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The Science Within
12-Step Recovery
Bill Smith, MA, BCC, CSAC, CIP
President, HJF Recovery Services LLC
Objective:
Informed Consumers of Recovery Products
This…
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Not That…
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SPIRITUAL
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Spirituality?
For many, spirituality
takes the form of
religious observance,
prayer, meditation or a
belief in a higher
power.
For others, it can be
found in nature,
music, art, or a secular
community.
Spirituality is different
for everyone.
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• No Particular Wisdom
Tradition Required
• Clearer Life Purpose
• Connection with self and
with others (God?)
• Development of Personal
Value System
• Discovery of the Meaning
of Life
• Connection to Whole =
Release of Control
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What is 12-Step Recovery?
(Big Book or Spiritual-Based Recovery)
• Recovery is an individual’s experience of the
transformative power that comes from taking the
12-Steps.
• That is, the program of prescribed spiritual action
originally described in the Big Book of Alcoholics
Anonymous’ Forward, Doctor’s Opinion, and 1st
103 pages.
• Abstinence is simply the absence of the chemical
of NO CHOICE:
– Untreated addiction results from abstinence.
– Recovery results from TRANSFORMATION via the
Steps.
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What Does NOT Work?
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Self-Knowledge
Self-Efficacy
Will Power
Quitting
Abstinence Alone
“It Can’t Be That Simple…”
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6 Lessons of the Big Book
• We are spiritual beings having a human experience. The
solution is already a part of who we are.
• We have everything we need to be happy RIGHT NOW
(always have, and always will).
• Harmony (balance) is the goal; this is our default position.
• Manifestations of SELF (fear, resentment, pride, ego, anger)
are the cause of all our problems (imbalance).
• Over-reliance on SELF is food for the “Spiritual Malady”. It
blocks an effective relationship with Spirit and others.
• Intention is insufficient; specific action is required. You
can’t solve a ME problem with more ME.
“It Can’t Be That Simple…”
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12-Steps Start Where We Are:
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Step 1
Step 2
Step 3
Steps 4 – 9
Steps 10 – 12
Where We Were
Where We Could Be
Where We Wanted To Be
How We Got There
How We Stayed There
“It Can’t Be That Simple…”
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What is “The Program”?
• Alcoholics Anonymous is the life changing program
formed by two desperate alcoholics in 1935.
• The Forward, Doctor’s Opinion, and 1st 103 pages
detail the program in it’s entirety.
• Works for any addiction or mal-adaptive behavior.
• Precise set of directions for recovery, NOT
abstinence.
• Purpose is NOT how to NOT drink…
• But how to LIVE (Spiritually) !!
• Simple, but NOT EASY!!!
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Spiritual Transformation:
What Happens?
• Steps 1 – 3 INFORM what the problem and the
solution are:
– Problem = Over-reliance on self
– Solution = Reliance on Power greater than self
• Over-reliance on self blocks innate knowledge of the
solution.
• Results in life based on pomp, calamity, and worship
of other things.
• 4 – 9 removes these blocks and TRANSFORMS the
alcoholic to a complete, whole person of integrity.
• 10 – 12 sustain and grow the alcoholic in Spiritual
Living (NEW NORMS).
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Sustenance & Growth:
What Happens?
• Balance is achieved. When anger, fear,
resentment creep in, we see this as
counterfeit (Secret Service Training!!)
• Not a performance-based system – progress
not perfection.
• Moved away from “Victim Status”.
• Fear is no longer the bottom-line motivator.
• Return of values, dreams, self-esteem…
• An Unshakable foundation for life!
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SCIENCE
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What is Addiction??
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Addiction is…
Any behavior that is associated with craving,
temporary relief, and long-term negative
consequences (that are generally predictable and known to the individual)
along with impairment of control over the
behavior so that the person wishes to quit, or
promises to quit, but can’t follow through with
the intention.
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Alcohol
Consumption and
Genetics
Scientists have found that the genes
which influence the amount of alcohol
people drink may be distinct from those
that affect the risk of alcoholism.
Drinking behavior is linked to the
“pleasure and reward” pathways in the
brain and some of the systems that
control food intake.
The results emphasize the importance of
looking at signaling pathways rather than
single genes, and show cross-species
similarities in predisposition to alcohol
consumption (Lab Rats).
They found that genetic factors account
for 40 to 60 percent of the variance
between people in risk of alcoholism.
The genes involved in susceptibility to
alcoholism include both alcohol-specific
genes and those that affect neuronal
pathways to do with reward, behavioral
control and resilience to stress.
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Pleasure
Principle
Pleasure, regardless of source is
registered the same way:
1. Lobster & Steak
2. Sex
3. Winning the Lottery!
4. Psychoactive drug
Mood-altering chemicals cause a
particularly powerful surge of “feel
good” chemicals in the brain’s pleasure
center – Also a response to:
Route of administration influences
likelihood of becoming addicted:
1. Speed of dopamine release
2. Intensity of the release
3. Reliability of the release
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Learning &
Memory
Pleasure alone is not enough!
Dopamine = Experience of pleasure
AND learning and memory
Addictive drugs provide a shortcut to
the brain’s reward system by flooding
the nucleus accumbens with
dopamine
The hippocampus lays down memories
of this rapid sense of satisfaction
The amygdala creates a conditioned
response to certain stimuli (learning)
Dopamine not only contributes to the
experience of pleasure, but plays a
role in learning and memory—two key
elements in transition from enjoying to
addiction - Like to Need
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90-Second Dyad
• 1st partner crosses arms
• Then, reverse & hold
• 1st Partner tell 2nd
partner three things
you learned about brain
chemistry & addiction
• Switch!
• What were you
thinking?
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What is
Recovery??
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Recovery is…
Beyond abstinence, a series of interventions
designed to enable the individual to separate
the person they have become as a result of a
primary relationship with their chemical of NO
CHOICE from their true, authentic selves.
With this restoration, the individual is free to
resume the normal and ongoing processes of
learning, growth and healing – physically,
mentally, and spiritually.
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Interventions?
Prevention Professional?
• Community policies
• Professional education
• Peer Support Groups
• Screening & referral
Intervention Professional?
• Family education
• Intervention team
• Support recovery!
• Case management
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Counseling Professional?
• Safe structure
• Group dynamics
• Role-plays / exercises
• O.A.R.S.
Treatment Professional?
• Theoretical frame
• Pharmacotherapy
• Controlled environment
• Preparation for aftercare
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Recovery?
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Traditional
Model:
Spiritual
Conversion
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Contemporary
Model:
Re-Socialization
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Scientific Model:
Underlying
Pathology
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Traditional Model of Recovery:
“Recovery is the result of a spiritual conversion experience”
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William James / Bill Wilson
Displacement / Rearrangement of
Convert’s Personality
Disease Model / Jellinek
Obsession is replaced with sense of
Personal Spirituality – Individually
Interpreted
Focus is on Enlargement of Spiritual
Life via Steps 10 – 12 (Spiritual Truth)
Meetings = Opportunities for
Testimony & Sponsorship
Big Book-Based - Prescribed
Fidelity = High Success
Conservative & Blinkered Views
Stories = Obsession, Surrender &
Personality Change
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Contemporary Model of Recovery
“Recovery is a process of re-socialization to sober addicts”
• William White (et al.)
• Underlying Pathology is 2nd to
Maintenance of Abstinence
• Recovery is Hard = Suppressed
Feelings while Using
• Focus is Meeting Attendance
/Fellowship & “Medicine Chest”
• Meetings = Opportunities for
Surrender & Willingness to Share
• Fellowship-Based – Prescribed
• Success = Long & Painful; Relief
from Obsession is Lifetime
• Liberal & Tractable Views
• Stories = Physical & Despair /
Hopelessness of Addicted Life
(Reminder)
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Scientific Model of Recovery
“Recovery happens when underlying psychological causes are exposed and treated”
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Addiction = symptom of an
underlying psychological disorder
Many Theoretical Frames!! (Thanks,
Freud!!)
Range = Freud’s latent homosexual
tendencies to the Family Systems
Theory’s addict is playing a role
Addict uses to cope with some kind
of pain or trauma
Recovery = Learning appropriate selfcare
Success = Equal or Less than ReSocialization
12-Steps not essential, but often
referred; IP = 1 – 5 (?)
Stories = Experience in therapy
(feelings, trauma, self-care)
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IMPLICATIONS
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12-Step Implications:
TTM
• Transtheoretical Stages of Behavioral Change:
– Deals with intentional behavior change - Specific overt
modifications to lifestyle
– Views change as a process rather than an event
– Characterizes change as a consecutive, scaffolding steps
– Cycles back and forth through previous stages / steps
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12-Step Implications:
AA, Stages, & Process
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12-Step Implications:
Decisional Balance (MI)
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12-Step Implications:
Social Cognitive Theory
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12-Step Implications:
Cognitive Restructuring
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Observing, identifying, and modifying
irrational thoughts:
– Inform – Emotions
– Transform – Thoughts
– New Norms – Behaviors
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12-Steps:
– Behavioral modification and neurolinguistic programming
– Explore & Reframe
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Meetings:
– Programming Process
– Slogans: Messages of cognitive
restructuring
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Sponsorship:
– Addresses faulty beliefs and
maladaptive cognitions
– Progression from the drinking phase,
through transition, early recovery, and
ongoing recovery
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• Use Models to Keep
YOURSELF Right-Sized
• Know your Referral!
• Know your Referee!
• Involvement is WAAAY
better than Attendance
• Integrate DON’T Populate!
• 12-Steps + Treatment =
Better Outcomes:
– Increase Counseling
Opportunities!
– Additive Effect!!
• Works GREAT with Relapse
Prevention Methods
• Severity of Use = Motivation
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Selected Bibliography
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Blonigen, D. M., Timko, C., Finney, J. W., Moos, B. S., & Moos, R. H. (2011). Alcoholics Anonymous
attendance, decreases in impulsivity and drinking and psychosocial outcomes over 16 years:
moderated‐mediation from a developmental perspective. Addiction, 106(12), 2167-2177.
David A. Patterson Silver Wolf (Adelv Unegv Waya), & Nochaski, T. H. (2010). Combining the
Transtheoretical Stages of Change Model and the 12 Steps of Alcoholics Anonymous to monitor
treatment progression. Journal of Social Work Practice in the Addictions, 10(2), 224-227. doi:
10.1080/15332561003730262
Ducci, F., & Goldman, D. (2008). Genetic approaches to addiction: Genes and alcohol. Addiction,
103(9), 1414-1428. doi: 10.1111/j.1360-0443.2008.02203.x
Galanter, M. (2014). Alcoholics anonymous and twelve‐step recovery: A model based on social and
cognitive neuroscience. The American Journal on Addictions, 23(3), 300-307.
Galanter, M., Dermatis, H., Stanievich, J., & Santucci, C. (2013). Physicians in long‐term recovery
who are members of Alcoholics Anonymous. The American Journal on Addictions, 22(4), 323-328.
Greenfield, B. L., & Tonigan, J. S. (2013). The general alcoholics anonymous tools of recovery: the
adoption of 12-step practices and beliefs. Psychology of Addictive Behaviors, 27(3), 553.
Heydari, A., Dashtgard, A., & Moghadam, Z. E. (2014). The effect of Bandura's Social Cognitive
Theory implementation on addiction quitting of clients referred to addiction quitting clinics. Iranian
Journal of Nursing and Midwifery Research, 19(1), 19-23. doi: PMID: 24554955 [PubMed] PMCID:
PMC3917180
Kelly, J. F., & Greene, M. C. (2014). Toward an Enhanced Understanding of the Psychological
Mechanisms by which Spirituality Aids Recovery in Alcoholics Anonymous. Alcoholism Treatment
Quarterly, 32(2-3), 299-318.
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Selected Bibliography
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Kelly, J. F., Greene, M. C., & Bergman, B. G. (2014). Do Drug-Dependent Patients Attending Alcoholics Anonymous
Rather than Narcotics Anonymous Do As Well? A Prospective, Lagged, Matching Analysis. Alcohol and Alcoholism,
agu066.
Kelly, J. F., Stout, R. L., Magill, M., Tonigan, J. S., & Pagano, M. E. (2010). Mechanisms of behavior change in
alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression
symptoms?. Addiction, 105(4), 626-636.
Kelly, J. F., Stout, R. L., Magill, M., Tonigan, J. S., & Pagano, M. E. (2011). Spirituality in recovery: a lagged
mediational analysis of Alcoholics Anonymous’ principal theoretical mechanism of behavior change. Alcoholism:
Clinical and Experimental Research, 35(3), 454-463.
Krentzman, A. R., Robinson, E. A., Moore, B. C., Kelly, J. F., Laudet, A. B., White, W. L., ... & Strobbe, S. (2011). How
alcoholics anonymous (AA) and narcotics anonymous (NA) work: Cross-disciplinary perspectives. Alcoholism
treatment quarterly, 29(1), 75-84.
Mathias, R. (1999). Adding More Counseling Sessions and 12-Step Programs Can Boost Drug Abuse Treatment
Effectiveness (5th ed., Vol. 14, December) (USA, National Institute on Drug Abuse (NIDA), NIDA Notes).
Miller, W. R., & Rollnick, S. (2004). Talking oneself into change: Motivational Interviewing, Stages of Change, and
Therapeutic Process. Journal of Cognitive Psychotherapy, 18(4), 299-308. doi: 10.1891/088983904780944306
Pagano, M. E., White, W. L., Kelly, J. F., Stout, R. L., & Tonigan, J. S. (2013). The 10-year course of Alcoholics
Anonymous participation and long-term outcomes: A follow-up study of outpatient subjects in Project MATCH.
Substance Abuse, 34(1), 51-59.
Shiffman, S. (1996). Addiction versus stages of change models. Addiction, 91(9), 1289-1290. doi: 10.1111/j.13600443.1996.tb03614.x
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Selected Bibliography
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Stack, K. M., Fore Arcand, L. G., & Briscoe, G. (2012). Use of alcoholics anonymous as part of medical school
education: students’ and educators’ perspectives. Substance Abuse, 33(4), 387-391.
Steigerwald, F., & Stone, D. (1999). Cognitive Restructuring and the 12-Step Program of Alcoholics Anonymous.
Journal of Substance Abuse Treatment, 16(4), 321-327.
Subbaraman, M. S., Kaskutas, L. A., & Zemore, S. (2011). Sponsorship and service as mediators of the effects of
Making Alcoholics Anonymous Easier (MAAEZ), a 12-step facilitation intervention. Drug and alcohol dependence,
116(1), 117-124.
Tabakoff, B., Saba, L., Printz, M., Flodman, P., Hodgkinson, C., Goldman, D., ... Hoffman, P. L. (2009). Genetical
genomic determinants of alcohol consumption in rats and humans. BMC Biology, 7(1), 70-91. doi: 10.1186/17417007-7-70
Tonigan, J. S., & Rice, S. L. (2010). Is it beneficial to have an Alcoholics Anonymous sponsor?. Psychology of
Addictive Behaviors, 24(3), 397.
Ullman, S. E., Najdowski, C. J., & Adams, E. B. (2012). Women, Alcoholics Anonymous, and related mutual aid
groups: Review and recommendations for research. Alcoholism Treatment Quarterly, 30(4), 443-486.
White, W. L. (1998). Slaying the dragon: The history of addiction treatment and recovery in America. Bloomington,
IL: Chestnut Health Systems/Lighthouse Institute.
Witbrodt, J., & Delucchi, K. (2011). Do Women Differ from Men on Alcoholics Anonymous Participation and
Abstinence? A Multi‐Wave Analysis of Treatment Seekers. Alcoholism: Clinical and Experimental Research, 35(12),
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Witbrodt, J., Kaskutas, L., Bond, J., & Delucchi, K. (2012). Does sponsorship improve outcomes above Alcoholics
Anonymous attendance? A latent class growth curve analysis. Addiction, 107(2), 301-311.
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