10/01/2014 2014 HJF Recovery Services LLC 0

The Science Within 12-Step Recovery Bill Smith, MA, BCC, CSAC, CIP President, HJF Recovery Services LLC

Objective: Informed Consumers of Recovery Products This Not That 10/01/2014 2014 HJF Recovery Services LLC 2

SPIRITUAL 10/01/2014 2014 HJF Recovery Services LLC 3

Spirituality? For many, spirituality takes the form of religious observance, prayer, meditation or a belief in a higher power. For others, it can be found in nature, music, art, or a secular community. Spirituality is different for everyone. No Particular Wisdom Tradition Required Clearer Life Purpose Connection with self and with others (God?) Development of Personal Value System Discovery of the Meaning of Life Connection to Whole = Release of Control 10/01/2014 2014 HJF Recovery Services LLC 5

What is 12-Step Recovery? (Big Book or Spiritual-Based Recovery) Recovery is an individual s experience of the transformative power that comes from taking the 12-Steps. That is, the program of prescribed spiritual action originally described in the Big Book of Alcoholics Anonymous Forward, Doctor s Opinion, and 1 st 103 pages. Abstinence is simply the absence of the chemical of NO CHOICE: Untreated addiction results from abstinence. Recovery results from TRANSFORMATION via the Steps. 10/01/2014 2014 HJF Recovery Services LLC 6

What Does NOT Work? Self-Knowledge Self-Efficacy Will Power Quitting Abstinence Alone It Can t Be That Simple 10/01/2014 2014 HJF Recovery Services LLC 7

6 Lessons of the Big Book We are spiritual beings having a human experience. The solution is already a part of who we are. We have everything we need to be happy RIGHT NOW (always have, and always will). Harmony (balance) is the goal; this is our default position. Manifestations of SELF (fear, resentment, pride, ego, anger) are the cause of all our problems (imbalance). Over-reliance on SELF is food for the Spiritual Malady. It blocks an effective relationship with Spirit and others. Intention is insufficient; specific action is required. You can t solve a ME problem with more ME. It Can t Be That Simple 10/01/2014 2014 HJF Recovery Services LLC 8

12-Steps Start Where We Are: Step 1 Step 2 Step 3 Steps 4 9 Steps 10 12 Where We Were Where We Could Be Where We Wanted To Be How We Got There How We Stayed There It Can t Be That Simple 10/01/2014 2014 HJF Recovery Services LLC 10

What is The Program? Alcoholics Anonymous is the life changing program formed by two desperate alcoholics in 1935. The Forward, Doctor s Opinion, and 1 st 103 pages detail the program in it s entirety. Works for any addiction or mal-adaptive behavior. Precise set of directions for recovery, NOT abstinence. Purpose is NOT how to NOT drink But how to LIVE (Spiritually)!! Simple, but NOT EASY!!! 10/01/2014 2014 HJF Recovery Services LLC 11

Spiritual Transformation: What Happens? Steps 1 3 INFORM what the problem and the solution are: Problem = Over-reliance on self Solution = Reliance on Power greater than self Over-reliance on self blocks innate knowledge of the solution. Results in life based on pomp, calamity, and worship of other things. 4 9 removes these blocks and TRANSFORMS the alcoholic to a complete, whole person of integrity. 10 12 sustain and grow the alcoholic in Spiritual Living (NEW NORMS). 10/01/2014 2014 HJF Recovery Services LLC 12

Sustenance & Growth: What Happens? Balance is achieved. When anger, fear, resentment creep in, we see this as counterfeit (Secret Service Training!!) Not a performance-based system progress not perfection. Moved away from Victim Status. Fear is no longer the bottom-line motivator. Return of values, dreams, self-esteem An Unshakable foundation for life! 10/01/2014 2014 HJF Recovery Services LLC 14

SCIENCE 10/01/2014 2014 HJF Recovery Services LLC 15

What is Addiction?? 10/01/2014 2014 HJF Recovery Services LLC 16

Addiction is Any behavior that is associated with craving, temporary relief, and long-term negative consequences (that are generally predictable and known to the individual) along with impairment of control over the behavior so that the person wishes to quit, or promises to quit, but can t follow through with the intention. 10/01/2014 2014 HJF Recovery Services LLC 17

Alcohol Consumption and Genetics Scientists have found that the genes which influence the amount of alcohol people drink may be distinct from those that affect the risk of alcoholism. Drinking behavior is linked to the pleasure and reward pathways in the brain and some of the systems that control food intake. The results emphasize the importance of looking at signaling pathways rather than single genes, and show cross-species similarities in predisposition to alcohol consumption (Lab Rats). They found that genetic factors account for 40 to 60 percent of the variance between people in risk of alcoholism. The genes involved in susceptibility to alcoholism include both alcohol-specific genes and those that affect neuronal pathways to do with reward, behavioral control and resilience to stress. 10/01/2014 2014 HJF Recovery Services LLC 19

Pleasure Principle Pleasure, regardless of source is registered the same way: 1. Lobster & Steak 2. Sex 3. Winning the Lottery! 4. Psychoactive drug Mood-altering chemicals cause a particularly powerful surge of feel good chemicals in the brain s pleasure center Also a response to: Route of administration influences likelihood of becoming addicted: 1. Speed of dopamine release 2. Intensity of the release 3. Reliability of the release 10/01/2014 2014 HJF Recovery Services LLC 20

Learning & Memory Pleasure alone is not enough! Dopamine = Experience of pleasure AND learning and memory Addictive drugs provide a shortcut to the brain s reward system by flooding the nucleus accumbens with dopamine The hippocampus lays down memories of this rapid sense of satisfaction The amygdala creates a conditioned response to certain stimuli (learning) Dopamine not only contributes to the experience of pleasure, but plays a role in learning and memory two key elements in transition from enjoying to addiction - Like to Need 10/01/2014 2014 HJF Recovery Services LLC 21

90-Second Dyad 1 st partner crosses arms Then, reverse & hold 1 st Partner tell 2 nd partner three things you learned about brain chemistry & addiction Switch! What were you thinking? 10/01/2014 2014 HJF Recovery Services LLC 23

What is Recovery?? 10/01/2014 2014 HJF Recovery Services LLC 24

Recovery is Beyond abstinence, a series of interventions designed to enable the individual to separate the person they have become as a result of a primary relationship with their chemical of NO CHOICE from their true, authentic selves. With this restoration, the individual is free to resume the normal and ongoing processes of learning, growth and healing physically, mentally, and spiritually. 10/01/2014 2014 HJF Recovery Services LLC 25

Interventions? Prevention Professional? Community policies Professional education Peer Support Groups Screening & referral Intervention Professional? Family education Intervention team Support recovery! Case management Counseling Professional? Safe structure Group dynamics Role-plays / exercises O.A.R.S. Treatment Professional? Theoretical frame Pharmacotherapy Controlled environment Preparation for aftercare 10/01/2014 2014 HJF Recovery Services LLC 26

Recovery? 10/01/2014 2014 HJF Recovery Services LLC 27

Traditional Model: Spiritual Conversion 10/01/2014 2014 HJF Recovery Services LLC 28

Contemporary Model: Re-Socialization 10/01/2014 2014 HJF Recovery Services LLC 29

Scientific Model: Underlying Pathology 10/01/2014 2014 HJF Recovery Services LLC 30

Traditional Model of Recovery: Recovery is the result of a spiritual conversion experience William James / Bill Wilson Displacement / Rearrangement of Convert s Personality Disease Model / Jellinek Obsession is replaced with sense of Personal Spirituality Individually Interpreted Focus is on Enlargement of Spiritual Life via Steps 10 12 (Spiritual Truth) Meetings = Opportunities for Testimony & Sponsorship Big Book-Based - Prescribed Fidelity = High Success Conservative & Blinkered Views Stories = Obsession, Surrender & Personality Change 10/01/2014 2014 HJF Recovery Services LLC 31

Contemporary Model of Recovery Recovery is a process of re-socialization to sober addicts William White (et al.) Underlying Pathology is 2 nd to Maintenance of Abstinence Recovery is Hard = Suppressed Feelings while Using Focus is Meeting Attendance /Fellowship & Medicine Chest Meetings = Opportunities for Surrender & Willingness to Share Fellowship-Based Prescribed Success = Long & Painful; Relief from Obsession is Lifetime Liberal & Tractable Views Stories = Physical & Despair / Hopelessness of Addicted Life (Reminder) 10/01/2014 2014 HJF Recovery Services LLC 32

Scientific Model of Recovery Recovery happens when underlying psychological causes are exposed and treated Addiction = symptom of an underlying psychological disorder Many Theoretical Frames!! (Thanks, Freud!!) Range = Freud s latent homosexual tendencies to the Family Systems Theory s addict is playing a role Addict uses to cope with some kind of pain or trauma Recovery = Learning appropriate selfcare Success = Equal or Less than Re- Socialization 12-Steps not essential, but often referred; IP = 1 5 (?) Stories = Experience in therapy (feelings, trauma, self-care) 10/01/2014 2014 HJF Recovery Services LLC 33

IMPLICATIONS 10/01/2014 2014 HJF Recovery Services LLC 34

12-Step Implications: TTM Transtheoretical Stages of Behavioral Change: Deals with intentional behavior change - Specific overt modifications to lifestyle Views change as a process rather than an event Characterizes change as a consecutive, scaffolding steps Cycles back and forth through previous stages / steps 10/01/2014 2014 HJF Recovery Services LLC 35

12-Step Implications: AA, Stages, & Process 10/01/2014 2014 HJF Recovery Services LLC 36

12-Step Implications: Decisional Balance (MI) 10/01/2014 2014 HJF Recovery Services LLC 37

12-Step Implications: Social Cognitive Theory 10/01/2014 2014 HJF Recovery Services LLC 38

12-Step Implications: Cognitive Restructuring Observing, identifying, and modifying irrational thoughts: Inform Emotions Transform Thoughts New Norms Behaviors 12-Steps: Behavioral modification and neurolinguistic programming Explore & Reframe Meetings: Programming Process Slogans: Messages of cognitive restructuring Sponsorship: Addresses faulty beliefs and maladaptive cognitions Progression from the drinking phase, through transition, early recovery, and ongoing recovery 10/01/2014 2014 HJF Recovery Services LLC 39

Use Models to Keep YOURSELF Right-Sized Know your Referral! Know your Referee! Involvement is WAAAY better than Attendance Integrate DON T Populate! 12-Steps + Treatment = Better Outcomes: Increase Counseling Opportunities! Additive Effect!! Works GREAT with Relapse Prevention Methods Severity of Use = Motivation 10/01/2014 2014 HJF Recovery Services LLC 40

Selected Bibliography Blonigen, D. M., Timko, C., Finney, J. W., Moos, B. S., & Moos, R. H. (2011). Alcoholics Anonymous attendance, decreases in impulsivity and drinking and psychosocial outcomes over 16 years: moderated mediation from a developmental perspective. Addiction, 106(12), 2167-2177. David A. Patterson Silver Wolf (Adelv Unegv Waya), & Nochaski, T. H. (2010). Combining the Transtheoretical Stages of Change Model and the 12 Steps of Alcoholics Anonymous to monitor treatment progression. Journal of Social Work Practice in the Addictions, 10(2), 224-227. doi: 10.1080/15332561003730262 Ducci, F., & Goldman, D. (2008). Genetic approaches to addiction: Genes and alcohol. Addiction, 103(9), 1414-1428. doi: 10.1111/j.1360-0443.2008.02203.x Galanter, M. (2014). Alcoholics anonymous and twelve step recovery: A model based on social and cognitive neuroscience. The American Journal on Addictions, 23(3), 300-307. Galanter, M., Dermatis, H., Stanievich, J., & Santucci, C. (2013). Physicians in long term recovery who are members of Alcoholics Anonymous. The American Journal on Addictions, 22(4), 323-328. 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. Heydari, A., Dashtgard, A., & Moghadam, Z. E. (2014). The effect of Bandura's Social Cognitive Theory implementation on addiction quitting of clients referred to addiction quitting clinics. Iranian Journal of Nursing and Midwifery Research, 19(1), 19-23. doi: PMID: 24554955 [PubMed] PMCID: PMC3917180 Kelly, J. F., & Greene, M. C. (2014). Toward an Enhanced Understanding of the Psychological Mechanisms by which Spirituality Aids Recovery in Alcoholics Anonymous. Alcoholism Treatment Quarterly, 32(2-3), 299-318. 10/01/2014 2014 HJF Recovery Services LLC 41

Selected Bibliography Kelly, J. F., Greene, M. C., & Bergman, B. G. (2014). Do Drug-Dependent Patients Attending Alcoholics Anonymous Rather than Narcotics Anonymous Do As Well? A Prospective, Lagged, Matching Analysis. Alcohol and Alcoholism, agu066. Kelly, J. F., Stout, R. L., Magill, M., Tonigan, J. S., & Pagano, M. E. (2010). Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms?. Addiction, 105(4), 626-636. Kelly, J. F., Stout, R. L., Magill, M., Tonigan, J. S., & Pagano, M. E. (2011). Spirituality in recovery: a lagged mediational analysis of Alcoholics Anonymous principal theoretical mechanism of behavior change. Alcoholism: Clinical and Experimental Research, 35(3), 454-463. Krentzman, A. R., Robinson, E. A., Moore, B. C., Kelly, J. F., Laudet, A. B., White, W. L.,... & Strobbe, S. (2011). How alcoholics anonymous (AA) and narcotics anonymous (NA) work: Cross-disciplinary perspectives. Alcoholism treatment quarterly, 29(1), 75-84. Mathias, R. (1999). Adding More Counseling Sessions and 12-Step Programs Can Boost Drug Abuse Treatment Effectiveness (5th ed., Vol. 14, December) (USA, National Institute on Drug Abuse (NIDA), NIDA Notes). Miller, W. R., & Rollnick, S. (2004). Talking oneself into change: Motivational Interviewing, Stages of Change, and Therapeutic Process. Journal of Cognitive Psychotherapy, 18(4), 299-308. doi: 10.1891/088983904780944306 Pagano, M. E., White, W. L., Kelly, J. F., Stout, R. L., & Tonigan, J. S. (2013). The 10-year course of Alcoholics Anonymous participation and long-term outcomes: A follow-up study of outpatient subjects in Project MATCH. Substance Abuse, 34(1), 51-59. Shiffman, S. (1996). Addiction versus stages of change models. Addiction, 91(9), 1289-1290. doi: 10.1111/j.1360-0443.1996.tb03614.x 10/01/2014 2014 HJF Recovery Services LLC 42

Selected Bibliography Stack, K. M., Fore Arcand, L. G., & Briscoe, G. (2012). Use of alcoholics anonymous as part of medical school education: students and educators perspectives. Substance Abuse, 33(4), 387-391. Steigerwald, F., & Stone, D. (1999). Cognitive Restructuring and the 12-Step Program of Alcoholics Anonymous. Journal of Substance Abuse Treatment, 16(4), 321-327. Subbaraman, M. S., Kaskutas, L. A., & Zemore, S. (2011). Sponsorship and service as mediators of the effects of Making Alcoholics Anonymous Easier (MAAEZ), a 12-step facilitation intervention. Drug and alcohol dependence, 116(1), 117-124. Tabakoff, B., Saba, L., Printz, M., Flodman, P., Hodgkinson, C., Goldman, D.,... Hoffman, P. L. (2009). Genetical genomic determinants of alcohol consumption in rats and humans. BMC Biology, 7(1), 70-91. doi: 10.1186/1741-7007-7-70 Tonigan, J. S., & Rice, S. L. (2010). Is it beneficial to have an Alcoholics Anonymous sponsor?. Psychology of Addictive Behaviors, 24(3), 397. Ullman, S. E., Najdowski, C. J., & Adams, E. B. (2012). Women, Alcoholics Anonymous, and related mutual aid groups: Review and recommendations for research. Alcoholism Treatment Quarterly, 30(4), 443-486. White, W. L. (1998). Slaying the dragon: The history of addiction treatment and recovery in America. Bloomington, IL: Chestnut Health Systems/Lighthouse Institute. Witbrodt, J., & Delucchi, K. (2011). Do Women Differ from Men on Alcoholics Anonymous Participation and Abstinence? A Multi Wave Analysis of Treatment Seekers. Alcoholism: Clinical and Experimental Research, 35(12), 2231-2241. Witbrodt, J., Kaskutas, L., Bond, J., & Delucchi, K. (2012). Does sponsorship improve outcomes above Alcoholics Anonymous attendance? A latent class growth curve analysis. Addiction, 107(2), 301-311. 10/01/2014 2014 HJF Recovery Services LLC 43