216 Book Review

described and the point made that this is not ‘counselling’ but a form of crisis intervention providing a framework for the individuals to express their emotions in a safe environment with their colleagues, to understand their reactions to the event, and to identify future actions. This is aimed at decreasing the likelihood of longer term psychological disturbances.

One chapter focuses on therapeutic intervention with individuals who are suffering from post-traumatic stress disorder. A variety of techniques are described and the use of medication discussed. The last chapter is a careful evaluation of the effect of helping on the helper and makes the point that support for staff should be included in the planning and setting up of disaster services.

This book is a valuable reference text based on well researched and well organized material, but it is also a book about ordinary people who suffer as a result of being in the wrong place at the wrong time. The verbatim passages provide an unforgettable account of their experiences.

ELSA SCHMIDT Psycho log,), Depur tnzen t ,

Bath Mentul Health Cure N H S Trust

McCrady, B. S. & Miller, W. R. (Eds) (1993). Research on Alcoholics Anonymous: Opportunities und Alternutives, New Brunswick, NJ, Rutgers Center of Alcohol Studies. Pp x + 430. $29.95 paperback. ISBN 91 1290-24-9.

As a mutual help organization that was started by two alcoholics in 1935 and now has 1.7 million members in 170 countries, Alcoholics Anonymous (AA) has justly commanded con- siderable attention from social scientists. Building on a conference that they organized on AA, Barbara McCrady and William Miller have assembled recent efforts to conduct research on AA in a volume that should be viewed as essential reading for self-help group researchers. Among the topics covered are how to measure and understand AA spirituality, the sociological context of AA research, women and racial and ethnic minorities in AA, and the question of whether professionals can or should match clients to AA. Although none of the 21 chapters is without interest, for the sake of brevity 1 comment only on the highlights of this volume.

The book opens with a fascinating chapter by Ernest Kurtz on the history of AA research. Kurtz traces an alarming tendency for some AA researchers to fail to show respect for AA by either not taking the time to understand the organization before commenting on it, or citing AA research inaccurately to put the organization in a bad light. As alcoholism researchers have been more vigilant in monitoring researchers’ biases in favour of AA, Kurtz’s careful documentation of biases against it is an important contribution.

Given the recent turn of AA research towards quantitative methods, Chad Emrick and colleagues’ meta-analysis of the predictors and consequences of AA affiliation is likely to garner much attention. The results suggest modest benefits of AA in psychological functioning and drinking related outcomes. Emrick and his co-authors deserve praise for their statistical acumen and for assembling a treasure-trove of AA references, but one wishes they had spent more time considering whether AA studies done 20 years ago could be compared with studies of the much-changed AA of today, or whether studies of AA in professional treatment agencies are really studies of AA proper. (The latter criticism could be leveled at many of the chapters in the volume.)

Greater sensitivity to the variation across and within AA groups is shown in the chapters of Joseph Nowinski, Robin Room, and Klaus Makela. Nowinski correctly points out that contrary to the view that AA is authoritarian and dogmatic, the organization actually gives enormous latitude for individual members and groups to define their roles and activities. In a chapter whose perceptiveness and subtlety defy brief summation, Room goes further by pointing out that AA is noteworthy for its ability to confound the iron rule of oligarchy despite tremendous expansion. Makela provides fascinating cross-cultural data on AA, show- ing that virtually every generalization one hears about the organitation (e.g. its members are largely male, middle-class, middle-aged, etc.) can be contradicted simply by looking beyond American borders. He also describes variations in how meetings are conducted and in how strongly AA is influenced by Christianity in various cultural contexts. Taken together, these

Book Review 2 17

three chapters suggest that researchers should exercise more caution in making generalizations about such a diverse organization.

A number of chapters address themselves to how change in AA can be conceptualized and measured. In an intriguing contribution, DiClemente puts AA recovery in the context of his transtheoretical theory of change, although his analysis does not give spirituality as prominent a role as it deserves. This later task is more seriously engaged in chapters by Stephanie Brown, Richard Gorsuch, and James Fowler. Through qualitative analysis of inter- views, Fowler demonstrates how AA members progress through various stages of faith as specified by his faith development theory. Along with the Brown and DiClemente chapters, Fowler’s work is a refreshing application of a coherent framework to an area where atheoretical research has been too frequent.

Frederick Glaser concludes the book by discussing the possibility of matching alcoholics to AA. He cogently argues for a referral policy of suggesting all clients try AA but none be forced to, and he also offers helpful comments on the empirical challenges of designing AA matching studies. Yet it is disappointing that neither Glaser nor any other advocate of AA matching seems sensitive to the moral question of whether helping professionals have the right to exert control via matching over a successful, independent voluntary association such as AA. Sixty years ago, helping professionals collectively threw up their hands and said that alcoholics could not be helped, and AA proved them wrong. For clinicians and researchers now to arrogate the right to make judgements over who should go to AA seems an act of hubris.

As editors, McCrady and Miller deserve praise for their choice of contributors. One of the strengths of self-help research is its interdisciplinary history, and this is respected by chapters from historians, sociologists, theologians, and psychologists. The inclusion of researchers from Canada and Europe is also commendable. However, no generalist self-help researchers were included, an unfortunate continuation of the separation of research and ideas on AA and the growing literature on mutual help groups that are not based on the 12 steps and d o not take alcohol as a focus.

My only major criticism of the book is that the editors could have done more to clarify the controversies of AA research by asking individual authors to respond to each other, as directly contradictory views are expressed across chapters. For example, Moos and col- leagues lay out an elegant paradigm for evaluating AA, while Makela argues that ‘no attempt should be made to evaluate AA as such since social movements cannot be evaluated in any technical sense’. Further, Richard Gorsuch’s argument that alcoholics’ degree of religious commitment to spirituality ‘should always be included in every study of alcoholism’ was clearly not accepted by many of the contributors, and some debate on this and other points of disagreement could have helped make the book more informative and lively. Despite this shortcoming, this is the most interesting book on AA to appear in several years and will hopefully guide and galvanize future AA research.

KEITH HUMPHREYS Cknter for Health Care Evaluation,

Palo Alto. USA

Lee, L. & Lee, M. (1992). Absent Friend, High Wycombe, Henston. P p vi + 139. E4.95 paper- back. ISBN 1-85054-089-6.

There are certain books which are impossible for any hopelessly sentimental animal lover to read: I have studiously avoided Dances with Wolves since I heard the wolf died, but when I recently lost my own very close companion, a Siamese cat called Monty, things changed. Like parenthood, I felt I had been admitted to another dimension of human experience, another exclusive club. I feel I am, therefore, reasonably qualified to put this book to immediate practical use.

Absent Friend is written by Laura and Martyn Lee, a bereavement counsellor and vet respec- tively, and sponsored by the Cambridge Pet Crematorium. The result of this promising combi- nation is a practical, readable little book with just the right balance of compassion and vetinerary experience to keep it comforting without being sentimental.

The ten main sections in the book refer to a distinct aspect of the loss of a pet. Each