When it comes to the current conceptualization of addiction, most would subscribe to the compelling disease model, which decidedly states that addiction is a chronic, progressive and incurable disease of the brain.
In fact, most of the current addiction treatment methods and therapies utilized in recovery programming are based on this notion of addiction being a psychological and physical malady stemming from a disease of the brain. However, clinical recovery programs aren’t the only treatment option available to those in need.
12-Step programs like Alcoholics Anonymous and Narcotics Anonymous have remained one of the go-to methods of recovery for millions upon millions of individuals. Whereas the programming at most alcohol and drug rehabs is heavily dependent on counseling and psychotherapeutic methods, the 12-Step method is more about one’s emotional, social and spiritual recovery from alcoholism or drug addiction. In fact, while 12-Step groups are often recommended as a means of sustaining one’s sobriety after completing a treatment program, it’s not uncommon for professionals to devalue the 12-Step method 1 as a primary recovery tool.
However, 12-Step literature not only acknowledges the disease model of addiction, but it seems to incorporate scientific paradigm into its spiritual modality of recovery. With a closer look at the 12-Step method, it becomes increasingly clear that there are numerous scientifically-based processes underlying much of the 12-Step recovery method.
Social and Cognitive Neuroscience Explain the 12-Step Method
Although clinical treatment programs are most often recommended by physicians and healthcare providers as the most effective means of recovering from addiction, membership to 12-Step programs has grown tremendously since the inception of the first 12-Step group in 1935. Despite the seemingly minimal employment of evidence-based addiction knowledge, many individuals who have recovered from alcoholism and drug addiction credit their respective recovery fellowships for saving their lives. In some instances, these individuals had even been in clinical treatment programs without much success and were able to overcome chemical dependency only after they began attending meetings and working the 12 Steps.
Although there has traditionally been a rivalry between the respective communities who are avid supporters of these paradoxical rehabilitation methods, some social researchers and cognitive neuroscientists are attempting to bridge the divide. They suggest that the 12-Step method of recovery is effective because, contrary to perceptions, it is actually based on a number of underlying processes with firm roots in science and clinical evidence.
Positive Psychology as the Gateway for Spiritual Renewal
In 12-Step literature, the process of recovery is described as and depends on individuals achieving a so-called “spiritual awakening,” 2 which is thought to afford a more grateful, upbeat and empathetic outlook. This is likely one of the reasons that the 12-Step method is often perceived as borderline-mysticism by members of the scientific community. However, the spiritual awakening achieved through 12-Step recovery occurs as the result of cognitive interventions and adjustments that accumulate as individuals work through the 12 Steps.
According to research, positive psychology underscores this process of spiritual renewal and awakening. As an approach, positive psychology 3 focuses on instilling a sense of resiliency, which will allow individuals to more readily face and overcome the problems they may encounter in day-to-day life, while also enhancing one’s feelings of gratification and enjoyment in life. Moreover, the evidence suggests that the overall enhancement of one’s state results in a marked improvement in mood and health with such individuals showing a tendency to score higher when their levels of happiness were measured using psychological tests.
Sponsorship and the Process of Mirroring
As a recovery fellowship and support group, each 12-Step program is a community, which might be more accurately compared to a family. Relationships are built and maintained in a 12-Step group under the idea of mutual benefit through encouragement, support and empathy. Additionally, members of 12-Step groups are encouraged to find a sponsor, which is a senior member of the group who has already worked through the 12 Steps and, therefore, can offer insight and guidance on the 12-Step recovery process. In effect, a sponsor becomes a new member’s mentor and a valuable resource who helps the newcomer learn about each of the 12 Steps and how to complete them. One might compare a sponsor with the role of a life coach. And once a newcomer has worked through the 12 Steps himself or herself, the final step encourages the individual to become someone else’s sponsor, which preserves the philosophy of mutual aid and ensures the continuity of sponsorship.
The utility of the sponsorship model of the 12-Step method can be explained by a concept called mirroring, which refers to the behavioral phenomenon that has been observed in social settings. According to the mirroring concept 4, people have a tendency to mimic, or mirror, the behavior of individuals around them with whom they have developed or are developing some sort of rapport. One very obvious example of mirroring seen in everyday life is the tendency for adolescents to adopt the behaviors or traits of their peers. However, sponsorship in 12-Step groups is based on mirroring as well. Sponsors are the behavioral models who have worked through the 12 Steps and are lending their expertise to newcomers who mirror their sponsors’ behaviors. Due to mirroring, sponsorship reinforces many of the principles that 12-Step group members learn and adopt while in recovery.
The Neurological Effects of Storytelling
Alcoholics Anonymous and its derivative groups are maintained and run by group members, which results in programs having a built-in aura of acceptance and camaraderie with members consisting of peers who have had comparable experiences and oftentimes have similar backgrounds. Therefore, members are often more willing and able to share with the group, which is, in fact, encouraged as part of the experience. However, research has indicated that the acceptance and encouragement individuals feel when attending 12-Step meetings doesn’t solely account for the high level of sharing that occurs at 12-Step meetings.
Dopamine—an important neurochemical that has a crucial role 5 in processes in the mesolimbic pathway 6 related to reward-motivated behavior—is widely considered to be a central piece of the addiction puzzle. When an individual consumes alcohol or drugs, he or she experiences a spike in dopamine in addition to other neurochemicals; the overall effect of this spike gives the substance user the feeling of pleasure, which is rewarding and serves to reinforce the using behavior. However, similar to the dopamine surge that individuals experience from substance abuse, sharing—or “storytelling” 7—has been found to cause similar neurological responses as substance abuse. In effect, when individuals speak during 12-Step meetings, the brain releases dopamine and rewards them for the sharing behavior, which might also explain why so many individuals readily pay for therapy. Meanwhile, offering one’s past experiences and sharing stories of previous behaviors and mistakes results in an individual feeling more connected to the group and its shared identity as a congregation of individuals striving for sobriety.
Clearly, the 12-Step recovery process is more than just spiritual awakenings and pseudo-mysticism. There are a number of evidence-based, scientific processes that underlie the 12-Step method, which helps to validate Alcoholics Anonymous and its numerous sister groups as a valid means of achieving sobriety. Therefore, the optimal and most effective method of overcoming addiction would offer individuals options that can include the best of both worlds rather than just one or the other. The widespread perception of irreconcilable incompatibility between 12-Step recovery and clinical treatment of addiction is an unfortunate example of misconception.
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1. https://www.psychologytoday.com/blog/where-science-meets-the-steps/201211/why-the-hostility-toward-the-12-steps2. http://www.aa.org/assets/en_US/en_step12.pdf3. http://www.ww.bettyfordinstitute.org/uploaded-assets/pdf/what_is_recovery/Galanter_spirituality_model.pdf4. https://www.psychologytoday.com/blog/beyond-words/201209/mimicry-and-mirroring-can-be-good-or-bad5.http://www.slate.com/articles/health_and_science/science/2013/07/what_is_dopamine_love_lust_sex_addiction_gambling_motivation_reward.html6. http://neuroscience.mssm.edu/nestler/brainRewardpathways.html7. http://onlinelibrary.wiley.com/doi/10.1111/j.1521-0391.2014.12106.x/abstractWritten by Dane O’Leary