01 Mar Why the 12-step program works
Why the 12-step program works
Look online for the merits of the 12-step program for treating addiction and you will encounter fevered debate. Both advocates and detractors argue with a passion born of the seriousness of the topic itself. For many, addiction is a matter of life and death. ViewPoint Rehabilitation uses the 12 steps as a therapeutic container for helping clients recover from alcohol addiction and reclaim their lives. Within this container, we also use other multi-disciplinary modalities for a holistic treatment model that optimizes the rehabilitation process. Much criticism of the 12 steps are not only based on misconceptions but analyze outcomes divorced from this broader context.
Psychology Today outlined seven common myths about 12-step programs, some of which center on the stereotypical image of a recovering addict as a pathetic lost cause seeking to defer responsibility. Two of the steps to attract the most attention are Step Two, where the person struggling with addiction admits they are powerless over alcohol; and Step One, where they surrender to a higher power.
Invoking the spiritual in the secular world of evidence-based medicine alone is sure enough to create some friction. The 12 steps were originally conceived from a Christian perspective, but they do not impose a particular God or belief system. As David Sack M.D. writes in Psychology Today: “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.” For many, bringing the addiction into a relationship with the spiritual is central to their faith experience of recovery.
Admitting powerlessness, meanwhile, is simply an acknowledgment of the corrosive nature of addiction itself. Brain science attests to the chemical process involved. “From a certain point of view, everything we do is a choice,” writes Gabor Mate in his book, In the Realm of Hungry Ghosts. “It sounds like a cop-out, but in neurological terms, it’s not. If it wasn’t enough that powerful incentive and reward mechanisms [in the brain] drive the craving for drugs, on top of that the circuits that could normally inhibit those mechanisms are not up to scratch. In fact, they are complicit in the addiction process.”
From a psychological point of view, the first two steps help remove the stigma and shame associated with addiction, as well as connect the person in recovery to something greater than themselves – an antidote to the all-consuming self-centredness of seeking the next drink or fix.
One of the effects of serious addiction is the loss of community and friendship, other than those who also abuse substances. In addition, many people from abusive or traumatic backgrounds have never had a sustained experience of nurturing community, a form of alienation that actually creates a pathway to substance abuse itself.
Twelve-step recovery is a peer-support program that directly addresses this absence by placing the person within a recovery community and giving them a social network once they return home. Crucially, the community validates the recovering addict, empathizes with their experience, and offers encouragement for the future.
Both Dr. Philip Flores, Ph.D., a clinical psychologist and author of Addiction as an Attachment Disorder, and Mate write that people suffering from addiction use chemical substitutes for emotional disconnection. “We, as social animals, cannot regulate a central nervous system by ourselves. We need other people to do that,” writes Flores, who adds that 12-step programs help people “break the isolation and to start [to] connect on an emotional level with other people”.
One of the myths that David Sack M.D addresses is the idea that the 12-step movement is a cult that robs the individual of their power, but he clarifies: “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.” This is affirmed by a member, who told Vox: “You could be forgiven for looking at AA as a quasi-religious, spiritual entity. But if you went to 10 AA meetings and listened, you would hear, essentially, cognitive behavioral therapy.”
The federal Substance Abuse and Mental Health Services Administration’s registry of Evidence-Based Programs and Practices list Twelve Step Facilitation Therapy as one of the evidence-based practices of modern addiction treatment. A study by the National Institute on Alcohol Abuse and Alcoholism Project MATCH also states: “By incorporating 12-Step facilitation into treatment, providers can increase the likelihood that patients will continue to improve, even after professional treatment has ended.”
However, according to Sack, research has not given equal weight to psychosocial therapies such as 12-step programs alongside pharmacotherapies. What can be concluded is that it is not necessarily a black-and-white choice between 12 steps or some other modality. At ViewPoint Rehabilitation, our experience shows that residential 12-step programs provided within a broader holistic framework maximizes the efficacy of the entire treatment.