What Everyone Needs to Know About the Twelve-Step Program
The 12-step program is the main model currently used for the treatment of addiction If you look at the statistics, however, the actual success rate is dismally low; perhaps 15% long-term. Sadly, no-one has developed an alternative to the program, so this ineffective means of treating addiction remains the gold standard.
The program fails for a number of reasons: The main problem is that it considers addiction to be a disease, and the disease model just doesn’t make sense. The founders of the program weren’t medical doctors, and weren’t actually qualified to make such a classification.
The truth is, addiction isn’t a disease; it’s an unconscious, dysfunctional choice. The addict has two basic needs: to heal their long-standing emotional wounds and to feel loved, nurtured and comforted. A primitive part of their psyche associates the addiction with the resolution of these needs.
The disease model has the best of intentions: if the addict is sick, they shouldn’t be condemned for their behavior. On the one hand this is positive, because the person is psychologically compelled to be an addict and is not deliberately trying to hurt themselves or others. On the other hand, this model makes the addict a passive victim of their problem rather than someone who has a specific agenda which they are attempting to fulfill (and which needs to be met another way).
There is a physiological component to addiction. In addicts, certain parts of the brain, including an area called the “reward pathway” can be more sensitive to stimulation. Some people may even be biologically predisposed to a particular addiction, but not everything that is passed along genetically is a disease. Personality traits, eye color and singing talent all run in families, as well.
The 12-step program fails because is behavioral in nature and ignores the emotional and psychological factors driving addiction. As such, it doesn’t provide tools for emotional healing. Abstinence, group support and working the steps with a sponsor are the primary treatment modalities.
Neglect, abuse or trauma suffered in childhood can cause an individual to develop emotional wounds. Deep in their psyche, a primitive survival mechanism kicks in which drives the wounded individual to look for emotional healing as well as the love and nurturing that was missing when they were small.
People can be drawn to different addictions because of what is familiar – they drink because a parent did – or because of specific emotional needs: an alcoholic might want to silence a critical inner voice; an over-eater might want to comfort themselves around pain or loneliness; a drug or alcohol abuser might be attempting to soothe the symptoms of a more serious mental illness such as insomnia, depression or bipolar disorder.
None of the treatment modalities of the 12-step program address the addict’s real needs. If a person has emotional wounds and especially if they are suffering from a real mental illness, they require actual treatment. It’s ironic that the 12-step program sees addiction as a disease when in fact it’s a misguided attempt at treating one’s emotional wounds and/or mental illness.
The 12-step program promotes abstinence when not all addictions can be completely abstained from. It’s possible to completely give up alcohol or drugs, for example, but a person needs to eat on a regular basis. It doesn’t make sense for the program to tell an alcoholic that an essential part of their treatment is that they must never have another drink for the rest of their life, while the over-eater doing the same program must deal with food several times a day.
On top of which, abstinence deprives an addict of whatever comfort they might have obtained through their addiction without offering them another way to meet their needs. This results in an increase in cravings, so that if the person is able to abstain from one addiction, they’ll often simply pick up another. Abstinence magnifies the drive to meet these needs and thus supports further addictive behavior.
This explains why many people using the 12-step program to stop drinking, for example, either continually relapse or turn, say, to overeating. Those using OA either fail to lose weight or might go from compulsively over-eating to compulsively dieting. Some became compulsive exercisers, spending hours each day at the gym, or turn to shopping, gambling or smoking.
The only way to prevent relapses or the transfer of addictions is to find more meaningful and constructive ways, like psychotherapy, for example, to address the emotional wounds and fulfill the emotional needs at the root of the addiction. Rather than forcing oneself to resist a behavior, real healing would eliminate the urge to engage in addiction.
The 12-step program denounces medications such as anti-depressants, anxiolytics or sleep aids, saying that these medications are as harmful to the person as the drugs or alcohol they’re trying to give up. The program suggests that medications promote the same emotional or physical dependence as typical addictive substances.
This demonstrates a serious misunderstanding of how medications work. When prescribed by experienced, licensed practitioners and used appropriately by informed individuals, these medications actually promote freedom from addiction, giving drug abusers and alcoholics appropriate treatment for their anxiety, depression, mania or sleep disorders. The majority of these medications don’t cause either tolerance or dependence and can safely be used long-term even in people prone to addiction.
When properly treated, these individuals can finally achieve restful sleep and a stable mood. This greatly diminishes their cravings for the less effective alcohol or drugs. Once they stabilize, they can then deal with their emotional issues in psychotherapy.
When people fail at AA, OA or CA, they are accused of not “working the program” diligently enough. In reality, it is the program that has failed these individuals who are in need of real healing for the underlying problems which are driving their addiction.
When people are able to receive appropriate treatment for the causes of their addiction, they will no longer need to force themselves to abstain, but will find that the urge to engage in the addiction has gone away. When someone is experiencing emotional healing and nurturing and is being treated for any psychological or sleep disorders, addiction becomes irrelevant.
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Dr. Marcia Sirota is a Toronto-based board certified psychiatrist specializing in the treatment of trauma and addiction, as well as founder of the Ruthless Compassion Institute, whose mandate is to promote the philosophy of Ruthless Compassion and in so doing, improve the lives of people, everywhere.