Rehab’s Use of The 12 Step Program

To see a copy of the 12 Steps of Alcoholics Anonymous click here.

The vast majority of addiction-treatment facilities adopt the 12-Step model. Rehab’s use of the 12-Step Program isn’t the only model, but it’s the one most patients encounter. The Steps describe how to build a spiritual program which is what AA says is necessary to live sober.

If admitting you qualify for Step 1 (that you’re powerless and can’t control your drinking or drug use), is the beginning of the solution, learning tools to manage it is the rest of the solution. Raising one’s hand at 12-Step meetings and identifying yourself as a “newcomer” for the first 30 days satisfies the initial requirement and, after getting over the embarrassment, is relatively easy. Learning to live sober is infinitely harder. That’s what the program is designed teach.

It helps you deal with “the committee” of voices you hear in your head, the normal chatter of conflicting wants, needs, and motivations expressing all shades of personality. It helps prevent “spending too much time in your head,” listening to the wrong voices but not being able to help it.

Rehab reminded us constantly that all emotions are legitimate: there are no “right” or “wrong” feelings. But emotions are not created equal. Some are rational, some aren’t. Addicts hear critical voices louder and more often than positive ones, which are fleeting and dismissed. We drink and drug ourselves unconscious to escape those negative voices.

The program is an antidote, a form of mind-training designed to transform our default response to those negative impulses. It’s a mechanism to keep relapse triggers at bay instead of turning to chemicals to cope. Of course, recasting the addict mind isn’t easy. Everything seems to happen so automatically it’s hard to believe you can intervene, that you’re more than just a spectator. You have to learn that you don’t have to accept those negative voices passively; they’re an active thing and it takes action to counter them. That’s what working the Steps is all about.

Though the program does call for a spiritual solution, it isn’t a dogmatic religious doctrine. Rather, it’s styled as “a suggested program for recovery.” This was brought home to me at a meeting where I heard someone say she was grateful they were only suggestions because if they’d been requirements she would have spent all her time trying to get around them.

Step 2 and Step 3 say that God (or the individual’s concept of a “Higher Power,” whatever that is) can restore addicts to sanity if they make a decision to turn their lives over to Him or It. Steps 6 and 7 advise that one ask that one’s personality defects be removed. Prayer and meditation are suggested to deepen a conscious contact with one’s Higher Power (Step 11). (If you have problems with the spiritual basis of the program, click on Doubt a Spiritual Program Works?, “The God Thing,” and Contempt Prior to Investigation.)

The program prescribes sharing a rigorous, ruthless, moral inventory (Step 4) and an informal confessional (Step 5). It suggests that responsibility be taken and amends be made (Steps 8 and 9) to short-circuit the mind jumping from regret, anger, guilt and shame to the relief of a first drink or drug.  It counsels continuing daily ethical reckonings, accompanied by action to atone for transgressions (Step 10) so resentments can’t build up and fester. This provides a constructive way to deal with the “fuck you” impulse to people, places and things which can lead to using. Finally, it recommends carrying the message of sobriety to those still suffering (Step 12).

All these tools teach you how to distinguish rational impulses from irrational ones and to stop yourself from acting on the irrational ones.

How? Practice, practice, practice. Go to AA meetings, share so others can help point you in the right direction. Do the Steps with the help of a more experienced sponsor.

AA groups and individual members were our best resource, rehab said, and we were advised to immerse ourselves in the fellowship, to let the group buoy us until we could tread water on our own. Newly sober, we were still too susceptible to the addict brain to rely on our own devices. Alone, it was too easy to disregard rational plans. When a craving hit, it obliterated the best intentions. At that moment, the mind forgot its rational survival tools (for more, click on Amnesia and Amnesia Explained). It would take time, a lot of time, before we’d be able to cope by ourselves, one of the reasons AA was always described as a “we” program, meant to do with others, not alone. Most addicts can’t master sobriety on their own, we were told, because it’s so difficult to see one’s own irrationality. You need to rely on others who can hold a mirror up to your thoughts and actions and show you the way.

For the next article in the Treatment Series click here.

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5 Responses to “ Rehab’s Use of The 12 Step Program ”

  1. The 12-Steps are not science, it’s faith healing, so why is your website subtitled “Science of Addiction”?

    Now I have no problem with people who believe in faith healing, but don’t foist that belief upon other addicts, and don’t imply that a spiritual program is “science”. It’s not, nor is it even close.

    Thank you

  2. I agree, “the 12 Steps are not science.” But what the science demonstrates is that aspects of 12-Step programs (social support, etc.) can be helpful in treating addiction. If AA isn’t for you, try another program, like SMART Recovery. Thanks for your comment.

  3. Interesting website, but I don’t quite understand your advocay of the 12-Steps as treatment for a biological disease.

    If addiction/alcoholism is a brain disease with a biological component (which is what you appear to strongly believe), how do the spiritual Steps of AA/NA repair that organic brain disease?

    For the sake of discussion, let’s assume no divine deity has miraculously repaired the physical aspects of the diseased portion of an addict’s brain or body.

    I’m not necessarily disagreeing with the disease model, but I don’t understand why a spiritual program would be the treatment for an organic, biological disease?

    For example, if someone had a brain tumor, we wouldn’t suggest that person attend 12-Step meetings in order to remove the tumor and allow the brain to heal. So why prescribe the 12-Steps as a way to heal the organic “disease” of addiction?

    Thank you

  4. I had exactly the same question when I was dragged into rehab, very much against my will. Why prescribe a spiritual program for a brain disease?

    What I learned over many years of studying the science and participating in AA was that aspects of 12-Step programs — especially those that provide social support, like meetings, sponsorship and the like — are therapeutic. If you haven’t read them already, I suggest you look at the articles on love, mind training and social support.

    Repairing organic brain disease, I think, results from two things. First, abstinence allows the brain’s inherent recovery-mechanisms work to regain a more normal balance between the rational and emotional. The power of the “toxic memory” of “drugs as the solution” atrophies over time; breaking the cycle of craving-and-relief (over time) weakens the synaptic bonds that are involved in habit formation generally and addiction in particular. As a result, it becomes easier to resist the emotional pull of cravings and exercise willpower.

    Second, the brain is plastic, it changes to accommodate new experiences and environments. Though drug therapies can change the brain, so too can non-drug therapies. So, for example, talk psychotherapy has been shown to change the brains of clinically depressed people in the same way that anti-depressants do.

    Active sobriety (that is, active participation in 12-Step programs by doing the steps with a sponsor, attending meetings, sharing, accessing social support, helping others, etc.) changes the brain, retraining it. The program acts as a form of habit-replacement therapy, in which emotional needs previously met by drug-taking are now met by participation in the program. Active participation also strengthens the parts of the brain — the Limbic System, including parts of the prefrontal cortex that exercise self-control –that were weakened from substance abuse.

    I don’t think this isn’t only true of 12-Step programs. Other recovery programs (SMART Recovery, Women for Sobriety, etc.), employ different techniques but seek to retrain the mind in a similar way. I’ve known people who weren’t comfortable in AA who benefited from these other programs. So I don’t think 12-Step programs are the ONLY way.

    The problem with the brain-tumor comparison is that whereas a tumor is a an abnormal, out-of-control growth, addiction involves the opposite; contraction of brain tissue that makes the Limbic System (the “emotional brain”) much less efficient. Researchers have demonstrated that addiction results in lesser surface area, volume and density in neurons in the Limbic System. Rather than removing a growth, some addiction therapies seek to make the less-efficient system resulting from tolerance into a more efficient one so the reinforcing qualities of drugs are less salient and alluring.

    Hope this helps, and thanks for your comment.

  5. Thank you for the detailed explanation; you’ve answered a number of my questions regarding this issue.

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