When the 12 Steps Fail: Part I
This article is in no way an effort to bash the 12-steps, but rather to give further guidance for clients that seem to need something more. 12-step programs are used nationally in most substance abuse treatment centers and has been for a very long time. It would be a lie to say no one ever benefited from 12-step programs, in fact, many people who once had addictions credit the 12 steps for their recovery process and success.
Which is why it is confusing to see the success rate is astonishingly low; 5% to 10% in a 2014 statistic. So, what should you do when the steps fail to work for your client? Even though many scholars and theorist have conflicting views about this subject, we focus on Dr. Lance Dodes, MD. He has helped shine some light on why the 12-step program is outdated and why it often fails to create long-term change.
Dodes cites addictive disorders as being psychological and classifies them as compulsions. Further, Dodes considers Alcoholics Anonymous (AA) to be “bad science.” His book, The Heart of Addiction, has been making waves in addiction treatment and causing many to reconsider the approach to treatment through legitimate science.
The Big Book (AA) text was written in 1939 by Bill Wilson, a businessman, and Dr. Bob Smith, surgeon. Wilson’s personal life following the writing of the AA text would surprise those who do not know the details. It is cited that Wilson advocated small doses of LSD to overcome depression and alcoholism after an experimental period in 1956 (Hill, 2012). I wonder how many substance abuse treatment centers are experimenting with this type of treatment today? Who knows, maybe Bill Wilson was on to something. We must admit the limitations in an approach in order to continue progressing. It is also vital that we take into account the uniqueness of each individual seeking help from addiction.
Below are 3 reasons I would like to discuss from my own point of view why 12-step programs are not suitable for everyone. By getting the conversation started to discuss a summary of limitations, it would be interesting to know what other practitioners and professionals think.
1. Unrealistic Expectations and Fear
Imagine you have been sober for 6 months. Life is going great, no more days vomiting in the sink, no more withdrawals, and a slew of additional benefits to go along with it. Now, you’re at a dinner party with friends for a wedding and you have one glass of wine. Does this constitute as the first step to a downward spiral? I think......Absolutely not!; however, according to Alcoholics or Narcotics Anonymous, this is time to start over.
Psychology Today writer, Marc Lewis, PhD, cites a possible specific type of Post Traumatic Stress Disorder (PTSD) brought about by 12-step programs (2013). One pill, one glass of wine, anything constitutes as a failure to work the program (12-steps). It’s very similar to the concept of, "religious guilt." Lewis cites, "Many people who have been through 12-step programs may constantly feel similar symptoms experienced by those with PTSD." Basically, to stay clean, stay scared. Sadly, this could be the best option for those with very long bouts of addictive behavior. Thoughts?
2. The Steps May Not Help Trauma Victims or Those with Co-Occurring Disorders
The steps have been modified in many different ways to seek “freedom from resentments.” For many who attend 12-step programs, the program itself proves to be beneficial in revisiting past events that have caused great turmoil. Now, if we take into account severe trauma, the steps are not equipped to treat it. A therapy such as EMDR may be able to assist a client in treating their trauma in addition to a 12-step program with greater positive results. Intense trauma remaps the brain and must be properly addressed and treated through evidence-based interventions. Also, I feel the 12-steps found in AA/NA are not equipped for treating co-occurring disorders.
3. Lifelong Identities Inhibit Growth
Let us think for a moment of the many young adults who enter substance abuse treatment every year. In fact, let’s consider all ages of people who enter treatment. If an entire group of people are at a substance abuse treatment center, why should anyone identify as “alcoholic” or “addict?”
It is fairly straightforward why they are there: an addiction. To spend years post-treatment identifying as an “addict” seems to be troubling to me, especially considering when we think about someone who is 20 years old. I feel it is time to focus on a holistic healing of a person rather than a label to stamp on them. Which resonates more with recovery?: “Hi, I am Bill, and I am an alcoholic” or “Hi, I am Bill. I once struggled with alcohol addiction.” Let us separate the disorder from the person.
Closing Statement
I would like to close this first article included in a series of articles by saying this:
Addiction is a complex disorder and it can be treated in various ways. Just as cognitive behavior therapy (CBT) is unable to work for everyone and every disorder, the same is with addictive disorders and AA/NA. Importantly, I feel an individual struggling with an addiction deserves a much deeper analysis of their life found through a supportive therapeutic alliance.
The 12-steps are always an option and a vast amount of resources are available using the method; however, to accept the method as a catch-all intervention is a falsehood and disservice. In the next article of this series I will be examining other weaknesses found in the 12-step models and also the strengths within it.
Stay Tuned…
Mikkel
References:
https://www.theguardian.com/science/2012/aug/23/lsd-help-alcoholics-theory
https://www.psychologytoday.com/blog/addicted-brains/201301/does-12-step-treatment-work-inducing-ptsd
http://www.wbur.org/npr/291405911/the-sober-truth-debunking-the-bad-science-behind-12-step-programs-and-the-rehab-