Addicted Brains

A neuroscientist examines life on drugs.

Does 12-step Treatment Work by Inducing PTSD?

AA and NA may keep you clean and sober by keeping you scared.

Hi readers! I'm back after a 2-month absence. I've been busy doing other things and taking some time off, but now I want to get back into this blog, starting pretty much where I left off. My last two posts offered some praise for the 12-step approach, but this time, based on some of the nasty stories I've heard from 12-step drop-outs, I'm going to explore its downside. 

The 12-step approach to recovery from addiction has been hailed by some and damned by others for decades. It’s an important debate, because 12-step treatment programs – usually variants of AA or NA – are still the mainstay of addiction treatment in North America, for better or worse. In this post, I want to suggest that 12-step recovery works for some addicts, but it does so by promoting a kind of PTSD. Which makes it as damaging for some as it is beneficial for others.

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The 12-step approach has been said (by some ex-members) to put a freeze on emotional development. For those who believe that people can develop out of addiction (like me, for one), this is not an optimal solution. Twelve-step groups are notorious for convincing members that, even if they’ve been clean for a while, their addiction is out there waiting for them, waiting to sneak up on them in moments of weakness. So they have to remain constantly vigilant: Any slip, even one drink or one pill, will be the first step on a journey that inevitably leads to full-scale relapse. Twelve-step groups want you to keep coming back, to help gird your loins against the hazards of relapse, and they encourage you to define yourself as an addict – for life. In other words, not only the way you govern your life but your whole self-image is frozen in place. This is what you are, and if any change occurs, be warned: it’s going to be a change backward – back to being out of control.

A reader of my other blog suggested that the net effect of the scare tactics used in some 12-step groups is to induce a kind of PTSD (Post-Traumatic Stress Disorder). People with PTSD live with continuous anxiety, denial and avoidance mechanisms, intrusive thoughts, and more, about what happened to them, whether it was a serious accident, a mugging, physical or sexual abuse, rape, or getting wounded in a war. PTSD is in some ways an adaptive emotional response to trauma. It’s one way to stay clear of danger. After getting mugged or raped, you won’t go strolling through city parks at night, you’ll stay inside when the parade comes by, you’ll avoid people of a certain type, you might avoid eye-contact with strangers altogether, but you’ll continue to see yourself as a victim or a loser. This is a static state; obviously it’s also an unhealthy state, at least compared to normal, flexible, spontaneous functioning. It maintains anxiety rather than relieving it.

But for some people, this might be the best way – the only way – to stay clean. You stay clean because you stay scared.

One of the coolest (but still experimental) treatments for PTSD is to relive the traumatic event while you’re taking beta blockers, drugs that reduce sympathetic arousal. This article describes the approach. So why should that work? Aren’t you just relieving anxiety with these drugs? No, the theory says you are interfering with the maintenance of traumatic memories. Memory strength and endurance depend on a kind of rehearsal process. You have to keep on reliving the memory (at least some version of it) while feeling the emotions that came with it – e.g., the fear unleashed when a trauma occurred, or maybe that stew of shame, anger, and horror that comes with addiction. Without that emotional charge, the memory fades…just like other memories.

Memories are encoded in the connections (synapses) between brain cells. You have to reinforce those connections (keep strengthening those synapses) to keep vivid memories vivid. With beta blockers in your blood, you can relive the memories without the anxiety, allowing the memories to become diluted or dissipated. Yet many, perhaps most, 12-step groups intentionally reinforce synaptic connections that maintain a terror of relapse. They keep the anxiety alive in order to entrench traumatic memories of addiction, by telling and retelling anecdotes about how bad it was at its worst or about the awful repercussions of their last relapse. Twelve-step practice is pretty much the opposite of trauma treatment using beta blockers, because 12-step groups intentionally rekindle the emotions that have cemented your already vivid memories. Almost like telling scary stories to keep little kids in line. Be afraid…be very afraid…

If that’s the solution offered by many (surely not all) 12-step programs – to plug yourself into a static state of PTSD in order to avoid the dangers of relapse – then I can see why a lot of people don’t sign on, or stay for a while and then get out. And I can see why defining yourself as a lifetime addict can be a self-fulfilling prophecy.

For the most serious, interminable addictions, this might well be worth the price. As I’ve described in other posts, 12-step groups may be the last resort – and the best option – for addicts who have tried everything else without success.

But for those who do have the capacity to continue growing, who can develop out of their addictions rather than cementing their identity with the label “addict,” it doesn't sound like the ideal solution. 

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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