Does a 12-step based recovery program work?

There appears to be some aversion to attending, participating in, and following the 12-steps of sober support meetings. The underlying question: does a 12-step program help people achieve sobriety? In Chapter 2, of the second edition of the Big Book of Alcoholics Anonymous, we read the following introductory statement:

WE, of Alcoholics Anonymous, know thousands of men and women who were once just as hopeless as Bill. Nearly all have recovered. They have solved the drink problem.

Yes, a 12-step based recovery program has helped many men and women. Not only in Alcoholics Anonymous, it appears to have helped people with co-dependency issues (CODA), Eating Disorders, Sexual integrity issues, Marijuana, Al-anon, Ala-teen, Adult-Children of Alcoholics and Family dysfunction, Cocaine Anonymous, Narcotics Anonymous, Celebrate Recovery, and the LDS Recovery Program.

How does a 12-step based recovery program help people?

In Sobriety Demystified by Byron A. Lewis, M.A. we read the following:

There are a number of factors that help to explain the success of Twelve Step programs. … The Twelve Step recovery process offers prescriptions for recovery from physical addiction and psychological distress, as well as for social reintegration, and spiritual growth. (p. 76).

Lewis provides vignettes of brief explanations on these factors. How they work, how they motivate change, and the reason these programs work in changing individual lives.

Prescription for Physical Addiction:

The early formation of Alcoholics Anonymous focused on the idea that this was a disease of the body. Lewis references how medical practitioners provided testimonies of how the problems originate in the bodies of those individuals afflicted with substance use disorders. This seemed to echo the disease model. Today, the disease model of addiction describes how it is biological, neurological, genetic, and environmental in origin. When doctors focused on identifying something as a disease, and how it impacts their patients, they stopped treating the symptoms, and began focusing on finding ways to treat the core issue. With substance use disorder, the symptoms are physical withdrawals and cravings. The organ is the brain, however, the entire body.

In order to address physical addiction of substances, one had to develop an abstinence approach. That still did not deal with the intense cravings a person may experience.

Prescription for Psychological Distress:

There is a reason substances, like alcohol, are referred to as mind/mood altering substances. They literally alter the way we think and feel. They alter our moods. For instance, a person suffering from clinical depression is prescribed Anti-Depressants in the hopes to alter the mind and mood of the individual suffering from depressive episodes. Lewis, references how the founders of Alcoholic’s Anonymous came to understand the role a person’s mind played in the addictive process. The Second Chapter of the Big Book references this. Therefore, recovery is not merely about physical sobriety (achieving abstinence); we also achieve what professionals refer to as emotional sobriety.

However, where Lewis does not mention, I share with my patients that there are five core distressing emotions a person experiences in the early stage of recovery:

1. Depression
2. Anxiety
3. Boredom/Emptiness
4. Shame/Guilt
5. Anger

These core emotions are quite intense. Depression and Anxiety being indicative of psychological withdrawal (or, Post-Acute Withdrawal Symptoms). For those suffering substance use, these intense emotions drive cravings, lapses, and relapses in the early stages of recovery. However, through 12-step based sober support recovery programs, a person may learn to gain the ability to manage and sustain emotional and mental stability.

Prescription for social reintegration:

12-step based recovery programs is not solely focused on working the steps, finding a sponsor, and going to meetings. These programs are referred to as “fellowships” where individuals connect with one another. While substance use disorder is a learned behavior, recovery is just as well a learn behavior. The core truth: people and the power of peer support and influence. The aim of each fellowship is to support each person serious about recovery, abstinence, and changing from an active addictive lifestyle to an active sober lifestyle. This also focuses on being of service toward others. Finding empowerment and encouragement with other people engaging in a recovery process helps sustain abstinence and promotes continual movement toward sobriety.

Prescriptions for Spiritual Growth:

One of the central complaints people have about 12-step based recovery programs is the misconception that it is a “religious” organization. This stems from the theme of God, Higher Power, and other such spiritual connotations. The 12th step reflects: “Having a spiritual awakening…” Dr. Carl Jung is quoted in the Big Book (Lewis provides the excerpt in the book) describing how many people come to a station of having “spiritual experiences”. For those in recovery, this is also true, even among those who may classify themselves as atheists and agnostics. Different from religious conviction, spiritual awakening and growth flows from principle values and beliefs. This awakening establishes a belief in something that is more powerful than the individual and their own will and desire. Lewis spends a great deal more on providing understanding the important role spiritual awakening and growth has on one’s recovery.

The Twelve Steps as a Spiritual Discipline:

Another book is The Twelve Steps for Christians. On one of the introductory pages, the reader is given information on the breakdown of the Twelve Steps and their spiritual disciplines.

It outlines how the steps are collectively focusing on the goals of achieving peace with God, with self, with others, and learning to maintain peace in all three areas. The disciplines focus on submission, conversion, confession, repentance, amends, maintenance, prayer, and continual forgiveness and repentance. All these disciplines are core teachings and concepts of various sacred religious traditions.

One of the more prominent Christian based 12-step recovery programs focus on the spiritual component and principles of the Beatitudes Christ taught in Matthew 5. CR focuses on 8 driving principles by utilizing the Acrostic terminology of R.E.C.O.V.E.R.Y.

The Church of Jesus Christ of Latter-day Saints, through the ministry and service of the LDS Family Service program, has developed an Addiction Recovery program to that implements teachings, doctrines, and principle Gospel truths for those struggling with substance use, and family who are dealing with someone suffering from substance use.

Rami Shapiro published a book called the Sacred Art of Recovery and focuses on the spiritual components of the 12 steps.

Does a 12-step recovery based program really help people?

When we understand that recovery requires a lifestyle change, there needs to be a program in place with simple guidelines that has worked for many others. In any sober support meeting, there is a legacy of fellowship of all people who have successfully found a solution to their substance use issue. Many men, women, and families have changed, improved, and achieved a healthy and sober lifestyle. As one may hear at the end of most meetings, if we keep coming back, continue to work the steps, we may find the program working in changing our lives for the better.