January 08, 2021

By Randy Withers, MA, NCC, LCMHC

Alcoholics Anonymous has helped millions escape the clutches of addiction. For those of us who are in recovery, we know that AA works. Over the years, hospitals, community agencies, rehabs and even the court system have come to respect the effectiveness of 12-Steps programs as well.

For most of my career, I have served as a substance abuse counselor at various community agencies and hospitals. In those settings, 12-step facilitation makes sense. After all, active involvement in community support groups is an excellent complement to therapy.

What I have learned, though, is that the 12-Steps are valuable in mental health settings, too. Indeed, the point of working steps is to become a better version of yourself — is that not the point of therapy as well?


Why 12-Steps and Therapy Are Complementary

Alcoholics Anonymous first introduced the concept of the 12 Steps in 1935. In 1953, Narcotics Anonymous was established to address the use of all addictive substances, most notably heroin and other opiates. Since then, many other 12-Step programs have emerged, including:

  • Cocaine Anonymous
  • Marijuana Anonymous
  • Heroin Anonymous
  • Co-Dependents Anonymous (CODA)
  • Gamblers Anonymous
  • Sex Addicts Anonymous
  • Overeaters Anonymous

While several of these groups provide support for addictions to specific substances, many others do not. CODA’s goal is to promote healthy and loving relationships. Gamblers and Overeaters Anonymous deal with process addictions.

Over time, 12-Step methodology has expanded to exceed the treatment of addiction.

The reason 12-Step principles help with other problems is that substance use and addiction, no matter the form it takes, is often a symptom of a deeper mental health problem. And going through the steps can help address the root of the issue.

Similarly, many modern counseling approaches use cognitive-behavioral theory: how we think affects how we feel, which, in turn, affects how we behave. To facilitate lasting change, therapists help clients identify, challenge and overcome harmful patterns of thinking.

Clinicians call these patterns of thinking “cognitive distortions.” The 12-Step community calls them “Stinking Thinking.” They are one and the same. As such, the goal of 12-Step programs is parallel to the goal of psychotherapy.

12-Step programs are far more involved than anything an individual therapist can offer, if only for the sheer amount of time that a person spends in them when compared to the time spent in face-to-face sessions with a therapist. That doesn’t mean that one is an effective replacement for the other, but it does mean that the two are complementary and can be used together to treat both substance use disorders and mental illness.


How 12-Steps Can Be Used to Treat Mental Illness

I encourage my clients to embrace the “spiritual principles” that members of the 12-Step community believe provide the foundations for long-term recovery.

Spiritual principles are universal values that help us become better people. Behind each step, you’ll find several spiritual principles that bind them together. Some examples include:

  • Acceptance
  • Awareness
  • Honesty
  • Open-mindedness
  • Personal responsibility
  • Willingness
  • Trust
  • Faith
  • Humility
  • Tolerance
  • Fairness
  • Service
  • Forgiveness
  • Love

Many people who are addicted to drugs and alcohol use unhealthy coping mechanisms to survive, like dishonesty and intolerance. In recovery, you have to unlearn these harmful traits. Honesty takes the place of dishonesty, acceptance takes the place of denial, and so on. An exploration of spiritual principles is how people start to get better.

When you work Step One, the spiritual principles you examine include self-awareness, personal responsibility, acceptance, honesty, open-mindedness and willingness. As a person progresses with step work, they encounter and explore the different spiritual principles. For example, Step 5 is built on the spiritual principle of trust, and Step 12 is about the principle of service.

These principles are not solely helpful for issues with addiction, but can also help someone trying to get on the path to recovery from mental illness. And with slight modifications, we can customize all the steps to suit our needs in therapy.


An Example

Let’s take a look at Step One:

“We admitted that we were powerless over X, that our lives had become unmanageable.”

With AA, the “X” is “alcohol.” However, there’s no reason why it can’t be changed in therapy to deal with something like clinical depression.

The first component of Step One is the “powerlessness,” which refers only to the futile attempts made to manage our condition without support. Alcoholics refer to this as “hitting rock-bottom.” For someone with clinical depression, this powerlessness is often what leads people to seek help.

The second component is analyzing the impact of the problem on a person’s life. It refers to the consequences we see from our failed struggle with “X.” In recovery from substance use, we take a long, hard look at the damage done to our lives to define and accept the scope of the problem. Similarly, when a person starts going to therapy, they have to dig deep to open up and explain the symptoms they experience in order to receive an accurate diagnosis.

The next component is taking responsibility for the problem at hand. The Basic Text of Narcotics Anonymous says that, “we aren’t responsible for our addiction, but we are responsible for our recovery.” This also happens to be true with mental illness.

To be clear, responsibility is not about assigning blame. It isn’t about making people feel bad about their symptoms. But while nobody asks for substance use disorders, clinical depression, social anxiety or trauma, successful treatment for those conditions depends on the person taking ownership of their illness. Every clinician knows the challenge of treating someone who refuses to do this. We also know that sense of triumph when a person makes a commitment to recover.

In recovery, understanding Step One is critical. It’s a solid foundation upon which to build from. And if growth occurs from working Step One, imagine the growth from working all 12.

While nobody ever masters any of the spiritual principles, the goal is to aspire to be something greater than we were when we first began the journey. The Steps provide a roadmap and direction, but the spiritual principles give that journey a soul.


Randy Withers, MA, NCC, LCMHC, is a therapist and author of Therapists Share Their Thoughts on Suicide. He earned his Master’s degree in Counseling from Lenoir-Rhyne University and is the Founder of Blunt Therapy, a blog about mental health.

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