
,read
regards 'to your position^on 24-hour-a-day.
so.
feel
Finally
advantageous.
debate
how
your
when
Please listen
First think to which group you would belong
it.
to
as
Then explain why
you
good
or
position
is
Try to convince others to your vie'w point.
Procedure
As
members get into different groups,
their view why they have such a stand.
up
for
and debate.
discussion
The
they are asked to
explain
Then the group is
Counsellor
opened
the
mediates
discussion without allowing it to get into heated exchanges.
members start feeling that their position is not convincing
can
be
allowed
different
group,
Counsellor
winds
to join a different group.
up
with
a
talk
advantages, . how it can be followed,
The
Counsellor's
As they
they are again asked to explain.
role
about
24-hour-a-day,
what it. really
is to convince those
who
means,
are
convinced about 24-hour-a-day and explain the concept.
Time Frame
40 to 50 minutes.
get
Finally
not
As
they
to
a
the
its
etc.
yet
CLAY MODELLING
Purpose
To help group express through the medium of clay.
Materials
A blunt chisel or knife.
Coloured clay.
Instructions
I
you all to work as a group and
like
would
each one offering
than
rather
model
this
yourself as to what you would like to make
Discuss
among
group.
Then start modelling.
clay
contribution.
individual
their
as
a
Procedure
The
clay
provided and a work table is
is
chosen.
discusses what it will model and starts working.
group
dynamics
involved in the
pat liruJar
interpersonal and itrapersonal re la hinosh' ;>■
The process is done .in
Counsellor.
The
group
fit the end,
the
rsl at :i unships
are discussed !?y the
understanding
outputhettr.
and non—judgemental atmosphere»
Time Frame
50 to 60 minutes.
GROUP ART WORK
Purpose
1.
.Using
art
work
cohessiveness.
in
the group
as
focus
ito.
bring
about
i
Materials
L Cards containing following words
R Hallucinations
Warden
E
Anger
L
Cupboard
Coordinator
Psychiatrist;
Attendance
Address
Depression
Personality
Responsibility
Sobriety
Loneliness
Assignment
Feedback
Relapse
Budget
After-effect
Relaxation therapy
Self-pity
Research Foundation
Harmful dependence
Delirium Tremens
Security staff
Esperal reaction
Three months
New comer
Family support
Alcoholics Anonymous
Withdrawal symptoms
Enjoyment of sobriety
Non-smoking area
Getting active physically
Postponing first drink
Fearless moral
inventory
Dry drunk syndrome
1 Goals for future
Individual Counselling session
Changing old routine
Losing
control
over
I Loss of self-respect
Committed to change
1 24-hour-day
Avoiding drinking situation
Community meeting
Procedure
The
is
game
has
Counsellor
forward
with some variations
in
others
reading
the
he acts it out to the group and
the
chances
to
is
the
word.
The group is
3
given
to act the word out and the group continues
If still the group is unable to identify the
E
Instructions
it.1
11
not talk or move your lips to indicate the word.
|the
group
to the group by gestures and mime,,
word
read
You
should
You can explain
rest
The
of
is required to listen and identify what the word is.
can havp three chances to identify,,
will
Please
What you are required is to act out the word.
II
J fc
identify.
to
word is read out.
One of you is requested to come up and take a card.
■ .1J
of
come
to
If they are not able to identify, a second member
identify
identify.
Later,
The
number
of
One of the members is to be asked
from the group and take one card and after
word, gives it back.
asked
rule.
the
the card with words in the order
the hand.
in
words
played
If you fail,,
asked to act the word out.
be
Okay,
let
another
us
the
You
person
start.
Who
I would like to volunteer first?
1S
I
I Time Frame
30 to 45 minutes.
Note
J^kThe ■■ Qounsel lor
does not participate,
related to addiction,
^^Sadvance.
though all the
words
this .clue is not disclosed to the group
At the end of the activity,
the group can be
are
in
explained
the importance of non-verbal communication
about
and
social
aware
of
life.
our
individual
How we are using it every day
usage,
how to
sharpen
that
without
to
skill
being
enhance
communication.
ROLE PLAY
Purpose
1.
To
help
the group understand how it feels to be
some
one
else.
2., v
To .better understand .others roles and feelings.
Materials
None.
Instructions
Two members from the group will be acting a particular
situation
before you, watch and listen carefully while they act.
Procedure
The
Counsellor
selects
person
selects the role playing
problems.
She
also
the members of the group who will play each
role.
The
who plays SELF is made to sit its a highlight position
front of the group.
The 'actor'
is readied for the
in
presentation
of the problem situation.
The way to conduct,
the dialogues
and
the
Then the actor is asked to act out
the
mood are explained.
situation along with another member whp is self.
cuts
off at a point where the problem-, han been
The
Counsellor
dramatised,
but
the
solution
or
outcome is still
uncertain,
T he
Counse11 or
discusses and analyses the ways in which the actors played
and
better
ways of facing such a situation.
The
next
roles
set
of
actor are readied and the procedure repeated.
Time Frame
45 to 60 minutes.
Note
The Counsellor should effectively discuss the ineffective ways in
actors played the roles and suggest
which
the
coping
effectively
also-
be
to such a situation.
The
better
ways
solutions
addressed to thei observing members, as role
of
should
play
sets
..,stage .for learning in the,members too.
CLAP TOGETHER
Purpose
To focus attention of the group to the group and its leader.
Materials
None.
Instructions
I would start clapping in a particular pattern.
watch
The group has to
out and continue clapping along with me at the same
beat.
I might suddenly change the clapping pattern and the group should
realise the change and change their pattern of clapping according
to
clapping.
my
Another member can
responsibility of leading the clap,
the lead.
the
over
take
should be watching out and notice change of
group
Thus
suddenly
by clapping differently.
clapping
the
The
and
The group now follows this member's clapping
pattern.
clapping may be altered between persons
clapping
and
patterns too.
Procedure
The group sits in a circle and the leader claps.
the group follows the changed
changes,
leaders'
When the leader
Thus
claps.
it
continues.
Time Frame
10 to 20 minutes.
Note
When
there is excessive confusion over who is leading
the clapping pattern, the group can be asked to step
and then restart.
Counsellor(s)
If confusion still continues,
about
or
fiji
a second
the leader(s)
interrupt and can start clapping to end
/
confusion.
Then the game continues as usual.
SELF DISCLOSURE
Purpose
1.
"To provide conducive environment for self-disclosure.
2.‘
“fd
provoke discussion of different self-disclosure
members.
of
the
Materials
F The self-disclosure activity questions
1.
.....
What is your favourite leisure time interest? •
I 2.
What do you regard as your major personality fault?
I 3.
What do you regard as your major personality strength?
4.
Do you feel that you have a drinking problem?
5.
Do you smoke grass or use drugs?
6.
What emotions do you find most difficult to control?
7.
What was your worst failure in life?
8.
What are your carrer goals?
9.
With what do you feel the greatest need for help?
10,
What was the greatest turning point in your life?
11.
Do you have trouble sharing feelings with others?
12.
Do you speak up for your opinions and convictions?
13.
Are you as sociable as you want to be?
14.
Can you accept compliments without embarrasment?
15.
Do things usually turn out the way you want them to?
16.
Are you able to set goals and achieve them?
17.
Do you know what you are heading for in life?
18.
Do you hesitate to try new ways of doing things?
19.
Are you getting what you want out of life?
;20.
Do you feel you have a real purpose in life?
621.
Do you feel that you are in control of your life?
■22.
Is
there an area in yourself of your life that you want
change?
''W
Instructions
;^K . I would like
you
to
call
out
numbers
the
,one
and
alternatively, so that members could be divided iinto two
-jj •■The
number i group should sit. in the iside circle and
two
groups.
number
2
on their right till the self disclosure questions are finished.
Procedure
The
self
copy.
disclosure questions are called out
one outside circle.
When the Counsellor
says change,
circle members are asked to change one chair.
outside
the
the
and
circle members change one? ciia.it
sharing
continues.
to their
For each sharing
ended,
the members are asked to discuss on the following
What did it. feel to share?
How did they feel after sharing'?
Did any member find any block to share?
After
the
thus
changing
approximately
£2.
inside
right and
before
3 minutes may be given.
the
The next time
jthair,
11.
members
Then they are split into two grouos, one inside circle and
sharing
lines
the
CHALK GAME
help members to be aware of the dynamics involved while
To
they
are in relation with others.
Materials
Chalk pieces.
Instructions
I
would like the group to call out numbers one and two, so
you would split up into pairs.
When I indicate 'start',
required to balance the chalk
members
are
fingers
and keep moving for 3 minutes.
do
down
not
should
you want with it.
whatever
your
index
In case the chalk
falls
between
the
During
to each other but experience
talk
that
both the
activity
what
you
other
the
partner is feeling.
Procedure
The
follower
moving
around
Counsellor takes note of the
leader—
are given and the group starts
instructions
balancing
The
the chalk.
pattern, . their adherence to rule.
the conclusion
of
space
the
covered
and
activity,
the
Counsellor enquires the members of their.feelings when they
led,
their
when
seriousness.
they
feelings.
At
of
partner's
The Counsellor confronts the members of the
behaviour
were
led
and what
they
experienced
which are not shared and brings it to the members awareness.
behaviour manifested in the activity and real
compared and discussed.
The
life situations are
Time Frame
40 to 50 minutes.
Note
HF
Since
confrontations can be challenging to the member
care should be taken to do it in non-evaluative,
B'
'
and understanding manned,
®
defensive denial system.
W.
TRUST WALK
3
involved,
non-judgemental
lest should the member shrink back into
Purpose
To
1.
make
group
members aware of their level
of
trust
in
others.
■1.
To increase the feelings of trust within the group.
2.
Materials
None
Instructions
I
would like the group to call out numbers one and two, so
you
would split into pairs.
out the walk.
lead by touch.
The pairs must not talk to each other
You can devise a communication style which
help you to lead each other.
and then change positions.
The
or
will
You will, keep walking for 3 minutes
The membei
who lead would now follow.
same rule of closing eyes, no interact i.on and no touch
applies now
one
The numbers twp- should close their eyes
should lead numbers two.
through
When I indicate start, numbers
that
also
Procedure
The
are given and the group starts
instructions
seriousness,
their
adherence to rule of
the
The members change
is again taken note of.
pattern
the
their
pattern etc.
leader-fol lower
for
moving
The Counsellor takes note of space covered by
minutes.
the
game,
and
positions
fit the conclusion
the
of
the Counsellor enquires the members of their feelings
walk
they led when they were led and what did they feel towards
The
partner.
Counsellor
member's ’ awareness
participated.
of
now gives feedback
the facts hie did
and
not
3
members,
when
their
into
brings
notice
while
he
The relation of behaviours during activity and the
real situational
reactions in life arc? compared and discussed.
Time Frame
30 to 50 minutes.
Note i
Since,
confrontationscan be challenging to the member
care
should
be
taken
judegemental
and
understanding manner,
to
do
it
in
a
involved,
non-e^aluative,
lest should
the
nonmember
shrink back into defensive denial system.
■T'
PUZZLE
Purpose
1.
To
,
make
group members to be aware
of
their
motivational
level.
2.
To help member to build a positive attitude towards
solving
problem
Materials
The broken
'T'cut from stiff board.
Instructions
I
like each of you to put the broken pieces
together
so
that the pieces form a whole T. You can take as much time as
you
would
want,
Procedure
The members are given the piece of
them
a
into
"T'.
letter
verbalisations,
the
The
the problem solving method,
during
the activity.
are
checked
on
Counsellor
motivation to work,
work,
assemble
*T' and are asked to
the
response to
takes
attitude
towards
frustration
At the conclusion of activity the
their
Counsellor then gives the
feelings
during
feedback about
the
etc.
members
activity.
The
’.he observation made and
confronts the member in case he does not agree.
The activity
up by enquiring each member about his experience in
wrapped
the
note
is
the
activity.
Time Frame
45 to 60 minutes.
1 Mote
Since
confrontations can be challenging to the member
care
should
judgemental
be
and
taken
to
do
it
in
understanding manner,
denial system be re-awakened
to
a
involved,
n<pn -evaluative,
lest should
the
form strong defenses which
non
members
would
block positive growth.
ineffective
problem
The Counsellor can finally summarise
the
found
and
solving
method
in
the
group
contrast it with the effective problem solving method.
REVIEW OF PATIENT'S STAY BY OTHER MEMBERS
i
Purpose
To give feedback to1, the member about how others see them.
give member a chance to reflect on different
To
2.
skills
he
had learned during the stay.
Materials
None.
Procedure
A
is chosen to be given the feedback and
member
members
are informed two days in advance.
the feedback, sits in
others
the
he
other
and
The member
receiving
position before the group.
'highlight'
give their feedback to him on the selected areas.
feedback,
the
member in
'highlight'
too
reflects
The
After
on
his
You
all
experience in the centre.
Instructions
As
can
you all
know, we have (name's)
give your feedback to him.
genuine, honest,
board.'
review of his stay.
I would like the feedback to
precise and specific on the areas listed on
be
'the
Personal grooming and hygiene.
Family
Relationship with family membe
Involvement in family duties
Social
Relationship with others / fri
Gain in new positive friendshi
Development
activities.
of
new
hobbies,
Occupational
Job
Involvement in the job or to f:
Values
SHAME
Understanding and Coping
Understanding and Coping
^zelden.
ft zelden
7-L-S
First published, September, 1981
Copyright © 1981 by Hazelden Foundation. All rights'
reserved. No part of this pamphlet may be reproduced
without the written permission of the publisher.
ISBN: 0-89486-131-X
Part I: Understanding Shame
Shame, Guilt or Embarrassment/3
Portions of the Twelve Steps reprinted with permission of
A.A. World Services, Inc.
A list of works referred to or consulted by the author
appears at the back of the text. Hazelden expresses its
appreciation to those authors and publishers whose materials
have been quoted.
Printed in the United States of America.
Shame and Being Human/11
Shame and the Non-moral/15
Shame and the Involuntary/21
Editor’s Note:
Hazelden Educational Materials offers a variety of informa
tion on chemical dependency and related areas. Our publica
tions do not necessarily represent Hazelden or its programs,
nor do they officially speak for any Twelve Step organization.
Shame and the Trivial/29
Introduction
Part II: Coping with Shame
Needing Others/41
Making a Difference/45
Honesty with Self and with Others/49
Dependence and Independence/53
Conclusion/61
Recovery from active alcoholism is simple. You just don’t
drink — that is, you stay away from the first drink, one day at a
time. Living as a sober alcoholic, not only maintaining sobriety
but progressing in recovery, can prove a bit more complex.
As usual, among those who try to live the program of
Alcoholics Anonymous, let me start off by saying sincerely that I
write these pages for my sake — to help me stay sober. I hope
what you read will help you in your sobriety.
My real name is irrelevant, but 1 am an alcoholic. Also, toward
the end of my drinking, I popped quite a few pills — all legally
prescribed, although not all honestly obtained from the trusting
doctors I made a hobby of conning.
It wasn’t a difficult hobby. We alcoholics develop considerable
skill at conning, what with all the practice we get conning
ourselves. Besides that, I am one of those over-educated,
professionally trained alcoholics who can talk in psychology.
Doctors have a hard time labeling us “alcoholic” — about as
hard a time as we have ourselves. “Denial” is no respecter of
degrees.
«•
“
Over time, the mounting dishonesties in my life caused it to
fall apart. Alcohol and other.chemicals no longer killed the pain.
In fact, I dimly came to realize that they were adding to it. During
my fourth admission for detoxification, a caring physician, a
street-tough cop, and a respected clergyman friend all “suggest
ed” treatment for chemical dependency. Having nowhere else to
go — my employers and my living companions had both
strongly indicated t|iat they would just as soon never see me
again — I graciously consented to use the airplane ticket to
Minnesota that a former employer generously provided in lieu of
severance pay.
For someone so smart, 1 learned a lot in treatment: complicat-
ed concepts like “Easy Does It" and “First Things First.” I also
absorbed a few things that didn’t come packaged in such neat
maxims, and it is one of these that I hope to share with you in
this booklet. My story reveals that the pain of dishonesty, the
trauma of knowing I was not the person I pretended to be and
was supposed to be, lay at the core of my alcoholism and
addiction. After all, who ever heard of a professional person,
with degrees and even titles, needing a drink?
Fortunately, I met others like me in treatment. And even
more fortunately, the first important thing I discovered was that
they were “like me” not because of the degrees and titles —
some didn’t have them — but because they hurt as humans. An
alcoholic mother or a pill-popping wife or any of a hundred other
kinds of people in a thousand different situations can hurt and
ache and wrench and clutch inside just as I did — and then can
get caught in the trap of trying to soothe that pain with chemicals
such as alcohol.
Some people, I learned, can do that — soothe the pain —
and get away with it. They seem not to have the physical
metabolism or the “physiological x” or the whatever that is
somehow a part of those of us who become alcoholics. For a
brief time, I envied such people. My “Why me's?” oozed self-pity
until one crisp fall day as I walked privately, sensuously absorbing
the beauties around me, a new — truly sober — way of thinking
gently insinuated itself into my mind and feelings.
“Why me?” indeed! Why should I be one of the lucky ones to
see the vibrant colors of autumn leaves through unhazed eyes?
To hear the breezy rustle of those leaves punctuated by
chipmunk chirps and the lap of the waves on the lakeshore and
the resounding calls of migrating waterfowl? To smell the clean
fall air with its scents of apples and wood-smoke and of the
furrowed and harvested good earth preparing for its winter
sleep? To feel on my face the occasional sting of a gust of wind
— was that an early snowflake that just pinched my cheek? —
and the resilient, grassed path under my feet and the gnarled
bark of the wise, aged trees that I rub against in passing. Why
should I be one of the lucky ones able to stand before and within
all this beauty, to drink it in with clear senses, able to confront
and to appreciate reality as it is without a curtain of chemicals?
Indeed, “Why .me?”!
They told me something interesting in treatment: there is a
difference between getting sober and staying sober. I pegged my
memory of that warning — of that promise — on some words of
Bill Wilson, co-founder of Alcoholics Anonymous. “Honesty
gets us sober but tolerance keeps us sober,” Bill once said. Over
the years, I have hung a lot on that phrase. But especially, I
hang on it whenever 1 catch myself feeling bad.
In treatment and in early sobriety I began to learn quite a few
things about feeling bad. I learned that there were some kinds of
feeling bad that I never had to go through again. The physical
side, the terrors of withdrawal, headed that list; but it included
the worries about behavior during blackouts and other misbehav
iors fueled by alcohol. What a simple, liberating truth it was to
know that if 1 didn’t drink, 1 wouldn’t get drunk!
.Tet there was more to learn about feeling bad. Growing
sobriety taught, for example;.that there i§_a vast difference
between feeling bad and feeling bad. That is not, believe me, just
a play on words. Feeling bad means hurting. The active
alcoholic experiences myriad'ways of feeling bad.
Feeling bad is something else. In fact, as we shall see, it is two
things else. Feeling bad means feeling that there is something
wrong with me, about me. One thing I had to learn was that
feeling bad is different from feeling bad, and there are two
different kinds of feeling bad. Until I learned to tell them apart,
getting and staying truly sober was a lot harder. In fact, for me,
staying sober at all seemed nearly impossible.
There were two ways, I learned not so quickly, in which even
the non-drinking alcoholic could feel bad. And until 1 learned to
sort them out, learned to handle each one differently, this non
drinking alcoholic was never able to find even the semblance of
true sobriety. There was, 1 discovered, a real and significant
difference between the feeling bad of guilt, and the feeling bad of
shame. “Guilt” concerned what I did. “Shame” was about what I
was. And there’s more: let me try to tell you about it.
Part I:
Understanding Shame
.Shame, Guilt or Embarrassment
fShame differs from guilt. For one thing, it is a more
troublesome feeling to confront and relieve. Facing up to guilt —
the things that we do — although it can be painful, is not really
difficult .(The beginner in Alcoholics Anonymous, for example,
finds guilt eased by A.A.’s very.First Step, in the admission of
powerlessness and unmanageability. As recovery progresses, the
alcoholic finds further help in dealing with guilt in the inventory
and amendment Steps of the A.A. program. Especially A.A.’s
Fourth, Eighth, and Ninth Steps guide us directly to the
resolution of guilt.1
Facing up to shame — to what we are — proves more tricky
and, for most of us, more difficult. As'with guilt. Alcoholics
• te
Anonymous suggests a solution for shame. * That solution is
anticipated in the admission of powerlessness and unmanagea
bility. Steps Five, Six and Seven start the process of resolving
shame.2 But it is Alcoholics Anonymous as a fellowship that
makes the solution real. I hope, in what follows, to show how;
but, first, it is necessary to spend a few moments thinking and
talking about those words, “guilt” and “shame.”
Neither word is used much nowadays. “Guilt” seems mainly a
technical term, used appropriately only by psychiatrists and
lawyers. Our modern age so mistrusts any whiff of moralism that
most people have become uncomfortable with the term “guilt.”
“Shame” labors under a different disability. Generally reserved
for training children and animals, it suffers mightily from this
association with helpless dependency. “Shame” carries echoes
of being caught; and, of course, no truly mature person is ever
naughty.
Such an understanding of shame contains a trap. 1 used to
think that shame was the same as embarrassment, that it resulted
from being seen or caught by someone. As children, we are told
to be ashamed of ourselves when we are caught publicly. But
even as children, shame results not from being seen doing
something, but from what we are caught doing! Embarrassment,
therefore, is not the same as shame, but is the result of one’s
shame being seen.
In my home A.A. group, one oldtimer — a seasoned
alcoholic literally grizzled and occasionally crass, but filled with
the deep and loving wisdom that comes from long and joyous
sobriety — once suggested a thought that, although it offended
me at first, made a point that for the sake of my sobriety it seems
I had to hear. According to Ben, the words themselves help you
■
'The opinions expressed are solely those of the author and do not represent
A.A. as a whole.
to tell embarrassment from shame. “Embarrassed” means being
caught “bare-assed.” “Bare” means uncovered, and therefore
seen, but it is what is seen, one’s derriere — the testimony to
one’s shame — that causes embarrassment. “Bare-faced,” Ben
liked to point out, means the exact opposite of “embarrassed.”
As I said, I didn’t like Ben’s image when 1 first heard it, but
over time 1 discovered in it a deep wisdom that 1 now find helpful
in handling my shame. For now, let’s nail down this important
distinction between shame and embarrassment by noting that the
sense of shame comes before any sense of being seen by
another. Our shame exists in us, in ourselves — indeed, in our
very self, which is why shame is so important to the discovery of
who we really are. Other people do not cause our feelings of
shame. Rather, as we shall examine in later chapters, in a
strange quirk that reveals the treachery of confusing embarrass
ment and shame, we learn in A.A. that others provide the only
true therapy for the discomforts and agonies of shame.
So much for the distinction between shame and embarrass
ment; now to the difference between shame and guilt. Both guilt
and shame involve feeling bad -Ifeeling bad about one’s actions
in the case of guilt; feeling bad about one’s self in the experience
of shame. “Picture a football fielcT,” I was once told by a wellmeaning counselor; “with its two kinds of boundaries: sidelines
and endlines. The sidelines are containing boundaries: to cross
them is to ‘go out of bounds ’ to do something wrong. The
endlines are goal lines: the purpose of the game is to attain them
and to cross them. One feels guilty when one crosses the
sideline, the restraining boundary. Feeling bad about the goal
line' (shame) arises not from crossing it but from not crossing it,
from failing to attain it.”
T
As a child, 1 habitually played hooky on test days: it seemed
safer to do the wrong thing of skipping school than to risk falling
short. The guilt of playing hooky pained less than the possible
4
5
shame of not measuring up on the tests. That does seem like
alcoholic behavior, even without alcohol, doesn’t it? In any case,
in later years, 1 would do many similar things — with the help of
alcohol and other chemicals.
Guilt, then, arises from an infraction, a violation or transgres
sion of some “rule.” Shame, on the contrary, occurs when a
goal is not reached. Shame indicates a literal “shortcoming,” a
lack or defect of being. This little chart may help clarify:
A chart is neat, but examples sometimes prove more helpful.
When I cheat, or steal, I do something wrong and feel guilt over
this violation of the rights of another. But also, on at least some
occasions, my cheating er stealing can inspire shame. When my
son got a job and worked on his own all summer to save money
for college and clothes, what kind of person was I that 1 stole
from his savings to buy booze I could hide from the family
budget? Especially when it became clear that the “few dollars” I
thought he’d never miss turned out to be almost half of what he
had earned?
Stealing a physician’s prescription pad is against the law. I
knew that, but it didn’t bother me much, because I had worked
out a foolproof way of using those precious, powerful pieces of
paper. What kind of person was I to do such a thing? I mean, I
was acting like a junkie! Was I just a junkie? I thought up a
thousand reasons why not, why I was different, but the nagging,
gnawing thought and fear burrowed deep into my mind and
never left me until I confronted that question in treatment.
Not long ago, one of my pigeons called and asked, sort of
desperately, to talk with me — suggested that we go to a
meeting together and then have coffee or even, since we hadn’t
talked lately, maybe meet for dinner before the meeting. Now, I
was planning to go to that meeting, and I like Sandra. But I was
hoping to go to that meeting for my sake. 1 had even thought,
earlier in the day, before she called, how nice it would be to go
to that small, quiet meeting — one at which I generally do not
meet any of my pigeons.
Now obviously, when Sandra called 1 should have told her
how I felt — should have admitted my own needs. But I didn’t.
The old alcoholic need to be perfect, the need to be thought
perfect, welled up; and almost without thinking I reeled off a
cock and bull story about how, despite my great fatigue and
overwhelming professional obligations, 1 had to reach out, that
very evening, to a co-worker who was obviously having trouble
with booze.
Never mind Sandra’s obvious disappointment (why is it that
our A.A. pigeons Seem to read us so well?); never mind even
my rapidly drying mouth as I realized that my voice was getting
higher and my words spilling out ever faster — a sure sign, for
me, of dishonesty. Let’s focus on the guilt and shame. Guilt: I
was, in a sense, breaking a rule. Oh, there are no “rules” in
A.A., but ITiad been taught about gratitude, and about the
responsibilities of sponsorship, and besides that, I was lying. In
several ways, then, according to my standards, I was doing
wrong. But what nagged at me and hurt most and confused me
desperately was what I had revealed about my sobriety, about
me. Even before my hand finished replacing the telephone on its
cradle, the ball of hollowness that was beginning to expand in
my stomach forced me to confront my shame. Was this sobriety?
6
7
Results from:
Results in:
GUILT
a violation, a transgres
sion, a fault of doing
the exercise of power, of
control
feeling of wrongdoing,
sense of wickedness:
“not good”
SHAME
a failure, a falling short, a
fault of being
the lack of power, of
control
feeling of inadequacy,
sense of worthlessness:
“no good"
How real was my sobriety, what kind of recovering alcoholic was
1, if 1 could so easily, glibly, almost thoughtlessly lapse into such
obviously alcoholic dishonesty?
The point here, of course, is that guilt and shame are distinct:
there was a difference between knowing that I had done wrong
and feeling that something was wrong with me. In these
examples, guilt and shame come mingled. But before we turn to
examine that mingling more closely, let me finish my little story,
for its end does tell something about A. A. and shame.
1 called Sandra back and, without attempting an explanation,
arranged to meet her and go to that meeting. Over coffee, I told
her the truth: that I had lied, and how that had led me to
question my own sobriety, and that she clearly had chosen a
very non-perfect sponsor. Sweet Sandra! She calmed my guilt
by very seriously and carefully reminding me that “there are no
rules in A. A.” And then, without realizing it, she spoke to and
touched and soothed my shame. “1 felt your rejection, and it
hurt me; and even when you called back, 1 wasn’t sure. It still
hurt, and 1 was almost afraid you were calling back because you
felt you had to, had to at least go through the motions. How
marvelous that you’re not perfect, that you are human! I
wouldn’t have any other kind of sponsor!” She said more, but 1
hugged those words close and 1 want to share their warmth with
you now: how marvelous it is to learn, as alcoholics, that we are
human — that we are not perfect, and that it is our very lack of
perfection that makes us valuable to others. Experiences of
shame are valuable because they teach and remind us of that
very important — and very happy — reality.
It is sometimes difficult to deal with shame because experi
ences of shame come mixed with parallel feelings of guilt. My
son’s money, my doctor’s prescription pad, my dishonesty with
my pigeon: in each case there was guilt over wrongdoing, but
concentration on that guilt would have missed the main point. I
8
stole from my son, but I could make restitution. I broke the law,
but I could stop breaking it. I lied, but I could confess the truth.
However, in no case would those amends, although necessary,
have been sufficient to touch and to heal my shame — to help
me know and live with the “real me.” To get sober, I had to deal
with the “What kind of person?” question buried in those
episodes. To stay sober, I also had to confront such questions as:
“What kind of sponsor?” “What kind of sobriety?” “What kind of
member of A.A.?”
Making that separation, exploring its significance, and building
on its foundation are the tasks of the next chapter.
Shame and Being Human
Although guilt and shame are different, they often come
mingled. Guilt, especially, rarely occurs alone. Most of the time,
a wrongdoing also involves falling short or failing to live up to
your ideals. When I stole, for example, I not only did wrong, I
also fell short of my ideal of honesty. Although it does not
always happen, one can feel shame and guilt over the same
thing — the same act triggers both kinds of feeling.
When this happens, distinguishing between guilt and shame
and responding first to shame is essential to the development
and maintenance of quality sobriety. Guilt and shame are
accented differently. Feelings of guilt place emphasis on the act
committed: “How could 1 have done that?"
Shame, on the other hand, focuses on the person who
committed the act: “How could 1 have done that? What an idiot I
am! How worthless I am!”
Resolving guilt is important: that is why the Eighth and Ninth
Steps play such an essential role in recovery. But confronting
shame is more important because it is shame far more than guilt
that lies at the root of our alcoholism. And our alcoholism itself,
if we stop to think about it and have learned anything about it,
involves much more a falling short than any sort of transgres
sion. I denied my alcoholism for so long, not because alcoholism
was a bad thing, but because admitting that I was an alcoholic
would have meant acknowledging that I was a bad person.
The first truth that A. A. teaches us concerns the reality of our
personal limitation: “We admitted we were powerless over
alcohol — that our lives had become unmanageable.” The first
thing we learn in Alcoholics Anonymous (and how welcome a
lesson it is!) is that A.A. is concerned not with the thing,
alcoholism, but with the person, the alcoholic. A.A. thus speaks
to and touches our shame in its very First Step. The acknowledg
ment “1 am an alcoholic” contained in the admission “powerless
over alcohol” invites us and frees us to accept the truth of our
essential limitation. Newcomer’s to Alcoholics Anonymous thus
come to admit, to accept, and even to embrace essential .
limitation as the definition of their alcoholic (human) condition.
The acceptance of essential limitation is the core and the heart
of Alcoholics Anonymous. This acceptance, indeed, becomes
both the price and the reward of our First Step admission:
“powerless over alcohol.” By this emphasis on essential limita
tion, Alcoholics Anonymous teaches us a profound and healing
truth: accepting the reality of self-as-feared is necessary to
finding the reality of self-as-is. Learning this truth enables us to
begin on the road to sobriety. Building upon it becomes, in
sobriety, equally necessary to progress and grow.
As we grow in sobriety, we must remember this first lesson;
but if we truly grow in sobriety, we also come to see that our
alcoholism is not our only essential limitation. We learn, within
Alcoholics Anonymous, that our fundamental limitation is not
that we are alcoholic, but that we are human.
Alcoholics Anonymous as a way of life builds on our
alcoholism to teach us that to be human is to be essentially
limited. We exist in a contradiction, between opposite pulls to be
more-than-human and to be less-than-human. The idea should
be amply familiar to us from our days of active alcoholism. We
drank, often, in an effort to be more than we were: more witty,
more relaxed, more charming, more whatever. And the result of
that effort, once we became alcoholics, was inevitably the
opposite: we got sick, or passed out, or made fools of ourselves,
or in any of far too many ways concluded our drinking far less
than the human beings we were before we turned to alcohol.
At other times, perhaps, we drank in the effort to be “lessthan-human”: we drank to be less inhibited, less awake, less
feeling, less aware. The result of those efforts was inevitably to
heighten the sensibilities we had hoped to diminish, wasn’t it?
We perhaps shed an inhibition, but we became acutely sensitive
*.to imagined inguJts. Or-we found ourselves less sleepy than ever,
aware of even the slightest sound. Often, the pain we tried to
escape became intensified by the very drugs we took seeking
relief. Remember when?
Blaise Pascal said, “He who would be an angel becomes a
beast.”3 The attempt to be more than human leads to being less
than human. Another thinker, George Santayana, suggested a
related observation: “It is necessary to become a beast if one is
ever to be a spirit.”4 That is, in order to know the heights of
human existence, one must also touch its depths.
Together, these understandings summarize the heart of what
Alcoholics Anonymous teaches us about being human — about
12
13
being “a god who shits.”5 In the A.A. diagnosis, active alcoholics
drink in the attempt to be either an angel or a beast. Sobriety
means accepting the reality that we are both. Acceptance of this
reality of being human comes easily to the alcoholic who
understands alcoholism, because the condition of alcoholism
mirrors the essence of the human condition.
Shame and the Non-moral
(Love, Sickness., Freedom and Reality)
Three characteristics of shame help us come to terms with its
painfulness: 1) shame can arise over a non-moral failing; 2) it
tends to be occasioned by an involuntary shortcoming; 3) it
seems magnified by the very triviality of its stimulus. These
qualities aid in distinguishing shame from guilt and shed light on
the nature of the essential limitation that Alcoholics Anonymous
teaches us lies at the core of the human condition.
Guilt, you may recall from our earlier discussion, arises from
the violation of some restraining boundary. This implies that guilt
characteristically has to do with moral transgression, results from
a voluntary act, and tends to be proportionate to the seriousness
of the offense committed. Guilt thus follows from a wrong that
14
. H ...III
15
one chooses to do; and the graver the wrong, the greater the
guilt.
Shame differs from guilt on all three counts, even when both
arise together after a wrongdoing that marks also a falling short.
We will come to understand shame best, however, by separating
these qualities that characterize it and by examining cases of
shame uncontaminated by guilt. The next two chapters will
examine shame’s connection with the involuntary and the trivial.
Although shame may arise over a moral lapse such as
stealing, some of our failings have nothing to do with morality.
Two such cases seem especially important for us to deal with as
alcoholics: failure in love and the failure of sickness.
Love
Perhaps the most common source of non-moral shame, and
not only for alcoholics, is disappointment in love. But especially
for alcoholics, such shame can be particularly dangerous. How
many times have we turned to alcohol out of the frustration of
feeling unloved or rejected? Guilt over wrongdoing plays no role
such cases; we seek rather the solace of fl,? bottle in the
attempt somehow to warm.or to fill the chill,Tiollow emptiness of
felt inadequacy.
Defeat, disappointment, frustration, or failure evoke shame.
Guilt, as transgression, always involves aggression: one feels
guilty about the aggression. Shame arises over the failure — or
the foolishness — of the attempt, rather than ov.er the attempt
itself.
Shame arising from failure in love can haunt the alcoholic
drinking or sober. Being “passed over,” failing to win a hoped
for and sought after raise or promotion, can wound painfully.
Defeat and disappointment, frustration and failure, haunt the
human condition. As active alcoholics, our disadvantage on
such occasions was that we had a cop-out that inevitably made
things worse. Our advantage as recovering alcoholics is that we
know what it is to be human, and we have learned to find solace
even in our hurt, for that hurt proves that we are human,
whereas once we very nearly were not.
Sickness
Painful as is the shame of failure in love, the failure of sickness
can be worse. To be ill is not to transgress, to do wrong, but to
fall short, to be lacking. Health is the norm: we naturally feel that
we should be healthy. Lacking health, we feel that there is
something wrong not only with us, but about us. Being sick
implies inadequacy.
We need to think about that, for both the disease concept of
alcoholism and A.A.’s emphasis on alcoholism as malady serve
two functions. They remove alcoholism from the category of
morality and thus render us less guilty; but they also firmly locate
us as alcoholics in the shameful situation of being chronically ill.
Alcoholics Anonymous, in emphasizing that alcoholism is
malady rather than sin, also proclaims that there is a difference
between the guilt feeling of wickedness and the shamed sense of
worthlessness. A.A.’s experience — our experience — teaches
clearly that the alcoholic’s problem is not that he is wicked, but
that he feels worthless.
„
The feeling of worthlessness is worse than the sense of
wickedness. How, then, does it mark progress in therapy to label
alcoholism a disease? Does it not rather render the plight of us
poor alcoholics even more pitiful and hopeless, if it means
exchanging guilt for shame? It might seem so, except that the
experience of over a million members of Alcoholics Anonymous
clearly testifies that “It Works!”
Freedom and reality
' I
It works because it teaches reality, and the first truth of human
reality is that we are limited. Alcoholics Anonymous understands
the deep danger to sobriety of the alcoholic’s tendency to
demand “all-or-nothing.” A.A. therefore teaches us, as recover
ing alcoholics, not only the fact of our limitation and our need to
accept it, but also the positive side of that limitation and its
acceptance. There is an equation — a necessary connection —
between being limited and being real. We see this most clearly in
the matter of freedom.
The drinking alcoholic turned to alcohol in search of freedom;
the recovering alcoholic searches for freedom from alcohol. The
experience of Alcoholics Anonymous teaches us that the second
search will prove as vain as the first, unless we accept the simple
truth that to be human is to be both free and unfree. For the
alcoholic, as for any other human being, there is no absolute
freedom.
As^ecovering alcoholic*, we le^jri first in Alcoholics Anony-«j*. *.
mous-thafljfur freedom although f<»al, is limited. Conversely out f
freedom, o/ch'oughlimited,- is real. Tt> attain the freedom to not- ’ •.
‘drink, we acoeptlimitation of our-freedpm to drink. In recovery
on the other hand, how the limited freedom to not-drink brings
in its wake ever-increasing freedom.
As recovering alcoholics within Alcoholics Anonymous, we
thus learn a profound truth: with freedom, as with any other
human phenomenon, to be real is to be limited, for limitation
proves reality. This understanding enables both joyous accept
ance of the human condition and true recovery from alcoholism.
It enables both because that acceptance and recovery are one
and the same.
we must'come ’to see thatthis acceptance is not a concession.
The word “although,” must-be replaced in our thinking by the
affirmation “because”: because real, our freedom is limited;
because limited, our freedom-is real.
A.A. experience continually reminds us, as recovering alco
holics, how the apparently, unlimited freedom to drink inevitably
leads to increasing bondage and ever greater losses of freedom.
Some of us, in defending our “freedom” and “right” to drink,
lost jobs and status, wealth and love and more; some, we know,
lost life itself. The same A.A. experience progressively reveals,
18
‘
19
WJll'.
> ,■
Shame and t-Ue Involuntary
-t-Q..
(Problems of Willing J.- -
•’
Guilt implies choice. Shame, on the other hand, occurs over
something involuntary: it arises from incapacity. from the failure
of choice. The memories of car accidents, of tumbles down
stairs, of food or drink spilled on friends or guests, remain painful
well into sobriety. Of course we didn’t “choose” to do those
things — they were clearly involuntary, but can’t those memories
still sting?
The pain in shame arises from the failure of choice, of will, of.
self. A married man who committed adultery might feel both
guilt and shame: guilt over the violation of the marriage promise:
shame at falling short of the marriage ideal. The man who finds
himself sexually impotent with a woman he loves will feel
21
Uu
predominantly shame: the question of morality does not enter,
and surely such sexual disability is anything but voluntary.
When a drinking alcoholic asks “Why?” — “Why do I drink; I
know 1 don’t want to!” any sober alcoholic who knows and lives
the philosophy of Alcoholics Anonymous knows better than to
try to prove that he really did want to. The A.A. answer accepts
involuntariness: “You didn’t want to, but you did. You did
because you are an alcoholic. That is what an alcoholic is: one
who drinks when he doesn’t want to. The answer to ‘Why?’ lies
not in your will, in its strength or its weakness, but in the fact that
you are alcoholic.”
The involuntariness of shame is important because we learn
from it something about the human will and its limitations. The
alcoholic cannot will to not-drink any more than the insomniac
can will to fall asleep. The example is exact: in each case, we can
will the means, the context that will enable the desired end to
come about; but also in both cases, any attempt directly to will
the end — any effort to seize the object desired — proves selfdefeating.
There are two very different ways in which we attain two
different kirrds of things that we will. In some matters, we choose
particular objects: I can choose right now whether to write in
pencil or with pen, whether to keep writing, or to refill my coffee
cup, dr to go for a walk. In other matters, we choose an
orientation, a direction, a context that will allow — we hope —
our end to be achieved. I choose right now to sit at this desk,
with good light and away from distractions, and to rehearse in
my mind the many things I have learned at meetings of
Alcoholics Anonymous. But I cannot will, as 1 will to use this
pen, either brilliant thoughts or that you — one particular reader
— understand my point here. Indeed, were I to attempt to will
either, the writing would cease, for the very effort would
overwhelm me and become a “block.”
We get into trouble with willing when we try to will directions,
contexts, in the same way that we will to choose objects. There
are some contexts that vanish under such attempts at coercion. I
cannot will sobriety, but I can choose not to pick up the first
drink, today. I cannot, over any length of time, will to not-drink:
but 1 can choose to go to A. A. meetings and to work on the
Steps of the A.A. program. If 1 should try to will sobriety in the
same way that 1 choose to pick up the telephone to call my
sponsor, I would be drunk within a week. If 1 should try to will to
not-drink in the same way that I choose to get in my car to go to
an A. A. meeting, my track record before finding Alcoholics
Anonymous offers ample proof that I’d be getting in my car to go
out to buy booze.
And all this is true not only of things having to do with
drinking and sobriety. I can, right now, will to write vividly, but
not directly that you continue to read. I can will knowledge, but
not wisdom; submission, but not humility; self-assertion, but not
courage; physical nearness, but not emotional closeness.
Because shame so often arises from the failure of the effort to
will what cannot be willed, experiences of shame contain an
important lesson for us as alcoholics. To know shame is to Realize
that certain things fall outside the reach of what we often thitik of*
as “will,” beyond the scope of the manipulative will that chooses
objects. Sobriety, wisdom, humility, courage and love are not
objects: we can choose to move toward them, but any effort to
seize them runs the self-defeating risk of destroying them. Again.
recall the promise of Alcoholics Anonymous; “progress rather
than perfection” — movement toward rather than absolute
possession.
To be human is to be limited, and because our human will is
especially limited, there can be no absolutes or unlimitednesses
within our human power. Alcoholics Anonymous inculcates this
truth by clearly directing our attention to the two areas in which
22
23
5*
the alcoholic seeks, by using alcohol, to deny the limitation of
the will. These two areas are control and dependence.
Drinking alcoholics, we learn if we listen carefully at meetings
of Alcoholics Anonymous, drink alcohol in an effort to achieve
control — absolute control — over their feelings and their
environment. Whether we drink to feel “high” or to relax, to
make us witty or to soothe our pain, we drink to control. In
drinking to control mood, we attempt to deny that our moods
depend upon situations — and especially upon people —
outside ourselves, beyond our control. We drink in an effort to
deny such dependence; yet, in this effort, our dependence upon
alcohol itself becomes absolute.
The alcoholic’s problem, then, involves the demand for
unlimited control and the denial of real dependence. The
fellowship and program of Alcoholics Anonymous meet this
double problem in a twofold way. First, A.A. confronts us as
alcoholics with the plain facts that, so far as alcohol itself is
concerned, we are absolutely out of control and absolutely
dependent. Then, after we accept this reality by the admission
“powerless over alcohol,” Alcoholics Anonymous both pre
scribes and teaches the exercise of limited cdntrol and limited
dependence.
The Seventh Step of the A.A. program originally began with
the words, “Humbly on our knees. . .” Kneeling is a middle
position — halfway between standing upright and lying flat. In a
sense, Alcoholics Anonymous understands the alcoholic to be
someone who, by claiming absolute control and denying all
dependence, insists on trying to stand upright unaided, only to
fall repeatedly flat on his face — often literally in the gutter. To
the alcoholic lying prone, A.A. suggests: “Get up on your knees
— you can do something, but not everything.” Later, as we
progress toward sobriety, A.A. often has occasion to temper our
tendencies to grandiosity with a similar suggestion: “Get down
on your knees — you can do something, but not everything."
A.A.’s emphasis on limited control runs through its whole
program. Think about that encouragement combined with the
admonition, “You can do something, but not everything." We
are warned against promising “never to drink again” and laugh:
instead how not to take the first drink, “one day at a time." We
learn to reach for the telephone instead of the bottle. A.A.
encourages us to attend meetings, something we can do. rather
than to avoid all contact with alcohol, which is virtually
impossible. For me, the whole point of limited control is
beautifully summed up by the Serenity Prayer: “Grant me the
serenity to accept the things 1 cannot change, the courage to
change the things 1 can. and the wisdom to know the
difference.”
The “can” and “cannot” of the Serenity Prayer remind me
powerfully not only of the limitations on my ability to control, but
also of how as recovering alcohojjps we owe our priceless
possession of freedpm to the fellowship and program of
Alcoholics Anonymous. As we learn in A.A., alcoholism is
obsessive-compulsive malady: the active alcoholic is one who
must drink, who cannot not-drink. Thus, when we join A.A.. •
do not surrender any*'freedom to drink”: rather we gain the
freedom to not-drin.lt-. 1 sometimes think, indeed, that within
Alcoholics Anonymous our passage from “mere dryness" to
“true sobriety” is marked precisely by that change of perception
We begin, as each of us must, by “putting the cork in the boule
We start by accepting the prohibition, “I cannot drink." But
somewhere along the line, if we work the Steps and live our
program, we come to see that that acceptance is not primarily a
prohibition, a negative. Our life in recovery discovers the ioy<>uaffirmation behind that apparent restraint, and we begin t< •
24.
25
Limited control
rejoice in this happy new reality — in the real freedom of “I can
not-drink.”
Limited dependence
between that upon which one will acknowledge dependence: a
less than human substance such as alcohol within oneself, or a
more than individual reality that remains essentially outside —
beyond — the self.
This understanding of human freedom suggests not only
“limited control,” but also “limited dependence.” The dead-end
trap in which active alcoholics are mired consists of two denials:
their denial of dependence upon alcohol is but one manifestation
of their larger denial of dependence upon anything outside
themselves. Alcoholics turn to alcohol inside themselves in order
to enforce that denial of dependence.
In confronting this dual denial, Alcoholics Anonymous subtly
challenges a frequent modern assumption. Other therapies tend
to approach alcoholics from their own point of view — to agree
that all dependence, but especially essential dependence such as
that which binds alcoholics to their chemical, is humiliating and
dehumanizing. They try to convince the alcoholic that maturity
and “recovery” — becoming fully human — mean overcoming
all such dependencies. Diagnosing alcoholism, virtually all
modern therapies see the alcoholic’s problem as “dependence
on alcohol," and they endeavor to break the alcoholic’s
dependence.
The larger-wisdomed insight of Alcoholics Anonymous does
not exactly contradict this understanding. Indeed, A. A. agrees
with and accepts this diagnosis that the alcoholic’s problem is
“dependence on alcohol.” But Alcoholics Anonymous pene
trates deeper, locating the definition’s deeper truth by shifting its
implicit emphasis. A.A. interprets the experience of its members
— our experience — as revealing that the alcoholic’s problem is
not “dependence on alcohol,” but “dependence on alcohol."To
be human is to be limited, Alcoholics Anonymous insists, and
therefore to be dependent. The alcoholic’s choice — the human
choice — lies not between dependence and independence, but
26
27
Shame and the Trivial
(The Exposure of Denial)
The third and final characteristic of shame to be examined is
the frequent triviality of its source — the apparent disproportion
in shame that makes it literally such a monstrous experience.
Usually, when we.feel guilt, the intensity of our guilt is
proportionate’to thegravity of our offense: the more serious the
transgression, the greater the guilt.
Shame, on the contrary, tends to be triggered by the most
trivial of failings, by some small and even picayune detail. This
happens because such little things point unmistakably to the
failure of self as self, rather than as breaker of some rule. The
employee who embezzled a thousand dollars, when he comes to
doing his Eighth and Ninth Steps, feels mostly guilt. The person
29
who has cadged quarters off a co-worker’s desk or consistently
ignored the office coffee pot’s plea for coin contributions, feels
more shame than guilt. If we can tap that shame, can touch that
triviality, we will find in A. A.’s Eighth and Ninth Steps profound
help in confronting ourselves as we are. Attending to the trivial
invites examining “What kind of person am I to have done that?”
The more trivial the “that," the greater the light shed upon
“person.”
The disproportion inherent in experiences of shame — the
tendency of shame to be greater as its apparent occasion is
smaller — also reveals something about the appropriateness of
Alcoholics Anonymous as a therapy for shame. In a sense,
shame is addictive. The disproportion in the shame reaction
tends to magnify shame itself: we become ashamed at the very
inappropriateness of our reaction, and therefore ashamed of
shame itself. Shame becomes, in a way, insatiable: the more we
feel it, the more we feel it — a vicious circle not unlike the
squirrel cage that is alcoholism. Perhaps because of this parallel,
it is this characteristic of shame — the apparent triviality of its
occasion — that I found it most helpful to fasten on, as I
progressed in sobriety, in trying tp-turn experiences of shame to
constructive use. Let me try to explain why and perhaps also to
show how.
Alcoholics Anonymous teaches us to locate the “root of our
troubles” in the selfishness of “self-centeredness” — in pride. As
drinking alcoholics, we think ourselves exceptional, special,
different, and this tendency does not suddenly cease in early
sobriety. This is one reason why we hear so often at A. A.
meetings the advice: “Identify, Don’t Compare.” That is,
concentrate on how you are like us, not on how you think you
are different. Despite that frequently repeated warning, how
ever, most of us go through a stage, in early recovery, in which
our enthusiasm for A. A. and for the very newness of the
experience of honesty tempts us to judge and proclaim our
selves, as we review our personal history of alcoholism, especial
ly “wicked.”
I cannot claim to have completely escaped that trap in my
own early sobriety, but something I heard in treatment helped
me at least avoid becoming mired in it. A speaker told us that for
both drinking and sober alcoholics: “The alcoholic’s problem is
not that he feels, ‘I am a worm’; nor even that he feels, ‘I am
very special.’ The alcoholic’s main problem is that he feels, ‘I am
a very special worm.’ ”
That insight has helped me in many ways. At times, I’m sure
you’ve noticed, even “good” A. A. meetings seem momentarily
to be in danger of degenerating into “Can you top this?”
competitions. When that begins to happen (and I must admit
that at times 1 catch myself contributing to it) remembering “very
special worm” helps to rescue me, and often the meeting. After
all, our telling of stories at A.A. meetings is related to (although
not the same as) the Fifth Step of the A. A. program. They are
most alike, indeed, in providing therapy for precisely the “very
special worm” snare-; .
“Admitted to.God, to ourselves, and to another human being.
the exact nature d^our wrongs.” Such confession is, of course,
an ancient religious practice as well as a modern therapeutic
technique. But Alcoholics Anonymous took it over directly from
the Oxford Group within which A": A. was born, and the Group
used the public confession of "sharing” specifically to minister to
its adherents’ shame rather than their guilt. As one of the Oxford
Group books used by the early A.A. members says: “This
sharing leads to the discovery that sins we thought were so bad
are quite run-of-the-mill. The regard of one’s sins as particularly
awful is a vicious form of pride that is overcome by sharing.”6
The A. A. practice of story-telling at meetings, like the more
private Fifth Step , serves the same function: to drive home the
30
31
point that the alcoholic is very ordinary. 1 suspect this is why Bill
Wilson, in writing about A.A.’s Fifth Step in Twelve Steps and
Twelve Traditions, presented it as ending “the old pangs of
anxious apartness” and beginning the alcoholic’s “emergence
from isolation.”
Philip . . . got his teeth in the pillow so that his sobbing
should be inaudible. He was not crying for the pain they
had caused him, nor for the humiliation he had suffered
when they looked at his foot, but with rage at himself
because, unable to stand the torture, he had put out his foot
of his own accord.7
Exposure of his deformity to others was less painful to Philip
than the exposure to himself of his own weakness.
Alcoholism — in fact, any chemical dependency — often
arises from and is almost always connected with the effort to
conceal weakness, to prevent its exposure to oneself. The
alcoholic or addict uses a chemical in order to hide, and
especially to hide from self. The attempt at hiding reveals that
the critical problem underlying such behavior is shame.
This is one reason why distinguishing between shame and
guilt is so important. It is also a large reason why the more classic
therapies, or the usual consolations of religion, provide little help
to the alcoholic. During the years I was drinking, wanting to be
absolved of guilt was not my major problem. If anything. I was
pleading dimly but passionately within myself to be able to feel
guilty. At some deep level I knew, even as an active alcoholic.
that others’ admonitions to “mend my ways” or even marshalling
my own will to “grow up” didn’t work. But 1 sought out such
admonitions, at times, from therapists and clergy, and I at least
went through the motions of such willing.
Yet, more deeply. I somehow realized, even as 1 did all this.
'that 1 had to maintain my addictions? What 1 didn’t realize, then.
was that 1 had to in order to conceal my unendurable shame
from myself. Of the other therapies 1 tried — or pretended to try
— many, couldn’t work, because I could not afford to allow any
interference with my true problem of chemical dependency. Any
such interference seemed to threaten my very being, and so 1
sought help only from those who I knew — or hoped — would
not interfere with it.
Let me tell you — or remind you — of something that we all
know now, as recovering alcoholics, but refused to face then, as
active alcoholics: a major component of alcoholic addiction is the
attempt to avoid or to deny pain. The real pain that we try
primarily to deny, let me suggest, is the existential pain of
32
33
Exposure
Because shame’s stimulus is so often trivial, shame itself
frequently catches us by surprise. This helps to make experi
ences of shame episodes of exposure. Experiences of shame
throw a flooding and searching light on what and who we are,
painfully uncovering unrecognized aspects of personality. Expo
sure to oneself lies at the heart of shame: we discover, in
experiences of shame, the most sensitive, intimate, and vulnera
ble parts of our self.
Somerset Maugham, in his study Of Human Bondage,
acutely penetrates the essence of shame as the exposure of one’s
own weakness. The story describes a boy, Philip, away from
home for the first time, at school. Philip has a clubfoot, and his
new classmates tease him, demanding/o see his deformity.
.
Although he wants their friendship,. Philip refuses>to show they.
other boys his deformed foot. One night, however, a group’of
the boys attack Philip in the dormitory, after he has gone to bed.
The school bully twists his arm until Philip sticks his leg out of the
bed, allowing them all to stare at his misshapen foot. After" a
moment of laughter, the boys run off. And Philip?
We thus again see the wisdom of the “treatment” provided by
Alcoholics Anonymous, which aims and claims not to cure our
alcoholism, but to care for us as alcoholics. Because it realizes
that shame is the root of our alcoholism, A. A. sets out directly to
touch that sore nerve, to enable us to confront our own shame.
A. A. does this by.allowing — and at times even by bringing
about — the humiliation that we had sought so desperately to
avoid by our use of chemicals. The process, which we will
explore at depth in the next three chapters, is amazingly simple.
It is precisely our falling short, our shame as alcoholics, that
becomes the source of our new sober life in A. A. We come to
see, in Alcoholics Anonymous, that our most meaningful
strengths flow directly from our most shameful weakness.
It is fascinating to observe how Alcoholics Anonymous cuts
through our last vestiges of prideful denial and taps our
humiliation and shame. We see it most clearly with Beginners.
although'guoups will apply-the same treatment to oldtimers.
Perhaps because I sought help from so many other places before
Alcoholics Anonymous, I cherish an image that I think aptly
sums up the essence of A.A.’s initial approach to our shame.
Any hyriing person who seeks help brings to therapy a tiny.
flickering flame of sell-respect. Classic, guilt-oriented therapies
strive to nourish that tiny glimmer, to enlarge self-respect. The
initial response of Alcoholics Anonymous is different. Newcom
ers who display self-respect meet with caring confrontation: they
are offered, for example, a carefully half-filled cup of coffee.
Such confrontation of lingering denial invites hesitant newcom
ers to acknowledge the fact of their shakes and to realize that the
coffee-server who recognizes the shakes accepts them. The
message is less “It’s okay” than “It’s tough, but I’ve been there
too.” More stubborn cases may. in time, be told: “Take the
cotton out of your ears and put it in your mouth!” Any flicker of
self-respect that reveals denial of the felt worthlessness of shame
is gently quashed rather than nourished within A.A. Why?
Because A.A. experience testifies that, until that denial is
shattered, its own constructive therapy cannot be effective. The
alcoholic must confront self-as-feared to find the reality of self-asis.
Denial is the characteristic defense of alcoholics. Against
denial, the shared honesty of mutual vulnerability openly
acknowledged operates most effectively. Denial involves the
hiding of felt inadequacy of being. Shame, as herein explained.
relates so intimately to denial because it results not merely from a
sense of failure, but from a sense of essential failure — failure as
a human being, the failure of existence. This understanding
captures, 1 believe, the insight of Dr. Harry Tiebout, who was Bill
Wilson’s own therapist and whose writings help so many of us
understand both our alcoholism and our recovery. Tiebout’s
greatest contribution was his distinction between “compliant.."
which he saw as worse than useless because it obscured the
obsessive-compulsive nature of alcoholism; and “surrender,”
which he presented as the key to the process of recovery.
Tiebout’s compliance may be understood as motivated by guilt; ?
surrender, as enabled by the alcoholic’s acceptance pf shame.
Denial, Tiebout realized, could continue despite acknowledg
ment of guilt — despite, indeed, attempts to make amends for
guilt. Guilt, he suggested, could even be a defense against
confronting and accepting what is denied. For example, when
an alcoholic accepts responsibility for what he or she did while
drinking as preferable to admitting that the drinking itself was out
of control, then guilt is a form of denial. That was a trick I often
played on my unwary therapists, some of whom fell into the trap
34
35
shame: the gnawing hollowness of the fearful feeling that in
some essential way we are failures as human beings.
Denial and hiding
of praising my “maturity” and “responsibility” and my “taking
charge” of my own life. Ha! Real guilt fears punishment and tries
to escape it. The person whose problem is shame, on the other
hand, tends to seek and even to embrace punishment. Admit
ting “guilt,” and paying for it, confirms the denial of what is most
deeply feared and most profoundly painful — the sense of
having failed as a human being. How sweet it was to be praised
for my “honesty” at the very moment that 1 was being most
dishonest, to be commended for my “courage” at the very
moment that 1 was being most cowardly! Sweet?!
My alcoholic and chemical history was one long tale of everincreasing denial and hiding. I hid from others and from myself. I
denied not only my alcoholism and chemical dependency, but
ever larger areas of my life and realities about myself. I tried to
pull over myself that chemical veil, to deny reality by hiding
behind alcohol and pills, until one day it seemed that there was
nothing left to hide. Not “nothing else” — nothing at all.
At that hollow, empty moment, moved by the love of two
A.A. members, a clergyman and a cop, I reached out for
treatment and for Alcoholics Anonymous. Abandoning my
denial and hiding and beginning to find mjtjeal self was nol.
easy. I remember v’ividly an incident in treatmentr.a group- '
■<
session after we had somewhat begun to know each other and
the principles of A.A. I forget exactly what I was talking about;
but 1 do recall that I was trying so hard to be honest, yet sensing
within myself and from the glances of the group that somehow
my denial was still clinging to me, and I to it.
My words trailed off into silence. Finally, one of the group
members, a young counselor-trainee, looked at me sadly and
spoke gently in words of pained love: “If you — all of you —
were ever on that TV show where they said, ‘Would the real you
please stand up!’. . . you wouldn’t know what to do, which one
of you should stand up, would you?”
The blinding accuracy of those words cut, but the love and
concern and identification that I heard in them — and in the
empathetic, understanding nods of the others in the group —
began to heal. On occasion, as I progress in sobriety, I re-live
that scene in my imagination. A few times, when I have felt the
need for help with my continuing denials and fearful hidings, I
have re-told the story at my A.A. discussion group. Each time, I
have been healed further.
Recovering alcoholics know the treacheries of denial and
hiding. And we learn, from the wisdom of A.A., to tap the trivial
instances that expose our shame. That exposure, within A.A.,
allows and invites us to move beyond our alcoholic denials and
hidings. Exploring how this happens and why it works is the task
we turn to in the next chapters.
37
■ w:
Part II
Coping with Shame
Needing Others
Growth in sobriety may be understood as the continuing
process by which we get beyond our hiding, transcend our
denial, solve our shame. How do we achieve this? Alcoholics
Anonymous provides a model and suggests a method of
attaining continuing growth. The model is A.A.’s penetration
of our denial that we are alcoholics. The method is A.A.’s
inculcation of the reality that as limited — alcoholic — human
beings, we need other people. Other people are not the
problem in shame, but the solution. Denial and shame have to
do with our limitations. We deny our need for alcohol and
other people because admitting our need forces us to face our
limitations. We hide our limitations because we are ashamed
of them.
k Early in my alcoholic career, I denied to myself as well as
41
to others that I was seeking comfort or excitement in alcohol
because other people could not fill my insatiable needs. At
parties, for example, “a few drinks” and a strategic location near
the liquor supply became far more important to the “success” of
the evening than any people I might meet. Alcohol more and
more furnished a surer source of satisfaction than “all that silly
party conversation.” A bit further down the road of alcoholism 1
shifted more directly to denying any need for others: “Just let me
alone — I can lick this thing by myself.”
Alcoholics Anonymous worked — and works — for me
because its fellowship and program continually break through
these twin denials of my need for alcohol and my need for
others. A.A. as a fellowship helped me discover and admit my
need for others by being the one place — the only place by the
time I got there — where I myself was needed, and needed
precisely and only as an alcoholic. Realizing that enabled me to
admit that 1 was an “alcoholic” and, therefore, to admit my
insatiable need for alcohol. As a program, A.A. builds on my
acceptance of myself as an alcoholic and an ever deepening
awarenesS^jf my need for others. Without those others in A. A.. I
could rj,ev*er have admitted my own alcoholij^.-Arid .1 fairly soon
came.tdrealizeihat the “We” that begins the Pirst of A.A.’s
Twelve Steps stands also at the beginning of tbfe other eleven.
Outsiders who study Alcoholics Anonymous usually recognize
and often even fasten on our twin admissions of need — for
alcohol a.nd for other alcoholics. Many of the supposedly smart
ones look down upon us because of these admissions: they try to
explain away our recovery according to “labeling” or “deviant
role” theories; or they interpret A. A. away as “the substituting of
a social dependence for a drug dependence,” or as “accepting
the emotional immaturity of alcoholics and supplying a crutch for
it.” We know better, I think, and we do not need outside support
— although there happens to be plenty of that, and also from
42
some pretty respectable “smart” people — to validate the joyous
reality of a human life, humanly lived, to which our own lives
and the stories of over a million sober members of Alcoholics
Anonymous attest.
In dealing with shame, as I have tried to suggest, other people
are not the problem, but the solution. The experience of
Alcoholics Anonymous teaches us further that, for “others” to be
shame’s solution, they cannot be merely “others” — merely, thais, objects. Within A. A. we do not relate to each other
“objectively.” Objectivity is a quality that is valued in the medical
— the curing — model. Think, for example, of the surgeon.
Surgeons do not operate on their own family members, on
persons with whom they have a caring relationship. Further,
even the ordinary patient’s body is so prepared and draped for
surgery that his or her personhood and individuality are
concealed insofar as possible. Everything about the ritual and
procedures of the operating room is designed to enable surgeons
to perform their skills upon a body rather than upon a person.
gut Alcoholics Anonymous is not medicine nor surgery.
In f<ct, pne thing the earh/^X.A. members fojtjfd-most
•■.objeCfianable about-the'Oxfisfd Group was its use Of the term
/soul-surgery.” That first generation of Alcoholics Anonymous
sensed that wasn’t how they worked, how A.A. worked. The
uniqueness of Alcoholics Anonymous was that it did not claim to
cure, but to care. In A.A., therefore, “others” are not objects"who are “out there.” “Identify, Don’t Compare” mandates •
getting inside of and being with, as opposed precisely to standing
off or viewing “objectively.”
Accepting persons as persons, as fellow subjects rather than as
; mere objects, is the key to the A.A. model of caring rather than
curing. This caring mode) pioneered by and lived out within
Alcoholics Anonymous presents fully human relationships as
characterized by two qualities: complementarity and mutuality.-
43
to help other alcoholics: none of them wanted what Bill thought
he had to give. But on Mothers’ Day of 1935, when Bill found
himself stuck in Akron, Ohio and became desperately afraid that
he would drink again, he sought out Doctor Bob Smith for what
Bob, as an alcoholic, could give him. Bill sought out Bob not to
give, but to get: because of this, his attempts to give finally
became effective. Doctor Bob listened and was touched,
because Bill not only admitted his own need for him, but even
thanked Bob for listening,and for thus helping him — Bill — to
stay sober.
Perhaps an even clearer and more significant moment
occurred at the bedside of the alcoholic who was to become
“A. A. Number Three.” Wilson and Smith told Bill D., when they
called on him in the hospital, that talking with him was the only
way they could stay sober. Bill D. believed them and therefore
— as he tells us in his own story — he listened.
All the other people that had talked to me wanted to help
me, and my pride prevented me from listening to them,
and caused only resentment on my part, but I felt as if I
would be a real stinker if I did not listen to a couple of
fellows for a short time, if that would cure them?
Do you see the point — the first “secret” of A.A.? Somewhere
in the world, at this very moment, two A.A. members are
finishing up with an obviously “hopeless” Twelfth Step call. They
have each told their stories to the bleary-eyed, swaying drunk
who popped down “one or two more for courage” after calling
the A.A. number, and they are wondering whether this sorry
hunk of humanity, besotted with booze and self-pity, even heard
anything they have said. Clearly, they can do nothing more
today; but as they stand up to leave, one of the callers
remembers what makes a “successful” Twelfth Step call and
blurts out in honest gratitude: “You’ve got our phone numbers,
and I hope you’ll call when you’re feeling better. I don’t think
46
. we’ve helped you much today, in the condition you’re in, but I
want to thank you for helping me. Seeing you like this, and
i-y telling you my story, helps me keep sober today. I know that I’m
not going to take a drink today, and 1 thank you for giving me
that gift and this opportunity.”
And somehow, perhaps, that message gets through the
alcoholic’s self-pitying haze of self-hatred. That honest “thank
you” somehow taps the desperation that motivated the call to
A. A. It touches and soothes the absolute sense of “no good" that
eats away at the alcoholic’s last shred of self-respect. Whatever
else is said as the Twelfth Steppers leave, the alcoholic knows
that something has changed, something is now different. There
is a place, there are people to whom the alcoholic has something
■ of value to give.
..
Every human being needs to make a difference. Alcoholics
Anonymous recognizes and utilizes this reality, and thus its
wisdom taps an unchanging truth of the human condition. To be
human is to require “significance” — place in another person's
world.
It seems to be a universal human desire to wish to
occupy a place in the world of at least one other person
Perhaps the greatest solace in religion is the sense that one
lives in the Presence of an Other.9
We ^'irselves want to be needed. We do not only
have needs, we are also strongly motivated by
neededness. . .We are restless when we are not needed,
because we feel “unfinished,” “incomplete,” and we can
only get completed in and through these relationships. We
are motivated to search not only for what we lack and need
but also for that for which we are needed, what is wanted
from us.10
We introduced, in the preceding chapter, the terms “mutuali
ty” and “complementarity.” Mutuality implies having signifi-
cance, making a difference, by both giving and getting.
Complementarity means that one both gets by giving and by
getting. Alcoholics Anonymous not only teaches these truths —
it enables even the most “hopeless” drunk to live them out, and
by living them out to attain the honorable condition of alcoholic.
When we say at A. A. meetings, “1 am an alcoholic,” we
proclaim not only that we need, but that even from the depths of
our need, we have something to giue.
We learn, as recovering alcoholics, that we need. By accept
ing our need, we confront our shame. But one of our deepest
needs, we discover, contains shame’s solution — if there are
others like us. The need to be needed is the solution for our
shame. The need to be needed gnaws sharply. If shame is to be
resolved, we need to be needed for our uery need. To find this
need met is to put shame itself to shame.
Honesty with Self and with Others
The second mutuality that we learn and live within Alcoholics
Anonymous involves hbnesty A.^X. experience vividly teaches
that there is an Essential connection of mutuality between
honesty with seif and honesty with others. Most alcoholics who
reach Alcoholics Anonymous already know quite a bit about the
necessary mutuality between honesty with selLand with others.
Our drinking experience*Before reaching A.A. was, after all, one
long, downhill story illustrating the inevitable mutuality between
dishonesty with self and with others.
Remember how successful we were for a time? After convinc
ing ourselves that we didn’t have a drinking problem, how we
managed to convince others? And after convincing a few
compliant friends, how we then used their “evidence” to re
convince ourselves? I recall an interesting first few months when
I returned from treatment, having finally found A. A. Back
48
49
home, 1 began telling a few close friends that 1 was an alcoholic
and had joined Alcoholics Anonymous. Guess what? You
know, I’m sure, how a lot of people are about A. A. anyway.
Well, several of my erstwhile friends tried hard to convince me
that 1 wasn’t “really” an alcoholic (can you hear their tone of
voice?) — and they gave back to me all the arguments and
“proofs” that I had fed them over the years! We really need our
sponsors — someone with whom we have established a
relationship of honesty — especially during such beginnings.
“Those who deceive themselves are obliged to deceive others.
It is impossible for me to maintain a false picture of myself unless
I falsify your picture of yourself and me.”11 Yes — and our
alcoholic experience also teaches us the complementary truth:
“Those who deceive others are obliged to deceive themselves. It
is impossible for me to project a false picture of myself unless I
falsify my own picture of me and of you.” The quotation below
portrays what I have come to understand about this aspect of my
alcoholism much better than I could:
As a child grows gradually aware of the absolute
separateness of his being from all others in the world. he
discovers that this condition offers both pleasure and
■ terror. ... To the extent that he must — or believes that he
* •’ must — toy with his own presentation of himself to others
. to earn the attention and approval he craves. . he will
experience a queer, unnamable apprehension. . This
uneasy state is both painful and corrupting.
It is commonly believed that this pain and corruption are
consequences of his low self-esteem and fear of others’
indifference and rejection, that these cause him to project
himself falsely. It seems more likely that once this habit
begins to harden, the crucial source of pain is his corrup
tion. In his constant inability or unwillingness to tell the truth
about who he is, he knows himself in his heart to be faking.
Not merely is he ashamed of having and harboring a
secret, unlovely, illegitimate self. The spiritual burden of not
appearing as the person he “is,” or not “being” the person
As often now, in sobriety, as I have meditated on that
description, a new tingle of recognition goes through me each
time I re-read it. Those words touch deeply and sharply one
precise shame of my alcoholism: its vicious circle of dishonesty. 1
have learned in A. A., from A.A., that it is necesary to avoid self
deception if one is to be honest with others, and that at the same
time one must be honest with others if one is to avoid self
deception. One great gift that 1 have received from Alcoholics
Anonymous is the vision that this circle of mutuality need not be
“vicious." If there is a mutuality between dishonesty with self and
with others, there is also a mutually between honesty with self
and with others. The key to breaking the vicious circle of
alcoholic dishones.ty is the honest admission, “1 am an
alcoholic.”
Our honesty in sobriety, of course, reaches far beyond that
first admission. Our alcoholic dishonesty when drinking, after all.
extended far beyond our denial of alcoholism. One reason why
Alcoholics Anonymous works so effectively is that its meetings
furnish an ideal format for reaffirming and extending that first
honesty with self and with others. The honesty of each, at an
A. A. meeting, enables the honesty of all. Among you, 1 cannot
be dishonest, with you or with myself. You do not let me, for
you need my honesty as I need yours. And our honesty,
established in this way, grows, touching ever wider areas of each
51
50
W^MRpilJIU.IJ.UIIIUII
he appears to be — the extended and deliberate confusion
of seeming and being — is by and large intolerable if held in
direct view. If the integrity he craves is to be denied him, at
least he will have its illusion. If he cannot publicize his
private self. . . then he will command his private self to
conform to the public one. This beguiles to a loss of truth;
not only “telling” it, but knowing it.
There are some things it is impossible both to do and at
the same time to impersonate oneself doing. Speaking
truthfully is one of them.12
..
III.oil 1
of our lives. A much-maligned modern philosopher has called
the “bad faith” of self-deception the ultimate sin. Living the A.A.
program, within the A. A. fellowship, delivers us from its evil.
Dishonesty becomes a habit, an addiction as tenacious and as
treacherous as alcoholism itself. If I am to find the real me, I
need your honesty. I need your honesty in order to find my
own. And one reason I love going to A. A. meetings is that I
sense that you have the same need. Because you need my
honesty as I need yours, we all give by getting and get by giving.
I’d like to conclude this chapter by sharing with you another
honest secret about the real me. Because children are so honest
and simple, 1 love to read children’s books. In one of them,
Margery Williams’s The Velveteen Rabbit, I came across some
thing about being “real” that I think pretty well sums up how
A. A. works for me as far as being real is concerned.
Early in the story, the young Velveteen Rabbit asks another
toy, a wise, old Skin Horse, “What is REAL? . . . Does it hurt?”
“Sometimes," said the Skin Horse, for he was always
truthful.'.“When you are Real you don’t mind being hurt."
“Doesit happen all at once, like being wound up," the
Velveteen Rabbit asked, “or bit by bit?"
“It doesn't happen all at once," said the Skin Horse.
“You become. It takes a long time. That’s why it doesn’t
often happen to people who break easily, or have sharp
edges, or who have to be carefully kept. Generally, by the
time you are Real, most of your hair has been loved off,
and your eyes drop out and you get loose in the joints and
very shabby. But these things don’t matter at all, because
once you are Real you can’t be ugly, except to people who
don’t understand."13
1 love Alcoholics Anonymous because I find in A. A. people
who do understand. And A.A.’s greatest gift to'me, after
sobriety, I like to think and to hope, has been to help me become
not only REAL, but someone who also understands.
52
Dependence and Independence
Both mutualities already examined — those of making a
difference and ®f honesty witTi self and with others — flow into
the third mutuality taught and enabled by Alcoholics Anony
mous: that between personal dependence and personal
independence.
As with the earlier mutualities, A.A.’s insight into the neces
sary connection between dependence and independence derives
from its intuition that the reality of essential limitation is the first
truth of the human condition. It is because the human is
somehow the juncture of the infinite with the limited — because
to be human is to be both angel and beast, “a god who shits"1’
— that human dependence and human independence must be
mutually related, not only between people, but within each
person. Mutuality means that each enables and fulfills the other
53
• ■£>
To speak of a mutuality between dependence and indepen
dence, then, is to point out not only that both are necessary
within human experience, but also that each becomes fully
human and humanizing only by connection with the other.
Remember the image and its message, explored earlier,
“Humbly on our knees”? A.A.’s mandate and caution to the
alcoholic are one and the same: “You can do something, but not
everything.” To be human is to be in a middle position, and
therefore to combine rather than to choose between dependence
and independence. When we were drinking, we alternated
between the defiant.claim, “I can do it alone,” and the desperate
plea, “Please do it for me.” Sobriety means putting aside both of
those cries and accepting not only that we ourselves must do
something, but that we need others in order to be able to do
even that “something.” The sober alcoholic learns in Alcoholics
Anonymous both to acknowledge dependence and to exercise
responsible independence. When, for whatever reason, the
thought of chemical relief crosses my mind, it is I who pick up
the telephone instead of the bottle — that’s responsible inde
pendence. But it is the telephone that 1 pick up — and that
acknowledges my dependence, my need for others.
Too many other therapies — the therapies at least that I tried
before finding A. A. — look down upon the A. A. way because
they prefer to interpret personal dependence and personal
independence as contradictory rather than as mutually fulfilling.
Their goal of independence for the alcoholic is not unrelated to
their ideal of “objectivity,” which leads them to ignore mutuality,
and to their hope of curing, which stands in the way of their
caring. Yet, as we have seen, as alcoholics we gain the freedom
to not-drink only by acknowledging that our problem is not
dependence on alcohol, but dependence on alcohol.
The Alcoholics Anonymous model of mutuality and caring
works because it rescues alcoholics from the dire need and the
doomed effort to deny all dependence. A.A. members, because
they accept their essential limitation as humans, come to
understand that dependence demeans and dehumanizes only if
that which is depended upon is less than human. It seems to be a
law of human growth that we become what we depend upon.
Our choice as alcoholic human beings is not between depen
dence and independence, but whether we shall be dependent on
a less than human substance such as booze, or on a more th ■
individual reality such as our “Higher Power” however unde.
stood. And most of us, 1 think, find at least the best evidence c.
our “Higher Power” in others —.especially in other alcoholics.
In the A. A. understanding, the truly mature person is
characterized not by “independence,” but rather by what some
psychiatrists have termed “ontological security.” For the person
so secured, “dependence or independence do not become
conflicting issues, rather they are complementary.”15 Such a
person finds relatedness with others potentially gratifying and
fulfilling.
The “ontologically insecure person” described by these thera
pists, on the other hand, closely resembles the active alcoholic.
Having failed to come to terms with the complementarity of
dependence and independence, such a person becomes preoc
cupied with preserving rather than fulfilling the self. Obsessed
with the task of preserving, the ontologically insecure person
reaches out to others in se/J-seeking dependency, out of the
same needs that drive the alcdholic or addict to seek chemical
relief.
Let me try to illustrate from my own story, 'which contained
many attempts to treat my alcoholism through the more classic
therapies. Those efforts proved unfruitful until I discovered their
fulfillment in Alcoholics Anonymous. Several therapists suggest
ed to me, as Dr. Harry Tiebout had pointed out to Bill Wilson,
that the alcoholic seems to be fixated as a perpetual infant. The
54
55
'- -^l1
.... . ..............
-'UW-
alcoholic is like the newborn infant whose cries are meant to
enforce the demands of grandiose omnipotence — “His Majesty
the Baby,” in Tiebout’s Freudian phrase.
Periodically for the alcoholic, however, as for the baby, the
pinchings of reality push this sense of grandiose omnipotence to
its opposite extreme. The self-pity of the hurting alcoholic echoes
the implicit complaint of early childhood after the individual
becomes aware of his or her relative powerlessness in a world of
mature adults. From the demanding claim, “I am everything,”
the disillusioned alcoholic — like the helpless child — moves to
the lament, “I am nothing.” This understanding reflects, I think,
the “very special worm” insight that we explored earlier.
Before 1 found A.A., my therapists all tried to convince me
that maturity meant accepting the middle between “I am
everything” and “1 am nothing.” Maturity, that is, meant
embracing the realization that the proper affirmation for human
beings runs. “I am something.” 1 tried to accept that, to live it —
oh how I tried! The trouble was that when things went well, 1
tended to lean on the first syllable — to think and to act out the
sense “I am something.” And when things were not going well.
when reality pinched, I was inclined to add a word that signaled
my alcoholic exceptionalism: “I am something else" expressed a
demand that implicitly denied essential limitation. In both cases,
it seemed logical and even necessary to turn again to alcohol —
either to sustain the self-centered inflation of "I” or to enforce the
self-centered exclusiveness of “something else. ”
Alcoholics Anonymous, when I finally found it, suggested a
further growth, a different maturity. Because it sees “selfishness
— self-centeredness” as “the root of our troubles,” because also
of its sensitivity to the alcoholic as human being rather than as
object, A.A. offered me an alternative to “being something.” In
its fellowship, 1 learned, 1 was to become someone. "1 am
someone” reflects more accurately human reality as essentially
56
limited. “Someone” invites a double accent, thus removing all
emphasis from the “1. ”
Because I learned in A.A. to accept being some-one, I no
$ longer needed to try to be all; nor did 1 need to complain of
being nothing. Both infantile claims of my alcoholic personality
were closed off. Because 1 embraced being “some-one,” 1
became able to fulfill and to be fulfilled by others, rather than
v . threatening or being threatened by their individuality. I thus
began to live the joyous pluralism of complementarity that ha'
been pointed out as the essential dynamic of Alcoholics Anor
mous: “the shared honesty of mutual vulnerability openly
acknowledged.”
The concept of “some-one-ness” really helps me to see the
inherent mutuality of being human as a sober alcoholic in
Alcoholics Anonymous. 1 cannot be either wholly dependent or
wholly independent. To be human is to be both independent
and dependent, and because both, neither totally. I can achieve
true independence only by acknowledging real dependence.
Similarly, I am able to be dependent in a truly human way only if
I also exercise rearindependence. My independence is enabled
and enriched by my dependence.
Once 1 heardl&n A-A. speaker suggest that in a sense we
“charge batteries” by periodically acknowledging dependence. It
is that acknowledgment that allows our independent operation.
And, the speaker went on to point out, the other side of the
image is just as true. We can’t be only dependent and never
exercise independence, for that would be like over-charging a
battery that is never used: it would destroy both the dependent
self and the charging source. The trouble with this image is that it
implies some sort of “either-or” sequence. In human reality.
among us as members of Alcoholics Anonymous, dependence
and independence do not so much alternate as reciprocate. Our
needs for dependence and independence are not met one after
57
each other, but at the same time, in such a way that they
mutually reinforce each other even as they mutually satisfy each
other.
Note how well A.A. teaches and enables this, not only by its
suggestion that we have some “Higher Power,” but even in the
way that its program and meetings work. The very First Step of
the Alcoholics Anonymous program already contains the whole
point here and establishes the foundation for its deeper under
standing. Only by admitting that we are powerless over — and
therefore dependent upon — alcohol, do we achieve the
independence of freedom from addiction to alcohol.
The mutuality between personal dependence and personal
independence, which we have explored in this chapter, also aids
our deeper understanding of the A. A. emphasis on limited
control and limited dependence. It is similar to the difference
between “I cannot drink” and “I can not-drink”; and the
distinction between “dependence on alcohol” or “dependence
on alcohol." If those suggestions rang true then, 1 hope that you
now share my vision of why they are true. Each is true because
the other is true. As I learn so often in A.A., in so many ways, I
am real because I am limited, just as 1 am limited because I am
real.
All that may sound strange — even weird. Yet, if you have
been where 1 have been, and of course you have, I think you
understand. Remember? The agonizing over whether to drink at
all in a situation in which we fear that there might not be
“enough”? For us, when we were actively drinking, was there
ever “enough”? The double falsity, then, of saying “No,” or of
“protecting our supply” when, for example, unexpected guests
dropped in over a holiday when the liquor stores were closed?
Were we ever “real” when, denying limitation, we thus played
false? Or how about the games of hiding from ourselves? One of
my favorites was to “cut down” by buying fifths instead of quarts;
58
only I made sure that the fifths — do notice the plural — were of
one hundred proof instead of eighty proof.
Today, sober, I no longer have to play such games. Accepting
that I am an alcoholic, accepting that I am essentially limited, I
have found the reality of my dependence and of my need. I
have also found — or at least am in the process of finding — the
reality of myself: and that is rea/“independence.”
59
Conclusion
?£
’’
Sg'>?'
I am an alcoholic. Accepting that, 1 can be myself. And
strange as that may seem to some, impossible as that was when I
was actively drinking, I like it. In fact, I love it so much that I
wouldn’t exchange it for anything else, and because it is the most
precious thing 1 have, it is what I have tried to share with you in
these pages. I hope that by your reading them we have both
gained by giving, given by gaining. I know that I have; so —
thank you. 1 would like to share with you in conclusion, and out
of gratitude, something that 1 came across recently. Its author
called it “an alcoholic’s meditation on honesty, pain, and
shame”:
Honesty involves exposure: the exposure of self-asfeared that leads to the discovery of self-as-is. Both of these
selves are essentially vulnerable: to be is to be able to hurt
and to be hurt. But something tells us.that we should not
61
hurt: that we should neither hurt others n^^urt within
ourselves. Yet we do — both hurt and hurt, both cause and
feel pain.
When we cause pain, we experience guilt; when we feel
pain, we suffer shame. The pain, the hurt, the guilt of the
first is overt: it exists outside of us, “objectively.” The pain,
the hurt, the shame of the second is hidden: it gnaws
within, it is “subjective.” Neither can be healed without
confronting the other. A bridge is needed — a connection
between the hurt that we cause and the hurt that we are.
That bridge cannot be built alone. The honesty that is its
foundation must be shared. A bridge cannot have only one
end. Without sharing, there can be no bridge. But a bridge
needs a span as well as foundations. This bridge’s span is
vulnerability — the capacity to be wounded, the ability to
know hurt. “I need” because “1 hurt” — if deepest need is
honest. What I need is another’s hurt, another’s need. Such
a need on my part would be “sick” — if the other had not
the same need of me, of my hurt and my need. Because we
share hurt, we can share healing. Because we know need,
we can heal each other.
Our mutual healing will be not the healing of curing, but
the healing of caring. To heal is to'make whole. Curing
makes whole from the outside: it is good healing, but it
cannot touch my deepest need, my deepest hurt — my
shame, the dread of myself that I harbor within. Caring
makes whole from within: it reconciles me to myself-as-l-am
— not-God, beast-angel; human. Caring enables me to
touch the joy of living that is the other side of my shame, of
my not-God-ness, of my humanity.
But 1 can care, can become whole, only if you care
enough — need enough — to share your shame with me.
Could the same be true for you? It has been for me. Thank
you for your time and your sobriety, for the hurt and the need
that led you to read these pages. It is my prayer that my need
and my hurt, which moved me to write these pages, may help to
heal yours and you.
62
THE GOLDEN BOOK
OF
RESENTMENTS
By
FATHER JOHN DOE
Author
of
SOBRIETY AND BEYOND
4l>
The SMT Guild, Ine.
P.O. Box 313
All. Rights Reserved
No part of this book may be
reproduced in any form with
out written permission from
the publisher.
RESENTMENTS
o
o
Copyright 1955
The SMT Guild, Inc.
Indianapolis
Eleventh Printing, 1978
"Il'/iom the gods would destroy
In analyzing the various principles of Alcoholics Anonymous
we now come to one which has come up for more discussion, and
which is at the bottom of more difficulties than any of all the ones
listed. This principle is:
“THE DANGER OF R E S E N T M E N T—S E L F PITY"
In the alcoholic, “frustration begot resentment, resentment begot
self-pity, self-pity begot drinking, and drinking begot frustration,.
and frustration begot resentment, and resentment begot self-pity,”
and on and on and on—in an unending cycle, until faced with the
three-pronged choice: sobriety or insanity or death. And then we
chose sobriety in A.A. And we learned the principle that: If thealcoholic repeated any PART of the cycle, the ENTIRE cycle would
repeat ITSELF, "in toto."
■'
We learned through the above principle that to the alcoholic,
resentment and self-pity would always remain his number one *’vinenemy—no matter how long sober. And this means that, if he per
mits himself to indulge in resentment or self-pity too frci/ucntly or
for too prolonged periods of time, he will automatically set off the
compulsion to drink. In short: \N ALCOHOLIC CANNOT TOL
ERATE RESENTMENT.1
If he does, there automatically will begin the old pattern:
“stinking-thinking; drinking-thinking; drinking." And so also will
it be with any part of the cycle above: If_the alcoholic takes a drink,
he will (lutpmaticaljy and ultimately become full of resentments, etc.
etc. We do not know why this happens, but we do know from long,
long experience, that it does happen.
1 In the writer’s opinion self-pity is nothing more than resentment "turned
inside out.” Self-pity is the coward’s type of resentment, and when such a
persop finds himself frustrated in vindicating his resentment, he turns "inside
.to himself” and becomes full of self-pity. So from this point on we shall
only use the term "resentment" and in it include also “self-pity.”
In fact the experience of the race, although somehow little is
ever written or said about it, is that at the bottom of most troubles
in life, including our spiritual life, is resentment. So important is
this truth that he who controls resentment (and by this term we
include any of the thousands of degrees of resentment from a
mere "dislike” to a positive and malicious "hatred") controls life
here and hereafter. Ninety-eight percent of all “troubles” in the
lives of all people stem in some way, directly or indirectly, from
resentments. And, in alcoholics—it is without exception the prel
ude to the bottle.
Now if this be true, then let us try to answer three very per•tinent questions: What is resentment? Whpre docs resentment
■come from? And what are we going to do about resentment?
The answers to all three of these questions are contained in the
analysis of the term itself. ‘‘Resentment” comes from the Latin
words “re" and “sentire.” “Sentire” means “to feel” and “re” means
“again.” Therefore a resentment is born when one “re-feels” any
injury to pride, and any “hurt” to one's ego. And so, when any
thing happens or exists that injures our pride, we are “hurt,” “irri
tated," "angry" but not yet resentful. This injury grows into a
resentment only because we “re-feel” it; we “nurse” it; wo “mull
over” it; we “dig around” it;—in short we “cultivate” it. We
are injured, and we “infect” the wound because we “re-sentire”:
we “re-fccl" it. And once infected, once the resentment has taken
hold, then only a "positive antibiotic" will cure it or eliminate the
poison. And in the area of haired, toward which all resentment
tends, there is only one antibiotic: that is love.
From this short analysis three very important truths become
apparent.
z
1. B’c get resentments from pride, ll'c will always have, this
tendency, for pride will be with us-until -ice are dead. But we can
minimize this tendency and eliminate many an occasion by the
PRACTICE of humility—the opposite of pride.
Many people in this world wrongly think that they 'can “eii
nate" various of their passions, e.g pride. Or as the story g>
a certain teacher of the spiritual hie was teaching her prole
to “slay” one passion a year! This can't, be done! We have sc
basic passions, seven basic “drives to action," seven basic “hui
tendencies.” It is "the law of the flesh lighting against the
of the spirit" mentioned by Saint Paul. But they cannot be eh
nated. They are necessary for life, for action. They are good
themselves, but tend to get out of control. It is our job to Ct
TROL them. Closing our eyes to them is wiiat psychiatry t
"repression” and is responsible for many neuroses. Let's tai..'
example or two.
z We all have the passion of lust: sex. To deny v e have
drive or desire is “repression"—H is not healthy, and
neurotic behavior. Bn', that does not mean we should the:
indulge in sex. Sex indulgence never cured a neurosis. Rut it d
mean that we must admit consciously that we have the scr
and then cither 1) use it according to r.ason in lawful marriage
indicated by our Maker or 2) abstain wilfully in the single
These two are “control"—by 1) reasonable use or by 2) :
abstinence. Both are healthy practices, fur “abstinence" is not "
pression.”
Likewise we all tend to “get angry." (They say there ;
people in this world who never get angry or irritated. Bu: •;
they also say there are people in this world who are too dumb to
init sin! But we ain't in that class, Bud!) Thatis a good tend*.::
It gives “drive” and “push” and “initiative” and all those th::
that go for successful living. But when it is indulged in as a
to frustration, and vindication, and self-pity, then it has gone "ag.-.l
reason” and also leads to neurosis—and in the alcoholic to rcs<>.'.and drinking.
So we never even try to rid ourselves of these “lendv:..-:
They will be with us until we are dead. But we can grad.:
control and. direct them by the practice of the opposite virtue.
We must do good to those whom we resent. We must speak
well of those whom we resent. We must practice some positive
action for love of them,—and love is the willingness to do I-'OR.
Otherwise we will continue to resent, we will continue to dislike,’
we will continue to hate—no matter how long or how deeply we
might wish, we didn’t resent or dislike or hate.
We can by practice of the opposite virtue achieve at least a
modicum of control, minimize or cut down the number of occasions,
and in the matter of pride, and "injured pride," which is the seed
of resentment, we can go far in cutting down the number of times
and the severity of these "injuries” IF" we DAY IN AND DAY
OUT practice the opposite virtue of humility. Let’s not forget:
The greater a guy or gal I think I am, the less it is going to take for
someone to dispute that idea!
And here again, the more consistent our habit of love is it: cur
daily lives, the less chance for resentments to take hold; and also
the more easily and quickly will they disappear when they do,
on occasion, crop up.
Therefore as a practical corollary to the above truth, we learn
that we cut down the number of chances of BECOMING resentful
in direct ratio to how much true humility we acquire.
In A.A. we find, especially in the beginning of our sobriety,
that we are not very adept at the practice of humility and love.
We have lived for so long with our drinking pattern that we have
picked up pathological habits, of pride and hatred and resentment.
We were “loaded” with them. And now we find that we cm. use
a few extra “natural” helps to sorta “protect” our touchy, alcoholtenderized natures until we arc more able to pursue a stable course
along the path of virtue, particularly until we are more aide to
“control” our hurts more consistently. And so we picked mr.hhig
more than wise little sayings which if ingrained into our co:;; J.cusness will serve as a suit of armor against “the slings and a...• .a
of outrageous fortune."
2.
Resentments take hold and grow within ms by "re-feeling"
the injuries. Therefore they cannot remain or grow if we "let
go” of them and refuse to think about them, refuse to mull over
them, refuse to "re-fctl" the irritation.
Most irritations would evaporate quickly if on every occasion
of being “angered” or "hurt” all parties involved would imme
diately dismiss the incident from their minds. But how often is
it not the opposite? Instead of dismissing the injury at once, we
hold on—we think it over—we "re-feel” it . . . over and over
again. Then in twenty-four hours what was only a ‘'scratch” has
become a deep, dark, dangerous resentment. “What was that he
said?” “Why, he meant....” “The so-and-so!" "I’ll get even!"
And—then “resentment begot.... !” Remember?
What to do? Let it go! He said thus-and-thus. So what? Re
fuse to “re-feel”!
You know sumpin’? If someone calls us a “so-and-so," we either
are or we aren’t! If we are, that’s that! If we aren’t, then why be
come one by “getting ‘mad’ about it”!
V
3. U'e eliminate those resentments already conlractqd NOT by
wishing them away, but only by the practice of positive ACTIONS
of love.
8
'' The fust of these “gimmicks" which we throw out for
perusal is:
-
'EXPECT CRITICISM.
No matter who we may be, no matter how important
petent we may be, no matter how good either we or our
1 There is a form of emotional “dislike” which is not from injured rride,
but simply a reaction of nature’s law of attraction and repulsion. It .- like
the positive and negative poles in the inanimate world. So certain t.y.'de
we like; but a certain few we will not "like," no matter what we do. '■■hat
to do? Just don’t try to “like them”—love tlicinl
are, if we do anything in life we will be criticised. But any criticism
is in no way a measure of the value, sincerity or morality of our
actions. Now, if we meet each day in life expecting criticism,
then, when it comes (and it will!) we will not be surprised, nor
hurt, because we were looking for it—and we can even reach a
state of mind wherein we so look for these criticisms that rather
than upsetting us or irritating us we enjoy them.
The writer learned this first "gimmick” in the early days of
his speaking and writing. He had the privilege of getting it first
from Bill W., our founder. And, allho’ for some time criticisms
here or there did "irritate,” he now so looks for them in every
area that he enjoys them, like the funny papers on Sunday morn
ing! He would almost feel “lost” without criticisms levelled at him.
"Gimmick” number two: THERE IS IN EVERY GROUP OF
■ HUMAN ENDEAVOR AT LEAST ONE WHO IS AGAINST
■ EVERYTHING AND EVERYBODY. GOD PUTS THEM THERE
—TO GIVE ALL OF THE REST OF THE GROUP A CHANCE
.TO PRACTICE TOLERANCE, AND PATIENCE, AND KIND' NESS, AND UNDERSTANDING, AND LOVE.
With this knowledge, it will be a pushover to tolerate and
overlook all the diatribes of that “guy” or “gal” in your group
who is always "agin” everything and who never lets anyone’s
work go by unchallenged, and who, in short, just doesn’t seem to
like anybody (including himself). They are to be pitied, not
blamed. They are “psychopathic.” But they are filling their “niche”
in life which demands all parts to make the machine of life go on:
yes, even the "nuts,” and the bolts — and the ubiquitous “crank”!
One such fellow died. At his wake there was overheard the fol
lowing remark: "Poor John (his name was John Doe) he won’t
like God.”
7
The next “gimmick” to help protect that “tender” ego of-ours is:
LET THE OTHER FELLOW GET MAD.
10
We are in A.A. (at least we presume most of us are) primarily
to stay sober and secondarily to achieve and maintain happiness.
Both sobriety and happiness are dependent one on the other. We
can’t be happy unless we stay sober; we won’t stay sober unless we
are happy. Therefore when someone "irritates” us, or criticises us .<
or talks about us, let the other fellow get mad. He is unhappy. All j
people who criticise or gossip or slander are basically very unhappy |,
people. We, on the other hand, want to be happy. So let’s stay
happy. Let them get upset or talk or what have you. We simply
ignore it. We stay happy. We avoid resentment.
Some years ago when the writer arrived to speak at a large
A.A. Conference, someone came “a-running” witii the report that
"someone was talking awful about us” and the "reporter" thought
toe should do something about it. We replied:
"We do something about it? Why should we? We’re happy,
and we are going to stay that way. He’s unhappy. Let him get
mad.” (Which he did!)
Another "gimmick":
WORDS CAN NEVER HURT NOR CHANGE US IF WE
DON’T LET THEM. AND WE WON’T LET THEM IF WE ARE
MORE CONCERNED ABOUT WHAT AND HOW WE ARE DOING
INSTEAD OF WHAT PEOPLE ARE SAYING — FOR GOD
ALONE CAN APPROVE OR DISAPPROVE, ABSOLVE OR
CONDEMN.
What was that saying we heard in our early school days?
"Sticks and stones may break our bones but words can never hurt
us.” Someone has criticised? Okay, what is that to us? Let them
criticise, we will simply pursue our way of living happily and soberly
and completely oblivious of any verbal ammunition that may be
hurled our way. Words aimed our way will remain a mere "mirage”
provided we neither run towards nor from their vocalizer.
“Gimmick” number five:
Zl
x .KNOW THYSELF.
An honest inventory of our own shortcomings will go far in
eliminating that tendency to “take up” everything that is said about
us or to “strike back” at critics. For if we are honest, we aro
pretty sure to accept all things in life inorc passively and readily.
Like the story goes which tells of a fellow in tatters and rags, sitting
on the curbstone, a "leettle" bit drunk, who was heard to mutter in
a flash of honesty, as a very successful and wealthy gentleman
passed in his limousine, "There but for inc go I.” We think he's got
something there!
We will content ourselves with one more "gimmick,” and one
that will go far in encouraging anyone to keep on doing things
no matter who says what, for:
ZF IFF GET .4 KICK IN THE PANTS IT CAN MEAN ONLY
' ONE THING—WE ARE STILL IN FRONT!
'
Someone said: "Criticism is the unconscious tribute mediocrity
and failure pay to success.” This explains our “gimmick.” There
is another way of putting it: “Every knock is a boost.” (A school
boy misquoted the above to read: “Every knock is a boast.” He
wasn’t far wrong at that!). Get angry? How silly. Rather take
’ a bow!
And now we shall give you a bag to keep all your “anti-resent
ment gimmicks” in. It consists of a bag and string to tie them all
together. It belongs to each. Maybe we could call it a “ginunickchorus.” But anyway here it is, stoleri from “Easy Does It”:
/
z
resentment; and 3) love—ACTIONS of love to eliminate r-.
meats.
1)
IN OUR HOME LIFE.
Humility would tell us that we are not the most important guy
or gal in our home relationship. Wisdom would tell us that being
alcoholic we simply cannot tolerate resentment. Therefore we posi
tively will refuse to “re-feel" any hurt apparent or real, from the
other members of the family. And love demands practice—actions
of love, day in and day out.
The attitude'of humility will avoid many “hurts” or "irritations”
from others in the family. The smaller our “ego” the less chance
there is for it being “hit”—therefore the fewer upsets, irritations,
etc. But being human, and since it is impossible to “eliminate"
the ego, there will be irritations, and fusses, and hurt feelings. The
family who is free from these just doesn’t exist! IL is part and
parcel of life but we do not have to nurse these hurls.
To eliminate those resentments already picked up? M’e simply
refuse to “rc-fecl" any hurt, or irritation, or slight, or whatever
may be directed towards us—actually or apparently. And a con
scientious regular inventory of our own selves will help immensely
toward accomplishing this ability to “overlook" whatever is said or
done to or about us. Then, no "re-sentire”... no “re-feel”—no
resentment!
HOW IMPORTANT CAN IT DE?
So in all of our affairs we practice: 1) humility in order to
avoid irritations; 2) refusing to “re-feel" any irritation to avoid
To eliminate those resentments already picked up? We simply
must practice love! There just “ain’t” no other way. And love
means doing FOR the other—love does not mean "making love."
This latter, this indulgence in passionate loving, in sex is the reward
of love and an expression of love, only if indulged in to please
or increase the happiness of, or to satisfy the other in marriage.
Sex pleasure, sex satisfaction is the human, fleshly part of love
placed there by the Creator to bind "two in one flesh." But when
this is indulged in a selfish way—because WE want it, it will -.-ver
so gradually sap the vitality of both attraction and love. But if
12
33
And if you want to see what we mean, just quietly sit down
and think over all the irritations and resentments that have taken
hold of you for the past month or so? Most of them were over
something that actually disappears when exposed to the importance
of the over-all picture of living happily and soberly and justly—
day in and day out.
indulged in because the other wants it, it will as tilling on the
cake, ever so gradually make one’s love more and more attractive
and beautiful.
But like the cake itself which provides that on which the icing
is able to exist so attractively, you "gotta" have cake or the icing
will fall to pieces and have nothing on which to exist, so with love:
unless there is “cake,” unless there is giving, doing FOR—day in
and day out—there just won’t be any icing because there is nothing
upon which to have it. And this "cake” of love consists in actions
done for the other for no other reason than to please them or sim
ply because you love them. They who practice this giving regularly
will never be troubled with many resentments—neither with those
that are already there, nor with those which might try to creep in.
Okay, lad or lassy, just how long has it been since you actually
did something for your husband or wife, or children JUST BE
CAUSE YOU LOVED THEM? Well, then, what do you expect ? ? ?
Let’s always remember, relative to resentments in the home:
Passion without actions of love, will, whether one likes it or not.
gradually dissipate BOTH LOVE AND PASSION; but ACTIONS
OP LOVE faithfully practiced, day in and day out, will continually
replenish and cultivate and perfect, as far as possible in this vale of
tears, BOTH PASSION AND LOVE. Try it!
no "upset.” ReniSnber, what the Lord once said, "I will repay’”?
So, let’s not expect much from people. (They are all too busy ex
pecting from you!) A good conscience and the approval of God will
be the never-failing result of the habit of looking to God instead of
to people. Even though “the best of men likes a wee bit of praise
now and again.”
There was one individual who claimed he had reached this habit
ual practice of never looking for praise—claiming that all such
“ran oft' him like water oft a duck’s back.” One time after a rather
successful and well-accomplished action, a little old lady came to
heap praises upon him.
"Madam,” he said, "all that runs oft just like water oft a duck’s
back."
"Yes, I know,” replied the lady, "but oh how the duck likes it!”
To refuse to LOOK for it is possible; to refuse to ‘‘LIKE" it
is impossible. We are human.
Yet how many resentments begin with those so-called “slights"
in not being praised or being thanked. How often we hear: “And
to think they didn’t even thank me!"
"Don’t expect from people.”
2)
IN OUR SOCIAL LIFE.
Here again the attitude of humility will tell us that we are not
the most important, or even a “little important” person among our
acquaintances—and no matter who we are we must expect criti
cism, and use all the "gimmicks” we can to avoid irritations. So
for our social intermingling with our fellow man, we will find a
"special gimmick” which should help us very much to avoid those
“hurts,” etc. which seem to constantly try to upset our sensitive
natures. This "gimmick” is: always do the best we can never EX
PECTING praise or gratitude. Why? Well, humans being what
they are, you just won’t get much of either—so no disappointment,
u
And if by chance we have already’ picked up resentments, against
certain of our fellow men, then there is only one way to get rid
of them: Do something good for them, or to them or- in short practice
love—actions of love.
3)
IN OUR BUSINESS.
No man in the business world ever had much business acumen
if resentments clouded his thinking. And in business we wiil be
open to many resentments if we get the idea that we are partiemir
"big-shots” in that business, or in our office. The "bigger” we b’.rv
ourselves up to be in our own minds, the better the "target” i.r
all with whom we come in contact. We must simply, in business, teo.
15
adopt an attitude of humility which would tell us to “work with"
others, and for others, and not demand always to work “over”
others, not emphasize that we are “boss” or “the one who dictates
the policy” or the “one who makes the decisions." Such type people
seldom go very far in the business world; and, if alcoholic, they just
won’t go very far in the world of sobriety. The “boss” who lets
all the world know he is the boss is a “sitting duck" for criticisms,
etc. without end. You know them—big name-plates; name always
qualified “in charge," “manager," etc. etc.; or unique eye-catching
names: “J. Jonathan Doc, Esq."
The successful business man? He has an honest knowledge of
his limitations, doesn’t “brag” about his acumen, but “uses” it in
stead; he has an attitude of humility. One never hears of his suc
cess save from somebody else. When he needs advice, he calls in
an "expert” realizing his need.
“Words” or "criticisms” cannot throw out of focus what he
himself knows of himself. He is seldom irritated.
The "failure”? No matter what actual success he might have
had in business, to hear him tell it "day in and day out” he SHOULD
HAVE BEEN the most successful! “Irritations”—“resentments”?—
just contradict him and watch the explosion!
And if we are resentful of someone in our business, or office?
There is only one answer—actions of love—do something for
them.
4)
IN OUR FINANCIAL AFFAIRS.
Resentments are costly! Remember when we “spent just for
spite”? “I’ll show ’em, I’ll get even, 1’11 just spend it all!" And then
just add up the "costs” on that last spree!
This attitude will keep us from being too upset or irritated or
hurt when we “lose” some money or material things. What was
it Job said? “The Lord gave, the Lord hath taken away”! - No won
der he was so patient—or should we be “mad” at what the Lord
does?
Then there is love: which tells us to share what wc have with
those who have it not. Give! That's what God gave it to us tor.
Particularly to those whom we resent! It works!
5)
IN OUR SPIRITUAL LIFE.
Resentments, 0 resentments, we deplore—
If it weren’t for resentments, we'd be
So happy and so holy—forever more!
“Lousy12—poetry, but one of the greatest truths in the spiritual
life, for it is our conviction that 99.99% of all spiritual ww.: and
sins and failures begin with resentment! And the more we sneak
to people with spiritual problems and sins the more we see of re
sentments. And yet, on analysis we do not ever remember !o Lav
ing heard a talk, or sermon, or retreat conference on resent.
That is until we came to A.A. And as the ycats pass alo:-:-.
and more we can see resentments as the CAUSE OF and ' ■■ kSION OF most spiritual disintegration.
Let’s look at a few:
a) Drinking, drunkenness, alcoholism—usually took hold ir.
the soil of discontentment, resentment.
Whatever we have financially or materially, we have it because
God gave it to us. That is honesty—that is an attitude of humility.
You say you worked for it? Well, then, who gave you the ability,
tlie opportunity, the health, etc., to do so? ? ? Hmmmmmmmmmm?
b) Philandering, divorce, etc.—usually began in resentment, most
men (and women) who started an affair with another woman (er
man) FIRST became discontented with or resentful towards the
other! It was not usually because some “good looking lass” tempted
one to follow. They first turned against or away from the wife—
then anyone is a pushover for any “dame” that might happen along.
Resentments pushed love out, .and the vacuum drew lust in.
16
17
c) Laziness—resentment toward working or working as we
must, or just towards life, albeit unconsciously. It is the back
ground of every “loafer,” of every neglect of duty, and of every just
plain “bum.”
tliat tire opposite of love, which is hate and begins with resentments. '
is the most dangerous enemy to all spiritual life?
6)
d) Gluttony in eating—psychiatrists now tell us, and it is
evident to those who have dealt with such, there are many who
over-cat just for spite, or because of boredom and discontentment
and resentment.
e) Jealousy—this passion feeds on resentment. Jealousy could
never get hold without- resentment coming first. (We speak not of
"normal” jealousy, but of that "extreme type” which spiritual writers
would label "sinful jealousy” and which psychiatry would call "ab
normal”—it leads to revenge, etc. etc.)
f)
Omission of prayers—how many who had such a good start
in the spiritual life, gave up their prayers, and of course their
spiritual living, because of resentments.... "God never hears my
prayers”—“For other people the birds sing"!
g)
Quitting church—most such cases happen because of “what
the pastor said, or did” or “some of the other members of the con
gregation said or did” ... Resentments!
h)
Giving up belief in God—because of the pathological re
sentment towards life, or men, or God....
All of which brings out into full view and gives a depth of
new meaning to that saying of one of the philosophers centuries
ago. His name was Plato: "whom the gods would destroy, they first
make mad"!
The prime enemy of alcoholics, the prime enemy of all spiritual
life—RESENTMENTS!
IN OUR EMOTIONAL LINE.
We can not tolerate resentments! How many ills and woes
of the emotions—begin with resentments! Nervousness, upsets, -eli
sion, fears, and phobias of all types come when our emotions turn
away from the realities of life and, because of resentments, seek
outlandish outlets. The alcoholic? The outlet, the bottle! "Let the
other fellow get mad!" Expect criticism! And all the “gimmicks”
will rush in to help us attain and preserve an evenness of the
emotions, if we use them, and practice them—day in and day out.
And love? It is, when true, the great leveller of life and emo
tion. That love which upsets emotion is not love but either imaiuation or lust. Actions of love will rid our emotions of r.
tendencies—a “hangover” from our drinking days!
7)
IN OUR PHYSICAL LIRE.
Ulcers and tiredness and migraine and allergies and "pains”
in the “neck”—and physical ills of every type, come from r- ■
ment—either conscious or subconscious. Wilk. the advent of
.
somatic medicine, it has been learned that more than 50'-.
apparent physical distress comes from cither known or hidden m
attitudes—mostly resentment. (Many such ills have been
•..
to be from discontentment—resentment against our role in life: eur
profession, social status, nationality, even.our being a "man" or a
"woman"! More and more maladjusted people in marital relations
are finding the cause is resentment against living the role of "ma."
or "woman" which God has given to us.)
But you know something? We should have known that long,
iong ago. For it was long, long ago, when the Lord told us: “Thou
shalt love the Lord thy God with thy whole heart.... this is the
greatest commandment." Then why should we not have realized
Many people have actually cured a "pain in the neck" (“wry
neck” in medical language) by removing the cause, by changing
their job and thus eliminating the boss or fellow worker who l;_d
actually been a "pain in the neck."-
18
19
Many too, they say, have had heart attacks as a result of re
sentments. .Under date of July 25, 1955, we read:
‘'Philadelphia—Want to avoid a heart attack.. . ? ‘Avoid resent
ments,’ Dr. David Gelfand stated here today.
"Dr. Gelfand heads the cardiac work evaluation unit at Phila
delphia General Hospital and in 3% years of careful study lias ex
amined 438 persons.
“He said 46% of the patients—each examined by a cardiologist,
a vocational counsellor, a medical social "worker and a psychiatrist—
have a psychological factor present.
"Resentment that is not expressed or removed goes into the
cardiovascular system, where it tightens the blood vessels. Contin
ued insult to blood vessel tissue results in permaneilt hypotension—
and then, a heart attack.”
(Well that might be a comfort to us in A.A. Maybe many
times those binges prevented a heart attack! ? ?)
In the alcoholic—a “bottle-attack"!
And now speaking of love—families who practice actions of love
are proven to be the healthiest families! And who usually is healthier
than a person in love?
8)
IN OUR THOUGHT LIFE.
Mental aberrations, mental illness, forgetfulness, etc. etc., come
from resentments—which cause retreat from reality. The answer?
Refuse TO RETAIN the thought. And now then that love “busi
ness.” “It’s those we love we think about”—lovingly! No room for
negative, resentful thinking! Simple, isn’t it? ?
9)
IN OUR A.A. LIFE.
Dissention in groups, slips, gossip, slander, splits, and what
have you—all stem from resentments. To the alcoholic—resentments
20
retained mean drinicing—there is no other answer. But how abcii
those in the groups who seem to thrive on resentment: those v.i.c
are constantly “mad at” or “against” something or someone? Well,
they arc “drunks” not alcoholics. They have not the “compulsive"
factor of drink. They can remain resentful day in and day out—
and stay sober. God bless them—lie put them there for the rest
who can not tolerate resentment, to have opportunity to practice
patience, and kindness, and love—and to use "gimmick” after “gim
mick” for protection until one achieves a habit of patience ami tol
erance and love! (Remember, there’s at least one in every group.;
The alcoholic cannot tolerate resentment. That is why so much
of the A.A. program is aimed al achieving those attitudes whies will
protect us from resentment—attitudes of humility (“there are
big-shots in A.A., no seniority, no graduation, etc., etc." “Anonymity"
is to give humility) ; and attitudes of love (“this is a give program,”
“you don’t have to like the “dope,” but you can love him.”)
Resentments, 0 resentments we deplore—
..LLif weren’t for resentments, we’d be
So happy, and so holy and so sober FORE'/ ERiiORE.
And as a parting “gimmick”: It takes a REAL man ar.s. i
REAL woman to LOVE; ANY "nincompoop" can hate!
So, there you have it
SCHEME FOR PREVENTION OF ALCIIOLISM
AND SUBSTANCE (DRUGS) ABUSE.
APPLICATION FROM
l.
Name
and complete address of the organisation /institution/establishment and date of t
establishment.
PROF.SIVARAMAN MEMORIAL TRUST,
47.CHINNIAH PILLAI ROAD,MARA VANERI,SALEM-7,TAMILNADU.
DATE OF ESTABLISHMENT: 8.9.1993.
2.Whether registered under societies registration Act,1860 or any other relevant act of the st;
^povemment/union territory Administration or under any other State Law relating to rcgistrati
()f literacy,scientific and charitable socities or as public Trust and as a charitable company,if sc
a)
Give
name of the Act under which registered: Registered under Tamilnadu Trust Act.
^Registration No.and date of registration
: 354/8.9.1993
An attested photocopy is enclosed.
3.
Whether or not receiving foreign contributions,if so
a)No.and date of the registration certificate issued by the Government of India in the Ministry
Home Affairs under the Foreigh contributions Regulations Act 1976.
(Please attach an attested photocopy thereof)
FCRA NO. and date of registration
: 076000068 Dt 3.3.2000.
▼An attested photocopy is enclosed.
• Our Organisation have not received any foreign contributions till date.
4.List of papers/statements attached.
a)Constitution of Board of Managcmcnt/Govcrning body.etc and the particulars oi .c;
member(i.e/Name,Complete residential address.Parentagc,Occupation with designation)
Separate sheet Enclosed.
The life of the Board of Management (i.e.the last date on which it was constituted and upt
which date may also be indicated)
Enclosed
Constitution/Memorandum
b)
of
Association
and
Byelaws
of
th
Organisation/institution/Establishment.
. Enclosed.
C) A Copy of the Annual Report for the previous year.
Enclosed.
d)A Copy of the Receipt and payments,Income and Expenditure and the Balance, sheet for il
previous three years certified by the Chartered Accountant or a Government Auditor.
Enclosed.
c) Detailed Budget Estimates with breakup of expenditure for which grant is required
Enclosed
jd) Brief note indicating the sources of income,including foreign contribution,if any and al:
^details of assets acquired during the previous three years.
Our Organisation have not received any foreign contributions till date.
Balance sheet and work plan are Enclosed.
Additional information,if any not covered by the above but relevant io the project may also
5.
submitted
NIL.
SIGNATURE
Dr.R.Anandkumar,Managing Trustee.
Name of the Organisation/institution/establisfiment with Office stamp.
Place:
Date:
13
BUDGET I OR SETTING UP 15 BEDDED TREATMENT
-CUM-REHAB1L1TATION CENTRE.
SI.No
Name of the Post
No.of Posts
A-RECURR1NG EXPENDITURE(ESTT)
a. Administrative
1.
Project Director
1
2.
Accountant cum Clerk
1
3.
Sweeper/Chowkider
2
b.Medical
Medical Officer
1.
(Part time)
2.
Counsel lor/Social
work er/Psy c ho 1 o g i st
Yoga/Other therapist
3.
Nurse/Ward boys
4.
Monthly Exp.
Yearly Exp.
7000
3000
4000
84,000
36,000
48,000
5000
60,000
3
12,000
1,44,000
1
2
2000
6000
24,000
72,000
39,000
4,68,000
1
Total A
B.RECURRfNG EXPENDITURE
1,44,000
12,000
Rent
1.
72,000
6000
Medicines
2.
• 60,000
5000
Continengicies( stationery electricity
3.
postage,telephone etc)
4.
Transport/Petrol & Maintenance of
36,000
3000
vehicle.
Total B
3,12,000
26,000
Total A+B
7,80,000
*•
C.NON RECURRING EXPENDITURE
1.
20 beds,tables,3 sets of linens,blankets .other office equipments : 1,50,000
Total
10% Organisation contribution
Total amount requested
= 1,50,000+ 7,80,000 = 9,30,000.
= 93,000
= 8,37.000.
/•/
STAFF MEMBERS FOR DRUG DEADDICTION CUM REIlABILH A I IO
CENTRE.
The following staff members are appointed for the Drug Deaddiction cum rehabilitation centre
•
1.Project Director
2.Accountant cum clerk
Educational Qualification
3. Sweeper
4.Chowkider
5.Medical Officer
6.Counsellor
7.Social worker
8.Physical & Yoga therapist
9.Nurse
10.Ward boys
Dr.R.Anandkumar
: Mrs.K.Geetha
B.Com
Mrs.Manomani
: Mr.Chellapan
: Dr.S.Balaji.MBBS
: Miss.K.Gcetha M.R.S.C.M.A Psychology
Master of Rehabilitation Science
Experience:
Worked as a Counsellor for 6 months in Pudhu vazhvu.
Drug Awareness counselling centre,saIem-4
Worked as a Family Counsellor in Sahodari Family
Counselling centre,Salem.
: Mr.Karikalan
: Mr.Muthu k urn ar,
Qualification: C-P- •
: Kkd. M-LAkSHMI r 8-3^
: Mr.Mani,
IS
COPY OF THE RESOLUTION
Date:
Place:
Subject
Resolution
Seeking Financial assistance for DRUG DEADDICTION It is unanimously resolved that
CUM REHABILITATION CENTRE in Ministry of
Prof.Sivaraman Memorial Trust w
Social Justice and Empowerment in Salem District.
Apply for the scheme and abide b
the terms and conditions of the
scheme.
Appointing Managing Trustee as Project Director
^jpor this project.
It is unanimoulsy resolved that the
Managing Trustee Dr.R.Anandkum;
Of PSMT will be the Project
Director and getting all rights about
The Project.
Dr.R.Anandkumar.Managing Trustee
Executive Members
S.Prema
’’ r>ndmiiii
WLakshtiii Animal
C.lndiraiii
R.Sivakumar
16
JUSTIFICATION AND NEED OF THE PROJECT:
Salem is a place where alchol and other kind of drugs are more prevailing.Most of the men ar
addicted to alchol and other drugs.As a result their family members are suffering including the
children.Our PSMT is already doing Drug dcaddiction counselling in and around Salem distrn
for the past three years,have decided to start a Dnig De-addiction center in salem district./'
such there is no Drug De-addiction cum Rehabilitation center in Salem district and other neart
places.We will be interacting with the Pudhu Vazhu maiyam,which is a Govemme
Counselling center in Salem district.We have conducted a lot of Awareness programme in dn
deaddiction in and around Salem district.Now we have rented a suitable place for running il
Drug De -addiction center in salem district.Necessary alterations have been made in the buildn
to run a Drug dc-addiction ccnterWc have also appointed the necessary st;
members,counsellor,Medical faculties with necessary qualifications and Training and all t
other arrangements are being made to run a Drug De-addiction center.The informatio
regarding the survey and other details arc collected from the Pudhu vazhu maiyam,counselli
center,salem and we have enclosed the case sheet model and Questionnarie for intervention (
Staff members have undergone the necessary Training in Kajamalai Drug D *-A 'diction ci
Rehabilitation center,Trichy.The Training certificates are Enclosed for your reference T
Rental deed for the Drug de-addiction center for 11 months is also enclosed.I.ist of st
in^nbers appointed for the Drug de-addiction center are also enclosed.We have purchased i
necessary Books on counselling,Drugs and other Books for our reference.Being a Medij
faculty and* with an experience in this drug de-addiction programme for 3-yeais,and havi
already the necessary staff members to run the programme,it is justifiable for our Organisation
run a Drug Dc-addiction center in salem district.
17
STAGESAND MODALITIES OF TREATMENT
1 .Identification and screening the addicts.
i^iMprivation for treatment.
^^0itment-Medical and Psychological
^.Rehabilitation
TREATMENT
1 .Medical:
a.
Detoxification
Control of with drawal symptoms
b.
Body restructuring
c.
Aversion thcrapy-Disulfrim treatment.
d.
2.Psychological treatment
lndividual counselling
a.
b.
Group
therapy
Family therapy
c.
Yoga and1 exercise therapy.
d.
Follow-up’1 ii
Follow-lip will done in Medical and psychological treatment
AA (Alcliolic Anonymous)
Forming an association of Ex addicts and others for improving their self confidence.
18
■ PROF.SIVARAMANMEMORIAL TRUST
MARA VANERI, SALEM-7
DRUG DE-ADDICTION CUM REHABILITATION CENTR
Psychatrist:
Counsellor:
Social worker
Follow up No:
Registration No:
Date of Discharge:
Date of Admission :
Sex:
Age:
Name :
Father’s Name:
Reffered By:
Address:
Religion :
Educational Status:
Income:
Mother tongue:
Marital Status:
Occupation:
Diagnosis:
Prug.H.iapry :
Drug .
Informant
Pose
Duration
Year
Client
Present complaints:
Client
Informant:
Treatm
Reasons for Abusing Drugs:
Informant:
Client:
Past history
Year
Duration
Treatment
Physical illness:
Mental illness :
Suicide Attempt:
PERSONNEL HISTORY
Delivery:
Feeding:
Birth Order:
Developmental Mile stones:
Upbrining
Day Time care:
Childhood disorders:
Fcars/Phobias:
PREMORBID PERSONALITY:__________________________________________ __
Chronological History_____ 5 to 10
10 to 15______15 tO 20________ Above 20
Scholostic
Achievements
Aspiration
Hobby, -i-V.
Play
---------- —
Extracurricular activities
Sociability with
Neighbours
Relatives
Friends
Organisations
Clubs
Significant
Events___________
OCCUPATIONAL HISTORY
Age
Jobs Held
Income
Present position
Reasons for change
Satisfaction
Dissatisfaction
SEXUAL HISTORY:
Puberty:
Age of Onset:
Sex Knowledge at the age of:
Pre marital experience:
Menstruation:
Masturabation:
MARITAL HISTORY:
Age :
Love/arranged/forced ;
Age at the birth of first child:
Spouse:
Age:
Education:
Occupation:
Children:
Bom:
Alive:
Died:
Adjustement:
1.
4.
Personality:
Pregancy/Abortions:
Reasons for maladjustment:
3.
6.
2.
5.
Sexual Relations:
Disorders:
Extramarital Experience:
Mental illness:
History of family illness:
Suicide Attempt:
Addiction :
FAMILY HISTORY
House :
Neighbours:
Relations Between:
Falher/Mother
Clicnt/Father
Siblings:
Client/Mother:
Family
Client/In-laws
Type of Family:
No.
Name
Relation
Age
Sex
Education
Occupation
Income
Person a 11
PHYSICAL STATUS:
Weight
General
Systems:
CVS
RS
CNS
ABD
OTHER
>
MENTAL STATUS:
Generral Appearance:
Attitude:
R ■
tklehtiilon:
!•
ilUtihory: .
Thinking:
Height
B.P
Body Built
Pulse
Perception:
Mood:
Intelligence:
Insight:
II
Judgement:
Motivation:
PRESENT PROBLEMS:
School
Sexual
Fa in i I ia 1
fi n ancial
"
occ u pa t i o i
FAMILY THERAPY
DATE
SUBJECT
COUNSELLOR FAMILY
MEMBER
j REMARKS
I
I
8
y- /uum
(^ujuai UJGrrKQff
GROUP THERAPY
DATE
NO.OF
SESSIONS
SUBJECT
PSYCHIATRIC
SOCIAL
WORKER
REMAR
Q
FOLLOW - UP CARD
KffC HOSPITAL
Name of the patient:
Date of admission:
Occupation:
Age :
Marital Status :
Name of Wife / Mother :
Type of drugs abused:
Reg. No:
Address & Phone:
a) Residence:
Counsellor:
Duration of abuse:
TTR / Self-Payment / Company:
Medicines on discharge:
- Disulfiram / Disulfiram P
b) Work Place:
Date/
Month
Sober/
Relapse
Counselling
Name of support persons with address and phone No.:
Residence:
1.)
2.)
Details of
Communication
Date/
Month
Sober/
Relapse
Work Place:
Counselling
Details of
Communication
ft
HIGH RISK SITUATIONS / LIFE STYLE
Presence of co-morbidit^Specify)
YES
Present
Absent
1.) Medical problems
Family member living with him drinks
Drinking in the work environment
On shift duty
Travelling on work frequently
2.) Psychiatric problem (specify)
a) Depression
b) Mood disorder
c) Psychotism
d) Personality disorder
e) Any other
Lives alone
Having EMR at present
Problem gambler
Unemployment
Any other
CHARACTER DEFECTS
NIL
MILD
MODERATE SEVERE
Debts - Amount
Perfectionism
Grandiosity
Impulsiveness / Impatience
Over sensitive
Lazy
Arrogance / Defiance
Selfishness
Anxiety
Anger
Lack of assertiveness
Withdrawn
Denial
Any other (specify)
ISSUES IN FOLLOW-UP
Non-availability of AA in home town
Lack of resources to come for follow-up
Issues in family relationship
YES
NO
Inability to get leave / not able to leave work
Any other (specify)
Referral to ACC / Any other Centre / Vocational Therapy :
Patient's'level of involvement V.Poor Poor
Average
Good
Excellent
Family’s support
V.Poor Poor
Average
Good
Excellent
Prognosis
V.Poor Poor
Average
Good
Excellent
MH- "BA.
Hospital
T T RANGANATHAN CLINICAL RESEARCH FOUNDATION
IV MAIN ROAD, INDIRA NAGAR, CHENNAI 600 020
IN-TAKE FORM
Regn. No.
:
Counsellor’s Name
1.
Name in BLOCK letters
:
2.
Date of
:
Admission at detox ward
Admission at therapy ward
:
Discharge
3.
Sex
Year of birth
Age
Religion:
Hindu
Christian
Jain
Muslim
Parsi
Any other
4.
5.
Religion
Caste
Caste:
=
=
=
=
=
=
H
C
J
M
P
Z
Forward Caste
Backward Caste
Scheduled Caste
Scheduled Tribe
Years of education (Mention only no. of years):........
Illiterate
= 0
1to12
= 1 to 12
B.A.,B.Sc.,B.Com.
= 15
B.L., B.Ed.
= 17
M.A.,M.Sc.,M.Com.,
Medicine, Engineering
Accountancy
Qualification
Primary & Secondary
Higher Secondary
Graduate
Post Graduate
Pre-Doct., Ph.D.
Engineer
Medicine
PG Medicine
=
=
=
=
=
=
=
=
A
B
C
D
E
F
G
H
=
=
=
=
M.Phil, Post Graduation
in Engineering, Medicine
Ph.D.
Accounts
Law
B.Ed.
Diploma in ....
MBA
Any Other
Not applicable
=
=
=
=
=
=
=
I
J
K
L
M
Z
NA
F
W
C
T
=
=
19
22
6.
Can read and write
Can only read
Cannot read and write
7.
Permanent address:
8.
Contact Person: Local address (for emergency)
9.
Names and addresses of two support persons with telephone Nos., indicate relationship:
Telephone No.
Patient Res.:
Off. :
Family
Off. :
Email:
Telephone No.
Off. :
Res.:
Telephone No.
Email:
Telephone No.
Email:
10.
Living Arrangements :
Reside in family units (parents I spouse I children I siblings)
Live with friends or distant relatives
Live alone (own place, lodge) Details
Institutional arrangements - Details :
Transient - Details:
11.
Urban (U) / Rural (R)
12.
Language which you are most comfortable with
(indicate I & II priorities)
Tamil
= T
Hindi
= H
Malayalam
= M
Kannada
= K
Urdu
= U
Bengali
= B
=
=
=
=
=
A
B
C
d
e
Marathi
Gujarathi
Telugu
English
Oriya
Any Other
=
=
=
=
=
=
R
G
L
E
0
Z
13. Language which your family member is most comfortable with (indicate I & II priorities)
= T
Tamil
Marathi
= R
Hindi
= H
Gujarathi
= G
Malayalam
= M
Telugu
= L
= K
Kannada
English
= E
= U
Urdu
Oriya
= 0
Bengali
= B
Any Other
= z
2
14. Marital Status
Married
Single
Separated
Widower/Widow
Divorced
Any Other
(living together
without marriage)
15. Occupational Status
Employed full time
Employed part time
Unemployed
Retired
=
=
=
=
=
|
T
W
=
Z
=
=
=
=
E
P
U
R
=
=
=
=
=
=
=
=
=
=
U
K
O
E
B
I
L
G
R
A
m
d
16. Occupation Type
Unskilled /Semi
Skilled Labour
Skilled Labour
Tailor
Executive
Business
Student
Lawyer
Engineer
Sales Representative
Accountant
€
17.
I ncome per month
18.
Place of employment
Name & address
Teacher
Farmer
Defence Services
Housewife
Social Worker I Psychologist
Clerical
Doctor
Retired
Any Other
Not Applicable
19. Prior treatment for addiction
If yes,
Yes
Duration of
Treatment
(days)
Year
T reatment at TTR
Other Addiction Centres
Psychiatrist
(In / out-patient basis)
At General Hospital
At Nursing Home
Traditional Treatment
Any Other
= T
= A
=
=
=
=
=
P
G
H
D
Z
3
=
=
=
=
=
=
=
=
=
=
T
F
D
H
P
C
M
Q
Z
NA
No
Period of
Abstinence
(days)
Name of
the place/
Doctor
20. Any previous attempts to abstain from alcohol / drugs for more than two weeks (Other than organised help
for example, pilgrimage, self-effort, etc.).
______________________________
Year
Periods of
abstinence
Method used
Motivating
factor
(any crisis)
21. Referral:
Family / Wife
=
Employer
=
Recovered Alcoholic
Media / awareness programme =
Self
W
E
A
M
I
Physician / Specialist
Mental Health Professional
Friend
Government Hospital
Any Other
22. Diagnosis :
=A
=D
Alcoholism
Drug Dependence
Alcohol and Drug
Dependence
Poly Dependence
= AD
= PD
FAMILY HISTORY
Details regarding parents
(if alive)
23. Father's age :
Occupation
24. Mother’s age :
Occupation
(if not alive)
Reason for death -
Father :
Mother:
25. In case of death of parents,how old were you at that time?
Father's death :
Mother’s death
Not applicable = NA
....
years
years
4
= P
= H
= ■ F
= G
= Z
26. Details regarding siblings (write according to the order of birth).
Relationship
27.
Education
Occupation
Remarks
Order of Birth
First
Middle
Last
28.
Age
=
=
=
1
2
3
Only Child
Only male
=
=
0
4
Health Status of Family
Has there been anyone in your family who has suffered from any of these problems?
II Degree
Grand Parents
Parents’ Siblings
I Degree
Parents & Siblings
Problems
Yes
Major Depression
= M
Suicide /
attempted suicide
= U
Psychiatric illnesses
= P
Alcohol Dependence
= A
Drug Dependence
= D
Gambling
= G
Any Other
= Z
Rela
tion
No
Don't
know
Yes
Rela
tion
No
Don’t
know
In the case of addiction, not to include social drinkers or occasional drinkers. Addicts are those who have
had one or more of these problems.
Marital I job / legal problems ; Alcohol withdrawal symptoms; Physical impairment; Blackouts ;
Social disapproval
5
29.
Were there any deaths in your family due to alcoholism / drug dependence.
No
Yes
If yes, indicate relationship.
1 Degree
Relationship =
11 Degree
PERSONAL HISTORY
30. Did you experience the following before the age of 15 years?__________ ____________ ___________
Present
Code
Absent
Situations
A
B
C
D
E
F
G
H
Z
- Poverty / severe debts / sudden economic changes
- Parental loss
- Separation from parents
- Extra-maritai affairs of parents
- Broken home / single parenting
- Frequent family conflicts
- Violence in the family
- Punitive parenting (too strict and punishing)
- Any other
- None
(
31. Childhood / Adolescence (before the age of 15 years)
Behaviour problems Identified
Code
Truancy
Running away from home
Frequent physical fights
Forced someone into sexual activity
Cruelty to animals
Physically cruel to other people
Destruction of others property
Lying frequently
Stealing
Scholastic backwardness
Excessive indulgence in money / movies
Experimenting with drugs / alcohol
Gambling
Any Other
32. Achievements identified
Responsible
Good academic records
High achiever
(Extra curricular activities)
Present
A
B
C
D
E
F
G
H
I
J
K
L
M
Z
Present
-A
-B
-c
Ab
sent
33. The relationship with parents and significant others during childhood as perc
;eived by patient.
6
Absent
34.
Anti-social personality during adult life :
(Presence of 4 or more before the onset of problem drinking)
Unable to continue with job I school (repeated absences or
resigning job without planning / 6 months of unemployment)
Involving in unlawful activities-stealing, destroying property,
harassing others, illegal occupation.
Irritable, aggressive (including spouse and child beating)
Failure to honour financial obligations
Impulsive behaviour (leaving home without any plan, no address).
Repeated lying
Drunken driving, recurrent speeding
Inability to function as a responsible parent
(not providing medical care, not providing for basic needs,
repeated squandering of money)
Inability to sustain monogamous relationship
Lacks remorse (feels justified in hurting, stealing, etc.)
HISTORY OF ALCOHOLISM
35.
36.
37.
38.
How old were you when you had your first drink?
How many years were you drinking regularly
(at least once a month) without any problems
..............
How many years has your drinking been creating problems?
Describe below the pattern of alcohol use :
If possible demarcate 2 or more stages of drinking in chronological order, starting with the recent past. It
is important that atleast the recent pattern of drinking should be described :
Type of
Beverage
Total Quantity
in a day
Frequency
Day/Month
Duration in
years
Frequency
Type of beverage
Beer / Toddy
=
T
Once a fortnight
=
1
Wine
=
W
Once a week
=
2
Brandy / Rum / Whisky / Gin
=
R
2-3 times a week
=
3
Arrack
=
A
4-5 times a week
=
4
Once a day
=
5
Twice or more a day
=
6
Binge
=
7
7
Quantity
1/4 bottle / 3 pegs /1 pkt. of arrack
1/2 bottle / 6 pegs 12 pkts, of arrack
3/4 bottle I 9 pegs 13 pkts, of arrack
1 bottle 112 pegs / 4 pkts, of arrack
More than 1 bottle
39. Malt - Munich Alcoholism Test (Tick True or False) :
_________________________
False
True
a. My hands have been trembling a lot recently.
b. In the morning I sometimes have the feeling of nausea
c. I have sometimes tried to get rid of my trembling and nausea with alcohol
d. At the moment I feel miserable because of my problems and difficulties
e. It is not uncommon that I drink alcohol before lunch
f. After the first glass or two of alcohol I feel a craving for more
g. I think about alcohol a lot
__________
0
h. I have sometimes drunk alcohol even against my Doctor’s advice
i. When I drink a lot of alcohol, I tend to eat little
j. At work I have been criticized because of my drinking
k. I prefer drinking alone
I. Since I have started drinking I have been in worse shape
m. I have often had a guilty conscience about drinking
n. I have tried to limit my drinking to certain occasions or
to certain times of the day
o I think I ought to drink less
0
p. Without alcohol I would have fewer problems
q. When I am upset, I drink alcohol to calm down
r. I think alcohol is destroying my life
s. Sometimes I want to stop drinking and sometimes I don’t
t. Other people can’t understand why I drink
u. I have sometimes tried to get along without any alcohol at all
v. I would get along better with my spouse if I didn’t drink
w. I’d be content if I didn’t drink
x. People have often told me that they could smell alcohol in my breath.
8
To be assessed by the Physician
a. Diseases of the liver (at least one symptom found on physical
examination in addition to one positive laboratory test)
Yes
No
b. Polyneuropathy (only if no other cause is known, e.g., diabetes mellitus)
Yes
No
c. Delirium tremors (on the present examination or previously)
Yes
No
d. Alcohol consumption of more than 150 ml (women 120 ml)
of pure alcohol a day at.least continued over several months
Yes
No
e. Alcohol consumption of more than 300 ml (women 240 ml)
of pure alcohol at least once a month (alcohol benders)
Yes
No
f.
Yes
No
Yes
No
Foetor alcoholicus (at the time of medical examination)
g- Spouse, family members or good friends have sought help
because of alcohol related problems of the patient
(e.g. from a physician, social worker or other appropriate source)
Score of MALT =
-1 point for each ‘True’ answer
Questionnaire
Medical component items
- 4 points for each ‘Yes’
Less than 6 points
- no evidence of alcoholism
6-10 points
- suspicion of alcoholism
11 or more
- alcoholism
DETAILS OF DRUG TAKING
40. Record all details about drugs abused (exclude alcohol):
Drugs
Age
of
first
use
Years
of
exces
sive
use
Speci
fic
type
of
drugs
Frequency
Route of of use in
adminis the past
tration
6 months
Depressants
T ranquilizers,
sedatives /
Hypnotics
Narcotic
Analgesics
Opium,
Heroin/
brown sugar,
Morphine,
Codeine,
Pentazocine
Buprenorphine
9
Quantity
used in
the past
6 months
Past
use
if any
Primary
/secon
dary
Age
of
first
use
Drugs
Years
of
exces
sive
use
Speci
fic
type
of
drugs
=0
=1
=2
2-3 times a week
4-5 times a week
Once a day
Twice or more a day
Route of
adminis
tration
Frequency
of use in
the past
6 months
Cannabis
Ganja, Charas,
Bhang
Stimulants
Amphetamine
Cocaine
Hallucinogens
LSD, PCP
Inhalants
Petrol, Glue
Substance not
classified
Cough syrup,
Anti histamine /
Anti depressant/
Anti psychotic /
Anti cholinegic
(Frequency of use codes)
Never used
Once a fortnight
Once a week
=3
=4
=5
=6
Route of administration
oral
Smoking/chasing
Intravenous
=1
=2
=5
Inhalation
Intramuscular
Not Applicable
=3
=4
= NA
41. If the patient is an IV user, frequency of sharing practices
Sharing practices
Never
- N,
Occasionally -0,
Needle
Needle and syringe
Paraphernalia
Drugs
10
Rarely
-R
Frequently-F
Quantity
used in
the past
6 months
Past
use
if any
Primary
/secon
dary
42. Score of DAST
43. Other compulsive behaviour (within 5 years)
Compulsive behaviour
Frequency
Circumstances
Gambling (cards, betting
on horses, lottery)
Casual sex
Frequency
44.
Circumstances
N - Never
N - Never
R - Rarely
A - Only under the influence of alcohol
O - Occasionally
B - only when not drinking
F - Frequently
C - Both
Tobacco Use:
Tobacco
No
Yes
Smoking
=S
Chewing tobacco / snuff
=T
Pan Parag
=P
Zarda Pan
=Z
OCCUPATIONAL HISTORY
45.
At what age did you start working? ...........................
Not Applicable
= NA
46.
How long have you been working?
47.
Did you change your job frequently due to drinking?
..........................
Yes
If yes, how many jobs have you changed in the last 10 years due to drinking?
11
No
48.
Did you have any periods of unemployment in the last 5 years?
No
Yes
If so, for how long and for what reasons?
49.
Specify nature of current work:
50. Have you been subject to the following?
Business/
Agriculture
Yes
Regular
Employment
Impact of addiction on work
No
Yes
A- Absenteeism
Warning / Memos
Suspension order
Dismissal order
Transfer order
Loss of pay
Accidents on the job
Deterioration in quantity
& quality of work
Attend work under the
1 influence of alcohol
Not fulfilled financial/
other commitments towards
J employees
Closed down business,
faced major loss or
K given on lease
Not applicable
=
=
=
=
=
=
=
A
B
C
D
E
F
G
=
H
=
|
No
=
51. Have you received any special award, recognitions, merit certificates or promotions?
Yes
No
52. Occupational damage (as perceived by the Counsellor)
12
Mild
Moderate
Severe
Financial
59.
Moderate
damage as perceived by the Counsellor.
60.
The impact of financial problem on patient/ family I others.
Provide details.
61.
Details regarding spouse:
Severe
MARITAL HISTORY
Name
Age
Religion
Education
Occupation
Income
Not Applicable
= NA
Other details about spouse (history of addiction in her family, her drinking history, any other significant
event in her life, attitude towards drinking, etc.)
62.
63.
No. of years of marriage
Is this marriage arranged or by choice?
Arranged
64.
=
Choice
A
= C
If by choice, accepted by family (present status)
if no, give details
Yes
No
Details regarding previous or subsequent marriages of patient, if any
Yes
No
(If yes, provide details)
65.
Health status of spouse / children
Spouse
Suicide or attempted
=
M
U
Psychiatric problems
Alcohol Dependence
=
=
P
A
Drug Dependence
=
Mental Retardation
=
Childhood behaviour disorder
(conduct disorder, attention
deficit, school refusal)
=
D
R
C
Not Applicable
NA
Major depression
=
=
14
Children___________
66.
Have you been separated due to your drinkih'^H IJAUX
:
Yes
If yes, No. of times separated
Longest duration of separation
Not Applicable
= NA
67.
No. of children
Age
<y
Sex
Education
Occupation
Income
Marital
Status
Behaviours
Problem
If, any
____
68. If there are no offsprings, state reasons:
Medical Reasons
Due to drinking
Personal choice
Married for a short duration
Any other
=A
=B
=C
=D
=E
69. Is patient suspicious of wife?
While drinking
Yes
No
During abstinence
Yes
No
If yes, details
Not Applicable = NA
70. Any instances of family violence?
(please indicate N = never, R = rarely, 0 = occasionally, F = frequently).
While drinking
Physical violence directed
towards spouse / children/
parents / siblings
A
Verbally abusive
B
Violent incidents with
neighbours and outsiders
C
Breaking articles at home
D
During abstinence
71. Damage to the family system as perceived by the Counsellor.
Mild
15
Moderate
Severe
SEXUAL HISTORY
Present
72. Record pre / extra marital experiences
If sustained relationship is present
- Age of partner:
- For how many years have you
known each other?
N/A
Absent
- What is the living arrangement?
Separate house
Both wives live together
Lives with her parents
Lives with her husband / children
Any other
- Any children through patient
Yes
Details
No
73. Have you been involved in any high risk sexual activities?
Always
Yes
Sometimes
Yes
Sometimes
Yes
No
Sex with commercial sex workers
If yes, did you use condoms
Sex with casual acquaintance
If yes, did you use condoms
74. Have you been tested for HIV?
Always
No
Never
No
Never
If yes,
Positive / Negative
Not willing to reveal
Not collected Reports
Not Applicable = NA
75. At present do you have any sexual problems?
If yes,
Reduced libido
= R
Impotency
= 1
Excessive sexual urge
= E
Complete abstinence
= C
Any deviant behaviour
= Z
Yes
No
N/A
76. Have you driven a vehicle under the influence of alhocol?
If so,
No. of times......
- Stopped by police
- Arrested / fined
- Had an accident (major or minor)
Yes
No
77. Have you got into trouble with law for the following?
Yes
No
LEGAL HISTORY
- Assault
- Possession of drugs
- Pushing drugs / sale and production of alcohol
- Any other crime
16
?ADJyiST^ENT-P^ERNS
78. Inter-personal relationship (present status)
Relationship with spouse
children, parents, siblings
Spouse
No family
(dead or living distant)
_ a
Disowned by family or
vice versa, mutual
rejection
= B
Mixed or indifferent
feelings
= C
Usually friendly,
minor conflicts
= D
Supportive
= E
Not applicable
= NA
Children
Parents
Siblings
79. Leisure time activities or hobbies:
Record: never.= N, rarely = R, occasionally, = O, frequently = F.
Before
_____________ Activities___________________
Playing Games, Physical
exercises
=
A
Going to movies, dramas
=
B
Watching T.V. / Video,
listening to music
=
V
Reading
=
L
Visiting and entertaining
parents,
siblings
other relatives
friends
=
1
Hobbies / talents
(playing music
painting, etc.)________
=
H
RELIGIOUS BELIEFS
80. Are you a
believer
non believer
indifferent
=
=
=
B
E
I
81. Do you (record never = N, rarely = R, occasionally = O, frequently = F
Visit temple
Go on pilgrimages
Celebrate festivals
Have prayer at home
=
=
=
=
A
B
C
D
H
17
After
8M1PddNg^^Tr?FbWM
The following information has been explained to me :
1.
The possible consequences of any intake of alcohol while on disulfiram.
2.
The side effects of disulfiram.
3.
I am hereby informed that should I ingest even a small amount of alcohol while taking disulfiram, I
will probably experience a highly unpleasant reaction consisting of flushing, palpitation, vomiting with
a possibility of aspiration. I am hereby informed that a fatal reaction as a result of consuming alcohol
while taking disulfiram is a possibility.
Knowing and having been informed of the risk involved as noted above, I agree to refrain from the use
of alcohol.
I hereby accept the full responsibility of taking disulfiram.
Signature of a
responsible person / relative
Signature of the patient
Address of the responsible person / relative
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THERAPY CHECK LIST
Month / year of admission
1.
Name of the Patient
2.
Name of the Counsellor
3.
Diagnosis
Regn.No
4.
A
Participation in family programme
Average
Good
PD
AD
D
Poor
Wife
Father/Mother
Children
Other family members
If the family did not attend 50% of family programme, state reasons
5.
Support person
Active involvement of support person
(during treatment)
Present
Absent
Good
Average
Poor
Relationship of support persons
(check if you have written the names and addresses - ‘very important’)
6.
Indicate N = Never, R = Rarely, O = occasionally, F = Frequently
Behavioral observations
Restlessness
Irritability
Not attending / coming
late for classes and counselling
Demanding
Critical of facilities
Argumentative and aggressive
At admission
C
D
E
F
Yes
7.
At discharge
A
B
Reluctant to change
Drinking while on outpass
G
H
Experimenting with drugs / alcohol
on premises
Planning future drinking
Not willing to take Disulfiram
I
J
K
Denial on admission
Denial on discharge
Nil
Nil
Mild
Mild
No
Moderate
Moderate
Yes
Severe
Severe
No
MOTIVATION AT DISCHARGE
Behavioural observations
8.
Acceptance of alcohol / drug addiction as problem
9.
Presence of guilt / remorse about
consequences of drinking
Total
Partial
10. Acceptance of total abstinence as a goal
11. Willing to take disulfiram
12. Willing to make changes in oneself
13. Recovery is hindered by severe physical problem.
14. Recovery is hindered by psychiatric problem.
15. Recovery is hindered by lack of family support
16. Recovery is hindered by severe financial problem.
17. Additional indicators:
Yes
No
Referral by Employer
Exposed to AA meetings
Past history of abstinence
Short duration of addiction / early phase
18. Attitude of patient towards programme
Excellent co-operation
Moderate co-operation
Low co-operation
Non co-operation I drop out
19.
In case of drop out, give reason
Physical I Pschiatric problems - A
Inadequate motivation
- B
Inability to get leave
- C
Lack of family support
- D
Legal problems
- E
Any other
- Z
20.
In case of extension beyond one month, record period of extension and reasons for extension
Nil
VERY IMPORTANT
21.
Please fill up this column. In case of 'no news’ we need two addresses other than that of patient for
contact.
Relationship
Telephone
Name and Address
22. Baseline data with regard to patient's functioning at the TIME OF DISCHARGE
Physical well being
I
2
3
4
5
Gainfully employed
1
2
3
4
5
Financial stability
1
2
3
4
5
Crime free
1
2
3
4
5
Healthy relationship with
family members
1
2
3
4
5
5
23. Recovery Status at the end of SIX MONTHS
Alcohol / drug free life
0
1
2
3
4
Physical well being
0
1
2
3
4
5
Gainfully employed
0
1
2
3
4
5
Financial stability
0
1
2
3
4
5
Crime free
0
1
2
3
4
5
Healthy relationship with
family members
0
1
2
3
4
5
Alcohol/drug free life
0
1
2
3
4
5
Physical well being
0
1
2
3
4
5
Gainfully employed
0
1
2
3
4
5
Financial stability
0
1
2
3
4
5
Crime free
0
1
2
3
4
5
Healthy relationship with
family members
0
1
2
3
4
5
24. Recovery status at the end of ONE YEAR
Counselling Notes:
Session
No. & Date
With whom
Summary
1. Demographic details
2. Family background (family of origin)
3. Alcohol I drug use history
4. Medical history
5. Occupational history
6. Financial situation
7. Marital history
8. Social support available
9. Counsellor's impression
10. Short and long-term goals
Key issues dealt with
MH -
-I have the Honour and privilege to present this paper on
“Drug-Abuse prevention and Treatment of the Drug addicts
and camp approach” undertaken of Manaklao De-addiction
centre and Mobile camps before the honourable delegates of
FINGO-DAP.
The history of Drug abuse in India is very old, because in India
drug-use is well knit with her cultural and traditional heritage. In old
days there was common use of SOM-RAS
(essence derived
from the natural herb) and in later on the Som-Ras was substituted
by the BHANG/GANJA/CHARAS and OPIUM. The Bhang, Ganja
and Charas became popular in Faquirs,
Baba and Saints
(Maditational-class), whereas the opium in its different shapes and
varieties became much more popular in Rural and Urban Class.
Mostly it is being taken in solid state, liquid from or smoking as
Madak or chandu etc. etc.
Gradually opium-use became the part of Cultural and Royal
tradition. The warriors of old days used it as a medicine while
fighting in battle-field and Rajputs were the formost class to join
armies, thus opium-spread was commonly seen in West Rajasthan,
which has long rooted in families, generations after generations, and
became a symbol of social custom. There are community meets
called as “RIYONS” or Hathai where people assemble and opium is
offered amongst each other. The refusal is taken as dishonour of the
Hathai and enemity starts. In various social occasions or family
customs just as-pleasure, on child birth (boy), purchase of cart, land
or property etc., engagement or marriage ceremonies, removal of
old enemity (xWit) or call for unite to face battle (vl^) or on the
occasion of death of a person. It is seem in poor working class that
working mothers use to give a piece of opium to an infant to keep
him under sleep so that she may be free to do labour.
The values of life gradually changed, so as with time the traditional
drug abuse is changed. The taste of drug-demand diverted from
opium to Barbaturates, Sadatives Heroin, Smack (Brown Sugar)
etc. and young boys and girls of big cities and from affluent families
begane to use this drug. The present average is 20 to 40% of the
youngster who are dependent of these dangerous drugs.
INCEPTION OF CAMP APPROACH IN TREATMENT
OF ADDICTION
(A)
Origin
The belief that, it is rather impossible to give-up opium in ones
lifetime, is creation of pushers and it gained momentum by the
failure of adequate treatment of detoxification in Government
hospitals and institutions. Hence addition of drugs grabed rural
population day by day.
In the year 1978 Government of India launched a programme for
uplift of persons living below poverty line and loaned amount to
various persons for self employment i.e. purchasing Livestock. But
all were squandred away only to sustain daily opium or drug
consumption. The auther of this paper, a former University-lecturer
and than Mayor (Sarpanch) of the village MANAKLAO realized the
seriousness of the drug-abuse problem. His constant meet with local
Doctor Mr. B.R. vyas, member of the addict’s families, philanthropic
societies and addicts themselves, could help him to conceptualise
the plan to start a treatment-means to detoxify those persons and to
eradicate opium abuse dependency. The auther came forward and
started First-Deaddiction Camp in the Year 1979, at Manaklao and
Dr. Vyas stood with him as medical expert.
(B)
Method of Treatment :
The method of Camp treatment-service has its unique technique
and the way of handling, the addicts who are taken under
treatment, is also uncomparable. No addict in de-addiction camp is
taken as a patient but is accepted as sufferer of social evil. Thus the
difference in the treatment between hospital or Medical Institute and
Drug de-addiction Camp is quite obvious. Hospitals believe in a
system of treatment, where as in de-addiction camps concentration
is given on S.O.S., and each addict is served individually. A hospital
could treat a patient, when de-addiction camp helps and addicts to
get himself relieved from the habit of drug abuse through Love,
Affection,
Selfless service,
dedication,
religious,
spritual and
emotional touch, along with needed medical aid. The Camp
treatment therapy has given grand success in its results.
But one basic point is that whosoever is willing to be relieved from
drug dependency, writes himself case history of his own, along with
his postal address. His name is registered in Registration record and
when de-addiction Camps are organized there registered addicts are
invited and admitted for detoxification.
(C)
The bound daily working programme of De-addiction
Camp.
One de-addiction camp runs for 10 days at de-addiction center but
in mobile camps the duration is for 15 days. When camp started the
burning problem was a opium dependency and limitation was up to
Rajasthan only, but later days many addicts came who were addicts
of Mendrex, Chandu, Madak, Ganja, Heroin and Doda (Dried cells
of opium fruit). The careful observation of behaviour and acceptingattitude towards the camp therapy of these addicts could give us
wide experience to detoxify them at minimum pains and troubles.
This successful treatment of various drug-abusers of different
economic-class gave us chance to organize a Smack-detoxification
camp at Delhi in Kanjhawala village 33 Km. Away from city on
Nangaloi Road. Its further success compelled us to held a de
addiction camp at Bangalore.
Now the camp strategy of 10 days, treatment is putforth for detailed
information
First day is the medical checkup & admission day; because history
of every addict which is already kept in record gives the real picture
of his habits, behaviour, attitude and health. After check-up and
admission for de-toxification treatment the period of 9 days is
devided in three phases.
First Phase is of three days i.e. 2nd, 3rd & 4th day. In this period
addict gives-up the drug-dose and falls to severe physical
withdrawal symptoms, which differs from man to man due to his
bodily and mental tendencies. By the Second and Third day
Insomnia, Anxiety, Vomiting, Diarrhea, Body-pains, Crams in limbs,
Muscular, Abdominal and Chest-pains develop, which upset the
mental balance of addict and he starts to act under nervousness.
Some times even blood-pressure goes down and an addict comes to
collapsive condition. These are the days when Doctors, Nurses and
Social workers and deaddicted volunteers service, is required. Here
medical-aid plays its major role in bringing up an addict to safer
condition.
Mild Tranquilizers,
non-narcotic analgesic
and
if
necessary fluid replacement and Vitamins are administered.
Besides this, the spritual therapy is done. Prayers are done at the
worshipping comer already reserved in the De-addiction camp,
where all the campers assemble willfully, forgetting their bodypains
and emotionally they pray to the “GOD” to help them to get
courage to face the pains and troubles of the de-addiction period
and make them bold to live in there future-life de-addicted and
good-natured citizen. This prayer is done every day in morning and
evening
in
all
the
three
phases.
The
inmates
becomes
psychologically prepared to detoxify themselves in any condition
but each and every camper is handled carefully and emotionally
around the clock specially by those volunteers who de-addicted
themselves while attending such camps in past and are well-
acquainted with the behavioural tendencies of the inmate under
treatment. There are group meetings in nights with painful campers
and due consolation is being given by co-friends who were drug
dependent in past but are good faithful brothers in present. Thus the
myth of death that had a psychosis, in addicts mind disappears
automatically and he starts to think in other optimistic way.
Second Phase is of 5th, 6th & 7th day period when an addict of
yesterday feels de-addicted and his withdrawal symptoms are
reduced to that level that he begins to feel as if he has come out
from the Hell. The 5th day morning-sun rises with the new ray of
hope of new life for campers. They all begin to think with an
astonishment that a few days back they could not pass a few hours
without the drug and had lived for 4 days without it and no harm
had been done to them without taking it. Thus they come forward
willfully to undergo group therapy and hug therapy which give them
mental courage to face the life without drug dependency. In group
therapy some topics are discussed, new ideas are cultivated in their
minds, fold and devotional songs are sung, recreational activities,
indoor and outdoor games, light physical exercises of Yoga are
arranged to boost moral and interest for free life of tomorrow. This
is the turning point of an addict’s life when all types of preventive
education,
moral
strength
are
infused
resulting
change
in
behaviourial attitude and response to advise given to him. Good
rich diet with homely affection when given, make physically strong
and demand for medical aid is reduced gradually by under
treatment addict.
Third Phase is of 8th, 9th and 10th days. These days are the days of
new life, the period when a camper feels with pleasure that he has
been rescued from the jaws of Death, of the mouth of Hell. He
prays to the God and thanks him for the courage he gave to come
out from the dark to the light of new hope. For all the campers
addiction has become the tale of past days. None believes the
magic-change he has got while living as family in the camp and can
hardly reach to that point which made them all the detoxified citizen
of today, living together in a lonely camp far away from modem
poisonous life that attracted them to drug abuse social evil. These
are the days in which they talked freely of their bad habits,
accepting wrong act done by every one to each other’s family,
Society and to the Nation and the courage they got to pass through
the life-test to whenever the bad habit. This is the phase when
campers sit in front of the God and accept their sins, whole
heartedly without any pressure, they had done to their lives and
repent for disintegration from society. This is the important period
when these campers are made strong mentally and morally to not to
fall back to the Drug-abuse, despite the hardened time comes in
future life. The behavioural change is made in them for reduce the
demand of Drug in future. Not only that become preachers who
could work as preventive force in their locality to keep away
youngster from Drug abuse.
Tenth day is the last day of the camp. The day of parting away from
that camp where campers lived as brothers of a new society. All
those who came as broken and weekend persons disintegrated from
their families and society, hatered by many, darkened future with
little hope of detoxification, made transformation of their life
(Wfl^r) by their own courage, are ready to go back to the real
happy life they lost under Drug dependency. They are leaving camp
for entering into their homes, sweet homes where their parents are
awaiting their arrival as a changed child, to whom they would offer
their affection, love, regard and blessings, where they would be the
embassador of our De-addiction campaign done at Manaklao or at
mobile-camps arranged by the Opium De-addiction Treatment,
Training & Research Trust.
Achievements
Since 1979, when the author of this paper took this mission as the
Social service, 720 Drug deaddiction camps have been arranged
and approximately 60,000 persons ..have been de-addicted.
It was the 21st camp when Ministry of Welfare gave recognisation to
our work and sent a team of Higher officers in which the then Joint
Secretary was the incharge, who perused the working of camp and
its result; and a pilot camp, which was our 22nd camp, was arranged
with Ministry’s financial aid, at Delhi in Kanjhawala village, in which
young boys of Heroin addicts were detoxified and thus with
combined efforts of Ministry of Welfare more camps have been
organized in Rural areas of Rajasthan, '
■
. ■ ■
■ , . -
’:
big camp at Bangalore city. The table
noted below will enable you to know our camping places.
The economical condition shows that those who earn less than US$
30 per month are very high in addict percentage. More is the
income lesser is the rate of Drug addiction. Similarly the age group
is also very fearful, Young boys and girls are high in Drug
dependency in cities and in village old are opium addict.
Table No. - 1
Income Group Per Month
Percentage
Less than US$ 30 p.m.
44.47%
More than US$ 30 to 50 p.m.
29.79%
More than US$ 50 to 100 p.m.
18.34%
More than US$ 100 p.m.
7.40%
Table No. - 2
AGE GROUP IN CITIES
Participant’s Age
Percentage
15 Years
40%
16 to 24 Years
25%
25 to 34 Years
18%
34 to 44 Years
10%
7%
45 & above
Table No. - 3
AGE GROUP IN RURAL AREAS
Participant’s Age
Percentage
15 Years
5%
16 to 24 Years
10%
25 to 44 Years
20%
45 to 54 Years
30%
55 & above
35%
Thus campers stand as an example of reoriented life, who would
motivate others addicts brothers & sisters to live this drug-abuse
habit while attending the de-addiction camps, where they lived and
magic change they got by their own efforts, courage and will-power.
Thus new horizon comes for them and our camp organizational
cycle goes on to save the present Society.
In this manner, giving free service, food, medicine, medical aid and
preventive education to the addicts our trust is detoxifying addicts
achieving result of 70% to 90% for opium addicts and 50% to 60%
for Heroin Ganja etc. Drug-dependents. The followup is done by
postal survey and keeping touch with selected de-addicted persons
who are called for volunteer help in camp arranged time to time.
CONCLUSION
The country - the whole UNIVERSE is in danger of this social evil.
To prevent and eradicate this menace the Opium De-addiction
Treatment, Training and Research Trust, manaklao is devoted to
the sacred cause and is proving a source of inspiration.
The innovative approach and detoxification of addicts conducted at
Manaklao De-addiction Centre and in Mobile Camps has changed
the Social situation - particularly in Rajasthan tremendously.
To sum up the status of our organization, it can conveniently be
said that MANAKLAO MAGIC : Yes the very name consumewr the
healing almost magical touch of our team even on hard-core
addicts, which is evident from the large number of addicts coming
of their own in every camp. Yeoman Services are rendered to the
cause of de-addiction, which has been recognized on national and
international fare.
Paper presented by:
Dr. Narayan Singh Manaklao
(Padamshri, Padambhushan)
Opium De-addiction Treatment Training & Research Trust
MANAKLAO (JODHPUR)
Tel.
Fax
e-mail
: +91-291-636374, 439543 (Office)
+ 91-291-213521, 213501 (Camp)
: +91-291-439543
: snehprod(a>del3.vsni.net.in
Date & Day
27th Jan., 2001, Satuday
Venue:
T.T. Ranganathan Clinical Research Foundation,
CHENNAI
M H - 2-S. I o
EVALUATING RECOVERY SERVICES:
THE CALIFORNIA DRUG AND ALCOHOL TREATMENT
ASSESSMENT
(CALDATA)
Executive Summary
Submitted to
State of California
Department of Alcohol and Drug Programs
by
National Opinion Research Center
at the University of Chicago
and
Lewin-VHI, Inc., Fairfax, Virginia
Principal authors:
Dean R. Gerstein, Robert A. Johnson
National Opinion Research Center, Washington Office
Henrick Harwood, Douglas Fountain
Lewin-VHI, Inc., Fairfax, Virginia
Natalie Suter, Kay Malloy
National Opinion Research Center
Chicago, Illinois and Pasadena, California
July, 1994
Support for this study has been given by the State of California, Health and Welfare
Agency, Department of Alcohol and Drug Programs, under Contract No. 92-00110.
STATE of California—health and welfare agency
PETE WILSON, Gavtmor
department of alcohol and drug programs
’700 K STREET
SACRAMENTO. CA
ny (916) 443-1942
95814-4037
August, 1994
Dear Colleagues:
Twenty-two years ago I was administering the drug treatment program in Vietnam. We
did not know what worked then. Now we do! The recent California Outcome Study brought
the most rigorous science ever applied to our treatment system and documented that treatment
and recovery programs are a good investment.
In California, we have assumed that alcohol and other drug abuse treatment works. We
have viewed it as an investment and not a cost. Recognizing the significant return on
investment, economically, and in terms of social and individual opportunity, we asked the next
question: Does treatment work well enough to justify the use of scarce public funds to help pay
for it?
Governor Pete Wilson has taken this question very seriously. As Governor, he invested
more than $2 million in this landmark study of the effectiveness and benefits of alcohol and
other drug abuse treatment. This monograph summarizes the most rigorous, retrospective
outcome study ever conducted on drug abuse treatment. This scientific investigation documents
the success of treatment and recovery.
In 1992, there were approximately 150,000 persons in treatment in California. A
rigorous probability sample of 1900 were included in this study with follow-up covering as much
as two years of treatment. This sample was drawn from all four major treatment modalities
including therapeutic communities, social model, outpatient drug free and methadone
maintenance.
Results indicate three major points. First, treatment is very cost beneficial to taxpayers.
The cost benefit averages $7 return for every dollar invested. Second, criminal activities
significantly declined after treatment. In 1992, the cost of treating approximately 150,000
individuals was $200 million. The benefits received during treatment and in the first year
afterwards totaled approximately $1.5 billion in savings. The largest savings were due to
reductions in crime. Finally, significant improvements in health and corresponding reductions
in hospitalizations were found during and after treatment. Emergency room admissions, for
example, were reduced by one-third following treatment.
The next phase of our research will focus on extending these projections to cover lifetime
benefits, and better recognizing cost-beneficial forms of treatment. This California study
corroborates a number of smaller studies in the United States which prove that appropriate
alcohol and other drug abuse treatment works. Treatment is a good investment!
Sincerely,
PURPOSE
Under the leadership of Governor Pete Wilson, the California Department of Alcohol and
Drug Programs (CADP) launched an initiative, in 1992, to determine the epidemiology of
substance abuse and the outcomes of substance abuse treatment. The California Drug and
Alcohol Treatment Assessment (CALDATA) is the first product of this initiative.
CALDATA is a pioneering large-scale study of the effectiveness, benefits, and costs of
alcohol and drug treatment in California, using state data bases, provider records, and
follow-up interviews with participants in treatment. CALDATA’s primary source of
information is a voluntary survey of publicly supported participants. CALDATA is the first
follow-up interview study to use random sampling techniques with this population.
The purpose of CALDATA was to study:
• the effects of treatment on participant behavior;
• the costs of treatment; and
• the economic value of treatment to society.
The effects of treatment are the differences in behavior and experience reported by
respondents before and after treatment. The costs of treatment were calculated from
financial records collected directly from the providers involved in CALDATA. These cost
figures have been verified for consistency with other data about these programs and are quite
consistent with other study results on treatment costs. The economic value of treatment
was based largely on the costs avoided due to reductions in the burden of crime and illness,
as well as a careful review of shifts in income sources.
The California Department of Alcohol and Drug Programs in partnership with the
National Opinion Research Center (NORC) at the University of Chicago and Lewin-VHI,
Inc., conducted the study during the period of September, 1992 through March, 1994.
METHODS
Phase One
CALDATA gathered information in two phases. The first phase involved sampling
counties, providers, and participants in four types of treatment programs in California. The
treatment types include:
•
•
•
•
Residential programs
Residential "social model" programs in particular
Outpatient programs
Outpatient methadone
Participants were selected at random from discharge (or in-treatment) lists developed on
site at cooperating providers. Sixteen counties, 97 providers, and approximately 3,000
participants who were in treatment or were discharged between October 1, 1991 and
September 30, 1992 were selected into the study sample. The random sample was
specifically designed to represent the nearly 150,000 participants in treatment.
The number of programs involved in CALDATA is larger than any prior treatment
follow-up study. Further, these programs were systematically selected with known
probabilities from a rigorously developed sampling framework, so that those individuals
followed up are representative of all participants in treatment in the selected modalities
throughout California.
As authorized by federal and state law and permitted by consent obtained routinely on
admission to treatment, the program records of participants selected for the follow-up sample
were read and abstracted to determine additional important research information and to verify
the self-reported data1. Using a combination of methods including letters, postcards,
telephone calls, visits to last known addresses, contacting relatives or institutional
connections, and searching various accessible public records, CALDATA staff sought to
locate members of the sample and seek their participation in the study.
In order to protect the privacy of respondents, strict confidentiality was maintained
throughout the data collection period. The methods used to protect confidentiality were
approved by the California Health and Welfare Protection of Human Subjects Committee.
Phase Two
In the second phase, more than 1,850 individuals drawn from 83 cooperating providers
were successfully contacted and interviewed in 9 months. The participant follow-up
interview was developed for CALDATA based on extensive work with previous research
studies. The questionnaire took approximately one hour and fifteen minutes to administer on
average. Follow-up interviews occurred an average of 15 months after treatment, with the
longest interval being 24 months. Part of the sample was comprised of individuals who were
in continuing methadone maintenance treatment, since this type of treatment is typically
longer term than other services.
The results of this study will fill many of the gaps in the research literature-such as the
detailed coverage of social model programs and the side-by-side comparison of cost and
effectiveness of treatment for alcohol, cocaine, and heroin abuse.
The major goal of the study was to provide CADP a thorough analysis of the data on
which data-driven policy decisions can be made. Public policy based on fact ensures the best
return on investment for taxpayers.
'Studies of the reliability and validity of responses to surveys by drug abusers show that addicts provide
generally truthful and accurate information (Hubbard, R.L., et .al., 1989, Drug Abuse Treatment: A National
Study of Effectiveness, Chapel Hill: The University of North Carolina Press, p. 31).
2
KEY FINDINGS
THE COSTS-BENEFITS OF TREATMENT IN CALIFORNIA
Taxpaying Citizens
• Costs and benefits to taxpaying citizens2'. The cost of treating approximately 150,000
participants represented by the CALDATA study sample in 1992 was $209 million, while the
benefits received during treatment and in the first year afterwards were worth approximately
$1.5 billion in savings to taxpaying citizens, due mostly to reductions in crime.
• Daily trade-off. Each day of treatment paid for itself (the benefits to taxpaying citizens
equaled or exceeded the costs) on the day it was received, primarily through an avoidance of
crime.
• Cost-benefit ratios for taxpaying citizens: The benefits of alcohol and other drug
treatment outweighed the costs of treatment by ratios from 4:1 to greater than 12:1
depending on the type of treatment.
• Differences by treatment types: The cost-benefit ratio for taxpaying citizens was highest
for discharged methadone participants, lowest—but still clearly economically favorable—for
participants in residential programs, including social model recovery houses.
Total Society: Economic Benefits
• Cost-benefit ratios for the total society: Findings differed when cost-benefit ratios for the
total society were calculated. The cost-benefit ratios ranged from 2:1 to more than 4:1 for all
treatment types, except methadone treatment episodes ending in discharge. For methadone
episodes ending in discharge, there were net losses—mainly from earnings losses to the
treatment participants themselves.
Benefits Projection
• Benefits projection: Benefits after treatment persisted through the second year of follow
up for the limited number of participants followed for as long as two years. This suggests
that projected cumulative lifetime benefits of treatment will be substantially higher than the
shorter-term figures. An additional phase of follow-up interviews and analyses would permit
a more valid projection of lifetime treatment costs and benefits.
:The economic benefits of treatment were calculated two ways: benefits to taxpaying citizens and benefits to
the total society. The major difference is that taxpaying citizens benefit when there is less theft and other crime
and when the State makes fewer drug-related disability payments and other welfare-type transfers. However,
these transfers of income and property are considered economically neutral to the total society, since one
person's loss equals another's gain.
TOTAL SAVINGS AND COSTS OF
TREATMENT SYSTEM
FOR TAX-PAYING CITIZENS
TREATMENT EFFECTIVENESS
• Crime-. The level of criminal activity declined by two-thirds from before treatment to after
treatment. The greater the length of time spent in treatment, the greater the percent
reduction in criminal activity.
• Alcohol/Drug Use: Declines of approximately two-fifths also occurred in the use of
alcohol and other drugs from before treatment to after treatment.
• Health Care: About one-third reductions in hospitalizations were reported from before
treatment to after treatment. There were corresponding significant improvements in other
health indicators.
• Differences by substance-. There has been concern that stimulants, and crack cocaine
especially, might be much more resistant to treatment than more familiar drugs such as
alcohol or heroin. However, treatment for problems with the major stimulant drugs (crack
cocaine, powdered cocaine, and methamphetamine), which were all in widespread use, was
found to be just as effective as treatment for alcohol problems, and somewhat more effective
than treatment for heroin problems.
• No gender, age, or ethnic differences'. For each type of treatment studied, there were
slight or no differences in effectiveness between men and women, younger and older
participants, or among African-Americans, Hispanics, and Whites.
• Ethnic differences in selecting treatments-. There were ethnic differences in the selection
of treatment types and in reported main drugs of use. Hispanics were disproportionately in
methadone programs for heroin addiction and African-Americans were disproportionately in
residential programs (primarily for alcohol and cocaine) compared with non-Hispanic Whites
and with African-Americans in other types of treatment.
• Employment and economic situation: Overall, treatment did not have a positive effect on
the economic situation of the participants during the study period. However, the data
indicate that longer lengths of stay in treatment have a positive effect on employment. This
finding is greater for those in social model or other residential programs than for the other
treatment types. The largest gains in employment occur with those individuals staying in
treatment beyond the first month.
• Disability and Medi-Cal: In every type of treatment there were greater levels of
enrollment and payments received from disability and Medi-Cal after treatment; these
increases ranged from one-sixth to one-half. The study analyses indicated that treatment
increased the eligibility to receive disability payments and led to overall improvements in
health status.
4
THE HABIT OF
EXCUSE
"I pray thee, hold me excused ..
The habit of excuse is as old as the human race. It had its begin
nings with the beginning of the human race. It began with the first
man and the first woman—with Adam and Eve. And ever since that
time history is filled with people who in order to justify themselves, in
order to escape from responsibility, in order to minimize their guilt
and/or in order to salve their conscience, excused themselves.
Let us take a look at the sequence of the events that brought about
the first excuse ever used.
According to the scriptures, Adam and Eve were created by Al
mighty God and placed in the garden of Eden. They were given every
thing therein for their pleasure and happiness with but one exception.
They were told not to eat of the fruit of the tree of the knowledge of
good and evil which grew in the center of their paradise. And they
were also told that if they did eat it they would die.
Then along came the serpent. He asked Eve how it was that she
did not eat of the fruit of the tree. And Eve told him that the reason
was that God had forbidden them to do so and if they did eat of it they
would die.
But the crafty serpent countered with: “You will not die. God
knows that in what day soever you shall eat thereof, your eyes shall be
opened and you shall be as gods knowing good and evil.”
Then Eve doubted God, believed the serpent, and ate the fruit.
And immediately realizing the evil she had done, she in turn
offered the fruit to Adam and he (like so many husbands down through
the ages!) in order to please his wife, also ate of the fruit.
And then both Adam and Eve began to be afraid. And when God
asked them why they had eaten the fruit, seeking to escape full respon
sibility for their actions, they began to make excuses.
Adam excused himself and endeavored, to put the blame and re
sponsibility upon Eve, “The woman you gave me as my companion,
gave it to me."
But Eve too tried to escape responsibility and she in turn put the
blame upon the serpent, “The serpent deceived me, and I did eat”
And thus began the use of excuses to justify oneself, to escape
15
from, responsibility, to minimize one’s guilt, and/or to salve one/s
conscience.
A little later in history we have another excellent example of
using excuses. It happened in Adam’s immediate family.
Cain and Abel were sons of Adam. They both, the scriptures tell
us, offered sacrifices to Almighty God. And we are told that God
accepted Abel’s sacrifice, but did not accept Cain’s. So Cain in his
resentment and anger, killed .Abel.
Then the Lord called to Cain and said, “Where is thy brother
Abel?” And Cain replied with that classical oft-repeated endeavor at
excuse, "Am I my brother’s keeper?” in order to quiet the fear within
and to minimize his own guilt.
Centuries later, the Lord Himself gives three more vivid examples
of excuses in His parable about the man who gave a great supper and
who invited many of his friends to partake of it. Here’s the story:
“A certain man gave a great supper, and he invited many. And
he sent his servants at supper time to tell those invited to come, for
everything is now ready. And they all with one accord began to make
excuse.”
“The first said to him, ‘I have bought a farm, and I must go out
and see it I pray thee hold me excused.’ And another said, ‘I have
bought five yoke of oxen, and I am on my way to try them; I pray thee
hold me excused.” And another said T have married a wife, and there
fore I cannot come.”
And in all of these instances, they excused themselves seeking to
justify themselves, to escape responsibility, to minimize their guilt
and/or to ‘salve’ their consciences.
The alternative in all of the above instances? There is only one
alternative to all excuses and that is the truth or as a very common
current expression tells us ‘let’s face it.’
And what would Adam and Eve have said in place of excusing
themselves? Just the simple truth which would have been: “I did
wrong Lord, I disobeyed your law, I am sorry.” And you know some
thing? I don’t think the good God would have punished Adam and
Eve nearly so severely had they done just that: given an honest reply,
the truth instead of attempting to excuse themselves.
16
And Cain? It would have been just as simple, “In a flit of anger,
I killed him Lord, please forgive me.” And I don’t think Cain’s punish
ment would have been as great either.
And the three who were invited to the supper? That would have
been simple too, “We don’t want to come to your supper.”
If this had been done in all the above instances, from Adam on
down, they would not have endeavored to justify themselves but would
have let the truth seek the justification of God which always is mercy.
Whereas an excuse is but a lie cleaverly cloaked in a semblance of
truth endeavoring to deceive another but usually only ending in selfdeception. It's root is in fear, usually fear of reprisal or punishment
Its primal stirrings are echoed in the words of the small child, “Mom
my, I couldn’t help it!" instead of “I’m sorry, mommy, the next time
I shall be more careful.”
And thus in the alcoholic we find this age old habit of excuse
very accentuated to the extent that every alcoholic is a past master at
giving and manufacturing excuses from the initial, “I fell asleep” to
the ultimate “I ain’t been in the gutter yet.” Remember?
And in the alcoholic personalities we find two causes of this over
accentuated characteristic; fear and sincerity.
Most alcoholics are very sincere by nature and in a frantic en
deavor to avoid insincerity in facing their human failings, they, more
than the average individual, rely on an excuse to justify their actions,
to escape from responsibility, to minimize their own guilt, so ‘salve’
their consciences.
Coupled with this circumstance within, every alcoholic is goaded
on in many of his actions by an abnormal fear element operative in
either his consciousness or sub-consciousness?
Thus fear leads one to attempt escape and over-sincerity leads
one to self-justification. He (so he thinks) has to escape; and also
he (so he thinks) has to have justification for his actions. And thus,
(so he thinks) he retains his security and his character but in doing
so he really only retains the shell of both which ultimately completely
deteriorate in his alcoholic excesses. And the more he lies, the more
he has to lie to justify his lies—and so the cycle goes on and on until
<
1 Cf. Alcoholism: Sin or Disease published by the Catholic Information Society
214 W. 31st St, New York, N.Y.—10<! per copy.
*
17
at his ‘level’ he fails to find another excuse and he comes face to face
with reality and truth in the ultimate dilemma of every alcoholic:
insanity or death or total sobriety.
The habit of using excuses comes from a habit of rationalization,
and an excuse may be defined as “an attempt to find a reason, where
ther is none,” in order to avoid facing the whole truth.
This fact is excellently brought out in the story about the Pharisee
who asked Christ, “Who is my neighbor”? He wasn’t really looking
for a true definition of his neighbor, but he was endeavoring to find
some definition which would enable him with smug conscience to omit
some of his obligations to his neighbor. That is the reason the scrip
tures preface his question with “Seeking to justify himself."
The same rationalizing takes place wherever you find a gathering
of AAs discussing *ad nauseam,’ “What is an alcoholic”? In such a
gathering you can usually be certain that one or more of the gathering
is looking for an out: “Seeking to justify himself”; seeking to justify
another drink. He is looking for a reason which would permit him
without qualms to disassociate from AA and to drink again. But there
isn’t any such reason, so he queries on and on “What is an alcoholic?”
hoping sometime to find an ingredient given by someone which doesn’t
apply to him, and which he can use then as an excuse for drinking
again, and thus he justifies himself, he minimizes his guilt, he escapes
responsibility for doing it (until the ‘Brooklyn boys’ appear on the
scene!) and he ‘salves’ his conscience. The little child again, “Mommy,
I couldn’t help it”
Now, since the habit of excuses is a basic human fault, let us
analyze a few of the more commonly used ones and endeavor to find
out their fallacy.
1.. "Everybody else does it.”—One of the most common excuses
used to justify almost any behavior no matter how wrong in itself.
The more people we can adduce who do something which we are trying
to justify in ourselves, the more is our own guilt minimized—so we
■ think. And in the thinking we do ‘salve’ our own conscience, don’t we?
But do we change the basic law we are breaking? Now really do we?
Or rather doesn’t it remain the same even if everybody acts contrary
to it?
2. "They dll say ...—Here we have coming to the rescue of the
'y excuser that old familiar "they”—did you ever meet “they” ? Quite a
fiction, not? But when an excuse is needed “they" are so easily quoted;
and exactly as we wish them to be, in order to justify ourselves, and
it does ‘salve’ our conscience, doesn’t it? The only difficulty is “they”
did not make the law we are breaking, did “they” ?
3.
“Men of importance (or position, or distinction) do thus and
thus.” A very common excuse of the modern era. “Men of distinction”
do it so we simply must too, and since “men of distinction” do it, it
simply must be right. Or must it? To commercialize on this common
excuse of human nature, a certain liquor firm used to portray “men of
distinction” who used their brand. At one time they used for a long
time the same man as model in their advertising. Then he appeared
no more. But the writer met the gentleman a short time later—in a
sanitarium on the west coast—coming off a binge, in a ward of drunks!
—where there no longer seemed to be much "distinction.”
What “men of distinction” do or say does not point to what is
right, or good, or best—but gosh, it does ‘salve” our own conscience
somewhat doesn’t it?
4.
“My mother told me so.”—Poor mom! She’s gone now, and
what a lovely one to blame for our short-comings! She can no longer
dispute it. And it is a wonderful ‘trump’ excuse excellent of use on
the spur of the moment when we can’t seem to find another. And it
will shift the blame; it will enable us (so we think) to escape respon
sibility : and it certainly will ‘salve’ the ole conscience quite a bit
5.
“Every bucket must stand on its own bottom”—A trite little
phrase. And one that is conunonly and widely used to excuse from
innumerable obligations of charity. When we are too stingy, or too
lazy, or too bitter to extend a helping hand to our neighbor, this excuse
is a wonderful one to dish out. Or when a twelfth-step call is to be
avoided for the same reasons of stinginess, or laziness, or bitterness,
just come up with “ever bucket must stand on its own bottom” and
after all, let the guy or the gal have a little ‘cold’ treatment and fur
thermore one doesn’t want to ‘pamper’ one, does one? And ecce, our
conscience is quiet! Shades of Cain! “Am I my brother’s keeper”?
But you know, bub, it’s a funny thing about this law of charity and
brotherly love, you are!
6.
"Well, after all, one doesn’t HAVE to do this or that— to stay
sober, or to accomplish this or that or the other thing." A long one,
but an old-stand-by so often used by our ‘first-step Johns and Jills' and
our ‘twelfth-step busy-guys and gals’ and the ‘meeting every-now-and-
then gents.’ Since everything in AA, including the twelve steps, is
only suggested, this excuse is a fine one to permit one to omit almost
anything not strictly of obligation with a clear conscience. How often
do we not hear this excuse in the spiritual life: one doesn’t have to
pray every day one doesn’t have to go to the Sacraments frequently;
one doesn’t have to meditate regularly—and on and on. No, one doesn’t,
but one does gotta die, doesn’t one? And then? You take it from there.
7.
“I don’t (didn’t) have the time"—This is perhaps the most
widely used excuse there is and also probably the biggest lies frequently
told. Listen to the guy or gal just back from their vacation: “I would
have loved to write you, but I just didn’t have time’’! Listen to the fel
low or girl reneging from helping with a church, or AA or social affair:
“I would love to help, but I just don’t have the time”! And listen to
the AA slipping out of a twelfth step call: “I would love to make it,
but I just can’t find the time right now” 1 Such really mean they don’t
want to take the time, but using the verb have in place of take does
justify them, nor does it disquiet their conscience either.
8.
"I don’t FEEL well"—The obligations that are sidestepped by
this, one of the most common of excuses! Duty beckons, but gosh
I just don’t fe® well, so I can thus omit the duty, justify myself, and
'salve’ the conscience!
There is a story told about a certain young man who went to his
boss and asked if he might go home for the rest of the day, because as
he expressed it “I just don’t feel well.” To which his boss very aptly
and with much wisdom replied: “My boy, there is one thing you can
never learn too soon nor remember too well, and that is this: most of
the work in this old world of ours is done each day by people who
just don’t feel well."
They also tell the story about a certain member of AA who had
promised to lead a meeting at a neighboring group. However, on the
day he was to do so, he called the secretary of the group and begged
to be excused because he had laryngitis and the doctor told him he
should not speak over a few minutes at a time. It was forty minutes
later when he hung up the phone after talking that length of time to
the secretary!
9.
"At least I’m not a hypocrite"—A wonderful conscience-salver
used profusedly by alcoholics and even on occasion by many others.
"I don’t go to church, but ‘at least I’m not a hypocrite about it’—I
admit it”! “Sure I drink—even too much on occasion, but ‘at least
I’m not a hypocrite about it’ and I could stop any time I choose"! “Yes,
I know I should do something about my faults, but ‘at least I’m not a
hypocrite about it’—I admit I have them”! So not being a hypocrite
excuses from anything that I have a sneaking suspicion I can’t or
don’t want to do anything about. And lo and behold there is peace
within my conscience. Is there really, chum?
10. "I’m not a saint"—A very potent excuse for any fault, wrong
doing or sin that I may not want to or be able to correct. And the
funny thing about this excuse, it has more of truth than the usual mine
run ones. There can be no doubt about it—I’m not a saint. But you
know something? Do you know what the Lord is going to say when
we use that one with Him? He is going to simply query back, "Why?"
“With all of My helps, and opportunities given you of grace and
strength and direction, why?” Then, what will the answer be? Huh?
... but for the nonce it is a lovely excuse isn’t it?
11. “You gotta let go once in a while."—And to this rationaliza
tion is often appended as verification, “and my doctor, or the psychia
trist said so.” So thus I can indulge in anything good, bad or indiffer
ent and my conscience is at rest, for after all, “You gotta let go.” And
strange as it seems, one hears the same advice when one comes to AA
but it is a bit different in its content. It contains the whole truth—
"Let go"—but "Let God” direct the extent of it. Remember? Let go
—let God ? And then, strange as it may seem to some too, we no longer
need excuses if we let go—and let God! For God is truth!
12. "I know a fellow (gal) and he (she) is a WONDERFUL
CHARACTER who does this, or that or the other thing....”—It is
amazing how many very ordinary people become wonderful characters,
wonderful AAs or wonderful church members when we want to use
them as an excuse! D’jever hear it? “I know a fellow, and he is a
wonderful AA and he doesn’t go to meetings very often, or he doesn’t
do much twelfth step work, or he doesn’t go for this prayer and medita
tion stuff, etc. etc. etc.” ... ad infinitum. And having identified our
selves with this imaginative ‘wonderful fellow1 our conscience is easilylulled and we stand justified—so we think!
13. "If I don’t, he will.”—The favorite excuse for the one in busi
ness. The fact that one’s competitor does this, that or the other shady
business certainly does not change the basic moral law for us, but it
certainly does provide a wonderful excuse for our breaking it because
after all, "If I don’t, he will” and so we are justified ... are we, really?
21
14.
“TVs a woman’s privilege.”—The ladies would like it much
better if we left this one out, but then this is no time to be using an
excuse, is it? And the one thing we could never find out about this
almost universally used excuse about a woman's privilege, is who gave
them the privilege? But gosh, it surely does excuse almost every ec
centricity of womanhood, and justifies their every aberration, and
gives them a blissful conscience, doesn’t it?
15.
"I’m a little ‘wacky’ ”—Why some people would rather be
considered a “little wacky” than a sinner is incomprehensible, but the
fact is that many would. But do you know the real reason behind such
‘screwy thinking’? Being a Tittle wacky* excuses one from doing any
thing very seriously about all the faults and failings and sins. And it
does soothe the conscience and blind one from the real truth. The real
truth? If one is a sinner, he has an obligation of changing, hasn’t he?
19. "Well, I am always very frank and outspoken.”—And with
that trump up my sleeve we may say what we please no matter whom
it hurts or how much it may sting to the very depths the heart and
soul of one of whom or about whom we are ‘so frankly’ speaking. Gosh,
what an out: No effort needed now to ‘hold back’ this or that unkind
remark—just be frank! And so we are justified in omitting all that
tedious discipline necessary so often to keep back the uncharitable dag
ger—which the Scriptures themselves tell us is the most difficult of
disciplines. But you know something? The Scriptures also states that
“he who thinks himself to be religious not bridling his tongue, that
man’s religion is “vain.” And “vain,” brother means “worthless” in
the English language.
18.
“Times change.”—This old stand-by takes several forms and
is first cousin to the one above. “You gotta be modern” or “you gotta
keep up with the times” express the same theme and are but two of
its many dresses. And since the modem crowd does this or that, one
simply must “keep up with the times.” But we wonder what would
happen to this excuse when placed side by side with the time-proven
truth: “Times indeed do change a lot; but souls change very little;
and God not at all.” Gotcha thinking, hasn’t it?
20. “You see, I’m the nervous type.”—And thus tantrum after
tantrum; explosion after explosion: and fault after fault will go un
censored—for after all since “I’m the nervous type—it’s nerves.”
Faults? Of course not, it’s nerves! And that label so nicely fits any
and all aberrations I don’t want to overcome—listen: "I wasn’t angry,
I was only nervous”! "I don’t ‘blow-up’ at him, it was my nerves”!;
"I’m not lazy, just resting my nerves”!; “I’m not jealous, she just
simply makes me nervous”!; and on and on and on—by the way, who’s
kidding whom?
21. “AA comes first.”—and thus, my friend, we are exempted
from many, many obligations—to wife, home, work, and what have
you. The excuse that has produced so many ‘AA widows’ throughout
the ranks of AA. And believe me, it is amazing how many otherwise
honest fellows and gals blissfully side-step obligations of every sort
with a smug: “AA comes first.” It’s number 3 on the hit parade.!
We could devote much space to a discussion of this one of the
most common excuses in AA, but suffice it to repeat what we have
written in the Silver Book of Attitudes, namely: AA does come first,
but that means, chum, the twelve steps in one’s daily living, not neces
sarily the Twelfth Step with all of its activities.
22. "No dues, no fees, no money needed in AA so why should I
give to this, or to that...”—And here comes the one in the number
2 spot on the hit parade of AA excuses. But a wonderful one to use
for soothing the ole conscience when one wants to avoid giving to any
A A project—from the weekly ‘kitty’ to the special ‘kitty,’ the Club,
the banquet, and every request for financial donations. And to rhe
above rationalization some subtly add: “And furthermore you carft
buy and sell sobriety.”
22
23
16.
"But, you see, I’m different."—Different from what? But that
matters very little, just so we are different from others—and who
isn’t pray tell? “But to my mind if I am different (no matter how little
or hazy that difference may be) I must then have different obligations,
and since everybody else accepts most basic human obligations I must,
since I am ‘different,’ be freed therefrom—especially those obligations
I do not want to live up to.” And so our conscience is ‘salved’ and we
are justified in our misdeeds—well, at least in our own mind. Peace—
it’s wonderful!
17.
"I have changed”—and of course sinc^ “I have ‘changed’ one
would hardly hold me to anything I may have promised, or planned, or
agreed to before ‘I changed,’ now would they? And, by ‘changing* I
have set aside rather easily, if not so truthfully, quite a number of old
responsibilities. And then too, one would hardly be expected to have to
live up to a promise made so long ago. And now I can go merrily along
without the slightest pang or twinge of conscience and I do feel so
justified.”
Since this excuse is one of the very “fine-line” ones, perhaps a
little story might throw the light of exposure on it.
One time a preacher was urging all of his listeners to ‘be saved.’
And in flight of oratory he told them again and again: “And the
salvation of the Lord costs us nothing; it is absolutely free.”
After he had finished speaking, one of the audience approached
him and queried: “Say, preacher, you talk and talk and you say that
salvation is free, that it costs us nothing. And then how is it that every
time you preach you pass the collection basket?”
To this the preacher replied with an answer that is a classic:
“Yassah, I did and I do say that salvation is free, that it (costs you
nothing just like the water that the good Lord has given us—it costs
absolutely nothing, but when it comes to the ‘piping,’ we gotta pay
for it!”
THE TWELVE STEPS
23. “I’m an alcoholic”—Lo, the number 1 excuse in AA. And
with this trump card up one's sleeve almost any aberration can be
easily excused, and our conscience will feel peaceful, and our responsi
bility practically nullified. For what can one expect? I’m an alcoholic!”
AND
EXCUSES
n_ We get angry—but what can you expect? We’re alcoholics!
'
We are lazy.—but what can you expect? We’re alcoholics!
We are dishonest—we lie—but what can you expect? We’re alco
holics!
We chisel and cheat, we nurse every fault we ever had—but what
can you expect? We're alcoholics!
And on and on—but you know what? It won’t be long until such
will have to add an adjective to that excuse; or perhaps just another
line: “We’re alcoholics, and we’re drinking again!”
But after all what did you expect?
Really, let’s face it, aside from the compulsion to drink, there isn’t
any difference between the alcoholic and the rest of men. Remember
the saying: “If you can’t smell ’em, you can’t tell ’em”?
24
"Nothing counts but HONESTY ...”
But the lives of all are loaded with excuses which is but another
way of saying that poor human nature is frantically endeavoring to
justify itself and its actions, is trying to escape from responsibility,
is trying again and again to minimize its guilt and is attempting at
every turn to ‘salve’ its conscience so that it may somehow or other live
in ■peace with itself.
Books and books could be written and much space given to little
else but a listing of the thousands upon thousands of excuses that hu
man beings have and do use. However such is not within the scope of
this booklet, and the above is merely a cross-sampling of the excuses
that you and I, that all of us are familiar with. And as alcoholics we
were past masters at the art of excuse making.
When we came to AA and were confronted with the twelve steps
again we were faced with a ‘big" order to handle. And again we with
hangover of habit or designedly used excuses in taking these steps;
so that many members along the twelve steps’ path have so rationalized
and excused that they have never fully and honestly taken the twelve
steps literally. Why! It is the old story: we want to escape respon
sibility, we want to minimize our guilt, we want to justify ourselves in
our omissions, and we want to thus ‘salve’ our consciences. Because we
as alcoholics must have serenity even though it be ‘frantic’ serenity.
Now let us go over the twelve steps quickly—merely listing one
excuse as a sampling of the hundreds that many come up with to ‘get
around’ each step.
I—We admitted we were powerless over alcohol and that our lives
had become unmanageable.
Because of the necessity of admitting, perhaps for the first time
in our lives, an absolute truth: that we are powerless and because of
the humility necessary to make such an admission, the alcoholic is
adept at finding hundreds of excuses that will enable him ‘in good
conscience’ and with ‘self-justification’ to avoid taking this step in a
hundred percent fashion. And among all of these rationalizations, per
haps the most common is that one that has been used for years and
years. “But I’m not that bad.” “Yes, I get drunk, I get into t
etc. etc. but powerless? O no, I’m not that bad”!
Some months ago the writer had a long-distance call from a party
27
who was interested in helping a certain individual who had had diffi
culty with his drinking. His problem had become such that for many
months he had not been able to work. And somewhere along the way
someone had given him the writer’s name whom he had been told
might be able to get him work.
When the one with the problem himself came to the phone, he
was asked whether he had had any contact with Alcoholics Anonymous.
But to this ‘insult’ he quickly replied in typical excusing fashion: "0,
but I’m not that bad!”
To which came back just as quickly: “Then why in the world
aren’t you working?”
He now is a very active and sober member of AA and has an ex
cellent position in which he is making a fine record.
However, there are many alcoholics who are not so easily exposed
in their excuse-making and who thus come forward with many an
added one to ‘justify themselves’—in their drinking.
many other obligations that come along which will necessitate the sin
cere person working at changing these ‘personality patterns’ which so
often—whether we admit it or not—got and still gets us into trouble.
And here again—to justify our eccentricities and neurotic tan
gents of character—we are very expert at producing an excuse. Here’s
a rather amusing one heard at an A A meeting some years back:
The discussion had drifted into the question that is often ‘kicked
around’ at A A gatherings, namely, “Are all alcoholics neurotic”? Pros
and cons were given by the members—‘pros’ by the honest ones ‘cons’
by the rationalizers. Then from the back of the meeting room came the
pay-off. Suddenly in the middle of a lull in the discussion came this
apt observation—a very patent excuse: “I object,” this member an
swered to the remark that all alcoholics are neurotic, "Neurotics is nuts,
and I ain’t nuts.”!
“I beg you hold me excused 1”
II—We came to believe that a Power greater than ourselves could
restore us to sanity.
III—We made a decision to turn our will and our lives over tothe care of God as we understood Him.
It is amazing and amusing to hear the many excuses that the
fellows and gals produce in ‘wholesale’ fashion to get around this step
—this ‘God-business.’ Let us examine the one most frequently ex
pressed. It excellently fits the present materialistic era. Listen:
Much has already been written on this step and the difficulties in
taking it in our Blue Book of Happiness. But there is one excuse used
in side-stepping it that is a most common one, and which is very fre
quently used by human nature in escaping responsibility of all sorts
and in justifying all of our procrastinations. And that excuse is just
one little word: "Manana”—which translated means “to-morrow” and
which Augustine so aptly calls the “corvina” or "raven” of work, duty,
and virtue. "Tomorrow”—“yessir, I’m going to take the third step—
to-morrow" But, you know—there happens only and always to be
just to-day. For we can never do anything to-morrow—not until to
morrow becomes to-day—and if we are always going to take the step
to-morrow—that means in plain language—never! But it does make
us seem to have good will, and good intentions, (but incidentally not
many good actions') and that justifies us, and ‘salves’ our conscience
and permits us to escape without too much disturbance many, many
responsibilities.
“Yea, I could possibly go for this God stuff, but after all you
gotta be practical.” So, in case you do not realize it, that excuses
from all spiritual obligations, and in the excusing justifies one, escapes
any responsibility for so doing and lullabies to sleep that wee small
voice which most mortals call conscience.
It may not be out place to mention at this juncture an observa
tion on this second step which we feel is often over-looked, but which
also often evokes excuses, and sometimes very amusing ones.
We say in the latter part of the second step that we could be
“restored to sanity.” Now it is the writer’s opinion that we cannot
be restored to anything unless we have been away from it. Therefore
in this part of step II we are admitting that we have been insane. Else
how could we be ‘‘restored to sanity ?”
And, of course, if we have been ‘insane’ or are ‘neurotic’ there are
28
And thus always and everywhere: "I beg you hold me excused
to-day—because I’m going to do it to-morrow”!
•
Whom are you kidding?—besides yourself!
29
IV—We made a searching and fearless moral inventory of our
selves.
A job and a big one. And a rather ‘nasty’ one too—very unpleas-.
ant. So we need a good excuse here—and a very common one is taken
from the Scriptures—that gives it authority. "A searching and fear
less moral inventory? Why, I just don’t believe in such things for the
Scriptures say: ‘Let the dead bury the dead,’ and again, ‘Let sleeping
dogs lie,’ and furthermore it ‘disturbs my peace of mind’ ”!
And having what we think is scriptural backing, our conscience
is in fine mettle, we are justified, and escape much guilt and respon
sibility of restitution.
By the way, where is it also written: “Woe be to them who cry
peace, peace, where there is no peace’ ” ?
‘Frantic’ serenity!
V—We admitted to God, to ourselves and to another human being
the exact nature of our wrongs.
In this step we very often find used another excuse that justifies
procrastination in order ultimately to side-step or omit all or part of
the humbling experience intended by the 5th step. And again, under
the mantle of truth, an axiom of AA is adduced in the role of an ex
cuse. "Easy does it”—so why make oneself go to another human
being? "Easy does it”—so why take a chance in revealing my misdeeds
to another one? “Easy does it”—there’s plenty of time to take this
step. And lo and behold “Easy does it” gets an entirely new meaning,
which translated means: “Keep putting it off, chum—that’s the easiest
way out of it”!
His mercy. What is that He tells us: ‘the greater the sin, the greater
the mercy’?
VII—Humbly asked Him to remove our shortcomings.
“Humbly”—which means that it demands humility. And wherever
there is a question of practicing humility, the pathologically proud al
coholic immediately seeks escape and becomes the master again in
excuse-making. And in the seventh step one of the most common goes
something like this: “God knows me, so why should I bother to ask
Him to remove my shortcomings”? or “Who am I to tell God what to
do.” Very subtle, very suave and very effective—in justifying one’s
faults, and in minimizing their guilt.
They tell the story of the old fellow who was asked by his minis,
ter why he did not say his prayers. To the query of the minister the
old fellow always replied: “Me pray? Why who am I to tell the good
Lord how to run his business?”
“I beg you hold me excused”!
VIII—We made a list of all the people we had harmed and be
came willing to make amends to them all.
In this step the most often used excuse consists of only one little
word: "But.” “Yes, I did a lot of wrong, but—it wasn’t all my fault
—but—he also harmed me—but—it just couldn’t have been helped.”
And thus, in blaming others our responsibility is minimized, we
‘salve’ our consciences and we are justified in omitting many ‘harms’
from our list.
By the way, who is going to even those up?
VI—We were entirely ready to have God remove these defects of
character.
IX—We made direct amends wherever possible except when to
do so would injure them or others.
“Who, me? Why, I’m too bad for that. You just don’t know what
I have done. I’ve done too many wrongs for God to forgive and to
change me.” An excuse stemming from ‘big-shot-itis’ in reverse. It is
positive that we’re not the best guys now, so why not be the worst?
And then, too, that excuses us from doing anything about all of our
past. And it justifies us in retaining all of our defects of character, and
soothes our conscience, and we are freed from all responsibility.
In this step many fail to derive any benefit and excuse themselves
from the many valuable acts of humility intended by it by glibly com
ing forth with, “My priest, (minister, adviser, etc.) said it wasn’t
necessary.” Having gone to such a one who although perhaps thorough
ly grounded in theology was not familiar with the basic needs of the
alcoholic, these individuals indeed were told that it would be sufficient
to make indirect amends, and that such would suffice to satisfy justice
and rights and restitution. However any solid AA could have told
It seems like one of God’s greatest attributes has disappeared—
an
31
them in the twelve steps ‘something has been added' in this matter
of restitution, that direct amends is advised because thus and thus
alone does the alcoholic acquire true practice of humility, which hu
mility the alcoholic needs perhaps more than anything else. But by
indirect amends we keep our anonymity, don’t we? Yea chum, we
keep our pride too ... I And incidentally, we are laying aside a ‘leetle’
drink for a rainy, blue day!? Indirectly!
X—We continued to take personal inventory and when wrong
promptly admitted it.
Stepping all around this step but never taking it are all of the
many "extroverts” in AA. And with the mental ‘ambi-dexterity’ of
such they proffer a time-worn excuse: “It disturbs my peace of ^nind.”
But of course such do not hear the echo that always accompanies such
an excuse, and which has been and is sounded down through the ages:
“Peace, peace and there is no peace,”—except on the surface. So these
deluded souls go blissfully on in their frenzied activity with their
‘frantic serenity,’ and their consciences are ‘salved’ but never healed
until the day sooner or later when their ‘problems’ will ‘come busting
out all over1—with the help of the bottle. Better continue the process
begun in the fourth step fella, it is much easier to daily ‘dislodge’ than
to ultimately ‘dynamite’—remember? ?
XI—We sought through prayer and meditation to improve our
conscious contact with God as we understood Him, praying only for
knowledge of His will for us and the power to carry it out.
In approaching this step, which, incidentally, could contribute so
much to peace of mind, sobriety and serenity, one very frequently sees
it side-stepped by the much over-worked excuse: “I ain’t no ‘Bible
thumper,’ I ain’t no ‘pious-puss,’ I don’t go for that constant prayer
business.” And to this is usually added an echo of the excuse used in
the seventh step, ‘‘and furthermore, God knows what I need, He knows
what to do.”
How very true,- chum, but do youV.
XII—Having had a spiritual awakening as a result of these steps,
we tried to carry this message to alcoholics and to practice these prin
ciples in all of our affairs.
Since this step comprises much on the activity side of the program
32
with its speaking, twelfth-step calls, meetings, etc. etc., we find hun
dreds of excuses offered. But again, let’s look at only one—a very fre
quent one: “I wouldn’t mind speaking, (or I wouldn't mind making
twelfth-step calls, etc.) but I have so many other things to do!” And
so, with smug conscience, we enjoy all the blessings of sobriety without
having to make an effort to give in return. Shades of the parables!
“I bought a farm and must go see it; I have bought five yoke of oxen
and must go try them; I married a wife... I beg you hold me excused.”
But you know what? It won’t be very long until those old excuses are
again slightly changed—“I bought a ‘fifth’ and must go sample it.”
Which you will.
LET’S FACE IT
"And the TRUTH shall make you free ...”
As we have tried again and again to point out in previous volumes,
the tenth, eleventh and twolfth steps are the daily living of the AA
program. And if we look a bit closer in our analysis, we shall find
that all three have one aim—namely, to learn truth in order to elimi
nate the habit of excuse, so that gradually and little by little we can
motivate our daily living with truth instead of the habit of excuses.
In the tenth step we take our regular inventory so that we may
be able to see ourselves as we are—faults, talents and all; in order to
learn the truth about ourselves and thus eliminate excuses about our
selves.
In the eleventh step we seek through daily prayer and meditation
to learn the truth about God and ourselves, and thus knowing the truth
about our relationship with God, we are able to eliminate the habit of
excusing ourselves in our obligations to God.
In the twelfth step we work with others, with our neighbor, in
order to learn the truth about our neighbor and- ourselves so that thus
knowing the true relationship between our neighbor and ourselves we
are able to eliminate the habit of excuse which so often -wrongly freed
us from so many of our obligations to our neighbor.
In these three steps we also find on further analysis that their
core is meditation which is nothing more nor less than a searching
with God for truth in order that we may ultimately motivate our living
with truth instead of the habit of excuses. And so we do not hesitate to
offer as our opinion that without meditation contented sobriety is im
possible and without contentment, sobriety will not be permanent.
"We sought through ... meditation.”
This is probably the most talkative age of history—not only be
cause of the abundance of mechanical devices to diffuse our talking,
but also because we have little inside our minds which did not come
there from the world outside our minds, so that human communica
tion seems to us a great necessity. There are few listeners, although
St. Paul tells us that “faith comes from hearing.” If the bodies of
most of us were fed as little as the mind, they would soon starve to
death. Many otherwise good and pious individuals wonder why ttjey
make little or no progress in their spiritual life in spite of daily and
frequent vocal prayer. The real reason is that they are spiriiaaUy
37
mentally starved. They say hundreds of verbal prayers—but they
never regularly meditate and as a result they are attempting to live
in a spiritual vacuum—a metaphysical impossibility. And so there is
of necessary hyperactivity, restlessness, talkativeness—and a tremen
dous over-emphasis on activity and movement. One’s soul and body in
this contradictory state of affairs is constantly attempting to rest in
motion. WTience such excuses as “I went out to a party to relax!";
or for a drive, or dancing, or on a trip! Someone has said that the
rocking-chair is symbolical of this vacuum-starved mentality of the
era—it enables one to sit in one place and still be on the go.
Anyone who becomes ill at ease or disquieted when the activities
of the day or evening cease and one is alone proves that he or she is
living in flight from his or her true self. Gregariousness, the passionate
need for a crowd, or the “gang” or the incessant urge to identify one
self with the tempo of the time or the continual “pushing the day into
the night” is proof positive that one is seeking distraction from innerself, because innerself is a void, is a vacuum, is spiritually mentally
starved. As we mentioned above in the beginning: "they attempt
forgetfulness by courting the sham fancies of the night and by rush
ing headlong through the chores of the day”—even the spiritual chores!
In their spiritual life, not even having stopped long enough to
know God in meditation, they again resort to constant activity—
prayers, services, novenas—by the dozen. Thus they cover up their
true spiritual status which is builded upon activity and not on God’s
will. They merely work for God; they do not love Him. They do not
want to be on the “outs” with God, as a clerk does not want to be on
the “outs” with his boss. And so, with so little love operative in their
arid and empty spiritual life, God’s law and prayer are regarded as
mere correctives, as something negative and restraining to their
wishes. They ask of prayer that they keep from serious sin—that they
will be enabled to restrain themselves moderately in their avarice, in
their selfishness, in their intemperances, in their sins of the flesh.
Their excuses in pursuing this half-track to God which always ends
in wreckage here or hereafter are ridiculous. Listen to a few: “just
a “white” lie; just a “little” drink just a “little” petting or “pitching";
God can have this and that but this and that ! shall keep for myself,
and after all I do say a lot of prayers.” Like the wife who sets out just
what her husband may and may not do and then adds: “And after all
I do “yackity-yack” at you so much!”
Such souls have no real desire to know what God wants—they only
38
wish to tell Him what they want Him to do—so much, no more. One
finds out what God really wants only in meditation.
Meditation feeds the mind with truth about God, themselves
and their neighbor—it breaks down and through the self-deceit and the
excuses which so foster the aimless and ceaseless activity of which we
have spoken. It puts back again into one’s life the only safe guide
posts : His Laws as He meant them to be, to offset the excusing habit
of His laws as we want them to be for us.
But here again human ingenuity and diabolical rationalization
side-step what seems to be such an evident truth and necessity for
both peace of soul and salvation—with an excuse. Any excuse—just
so it will justify more activity, just so it will excuse one from facing
the truth in meditation. A common one: “I’m too busy”—and of
course, with the over-activated-mind-starved-triphammer-gregarioussoul there is little doubt but that they are very busy—in fact they are
too busy—period. For, if one is too busy to meditate regularly, that
person is too busy.
Little do they realize that logic (of which they have seemingly
such paltry knowledge) would point out to them that it is impossible
not to have enough time to meditate. Rather, it is just the opposite:
the more one meditates the more time one will have. We don’t have
enough time for God because we don’t think enough of Him in medita
tion. The time one has for anything or anyone depends on how much
one values such. Thinking determines the use of time; time does not
rule our thinking. So the problems of spirituality, of spiritual reading,
of prayer and meditation is never a matter of time; it is a problem of
thought. Silence and thought have made many a saint; words and
talk never have—it is possible to pray vocally until life’s last hour and
still lose one’s soul; it is impossible to meditate regularly and lose ones’
soul—for, it does not require much time or activity to make a saint
—it requires only much love—and who can love a person without
frequently thinking about them ? ? ?
So let’s take a closer look at this meditation business, which seems
to prove such stumbling block to so many. Why, we know not, for in
reality meditation is so simple. Again, it is merely a thinking about
truth in the presence of God in order to motivate our lives with truth
instead of the habit of excuses.
It need not be formal. We personally feel that the less formality
the better. We need only to see that there are three ingredients:
39
mentally starved. They say hundreds of verbal prayers—but they
never regularly meditate and as a result they are attempting to live
in a spiritual vacuum—a metaphysical impossibility. And so there is
of necessary hyperactivity, restlessness, talkativeness—and a tremen
dous over-emphasis on activity and movement. One’s soul and body in
this contradictory state of affairs is constantly attempting to rest in
motion. Whence such excuses as “I went out to a party to relax!”;
or for a drive, or dancing, or on a trip! Someone has said that the
rocking-chair is symbolical of this vacuum-starved mentality of the
era—it enables one to sit in one place and still be on the go.
Anyone who becomes ill at ease or disquieted when the activities
of the day or evening cease and one is alone proves that he or she is
living in flight from his or her true self. Gregariousness, the passionate
need for a crowd, or the “gang” or the incessant urge to identify one
self with the tempo of the time or the continual "pushing the day into
the night” is proof positive that one is seeking distraction from innerself, because innerself is a void, is a vacuum, is spiritually mentally
starved. As we mentioned above in the beginning: “they attempt
forgetfulness by courting the sham fancies of the night and by rush
ing headlong through the chores of the day”—even the spiritual chores!
In their spiritual life, not even having stopped long enough to
know God in meditation, they again resort to constant activity—
prayers, services, novenas—by the dozen. Thus they cover up their
true spiritual status which is builded upon activity and not on God’s
will. They merely work for God; they do not love Him. They do not
want to be on the “outs” with God, as a clerk does not want to be on
the "outs” with his boss. And so, with so little love operative in their
and and empty spiritual life, God’s law and prayer are regarded as
mere correctives, as something negative and restraining to their
wishes. They ask of prayer that they keep from serious sin—that they
will be enabled to restrain themselves moderately in their avarice, in
their selfishness, in their intemperances, in their sins of the flesh.
Their excuses in pursuing this half-track to God which always ends
in wreckage here or hereafter are ridiculous. Listen to a few: “just
a “white” lie; just a “little” drink just a “little” petting or “pitching”;
God can have this and that but this and that I shall keep for myself,
and after all I do say a lot of prayers.” Like the wife who sets out just
what her husband may and may not do and then adds: “And after all
I do “yackity-yack” at you so much!”
Such souls have no real desire to know what God wants—they only
38
wish to tell Him what they want Him to do—so much, no more. One
finds out what God really wants only in meditation.
Meditation feeds, the mind with truth about God, themselves
and their neighbor—it breaks down and through the self-deceit and the
excuses which so foster the aimless and ceaseless activity of which we
have spoken. It puts back again into one’s life the only safe guide
posts : His Laws as He meant them to be, to offset the excusing habit
of His laws as we want them to be for us.
But here again human ingenuity and diabolical rationalization
side-step what seems to be such an evident truth and necessity for
both peace of soul and salvation—with an excuse. Any excuse—just
so it will justify more activity, just so it will excuse one from facing
the truth in meditation. A common one: “I’m too busy”—and of
course, with the over-activated-mind-starved-triphammer-gregarioussoul there is little doubt but that they are very busy—in fact they are
too busy—period. For, if one is too busy to meditate regularly, that
person is too busy.
Little do they realize that logic (of which they have seemingly
such paltry knowledge) would point out to them that it is impossible
not to have enough time to meditate. Rather, it is just the opposite:
the more one meditates the more time one will have. We don’t have
enough time for God because we don't think enough of Him in medita
tion. The time one has for anything or anyone depends on how much
one values such. Thinking determines the use of time; time does not
rule our thinking. So the problems of spirituality, of spiritual reading,
of prayer and meditation is never a matter of time; it is a problem of
thought. Silence and thought have made many a saint; words and
talk never have—it is possible to pray vocally until life’s last hour and
still lose one’s soul; it is impossible to meditate regularly and lose ones’
soul—for, it does not require much time or activity to make a saint
—it requires only much love—and who can love a person without
frequently thinking about them 1 ? ?
So let’s take a closer look at this meditation business, which seems
to prove such stumbling block to so many. Why, we know not, for in
reality meditation is so simple. Again, it is merely a thinking about
truth in the presence of God in order to motivate our lives with truth
instead of the habit of excuses.
It need not be formal. We personally feel that the less formality
the better. We need only to see that there are three ingredients:
39
1)
2)
3)
The presence of God.
Thinking.
A decision to apply the truth to our lives.
It is immaterial where we meditate, or when we meditate, or what
position we take when we meditate. We can meditate anywhere, be
cause God is everywhere especially inside us, so that no matter where
we may be God is present.
We ma/ take any position when we meditate. We may sit down,
or stand up, or lie down, or walk up and down—or, should it more
facilitate the matter for some alcoholics—we may even “stand on our
heads” to generate the thinking process I Many may prefer to kneel,
but we should bear in mind that all of this makes little difference to
God who is not looking at our position but at our hearts. Just so we
“set and think” instead of only “settin’ ” 1
Likewise, one may meditate morning, noon or night. For this too
makes no difference to God, we feel sure. However, it will facilitate
the forming of a habit of meditation if we set aside a regular time each
day. It gives our wills something to hang on to. It is good psychology.
What should one meditate about? We should meditate about
truth—any truth. They may be truths about God, about our neighbor,
about ourselves, about objective things—about anything. A few ex
amples: death, God, marriage, alcoholism, drunkenness, Christ, the
Bible, the universe, the laws of nature, the virtues, the vices and on
and on—any of the thousands of truths. All we need to do is to examine
it in the presence of God; apply it to ourselves and our lives; make
a descision to motivate our living by it.
A good spiritual book will be a great help to many in guiding
their thinking—especially in the beginning. Spiritual reading provides
the fuel for meditation, it gives us food for thought. And we should
never forget that the more spiritual our reading is, the more practical
it will become!
Is there a method for our meditations? There are hundreds in the
many volumes written about meditation. But here again, let’s keep
it simple. We are alcoholics, remember? And of all the methods, we
feel that there is one that is very simple, very effective, and very easy
to use. That we like to call the “Who, which, what” method. And in
using it, all we do is to present the truth to be meditated about to our
minds and ask the seven basic questions of analysis:
40
Who?
What?
Why?
Where?
By what means ?
How?
When?
The answers to these seven questions will give ample analysis of
any truth and will provide an excellent and effective meditation. A de
tailed example will be given later on in the meditation on death, ap
pended to this little booklet.
The secret of every meditation is the decision, for action is still
the magic word. In other words, when we meditate we should always
conclude by thinking to ourselves: if this or that or the other thing
be true—therefore we shall do this or that or the other thing—today.
Let us never forget that the more we meditate the less we shall
excuse oursleves; the less we excuse ourselves the more we shall accept;
the more we accept, the less conflict shall we have; and the less con
flict we have the more peace of mind; the more serenity we shall
acquire. And it is our opinion that unless a human being meditates of
his own free will, the day will come and has come for all of us when
God will force us to meditate—and that meditation will not be so
pleasant. Remember coming off the last binge?
Therefore if we regularly meditate, we shall never have to medi
tate ! So—
LET’S FACE IT!
MNH/dAT/87.5
MOBILIZING THE COMMUNITY
TO REDUCE DRUG AND
ALCOHOL ABUSE
A Manual for the
Community Health Worker
00 77g
^o&)
Contents
Page
Preface................................................................................ 1
Introduction......................................................................... 2
The Need to Mobilize Communities................................... 2
The Community Action Team..............................................3
Background Information......................................................4
Developing and Implementing a Community
Drug and Alcohol Strategy..................................................9
Monitoring and Assessment............................................. 16
Final Comments............................................................... 17
Annex 1: What are commonly abused substances?...... 18
Annex 2: Terms - What do they mean?........................... 21
PREFACE
Developing a community programme to prevent drug abuse can be
a massive exercise involving many organizations or it can be the parttime activity of one person. We hope that this booklet will be useful in
both of these contexts. On the whole we are assuming that a primary
health care worker will be able to get together with at least two or three
others to form a community action team, but we realize that this might
not be possible in some settings. A community alcohol team (CAT) is
made up of representatives from health, the police, business, social
services, voluntary bodies, parents, teachers and any other groups or
organizations with an interest in preventing drug and alcohol abuse and
their related problems Throughout this booklet we attempt to provide
wide ranging advice on how to mobilize a community and it may appear
that we are expecting too much. Before we proceed, therefore, it is
appropriate that we provide some reassurance. Tfiis booklet should be
used in any way that seems relevant to your specific situation. An
isolated primary health care worker or other interested person might be
able to develop one small programme. On the other hand a large and
enthusiastic community action team might be able to develop a series
of projects. Also a trainer will be able to use it as a teacher's resource.
We hope that this booklet will be useful to all three.
Ideally, Ulis booklet should be read in conjunction with other booklets
in the series.
Introduction
When individuals, groups or organizations work together it is often
noted that the whole can be greater than the sum of the parts. This
manual is concerned with the task of mobilising the whole community to
take coordinated action directed towards the prevention of drug and
alcohol abuse. In a recent innovative programme in Pakistan, for
example, village health committees have worked in close liaison with a
medical practitioner to develop just such a community response. Village
committees consist of influential and enthusiastic people who can make
sure that changes occur. They have been given training in the early
detection, referral and rehabilitation of drug users in their localities. Also
working in close collaboration with school teachers and students they
have placed a great deal of emphasis on health education. It is this kind
of active liaison between groups or organizations that must be encour
aged if the recent worldwide escalation in the problem of alcohol and
drug abuse is to be reversed.
I.The Need to Mobilize Communities
The use of psychoactive substances is a phenomenon with which all
communities and countries have intimate acquaintance. Some drugs
will be illegal but others with abuse potential will have been sanctioned
for use in’ religious rituals, community ceremonies and leisure lime
activities. Although these socially acceptable drugs are in everyday use
they will, almost certainly, result in some harmful consequences.
Whenever a new drug appears on the scene, it becomes a matter of
some concern, all the more so if it affects the young, the women, and the
economically productive adults or becomes symbolically associated
with changes in social norms and values. This concern leads to many
kinds of community response which, if properly channelled, can form the
basis for a community action programme. It is, however, a much more
difficult task to persuade a community that there are good reasons to be
2
worried about substances which have been traditionally used for cere
monial and recreational use (e.g. tobacco, alcohol, rawopium, cannabis
products, khat and coca chewing). The community may have (ailed to
recognize the capacity of these drugs to produce harm, or may have
decided simply to accept the costs.
Il Is sometimes dlfflcult to
persuade a community that
they should be concerned
about cigarettes and
alcohol abuse.
Since traditional drugs of abuse are accepted by a society, a change
can only be sustained if the community becomes actively involved in
promoting good health. What follows is an attempt to provide guidelines
(or primary health care workers who are ready to be involved in the
challenging task of mobilizing a whole community.
2. The Community Action Team
At this stage we must refer the primary heal th care worker back to the
preface of this publication, wtiere we attempt to provide some reassur
ance. Al It rough we hope that the primary care worker will have a key role
to play in nudging a community towards healthier altitudes and life
styles. there is no doubt that help will be required, right from the start. For
example, one ol the most dillicult but interesting tasks will be to build up
a clear picture of the community. This will include some knowledge ol
the drugs which are used and abused but it includes much more
besides, including answers to some of the following questions:
-
3
Which organizations make important decisions?
Who are the key individuals?
How are plans and concerns communicated or disseminated?
How are the price and availability of drugs determined?
What legislation is involved and how is it enforced?
Which professional and voluntary workers are interested or could
be persuaded to take an interest in drug abuse?
Which other individuals or groups could help or have some
influence?
To (acililate the collection of this type of information, a community
action team (CAT) should be formed with representatives from health.
the police, business, social services, voluntary bodies, parents, teach
ers and any other groups or organizations with an interest in preventing
drug and alcohol abuse and related problems. The first taskof this group
will be to collect a wide range of background information.
3.
Background Information
A complementary publication in this series provides guidelines on
how to assess drug related problems within a community. Ideally this
should be consulted before attempting to build up a file of useful
information.
Evidence and information should be collected and collated on the
following topics:
o How is the community organized?
Even within a small area, communities have their similarities and diffe
rences. Some village communities have hierarchical structures whereas
others are more democratic. There will be differences between rural and
urban societies and different types of groups will co-exist within a
particular community. There will be various pressure groups, as well as
formal and informal associations involved in a wide range of areas such
as agricultural development, education, women's concerns, parent
teacher activities and labour unions.
It is important to be able to understand how the individuals and the
groups relate to each other and how the community leaders lead, as well
as the communication styles that they use. The interactions that would
prevail in a hierarchical rural society may be different from those
obtaining in the urban areas. Even within a hierarchical rural society,
the village headman or tribal chief may have absolute authority in settling
certain kinds of issues, e.g. disputes about land, marriages and eco
nomic rights, whereas, on other issues such as drug abuse, the authority
may be exercised by some other person or group.
A clear picture of the leadership and communication patterns within
a community is an invaluable asset to the PHC worker or the community
action team. An ability to plug into the correct community communica
tion channels and the ability lo influence opinion leaders and decision
makers will make a or-break a community action programme.
o What are the customary methods of problem solving
and decision making?
Communities have their own methods of solving problems and taking
decisions about issues of common concern to their members, such as
drug abuse. In some rural societies this could involve a discussion of the
problem by an informal group or a committee under the leadership of an
elected or traditional leader. The decision might then be binding for the
rest of the community. In urban societies problems might be discussed
5
by ah elected community welfare group (e.g. The Resident's Welfare
Association) or a recognised formal association (e.g. the Employee's
Union). The community action team (CAT) will be attempting to negoti
ate with these key decision making groups in order to get drug abuse
issues onto their agenda and effect an appropriate response. This can
only be achieved if the appropriate groups are being approached in an
acceptable way.
Changing a
community will
Involve negotiations with
key Individuals and groups
If the action group is attempting to increase drug education in schools
then should they approach the education minister, parent-teacher
associations, headmasters or a group advising the minister on the
content of the school curriculum? Which groups or individuals have a
vested interest in preventing accidents resulting from drug and alcohol
abuse? This type of information is as important as information about the
prevalence and the nature of drug abuse within a community.
o What are the major drug and alcohol related prob
lems?
In the complementary WHO publication on assessment of drug and
alcohol abuse in the community we outline ways of exploring the
problems resulting from drug abuse within a particular area. Evidence
of local drug-related problems, when clearly and vividly presented, pro
vides a very useful method of encouraging a community to regulate
6
itself. Evidence such as the following speaks for itself:
-
Over 30% of drivers killed in road accidents have high blood
alcohol levels. On Saturday nights this figure rises to 70%.
Over 30% of those requesting help from primary health care
workers and social workers are abusing drugs and/or alcohol.
Drugs and/or alcohol are implicated in 40% of family disputes
involving the police.
-
Over 90% of people dying from lung cancer are smokers.
Of course, this evidence is not always available for a particular
community and evidence from other sources will have to be used.
o What community programmes already exist?
Within the communit^jplth service there will be programmes and
services that have to cdpe<with drug related illness. It is important to
identify these and start upTa dialogue with the following aims in mind.
First to convince health service managers and clinical teams that drug
and alcohol abuse shouldbe given a high priority. Second, to encour
age key individuals to participate either in the CAT or in specific pro
grammes. Third, to discuss the possibility that materials, resources and
funding be assigned to the CAT.
Of course, the health service is not the only sector which develops
health related programmes. Organizations responsible for education.
housing, safety, nutrition, policing and leisure might already have an
interest in drug and alcohol abuse. If not they could be encouraged to
develop an interest. Furthermore, most communities have a number of
voluntary organizations which are very active and influential (e.g. Rotari
ans, youth clubs, study circles and women's groups). When collecting
background information about all of these groups and organizations the
emphasis should be placed upon two questions, namely: Who are the
key decision makers and what makes them tick? If you know what
motivates the chief of police then you will know how to present your
proposal to him.
7
o What existing legislation relates to drug abuse ?
Within most communities there will be longstanding or relatively new
legislation relating to substance abuse. In most countries of the world
there will be laws derived from the Single Geneva Convention (1961) and
the International Psychotropic Convention (1971). Such legislation will
have a built-in component to deal with treatment and rehabilitation (e.g.
compulsory treatment, legally designated treatment centres, rehabilita
tion programmes). This information may be available from the police or
district health authorities.
The CAT should also be aware of other legislation directed towards
tobacco and alcoholic beverages (e.g. health warnings). There may be
laws relating to home brewed alcoholic beverages, permitted quantities
of alcoholic beverages in individual possession for consumption, age
restrictions on the sale and consumption of alcoholic beverages, desig
nated places of consumption, as well as drinking and driving. This
information may be available from the alcohol licensing authority or the
police.
There will also be existing legislation and penalties that govern the
sale and possession of opiates for medicinal uses as well as other
psychoactive drugs which have prescription control (e.g. barbiturates.
amphetamines, benzodiazipines). The pharmacist, the drug control
administration and the district health administrators should be able to
provide this type of information.
° How can the CAT get
the message to the
community?
Most communities.will have a
local newspaper or news sheet.
Many have more than one, as well
as other forms of communication
(e.g. radio. TV). A very important
component of the CAT's work will
be to raise the community's level of
awareness about drug problems
and drug programmes. Again this
will involve patiently developing a
8
strang relationship with key individuals with access to communication
channels. Who are the people? Are they interested in health issues? Will
they run a campaign? Can they help to develop materials (e.g. leaflets)?
A journalist or a media representative usually turns out to be a very
useful and helpful member of the community action team.
4. Developing and Implementing a
Community Drug and Alcohol Strategy
Having formed a CAT and collected background information on the
extent of drug abuse as well as key groups and decision-makers, the
next stage is to use all of this information to develop a few plans. Before
moving on to this stage the following basic principles should be borne
in mind.
o
Negotiate, don’t dictate: When attempting to change rela
tively fixed beliefs it is wise to look for areas of agreement or
common agendas. For example, if a school or sports club is
obsessed with “fitness through exercise" it should not be too
difficult to discuss a drug programme within the same framework.
The owner of a bar is in business to make a profit. Encouraging
the sale of low' alcohol beers should help his profits and also
reduce drink-driving accidents.
o
Aim for small successes: Don't worry too much about the
daunting prospect of developing a large, comprehensive com
munitydrug and alcohol strategy which addresses all drug issues
in all age groups within all sectors of the community. Instead go
for smaller scale objectives which stand a chance of succeeding.
Plan an article in the local newspaper. Persuade a policeman to
start a drink-driving campaign. A small success tends to lead to
other small successes. Small successes are good for morale.
Furthermore, they attract support and sometimes resources and
funds. Wherever possible ensure that one key worker has
responsibility for a particular project since diffusion of responsibil
ity can lead to confusion and chaos.
The rest of this chapter provides a number of possible interventions
9
which mayor may not be relevant to a particular community. They are
provided simply as examples.
o Developing a drug and alcohol information resource
The CAT should be in a position to utilise information derived from the
community assessment. This data may show, roughly, the numbers of
individuals who abuse a given type of substance. It might also indicate
some of the adverse health and social consequences, e.g. loss of weight
related to a drug habit, repeated chest infections (tobacco, marihuana
smoking), drug overdose (suicide and accidental overdose), poisoning
(related to methy-alcohol consumption), family discord and violence
(alcohol intoxication), loss of family assets (opiate habit), petty crime and
theft, (alcohol and opiate habit).
In addition some information might have emerged about existing
programmes, including those directed towards treatment, rehabilitation
and continuing care. Put all of this information together and the primary
health care worker, or other member of the CAT, is in a very good position
to serve as an information resource for the community. The CAT might
consider publishing a booklet entitled "Dealing with drug abuse in
Kandi" or something similar. Sections would cover the extent of the
problem, the consequences of drug and alcohol abuse, as well as
suggested strategies for groups and organizations (e.g. education,
health, police, leisure, etc.).
o Raising awareness
Publicizing and disseminating the bookieton dealing with drug abuse
could mark the launch of a programme or a campaign. Discuss such an
initiative with a newspaper or your local radio well in advance of the
publication so that the dissemination of information is planned and not
fortuitous. If you have a wealth of information then you could hold back
some of it for future publicity events or newspaper articles. The best
strategy is to remind the community about drug abuse at regular
intervals but not so frequently that they mentally switch off and the
campaign just becomes part of the wallpaper.
Publicity events should be as vivid and as memorable as possible.
With the cooperation of a school, arrange for a group of children to
dramatically display the number of people who will die prematurely as
10
a result of alcohol, drug or tobacco use. Ask a local drama group if they
could act out a number of brief stories involving the consequences of
drug abuse (e.g. drinking and driving, violence within the family). If
possible persuade a well known person, or role model, to lead the
campaign.
Ask a local drama
group to act out
alcohol-related
violence within
the family
Members of the CAT or other interested individuals could be encour
aged to address various community groups, e.g.. the women's institute.
parent-teachers associations, youth clubs.
o Integrating drug abuse interventions with other
programmes
Most people are very concerned about their health and well being.
When they visit a doctor, primary health worker or pharmacist they are
usually ready to listen to advice and this is when health workers should
be ready to discuss drug abuse. These workers should routinely ask
about drug use and provide advice about changing lifestyles and
obtaining further help. Early identification and early intervention is
discussed in another booklet in this series but the most important first
step is (or the primary health care worker to be continuously vigilant.
Problems as diverse as depression, nausea and family disputes could
well be linked to drug abuse.
The pharmacist is one of the local experts on drugs and will usually be
a supportive member of the CAT. Leaflets and advice provided by the
pharmacist might be one way in which information can be disseminated.
11
In Zimbabwe (as in many countries) the occupational health nurse is
very well placed to identify drug and alcohol problems at an early stage.
In one project the nurse has been able to routinely include questions
about drug use and especially look out for signs of possible abuse such
as Monday morning symptoms, accidents, disputes at work and absen
teeism after pay-days. The occupational nurse is then able to follow up
early identification with advice and a home visit if this is indicated. If all
primary health care workers could follow this model and also obtain help
from others then a great deal could be done to prevent the escalation of
the drug abuse problem.
o
Alcohol and drug policies for organizations
A great deal of drug use occurs wilhin the working environment. Most
organizations could be encouraged to develop a policy relating to drug
use focused upon health and safety at work. Here are a few examples:
Wherever alcohol is served on the premises there must also be
cheap non-alcoholic beverages so that a choice is offered.
Employees using complex machinery should not drink or use
drugs whilst at work.
Employees with a poor work record resulting from a drug or
alcohol problem will be offered counselling as a first step.
Smoking will only be allowed in certain designated places since
non-smokers have the right to work in a smoke-free atmosphere.
Developing a drug and
alcohol policy is an excel
lent method of raising —
awareness. It is particu
larly important that mem
bers of the health service
provide an example for the
rest of the community to
follow.
12
Dovelop a Youth-Link Network
A group of young people could be encouraged to develop a
■youth link" network of youth groups who are interested in prevent
ing drug and alcohol abuse. Such groups could be linked to the
CAT but they would be encouraged to produce ideas and pro
grammes developed by young people for young people.
This youth programme would be one distinct component of the
community response and as such it should be managed and monitored
by one person, perhaps a teacher, a parent or a young person.
o
Law enforcement
The community action team should develop a close relationship with
law enforcement agencies since the CAT and the police certainly have
common agendas which must be explored. For example in many
communities the under-age purchase of alcohol and cigarettes is a
major concern. How can the police help to solve this problem? How can
the law enforcement agencies influence drug availability? In those
districts where community policing is considered to be an effective
crime prevention strategy a great deal can be accomplished. For
example in some societies it is illegal to serve drinks to people who are
already intoxicated and to those who are under age. In one study carried
14
o Self-help approaches
Fifty years ago in the United States of America two alcoholics
concluded that they could not conquer their problem alone but won
dered if they could beat it together. Their success lead to the worldwide
movement now known as Alcoholics Anonymous. Working on a problem
in a group has a number of clear advantages. First, understanding and
support is provided by others with a similar problem. Second, those who
are coping successfully can pass on helpful advice. Also when attempt
ing to solve a problem two heads are usually better than one. Finally,
some people find that they get a great deal of satisfaction from giving
help to others.
in Hong Kong the Alumni Association of Sarda is a self help organi
zation composed of and managed by ex-addicts. Following detoxifica
tion and rehabilitation former addicts are welcomed back into the
community by the group who arrange support and after-care in liaison
with health and social services.
A self-help group should be started by three or four enthusiastic
people who feel that they would like to get help and give help. They could
be drug abusers, recovering drug abusers or members of their families.
Self help groups could also provide valuable support to the community
action team in a number of ways.
o
Developing a youth programme
Drug use is a habit that often begins during adolescence. Perhaps the
most effective method of dealing with the drug abuse problem within a
community is to prevent the habit developing in the first place. There are
a number of ways of educating and influencing young people including
the following:
Education about the harmful effects of drugs should be included
within the basic school curriculum, either as a separate course or
as an adjunct to other courses (e.g. biology, health care).
One method of consolidating this teaching is to ask a class to
design a set of posters warning about the dangers of drug abuse.
A group such as the Rotarians might be persuaded to run a poster
competition and present prizes.
13
5.
Monitoring and Assessment
It is important that the CAT obtains as much feedback as possible
about developments and achievements since knowledge of results is
the only way to ensure that the programme is proceeding in the right
direction. If a particular programme is failing then it will have to be
modified. On theotherhand.knowtedgeof successes keepsmotiviation
high and encourages everybody involved to keep up the good work.
When trying to keep track of community action it might be helpful to
think of three types of information:
I.
Inputs:
What actions are taken by the CAT? e.g. discuss drug
education with the headmaster and the parent-teacher
association: persuade Rotarians to be involved.
2.
Processes:
What chain of events follow from these activities? e.g.
one teacher volunteered to run a poster campaign.
winners' names were published in the newspaper, the
Rotarians paid for the printing and distribution of the
winning poster.
3.
Outcome:
As a result of all the inputs and processes what
objectives are achieved? e.g. is it possible to identify
changes in accidents or crime rate, do children know
more about drug abuse?
Some of the information needed to monitor the programme can be
provided by members of the CAT and the wider group of people involved
in the project. Outcome information will also have to be collated from a
variety of official sources and if a community survey has been carried out
then perhaps it can be repeated.
The CAT should delegare overall responsibility for monitoring to an
appropriate person and regular meetings would need to be held in order
to keep track of relevant information and feedback.
16
out in the UK a 20% reduction in crime was achieved by a police force
who reminded bar staff of these laws and paid regular visits to particular
bars to ensure that these laws were being enforced.
The police usually come into contact with drug abusers and their
families and could serve as a comminication channel to disseminate
information about sources of help and advice.
o Accident prevention
In many societies accidents are a major cause of death in young
people and in old age. Because large numbers of young people are
involved, accidents are usually near the top of the list of events or
illnesses which result in the greatest number of lost years of life. Since
drugs or alcohol are usually implicated in more than 30% ol accidents
on the roads, in the home and at work an accident prevention campaign
is an excellent way to start a drug abuse prevention campaign.
Accident
prevention
will be
supported by
most
communities
One great advantage of such a campaign is that it is usually noncontroversial. An accident prevention group could involve brewers, bar
staff, the police, public transport and young people as well as health and
social services. An accident prevention campaign will be well-received
by most community groups and is a good method of developing a
nucleus of concerned people. This nucleus could then move into other
drug abuse prevention activities. Focusing upon accidents serves as a
point ol entry into those networks which are involved in decision-making
and the process of change.
15
Final Comments
Drug abuse is a problem that is either stigmatized and considered to
be beyond the pale (e.g. heroin abuse) or it is accepted as a leisure and
recreational activity (e.g. excessive use of alcohol). Both of these
attitudes can persuade a community that no action needs to be taken by
them. Furthermore, with alcohol and cigarettes, it is sometimes argued
that drug users are free to abuse themselves if they want to. We have
suggested that these attitudes should not be confronted directly but that
common agendas should be identified (e.g. Is heroin abuse draining
health service resources? Are smokers polluting the office environ
ment?). In addition to society's ambivalence about drug abuse there will
be many vested interests involved. These should be identified by the
CAT.
A community will only have limited energy and resources to direct
towards the problem of drug abuse. In order to harness this energy and
attract resources the CAT will have to be persuasive and enthusiastic.
We have pointed out that small successes can generate a great deal of
enthusiasm.
Finally it should be noted that members of a community action team
should look towards their own use of drugs before they try to influence
the community. Changing lifestyles whether they be yours or those of the
community is a difficult but rewarding task.
17
ANNEX I
What are the commonly abused substances?
The classes or groups of psychoactive substances that can be
abused and cause problems are diverse. The following are the ma|or
classes and general characteristics of such substances:
Depressant substances: This group includes alcohol, the
barbiturates, and an enormous variety of synthetic sedatives and
sleeping tablets (hypnotics). These substances have in common
the ability to cause a degree of drowsiness and sedation or pleas
ant relaxation, but may also produce "disinhibition" and loss of
learned behavioural control as a result of their depressant effect
on higher centres of the brain, a property that accounts for the
apparent “stimulant" effects of alcohol. These drugs all have the
potential to induce changes in the nervous sytem that lead to
withdrawal symptoms and the possible seriousness of these
withdrawal states needs to be emphasized. Withdrawal from
severe physical dependence on alcohol or barbiturates can be
life threatening.”Mlnor tranquillizers ” of the benzodiazepine
type, such as diazepam (Valium) or chlordiazepoxide (Librium),
are probably best placed in the general depressant group,
although they also have some distinctive features: the benzodi
azepines have less potential to induce serious withdrawal states
and are generally far safer drugs in clinical practice than the
barbiturates, although their dependence potential should be
borne in mind. Alcoholic beverages are widely used in many
societies and because of this their abuse potential is underesti
mated. Alcohol is a drug and must be used with equal caution.
Opiates (or opioids): The prototype drug for this group is mor
phine, the major active ingredient in opium. Opium is the resinous
exudate of the capsule of the white poppy and contains, as well
as morphine, other psychoactive substances that can be ex
tracted in pure form, including codeine, a commonly used drug for
relieving pains and coughs.
18
Morphine can be converted, by a relatively simple chemical
process, to heroin. Besides these opium derivatives, there are
many entirely synthetic opiates, such as methadone (a drug used
widely in the management of heroin abuse), pethidine (meperid
ine or demerol). and dipipanone. All the opiates share a capacity
to relieve pain and produce a pleasant, detached, dreamy
euhphoria. and the capacity to induce dependence. Withdrawal
from the opiates can be very distressing, but will not be fatal
unless the patient is otherwise severely ill or debilitated.
Stimulants: Cocaine is the psychoactive ingredient of the coca
leaf. It produces a sense of exhilaration and a decreased sense
of fatigue and hunger. Similar effects are produced by a number
of synthetic substances, such as the amphetamines and related
substances, including phenmetrazine, methylphenidate, and vari
ous drugs that have been marketed tor the treatment of obesity.
Khat is a shrub, the leaves of which are chewed in the Middle East.
The active ingredient is cathinone, which has actions that are
similar to those of amphetamine.
Cocaine, the amphetamines, and some of the synthetics can
cause extreme excitement and induce short-term psychotic dis
orders. These substances have a high potential for dependence
although the withdrawal symptoms seem to be limited to tempo
rary feelings of fatigue, "let down", and depression.
Millions of people all over the world consume coffee and tea
containing caffeine (tea also contains some theobromine). These
substances tend to be stimulants in that they alleviate mild
degrees of fatigue, but they have a mechanism of action in the
body that is quite distinct from that of cocaine and the ampheta
mines. Generally, they produce very tow levels of dependence.
Withdrawal, if any, seems limited to some headache and fatigue.
Hallucinogenic drugs: This group includes LSD (lysergic acid
diethylamide), mescaline, peyote, and certain other plant-derived
or synthetic substances. These substances have the capacity to
induce highly complex psychological effects, including transcen
dental experiences of other-worldliness, hallucinations, and other
types of perceptual distortion. Sometimes this experience be
comes bizarre and frightening, producing what is commonly
19
known as a "bad trip”. These drugs do not induce physical de
pendence.
Cannabis: This is the generic name given to the drug-containing
plant products of Indian hemp: this plant material offers an ex
traordinary array of psychoactive chemicals, the most important
of which is delta-nine-tetrahydro-cannabinol. or THC. The dried
leaves or flowering tops are often referred to as marijuana or
ganja, and the resin of the plant is referred to as hashish or 'hash".
Bhang is a drink made from cannabis. Cannabis appears to have
some depressant qualities, but it can also have hallucinogenic
effects. Until recently, it was believed that cannabis was innocent
of dependence potential but recent evidence throws some doubt
on this belief.
Nicotine: This is another drug that merits a separate category.
Nicotine can have either a calming or a stimulating effect, or it can
have a dual action. Nicotine readily induces a degree of depend
ence. but withdrawal symptoms are more a matter of restlessness
and irritability than acute physiological disturbance.
Volatile inhalants: These include: anaesthetic gases, glues,
lacquers, paint thinners, and so on. There is some doubt as to
where to place these substances. They may have some depres
sant and anaesthetic effects, but they also seem capable of
producing perceptual disturbances. The chief danger is their
physical toxicity. Solvent sniffing can become a frequently
indulged habit, but it is unclear whether in practice any severe
degree of physiological or psychological dependence develops.
Miscellaneous Intoxicants: There are a few other drugs that do
not fit neatly into any of the drug categories mentioned. Included
here are kava, a substance used in some islands of the Pacific.
and betel nut. which contains the drug arecoline and is widely
used in Asia and the Pacific basin. Still another is the synthetic
drug phencyclidine, currently popular among some groups of
young people in the USA; in comparatively low doses it causes a
mixture of drunkenness and anaesthesia, but in higher doses it
causes psychotic states that may resemble schizophrenia.
20
ANNEX 2
Terms - What do they mean?
A drug is a chemical substance of natural, semi-synthetic or synthetic
origin which, when consumed, will modify physiological and psycho
logical functions.
A psychoactive substance is a chemical entity that is capable of
altering mental functions in particular. Nearly all of these substances
will cause psychological dependence and some will also cause
physical dependence.
Psychological dependence is a condition in which a drug pro
duces a feeling of satisfaction and a psychological drive that calls for
periodic or continuous use of drugs to produce pleasure or avoid
discomfort.
Physical dependence is a state of physiological adaptation that
occurs due to regular intake of a drug, such that it causes severe
physical disturbances when the administration of the drug is stopped.
These disturbances, called withdrawal or abstinence syndromes are
a collection of specific symptoms and signs both of psychological
and physical nature that are specific for each drug class.
Hazardous use refers to the occasional, repeated, or persistent
pattern of use of a psychoactive substance (or multiple substances)
which carries with it a high risk of causing potential damage to the
physical and mental health of the individual but which has not yet
manifested these ill-effects.
Harmful use refers to the pattern of use which is already causing
damage to the individuals health. The damage may be physical (e.g.
infections such as hepatitis from self-administration of injected drugs)
or psychological (e.g. episodes of depression after cocaine use).
Abuse is a word that is widely used in the field, however, it really is an
umbrella term that encompasses hazardous and hamiful use.
21
ANNEX 3
Community Participation Checklist
The following checklist can be consulted when assessing a specific
intervention. The ideal programme involves the active participation of
the wider community at all stages. It is developed by the community and
not imposed upon it.
I-. Planning: Was the programme developed after discussing the drug
problem with community representatives or was it started without
discussion?
2.
Priorities: Were the priorities determined by the people themselves
or by a government agency?
3.
Skillstraining: Did training involve short local courses followed by
regular in-service training or support? Alternatively was the training
provided by a remote institution with no follow-up support?
4.
Implementation: Was the programme implemented by a commu
nity action team (CAT) or was it implemented with no community in
volvement?
5.
Monitoring: Was the CAT closely involved in the monitoring proc
ess?
6.
Ownership: Is the programme perceived as a local programme
developed by and-for the locality?
7.
Representativeness: Does the programme fully involve women.
young people, the old and the disabled?
8.
Communication: Does an infrastructure exist for the exchange of
information at the local level?
22
$
s>.
GRIEF
A Basic Reaction to Alcoholism
Joseph L. Kellermann
i
j
A BASIC REACTION TO ALCOHOLISM
by
Joseph L. Keilermann
SHAZELDEN*
First published, 1977
Copyright © 1977 by Joseph L. Kellermann
All rights reserved
No part of this pamphlet may be
reproduced without the written permission
of the publisher.
ISBN: 0-89486-037-2
Printed in the United States of America.
Editor’s Note:
Hazelden Educational Materials offers a variety of information on
chemical dependency and related areas. Our publications do not
necessarily represent Hazelden or its programs, nor do they
officially speak for any Twelve Step organization.
Depression or Grief?
“Grief is the real or the imaginary loss of a cherished
person or thing. Depression, by contrast, exists despite all
evidence to the contrary. The person suffering grief is very
much aware of the nature of grief as to its cause or origin. The
depressed person is not aware of the cause.”
The above definition was given a few years ago by Dr.
Hans Lowenbach, of the Duke University Medical Center, now
retired. His essential contrast between grief and depression will
be followed as well as his descriptions of the symptoms of grief
and the suggested steps in recovery.
Depression is completely irrational and may be a
psychotic condition. It does not respond to reason, intelligence,
or to counseling, but in most cases is self-limiting. It may
respond to medication or the treatment of a mental illness
through chemotherapy.
Grief, on the other hand, is usually a normal loss reaction,
but does not require the loss of a loved one by death. Any
basic loss may produce grief, such as the damage to a new car
or the loss of a family pet. Retirement and giving up responsi
bility may produce real grief. Losing a contract or a bid may
induce grief. Teen-age lovers frequently experience grief,
which is a part of growing up.
Separation or divorce brings grief even though both
parries are aware that the action is necessary. Each loses some
thing that was once very dear to them both.
The breaking away of a child as it passes through the
period of adolescence may produce grief for a parent. If the
parent tries to reach down and pull the child back, the grief
increases. The parent must accept the child as a young adult
who may or may not turn back to the parent. Pursuing the
child in grief only makes it worse. Any family situation which
focuses on the lost person or thing, rather than self, increases
grief.
Grief is the universal experience of all persons of every
race or creed. The only persons who escape grief are those
who die before any human love is formed or experienced.
Grief is common to all persons and it is included in the
Beatitudes: “Blessed are those that mourn, for they shall be
comforted.” Mourning is working through grief, or the means
whereby grief is overcome.
The only persons who are incapable of grief are those
unable to experience love and affection' with others. The
capacity to love entails the experience of grief at some point in
life. Husband or wife lose each other in time. Parent and child
do the same. The experience of grief indicates the ability to
care and relate to other persons. It also entails the ability to
enjoy God’s gifts to us, things in life which we cherish to the
extent we miss them when lost.
Many counselors do not distinguish between depression
and grief and treat them as one and the same thing. As the
origin of each is entirely different, then working through each is
an entirely different process. Unfortunately, in the field of
alcoholism, grief is rarely mentioned in the literature and is not
considered in most recovery programs for the alcoholic or
family members. It is ignored, or even worse, grief-stricken
2
persons are told that they are depressed, which is considered a
form of mental illness.
As grief is a normal condition, medication is not indicated
except for one specific purpose. At the time of death, it is
permissible for the person who cannot sleep to have
medication to get a good night’s rest in order to go through the
service of the burial of the dead and all that is entailed, which
often requires facing an enormous number of persons.
If grief occurs, the grieving person must be permitted to
experience grief and helped through grief with the most
appropriate mean: available to the person. Each society and
culture has its own process of working through grief, and
persons must be permitted to do those things which they have
been taught or think are proper in expressing their grief. The
same is true in regards to expressions of grief which do not
relate to death. The use of medication is an escape from the
process of working through grief and postpones a return to a
condition of normalcy which cannot occur until grief is
resolved. To reduce the pain artificially is not an answer to
grief.
Symptoms of Grief
The impact of grief on a person is clearly visible and
manifests itself in several ways. The following are observable
characteristics:
1.
Fatigue and loss of energy are so pronounced that a
grief-stricken person may collapse while walking across the
floor. Grief drains off energy and the desire to be physically
active.
2.
Loss of appetite often occurs, although this is not true
in all cases. Not eating, of course, adds to the loss of energy.
3
3.
The face may look ten or fifteen years older. The curve
of the mouth may turn down as a manifestation of sadness, the
opposite of smiling, which often cannot be expressed. The
uhole countenance of the person takes on an appearance of
sadness. This appearance may be only temporary or may last
for weeks or months. Working through grief changes the facial
expression to the extent that the facial expression is younger.
4.
Initially, acute grief comes in waves, and much later on
when grief has been overcome, a small wave of grief may
appear for a moment. During an initial wave of grief, the
person may think that he cannot breathe, and it may be so
intense the person may feel he does not want to live. It is like
being knocked down by an unexpected wave at the beach and
having salt water get into the eyes, mouth, and nose and choke
one. Wave after wave is to be expected, but the waves get
smaller and the period of calm between the waves becomes
longer and longer. In time the calm prevails, but the knowledge
of this wave reaction of grief can be of great benefit to the
grieving person, by permitting him to know the intensity will
last a short while and a less painful condition will follow.
5.
Another symptom of the grieving person that is in
contrast with the depressed person is that the grieving person
focuses on the lost object and can talk about nothing other
than the person or thing that has been lost. In alcoholism, this is
expressed by the constant focus on drinking and ignoring all
other aspects of alcoholism, including any planning or realistic
approach to the other problems involved. It does not reduce
the grief of the family member (although it may relieve the
tension of the moment), but leaves the person with increased
emptiness. The constant verbalization about the grief object is a
major symptom of grief as it relates to alcoholism.
6.
Grief also entails such intense pain that it almost
prevents the grieving person from doing anything which adds
to pain at that time. This is why the grieving person benefits
4
enormously by working through grief if alcoholism is the
source of grief. Until grief is overcome, it is virtually impossible
to take creative action to cope with alcoholism more effective
ly. To do something which increases the intense pain of grief
may seem impossible. Every person has a limit to the pain he
can endure and acute grief for the moment is a bit more than
most persons can bear if other pain is added at that time. When
the grief dies down, the person will be able to consider bene
ficial action. At that moment, understanding, love, and comfort
are needed, not advice.
So grief is the most normal and the most common of all
human pains. It is not something that happens to other
persons, it happens to all living persons who are capable of
caring for others.
Grief of the Alcoholic
The nature of alcoholism produces losses for the
alcoholic. There are several forms of alcoholism, but for the
great majority of persons, it is a progressive illness which brings
on greater losses as the person continues to drink over the
years.
1.
The first loss is the ability to drink in keeping with the
social norm which involves the time, place, with whom, and
how much. It also involves the conduct and responsibility of all
involved in the social event. The first loss then, is the loss of
interest in people and increased interest in the bottle.
2.
The loss of memory of drinking experiences, which is
alcoholic amnesia, commonly called a blackout. It appears in
most in the late twenties, but may appear in the teens or at fifty,
sixty, or even seventy in some rare cases. It is the first medical
symptom of alcoholism that is clearly visible and occurs when
5
3. The face may look ten or fifteen years older. The curve
of the mouth may turn down as a manifestation of sadness, the
opposite of smiling, which often cannot be expressed. The
v.hole countenance of the person takes on an appearance of
sadness. This appearance may be only temporary or may last
for weeks or months. Working through grief changes the facial
expression to the extent that the facial expression is younger.
4. Initially, acute grief comes in waves, and much later on
when grief has been overcome, a small wave of grief may
appear for a moment. During an initial wave of grief, the
person may think that he cannot breathe, and it may be so
intense the person may feel he does not want to live. It is like
being knocked down by an unexpected wave at the beach and
having salt water get into the eyes, mouth, and nose and choke
one. Wave after wave is to be expected, but the waves get
smaller and the period of calm between the waves becomes
longer and longer. In time the calm prevails, but the knowledge
of this wave reaction of grief can be of great benefit to the
grieving person, by permitting him to know the intensity will
last a short while and a less painful condition will follow.
5. Another symptom of the grieving person that is in
contrast with the depressed person is that the grieving person
focuses on the lost object and can talk about nothing other
than the person or thing that has been lost. In alcoholism, this is
expressed by the constant focus on drinking and ignoring all
other aspects of alcoholism, including any planning or realistic
approach to the other problems involved. It does not reduce
the grief of the family member (although it may relieve the
tension of the moment), but leaves the person with increased
emptiness. The constant verbalization about the grief object is a
major symptom of grief as it relates to alcoholism.
6. Grief also entails such intense pain that it almost
prevents the grieving person from doing anything which adds
to pain at that time. This is why the grieving person benefits
4
enormously by working through grief if alcoholism is the
source of grief. Until grief is overcome, it is virtually impossible
to take creative action to cope with alcoholism more effective
ly. To do something which increases the intense pain of grief
may seem impossible. Every person has a limit to the pain he
can endure and acute grief for the moment is a bit more than
most persons can bear if other pain is added at that time. When
the grief dies down, the person will be able to consider bene
ficial action. At that moment, understanding, love, and comfort
are needed, not advice.
So grief is the most normal and the most common of all
human pains. It is not something that happens to other
persons, it happens to all living persons who are capable of
caring for others.
Grief of the Alcoholic
The nature of alcoholism produces losses for the
alcoholic. There are several forms of alcoholism, but for the
great majority of persons, it is a progressive illness which brings
on greater losses as the person continues to drink over the
years.
1.
The first loss is the ability to drink in keeping with the
social norm which involves the time, place, with whom, and
how much. It also involves the conduct and responsibility of all
involved in the social event. The first loss then, is the loss of
interest in people and increased interest in the bottle.
2.
The loss of memory of drinking experiences, which is
alcoholic amnesia, commonly called a blackout. It appears in
most in the late twenties, but may appear in the teens or at fifty,
sixty, or even seventy in some rare cases. It is the first medical
symptom of alcoholism that is clearly visible and occurs when
5
As the losses of the alcoholic increase in severity, so does
the grief of the spouse of the alcoholic increase, especially that
o: the wife. Initially she does not attempt to deal with the
excessive drinking, because so many persons drink and exces
sive drinking is, unfortunately, all too acceptable in our culture,
which increases the potential for alcoholism. So initial drunk
enness does not bring grief in most families.
1.
The first real grief appears when the wife attempts to
keep the bottle away from the alcoholic, or keep him away
from drinking situations or events. It simply does not work. The
wife may stop going to social events where drinking is likely to
occur, and she loses social contacts with other persons. Vaca
tions cannot be planned in many cases, for drinking begins to
disrupt the anticipated happiness of such events. So normal
family living and normal social life are lost, which leads to
sadness and grief.
2.
The next noticeable loss is the loss of order. Life is
chaos and confusion. Anything can happen, and usually does,
in an alcoholic marriage, so plans cannot be made. The only
real order is a state of disorder. This is a loss of responsibility
within a home for all parties.
3.
Most wives attempt to overcome this irresponsibility by
taking over the responsibility as head of the house, and may
even go to work to be certain that necessary bills are paid. This
is a loss of proper role in marriage, as she becomes sole
disciplinarian, dispenser of money and permission to do things,
and is attempting to be both father and mother to the child.
She also sees her children deprived of what others have in
social life and benefits, and this adds to her grief.
4.
A fourth loss for the wife may be described as attempts
to escape from the reality of the situation. She may become
a hermit, or become so active that she does not have time to
8
feel the losses. Having lost happiness in the home, she may
attempt to find it everywhere other than in the family.
A common experience in this stage of adjustment of the
family may be called “divorce within the home,” which is just
as grievous and damaging as separation. This condition may
occur only while the alcoholic is drinking, or it may be a
prolonged situation, but another tender part of a marriage has
now disappeared.
5.
Separation is something that happens in most
alcoholic marriages, although it may be disguised in many
ways. An extended visit with one’s parents is a frequent
example. Hospitalization for a psychosomatic illness is another.
However, separation never occurs as frequently as threats,
because the very idea of separation is too painful.
If separation occurs, the alcoholic usually stops drinking
and asks that he be permitted to reenter the marriage based on
promises not to drink again. Such a request is often granted
without requiring that the alcoholic be engaged in a structured
recovery program or active in Alcoholics Anonymous.
The wife usually reenters marriage without having
become active in her own program to learn how to cope with
alcoholism. The idea of divorce is painful and the separation so
filled with emotional conflicts, most marriages are resumed
after separation with no structured program for either husband
or wife.
If reconciliation of the separation occurs without sufficient
time and a recovery program for both, the end result is that
drinking starts in a short period of time. The result is extreme
grief for the wife, who feels that the painful process of separa
tion did not work. She may feel utter despair and that it is a
hopeless situation. The separation worked, in a sense, but it
was the reconciliation which did not work, because neither was
9
prepared for it. These are things a spouse should know before
taking steps to separate.
Separation should never be undertaken in an effort to
make the other party stop drinking. Separation may occur
when to remain is so destructive it might take both parties
beyond the point of no return. Separation may be undertaken
if the sober spouse seeks help, enters a recovery program, and
separates on the basis that the alcoholic chose not to enter a
recovery program in order to solve the intolerable marriage
problems. Separation should not be tried to force the alcoholic
to stop drinking, but is justifiable on the grounds that the
alcoholic may no longer force the spouse to live in an intoler
able situation. In effect it is saying that the wife will not coerce
the husband into sobriety, but she can no longer be forced to
live under the intolerable drinking situation. It is giving the
alcoholic the choice to drink, if this is more important than
learning to stay sober and enter into the rebuilding of a
marriage, with both parties seeking help in this process. For a
wife who enters and remains in her own program, there is a
reasonable chance of her working through grief regardless of
the choice the alcoholic makes. She also has a real chance of
motivating recovery for the alcoholic, with lasting sobriety, true
reconciliation, and a good marriage being the possible results.
Attempting to put a marriage back together without an
alcoholism recovery program brings added grief for both
persons.
There are additional losses for the spouse of an alcoholic
husband as well as wife. The spouse may begin to suffer
psychosomatic illness which interferes with work activities.
Wives of drinking alcoholics may fail on the job in the same
pattern that the alcoholic misses work. She has sick headaches,
makes mistakes, and her absenteeism parallels the husband’s
stay at home. She may go to the doctor about her anxiety and
grief related to alcoholism. Doctors see women in this condi
10
tion more than they see husbands who are hungover. The wife
also loses self-respect and is aware that she is not truthful with
her doctor, covers up for her husband with his boss, and never
tells the truth about her absenteeism with her own employer.
This is the pattern of alcoholism. Grief is a normal reaction to
the total aspects of alcoholism and therefore is something that
can be understood, and plans can be made for working to
overcome it.
Three Steps in Overcoming Grief
There are three basic steps in overcoming grief which
may be taken by the grief-stricken person which do not require
changing outside circumstances.
1. First one must make a sacrifice. This is true as related
to death and other forms of grief. Despite the fact that all seems
lost, the beginning of recovery requires the ability to give of
one’s self in a sacrificial manner. This is the first step out of the
emptiness, the utter void of feeling that nothing is left. It is like
overcoming paralysis by doing that which seems impossible. It
requires faith and courage, but this is the beginning of
conscious recovery. For the spouse of the alcoholic, it means
giving up the “poor me” syndrome and doing something about
the painful condition. It means going to Al-Anon meetings, or
to group therapy, or both. It involves the help of other persons
who understand and can join in the recovery process.
Essentially, it means an investment of time and energy in
a sacrificial manner, in a program specifically designed to meet
the needs of the spouse of the alcoholic which will permit her
to overcome the sense of loss.
2. Secondly, it means giving up the three questions
which begin with “why.” “Why did 1? Why did he? Why did
we?” These questions are asked a million times by the spouse.
11
Or they can be asked in the negative form, “Why didn’t 1-or
he-or we?” It is impossible in life to find an answer to “why” in
human conduct, other than all persons exercise choice, and in
the process of volition, people do what they want to do, and
this is not always right or best for them or others. This is the
way life is. There is no valid basis for the pursuit of “why,” and
in solving a problem, this is the first. thing that must be
abandoned.
Prayer, Ten Commandments, the Serenity Prayer, nor the
Twelve Steps of AA or other similar groups.
If we cannot tell God why we did anything other than it
was our own human choice and that we are responsible for
what we did, then we cannot demand that others tell us why.
To do so would be assuming that we could push God aside
and demand that persons answer to us in a way that God will
not permit us in our relationship with Him. And like Job, we
cannot find fault with God as Job did initially and demand that
He tell us why things happened.
The real problem cannot be faced until “why” is
abandoned and one looks at “who, how, when, and where” *
So “why, why, why?” has to go, and the focus must be
things happened. Then and only then is it possible to decide |
placed on one’s own healing.
what can be done about it from the point of view of changing
one’s self, one’s attitude, and eventually, the reactic.i to what
3.
The final step may be termed sanctification, which is
has happened. We cannot change what has happened. It has
the ability to see the lost person or object in an entirely different
happened. It is a fact. We cannot change the historic fact, but
light. It is a releasing in love that which has been lost. If it is the
we can change ourselves and our response to the fact.
death of a loved one, it is giving back to God with thanksgiving
for the joy and happiness shared with the person before the
In this aspect, basic religious truth must come into the
loss. In alcoholism, it is releasing the alcoholic in love and
picture. To ask “why” on a repeated basis is to blame God for
seeing whatever is good in the alcoholic and being thankful for
letting it happen. If we take a good look at Biblical truth, we
it without bitterness, anger, hatred, or resentment. It does not
learn that God does not let us explain why we did things. We
mean that one continues to be an unnecessary martyr to
dare not make excuses in approaching God. The author of the
alcoholism. Sanctification comes only as a final stage in one’s
Book of Job deals with the question of “why.” Job cried out
own recovery; it is not the beginning of it.
and asked God why all these things happened to him, a godly
This ability to see the alcoholic in a new light is a powerful
and upright man. The book deals with the suffering of one who
force in the healing process, for it removes the spouse as a
is innocent and does not deserve all these losses. Finally, when
provoked
female in the merry-go-round aspect of drinking,
Job understood he would be challenging God to continue the
reaction, response, and drinking again. The reaction of the
protest, he was able to change his whole approach and ask that
God teach him. This is when Job began to heal and to be ■ spouse is now entirely different, so the response must be differ
ent. The spouse no longer helps keep the merry-go-round
restored. It is the same process for all persons.
going, and in most cases, this will lead to recovery of the
alcoholic as well.
“Why” has to be abandoned in overcoming grief as well
as in understanding the nature of one’s own conduct. "Why"
By resolving her own grief, the spouse can now act in
never appears in the creed of any religious faith and is certainly
freedom, as the intense pain of grief is so reduced it no longer
not in any form of confessional. Nor is it found in the Lord’s
12
13
controls her life. This also has tremendous impact on the grief
of the children, who also are freed by her freedom.
Children in a family with alcoholism suffer grief, for they
lose not only their security with the alcoholic parent but also
lose the other parent to alcoholism by the focus of the sober
spouse on the alcoholic. It is not the drinking or drunkenness
that cuts the children off, but the fighting and quarreling that
does it. Also the children see both parents so involved with
each other and the drinking problem that they are left out, and
neither parent is seriously concerned with the needs of the
children.
A case history will illustrate it. Recently, a forty-two-yearold wife in Al-Anon heard a lecture on grief as it relates to
alcoholism, and two days later a program on reconciliation
with one’s family of origin as the basis of mental health. She
put the two together and became aware of the fact that when
she was fifteen, she felt that she lost her mother to her father’s
alcoholism. Later the father died, and she resolved this grief.
However, twenty-seven years later there was still a painful rela
tionship with her mother which she recognized as grief which
had never been reconciled.
This woman learned she can turn back to her mother,
work toward reconciliation with her and overcome the grief.
Not only is it her responsibility to do this, but she is aware of the
joy she will have in the reconciliation.
Working through grief and achieving sanctification is a
problem for children of alcoholics who grow up. There are
some who claim that the injury which occurs during the early
years of a child’s life with an alcoholic parent cannot be
removed later on. For adults who still suffer grief from child
hood experiences, it is never too late to overcome the grief
reaction. Recovery from alcoholism is a lifelong process. For
14
the alcoholic, the spouse, and their children, it does not occur
in a thirty-day treatment program for the alcoholic.
How to Help
How does one help a grief-stricken person? There are
some things which often prove beneficial and other things
which may be avoided.
First and foremost, when a person is suffering from grief,
your presence is helpful if you are a loved one and your
presence is one of comfort. Most rush in at the first indication
of grief and do not go back again when the real problem
stretches out over a long period of time. Grief does not
disappear quickly. In some cultures and families, when death
occurs, other members of the extended family do not let a
widow live alone at home for a year or more. A sister, aunt,
cousin, or niece is scheduled by family planning to provide
residential companionship of a loved one to help the mourning
person through the grief period. So the two things you can
always give a grieving person are your companionship and
your love.
When visiting a grieving person, lend an ear and not a
mouth. Do not advise and counsel as did Job’s comforters.
They tried to tell him why it all happened and nearly drove him
out of his mind. Do not try to solve the problem, just be there.
Do not try to make him eat, but see that food is available that
can be eaten in small quantities. If the grieving person suggests
an activity, join him, but do not push or insist that he do what
you think he should do. Remaining in familiar surroundings is
essential.
Remember also that healing is as much a part of life as
sickness or hurt. Time is necessary in healing, but grief should
15
not be prolonged. Overcoming grief is a spiritual process, and
those who wish to participate in spiritual healing need to
understand that in spiritual healing, one must be a wounded
healer. If a person has not been through real grief, it is
impossible to say that “I understand how the grieving person
feels.” If one has experienced grief, one knows that this need
not be said. Your presence and your compassion indicate that
you understand the need of the other person and that you
really understand how he feels. Your presence conveys the
message.
Al-Anon Is Helpful
family, especially the in-laws, turned against her. Having an
extended foster family at this time is essential in maintaining
the recovery process.
This principle is the same as the fellowship of Alcoholics
Anonymous when the alcoholic gives up his/her best friend,
the bottle, and cuts off from his/her old drinking buddies,
which is a basic part of recovery. Understanding persons are
essential for the spouse, male or female, as well as for the
alcoholic.
Using the Twelve Steps
For the spouse or older children in a family where there is
alcoholism, it becomes an extended foster family of caring
persons who have been wounded and are healing. The fellow
ship of this group is one of understanding, and with this group
support, the recovery from grief has increased assurance.
The Twelve Steps are wonderfully structured for working
through grief, and they are in complete accord with Biblical
teaching and faith. First there is the process of surrender of self,
which, in effect, is true sacrifice, admitting one is powerless and
turning one’s life over to the care of God. The other side of this
coin is that one does not sit at home and do this. It means
going out to the meetings. When God comes to us, he leads us
to others with whom we can share our belief in restoration of
faith. When we pray, we must put legs on our prayers by
getting off our knees and doing something about the prayers
we have just uttered. Admitting we are powerless over alcohol
gives us the strength to do something about ourselves. At the
same time, this is the abandonment of asking why and focusing
on how the problem can be resolved.
Also as the spouse learns to cope with alcoholism and
makes basic changes, other members of her own family,
especially the alcoholic, initially will often insist that she not
rock the boat or that she turn back to where she was. He may
even make threats if she does not return to the former position
of riding the merry-go-round. If the spouse makes significant
changes, she may find herself standing alone with all of the
The Fourth and Fifth Steps, taking one’s own inventory
and then making a complete confession to God and another
human being, is a cleansing of guilt if complete honesty is
followed in the inventory and confession. Once this has been
accomplished, the loss can no longer be associated in any way
as God’s punishment for failures of the spouse, either of com
mission or ommission. It takes away from the spouse the
16
17
For the spouse of an alcoholic or for other members of
the family, there is one group that is capable of providing the
healing process in overcoming grief. By the very nature of its
program, Al-Anon provides this, as it is a program of spiritual
recovery based on the same Twelve Steps and Traditions of
Alcoholics Anonymous. The following are beneficial aspects of
Al-Anon as they relate to grief, but there are many other
benefits as well.
feeling that drinking is her/his fault or that stopping it is her/his '
responsibility. Consciously or unconsciously, when the Fourth
and Fifth Steps have been completed with honesty, it is
impossible to blame God or one’s self for the drinking and its
consequences. It puts it where it belongs, the responsibility of
the drinker, who may continue to drink in a destructive
manner or enter a recovery program. It also helps the spouse
understand that any statement on the part of the alcoholic as
to why drinking occurs is an alibi and cannot be accepted.
In completing the Twelve Steps, the spouse achieves that
state of condition which permits sanctification. By releasing the
alcoholic in love, one gives back to God and to the alcoholic
the responsibility of deciding what to do. It gives the spouse the
freedom to remember what is good in the alcoholic and to
remember the joy in the life shared with this person as well as
the sorrow. This minimizes the loss.
In this process of releasing in love and permitting the
alcoholic to choose to drink or seek help in learning to abstain,
the spouse is not required to separate or is not required to
remain in the marriage. This is the choice of the spouse, who
knows not only what is best, but also what is possible for
her/him to do at this particular time.
The new freedom of the spouse and the ability to cut the
strings which the alcoholic has used to control the spouse as a
puppet have profound effect. In a reasonable period of time,
most alcoholics seek help and enter their own program. If they
do not or will not do this, the spouse at any time may offer the
alcoholic reasonable choices as a condition of continuing the
marriage or separation. In fact, the spouse may do this to
discover if remaining as housekeeper or husband permits the
alcoholic to choose not to do anything about the problem.
rescue, or protection. This means that we trust the built-in
structure of life itself and its corrective measures, which just
might be more successful than those we have practiced in the
past. It also means giving up the effort to impose one’s will on
another person while accepting the responsibility of surrender
ing one’s own to God’s will, not to the alcoholic’s demands.
Within the family system, healing is as contagious as sick
ness. When one member of the family seeks help and over
comes grief and remains in that condition of healing without
changing back to the old method of dealing with problems, it is
predictable that in time others in the family will move toward a
recovery also. The real hope of the spouse and children or
parents in an alcoholism situation is that of seeking help in
overcoming their sense of loss. This, in a sense, is abandoning
the alcoholic, but it is done in love. The hope is that this
removal of the pampering and protection routine will result in
the free choice of the alcoholic to surrender and admit he is
powerless over alcohol and enter a recovery program.
If the spouse is the husband and the alcoholic a wife, the
needs of the husband and his specific program are even
greater. His role as husband is so controlling that unless he is
able to overcome his grief and stop asking his wife and God
why it all happens, there is little chance of recovery for either
partner in the marriage. His healing is the most powerful
condition that an alcoholic wife can experience. Few wives fail
to respond when a husband overcomes his Pride and his Grief,
and humbly seeks help for himself while releasing his wife in
love.
Finally, it means loving a person enough to permit
him/her to fail in dignity without our interference, control,
A result of overcoming grief is the willingness and effort
to share the healing experience with other persons who also
suffer grief, especially from alcoholism. The Twelfth Step
indicates that the person who has been through a spiritual
recovery tries to take this message to others. The message can
be extended, understanding and compassion can be offered,
18
19
but the witness one bears in the practice of these principles is
the means whereby others are able to accept the message and '
practice it in their lives. Once the healing occurs and there is
understanding of how it happened, one is aware of the fact
that the main thing worth offering is simply sharing our
presence and our love.
As grief is the common experience of all persons and
therefore is a normal condition - not a pathology or sickness -then recovery is a normal process and falls within the realm of
normal spiritual experience. As each of us is able to release in
love that person or thing that we have lost, so do we receive
the healing power of God’s grace. Also as our wounds are
healed, so do we become instruments of God’s grace in reach
ing out to others with the message of our recovery and the
willingness and need to share this with all others who mourn.
1.
The willingness to make a sacrifice.
2.
Stop asking “why?” which is to imply that God is guilty
and we are innocent.
3.
Sanctification, that condition which permits remem
bering that which is good rather than dwelling on that which
has been lost.
Everyone has a choice: to remain in grief or to overcome
it with the help of those who bear the scars of the same
wounds.
Dr. Hans Lowenbach states that ninety percent of
persons thought to be suffering depression are actually
experiencing acute grief and deserve the dignity of knowing
they are not mentally ill.
This is especially true in the area of alcoholism. The
spouse is not a neurotic person who needs a drunk husband or
wife, but an average person who is also a victim of alcoholism
and experiencing grief, not depression. To know this, to accept
it, and to act upon it has tremendous power in solving the
problems of alcoholism for the alcoholic and the spouse who
initiates the action. Children also benefit by such action on the
part of the sober parent.
Today no one needs to remain in grief due to alcoholism.
There are counselors who understand and there are thousands
of Al-Anon groups capable of assisting the spouse through the
steps in overcoming grief.
These steps are simple but profound in effecting a
recovery from grief:
20
21
Other titles by Joseph Kellermann that will interest you.
A.A. - A Family Affair
A fresh look at the importance of the family unit in the recovery
process. The author examines the roles of A A.. Al-Anon, and Alateen
and suggests that more effort be made to reach whole families rather
than just the alcoholic. (12 pp)
.
Order No 1120
Al-Anon: A Message of Hope
The author takes a sensitive look at the demands and expectations
placed on the spouse of the alcoholic and details ways that Al-Anon
can help. (16 pp.)
Order No. 1135
Alcoholism: A Merry-go-round Named Denial
Thousands of readers have benefited from this analysis of the roles
people play in alcoholism, the "enabler." the "victim." and the
"provoker." Recovery can begin when the actors stop playing these
roles and get off the merry-go-round (16 pp.)
Order No. 1140
The Family and Alcoholism:
A Move From Pathology to Process
Kellermann describes grief in the alcoholic family, suggesting
behavior changes that can help the family and the alcoholic. (20 pp.)
Order No. 1296
A Guide for the Family of the Alcoholic
;
;
Weapons used by the alcoholic to control the family and cover up
for consequences of problem drinking are destructive and deadly. Here
are ways that the family can defend itself (16 pp)
Order No 1300
Reconciliation with God and Family
Recovery for the family includes reconciliation with God and one's
‘amily of origin. Find out how family members can initiate a process ol
'econciliauon rather than attempt to change others within the family.
Order No 1413
HAZELDEN
™ey Road
Educational Materials
Center City, MN 55012-0176
1-800-328-9000
(Toll Free U S Only)
1-800-257-0070
1-612-257-4010
(Toll Free MN Only)
(Alaska and Outside U.S 1
MH - *2A.i-S"
Draft for discussion
MU-SEV^
COMMUNITY BASED SUBSTANCE ABUSE PREVENTION
PROGRAMME WITH A FOCUS ON ALCOHOL
I.
Community Based Substance Abuse Prevention aims at helping the community to
prevent the abuse of substances. This covers a part of large area which requires
behavioural changes of the members of the community. A major point of it, for
practical implementation, will be community based rehabilitation of persons
involved in substance abuse.
Community based rehabilitation can be defined as a process in which all affected
persons of a particular geographical area are helped to develop themselves to their
full potential, within their own community, making the best use of local resources
and thus, achieve maximum possible integration in to their families/communities. ■
II.
AIM OF THE PROGRAMME
a)
The primary aim of the community based substance abuse prevention
programme is to shift intervention from the costly, professionalised.
specialist institutions to the homes and communities of the persons with
disabilities(Francis 1997).
b)
By the innovative use of local resources, interventions can be made
more appropriate,
more effective and
more acceptable (Thomas and Thomas 1997).
c)
The programme will also be undertaken in the context of the paradigm shift is
health from a
Medical model
->a social/community model
Individual
-►Community
Patient
-►People
Disease
-►Health
Providing
-►Enabling
Drugs Technology
-►Knowledge / Social process
Professional control
-►Demystification
(CHC)
III.
PROGRAMME GOALS
• Abstinence from alcohol/drugs
• Change in lifestyle to enhance quality of life.
IV.
COMMITTEES
a)
PLANNING FRAMEWORK AND PROCESS
b)
AT COMMUNITY LEVEL COMMITTEE
|
Planning, implementation and monitaring community level activities.
Local government
Eg. Corporation
Municipality
Panchayat
V
NGOs working
in the area and
other local
interest group
V
Community
residents
Eg. Women group.
Youth group,
Men group,
and other socio
economic
groups
j_____
;
Key
community
institutions and
service
providers.
Eg. Local
1
hospitals.
i
Schools,
Industries,
Business,
Police,
Sponsoring
institution
c)
COMMITTEE TO MOBILISE FUNDS FOR PROGRAMME
PROGRAMME DURATION
One year
Venue: Programme will be conducted in a school, marriage hall or community
centre situated in the areas (slum).
THREE MAIN FACTORS IN COMMUNITY BASED REHABILITATION
OF SUBSTANCE ABUSE PERSONS.
The community based treatment programme calls for a coordinated and skillfully
orchestrated effort of the programme-undertaking agency, the treatment team and
the affected persons and the families in close cooperation with the community.
VII.
PROGRAMME TEAM
LINK WORKERS / LOCAL VOLUNTEERS OR ANIMATORS
ACTIVITIES
Prevention and
Promotion
Awareness
creation for the
public.
Poster
campaign
Rally
School and
college
education
Medi^coverage
advertisement)
Community based treatment Reducing alcohol availability
and rehabilitation, n .
• Publicity in the area 'JiMicro level
through film shows,
pamphlets, posters and
Reduction of alcohol
different group meetings.
problems.
Aprofessiena^sdig^^ Reduce alcohol
visit to the affected house
availability.
to motivate the person.
Prevention strategies that
clarify the programme.
target environments where
infuse hope about
young adults are likely to
recovery.
congregate hold
Meeting the family
considerable promise for
members of the affected
reducing alcohol-related
person to assess problems
problems.
and elicit their cooperation
Prevent illicit - arrack
and enable them to cope
brewing and selling in the
with the situation.
slum..
Medical screening of the
affected persons with the
help of local hospital
doctor to rule out major
medical problems.
Treatment process
(NIMHANS).
Group therapy
Family therapy
Individual counselling
After care activities
Group activities
Recreational activities
Social skills and
assertiveness training
Training to the field
workers and local NGO
staff.
IX.
Macro level (Policy)
• Regulation and taxation of I
/alcoholic beverages
\!
*/ Strategies to reduce
\
|\
/ alcohol availability.
/• Increase alcohol price.
i \
• Motorcycle helmet.
| \
• Motor vehicle safety
i \
devices.
IMPLEMENTING AGENCY, COORDINATING AND SUPPORTING
INSTITUTIONS ROLE.
Locnl NGO
;7?7
NIMHANS
RESEARCH STUDY INTO
Extent of problems
The number of people involved.
Type of people involved.
Demographic details.
Effects of substance abuse on others - family harm and disruption, violence and crime.
Facilities available for rehabilitation.
Relative effectiveness of various methods of rehabilitation.
Evaluation of the programme.
Number of people available to participate in the programme.
All legal issues.
Physical and mental effects of alcohol abuse.
4-
—1
- ?-■
■
j !^r.
4^^
A- W '
AaV
HELPING ALCOHOLICS
TO HAVE
A SMOOTH RECOVERY
GUIDELINES
FOR SUPPORT
PEOPLE
HELPING ALCOHOLICS TO HAVE A
SMOOTH RECOVERY
- GUIDELINES FOR SUPPORT PEOPLE
Alcoholism is a disease which leads to physical and emotional problems.
Alcoholics are people who need support and help to give up alcohol and
lead a qualitative life. For an alcoholic, recovery begins with abstaining
from alcohol. This abstinence should be total and for life time. It
should also be followed by the alcoholic learning to manage his life better;
making positive changes in various aspects of his life.
To help the alcoholic in the recovery process, it is very important that he
has well wishers - support people, who are willing to assist him in his
recovery.
1
Support people are those who have a keen interest in the welfare of the
patient. They may be the alcoholic’s
Family member
eg. Uncle, Sister,
Brother, Father-in-law
Personnel at office
eg. Supervisor, Manager,
Co-worker
Family Doctor
Clergymen
Friend
Support People are those
who do not use alcohol
who meet the patient frequently
g
whom the patient respects and holds in high regard.
The reasons behind having support people are:
to give additional help and support to the recovering person
to help in rehabilitating him during his recovery
to help prevent relapses from occurring and
to bring him back for treatment in case he relapses.
2
UNDERSTANDING ALCOHOLISM AS A DISEASE
After extensive research, it has been established that ALCOHOLISM
BY ITSELF IS A DISEASE - a disease which can be treated by giving
medical and psychological help.
Without treating this disease, any other alternative like changing the
alcoholic’s job, getting him married, etc. will not help him stop drinking.
Unless the alcoholic totally stops drinking, his condition will get worse
•day by day.
The disease of alcoholism can be treated. In the process of treatment,
the patient gets help to keep away from alcohol totally for life. Such total
abstinence is essential and it is the only solution to the problem of
alcoholism.
3
GIVING A HELPING HAND
The patient needs medical and psychological treatment to give up alcohol
totally and lead a qualitative life.
Medical Treatment (Detoxification - 5 to 7 days) - aims at
helping the patient overcome withdrawal symptoms such as
tremors, fits etc., which may occur on stoppage of drinking.
treating associated physical problems like gastritis, neuritis, dam
ages due to malnutrition, etc.
helping him to get back to normal eating and sleeping pattern.
Psychological Therapy Programme - 21 days
Detoxification is followed by psychological therapy programme. The
programme provides an understanding of the various aspects of alcohol
ism and gives an insight into the associated problems. It helps the patient
to strengthen his goal of leading a comfortable life without alcohol.
Psychological therapy programme includes
- lectures
- assignments
- group therapy
- relaxation therapy
- individual counselling sessions
4
CONTINUING TO PROVIDE HELP
Follow-up isa very importantpartof the treatment programme. Follow
up facilities are provided for five years after the primary treatment. A
family member has to accompany the patient during every visit.
As part of follow-up, medical and psychological help are offered.
Medical care
The patient is asked to meet Doctor / Psychiatrist / Counsellor during
follow-up.
Frequency of visits
Period following treatment
1st
4th
7th
After 1 year
Once in fifteen days
Once a month
Once every two months
Every quarter
3rd month
6th month
12th month
The first one year after the primary treatment, is a very crucial period for
the patient.
The patient will be on the following medications
1.
2.
3.
Disulfiram (Antabuse)
Vitamins
Other medications, if prescribed.
5
Disulfiram is prescribed to help the patient abstain from alcohol. It
serves as a deterrent to the alcoholic, because severe adverse
reactionsareproduced if alcohol is consumed after takingDisulfiram.
The patient is advised to take Disulfiram (one tablet daily) for a
minimum period of one year. Once he crosses the first year without
drinking, it paves the way for his future sobriety.
Some cautions to be kept in mind while the patient is on
Disulfiram.
a)
The patientshould not consume even a small amount of alcohol
after taking Disulfiram. It produces several unpleasant effects
like flushing, sweating, palpitation, shortness of breath, dis
comfort in the chest, fall of blood pressure, blood vomiting,
unconsciousness, etc. It can become life threatening.
b)
If the patient has consumed alcohol over Disulfiram, it is an
‘Emergency.’ Take the patient to a nearby Hospital. The
patient has an emergency card which has to be shown to the
doctor.
c)
During recovery, even cough syrups or tonics containing
alcohol should not be taken by the patient, as this can precipi
tate a reaction.
d)
Even if there is a suspicion that the patient might have taken
alcohol, do not give him Disulfiram.
6
This card gives the list of necessary medications to be administered in this
condition. Ensure that this is done immediately to revive the p itient. If
not attended upon, the patient’s life will be in danger.
Sri....................................................
on Disulfiram Tablet. If you find him unconscious, vomiting and
with low B.P., it is probable that the person has taken alcohol
when on Disulfiram Tablet against medical advice. Hence, he
has to be treated as an Emergency Case and the following
treatment should be given
1. Injection Decadron 2. Injection Vit. C.
3. Injection Avil
4. Injection Glucose
2 Vials
2 Amps
1 Amp
5% drip
I.V.
I.V.
I.V.
Injection, Vit. C. and Decadron can be repeated till the B.P.
is restored to normalcy.
Note: Disulfiram tablets are available only at our Hospital. Patients
outside Madras city may send a money order to the Counsellor. The
tablets will be sent immediately.
2.
Vitamins are given for the improvement of general health of the
patient.
3.
Other medications like anti-depressants, anti-psychotics etc., are
prescribed if necessary. These medicines have to be taken by the
patient for 3 to 6 months. The patient has to periodically review the
dosage with the Doctor / Counsellor.
Even after treatment, patients need counselling. Many issues like
problems in the family / workplace have to be dealt with during recovery.
Patients need support and strength to face and manage them.
7
To help them in their recovery process, the following facilities are
offered:
1.
Medical help
Patients are encouraged to meet the doctor to seek medical advice
and report on their progress.
2.
Counselling
This helps the patient to face his problems like inability to cope with
tension, difficulty in taking up responsibilities etc., and deal with
them appropriately. Martial counselling is also provided. Even if
there are no problems, the patient is expected to meet the Counsellor
with his family member to report about his progress.
3.
Letter writing
The patient is asked to write regularly to his Counsellor about his
welfare. Counsellors will also periodically write to each patient.
4.
Telephone calls
Patient can contact his Counsellor over the telephone.
Apart from these, patients are asked to attend Alcoholics Anony
mous meetings regularly. These meetings serve as a further support
in their recovery process.
8
UNDERSTANDING RELAPSE SYMPTOMS
Relapse can and does occur with some alcoholic patients. It is part of the
disease of alcoholism. Relapse is a process that creates an uncontrollable
craving for alcohol. Prior to drinking, a set of warning signs occur.
Some of the significant warning signs that appear before the patient goes
back to drinking are as follows:
The patient
Becomes over-confident - ignores follow-up measures.
Example: “I can take care of myself.” “ I don’t need the
Counsellor’s advise.”
2. Appears depressed - does not communicate, prefers loneliness.
3. Becomes irritable, angry, argumentative, resentful over minor
issues.
4. Indulges in gambling etc.
5. Makes major decisions
without adequate thinking.
6. Is unable to eat / sleep properly
7. Stops taking disulfiram tablets
and other medicines.
8. Goes with drinking friends
9. Stops meeting Counsellor / going to A.A. meetings
10. Talks about social drinking
If these symptoms areseen repeatedly, the patient has to be persuaded
to meet his Counsellor.
Relapse is preventable.
9
METHODS TO HANDLE RELAPSE
If the patient has started drinking again
Bring him to the Hospital. Guilt feelings are very high during the
first few days. Therefore, be supportive and make him understand
that with help, he can recover. He needs medical help and
counselling.
YOUR ROLE AS A SUPPORT PERSON
You, as a support person have an important role to play in the recovery
of the patient. We need your help in the following areas:
1.
2.
3.
4.
When nomews is received from the patient and his family members,
we will contact you to get necessary information.
If the patient changes his residence, we request you to intimate his
new address to us.
If the patient needs a job or wife has to be reconciled, we may seek
your help.
If the family member finds it difficult to bring the patient back to the
Hospital when he has relapsed, we request you to motivate him to
take help.
Even if there are no problems, it is important that you keep in touch with
the patient regularly and encourage him in every progress he makes
during recovery.
A TREATMENT CENTRE FOR ADDICTION
TTK Hospital of TT Ranganathan Clinical Research Foundation is a
pioneer, voluntary, non-profit organisation dedicated to the treatment
and rehabilitation of people addicted to alcohol and other drugs. The
Hospital offers a comprehensive in-patient treatment programme for a
period of 4 weeks.
A programme for Support People is conducted on alternate Satur
days between 10-15 a.m. and 11.30 a.m.
For further information - contact:
TT RANGANATHAN CLINICAL RESEARCH FOUNDATION
‘TTK HOSPITAL’
17, IV MAIN ROAD, INDIRA NAGAR, MADRAS 600 020
Phone: 418361 /417528
Working Hours
Monday to Friday :
Saturday
Sunday
Counsellor's Name:
10.00 a.m. to 4.00 p.m.
10.00 a.m. to 12.00 noon
Holiday
Printed by Mr. N.Balakrishnan, Printograph, 59, Luz Avenue, Madras - 600 004.
Published by Mrs. Shanthi Ranganathan, TT Ranganathan Clinical Research
Foundation, 17, IV Main Road, Indira Nagar, Madras 600 020.
Distributed by Mr. J.Srinivasan, TTR Education Foundation, 17, IV Main Road,
Indira Nagar, Madras 600 020.
Prepared by:
TTRanganathan Clinical Research Foundation
17, IV Main Road, Indira Nagar, Madras 600 020
Sponsored by:
Ministry of Welfare, Government of India,
New Delhi 110 001
HH - 7-L.I £
SELF - ESTEEM
"A BETTER YOU" SERIES -1
ttk
TT Ranganathan Clinical Research Foundation
"TTK HOSPITAL"
17, IV Main Road, Indira Nagar
Madras 600 020.
Phone : 418361 / 417528
SELF - ESTEEM
SELF-ESTEEM is essentially a measure of self-worth and
importance. When this assessment of oneself is level-headed,
reasonable and positive, the person has a strong self-esteem. He
then sees himself as a valuable, worthwhile person and feels ‘good’
about himself. For him, life becomes enjoyable and the future
seems to hold a lot of promise. When this self-assessment is a
negative one, the person has a.weak self-esteem. This individual
feels that he is worthless, incompetent and unfortunate. For him,
life becomes insipid and the future appears hopeless.
Self-esteem is one’s evaluation of himself that colours his perception
of events and determines whether he is going to act decisively or
give in with a sigh and carry a sense of failure. Self-esteem thus
is a very important part of one’s personality.
Self-esteem has been shaped from our very early years. During
childhood, if an individual’s feelings are respected, thoughts valued
and abilities recognised, his self-esteem gets strengthened. If, on
the other hand, his feelings are trampled upon (‘I don’t care about
what you think/want’), thoughts belittled (‘What a lousy idea!)
and abilities criticised (‘You can never do anything properly’), his
self-esteem remains at a low point of development. Thereafter,
depending upon the success or failure in every significant situation
in life, coupled with his own reaction to it and the amount of
support he receives from others, his self-esteem either grows stronger
or gets weakened.
STRONG SELF-ESTEEM
Individuals with a strong self-esteem are able to relate to others in
a friendly, understanding manner, build healthy relationships and
find themselves successful. They are
-
confident
- appreciative
- goal-oriented
- contented
Confident
An individual with a strong self-esteem knows his strengths
and feels secure in accepting his limitations. He is able to
place a lot of confidence in himself and in his ability to handle
problems. This confidence stands him in good stead through
the triumphs and diasters he faces. A crisis does not lead to
despair, and triumphs do not lead to over-confidence.
'Rags to riches’ stories and lives of people who have overcome
disasters, all have one thing in common - a belief that one can
do it. These success stories are a testimony to what self
confidence can do.
Goal-oriented
His goals are always appropriate and realistic. When he sets
his mind on a goal, he is willing to give a lot of himself to
achieve it. He readily makes efforts, for he knows that no
achievement can be reached without the sweat of the brow.
Hard work does not frighten him. On the contrary, it adds
excitement to the whole exercise. More important is that he
is prepared to own up responsibility for his failures as readily
as he does for his successful endeavours.
Appreciative
A person’s feelings about others, corresponds to his feelings
about himself. The individual who feels happy and ‘good’
about himself, can make others feel ‘good’ about themselves
too. He is able to readily acknowledge the good in others.
He is warm, appreciative and shows a genuine interest in and
regard for others. These qualities help him in establishing
meaningful relationships.
Contented
This person is able to accept himself with his limitations and
weaknesses while clearly being aware of his assets and
strengths. He tolerates and accepts imperfections in himself.
He is fully aware of his limitations and continues to grow
despite their presence. In short, he does not focus on what he
does not have and cannot do. He looks into the future and
sees what he has and can do.
3
WEAK SELF-ESTEEM
In contrast, individuals with a weak self-esteem have a negative
self-image and a poor self-concept. These hinder their ability to
build relationships, to feel comfortable and 'good’ about themselves.
Weak self-esteem also brings with it other penalties in terms of
negative personality traits as detailed below.
Critical
An individual with a weak self-esteem constantly tries to
strike out at people. Nothing seems to satisfy his expectations
and minor slips are singled out for severe condemnation.
Self-centred
Not willing to consider
the feelings and needs
of others, his selfcentredness alienates
him from them. The
intensity with which he
hangs on to his ideas
and needs, inconsiderate
of others, only leads to further frustration.
Cynical
Firmly believing that the world is treating him unjustly, this
person is ready to believe the worst of others. He carries a
huge load of past resentments based on real or imagined
injustices done. He misinterprets others’ thoughts and actions
and makes himself and others miserable.
Diffident
An individual with a weak self-esteem suffers from feelings
of self-doubt and insecurity. He looks at even minor failures
as proofs of his inadequacy. Even though he may be gifted
with abilities, he fails to take up responsibilities and utilise
his strengths because he is convinced he will fail.
An individual with a weak self-esteem is, in short, the very
antithesis of an individual with a strong self-esteem. A person
with a strong self-esteem is all set to enjoy an interesting
present and a happy future, whereas the one with a weak self
esteem is heading towards unhappiness and failure.
STRENGTHENING SELF-ESTEEM
A strong self-esteem is thus of crucial importance and the wonderful
thing is that it is more NATURAL to us than a weak self-esteem.
Self-esteem is a qualilty that can be strengthened at any point in
life regardless of age, educational background and social standing.
Building up one’s self-esteem is a slow process requiring patience
and perseverance. Yet it can be done with relative ease, considering
that its fruits can be enjoyed for a life-time. We have some basic
tips for strengthening self-esteem which are practical and easy to
follow.
**
Give positive strokes
generously
Appreciation in the
form
of
words
(compliments), facial
expression (a smile) or
5
gestures (a pat) are termed ‘positive strokes’. Positive strokes
help in strengthening the self-esteem of the recipient as well
as the giver.
Giving ‘positive strokes' is a healthy exercise which calls for
recognition of worth in other people. When we treat others
with dignity, respect and love, our own self-esteem
automatically grows stronger.
In this mechanical world, we are so caught up with life and living, $
that we take many things for granted. If we could only pause for
a minute and show our appreciation, the world would indeed be a
wonderful place to live in.
Murthy sat back and recollected all the pleasant things
that had happened over the previous week. “My daughter
willingly offered to massage my hfcad, when I had
migraine.... my son enthusiastically washed my scooter
during the weekend... my colleague volunteered to handle
my client when I was pressurised for time. Everyone
readily helped without my even making a request.” These
thoughts made Murthy feel loved, cared-for and ‘good’
about himself. He would have felt even better if only he
had expressed his feelings directly to the people
concerned.
t
We need to put in some effort to recognise the merits of people
around us and express our appreciation explicitly. People are well
aware of things that go right and feel good about these within
themselves. The barrier lies in communicating this positive feeling
to the other person. Building up self-esteem calls for breaking this
restraint completely. We must be able to comfortably, easily,
instinctively appreciate whenever something is done well or better
than usual.
6
While giving a positive stroke
Look directly into the other’s eyes. Looking elsewhere may
make the other person feel you don’t care or really mean what
you say.
Be specific about what you state. Instead of making
generalised statements like, “This shirt is good”, be descriptive
to make it more meaningful. “This print and the pastel shade
suit you”, would be better.
Say it in a clear, warm, tone. A dull, low monotone can
convey boredom.
Muthu’s son had won a prize at the drawing competition.
Muthu took great pride in relating this to all his colleagues
the very next day. Surprisingly, he did not say a word of
appreciation to his son. The least that Muthu could have
done is to have given his son a bright smile and a hug,
when he so proudly narrated the good news.
Malathy keeps a beautiful house and is a wonderful cook.
Her husband Shekar is proud of her. But in all their 10
years of married life, he has never communicated this to
her. All that Shekar needs to have done is to have just
looked at Malathy’s eyes and told her that he enjoyed
eating food prepared by her.
Muthu and Shekar appreciated the other persons deep inside
but did not voice their feelings openly.
A positive stroke expressed explicitly and directly, surely helps
to strengthen the relationship and build self-esteem.
**
Do not give plastic strokes
Compliments which are exaggerated or not genuine, can be
referred to as ‘plastic strokes’. Like counterfeit money, which
has no market value, fabricated compliments do nothing to
improve the self-esteem of the giver or the receiver. This
dishonest underhand exercise is deterimcntal to the giver as
he loses the ability to pay honest compliments. For a while,
plastic strokes may be received well. But soon, the receiver
becomes aware of this fraudulent exchange and receiving them
only makes him feel uncomfortable. Gradually, the ‘giver’
loses his credibility and his message is discarded, so much so,
that even if a positive stroke is presented by him, it is not
honoured.
“Balu is a good boy. He always docs the jobs I ask him to
do.... Come on, Balu! Run over to the cornecr shop and
get me some sugar” - compliments like these are not genuine
and are obviously made to manipulate others to get things
done for themselves. These do not benefit either the giver
or the receiver.
**
Accept positive strokes with grace
Culturally, we have been trained to feel uncomfortable while
receiving positive strokes. Refusal to accept these valuable
strokes, is not a virtue. It is a drawback that discounts our
feeling of self-worth and makes sure that our self-esteem stays
weak.
Positive strokes are as necessary for maintaining a strong
self-esteem, as water is for the plants. Positive strokes ensure
emotional well-being. These are invaluable gifts given to us
in recognition of our worth. They need to be treated well and
8
accepted gracefully. Refusal to accept them, is as ludicrous
as throwing away a priceless gift. When positive strokes are
rejected, it offends the giver and he desists from giving them
in future.
Nita remarked to Rekha, "You are a very efficient
person." Rekha's immediate reaction was "You
should hear what my mother says!"
Kumar's manager said, "You have done an excellent
job of the Brochure". Kumar responded saying,
"Well, frankly speaking I am not totally satisfied with
the outcome. I feel I could have improved upon the
cover page. I am sure the Chairman will not like it".
In the above examples, positive strokes have been examined with
suspicion and found wanting. Such an approach prevents us from
utilising these positive strokes for our healthy personality
development. When positive strokes are given, we need to accept
them, relish them and store them carefully to strengthen our selfesteem.
Rekha could have gracefully accepted Nita’s
compliment with a smile or a nod, while Kumar could
have received the compliment by saying “Thank you
for your encouragement, Sir. I am happy that the extra
efforts I had put in, have proved valuable.”
Even a person with a strong self-esteem, experiences periods of
uncertainity. During such moments, sharing one’s feelings with
someone who is empathetic and compassionate, will help in
strengthening his self-esteem.
Pushpa had been preparing for her examination months
in advance. Yet, on the day of the examination, feelings
of self-doubt built up. She felt anxious and was afraid
she might not do well. After listening to her, her mother
9
drew Pushpa’s attention to the positive aspects. She
reminded Pushpa of her consistent good performance in
the previous examinations and the hard work she had put
into the preparation. Her mother also expressed her
conviction that Pushpa would do well. Pushpa felt better
on receiving this positive feed back and left for her
examination in a confident frame of mind.
During periods of despondency, when everything seems lost, being
open about our feelings to a supportive listener, gives us an
opportunity to receive positive strokes. These positive strokes
remind us of our past triumphs and our potential for further
achievements and thereby strengthen our self-esteem.
**
Reject unconditional
negative strokes
Unconditional negative
strokes are generalised, allencompassing, negatively
toned statements. Though
these statements lack any
factual basis, they can
cause havoc to the selfesteem of the recipient.
The recipient is often aware that the statement is not fully true.
But he ponders over it and asks himself “How could he say it of
me?”, and wallows in self-pity.
Usha’s son said, “You are the worst mother I have ever
seen." Usha was aware that this remark was made because
he was irritated by her refusal to let him go to a movie.
Yet she told herself, "How ungrateful he is! I work so
10
Q
hard just io make him happy and I get only these words
in return."
Praveen was in a hurry and his breakfast was not ready.
He told his wife, "You never do anything on time." His
wife was upset because she was an efficient lady and
usually finished cooking early. She felt that he was being
very unfair and unjust and she was deeply hurt.
The penalties for accepting these negative strokes are high. Here,
every negative stroke is treated as valid, held as further proof of
one's worthlessness and inadequacy, and this perception weakens
one's self-esteem.
When an unconditional negative stroke is given, we have the right
to reject it. Unconditional negative storkes are garbage which mess
up our self-esteem. They make us feel less worthy and we lower
ourselves in our estimation.
Self-esteem is of great importance, as our actions, feelings, behaviour
and even abilities, and success in life are dependent upon it. By
developing a strong self-esteem, we experience happiness, self
confidence and enjoy life. The wonderful thing about self-esteem
is that we can change it and improve upon it at any time in life.
A strong self-esteem is ours for the asking with a little effort.
Work at the following four steps and enjoy a brighter, happier
life.
Compliment people directly and explicitly and experience that
warm feeling within yourself.
Shun flattery.
11
Receive genuine compliments with confidence and grace.
Ignore unconditional negative strokes, and stay balanced,
secure and comfortable.
Now you are letting yourself in for something marvellous in short.
A BETTER YOU
12
EXERCISES TO STRENGTHEN YOUR SELF-ESTEEM
1.
Building up self-esteem means being aware of one's own
positive qualities.
If your family members and colleagues were asked to describe
you, what words do you think they would use to describe
you? (Only the positive ones, ofcoursel). Think for a while
and list five adjectives.
Taking stock of your positive qualities in this manner, helps
you to see yourself as a 'worthy' person.
2.
Choose one significant person among your close family
members. Think of two qualities in that person which you
appreciate. Set a time limit to express it directly to that person.
Malini felt that her mother-in-law
had always been supportive in moments of crises
took great interest in the up-bringing of her grandchildren,
enthusiastically narrating value-based stories daily.
took genuine interest in preparing new dishes.
Even as she was recollecting, she realised that she had never
expressed her genuine appreciation directly to her mother-in-law.
"Her birthday is just a week away. I will use that as an opportunity
to tell her this," she thought.
Like Malini, identify qualities that you have liked in the family
member you have chosen. Remember, when you are going to express
it directly to him/her, say it clearly, be specific about the quality
you appreciate and while doing so, look directly into his/her eyes.
13
3.
Maintain a 'positive strokes' diary. When compliments are
given, record them. Record also the positive feelings you
experienced while receiving them - proud, happy, comfortable,
thrilled, honoured. During those moments when you are feeling
'low', flipping through this diary will help.
4.
List the false accuasations that people made about you in the
past. How did you feel? If you did feel hurt, how did you
handle it? What are the steps you have planned to take to
protect your self-esteem in future?
'ri"ted by Mr N-
Indira Nag^MadrasSr6<M020.
3000 Copies/October 1994.
Madras - 600 004?
EdUCat'°n Founda’i°n1 17, IV Main Road,
ALCOHOLISM MEETING AT NIMHANS ON 18th JUNE(Tuesday) 2001
The sharing session facilitated by CHC in collaboration with NIMHANS, was well attended by
members particularly from ‘REDS, APSA, APD, Nava Jeevan Mahila Pragati Kendra and FRLHT. Dr. Latha
Jagannathan from the Rotary TTK Blood Bank and Ms. Padmasini Asuri from CHC were also present.
NIMHANS was represented by Dr. Mohan Isaac, Dr.Pratima Murthy and Dr. Vivek Benegal and CHC by S.D.
Rajendran and Arjun Krishnan. The meeting commenced with Mr. Rajendran telling us all why he had
requested this meeting. Each time he visited some of the slums on a particular assignment, the women
residents would invariably approach him with one request - “Do something about the alcohol problem in our
community’’. Mr. Rajendran said that even though many of us had been addressing this growing problem for
some time now, an effective solution was yet eluding us. It is a big challenge but together strategies could be
evolved. He requested the group to share their views and experiences and together attempt at initiating a
novel and effective action plan to address the issue. He read out the main issues to be addressed. These
were:
□
□
□
□
□
Strategies focused on women to cope with husband's / family member's alcohol addiction.
Ways to reduce alcohol consumption in the affected areas
How to instruct the community to support and address this problem
How to maintain sobriety of people after treatment
Finally come up with ideas which could seek the eradication of this problem.
He then requested Dr. Mohan Isaac to chair the meeting.
Dr. lsaac spoke of how NIMHANS had been addressing this problem for many years and had not confined
their initiatives to the Hospital grounds alone but had ventured into areas where society was facing this
problem. He asked each one of us to introduce ourselves to each other and then share our views on what Mr.
Rajendran had shared.
Sr. Elise Mary of Nava Jeevan Mahila Pragati Kendra, Dr. Isaac felt, could begin as she was directly
involved with women's groups who were facing this problem. Sr. Mary spoke of a successful campaign she
had recently helped in Tamilnadu. She felt that women need to be united and that was where the success of a
campaign or project lay. For instance, in one case the women of a village in Tamilnadu had come together,
viewed the problem and taken action by enforcing the closure of a liquor shop in their area. They had the
support of the District Collector, without which, she felt the project may not have succeeded. In Karnataka,
she said, the women were afraid. Scared of something; possibly their husbands and other men folk. The
police were ineffective or reluctant to come forward to help and they too were a deterrent. Here, Mr. Joe Paul
of REDS, said that it was not the women in Karnataka who were in question, since most of the migrant
population in the slums comprised also of Tamil women. It was probably motivation which was more
important. He said that their groups programmes focused mainly on women and children and they had noticed
that when they involved this group in some activity or initiative, the men folk were always curious to join in.
They came forward to see and ask questions. He felt that women and children were ideal entry points to
approach the entire community.
Names of participants are given on the last page of this report.
Ms. Kamakshy of APD, said that their groups were working with the poor and focused on disability.
However the problem of alcohol was often encountered. She said that nowadays due to awareness and
empowerment programmes, the women in these areas were now taking on responsibilities and were earning
to help support their families. This left the men with freer time and no alternate activity. Probably this
freedom with nothing to do and boredom were responsible for them to start drinking. What was needed was
a family oriented programme offering alternate ways of recreation / relaxation that could be sustained. She
also felt that this initiative should be taken up just like the anti tobacco one.
Dr. Vivek Senegal was of the view that most of the programmes sought only to marginalize the men
with an alcohol problem They were singled out and this led only to denial and an attitude of defensiveness
among them. It would be more appropnate if in the course of other programmes the issue of alcohol could be
mentioned and elaborated upon seeing the response and circumstances. Prohibition had always been a
miserable failure wherever it had been enforced. Creating awareness among the male members of a
community was of little help as past evidence shows. Holding de-addiction camps was again a way of singling
out the drinkers. This was effective to a certain degree but large % ages of relapses are certain in these
situations. For instance he spoke of a village in Orissa where the women folk had succeeded in stopping the
sale of alcohol. The result was that the men folk were now not available having made alternate arrangements
in a neighboring village. Such drastic steps were not effective in the long run, he felt.
Why do men drink in the first place? This was a question that came from
Ms. Padmasmi Asun A very valid question. Dr. Senegal gave some reasons- To get Intoxicated was the
prime reason, he said. There were also numerous traditional myths coming down the ages, associated with
drinking. Some even encouraged it. Stating alcohol as a medicine, aphrodisiac or tonic . Though modern
research shows contrary evidence. One of the interventions has always been reduce supply and demand will
reduce. One important thing Dr. Senegal pointed out was that generally the emphasis of those addressing
alcohol problems was on the 4% of alcohol dependant people who caused only a fraction of the problems
arising out of alcohol abuse. The 40-50% who composed of problem drinkers caused 90% of the problems
i.e. violence, accidents etc. and yet were not thought of as having a problem. It is this segment of drinkers that
needs to be approached. Dr. Latha Jagannathan suggested that working with school children could be
considered and that this was a factor which many tended to ignore. This would be helpful, seeing that children
being brought up in that environment being made aware of the dangers of alcohol would tend to stay away
from it.
Dr. Pratiina Murthy suggested identifying one small community and trying out whatever initiative and
plan of action that would evolve from further meetings. The involvement of the community, she said, has to be
given priority. She also felt that one of the main reasons for this problem was the lack of adequate
recreational/ alternative activities. Members of a particular community could be asked to share their views
and entire families could be involved. This is a very viable and practical idea. Mr. Rajendran felt that sitting
with the people and sharing ideas was essential to the success of any proposed project. What they wanted,
their likes and dislikes what alternative activity could merge with their culture and way of living would be an
effective way to come up with a strategy. There were other very practical and useable ideas by all the
participants. The entire group however agreed on one basic factor- alternative ways of coping with day to
day adverse socio-economic situations that led many of these slum residents to drinking, would have to be
thought of. Entertainment, different forms of recreation and relaxation, that the affected people think useful
should be adopted. Helping the person utilize his free time more fruitfully, instead of succumbing to boredom
or inactivity should be a priority.
Finally Dr. Mohan Isaac summarized the discussions session with the following points:
Alternate forms of coping
School Children
NGOs work with men?
Remove popular myths? ■
Women/children programs - can become entry points
Empowering families as a whole - a sense of unity - family oriented
Awareness ?
One point that was noted was that almost all of the NGOs worked with women and children. What about an
NGO that worked with men? An idea worth considering. It was finally decided that there should be more
meetings to try and evolve an action plan. Dr. Mohan Isaac suggested that a network could be formed,
comprising of NGOs and individuals who consider the problem of alcohol abuse worth working for. CHC as
an organization dealing with community and public health ( and alcohol is certainly a community I public
health issue) could consider initiating or facilitating a project. Funding could be thought of once a proper
project evolved and a project proposal made. Some of the ideas which could be worked upon are -
Identifying one community. A small group.
Interacting with them to get to know their likes and dislikes, their traditions and way of life.
Involve them in meetings to ask them their views on certain issues, especially alcohol. Ask them what they
would consider as enjoyable activities or recreation.
And empower them - not women and children alone- but men also, to try and actively participate in
programmes that they themselves have thought of.
And monitor and record / document the entire initiatives’ progress.
So, taking into consideration all of the above thoughts and ideas, we could call for another meeting around the
second week of July 2001. This will give us all enough time to think about more possibilities which we can
share during our next meeting.
Participants:
Mr. Joe Paul (REDS); Dr.P.M.Unnikrishnan (FRLHT); Ms. Pushpalatha (APSA);
Mr. Bhimashankar (APSA); Sr. Eiise Mary (Navajeevan); Ms. Kamakshy (APD);
Ms. Padmasini Asuri (CHC); Ms. Rani (APO); Ms. Mary and Ms. Gracy (REDS);
Dr. Mohan Isaac; Dr. Vivek Senegal and Dr. Pratima Murthy (NIMHANS); Dr. Latha Jagannathan (Rotary
TTK BB); Mr. S.D. Rajendran and Mr. Arjun Krishnan (CHC)
SECOND MEETING OF ACTION GROUP FOR SOBRIETY
HELD AT NIMHANS ON 27™ JULY 2001.
The meeting commenced with Dr. Pratima Murthy welcoming the gathering
and initiating the discussion. Mr. Rajendran (CHC) began with reminding the
participants that this meeting had been called to specifically address the following issues:
Specific Area / Locality ( for implementation) and its ethnic composition
Details about the residents’ culture, prevailing traditions, likes & dislikes
Cun-ent ongoing development programmes if any
The resident’s views on alcoholic problems and programmes they would
like to adopt to address the problem
o Their views on any recreational activities
o
o
o
o
Mr. Rajendran also emphasized the need to tackle this issue at both macro and micro
levels. He felt that addressing the alcohol issue at the policy level is also important to put
pressure on governments and respective departments.
After Dr. Sampath Krishnan read out the main points of the last meeting, Dr.
Pratima Murthy requested the group to present the basic information collected from
their work areas. Sr. Elise Mary of Mahila Pragati Kendra began by saying she had
information about the Jayarajnagar slum just behind Infant Jesus church in Austin Town.
She said they had identified 25 families which could be a potential group to work with.
She further elaborated on the situation saying that most of the women there were
domestic workers with alcoholic husbands. This had resulted in incidents of severe
domestic violence and other related problems.
At this point Mr. Joe Paul of REDS intervened saying that the area Sr. Elise
Mary was talking about was not exactly a slum but rather a lower middle class area. It
comprised a population that saw growth as a need. Education among the adolescent boys
was fairly good and schooling was popular. However the lack of jobs, led these young
people to take to crime and the main problem was a rise in criminal activity. Politics
also played a big role in the life of the residents in this area. As the views expressed by
both participants presented quite a contradictory picture of the Jayarajnagar slum, Dr.
Vivek Benegal told the group that there was a need for a defined area where work could
be initiated. By this defined area he meant a particular group which is facing a problem
with alcohol; a potential group with which we could work with. He also felt that
selecting a particular pocket in a large area would only diffuse the effect of the proposed
program as the surrounding environment also played a vital role when trying to sustain a
particular project. He also felt that if there was a strong political leaning in the area,
implementing an alcoholic program could be a problem.
. »
Dr. Sampath Krishnan (CHC) also suggested that one of the approaches for
tackling alcoholism was the emphasis on spiritual health. Positive values could be
taught to these people. Dr.Vivek Benegal felt that this approach though promising and
helpful, would only create more problems, as fundamentalists of religions were always on
the look out for such type of activity to jump in and destabilize the environment. These
groups would find ways to sabotage any religious/spiritual approaches. It was dangerous
ground to tread on under the circumstances. Dr. Krishnan also felt that lobbying at
higher levels was a necessity as most liquor shops were flouting rules.. Especially the
timings laid out by the Government regarding the stipulated opening and closing of liquor
shops. Once these cases were documented and presented before the authorities there was
some chance of action being taken against the erring party This was agreed upon.
Another point he raised was about the funds being used by the Women and Child
Development department for de-addiction. The Health & Family Welfare department
currently runs about 6 rehabilitation centers in the city and these funds were being
channeled for their use. It was decided to follow this up with the Women and Child
Development department to find out whether any funds could be generated toward a
proposed alcohol de-addiction programme.
While communicating with them copies of the minutes of the two meetings held
at NIMHANS should also be sent to them. He also felt that documentation of all illegal
activities by liquor shops would be a great help while macro level lobbying. Dr.
Krishnan also suggested that training of NGO staff in methods of counseling affected
families especially women could help curtail their present antagonistic behaviour toward
the men which was one of causes which led to their indulging in sudden binges.
Sr. Sahage of Kanthi Kiranam said that they were working in Ragigudda slums in JP
Nagar with 1400 households and more than 4000 population. She said in their experience
the problem of alcoholism was quite high as majority of the men and women there
consumed alcohol. She also mentioned that they had conducted a de-addiction
programme in collaboration with NIMHANS some time ago. The patients had been given
free nutritious meals, courtesy World Vision and had been asked to report once a week
for counseling. However even though their turn out was substantial, it was noticed that
they arrived just to eat the free food and not for serious counseling. The program had not
been successful.
Dr.Vivek Benegal wondered whether it was feasible to work with a small group in one
part of this large area and especially within a big population like this one. He even
suggested that as needs of big and small groups were different we could consider
working in both large and small slums for purposes of comparison. . He also suggested
mapping of the area. A pattern of alcohol use could be ascertained. Alternatives the
community would like to participate in could be a place to start.
Mr. Bhimashankar from APSA mentioned that they had noticed that this was an issue
of concern even among street people. Whatever they earned was spent on alcohol and
most of the time the women folk were forced to part with money. Dr. Benegal said that
the problem with this kind of nomadic population was more severe and it was very
difficult to work with them as this segment did not have a regular base and they were
constantly on the move. Hence it would be very difficult to implement long term
programmes with them.
Dr. Pratima Murthy said a community needs assessment would be a useful exercise as
it gives a lot of information about a community and their expectations. This assessment
should collect the following information, she suggested:
❖ Socio-demographic details of the slum
❖ Alcohol use habits in the slum
❖ Possible, positive alternatives for the alcoholic problem. She even suggested that
if possible to include inter actors present in the area .
Dr.Pratima also said that she has a Performa which could be used to determine the
socio-demographic status in a slum. She had earlier talked about the relapse rates of
NIMHANS which she estimated to be about 50-60%. It was then suggested to have a
follow up team among NGOs working in areas where these relapsed patients lived.
These NGO members could locate these patients and see how they were progressing and
whether they required any further help.
At this point Mr. Chander , CHC, thought that the needs based questionnaire of the
People’s Health Dialogue could possibly get a few answers. This was planned as a part
of Janaarogya Andolana and could be used as tool. Mr. Prahalad (CHC) also
expressed the view that any information gathering if done on thelHowever Dr. Pratima
was of the opinion that though it was a useful idea, it encompasses a large number of
issues while alcohol constituted only a small component of it. She however agreed to go
through the questionnaire and modify it to suit the present requirement. She also said that
when going to the community to determine their needs, care must be taken not to allow
raising their expectations
Thanking everyone for sharing their views, Mr. Arjun (CHC) suggested that until the
next meeting the group could make a concentrated effort to find out about the existing
trend of alcohol consumption and related problems in the particular slums they worked in
and attempt to identify a particular group. A group which could serve as a starting point
for the evolving action plan. A sample questionnaire would be prepared and sent to
everyone in the group so that the required information would be available at the next
meeting. We could then have some positive ideas on alternatives and action. It was
decided to meet again on the 16th of August, Thursday when some more concrete
information would be available.
FOLLOW UP ACTION
NGO members working in communities could begin finding out current trends of
alcohol consumption and related problems their respective areas and present their
findings at the next meeting.
A letter should be mailed to WCD department asking if funds were available if a
feasible project plan I initiative was forwarded to them.
Dr. Partima Murthy would have a sample questionnaire ready (needs based) which
could be used by the NGO members in their work areas.
NGO members would try and identify a specific group and based on their responses
an action plan could evolve.
The NGO members would also note down the exact timings of the opening and
closing of the liquor shops in the locality. And the respective government
department could be contacted to find out about the rules that these liquor shops
are supposed to follow.
NGO members would try and determine the needs of the community ( related to
alcohol) with whom they work without raising any of their expectations.
Dr. Vivek Senegal
Dr. Pratima Murthy
NIMHANS
Sr. Elise Mary
Navajeevan Mahila Pragati Kendra
Mr. Joe Paul
Mrs. Gracy
Ms. A Kauhalya
Ms. Jabeena Taj
REDS
Sr. Sahage CM
Kanthi Kiranam
Mr. Bhimashankar
Mr. Manjunatha
APSA
Dr. Sampath K Krishnan
Mr. S.D. Rajendran
Mr. A. Prahalad
Mr. S.J. Chandar
Mr. Arjun Krishnan
Community Health Cell
THE THIRD - ALCOHOLISM CONTROL IN SLUMS MEETING AT NIMHANS
16th August 2001 (Thursday) 2:30 p.m.
The meeting began with Mr. Rajendran (CHC) welcoming the participants.
Some of those who attended the last meeting had not come due to some prior
commitments. Dr. V. Benjaim, A. Prahlad, S.D. Rajendran and Arjun Krishnan from
CHC attended. Mr. Joe Paul( REDS), Sr. Elise Mary(NMPK), Sister Sagaye
( Kanthi Kiran ) and Mahesh (TREDA) had brought the needs assessment information
needed as discussed at the last meeting. Dr. Vivek Benegal NIMHANS requested Dr. V.
Benjamin to chair the meeting. Dr. Benjamin stated that though he had not been present
for the previous meetings he was interested in the whole process. For the presentations
Dr. Benegal had arranged an overhead projector which made it easier for the speakers to
present their findings. He asked Sr. Sagaye to begin with her presentation of the
Ragigudda Slum near J.P. Nagar, where she and her group work.
d^G^guitZlAThis slum established in 1970 now has more than 1400 houses and is located near the up
market IP Nagar area. The residents belonging originally from Chikmagalur, Tamilnadu
and Andhra Pradesh speak predominantly Tamil followed by Telugu, Kannada and Urdu.
While the majority of women work as housemaids, the rest sell vegetables, flowers and
are employed in garment factories, the men work as carpenters, coolies, plumbers and
painters. The women bring home about Rs. 200/ to Rs. 300/- per month and the men earn
about the Rs. 50/ Rs.60/- per day whenever they get part time jobs. There are an average
of three children per household and very few joint families Though it is a regularized
slum, the land belongs to KSRTC, BDA and a portion to private owners. There are two
borewells and very few have water connections at home. The water supplied from the
Bangalore City Corporation comes only on alternate days. The drains are open and there
are public toilets used mainly by the women folk, as most of the male population prefers
to go outdoors.
Of the houses in the slum about 500 are semi-pucca while the rest have thatched roofs
About 200 of these houses have their own toilets. One out of ten houses have access to
cable TV. Dr. Vivek Benegal felt that TV was an important factor to consider as it
influenced attitudes and behaviour. Sr. Sagaye also noted that during the last five years
living conditions had not improved at all.
Formal and non formal education was available. One school offers education up to the
10th grade. There was a Government school where though the students were provided
school uniforms there was no sign of any regular teaching being conducted. A number of
primary schools also were functioning in the area. An NGO - World Vision offered
financial help to some families for education but this was not enough as the major portion
of school fees had to be borne by the parents which they could not manage. The result
was that very few availed of this aid. Not all children were attending school due to
primarily three reasons:
Have to take care of their siblings
Lack of money to pay fees
Poverty
Dr. Benegal said that he knew of certain government requirements for Urban slums.
These could be looked into. When asked about community health, Sr. Sagaye said that
the most prevalent ailments were cough, cold, fever, Asthma and Jaundice. There was
an IPP center about 20 minutes away and there was a once a week clinic being run by
REDS. Many patients were often referred to St. John’s or Rajiv Gandhi Hospital as they
were given concessions. There were about four to five private clinics all run by MBBS
doctors.
There were about 15 to 20 illicit liquor shops operating within the slum. Dr. Benegal
informed the group that there were three types of alcohol available the Government Arrack shops and the IMFL private liquor shops both of which were
legal while the other two were illegal being sold in sachets without a stamp or in open
bottles corked with lids made out of paper. According To Sr. Sagaye, there was only one
legally run liquor shop close by. Within the slum, two families brew liquor though they
are scared of the police. Majority of the men drink alcohol while a quarter of the women
population also consumes it. For income generation, self-financed petty business exists.
There was no agency giving loans save for World Vision which had extended a few
housing loans. For recreation, TV and gambling seemed to be the only avenues open to
the people. The unemployed are mainly youth. Seasonal jobs are prevalent and most of
the men prefer this. While most of the men smoke quite a few women chew tobacco.
There was also the use of inhalants (typewriter correction fluid) beside some other drugs.
Suicide was quite frequent and only last Sunday about four people killed themselves.
The reasons were different. Ranging from an unfulfilled love affair to a family quarrel.
Sex Workers were operating from the slums but not conducting business within it. When
asked by Dr. Benegal about the prevalence of HIV/AIDS, Sr. Sagaye said there was no
real information or statistics on this problem. Movies were also popular among the youth
who often were seen going to theatres in the evenings.
Only one-room houses existed and there was hardly any privacy. Husband wife quarrels
are common due to the problems of unemployment, worries, lack of any proper
recreation and unfulfilled needs. Community fights were rare, the last one having
occurred about six years ago^J
Dr. Benegal by then had divided the report into separate sections namely
Housing
Sanitation
Nutrition
Education - Adult, Children
Health Income generation
He said that he knew of many agencies who financed schemes in these areas. For
instance, Infosys and Wipro had two foundations, which helped underprivileged people.
They could be approached for any intervention which may come up.
The Department of Women and Child Department has self financing schemes for
women’s activities, most of which are not tapped. Most of these unutilized funds are
either returned to the Central Government or misused. Joe Paul (REDS) informed the
group that some private foundations had a MOU with the Karnataka Government.
Through which they financed only specific projects or schemes. However Prahalad
(CHC) said that they also had other budgets and did not know where and how to use
them. Dr. Benegal said that Institutions like NIMHANS and St. John’s good offices
could be used to obtain funds for certain priority programmes. Akshara is an educational
society which works in disadvantaged areas and could be approached. The Department of
Sports and Youth Development could also be approached to find out whether they could
be of help in terms of providing suggestions for the youth in the slums. Dr. Benegal also
felt that the alcohol control group could select a core group who should approach the
appropriate authorities as a collective forum. The group could also find out about the
government’s commitments made to the Task Force on Health with regard to alcohol
control. Certain medical colleges were adopting slums for sending final year students to
work in who were sent in batches to a defined area. These students could be used in the
proposed intervention. Some kind of infrastructure has to be worked into the plan and
while the group ran the programme the institutions could be asked to help out. Prahlad
(CHC) said that St. John’s and KIMS’ Department of Community Medicine to could be
approached for the intervention. CHC could possibly facilitate this process.
Sr. Elise Mary was next to present her report on the Jayaraja Nagar near Austin Town.
This slum, a corporation approved one, had a population of about 4000. 90% were
Tamils and 10% Kannadigas. The men worked in the painting and hotel trade. The
women were mainly domestic workers and a few were in the tailoring industry. Their
wages amounted to Rs. 75 per day for men and Rs. 20 for women per day. Housing
comprised of 90%> semi-pucca houses and 10% pucca houses and all are electrified. 90%
of the residents have yellow ration cards and 10% green. The literacy rate is about 75%
(10th std. And PUC). Anganwadis are properly run and maintained. Water borne diseases
are quite common. Health facilities were available through the corporation’s maternity
welfare centers which were close by (200 yards).
Regarding alcohol, 90% of the men drank and caused related family and domestic
problems. Family quarrels are common. The reasons for liquor consumption are mainly :
family and personal problems, unemployment and under employment, hard work, lack of
any enjoyment, social functions used as events to drink and unsuccessful love affairs.
60% used tobacco. 50% of the youth were unemployed and gambling is common among
them. Legally sold liquor was available 200 yards away from the slum, while illicit
hooch was also available in the slum itself. People are not aware of the health
consequences of tobacco and alcohol consumption. The main reasons for domestic
violence are liquor consumption, unemployment and poverty and extramarital
relationships. The slum has a women sangha with 75 members, a Youth club which
helps in organizing religious functions etc. and Helping Hand a group of 35 people. The
women face enormous problems with the present alcohol consumption situation.
However compared to the other slums suicides were uncommon. Sr. Mary felt that the
problem can be lessened by creating employment opportunities besides initiating
recreational activities and awareness campaigns. At present there was no income
generation activity within the slum. The corporation councilor is also the local political
leader.)
Joe Paul’s view of the same slum was a bit different. He said that it was a developing
slum in the sense that the population comprising of lower middle income groups and
those holding government jobs, were progressive. More education and career oriented.
Though Sr. Mary’s report projected a different picture. Anyway Dr. Benegal said that the
Ragigudda and the Jayarajnagar slums represented two different areas with two different
populations. And these could be considered as place to experiment with the new
interventions. Dr. Benegal had to leave after this to attend a staff meeting saying he
would try and return.
The third presentation was by Mr. Joe Paul of REDS. He had a sample survey of two
slums ( Byrasandra and Satiyeval Nagar) both of which radically differed in statistics.
With the use of the overhead projector, Mr. Joe Paul showed us the differences in the two
slums. While the statistics contained all the regular information about both the slums
especially the number of years they had existed, the population, the basic needs etc. the
main area of focus was the residents affected by alcoholism and some of the reasons for
it. Wages was an important factor. While in Byrarsandra the workers depended more on
luck than any other thing, and they did earn good wages whenever they could, ( extortion
was reported to be one of the ways they eared money) the workers in Satiyeval largely
women, worked regularly yet earned very meager wages. Educational facilities were
availed of by the Satyivel population who thought learning was essential, but the
Byrasandra population avoided the schools. The reason was lack of motivation.
Regarding the health status- Alcoholism Bum cases and mental cases formed the
majority of cases in Byrasandra. Mr. Joe Paul referred to them as Hard Core Psychopaths
who needed an entirely different approach. No women sanghas existed there. TB, Cancer
and accident cases were also reported. In Satiyeval the health problems constituted Gynae
cases, alcoholism, malnutrition and bad sanitation. REDS ran a once-a-week clinic
There were women sanghas and a youth group. These residents however faced the
constant threat of eviction as the land they lived on was under dispute. They urgently
required the comfort of Tenancy Rights. On the other hands the Byrasandra populace
was constantly confronted by the Police and experienced constant surveillance by them.
There were a number of illegal liquor shops operating within the slum. The reason for
widespread alcoholism was the attitude of masochism that the residents nurtured. The
reasons for alcoholism in the other slum were completely different, Here they were
fatigue, sickness, and poverty. There were fewer liquor shops here.
What was needed was ‘behaviour modification in the Byrasandra slum. They needed
some kind of mental health programme to help them. There were a lot of sex workers
also operating from here. The men drank and gambled. The women drank and slept while
the children loitered around. Byrasandra was also considered a safe place to seek refuge
after committing a crime.
In Satiyeval the men would get occasional employment and the entertainment was of a
different kind here. Watching TV, films and playing cricket, Carom and cards were
common. However the youth would indulge in petty theft. The women are empowered
and are doing what they can to improve conditions.
Mr. Mahesh of TREDA spoke briefly on the Tarakaramanagar slum near Nellurpuram
which has been in existence for the last 40 years. There about 700 houses with a
population of about 3000. The majority speak Telegu (85%), 10% Tamil and 0.5%
Kannada. The nearest hospital is HAL and there are two private practitioners. The
common health problems are malaria, cholera and diarrhea. The main occupation of the
men folk is casual labour and 40% of them drink regularly. Crimes are extremely rare
and there have been no reports. There is a Dr. Ambedkar Social Welfare Union within the
slum. All the houses are electrified though there are no proper roads. There is a Fair Price
shop selling rice, wheat and Kerosene. There are 12 public toilets ( 6 for men and 6 for
women) but these are in a very bad condition. 30 houses have concrete roofing while the
rest are tiled or have coconut thatch. 8 drug addicts have been identified. For education
there is one primary school and one middle school and no high school.
Finally after discussions it was decided that in the next meeting the following would be
discussed and decided. In the meanwhile the group was asked to think of any possible
intervention which could be discussed.
Follow Up Action Proposed
At the next meeting we invite some of the patients and their relatives from the
NIMHANS De- addiction ward, some members of AA (Alcoholics Anonymous) and
others to give their views.
A plan of action could materialize once it was decided on
What kind of human resources were available
What kind of framework and time limit was needed to implement a programme
What kind of financial requirements were needed.
It was also felt that the presence of Dr. Mohan Isaac, Dr. Vivek Senegal and Dr. Pratima
Murthy was essential to the formation of a programme and that could only be evolved
when they were present.
In the meanwhile all the participants were urged to come up with specific ideas of an
experimental alcohol control programme which could work in any one or two slums out
of the ones mentioned in this meeting.
At the next meeting we could consider the different plans which members of the group
came up with.
Participants in the meeting
Dr. Vivek Benegal
NIMHANS
Sr. Sagiye
Kanthi Kiran
Sr. Elise Mary\
Ms. Kanige
Ms. Lurdammal
Navajeevan Mahila Pragati Kendra
Mr. Joe Paul
Sr. Gracie
REDS
Dr. V. Benjamin
Mr. A. Prahalad
Mr. S.D. Rajendran
Mr. Arjun Krishnan
Mr. Mahesh
Community Health Cell
TREDA
DRUG ABUSE PROBLEM IN MANIPUR (NORTH EAST STATE)
DR. JAYANTA KUMAR, GALAXY CLUB, IMPHAL
The North East States comprises of Manipur, Mizoram, Meghalaya,
Nagaland, Assam, Arunachal, Tripura and Sikkim. Manipur is one of the
eight sister state of the North East India.
Of these, Manipur is one of the underdeveloped states of tire country. There
is no factory or industry worth its name. There is no train connection. Bus
services are available through Nagaland but frequently disturbed to due law
and order problems and ethnic clashes. I lowever, air connection is available
between Gawhati and Calcutta. Unemployment is a very severe problem in
the state. Out of the 18 lakh population, the- state employment exchange has
registered 4 lakh individuals as being unemployed. Non-availability of raw
material, poor power system, unstable law and order, frequent bundh, etc.
has also severely crippled self employment schemes. Drugs peddling has
become a very common means of livelihood. The state voluntary
organisations have estimated that there arc about 30,000 drug addicts in the
state.
Drug abuse scenario in the state of Manipur
The nature of drug abuse in this liny stale is very different from the rest of
the country. Socioeconomic, demographic status and pattern of drug abuse
of 2650 drug addicts treated at the de-addiction centre run by the Galaxy
Club at Imphal is as follows:
Age group
Upto 25 years
26 to 35 years
36 years and above
32%
57%
11%
89% of the drug addicts are youths
Educational level
Upto High School
Upto Higher Secondary
Graduate and above
Illiterate
34%
42%
23%
01%
99% of drug addicts are educated
Occupation
Unemployed
Employed
84%
16%
Unemployment is a major cause of addiction
Family income
Upto RS.200Q p.rn.
2001 to 4000 p.m.
Rs.4001 and above
28%
43%
29%
71% of the family cannot afford complete treatment
Chemical of choice
Heroin with other drugs
Alcohol
87%
13%
Heroin is always the drug of choice
Mode of use
Injecting
Chasing
Oral
79% (sharing of syringes 82%)
07%
14%
Injecting carries risk of HIV and other complications
Problems encountered
a)
The attitude of pressure groups like insurgents, students union, Mera
Palbis, Village Chiefs etc. towards drug addicts is still negative.
Shooting of drug addicts, raiding houses of drug addicts, parading
them on the streets etc. are common scenes.
b)
Due to the poor economic condition of the family most clients are
discharged even before completion of treatment.
c)
Due to frequent raid by pressure groups, the clients migrate and
follow-up becomes very difficult.
d)
Poor and ineffective telephone and postal systems, and the poor road
conditions make follow-up very difficult.
e)
There is a severe shortage of man power in the various service centres.
Hardly 15% of the staff in the service centres have received training.
f)
There is a high influx of drugs due to legalised trading routes with
Myanmar.
g)
Medical complications like injection abscess, gangrene etc. are verycommon. H1V-AIDS is a very severe problem that complicates issues
(60% of HIV positive cases are from IDU's).
h)
Due to the poor economic condition of the state, resource mobilisation
is very difficult.
i)
Work placement for job facilities are very difficult as there is no factory
/ industry.
What needs to be done
Hiuaan resources
1.
Developing a local based Regional Resource Training Centre to impart
training for all project staff to help them understand the ground
needs and ensure sustainability of the programmes.
3
2.
’ Identifying established centres for field exposure
3.
Identifying training needs and develop a training calendar to offer
training on a continued basis.
4.
Meet at least once a year to review and revise the quality of training
and its impact.
Materiai resources
1.
Improving the communication and documentation system by providing
e-mail etc.
2.
Developing good I.E.C. material, news letter
3.
Providing access to good books, manuals etc. for the staff
Financial resources
1.
Flow of grant to be regular and .-ensure sanctions in due time by
minimising the state level procedures.
2.
Grant needs to be 100% as local resource mobilisation is very difficult
The Government of India scheme should also address the following:
1.
Encourage NGOs that offer good services by waiving
recommendations and encouraging innovative schemes.
2.
Scheme for opening drop-in-centres, half way homes etc. as well as
encouraging other relapse prevention strategies. Recreational facilities
are almost nil in the northeast and resources need to be allocated to
offer the same.
3.
state
Vocational / income generating programmes should be an integral
part of the scheme as unemployment is a major cause of relapse. The
ILO project could be reference to this.
4.
Revision of the scheme should be carried out every three years,
especially the staff salary structure to prevent drop out amongst staff.
IMMEDIATE NEED FOR THE NORTH EAST STATES
I.
DEVELOP A TRAINING CALENDAR
(At least 60% staff should be training)
2.
IMPROVE THE COMMUNICATION SYSTEM
(provide E-mail, IEC materials, News letter, Reference books)
4
3.
RELAPSE PREVENTION STRATEGIES (Pilot study)
a)
b)
c)
4.
Half way home, Drop in centre
Vocational / income generating scheme
Advocacy for piessure group and community leaders
TRAINING TO RE CONDUCTED EVERY YEAR TO BUILD AND
EMPOWER TEAMS TO IMPROVE THE PROGRAMME
Brief CV of Dr. Jayanta
Working in the. field of Drug Abuse Prevention for the past 12 years.
Given training to many NGO / CBOs at state, North east and National level
Trainer on intervention programme of State AIDS Society, Manipur
Exposure to Bangkok, Hongkong, Singapore, Malaysia, U.K. on drug related
programmes.
Acted as resource person and present numerous papers on Drug and HIV
related issues al national and international level.
M H - 2-4> .
V
THE USELESS EMOTIONS - GUILT AND WORRY
If you believe that feeling bad or worrying long enough will change a past or future event, then you are
residing on another planet with adifferent re-’Uty system.
Throughout life, the two most futile emotions are guilt for what has been done and worry about what
might be done. There they are! The great wastes - Worry and Guilt - Guilt and Worry. As you ex
amine these two erroneous zones, you will begin to see how connected they are; in fact they can
be viewed as opposite ends of the same zone.
___ Present
X
Guilt
£______ -______ X
(FUTURE)
(PAST)
...
Worry.
There you have it. Guilt means that you use up your present moments being immobilized as a result
of past behavior, while worry is the contrivance that keeps you immobilized in the now about some:
thing in the future - frequently something over which you have no control. You can see this clearly
if you try to think of yourself as feeling guilty about an event that has yet to occur, or to worry about
something that has happened. Although, one response is to the future and the other to the past, they
both serve the identical purpose of keeping you upset or immobile in your present moment. Robert
Jones Burdette wrote in Golden Day:
It isn't the experience of today that drives men mad. It is the remorse, for something that happened
yesterday, and the dread of what tomorrow may disclose.
You see examples of guilt and worry everywhere, in virtually everyone you meet. The world is popu- >
lated with folks who are either feeling horrible about something that they shouldn't have done or
dimayed about things that might or might not happen. You are probably no exception. If you have
large worry and guilt zones, they must be exterminated, spray-cleaned and sterilized forever. Wash
out those little "w" and "g" bugs that infest so many sectors of your life.
Guilt and worry are perhaps the most common forms of distress in our culture. With guilt you focus
on a past event, feel dejected or angry about something that you did or said, and use up your present
moments being occupied with feelings over the past behavior. With worry, you use up those valuable
nows, obsessing about future event. Whether you're looking backward or forward, the result is the
same. You're throwing away the present moment. Robert Burdette's"Golden Day" is really "today,"
and sums up the folly of guilt and worry with these words.
There are two days in the week about which and upon which I never worry. Two carefree days,
kept sacredly free from fear and apprehension. One of these days is yesterday . . . and the other
day I do not worry about is tomorrow.
A CLOSER LOOK AT GUILT
Many of us have been subjected to a conspiracy of guilt in our lifetimes, and uncalculated plot to
turn us into veritable guilt machines. The machine works like this. Someone sends out a message
designed to remind you that you've been a bad person because of something you said or didn't say,
felt or didn't feel, did or didn't do. You respond by feeling bad in your present moment. You are the
guilt machine. A walking, talking, breathing contraption that responds with guilt whenever the ap
propriate fuel is poured into you. And you are well oiled if you've had a total immersion into our
guilt-producing culture.
49
Why have you bought the worry and guilt messages that have been laid on you over the years? Largely
because it is considered "bad" if you don't feel guilty, and "inhuman" not to worry. It all has to do
with CARING. If you really care about anyone, or anything then you show this concern by feeling
guilty about terrible things you've done, or by giving some visible evidence that you are concerned
about their future. It is almost as if you have to demonstrate your neurosis in order to be labeled a
caring person.
Guilt is the most useless of all erroneous zone behaviors. It is by far the greatest waste of emotional
energy. Why? Because, by definition, you are feeling immobilized in the present over something that
has already taken place, and no amount of guilt can ever change history.
DISTINGUISHING GUILT FROM LEARNING FROM THE PAST
Guilt is not merely a concern with the past; it is a present moment immobilization about a past
event. And the degree of immobilization can run from mild upset to severe depression. If you are
simply learning from your past, and vowing to avoid the repetition of some specific behavior, this
is not guilt. You experience guilt only when you are prevented from taking action now as a result
of having behaved in a certain way previously. Learning from your mistakes is healthy and a necessary
part of growth. Guilt is unhealthy because you are ineffectively using up your energy in the present
feeling hurt, upset and depressed about a historical happening. And it's futile as well as unhealthy.
No amount of guilt can ever undo anything.
THE ORIGINS OF GUILT
There are two basic ways in which guilt becomes a part of the emotional makeup of an individual.
In the first, guilt is learned at a very early age and remains with a grown-up as a leftover childish
response. In the second case, guilt is self-imposed by an adult for an infraction of a code to which he
professes to subscribe.
1. Leftover Guilt. = This guilt is the emotional reaction which is carried around from childhood mem
ories. There are scores of these guilt producers, and while they work in that they produce results in
children, people still tote around these sentences as adults. Some of these leftovers involve admonoitions like:
“Daddy won’t like you if you do that again.”
"You should feel ashamed of yourself." (As if that will be helpful to you.)
"Oh, all right. I'm only your mother."
As an adult, the implications behind these sentences can still produce hurt if a person disappoints his
boss, or others whom he has made into parents. The persistent attempt to win their support is there,
and so is the guilt when the efforts are unsuccessful.
Leftover guilt also surfaces in sex and marriage. It can be seen in the numerous self-reproaches and
apologies for past behavior. These guilt reactions are present as a result of learning to be manipulated
by adults in childhood, but they can still operate when the child has grown up.
50
2.
Self-imposed Guilt. = This second category of guilt reactions is a much more troublesome area.
Here the individual is being immobilized by things he has done recently, but which are not neces
sarily tied to being a child. This is the guilt imposed on the self when an adult rule or moral code
is broken. The individual may feel bad for a long time even though the hurting can do nothing to
change what has happened. Typical self-imposed guilt includes having told someone off, and hating
one’s self for it, or being emotionally drained in the present moment because of some act such as
shoplifting, not going to church, or having said the wrong thing in the past.
Thus you can look at all of your guilt either as reactions to leftover imposed standards in which
you are still trying to please an absent authority figure, or as the result of trying to live up to selfimposed standards which you really don't buy, but for some reason pay lip service to. In either
case, it is stupid, and, more important, useless behavior. You can sit there forever, lamenting
about how bad you've been, feeling guilty until your death, and not one tiny slice of that guilt
will do anything to rectify past behavior. It’s over! Your guilt is an attempt to change history, to
wish that it weren’t so. But history is so and you can't do anything about it.
You can begin to change your attitude about the things over which you experience guilt. Our
culture has many strains of puritanical thinking which send out messages like, "If it's fun, you're
supposed to feel guilty about it.” Many of your own self-inflicted guilt reactions can be traced
to this kind of thinking. Perhaps you've learned that you shouldn't indulge yourself, or you must
not enjoy a dirty joke, or you ought not to participate in a certain kind of sexual behavior. While
the restraining messages are omnipresent in our culture, guilt about enjoying yourself is purely
self-inflicted.
You can learn to savor pleasure without a sense of guilt. You can learn to see yourself as someone
who is capable of doing anything that fits into your own value system and does not harm othersand doing it without guilt. If you do something, whatever it may be, and you don't like it or your
self after having done it, you can vow to eliminate such behavior for yourself in the future. But to
go through a self-inflicted guilt sentence is a neurotic trip that you can bypass. The guilt does not
help. It not only keeps you immobilized, but it actually intensifies the chances that you'll repeat
the unwanted behavior. Guilt can be its own reward as well as permission to repeat the behavior.
As long as you retain the potential payoff of absolving yourself with guilt, you'll be able to keep
yourself in that vicious treadmill that leads to nothing but present-moment unhappiness.
TYPICAL GUILT-PRODUCING CATEGORIES AND REACTIONS'
PARENTAL GUILT ON CHILDREN OF ALL AGES
Manipulating the child to complete a task through guilt:
Parent - "Donny, bring up the chairs from the basement. We’ll be eating soon.”
Child - "O.K., Mom, in a minute, I’m watching the ball game and I’ll do it when this inning is over.”
Parental guilt signal - “Never mind then, I’ll do it with my bad back. You just sit there and enjoy
yourself.”
Donny has visions of his mother falling down with six chairs landing on top of her. And he’s
responsible.
51
The "I sacrificed for you” mentality is an exceedingly effective guilt producer. Here a parent can
recall all the hard times in which he gave up his happiness so that you might have something.
You naturally ask yourself how you could be so selfish after you've been reminded of your debts.
References to the suffering of childbirth are one example of this guilt-producing attitude. “I went
through eighteen hours of labor just to bring you into the world.” Another effective statement is,
“I stayed married to your father because of you.” This one is designed to make you feel guilty for
Mama’s bad marriage.
Guilt is an effective method for parental manipulation of a child's actions. “That’s okay. We’ll stay
here by ourselves. You just enjoy yourself the way you've always done. Don't worry about us.”
Statements like this are effective in getting you to telephone or visit on a regular basis. With a slight
twist you hear: “Whatsamatter; you got a broken finger and you can't dial a telephone?” The
parent switches the guilt machine on and you behave accordingly, albeit resentfully.
The “You disgraced us” tactic is also useful. Or "What will the neighbors think?” External forces
are marshaled to make you feel bad about what you’ve done, and to keep you from thinking for
yourself. The "If you ever fail at anything you’ll disgrace us” guilt excursion can make living with
yourself after a shabby performance almost impossible.
Parental illness is a super guilt manufacturer. “You've made my blood pressure go up.” References
to "killing me” or “giving me a heart attack” are effective guilt producers, as well as blaming you
for virtually all of the normal ailments associated with growing older. You need big shoulders to
carry this guilt around, since it can literally last a lifetime, and if you are particularly vulnerable,
you can even carry the guilt of a parent’s death.
Sexual guilt imposed by parents is quite common. All sexual thought or behavior is fertile soil for
the cultivation of guilt. "God forbid you should masturbate. It's bad.” Through guilt you can be
manipulated into the right sexual stance. "You should be ashamed for reading such magazines.
You shouldn’t even have such thoughts.”
Socially appropriate behavior can be fostered with guilt. "How could you embarrass me by picking
your nose in front of Grandma? " "You forgot to say thank you. Shame on you, do you want
our friends to think I didn’t teach you anything?” A child can be helped to learn socially accept
able behavior without the accompanying guilt. A simple reminder which follows an explanation
of why the behavior is undesirable is much more effective. For example, if Donny is told that his
constant interruptions are disconcerting and make conversation impossible, he will have the first
seed planted without having the guilt that goes with a statement such as, “You’re always interrupt
ing, you should be ashamed of yourself, it’s impossible to talk with you around.”
Merely reaching adulthood does not put an end to parental manipulation by guilt. I have a friend
who is fifty-two-years old. He is a pediatrician of Jewish extraction married to a non-Jewish
woman. He keeps his marriage a secret from his mother, because he is afraid it might “kill her”
or more aptly, he might kill her. He maintains a separate apartment with all of the household trim
mings for the sole purpose of meeting with his eighty-five-year-old mother every Sunday. She
does not know that he is married and owns his own home where he lives six days a week. He
plays this little game out of fear and guilt about being married to a “Shiksa.” Although he is a
fully grown man who is highly successful in his own professional world, he is still controlled by
his mother. Each day he talks to her from his office and lives out his bachelor fantasy.
52
Parental-and family-associated guilt is the most common strategy for keeping a rebellious person
in tow. The examples above are only a small sample of the multitude of statements and techniques
for helping a son/daughter to choose guilt (present-moment immobility over a past event) as the
price of genealogy.
LOVER AND SPOUSE RELATED GUILT
The “If you loved me” guilt is one way to manipulate a lover. This tactic is particularly useful
when one wants to punish a partner for some particular behavior. As if love were contingent upon
the right kind of behavior. Whenever one person doesn’t measure up, guilt can be used to get him
back into the fold. He must feel guilty for not having loved the other.
Grudges, long silences and hurtful looks are useful methods of engendering guilt. ‘Tn; not talking
to you, that'll fix you” or "Don't come near me, how do you expect me to be loving after what
you’ve done?” This is a commonly employed tactic in the case of straying behavior on the part
of one partner.
Often, years after an incident, an action is recalled to help the other person to choose present
moment guilt “But don't forget what you did in 1951" or “How could I ever trust you again
when you let me down before?” In this way one partner can manipulate the other’s present with
references to the past. If one partner has finally forgotten it, the other can periodically bring it
up to keep the guilt feelings about the past behavior current.
Guilt is useful in making a love partner conform to the other's demands and standards of behavior.
“If you were responsible, you would have called me” or “That’s the third time I had to empty the
garbage, I guess you just refuse to do your share.” The goal? Getting one partner to do what the
other wants him to. The method? Guilt.
CHILDREN - INSPIRED GUILT
The parental guilt game can be reversed. Guilt can be a two-way street and children are just as apt
to use it in manipulating their parents as the reverse.
If a child realizes that his parent cannot cope with his being unhappy and will feel guilty for being a
bad parent, the child will often try to use that guilt to manipulate the parent. A tantrum in the
supermarket may produce the desired candy. “Sally’s father lets her do it.” Therefore Sally’s
father is a good father and you're not. "You don't love me. If you did you wouldn’t treat me
this way.” And the ultimate, “I must be adopted. My real parents wouldn't treat me like this.”
All these statements carry the same message. You as a parent ought to feel guilty for treating me,
your child, in this way.
Of course, children learn this guilt-producing behavior by watching the adults in their world use it
to get things that they want. Guilt is not a natural behavior. It is a learned emotional response that
can only be used if the victim teaches the exploiter that he is vulnerable. Children know when you
are susceptible. If they constantly remind you of things that you've done, or haven’t done, for the
purpose of getting what they want, then they have learned the guilt trick. If your children use
these tactics, they picked them up somewhere. Very likely, from you.
SCHOOL - INSPIRED GUILT
Teachers are superlative guilt originators, and children, since they are most suggestible, are excellent
subjects for manipulation. These are some of the guilt messages that produce present-moment
unhappiness for young people:
53
“Your mother
really going to be disappointed in you."
“You should be ashamed of yourself for getting a C - a smart boy like you.”
“How could you hurt your parents like that, after all they've done for you?
Don’t you know how badly they want you to go to Harvard?"
“You failed the test because you didn’t study, now you’ll have to live with yourself"
Guilt is often used in schools to make children learn certain things or behave in certain ways. And
remember that even as an adult you are a product of those schools.
CHURCH - RELATED GUILT
Religion is often used to produce guilt and therefore manipulate behavior. Here, God is generally
the one you have let down. In some cases the message is that you will be kept out of heaven
for having behaved badly.
“If you loved God, you wouldn't behave that way.”
"You won’t get into heaven unless you repent for your sins.”
“You should feel bad because you haven’t gone to church every week,
and if you feel bad enough, perhaps you’ll be forgiven.”
You've disobeyed one of God’s rules and you should feel ashamed of yoursef.”
OTHER INSTITUTIONAL GUILT PRODUCERS
Most prisons operate on guilt theory. That is, if a person sits long enough thinking how bad he’s
been, he will be better for the guilt. Jail sentences for nonviolent crimes such as tax evasion
citations, civil infractions and the like are example of this mind-set. The fact that a strikingly
large percentage of inmates return to law-breaking behavior has done nothing to challenge this
belief.
Sit in a jail and feel bad for what you’ve done. This policy is so expensive and useless that it
defies logical explanation. The illogical explanation, of course, is that guilt is such an integral
part of our culture, that it is the backbone of our criminal justice system. Rather than have
civil law breakers help society or repay their debts, they are reformed through guilt-producing
incarceration that has no benefit to anyone, least of all the offender.
No amount of guilt, however large, will change past behavior. Moreover, jails are not places
where new legal choices are learned. Instead, they encourage a repetition of illegal behavior by
embittering the prisoner. (The policy of imprisoning dangerous criminals to protect others is
a different issue, and not under discussion here.)
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In our society tipping is a practice that has come to reflect not superior service but the guilt of
the person served. Effective waiters and waitresses, cab drivers, bellboys, and other serving em
ployees have learned that most people cannot handle guilt for not behaving in the correct way and
will tip the standard percentage regardless of the quality of service received. Thus blatant hand
extending, nasty comments and looks that are designed to wither are all used to produce guilt and,
fast on its heels, the big tip.
Littering, smoking and other unacceptable behavior may be things that you can be made to feel
guilty about. Perhaps you’ve dropped a cigarette or a paper cup. A stern look by a stranger can
send you into paroxysms of guilt for having behaved in such a crass fashion. Instead of feeling
guilty about something you have already done, why not simply resolve not to behave in an anti
social manner again.
Dieting is an area that is loaded with guilt. The dieter eats one cookie and feels bad for a day for
having been weak for a moment. If you are striving to lose weight and give in to counterproduc
tive behavior, you can learn from it and work at being more effective in your present moment.
But to feel guilty and full of self-reproach is a waste of time, for, you feel that way for very
long, you are likely to repeat the excess eating, as your own neurotic way out of your dilemma.
SEXUAL EXPRESSION GUILT
Perhaps the area where guilt flourishes best in our society is in the realm of sex. We have already
seen how parents engender guilt in children for sexual acts or thoughts. Adults feel no less guilty
about matters of sex. People sneak into porno films so that others won’t know how bad they've
been. Some people can't admit to enjoying oral sex and often feel guilty for even thinking about
Sexual fantasies are also effective guilt producers. Many feel bad about having such thoughts and
deny their existence even in private, or in therapy. In fact if I had to locate a guilt center in the
body, I would place it in the crotch.
This is only a brief listing of the cultural influences that conspire to help you choose guilt. Now
let’s take a look at the psychological payoffs for feeling guilt. Keep in mind that whatever the
dividend, it is bound to be self-defeating, and remember that the next time you opt for guilt over
freedom.
THE PSYCHOLOGICAL PAYOFFS FOR CHOOSING GUILT
Here are the most basic reasons for choosing to waste your present feeling guilty about things
that you've done or failed to do in the past.
By absorbing your present moments feeling guilty about something that has already taken place,
you don’t have to use that now moment in any kind of effective, self-enhancing way. Very
simply, like so many self-defeating behaviors, guilt is an avoidance technique for working on
yourself in the present. Thus you shift responsibility for what you are or are not now to what you
were or were not in the past.
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By shifting responsibility backward you not only avoid the hard work of changing yourself now
but the attendant risks that go with change as well. It is easier to immobilize yourself with guilt
about the past than to take the hazardous path of growing in the present.
There is a tendency to believe that if you feel guilty enough, you will eventually be exonerated
for having been naughty. This being forgiven payoff is the basis of the prison mentality described
above, in which the inmate pays for sins by feeling terrible for a long period of time. The greater
the transgression, the longer the period of remorse necessary for pardon.
Guilt can be a means of returning to the safety of childhood, a secure period when others made
decisions for you and took care of you. Rather than taking yourself in hand in the present, you
rely on the values of others from your past. And once again the payoff is in being protected from
having to take charge of your own life.
Guilt is a useful method for transferring responsibility for your behavior from yourself to others.
It is easy to get infuriated at how you are being manipulated and to shift the focus for others, who
are so powerful that they can make you feel anything they want, including guilty.
Often you can win the approval of others even when those others don't approve of your behavior
by feeling guilt for the behavior. You may have done something out of line, but by feeling guilty
you are showing that you know the proper way to behave, and are making an attempt to fit in.
Guilt is a superb way to win pity from others. No matter that the desire for the pity is a clear
indication of low self-esteem. In this case you'd rather have others feel sorry for you, than like
and respect yourself.
There you have the most notorious of the dividends for hanging onto guilt. Guilt, like all self
nullifying emotions, is a choice, something that you exercise control over. If you don't like it
and would prefer to make it go away so that you are entirely “guilt-free” here are some beginning
strategies for wiping your guilt slate clean.
SOME STRATEGIES FOR ELIMINATING GUILT
Begin to view the past as something that can never be changed, despite how you feel about it.
It's over! And any guilt that you choose will not make the past different. Emblazon this sentence
on your consciousness. "My feeling guilty will not change the past, nor will it make me a better
person.” This sort of thinking will help you to differentiate guilt from learning as a result of
your past.
Ask yourself what you are avoiding in the present with guilt about the past. By going to work
on that particular thing you will eliminate the need for guilt.
A client of mine who had been carrying on an extramarital affair for some time provides a good
example of this kind of guilt elimination. The man professed to feel guilty about the affair, but
continued to sneak away from his wife each week to see the other woman. I pointed out to him
that the guilt he spoke so much about was a totally futile emotion. It did not improve his mar
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riage and even prevented him from enjoying his affair. He had two choices. He could recognize
that he was devoting his present to feeling guilty because it was easier than examing his marriage
closely and going to work on it - and himself.
Or he could learn to accept his behavior. He could admit that he condoned extramarital sexual
exploration and realize that his value system encompassed behavior which many people condemn.
In either case, he would be choosing to eliminate the guilt, and to either change or accept himself.
Begin to accept certain things about yourself that you’ve chosen but which others may dislike.
Thus, if your parents, boss, neighbors, or even spouse, take a stand against some of your behavior,
you can see that as natural. Remember what was said earlier about approval seeking. It is neces
sary that you approve of yourself; the approval of others is pleasant but beside the point. Once
you no longer need approval, the guilt for behavior which does not bring approval will disappear.
Keep a Guilt Journal and write down any guilty moments, noting precisely when, why, and with
whom it occurs, and what you are avoiding in the present with this agonizing over the past. The
journal should provide some helpful insights into your particular guilt zone.
Reconsider your value system. Which values do you believe in and which do you only pretend
to accept? List all of these phony values and resolve to live up to a code of ethics that is selfdetermined, not one that has been imposed by others.
Make a list of all the bad things you’ve ever done. Give yourself guilt points for each of them on a
scale of one to ten. Add up your score and see if it makes any difference in the present whether
it's one hundred or one million. The present moment is still the same and all of your guilt is
merely wasteful activity.
Assess the real consequences of your behavior. Rather than looking for a mystical feeling to
determine yes’s and no’s in your life, determine whether the results of your actions are pleasing
and productive for you.
Teach those in your life who attempt to manipulate you with guilt that you are perfectly capable
of handling their disappointment in you. Thus, if Mama gets into her guilt act with "You didn’t
do this” or “I’ll get the chairs, you just sit there, ” learn new responses like “Okay, Mom, if you
want to risk your back on a few chairs because you can’t wait a few minutes, I guess there is little
I can do to dissuade you.” It will take some time, but their behavior will begin to change once
they see they cannot force you to choose guilt. Once you de-fuse the guilt, the emotional control
over you and the possibility of manipulation are eliminated forever.
Do something which you know is bound to result in feelings of guilt. As you check into a hotel
and a bellboy is assigned to show you to a room that you are perfectly capable of finding alone
with your one small piece of luggage, announce that you’ll do it alone.
If you’re rejected,
tell your unwanted companion that he is wasting his time and energy since you will not be leaving
a tip for a service that you don't want. Or take a week to be alone if you’ve always wanted to
do so, despite the guilt-engendering protestations from other members of the family. These
kinds of behavior will help you to tackle that omnipresent guilt that so many sectors of the
environment are adept at helping you to choose.
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\
The following dialogue represents a role-working exercise in a counseling group led by myself,
in which a young girl (23) was confronting her mother (being played by another group member)
about wanting to leave the nest. The mother was using every conceivable guilt-producing response
to keep her from leaving home. This dialogue was the end product of an hour of teaching the
daughter how to outmaneuver her mother’s guilt-producing statements.
DAUGHTER: Mother - I’m leaving home.
MOTHER: If you do, I’ll have a heart attack, you know how my heart is, and how I need you to
help me with my medicine and all.
DAUGHTER: You’re concerned about your health and you think you can’t make it without me.
MOTHER: Of course I can’t. Look, I’ve been good to you all these years, and now you’re just
walking out, leaving me here to die. If that’s all you think of your mother, go ahead.
DAUGHTER:
You think that because you’ve helped me as a child that I should repay you b^
staying here and not become independent and be on my own.
MOTHER: (Clutching at her chest) I'm having a tachycardia attack right now. I think I’m going
to die. You’re killing me, that’s what you're doing.
DAUGHTER: Is there anything you’d like to say to me before you leave?
In this dialogue, the daughter refused to yield to the obvious guilt producers offered by her
mother. The daughter had been a literal slave, and any effort to be on her own had always been
met with guilt-engendering talk.Mama was willing to use anything to keep her daughter dependent
and in her control, and her daughter either had to learn new responses or be a slave to her mother
and her own guilt for the rest of her life. Take careful notice of the daughter’s responses, They all
begin with references to her mother as responsible for her own feelings. By saying "You feel,”
rather than "I feel,” the potential for guilt is tactfully minimized.
Such is guilt in our culture - a convenient tool for manipulating others and a futile waste of time. (
Worry, the other side of the coin, is diagnostically identical to guilt, but focuses exclusively on
the future and all of the terrible things that might happen.
A CLOSER LOOK AT WORRY
inhere in nothing to worry about! Absolutely nothing. You can spend the rest of your life, begining right now, worrying about the future, and no amount of your worry will change a thing. '
Remember that(worry is defined as being immobilized in the present as a result of things that are
going or not going to happen in the future. You must be careful not to confuse worrying with
planning for the future. If you are planning, and the present-moment activity will contribute to
a more effective future, then this is not worry. It is worry only when you are in any way immobil
ized now about a future happening.')
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Just as our society fosters guilt, so it encourages worry. Once again it all begins with equating
worrying with caring. If you care about someone, the message goes, they you are bound to worry
about the person. Thus, you'll hear sentences like, “Of course I’m worried, it’s only natural when
you care about someone” or "I can’t helpworrying, its, because I love you.” Thus, you prove your
love by doing an appropriate amount oi worrying at the correct time.
Worry is endemic to our culture. Almost everyone spends an inordinate amount of present mo
ments worrying about the future. And all of it is for naught. Not one moment of worry will make
things any better. In fact, worry will very likely help you to be less effective in dealing with the
present. Moreover, worry has nothing to do with love which predicates a relationship in which
each person has the right to be what he chooses without any necessary conditions imposed by the
Other.
Think of you -.-self as being aline in 1860, at the beginning of the Civil War. The country is mobil
izing for war, and there are approximately thirty-two million people in the United States. Each or
those thiry-two million folks has hundreds of things to worry about and they spend many present
moments agonizing about the future. They worry about war. the price of food, the draft, the
econoiit',- all the things, that you worry about today. In 1975, some 115 years later all of t' •.
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dead and all there cosnbinwot. m ■
Just as our society fosters guilt, so it encourages worry. Once again it all begins with equating
worrying with caring. If you care about someone, the message goes, they you are bound to worry
about the person. Thus, you’ll hear sentences like, "Of course I’m worried, it’s only natural when
you care about someone” or “I can’t helpworrying, its, because I love you." Thus, you prove your
love by doing an appropriate amount of worrying at the correct time.
Worry is endemic to our culture. Almost everyone spends an inordinate amount of present mo
ments worrying about the future. And all of it is for naught. Not one moment of worry will make
things any better. In fact, worry will very likely help you to be less effective in dealing with the
present. Moreover, worry has nothing to do with love which predicates a relationship in which
each person has the right to be what he chooses without any necessary conditions imposed by the
other?)
Think of yourself as being aline in 1860, at the beginning of the Civil War. The country is mobil
izing for war, and there are approximately thirty-two million people in the United States. Each of
those thiry-two million folks has hundreds of things to worry about and they spend many present
moments agonizing about the future. They worry about war, the price of food, the draft, the
economy, all the things that you worry about today. In 1975, some 115 years later all of those
worries are dead and all their combined worriers are dead and all their combined worrying did
not change a moment of what is now history. The same is true of your own worry times. When
the earth is populated by an entirely new crew, will any of your worry moments have made a
difference? No. And, do any of your worry times make a difference today, in terms of changing
the things you worry about? No, again. Then this is one zone that you must tidy up, since you
are just wasting those precious present moments on behavior that has absolutely no positive
payoff for you. Much of your worry concerns things over which you have no control. 'You can
worry all you want about war, or the economy, or possible illness, but worry won’t bring peace
or prosperity or health. As an individual you have little control over any of those things. More
over the catastrophe you’re worrying about frequently turns out to be less horrible in reality
than it was in your imagination.
/'Ma.'-V -
I worked with' Harold, who was forty-seven years old, for several months. He was worried about
being laid off and not being able to support his family. He was a compulsive worrier. He began
losing weight, was unable to sleep and was getting sick frequently. In counseling, we talked about
the futility of worry and how he could choose to be content. But Harold was a true worrier, and
he felt that it was his responsibility to worry about possible impending disaster every day. Finally,
after months of worry, he did receive his pink slip and was unemployed for the first time in his
life. Within three days, he had secured another position, one which paid more, and gave him a
great deal more satisfaction. He had used his compulsiveness to find the new job. His search was
rapid and relentless. And all of his worry had been useless. His family had not starved, and
Harold had not collapsed. Like most worry-producing gloom pictures in one’s head, the event
uality resulted in benefits, rather than horror. Harold learned firsthand the futility of worry, and
he has actually begun to adopt a nonworry stance in his life. >
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In a dever essay on worry in The New Yorker, entitled "Look for the Rusty Lining,” Ralph
Schoenstein satirized worry.
What a list! Something old and something new, something cosmetic yet something triveal too,
for the creative worrier must forever blend the pedestrian with the immemorial. If the sun bums
out, will the Mets be able to play their entire schedule at night? If cryogenically frozen human
beings are ever revived, will they have to re-register to vote? And if the little toe disappears,
will field goals play a smaller part in the National Football League?*
You may be in the professional worrier classification, creating unnecessary stress and anxiety in
your life as a result of the choices you are making to worry about every conceivable kind of
activity. Or you may be a minor league worrier concerned only about your own personal prob
lems. The following list represents the most common responses to the question, “What do you
worry about?"
TYPICAL WORRY BEHAVIORS IN OUR CULTURE
I gathered the following data from some two hundred adults at a lecture one evening. I call this
your worry sheet, and you can give yourself “worry points” similar to the “guilt points” discussed
above. They are not listed in any particular sequence of frequency or importance. The paren
thetical statements represent the kinds of sentences that justify the worry.
YOUR WORRY SHEET
I worry about
1.
My Children (“Everyone worries about their children, I wouldn’t be a very good parent if
I didn't now would I?”)
2.
My Health (“If you don't worry about your health, you could die at any time! ”)
3.
Dying (“No one wants to die. Everyone worries about death.”)
4.
My Job (“If you don't worry about it, you might lose it.”)
5.
The Economy (“Someone- ought to worry about it, the President doesn't seem to care.”)
6.
Having a Heart Attack (“Everyone does, don't they?” “Your heart could go at any time.”)
7.
Security (“If you don’t worry about security, you’ll find yourself in the poorhouse, or
on welfare.”)
8.
My Wife’s/Husband’s Happiness ("God knows I spend a lot of time worrying about him/her
being happy, and they still don’t appreciate it.”)
9.
Am I Doing the Right Thing? (“I always worry about doing things right, that way I know
I’m okay.”)
’Ralph Schoenstein, “Look for the Rusty Lining,” The New Yorker (Feb. 3,1975)
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10.
Having a Healthy Child if You're Pregnant ("Every mother-to-be worries about that.”)
11.
Prices ("Somebody ought to worry about them before they skyrocket out of sight.”)
12.
Accidents (“I always worry that my spouse or the children will have an accident. It's only
natural, isn't it?”)
13.
What Others Will Think ("I worry about my friends not liking me.”)
14.
My Weight (“No one wants to be fat, so naturally I worry about not gaining back any of
the wreight I lost.”)
15.
Money (“We never seem to have enough, and I worry that someday we'll be broke and
have to go on welfare.”)
16.
My Car Breaking Down ("It’s an old clunker and I drive it on the expressway, so of
course I worry about it and what might happen if it did.")
17.
My Bills (“Everyone worries about paying their bills. You wouldn’t be human if you
didn't worry about bills.”)
18.
My Parents Dying ("I don’t know what I'd do if they died, it worries me sick. I worry .
about being alone, I don’t think I could handle it.”)
19.
Getting into Heaven or What if There is no God (“I can’t stand the idea of there being
nothing.”)
20.
The Weather ("I plan things like a picnic and maybe it'll rain. I worry about having
snow for skiing.”)
21.
Getting Old (“No one wants to get old, and you can’t kid me, everyone worries about
that one.” "I don’t know what I’ll do when I retire and I really worry about that.”)
22.
Flying (“You hear about all those plane crashes.”)
23.
My Daughter’s Virginity (“Every father who loves his daughter worries that she’ll be
hurt, or get into trouble.’’)
24.
Talking in Front of Groups (“I get petrified in front of a group and I worry like crazy
before I do it.”)
25.
When my Spouse Doesn’t Call (“It seems normal to me to worry when you don't know
where someone you love is, or if they're in trouble.”)
26.
Going into the city ("Who knows what’ll happen in the jungle. I worry every time
I go in." “I always worry about whether I’ll get a parking space.”)
And perhaps the most neurotic of all.. . . .
27.
Having Nothing to Worry About (“I can’t just sit still when everything seems all right, I
worry about not knowing what will happen next.’’)
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This is the collective worry sheet of people in your culture. You can give worry points to
each of those that seem most applicable to you, total it up, and no matter what your score
it still adds up to zero. The following paragraph illustrates the extent of worry in our world.
It’s taken from a story in Newsday (May 3, 1975) on hospital malpractice insurance.
West Islip - Two officials of the Nassau-Suffolk Hospital Council warned yesterday that those
worrying about the problems that the malpractice insurance crisis could create - if doctors
cease treating patients entirely or treat only emergency cases - have not worried quite enough.
Indeed, a call to spend more time worrying about a problem. How could a story like this even
appear? Because the cultural pressure is to worry, rather than to do. If all of those concerned
were to worry a lot more, perhaps the problem would go away.
In order to eliminate worry it is necessary to understand the why behind it. If worry is a
large part of your life, you can bet that it has many historical antecedents. But what are the
payoffs? They are similar to the neurotic dividends that you receive for guilt, since both
worry and guilt are self-nullifying behaviors, that vary only in a temporal sense. Guilt focuses
on the past; worry on the future.
THE PSYCHOLOGICAL PAYOFFS FOR CHOOSING WORRY
Worry is a present-moment activity. Thus, by using your current life being immobilized over a
future time in your life, you are able to escape the now and whatever it is in the now that
threatens you. For example, I spent the summer of 1974 in Karamursel, Turkey, teaching
and writing a book on counseling. My seven-year-old daughter was back in the United States
with her mother. While I love writing, I also find it an intensely lonely, difficult chore which
requires a great deal of self-discipline. I would sit down at my typewriter with paper in place
and the margins set, and all of a sudden my thought would be back on little Tracy Lynn. What
if she rides her bicycle into the street and doesn’t look? I hope she's being watched at the
swimming pool, because she has a tendency to be careless. Before I knew it, an hour had
elapsed, and I had spent it worrying. This was all in vain of course. But, was it? As long
as I could use up my present moments worrying I didn’t have to struggle with the difficulty
of writing. A terrific payoff indeed.
You can avoid having to take risks by using your worry as the reason for immobility. How
could you possibly act if you are preoccupied with your present moment worry? "I can't
do a thing, I’m just too worried about----- This is a common lament, and one with a payoff
that keeps you standing still and avoiding the risk of action.
You can label yourself as a caring person by worrying. Worry proves that you are a good
parent, good spouse, or good whatever. A handsome dividend, although lacking in logical
healthy thinking.
(Worry is a handy justification for certain self-defeating behavior. If you’re overweight, you
'-undoubtedly eat more when you worry, hence you have a sensational reason for hanging on to
the worry behavior. Similarly, you find yourself smoking more in worrisome situations, and
can use the worry to avoid giving up smoking. This same neurotic reward system applies to
areas including marriage, money, health and the like. The worry helps you to avoid changing.
It is easier to worry about chest pains than to take the risk of finding out the truth, and then
have to deal forthrightly with yourselfA'
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Your worry keeps you from living. A worrier sits around and thinks about things, while a doer
must be up and about. Worry is a clever device to keep you inactive, involved person.
Worry can bring ulcers, hypertension, cramps, tension headaches, backaches and the like. While
these may not seem to be payoffs, they do result in considerable attention from others and justify
much self-pity as well, and some people would rather be pitied than fulfilled.
Now that you understand the psychological support system for your worry, you can begin to
devise some strategic effort for getting rid of the troubelsome worry bugs that breed in this erron
eous zone.
SOME STRATEGIES FOR ELIMINATING WORRY
Begin to view your present moments as times to live, rather than to obsess about the future.
When you catch yourself worrying, ask yourself, “What am I avoiding now by using up this mo
ment with worry?” Then begin to attack whatever it is you're avoiding. The best antidote to
worry is action. A client of mine, formerly prone to worry, told me of a recent triumph over it.
At a vacation resort he wandered into the sauna one afternoon. There he met a man who couldn’t
take a holiday from his worries. The other man elaborated all of the things my client should be
worrying about. He mentioned the stock market, but said not to worry about short-range fluct
uations. In six months there would be a virtual collapse, and that was the thing to really worry
about. My client made sure of all the things he should worry about, and then left. He played a
one-hour game of tennis, enjoyed a touch football game with some young children, participated
with his wife in a Ping-Pong match which they thoroughly enjoyed, and finally, some three hours
later, returned for a shower/sauna. His new friend was still there worrying, and began once again
to chronicle more things to worry about. Meantime, my client had spent his present moments
excitedly alive, while the other man had consumed his in worry. And neither man's behavior had
any effect on the stock market.
Recognize the preposterousness of worry. Ask yourself over and over, “Is there anything that will
ever change as a result of my worrying about it?”
Give yourself shorter and shorter periods of “worry-time.” Designate ten minutes in the morning
and afternoon as your worry segments. Use these periods to fret about every potential disaster
you can get into the time slot. Then, using your ability to control your own thoughts, postpone
any further worry until your next designated “worry-time.” You’ll soon see the folly of using any
time in this wasteful fashion, and will eventually eliminate your worry zone completely.
Make a worry list of everything you worried about yesterday, last week and even last year. See if
any of your worry did anything productive for you Assess also how many of the things you
worried about ever materialized at all. You’ll soon see that the worry is really a double wasteful
activity. It does nothing to alter the future. And the projected catastrophe often turns out to be
minor, or even a blessing when it arrives.
Just Worry! See if it is something that you can demonstrate when you are tempted to worry.
That is, stop and turn to someone and say, “Watch me - I'm about to worry.” They'll be con
founded since you probably won't even know how to demonstrate the thing you do so well,
so often.
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Ask yourself this worry-eradicating question, “What’s the worst thing that could happen to me
(or them) and what is the likeihood of it occuring?” You’ll discover the absurdity of worry in
this way.
Deliberately choose to act in some manner that is in direct conflict with your usual areas of worry.
If you compulsively save for the future, always worried about having enough money for another
day, begin to use your money today. Be like the rich uncle who put in his will “Being of sound
mind, I spent all my money while I was alive."
Begin to face the fears you possess with productive thought and behavior. A friend of mine
recently spent a week on an island off the coast of Connecticut. The woman enjoys taking long
walks, and soon discovered that the island was populated by many dogs who were allowed to run
wild. She decided to fight her fear and worry that they might somehow bite her or even tear
her limb from limb - the ultimate calamity. She carried a rock in her hand (insurance) and de
cided to show no sign of fear as the dogs approached. She even refused to slow down when the
dogs growled and came running toward her. As the dogs charged forward and encountered some
one who refused to back down, they gave up and ran away. While I am not advocating dangerous
behavior, I do believe that an effective challenge to a fear or worry is the most productive way to
eradicate it from your life.
These are some techniques for eliminating worry in your life. But the most effective weapon
you have for wiping out worry is your own determination to banish this neurotic behavior from
your life.
FINAL THOUGHTS ON WORRY AND GUILT
The present moment is the key to understanding your guilt and worry activities. Learn to live
now and not waste your current moments in immobilizing thoughts about the past or future.
There is no other moment to live but now, and all of your futile guilt and worry are done in the
elusive now.
Lewis Carrol in Alice Through the Looking Glass talked about living in the present.
" The rule is, jam tomorrow, and jam yesterday. . but never jam today.”
“It must come sometimes to “jam-today,” Alice objected.
How about you? Any jam today? Since it must come sometime, how about now?'
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