More on the 12-step debate at
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The 12-step fellowships are a
life-saver for some – but for
others, the concept of total
surrender can do more harm
than good. Alex Boyt makes the
case from his own experience.
Photo by Nigel Brunsdon
I
was first arrested for drugs in 1973, did my first three rehabs by 1987, and
having been told early on I had a progressive and terminal disease that
needed a permanent 12-step solution, I did about 3,000 Narcotics
Anonymous meetings over the next 28 years. Though twice in my life it had
played a central part in pulling me out of extreme injecting drug use, I was
never convinced by the requirement to surrender and admit powerlessness.
The notion that I would always be an addict because I once had a problem felt
very limiting to me. The relentless echo chamber of the fellowship however had me
trapped, afraid that to question the need for a 12-step remedy would lead me back
to jails, institutions and death.
The continuous references to God and prayer had always been an irritant, but
what really began to grate on me was the requirement to swallow and regurgitate
the ‘fact’ of suffering from an endless incurable illness that meant eternal vigilance.
The sense of belonging was undeniably valuable, but it was conditional on acknow -
ledging the 12-step programme as a God-given gift for which one must be grateful.
Within the 12-step environment you cannot have conversations about healthy
ways to disengage, since leaving is the first step to relapse. Stories of people doing
well without NA meetings were rarely mentioned and then dismissed as rare excep -
tions, or otherwise as people who had never really had ‘the problem’ in the first place.
When I started to work in the addictions field in 2005 however, I began to
experience a wider world of addiction and recovery and to discover that endless
disease was not seen by all as the optimum route to wellbeing. I came across
research papers and data, witnessed the tensions between harm reductionists and
abstentionists, and began to build a picture of reality that made more sense to me.
I found support groups for people trying to leave 12-step fellowships, heard of
counsellors who specialised in helping de-programme people from the fellowship
mindset and I caught up with people I knew from Narcotics Anonymous in the ’80s
and ’90s – many of whom had long given up meetings and were doing fine,
abstinent or not.
I embarked on the process of disengaging myself, though the years of exposure
to fellowship mantras had me wondering if, somehow, I was being deceived by a
mind I had been taught I could not trust. When I met fellowship people, there was
often a look of concern in their eyes and I found myself being defensive and feeling
a little uneasy… I thank my therapist for supporting me through the transition.
Nonetheless, as I continued my journey it became clearer that the 12-step
model, sold to me as the one true route out of addiction – though it suited some –
did not hold up so well to closer inspection. Although you can, of course, find
numbers and evidence to support any stance, I found the large American NESARC
study that showed most people with a drink problem recovered without any
intervention (12-step or otherwise) and many without abstinence.
I started to look at success rates which could be measured in different ways;
many of the headline numbers put AA success rates at around 10 per cent, though
better for those that stuck around longer.
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The peer support, collective direction and structure of 12-step fellowships are a
perfect combination for some. But it could be argued that for the population as a
whole, 12-step intervention is little better than doing nothing. What is clear is the
12-step environment is no magic bullet and that significant amounts – if not more
– recovery in its various forms takes place elsewhere.
Another piece of research that resonated with my experience was the Miller
et al study, showing that when you want to find the main predictor of relapse,
belief in the disease model is a significant factor. The ‘all or nothing’ measure of
success and failure within the total abstinence framework is a two-edged sword.
If you convince someone that any use is a calamity and that any attempt at self-
control is futile, it can be a dangerous combination. A beer on a sunny afternoon
will wipe all the clean time and status within the support group and bring the
shame of failure bearing down, so there is very little more to be lost in returning to
problematic use.
Now someone who has never come across the disease concept would very likely,
well, just have a beer. The powerlessness message may help those who are totally
abstinent, but is more likely to harm those who are not.
If we throw into the mix people who have been persuaded off their psychiatric
meds by well-meaning amateurs in the name of being ‘clean’, then ris ks begin to
increase. If you function well and are happy with total abstinence of the purest
kind, then great, and hats off to you. But it is rarely right to tell someone with a
whole personalised set of trauma and resources to follow your path.
Those on methadone may not be ‘clean’ in some people’s eyes, but it is the
number one evidenced intervention in reducing drug-related deaths, which are at
an all-time high. Those on medications are often being kept safe by them, but all
too often are subject to stigma within the 12-step environment, and pressure
mounts to stop taking them.
S
ome say that addiction is an equal opportunities affliction, but that is
demon strably false. The data shows that deprived communities have
the highest rates of addiction, and the privileged have better rates of
recovery. Too often I hear celebrities extolling the virtues of 12-step
recovery – and that is all very well If you are successful, with
significant internal and external resources. But telling someone with
problematic drug use to get clean can be like telling a homeless beggar to get a job.
Last time I wrote an article discussing the merits of the 12-step environment the
letters pages were hot for months, attacking and defending me, and I was reluctant
to take the flak again. Nonetheless I write this for two reasons.
Firstly, I say to those for whom it works well: be gentle with others. The chances
are that they may well find a way to recover without the fellowships, so go easy on
the ‘all or nothing’ rhetoric. You may mean well, but it does not help everyone.
Secondly, for those who do not feel the fellowship environment is right for them,
either initially or after some time, there is nothing wrong with exploring other
options. If my son had a problem, the 12-step solution would not be my first choice.
I was thinking about those I know with drug histories who have died too early –
either accidentally or who have killed themselves – and you know what? It’s the
ones who have been told they are powerless and have failed without abstinence
that make up the majority who have gone. I don’t hold this up as evidence; just an
observation from my experience.
The six 12-step rehabs I went through were sometimes a godsend and at other
times served only to reinforce my sense of failure. The fellowships have been a great
resource for me at critical times, and the weird cult-like structures have been useful
to turn things round. But the premise of endless disease has not felt healthy for me
in the long run.
I know many people who consider the 12-step model a life saver for which they
are very grateful. I know others who used it for a while and then happily moved on.
But I also know too many who have felt diminished by their experience.
I will end with a word of caution. A support structure is a big deal; if you leave
one, don’t do it without putting something else in place. And if you choose a beer
on a sunny afternoon after a period of 12-step abstinence, the sense of failure is
more likely to do the damage than the thing you consume.
Whatever you choose, I wish you well.
Alex Boyt has worked until recently as a service user coordinator in London and is still
actively involved in drug policy debate
April 2018 | drinkanddrugsnews | 13