The twelve-step program as an adjunctive to the treatment for CPTSD and addictive disorders increases the patients capacity to experience a process of socially supportive action resulting in the interactive experience of helping others. This experience decreases the likelihood of the patient maintaining dysregulated states through profound isolation, and increases the likelihood of the patient being encouraged to interact with others disclosing his or her problematic tendencies towards isolation and despair. The capacity to identy with others is encouraged. This interactive identification results, more often than not, in the members experienceing resonance and compassion. The twelve-step model, encourages the participant to share his or her experience, strength, and hope, which ultimately leads to the patient feeling as though the traumatic experience has cohesiveness and meaning.
The basic tenants, procedural behaviors, and non-verbal cues of the group meetings facilitate the members increased capacity for interoception, the modulation of arousal and the decreased likelihood of loneliness. This experience provides many participants with a collaborative social family which is mostly available twenty-four seven. There are meetings held around the world as well as on line.
The twelve-step group should be considered as a possible adjunctive with other therapies. Unlike a clinical group, a twelve-step member may extend membership for as long as she or he desires. This provides a sense of belongingness, longevity, history and security. Most clinical groups are time sensitive, and the theraputic relationship is sometimes time sensitive, unlike the twelve-step group and many of its members. To date, there are members in twelve-step programs with fifty years of active participation. A therapy group rarely if ever provides that longevity. Research supports positive interactive group experiences as a predictor of treatment outcome with this population, so these meetings should be highly considered for the above population.
There are many different types of twelve-step meetings, addressing various disorders. Meetings are defined as a group of two or more suffering alcoholics who have the desire to stop drinking. There are closed meetings, where only the admitted alcoholic can attend, and open meetings where anyone is invited, but cannot always share. Therefore, the therapist and the patient need to assess which meetings are appropriate. There are Overeaters Anonymous Meetings, Alanon Meetings, Narcotics Anonymous, and many more. The only requirement for membership is the desire to stop the addictive behavior and/or the unmanagable obsession and compulsion.
The twelve-step program adheres to twelve-steps, twelve traditions, and twelve concepts. Some misconstue the twelve-step program as a religion. The absence of a religious affiliation is stated in the tenth tradition. "No A.A. group or member should ever, in such a way as to implicate A.A., express any opinion on outside controversial issues-particularly those of politics, alcohol reform, or sectarian religion. The Alcholics Anonymous groups oppose no one. Concerning such matters they can express no views whatever" (Big Book, p.565) Additionally, the chapter We Agnostics, in The Big Book of Alcholics Anonymous states, "To us, the Realm of Spirit is broad, roomy, all inclusive; never exclusive or forbidding to those who earnestly seek. It is open, we believe, to all men. When, therefore, we speak to you of God, we mean your own conception of God. This applies, too, to other spiritual expressions which you find in this book" (Big Book, pp 46-47).
The utilization of a twelve-step program is certainly not for all patients with CPTSD and addictive disorders, It is not a panacea for healing, but has the capacity to support patients in an environment that encourages interactive experiences, for the sake of helping others and the self.
The twelve-step meetings are not overseen by a clinician or clinical staff, therefore therapeutic assessment of appropriateness and therapist/patient discernment is necessary. Additionally, confidentiality is not secured by a legal or ethical board, it is built on mutual trust and the traditions of the twelve-step model. But, because the twelve-step model suggests anonymity there is a sense of confidentiality for the patient.
The twelve-step program group model not only allows the traumatized patient to give meaning to his or her trauma, but also provides an opportunity for the traumatized addict to learn positive attachment patterns, how to share painful experiences while helping others, how to identify with others who have had traumas and loss, and how to regulate one's own affect and state through the bonding experience. This altruistic experience, of a twelve- step program, allows for increased healing in both areas of attachment and regulation, Studies indicate that the quality of social support, when positive, predicts the severity outcome of PTSD(Guay, 2006). It is important that the patient bonds with others in the twelve-step program that are attuned to his or her trauma, loss and addiction, otherwise, a mistuned bond may only exacerbate PTSD symptoms (Guay, 2006).
Some studies view the twelve-step model as more of a class or cognitive model, completely denying the impact sharing "experience, strength, and hope" can have on a patients attachments and regulation. (Cochrane, 2006) (other research) The Cochrane review states, "The 12-step approach consists of a brief, structured, manual-driven approach to facilitating recovery from alcohol abuse, and is intended to be implemented over 12 to 15 sessions." This perspective does not include how the 12-step program emphasizes helping others, writing about the events in one's life, not keeping secrets, and most importantly finding meaning in one's own pain, as a way of becoming intimate with others through honesty, openness, and service to others. Therein lies the true healing perspective for the addict who has also suffered from CPTSD.
Throughout the years I have practiced, I have observed patients who attended twelve- step programs, as well as those who have not. The most positive outcomes in treatment were those who attended the program and were able to find bonding relationships within the program. More often than not, I recommend the twelve-step program, and at times made attendance in the twelve-step program a requirement in treatment. More often than not, that patient that was massively dysregulated and isolated begins living a lifestyle with compassion at its core.
I will utilize a case study as well as an analysis of a group of patients from my private practice to illustrate my findings regarding the utilization of the twelve-step model with the CPTSD/Addicted patient.