Where Science Meets the Steps

The new science of addiction

Why the Hostility Toward the 12 Steps?

These misconceptions about 12-Step programs could interfere with recovery

Few approaches to addiction generate as much controversy as 12-Step recovery. On one side are the ardent supporters of the program, some of whom credit it with saving their lives. On the other side are the critics and those who found that the program didn’t resonate with them or even hindered their recovery. Both have valid points, and both, in the end, are seeking answers to a problem that defies easy solutions.

It is understandable that 12-Step recovery would generate such strong opposing views. The program touches on fundamental questions everyone has to answer for themselves. Still, it works for many where other approaches fail – and that, to me, is enough to warrant further investigation.

Although it is by no means a perfect program, many of the objections to 12-Step recovery are based on widespread misconceptions. Let’s clear up a few of the most common misunderstandings:

#1 You have to be religious or believe in God to make the program work.

The 12 Steps contain numerous references to God or a higher power, and some meetings conclude with a prayer. Although the Steps were initially conceived from a Christian point of view, the core principles have been beneficial for millions of people who do not believe in God. Like other texts and programs, the 12 Steps are a series of words and concepts that are open to interpretation.

Some people have difficulty maintaining abstinence by willpower alone and need to look outside themselves to a “higher power” to change their behavior. A higher power can be a religious deity or entity, but it can also be the power of a group working toward a common goal, nature or some other outside force. If you feel uncomfortable with the spirituality of a particular group, keep searching until you find a closer match.

#2 Powerlessness frees the addict from accepting responsibility.

While the initial choice to use drugs or alcohol is within the individual’s control, once physical or psychological dependence sets in, they have lost control. Despite repeated attempts to quit, they continue using even in the face of job loss, financial and legal troubles, and other negative consequences. Powerlessness occurs because prolonged drug abuse changes the structure and function of the brain, and it takes time in sobriety to repair the damage.

Powerlessness does not mean that the addict is inherently flawed, exempt from thinking for themselves or incapable of recovery, or that they can rely on their higher power to fix everything without taking steps to improve their own lives. That would contradict the entire premise of the 12-Step program. Instead, it is a statement about the nature of the disease, designed to remove the blame and shame that often prevent addicts from getting help, and to show addicts one way of reclaiming power over their lives.

#3 Addicts substitute their addiction with a dependence on 12-Step meetings.

As a chronic, relapsing disease, long-term care is vital for sustained addiction recovery. If meetings provide some recovering addicts with the support and fellowship they need, they are encouraged to keep going as long as they wish. In the early stages, people may benefit from frequent attendance, which often diminishes over time as they develop other support systems and become more firmly grounded in their recovery.

Addicted or not, everyone needs support. If recovering addicts find that support in 12-Step meetings, they should continue to go. This type of ongoing participation in a program that improves members’ lives is very different from a destructive drug or alcohol dependency.

#4 The 12-Step program is a cult.

Twelve-Step programs have overarching principles and traditions that may seem unusual to people unfamiliar with addiction and recovery. It is a close-knit group of people who share similar struggles, but this does not make it a cult. People are free to participate or not, and to take what works for them and leave the rest. There is hope that participants will embrace the wisdom of some of the 12-Step principles but they are also encouraged to think critically and to find their own way.

#5 There are too many rules.

Twelve-Step recovery is full of guiding principles and suggestions, but there are actually very few rules. Working the Steps is a choice participants make, of their own volition, every day. You can come and go as you choose, adapt the program to suit your needs, and if you relapse, the group will welcome you back with open hearts.

The 12-Step principles are not random or haphazard. Rather, they address specific deficits in learning, memory, empathy and other areas impacted by drug abuse. Sharing stories, along with routinely scheduled meetings and oft-repeated mantras, for example, help addicts remember the next right thing to do even when their thinking is still clouded by drugs.

#6 Twelve-Step recovery is for old men, losers and people who are too weak to do it on their own.

This misconception is based on inaccurate and outdated information. Addiction is a chronic, progressive illness, not an issue of willpower, and it affects all types of people. The opposite of weak, it takes tremendous strength and courage to reach out for help. Some people may be able to recover on their own, but most cannot – and there is no shame in that. People with other chronic diseases do not expect to heal themselves, nor should addicts. Even teens benefit from 12-step programs.

Addicts often feel they are different, better or less damaged than the people they meet at 12-Step meetings. In a group as diverse as is typically found in a 12-Step meeting, it would be surprising to instantly connect with, or even agree with, the perspectives of every member. You may look different on the surface but inside, the people in 12-Step recovery are fighting to stay clean just like you. Even if their stories are different, the underlying messages, struggles and goals are similar. If you feel out of place in a specific meeting, look inward to see if you are unfairly judging people before you get to know them. If you get to know the people a bit better and still feel uncomfortable, consider trying a few other meetings.

#7 Twelve-Step programs don’t work.

There has always been a divide between two schools of thought on addiction: the scientific community and the recovery community. At least in part because of this divide, there is a lack of scientific evidence documenting how and why the 12-Step program works (though anecdotal evidence is abundant). Science has long dismissed 12-Step recovery, leaving a dearth of data where 75 years of history should provide much more, and 12-Step recovery has long rejected the need for and validity of scientific inquiry. But the necessary conclusion is not that 12-Step recovery doesn’t work; rather, the research, to date, has been inadequate.

It’s unfortunate that 12-Step recovery is widely misunderstood and under-researched. Even less fortunate is the fact that these misconceptions drive people away from the process before they can evaluate whether the program might make a difference in their recovery. Like any single approach to addiction, 12-Step recovery isn’t for everyone. But for those who give it a fair try, the potential payoff is great. Recovery is not just about stopping one isolated behavior (drug use) but learning a new way of life – and this is the real value of 12-Step recovery.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry, and addiction medicine. As CEO of Elements Behavioral Health he oversees addiction treatment programs at Promises Treatment Centers in Malibu and West Los Angeles, The Ranch outside Nashville, The Recovery Place rehab in Florida, Texas drug rehab The Right Step and Spirit Lodge, and San Cristobal rehab for men in New Mexico. You can follow Dr. Sack on Twitter @drdavidsack.

David Sack, M.D. is board certified in Addiction Psychiatry and Addiction Medicine and serves as CEO of Elements Behavioral Health and Promises Treatment Centers.

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