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A few Fridays ago, “Keith” said, in an Alcoholics Anonymous (AA) meeting I attended, that his niece is an addictions counselor, and that she does not recommend AA for her clients, that AA “is a cult, and all my clients would do is switch dependencies”. At another meeting, “Jasmine” said that her therapist told her that AA is okay for the first few weeks of recovery, but that she should not come to depend on anything but herself for her addictions recovery. “Mike”, a school counselor, believes that he would never recommend AA to an addicted student, since it is too full of God-talk and is not for young people. Finally, a counselor named Jackson says, “I went to a few AA meetings, and I hated them—too many slogans, rules, and corny sayings.” In an article entitled “Why the Hostility Toward the 12 Steps?”, Dr. David Sack (2012) stated that false beliefs about 12-step programs keep many addicts away from resources that could change the trajectory of their lives, and that the 12 steps have worked when many other approaches have failed. In a later article, Dr. Sack (2014) cited the research of Dr. Marc Galanter, professor of psychiatry and founding director of the Division of Alcoholism and Drug Abuse at New York University, who has found that many of the cognitive and emotional experiences and changes that occur in 12-step meetings can be explained with neuroscience.
Mental health professionals who reject the relief and recovery offered by adjunct helping groups such as AA and other 12-step programs do a dangerous disservice to their clients. Every sort of satirical and critical remark can be made, and is made, about the 12 steps and AA. People make fun of the call-and-response format of the meetings: “My name is Lissa, and I am an alcoholic.” . . . “Hi, Lissa!” I have heard the slogans (“one day at a time”, “first things first”, “keep coming back”) articulated with derision, and seen the “recovering type” satirized both in print and on programs like Saturday Night Live (e.g., by the comedian Stuart Smalley). More disturbing, though, than this stereotyped ridicule is the antipathy on the part of some mental health professionals dealing with addiction, who maintain hostility toward AA. I strongly suggest that this could be foreclosing a possibility of recovery for their addicted clients.
Perhaps we should take a look at professional arrogance and territoriality in the therapeutic community. A practitioner who cleaves too closely to one school of practice to the exclusion of others runs the risk not just of obsolescence but, more critically, of disservice to clients. In my roles as counselor and counselor–educator, I have encountered therapists who identify as CBT (cognitive-behavioral therapy) or DBT (dialectical behavioral therapy) or Freudian or Adlerian practitioners, who reject findings, or even possibilities, that supersede or refute the effectiveness of their particular therapeutic point of view. And in my roles as coach and coach–educator, I have encountered therapists who look askance at coaches, who see coaching not as a legitimate helping profession but as a suspect advice service with the added implication that one has “gone over to the dark side”.
Mental health workers need at least a passing understanding of neurobiology to contend that they are current in their field. Just as we need to adapt to changing ideas and practices, we need open minds to look at old systems afresh. Neuropsychotherapy and AA are not uneasy bedfellows: I suggest they are a pretty solid marriage, in fact. Further, I suggest that people who claim to help others ignore either of these partners at their peril. More and more professionals and lay people understand terms such as “mirror neurons” and “neuronal pathways”, and therapists who are willing to embrace new ideas will be more likely to discover interventions that can work in the lives of their addicted clients (Hall, Carter, & Morely, 2004). It is my hope that henceforth neuropsychotherapists will strongly and enthusiastically recommend working through a 12-step program as a complementary practice to counseling with addicts and their families, if they are not already doing this.
The 12 steps and, especially, the customs of AA, underscore several crucial aspects of neuroscience. For example, Dr. David Sack asserts in his article, “Mapping AA: The Neuroscience of Addiction” (2014), that not only does chronic substance abuse rewire the neural pathways but that 12-step recovery can be of great help by correcting the faulty wiring that chronic substance abuse has caused.
Alcoholics Anonymous meetings can be of utility concerning this rewiring in three main ways, by
- providing a safe, enriched environment;
- giving opportunity for strong social connections; and
- offering repetitive, positive experiences.
A safe, enriched environment
Of crucial importance in neuropsychotherapeutic interventions are enriched environments and social wellness, which includes interpersonal connectivity (Rossouw, 2013a). AA meetings provide instances of both these basic requirements. The format of most meetings includes readings that establish a safe and accepting environment. Similar passages are read at meetings the world over—so if you are in the English-speaking world, you are likely to hear the AA “Preamble” or “How It Works”. I have heard these read in at least 11 States of the USA, in London in the United Kingdom, and in Grand Bahama Island. I have heard similar readings in French and Spanish, as well. Every time the old rhythm of “How It Works” initiates a meeting, I remember that I am in a safe environment. The language itself is reassuring: “Rarely have we seen a person fail who has thoroughly followed our path” (Alcoholics Anonymous, 2008, p. 58). Most meetings include a reading of the 12 steps where newcomers and old-timers alike come to understand that there are pathways to maintaining a new way of living, and that many of us have traveled them to success. The newcomer is assured that one does not need “perfect adherence” to these principles and that Step 12 means that others are available to help if it is requested. Safety is enhanced by the knowledge that all attending have a clear purpose: to remain sober and to help other alcoholics achieve sobriety.
There are dozens of other examples in AA meetings of what LeDoux (2003) calls an enriched environment—a place where the brain can flourish, and stress is effectively managed. In his discussion of interpersonal connectivity, Pieter Rossouw (2013b) underscored the importance of environment when he wrote that the brain processes and responds “as a result of interplay with its environment [and that] it also adjusts itself and changes as a result of such interactions” (para. 11). A brain that is exposed to a healthy environment will develop new, stronger neuronal networks that will help develop resilience when faced with adverse conditions; in contrast, a brain that is exposed to adverse circumstances results in “an increasing inability to manage life’s challenges” (para. 10).
If therapists are to believe that talking therapies facilitate enriched environments and can elicit structural changes in the brain (Feldstein Ewing & Chung, 2013), then it seems reasonable to suggest that therapists would do well to recommend other environmentally enriching opportunities to clients as well—ones that might supply a more consistent reinforcement beyond weekly therapy sessions. With online and phone sessions available, and with almost ubiquitous face-to-face meetings, AA can be accessed at times when a therapist is not reachable or available. The AA practice of sponsorship, for example—where a more experienced recovering alcoholic agrees to provide support to a person new to sobriety—offers 24/7 encouragement even when a talking therapy is out of reach.
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