Thoughts on If You Work It, It Works!
Does Alcoholics Anonymous work and if so does it matter whether or not one actually works the steps? If it does work, how does it work, and how do we know that it works? Clinical Psychologist Joseph Nowinski’s new book provides the answer to these questions. If You Work It, It Works!
Dr. Nowinski is an internationally acclaimed psychologist and author. He is the primary author of Twelve Step Facilitation Therapy, an important work in the field of addiction treatment which is included in the National Registry of Evidence-based Programs and Practices. In If You Work It, It Works!, Nowinski explains complex scientific studies in language a layperson can easily understand. Whether you are actively participating in a Twelve Step Program or just realizing that you may have a problem, I believe you will find this book informative, helpful and inspiring.
The studies Nowinski cites focus on the effectiveness of Twelve Step programs for those who actually work the program. Most of the studies define “working the program” as attending meetings, identifying as an A.A. member, getting a sponsor and working the steps. Unfortunately about half of all people who attend A.A. will never do these things and they drop out after only three months. There are a number of reasons for dropping out; they may feel uncomfortable, suffer from social anxiety, perhaps they had a single negative experience giving them a bad impression of the program, or they were turned off by the spirituality of the program and the frequent mention of God. This book doesn’t address the fate of those people.
The first section of the book covers various studies that were performed over long periods of time, in multiple locations and with results that were replicated. The findings of these studies will be of particular interest to A.A. members and validate much of A.A. experience. The most common measure of success used in these studies was the percentage of days abstinent and the number of drinks per drinking day. It was found that those who actively participate in Twelve Step programs experience significantly higher percentage of days abstinent and fewer drinks per day if they slip.
However, simply attending meetings isn’t enough. Recovery begins as an inside job, one has to want to get clean and sober. I recall that before I made it to A.A., the people who pleaded with me to get help told me to do it for myself. As it turns out, science has proven their advice to be spot on. In studies where a person was given an external reward, say $20 for attending A.A. meetings, they were less likely to experience a successful recovery. The higher recovery rates were realized by those who believed they were doing something for themselves, and this attitude was helpful to their self-esteem.
It’s also critical that one identifies as a member of A.A. As Nowinski puts it, “they need to feel that they are on the inside looking out rather than the outside looking in”. This shows the importance of helping the newcomer feel welcome especially during that critical first three months when the dropout rate is so high. It’s also important for the newcomer to get a sponsor and the sooner the better. The evidence shows that those who get a sponsor during the first three months experience higher percentage of days abstinent than those who don’t get a sponsor. The old saying that the newcomer is the most important person in the room is very true.
Those of us who have spent any time at all in A.A. have no doubt heard, “change your playmates and playgrounds”. In other words, don’t hang out in bars with old drinking friends. This is good advice but studies show that it’s actually more important to add one non-drinking person to one’s support network than to eliminate a person who doesn’t support recovery. Just avoiding playgrounds and playmates won’t do the trick. In order to increase chances of recovery, it’s important to have a network of people who support abstinence. A.A. with over two million members world-wide provides an incredible network of support.
There have actually been scientific studies that examined the efficacy of working specific steps by placing them in categories of behavioral steps and spiritual steps. For the purpose of the studies, spirituality was defined in terms of ethics, values and living a meaningful life. It had nothing to do with religion or even a belief in a god.
There is a line from the Big Book that I unintentionally have committed to memory:
“Selfishness, self-centeredness, that we think is the root of our troubles, driven by a hundred forms of fear, self-delusion, self-seeking, and self-pity, we step on the toes of our fellows and they retaliate. Sometimes they hurt us, seemingly without provocation, but we invariably find that at some time in the past we have made decisions based on self which later placed us in a position to be hurt”.
Dr. Nowinski quoted this statement as an example of the insight that Bill W. had of the importance of ego reduction and reaching out to help others. Spirituality in A. A. is about altruism, honesty, building character and reducing one’s ego by reaching out to help others. Studies cited in the book indicate that this “spiritual work” contributes to sustained recovery.
There’s much more to If You Work It, It Works than what I could describe in this short essay, and I will surely return to it in the future and gain further insight. Though this was not the intention of the book necessarily, it did help guide me through my continuing journey as an atheist in A.A. and to somehow find a place for what we commonly term “spirituality”.
I have always seen value in the steps, but recently I have begun to see them as more about personal growth than about staying sober. I am changing that view in light of the evidence presented in this book. The steps do have an impact on continuing sobriety. In particular, I am going to spend more time learning about the practice of meditation as Step Eleven was shown to be particularly helpful in one of the studies. Though I agree that the so called “spiritual” steps promote sustained sobriety, I will make a point to avoid using the word “spiritual” and be more specific with the words I choose to describe the experience. Terms such as honesty, humility, character, altruism, shift in thinking, psychic change convey human traits and experiences we can all understand .
After reading the book, I have changed my opinion about sponsorship and I now support the idea of the newcomer getting a sponsor as soon as possible, especially during those first three months. My former opinion was that he or she wait a while and get to know people in the group before selecting a sponsor. My concern was that they could end up with an authoritative drill sergeant sponsor. Now, I view sponsorship as a means of helping the newcomer feel part of A.A. and of providing additional support early on in the recovery process. The risk of an overbearing sponsor is much less dangerous than a relapse to drinking.
Finally, I am further convinced of the importance of devoting attention to the newcomer and removing barriers to recovery. In particular, there is no reason that spirituality should drive people away from A.A. How many people leave and never return because at their first A.A. meeting they are asked to join hands and recite the Lord’s Prayer? How many of these people end up dying from alcoholism? We may never know the answer, but I have seen from personal experience at our We Agnostics group in Kansas City that people who were avoiding A.A. because of the perception of it being a religious program are now finding recovery at our meeting.
Let’s continue to widen the gateway to recovery for all. Lives depend upon it.
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