An Apologetic Interpretation of Alcoholics Anonymous (AA): Timeless Wisdom, Outdated Language.

BACKGROUND: The Twelve Steps of Alcoholics Anonymous (AA) has proven to be an effective aid in recovery for many people with alcohol use disorder. While constructive criticisms of AA can be beneficial to the organization, other criticisms have merely served as rhetorical devices intent on discrediting the 12-step approach. OBJECTIVES: This paper examines six prominent critiques of AA, paying special attention to the premises, tone, and factual basis of the statements. Interpretations grounded in AA literature are offered to address claims or critiques around prominent themes, which are organized into two main classes: purported causes of alcoholism and factors maintaining alcoholism. RESULTS: Findings reveal tenuous statements in the AA literature that appear contradictory and thereby invite a misreading. These statements, some of which misrepresent the tenets of AA and its founders, underscore certain vocal criticisms that are not entirely unfounded. While many pages of the AA literature are imbued with timeless wisdom, even the most apologetic interpretations-distilled into benefit-of-the-doubt renderings-largely falter in defending the nature of the language that originated in the early 1900s at odds with 21st century understandings of alcohol use disorder. Conclusions/Importance: The AA literature essentially presents a valid target for critics, fueling resistance to this free community-based resource that may prevent people who could benefit from AA from seeking the help of the 12-steps.

Native Hawaiian culturally based treatment: Considerations and clarifications.

The purpose of this article is two-fold. First, it aims to understand some of the earliest documented perspectives voiced by Native Hawaiian communities and their appeals for the concept of culturally based treatment. Second, it presents research, practice, and policy considerations with the goal of evolving the base of evidence supporting cultural treatment. Within the context of Hawai'i and Native Hawaiian history, this paper first contextualizes the emergence and conceptual orientation of culture-based addiction treatment. In discussing substance use disorder treatment in the Hawaiian context, insights and perspectives consider cultural-political trauma a key factor in developing a beneficial framework of practice. This historical background, however, reveals that contemporary culturally based design and service delivery is not aligned with the objective of specifically improving treatment for Native Hawaiians.

Moving Clinical Deliberations on Administrative Discharge in Drug Addiction Treatment Beyond Moral Rhetoric to Empirical Ethics.

Patients' admission to modern substance use disorder treatment comes with the attendant risk of being discharged from treatment-a widespread practice. This article describes the three mainstream theories of addiction that operate as a reference point for clinicians in reasoning about a decision to discharge a patient from treatment. The extant literature is reviewed to highlight the pathways that patients follow after administrative discharge. Little scientific research has been done to investigate claims and hypotheses about the therapeutic function of AD, which points to the need for empirical ethics to inform clinical addictions practice.

The intersection of structurally traumatized communities and substance use treatment: Dominant discourses and hidden themes.

This article reviews multidisciplinary literature to propose a structurally traumatized communities theoretical framework relating to three major topics: (a) addiction as an equal opportunity disease, (b) the psychology of marijuana use, and (c) anger and rage. From an ecological and structural perspective, the socially defined themes of stigma and stereotypes interplay with sociopolitical, historical, and cultural forces that contribute to substance use and addiction among African Americans and the treatment success gap that they experience in drug treatment. Empathy serves as an underlying mediating construct in clinical training and accreditation standards, inducing a systematic improvement in programmatic service delivery.

Indigenous Hawaiian Psychoactive Drug Use: Before European Contact, and after 1778.

This article builds on an existing body of scholarship on historical and intergenerational cultural trauma to elucidate deliberate attempts to eliminate Native Hawaiian cultural practices related to psychoactive drug use and replace them with the foreign (Western) tradition of alcohol use. This action, to instill alcohol as a component of colonial domination, was one example of the resulting assault on cultural identity that has often been overlooked, particularly in relation to transgenerational trauma in the history of Hawai'i and the Hawaiian context. In this article, we argue for the use of the term historical trauma, introduced by Brave Heart, which allows for a more inclusive consideration of the many aspects of trauma. Drawing on literature related both to alcohol use in indigenous Hawaiian society and to the wider historical context of Hawai'i since the late eighteenth century, we endeavor to demonstrate the correlation between the historical trauma experienced by the population and the incidence of alcohol consumption and alcohol use disorder. The article is intended to augment the existing paradigm on cultural trauma as it specifically relates to Hawaiians, and potentially to widen the explanatory power of this paradigm with regard to present-day psychoactive drug use among Hawaiians as well as the implications for treatments.

Web-based tracking methods in longitudinal studies.

The use of online resources to reduce the attrition of program participants in longitudinal studies is examined. Higher-risk individuals, those involved in illegal activities, and females with last name changes are typically more difficult to locate. The effectiveness of using online resources for these participants is addressed. These resources include social networking sites, people-finder search engines, telephone and address directories, judicial records, and death records. The strengths and limitations of these resources are presented and discussed. Longitudinal studies using these resources are examined to evaluate their successful follow-up rates. The results of these studies indicate that participant characteristics are more important to successful follow-up than the length of time since participation or sample size. The use of multiple online sites increased follow-up rates, especially for those who are typically difficult to locate. The variables and websites to consider are discussed, and six lessons learned are offered. The prospective use of online participant involvement is especially important for successful longitudinal evaluation and program planning.