Should you refer a client struggling with addiction to a 12-Steps programme?
Thresholds, April 2021

On 25 October 2007, I woke with a hangover. There was nothing unusual in that. What was unusual that day was that I turned to my husband and said, ‘The data are in. I can’t do this on my own. I need help.’ I had been trying to cut down on my drinking for years. I couldn’t seem to manage it. I could easily skip a day or two, especially when I felt terrible on account of my hangover. But once the nausea and headache wore off and I’d had a good night’s rest, I’d have my usual glass of wine with dinner and the whole cycle would repeat itself. Sometimes, I would manage to go without in the working week and only drink at the weekend. Once, I managed nine days without alcohol, but my goal had been a sober month. After nine days on the wagon, I had forgotten why I didn’t want to drink, and besides, no alcohol for a month seemed excessive, so I abandoned my goal.

With hindsight, I could see that the consequences of taking a drink were predictable: unhappiness, anxiety, indignity, shame. And this even though I have a PhD in clinical psychology and have never missed a day’s work on account of drinking, have never driven while drunk, and have never been arrested. I didn’t drink every day and certainly never drank in the morning, but in my mid 30s, married with two young children, I finally came to understand that I was an alcoholic and when I drank my life was unmanageable.

A path to spiritual awakening

What happened when I stopped drinking was nothing short of miraculous. My life transformed completely. How did this happen? I encountered something called the 12 Steps and had what can reasonably be described as a spiritual awakening. The Steps – as they are referred to by people in the fellowships – were developed in the 1930s to help alcoholics stop drinking. Since the formation of the first 12-Step fellowship – Alcoholics Anonymous – in America in the 1930s, the 12 Steps have helped countless millions to turn their lives around. They offer a solution to all sorts of addictions, from gambling to sex and even behavioural patterns that most people would never consider addictions, like shopping and helping other people. While there are considerably more than 100 12-Step fellowships worldwide, there are 30 known to be operating in the UK. Many thousands of weekly meetings, now mostly on Zoom, are available to support many more thousands of people who consider themselves grateful members of these amazing fellowships.

In my case, I first worked the Steps specifically in relation to alcohol. But I came to understand that they could be used to radically overhaul my life and make changes I had wanted to make for years, but somehow never managed. What sort of changes? There are too many to mention them all, but, in no particular order, here is a sort of top 10.

Transformation

I became less dependent on my parents’ approval in a way that meant I could have an enjoyable relationship with them. My own parenting changed dramatically and my relationship with my children improved enormously. I became significantly less anxious about everything. My litany of sub-syndromal mental health conditions subsided: my mild OCD, my PTSD symptoms, my disordered eating, my paralysing shame attacks, my imposter syndrome. My anger and rage gradually evaporated. My husband and I ceased being adversaries and became allies. Opening an official-looking envelope no longer made my heart skip a beat. My life expanded and became more fulfilling, more successful, more enjoyable. I gained a deep-seated but, I hope, quiet, confidence that isn’t rooted in achievement or possessions or anything else ephemeral. The first Step involved cutting out alcohol. But as 12 Steppers are fond of saying, the next 11 steps don’t even mention alcohol (or your addiction of choice) at all.

People who are familiar with the fellowships can easily accept the peer-to-peer support aspect of membership in a 12-Step fellowship. Within drug and alcohol service provision here in the UK, 12-Step fellowships are understood to be a form of mutual aid (MA) where support is provided to people with a particular addiction by other people with the same addiction. When you join a 12-Step fellowship, you get plugged in to an amazing support system that can alleviate the loneliness that besets so many people today, and which is so detrimental to our emotional and physical wellbeing. It is also deeply encouraging to discover that you are not the only person in the world dealing with a particular problem. It doesn’t take many fellowship meetings to discover that whatever you are going through, someone else has been there before you.

The Steps as a form of CBT

I also like to point out that the Steps and fellowships are a powerful yet casual form of cognitive behavioural therapy (CBT),¹ where each member is encouraged to radically overhaul the way they think. Fellowship members learn to use a plethora of slogans and catchphrases that are designed to help address ‘stinking thinking’ and encourage a one-day-at-a-time approach to life. Step 11, considered one of the three spiritual Steps, along with Steps 3 and 7, is an inducement to incorporate prayer and meditation into your life. We have evidence that both prayer and meditation are greatly beneficial for health and mental wellbeing. So, while I regularly hear there is no evidence of or insufficient evidence to support the 12 Steps, I believe this is a disingenuous claim. We have plenty of positive evidence about the beneficial effects of the various components of the 12-Step programme, such as social connection, CBT, prayer² and meditation.³

Healing relationships

One of the greatest gifts I have received from incorporating 12-Step spirituality into my life has been my transformation as a mother. Working the Steps has allowed me to go beyond my previous limitations and break chains of dysfunction from my family of origin. As an example, my previous reaction to physical pain in my children was anger and blame, rooted in fear. Through the 12 Steps, I have been able to transform this reaction into the more helpful response of compassion. I now have an automatic approach response, rather than an unhelpful but similarly automatic, avoid reaction. This change was hard won. I remember one evening when my exuberant four- and six-yearold children were bouncing on my bed, I had to literally sit on my hands and bite my tongue to stop myself going into critical parent mode and crushing their joyful fun. In a previous phase of my growth, I would have been grateful for this critical parent, which I later came to understand as an ineffective attempt to stave off accidents. Because, if an accident occurred, I might fly into anger, which was even more unhelpful and hurtful. Both reactions, the angry and the critical, were part of the hangover from my childhood interacting with my innate temperament. My own parents had been similarly unable to deal compassionately with the minor physical accidents that are a hallmark of a normal childhood.

Lessons in self-control and accountability

The 12 Steps have also been of benefit to me in my role as a behavioural psychologist working with parents and children. The lesson that the only person you can control is yourself is helpful to anyone, not just people wrestling with addiction. I’m aware this wisdom isn’t new to therapists and counsellors, but the 12 Steps give you a unique perspective because you commit to living this knowledge and you get daily, free support to do so. As you can only pass on what you’ve truly got for yourself, I find that I’m more effective in my role as a helping professional as a result of the Steps.

The 12-Step practice of taking a daily inventory and discussing one’s shortcomings with a sponsor or trusted recovery friend is a vital part of the accountability we know is beneficial to transformation. Twelve-Step spirituality is a philosophy of radical personal responsibility, coupled with immense compassion. Some people refer to this aspect of the 12-Step programme as accountability and forgiveness. My sponsor held me accountable until I learned to hold myself accountable. As I became more compassionate towards other people by learning to use the Steps to process and let go of hurts and resentments, I became more compassionate towards myself as well.

Breaking down biases about spirituality

The 12th Step is about carrying the message of recovery to other people. In February 2020, Lord Clive Brooke, a Labour life peer, set up the All-Party Parliamentary Group (APPG) for 12-Step Recovery from Addiction, and I accepted the role of Secretary for the group. Dr Lisa Cameron (SNP MP), who worked as a clinical psychologist before entering politics, is our Co-Chair. The APPG for 12-Step Recovery is conceived of as part of how we hope to create a nationwide attitude of understanding, tolerance and openness towards 12-Step recovery and the people who pursue this route out of addiction. We are calling our initiative the National Welcome because we hope that one day people who work at the front lines of addiction and dysfunction throughout the UK – counsellors and therapists included – will come to see the power of the 12 Steps to effect change and thus be open to incorporating the Steps into their work. We are hoping to break down bias which still exists against recovery approaches that speak of spirituality.

It is interesting this bias exists when so many people are longing for greater spirituality in their lives. We see this in the popularity of spiritual practices like yoga and mindfulness, even if some people insist these are not actually spiritual practices. We can also look to the perennial popularity of spiritual books like Eat Pray Love, The Happiness Project and The Secret, in support of the idea that many people are incredibly open to spirituality. The 12 Steps use the word ‘God’, which some people have a negative reaction to. We know this is part of why some people working in the field of addiction have a negative bias against 12-Step fellowships, despite the evidence being in favour of them.

A tool in tackling lockdown isolation

Since the first lockdown last March, we have been sitting on a ticking time bomb of increased drinking and mental health problems. The sense of isolation and disconnection that people are feeling can barely be overstated. The 12 Steps create connection where there has been disconnection – from the self, from others and from the spiritual aspect of life. They help recreate this vital sense of connection by encouraging the person to reach out to other people and thus, ultimately, connect with both the self and a Higher Power of the person’s own choosing. The phrase ‘Higher Power’ is used in the 12-Step fellowships to refer to some source of support or ‘power’ that can help the person maintain sobriety. For some, this is not a recreation of connection, but rather the first time in life that such connections have been made. I am convinced that the 12-Step fellowships can and should play a vital role in our recovery from the pandemic and the lockdown response.

Making spirituality accessible

One of the best things about using the 12-Step approach to overcoming addiction is that through the fellowships the addict is introduced to 12-Step spirituality, which is completely non-didactic and presents spiritual ideas in ordinary, accessible language. Therefore, the steps and the principles they embody can fit with all kinds of spiritual and religious beliefs, as well as atheist and agnostic positions. The 12-Step practitioner is encouraged to find a God of their own understanding. Although the Steps use the word ‘God’ (of your own understanding), you will more frequently hear people in fellowship meetings speak of their Higher Power. In 12-Step recovery, you discover lots of acronyms for G-O-D, which can be used to get you started on a spiritual journey that might lead to a different conception of God, or which can serve as a long-term functioning conception of Higher Power. These acronyms include Good Orderly Direction, Group Of Drunks, Great Out Doors and Gift Of Desperation. 12-Step practitioners vary enormously in the degree to which they incorporate the spiritual principles of the programme into their lives. Some enjoy the fellowship and mutual support on offer. Others value having their lives placed on a spiritual footing and go to great lengths to incorporate spirituality – as they understand it – into their lives.

A source of support for clients

I was recently interviewed by Dr Nat Wright, a GP and addiction specialist, who has developed much of the Royal College of GPs’ training on addiction over the past 20 years.⁵ He asked me what I thought GPs could do to help people with addiction and alcohol issues. My answer was to make more use of the free and constantly available resource that is the 12-Step recovery movement in the UK. I say the same to counsellors, chaplains, nurses, ambulance drivers, paramedics and care workers. Find out more about 12-Step recovery. Read the website of a fellowship like AA, Al-Anon (the fellowship for the friends and family members of alcoholics), Gamblers Anonymous or Sex and Love Addicts Anonymous, Overeaters Anonymous or Codependents Anonymous (CoDA). Read some fellowship literature or attend a 12-Step meeting. It is probably worthwhile noting that the fellowships are not a substitute for counselling, and many 12-Steppers pursue personal counselling in addition to their fellowship meetings. In fact, a disproportionate number of 12-Steppers are counsellors themselves, often retraining after their encounter with the 12-Step movement.

The need for recovery from addiction is great. I believe we owe it to people who struggle with alcohol, gambling or other problem behaviours, to offer them the solution of 12-Steps. Whether they take it or not is up to them. It doesn’t work for all of the people, all of the time. But for those for whom it works, the transformation is profound and lasting. I consider myself lucky to be among that number.