My visit to the land of 12 steps

I see a lot of comments rolling in on my recent post. That really makes my day. Or night, in this case: it’s currently just after 4 AM. Can’t sleep.

I had an amazing two days in England just now, visiting people who work in one way or another with addiction. My first evening there, spent in Oxford, was with two Australian philosophers who’ve received a large grant to study the identity issues of addicts. Lovely people, but I did not learn much from them. In all fairness, they have just begun to analyze the first wave of data in a multi-year study. Still, I recall JLK’s contention that a high level of abstraction sometimes seems to miss the boat when it comes to addiction.

So let’s get down and dirty.

The following evening I met Peter, who has recently posted comments on this blog. I won’t tell his story – it’s his to tell – but after a three-hour train ride to the north of England, I’m received by a large, smiling man, who lives in a small house that seems to be tilting on its foundations, together with a very large dog and a quiet friendly woman, his partner.

But we didn’t go to his home first. On the long drive through rush-hour traffic I told Peter I’d never been to a 12-step meeting. Hint hint. Would you like to got to one tonight, he asked? Indeed I would. He said we’d be a few minutes late but it didn’t matter. We were on our way to a meeting of one of about 30 NA (Narcotics Anonymous) groups in the region.

We walked in the door of a modern, nondescript building, and approached a group of about 30 or 40 people sitting in chairs in a large ragged circle. Many looked up at Peter as we approached, nodding or smiling. He seemed the granddaddy of the group. He’d been clean and sober for over ten years, a state many of the others could barely imagine. I felt their love and their respect for him. And they looked over at me, some with flickering smiles: who is this diminutive, academic looking fellow, never before seen in these parts? What’s his story? I heard them thinking.

So we sat down at the outskirts of the group and just listened. Through very strong accents from the north of England, their stories found their way into my brain and my heart. These people, mostly men, looked like they’d been through the ringer. Their faces were hard, their endurance carved in the creases around their eyes and the grim holding pattern of mouth and jaw. But there was a softness here too. They listened to each other’s miseries with real caring, with a kind of empathy that doesn’t run out, because if there’d been any limit to it, it would have run out ages ago. Later, I asked Peter what was the approximate range of clean time for the people there that night. He said: mostly under a year or so, some a few months, some a few weeks, some just a few days. I could recognize the last group from their constant sniffling and jerky movements. Everyone there was a heroin addict.

With all my negative presentiments about the 12-step program, I found myself shifting like a boat with no keel. There was something intrinsically good here. And I knew what it was: that old thing variously called friendship, warmth, brotherhood, support, caring. These people cared for each other, and given the degree of their helplessness, what better treatment could you want? That’s why they kept coming back. Their stories were sad, of course they were, full of bitter irony and gut-wrenching failure, self-rebuke, hopelessness tinged with a bit of hope. But there was always a smile there too. Maybe not until the last sentence, at which point the person might look up, his face finally relaxing into a crooked grin, as if to say, I know you know that I probably won’t make it, at least not for good, at least not this time, but you know, I might…

On the way back to Peter’s crooked house, I asked him how many of the people sitting there tonight would stay clean…for a good long time, maybe barring the occasional relapse. He thought for a moment and then said: maybe 30%.

He also explained what some people mean by being a “true addict” – a phrase we’ve recently argued about on this blog. From the perspective of NA or AA, being a true addict means that you could not, simply could not, after trying everything under the sun and the moon, time after time, year after year, could not stop. So these groups were really the only thing left. And sometimes they worked. But even if they didn’t, they probably made life bearable. Peter felt that the “true addict” polemic did more harm than good, magnifying differences rather than commonalities. But at least now I knew what it meant. And I was damn glad I didn’t fit that bill.

I asked Peter a lot of questions that night, and I’ll just mention one more. I asked: why the dogma? Why do some 12-steppers insist that this is the only way…when we all know it’s not the only way? He thought about that one for a while. Then he said something like this: When you’ve been trying that long and failing that long and then, finally, something works, you don’t look around and compute the statistics. You tell everyone who will listen: This is what works. This is the only thing that works. The unspoken part remains “for me.”

 

 

 

 

 

51 thoughts on “My visit to the land of 12 steps

  1. Carolyn Kay October 9, 2012 at 5:32 am #

    I’m so glad you finally had that experience, Marc.

    I’ve been to a lot of AA meetings, some that were like the one you went to and some I didn’t like. Fortunately, there are so many meetings available that no one has to keep going to the ones they don’t like.

    As to why some people are dogmatic, I think it may be the same reason that some religious people are dogmatic. Needing to be a “true believer” (http://bit.ly/Qa4JKm) may be built in for some people.

    Addicts tend to be secretive loners, and I’m pretty sure it’s the human connection, a basic need for all of us, that keeps people coming back to meetings.

    • Marc October 13, 2012 at 9:28 am #

      The human connection in the room was palpable, Carolyn. It made me smile to see all these hardened junkies hug each other at the end. A lot of them even came up and hugged me! (a stranger)

      Dogmatism can be something you acquire as a personality trait, absolutely. Did I say “absolutely”? But I think groups can also grow their own. Peter felt that groups of newbies tended to be the most dogmatic.

  2. Jo October 9, 2012 at 5:58 am #

    Those unspoken words are so very important. As someone who was a member of NA for over 8 years with most of that time not using ( cant stand the term ‘clean’), Some other words not often heard by the non-attenders are things like; “if you stop coming you’ll die” and ” everyone who leaves comes back worse than before”. I only mention this because while the rooms of 12 step fellowships can indeed be very loving and supportive and appear to be a “brotherhood” or “sisterhood” of sorts, it’s still important to maintain or find an independent life away from the fellowship. In case anyone is wondering, yes, I am not using apart from a very very occasional drink and haven’t for years now. Life on life’s terms is indeed possible outside of those fellowships, wonderful as they can be.

    • Marc October 13, 2012 at 9:34 am #

      Very good to hear about the truce or rapprochement you’ve made with NA. Another thing Peter said is that people who are fragile themselves hate it most when others leave the fold or start using, occasionally or not. It makes them feel that this foundation they;ve based their lives on is completely wobbly or else contrived.

      I hate the term “clean” too, though it does have it’s uses.

      Congratulations on finding your way and feeling that it’s natural and it fits who you are.

  3. Elizabeth October 9, 2012 at 9:02 am #

    Perhaps this is a bit tangential, but I am reminded of research similar to this:

    http://pss.sagepub.com/content/17/12/1032.short

    Here, the researcher shows that holding the hand of a supportive partner can attenuate threat responses. SIMPLY HOLDING A HAND! I went to one of his talks and he mentioned finding the same effect when someone was in the mere presence of a supportive individual. I am always struck by how dependent we are, for the most part, on having social bonds. I agree that there is some sort of basic need of community that these groups provide that can sometimes be lost while one struggles for addiction. I found myself drawn to groups for that very reason. I actually left because I was afraid of becoming to dependent on having that sort of interaction and I wanted to begin to live life as someone who didn’t have their “addiction” as a defining aspect. I didn’t want to give it that salience. If anything, I want my identity to encompass someone who has struggled (or continues to struggle) and is overcoming her disorder. It is also true that I left so I could one day come back as a volunteer :).

    But yes, I do believe that perhaps the most important aspect of these groups is to provide a sense of belonging and support. Perhaps that support attenuates stress responses that can contribute to chronic relapsing, thus providing additional strength to combat the addiction.

    • Marc October 13, 2012 at 9:41 am #

      Hi Elizabeth. I know of these studies, and yes they show vividly how bondable we are. We are built to interact with family and troupe or tribe. A primate who is alone in nature is a dead primate. So…I love these studies too.

      Sometimes when I meditate enough (which isn’t often) I feel a warm loving look or voice coming from inside. I think there are shadings of this sense of connection that can be with us in our day-to-day lives. It may really come from somewhere magical or it may be the substance of layer upon layer of our memories of loving others. Either way, it seems to permit us to feel whole when we’re alone.

  4. Chinagrrrl October 9, 2012 at 9:52 am #

    You had never been to a 12-step meeting Marc. I didn’t know that. I got clean in the rooms of Narcotics Anonymous and learned the foundations of how to stop making the same bad choices over and over. I also learned how to develop healthy boundaries because truthfully, as much as I love 12-step recovery, there *are* a lot of sick people in those rooms and some of them would love to exploit me (or whoever they can) just to get some sick sense of “power” in their powerless state.

    All of those things are good for long-term recovery. I just celebrated my ninth year and it was with my sponsor and my sponsees in the 12-step rooms. I don’t go to nearly enough meetings, but I do what I can and I’m glad that when I need them, the rooms are there.

    • Marc October 13, 2012 at 5:43 pm #

      Hi Chinagrrrl, Yes, this was my first. And my eyes have been opened. It’s amazing to me that I now see the positives much more clearly, but that doesn’t take away from the ambiguity of the thing. Your description also speaks to how much power there is in these groups — power that can be used to heal or to hurt.

      It sounds like you ended up not only intact but also wanting to stay connected and help others. That speaks well for NA. The idea of being with your sponsor and your sponsees is heart-warming. It sounds like a family gathering.

      Best,
      Marc

  5. Jeff Skinner October 9, 2012 at 2:26 pm #

    My exposure to 12 step programs is through Al-Anon, a support organization for family and intimates of Alcoholics. It is run along the same lines as AA;, same slogans, same orthodoxy about abstinence being the only way to recovery.

    I found the meetings very helpful in helping me understand the alcoholic in my life. The fellowship was also very important in the early stages of recognizing and dealing with the addict’s behavior. I didn’t have a clue how the person I loved most could go from loving companion to appalling asshole behind a bottle of wine.

    I still don’t understand, but I have developed a whole range of strategies for coping with and not provoking the behavior I hate.

    I have long since stopped going to Al Anon, for the same reason I wouldn’t hang around with Mormons: I am not a candidate for conversion to their way of life and they never stop trying to convert you. Ultimately it’s an organization for true believers, not thinkers.

    An interesting recent book describing an alternative to the absolutist disease model is ‘Almost Alcoholic’ by Robert Doyle MD, Harvard Health Publication.

    Has anyone seen it?

    • Marc October 14, 2012 at 2:54 am #

      I haven’t, Jeff, but I’ll look for it. It may be that the 12-step programs are for believers rather than thinkers, but I don’t necessarily think people come prepackaged that way. There is a certain desperation that comes with severe addiction, that can undercut any faith in logic and reason and have nothing else to rely on but belief. It’s also possible that personality characteristics that predispose toward addiction also predispose toward a compulsive style, thus also good grounding for being a true believer. But I’m not very convinced about that. My compulsivity was constrained to being clean and good and perfect–but those were hardly the characteristics of my addiction, and I’ve never been a “true believer”.

      I’m glad you learned how to deal. As to understanding it, we’re working on it. Bear with us…I think we’re getting close.

  6. peter sheath October 9, 2012 at 4:01 pm #

    Hi Marc
    What a great desription! I’ve been doing lots of reflection since meeting you. Some of this has been writing stuff down, some has been meditating and thinking, but it’s led to some very thought provoking conversations.
    I’m becoming increasingly intrigued by the similarities of addiction and, to some extent, the very different paths we take in recovery. I’ll put something together about it on here shortly

    • Marc October 14, 2012 at 3:00 am #

      Hi Peter. Well it seems I’ve done lots of reflection since meeting you too! And it’s amazing and wonderful that the people on this blog are reflecting together. In a year of blogging about this stuff, this is the first time there’s been a first-person, intimate, friendly sharing of ideas about the 12-step program. And what seemed like two opposing camps now sounds like a lot of gradations, a lot of gray areas, between fully accepting and thoroughly rejecting the 12-step treatment approach.

      I’ll look forward to whatever you have to say, and if it’s more than a paragraph or so, please send it to me by email so I can put it up as a post.

  7. Donna Gore October 9, 2012 at 6:11 pm #

    Any person suffering from any disease or disorder can benefit from a support group. Especially addicts, because the compulsion/obsession can be so strong. It’s like tug-of-war. You need some folks on your team to help you resist the pull of addiction.

    I met many wonderful friends in AA that helped me a lot. One thing they got right was the “One day at a time” thing. The idea that I can never ever have another drink for the rest of my life……..well it was just too overwhelming. So they told me, “You can get drunk as shit tomorrow. Just not today.” There were times I even had to break that down into hours. It’s 5, I can have a drink at 6. And so on.

    As for the effectiveness – there is no way to scientifically measure it, no way to gather accurate statistics. To do that, you’d have to get the name and phone number of everyone who walked through the door – which you can’t do because it’s ANONYMOUS. And then monitor them 24-7 for the next couple of years, which you can’t do because it would be expensive , intrusive, and impractical.

    The problem with addiction studies is the reliance on self reporting. Nobody has any way of knowing FOR A FACT that another person did or did not drink, unless they are with that person every minute of every day, using a spy-cam, or whatnot.

    Therein lies one of my beefs with the “recovery industry.” They are forcing on everyone a treatment which has no scientific evidence whatsoever, and insisting that their unproven way (which is basically “faith healing”) is “the only way.” When I go to the hospital, I want my doctor to use the latest treatments and drugs which have demonstrated efficacy THROUGH CLINICAL TRIALS. If he tells me to go home and pray………..I’m going to find another doctor.

    If you have a real “disease” (and there’s a whole other argument there) — then you should be getting medical treatment first and foremost, and the group support should supplement that. Support groups are a huge help, but they are not a substitute for medical treatment.

    I tell people who come to my group that we do not have any program or rules. We just share whatever worked for us as individuals. I tell them, “You should use AA, SOS, Rational Recovery, SMART recovery, church, professional counselling, a medical doctor – any combination thereof. You should use whatever tools are available to you –the more the merrier. There is no ONE RIGHT way.” (Any group that tells you they have the one simple answer to all of life’s problems is a cult, and you should run for your life!)

    AA groups are different. I’ve been to one where the leader had a bible on one knee and a big book on the other. They can be very fundie. But there are other groups that are more progressive and open-minded. When people come to me griping about the evangelism in AA, I tell them to try different groups, and get to know different individuals within those groups. If you take the time to get to know them, you will find other like-minded individuals who are not holy rollers.

    I knew an atheist man who went to AA just as a safe place to hang out, because he was a loner and he drank at home. AA offered him a place to keep his nose out of trouble. He sat in the back, and listened but never raised his hand. He never got a sponsor, never worked any steps. But he went to meetings, 2 or 3 times a week, and this worked for him, for 7 years.

    You just have to find your comfort zone.

      • Donna Gore October 10, 2012 at 7:36 pm #

        Exactly. This is a perfect example of biased sampling. It is not a random survey of all alcoholics, only those who consider themselves AA members. So it doesn’t count the drop-outs. It could be a measure of varying degrees of success WITHIN AA, but it does not reflect the success of AA as compared with other treatments (or no treatment at all) in the general population. I’m sure the GSO has its own uses for the survey, but from a scientific viewpoint, it’s pretty worthless.

        I remember reading an article a few years ago by a therapist who tracked patients who had various types of follow-up treatments when they were released from the hospital. Some had AA only, some had Cognitive Behavioral therapy only, some had psychotherapy only (and I forget what else). He followed up with them and assessed that those with cognitive behavioral therapy had the best results. Although here again, you have the problem of self-reporting. (I don’t see how that problem can ever be overcome.) But that’s still more objective than assessing success rates within only one of the subgroups.

      • Marc October 16, 2012 at 12:51 am #

        Interesting stats here, Donnie…. but may be hard to interpret without knowing how these variables are measured.

    • Marc October 14, 2012 at 6:17 pm #

      You make many excellent points, Donna. Let me reply to two of them:

      The measurement issue — yes, that’s a tough one, and self-report is notoriously unreliable. But this is where the formulas of medicine and those of psychology are almost irreconcilable. Because psychological problems or issues are usually considered, most basically, as experiential problems, self-report is one of the only ways to get at them. Sometimes it is the only way. A century ago, “introspectionism” was considered the most progressive method for collecting psychological data. Now we know how unreliable self-report really is, and so we distrust it, and rightfully so. But the only alternatives, as you point out, have their own accompanying problems. So we need to be clever and to accept compromise in gathering the most reliable measures of “recovery” possible.

      Another way in which psychology is at odds with medicine is in the notion of “cure” for disorders. You say that any disease (and yes, we know the problems with that label) needs to be treated first, according to current scientific knowledge, and then in comes the support group, as a secondary form of help. I get your point, and I’m no fan of “faith healing”! But this medical perspective might not make any sense with psychological problems. After the recent published evidence for the ineffectiveness of SSRIs for many types of depression, and so much else we now suspect about mood disorders, anxiety, trauma, PTSD, etc, it may be that social intervention is the best form of PRIMARY treatment. Most psychotherapy is based on the primacy of a social bond, and there is good evidence that the quality of the therapist-client “alliance” is the best predictor of outcomes. So why shouldn’t that be the case for “group treatment” — of which AA is a prime example? Not to mention the value of psychological interventions for bodily ailments (like hypertension, ulcers, etc, to name the most obvious) — and the fact that holding the hand of a supportive individual reduces the neural activation underlying reactions to pain, trauma, etc. (see Elizabeth’s comment above).

      Well, enough said. Thanks for a great synopsis of many important considerations — and lots of food for thought.

      • Donna Gore October 15, 2012 at 8:59 am #

        I guess it depends on how you define addiction. Some say it’s a real disease in the physiological sense, others think it is more of a psychological disorder. Also I think it depends on the individual and what stage they’re in. I always found it ironic that we spend thousands of dollars on rehab hospitals – where they tell you to go to AA which is free. But then I realized that “detox” is a state that needs medical supervision. You have to go through withdrawals first. Then after the fog lifts the therapy can begin in earnest. Although some detox on their own. I’ve done it both ways and it was easier in the hospital environment.

        • Marc October 18, 2012 at 2:43 am #

          But when you consider that brain changes ALWAYS go on in parallel with learning/development, it becomes hard to draw the line. In other words, from a brain perspective it’s always physiological AND psychological at the same time.

          So the only issue left over is whether we call it a “disease” or not, and again, I find it impossible to draw the line. Physiological changes just keep going on, and in the case of addiction certain learning patterns “harden” or stabilize — the flow of activation through the synapses becomes entirely self-perpetuating.

          See the last comment, by Jean S, two posts ago, in the “hourglass” post. And see Persephone’s arguments (comments on last post) about addiction/recovery as a developmental process.

  8. Jaliya October 10, 2012 at 12:37 am #

    Marc! This post is a gem 🙂 Your experience makes me think that we all approach our common humanity by our own singular path … and the point is to keep moving. Be curious. Dare. ~ I cracked up about the “high level of abstraction” –> One of my teachers, recognizing this in me, said, “You’re too much a head case. You have to be more of a…heart case!” (Imagine a 60-ish man who looks like Santa Claus, saying this in a robust Austrian accent.)

    “…let’s get down and dirty.” –> reminds me of a ‘big dream’ (per: Jung) I had about 22 years ago; I was being hounded by evil men in long, black cars. I saved my own life by jumping out a farmhouse window into a huge compost pile, and — ! — my relative who is a true addict directed the evil men away from my sanctuary of shit. I think it was Stephen Levine who wrote (paraphrasing), “You’ve got to go into your shit to bring up a flower.” LOL!

    Sounds like this first experience of a 12-step gathering softened something in you. It definitely is a life-saver for people who work it step by step by step … and allow the principles to work through them over time.

    However we heal ourselves (come to know our own wholeness, no matter what we’ve done), we do it by building that keel you write of … and letting it steady our life.

    You’ve made so clear the experience of the true addict: s/he CAN NOT STOP. Makes me feel sure that addiction to this degree is a brain injury in itself — a corrosive process that becomes a disease. Perhaps there are ‘degrees of addiction’ … and at some point, the process and the damage become irreversable (?) …

    You write that the 12-step groups can make life bearable … You write of friendship, the affiliation found in our commonalities, the telling of stories … of empathy. The open, listening ear; the nodding head, the nodding soul.

    That something works “for me” … YES. The trick is to find that something …

    To hear another person tell you with surety that “This works for me” is living proof that something *can* work … My dearest mentors gave such an example to me, and I draw on it daily.

    Wow, what a post … thanks. ((( hug! )))

    • Marc October 16, 2012 at 1:05 am #

      Hey, thanks for the nice words and thanks for the hug! The experience did soften something in me. I can’t quite separate the experience of meeting Peter from that of being at the group. But that’s as it should be. Peter is a part of that world, though he’ lives in many other worlds beside.

      I’d like to put together my sense of what was happening in that room with the research that Elizabeth pointed to — see her comment about 10 or 15 up — and here is the article she linked to: http://pss.sagepub.com/content/17/12/1032.short. There’s something that group provided that really actually does replace — in terms of functional neuroanatomy — what these people were missing without their heroin. This also relates to the discussion I had with Donna, above, in which I argued that social support can be a primary, not secondary, treatment for addiction. I’ll post more on this soon.

      Your last comment captures another aspect: the importance of the BELIEF that something can work, because it has worked for someone else. Not something to sneeze at when you think you’ve tried everything.

      • Jaliya October 18, 2012 at 11:39 pm #

        The best book — the most thorough and convincing — about the neurobiology of relation / attachment / love is *A General Theory of Love*, by Thomas Lewis, MD, et al. —

        And yes … belief is so important … as long as it doesn’t become “true belief” — i.e., one belief strikes out other possibilities. I like to apply belief to the ‘small things’ — i.e., “I believe that I can do this one particular thing” — rather than to the huge questions …

  9. JLK October 10, 2012 at 9:59 am #

    HI Marc

    Thanks for the mention and no longer “condemnation before investigation” deals from me. You now have a rough idea of what we in the program are all about.
    A few minor quibbles then a Mea Culpa on my part.

    First AA was founded in the 1930’s by Bill Wilson and Bob Smith and tailored from an amalgamation of other programs adding their own experiences along the way (like the Oxford Club which is where the “God thing” comes in) for ALCOHOLICS.

    Later on other addicts joined and copied the program. Overeaters Anon has been around since 1960! Therefore I do not believe it is quite as effective for other types of addiction. And as you know as well as anybody there
    are differences between say alcohol and crack cocaine in the speed and level of addiction.

    That said: we believe in a 20% success rate and by that we mean a lifetime of sobriety. I noticed the small amount of time in the group you visited. I have the roughly the same as your host and my meetings will invariably have guys with 30 or more years along with newbies of course like 2 years or less. To me this would show the level of success of ours versus the one you visited….but that is only one example.

    My (one and only) sponsor has 41 years. But here comes the Mea Culpa. After trying to explain the reasoning behind the “grenade” I threw that started all this, he sided with MARC!! So did my wife but never having been there I will give her a 1/2 vote. So I was outvoted in favor of Marc. My sponsor does not know nearly as much as me about various subjects because of the lack of global travel and dyslexia. BUT he knows more about alcoholism than I will ever know.

    I am basing my Mea Culpa on the fact that I had a similar early experience with what Marc describes in is book and was basing my comments solely on that. Giving up all the drugs was relatively easy so I came to believe that after experiencing “true” addiction in my late forties that I was not addicted back then. So was guilty of another AA no-no aphorism “condemnation before investigation”.

    Thanks for the follow thru and the usual beautiful descriptive writing about your experience.
    JLK

    • Donnie Mac October 13, 2012 at 12:50 pm #

      Your infuriating JLK , the only thing weaker than your step 10 work here is your sloppy and lazy historical references . The quote your trying to relate ( yip in the Big Book ) goes:
      “There is a principle which is a bar against all information, which is proof against all argument, and which cannot fail to keep a man in everlasting ignorance. This principle is, contempt prior to examination.”
      This is not a Herbert Spencer quote as stated in the book it is wrongly attributed to him. Secondly N/A history is only 10 or so years younger than AA . The steps were freely given to 12 step organizations STARTING with N.A., Bill W writes freely about A.A’s “Primary of purpose” in tradition 5 . But a guy like you with a high I.Q knows that . If you would like to walk into any of the 100 organizations that use the 12 steps and say they are “less than” , good luck.
      Here are a couple folks who are dyslexic :
      Albert Einstein , Alexander Graham Bell , Thomas Edison , Walt Disney , Richard Branson , Jay Leno and me .
      I did look for your name but only found it on the ” Arrogant Churls top 3 list ” .
      So next time your talking to your one and only sponsor ask him this ” There is a man on the internet that will not step into a 12 step meeting anyplace on the planet BECAUSE I MIGHT BE THERE ” There are thousands of JKL in the rooms of A.A , you and folks just like you are the reason I don’t go to meeting . If I was your wife I would take the 1/2 a vote remaining and “Clobber You ” .

    • Marc October 16, 2012 at 1:16 am #

      Thanks, JLK. The Mea Culpa is much appreciated. Indeed, getting off drugs was NOT easy for me, though for you it sounds like it was a stage in the path toward much more serious problems. So I can see how one might classify these different kinds of addictions too hastily, based on one’s own history.

      As for success rates, and comparisons across different 12-step programs, I think that’s a really tricky issue. First of all, the criteria by which you guys judge recovery is extremely strict: not one single relapse for the rest of one’s life?! As I’m sure you know, in some circles, relapse is considered a step toward recovery — but maybe that’s putting too kind a face on it. Anyway, there are so many factors to consider. To take an example, it may simply be harder to get off heroin in the dark and gloomy nights of Liverpool than it is to get off booze in sunny L.A. I say this lightly, not to cause a ruckus, but I do think that comparing success rates is a non-starter.

      Au contraire, the wonderful thing about the 12-step approach is that it HAS spread across different addictions. It must work for at least some people with very diverse addictions, and that is to its credit. As for the negatives, well, this is be-nice-to-12-step week here on the blog, so let’s leave it at that.

      • Marc October 16, 2012 at 2:01 am #

        But I can see that it’s still not be-nice-to-JLK week, at least not for Donnie Mac. Maybe that will come next week. Meanwhile, I see that you go the next round, below, so I’ll just wait for the bell and see what happens next.

  10. nik October 10, 2012 at 11:41 am #

    Hi Marc,

    You did, in my opinion, hit upon a central issue–and strength–of many 12-step programs.

    “friendship, warmth, brotherhood, support, caring..”

    I have only a hundred or so “S” meetings in my direct experience and ‘hearing’ from those who’ve attended AA, CA, OA and others.

    To your insights of a fine post, I’d just add a couple points.

    1) Those ingredients seem central in *medical* interventions, hence a ‘placebo’ effect. Esp. they are central in psychotherapeutic and “talky” or possibly including CBT efforts. One obvious implication (hypothesis) may be the following: The content may *not* matter so much, be it AA 12-steps (e.g. ‘making amends’), or, in taking a particular drug for mild moderate depression or anxiety, such as Prozac (as opposed say to herbal, vitamin or homeopathic concoction),. As an investigator of brain science, the common pathways of ‘cures’ or ‘recoveries’ may be of interest *above and beyond ‘specific effects’ [e.g. raising serotonin levels].” This is not a critique or put down or dismissal of ‘specific methods’ in any of the above areas.

    2) You didn’t really mention a crucial feature: the people are a stigmatized ‘out group.’ And from the self labeling (intended as honest), comes, as in a jiu jitsu move, strength. Bill W said he was a ‘drunk’; newer groups say ‘food addict,’ ‘cocaine addict,’ or ‘porn addict’. These are not admissions that get one accepted in the larger society. Indeed, in our time, unlike the 1930s, ‘alcoholic’ [at least in recover] may be one of the lesser stigmatizing labels. An ‘out group’ getting together and finding strength is a widely applicable social dynamic, such as the Black Power groups in the US, “queer’ groups and others. There is a great relief in being able, within a group, to be open. This is partly, then, a *difference* say, with a support group for, say, prostate cancer survivors. I mean an *additional* factor besides ‘brotherhood/sisterhood’.

    Just a couple thoughts. Keep up the good work and provocation of discussion.

    • Marc October 18, 2012 at 3:33 am #

      These are great points, Nik. You seem to worry that I’ll take your points as too critical — I hope I’m not putting across the impression that you have to watch your step in your comments. Even if these points were challenging and critical, it would be fine with me, exciting and enlivening.

      As to your first point, I think it’s brilliant to compare the effect of AA to a placebo effect. Some people would imagine that this is a put-down of AA, but you see it conversely: you are showing a solid admiration for the placebo effect. The placebo effect is real, I agree, and in a sense it is the foundation of “talk therapy”.

      There was a recent piece in American Psychologist, arguing that any and all impact of CBT on clients is mediated by the quality of the relationship between therapist and client–as in “come on, guys, even Freud knew that!” And, as I mentioned, the “therapeutic alliance” is considered that best predictor of outcomes in current clinical research.

      So what you’re saying is that the placebo effect is not a result of “nothing” — it’s a result of a connection between people, even a small connection, perhaps providing not only a bit of care but also a bit of hope. So it is with AA, but here the effect is at centre stage: no one is shying away from the thought that ALL YOU NEED IS LOVE (Lennon-McCartney, c. 1967).

      And as to your second point, yes, misery loves company, and being part of an outgroup must magnify the power of mutual regard/acceptance, perhaps in ways we don’t understand.

  11. Christina October 11, 2012 at 4:43 am #

    I have met many ‘ex-12 Steppers’ who are doing ‘their own thing’ for a variety of reasons….. Some do not like the ‘One Size Fits All’, in-your-face GOD-Christian prayer that slams you quickly after the soft & gentle invitation of a ‘god-of-your-understanding’ expires.
    Many Ex-12 Steppers who are still Very Sober in whatever vice they are battling, do not like the ‘Sit Down and Shut-up’ approach that is often dumped on anyone with less time.
    (This might be suitable for someone who has had significant cognitive brain damage due to excessively massive drug and/or alcohol abuse – but is less effective for those who have held on to good reasoning, cognitive awareness, contemplative thought process and analytical reasoning).
    But I will say that I would encourage anyone who is looking for support and help to head to the nearest 12 Step meeting – because when you are desperately searching for someone or something to hang on to… They will be there to help!

    • nik October 11, 2012 at 11:14 am #

      Nice post, Christina,

      There is a definite ‘sit down and shut up’ phenomenon, including reading from, or listening to endless portions of scripts, not just sections of ‘big books’, but word-for-word (read-out) greetings, invocations, admonitions, etc.

      I suppose the rationale is that cognitive awareness, reason, etc. did not solve the problem (and may have helped create or maintain it). Hence, ‘faith,’ surrender to Higher Power, or some such is appropriate. Plus some practical steps of implementation and/or avoidance. As some above posts indicated, some persons come with a sense of ‘last resort,’ desperation, thoughts of suicide, etc.

      To be fair, I’m sure such methods are used for induction into several other institutions, which are quite respected, e.g. monasteries, nunneries, not to say the armed forces, and so on. And perhaps correctly so: a process designed for a certain outcome (devotion, loyalty, performance under fire), does not–and probably should not–rely on producing better reasoning and critical processes. These are not graduate. programs in philosophy or history.

      That said, I’m with you–there’s an affront to cognition! (And that, after all, is the intent, isn’t it?)

  12. Christina October 12, 2012 at 4:04 am #

    Dear Nik,
    Thank you for your reply. Sometime I might share my experience at a Zen / Neuro-Attachment week long seminar at a Zen Monastery in Santa Fe, NM a few years ago – it is still in my top five ‘experientially’ funny and challenging trips to date!
    Christina

    • Marc October 18, 2012 at 4:08 am #

      I wish you would, Christina. I’m struck by your perspective on the domineering aspects of 12-step programs, so articulately expressed, and then your saying that you would direct anyone really desperate to the next meeting. This paradox continues to emerge among readers on this blog, so I have to believe it’s not only real but also a central feature of the 12-step process.

      In a very loose and metaphoric way, this paradox matches the paradox of the placebo effect, which Nik referred to in a recent comment. A placebo is meant to do nothing, it is a sort of trick, and yet it seems like it does a lot — and maybe what it does is simply to provide the human connection, devoid of anything substantial, devoid of any content. Like reaching out your hand but having nothing in it.

      To extend the metaphor, imagine someone who is cognitively functional and rational being told that they’re in the placebo group. They’d be outraged. But if your brain had turned halfway to mush, you might just say….I could use some of that.

  13. Barbra j. October 13, 2012 at 10:13 am #

    I spent many years in 12 step programs and finally stopped using drugs after leaving these groups. Why? I have no idea. i had a terrible addiction to prescription opiates which very nearly killed me, and I tried everything in pursuit of some solution . I have never been somepne who was comfortable in groups, whether it be AA or church or the girl scouts, and although I know that support groups help many people and can teach us some invaluable lessons about addiction and about just simply living life, I am now drug free and have been for four years, through a combination of living a fairly structured life, living simply, and keeping it simple, which is one valuable thing i learned in AA. I am now 60, and i feel that as i have aged, I have felt the desire for drugs to diminish, and I wonder if the aging process itself is some kind of treatment for addiction, or if I just work hard and at the end of the day, at my age, I’m too tired to get into trouble.

    • Marc October 18, 2012 at 4:22 am #

      Barbra, your comment laces together a whole lot of key threads that have emerged on the blog, especially from comments on my last post (Diversity and its discontents) by JS, Fred, Ron, and Persephone in particular. There’s that paradoxical thing again, and the theme of growing more after leaving the group, yet honouring what you learned in the group, and also the notion of developmental changes that may be at the heart of “real” recovery, including an age-related change in the character of craving. Thank you for that.

  14. JLK October 13, 2012 at 4:03 pm #

    To Donnie Mac

    Since Marc prefers “polite” replies and I will try to be much more polite than yours. But the best I can do is that I find yours one of those most nit picky arrogant replies ever and I will stay with that. Congratulations on your navel gazing!

    Saying who said what in such an offensive manner shows that you know very little about the “real” 12 step program. What I stated was a Mea Culpa to Marc not you. If I paraphrase (using the meeting language) it still comes out the same.

    All you are showing is a personal dislike for me. I don’t really care what you think but is this the right forum for that kind of obviously motivated personal attack?

    The other comments were fine ….to each his own. I found success within the rooms of AA period. I also found others who did not do the hard work of personality and personal change to be the same as ever…jerks. I am not going to make the obvious comparison but you do sound a bit like them.

    JLK

    • Marc October 16, 2012 at 2:06 am #

      Back to your corners, gentlemen. I’d rather be a referee than a judge, but I have to commend you on your restraint, JLK.

      Clearly you are infuriating to each other. Is there actually an ideological issue being argued here, or is this just a matter of two outspoken speakers grating on each other?

  15. Kathleen October 13, 2012 at 5:11 pm #

    Marc,
    I didn’t know you had never actually been to a 12 step meeting! I thought you poo-pood AA/NA because it didn’t work for you. Although I don’t remember you mentioning going to meetings in your book… you hit it right on the nose when you figured out what the attraction is, ” Friendship, warmth, brotherhood, support and caring.” By the time I made it to the “rooms” I had lost most of my freinds, my support system was fragmented at best and I didn’t care whether I lived or died. My sponsor (when I was in treatment in B.C) told me that her only job at the start of our relationship was to love me until I could love myself.(unfortunately, I was discharged before the miracle ever happened) I am in treatment for the third time and it’s different because of the desperation I have constantly felt over the past months and my growing commitment to myself and my recovery. Thank you for another beautifully written piece.

    • Marc October 16, 2012 at 1:16 pm #

      Yes, it’s true. I didn’t really poo-poo it, well maybe a little, but I’d heard so many stories about the rigidity of the program, and the religiosity at least in some groups. Now I see the other side, and I can see how warm and healing those groups can be. But it’s all just learning for me. I didn’t know much about the treatment community until I started this blog. I’m learning as I go and it’s changing the way I see things.

      Thanks, Kathleen. Good luck with phase 3!

  16. JLK October 14, 2012 at 11:14 am #

    Further to Donnie Mac (don’t ask me why I am bothering)

    You are obviously very touchy about your dyslexia. Yes I am aware that all those guys had/have it. One of my best friends, greatest Int’l business mentor, and self-made Austrian multi-billionaire (flew in just to be Best Man at my wedding) and my greatest financial benefactor (working as his US agent) is a Gay Dyslexic. He learns from talking, asking questions and spending 4 months each year traveling to places that would make your hair curl. He also has a prodigious memory for his conversations and observations. His one weakness is a good feel for the geo-political big picture because he cannot read except slowly. Left school at 17 because of the way he was treated at the local Catholic schools. He is one of many I know.

    You obviously made the wrong conclusion about my remark that set you off. What I was trying to say (clumsily perhaps) was that no matter how much you think you know about a topic there is always more to learn. You might keep that in mind. My sponsor is frank and open about his…not touchy.

    BTW I have had a mental disorder for 51 years that some call debilitating and makes dyslexia look like a “walk in the park”. I am not super-sensitive about it, but very open as I find myself wanting to “out” myself at this stage in order to help others with similar mental disorders. I have made a fairly successful career by putting one foot in front of the other while hiding the fact that 3-4 days per month I had to drag myself to work while thinking about nothing but suicide. Ever been there Donnie? Alcoholism and drugs were only a symptom and compared to the disease no big deal.

    JLK

  17. Donnie Mac October 15, 2012 at 1:44 pm #

    John I give up , this conversation just gets more offence as it goes along . Your the best / worst Alcoholic ever ! You live in a “Rough and Tumble world ( in a $500,000 home in a small town ) , You swear by a program that is only “Real” when you say it is and know more about it that anyone else . I leave you with this . The first part of Tradition 11 : “Our public relations policy is based on attraction rather than promotion”

    What part of any of your responses are “attractive ? ”

    Donnie Mac 2012

    • Marc October 16, 2012 at 2:22 am #

      Guys, what the hell? Your responses aren’t attractive either, Donnie, and at least John is trying to tell us about his problems in a forthright way. How do you know what kind of house he lives in? And why would it matter? John admits to some “clumsy” phrasings, but I don’t think he’s out to attack you…or at least not until lately, and he might claim self-defense on that.

      Pronouncing on what’s real and what’s not… is that it? But that’s just a matter of style, man. Okay, a bit presumptuous, but not evil.

      I’ll ask it again: is there anything substantive you guys are actually arguing about?! You’ve both been very involved in AA, as far as I can tell, which means you’ve both benefited from it, and you both have strong opinions about it — not surprising, since the group is such a powerful part of one’s life. But I’m losing the thread of what you’re debating.

      I’m not saying you have to kiss and make up, but is there any common ground here?

  18. JLK October 16, 2012 at 11:41 am #

    Marc has kindly warned me off the personal Donny diatribes so, considering my temper and blood pressure I will just replay to Marc.(fortunately for Donnie)

    Yes it is impossible to compare program effectiveness but AA is the only Int’l program with millions of members who have the overall numbers to really make a 20% success rate count. That is why I consider it the “most successful mental health program in history”. We believe that MILLIONS have been saved from a lifetime of nightmare and misery. The “always gets worse never better” part which we believe to be true as well as a lot of modern researchers, is the reason a lifetime of sobriety is the only measure of success.

    True we have a lot of people that “go back out again” and it is also true that I preach to them to try again (always harder the second time) to consider their 5 or whatever (I have seen as much as 25 years) years sober as a reprieve and not a waste as the tendency to think the latter way is almost invariable.

    That is why it is so important to stay sober once you have gotten past the first 2 or 3 years of Hell.

    In my case I tried 3 or 4 “fluff and buff” programs before “surrendering” and joining AA. The last one was called “Moderate Drinking”. But when I found out that the founder of the program had killed a mother and daughter in a car accident before blowing a .16 alcohol content (twice the legal limit) I gave it all up and knew at that point I could never drink again.

    So I joined “the last house on the block” and have since witnessed many “miracles”. The best was a woman friend who started 3 months after me who lost her law license after becoming addicted to alcohol, gambling AND crack cocaine. She also had 250 grand in student loans to pay with no income. Today she is a successful lawyer (successfully retaking the Bar Exam after spending 3 years going bankrupt and talking the Bar Assoc into giving her another chance). Wow…that is a goddam miracle.

    I also spent two years studying and practicing Virpassna (Mindfulness) Buddhism (I even had a former monk as a Guru!) as an ADJUNCT to AA AFTER I quit. It helped but would not have been successful on its own.

    And that my friends (with one exception) are a few of the many reasons why I think the way I do about 12 step programs.

    BTW For those still focused on the :God Thing”….I am an agnostic who developed my own version of a Higher Power” with a lot of help from Einstein’s thoughts on the subject and my particle physics studies. I have only been to one meeting out of many hundreds that had an irritating God proselytizer. I just left after 1/2 hour. Easy Peasy.

    JLK

    • Marc October 18, 2012 at 4:51 am #

      John, I love your anecdotes of recovery — miraculous recovery in fact. They are moving AND informative. These give you a certain emotional authority to speak about the successes of AA. But as a scientist, I come down hard on my students when they use phrases like “we believe” — a phrase you use a lot. I tell them: if it’s a matter of belief, then, fine, go ahead and believe it. But belief takes it right out of the realm of science, which is based on evidence that is independent of belief. I also show them how “belief” can be a terribly destructive force in human endeavors. Not long ago, “we believed” that blacks were inferior to whites and women inferior to men, etc, etc. “We” believed it so strongly that evidence was irrelevant and had no role to play. That’s the trouble with beliefs: they require nothing more in order to appear so obviously true.

      Of course you don’t have to be a scientist, and even scientists stop being scientists when they come home at night and argue with their spouse and children. In other words, we all base our feelings and most of our actions on beliefs, no matter how “unscientific” that may be. But you can’t have it both ways. You can’t say “I believe” at one end of a sentence and cite statistics at the other.

    • Donnie Mac October 19, 2012 at 2:57 am #

      I said “Good Day to you Sir “

  19. JLK October 19, 2012 at 12:31 pm #

    Hi Marc

    Aha! The “Scientific Method vs “Faith”. I have been reading a lot of philosophical argument about that but that is irrelevant to my reply.

    I use those terms for two reasons:
    1) These concepts to my knowledge have not been “proven” by applied science therefore MUST be considered “beliefs” or articles of faith according to “Scientific Method”
    2) I do NOT want to be accused of saying the wrong thing again by nit pickers on the blog who may come up with some rat or, more importantly, human brain experiment, either outright disproving or niggling with what I say to be “fact”. That is why I avoid the pitfalls of “statements of fact” as you might say.
    JLK

  20. JLK October 20, 2012 at 11:47 am #

    To Donnie mac et al:

    Thank you. But after the last 4 personal attacks i can’t shake the feeling of not-so-well concealed sarcasm.

    If not I apologize. If so it confirms my opinion and leave it there. Sometimes motivations are hard to read w/o face-to-face and and that is another “bitch I have about blogging/E mailing with total strangers. I for one LOVE reading people as I talk to them.

    On that subject (if Marc does not mind), I had an interesting recent episode. I was at a Starbucks in one of the mixed (economically/racially) areas of town visiting my “brainwasher”. After my apptment I found everything on my hybrid (don’t get excited Libs…it’s a 350HP performance job) was dead. And as I found out…. when everything dies FORGET it and have it towed… jumps don’t WORK $%#&^%

    Anyway while I was standing there waiting for a couple obese people making up their minds about double or triple caramel on their 5000 cal drinks a Black guy approaches me. Very nice looking guy in all ways. He tells me by my “clothes and body language” I look like an “important person” First thought: scam, but disarming and original. Only gave him my website info to read my published stuff and regretted even that as I am all over Goddam Google if my full name is typed in..

    Question to the bloggers: Am I being racist or cautious? (It’s been really bugging me)
    JLK

    • Marc October 24, 2012 at 7:48 am #

      We all generalize and we all judge. Our brains register racial distinctions in roughly 20 milliseconds (20 thousandths of a second). Judgements take a bit longer, but they start to happen within a second. Whether you were being a racist or not seems like a matter of semantics. My own view is that we are all racists — almost nobody is exempt. But many of us try to deal with our racism, and we can be successful in overpowering it.

      Now will you please DIS-engage from your battle with Donnie. I recently gave him shit, so now I’m giving you shit. You guys both have truly original voices to add to this blog. I don’t want either of you skulking away resentfully. Didn’t you mention in a recent comment that resentment is the most important emotion to overcome?!

  21. JLK October 24, 2012 at 11:10 am #

    Hi Marc

    I have learned to “compartmentalize” resentments. They are not part of my life and certainly not with somebody like Donnie. It is just the personal nature of the attacks that forces me to answer.

    I disagree with a lot of what is said and have tangled with others but those were not personal. Those I don’t “let go”. I held off because of your request last time but I also warned that next time I go nuclear …fortunately I did not. It is not temper it is just irritation

    I don’t like crossing swords with people who don’t know what they are talking about. Donnie may be a smart guy but he certainly does not know jack about the program.

    Don’t know about Donnie but I don’t “skulk”. It’s not in me. I believe anger is human nature but resentments are killers. That is why i have not had a drink in 2 years.

    I have got a skin thicker than most of you put together after 35 years in the Commodity business.

    BTW my fault for mentioning the “forbidden” name in the previous post. That makes it personal for Donnie. Apologize for that. Kinda hypocritical on my part.

    JLK

    • Donnie Mac October 29, 2012 at 3:23 am #

      I have been navel gazing again :

      Marc wrote in this post :

      “Many looked up at Peter as we approached, nodding or smiling. He seemed the granddaddy of the group. He’d been clean and sober for over ten years, a state many of the others could barely imagine.”

      In your reply JLK

      ” I have the roughly the same as your host and my meetings will invariably have guys with 30 or more years along with newbies of course like 2 years or less.”

      In your last post :

      “That is why i have not had a drink in 2 years.”

      I’m confused , I know I’m dyslexic ( and not so touchy about it ) but even for a learning disabled guy like myself “Something is fishy” . I know , I know , this email communication stuff is hard and maybe you were mistaken or misunderstood . I really want to hear what it is this time .
      I guess your right , I have not given much of a “Resume ” on how I became to know ‘Jack” about the program of A.A . I will share a wonderful experience that took place at “The 10th International Convention of Alcoholics Anonymous” in San Diego in 1995 . I was 4 and a bit years sober at the time and took a loan out so I could buy an airline ticket and get a car . My employer at the time was more than encouraging , they had seen a major change in me but didn’t know that I was involved in the program . I went to a publicly funded treatment centre “Fluff and Buff” did 90 meetings in 90 days , got a sponsor , got a home group got a mens only step group , did so much service work that it helped me change careers and work in a Shelter for Homeless folks here in Vancouver . I did a “Novelco ” little Red Book study , returned to the church , did several set of steps and lots of step work with my sponsor . All the work I had done was paying off with my trip . The first nights meeting was held Qualcomm Stadium where the Chargers play , it was a standard meeting until the end , thats when 100,000 people ( the place was filled even on the field ) held hands and said the serenity prayer , with a few exceptions , it was the most beautiful thing I have ever been involved in . The next day were speakers at the convention centre , I stumbled into one and a very pleasant man took the stage , he said his name was “Paul O” and he was alcoholic . Paul O is really Dr Paul O who wrote the chapter Doctor , Alcoholic , Addict in the Big Book . His energy was amazing , the room was still and you could feel his smile . He told a couple of great jokes about Bill Wilson as they were great friends . And then at the very end he looked over the packed room and said “You’re sober now , go out and do what it is you have always wanted to do !” “You’re sober, just go out and do it “.
      So if that ain’t “Jack” I don’t know what is . I have become contemptuous AFTER INVESTIGATION !!!!

      • Marc October 29, 2012 at 8:21 am #

        Donnie, This is a great anecdote. My suggestion: stop fighting with JLK (and you won’t get a lot of people reading comments from past posts), and make this into a piece for the new memoir page. Please see the latest post. You can embellish it if you want….or not. It’s just a very uplifting story, and people are much more likely to read it under Guest Memoirs.

    • Marc October 29, 2012 at 8:17 am #

      John, Good of you to notice and apologize. We call that being “a mench” (which sort of means “being a man”, except that it can apply to women too).

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