The Death of the 12 Steps

Anyone with a home group in Alcoholics Anonymous or Narcotics Anonymous knows the joys of entering a room full of familiar faces brimming with the spirit of recovery. It’s a home away from home – a safe refuge where life’s elements are shared, some intimate, some hilarious.

But that’s soon to be a distant memory. One day, as a sober old goat, I can see myself recalling the glory days of AA with my grandkids. They might wonder why, at times, grandpa still refers to himself as an alcoholic. Or how he jokes with his old friends that they should, "Keep coming back!”

If you’re sober in AA or NA, chances are you gawk at the death of 12 step recovery. You shouldn’t. Here’s why.

Health Insurance Finds Loophole in Obamacare

Barack Obama touted the ability of his health care initiative to address the need for access to substance abuse and mental health services. It didn’t.

The “Final Rule” is part of the Mental Health Parity Act and stipulates that all addiction treatment must be evidence-based medicine. Insurance companies capitalized on this to justify denial of patient claims on the basis of a facility’s 12 step program model.

Now I won’t go into the fact most treatment center’s claims of a “12 step-based” program is dubious. Usually, 12 step-based means a few classes a week for an hour or so. But health insurer’s response to the “Final Rule” shifted addiction treatment’s model to a more psychopharmacological approach.

This means patients often leave facilities on medications like Suboxone or anti-depressants. Again, I won’t go into the hazy claim of anti-depressant efficacy (hint: click the link if you want to read more). And I’m certainly not anti-medication with regards to addiction recovery. Yet I can’t help but think there’s a good chance over-medication in modern substance abuse treatment is right around the corner. Scratch that, it’s already here.

Personal Experience with "Evidence-based" Medicine

Prior to getting sober, and this isn’t something I usually advertise, I was given mental health diagnoses galore. Everything from Bipolar Disorder (I and II), to major depressive disorder, to personality disorders and even a disorder I won’t mention. My first round of medications consisted of Abilify, Depakote, Remeron, Zyprexa and Ativan. I gained approximately 80lbs, slept all day and was morbidly depressed. Didn't help that I worked security at the airport. Other medications encountered down the road included Seroquel, Lexapro, Wellbutrin and Lithium.

As soon as I stopped taking the medication, weight gain and depression disappeared. As soon as I got sober and stayed sober, there was no need to take meds. Two and a half years later, I’m still sober solely through a 12 step program. There’s a time and a place for psychiatric evaluations and medication. But that time is not at 5 minutes sober, entering a detox facility, about to withdraw like the French from war.

The problem? I was not honest with a doctor or therapist. These professionals, though well-intentioned, lacked experience – the critical ingredient necessary to break down the walls of a substance abuser. You can’t learn how to work with people with chemical dependency in a textbook. It’s an art. And requires experience. It's the same reason most good jobs require experience. Experience is the ultimate doctor.

Let's forget for a minute that psychiatrists, for the most part, receive almost no training in the area of addiction. Let's forget social workers and therapists also receive little training and often harbor prejudice against substance abusers.

Now I know everyone’s story isn’t mine. Some people do need medication. My beef with the white coats is the psychiatric evaluations that occur at ground zero of addiction recovery. Day 1: going through withdrawal symptoms like an Afghan poppy farmer. Did psychiatric evaluation. Doctor said I was crazy.

That pretty much sums up my experience at mental health facilities. Go in for substance abuse. Leave with a mental health condition. And thinking I'm crazy. Ok, maybe I was a little crazy. But it was mainly the drugs. Mainly.

There MUST be a stabilizing period, a time where the body can begin to heal, before the shrinks arrive armed with prescription pads and mental disorders. Unfortunately that’s not going to happen.

What is going to happen?

In the coming years, you will slowly see 12 step programming phased out of addiction treatment centers. The old saying, “He who makes the money makes the rules” fits this scenario perfect.

Health insurance providers say, “We want addiction medicine, harm reduction and that’s all we will cover.”

Addiction treatment responds, “Ok, that’s all we will offer.”

And it’s just that simple.

In the process, 12 step programs wither and die. Rehab centers provide the lifeblood of recovery fellowships like Alcoholics Anonymous. Treatment facilities are to sober communities what the minor leagues are to Major League Baseball.

Who Killed the 12 Steps?

Now it’s easy to blame health insurance companies. There’s just-cause too, as Cigna settled out of court due to their denial of substance abuse and mental health claims. Yet the principle of anonymity espoused in Alcoholics Anonymous bears partial responsibility. By refusing to open its doors to researchers, it’s difficult to conduct, well, research.

Now I have to give credit where credit is due. Matthew Leichter, a researcher, recently wrote an article on The Fix that inspired this article. I thought I could use his work and build on it with my own experience, since he doesn’t appear to have any personal experience with substance abuse.

To me, a researcher without personal substance abuse experience is a lot like a commentator on sports versus an athlete who plays the game. It’s easy to watch and read and study, but it’s no substitute for playing the game.

Mr. Leichter’s article cites several studies that conclude 12 step programs are not effective. I wonder if he read this study, or this study, or this study, or this study. You get the idea.

Truth is, the health care industry doesn’t like 12 step fellowships because they are free and unable to profit from them.

But with the fall of 12 steps in addiction treatment, and AA membership dwindling, I can’t help thinking of a day when my support group isn’t there to support my recovery. What will I do then? What will people do who can't afford high-roller services like private therapists and counselors?

Guess I should start putting aside a therapist fund. Without the support I’ve found in 12 step fellowships, I’m going to need all the counseling I can get. Remember, I'm Bipolar I and II with major depressive disorder with personality disorders and another unspeakable disorder. 

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