One of the key components to a sustainable and prolonged recovery from substance abuse or dependency is often the active participation in a support or self-help group after successfully completing a drug or alcohol treatment program.
Peer support and the creation of a healthy network of individuals with similar circumstances may help maintain long-term sobriety. Probably one of the most well-known support groups is Alcoholics Anonymous, or AA, which is based on the 12-Step model, promoting spiritual growth while maintaining complete abstinence from substance abuse. AA is often used to refer to all 12-Step groups, including those for supporting drug abuse recovery like Narcotics Anonymous, or NA.
The General Service Office (GSO) of AA estimates that there are over 115,000 groups operating in approximately 170 countries with over two million current members worldwide. A study published in Addiction cites that those who attended and participated more frequently in AA or NA meetings after completing a residential drug treatment program were more likely to remain abstinent from opiates and alcohol over a five-year period than those who attended AA or NA less regularly or not at all.
AA and NA groups are designed to be available to everyone regardless of race, gender, orientation, or professional, social, or economic status. Meetings are open to all people from all walks of life The key components of AA and NA are spiritual in nature, however, which may alienate those who do not accept giving themselves over to a higher power or God. AA promotes honesty and morality at its core, and for nonbelievers, the spiritual components, including prayers and acceptance of a higher power, may be overwhelming and counterproductive. Fortunately, a large number of nonreligious, or secular, AA-type groups exist. These recovery support groups include agnostics, atheists, humanists, and freethinkers, and The New York Times reports that there are as many as 150 such groups operating in the United States today.
Modifications of the 12 Steps
The key components of a 12-Step program boil down to three main ideals: acceptance and recognition of substance abuse as uncontrollable and problematic thereby necessitating complete abstinence, fellowship with other members and the surrender to a higher power, and active participation in the 12-Step methodology, activities and meetings. Most of the ideals held up by the 12 Steps are viable regardless of your faith orientation; however, the giving of oneself over to a higher power is problematic to agnostics and atheists alike who may not believe in or accept the existence of such a power or outside influence. Some may remain in AA and substitute the program or group itself for their higher power while others may seek out alternatives.
The individual 12 Steps of AA themselves are inherently religious and faith-based in nature. Many of the non-religious AA, or 12-Step secular groups, in existence today therefore modify the traditional 12 Steps to fit a less spiritual model. The original 12 Steps included in the AA doctrine are largely spiritual in nature, with at least seven of them referring to a higher power, God, or a spiritual awakening. These steps can be modified to instead refer to increased self-awareness and acceptance of the modified program itself. Some groups rely on scientific methods, while others replace spirituality with morality and more humanistic ideals for instance. Self-reflection can be substituted for the outside influences also.
The coordinating body of AA, or the GSO, allows other groups to imitate its 12-Step program, although many are not permitted to call their meetings or groups “AA” specifically if the faith component is removed. The Toronto Star reported on a split between the Greater Toronto Area Intergroup (GTA) local coordinating body of AA groups and Beyond Belief, a known agnostic AA group who removed the word “God” from the 12 Steps, modifying the program to incorporate less-spiritual individuals in recovery. The GTA removed these agnostic “AA” groups from its lists of meetings and literature, citing too many alterations to the traditional AA 12 Steps.
Less-traditional AA models shy away from the faith-based methodology and prayers, although they embrace the ideals and basic concepts of the 12-Step program and its effectiveness in maintaining sobriety. For example, several of the 12 Steps refer to becoming more self-aware and taking responsibility for one’s actions and previous shortcomings as related to addiction and substance abuse. By admitting fault and character flaws, denying secrecy and indicating the desire to make healthy changes and amends to wronged family and friends, AA programs promote recovery.Several different types of groups and organizations exist to support alcohol and drug abuse recovery in a less spiritual manner, including:
- SMART Recovery groups, which are self-empowering and science-based
- Secular Organizations for Sobriety (SOS) is an non-profit network of secular addiction recovery groups, replacing God with good
- AA Agnostica hosts an online forum with information on non-spiritual recovery models, news and group details
- We Agnostics and Beyond Belief groups ask members to believe in nothing except that recovery is possible
- LifeRing Secular Recovery groups offer abstinence-based peer support that is both secular and self-directed
- Women for Sobriety is a non-profit organization offering groups exclusively for women suffering from addiction in a secular and self-empowering format
- Center for Inquiry (CFI) is a non-profit humanist organization with secular and evidence-based methods and models
Isolation can be a component of substance abuse, and finding a peer support group that you can identify with regardless of your faith can go a long way toward sustaining your recovery.
Importance of Self-Help Support Groups
A study published in the Journal of Studies on Alcohol found that attending AA increased long-term abstinence, and belief in a God, or lack of belief, had no effect on recovery; however, those unclear about their beliefs were more prone to suffer a relapse. So it seems that those more clear about their beliefs, whether spiritual or secular in nature, have a greater success rate than those unsure what they believe in. Becoming more self-aware and understanding the nature of your own personal core belief system as it relates to your life is an important part of the healing process.
Behavioral therapies are employed during drug and alcohol treatment in order to help increase self-esteem and modify negative self-images. Feelings of guilt and shame and lowered self-worth are examined and reimagined into more positive emotions and behaviors. Emotional and social triggers are identified in treatment, and coping skills are learned to manage these triggers in everyday life. Support groups provide a safe and secure environment where difficult emotions can be shared and understood by peers experiencing similar situations and circumstances. Treatment does not end with the completion of a residential or outpatient program, and peer support groups are an important component of aftercare during recovery.
The American Psychiatric Association (APA) reports that self-help groups like AA, NA or other 12-Step programs support and reinforce behaviors, ideas, and messages learned in treatment for substance abuse, and therefore, they should be included in substance abuse treatment plans. Dual diagnosis treatment seeks to treat the whole individual, including all physical, emotional and spiritual aspects. Complete treatment may include evidence-based models combining clinical, scientific, personal, and cultural preferences. Specialized integrated care models are employed to treat those suffering from both a mental health disorder and a substance abuse disorder simultaneously. Dual diagnosis treatment is the highest standard of care for co-occurring disorders.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.