The information age has unleashed a boatload of alternative opinions on addiction, recovery, and treatment. The most popular alternative opinion we’ve seen is that there are a lot of problems with 12-step programs. Are these expressions merely blind hatred for AA, or is it something more meaningful?
Formerly, those of us who were AA rejects were made to feel insane when the program made no sense to us, and thus offered no help to us. Any avenue toward “help” sent us back into 12-step programs, because they were essentially the only game in town. And there, we could once again feel crazy, alone, and hopeless when we failed to see exactly how we were powerless and how the recovery lifestyle, with all of its contradictions, self-defeating ideas, and irrational recommendations, could save us from ourselves. We proceeded to feel more and more hopeless as each stint of “help” resulted in worsening personal problems.
But then, we went online, and almost like what people say they experience at 12-step meetings, we heard that others had the exact same experience of increased feelings of helplessness and confusion after attending 12-step-based programs. We didn’t feel so alone. We weren’t the only ones who saw through the tenets of powerlessness, spiritual maladies, and substances as “cunning and baffling” entities. We weren’t the only ones who knew that “higher power” really meant “god”, and that no matter how much we wished for it, a doorknob, oak tree, or Group Of Drunks (G.O.D.) couldn’t magically enter our soul and remove the will to drink or drug.
It has been no small event that millions of people have read these accounts and/or revealed themselves online as 12-step rejects. It has been important for others to know that they aren’t crazy if they find themselves unable to drink Bill Wilson’s Kool Aid. But what’s next? Are we offering a true alternative to the madness of the 12-step recovery culture – or delivering troubled people into the hands of an equally dangerous piper?
Are you “in denial” of the true problem with AA?
In order to ensure that we don’t promulgate the faults of the 12-step approach to drug and alcohol use problems, we need to understand what those problems truly are. I think, for most of us, they were mostly covered in steps 1 thru 3:
1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
Everything about those first three steps essentially tells us: you are weak and you can’t control yourself, thus you need some other entity to control your behavior for your own good. Isn’t that what you found most offensive to your understanding of life and human behavior? Isn’t that what sabotaged you, and made any choice to use substances into the equivalent of the choice to jump off a cliff? Wasn’t the experience of being browbeaten into accepting these tenets completely devastating to your sense of control over your own behavior, and your hope for a better life?
Don’t you hate the way that 12-step programs teach people to believe that they are weak, powerless, and need to depend on others to “manage” their “addictions?”
I think a lot of you feel this way. I’ve seen it expressed plenty online. Yet many of you seem to promote and focus on things that further the exact notions put forth in those first three steps. For example, over the past few days, a spate of 12-step-critical articles have appeared in my facebook newsfeed. In said articles, the authors tear apart 12-step programs because they aren’t run by “professionals”, such as addiction counselors or therapists. They complain that we should be providing “evidence based treatments” for people with “addictions.” There are several things wrong here:
1. Evidence Based Treatments (EBT) are a fantasy. Twelve Step Facilitation is an EBT. That’s right, the thing that you know so well to be ineffective and perhaps harmful to people with substance use problems is officially an “Evidence Based Treatment.” (12-Step programs are Evidence Based Treatments?) If this is so, what does that say about the claims supporting other EBTs?
2. Since you’re demanding that people get “treatment” from medical and psychological professionals, you are implicitly accepting and promoting AA’s disease theory. That disease theory is the same one that teaches people they are weak and powerless. It’s the same one that convinces people to resign themselves to a lifelong struggle with a boogie monster called addiction or “alcoholism.” It’s the same one that increases binge drinking and “relapse” in those who believe it most strongly.
3. The same disease/powerlessness theory that has been so disillusioning and disempowering to so many people who entered 12-step programs over the years becomes no less harmful when it’s taught by someone with medical/counseling credentials. In fact, there’s good reason to believe it could be even more harmful in such hands, because it’s coming from a more convincing source.
Need I continue? The professional medical treatment that is usually offered up as an alternative, first of all, doesn’t usually exist. The treatment programs claiming to use it almost always end up funneling people into 12-step programs. But even if they were to stop sending people into 12-step programs, they are still teaching them that they can’t control themselves – that they need to “avoid triggers” in relapse prevention programs; that their brain makes them do it – by promising that some sort of pharmaceutical will be their ultimate solution; or by teaching them that without “ongoing support” from group and individual counseling sessions (unofficial AA meetings led by a therapist) they will succumb to their inherent weaknesses caused by their disease. They need constant help with stress and anxiety and other “underlying causes of addiction” or else they’ll “relapse” – a word that can only invoke a powerful disease that robs you of the power of choice.
What I’m getting at, obviously, is that AA and other 12-step programs are dangerous because they teach people to view themselves as weak and powerless and in need of an external force to cause them to change – but meanwhile, the supposed “professionals” that the anti-12-step movement so readily recommends as an alternative do the exact same thing.
In some cases, the professionals may actually be worse. First off, most of them are definitely going to teach people 12-step principles and refer them to 12-step programs. But even the rare few who don’t do this are going to sabotage them in other ways: They tie every normal problem of life to drugs and alcohol. Did bad things happen to you as a child? That’s gonna cause you to drink and drug. Did you have a stressful day? That’s gonna cause you to drink and drug. Anxious about something? That’s gonna cause you to drink and drug. Depressed about something? That’s gonna cause you to drink and drug. Feeling lonely? That’s gonna cause you to drink and drug. These are normal difficulties that nearly everyone faces at one time or another, yet not everyone chooses drug and alcohol use as a response to these problems – nor does everyone run to a counselor every time they have these difficulties, lest they drink or drug. Nor do they all have wonderful “alternative coping strategies” for these difficulties – most probably have no “coping strategies” whatsoever. Most people don’t connect these difficulties to drinking and drugging to begin with. They aren’t constitutionally any different than those of us who have had substance use problems – they just haven’t been taught that these things are necessarily connected.
Maybe some of you have completely rejected the addiction treatment world and the disease concept. But then you turn around and say that people need vitamins and nutritional supplements or macrobiotic food or whatever in order to stay sober. Don’t you realize that you’re doing the same exact thing as the 12-step groups – you’re teaching people that the cause of their substance use has nothing to do with direct choice, and that it’s actually caused by a biological factor. Doesn’t such a theory suffer the same problems as the disease concept of addiction? With this crowd, as much as with the 12-step crowd, the troubled person can’t simply recognize what choices work or don’t work to achieve their goals, they can’t rethink what they’re doing with their lives and choose a new path – instead, their choices are caused biologically and they need to depend on the nutritionist to prescribe a cocktail that flips the proper switches in their brain.
And then there are the spiritual experience people who latch onto a new hallucinogenic every few years. Tripping on acid, ibogaine, ketamine, or ayahuasca becomes a popular suggestion every few years as a “cure” for addiction, and is all the rage in the press each time it makes a resurgence. The theory here is exactly the same as the 12-step programs – you are weak, and this spiritual experience will connect you to the power you need to change. Screw the spiritual experience of the 12-step programs, get the spiritual experience of the latest hallucinogenic.
Missing The Point
I saw a post on Facebook that compared AA to Narconon (the rehab based on Scientology). It drew several comparisons – that both are cults, based on a personality (Bill W or L Ron Hubbard), based on teaching from an old book, etc. But most importantly, the post kept stressing that neither were run or founded by medical professionals. So what? Yes, Narconon has deep problems, but the bigger fundamental problem is that they claim addiction is not a disease, yet they purport to offer “treatment” for it. Treatment for what? A nonexistent disease? How can someone be expected to believe they don’t have a disease when this taught to them by people claiming to “treat” them for the very same imaginary disease? Narconon centers aren’t the only ones making this tragic error. There are others out there, and you can easily figure out who you are.
This course of action is clearly ill-conceived: to battle the disease concept of addiction, and preach that it’s false – then offer “treatment for addiction” is self-contradictory. If you activists reading this can understand how utterly nonsensical this is in practice, then hopefully you will stop missing the point, and understand that it’s also ridiculous to recommend the same. You can’t argue against the disease concept, and then recommend treatment. You can’t argue against teaching people to feel personally weak and dependent on a lay-led support system – then proceed to teach people to feel personally weak and dependent on a “professionally” led support system. You can’t argue so brilliantly against the biological determinism of the disease model of addiction, only to turn around and proclaim that nutritional deficiencies or even simple withdrawal are the causes of substance use. Well, I guess you can do these things, but if you expect to be taken seriously, then you’re headed for a deep disappointment. Such advice is inherently self-contradictory. If the disease and weakness teachings are the problem, they are the problem.
To those of you who are against 12-step programs because of its cult-like aspects, yet you turn around and recommend alternative support groups, what do you think you’re recommending? The elements that lead to this problematic atmosphere are clear enough for anyone to see:
- See yourself as being “in need of support”
- See relationships with others who’ve “faced the same struggles” as some sort of medicine you need in order to “cope”
- Create a system where anyone can join this group of others
- Get all of these people together, and encourage them to pour their guts out to each other – and to rely on each other as lifelines
Why should a “mutual support group” by any other name result in anything less than the mess that is AA?
How absurd do the following statements sound?:
You’re not powerless – but you need a mutual support group. Screw those people who say you’ll relapse without the support of AA – but you better make sure you get help with your “underlying issues” from the properly trained and licensed professionals. You don’t have a disease, but you need medical treatment for your addiction.
AA members and other 12-step pushers (such as interventionists and those who work in treatment centers) are quick to confront troubled substance users, label them as diseased and powerless, and claim that they’re in denial if they disagree with these views. Many anti-12-steppers and “alternative treatment” pushers are quick to reject this nonsense, but then they more subtly tell people that they’re weak. They tell them that without the proper “coping methods” and “support network” they’ll relapse. They often sell people a kinder gentler version of powerlessness. Is this any better than being straightforward about it?
To the anti-12-step/anti-disease-model movement – I beg of you, stop missing the point. Figure out what you’re fighting for, and fight for it consistently. Otherwise, you risk delivering troubled people into the hands of equally harmful systems of help.
What if you recalled what really hurt you and others in 12-step programs – being taught that you were weak, powerless, diseased, and in need of an outside force to direct your life – and you threw all of that garbage out, then started fresh? What if you tried to help people without all of that baggage? What would you do?
- Would you tell them they need medicine and professional medical help for anything other than detoxification (or related medical problems)? That is – would you tell them they need medicine to make different choices?
- Would you tell them that instead of a 12-step sponsor, they should have a therapist or counselor direct their life?
- Would you offer up a total non-sequitur, such as “you need vitamins and nutritional supplements to stay sober?”
- Would you tell them that if they don’t find a way to avoid or deal with every normal problem of living that everyone faces (stress, anxiety, depression, sadness, loneliness, etc), then they will be forced to continue to use substances heavily?
- Would you tell them anything that indicates that they are inherently weak and helpless/powerless?
- Would you tell them anything that would overcomplicate their problem?
Try this when you personally take the time to attempt to help someone with a substance use problem: Don’t believe that they are powerless or weak, because they aren’t. Believe that they are powerful and capable of making whatever changes they may end up wanting. Don’t believe they are a helpless victim when it comes to substance use, because they aren’t. Believe that they are willfully choosing substance use for the same basic reason everyone else chooses it – because it offers a quick thrill in the form of a physical sensation – immediate gratification. Don’t believe that stress or anxiety or any other so-called “underlying issues” are causing their substance use, because it isn’t. Believe that human behavior has reasons, not causes. Don’t believe that people use substances for negative reasons, because they don’t. Believe that people use substances for the quick bursts of pleasure that they bring. Also, believe that everyone is capable of making choices that bring them greater levels of happiness than substance use.
After you’ve got these ideas straight, have a real conversation, where you listen, where there is a give and take, where you don’t tell them how to live their life. Ask questions. Do they think that their substance use habit is bringing them the quality and quantity of happiness they’re looking for? If so, leave it at that – you don’t get to decide what they want. If not, do they think they might have better options available to them? Would they be happier with no substance use? Less substance use? How so? What would they rather do with their time and resources? How could they make that happen? When do they want to make that happen?
Why would anyone need credentials to have this conversation? Why would anyone need “support” to keep themselves from making choices that they no longer find attractive? Why should people think that this needs to be a big struggle, and that it needs to be dragged out? Why shouldn’t people just believe that they can move on with their lives as soon as they realize they want to pursue greater happiness in other ways?
And if you’re going to try to offer a formal system of help for people with substance use problems, make sure it offers them the same as above, and more if possible. Are you capable of offering people a path to self-discovery, shame free evaluation of choices, empowerment, and new awareness of life options? If you can design a method of help that offers these things, without breeding a sense of inherent weakness and dependency, then you will have something helpful. If not, then you’re probably offering 12-step-lite.
Don’t get me wrong here – you don’t have to offer an alternative method of help in order to spread a message that is helpful to people with substance use problems. Far more people get over these problems without help than with help. Moreover, the best data available show that people are not more likely to change their substance use habits with help than without it. And let’s be clear about something, if people weren’t told that addiction is a special hard to solve problem, then they would deal with it as they do other life problems – just like bad relationships or dead-end jobs – they would naturally look for something better and change it. So, you can be helpful just by arming people with the knowledge that their substance use problems are not a special case of disease, powerlessness, or weakness. If you’re good at spreading that message, why would you turn around and ruin it by recommending a form of help that contradicts that message? Why not just spread the word that people are powerful and capable of changing and making more fulfilling choices?
One quick note – Medical help is obviously needed in some cases of withdrawal syndrome from drugs and alcohol – in order to safely treat the physical symptoms of withdrawal (not to “treat addiction”), but I don’t know why anyone would recommend medical help for the ongoing choice to use substances, unless they already believed that addiction is a disease.
I don’t know how it happened – whether the recovery culture co-opted the anti-12-step/anti-disease movement, or whether this movement has simply fallen into the trap of accepting the premises laid out by AA (powerlessness, disease, loss of control) – but I’m afraid that many in this movement are doing nothing more than putting gold paint on the giant turd that is the conventional recovery culture. If you want to offer something different, then offer something that is truly different – something that isn’t built on the same weak foundation as the recovery culture.
The 12-step/recovery movement has it’s detractors – the anti-12-step movement – and accordingly, this movement has its own detractors. These devout 12-steppers say that we just want to bash AA and other 12-step programs. I’m sorry to say it, but in regard to many in the anti-12-step movement, they might have a point. If you detest the 12-step recovery movement, but you recommend replacing it with similar things minus the 12-step label and buzzwords, then your criticisms must be questioned. Is it just personal, or are you really trying to fight against the counterproductive ideas of the recovery culture? Figure it out.