Why do many people fail at traditional 12-step treatment?
Twelve step treatment is based on the principals of Alcoholics Anonymous. While I respect and admire the fine work of AA, I find that many people cannot grasp this style of treatment. Many have tried these principals only to relapse time and time again. Some studies suggest that as many as 95% of the people that try a 12-step treatment program relapse within the first ninety days.
Traditional treatment is based on spirituality and seeking help from a higher power to resolve addiction.
The first step is admitting that you are powerless over your drug of choice and that your life has become unmanageable. Without this step it is impossible to recover with 12-step therapy. Many have a problem grasping this step. They might be very high functioning and they feel that their life is not unmanageable, just their problem with a particular substance. The great majority of the clients we treat are very successful in their chosen field.
The second step looks to a higher power to restore sanity. Again, many don’t feel that their sanity is in question, just their chemical dependency.
Step three has the person make a decision to turn their will and their life over to the care of god as they understand him.
The remainder of the steps involve taking a moral inventory and working with the god of their understanding to deal with their past and make right all of their misdoings.
This program works for many people if they embrace the philosophy and follow the program. Alcoholics Anonymous teaches you to work these twelve steps over and over and to attend meetings the remainder of your life to reinforce these teachings and carry them to others who are still active in their addiction. They also encourage members to avoid any circumstances that might put them in an atmosphere where alcohol and drugs are used. While this is typically not a problem for drug use, it is often very impractical for alcohol since it is legal and permeates every aspect of normal life.
It is very rare that someone has substance abuse without having accompanying psychological disorders. These problems range greatly but all lead to moderate to severe depression. When the addict or alcoholic uses their substance of choice it becomes a vehicle that takes them away from their problem. Traditional treatment does nothing to address the co-occurring disorders and has a tendency to actually heighten anxiety and depression due to admitting past transgressions to one or more peers.
It is very common for people with substance abuse problems to feel a great deal of guilt associated with their addiction. While protecting and perpetuating their dependency many have lived a life of deception that creates this guilt. Drugs and alcohol share the common bond of depressing the central nervous system and lowering inhibitions. When the addicted person becomes dependent on the substance they will go to great extremes to protect themselves and insure that they are not discovered or interrupted. Many have lied or taken other deceptive measures to obtain or protect their drug of choice. Some have stolen or concealed the amount of money spent on the substances to the detriment of their family and loved ones. Most have hidden drugs or alcohol or gone to great lengths to cover their tracks and not reveal their dependency.
Traditional treatment encourages that all of these feelings of guilt and shame be exposed and shared with others in an attempt to cleanse the soul and it also encourages the addict to make amends wherever possible. This divulgence process is repeated over and over for the life of the person.
AA utilizes many sayings to help their members remain sober. “One day at a time”, Keep coming back, it works if you work it”, “Easy does it” are among them. Many have suggested that with this style of treatment you trade your addiction to drugs or alcohol for an addiction to 12-step. Many feel that this idea may have merit because most addicts that get sober and remain sober with 12-step teachings tend to stay that way only when they remain active in the AA lifestyle. If the lifestyle is discontinued many relapse and resume their addictions.
Addicts and alcoholics should be encouraged to face their past and deal with the issues that might be impeding their recovery, but they must understand that the past is just that, the past. While unpleasant memories can in some instances help keep the person sober, they cannot be changed. Reliving them and dwelling on them is counter productive and harmful. Issues that cause anxiety and depression must be resolved or the addict will seek their old friend alcohol or drugs to help them escape the mental anguish. Many have been dealing with psychological issues for the majority of their life and their drug and alcohol addictions have manifested in an attempt to escape the issues by self medicating.
Drug and alcohol abuse have numerous negative impacts on the human body. Many physical effects become glaringly apparent. Alcoholics will generally exhibit one or many symptoms of the disease. Hypertension, gastro-intestinal problems, lower back pain, bronchial infections, trembling and shaky hands are but a few. What few people realize is the tremendous impact these substances have on the addict’s mental state. Alcohol and virtually all drugs dramatically impair the body’s neurotransmitters that are responsible for one’s psychological state. Primarily affected are the serotonin and dopamine systems which are utilized in normal feelings of well being and joy. Both are dramatically impacted and there presence and normal function slow and become minimized. Neurotransmitter function will continue to decrease as the addiction continues and intensifies. The continued and accelerated use of the drugs and alcohol only increase the spiral of depression.
As the drug and alcohol use progresses and the depression continues the addict begins to experience feelings of hopelessness. Their self-esteem plummets and they begin to accept the role of being an addict or alcoholic. They wonder how this all happened but feel that there is no way out because they have become dependent on their drug.
Every tool possible should be employed to help addicts get control of their substance abuse issues and addictive issues cannot be addressed without simultaneously addressing the causes. Attempts should be made to expose any and all underlying problems. Treatment should include psychiatric, psychological, physical and social assessments. When the issues are disclosed, the appropriate treatment and therapy should be utilized to help the person resolve all of the issues. One of the most important aspects of treatment and cognitive behavior therapy is to restore a sense of pride and raise the dependents self-esteem and self-image. The alcoholic or addict cannot achieve their desired goal of sobriety without caring enough about themselves not to go back to the dependency they have escaped with treatment.
Many times treatment fails because the dependent person is trying to get sober for their spouse or family. Until the person truly wants sobriety for themselves their addictive issues will continue and sobriety will be short term at best. This simple fact is true not only of 12-step treatment but of all treatment. Addicts and Alcoholics must understand this. When physical discomfort and cravings are addressed and psychological issues are dealt with, the dependent person starts achieving clarity and the feelings of despair and hopelessness are replaced with optimism. As sobriety is sustained, cravings diminish, the brain and body heal and the person once again becomes whole.
February 23rd, 2008 at 12:03 pm
I was captured by your article title and it is an interesting observation that you choice to use the term”fail” in it.
Over the years I have observed many come in through the doors and leave again, and many return over and over, and I have yet to see one failure among them. I believe that there is something that every person receives from the AA program.
It is more often a “timing” issue, remember AA is all about progress not perfection!
We in our humanity can only have a certain amount of awareness as to our own selves and what it is we are thinking and believing in the moment.
From the outside it may appear as one thing yet that is not necessarily true. Layers are peeled away and as they peel our awareness opens up sometimes slowly and sometimes very quickly, thus you may notice a revolving door appearance, yet for the person who is entering is beginning their own awakening process, their own peeling of their layers of awareness. It is never a failed attempt, it is the process of change! And everyones process is very unique!
The big book states very clearly that, Nothing, absolutely nothing happens on accident in Gods world! Which leads me to believe that it is No accident that each person’s recovery has its own process! That sometimes a part of the process IS to walk in and out of the program many many times, or for some to walk in and stay the first time around. Everyone is exactly where they NEED to be in their own process of recovery or life for that matter! It is I who needs to deal with self, when I think I know what another’s’ process is suppose to look like, or when I feel frustrated with another!
Much love and light to you,
~Cheryl
February 24th, 2008 at 1:55 am
A.A. Recovery Outcome Rates
Dick B.
@ 2008 by Anonymous. All rights reserved
Are They “Contemporary Myth and Misinterpretation?”
Three A.A. gentlemen (one of whose historical work is well known to me and becoming more and more widely published) have written a ponderous article titled: “Alcoholics Anonymous (AA) Recovery Outcome Rates: Contemporary Myth and Misinterpretation,” January 1, 2008. And that is a good thing because it keeps our members, history writers, and recovery workers thinking—I hope.
This will be a very short comment on the article because I have written extensively on the early A.A. fellowship and its documented, high recovery rates, and I have written to a far lesser degree on the present-day recovery rates. I am a researcher, a writer, an historian, and a man who has been in the trenches of A.A. for almost 22 continuous years. I have read the literature, attended thousands of meetings, and spoken all over the United States. Therefore, I would rather have people read my documented, thoroughly-footnoted, and bibliographically helpful books, articles, and web postings than repeat all that here. However, I will list some principal sources at the end of this article.
What A.A. Literature States
Before I make my comments, let us consider three quotes from A.A. “Conference Approved” literature:
Of alcoholics who came A.A. and really tried, 50% got sober at once and remained that way; 25% sobered up after some relapses, and among the remainder, those who stayed on with A.A. showed improvement. Other thousands came to a few meetings and at first decided they didn’t want the program [In the Foreword to Alcoholics Anonymous, 2d ed., p. xx].
Is that true? I wouldn’t know. I have no data on that about which A.A. says: “Figures given in this foreword describe the Fellowship as it was in 1955” (p. xv). I just don’t know about 1955 or 1945, but I sure know about 1935-1937—the original program, the original Christian Fellowship, and the original forty pioneers whose names and sobriety records are well documented. If you read the “myth” article which is the subject of my comments, you will see that it cannot and does not dispute the 50% and 25% facts as related by the pioneers; it fails to see that the A.A. literature was not writing about the pioneers. It was writing about 1955—20 years after the pioneer years. And the article just ignores the difference.
The second quote popped up in a quote in Bill Wilson’s remark that can be found even in the Fourth Edition of Alcoholics Anonymous, published in 2001. It states (quoting Bill Wilson):
“Henrietta [Dotson—the wife of A.A. Number Three Bill Dotson], the Lord has been so wonderful to me, curing me of this terrible disease, that I just want to keep talking about it and telling people” (p. 191).
As the extensive research and documentation in the books of Richard K. of Massachusetts make clear, hundreds and hundreds of early AAs were quoted in newspapers across the United States in their statements that they had been “cured” of alcoholism by the power of God. They said that when they were following an entirely different program from the one now embodied in the Big Book and Twelve Steps. But instead of using the word “cured,” Bill adopted a “never cured” statement from a lay therapist who died drunk. And years later, A.A. chose to condemn “cure” in this strange quote in its DR. BOB and the Good Oldtimers:
It might also be noted that many terms now considered by A.A.’s to be misleading were then used, not only by non-members discussing the movement, but sometimes by members themselves: “cure,” “ex-alcoholic,” “reformed alcoholic” (p. 136).
So, in 1980, some writer or editor in A.A. decided that Bill Wilson, Dr. Bob Smith, Bill Dotson, Dr. William D. Silkworth, Frank Amos, Clarence Snyder, and about 200 AAs quoted in newspapers across the country had been “mislead” and had been stating falsehoods from 1935 to 1980. But that is a tall tale to prove. I have quoted and documented the statements in several of my titles and so have biographers of Bill Wilson, Bob Smith, Clarence Snyder, and William Silkworth, M.D. And recently I acquired the actual manuscript of DR. BOB and the Good Oldtimers with all the inked corrections, and we will see what it said before the page 136 footnote was added.
The Bible uses the word “cure.” Jesus used the word “cure.” Doctors use the word “cure.” Lawyers use the word “cure.” Nurses too. Even the dictionary. Were they all misled—even in 1935? You decide. What I know is that I followed the program of A.A. I was and am very, very active in the trenches of A.A., particularly helping newcomers. I also studied the Bible as the early AAs did. I relied on the Creator as the early AAs did. And I have been “cured.” I think I know what that word means. It means “cured.” Again, “cured”!
Now about the rest of the “myth article” which makes an attempt to establish that all the data about today’s substantially-lower A.A. success rates is flawed. I leave the veracity and accuracy of that claim to all the psychiatrists, A.A. General Service workers, psychologists, scientists, grant makers, counselors, treatment professionals, and government employees who have sometimes said otherwise. What is the success rate in today’s A.A.? I have conducted no surveys myself. I have merely gone to thousands of meetings, heard A.A.’s own archivist Frank Mauser state to me that one-third are out of the door in 90 days and fifty percent are out of the door in a year. I found that to be an accurate description in the California and Hawaii areas where my attendance was intense. I have had it confirmed by AAs all over the country. And as far as I am concerned, fellow writers and fellow A.A. members can conduct as many surveys as they like to see how many AAs “make it.”
The difficulty with many of the surveys is their pre-occupation with “scientific method.” They do not seem to care much for what they hear from the mouths of witnesses. This disdain for reliable accounts and writings by people of integrity is sometimes dismissed as merely “anecdotal.” A word that many an A.A. speaker probably does not even understand as he honestly pours out his experience, strength, and hope in meeting after meeting. If the “proof” is not based on a “randomized,” “double-blind,” “placebo-controlled” test, or presented by someone with an M.D. or Ph.D. degree, I suppose it may not meet the standards of academia. So too with our cures by the power of God. Every effort used to be extended by writers to distinguish between illnesses with “organic” causes (i.e., illnesses where the organ is diseased, physically impaired, or dead), “functional” causes (i.e., illnesses where a “perfectly good” organ does not function properly), and “psychogenic” causes (i.e., illnesses where the organ is “perfectly good,” but the person thinks the organ has a problem). The miraculous was not accepted. Or there were those who dismissed “cures” because they were viewed as examples of “misdiagnosis,” “spontaneous remission” (a recovery supposedly without reason or cause), the “placebo effect” (improvement in health or behavior not attributable to an administered medication or treatment), and so forth. The same problem exists with the charts and exclamations of the “myth” proponents. They just do not talk about God. They do not talk about miracles. They excuse or rationalize or denounce the commonplace observations and accounts of both failures and successes. The problem for me, as to early A.A., is that I have seen the early hand-written rosters. I have seen the hand-written address books. I have placed them in the Griffith Library in East Dorset, Vermont, where all can see. I have looked at the newspaper accounts. These too are both in the Griffith Library in East Dorset, Vermont, and at A.A.’s World Services Headquarters. I have read the A.A. literature. I even have a copy of one of the original A.A. Big Book drafts which states in large letters on the front page, “Their Pathway to a Cure.”
The statement may or may not be correct, but one cannot deny that the words quoted appear on the draft of the book cover.
Now I would be the last one in the world to claim that alcoholics do not tend to grandiosity on occasion, even outright dishonesty. Hopefully, they overcome some of that as they “take” the Twelve Steps and practice the last three. But I have a lot of difficulty with casual dismissal of mounds and mounds of genuine evidence which is neither hearsay nor lacking in foundation. For example, I did not come in to A.A. to produce a statistic. I came in, did my best to follow today’s program, added to it the same prayers, Bible study, and reliance on the Creator that early AAs did; and I have not touched a drop of booze or swallowed any prescription sleeping pills from the first day. I have seen the evidence of early A.A. And I have watched present-day A.A. people who came in voluntarily, by court order, by treatment van, by referral of ministers and doctors. And I cannot find them. Neither will you. That does not mean A.A. failed. It means A.A. has changed. And these people do not want to quit—yet!
I want people to know real A.A. history, surveys, statistics, and participation. And then decide for themselves if the A.A. path to a relationship with God is for them.
I can only say that since A.A. today keeps no rosters (though the early ones did), since members attend all kinds of different meetings (and sometimes give their opinion to the same survey from different meetings), and since the surveys themselves will not, for the most part, stand the test of sound statistical science, choose your own figures.
I like the statement in A.A.’s basic text: “Rarely have we seen a person fail who has thoroughly followed our path.” I followed it. I haven’t failed. That says nothing about my suffering comrades wandering in and out. But it defines for me my responsibility to reach out and help them if they want help. A day never passes without my talking to or working with some still suffering newcomer and communicating history to some wise oldtimer.
Gloria Deo
dickb@dickb.com
February 29th, 2008 at 3:50 pm
The 12 Step program doesn’t work because it is the corrupted and dis-ordered form of the program used by those who sobered up before the Big Book came out with its 12 Steps in 1939. Their program was the 4 Sp. Activity Steps of the Oxford Group (See 1933 book: What is the Oxford Group?), Sharing, Surrender, Restitution & Guidance, to which was added the Inventory before Sharing, most likely, by Rowland Hazard.
In it the present 1st Step came after the inventory
sharing. That’s when the alcoholic surrendered, as is quite clear from the paper submitted by Sr. Ignatia in 1951. She says in it, that after the alcoholic shared his inventory, “With self knowledge, he (the alcoholic) was asked to admit the truth “I am an alcoholic.” (see Employee Assistance Quarterly 1985)
Too bad Bill W. didn’t know what he was writing and he paid the price for it by tripping out on LSD from 1956 to 1959/8. If that’s not a relapse, I wonder what is. I guess LSD can give a better spiritual awakening than the 12 Steps. I can point out a number of other lies in the Big Book, but you can read them and also about what the actual solution, the so called ’spiritual experience’, is in my forthcoming Book.
& Yes, I agree with the author that now, with more knowledge about the brain and the neurotransmitters, treatment programs aught to be laying more stress on healing the brain & body of the alcoholic than confusing them with the 12 Steps program. Its a joke, not a cure. I landed into the mental asylum after making two years of daily meetings. But, thanks to Vipassana meditation I’m away from alcohol and heroin now for nearly 18 years.
Rajiv Bhole B.Tech.