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Another Look at Step 4

By Scott Alpert
March 05, 2014

This is the fourth in our series of reviews of the 12-Steps addiction treatment program and how each step compares with a 12 Steps alternative approach. We understand the 12 Steps have helped many, many people over the years, and we respect that success. We also recognize that the approach does not work for everyone. The main purpose of this series is to present some potential limitations with the 12 Steps that you may not have considered. We want to make it easy for you to understand the differences as you go through your addiction treatment research.

What is the AA 12 Steps Addiction Treatment Program?
The AA (Alcoholics Anonymous) 12 Steps program has been in existence since 1939. It was created by an alcoholic for other alcoholics, and relies on group support and behavior modification to a very large degree. It is still the main healing protocol and approach in the vast majority of addiction treatment programs (including very expensive residential treatment centers). Since that time though, there have been many breakthroughs in psychology, spirituality and healing, but the 12 Steps have not been updated to take advantage of these advances. With that let’s take a look at the 4th step, 12 Steps Step 4.

Another Look Step 4
Step 4 of the 12 Steps program states:
"We made a searching and fearless moral inventory of ourselves."

Now that the arguments of powerlessness are behind you (12 Steps Step 1) and you’ve picked up a traveling buddy in a Higher Power (12 Steps Step 2 and 12 Steps Step 3), it’s time to dig in. Step 4 of Alcoholics Anonymous separates the serious from the dabblers. In taking an honest look at ourselves it can, and has, opened up many deep-seated wounds. Does the 12 Steps approach do enough to close the newly opened wounds properly? Let’s take an honest look.

Many people engage in drug abuse, alcohol, or other substances to avoid dealing with sensitive issues. Step 4 forces these issues to the surface. Suddenly people have to deal the fundamental reason why they drink or do drugs, and deal with the feelings they have been trying to avoid and their traumatic life experiences.

Hard Questions, Little Training
The traumatic life experience issues are juicy and real for those suffering. But on a practical level, most 12 Steps practitioners lack this type of training and are ill-equipped to help the with these conditions. Psychological dynamics and therapeutic approaches were never taught to many inexperienced chemical dependency counselors, who often have minimal education founded on 12 Steps principles. But wait - it gets worse.

Many people going through 12 Steps programs are not fortunate enough to even have a counselor. Many addiction treatment and residential rehab programs strictly farm out their 12 Steps -based program to local volunteers who transport participants to and from 12 Steps meetings, become their month-long sponsor, and are asked to lead a participant through the 12 Steps. Opening up a gaping psychological or emotional wound during this process could lead to serious damage and possibly even death if not handled properly by the practitioner or sponsor.

And This Leads to the Real Challenge of Step 4
How quickly we forget that individuals who go to addiction treatment are sick. Many of them have deep emotional scars. Should these people be at the whim of an untrained or under-trained paraprofessional?

The vast majority of individuals who report difficulties with the 12 Steps approach point to Step 4 as “putting them over the edge.” Confronting and looking at their deepest darkest secrets is a vigorous and painstaking process for the average person. Add onto this the pain and shame of alcoholism or substance dependence. The recovering addict has many extra burdens to work through.

In conventional psychology, a therapist and client need to create a loving bond before any attempts are made to uncover the emotional wreckage of the past. This bond can be instantaneous or it can take months to establish. The 12 Steps programs often disregard this bond, while forcing patients to keep on a regimented schedule of 12 Steps completion.

Recovering addicts are well aware of the damage they have caused. Should the rehab and recovery industry humiliate them further or help them learn and grow? According to many studies (see below), under 5% of the people who complete the 12 Steps maintain control and sobriety. The other 95% struggle, falter and return to alcohol, drugs or other preferred substance in failure or simply for relief from these wounds.

A Modified Step 4
Utilizing a psychological approach, a modified Step 4 has some promise. It can be used as a tool to uncover deep seated wounds – if done so with compassion and sensitivity. Once a therapeutic bond is established between counselor and client, the Step 4 inventory can bring issues to the surface to be healed through psychological means. This would take on a different appearance from what you currently see, however. Instead of the 12 Steps being program-sensitive it would need to be person-sensitive. Going at the client’s pace instead of the program’s dictates can enhance its effectiveness.

The key to therapy is tapping into the client’s own resources. A little reminder – the vast majority of people have all the internal resources they need to deal with every circumstance. Once a client learns how to heal, the dynamics shift from a therapist / client bond to an internal bond with self! The practice of placing the care of a wounded client into the hands of often ill-equipped paraprofessionals has wreaked havoc on the rehab and recovery industry. We need to make this change – now.

Step 4 can be a good one, if handled professionally. Let’s mandate proper training and licensing for people working directly with clients in addiction treatment and residential treatment centers. This can at least begin to improve chances of success so more people can truly heal their substance dependence

Dr. Scott Alpert has worked in the mental health field since 1994. During his career he has seen over 8000 patients, many during his ten years at a Mental Health Urgent Care center in the Los Angeles area helping people in extreme crisis. Dr. Scott has perfected the unique combination of spiritual and clinical psychology in an extraordinarily effective and endearing way.


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