Toward an Elegant Integration

of the 12 Steps

Jon Weeldreyer, MA, LLP,

CAADC, CCS-M

• “Many books have been written about the nature of addiction. This book primarily concerns itself with the nature of recovery. If you are an addict and have found this book, please give yourself a break and read it”.

NA basic text, page 1.

Why encourage patients to try 12 step support groups?

• AA and NA are the largest support groups for any disorder in the worldNA: In 2010, there were over 58,000 weekly

meetings in 131 countries. (3)AA: Communities frequently have 3-8 times

as many AA meetings as NA.

• Difficult to track “success”, but generally acknowledged to have saved millions of lives.

Why encourage patients to try 12 step support groups?

• There are 36 distinct “something” anonymous groups such as:Alanon, Alateen, CoDAFood Addicts/Overeaters AnonymousGamblers AnonymousSexaholics/Sex Addicts Anonymous

• 76 years of history, hope, strength and experience

• Fortunate communities might have a handful of other support groups (such as DBSA: Depression and Bipolar Support Alliance)

• It has proven to be “What works best for most”

A brief history of AA • November, 1934: “Ebbie” tells ex- roommate Bill

W. about getting sober through a spiritual awakening in the Oxford Groups. (Narrative)

• December 11, 1934: Bill W. gets sober in NYC hospital where Dr. Silkworth works. (Narrative)

• June 10, 1935: Through Bill W’s aid, Dr. Bob gets sober in Akron Ohio. Now celebrated as Founders Week. (Narrative)

A brief history of the 12 Steps

Oxford Group “Absolutes”

• Honesty

• Purity

• Unselfishness

• Love

A brief history of the 12 Steps

Pre-1939 Big Book INITIAL PRINCIPLES:

• 1. We admitted that we were powerless over alcohol.

• 2. We got honest with ourselves.

• 3. We got honest with another person, in confidence.

A brief history of the 12 Steps

INITIAL PRINCIPLES continued:

• 4. We made amends for harms done others.

• 5. We worked with other alcoholics without demand for prestige or money.

• 6. We prayed to God to help us to do these things as best we could.

A brief history of the 12 Steps

Writing the Big Book• Everybody is an author. (Narrative)

• What’s first? Bio? Psycho? Social? Spiritual? (Narrative)

• Need for an accurately and clearly stated program

• “12 Steps in 30 Minutes” (Narrative)

A brief history of NA

• 1944: AA's Bill Wilson discussed a separate fellowship for drug addicts

• 1947 - 1953: Groups called NARCO, Addicts Anonymous, and AA/NA present in various prision systems.

• September 14, 1953: AA authorizes NA to use AA's 12 Steps and 12 Traditions on the condition that they stopped using the AA name. NA becomes the official name of the fellowship

A brief history of NA

• 1954, the first NA publication was printed, called the "Little Brown Book“ (now known as “The Little White Booklet”).

• Contained the 12 steps, and early drafts that would later be included in subsequent literature

• NA was not yet recognized by society at large as a positive force.

A brief history of NA

• Initially, groups had difficulty finding places that would allow them to meet, and often met in people's homes to avoid getting busted by police.

• Many NA groups did not follow the 12 traditions very closely, at times accepting money from outside entities, or adding religious elements to the meetings.

A brief history of NA

• Late 1950s: Meetings began to decline with a 4-month period in 1959 when there were no meetings held anywhere at all.

• 1960:Jimmy Kinnon and others dedicated themselves to restarting NA, promising to hold to the Traditions more closely.

Why use the 12 steps in a professional therapy setting?

• Project MATCH found 12 Step facilitation (TSF) to be equal to or greater in treatment outcomes to CBT.

• TSF is an accepted, evidenced based treatment modality.

• Given the vast resource of 12 step programs, does releasing patients without arming them with the language of 12 step fellowship borders on malpractice?

Therapeutic goals set in the frame of 12 steps

Step one: Admit• Anti-contemplation (Denial) vs. Pre-contemplation or

Contemplation Stage of Change.• Use of consequences to motivate therapeutic process.• Self-assessment of the relationship with the addictive

chemical (abuse/dependency).• Understanding nature of the brain disease

(compulsion/obsession).• Understanding limits of success by willpower and

intellectualization.

Therapeutic goals set in the frame of 12 steps

Step two: Believe

• Accepting the need for help.

• Identifying the support system and trustworthy Higher Power (HP) from which to receive help.

• Identifying personal spiritual beliefs.

• Preparation Stage of Change

Therapeutic goals set in the frame of 12 steps

* The concept of Higher Power (HP) in the above and following therapeutic goals is broad. It may be in the form of God/Creator, relationships including friends, families, groups, literature, therapist, or other input that supports healthy goals. The patient has the ultimate responsibility for identifying the HP. The therapist is responsible for aiding the patient in this process and promoting that the understanding of HP will usually change as the patient continues to gain life experiences. “And more will be revealed (4).”

Therapeutic goals set in the frame of 12 steps

Step three: Decide• Decision to involve HP (including others) vs.

continued reliance only on self.• Decision to accept help from the HP(s) identified

in step 2. • Decision to surrender decision-making and

actions to identified HP (be willing to follow recommendations instead of “doing it my way”).

• Starts Action Stage of Change

Therapeutic goals set in the frame of 12 steps

Step four: Honesty• Searching and fearless examination of areas of

emotional discomfort (resentments, fears, harms to others).

• Addressing primary reasons persons access MH tx: Depression, Anxiety, guilt and shame.

• Identifying locus of accountability: Self or others accountable?

• Beginning of trauma/grief process. “Give self pity it’s day in the sun”

• Initiation of “disciplined reliance” on HP.

Therapeutic goals set in the frame of 12 stepsStep five: Openness

• Verbalizing results of personal inventory.. Patient tells life story to clinician.

• Learning benefits of trusting the trustworthy.

• Release of tension… our secrets keep us sick.

• Continued grief process.

Therapeutic goals set in the frame of 12 steps

Step six: Willingness• Identifying character defects (self-defeating

learned behaviors) by assessing trends and patterns seen in moral inventory.

• Identifying payoffs and ripoffs from these patterns and behaviors. CBT: “Thinking errors”

• Gain motivation to change old behavior patterns• Becoming ready to use HP to aid in changing

these old coping techniques that no longer work. (Change the things I can)

Therapeutic goals set in the frame of 12 stepsStep seven: Humility

• Coming out of isolation about weaknesses. Drop the mask of perfection.

• Sharing character defects with support system and HP.

• Requesting support and accountability from HP.

• Giving “nagging rights” to supportive others.

Therapeutic goals set in the frame of 12 steps

Step eight: Integrity• Reviewing and updating “harms inventory” from step 4.• Inventorying the level of credibility earned to date from

those harmed.• Differentiating amends from apologies.• Requesting feedback from HPs on what, who, when and

how to make amends.• Identifying which amends to NOT make, to avoid further

harms. • Reviewing goals and responsibilities in amends process.• Identifying what to offer to attempt to “mend” the

relationship.

Therapeutic goals set in the frame of 12 steps

Step nine: Justice

• Systematic contact of persons harmed, admitting and owning wrongs committed.

• Processing of positive and negative responses.

• Processing impact on guilt and shame.

Therapeutic goals set in the frame of 12 steps

Step ten: Discipline• “Keep the house clean”. Identify a format

for continued rigorous personal self evaluation of patient’s emotional status. (5 minutes, 3x per day?)

• Identifying needed ongoing relapse prevention/recovery program.

• Integration of disciplined reliance on HP.• Maintenance Stage of Change.

Therapeutic goals set in the frame of 12 steps

Step eleven: Discipleship

• Continued processing of internal spiritual conflicts.

• Building of spiritual accountability with community based supports.

• Integrating disciplined quite time for spiritual growth.

Therapeutic goals set in the frame of 12 stepsStep twelve: Service

• Build boundary skills to identify when to focus on needs of others vs. self.

• Support “keeping it by giving it away” concept. Integration of new knowledge and skills by becoming the helper.

• Identify ways that ongoing MH symptoms can be improved through helping others.

Questions and Comments!

Bibliography

• (1)http://www.barefootsworld.net/aa12stepsorigin.html

• (2)VandenBos, Gary R. (2007). APA dictionary of psychology (1st ed.). Washington, DC: American Psychological Association.

• (3)http://web.na.org/admin/include/spaw2/uploads/pdf/NA_membership_survey.pdf

• (4) Narcotics Anonymous Basic Text

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