EFFICACY AND EFFECTIVENESS OF THE 12 STEPS IN LONG TERM RECOVERY

Scholarly Research Journal for Interdisciplinary Studies, Online ISSN 2278-8808, SJIF 2019 = 6.380, www.srjis.com PEER REVIEWED & REFEREED JOURNAL, MAR-APR, 2020, VOL- 7/58

EFFICACY AND EFFECTIVENESS OF THE 12 STEPS IN LONG TERM RECOVERY

Sameer Patil Kripa Foundation, Email: reachingsameer.sp@gmail.com Abstract Drug addiction is assuming alarming proportions and has become a worldwide phenomenon, spreading across nations. However, it is varying in magnitude and characteristics in the different areas and spectrums of society. It has grown as a raging epidemic, that has shaken the entire fabric of society, India being no exception. Every day there is an increasing number of people initiated into drugs, being addicted and getting caught in the vicious cycle of life and death. Addiction, not just affects the individual, but causes problems in terms of social disorder, increased expenditure, and transmission of infectious diseases, leading to disturbances in the socio cultural and political fabric of society. While there are different models of treatments available across the world, as well as in India, one model that stands out is the 12 step recovery model. Studies have shown that 12 step groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) among others have proved to be an effective and cost efficient approach to tackle this ever growing menace of addiction in our society. Across the globe, there are numerous addiction treatment facilities that recognise the 12 step recovery model as evidence based treatment. The therapeutic approach as, against othertherapies seems to work better, as it helps the individual to cope with life on a daily basis. However, there seems to be a missing element, either in treatment or post discharge, considering the low success rates for individuals with substantial long term recovery. There being no set standard in measuring recovery, according to the Betty Ford Foundation, in the U.S, “Recovery is achieving complete abstinence as well as wellbeing”. It is precisely in this context that the 12 Step recovery model assumes significance. This study has in no way received endorsement from Alcoholics Anonymous, Narcotics Anonymous or any other 12 step fellowship. This study has been solely done for research purposes, to educate service givers and organisations working in addiction treatment, about the significance of the12 step model in long term recovery for addicts, and to help them to facilitate their clients active participation in AA and NA or other 12 step support fellowships.In this analysis thefocus is on the significance of the 12 step model of recovery and its significant psycho-social and spiritual benefits along with theadvantages in lifelong recovery. There will also be a discussion on perspectives and success rates with the information derived through AA and NA literature, websites as well as from other research materials and journals. The study will conclude with a summary on understanding the scope and scale, and recommendations on implementing the right strategies to achieve the desired results. Keywords: Addiction, 12 Steps, Recovery, Abstinent, Society, Disease, Fellowship, Sponsor, Meetings, Support, Alcoholics Anonymous, Narcotics Anonymous, Psycho Social. 1

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Introduction Addiction is an illness that isolates the individual from self and society. The therapeutic value of this 12 step support addresses just this, and helps the individual reconnect again. Addressing this subject on the disease of addiction, Kelly and Beresin, in their study in 2014, propounded that there is data basedevidenceof success with 12 step programs. Involvement in the groupisan effective and evidence based treatment for behaviour changes in addicts. This support system being at no cost, easily accessible across the world, especially in the absence of professionals when most needed, in times of a relapse, makes it ideal for individualsinmaintaining long term abstinence and wellbeing. This therapeutic approach is firmly grounded in the belief that addiction is a spiritual and medical disease. Being practised by millions across the world, 12 step programs follow a set of principles, in order to help the addicts achieve and maintain abstinence from not just the drug, but also from the other behavioural issues, to become responsible and productive members of society. The addict’s brain is extremely emotional and guided towards pleasure seeking behaviour. Misguided motivation with a distorted perception of self and extreme comparison of self with others, are some of the psycho social characteristics of addictive behaviour. Engaging with the 12 steps, the individual experiences lesser emotional sensitivity and misperception.

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Practising these principles on a daily basisis helpful for individuals to achieve the desired goals in recovery.Steps 1-3 help in building that foundation, steps 4-7 help in breaking denial, making a decision and initiating change, steps 8-9 help to gain self-awareness and accountability, with steps 10-12 making ita way of life, with daily practice to maintaintheir recovery and reach out to help others. Through the 12 steps and meetings, sharing their Experience, Strength and Hope, keeping a sponsor and through service, addicts learn to cope with life, make changes to avoid triggers for relapse and become responsible and productive members of society. In 1955, the published success rate in Alcoholics Anonymous was described as follows, “Of those who came to AA and really tried, 50% got sober at once and remained that way, 25% sobered up after some relapses, and among the remainder, those who stayed on with AA, showed improvement. However there would still remain some ambiguity about those figures, which have been often debated, as this data was published by AA itself, and also because some members may have chosen not to participate due to anonymity issues. However AA, which is the largest 12 step fellowship in the world, boasts of a whopping 1.3 million membership in the United States alone, with 85,000 members in Canada and around 705,000 members across the world. Studies have shown that at least one out of 10 Americans has attended an AA meeting. The American society of Addiction medicine (ASAM), in a study estimated that around 10% of individuals who associate with a 12 step recovery fellowship, enjoy long term recovery. In an internal survey done by AA in 2014 in which 6000 members participated, 27% were in their first year in recovery, 24% were sober for 5 years, 13% had 10 years in recovery, 14% were sober between 10-20 years and 22% in recovery for more than 20 years.According to a study in 2011, Narcotics Anonymous, Its History and Culture, published by William White, Chris Budnick and Boyd Pickard, reported that Alcoholics Anonymous, being there, long since1935, its presence throughout the world, the sheer strength of its membership, easy adaptation of its program across all walks of life, its wide use in addiction treatment worldwide, and various studies done on its viability in substance abuse treatment, is generally used as a benchmark,with which all other 12 step recovery groups are measured. However, Narcotics Anonymous, a 12 step fellowship, which was founded in 1953, is distinct in its understanding that alcohol is also a drug,and that the coredilemma is addiction, has gained tremendous recognition in the recovery world. Though relatively lesser known with professionals worldwide, especially in India, we would be using information compiled from the recent results of a survey which was conducted over Twenty Copyright Š 2020, Scholarly Research Journal for Interdisciplinary Studies

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two years by the fellowship of Narcotics Anonymous, to better help us understand the effectiveness of this program. Efficacy of the 12 Steps: How effective is it in long term recovery? For this specificanalysis, the data reviewed, is from therecent survey published by Narcotics Anonymous, in 2018, at the NA world convention in Orlando, in Florida, where 28,495 membersof this fellowship participated. Of all the responses,63% were received via mail/fax or online, and the remaining completed at the event, using a questionnaire, with multiple answers allowed as responsesfor some questions. The sheer size of this survey, it being relatively recent, and the manner in which information was collated regarding the attitudes, past and present behaviours, other attributes and opinions of the participating members regarding self and the NA fellowship, made this information ideal to be reviewed for this study. 3 Although these survey results collected data on a wide array of other parameters, only the relevant information required for this analysis would be used for the study. Narcotics Anonymous since its inception in 1953has remarkably grown across the world. NA boasts of a total of more than 70,000 weekly meetings spread across 144 countries, according to thisrecent report. In addition to this, there are online groups on social media which also have an impressive membership of close to 200,000 members. For several years, professionals, as well as members, wondered whether addicts were able to maintain employment, familial relationships and housing, while doing drugs. In the survey, 48% of these individuals indicated that all the areas of their lives were affected by Drug use, while only 42% of these confirmed that they were able to maintain employment. Areas most notably affected by drug use were relationships and providing for the family. However, practising the NA program daily, and the support received from the fellowship, the recent survey results indicate aupward and positive trend for those individuals in recovery.

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Areas Of Life Affected by Drug Use (Multiple Answers Permitted) All of The Above 29%

Able to Preserve a Committed and Intimate Relationship 7%

Employed 25%

0% Retained Own Place of Residence 18% 0% 0% Capable of Supporting a Family 10%

Maintain Family 0% Relationships 11%

0%

Quality Of Life Improvement 91%

87%

79%

78%

76% 55%

4 In the survey, two areas of an individual’s life that improved with NA attendance have been family relationships, where 91% respondents indicated, that their lives were enriched, and the second area being social connection, where 87% responded, that it had remarkably improved. NA literature mentions that “Active addiction is marked by increased isolation and destruction with relationships”. Recovery in NA has helped addicts to repair the damage in their lives from drug addiction. Copyright © 2020, Scholarly Research Journal for Interdisciplinary Studies

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Other notable observations made in this study have been in the area of employment for addicts in recovery. 64% respondents replied that, they were employed full time, compared to 25% while in using, 11% were employed part time, only 7% were unemployed, with 11% being retired, 4% being students and the remaining 3% being homemakers. Employment Status 64%

11%

11%

7%

4%

3%

5 Some of the other demographic data collected in the survey is illustrated below for reference purposes: Average Age 46 Years

15%

Over 60

25%

51-60 20%

41-50

25%

31-40 14%

21-30 Under 21

1%

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Gender

Others

1%

42%

Female

57%

Male

6 Years Drug Free (Average Clean Time 11.41 years) More Than 20 Years 22%

Less Than 1 Year 12%

16-20 Years 9%

11-15 Years 11%

1-5 Years 31%

6-10 Years 15%

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Drugs Used On Regular Basis (Multiple Answers Permitted) 14% 11% 14% 17%

Inhalents

Pescribed Meds

23% 25% 25% 26%

Opoids

31% Opiates

38% 38%

52%

62% 73%

Alcohol

7 One other significantelementobserved in this study is the influence factor for addicts to attend NA meetings, where 45 % of responses indicatedthat treatment facilities referred them to NA meetings, 32% pointed out a family referral, and a majority 49% affirmed that they were referred by another NA member. One striking observation is that 82% of respondents expressing that identification is the key component for their staying with NA and 55% of respondents confirming that the first meeting, was one that influenced them to stay. Influences to Attend NA Meetings (Multiple Answers Permitted) 49%

45% 32% 14%

13%

10%

13%

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Importance Of First NA Meeting

Not at All Important Somewhat Important Neutral Important

9% 7% 16% 13%

Very Important

55%

8 Summary According to a 2013 study, in the journal, Social work in public health, it was suggested that early involvement in 12 step recovery groups has shown to reduce substance abuse and enhance the individual’s commitment to long term recovery. There is a report published from the conference “How Alcoholics Anonymous (AA) and Narcotics Anonymous work”: Cross Disciplinary Perspectives, held in the year 2009, in Michigan, USA. It wasnoted that, the effectiveness of treatment outcomes and rates of abstinence, among those who attended 12 step mutual aid fellowships, are twice as high, compared to those who did not. One area that needs mention in this study is the attrition rates in these groups, which indicate that nearly 85% of those who attend AA meetings, and 95% of those attending NA meetings eventually dropped out for a month or longer. Surveying the results to find out the reasons for this attitude, it was observed that while a majority of those individuals had relapsed and did not want to stop, 27% of those in regards to NA and 33% of those in regards to AA, asserted that they did not require a 12 step fellowship to recover. Notably 44% of those individuals affirmed the importance of recovery, to stay motivated and seek help and support. Anotherconclusion made during this study, was the attitude of clients towards the AA and NA programs, among outpatient treatment facilities. On a 10 point scale, clients rated 12 step recovery programs at an 8.7, while the helpfulness factor of a 12 step program was rated at 8.2. These high scores indicate that if treatment facilities and caregivers can work towards better motivation and help clients, to seek and accept support, the outcome of this Copyright © 2020, Scholarly Research Journal for Interdisciplinary Studies

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combination of treatment and 12 step recovery supports can yield effective and long-term results. Lack of participation hinders the outcomes and goals of this program. If individuals commit themselves to this program and attend meetings regularly, they will receive the full benefits of recovery.Understanding the scope and scale in which these 12 step support groups benefit those in addiction treatment and thereafter, and determining its effectiveness, post discharge, is critical, if we have to solve this intricateissue in the most efficient and timely manner possible. Therefore Institutions, Counsellors and caregivers working in addiction treatment, need to understand the relevanceand effectuallyimplement the 12 step holistic model in their therapies, the primary emphasis being on the goal to foster the client’s commitment to attendance and participation in 12 step meetings, while in treatment and post discharge. Clients can be served better, if they are encouraged to utilise the available tools (Program, Literature, Meetings, Sponsor, and Fellowship) effectively, to maintain abstinence and wellbeing. Acting as a catalystin educating, supporting and advising the client, and facilitating their entry into a 12 step support structure, is of prime significance,if we have to help the client tolive a drug free life, and experience recovery. 9 Implications/ Suggestions 

Working with clients effectually to enhance their motivation and to help them seek and accept support.



Holding 12 step support meetings onsite treatment facilities. Most 12 step recovery groups have outreach programs and Institutional groups which can be reached out for help. Individuals that have received exposure to meetings while in treatment were more likely to recover, than those who were not.

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Encouraging participation in12 step meetings, during and after treatment. Those individuals, who attended, participated and involved themselves in the group, showed better responses towards recovery over a longer period.

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Caregivers and Therapists themselves need to be aware and convinced about the effectiveness of this 12 step mutual aid theory. Becoming knowledgeable about the various recovery groups and getting familiar with different types of 12 step meetings, will help in educating and informing clients in making that definitive choice in their on-going recovery.

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References Narcotics Anonymous World Services, Inc:2018: Survey Reporthttp://www.na.org Alcoholics Anonymous (2001). 4th Edition, New York; AA World Services The History and Culture of Narcotics Anonymous; William White, Chris Budnick and Boyd Pickard, 2016.:www.williamwhitepapers.com American Addiction centres: Alcoholics Anonymous Statistics: Americanaddictioncenters.org › rehab guide › 12 step What Science Tells Us About Treatment Of Addiction: www.psychologytoday.com › blog › inside-out-outside-in › what-science-tells-us-aboutaddiction National Institute on Alcohol Abuse and Alcoholism Project MATCH Monograph Series Volume 1:http://archives.drugabuse.guv Daniel Fishburn:Neuropsychological Education and the 12 Stepshttps://www.naadac.org/assets/2416/daniel_fishburn_ac15_neuropsychological.pdf How Alcoholics Anonymous(AA) and Narcotics Anonymous Work: Cross- Disciplinary Perspectives: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140338/

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