12 Step Treatment
At The River Rehab, we take Recovery very seriously and our 12 week signature programme is designed specifically to give our clients the full 12 step experience.
We will take them through the whole 12 step journey, so that when they graduate that actually have a working knowledge of how they’re going to remain alcohol and drug free. This is a “no half measures” approach, as the 12 step programme has the very best evidence over all of the various practices aimed at overcoming addictions for almost 100 years and that over time it has proven itself to work most effectively in the most cases. We can still cater to those who have reservations in some way about the 12 step programme (usually the spiritual aspect) by finding alternative ways to move people through their challenges, and still get the same magnificent results – freedom from their obsession to drink and / or drug.
The 12 step treatment explained:
The 12-Step process prepares individuals to have a ‘spiritual awakening’ or a ‘psychological change’. These changes refer to the transformation in thinking, attitude, and outlook on life that occur during and after working the steps. This conversion allows them to free themselves from the compulsion and obsession to use and drink, and therefore from active addiction. It could also be considered a form of personal motivation and inspiration.
This alteration in thinking allows for a dramatic change in behaviour, which then permits the individual to feel better without the desire to return to damaging substances in order to attempt to elevate their mood.
The basis of the 12-Step recovery programme is firstly acceptance that addiction is an illness and secondly a desire to treat it through personal action, rather than self-medication. By letting go of the past and dealing with the problems as they arise in the ‘here and now’, combined with the self awareness they learn through this programme, the individuals can better identify their negative behaviours and celebrate their positive successes achieved each day.
Applying the principles of the steps within their daily lives enables addicts to establish and improve upon some form of conscious or unconscious contact with a God (good energy) of their own understanding or particular faith. The important part of this is not whether someone believes in God or not, but rather whether they believe it’s possible that there is a power (non-human) that can help them, such as nature, or spirit or something else (anything that isn’t them). This is commonly referred to as a ‘Higher Power’ or ‘Power Greater than Yourself’.
It must be stressed that the 12-Step Fellowships are not allied with any particular religion, sect or denomination, and that the form of God the individual chooses is completely up to the individual to discover. Indeed there are many atheists and agnostics who have progressed through the 12-Step programme relying upon a God they refuse to understand. I am also aware of a number of ‘Jedi Knights’ who have used their understanding of the ‘Force’ to help them with their addiction (successfully). The key here is simply about keeping an open mind and being willing enough to consider other possibilities.
Many recovering alcoholics and addicts believe that the greatest safeguard in preventing relapse lies in consistent application of the 12-Steps and continuing to place their trust in a power greater than themselves (whatever their personal interpretation may be) and understanding that ‘everything will be all right – if they choose not to use’, and the knowledge that ‘things will never improve, if they continue to use’.
Step 1: We admitted we were powerless over our addiction – that our lives had become unmanageable.
Two useful questions for deciding whether you or a loved one is really an alcoholic/addict are, ‘Can they actually stop permanently if and when they choose to?’ and, ‘Can they control the amount they drink/use once they begin?’ If the answer to either question is ‘no’, then they probably have an addiction problem that requires addressing.
The most important aspect behind this Step is honesty. The intention of this Step is to expose any denial that may remain in the client’s thinking – the idea that they may be able to drink or use safely again. Step one is the statement that summarizes their problem and the reason for seeking help, whether it is professional treatment or any other peer on peer support.
Powerlessness is the concept that drugs and drink have such a hold on someone they are powerless in their ability to choose not do it anymore, i.e., they’ve lost the power of choice.
It operates on three levels:
- A physical allergy to alcohol and drugs – known as the phenomenon of craving, which makes it virtually impossible for them to stop drinking and/or using once they start;
- A mental obsession, which makes it unlikely that they will remain sober or straight permanently on their own; and
- A spiritual malady, which separates them from their friends and family in their ability to become sober and maintain their sobriety, through their own self-centred thinking and behaviour.
People may assume that Step one means that they couldn’t get high anymore because they could no longer handle it. In fact, it really means that barring some sort of intervention, they are unable to stay away from that first drink, hit, line or smoke and that they will drink and/or use again and again, no matter how much they wish to stay clean. Lack of power against the first drink or drug is actually their dilemma. This person is typically drinking/using against their own willpower and they are powerless to stop themselves.
The second part of Step one refers to how they are unable to manage their own lives, even when they are sober. One example of this unmanageability is being restless, irritable, and discontent. Many recovering addicts and alcoholics are of the opinion that they were unmanageable before they began using substances and drink, and that their addiction initially removed the fear of feeling inferior and anxious around other people, places or situations.
Step 2: Came to believe that a Power greater than ourselves could restore us to sanity.
Step two is the summary of the solution to the identified problem outlined in Step one.
Coming to believe in a power other than themselves and this power’s ability to restore them to sanity (to becoming manageable again) does not require that they believe in a God. However, it is vital they have an open mind and find the willingness to believe there is a power greater than themselves – that they are not God, and that other people, places and situations produce their own actions and consequences.
Some people may find it useful to simply step aside from being the God of their own universe temporarily, while going through the Steps, with the idea that they can step back into their preferred role afterwards. This temporary measure has permitted many people to recover who may never have done so due to their fixed beliefs about God or the lack of the universe and everything else. It really is useful to have an open mind and be flexible. Remember, if getting sober were easy, then they’d have done it already without our help.
Many people in today’s recovering Fellowships did not have any religious or spiritual experience prior to their sobriety. However, once they were able to make a start towards what the concept of a Higher Power might mean to them, then they began to find some direction to their sobriety. Many of them use the Fellowship itself as a Power greater than themselves. Some call it ‘Group of Drunks’ or ‘Gang of Druggies’. Others choose to put an extra ‘o’ in the word and consider it ‘Good Energy’ as opposed to ‘Bad energy’. Some people have aspired to become ‘Good Guys’ instead of remaining ‘Bad Boys’. Any concept, no matter how inadequate we believe it to be at the time, is enough to make a start with Step two. Even agnostics and atheists have found this step easy enough to master once they understand that the Higher Power can be anything, as long as it’s not them. So, they are able to develop their entirely unique and understandable concept.
This is a Step about hope. Hope that there is a bright and beautiful future ahead of them if they are prepared to put the appropriate work into changing themselves. Much of this hope is found by seeing how other members of the group have changed and grown as a result of working this programme in their individual lives.
The insanity referred to in Step two is the part of their thinking that allows them to convince themselves that they can successfully drink/use again, often fooling themselves into the idea that they can do it without a negative reaction. Once this ‘mental obsession’ takes hold, they become compelled to use over and over again, regardless of the consequences that they know will follow. It is the consideration of this vicious cycle that helps them become willing to believe that perhaps a power greater than themselves may restore them to sanity. It is often said that insanity is repeating the same behaviour and expecting a different result. Or not learning from previous behaviours or conclusions and still making the same mistakes.
Step 3: Made a decision to turn our will and our lives over to the care of God as we understood Him.
In Step three, a decision is made to turn their will (thoughts) and their lives (actions) over to the care of whatever their concept of God is at that time. The first requirement is becoming convinced that anyone who runs his or her addictive life through self-will (selfishly, self-centred, self-obsessed, etc.) could hardly be a success. One of the ways to illustrate the meaning of a life run on self-will is by describing the behaviour of an actor who wants to run the whole theatrical show, and therefore falls short on the lighting, stage props, production, direction, ticket sales, etc. Many people may find it useful to substitute themselves into this idea and ask themselves honestly whether this scenario doesn’t sound similar to the way they are currently running their lives. We then suggest to them that these kinds of self-centred thoughts and behaviours are the root cause behind many of their troubles.
Step three is the understanding that if one is able to change the way one thinks, then one is able to change the way one behaves, resulting in feeling differently about oneself because of the different reaction received to one’s new way of dealing with things.
It is also about placing trust in the future and finding the faith that they can get well (recover), through the various professional treatment programmes around the world and within the established 12-Step Fellowships of recovering alcoholics and addicts such as those mentioned previously in the ‘Introduction to 12-Step Fellowships’ chapter.
The third Step also helps our clients get a grasp of the ‘One day at a time’ principle. This is the idea that if an alcoholic/addict can just stay sober/clean for a day, and get into this practice, then they have a much better chance of long term and permanent recovery.
Step 4: Made a searching and fearless moral inventory of ourselves
In the fourth Step, people are asked to examine the places in their lives that have had negative consequences, often accumulating from their behaviour while intoxicated. By completing and analysing their own moral inventory, they are able to see where their natural instincts for alcohol, drugs, money, sex, power, and prestige may have gone out of control, as they attempted to satisfy themselves in selfish and self-centred behaviours. The inventory involves looking at the people they have issues with, or resentments towards, the things they are afraid of, and the people they have harmed through their misconduct.
Step four enables them to realise their own methods of thinking and behaving, then to own these as previous ways of living, and begin to feel freedom from their addiction and selfishness by knowing that they are about to make some great changes to the negativity in their lives.
This Step takes a great deal of courage to do, since it involves looking deeply at themselves and taking responsibility for their own thoughts, feelings, actions and behaviours. It requires a high level of self examination, vulnerability and courage. But we have seen this type of courage displayed time and time again by people serious about healing from their addictions. They may find this courage through other members of their 12-Step group, who share their experiences of this Step and point out the benefits they have received as a result of completing it. This change is miraculous and a beautiful thing to witness.
Step 5: Admitted to God, to ourselves, and to another human being the exact nature of our wrongs
In Step five, they share their fourth-step inventory and continue to discover ‘the exact nature of their wrongs’.
Step five should be done immediately after having written and completed their fourth Step. This is usually on the same day. By taking this Step, they are able to identify areas where they may have allowed their addiction, their selfishness, their instincts, and their fears to control their thinking and emotions. Sharing this inventory with another person allows them to examine problems that they may have been unable to understand alone and offers them personal integrity.
It is at this Step that people begin to feel free from the shame, guilt and pain they may have experienced and been carrying with them throughout their lives. They are encouraged to trust this process and, as a result, they begin to taste a genuine prospect of a hopeful future.
Step 6: Were entirely ready to have God remove all these defects of character
In reviewing these ‘shortcomings’, which became highlighted in the fourth and fifth Steps, the clients ask themselves whether they find these defects of character are undesirable and whether they are ready to believe that a God of their own understanding (whatever their interpretation of the word God) may be able to help remove them.
In most cases, there will be some outstanding defects of their characters that they are not willing to let go of yet. By allowing them to feel these shortcomings (feelings) before moving them on to Step seven, most people find the willingness to have them removed within a few days, often hours. It is always a privilege watching the lights come on in their eyes and this is a very powerful moment for both the alcoholic/addict and their family.
Step 7: Humbly asked Him to remove our shortcomings
Step seven focuses on the things that cause our clients problems in life on general terms. Writing a balanced inventory of things they like about themselves is, of course, as important as writing down the negatives, particularly for those who may have lost a sense of self worth. It’s been my experience that people I’ve worked with have often found it genuinely difficult to balance their negative self-assessment with their own positive assessments.
We have also found that continuous attendance at 12-Step Fellowship meetings to be a particularly useful method of counterbalancing these defects of character, especially when someone ‘becomes of service’ or rather volunteers their time and energy towards the success of their meeting, or Fellowship. It is when people become active and involved in such a way, that their recovery and their commitment to it, shows up as their success becomes a genuine part of their lives. This is because these groups work in a ‘self-less’ way, completely the opposite to an addict’s usual selfishness and self-centredness. So by someone joining that culture of contribution, generosity and selflessness, real genuine life-changing character traits are very positively displayed. This newfound attitude and this charitable behaviour will also help deal with patience, tolerance, compassion, understanding, love and humility. It’s very beautiful to watch a loved one undergo this transformation, which can only have a positive impact on everyone’s lives.
Step 8: Made a list of all persons we had harmed and became willing to make amends to them all
In Step eight, all the people who have been harmed by the alcoholic’s drinking and the addict’s using careers are considered. This list was originally drafted in Step four, although it’s likely to have further additional names added to the list before it’s ready to work from.
They will discuss possible methods of making amends to them all and search for the willingness to accomplish this. Most of the amends they need to make have been disclosed in their fourth Step ’resentment’ inventory, their ‘harms to others’ inventory and their ‘sexual’ inventory. They also update this list to include anyone else they have come to realise was harmed as a result of their shortcomings, but was previously overlooked.
People are encouraged to discover love for their fellow humans and to display this love through interaction with the outside world. The important part of this Step is the willingness to accept their part in their past transgressions and the willingness to make things right. Willingness is the key, for if someone is still not willing to make right their wrongs, they may still be holding on to their selfish, self-centred view of the world, which doesn’t fit with the recovery concepts of selfishness, contribution and generosity of spirit.
Step 9: Made direct amends to such people wherever possible, except, when to do so would injure them or others
In Step nine, the recovering addicts/alcoholics begin to actually make amends to the people they have harmed and considered in the list of amends they made in Step eight. It is through Step nine that they become truly free from the guilt, fear, shame, and remorse that result from the harm they may have caused others.
This is the most forgiving Step. Not just of other people, but more importantly of themselves. By forgiving themselves of their past lives of chaos, deceit, cheating, lying, stealing, etc. they become freed from their addiction’s prison. It has been compared to re-balancing one’s karma.
Step nine may well be the most challenging of all the Steps, but by planning and working it thoroughly it has been seen to be the single most important part of the programme in establishing long-term sobriety and a healthy future.
Some of these amends may be worked directly by contacting the person face-to-face. Many of them are indirect amends, such as volunteering to work for a charity organisation. But most immediate amends are conducted as living amends – by living differently and no longer repeating their previous behaviours.
Step 10: Continued to take personal inventory and when we were wrong, promptly admitted it
Although the 12-Steps are designed to be taken in order, it is suggested that Steps ten, eleven and twelve are continuously taken on a daily basis. These are often referred to as the ‘maintenance Steps’ and they encompass much of the first nine Steps in their structure and application.
Step ten involves continuing to take a personal inventory and setting right any new wrongs as one goes along. Step ten is basically a way of practising Steps three through to nine on a daily basis. In this way, whenever their recovery programme goes slightly off track, the client has the tools to re-balance themselves and their karma, making sure they recalibrate themselves before going to bed at night. Through this method, permanent recovery is possible and, indeed, probable.
In Step ten they will constructively review their day and they will be able to notice when they were resentful, selfish, dishonest or afraid. They will consider to whom do they need to apologise? Is there anything they may have kept to themselves that ought to have been discussed with another person? Were they kind and generous towards everyone? What could they have done differently? Were they thinking about themselves most of the day, or were they considering how they could improve the quality of other people’s lives? And then they make it right as promptly as possible.
It has been said that any tenth Step amends need to be addressed immediately so that the client does not return to, or remain in, unhealthy thinking or behaving. It is common knowledge that those who do not take this Step seriously may lose all the good work they have already done in the previous nine Steps. It is for this reason that the clients are encouraged to find a sponsor (mentor) from the Fellowships. Step ten is worked daily with their sponsor, until such a time as they feel strong enough to manage their daily routines alone, at which point they’ll check in with their sponsor on a less frequent basis.
It is at this point that true freedom from their obsession around drink and drugs can be experienced. Strangely enough, this freedom comes through the disciplines that they find and practise in this Step. Freedom through discipline, despite being a contradiction, is often a statement particularly unfamiliar to recovering addicts and alcoholics. But we witness this new way of life embraced time and time again.
Step 11: Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out
Step eleven is a revitalising Step, and is there to encourage meditation and reflection. Because so many addicts and alcoholics were previously perfectly able to go to any lengths to secure their drugs or drinks, many of them find this eleventh Step where they are encouraged to be still and often silent, the most difficult of daily practices. This Step requires discipline, patience and practice.
Because Step eleven follows ten, once they have constructively reviewed their day, that they are able to seek through prayer and meditation God’s forgiveness and different ways of correcting their behaviours. The results are often surprisingly simple and effective, particularly after a few weeks of practising this discipline.
There are many definitions of prayer and meditation, and we’d encourage active debate from the recovering alcoholic or addict on this subject. They are encouraged to explore all types of religions and spiritual practices and decide if there is one, or parts of some, that feel more comfortable than others. Alternatively, many of them decide to use a method of their own fabrication. It is down to their personal choice. There is no dogma attached to this.
It could be considered that prayer and meditation is a private and personal moment with a Higher Power of their own understanding, saying, “Please keep me clean and sober today” in the morning, and “Thank you for keeping me clean and sober today” at night. There is no reason to be shy about this matter of prayer, or meditation. There are people around the world using it constantly. We find that when our clients develop an honest and genuine attitude around it that it works.
As the clients go through each new day and address new problems, we ask them to pause whenever doubtful or agitated and ask whichever power greater than themselves they have chosen to tap into, to provide them with the correct thought or action. They are reminded constantly that they are no longer running the show, and humbly say to themselves, “Thy will be done”. They are therefore in much less of a danger from over-excitement, fear, anger, worry, self-pity or poor life choices.
This Step is an on-going Step as it asks them only to improve their awareness as their recovery programme develops, particularly as they deal with life on life’s terms within society and the world.
Step 12: Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics/addicts, and to practise these principles in all our affairs
Having taken the first eleven Steps, they are now at Step twelve and are ready to carry the programme of recovery in some form or another to other addicts and alcoholics. Every time they work with another addict they are reminded just how bad it was for them when they first came into the programme. When a new alcoholic/addict arrives in the Fellowships, they will all recognise the same trembling hands, weight loss, the look of desperation and sheer terror that they themselves may have previously had. They all come face-to-face with the newcomer’s unmanageability in terms of depression, misery, and unhappiness (whether openly expressed or feebly concealed) and they witness the staggering destruction they may have caused everyone and everything around them. They are reminded of their own past troubles with personal relationships, as they see the new members struggle with theirs.
The therapeutic value at this point of one alcoholic/addict reaching out and helping another is truly incredible. It is at this point in the programme that the obsession and compulsion to use drugs and drink has been removed and a physical change is visible for everyone to witness.
Finally, their faith in the God of their own understanding’s ability to restore them to sanity is reinforced, as they see how this programme begins to transform the life of the new prospect, right before their eyes.
In addition to carrying the message of recovery to other addicts, Step twelve involves practising these principles in all areas of their lives. When we’ve seen addicts or alcoholics who, unfortunately, relapse but are fortunate enough to return to seek help again from the 12-Step community and practitioners, once beginning the programme again it becomes clear that once they’ve analysed what happened, that they’d stopped practising these principles in some or all of their affairs, they were no longer examining their motives, reviewing their days, caring for others, or carrying the message of hope and recovery to newcomers.
A summary of how to behave from a perspective of spiritual awareness could be in two complementary ways. Firstly, doing unto others what one would like done to oneself. And, secondly, doing for others that which they cannot do for themselves.
This Step is about being of service to society, the world and all those around them. The complete opposite to the way they would have thought, acted and considered behaving previously. Selfless as opposed to selfish.
How it works
If there were one watchword to describe how these Steps should be practised, it would be ‘continuously’, for it is only through constant application of these principles that our recovering and recovered addicts/alcoholics can be assured of the promises of freedom from addiction offered within these 12-Step programmes. That said, by the time most recovering addicts and alcoholics have completed the 12-Step programme, these principles have become a new way of life, and effectively the programme begins to work as if on autopilot.
Compare this programme to exercise. If, in your first year, you exercised a great deal, you’d (hopefully) get into a much better state physically. Then, if you kept up a regular discipline of a few times each week, you would maintain that for the rest of your life. However, if you stopped exercising, you would lose all that you gained from it in the first year and revert back to the way you were before you even started (or in some cases even worse). A very similar parable can be said for recovery. Despite how much good effort you put into it at the beginning, you will always need to ensure that you’re living your life upon these newfound principles and you’ll always need some interaction with the Steps. To not do so is likely to lead you back to previous ways.
This 12-Step programme is a design for living we hope our clients will continue to make use of, long after they have graduated and put down their drugs of choice (and any other substances, behaviours and procedures that cause them pain). The fact that recovering and recovered alcoholics and addicts alike keep attending Fellowship meetings in later years is often interpreted as a developing dependency upon the 12-Step Fellowships. But this interpretation is debatable, as the most poignant part of an individual’s choice to ‘keep coming back’ is the continued reinforcement of the learning process,which strengthens a personal commitment to change and can so easily be challenged in daily life by pubs, clubs, casinos, etc. So, the Fellowships encourage their members to return to their communities and become involved in local meetings and maybe start their own groups wherever needed and encourage others by carrying the message of recovery. Furthermore, once someone has recovered from their previously considered hopeless state of mind and body, they return to the Fellowship meetings, not so that they can receive help from others, but more so that they can contribute towards helping the newcomers. And so, the circle of recovery continues.