Text of Issue #3 of
the Post-Traumatic Gazette
(September-October 1995)
(The printed version of the first issue is available free. Simply fill out and send us the feedback form or write and send us your name and address at The Post-Traumatic Gazette, P. O. Box 2757, High Springs, FL 32655)
©1995 by Patience H. C. Mason. All rights reserved, except that permission is hereby granted to freely reproduce and distribute this document, provided the text is reproduced unaltered and entire (including this notice)
and is distributed free of charge..
The Twelve Steps of Alcoholics Anonymous
Here are the steps we took, which are suggested as a program of recovery:
Many of us exclaimed, "What an order! I can't go through with it." Do not be discouraged. No one among us has been able to maintain anything like perfect adherence to these principles. We are not saints. The point is, that we are willing to grow along spiritual lines. The principles we have set down are guides to progress. We claim spiritual progress rather than spiritual perfection. Alcoholics Anonymous, p. 59-60 Quoted with permission.
Editorial: The 12 Steps and Me:
The first time I read the 12 steps I was really irritated and annoyed. They seemed so wishy-washy. Where were the directions? Why were they so—so—nebulous? What did it mean, "Came to believe?" How would "humbly asking" God, in whom I didn't believe, to remove my shortcomings make me perfect? Bull. Drunks might be able to get something out of this, but not me. I didn't need them.
Later when I began attending an Adult Children Of Alcoholics group, some of us decided to to work the steps in a ACOA workbook, The Twelve Steps: A Way Out. I found it appallingly God oriented. Luckily, a friend who had been sober in AA for 7 years with Ozzie Osborne as a higher power told me I could take anything as my higher power. I didn't have to say God or believe in God to work the steps. As a sort of joke, I took Lee Iacocca as a higher power. I think he's a jerk, but I turned Bob and Jack over to him and stopped doing a lot of the stuff I thought they couldn't live without. Naturally Lee Iacocca wasn't calling Jack every morning to see if he'd gotten a job or telling Bob not to be depressed. As a matter of fact, he never called. And guess what? Bob and Jack were fine! It was pretty humbling, and my life got better.
Some of the steps really scared me like Step 9, amends. I was sure I didn't owe any but that I would be required (by the step police, no doubt) to say I was sorry for a lot of stuff that wasn't my fault because they deserved it. Someone said the most important amends for her were living amends, because when she was working her program, she could be there for her family in healthy ways that hadn't been available to her before. That really hit me hard. Could I be there for Bob and Jack without trying to control, manage, be right? Maybe the steps would help me do it. They certainly had helped her. That's how I got the key to the steps: willingness.
Take what you like and leave the rest was another concept that helped me.
Working through that step book, imperfectly, taking what I liked and leaving the rest, transformed my life. Later when I went to two other 12 step programs that experience gave me the capacity to ignore a few vocal oldtimers who were telling newcomers their opinions (Read the conference approved literature for the program's suggestions) as rules, saying you have to do the steps once perfectly the way it says in “the Big Book,” Alcoholics Anonymous. I knew they were wrong because I had already done the steps half-assed, not in order, and out of another book, and they had transformed my life. Later I did them Big Book style, and found that experience extremely helpful. The Big Book explains the program. I suggest that anyone who gets into a program read AA's Big Book and the conference-approved literature for the program they are in. When you read the literature, you find that everything in a twelve step program is suggested. Today I track my own recovery by whether I'm saying "you have to..."(advice giving is not recovering), "we have to..." (recovering a little), or "I have to..." (real recovery. I share my experience strength and hope).
When I noticed I had developed an addiction and my life had been affected by someone else's behavior, I started attending two other 12 Step programs. Because of the Eleventh Tradition (anonymity, see p 5) I won't say which ones. I take the Traditions very seriously. One of those programs gave me the opportunity to read the Big Book, which I consider a major spiritual work of the 20th Century. It is also the first book to describe the diseases of alcoholism and codependency (p. 60-62) and to offer a plan by which a person may recover by becoming self-actualized rather than other-centered. As I worked the steps and tried to follow the traditions, I developed an internal locus of control, the psychological term for taking responsibility for my actions and reactions. For me, this does not mean that I'm in control. It means I've relinquished control over things I don't have the power to control—like Bob's feelings or my addiction— but I'm willing to take the actions I need to take to get recovery and to be open to outside help and suggestion. I am responsible for my side of the street. When I tried to solve and control everything inside my own head my life sucked.
In the Big Book there is a section called "Doctor, Alcoholic, Addict." On the bottom of p. 449, he says:
"For years, I was sure the worst thing that could happen to a nice guy like me would be that I would turn out to be an alcoholic. Today, I find it's the best thing that has ever happened to me. This proves I don't know what's good for me. And if I don't know what's god for me, then I don't know what's good or bad for you or for anyone. So I'm bett4er off if I don't give advice, don't figure I know what's best, and just accept life on life's terms, as it is today--especially my own life as it actually is. Before AA I judged myself by my intenstions, while the world was judging me by my actions."
The emphasis is mine. These are most telling words a codependent or addicted person can read. We all have good intentions. Do our actions empower people or do they hurt people, cripple, control, people please, predict, judge, know best?
One reason why I continue to work a twelve step program is that I couldn't tell that by telling Bob "don't be upset," I was discounting and minimizing his feelings and being controlling. I thought I was being nice. I still have trouble identifying other unhealthy actions I take with the best of intentions. If you feel burnt out by your own addiction or PTSD, by veterans or other survivors, working the twelve steps will help. It won't be fast, it won't necessarily bring you where you want to go, but my experience has been that things got better in ways I never imagined. It has happened for me.
As I've done the steps more times and more thoroughly, my life has gotten better and better because I am living my life, not Bob's life. As they say in program, the only way to do the Twelve Steps wrong is not to do them at all. I am now also able to deal with painful feelings in healthy way instead of burying them with compulsive behaviors. I have all my feelings back and even when I'm in a great deal of pain, I am grateful that I can feel it instead of being numb. I know this too shall pass, because I've had the experience of it passing before. I also have days of joy.
In the three 12 Step fellowships I attend, I would say that more than half of the people have been traumatized and have PTSD symptoms. The people who go to therapists with PTSD are the tip of the iceberg. Yet people get help from the twelve steps! I think it is because the 12 Steps reframe our thinking so each of us can see that we are only human and it is okay to be human, to have been affected by what we've been through. It is better to know how what you've been through affects you than to be denying the effects and blasting others with suppressed emotions.
People often don't understand how admitting you are powerless can be good. For me it is facing reality. I don't have the power to make other people happy. I don't have the power to make peace in the world or to prevent trauma from occurring all over the world. That doesn't mean I am helpless or that I give up. It means I do footwork, like publishing a newsletter to help trauma survivors, like working the steps in my own life so that whether or not Bob has good days, I don't make them worse by blaming him for how I feel. It means I'm responsible for what I do today and that I'll keep examining my actions in the light of my intentions and work towards correcting myself if I drift off into old blaming habits. I practiced my old habits for 45 years. I expect that in another 45 they might be gone, but in the meantime. I'll be going to meetings, working the steps. I hope to see you there.
Patience Mason, Editor
12 Step Recovery and PTSD
When you read the 12 Steps on the first page of this issue, I bet they don't look like anything that can transform your life. It is one of the paradoxes of the program that by admitting powerlessness and taking these steps, you gain the power to change. You are no longer helpless in the grip of reactions you don't understand and would prefer not to even see in yourself. Help is available.
Working the steps causes a shift inside you from hopeless embitterment as you struggle to control your drinking, PTSD symptoms, or whatever, “pitiful and incomprehensible demoralization” as it is called in the Big Book, to the peace of knowing you are going to be all right whatever happens because you have support and steps you can take to deal with any problem that arises. This change is often a slow process, done one day at a time, but that is how human beings change: slowly. Don't quit before the miracle happens. 12 Step programs are not societies of white-knuckled control-freak goody-goodies dying for a drink or whatever. They are groups of people who are happy joyous and free of the compulsions that once made life hell. The people are full of fun, laughing about things that hurt a lot when they happened, and grateful for today. Today is what it is all about. AA shows you how to put together a long string of single days of not drinking by taking the actions AA suggests. It is the same in other 12 step programs. By working the steps your obsession will be lifted. This works whether you are an atheist like me or believe in God. You won't be sitting there dying for a drink, or a drug, or a twinkie, or obsessing about what you or someone else ought to be doing, but somehow able to “be good”, to control the desire or the obsession. The desire or obsession will be gone.
This is something most therapists have not experienced. Professional lack of understanding is clear in most of the stuff they write about the 12 Steps. Unless you have experienced the lifting of the obsession, it sounds pretty wacko. I believe this lack of experience is the basis of the hostility among some professionals towards the 12 Steps. They think the steps can't, shouldn't or couldn't be good for you. Admitting powerlessness is supposed to be bad for you, especially for women. I disagree. It is really important for women to acknowledge they are powerless in the sense that nothing we do can fix someone else. Working on ourselves is empowering. Trying to control others is a waste of our time and resources. If you really actually do not have the power to stop reacting in dysfunctional ways, admitting powerlessness is a relief as well as honest. It helped me reframe my feelings about myself from I am no good to I have a disease. I couldn't stop myself from saying, "You should blah, blah, blah" to Bob even when I knew it was the wrong thing to say. Could I fix Bob's PTSD? No. Can I make someone else happy? Momentarily perhaps, but why take on that burden and the damaging belief system that I'm just not doing it right or trying hard enough?
If you deal with the pain of PTSD or of living with it by drinking, drugging, eating compulsively, gambling, screwing around compulsively, you can get straight in a 12 Step program designed for your particular addiction. Survivors of Incest Anonymous is a program for survivors of that type of trauma. Workaholism, perfectionism, being nice, people pleasing, etc can be helped in Al-anon, CoDA, and Adult Children of Alcoholics. (By the way, I believe an Al-anon lecturing a drunk is higher than a kite on endorphins: I'd love to see a study the brain chemistry of people when they are being self-righteous.) If you are at a point where you have a desire to change and are willing to seek help from outside your own head, a 12 Step program can help you immeasurably in your recovery.
The steps are self-initiated. You want to stop whatever has been causing you pain. You take yourself to meetings. You pick what suggestions you want to try and you pick the pace, up to a point. Most people do become frustrated because they can't change as rapidly as they want to, but the steps also teach you to accept yourself as human, and human beings do not change quickly.
The steps are self regulated: You go to as many meetings as you need. When you feel brave enough, you get a sponsor (or a step group in ACOA) and start working the steps at your pace.
The steps internalize new healthy behaviors: When I choose to take an action, as opposed to being told to do it, I make it part of my repertory of skills. What I practice, I learn. Because I'm choosing to act in new ways instead of doing my old actions or reactions, I can learn from my mistakes. Sometimes I'll do the old action or reaction, and be able to see more clearly just how ineffective it is. Sometimes I'll take a new action, and it's not right for me at this time. I learn I can also persist in actions that help me even if they are uncomfortable. It is okay to hurt.
Why are the 12 steps important to people with PTSD and their families? The Steps can be used to deal with particular addictions which a survivor may have adopted to mask PTSD symptoms, they can deal with codependency that develops so easily when we live with PTSD, and the steps can deal with PTSD itself by reframing the symptoms as normal reactions to trauma and allowing the survivor to heal at his or her own rate. The steps heal your life.
The human capacity to become compulsive to avoid pain is phenomenal. If you or a loved one has become addicted to a substance or behavior, the twelve steps can free you from that addiction. If you work them, you will find a power greater than yourself that works for you, whether it is the group, Ozzie Osborne, nature, or a personal God. Finding something outside your own head which will help you with your problem is the whole point. Your compulsion to repeat actions which have damaged you in the past will be lifted.
What is a 12 Step program?
Twelve Step programs are the most laissez faire way of life on earth. Laissez faire means "noninterference in the affairs of others." I repeat, twelve step programs are a powerful tool for self initiated, self regulated, internalized personal growth. That is because the only requirement for membership in a 12 step program is the desire to stop doing what you keep doing that is causing you pain, whatever it has been. You do not have to be stopped to belong. You have to have the desire to stop. You initiate the process of recovery when that desire carries you to a meeting and keeps you coming back. When researchers say AA works no better for alcoholics who are mandated by courts to go to AA meetings than other forms of treatment, I wonder how they can be so unethical. Of course it won't work! They don't meet the only requirement for membership. A judge is making them go. Such slanted research says a lot more about researchers than it does about the 12 Steps.
When you get the desire to stop, you go to meetings, as many or a few a you want. It's self-regulating. There are no dues or fees, no required behaviors, no rules. Let me repeat that: no rules. If someone says you have to work the steps, they mean their experience has been if you want your obsession to be lifted, the way to do it is to work the steps. They don't mean the Step Police will be tracking your progress and throw you out if you don't. (There are no step police. It's a joke.) It is an extraordinary experience to be treated with love by the fellowship when you keep coming to meetings and still haven't gotten what they have. Sometimes it takes a long time, and that's okay. "Keep coming back," they say. "It works if you work it." That is where it gets internalized. No one will make you work the program, but when you choose to take some new suggested action of the program, you are internalizing new healthy behaviors.
This is a program of personal growth. Nothing in program will teach you how to change or control others. Program is about accepting others the way they are and working on yourself.
What are the steps? The steps are not “rules” but suggestions as it says above. In Alcoholics Anonymous, the "Big Book" of AA, it says, "Here are the steps we took which are suggested as a program of recovery:" (p. 59, my italics) and "Our book is meant to be suggestive only. We realize we know only a little. God will constantly disclose more to you and to us." (p. 164). Part of that "more," for me is the existence of PTSD in the lives of many addicted people. It's hard to stay sober, if sobriety brings flashbacks or rage reactions you don't understand and can't control.
This is a program of suggestion. You don't have to do any of it. No step police will check up on your progress. That is the great part for trauma survivors who often have very accurate and sensitive control detectors. Tell a trauma survivor what to do and you risk triggering the fight or flight reflexes. Tell the same person what worked for you and to take what you like and leave the rest, and that person may choose to try a new action.
In order to recover, a person must first admit something is wrong. Nothing can be done till you see the problem as a problem. The first three steps [see box above) can be thought of as being honest (I've got a problem I can't handle by myself), open (I'll look for help outside my own head), and willing (I'll try another way besides my way).
This is also a program of action. Steps Four through Nine are action steps to clean out the rubble of the past. This cleanup is broken into small stages which is one of the most helpful things about the steps. They are based on a realistic knowledge of people, especially our rebelliousness and the amount of time it takes to change. Each step helps you get more in touch with yourself and each step embodies a principle for living life which will be useful for the rest of your life.
Steps Four and Five which teach courage and integrity can be really helpful to trauma survivors. Working to get to know yourself, seeing what part you may have had in creating your own troubles, and sharing honestly with another can be life changing. This process can help an incest survivor understand they had no part in the abuse other than fear which may have kept them silent. Fear is not a fault, but it is helpful to know it is a big part of you if it is. On the other hand if the desire to be a hero put you in the position to be traumatized in war, it helps to release resentment towards society when you can see that you did "make decisions based on self which later placed us in a position to be hurt," as it says on p. 62 in the Big Book. I used to hate that phrase, right up to the day I realized that by placing my happiness entirely in Bob's hands, I had put myself in a position to be hurt. Willingness, humility (which is not humiliation but being right sized and teachable), self-discipline and love are the principles learned in steps Six through Nine.
People in program are recovering, not recovered. The last three steps are actions taken for maintenance. They teach perseverance, spiritual awareness, and service. "Repetition is the only form of permanence that nature can achieve," it says in the OA For Today. To continue to recover, I've found that I have to take the same actions, one day at a time, day after day.
When you decide to take a risk, get a sponsor, and do a step, you've chosen to take an action on your own behalf. In AA's Twelve and Twelve, it says, "... there are certain things only the individual can do...When he acquires willingness, he is the only one who can make the decision to exert himself" (p. 40). If you've ever tried to get a dawdling kid moving, you know the truth of that. Yes you can get him moving by coercion, but it won't last. Willingness is the key.
Some of the actions suggested in 12 Step programs are going to meetings, reading the program literature, calling people in the program to develop a network of support, getting a sponsor, working the steps with the sponsor, praying and meditating daily, writing out your steps and writing about troubling incidents so that you can see the patterns you may have developed to cope which may not be so helpful now.
Although prayer and meditation are suggested, the steps are not religious in nature. They are spiritual. Heard at a meeting: "Religion is for people who don't want to go to hell. Spirituality is for people who have been to hell and don't want to go back." In The Twelve Steps and Twelve Traditions of Alcoholics Anonymous it says on p. 26, "Alcoholics Anonymous does not require that you believe in anything. All of its Twelve Steps are but suggestions." Whenever I hear a researcher saying 12 Step programs make you believe in God, I wonder how they can live with themselves. Can't they read?. The word God appears in the steps joined with the word Him because they were written by people who followed the prevalent beliefs of their culture and time (America, late '30's). It doesn't mean you have to accept a God named Him. Many people use the steps themselves or the 12 Step fellowship as whole as a higher power. Others mean Good Orderly Direction when they say god. I'm an atheist. I use the phrase higher power.
AA was the original 12 Step program, so its literature is valuable to anyone who wants to try working the steps. I've reviewed a couple of AA books on pages 5-6. Each program has conference approved literature, books and pamphlets they publish which explain the program. The literature speaks for each twelve step group as a whole. Read it! What people say at meetings is their opinion, and they can be opinionated.
Sponsorship: Many recovering people are also recovering from cognitive distortions (for a list see David Burns, Feeling Good), or “stinking thinking.” They may want and need concrete directions. Although some sponsors become very codependent and controlling, program does not ask anyone to turn their will and their life over to a sponsor. Program literature helps here, too. If you want to know what a sponsor is, read the conference approved pamphlet on sponsorship of the fellowship you attend. If they don't have one, read the AA one, Questions and Answers on Sponsorship, [available from AA World Services, Box 459, Grand Central Station, NY, NY 10163] which says, “a good sponsor sees that the newcomer meets many other seasoned members as soon as possible. The newcomer with more than one sponsor shares in a wide range of experience and hears a great variety of ways to use the AA Program.” Your sponsor may suggest things to you that worked for him or her. You have the option of doing them or not. Some sponsors will fire you if you don't do what they say. In my opinion they've switched addictions, are now addicted to controlling others and having 'successful' sponsorees so they can feel good about themselves, but they still may have what you need when you start out. Only you can know. You can always change sponsors if it doesn't work out.
When I first read the steps, I wanted rules and I wanted proof it would work. Someone told me that my misery would be freely refunded if the steps didn't work. That cracked me up, so I gave them a try. As the first steps began to work in my life, I came to trust the steps, even the ones that I thought I'd never do like Step Four (the fearless and thorough moral inventory) and Step Nine (making amends). Willingness rose up in me to do what the program suggests. Sometimes I think that the steps are not only a blueprint for changing your life, but also a description of what will happen to you if you are willing to keep coming back to meetings. I was constantly p*ssed off and depressed when I got to my first meeting. Today I'm full of joy. I feel like I'm green and growing, flowering all over the place. I do have bad days, hours, minutes but they don't last. I used to have bad years.
I'm not saying the 12 steps are for everyone. Nor do I feel that the steps alone will be enough for everyone. Most trauma survivors benefit greatly from therapy. No 12 Step program is officially against therapy (even Bill W. the founder of AA went into therapy for depression) but there is a certain amount of hostility to it in some programs. That doesn't mean it won't benefit you. Remember in the old days therapists ignored the effects of trauma, so they were probably quite unhelpful to trauma survivors who eventually got sober in program. You can't heal what you can't feel, and while you're compulsively using a substance or behavior to avoid feelings, healing comes slowly if at all. Safety is also an important issue in trauma therapy, and no one is safe while using, so safety in the sense of sobriety must come before trauma work.
Anyone who tells you to quit therapy and just be in program is making judgements he or she is not qualified to make. Most traumatized people find good therapy helpful even though it may be painful. A therapist who tells you you don't need a twelve step program may also be unqualified to judge.
Twelve step meetings are not therapy groups or dumping grounds for all your problems. Meetings are a place to hear how other people apply the steps to their lives and to learn how to take actions that will change your feelings, as opposed to waiting till you feel on top of the world to change how you act which will probably never happen. It is okay to share whatever is going on with you, but after a while you will notice that the people who are recovering are taking action. They do the steps. They make phone calls. They read the literature. They share at meetings about the solution, and if they are having problems, they talk about how they are coping today using the tools of the program, doing what they could never do before.
Signs of a healthy group are that they have conference approved literature for sale, read the steps and opening and closing statements at every meeting. The traditions are read and followed. Group consciences are called to make decisions for the group. Everyone who is there has a vote and everyone gets to talk. Substantial unanimity is sought. The leadership rotates.
The healthiest groups have no cross-talk; that is no one will interrupt you, say you are wrong, give you advice, or comment about what you have shared. In the spirit of this, save your questions for after the meeting.
Don't judge a program by one meeting. Go to several and try to see what you have in common with the people there, and above all, listen. I have never been to a meeting where I didn't hear something that was helpful to me even if it was only the realization that other people were struggling too. That was important information for me because I was always comparing my insides with other people's outsides. Most people act as if they have no problems, but it is usually camouflage
Going to meetings was scary. Doing something new can be very uncomfortable. It was for me. My old ways were familiar. I knew how to be p*ssed off and depressed. I had to be willing to be uncomfortable to recover and I was given that gift when I got to my first meeting, willingness. I didn't make myself willing. I just was. I was so sick of myself and my life that I was willing to try anything.
If you can't find a meeting, write the world service office (addresses below). Start a new meeting. Read the group handbooks they have.
Where there are no meetings people also recover as "loners" who get support through the mail. The World Service Office of the 12 Step program you are interested in may have a list of recovering people who will write others.¦
The Twelve Traditions
These are the guidelines for dealing with each other which AA developed over the years, sometimes through bitter experience.
Alcoholics Anonymous, p 564
Alcoholics Anonymous:
General Service Office
P O Box 459,
Grand Central Station, New York, NY 10163
212-870-3400
Publishes “The Big Book,” “The 12 & 12,” (see book reviews) other books and pamphlets and a monthly magazine, The Grapevine
Al-Anon
Al-Anon Family Group Headquarters
1600 Corporate Landing Parkway
Virginia Beach, VA, 23462
From Survival To Recovery and How Al-Anon Works for Families and Friends of Alcoholics are their two newest books. Publish lots of other books and pamphlets, and The Forum magazine.
Overeaters Anonymous:
World Service Office
P O Box 44020
Rio Rancho, NM, 87174-4020
The Twelve Steps and Twelve Traditions of Overeaters Anonymous and Abstinence are OA's most recent books. Both wonderful. Also publishes other books, pamphlets and a magazine, Lifeline.
505-891-2664
Survivors of Incest Anonymous
SI A World Service Office
P O Box 21817
Baltimore, MD, 21222-6817
410-282-3400
Send # 10 SASE with 2 first class stamps for information. $5.00 brings an introductory packet of literature. If you can't afford the $5, they will send it free. 42 pieces of literature cost $33.55.
In the Welcome, it says “We had healthy, natural needs for love, attention, and acceptance, and we often paid high prices to get those needs met, but we did not seduce our abuser.” It can't be said better than that. Lots of good pamphlets.
Sex and Love Addicts Anonymous:
Fellowship Wide Services
P. O. Box 650010
West Newton, MA, 02165-0010
Publishes two books, pamphlets, and a magazine called The Journal.
617-332-1845
Narcotics Anonymous:
World Service Office
P O Box 9999
Van Nuys, CA, 91409
Publishes books, pamphlets and a newsletter, The NA Way.
818-773-9999
Gamblers anonymous:
P.O. Box 17173
Los Angeles, CA, 90010
Publishes two books, New Beginnings and Sharing through Recovery, pamphlets, and a monthly bulletin for members only.
213-386-8789
Incest Survivors Anonymous:
ISA World Service Office
P O Box 17245
Long Beach, CA, 90807-7245
Must include the phrase “I am an incest survivor,” or “I may be an incest survivor,” with request for literature list.
310--428-5599
Co-dependents Anonymous:
National CoDA Service Office
P O Box 33577
Phoenix, AZ, 85067-3577
Publishes a book, pamphlets, a quarterly newsletter, Co-NNECTIONS.
602-944-0141
Adult Children Anonymous:
ACA Region 8
P O Box 150331
Arlington, TX, 76015
World Service Office
P O Box 3216
Torrance, CA, 90505
Book Reviews:
Alcoholics Anonymous, Third Edition, AA World Service, address above, $5.00
Reading the Big Book as it is lovingly called by those of us whose lives it has transformed is a trip into another time zone because of the high quality of the writing and the use of he as a general pronoun, although most of the alcoholics in AA were men when the book was written. Despite its age, this is a book of infinite wisdom, wry humor, and practical application. The first 151 pages are about the program in general. The rest of the book is personal stories. Perhaps you'll see yourself in one of them. I did.
If you want to know how to work a twelve step program, read this book and substitute your problem for the words alcohol and alcoholism. Most of the time it will still make sense. When it doesn't you can get a good belly laugh from the effort or the funny results.
Chapter 5, How It Works, starts, “Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty...” Grasping and developing are the operative words here. It is a learning process. When you start to grasp the paradigm change, the reframing, the whole new way of looking at life, you also realize you have the rest of your life to develop this manner of living. Sobriety is just the beginning. Life improves as you work the steps and live by the qualities you develop in each step.
AA is for people who want to stop drinking but could not. The book has a self test for alcoholics: “you can quickly diagnose yourself. Step over to the nearest barroom and try some controlled drinking. Try to drink and stop abruptly. Try it more than once.”
Since there are several other quotes from the Big Book in the articles in this newsletter and I don't want to spoil the book for you, I'll stop there. A great book and a great read. Take what you like and leave the rest.
Highly Recommended¦
The Twelve Steps and Twelve Traditions of Alcoholics Anonymous, AA World Service, address above, $4.40.
Another funny wise practical book on how to work the 12 steps. Whatever program you may be in, this book will help you understand the Steps and the Traditions. The Steps help you have a relationship with yourself. The Traditions explain how such an unorganized organization works and explain the principles behind the free form organization. They also teach you principles which will help you in your relations with others.
Highly Recommended¦
One Day at a Time in Alanon, Al-Anon Family Group, New York, 1968, $7.00
The Courage to Change, Al-Anon Family Group, New York, 1992. $9.00,.P. O. Box 862, Midtown Station, N, NY, 10018-3757.
Two morning meditation books which are full of wisdom whether you are living with PTSD or have it yourself. Al-Anon encourages looking at yourself and growing toward becoming the kind of person you'd like to be. Slow growth is good growth. The fact that this can only be done one day at a time is reinforced by having a daily reading to think about.
Highly Recommended¦
Transcend: A Treatment Program for Veterans with Post-Traumatic Stress and Substance Abuse Disorders and Transcend Workbook: For Veterans with PTS and Substance Abuse Disorders, by Edgardo Padin-Rivera, PhD, Beverly Donovan, PhD, and Richard A McCormick, PhD. Available free from the VAMC Brecksville, OH.
Transcend is a twelve week inpatient program at the Cleveland VAMC which combines Substance Abuse and PTSD treatment. These books are used in the program and reading them was one of the highlights of putting out this issue. They are great. “...the importance of learning to tolerate uncomfortable feelings. Such feelings are viewed as an inevitable part of the human condition. For this reason vulnerable feelings such as sadness, loneliness, anger, fear, or helplessness need to be viewed as temporary states which will eventually pass. They alert us that there is a problem to be solved. These feelings therefore can not only be tolerated, but just as importantly provide an opportunity to learn more about ourselves and practice adaptive coping strategies.” That is a quote from the eleventh week of the program.
Transcend is a carefully laid out program of education about PTSD and substance abuse, skill building to increase self esteem and personal effectiveness combined with therapy to process experiences related to both childhood and war zone trauma. Up to ten clients go through this program together as a cohort, one of the ways to build community and trust which most inpatient PTSD units don't employ. Clients spend a lot of time writing and talking about reality, including the reality of what basic training is designed to do, the reality that everyone took family patterns with us to Vietnam, and the reality that in Vietnam terrible things happened and were done in the name of good. This program offers tools for getting to know yourself, for learning what you feel and some of the whys, for anger management and relapse prevention. “Without self-awareness we will condemn ourselves to repeat the same mistakes over and over again.”
This program has really helped the veterans who went through it.
Highly Recommended¦
Treating Addicted Survivors of Trauma, Katie Evans and J. Michael Sullivan, Guilford, 1995, $19.95.
Once again I have been absolutely incredibly gratified to find another book about treatment of PTSD which not only embodies the right attitude toward PTSD but for once reports accurately and correctly on 12 Step programs. For any therapist who is not familiar through personal study (of conference approved literature) and/or experience with the 12 Steps, this book has the clearest, most accurate discussion of the process and advantages of working a 12 step program. None of the inaccurate myths (like you have to believe in God or obey your sponsor) is repeated here.
The book opens with a chapter which lays out a well thought out “Philosophy of Treatment” based on reality. Two Chapters follow on PTSD (The Impact of Abuse) and Addictions, and one on the dual recovery model they have developed. The rest of the book discusses the process of recovery, stages they work through with clients, special ways of dealing with angry, depressed, and dissociative survivors, chapters on adolescents and families and even one on therapist self-care.
The Chapter called “The Impact of Abuse” is a fascinating overview of many types of research and points of view. The authors seem to have the capacity to see how to use many things in an eclectic mixture designed to be effective. Part of the problem with therapy has always been putting theoretical models between therapist and client and then blaming the client who doesn't fit. The history of PTSD is an example of that! It is nice to see people who look for what works.
One of the lovely things about this book is the reframing of sobriety as a safety issue. Working with clients teaching them to put their safety first must be a really moving experience for the clients. Reading about it was for me. “We present the [abstinence] agreement in terms of their need for safety and stress the fact that a brain affected by drugs or alcohol cannot be trusted to make therapeutically wise and safe decisions and the chemicals will interfere with achieving longed-for outcomes in treatment.” That is a brilliant reframe: Every trauma survivor longs for healing. A lot of them don't believe they can ever get it. This book lights the way. Reframing is mentioned a lot in this book and I find it one of the most helpful techniques in my own life. For me the most important reframe is to see symptoms as survivor skills and Evans and Miller see them that way too.
I can't speak highly enough of this book. Reading it will benefit anyone who works with addicted and/or traumatized people. If you have a client who is not progressing, this book may help you identify why. Breaking down the denial among PTSD specialists about addiction and the denial about trauma among addiction people is a very important issue for people who struggle with both problems. There are a lot of them out there.
Highly Recommended!
PTSD IN THE NEWS
Hippo-what?
As reported in “Hidden Scars,” Scientific American, October, 1995, several recent studies of abuse survivors (2 studies) and Vietnam Veterans (1 study) with PTSD showed they all had smaller hippocampuses than control subjects (people matched to them for the study who don't have PTSD). The hippocampus handles short term memory and may have a part in storing and retrieving long term memory. Seems like the high levels of some chemicals induced by traumatic stressors may actually have a physical effect on the brain. In 1965 World War II veterans reported continuing to have physiological reactions 20 years after their war ended. Researchers are beginning to catch up with what veterans knew (combat changed me. I am not the same.) studying some of the actual brain chemistry behind this stuff. It is nice to have scientific confirmation of human experience. Makes it easier for some people if we can point to scientific evidence that trauma changes you! Good work!¦
EMDR
Science News had a two page spread on Eye Movement Desensitization Reprogramming (sic) this week, October 21, 1995. (I've always heard it called “Reprocessing.” People who work with traumatized people are not into programming others.)
EMDR was mentioned in Treating Addicted Survivors of Trauma, as a technique that works for some clients and not others. Therapists I talked to at the Internationsl Society for Traumatic Stress Studies meeting in Boston this year had the same experience. Clients seem to like it and it works for a lot of them. I think that's great as long as no one believes that when a person is no longer having distressing feelings and images of a trauma, all the other problems in life will go away. If relief from pain is the only goal, veterans and other trauma survivors will continue to raise generations of children who do not know how to have, or live through, painful feelings. Living life is what it is all about, and many trauma survivors and families need talking therapy and 12 Step programs to learn healthier patterns of functioning.
The funniest thing about the debate on EMDR is not that they are worried about whether it works or not, but whether it should work. Kind of like the old days when the debate was about whether trauma should affect people.
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