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Article Why 12 Steps work for some people Medical professional have supported the 12 Step approach to recovery from addictions with good reason for a long period. While research continues for other solutions, it is generally recognized that, in the absence of any other alternative, the best advice open to doctors is to suggest that patients join 12 Step groups to help their recovery. Without doubt, practitioners of all sorts have the best interests of their clients at heart and many are closely involved in integrating the 12 Steps into their professional recovery treatment in clinics, hospitals and practices. To help increase patients chances and improve the quality of their lives, 12 Step methods have been combined with other psychological approaches and medication for dual diagnosis problems. Many doctors, however, are still disappointed by the low numbers of alcoholics and addicts who actually achieve lasting sobriety or a satisfactory level of emotional health. Research suggests that for every one person who achieves lasting sobriety, another four do not, despite 12 Step involvement and parallel professional medical attention. Moreover, most alcoholics and addicts seem to live out the rest of their lives suffering persistent psychological problems of one sort or another. Therefore, it might be a good idea to take a fresh look at why some people succeed in the Steps and why so many fail. From this we hope to draw some conclusions, which will improve treatment methods and strengthen people’s recovery chances. Suitability for Success Most people attending AA or an addiction clinic for the first time are anxious, fearful, lonely, shameful, confused, angry and depressed. They lack the inner resources and the ability to cope with the world around them. They are lost, seeking help, feeling abandoned, hopeless and desperate. They have poor powers of judgment and their decision-making abilities are severely impaired. Their sense of self-worth, self-regard and self-esteem is abysmally low. They have no clear conception of themselves and an uncertain sense of self-identity. Very often they are suicidal or unsure of what the purpose of living is. They have hit “rock bottom” as the saying goes. On this basis they are hopefully open and ready to accept unconditionally the advice of doctors and the 12 Step group. As we know, however, the typical patient is rarely as simple as this. Not all accept to attend 12 Step programmes or do so with resistance and skepticism. They may have many of the characteristics above, but still resist the advice of doctors and AA. Of course, denial is the main problem and a lurking belief that they can drink or use again. However, there may also be other factors involved, which shouldn’t be dismissed as just manifestations of denial. Strong personal values such as atheistic or non-Christian beliefs may create resistance to accepting the notion of a “Higher Power” or “God”. Victims of sexual abuse, rape, torture or violence can have difficulties accepting the 12 Step concept of “powerlessness”. Alternatively, they may, despite their condition, still retain a stubborn sense of independence and individuality, which causes them to resist group participation and identification. There are, indeed, people who sincerely wish to stop drinking or using, but who simply will not conform. It would, therefore, seem that it is not enough to for someone to hit “rock bottom”, or just want to recover in order to work the Steps. Those who succeed must not only suffer from severe psychological distress, but they really must have been broken by their addiction. They need to have no potential oppositional values to the 12 Steps or to have at least lost their ability to defend them. Their self-identity, which was mixed in with in with their life style must have begun to disintegrate and their strength of personality be too weak to offer resistance to the better counsel of others. Therefore, those most likely to integrate quickly and succeed better are the ones most ready to agree unquestioningly and submit unconditionally with their doctor and the12 Step authority. Providing Certainty over Uncertainty The mind of the recovering alcoholic, addict or disorder sufferer is extremely confused and their world is falling down around them. They and their lives are unstable, insecure and sometimes dangerous. Above all the recovering person seeks a sense of certainty over uncertainty. They need to find an escape from the whirl of confused ideas and emotions in their heads and have to people they can rely on. 12 Step programs offer practical and spiritual certainty for the lost and despairing. Groups are anonymous, always there for you, with daily meetings, lists of members’ phone numbers, emails and on-line discussions. Moreover, 12 Steps groups are bold, assertive and self-assured about their program. Their claims and language are unambiguous. They tell you that you can only recover with the 12 Steps and that no other method works. They proclaim unequivocally that they are “THE WAY”, the only way. New members are told that as long as they dutifully follow the Steps, refrain from criticizing or questioning, and are prepared to accept the wisdom of others, then they will survive and recover. At the same time, 12 Steps don’t beat about the bush in warning people that if you refuse to follow the Steps, then you will certainly relapse or die. Nothing could be clearer than that. Indeed, such a blunt warning can be very effective in creating fear and conformity. The logic is black and white and totalistic. Creating a New Environment The best way for a new member to succeed more quickly in AA/NA is to follow the dictum of “90 meetings in 90 days”. Indeed, some people end up doing two or more meetings a day depending on commitments. This, of course, is a very effective programming method. The constant repetition of the programme, day-in-day-out, helps condition members to the ideas of and methods of the 12 Step group. It’s a very effective saturation approach, which facilitates the absorption of the “groupthink” and the 12 Step sobriety path, in ways which professional treatment cannot achieve outside of the clinical setting. Furthermore,“90 meetings in 90 days”, means the recovery group can control and direct the individual’s time and environment, so that the member is less likely to fall back into maladaptive behaviors. In this way, former negative social ties are also loosened or broken, as members are encouraged to avoid friends or family who are considered a bad influence. This helps to creating a new parallel (sober) reality for the group member, separate from the outside world, where the member can begin to acquire a new (sober) mind set. Sobriety is, therefore, strengthened by simultaneously loosening the member’s practical and emotional links to the former “drinking” world and strengthening their ties to the group’s new sober environment. The member then starts to unconsciously think in terms of two worlds, in which the sober group world takes precedence. This rapid immersion in the 12 Step principles helps to get the new member operating as a new “Sober Self”, carrying the group mentality with them in the outside world. The “Sober Self” provides members with a sort of psychological cocoon or sober glasses through which to view and react to daily encounters and, therefore, help distance themselves from its temptations. Other members help in this integration process by meeting the new members privately befriending them and going for coffees, where they discuss personal stories and the Step principles and approach. This helps to alleviate feelings of fear, loneliness, abandonment and loss and builds up trust, loyalty and confidence in the group and its members. The new member now feels increasingly obliged to give back something in return by attending and following the programme regularly. The group really begins to become their world, the only world that really matters and so they try harder to be part of the sober world and to remain sober. Furthermore, contact with the group often helps to satisfy members needs to be “loved”, to be understood, cared for and to be accepted. This can stimulate very strong emotional desires in a member to be fully accepted and, therefore, to win acceptance, love and respect, they are unconsciously encouraged to make special efforts to conform, follow the rules and, indeed, stay sober. This alternative support environment becomes much like a new family or the supportive family they never knew. The group provides a sanctuary from a seemingly malevolent and uncaring world. It’s a place without prejudice, where one is understood, cared about and supported. The Group is a protective world and members begin to see themselves as different from other people or “normies” or “civilians” as they call them. Environmental and time control is vital to 12 Step success because it helps to break the individual away from the real world and introduce a new reality. Loosening practical and emotional ties to the outside helps to create alternative emotional bonds and strengthen a sense of belonging to the new 12 Step community. The mind of the recoverer begins to change and his view of himself, family, loved ones, acquaintances and the world in general alters as a result of the immersion process. Immersion in an alternative reality, structure and community is crucial for successful mental implantation of the 12 Step programme. . Reward & Punishment 12 Step meetings are places where sobriety and conformity are rewarded and transgression is punished. Of course, this is never physical in character, just psychological. Members who show they have understood and followed the approach are rewarded with being noticed, smiled at, mentioned, applauded or flattered. And the group often assumes the place that a good or caring family might have in their eyes. Members are even excited and look forward to the parental attention, which might be given at a meeting, especially by senior members. Those who transgress, however, especially without showing remorse, or who question the approach are frowned at, nodded at disparagingly, “tut-tutted” at or rebuked in front of the others. Worse still they may be isolated and shunned. This can be a powerful tool, especially with addicts whose cognitive and behavioral patterns have been dominated by a negative reward and pain relationship. Being rebuked or seeing other people reprimanded publicly, even in subtle, but painful ways, helps to train members to seek positive rewards through following the programme, rather than negative ones. Members, therefore, try harder between meetings to work the programme and stay sober, in order to gain the pleasure of praise, acceptance and support, rather than face the threat of reprimand or ostracism. Naturally most recovering people can’t help having bad thoughts, behaviors or temptations and this is catered for by the Group adopting an especially welcome and caring attitude to those who admit to their transgressions and at the same time humbly ask for forgiveness and support. Only those who show no remorse or challenge the norms of the group are attacked. Consequently, members soon feel able to open up about their difficulties in the form of a confession. Indeed, the more emotional the outpouring, the more it is usually applauded. Confessions about past life acts, transgressions remorsefully admitted and successful stories of following the Steps are the contributions most applauded (even if silently). The self-flagellation aspect in 12 Step meetings is very strong and probably holds significant therapeutic value for relieving painful emotions and feelings. It also allows members to display their fundamental loyalty to the programme and affords an opportunity for them to make a symbolic, ritualistic act of self-submission to the Group. In general, this psychological reward and punishment system helps the Group maintain conformity, cohesion, uniformity and discipline. It helps people stay sober by keeping them in line. Linguistic Programming Group discipline and focus is further reinforced by strict rules forbidding cross talk and debate. Meetings are characterized by one-way verbal communication, where people may speak but not speak to one another. Normally, nobody can interrupt, tell others they are wrong, give advice or comment on what was said. This “regime” keeps minds and behaviors focused on the 12 Step programme and avoids unnecessary critiques, confused ideas and deviant misconceptions, which might undermine the unanimity of the Group and its path to sobriety. A rotating chair helps to allow participation and unnecessary, irrelevant discussion of democratic practices elections or leadership. This all help to keep out unhealthy foreign ideas and maintain single-minded focus on the 12 Step programme. Members are keen to emphasize that 12 Step meetings are not therapy groups. Members should simply listen to how others apply the Steps to their lives and copy them. Another very useful tool in the learning process is the armory of slogans, sayings and quotations from the Big Book, which members learn by heart and are able to repeat at the right moment; “Easy does it”, “ A day at a time” ”You are not required to like it, you're only required to DO IT” “Don't take yourself so damn seriously!” “The time to attend a meeting is when you least feel like going” etc. The great thing with these is that can be used to stop “stinking thinking” right in its tracks. AA slogans are formidable thought-stoppers. No need to think any further, the issue is resolved. Indeed, “don’t think so much” is a retort often leveled at new members in 12 Steps. This has now also developed into a virtual secret language or “groupspeak” in the 12 Step movement has helped to cultivate a unique identity for the Group, which reinforces their feelings of being special and separate from “normies”, “civilians” and the rest of society. Mentoring In order to help members integrate and work the programme more quickly, 12 Step groups have a unique mentoring system called sponsors. Often newly sober members have low self-esteem and poor decision-making abilities. Indeed, the 12 Step programme program emphasizes that alcoholics are “powerless”, harbor “sever defects of character” and suffer insanity. It is no wonder then that recovering people have difficulties dealing sensibly with the problems of everyday life. The sponsor, therefore, may advise new member on taking important decisions in their lives. They relate the 12 Step programme to the interpretation of daily life in a way the group meeting cannot. Sponsors help members to absorb the ideas and methods of the program more quickly and thoroughly by providing more intense, accelerated, personal guidance. Also on the spiritual plain, if the new member is having problems “turning their will and lives over to the care of God” and have not yet had a “spiritual awakening” the sponsor can substitute as a temporary alternative icon and model for personal development. Mystique and “Groupthink” AA, especially, has developed a mystique around itself. Its is necessarily something of a secret society, not only because of its anonymity, but because of its missionary character (internally) and its concepts of “Higher Power”, “12 Steps”, secret language, “spiritual awakening” being “THE WAY” and a membership which views themselves as a sort of “chosen people” among alcoholics in recovery. This mystique creates a sort of “groupthink” or “Group Self” for members who fuse their sobriety and recovery with the defense and well-being of the group. Somewhat like Masonic lodges, they can enter a group on the other side of the world and speak the same language, know the same gestures, follow the same rituals and have the same lifestyles. Moreover, it has no need for a single Guru, which would , in fact, open it up to the danger of human fallibility (relapse, scandal, etc). “Luckily” it has a dead leader, Bill Wilson, whom members can venerate and the hallowed Big Book can be cited for the scriptures. This mystique and “groupthink” allows the Group to survive and grow more like an organism than an organization, continually replicating and reproducing itself, even where older members fall by the wayside. It is unique, has been perfected over 60 years by AA and something which cannot be replicated by professional practice. Instead most professional help maintain AA and other 12 Step groups by basing or integrating strong elements of the 12 Step programme into their therapy groups and methods, inviting 12 Step groups to hold meetings on the premises and by strongly encouraging patients to join. Professional treatment often acts as a bridge to 12 Step membership. Moreover many treatment facilities and staff (many of whom are in recovery and themselves members of a 12 Step programme) act as enablers for 12 Step programmes, almost to the level of being recruitment officers. Helping AA or NA and giving their official sanction is seen as a natural continuation of the treatment process. “Stepping Up” the Recovery Process In Steps 1,2,3, successful integration begins when the new member accepts and acknowledges their addiction or disorder. A member must break with Denial. Successful 12 Step members admit they are “powerless” and that their lives are “unmanageable”. They declare belief that a Higher Power can restore them to “sanity” and agree to turn their will and lives over to God. Although it may not be accepted or customary practice in professional circles to tell a patient that they are “mad”, this aspect of the 12 Step approach does seem to have the desired effect in helping people to understand and, indeed, separate from their addictive past. It avoids psycho-jargon and complicated explanations and simply put it says “you were mad and now will be sane”. Moreover, it helps members to put their past lives in a negative perspective, in order to better start a new one. To do this successfully, members are expected to give up their “egotistic” will, recognize their inability to manage themselves and their lives and, instead, hand it over to “God” as they understand Him. Very often members are, in fact, encouraged to consider the 12 Step group itself to be “God” or the “Higher Power” and this works very well in cultivating the unquestioning, faith, trust and devotion needed to successfully follow the 12 Step programme. For a person to accept that they are insane, powerlessness, that they can no longer manage their lives, and must give control over to someone or soothing else is an incredibly humiliating act for any human being. It can be debasing, causing extreme self-doubt, undermining self-confidence, self-identity and core conception of Self. It is often explained in terms of breaking lingering illusions in the old alcoholic self and being vital before real recovery can begin. It is probably serves symbolically as an act proselytism before the Group, a declaration of one’s psychological preparedness to give control of one’s life and guardianship of one’s sanity to another authority. To make this easier for non-believers members are asked to think of the Group itself as the Higher Power. In most professional therapy settings this type of approach would be avoided, but it seems to be generally accepted by professional when it comes to addiction. 12 Step groups are, of course, keen to emphasize that they are not therapy groups anyway. Steps 4, 5 and 6 take the recovery process further. By making a searching and fearless moral inventory” the “insanity” of their earlier lives is revealed and usually accompanied by considerable feelings of shame and guilt. Guilt and shame help to break illusions in the past and humble members before the real consequences and gravity of their illness, the hurt done to significant others and before the Group. By admitting to God, ourselves and others the exact nature of one’s wrongs and of recounting this past in front of the Group, the member is able to undergo a sort of purging and purification ceremony, which helps them to prove to themselves and the Group that they are ready and willing to submit to the programme. Furthermore, in order that the actions of their drunken or using past can not be misconstrued as simply the toxic effects of mind-altering drugs, all members are asked to accept that they suffer severe character defects (Step 6). Again, in the clinical setting, a professional might not normally tell a patient that they had a bad or defective character, but in the field of addiction and 12 Step programmes, this is normally accepted or unchallenged as an important technique in therapeutic growth. It seems to be effective in helping members to loose faith in their Self and undermine any existing illusions about their former personality or values, which could be barriers to accepting the treatment programme. Attacking one’s character again creates considerable self-doubt and identity confusion. It is tantamount to someone admitting that he or she is a bad or unworthy human being. It is again often degrading, but at the same time very useful in helping the person to come to accept the new and better character or personality that will be formed through the help of the Group. Steps 8 and 9 (making a list of hurt people and being willing to make amends) are a continuation of this process of burying the old personality and finding absolution through cleaning the slate in order to start anew. This also prepares the member for Step 10, (“continued to take personal inventory and when wrong promptly admitted it”), which commits the person to continuous critical, self-examination and a willingness to accept criticism and correction. Clearly an on-going personal inventory helps to maintain the Group’s power over the individual’s daily thoughts and behaviors and is necessary to ensuring they don’t stray from the programme’s path. It helps to stop people become complacent, slipping into former character or personality traits and keeps them developing along the new path of Sober Self prescribed by the Group. Finally, Steps 10 and 11 are concerned with spiritual awakening and following the 12 Step approach in all aspects of life. The aim is to “improve conscious contact with God”, “praying for knowledge of His will for us and the power to carry that out”. Of course, nobody knows exactly what the scientific, medical or therapeutic value of spiritual awakening is, but it clearly does seem to help many people. Obviously, when people feel they are doing the work of God, then they feel much more confidence, a sense of purpose and meaning. We can see the effect this has on the personalities of members of other religious groups and movements. Moreover, people who are “spiritually awakened” by a group, feel great loyalty to it, commit a great deal of their lives and time to it and follow more strictly its teaching and aims. They often feel at one with the group and see their person and life self-actualized, affirmed and given value through being a member. The member finally adopts completely the values and morals of the Group as their own and seems to self-actualize their own new identity in their oneness with the group and its values and beliefs. Any professional can see this manifested by the way in which successful AA members generally adopt similar mannerisms, voice style and demeanor. The “winner” has essentially succeeded in riding himself of the greater part of his old, addictive personality, has purged himself of a defective, former character and replaced it with a new sober, AA personality. The final words of the Step12 are a call on members to practice 12 Step principles in all their affairs. Members are called on to use their 12 Step values and beliefs in all dealings with the outside world. Seasoned members are somewhat like Christian soldiers carrying out God’s will, as well as helping other alcoholics or sufferers. This sense of mission helps provide the confidence and morale needed for members to get a new foothold in the outside world and become functional, socially acceptable members of the community. And, after all, this is the main aim and purpose of the professional treatment community. Summary 12 Step groups stress that the only qualification needed is the desire to stop one’s dysfunctional behavior. But, clearly, one must also be willing to submit to programme, in order for it to work it successfully. 12 Step membership means adopting a new set of core beliefs. Individuals must be ready to embrace the idea that they suffer “character defects”, “insanity” and “powerlessness”. They must be ready to turn themselves over to the will of God, in order to recover.12 Step programs seem to work best if people are already at psychological “rock bottom” and are open to embracing totalistic solutions. Moreover, integration and progress seems to be easier when one has also lost faith in any previous values and beliefs, which might be barriers to accepting the 12 Step programme. Alcoholics and addicts are clearly very disturbed people. Recovery demands the sort of discipline normally only found in military, authoritarian or cult environments. Professional centers can’t maintain that over a long enough period and would face legalistic or other problems if they did. Moreover, we also face the problem that once denial is broken, people can fall apart. Their personalities, identities and sense of self can become fragmented and distorted. Piecing a person back together is not always easy and sometimes there doesn’t seem to be a lot to work with. Moreover, some people have personalities or “character defects” which don’t fit in with the new model offered by the 12 Step program. Often old parts or the whole old personality need to broken off, demolished and swept away. This is especially the case with people who harbor non-religious, non-spiritual or diverse cultural values and beliefs antagonistic to the 12 Step program, as well as highly individuated people who have a strong personality, sense of identity and sense of Self, who may have developed addiction later in life and find it hard to fit into the milieu and “regime” proposed by the 12 Steps. Breaking down people like this is not easy and rarely succeeds through direct confrontation. AA experience has shown that many will “come to believe” and rather than overtly forcing people, it is better to leave options open like choosing another temporary symbol for God, telling people to take what they want and disregard the rest, and by stressing that everything is “suggested” and voluntary. 12 Step groups are very patient. They know that when people “keep coming back”, the power of the collective experience and the psychology of the group dynamic can eventually break down personal resistance and even the most ardent skeptics can be turned into zealous supporters of the program. Many AA members are probably able to maintain sobriety for the same reasons that members of certain religious orders are able to endure lifelong celibacy or abstain from vital foods banned by their religion. Strong belief and value systems, especially spiritual or religious ones, are great motivators of personal change and spiritual awakenings often provide the inspiration to undergo pain in the service of God's will. Where such group belief systems are totalistic and inflexible, the collective group pressure to conform and follow can become irresistible for many members. Also a system of psychological reward for willingness and execution of the programme, combined with the threat of reprimand, humiliation or ostracism for acts of transgression or opposition helps to encourage dedication to the programme and the Group. Because of the special character of addiction, the 12 Step approach is much better adapted and suited than other religious or spiritual groups, since abstinence is its key ritual. Moreover, it simultaneously provides an alternative value and belief system for the personality and identity vacuum or confusion suffered by many newly sober alcoholics and addicts. At the same time, the program is sufficiently flexible for use on more resilient individuals, where gradual personality and identity deconstruction is needed. The program's efficiency is largely due to the fact that members are rarely conscious of this process and, in fact, feel that they are actually choosing to internalize these beliefs themselves, of their own free will. The personality reconstruction which takes place in 12 Step groups, in many cases, goes beyond simply achieving sobriety and replacing the alcoholic Self with the sober Self. Instead, participation can lead to a whole new personality, identity and Self being created based around the Group ideas and outlook. A sort of 12 Step Man or Woman, so to speak. Copyright ©2000 (SOS Sobriety Europe) All rights reserved Revised 5 November 2000
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