Trauma and the 12 Steps

For many years now, traditional 12-Step facilitation (TSF) as promoted by Alcoholics Anonymous has been branded by some healthcare professionals as too old-fashioned, too unscientific, and too moralistic. Gabrielle Glaser summed it up in The Atlantic in 2015:

“Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment. But although few people seem to realize it, there are alternatives, including prescription drugs and therapies that aim to help patients learn to drink in moderation. Unlike Alcoholics Anonymous, these methods are based on modern science and have been proved, in randomized, controlled studies, to work.”

Numerous studies in recent decades have shown a strong link between exposure to traumatic experiences and substance use disorder (SUD) as even the term “addiction” is increasingly avoided by psychiatrists. SUDs are seen as primarily driven by posttraumatic stress disorder (PTSD) and other mood-related conditions such as depression and anxiety. Asking God to remove character defects (Step 6) is rejected by critics as pointless—even harmful.  

In a newly revised and expanded edition of her book Trauma and the 12 Steps, author Jamie Marich is suggesting a compromise.

“To heal the suffering connected to the crisis of addiction, we must learn to build bridges, not walls. We build walls when we promote our own preferred pathway as the best or most ideal way to get clean, sober, or well,” she writes. “To build bridges, we must recognize that certain components of tradition are not all bad while acknowledging that it is harmful to stay stuck in the mentality of this is the way we’ve always done it. I wrote Trauma and the 12 Steps in 2012 out of my commitment to promote a both/and paradigm for healing addiction.”

Marich does not oppose 12-Step facilitation but would like to move it forward with certain trauma-informed modifications for those who need them based on their past experiences. 

“A great deal has changed in the world since Alcoholics Anonymous originated in 1935,” she writes in Trauma and the 12 Steps. “We’ve learned much more about trauma and its impact on the brain since that time. This book, while fundamentally pro–twelve-step, continues the call made in the earlier edition to encompass what we have learned about trauma to help even more people.” 

One very important reason for Marich’s continued support for TSF is the crucial role her sponsor played in her own recovery: “Janet was trauma-informed before the phrase was even cool in the clinical professions. While she worked the steps with the spirit of an old-timer, her life was one of attraction rather than promotion, to quote a well-known saying in the rooms of twelve-step recovery. She practiced instead of preached. She validated me and then challenged me, honoring my dignity every step of the way.”

In the book, Marich explains that both trauma and addiction are complex conditions that require highly individualized attention. “Offering the addicted survivor of trauma proper, nonjudgmental support and guidance is critical.”   

She criticizes purists who insist that “The twelve steps of (insert specific fellowship) are meant as a program of recovery from (insert specific substance or behavior), not trauma.” Many other people participating in 12-Step programs, though, do understand the central role of underlying conditions. 

“I often hear at twelve-step meetings that alcoholism, addiction, or the problematic behavior is merely the manifestation (or symptom) of a larger personality problem,” says Marich. “Traumas can, and often do, play a critical role in shaping this larger personality problem, so approaching the twelve steps in a trauma-informed manner is more than relevant.”

Ultimately, recovery is about connecting with other people, and fellowship is one of the strengths of 12-Step facilitation. 

“All relationships have the potential to heal, not just the relationship between therapist and client or between sponsor and sponsee,” writes Marich. “Relationships heal, sometimes in a way that we least expect them to. Helping clients and those new to recovery to see the healing potential in each relationship, even if that relationship just provides an opportunity to set a boundary and thus promote personal growth, is one of the most powerful tools in trauma-informed recovery.” 

The Farley Center at Williamsburg Place understands that no two addictions are exactly alike, and no treatment approach is for everybody. While all our patients have the same goal—recovery— they are able to achieve it through various types of care. We are responsive to each individual and work collaboratively to provide the best possible treatment.

The Farley Center embraces the principles of 12-Step recovery. While the 12-Step process is not a medical treatment method, it is a recovery fellowship for peers who provide support, hope, and their experience to those working a daily recovery program. While in treatment at Farley, patients are encouraged to attend daily 12-Step meetings and identify a sponsor to support them through their early stages of recovery.

If you or someone you know is struggling with substance misuse but you are unsure what addiction treatment services are available during the current COVID-19 pandemic, please contact The Farley Center at 800.582.6066 to find out about your options.