How It Works
Here we address a question I have asked myself many times – why does AA and other 12 step fellowships seem to have a better understanding of the alcoholic/addict and offer better treatment of them than that suggested by the findings and conclusions of scientific study?
It is frustrating to read an excellent scientific paper detailing possible brain dysfunction in addicts only for the treatment implications to give them more drugs, e.g. to reduce craving.
As I have said previously, if alcohol was my main problem in life I would simply have given up. It is not my main problem in life, alcoholism is. ISM is my main problem, I-SELF-ME, my self dysregulation. Alcohol is the substance I used to treat my Internal Spiritual Malady. My emotional disease, my emotion recognition, processing and regulation disorder. My sense of being detached from the world, this painful separation.
The whole purpose of this blog is to marry my 12 step experience and acquired anecdotal evidence with my scientific research over a number of years. One academic researcher working in education once said that the best way to ruin your cherished theory is to apply it to a classroom. I feel that scientists should do the same by applying their theories to the reality of 12 step recovery or any other recovery. In my view addicts in recovery act differently to that suggested by various bio-medical models. A main purpose of science is to be able to predict behaviour. Can Science really say that it is doing this effectively in relation to recovery?
Why spend millions, if not billions on anti-craving medication research when I like many recovering persons, have not a craving for alcohol in years, since my spiritual awakening as a result of having taking the 12 steps?
Living life on life’s terms is my problem, not constant craving is my main problem. Acting not over-reacting is my constant concern.
The 12 steps is a way of living, a program which keeps me and and my emotions on an even keel. If I control my emotions they do not control me. If my emotions are in check, I am happy, joyous and free and my illness is not activated my distress, so craving is not an issue. Manage my emotional unmanageability and the rest takes care of itself. It proves to me that it is my ISM that leads to alcohol. In the BB it states that alcohol is cunning, baffling, powerful, I think this should read alcoholism is…. Alcohol is a symbol, a symptom of my underlying condition. Treat the underlying condition and alcohol loses it’s power.
AA helps me overcome childhood insecure attachment also – it helps me feel loved, that I belong, it helps fill the “hole in my soul” which may be the product of my upbringing.
Science needs the help of those in recovery and should ask for it. As Bill Wilson suggested we should, given the opportunity, be friendly with our friends, and share the best of all approaches to best understand and treat this most profound of mental and affective disorders.
Anyway we cite from one article (1) and add our observations and additions in italics.
“Science has never revealed as much about addiction—potential genetic causes, influences, and triggers, and the resultant brain activity—or offered as many opportunities and methods for initial treatment as it does now.
Even so, the grassroots 12-step program remains the preferred prescription for achieving long-term sobriety.
Since the inception of Alcoholics Anonymous (A.A.)—the progenitor of 12-step programs—science has sometimes been at odds with the notion that laypeople can cure themselves.
Yet the success of the 12-step approach may ultimately be explained through medical science and psychology. Both offer substantive reasons for why it works.
Climbing the Steps to Recovery
The “miracle” of A.A. can be traced to the evening of June 10, 1935, when a struggling alcoholic named Bill Wilson, fighting to stay dry while on a business trip to Akron, Ohio, met with an apparently hopeless drinker named Bob Smith in order to quell his own thirst.
It had been suggested to Wilson, through a religious organization called the Oxford Group, that talking to wet drunks about his experiences and trying to help them get sober would, in turn, help him stay dry.
Their discussion sparked the insight that the best hope for sobriety was a daily reprieve from alcohol, which stood with the singular practice of helping others.
Over the next five years, a non-denominational program emerged that drew much of its spiritual doctrine from Christian practices. It embodied an action plan in the form of 12 “steps” that are essentially guidelines for right living, including taking a personal inventory of one’s strengths and shortcomings, making restitution for past wrongs, and helping others find sobriety.
A.A. reports that more than two million members worldwide currently stay sober by regularly attending meetings and implementing these steps.
In recent decades, the 12 steps have been applied to other addictions—everything from drugs, food, and other substances to various compulsive behaviors around gambling or sex.
A “psychic change,” which in the 12-step world is linked to the marvel of a “spiritual awakening,” often results in a distinct personality and behavioral transformation that leads to long-term sobriety.
“The not-drinking is really just a part of it,” according to Paul Gallant, with 27 years sobriety. “It’s not drinking and changing as a person. That psychic change needs to come from a program of spiritual development, and so far the greatest success has been Alcoholics Anonymous.”
Thus…According to Nia Sipp, psychiatrist, the goal is not just removing the substance or behavior but also facilitating self-reflection and creating social systems. “Oftentimes people feel that it’s about God and other things,” Sipp said. But she believes that the A.A. concept is more about “the spirit of community.”
Rev. Jack Abel, agrees “When we say spirituality, we’re talking about connection. People who are addicted become disconnected. And spirituality, as it’s emphasized in the program of the 12 steps, is profoundly reconnecting.”
According to Marvin Seppala, chief medical officer at Hazelden and sober 37 years, attending 12-step meetings does more than give an addict warm, fuzzy feelings.
The unconscious neurological pull of addiction undermines healthy survival drives, causing individuals to make disastrous choices, he said. “People will regularly risk their lives—risk everything—to continue use of a substance.”
Addicts don’t want to engage in these behaviors, but they can’t control themselves. “The only way to truly treat it is with something more powerful,” he said—something, like the 12 steps, that can change patterns in the brain.
Rewiring the Brain
Andrew Newberg studies neurotheology—the science of how spiritual practices affect the brain.
“Irrespective of whether God truly exists or not,” Newberg said, “the brain is less interested in the accuracy of reality than the adaptability of how we respond.”
Bill Wilson had a famous “white light” experience in a hospital room, where he was recovering from what would be his last alcoholic bender. He claimed it was a spiritual awakening that not only changed his outlook but also removed his desire to drink.
Newberg said that “large-scale, existential-type crises” such as Wilson’s can bring instant changes to the brain. New neuronal pathways are activated or reactivated. This instant rewiring, Newberg said, generates a sudden and intense “aha” moment.
Power of Dopamine Receptors
D2 dopamine receptors connect dopamine, a key neurotransmitter, to neurons. When these receptors are not functioning—or there are too few of them available to connect the dopamine to neurons—memory, mood, and thinking may all be impaired.
A shortage of D2 receptors, some researchers surmise, could predispose a person to addiction.
In one study involving rats and alcohol, the increased number of D2 receptors led the rodents to consume less alcohol, compared with their baseline intake.
In the other study, the D2-receptor increase caused rats to significantly reduce their intake of cocaine.
Michael Nader, a researcher at Wake Forest School of Medicine, is investigating ways to raise D2-receptor levels naturally. One experiment he helped conduct focused on five separate groups of four monkeys. Each had been self-administering cocaine to the point of habit and were then deprived of the drug for an eight-month period.
After only three months, the socially dominant monkeys in each group had naturally increased their numbers of D2 receptors.
There was no increase in the subordinate monkeys. Further, the subordinate monkeys reverted to using cocaine at much higher levels than the dominant monkeys.
“There is an interesting relationship between D2-receptor numbers and vulnerability to drug addiction,” Nader said. “It appears that individuals with low D2 measures are more vulnerable compared to individuals with high D2-receptor numbers.”
Why did the socially dominant monkeys show D2-receptor increases? “One hypothesis,” Nader said, “is environmental enrichment.” For the monkeys, it seems, being dominant was the enriching trigger.
One physiological consequence of involvement in 12-step meetings, therefore, could be an increase in the natural production of D2 receptors.
(We know from other studies that enjoying being around others, as with 12 step meetings can lead to increased dopamine also, as we want to do it again, it is rewarding, we are motivated to do it, all of which increase dopamine levels. Helping others also raises dopamine. We learn new ways of living which also raises dopamine. Also we reduce stress levels which also raises dopamine levels as there is a direct relationship between excessive stress levels in the brain and dopamine production. Dopamine is increased, in short, by 12 step work and meetings.)
Need for Attachment
When someone becomes addicted, he said, mechanisms for healthy attachment are “hijacked,” resulting in dependence on addictive substances or behaviors.
Some believe that addicts, even before their disease kicks in, struggle with knowing how to form emotional bonds that connect them to other people.
“We, as social mammals, cannot regulate our central nervous systems by ourselves,” Flores said. “We need other people to do that.”
While it’s commonly understood that early childhood attachments to parents and family are necessary for healthy development, Flores maintains that emotional attachments remain necessary throughout adulthood.
This is where a 12-step program becomes valuable.
It’s not enough, Flores said, to remove the addiction, which in itself has become an object of unhealthy emotional and physical attachment. To achieve long-term well-being, addicts need opportunities for forging healthy emotional attachments.
“What A.A. does on the basic level is what good psychotherapy does,” Flores said. It provides “a community for people to break their isolation and to start to connect on an emotional level with other people.”
Lee Ann Kaskutas, a scientist with the Alcohol Research Group, has faced skepticism from colleagues for studying A.A., in part because of the numerous spiritual references that go with the 12-step program. It puts A.A. on “the fringe” in the minds of many scientists, Kaskutas said.
Kaskutas, a self-proclaimed atheist, said that the 12 steps bear fruit regardless of one’s spiritual beliefs. “If you don’t believe in God, the way it weasels in is in the help and behaviors that the 12-step group inculcates.”
Helping others, Kaskutas said, “is the internal combustion engine of A.A. I think that is the connection to spirituality.”
People feel better about themselves after helping someone else, Kaskutas said. “So it’s reinforcing—when you help somebody, I think your brain chemistry changes.”
1. National Geographic, “Does Science Show What 12 Steps Know?,” August 2013, http://news.nationalgeographic.com/news/2013/08/130809-addiction-twelve-steps-alcoholics-anonymous-science-neurotheology-psychotherapy-dopamine/
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