The Wisdom To Know The Difference Part 15

Some Thoughts on the 12-Step Approach This is not an AA book by any means. It's a book about using ACT as a model for recovery. This being the case, it's a fair question to ask why we've devoted a good deal of time and book real estate to the discussion of how ACT can be woven into a 12-step recovery approach. The reason is, simply, that 12-step is far and away the most common recovery resource available to people with substance abuse issues, certainly in the United States and also in much of the rest of the Western world. If you're an American with a substance abuse problem, depending on where you reside, AA may be the only source of support available to you while you recover. If your drinking or drug use has gotten you in trouble with the law, the courts may have mandated that you attend AA meetings or receive some kind of 12-step-inspired but professionally mediated treatment. One way or another, most people who wrestle with substance abuse, by choice or not, get some exposure to the 12-step approach to recovery.

We believe that ACT is compatible with 12-step recovery as we understand it. We believe that you can use this book in conjunction with partic.i.p.ation in a 12-step program, and neither your work in the book nor your partic.i.p.ation in AA, NA, or whichever group you're a part of will suffer as a result. Nevertheless, we made the decision early on not to mash together the ACT material with anything we might have had to say about 12-step. To do so would have been confusing to you, reader, and it wouldn't be doing due diligence insofar as respecting the independence of these two traditions. (Actually, ACT and 12-step do have some common intellectual ancestors, particularly the pragmatic philosophy of William James, but that conversation is very much beyond the scope of this book.) The reasoning we've used to come to this conclusion is, of course, selective and follows a line that sets out to understand 12-step in a way that's compatible with ACT. If you ask some folks whether our understanding of the 12-step model is right-headed, many will agree that it is. Others may take a more fundamentalist tack and disdain anything that isn't chapter-and-verse AA. This is how the world works, and we wouldn't have it any other way. We'll note this much: Kelly has been training substance abuse counselors all over the world to use ACT principles for more than twenty years, and the responses he has gotten from 12-step-oriented treatment providers have been nearly universally positive.

The Abstinence Question In the introduction to this book, we took a strong position about abstinence. It was, though, probably not the position that many in the 12-step world would take. Our firm conviction is that the decision to quit or moderate alcohol or drug use is fundamentally personal. And, as we indicated earlier, we know of no convincing evidence that suggests attempts to control drinking or drug use, as opposed to quitting completely, are necessarily doomed to failure.

We realize that this contradicts the broadly held opinion among most treatment centers and also among many within Alcoholics Anonymous. For example, the AA Big Book states that "We know that no real alcoholic ever recovers control" (30). We could quibble about definitions. For example, studies show pretty convincingly that some do indeed recover. We could say, "Well, they weren't real alcoholics." But if we take the criteria for alcoholism laid out in the major psychiatric diagnostic systems as defining alcoholism, the a.s.sertion is quite simply unsustainable. We much prefer the humbler claims found in the Big Book, which a.s.sert that "we," meaning the authors of the book, "admitted we were powerless over alcohol"-a personal affirmation made by particular individuals.

Many who believe real alcoholics never regain control believe it's dangerous to hold out hope that control is possible. We disagree and know of no systematic evidence that the mere discussion of this idea harms alcoholics. In this matter, we're in full agreement with the Big Book. It suggests that if you think you can return to non-problem drinking, give it a try:

If anyone who is showing inability to control his drinking can do the right-about-face and drink like a gentleman, our hats are off to him. Heaven knows, we have tried hard enough and long enough to drink like other people!...We do not like to p.r.o.nounce any individual as alcoholic, but you can quickly diagnose yourself. Step over to the nearest barroom and try some controlled drinking. Try to drink and stop abruptly. Try more than once. It will not take long for you to decide, if you are honest with yourself about it. It may be worth a bad case of jitters if you get a full knowledge of your condition. (3132)

We like this sentiment much better. It's more agnostic on the issue of control as a general matter. The writers a.s.sert that they have been unsuccessful and that you'll ultimately have to decide for yourself. We agree with this a.s.sertion.

Our position on this issue will probably make some people in AA mad. It will make a lot of the people who believe strongly in the disease model of alcoholism mad. That's just the way it's going to be. We're not writing this book for people with an investment in the categories and labels a.s.sociated with addiction. We're writing it for you, for people who suffer because of problems with substance abuse. It's not as if people reading this book have never considered the idea that they might moderate their drinking or drug use. In fact, we would be shocked if anyone reading this book had not already made some attempts to moderate drinking or using drugs.

We believe that you're the only one in a position to decide, ultimately, whether another attempt at control is possible or worth the effort for you. That this is the case seems beyond argument to us. It seems consistent with the scientific evidence. It seems consistent with the Big Book. And it seems consistent with the basic idea that your life is your own, that you get to choose your own way, and that the costs such choices incur are a matter only you can evaluate in terms of your own values.

Connecting with 12-Step Twelve-step programs have been around since the 1930s, beginning with Alcoholics Anonymous. If you're having problems with substances, you almost certainly have some knowledge of AA. In fact, anyone who watches a lot of movies or television has no doubt seen someone standing up at a podium or from their seat in a circle of chairs and saying something like "Hi, my name is Bob, and I'm an alcoholic."

Some people, certainly plenty of people who go to AA, will tell you that AA is the one and only way to get sober. This is simply not true. The Alcoholics Anonymous basic text does not make that claim. Yet a quick look at the research evidence suggests that the approach used in AA is at least as effective as other common evidence-based approaches.

But I Hate AA!

Without a doubt, not everyone finds 12-step programs appealing. (In fact, during their first long conversation a number years ago, long before we started working on this book, Kelly had to disabuse Troy of some long-held-and, truth be told, completely unfounded-biases against the 12-step tradition. These biases are still common enough, especially when they are based more on stories about AA or NA than experience of them.) Even if you have issues with some aspects of 12-step, you can and should feel free to take from that tradition anything that might be of use to you, including the support of a community of others in recovery.

We've collected a checklist of reasons people hate AA. Some of the reasons are misunderstandings and some are genuine objections, but we think they can be worked with. Let's take a look at them.

I hate AA because: I don't want to be confronted, accused of being in denial, and called an alcoholic. We feel the same way. Don't put up with it. There are no data showing that confrontation is an effective treatment strategy. Although AA is often thought of as confrontational, it's definitely not-or, at least, it was never intended to be. Many treatment centers that are allegedly AA-oriented are confrontational, but the confrontation has nothing whatsoever to do with AA.

The concept of denial and a client's desire to drink or use moderately rather than quitting entirely are intimately linked in the 12-step-oriented treatment community. According to the Big Book, "The idea that somehow, someday he will control and enjoy his drinking is the great obsession of every abnormal drinker...We learned that we had to fully concede to our innermost selves that we were alcoholics. This is the first step in recovery. The delusion that we are like other people, or presently may be, has to be smashed" (AA, 30). Presumably some treatment providers consider this a basis for the claim that anyone who shows drinking problems and wants to moderate is in denial and ought to be confronted. However, the position the AA literature articulates is much more complex.

Nowhere in the AA literature can you find the words "confronting denial" or any instance in which one member is reported to have confronted another. AA staunchly advocates self-diagnosis as the only useful or meaningful diagnosis. The Big Book suggests that, among those with drinking problems, "Some will moderate or stop altogether, and some will not" (AA, 109). And, in AA's advice on working with others, they suggest telling individuals who are reluctant to quit entirely that they may be able to control their drinking if they are not "too alcoholic" (AA, 1976, 92).

If self-deception is to be smashed, it's not to be done by another member of AA or by a treatment center. Rather, this conclusion will come about because of the drinker's own experience that drinking does not work. The lives of people with substance-abuse issues are often marked by confrontation: by authorities, medical personnel, employers, family members, friends. You may have already experienced quite a bit of this. Has it moved you? Done anything significant to motivate you to change? If confrontation were a constructive approach to helping abusers change, recovery would likely be a lot easier. The culture at large provides no shortage of confrontation.

If anyone within AA confronts you about your problems with drinking or drug use, you might consider reading him or her some of the quotations above and ask to be shown, in the Big Book or the 12 steps and 12 traditions, where AA recommends name calling and confrontation.

And this goes for you, too. Just because everyone at AA starts to speak by saying, "Hi, my name is Bob, and I'm an alcoholic," doesn't mean you have to follow suit. If you find yourself in this situation and you choose not to take up the label "alcoholic," try this: "My name is Bob and I'm grateful to be here." Or, "My name is Bob and I lost a wrestling match with alcohol." Some people might not like it. Let them not like it. Their liking isn't required. You're not at the meeting to make other people happy. You're there to recover.

I hate the idea of having a disease. The idea that alcoholism and addiction is a disease is actually quite controversial. Usually people think this is an AA idea. It's not. In fact, none of the AA basic texts say that alcoholism is a disease. Describing the condition broadly, the Big Book refers to alcoholism as "an illness which only a spiritual experience will conquer" (AA, 44). In 1961, AA founder Bill Wilson described the organization's position:

We have never called alcoholism a disease because, technically speaking, it is not a disease ent.i.ty. For example, there is no such thing as heart disease. Instead there are many separate heart ailments, or combinations of them. It is something like that with alcoholism. Therefore we did not wish to get in wrong with the medical profession by p.r.o.nouncing alcoholism a disease ent.i.ty. Therefore we always called it an illness, or a malady-a far safer term for us to use. (Kurtz 2002, 22)

In fact, until very recently, there was just about no place in any of the AA or NA literature that called these problems "diseases," yet many, many people within AA and NA believe in the disease model. Perhaps this is what they were told in treatment or were told by others in AA who, in their turn, got the concept in treatment. But it's worth noting that, by design, AA is made up completely and solely of its members. The organization has taken some pains to not recognize authorities or experts within its ranks, and professionally mediated treatment programs are explicitly outside the traditional scope of AA. Recognizing addiction as a disease, given our cultural expectations about health and wellness, does reasonably lead to the idea that there must be a doctor or other professional to treat that disease. The tenth tradition of AA holds that "Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never be drawn into public controversy." Whether or not alcoholism is or isn't a disease is a matter for scientists to sort out. People within 12-step programs generally don't have the means or training to determine this. And just because the idea is popular does not mean that it's correct.

The scientific community is quite divided. We could certainly be proved wrong in this matter. In the end, it doesn't matter all that much. People were getting sober in AA before the widespread adoption of the idea that alcoholism is a disease. And no matter which way the science goes, AA will have exactly the same benefit.

Think of it this way: imagine that some people thought mountain climbing was a disease. They could point to people who continue to climb, even after they lose toes and fingers to frostbite, even after their spouses divorce them because of extended time away climbing. If there were a program that helped people stay off mountains, it would work or not to the extent that it accomplished its stated goals of keep mountaineers at home in the flatlands, whether mountain climbing was a disease or not.

Maybe alcoholism is a disease, and maybe it's not. You don't have to figure this out to recover. And you don't have to figure it out to use AA. If you're going to AA, we don't recommend you argue with people about this. Doing so will be a waste everyone's time. And for the purposes of getting sober, it just doesn't matter. We suggest you focus your attention on things that matter. The bottom line is, if you think you have a problem rather than a disease, you're in good company.

I don't want to be going to meetings forever. Okay, so don't. Don't go to meetings forever. We mentioned at the beginning that you can put this book through its paces without ever setting foot into an AA meeting. We think there may be value in the experience of AA meetings for some people trying to recover, and if you don't know whether they're right for you, the best advice we can think of is to suggest you attend a few and find out. If and when you do, nothing says you have to keep showing up. You may find you want to. Many find fellows.h.i.+p and support at AA that they treasure for a lifetime. Others stop going after some period of time.

Some at AA will tell you that people who quit going to AA get drunk. They will sometimes say, "I go to meetings to see what happens to people who don't go to meetings." These folks often have the experience of watching people stop coming, get drunk, and come back with tales about how not going to meetings caused the trouble. This may seem like good common sense, but it's bad logic. Some people who quit going to meetings get drunk and some don't. The ones who don't have little incentive to come back and report on their successes. They're just out there living their lives. As with everything else we've been talking about, meeting attendance is, we strongly feel, a matter of personal choice. We said in the section on commitment: If you choose to attend meetings for a while, stop, and then start drinking or using again, our hope is to help you find a way to turn back to what worked for you, in kindness to yourself. If you decide to go to a meeting, go to it for now and let later take care of itself.

I hate all the G.o.d stuff. Without a doubt, there's a lot of G.o.d stuff going on at AA. And while there is certainly a segment of people in AA who would chafe at the suggestion, the plain fact is that "G.o.d," in the context of AA literature, is a subst.i.tute for "your own particular spiritual beliefs."

The tradition of tolerance for various spiritual beliefs in AA is goes back to the organization's earliest days. The first AA member, Bill Wilson, was from New York. While traveling on business, Wilson called on the second AA member, Dr. Bob Smith, in Akron, Ohio. Dr. Bob, as he has since come to be known, had been very involved with an organization called the Oxford Group. Wilson had also been exposed to that group, but s.h.i.+ed away from some of its authoritarian spiritual doctrine. In the early years of AA, had it been left entirely to the Akron faction of AA, there would have likely been a far stricter set of spiritual views in AA. But those darned New Yorkers were a more diverse lot and did not much like being told what to believe or what to do.

As result, the Big Book refers again and again to the idea of G.o.d as we understood Him and to the even more generic concept of a Higher Power. In fact, depending on where you are in the country, you may find a lot of people disaffected with organized religion in AA. Depending on where you live, this will vary. If you live in the Bible Belt, you will find a lot of Baptists. If you live in certain parts of Boston, you are likely to find a lot of Catholics. If you live in western Ma.s.sachusetts, you will likely run into a lot of Buddhists. It's possible to find people with all manner of beliefs who have found AA useful, including people who believed in traditional religions, but also individuals who regarded nature, love, or human fellows.h.i.+p as a higher power. There are even committed atheists who are committed members of AA.

As described above, this relative openness is by design. Here is what Bill Wilson had to say on the topic in his book Alcoholics Anonymous Comes of Age:

Who first suggested the actual compromise words I don't know, but they are words well-known throughout the length and breadth of AA today: In Step Two we decided to describe G.o.d as a "Power greater than ourselves." In Steps Three and Eleven we inserted the words "G.o.d as we understood him." From Step Seven we deleted the expression "on our knees." And, as a lead-in sentence to all the steps we wrote the words: "Here are the steps we took which are suggested as a Program of Recovery." AA's Twelve Steps were to be suggestions only.

Such were the final concessions to those of little or no faith; this was the great contribution of our atheists and agnostics. They had widened our gateway so that all who suffer might pa.s.s through, regardless of their belief or lack of belief. (Alcoholics Anonymous 1957, 167) If you go to AA and anyone tries to bully you about spiritual matters, show them this quotation from one of their own books and calmly ask them to show you where in any of the AA texts it says that members should bully other members about their spiritual beliefs. They will likely shut up. Folks in AA generally have respect for the AA texts. Wilson is clearly acknowledging the contributions of people who struggle with this aspect of the program, just like you. They made a contribution to AA, and so can you. If you go online and search AA and atheism, you'll get many, many hits. Some will go on a tirade about AA being a religious cult. Some will say partic.i.p.ation in AA is impossible if you're an atheist. But some will say things like, "I've been sober in AA for twenty years and am as much an atheist as I was the day I walked in the door." Clearly, it's possible. More challenging? Maybe. But if you're an atheist reading these sentences, that challenge is something you already know about.

WHAT ABOUT EQUAL RIGHTS FOR WOMEN, SENSITIVITY TO MINORITIES, GAY RIGHTS!?.

Okay, you definitely have us on this one. No two ways about it: the AA Big Book was written by white men and about white men. The newer editions have tended to include more stories of women, but the main text does not show the slightest sensitivity to gender issues. For example, there is a chapter called "To Wives" but not a chapter called "To Husbands" or "To Partners." And, of course, G.o.d is definitely a guy. Kelly once interviewed a woman in Spokane, WA, who got sober in Chicago in the 1950s. She reported that she had to practically physically fight her way into the AA meetings. They insisted that she should go with the wives. AA was a men's club. This should not be a shock to us. The fight for equality for all is a long and hard road. People are very, very reluctant to tinker with the first 164 pages of the AA Big Book. We expect it will come eventually. AA is getting bigger and more diverse by the year. For now, we recommend you read the Big Book as a historical doc.u.ment. It carries the language of the time in which it was written. We hope that if you can look past these flaws, you will find that many people from many backgrounds have found sobriety in 12-step programs. Who knows, twenty years down the road, perhaps history will look back and see that this year was the year that "differences" reached critical ma.s.s in AA that ultimately changed some of that language.

12-Step and Workability AA has a deeply practical side. "Take what you can use and leave the rest" is a common AA adage. The t.i.tle of chapter 5 of the Big Book is "How It Works." This chapter lays out the AA approach to recovery as a series of twelve steps, but before that section commences, the authors of that book state: "Here are the steps we took, which are suggested as a program of recovery" (AA, 59). We prefer to think that the word "suggested" in this context was carefully chosen. The authors of the AA text very often default to a very local and humble a.s.sessment of the facts as they see them. The texts are littered with phrases like "we have found" and "alcoholics of our type." There are many statements such as this one: "Our book is meant to be suggestive only. We realize we know only a little" (AA, 164). These simple a.s.sertions, we believe, are the best of what AA has to offer. If you go to AA and hear dogmatism and absolutes, we can only conclude that you're hearing opinions that evolved independently of the base AA literature.

Have we been selective in our approach to the AA texts? You bet! Are we providing the correct way of understanding AA? Not by any means! We're providing just one way of understanding AA that may be useful to you. And we would recommend that you be selective too. If you find things in AA that you object to, let them be and come back to them later. Some of these you may see in a different light with more time spent in the act of recovery. In reconsidering some, you may find yourself surprised that you were so put off about them early on. And some may continue not to sit well with you. All possible options are fine. We recommend you not let a single objection, or even a set of objections, dissuade you from exploring what benefits you might find in AA.

The Third Tradition of AA AA and other 12-step programs probably contain the same percentage of jerks as can be found in the culture as a whole. You can find bullies and know-it-alls at the office, at the supermarket, and yes, at an AA meeting. Fortunately, there's a way that you can inoculate yourself against these views. AA's recovery process is famously divided into the 12 steps. Lesser known, perhaps, are AA's 12 traditions. These are elaborated most clearly in the publication Twelve Steps and Twelve Traditions. Especially important for our purposes is the third tradition: "The only requirement for AA members.h.i.+p is a desire to stop drinking" (139). The door to AA is left wide open by the inclusion of this tradition. In the early days of AA, described in Twelve Steps and Twelve Traditions and elsewhere, there were many requirements for members.h.i.+p. Ultimately they were all dropped because the members.h.i.+p wanted to keep the doors open to all who sought help. In its earliest versions there was language suggesting the need for an "honest" desire to stop drinking. Even that was seen as a potential bar to some who might seek help. Any desire at all is enough, and you are, by the rules of AA, a member when you say you are. There's only one person who can revoke your members.h.i.+p and that is you.

This does not mean that, if you stand up at an AA meeting and declare that you're a devout atheist, everyone will applaud and tell you that you're welcome. Many will not. But try that same thing at a restaurant or at a local park. You'll no doubt find people happy to point out the error in your thinking in the strongest terms. But the people who have opinions that are different than yours have absolutely no power to revoke your members.h.i.+p. Your place in the meeting and the community is a.s.sured by the third tradition. Stick with AA for a while and see what the results are. Or, try something different. We're sure that if what you try doesn't work, you'll be able to tell, and your own sense of what works and what doesn't will matter more than anyone else's opinion. Here is what they ask in the 12 & 12: "Why did we dare say...that we would neither punish nor deprive any A.A. of members.h.i.+p, that we must never compel anyone to pay anything, believe anything, or conform to anything?" They feared that telling people what to do might exclude someone from help. Their answer to that question: "Who dared to be judge, jury, and executioner of his own brother?" (141). Whatever path, you chose it. Our sincerest wish is that this book helps carry you on your way.

Further Study.

Some people like to read. Some don't. This list is for you if you're in the first camp.

Something that we never got around to mentioning in the book is that knowing doesn't mean all that much. It's always been the case (ever met a drunk who didn't know he should quit drinking?), and now that virtually every one of us carries around instant access to each and every single thing known to mankind in our pockets (as long as we pay the bills on our smartphones), knowing stuff probably matters even less. The magic is in the doing, not the knowing. Instead of things you should read, think of the resources below as roads you might consider traveling. Happy trails.

Beautiful Writers What do these writers and their work have to do with recovery? Nothing, and everything. Start a conversation with any one of these folks, and you can change your life forever. There's no need for us to recommend specific t.i.tles here; the names are enough. Search by name on the Internet, at your local library, or at a bookstore.

Albert Camus Carolyn Elkins Naiomi s.h.i.+hab Nye Robert Frost Rudyard Kipling Sebastian Moore T. S. Eliot Viktor Frankl Books on ACT If you like the whole ACT thing, there's plenty for you to read. We have a couple of earlier books that cover some of the same ground this one does, only with different applications. Things Might Go Terribly, Horribly Wrong (New Harbinger 2010) is a book written for people struggling with anxiety, and Mindfulness for Two (New Harbinger 2008) is a book written for clinicians (although anyone can get the gist of it) about what it means to be genuinely present with a client (or, really, any other human being). With our dear friend and colleague Emily Sandoz, we also wrote a couple of books that apply this work to eating disorders: Acceptance and Commitment Therapy for Eating Disorders (New Harbinger 2010) and The Mindfulness and Acceptance and Workbook for Bulimia (New Harbinger 2011). These are obviously not for everyone, but they make use of many of the same concepts as this book-so someone in your life might be interested.

Another take on ACT (one that reads very differently from our books) is Steven Hayes and Spencer Smith's very popular book Get Out of Your Mind and Into Your Life (New Harbinger 2006). This book isn't written for any particular problem or challenge; it's just a general introduction to ACT. If depression is something you struggle with, The Mindfulness and Acceptance Workbook for Depression (New Harbinger 2008), by Kirk Strosahl and Patricia Robinson, is a great choice (and it comes with some really excellent audio exercises). The original book Acceptance and Commitment Therapy (Guilford Press, first edition 1999, second edition due out in October of 2011), by Steven Hayes, Kirk Strosahl, and yours truly, Kelly Wilson, is a challenging book written for scholars and clinicians, but if you really get interested in this work, you might give it a read.

Books on AA Throughout this book, we've referred to Alcoholics Anonymous, known as the Big Book (Alcoholics Anonymous World Services, Inc. 2002), and The Twelve Steps and Twelve Traditions, known as 12 & 12 (A. A. Grapevine, Inc, and Alcoholics Anonymous World Services, Inc. 2002). You can buy these books in paper editions, or you can access the complete text of either for free online at www.aa.org/bigbookonline and www.aa.org/1212, respectively.

For some amazing insights into AA work and a unique take on AA's history, we recommend the books of Ernie Kurtz: Not G.o.d (Hazelden 1991), The Spirituality of Imperfection (Bantam 1993), and Shame and Guilt (iUniverse 2007).

Online Groups and Resources The a.s.sociation of Contextual Behavior Science is a professional organization that loosely organizes folks who are part of the ACT community. Its website, contextualpsychology.org, has quite a few useful resources, including a directory of ACT therapists you can browse. Some of the content on the site is available to members only, but members.h.i.+p is open to interested nonprofessionals, and the dues are values-based: you only need to pay what you think members.h.i.+p is worth to you (as long as it's at least $1).

There are numerous online resources for AA, the most significant of which is www.aa.org.

There is an online group called ACT for the Public. It is a discussion group of people using ACT for all sorts of different difficulties from substance abuse to anxiety to depression. You can join it by going to http://health.groups.yahoo.com/group/ACT_for_the_Public/ You will find fellow travelers there, including Kelly, who is a semi-frequent contributor to the discussion.

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