Running out the door at the end of a long day, I paused to talk with Matt Tierney, our resident substance use expert, about the conversations I had yesterday about 12 step programs, their value and the role they play in people’s lives.
When I was new to psychiatry, I had a natural antipathy to 12 step. It seemed to embody the notion of rigid rules about behavior that always tended to make me feel rebellious. Of course, at the time, it was also true that 12 step programs often had very dogmatic views about psychiatric medications, views which most of them have since modified.
So at the onset, I was not well disposed to AA. In fact, I spent some time researching the effectiveness literature because I wondered whether there was any evidence that AA works. There is plenty of evidence, but most of it is methodologically flawed in a way that makes it difficult to really measure the impact of AA on preventing substance use or preventing harmful substance use.
But that wasn’t the reason I paused to talk with Matt, really it was the recognition that the people that I have been working with recently who have been the most consistent and long-term participants in AA programs have really impressed me with their maturity and psychological sophistication. They got me thinking about the negative reactions I had when I was younger.
Matt’s comments were first, that in joining AA, as in almost any other endeavor, including psychiatric treatment, the key is to “take what you need and leave the rest.” Now the dilemma with that is that sometimes we don’t know what we need, but the point is that if there’s something really irritating about AA (sometimes it has to do with a notion of a higher power) then you should leave that on the AA plate and see what else there is from AA that you can use and benefit from.
Also, AA is a set of guidelines and not rules, whatever some of the AA members might tell you.
And, finally, as we get older and more mature, we often find ways of understanding organizations and rules like those from AA and from churches, and incorporating them in some way into our own psychology and sense of the world. We refashion them to make them make sense for us, and that is what all of these long-term AA people have done.
At the end of our brief conversation as I was going out the door, Matt said, that there is a quote that he heard a couple of years ago that has really stuck with him, the Dalai Lama was asked what was the most relevant spiritual practice for the modern world. He didn’t say Buddhism, or meditation, or any of the things you might have expected. He said 12 step programs.
In another note, we are hoping to arrange an interview with Matt later in this month to get more of his thoughts about the relationship between substance use and mood disorders. Stay tuned.