the 12 - step habit
Should you get with the program?
Roberta Pollack Seid, Ph.D.
I confess, I really look forward to my stiff cocktail every night, eat-more fat laden calories than I intended to and worry a lot - even in my sleep - about my husband, children and our careers. Am I an alcoholic? Foodalcoholic? Workaholic? Codependent? Should I get off the treadmill and begin some serious 12-stepping?
You'd think so. Twelve -step recovery programs have been sweeping the nation, and an estimated 15 million to 45 million of us now participate in them. Book on codependency top best-seller lists, and in April, a cable station all about recovery, the Recovery Network, began airing two hours a day and already reports to have 15 million viewers. Even President Clinton and Vice President Al Gore use recovery lingo in some of their speeches.
It all began in 1935, when stockbroker Bill Wilson, struggling to stay sober, sought help from a fellow drinker. Wilson found that the mutual support, mixed with spirituality, was effective in keeping him sober, and he went on to write Alcoholics Anonymous (aka "The Book") which spells out the 12-step program he created.
In many ways, The Book shaped our current views of addiction by pointing out that, whether physical or psychological, it is not a contemptible moral defect; it's the product of a tragic, incurable disease. The best alcoholics can hope for is remission, which only comes with abstinence, because even a sip can trigger craving and abuse.
According to 12-step philosophy, you must get support by attending meetings with other recovering addicts for the rest of your life. The meetings are free and enforce anonymity, in part to encourage honesty: Hence the famous introduction, "Hi, my name is (first names only) and I'm an alcoholic."
A.A. Meets the '90s
By the late 1950s, applications of the 12-step model had spread from chemical dependency to compulsive behaviors (Gamblers Anonymous in 1957 and Overeaters Anonymous in 1960, for example). But in the past decade, the term addiction has ballooned to mean any activity or emotion we feel powerless to control: work, sex, shopping, love, moods, you name it. At the same time, "codependent" has expanded from its original meaning - family members of alcoholics only - to include anyone involved in, or dependent on, any unhealthy relationship, regardless of whether alcohol is involved. By the new definitions, it seems that nearly everyone suffers from or is affected by, some sort of addiction.
Today, 12-step philosophy is pervasive. Many therapists refer patients to such programs, and courts often order convicted drunken drivers to attend A.A. Millions who struggle with destructive behavior have found healing in the 12 steps. "Try it," says Laura, a thirteen-year member of Emotions Anonymous. "If you don't like it, we'll refund your misery."
But There's a Plot Twist
New research is starting to cool the 12-step fervor. A recent study by the National Institute on Alcohol Abuse and Alcoholism indicates that A.A. is no more successful in curbing alcoholism than behavioral or motivational psychotherapy treatments. Other studies suggest that A.A.'s strict insistence on abstinence sometimes backfires.
According to Reid Hester, Ph.D. director of division of the research Behavior Therapy Associates in Albuquerque, N.M., ex-drinkers who equate "one slip" with "relapse" end up bingeing more often than those who are more tolerant of their lapses. In fact, European alcoholic treatment programs generally encourage moderation rather than abstinence.
When it comes to drugs, studies have begun to challenge the assumption that one hit of an addictive substance begins a lifelong downhill spiral of dependency that only 12-step or professional intervention can control. Most of the soldiers addicted to heroin during the Vietnam War got over their addiction simply as a result of returning home. Of those who used heroin on their return, only 12 percent became addicted again. What's more, research suggests that by age 35, most substance abusers "mature out" of the abuse and become moderate users or abstainers, without intervention.
Critics also are concerned about the psychological impact of the 12-step philosophy. Addiction often is symptom of other problems, and fellow sufferers, while often offering precious support, don't have the training to treat such problems, says Stan J. Katz, M.D., and Aimee E. Liu in their book The Codependency Conspiracy: How to Break the Recovery Habit and take Charge of Your Life (Warner, 1991). In addition, the authors point out that we can become hooked on the recovery programs themselves, substituting one addiction for another.
The recent codependency craze also troubles some experts. Several codependency theorists contend that the modern family is dysfunctional, leaving more than 95 percent of us with a starved "inner child" and a personality primed for dependency. Many argue that the terms codependent and dysfunctional become meaningless when they include so many of us, and this viewpoint encourages us to perceive ourselves as victimized or diseased.
In fact, 12-step thinking may lead us to interpret potentially harmful behavior - like drinking a glass of wine every night - as an addiction. Some experts believe this label is counterproductive at best. Stanton Peele, Ph.D., author of Diseasing of America: Addiction Treatment out of Control (Lexington, Books, 1989), suggests that the A.A. message is dangerous because it implies that we don't have the willpower to change without help from others.
Happily Ever After
Culturally, 12-stepping may fill a deep need. "It's really a religious movement," says Harry Levine, Ph.D., professor of sociology at Queen's College City University of New York. Wilson modeled A.A. on evangelical ideas, but modern psychology infiltrated it and changed the words. You confess you're an addict as opposed to a sinner, and you seek recovery rather than salvation. In fact, the religious nature of A.A. has prompted some legal scholars to contend that courts violate the First Amendment's freedom of religion when they order drunken drivers to attend A.A., while new groups are sprouting for those who don't believe in a higher power.
Perhaps this movement just continues our historical search for perfection or the age-old struggle to deal with our destructive impulses. Surely, it has helped many improve their lives. But blaming our troubles on an addiction, or on dysfunctional upbringing, may not help us or our culture.
So before you assume you're addicted to something, consider the inner strengths you do have. Rather than nurturing your inner child in a 12-step program for the rest of your days, you might find more power in improving your coping skills and facing life's responsibilities head-on.
Roberta P. Seid, Ph.D., a historian/writer in Santa Monica, Calif., is author of Never Too Thin: Why Women Are at War With Their Bodies (Prentice Hall press, 1989).
(Source: SHAPE, November 1997)