Sun. Jul 3rd, 2022

Beyond the 12 Steps: The Benefits of Dual Diagnosis


If you’ve sought treatment for substance abuse, you already know that 12 Step programs are the prevailing addiction treatment model in the United States. They’re ubiquitous and accessible, often comprised of well-intentioned, compassionate individuals.

Yet when the 12 Steps were created in the 1930’s, the psychological science of addiction was in its infancy. As such, the 12 Steps were not designed to help people heal the underlying mental and emotional issues that fuel their addictive behaviors.

Today, we know that most people who struggle with addiction have what’s called a Dual Diagnosis – that is, a behavioral issue along with a mental health issue. For example, an individual might have a substance abuse issue paired with an eating disorder, or alcoholism as well as depression.

A true Dual Diagnosis program treats both the behavioral issue (addiction) and the mental health issue (such as anxietydepression, or PTSD). Dual Diagnosis treatment involves addressing both interrelated conditions at the same time.

If you have a Dual Diagnosis — and most people with an active addiction do — then seeking out 12 Step Alternative treatment programs can be key to your recovery.

Depression and Anxiety: Common Companions in Addiction

Anxiety and depression are two of the most prevalent mental health conditions that contribute to substance abuse and addiction.

According to the Center for Disease Control and Prevention (CDC)’s December 2014 report, 7.6% of Americans aged 12 and over had moderate or severe symptoms of depression between 2009 and 2012. And anxiety disorders are the most common class of mental disorders in the general population, according to the CDC website’s Mental Illness page.

One definition of depression is “anger turned inward.” When a person no longer feels that they can express their anger, they bottle it up and it becomes depression. But why is the anger there in the first place? Because the person has experienced something painful. But the person doesn’t want to work with the hurt, so they cut themselves off from it.

They don’t feel their anger and hurt, but there’s still energy bouncing back and forth between those two states. That energy is defined as anxiety. Thus depression and anxiety are both about emotions that a person is refusing to express and feel.

Millions of Americans cope with anxiety and depression, and their struggles often lead to addictive behaviors. After all, when negative feelings get triggered, people self-medicate in a way that works for them. To recover, they need a set of tools to work with their feelings rather than numb out.

Seeking 12 Step Alternatives for Dual Diagnosis

Most people who have a drug or alcohol addiction also have a mental health issue, and vice versa. According to the Journal of American Medical Association (JAMA), 50% of the people who have a severe mental condition also have a substance abuse problem … [and] 37% of alcoholics have a mental illness, as do 53% of drug addicts.

Yet, 12 Step programs don’t provide Dual Diagnosis treatment or address the underlying issues that drive addiction. This is one reason for the low success rate of traditional 12 Step programs. (Harvard researcher Dr. Lance Dodes  cites the results of a study concluding that the actual AA success rate is 5-10%.)

How 12 Step Programs Can Be Counterproductive

Individuals with Dual Diagnosis need to address the core mental and emotional issues driving their addictions, and some 12 Step traditions are counterproductive in this effort.

For example, 12 Step programs equate individuals with their addiction, as participants must identify themselves as alcoholics or addicts. Each time an individual attends a meeting, they must begin by saying, “My name is So-and-So, and I’m an alcoholic.” This reinforces the limiting belief that an addiction defines a person.

Likewise, 12 Step groups teach members that they are powerless over their addictions, that they have no choice but to use. But individuals with addictions are very powerful; they’re just using their power in an unhealthy way. As such, what they need is not a message of helplessness. Instead, they need to learn to consciously create a healthy life for themselves.

Furthermore, individuals who struggle with 12 Step ideology often hear shame-based messages from leadership. The popular program catchphrase, “It works if you work it” implies that the problem is always with the individual, never with the 12 Step program itself. Shame like this is a roadblock to recovery.

Finally, the 12 Steps don’t provide practical how-to’s for healing the traumas and emotional wounds that underlie Dual Diagnosis conditions.

By contrast, modern psychological approaches provide specific guidelines for healing and releasing judgments, as well as reframing limiting beliefs.

Healing All Four Levels of Self

Some 12 Step Alternative treatment programs use these techniques to facilitate healing all four levels of self: physical, mental, emotional, and spiritual. Such integrative Dual Diagnosis treatment programs help participants to build a bridge between spiritual principles and practical application.

Our addictions are about our relationships with ourselves. The issue isn’t the external circumstance, but rather how we are with ourselves as we navigate that circumstance.

It is important to focus on our relationship with ourselves, on understanding and healing the issues that cause upset within us. Recovery entails cultivating a loving, kind, positive relationship with ourselves, regardless of what’s going on “out there.”



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