Most of today’s treatment of substance abuse takes the form of an emergency, intermittent and temporary effort in a start stop
However, to achieve continuity in the treatment of addiction disorders we need more emphasis on models that take a long-term perspective, and where there is adequate overlap between the ongoing and the continuous efforts.
The following article is one of the best academic explanations of how AA and other 12 step group work that I have ever read.
It is a worth read – a glimpse inside 12 step recovery.
” The purpose of this article (1) is to elucidate the effective elements of the self-help methodology, as they are practised in twelve-step self-help groups in organisations such as AA and NA.
Are self-help groups the solution?
To solve the problem of continuity, the use of twelve-step self-help groups, such as those used by Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), have been brought forward as a useful, but insufficiently exploited resource in Norway (2).
The self-help groups represent a long-term and easily accessible programme for substance abusers – not only as a kind of followup
after other forms of treatment, but also as a relevant intervention during the period the patient spends waiting for treatment (3).
Several controversies and possible explanations can be found for why self-help groups are not used more frequently than they are
in this country, such as lack of knowledge of effectiveness (3).
Rehabilitation is «contagious»
Studies have shown that persons who spend more time in the company of people who do not abuse substances or have succeeded in rehabilitating themselves from their addiction stand a better chance of succeeding in their own rehabilitation (4).
This kind of research has helped establish a new understanding of the protective mechanisms that are inherent in good social
relationships and a drug-free environment for people who are undergoing a rehabilitation phase (5). The closest thing to such
drug-free social communities that can be found today are the twelve-step self-help groups run by AA and NA.
The basis for the self-help methodology is found in the experience-based knowledge of the individual participants (6), a type of knowledge which is acquired through life experience accumulated through living as a substance abuser over a prolonged period.
Through its association with the subjective individual experiences
of addiction, it is therefore specific and unique. However, even though experience based knowledge is unique and subjective
it still provides an opportunity for recognition of certain general traits in others, and may thereby also be meaningful to others.
The instrument which is used to achieve recognition, identification and establishment of a shared meaning in the self-help groups is a sharing of personal stories. Local AA and NA groups make use of this practice.
The typical storytelling format is described as a kind of narrative method that includes a description of the problem and how a solution to it was found (7).
Sharing of experiences in this manner implies that the narrator
becomes a pivotal storyteller and a communicator of meaning within a social community, which can be a redeeming experience
for many participants.
The importance of community and affiliation
All members of the self-help groups are equals. Herein we may possibly find part of the source of what makes rehabilitation
from addiction disorders «contagious» between individuals.
Not as an infection, but as affection, created by spending time
together and giving and receiving help from others who strive for the same goal, a drug free and better life. The participants form
strong social bonds, resulting in an experience of affiliation and community on the part of each individual (8).
These interpersonal relationships are also qualitatively different from those between a patient and a professional.
In this latter relationship, the patient will naturally assume a more passive role, and there is less room for reciprocity, equality and a sense of community – the patient is in need of help, and the professional is the expert. In the self-help groups, the problem is of an individual nature as well as shared by everybody, and this also
helps de-stigmatise it. Seeking help for an addiction disorder is still seen as a shameful act, but less so when help is sought from peers. This is because all participants are equals and are regarded as contributors, not merely as passive recipients of assistance.
Mutual aid and the helper therapy principle
In the twelve-step groups, however, the focus is not on the individual self, but on the group or the community. Mutual aid and equality are the core principles of the twelve-step groups.
International self-help literature refers to this as the «helper therapy principle» (9).
According to this principle, the participants help themselves by helping others who are in the same situation. This is an apparently
simple and altruistic principle, but it may nevertheless be difficult to conform to for substance abusers who have been used to stopping at nothing to obtain and use what they perceive as a matter of life or death, narcotic substances.
That is why the first of the twelve steps is formulated in this manner: «We admitted we were powerless over alcohol, and that
our lives had become unmanageable.» This implies a kind of capitulation and recognition that one can no longer fight the forces represented by the substance by will-power alone.
Step 2: «We came to believe that a power greater than ourselves
could restore us to sanity.» Many professionals and outsiders have interpreted this as indicating that the twelve-step groups are religious organisations, but what is «a power greater than ourselves» really referring to in this context?
The spiritual principle of AA and NA
The twelve-step self-help groups promote what they refer to as a spiritual programme, which is based on a fundamental recognition
that individual substance addicts are unable to fight addiction by themselves.
The founders of AA, Bill and Bob, came to this conclusion when they met sometime during the thirties in Akron, USA. Professionals
had declared both of them to be hopeless alcoholics, and they had gone through innumerable rehabilitation programmes. When they met, they discovered to their surprise that by meeting and sharing
their personal histories they were able to stay sober (10). In other words, they discovered how rehabilitation can become «contagious» through the practice of self help or the helper therapy principle.
Today, this principle constitutes the very hub of the spiritual programme practised by AA and NA. In the final analysis, this is an
attempt to reduce the egocentricity of each substance abuser, which AA perceives as the root of the problem (11). The «power»
referred to in several of the twelve steps is therefore unrelated to religion; it refers to the potentially healing power inherent in interpersonal relationships based on reciprocity and equality.
by Bjerke TN.
Centre for Clinical Research and Education, Psychiatric Research Centre of North Norway, University Hospital of North Norway, Norway