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The
Community
Psychologist

Volume 48 Number 4 
Fall 2015

Self Help and Mutual Support

Edited by Greg Townley and Alicia Lucksted

Impressions of Clubs of Treated Alcoholics in Post-socialist Zagreb, Croatia

Written by Thomasina Borkman (tborkman@gmu.edu), Professor of Sociology Emerita, George Mason University, Fairfax, VA; Affiliate scientist, Alcohol Research Group, Emeryville, CA

In the spring of 2012 I visited Croatia for two weeks at the invitation of sociologist Ann Dill from Brown University who had a Fulbright fellowship to continue her research on Croatian human service agencies.  Ann introduced me to many mutual help groups and their professional supporters whom she had known from her decades of research. The focus of this report will be on the Clubs of Treated Alcoholics; these are after-care programs sanctioned by the professionals in charge of government-based hospital alcoholism treatment programs.

Post-Socialist context of health and human services in Croatia. Croatia in the last 20 years has fought a war of independence and become a democratic and capitalistic nation, a member of the European Union.  Some mutual help groups were developed in and after the 1970s, but they were primarily under the aegis of professionals in governmentally based agencies.  Dill and Coury (2008) showed that both these older mutual help groups and newer ones for contemporary problems remain dependent upon the state and that few exist except as legally incorporated NGOs or nonprofit organizations.  Dill and Coury (2008) used Gidron and Chesler’s (1994, p.3) definition of mutual help which had been devised for international analysis as “the recruitment and mobilization of peers in an informal and non-hierarchical setting, and the sharing of their common experiences.”  This definition leaves open the issue of group autonomy.  Dill and Coury (2008, p.250) contend “that bracketing the question of group autonomy is essential when working in settings where there has been little independence of action beyond structures provided or condoned by the state.”  The Croatian case is important as an exemplar of how the governmental, economic and cultural context of a country affects the kinds and characteristics of mutual help groups that can develop (Dill & Coury 2008).

Methods: Research on the Clubs of Treated Alcoholics included: interviewing two psychiatrists at their hospital offices in Zagreb including Dr. Torres, the director of the Clubs; attending a yearly conference about the Clubs which had slides and/or talks in English about their activities in Croatia; interviewing in English in some depth a social worker, Ana M., who was a paid facilitator of two Clubs in Zagreb; and, briefly interviewing two long term members of a Club. This report conveys some initial impressions of a traveler who specializes in mutual help research (see Borkman 1999). Observing as an outsider not knowing the language, I was reliant on their speaking English or having a translator. My guide and colleague Ann Dill was invaluable in interpreting as well as providing context for what I was learning.

Clubs of Treated Alcoholics in Zagreb: American researchers of mutual help groups were probably introduced to Croatian Clubs of Treated Alcoholics (CTAs) in Humphrey’s extensive overview of addiction groups in Circles of Recovery (2004). Humphrey raises the issue: Are they really mutual help groups or are they professionally operated support groups? He defines mutual help organizations as having seven universal features: members share a problem or status, self-directed leadership, experiential knowledge, reciprocal helping, lack of fees, voluntary association, and include some personal change goals (Humphreys 2004, p. 14).  Like Dill and Coury, he noted that in socialist countries full group autonomy of mutual help is unlikely and cites research showing a wide spectrum of professionals operating CTAs—from peer led mutual help to professional treatment and gradations between these extremes (p. 59). 

I did learn several things about the current situation of CTAs in Zagreb.  The initiator of the Clubs, Dr. Hudolin defined alcoholism as a “chronic disease” and a “social disturbance” and established the Clubs in 1964 as a form of after care in order to foster long term abstinence (Humphreys 2004); this is in sharp contrast with addiction physicians and medical researchers in the US who have only recently begun to consider alcoholism and drug addiction as chronic diseases (Whyte, et al. 2002). “Treated alcoholics” refers to individuals who have been through professional alcoholism treatment in a hospital.  “Clubs” need to be legally registered non-governmental organizations (NGOs); to acquire the NGO status, Croatia now requires professional leadership (Dill 2014). The Clubs are composed of individuals with alcoholism and their families including young children; family members are also expected to abstain from alcohol. 

Historically, the Clubs were designed to have a professional facilitator operate them; this continues today.  Interestingly, each Club selects, hires, and contracts with the professional who will be their “expert help” (Ana 2012), and Clubs can choose to rehire a facilitator or not. One club failed to hire “expert help” one year—they behaved like a member-owned self-help group by year’s end (Ana 2012). In Zagreb the individual Clubs are organized into a federation of Clubs referred to as the Union which is also an NGO with officers. Each individual Club has officers (i.e., President, Vice-President, and Secretary) and elects someone (often an officer) to represent them at the Union level. Funding from the city of Zagreb pays for the professional “expert help,” among other things. Now the Union applies for funding on behalf of all local Clubs; this has increased the control of the Union over individual Clubs.

The role of the professional in the Clubs: The social worker Ana has a contract with two Clubs. These are part time jobs while she works on a doctoral degree in social work and social policy at the University of Zagreb. She said the professional staff were called “expert workers,”  “professional workers,” or “therapists.” Professional workers are required to have an initial sensitization training of four modules.  She went through the first module, but was excused from the others since she had learned the material in her basic social work training in college. She considers her role to be that of a non-directive facilitator; “We provide topics to enhance the discussion; we provide ways of them thinking about themselves and what they are doing” (Ana 2012). She indicated that professional workers varied with some being more directive than others—e.g., some phone or visit members who miss Club meetings; “they force discipline upon the members.”

When asked about members helping each other (i.e., mutual aid), the professional worker said the members are always helping each other, but then she referred to members abstinent for five or more years as being special helpers.  It was ambiguous as to whether that referred primarily or only to taking special positions such as being an officer of a Club, or also to helping other members in special ways (such as sponsor).  Golik-Gruber and others (2001) described a study of CTAs in Croatia among 117 “treated alcoholics”; some with 10 years plus abstinence help the community when alcohol related disturbances occur and some receive additional education to be “co-professional workers—amateur therapists.”

Analysis:  Are Clubs of Treated Alcoholics mutual help organizations or support groups with professional facilitators? If Humphrey’s definition is used which is similar to definitions of other American researchers (see Borkman 1999, Katz 1981), then they are support organizations with professional facilitators as there is no member-directed leadership. If Gidron and Chesler’s definition of mutual help organization which Dill and Coury (2008) use is followed, then CTAs could be mutual help organizations. Given the contested definitions and the ambiguity in different societal environments, perhaps we need to be asking different questions. We need to shift our approach from defining groups in simple dichotomies.  Instead, consider these groups on a continuum—look at how and under what conditions mutual aid and other outcomes occur in groups owned and controlled in various configurations (as was also suggested by Shepherd and colleagues [1999]).  Further, the professional’s orientation to the mutual aid paradigm of helping—(the self-help supporter [Oka and Borkman 2011] versus the traditional professional) needs to be considered. Reorient research to compare groups with similar focal problems but different ownership/leadership to see empirically what kinds of results can be obtained with different organizational structures. It is likely that all forms of “support groups” can and do provide some social and emotional support, but what differences, if any, are there in the amount and kinds of support in different types of groups?  Beyond support, however, how much of what kinds of mutual aid, advocacy and individual and collective empowerment can develop in various types of groups?  Further, what, if any, kinds of major changes such as change of meaning perspective (Borkman 1999) or identity transformation can evolve without group autonomy?

References

Ana M.  (Miljenovic).  (2012, May 27).  Interview at Conference of Treated Alcoholics, at Grand Hotel Adriatic in Opatija, Croatia.

Borkman, T. (1999). Understanding self-help/mutual aid: Experiential learning in the commons. New Brunswick, NJ: Rutgers University Press.

Dill, A. (2014). Health care and disability NGOs in Croatia: State relations, privatization, and professionalism in an emerging field. Voluntas 25:1192-1213. DOI 10.1007/s11266-014-9440-7.

Dill, A., & Coury, J. (2008). Forging a new commons: Self-Help Associations in Slovenia & Croatia.  In Susan M. Chambre and Melinda Goldner (Eds). Patients, Consumer and Civil Society, Vol. 10 in Advances in Medical Sociology (Vol. 10, pp.247-271). Bingley, UK: Emerald Group.

Gidron, B., & Chesler, M. (1994). Universal and particular attributes of self-help: A framework for international and intranational analysis. Prevention in Human Services, 11(1), 1-44.

Golik-Gruber, V., Thaller, V., Breitenfeld, D., Gruber, E.N., & Potkonjak, J. (2001). Characteristics of long-term abstinents in Clubs of Treated Alcoholics and the importance of Clubs in Treatment of Alcoholics. Alcoholism—Journal of Alcoholism and Related Addictions 37(2), 79-96.

Humphreys, K. (2004). Circles of Recovery: Self-Help Organizations for Addictions. Cambridge, UK: Cambridge University Press.

Katz, A. H. (1981). Self-help and mutual aid: an emerging social movement? Annual Review of Sociology, 7, 129-155.

Oka, T., and Borkman, T. (2011).  Self-help groups, self-help supporters, and social work: A theoretical discussion with some case illustrations of family survivors of suicide in Japan. Studies on Social Work, 37(3), 168-183.   (In Japanese).

Shepherd, M.D., Schoenberg, M., Slavich, S., Wituk, S., Warren, M., &Meissen, G. (1999). Continuum of professional involvement in self-help groups. Journal of Community Psychology, 27(1), 39-53.

Whyte, W., Boyle, M. & Loveland, D. (2002). Alcoholism/addiction as a chronic disease: From rhetoric to clinical reality. Alcoholism Treatment Quarterly, 20(3/4), 107-130.

Posted by aaron.mclaughlin09@gmail.com on
I would really be interested in knowing if there are similar articles regarding structure and efficacy of mutual help groups in post-Socialist nations outside of Croatia, including but not limited to the treatment of alcoholism among individuals in a community. Thank you for writing this article and citing several references below. Very helpful.
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