By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Alcoholics Anonymous big book.
Why do professionals send you to A.A?
Therapists and Counselors treat people with all sorts of serious and persistent mental illnesses so why do they recommend that clients with a drinking problem attend AA meetings?
It turns out that attending meetings provides a lot of benefits that a single therapy session each week can’t provide. In substance abuse treatment programs the standard treatment, after you are over the most immediate problems connected to your drinking or drugging, consists of recommending that clients attend twelve-step meetings.
Here are some of the reasons why professionals recommend A.A.
The 12 steps include a focused system of change.
Embedded in the “working” of steps are the elements of problem identification, change steps, and a program of maintenance. While a therapist may help you work on one problem, depression, or anxiety, the steps are a way of changing your thinking about life and all your problems.
Some people’s only problem is drinking too much, they just quit and are fine. Many others find that once they stop, all the problems they had before they drank are back in force. It takes more than putting the bottle down to stay sober.
Attending meetings helps creates a new set of friends that are clean and sober.
One critical issue in recovery is relapse triggers; hanging out with your old drinking or drugging friends results in a high risk of relapse. Finding friends that do not drink and use requires a change. The more sober friends you make the more support you will have in staying sober.
Seeing others who have changed is very encouraging.
When your therapist tells you that people can change and do recover, you may say yes some people do, but what about me? When you attend meetings and hear the stories of those who have turned their lives around it becomes easy to believe you can do this, especially with the help of people who have themselves recovered.
The longer you stay connected to therapeutic recovery the better the chances.
Continuing to stay in treatment for up to two years has been shown to create better results. Most therapy programs will not cover or include two years of aftercare. A.A. while not professional treatment is a free or very low-cost way to continue to have “booster shots” of recovery for as long as you need them.
Sometimes when I work with mental health clients, I find myself wishing this client had a drinking problem also, and then I could give them a referral to A.A.
There is a serious shortage of self-help, peer recovery groups for those with mental health issues. The few that do exist are often modeled after the 12 step system.
Therapists and counselors do not customarily work the steps with clients. That is something we encourage them to do at the 12 step meeting. What we should do is a process called 12 step facilitation, in which we explain A.A. or other self-help groups, how they work, what the steps are, and encourage people to participate in the meetings.
The posts I write about A.A. or other self-help groups are from my perspective as a therapist and clinical counselor and do not necessarily reflect the views of AA World Services. For more on AA and their program of recovery check out the “AA Big Book” titled Alcoholics Anonymous at the links below or contact AA World Services at their website.
The Big Book of Alcoholics Anonymous
The classic text on Alcoholism, recovery this is the book that started off the whole 12 step phenomenon.
Alcoholics Anonymous from The Anonymous Press
One of the Kindle editions – At 99 cents this is such a bargain. This edition needed a separate listing. No Kindle reader? No Problem, if you have a computer you can download a free Kindle reader.
Staying connected with David Joel Miller
Seven David Joel Miller Books are available now!
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Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.
Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.
As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.
Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.
Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.
Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.
Planned Accidents The second Arthur Mitchell and Plutus mystery.
Letters from the Dead: The third in the Arthur Mitchell mystery series.
What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?
Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.
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What’s important for professionals to realize is not that they *should* refer people to AA, but that they should present a variety of recovery options to their clients, including encouragement that they can do it on their own.
In my case, I was IN therapy because AA wasn’t working for me, and I had developed deep depression because I was constantly praying for the miracle to happen, felt that I was powerless, insane, defective, incapable of being honest, wondering how much more I had to drink or lose to ‘hit bottom’. I didn’t feel comfortable in AA meetings because I was expected to say things I didn’t believe.
After being repeatedly referred to AA and rehabs (more intensive and expensive AA), and getting worse and worse, I realized that all options were not being presented to me. This is called suppression of informed consent, and is not the ethical way to do therapy. I’d recommend all therapists be ready to recognize when AA has had a negative effect on a certain type of personality, and be ready to stress other options including the option to leave AA without believing that one will end up drinking oneself to death.
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Hi David,
Short version of why to refer people to 12-step:
1) It’s free/low cost and widely available;
2) It’s evidence based– research shows it works;
3) You get unlimited “do-overs.”
Many people criticize 12-step recovery, but that hasn’t stopped it from working. My favorite “paradox” is that AA has been criticized for being ethnocentric & limited because it was founded by two college-educated white protestant guys– but the largest AA membership outside the U.S. is in Mexico.
Oh, and Tim– my favorite question for clients with problem drinking who want to cut down is, “What’s the overwhelmingly necessary, can’t-get-it-anywhere-else benefit of one or two drinks?” It moves the process right along. Either they realize there is no such benefit or they tell you what it is (from their point of view). then you help them find non-drinking ways of getting the same benefit.
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Hi David,
I agree with your approach. Whilst I do have some reservations about the AA approach (I think it is dated and the emphasis on spirituality does not sit with many) and AA itself (many people don’t think that the other people at AA meetings are ‘like them’), I do feel that the intensive focus on the issue of drinking is invaluable when you are trying to manage problem drinking.
Further, I think AA and its member have developed a large first-hand body of knowledge, hammered out through the daily experience of millions about drinking and not drinking, that would be useful for most counsellors and psychotherapists to be aware of in the treatment of their clients.
Key amongst this is the very approach that people want to take when their drinking is a problem – ‘cutting down’. The experience of millions of people in AA is that it is a very rare person that can manage their problem drinking with in the long-term by cutting down. Most people need to painfully come to the idea that it’s an all-or-nothing thing if they want to end problem drinking with certainty.
– Tim Hill
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Hi Tim, Thanks for the comment. I think that a critical factor is the fit between the person and the helper. We all know that the fit between client and therapist predicts the success of therapy. For every person who has told me that they did not feel like A.A. was helping I have also talked with a person who told me they went for therapy and therapy was not helpful. There is a huge difference in the people you would meet at an A.A. meeting in the capital building and those you would meet in a meeting on skid row. In some future posts I want to write more about how a client could find a therapist who is a good fit and how a client might find a 12 step meeting that is a good fit. Thanks again for your comment.
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