Twelve-Step Programming    
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We are  in the process of revising this page.  The original article is available by clicking on this message. Revision will be extensive; although the main page on Guidelines for Addiction and Substance Abuse is near completion of its revision, significant portions of the revision of this page have not yet begun.  We will be turning type in blue that is not underlined into links to explanatory information.

This is an outline of this article:

        ●    Introduction
  
     o    Confusion created by “disease concept”
● 
Advantages of Twelve-Step
    
o   Must-dos
            ▪    "90 in 90"
           
▪     Home group
            ▪     Sponsor
            ▪    Share, listen, and observe in meetings
           
▪    Re-do steps

●  Genuine Limitations
      o  Cultural Dissonance
      o 
Need for Supervision of Young People
         
▪  Boarding School issues
      o  Need for the Vulnerable to Learn How  to Avoid Problems
      o  Not only source of wisdom
      o  Addiction-1, Addiction-2
      o  Using Twelve-Step for Addiction-1
      o  Need for coach
●  Apparent Limitations due to mishandling by schools and programs
      o
  Sometimes presented by people who don’t understand it
      o   Simulation meetings called AA (or NA, etc.) meetings
         
▪   Misinformation about what is a closed meeting
     
o    In-house meetings only

      o   Head stuff presented as being the program
      o   Sexual addiction groups
      o    Research outcomes
●  Wrong information
      o   Can’t do it with teens
      o   Lifetime commitment
      o   Religion
      o   Conflicts with religion
●  Bulleted List of Guidelines

*  *  *  *  *  *  *  *  *  *  *  *

I    ●  Introduction

Twelve-step work is probably the best known approach to substance abuse and addiction.  By "twelve step work" we mean the approach to change taken by Alcoholics Anonymous, Narcotics Anonymous, and some other mutual support fellowships focused on changing a behavior that its participants believe they have become powerless over.  This approach involves the use of twelve specifically defined steps originally published in the book Alcoholics Anonymous which members of that group often call the "Big Book."  Those steps have been adapted with minor changes of wording to each of the other fellowships. Although the approach is based on the anecdotal experience of the 1930s, recent brain research validates much that the twelve-step pioneers believed.  

 

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         ●  Introduction  
    
o  Confusion created by the  “disease concept”

Relevant to the issues surrounding twelve-step work is what is known as the disease concept of addiction, derived from the classic study by E. M. Jellinek, The Disease Concept of Alcoholism.  Although not truly identical, the understanding of addiction that is common in twelve-step groups and the understanding of addiction associated with Jellinek’s writings and those who have subsequently updated it have merged in the minds of many twelve-steppers.  

As a consequence it is common for twelve steppers to think of concepts and principles that are actually from Jellinek and those who have updated his work as core concepts and principles of twelve-step work.   In many cases the two ways of thinking are synergistic with each other, even if they differ,  with respect to emphasis on certain details.  In the minds of many if not most people involved in substance abuse services whether as consumers or providers, the "disease concept" and "twelve-step" seems to have merged into a single system of beliefs and practices. 

What has been surprising to some is the extent that the merged twelve-step/ disease concept  understanding of addiction has been validated by recent neuroscience.  We refer the reader to Dr. Kevin McCauley and his  Institute for Addiction Study. We have viewed some of the research Dr. McCauley cites in that website,  and believe his characterization of neuroscience of addiction is accurate. We believe his argument in support of addiction being a disease is persuasive.  Is it exactly the disease Dr. Jellinek described many years ago?  Is twelve-step work the best way to treat it?   Neuroscience  confirms much of the folk wisdom that developed with the twelve-step movement and with the disease concept.  It also confirms much that we have been told by proponents of alternatives to twelve-step. 

For example, for years twelve-step participants have associated relapse with stress. Twelve steppers have found many aspects of twelve-step activity to be stress reducers.  Proponents of alternative approaches have also encouraged stress reducers, such a Yoga, Transcendental Meditation, and even body massage as aids to remission or recovery. Now Neuroscience tells us exactly how stress induces addictive behaviors and relapse and how eliminating stress promotes recovery, remission, or abstinence, depending upon the vocabulary one might prefer.  In this example, the research shows why twelve-step is beneficial AND why it can be valuable to supplement twelve-step with other tools. 

Twelve-step and disease concept advocates tend to use a diagnostic rule of thumb to determine who is alcoholic/ addicted/ has the disease.  That tool is to suppose that anyone who continues to drink/ use drugs/ after knowing that it is harmful to them must have the disease.  Note that strictly speaking, the twelve-step fellowships have never used diagnostic tools. They officially leave it to each person do decide whether he or she is an alcoholic or addict.  But the commercial treatment centers  and some therapeutic schools that use twelve-step methods and promote the disease concept lack that restraint.

The official guide to psychiatric diagnostics, the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR) offers its own convoluted diagnostic criteria.  That rule of thumb or those criteria might diagnose something: we are not convinced that it diagnoses the disease the neuroscientists have in mind when they speak of a disease that cannot be cured.

Neuroscience also tells us why at least some people with this disease, like people with insulin dependent diabetes, are never completely cured of the disease, but can put it in remission.  This is where the folklore surrounding twelve-step/ disease concept people diverge from the neuroscience -- and in many cases the official literature of the twelve-step fellowships and from Jellinek's own writings.

Jellinek described five different kinds of Alcoholism.   (Currently -- September, 2010 --  Wikipedia has a description of these five different kinds of Alcoholism)   What Jellinek calls Alpha Alcoholism leaves people who are clearly alcohol troubled with the ability to decide not to continue if they simply put enough effort into it.  This is comparable to our concept of Addiction-1.  Jellinek describes Gamma Alcoholism as the form of Alcoholism most appropriate to Alcoholics Anonymous and denies that Alpha Alcoholism is a disease.   In broad strokes, this is quite similar to what we have described as the difference between Addiction-1 and Addiction-2 in our Guidelines on Addiction and Substance Abuse. 

Since Jellinek wrote his book, a huge network of for profit treatment centers, based upon selective reading of Jellinek and selective application of twelve-step principles has developed and vast quantities of money have changed hands.  In order to fatten the coffers of these treatment centers, people of all ages including children have been targeted by marketers because of addiction-1 (Alpha-Alcoholism and its other  addiction analog) issues and have been misled into accepting “treatment” for addiction-2 (Gamma Alcoholism and its drug addiction analog). 

Over the time this has been happening, a generation or two of clinicians have come on the scene believing the misunderstanding of addiction that was generated to promote the revenue base of the treatment centers.  This has led to a generation or two of twelve-step fellowship members who also believe the misinformation.   These generations of clinicians and twelve-step members promote both twelve-step work and Jellinek’s “disease concept” but inadvertently do so only selectively.   

Jellinek’s distinction regarding Alpha Alcoholism has been largely forgotten by people who usually appeal to Jellinek as the ultimate authority.  The twelve-step traditions 4, 6, 8, and 11 are less carefully observed in the twelve-step fellowships which too often have been excessively influenced by aggressively marketed dollar driven treatment programs that have financially depended upon mishandling of  addiction-1, Alpha Alcoholism, and the other addiction analogs of Alpha Alcoholism.

While twelve-step and disease concept advocates are often confused regarding who has a disease and who needs the lifetime support of a twelve-step fellowship, the twelve-step naysayers have built their empire on the house of cards consisting mostly of people who have experienced addiction-1 and have been inappropriately pressured to accept the level of intervention that is appropriate to addiction-2.  Those people frequently realize after the fact that they were misled. That kind of experience is responsible for much of the misplaced bitterness about twelve-step fellowships and principles. 

Almost all literature that we have seen  that specifically addresses opposition to twelve-step approaches (except for some faith-based approaches), can be explained as being based upon the experiences of people with addiction-1, and exploiting the mishandling of addiction-1 as a result of overly commercialized twelve-step interests. 

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        ●  Advantages of Twelve-Step

The unquestioned and unquestionable advantage to twelve-step work is its availability, worldwide, usually on a very frequent basis.  Probably the greatest number of meetings in the least probable locations are Alcoholics Anonymous meetings.  While other twelve-step fellowships are not so ubiquitous,  a person with another kind of addiction, not related to alcoholism, can attend an Alcoholics Anonymous meeting at times that their own fellowship does not have an available meeting.

Research has shown repeatedly that the most important ingredient of change is relationship.  Any twelve-step meeting is a place where people who are struggling can find a supportive relationship, that does not cost megabucks per fifty minute hour.  While there is no way to fully exclude negative influences from meetings, the "group conscience" of each twelve-step group, the depth of tradition, and the simplicity of the concepts, keep groups as a whole focused on the recovery issues that the twelve-step groups are intended to be about.

At the heart of what makes twelve-step approach to addiction especially valuable is the recognition that many people who are alcoholic/ addicted (probably all who are alcoholic/ addicted in the sense of addiction-2) are not able to change their behavior as a simple matter of choice.  AA founders knew this back in the 1930s; it took the neuroscience of the last two decades to come to a research based understanding of why this is true. 

In response to the fact that some people cannot simply choose to abstain from an addictive behavior,  the patriarchs of twelve-step have summoned the additional power of the supportive group surrounding the person in recovery, the resource of calling upon a "higher power," the simple structure of the twelve-step model, and the stress reduction component of twelve-step work to support real change.   Through the lens of contemporary neuroscience, one can see how this process impacts and relaxes the control the limbic system holds over the addict's behavior. 

Twelve-step is a tool or resource that can be applied to any situation in which people have a compulsion to repeat behaviors that in their better judgment they would prefer not to do.  (We qualify that by questioning the appropriateness of twelve-step work in cases of compulsions that are a consequence of Obsessive Compulsive Disorder (OCD). The possible connection between OCD and addictive behavior to which twelve-step work might be applicable is a matter of some controversy that FamilyLight chooses not to address.) 

While we firmly believe twelve step work is a possible resource in a wide variety of situations, we caution the reader to observe cautions and qualifications about that elsewhere on this page and on our Guidelines for Addiction and Substance Abuse.  In particular, we caution that twelve-step work might not be the best choice of methodology for people who are addicts only in the sense of addiction-1.  We do encourage its use for anyone who subjectively feels powerless to stop their addictive behavior, anyone whose relapse history demonstrates an addiction-2, and for anyone who has benefitted from it in the past. 

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●  Advantages of Twelve-Step
       o  
Must-dos

When people work a twelve-step program, there are certain procedures that need to be followed for twelve-step to be most effective. Schools and programs following our guidelines will teach their students/ participants to follow these procedures. 

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●  Advantages of Twelve-Step
       o  
Must-dos
           
▪    "90 in 90"

When a person following twelve-step, at least in the substance abuse areas, most authorities recommend that the person complete "90 in 90" or ninety meetings in ninety days when they begin their twelve-step journey and each time they move to a less restrictive setting. This would apply when moving from a residential treatment center to a transitional setting, again when moving from there to home.  Teens are likely to be involved in other obligations, such as individual counseling, family therapy, and perhaps a professionally guided transition group.   In most cases, competent recovery coaches will suggest that such obligations might substitute for a regular meeting but still suggest at least a telephone "check-in" with a sponsor or other person experienced in recovery. 

While we would like students/ residents in schools and programs to experience a 90 in 90 while in those schools and programs, we do not make it a requirement of our guidelines in a highly structured treatment center.  We do expect that when preparing people for twelve-step support, those schools and programs will teach people how to find quality meetings to attend.  Those lightly structured programs such as  transitional programs meeting our guidelines will expect twelve-step participants to experience a 90 in 90 if they are entering from a more structured environment or just beginning recovery. 

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●  Advantages of Twelve-Step
       o  
Must-dos
           
▪    
Home group

Every person using twelve-step needs to associate with a home group.  The person may attend many other meetings and may vary which group he or she attends. But there needs to be one group that is home base.  That group should be attended regularly, and where particularly close relationships are formed. 

As in previous section, highly structured schools and programs meeting our guidelines will prepare students/ residents to find a home group but need not have their students/ residents experience that while participating in their school or program. However, less structured schools and programs and transitional offerings will expect their twelve-step participants to experience finding and being a contributing member of a home group. 

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●  Advantages of Twelve-Step
       o  
Must-dos
           
▪     Sponsor

Every person using twelve-step needs to have a sponsor.  A sponsor is a mentor in the experience of a twelve-step fellowship, a confidante, and a teacher in the use of twelve-step.  Although a sponsor and person sponsored need not be of the same age or generation, a strong bond of empathy is very important. The person using twelve-step needs to select a sponsor very carefully.  The sponsor should be a person with at least five years of stable recovery and appear to personify the principles of the twelve-step fellowship.  

Twelve-step participants can choose a sponsor.  We qualify that in one respect:  Traditional twelve-step participants will probably disagree, but we believe sponsors of teen-agers should be expected to meet the teen's parents, gain parents approval, and also submit to the same background checks as workers in child care facilities. The family of the teen should pay the fees required for those background checks. 

When a person first arrives in a new area and/or is just starting in recovery, they might engage a "temporary" sponsor whom they don't know well enough or might not meet all requirements of a regular sponsor.  With teens, a temporary sponsor might not have background checks or parent interview but might not meet the temporary sponsor except in a public place at a meeting.

Schools and programs that meet our guidelines will support their students/ participants in using community twelve-step resources and finding and using a sponsor.

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●  Advantages of Twelve-Step
       o  
Must-dos
           
▪    Share, listen, and observe in meetings 

Schools and programs observing our guidelines will foster participation in community twelve-step meetings for those for whom twelve-step is appropriate.  This applies while the person is in program and after they discharge. When students/ participants bring up questions and concerns about recovery in program, the student/ participant will be asked "Have you raised that at a meeting or with a recovering person you met at a meeting?"  A goal for people for whom twelve-step is appropriate is to shift dependency to a large degree from the school/ program to the twelve-step meetings. 

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●  Advantages of Twelve-Step
       o  
Must-dos
           
▪    Re-do steps

As a person progresses in recovery, a twelve-step group will encourage that person to go through the steps, concentrating on one at a time, personally taking the action that step suggests for them.  Schools and programs that meet our guidelines will start this process as they introduce twelve-step. 

Unfortunately, many schools and programs that claim to be twelve-step oriented do very little other than take their students/residents through the steps. This is not being twelve-step oriented.  We call this doing just the "head stuff." 

Schools and programs meeting out guidelines will introduce the concept of working through the steps in a repeating cycle.  This means starting over from step 1 when:  (1) moving to a less restrictive environment, (2) at the time of any life crisis or major change of lifestyle, and (3) after completing the process of working through all twelve-steps.  

A person going through a school or program offering twelve-step according to our guidelines will know what is meant when asked, "What step are you working on now?"

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●  Genuine Limitations

While we believe firmly that twelve-step is a very powerful tool it does have limitations.  Many of these limitations are best understood with through a small history lesson.  Twelve-step began with Alcoholics Anonymous.  Alcoholics Anonymous began when two desperate alcoholics met together in Akron Ohio in 1935.   Both were members of the Oxford Group a Christian fellowship devoted to spiritual renewal. Both were upper middle class Caucasian evangelical protestant Christian men who were desperate to overcome alcoholism and both had presumably joined the  Oxford Group in the hope of finding sobriety from the resources of that group.

When  Alcoholics Anonymous began it was an unabashedly Christian group, hardly distinguished from the Oxford Group. In the late 1930s, Alcoholics Anonymous was growing rapidly.  Key people came together and decided that Alcoholics Anonymous should be for all people, regardless of faith.  Today an organization making that decision would probably remove all trappings of specifically Christian ritual, such as use of the word "God" for "higher power" and use of the Lord's prayer, for example.  But in the late 1930s it would not occur to most people that these are words that would make anyone uncomfortable.

A consequence of this is that the thinking that went into the formation of Alcoholics Anonymous came from people with much narrower demographics than the current make-up of Alcoholics Anonymous, not to mention the demographics of a larger group that might benefit from Alcoholics Anonymous but includes many who stayed away because of discomfort with the culture and language that came down from the membership of the 1930s.

Schools and programs operating within our guidelines will educate their students/ participants (and parents, in the case of young people) to the matters discussed in our "genuine limitations" section. 

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●  Genuine Limitations
       o  Cultural Dissonance

As a result of this, women, young people, minorities, senior citizens, low income people, non-Christians, Catholics, and people of other branches of Christianity not completely comfortable with the culture of twelve-step groups, need to make a cultural adjustment in order to be a part of Alcoholics Anonymous and other twelve step groups.  Most people who would benefit from twelve-step have some cultural adjustment to make in order to benefit.  We believe that it is incumbent upon professionals  (and  would-be helpful non-professionals and volunteers)  in the substance abuse and addictions field to assist in and support that cultural adjustment and not to make it a bigger obstacle than it needs to be.

We deplore substance abuse professionals and religious leaders who reinforce the resistance that potential beneficiaries of twelve-step work might have when assistance with a transition might be in order.  This is not to be confused with the same people recommending that twelve-step be supplemented by resources consistent with the culture and religious framework of the potential beneficiary of twelve-step work. It is also not to be confused with the same people suggesting a cautious approach at best, regarding people to whom twelve-step genuinely does not apply. 

For example, we have great respect for recovery groups rooted in the faith commitments of people of any religion.  Currently, various forms of Christian recovery are popular and Rick Warren's Celebrate Recovery has helped many people. Many people whose faith commitments fit with these support systems might benefit people whose needs might also be well served by twelve-step as well as people whose needs would not be well served by twelve-step.  For those who might benefit from both, we encourage the use of both.  Our guidelines do not support failure to encourage use of both areas of support for a person whose needs are relevant to both.

On the other side of the religion coin, non-Christians will often find the "God talk" in Alcoholics Anonymous unsettling.  When the patriarchs of Alcoholics Anonymous decided, in the late 1930s, to open Alcoholics Anonymous to all regardless of religious faith or absence thereof, arguably they did not go far enough in removing wording that is specifically Christian.  The word "God" in the steps puts people off who do not believe in God and especially those who have been subjected to religious abuse. 

Twelve-step proponents explain that "God" in this context simply represents each individual's "higher power," and need not represent the god of any religion.  That was the intention of the patriarchs of Alcoholics Anonymous,  but it is an awkward choice of words for many.  To be consistent with our guidelines, schools and programs will assist their participants in making that transition.  See also our notes on Wrong Information: Twelve-Step is a Religion and Conflicts with Religion.

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     ●  Genuine Limitations
       o 
Need for supervision of young people

In addition to the fact that young people, especially teen-agers, are moving outside their own culture, when they participate in twelve-step work, they are exposing themselves to certain risks.  Not everyone attending a twelve-step meeting is coming from a good purpose.  Twenty five years ago, we advised teens at AA and NA meetings to get five new phone numbers per meeting of people they could call when feeling stressed and to find a sponsor they could relate to -- on their own.  That probably wasn't the best possible advice then and it certainly isn't now. But the informal traditions of AA and NA die hard.  Many twelve-steppers will insist on doing things that way. 

Teens need some independence as they attend meetings, but they also need to be safe.  Some parents have taken the position that their son or daughter may only attend meetings with them, but that destroys the effectiveness of the meeting.  Basic rules should be that the teens do not meet anyone away from the meeting without parental prior knowledge.  We believe that adults sponsoring teens should be interviewed by parents and, if the parents are satisfied, they prospective sponsor should apply for the same clearances required of employees in child care facilities.  The parents of the teen should pay the cost of the clearances. 

Characteristically and understandably, AA and NA members and members of other twelve-step fellowships will frequently object to this recommended procedure.  It does conflict with the customary standard of anonymity.  No negative assumptions should be drawn regarding any person who declines to participate in this procedure in order to sponsor a teen. But the traditions were formulated without considering the contemporary issues surrounding adult-teen associations.  Schools and programs meeting our guidelines will caution parents on safety but not to prevent full participation of the teen in the twelve-step groups.

Teens must be carefully cautioned as to dangers from predators and from the danger of becoming emotionally dependent on people who might relapse.  To avoid a problem, it is important to remind them that sponsors should be people with many years experience in recovery and sobriety, which virtually guarantees a sponsor of an older generation. 

Teens (and others in early recovery) should not "travel in a pack" but should have friends both in the twelve-step program and outside of it. When a group of teens in recovery begin to focus their entire social life on each other, then if one relapses, all tend to relapse.   The same tends to be true if the group of teens tends to attend the same meetings together at all times. 

So-called "young people's meetings" are a mixed blessing and must be used with caution. The same might apply to Narcotics Anonymous meetings that generally attended only by the very young and newly sober (and not yet sober).   These have the advantage that they provide a better opportunity for young people, especially teens, to identify.  But there is one consistent problem with these meeting and one additional potential problem.

One major benefit of attending twelve-step meetings is to interact with people with long term sobriety experience.  By definition, "young people's meetings do not provide that opportunity.  Therefore, a young people's meeting should never be any person's entire experience with twelve-step.  If a young person is attending meetings daily, two per week might be young people's meetings. Maybe three if advised by a well qualified sobriety coach.  But young people's meetings should never be as many as half of the total number of meetings attended. 

The other problem with some  young people's meetings is that they are frequently led or sponsored by a single older recovering person.   That is, one older person guides the young people in everything they do.  These meeting should simply be avoided.  Totally avoided.  In twelve-step/ twelve-tradition terms they violate the second tradition. One person is governing.  In non twelve-step terms the older sponsor is setting himself/herself up as the guru of a cult-like situation, that loses the group effect of a proper twelve-step fellowship.  To get a very specific picture of the problem, read The Pied Piper of Hamelin. 

It is also very important for young people to be actual participants in the twelve-step meetings.  Too often, the leaders of a meeting will get the young people to do jobs like selling raffle tickets, a task that distracts from the content of the meeting.  We call it making the young people "mascots."  Involving the young people in the meeting is good thing but it needs to be consistent with the young person having full participation in the meeting and the program. 

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●  Genuine Limitations
      o 
Need for Supervision of Young People
         
▪  Boarding School issues

It is common for students with a history of substance abuse to go from therapeutic schools or programs to a conventional boarding school.  This works out well in many situations.   However, independent boarding schools that are not therapeutic schools are usually ill equipped to support a "clean and sober" lifestyle and especially ill equipped to support students who need to pursue twelve-step support.  Therapeutic schools and programs -- and educational consultants -- who adhere to our guidelines need to plan education and therapy of young people with a history of addictive behavior or substance abuse so that they are always in a environment supportive of "clean and sober" and IF they have been helped by twelve-step they will be encouraged to continue that. 

Historically,  if we go back twenty or thirty years, the culture of most boarding schools has been highly entangled in liberal use of alcohol among faculty and administrators. The culture tended to exemplify the drama triangle that is so much intertwined with addiction.  In many of these cases alcohol consumption by students was given a wink and a nod. 

Clearly, this has improved in many schools but vestiges of that culture remain in many schools.  Therapeutic schools and programs and referring professionals need to be alert to evidence of this culture and ensure that students with addictive history are not referred to schools with remnants of this culture. 

Boarding schools that are appropriate for students who need twelve step support should have specific policies regarding such work.  This means that the school should have very specific policies and practices supporting students in maintaining full participation in twelve-step groups, preventing students from participating who simply want to get off campus, and providing constructive support for the students who, by reason of twelve step participation must have one foot in the community of the school and the other in the community of their twelve step fellowship. 

We limit our comments on non-therapeutic boarding schools to this much as this is not really a guideline about such schools. We plan to further develop this topic elsewhere on this website. 

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●  Genuine Limitations
       o   
Need for the vulnerable to learn how to avoid problems

The issues here are not significantly different from those suggestions under Need for Supervision of Young People.  We also suggest that use of a coach  is an important means of offsetting this limitation.

It is important to remember that twelve-step fellowships are generally highly supportive. But the people visiting or or participating are not screened.  People who are vulnerable need to make sure they know how to stay safe even if others have negative intentions.  They might consider attending at least initially with a trusted friend who is a regular participant in that fellowship.   Absent that possibility, we cannot emphasize strongly enough the importance of a coach. 

Programs and schools meeting our guidelines will (except possibly wilderness programs and other short term programs) provide that guidance while the resident is in the school or program and will also stress the importance of coaching as the person integrates into a twelve-step fellowship in their home community. 

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     ●  Genuine Limitations
       o  Not only source of wisdom

Skill with twelve-step approaches does not warrant ignorance about everything else.  While we fully respect the power of twelve-step, even with people whose sole issue is some form of addiction, the ability to teach twelve-step is never by itself an adequate approach to addressing addiction and substance abuse in a clinical setting.  The first skill requirement for all staff at all levels – not just clinicians, therapists and counselors – is the ability to form a positive relationship with the student/ client/ resident.   Every research study ever completed affirms that.

 

In addition all clinicians, counselors, and therapists should be fully competent in working with  Stages of Change (also know as the Transtheoretical Model) and Motivational Interviewing. All staff other than clinicians, counselors, and therapists, having direct contact and interaction with the students/ clients/ residents should be sufficiently skilled in these areas to support these tools under clinical direction.  In addition, all clinicians, counselors, and therapists should be up to date in the recent research in neuroscience as it affects addiction.

Schools and programs working with addiction and substance abuse should have the skill to work with co-occurring disorders and handicaps that may affect their students/ clients/ residents.   This implies that they have the ability to screen out through the admission process those with issues they are not skilled to deal with.  We realize that the most conscientious schools and programs can have a problem sneak up on them notwithstanding t the most careful screening.

However mood disorders (all forms of depression and bipolar disorder), personality disorders, sequellae of trama (including but not limited to Post Traumatic Stress disorder), Attention Deficit Hyperactivity Disorder, and various learning differences and disabilities are common among addicted and substance abusing populations. Although personality disorders cannot officially be diagnosed in people under 18, the traits that contribute to personality disorders are often observed in younger people suggesting high risk that a personality disorder diagnosis may become appropriate as the person reaches adulthood. 

Unless schools and programs can and do effectively screen out people with these issues, they should be prepared to address them when indicated as they treat substance abuse and/or addicti0n.  In particular they should be prepared to offer DBT and EMDR therapy for those who would benefit. 

Schools and programs meeting out guidelines will be in compliance with the recommendations indicated with the word “should” in the above paragraphs.

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●  Genuine Limitations
       o   Addiction-1, addiction-2

In our main article on Guidelines for Addiction and Substance Abuse, we offered a distinction between what we call Addiction-1 and Addiction-2, reflecting Jellinek's distinction between Alpha Alcoholism and Gamma Alcoholism.  Schools and programs meeting our guidelines do not pressure or unduly influence those who may be Alpha Alcoholics or Addicts-1 (Addicts in the sense of Addiction-1) to make the statement of powerlessness in the first step, nor attempt to convince the those who may be Alpha Alcoholics or Addicts-1 that they have a disease that will last a lifetime. The problem with doing so is explained in our main article on Guidelines for Addiction and Substance Abuse.

Schools and programs addressing the needs of those who may be Alpha Alcoholics or Addiction-1 will use their resources to bring to those people an awareness that they are very high risk for Gamma Alcoholism or Addiction-2.  Under most circumstances, these people should be integrated with twelve-step programming so that they will be fully prepareed to turn to that research should it turn out that they were Gamma Alcoholics or Addicts-2 or if they succumb to risk factors and become Gamma Alcoholics or addicts-2 in the future.

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●  Genuine Limitations
       o   Using Twelve-Step for Addiction-1

Twelve-Step can be beneficial to alpha-alcoholics and addicts-1, but some cautions are in order.   How people who appear to be alpha-alcoholics or addicts-1 might relate to twelve-step depends in a large measure upon how the person relates to the word "powerless" in the first step.   If a person feels powerless over alcohol, drugs, or another addictive behavior, twelve-step is a resource that can be helpful whether the person is addicted-1 or addicted-2 (or alpha alcoholic or gamma alcoholic).

This person might function as anyone else in twelve-step groups, as if an addict-2 or gamma alcoholic.  The biggest difference between this person and others in the fellowship might be that this person did not hit bottom in the same way as most others and might lowse motivation to keep at the program. 

If the same person shows some signs of addiction or alcoholism but there is not evidence if addiction-2 or gamma alcoholism and the person does not identify with the wording of the first step, twelve-step might not be the best resource to deal with the issues at hand.  However, the person is at high risk for addiction-2 or gamma alcoholism.  Accordingly the person should gain familiarity with a resource to apply in case of addiction-2 or gamma alcoholism and frequently twelve-step is a preferred resource.  

When this person is attending meetings to learn how it works but not accepting the first step, it is probably not viable to get sponsor or to speak frequently at meetings.  It may be appropriate to say, "I'm here to see if this fellowship can help me. I'm not sure I qualify." 

(This section under development)

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●  Genuine Limitations
       o  Need for Coach

Because of these concerns we encourage people who do not meet the demographics of the founders of Alcoholics Anonymous to have the benefit of a coach to guide them as they get involved in twelve-step fellowships.  A coach is not the same as a sponsor. A sponsor is a mentor the twelve step participant chooses from within the fellowship.  A coach is any person who has the ability to guide you through the process of integrating into twelve step fellowships with the intention of pulling back from this role as the person integrates into the fellowship.

A good coach guides the newcomer to find appropriate meetings, prepares the newcomer for what to expect, and suggests ways to become integrated into the appropriate twelve-step fellowship(s).  The coach will meet with the newcomer being coached frequently from the beginning of time the newcomer enters twelve-step activity until the newcomer has settled into a productive relationship with a sponsor. At that point the coach becomes less involved and gradually fades out, reminding the newcomer he or she is available if problems arise. 

A school or program that meets our guidelines will advise students/ residents of the importance of a coach as they move into twelve-step work at home or in other less structured settings.


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●  Apparent Limitations due to mishandling by schools and programs

One of our frustrations is the mishandling of twelve step resources by schools and programs that claim to promote twelve step approaches.  Frankly we prefer schools and programs that inappropriately limit or avoid twelve step work to those that claim to use twelve step and then misrepresent to their residents/ participants what twelve step work is really all about. 

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●  Apparent Limitations due to mishandling by schools and programs
      o   Sometimes presented by people who don’t understand it

Unfortunately, many people achieve credentials a substance abuse counselors without real knowledge of how twelve-step fellowships actually function.  In many cases these counselors simply avoid twelve-step.  In others they teach about it on a textbook basis.  Schools and programs consistent with our guidelines will make decisions about use or non use of twelve-step informed by people who are or have been twelve-step experience.

Staff guiding twelve-step  in schools and programs meting our guidelines will be people with twelve-step experience.  Our expectation of twelve-step experience does not imply that only recovering addicts and alcoholics are eligible.  Family groups like Al-Anon and Nar-Anon are twelve-step groups.  Most twelve-step recovery groups have open groups for the purpose of allowing non-recovering people to experience and/or witness their fellowship.  

Experience with twelve-step  is important for clinicians using it as a therapeutic tool, but we don't want to suggest that is the only skill that is important.  Just as important, and, in some cases, more important, are skills in the core areas such as relationship building, motivational interviewing and application of the recent findings in neuroscience. 

We also do not mean to imply that every staff member in a school or program supporting twelve-step must be individually experienced in twelve-step.  A well integrated team made up of people with differing expertise may work well.   We simply do not want any student or program participant to experience their primary exposure to twelve-step to come from clinicians who learned twelve-step only in a classroom or a text-book or in clinical practice from other clinicians who had not been twelve-step participants.

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●  Apparent Limitations due to mishandling by schools and programs
      o    
Simulation meetings called AA (or NA, etc.) meetings

Many schools and programs offer groups led by staff members, open only to students/ participants in the school/ program,  that are called Alcoholics Anonymous or Narcotics Anonymous meetings.  This is destructive, as groups that are composed of the same people who are always together in the program, simply cannot be effective as twelve-step meetings.  If the students/ participants are told these are Alcoholics Anonymous or Narcotics Anonymous meetings, they will judge the effectiveness of twelve-step fellowships by their experiences and usually will come to the conclusion that they are not effective. 

Schools and programs that claim to use twelve step and do not provide access to genuine twelve-step groups appear to us to be doing more harm than good, and are, in a major way, contrary to our guidelines

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●  Apparent Limitations due to mishandling by schools and programs
     o     Simulation meetings called AA (or NA, etc.) meetings
         
▪   Misinformation about what is a closed meeting

A closed meeting in a twelve-step fellowship is a meeting open only to people with the recovery issue for which the fellowship was created. An open meeting is open to the general public. Too many schools and programs conduct meetings on their premises open only to staff and participants in their school or program but call it a “closed” meeting of a specific twelve-step fellowship.

This is improper. The least of its issues is that it is not consistent with out guidelines. It also improperly takes the name of the fellowship at issue. The fourth Tradition requires that all groups be autonomous – not dependent on another organization. A group that bears that relationship to a school or treatment program cannot be part of a twelve-step fellowship that maintains the fourth tradition. This is more than a technicality. Without the input of community people with long sobriety and community people who still struggle not a recap of the issues of just the people they live with, the group will be of dubious effect. Then the people participating in these groups think the actual effectiveness of twelve-step is like the effectiveness of these groups. Based upon that, when they really need twelve-step they will think they have already tried it and found it doesn't work. Actually they haven't tried it. They think they have because their school or program misled them.

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●  Apparent Limitations due to mishandling by schools and programs
   
o   In-house meetings only

Many of those schools and programs improperly refer to meetings limited to their own internal populations as Alcoholics Anonymous meetings or Narcotics Anonymous meetings.  True Alcoholics Anonymous meetings or Narcotics Anonymous meetings are never limited to people associated with or vetted by a particular institution. They might be closed in the sense of being limited to actual alcoholics or addicts. However, if closed in the sense of participants being associated with a particular school or program and is called an Alcoholics Anonymous meeting or Narcotics Anonymous meeting, this shows blatant disregard for the fourth, fifth and sixth traditions and gross ignorance on the part of people operating that school or program with regard to something that ought to be their expertise. There is no problem with educating people with simulated Alcoholics Anonymous or Narcotics Anonymous meetings, if they are called simulated meetings and the same people get to real meetings when that is safe -- and they are taught  the difference. 

We have made this point visiting treatment centers, where the above described practice was defended on the basis of the fact that the anonymous groups do allow "closed meetings."  Again the defenders of this practice on this basis are showing their ignorance.  A closed meeting in Alcoholics Anonymous is a meeting that is open only to alcoholics, not visitors.  It is never a meeting open only to people with an affiliation with a particular other group, such as a particular school or treatment center. The issue has pragmatic significance in that it first suggests a lack of competence on the part of school or program staff that would sanction this kind of thing.  More directly, it creates confusion on the part of the students / clients, leading them to judge the impact of true twelve step meetings by what happens at the simulations. 

Serious twelve step based treatment in a school or program anticipating students / clients moving to unstructured living after discharge (home, college, conventional boarding school) includes participation in real meetings of the twelve step fellowships and opportunities for full participation in these meetings plus sponsorship from community people, opportunities to gain experience in reaching out to recovering people in the community at large, and opportunities to witness community people finding acceptance and recovery without the advantages they have in a special school or program. 

Some otherwise well conceived twelve-step programs limit participation in interaction with  twelve-step activities in the community outside the school or program in which the student is enrolled to the last few months before discharge; others begin that process near the time of enrollment.  We understand arguments for both.  But it is not reasonable to expect a person to maintain twelve-step recovery in the community after returning home or moving on to a non-therapeutic boarding school if they have not been a full participant in community based twelve-step fellowships while enrolled in the school or treatment program where they became sober.

The power of twelve-step recovery depends upon becoming part of the culture of the twelve-step fellowships.  Use of twelve-step concepts in isolation from participation in those fellowships is probably useless.  There is no reason to believe that any significant number of students / clients discharged from those programs will become more deeply involved in those fellowships than they were prior to discharge. What happened in the school or program is a rehearsal for the recovery effort that begins when the students / clients hit the streets.  If there was not a genuine rehearsal, there is no reason to believe that genuine recovery will take place once on the streets. 

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●  Apparent Limitations due to mishandling by schools and programs
     o    Head stuff presented as being the program

Unfortunately, many schools and programs describe their work with addiction and/or substance abuse as “twelve-step” when there is no exposure to recovery groups in the larger community. In the schools and programs of concern here, residents might learn about twelve-step recovery, they might work on twelve-step worksheets or workbooks to get through some of the early steps, or they might even have simulation groups within their school or program, under staff supervision.

Wilderness and other short term  programs may be an exception  if they make clear to their participants that they have not truly experienced twelve step work and have only learned some tools they might apply if and when they actually participate in twelve step.

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●  Apparent Limitations due to mishandling by schools and programs
      o     Sexual addiction programs

Sexual addiction is the only area in which we support twelve step work as an appropriate resource for adults but express a strong caution about involving teens. The obvious risk of exposure to predators – possible in any twelve-step group but particularly at issue with sexual addiction – is our primary concern. There are others, as you will see in the following paragraph. As with all twelve-step groups, our confidence in the process depends upon access to recovery groups in the larger community, and preparing the residents to access those groups when moving on.. We believe that teaching about twelve-step work in a closed environment and use of simulated twelve-step groups restricted to that environment is usually counter-productive. We cannot support the use of sexual addiction groups in the open community. We would be willing to be overruled on this if participation in twelve-step sexual addiction recovery work is part of a larger treatment plan for sexual reactivity, under supervision of a well qualified clinician who specializes in treatment of sexually reactive adolescents.

Another concern is that sexual addiction is an area where we find competing ideologies regarding what constitutes proper recovery. While there is only one twelve-step fellowship for alcoholics and there is a consistency of philosophy and methodology when a person in Alcoholics Anonymous is also addicted to other drugs and participates in Narcotics Anonymous and/or Cocaine Anonymous. By contrast, there are several different twelve-step sexual addiction fellowships with conflicting theories, philosophies and expectations of the recovering addict. In particular, there is disagreement as to what constitutes sobriety. For example in SLAA, each person sets his or her own “bottom line” or standard of sobriety depending upon what might have been their particular addictive behavior. This contrasts with most other twelve-step groups where there is one bottom line for all. For example in Alcoholics Anonymous, the common bottom line is no consumption of alcohol.

This also contrasts with SA, where there is a common bottom line: sexual activity or stimulation of any kind is only acceptable in marriage. We have serious concerns about application of this standard – which considers masturbation to be an addictive behavior in all cases – in a school or treatment center where people might be under staff or peer pressure to participate.   We believe that too much damage has been done by fostering unwarranted guilt over activity that is completely normative in adolescents and introduction of this material can exacerbate that problem. Again, we would make an exception here as to situations where twelve-step participation is part of a larger treatment plan supervised by a well qualified clinician who specializes in sexual reactivity in adolescents.

We also note that schools, programs, and well qualified individual clinicians which have informed our guidelines consistently insist that where there are residents of schools and programs who are sexually reactive to an extent that would justify exceptions noted above, these residents should have complete privacy with respect to dressing, bathing and use of bathroom facilities. These exceptions ought not to occur where group bathing, showers, dressing areas and toilets are in use, notwithstanding that these are gender specific. When we say “complete privacy” we do not rule out staff supervision where necessary, but there should be no exceptions to the privacy rule in peer situations for these residents.

Consistency with our guidelines requires consistency with all recommended procedures described above.
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●  Apparent Limitations due to mishandling by schools and programs
      o   Research outcomes

We are still in the process of developing information about research on twelve step outcomes.   Research is difficult because of anonymity and sensitivities created by anonymity.   We have seen research (and are searching for the original publication so that we can cite it appropriately) that shows that people with a history of alcohol abuse show a higher percentage of maintaining abstinence after one year if they have attended Alcoholics Anonymous on a regular basis. 

We put great emphasis on the importance of research based evidence of success.   But it is also important to recognize that every innovation is in place prior to the opportunity to research it in full depth.  If we only used fully researched methods, there could be on innovation.

Twelve step has not been researched thoroughly not because it is new but because its very nature makes it hard to research.  It is not responsible to rule out the value of twelve step work solely on the basis of absence of research.   Programs that avoid twelve step work because research is inconclusive and treat that as if there is research showing ineffectiveness are outside our guidelines

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●  Wrong information

Far too many of the reasons given for using or not using twelve-step are simply based on wrong information.  We understand that when it comes from people who simply don't want to stop their addictive behavior.   We could understand a negative attitude when comes from a person who had somehow been mistreated in the context of twelve-step work.  We can understand excessive reliance on twelve-step from someone who believes that twelve-step saved their life.    

It is harder to understand when it comes from professionals who simply ought to know better.  We lament the fact that far too many decisions about use of twelve-step are based upon wrong information.  We believe that the decision to use or not use twelve-step in schools and programs should be made by people who have an accurate understanding of it.  One necessary step in having an accurate understanding is to participate in a twelve-step program.  This is not to say that one must be an addict in recovery.   Any person may attend open meetings of a twelve-step group and almost all twelve-step fellowships offer open meetings. 
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●  Wrong information
     o   Can’t do it with teens

We want to challenge schools and programs that say it is not possible to convince teenagers to accept the spiritual dimension of 12-step work or to relate to being "powerless" as used in the first step.  Yes, it is possible and competent staff and competently designed programming can achieve that. When we hear representatives of schools and programs make that claim we hear only a statement about the competence of their particular staff, not a general statement about substance abuse treatment. Competent substance abuse professionals can successfully introduce twelve-step work to teens.

Schools and programs that want to engage teens in twelve-step activities and are dubious that it can be done, should look at what Elk Mountain Academy and In Balance Ranch accomplish by taking their residents to national Alcoholics Anonymous conventions. 

These are some examples of reasons given for claiming that twelve-step cannot be done with teens and an explanation why those claims are bogus. Typically they come from people with an academic understanding of recovery but not real experience interacting with people using twelve-step successfully.

Teens won't accept “God talk.”

Let's keep in mind that many teens have been subjected to religious abuse, and, for them, getting past this barrier can be challenging. When that is the case you might need to work specifically with the issues surrounding the abuse. It will probably be necessary to take special steps in order to help that person understand – and then experience – that the “God talk” and “higher power” need have no relationship to the deity involved in whatever abuse was taking place. If this abuse is associated with a particular religion, it might be important to enlist the services of clergy from that religion to reinforce the point that the abuse never was an appropriate expression of the religion involved.

The key to working with this successfully is to acknowledge that the specific word “God” can be misleading as to what the twelve-step groups are really suggesting. Encourage the teens to think in terms of “greater power” instead of God if they are not operating from a religious faith. If they are, make sure they see how the God of their religion works as the higher power or God as referenced in the twelve steps..

It is fairly simple to set up a demonstration. If there are other people around, as the teen to do something that one person cannot do but a small group of people can do. Hopefully the teen will attempt the task and fail. Then call over the others and ask them to perform the task together. Then they succeed. If they don't accept a greater power or higher power from a religious tradition, they can at least see how a greater power can be simply a group of people. This suggests that a group of recovering people together can be the “higher power” or “power greater than self.”

It is also appropriate to go with the slogan “Fake it until you make it.” Ask the person to act as if he or she believes in the strength of a higher power and see what happens. This kind of experience.

It is not always quite that simple, but this is a place to start. When it is not quite that simple, and you are a substance abuse counselor who can't cross that barrier, it is time to consult with a substance abuse counselor who has worked with this process successfully in the past. Rarely – very rarely – you might find a client of any age who simply cannot get past the concept of higher power or greater power.

Teens won't accept “powerlessness.”

We suppose no one likes to admit powerlessness. So we only want to press this point with those who are actually powerless. We think the main reason why many addiction counselors claim that teens can't be convinced of their powerlessness is that many teens being pushed into twelve-step activities are not powerless. To understand what we mean, look at our explanation of addiction-1 and addiction-2. Teens who are addicts only in the sense of addiction-1 probably are not powerless in the requisite sense. It is also possible that there is insufficient information to determine whether they are addicts in the sense of addiction-2, although clearly addicts in the sense of addiction-1.

When people are addicts in the sense of addiction-2, it is highly probable that that they know they are powerless and they aren't the ones fighting the concept. When people who are clearly addicts in the sense of addiction-2, and are resisting the concept of powerlessness, we call attention to the principles of Motivational Interviewing for insight on how to proceed. However, we see no reason to assume that there is no way accomplish bringing people who are clearly addicts in the sense of addiction-2 to the realization that they are powerless.

When people are in the group that can't be determined whether they are addicts-1 or addicts-2, they these people should be taught the risks indicated by the known facts. That includes that if they are addicts-1 they are at risk for addiction-2 and should be learn how to use twelve-step as a potential resource, including practicing its use. Click on this sentence for detail. They might work with first step worksheets to help determine whether they are addicts-1 or addicts-2. But it contrary to our guidelines to pressure a teen to “own” the concept of powerlessness unless there is evidence of addiction-2. Also keep in mind that some teens (and adults) who are addicts-1 will claim powerlessness and accept the first step. If that is personal choice, we have no problem with that. But that should never be forced.

Teens won't accept that they have a disease

This is an obstacle, and reinforces the need for schools and programs to stop telling teens they have a disease that they don't have or might not have.  Once more, let's look a the history.  When Alcoholics Anonymous was founded, drunkenness was understood as a moral deficit.  The concept of alcoholism as a disease was introduced to remove the moral issue.   Teens drinking and drugging on  our day do not seem to feel stigmatized by their behavior but they might feel like "damaged goods" if they have a disease, especially one that can be treated or put in remission but never cured. 

We see no reason to emphasize the word "disease."  For alpha alcoholics and addicts-1 we see no reason to bring it up -- just as we see no reason to push twelve-step except as a resource to fall back on in case things get worse.  If there is evidence that there is a problem of gamma alcoholism or addiction-2 the only responsible thing to do is to acquaint the person with the fact that it appears that their brain has been altered and it is important that they establish a lifestyle of recovery.   This is directly parallel to the need to inform a newly diagnosed type one diabetic that they will need to take insulin and engage in certain other disciplines for the rest of their lives.  Whether they use the word "disease" is not important to us. 

Teens won't accept that they must stay with a twelve-step fellowship for a lifetime

The first thing to note is that twelve-step fellowships focus on the notion of "one day at a time" and do not emphasize what might happen a lifetime away.   Still it is assumed that alcoholics and drug addicts will need lifetime support to remain clean and sober.  Twelve step meetings often call attention to people who stopped "working the program," subsequently relapsed, and returned to health only after recommitting to a twelve step lifestyle. 

This is appropriate for gamma alcoholics and addicts-2.  If there is genuine evidence of that, it is important to get that message across and any method of recovery that fails to do so will likely fail.  It simply not appropriate for alpha alcoholics and addicts-2. 

Teens won't accept that they can never drink or smoke a joint again.

This is simply a variant on the above point.  If a person is a gamma alcoholic or an addict-2,  he or she cannot safely drink or use drugs in the future whether they participate in twelve-step.   If the person is an alpha alcoholic or an addict-1, that is not clearly the case.  The person is at high risk for getting to that point if not there yet.  We think the safest choice is to avoid that and we want schools and programs to be clear about that. We also expect most teens will try it again anyway.  That might help to clarify whether the person can safely use again -- perhaps at a very high cost.

The point is that twelve-step or not twelve step  has nothing to do with whether they person can safely use again.  The person's depth of severity in their addiction is what determines what he or she must do.

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●  Wrong information
     o     Lifetime commitment

One therapeutic school that has much quality at one time prohibited all twelve-step activity – including for students who have benefitted from twelve-step activity in the past.  That alone was irresponsible – if that is to be the policy for whatever reason, then students who have previously benefitted from twelve-step work should be totally excluded from that program.   But the reason was even more bizarre.  One of their owners has told me that their focus was then on keeping their graduates clean and sober for the first year, and they don’t want twelve-step because it involves a lifetime commitment.  What makes this bizarre is that that one thing that the limited research available on twelve-step work seems to confirm is that people who attend twelve-step meetings in the first year of recovery outside of a structured environment are more likely to remain sober than those who don’t. 

The “lifetime commitment” statement is ridiculous.  Mainstream twelve-step groups we are aware of are not cults that make it difficult to leave.  (We have heard of one example of a local twelve-step group encroaching cult territory, but that is a highly unusual situation).  There is nothing in the approved literature of Alcoholics Anonymous, Narcotics Anonymous  or any other twelve step group we are familiar with that calls for lifetime commitment. 

The literature of Alcoholics Anonymous has long stated that alcoholism is a lifelong illness from which people recover but are not cured.  If the reader looks further at the literature of Alcoholics Anonymous, it is quickly evident that the people at issue in that literature are the people who have been  overwhelmed by failure to fight the compulsion to use alcohol over a period of time.  Jellinek has introduced the concepts of Alpha, Beta, Gamma, Delta, and Epsilon Alcoholism.  We have offered the distinction between Addiction-1 and Addiction-2.  Many people benefit from twelve-step when they are alpha-alcoholics or have addiction-1, but we know of no reason to suppose these people need to make addiction or alcoholism  part if their lifetime identity.  We also know many successful alternatives to twelve-step work for addiction-1.  

Recent neurological research seems to support that.  It is common for twelve-step people to make twelve-step participation a way of life, but it is also common for many successfully recovering people to allow their involvement in the twelve-step groups to fade away gradually as recovery takes hold.  We share with Alcoholics Anonymous and with Jellinek that for Gamma Alcoholism and for addiction-2 this is a very risky thing to do;  we expect that it is a realistic course for alpha alcoholism and for addiction-2. 

Members of Alcoholics Anonymous often correctly point out the danger of dropping out, as there are many tales told at meetings of people with many years sobriety who stopped attending, then took one  drink or one dose of a drug and quickly reverted to where they had been, and got back on track due to re-investment in twelve-step groups. We agree that when a person has relied on twelve-step meeting participation for recovery, they put themselves at risk if and when they stop, but we also know people who have done it successfully. We also know some who have done it and it led to tragedy.  If the "lifetime commitment" is to maintaining sobriety for a lifetime, that is a principle supported much more broadly than just in  twelve-step groups. It is supported among other places in scientific research on addicts and alcoholics.   But there is no basis for the suggestion that “lifetime commitment” is a sound reason for rejecting twelve-step participation for all.

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●  Wrong information
     o    Twelve-step is a Religion

Many have objected to twelve-step alleging that it is a religion.  This is apparently due to the references to "God" in the literature.  We are also aware of aberrant twelve-step groups that use the "God" references in a way that implies that that "God" must refer to the god of a specific religion.   Twelve-step groups that take the Twelve Traditions seriously do not do that.

The founders of Alcoholics Anonymous were previously active in Frank Buchman’s Oxford Group, which had all of the religious and spiritual foundation  of today’s twelve-step groups, but lacked the immediate contact between recovering people focused on recovery.  It did not work for those people until they began to gather specifically to share their recovery. Alcoholics Anonymous began as Oxford Group members who were struggling with alcoholism, meeting together for mutual support, and also employing the resources of the Oxford Group.   At that time it was explicitly a Christian group, but with no official leadership or officially defined policies.

Several years into it, in the late 1930s, the people who were the de facto leaders of Alcoholics Anonymous joined together to set the core identity and principles of the  fellowship.  The product of their labors was the book , affectionately known as "The Big Book."  Among other things, this was the codification of the Twelve Steps and Twelve Traditions.   One major decision made in the process was to end the identity of Alcoholics Anonymous as a specifically Christian group.

When they took that action they left in language and an organizational culture that in   1939 would reasonably have seemed neutral with respect to religion, but in our day seems to carry at least Christian bias. This result was clearly not intended. On the other hand, we have encountered people in twelve-step groups who do appear to choose to use twelve-step  fellowships as a  religion.  

A quasi-official refutation of twelve-step as a religion is available at this site:  https://www.hazelden.org/web/public/ade80121.page   A variety of arguments to the contrary can be found by running the following series of words in your favorite search engine:  "twelve step religion." This will take you to a number of articles arguing for the claim that twelve-step is a relatiou.

Schools and programs using twelve step that also meet our guidelines, will specifically instruct their students/ participants on how to work with the terminology that appears to favor Christian religion so that they are not feeling pressure to move away from a different religion or an absence of religion.

The core issue for twelve-step programs regard in spirituality is to remind participants that they are  not God. It is also to call attention to the fact that we can access strength outside ourselves for what we cannot accomplish alone. One need not believe in God or adhere to any religion in order to experience that.

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  Wrong information

      o   Conflicts with religion

We sometimes hear of people avoiding twelve-step because they claim that twelve-step requires them to worship a god that is not the God of Christianity. It is not obvious to us what prompts people to think that.  Clearly each person is free to understand the words "God" and "higher power" as they choose.  Any bias in the language would favor the understanding of those words as references to the
Christian God. Perhaps they are simply upset that others can interpret that language to mean something different. Alcoholics Anonymous is not about proselytizing for any religion. It is about getting and staying sober. We can make the analogous point about other twelve-step fellowships. However people with a strong religious faith are encouraged to understand the references to “God” and “higher power” to be the God they worship in their religion.

We point out that the founders of Alcoholics Anonymous were previously active in Frank Buchman’s Oxford Group, which had all of the religious and spiritual foundation  of today’s twelve-step groups, but lacked the immediate contact between recovering people focused on recovery.  It did not work for those people until they began to gather specifically to share their recovery.  Most purely religious recovery is handicapped by the same element.  We don’t claim it can’t work, but for many people it works better for religious people in recovery to take their God with them to twelve-step meetings – if they otherwise are people who would benefit from twelve-step work. 

We have heard of people being criticized in twelve-step meetings for stating that their higher power is the God of Christianity or Allah or Buddha. However the people criticizing are the ones who are out of order unless the speaker is advocating that recovery only occurs through the power of their God. That suggests that people of other religious are excluded, contradicting Traditions Two, Three, Four, Six, and Ten..

We hear, “We don’t need Alcoholics Anonymous, we just need Jesus.”  First we want to acknowledge having witnessed genuine recovery in a purely religious context. We encourage reliance on Christian recovery groups when the doctrinal commitments and religious expression are compatible with the participant's own tradition. We assume there is analogous recovery support in other religious traditions, although we lack specific knowledge.   For all of those reasons, we encourage people who would benefit from a twelve-step group to also participate in recovery groups in their own religious tradition along with twelve-step groups, so long as the religious program does not undermine twelve-step.

We have several concerns about existing religious recovery groups as a sole source of support in recovery. These are based upon knowledge of specific groups. We do not think there is any reason why a religious recovery group could not emerge that would be effective as a stand alone support. The first concern is availability. We know of no such recovery group with daily meetings even in densely populated areas. We know of only one – Celebrate Recovery – that is available at multiple locations around the country. For further information about Celebrate Recovery, click on the name. In general, these groups do not have people with the recovery experience that we see in the better established twelve-step fellowships. In some cases (including Celebrate Recovery) they are not focused on a single recovery issue, as are most twelve-step groups.

Remember, the history of Alcoholics Anonymous's forerunner, the Oxford Group included many – probably almost all – of the spiritual supports of the twelve-step groups in a specifically Christian context. The founders of Alcoholics Anonymous found that they did not find sufficient support for their recovery in the Oxford Group until they joined together to strengthen each other with a specific common goal: recovery. We are dubious about the effectiveness of a Christian group with exactly the same issue. The experience of Alcoholics Anonymous and the Oxford Group suggests that people need association with people of the same issue in order to maximize support in recovery.

Our guidelines call for recognition of the potential value of religious or faith-based recovery groups but require that where twelve-step work is otherwise indicated, the people be sufficiently prepared to become involved in twelve-step to integrate that they will find support there when the faith-based group is not available and/or if the faith based group is not specific to the addictive behavior targeted. Until ubiquitous addiction specific faith-based groups become available our guidelines require that twelve-step still be offered as a core support system for people would benefit from it without reliance solely on religion specific faith based resources. This includes faith-based schools and treatment centers.

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L Vaughn of Second Nature Blue Ridge is a therapist we greatly admire.  Lu is fond of saying, "What is the difference between treating an addicted kid compared to a substance abusing kid?"  Then giving the answer, "None."  With rare exceptions that answer is right on target.  Almost all the time, when teenagers or young adults enter a therapeutic school or treatment center with a substance abuse history or history of other potentially addictive behaviors, no one knows for sure where they are on the addictive spectrum.  Involving the residents in healthy activities that guide away from addictive behaviors and teaching about addiction are constructive at any point. 

Bulleted List of Guidelines

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The twelve steps of Alcoholics  Anonymous

The twelve traditions of Alcoholics  Anonymous

Feedback is invited. We will  publish selected feedback.  Email FamilyLightResponse@yahoo.com

Disclaimer: No  program review, no matter how positive, is a blanket endorsement. No criticism is a blanket condemnation.  When we express our level of confidence in a school or program, that is our subjective opinion with which others might reasonably disagree.  When we assert something as fact, we have done our best to be accurate, but we cannot guarantee that all of our information is accurate and up to date. When we address compliance with our guidelines, you need to remember that these are only OUR guidelines -- not guidelines from an official source.  We have also set the bar very high, and do not expect any school or program to be in total compliance.  It is not appropriate to draw a conclusion of impropriety (or even failure to live up to conventional wisdom) from our lack of confidence in a school or program or from less than perfect conformity to our guidelines.  Some will say we expect too much. Readers are responsible for verifying accuracy of information supplied here prior to acting upon it. We are not responsible for inaccuracies.

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Last update 1-11-2011

 
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