1996 Treatment Center Survey. Fourteen treatment centers, representing nine states, responded to the survey. Half of theAMERICAN treatment centers indicated that "most of " their treatment methodology was based on AA. The rest indicated that "some" of thei treatment methodology was based on AA. Most of the treatment centers (64%) reported that their clients did not experience significant cultural barriers to their participation in AA. Half of the treatment centers reported that their use of AA has stayed the same over the years, 29% said they were integrating more of it in recent years, and the remainder were more ambiguous in their responses. Half of the treatment centers reported their AA program as being "Nativized", with the most common method being sweat lodges (four centers). Meditation was used at three centers, and two centers used the medicine wheel. Counselor Focus Groups. Counselor focus groups of 6-12 participants were conducted in three states: Texas, New Mexico, and Arizona. The counselors from Arizona and Texas were primarily Anglos; the New Mexico counselors were primarily from the Navajo Indian Tribe. One common theme concerned the client application process and eligibility determination for VR services. Another recurrent theme concerned alcohol abuse as a secondary disability. The counselors reported that in some cases they were not aware that a client had an alcohol abuse problem until VR was already in process. Some VR counselors thought that dealing with alcoholic clients required more time and effort than with other clients, but that this effort was usually worthwhile.

One of the biggest differences between abstinent and abusing clients was apparent in their ability to make goals and plan effectively. All three groups of counselors agreed that seeing their clients succeed and make positive changes was one of the things that motivated them the most. Counselor Survey. Thirty-two VR counselors from 10 states completed the follow up surveys regarding American Indian or Alaska Natives (AI/AN) clients who were eligible for VR services and for whom alcohol or substance abuse or dependence was a primary, secondary, or tertiary disability. With regard to eligibility for VR services of AI/AN clients, the five contributing problems concerning eligibility included lack of transportation, lack of follow-through by client, cultural differences, lack of trust, and confusion about eligibility. Some of the special needs of AI/AN clients with alcohol or drug disorders in regard to maintenance of services included the ability to obtain diagnostics, financial assistance, access to a halfway house, a centrally located treatment center, positive role models, and more education for families. Client Focus Groups. Client focus groups of 6-12 participants were conducted in Texas, New Mexico, and Arizona. The focus groups in Texas and New Mexico thought that one barrier to eligibility sometimes was lack of follow-up by the client. Other possible barriers to eligibility included length of time it took to determine eligibility, cancellation of appointments by the counselor, lack of transportation, and client relapse. In regards to abstinence versus abuse, an abstinent client is one who thinks ahead and makes plans to improve their life, attends AA/NA meetings, is involved in religion, and is employed.