There are a number of slogans and sayings that get chucked around in health circles, which some people find really helpful, and other people find both helpful and irritating, depending upon their mood.
One of the most common sayings, although not an actual slogan, is telling people directly or indirectly that they are as sick as their secrets.
The message behind the saying is that people need to open up, tell either an individual or a group what is going on in their life, or what it is from their past what is troubling them.
People will rarely question this message, in part because the process of 12 step recovery does involve an individual realistically assessing the past, sharing it with someone on a one-to-one basis and making amends harm done as a basis for moving forward and staying sober.
A degree of defensiveness can often mask a sense of underlying anger, which in reality is often protective rather than confrontational.
As Sick As Your Secrets ?
The problem with telling people that they are as sick as their secrets is that it often moves away from what is suggested in the book Alcoholics Anonymous to a different level.
This either puts significant pressure on people to share at meetings, and pressure on people that they should be telling everyone everything about their lives.
This is a hugely important issue, and unsurprisingly is really to do with boundaries.
When anyone starts the process of getting sober and staying sober they are quite likely to have experienced a significant degree of isolation, often both physical and emotional, often for a significant period of time.
Any emotional isolation is likely to have had a fairly devastating affect on the individual, often making them highly inward looking and secretive about their lives.
Telling individuals like this that they are as sick as a secrets can seem to make sense, as they will often think that they have to force their way out of that isolation in order to share and get better, otherwise they will drink again.
The process or an individual frame themselves in this type of isolation is as detailed in the book Alcoholics Anonymous. It is not a forced process and never should be.
A sense of moving out of this type of emotional isolation can only come from the individual feeling safe enough to let go of the various emotional coping mechanisms that they have set up within themselves.
These coping mechanisms are essentially what the isolation involves, and need to come down so that the individual can have a healthy sense of understanding what their own issues are.
What is key is that they come down from within, not as a result of being pressured from outside.
Whenever an individual is starting a process of getting or staying sober, either in a rehab or in a meeting of Alcoholics Anonymous, it is a fair bet to say that the last thing in the world they need is any more external pressure.
Whilst every individual’s life is different, and their circumstances different, it’s a fair bet to say that they are already experiencing a high degree of internal pressure, as well as probably external pressure as well.
Telling people that they are as sick as their secrets invariably puts pressure on them. They either feel that they have to share at meetings, or that they need to share things that they are not ready to yet own themselves emotionally.
This type of pressure and the ensuing belief that people have to tell everyone everything about their lives often replicates the type of enmeshment found in alcoholic homes.
This is not surprising given number of AA members who grew up having been affected by someone else’s alcoholism.
It is important to realise the distinction between privacy and secrecy, and to realise that this is fundamentally a boundary issue, and one that can be hugely important in people’s recovery.
Bottom line is that putting pressure on people who are vulnerable is always a no no, especially when it potentially takes away from them one of the main things that they need in order to get well, a sense of safety at meetings where they can simply learn to be themselves.
A 12 step program normally refers to the recovery process outlined in the book Alcoholics Anonymous, that has been subsequently adopted by a number of other organisations that help people with various addictions and problems.
The book Alcoholics Anonymous was written by the early members of AA, and was intended to be a record of their experience of how they got sober.
Up until the time the book was written, the members who were sober had used a number of different principles in their recovery, most of which were shared by word of mouth.
Part of the intent in the book was to codify these principles into a more formal set of specific ideas and actions that people could take, which was generally agreed to form the basis of most people’s sobriety.
The Value of Experience
As AA grew in size and more people got sober, people who had other addictions and problems began to realise that they were able to use the same principles that were used in Alcoholics Anonymous as a way of freeing themselves from whatever it was they were trying to deal with.
In effect, all they had to do was to swap the word alcohol with something else, such as drugs, gambling, food etc.
New fellowships grew up such as Narcotics Anonymous, Gamblers Anonymous and Overeaters Anonymous. All these organisations used the basic principles of the AA 12 step program, but adapted it to their own needs.
There are a number of basic principles behind all 12 step programs, that form the basis of most people’s recovery.
These in essence include the acceptance of being powerless over the addiction, a moral inventory, becoming willing to make restitution for harm done and developing a sense of God in their life, however they may come to understand that.
Powerless Not Helpless
Some people criticise 12-step programs because they see the idea of powerlessness almost as a form of weakness.
This actually misses the point that people who admit they are powerless to the addiction do so because they actually are, not out of any issue related to their self-esteem or identity.
Acknowledging powerlessness over something is simply an acknowledgement of reality. If someone is not powerless over alcohol or drugs or anything else then they are not powerless over it, period.
If they are powerless over alcohol or anything else than they are powerless over it, period
In fact acknowledging that one is powerless over something is a source of strength not weakness.
It means that one can focus one’s energies on things that you do have control over, rather than focusing them on things that you do not have control over, and draining your whole sense of spirit as a result.
A Moral Inventory
Whilst this is a somewhat awkward phrase, it is really about developing a sense of self awareness, and being willing to look at oneself through the eyes of various emotional drives, such as resentment or anger, fear, anxiety etc.
This can sometimes seem a bit negative, and people often talk about developing both positive and negative traits in terms of inventory.
In fact thinking about both positive and negative aspects of emotions tend to blur the reality of anyone’s emotional life.
Emotions are of themselves neutral in that sense, seeing them as either positive or negative is in fact a judgement.
Any type of moral inventory, or developing of self-awareness can only be really effective when there is no judgement itself, which can take a significant amount of time for most of us, but does fit to the cycle of an inventory being a process.
As with any process, like learning to ride a bike or drive a car, we learn by doing, and in doing we develop a degree of inner stability that we quickly build on each time we repeat the process.
Developing self awareness can be done in many different ways, but the emphasis on it in 12 step programs tends to suggest that it is both a historical and current need. This is why it can sometimes seem a bit overwhelming to people, as it seems to suggest an almost relentless focus on oneself.
Whilst there is some truth in this, it is also true to say that without self-awareness it is almost impossible to really move forward, and the real sense of freedom that 12 step programs bring is inherently linked to an internal sense of being at peace with yourself, which is to a large part conditional on self acceptance and self-awareness.
For many people this is often the most difficult part of any 12-step program. It often means going back to people who you would rather forget, and would often rather forget you as well !
This is also an unconditional acceptance of one’s own reality, and can certainly seem fairly daunting.
The key to making restitution for harms done, is in many ways to keep the focus on harm.
This process is not meant to be a way by which someone auto corrects their whole life as if it hadn’t happened, or had happened in a different way.
It is about trying to make right harm you have done to other people. Focusing on the harm actually makes the whole process possible, although it can obviously take time for this to materialise.
Once it does, there is a quite natural and obvious sense of need to try and put it right, however daunting this may seem.
There comes a sense of naturalness about wanting to make peace both internally and externally, and a realisation that trying to put right whatever harm was done is an integral part of that process.
The God Question
Perhaps more than any other, the God Question has been at the heart of AA since it started, and is often seen as both the solution and the problem as to why people struggle with sobriety, and the 12-step program as a whole.
The God question tends to attract fundamentalists on both sides, and any fundamentalism turns to distort the reality of any issue.
This is certainly true both in the reality of AA meetings, and the level of defensiveness that tends to come up in individuals whenever this issue is raised.
This is really sad in many ways, largely because it eats away at the real freedom people can experience, which is the freedom to be themselves, and to interpret the whole God question in whatever way they feel most appropriate to their lives.
The essence of AA, and the reason the book was written, was and is about experience. The book was intended as a body of experience that people could use in anyway that they found helpful or not.
This is inherently true of all 12 step programs, whatever the problem or addiction. 12 step programs have never been about ideologies or belief systems, although individuals and groups will sometimes make them so.
Whilst there are many sides to the discussion about 12 step programs, perhaps the most important thing to remember is that the ultimate goal is freedom, both internal and external, and anything that leads to that should be encouraged, and anything that takes away from that should be discouraged.
Step Four is often thought of as the bogeyman and is portrayed as a turning point for people once they have initially got sober.
It is sometimes seen as almost a litmus test as to whether people are really willing to begin the process of facing themselves and their demons.
In reality, there are really several different things going on behind all these issues that are probably worth looking at and unpicking.
The phrase, a moral inventory, is used in the book Alcoholics Anonymous, specifically in step four of the AA 12 step program.
Many people find this phrase a bit baffling or a bit scary, and people in recovery often find the whole idea of doing a step four one of the biggest blocks or obstacles they face in staying sober.
Some of the confusion around the word inventory is because it is normally used in a business or commercial sense, and refers to a stocktaking or assessment of assets and liabilities in a company.
Fear in Recovery
Many people are pretty terrified when they get sober, normally for a number of different reasons.
Often it is about a fear of what it means to be sober, often it is a fear about losing alcohol even when it has stopped working, and often a fear about the possibility of change and what it might mean.
All these fears can combine and at times be quite debilitating, but it is worth unpacking them all and dealing with each as a separate issue in order to fully understand what someone is saying to themselves.
This can be true about a number of issues in recovery. It is often the overall effect of a number of fears or issues that can be quite traumatic, and it is really important to break them down into specifics.
These specifics can normally be isolated and looked at, and whilst they may be daunting in their own right, they are at least focused and tangible and In some measure can be dealt with.
When fears or issues come together as one, they not only can produce a chilling effect, but can also be seen unsolvable because of the emotional fog they generate, almost as one big glob of terror.
Fear of Step Four
There can be many reasons people have a fear of doing a step four, but there are probably two or three main ones.
Firstly is the fear of specific things they have done in the past, and the possibility of having to own that reality and share it with someone else can be very daunting.
Secondly is a more general fear about the fact that doing a step four is moving in a different direction to where they have previously been travelling, and the prospect of change, or the unsettling nature of change can be fairly daunting.
The other fear can be simply what if it does not work. This is a fear that can be quite common in the context of seeing the steps as an event, rather a process, seeing them in a very black and white context.
This is normally part of a broader thought process, where everything is seen in very stark terms.
Whilst this hopefully changes in long-term recovery, part of the nature of change is going through the steps as a process, which does become a bit of a catch 24 problem.
Whilst any fear can be powerful in its own right, often in recovery it is a bigger fear that can move a person through it.
Sometimes the bigger fear around an inventory is either fear of going back drinking, or the fear of what it means to live effectively as a dry drunk.
Fear can often push people to do things that they don’t want to do.
Sometimes this is a good thing, and sometimes not a good thing. Perhaps the important thing to add in terms of recovery is that this fear should generate itself from within people, and not from other people trying to bully them.
A Moral Inventory
In the book Alcoholics Anonymous, a moral inventory initially is used to describe the process of a person looking at three areas of their life, those of resentments, fears and their sex conduct.
Other literature broadens this process to an extent, but the main focus is still on an individual looking at a number of areas of their life, and trying to gain some level of self-awareness about who they are and how they function in the world.
Other 12-step fellowships use the idea of a moral inventory in slightly different ways, each of which will have a somewhat unique take on what it means to begin the process of becoming self-aware. However the principle of self-awareness and ownership of one’s own emotional well-being is the same throughout.
An inventory is normally used in a business or commercial context. The fact that it is used in 12 step recovery should in fact be an asset not a liability.
People often get very bogged down in judgements about how they feel, and whether or not their feelings are okay, whether or not their feelings are good or bad, whether or not they should feel grateful or angry etc.
Pretty much the only way to really get a true and real assessment of yourself is to be able to look at yourself without judgement, to look at yourself in the context of unconditional love.
Whilst for many people this can take a long time to get to, it is a crucial element in any roadmap of recovery. Judgement of self kills any ability to be objective, and any ability to free yourself of judging other people as well.
The term inventory is very non-judgement of itself, whether or not that was the original intent when it was used in the forming of the 12 step program.
When any store owner or business is doing an inventory of their business, they will tend to do it in a fairly objective manner.
They simply want to know what are their assets and liabilities. They normally do not get bogged down in any type of emotional baggage around what they are doing.
This normally frees them to look at things objectively.
This should absolutely be the endgame and objective of a moral inventory in the context of 12 step recovery, the ability to analyse oneself without judgement.
The book Alcoholics Anonymous refers to an inventory as a fact-finding process. Facts are of themselves not normally that emotional, it is normally their interpretation that is.
It is really both a strength and a weakness of the approach to a personal inventory that it is meant to be a fact-finding process, not an in-depth emotional rebirth.
What this means is that the initial inventory should be fairly objective and analytical.
For a lot of people in early recovery this is all they can deal with.
It does also mean that the really powerful emotional drives behind a lot of this understanding do come later on in people’s recovery, either through other inventories, therapy or inner child work.
This process is probably what most people would mean by emotional sobriety.
Most people have heard of Alcoholics Anonymous, and know that it has something to do with people stopping drinking.
People also have very different and often conflicting views of what an alcoholic is, and also the difference between someone who is an alcoholic and a heavy or problem drinker.
Some people are also wary of Alcoholics Anonymous because they have heard that it is a religious or spiritual organisation, and do not want any involvement with something akin to this.
For anyone really wanting to understand how Alcoholics Anonymous works, there are two important things.
Firstly is to understand the context of Alcoholics Anonymous in today’s world, and do that it is really important to have some sense of the history of AA and how it has developed.
Describing Alcoholics Anonymous
Alcoholics Anonymous describes itself as a fellowship of men and women who share their experience strength and hope with each other, in order to stay sober and help other alcoholics achieve sobriety.
Whilst this is quite a broad generalisation, there is a good deal of truth in this very simple premise, that AA is about individuals sharing their experiences in the hope of helping others.
History of Alcoholics Anonymous
AA is fairly unique as such, apart from other 12-step organisations, and does not have a traditional form of structure. Understanding the history of AA is a big part of being able to see how the reality of AA functions.
There are a number of history books, some written by AA itself, others written by independent journalists and authors. All will give slightly differing viewpoints as to how AA developed, and what its strengths and weaknesses are.
The books written by AA itself are slightly sanitised, but do also carry much if not all of the historical information that is relevant and pertinent to how AA developed.
AA, both in print and in reality, can have a slight gloss to it that is part protective, and in part slightly focused on not wanting to appear divisive or confrontational.
Independent books on the history of Alcoholics Anonymous are quite often written either why people who are members of AA themselves, although not always, and people who are quite unashamedly opposed to AA and everything about it.
The fact there are differing viewpoints about AA is not surprising, and should not of itself be a problem or an issue.
It can become an issue because people tend to become either very hostile or a protective about AA, both approaches tend to blur the reality.
Reality of Alcoholics Anonymous
Anyone wanting to understand the reality of Alcoholics Anonymous should really go to one or more meetings and experience it for themselves.
Whatever meeting they go to, they are likely to experience a different reality to other meetings, and other people’s experiences of them.
This is simply because anyone’s reality is different to someone else’s.
However there is a general shape and form to AA meetings, which largely focus around the definition given at the beginning of this post.
Individuals who have had serious problems and have been able to get sober, meeting together and sharing their experience in the hope of helping others who have had similar problems.
This has always been at the heart of AA, and continues to be in most of the meetings that anyone is likely to attend.
This will vary to an extent, simply because there are literally hundreds of thousands of meetings all around the world, all of which will have a slightly different structure and format.
The other thing that is worth saying about AA is that at most meetings, if not all, there is a mix of both practical and spirit. The practical tends to be the physical reality of individuals meeting and talking and sharing with each other.
The spirit tends to be an underlying energy which pervades the nature and process of the meeting, and for many people is the most powerful element of what happens to them, both in terms of getting sober and staying sober.
This mix of practical and spirit is perhaps the unique element of AA that makes it so difficult to describe. The good news is that people do not have to understand it in order to experience it.
Pretty much anyone can attend an AA meeting, as all are open to anyone thinks they may have a drink problem, and a good number of what are known as open meetings, where anyone who is interested in AA can attend and listen to what is being said.
Potted history of AA
There are a few basic points of history that should probably be flagged up, although none are a substitute to really understanding the full time line of AA.
AA was started in America in the mid 1930s, largely as a result of a chain of individual experiences of people who had a drink problem, and who got sober using a number of spiritual principles.
The best-known of these individuals were the two co-founders of AA, who stayed anonymous during their own lifetimes, but became quite well known afterwards.
Their individual experiences formed the basis of how AA developed, both in terms of individual groups in certain cities, through to the enormous growth of meetings and groups throughout the world today.
These and other individual spiritual experiences were collated into a book, which was entitled Alcoholics Anonymous, which became the name and basis of the whole organisation itself.
Perhaps the most important thing to take from the history of AA is that it has always been a collection of experience.
It has no ideology or belief system or any agenda other than an openness to share its experience in the hope that it can help others.
This sharing of experience is done primarily through the AA literature, which is open for anyone to buy or download on-line, as well as through AA meetings and individuals sharing their experience on a one-to-one basis.
What should in fact be a relatively simple question, is often quite difficult to answer, simply because there is normally another issue underlying it.
For many people, going to an AA meeting itself is an acknowledgement or a recognition of the fact that they may have a drink problem, and this is often a huge deal for them and other people.
Most people who have a serious drink problem are in denial about it, often for a large part of their life.
It often takes something seismic for them to recognise that they have a problem, let alone become willing to do something about it.
AA has become almost synonymous with the idea of getting sober and staying sober.
Whilst people may have very differing interpretations of what alcoholism is and means, the reality is often that going to AA is the first or the most focused thing people will do.
People may go on to other types of treatment, or simply get sober and stay sober on their own, but at some point there is a strong likelihood they will go to an AA meeting.
The nature of denial is often misunderstood, especially in the context of alcoholism and Alcoholics Anonymous.
Anyone who is an active alcoholic is likely at some point to become protective about their drinking, and depending upon the extent of that alcoholism, that defensiveness will increase as the drinking progresses.
Denial in this sense is protective, and someone who is an alcoholic is likely to get to a point where they see alcohol is being only thing that matters to them.
At this point, the worse things get both internally and externally, the more the alcoholic will turn to alcohol as being the only thing that matters, the only thing it is important for them to hold onto.
This is often why it is so baffling for someone who is not an alcoholic to understand try and make sense of why an alcoholic will carry on drinking in the face of almost relentless pressures to stop, both internal and external.
There has to come a point, where the internal pressure is so great that the alternative of going to AA as opposed to carry on drinking becomes a reality.
It is at this moment that someone might attend an AA meeting. Timing is crucial, as this may be the only time the alcoholic is exposed to the reality of what can happen to help them get and stay sober.
This is really about the reality of what happens at an AA meeting. There may be many different formats, readings talks etc, but there is one central element which should run through all and any meeting.
What is at the heart of all AA meetings is a mix of people from all walks of life, some of whom will be new, some will have been sober a long time and some have been sober for differing lengths of time. there may also be some people whoa are still actively drinking, although not usually at the meeting.
All are there on an equal basis, and will share with each other what helped and did not help them get sober, and what they find helpful in their day-to-day life regarding sobriety.
It is this sharing of experience, both at a group level and on a one-to-one basis that really is the heart of Alcoholics Anonymous, and should be at the heart of most meetings.
There is also often continual sharing between people before and after meetings, and often on the telephone during the day or at night when there are no meetings taking place.
The Spirit of AA
The practicality of describing an AA meeting can give it a sense of normality that in fact it does not have.
In addition to individuals sharing with each other about their alcoholism and recovery, there is an energy to the meeting that transcends the actual event itself.
This energy is hard to define, but most people seem to experience it, albeit in different ways.
This energy goes a long way to explaining the reality of Alcoholics Anonymous, but is also as one of the undefinable elements that makes it so hard to give a concrete picture of what Alcoholics Anonymous is, and how AA meetings work.
Anyone familiar with this phrase will recognise it from the early part of chapter five of the book Alcoholics Anonymous, which sets out the 12 step program which is at the cornerstone of AA’s recovery process.
As with many things in life, context is crucial.
This phrase is used in a very specific context in the book, which really needs to be looked at and read to be properly understood.
The intent behind this phrase, and the whole tone of the book Alcoholics Anonymous is really one of urgency, rather than fundamentalism.
The book was written by the early members of Alcoholics Anonymous.
Many of them were what would be referred to today as street drunks, even though some owned their own homes or had somewhere to live.
It is certainly true that most of them had reached a stage of their lives where they were completely desperate about drinking, and knew they had something that worked.
Chapter five of the book Alcoholics Anonymous is often referred to by its title, How it Works.
This is because this specific chapter begins to spell out in great detail the experience of these early AA members as to what they collectively did in order to get sober and stay sober.
The principles of the 12 step program can seem fairly daunting to many people, and certainly were to the early members of AA.
Most of them found however that they came to apply them to their lives when they had little or no option in terms of doing anything else.
They felt they were completely beaten in many ways, often referred to in AA as reaching a rock bottom.
The phrase ‘willing to go to any lengths’ should always really be understood not only in the context of how it was written, but in the fact that it applies to the principles of the 12 step program.
The reason this matters and is important, is because the phrase is often used in the reality of daily AA, and AA meetings, almost as a litmus test for peoples approach or commitment to their own recovery.
This type of fundamentalism is actually about forcing people into a position that they may not yet be ready to be in, and distorts the very freedom that AA actually offers.
Process and Experience
The nature of AA is really about experience. The real DNA of Alcoholics Anonymous lies in the value of its experience, collectively written in the book Alcoholics Anonymous and other literature.
This literature gives people the opportunity to access and utilise the whole experience of AA as it is understood today, from when it first started.
The other aspect to this is that people have the individual freedom to use that experience in any way that they feel appropriate or not.
This is an absolute freedom that sadly it’s not always recognised or acknowledged within the reality of daily AA.
Fundamentalism may seem a slightly strong way of describing the pressure that is often put on people who are new to AA, as well as some have been sober for a while, to embrace the AA program in a particular way or manner.
However, the pressure can be very real and is often exerted on people who are in many ways quite vulnerable, by people who have been sober for a while and should know what they are doing.
The nature of fundamentalism is closely linked that of sponsorship within AA.
Sponsorship should be a type of buddy system to help people who are new, or are generally in need of help. Unfortunately, a lot of the time, it is much more hierarchical in nature than a one-on-one buddy system should be, and develops a level of status that distorts the relationship.
This issue of status can often lead to a degree of fundamentalism, sometimes based on good motives, other times motives more to do with power and control than anyone else’s well-being.
It is often in the context of sponsorship that this phrase, willing to go to any lengths is used. A potential sponsor will sometimes ask an individual who has asked them to sponsor them, if they are willing to go to any lengths.
Invariably the individual will say yes, not knowing really what it means. This is then used as a general big stick approach to how the sponsor controls the individual they are sponsoring.
The issue of sponsorship and control is a huge one, and one that needs much thought and correction within AA generally.
It is important however, to make a distinction between the urgency of the message carried in the book Alcoholics Anonymous, and an individual’s use of that message to try and control someone else.
There is a paradox about meditation, in that most types of meditation of themselves are fairly simple to do, but many people find meditation as a practice, or a process, incredibly difficult.
Sometimes people put this down to a lack of discipline, or more commonly people simply say that they find meditation so difficult that they cannot do it.
Meditation as a practice has become hugely popular in the west in the last few years.
People used to think of meditation as a slightly mysterious ” eastern” process, akin to the spiritual world, but which you had to travel to India to learn how to do.
People in 12 step recovery are invited to look at the practice of both prayer and meditation as a way of deepening their sense or understanding of God, or their spiritual world.
In many ways this is a unique opportunity for people to really explore what both these words really mean to them, and experience a level of freedom that very few other practices can really give.
Dogma and Discipline
One of the reasons people are attracted to meditation is because it is an experiential process. It is something you do, and receive the benefits or insights of as a result of doing.
Whilst this is actually true of most types of prayer as well, most people see prayer in a much more disjointed form.
Disjointed in the sense that they see prayer as somehow trying to connect to a being that is outside of them, that in some way they have to ask help from, or pay homage to.
Whilst this presents a very stereotypical type of God, it is nevertheless the basis upon which many people in society pray, and many people in AA and 12 step recovery use as the basis for their prayer as well.
Meditation on the other hand, has always been seen as a much freer process, with no belief system attached to it, as something you can simply do or not and receive the experience of it as a result.
Prayer and Meditation
The reality is that both of these terms are really interchangeable, and can to an extent mean what you want them to mean.
What is important, is the sense of where the individual is coming from, in terms of their understanding of their sense of God, and their sense of self, and their sense of the connection between the two.
This is not to advocate any one type of belief system or other.
The real freedom of Alcoholics Anonymous and other 12 step organisations is the freedom to discover for yourself what these ideas mean to you.
Often the difficulty around meditation is this freedom itself. Often in AA there is a sense that prayer should be carried out in a particular manner, often on your knees asking for a sober day etc.
Whilst this is of course something anyone can do or not, there is often a real pressure that this is the right and only way to pray.
What of course this does is to block off people’s freedom to experience the reality of prayer, which is asking themselves what prayer means to them, what God means to them and what meditation means to them.
The Discipline of Meditation
Many people believe they have difficulty with meditation because of the issue of discipline. They see discipline as some sort of mysterious internal force which allows them to do things or not.
Many people in AA see discipline is something they lack, and as such associate it with a lack of power or lack of willpower.
Whilst people can debate the issue of discipline, in reality it probably has little to do with why people find it difficult to meditate or not.
The reason is much more likely to be associated with people’s own sense of freedom to own their own recovery, or not, and to discover for themselves what these words really mean.
There is a real danger of generalising a lot about these things. In fairness though, there is probably quite a lot of truth in saying people like to be told what certain things mean and certain things don’t mean.
People often like a degree of certainty about these matters.
The Illusion of Certainty
Most people in life prefer certainty to uncertainty.
People in AA and 12-step recovery often crave certainty more than others, and this is most likely an effect of growing up in an alcoholic home, which anecdotally, most people in AA do.
The uncertainty and chaos of an alcoholic home not only leads to an overbearing sense of responsibility at an inappropriate age, but also a craving for the certainty that a stable home should bring.
This craving for certainty is normally at an inner child level, and is often at odds with wanting the freedom that uncertainty normally brings with it.
This conflict of wanting to explore and experience life itself, with a craving for certainty, is in effect a conflict of differing energies within an individual.
Normally the individual will be unaware of these differing sources of energy, but nevertheless they often generate a sense of conflict or in many cases a sense off being frozen internally.
Why Meditation can be Difficult
It is important to understand that meditation can take many forms. For some it is about following patterns of breathing, for others using a mantra.
For others it can be more akin to to contemplation, others seek meditation by way of visualisation and affirmations.
Whatever type of meditation one chooses to follow, the sense of it being difficult can crop up at any time. Some of it is undoubtedly going to issues around commitment and so called discipline.
It is important to realise that, when meditating, it is a process that you come back to when you need to and when you can do it. Much talk of meditation is about developing a regular pattern, and a regular practice.
Whilst there is no doubt this can be beneficial, it can also have the drawback of making people believe that if they do not do it on a regular basis, as part of a daily ritual, there is no point in doing it at all.
People who find meditation difficult for whatever reason should simply see it as something that can be hugely beneficial in the life, and simply come to it when they are able to and not worry too much and they are not able to for any reason.
Most people have normally been asked at some point in their life if they believe in God or not.
In AA and in 12 step recovery generally, people are likely to be asked this question more than once, sometimes directly, sometimes indirectly and quite often in fairly intense and overbearing circumstances.
Whilst people in life can often walk away from those who they feel put pressure on them as to what they should or should not believe in, this is much harder in AA.
People come to AA effectively to get sober, whether they realise it or not at the time ! Once in AA, they enter a different world that can seem very intense and quite surreal in many ways.
People are invariably quite vulnerable, and are susceptible to being given lots of advice about all things to do with being and getting sober.
The God Question
AA in many ways reflects normal society, but often in more intense and intrusive ways. One of these is about the overbearing question of what other people do or do not believe in.
The nature of AA, and of the 12 step program itself, is rooted in the world of God and of the spirit, as any cursory look at the literature, or attendance at any AA meeting will quickly verify.
This by its very self often presents real problems for a lot of people, which are often compounded by the attitude of some sober members, who can appear very evangelical about the need to believe in God.
This attitude that some AA members have is often reinforced by their own experience of sobriety, and their own experience of using the 12 step program in their life.
These act as a sort of rationalisation for their actions and behaviours, whatever their motives, in trying to force people to have their sense of what they should or should not believe in.
The sense of trying to convince people about a belief in God is not necessarily about specific belief systems.
It is normally much more about a general sense that they need to have God in their lives, and if they don’t they won’t get or stay sober.
Sobriety and Beyond
There are so many potential dangers around this forcing of belief systems that it is difficult to pick any one in particular out.
Whilst there is obviously an issue about the motives of the people being quite evangelical, the reality is that it can exploit the vulnerability of people who are new.
Someone getting sober is faced with a whole range of issues, both internal and external, that at some point they will begin to own and realise that they need dealing with.
Some of these problems are likely to be fairly major, others less so. However, the pressure that someone getting sober feels is normally fairly intense, whatever the source.
The last thing they need, quite literally, is the pressure of someone in AA else telling them what they should or should not believe in ‘as a matter of saving their life’.
A Life Saver
It is quite common in AA for people to talk in quite melodramatic ways about life and death.
What is often forgotten or not fully realised, is the enormity of someone coming to their first AA meeting, and the potential implications for them if they do not come back.
This is not meant as a do or die fear, simply an acknowledgement that if someone is exposed to AA, they are exposed to a potential way of reconciling and healing their alcoholism.
If that same person feels overly pressured by anyone, about anything, there is a fair chance they will either leave or certainly not return in the near future.
This does potentially deprive them of the opportunity of using the experience of AA as a way of getting and staying sober, and potentially saving their life.
It is worth making the point, over and over again, that AA does not have any belief systems about anything.
Individual members have the freedom to believe anything they want, and unfortunately often cross that line of representing their own belief systems as being those of AA.
AA is a body of experience that is primarily expressed through its literature at a global level. The literature of AA represents its experience from the time it started through to present day.
This is of paramount importance to how AA functions, and people’s freedom to use that experience in any way that they find helpful or not.
This sense of balancing a body of experience, and an individual’s freedom to use that experience in anyway they find helpful is the linchpin of Alcoholics Anonymous, and all 12 step fellowships.
It has what has held AA together for most of its existence, and allowed it to grow on a worldwide scale.
Unfortunately, the reality of many AA meetings do not live up to this ideal.
Many meetings will contain individuals who, for whatever reason, feel the need to try and impress on other people how they should or should not think.
Whilst this often focuses on the God question, it shows up a deeper symbolic problem in AA around the whole issue of boundaries, and of giving people the freedom to be themselves
The freedom to discover for themselves what the world of the spirit really means, or not, to them
When people talk about an inner voice in the context of spirituality, they are normally referring to an inner intuitive sense of direction in their life.
This sense of there being an inner world, and it somehow helping to direct our life is for most people a hugely attractive idea, and for a great number of people a hugely attractive reality.
In the same way that the idea of an external control freakery God puts numerous people off the whole idea of God and/or any religion, the idea of an inner sense of the spirit can attract people in large numbers.
In many ways, people in 12 step recovery often mirror people not in recovery, but in a much more intense and often urgent sense.
This is probably true in the whole area of spirituality, and the idea of listening to an intuitive sense of self.
Healing the Pain
When someone gets sober, it is probably fair to say that most of their life, both internally and externally, is somewhat of a blur. This is true whether or not they get sober in a rehab, or on their own through AA meetings.
Once sober, it will become apparent at some point that the real issue they have to deal with is what is going on inside their head.
The emotional turmoil that underlies most alcoholics drinking does not go away when someone gets sober, on the contrary for most people it begins to get more intense.
The search or journey to reconcile this emotional turmoil is in reality the purpose of going through the 12 step program, as a way of trying to bring some sort of internal stability to their life.
This necessity to reconcile their emotional life at some point leads to a degree of stability and internal peace that is normally the first time an alcoholic is likely to have experienced it.
This sense of peace and stability is in some ways both a precursor and an experience of listening to the inner voice, even if the person is not at all aware of it.
It is really the expression of turning inwards, in a healthy sense, and letting the world of the spirit work in its own unique fashion.
Looking for Meaning
Once there is a degree of emotional stability internally, people’s lives can take very different directions. There are likely to be a significant number whose lives will have been touched by the reality of this sense of the spirit.
This can of course mean different things to different people, but in general people will have some sort of sense of their inner world moving them in a different direction to where they were going before.
This sense of there being an inner world, and a felt sense of it guiding them comes to feel a very natural and healthy place to want to be.
It is rather like a sense of feeling truly connected to their life, in the context of its real meaning. It is not necessarily about understanding or even becoming aware of the nature of God.
It is really about feeling connected to the inner reality of one’s life, which in a more traditional sense used to be referred to as balancing the light and dark of the soul, of the spirit.
The inner world is not necessarily a land of milk and honey. It is more of a journey, a process, a sense of connecting to our real sense of authenticity, and a sense of where the spirit works with us.
Authenticity not Sainthood
Whilst there is nothing wrong at all with sainthood, there is sometimes a belief that people who really connect to their inner world, who really do get a sense of God in their life, necessarily become better people, become good people, and do good works.
There is obviously some truth in this, but there is something more important, the value of connecting to ones inner life, the value of authenticity.
The phrase to thine own self be true has always resonated with people, even if it has become a bit of a cliche. It’s truth however remains a constant.
The importance and value of having the freedom to be authentic cannot be overstated.
This is true in life generally, and especially true in 12 step recovery. The value of authenticity more than anything else is an inner freedom, and a real awareness of one’s own truth.
The idea of an inner voice is really an expression of a calling for people to turn inwards rather than outwards in their search for meaning.
The search for meaning is really about an inner journey, and importantly a freedom to pursue the journey however the individual feels the need to process it.
Looking outside of yourself invariably takes you away from the real you, and will take you in the wrong direction.
An inner voice is for most people a really comforting notion. It is an invitation for most to really begin the process of coming home to their true world, the world of the spirit.
The phrase ‘pray as you can not as you can’t’ isn’t terribly well known to a lot of people, but to those who do know it and use it as a literal guide to prayer, it can be an absolute lifesaver.
The phrase originated from a monk at Downside, John Chapman, Abbott in the 1930s, and is as relevant and pertinent today as it was then.
As with many words and phrases that seem almost overly simplistic, the real strength in many ways lies behind the words, both in terms of intent and freedom.
The Need for Prayer
For many people, understanding that the need to pray, let alone having the freedom to really explore what prayer means to them, can be a lifelong process in its own right.
For people in 12 step recovery, this process or journey can be complicated further by a degree of pressure to pray in particular ways, not always overtly religious, but nevertheless carrying quite fundamentalist overtones.
These overtones are not always only about prayer, but also about God or the nature of God as well. This pressure can come from other people in AA, from sponsors, from groups or society at large.
However, the flip side of this, is that people in recovery normally reach a point when they start to really search for something.
This searching may not always be obvious or conscious, but does at some stage become apparent as a real quest.
Hopefully, this searching is eventually recognised not so much in terms of what someone is looking for, but as a real need to connect to ones inner world in some sense.
Like all needs, the recognition that it comes from within is of paramount value, and often needs to be fostered and nurtured in different ways.
Quite often the biggest threat to this need is other people’s insistence on how an individual should pray, or what they should or should not believe in.
This problem is of course not unique to AA or 12 step recovery, but does carry an extra dimension.
People in AA are conscious about their need to get sober and stay sober, and their awareness of the nature of their own spirit or soul will grow stronger in time, as part of their need to stay sober.
The World of the Spirit
Giving people the freedom to be themselves, and to discover for themselves the reality of their own life is perhaps the ultimate freedom that is.
It is also a freedom that needs to be fought and won for in many areas of life, especially in AA and 12 step recovery.
People in AA get very excited about how other people should live their lives, and are often very quick to give advice both asked for and un-asked for.
Sometimes this advice is good, sometimes not so good and sometimes disastrous.
When it comes to prayer and the nature of God, giving advice or trying to direct another person carries much more dangerous long-term consequences.
The main consequence is that it erodes the freedom people need to be able to explore for themselves what their inner world means, and more importantly what it does not mean to them.
Whilst the world of the spirit may seem a bit of a vague term, it really applies to that inner world or inner voice that people have inside them, that transcends their emotional, mental, sexual, physical realms that make up a human being’s life.
Many people try and define the nature of such a spirit or inner world. Sadly, most people who need to try and define it have little or no real experience of it in their own lives.
These people who have experienced a connection to that inner world in a real and meaningful way do understand the need to give other people that same freedom.
Why Prayer Matters
If anyone is to have the freedom to explore what their inner world, or the world of the spirit really means to them, then they have to have the freedom to explore what the term prayer means to them as well.
Without wanting to get into definitions of what prayer and meditation mean, the important point is that they are both means of communicating with ones inner world.
It is this freedom to explore how to communicate that is at the heart of this phrase, and of the necessity to have the freedom to explore it.
The nature of prayer is of course an immense and in many ways complex subject.
Complex because so much of it is either ritualised, comes from other people or comes from books etc.
It is also complicated by a belief system in many people and religions that there is somehow a right way to pray and somehow a wrong way to pray.
This idea of a right or wrong way to pray or meditate, of course pretty much sets up everyone who tries it to fail, not least of all because it simply is not true.
What it does do is set up an external validator of what is going on internally within someone, which inevitably leads to a breakdown of the truth, the whole process.
Learning to Trust Yourself
The reality of having the freedom to discover what prayer means to oneself is both a practical and a spiritual necessity.
Practical in the sense that there are literally hundreds of different ways to pray and meditate, and any individual is going to feel more comfortable with some with others.
Comfortability with a process is more likely to lead someone to trust the process.
A lot of the truth about having the freedom to discover how to pray and meditate for oneself is really about having the freedom to be oneself.
Many people who have really developed some type of real connection with their inner world, realise that this spiritual direction of themselves is in fact their true self, a true nature.
It is not at odds with any other part of their identity or self, in fact it unifies their entire being.
This sense of internal unity can only really come to having the freedom to be open to this reality, where ever it comes from and whatever it may mean.
Whilst this is a different journey for everyone, what can unite people, especially in 12 step recovery, is the recognition that this is perhaps a core need for people, and that it is about freedom.
Perhaps today’s world teaches us that the need to preserve freedom, both internally and externally, is as acute as it has ever been.
When it pertains to one’s inner world, one’s spirit or soul, then the freedom to pray as you can, not as you can’t is perhaps one of the few absolutes that should be really etched into people’s consciousness.
The term rigorous honesty is used a lot in Alcoholics Anonymous, and in the 12 step recovery world generally.
Its original intent was to make clear the need for people to really own and take responsibility for the reality of their lives, both internally and externally.
Like a lot of phrases and concepts in recovery, its usage tends to depend largely on the motives of the person saying it.
That is why it can often be used in a slightly overbearing way, making people feel they are either being bullied, or pressured into a degree of accountability that they are not yet ready for.
The 12 step world generally has a number of degrees of vulnerability, and a number of people who seek vulnerability in different ways.
Some can seem quite harsh, others quite gentle and a fair number somewhere in between the two.
Why this phrase rigorous honesty matters so much is really because of what lies behind it in terms of its original intent.
This raises the issue of the reality of an active alcoholics life, and their denial of the fact that alcohol is causing a problem in it.
This covers both the inner and outer world of the alcoholic, as well as their potentially more deep seated emotional and mental issues.
AA uses the phrase moral inventory when effectively referring to the need for self-analysis.
There is often a strong sense of urgency about the need for people who are recovering alcoholics to begin the process of becoming self-aware, and it is in this context that the term rigorous honesty is meant to apply.
Implying that an individual has to be honest with themselves can also imply that they had been lying to themselves beforehand. Not always the case, but in recovery is often taken as the norm rather than the exception.
This raises all sorts of questions about motives and denial, and why an alcoholic is so reluctant or unable to accept the reality of their own life.
These questions are quite complex, and will be different as are the answers for a wide variety of different people. There are however a number of important factors which do sit with these questions.
Whatever the form denial takes, it is worth remembering that denial is a form of protection.
It can sometimes be quite delusional, but for a significant number of alcoholics denial is about protecting their need to drink. This may seem ludicrous in the light of the havoc that alcohol is causing them, but is normally part of the alcoholic mindset.
It is probably fair to say that most alcoholics believe that alcohol is the solution to the problems rather than the problem itself, even if they are not consciously aware of this belief.
As such, the worse their life gets, both internally and externally, the more they turn to alcohol as being the thing that is holding them together.
Denial of the reality of the life is often their way of protecting alcohol, which they believe they need to do at any cost.
It is important to realise that denial is usually a defence mechanism, trying to protect something the person believes is of utmost importance to them.
The depth of the denial can often make this difficult for someone who is not an alcoholic or addict to understand.
The need to feel safe or secure is a core element of most human beings identity, and for an alcoholic it can achieve enormous proportions.
Their sense of safety is often disfigured by growing up in an alcoholic home, or other childhood dysfunction.
Many people in recovery link a lot of their emotional dysfunction, both whilst drinking and recovery, to the issue of safety and security.
The denial mentioned above is a core part of helping someone feel safe, however irrational it may seem to anyone else.
Safety is primarily an emotional issue, and is also the key element in allowing people to change their inner world. A real sense of safety allows people the freedom to change – threatening them and making them feel cornered does the exact opposite.
This is why the issue of how people approach their moral inventory, and the whole process of developing a level of self-awareness in recovery is so important.
Self-awareness, without judgement, is the cornerstone of real freedom in recovery.
Although it has become a bit of a cliche, the phrase”know the truth and the truth will set you free” is perhaps the most important element of a person’s recovery.
Developing a degree of self-awareness allows an individual to question themselves without judgement, allows them to question their motives and allows them to develop a real relationship with themselves, with others and with God.
This self-awareness, which is often associated with the phrase rigorous honesty, is about feeling safe enough to begin and continue the process of self searching. Of understanding the nature of one’s own alcoholism, as far as possible, and of putting the nature of denial into its proper context.
Whilst it may take a while to really develop, the willingness to really look at oneself and genuinely reflect on behaviours and motives is not something that people normally want to do. For alcoholics in recovery there is often a sense of urgency, as this need to self-awareness is usually a key element in staying sober.
It is in this context that the phrase rigorous honesty should really be understood, almost as a plea for urgency rather than a call to fundamentalism.
With quite literally thousands of rehabs to choose from, deciding which one to choose can be quite a daunting process.
The majority of rehabs in the US will offer quite similar addiction treatment programs, the majority of which will be rooted in the 12 Step program of Alcoholics Anonymous.
Some people will want to go into a rehab close to where they live, others will want to go to a rehab as far away as possible, either in another state or in another country completely.
Some people believe that a complete change of scenery and location can help someone in their early days of recovery, others believe they should confront their issues in a more known and local environment.
This means that the choice of rehab can literally be a worldwide one for everyone.
Very few rehabs will advertise any type of success rate, although some will talk of a percentage rate of completion. These are two very different things.
A rate of completion is simply the number of people who complete their course of treatment, which is normally 28/30 days, although in some cases this can be longer.
The reality of recovery from alcoholism and addiction is that it is a tricky road for most people, and no one really knows how many people make it in the long run.
Some rehabs will keep in touch with as many of their ‘alumni’ as possible, but very few if any will talk of a success rate. Recovery is a long-term process, often taking many years to embed in the individual.
A stay in rehab is relatively short, and is seen by most people as initially breaking the cycle of alcoholism and addiction, and laying the foundations for long-term recovery.
There are however a number of factors can that be used to determine how effective a rehab treatment center is likely to be, and all the information required should be available via the rehab’s website.
Wherever you are looking in terms of location, there are likely to be a number of legal requirements for any type of clinical facility that is offering addiction treatment programs.
It is well worth checking what these are, and making sure that the rehab adheres to them. If in doubt ask the rehab itself.
If they are at all reluctant to help, it may be an indication to move on and find somewhere else.
As already stated, for many people location is an important issue. Within the geographical area make sure that the facility itself is an attractive and comfortable place for a short-term stay.
Some rehabs will offer single accommodation, others will insist on sharing a room and facilities as part of the recovery process.
Also make sure there is plenty of outdoor space, ideally near water, as this can be very therapeutic for a number of people who need time to have a break from the intensity of the rehab itself.
All rehabs will employ a wide variety of staff, both clinical and administrative.
Clinical/ therapeutic staff can/should include a medical doctor, nurses, psychiatrists / psychologists, therapists, yoga teachers, tai chi teachers, reflexology practitioners, acupuncture practitioners, art therapy practitioners, meditation practitioners, politicians, nutritionists, social workers, transitional living workers, and priests/rabbis.
Obviously this is a wide range of differing staff, but should give a fairly good indication of the facilities that the rehab offers as well. In addition to the numbers and types of staff, it is worth checking the qualifications and experience of the most senior staff available and their experience of addiction and alcoholism.
All rehabs should have their own clinical facilities and staff that allow them to assess at the outset of treatment whether a medical detox is needed or not for any individual entering the treatment center.
If they do not have such facilities, then they should have access to a local clinical facility such as a hospital, who can make this assessment for them.
This is a crucial element of any rehab or treatment center, because of the necessity to assess the need for a detox for anyone coming off alcoholism/drug addiction.
Most rehabs do not advertise how much they charge, but it is probably fair to estimate a charge of between US$ 28,000 / $35000 for a 28 day stay in most treatment centres in the USA.
It should be noted that there are a number that describe themselves as luxury rehabs that can easily charge three or four times this amount.
Most of this cost is normally covered by insurance, but there are one or two things to be aware of.
Many insurance companies will agree to cover the cost of rehab, but will sometimes review this on a weekly basis while the individual is in treatment.
This means that they could withdraw cover at any point during the individuals stay in rehab if they deem it not necessary any longer.
Also be aware that some rehabs offer loans to help pay for the cost of their treatment, especially if the individual does not have insurance, or their insurance plan does not cover rehab treatment.
This can end up being very expensive indeed, and is an option that should probably be avoided if at all possible.
Addiction Treatment Programs
Most treatment programs should begin with an assessment of need for a medical detox as referred to above.
Most rehabs will base their addiction treatment programs around the first five steps of the Alcoholics Anonymous program.
Some will be slightly more specialised, and based around certain steps such as step one, or steps three and 11.
There is also likely to be a significant amount of personal therapy/counselling done, either on a one-to-one basis or in group. Some rehabs also offer specialised therapy such as CBT/EMDRA
Most treatment centers will also encourage, sometimes insist, that individuals attend meetings of Alcoholics Anonymous or Narcotics Anonymous whilst in treatment.
These may sometimes be held on site, by local groups or in the locality where the treatment center is based.
A number of rehabs will also offer so-called alternative therapies, which are recognised by the therapists listed above.
They may also include things such as adventure programs which can be things such as white water rafting, hill or rock climbing or equine therapy.
A rehab’s approach to what happens when someone leaves rehab is almost as important as what happens to them when they are in treatment.
It is generally recognised that a rehab is something of a bubble, almost intentionally, that takes the individual out of their normal environment to provide a safe place allowing them to lay the foundations for their recovery.
Like all bubbles, a return to normality has to be thought through and carefully planned.
Thus a rehab should from day one lay the foundations for being able to integrate what happens in rehab back into the individuals normal life once they have returned to their home and family.
Most rehabs will encourage continued attendance at meetings of Alcoholics Anonymous, and in addition could have their own regular meetings, normally monthly, that are open to any residents or former residents to attend if they so wish.
Former residents are normally referred to as alumni and are encouraged to return to the treatment center, both for their own good and as examples to current residents.
Sober Living / Transitional Living
Some rehabs will have links to what are referred to as sober living or transitional living houses.
These are normally long-term shared houses, normally under some type of supervision, where people in early recovery can live together, and stabilise their own lives once sober.
This is an option foro some people who need an additional degree of stability around where to live and what do for work once they have finished treatment.
Many people have heard the phrase ” going into rehab” or simply the phrase ‘rehab’ itself, but are unclear about what it means or what is really involved with it.
A rehab is essentially a clinical institution, in the same way that a hospital is a clinical institution, but one that deals purely with different types of addiction.
There are other significant differences between hospitals and rehabs which are explained further on.
Traditionally, a rehab would deal with people who were alcoholics, or who had a serious drink problem, even if they were unaware of what alcoholism was or whether or not they were alcoholics.
As time went on, rehabs realised that they could treat people who had other addictions as well, namely addictions relation to drug abuse, gambling, food, sex etc.
Rehabs and treatment centers realised that their approach to recovery meant they focused mainly on the individual and their internal triggers, and as such could apply the process to anyone who had any type of addiction at all.
With this overall approach to addiction, some people and some rehabs felt their message was a bit blurred, and started describing themselves as alcohol rehabs or drug rehabs or alcohol and drug rehabs.
Other treatment centers found this approach unnecessary, but it has meant that sometimes there has to be a distinction as to what an alcohol and drug rehab is.
The reality is that the majority of rehabs will focus on alcohol and drug addiction, and the majority of people entering a rehab will be doing so for the same reasons.
There is one proviso relating to rehabs offer treatment programs for drug addiction specifically. They will often enlist the specific types of drug addiction they have expertise in, and this may be of some value to people.
Not necessarily in terms of the addiction treatment programs that they offer, but much more in that knowledge of and treatment facilities they have for any detox or withdrawal program that may be necessary at the start of their recovery.
Rehabs and Hospitals
Describing a rehab as a clinical environment is an important element of its institutional nature, but it is also important to clarify what that means.
It simply means that the rehab will have clinical staff as part of its overall recovery team.
They will have specific clinical functions within the team. It normally applies to doctors, nurses, psychologists, therapists etc.
These clinical staff will have very specific roles in a professional capacity, relating either to any detox program in place at the beginning of the treatment program, or a role in the addiction treatment program itself.
In most other respects, a rehab is very unlike a hospital. Most rehabs are more like country clubs, and make a serious effort to provide a gentle and soothing environment within which an individual can begin the process of recovery.
Depending upon the rehab, the country club type approach will vary considerably in terms of its rules and regulations.
Some rehabs make a big point of incredibly rigid regulations about every aspect of the individual’s life whilst there, largely as a way of providing structure, which they believe helps aid recovery.
Other rehabs take a very different approach, believing that giving an individual freedom to be themselves as part of their recovery process is an integral part of them being able to find recovery in the first place.
Most rehabs will offer some part of their treatment program or focus on the spiritual aspects of recovery.
Some will be more forthcoming than others, emphasising that the spiritual element of a 12 step program is an important one in any recovery.
Others will play the spiritual element down a bit, realising that the overall God question is perhaps the biggest bloc for many people in the recovery.
The above descriptions applies to what could be referred to as mainstream rehabs.
These are very different to what is commonly referred to as a Christian rehab, although there are some who would dispute this term.
One has to be very careful when using the term Christian, as there are many people who will use the term very differently, and have very different meanings for it.
With relation to a Christian rehab, there are many of these treatment centers who advertise themselves as Christian rehabs with a particular emphasis on certain areas of recovery.
Generally speaking they promote themselves as being long-term recovery projects, where the emphasis is mainly on a purely religious understanding of alcoholism and subsequent recovery.
Most of these rehabs will avoid totally the 12 step process, and focus instead on an extensive program of prayer sessions, Bible readings, so-called faith initiations etc.
A lot of these rehabs will offer long-term programs, sometimes in the region of 6 to 9 months.
They will also offer low-cost accommodation, and promote the so-called Christian activities as free, meaning that someone can enter this program with relatively little money for a long period of time.
Needless to say these so-called Christian rehabs attract a lot of criticism, in two distinct areas.
Mainstream Christianity often takes the view that this type of religious activity is an extreme form of religious doctrine and indoctrination.
It takes people who are extremely vulnerable and in need of help, and uses that vulnerability as a way of recruiting them into a much more fringe view of religious activity.
The other criticism that these rehabs attract is not quite so generous in terms of its interpretation of religion.
These rehabs are seen as recruiting grounds for a number of the major churches in America, a number of which are regarded as very cult like or having a very cultic dynamic.
It is certainly true that a number of these so-called Christian rehabs are attached to or part of much larger Congregational churches, many of which are regarded as evangelical, but also regarded as quite cult-ish.
Given the nature of these types of churches, who unashamedly believe in recruiting members as part of their evangelical approach to ministry, it is quite natural that most people who understand the nature of alcoholism and recovery are fairly wary of that approach.
This is a quite different issue to the perfectly valid one of whether this type of religious indoctrination is essentially abusive, but raises an equally valid issue of abuse in its own right.
Whilst much of the work itself, or the motives of people who work there may have some genuine love and compassion in it, the reality is that these types of rehab do offer the potential for a significant amount of abuse.
This is because the people they are offering help to are extremely vulnerable and in need of low cost effective treatment.
A regimen is offered that not only has no clinical basis for its program, but also potentially acts as a recruiting ground for many much larger organisations.
People who work in the mental health field have serious reservations and concerns about this tupe of rehab and its treatment programs.
Anyone who would describe themselves as a Christian, or is looking for some element of religious or spiritual input into their recovery, and is looking to enter a rehab, would do well to firstly avoid these so-called Christian rehabs.
It is a perfectly valid question to ask more normal mainstream rehabs, as to what their approach to religious and spiritual activities is, and what extent these are built into their addiction treatment programs.
Rehabs will vary widely, and it should become fairly apparent which ones are more suited to the needs of someone with a particular religious inclination than others.
Very few treatment centers will actually declare themselves as non-12-step based, but many will offer alternative programs that are designed to help people deal with alcoholism and addiction, but which use no part of a 12 step program in their recovery.
Sometimes this is because these rehabs believe the 12 step model is in some way flawed, and other times because they know there is a market for people who are apprehensive about what is perceived as a religious/spiritual approach to recovery.
The majority of treatment centers and rehabs base their addiction treatment programs around some elements of the AA 12 step model of recovery.
Historically, what most of them have done is to take the principles of the first five steps, and modify or change them to their own requirements, yet still present them as being part of the AA recovery approach.
This approach does inevitably lead to some confusion, especially for the individuals undergoing treatment, who believe they have gone through the AA approach to recovery, when in fact they have gone through a different version of it.
Traditional 12 Step Rehabs
A number of people believe that the real value of most treatment centers and rehabs is twofold.
Firstly they provide a physically safe environment for people to begin to deal with their alcoholism and addiction, that is out of their normal life, and as such away from pressures that they associate with their drinking.
In this environment, it is believed that it is easier for people to begin to comprehend the enormity of what they are dealing with, and lay the foundations for their recovery.
The second value that people associate with treatment centers is that most of them will introduce people to the actual reality of Alcoholics Anonymous, both in terms of the treatment centers approach to 12 step recovery, and an introduction to actual meetings of AA, either on site or in the local community.
It is believed that if individuals in recovery are exposed to AA early on, then it is more likely they will make AA a part of their recovery process, both whilst in treatment and once they have left.
The above is a slightly simplistic approach to the effect that rehabs and treatment centers can have on people, but is probably a fairly good basic guide to the 12 step model that is often used in this type of recovery.
12 Step Programs
12 step programs inevitably apply to the principles used in Alcoholics Anonymous, and a wide range of other fellowships/organisations that have borrowed this approach, and applied it to their own recovery needs around different addictions.
Whilst there is a significant amount of experience, both current and historical, that this 12 step approach can be hugely beneficial for a lot of people, there are also a significant number of critics of this approach, for different reasons.
Without going into the debate itself, it is fair to say that a number of people on both sides tend to get quite fundamentalist about it, and inevitably distort many of the actual issues themselves.
When someone is looking for help to deal with an alcohol or drug problem, it is probably not that helpful to get involved in this debate itself.
There are however a significant number of people who have already decided that they don’t want anything to do with a 12 step program, and such seek some type of recovery that does not include it.
Non 12 Step Recovery
Any type of recovery that begins with the premise that it is not something else is perhaps slightly suspect, but is perfectly valid in the sense of trying to help people who are heading in a particular direction.
There are a number of treatment centers whose programs tend to be focused around a more holistic approach, the word holistic implying a rounded approach to recovery.
This approach will often include a number of different areas of help, including diet, yoga, meditation, therapy, exercise etc.
All these areas of recovery can be extremely helpful, if practiced professionally and correctly, and which in theory can benefit anyone, whether they are in recovery or not.
Whilst this type of recovery can be beneficial to anyone, it is more debatable whether it can genuinely help shift the nature of someone’s alcoholism and addiction.
Often in all types of medicine and approaches to illness and recovery, the phrase clinical evidence or evidence-based research is used to verify a particular type of treatment or not.
The intent is to make sure that any treatment for any illness is based on actual evidence and proof that the treatment works, and that such proof can be validated in clinical terms.
With regard to alcoholism and addiction this is very difficult, if not impossible to do.
AA itself keeps no records of membership, or any type of records about so-called success rate in terms of sobriety.
As such we can simply do not know how effective it is, in terms of short-term and long-term success rates
The same applies to virtually all treatment centres and non-step approaches to recovery.
Some rehabs will talk about a success rate in terms of percentages, but they are normally meaning how many people have actually physically stayed and completed their recovery program.
As such, assessing the most suitable approach to treatment can be quite a difficult thing.
Many people will simply go with the accepted wisdom of our age that Alcoholics Anonymous, and rehabs and treatment centers based program around it, offer the best hope of recovery.
There are others who are for whatever reason are ideologically opposed to the whole idea of 12-step recovery, and will look for any type of alternative recovery available.
Spirit of Recovery
The spirit of the early members of AA was very open in that they believed they did not have a monopoly on recovery, and genuinly encouraged people to try alternatives if they were not able to adhere to the principles of the AA program itself for any reason.
This was an authentic approach to recovery. These people knew that they had something that worked, but were also humble enough to know that there may well be other ways for people to heal their alcoholism and addiction as well.
The spirit of openness and looking for help whenever it may be has probably become much more marginalised in the recovery world today, where the different approaches to recovery have become more driven by ideology, rather than simply being driven by need.
Buddhism and the Smart Recovery Program are two good examples of this.
Anyone looking for help to get sober or stop drinking has a number of options, which can make the process both a bit more confusing and a bit more difficult knowing which way to go.
Some people will get sober on their own without any intervention or help to all, but the majority will need some assistance, short-term and long-term.
Alcoholics Anonymous is the oldest and perhaps best known source for helping people to get sober, and there are a number of other 12 step fellowships that relate to different addictions, such as Narcotics Anonymous, Overeaters Anonymous etc.
A number of people will go into residential treatment centers, or rehabs, and some will seek a variety of outpatient type sources of help, commonly referred to as partial hospital treatment.
Historically, Alcoholics Anonymous has been thought of as the go to place for anyone who has a drink problem, or wants to get help getting sober. For many this is still the case. People sometimes debate the effectiveness of AA, but for many people this is an academic exercise when trying to get sober.
If someone has a serious drink problem, then going to AA is inevitably a good first place to start. It is certainly fair to say that people have problems with some aspects of the AA program, normally centring around the God question, and these are not always easy to address.
On the other side, once someone gets sober and stays sober, they have a much greater freedom in their life to address any of the issues they feel uncomfortable with, either in AA or in other areas of their life.
One of the real aspects of AA at its best, is the freedom people have to simply turn up at a meeting, to stay or to leave at their own will – there should normally be no pressure within any meeting on any individual to disclose information about themselves or their situation.
The anonymity aspect of AA is a crucial part of giving someone who is newly sober a degree of protection, both within AA and outside it. This level of protection gives people some time and space to come to terms with what it means to be sober for themselves.
It is also fair to say that the reality of AA in terms of this level of freedom does not always add up or match the theoretical sense of how it should be.
People in Alcoholics Anonymous may often seem over keen or sometimes a bit overbearing in terms of trying to convince people that AA is the right solution. There are also groups in AA that very definitely have what could be called a cult dynamic, and anyone experiencing any group of this type would do well to run a proverbial mile.
Being aware of the failings of AA is not a criticism of such, simply an acknowledgement of its reality. Anyone newly sober or getting sober may not be immediately aware of these issues, but will probably come to acknowledge and understand some of them in due course.
Rehabs / Treatment Centers
The enormous growth of treatment centers over the last few years has led to a belief that anyone needing help for a drink or drug problem needs to go to a rehab in order to get sober.
Whilst this is not the case, as anyone can go directly to a meeting of AA or NA, many people find the idea of a rehab attractive in so far as it provides something of a bubble out of their normal life, away from family, friends and work.
In many ways a rehab or treatment center is intended to be something of a bubble, providing a safe space where people can address issues away from day-to-day distractions.
There are obviously benefits to this, as well as potential problems.
The main benefits are that it gives people time and space away from day-to-day life to begin to look at and address problems that may have been long seated and serious for their entire life.
People also have problems with the fact that a number of rehabs can seem quite institutional, and many have fairly strict rules and guidelines that cover every aspect of an individual’s life, from what clothes they can wear, to what music they can listen to, to what perfume they can use etc.
Many rehabs make a virtue of these types of rules and conditions, insisting they provide a structured framework that allow people to address more fundamental issues uncluttered.
On the other hand, many people find the rigidity of these rules and regulations incredibly oppressive, and as such it can have the opposite effect to that intended.
Having said all that, there are numerous different types of treatment centers around, although different from each other in many ways, and if time permits is normally possible to find one that seems to be in keeping with what the individual who is seeking treatment is looking for.
Treatment Cost and Programs
The other issue around rehabs and treatment centers is cost. Whilst most rehabs are fairly reluctant to give any idea of costs, Hazelden estimate that a 28 day stay in one of their treatment centres is likely to cost around US$30,000.
This is only a very rough estimate, and some of the high end luxury rehabs can charge three or four times this amount. It does however give some indication of cost, a cost that can often be covered by a health insurance plan
It should also be mentioned that most rehabs base their treatment programs on the 12 step model of Alcoholics Anonymous. Whilst they don’t actually use the AA program itself, they take some elements of it and adapt them to their own type of recovery ideas.
In addition, most treatment centers will actively encourage residents to attend meetings of AA/NA etc whilst they are in treatment, and once they have left as well as a form of after-care.
Some AA meetings will take place on site at the rehab itself, although the meeting will be independent and have no connection to the center.
Anyone getting sober is likely to have to do with the issue of withdrawals from alcohol, whether or not a detox is necessary, and possibly the effects of withdrawal from narcotics as well.
If someone has been drinking heavily for a while, or to a point where it has become a problem for them, then suddenly stopping is likely to have an impact on them.
Not only their physical body, but on the emotional issues it is likely to start bringing up as well.
The reality is, that withdrawal effects from alcohol can vary significantly from individual to individual, irrespective of the amount they have been drinking beforehand.
What is important is to be aware of the potential dangers of withdrawal, how they can be managed and how best to prepare for the need for a proper detox.
A lot of people will get sober through a rehab or treatment center, and one issue about which rehab to choose is its approach to how to detox someone.
Any rehab should have clinical facilities and staff, or access to such locally, who can assess whether there is a need for a detox, and if so overseas and manage it in a safe and effective manner.
Clinical facilities in terms of staff, location and appropriate medication are a key element of ensuring the safety of an individual once they get sober, and beginning the process of rebuilding their life.
Withdrawal symptoms from alcohol or alcoholism are the body experiencing the withdrawal of something it is used to, which it has become heavily addicted to.
It is almost worth thinking of these symptoms as the body fighting back in the way.
Symptoms can range from nausea, headaches, shakes, sweats etc through to full-blown hallucinations, DT’s etc.
Many medical websites offer a full range of the potential symptoms of withdrawal, as well as a timeline of how this can affect people.
While this can be helpful it is worth remembering that individuals do differ significantly as to how they withdraw from alcoholism, and what is important is to be aware of the potential dangers, and have strategies in place in order to cope with them.
When a person does not go into rehab, and sobers up on their own in any way, the process of managing withdrawal is normally referred to as a home detox.
This does not normally mean that they actually do do any type of formal detox, it normally refers to the process of simply getting through it, albeit in a fairly unpleasant manner.
What is crucially important that someone is getting sober, is at they have access to medical help, and a medical assessment of what they are doing.
This is best done through a primary care physician, but if this is not possible and maybe other help available.
There are a number of websites available that give practical advice about the possible effects of withdrawal from alcoholism and how to manage it.
This is a phrase that is used to describe anyone who is addicted to alcohol and any other drug or narcotic.
A significant number of alcoholics also use drugs and pills, prescribed and non-prescribed, and this can also be a significant issue in stopping using them.
There are significant potential dangers when stopping using any type of narcotic, and these potential dangers can be multiplied significantly when the person has been using alcohol as well.
If someone is entering rehab, it is essential that completely honest about what drugs they have been using, how much and or how long.
This can be very tricky, as someone who is an active alcoholic will almost invariably minimise the amount they have been drinking and using.
If someone is getting sober on their own, even if they are using some type of therapy or 12 step based program to help them, it is essential to get some type of medical help as well.
This medical help can be in terms of assessing the need for a detox, and how that can best be managed. It is really important that this process is looked at as soon as a decision is made to stop drinking or using.
Everyone’s journey from active alcoholism into sobriety is both unique and complex.
One thing that is fairly common however, is that when people do sober up, they have to start living with themselves without alcohol.
This means beginning to live with the reality of what they were trying to escape from when drinking, both internally and externally.
For many people, this can be a pretty daunting process, can take a long time and is a lot of work to really heal. It is probably fair to describe this process as emotional sobriety.
The phrase emotional sobriety was first used by Bill Wilson, one of the co-founders of Alcoholics Anonymous, in an article he wrote for the AA Grapevine in January 1958.
The article was entitled The Next Frontier : Emotional Sobriety.
In the article, Bill Wilson outlined his thoughts on the emotional struggles he had had, largely during the time of his depression, and how he had come through them with a much stronger sense of his inner world and what it meant to him.
Many people seek to interpret this phrase, and how Bill Wilson wrote about it, in a number of different ways.
The reality is, as with everything that he wrote, and all AA literature, that people have an absolute freedom to interpret in anyway they find helpful or not.
Trying to interpret his writings in ways that mean people have to fit their own experience into the context of what he was saying, is in many ways an emotional death wish, and something he most likely would never have intended or wanted.
It is clear from pretty much all of his writings that he intended to share his experience, both at a personal and an AA level, in the hope that it could be helpful to people, and that they could use his experience as part of the process of rebuilding their own life once they got sober.
It is probably a fair assumption to say that the emotional drives that fuel people’s alcoholism are for most people fairly deep-rooted, and quite often go back to childhood.
When someone gets sober, they start to live with the legacy of these emotional drives as they affect them on a day-to-day basis. The depth of this emotional trauma can often seem too overwhelming to go near for many people.
Most people soon begin to realise that their emotional lives are out of control at some level, and that in some way this either contributed to their drinking, or was the cause of the dread/terror inside them that alcohol seemed to be the solution to.
People’s understanding of their own alcoholism comes in time, and this sense that alcohol was the solution, not the problem, is pretty common and pretty core to this understanding.
It is also completely at odds with the understanding that someone who is not an alcoholic is likely to have of alcoholism generally.
There is a saying in AA, that when you get sober you begin to realise why you drank.
This is not normally intended to be taken literally, as in finding the reasons people drink alcoholically.
It is meant to refer to the fact that when people get sober, they begin to live with themselves without alcohol, and as such soon begin to realise at some level this emotional turmoil that fuelled their drinking.
At some point in their recovery, people are likely to realise that they need to in some way process this emotional turmoil or they are likely to start drinking again.
This is normally around the fact that most alcoholics see / saw alcohol as the solution to their problems, not the problem itself.
Once sober, the alcohol is gone, and people have to start living with themselves without it.
This can be a fairly tough thing to accept, and people’s ways of dealing with it differ significantly.
It is very likely however that it will take a significant degree of emotional pain before people become willing to really own and address their underlying emotional issues, although there are obviously many different reasons for this.
The phrase emotional sobriety really covers this entire process, pretty much from day one through till whenever it stops !
It is probably a mistake to think that the phrase only deals with issues of later recovery, or with issues of depression.
The nature of staying sober for many people is around finding ways of healing the internal emotional turmoil that alcohol helped to give some relief from, and this is normally a lifelong process.
Although anecdotal, it is fairly clear that a significant number of alcoholics in recovery grew up in what are normally referred to as alcoholic homes.
This normally refers to homes where either one or both parents were active alcoholics, or where there was a significant number of alcoholics in the extended family.
The effects of growing up in an alcoholic home can be varied, but there are a number of common traits.
The most common one is an absence of safety.
This can either be an emotional absence, or an actual absence or both.
People growing up in alcoholic homes describe a total lack of stability or safety, the lack of feeling anyone is in control, and the need to take responsibility for their own lives at an early age.
Growing up in an alcoholic home has a significant impact on someone’s development and sense of self.
It can distort ancestry damage how someone relates to themselves and other people.
Someone who is also an alcoholic themselves and grows up in an alcoholic home will find that the emotional chaos of their childhood is likely to have played a significant part in their own emotional development, and how they tried to force their life to work in some way.
Emotional sobriety is about finding ways of healing this emotional turmoil, and getting a real sense of peace and stability internally that can enable someone to really live at peace with themselves, possibly for the first time ever.
Quite a simple question in many ways, but one that many people struggle with, both in terms of trying to set boundaries of their own, and dealing with other people who don’t respect, or don’t seem able to respect anyone else’s boundaries at all.
The issue of boundaries is not unique to people in 12-step recovery, but is perhaps more acute because so many of them have grown up either in alcoholic homes or enmeshed homes of one type or another.
Anyone who has grown up in such a home would to some degree have felt that they did not have their own sense of space, or their own sense of privacy, or simply their own right to be themselves.
It is sometimes described as not knowing where your life ends and the other person begins.
This is really about someone having the space to be themselves.
This sense of not having your own personal space becomes more apparent as you get older, and becomes more important as you try to reconcile the responsibilities of your own life, with the responsibilities of other people’s lives around you.
Trying to define boundaries is quite difficult in one sense, but is normally much more obvious when there are really being blurred. When people do not respect other people’s boundaries, they do not respect the person themselves.
Respecting someone as an individual, is in large part about giving them the freedom to be themselves, and giving them the space to process their own needs, and also to have the space where they come to the realisation of what their own needs are themselves first.
Respecting the Individual
Respecting boundaries is about respecting an individual.
Where someone does not respect boundaries, they do not respect the individual’s right to be themselves and make decisions for themselves.
Inevitably they try and manipulate the other person into doing what they want them to do, whilst trying to make them think that it is their decision in the first place.
Boundaries are often talked about in terms of childhood development, because they are about setting a safe place for a child to learn what is and is not acceptable. Boundaries are about creating a real sense of freedom within the confines and context of your life.
In adulthood this is a very different process to how a child will learn how boundaries affect a sense of space.
The problem in many ways for people in 12 step recovery is that they are playing catch up. Many who have grown up in alcoholic or enmeshed homes will have experienced acute levels of a lack of boundaries.
This will have manifested itself in a lot of complications and problems in the individual, often leading to a real sense of emotional limbo, feeling they have no responsibility or power over their own life, but feeling responsible for the lives of other people that they have no control over.
This is normally a direct reflection of the home they grew up in, and becomes a pattern of behaviour and thought throughout the life.
Learning to set boundaries as an adult is not an easy thing, Especially if other people in your life used to getting their own way and being able to use you as they want to.
Learning to say no, and to own your own right to make your own decisions is really what setting boundaries is about.
At first it may feel a bit awkward, or even a bit controlling. As time goes on learning to set boundaries will become a very real and natural part of your life, and ultimately will give you the safety of being able to own your own emotional space, and really feel you have your life back.
People quite often like to categorise emotions as being good or bad, with emotions such as anger and self-pity been thought of as bad or weak .
Emotions such as gratitude and a positive outlook are thought of as good healthy emotional states.
Truth is that judgement of any emotional state is of itself counter productive.
Emotions are neither good nor bad of themselves, neither strong no weak, they simply are.
This may sound a bit trite, but is really important because of what ones emotional state can tell us about ourselves.
Many people in 12 step recovery struggle with emotional drives once they get sober.
Often the alcohol has been used as a way of quite simply blotting out the emotional pain someone has lived in, and has been used to simply avoid reality.
When someone gets sober, one of the first lessons that they learn is that this is, how do they live with themselves sober.
This may not be immediately obvious at a conscious level, but they soon into realise that the emotional unmanageability of their lives is often as strong as the practical unmanageability of their drinking which caused them to seek help.
One of the important part of the process of 12 step is recovery is to be able to consciously look at and evaluate how our emotions work at a normal instinctive level, simply because on a daily basis people just act or react to what goes on around them.
This can be particularly true when someone has a high level of anger or resentment that determines their attitudes and their reactions to much of what happens in their life.
The book Alcoholics Anonymous describes resentment as the number one offender, and says it destroys more alcoholics than anything else.
Anyone who has lived with their own anger, or with an angry alcoholic, drunk or sober, knows the power of resentment, and how overwhelming it can be.
Perhaps the most important thing to realise about our emotional states is that they give us information about ourselves.
The process of the 12 step program allows us to consciously evaluate this information at both a head and a heart level.
Being able to develop a degree of self awareness is a huge freedom, even if it does not seem so at the beginning throughout the process.
Knowing what one’s own emotional baggage and drives are, does give you the freedom to be able to process them, even if it is painful or takes you to dark places.
Thinking of people as being emotionally weak or emotionally strong is a fundamental misconception.
The real problem behind this attitude is one of judgement. If someone is judging themselves or other people for how they are feeling, they will be completely unable to accept it as a real state.
If they cannot accept that, in reality they will never be able to change it.
The term emotional sobriety is often used to describe the process of people coming to terms with their more complex and serious emotional drives that may only begin to become apparent after someone has been sober for a while.
This journey can be a tough one, but ultimately is the only real root to any lasting happiness or internal sense of stability and peace.