Archive for the ‘12-Step Recovery’ Category

Combining Medication-Assisted Treatment and 12- Step recovery: One Patient’s Success Story

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A few weeks ago, I posted a few articles about 12-step recovery. Several readers became very upset, even saying that if I was pro-12-step, I couldn’t really be an advocate for medicated-assisted treatment of opioid addiction. That’s their opinion, and I honor their views, though I heartily disagree with them.

Now I’d like to present an interview I did with a very successful Suboxone patient who did find help from 12-step meetings.

JB: Please tell me about your experience with pain pill addiction and your experiences with buprenorphine (Suboxone).

XYZ: For me, my opiate addiction got so bad, I was taking two hundred and forty to three hundred and twenty milligrams of OxyContin per day, just to stay normal. It had gotten really, really bad. And it started out with a reason. I had kidney stones, and I was in all this pain, but then it got to the point where it solved some other problems in my life and it got out of hand. I tried a lot of different things. I went to detox, and they helped me, but it was…it was almost like I never came out of withdrawal.

JB: How long were you off pain pills?

XYZ: Even after being clean for thirty or sixty days, I would still feel bad. Bowels, stomach…really all the time.

JB: Did it feel like acute withdrawal or just low grade withdrawal?

XYZ: No…I’d try to fix it myself, sometimes, and I would just put myself back where I was. It got to the point where I was making myself sicker and sicker and sicker. And then I got off of it, and stayed off of it for a hundred and twenty days, I guess…but still just sick. Just miserable, and not feeling right. I was miserable. I wouldn’t eat, I was losing weight…

It [buprenorphine] gave me something that replaced whatever was going on in my head physically, with the receptors. It took that [prolonged withdrawal] away, to the point that I felt well. All that energy I would spend getting pills…and I was going to the doctors almost daily. Because taking that much medicine, nobody would write me for that much, so I had to doctor shop.

My only life was going to the doctors, figuring out what pharmacy I could use. I had a whole system of how many days it could be between prescriptions, what pharmacy to go to. It was sick. I was just trying to not get sick.

JB: And you were working during that time?

XYZ: Yeah! I was working, if you want to call it that. I wasn’t a very good employee, but I held a job. I was a regional vice president for “X” company. I traveled a lot, so I had new states where I could see new doctors. That was bad. When I came off the road, I owed $50,000 in credit card bills.

JB: And your wife didn’t know about it?

XYZ: No. It all came tumbling down. And I had gotten into trouble, because they were company credit cards, and they wanted the money back! So, all of the sudden my wife found out that not only do I have a pain pill problem, but we’re $50,000 short, and I wasn’t very ethical in the way I got the money, because it really wasn’t my credit, it was my company’s credit card.

JB: So addiction made you do things you wouldn’t do otherwise?

XYZ: Absolutely. I lied to people, I took money from people, I ran up credit cards tens of thousands of dollars, and really put my family in serious jeopardy at that time. But buprenorphine took away that whole obsessive-compulsive need for pills, made me feel better, and took away all the withdrawal symptoms at the same time. I didn’t worry about it.
To be honest, I was such a hypochondriac before. I haven’t been sick in years now. I haven’t had a backache or headache that ibuprofen didn’t cure [since starting recovery]. I was fortunate it was all in my head. I would milk any little thing. I had two knee operations that probably could have been healed through physical therapy, but I was all for surgery, because I knew I’d get pain pills.

JB: That’s the power of addiction!

XYZ: Yes. Finally I did some research about buprenorphine, online. Actually, I had some good family members, who did some research and brought it to me, because they were concerned for me, and they brought it to me and said, “Hey, there’s a medicine that can help. Call this number,” and I found places out there that would do it [meaning Suboxone], but my concern was the speed that a lot of them were doing it. A lot of them said, OK come in, and we can evaluate you, and after a week you’ll be down to this, and after a month you’ll be down to this.

This was in 2005. And when I asked them what their success rate is, it wasn’t very high. It was something like twenty percent of the people who were doing it [succeeded]. So when I’d finally gotten a hold of “X,” [receptionist for Dr. H], she saved my life over the phone. Because she said, you can come tomorrow, and she said that whatever it takes, they’ll work with you. And I felt good about going to a place where it wasn’t already determined how long it would take. Because I already knew how I was feeling after I would come off of opiates. I didn’t want to do that again.

I saw Dr. H. and felt better within twenty-four hours, although it took a little while to get the dosage right. I think we started off at a lower dose, then we went up on the dose and it kept me so level. I had no symptoms. It cured my worst withdrawal symptoms, my stomach and my bowels.

There’s always a kind of stigma in the rooms [12-step recovery meetings] because I’d been in NA for a little bit of time then [he’s speaking of stigma against medication-assisted treatment]. You realize who [among addicts in NA] is die-hard, one way to do recovery, and who is willing to be educated about some things and understand that there’s more than one way to skin a cat.
And I was fortunate that I had a sponsor at that time, and still do, who was willing to learn about what exactly it was, and not make me feel guilty about it. It wasn’t necessarily the way he would do it, but he was a cocaine addict, so he didn’t understand that whole part of it.

He said, “Your family’s involved, you’ve got a doctor that’s involved, your doctor knows your history. If all these people, who are intelligent, think this is an OK thing, then who am I to say it’s not going to work?” He was open-minded. And there are not a lot of people I would trust right off the bat [in recovery], that I would tell them. [that he’s taking Suboxone]. I’ve shared it with some people who’ve had a similar problem, and told them, here’s something that might help you. I always preface it with, [don’t do] one thing or another, you’ve got to do them together. You have to have a recovery program and take this medicine, because together it will work. Look at me. I’m a pretty good success story.

One of my best friends in Florida called me, and I got him to go see a doctor down there, and he’s doing well now. He’s been on it almost eleven months now and no relapses.

To me, it takes away the whole mental part of it, because you don’t feel bad. For me, it was the feeling bad that drove me back to taking something [opioids] again. Obviously, when you’re physically feeling bad, you’re mentally feeling bad, too. It makes you depressed, and all of that, so you avoid doing fun things, because you don’t feel good.

Once I trained myself with NA, how to get that portion of my life together, to use those tools, not having any kind of physical problems made it that much easier to not obsess.

JB: So, how has your life improved, as a result of being on buprenorphine?

XYZ: Well, the most important thing for me is that I’ve regained the trust of my family. I was the best liar and manipulator there was. I’d like to think of myself as a pretty ethical and honest person, in every aspect of my life, other than when it came to taking pills.

JB: So, you regained the trust of your family, felt physically better…

XYZ: I gained my life back! Fortunately, I had enough of a brain left to know it had to stop. Once I started on buprenorphine, it gave me back sixteen hours a day that I was wasting. That’s when I decided I really don’t want to jeopardize my recovery, by going out and looking for a job again [he means a job in corporate America, like he had in the past], because I’ve got this thing, this stigma…they’re going to check a reference and I’m screwed. I’m not going to get a job doing what I was doing for the same amount of money.

My brother had enough faith in me that it was worth the risk of starting this business [that he has now] together. My wife and I started on EBay, making and selling [his product], and slowly grew it to the point that, three years later, I’m going to do over two million dollars in sales this year, I’ve got [large company] as a client, I’ve got [large company] as a client, I’m doing stuff locally, in the community now, and can actually give things back to the community.

JB: And you employ people in recovery?

XYZ: Oh, yeah. I employ other recovering addicts I know I can trust. I’ve helped some people out who have been very, very successful and have stayed clean, and I’ve helped some people out who came and went, but at the same time, I gave them a chance. You can only do so much for somebody. They have to kind of want to do it themselves too, right?

JB: Have you ever had any bad experiences in the rooms of Narcotics Anonymous, as far as being on Suboxone, or do you just not talk to anybody about it?

XYZ: To be honest, I don’t broadcast it, obviously, and the only other people I would talk to about it would be somebody else who was an opioid addict, who was struggling, who was in utter misery. The whole withdrawal process…not only does it take a little while, but all that depression, the body [feels bad]. So I’ve shared with those I’ve known fairly well. I share my experience with them. I won’t necessarily tell people I don’t know well that I’m taking buprenorphine, but I will let them know about the medication. Even though the information is on the internet, a lot of it is contradictory.

It’s been great [speaking of Suboxone] for someone like me, who’s been able to put a life back together in recovery. I’d tell anybody, who’s even considering taking Suboxone, if they’re a true opioid pill addict, (I don’t know about heroin, I haven’t been there), once you get to the right level [meaning dose], it took away all of that withdrawal. And if you combine it with going to meetings, you’ll fix your head at the same time. Really. I didn’t have a job, unemployable, my family was…for a white collar guy, I was about as low as I could go, without being on the street.
Fortunately I came from a family that probably wouldn’t let that happen, at that point, but who knows, down the road… I had gotten to my low. And that’s about it, that’s about as much as I could have taken.

It [Suboxone] truly and honestly gave me my entire life back, because it took that away.

JB: What do you say to treatment centers that say, if you’re still taking methadone or Suboxone, you’re not in “real” recovery? What would you say to those people?

XYZ: To me, I look at taking Suboxone like I look at taking high blood pressure medicine, OK? It’s not mind altering, it’s not giving me a buzz, it’s not making…it’s simply fixing something I broke in my body, by abusing the hell out of it, by taking all those pain pills.

I know it’s hard for an average person, who thinks about addicts, “You did it to yourself, too bad, you shouldn’t have done that in the first place,” to be open minded. But you would think the treatment centers, by now, have seen enough damage that people have done to themselves to say, “Here’s something that we have proof that works…..”

I function normally. I get up early in the morning. I have a relationship with my wife now, after all of this, and she trusts me again. Financially, I’ve fixed all my problems, and have gotten better. I have a relationship with my kids. My wife and I were talking about it the other day. If I had to do it all over again, would I do it the way I did it? And the answer is, absolutely yes. As much as it sucked and as bad as it was, I would have still been a nine to five drone out there in corporate America, and never had the chance to do what I do. I go to work…this is dressy for me [indicating that he’s dressed in shorts and a tee shirt]

JB: So life is better now than it was before the addiction?

XYZ: It really is. Tenfold! I’m home for my kids. I wouldn’t have had the courage to have left a hundred thousand dollar a year job to start up my own business. I had to do something. Fortunately, I was feeling good enough because of it [Suboxone], to work really hard at it, like I would have if I started it as a kid. At forty years old, to go out and do something like that…

JB: Like a second career.

XYZ: It’s almost like two lives for me. And if you’re happy, nothing else matters. I would have been a miserable, full time manager, out there working for other people and reaping the benefits for them and getting my little paycheck every week and traveling, and not seeing my wife and kids, and not living as well as I do now.

I joke, and say that I work part time now, because when I don’t want to work, I don’t have to work. And when I want to work, I do work. And there are weeks that I do a lot. But then, on Saturday, we’re going to the beach. I rented a beach house Monday through Saturday, with just me and my wife and our two kids. I can spend all my time with them. I could never have taken a vacation with them like that before.

JB: Do you have anything you’d like to tell the people who make drug addiction treatment policy decisions in this nation? Anything you want them to know?

XYZ: I think it’s a really good thing they increased the amount of patients you [meaning doctors prescribing Suboxone] can take on. I’d tell the people who make the laws to find out from the doctors…how did you come up with the one hundred patient limit? What should that number be? And get it to that number, so it could help more people. And if there’s a way to get it cheaper, because the average person can’t afford it.

The main thing I’d tell them is I know it works. I’m pretty proud of what I’ve achieved. And I wouldn’t have been able to do that, had I not had the help of Suboxone. It took me a little while to get over thinking it was a crutch. But at this point, knowing that I’ve got everybody in my corner, they’re understanding what’s going on…it’s a non-issue. It’s like I said, it’s like getting up and taking a high blood pressure medicine.

I originally interviewed this patient in 2009, for a book that I wrote. Since that time, he and his family have moved to the west coast, but I’ve stayed in contact with him. He’s been in relapse-free recovery for over eight years, he’s still on Suboxone, and still happy. He has excellent relationships with his wife and children, and his business has thrived and continues to grow.

He’s an excellent example of how a recovering addict’s life can change with the right treatment. For this person, Suboxone plus 12-step recovery worked great.

The Differences Between 12-Step Recovery and Other Group Therapies

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It struck me that some of my readers may not know that 12-step meetings are run differently and have different norms of interaction than other support groups. While it’s true each group has the freedom to run its meetings as it sees fit, most follow AA’s Twelve Traditions as a pattern for interaction.
Physicians, therapists, or educators of any kind would not be allowed to talk to any group to educate them about anything. If such a person is a member of a 12-step group, he/she is welcome to talk only about her personal experience, strength, and hope. In fact, in Alanon, if there are members present who are also members of AA, NA, GA, or any other 12-step group, they are asked to keep that to themselves, as it can distract from the focus of the meeting.
In 12-step meetings, there’s no therapist or counselor in charge of the meeting. Instead, there’s a chairperson, a member of the 12-step program who opens and closes the meeting. This person is in charge only in the sense that she guides, rather than controls, the meeting. Some chairpersons guide more than others. For example, some chairpersons will interrupt a member who’s sharing something that can be harmful to the group. This could mean interrupting a “drunkalog” (long pointless sharing that glamorizes drinking or using drugs). Other chairpersons let the meeting run its course, believing that a Higher Power is always in control. The chairperson is responsible for starting and ending the meeting on time.
Members don’t give advice to each other. Or at least, experienced members of Narcotics Anonymous and Alcoholics Anonymous don’t tend to give advice to each other. Instead, members share their own experiences. They tell about what worked for them, and what didn’t work. The topic is often about how to get through situations without using drugs or alcohol, but may also be about how to live with difficult life situations, and still retain one’s serenity.
In group therapy, members are encouraged to give advice, or feedback, to other members. Some treatment centers believe that alcoholics and addicts must be confronted, so that denial can be broken through. Twelve-step meetings don’t take this stance. Instead, members offer their own experience, freely and without expectations. It’s a subtle difference, but important. Other 12-step members don’t assume they know what another person should do about life decisions; they simply offer their own experiences.
Twelve-step meetings are free. Most group therapy costs some amount of money.
No record of attendance is kept at 12-step meetings. A person is considered to be a member of Narcotics Anonymous when that person says they are a member. The only requirement for membership is a desire to stop using drugs.
Twelve-step groups don’t promote themselves. One of their twelve traditions says that new members should be gained by “attraction, rather than promotion.” However, some group have websites for group members, and some groups do advertise times and locations of local meetings as public service announcements.
Twelve step meetings are held in slightly different ways in different areas of the country. In some places, meetings range from fifty minutes to an hour and a half. At “speaker” meetings, one person tells their story of addiction and recovery for the whole hour, traditionally telling “what it was like, what happened, and what it’s like now.” At other types of meetings, all persons present are offered a chance to share or pass to the next person. In some meetings, members who wish to share raise their hands and are called on by the meeting chairperson. In group therapy, all members are usually expected to say something during the session, but at NA or AA, no one is coerced to speak.
Problems are shared at meetings, but the emphasis is on solutions. Most good meetings don’t allow the meeting to become a dumping ground for negative experience. The emphasis of meetings is on solutions to problems. In most meetings, sharing about specific drugs is discouraged. NA members are encouraged to share about what they are feeling, and what kind of help they need to remain abstinent from all drugs.
Overall, the mood of 12-step meetings is one of humbleness, where one recovering addict shares what worked for her with the rest of the group, without expectations and with humility. By contrast, in group therapy, feedback or advice is usually given by other group members. But an addict’s tendency with such an approach is to ask, “Who are you to be telling me what to do?” Narcotics Anonymous meetings recognize that advice and feedback often grates on addicts, and their meetings are constructed differently. Other member’s experiences are offered as learning opportunities.
Twelve step members aren’t perfect, to say the least. Many members are wrestling with serious mental and emotional problems. Sometimes members do lapse into advice-giving and preaching, but most lose this tendency to try to control others as they progress in their own recovery.

12-Step Recovery and Medication- Assisted Treatment: Mutually Exclusive?

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I’m surprised and disappointed by all the negative comments to my blog from medication-assisted treatment (MAT) advocates who strongly criticize my article on excuses people use to justify not attending 12-step recovery.

Actually, the blog entry is a re-run, from about a year and a half ago, when it didn’t get much attention at all. I first wrote the piece years ago, for patients with all sorts of addiction, and not specifically those in medication-assisted treatments. Most of my readers have interpreted the blog to be targeted at MAT patients. I guess that’s not unreasonable, since my blog is dedicated to opioid addiction and its treatment with medication.

I’m surprised that some MAT advocates, who must have endured much discrimination and misunderstanding, are equally judgmental and biased against 12-step recovery.

Hear this: 12-step recovery is an evidence-based treatment. I’m preparing a blog with all of the study references so those who are open-minded enough can read them, and make a more informed judgment of 12-step recovery. Each time the American Society of Addiction Medicine holds their review course, there’s a lecture on 12-step recovery and the literature that supports it, just like there’s a lecture on methadone and buprenorphine for treatment of opioid addiction.

I’m sorry people have had bad experiences with 12-step recovery, but to use one bad experience as an excuse to denigrate 12-step meetings in their entirety is no different than saying because one person overdosed and died from methadone, it’s dangerous and should be outlawed.

For the record, I’m not in favor of forcing anyone to go to 12-step meetings if they don’t want to. Patients in my Suboxone practice have to do some kind of regular counseling, and they have their choice of seeing an individual counselor in my office, seeing their own therapist, going to 12-step meetings and documenting their attendance, or going to an intensive outpatient program at a local treatment center. About one-third of the new patients pick 12-step meetings because that’s the cheapest option, and that’s fine with me. At the opioid treatment programs where I work, I don’t force patients to go to 12-Step meetings. In situations where patients can’t stop drinking alcohol, I will recommend AA as an alternative to try before I have to recommend inpatient drug rehab, but those patients also have the option to attend the group meetings held at our OTP. However, one the OTPs doesn’t have any group meetings, so I’m more likely to recommend AA. That’s in Boone, and from what I hear, there’s no NA up there.

My office Suboxone patients give me a unique view. I inherited a group of about 30 patients from another Suboxone doctor. She was well-loved and well-known in local 12-step meetings, and any AA or NA member who got addicted to opioids after they were in recovery were referred to her. When she retired, I got most of those patients. Some of these patients had many years of sobriety from other drugs when they got put on pain pills for some reason, and they developed a secondary addiction to pain pills. After they got on Suboxone, they continued to go to their recovery meetings as usual.
I’m starting to realize that these patients may be rare. They’re comfortable with being on Suboxone and equally comfortable going to and participating in 12-step meetings. I enjoy them very much, and they’re easy to treat, since they’ve already had recovery experience.

These patients don’t share in meetings about buprenorphine, because that’s not their problem. These patients go to meetings to learn how to live a happy life without getting high. They talk about how to get through difficult life circumstances without losing their serenity, sanity, or sobriety. For them, the fact they are on a maintenance dose of medication is a non-issue. They aren’t looking for opinions or advice about their methadone or Suboxone dose.

If you are at a place in your life where you feel you must share about medications, I agree 12-step probably isn’t going to work for you, unless it’s MA (Methadone Anonymous).

It sounds like many MAT advocates have been to some very bad 12-step meetings. I hate that, but it’s not the norm. For example, 12-step members aren’t supposed to give advice, but only share what worked for them. In Alanon, one of my favorite 12-step groups, the readings at the beginning actually tell attendees not to give advice or comment on what other members have shared, but only about what you are going through and what is working or has worked for you.

It breaks my heart to hear an NA member castigate a newcomer to the group for being on methadone or Suboxone. It also breaks my heart when patients on medication-assisted treatment put down 12-step recovery. I always think to myself, “Oh if you only knew how much this helps some people, you wouldn’t talk bad about it…”

Maybe that’s just human nature.

Excuses for not going to 12-step meetings:

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Some people collect stamps. I collect reasons for not going to 12-step meetings:

I’m too busy.
I don’t have a car.
I don’t have a license to drive my car.
Gas is too expensive.
I hate cigarette smoke.
I can’t smoke at meetings.
I don’t have childcare.
I won’t know anyone.
I might know someone.
I hear that it’s really a cult.
I’d have to drive too far.
All they talk about is drinking.
They sell drugs at the meetings.
The meetings are too depressing.
The people at meetings are too happy.
I get my recovery at church.
Meetings are too far away.
Meetings are too close and I’ll know people there.
My probation officer won’t let me go because of my curfew.
Going to meetings makes me want to drink or use drugs.
I have social phobia and don’t feel comfortable in groups.
I don’t want to hear a bunch of other people’s problems.
I don’t want to tell a bunch of strangers my personal problems.
The only time I ever think about drugs or alcohol is when I’m at a meeting.
The people there are a bunch of fakes, lying about being clean/sober.
The last time I went, the men wanted to hook up with me sexually.
The last time I went, the women wanted to hook up with me sexually.
I got into recovery to have a life, and going to meetings just interferes with that.

And…my all-time favorite: I don’t want to get addicted to meetings. I just love that excuse…you may be snorting dangerous pills, alienated your friends and family, be nearing financial ruin, but none of that bothers you as much as the possibility you may get addicted to going to recovery meetings.

I’m not unreasonable. I know some of these excuses have some merit, like lack of childcare. But I also know there’s usually a way to overcome these barriers. People in active addiction often overcome great challenges to continue to getting their drugs. They create clever and imaginative solutions. Similarly, people can get to meetings if they want to do so.

I’d rather hear real reasons for not going: it’s scary and humiliating to admit you are addicted. It takes tremendous courage to walk into a 12-step recovery meeting for the first time, and it takes courage to continue to go to meetings. Meetings aren’t always pleasant or convenient.
But this form of recovery has worked for millions of people in a few hundred countries. It’s been around for seventy-seven years. What other drug addiction recovery programs have been in existence for that long? Twelve- step recovery isn’t a flash in the pan, and it has multiple clinical studies to show that it works. And it’s the best deal in town, since it’s free. So even though it can be intimidating to start going to meetings, the benefits are worth the effort.

Is it possible to recover without going to 12-step meetings? I believe so, yes. But I think it’s harder and takes more time and energy. I imagine the difference to be like hacking your way through a dense forest rather than taking a wide and well-worn path through the forest.

Twelve step programs aren’t the only recovery option and may not work for everyone, but please don’t tell me it doesn’t work for you until you’ve tried it.

Does 12-Step Recovery Really Work?

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I recommend 12-step meetings to my patients, because we have evidence these meetings work, at least for some patients. Studies of AA’s effectiveness, obviously difficult due to the anonymous nature of the program, have been conducted since 1945.

A metanalysis of thirty-three studies, done from 1945 until 1990, shows a positive association between the frequency of AA meetings attended by an alcoholic and increased abstinence from alcohol. In other words, an overall summary of these studies shows that the more AA meetings attended, the more likely the alcoholic stayed sober. (1) However, there were two of the thirty-three studies that showed a negative association, meaning that more AA meetings was associated with less time of sobriety. At times, organizations that oppose Alcoholics Anonymous quote one of these two studies and give no information about the other twenty- nine studies.

Of course, it may be that alcoholics who are more motivated to stay sober go to more AA meetings, and the number of meetings attended was thus a marker of commitment to sobriety. Was it the degree of motivation of the person, rather than the AA program, that produced the better outcomes? Later studies done in the 1990s controlled for the degree of personal motivation,  and still showed a positive correlation between number of meetings attended and sobriety. (2)

Later studies looked not at the number of AA meetings attended, but rather the degree of involvement of alcoholics in the AA program. These studies showed the degree of involvement in AA correlated higher with longer time of alcohol abstinence than did the number of meetings attended. Multiple studies, looking at outcomes other than abstinence from alcohol, have found that AA attendance was also associated with emotional well-being, serenity, and finding purpose in life. (1)

AA has never claimed to have all the answers or solutions. (3) Strangely, most alternatives to twelve step recovery use as their main selling point, “Not like Alcoholics Anonymous.” I have read books authored by people who seem quite bitter that AA did not “fix” them, as if AA had some obligation to do so. Twelve step recovery programs don’t force membership on anyone. In fact, the only way to become a member is to say you want to be a member.

So… if 12-step meetings help, great.

If not, then don’t go.

They have helped about two million people worldwide, but they don’t work for everyone. Thankfully, there’s more than one path to recovery.

1. Tonigan, J. Scott, “Alcoholics Anonymous Outcomes and Benefits,” in Recent Developments in Alcoholics, Volume 18, Research on Alcoholics Anonymous and Spirituality in Addiction Recovery, edited by Marc Galanter and Lee Ann Kaskutas. P 357-372.
2. McKeller J, Stewart E., Humphreys k, “Alcoholics Anonymous and positive alcohol-related outcomes: cause, consequence, or just a correlate?” Journal of Clinical Psychology, 2003, April, 71 (2) p 302-308.
3. Alcoholics Anonymous, 4th ed., (often called the “Big Book of Alcoholics Anonymous”) Alcoholics Anonymous World Services Inc., New York City, 2001, p 164.

 

12-Step Meetings Are Not the Same as Group Therapy

Before I actually went to some open 12-step meetings, I thought they would be like group therapy meetings. However, 12-step meetings have basic differences from group therapy meetings.

Twelve-step meetings are free. Most group therapy costs some amount of money.

Members don’t give advice to each other. Or at least, experienced members of Narcotics Anonymous and Alcoholics Anonymous don’t tend to give advice to each other. Instead, members share their own experiences. They tell about what worked for them, and what didn’t work.  The topic is often about how to get through situations without using drugs or alcohol, but may also be about how to live with difficult life situations, and still retain one’s serenity.

In group therapy, members are encouraged to give advice, or feedback, to other members. Some treatment centers believe that alcoholics and addicts must be confronted, so that denial can be broken through. Twelve-step meetings don’t take this stance. Instead, members offer their own experience, freely and without expectations. It’s a subtle difference, but important. Other 12-step members don’t assume they know what another person should do about life decisions; they simply offer their own experiences.

In 12-step meetings, there’s no therapist or counselor in charge of the meeting. Instead, there’s a chairperson, a member of the 12-step program who opens and closes the meeting. This person is in charge only in the sense that she guides, rather than controls, the meeting. Some chairpersons guide more than others. For example, some chairpersons will interrupt a member who’s sharing something that can be harmful to the group. This could mean interrupting a “drunkalog” (long pointless sharing that glamorizes drinking or using drugs). Other chairpersons let the meeting run its course, believing that a Higher Power is always in control. The chairperson is responsible for starting and ending the meeting on time.

No record of attendance is kept at 12-step meetings. A person is considered to be a member of Narcotics Anonymous when that person says they are a member. The only requirement for membership is a desire to stop using drugs.

Twelve step meetings are held in slightly different ways in different areas of the country. In some places, meetings range from fifty minutes to an hour and a half.  At “speaker” meetings, one person tells their story of addiction and recovery for the whole hour, traditionally telling “what it was like, what happened, and what it’s like now.” At other types of meetings, all persons present are offered a chance to share or pass to the next person. In some meetings, members who wish to share raise their hands and are called on by the meeting chairperson. In group therapy, all members are usually expected to say something during the session, but at NA or AA, no one is coerced to speak.

I tell my patients about these differences, because many people who really need the guidance and support that 12-step meetings don’t go, because of their mistaken opinions about meetings.

They think they will be made to speak at an NA or AA meeting, and don’t want to go for that reason. Other patients say if they hear people talking about drugs it will make them want to use drugs. Other people say they “don’t want to hear everybody else’s problems.”

Problems are shared at meetings, but the emphasis is on solutions. Most good meetings don’t allow the meeting to become a dumping ground for negative experience. The emphasis of meetings is on solutions to problems. I explain that in most meetings, sharing about specific drugs is discouraged. NA members are encouraged to share about what they are feeling, and what kind of help they need to remain abstinent from all drugs.

Overall, the mood of 12-step meetings is one of humbleness, where one recovering addict shares what worked for her with the rest of the group, without expectations and with humility. By contrast, in group therapy, feedback or advice is usually given by other group members. But an addict’s tendency with such an approach is to ask, “Who are you to be telling me what to do?” Narcotics Anonymous meetings recognize that advice and feedback often grates on addicts, and their meetings are constructed differently. Other member’s experiences are offered as learning opportunities.

Twelve step members aren’t perfect, to say the least. Many members are wrestling with serious mental and emotional problems. Sometimes members do lapse into advice-giving and preaching, but nearly always lose this tendency to try to control others as they progress in their own recovery.

There’s a reason 12-step recovery has been around for seventy-five years. Many other recovery methods have attained a brief popularity, only to fade away within ten or twenty years. Twelve step recovery has helped millions of people worldwide, continues to grow, and will be with us for a long time to come.

Excuses for not going to 12-step meetings:

Some people collect stamps. I collect reasons for not going to 12-step meetings:

I’m too busy.

I don’t have a car.

I don’t have a license to drive my car.

Gas is too expensive.

I hate cigarette smoke.

I can’t smoke at meetings.

I don’t have childcare.

I won’t know anyone.

I might know someone.

I hear that it’s really a cult.

I’d have to drive too far.

All they talk about is drinking.

They sell drugs at the meetings.

The meetings are too depressing.

The people at meetings are too happy.

I get my recovery at your church.

Meetings are too far away.

Meetings are too close and I’ll know people there.

My probation officer won’t let me go because of my curfew.

Going to meetings makes me want to drink or use drugs.

I have social phobia and don’t feel comfortable in groups.

I don’t need to hear a bunch of other people’s problems.

I don’t want to tell a bunch of strangers my personal business.

The only time I ever think about drugs or alcohol is when I’m at a meeting.

The people there are a bunch of fakes, lying about being clean/sober.

The last time I went, the men wanted to hook up with me sexually.

The last time I went, the women wanted to hook up with me sexually.

I got into recovery to have a life, and going to meetings just interferes with that.

And…my all-time favorite: I don’t want to get addicted to meetings. I just love that excuse…you may be snorting dangerous pills, alienated your friends and family, be nearing financial ruin, but none of that bothers you as much as the possibility you may get addicted to going to recovery meetings.

I’m not unreasonable. I know some of these excuses have some merit, like lack of childcare. But I also know there’s usually a way to overcome these barriers. People in active addiction often overcome great challenges to continue to getting their drugs. They create clever and imaginative solutions. Similarly, people can get to meetings if they want to do so.

I’d rather hear real reasons for not going: it’s scary and humiliating to admit you are addicted. It takes tremendous courage to walk into a 12-step recovery meeting for the first time, and it takes courage to continue to go to meetings. Meetings aren’t always pleasant or convenient.

But this form of recovery has worked for millions of people in a few hundred countries. It’s been around for seventy-seven years. What other drug addiction recovery programs have been in existence for that long? Twelve- step recovery isn’t a flash in the pan, and it has multiple clinical studies to show that it works.  And it’s the best deal in town, since it’s free. So even though it can be intimidating to start going to meetings, the benefits are worth the effort.

Is it possible to recover without going to 12-step meetings? I believe so, yes. But I think it’s harder and takes more time and energy. I imagine the difference to be like hacking your way through a dense forest rather than taking a wide and well-worn path through the forest.

Twelve step programs aren’t the only recovery option and may not work for everyone, but please don’t tell me it doesn’t work for you until you’ve tried it.

 

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