The Psychology of the 12 Steps

Hello. My name is Paul and I am an alcoholic. Hello. My name is Paul and I am a psychologist. I can confidently state the latter would not be possible without the 12 steps of Alcoholic Anonymous. However, it is not as simple as that. The steps of the program are only a part of the entire experience. “The fellowship” which many a crusty “old timer (member with a lot of sober time)” will emphasize is not the program, was also a large part of my recovery from alcohol and drug addiction. This work is an attempt to aid in the understanding of how the 12 step programs work and can be implemented in treatment. Or at the very least, outline the homogenization between the 12 step principles and the theoretical and therapeutic aspects of psychology. The fields of medicine and psychology which dominate the current treatment industry, in my experience and opinion, can, should and could be facilitating more productive outcomes. Specifically, when speaking of maintaining long term sobriety in the people whom they treat. Also, I believe it is important to include the many lessons I and others have learned, as members of these 12 step societies which were important in achieving sobriety. A primary motivation for my seeking an advanced degree in psychology was the belief that my experience of getting sober could serve as a crucial element in my work as a psychotherapist. Also, I thought it would be an effective avenue in the fight against alcohol and drug addiction while possibly making the world a little bit better place. For the most part, I believe psychology wants to make a difference in the fight, however the clinics that I have worked in, which focus on psychology first are missing the proverbial boat. As far as the medical fraternity is concerned, I don’t understand the logic in trying to cure a substance abuser by giving them substances, but that is not my scope of practice. These ideas will be covered in more detail in later chapters. As is the custom in A.A. and in some schools of psychological thought, I will start with my story... One final thought about substances, identity and stigma in the treatment environment has to do with medications. Medications are also substances and like alcohol (and marijuana for the most part) are legal. Legality, though unimportant often serves to distort reality. When discussing marijuana, say in a group therapy setting, denial seems to manifest in the statement, “It’s legal.” Prescribed medications often replace illicit substances as the client’s primary coping mechanism. This is equally as harmful, in my opinion, in both dual and non-dual diagnosis populations. I have spoken with several physicians to confirm my suspicions that people build tolerance to most or all substances whether prescribed or purchased in a dark alley. What does that mean? It means that a person is going to need more medication to maintain the gains they have achieved by using said medication. In essence the same cycle of addiction becomes active only it is reinforced by the idea that it was prescribed by a doctor. Of course, there are the cases where medication is absolutely necessary, but for those of the non-necessary class, who do not incorporate coping skills, they are destined for an eventual relapse as tolerance builds. This makes me wonder why the criteria of tolerance was removed from the most current edition of the DSM. I have met a few psychiatrists who actually engage in psychotherapy, but my experience in the treatment center realm has not confirmed the majority do. Many individuals manifest the same behaviors which have incapacitated their lives outside the treatment environment while they are in treatment, often stating, “I am waiting for my meds to kick in.” This again becomes part of the identity. An identity that believes there will be no emotional distress in their lives if only the get the right amount or type of medication or drugs. What is forgotten is the lessons on how to “live life on life’s terms” (also a slogan used in AA).