Tag Archives: The 12 Steps

Tag Archives: The 12 Steps


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.

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.

 


For six years, Jason Isbell was drunk at every show he played.

During his tenure with beloved Southern rockers Drive-By Truckers, Isbell planned his drinking to keep him on his feet for the duration of the band’s marathon live shows – barely.

Something More Than Free: Jason Isbell's Journey to His Most Popular Album | Grammy Awards 2016, Individual Class“I had it timed where, by the very end of the show, I’d done just about all I could do standing up,” he told NPR in 2013. “I knew I needed two or three before I went on, and then during the show, we’d just pass a bottle around between the band.” The routine totaled about a fifth of Jack Daniels per show.

And Jack and Jason didn’t get along well: “Some people get drunk and become kind of sweet,” Patterson Hood, Drive-By Truckers founder and singer-songwriter, told The New York Times Magazine in 2013. “Jason wasn’t one of those people.” It didn’t help that the younger Isbell, a virtuoso guitarist with a proclivity for fast and fiery licks, was also a stellar songwriter, whose finely wrought and frequently heartbreaking character sketches were obviously on par with those of the older and principal Truckers, Hood and guitarist/singer-songwriter Mike Cooley. Isbell, who also managed to marry and divorce then-Truckers bassist Shonna Tucker during his time with the band, left in 2007. At the time, it was portrayed as amicable; in 2013, Isbell revealed he’d been forced out, mostly because of his drinking.

After his dismissal from DBT, Isbell went off the rails a little bit. He was arrested for public drunkenness and at one point accused Dierks Bentley of plagiarizing one of his songs on Twitter. He knew he needed help, and told his then-girlfriend, fellow musician Amanda Shires, he had to go to rehab. Unfortunately, both times he said it, he was drunk. “I only got to do that twice, I think,” he told NPR. The second time, Shires told him, “You’re telling the wrong person.”

Isbell got the message, and in February 2012, spent two weeks in Cumberland Heights, a rehab center in Nashville. Coming out, he started playing live again, dropped 40 lbs. and started writing the songs that would make up 2013’sSoutheastern. That September, Isbell’s song “Alabama Pines” won song of the year at the Americana Music Awards, kick-starting a wave of critical appreciation that Southeastern built upon when it was released in July 2013. The album contains Isbell’s most-streamed song on Spotify, “Cover Me Up,” and the devastating “Elephant” – coined by one music writer as “the saddest song of the millennium” – a quiet ballad about a cancer patient that concludes, “no one dies with dignity.”

Isbell toured steadily behind Southeastern, backed by a crack band named the 400 Unit – after the psychiatric ward of a hospital near Muscle Shoals, Alabama, where Isbell grew up – that included his now-wife Shires. (“She has a big conscience, a big heart,” he told Rolling Stone in 2013. “Essentially, she’s just a good person.”)

Southeastern was rewarded with a near-sweep at the 2014 Americana Music Awards that saw Isbell take the honors for album, song (“Cover Me Up”) and artist of the year. But none of that weighed on his mind when he returned to the studio for his follow-up, 2015’s Something More Than Free. “I have so many people ask me… ‘Did you feel pressure to follow up Southeastern?” Isbell told Stereogum in 2015. “That same question every damn time! No, that’s not an actual problem to have. I know people who can’t pay their f—ing bills. Following up a successful piece of work with another piece of work is the most ridiculous first-world problem I can think of.”

Sure enough, Something More Than Free was a mature, confident continuation of the work Isbell started with Southeastern. Anchored by the stellar lead single, “24 Frames,” it debuted at No. 1 on Billboard‘s Top Rock, Top Country Albums and Top Folk Albums charts, and No. 5 on the Billboard200. By way of comparison, Southeastern peaked at No. 23 on the Billboard200.


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