Self-help groups Health Article

Spiritual recovery

The final step in a 12-step program recognizes that recovery entails a spiritual awakening; furthermore, recovering addicts are enjoined to spread the message to others suffering from addiction. Recovery depends on giving up both injurious self-will and denial of maladaptive behavior, and turning to a higher power. Members are urged to seek guidance or inspiration from this higher power. For many addicts, the key to recovery is a spiritually guided movement away from self-centeredness or self-absorption, and a turning towards the "Power greater than ourselves" through prayer and meditation.

Advocacy

Some self-help groups meet to advocate or promote social and legislative remedies with respect to the issue of concern. For example, HIV/AIDS groups have lobbied for improved access to prescription drugs. Groups lobby for reforms by identifying key legislators and policy makers; they submit papers or suggestions for more equitable laws and policies to these key people. They also conduct public education programs (including programs meant to redress the harm of stigmatization). There are groups that advocate for more funds for research and for improved services for people who suffer from one of many diseases or mental disorders. The most important grass roots organization of families and consumers of psychiatric services (former or current patients) is the National Alliance for the Mentally Ill (NAMI). This organization was founded in 1979, and blends self-help with advocacy efforts for the improvement of research, services, and public awareness of major mental illnesses. Their advocacy efforts target both the federal and state levels.

Advocacy vs. mutual aid

In some organizations, there is a growing overlap between self-help efforts and community development. Critics maintain that focusing on issues such as crime prevention, affordable housing, and economic development drains time and effort from social support and mutual aid. Nevertheless, some organizations continue to develop both advocacy and support.

Lack of professional involvement

The absence of professional guidance may mean that a member in need of formal psychotherapy or treatment may be discouraged from seeking professional help. On the other hand, too much professional involvement in the group may compromise the quality of mutual aid.

The " thirteenth step"

There is a well-known risk associated with attending 12-step groups termed the "thirteenth step." Women new to the groups, especially young women, are at their most vulnerable in the early stages of recovery. Male sexual predators who attend meetings take advantage of the atmosphere of intimacy and mutual trust. To cope with the possibility of sexual exploitation, young females are encouraged to attend meetings with a family member or a trusted adult, and all women are encouraged to find a same-sex sponsor.

Substituting addictions

The early months of a 12-step program are especially difficult. Typically, an addict in early recovery either replaces an addictive substance with a new one, or intensifies his/her concurrent use of another substance.

It is not uncommon for people who are chemically dependent to also have an addictive sexual disorder. (When someone is addicted to sex, there is an intense desire to gratify sexual urges and fantasies or to behave in ways that cause clinically significant distress; sexual indulgence, often compulsive, is a major disruptive force with respect to social relationships.) In one four-year study of a treatment program, 33% of the chemically addicted patients also were sexually compulsive. Some physicians believe that the predatory "thirteenth step" is evidence of turning from one addiction to another—in this case, addictive sexual disorder.

Members at varying stages of recovery

Another common risk is associated with the varying levels of recovery in a self-help group—that of being actively involved in the abuse of alcohol and/or drugs. Newcomers need to realize that not all members are interested in supporting their recovery, and that people in later stages of recovery may be more reliable. Furthermore, some members are required to attend by disciplinary entities, such as employers or correctional authorities.

Ongoing meetings

One criticism of self-help groups, especially 12-step groups, is that in the eyes of families and friends, members who persevere and faithfully attend the seemingly endless number of meetings only to become "addicted" to the program. However, physicians who support self-help groups point out that since addiction is a disease, addicts are particularly vulnerable to relapse, and that ongoing involvement with a self-help community surely is better than suffering the recurring misery associated with active addiction.

Rational alternatives to 12-step groups

For addicts who find the spirituality of 12-step groups offensive and irrational, and who believe that public proclamation of powerlessness at group meetings is demoralizing, alternative groups exist. For example, a well-known organization, Rational Recovery (RR), is based on the cognitive-behavioral principles of Albert Ellis. RR emphasizes self-reliance, rational thinking as a result of cognitive restructuring, and the development of a new repertoire of behaviors to respond effectively to events that trigger relapse.