Aa Step Five

In 12 steps…

The 12-Step (Steps) Program of Alcoholics Anonymous.

The 12 Steps or Steps were first developed in 1939 by the founders of Alcoholics Anonymous (AA) in the United States. Over the past decades, these steps have been adopted and adapted by a wide variety of “mutual aid” groups, proving to be an invaluable aid and guide for people on the road to recovery. The 12 steps (stages) are therefore not an exclusive anti-alcoholism program. The first step often addresses self-destructive behavior in only one word. In AA, Alcoholics Anonymous, it is alcohol. “We admitted that we were powerless over alcohol and could no longer manage our lives.” Those who have really completed the first step, the so-called surrender (“surrender”), have something they did not know before: they have the choice to distinguish whether they want to go back to living their old, self-destructive behavior, whatever it is – or to go the newly recognized way in life. The further 11 steps (stages) are recommendations for this new path. Whoever takes these 12 steps as a guide will, with their help, rediscover what he or she really thinks and feels and believes. The important thing is that recovery cannot take place in isolation, each one for himself or herself, but in connectedness with others who are also in the process of recovery. AA is a model for mutual aid programs. It is in mutuality – the open sharing of feelings, struggles, hopes and successes in the groups, without recriminations and condemnations, that lies the most effective tool for recovery. The absence of hierarchical structures is also attractive. In the 12-step program there are no experts, no examiners and supervisors, and no people who exercise authority over the members in the program by financial means. Each member is seen simply as someone who has opportunities to support the recovery of all other group members. The language in which the program is written can be difficult to understand. It has been several decades since it was developed. So it comes from a different era. We must therefore learn to pay particular attention to the spirit and the meaning of the language and interpret it in a way that supports our recovery. Someone has put it this way, “The program trumps the expression of the steps.” In other words, hidden beneath the perhaps initially alienating language of the individual steps lies something very powerful, helpful and healing, impetus and help for post-maturation, so that the individual can use the crisis in which he or she has fallen to become what each and every one was meant to be in his or her particular way. Once again – recovery is not a solitary process. We are supported in the group in the best Twelve Steps tradition, sharing experiences, strength and hope. From each other we learn. Sentences from Stephanie S. Covington, “Women and the 12-Step Program” 2006 – and “Workbook” 2006 and Walther H. Lechler “The fine line between help and self-help support” 1994 Example: the 12 steps (stages) of EA (Emotional Anonymous) in which the word “alcohol” of AA is exchanged: Text from EA. Emotional Health Support Group “[email protected] Twelve Suggested Steps. Step 1: We admitted that we were powerless over our emotions, that our lives were unmanageable. 2nd Step: We gained the conviction that a power – greater than ourselves – could give us back our mental health. 3rd step: We made the decision to surrender our will and our lives to God’s care, as we understood him, to the care of God as we understood Him. 4th Step: We have made of ourselves a thorough and fearless inventory of conscience. 5th Step: We admitted to God, to ourselves, and to another person the exact nature of our transgressions. 6th Step: We were completely willing to let God remove all these character defects. 7th Step: Humbly, we asked Him to rid us of our shortcomings. 8th Step: We made a list of all the people we had hurt and became willing to make amends. 9th Step: Wherever possible, we compensated those people, unless it would hurt them or others. 10th Step: We continued our personal inventory and when we were wrong, we admitted it immediately. 11th Step: Through prayer and reflection, we tried to maintain our conscious connection to God, as we understood him, and have asked for the realization of what He wants with us and for the strength to do it. 12th Step: Having experienced a spiritual awakening through these steps, we sought to pass on this message and apply these principles to all we do Further information pages from 12-Step (Steps) groups (selection): AA (alcoholics groups): anonyme-alkoholiker.de Al-Anon (relatives groups): al-anon.de CoDA (groups for relationship addicts): coda-deutschland.de EA (emotional health groups): ea-selbsthilfe.net OA (groups for people with eating disorders): overeaters-anonymous.de NA (groups for drug addicts): narcotics-anonymous.de GA (groups for gambling addicts): anonyme-spieler.org For alcoholics, the road out of addiction is difficult – many struggle with drinking their entire lives. That’s why researchers have now investigated how effective different methods are on the road to abstinence as part of a Cochrane metastudy. The focus was on the question of how well the Alcoholics Anonymous (AA) concept performs compared to classic forms of therapy. The study showed that the twelve-step program of Alcoholics Anonymous and its system of self-help groups help more participants achieve sustained abstinence than other forms of therapy, and that it is at least as good in terms of other parameters. The origin of Alcoholics Anonymous lies in the U.S. city of Akron in 1935, when two men were looking for the best way to overcome their alcohol addiction and founded the first self-help group. Over time, this evolved into the concept of regular meetings led and organized by lay people and the Twelve Steps program. It starts with the realization that one can no longer control one’s drinking alone, the admission of one’s addiction to others, and the willingness to change addictive behaviors. Another part of the program is the mentoring of new participants by mentors who have been dry for some time. There are now more than 118,000 AA groups worldwide with a combined membership of more than two million.

Comparison of therapies

However, Alcoholics Anonymous is not without controversy because of its quasi-religious character and the fact that the groups are led by lay people. Psychologists and addiction therapists in particular often doubt that this method works any better than targeted behavioral or motivational therapies, as lead author Keith Humphreys of the Stanford School of Medicine also confirms: “I thought: How dare these people just do the things I have all these degrees for,” he said. To investigate the question of how well Alcoholics Anonymous actually helps its participants, he and his colleagues have now conducted a comparative analysis of this. To do this, they analyzed data from 27 studies with a total of 10,565 participants and compared AA and twelve-step programs with traditional clinical forms of therapy. They determined whether and to what extent the participants reduced their drinking, how long they remained abstinent, and what effect this had on their health. The evaluations showed that Alcoholics who tried to get sober with the help of AA had at least as good a chance of success, and often a better one. If the AA groups strictly followed the rules of the twelve-point program, the chance of success was even significantly higher: 42 percent of AA participants were still dry one year after starting therapy, compared to only 35 percent for classic methods such as cognitive behavioral therapy. Most of the AA participants were also still abstinent 24 and 36 months after starting therapy, the researchers report. Among alcoholics who did not achieve complete abstinence, at least the intensity of drinking decreased just as much as in classic therapies. Also, for addiction symptoms and health status, the results for AA were just as good as the other methods.

“It works!”

“There is thus high-quality evidence that the interventions of Alcoholics Anonymous and the Twelve-Step Program are more effective for sustained abstinence than other established treatments,” Humphreys and his colleagues conclude. This is because the studies demonstrated these results for people in five different countries and from very different age groups and social backgrounds. The principle of regular group sessions and close-meshed support, even over a long period of time, thus seems to help best against addiction in the long term. Humphreys therefore sees it as perfectly reasonable for psychologists and medical professionals to encourage their patients to join an AA group after participating in shorter-term therapies. “It clearly works,” the researcher said. And here’s something else the meta-study found: “In terms of health care costs, policymakers should be interested to know that four of the five relevant studies we identified showed significant cost savings for AA and related twelve-step clinical programs to increase AA participation,” reports John Kelly of Harvard Medical School. “This suggests that these programs could significantly reduce costs for health systems.” Source: Cochrane Database of Systematic Reviews, doi: 10.1002/14651858.CD012880.pub2 © wissenschaft.de – Nadja Podbregar


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The goal of Alcoholics Anonymous is absolute abstinence. Photo: Caro With more than two million members worldwide, Alcoholics Anonymous is one of the largest self-help groups. Their concept is both pragmatic and philosophical. More than 5,000 Alcoholics Anonymous (AA) came together for the annual meeting in Hamburg on May 1 to celebrate their “dryness.” At the “meetings,” they tell each other their stories and encourage each other in their resolve to stay “dry.” The “12-step program” – the name of the AA concept – often makes outsiders think of a cult at first. However, anyone who has had the opportunity to accompany a few “hopeless” cases over the years as a doctor knows about the special competence of Alcoholics Anonymous. “Redemption stories” poisoning, suicide attempt or delirium: those who have been abstinent for a long time emphasize at the meetings that they only found their way to the fellowship because they had reached the edge of the abyss. Many report that only this uncompromising crisis, in which loss of partner, job or even death threatened, made this conversion possible. They speak of their “rock bottom.” The doctor-patient relationship can become very difficult in such crises. Jürgen from Hamburg: “My doctor gave me strong tranquilizers and psychotropic drugs. Actually, these preparations only aggravated my misery at that time. He treated me regularly for all kinds of chronic diseases. But alcohol was never mentioned.” At one point, Jürgen says, he asked the doctor why he had not addressed his alcohol consumption earlier. The answer: “If I had brought it up right away, you probably wouldn’t have come back. At least this way I could keep your situation under control.” Especially in the early years of abstinence, many AAs still accuse their primary care physician of playing a role in staging the addiction drama. Experienced AAs, however, know the difficulty their doctors have in recognizing the right time to openly address the alcohol problem. They can see what a gamble it is for a doctor to speak “plainly” for once. Many find their way to Alcoholics Anonymous only after years in which alcohol has ruined themselves, their partners, and their children. When they finally “capitulate” and make contact with one of the groups, things move very quickly for some. Others have to struggle for a long time to get dry. No one tells the other what to do, everyone just listens to the often exciting “redemption stories”. The goal is absolute abstinence – to take the world as it is. Social drinking is no longer conceivable for the “real” alcoholics. AA emphasizes that they are not a “temperance or abstinence movement,” but only a community of “practitioners” who share their strength and experience toward the single goal of each remaining abstinent. “Sponsorships” are formed in which experienced people make themselves available on the phone day and night for the beginners. The older people often do this in part to insure their own sobriety. “Because even after 20 years of sobriety, I’m only an arm’s length away from the next glass,” says Jim from the U.S. “I’m still a little bit sober. To maintain their sobriety, AAs have developed “twelve traditions” in addition to the twelve steps: These postulate staying out of politics, business and other addictions. AA accepts no donations; all expenses are met from the “hat collections” of meetings. Today, there are more than two million AA members worldwide and more than 2,000 groups in Germany alone. This fellowship originated in 1935 in the USA, where a handful of desperate lay people developed the pragmatic and at the same time philosophical concept. After a few years, the women of early AA found that they too needed something for mental recovery. Thus was born “Al-Anon,” the self-help group for relatives. This established a preliminary form of family therapy, ten years before the latter came into being. Spirituality instead of spirits AA and Al-Anon describe themselves as non-religious, they speak of “God as everyone understands him for himself”. They understand their program as a spiritual concept that leaves it open to everyone to develop their own idea of a “higher power.” The “twelve steps” are reminiscent of purification or cognition paths of earlier mystical communities. However, it is emphasized again and again that it is only about the liberation from addiction. This path contains stations such as the recognition of one’s own powerlessness, daily self-acceptance, entrusting oneself to a higher power, confrontation with one’s own guilt, personal “post-maturation” and commitment to those who come later. Dr. med. Friedrich Ingwersen Specialist in psychosomatic medicine and psychiatry Contact: Alcoholics Anonymous, P.O. Box 46 02 27, 80910 Munich, phone: 0 89/3 16 95 00, Internet: www.anonyme-alkoholiker.de; e-mail: [email protected] Aa Step Five.

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