When is AA Not Enough?

February 5, 2020

Mutual aid groups like AA and NA are typically the first thing someone thinks of when they think about getting help for themselves or for a loved one. AA has been helping people quit drinking for nearly 85 years. AA and the groups based on it have a lot going for them. They are free and open to anyone who wants to get sober. They are also widely available. There are more than 120,000 AA groups and more than 67,000 NA groups worldwide, so no matter where you live, there is probably a meeting within driving distance and maybe a meeting within walking distance. The 12 steps give structure to your recovery and, perhaps most importantly, these groups provide you with vital social support. AA and its offspring have helped millions of people quit drinking, using drugs, and engaging in other self-destructive behaviors.

However, despite the advantages of these programs, they may not be enough for everyone. Substance use disorders are different for everyone and no single approach can be universally effective. If mutual aid groups haven’t worked for you or a loved one, some of the following causes may be to blame.

You have a hard time detoxing.

Detox is the first major hurdle for anyone who wants to get sober. You don’t have to be sober to attend an AA or NA meeting; you just have to want to be sober. Detox can be painful and even dangerous. Many people try to detox on their own but give up early because of discomfort or fear. Unfortunately, there’s not much a mutual aid group can do to help you through withdrawal other than give you advice. It may be good advice, but the fact remains that you may have to seek help elsewhere.

Most of the time, detox is just unpleasant, sometimes it can be extremely unpleasant. People detoxing from opioids, for example, often say it’s like the worst flu they’ve ever had, with nausea, vomiting, shaking, sweating, cramps, diarrhea, runny nose, headache, body aches, and chills. People trying to detox on their own often get a few days into it and give up because it is so miserable. Detoxing in a facility can make the process slightly less uncomfortable and there are people around to take care of you and give you food and plenty of fluids. 

Detox can sometimes be life-threatening, as with severe alcohol withdrawal or DTs. Only about three to five percent of people who quit drinking experience DTs, but of those who do, it is fatal in up to 37 percent of cases. With the right care, DTs can typically be managed, making medical detox a much safer option for heavy drinkers.

It’s not always possible to know in advance whether you will need help detoxing. One sure sign is if you’ve tried and failed before or if you had a difficult detox experience and then relapsed later. Withdrawal can be extremely hard on the body so if you’re older or have other health problems, you should look into medical detox.

You can’t stick with the program.

As noted above, one of the great advantages of mutual-aid groups is that they’re free and open to everyone. However, this feature can also be a bug. Most people who attend meetings of their own free will also stop attending meetings sooner rather than later. One study found that more than 80 percent of new AA members stopped coming within the first month and only about 10 percent made it 90 days. Other research suggests that AA can be effective for people who keep showing up but there is often little commitment for people who start showing up to meetings. 

This is where entering a professional treatment program can be helpful, especially if you choose a residential program. Few people enter treatment feeling completely sure they want to get sober. More often, they are appeasing a partner or relatives or they just feel like something has to change. Motivation tends to grow as they participate in treatment. Treatment programs often use a method called motivational interviewing that helps clients find their own motivations for getting sober, which increases their commitment to recovery. Also, being in residence or just paying for a structured program of treatment tends to increase commitment. Research shows that we tend to value what we pay for. While it’s great that AA and similar groups are free, it may also make people undervalue the opportunity they offer.

You have a co-occurring mental health issue.

Co-occurring mental health issues are extremely common among people with substance use disorders. According to the National Institute on Drug Abuse, more than half of adults with substance use issues also have a mental health issue. These typically include major depression, anxiety disorders, PTSD, ADHD, personality disorders, bipolar disorder, autism spectrum disorders, and schizophrenia. These interact with substance use in complex ways. Sometimes substance use issues begin as a way of self-medicating and in a smaller percentage of cases, substance use can cause mental health issues. Often, both substance use and mental illness share a common cause. Typically, they feed on each other and make each other worse, so it’s crucial to treat the co-occurring condition at the same time as the addiction.

Unfortunately, mutual-aid groups are not set up to help with mental health issues. Meetings are run by members and not by people with special training in mental health or addiction. Anyone with a mental health issue and a substance use issue at least needs to get help from a doctor or therapist in addition to attending 12-step meetings. Even better is to find a program that can address co-occurring mental health issues at the same time.

You don’t like the culture.

Finally, you may not like the culture of a mutual-aid group. In areas with many options, this may not be a problem because you can just keep trying different groups until you find one you like. After all, mutual-aid groups are fairly autonomous and the culture of each group largely depends on the particular members. However, if you live in an area with fewer options, you may feel stuck in a group with an unhealthy dynamic or one where you just don’t click with the other members. There are some groups that can be extremely dogmatic and this sometimes puts people off. If you can’t find a meeting that works for you, it may be better to consider other options.

Twelve-step groups can be a great asset for anyone recovering from addiction. Even people who enter a formal treatment program often find that 12-step meetings help them continue their recovery. Some people just need more than AA or NA can offer and that’s fine. At Steps Recovery Centers, we understand that there are many roads to recovery and that everyone faces different challenges. We can help you find your road with a variety of treatment options. To learn more about our programs, call us today at 385-236-0931 or explore our website.

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