12-Step Support Groups: Part II
A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.While there is a group norm in 12-step groups to comply with the program, in its truest form AA is invitational not coercive. Just like all support groups, whether the organization achieves its ideals will vary from participant to participant, and group to group. If you visit a 12-step program, or any support group, and experience something that feels manipulative, it may be wise to pay attention to that. Perhaps you need a different meeting, a different support group, or an entirely different approach. For this reason, many addictions professionals who may encourage therapy participants to explore 12-step support groups, request they attend at least five meetings (preferably different ones) before judging whether this group will be a beneficial addition to their recovery efforts. This recommendation would appear to be good advice when considering any support group.
This leads to an important issue when considering any non-professional support group of any type. We cannot consider these groups a form of addictions treatment. These groups are not composed of professionally trained people and cannot be legally compelled to enforce confidentiality. Self-help groups are just that. They are groups of non-professional people with a common problem who attempt to help each other. This in no way diminishes the value or benefit of these groups. However, we must understand these groups in the proper context. Many people consider support groups a valuable addition to their natural recovery efforts, and/or their professionally supervised recovery efforts.
12-step programs encourage sober living and complete abstinence from alcohol and other recreational drugs. This is true regardless of a person's original addictions. 12-step support groups for activity addictions may specify certain behaviors that require abstinence. For instance, while possible, it is not practical to abstain from all sexual activity. This is particularly true for persons in partnered relationships. Therefore, sex addicts may specify clear limits to certain behaviors. These limits are usually determined with the aid of a sponsor. In this respect, for some activity addictions, recovery more closely resembles moderation, rather than abstinence.
12-step programs do not ask members to discontinue the use of pharmaceutical drugs so long as they are prescribed by a physician, and taken as directed. Some groups and their affiliated members may discourage the use of legitimate medications. Because of concerns about this practice, AA produced a pamphlet to address this concern. "It becomes clear that just as it is wrong to enable or support any alcoholic to become re-addicted to any drug, it's equally wrong to deprive any alcoholic of medication which can alleviate or control disabling physical and/or emotional problems (Alcoholics Anonymous, 2012a)." If you encounter a particular group that seems to contradict this statement, you would be wise to consider an alternative. Try a different meeting, a different group, or seek professional consultation.
Research on the effectiveness of AA has been limited. There is insufficient evidence to soundly weigh-in on this issue. Sometimes group members' understanding of the principle of "anonymity" has hindered research. Like other addiction research, there is also the difficulty of keeping track of persons with addictive disorders. Presumably, research will someday reveal that AA is indeed effective for some people.
Unfortunately, anecdotal evidence (versus rigorous scientific research) causes people to over-estimate the effectiveness of 12-step programs. Unlike randomized clinical trials that control for the effect of self-selection, support groups are only as effective as the people who decide to attend that group. Therefore, without the benefit of scientific study, the "effectiveness" of such groups remains anecdotal, rather than scientific.
Furthermore, many addiction professionals are themselves in recovery. They are attracted to the profession because they altruistically wish to share their own personal recovery experiences to benefit others. Many of these professionals have relied upon a 12-step approach to recovery. Thus, their personal experience is limited to this one method. While it may be valuable for clinicians to share their personal experiences, they must ethically avoid bias. If they choose to disclose their own recovery stories they must recognize their personal recovery experience is but one of many recovery stories. The people who seek their assistance with recovery are quite logically, different people. They may, or may not succeed with the same approach. Most clinicians do recognize this.
Nonetheless, it always possible that a clinician will become particularly attached to the method and culture that worked for them. In AA, members frequently assert, "AA is the only thing that worked for me." While these statements may be true for the person making that statement, the research does not support such an assertion. A meta-analysis of eight clinical trials with 3,417 participants concluded, "No experimental studies unequivocally demonstrated the effectiveness of AA or [Twelve Step Facilitation] approaches for reducing alcohol dependence or problems."
Resources
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Articles
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What is Addiction?
- Introduction to What is An Addiction
- Definition of Addiction
- Definiton of Addiction Continued
- The Addiction Definition Compared to Other Addiction Terms
- How Do I Know if I Have An Addiction?
- Why Don't They Just Stop? Addiction and the Loss of Control
- Is Alcoholism a Disease?
- Addiction Statistics: How Big of a Problem Is It?
- A Brief History of Alcoholism
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What Causes Addiction?
- Introduction to Causes of Addiction
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- Moral and Spiritual Causes of Addiction
- Addiction and Personal Responsibility: A Fundamental Conflict
- Personal Responsibility and Locus of Control
- Controversies in the Addiction Field: Change Versus Acceptance
- Conflict between 12-Step Anonymous Groups and Science: A Historical Perspective
- Conflict between 12-Step Anonymous Groups and Science Continued
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How Do You Get Addicted?
- Introduction to How Do You Get Addicted?
- The Biology of Addiction and Recovery
- How Does Addiction Affect the Brain?
- Addiction Changes the Brain's Chemistry
- Addiction Changes the Brain's Communication Pathways
- Addiction Changes Brain Structures and Their Functioning
- Impaired Decision-making, Impulsivity, and Compulsivity: Addictions' Effect on the Cerebral Cortex
- Drug Seeking and Cravings: Addictions' Effect on the Brain's Reward System
- Habit Formation, Craving, Withdrawal, and Relapse Triggers: Addictions' Effect on the Amygdala
- Stress Regulation and Withdrawal: Addictions' Effect on the Hypothalamus
- The Good News: The Brain Also Helps to Reverse Addiction
- The Psychology of Addiction and Recovery
- Learning Theory and Addiction
- Classical Conditioning and Addiction
- Operant Conditioning and Addiction
- Social Learning Theory and Addiction
- Cognitive Theory and Addiction (Thoughts, Beliefs, Expectations)
- Cognitive Theory and Addiction Continued
- Cognitive-Behavioral Therapy: Improving Coping Skills
- Addiction and Other Psychological Disorders
- Developmental Theory and Addiction
- Recovery from Addiction: The Psychology of Motivation and Change
- Addiction: Social and Cultural Influences
- Addiction and Sociological Influences: Culture and Ethnicity
- Recovery from Addiction: Becoming Aware of Cultural Influences
- Recovery from Addiction: The Powerful Influence of Families
- Recovery from Addiction: Social Support
- The Spirituality of Addiction & Recovery
- The Spirituality of Addiction & Recovery Continued
- Incorporating Spirituality into Recovery from Addiction
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Signs and Symptoms of Addiction
- How Do You Know If You Have An Addiction?
- The Diagnostic Criteria for Substance Use Disorders (Addiction)
- The Diagnostic Criteria of Substance-Induced Disorders
- Alcohol-Related Disorders
- Caffeine-Use Disorders
- Cannabis-Related Disorders (Marijuana)
- Hallucinogen-Related Disorders
- Inhalant-Related Disorders
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- Sedative-, Hypnotic-, Or Anxiolytic-Related Disorders
- Stimulant Use Disorder: Amphetamine Type (e.g., methamphetamine)
- Tobacco-Related Disorders
- Other Substance-Related Diagnosis and Unspecified Other Substance-Related Disorder
- Activity Addictions (Behavioral Addictions)
- Gambling Disorder (Addiction)
- Sexual Addiction and Pornography Addiction
- Other Activity (or Behavioral) Addictions: Internet Gaming Disorder (Addiction)
- Other Activity (or Behavioral) Addictions: Food Addiction
- Addiction and Other Psychological Disorders
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- Summary of the Diagnostic Process
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Treatment for Addiction
- Treatment for Addiction
- Natural Recovery: Recovery from Addiction Without Treatment
- Natural Recovery Continued
- Choosing An Effective Treatment Approach: Evidenced-Based Practices
- What Makes An Addictions Treatment Effective?
- Biological Approaches to Addiction Treatment: Medications
- The Role of Medication in Addictions Treatment
- Pharmacologic Medications for Addictions Treatment
- Pharmacologic Medications for Addictions Treatment: Part II
- Psychological Approaches to Addiction Treatment
- Motivation for Change: The Stages of Change Model
- Motivation for Change Continued
- Types of Evidenced-Based (Effective) Treatments for Addiction: Motivational Interviewing
- Relapse Prevention Therapy
- Contingency Management
- Cognitive-Behavioral Therapy
- Dialectical Behavioral Therapy
- Acceptance and Commitment Therapy
- What The Pros Know: The Practical Recovery Model
- Social Approaches Addictions Recovery
- A Cultural Approach to Addictions Treatment: Harm Reduction
- Family Approaches to Addictions Treatment: CRAFT, Intervention And Al-Anon
- The Social Support Approach to Addictions Recovery: Recovery Support Groups
- Self-Empowering Support Groups for Addiction Recovery: Smart Recovery
- Moderation Management
- Women for Sobriety
- LifeRing Secular Recovery
- Summary of Self-Empowering Support Groups
- Spiritual Approaches to Addiction Recovery
- 12-Step Support Groups: Groups That End With "Anonymous"
- 12-Step Support Groups: Part II
- 12-Step Support Groups: Part III
- Expanding Addiction Treatment Choices in the United States
- Developing a Personal Action Plan for Addiction Recovery: Part I
- Developing a Personal Action Plan for Addiction Recovery: Part II
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Videos
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- Why People Can Become Addicted to Opioids
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- Teen Drug Use: 2014 Monitoring The Future Survey Results
- Sex and Gender Differences of Importance to Addiction Science
- How to Tell if a Loved One is Abusing Opioids
- Why Addiction is a “Disease” and Why Is It Important
- NIDA Emerging Drugs-Methylone and Molly
- Designed to Drink? The Genetics of Alcoholism
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- Women and Addiction: Why Gender Matters
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- Energy Drink Sparking More ER Visits
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- Anyone Can Become Addicted to Drugs
- Substance Use: Addiction Theories New Treatments and the Role of Doctoring in Society
- The Impact of Changing Social Behaviors on Teen Drug Use
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- Cannabis Effects on Driving Performance
- Epidemiology of Tobacco Use
- Addiction: Learning to Forget
- Addiction: What Can I Do About It?
- Addiction: Treat It Like a Disease
- Addiction: What Is It?
- One in 4 People Prescribed Opioids Progresses to Longer-Term Prescriptions
- NIDA’s Dr. Phil Skolnick discusses intranasal naloxone
- "Eyes On" Research in Drugged Driving
- How Will Anti-Drug Vaccines Be Used? An Interview With Dr. Thomas Kosten
- Opioid Use in Pregnancy: A Community’s Approach
- Naloxone Rescue Kits
- Living Without Fear
- What You Need to Know About Internet Addiction
- Hooked, Hacked, Hijacked: Reclaim Your Brain from Addictive Living
- The Neuroscience of Internet Addiction
- Internet Addiction: Signs You Need to Shut Down
- What the Internet is Doing to Our Brains
- Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment
- The Reward Circuit: How the Brain Responds to Cocaine
- The Reward Circuit: How the Brain Responds to Methamphetamine
- The Reward Circuit: How the Brain Responds to Marijuana
- The Reward Circuit: How the Brain Responds to Natural Rewards and Drugs
- Mindfulness-Based Relapse Prevention (MBRP) for Addictions Video (vol. 1)
- Mindfulness-Based Relapse Prevention for Addictions (vol. 2)
- Prescription Opioid Misuse
- Substance Use Disorders/Addictions - Clinical Overview
- Addiction in the Elderly
- Teenagers, ADHD, and Substance Abuse
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