The Cottage Project
Redefinition of the Situation As a Treatment of Problem Drinkers
Prolog
The Use Of The Sociological Method to Change Behavior
Throughout the project, constant attention was given to adhering to the
rules of the sociological method (Durkheim, 1950). Particular care was
taken to avoid common pitfalls, such as misplacing the locus of the
problem at the level of the individuals who manifest it. In short, if
the unit explanation is social the rules of the sociological method
determine that the unit of intervention must also be social. That is,
the problem is in the situation; thus, situations, and not the
individuals, are the target of change. This definition of the situation
suggests treatment options, such as changing the problematic situation
for the benefit of the occupants or evacuating them and relocating them
to situations with less risk.
In this instance of intervention the definition of the social problem
has been medicalized. Lemert's (1974) comment directed to the HEW
Secretary's Report on Alcohol and Health, sums up the major part of the
medicalization process with regard to problem drinking.
"Aye, there's the rub; for whether 'tis better in the
mind to have a medical model of alcoholism and thereby gain Federal
bounty or to suffer other designs of thought closer to the facts of
inebriety is a core question... So be advised social scientists our
Federal fathers have decreed that alcoholism is a disease; we may now
reserve our time and energies for other questions." p. 246
Linked to the process of medicalization are a series of clinical
industries and bounty hunters which survive and even prosper by
suffering designs and definitions compatible with the medical model (Gusfield,
1989).
In a similar light, several authors (Galinski and Galinski, 1966,
Friedson 1961, Scheff, 1966) have commented on their explorations of the
organizational processes which result from treating a variety of
medicalized social problems. Street et. al.(1966) focus on the existence
of three distinct types of treatment which they found in different
centers treating a medicalized definition of delinquency. These
treatments varied from military style obedience models to
psychotherapeutic approaches. And each of these types defined the
problem of delinquency in the context of the services the treatment
facilities had to offer.
Starting the New Treatment Program
Because of the Center's research design, the staff were required to
participate in an orientation and training program to prepare them to
carry out their assignments when the Center opened for patients. While
the training presented the staff with a set of behavioral and
psychotherapeutic definitions of problem drinking, definitions of
drinking derived from AA dominated the discussion1s orientation. To
maintain a sense of harmony the trainers would pause from time to time
and carefully explained that the proposed treatment programs did not
conflict with the "AA approach."
In the middle of the orientation session, which was to last a month,
the staff were told that the first group of patients would arrive by the
end of the week. Training and orientation were suspended to get the
Center facilities ready to receive the first patients. All of the staff
pitched in and did everything from moving furniture to mopping floors to
cleaning the "johns." The emergency mobilization gave the staff morale a
boost and encouraged the formation of a group of friendship circles. As
promised thirty patients arrived late Friday afternoon and the treatment
started.
The Definition of Authority
Three weeks after the first patients arrived at the Center, the first of
a series of confrontations took place. During a group therapy session,
two patients demanded weekend passes from their counselor. Only then did
the administrative staff realize that the Center had not yet established
a policy for giving out passes. Ten senior staff members were summoned
by the director and were involved in "negotiations" with the group of
men demanding a pass. By now the size of the group had doubled.
Meanwhile, everyone else in the Center milled around and waited to see
what would come of the challenge. The patients set the stakes for the
negotiations by stating that if they did not get passes they would leave
the Center against medical advice (AMA). After several hours of
negotiation, a "decision" was reached. The staff proudly announced that
the men would be given a two day pass if they promised to return to the
Center. The challengers were jubilant. An action spawned of boredom had
produced a victory2. The organization had started down a slippery slope.
In all of their discussions, the administration had not looked at the
treatment center as an organization. Moreover, they had never examined
the limits of their authority. In particular, they ignored the potential
impact patients had upon the life of that organization, i.e., that
patients could play a role (Sykes, 1956) in the life and goals of the
institution (Etzioni, 1961). The frequent displays of patient authority
raised the question, since the inmates are going to run the asylum, why
not show them how to run it well?
Building a Social Program the first steps
On the campus of the treatment center there were two cottages which were
separated and remote from the main dormitory buildings and Center
facilities. Their proximity to the road made it possible for the
residents to slip away unnoticed and "elope" from the Center, which they
did with great frequency. For this reason, treatment staff tried to
avoid using the cottages to house their patients. Thus, the author's
request to have the men in his group stay in one of the cottages was
granted quickly. As soon as permission for exclusive use of the cottage
was obtained, a plan to set up the cottage as a self-governing community
commenced. Initially, the project was called a Co-Operant ward. But as
suitable as that name may have been, the program became known as the
Cottage project.
An Overview
Starting the change process included several activities which, though
described sequentially in this report, took place at the same time. The
Cottage, which served as the unit of intervention, could be described as
a staffed voluntary association. All of the definitions and
interventions3 were maintained at the collective level. Participation in
the cottage produced the social redefinition and relocation of the
residents to a new social life with new definitions of the situation.
A blue print established the Cottage as the vehicle for building a
set of definitions of the situation that would affix sign equipment to
the participants which would produce a reduction in problem drinking.
These new definitions were embedded in the events and social structure
and everyday life of the Cottage. The drafting of the cottage rules was
one of the methods used in this ongoing process. These rules4 were to
define a membership system/situation. A system producing the new
behavioral patterns and new lives were based on the newly formed
generalized other in the Cottage.
The Initial Round Of Changes
Both of the original therapeutic practices, behavioral and psycho
therapeutic, which were part of the Center research design were based on
the assumption that there were causal links between personal deficits
and drinking problems. Although in the process of building the Cottage
existing programs were radically restructured, in most cases the names
were not changed. The group therapy sessions5 are an example6. These
groups were changed and the talk of drinking problems which had
monopolized these meetings were replaced by matters of every day life
and Cottage activities. Most prominent of these were the new activities
in the Cottage and decisions regarding the rules and activities of the
Cottage. An additional "therapy" called Industrial therapy (IT) was
developed. Industrial Therapy included performance of a group of tasks
ranked according to successive increases in complexity, difficulty and
responsibility. The author's role shifted from therapist to consultant,
co-worker and sounding board.
Pump Priming and Role Taking
The development of the Cottage can be divided into three phases, startup
phase using "pump priming" techniques, the operational phase, and
expansion. To start the project there had to be something in place.
There had to be persons occupying positions which would permit the
learning of the membership system by modeling and or manifesting the new
definitions and lives. Pump priming was used to establish a beach head
in the Cottage. Four men from the group were selected by the author and
sold on the concept of the Cottage. They were then persuaded to move
into the Cottage and serve as the first members of the new Cottage
system.
Next, during informal meetings the four men were prepared by the
author to present the Cottage program to the rest of the group during a
series of open meetings which included all of the men in the group7. One
of the benefits of earned membership was residence in the Cottage. A
careful explanation of the rationale for placing these men in the
Cottage had to be explained so the four men could avoid being perceived
as the beneficiaries of favoritism. During their presentations, each of
the four men stated that they would be willing to trade places with a
man who would vote against the Cottage because he was not selected to be
one of the first four to live in the Cottage. They explained how pump
priming would work and added that during the next week they would be
meeting privately with anyone interested in being one of the first three
supervisors for the new Industrial Therapy program. After a week of
formal and informal discussions the group agreed by consensus, that the
four men should go ahead and establish a beach head in the Cottage. The
agreement took place in an open meeting which was to serve as the first
of the weekly Town meetings
During the first of these open meetings, later called Town meetings8,
the four men gave an overview of the Cottage and outlined the initial
committee structure and the requirements of membership. The group
decided to show support for the men who took the beachheads in several
ways. They visited the Cottage frequently and held as many meetings and
informal gatherings in the Cottage as possible. In addition, there was a
Town Meeting held once a week in the Cottage. The Cottage rapidly became
the center of the group's activities.
Membership
A system of rewards based on membership was built into the cottage.
Rewards and promotions came from two sources, committee work and the
Industrial Therapy program.
Establishing Initial Definitions and the Cottage Committee Structure9
Because everyone assigned to the group was involved in committee work
from the time he entered the Center some of the men in the group
jokingly referred to the Cottage program as "committee therapy." There
were two types of committees, standing committees and ad hoc committees.
Standing committees were led by officers elected by the community and
were part of the official Cottage structure. Ad hoc committees, on the
other hand, could be led by non-members. This gave new admissions to the
treatment center a chance to get involved in the leadership of the
program, show willingness and responsible behavior as soon as they
wanted to. All of the committees contributed to the maintenance and
growth of the Cottage process. More important, however, was the
increased intensity and depth of interpersonal relations.
The First Committee served as a prototype for all of the committees
which would follow. New committees were spun off from the First
Committee as that committee generated new functions. One of the most
important standing committees to spin off was the orientation committee.
Its formation will serve as an example of committee building. The
orientation committee was charged with:
1. Meeting new patients assigned to the group within
five minutes of their arrival at the treatment center.
2. Taking the new men on a tour of the Cottage
3. Giving each new man a copy of the Cottage rule book
4. Introducing each new man to the other men in the group.
5. The introduction of each man to the IT coordinator so they could be
given their first IT and committee assignment.
6. The orientation committee assisted the new person in the formal
admissions process at the Center and generally stuck to them during the
first three weeks10 of their stay in the treatment center.
To start up a committee, one or more of the members of the First
committee would recruit four men to serve as the core of the new
committee. Recruits were then given an initial outline of the
committee's tasks. Next they met with the First committee and the author
for training and technical assistance and to flesh out the initial
outline and develop a plan of action. Once a committee started to
operate, committee members could meet with the First Committee or the
author for consultation as frequently as needed. The leadership in the
Cottage made sure that there was equal opportunity for committee
assignments and prided themselves on discovering new leadership.
Industrial Therapy11
After the initial pump priming placements in the system each admission
was immediately assigned an entry level job by the industrial therapy
coordinator12 by the Work Advisor13 on a weekly basis. Work Advisors
gave their reports on workers to the line supervisor who then met with
the worker to review it, offer assistance and make the report a part of
the workers record. When a worker had demonstrated that he could handle
a task in a responsible way, he would receive a promotion to a more
responsible position with a higher rank.
Tasks ranged from cleaning tables or working in the kitchen14 to
supervision to administration. Each of the tasks was ranked based on
responsibility and difficulty and placed in categories called levels.
Most of the tasks in the program had at one time or another been
performed by the hospital staff and none of the tasks were make-work.
The inclusion of supervision in the system increased the range of skills
and promotions available. As a worker moved up from level to level he
could become a supervisor, then a manager and finally a coordinator.
Part-time jobs outside of the Center were also available. These jobs
were reserved for those who had reached the upper levels of the IT
program or had completed it.
To dramatize personal progress, a large board which contained all of the
positions in the system, their description, and the name of the current
occupant was placed in the Cottage. The board was maintained by the IT
coordinator and was often the site of promotion ceremonies during which
the man moved his name up to the new position. Often a round of applause
accompanied the moving of the name.
When the industrial therapy program was initiated, some of the men
assigned to the group complained that their group was the only one which
had to work15. Even though outside of the Cottage group few of the men
in the hospital were involved in industrial therapy, the process of
working and earning membership and social rewards appears to have been
able to hold the participant's commitment and redefine the situation.
Over time, the protests shifted to statements which reflected their
pride and the belief that they were benefiting from the work program.
They were replaced by statements such as, "You don't get anything
worthwhile unless you work for it." Then, when patients outside the
Cottage group occasionally made fun of the Cottage men because they "had
to" work, the men in the Cottage laughed it off and called them "bums"
and "freeloaders." The most frequent criticism of the men in the Cottage
was that they were a bunch of big shots. These criticisms often came
from staff members who were skeptical of the men, their behavior, and
their rise to power in the patient community as well as the treatment
center. Critics claimed that these men, because of their assertiveness
and social skills, did not act like "real" alcoholics. Other critics
complained that the author was trying to build an empire.
Industrial Therapy Coordinator
Coordination of the IT program was the task of the Industrial Therapy
Coordinator. He had one of the top three positions on the Cottage
organizational chart and was initially filled by one of the men who were
the first group residents in the Cottage. Subsequent coordinators were
elected by the cottage members only after they had earned eligibility.
The occupant of this position was also one of the policy-makers, and set
up committees. The coordinator was frequently involved in program
development and planning with the author and other professional staff
members at the Center. One graduate of this position parlayed his
experience and skills from the job into a successful application to a
graduate school in social work.
Becoming a Member, an evolving process
The process for becoming a member and the criteria both evolved.
Application for membership in the Cottage was initiated by the
prospective members submission of a petition to the membership committee
with the signatures of at least two sponsors. As there was no limit to
the number who could sign as a sponsor, some of the more enterprising
applicants collected all of the signatures they could including those of
staff members. This process had the unexpected effect of providing the
men with clear evidence of the community and its support. Because of the
search for sponsors, it often became common knowledge throughout the
treatment center when a man was up for membership. That knowledge
produced unsolicited support. The author even received several calls
from staff who had nothing to do with the Cottage wishing to put a good
word in for a man who was coming up for membership. All of this material
became part of the applicant's file.
Conditional Membership
After the petition was submitted, it was reviewed by the membership
committee which evaluated it in the context of the applicants progress
and contributions in the Cottage program. In the committee, a decision
to accept or reject the application was made. Conditional membership
began when an applicant did not qualify for membership and the committee
wanted to avoid rejecting the application. This was based on the premise
that failure would interfere with learning. The committee never did
reject an applicant. After a lengthy discussion a resolution was
reached. The committee decided to grant a conditional membership with a
list of conditions to be met by a specified date and reviewed by the
committee. This decision was based on the belief that this practice
would be more consistent with the goals of the cottage than outright
rejection.
Use of a conditional membership worked so well the first time that it
replaced the initial practice. Providing conditions and scheduling a
follow up meeting with the applicant became the new practice. Many of
the most effective rules and policies which defined the social structure
of the Cottage were developed as a result of the process of the group
solving the everyday problems which confronted it. Progress brought
progress and the more that was accomplished the more visible the next
steps for programming16 became. Sometimes the new ideas seemed to force
themselves on the Cottage program.
One of the more interesting examples of improvised program was the log
book. Each time a man left the hospital grounds he signed out, giving
his destination and expected time of return. When he returned to the
cottage he was to be signed in by a fellow resident. Use of the log book
was started as a method of monitoring men on pass privileges. This
modification of the buddy system was intended to help a man demonstrate
how well he could carry out his own day-by-day plans and commitments.
The log book also emphasized the group's responsibility for greeting the
returning member and sharing his experiences, good or bad. But, as the
activities in the Cottage expanded and the number of the men involved
increased, the log served as a way to keep track of their numerous
activities. The cottage eventually had a position of receptionist who
answered the phone and used the log book to keep track of each member's
whereabouts and when he would return. A place for messages was added and
the Log became an on going record of the members activities.
Norm Shaping
There were major additions and modifications to the program were
continuous. The group shaping project which is described below captures
an important component of that growth. Soon after the start of the
treatment program at the Center, it became clear that staff had little
control over the patients' behavior. This was particularly true of
patient drinking. At night and on weekends when the program staff were
gone, drinking was frequent17occurance. After all, they had brought
their drinking problems to the Center for the staff to treat. On the
other hand, the staff wanted the patients to take responsibility for
their drinking. Reporting any drinking incidents which they saw at the
Center was, in the view of the staff, a minimal sign of commitment to
sobriety. From the patients point of view reporting the drinking of
other patients was considered "ratting" on a fellow patient. And
"ratting" was taboo. It was widely believed by the staff that they could
not change this situation because non-reporting was part of the denial
process the staff believed to be typical of alcoholics. Thus, the
"ratting" norm was a crucial test for the use of intervention at the
social level to change a social or collective action.
The goal was to reverse the ratting norm. This goal would be considered
as having been achieved when the new definition of the situation was
made an integral part of the Cottage system by consensus. Modeling and
role structuring were used in conjunction with the norm shaping
process18
The initial group behavior analysis produced a range of positions
regarding the members willingness to report drinking. The lowest point
was refusal to become involved and ignore drinking on the grounds. The
following is a condensed partial hierarchy of behavior used in the
shaping:
1. Admitting that patients drink in the hospital.
2. Willingness to confront a member of his group who he sees drinking.
3. Willingness to ask a member of his group who he sees drinking to
report himself to the group.
4. Asking a member of his group to report himself to the cottage
chairman.
5. Reporting a man who he sees drinking to the Cottage chairman if the
man refuses to report himself
A group of men who were high on the shaping hierarchy were selected as
models. Throughout the shaping process, they were maintained at least
four steps above the current consensus point in the group. Whenever
difficulty was encountered reaching a step, that step was divided into
sub-steps. Each step was discussed until consensus was reached. Once
reached, the consensus was reinforced by the core group and the group
members' affirmation of solidarity.
Discussions of the steps were a major topic on informal discussions.
Those in the group who moved up a step on the hierarchy were positively
reinforced by the group as a result of their change: on occasion, there
was a Cottage wide celebration for having reached a new consensus point.
Pizza was often the prize. It should be noted that the non professional
staff provided major perks for the Cottage.
Collective shaping culminated in the Cottage members redefining
"ratting." A new definition of the situation replaced the original one.
The new definition specified that the person who let a fellow cottage
member drink and ruin his chances for recovery was the "rat." The group
wrote clear and effective rules and took pride in being the first group
in the hospital to face the matter squarely.
The New Focus of the Daily Group Sessions
Discussion of problems with children, sex, dating, and other areas such
as IT progress started to dominate the group "therapy" sessions. The
process of solving the problems of everyday activities of cottage life
learning and skills that were easily transferred to solving the personal
problems of everyday life. The men in the Cottage requested group
meetings in addition to the six hours of staff-led group sessions
scheduled each week. These additional sessions were small informal
discussions which took place in the evening and were dubbed Bull session
therapy. They were so successful that staff and patients who were not
connected with the Cottage program dropped in to the Cottage to listen
and participate. Such sessions would not have worked so well had the
problem solving committees not been so well run by the members and
trained them to work independently
The Expansion Phase
Social Activities
During a field trip to a mall, the social activities committee was
started. On the way back to the Center, the men in the van decided that
there ought to be regular field trips. When they returned to the Center
an ad hoc committee was assigned to setup and organize future trips.
After a few recreational trips to nearby malls to shop and see films, a
group of the men asked if they could visit one of the other local
alcohol treatment centers in the general area. Arrangements for a visit
to another treatment center were made by an ad hoc committee; that visit
lasted a day. By the end of the visit, the group members had invited the
patients at the host hospital to visit their Cottage. The Cottage of
which they were so proud had been the major topic of numerous
conversations19 during the visit.
All of the planning for the activities for the return
visit hosted by the Cottage, including a quest speaker, was done by the
men through the committee structure. They did an impressive job. All of
the visitors assumed that the day's activities had been planned by staff
at the treatment center. When that assumption was voiced, the men were
even more proud and quickly let it be known that they had done all of
the planning and made all of the arrangements. The only flaw in the
program was the failure to invite the director of the Center to the
occasion.
This visit was so successful the Cottage membership
developed an exchange program which included additional local treatment
programs. The original reason for the visits to the other treatment
centers was to develop social situations which included women. Some of
the men said that they needed these contacts to learn how to interact
with women. However, the social activities of the cottage grew well
beyond the goal of meeting women. At each of the visits on their side of
the exchange the members of the Cottage developed a series of workshops.
These workshops were modified and became the basis for day-long
workshops to which the families and friends of the men in the cottage
were invited. These programs took place on the weekends and marked a new
dimension to the Cottage program.
Weekend Programs
Several of the members of the Cottage raised a set of valid complaints
about the absence of activities on the weekend. From Friday afternoon to
Monday morning there was no program staff on the grounds and the
patients were left to fend for themselves. Not surprisingly, weekends
were also the times when most of the patients eloped from the Center20.
Every Monday morning the staff met to go over the incident reports and
attempt to retrieve the patients who had eloped during the weekend. A
Cottage Town Meeting was devoted to a discussion of the absence of
programs on the weekend. Some of the men asked why when life was seven
days a week the program was only five days a week. The Cottage members
agreed that the weekends were not only wasted time but that they were
dangerous because so many men eloped. At the Town Meeting the men
concluded that the major reason for the elopements was the absence of
activity on the weekends. And as could be expected an committee was set
up. At the end of the Town meeting the Cottage members assigned an ad
hoc committee to work out a solution to the problem. It was the Cottage
way.
The weekend committee decided that if they could set up
a workshop program for visitors, complete with guest speakers, they
could set up a weekend, program for themselves. From then on the cottage
ran a weekend program three times a month. After the second successful
weekend the members of the cottage decided to open the weekend program
to everyone in the hospital. This was not much of a change as by now the
Cottage group had grown to the largest group in the Center. Also because
the weekends were dead most of those who were on the campus showed up at
the program anyway.
The weekend programs were an example of the learning going on in the
Cottage. They were also a clear indicator that the Cottage had
dramatically redefined the definition of the situation. As new people
entered the treatment Center and were assigned to the group (group 7)
they were quickly and smoothly integrated into the cottage program. It
was also clear that the Cottage members had changed the hospital. They
had formed very solid relationships with the weekend and non
professional staff. As a result the Cottage always had the newest and
best facilities on the campus. This included TV's, refrigerators,
mattresses, left over food, and such.
The Cottage II
One of the treatment centers which participated in the exchange program
was a local halfway house. The half way house had recently moved to a
new and much larger facility and was in the process of reorganizing its
program and recruiting residents. The exchange program developed by the
men in the cottage dove tailed into the halfway house outreach program.
The first group of men be discharged from the Center and go to the
halfway house were the four men who were the first to move into the
Cottage. Once they were in the halfway house they worked with the staff
of the half way house to develop some of the
Cottage at the halfway house.
The staff at the Halfway house encouraged their activity because they
had seen the Cottage as a result of the exchange visits set up by the
Cottage government. In addition the exchange program among the treatment
programs in the area had spread. The Half Way House used them as a means
of recruitment and evaluation of the perspective patients. While the
Halfway House took patients from all of the area facilities the presence
of the men from the Cottage had created a career path. Now most of the
men in the Cottage saw the Half Way house as the next step in their
plan.
Exodus The Dismantling of The Cottage
When the activities of the Cottage project became known throughout the
Center a barrage of complaints and protest arose. The administration was
alerted by protests of the other counselors who complained that they had
too few men in their groups. There were eight groups and the Center had
a capacity of 100. At the time the complaints began the size of the
Cottage group was 38 and the total population of the Center was 61.
Everyone associated with the Cottage was
attacked21occasionally members of other groups physically attacked
members of the Cottage. Some the professional staff complained that the
men in the Cottage group were not "real alcoholics" and should be
discharged. Another group of staff members led by recovering persons
started to insist that the author publicly renounce his position that
alcoholism was not a disease or resign.
The impact of the Cottage did appear to threaten the
Center program. Some the groups had as few as 3 or 4 patients a
condition which did make group therapy difficult. The staff leaders of
those groups convinced the director of the Center that it was not fair
to let Group 8 have so many men.
Several solutions to the problem posed by the Cottage
surfaced and were considered during a series of semi clandestine
meetings which took place between the Center counseling staff and the
Director. One was the random reassignment of all of the men into the
eight groups so that all of the groups would be of equal size. The
initial step was to close down new admissions to the Cottage group. When
the members of the Cottage learned of the meetings and the plans through
the Center grapevine22 they were incensed. They drew up petitions and
pressured the director of the Center to meet with them. In their meeting
with the Director, he denied23 the existence of the meetings he had held
with staff and the plan to break up the group by reassigning the men. He
gave his word that nothing would be done for at least a month, although
intake to the group was stopped. During a series of marathon meetings
held over the weekend, the members of the cottage decided to use that
time to transfer en mass to the Halfway house which was being made over
in the image of the Cottage.
During the month of the exodus, problems with the census
and what to do about it occupied the attention of the Center staff. The
Director's word and the plans did not matter as the institution was soon
plunged into the throes of discovering a new mission. The Director had
visited Daytop Village where he had undergone a conversion experience.
That program had such an impact on him that it was rumored that he had
even considered turning in his medical license. All of the Center staff
were required to participate in a series of marathon encounter sessions.
As a result for a period of several weeks most of the professional
activities were suspended and the staff wandered around trying to find
themselves. During this upheaval the Cottage was ignored and carried out
the exodus to the halfway house with success. There they continued the
Cottage project.
After a time the staff of the Center returned to normalcy. There were
new rules regarding the Cottage. They had decided that the Cottage
represented a modification of the research design upon the Center was
based. As all new therapies had to be approved by the administration the
author was asked to submit a proposal for the Cottage. The
administration took three weeks to review the proposal. They decided
that the program as proposed showed promise. However, despite the
interesting philosophy they knew that the program would not work. They
thanked the author for sharing the interesting philosophy with them. The
proposal to the committee was modified and subsequently published.
The turmoil among the professional staff at the Center
had provided the Cottage membership with time enough to move the Cottage
members to the Halfway House. It was suggested that some of the
maintenance staff had helped with the move and the Half Way house had
more TV's than they could account for.
References
Blane, H.T., Overton, W.F. and Chafetz, M.E.
1963 "Social Factors in the Diagnosis of Alcoholism." Quarterly Journal
of Studies on Alcohol: 24.
Coch and French, "Overcoming Resistance to Change," in Group
1953 Dynamics, C. Cartwright and A. Zander, Eds., 1953, pp. 287-301.
Clark, Burton Adult Education in Transition University of 1956
California Press.
Durkheim, Emile
1950 Rules of Sociological Method. Translated by Solvay and Mueller,
Glencoe:
FreePress.pp. 65-73
Etzioni, Amatai A Comparative Analysis of Complex Organizations
1961 Free Press of Glencoe,Inc. New York.
Galinski Maeda J. and Galinski, M. David "Organization of
1967 Patients and Staff in Three Types of Mental Hospitals," in E.J.
Thomas, Ed., Behavioral Science for Social Workers, Free Press, New
York: .
Gusfield,
King, S.H. Perceptions of Illness and Medical Practice (New 1962 York:
Russell Sage Foundation, ).
Lemert, Edwin
1975 "Review of Alcohol and Health: Report from the
Secretary of H.E.W." In Contemporary Sociology, p. 246
.
Litwak, Eugene "The School-Community Manual" (Ann Arbor: University of
Michigan School of 1966 Social Work, chap. 8. (Mimeographed.)
Litwak, E. "Organizations Which Permit Conflict," University of
Michigan, mimeo.
1966
Litwak E. and Meyer, H. "The Balance Theory," in E.J. Thomas,
1967 Ed., Behavioral Science for Social Workers, Free Press, New York.
Rutledge et al.
1974 "A Socio-Epidemiological Study of Alcoholism in East Baton Rouge
Parish." Louisiana Division of Mental Health and Social Rehabilitation.
Scheff, Thomas
1965 "Typification in the Diagnostic Practices of Rehabilitation
Agencies." In Sussman (Ed). Sociology and Rehabilitation. American
Sociological Association.
Street, D. Vinter R. and Perrow, C. Organization for
1966 Treatment, Free Press, New York: pp. 21-22.
Sykes, Cresham The Corruption of Authority and Rehabilitation
1956 Social Forces, December pp. 257-62.
Szasz, T.S.
1967 "Alcoholism: A Socio-Medical Perspective." Washburn Law Journal: 6.
Thomas, C.H. "Use of Real Life Models for The Treatment of People with
Drinking Problems." 1968 Unpublished paper presented at the Seminar on
Social Pathology, Temple University, Philadelphia, Pa., May
Thomas, C.H. "A Socio-Behavioral Approach to the Treatment of
Hospitalized Alcoholics" 1969 in Human Services and Social Work
Responsibility," W.W. Richan (ed)., National Association of Social
Workers.
Thomas, Edwin J. Behavioral Science for Social Workers (New York: Free
Press, ), p. 62.
1968
Notes
1. At least half of the line treatment staff at the Center, called counselors, were recovering persons continuing their recovery through AA. They qualified for the job by having a long period of sobriety and their work with AA.
2. All four of the men left on passes. Three returned.
3.This mechanism was modified from Litwak's series of linking mechanisms. These were originally used to coordinate the social distance between a formal organization and a community group. They are pieces of social structure which can be used to change the social dimensions and definition of a situation. Eugene Litwak, "The School-Community Manual" (Ann Arbor: University of Michigan School of Social Work, 1966), chap. 8. (Mimeographed.)
4. All decisions were made by consensus to emphasize the collective nature of the intervention.
5. Despite comments to the contrary the men in the program insisted that every thing in the program be called therapy. They would refer to Cottage therapy.
6. The format of the behavioral group sessions was originally structured as a class. Each of the participants was issued a manual which was designed to provide them with a basic understanding of behavior modification and how to use it to control their drinking. However, this process worked poorly as new admissions would arrive in the middle of the book, e.g. chapter 6 and would not be able to follow the lessons because they did not have the foundation of the earlier chapters. The manual fell into disuse several months after the Center opened.
7. These meetings were modeled after the New England Town meetings and everyone had a chance to speak their piece.
8. After this decision it was decided that the Town Meeting format would be the format for all decisions which effected the group.
9. The committee structure was the easiest way to dramatize the new definition of the situation and permit it to be personified.
10. This time period was selected intentionally as most of those who eloped or left AMA did so during the first two weeks of their stay in the program.
11. All activities had to be called therapy to be respected and part of the daily schedule.
12. This position was held by a patient who had worked his way up through promotions resulting from responsible work performance.
13. These people were members of the treatment center staff, e.g. kitchen staff, hospital engineer, and the like.
14. The work done by the patients made the task of the center employees much easier. It very likely saved the Center money as the men were not paid. There is the possibility that in some ways the men were exploited. However, a formal contract with pay may have made the program impossible. The work the men did was, however, not without reward. Huge amounts of food appeared in the cottage without explanation. And the cottage was given a new paint job by the maintenance staff. A refrigerator appeared and nothing that a member of the group needed was ignored. Each room had its own TV and the lounge was refurbished and a color TV added.
15. None of the many programs at the center were mandatory. A patient could leave any time he wanted to. Many men did this on a regular basis. The programs in the Cottage were also not mandatory. However, they were the only ones which were managed by the patients and gave rewards.
16. This process, while it has been replicated several times, is thwarted by the traditional proposal process.
17. It is curious that most treatment programs operate from nine to five and during the week when the patients' whose problems they sought to treat came from drinking which occurred from drinking after work and on weekends. Thus, the typical treatment schedule deserted the patient when they faced the most difficulty.
18. Modeling is what is involved when a person takes on the attributes of another - imitation is a form of modeling. It is a form of interpersonal influence. Role structuring is the process of rearranging the structure of the expectations related to the position a person holds (e.g., teacher-pupil) along various dimensions, e.g., time, context, strength, and so on.
19. The men often talked at length about the Cottage way. The Cottage way was how things were to be done in the Cottage. The Cottage way was extended to a variety of problems which existed in every day life. It was not unusual for a man to say that he had solved a problem using the Cottage way. Anyone, who asked what that meant would receive a lengthy explanation.
20. During an eleven mouth period while the Cottage project was in operation not one of the men left the program by eloping or AMA. The lose rates of the other groups was two or three a week. This resulted in the number of men in the cottage continuing to grow until they comprised more than 50% of the total population of the center. When the group size reached 38, the center stopped assigning men to it.
21. Once the issue was raised the staff found that the Cottage members were almost running the Center. They put out the major part of the Center newsletter, they had all of the part time jobs in the community. What was even more frustrating was the fact that they did not drink, elope, or return late from their passes.
22. As with most institutions there is an effective flow of informal information. In this case most of the patients knew of the policies and major decisions before they became official. Their were occasions that the staff in an effort to keep up responded to the grapevine and by passed the formal system.
23. His denial was ill advised. The men were ready to state the dates and who was at the meetings. The denial made them angrier and increased their resolve.
