Beyond Blue

Beyond Blue

Competing Models? When Mental Health Recovery Clashes with Twelve-Step Programs

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In my chapter about substance abuse in Beyond Blue, I wrote:

Today I realize the recovery cultures of addiction and mental illness clash. Like the Church of Scientology and neurobiology. Like Tom Cruise and common sense. Because complaining is considered whining to most twelve-steppers–“poor me, poor me, pour me a drink”–but as a smart disclosure of symptoms to mental-health professionals. Because many recovering alcoholics and drug addicts are not educated about mental illness, a lot of bad advice is doled out at meetings and/or social hours. With the best of intentions, of course. But dangerous all the same.


I was intimidated by the AA old-timers and afraid to think any differently from them, fearing that if I listened to my gut, I would become one of those people who were “too smart” for the program and relapsed continuously. Who was I to question the direction and counsel given by the guys who had been sober over a quarter of a century? They want to die, too. They just don’t talk about it, I surmised. And neither will I.

Back then I wish I would have known about the research done by people like Ken Duckworth, M.D, the medical director for the National Alliance on Mental Illness and an Assistant Professor at Harvard University Medical School. I interviewed him last year for Beyond Blue, and here’s what he said:


In the substance abuse culture, the person is generally viewed as the agent of the problem, and they are held accountable and have consequences for their relapses. In the mental illness culture, the person is often viewed not as the agent of the problem, but as the victim of their illness. We tend to hold people a little less accountable for bio-chemical processes.

You can see this dichotomy. And when I work with families dealing with both conditions, my heart really goes out to them because in the AA world, and in the substance abuse culture, they are encouraged to have the person hit bottom and be accountable, but that’s not the case in the mental health world.


Group Beyond Blue member Luthitarian continues the conversation on a discussion thread, where he writes:

This is something I’ve noticed too. “Hitting bottom” in “the mental health world” would be too friggin’ late!


In fact, though AA works hard to seem nonjudgmental, this accountability comes across at times as almost pointing to relapse as a character flaw, a sign of weakness. AA types can be suspicious of taking psych meds, in fact, as if it were a weakness. Therese points to this in her own experience as well. “Happy pills” mean caving in and not being accountable in some way to 12-steppers. She refers to this as the complaining or “Poor me, poor me, pour me a drink scoffed at by AA old-timers who see mental health treatments involving medication as a “compromise” on “your sobriety.”

Certainly, this most likely doesn’t mean ALL 12 step/AA type groups or members. Mostly those who are “very concrete” in their thinking–as my wife, the psych nurse, would put it. Those who can move on to more abstract approaches to 12-step thought might see an implied “13th step” that says to take care of the underlying emotional or mental disorder that DRIVES one to drink or to use drugs.


Just wondering: has anyone else experienced this apparent disconnect between what Duckworth describes in Therese’s quote as the two “cultures”? Anyone else, thinking that the substance abuse model would mean “NO MEDS!”, have been or would be reluctant to consider taking psychotropics or other forms of medication for mental illness? Anyone else here who has experienced a lack of interest (as if it were somehow irrelevant) in MH diagnoses in their 12-step groups?

What about you? Have you experienced this disconnect?

  • http://absolutely LM

    I found this with my son. He had depression that led to the drug abuse, but the entire focus on all addiction treatment was getting him off the drugs *first* before he could begin any treatment for the depression. It was frustrating because I knew the cause and no one initially would even go there with him. Whenever he became “clean” he was battered again with depression with no tools to cope with it, which of course put him right back on the street. The drugs they prescribed in the rehab places were to keep him under control for their convenience, not to address the depression. Finally we found a program that started him along the cognitive path, and it began to turn him around. He’s off hard drugs now, but still deals with depression.
    Also, a side issue, is that AA is Christian-based, whether they admit it or not. My son, who is not Christian, always felt pressured to accept God in a way he never connected to, contributing to his feelings of strangeness. Where are the addiction treatment programs for atheists?

  • Lulu

    As a social worker who worked with addiction and mental health, this was one of my favorite analogies and chapters. Great book, btw.

  • Healthy Eating Recipe

    I haven’t experience this but based on what I read and people I know who have suffered from this, I think it’s best if health care providers treat addiction and/or mental health problems objectively and as cases of dual diagnosis. This way, both problems are addressed together since it is rare for one to appear without the other.

  • Your Name

    It sounds to me like the author’s education on mental illness comes from a Pharmaceutical company. I know, the ‘experts’ tell us that they can help depression with their different psychotropic drugs, that they have an ‘illness’. This makes it sound like they have caught a virus or it is hereditary (there has never been any proof of an inherited physical problem in a brain that causes these pretend illnesses) but the hard truth is that they cure nobody. They never have, and they don’t even claim to! All they do is maintain a level of foggy consciousness, at best. They are amphetamines! Quite often these lead to terrible acts of violence. At least AA CAN help a person spiritually quite often. There is no spiritual gain from an anti-depressant; only a fog that leads to more depression eventually. Psychiatry is an atheistic based, faulted ‘science’, with no room for the human spirit in its basis……look it up, I am not making this stuff up!
    Feed them healthy food, give them friendship and love, and help them find their humanity, and spirituality will come soon after. To encourage someone to go from one crutch to another is a disservice to them, and yourself.

  • Your Name

    Hello my name is Jim, you guessed it, an alcoholic. I suffered from depression all of my life childhood to present. When I discovered alcohol in high school it was a wonderful experience for sure. I did not know I was adding a depressant to depression. During and after serving in Vietnam, I continued to use alcohol and any other drug prescription or street. I finally “hit my bottom” the “Jumping off place” as the big-book calls it in 1986. I worked the program (12 steps) to the best of my ability but sponsored myself. I visited a doctor and for the first time in my life I was rigorously honest with him. (that is the key) He prescribed an anti-depressant which I still take today. I was told by some that in AA we don’t use any form of mood-altering substances, that is not what the Big-Book says. It states “we stay out of this controversy” We do, get active in the program, attend meetings with regularity, obtain a sponsor to help us work the program (12 steps) and while doing that we come to understand that we in fact have a mental and physical illness that ONLY a spiritual experience can relieve. “When we straighten out spiritually we straighten out mentally and physically as well. I think doctors do not get a fair shake as they are rarely told the truth and prescribe to treat the problem they see in their office: anxiety, worry, depression, restlessness, discontentment. The AA program works for those who work it (12 steps)and it does not matter if one suffers strictly from alcoholism or dual-diagnosis like myself.

  • Tom

    I have been sober 29 years. The thinking Terese talks about is all to prevelant within AA, and other 12 step groups. I have been to ACA, Alanon, and GA. I think that because of the Peer pressure I did not get my Mental Illness treated soon enough or properly. I even had a Pdoc, who refused to treat my Panic disorder, or my insomnia. He treated my depression but didn’t DX my Bipolar for 14 years. Those 14 years were hell. He was closely connected to AA. I know now it was his own fear, insecurities, ignorance, and lack of trust of the mental Health community, that led him to believe he was more qualified, well he wasn’t. I personally witnessed numerous times where people with mental illness were told they were not sober if they continued to take their Psych meds. I saw 2 people commit suicide because of this, and many others relapse. The stigma that accompanies mental illness within the recovery community is atrocious.
    It is my opinion that AA, specifically is not a safe place for us thank God I got a Psychologist that specialized in Bipolar disorder, who convinced me to get a psychiatrist. I have finally found a med combo where I don’t have intrusive suicidal thoughts and self destructive behaviors that accompany untreated Bipolar disorder, constantly. Tom

  • Steve

    The two opinoins above seem compelling, but I don’t beleive they are typical. The overwhelming evidence points to this route being a failure. Don’t gamble with your health; try nutritional and holistic before you let these wich doctors get a hold of you. I have known quite few few over the years who have been taking the Pharmacutical solution, and not one of them is close to the person they once were.

  • Debra Rincon Lopez

    I don’t think alot of people even know they have mental health problems. I have been in Recovery for the past 3 yrs now.I am finally working with a therapist now and trying to get a handle on my depression, anxiety and other mental health issues. Beside’s my addiction to drugs & alcohol for the past 30+yrs. I think that if alot more people would get therapy they would not have to seek Treatment so many times in their lives. Most of the issue’s are deep underlying issue’s from childhood and other abuse in their past. That’s why alot of people never get clean except for the 5th 6th or 10th time. I know if I would have known this It would have helped me alot faster and alot more. Than just giving me anti-deppressant’s for years and years.

  • Caroline R

    There is a twelve step program I have found helpful for people with mental illness and addictions. It’s called Dual Recovery Anonymous. I have been in other 12 step programs and did experience some of what Therese mentioned. In DRA, the idea is to address both issues in a compassionate way. The workbook for working the 12 steps is the most helpful way I have found to work the steps in my life.

  • Your Name

    It makes me very sad when people in AA diagnose and judge other members. In my 35 years of sobriety, I have come to love AA and the people in it and in fact, owe my life to those people. But they are only people…the same ones who complain about the stigma of alcoholism and say that it is something that you can only understand if you experience it yourself. I have seen people called out in meetings and accused of not being sober because of taking medications, people who were in desperate straits, reaching out for help and support. This is not in the spirit of our program. “We are not professionsls…” We are there to share our experience,strength and hope, and if we lack experience in certain areas, then we certainly do not need to express our opinions. The thing is that some people can ONLY stay sober if they are on medication; some people can only stay alive if they are on medication. Remember – live and let live.

  • TheHealthProtector

    I am 27 years old, I think Our body comprises of many system that controls and regulates the function of organs. Our organs need proper nutrition, blood, and oxygen to function properly. The respiratory system of the body is one of the most essential systems of the body that helps our body to inhale oxygen. The inhalation and exhalation process of the body is controlled by respiratory organs.
    After all you have no depression then you mental and physically healthy.

  • Anne

    I have always had trouble fitting into the AA plan. It works for some. Lately I have found that my recovery is still uprooted by circumstances in my life, and I agree that a good counselor is the best for me, but other than this blog, I feel alone in my struggles, and would like to find a group. Thank you for being there every morning.

  • mary

    very good discussion. i am bi-polar and also alcoholic, have been sober and in AA for 4+ yrs. i agree that AA is great for getting and staying sober, that is free from alcohol, and NA same for other drugs; however i, too have seen the dichotomy that the author speaks of that many AA’s make between the illnesses of alcoholism and mental illness. this is wrong, esp. w/ many of us are dually diagnosed. i have been “chastised” many times for even mentioning bi-polar in meetings. however, i continue to do so because the “only requirement for membership is a desire to stop drinking” so they can’t kick me out and they have gotten used to me saying what i think, and because whenever i do talk about it, lots of other people are relieved that they can then talk aobut their mental illness.
    the problem is that these AA’s esp. old-timers are narrow minded in their wrong-headed “worship” of bill wilson and the other founders of AA, whom they believe never intended for AA to address anything other than a person’s desire to drink. indeed the whole big book, as encompassed in the 12 steps is designed to find out how to live a whole lifem which a mentally ill person can never do with an untreated illness. the best defense is find another group, and faiing that, seek treatment and attend meetings, with the caveat that you are probably not going to fit into any of their more popular clicks. oh well, since when did any of us mentally ill people fit in percfectly anywan????

  • Sandi

    When I was in treatment in 1998, the head of the center I attended believed that there was no need for meds. He happened to also be a family practice doctor. One member of our group was suicidal. She was told that she wasn’t working a program, there was no reason for her depression/suicidal tendencies, and the 12 steps could solve all of her problems. About two days later, she did try to commit suicide. Thank God that she didn’t succeed. She did not return to the treatment center, and I learned a valuable lesson. It was many years later that I saw her at an AA meeting. She had found and received appropriate treatment for her depression and was thriving in life.
    I have heard speakers from the podium say that you can’t be sober if you are taking meds. These people scare the bejeezus out of me because who knows what vulnerable person might actually follow their ignorant dictum and end up in a lot of trouble.

  • Lisa

    In reading the comments above, I can see that there are people who have had similar kinds of experiences with AA that you have, but that has not been my personal experience at all. At the AA meetings I attend, sobriety comes first, last and always, and no one is chastised or judged or “called out” for taking psych meds or any other kind of anti-anxiety or other types of sedation medication where necessary. I tend to go to women only meetings, so perhaps that is the difference? However, at the mixed meetings I’ve attended I’ve never had the experience of people not understanding depression and anxiety or other mental disorders as contributors. I feel bad that your AA group isn’t the same as mine.
    Re the spirituality issue: it’s never about God, it’s about a Higher Power as you perceive it to be, and your higher power can be the AA group itself if that’s what keeps you sober. And as for it being Christian–just not true. There are people of several faiths and belief systems in my group, and all are welcome. I guess AA groups are run by human beings, and as such are subject to the flaws each of us bring to the program, but I wish that those of you who have had negative experiences could join my wonderful group of friends, and see how it’s supposed to work. I never realized how lucky I am to be where I am geographically–Connecticut, if you’re wondering.


    My perspective is somewhat different. My wife has suffers from severe mental illness and she is a longstanding member of AA. She often uses AA language and self help spirituality in an effort to hide from her mental illness. Aberrant behavior and comments are deemed to be co-dependency. Instead of serious therapy she retreats to yet another 4th step inventory. I have concluded that though the twelve steps are incredibly valuable they can somtimes get in the way of a different sort of honesty that is necesary before one can start to deal with disorders like schizophrenia and compulsive hoarding.

  • Johanna L

    If any one in the 12 Step program or in the psych career, has read the book of Alcoholics Anonymous, it says AA is to help recover from the disease of Alcoholism. It doesn’t state anything about being doctors. If you have a problem with mental illness, go to a psychiatrist and if you need meds for your depression who is to say not to take them. If you have a tooth ache, go to the dentist, not AA. I suffer from depression and I take an anti-depressent and go to counseling. I am a recovering Alcoholic and I go to AA. I DEFINATLY see where you are coming from. People who suffer from depression are likely to abuse alcohol to ease the discomfort and symtoms and could not be alcoholics. I’ve seen many people come into AA, get well and never have to go back again and can drink successfully. I am a to the bone alcoholic I can not take one drink and never wil be able to. I think their are alot of people who are in AA who are not “true alcoholics.

  • Lynda

    I have attended 12 step meetings for alcohol and compulsive eating for 25+ years. During that time I have never heard anyone speak against medication, therapy, or treatment of any kind.
    I do not believe that the 12 steps work for every problem. While I have been sober for 25 years, I have never been able to control my food addiction. About 9 years ago, I was put on antidepressants.
    While my depression is controlled, I continue to talk about problems other 12 steppers.

  • Your Name

    I, too, am a recoverining alcoholic and person with a chronic mental illness. Asking whether I am an alcoholic because I suffer from depression or whether I am depressed because I am an alcoholic creates a pointless spiral. The fact is I am both. I require certain things for each aspect of my health. The alcoholism requires that I do not drink under any circumstances. It also requires me to acknowledge that I am not able to control anything except for myself, and sometimes my ability to do that is questionable. As a person with clinical depression, I also do not have the luxury of engaging in too much ruminative thinking. This means that I need to work the steps, but I also have to know that sometimes I need to move on whether or not I feel that I am finished. Also, as part of the treatment for my clinical depression, I require medication. Period.
    Both of my mental health issues are conditions that try to convince my brain that there is nothing wrong with me and that a) I could drink like everybody else (An absolute lie!) and b) that I don’t need medication because I am well now (Another lie!). If I think I don’t need medication because I feel fine, it means that the medication is working to balance out my biochemical imbalance. Listening to my illnesses when they tell me either of these lies could be fatal.

  • Ilumina

    There is a program called GROW that started in Australia and it combines the 12 step approach with mental health recovery. So you’re going to the meeting to recover from mental illness not alcoholism etc. It has been quite successful and is now found around the world. Google GROW for groups in your area! :)

  • Laura Droege

    I’ve seen the dicotomy you’re speaking of, only in a different context. I’ve been in churches where people with depression, etc., are expected to hit bottom (even when that is dangerous and needless) and taking medication is considered shameful. The assumption is that all people with depression (or other MI) are at fault; “they shouldn’t need meds, they just need to get right with God, stop whining, etc.” Dangerous attitude, really.
    I think there needs to be a balance here. Not everyone needs an anti-depressant. (Just guessing here, but maybe if the alcoholism gets under control, the depression might go away. Just a guess, like I said.) But we can’t rule out the possibility that someone might need to take meds.

  • Cheryl

    I find the constant referral to “AA types” as offensive. What exactly is an “AA type”? Is it a person who uses the 12 steps in their daily living? Is it a person who recognizes that restoration to sanity requires the application of simple principles? I mean, really, what’s the type?
    I live with a mental illness and in addiction recovery, and I find that I am responsible. I am responsible for addressing both of my issues, and not relying on the excuse of being a victim. I owe it to myself and the general public to take my medication and do the things necessary for me to remain healthy. I find great congruence in the models of recovery for mental health and drug addiction. I get a daily reprieve when I stick to my regimen, and no one can do that for me.
    Anyone who listens to anyone outside their personal medical professional on how to take their meds or what meds to take is an idiot. Even if the person giving the advice in a 12 step meeting is a medical professional, he has left his title and credentials at the door upon entering a meeting. There are purists in AA and NA alike who will denounce the use of meds, but what both models of recovery have in common for me is that there is no ideal for everyone. It must be tailored specifically for the individual and then applied by that individual to work.

  • Barb

    I am a member of AA and am considered an “Old timer”, I also seek help for a mental health illness. I have of course heard people in AA downplay therapy and medication, but these individuals are few and far between any more. I am fortunate to live in a city where there are a tremendous amount of AA meeting, so I can easily choose another AA group if I run into this thinking, but again this hasn’t occurred often in my experience. It seems those of us with dual diagnois need to seek support from those who understand the need for therapy and medicine. Individuals
    need to keep this in mind especially when seeking a sponsor that understands the need for mental health treatment. When I work with a “sponsoree” I know there are some areas that I am not equipped to handle and ask the person I am working with to seek professional help.

  • Kaitlyn

    I’m going to agree with most of what’s been said here. I too, suffer from both mental illness and addiction. But I have not found it hard to put the two together. The Big Book, Bill W. writings, all of these emphasize that the program doesn’t work if you don’t get “professional help” when you need it. I read this as: take your meds. I don’t know if it’s because I go to meetings in a big city, but I’ve found meetings here to be VERY accepting of talks about suicide, professional help, people even share numbers and recommend therapists.
    So I feel terribly, terribly concerned that there are AAs out there that don’t get this support, because I NEEDED IT SO MUCH when I first got sober, which meant BOTH taking proper medication AND abstaining from drugs and alcohol.
    A good source for those suffering without this support is the AA grapevine. I’ve found that it is also open and accepting of those suffering from dual diagnosis issues. I can often relate to stories about therapists encouraging AA and sponsors encouraging therapy. Also, call an AA hotline in a more accepting area (like a big city). Many are available 24 hours a day and the people on the end of the line really care.

  • Pam S

    Had it not been for AA, I would not have the wonderful life I have today; and, had it not been for a mental health professional who understood alcoholism and addiction, I would not have the wonderful life I have today! I’m 30 years clean & sober, and after my “last” melt-down in 1992, I decided that I will take Prozac and Welbutrin for one-day-at-a-time, just as I do many other things in my life.
    I grew up in an Irish-Catholic family, alcoholism was on both parents’ sides. Mental illness (depression, anxiety, psychotic behavior at times) was on my dad’s side of the family. I believe (my own opinion) that I was “an alcoholic waiting to happen” being born into that mix…”just add______” you-name-it, and out popped me, the alcoholic/addict.
    Over the years I’ve run into those in AA who are ANTI almost everything, yet this isn’t an “AA” thing, this is THEIR interpretation of what AA is suggesting they do. Usually they are older guys, miserable & grouchy, who are technically “sober,” but not “happily sober.” I decided early on to do as MUCH outside work as it took, and went to co-dependent treatment for 28 days. Once I tackled mental health issues, I was able to more successfully work my AA program. I also stopped smoking cigarettes after 8 years of sobriety and started having monthly massage therapy; it is truly body, mind and spirit and we have to address them all. It’s a difficult message to get through to some folks, but the ones who have embraced real sobriety are fantastic “winners” in my book. And I have hung with a wonderful & healthy group of winners from Day 1.

  • Maria

    I’m so glad you addressed this topic. I’m on medication for depression and bipolar II and I also attend Overeaters Anonymous meetings. In my particular meeting, I’ve been welcomed without judgement or prejudice. There is one member who says that when she got in line with her higher power, her depression left and she hasn’t had to deal with it since. But even she is quick to say that that’s just her story and is not against others following a different path.
    I’m only now pursuing finding a sponsor, and I am praying I will find one who understands and accepts that my addictions are interwoven with my mental illness.

  • Diane

    I am a recovering alcoholic ( 10 years sober) and am being treated for depression and anxiety disorders. Others in this situation know that the effects of medication are nothing like the “high” you get from alcohol. The medication makes the pain of mental illness less and it lasts. Medicating the mental illness with alcohol results in feeling even worse the next day. I have dealth with many of these issues in therapy and would not have gotten this help with AA alone.

  • Jen

    As far as anti-depressants are concerned, I consider myself — as Temple Grandin said — “a lifer.” And I think that’s just fine. I also find my Al-Anon group to be very accepting and non-judgemental. We are always talking about alcoholism as a “disease.” Others in my group also take meds. I think it depends on the group. If the group doesn’t work for you, look for a new one — if you want and need support, as I do.

  • Jamie H

    Hi Therese!
    I have had this happen more times than I care to comment. This last time was only a couple of weeks ago when I spoke to a woman on a phone meeting for OA and was telling her of my overwhelming depression, how I am in relapse with my food addiction, and my depression, and how I was having difficulty with my psychiatrist returning my calls.
    She told me I didn’t need a psychiatrist since I was already on medication (meaning, since I already knew what I was taking, which, um, duh! wasn’t working!) and that I should just call my GP and have her prescribe the drugs. I informed her I DID need a psych for several reasons whereby she informed me that SHE was a psychologist and that she “felt” that a GP could just prescribe me the drugs and the 12 steps could help with the rest. UGH!!!!!!!
    I can’t even remember how many times I have to tell people on a consistent basis that I believe my so called “negativity” is due to the fact that I would rather be curled up somewhere with my dead dog and my dead mother and all my other dead animals and the new live one we have now than anywhere else, never take another shower or wash my hair…and never have to see another live being again. Does that sound negative? Oh, sorry…didn’t mean to bring you down.
    Jeez!! People in my 12 step meetings are always telling me to lighten up, to “trust” that things will be fine. No body asks to learn about MY real illness. Now if I had, God Forbid some illnes they could see…like if my depression was outside of my brain…Ugly, oozing, gray, and decaying, black, moldy, pussy, red and angry, anxiety outside the skull depression…I wonder if then people would be so quick to dismiss it? I wonder…
    Thanks so much for writing the blog Therese. As you can see it really strikes a chord with me :)
    Jamie H

  • Stanley

    Everyone that I know who drank and used were not healthy in their feelings or choices. I am getting to know myself and found out the same. If knowledge alone could be beleived and followed, education would always work. But the bad feelings that create bad or sad thoughts in me cannot be cured with words alone. Just like talking about being warmed & filled cannot give my body what it needs, so also trying to talk me into not needing medications cannot change my need for them. Why would anyone want to help me become abnormal simply because they pre-judge what they do not understand. I had a brother{until Sunday night} who was told not to take medications by pea-brained people. During the years when he beleived them he did more relationship and emotional damage to himself & his family than any alcoholic alone could surpass. Of course when he couldn’t deal with his feelings and rejection any longer he would use “unperscriped medication” that he wasn’t stigmatized for – ie: weed, alcohal, and other ‘acceptable’ remidies. I have a daughter-in-law in Kentucky that discontinued her bi-polar medication so fools wouldn’t think of her negatively. So, instead she resorted to the same “cure” for her feelings as brother Jerry would. And if her baby needed the attention she could no longer give, she would drug him too. Enough’s been said. And for my brother, he’s dead. He’s 6′ under now. You want to dispise medication, wow.

  • Bipolar Disorder

    Quite good and knowledgeable post.Thanks.

  • khris kenney

    i think you are just a little off course .there are recovery programs you didn’t list; 12 step programs like emotions anonymous ,dual recovery anonymous for example . in each of these the programs for recovery from drugs, alcohol, and addiction we find none other than a disease process at work ; indeed – mental illness one common mental illness twist is denial -basically a delusion ; we say we are not addicted for example – but certainly we are .in a.a., n.a., o.a., alanon ,d.r.a.,- e.a. the focus is on solving a problem through love , faith , spirituality found in the 12 steps . also – all of these problems , overeating , gambling , drugs ,alcohol , family sickness due to alcoholism / addiction are all said to be illnesses ,diseases , and – indeed – just plain mental illness .

  • Ruth

    Yes, I have been in this situation more than once, and I stopped going to meetings. The drug I was taking that was and still is unacceptable, is methadone. I am here to tell you that keeping quiet is easist, but then you end up stuffing everything because there is no one to talk to who understands. On top of this I suffer with major depression, which I also talke medication for. So finally I decided it is more important what I think of me, and what I can live with that counts, not what other people think or wish I woudl be. I am who I am and thank God every day for another day. God Bless Ruth

  • Ami Mattison

    Thanks for raising this topic. I’ve found my AA meetings to be supportive, and I’ve never had anyone openly judge me and my medical management of my bipolar disorder.
    I have been told by people in AA that once they got sober they were “cured” of their mental disorders. While I believe that some people who are dealing with situational depression (especially the kind that comes with alcoholism)will find relief in addiction recovery alone, I do not believe that anyone with another chronic mental disorder will find relief without some sort of health intervention–whether that’s a holistic or traditional psychiatric approach.
    Also, I was only able to quit drinking after I had been properly diagnosed as bipolar and properly medicated. When my bipolar disorder was addressed medically, I was able to quit drinking and have been in recovery from alcoholism for 16 months.
    I take my meds, and I go to meetings and work the steps. I’m happy and productive again, and I’m grateful–to be sober and healthy and in recovery from alcoholism and bipolar disorder.

  • Bev M

    I too had much trouble in AA – and Alanon too – people assuming that working the steps would cure everything emotional. I’ve needed anti-depressants and have suffered criticisms.
    Finally I realized that “we are not professionals” and “more will be revealed” and when I’m in a good space I can point these out to critics! And I can politely say that “if you don’t have a PhD you are not qualified to make a medical or psychological diagnosis!” Now this offends some – and makes others think – the same as any dispute with others in the Program.
    The problem is that when I’m in a Depression or have not been able to financially afford anti-depressants or a therapist, I end up with no support for my depression. And AA with steps, reliance on God, taking personal responsibility (which often means taking the blame), etc., etc. has actually aggravated my depression at times.
    I got tired of fighting the rude, “un-recovered” creeps in AA (and there are many of them) so I stopped going to meetings after 18 years of sobriety. I wish I was strong enough to to deal with everything – but – I have to pick my battles. When I faced another physical disability and was told to think positive, work the steps, etc. etc. as if everything was related to or a result of alcoholism, I had to stop torturing myself and drop AA and put my energies into dealing with the situation that needed attention – not aggravation.
    Too bad.
    I think now that AA is great for getting sober – and sadly not very good for dealing with “life on life’s terms” when it involves non-alcohol problems!
    Even the founders of AA realized and spoke to not being experts on anything EXCEPT alcoholism! All who want to apply the solutions to alcoholism to every life problem are seriously in error! The founders by the way did not even include drug addiction or being the child of an alcoholic as within the realm of their expertise! In the history of AA there is plenty of discussion about who they felt they could help – and they realized that AA was only for alcoholism.
    AA was not intended to be the ONE solution to fit every problem!

  • Ann M

    Have you heard of the SMART recovery program? It’s a non-theistic approach to addiction counseling., without a disease model. I just read about the developer in an article in the Guardian.
    From their website
    Our Approach
    * Teaches self-empowerment and self-reliance.
    * Works on addictions/compulsions as complex maladaptive behaviors with possible physiological factors.
    * Teaches tools and techniques for self-directed change.
    * Encourages individuals to recover and live satisfying lives.
    * Meetings are educational and include open discussions.
    * Advocates the appropriate use of prescribed medications and psychological treatments.
    * Evolves as scientific knowledge of addiction recovery evolves.
    * Differs from Alcoholics Anonymous, Narcotics Anonymous, and other 12-step programs.

  • Linda Appleman Shapiro

    Dear Therese,
    Although I only discovered your blog recently, I have been following what you write with great admiration.
    So much so that I want you to know I devoted my weekly blog (yesterday)to the topic you addressed about COMPETING MODELS. As I never quoted you, I did not feel I needed permission to contact you for your permission. (I credit you from the start and refer my readers to your blog and to your books.)
    As a psychotgherapist/author/blogger and a woman who is probably old enough to be your mother, please know how delighted I am to see that you are not only prolific but wise, articulate and sensitive in sharing personal aspects of your life in ways that surely allow your readers to appreciate you all the more.
    God bless!
    Linda Appleman Shapiro
    Memoir: FOUR ROOMS, UPSTAIRS: A Psycotherapist’s Journey Into and Beyond Her Mother’s Mental Illness (please see comments on
    Blog: A Psychotherapist’s

  • Casey

    I completely understand where you were coming from in this blog. When I was a teenager I was an active participant in NA/AA meetings. Relapses are undeniably seen as weaknesses in those outings, or failures of some sort… and many addicts already live with a fragile self-view & confidence. Needless to say sobriety did not stay with me long. I recently decided to give it another try, but instead of using AA/NA meetings for support, I joined a program called “Celebrate Recovery” through the United Brethren Church. I cannot even begin to tell you the enormous difference between these types of groups. I dont leave my meetings now feeling like i spent the last hour swapping war stories or sob stories… whatever im feeling & obstacles im facing are met with concern & support. I highly recommend this program to anyone and everyone who is struggling with ANYTHING, not just addiction. Celebrate Recovery focuses on getting us through our lives “Hurts, Habits & Hangups”… whether they be addictions, mental illness, abusive relationships, eating disorders, abandonments issues, ect… anything life has thrown at us that has somehow left us feeling broken, when we just cant seem to mend that break on our own no matter how hard we try. Its a nationwide program, and it has made all the difference in my life.

  • Mariah

    I can’t thank you enough for posting this piece. I am in recovery in a very conservative community and there is a very strong message that depression is a spiritual shortcoming. It is so painful that it has almost driven me out of AA and I need AA too. I have searched for Dual Recovery, but there is none here. If anyone would be willing to communicate on this, please let me know. I’m really hurting. I have treatment resistant depression. I look for the light and hold on to faith, but it is a lonely road.
    For anyone who has recovered from both alcoholism and depression, just please know that you are doing exactly the right thing if you have found medication that works for you. You are sober even if you take medication and are not taking the easy way out. You are taking care of yourself. You might not be able to stay sober without the medication. Thanks again, Terese, for this piece. I think there are thousands of us out here.

  • PJ

    Thank you so much for your post. I have had the exact same experience in AA and it was very discouraging. I’m so glad I found someone who thinks about things the same way I do. I felt like I didn’t belong in AA when dealing with my depression and bipolar illness. I had a few close friends who were very sympathetic and saw what was happening to me. But on the whole I felt like people stayed away from me and were hypocritical in thier way of being “non-judgemental”.
    I haven’t totally left AA, I keep trying to see if I can conform, but I agree with everything you said. Thanks so much.

  • angelique

    i am so glad i came across this blog, i live with bipolar and have for many years. i have also been to AA/NA where, when i have talked about my mental illness, it was looked at as not important, i was an addict and that was where my problems stemmed from. i felt for a long time, not a part of. i was made to feel very uncomfortable about being on meds going to therapy and seeing a psychiatrist. my faith in the 12 step programs has deminished and i find more satisfaction with my spirituality. i would like to find groups geared toward good mental health in philly.i rarely go to an AA/NA meeting, i don’t like the atmosphere. but i believe also in good healthy living, taking care of myself ,giving myself little treats and learning to love me just as i am. mental health treatment taught me those things…
    thanks, Angelique56tmzu

  • Heather

    Thank you to everyone sharing (you, too, Therese!)
    This is one of your best columns ever. And it’s a subject you RARELY read about. Had I known about the difference in these therapeutic orientations, I would have chosen very differently! And you would have to be a VERY sophisticated client to even know what questions to ask about a therapist’s approach. Most of the time you’re in such pain you just want help. I saw this push-me, pull-you dynamic during my first (and last) DBSA meeting in which a man with severe bipolar disorder shared with the group that using mood stabilizing medication was a crutch he wasn’t “allowed” to use. His addiction counselor had convinced him of this.

  • Rose

    I am an addict, who through the grace of God, has been clean for 4 straight years. I went into my first rehab after suffering with my addiction for about 25 years. I learned so many things about addiction that first time, I was completely in shock. I never knew I had a disease, I thought I was just weak. I learned so much about drugs and how they affected not only me, but the whole dynamic of how it affected almost everyone I had any kind of relationship with, especially my family. Anyway, I was discharged and of course it was suggested that I join a twelve step program if I wanted to stay clean. I did just that and the program did help me. However, as time went by, I began to become more and more confused, disheartened, disillusioned and finally disgusted. Naturally, being in that frame of mind, I relapsed. There was a period of a few more years of relapse and rehabs and twelve step programs. I was very, very unhappy, depressed and mad at myself for my weaknesses. I knew I had to somehow stop this new cycle of misery I was putting myself into. I stopped the rehabs, the programs, and the drugs. I have a small circle of friends who I can talk to, cry to and yell at when the need arises. I no longer have counselors, psychiatrists, psychologists, sponsers, or a hundred fellow addicts pulling me in fifty different directions. I am finally serene, mostly happy, and very proud of myself. I am not putting any doctor, counselor, program, religion, etc. down. I am just saying that for me, twelve step programs did not work. I think when I stopped blaming everyone else and everything else for my shortcomings,and put it all into my own lap, that is when I really started to recover. Will I ever replapse again? I don’t know. I hope not. I think that I have a better chance not to today then I ever had before. I truly believe today, that for some reason, God guided me to the place I am at and continues to guide me everyday. If I did get anything from the twelve step programs it is this, “One day at a time”. That is how I live today.

  • Jesse

    Experience, Strength & Hope. I think they put experience first because it is the most important one of the three I can share.
    I was one of those people that attempted suicide two years before I had my first drink. Alcoholism? My heart goes out to those of you who have been living with this most of your lives. I have too.
    I have been sober now for just days shy of 8 years. In my second year of sobriety I had some of the worst depressive episodes ever. It was one of the very worst years of my life. I had completed all the steps and was sponsoring people. I decided to go see a medical professional and try meds. My sponsor at the time made it very clear that he did not approve. At the time, there was a lot of controversy around this issue at meetings I was going to. I even saw a couple of shouting matches during meetings about this topic.
    I learned a few things: 1. an AA meeting is typically not the best place to discuss personal medical, financial, legal and relationship issues. 2. I am the only person in the room that has to live with ME – they don’t, and God as I understand him is the ULTIMATE authority in my life. 3. Afterwards, I did a thorough resentment inventory with my new sponsor and he asked me why I felt it was so important to me that these people I didn’t like – for them to like me. I saw then that I would rather be happy than “right” (insert lightbulb moment here), personally, being angry\resentful has never done anything positive for either my alcoholism or depression. 4. And why make myself a target for controversy at meetings? There are some people that just like controversy, and this may come as a shock: there are some controlling, opiniated types in AA. (really?) 5. ” We avoid hysterical thinking or advice…counsel with others is often desirable, but we let God be the final judge.” That is from the sex part of chapter 5, but it has helped me out in a lot of other situations.
    So my advice is simply this: Use meds or don’t use them, but above everything keep your sobriety date and be honest with yourself (your trusted medical professional and a close mouthed freind)- to thine own self be true as those coins say.
    I weaned myself off Wellbutrin and Paxil because I was feeling more side effects than recovery. I have done enough stepwork, meditation and recovery from AA and non-AA sources that I am not as close to the treeline as I used to be. But I still need help. I am considering trying other medication. Time will tell
    So maybe I am still not as happy joyous and free as I would like to be on a consitent basis, but I am a lot better off than I was that second year. Don’t give up! gotta go…

  • Nanc

    I am 25 years sober and through it all I have lost almost everything, mostly due to mental illness. While I’m not considered an ‘old-timer’, I am referred to as a ‘long-timer’. I no longer attend AA meetings and haven’t for a long time, but I do remember coming upon this attitude frequently while attending them for 18 years. One of the compromises I made and before my final dx of major depressive disorder with ptsd was given, was not to give a talk at a speaker meeting while I was on medication for depressive episodes. At one point in earlier sobriety, I was even ‘fired’ by my sponsor because as she put it, she could not understand how I could still be depressed after not drinking for more than 3 years.
    There were many things that I would not discuss nor talk about at meetings, including my mental illness, when I had I was avoided and ignored, my comments often being overturned by a newer people though not so often by old-timers. I didn’t have the same experience with true old timers, more often than not, they were the ones who told me to follow my doctor’s advice carefully when I had problems other than alcohol. This is not to say that there weren’t possibly a few around, however I have come to view the rooms and social atmosphere of AA as simply another segment of general society, doing what they do best and sticking to it when in doubt.
    By no means do I wish to lessen the impact that med-opposers have had on many people in the recovery communities, I simply want to present another side to what I have experienced within the context of this discussion. It was the newer people I found who displayed the least tolerance and lack of open mindedness. Even today, there are only one or two members of AA who remain in contact with me since I left the meetings, citing that anyone who doesn’t attend is sure to relapse.
    I do believe that when one is living the precepts of the original 12 step program as undertaken by Bill W. and Dr. Bob, and including the traditions in one’s life as well as the steps laid out for it, one will find that members who adhere to these will tend more to the open mindedness required when talking with someone with a mental illness.
    As to the accountability required by AA for my actions, I apply this to my MI as well, I am doing all I need to do and going to any lengths to preserve my life, I take my medication responsibly and as prescribed, no changes unless I have checked with my doctor and in this way I am able to follow the program of living in every aspect. I believe in the help AA has to offer no matter what the individual’s position or predisposition and all avenues of recovery must be allowed to be explored or a person can and will relapse. I am honest with all my medical professionals and work with them to prevent situations with meds where relapse may be a side effect of something that my own brain chemistry needs.
    I do advise that one treat nay-sayers as one would an insensitive therapist and run away as fast as you can, there are some in AA who will go the extra mile to help you hold your sobriety intact no matter what happens, I found them and I know they must still be there though getting harder and harder to find. Please don’t give up this avenue of treatment when you run into the small minded and those unable to see beyond themselves and their own situations. They exist everywhere and not just in 12 step rooms. Thanks for listening. Nanc

  • tom b

    i have read with interest the replies on your blogs concerning meds. The information that comes to me appears to be negative towards 12 step programs (AA). Early in my recovery in AA I learned how it works by being honest,open and willing. This included taking suggestions from my sponsor and if needed my doctors. Thank God for AA, my sponsor and truly the wonderful people I’ve met ,I haven’t picked up since April of 93. Thank You.

  • Debra Rincon Lopez

    I know exactly what you mean? That’s why it has taken so long to get diagnosed? Because I was using drugs & alcohol to calm my mental issue’s. I was depressed by whole entire life and that’s why I used drugs to combat that. Then when I was on drugs it made me normal; Finally I got the right diagnosis, and I am in Recovery from drugs and am taking care of my mental health issues. Now I am a whole person finally. That might be big problem these day’s, sometimes it takes too long to diagnose people with mental health issues, cause they are in addiction problems also. I am finally so happy that I am in counseling and medication and I been sober for 3 yrs now from all drugs and alcohol. I never thought this day would come. Thanks for the help of my counselor’s and doctor’s all talking togther helped me.

  • Tammy

    Very interesting, I am going to make a copy of this for a person who heads up a program at my church, for recovering addiction person’s. I have been getting for awhile now through email and enjoy their occassional readings. Also my daughter is studing to become a counseler for drug and alcohol addiction.

  • Howard Schwartz

    I am in a 12 step group. We already have a 13th step. It is bedding someone in the program. The odds are good-but the goods are odd.

  • David J

    My name is David and I am an alcoholic. I used to be a fundamentalist Christian, was sober for 2 years totally buying into the steps as they are presented from the Christian world view. I accepted that I had to turn my will over to a higher power. At some point I denounced my faith due to many reasons such as contradictions in the bible, getting honest with myself that my faith was counterfiet due to fear of going to hell being the REAL reason I ever believed Jesus had saved me, etc etc etc. I liked the Buddhist world view, studied Zen, the Dalai Lamas teachings, Diamond Sutra, Heart Sutra, Dammapada, then discovered the SGI-USA. I became a Nicheren Buddhist. Denouncing my faith as a Christian shattered my world, I relapsed during this transistion and was in and out and in and out of the meetings for several years. I tried reprogramming my mind as far as the obsession over alcohol which didn’t eradicate the returned desire to drink then started chanting for about 2 hours a day. I finally have 10 months free of the desire to drink as of tommorrow which is the longest that I have been sober since denouncing Christianity about 5 years ago! I even quit smoking 2 weeks into this deal by chanting for that(so as of tommorrow I will have 9 and a half months free of the desire to use nicotine, no withdrawals, no nicotine replacement, all by blatantly ignoring those people in the meetings that have 10 years sober, they never quit smoking and have always told people like me that I shouldn’t quit smoking within the first year when all me quitting so early on made those “old timers” look bad-did this again by using self reliance as taught by Nicheren Daishonin not the “just turn it over” as taught by Bill W. and all the “experts” as they seem to believe themselves to be in the meetings many times). I feel though due to the nature of my religion, it is totally based on self reliance. This contradicts the AA program(it does mention Buddhism in the begginning of the book but let’s just be honest and say that the view presented in the book is VERY different from Nicheren buddhism) and I feel that my sobriety far surpasses many people that I know. I flat out like what I have and don’t want what they have. I feel that my sobriety, demeaner, attitude, so on and so forth is more like “old timers” who have about 20 years sober. I don’t have a sponser, I go to meetings seemingly whenever I please, I have no god(consider myself an Atheist within the confines of using my Gohonzon), I have no sponsees, don’t buy all the made up “rules” that people are so quick to shove in newcomers faces(it has to be this way, you have to have a sponsor, you have to go to meetings, have to have to have to). I feel I have evolved past the AA program. I made a determination that if I have to choose between something Soka Gakkai related compared to AA related, any given day of the week the Soka Gakkai event will ALWAYS take precedence over something related to AA. I feel on that pink cloud 90-95 percent of the time(as long as I keep chanting I think) and others in the meetings also see it, they seem jealous sometimes being that I am open about not having a sponser and seem to not just “buy” the whole AA thing anymore. I don’t argue with them or slander there beliefs but now I am blatantly honest about what I actually believe(I am my own higher power, I run my life, I rely on myself). If someone tells me “you’ll find out someday” I simply grin and say “I don’t have to worry about that because I have a Gohonzon.” and it seems to be consistently true for me. If I fall on my face and am proven to be deceived I already know what to do, but just for today I’ll keep doing what I’m doing and I believe that I’ll just keep getting what I’m getting…

  • David Wayne McCannon

    Hi, my name is David and I have Bipolar Disorder and I attend 2 twelve step groups. (1) Emotions Anonymous and (2) Celebrate Recovery. I found both groups to be helpful with my illness. Correct me if I got this wrong? You say a person with mental illness, should not be held accountable for their illness. Is this not a dangerous thought? If a diabetic don’t take responsibility for their life by taking insulin, eating right, they die. The same is true for mental illness. You use your tools, medicine, therapy, support groups, journaling and some use the wrap plan. Medicine only gives you a booster shot to get started, and by itself it is only 30% effective. Therapy is up to you. As said is most 12 steps program you must work the steps to obtain recovery. You must work your steps to obtain recovery with mental illness. Our addiction is our bad coping skills and bad behavior we use to cope with our life. Weather you have a physical illness, mental or addiction, work is required to get better.
    ‘Thought… Should someone with mental illness not make amends when they harmed someone else… maybe themselves?’ Absolutely, when they come to themselves, they need to forgive self, and ask for forgiveness of other they have harmed. Suicide don’t just hurt you, it hurts family and friends as well. Forgiveness is the first step to recovery.

  • http://AddaURLtothiscomment Chai

    I have experienced all this. I shoved my depression to the side for 18 years, sober in AA and often thinking about death all day. I couldn’t tell anyone though or they would say I “wasn’t working a good program”. I wanted to be a good AA, but I finally gave in and sought help for my depression after a death in the family. I was just done with the suffering. The mental clarity I got when the meds kicked in was nothing I ever imagined experiencing! I had mentally thrashed myself so long for not doing well enough in AA, not sponsoring enough, not doing the steps as well as others, just on and on; then suddenly I saw life as more. I could even see my past in reality and the part that my poor mental health and the mental illness of my mother had played. I had supressed these huge parts of my past for long years because you aren’t supposed to “blame” anyone but yourself and oh my God, I was so scared of drinking again.

    I don’t believe that seeing one’s mental illness is not taking responsibility, it is taking responsibility. I cannot be a fully contributing memeber of society unless I see the real factors in my life and not just what AA people want me to see. By taking care of my depression I am bettering myself and improving my interactions with all thsoe around me.

    I still go to my home group, but I have started to let go of the AA fears that haunted me. It’s a gradual process. I’ve come to realize that some things about AA just don’t make sense to me, and I tell myself that’s ok. If people would rather have a miserable human toeing the AA line than someone much healtier who has questions about a 75 year old program that doesn’t allow for any changes or updates, sorry about their luck. I’ve seen too many sick, scared, and angry people with years of time, and I was one of them.

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