< Previous10 PERSPECTIVES VOLUME 45, NUMBER 3 PRODUCTION STAFF Veronica Cunningham Editor in Chief Kimberly Kras Perspectives Co-Editor Jason Stauffer Perspectives Co-Editor Kevin Sweeney Production Coordinator Julie Pelstring Desktop Publisher APPA DIRECTORY APPA Main (859) 244-8204 Publication Orders (859) 244-8204 General Training Institute (859) 244-8204 Information Clearinghouse (859) 244-8204 Membership (859) 244-8204 Request for Training (859) 244-8206 Resource Expo (859) 244-8206 Advertising (859) 244-8206 Grants/TA (859) 244-8236 BOARD OF DIRECTORS Brian Lovins President Susan Rice President-Elect Marcus Hodges Vice President Tom Gregory Treasurer Audrey Rigsbee Secretary Tim Hardy Immediate Past President Scott Taylor Second Past President Isabel Perez-Morina Affiliate Representative Tania Appling Member At-Large Representative Alyza Gonzalez Line Staff Representative Herb Sinkinson Region 1 Representative Corinne Brisco Region 2 Representative Dena Davis Region 3 Representative Gene Cotter Region 4 Representative LaTasha Jones Region 5 Representative Veronica Cunningham Executive Director/CEO Communications should be addressed to: American Probation and Parole Association c/o The Council of State Governments 1776 Avenue of the States, Lexington, KY, 40511 Fax: (859) 244-8001, E-mail: Website: Perspectives is published four times annually by the American Probation and Parole Association through its secretariat office in Lexington, Kentucky. ISSN 0821-1507 Reprint permission. Direct requests for permission to use material published in Perspectives in writing to © 2021 The Council of State Governments CO-CHAIRS JASON STAUFFER Assessment and Classification Services Supervisor, Treatment Services Division, Bureau of Reentry Coordination Pennsylvania Department of Corrections 1920 Technology Parkway Mechanicsburg, PA 17050 Phone: (717) 361-4300 KIMBERLY R. KRAS, PHD, San Diego State University Department of Criminal Justice School of Public Affairs 5500 Campanile Drive San Diego, CA 92182 Phone: (619) 594-1158 BOARD MEMBERS: Eileen Ahlin, PhD, Penn State Harrisburg Ansley Dille, Utah Administrative Office of the Courts Lauren Duhaime, Bureau of Justice Assistance/George Mason University Phillip Galli, University of Wisconsin-River Falls Lily Gleicher, PhD, Robina Institute/DePaul University Shelley Johnson, PhD, University of North Carolina Charlotte Jennifer Lanterman, PhD, University of Nevada Reno Sarah Manchak, PhD, University of Cincinnati Katie Meyer, CAIS/JAIS Program Manager Carrie Ross, Yavapai County Adult Probation David Sattler, Washington State Administrative Office of the Courts Reveka Shteynberg, PhD, California State University San Bernardino Renea Snyder, Public Health Advisor Mark Stodola, NHTSA Probation Fellow David Taylor, Montgomery County (OH) Probation Reyna Cartagena Vasquez, CSOSA Jill Viglione, PhD, University of Central Florida Melissa Waldock, Kansas Department of Corrections Susan Wright, Pennsylvania Counseling Services editorial board The American Probation and Parole Association is an affiliate of and receives its secretariat services from The Council of State Governments (CSG). 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Box 802 Salt Lake City, UT 84110 Phone: (877) 744-1360 Email: 13 AMERICAN PROBATION AND PAROLE ASSOCIATION EVOLVE AND ADAPT BY NANCY MCCARTHY ALCOHOLICS ANONYMOUS: A FRESH LOOK DURING COVID-1914 PERSPECTIVES VOLUME 45, NUMBER 3 EVOLVE AND ADAPT At the end of 2018, there were 4,508,900 people on community supervision, 80% on probation and the other 20% on parole supervision, as reported by the Bureau of Justice Statistics (Kaeble & Alper, 2020). Each probation/parole officer (PO) working with this growing supervision population faces a more difficult job when individuals on supervision have alcohol or substance abuse disorders and, without question, alcohol use has increased in America during the COVID-19 pandemic. A national study of adults over 30 published in the Journal of the American Medical Association Network Open showed that the frequency of alcohol consumption has increased by 14% over 2019 and that women are drinking more heavily, an increase of 41% over 2019 (Pollard, Tucker, & Green, 2020). Alcoholics Anonymous (AA) has shown great resilience in adapting to the pandemic and remains a viable community of support for alcoholics on community supervision. The help that AA offers individuals suffering from alcoholism is valued by many POs, but there remain misconceptions about AA in terms of what it can and cannot do. During a crisis period, with an increase in clients on community supervision, it is time to restate the benefits AA can provide for those on probation and parole and for the criminal justice system in general. In this article, I will provide information on the history and effectiveness of AA alongside perspectives of justice professionals who routinely interact with AA. The justice professionals I interviewed for this article include those who have served as U.S. District Court and State Circuit Court judges as well as a Chief Probation Officer who has managed individuals placed on community supervision by the federal court system. I then present notes and recommendations from my time as an officer and ultimately as Regional Administrator for the Missouri Division of Probation and Parole. Origin and Overview of Alcoholics Anonymous The world’s first and oldest Twelve Step recovery program, Alcoholics Anonymous, was founded in 1935 as the outcome of a meeting between Bill W., a New York stockbroker, and Dr. Bob S., an Akron surgeon, both suffering from alcohol addiction. Their meeting initiated a peer-to-peer program of recovery from alcoholism that has touched many lives and has grown to include more than two million people worldwide (Alcoholics Anonymous World Services, Inc., 2021). To understand the nature of the AA program, it is important to learn certain core aspects of AA structure and policies. For example, while AA has one central clearinghouse for information (its General Service Office in New York), AA groups are autonomous and varied, guided only by a set of suggestions put forth in AA’s Twelve Traditions. AA does not accept outside contributions; it supports itself through member donations and the sale of literature. In addition, it does not offer medical advice. It has no opinion, for instance, on the use of prescribed medications or on Medication-Assisted Therapy. Finally, AA is a program of complete abstinence, but only AA’s First Step mentions alcohol. The rest of the Steps are aimed at changing behaviors to arrest a disease that affects mind, body, and spirit. There is no timetable for doing the steps; AA members progress, with the help of a sponsor, at their own pace. Essential to an alcoholic’s recovery is finding a network of support among fellow alcoholics who have gone through similar experiences, which is why AA can be so effective in working with individuals released under community supervision who suffer from alcohol addiction and are seeking help with their drinking. Because of the use of quasi-religious language in AA’s Twelve Steps and main text (Alcoholics Anonymous or “the Big Book”), the courts have found AA to be a “deity- based” program. As such, courts can refer clients to Alcoholics Anonymous but cannot require participation without violating the First Amendment. Is Alcoholics Anonymous Effective? Many POs do see AA as a free and readily available support for clients with alcohol 15 AMERICAN PROBATION AND PAROLE ASSOCIATION EVOLVE AND ADAPT use disorders. Research shows evidence of the effectiveness of this support. Studies indicate that individuals who participate in AA following in-patient treatment have more alcohol-free days compared to non-participants (Gossop et al., 2003; Humphreys, Blodgett, & Wagner, 2014). In March 2020, a meta- analysis published by Kelly and colleagues, examining 27 previous studies involving nearly 10,565 participants, found that people who experience Twelve Step Facilitation in AA are 20-60% more likely to remain abstinent than they are with other scientifically proven treatments for alcohol use disorder, including cognitive behavioral therapy and outpatient treatment by a mental health professional (Kelly, Humphreys, & Ferri, 2020; see also Stanford University, 2020). One of the study’s co-authors, Dr. John Kelly, the Elizabeth R. Spallin Professor of Psychiatry in the Field of Addiction Medicine at Harvard Medical School and Director of the Massachusetts General Hospital Recovery Research Institute, told the Cochrane Collaboration (2020) in an interview: When compared to other well-established, commonly delivered treatments for alcohol use disorder, AA/TSF generally performs as well as other interventions on most clinical outcomes, except for abstinence, where it does quite a bit better—particularly true for helping many more patients achieve sustained abstinence and remission. The review also found that AA/TSF reduced health care costs substantially while simultaneously improving patient abstinence relative to other treatments. One of the ways AA helps more people over the long-term is through its ability to keep people actively involved in its recovery focused peer support social network (paragraphs 6 and 11). Even though some consider Alcoholics Anonymous to be religious in nature, those familiar with AA often have had a different viewpoint. In an interview I conducted with Judge Ivan A. Lemelle, a Senior United States District Judge for the Eastern District of Louisiana in New Orleans and a former Class A (nonalcoholic) trustee on the General Service Board of Alcoholics Anonymous, he stated: There may be people who have the idea that Alcoholics Anonymous is religiously based, but after decades of personally witnessing life-saving experiences shared in the rooms of AA by persons from all walks of life, I can unequivocally say AA is not a religion, nor a sect. It is open to all who wish to stop drinking. AA’s Twelve Steps help suffering alcoholics on probation or parole in terms of sponsorship and getting them to meetings—all without any requirement to practice or align themselves with any religious ideology. AA doesn’t judge anyone. Its doors are open to everyone. It is important to note that individual AA meetings can vary greatly. A client may find one meeting that does indeed strike him or her as religious if, for instance, a prayer is said, or another where he or she may not relate to the group members. If one AA meeting does not meet a client’s needs, the solution is simply to find another meeting. According to the best annual estimates from AA’s General Service Office, as of December 2020, there were nearly 75,000 AA groups in the United States and Canada in addition to 1,500 meetings which are held in correctional facilities (Alcoholics Anonymous, 2020). Most of these groups hold multiple meetings at their locations, and the only requirement for membership, as stated in AA’s Third Tradition, “is a desire to stop drinking.” A Meeting for Everyone It is helpful for clients to become aware of the wide variety of meetings held in AA, as there is, almost literally, a meeting for everyone. There are meetings for newcomers and young people, Spanish-speaking meetings, LGBTQ+ meetings, meetings for those with dual diagnoses, sign language meetings for the deaf, meditation meetings, secular (or “atheist/agnostic”) meetings, and many more. AA meeting listings are generally accompanied by the notation “open” or “closed.” An open meeting means that non-alcoholics such as family members or professionals can attend, while a closed meeting is only for those with a desire to stop drinking. AA welcomes the attendance of POs 16 PERSPECTIVES VOLUME 45, NUMBER 3 EVOLVE AND ADAPT at open meetings. Group members appreciate the opportunity to be of service and to help POs understand how AA works, so that this information can be imparted to clients seeking sobriety. The Pandemic and Isolation It is well known that loneliness and substance abuse go hand in hand (Hosseinbor, Ardekani, Bakhshani, & Bakhshani, 2014), and social-distancing measures to thwart COVID-19 have spawned an increase in isolation that is difficult even for those without addiction issues. AA recommends that individuals seeking sobriety stay away from “playmates and playgrounds,” i.e., avoiding the people, places, and things that led them to make poor decisions previously. For the client who is diagnosed with alcohol use disorder, AA can become a new community of support. Attending meetings with sober people surrounds the individual with others in a like-minded group who are not drinking and who are seeking ways to lead responsible lives. AA challenges its members to change cognitively in terms of thinking and responding to issues without using alcohol, encouraging a program of honesty and self- examination. The focus is on examining past misdeeds with clarity and learning how to move forward. In addition, AA can provide a “sponsor” who offers no judgment, but instead helps guide the newcomer toward a solid recovery by working AA’s Twelve Steps. During an interview with Veronica Ramirez, Chief Probation Officer for the Eastern District of Louisiana, who has attended open AA meetings as an observer, she said: “Some of our clients have no one—just no one. And so, to have this environment available to them is tremendously important.” Even before the pandemic, AA had been turning to new technologies to reach suffering alcoholics, but it redoubled its efforts as in- person meetings ended. These new technologies have been largely supported in the research literature (see Huskamp et al., 2018, and Lin et al., 2019). In a review of telehealth models for providing services to people with a substance use disorder, Oesterle et al. (2020) found that the use of telehealth programs is increasing but remains underutilized. In a study of the potential for online 12-step meetings to promote the same therapeutic benefits as in person programs, Bergman, Kelly, Fava, and Evins (2021) found that online meetings were as effective as those conducted in person in facilitating sobriety; however, they note that barriers to accessing treatment remain, such as lack of adequate technology or broadband and concerns with privacy issues. The consensus appears to be that there is reason to believe that AA can aid its members and remain a useful tool for community supervision even in the face of the pandemic—a time of great need for support of people with substance use disorder (especially those in isolation). The Meeting Guide App Those who are newly released from jail or prison may now take advantage of a convenient option for finding AA meetings and a host of different meeting platforms and formats from which to choose. For example, to help clients find AA meetings, POs can now recommend the Meeting Guide app. Free of charge and easily downloadable to a clients’ phone, tablet, or computer through typical app vendors, the Meeting Guide app is connected to hundreds of local AA central offices, allowing users to access updated information about meeting locations and times. This easy-to-use app gives directions to physical meetings close to people’s homes or places of employment; provides links to virtual meetings; and clearly enumerates the name, address, and time of each meeting as well as what type of AA meeting it is. Currently, there are nearly 125,000 meetings on the app, with 251,000 monthly active users. Online Meetings Because of the COVID-19 pandemic, 95% of AA meetings are being held virtually, mostly on Zoom, but also on Skype, WebEx, and other platforms. When POs recommend that clients attend AA meetings held on Zoom, 17 AMERICAN PROBATION AND PAROLE ASSOCIATION EVOLVE AND ADAPT it is important to make sure that clients ask meeting chairs how best to verify attendance. Currently, some clients are taking pictures of the Zoom screens in order to prove they were present, but from the point of view of AA this compromises the program’s all-important principle of anonymity. Some meeting chairs are verifying attendance through electronic signatures in Zoom chats, and certain online meetings can be verified via an email to the PO. However, other groups have made a group decision not to provide such verification due to anonymity concerns. Clients may also be concerned about anonymity, and, if so, then POs can advise them to use only their first name on a Zoom meeting call and turn their cameras off, if they wish. Once again, it is important for clients to find the right meeting to suit their needs and determine what their PO will require to verify attendance. In another and possibly more valuable approach, the supervising officer can ask what type of meeting clients attended, what step the meeting covered, or how clients are going to incorporate what was learned at the meeting into their sober lives. Once AA’s gatherings resume in person, these same questions can also aid in determining whether a client is present at meetings. In fact, repeated questions to clients may be a more accurate way of assessing the value of attendance than a signed meeting card. Zoom meetings cannot match the warmth and sense of connection found at in-person AA meetings. In the interview with Judge Lemelle, he stated, “This may be affecting those who want to go to a meeting but can do so only virtually.” However, virtual meetings do have benefits for clients on community supervision. One such benefit is ready availability; if the client has smartphone or computer access, he or she can find a meeting almost 24 hours a day, without need for transportation. Zoom meetings are not the only online option. There are email meetings where an email is sent out on a specific topic; chat (text) meetings that include a live chat following the same format as a face-to-face meeting; discussion forums or message boards where a topic is posted and group members post in return (these are active 24/7); and the old-fashioned telephone, where meetings are conducted via a conference call format. If POs have a client who does not have access to the internet or a smartphone, they can contact their local AA central office to arrange a process by which these individuals can attend meetings online. Other AA Connection Points During COVID-19 Because AA has come a long way technologically in recent years, clients can benefit as never before. AA’s central website, aa.org, contains free links to crucial AA recovery literature such as Alcoholics Anonymous (the “Big Book”), Twelve Steps and Twelve Traditions, AA’s Daily Reflections, and numerous pamphlets outlining AA’s history and mission. The aa.org website also offers publicly available videos and audios. Grapevine, AA’s monthly magazine, contains contemporary stories of the struggles and achievements of sober people. Issues of the magazine focus on race, prison life, money, sobriety, being LGBTQ+ and sober, getting through tough times, learning how to enjoy sober life, being atheist/agnostic in AA, and other themes. Clients can sign up to be emailed Grapevine’s free inspirational “Daily Quote,” available in English and Spanish, which arrives every morning in the mailboxes of thousands of sober individuals. Grapevine also has a strong YouTube presence. Its AAGrapevine channel contains playlists featuring stories recorded by ordinary AA members who outline their experiences in maintaining sobriety. The AAGrapevine YouTube channel also contains Spanish-language audio stories from its sister magazine, La Viña. Reaching Out to Promote Connections and Understanding In an interview with Judge Christine Carpenter, who is an attorney and a retired circuit court judge in Columbia, Missouri, as well as a 18 PERSPECTIVES VOLUME 45, NUMBER 3 EVOLVE AND ADAPT Class A (nonalcoholic) trustee on AA’s General Service Board, she said: During my whole career, the concept I really wanted to work on is bringing the treatment court world and the AA world together. I would say that if I were a PO, I would try to establish some relationship with the AA Fellowship in my community, to get solid contact and specific Zoom meetings that are welcoming to newcomers. Another issue in need of clarification is what AA refers to as “singleness of purpose.” A desire to stop drinking is required for AA membership. Judge Carpenter says: “I think some probation officers see substance abuse and they recommend the client to AA, but that may not be appropriate if they are drug addicts and not alcoholics.” AA’s focus on alcoholics does not exclude alcoholics with other addictions, but first and foremost they must identify as suffering from alcohol addiction. Community supervision and AA share a common goal: to help those with alcohol use disorder attain stable sobriety. To achieve this, communication needs to be a two-way street. In the above-mentioned interview with Chief Probation Officer Ramirez, she discussed this issue: Having AA build relationships with the probation department and explaining what happens in AA will help us understand where AA fits into the supervision process. I do think that if AA could enhance those relationships—meet with chief probation officers and community corrections staff—it would help dispel misconceptions... But probation can do better in reaching out to AA. It fits in perfectly with what probation does, because we understand that when people reenter the community it is so important for them to have a strong support system and prosocial network. What AA does in terms of sponsorship and meetings—all of that is exactly what we do. Our contracted [treatment] services do a great job, so the idea of contracted services coupled with AA is very important to producing positive outcomes. And so, I think that if there is a little bit more education and a little bit more conversation between AA and probation and parole, we could really work together to help our clients. In this regard, the AA community, particularly through its Cooperation with the Professional Community (C.P.C.) committees, is eager to provide information and education to supervising officers. C.P.C. volunteers are willing to hold training seminars on virtual platforms, or to make such presentations in person once the pandemic is over, to help POs understand how better to connect their clients to the AA community. A Personal Note When I started as a probation and parole officer, I knew just a little bit about alcoholism and even less about treatment and recovery. When clients were diagnosed as needing treatment for alcoholism, I did what all POs did: I sent these clients to a treatment program and gave them a sheet to take to an AA meeting to get signed. When the client returned with the sheet, I did what all good POs were supposed to do: I looked at it to make sure there was different handwriting and different color ink. Then, if I was satisfied the client was not lying to me, I threw the sheet in the file and gave the client the same instructions: “Go to AA meetings.” However, in part through the experience of watching a family member get sober, I learned that a signed sheet tossed in a file, with no understanding of what I was asking the client to do, was not always beneficial for my clients. I began to realize that I had to not only understand what AA’s Steps are but also to ensure that my clients understood that AA was not just a check off on my to-do list—that I had a genuine desire for them to achieve and maintain sobriety. Through reading AA materials and conversing with people in AA, I learned how to support my clients and how to help them as they strived for long-term sobriety. I took a few relatively simple steps that I believe helped the clients I worked with and may be helpful to POs today: 19 AMERICAN PROBATION AND PAROLE ASSOCIATION EVOLVE AND ADAPT • I attended “open” meetings of AA; • I signed up for the Grapevine magazine free email, “Daily Quote,” which is avail- able in English and Spanish, can be truly inspirational, and gives a window into the program; • I worked with local AA committees to learn about their process for helping clients tran- sition; • Once I understood that the AA program is about behavioral change, I was able to speak that language to clients—it is all about taking responsibility for actions with- out needless shame or guilt. Clients may feel a tremendous amount of shame due to the harm they have done to others. Their shame can be compounded by the additional burdens they have placed on their families. However, when they enter an AA meeting and share what they have done, there is no judgment, only understanding. In the world of corrections, we talk of the need for a community of support for our correctional clients whether they are on probation, in prison, or on parole. For those clients who are alcoholic, the fellowship of AA, through the sharing of stories of experience, strength, and hope, can become that community of support. Useful links to more information about Alcoholics Anonymous: Alcoholics Anonymous official website: Find Local AA: a state-by-state link to AA’s central Online Intergroup: AA’s directory of online meetings AA’s Cooperation with the Professional Community (C.P.C) desk at aa.org is available to provide information for professionals and connect them with the local C.P.C. committees in their area: About AA, AA’s newsletter for professionals: Box 459, AA’s monthly newsletter: Grapevine, The International Journal of Alcoholics Anonymous: La Viña, Grapevine’s Spanish-language sister magazine: Next >