Volume 18, Number 5
Demystifying 12-Step Programs
By Mary Greiner
If you are bewildered by the workings of 12-step programs but think that you or someone you know might benefit from one, this article is dedicated to you. If someone (or more than one person) has recommended that you check out a 12-step program, but you don't think that you have an addictive or compulsive behavior, you can find information here in case you change your mind. If you are trying to get a loved one into recovery, you can read this article in the context of how 12-step programs such as Al-Anon might be of assistance to you as well. If you are merely curious, I hope you will learn more about the largest public health issue facing our country today.
The insights in this article come from personal experience, study of both 12-step literature and scientific research, and the gracious contributions of many friends and colleagues. My deepest thanks go to those in recovery who are willing to share their experiences, strength, and hope with others. Any errors are mine alone.
Alcoholics Anonymous (AA) is the original 12-step program. AA support groups focus on recovery issues related to use of the drug called alcohol. For some people, alcohol is a physically and emotionally addictive drug. Al-Anon was the second 12-step program to be developed. It is a recovery program for the family and friends of alcoholics, and focuses on recovery from the compulsive behaviors generated by trying to cope with a loved one's alcoholism. Some call alcoholism a "family disease" because almost everyone in the family of an alcoholic develops certain ways of thinking, feeling, and acting that may originally have served to protect the family members but soon begin to interfere with each person's ability to function fully in the world.
Other 12-step programs have been developed to focus on other drugs or compulsive behaviors. There are programs for people addicted to narcotics, nicotine, and refined sugar; and programs for persons engaging in compulsive behaviors such as overeating, gambling, gaming, sex, love, emotion, shopping, Internet use, pornography, and so forth. Further, there are 12-step programs for people with dual diagnoses (for example, addiction/compulsion combined with a mental disorder such as depression).
The common denominator in all these programs is that the participants find themselves using something or someone outside themselves to change how they feel. Twelve-step programs are based on the premise that inner serenity comes when people find a way to live without addictive and compulsive behaviors. Active members of 12-step programs find that their lives get better as a result of participating in the group process, a dynamic as complex as human nature.Myths and Common Concerns
They are a bunch of losers. This myth comes in many forms, from the belief that meetings are made up of scuzzy old farts in dirty trenchcoats, to the assumption that all attendees are there because they were ordered by the court to go. Those in denial about their own problem might assume that only people who can't "hold their liquor" or are "stupid enough to get caught" attend meetings.
Another fallacy driving this myth is that addiction is a moral deficiency rather than a disease. Although the American Medical Association acknowledged that alcoholism is a disease in 1956, and former U.S. Surgeon General C. Everett Koop declared nicotine addiction to be a public health issue, there are still folks out there who consider quitting to be no more than a matter of willpower. For those who have never been addicted, it can be hard to understand that addiction is a disease needing treatment, just like diabetes. Without treatment, the disease is fatal. With treatment, the disease may not be cured, but the quality and length of life can be greatly enhanced.
As for the "losers" who attend meetings, members include state supreme court justices, former governors, senior corporate executives, financially successful entrepreneurs, managing partners of nationally known law firms, religious leaders, and renowned artists of every genre. Other members include felons who have served their time; functionally illiterate people who struggle to read the literature; and people who have lost their jobs, homes, and families as they spiraled down through their disease. There is no "typical" member of a 12-step group. Addiction is an equal opportunity disease.
What will people think of me? What if I see someone I know there? Members of 12-step programs are glad to have new members and see them not as "losers" but as people ready to do something about their problems. All people have problems; who is in a position to judge another for seeking a group process-based solution? Twelve-step groups have a tradition of anonymity. If you believe you have something to lose by being seen at the group meeting, remember that so does everyone else attending the meeting. If others are willing to face that risk, why shouldn't you?
If I go, I will be admitting that I have a problem. Meetings are often described as "open" or "closed." The open meetings are open to anyone who wishes to attend, so your presence will not be considered an acknowledgment that you have a problem. You can find out whether a meeting is open or closed by checking for the codes describing the meeting in the relevant directory, or by calling the telephone number of the appropriate group and asking for open meetings.
You have to stop using to go to the meetings. "I want to stop, but I can't," said Ben when asked why he didn't go to a 12-step meeting. "I don't want to embarrass myself by going there 'loaded,' so I'm waiting until I have a clean day to go." If you can relate to Ben's comment, just go to the meeting! You do not have to stop using before you go. You will not be the first person to start attending meetings while under the influence. The only requirement for membership is a desire to stop. Once you begin attending meetings, you may well acquire that little extra tool you need to lay "it" down, whatever your "it" may be.
It doesn't work. Actually, research indicates that 12-step programs work better than other forms of treatment most of the time. Yes, it is true that 12-step programs are not for everyone. One of the main reasons "it" does not work for someone is because "it" works only when the someone "works it."
Georgia went late and left early, when she went to meetings at all. She focused on what was wrong with the meeting and made no effort to read the literature, find a sponsor, or meet anyone in the meeting (after all, they should have introduced themselves to her!). She proved 12-step meetings didn't work for her.
Allen was on the verge of losing everything, and out of fear, he threw himself 110 percent into the process. He went to meetings daily, met people, listened to a guy he could relate to and asked him to be his sponsor, and he read the approved literature. Soon, Allen was helping out before and after the meetings with setup and cleanup, and joining a group after the meeting for coffee. Although he still had all his problems, within two weeks, he began to believe that life would get better, and it did.
The groups are a cult. To qualify as a cult, there must be a leader, usually a charismatic individual. In 12-step groups that are operating in accordance with the model, there are no leaders at all. There are only volunteers who serve the needs of the group for a set period of time. The only paid employees are at the national or international level, and those employees do not govern the individual groups.
I am happy with my religion and don't need another one. Excellent! No 12-step group holds itself out to be a religion. In fact, the literature reflects only a spirit of cooperation. The group offers the person suffering from an addiction or compulsion a form of spirituality that should be consistent with any religious program that an individual may choose to follow.
I don't want anyone telling me how to live and what to believe. The Higher Power or "God thing" can be a real turn-off for some people. This issue is so big, in fact, that the founders of AA considered it worthy of an entire chapter in the book Alcoholics Anonymous (familiarly known as the Big Book). In the chapter entitled "We Agnostics," readers are encouraged to consider whether there might be any power greater than themselves. (See "The Bekins Van" for an illustration of the lengths to which some people will go to avoid such reflection.)
I don't need a group. You may not. Although the group process just might teach you a few things about the balance of independence and interdependence, you do not have to open yourself to learning a new way of solving your problems if you do not want to. Many people with addictions or compulsive behaviors grew up in families where they learned that people are not to be trusted. You will never find trustworthy people unless you learn how to open your heart to those who earn your trust.
My drinking/using is situational, not really an addiction or compulsive behavior. If only she/he/they would act right, I wouldn't have to drink/use. You might want to try going to an open meeting. You might learn more about your own behavior if you listen with the intent of seeing how the meeting content might apply to you and not your problematic loved one. Go at least six times before you make a decision that there is nothing there for you. It takes a while for the message of recovery to come through.
The meetings will be depressing, boring, dark, unhappy, etc. Why would anyone want to go to a meeting described by such adjectives, especially when so many of us must go daily to places characterized by those qualities in the course of our professional lives? Recovery meetings are like that only in the minds of the people coming in already feeling depressed, bored, and unhappy. While a few meetings may well be like that, the vast majority are not.
When Marcie finally got up the courage to go to a meeting, she found one held in a church that was on the way home from work. The meeting was listed as a women-only meeting, and she thought she would be more comfortable in such a setting. As she drove into the parking lot of the church, she wasn't sure where to go, so she parked among a collection of other cars and walked in the nearest door. The hallway loomed in both directions, and she again felt panic. Then she heard laughter floating down the hall. She shrank as small as she could make herself, and walked into the well-lit room. There were, maybe, 20 women in there. Many of them noticed her, and said, "Welcome. Come sit here." Marcie felt instantly welcomed, and saw a look on those women's faces that she wanted-that look of joy, calm, and freedom from worry. She wondered how everyone seemed to know right away that she was a newcomer. Only later, after several months of attendance, when another newcomer walked in, did Marcie know how they recognized her as a newcomer. Marcie saw in the newcomer's face what she had felt on walking into that room-fear, shame, the edge of panic, and even some anger. Even later, Marcie was told by newcomers that they saw on her face what they wanted for themselves, and Marcie realized that, indeed, she did feel the joyousness, serenity, and sense of personal freedom that she had wanted when she first entered the doors of AA.Just for Lawyers
Most states have some kind of lawyer-related program, many of which are totally independent of the licensing authority of the state. You can find out about the one in your state by calling the ABA Commission on Lawyer Assistance Programs (CoLAP) at 312/988-5359 or online at www.abanet.org/cpr/colap. Locally, you can find help through your state bar association by asking for a contact number for the LAP or LCL (Lawyers Concerned for Lawyers). You may find a listing in your bar phone directory or an advertisement or article in your bar literature. These professional groups serve as an excellent adjunct to 12-step groups because the topic of discussion often revolves around how to practice law according to the principles and suggested behaviors of 12-step groups.
I don't like other lawyers. You may find that the lawyers in these meetings are very different from those you meet in other professional settings. Helpfulness, friendliness, and joy actually fill these rooms! You may experience a level of humility in your fellow lawyers that you have not experienced elsewhere.
I'm afraid I won't be able to try cases without drinking. There are many solutions for "stage fright" other than alcohol or drugs. It's amazingly comforting to hear one of the top trial lawyers in town talk about his special spot in the courthouse where he prays for strength before every trial!
I am supposed to entertain clients, prospective associates, etc. The only people who will notice you are not drinking are those who have a problem of their own or are worried about yours. The former will try (usually subtly) to get you back "in the fold," and the latter will be relieved. You can learn from the others in your recovery group how to handle these situations. Comments such as "Not tonight, thanks" are usually enough. You can learn some excellent ways to respond to the persistent ones at your meetings.Don't Be Afraid
I hope that the myth that keeps you away from recovery has been addressed here. The main reason people stay away is fear-fear of the unknown, fear of how participation will look to others, or fear of living fully without the addictive substance or behavior.
If you are considering attending a group but are not quite ready, remember the words of Herbert Spenser: "There is a principle which is a bar against all information, which is proof against all arguments and which cannot fail to keep a man in everlasting ignorance-that principle is contempt prior to investigation" (Alcoholics Anonymous, 3d ed., Alcoholics Anonymous World Services, Inc., 1976, p. 570).The Bekins Van-A True Story of Finding a Higher Power
Larry listened to the AA recovery story of Carla without relating to much of what she said, except on the topic of a Higher Power. Carla had a tragic story of violence, prostitution, and homelessness as a result of her drinking and drug use. Carla didn't want any hint of any kind of God in her recovery. She said, "If there is a God, how could all those horrific things have happened to me? And if there is a God, He sure as h*** hasn't helped me so far, so why should I start believing now?" Carla's sponsor, however, insisted that she find something to make her Higher Power. Carla looked out the window just as a Bekins moving van was rolling past. In a moment of rebellious temper, Carla boldly announced that the Bekins van would be her Higher Power. She was surprised when her sponsor cheerfully accepted her choice.
As Carla's story unfolded, Larry heard how a Bekins moving van seemed to go by whenever Carla was struggling with an urge to drink or drug, or when she encountered an old, abusive boyfriend on the street who tried to woo her back into a relationship, or when she was really mad at someone because of a comment she thought had been directed at her. Each time Carla saw the Bekins van, she would think some more about her options and would make choices based on her recovery rather than the self-destructive behavior she was about to take. Carla began to believe that these "coincidences" were more than that, and she began to develop a concept of a Higher Power, a spiritual presence in her life.
Larry was impressed by the story, but didn't think it would apply to his life. He joked with his friends about it, yet what happened to Carla just seemed stuck in his mind. Several months later, he went with some friends to a recovery conference high in the Rocky Mountains. He enjoyed the few days in the mountain air, the hiking, and the people he met, but he still didn't quite relate to the God stuff in people's stories. Driving toward home with his friends when the conference was over, he was taking his turn in the back seat as they headed toward one of several mountain passes. Suddenly, out of nowhere, a huge thunderstorm blew up, and they were caught in a combination of wind, lightening, hail, and rain. His friends were debating the merits of pulling onto the shoulder, next to a drop-off of several hundred feet, versus continuing to drive in near-zero visibility.
Just then, through the pouring rain, Larry saw, on the other side of the road, a Bekins moving van. He felt a sense of calm that he hadn't experienced in years, quickly followed by the excitement of a heartfelt "aha!" He knew they were going to be okay. He yelled to his friends, "Look! There's a Bekins van! We're going to make it!" His friends looked at him as if he had just arrived from another planet, but Larry didn't care. He felt safe and knew that his journey to find a Higher Power had begun right then.A Variety of 12-Step Meetings
The following descriptions will give you a general idea of the types of meetings available. Your particular locale may vary somewhat from this list. In some areas, the meeting directory will tell you the type of meeting via a code system described in the directory (for example, "O" usually stands for an open meeting).
Open/Closed. Open meetings are open to whomever wishes to attend. Closed meetings are limited to those who have the desire to stop their troublesome behavior, whether drinking, gambling, etc.
Newcomer. Meetings where foundational issues provide the focus, such as "Why do I need and how do I find a sponsor?" "Why attend meetings at all?"
Speaker. One person will tell his or her story of recovery-what it was like during the addictive phase of his or her life, what happened to interrupt the addictive pattern, and what it is like now to live in recovery.
Step speaker. A speaker uses personal examples to illustrate how the 12 steps have influenced his or her life choices. The speaker may also offer an explanation of the deeper meaning of each step.
Discussion. A chairperson starts the meeting by introducing a particular topic, and members discuss the topic. The meeting may be designed to give everyone an opportunity to share or to allow a few people to share in the time available. Everyone always has the option to pass.
Step meeting. The topic is about one or more of the steps and how it applies to the attendees' lives. The meeting may begin with a chairperson introducing a topic from a specific step or by everyone reading all or part of a step from the literature (e.g., in AA the book Twelve Steps and Twelve Traditions), then discussing how it applies to their personal situations. Some meetings are always on certain steps, e.g., 10-11-12. (Meetings that focus on the 10-11-12 steps can be more spiritual in content.)
Big Book study. "Big Book" is a pseudonym for the main literature of the recovery group. For example, in AA the book is titled Alcoholics Anonymous, not a name some folks would willingly use in public. These meetings use a portion of the literature to facilitate discussion of how the reading applies in one's own life.
Gender specific. Men and women have their own meetings, not so much to complain about the opposite sex, but because relationships and sexual matters have often been a source of tremendously painful wounds. Gender-specific environments can feel safer and allow for more personal sharing.
Other specialties. These are groups run in a language foreign to the majority (e.g., English meetings in Germany), groups formed to serve particular ethnic or cultural groups, and groups for gays and lesbians. There are also groups based on a common profession. Some groups eschew any mention of God or spiritual matters and refer to themselves as agnostic or atheist groups.
Smoking/non-smoking. Smoking meetings can be dense enough to get your fix on passive smoke alone. Non-smoking meetings often include smokers who are willing to take a break from nicotine for the benefit of that particular meeting.
Candlelight. Usually held late at night, these meetings can be more spiritual.How to Find a Meeting
Now that you have decided to go to a 12-step meeting, how do you find one? Lawyer assistance programs. Almost every state has a program, some of which are totally independent of the licensing authority of your state. You can find your local program through word of mouth, notices in bar journals, or by calling your state or local bar association. You can also make contact via the ABA Commission on Lawyer Assistance Programs at 312/988-5359 or www.abanet.org/cpr/colap.
Telephone. Look in the white pages of your telephone book under the organization's name, e.g., Alcoholics Anonymous.
Online. Many groups have their own website, such as www.aa.org, www.al-anon.org, www.gamblersanonymous.org, www.debtorsanonymous.org, www.overeatersanonymous.org, and www.codependents.org. Other websites that contain useful information, directories of meetings, and links to other websites include www.anonymousone.com and www.onlinerecovery.org.
Personal referral. You may know someone in recovery. Expect to have your inquiry received with enthusiasm and confidentiality. Even if your contact person lives on the other side of the world, you can count on receiving encouragement and support.Meeting Etiquette and Vocabulary
Nobody likes to break an unknown rule of conduct. While there are very few "musts" in 12-step meetings, the following information may help you to understand how meetings operate. Meeting times. Depending on your location and the type of meeting, the length will be approximately one to one and one-half hours. You will be accepted for any part you can attend, and you will benefit more if you are there for the entire meeting, as well as for conversation before and after the meeting.
Introductions. In some meetings, everyone introduces themselves, and in others only those actually speaking introduce themselves. First name only is part of the anonymity (even if we recognize each other). You will hear people follow their name with "and I am an [alcoholic, compulsive gambler, etc.]." Those who are not ready to say that out loud may simply use their names or say "I'm not sure," or even "... and I have a problem with [alcohol, gambling, etc.]." Recovery date. In some parts of the country, people will also give the date on which their recovery began, such as "I am [name], and I am an alcoholic, and I have been sober since [date]." Others choose to say "and I was [sober, clean, abstinent] today." Still others choose not to mention it. This is strictly personal preference.
No cross talk. Each person shares without interruption unless the chairperson stops them for talking too long or inappropriately (abusive comments, language beyond colorful). Any feedback is saved for after the meeting. If you have a lot of advice for other people, you may not be focusing on your own issues.
Conference-approved literature. The written material generally used in a meeting has been published or sanctioned by the relevant international service center. This material is referred to as "conference approved." The limitation of material used during meetings avoids controversy.
Sponsor. A person who shares his or her experience, strength, and hope with you as you learn your way around recovery. Sponsors often help provide structure and guidance during the early fog of recovery, and offer advice on how to have healthier relationships. Sponsors are not parents, hotels, bankers, or bailbonders. Sponsors cannot give you what they do not have for themselves, so if you find a sponsor who is a lot of fun, but who has not worked the steps, you will get more fun than recovery.
Thirteenth step. The so-called thirteenth step refers to newcomers being "hit on" by people who have not yet learned how to have a relationship other than the proverbial "one-night stand." Healthy groups frown on this type of fraternization, and you can find folks in the group who can assist you in avoiding unwanted advances. While this type of activity does not happen often, many people who are vulnerable in this area choose to go to same-gender groups to avoid it. The thirteenth step is also the reason same-gender sponsors are suggested, as newcomers often confuse their healthy dependency on a sponsor with "love."
Mary L. Greiner, J.D., LMSW-ACP, practices psychotherapy and spiritually based divorce mediation at the Pastoral Counseling and Education Center in Dallas, Texas. She made a career transition after almost 20 years of law practice, primarily as in-house counsel to technology corporations. She can be reached via e-mail at firstname.lastname@example.org.
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