Tag Archives: Step Work

Tag Archives: Step Work


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.

Back to Basics – FREE Intensive 12 Step Workshop open to ALL in Recovery!

The Original AA Big Book Manuscript written by Bill W
One page of Chapter 5, “How it Works”, part of The Original AA Big Book Manuscript with edit notes. Very Cool.
Due to concerns regarding inclement weather of snow/ice on the weekend of January 12th & 13th, the Back to Basics has been rescheduled for Saturday, February 24th (same time from 9:30AM – 3:30PM). Please make sure to save this date on your calendar.


WHO: Open to all persons in recovery!
WHAT: An intensive 12 step workshop
WHEN: RESCHEDULE: Saturday, February 24, 2018 from 9:30AM – 3:30PM
WHERE: Cumberland Heights Main Campus in the Dr. John Ishee Auditorium

Also due to the AMAZING participation response we are at capacity for the Back to Basics course. The RSVP for this event is CLOSED. Sorry! We will start a waiting list in the event of any cancellations. If you are not able to attend, please let Jaime Gibbons know you won’t make it and free up a spot for someone else.

CANCELLATIONSWAITING LIST

Cumberland Heights will be hosting an intensive 12 step workshop, much like the original step working format from the 1940’s. This workshop is open to all persons in recovery. This includes all 12 Step fellowships.  Lunch will also be provided free of charge.

All materials will be provided for participants.

This workshop will be facilitated by Carver Brown, a Behavioral Health & Addiction Services’ Alumni Coordinator at Pine Grove. Mr. Brown is an experienced facilitator of the “Back to Basics” nationwide and we are very proud to welcome him here at Cumberland Heights. Please remember this workshop is open to everyone in recovery, including all varieties of 12 Step fellowships. We hope to have you sign up below and see you on January 13th!

We will begin promptly at 9:30AM, please make sure to arrive at least 15 minutes prior to get your supplies and seats. Lunch provided will be free from the Kitchen and during lunch there will be an assignment to process with your partner or small group. Please be prepared to stay for the duration of the workshop, each participant should begin and end the day with the group.



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