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A few suggestions about using 12-step programs

One of the more frequent recommendations I make to patients with addictions is to attend 12-step meetings in the community at least several times a week. Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, Marijuana Anonymous -- whatever the addiction, you can find a 12-step group to help. For family members there's AlAnon, CODA, and similar groups. Here's a guide to making these invaluable resources work for you.

Finding the right meetings

One treatment program where I worked once felt so strongly about attending 12-step groups that they insisted you go as a condition of staying in treatment. Later they dropped this as a requirement and made it a strong suggestion.

Why? Frankly, 12-step programs don't work for everybody. But on the other hand, AA has the strongest evidence in the scientific literature of effectiveness in treating addictions, compared with any other approach.

Most of those who complain how much they hate AA and its brethren actually haven't learned how to use these incredibly powerful tools for recovery. Simply put, Alcoholics Anonymous and the others are great once you know what you're doing, but they are hard to get started with. A lot of people go to one or two meetings and come away with the impression, "What's a nice person like me doing in a place like this?" They get ticked off and vow never to go again.

The problem is that many completely different kinds of people can have problems with chemical dependency. Truck drivers, doctors, lawyers, housewives, machinists, actresses, students, retired people, gays, straights -- you name it, virtually any class of individual can be at risk for alcoholism or addiction.

You have to be picky about which meetings you attend, so that you are with people like yourself. Otherwise AA may simply be a pain.

Here's an example. Sam was a 40-year-old insurance executive. Gray suit, red power tie, every hair in place, Sam looked like he had just stepped off the cover of Forbes. He was an alcoholic, so I recommended Alcoholics Anonymous. On his return visit, Sam swore he'd never go to AA again. Why? He'd gone to a meeting for bikers. Leather jackets, boots, long hair, and tattoos -- these guys were not exactly the executive type. Sam had little in common with them.

What's the answer? Bikers need AA too; go to another meeting! Various 12-step groups meet all around Los Angeles 24 hours a day. So whatever your preferences or schedule, you can find meetings that will accommodate you.

It's a little like dating. If you go out on a first date with ten potential girlfriends/boyfriends, you'll find that you can stand to see only one of the ten again. The other nine are perfectly fine people, but they're great for somebody else, not you. You have to go out with a lot of people and be picky. (By the way, 12-step meetings are a lot less work than dating.)

Here's another example. Some alcoholics are party animals. They like getting loaded, putting lampshades on their heads, and having a good time. But what if you're a "closet drunk"? You buy a fifth of vodka, go home alone, turn out the lights, and drink until you pass out. Going to a meeting full of party animals who pound you on the back is like attending a Superbowl party when you're a ballet fan. This is a great way to continue pretending that everything is hopeless so you can keep drinking yourself into oblivion. A better bet is to find other meetings where you feel relaxed and understood.

You may need to visit thirty to fifty meetings to find five that work for you. In fact you are looking for "home meetings" that you can attend regularly for the next three to five years. This is a lot of time and effort, but the results will amaze you.

How you can tell if you're in the right meeting? You feel comfortable, like you can relax and let your hair down. It's better than family, because you're surrounded by people who just naturally seem to understand you. They speak your language. You feel included, part of the group.

Okay, let's say that you've visited ten or twenty AA meetings and have found one real favorite, your "home meeting," and a few other groups that you enjoy but aren't quite as special. You're going five times a week. You're all set, right?

Afraid not. The problem is there is a lot of movement in and out of 12-step meetings. The average group changes a third of its membership every year. So if you have found that one really special home meeting, chances are that its members will come and go over time, and in a few months or years, you won't feel nearly so comfortable there.

"Losing" a home meeting can be like having a friend die. In fact, some alcoholics use this as an excuse to resume drinking. It can be pretty upsetting.

The answer is finding three home meetings. Yup, that's right, three home meetings. It's like a tripod -- it needs three legs to stand up. This way, if one of those special gatherings becomes uncomfortable, you've got two more to get you through until you've found another.

What to do at meetings

Okay, you've found several meetings in the community where you feel at home. You go five times a week and sit in the back and listen like crazy. You're afraid to talk with anyone because you might say the wrong thing, and besides, no one seems to notice you're there. Not much is happening. You enjoy the speakers, but this is beginning to feel like a waste of time.

Besides, you're getting really tired of all the sob stories. When are these people going to get a life? Once in a while somebody comes up to you and promises to help you stop drinking, but they're so pushy, you just wish they'd go away. This is not fun.

It's time to make Alcoholics Anonymous work for you. You need to speak up -- not in front of everybody unless you want to, but one to one. You want to speak with people like you, who seem to understand you naturally. If you get approached by an AA fanatic who wants to take over and tell you what to do, thank them for sharing and make it clear that you want to speak with someone else.

Remember, 12-step meetings are full of people you shouldn't lend your car or house keys to. Keep your wits about you and use appropriate skepticism. Avoid romantic entanglements or charismatic people who want to take over.

When you find somebody interesting, approach them and tell them the truth, whatever's true for you. If you're shy and don't know what to say, say, "Hi, I'm Joe/Josephine. I'm shy and I don't know what to say." Or if you're a closet drinker and want to find former loners like yourself, say, "Hi, I'm a closet drinker and I want to find people who used to drink in the dark."

When you find people you like and feel comfortable with, get their phone numbers and ask if you can call them when you need someone to speak with. This is how you build your phone list: twenty people you can call at any time of day or night if and when you become upset and feel the overwhelming need to get loaded. Get at least one person's phone number every time you go to a meeting. Call two to three people every day.

Part of the purpose of building your phone list is to find a sponsor -- one individual with whom you will talk every day, who will get to know you better than anyone you've met, and who agrees to be available to you 24 hours a day. (Some exceptions apply, but there shouldn't be many times you can't reach your sponsor or aren't supposed to call.)

It's okay to have a provisional sponsor, somebody you'll work with for two or three weeks while you're both deciding if this will work out. It's okay to fire your sponsor if things turn out terribly, or you get along great for a while and then they lose interest. Be picky, and remember that ultimately it's up to you to make this relationship work. Don't pick a sponsor of the opposite sex unless you're gay (then pick a gay person of the opposite sex). Your sponsor should have been clean and sober at least two years. They should have fewer problems than you do and be comfortable with themselves.

Many alcoholic/addicts don't like asking others for help because it seems like you're imposing on people, sucking on them or using them. Here's the biggest secret in the 12-step universe: the best results and the most personal growth occur after you've been sober for a while and begin "to give away what was freely given to you." Helping other alcoholic/addicts is the only way to complete the transformation that solidifies your recovery. So by asking people in the 12-step program for help, you're offering them the opportunity to succeed. Don't be shy; ask for what you need. You may need to ask several people before you get a "yes."

How long should you attend Alcoholics Anonymous? Research shows that people who attend 300 or more meetings and who sponsor at least two other people have a 92% chance of maintaining long-term sobriety. This takes three to five years. You don't need to keep going forever unless you want to or feel the need, but stopping in a few months as soon as you begin to feel better has a very high likelihood of leading to a relapse.

Excuses, excuses

Frequently people complain that they can't go to 12-step meetings because they don't have a car or a driver's license. Since this is such a common problem, you might be surprised how many people you're apt to find at a meeting who are delighted to give you a ride. Ask. One other common complaint is that Alcoholics Anonymous is too "religious," too focused on all that "higher power" stuff. Unless you're comfortable with a religious tradition, you may indeed find that certain meetings or certain people seem way too pushy and intrusive on this issue. But hang in there; it takes time to sort this out. Roughly a third of alcoholic/addicts are atheists or agnostics, and it may take a couple of years before they've worked out their own version of the "higher power." One solution is 12-step meetings specifically for atheists and agnostics; they do exist. Also there are alternatives to the 12-step tradition like Rational Recovery or groups called "SOS." (You may find these groups have dogmas all their own.)

The bigger issue is that 98% of alcoholic/addicts are "control freaks" determined not to ever let anyone else tell them what to do. The more resistant you are to asking for -- and receiving -- help for your addiction, the more difficulty you're apt to have with the "higher power". So a great deal of the problem is you lack the willingness to surrender to something larger than yourself. For many nonreligious people, what you discover is a deep, profound sense of a quiet inner voice that is stronger, softer, wiser, more accepting, and more loving than your usual ego or fearful self or need to control everything. This may not seem like a big white dude with a beard; it's more like something within yourself you've lost touch with, a sort of inner knowing. It takes time to get in touch with this inner sense, in large part because unresolved emotions tend to cover it up. (Let's face it, when you start in recovery, you're loaded with unresolved feelings.) And when you become fearful and try to control, you lose touch as well. But dealing with these issues is a lot of what early recovery is all about.

Finally, here's a secret. Why in the world do speakers at 12-step meetings go on and on about how horrible it was while they were drinking and using? Ask any woman who's gone through labor and now has only a vague recollection of what it was like: it's hard to remember pain. So reciting to one and all how lousy it was to be an addict may be the only way to retain that vivid memory of what it was like. You never want to forget this, or the next time that inner addict voice tells you what a good idea it would be to get loaded again just this once, you may be more apt to listen.


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©2011, James Gagné, MD