Twelve-Step and Other

Types of Support Groups

A Unique Part of the Treatment of Addictive Disorders

But it ain’t treatment…

W. Bryce Hagedorn, PhD, LMHC, NCC, MAC

 Twelve-Step Groups

• Essential part of many or most Tx programs

• Most Tx programs are disease based
• Most will require or encourage AA/NA attendance
• An often misunderstood program
• Often passionate reactions
 Alcoholics Anonymous
• Established June 10, 1935
– Bill Wilson and Dr. Bob
– Akron, Ohio
• The Big Book
• Focus on surrender, forgiveness,
humility, limitations, and service
• 100,000 groups worldwide
– 2 million members
 Alcoholics Anonymous
• 12 Steps and 12 Traditions
• Steps are suggestions for individuals
• Traditions are suggestions for groups
• Sponsorship, temporary sponsorship
• Anonymity to avoid controversy and maintain
focus
 The 12 Steps
• Step 1 – We admitted we were powerless over
our addiction, that our lives had become
unmanageable.
• Step 2 – Came to believe that a power greater
than ourselves could restore us to sanity.
• Step 3 – Made a decision to turn our will and
our lives over to the care of God as we
understood him.
 The 12 Steps
• Step 4 – Made a searching and fearless moral
inventory of ourselves.
• Step 5 – Admitted to God, to ourselves and to
another human being the exact nature of our
wrongs.
• Step 6 – Were entirely ready to have God
remove all these defects of character.
 The 12 Steps
• Step 7 – Humbly asked Him to remove our
shortcomings.
• Step 8 – Made a list of all persons we had
harmed, and became willing to make amends
to them all.
• Step 9 – Made direct amends to such people
wherever possible, except when to do so
would injure them or others.
 The 12 Steps
• Step 10 – Continued to take personal inventory
and when we were wrong promptly admitted it.
• Step 11 – Sought through prayer and meditation to
improve our conscious contact with God, as we
understood Him, praying only for knowledge of His
will for us and the power to carry that out.
• Step 12 – Having had a spiritual awakening as the
result of these steps, we tried to carry this
message to other addicts, and to practice these
principles in all our affairs.
• The Swamp
The Twelve Steps and Motivational Stages

12 Termination
11
10
9
8
7 Maintenance
6
5
4
Action
3
2 Preparation
1 Contemplation
Pre-contemplation
 Alcoholics Anonymous
• Alcoholics Anonymous does not assert that:
– there is only one form of alcoholism
– moderate drinking is impossible for everyone
– alcoholics should be labeled, confronted aggressively or
coerced
– alcoholics are riddled with denial and defense
mechanisms
– alcoholism is purely physical, alcoholism is hereditary
– there is only one way to recover
– alcoholics are not responsible for their actions
 Other Twelve-Step Groups

• Narcotics Anonymous, 1953

• In part a response to AA’s
“exclusion” of drug addicts
• 600% growth from 1983-1989
• These days there are few “pure”
alcoholics or addicts
• Clients should be encouraged to
explore options (try a variety of
groups to meet their needs)
 Other Twelve-Step Groups
• Al-Anon, 1954
– Founded by Lois Wilson, wife of Bill
– For family/friends of those addicted to alcohol
– Use the same steps/traditions of AA
• Focus – Lack of control over the loved-one’s alcoholism
• Focus – learning how to control one’s own life
• Alateen, 1957
– Component of Al-Anon
– Founded by a teenager (who would have thought?)
 Other Twelve-Step Groups

• Nar-Anon Family Groups

– For family/friends of those addicted to drugs
– Use the same steps/traditions of NA
• Focus – lack of control over the loved-one’s drug use
• Focus – learning how to control one’s own life
 Other Twelve-Step Groups
• Focus on all chemicals • Process addictions
– Chemical Dependence – Gamblers Anonymous
Anon – Sexaholics/Sex Addicts
• Focus on specific drugs Anonymous/SLAA
– Cocaine Anonymous – Overeaters Anonymous
– Marijuana Anonymous – Emotions Anonymous
– Crystal Meth Anonymous – Codependents Anonymous
• Dual Diagnoses – On-line Gamers Anonymous
– Double Trouble in Recovery
• For families
– Dual Recovery Anonymous
– Families Anonymous
– C-Anon, S-Anon, etc.
 Twelve-Step Groups:
Potential Advantages
• Cost
• Availability
• Support, acceptance
• Structure
 Twelve-Step Groups:
Potential Disadvantages
• Conflict between “religious” and “spiritual”
– Lord’s Prayer implies Christianity
– Judeo-Christian God as Higher Power
• May be problematic for some clients
• The issue of cross-dependence
 So what’s up with all the Spirituality
in the first place?
• “Why AA works is fundamentally a mystery.
When we consider that for thousands of years,
few alcoholics escaped from their misery and
that now we are witnessing a wholesale
escape, that adds up to a miracle. And a
miracle is a mystery.” – Bill Wilson
 Other Self-Help Groups
• Rational Recovery (RR), 1986
– Founded by Jack and Lois Trimpey
– Response to lack of choice/spirituality
– Based on REBT of Albert Ellis
– Reframes irrational beliefs
– More at www.rational.org
 Other Self-Help Groups
• Women for Sobriety (WFS)
• Founded by Jean Kirkpatrick, 1976
– Found AA meetings to be rigid, dogmatic & chauvinistic
– Believes women’s drinking is different from men’s
• Women drink because of frustration, loneliness, and emotional
depravation and harassment (Men drink for power)
• Based on the Thirteen Statements
– Encourage emotional and spiritual growth, with
abstinence as the only acceptable goal
– Daily meditation is encouraged, no emphasis on God or a
higher power
– 300 meetings held weekly
 Other Self-Help Groups
• Men for Sobriety (MFS)
• Founded by Jean Kirkpatrick, 1994
• At the request of men who wanted their
own group based on the principle of WFS
• Still very small – only 15 meetings in three
states, 2 in Canada
 Other Self-Help Groups
• SMART Recovery
– Cognitive-behavioral focus – managing beliefs and emotions that
lead to drinking/drugging
• enhancing motivation
• refusing to act on urges to use
• managing life's problems in a sensible and effective way without
substances
• developing a positive, balanced, and healthy lifestyle
– No labels of “alcoholic” or “addict”
– Less focus on spirituality
– 300 weekly meetings worldwide
– Online meetings and a message board discussion group on its
Web site (www.smartrecovery.org)
 Other Self-Help Groups
• Moderation Management (MM), 1993
– Founded by Audrey Kishline
– For individuals who wish to learn moderation (early
in the abuse cycle)
– Audrey was in AA for several years, attending
hundreds of meetings
– More at www.moderation.org
 Other Self-Help Groups
• Secular Organizations for Sobriety (SOS)
– Takes a self-empowerment approach to recovery
– Addresses sobriety as “Priority One, no matter
what!”
• Those with a Christian focus:
– Celebrate Recovery – uses the beatitudes and
blends them with the 12-steps (18,000 meetings)
– Faithful & True/LIFE – sexual integrity/addiction
 Evidence for Support Group
Effectiveness
• Research demonstrates that:
– Participation in any type of support group significantly increases the
likelihood of maintaining abstinence
– Participation in 12-Step support groups is related to abstinence from
alcohol and drug use.
– Abstinence rates increase with greater group participation.
– People who attend support groups have lower levels of alcohol- and
drug-related problems.
• Another benefit of support group participation is that
“helping helps the helper.”
– Helping others by sharing experiences and providing support increases
involvement in 12-Step groups, which in turn
• increases abstinence
• lowers binge drinking rates among those who have not achieved abstinence
 Counselors’ Responsibilities
• Become familiar with the different types of groups and their
philosophies
• Determine which groups are active locally (check meeting
locator services on-line)
• Find out about the different types of meetings available within
local groups (e.g., which meetings are for women only).
• Establish contacts in local groups. AA and NA have committees
that work with clinicians to help get clients to meetings and to
provide information to providers.
• Attend open meetings to expand knowledge of support groups
and how local meetings are conducted (you’re welcome!)
 For More Info:
• Twelve Steps and Twelve Traditions
– (AA Services, 2002)
• The Clinician’s Guide to 12-Step Programs:
How, When, and Why to Refer a Client.
– Parker and Guest (1999)
• When talking won't work: Implementing
experiential group activities with addicted
clients.
– Hagedorn and Hirshhorn (2009)
– Journal for Specialists in Group Work, 34