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When God is Required for Recovery: The 12-Step Program Problem.

Posted Jun 23 2009 6:54pm

...Crede, ut intelligas...

~ St Augustine ~

Oie_mans_brain   If the 90s were dubbed The Brain Decade, then this new millennium should be called The God Decade.  In less than 10 years we have gone from our obsession with finding the G-spot to our current search for the God-spot.   Nearly every major American magazine in the past 3 months has displayed a cover page featuring God and healing. 

The more sophisticated we become on this planet of ours, the more we desire to keep it simple, to experience the basics, and to return to those things that bring us comfort - the familiar and non-complex.  The more advanced our technology, the greater our desire to know the unknowable, and the more grounded we become, the more we point to the sky for our answers.  In sum, the more complex our world and the more sophisticated our knowledge and understanding of the world, the more we feel out-of-control and yearn for basic comfort and solace.   And when that fails, when all else fails, there is always anesthesia which generally takes the form of some substance or process that we take or do that hits the pleasure center of our cortex and temporarily knocks us out of reality.  

I blog AND twitter and text and Skype regularly, and conduct a portion of my psychotherapy via webcam and laptop with patients from locations the world over, some of which use software to translate their native tongue into English.  I wonder what those in the high-tech fields are doing? When my world gets unglued I long for a cheese doodle, nothing fancy - as basic as you please.  The more we become overwhelmed, the more we return to what is basic and familiar.  To the vast majority of folks, what is most basic and familiar is God.

When those under my care begin to hit a low or feel disconnected, or become triggered, or simply have some spare time on their hands, the thing they are told to do, know to do, is to attend a "meeting" - a 12-step meeting.  There, they can connect with otherwise total strangers with whom they can relate, share their struggles, share their stories and their glories, and find friendship, fellowship, and attachment.  It makes the world a little smaller, a little more doable, a little safer.  But there is a problem.  The "program", based upon the 12 steps and 12 traditions, has not changed its verbiage - not a single word, since its published inception of the Big Book in 1939.  And what is the language?  It speaks of God.  For a program that prides itself on the language of the everyday non-religious person, this is more than a simple failing.  It is an example of saying one thing and doing another.  It is, among other things, a significant breach in the semantic commitment of scientific realism.  More on this not so unimportant concept later.

If you have ever worked in the healthcare profession, if you have ever been in a hospital for physical and/or mental health reasons, then JCAHO has meaning for you whether you know it or not.  JCAHO is the abbreviation for The Joint Commission of Accreditation of Healthcare Organizations, recently shortened to just plain The J oint Commission.  JCAHO is the most widely held and singularly most important/prestigious accreditation body for all healthcare facilities in the United States of America.  Facilities that do not "pass" accreditation requirements set forth by the JCAHO or are in violation of their established standards, can and do loose their license and eventually their ability to operate.  Did you know that one of the standards established by the JCAHO for addiction treatment facilities is the quality of the "spiritual" (almost always interpreted as "religious") component that must be incorporated into the treatment planning of every individual who attends a non-governmental regulated addiction treatment facility, which is almost everyone?  This is a problem.

The "12-steps" of AA (and "SA", "OA", "NA", "CA", and all the other "A" self-help peer-to-peer programs) were founded by members of the "Drunk Squad", AKA the Oxford Group as they have come to be called, which were members of The First Century Christian Fellowship.  Not a Jew or Hindu or atheist among them.  Not a Zoroastrian anywhere in the vicinity.  Their preaching was based upon 4 absolutes which became 6 principles which turned into the 12 steps, in the house that Bill W. built.  It was based upon known, solidly religious (not spiritual), and not just religious but Christian tenets.  Period.  Not a word has been altered.  Some of the programs based upon AA such as SLAA and others, HAVE changed some of their verbiage, but not the verbiage having anything to do with the Christian notion of God.  That verbiage remains.  The Big Book as it is called, is based on a panentheistic God.  This is a huge problem for a program whose mission is purportedly based solely on one and only one overriding criteria - the singular desire not to drink, use, or otherwise imbibe in a drug or drug-producing process such as sex, gambling, or carving one's body with a knife.  And in the sexual addiction programs - the one group whose drug-of-choice is shame - this is the most troublesome.  What is it that you think folks will feel if they cannot fully endorse the tenets of the very program whose ideals and goals are meant to lower their shame quota?  It is at best a conundrum, at worse, a shame fest.

Not all, certainly, but a majority of those that worship the scientific method, whether or not they are actually scientists in their day jobs, do not believe in god.  For example, Creationists, newly repackaged and currently renamed the Intelligent Design folks, are, by and large, deeply religious Christians.  Intelligent Designers are anti-Darwinians.  They do not believe in Darwinian/evolutionary science, and they certainly do not subscribe to the scientific method.  Despite all of this, despite the current religious fervor as featured on the front covers of a plethora of modern American magazines that have no bearing on religion per se, Atheism is on the rise more than ever!  Now, what happens to folks that have an addiction, say a sexual addiction for example, and they want to do what most experts in the field would agree is the right thing to do in such a case, and become a part of the recovering community?  Well, that means that they are obliged to join a 12-step "Anonymous" program.  Likely, the two most important factors in any 12-step program of recovery are accountability and fellowship, the one having everything to do with the other.  The problem?  The other shoe?  Have you read the 12 steps lately?  The other shoe is that the 12-steps are all about god!  What is an atheist to do?  However, if it were ONLY a theistic problem, it would pale in comparison.  The problem, the really big problem is that it is a betrayal of the very ideal that it is supposed to stand for.  What in part makes the 12-step programs work, when they work, is that it was supposed to be fashioned on that one ideal, that one criteria, and that criteria is based upon inclusion.  Meaning, that it is independent of religion, gender, and anything else exclusionary.

I am listing the The 12-steps of AA (substitute "sex" for "alcohol" for the "S" sex addiction programs) below:

1.  We admitted we were powerless over alcohol - that our lives had become unmanageable

2.  Came to believe that a Power greater than ourselves could restore us to sanity

3.  Made a decision to turn our will and our lives over to the care of God as we understood Him

4.  Made a searching ad fearless moral inventory of ourselves

5.  Admitted to God, to ourselves and to another human being the exact nature of our wrongs

6.  Were entirely ready to have God remove all these defects of character

7.  Humbly asked Him to remove our shortcomings

8.  Made a list of all persons we had harmed, and became willing to make amends to them all

9.  Made direct amends to such people wherever possible, except when to do so would injure them or others

10.  Continued to take personal inventory and when we were wrong promptly admitted it

11.  Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out

12.  Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

As we have already discussed, recovery as it pertains to addiction, be it alcohol and drugs or the "process" addictions such as sex or gambling for example, nearly always includes serious adherence and mandatory group attendance in one of the 12-step programs modeled after Bill W's "AA"  12-step "anonymous" self-help programs.  Sponsorship, a buddy-system based upon a tight "mentoring" process is an essential element for the life-long journey of the addict, as is "working the steps", and the ultimate goal, sobriety notwithstanding, is to attain a spiritual awakening and give back to the community in a cosmic what-goes-around-comes-around Gaia sort of way.       

I have always advocated the 12-step model as an ancillary part of their treatment regimen for anyone who suffers an addictive disorder.  I "get around" the god issue by instructing those that may be offended by it to substitute something other than themselves, a "higher authority" if you will, for the word "god".  However, with every passing year I am becoming more and more concerned about the issue of "god" in recovery, and that issue is highlighted at its very core by the verbiage in the 12-step community.  It simply is not enough any more to say, hells bells, what's in a word?  Because sometimes, words, or lack thereof, are everything.  Words are everything.  To change a word is to change a meaning.

Advocates of the 12-step model of recovery maintain that it is not and has never meant to be affiliated with religion, but rather, relies on spirituality as its cornerstone.  I used to agree with that argument.  Philosophically, and psychologically, I am finding more and more evidence to the contrary.  If the program really is about spirituality and not religion, then the language must reflect that.  Sometimes all we have to go on is language.  And when language means something different to different people, then we are no longer speaking the same language and communication becomes a major stumbling block.  To wit, all of the results derived from the scientific community on the research of the efficacy of 12-step programs and recovery, would be up for grabs because of this.

One of my favorite commercials shown in the US opens with a patient sitting on a couch and telling a personal story of some existential angst that he is sharing with his psychologist.  The camera then pans to the chair where the psychologist sits with pen in hand, and before you know it, the psychologist begins to speak in French to the English-speaking patient.  The look on the face of the patient is one of utter astonishment in the realization that he has just shared his inner most thoughts with someone who doesn't even speak his language.

In science, specifically referring to the use of the scientific method in research, we are taught and believe with something akin to religious zeal, that the use of operational definitions are imperative in order to produce and replicate our findings.  Operational definitions as I tell my students, are the universal language of science.  When we define a word, the definition of that word is precise in its meaning and it means the EXACT same thing in New York as it does in Kenya, not a single iota different.  This is a hugely important concept in that the scientific literature that we count on to inform and educate us, must mean the same thing no matter who reads it or in what language.  Science, even the INTERPRETATION of scientific findings, should be equivalent no matter who is doing the interpreting.  If we know that the 12-step programs are based on the concept-of-god in its verbiage, then to change that verbiage is in fact to change the program. 

This is a stunning problem of scientific realism, specifically the semantic commitment of scientific realism that maintains that the language of scientific theories is not interpretable into language about some other domain without change in meaning, and that scientific knowledge is progressive in nature, that it builds on previous understanding.  Now before you scream about AA not being "scientific"  I wholly understand that AA and the rest of the 12-step programs are certainly not about, nor based upon anything resembling science, let alone scientific realism.  However, that does not deter the argument that a program that is supposed to do one thing while it expressly states another, is problematic, and the reason it is problematic is based upon, among other things, a scientific premise.

There are two issues here, one being the actual efficacy of the 12-step model as defined by the scientific literature based upon the concepts they espouse which is further grounded in the language they speak.  The other issue has to do with a more core problem, central to all those that are a part of it - that of a program that advocates one thing but says another.  If in fact the 12-step programs are not based upon nor steeped in religion, then they must reflect that in both the language they speak and the practices that arise out of those concepts.  Again, I am reminded of the Intelligent Design movement that says it is not creationism, while all the while saying EXACTLY the same thing in exactly the same language.  It is not enough to say GOD and then say, yeah, but we don't really mean GOD.  If you do not mean god, then do not say god.  The very word has more meaning, for better or worse, than most any single word in the English language that I can possibly think of.

It might be time for the powers that be to seriously reconsider the language, and of more importance, the MISSION of the 12-step programs - is it really about inclusion?  The same language has been used since its inception in the 1930's, but the planet, and those of us that currently inhabit it, have become much more culturally aware and have changed considerably since the early days of Bill W. and the Drunk Squad.  If the 12-step programs are to continue to offer hope and healing to those that need it most, the very purpose of all of those rooms, and certainly the two stand-outs of accountability and fellowship, then it needs to take a closer look at the words it expects hundreds of thousands if not millions of people worldwide, to live by each and every day.  Perhaps when that happens, those of us in the scientific community can finally feel more comfortable endorsing the 12-step model as an important adjunct to treatment for the many folks under our care, and one that can offer (and do so with genuine integrity), a place for ALL people in need, regardless of religious affiliation and belief.



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