Alcoholics Anonymous (AA) and its sister organizations have helped millions escape the clutches of addiction. For those of us who are in recovery, we know that AA works. Over the years, hospitals, community agencies, rehabs, and even the court system have come to respect the effectiveness of 12-Steps programs as well.
For most of my career, I have served as a substance abuse counselor at various community agencies and hospitals. In those settings, it’s easy to see how 12-Step Facilitation makes sense. After all, active involvement in community support groups is an excellent adjutant to both individual and group therapy.
What I have learned, though, is that the 12-Steps are valuable in mental health settings, too, as they offer far more than just a path to sobriety. Indeed, the whole point of working steps is to become a better version of yourself. Is that not the whole point of therapy?
Alcoholics Anonymous first introduced the concept of the 12 Steps in 1935. In 1953, Narcotics Anonymous was established to address the use of all addictive substances, most notably heroin and other opiates. Since then, various other 12-Step programs have emerged, including:
Co-Dependents Anonymous (CODA)
Sex Addicts Anonymous
While several of these groups provide support for addictions to specific substances, many others do not. Al-Anon, for example, is for family members of alcoholics. CODA’s goal is to promote healthy and loving relationships. Gamblers and Overeaters Anonymous deal with process addictions.
Over time, 12-Step methodology has expanded to include support and direction for myriad problems, many of which transcend addiction.
The reason 12-Step principles can help with other problems besides substance abuse is that the real issue was never the substance abuse itself. Substance use was merely a symptom of a far more insidious problem. And that problem, as they say in 12-Step communities, is us. It’s how we think, how we behave, and what we believe. And the only way to treat that problem is to treat the person, not the behavior.
Most modern counseling approaches are rooted in cognitive-behavioral theory. How we think affects how we feel, which in turn affects how we behave. To facilitate lasting change, therapists help clients identify, challenge, and defeat irrational patterns of thinking.
Clinicians call these patterns of thinking “cognitive distortions”. The 12-Step community calls them “Stinking Thinking”. They are one and the same. As such, the goal of every 12-Step program is virtually identical to the goal of modern psychotherapy.
In truth, 12-Step programs are far more comprehensive than anything an individual therapist can offer, if only for the sheer amount of time that a person spends in recovery communities when compared to the average time spent in face-to-face sessions with a licensed therapist. That doesn’t mean that one is an effective replacement for the other, but it does mean that the two are complementary. As such, I encourage all my clients to embrace the “spiritual principles” that members of the 12-Step community believe provide the foundations for long-term recovery.
Spiritual principles are universal values that help us become better people. Behind each step, you’ll find several spiritual principles that bind them together. Some examples include:
When you work with a sponsor, one of the things they do is help you to better understand the role of spiritual principles in recovery. Many people addicted to drugs and alcohol lived with character flaws like dishonesty and intolerance that functioned like survival mechanisms. In recovery, you have to unlearn all these harmful traits. Honesty takes the place of dishonesty, acceptance takes the place of denial, and so on.
An exploration of spiritual principles is how people start to get better. The way you do this is by working the steps.
When you work Step 1, the spiritual principles you examine include self-awareness, personal responsibility, acceptance, honesty, open-mindedness, and willingness. As it happens, those are also the principles a client needs to embrace to be successful in therapy.
With only slight modifications, we can customize all of the steps to suit our needs in therapy. For the purposes of this discussion, we’ll confine our discussion to Step 1. Let’s take a look at it here:
“We admitted that we were powerless over X, that our lives had become unmanageable.” – Step 1
With AA, the “X” is “Alcohol”. With Narcotics Anonymous, The “X” is “addiction”. Over the years, other 12-Step programs changed the wording to suit their needs. There’s no reason why it can’t be changed in therapy to deal with something like clinical depression.
The problem of “X” isn’t the only component of Step One. Another key concept is the idea of “powerlessness,” which refers only to the futile attempts made to manage our condition without additional support and guidance. Alcoholics refer to this as “hitting rock-bottom,” that moment when we can no longer ignore their predicament. This is analogous to the precipitating events that lead people to seek therapy.
“Unmanageability” is the third component of the First Step. It refers to the consequences we see as a result of our failed struggle with “X”. When therapists make a diagnosis, we look at the various life domains being affected to determine if a disorder is present. That’s exactly what the First Step does, too. In recovery, we take a long, hard look at the damage done to our lives in order to define and accept the syncope of the problem. That’s also what we do in therapy.
It doesn’t take much editing to make that first step applicable to most mental disorders. Clients come to therapy for these things precisely because they haven’t been able to manage those conditions on their own. If they could, they wouldn’t be in therapy. As it happens, that’s the reason alcoholics seek help through AA.
The First Step is also about accepting that you have a problem and taking ownership of it. The Basic Text of Narcotics Anonymous says that we aren’t responsible for our addiction, but we are responsible for our recovery from it. This also happens to be true of mental illness, relationship problems, work/life balance, stress management, and parenting, to name just a few things for which people seek help in therapy.
As a person progresses with step work, they encounter and explore other spiritual principles as well. For example, Step 5 is built on the spiritual principle of trust, and Step 12 is about the principle of service.
To be clear, responsibility is not about assigning blame. This isn’t about making people feel bad about their problems. Nobody asks for clinical depression, social anxiety, or trauma. But successful treatment for those conditions depends on the client taking ownership of their illness. Every clinician knows the futility of treating a client who refuses to do this. We also know that sense of triumph that comes when a client accepts responsibility and makes a commitment to change.
In recovery, a solid understanding of Step 1 is critical. In truth, you could spend the rest of your life working that step alone and make excellent progress. It’s a solid foundation upon which to build recovery from anything. I’d just ask you to consider the benefits of incorporating additional steps as your clients progress on their journey. If they grow from working Step 1, imagine how they will grow from working all 12.
Of course, it’s not the role of a therapist to make their clients do anything. Whether they want to follow that path is a decision they have to make for themselves. I certainly don’t require my clients to do anything of the sort, but I do try to educate them so that they can choose the right path for themselves.
One thing I have learned from both personal and professional experiences is that spiritual principles are not negotiable in recovery. I don’t know how anyone truly recovers from drug or alcohol addiction without them. Like anything else that we teach in therapy, I only want clients to be aware of the tools so that they can make the choice to utilize them.
While nobody ever masters any of the spiritual principles, the goal is to aspire to be something greater than we were when we first began the journey. The Steps provide a roadmap and direction, but the spiritual principles give that journey a soul.