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The Twelve Step Program: Cure or Cover? - Utne Reader, November/December 1988

The Twelve Step program:
Cure or Cover?


Anyone who cares to look can find serenity. It leaves tracks: neat rows of folding chairs lined up in musty church basements; the dull buzz of fluorescent lights in hospital lecture halls; schoolrooms where half-erased algebra problems remain on green chalkboards. Hundreds of thousands of people across the country and around the world make regular trips to such places-as often as once each day. They are members of Twelve-Step and other recovery programs.

Alcoholics Anonymous (AA) is the oldest and best known of these self-help programs, and its structure and philosophy have served as models for many others: Narcotics Anonymous (NA); Overeaters Anonymous (OA); Incest Survivors Anonymous (ISA); Emotional Health Anonymous (EHA); Emotions Anonymous (EA); Gamblers Anonymous (GA); Al-Anon and Alateen (programs for family members and friends of alcoholics); and, most recently, Sex and Love Addicts Anonymous (SLAA). The sole requirement for membership in any of them is a desire to stop substance abuse or change a compulsive behavior.

In the past few years, such programs have become so popular that they constitute a Twelve-Step movement. Many people know, through personal contact, that Twelve-Step programs, especially AA, can be lifesavers. But these programs sometimes resemble modern-day cults. They describe themselves in universal terms, pride themselves on excluding on one, suggest that their fellowship are supportive without ever being critical, and claim to offer a philosophy of spiritual enlightenment without religious trappings. To the uninitiated, this description might sound like old-style evangelical religion or New Age pop psychology, with a do-you-believe-in-magic touch thrown in for good measure.

I have never been a member of a Twelve-Step program. To research this article, I attended a lot of meetings and talked to many people. I asked certain key questions about the nature of addiction and the methods these programs offer for recovery: Are all the problems addressed by Twelve-Step recovery the same? What are the resources and analyses developed by feminists, gays, and progressives in response to addiction and other personal life crises? Does Twelve Step philosophy have anything to say about politics? What needs to these programs address that could or should have been met by political movements? And how does living in a Just Say No culture change the meaning of all of the above?

The Twelve Steps are the heart of Alcoholics Anonymous and the programs based on the AA model. These 12 specific actions are the programs’ official recipe for recovery, the ingredients of an addiction-free life. Their purpose is “to relieve pain and suffering, fill our emptiness, help us find the missing something, help us discover ourselves and the God within us, and release great quantities of the energy, love, and joy dammed up inside ourselves”-all with a minimum of discomfort and a maximum of self-awareness.

Unlike medical professionals, therapists, or some political activists, Twelve-Step programs do not dwell on the causes of addiction. It is simply understood that anyone who uses substances or activities in a way that interferes with his or her life has an addiction problem.

Accordingly, Twelve-Step programs offer very simple explanations and a decidedly behavioral approach, two important reasons why they seem to work for so many people. They pay serious attention to ordinary pain by requiring people to pay attention to it themselves by taking inventories, admitting wrongdoing, making direct amends, praying and meditating, and spreading the message of spiritual awakening. Working the steps one by one, and repeating them indefinitely, gives people at least two things that neither science not politics consistently seems to trust people with: A largely self-determined behavioral routine and permission to understand our problems differently at different stages in our lives, in ways that make sense to us even if they don’t to anyone else.

On a day-to-day basis, Twelve-Step programs offer members handy directories of meeting times and places, “Approved” literature on a range of topics, and slogans to live by, like “One day at a time” and “Let go and let God.” A set of 12 Traditions governs program structure. Members are strongly urged to frequently attend meetings, although they are completely voluntary. Still, it is not unusual for individuals to participate in four or five meetings each week for many years. Meetings roughly follow a standard format: An opening statement, a speaker who comes prepared to tell his or her story, spontaneous sharing by those present, and a closing statement. When people speak, they do so for as long as they wish to without interruption. No one responds directly to anything that is said. There are slight variations on this format, and a meeting in rural Nebraska would certainly feel different from one on Castro Street in San Francisco, but a Twelve-Step meeting anywhere would be easily recognizable to anyone who had ever attended one before. Predictability is the point.

Programs encourage a sponsorship system, where individuals who have been in the program for a while act as buddies to newcomers, orienting them to program philosophy and structure. In addition to their sponsors, members have no trouble finding willing listeners outside meetings. Telephone numbers are exchanged and used, at all hours of the day and night, when people need help or support or just want the comfort that comes from making contact with other human beings who care.

Twelve-Step programs also provide another thing that people are desperate to find: a predictably safe place in which to feel understood and accepted. Safety was almost tangibly present in many of the meetings I attended, and I believe the feeling of uncritical acceptance people find in these programs may be one of the main reasons they flock to the meetings. The safe environment has been purchased at a rather high price, however: a community culture that does not allow room for direct reaction or interaction of any kind, in particular, criticism.

They look alike, but are all the Twelve-Step programs really the same? Does it make sense to change compulsive eating behavior with the same techniques alcoholics use to keep sober? Is sexual addiction different from food addiction, and are they both different from addiction to mind-altering substances?

Food is something we all need to live; none of us needs drugs or alcohol to survive, but alcoholism and drug addiction are characterized by a physiological process of dependence completely unknown to most overeaters or sex and love addicts. Food can be a way for people to establish and maintain relationships, express their cultural identities, or spend leisure time. One progressive political analysis of food and eating-fat liberation-comes in direct conflict with the Twelve-Step approach of Overeaters Anonymous.

In particular, feminists have exposed American society’s cultural imperatives about the physical body-what it is supposed to weigh, look like, feel like, smell like, and act like-and claimed that accepted notions of clothing, diet, and appearance are among the causes of women’s self-hatred. Fat liberationists have developed the convincing argument that fat itself is far less of a health or self-esteem issue in the lives of fat people than are endless cycles of debilitating diets or stereotypes about what fat (and thin) people must be like.

Sex is no more a survival need than alcohol. Yet, like the desire for food, the desire for sex often exceeds the body’s need to satisfy the basic hungers of human emotion and spirit. It can be a tremendous source of pleasure, which is why most people do not choose long-term celibacy. People, who enjoy sex because of how it makes them feel about their partners, or those who simply look forward to the next time they have an orgasm, may be considered perfectly normal. They also can be considered slightly neurotic, or completely obsessive. Whether an individual feels sexually normal or abnormal is determined by social attitudes as much as by specifics of sexual pain and pleasure in her or his own life.

Sex and Love Addicts Anonymous (SLAA) is a relatively new program; it was founded in Boston in 1976 by recovered alcoholics. An SLAA pamphlet, entitled “40 Questions for Self-Diagnosis,” asks: ”Have you ever wished you could be less emotionally dependent? Do you find yourself in a relationship you cannot leave? Do you believe that sex and/or a relationship will make your life bearable?” I think many people-certainly large numbers of women-would be inclined to answer yes to questions such as these. Does that make us all sex and love addicts?

What exactly does recovery involve for an SLAA member? According to members, the goal is to find love and sex within a true partnership, a kind of relationship (generally understood to be monogamous) that does not fuel the addiction. If no committed, continuing relationship is possible, then total sexual abstinence is called for as the only method of maintaining sexual sobriety. Clearly, a traditional hierarchy of sexual values is being upheld here; Monogamy is the healthy ideal, and celibacy is preferable to promiscuity.

The Twelve-Step approach does not take up the significant differences between addictions or people. The programs downplay contradictions and differences by implying that all substances and activities are addictive when the enable the user (or doer) to numb out and suggest that people are trying to fill painful psychological/spiritual voids that no substance or activity can actually satisfy. Can all human pain be collected into one big bundle labeled addiction? Should it be? What about the feelings of pleasure that people derive from food, drugs, alcohol, sex, and a host of other substances and activities? Are these merely self-delusions, the sneaky evidence of addictions-in-the-making? Or are Twelve-Step programs simply adding to the guilt already inflicted on us by our pleasurephobic culture?

If defining addiction is difficult, the Just Say No campaign has made it even more so by throwing every manner of excess into the addiction pot and suggesting that a stiff upper lip can solve everything from a monster federal deficit to urban crime. Just Say No sounds catchy, but what the slogan really means is that self-control is the entire answer, that saying no is an act of moral significance, and that the people who do so are strong, whereas the people who don’t are pathetic weaklings. This trend toward championing the heroism and romanticizing the virtue of the will is probably a significant contributing factor to the popularity of Twelve-Step programs.

The current war on drugs, sex, and other modern “evils” is a hypocritical effort to rub out the cultural changes of the past two decades by masquerading as a caring crusade. Take, for example, the dismal state of sex education. The Regan administration has suggested that parents instill the concept of chastity in their children by whatever means they see fit. Millionaire John LaCorte recently made national headlines with his modest contribution to the Just Say No campaign: an offer to pay $1,000 to any girl who guarded her virginity until age 19.

AIDS educators know that they too must play by the rules that put them in an impossible bind. They can squeak by only as long as they say no to frank discussions about sexual pleasure, as a recent case in Massachusetts clearly illustrates. In November 1987, when it looked like a long-fought-for state gay rights law might finally pass, opponents of the bill instigated extensive publicity about sexually explicit AIDS education materials and succeeded in killing the bill for yet another year.

If our government were really interested in eradicating alcohol and drug abuse, it would be spending time and money on rehabilitation, but it is not. In January 1987, while Nancy Reagan was having her picture taken with born-again drug addicts, her husband cut nearly $1 billion from the national anti-drug budget and actually recommended that not a single federal dollar be spent on treatment programs. Meanwhile, 30 million Americans undergo drug screening today-in prisons, workplaces, sports, the military and on campuses-and some estimates indicate that 50 percent of the working population will be tested regularly for drugs by 1992.

No matter where the political winds are blowing, however, the Twelve-Step programs are determined to ignore them. In fact, avoiding public controversy at all costs is one of the most consistent structural features of such programs. AA publishes a booklet describing the “Twelve Traditions” that govern the structure of Twelve-Step programs. The 10th tradition specifies: “Our fellowship has no opinions on outside issues, hence our name ought never to drawn into public controversy.” This tradition implicitly recognizes that diverse individuals with conflicting viewpoints participate in Twelve-Step programs, and it indicates that a formal, non-political identity is the only logical way to preserve internal unity and prevent groups from being diverted from their purpose by secondary issues. Some important questions do remain, however, about the political implications of Twelve-Step philosophy and structure.

The programs’ core concept-personal accountability for one’s actions-is decidedly apolitical: The responsibility for both addiction and recovery rest squarely on the individual. In particular, the programs’ philosophy that addiction is a disease emphasizes the person and problem in isolation from any outside social forces. This may ease some of the guilt that people feel for pain that they and others have experience. One Al-Anon member, in great relief, told me: ”I make no decisions. The disease does. I am sick.” This kind of language and the Twelve Steps constantly refer people back to themselves with the message that their old negative ways of thinking and behaving are the sources of their pain. Consequently, only new, positive approaches, nurtured by the programs themselves, will produce serenity.

I rarely heard any speakers in meetings-whether recounting stories of assault, workplace hassles, or matters of the heart-mention directly the realities of physical power, economic inequality, racial bigotry, or sexual coercion, even in instances where these were clearly being described. This is true even in Women for Sobriety (WFS), a “new life” program for women alcoholics that differs from Twelve-Step programs in that it tries to identify the unique recovery needs of women. For example, one WFS member was talking happily about her new job as a clerical worker in a big law firm but started sounding anxious when she described her new boss as “a man with a bad reputation for kicking his secretaries around like dogs.” She concluded that this worrisome situation was really a test of her sobriety, and she resolved to “meet the challenge to be a pleasant person, no matter what.” Because meeting rules do not permit direct responses from others in the room, and because no larger social context is officially recognized, no one in the room suggested to this young woman that she did not deserve to be treated like an animal or that she was the potential object of sex discrimination. As far as the program went, the answer was for her to “think positive.”

The conflict between seeing responsibility in purely individual or purely political terms arises in the first of the Twelve Steps: “We admitted we were powerless over (   )--- that our lives had become unmanageable.” For many, this step is problematic because it turns the progressive political goal of empowerment on its head. But because people generally do not like living with intense contradictions, politically aware Twelve-Step members creatively manage the conflicts between their politics and their Twelve-Step experiences. Here is how one politically active lesbian explained the importance of taking the first step, admitting powerlessness, and another sticky concept, the Higher Power.

When I was getting sober, AA was completely in opposition to my experience as a politico because one of the big words was powerlessness. Every activist’s hair stands on end at the idea of embracing powerlessness, which you’re supposed to be wild about in AA….I found a way to rework the philosophy. It was clear to me that the minute you “give up,” you begin a process of empowerment….The big stumbling block for me was the whole God thing…. To me, this was completely patriarchal and repugnant. So someone suggested a concept of God that wouldn’t offend me-historical materialism [the orthodox Marxist theory of history].

Members who aren’t quite as good at fine-tuning the Twelve-Step approach to their own personal philosophies are simply reminded to “take what you need and leave the rest,” a handy Twelve-Step slogan designed to minimize conflict and to help people feel comfortable.

The custom fit of the Twelve-Step experience is undoubtedly part of its appeal, but in the context of a Just Say No culture, it risks distorting personal pain to a point where people who really do not have addiction problems are encouraged to think they do. The most striking evidence of this is that many people who are not alcoholics, overeaters, or drug addicts are regularly attending meetings and adopting the Twelve-Step philosophy as their own, anyway. The presence of non-addicts is controversial in some but not all meetings, where addicts consider them to be diluting the program and distracting members from their main goal of recovery.

As one follower said, “There are some people-I won’t say they’re addicted to the programs because that’s not an appropriate use of the word-who do use the programs as a crutch. The meetings aren’t about making friends. They’re about changing your life.”

But for many, the programs are about making friends, and it is not unusual for members’ friendship networks to change radically, even completely, after entering the program. For some, this is a necessary part of learning that relationships that do not revolve around alcohol or drugs are possible. For others, the programs are just new ways of feeding unsatisfiable hungers for visibility and recognit-ion and a place to experience contrived interactions dressed up as a recovery. The latter experience is merely a new form of dependency.

Substance and other abuses clearly exist in our society, taking horrible tolls on individual lives. Total abstinence must be supported for those who feel it is their only non-abusive option. But just because many things can be dangerous does not mean that they always are. Positive and negative potentials exist side by side. Drugs, sex, food, and other things can be quite wonderful. We should be as determined to define our right to pleasure as we are to eradicate the reality of our pain. To some degree, our dignity as a society will be measured by our success or failure in this regard.

Progressive political movements should be taking notes on what is so appealing about the recovery movement. Political leaders and artists inspire us with visions of peace and social justice; activists discuss and strategize; foot soldiers do the work of getting us from here to there. Meanwhile, we all have to get through the day. Getting through the day might mean staying away from a bar, finding a friend to cry with in a moment of sadness, or having wonderful sex all afternoon. It might just be another day at work. Whatever it is, it is what political movements should be about. Changing the structure of political power is not as possible, certainly not as meaningful, when changing ourselves is absent from the political agenda.

There is no doubt that Twelve-Step programs have helped people get through a lot of days. But they do nothing to decipher or change the larger context in which time passes, especially in a Just Say No culture that would like to wipe out progressive gains for good.

Political movements can address the larger context, and they have something unique to contribute to the recovery process: an understanding that prevailing cultural messages affect how people feel about themselves just as much as “Think Positive” slogans do. Self-hatred and self-love are not matters of luck or fate; they do not come and go only on uncontrollable tides of willpower. People struggle for and against them, and they will be won or lost just as all contests of power are won or lost. We must keep our eyes on the prize of pleasure even when we are in pain, not allowing suffering to become a symbol of sin or sainthood, nor endorsing sickness as a test of moral character, and not making addiction a prerequisite for support and community. If we succeed, we may all get to serenity.

Excerpted with permission from Out/Look: National Lesbian and Gay Quarterly (Summer 1988 Subscriptions:$19/yr. (4issues) from Box 46030, San Francisco, CA 94146-0430. Back issues available from same address.

(Source: Utne Reader, Nov. Dec. 1988)


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