Addicted Brains

A neuroscientist examines life on drugs.

Does 12-step Treatment Work by Inducing PTSD?

Nobody really knows how the 12-step approach works. But some who've tried AA or NA don't like the price they end up paying. Like PTSD sufferers, group members may stay clean by remaining anxious and vigilant — too scared to go backward and too stuck to move forward. Read More

12 Step and PTSD

Thank you Marc Lewis for understanding and writing about this topic. You touch on many aspects of the 12 step program which I found personally damaging in my experience.

Living the label of "addict" and living scared is not ideal for those wanting to change their lives. I didn't want to be an addict anymore but in the program it was ingrained into my conscious that I focus my life on that aspect which was depressing.

Since leaving, I'm no longer scared of not focusing on that part of my life history. While in NA and AA I was informed that I needed to forever have my addiction problem on my mind to ward off a relapse. However, since I have retrained my brain into believing that I could heal, I was able to do just that. I'm no longer an addict and now that I'm identifying myself by my positive features (wife, mother, professional in my work)my spirits have lifted.

Empowering myself and developing healthy tools to help me deal with the reasons why I used drugs was definitely the most appropriate model towards a clean life.

Thanks for the confirmation

Thanks, Sally. I know that my description and analysis of what goes on in 12-step meetings will raise a lot of controversy, and I guess the perspective expressed here is somewhat extreme. Yet I keep hearing stories just like yours, so there's got to be some truth to it. Thank you for telling about your experience in these programs here on this blog. It will help to show readers that there is definitely a "downside" for some (if not all) who try the 12-step approach.

Confused by Sally J's comment

Since she's no longer an addict is she able to use drugs successfully now ,or is she still an addict?

Just not an addict

I don't use drugs anymore and honestly don't want to. If I did however, and continued to do so, I'd likely become addicted again. Perhaps it is best for me to think of myself as at risk or at high risk to becoming addicted, but that doesn't make me "an addict" now. Kind of like smoking, if someone quit they are now a former or ex smoker. IMO if you give most people a drug for an extensive amount of time they will become addicted and crave it.

That makes sense. If you

That makes sense. If you quit smoking or lose weight, nobody insists you continue to call yourself a "smoker" or a "fat person". Why should someone who has quit an addiction be expected to call themselves an "addict" for the rest of their lives?

Well thought!

A great way to put it into perspective!

Shira~

Does 12-step Treatment Work by Inducing PTSD?

While Dr. Lewis raises some provocative issues informed by some people's reported experience with AA and NA, that to suggest that 12-step treatment programs may induce PTSD strikes me as reckless and induces its own sort of panic.

As a clinician who treats individuals in various phases of recovery, I appreciate that one-modality treatment rarely , if ever, fits all. Contrary to Dr Lewis ' opening statement that "Nobody really knows how the 12-step approach works," many people do know how the 12-step approach works and have written, and shared much about the methods and its efficacy, for some.

One key component of AA and NA programs is the promotion of an awareness specific triggers for the individuals, coupled with a very strong, supportive community model of healing. Hmm, if this reveals a "lack of the capacity to grow' I doubt we agree on what emotional growth even looks like.

Regarding the success stories, those who have sustained their recovery; Dr Lewis glibly remarks " You stay clean because you stay scared."

If it were only this simple there would a much higher success rate.

Rather than dismissing AA and NA treatment programs, I recommend checking out the 12-step treatment philosophies. Consider them carefully, cautiously and thoughtfully.

With all due respect, Dr. Weinstein

in all of my experience with 12 step treatment/programs (even private counselors who were members), I have yet to see any true focus on finding a person's "specific triggers". In fact, what I have seen is a lack of focusing on the self as an individual whatsoever and instead a shift to being one of the group (or the "script", or the stereotype, etc. in terms of how AA/NA define those addicted to drugs and/or alcohol), quite the opposite of what you describe.

That doesn't mean, naturally, that in some groups or in your practice this does not occur, but what I (and apparently others commenting here, not to mention many commenting at Dr. Lewis' blog and many other sites) have personally experienced is more akin to a carpet-bombing approach. No attention paid to other factors that played into the addiction, nor the individual triggers at all. Merely a constant refrain that if you don't follow very specific instructions and give yourself over to a "simple program" that you will be utterly destroyed by an almost personified "disease" that is progressive, fatal, and lurking around every corner (or "doing push-ups in the parking lot"), waiting to hurl you headlong into jails, institutions or death. I've seen longtime members keep repeating this, I've seen the carpet bombing approach in so many venues that I can scarcely believe (though I do) that there are happier, less fear-inducing meetings anywhere.

I do wish, most sincerely, that there were more people trained in psychology who did put the focus where you say that it is, but I have only seen the opposite.

Hi Persephone--

You are as eloquent as ever. Your views on the pitfalls of AA/NA treatment combine the power of your and others' direct emotional experience with a coherent overview of what it is that goest wrong. Needless to say, this packs a wallop and leads to controversy. But we have seen that this controversy can be productive. It can teach us. Thanks for your input!

Absolutely

I agree! There are many times in the past 20 years of my sobriety that I've begun shaking just imagining all that would happen to me if I ever took another drink. And when you say people in AA are stereotyped, that is absolutely my experience. The "alcoholic personality" is something I've heard for the whole time I've been in AA, how we are all simply egotistic and selfish with the oft-spoken "self-centered fear". The fear is also used to run all the segments of AA itself, if you say you haven't time for a service commitment "Well, remember that your DISEASE is out doing pushups in the parking lot and if you drink again you will go to jail or die, and people who are busy in service work to AA don't get drunk". Very convenient, that guilt and fear.

I have long known that an insane level of fear helped to get me sober and keep me sober. I have been seeing for the past few years though, that the fear brought on by my being way too wrapped up in AA was holding me back in emotional growth. I felt like a middle-aged child, with fear and obsession if I started "missing meetings", terrified I would suddenly throw my life away in a bottle again. I had to get some real help at that point. I still go to an AA meeting each week, but it is not one where I am going to be looked at suspiciously for not being in a meeting every night, or quizzed as to why I don't have enough service commitments. But meetings like this are very hard to find.

It looks like you have grown

It looks like you have grown loads and are missing that growth.
People new into recovery use them type of words and i feel they are needed for the new comer, because they are in a vunrable state.
I feel the longer in we get we grow and develop and become strong, we get lives, jobs, family and we cant make a meeting, but that is ok. some people want to live there lives through meeting and that is ok. each to there own

Perhaps a stage

Please see my comment below, which was meant as a reply to Dr. Weinstein. I do see that "scare tactics" can be viewed as appropriate when seen as a stage -- especially a stage for newcomers who really don't have a clue how to stop. So....your point is well taken.

The question is whether and why these tactics continue to prevail in some groups, as a steady diet rather than a temporary stage, as argued by Persephone.

I wasn't told things like

I wasn't told things like that. I was told to remember where alcohol took me and to have a healthy respect for the fact that it could happen again (and with worse results). Booze isn't my friend and it doesn't add much value. I had a good time in AA, and I was sad when I moved and couldn't find meetings of the caliber I had experienced where I got sober.

For people that claim that 12 stpes keep them in their negative experiences without moving forward, it astonishes me to find so many of them here that relive those experiences not in AA meetings, but in anti-AA forums. What's the difference? Much of the behavior that they decry in the rooms takes place in those forums and for the same reasons - to expose, to degrade, to break down... to get you to share their beiief that 12 step program are evil because they didn't work for them. I don't agree with everything AA puts forth, but I agreed with enough of it to benefit and move on to a good, sober life. I don't think I would have gotten that from a site where a person making a suggestion to a 12 step program is akin to a war criminal and should be prosecuted as such. I hope Orange has removed that thread as it discredits the whole site. He was completely earnest, but I think most people would conclude the guy was cuckoo.

Astonished

Astonished, seems rather intentionally naive, given the words which follow.

Maybe reliving them is what some individual learned in less functional/healthy XA mtgs. Maybe that is what counseling does to some extent. What is wrong with reliving them in another environment than, as i just wrote, less healthy productive cult mtgs. I use the word cult not in the derogatory/condescending, as some of your writing comes off to me-nothing personal you may not be a writer like i am not a writer.
But we might find common ground that some, majority of people, might find it cuckoo to not be able to stop taking drugs and/or alcohol with prayer mtgs and rigid/non-rigid step work so an personal attack on an individual like you end with, an individual like you to me will never know or meet, might not be the best approach.

I continue to try to point this anomaly of thinking/writing/speaking out. If there is the least bit of criticism of XA, overtly dismissive comments statements (borderline cognitive dissonance) begins. I will finish by pointing out what seems to be obvious. People were let down by the function of XA meetings for whatever reason therefore they feel, rightly in my estimation, angry and resentful...most do not in any unhealthy way....but some end up drinking druggin and dying because people are "astonished" when the XA "Promises" are not fulfilled and in many cases the road/path to those same "promises" are very damaging for many people. For example people with severe mental disorders which require professional treatment, i know there's a caveat emptor in the promises and elsewhere in the big book (s/b footnoted on every page in my estimation),
I was very angry that when i stopped going to mtgs, i felt very detached from normal life and in fact had to deprogram...this is why ia m here writing, i read marcs book, not just his article and many other books like gabor mate and etc...

To deny Orange (think his name is Terry by the way) or anyone else, who does not self-proclaim their "anti" XAness is to ultimately to deny ones own ability to be part of the whole. Seems to me not healthy but i understand i fell that way to at times.

:-)

My question, you and others (not being glib) who are recovered through or recovering in XA, it comes to me now, why if XA works so well for you do you continue to look elsewhere for answers?

Glib, set to on now:
Why are you here reliving anti-step stories and being a bit critical of what works for those who do not live the XA good life? No one here or at Orange-Papers tells anyone to stop going to meetings....why should XA faithful care if I don't think it works and then say something about it? - i think there is a shadow of a doubt by those who protest too much, personally my opinion. I do not care one way or the other 'cept what i keep writing too, the XA machine/dogma/party line has traditionally impeded scientific progress-luckily that is changing rather quickly...but for many, as terry? orange points out his anger, it is too late. Finally if one of my three daughters finds herself addicted, i want science based help for her and want the odds to be in her favor...that is not the case now after what 75 years of XA? Not a good record really...3:1 or 10:1. sucks in fact for all the science and tech we have.

Horse Manure about AA

Thank You Clara for your insight: I've been sober over 29 years, never went to rehab just to AA and the absurd accusations about what people said, and how it was perceived, is bizarre. I loved that no one told me what to do, they told me what they did. They weren't against alcohol,it was how they got new members. I can go anywhere and do anything without fear.I still go to AA but not out of fear,but because it is a pleasure to help others. What is the agenda of a person that insinuates, that making a suggestion about a 12 step program is akin to being a war criminal.Don't go to AA if that's how you feel,or as a co-founder of AA suggests in the literature: "If you still think you are strong enough to beat the game alone, that is your affair.But if you really and truly want to quit drinking for good and all,and sincerely feel that you must have some help we know that we have an answer for you.It never fails if you go about it with half the zeal you have been in the habit of showing when you were getting another drink."

Andy H, it's no longer just about alcohol

and AA. People are herded into AA/NA for a variety of reasons, many via rehabs when they are seeking medical help and instead just are told things that for many of them are damaging.

I understand and respect that many have found happiness and success in AA/NA, but I don't see the need to feel threatened by criticisms of 12 step programs. What I saw, when I went back to visit after I'd been clean for a few years was exactly this. People not developing (rather, they were going backwards, just not in terms of using) but in a state of extreme anxiety about their "recovery", despite not reporting any cravings and having been clean for many years. They were hitting multiple meetings per day, adhering to the fear they were being consumed by.

I'm glad people didn't tell you what to do, in many cases (as evidenced by the many commenters here and elsewhere online) people are told not only what to do and how to do it, but that they are defective people who must constantly be on guard when it comes to their own thoughts. Now, that is the real "horse manure" in the rooms that few are willing to talk about.

Yes, that's the thing. Why

Yes, that's the thing. Why are AA members so bloody threatened by criticism? They talk so much about how important it is for addicts to share their experiences, but it seems that one is only welcome to discuss positive ones. During my time in AA I saw people get sober, yes, but I also saw and personally experienced predators (sexual and financial), a lot of anti-medication stuff (often resulting in relapse) and rampant fear-induction. Is AA horrible and no one should go? Of course not. But if attraction rather than promotion means anything, it means that people are allowed to check it out, form an opinion and discuss it--even if that opinion is negative.

Thanks Anon, that is so refreshing

So good to hear that you are very good.Thanks for posting it helped me right now.
peace

Thanks Anon, that is so refreshing

So good to hear that you are very good.Thanks for posting it helped me right now.
peace

private counselors who were members

This is another iffy-ethical thing about the "fellowship" which should be disclosed upfront at mtgs and in sessions, otherwise it should be considered malpractice. For example, if a medical professional "healed" their cancer with say pot oil they would be a little biased toward pot oil while being pretty darned dismissive of other treatments. Which is completely understandable from my perspective. I am not condemning individuals for what works, but I am condemning a invasive propaganda machine built into AA which inhibits and thwarts science based treatment and cures.

These two-hatters, the common AA term, for XA para-pros(fessionals) are often on very unstable ground. From my experience, their jobs are very stressful and their relapse rates are by some measures higher than the average XA member. Further I guess, i found a lot of professionally marginal things about the function, as oppose to the ideals, of XA works.

Beyond a "conflict of interest"

Any so-called "counselor" who is "two-hatting" counseling clients, while attending 12 Step groups themselves is engaging in the WORST conflict of interest imagineable! Most ethics statements for AOD counselor certification/licensure REQUIRE that the the client's individuality and "best interests" are paramount. This is NOT the case in 12 Steppism, where an individual is NEGATED for "group-think" (look at the phrasing of the 12 Steps-they are all WRITTEN WITH PLURAL PRONOUNS!). I would personally file an ethics complaint against ANY counselor that I was aware of who is "referring", "recommending", or COERCING 12 Step groups, while being a "member" of one themselves! It is beyond unconscinable, and a so-called counselor doing this needs to be stripped of their certification/licensure. and SUED!

thanks too

NEGATED for "group-think" (look at the phrasing of the 12 Steps-they are all WRITTEN WITH PLURAL PRONOUNS!

Self talk is important, as science points out, and in my experience. It can be very powerful in some individuals. and if i don't stay positive i get all backwards.

thanks x 2!

carpet bombing, lol

with napalm...hard to get off and its like the light of morning to us vampires...it burns, guttural intonation.

Just my story...sticking to it.

thanks too, Pers. I love your writing too, hope you make a living at it.

12-step fellowships are SUPPORT GROUPS, not PROGRAMS

There roots and practices are religious. Stop lying about this, please.

Religion helps some people, no question. But the (1) problems lies in the entanglement of religions distrust of science. This country, US, is off the spectrum on industrialized countries and religious fanatacism...XA (12-step) groups are a very good example.

I cannot tell you how many mtgs I have went to in over 7 years, coast to coast. People (old timers) criticize and will not let others talk in open or closed mtgs about anything not AA conference approved-that means modern science. The Bible of AA has not changed since it was written and the rights stolen in 1939ish...what kind of "program" is it , if one must keep insisting to lie, does not change the blueprint in over 75 years?

Further, and finally, the author of this article is correct, in my opinion and the fact i have garnered over the decades...if you ask 10 different AA successful participants how it really works you get at least 10 different answers, but a common thread is going to be god or HocusPocus. But if one fails to stay sober it is never the "programs' fault. Blech!

This all very well and fine if the people in these mtgs were completely upfront and honest about the reality of the FELLOWSHIP and the steps...and the truth about the founders. And a consistent way to "work" the steps, though the steps are a bit crazy religious. the other thing which disturbed me were the amount of people who committed suicide I KNEW THROUGH AA. It's been three years and nobody I know has committed suicide. Weird?

Just my opinion. Do what works for you and it took a lot of courage to write anything neutral to negative about AA...they seem to hate on people who are not 100% Big Book.

It's like being pro-communist/socialist/skeptic in academia, you won't get as far as you would otherwise.

Finally it is my recommendation to not waste your time going to AA/NA/Al-Anon meetings - especially if your disperate. Women should go to women only mtgs.
But really you'll be better off call you mother-in-law or skipping the middle step and go to church. Maybe take a couple classes at your local college on current psychology and try not to drink or use.

Peace.

Fuck the blue book, fuck

Fuck the blue book, fuck AA/NA, fuck your scare tactics and sociopaths running "rehab centers".

It's brainwashing, period.

Hello. Your points are well

Hello. Your points are well taken. But I don't mean to be glib, and I did try to specify that some but not all 12-step programs work according to this dynamic. I also said that this approach is surely worthwhile for people who have tried other approaches without success.

But I keep hearing stories very much like the one above, posted by SallyJ. I mean dozens and dozens of them! And, as you say, clearly one size does not fit all when it comes to treatment. But my last two posts were quite enthusiastic about the 12-step approach. To be even-handed, it's absolutely necessary to spell out the negatives. The comparison with PTSD is not just a glib turn of phrase. I think there is truth to it. Ex-members have said they are brow-beaten with scare tactics and other unpleasant polemics. They are told that their addiction is waiting for them, doing "push-ups in the parking lot" (surely you've heard this phrase). Isn't that a deliberate attempt to maintain anxiety?

Now, you could argue that this tough (and sometimes damaging) talk is a stage in recovery, and it can make way for further development. After all, recovery has to take place before further development is even possible. There I think we might come to some sort of middle ground.

Hmm. dr marc

my comment was meant for a reply to the person who maintained AA is "traditionally not religious," sorry, apparently the the reply button didn't function appropriately at that time or i made an error...but i am pretty sure i clicked reply. MacOS10.6/Safari.

further

glibbnish detector failed to pick up anything...maybe its on the fritz or operator error. ID10T error one might say.

i love your piece, i refer mentally to it occaisionally for help in remembering PTSD and to keep positive. Also, kudos for your writing again for ALL the comments have been very much positive, in that they are thought provoking and tend toward advancing science and treatment programs. Stasis is death for me.

Thanks x 1 million, for reading and replying to your piece more writers should take your cue.

keep on keepin on, my young brother.

:-)

Ms Weinstein, I’d like to

Ms Weinstein, I’d like to point out that you made a contradictory statement that reminds me of one of many 12 Step arguments in which one that opposes it, can never “win”. You mentioned the many people that know that/how the 12 step approach works, which shows it’s efficacy and success. On the flipside, because Mr. Lewis points out some negatives you assume that he has yet to check out 12 step philosophies. This perhaps until he “agrees” with it’s effectiveness.

As a member I got stuck in a similar circle of “find a new meeting or sponsor until it works”. This for a long 5 years, a wasteful amount of time for someone with an affliction that I was told would soon kill me.

I do find it admirable to hear that you don’t rely on this one modality of treatment. Too many professionals, including doctors and counselors, will only recommend XA without recognizing that for some it can be very negative. It’s time that the mainstream understand that too many walk into the rooms of the program to find some of it’s quirkiness intolerable and walk right back out. Thus unaided in their difficult time. Individuals are unique and this 1 step – 12 step approach is not compatible with too many personalities. For those that it harms, a deep and very true injustice has been shoved onto them.

The “supportive community model of healing” is just an assumption. There is no way to know the type of people that ingrain themselves into the thousands of different areas of XA. My area in particular, which is near a very large city, is manifested with professional want-to-be,s, that were only supportive if newcomers participated in their rather unrealistic expectations of being completely powerless and relying only a HP (God) to keep them from picking up my next drug. My point being is that I found that meetings were more NOT what professionals thought they were. There is very little support for the individual and a mass loyalty to the program in which the expectation is to give your life over to a HP. One that “makes sense” anyway.

According to the teachings of the Big Book, they correctly depict addicts as being selfish and self centered egoists that continually lie and are full of character defects. Although all humans have a tinge of each, this is not the “reason” many turn to substance abuse. Focusing only on those negatives was damaging to my already depressed state. Throughout my years of continually trying to work something that was harmful for me, I stayed in a suicidal state. I imagine that there are many similar to myself that need models much different from what is standard approach to helping people recover.

Thanks both for reading and most of all, for focusing on this very important matter.

Thank you for your insightful article, Dr. Lewis.

Thank you for your insightful article, Dr. Lewis. I have to agree that the 12-step model induces and keeps people in perpetual fear of relapsing. One quote from the big book of AA that reinforces this idea is:

“They had said that though I did raise a defense, it would one day give way before some trivial reason for having a drink. Well, just that did happen and more, for what I had learned of alcoholism did not occur to me at all. I knew from that moment that I had an alcoholic mind. I saw that will power and self-knowledge would not help in those strange mental blank spots. I had never been able to understand people who said that a problem had them hopelessly defeated. I knew then. It was a crushing blow.” BB p.42, More About Alcoholism

“Hopelessly defeated” by “strange mental blank spots”. One must always fear the next drink which is inevitable unless one completely turns their will and life over to God, and becomes “spiritually fit.” But how does one quantify just how spiritually fit they are? And how much “spiritual fitness” does one need to avoid taking a drink? And I must say it’s frightening to hear an old-timer with 30 years of sobriety share that if he makes it “another 3 hours and 24 minutes” without drinking, he will have made it another 24 hours under his belt, “one day at a time.”

And I have to disagree with AA’s stereotype of alcohol dependent people. It was a huge stumbling block for me which kept me in a weird mental paralysis trying to figure out just how I fit that stereotype. Fortunately I found information to the contrary like this one:

”Fifty years of both psychological […] and longitudinal studies […] have failed to reveal a consistent 'alcoholic personality.' Attempts to derive a set of alcoholic psychometric personality subtypes have yielded profiles similar to those found when subtyping a general population […]. That is, alcoholics appear to be as variable in personality as are nonalcoholics. Studies of character defense mechanisms among alcoholics have yielded a similar picture. Denial and other defense mechanisms have been found to be no more nor less frequent among alcoholics than among people in general. […] There was simply no support for the view that alcoholics in general come into treatment with a consistent set of personality traits and defenses. (p. 90)”

http://web.archive.org/web/20100722131540/http://207.228.230.17/booktalk...

It wasn’t until I left AA and did a huge amount of research into the matter that I realized just how much AA relies of myths, rather than the facts one would expect from the “leading authority” on alcohol dependence. And in doing so, I eventually found my sobriety on very solid footing, unlike the old-timers who had been shaping my beliefs in a detrimental way.

Another thing I’ve found in my research is that 12-step ideology doesn’t seem to have any efficacy whatsoever, other than convincing people that it does, making it appear that “it works for some”:

“the mesa-grand study found evidence of ineffectiveness of 12-step facilitation from 6 studies and of ineffectiveness of Alcoholics Anonymous from 7 studies (109). An additional systematic review of 8 studies found no studies that unequivocally demonstrated the effectiveness of Alcoholics Anonymous or 12-step facilitation approaches for reducing alcohol dependence or alcohol-related problems (133).”

http://www.euro.who.int/__data/assets/pdf_file/0020/43319/E92823.pdf

And as stated above by Sally, it’s been my experience that unless you are completely ready to conform to the dogma in AA, and rewrite your personal history, you are not likely to find a warm and supportive environment.

Thanks again, Dr. Lewis, for taking the time to write this article.

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Marc Lewis, PhD has been a professor of developmental psychology and neuroscience for over 20 years and is the author of Memoirs of an Addicted Brain. 

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