12-Step Traditions, The Disease Concept,
and Group Psychotherapy Integrations
Chapter 3 and 5 in Flores
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12 - Step History and Foundations
Ideologies spawned from Christian religious sect “Oxford
Group”
Temperance movement ideas and concepts
Connection to and between struggling alcoholics (Bill Wilson /
Dr. Robert Smith)
Founded June 10 1935
Conversation with Carl Jung
Bill’s Spiritual Awakening...
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Bill W. Reports:
Lying there in conflict, I dropped into the blackest
depression I had ever known. Momentarily my prideful
depression was crushed. I cried out, "Now I am ready to do
anything - anything to receive what my friend Ebby has."
Though I certainly didn't expect anything, I did make this
frantic appeal, "If there be a God, will He show Himself!"
The result was instant, electric beyond description. The
place seemed to light up, blinding white. I knew only
ecstasy and seemed on a mountain. A great wind blew,
enveloping and penetrating me. To me, it was not of air but
of Spirit. Blazing, there came the tremendous thought, "you
are a free man." Then the ecstasy subsided. Still on the
bed, I now found myself in a new world of consciousness
which was suffused by a Presence. One with the Universe,
a great peace came over me.
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Bill continues...
I thought, "So this is the God of the preachers, this is the great Reality." But
soon my so-called reason returned, my modern education took over and I
thought I must be crazy and I became terribly frightened. Dr. Silkworth, a
medical saint if ever there was one, came in to hear my trembling account of
this phenomenon. After questioning me carefully, he assured me that I was
not mad and that perhaps I had undergone a psychic experience which might
solve my problem. Skeptical man of science though he then was, this was
most kind and astute. If he had of said, "hallucination," I might now be dead.
To him I shall ever be eternally grateful.
Good fortune pursued me. Ebby brought me a book entitled "Varieties of
Religious Experience" and I devoured it. Written by William James, the
psychologist, it suggests that the conversion experience can have objective
reality. Conversion does alter motivation and it does semi-automatically
enable a person to be and to do the formerly impossible. Significant it was,
that marked conversion experience came mostly to individuals who knew
complete defeat in a controlling area of life. The book certainly showed
variety but whether these experiences were bright or dim, cataclysmic or
gradual, theological or intellectual in bearing, such conversions did have a
common denominator - they did change utterly defeated people.
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Disease Perspective: Primary Keys
• Addiction to chemicals or behaviors or processes is not a symptom of a
more serious core issue
• Primary condition that must be arrested if any progress in treatment is to
occur
• AA holds total abstinence as key
The Field is Merging
• Academic perspective
• Disease practitioners
• Sharing of evidence
• The legitimization of dual disorders
• The question of controlled drinking?
Specific Implications of Group Therapy
& the Disease Model
• Beginning of treatment is not aimed at uncovering psychological pathology, but at identifying
the defenses and characterological deficits that prevent compliance with abstinence and
recovery
• Relieving or discovering underlying symptom will not bring about recovery or abstinence
• Disease can be viewed as a lifestyle of behaviors
• Characterization of “oneself as an alcoholic”
• AA doesn’t so much teach us how to handle our drinking but how to handle our sobriety
• Folks in AA don’t go for knowledge they go for inspiration
• They need to be emotionally touched
An A.A. Briefing
❖ Most
frequently consulted source for help with drinking
problems
❖ Approx.
1 in every 10 adults in the US has attended an AA
meeting
❖ 2/3
of these have attended ONE meeting because of another
person’s drinking
❖ Empirical
evidence on 12-steps efficacy is sparse and
inconclusive
Membership Stats
❖ Currently
there are 97,000 groups spread over 150 countries with
a total membership estimated at 2 million
❖ 1.2
million of these are from the U.S. and Canada
❖ As
of Jan 2006 - Canada reportedly had 110,449 members in AA
(General Service Office of AA, 2007).
❖ Non
for profit group
Primary Purpose ?
❖ Provide
its members with a program for ‘living” without
chemicals / behaviours
❖ Carry
message to other addicts who still suffer - there is a way
to sobriety!
❖ This
all done with a language an addict understands
❖ BECAUSE
AN ADDICT IS TALKING TO ANOTHER ADDICT
How it works?
❖ “Mirroring”
❖ See
break thru defenses
through preoccupation with the “self”
❖ Spiritual
growth includes self - but learn to be apart of...
❖ Seeing
❖ Offered
the “one as whole”
a choice: New life or Old life
Here’s the Kicker
❖ Requires
❖ Not
active participation!
passive attendance
❖ You
have to work the
program
❖ Accept
you are powerless
and your life has become
unmanageable
The Bottom Line
❖ Stop
looking for a cause and take responsibility for your
actions
❖ Come
to see that YOU ARE YOUR PROBLEM - not the drug
of choice or behavior
❖ Lifelong
process
How it works (cont.)
❖ Challenges
❖
Loneliness
❖
Uniqueness
❖ Provides
and usurps,
and offers
❖
Distillation of Hope
❖
Predictability
More How About it Works
Later in the Lecture
The 12 Steps of
Alcoholics Anonymous
12 STEPS OF ALCOHOLIC ANONYMOUS
Step 1 - We admitted we powerless over alcohol that our lives had become unmanageable
Step 2 - Came to believe that a Power greater than ourselves could restore us to sanity
Step 3 - Made a decision to turn our will and our lives over to the care of God as we
understood him
Step 4 - Made a searching and fearless moral inventory of ourselves
Step 5 - Admitted to God, to ourselves, and to another human being the exact nature of our
wrongs
Step 6 - Were entirely ready to have God remove all these defects of character
Step 7 - Humbly asked Him to remove our shortcomings
Step 8 - Made a list of all persons we had harmed, and became willing to make amends to
them all
Step 9 - Made direct amends to such people wherever possible, except when to
so would injure them or others
do
Step 10 - Continued to take personal inventory and when we were wrong promptly
admitted it
Step 11 - Sought through prayer and meditation to improve our conscious contact
with God as we understood God, praying only for knowledge of God's will for us
and the power to carry that out
Step 12 - Having had a spiritual awakening as the result of these steps, we tried
to carry this message to other addicts, and to practice these principles in all our
affairs
More Metaphoric
Disease as metaphor more than
scientific disease
More clinically relevant
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Is abstinence necessary?
Heavy drinkers might not be alcoholic!
Controlled drinking?
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Controlled drinking camps
Critically important to distinguish the diseased from
the abusers
One defines an addict
“Pickle can’t become a cucumber again”
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Heavy drinker’s who may not be
alcoholic
Display less severe physical
dependence
Tend to be younger
Tend to not have positive family history
of addiction
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Low bottom, high bottom
High bottom (airline pilots, neurosurgeons, veterinarians, attorneys, nurses,
priests)
Function responsibly in their demanding careers (eventually may crash)
Degree of social consequences before recovery and after abstinence may
have not brought about severe social consequences
Still considered alcoholics
Diagnose yourself (admit powerlessness and unmanageability)
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An Example of a High
Bottom
QuickTime™ and a
H.264 decompressor
are needed to see this picture.
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Valliant’s deviance and social
consequences as diagnostic criterion
Believes deviance and social consequence
more reliable that loss of control
Put 10 alcoholics in a room and tell them that
research shows that 1 out 10 people can return
to normal drinking... Each of those 10 will think
they are SPECIAL ONE
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Jerome Frank: Anthropological
Perspective
AA has always know that group
affiliation can counteract isolation
and demoralization...
This is for you cell phone addicts
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Specific Implications of Group and
the Disease Concept
Chronic diseases require constant monitoring
For the addict this means monitoring of
lifestyle
Alcoholism cessated never cured
Beginning group psychotherapy is not so much about
uncovering psychological pathology as it’s about identifying
defenses that prevent abstinence and recovery
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What is the defense here?
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Exotic beliefs and useful
illusions
Blowing out the flame of desire
NIRVANA AND SAMSARA ARE
ONE
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Why it works?
Program will not work with those who only want to quit, or want
to quit because they are afraid of losing their families or jobs
Desire based on enlightened self-interest
Back to step 1 - illness is an uncontrollable drinking problem even one drink is too many
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Surrender
Gut level, surrender to power greater than oneself
Confront naked existence
Haven’t be able to manage part of life affected by their drinking
Cannot do anything about tomorrow
All have quit for 24 hours, a few days, a week, a month... Constant
state of staying sober (back to useful illusions)
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