A delicate balance: 12-Step recovery and co-occurring disorders treatment

As more addiction treatment programs begin to offer integrated treatment for persons with co-occurring serious mental illness, they likely will encounter patient concerns over attendance in 12-Step recovery groups. A pair of clinicians with New Hampshire-based WestBridge Community Services told a session audience Sept. 29 at the National Conference on Addiction Disorders (NCAD) that 12-Step meetings can be highly productive for patients with co-occurring disorders, although matching a group to a patient’s particular needs becomes critical.

“To take a person to a meeting that’s too big or too loud is going to be problematic,” said James Gamache, MSW, mentor team leader and quality assurance coordinator at WestBridge. Other concerns that individuals with serious mental illness might express about the 12-Step group atmosphere include being repeatedly asked if they need support, and the perception that these groups are dogmatic and even cult-like.

Gamache and John Colby, MSW, a clinical care manager at WestBridge, showed the NCAD session audience two videotaped interviews with WestBridge patients (“participants,” in the organization’s vernacular) who came to find 12-Step groups that bolstered their recovery. One individual mentioned that he usually didn’t discuss his co-occurring mental illness with others in his group for fear of not being accepted, and added that it was challenging to find a group that didn’t mind his aversion to prayer. But he said that Alcoholics Anonymous (AA) has directly helped him in dealing with his co-occurring mental illness, with respect to learning to live life on life’s terms.

Both the presenters and audience members wrestled with the practical application of the concept that “AA is not therapy and therapy is not AA.” Gamache related the story of a clinician he heard about who had told a mentally ill client that everything he needed to know about his illness could be found in sections of AA’s Big Book, only to have that client see his condition worsen and commit suicide shortly thereafter.

On the other side of the coin, one audience member expressed frustration that some 12-Step group members with mental illness will turn a recovery group into a therapy session by dwelling on problems of origin in the meeting discussion. “That’s not the place for that,” the audience participant said.

Clearly, bridges need to be built between the dual disorders treatment and 12-Step recovery communities. Gamache and Colby said WestBridge tries to achieve this in several ways, from its direct outreach to the local recovery community to its orientation of program staff and patients to 12-Step principles.

But the bottom line is that WestBridge staff will never mandate that a participant go to meetings. It sees this effort as an ongoing process for its seriously ill target population.