Research Analysis: Acceptance of Non-Abstinence Goals

Research Analysis: Acceptance of Non-Abstinence Goals Aaron Glogowski Dr. Michael E. Dunn Davis, A. K., Rosenberg H. (2013). Acceptance of Non-Abstinence Goals by Addiction Professionals in the United States. Psychology of Addictive Behaviors, 27(4), 1102-1109. doi: 10.1037/a0030563 Alan K. Davis and Harold Rosenberg have observed some formerly unexpected results from the use of drugs and alcohol recreationally. While the effects of excessive drug and alcohol use have been monitored and proven to be unsafe and unhealthy, recent studies have shown that a controlled use of them, otherwise referred to as non-abstinence, may bring several health benefits. Addiction professionals specializing in substance use disorders (SUD) are beginning to open their eyes to new alternatives of drug therapy for their patients. While many of these views are controversial among the professional world, many clinicians and doctors are starting to turn to the idea of non-abstinence in an attempt to help their patients more in the long term, by giving them short term goals that are easier for them to achieve. In this article, Davis and Rosenberg have catalogued their findings from a study that they conducted on the changing attitudes and ideals of professionals in many different clinical fields, in regards to the practice and implementation of non-abstinence. Davis and Rosenberg conducted their study based on previous surveys that they found that had been created to determine people’s opinions on the idea of non-abstinence. They asked the participants about how acceptable they thought it would be to administer a suggestion of non-abstinence to patients in eight different categories. They divided these categories based on the type of substance use disorder, as well as the severity of the problem and the intended final result from the practice. All of the survey respondents were then asked (using the eight categories from the previous question) to give a proportion of patients whom they had prescribed a non-abstinence procedure to. They gave proportions in increments of 25%, from none to 100%. After this, the participants were asked to rate its acceptability in different clinical settings. The survey was concluded with questions about the personal history of the respondents, such as their work environment, and whether or not they had any past history with substance abuse. The survey respondents were mostly Caucasian members of the National Association of Alcoholism and Drug Addiction Counselors, and over half of them had previous experience with a substance use disorder. The results appeared to be in favor of non-abstinence being used as a mid-term goal on the way to giving up drug abuse, however, only 32% of respondents said it was acceptable to use non-abstinence as an end-goal. When the issue came to alcohol abuse however, 51% agreed that non-abstinence was an acceptable end-goal. On the other hand, when it came to drug or alcohol dependence, far fewer participants agreed with non-abstinence as a procedure. The participants ranked non-abstinence acceptability for drug dependence as 27% for an intermediate procedure, and 15% for an end-goal. They found very similar results with alcohol dependence, at 28% and 16% respectively. No matter what type of drug or severity of the problem, Davis and Rosenberg’s participants seemed to disagree with non-abstinence more often than agree with it. At least half said that they would not consider non-abstinence as a procedure in any case, regardless of the situation. Most of the respondents who were against non-abstinence thought it was ineffective, or it did not agree with the treatment philosophy that they had laid out for themselves. Some other reasons why participants disagreed with non-abstinence included things such as a fear for a medical condition that a patient could have, or worries over the legality of the substance that was being used, or the context in which the patient would be using it (such as underage drinking, or drug use in a stressful work environment). Another key player in the determination of the acceptability of non-abstinence procedures was the environment in which professionals would be recommending the procedure. In both rehab and detoxification programs, the majority of survey participants found it to be a completely unacceptable treatment, with unacceptability ratings at 74% and 68% respectively. However, outpatient programs, DUI/DWI education programs, and independent practices saw significantly better results in terms of acceptability, with unacceptability ratings at 57%, 45%, and 28% respectively. Davis and Rosenberg also observed various characteristics of their respondents to determine whether there was any correlation between those factors and their acceptance of non-abstinence programs. They found that participants who had history with alcohol or drug related issues tended to disagree with non-abstinence programs more than those who had no history with drugs and alcohol, however, the variation was so small that it was deemed insignificant. In observing the results of their study, Davis and Rosenberg noticed some outside circumstances in relation to their topic of discussion. They realized in conducting the surveys that there was a possibility of bias, especially in regards to whether or not the addiction professional was willing to work with the client. They found that some professionals were simply unwilling to work with clients who were attempting to continue taking drugs or alcohol in moderation. These professionals were less likely to accept the possibility of non-abstinence treatments. These same professionals also accepted the fact that some of their clients may resort to non-abstinence procedures anyway, even if they didn’t prescribe or condone the procedure. Davis and Rosenberg’s study, when compared with previous studies on the subject, found that American addiction professionals had become more accepting of non-abstinence in terms of drinking than they had been 20 years prior. The amount of participants who rated non-abstinence as an acceptable mid-goal for alcohol abusers is twice as many as 20 years before their survey. Davis and Rosenberg claim that the increase in acceptance could be due to several factors, including an understanding of non-abstinence as a potential method for reducing long-term harm, and a reduction of total abstinence, or the 12-step program. Other regions still appear to be more accepting of non-abstinence in general, whether it is for a mid-goal or an end-goal. From previous studies, Rosenberg found that the United Kingdom had over an 80% acceptance rate of non-abstinence for alcohol abusers, and a 68% mid-goal as well as a 50% end-goal for alcohol dependence. Overall, even though America is slowly becoming more accepting of non-abstinence, they still have a long way to go before they reach the United Kingdom’s acceptance level. Davis and Rosenberg realize that their study may be skewed by outside factors, such as the study being a web-based study, or an inherent bias with the way that questions were asked. With regard to the outliers, Davis and Rosenberg conclude their study with notice for those practicing non-abstinence as it is becoming more common, especially in outpatient or independent practices. Everyday Use, Alice Walker | Symbolism And Characters: Everyday Use, Alice Walker | Symbolism And Characters: In the story Everyday Use, Alice Walker uses a detailed description to help describe the symbolism of the unique and highly valued quilts, as well as, contrasting the characters throughout the story. The quilts stand as a specific symbol and as more than just a creative piece of artwork throughout the story. According to an article written by Sam Whitsitt, the quilt, itself, represents the history and tradition that binds the African culture to the past and the past to the present (Whitsitt, 445). The quilts helps portray the theme of African American heritage throughout the story and binds Mamas ancestors and her heritage altogether. The quilts signify the bond between each generation and the impact they have on each main character in the story, which include Mama, Dee and Maggie. Walkers usage of the quilts throughout the story also helps demonstrate the differences between each of the characters. The quilts are the main focus in the story that brings out the characters true person alities and shows the differences in those personalities. Throughout the story Everyday Use by Alice Walker, the quilts help portray the unique cultural symbolism of the African culture and the way they view quilting, as well as, illustrating the differences of the main characters in the story. In the story, quilting is used as a symbol to signify the African American past. The quilts are a primary symbol that stands for the ties of heritage and the distinctive culture of Mamas family. According to an article written by Claudia Tate, Barbara T. Christian, the person who showcases the corpus of Walkers works and the traditions of African-American literature, explains that Walker articulates the metaphor of quilting to represent the creative legacy that African Americans have inherited from their maternal ancestors (Tate, 308). Quilting is part of the African American past and travels from generation to generation. According to an article written by David Cowart, the quilt that Dee, or Wangero Leewanika Kemanjo, fights over links her generation to previous generations and, therefore, the quilt is shown to represent the African American past (Cowart, 171). There are many types of unique patterns in the quilts that Mama and Dee are disputing over. According to Whitsitts article , many African American quilters employ large, often abstract designs, the use of these different designs shows the uniqueness of the quilt (Whitsitt, 454). The patterns in the quilts represent the African American past and Mamas heritage. In both of them were scraps of dresses Grandma Dee had worn fifty and more years ago. Bits and pieces of Grandpa Jattells Paisley shirts. And one teeny faded blue piece, about the size of a penny matchbox, that was from Great Grandpa Ezras uniform that he wore in the Civil War (Walker, 113). The use of these different types of patterns in the quilts symbolizes the history of Mamas family and the creativeness they had. The precious materials used in making the quilts represent the culture and the high value they each contain. The fabric that is used in the making of the quilts shows Mamas unique culture and the love her family has for their culture. The work Mama, Grandma Dee, and Big Dee put into the quilts show their strong African American herit age and background. In the African American culture many quilts travel from generation to generation to show ones familys culture and where they came from (Cowart, 171). The quilts Dee and Mama are fighting over are to be traveled from generation to generation, also, to help keep the culture alive. The quilts play a major role in the family because of the prestigious heritage they each contain. They help show the distinctive African heritage and special cultural symbolism. The quilt ties everything, heritage included, together. As the quilts are passed down the familys history and culture is past down, also, which makes the quilts play a special role in the African American culture. The quilts made by Mama, Grandma Dee and Big Dee are not only used as a symbol throughout the story but are shown as objects that the African American culture keeps in reserve because of the value the they contain (Whitsitt, 455). The quilts contain a historic value because of the creativeness that was put into making them. As Patricia Mainardi notes in Whitsitts article, many inhabitants of the African culture who make the quilts sign them and date them to show the high value they contain and also put a list in their will of who should inherit the quilts they make once they pass away (Whitsitt, 455). The quilts have a specific value and are treated with much care because of the strong culture they uphold. Throughout the story Mama and Maggie distinguish the quilts as more than just a piece of artwork, instead they see them as something to treasure in remembrance of loved ones. According to Whitsitts article, the quilt represents those values of things which do not circulate, do not wander, do not gel traded or sold but, rather, stay at home (Whitsitt, 454). They value them because the quilts remind them of their beloved relatives, such as Grandma Dee and Big Dee. The quilts portray a high value throughout the story and because of this high value Mama promises the quilt to Maggie for when she marries (Whitsitt, 455). Mama wants to give Maggie the quilts because of the history they each contain and because Mama wants the quilts to be utilized in everyday use. If the quilts were to be hung on the wall, like Dee wanted to do to preserve the African American heritage, then the true culture wouldnt be shown. On the other hand, if the quilt was put to everyday use, like Maggie would do with the quilt, then the African heritage would be shown and kept alive because it was being put to use. Mama wants to give Maggie the quilts for that reason. Mama knows Maggie will preserve the quilts and put them to everyday use to remember her ancestors and their families history and culture. Throughout the story the quilt not only shows symbolism and value but also helps in contrasting each character. According to the article by Susan Farrell, Dee is seen throughout the story as shallow, condescending, and manipulative, as well as, overly concerned with style, fashion, and aesthetics, and thus as lacking a true understanding of her heritage (Farrell, 179). Mama remembers Dee as a fearless girl who, unlike herself, would always look anyone in the eyes. Hesitation was not part of her nature (Farrell, 181). Dee is seen throughout the story as very different then Mama and Maggie because she is very selfish and demanding (Farrell, 181). Maggie, on the other hand, was the complete opposite of her sister. Maggie, throughout the story, was seen as the quiet and timid child with no characteristics that related to her sister. In Farrells article, she states that most readers see Mama and Maggie as having a true sense of heritage as opposed to Dees false or shallow understanding of the past (Farrell, 183). Mama and Maggie are seen throughout the story as wanting to cherish their heritage by keeping the quilts to use, as well as, to remember loved ones. Dee, on the other hand, sees the quilts as something that should be kept in reserve and to hang on the wall as a unique piece of artwork. Maggies moderation in the story contrasts with Dees courage (Farrell, 183). When Dee says that Maggie would ruin the quilts by putting them to everyday use, and that hanging the quilts would be the only way to preserve them, Maggie, like somebody used to never winning anything, or having anything reserved for her, meekly replies: She can have them, Mama, I can member Grandma Dee without the quilts(Farrell, 183-184). Once this occurs, Mama acts in a different manner than she has before. She sees Maggie standing with her hands hidden in her skirt and says: When I looked at her like that something hit me in the top of my head and ran down to the soles of my feet. Just like when Im in church and the spirit of God touches me and I get happy and shout (Farrell, 184). This powerful feeling causes Mama to do something she never had done before; she snatched the quilts out of Dees hands and dumped them into Maggies lap(Farrell, 184). This scene in the story is the only part where Mama acts differently than before. Instead of acting like the patient Maggie, Mama begins to act more like Dee, with her refusal to back down and her motivation to stand up for herself (Farrell, 184). The quilt in the story acts as a way to contrast the characters and show their different personalities. Throughout the story, the quilts symbolize and show the value of the African American culture, as well as, acting in a way to show the differences between the main characters in Everyday Use. The quilts play a major role in Everyday Use and are mentioned throughout the entire story. The quilts have an impact on each character throughout the story, and they help in contrasting each character and showing symbolism of the African American culture. The mentioning of the quilts display the importance of the African American heritage and the true value it has on Mama, Maggie, and Dee. Dee is shown wanting the quilts to just hang on the wall and show their unique culture from afar. In actuality, the quilt is shown as a symbol of the African American heritage and importance of remembering loved ones. The remembrance of Mamas ancestors will also be preserved forever with the use of the quilt in everyday life. The values of the quilts are shown as a way to remember the loved ones who helped in the making of them and also of Mamas ancestors. The quilts portray the unique cultural bond between Mamas ancestors and her heritage. The quilt binds Mamas ancestors and the value of her heritage together and shows the impact the quilt has on her, Maggie and Dee. The quilt brings out the diverse personalities of Mama, Maggie and Dee throughout the story and the different views they have on their heritage, as well as, the actions they each take. With the usage of the quilts, the distinction between each character is shown, as well as, the unique cultural symbolism throughout the entire story.