Understanding and Working AA’s 12 Steps using CBT
We previously put out an article titled “The Psychology behind the Controversial 12 Steps in Addiction Recovery” which translated AA’s 12 Steps into the language of Cognitive Behavioural Therapy (CBT), an incredibly effective and widely recognised method of addiction treatment which we use as one part of our comprehensive treatment programme across all treatment centres run by The Cabin Addiction Services Group. The article was received well, but it also sparked questions regarding the implementation of these steps from a CBT perspective. One of the main qualms voiced about the 12 Steps is its focus on religion, but when we remove that aspect and focus on the CBT translation, the 12 Steps is a programme that most addicts find quite helpful in addiction recovery. The following aims to guide you through the 12 Steps from a scientific, psychological perspective.
Implementing the 12 Steps from a CBT PerspectiveTake a look at this overview of the 12 steps translation by clicking here. Now, we will break down each step a little bit further to offer a better understanding of how we can use the 12 Steps, despite religion, to create an integral part of addiction recovery.
AA: We admitted we were powerless over alcohol (drugs/compulsive behaviours) — that our lives had become unmanageable.
CBT: We accept the compulsive nature of the disease, recognise its symptoms and detail the costs and consequences of our addictive behaviours.Explanation: The American Society of Addiction Medicine defines addiction as the following: “Addiction is characterized by inability to consistently abstain, impairment in behavioural control, craving, diminished recognition of significant problems with one’s behaviours and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.” In Step One it is important to accept that addicts are ‘powerless’ over the disease of addiction just as those with chronic heart problems are powerless over theirs. Indeed, someone who is prone to high blood pressure or heart failure can minimise their chances of developing a full blown disease with certain behavioural and nutritional lifestyle changes, and so can addicts — but while symptoms can be minimised, the disease will never fully go away. Another part of Step One deals with the concept of manageability. What price have you paid literally, emotionally, mentally and physically? At The Cabin, we use mind maps to help identify these features and accept the fact that we are addicted and that our ability to control ourselves in many ways has been lost.
AA: Came to believe that a Power greater than ourselves could restore us to sanity.
CBT: We create a new vision of life replacing the belief system we developed through our addiction with a positive belief system to help us experience transpersonal growth.Explanation: At Step Two, sceptics are already showing their faces when it comes to a higher power. However, this in no way has to mean God in the traditional sense of the word. According to CBT methods, Step Two is a chance to create an internal process of self-development and re-balancing within. Step Two is a time for building a life vision based on recovery principles and to begin practising positive self-talk.
AA: Made a decision to turn our will and our lives over to the care of God as we understood God.
CBT: We committed to following the guidance of a process greater than ourselves in order to better manage our symptoms.Explanation: If sceptics were showing their faces at Step Two, Step Three will see many more want to back out of practicing the 12 Steps. However, we cannot stress enough that God in these terms does not have to mean God himself, or even committing to any type of religious belief system. Instead, open yourself to the possibility of a spiritual experience, whether outside or inside of yourself. For some, believing that everyone is connected with all beings and nature in some way is enough of a belief system. Buddhism suggests that divinity resides within the person. Regardless of what you choose to believe, Step Three focuses on exploring self-development philosophies and lifestyles (mindfulness meditation and positive psychology) which are highly effective life pathways for many recovering addicts. Focusing on these philosophies will help a person to stop trying to control everything in a pathological way.
AA: Made a searching and fearless moral inventory of ourselves.
CBT: We comprehensively list our problematic thoughts, feelings and behaviours that are part of our condition.Explanation: Scrapping the term ‘moral inventory’, Step Four is about restoring mental and emotional balance by recognising and listing problems we have with our negative thoughts, feelings and behaviours (symptoms of the disease). It is also important to list any resentment you might have with other people and question in which ways you may have contributed to those situations. In Step Four we also introduce the ABCs of CBT to explore the ineffectiveness of unhealthy thoughts, emotions and behaviours which we will share and change in the following three steps.
AA: Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
CBT: We disclose those problematic thoughts, feelings and behaviours to a sponsor, counsellor or support group, knowing that the addiction cycle depends on secrecy and isolation.Explanation: In Step Four you were required to make a list of unhealthy thoughts, emotions and behaviours. In Step Five it is time to share this list with a trusted support network and/or advisor. Addiction thrives on secrecy and so sharing these aspects of one’s self helps to alleviate a lot of the tension that holds addiction symptoms in place. Indeed the most daunting step thus far, sharing this list with others will actually cause the production of dopamine in the brain, in turn creating a healthy brain chemical balance — the positive effects of which you will never truly understand until you have experienced it.
AA: Were entirely ready to have God remove all these defects of character.
CBT: We list the ineffective character traits which we have developed as a coping mechanism for living with our disease.Explanation: ‘Ineffective character traits’ refer to traits that are present either because or as a result of the disease of addiction. Also referred to as defense mechanisms, these traits lead to an imbalance in one’s personal life. These traits may include, but are not limited to:
- Behaving aggressively or passive aggressively
- Being overly compliant or compromising ourselves
- Sabotaging and game playing