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Substance Abuse: Growing Beyond 12 Step Program Dependency
10 CEUs Substance Abuse: Growing Beyond 12 Step Program Dependency

Section 12
12 Step and Autonomy

CEU Question 12 | CEU Test | Table of Contents | Addictions CEU Courses
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

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On the last track, we discussed Step One and denial. We also discussed the stress relief techniques "Pushing the Right Button" and "Ritual for Release."

On this track, we will talk about how 12 step program can actually impede the addict’s growth toward independence and a 13th step. Sound interesting?

According to Tessina, author of "The Real 13th Step," the 12 steps can impede autonomy. See where you stand regarding Tessina’s ideas.

How the 12 Steps Impede Autonomy

Step One - Concerning Step One admitting powerlessness, after the addict has admitted that he or she is powerless, he or she then needs to reclaim their power, and take control of their life to increase independence and decrease dependence on 12 step groups.

Step Two - Regarding step two believing in a higher power, relying solely on an outside force to help an addict stop his or her addiction and restore him or her to sanity Tessina feels reinforces the kind of dependent behavior that made the addict keep his or her addiction in the first place.

According to Tessina, as long as the addict goes through life believing that he or she is not powerful enough on his or her own to control his or her addictive behaviors, he or she will never feel confident enough to stand freely on thier own two feet. Tessina feels this belief also becomes a convenient excuse for relapse, the addict stating "God didn’t help me."

Step Three - Regarding step three, turning problems over to a higher power according to Tessina is at best a temporary expedient to assist the addict through a period when he or she has not yet developed the confidence and ability to face and solve problems him or herself. According to Tessina, it is more effective for an addict to consider that he or she has a partnership with his or her higher power.

The addict can then cooperate with his or her higher power in an autonomous way, making decisions according to his or her spiritual or ethical precepts and values. Continuing to leave his or her sanity solely to the care of his or her higher power, according to Tessina, is an abdication of the addicts responsibility to think for him or herself, therefore plummets the addict back into denial.

Step Four - Regarding step four, a searching and fearless moral inventory, while this step was created to help break the cycle of addiction and denial, in actual use members and sponsors, according to Tessina, often focus exclusively on faults. Do you agree? As discussed on a earlier track if the addict comes from a dysfunctional family, he or she may already carry a tendency to overemphasize his or her faults. To move beyond mere destructive behavior to the ability to evaluate oneself objectively and honestly, Tessina feels your client needs to include the positive in the step four moral inventory.

Step Five - Regarding step five, like step four, admitting the nature of wrongs to another human being, Tessina feels there is an overemphasis on the negative. Concentrating too much on the negative induces despair; too much emphasis on the positive can become denial. Tessina feels independent, healthy self-evaluation requires keeping a balance. Do you agree?

Step Six - Regarding step six, and the removal of defects, being willing to stop one’s addiction and being willing to have someone else do it are two different things. According to Tessina, as long as the addict relies on a power other than him or herself to help overcome his or her flaws, he or she will remain dependent on both God and/or the group.

Remaining dependent on God or the group leads the addict away from learning to depend on him or herself. Once again, Tessina suggests the alternative of accepting a higher power as a partner in the addicts quest to change his or her attitudes and behaviors, rather than an all power sources who have the sole power to  remove all these defects of character.  How do you feel about this?

Step Seven - Regarding step seven, and asking for the removal of other shortcomings, the addict may not realize how much strength he or she has developed by taking this step and continue to believe it has all been the work of a higher power. As long as only God or the group can remove your client’s addiction, according to Tessina, he or she will believe they need God and the group to keep him or her free of his or her addiction. Again, Tessina recommends a partnership with God that would work best.

Step Eight - Regarding step eight, listing and making amends, the danger here, according to Tessina, is that the emphasis is once again on the negative and entirely on the harm your client has committed. Because many addicts have been victims of neglect and abuse as children, it is important to be able to acknowledge any harm that has been done to them.

In order to have control of his or her life, the addict needs to be able to ask for amends when they are owed to the addict. Thus, Tessina feels it is imperative that the addict needs to address the harm done to him or her. This is a touchy one, do you agree? How do you do this and not support and encourage your clients grandiosity?

Step Nine - Regarding step nine and making amends, Tessian feels by placing all emphasis on the addict in the amends making process, this step reinforces the addict’s old pattern of feeling that they have to control the situation. Being autonomous or independent means learning to acknowledge the autonomy or independence of others.

Only others know how much they feel the addict has harmed them and how the addict can best make amends. Healing relationships, as you know, require emotional awareness and competence. Tessina feels the addict can begin to respect the autonomy of others by first asking if they felt harmed or offended and find out what they think would make amends. Sound interesting?

Step Ten - Regarding the step ten personal inventory, because Tessian feels the twelve step program focuses on destructive behaviors that must be arrested, this inventory can become another list of problems and defects. According to Tessina, to move from recovery to health also requires an equal emphasis on admitting what the addict did right.

Otherwise, if the addict does not learn to encourage and acknowledge his or her positive qualities, he or she remains dependent on others to validate which traits are worthy of praise. Because according to Tessina only the addict can truly judge what is best for him or her, this dependence can keep the addict from following his or her own best course.

Step Eleven - Regarding step eleven, prayer and meditation, as in the other steps, the focus on the will of the addict’s higher power can play into the addict’s tendency, according to Tessina, to depend on the will of something or someone else to help them through life and not on their own. Thus, step 11 can lead the addictive client to expect meditation to solve their problems without taking action. If the addict thinks about meditation in this way, he or she will never develop a will strong enough to make decisions and achieve goals and take action.

Step Twelve - Regarding step twelve, practicing these principles in all affairs, having clients who have been in recovery continue their involvement in the program as sponsors, according to Tessina, can work against the development of the client’s autonomy and independence in several ways.
-- First, interactions with persons your client sponsors can replicate old toxic family patterns and become emotionally painful and damaging to both your client and the person he or she sponsors.
-- Second
, the member who your client sponsors is dysfunctional by definition and may have several emotional problems beyond your client’s knowledge and scope. This can be damaging to your client’s self esteem and impede your client’s emotional progress, according to Tessina.
-- Third
, the sponsoring process can put the sponsor in a powerful position emotionally, similar to that of a parent or therapist. For the addictive person who is controlling, it can become a way to avoid healthy peer relationships. Do you agree?
-- Fourth
, sponsoring and maintaining ongoing involvement in the program can be away of avoiding the challenges of life on the "outside."
-- Fifth
, as you are well aware, not every addict is emotionally suited to be a sponsor. The concept of giving back is too limited, according to Tessina, if it focuses solely on staying in the program.

Tessina proposes a 13th step is needed that would emphasize your client’s responsibility for him or her self, emotional self-awareness, independent thinking, and functional life skills. What do you think?

On this track we have talked about how the 12 steps can actually impede autonomy and the 13th step Tessina proposes.

On the next track we will talk about addictions to the program and the five reasons addicts become addicted to the program.

- Peiser, K., & Martin, S. (2000). In The Universal 12-Step Program: How to Overcome Any Addiction and Win! Massachusetts: Adams Media Corporation.
- Tessina, T. B., Ph. D., (2001) The Real 13th Step. New Jersey: Career Press.

Peer-Reviewed Journal Article References:
“Evaluating autonomy, beneficence, and justice with substance-using populations: Implications for clinical research participation”: Correction to Strickland and Stoops (2018) (2018). Psychology of Addictive Behaviors, 32(6), 678. 

Greenfield, B. L., & Tonigan, J. S. (2013). The General Alcoholics Anonymous Tools of Recovery: The adoption of 12-step practices and beliefs. Psychology of Addictive Behaviors, 27(3), 553–561. 

Kinsella, M. (2017). Fostering client autonomy in addiction rehabilitative practice: The role of therapeutic “presence”. Journal of Theoretical and Philosophical Psychology, 37(2), 91–108. 

Online Continuing Education QUESTION 12
Regarding step twelve, practicing these principles in all affairs, having clients who have been in recovery continue their involvement in the program as sponsors, according to Tessina, can work against the development of the client’s autonomy and independence in what 5 ways? To select and enter your answer go to CEU Test.

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