The helper therapy principle (HTP) observes the helper’s health benefits derived from helping another with a shared malady. The HTP is embodied by the program of Alcoholics Anonymous as a method to diminish egocentrism as a root cause of addiction. This article reviews recent evidence of the HTP in alcohol populations, extends to populations with chronic conditions
beyond addiction, and concludes with new directions of empirical inquiry.
The Benefits of Helping Others
Although the 12 Steps have been practiced daily by recovering alcoholics for decades, empirical support for the link between helping others in AA and positive drinking outcomes only emerged in 2004 (Pagano, Friend, Tonigan, & Stout, 2004).
Using data from Project MATCH, one of the largest clinical trials in alcohol research, Pagano and colleagues (2004) demonstrated that alcoholics who helped others during chemical dependency treatment were more likely to be sober in the following 12 months.
Specifically, 40% of those who helped other alcoholics avoided taking a drink in the 12 months following a 3-month chemical dependency treatment period; only 22% of those who did not help others stayed sober for twelve months.
In a second investigation involving data from Project MATCH, Pagano and colleagues (Pagano, Zemore, Onder, & Stout, 2009b) demonstrated that 94% of alcoholics who began to help other alcoholics at any point during
the 15-month study period continued their helping behaviors. Also, depression levels in alcoholic helpers significantly diminished once they started helping others (Pagano et al., 2009b).
Lastly, in a longitudinal study of body dysmorphic disorder (BDD), individuals with comorbid alcohol dependency disorder who engaged in service were significantly more likely to get sober and to remit from BDD than those with low service participation (Pagano, Phillips, Stout, Menard, & Piliavin, 2007).
These studies indicate that among alcoholics, AAH and giving general help to others has positive effects on drinking outcomes and mental health variables. These findings suggest that getting active in service helps addicts/alcoholics become sober, stay sober, and is applicable to all treatment-seeking individuals with a desire to not drink or use drugs.
THE HTP: PRACTICE AND BENEFITS
The HTP can be traced back to the “wounded healer” tradition, a belief that a sufferer of a certain malady is particularly adept and impassioned in assisting fellow sufferers (White, 2000). The HTP first emerged in academic circles with a widely cited and often reprinted article by Frank Riessman (1965).
He defined the “helper therapy” principle on the basis of his observations of AA and similar self-help groups that had adopted AA’s 12-Step program. Riessman observed that the act of helping another often heals the helper more than the recipient.
In the early 1970s, the HTP garnered a great deal of attention. The shared
problem between sufferers could be nicotine addiction, substance abuse, depression, a medical condition such as diabetes, or mental impairment such as post-traumatic stress disorder (PTSD).
Regardless of the problem, members of a mutual help group are deeply engaged in helping one another, in part because they are motivated by an explicit interest in their own healing. A shift effect is theorized to occur, whereby the giver/helper gains a sense of meaning, self-worth, a social role, and health enhancement (Schwartz & Sendor, 1999).
Helping others who have the same chronic problem has benefits for mental illnesses beyond substance use disorders.
Today’s practice of the HTP is adopted by many mental health communities, such as the International Center for Clubhouse Development (ICCD) and Oxford House communities (Magnolia Clubhouse, 2009). The Magnolia Clubhouse in Cleveland, Ohio, a residential community based upon the ICCD model, rehabilitates adults with chronic mental illnesses such as depression. The Clubhouse operates on the principle that, “meaningful work with
others is rehabilitative” (Magnolia Clubhouse, 2009). Clubhouse members choose to participate in a variety of service activities, such as meal preparation, serving in the snack shop, helping with hospitality, writing letters, handling finances, or grounds keeping.
Since its inception in 1975, the Oxford House, a parallel movement to the ICCD, provides homes each year to more than 24,000 individuals in recovery. With no professional staff, these recovery coops operate from democratic self-management, financial self-support of each home, and mutual aid. These recovery homes provide opportunities for the practice of the 12th Step.
The HTP has demonstrated efficacy in a variety of clinical populations (Arnstein, Vidal, Well-Federman, Morgan, & Caudill, 2003; Schwartz & Sendor, 1999).
Patients suffering from multiple sclerosis (MS) were trained to provide compassionate, unconditional, positive regard for other MS sufferers through monthly, 15-minute supportive telephone calls; helpers showed improvements in self-confidence, self-esteem, depression, and role functioning (Schwartz et al., 2009). Individuals with chronic pain who counseled other patients with pain reported a significant decrease in their own symptoms of pain and
depression (Arnstein et al., 2003). Providing peer support to others may allow
helpers to break away from patterns of self-reference, allowing a shift in quality of life, personal meaning, and experiences of ailments.
These findings indicate that the helper experiences healing when he or she helps another who is living with the same chronic condition .
GENERAL HELP TO OTHERS: PRACTICE AND BENEFITS
A large body of research in the social sciences suggests that the HTP applies more widely to benefit all humans. When we reach out to others, we are helping individuals with the same vulnerabilities that threaten our own lives—for example, brokenness, quiet desperation, loss of meaning, illness, financial downturns, and mortality.
However, HTP is eroded when the helper is overwhelmed (Post,
In practice, cautionary guidelines have been formed to avoid helper’s burnout. For example, AA literature clearly recommends newcomers and old-timers alike to practice moderation in AAH in a balanced lifestyle.
From its inception, AA has been clear that helping others does not translate to carrying the burdens of another: “Those of us who have tried to shoulder the
entire burden and trouble of others find we are soon overcome by them” (A.A., 2001, p. 132).
Further, the principle of self-care first has been one of the foundations of AA: attend first to self when hungry, angry, lonely, or tired (designated by the acronym HALT)—then help others (A.A., 1998). However, the risk of “burnout” and “fatigue” is low for alcoholics who are characterized by defiance and self-involvement (A.A., 1981, p. 5).
Clearly, getting active in service appears beneficial in early recovery as well as ongoing recovery.
Youth in particular have an enormous potential to benefit from actively
participating in service as part of their treatment. The majority of young adults with severe addiction, as well as older adults in later stages of this progressive illness, began experimenting with alcohol and or drugs prior to age 13 (Altose, Davis, Tager, & Pagano, 2009; Donovan, 2004).
AAH may promote improved alcohol outcomes earlier in life while
naturally facilitating normal developmental transitions by furthering youths’ sense of selfworth, leadership skills, and validation of inner experiences. In the past 5 years, National Institute on Alcohol Abuse and Alcoholism has shifted toward understanding addiction as a brain disease. Advances in brain imaging research suggest the anterior insula as the brain region responsible for compassion and its structural growth occurring in adolescence
(Holden, 2004). Alcohol and drug use may stunt growth in this area, leading to deficiencies in other-oriented behaviors and dysregulated interoception (Paulas, Tapert, & Schulties, 2009).”
Helping others may improve this brain region and help recovering people know their own feelings better, and in relation to how others feel. It may even reduce the self-centred emotional immaturity common to addicted populations?
It may also generate enough of the “helper high” to satisfy an alcoholic’s need to feel good?
– 1. Pagano, M. E., Post, S. G., & Johnson, S. M. (2011). Alcoholics Anonymous-related helping and the helper therapy principle. Alcoholism treatment quarterly,29(1), 23-34.