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The Twelve Step program:
Cure or Cover?
who cares to look can find serenity. It leaves tracks: neat
rows of folding chairs lined up in musty church basements;
the dull buzz of fluorescent lights in hospital lecture
halls; schoolrooms where half-erased algebra problems remain
on green chalkboards. Hundreds of thousands of people across
the country and around the world make regular trips to such
places-as often as once each day. They are members of Twelve-Step
and other recovery programs.
Alcoholics Anonymous (AA) is the oldest and best known of
these self-help programs, and its structure and philosophy
have served as models for many others: Narcotics Anonymous
(NA); Overeaters Anonymous (OA); Incest Survivors Anonymous
(ISA); Emotional Health Anonymous (EHA); Emotions Anonymous
(EA); Gamblers Anonymous (GA); Al-Anon and Alateen (programs
for family members and friends of alcoholics); and, most
recently, Sex and Love Addicts Anonymous (SLAA). The sole
requirement for membership in any of them is a desire to
stop substance abuse or change a compulsive behavior.
In the past few years, such programs have become so popular
that they constitute a Twelve-Step movement. Many people
know, through personal contact, that Twelve-Step programs,
especially AA, can be lifesavers. But these programs sometimes
resemble modern-day cults. They describe themselves in universal
terms, pride themselves on excluding on one, suggest that
their fellowship are supportive without ever being critical,
and claim to offer a philosophy of spiritual enlightenment
without religious trappings. To the uninitiated, this description
might sound like old-style evangelical religion or New Age
pop psychology, with a do-you-believe-in-magic touch thrown
in for good measure.
I have never been a member of a Twelve-Step program. To
research this article, I attended a lot of meetings and
talked to many people. I asked certain key questions about
the nature of addiction and the methods these programs offer
for recovery: Are all the problems addressed by Twelve-Step
recovery the same? What are the resources and analyses developed
by feminists, gays, and progressives in response to addiction
and other personal life crises? Does Twelve Step philosophy
have anything to say about politics? What needs to these
programs address that could or should have been met by political
movements? And how does living in a Just Say No culture
change the meaning of all of the above?
Twelve Steps are the heart of Alcoholics Anonymous and the
programs based on the AA model. These 12 specific actions
are the programs’ official recipe for recovery, the
ingredients of an addiction-free life. Their purpose is
“to relieve pain and suffering, fill our emptiness,
help us find the missing something, help us discover ourselves
and the God within us, and release great quantities of the
energy, love, and joy dammed up inside ourselves”-all
with a minimum of discomfort and a maximum of self-awareness.
Unlike medical professionals, therapists, or some political
activists, Twelve-Step programs do not dwell on the causes
of addiction. It is simply understood that anyone who uses
substances or activities in a way that interferes with his
or her life has an addiction problem.
Accordingly, Twelve-Step programs offer very simple explanations
and a decidedly behavioral approach, two important reasons
why they seem to work for so many people. They pay serious
attention to ordinary pain by requiring people to pay attention
to it themselves by taking inventories, admitting wrongdoing,
making direct amends, praying and meditating, and spreading
the message of spiritual awakening. Working the steps one
by one, and repeating them indefinitely, gives people at
least two things that neither science not politics consistently
seems to trust people with: A largely self-determined behavioral
routine and permission to understand our problems differently
at different stages in our lives, in ways that make sense
to us even if they don’t to anyone else.
On a day-to-day basis, Twelve-Step programs offer members
handy directories of meeting times and places, “Approved”
literature on a range of topics, and slogans to live by,
like “One day at a time” and “Let go and
let God.” A set of 12 Traditions governs program structure.
Members are strongly urged to frequently attend meetings,
although they are completely voluntary. Still, it is not
unusual for individuals to participate in four or five meetings
each week for many years. Meetings roughly follow a standard
format: An opening statement, a speaker who comes prepared
to tell his or her story, spontaneous sharing by those present,
and a closing statement. When people speak, they do so for
as long as they wish to without interruption. No one responds
directly to anything that is said. There are slight variations
on this format, and a meeting in rural Nebraska would certainly
feel different from one on Castro Street in San Francisco,
but a Twelve-Step meeting anywhere would be easily recognizable
to anyone who had ever attended one before. Predictability
is the point.
Programs encourage a sponsorship system, where individuals
who have been in the program for a while act as buddies
to newcomers, orienting them to program philosophy and structure.
In addition to their sponsors, members have no trouble finding
willing listeners outside meetings. Telephone numbers are
exchanged and used, at all hours of the day and night, when
people need help or support or just want the comfort that
comes from making contact with other human beings who care.
Twelve-Step programs also provide another thing that people
are desperate to find: a predictably safe place in which
to feel understood and accepted. Safety was almost tangibly
present in many of the meetings I attended, and I believe
the feeling of uncritical acceptance people find in these
programs may be one of the main reasons they flock to the
meetings. The safe environment has been purchased at a rather
high price, however: a community culture that does not allow
room for direct reaction or interaction of any kind, in
They look alike, but are all the Twelve-Step programs really
the same? Does it make sense to change compulsive eating
behavior with the same techniques alcoholics use to keep
sober? Is sexual addiction different from food addiction,
and are they both different from addiction to mind-altering
Food is something we all need to live; none of us needs
drugs or alcohol to survive, but alcoholism and drug addiction
are characterized by a physiological process of dependence
completely unknown to most overeaters or sex and love addicts.
Food can be a way for people to establish and maintain relationships,
express their cultural identities, or spend leisure time.
One progressive political analysis of food and eating-fat
liberation-comes in direct conflict with the Twelve-Step
approach of Overeaters Anonymous.
In particular, feminists have exposed American society’s
cultural imperatives about the physical body-what it is
supposed to weigh, look like, feel like, smell like, and
act like-and claimed that accepted notions of clothing,
diet, and appearance are among the causes of women’s
self-hatred. Fat liberationists have developed the convincing
argument that fat itself is far less of a health or self-esteem
issue in the lives of fat people than are endless cycles
of debilitating diets or stereotypes about what fat (and
thin) people must be like.
Sex is no more a survival need than alcohol. Yet, like the
desire for food, the desire for sex often exceeds the body’s
need to satisfy the basic hungers of human emotion and spirit.
It can be a tremendous source of pleasure, which is why
most people do not choose long-term celibacy. People, who
enjoy sex because of how it makes them feel about their
partners, or those who simply look forward to the next time
they have an orgasm, may be considered perfectly normal.
They also can be considered slightly neurotic, or completely
obsessive. Whether an individual feels sexually normal or
abnormal is determined by social attitudes as much as by
specifics of sexual pain and pleasure in her or his own
Sex and Love Addicts Anonymous (SLAA) is a relatively new
program; it was founded in Boston in 1976 by recovered alcoholics.
An SLAA pamphlet, entitled “40 Questions for Self-Diagnosis,”
asks: ”Have you ever wished you could be less emotionally
dependent? Do you find yourself in a relationship you cannot
leave? Do you believe that sex and/or a relationship will
make your life bearable?” I think many people-certainly
large numbers of women-would be inclined to answer yes to
questions such as these. Does that make us all sex and love
What exactly does recovery involve for an SLAA member? According
to members, the goal is to find love and sex within a true
partnership, a kind of relationship (generally understood
to be monogamous) that does not fuel the addiction. If no
committed, continuing relationship is possible, then total
sexual abstinence is called for as the only method of maintaining
sexual sobriety. Clearly, a traditional hierarchy of sexual
values is being upheld here; Monogamy is the healthy ideal,
and celibacy is preferable to promiscuity.
The Twelve-Step approach does not take up the significant
differences between addictions or people. The programs downplay
contradictions and differences by implying that all substances
and activities are addictive when the enable the user (or
doer) to numb out and suggest that people are trying to
fill painful psychological/spiritual voids that no substance
or activity can actually satisfy. Can all human pain be
collected into one big bundle labeled addiction? Should
it be? What about the feelings of pleasure that people derive
from food, drugs, alcohol, sex, and a host of other substances
and activities? Are these merely self-delusions, the sneaky
evidence of addictions-in-the-making? Or are Twelve-Step
programs simply adding to the guilt already inflicted on
us by our pleasurephobic culture?
If defining addiction is difficult, the Just Say No campaign
has made it even more so by throwing every manner of excess
into the addiction pot and suggesting that a stiff upper
lip can solve everything from a monster federal deficit
to urban crime. Just Say No sounds catchy, but what the
slogan really means is that self-control is the entire answer,
that saying no is an act of moral significance, and that
the people who do so are strong, whereas the people who
don’t are pathetic weaklings. This trend toward championing
the heroism and romanticizing the virtue of the will is
probably a significant contributing factor to the popularity
of Twelve-Step programs.
The current war on drugs, sex, and other modern “evils”
is a hypocritical effort to rub out the cultural changes
of the past two decades by masquerading as a caring crusade.
Take, for example, the dismal state of sex education. The
Regan administration has suggested that parents instill
the concept of chastity in their children by whatever means
they see fit. Millionaire John LaCorte recently made national
headlines with his modest contribution to the Just Say No
campaign: an offer to pay $1,000 to any girl who guarded
her virginity until age 19.
AIDS educators know that they too must play by the rules
that put them in an impossible bind. They can squeak by
only as long as they say no to frank discussions about sexual
pleasure, as a recent case in Massachusetts clearly illustrates.
In November 1987, when it looked like a long-fought-for
state gay rights law might finally pass, opponents of the
bill instigated extensive publicity about sexually explicit
AIDS education materials and succeeded in killing the bill
for yet another year.
If our government were really interested in eradicating
alcohol and drug abuse, it would be spending time and money
on rehabilitation, but it is not. In January 1987, while
Nancy Reagan was having her picture taken with born-again
drug addicts, her husband cut nearly $1 billion from the
national anti-drug budget and actually recommended that
not a single federal dollar be spent on treatment programs.
Meanwhile, 30 million Americans undergo drug screening today-in
prisons, workplaces, sports, the military and on campuses-and
some estimates indicate that 50 percent of the working population
will be tested regularly for drugs by 1992.
matter where the political winds are blowing, however, the
Twelve-Step programs are determined to ignore them. In fact,
avoiding public controversy at all costs is one of the most
consistent structural features of such programs. AA publishes
a booklet describing the “Twelve Traditions”
that govern the structure of Twelve-Step programs. The 10th
tradition specifies: “Our fellowship has no opinions
on outside issues, hence our name ought never to drawn into
public controversy.” This tradition implicitly recognizes
that diverse individuals with conflicting viewpoints participate
in Twelve-Step programs, and it indicates that a formal,
non-political identity is the only logical way to preserve
internal unity and prevent groups from being diverted from
their purpose by secondary issues. Some important questions
do remain, however, about the political implications of
Twelve-Step philosophy and structure.
The programs’ core concept-personal accountability
for one’s actions-is decidedly apolitical: The responsibility
for both addiction and recovery rest squarely on the individual.
In particular, the programs’ philosophy that addiction
is a disease emphasizes the person and problem in isolation
from any outside social forces. This may ease some of the
guilt that people feel for pain that they and others have
experience. One Al-Anon member, in great relief, told me:
”I make no decisions. The disease does. I am sick.”
This kind of language and the Twelve Steps constantly refer
people back to themselves with the message that their old
negative ways of thinking and behaving are the sources of
their pain. Consequently, only new, positive approaches,
nurtured by the programs themselves, will produce serenity.
I rarely heard any speakers in meetings-whether recounting
stories of assault, workplace hassles, or matters of the
heart-mention directly the realities of physical power,
economic inequality, racial bigotry, or sexual coercion,
even in instances where these were clearly being described.
This is true even in Women for Sobriety (WFS), a “new
life” program for women alcoholics that differs from
Twelve-Step programs in that it tries to identify the unique
recovery needs of women. For example, one WFS member was
talking happily about her new job as a clerical worker in
a big law firm but started sounding anxious when she described
her new boss as “a man with a bad reputation for kicking
his secretaries around like dogs.” She concluded that
this worrisome situation was really a test of her sobriety,
and she resolved to “meet the challenge to be a pleasant
person, no matter what.” Because meeting rules do
not permit direct responses from others in the room, and
because no larger social context is officially recognized,
no one in the room suggested to this young woman that she
did not deserve to be treated like an animal or that she
was the potential object of sex discrimination. As far as
the program went, the answer was for her to “think
conflict between seeing responsibility in purely individual
or purely political terms arises in the first of the Twelve
Steps: “We admitted we were powerless over (
)--- that our lives had become unmanageable.”
For many, this step is problematic because it turns the
progressive political goal of empowerment on its head. But
because people generally do not like living with intense
contradictions, politically aware Twelve-Step members creatively
manage the conflicts between their politics and their Twelve-Step
experiences. Here is how one politically active lesbian
explained the importance of taking the first step, admitting
powerlessness, and another sticky concept, the Higher Power.
When I was getting sober, AA was completely in opposition
to my experience as a politico because one of the big words
was powerlessness. Every activist’s hair stands on
end at the idea of embracing powerlessness, which you’re
supposed to be wild about in AA….I found a way to
rework the philosophy. It was clear to me that the minute
you “give up,” you begin a process of empowerment….The
big stumbling block for me was the whole God thing….
To me, this was completely patriarchal and repugnant. So
someone suggested a concept of God that wouldn’t offend
me-historical materialism [the orthodox Marxist theory of
Members who aren’t quite as good at fine-tuning the
Twelve-Step approach to their own personal philosophies
are simply reminded to “take what you need and leave
the rest,” a handy Twelve-Step slogan designed to
minimize conflict and to help people feel comfortable.
The custom fit of the Twelve-Step experience is undoubtedly
part of its appeal, but in the context of a Just Say No
culture, it risks distorting personal pain to a point where
people who really do not have addiction problems are encouraged
to think they do. The most striking evidence of this is
that many people who are not alcoholics, overeaters, or
drug addicts are regularly attending meetings and adopting
the Twelve-Step philosophy as their own, anyway. The presence
of non-addicts is controversial in some but not all meetings,
where addicts consider them to be diluting the program and
distracting members from their main goal of recovery.
As one follower said, “There are some people-I won’t
say they’re addicted to the programs because that’s
not an appropriate use of the word-who do use the programs
as a crutch. The meetings aren’t about making friends.
They’re about changing your life.”
But for many, the programs are about making friends, and
it is not unusual for members’ friendship networks
to change radically, even completely, after entering the
program. For some, this is a necessary part of learning
that relationships that do not revolve around alcohol or
drugs are possible. For others, the programs are just new
ways of feeding unsatisfiable hungers for visibility and
recognit-ion and a place to experience contrived interactions
dressed up as a recovery. The latter experience is merely
a new form of dependency.
and other abuses clearly exist in our society, taking horrible
tolls on individual lives. Total abstinence must be supported
for those who feel it is their only non-abusive option.
But just because many things can be dangerous does not mean
that they always are. Positive and negative potentials exist
side by side. Drugs, sex, food, and other things can be
quite wonderful. We should be as determined to define our
right to pleasure as we are to eradicate the reality of
our pain. To some degree, our dignity as a society will
be measured by our success or failure in this regard.
Progressive political movements should be taking notes on
what is so appealing about the recovery movement. Political
leaders and artists inspire us with visions of peace and
social justice; activists discuss and strategize; foot soldiers
do the work of getting us from here to there. Meanwhile,
we all have to get through the day. Getting through the
day might mean staying away from a bar, finding a friend
to cry with in a moment of sadness, or having wonderful
sex all afternoon. It might just be another day at work.
Whatever it is, it is what political movements should be
about. Changing the structure of political power is not
as possible, certainly not as meaningful, when changing
ourselves is absent from the political agenda.
There is no doubt that Twelve-Step programs have helped
people get through a lot of days. But they do nothing to
decipher or change the larger context in which time passes,
especially in a Just Say No culture that would like to wipe
out progressive gains for good.
Political movements can address the larger context, and
they have something unique to contribute to the recovery
process: an understanding that prevailing cultural messages
affect how people feel about themselves just as much as
“Think Positive” slogans do. Self-hatred and
self-love are not matters of luck or fate; they do not come
and go only on uncontrollable tides of willpower. People
struggle for and against them, and they will be won or lost
just as all contests of power are won or lost. We must keep
our eyes on the prize of pleasure even when we are in pain,
not allowing suffering to become a symbol of sin or sainthood,
nor endorsing sickness as a test of moral character, and
not making addiction a prerequisite for support and community.
If we succeed, we may all get to serenity.
with permission from Out/Look: National Lesbian and Gay
Quarterly (Summer 1988 Subscriptions:$19/yr. (4issues) from
Box 46030, San Francisco, CA 94146-0430. Back issues available
from same address.
Utne Reader, Nov. Dec. 1988)