By Larry VanderPlaats, LMSW, CAADC
When asked to write an article on whether there is still place for Alcoholics Anonymous (AA) in the treatment of substance use disorders, I became a bit anxious. As a therapist who is also a recovering person, however, I feel qualified to address this subject. I do know that some professionals in the mental health field and sometimes those in the general community have a bias against AA.
The organization and its principles have been viewed as an unsophisticated, simplistic intervention where religion (disguised as the Twelve Steps) is forced on the unsuspecting client. From my perspective, the Twelve Steps of AA are the true foundation of recovery and are absolutely critical in maintaining long-term abstinence. Therefore, treatment facilities that do not incorporate them into their treatment programs are remiss.
The steps to recovery
There are 12 steps to recovery. They start with the admission of powerlessness over alcohol and other drugs - acknowledging that life has become unmanageable. They end with the realization of having had a spiritual awakening and the recommendation to help others who are still suffering. In other words, a self-focused, out-of-control individual who is geared toward short-term, immediate gratification does a complete, 180-degree flip-flop in worldview and becomes concerned with others rather than self. A miracle?
Those recovering in AA would say “Yes.” My sobriety, my serenity are indeed miracles. The person struggling with addiction is filled with a deep sense of guilt and shame resulting from the huge gap between his or her values and behavior that invariably develops from living a life based solely on self-will. He or she attempts to hide these feelings from self and others with a highly developed denial system. Efforts to break this denial system are usually met with an array of defense mechanisms, including rationalization, self-righteousness, and minimization. Only when the internal pain of guilt and shame becomes greater than the pain caused by external consequences (“hitting bottom”) will the addict abandon his or her alibi system and seek help.
Therapy, in its initial stages, must assist the person in reaching the conclusion that any life managed by self-will is doomed to failure, and that there is an alternative that provides hope for the future.
Every person who has honestly inventoried his or her life can only come to one conclusion. “We could wish to be moral. We could wish to be philosophically comforted. In fact, we could will these things with all our might, but the needed power wasn’t there. Our human resources, as marshaled by the will, were not sufficient. They failed utterly.” (Alcoholics Anonymous, 1976, p. 45)
Therefore, a power greater than ourselves must exist if there is to be hope for the future.
The Second Step of Alcoholics Anonymous suggests we come to believe this very fact. We do so through observation. We listen to the strengths, hopes, and weaknesses of others who have gone before us. Because of their compassion, acceptance, and desire to help us, we start to realize we are not so unique, and they are not so powerless anymore. In fact, we see they are not drinking or using and they are peaceful. Suddenly we find a glimmer of hope that we, too, may be able to find peace. We also get our first awakenings about how wonderful it can feel to make a connection with another human spirit where there are no strings attached. This connection to fellowship, in many cases, is the first positive contact with a higher power and the beginnings of hope.
In Step Three, it is suggested we make a decision to turn our will and life over to the care of this higher power. When we do so, we find our sanity returns. Many of us - in fact, all of us who diligently work this program find that after making this step, it is next to impossible to drink. This truly is a miracle of healing. I, who could not say ‘no’ to a drink, now cannot say ‘yes.’ Entrusting your sobriety to the covenantal relationship with God and others is like putting your money in the bank. It is only in jeopardy if taken out of the bank. Our sobriety and peace of mind are secure and protected when in the care of our Higher Power and those in the program. They are only in jeopardy if we take them out of that care.
Who is right?
The testimony of countless persons support what a 1999 study by the Stanford University School of Medicine suggested: Twelve Step programs work. People who use them are more likely to remain sober regardless of their religion. Yet the use of the program in formal treatment settings is being challenged. It has been reported that a 59-year-old agnostic ordered to attend AA after a drunk driving conviction, instead took 30 days in jail. He then filed suit against the judge and a treatment center, claiming they violated his First Amendment rights. His complaint was that they were suggesting he could not depend on himself and were asking him to put faith over science. He was unwilling to do that.
Treatment programs employ many other interventions besides AA. Rational Emotive Behavioral Therapy (REBT), Reality Therapy, Dialectical Behavioral Therapy (DBT), Systems Theory, and Cognitive Behavioral approaches are also a large part of both residential and outpatient treatment. However, if I tell the truth, when I walk out of my office at the end of the day, I think of those who participated in treatment with me that day, and I’m praying for the miracle that they may find in the twelve step program.