From Powerlessness to Empowerment
“Hello, my name is Jonas and I am an addict.” This public confession at a l2-step meeting is almost universally accepted as the beginning of the road to recovery for anyone seeking treatment for a substance abuse problem. The collective response to this statement by the other members in attendance is a solemn “Hello Jonas.”. This affirmation can be roughly translated, in the context of the meeting, as “Yes you are and so am I”. The implication is that the 12-step members were born addicts, are addicts, and will continue to be until they die. This ritual plays out daily at the more than 20,000 l2-step chapters with the participation of it’s more than 2,000,000 members as well as the vast majority of rehabilitation centers in America.
The emphasis on the personal and social designation of an individual as a perpetual, incurable addict or alcoholic as a basis for change and rehabilitation seems to be a fairly counter-intuitive introduction to treatment. This seems akin to a person saying “My name is Bob and I will always have a minimum wage job” or “My name is Julie and I will never receive a college education” as an avenue to achieving those goals. So what is the rationale behind this act? The l2-step model espouses the notion that alcoholism and drug addiction are incurable progressive diseases and frequent acknowledgment of that fact is vital to keep relapse at bay.
In order to take a realistic look at these claims, lets look at concrete definitions of these terms. Alcoholism is dermed as ” the habitual and compulsive consumption of alcohol to excess” and drug addiction is defined as “the condition of being addicted, spec. The habitual use of narcotic drugs”. It seems odd that the 12-step model would characterize their members as such considering that many have not been intoxicated in months, years, or decades. There seems to be a fundamental gap between the modem conception of addiction and that of the 12 steps. That said, this model continues to dominate the field of rehabilitation with over 250 organizations based on this approach.
The 12-step approach to rehabilitation originated in the form of Alcoholics Anonymous in 1935 by two alcoholics. As medical science of that era had no understanding of dependence it was generally considered a symptom of a lack of moral fiber and practiced by degenerates. By accurately observing that the later stages of alcoholism had a physical quality, the founders came to the conclusion had that individuals were predisposed to alcoholism by a physiological abnormality. They felt that the only option open to them in the area of recovery was the denial of personal responsibility and the seeking of divine intervention. This idea rapidly gained acceptance and eventually ballooned into what is now the face of the rehabilitation industry.
Predictably, the understanding of addiction has advanced dramatically over the past 73 years. Rather than being considered an innate condition, addiction is generally considered to be a temporary physical state induced by the initial consumption of a substance. This condition persists during active use but subsides over time after use has ceased and the person maintains a period of sobriety. The mechanism at blame appears to lie in the areas of the brain dealing with survival motivations and pleasure. Pleasure usually follows as a reward an action taken by the individual that in some way enhances survival such as eating, having sex, getting a raise, receiving praise, etc. In the case of addiction, however, that natural process is completely turned in its head. Drugs and alcohol mimic an intensely amplified version of survival satisfaction although the act they took in consuming the substance is harmful to them. Since the brain doesn’t know the difference the addict then concentrates their efforts in the realm of substance abuse and begins to rapidly deteriorate. This accounts for people drinking or using at the expense of food, sleep, family, friends, relationships, and employment. Although those associated with the person can readily observe that they are destroying themselves, the addict feels that he has a leg-up on the fundamental motivator of human behavior, the obtainment of pleasure. Eventually, as the addict gains some clarity on the destructive nature of their actions, it is easy to understand why he may feel that something is fundamentally wrong with him physically. Although he may feel diseased, evidence points out that his cravings are nothing but an induced inclination.
Now that the nature of addiction is essentially established where does this leave the 12step approach and its effectiveness in combating addiction? Not a single study has been conducted that has been able to show that the percentage of people who got clean using this approach is any greater than the percentage of those who got clean on their own. That is a remarkable fact considering the 12-steps are nearly synonymous with rehabilitation.
Critics argue that the 12-step’s insistence on powerlessness is counterproductive and actually prompts members to relapse. It produces the perception in the individual that he must be vigilant against the drink or drug lurking around every comer compounding any residual problems brought about by prior use. These combine to create an extremely stressful situation, which is interesting because environmental stress is the leading factor in initial drug of alcohol abuse. Apart from actually being offered drugs or alcohol stress is also the primary relapse trigger beating all other factors by 300%. This gives rise to a revealing cycle that begins with a person experiencing stress in some aspect of his life. Seeing no way to meet the problem head-on, his “solution” is to replace the satisfaction he would feel in resolving the issue with the satisfaction of using or drinking. Eventually, this approach to dealing with problems is firmly established and the consumption itself becomes the primary problem. Once again a solution is required and, for most, the only one available is a 12-step program. There any hope of self-sufficiency is duly met with the theory of powerlessness, the central tenet of the 12-step program. This brings about the recurrence of a stressful environment and after varying periods of sobriety, most relapse closing the cycle. What makes the process all the more insidious is that while this is occurring it appears to the newcomer that the 12-steps are fostering long term sobriety. The snowball effect of this process seems to be what has propelled the 12steps to the forefront of substance abuse treatment.
So if the 12-steps don’t work, then what does? The answer is evidently old-fashioned success. 80% of ex-addicts who have achieved long-term sobriety cite life success as the contributing factor. This includes the formation of goals and the achievement of those goals, whatever they may be, as long as they are productive. This seems very sensible. If a person were doing well in life, why would they need to rely on the crutches of drugs and alcohol? Over time these simple, successful actions serve to stabilize the brains survival and pleasure seeking functions.
There is a vast array of 12-step alternatives ranging from the holistic to those utilizing the latest psychiatric advances but the most successful tend to be the most practical. The highest success rates are those which focus on fundamental life-skills. The methodology employed by the multinational Narconon network has evidently made huge strides in this field. At its more than 100 treatment centers worldwide, patients are rehabilitated by treating substance abuse as a symptom of an underlying issue. The program seeks to address the core of what led the person to the drug lifestyle in the first place and this usually turns out to be an inability to deal effectively with environmental stress. The length of the program is usually between 2.5-4 months but the patient is allowed to stay as long as is necessary to make the change required. During this period the patient is guided through a series of 8 life-skills courses ranging from communication to courses on ethics and morality. Eventually he is able to assume responsibility for the behavior that brought about his need for treatment and is given a systematic way to move forward with life ambitions. By giving patients the ability to deal with life on its own terms, Narconon has achieved an unheard oflong-term success rate of75%. From all accounts the condition in which they graduate the program is far from powerless.
Recent medical advances have made abundantly clear that the road to rehabilitation lies not in a theory of powerlessness but empowerment. If you or a loved one are seeking treatment it would be wise to consider an option with proven results. There will be a day when you can introduce yourself without carrying the stigma of being an addict.
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