Real World Clinical Blog: Rethinking Addiction Treatment

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AA/12 Step

AA/12 Step is about support and and taking responsibility. It is not a silver bullet. It has worked for thousands of people who are ready to work the steps. (and work it is) It really depends on the individual. AA/12 step has its issues, but it is by far the most available systematic approach to teach/talk/support people with addiction and put them around other people who are also wanting to be free from addiction.

Tim Anderson more than 4 years ago

12 Step and Trauma

I think the only flaw in this wonderful article is by not stressing strongly enough how dangerous AA can be for those with trauma, since it is almost a given that those who tend to lean more towards being a victim than victimizer will suffer a great deal in 12 Step until they realize that the problem is 12 Step and not themselves. Yes, everything that Bodenheimer says about these unhelpful myths is valid, but I would say the problem is even more serious than she suggests. For example, I was even referred to p62 in the "Big Book" of AA when I complained that other AA members were being abusive to me. This
textual crux is very clear that if someone is in pain it is their own fault, which is probably the most unhelpful approach one can take with someone who has been abused.

"Selfishness - self-centeredness! That, we think, is the root of our troubles. Driven by a hundred forms of fear, self-delusion, self-seeking, and self-pity, we step on the toes of our fellows and they retaliate. Sometimes they hurt us, seemingly without provocation,
but we invariably find that at some time in the past we have made decisions based on self which later placed us in a position to be hurt."

Silver Damsen more than 6 years ago

Alternatives to 12 Step

Here is a list of 11 Major Alternatives to AA (circa 2016)

Free Self-Help (includes men for sobriety) (entirely online)

Help involving paid professionals (for alcohol)* (for opiates)***
*use medication to rewire the addiction pathways in the brain
**aftercare is recommended, such as,, and

Indeed, the bulk of the harmful myths that Bodenheimer refers to are points of AA ideology, which should help to persuade professionals to stop encouraging their clients/patients to attend AA and 12 Step. In addition to having a written group psychology that is antithetical to trauma work, my experience would argue that AA will repeat the pattern of previous trauma as part of what it thinks is being helpful, and it will follow this pattern of abuse in order to help the AA/NA member realize that their pain "is of their own making" and that they had put themselves "in a position to be hurt." (as p.62 teaches

Silver Damsen more than 6 years ago

What about food!?

I am stunned to see that you do not have food listed with the rest of the topics that are on those chairs. Food is one of the widely practiced process addictions that people do not understand. I know it all too well because I've dealt with it my entire life, and I'm now an LPC that works with people with eating disorders. I am angry that food is not on one of those chairs.

Pam Rusch more than 3 years ago


Thank you for your comment and for bringing attention to eating disorders, and for your work in this area. The photo only depicts a few examples of the many types of addictions. Food is mentioned in the article. more than 3 years ago

About Real World CSW

Dr. Danna Bodenheimer is the author of Real World Clinical Social Work: Find Your Voice and Find Your Way and On Clinical Social Work: Meditations and Truths From the Field. She shares practice wisdom with new clinicians.