On Twelve-Step Programs

I’m currently working on a short story about addiction and group therapy. It’s a topic that regularly graces headlines, often for the wrong reasons. When a noted celebrity checks into rehab we sit up and pay attention– will this be the catalyst for their redemption, or just another stop on their journey towards self-destruction?

The media does its best to feed our fascination with addicts– through exhaustive coverage of drug-fuelled meltdowns from the likes of Charlie Sheen or Amy Winehouse– and in a culture that encourages excess it’s no surprise that we’re often confronted with people who have gone too far.

But it’s the methods that we use to treat addiction, rather than the thing itself, which are most revealing. In 1935 Bill Wilson and Bob Smith founded Alcoholics Anonymous, the most famous support group network and the originator of twelve-step programs. The idea was to create a fellowship between addicts, who could rely on one another for encouragement as they worked their way through twelve simple steps to sobriety. Humans are social animals and addiction can be an extremely isolating experience, so group therapy makes perfect sense, right?

Studies have put the success rate of Alcoholics Anonymous and similar programs in the region of three to five percent. Others have stated that when it comes to achieving sobriety, there is no discernible difference between people who’ve attended group therapy and those that go it alone. But why is this? And why has an approach with such dubious appraisal remained prominent to this day?

The twelve steps as originally devised for AA emphasise the individual’s powerlessness against their addiction. In order to overcome it, they must place their trust in the hands of God, admit their shortcomings (hence the famous line, “Hi, I’m ___, and I’m an alcoholic.”) and make amends for the damage they’ve caused to themselves and those around them. It’s an appealing path to take– faith, atonement and rectifying old transgressions– but it fails to address the cause of addiction.

People often think addiction is caused by overindulgence– take too much of something, and you’ll find it hard to go without. This is the typical ‘drugs are bad’ rhetoric that we hear from a young age which utterly disregards social and psychological factors. Why don’t people given morphine in hospitals become heroin addicts after they’re discharged? Why did American soldiers in Vietnam stop taking opiates when they returned to the States?

A study of 17,000 adults linked cases of addiction with the presence of childhood trauma. Instances of physical or sexual abuse, emotional neglect or mentally ill family members can cause deep-rooted psychological problems which manifest as addictive tendencies in adulthood. The theory goes that traumatic experiences at a young age interfere with the brain’s development, disrupting its ability to regulate emotions. This causes fundamental damage to the brain’s reward system, which, as they grow up, results in people depending on external sources (drugs, alcohol, sex, food, etc.) to provide emotional regulation or stimulation. Because childhood trauma takes place at a young age and can be highly distressing, individuals may even repress these events and be completely unaware of their existence.

Twelve-step programs are unlikely to bring any of these realisations to the fore. In fact, the first three steps require participants to accept their powerlessness towards addiction and submit themselves to God– again, an entity over which they are powerless. Considering that one of the dominant psychological states of childhood trauma and victimisation is powerlessness, it would seem that this approach, far from remedying addiction, serves only to compound and amplify its cause.

But if it’s such a bad idea, why do so many people do it? As it turns out, AA has a phenomenally effective marketing approach. Success is highly celebrated– tokens are famously awarded for staying sober over certain milestones (thirty days, six months, a year, etc.). The twelfth and final step of the program is to spread the word and help other addicts onto the program. Essentially, to evangelise.

Adversely, anyone who falls off the wagon is treated with extreme stigma. They are seen to have ‘dropped out’, failed the program. They weren’t doing it properly. For a network that emphasises social support and the importance of the group, it is telling how quickly they persecute the individual. Add to this the fact that people who did ‘fail’ are unlikely to talk about their experience for fear of reproach, and what you’re left with is a near universal positive press.

So the next time someone famous checks in at Palm Springs, perhaps we should stop to consider that their misfortune is likely the product of psychological wounds, not deep pockets. And if they do quit the program, perhaps we shouldn’t blame them, but look instead at the shortcomings of their treatment. At the very least, Heat magazine could sell a few more copies with an exposé on Justin Bieber’s childhood trauma.


Sources/Further Reading:

“How Effective is AA and 12 Step Treatment?” http://www.hamsnetwork.org/effective.pdf

“The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study” http://www.nijc.org/pdfs/Subject%20Matter%20Articles/Drugs%20and%20Alc/ACE%20Study%20-%20OriginsofAddiction.pdf

“Everything You Think You Know About Addiction Is Wrong | Johann Hari | TED Talks”https://www.youtube.com/watch?v=PY9DcIMGxMs

“The Science of Addiction | CBS” https://www.youtube.com/watch?v=gN7-2kGjHz8

2 thoughts on “On Twelve-Step Programs

  1. Cite the sources that said people who “fall off the wagon” are treated with extreme stigma and by whom. Your statement is vague–do you mean other members of AA look down upon the ones who fall? This tells me you have not actually been in the rooms. I’ve been in there multiple times as a support person and I have witnessed only support, only the non-judgement of alcoholics fighting to be sober for another day. Have you stayed and listened to the sharing? Have you recognized the guilt as well as the hope that each person carries?

    Go write your short story of statistics and vague assertions. I was a graduate student once and understand and recognize the vanity of writing well about things you really don’t understand. If you have not sat in the rooms and absorbed how complex and devastating this disease is, you cannot begin to make sweeping arguments about the overall effectiveness of a program that offers a path to sobriety and the tools to stay the course.

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  2. Newcomer,

    Thanks for reading! ‘The Big Book’, written in 1939 and a seminal text of both AA and twelve-step programs, contains the following passage regarding failure:

    “Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.”

    No scrutiny is given here to the program itself, but instead placed squarely on the individual. That’s not to say they won’t receive compassion from their group, but the old AA adage, “It works if you work it,” demonstrates the supposed infallibility of the twelve steps which, as I stated above, is highly suspect.

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