I heard from many of the “old-timers” in Twelve Step support groups when they were sharing their experiences, strengths and hopes that when they entered the Twelve Step rooms as newcomers they were ‘spiritually bankrupt’. My AOD counsellors informed me that it was quite natural to go through a grieving process and sense of loss once the relationship ties to the drugs of my choice were severed. They said this could often leave a void within me and a way to fill the hole or gap that had been left by drugs and alcohol was to do so spiritually. Johnny Dow (personal interview, Auckland, 22 August 2012) says:
I think spirituality has been left out of the medical model for so long in many ways. It’s an important part of who we are. It’s not about God or anything like that, it’s about the world, the being, the earth, it’s about…it’s an important part of getting well. It is that existential dilemma really. Spirituality, however you find it, is really, really important. I think it is one of the big keys to staying well you know, and um, requires work for all individuals coming through.
Two of the three residential treatment centres I interviewed incorporate spirituality and Twelve Step methodology into their programmes. Both Higher Ground and the Salvation Army ran regular workshops on spirituality and Higher Ground also ran Tai Chi classes where
101 clients could experience Eastern forms of meditation and wellness. Twelve Step programmes such as Alcoholics Anonymous and Narcotics Anonymous are key methodological pillars of these two treatment centres, as NA and AA have helped millions of people worldwide over the years achieve a healthy sobriety. ‘Recovering individuals who are actively involved in a number of 12-step activities are likely to have better outcomes related to abstinence, such as self- efficacy for abstinence’ (Majer, Droege and Jason, (2010:157) and decreased stress levels in early recovery. I was interested to find out why these treatment programmes had such a strong focus on Twelve Step methodology. De Leon (2000:341) states:
Self is a central concept in the TC perspective. The disorder and the person are inextricably bound such that self is the nexus of the whole person. TC teachings speak to the individual as taking responsibility for their own recovery; they emphasise that change itself involves mutual self-help leading to self-esteem. Thus, residents are not simply treating their addiction, or modifying their behaviours and attitudes, they are working on changing themselves.
Recovery was described to me as a ‘baton race’ and that the treatment centre would only hold the baton for a limited period of time before handing it to a Twelve Step community. White (1992:246) argues that if addicts are to break free from the grips of their addiction long- term then clear linkages must be established between the treatment culture and the self-help cultures. He maintains that it just isn’t feasible to have the addict stop without some plan of long-term recovery maintenance:
It is not enough that treatment disengage the addict from the culture of addiction and initiate the earliest stages of recovery. The treatment experience must provide the pathway to long-term recovery, either through linkage to the traditional self-help groups or to some alternative support structure.
The first group of the day at Higher Ground is a Steps Working Group, where residents will share a Twelve Step reading and how they’re feeling in line with the first three steps. They also have a pool of volunteers who will collect a group of residents and drive them to a scheduled Twelve Step meeting six days a week. Guest speakers from Twelve Step groups will
102 attend in-house meetings and share their experiences, strengths and hope with the residents and explain how they have used the programme to stay well. Residents are also expected to have a Twelve Step sponsor to help guide them through the residential treatment programme and it’s expected that they make contact each week. Johnny Dow (personal interview, Auckland, 22 August 2012) says:
Higher Ground believes that a Twelve Step focus and getting people into that community, either Alcoholics Anonymous or Narcotics Anonymous is the best way for someone to get free of substances and form a new community around themselves and that is healthier than going back into their old community of using and using friends.
It costs nothing monetarily to belong to a Twelve Step community, as they don’t charge for their support and have a tradition of self-sufficiency, declining any outside contributions. My sponsor once told me that people may have already lost their home, their job, their relationships, their families, or the car – so it’s already cost them a great deal and they’ve probably earned their seat. However, clients in residential treatment centres are only residents for a finite period of time. It seems like a natural progression to become part of a Twelve Step community after treatment has finished and this was strongly suggested to me as a client. Urschel (2009:114) contributes from the United States experience:
Due to financial considerations, most addiction treatment programmes only last four to eight weeks. This may sound like a long time when you enter into a programme, but it is impossible to completely overcome addiction in one or two months – even six months or a year. Addiction is a lifelong chronic disease that requires lifelong commitment. Unless you’re prepared to pay for years or decades of treatment, the only place to go for that kind of continual care is AA.
Goldstein (1994:131) argues that ‘[t]here is a shared impression among most professionals that 12-step programmes are the best for most alcohol addicts. The method depends on peer support, honest self-examination, self-accusation, confession and acceptance of guidance by a ‘higher power’. Goldstein’s explanation of the Twelve Step method dependencies is mostly in tune with the desired outcomes for clients of the treatment centres
103 I interviewed, for example, ‘peer support’ and honest self-examination’. But there was one treatment centre that didn’t have a specific spiritual element to its programme, and I was interested to see what Odyssey House’s view on spirituality is. Kerry Manthenga (personal interview, Auckland, 1 December 2012) said:
Odyssey’s view on spirituality is that it is a personal matter and we will support you to be spiritual in whatever way makes sense to you, so there isn’t really a spiritual, um, a spiritual dictum, I guess, that goes with the programme in the way that the Twelve Steps have with that spirituality built in. Um, but, I think people also talk about the pillars of Odyssey House….those core values…as becoming almost a spiritual experience. Living to those values becomes in some ways, that….internalising that…those aspects of right living becomes kind of a spiritual experience. But it is an externalised thing. If people come in and they have a Twelve Step background, or they have strong Christian values, or they have strong religious values affiliated with whatever sect, um, the response is to do whatever we can to support them in not only engaging with that externally, but also to create an environment where they can talk about that, how that fits into their recovery, and we encourage it and we support it….it’s seen as important and to be nurtured in people, that’s for sure.
White (1996:261) sees that for ‘many addicts, the spiritual zone of action and experience is the initiating and driving force within the recovery process. The zone broadly embraces empowerment from beyond the self, and openness to spiritual and/or religious experiences and the reconstruction of personal values.’ For an organisation such as the Salvation Army Bridge programme, whose ethos is to transform lives through Christ, a spiritual dimension is very much a cornerstone of the treatment programme. Like Higher Ground, clients are similarly encouraged to attend Twelve Step meetings, guest speakers attend the facility and a Twelve Step meeting is held on-site weekly. On top of this, the Bridge programme has its own Recovery Church and services are held weekly on Tuesday evenings (for graduations and celebrations) and Sundays (for more formal church services). Clare Luamanuvae (personal interview, Auckland, 26 October 2012) explains the Bridge programme’s approach to spirituality:
104 We have um, spirituality groups which are run by the chaplains and
explore that inner self. Um, we do and look at the Twelve Steps, the first three of the Twelve Steps, but also explore other spiritual aspects to a person and that deeper relationship with who they are and then whatever is their Higher Power, which is the essence of them really. Um that’s my…..that’s how I see it. We have a Quiet Room which is um, for reflection. We have a church on site which is a recovery church, so it’s a recovery community, but it allows people to see achievement and change in others which can ignite that belief in themselves. Um, we also run um, a relaxation group for four weeks….for the first four weeks. Trying out different ways of relaxing and just being with yourself, which is actually quite challenging for a lot of people, to actually even be still with themselves, and try and be just present, for twenty minutes; half an hour. It’s hugely challenging but part of what we do, um because we think it’s important to try and centre people and to ground people.
Cynthia Young from the Salvation Army (personal interview, Auckland, 26 October 2012) added that part of the Bridge programme is trying to rebuild a values system by creating a vision for the future, and providing an opportunity for rebuilding spiritual resources by ‘tapping into Twelve Steps, it’s part of the same thing. People don’t have to do that but if they do take those opportunities, it does seem to work out very well for them. It connects them very strongly into Recovery Church, AA, um, if they remain along or more agnostic sort of path then well, they have to develop other sorts of resources. And that’s fine, that’s their choice’.
But in the field of addictions, spirituality is poorly defined and understood (Cook, 2004). Csordas and Kleinman (1990:14-15) highlight an interesting paradox of medical anthropology as it relates to non-medical forms of healing, that can be applied to how mutual self-help Twelve Step groups are viewed with healing their members. They argue the paradox is one in “which non-medical forms of healing are explicitly acknowledged as religious but analysis then abandons the explicitly religious to focus on ‘therapeutic aspects of healing’.” Twelve Step groups have a history rooted in Western Christian orthodoxy, as discussed in a previous chapter, and Wilcox (1998:109) adds that ‘Alcoholics Anonymous is effective as a community of healers’. Proponents of the Twelve Step faith are quick to point out that it’s not a religious programme, but a spiritual programme, and that all I needed to know was that ‘it
105 works’, which I read as, “Don’t question the process, just do it.” Csordas and Kleinman (1990:15) then contend that :
An important consequence for the study of therapeutic process is failure to distinguish clearly between traditional forms of healing such as shamanism and healing movements such as faith healing. The latter are not exclusive to industrialised, developed societies but are distinct from traditional healing in that they recruit adult participants. Unlike the prototypic case of a small-scale society were people take for granted and are familiar from birth with the shaman as healer, adult recruits to healing movements may never before have considered the possibility of divine healing, requiring secondary socialisation to establish a predisposition toward such healing. In addition, unlike healing in traditional societies, such movements typically attract two quite distinct groups, one consisting of committed disciples and the other of marginal participants seeking relief for particular complaints.
Twelve Step groups are ‘healing movements’ who are very careful not to ‘recruit’ members, as their traditions explain that membership is based on attraction rather than promotion and that you’re an alcoholic or an addict when you say you are. However, the two distinct groups that Csordas and Kleinman explain above are very prevalent, for example, ‘old- timers’ (committed disciples) and ‘newcomers’ (marginal participants seeking relief).