Volume 29 Number 46
December 4, 2017
Alcoholism & Drug Abuse Weekly

The 12 Steps of Alcoholics Anonymous
The 12 Steps of Alcoholics Anonymous, part of the foundation of AA
Many people mistakenly define the 12 Steps as a treatment approach, which therefore somehow serves to exclude other strategies in working with patients with addictions. In reality, the Steps are more of a philosophy that can serve as a foundation around nearly every accepted treatment modality, which is why a wide range of programs are able to integrate the Steps into their patients’ experiences in treatment every day. “The 12 Steps are more of a point of view, which means you can believe all that and still do straight ahead [cognitive behavioral therapy],” Keith Humphreys, Ph.D., section director for mental health policy at Stanford University’s Department of Psychiatry and Behavioral Sciences, told ADAW.

“People think of the 12 Steps as a rigid set of procedures. It’s not,” Humphreys said. He is quick to remind, in fact, that one of the adages in the Big Book of Alcoholics Anonymous (AA) is that “the 12 Steps are but suggestions.” The 28-day residential programs that were the most fervent in structuring each week of treatment around a progression through the Steps may be fading in today’s market, but the treatment field’s belief in the power of the Steps certainly has not diminished. Twelve-Step Facilitation is a research-based practice in which programs seek to help patients establish lasting connections with recovery support resources in the community. This effort is based on the realization that when addressing a chronic disease, the meaningful and ongoing connections that patients can establish post-treatment may prove more important than what happens in the time-limited context of a primary treatment stay.

Looking through the 12-Step lens

This establishes a repetitive pattern, it reminds patients of the small actions they will need to take in order to stay in recovery every day.
– Cinde Stewart Freeman discussing a New Design for Living for individuals in Recovery

ADAW spoke with Cinde Stewart Freeman, chief clinical officer at Cumberland Heights in Nashville, Tennessee, who explained, “We use a variety of evidence-based practices that operate through the lens of a 12-Step-based philosophy.” Cumberland Heights patients’ exposure to the Steps is early and frequent, although Freeman says their very first experience with the Steps might actually occur unconsciously. A daily routine that includes morning meditation, periodic pauses to check in at intervals during the day, etc., is grounded in the Big Book’s Design for Daily Living. “This establishes a repetitive pattern,” Freeman said. “It reminds patients of the small actions they will need to take in order to stay in recovery every day.” In their orientation to treatment at Cumberland Heights, patients are introduced to the Steps, but not simply in terms of what the principles are. The practices that go with that, and the importance of the 12-Step fellowship, are emphasized from the start, Freeman said. Every patient who comes in receives a copy of either the AA Big Book or the basic text of Narcotics Anonymous, Freeman said. These are used in numerous ways over the course of treatment, which in many of the facility’s program lasts for around a month. The night staff in the residences are very familiar with the texts and will be able to use them in a practical fashion when everyday problems such as an uncomfortable phone conversation with a spouse or a spat with a roommate threaten to distract. “These things seem ginormous when someone is struggling with recovery, and they often make people want to leave [the facility],” Freeman said. Staff will be able to use specifics from the Big Book to show how these everyday concerns can be addressed. “In that way the books are treated not as literature, but as instruction manuals,” she said.

Meeting attendance

Attendance at 12-Step meetings also becomes an important component of a Cumberland Heights patient’s treatment stay. Freeman said an on-site AA meeting takes place at the facility every Friday, but the majority of the meetings patients attend while in treatment are located out in the community. “We try to get people to meetings at least three times a week,” Freeman said. “We want them to experience different meetings,” which will help familiarize them with the types of recovery support options that will be available to them posttreatment, she said.

Cumberland Heights patients routinely rank their experiences in community meetings favorably in patient satisfaction surveys. “They see what people are like out in real life,” Freeman said. “People there are talking about real problems. It lends a genuineness to things. It leaves patients thinking, ‘Maybe I can really do this.'” Ironically, some research has shown that patients who have the opportunity to attend in-facility support meetings have better outcomes, says John F. Kelly, Ph.D., associate professor of psychiatry in addiction medicine at Harvard Medical School. Both a program’s outreach into the community and its ability to provide resources in-house appear to have a significant impact, Kelly indicated. Kelly told ADAW that residential programs tend to be able to incorporate more components of the 12 Steps because they have more time with the patient. Outpatient programs still can have an impact by exposing
patients to the roles of 12-Step groups and sponsors. “Ideally you can have a warm handoff” to resources in the community, he said.

A good fit with therapy

Even for a program as steeped in the 12 Step philosophy as Cumberland Heights, “That’s not all we do,” Freeman said. She said her staff ‘People think of the Steps as a rigid set of procedures. It’s not.’ Keith Humphreys, Ph.D. colleagues probably have grown tired of hearing her say, “If all we do is what AA and NA did, we need to charge just a dollar.” Therefore, the organization has worked to understand how numerous treatment modalities can work through a 12 Step lens. Freeman said Cumberland Heights has worked with clinical experts at the Center for Dependency, Addiction & Rehabilitation (CeDAR) at the University of Colorado Hospital to incorporate a 12-Step-influenced model of dialectical behavior therapy. It also has tailored interventionist Judith Landau’s ARISE model to its 12 Step framework, helping patients to see the issues they are facing in a familial context. Around two-thirds of Cumberland Heights staff are in recovery, but the organization’s leaders want all employees to be literate in the Steps. The organization is establishing what leaders affectionately call a 12-Step “boot camp” for new employees, Freeman said. Humphreys believes that a 12 Step philosophy basically can fit with any research-supported treatment modality — with possibly one exception.

“We know there is a class of people who will wind up as moderate drinkers,” he said. “That doesn’t mesh with people’s understanding of the Steps.” Ironically, that is the case despite language in the Big Book that references some people ultimately being able to drink “like a gent,” or in moderation, he said.

AUTHOR: Nancy Floyd | PHOTOGRAPHER: Eric England | DATE: APRIL 28, 2017

 

The Reaching New Heights luncheon for Cumberland Heights reached new heights indeed with a record-size crowd showing up for the annual women’s fundraiser at Hillwood Country Club. Co-chairs Grace Clayton and Kathleen Estes joked that they’d like to take all of the credit for the sold-out event, but they knew the real draw was keynote speaker Jeannette Walls, the best-selling author of The Glass Castle, The Silver Star and Half Broke Horses.

 

Fans of The Glass Castle — which appeared to be just about everyone in the room — were thrilled to hear Jeannette recount many of the memoir’s most remarkable stories along with several other tales from her unconventional childhood. Alternating between humor and poignancy, Jeannette took the audience on a journey from her troubled upbringing to her discontented young adulthood to the place of peace and acceptance she found once she learned to embrace her past. And at an event benefiting Cumberland Heights, which provides treatment for drug and alcohol addiction, Jeannette’s heartfelt words about her alcoholic father resonated with everyone in the crowd, particularly a story about how, as a child, she hunted for an imaginary monster called Demon with her dad in the Arizona desert.

 

“He couldn’t battle his own demons, but he gave me the tools to battle mine,” she shared.

 

Jeannette proved to be as down-to-earth, funny and warm as she comes across in her books, chatting and posing for photos with women before the luncheon and long after it concluded. For someone who has been wildly successful in her career, it’s obvious Jeannette’s true passion is finding ways to use her past to help others. Prior to the luncheon, when asked how it feels to share her story with a roomful of women who have battled addiction or been touched by it in some way, she said, “It doesn’t get any better than that. That’s what it’s about. That’s what storytelling is about … It’s connecting with people and having your story mean something.” Her story certainly meant something to this crowd and to Cumberland Heights, which raised $140,000 at the luncheon for the women’s program, funds that will go a long way in offering redemption and hope to countless women across Middle Tennessee and beyond.

 

Photo Gallery of the Reaching New Heights luncheon for Cumberland Heights Event

NASHVILLE, Tenn. (WKRN) – A hard hit can do more than just knock the wind out of a player on the field. It can leave them with an injury requiring medical attention and possibly pain medication.
“Sports are probably the leading cause of injury in kids but I think it is important to understand that sports in general are protective,” Dr. Alex Diamond said. “We know kids who play sports compared to kids who don’t are typically less likely to be involved in risky behaviors.”

 
High school sports injuries can lead to addiction depending on treatmentDr. Diamond is an assistant professor of Orthopedics and Pediatrics at Vanderbilt University Medical Center. He is also the team physician for Vanderbilt University, Nashville Predators and the Nashville sounds. He along with the other physicians at in his department treated 26,000 adult and children athletes in 2016.
“As physicians we need to be mindful when treating children with injuries what situation require pain medication and what situations can be handled without pain medication,” he said. “Most of them can be handled without pain medications.”

 
Pain medications like hydrocodone, oxycodone and other opioids can be very effective in treating chronic pain. But, they can also be addictive and lead to more illicit drugs like heroin.

 
At Cumberland Heights, a non-profit addiction treatment facility, the number of teens entering the facility’s Adolescent and Young Men’s Services department has grown so much in the past couple of months it is expanding to keep up with the need.

 
“We take kids from all over the country,” Director of Adolescent and Young Men’s Services Dean Porterfield said. “The primary diagnosis is substance abuse, but It is not uncommon though that the underlying issues once you take those substances away are anxiety, depression or trauma.”

 
According to Porter for the 18 year old to 25 year old age group that makes up the Young Men’s program a growing number are addicted to heroin.

 
“A notable factor with the young adult population that we serve is that several of them are athletes who have experienced high school or college sports injuries that have required surgery and have become addicted to painkillers.”

 
He continued, “When the painkillers run out or they become more expensive the more accessible affordable drug is the heroin. That replaces what used to be that passion for sports and athletics and now their primary goal is to drug seek.”

 
Porterfield said with heroin it is not uncommon for the treatment center to get a call from family or the patient themselves saying they are in route for immediate admission to the facility.

 
“They are also some of the most vulnerable patients and need a great deal of attention throughout the painful detox and early days of treatment to prevent them from leaving against medical advice,” he said. “One of the things Cumberland Heights clinicians have made a priority is educating these young men on the risks of relapse and the lethal dangers associated with resuming the volume of heroin use they came in handling with the assumption their tolerance level is the same.”

 
He continued, “This scenario increases the likely hood of a lethal overdose.”

 
At Cumberland Heights the process is based on the 12-Steps.

 
After detox the work begins to help the young men understand the underlying reasons they abused drugs. In many cases its tied to the emotion effect their injury had on them and their identities.

 
“Just being an adolescent adult in general is full of ups and downs,” Porterfield said. “When they realize this substance can help alleviate that, they get hooked pretty quick.”
The same progression from painkillers to heroin and stronger opioids is much the same in adult users.

 
According to the CDC Tennessee is one of the most overprescribed states for painkillers.

 
At one point doctor’s wrote more prescriptions for painkillers than there were people in the state.

 
“As physicians we need to be mindful when treating children with injuries about which situations require pain medication and what situations can be handled without pain medication,” he said.

 
“We have a lot of other options that don’t have the same complications and risk involved with addiction.”

 
Dr. Diamond said things like physical therapy, proper braces or casts and anti-inflammatory medications can be very effective.

 
“As a parent you need to be diligent on what pain medication your kids are getting,” he said. “For the most part the narcotic pain medication is not needed for what we are seeing in our children. It is very rare.”

 
Porterfield said parents should be involved in their teens lives take note if you start to notice missing money, missing prescription medication, if your child is hanging out with friends or in places you do not know, and if your child attends unsupervised parties.

 


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