Social And Selfhelp Movements

Abstinence-oriented social movements first appeared among organized religions (Johnson & Westermeyer, 2000). Certain South Asian sects, arising from early Persian religions and Hinduism, abstained from alcohol over two millennia ago. Buddhist clergy were forbidden to drink alcoholic beverages, and pious Buddhist laity were urged to refrain from drinking, or at least to drink moderately. Early on, Moslems were urged not to drink; tradition has it that Mohammed himself established abstinence for his followers. Abstinence-oriented Christian sects evolved in England and then in Central Europe at about the time of the gin epidemic.

Religiomania has long served as a cure for dipsomania and narcotomania. Opium addicts in Asia have gone to Buddhist monasteries in the hope that worship, meditation, or clerical asceticism would cure them, which it sometimes did (Westermeyer, 1982). Many Latin Americans and Native Americans with high rates of alcoholism have abandoned Catholicism and Anglicanism in favor of abstinence-prescribing fundamentalist Christian sects and the Native American Church (Albaugh & Anderson, 1974; Hippler, 1973). Children raised in these sects are taught the importance of lifelong abstinence from alcohol and other drugs of abuse. Despite this childhood socialization, those leaving these sects as adults can develop substance use disorders. Thus, the effects of various religions in preventing substance abuse disorders appear to persist only as long as one is actively affiliated with the group.

Abstinent societies not tied to specific religions began to appear in the 18th and 19th centuries. Examples include the Anti-Opium Society in China and the Women's Christian Temperance Union in the United States. These groups engaged in political action, public education, social pressure against addiction or alcoholism, and support for abstinence. These led eventually to prohibition movements that sought legal strictures against the production, sale, and/or consumption of psychoactive substances outside religious or medical contexts. In Asia, these movements began against tobacco (which was viewed in the 1600s and 1700s as a slothful habit associated with political sedition) and then later changed to oppose primarily opium. In Northern Europe and the United States, prohibition laws first involved opiates and cannabis but later expanded to include alcohol. As Moslem peoples emerged from colonial regimes, their nations passed anti-alcohol legislation that ranged from mild strictures for Moslems alone, to harsh measures against all inhabitants of the country.

Numerous self-help groups in the United States were founded during the Depression era. Many more were begun after World War II. These groups involved individuals who banded together to meet their common financial, social, or personal needs (Lieberman & Borman, 1976). Movements of the era differed in several important aspects from earlier abstinence-oriented groups as follows:

• Individuals could remain in their homes, families, and jobs rather than joining a separate sect or going off to an asylum or special group.

• Considerable structure was involved, with specific meetings and phased "step" recovery activities.

• The concept of a recovery process over time was introduced, as distinct from a sudden cure or conversion; this had biological, psychological, social, and spiritual dimensions.

• Organization was kept predominantly atomistic (i.e., autonomous small groups) rather than hierarchical.

• Membership required self-identity as an alcoholic or addict (i.e., supportive or concerned persons were excluded).

Like earlier movements, these self-help groups emphasized the importance of abstinence from psychoactive substance abuse (although tobacco and coffee are notably present at some Alcoholics Anonymous [AA] meetings today), reliance on a superior spiritual force (the "Higher Power"), and social affiliation or "fellowship" for mutual support. AA, perhaps the best known of these groups today, was first established in the United States. It has spread to many other parts of the world over the last 50 years and has served as a model for similar groups whose identity centers on other drugs and even other problems (i.e., Narcotics Anonymous, Cocaine Anonymous, Overeaters Anonymous, Gamblers Anonymous, and Emotions Anonymous [formerly Neurotics Anonymous]). Groups for those personally affected by alcoholism have also appeared, such as Alateen for the teenage offspring of alcoholic parents and Al-Anon for the spouses, parents, and other concerned associates of alcoholic persons. Over the last several years, the Adult Children of Alcoholics and Addicts (ACOAA) movement has also evolved to meet the needs of those distressed or maladaptive adults raised by alcoholic parents. Mothers Against Drunk Drivers (MADD) was originally formed to meet the support needs of parents whose children were killed by drunken auto drivers. MADD has since expanded its activities as a "watchdog" group that follows the records of legislators and judges in regard to alcohol-related legal offenses. The social and cultural com position of the self-help group appears to be an important factor in attracting clients and effecting therapeutic outcomes (Jilek-Aal, 1978).

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