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.
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.
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.
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.