Scientific Research Shows Effectiveness of 12 Step Based Treatment

May 11, 2017 alcoholdrugsos

For years, I worked in the addictions treatment field and taught graduate courses in addiction at a local university. I also was, and still am, a strong, impassioned proponent of ongoing involvement in 12 Step Programs (e.g., Alcoholics Anonymous, Narcotics Anonymous) as an integral part of the traditional modalities of addiction treatment such as cognitive behavioral therapy, group therapy, and other research based interventions. However, until about ten years ago, the only evidence of the effectiveness of the 12 Step Programs was dismissed by academics and mental health professionals as “anecdotal”, that is, reports based on stories by those directly involved in recovery such as 12 Step Program members, or on non-scientific surveys of AA or NA members, or statistics from treatment centers. Therefore, for the past 40 years or so, the only evidence of effective addiction treatment based on adequate and well controlled clinical investigations has supported treatment that did not include 12 Step Program involvement.

Happily, there is now increasing evidence, based on studies using valid scientific methodology, that the most effective treatment for addiction will include ongoing, significant involvement in 12 Step Programs, along with the traditional interventions such as cognitive behavioral therapy, and other evidence based interventions. For an excellent summary of the evidence for the effectiveness of 12 Step based treatment, please go to this resource published by Hazelden Betty Ford Foundation, entitled, Recent Research Offers Compelling
Support for the Effectiveness of Twelve Step-based Treatment
Comments are invited. Jan Edward Williams, www.alcoholdrugsos.com, 05/11/2017.

Risk Factors for Problem Drinking in Seniors

Researchers at University of Georgia, American Geriatrics Society Journal, recently reported that seniors (1600 individuals ages 57-85), with chronic multiple health conditions and depression were at a high risk of developing into probl m drinkers. This research is reported to be the first to document a link between chronic health problems, with depression, and consequential problem drinking in seniors.

The study found that seniors with multiple ongoing health conditions and depression were five times more likely to become problem drinkers than seniors with such health conditions and no depression. The summary of the study in the January 12, 2017, issues of ScienceDaily (www.sciencedaily.com/releases/2017/01/170112110038.htm) stated:

“’These findings suggest that effective training in screening and referral for mental health and alcohol use issues for health care providers of older adults may better serve the approximate 4 million older adults who currently experience problem drinking in the U.S.,’ said Orion Mowbray, assistant professor at the UGA School of Social Work and lead author of the study.”

Add these findings to the fact that most seniors tend to develop greater sensitivity to the effects of alcohol as they age, and often are taking multiple prescribed, and over-the-counter, medications that can interact adversely with alcohol, for their chronic health conditions, it is important for seniors, and those that care for, and about, them to exercise caution in their use of alcoholic beverages.

As always, comments are invited on this post. Jan Edward Williams, Alcoholdrugsos Services, Ltd., http://www.alcoholdrugsos.com, 01/17/2017.

Some Observations on the Problem with Research on the Effectiveness of the 12 Step Programs

Researchers tend to reject assertions based on human experience, often referred to as "anecdotal evidence" because supported by individual observations or experience and not buttressed by scientific investigations. Therefore, the scientific research literature tends to discount experience of members of 12 Step self-help groups such as Alcoholics Anonymous and Narcotics Anonymous, who have achieved abstinence and sobriety. Even more confounding for those in scientific circles is the spiritual aspect of these 12 Step Programs, which is also often viewed with intense suspicion. The research mostly concludes that there is little definitive scientific proof that the 12 Step Programs are more effective than other approaches such as cognitive behavioral therapy. However, according to research, the best hope for recovery from  alcoholism, is through use of recognized therapy such as cognitive behavioral therapy, coupled with regular (the longer the better) attendance of programs such as Alcoholics Anonymous. Unfortunately (in my abstinence-biased view), the research into recovery from drug addiction, especially opiate addiction, supports treatment using methadone and suboxone (using legal, long lasting opiates instead of illicit opiates, with counseling and medical support), rather than abstinence based treatment and use of the 12 Step Program known as Narcotics Anonymous.

As one who has worked as an addiction counselor for over 37 years, and as a professor teaching graduate courses on addiction for over 24 years, and as an individual in longterm recovery from addictive disease with intimate knowledge of 12 Step Programs, I have looked at the research on the effectiveness of the 12 Step programs, pro and con, and have arrived at the following conclusions about such research that, admittedly, are colored by my bias in favor of the spiritually based 12 Step Programs:

1) Researchers, with a few wonderful exceptions (I can furnish citations), do not understand the spirituality of the 12 Step Programs;
2) Most researchers do not understand the powerful healing effects that arise when individuals with the same life-threatening disorder help one another at meetings as well as through the relationships of home group members and sponsors, though the researchers may use fancy terms such as universality, role modeling, and the like to explain such dynamics; and, finally,
3) The vast majority of researchers do not have the personal experience of addiction and recovery using the 12 Step Programs that, I believe, would allow them to understand how these programs work, thereby enabling them to construct scientifically valid investigations to evaluate the effectiveness of the 12 Step Programs.

I realize that these observations are driven more by my personal and professional experience than by scientific evidence, but so be it.

As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com, 09/22/2016.

Addiction Recovery Tip, Easy Does It, But Do It!

From time to time I will present here samples of my Addiction Recovery Tips (available by email; click on Get Help at top of www.alcoholdrugsos.com page). Here is one. Easy does it, but do it! is a slogan oft used in 12 Step recovery, whose second part is as important for the newcomer to recovery in the Twelve Step Programs, such as Alcoholics Anonymous, Narcotics Anonymous, or Al-Anon, as the first part. Maintaining emotional balance by not getting too upset or too excited helps one to avoid relapse. HALT is a useful tool in this regard: Don't get too Hungry, too Angry, too Lonely, or tooTired.

The AA Grapevine of July 1948 has its own unique take on the slogan, Easy Does It, in the language of that time, just three years after the end of World War II (I was 10 years old then):

"Fortunately, this is a saying which can be tested easily. It does not have to be accepted on faith alone. Anyone can find out for himself whether it works simply by trying it himself. Suppose a problem has arisen. Suppose it is the old urge to reach for the bottle. Or suppose the problem is one of those byproducts of alcoholism which continue to come up long after the urge to drink has gone. The reaction of the alcoholic, and of more than a few non­alcoholics, is to fight the problem, to worry about it, to get into a stew. The tension begins to mount. Emotion runs wild. Self control is slipping rapidly.

"That’s the usual sequence. It can be broken if in the midst of it, the victim sits way back, physically and mentally, and relaxes. First he must relax his muscles, because that’s the easiest to do. Then he must relax his mind, by directing his thoughts to pleasant subjects, to a reminder that others have succeeded and so can he, to mental pictures of peace and success. If he will but direct his mind away from the problem, he will find a new source of strength rising up within him.

"At least that is the way it has worked and still works for others. The individual who has learned how to relax has already advanced a long way towards happiness and success.

"Relax and enjoy A.A. Relax and enjoy life. "Easy Does It." If you don’t believe it, try it."(http://silkworth.net/grapevine/easydoesit.html)

However, there ARE things the recovering person must do: like sleep, eat, pay bills, go to work, attend AA, NA, or Al-Anon meetings, get a sponsor and listen to him/her, and don't pick up a drink or drug, or have an emotional relapse into trying to control the uncontrollable, even if your posterior falls off, to name but a few. So, easy does it, but do it!

As always, comments are welcomed. Jan Edward Williams,AlcoholDrugSOS Services, 07/12/2016.

Key to Spirituality in 12 Step Addiction Recovery

Is it necessary to believe in God to recover from an addiction through use of the 12 Step Programs such as Alcoholics Anonymous, Narcotics Anonymous, Al-Anon (12 Step Program for those in a relationship with an alcoholic), Nar-Anon (addict), and other such programs? My answer is: "No, you do not, at least in the beginning." However, I suggest that one's chances of developing and maintaining a long term mentally healthy, balanced, and serene recovery will be enhanced with willingness to seek and find a source of spiritual strength.

First a word about those new to recovery who take the position that they know all about God, theology, and organized religion and have had an excellent relationship with God, and, therefore, need not work to improve their relationship with God in order to stop use of drugs of alcohol; often these folks are clergy or religious who have developed a drug or alcohol addiction. I suggest to these individuals that they look at how, by definition, addiction had proved more powerful than their own efforts to control it, and has proved somehow resistant to their requests for help from God to do so. Usually, with guidance, these individuals will come to see that drug or alcohol use has come between them and God because of their own self-centeredness that is powered by the relentless demands of addiction. It is almost impossible for a drug or alcohol addicted individual to have an intimate relationship with another person or with God; drugs or alcohol become the addicted individual's God.

The key for all individuals suffering from addiction, including clergy, to beginning a successful recovery through the 12 Step Programs using spiritual principles can be found inAppendix II of the book Alcoholics Anonymous; this quotation from that Appendix sums up in a few words what is needed:

"Most emphatically we wish to say that any alcoholic capable of honestly facing his problems in the light of our experience can recover, provided he does not close his mind to all spiritual concepts. He can only be defeated by an attitude of intolerance or belligerent denial. We find that no one need have difficulty with the spirituality of the program. Willingness, honesty and open mindedness are the essentials of recovery. But these are indispensable.

'There is a principle which is a bar against all information, which is proof against all arguments and which cannot fail to keep a man in everlasting ignorance—that principle is contempt prior to investigation.' (Herbert Spencer).”

In my experience anyone can find recovery support in the 12 Step programs, if he or she is willing to have an open mind and is willing to seek a source of spiritual strength, or, as phrased in 12 Step circles, a higher power, or God as you may understand him. It is vital to success in 12 Step programs that the new person put to one side any negative experiences and thoughts about organized religion; indeed, prior negative experiences do not have to be an obstacle to spiritual recovery in the 12 Step programs. One need only approach 12 Step meetings as a place to learn practical tools, including spiritual tools, to stay away from the first drink or drug one day at a time. or to avoid, one day at a time, trying to control another person's behavior (Al-Anon or Nar-Anon).

The best mind set or way of thinking for the newcomer to have is one of a student who seeks to find information that he/she can relate to, not looking for information that he/she cannot relate to; that is, to seek to compare in, not out. After attending, say, ten or so 12 Step meetings with an open mind, one should have had the awesome experience of hearing real people share real feelings that he/she can relate to, maybe even hearing a part of one's own story. The ability to relate to stories, experiences, feelings, in 12 Step meetings is in my view a spiritual experience that is the essence of spiritual recovery. In my personal journey in 12 Step recovery, I was intellectually opposed to anything I heard in meetings that even remotely sounded like God or religion. That intellectual position almost resulted in my death through drinking. At some point, I was able to really hear and relate to (and get chills of recognition) when listening to real people sharing from the heart. Being able to connect through the sharing in 12 Step meetings can be the gateway to finding a source of spiritual strength.

I invite comments from others about their experiences with spirituality in recovery. Jan Williams, 06/15/2016.

Recovery Tip: Live in the here and now.

In one of the daily meditation books that I read, I came across a quote that is familiar in its message to those in recovery from addiction who are guided by Twelve Step principles:

"The real enemies of our life are the 'oughts' and the 'ifs.' They pull us backward into the unalterable past and forward into the unpredictable future. But real life takes place in the here and now. God is a God of the present. God is always in the moment be that moment hard or easy, joyful or painful." --Nouwen, Henri. (1994). Here and Now: Living in the Spirit. Crossroad Publishing Company, page 18.

Of course, the Twelve Step programs talk about living one day at a time, at first, suggesting that the newcomer not take a drink or a drug just for today (or maybe just for this hour). Eventually, experience in applying spiritual principles leads one to realize that attending to the present, to what is happening in the moment, can be the key to serenity. A favorite question I try to remember when I am pestered by fear of the future or pain from the past is to ask: What bad thing is happening at this very moment? Usually the question brings awareness that the issue bothering me is from the past or the future, resulting in perspective and distance from the problem and the opportunity to apply spiritual principles, such as turning the problem over to God (my source of spiritual strength).

Over time in recovery and experience in use of spiritual principles, I have found the Nouwen quote to be true. The hard part is remembering to seek God's help in the moment of emotional, physical, or spiritual upset.

As always, comments are invited. Jan Edward Williams, 04/27/2016.

Selfishness, self-centeredness is the root of the troubles of the alcoholic

An article in Science Daily, published on the March 31, 2016, summarizing the results of a scientific study done at Case Western Reserve University, supports the frequently quoted statement from the basic text of the 12 Step Program of Alcoholics Anonymous (known as the Big Book or Alcoholics Anonymous) written around 1938, that self-centeredness is the fundamental problem of alcoholics, and also supports what has become a key to the success of the Fellowship of Alcoholics Anonymous from 1938 to date, namely, altruism, or, one alcoholic helping another.

Here is a quote from the article"

"Developmental psychologist Maria Pagano, PhD, found adolescents  with severe alcohol and other drug (AOD) problems have a low regard  for others, as indicated by higher rates of driving under the influence  and having unprotected sex with a history of sexually transmitted  disease. The findings also showed that they are less likely to volunteer  their time helping others, an activity that she has been shown to help  adult alcoholics stay sober."

The AA Big Book states:

"Whatever our protestations, are not most of us concerned with ourselves,  our resentments, or our self-pity? Selfishness - self-centeredness! That,  we think, is the root of our troubles That, we think, is the root of our  troubles. Driven by a hundred forms of fear, self-delusion, self-seeking,  and self-pity, we step on the toes of our fellows and they retaliate.  Sometimes they hurt us, seemingly without provocation, but we invariably  find that at some time in the past we have made decisions based on self  which later placed us in a position to be hurt. So our troubles, we think,  are basically of our own making. They arise out of ourselves,  and the alcoholic is an extreme example of self-will run riot, though he  usually doesn't think so. (Alcoholics Anonymous, p. 62)."

Refreshingly, since most researchers do not understand the effectiveness of AA, Science Daily article reports that the author of the study, Dr. Pagano:

"...believes that alcoholics and drug addicts may be hindered by a low awareness of how their actions impact others. "The addict is like a tornado  running through the lives of others," said Pagano. Even when they are in  recovery there is little indication that they understand how their actions  impact those around them. "This is part of the illness," she added. Helping  young people to get out of that self-centeredness in the service of others  helps them in the recovery process. Service to others is a big part of the  12-step Alcoholics Anonymous and Narcotics Anonymous programs."

I am always amazed at the wisdom and prescience of the authors of AA's basic text. Alcoholics Anonymous, who were able to capture the essence of alcoholism without the benefit of the modern science of the 21st century.

As always, comments are invited. Jan Edward Williams,AlcoholDrugSOS Services, 04/03/2016.