Some Assembly Required

Musings on addiction, recovery, mindfulness, and chronic pain

What Makes Twelve-Step Programs Therapeutic?

More people have achieved and sustained recovery from addiction in its various forms through twelve-step programs than any other approach, by far. But what makes these mutual-aid programs attractive and helpful? If you've ever wondered about the mechanisms that underlie the therapeutic efficacy of twelve-step programs, keep reading. Read More

Rose colored glasses

You are wearing rose colored glasses when it comes to 12 step programs. The "program" is dis-empowering and denies individualism. Many "sponsors" are control freaks. There are also numerous predictors, both financial and sexual. There are many suicides in 12 step programs when people don't "get it" and relapse and have been told over and over that it's 12 step or "jails, institutions, or death". There is such a loss of status and disgust from other members when someone relapses that who can blame them for suicide?

An impressively one-sided perspective

I'm curious as to what type of direct experience you've had with regard to 12-step programs. While there are certainly legitimate critiques & the 12-step approach doesn't fit everyone, the total trashing of it undercuts any credibility your comment could have. Taking the most extreme/negative examples & presenting them as common occurrences is neither accurate nor helpful. I have had considerable personal, as well as professional experience with 12-step step programs, & while they are far from perfect, the reality remains that they have helped many millions of people around the world recover from addiction to lead healthier, more productive, & more complete lives.

I was brief and to the point

I was throwing out a counter argument as briefly as I could. My experience has been over 20 years of sobriety in AA. I still occasionally attend a meeting, mostly because it is expected of my by loved ones and some friends I have made there; I do not want to burn bridges with people, but much of the Big Book has been difficult for me to deal with long-term.

When I arrived in AA I had been self-medicating anxiety and depression with alcohol for about 10 years. I had sought help for these problems before I ever picked up a drink, when I was still a teenager. No one could accept the fact that a child with good grades who wasn't in trouble could be suffering so terribly as I was, so I did not get good help. I found alcohol and it seemed to fix my symptoms. I don't have to tell you what happened in my life on that path, it was pretty typical.

As a new member in AA I was basically told that my problems were all because of the "ism" - I, Self, and Me; and if I would work the steps properly my problems would be solved. I did the best I could; I did not drink, but got no help either. My bad experience with Psychiatry along with AA "oldtimers" saying that a person isn't sober if they are on any mental health meds kept me from seeking help for a very long time. I never felt good, but I did not want to tell anyone in "the program" because I would be told that it was because I hadn't worked the steps "right", which would mean I would have to go through some kind of additional grueling, self-examination leading to self hatred through picking apart my every thought then go "make amends" to anyone I had imagined I had even looked at the wrong way. I kept feeling bad because in my heart I knew that "applying the principles" further than I already had (and I had done a pretty good job on myself) would cause me further emotional damage. I lived terrified of AA, afraid that if I ever drank again I would lose my husband, my job, and be nothing again in my new-found culture. I was addicted to meetings, scared of the self-deprecation I heard there and scared to not be there, meeting after meeting. I would obsess on things I worried I "hadn't done right" in the steps. Terrified that one day I would just up and drink over something I had neglected. I told myself that if I drank again I needed to be strong enough to commit suicide since that would be better than losing everything again and "starting over", and especially better than the pity and disappointment I would see on people's faces in "the rooms".

Then there are the predators. AA is little different from many other religious communities (and YES, that is what it is) in that the idea of not judging others and forgiveness is so ingrained that it allows predators a great deal of opportunity. A woman once told me of how an AA guy had given her a ride to a meeting, but she was taken out into the country and he said she could either have sex with him or he would leave her there. She was brand new and had almost no resources at the time. I was so ingrained in program thinking that it never even occurred to me at the time that she should have gone to the police, you just don't do that. And in AA the victim is always told to look at their part, shame the victim enough and she will shut up, her life depends on "getting IT" after all?

I have not drank, but I reached a point in my life where I just knew I needed real medical help. I was finally diagnosed and treated properly by a good Psychiatrist. The change in my outlook on life and my ability to live was absolutely drastic once I received actual treatment for my mental health issues. I can't stress that enough. I had languished in fear for YEARS and suddenly I was waking up alive. I also saw other people leave completely and stay sober through the years, yet I heard people say over and over in meetings that they knew of no one who ever did this and to do so meant a terrible death. Why the lies?

There are a lot of suicides in AA. People are told they have to "get it" but if they are one of the "unfortunates" it's "jail, institutions and death" for them. They are almost NEVER told of alternatives. Many people get fed up with the authoritarian attitudes and fear mongering in AA and just leave, not telling anyone how they feel. I understand this, who wants to be cut down and told they are fools and playing with fire? I had a friend who hung herself years ago. A bright and beautiful woman who could light up a room. She didn't "get IT" and her own depression raged on, this is unacceptable to me. The messages in AA all point to "do it our way or go off and DIE". And the steps are too often used as a bludgeon, in fact, I believe a lot of well-meaning mental health providers proof-test the steps and the Big Book in order to prove to their clients (and to themselves) that it is not so bad, that it has therapeutic value; when it is demeaning and leads to self-hatred and despair.

That is my experience with 12-step. I am currently in limbo, I guess I post to articles such as yours as a sort of additional therapy. I have friends in AA, good people, completely ham-strung by the doctrine they MUST follow. They could do so much more good for people if they had something to work with that wasn't a self-hating faux spirituality from the 1930's.

Wow.

Thank you for that heartfelt & in-depth description of your experience in AA. I am sorry for the pain you suffered there in your attempt to recover & heal. It sounds like you were traumatized in a setting that is intended to be emotionally, as well as physically safe. I'm glad that you ultimately found the help that is the right fit for you.

In my experience (and AA is not my 12-step program), different fellowships & different groups within fellowships have different attitudes & perspectives on co-occurring mental health issues - some are more "enlightened" & understanding than others. I believe than when any 12-step program can't recognize the validity of genuine mental health issues, along with the legitimacy of "outside assistance" (including therapy & necessary medications), they do their members a great disservice - the effects, as you describe, are often shaming & traumatizing (or retraumatizing). As wonderful as the Steps can be as a pathway toward learning, growth, & healing, many mental health issues are not addressed effectively by simply working them harder or better. It's truly tragic when a helping resource sends the message (in any form) that a victim is to blame.

Predators exist in 12-step programs as they do in all walks of life, however, it is especially grotesque & unacceptable when it is perpetrated in the context of recovery. There are a great many damaged & disturbed individuals in this world, & the rooms of recovery have their share & then some.

By the way, as there are exceptions to every rule, I know there are individuals who remain abstinent from alcohol & other drug use after leaving AA/NA. In my personal & professional experience, those folks are rare exceptions, but they certainly exist.

Personally, I don't feel as though I don't have to follow any particular doctrine & my own experience is of the 12 steps as a more general path that has structure but also the flexibility for me to practice applying them in a way that meets my individual needs. That being said, I have a home group, attend meetings, have a sponsor, and I have service commitments. And I'm grateful for my 12-step program as an important part of the foundation of my recovery.

Thank you again for sharing your experience & your truth.

Thank you for your response

Thank you for your reply. You stated “That being said, I have a home group, attend meetings, have a sponsor, and I have service commitments. And I'm grateful for my 12-step program as an important part of the foundation of my recovery.” I just want to say that I have had/done all those things for many years as well. I was able to choose a kind sponsor, who was not cruel. I believe that instinct to avoid the hateful ones was life preserving for me. I have served in home-group offices as well as IGR and GSR. I have attended more intensely passive-aggressive Area meetings than I like to remember.

I have not suffered in AA like so many people I have seen suffer. I have tried to stay out of the way of those who inflict the most suffering; I am quiet and tried to appear compliant. But I really do believe that having a set of “spiritual” rules as the primary treatment offered for addiction in a first world country to be completely missing the mark. I do believe that one has to do mental gymnastics to get much that is positive from the steps themselves.

I absolutely do agree with you on the idea of a “holding environment” being very beneficial to someone going through early recovery, or anything traumatic. I wish such an environment could exist without a religion co-opted from the Oxford Group by Bill Wilson in the late 1930s. I do know without a doubt that the acceptance I found with other newly sober people when I got to AA saved my life after my family had rejected me for my failure. But after a number of years in the program people become entrenched in the steps and, in my experience, friendships within the “fellowship” are difficult to maintain as people judge one another on being either on or off the beam.

Mixed Feelings About AA

I know where minivans is coming from to some extent. I'm not enough of an AA insider to have heard the kinds of horror stories that minivans has, though it wouldn't surprise me to hear of similar ones in my area (I've been a member for 2 years).

But I have been around AA long enough to know that rigidity is a serious problem. I went for several months without a sponsor because it was darn near impossible to find someone who didn't have a "my way or the highway" type attitude. Maybe some guys benefit from the drill sergeant approach, but I'm not in the military anymore and don't feel inclined to put up with it. I do finally have a sponsor who follows the 12 Steps closely, but doesn't try to shove it down my throat.

I agree with minivans regarding friendships within AA. The guys who are totally immersed in it seem to have alot of AA friends (often, they don't seem to have any life outside of AA). But I have young kids at home and can't spend 10-15 hours a week at meetings, doing service work, etc.

Also agree that depression is a very common problem, but equally big problems include anger and general drama. Even guys who've been in for at least a few years seem to have serious anger management problems. And I swear, some of these guys are bigger drama queens than the stay at home moms at the playground.

But, I don't really have anywhere else to go at this point in time. I just try to stick to the meetings where the idiot factor and the behavior problems are minimal.

Ambivalence is not uncommon

Thanks for your comment. The spectrum of perspective on 12-step programs runs the full range: from those who are completely down on them, to those who sing their praises unequivocally. Most people are likely somewhere in between those two extremes - though my sense is that they are probably at least a little bit more toward one end than the other (as opposed to straddling the middle).

Philosophical/ideological rigidity can definitely be a concern, and when we encounter that in specific groups, it may well be time to research different groups within our fellowship. In my experience, different groups/meetings often have very different tones, attitudes, expectations, etc. Sometimes, changing fellowships may be helpful to consider.

What's most important is to find the recovery support system that works for us. One of the aspects of my 12-step program that I greatly appreciate & respect is that (within certain basic parameters) it allows for people to participate in an impressively individualized way. I'm glad you found a sponsor whose style works for you - that's critical. A "my way or the highway" approach would never engage me.

Balancing our recovery needs against the other demands of life: relationship/marriage, kids, work, etc. is often a great challenge. It's difficult not to feel as though we are neglecting one area or another. In my 1st year of recovery I prioritized my recovery & it hurt my marriage & relationship with my kids (though they were 20 & 15 at the time, & the oldest was away at college). As the years have progressed, I've learned how to achieve & maintain a more healthy balance. It's taken time, experience, & practice.

I agree that anger among folks in recovery is often a significant issue. Hopefully, especially if their anger & the ways they act on it create suffering for them & those closest to them (& it usually does) they become consciously aware of it & become motivated to work to change that facet of themselves. That's what Steps 6 & 7 and 10 & 11 are for.

Although I had no idea of it when I entered recovery, one of the beauties of the 12-step programs is that they are much more than just a way to get & stay clean and sober; under the right circumstances, they create a pathway to learn how to live a more whole, healthy, and healed life.

correction needed

"More people have achieved and sustained recovery from addiction in its various forms through twelve-step programs than any other approach, by far."

I don't think that this is true unless you're only comparing it to other "programs" or something. More people get over addiction without treatment than by any other method, by far. And even if we get over semantic quibbles and concede that your opening statement is true, it doesn't suggest what you want the reader to think it suggests. Of course it gets more "recovered" people than any other method since it has so little competition. But if our government funneled people into some cult of praying to the birdman for recovery and all rehabs pushed praying to the birdman, then praying to the birdman would be the thing by which "More people have achieved and sustained recovery from addiction in its various forms through twelve-step programs than any other approach, by far."

Here's a good question. Now that the internet is helping us share information and wake up to the atrocity that AA actually is, will the author of this piece, who seems like a decent enough guy, ever realize his error and recant?

Disagreements do not inherently necessitate corrections

While 12-step programs don't work for everyone, to say that AA (or any other 12-step program) is an "atrocity" is really discarding the baby with the bath water. The reality is that scientific research is increasingly identifying the factors that make 12-step programs so helpful for so many people.

By the way, 12-step programs are not treatment at all. Rather than being driven by professionals, they are mutual-aid support fellowships facilitated by their members, & their members alone. And it is true that some people simply stop using alcohol & other drugs on their own, however the majority, once they cross the tipping point from heavy recreational use into diagnosable addiction, need some additional assistance - be it professional treatment, 12-step involvement, or a combination of the two.

Lastly, to suggest that 12-step programs are a cult is to demonstrate a lack of understanding of what defines cults. The 2 most notable hallmark characteristics of cults are:
- A dynamic, charismatic leader or group of leaders directs the activities of the organization and the members. Cult leaders hold absolute authority over the cult members and may govern many personal areas of life. 12-step programs have no identified leaders. Members hold generally equal status;
- Cults isolate members from family and friends. Some may require that members only associate with other members. Some cults move new members far from friends and family and restrict access to them. While some 12-step program members choose to keep their social contacts/friendships closely tied to their recovery network, most have important relationships outside (as well as within) it. It is a choice left to the individual. In fact, recovery helps people reconnect with family & friends from which active addiction separated them.

I'm sure that you are a decent person as well. We'll have to agree to disagree here.

I did it naturally

This is from the NIAAA.

http://pubs.niaaa.nih.gov/publications/arh29-2/131-142.htm

The researcher puts natural recovery at 24.4%. Meaning 1/4 of the drunk population stops on their own.

I've also read other studies that have put it at 54%.

I wish the AA organization would stop telling people the only real road to recovery is theirs. There is a lot of smart people in AA. They must know when the organization makes statements that people can refute with research it makes them look bad. It destroys credibility in the entire addiction services community.

How often do you listen to that you knew were wrong and that were willing to propagate deceptive information to you.

This sort of thing gives people that do not want to hear that they have a problem a valid reason to resist treatment.

If you wanted to quit drinking alcohol and AA helped you I applaud both you and AA. AA has done more to help drunks than any other program I know of. The problem is that their treatment model needs an upgrade. They are using anecdotal evidence when scientific studies exist. What has their tradition become if people are using AA as an excuse to avoid treatment that they know they need.

There isn't a single pathway.

There are many potential routes to recovery from addiction. I've never expressed & certainly have never meant to imply that 12-step programs are required or are the only way. However, the reality is that they are extremely helpful for a great many people.

Moreover, the 12-step programs are not a treatment model (they are explicitly non-professional mutual-aid, self-help programs), although many treatment programs are "12-step-based." There are a lot of individuals with addiction for whom a combination of professional treatment & 12-step or other mutual-aid, self-help resource is the most effective combination. But as you state, & as research confirms, it is possible for people can become & remain abstinent on their own.

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Dan Mager, MSW is the author of Some Assembly Required: A Balanced Approach to Recovery from Addiction and Chronic Pain. He received his MSW from CUNY's Hunter College.

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