There's something about AA (and the spin-off 12-step programs for other issues) that definitely works. As one of their slogans says, "meeting makers make it" in recovery.
Specifically WHAT works seems to depend on whom you ask. From my perspective, however, I see social support as the program's #1 strength. There are 12-step meetings available every day of the week, at just about any time of day, in just about every corner of the globe. It's a powerful thing to find a community of people who really get what you're going through, because they've been there too. And it's an even more powerful thing to have one of those people (i.e., a sponsor) commit to doing whatever it takes to get you through the recovery process - including answering the phone in the middle of the night, coming to get you from wherever you've gotten yourself stranded, sitting with you in emergency rooms...and probably a lot of other scenarios my clients haven't shared with me.
I wish that kind of ready-made support group and mentoring were available to people without addictive or compulsive behaviors!
Beyond the support, some people really see the steps themselves as pivotal - an intentional changing of mind, body and spirit from willful to willing, by admitting powerlessness, accepting a higher power, taking moral inventory, making amends, and choosing to live differently moving forward. I have some theological issues with the specific steps, but on the whole, it's a decent description of the change process some go through.
Here's the thing, though: I'm not convinced that this process is necessary or helpful for everyone with this kind of problem. In fact, I think it can be counterproductive for people (often trauma survivors, but not exclusively) who are already struggling with learned helplessness, feelings of worthlessness and shame. To emphasize one's powerlessness and "moral failings" seems only to solidify these people's negative self-image. Sure, working the program may still help them stop their addictive or compulsive behavior...but at what cost?
The concept of "character defect" particularly gets under my skin. Here I am, working to empower my clients and build up their strengths, and they respond by telling me about their permanent, inherent character defects. From the perspective of narrative therapy it is incredibly challenging to develop a less problem-saturated view of oneself in the face of constant reminders to stay vigilant lest one's character defects cause relapse.
It's challenging to come up against this viewpoint in therapy, both because it flies in the face of much of what we're taught about practice, and because expressing disagreement with "the program" may feel threatening to clients who are very involved in AA (etc.). They may experience a loyalty bind between the program, to which they may feel they owe whatever sobriety they have, and the therapist - not a good scenario for client or clinician! Yet, when I feel like an aspect of the 12-steps (usually the character defect piece) is actually harming a client, I will introduce the idea that it's possible to take what works for them, and leave the rest - recovery doesn't have to be mindless acceptance of the whole AA package. However, because many clients are very attached to that model, I am always careful to affirm the excellent things AA teaches about sober living.
Since this is an issue about which many people have varied strong opinions, I'm curious how others address the 12 steps in their practice - particularly with folks whose perspective differs from your own. Leave a comment below!
In closing, another excellent contribution from AA, the "Serenity Prayer:"
God, Grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And the Wisdom to know the difference.