12 Step Programs as Efficacious for Recovery

Charles J Popov

University of Georgia

12 Steps Programs as Efficacious for Recovery

Introduction

Searching online, I found and attended the 730-815 am AA open group at the Newnan City Church in Newnan Georgia. I arrived at the “Early Bird” meeting a few minutes early and was greeted by about 20 people who acted like they already knew me, as they were very friendly and welcoming. The only prior experience I had to AA was graduate school assignments and the online venue www.intherooms.com.

Review of meeting

Promptly at 730, the group leader said, “Good morning, everyone, this is the regular Early Bird Meeting of Alcohol Anonymous, and I am _____, and alcoholic, and your group lead.” Then he led the group in serenity prayer, and gave a short explanation of AA.  Another person read excerpts from Chapter 5 of the Big Book explaining “how it works.” Still, another person read the “promises” of AA. The lead then asked any new people to introduce themselves, and that this was optional. Finally, the chip system was introduced (a white chip for any new person that is sober for one day, and various other colors for additional days of sobriety up to 1 year). A person responded and was cheered and hugged.  Announcements were made, and the lead introduced a topic for discussion along with parameters of decorum and protocol. Discussion ensued by different participants, and promptly at 815, the meeting closed with everyone taking hands and reciting the Lord’s Prayer. Afterwards there was much friendly dialogue amongst the group, and I was thanked for attending.

Relationship to course content

Historical context: To adequately observe, analyze, and relate the experience to coursework, a brief history of AA is helpful. Founded by two men in 1935, the roots of AA are based on the spiritual and moral models of addiction, and later, incorporated the disease model (verbiage used by a non-alcoholic doctor who joined and become sober). AA has grown to over 3 million international members. From its inception, the main leader (Wilson) believed that his sobriety was founded upon spirituality, having after many failures of relapse, an experience of intense euphoria (“bathed in a white light”) in which his obsession with alcohol was lifted, and no longer had a compulsion to drink (Sherwood, 2023). This experience got me thinking about how this venue compares with our assigned readings: The SOS (secular/nontheistic) approach that does not identify with the “superstition” about God, but still employs some AA principles, the SMART (CBT) approach that is more treatment oriented, Moderation Management (behavioral), identified as the most researched approach to controlling one’s relationship to alcohol, MDFT (substance use is functional within family systems), and CRA (behavioral). All these approaches, like AA, emphasize the importance of social connection, but AA emphasizes the spiritual aspect saliently efficacious.  However, social interaction and sharing (“sharing my experience, strength and hope”) with another human being runs a close second.  Wilson, after many relapses, experienced a dramatic change (“white light”), after conversing with yet another alcoholic doctor who he found to be enthused about his experience (not as transcendentally dramatic), and noted that the conversation assisted him in maintaining abstinence (Sherwood 2023).

Observations: This brief history, and my meeting attendance, raises observations of note about AA. It conceptualizes the model(s) of addiction, elaborating on the spiritual and the disease aspect; and furthermore, that relapse in recovery is expected. Noted in one study, another relevant aspect to course work is that AA is the most prevalent form of support for people seeking help for AUD, and facilitates support for recovery, collaborative support during treatment, and aftercare (Beasley, 2023). As was further shown in this study, this can be realized through religious practices. Unlike the above approaches cited from our class readings, this study also points out the importance that spirituality emphasized in AA promotes happiness and optimism, which in turn, is assistive in recovery.  Relationships within AA provide members with the opportunity to learn sobriety from each other, and spiritual growth is the framework for building mutual trust, support, and open-to-learning ties within AA sponsorship.   In the process of mutual exchange, people can learn ways to maintain alcohol abstinence and build an optimistic attitude. In this relationship, sharing experiences and giving examples represent chances to model effective pro-abstinence and optimistic cognitive schema and behaviors.

Implications for practice

The main aims of AA are to stay sober and to help other alcoholics achieve sobriety (Alcoholics Anonymous 2001), and ultimately this is the goal for clinicians in working with persons with AUD.   In AA, this mutual exchange plays out in the sponsor/sponsee relationships in working the 12 Steps and modeling of abstinence and spiritual growth (Mickiewicz, A., 2022).  Likewise, the astute clinician can work collaboratively with these principles to assist the client in their recovery. Furthermore, I believe clinicians can effectively combine therapeutic actions and self-help group encouragement to yield higher success rates (Mickiewicz, 2022).

Micro level: 12 Step groups are a salient part of the individual’s recovery process.  Glaringly obvious in this group observed, as well as others I’ve attended, is the emphasis on inclusivity regardless of race, social class, sexual orientation, criminal past, etc., and that the only prerequisite for attendance is a desire to stop using. Furthermore, AA literature emphasizes the pursuit of support from a “Higher Power”, and that spirituality may indirectly increase abstinence by increasing 12-step involvement, degree of affiliation, and engagement in various 12-step practices (Beasley, 2023). As a clinician who is recovering, I am convinced that the need for spiritual experience is essential for my recovery. Self-knowledge or knowledge in general is not sufficient. I also believe, as did Wilson, that the determination of what that looks like should be left to the individual. One Polish cross-sectional design study differentiated between religiosity and spirituality, and that the spirituality influences the well-being of recovering alcoholics.  This is in keeping with the traditional AA view, as the essential element in recovery (Mickiewicz, A., (2022). Valid and reliable assessment tools, such as the IAA-SF measure important constructs (i.e., adherence to principles, social interactions, spirituality) in recovery (Beasley, 2023) and these aspects combined with therapeutic actions can yield better effects than using only one form of support. At the end of the day, I concur with our reading this week that both self-help and group therapy are complimentary.  The writer of one of our articles (Washton, 2014) noted that both are essential (one can’t be substituted for another) as AA type groups don’t offer focus on the details of individual, and direct feedback is not given in these venues.  I disagree, as this important aspect for recovery can essentially be experienced with a sponsor in effective step work. 

Mezzo level: Within the community, identifying, coordinating, and resourcing persons with the 12 Step program involvement, and working collaboratively with these groups, can fill a potentially important role for the clinician. These experiences not only help the individual with recovery but connect them with existing agencies and organizations providing food, housing, job opportunities, etc., through the networking processes that naturally take place in these contexts.

Macro level: As a clinician, and having been a pastor and Army Chaplain, I am impressed by the way that the clinical and ecclesiastical communities have embraced the AA concept. Regardless of past differences, the mental health field (agencies, individual providers, etc.) usually encourage AA involvement in treatment plans, and many churches allow AA groups to function on their premises. We have learned historically that legislating sobriety does not work (i.e., Prohibition), and has even caused criminality, and that being “tough on crime” and “saying no to drugs” (and alcohol) has ostensibly filled our prisons with too many comorbidly diagnosed “criminals.” While the AA approach has had many criticisms (i.e., brainwashing members into powerlessness, promoting religion, uncontrolled clinical testing), to name a few,  the success rate of AA is as high as prestigious medical approaches, and is considered a major turning point in American history (Sherwood 2023). As such a catalyst for recovery success, advocacy for legislative change towards implementing these evidenced based programs more ubiquitously within existing societal systems should be undertaken.  One study (using an exploratory and principal axis factor analysis, correlation, and logistic regression with two unique and diverse samples were collected from a northern Illinois sample of 110 post-treatment adults and cross-sectional data were from a random sample of 296 recovery home residents in the United States), noted that members of 12-step programs appear to have a greater likelihood of abstinence than nonmembers after formal treatment (Beasley, 2023).  Longitudinal data points out that more involvement in the 12 steps is related to better outcomes among AA members, including more post-traumatic growth, social support, and gratitude, as well as less stress and physical health symptoms (LaBelle & Edelstein, 2018).

Personal Reaction

As a clinician, I can see how this social interaction can be helpful for my clients in recovery. This experience didn’t change my mind on any issues, but served to strengthen my view that programs/interventions should consider the construct of spirituality in recovery.  I personally have no problem with the Higher Power concept, but I need to be sensitive to others that may.  As I already embraced the disease concept of addiction, this was only expanded upon through my attendance in this meeting. Change is a process (i.e., transtheoretical model), and this process can be facilitated within a non-judgmental, accepting environment like AA. Most importantly, I was reminded that we need other people in recovery. Many in recovery are coming from adverse child experiences (ACE) and other trauma, as well as dysfunctional and lacking social supports for which AA can provide new and healthier models for recovery. I am not sure about some of the wording of the Big Book (i.e., referring to alcoholics having an “allergy” as we know now that while there are underlying pathological mechanisms, an allergy is not a correct explanation), the emphasis on labeling oneself a socially etymologically derisive term like “alcoholic” (understanding that this acknowledgment of total loss of control over alcohol is essentially a key aspect of AA, and needful for healthy recovery, I have embraced it), and the focus on identifying and removing “character defects” (just not sure if this is correct, or if we should be identifying and individuating these “shadow” aspects of our ego in a Jungian fashion). Concerning relapse, I like AA’s acknowledgement of a slip or relapse being not a complete starting over, but a gaining of new knowledge for further successful recovery.

Conclusion

AA 12 step groups are an important component to recovery, emphasize the importance of spirituality and connection, are not at odds with most other treatment approaches, and can be effectively implemented on the micro, mezz, and macro levels of social work towards efficacious sobriety.  

References

Beasley, C. R., Labelle, O., Olson, B., (2023). The involvement in alcoholics anonymous

      scale- short form: Factor structure & validation. Substance Use and Misuse, 58 (1), 119-128.

Mickiewicz, A., (2022). Underlying the indirect links of religious and spiritual involvement

     with the happiness of alcoholics anonymous. Religions, 13(853), 1-12.  https://doi.org/10-  

     3390/rel13090853

Sherwood, M. A., (2023). Formation of alcoholics anonymous. Salem Press Encyclopedia, 1-3.

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Washton, A. M. (2014). Group therapy for substance use disorders. In G. Gabbard (Ed.), Gabbard’s

     Treatments of psychiatric disorders (chap 58). American Psychiatric Association