Jump up ^ "Corrections Catalog". Archived from the original on 12 December 2009. Retrieved 12 December 2009. The titles include: Carrying the Message into Correctional Facilities, Where Do I Go From Here?, A.A. in Prison: Inmate to Inmate, A.A. in Correctional Facilities, It Sure Beats Sitting in a Cell, Memo to an Inmate Who May be an Alcoholic, A Message to Corrections Administrators
The illness of the spiritual dimension, or "spiritual malady," is considered in all twelve-step groups to be self-centeredness.[17][18] The process of working the steps is intended to replace self-centeredness with a growing moral consciousness and a willingness for self-sacrifice and unselfish constructive action.[18] In twelve-step groups, this is known as a spiritual awakening not a religious experience.[21] This should not be confused with abreaction, which produces dramatic, but ephemeral, changes.[22] In twelve-step fellowships, "spiritual awakening" is believed to develop, most frequently, slowly over a period of time.[23]
Alcoholics may also require treatment for other psychotropic drug addictions and drug dependences. The most common dual dependence syndrome with alcohol dependence is benzodiazepine dependence, with studies showing 10–20 percent of alcohol-dependent individuals had problems of dependence and/or misuse problems of benzodiazepine drugs such as valium or clonazopam. These drugs are, like alcohol, depressants. Benzodiazepines may be used legally, if they are prescribed by doctors for anxiety problems or other mood disorders, or they may be purchased as illegal drugs. Benzodiazepine use increases cravings for alcohol and the volume of alcohol consumed by problem drinkers.[145] Benzodiazepine dependency requires careful reduction in dosage to avoid benzodiazepine withdrawal syndrome and other health consequences. Dependence on other sedative-hypnotics such as zolpidem and zopiclone as well as opiates and illegal drugs is common in alcoholics. Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as barbiturates, benzodiazepines and nonbenzodiazepines. Dependence upon and withdrawal from sedative-hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of psychosis or seizures if not properly managed.[146]
The first female member, Florence Rankin, joined AA in March 1937,[6][7] and the first non-Protestant member, a Roman Catholic, joined in 1939.[8] The first Black AA group was established in 1945 in Washington DC by Jim S., an African-American physician from Virginia.[9][10] AA membership has since spread internationally "across diverse cultures holding different beliefs and values", including geopolitical areas resistant to grassroots movements.[11] Close to 2 million people worldwide are members of AA as of 2016.[12]
Risk factors for developing a drinking problem include depression, anxiety, or another mood problem in the individual, as well as having parents with addiction. Low self-esteem and feeling out of place are other risk factors for developing alcohol dependence. In women, antisocial behaviors and impulsivity are associated with the development of severe alcohol use disorder. Both men and women are more likely to develop alcoholism if they have a childhood history of being physically or sexually abused. Children and teens who have their first drink of alcohol between 11 and 14 years of age are more at risk for developing a drinking alcohol problems than those who do so when either younger or older.
The endpoint of “recovery” from addiction, if there is an endpoint, is to change one’s life for the better, to gain stability in one’s life, and to become more functional in one’s family and in one’s community. Being responsible, being reliable, being interested in others and not just in oneself, and being a loving being who cares about and is helpful to others, are all part of recovery.
The Oxford Group’s creed was based on four principles: all people are sinners, all sinners can be changed, confession is required for that change, and the change must also change others. One of the people Hazard spread his word to was Bill Wilson, an old friend and former drinking partner. Through Hazard, Wilson (who was struggling with his alcoholism) learned of Carl Jung’s pantheistic musings on the importance of healthy spirituality; for Wilson, that healthy spirituality manifested in the form of a desperate conversion to Christianity in an attempt to quit drinking. When this happened in 1934, Wilson attributed the victory to his faith, and specifically Hazard’s intervention. He spoke to Dr. Bob Smith, a fellow Oxford Group member and recovering alcoholic who applied the same principles to his own battle with addiction. Smith had his last drink on June 10, 1935, one month after he and Wilson started working together; today, that date is celebrated as the birth of Alcoholics Anonymous, and its founders are remembered as “Bill W.” and “Dr. Bob.”
Signs that indicate a person is intoxicated include the smell of alcohol on their breath or skin, glazed or bloodshot eyes, the person being unusually passive or argumentative, and/or a deterioration in the person's appearance, judgment, or hygiene. Other physical symptoms of the state of being drunk include flushed skin. Cognitively, the person may experience decreased ability to pay attention and a propensity toward memory loss.
The World Health Organization estimates that as of 2010 there were 208 million people with alcoholism worldwide (4.1% of the population over 15 years of age).[9][10] In the United States, about 17 million (7%) of adults and 0.7 million (2.8%) of those age 12 to 17 years of age are affected.[11] It is more common among males and young adults, becoming less common in middle and old age.[3] It is the least common in Africa, at 1.1%, and has the highest rates in Eastern Europe, at 11%.[3] Alcoholism directly resulted in 139,000 deaths in 2013, up from 112,000 deaths in 1990.[21] A total of 3.3 million deaths (5.9% of all deaths) are believed to be due to alcohol.[11] It often reduces a person's life expectancy by around ten years.[22] In the United States, it resulted in economic costs of $224 billion USD in 2006.[11] Many terms, some insulting and others informal, have been used to refer to people affected by alcoholism; the expressions include tippler, drunkard, dipsomaniac and souse.[23] In 1979, the World Health Organization discouraged the use of "alcoholism" due to its inexact meaning, preferring "alcohol dependence syndrome".[24]
The story behind the steps starts in Switzerland, specifically with Carl Jung, the famous psychiatrist and psychologist who is considered the father of analytical psychology. Renowned as he is for his pioneering work in the understanding of the psyche and the self, Jung was also a pantheist; his study of world religions and mythologies was instrumental in his belief that spiritual health was vital to an individual’s wellbeing. This came into play when Jung was confronted with an alcoholic patient, Rowland Hazard III, whose problem was so severe that contemporary methods of treatment proved ineffective. Jung counseled the patient that the last remaining measure to overcome the demon of addiction was to experience a spiritual rebirth.
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No conversation about alcoholism or substance abuse recovery is complete without mentioning Alcoholics Anonymous. The group has become synonymous with the concept of addiction rehabilitation in general, and it was instrumental in changing the conversation in how people with drinking problems came to be understood and regarded. As the science and psychology of addiction evolves, the role of Alcoholics Anonymous is also changing, but it remains a cornerstone of the aftercare experience.
When most people think about “alcoholism,” they assume the chronic severe group is the only group. However, adolescents and young adults, both with and without mental illnesses, can struggle with compulsive behaviors around alcohol, and many adults in the US are dependent on alcohol to stabilize their emotions. These conditions, too, indicate a potential AUD. If alcohol abuse remains unaddressed, it can lead to severe health consequences, both acute and chronic.
When a person struggling with problem drinking or alcohol dependence decides to get help, it is important for them to consult with a doctor regarding how serious their physical condition may be. Gauging the severity of withdrawal symptoms is important, as quitting alcohol suddenly can lead to seizures, which may be deadly. Racing heart rate, high blood pressure, insomnia, vomiting and related dehydration, and fever can also be dangerous alcohol withdrawal symptoms.
Twelve-step programs approach alcoholism and drug addiction as diseases that can only be managed by surrendering one’s will to a higher power. In spite of their reliance on the disease model of addiction, 12-step groups offer rewarding experiences that reinforce healthy, sober behaviors. In this sense, the 12 steps reflect the principles of positive psychology, notes the Journal of Substance Abuse Treatment. Positive psychology is based on the belief that gratifying experiences will encourage the individual to repeat a healthy behavior, such as attending meetings or reading AA literature, rather than reverting to a self-destructive behavior, such as drinking or using drugs.
When alcoholism affects a spouse or partner, it’s possible to become too wrapped up in their well-being. This is called codependency. You may get to the point where you feel compelled to help your person get well. However, family members and friends often have deep emotional ties that prevent them from having the objective viewpoint necessary for treatment.
The story behind the steps starts in Switzerland, specifically with Carl Jung, the famous psychiatrist and psychologist who is considered the father of analytical psychology. Renowned as he is for his pioneering work in the understanding of the psyche and the self, Jung was also a pantheist; his study of world religions and mythologies was instrumental in his belief that spiritual health was vital to an individual’s wellbeing. This came into play when Jung was confronted with an alcoholic patient, Rowland Hazard III, whose problem was so severe that contemporary methods of treatment proved ineffective. Jung counseled the patient that the last remaining measure to overcome the demon of addiction was to experience a spiritual rebirth.

We AAs have never called alcoholism a disease because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease. Instead there are many separate heart ailments or combinations of them. It is something like that with alcoholism. Therefore, we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Hence, we have always called it an illness or a malady—a far safer term for us to use.[63]
Dr.Miller, if it were that simple, we wouldn't be discussing the issue at all. I have experienced both sides of the fence so to speak. I've been the guy in the back of the room who couldn't put 24 hours of sobriety together, life in shambles, family gone, and without the ability to function in society.   On the other hand I have worked in the treatment field, worked the program in every aspect of my life, as well as sponsored countless people.  The sponsorship is where I have the "BEGINNING" of difficulty, not that it's all bad. Especially when it comes to forth step.  A person who has resentments should be made to see their part in their resentment. All to often though the addict is made to blame.  A sponsee of mine was raped in jail and he had put it on his forth step.  So he had sexual issues, self worth issues, ECT.  I deferred to my sponsor on how to deal with such a resentment. He and his sponsor both told me to tell the kid, yea, it was bad, but you put yourself In jail, so it your fault. I've taken enough psychology to know you never under any circumstances  tell a rape victim it's their fault that they were raped. I told him to defer to a mental health professional, and for a time he improved. Later after being forced back into AA by the legal system he was again told on a fourth step that it was his fault for being raped. But this crazy "tough love", "it's your fault"  "now learn some humility and fix it", kind of thinking permeates AA to it's core.  The kid did stay sober, his determination was so strong the police found him with both barrels of a shotgun in his mouth and the back of his head splattered against the wall. Next to him they found and unopened bottle of wiskey and a note saying "this is how bad I don't want to drink". You see, he had floundered in AA and so of course the finger was pointed  at him for failure, by his family, by the program, and most people he knew. This is just one of countless horror stories. If you look at the founder. I realize that most believe AA  was co founded by Dr. Robert Smith M.D.  In reality, Dr. Bob was the first person to have tried the program and had any success. Everyone Bill Wilson tried his program on previously failed miserably. But looking at the heart of the origins of the program, and I dont mean the Oxford groups of whom Bill Wilson would derive his 12 steps from their 6 step program, I mean at the thinking of Bill Wilson himself. He says in his biography that he had a literal disease that left him virtually powerless over every vice and compulsion he indulged in.  AND I don't say this to degrade In anyway the hardworking and caring people of AA. Heaven knows, the vast overwhelming majority of AA's have their hearts in the right place, but the whole thing is based on an excuse. The idea of having a disease took the heat off of Bill.  The program  slowly built up around that notion that there's a disease to blame. After 20 years of life experience, and a lot of academia,  I believe the problem lies in unintentional conditioning. Really a learning disorder to put it in other terms. Susceptible individuals, usually because of one form of trauma or another seek out relief. By repeated chemical administration the brain slowly starts to think that chemical is necessary for survival. Probably because the instinctual systems become involved. When a compulsion is more powerful than a individuals desire for oxygen, and food ECT.  Words are useless, consequences will have no effect. Mostly because a person can't directly access the sub conscience.  But you can unlearn something. Email me for the real solution
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In asking questions about mental health symptoms, mental health professionals are often exploring if the individual suffers from alcohol or other drug abuse or dependence disorders, as well as depression and/or manic symptoms, anxiety, hallucinations, or delusions or behavioral disorders. Physicians may provide the people they evaluate with a quiz or self-test as a screening tool for substance-use disorders. Since some of the symptoms of alcohol use disorder can also occur in other mental illnesses, the mental health screening is to determine if the individual suffers from a mood disorder or anxiety disorder, as well as schizophrenia, schizoaffective disorder, and other psychotic disorders, or personality or behavior disorders like attention deficit hyperactivity disorder (ADHD).

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Among older patients with alcoholism, from one third to one half develop alcoholism after age 60 years. This group is harder to recognize. A population-based study found that problem drinking (>3 drinks/d) was observed in 9% of older men and in 2% of older women. Alcohol levels are higher in elderly patients for a given amount of alcohol consumed than in younger patients.

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Doctor On Demand
Received income in an amount equal to or greater than $250 from: Blue Cross Blue Shield Federal Employee Program
Received royalty from Lippincott Williams & Wilkins for book editor; Received grant/research funds from National Alliance for Research in Schizophrenia and Depression for independent contractor; Received consulting fee from Blue Cross Blue Shield Association for consulting. for: Received book royalty from American Psychiatric Publishing Inc.

The risk of developing alcoholism has a definite genetic component. Studies have demonstrated that close relatives of people with alcoholism are more likely to become alcoholics themselves. This risk exists even for children adopted away from their biological families at birth and raised in a non-alcoholic adoptive family with no knowledge of their biological family's alcohol use. However, no specific gene for alcoholism has been found, and environmental factors (e.g., stress) and social factors (e.g., peer behavior) are thought to play a role in whether a person becomes alcohol dependent.
Jump up ^ Agrawal, A; Sartor, CE; Lynskey, MT; Grant, JD; Pergadia, ML; Grucza, R; Bucholz, KK; Nelson, EC; Madden, PA; Martin, NG; Heath, AC (2009). "Evidence for an Interaction Between Age at 1st Drink and Genetic Influences on DSM-IV Alcohol Dependence Symptoms". Alcoholism: Clinical and Experimental Research. 33 (12): 2047–56. doi:10.1111/j.1530-0277.2009.01044.x. PMC 2883563. PMID 19764935.
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Alcohol detoxification or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs, such as benzodiazepines, that have similar effects to prevent alcohol withdrawal. Individuals who are only at risk of mild to moderate withdrawal symptoms can be detoxified as outpatients. Individuals at risk of a severe withdrawal syndrome as well as those who have significant or acute comorbid conditions are generally treated as inpatients. Detoxification does not actually treat alcoholism, and it is necessary to follow up detoxification with an appropriate treatment program for alcohol dependence or abuse to reduce the risk of relapse.[7] Some symptoms of alcohol withdrawal such as depressed mood and anxiety typically take weeks or months to abate while other symptoms persist longer due to persisting neuroadaptations.[65] Alcoholism has serious adverse effects on brain function; on average it takes one year of abstinence to recover from the cognitive deficits incurred by chronic alcohol abuse.[126]

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I disagree. The underlying premise of "recovery" is not hope, but wellness. Becoming well. Staying well. By AA's own statistics, only 10.4% of participants continue with the program after the first year. What about the 89.6% that don't continue? According to AA, they failed. It's their fault. They weren't "working" the program. Or, they're "constitutionally incapable of being honest." If one defines normality as what the vast majority of people do in a given situation, then it is "normal" for people to fail in AA.
ASAM defines addiction as a “primary, chronic disease of [the] brain … [with] characteristic biological, psychological, social and spiritual manifestations.” It isn’t just a social or criminal justice problem—it’s a medical and public health problem. Medical diagnosis and treatment are appropriate responses to addiction; ASAM’s definition points out that “without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.” So it is a serious, potentially fatal illness, but it is treatable: recovery is possible, and happens for millions of individuals with this disease every year.
Photodynamic therapy (PDT) is a procedure that treats precancerous cells, in addition to other types of cancer cells. The medical treatment does this with the help of a photosensitizing drug and a light source that activates the applied drug, destroying cancer cells. PDT is approved to treat non-small cell lung cancer, esophageal cancer, and Barrett's esophagus. It's used to treat actinic keratosis, as well as acne, rosacea, skin cancer, sun damage, oily skin, wrinkles, warts, psoriasis, and enlarged sebaceous glands.
Alcoholism is appropriately considered a disease rather than a weakness of character or chosen pattern of bad behavior. It is the third most common mental illness, affecting more than 14 million people in the United States. Other facts and statistics about alcohol dependence include its pattern of afflicting about 4% of women and 10% of men. It costs more than $200 billion per year in lower productivity, early death, and costs for treatment. Worldwide, alcohol is thought to contribute to more than 200 illnesses and injuries, like liver disease, heart disease, and neurological problems. Alcohol-related deaths number more than 3 million per year, nearly 6% of all deaths worldwide. For adults between 20-40 years of age, that percentage rises to about 25% of deaths due to alcohol.
As is true with virtually any mental health diagnosis, there is no one test that definitively indicates that someone has an alcohol-use disorder. Screening tools, including online or other tests may help identify individuals who are at risk for having a drinking problem. Therefore, health care professionals diagnose alcohol abuse or dependence by gathering comprehensive medical, family, and mental health information. The practitioner will also either perform a physical examination or request that the individual's primary care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition that might have mental health symptoms.
In the United States and Canada, AA meetings are held in hundreds of correctional facilities. The AA General Service Office has published a workbook with detailed recommendations for methods of approaching correctional-facility officials with the intent of developing an in-prison AA program.[79] In addition, AA publishes a variety of pamphlets specifically for the incarcerated alcoholic.[80] Additionally, the AA General Service Office provides a pamphlet with guidelines for members working with incarcerated alcoholics.[81]
Elderly people who drink excessively are at risk for having more serious illnesses, doctor visits, and symptoms of depression, with less life satisfaction and smaller social support networks compared to senior citizens who have never consumed alcohol. While binge drinking is often thought to be a symptom of young people, an often unknown fact is that a significant percentage of middle-aged and elderly individuals also engage in binge drinking. This behavior increases the risk for driving drunk, no matter what the age. That, in turn, puts the individual at risk for being arrested for driving under the influence (DUI) of alcohol.
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

In a closed AA meeting, the only people who may attend are those who are recovering addicts (or those interested in learning more about overcoming their addiction). Open meetings allow the attendance of friends, spouses and family members. Whether you decide to go to a closed or open meeting depends exclusively on what you’re comfortable with. Some people would rather keep their recovery separate from the rest of their life. Others thrive on the support that loved ones can provide during meetings.
The Traditions recommend that members remain anonymous in public media, altruistically help other alcoholics, and that AA groups avoid official affiliations with other organizations. They also advise against dogma and coercive hierarchies. Subsequent fellowships such as Narcotics Anonymous have adopted and adapted the Twelve Steps and the Twelve Traditions to their respective primary purposes.[4][5]
Misuse, problem use, abuse, and heavy use of alcohol refer to improper use of alcohol, which may cause physical, social, or moral harm to the drinker.[91] The Dietary Guidelines for Americans defines "moderate use" as no more than two alcoholic beverages a day for men and no more than one alcoholic beverage a day for women.[92] Some drinkers may drink more than 600 ml of alcohol per day during a heavy drinking period.[93] The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as the amount of alcohol leading to a blood alcohol content (BAC) of 0.08, which, for most adults, would be reached by consuming five drinks for men or four for women over a two-hour period. According to the NIAAA, men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. It defines a standard drink as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits.[94] Despite this risk, a 2014 report in the National Survey on Drug Use and Health found that only 10% of either "heavy drinkers" or "binge drinkers" defined according to the above criteria also met the criteria for alcohol dependence, while only 1.3% of non-binge drinkers met the criteria. An inference drawn from this study is that evidence-based policy strategies and clinical preventive services may effectively reduce binge drinking without requiring addiction treatment in most cases.[95]

People who struggle with AUD may begin drinking because of social situations or anxiety about being around people; however, signs of a potential AUD include changes in friend groups, especially geared toward friends who drink versus those who don’t, and avoiding social situations to drink instead. Those who have a family member who struggles with AUD are more likely to suffer from high stress, emotional and physical abuse, and mental health or substance abuse problems later in life.


Jump up ^ Sullivan, JT; Sykora, K; Schneiderman, J; Naranjo, CA; Sellers, EM (November 1989). "Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar)" (PDF). Br J Addict. 84 (11): 1353–7. CiteSeerX 10.1.1.489.341. doi:10.1111/j.1360-0443.1989.tb00737.x. PMID 2597811. Archived from the original (PDF) on 10 August 2013. Retrieved 25 October 2017.
Babies who are born to mothers who are heavy drinkers are more at risk for being born with significant medical, developmental, behavioral, and emotional problems, including fetal alcohol syndrome (FAS). However, many babies whose mothers consumed even minimal amounts of alcohol during pregnancy have been born with such problems. Therefore, there is no amount of alcohol intake that has been proven to be safe during pregnancy.
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Excessive alcohol consumption is correlated with increased risk of stroke, liver disease, and decreased life expectancy. In fact, binge drinking during only the weekends is still enough to damage the liver, studies show, and moderate drinking interferes with sleep quality by interrupting circadian rhythms and REM sleep. However, a number of different treatment options are available to address alcoholic dysfunction.

People who drink too much are at an increased risk of ulcers, digestive problems, low hormone levels, and several cancers, including esophageal, stomach, colon, liver, mouth, and breast cancers. People who drink too much may induce a mood disorder, like anxiety or depression, or they may trigger a seizure disorder due to changes to the GABA system in the brain.


Research and population surveys have shown that persons under stress , particularly chronic stress, tend to exhibit more unhealthy behaviors than less-stressed persons. Stressed people drink more alcohol, smoke more, and eat less nutritious foods than non-stressed individuals. Many people report drinking alcohol in response to various types of stress, and the amount of drinking in response to stress is related to the severity of the life stressors and the individuals' lack of social support networks.
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Alcohol dependency occurs on a continuum. Many Australians are only moderately or mildly dependent on alcohol (e.g. they may find it difficult to stop drinking once they start). They do not exhibit physical withdrawals like those with severe alcohol dependence, and do not consider their drinking patterns problematic. This may be because the major health and social consequences of alcohol dependence (with the exclusion of violence) do not begin when an individual first becomes alcohol dependent. For example, it may take years for an individual who is alcohol dependent to have financial or relationship problems as a result of drinking. In many cases chronic excessive drinking may have no immediate health and social consequences.

A study found an association between an increase in attendance to AA meetings with increased spirituality and a decrease in the frequency and intensity of alcohol use. The research also found that AA was effective at helping agnostics and atheists become sober. The authors concluded that though spirituality was an important mechanism of behavioral change for some alcoholics, it was not the only effective mechanism.[54] Since the mid-1970s, a number of 'agnostic' or 'no-prayer' AA groups have begun across the U.S., Canada, and other parts of the world, which hold meetings that adhere to a tradition allowing alcoholics to freely express their doubts or disbelief that spirituality will help their recovery, and these meetings forgo use of opening or closing prayers.[55][56] There are online resources listing AA meetings for atheists and agnostics.[57]


Thank you for letting Los Angles Central Office serve and support you. LACO maintains this website and publishes both the online and print meeting directories, and it is the information hub for AA in the Los Angeles area. At Central Office volunteers are of service 365 days a year answering the phones and sharing experience, strength and hope. Let us know how we can help your group carry the message.
At the end of an intervention, the stage is set for entry into addiction treatment programs. There are many different options out there. Some facilities, for example, offer inpatient treatment for addiction. These programs allow people to step away from their day-to-day concerns and tackle an addiction around the clock, every single day. For some people, that tight focus is an ideal setup for healing. But outpatient centers can be ideal for those who want to stay at home, surrounded by family, while they work on addictions to alcohol. It’s a personal decision that families can make in consultation with the person who needs help.
The Twelve Traditions encourage members to practice the spiritual principle of anonymity in the public media and members are also asked to respect each other's confidentiality.[39] This is a group norm,[39] however, and not legally mandated; there are no legal consequences to discourage those attending twelve-step groups from revealing information disclosed during meetings.[40] Statutes on group therapy do not encompass those associations that lack a professional therapist or clergyman to whom confidentiality and privilege might apply. Professionals and paraprofessionals who refer patients to these groups, to avoid both civil liability and licensure problems, have been advised that they should alert their patients that, at any time, their statements made in meetings may be disclosed.[40]
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