Trauma and the 12 Steps: A Synthesis Whose Time Is Now

For many people a trauma-informed approach to the 12 Steps can be critical.

Posted Jun 29, 2020

North Atlantic Books
Source: North Atlantic Books

“This is not an either/or dynamic—it’s both/and.” ~Jamie Marich, PhD

Over the last two decades it has become clear that a significant percentage of people who struggle with addiction to alcohol and other drugs have had traumatic experiences. Based on different scientific studies, the percentage of people with both trauma and addiction ranges from about 40 percent to as high as 80 percent, with the figure being somewhat higher for women than for men. The connection between trauma and addiction is reciprocal: trauma increases the risk of developing addiction and active addiction increases the likelihood of experiencing trauma. 

Using alcohol and other drugs can take the form of self-medicating in response to the intrusive memories, distressing thoughts, and painful emotions of traumatic experiences. In this way, addiction may begin as a coping mechanism and evolve into an emotional survival strategy. Conversely, the vicious obsessive-compulsive circle of alcohol and other drug use impairs judgment and decision-making in ways that often lead to risk-taking behaviors and puts people in situations that greatly increase the likelihood they will be traumatized or (if they have been traumatized previously) re-traumatized.

Because trauma and addiction are prevalent co-occurring disorders, increasingly professional treatment settings are attempting to address them as such. While there are dramatic differences in the breadth and depth of these efforts across providers and programs, more and more there is an understanding that it is critical for addiction treatment to be fundamentally trauma informed. 

Arguably, more people have been helped to achieve and sustain recovery from addiction through 12-step programs—most notably Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)—than any other method in history. This notwithstanding, many people struggle with, have negative reactions to, or have had negative experiences with 12-step recovery programs. Common criticisms include that: the language and approach are too old-school, the emphasis on spirituality too limiting, the intermittent use of the g-d word too off-putting, the methodology too narrow, or the setting too cliché. 

Moreover, because of their laser-like focus on addiction as a disease unto itself, these invaluable mutual-aid resources have historically underappreciated the effects of adverse experiences like trauma. Advances in addiction medicine and treatment and trauma, and overall strides in inclusivity need to be integrated into modern-day 12-step recovery programs to reflect the latest research and what it means to live with an addiction today.

This is the focus of the latest book by Jamie Marich, PhD, a clinician in long-term 12-step recovery herself, who travels internationally speaking on EMDR therapy, trauma, addiction, expressive arts, and mindfulness while maintaining a private practice in Warren, OH. She is the author of seven books, including EMDR Made Simple and Process Not Perfection: Expressive Arts Solutions for Trauma Recovery, as well as co-author of EMDR Therapy and Mindfulness for Trauma Focused Care. (Full disclosure: Dr. Marich is a colleague and friend with whom I’ve collaborated on several projects, including Process Not Perfection on which I was lead editor.)

Trauma and the 12 Steps: An Inclusive Guide to Enhancing Recovery (published by North Atlantic Books and available 7/7/2020) builds necessary bridges between the 12 Steps and the core components of 12-step programs and state-of-the-science developments in trauma-informed care. 

Written inclusively for clinicians/therapists, sponsors, and those in recovery, Trauma and the 12 Steps:

  • Explains how trauma impacts addiction, recovery, and relapse
  • Celebrates communities who may feel excluded from 12-step programs, such as atheists, agnostics, and LGBTQ+ folks
  • Welcomes outside help from the fields of trauma, dissociation, mindfulness, and addiction research
  • Explains the differences between being trauma-informed and trauma-sensitive
  • Discusses spiritual abuse as a legitimate form of trauma that can profoundly impede 12-step and other spirituality-based approaches to healing

Importantly, the book includes a chapter on trauma specific to racism, oppression, and discrimination—written long before recent/current events brought this topic into mainstream consciousness. It speaks to the intersections of addiction, trauma, identity, and systems of oppression.

As Dr. Marich describes, this a book for people who’ve been put off by or conflicted about the orthodoxy and dogmatism that can characterize 12-step programs. It does NOT oppose 12-step-oriented recovery, but rather supports it with certain adaptive trauma-informed modifications for those who need it based on their past experiences. All too often there is harmful rigidity on the part of both 12-step and professional treatment communities that leads to mutual rejection. “We need to honor and respect the 12-step approach and, where needed for individual engagement and healing, enhance it.” 

“There are numerous reasons for recovery communities to embrace (these) trauma-sensitive approaches. The most obvious is that many individuals in recovery affected by trauma return to their addiction of choice. If you have spent any time at all working in a treatment center or around twelve-step meetings, the unhealed trauma-addiction connection is obvious. These individuals often find it difficult not to be overwhelmed by the shame-based ideologies they acquired due to unhealed trauma, while trying to address the past and take appropriate responsibility for their actions." (From Trauma and the 12 Steps, Ch. 1)

Dr. Marich first self-published Trauma and the 12 Steps in 2012. In this updated and revised edition, she skillfully weaves together her personal history, deep hard-won insights, and vast professional experience, with client anecdotes and extensive research to articulate the art and science of multimodal trauma-informed care and how it can be actualized in the context of both addiction treatment and twelve-step-oriented recovery. The result is a volume that will be of great benefit to clinicians and other addiction treatment professionals, trauma survivors in twelve-step recovery, and anyone challenged with co-occurring substance use and trauma. This work embodies the essence of Step Twelve as well as one of the foundational spiritual principles of twelve-step recovery—service to others.

Copyright 2020 Dan Mager, MSW

Author of Roots and Wings: Mindful Parenting in Recovery and Some Assembly Required: A Balanced Approach to Recovery from Addiction and Chronic Pain