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What if the 12 Step Program Isn’t Working for Me?

12 Steps Recovery Program

Episode 30: Why 12 Step Programs Don’t Work for Everyone

In this episode, Clare Waismann, RAS/SUDCC and David Livingston, LMFT address a listener’s question, “What do I do if 12 step groups do not work for me?” The answers to this question involve treatment planning, self-advocacy, goal-setting, and much more.

Dwight Hurst, CMHC: Hi, everyone. Welcome back to a podcast to answer your questions on addiction, recovery and mental health by Waismann Method Advanced Treatment for opioid dependence. I’m Dwight Hurst. As always, I am joined by Clare Waismann and David Livingston to answer your questions. Today, we’re going to be talking about 12 Step groups as a support and particularly what do we do if that particular resource isn’t really doing it for us? So specifically, today’s question comes from a listener from Joe, and he says, “12 step groups don’t help me. Is there anything else that I can do to help me maintain sobriety and health?” I know we’ve talked a lot about different approaches and how a one-size-fits-all obviously is not that, and Joe is finding that this is not directly helpful for him to be involved in a 12-Step community. And what else can he do? That’s a good question.

David Livingston, LMFT: You know, you want to start, Clare?

Clare Waismann, RAS/SUDCC: No, you can start.

David Livingston, LMFT: The first thing I would want to ask him is, you know, it’s a hard thing to answer without knowing him better. But ultimately he’s saying that, you know, I can I can say that sometimes what people need. I think 12 steps can be very supportive. And if people feel isolated in their lives and really feel like they need, you know, a certain type of access to other people and their stories and their interest in sobriety and so forth, it can be very helpful. There are some people that are either uncomfortable with that for a variety of reasons. Don’t like that process exactly. Or maybe they’re so busy in their own lives that what they’re needing isn’t more support per se as much as what they need is. I would say a way to get to understand their, to titrate the tensions and the unmet needs and understand themselves in a way in which they can feel more relaxed. You know, understand and get into specifically the issues that are driving their need to want to cope through a substance. You know, and I think therapy is built for that, depending on the perspective of the therapist you’re working with. And you know, so there’s you know, I think there’s also something called Smart Recovery, which I’m not super familiar with. I know some about it, but I think those are the two major avenues, but it really depends on, you know, what the need is, what is needed specifically that, you know, and I think that has to get assessed.

Dwight Hurst, CMHC: So kind of in a way that’s almost like a guidance right there or a tip is to say no what your know yourself, maybe know what your own risk factors are, because if downtime, for example, is a big killer, then you’re going to address it differently than if burnout is your killer in a way. Right? If you have to increase your downtime or if you have to increase your structure in your downtime? Exactly. Yeah. Knowing where you tend to trip up, maybe.

David Livingston, LMFT: Right, right, that that you could say that needs drive everything, right, so what, you know, needs drive frustration, they drive. So but but but needs are so varied and they’re often not really clear in terms of what they are or their importance or, you know, and so when that gets sorted out and that starts to be made clear, you start to have a way forward. So if what you need is, you know, some people sleep horribly. It sounds so basic. But I can’t tell you how many people, you know, struggle with sobriety because they’re never relaxed because they have, they sleep so badly and they’ve really never dealt with it. So. So that’s just a, you know, that’s a singular issue. But if that’s never solved, it will leave you more vulnerable, for instance. So you’ve got to assess what the needs are.

Dwight Hurst, CMHC: That’s a great point, because some of that ties in with just sort of health management. If you are, you know, talking with, well, your doctor, I guess, and your therapist and things. But also the sleep is something we probably don’t think of often enough. And it’s an example of something that you do every day. Right? I mean, you sleep every day, hopefully, at least at least once. And if we’re it, we think of things in terms of I’m going to a meeting and talking about addiction as a thing it has to do with relapse prevention. But we don’t necessarily think of sleep as something that does, and we do it probably more often than we would go to a meeting if we’re doing meetings.

David Livingston, LMFT: Right, right, and there’s no more important regulating function. So so imagine if you’re going to meetings and you’re pushing yourself to get to meetings and then you know, you haven’t had a good night’s sleep in and weeks or months, or maybe you don’t sleep well and then you’ve got to assess why. Right? You know, is there anxiety involved? Is it a hereditary issue? You know, there are other causes of it that have to do with another potential diagnosis. So then you have to assess what’s, you know, the whole issue around the sleep so you start to break down, you know what the causes are? And as these things get better, you find that people are less vulnerable. What they need or don’t eat is getting parsed and sort of figured out and their lives are, you know, getting better. And so something like that,

Clare Waismann, RAS/SUDCC: Then I would go back to the question 12-Step is not working for him. What does it mean, not working? Is he looking at 12-Step as a treatment or peer support? And I think that’s a very, very big distinction to make. If you’re looking as treatment, it is not treatment. And if you expect it to work to treat, you know, chemical imbalance or depression or other things that can cause craving, it’s not going to work. If you’re looking as a place where you have peer support, you can talk to people that have been, you know, in similar conditions then you have then is a different story. So I think it’s really, really important to distinguish the question here.

Dwight Hurst, CMHC: It’s a really good point, yeah.

Clare Waismann, RAS/SUDCC: You know, again, you know, sleep is, as David said, is a major component, but there is another 20 that, you know, I can think of really fast that is also going to make a huge difference. You know, there are people that have severe, you know, chemical imbalances. There are people that have severe PTSD. I mean, there are mental health conditions that, if not treated, who lead somebody to crave, you know, self-medication. So regardless of how much peer support they have around them. So the question is, what is John expecting to get from the 12-Step?

Dwight Hurst, CMHC: Yeah, it’s a great point because, you know, you wouldn’t maybe call a plumber and then get upset because he didn’t, I don’t know, do your roof correctly? I don’t know that that’s a dumb example. But knowing who you’re calling and knowing where you’re going is important. Like you said, am I going for peer support? Because it’s not. It’s not a therapy, it’s not an intervention or a treatment. It’s meant to be a support group support system. Yeah.

Clare Waismann, RAS/SUDCC: If you want to use the analogy of the plumber, you know you can call a plumber to fix a plumbing issue or you can call your neighbors that had plumbing issues and discuss it. It’s not going to fix the plumbing issue, right?

Dwight Hurst, CMHC: But you did fix my analogy. That was good.

Clare Waismann, RAS/SUDCC: There you go.

Dwight Hurst, CMHC: Yeah, absolutely. And it’s not that I wouldn’t talk to my friend about it either. Maybe if it was just something small, so we could. I tend to overextend metaphors, but I like that. You know, knowing what it is, I read a piece of research. This is a while ago, so I don’t know if it’s true or was true or is true still. Maybe it changed. Anyway, this research has indicated that for many people, having a good social group actually did accomplish some of the same psychological benefits as having a good support group. And this was more I think this is more oriented around general therapy groups and things. But and it may not be true for everyone, but it was very interesting that how powerful a good social group was to say if they had friends or socialized with friends and family in an effective way, it did a lot of the same things. Maybe I’m causing trouble by saying that.

Clare Waismann, RAS/SUDCC: No, no, no, listen, it’s a subject that is very touchy for a lot of people because they base their sobriety on it. And, you know, it’s been decades where people hold each other hands in groups not to relapse. But again, this. It’s based on a book that was written in the late 30s. You know, uh, we have evolved tremendously, especially, you know, the science of understanding our brains and how the nervous system works and what substance, how can affect us and so much more. So I think we have to be very careful if you’re going using a guide, you know, that was written over 80 years ago. Use it as support, but not as a guide.

Dwight Hurst, CMHC: Yeah, I think that a lot of times it won’t surprise anybody who’s listened to us before that. I think we’re all probably on the same page that even if you do get something from if you get a lot from a 12-Step group, that’s great, but you probably shouldn’t be limiting yourself to just that either. For most people, it’s probably good to also have lots of other or other balances there of help from the management and things like that.

Clare Waismann, RAS/SUDCC: I think you can evolve from that to you don’t need to be there forever. You know, there’s a time in your life that you might need that peer support and then there’s a time in your life. We’re talking about, you know, a place that you were that was not a good place. Um, you know, not productive, just counterproductive. So, you know, people can and should evolve from the conditions they’re suffering from.

David Livingston, LMFT: You know, we live in a culture in which people get very disconnected. And I think they feel very alone sometimes and having a place to go where there are people interested in supporting them and helping them and they can get to know can be really useful. And I think that’s been a great strength of of AA and a sometimes there’s also downsides to it and dangers that are inherent within them because, you know, people are also often very vulnerable at meetings like that, and sometimes no can influence each other towards things that aren’t healthy. So there’s upsides and downsides at times, but that’s not always the case, and some people do really benefit from it. But like you’re saying, Dwight, you know, a good social group, you know, because you need support, you need whether from family or your friends or, you know, at times, a therapist or even if it’s a good 12-Step meeting that you feel supported if you can find that support. But that’s, you know, there are some people with very busy lives and very, you know, have a lot of things going on that really need a different type of help for valid reasons. And you know, you know, or just don’t like that the process of 12 steps.

Dwight Hurst, CMHC: And I think one of the main things is that that’s OK. A lot of times. I think validation is necessary in these situations where you think, well, if it’s not working for me, that means I’m not working or that there’s something wrong with me in a way, and I don’t really care for that personally. I think being willing and able to talk to people. I think the concern that I see a lot of times people have is everybody knows what a 12-Step group is, and it’s not uncommon for a spouse or even sometimes a professional in the field to tell someone, you know, “I want you to be doing this.”, “I think you should be doing this.” And if the person is like, you know, I went and it didn’t help or in some cases, even maybe triggered me. I’d like to focus my energies other ways. Sometimes they’re confronted with that. Well, you’re not taking it seriously then, because I can tell you, you’re not taking it seriously because you’re not doing this one thing that I know is a good thing for many people or people say it’s a good thing,

Clare Waismann, RAS/SUDCC: I agree with you a thousand percent. You know, there’s so is often when I hear, you know, people saying that, you know, especially, parents and loved ones, well, he failed treatment because he lacked a desire to get, well, you know, he did not. Did you know what was expected of him? Maybe that didn’t work for him. You know, I believe everybody wants to be happy, period. Some people just don’t have the tools to be happy or have found the right road to be happy.

Dwight Hurst, CMHC: And I think it’s like so many things where we fear what we think is the majority and it’s really the minority. In other words, I think most people who say, “Oh, well, this isn’t really working for me,” my experience has been that most people who say that about 12 steps or really about anything, most people fall into that category said where it’s like, “Well, this isn’t working for me. I’d like to find something else that is working for me.” And I think the minority are probably people that are like, “Nah, it doesn’t work because I want to manipulate. Now, maybe I’m being a little optimistic, but I would say one thing that I really do believe is that you can pretty quickly tell the difference. You don’t have to say, How can I tell if they’re invested? I think you can pretty quickly tell if someone’s saying, I want to focus, focus more on my therapy and I want to focus more on this type of, you know, approach. And they’re then not relapsing. They’re serious. You can rest assured just because they’re not doing that one thing. You know, if they’re not serious about getting healthy, they’re not going, then nothing’s going to work for them. They’re going to say this isn’t right about everything. I don’t think it’s a marker just because they say it about 12 step groups that they’re not going to get better.

Clare Waismann, RAS/SUDCC: But don’t you think sometimes they are serious and they wanted that enough, but fear just overwhelmed them? So I think they might be fighting something, you know, based on fear and not based on the will to get well.

Dwight Hurst, CMHC: And that’s absolutely a good point. I think you bring a good point. I didn’t mean to cut out people who like they mean well and they are serious, but then they still have the bumps in the road or they don’t succeed all the time. Yeah, that’s a good point. I didn’t mean to cut those people out or make it sound like they’re not trying, but I think you’re absolutely right. It’s like trying to ask why isn’t something working like you say instead of saying, like, “Well, it’s not working, let’s blame somebody.”

David Livingston, LMFT: First, a terrible it’s like you’re both saying it’s a terrible idea, because you immediately put the person into conflict with their own instincts, and that’s probably the worst thing you can do to help somebody when someone’s saying this isn’t working for me. You know, first of all, you want to understand why. Right? So because just in articulating the reasons why something isn’t working, you will get a sense of who the person is, what they’re looking for and what’s not working, and you’ll actually get to know them. And you also get to know a sense of who they are. So we have this misconception and kind of goes to the heart of what I think we’re talking about, that we’re supposed to be able to choose what’s going to work or choose for other people, what’s going to work. That’s just an absolute fallacy and causes more failures in treatment and help than anything I know. The truth is we discover, we discover who people are and they discover what works for them. You choose it far less now. Once you’ve discovered like, OK, this doesn’t work for me, I need to find something and more in this area, then yes, you’ve got to make choices and you’ve got to take responsibility for moving in those directions. But it is far more of a discovery about who we are and what works for us and the willingness to go through that process, and it is being told. And you know, while it’s good to keep an open mind so that we can take in new information and go through a discovery process, in the end, we, you know, it’s like I say in all these podcasts, you’ve got to listen to people because you’ll discover who they are. They’ll tell you if you’re listening and you’ll actually see them sort of unfold in front of you and they’ll be grateful and they’ll be more participatory because they feel like who they are is going to get help. And when you have a better treatment.

Dwight Hurst, CMHC: Absolutely.

Clare Waismann, RAS/SUDCC: Absolutely, but there you go again, if you go back to the question where you know, we started today is what David is talking is about, you know, treatment, individual therapeutical treatment. And what the listener was asking was about, you know, a peer support group. So again, to be heard to be understood. It’s really important, you know, to to decipher your needs and the way you do that is mostly through therapy.

Dwight Hurst, CMHC: Yeah, and I really like the emphasis on making sure, you know, you know, what are you shooting for and what are you trying to get out of something? One of the things that occurred to me as you’re talking, is that there are one one thing people might want to try with the 12 Step approach, if that’s not really working for them, they may want to Google harm reduction support groups because harm reduction is it’s basically just another philosophical orientation that says it. Basically, they err on the side of not telling people how to define their health or sobriety or whatever, but it is a different approach. The other is to say maybe cognitive-behavioral addiction support groups, and some of these may be online because they’re not necessarily as available. Some of them are run by therapists, and then some are also just support groups. And so there are other kinds of support groups out there. I think it’s important for people to do their research and…

Clare Waismann, RAS/SUDCC: Yeah, but again, don’t don’t confuse them. They are support groups. So in the reason I keep going back to this over and over again is because, you know, I spend most of my life on the phone with people, you know, struggling with addiction or with family members. And most of them have been in so many years, so many treatment centers, you know, different support groups. And they have relapsed over and over again and they feel lost. They feel, you know, hopeless. They feel and hurt because they never, ever been really treated. And most of these people do have some kind of mental health issue that has not been dealt with because not because it wasn’t obvious, but because there was no professionals diagnosing them. What there was others that have been in the same place they have been or similar places, you know, talking about their own experience.

David Livingston, LMFT: Right, right, so. These are support groups, and I think you’re 100 percent right. It’s rare the people get effective treatment. And as I’ve said in other of our podcast, most of the time when I ask people why they’re they’re struggling with addiction, they have no idea, even if they’ve been through all kinds of programs and this and that they they’re like, I don’t know, you know, or they’ll they’ll say things like, well, it’s a disease. And and like I said before, the problem with that is there’s no benefit to that thinking in terms of getting better. Right. It’d be like going to the doctor and the doctor saying, Well, you’ve got a disease, there’s no usefulness. And in that in that type of. So so what a doctor does and what anybody does in this field should do is break it down. Well, let’s understand. Let’s let’s just see what’s driving all of this, right? Because. And so if you and you can, you should be able to quickly surmise and help someone see exactly why they’re struggling now. The why isn’t that the end of the treatment by a long shot, but it gives you a direction, a real direction. And if you never know exactly why, I mean exactly why that in a way that feels right to you, like you go, Yeah, OK, well, that makes sense. That makes sense. That makes sense. If that isn’t happening, it’s you’re probably not heading in the right direction. You’ve got to know why. For starters.

Dwight Hurst, CMHC: I know people go in sometimes to there are certain prescribers, psychiatrists and nurse practitioners I know who run kind of a little battery of tests. And of course, I know psychologists who run a big battery of tests for diagnosis. And yet I know the majority of people I know who actually get treatment or medication, they go in and they might say, you have an addiction and they get, OK, your diagnosis is opioid dependence, use disorder? Do you ever get depressed? Ok, depression? Yeah. Great. Let’s work on it. And it’s like, sometimes there’s not that time, I say. Sometimes I think, probably mostly when we go to treatment. Treatment still works a lot of times because a lot of it might be similar. But to really understand ourselves, I am always surprised how infrequently we go and get like testing done to say, you know, take these psychological tests or even get your thyroid checked and different things that can affect your emotions. We just don’t do it as often as I think we should.

Clare Waismann, RAS/SUDCC: Absolutely. Yep. Treat the whole patient. And again, no one professional can treat the whole patient, but if a professional, you know, can help make a diagnosis and at least you know a path of what should be done from here. Now, I think we spoke about this in other episodes before we all have to continuously work on our health or mental health or physical health is not something that we fix one time and that’s it. We don’t have to look back, so it could be multifaceted, you know, you know, it could be a chemical imbalance. It could be again, a lack of sleep because of a hormone imbalance could be, you know, an actual cause of trauma. So it could be a million different things. So if one thing didn’t work, it doesn’t mean you failed, it means you didn’t get the right treatment for your health needs. Let’s try something else.

David Livingston, LMFT: Right, right. And kind of to this end, I was reading something the other day where they were talking about sort of the two, the two main things that people look for in life, which is in order to have a good life, which is, as you said, Clare to be happy and then also to, you know, to have a meaningful life. So those are kind of the two things you hear a lot for good reasons. And but then what this person was saying is that there’s another it’s actually not necessary to have a meaningful life or even necessarily a happy life to live a good life. And the thing they were also saying is that there are many people who live different types of lives who one of the components that really sort of fortifies them and helps them feel like they’re having a good life. Is their own psychological awareness? So the ability to understand what you’re in the midst of creates a whole other dimension of of of of just feeling like, you know, how to be with yourself, you know, how to be with other people. You know, you can understand it and think about what’s happening. And so there’s a there’s another dimension to it. And I think that as people become more psychologically sort of aware and insightful and have that capacity to kind of have an observing ego of themselves and other people, it’s really useful and sort of creates another dimension to having a good life.

Dwight Hurst, CMHC: And thank you so much for tuning in, everybody. This is going to do it for us today on this question. A lot of complicated things to look at when you’re looking for different supports. And above all, we have a recurring message on this show, of course, which is find the treatment that is right for you and find the treatment professionals that are there for you. We’re there for you as far as answering questions that you have, and we love to hear them and we’d love to talk about them on the show. You can get a hold of us by sending an email with your questions or anything else you’d like to share to info@opiates.com. You can also go to our website opiates.com or hit us up on Twitter @opiates. Our music is the song Medical by Clean Mind Sound for David Livingston and Clare Waismann, I’m Dwight Hurst and glad to be with you all today. We’ll look forward to answering your questions again. Keep asking them because if you ask questions, you’ll find answers. And if you find answers, you can always find hope. Bye-bye before now. Be with you again soon.