If you participate in outpatient or inpatient treatment programs for alcohol or drug use disorder, you may notice that while they encourage you to participate in twelve-step programs and indeed sometimes make attendance at these programs part of the program itself, there is a difference between the psychological approach your program takes to recovery and the approach the twelve-step programs do*. From a twelve-step perspective, the break first appears in step two:
"2. Came to believe that a Power greater than ourselves could restore us to sanity."
From a psychological perspective, this simply isn't true: while all kinds of influences may encourage the restoration of sanity, in the end the only power capable of restoring sanity is the sufferer's own mind. Specifically, one of the central ideas of contemporary psychology, articulated in cognitive behavioral therapy and dialectical behavioral therapy, is that a change in the patient's mind will translate to a change in the patient's behavior. Once a patient is able to monitor their own thinking, remove cognitive distortions, and replace their thoughts with more accurate ones, their behavior will change accordingly.
This idea is not at alien to any layman, or to programs like AA (from now on, I'll use AA to stand in for other similar twelve-step programs). Indeed, one could argue that AA believes, with psychology, that changing the addict's mind is necessary to changing the addict's behavior. Where AA and contemporary psychology differ is in contemporary psychology's belief that it is also sufficient to change the addict's behavior.
Here's where I need to bring in the concepts of "necessary" and "sufficient," as used by analytic philosophy and logic. I'll just quote Wikipedia here, since its summary is as good as any:
"In general, a necessary condition is one (possibly one of several conditions) that must be present in order for another condition to occur, while a sufficient condition is one that produces the said condition."
To give an example, a creature being a mammal is necessary for it to be human. That is, if something is not a mammal, it can't be human. However, it isn't sufficient. Just because a creature is a mammal doesn't mean it's human. There are lots of other things a creature needs to have in order to be considered a human.
On the other hand, today being the fourth of July is both a necessary and sufficient condition for today being Independence Day in the United States. Not only is it necessary for a date to be the fourth of July for it to be Independence Day in the United States, a date being the fourth of July is sufficient for it to be Independence Day, simply by it being that date. It doesn't need to have any other qualities.
Applied to the idea above, psychology believes that it is both necessary and sufficient that an addict change their mind in order to change their behavior. In other words, an addict can't halt their addictive behavior unless they change their mind. Additionally, once an addict changes their mind, their addictive behavior will, by virtue of that fact, change as well. To give a specific example, once an addict knows it's a terrible idea to pick up a drink, once that belief is truly, firmly embedded in their mind, they won't pick up that drink.
AA only goes down this road halfway. In most interpretations, AA believes that it is necessary that the addict change their mind. However, it doesn't believe that it is sufficient. An alcoholic must understand that it's a terrible idea to pick up a drink in order for them not to pick that drink up. However, that belief may or may not cause the addict to abstain from drinking. This is, as AA's "Big Book" states over and over, the problem of self-knowledge. Perfect self-knowledge is no guarantee of sobriety**.
The Big Book also calls this the “subtle insanity which precedes the first drink.” As suggested by the word "subtle," it is not insanity in any traditional sense of the term. An alcoholic might pass any test designed to detect a psychological disorder other than alcohol use disorder (according to the DSM-5, AUD is "a problematic pattern of alcohol use leading to clinically significant impairment or distress.") They might be extremely logical and reasonable in all their thinking. They could solemnly and fervently believe that drinking is killing them. However, they still might pick up a drink***.
Having stated this difference in rough terms, in the next post I'll explain further and consider possible quibbles a critical reader might have, as well as the implications of this idea for the AA and psychological worldviews in general. What do you think so far? Feel free to lambast me below.
*SMART Recovery is not a twelve-step program and has no such conflict with the psychological approach.
**which is frustrating as all hell.
***did I mention that this is fucking intensely frustrating? Even if you are, as mentioned, very sane to begin with, this fact itself might send you over the edge.
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