Article 132

Magazine and Newspaper Articles

The Happy Humanist - The Humanist, November/December 1992

Albert Ellis
Rational Recovery and the Addiction to 12-Step Therapies

Several alternative self-help organizations to Alcoholics Anonymous have sprung up during the last several years. This article will discuss one of them: Rational Recovery System, which was started in 1976 by Jack Trimpey, a licensed social worker. Rational Recovery now has groups in over 360 cities throughout the United States and abroad; its headquarters is in Lotus, California (Box 800, Lotus, CA 95652; 916-621-2667).

While there are few data other than testimonials available, attendance at AA meetings and belief in 12-Step programs have probably helped great numbers of people to overcome their harmful addictions to alcohol and other substances and to lead happier and emotionally healthier lives. But, alas, the same thing can be said when disturbed people devoutly follow various dubious groups and cults, such as those promoted by the Christian flagellants, the Moslem dervishes, the Hebrew cabalists, and the Catholic Inquisition. Literally millions of people have made themselves less anxious and depressed by swearing allegiance to extremist religious and political gurus-ranging from Rasputin and Adolf Hitler to Jim Jones and Tammy Baker-who dogmatically believed that they could save the world for their fervent followers.

The point is that none of these prophets had magical curative powers; nor did the sacred views that they passionately promulgated to hordes of gullible followers. But the faith of their adherents obviously helped these troubled people to change themselves and to give up all kinds of harmful addictions. Similarly, people’s intense belief in a wide variety of implausible creeds and nostrums frequently help them change their dysfunctional thoughts, feelings, and actions. Witness, for example, the fervent testimonials that innumerable people keep giving for cults, superstitions, and hoaxes like astrology, shamanism, psychic surgery, fortune telling, channeling, witchcraft, communications from ghosts, satanism, and demonism.

We have considerable testimonial evidence, therefore, that AA and other 12-step programs help a good number of people. But we do not know whether the content of these programs leads to their presumed benefits or whether those benefits stem from a new belief system their adherents adopt. Furthermore, we do not know whether greater benefits would be derived from alternate self-help programs. Just as soon as we acknowledge the possible effectiveness of 12-step programs, we had better also recognize their serious failings and lapses.

First of all, AA is clearly a religious organization, in spite of its allegations that its group members need only pray and meditate “to improve our conscious contact with God as we understand Him.” Steps 2,3,5,6,7,11, and 12 of its 12-step program explicitly endorse God with a capital G, advocate allegiance to a Higher Power (capitalized again!), or call for a “spiritual awakening.” And the other five steps, though they include some sensible advice to help addicts, strongly hint that only dependency on some supernatural entities and on Christian-like salvation, atonement, and redemption will enable one to stop and continue to desist from drinking.

Clearly, then, AA groups are no haven for millions of secular humanists, agnostics, atheists, feminists, and other nonreligionists-nor for many religionists who see that humans can help themselves without relying on any higher powers. Because AA often zealously proselytizes for its endorsement of divine intervention, it turns off thousands-and quite possibly millions- of potential adherents who might profitably join a self-help group to combat their harmful addictions. Almost every psychotherapist and physician encounters many alcoholics who attended AA groups for a few sessions, only to be turned off by their religious and spiritual approach, and who fought vigorously against attending more meetings even though some court or medical authority insists that they do so.

To make matters worse, AA subscribes to many rules and cannons about alcoholism that are controversial, questionable, and sometimes iatrogenic. The 12-step programs strongly state or imply these dubious points:

- Alcoholism is unquestionably a disease and takes a single, invariant course which ends in total abstinence or death.

- Addicts can never stop their addictions outside of 12-step programs.

- Once “alcoholics: stop drinking, a single drink will lead to total relapse and send them to skid row.

- Problem drinkers need a higher power to quit drinking; if they are not theists, they can use anything (beauty, justice, an ashtray, a tree, etc.) as the power to which to turn over their lives.

- Addicts can only properly be treated by other recovering addicts.

- Children of “alcoholics,” even as adults, are invariably disturbed and have to go through 12-step programs themselves in order to lead sensible, happy lives.

- Spouses and close relatives of alcoholics are “codependents” who must be indoctrinated with 12-step programs and materials.

- AA members, to stay off booze, must attend regular AA meetings practically forever.

- All effective programs for addicts must have strong religious or spiritual elements. Faith-not reason-must prevail in these programs.

- “Alcoholics” who refuse to keep coming to AA meetings or who disagree with the 12-step program are seriously disturbed deniers.

- Addicts can overcome their emotional disturbances with AA meetings instead of with psychotherapy.

- “Alcoholics” never really recover from their addiction; they remain “recovering” addicts for the rest of their lives.

- “Alcoholics” who no longer drink but are still anxious, depressed, or manic are “drydrunks” who need still more 12-step treatment rather than psychotherapy.

- The use of psychotropic medication by addicts is wrong and almost certainly leads to readdiction.

- Endless cathartic confession at AA meetings is the best form of treatment for alcoholism.

While AA subscribes to a number of questionable ideas, it has many good points and has served hundreds of thousands of problem drinkers very well since it was founded in 1935. Many of its tenets and practices are quite sensible and practical and overlap with the rational-emotive therapy concepts that are used by Rational Recovery. Thus, like RET, AA includes the following rational ideas:

- It sometimes looks for and tries to combat compulsive drinkers’ dysfunctional beliefs.

- It uses many educational and bibliotherapy procedures.

- It advocates some nondisturbing beliefs, such as “Make plans but don’t think that you have to plan the results and have to achieve them.”

- It uses many coping statements, such as “Live and let live.”

- It follows many self-help procedures and urges active homework.

- It emphasizes the serenity prayer of Reinhold Niebuhr: “Give me the courage what I can change, the serenity to accept what I cannot change, and the wisdom to know the difference.” Whereas RET, however, uses this as a philosophy and not as a prayer, AA uses it as an appeal to God.

- It believes that most conventional “past-oriented” therapies do not help people to stop drinking and maintain abstinence and that new thinking and changed behavior can aid these goals.

As can be seen, AA has many good (we could even say rational) philosophies and procedures. It never meant to coerce members and participants. Many of its limitations follow what humans do when their ideology is founded on religious faith-not on reality and experimentation-and is taken to devout extremes.

On both religious and nonreligious grounds, AA and other 12-step programs have limited value and sometimes, because of their devout orientations, can be said to lead to addiction to the 12-step process itself. So, despite its distinct advantages (and despite the likelihood that some substance abusers would not have stopped their addictions without its help), AA has distinct limitations. Consequently, several non-higher power groups have been established during the 1980s which serve as alternatives to AA. These include, in addition to Rational Recovery, the Secular Organizations for Sobriety, Methods of Moderation, and Men and Women for Sobriety.

As might be expected, I favor Rational Recovery because it is the only self-help group that not only has no religious or spiritual orientation but also solidly links its program to rational-emotive therapy and cognitive-behavior therapy. RR groups are educational rather than therapy groups and, although members pay no fees, each group tries to be closely connected with a professional consultant who is trained in RET. The consultant or advisor need not have a history of addiction or attend every single RR meeting. He or she tries to help the group members learn the basic principles and practices of RET and to apply them to disputing the irrational beliefs that were instrumental in driving them to drink and in blocking their achievement of sobriety.

RR holds that, although problem drinking and substance abuse have many biological and social origins, much of the thinking of “alcoholics” follows the famous ABCs of RET and CBT. According to RET theory, many (not all) problem drinkers first tend to bring about dysfunctional consequences Cs), such as anxiety and depression, when unfortunate activating events or adversities (As) occur in their lives. They do this mainly by constructing irrational or self-defeating beliefs (Bs). Second, they then tend to construct additional irrational beliefs (iBs) about their feelings of depression and anxiety-especially “I must not be anxious! I can’t stand this anxiety!”- and consequently take to drinking in order to allay their pain. Third, problem drinkers often take their secondary consequence-“alcoholism” – and create more irrational beliefs about that, such as “I must not be an alcoholic. What a worm I am for drinking too much!” This creates a tertiary consequence-self-damnation-that frequently drives them to drink even more. Also, because of their self-castigation for being addicted, problem drinkers frequently minimize their serious drinking problems and resort to many rationalizations and denials about their drinking.

In the course of RR meetings, the ABCs of alcoholism and its related emotional and behavioral disturbances are discussed and the RET techniques of actively, forcefully disputing (D) the members’ dysfunctional beliefs are taught and practiced. Jack Trimpey’s Rational Recovery from Alcoholism: The Small Book and other RET-oriented self-help books, pamphlets, cassettes, and materials are steadily used, examined, and applied to the members’ addiction and to their other problems. A number of cognitive, emotive and behavioral techniques of RET are practiced, with the goal of showing the participants how to think, feel, and act more appropriately and to achieve their personal goals. Members are thereby helped preferably to make a profound philosophic change that will promote their continued sobriety and minimize their general disturbance. Ideally, they will become significantly less disturbable and, after being in RR for a while-though hardly forever!-will often prevent themselves from emotionally upsetting themselves in the future.

Rational Recovery, as can be seen, is more of a self-help than a support group and in this respect is much closer to Recovery Inc., than it is to AA. It differs from AAA in several other important aspects:

- It doesn’t endorse the disease concept of “alcoholism.”

- It sees its members’ participation in RR as time-limited and discourages their perpetual dependence on RR meetings.

- It recommends lifetime abstinence when there have been repeated failures to exercise moderation but recognizes that some problem drinkers can and do learn to drink moderately and responsibly.

- It accepts the treatment of addicts by counselors and therapists who have never themselves been addicted.

- It doesn’t see all children of alcoholics as emotionally disturbed, nor all their close relatives as disturbed codependents. Instead of Codependents Anonymous groups, it soon will sponsor generic self-help groups where members learn how to stop being too dependent upon anyone or anything, including RR meetings.

- It has no objection to its members using a religious or spiritual orientation to help themselves with their addiction and other problems, but it takes a completely pro-choice attitude and holds that problem drinkers do not need any support from a higher power and that they clearly have the ability to change themselves without any spiritual support. It encourages them to rely on their own capacities to make meaningful, existential, and philosophic alterations in their lives-and if they want to invoke gods or spiritual forces in the process, that is their prerogative rather than their necessitude.

- It recommends some form of intensive individual or group psychotherapy-especially RET or some other mode of cognitive-behavior therapy-as a highly important part of the anti-addictive process and encourages its members to explore and change the feelings and behaviors that led to their addiction and that keep them at risk for relapses.

- It recognizes that problem drinking and the emotional disturbances that frequently accompany it often have biochemical and biological, as well as psychological and social, aspects, and it therefore often encourages the combined use of psychotherapy and medication to help addicted persons.

Rational recovery is opposed to the one-party system for helping problem drinkers-meaning AA and its higher power indoctrination-and strongly favors a democratic multiparty system that may well include AA plus other anti-addiction groups which aim to provide a meeting ground for people who want nothing to do with any kind of higher power and who want to rely on themselves and other humans to achieve and maintain sobriety. RR particularly opposes the unconstitutional stand of many courts and public agencies that now force alcoholics to join religiously oriented 12-step programs and dictatorially give them no nonreligious choice.

RR, unlike AA, welcomes research on the effectiveness of self-help groups, including RR itself, in helping addicts stop their substance abuse and stay stopped and is therefore cooperating in studies to evaluate its therapeutic results-studies such as are now in progress at the Harvard University Medical School and the New York University Medical School.

Following the theory of RET, RR teaches its participants unconditional acceptance of themselves and others and shows them how to evaluate their thoughts, feelings, and actions, but not to measure or devalue their self or personhood.

Rational Recovery-and the other addiction recovery groups that are without any religious or spiritual tenets-are by no means the only answer to the problem of helping people to overcome their serious addictions. The 12-step programs obviously have some excellent results and are not likely, in the near future, to go out of business. But as RR continues to grow and to serve large numbers of participants, it will be valuable to discover just how effective an anti-addictional program is that places no emphasis on a higher power and that attempts to incorporate in its self-help procedures specific rational-emotive and cognitive-behavioral therapeutic methods.

Here’s a selection of material that you might find helpful:

- The Essential Albert Ellis by Windy Dryden (New York: Springer Publishing Company, 1990).

- The Practice of Rational-Emotive Therapy by Albert Ellis and Windy Dryden (New York: Springer Publishing Company, 1987).

- Rational-Emotive Therapy with Alcoholics and Substance Abusers by Albert Ellis, John McInernery et al. (New York:Pergamon, 1988).

- “Divine Intervention and the Treatment of Chemical Dependency,” by Albert Ellis and Eugene Schoenfeld, Journal of Substance Abuse (1990) 2:459-468.

- When AA Doesn’t Work For You: A rational Guide for Quitting Alcohol by Albert Ellis and Emmett Velten (New York: Barricade Books).

- The Truth About Addiction and Recovery by Stanton Peele and Archie Brodsky (New York: Simon and Schuster, 1991).

- Rational Recovery From Addiction- The Small Book by Jack Trimpy (New York: Dell Books, 1992).

- Rational Recovery from Fatness-The Small Book by Jack and Lois Trimpy (Lotus, CA: 1990).

Albert Ellis is president of the Institute for Rational-Emotive Therapy, 45 East 65th Street, New York, NY 10021-6593. He is the founder of RET and is considered the “grandfather” of cognitive-behavior therapy.

(Source: The Humanist, November/December, 1992)


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