Andrey Nailor, M.D.·Published 4 October 2008·10 min read
Key points
During the early decades of the twentieth century, a man named Bill Wilson, a talented entrepreneur and businessman, was sinking deeper into addiction to alcohol.
He eventually encountered a friend and old drinking buddy who was sober, happy, and apparently doing well.
What his friend had discovered was that by giving his "struggle over to God" and by "taking it one day at a time" he was able to stay sober; his life had turned around, and he was happier than he had ever been.
Recognizing that he had to be of service to others in order to stay sober, he began to spread the word by calling on alcoholics who were willing to listen - those in hospital wards or on the streets - and simply relating his experiences and offering to listen.
During the early decades of the twentieth century, a man named Bill Wilson, a talented entrepreneur and businessman, was sinking deeper into addiction to alcohol. He tried everything available at that time to give it up but would always eventually return to drinking, as his career and home life deteriorated. He sought opinions about his drinking problem from experts and found that there were no satisfactory answers.
He eventually encountered a friend and old drinking buddy who was sober, happy, and apparently doing well.
What his friend had discovered was that by giving his "struggle over to God" and by "taking it one day at a time" he was able to stay sober; his life had turned around, and he was happier than he had ever been. Bill Wilson took the same steps.
Recognizing that he had to be of service to others in order to stay sober, he began to spread the word by calling on alcoholics who were willing to listen - those in hospital wards or on the streets - and simply relating his experiences and offering to listen. By 1935, the organization Alcoholics Anonymous was born. Today there are tens of millions of members worldwide. The 12 steps of Alcoholics Anonymous have been adopted and utilized by people with all types of addictions and behavior problems; groups include Overeaters Anonymous, Gamblers Anonymous, Narcotics Anonymous, and Codependents Anonymous.
The basic premise of 12-step recovery is a spiritual one. It is based on the conviction that addiction involves spiritual bankruptcy characterized mainly by "self-will run riot." Recovery begins by admitting that the addiction is out of your control and that your life is out of control. This is the first step, and it is an admission of hopelessness. What happens next is best decribed in "Who Gets Addicted and How" section, "There Is a Solution." The section tells of a man's trip to Europe to consult with Dr. Carl Jung, a noted psychoanalyst, about his alcoholism:
Some of our alcoholic readers may think they can do without spiritual help. Let us tell you the rest of the conversation our friend had with his doctor. The doctor said: "You have the mind of a chronic alcoholic. I have never seen one single case recover, where that state of mind existed to the extent that it does in you." Our friend felt as though the gates of hell had closed in on him with a clang. He said to the doctor, "Is there no exception?" "Yes," replied the doctor, "there is. Exceptions to cases such as yours have been occurring since early times. Here and there,
Written and revised by
Andrey Nailor, M.D.
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once in a while, alcoholics have had what are called vital spiritual
experiences. To me these occurrences are phenomena. They
appear to be in the nature of huge emotional displacements
and rearrangements. Ideas, emotions, and attitudes which were once the guiding forces of the lives of these men are suddenly
cast to one side, and a completely new set of conceptions and
motives begins to dominate them. In fact, I have been trying to
produce some such emotional rearrangement within you. With
many individuals the methods which I employed are successful,
but I have never been successful with an alcoholic of your
description."
Upon hearing this, our friend was somewhat relieved, for
he reflected that, after all, he was a good church member. This
hope, however, was destroyed by the doctor's telling him that
while his religious convictions were very good, in his case they
did not spell the necessary spiritual experience.
Here was the terrible dilemma in which our friend found
himself when he had the extraordinary experience, which as we
have already told you, made him a free man.
We, in our turn, sought the same escape with all the
desperation of drowning men. What seemed at first a flimsy
reed has proved to be the loving and powerful hand of God. A
new life has been given us or, if you prefer, "a design for living"
that really works.
The original members of Alcoholics Anonymous were quick to point out that this was not a religious program, even though there is an emphasis on God. Instead they stressed the importance of personal spirituality in the process of recovery.
They recognized that many alcoholics had problems with the concept of God, and the final version of the book Alcoholics Anonymous contained the additional words "as we understood Him" when God was mentioned in the 12 steps. A belief in God is not necessary in order to begin recovering through a 12-step program, but a "spiritual awakening" is part of a successful 12-step recovery. Recovering alcoholics and addicts in 12-step programs often express gratitude, saying that when the addiction knocked them to their knees was when they found God.
Many people find that their addiction goes into remission following a spiritual conversion. Church-based addiction programs emphasize spiritual growth and religious maturity.
The basic concept of recovery here is not very different from Alcoholics Anonymous and the other 12-step programs, but these approaches include a doctrinal aspect specific to a religion.{pagebreak}
People who have a spiritual conversion, stop drinking or using drugs, and start attending church without professional help or AA attendance sometimes run into snags. In some churches a stigma is associated with addiction that makes it difficult to talk honestly about day-to-day problems. Some churches have legalistic doctrines, and the addict is tempted to adopt a set of rules that substitutes for actual recovery.
Long-term abstinence in this situation can be difficult, and relapse can damage the addict's faith. There are addiction and mental health professionals who can work effectively with religious beliefs, and most religious doctrines dovetail nicely with the principles of 12-step recovery. For example, church attendance and Bible study along with regular 12-step meetings is a good combination. As one AA member put it, "I go to church to save my soul. I go to AA meetings to save my behind." Crudely put, maybe, but useful advice.
But what if you are agnostic or atheistic? A number of solutions are available. The reference to "a power greater than ourselves" in step 2 offers the possibility of accepting a "higher power" - not necessarily God - to help with recovery.
Sometimes people begin with just the awareness that the addiction is beyond their personal power, and they rely on the support of the group as a higher power.
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One woman, early in recovery, was told by her AA sponsor that she needed to pray if she was to have another sober day.
She had been raised Catholic but had turned away from the church in her teens. She started out not believing in God, but she knew she had no option other than to try and do what her AA sponsor told her to do. She began praying to "Howard" - and got sober for the first time in her adult life. She later explained that she prayed to Howard because of how she had first heard the Lord's Prayer as a child: "Our father, which art in heaven, Howard be thy name . . ." Another woman in treatment had a small rubber ball that she kept with her at all times. She explained that this was her higher power. She did not believe in God, but she had started out on the road to recovery.
Of course, the "God thing" remains problematic. Atheists and agnostics may object to the emphasis on God in 12-step recovery (contrary to popular belief, the Big Book unapologetically refers to "God" again and again, and not just to the concept of a "higher power"). Conservative religious people sometimes object to the lack of emphasis on doctrine. Some people have characterized AA as a type of cult religion that comes to substitute for the original addiction.
Various research approaches have attempted to define and analyze what the effective factors are in 12-step recovery. An increase in a sense of self-efficacy, renewed connection with others in the context of the group, and the repair of attitudes and relationships are some which have been studied. But many recovering people and addiction professionals consider the activity of a loving God in the recovering person's life to be a real and effective factor in successful recovery. A lot of the addicts I've seen in my practice who are unable to stay sober for more than a few weeks or months have trouble with the "God thing," and they use their discomfort with the spiritual aspects of AA to avoid getting involved. Sometimes this is a symptom of denial, sometimes it comes from deepseated hurts and disappointments that have occurred in their lives, and sometimes it indicates an unwillingness to admit that there is something going on with them that they cannot control.
Does this mean that being atheistic or agnostic makes it impossible to get sober and bring the addiction into remission? No. The concepts within the 12 steps can be adapted, and behaviors changed through strategies like cognitive-behavioral or reality therapy - approaches that encourage you to look at your behaviors, your basic assumptions, and the consequences of your actions, and begin to make better choices. Rational recovery is a program available in some urban areas which provides group support within a nonspiritual context. If you are atheistic or agnostic these programs may work for you. But if you have struggled with staying clean, and nothing seems to be working, you may need to reflect carefully on the spiritual aspect of your life. A section in "Alcoholics Anonymous" entitled "We Agnostics" is worth reading.{pagebreak}
Moderation management is another strategy for the treatment of alcohol abuse that has a following, but it is viewed with skepticism by many addiction professionals, and I am among them. The idea behind moderation management is that alcoholics can learn to drink socially if given enough support and input. The problem I have with this approach is that it flies in the face of what we know scientifically about addiction and the changes that occur in the brain. People who have been successful in moderation management programs may be people who were abusing alcohol, but did not develop actual addiction.
Most addiction treatment centers introduce patients to the concepts of 12-step recovery and include AA or NA meetings in their schedules. But anyone can go to an AA meeting.
According to the AA preamble, "the only requirement for membership is a desire to stop drinking." Closed meetings are for alcoholics or addicts only. Open meetings, which often feature a speaker, are open to family members or other interested individuals as well.
Anonymity, or confidentiality, is stressed in 12-step groups.
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The opening announcements often include this directive: "Who you see here, what you hear here, when you leave here, let it stay here." Only first names are used, and people are encouraged to drop the usual social barriers; a lawyer might be sitting next to a pipe fitter who is sitting next to a society matron, and so on.
Several varieties of 12-step meetings exist: speaker meetings, when one or two members relate their stories, discussion meetings, which involve the entire group and usually center on a topic, and step study and Big Book meetings, where detailed study of the 12 steps and other related material is undertaken.
These are not "group therapy" sessions. Highly personal issues are generally not discussed, and "cross talk" - one member addressing another - is frowned upon. Members are encouraged to talk about their own experiences with recovery and share their "experience, strength and hope."
A good 12-step meeting has a warm and accepting atmosphere. Most addicts have had problems with social anxiety, and the fear of being confronted or shamed keeps many people away from these meetings. Recovering people know this, and will usually go out of their way to welcome newcomers and help them feel comfortable.
When you start out in 12-step recovery, it is suggested that you choose someone as a sponsor. A sponsor is another person in recovery who helps with working the steps and dealing with more personal problems on a one-to-one basis.
A sponsor should be someone of the same sex who has had several years of good recovery. At first, you can request telephone numbers of people available as temporary sponsors or phone contacts and take time to get to know the group before choosing a sponsor.
When you're starting out in 12-step recovery, it's also a good idea to check out a number of different meetings. Meetings have different atmospheres and personalities; it's not a "one fits all" situation. Go several times to a meeting before you decide whether or not you like it. You might hit one on a bad night or a good night. You want to be familiar with what's average for that meeting. Some people attend different meetings in different locations on different nights.
That way they have a chance to hear a variety of points of view. If you find a group that you like you can choose it as your "home group."
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