Difference between revisions of "Twelve Step Programs"

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(Unless you're interested in the minutiae of these types of studies, you may want to skip this paragraph.) One of the criteria for "establishing causation" in such studies is known as specificity. In biology and pharmacology, specificity is defined (per dictionary.com) as "the selective attachment or influence of one substance on another, as an antibiotic and its target organism" — that is, a specific drug eradicates a specific germ. In our case, it means there is no confusion regarding what caused the outcome — a result is or is not specifically related to a 12-Step program, and is not related to other causes. In this overview of the literature, the "rigorous experimental evidence" for specificity of 12-Step programs yielded mixed results. The author notes that in some studies, some participants who were assigned to a non¬–12-Step treatment program also attended AA. This means the 12-Step treatment group was really being compared to an alternative treatment plus AA, which could make the alternative treatment look better than it actually was. In other studies, the 12-Step meetings provided were run by the people doing the study, who were not AA members -- so these were not actual AA meetings.
 
(Unless you're interested in the minutiae of these types of studies, you may want to skip this paragraph.) One of the criteria for "establishing causation" in such studies is known as specificity. In biology and pharmacology, specificity is defined (per dictionary.com) as "the selective attachment or influence of one substance on another, as an antibiotic and its target organism" — that is, a specific drug eradicates a specific germ. In our case, it means there is no confusion regarding what caused the outcome — a result is or is not specifically related to a 12-Step program, and is not related to other causes. In this overview of the literature, the "rigorous experimental evidence" for specificity of 12-Step programs yielded mixed results. The author notes that in some studies, some participants who were assigned to a non¬–12-Step treatment program also attended AA. This means the 12-Step treatment group was really being compared to an alternative treatment plus AA, which could make the alternative treatment look better than it actually was. In other studies, the 12-Step meetings provided were run by the people doing the study, who were not AA members -- so these were not actual AA meetings.
  
Many other individual studies have found that attendance at 12-Step meetings improves outcomes for people recovering from addiction; a handful are referenced here.<ref> Moos RH, Moos BS: Participation in treatment and Alcoholics Anonymous: a 16-year follow-up of initially untreated individuals. Journal of Clinical Psychology 62(6):735–750, 2006. Found at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2220012/.</ref>, <ref>Gossop M, Harris J, Best D, et al: Is attendance at Alcoholics Anonymous meetings after inpatient treatment related to improved outcomes? A 6-month follow-up study. Alcohol & Alcoholism 38(5):421-426, 2003. Abstract found at https://www.ncbi.nlm.nih.gov/pubmed/12915517.</ref>, <ref>Gossop M, Stewart D, Marsden J: Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up study. Addiction 103(1):112-125, 2008. Abstract found at https://www.ncbi.nlm.nih.gov/pubmed/18028521.</ref>, <ref>Kaskutas LA, Ammon L, Delucchi K, et al: Alcoholics anonymous careers: patterns of AA involvement five years after treatment entry. Alcoholism, Clinical & Experimental Research 29(11):1983-1990, 2005. Abstract found at https://www.ncbi.nlm.nih.gov/pubmed/16340455.</ref>  
+
Many other individual studies have found that attendance at 12-Step meetings improves outcomes for people recovering from addiction; a handful are referenced here.<ref> Moos RH, Moos BS: Participation in treatment and Alcoholics Anonymous: a 16-year follow-up of initially untreated individuals. Journal of Clinical Psychology 62(6):735–750, 2006. Found at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2220012/.</ref> <ref>Gossop M, Harris J, Best D, et al: Is attendance at Alcoholics Anonymous meetings after inpatient treatment related to improved outcomes? A 6-month follow-up study. Alcohol & Alcoholism 38(5):421-426, 2003. Abstract found at https://www.ncbi.nlm.nih.gov/pubmed/12915517.</ref> <ref>Gossop M, Stewart D, Marsden J: Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up study. Addiction 103(1):112-125, 2008. Abstract found at https://www.ncbi.nlm.nih.gov/pubmed/18028521.</ref> <ref>Kaskutas LA, Ammon L, Delucchi K, et al: Alcoholics anonymous careers: patterns of AA involvement five years after treatment entry. Alcoholism, Clinical & Experimental Research 29(11):1983-1990, 2005. Abstract found at https://www.ncbi.nlm.nih.gov/pubmed/16340455.</ref>
  
 
== How Does It Work? ==
 
== How Does It Work? ==

Revision as of 21:53, 15 May 2019

One of the core concepts of Theosophy is that of spiritual self-transformation — the idea that we can certainly change our lives if we want to. This belief also lies at the heart of 12-Step programs, which by now are ubiquitous. Twelve-Step meetings are found daily in every city and many, if not most, small towns in the U.S., as well as worldwide.[1] People who use these programs successfully are profoundly grateful for them, and say so.[2]

History of 12-Step Programs

The first and best-known 12-Step program was and is, of course, Alcoholics Anonymous. AA was founded in Akron, Ohio, in 1935 by two alcoholics who discovered that helping other problem drinkers seemed to keep their own demons at bay. Both Bill W. and "Dr. Bob" S. had been involved with the Oxford Group, a Christian organization that emphasized universal spiritual values.[3] These concepts — the basics of which were (and are) honesty, unselfishness, and unconditional love for one's fellow humans[4] — became the foundation of the 12 Steps.

Bill W. had been in Ohio on business when he met Dr. Bob. After a few months Bill returned to his home in New York, taking the AA concept with him. The first AA meetings, in the Midwest and in New York, were held in member's homes. The attendees were mostly but not exclusively men, whose families often gathered in another room to talk about their own common problems — those of loving an alcoholic. Eventually these family meetings also became more organized. In 1951 Al-Anon Family Groups, the world's second 12-Step program, was made official.[5] In 1957, Alateen, which is Al-Anon for teenagers, was founded by a group of teens in southern California.[6]

The 12 Steps have since been adapted for use by myriad organizations — whatever the obsession, there is a 12-Step program to help with it: drug addiction, compulsive gambling, eating disorders, overspending and consequent debt, issues affecting adult children of alcoholics, issues with codependency, and many more. The Steps as originally written may be paraphrased somewhat to suit the needs of the specific group, but they remain universal principles that are found in nearly all prescriptions for living a spiritual life. These include practices such as fellowship, prayer & meditation, surrender to a higher power (or one's higher self), study, contemplation, confession, gratitude, self-examination, and celebration. For people who practice the 12 Steps, spiritual growth is the key to their effectiveness.[7]

Although some people object to the use of the word "God" in the 12 Steps, the Higher Power referred to is for each individual to define or discover. There is no dogma in 12-Step programs (although there are dogmatic people in all walks of life. Those who are not religious may find AA dogmatic because some of its members are, and it can be difficult to separate the people from the program).

The Steps as given below use the word God for the sake of simplicity, but — unlike as originally written — do not use "He" or "Him."

  1. We admitted we were powerless over [an addiction or unhealthy behavior/attitude] and that our lives had become unmanageable.
  2. Came to believe that a Power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understood God.
  4. Made a fearless and searching moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. Were entirely ready to have God remove these defects of character.
  7. Humbly asked God to remove our shortcomings.
  8. Made a list of all people we had harmed and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take personal inventory and when we were wrong promptly admitted it.
  11. Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God's will for us and the power to carry that out.
  12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to others and to practice these principles in all our affairs.

In the AA "Big Book," the Steps are followed by this acknowledgement: "Some of us exclaimed, ‘What an order! I can't go through with it!' Do not be discouraged. No one among us has been able to maintain anything like perfect adherence to these principles. We are not saints. The point is that we are willing to grow along spiritual lines. The principles we have set down are guides to progress. We claim spiritual progress rather than spiritual perfection."[8] As many other spiritual traditions have also noted, being committed to a spiritual path is not easy, but for people who give it their best effort the rewards are well worth the hard work.

In the academic community — as well as outside of it — there is some debate regarding 12-Step programs because of the spiritual aspect. Some people do not understand how such a program could work. Academics on both sides of the issue probably have more opportunity than others to publish their views.

Effectiveness of 12-Step Programs

How effective are the 12 Steps? For people who practice them successfully, the Steps hold the key to happiness and serenity. There is plenty of anecdotal evidence along these lines, and also plenty of evidence from clinical studies. The clinical studies are largely based on treatment of alcoholics and addicts who may or may not attend 12-Step programs as part of their treatment and/or follow-up.

A 2009 overview of the literature on AA's effectiveness[9] observed, among other positive findings, (1) rates of abstinence are about twice as high among those who attend 12-Step meetings following clinical treatment as those who do not attend, and (2) higher levels of attendance correlate with higher rates of abstinence. These two results were consistent across different groups of people and a variety of follow-up times. In addition, "mechanisms of action predicted by theories of behavior change are present" in 12-Step programs — that is, psychology recognizes the tools that people in 12-Step programs use to change their behavior. These tools include learning to view oneself as others do (in 12-Step rooms this is known as coming out of denial) and, naturally, having a support group of people who are working on the same life changes, which provides successful role models as well as psychological support.

(Unless you're interested in the minutiae of these types of studies, you may want to skip this paragraph.) One of the criteria for "establishing causation" in such studies is known as specificity. In biology and pharmacology, specificity is defined (per dictionary.com) as "the selective attachment or influence of one substance on another, as an antibiotic and its target organism" — that is, a specific drug eradicates a specific germ. In our case, it means there is no confusion regarding what caused the outcome — a result is or is not specifically related to a 12-Step program, and is not related to other causes. In this overview of the literature, the "rigorous experimental evidence" for specificity of 12-Step programs yielded mixed results. The author notes that in some studies, some participants who were assigned to a non¬–12-Step treatment program also attended AA. This means the 12-Step treatment group was really being compared to an alternative treatment plus AA, which could make the alternative treatment look better than it actually was. In other studies, the 12-Step meetings provided were run by the people doing the study, who were not AA members -- so these were not actual AA meetings.

Many other individual studies have found that attendance at 12-Step meetings improves outcomes for people recovering from addiction; a handful are referenced here.[10] [11] [12] [13]

How Does It Work?

So, it's clear that 12-Step programs are successful. Still, some practitioners in the medical and therapeutic communities are doubtful about how effective the 12 Steps are. As noted above, this appears to be due to an inability to understand how they work. The 12 Steps expound universal spiritual principles -- hence people who don't believe that humans have a spiritual dimension can't understand how they could work.

To understand how something works, it may be helpful to first understand what is being worked on — in this case, addiction. Probably the simplest definition of addiction is that it is continued use of a substance or behavior despite negative consequences.[14] Some in the medical and therapeutic communities view addiction as primarily a brain disease, although the influence of both genetics and early childhood experiences is clear.[15] There is also the view that substance use itself is the cause: simply using a drug that is addictive causes the brain changes that lead to addiction. However, Canadian psychologist Bruce Alexander and others refute this. Both experimental studies [16] and observation of veterans returning from Vietnam[17] show clearly that, given companionship and a decent environment (i.e., access to nutritious food and stimulating or meaningful activities), both humans and lab rats will stop using addictive drugs.

Many recovering alcoholics and addicts who are successfully using a 12-Step program -- as well as their relatives in Al-Anon -- believe the basis of addiction is the lack of a spiritual center. Rabbi Shais Taub puts it this way on his blog:

All human beings have a deep-seated need for spiritual contact. But most people can also live their lives without it. Addicts are people who, for whatever reason, are unsettled to the core and cannot handle the business of life without maintaining a continual and acute awareness of the Divine. Absent such higher consciousness, they are miserable and sick. What makes their dilemma fatal is that their drug of choice will actually produce in them short-term effects that simulate the release and relief that can only really be had through spiritual consciousness. Consequently, the only real treatment for their condition is to make sure that they get the "real thing" instead of self-medicating with the fake stuff, for if they do not get the real thing, they have no choice but to take the fake stuff.
In other words, for most people, spirituality is a luxury, something to be sought after more ‘basic' needs are met. Addicts are somehow different in this respect in that for them, there can be nothing resembling a normal life if their spiritual needs are not met first.[18]

For many people who use the 12 Steps successfully, these statements are Truth-with-a-capital-T.

Others, such as psychiatrist Lance Dodes, consider addiction a psychological problem, perhaps related to well-meaning but ineffective parenting.[19] While Dr. Dodes recognizes that spirituality is not the same thing as religion, he appears to view spirituality as a psychological phenomenon. He is at the other end of the spectrum regarding the effectiveness of 12-Step programs, and appears to consider AA a cult of sorts. As noted above, for people who don't believe that humans have a spiritual dimension, there is no way to understand how it works.

And it does not work for everyone. Some people have no interest in spirituality, and even those who do may struggle with "God as we understand God." It is possible to recover from addiction without the help of the 12 Steps, although — as seen in the studies cited above — a commitment to the Steps has a measurable effect on better outcomes.

Theosophy and the 12 Steps

Like any true spiritual discipline, 12-Step programs are not for the faint of heart. One often hears in 12-Step rooms that "it's a simple program but it is not easy." Similarly, a quote from the Collected Works of Madame Blavatsky is familiar to theosophists:

There is a road steep and thorny, beset with perils of every kind, but yet a road, and it leads to the very heart of the Universe: I can tell you how to find those who will show you the secret gateway that opens inward only, and closes fast behind the neophyte forevermore. There is no danger that dauntless courage cannot conquer; there is no trial that spotless purity cannot pass through; there is no difficulty that strong intellect cannot surmount. For those who win onwards there is reward past all telling—the power to bless and save humanity.[20]

Here we may be reminded of the AA Big Book's "What an order! I can't go through with it!" comment that follows the 12 Steps (see above). In theosophy as in 12-Step work, however, the emphasis is on willingness. As cited above, the AA Big Book notes that "The point is we are willing to grow along spiritual lines." Likewise, the Mahatmas who guided Mme Blavatsky and her followers told early theosophists, "We have one word for all aspirants: TRY."[21]

Perhaps the most striking similarity between Theosophy and 12-Step work is the emphasis on spiritual self-transformation. While some people have only an intellectual or academic interest in Theosophy, we are all encouraged to live it, not just study it. Simply put, this means living ethically and being of service to our fellow humans -- much easier said than done, for many of us. Twelve-Step programs emphasize the same notion, and the Steps are a highly effective road map to spiritual self-transformation. Many people who use them believe that their power to change people's lives is unparalleled.

Not surprisingly, the similarities between 12-Step programs and Theosophy have been noted in theosophical literature. The author quoted below (from 1987) was familiar with the 12 Steps and, when beginning to study Theosophy,

... was struck by the similarities of this philosophy with the general principles and ideas that compose the recovery program for Alcoholics Anonymous and the related organizations of Overeaters Anonymous, Narcotics Anonymous, and Alanon [sic]. An eclectic Judeo-Christian and Eastern spirituality is at the heart of these recovery programs, as are the concepts of fellowship, service, unity, love, transformation, acceptance, forgiveness, surrender, and humility. The roots of Theosophy lie also in diverse historical, religious, and spiritual traditions. ... Both AA and Theosophy speak of God(dess) being within and manifested as the Higher Self.[22]

This author, a psychotherapist who worked primarily with clients having addictions, "contend[s] that the growing problem of addiction in this society is a symbol of spiritual bankruptcy, emotional emptiness, and lack of human relatedness that affects increasing numbers of people. ... Increasingly I believe that spiritual hunger may be at the basis of most of the ‘disease' of addiction."[23]

Another excellent article on the similarities between theosophy and the 12 Steps appeared in a 2008 issue of Quest magazine (the journal of the Theosophical Society in America).[24] In it, the author notes that the principles of theosophy are so similar to those of a 12-Step program that, when one practices both, it is difficult to separate the two influences. Probably the chief difference between the two philosophies is that 12-Step work is eminently practical, while Theosophy, at least for beginners, is more theoretical. The Quest article observes that Theosophy is more "like a ‘sky road' while the Twelve Steps are like an ‘earth road.' The Steps give one a more practical or down to earth way to walk through life, while Theosophy is an elevated search. You can travel back and forth between the two as long as you balance the lofty abstractions with some down-to-earth practicality."

It is also not surprising that AA's founders knew Dora Kunz, President of the Theosophical Society in American from 1975 to 1987 and, of course, well known to theosophists world-wide. Both Bill W. and his wife (one of the founders of Al-Anon) had many a conversation with Mrs. Kunz regarding ways to approach spiritual seeking.[25] Mrs. Kunz as well as the 12-Step founders were proponents of spiritual growth rather than religious dogma. They felt it was important for people to come to their own understanding of a higher power or spiritual self, rather than having a particular creed imposed on them.

This is the essence of Theosophy: While there are universal truths, they cannot be dictated -- we only learn them through our own work. Theosophy shows us the signposts, and we each have to create our own path to a higher level of consciousness. Similarly, 12-Step programs promise a spiritual awakening to anyone who is willing to put in the work. Having a community of like-minded travelers makes the journey less arduous and more worthwhile.

 == Notes ==
  1. See, for example, Alcoholics Anonymous publication SMF-53, Estimates of A.A. Groups & Members, available at https://www.aa.org/assets/en_US/service-material-from-the-gso/smf-146-area-map-of-us-and-canada; and https://www.alcoholics-anonymous.org.uk/Professionals/Interesting-Statistics
  2. Attend any open meeting (i.e., a meeting designated as open to the public) to hear this demonstrated.
  3. https://www.aa.org/pages/en_US/historical-data-the-birth-of-aa-and-its-growth-in-the-uscanada.
  4. See https://www.12step.com/oxfordgroup.
  5. https://al-anon.org/for-members/wso/archives/history/
  6. ibid.
  7. Much of the discussion in this article is based on the writer's 2+ decades of experience with Al-Anon and related programs, including open AA meetings. Statements with no citation are based on this experience.
  8. Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism, 4th ed. New York: AA World Services Inc., 2001, p. 60.
  9. Kaskutas LE: Alcoholics Anonymous Effectiveness: Faith Meets Science. Journal of Addictive Diseases 28(2):145–157, 2009. Found at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746426/.
  10. Moos RH, Moos BS: Participation in treatment and Alcoholics Anonymous: a 16-year follow-up of initially untreated individuals. Journal of Clinical Psychology 62(6):735–750, 2006. Found at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2220012/.
  11. Gossop M, Harris J, Best D, et al: Is attendance at Alcoholics Anonymous meetings after inpatient treatment related to improved outcomes? A 6-month follow-up study. Alcohol & Alcoholism 38(5):421-426, 2003. Abstract found at https://www.ncbi.nlm.nih.gov/pubmed/12915517.
  12. Gossop M, Stewart D, Marsden J: Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up study. Addiction 103(1):112-125, 2008. Abstract found at https://www.ncbi.nlm.nih.gov/pubmed/18028521.
  13. Kaskutas LA, Ammon L, Delucchi K, et al: Alcoholics anonymous careers: patterns of AA involvement five years after treatment entry. Alcoholism, Clinical & Experimental Research 29(11):1983-1990, 2005. Abstract found at https://www.ncbi.nlm.nih.gov/pubmed/16340455.
  14. "A person with an addiction is unable to stop taking a substance or engaging in a behavior, though it has harmful effects on daily living." https://www.medicalnewstoday.com/articles/323465.php.
  15. https://drugabuse.com/library/what-causes-addiction/.
  16. https://www.huffingtonpost.com/johann-hari/the-real-cause-of-addicti_b_6506936.html.
  17. https://mayooshin.com/heroin-vietnam-war-veterans-addiction/.
  18. https://addictionblog.org/spirit/what-is-the-root-cause-of-the-spiritual-illness-called-addiction/.
  19. https://www.psychologytoday.com/us/blog/the-heart-addiction/201503/spirituality-and-addiction.
  20. Collected Writings, vol. 13, p. 219; found at http://www.katinkahesselink.net/blavatsky/articles/v13/ph_004.htm.
  21. Chin, Vicente Hao Jr. (ed): The Mahatma Letters to A.P. Sinnett in Chronological Sequence. Quezon City, Philippines: Theosophical Publishing House, 1993, p. 148. This is the most often quoted instance of the plea to "Try," although the admonishment was repeated in other letters as well. Also see https://theosophy.wiki/en/Try!
  22. Grynbaum Gail: Theosophy in healing addictions. American Theosophist 75(10):389-399, November 1987.
  23. ibid.
  24. Sides-Smith, Mona. A Practical Path to Theosophy: AA's Twelve Steps. Quest 96:(2), pp. 47-51, March-April 2008. Found at https://www.theosophical.org/publications/quest-magazine/1404.
  25. Chelsey, Frank, and Kirstin Van Gelder. A Most Unusual Life: Dora van Gelder Kunz: Clairvoyant, Theosophist, Healer. Wheaton, Illinois: Quest Books, 2015, pp. 93-97.