In a previous posting to this site I wrote about the basic ways in which addiction treatment specialists and other therapists can fold 12 step principals and themes into therapy. In that article I discussed the belief that clinicians treating addicts should generally steer their clients toward the external social support and guidance offered by 12 step programs, at the same time meshing 12 step work with therapy, because this combination gives addicts the best possible chance at long-term sobriety and a healthier, happier life.
To this end, a therapist might assign therapeutic tasks that align with the client’s 12 step work, thereby making therapy and 12 step recovery mutually reinforcing. This, of course, begins with the first step:
We admitted we were powerless over our addiction, and that our lives had become unmanageable.
The primary goal of Step 1 is to break through the addict’s denial about the problematic nature of his or her addictive behaviors. Sometimes addicts are lucky and they don’t struggle with this. For these folks, the act of walking into a treatment center, a therapist’s office, or a 12 step meeting and asking for help is a full admission of powerlessness and unmanageability. That, however, is the exception rather than the rule. Most addicts must return (or be guided back) to Step 1 repeatedly, continually doing battle with addiction-related denial. Many choose to incorporate Step 1 concepts into their daily routine as a way of continually reminding themselves about the power of their addiction.
To work Step 1 as part of their 12 step recovery program, recovering addicts typically write down examples of powerlessness over their addiction and the ways in which it has made their life unmanageable. To reinforce this work, therapists can assign related tasks. For instance, a clinician might ask an addicted client to list ten or more examples he or she has experienced with each of the following:
- Preoccupation/obsession with the addict’s substance/behavior of choice
- Attempts to either quit or curtail use of the addict’s substance/behavior of choice, noting with each attempt the approximate length of success
- Negative life consequences related to use of the addict’s substance/behavior of choice, including both direct (obviously related) and indirect (less obviously connected) problems, such as ruined relationships, trouble at work or in school, social and emotional isolation, depression, anxiety, diminished self-esteem, financial issues, legal woes, loss of interest in previously enjoyable hobbies and activities, lack of self-care, etc.
In therapy sessions these inventories can be discussed at length. During this process the therapist may need to point out examples of the client’s continuing denial. In fact, the therapist will very likely need to do so. Better yet, these inventories can be discussed in an addiction-focused group therapy setting, allowing the client’s fellow recovering addicts to point out the instances of denial they see—perhaps getting a better understanding of their own denial along the way.
When appropriate and needed, these inventories can also be discussed as they relate to the concepts of powerlessness and unmanageability, the language used in Step 1. Therapists can explain that powerlessness means that addicts have lost control over their addiction, engaging in addictive behaviors compulsively even when they don’t want to, and unmanageability speaks to both the consequences of the addiction and an addict’s inability to successfully quit. Then the inventories can be broken down into examples of powerlessness and examples of unmanageability.
If, after completing these therapeutic tasks and conversations and working Step 1 with a 12 step sponsor, an addicted client still struggles with denial, he or she can be assigned yet another inventory, listing ten or more examples of how the addiction is ruining his or her life. Typically, this is best done using the following format: ““Even though I (list a particular consequence), I continued to (list a particular addictive activity).” For example, the client might write, “Even though I had three arrests for possession of crystal meth, two of which involved a secondary offense, I continued to possess meth and to get high whenever I could.” Again, this listing can and should be discussed in both individual and group therapy settings.
Robert Weiss LCSW, CSAT-S is a digital-age intimacy and relationships expert specializing in infidelity and addictions—in particular sex, porn, and love addiction. He is the author of several highly regarded books, including “Out of the Doghouse: A Step-by-Step Relationship Saving Guide for Men Caught Cheating,” “Sex Addiction 101,” and “Sex Addiction 101: The Workbook.” Currently, he is Senior Vice President of National Clinical Development for Elements Behavioral Health, creating and overseeing addiction and mental health treatment programs for more than a dozen high-end treatment facilities. For more information please visit his website, robertweissmsw.com, or follow him on Twitter, @RobWeissMSW.