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12-Step Support Groups: Part II

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

While there is a group norm in 12-step groups to comply with the program, in its truest form AA is invitational not coercive. Just like all support groups, whether the organization achieves its ideals will vary from participant to participant, and group to group. If you visit a 12-step program, or any support group, and experience something that feels manipulative, it may be wise to pay attention to that. Perhaps you need a different meeting, a different support group, or an entirely different approach. For this reason, many addictions professionals who may encourage therapy participants to explore 12-step support groups, request they attend at least five meetings (preferably different ones) before judging whether this group will be a beneficial addition to their recovery efforts. This recommendation would appear to be good advice when considering any support group.

women talkingThis leads to an important issue when considering any non-professional support group of any type. We cannot consider these groups a form of addictions treatment. These groups are not composed of professionally trained people and cannot be legally compelled to enforce confidentiality. Self-help groups are just that. They are groups of non-professional people with a common problem who attempt to help each other. This in no way diminishes the value or benefit of these groups. However, we must understand these groups in the proper context. Many people consider support groups a valuable addition to their natural recovery efforts, and/or their professionally supervised recovery efforts.

12-step programs encourage sober living and complete abstinence from alcohol and other recreational drugs. This is true regardless of a person's original addictions. 12-step support groups for activity addictions may specify certain behaviors that require abstinence. For instance, while possible, it is not practical to abstain from all sexual activity. This is particularly true for persons in partnered relationships. Therefore, sex addicts may specify clear limits to certain behaviors. These limits are usually determined with the aid of a sponsor. In this respect, for some activity addictions, recovery more closely resembles moderation, rather than abstinence.

12-step programs do not ask members to discontinue the use of pharmaceutical drugs so long as they are prescribed by a physician, and taken as directed. Some groups and their affiliated members may discourage the use of legitimate medications. Because of concerns about this practice, AA produced a pamphlet to address this concern. "It becomes clear that just as it is wrong to enable or support any alcoholic to become re-addicted to any drug, it's equally wrong to deprive any alcoholic of medication which can alleviate or control disabling physical and/or emotional problems (Alcoholics Anonymous, 2012a)." If you encounter a particular group that seems to contradict this statement, you would be wise to consider an alternative. Try a different meeting, a different group, or seek professional consultation.

Research on the effectiveness of AA has been limited. There is insufficient evidence to soundly weigh-in on this issue. Sometimes group members' understanding of the principle of "anonymity" has hindered research. Like other addiction research, there is also the difficulty of keeping track of persons with addictive disorders. Presumably, research will someday reveal that AA is indeed effective for some people.

Unfortunately, anecdotal evidence (versus rigorous scientific research) causes people to over-estimate the effectiveness of 12-step programs. Unlike randomized clinical trials that control for the effect of self-selection, support groups are only as effective as the people who decide to attend that group. Therefore, without the benefit of scientific study, the "effectiveness" of such groups remains anecdotal, rather than scientific.

Furthermore, many addiction professionals are themselves in recovery. They are attracted to the profession because they altruistically wish to share their own personal recovery experiences to benefit others. Many of these professionals have relied upon a 12-step approach to recovery. Thus, their personal experience is limited to this one method. While it may be valuable for clinicians to share their personal experiences, they must ethically avoid bias. If they choose to disclose their own recovery stories they must recognize their personal recovery experience is but one of many recovery stories. The people who seek their assistance with recovery are quite logically, different people. They may, or may not succeed with the same approach. Most clinicians do recognize this.

Nonetheless, it always possible that a clinician will become particularly attached to the method and culture that worked for them. In AA, members frequently assert, "AA is the only thing that worked for me." While these statements may be true for the person making that statement, the research does not support such an assertion. A meta-analysis of eight clinical trials with 3,417 participants concluded, "No experimental studies unequivocally demonstrated the effectiveness of AA or [Twelve Step Facilitation] approaches for reducing alcohol dependence or problems."