Groups like Alcoholics Anonymous and Narcotics Anonymous have been a God-send to many of those addicted to drugs and alcohol. In my clinical practice, I often urged patients with drug and/or alcohol problems to make that difficult call and gave them the phone number. Typically, once the patient had gotten involved with the programs, he or she got away from the addictive substance, and expressed appreciation for the support received.
It was often a mixed-blessing.
Some individuals in therapy have problems that stem mostly from an addiction, but, at least in my own practice, there were more often far-reaching problems. Some may have become addicted in an attempt to self-medicate, and/or avoid facing some hard realities about themselves. Sometimes as therapeutic discoveries became painful, patients wanted to drink more or use more drugs.
I was always pleased and encouraging when it turned out that, without drugs and alcohol, individuals turned out to be capable of dealing with conflicts, internal and external, and really had no further need for my services, at least not on a regular basis. I've never intended to be in competition with twelve-step groups.
Unfortunately, I can't say it was mutual.
All too often the twelve-step group member hears that all psychotropic medicines are just happy pills that are at least as bad as alcohol and drugs. True, there was a time when the behavioral sciences didn't have the variety of medicines available today, and well-intended physicians, usually general practitioners, prescribed barbiturates for anxiety. More recently, some general pracititioners prescribed Valium like handing out M & M's. But for decades, mental health specialists have had much better chemical treatments and are much better trained in the dangers of addiction, yet twelve-step "sponsors" hand out opinions that might have had more validity in the 1930s.
Further, some twelve-steppers condemn psychology and psychiatry as generally toxic. One twelve-stepper I met said that psychology had no validity because since there have been psychologists around, the world has gotten worse, not better. This is a person who leads groups of very vulnerable individuals. The premise is, of course, preposterous for two reasons: By what stretch of the imagination do psychologists control the world? And in whose delusion is the world substantially worse than it was in, say, 1880, when child prostitution was accepted, when police brutality was the norm not the exception, when fully ten percent of the American population was addicted to opium, and . . . need I go on?
So the patient whom I may have spent hours getting to call AA soon decides that therapy is dangerous, quits, and continues life severaly depressed, although sober. A bi-polar patient stops taking mood stabilizers because someone said in a meeting "you don't need that s----," goes into a full-blown manic state, goes through the family savings in a month, and attacks strangers with little provocation. A patient of mine, who was in AA before coming to me, was told by his sponsor that recreational drugs were OK so long as he didn't drink. This was a man who already had one felony conviction for cocaine. A few months later he died of a cocaine overdose.
The reason I call this the twelve-step two-step is because these groups claim that they do not practice medicine. But someone who claims to have special knowledge of the effects of medications is practicing medicine, period!
Legitimate self-help groups do not practice mind control. That's the province of cults.
For some people, the twelve-step approach may be ideal. But it is no longer one of a kind. If I were in private practice again, talking to a patient with addiction problems, I'm not sure I would make a referral to AA or NA. If I did, it would be in combination with information about other approaches that anyone can learn about by simply Googling "alternatives to AA." Before encouraging anyone to contact a 12-step group, or accepting a patient already involved with one, I'd be sure the person knew about this unfortunate one-sided "turf war" in which, ultimately, the addict is likely to be the only casualty.