Addiction: The Real 13th Step

Excerpted from
The Real 13th Step: Discovering Confidence, Self-Reliance, and Independence Beyond the 12-Step Programs
By Tina B. Tessina, Ph.D.

A number of things have changed in the ten years since The REAL Thirteenth Step was originally published. In that time I've worked with many more clients who are recovering with the aid of Twelve Step programs. In that time, sponsors have referred program members to me, and I have referred clients to the programs and to sponsors. The program continues to be powerfully helpful to clients with addiction problems.

Research in addiction has progressed, recognizing new stages in the recovery process. Experts now say that people in second and third stage recovery can benefit from changing their relationship to AA or Other Twelve Step programs. Clients, sponsors and experts all agree today that psychotherapy is an important adjunct to the program, helping people in recovery with the aspects of recovery that are not covered by the twelve steps and twelve traditions.

In spite of changes in the recovery movement, my clients continue to need the information in The REAL Thirteenth Step as an adjunct to their recovery. Sponsors and group members now acknowledge that psychotherapy is not only helpful, but probably essential to recovery. Treatment centers report their best success rates when they use a combination of twelve-step and group psychotherapy techniques. In-patient treatment is usually brief because of insurance constraints, so most centers recommend that patients continue therapy after treatment along with their twelve-step attendance. "Drug courts", new court programs which are designed to reduce jail time for non-violent drug convictions, and instead focus on treatment and recovery, also acknowledge the need for therapy along with twelve-step attendance.

This book contains - in exercises, information and guidelines - the tools a person in recovery needs to complete the process. I have updated it to include new ideas and techniques. This is the work my clients do in therapy, and by following the program set forth in these pages, you can complete the same work. I have made it as rich and effective as possible.

Contrary to what some people have said, The REAL Thirteenth Step is not critical of AA or any other twelve-step programs. What I do here is to show how people with judgment problems can misinterpret their program in damaging ways, and how to correct those problems. You'll find it totally supportive of your involvement and progress in your program, and also encouraging in your discovery process beyond the twelve step programs.

You can use this information by yourself, with your sponsor, with a peer group of others who have similar goals, or with a licensed therapist. In fact, in the years since the first edition was published, I have heard from many therapists who use this book with their clients, sponsors who use it with the members they sponsor, and treatment programs and alcohol counseling degree programs which make it part of their curriculum. If you decide to embark on this journey, it may take considerable time to effectively do all the exercises, but you'll find the process worthwhile and the results will be better than you dreamed.

Nothing is more gratifying for a counselor than watching a client struggle through the growth and recovery process, to succeed in building a new life. I have laughed and cried with my clients, and supported and congratulated them as they graduated from therapy into fulfilling and satisfying lives. Clients have reported back to me, years later, that their relationships are working better than they ever imagined, and that they are happy and content as they never thought they'd be. This book is designed to help people I cannot see in person achieve the same results.

I wish you the best of luck, and a life after recovery that is full of satisfaction and happiness.

Tina Tessina, Long Beach, CA 2000

PREFACE

Support groups are the answer for 15 Million Americans... 500,000 ...will be attended ... this week... Support groups work

— Newsweek

In my work as a consultant, I have observed clients becoming addicted to the twelve-step program and unable to transcend it.

Drug Counselor Bob Holder, New Age Magazine

Since the founding of Alcoholics Anonymous in 1935, twelve-step based recovery programs have proved very effective in helping victims of addictive, obsessive and compulsive behavior put a stop to that behavior and the damage it has created in their lives. Up to now, these programs provide almost the sole support, hope, encouragement, and successful examples of people who were able to arrest their addiction and enter recovery.

In a nation that has eight million "problem drinkers," more than two hundred national Alcoholics Anonymous-style groups, and over two thousand meetings each week of support groups catering to those caught up in "relationship addiction" alone - and where millions of others attend groups specifically formed for recovery from problems such as substance abuse, alcoholic families, eating disorders and obsessive/compulsive behavior - there is no doubt that all these recovery programs based on the original Alcoholics Anonymous 12 steps have done a tremendous amount of good.

To my knowledge, they are the most effective programs known: most reputable alcohol and substance abuse treatment centers use the Twelve Steps or some variant of them in their own programs; and many therapists will not work with substance abuse patients unless they attend a twelve- step- style recovery program. For the last twenty years, these programs have done exactly what they were designed to do, to help people free themselves from whatever substance or behavior holds them in addiction.

No wonder a Scripps Howard News Service story back in 1989 maintained "Throughout the country, there is a rush to ... Alcoholics Anonymous, Cocaine Anonymous and Narcotics Anonymous. Nationally, AA membership has easily doubled in the last decade. The country's Cocaine Anonymous groups have seen an even more dramatic rise, from 169 to 1,042 in four years." Ask any experienced recovery counselor, and you'll hear that twelve step programs definitely work.

But recently another series of voices have begun to question certain aspects of the program. One of the foremost of these is psychologist Stanton Peele, author of The Diseasing of America: Addiction Treatment out of Control; who criticizes the 12-step process as "a religious conversion experience", and terms it "a kind of brainwashing."

"The... AA philosophy... that alcoholics... are unable to control their drinking from birth", writes Peele, means they "... are obligated to think of themselves as having a lifetime condition...alcoholics are taught to believe that they are exactly one drink away from total relapse and the need to start again at day one." Others criticize the program's insistence that "recovery is forever" as undermining self-esteem; the way groups absorb members' time to the exclusion of all outside activity; and the way many members seem to just transfer their addiction to the program without attempting any further growth or progress.

U.S. News and World Report called this "America's addiction to addiction". One social worker employed by a veteran's hospital alcohol treatment program voiced this concern recently when he said: "We need a Twelve Steps Anonymous to handle peoples' addiction to the program."

In fact, as the number of support groups and the problems they face has mounted, so has the controversy. Concern over whether they are to be viewed as effective methods for arresting addictions or simply as a means for transferring the addiction to a more benign and less disastrous form is becoming more widespread.

This growing doubt has penetrated so deeply among the public at large that it has even become the subject of comic strips. A Feiffer cartoon featured a woman worrying because she goes to her support groups "seven nights and three afternoons a week" for her eating, drinking, smoking, and intimacy "disorders". She couldn't "live without them." the woman says, and then concludes, somewhat crestfallen, that she may have a "support group disorder."

Recently, I have noticed that clients who had been in recovery groups and long ago stopped their addictive behavior were also beginning to voice these concerns and felt restless with the program. Among them are clients who have come to me feeling discouraged and disappointed with themselves because they couldn't achieve satisfying lives through the recovery programs alone, and clients who - after years spent going from one kind of a group to another (AA to Al-Anon to CoDA to Overeaters Anonymous) as they quit one addiction only to discover they still had others - are kept by the groups from noticing that the underlying cause of all these compulsions had yet to be addressed.

Friends also have expressed frustration with being "in recovery" for years, and wanting to get beyond it. And colleagues have expressed concern about clients who seem to be stuck because they can't transcend their recovery programs. Members of my weekly drop-in therapy group attend to work on issues not addressed in their twelve-step programs. Even as I write this, after overhearing a phone conversation about this book a young man who works for me (and incidentally is in recovery) said "Were you just talking about a book about something beyond the twelve steps? Where can I get three copies?"

Although twelve-step programs have limitations, their effectiveness can or should be discounted. When, in the second chapter, I analyze the problems of misusing the Twelve Steps, I am not attacking the steps or the program. Instead, I hope to show recovery group members how they can build on the foundation of continued long- term recovery from addictive behavior these groups have made possible to a full, autonomous life free of addiction and the fear of relapse, without feeling dependent on the program's support, whether or not they continue to attend.

My clients are justly grateful for the help they've gotten within these groups. "The twelve -step program saved my life" is a statement I hear often. As a therapist, I am also grateful, for the way these groups supply an ongoing, twenty-four-hour a day support structure and friendship that is both beyond the scope of, and an excellent adjunct to, private therapy.

But for many long- term recovery group members, It is no longer enough to remain "clean and sober", to learn the Steps, to be a part of the "family". Life beyond the group, beyond recovery calls to them; human beings have an innate need to grow, to accomplish, to achieve.

Their recovery program has done its work; its objectives have been achieved, and often successful group members have successfully completed recovery. But there is no culminating celebration, no movement to a new level. When students study diligently and learn their lessons in school or college, they get to graduate and move on to a higher level. But for members of recovery groups there is no graduation or recognition that they might have completed their work -no Thirteenth Step beyond recovery to a health and wholeness that transcends any further permanent dependency on the program to keep them free from addiction.

The philosophy and perspective of the twelve-step programs as they are currently constructed does not acknowledge that permanent recovery of any kind is possible. Members are convinced that nothing like a Thirteenth Step can ever exist, and they are convinced that addiction is a life long "illness" that can never be cured, that there is no such thing as graduation, and that all attempts to leave the group can only end in failure. This prevents them from learning the skills they need to know to fully enjoy their lives and relationships.

I agree that addiction is indeed a very serious problem, and very difficult to heal. But, just as people doubted the ability of anything to arrest addiction until Alcoholics Anonymous introduced the Twelve Steps and proved its effectiveness in the face of many doubts, there is increasing evidence that once addictive behavior has been stopped through the intervention of a recovery program, many people can recover further beyond the likelihood of relapse.

Because they do not believe in completing recovery, often program members and sponsors actively discourage members from leaving the group. As a result, even members who feel they've gotten all they can from the program and eventually leave feel burdened by a sense of incompleteness, self-doubt and guilt.

Helping clients, friends and colleagues resolve these conflicts and find meaning beyond their self-help programs led to the writing of The REAL Thirteenth Step, which addresses the following questions:

. How do you know you are ready to move beyond the program, and are not just in denial?

. What criteria must you meet to be ready for graduation from twelve-step programs?

. Does graduation mean you must leave the program forever? What is appropriate program participation once you achieve independence?

. How is self-reliant living different from arrogance and selfishness?

. What is healthy autonomy? Is it lonely?

. Why are some people on a treadmill of self-help group after group, and how do you stop the cycle?

The methods, exercises and ideas in this book build on what you have already learned in your recovery program, and are based on proven psychological theory and techniques. Through following the teachings here, you can both honor the accomplishments you achieved in recovery and effectively move beyond them, to normal, functional living. You can learn how to heal old dependency, old pain, and free yourself to enjoy the challenge of life. Because they are based on time-tested theories, (and because this book has been used by so many treatment programs) some of the exercises and teachings may seem familiar. But, never before has such a coherent, complete outline of the basic tools been presented in a way you can use on your own to effectively learn autonomy and create permanent, lasting recovery from the patterns of dependency that lie embedded in your subconscious mind.

Although this book is intended for people who are recovering from severe problems of addiction and dependency with the help of a recovery group, because of the social bias in most societies against independent thought and action almost everyone develops some degree of dependency and has their growth toward autonomy impaired. Therefore, the ideas and exercises in this book will also be useful for anyone striving to achieve a greater degree of personal freedom and autonomy in his or her daily life.

You may never have had problems with addiction, or obsessive compulsive behavior, but sometimes you might find it difficult to assert yourself in groups, to initiate conversations about painful topics, to ask salesclerks or repairpeople to correct errors, or to confront friends or relatives who need it. If so, by following the suggestions contained in this book, you'll find yourself able to deal with most of life's difficulties with greater ease and self-confidence.

I invite you to turn the page, and begin taking Thirteenth Step toward autonomy, self-confidence and self-reliance.

Author's Note:

As a member of a twelve-step recovery program, you may have heard the term thirteenth stepping used disparagingly to mean having inappropriate sexual intimacy with new members. In this book the phrase Thirteenth Step is used to mean completing recovery and achieving appropriate intimacy with yourself.

To me, taking the Thirteenth Step means taking the next step beyond the Twelve Steps and graduating from the group to healthy, fully autonomous living. That's why I have chosen to call this book The REAL Thirteenth Step, and any time I use the phrases Thirteenth Step or The REAL Thirteenth Step it is this healthy intimacy with self, not inappropriate intimacy with others, that I mean.

Although the twelve-step programs are among the best known of the self-help recovery groups, there are many others which are based on the Twelve Steps (such as Adult Children of Alcoholics (ACA), Overeaters Anonymous (OA), Gamblers Anonymous (GA), Narcotics Anonymous (NA), CoDependents Anonymous (CoDA), Debtors Anonymous (DA), and Al-Anon) or that, though they differ in the number of steps, or in some details, take basically the same approach.

Many incest survivor, codependency, or adult children of dysfunctional family and other self -help groups use a program based on the therapist's own feelings about the appropriate number of steps. But they are all very similar in their focus on a Higher Power, on fearlessly facing the self, and in making amends to those who have been injured. Since they all share the same focus on recovery through the support of the group, I have chosen to refer to them most often as recovery groups or programs. When you see these phrases, you will know I'm speaking about recovery groups in the most inclusive sense, and not exclusively AA-type twelve-step programs.

Addiction, obsession, compulsion and dependency all share common elements, since addictive behavior is compulsive and we become obsessed about anything we are dependent on. Although therapists and programs consider these to be technically different behaviors, for the purposes of this book I have used the terms addiction and addictive and related words (drunk, dry sober, abstinent) to include all compulsions, obsessions, and addictions.

Alcoholism - Autonomy : Recovery

Recovery:
Stepping up from Addiction

Chapter I

Autonomy: The Real Thirteenth Step

The trouble with twelve-step programs is that they just replace the addiction - then you're stuck with the program for life. I know people who've been going to three meetings a week for ten years.

— Wayne Curtis, Psychologist

Through twenty-eight years of doing therapy, I have seen numerous clients who benefitted enormously from a recovery program and then came to me for private therapy either on the recommendation of a sponsor or a fellow member, because they still had problems in their lives and relationships. I have also seen clients who gained sobriety through other methods, including Rational Recovery, in-patient treatment programs, religious conversion and even some who have made it on their own, through sheer strength of will. Even though they overcame alcohol, drugs, gambling, compulsive overeating or overspending, they still had anxiety, depression, broken relationships and problems with emotional control, so they came to me.

Those who followed the program felt it made them strong in recovery, and they were grateful. Knowing they were strong enough, with the help of the program, to achieve recovery led them to believe that, with effective help, they could achieve even more.

Richard O., 45, a self-employed professional, said, "The program created a miracle for me, my freedom from addiction. Moreover, I have never seen any other recovery program work the way AA's works. It works! But it took me to govern my mind and control my excesses. I am entering my tenth year of being sober. I stopped attending meetings after six months, primarily because they were repetitive. I don't want, desire nor have a yen for booze and I keep a fully-stocked bar in my home for guests." He discovered the importance of autonomy on his own.

Bob D., 62, an aerospace engineer who began having heart problems: "I'm grateful to AA, I really feel the meetings saved my life. But, now that I've been sober for three years, I realize that there's more I need to do, and I can't seem to find it in AA."

Mary L., 33, a successful real estate agent and divorced mother of two, says: "I found that my whole life, my friends, my activities were all limited to the program. For a while it felt great, being surrounded by recovering people, but then I wanted more variety. I wanted a life of my own! I'm grateful to the program, more grateful than I can say; but I never felt completely healthy until I left."

Like these people, you may feel you've benefitted enormously, but sense that your ability to function on your own in the outside world is limited. Like many other clients, you may feel the time has come for you to graduate from your dependence on the group, and to develop the additional skills you need to manage your problems and to cope successfully and fearlessly on your own. Even if you don't feel dependent on any group to maintain your sobriety and recovery, you may have many questions about what living a truly healthy life entails.

Twelve-step and recovery groups indeed offer many benefits. The support of the group, the living examples of people overcoming addition and compulsions, the intelligence and power of the Twelve Steps, and the security of a proven plan for overcoming old thinking and destructive behaviors are all invaluable benefits of following the program. But some experts maintain that the program becomes a replacement for the addiction- addiction to recovery. What the program does not provide is a way to progress beyond the Twelve Steps.

If you have been a member of a Twelve Step program, or if you have achieved recovery by other means, you may be ready to move on to the Real Thirteenth Step. That is, to develop an understanding of the emotional dynamics underlying your original addiction that enables you to gain true mastery of every aspect of your life.

Moving beyond the Twelve Steps is a gradual process - it does not mean leaving your group prematurely, it does not mean abandoning your personal program, and it does not mean leaving the support of your friends in recovery. What it does mean is gaining new understanding beyond merely maintaining recovery - understanding and information not available within the limits of your Twelve Step program.

How do you know if you are ready to take the Real Thirteenth Step? Ask yourself the following questions:

. Have you remained free from your addiction or compulsion for several years?

. Are you realistically confident that your life is no longer unmanageable?

. Are you happy to be in recovery and particularly to be clean/abstinent/sober, but still at a loss about how to run the rest of your life?

. Are you tired of being told you are an addict/alcoholic/codependent and will always be an addict/alcoholic/codependent?

. Are you feeling restless and confined in the group?

. Are you beginning to feel you may have just traded one crutch for another?

. Do you feel you are missing out on life because of the pressure to constantly attend group meetings?

. Do you realize that all your former friends were connected to your addiction, all your present friends are involved in the Program, and you have trouble forming friends with others outside these groups?

. Would you like to let go of the program and try your "wings" as an independent, fully recovered human being, but you're afraid you may slip back into your old, destructive behavior, because you have been told no one ever recovers?

. Do you sense you may be cured and ready for life outside the group, but you're not sure you possess the skills for coping with the world successfully by yourself?

If you can answer yes to most of these questions, you are ready to graduate from recovery, understand the reasons behind your addictions or compulsions and take the Real Thirteenth Step to self-reliance and freedom from dependency.

Why Graduate?

Although twelve-step style recovery programs are unsurpassed in transforming destructive addiction, compulsion or dependency into a much healthier dependency on the Program, your recovery remains incomplete. It still leaves you dependent upon the group. Your current doubts about the group and feelings of restlessness may be prompted by your inner awareness of this lack of completeness. Your restlessness means you are ready to complete your recovery and graduate to taking full and complete charge of your own life - to achieve autonomy.

Autonomy, which means to be self-governing or self-regulating, may seem cold and scientific, but it represents personal empowerment. Rather than being cold, autonomy is a source of emotional warmth: only when you feel able to take care of yourself can you successfully take the necessary risks to love and be loved. The exercises and information in this book will help you build the essential foundation you need to create intimacy with yourself and others.

Here is the information you need to take one more step than your recovery program has provided - recovery from your final dependency on the group. You will learn how to take charge of your own life, and devise your own program to keep yourself from becoming dependent, addictive, or obsessive again. The Twelve Steps are like a tourniquet that stops a hemorrhage; they have saved your life, but the wound itself still needs to be treated. Unless the injury is healed, you will always be, as the programs put it, "recovering" but never "recovered".

Your replacement addiction to a sponsor, the steps and the meetings is vastly more functional than your original addiction, but it eventually limits your ability to live a full and emotionally complete life. Recovery can absorb your time and attention, much as your original addiction did, and prevent you from moving on.

When you first entered recovery, you probably abandoned old friends or left an addictive or compulsive mate or dysfunctional family, because their influence was harmful. Finding a ready-made group of friends at AA or other groups probably produced initial euphoria, but eventually you discover these new friends also have difficulties and problems. Like you, they have the emotional dysfunction that accompanies addiction.

As you progress in recovery you may long for people who share your interests (such as music, sports, art, politics or books) other than addiction. But if you believe you must attend the group regularly to remain in recovery, you don't have the time to make friends outside the group. If your family of origin is dysfunctional, you may be at a loss about how to find new friends, and your recovery program probably does not provide information, encouragement or guidance about how to make friends outside of the group.

After years of dependency and addictive behavior, becoming autonomous, confident and self-reliant may sound like an impossible goal. Perhaps you have always been afraid you couldn't function successfully on your own. Your dependence on drinking, eating, shopping, sex, overwork or other excesses may even have been partly caused by your fear that you were too weak or stupid to manage your own life. Ironically, your destructive behavior patterns may look like the proof that you are incompetent.

But others who have had the same problems have learned to end their addictions - even after years of apparent failure - and so can you! Instead of remaining dependent on a substance, a behavior or even a self-help program to maintain your recovery, you can learn to manage your own life independently. You can take the same step Carl, a thirty-three -year- old long-haul truckdriver, took - the Thirteenth Step, beyond mere recovery to health and autonomy.

Carl

Carl began drinking at age fourteen. It was the "in thing to do". His buddies would steal alcohol from home, or talk an older guy into buying some beer. At first, it just seemed "grown up" and exciting, but, soon it helped him forget his problems at home and school. His father was a truckdriver, and gone a lot. Carl missed having a father like the other kids', but he liked it better when Dad was gone. When Carl's dad was home, with nothing to do, he drank, became angry and violent, and Carl and his mother got the brunt. With his inner turmoil about the abuse, and no guidance from his troubled parents, Carl was unable to cope with school. Drinking became his only relief, and a big problem. Carl had hangovers, blackouts, arrests for drunk driving, and disastrous relationships.

Carl tells how he got to AA at age twenty-eight: "I went to the first meeting because I was ordered to by the judge after a DUI. I hated it, but they said 'keep coming back,' and I had to anyway." Being arrested for a DUI got his attention, and the court's referral to AA got him moving. "I went to meetings because I had been ordered to, but I never shared [spoke]. When I first said 'My name is Carl, and I'm an alcoholic', I began to face my problem. The Twelve Steps changed my life. For the first time, I had some hope."

Carl spent four years in AA, working the Steps, attending daily meetings, and even speaking at hospital alcohol programs to introduce AA. "AA was all I needed - until I fell in love. Suddenly, I had no idea what to do. When that relationship broke up, I was afraid to meet other women. I had nothing in my life to talk about except AA. I discovered that meetings were not a good place to meet women. They were there because they needed to work the Steps - they were not ready for healthy relationships. I got restless. Meetings seemed repetitious, I had gotten what I needed, but I was afraid to leave, because I knew I was supposed to be in recovery forever. I didn't know what to do instead."

Carl had several relapses in his first six months in AA, and he didn't trust himself to stay sober without frequent attendance, but after a year he wasn't learning anything new. Carl felt he needed more help than his sponsor had to offer.

Carl came into therapy, because although he was a handsome, well-built man, he needed to learn how to relate to women, and how to meet people outside AA. In therapy, Carl learned to confront his feelings, and he discovered his awkwardness and shyness around people he didn't know was a result of internal emotional pain and a poor self-image.

As Carl learned to face his own feelings, he began to heal the trauma of his childhood. His confidence and energy were increasing. His self-esteem grew as he learned autonomous thinking and self-governing. He began to trust himself, to discover what was healthy for him, and to take good care of himself. Carl reclaimed his life, from the painful legacy of a dysfunctional and abusive family, from the ravages of out-of-control drinking, and finally, from dependency on AA.

Carl says, "I will always be grateful to AA. Nothing else would have gotten me sober. But I'm glad I found a way to graduate. Now, my involvement is voluntary - I can do it if I want to help someone, or to remind myself of what drinking was like, but I don't need the group any more to stay sober or keep my serenity. Life is more fun, I'm enjoying myself more, I have more friends, and I'm successfully in love."

Healing Is More Than Recovery

If you're one of the millions of men, women and young people who have successfully stopped a destructive behavior - involving addictive substances, food binges, spending, gambling, abuse of others, or codependent relationships - through participation in one of the many twelve-step or twelve-step inspired recovery groups. You have learned, grown, and with the help of your program, become able to manage the biggest problem in your life: addiction. Through the powerful examples and support of others in the program, you have achieved a status called being in recovery - you've stopped an addictive habit, and its devastating effects are gone from your life.

The support of the twelve-step program, and the "family" feeling that develops among members, rebuilt your self-esteem, which was so devastated by addictive behavior. This self esteem begins to develop in much the same way it develops in a small child, based on rewards and approval for "good behavior" (maintaining abstinence or sobriety, and attending meetings). For many, it's the first time that their productive, healthy behavior has been rewarded.

Rebuilding self-esteem in those who have had it damaged can be a long-term process. Frequently the damage began in early childhood, and takes considerable support and encouragement to repair. As your self-esteem grows stronger, your investment in your recovery also grows, and your chances of remaining free of your addiction increase accordingly.

Twelve Step recovery programs are a brilliant combination of factors that help people who are caught up in overwhelming addictions get into, and stay in, recovery. Many components of the program contribute to keeping members invested in recovery - even when it's difficult.

Twelve Step Programs create a strong influence which effectively helps its members combat addiction through:

. The support of the group

. the accountability of regular meetings, (especially once you have made friends there)

. the constant availability of your sponsor

. the continuity and encouragement provided by receiving tokens for each month of sobriety (chips), and celebrating each anniversary of your sobriety (birthdays), and

. a program of corrective steps which provide an alternative to old, destructive behavior and thinking.

But most recovery programs stop there - they insist you can never move beyond recovery. The underlying emotional shortcomings (such as low self-esteem, lack of self-control, inability to establish intimacy, lack of motivation, and inhibited emotional expression) that made you addictive are not addressed. If you want to move from recovery to full healing (autonomy) you must confront and correct these deficiencies.

There are more accurate ways to measure health than simply looking at the duration of your sobriety. Factors such as self-esteem, self-awareness, self-control, emotional balance, and how you handle change, problems, and relationships all effect your emotional health.

Alcoholism : Beyond Recovery

Overcoming dependency and moving beyond recovery means having the self-confidence to face your problems on your own, learning to think calmly and rationally about stressful situations, and knowing you can handle difficulty without resorting to an addiction to people, substances, or behaviors - in short, achieving autonomy.

A twelve-step group focuses on helping you get into recovery, then simply accepts that you will continue to remain addicted forever. That's why you are told to "keep coming back" and that "recovery is forever". The program does not confront the emotional patterns that accompany the addiction. For example: you may have stopped drinking, but you still have difficulties forming lasting relationships; you may have overcome bingeing, but you are still unable to work out problems on the job; You may have stopped working compulsively, but you don't know how to get along with your spouse and children.

Problems Underlying Addiction

From a therapist's viewpoint, addiction is not the problem but the symptom of greater underlying problems. What are these problems? What are the causes of addiction?

Experienced recovery counselors maintain that addictive behaviors are actually ineffective attempts to heal or relieve intolerable pain. As Anne Wilson Schaef says, when we have our addiction to hide in, "we do not have to deal with our anger, pain, depression, confusion, or even our joy or we feel them only vaguely. We stop relying on our knowledge and our sense and start relying on our confused perceptions to tell us what we know and sense. In time, this lack of internal awareness deadens our internal processes, which in turn allows us to remain addicted."

Yet, many people have faced enormous pain and suffering from childhood on without resorting to addictive behaviors to help them hide from it. People who are disabled, disadvantaged and from broken homes can often successfully cope with pain on their own in a healthy, functional manner, every day of their lives. They believe they can cope on their own.

Those who turn to addiction, in contrast, feel that they are not strong, capable or smart enough to cope with life on their own and needed outside help to survive their pain and suffering. Pain does not cause addiction - the conviction that you are unable to cope with pain does. When you believe you can't handle difficulty, you look for a place to hide, for a person, substance or behavior you can depend on to help avoid the problem. Therapists call this belief dependency and it, not the pain, is the cause of addiction, compulsion, obsession, and co-dependency.

To completely overcome your addiction requires that you change the mental attitudes that perpetuate dependency and develop into an autonomous individual dependent only on yourself. These attitudes are:

Hopelessness – Habitually thinking "what's the use" or "I'm not capable anyway"; often accompanied by a belief that you're undeserving.

Helplessness – This is an attitude related to hopelessness, a doubt that you can set intentions and keep them, or that you can take care of yourself when necessary

Dependence on others – Believing you must get motivation, support and comfort from outside yourself, because you lack the ability to depend on yourself.

Fear of pain – Not knowing how to heal your old hurts; experiencing constant self-criticism; and the inability to face unresolved emotions such as fear, rage and guilt.

Self-abandonment – Being disconnected with yourself, not understanding of your responsibility to yourself, and no experience of the security and comfort of self-awareness and self-love.

Mindlessness – Not thinking clearly and not being aware of your own thoughts because you habitually look for answers to problems from others - an inability to problem-solve or consider options, and the resulting lack of choice.

These attitudes create a feeling of powerlessness. (That is: I cannot help myself, I am not strong enough to cope with life, fear, pain, helplessness, choices, relationships, and so on.) Dependency is a conviction that you cannot survive without the addiction, person, substance or behavior that you rely on. When you try, feelings of rage, fear and panic begin to emerge, overwhelming you, and sending you back to the "safety" of addiction, which you depend upon to numb or deaden them. Facing your unresolved feelings and painful history seems more terrifying than the ravages of alcohol, abuse, or even the health risks of compulsive smoking, overeating or workaholism - because you believe you can't cope without help.

"An addiction," writes Anne Wilson Schaef , author of When Society Becomes an Addict, "is any process over which we are powerless. It takes control of us, causing us to do and think things that are inconsistent with our personal values and leading us to become progressively more compulsive and obsessive."

One of the underlying pains of addiction is the buried fear of helplessness and dependency that comes from growing up in a dysfunctional family. As Dr. Timmon Cermak, founder of the National Association of Children of Alcoholics, writes in A Time To Heal, "In the midst of this unhealthy environment, COAs [Children of Alcoholics] must pass through the critical stages of developing trust, autonomy, mastery, identity and the ability to separate themselves from those around them." In a healthy family, your parents would help you progress from an infant's normal dependency through childhood exploration and adolescent separation to autonomous adulthood. However, when family dysfunction prevents you from completing this process, you remain stuck in dependency. Because you never feel strong enough or confident enough to cope with life on your own, you look to something outside yourself to help you through it. The result can be addiction to anything from work to religion.

If you had grown up in a healthy, functional family, you would have been gradually encouraged to become increasingly autonomous and more self-reliant. You would have received support when you efforts went wrong, and approval when they turned out successfully. You would have learned you could trust and depend on your own abilities to cope with the problems you encounter in life, and that you did not need to depend on others to do so for you. As a self-dependent or independent person, able to face life on your own two feet, you would be far less likely to turn to addiction to help you through painful experiences.

Addiction is a symptom of a dysfunctional childhood, but it becomes so destructive and so all-absorbing that you have to stop the addiction and begin recovery before you can begin to handle the true, underlying problem. As Schaef says, "At some point we must choose to recover - to arrest the progress of the addiction - or we will die." By getting into a program, you have made that choice.

By numbing feelings, addiction also blocks learning and growth for the period of time covered by the addiction. For this reason, the AA Big Book defines alcoholism as "a state of being in which the emotions have failed to grow to the stature of the intellect." So, if you are addicted (to gambling, substances, or codependent relationships) from age fifteen to thirty-two, your emotional development, attitudes and reactions when you enter recovery will still be those of an adolescent. When you finally end your cycle of destructive behavior your social, emotional, and many of your mental skills will not have advanced much beyond the level of development they had reached when your addiction started, as Carl's story illustrates.

Carl (who drank heavily from age fourteen through age twenty-eight) had achieved five years of sobriety at age thirty-three, but was left with the social skills and the emotional development of an abused fourteen -year-old. He did not know socially polite "small talk" or etiquette, the correct approach to ask a woman for a date, or how to develop a lasting relationship. After getting sober, Carl had to catch up with his contemporaries and learn social skills, information and knowledge that he missed. He came to me wanting to know "how to talk to women" and completely mystified about how to make friends, ask for a date, or develop a relationship. He had missed all the skills adolescents and young adults are supposed to learn.

To make the difference between early recovery and completed recovery ( autonomy) clear, the following chart is a comparison of the related attitudes:

Alcoholism : Recovery, Autonomy

Recovery

Self-control: Overcoming my addiction/ compulsion is the most important thing - I still occasionally feel strong urges to revert to old behavior. I need a lot of support and encouragement.

Gratification: I am focused on instant gratification. I feel deprived when I don't get what I want.

The Program: I work hard at the steps of my program. I do it because it works, but I don't really understand why. Honesty: I struggle to tell the truth - to myself and others.

Competence: I have a lot of unanswered questions: What is functional living? What is a healthy relationship? I don't think I have everything I need to make my life work.

Change: Changes are scary - I want security, and I'm afraid of disappointment. Problems: Problems seem huge and difficult - they might threaten my recovery.

Feelings: I don't know what to do about my intense emotions. They frighten me.

Self-awareness: I don't know who I am and I usually don't know what I feel and can't figure out what I want.

Autonomy

Self-control: Addiction is no longer a big issue: a temptation may come up now and then, but I know how to control my impulses.

Gratification: I understand the value of long-term goals and delayed gratification, and I can motivate myself to keep my long term goals.

The Program: I understand what keeps me emotionally healthy. I've modified the steps and developed my own program to suit my individual nature.

Honesty: Telling the truth to myself and others is easier for me because I realize my life works better when I do.

Competence: I feel effective in everyday life. I have the skills I need to be successful, and when I need new skills, to achieve my goals, I know can learn them.

Change: Change is fun, a challenge, inevitable, an opportunity for growth. Disappointment is a part of learning and growth.

Problems: Problems may be frustrating, but they usually can be solved. I can trust myself to refrain from addiction even when things go wrong. Feelings: Emotions are natural, welcome, easy to handle. My feelings are important and I know what to do about them. Self-awareness: I know myself well, including what I want and how I feel. I am my best friend, my own partner in life.

Clearly, recovery can only be a halfway point. It is not possible or appropriate for recovery groups to attempt to fill all of a member's needs. The specific intent of the programs is to steer you into recovery and halt addiction. It is not the program's job to move you beyond recovery. Restructuring the psychic system that created the behavior in the first place is beyond their scope.

In early recovery, having a definite program of steps to follow was an enormous aid to your progress. It gave you the first concrete plan for dealing with your addiction and you welcomed the structure, even though you may have struggled with it. You learned and grew a lot.

But if you expected that ending your addiction would create a life-changing revelation you were probably disappointed. Even after you stopped your destructive behavior, you still had the same internal problems as before. Frequent meetings and endless talks with sponsors and members help, but when you are alone, your doubt and disappointment are still there.

You need something more than what your recovery program is giving you, but you're afraid to tamper with an effective formula that you don't understand. You've been warned if you don't follow the steps you can have a relapse at any time. "Keep coming back", which was encouraging before, has begun to sound oppressive. You're now feeling better - but you may also be feeling stuck.

Completing Recovery

To move from early recovery- beyond addiction and dependency - to autonomy, you need to replace the dysfunctional models of their past with new skills. The skills you need to achieve autonomy are:

. effective communication
. taking risks
. problem solving
. coping with failure
. facing pain
. learning
. forgiveness
. independent behavior

Stuck in Recovery: Does it Have to Be Forever?

Twelve-step programs insist you identify yourself as a lifelong addict for a good reason. You are far more likely to relapse if you leave the continuing influence of the group before you have mastered autonomous skills and changed your underlying dependency. This is a truth learned from experience, and not as unreasonable or arbitrary as it might seem at first glance. All group members have witnessed many actual relapses suffered when members, even of long standing, leave the support of the group.

Another good reason to identify yourself as a lifelong addict is that people caught up in addictive behavior have a truly astounding capacity to deny problems, to block them out. Addictive people often have learned to rationalize away even very destructive behavior - such as losing jobs and loved ones because of drinking, repeatedly going back to a battering spouse, or gambling away the rent money. Here's what denial sounds like:

I can stop anytime.
He/she really needs me.
I'll win it all back next week.
It's all my (husband, wife, boss)'s fault.
I just can't resist a good bargain.
No one else will get the work done right.
It's not so bad.
Everyone messes up.

Alcoholism : Causes of Relapse

People in denial often minimize the problem and believe they're cured as soon as the twelve-step program begins to help them gain control and they stop the damaging behavior. They then leave the program's support prematurely, before completing the work of the Twelve Steps. Hence, the danger of continual relapses (frequently demonstrated by public figures such as Robert Downey Jr, Charlie Sheen, and Whitney Houston) into the old, destructive behavior.

Former child star, now actress and director, Drew Barrymore learned this fact the hard way, when she prematurely announced that she was "cured" of her alcoholism in media interviews, then had several public relapses. She told People magazine: "The truth is that you are never fully mended. There is no happy ending because there is no end to the struggle for a clean and sober life." She has since been successful in recovery and in her career.

The addict's "quick fix" mentality is another factor in causing relapses for those who leave the program prematurely. If you have been addictive, compulsive, or obsessive you are probably familiar with this tendency to look for a quick or easy answer.

The twelve-step programs and most of the other recovery groups combat the relapses caused by denial and the quick fix mentality by reminding you that quitting destructive behavior alone is not enough and telling you that you will never get beyond recovery. That's why the twelve-step programs urge you not to refer to yourself as "recovered" but "in recovery." In order to tell your story at meetings, you must first say, "I am a recovering alcoholic (addict, overeater, and so on)...." As an AA pamphlet states: "...alcoholism does not go away... recovery is forever..."

In recent years, sponsors, researchers, and alcoholism counselors within the program are recognizing that there are different stages of recovery. People who have been in recovery for enough time to work a program, gain experience in sobriety, and mastered all the steps eventually are said to attain "second and third stage" recovery. I agree with these stages, and maintain that growth can continue even beyond them.

Recovery only lasts forever when nothing is done to combat addiction's underlying causes - when the emotional problems and dependent attitudes that precipitated the addictive behavior still exist.

One sign of this failure to address the patterns that created the addiction is a condition Alcoholics Anonymous calls a dry drunk. This occurs when someone has stopped drinking, but still exhibits "absence of favorable change in ...attitudes and behavior... or the reversion to these attitudes and behavior by the alcoholic who has experienced a period of successful sobriety." A dry drunk is someone who is not recovering from the addictive process and the unhealthy attitudes that created it.

As Dr. R. J. Solberg, alcoholism expert, puts it in the A.A. publication The Dry Drunk Syndrome, "The alcoholic, when drinking, has learned to rely on a deeply inadequate, radically immature approach to solving life's problems. And this is exactly what one sees in the dry drunk." Dr. Solberg describes the "obvious traits" of a "full-blown dry drunk":

Grandiosity -unrealistic expectations of your own abilities,
Judgmentalism - being highly critical of others,
Intolerance - not accepting others' individual mistakes or differences,
Impulsivity - acting without thinking,
Indecisiveness - inability to make up your mind,
Dishonesty - lying, cheating, making false promises,
Controlling - pressuring others into doing what you want, and
Self-centeredness - unable to consider others' feelings and needs.

According to Anne Wilson Schaef, the "dry drunk syndrome" means you can be in recovery and still be addicted: "Individuals who are not chemically dependent and yet function in the addictive process are on a dry drunk." Recovery literature implicitly recognizes the connection between relapse and failure to address the causes of addictive behavior. Dr. Solberg writes that the condition is dangerous because "...every relapse is preceded by a dry drunk which was allowed to go untreated."

The remaining reason that sponsors and members of twelve-step programs believe that recovery is forever is that those who created and maintained the program did so as a result of their own involvement with compulsion and obsession. In short, their conviction that recovery is forever may be a symptom of the very lack of self-trust and self-confidence that led to their own difficulties in recovering from addiction. Having spent years unsuccessfully struggling, unable to manage their own addiction without the constant support of a group, they become convinced that no one can. In fact, their very expertise in the field may be a resolution of a dilemma: How do you continue to grow and challenge yourself and still remain in recovery? The answer is: Become more and more expert about addiction.

However, the constant admonition to "keep coming back" can also mean that a member who has recovered sufficiently to venture out independently from the group will feel guilty for leaving. Members whose developing self-esteem is undermined by the resulting guilt feelings tend to react in one of two ways: Either they abandon their fledgling impulses toward autonomy and further growth and return to an even more complete dependency on the group; or they escape back into their old addictive behavior.

Because twelve-step programs often feel like "family," they can have a powerful influence. To the degree that you allow them to undercut your autonomy, and keep you dependent, they can replicate your original, dysfunctional family.

Susan

Susan, a thirty-two - year- old recovering from codependency, faithfully worked her program for two years, and began to feel stronger. She sought the encouragement of friends outside the program, and began to realize her dream: to open her own flower shop. Things went very well, at first, because Susan had a flair for floral design, and was personable with customers.

Then, the shop began to get very busy. Susan felt stressed. She was attending three meetings a week, and working constantly at her shop. After being exhausted and stressed for several months, she decided to drop her meetings. This gave her the extra time she needed for herself, but it had consequences: she felt guilty and afraid of relapse, and her friends from meeting began telling her she needed her meetings, and she was making a big mistake. Soon, they stopped calling her. Susan ignored her fear and stress for a while, but without emotional support, her enthusiasm for her business began to falter. She began overeating and bingeing, she became panicky and disorganized, and she eventually gave up her store lease and moved the faltering floral business into her home. She was in despair, and ready to give up, go back to being a secretary (which she hated), and attend all her old meetings. Susan says: "I was a mess - worse than before I joined CoDA. I even talked to a Doctor and tried prescription drugs, but they just made me drowsy. The anxiety was still there. I began to feel suicidal."

A concerned friend, seeing that Susan was overloaded with guilt and self-doubt, suggested therapy. In counseling, Susan got the help she needed to examine her decisions of the past year. Soon she was able to see that her problems had merely been the normal things that happen with a new business, and her relapse occurred because she let her guilt and fears override her thinking ability. We worked to resolve her fear of failure, which originally came from a family belief that she was the "pretty one" and "not too bright"; but was exaggerated by her twelve-step friends' insistence that she would fail if she left the group.

She got in control of her eating again, made friends among other people in the floral business, and reevaluated what she wanted to do with floral design. This time, she designed her business to meet her needs and desires, kept it smaller, to be less overwhelming, and took some courses in business, and ignored what friends thought she should do. Susan is now enjoying a small, exclusive and thriving business, and she has time for a social life, recreation, friends and romance. She says, " Without advice or help from anyone who knew floral business skills, I got frightened and confused, and stopped doing what I already knew how to do to keep myself healthy. I know now that it's my responsibility - not the program's, to keep me doing what I know is right, and to learn what I need to know."

Feeling stuck in the Twelve Steps is like being admitted into school to learn a skill, and never told how to graduate, no matter how competent you become. In this (twelve- step) school, a student may turn around and become a teacher (a sponsor), but there are no instructions for graduating honorably and finally.

This lack of encouragement begins to undermine the self-esteem so painstakingly won through the program. Although many people have successfully withdrawn from the program, they generally feel guilty and insecure about their ability to succeed on their own for years after leaving. This guilt and insecurity, coupled with a lack of information about achieving autonomy, can be a cause for relapse, which provides an excuse to return to the safety of the group. The less adventurous never leave at all. To encourage health and growth, twelve-step programs need a provision for graduation and moving on. They need a Thirteenth Step.

Alcoholism : Ready for the Thirteenth Step

Recovery is not a quick and easy process, but although the skepticism caused by relapses is understandable, you do not have to be in recovery forever. The experience of many people who have achieved autonomy beyond the twelve step programs proves that it is possible for a dysfunctional or "radically immature" person to mature, to become functional, and to develop a permanent and enduring ability to remain free from dependency and addiction.

You may already feel that you are ready for graduation and to take the Thirteenth Step to personal autonomy. Or, if you still believe that recovery is forever, you may be ready to take the step and not be aware of it - you may have dismissed the restless signs as denial, or further evidence of your own emotional problems. How do you tell if your feeling of restlessness and of having gotten all you can out of the group is simply denial or if it is a legitimate indication that you are ready to move on to healing and autonomy? The following quiz is designed to help you decide if you have completed the work of recovery and are ready for the Real Thirteenth Step. Answer the questions yes or no:

Quiz: Are You Truly Ready to Complete Recovery?

1. Have you identified and admitted your obsessive, compulsive or addictive behavior?

2. Have you maintained abstinence or sobriety for six months to one year without relapse?

3. Have you completed each of the Twelve Steps at least once, or completed the steps of another recovery program?

4. Have you been following your program faithfully for at least this time period?

5. Do you have a sponsor, buddy, therapist or other knowledgeable person with whom you discuss your problems in recovery?

6. Do you devote some time each day to meditation, prayer, or solitary contemplation?

7. Have you become aware of the difference between your conscious personality and the Higher Power within?

8. Have you learned to recognize and handle successfully the triggers and mechanisms that set off your compulsive/addictive behavior?

9. Have you shared your story repeatedly with others, and listened to theirs?

10. Are you able to rely on others for support and ask for help when you need it?

11. Have you had a successful relationship with a sponsor, buddy or other support person for a significant time?

12. If you are from a severely dysfunctional family, or a survivor of abuse or incest; have you had sufficient therapy, individually, and/or in group, to heal the damaging legacy of your childhood?

13. Have you severed or limited all relationships with people who supported your addictions and compulsions; unless they are also fully in recovery?

14. Can you say "no" when tempted or pressured?

15. Do you know the difference between instant and deferred gratification, and can you choose intelligently between them?

16. Can you act on thoughtful decisions instead of impulsively react to events and circumstances?

17. Do you have a clear sense of who you are, and what your goals are?

If you can answer yes to most of these seventeen questions, you are probably ready to take the Thirteenth Step.

If most of your answers were no, you need to do further work within a recovery group to overcome the worst of your dependency and addiction while you learn the additional skills you need to complete recovery.

Either way, you'll find that the exercises, guidelines, case histories information in this book will help you understand the underlying causes of your addictive behavior, and help you develop the emotional maturity and psychological tools necessary for autonomy.

Surrendering the Dream of Dependency

What is completing recovery? Of course it begins with entering recovery in the first place, but eventually moves beyond it. "My Wednesday night meeting has so many new people... I need to hear more recovery." said Ava, thirty- five, describing her changing attitudes after a few years in CoDA, "It's good for me to go to that meeting and share my recovery, that's my Twelfth Step; but I'm also joining another meeting where I can hear less of 'I'm having this terrible problem, and it's awful.' and more of 'I'm having a problem, and here's what I'm doing about it.'" Ava's description pinpoints the essence of recovery - moving from absorption with the problem to focus on the solution. In order to move beyond recovery toward a healthy and independent life, you must have laid that groundwork; but there are still hurdles to overcome. "As the price of liberty is vigilance - so the price of independence is self-determination, the price of dignity is self-assertion, and the price of respect is self-respect," wrote psychiatrist Dr. Thomas Szasz.

Self-determination and self-respect are the necessary keys most dependent people need to be able to take full responsibility for and control over their own lives. Without these keys, dependent people are like Teddy, a well-educated and talented man who, when he began to be aware of his internal attitudes, said in frustration, "I'm 36, and I still live my life as though someone else is in charge of it." Why does Teddy feel this way? Because he believes others can take care of him and advise and protect him from harm better than he could himself. To feel wholly in charge of himself and his life Teddy must give up the dream that there is someone else who can make it better, who can take total care of him, who can be responsible for him more effectively than he can himself.

My clients in recovery all exhibit this lack of belief in themselves - it is what I call the Dream of Dependency. This dream is seductive, because it encourages a fantasy view of life without responsibility or consequences.

Clients have this dream for three reasons: 1) when they were little their parents led them to believe that someone would take care of them and make it better; 2) dysfunctional parents failed to teach them the skills necessary to take care of themselves and consequently, 3) they never learned to feel capable of being responsible for t