Why do 12-Step programs work? What makes them effective? If we can figure out why AA and the 12 Steps work (what the “active ingredients” are) we might be able to improve them. In part 1 of this two-part series, I explored several factors that behaviorists suggest contribute to the success of 12 Step programs for treatment of addiction. In this article, we will look at three suggestions for improving 12 Step Groups.
Our inspiration comes from an article by Brendan Koerner that was featured in Wired magazine. Koerner cites a number of studies over the years trying to determine how effective AA is, and concludes with some suggestions for how to improve 12 Step groups. Their suggestions are interesting and instructive. Not surprisingly (given that it’s the techno-centric Wired magazine), two of the three recovery hacks involve better technology. I’ll list them, along with my added thoughts:
1. Better quality control.
The reality of 12 Step groups is that they are not professionally led. In the best situations, this can still work well, if and when groups are populated by a few “old timers” who have established significant recovery in their own lives (have sustained sobriety and are reasonably emotionally healthy). But this isn’t always the case. Sometimes 12 Step groups feel like the proverbial “lunatics running the asylum.”
The Wired article mentions the problem of cranky group leaders, often people with their own control and ego issues. Another way of saying this is: “Someone can have lots of sobriety and still be a jerk.” It’s best to look for people who have recovery (which involves doing the deep internal work of emotional and spiritual healing) and not just sobriety.
The article also mentions the phenomena of “13th Stepping,” which is when people in drug or alcohol programs use meetings to find sexual partners. For many people with drug or alcohol addictions, this behavior represents cross addiction at work: they’re just transferring their dependance from alcohol or drugs to sex.
2. Start encouraging medication that improves sobriety.
One of the exciting developments in addiction treatment is the new medications that are available to help people deal with detox, cravings, and mental disorders (such as depression and ADHD) that fuel many addictions. For readers who want to explore this topic, I encourage you to read “The Addiction Solution” by David Kipper. Written by a doctor, primarily for alcohol and drug addicts, the book makes a good case for the fact that we are entering a new era in the treatment of addiction, and that the right use of medications dramatically increase recovery rates of success.
3. Increase personalization of treatment based on neural imaging.
This relates the point 2 above. The more we know about what’s going on in the brain that gives rise to addictive cravings, the more we’re able to deal with that, and then the easier recovery is. Just one simple – and extremely common – example: let’s say someone is really depressed, and one of the ways they cope with depression is through their addiction. So to have that person go to a 12 step group, and get the relational support, and do the internal work of recovery will all help. But if you can add to that medication to deal with the depression, you will find that everything else in recovery gets so much easier, because the cravings will be so much less.
My mentor and friend Mark Laaser is a big proponent of using brain scans by Dr. Daniel Amen. If someone is not sure about taking medication to deal with neurochemical issues, having a brain scan will often be extremely helpful, because it allows you to see what’s going on. It makes psychological work much less subjective.