The traditional 12-step model was invaluable for raising early awareness for addiction, and also in providing a means for which to try and attain sobriety. When the 12-step model of Alcoholics Emerged first emerged in 1935, there were no viable alternative treatment options for addicts.
Example of a 12-Step Model
The original 12-step model of Alcoholics Anonymous is highly rigid, expecting members to accept the steps and diligently follow them through their conclusion. The set nature of that model has led to some organizations modifying the original to bring it in line with their views on addiction.
After the emergence of dual diagnosis and its uptake in the medical community, some organizations have adapted the original model further by adding in messages relating to co-existing symptoms. Below are paraphrased examples of the first few of steps of a dual diagnosis 12 step program:
- We are powerless to control our substance abuse and mental disorders.
- A greater power can restore us to sanity.
- We choose to turn our will and lives over to god.
- Take a moral inventory of our beings.
- Admit to another the natures of our wrongs.
Complexity of Dual Diagnosis
Since the early days of the 12-step model, we have thankfully come so far. In learning more about addiction, we have also discovered that it can co-exist alongside mental health conditions. Dual diagnosis is the term used to describe those instances.
Complexity is the primary concern of dual diagnosis, as it goes far beyond a solitary addiction. Because of an addict’s mental condition, they can be driven to substance abuse. Conversely, their abuse can then worsen their mental state, thereby resulting in greater anguish.
According to the National Alliance on Mental Illness (NAMI), dual diagnosis encompasses a range of mental health disorders, most commonly including depression, social anxiety, post-traumatic stress, bipolar, and schizophrenia. In dual diagnosis, a substance abuse disorder can emerge prior to the mental disorder and vice versa.
Substance addiction is incredibly difficulty to beat. The lightest mental lapse can result in a slip up that leads addicts to drink again. For people with mental disorders, the mere presence of a substance can cause dangerous changes in their brain chemistry, thoughts, and behavior, making recovery tougher than for sole addicts.
12 Steps Unsuitable for Complex Dual Diagnosis
A 12-step model can be incredibly effective for mild addicts who have not received a dual diagnosis. They can focus entirely on working the program to work through their addiction and make quick progress. For them, the traditional 12-step program is easy to enter and make progress as they share experiences with their peers. However, the same cannot be said for dual diagnosis.
The issue with dual diagnosis is that a 12-step model will not give them the complete extent of support that they require. Alternatively, there are some 12-step dual diagnosis programs, but they are not quite so prevalent. Another concern is that a dual diagnosis recovery meeting still heavily leans on the existing 12 steps, albeit with minor amendment to add in mental conditions.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has previously determined that integrated treatment is the most effective approach to dual diagnosis. That entails receiving substance and psychological treatment from a single source.
Ideally, dual diagnosis sufferers should be enrolled in an inpatient program that offers them integrated treatment. In a group context, they simply cannot expect to receive the support that they need to treat their complex psychological issues. As a result, they are missing out on the treatment and aftercare that they need.
Although some addiction organizations have made efforts to include dual diagnosis alongside the traditional 12-step program, this act highlights the original deficiencies of the 12-step approach: that people receive collective treatment that does not benefit their highly specific, individual needs.
A complex dual diagnosis should receive customized treatment for addiction and mental conditions in one place. SAMHSA also agrees that integrated treatment is most effective for dual diagnosis.