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.
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