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

Section 14
Dependence and 12 Step

CEU Question 14 | CEU Test | Table of Contents | Addictions CEU Courses
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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On the last track, we discussed the reasons that addicts can become addicted to the program. Five reasons addicts can become addicted to the program are lack of healthy replacement habits, lack of information about functional living, lack of models for healthy relationships, replication of dysfunctional family patterns, and dependency on the group.

On this track, we will be discussing the relationship between 12 step programs and the group treating members as “family assets."

As you are aware, the success of 12 step and other recovery programs is partly due to the supportive family-like atmosphere. Twelve step groups can provide unconditional love and support, reliable influences, and acceptance. Thus, recovery groups can provide a safe environment for experimenting, some risk-taking, foregoing addiction, and facing pain and fear that addicts had previously screened out with addictions. However, in some cases, they cause the addict to remain in a childhood state of dependency.

Eddie, age 27, addicted to alcohol, had been attending AA for a year and became the group secretary. After a few months as the secretary, Eddie felt ready to take some healthy risks and decided to take some courses to get his GED. Eddie asked for someone else to take over his duties of making coffee and setting up chairs so he could attend a class that met the same time his group met.

Eddie told me, "Everyone started warning me that I needed the group to get by. Instead of supporting me, or being excited for me, they told me horror stories about people who had left the group and gone back to drinking. I felt horrible, not just because no one was happy for me, but because I felt guilty for wanting to leave."

Although stopping drinking had prepared Eddie for taking healthy risks in his life, the group had not helped him build autonomy. Focusing on the group's welfare had made Eddie aware of other's feelings and needs, but had de-emphasized his need to be an independent adult. This emphasis on the "common welfare" can be not unlike a dysfunctional family as mentioned on track 9 the dread for dependency.

It reinforced Eddie's lifelong tendency to view himself as a "family asset", whose life does not belong to him, but to the group, and as a person with no legitimate entitlement to independent action.

By being treated by like a family asset, Eddie had not learned an important lesson from the group: recovering from dependence on alcohol or other drugs depends critically on finding the balance between caring for others and caring for himself. Eddie did not realize that by attending classes and caring for himself better, he would be more able to care for others.

His home AA group had not encouraged Eddie to realize that although it was important for him to give to the group, and help others, he was also entitled to help and support of his own decisions. Eddie was unwilling to go against the group; he felt that if he did not go along with their wishes, he would lose all of the support that was helping him recover from his alcohol addiction.

One approach to encouraging autonomy and independence in Eddie and dispel the family asset treatment of the group was to use the concept of the inner child. It is not enough for a group to focus on healing the hurts of the inner child. As you know, Eddie's inner child needed to be empowered to help it become stronger and more independent, just like a child growing up in a healthy family.

'Life Purpose' Exercise
Also while addressing Eddie’s wounded inner child that needed to please the group by attending and not going to classes to get his GED, I introduced the "Life Purpose Exercise" to Eddie to help him focus on his own needs and desires as an independent person.

I asked him to write down the answers to the following questions.
-- 1. What is your purpose in life?
-- 2. What are your long term goals that will move you towards your greater purpose in life?
-- 3. What are your short-term goals that will move you towards your long-term goals?
-- 4. What immediate choices are you in the process of making?
-- 5. How will practicing self-esteem help you achieve what you've answered above?

Eddie decided that his long-term goal was to finish school and get his degree, which would enable him to get a better job. He told me "Taking these classes will help me finish school, get a better job, and maybe make more money to take away the stress of all these god damn bills.” Eddie decided that he would choose to take the classes and step down as secretary of his home group, but staying in touch with certain group members support.

He also decided to attend meetings at another time that did not conflict with his classes. Realizing that he was entitled to choose taking the class was a big step for Eddie, and I noticed a marked improvement in his self-esteem.

On this track, we have discussed the relationship between 12-step groups and childhood dependence.

- Peiser, K., & Martin, S. (2000). In The Universal 12-Step Program: How to Overcome Any Addiction and Win! Massachusetts: Adams Media Corporation.

Peer-Reviewed Journal Article Reference:
Cho, S. B., Su, J., Kuo, S. I-C., Bucholz, K. K., Chan, G., Edenberg, H. J., McCutcheon, V. V., Schuckit, M. A., Kramer, J. R., & Dick, D. M. (2019). Positive and negative reinforcement are differentially associated with alcohol consumption as a function of alcohol dependence. Psychology of Addictive Behaviors, 33(1), 58–68.

“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. 

Field, M., Heather, N., Murphy, J. G., Stafford, T., Tucker, J. A., & Witkiewitz, K. (2020). Recovery from addiction: Behavioral economics and value-based decision making. Psychology of Addictive Behaviors, 34(1), 182–193.

Field, M., Di Lemma, L., Christiansen, P., & Dickson, J. (2017). Automatic avoidance tendencies for alcohol cues predict drinking after detoxification treatment in alcohol dependence. Psychology of Addictive Behaviors, 31(2), 171–179.

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.

Online Continuing Education QUESTION 14
What does it mean to see yourself as a "family asset"? To select and enter your answer go to CEU Test.


This CD has covered such topics as: the addiction process, the internal war, overcoming resistance, the fear of self-awareness, the six steps of effective choice, risk-taking, causes of relapse, the dream of dependency, internal resistance, why step one works, how the 12 steps impede autonomy, addiction to the program, and Being treated as a family asset.

I hope you have found the information to be both practical and beneficial. We appreciate that you've chosen the Healthcare Training Institute homestudycredit.com as a means for receiving your continuing education credit. I wish you the best of luck in your practice. Thank you. Please consider us for future home study needs at homestudycredit.com

Other Home Study Courses we offer include: Treating Self Mutilating . . . Teen “Cutters” “Physical Pain Stops My Pain”; Treating Post Holiday Let-Down and Depression; Living with Secrets: Treating Childhood Sexual Trauma; Interventions for Anxiety Disorders with Children and Adults; and Balancing the Power Dynamic in the Therapeutic Relationship.

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