Working With Addictions: Part I, The Pros and Cons Of 12-Step Approaches

A very popular idea in our society is that addictions are caused by diseases and are completely the result of genetic factors.  It does appear, from much research (e.g., Dick and Agrawal, 2008) that genetic makeup can contribute to alcohol and drug abuse.     But much addictive behavior, in my experience,  is partially caused by other factors:  underlying anxiety and depression from not having worked through the traumatic effects of childhood abuse and neglect; the negative example of having seen  parents and other adults solve their problems by the use of alcohol and drugs;  starting to drink or use drugs at an early age so that it becomes a habit by adulthood;  and finally, one’s social milieu.  For example, if a person’s  main social contacts are at bars or with friends and relatives who drink heavily, they are more apt to  become and stay addicted to alcohol.

But  it’s important to realize that addictions are not limited to alcohol or drugs; one can be addicted to shopping, gambling, overuse of fatty and heavily sugared foods,  watching porn, and compulsive exercising.  And I have never heard of a gene that leads one to compulsive shopping or gambling!

Those people, including therapists, who claim that  physiological factors are wholly causing addictions without any attention to historical and environmental factors, can lead people with addictions to feeling helpless about doing anything on their own toward overcoming them.    Also,  even if they  stop one kind of addictive behavior without discovering other causes of it,  they  often just switch to another addictive behavior.

AA and other 12-step programs are the most popular treatments for addictive behavior.    He or she must also admit to helplessness in the face of the addiction and to put his or her faith in a higher power.  I don’t use the terms “addicts” or “alcoholics” because people seeing themselves as nothing more  than their addictive behavior rigidifies and concretizes these behaviors into the belief that their sole identity is their addiction.     But AA and other 12-step programs insist that an attendee with an addiction say things like  “I am Joe Blow and I am an alcoholic.”

Now I have found that AA and other 12-step programs can provide some good things for  those with addictions.

1.  They  can help to reduce the shame people with addictions often feel about themselves by hearing at meetings  others admitting to the same problem.   But note that, as I pointed out above, the requirement is that they see themselves as alcoholics, drug addicts, etc. rather than worthwhile human beings with these addictive behaviors.

2.  Some people with addictions are isolated loners,  partly as a result of their feelings of worthlessness;   being in contact with other people at  12-step meetings can alleviate their loneliness.

3.  Having 12-step meetings readily available in many locations and at various times can give them something to do rather than indulge in their addictive behavior.

4.  Admitting that one has no control over one’s addictive behavior can make it less possible for them to deny they have a problem; denial they are addicted is  a common characteristic of people with addictions.

5.  Some of the 12 steps of AA and similar programs can be very useful:  # 4, making a moral inventory; # 8 and 9, making a list of persons the person had harmed and making amends.   People with addictions usually feel much unbearable guilt and shame about how they have hurt loved ones and other people in their lives and their addiction is often a desperate attempt to alleviate these feelings. Expressing remorse to these people can alleviate these very painful feelings.

6. The practice of obtaining and using a sponsor can be a very helpful part of the 12 step experience, assuming the sponsor is mature, wise and non-judgmental.   A good sponsor can provide  support, encouragement and understanding of the many conflicts and struggles  of the person with addictions since they have had the addictions themselves.

7.  12 step programs are free.

8.  They are supposed to be non-judgmental about the addictive behavior, even if the addicted person falls off the wagon.

9.  People with sever addictions are usually self-centered, with little ability or interest in relating to others in an authentic, cooperative fashion.  The involvement in a 12-step program, if on a long-term basis, can help them expand their interpersonal horizons.  They then can have satisfying relationships with others outside of the 12-step program.

10.  the emphasis on spirituality, if its ‘separated from religion per se, can eventually lead to spiritual transcendence, but, according to Michael Clemmons, a Gestalt therapy theorist, that is  the final stage in the growth of the addicted person, usually coming years after the person has abstained from substance abuse.

But 12-step programs, in my opinion, also can have some serious shortcomings:  

1.  They often promote many negative beliefs, one of which I mentioned above:   requiring the person with addictions to identify himself or herself as an addict rather than someone who displays addictive behavior.  So, at the core the person is an addict, not a complex human being with many attributes other than having addiction, even many identities.

2.  Most of the 12-steps have in them the word God or Higher Power and is identified as male.  One fact about AA that is not widely understand is that the program was originally influenced by fundamentalist Christian dogma, and many AA groups still are permeated by these narrow beliefs.. This is something that many people with addictions have great difficulty accepting, particularly those who are atheists or agnostics or object to cultural sexism.  Even though AA and NA specify that God is defined “as we understand him,” note that there is still the emphasis on a male higher power.  This also can be particularly difficult for people who have been traumatized by being brought up in a harsh, judgmental, patriarchal religion.

3.   They are often not a sufficient curative agent for many people because they tend to focus solely on the addictive behavior rather than the underlying causes of the behavior.

4.  The person with addictions is  forced to admit to feelings of helplessness.  As  Lance Dodes. MD, a Harvard-based psychiatrist who has run numerous treatment programs for addicts,  has shown in two excellent books (The Heart of Addiction and Breaking Addiction), a common underlying issue for all addictions is a sense of helplessness about dealing with important, underlying existential issues.  These can be  feelings of worthlessness, crippling shyness and loneliness, feelings of inadequacy, a fear of failure, or being the victim of  a very harsh inner judge.  In fact, this very harsh inner judge is often the catalyst that makes them feel worthless, inadequate and unworthy of being cared for by others.  It’s no accident that alcohol has been termed “mother courage” for people who feel afraid to attend social functions,”uppers” for stimulants for those who are weighed down by depression, or “downers” for those who are chronically scattered and anxious.  Therefore,  forcing the addicted person to  admit they are helpless can be exactly the wrong message to give them,  just as telling them that their entire identity is their addiction can be, in my experience, a limiting and shaming message.

5.  While the requirements for someone to serve as a sponsor sound very good, in actuality, from my experience with numerous persons with addictions over the years, many have not lived up to these requirements.  Frequently, they were perceived as judgmental, dogmatic, critical and narrow-minded. Also, they sometimes were very critical of the client being in psychotherapy or using other, additional, growth-oriented programs such as Smart Recovery to help them.  I want to stress that many sponsors were very helpful in providing the support that was needed.  But it is frequently the most primitively functioning addicted person who was unable to choose their sponsor wisely and were stuck with an inadequate one.

6.  12-step programs espouse a disease model of addiction, which has many problems:  unlike physical ailments, no part of the body or brain can be pointed to as “diseased,” although the addictive process can create many medical problems.  It also can make it easy for the addicted person to avoid responsibility for his or her addiction, e.g., saying things like “my disease was acting up again.”

7.  Finally,  12-step groups, on their own,  usually don’t actually  cure people with addictions of their addictive propensities; they often just substitute cigarettes and coffee for alcohol or drugs and the rest of their lives can still be dysfunctional.    They focus almost solely on abstinence rather than the expansion and growth of the person into a fuller, more productive, joyous life.  A common term for such people is “dry alcoholic.”  And I have seen people who were formerly addicted to a substance switch so they are now addicted to 12-step meetings!  The result is that sometimes 12-step programs  have the features of a cult.  In fact, as Dodes has written in a scathing article about the ubiquity of 12-step programs, they are not really successful, only 5-10% of addicted people who attend a meeting or a rehab program manage to get cured of their addictions.  For programs that can cost as much as $90,000 a month, this is a pathetic success rate.  The article can be accessed at

In summary, 12-step groups can often be helpful to people with addictions, particularly early in their recovery.   And I have known people, including clients, who got a great deal out of  12-step programs and, after many years of sobriety, still went to meetings and had formed important, lasting relationships within the 12-step programs.  But, in my experience they were  usually not enough to cure the underling causes of the addictive behavior.  In future posts I will spell out  alternatives or  adjuncts to 12-step groups for dealing with folks with addictive behavior.