Lessons From AA For Peer Support Networks

What can we learn from the 12 Step world about transformative mutual aid practices?

(Underground Transmissions originally began as a secret facebook group I made after Trump got elected in 2016. I had recently been hired to work at the New York State Psychiatric Institute (NYSPI) developing the peer role for a First Episode Psychosis program called OnTrackNY. I invited a bunch of interested people to dialogue with me about working inside the public mental heath system and then the conversations just got really interesting, and became it’s own kind of support network. This text was excerpted from a thread in 2018. There were 186 comments, I just took a handful of them. We are having similar conversations now about revitalizing the Icarus network. Feel free to join in!)

I went to an AA meeting last night and I can't stop thinking about it. I've been to a handful of them over the years with friends who identify as alcoholics. I am always struck by the level of support and camaraderie I feel in the room. The thing that always strikes me the most is how organized the relationship is between sponsors and sponsees. That as soon as you come to your first meeting there are people there willing to support you, not just there at the meeting that night but people you can talk to on the phone whenever you want. I am also so struck by the practicality of having a set of steps that everybody in the group goes through and talks about. Well some of those steps don't match up neatly unto the kind of group I would want to be a part of, some of them same amazing. For example the one about making a moral inventory, the one about making amends with people who you hurt, these are powerful powerful tools for growth, and having relationships with other people who have "worked the steps" and can you be there as a guides, as mentors, as peers I know what it's like to have gone through intense personal challenges... I want to be a part of a community like that. If it doesn't exist yet I want to be a part of creating it. Does anyone have to have thoughts? Hello from Tallahassee Florida where I was swimming in the ocean today and laying in the sunshine.

Okay a couple more thoughts about this. One of them is that it's clear the recovery movement in mental health is partially trying to borrow from the power of the addiction recovery movement. Which explains why there are governmental organizations like SAMHSA that put mental health and addiction in the same Arena. But while I definitely see the there is a utility in saying you are powerless over your addiction and therefore need to turn yourself over to a higher power, that is not work in the realm of Mental Health in the way I understand it. First of all, it is super problematic to use language like admitting you have a mental illness when what the fuck does that mean anyway? But in my work training Pierce specialists in other states I have definitely come across people working in peer roles who are using that kind of language because they are coming out of the 12-step movement. So, just to be clear, that is not what I'm talking about. That is some bullshit I want nothing to do with. What I'm talking about is the power of people supporting each other and building community with a basic set of principles and knowing there are other people in other place

One of the riddles in This conversation, the conversation about taking ideas and principles from AA and using them to build a new community, is this question about who can be a sponsor. And by the way in my mind I would never use that word sponsor, I would probably use the word mentor. In AAA it's about working through the steps and staying clean. And I suppose that means that there needs to be some steps to go through. Last night at that meeting I found myself thinking about the five sections of T-MAPs that Jacks and I developed to train peer workers at OnTrack. I found myself thinking that Mary Ellen Copeland has probably thought about this one in her design of the WRAP model. Maybe not. I suppose it's kind of grandiose thought, the thought of starting a home new model for Community Support. But I feel like we already tried to do it with the Icarus Project and it really didn't work because it wasn't standardized enough, just there was no mentorship built-in to it, because we were young, because we were crazy, because of a bunch of different reasons. But I'm still really interested in this idea. I think there is a desperate need for it.

Some comments (I’ve taken out the names)

TM: The powerlessness thing is a tricky one. I left a psychologist who suggested I try to admit my "powerless over my illness" or to "blame my illness" for the stupid things I did and I resented her for it. It is not for someone to say to another person, I don't think. It is something that needs to come from within, kind of a realization that I (my ego) am powerless to change or control others and my life is unmanageable. I need help and I need to allow myself to be helped.

ML : All that is meant by the word powerless in the twelve step community is that you can not control it (your addiction etc) and no amount of trying to control it will change it

KM: I know some medical model people do view 'mental illness' as the alien enitity that they are powerless over. so I'm not sure how you'd get that in the same group as those who don't.

SB:Only the Steps emphasize powerlessness. That isn't really emphasized anywhere else in recovery and it is shown to be one of the most harmful elements of the Steps.

I think it's strange that you feel like addiction recovery and mental health recovery are separate issues. To me, it's obvious that addiction recovery is just a subset of mental health recovery. Addiction has never been an organic disease, imo. I've always seen it as a maladaptive coping mechanism for mental health challenges. Addiction is MUCH more behavioral in nature than chemical, which nobody wants to admit. For example, I'm addicted to marijuana which has never been shown to have chemically addictive properties. And people try to deny that my addiction is real because I "can't be chemically addicted to marijuana" so in their mind that somehow makes my lack of control of my marijuana use different from addiction to drugs like opiates. When in reality they're not that different. Dermatillomania can also be an addiction-driven behavior. It can also be driven by OC spectrum disorders or ADHD. So addiction and mental health are two sides of the same coin.

KM: I look at so many things as 'coping mechanisms' and I can see cannabis use as a combination of coping mechanism and recreation. and then when you do a behavior long enough, it gets priority over other coping mechanisms. and coping mechanisms are about mental health issues or symptoms like anxiety or depression.

SB:Most problematic behaviors start as reasonable coping mechanisms and then through positive or negative reinforcement became so strong that they are no longer being controlled by our conscious decisions (which I believe is the source of the "powerlessness" idea but it's very different when framed in a behavior science framework). Behavior science is quite relevant to the issue of addiction and recovery.

CT: I want an excuse to make those kinds of lists and have someone read them and be present with me about it. When it comes down to it I don't think I need a therapist as much as I need someone like a sponsor just to help me get through some shit who's already been through the kind of shit I've been through or some form of it.

ML: Maybe check out some Adult Children of Alcoholics meetings or ACA,it is also for dysfunctional families you might find some good models there as well. I find that the mental health community and my recovery community are very intertwined. And yet AA is definitely primary purpose and doesn't work for a mental health model on its own ,it seems however that peer support is filling the space for The Sponsor sponsee relationship.

ES: To me, it's a tiny bit sad. And by sad I don't mean to shit on AA. For the people that they work for, 12-step communities are literally a lifesaver and a place of profound connection, of seeing and being seen, of supporting near-strangers in their struggles and in doing so becoming family.

But to me it also points to how community-starved we are all are. Here in Minneapolis I'm part of a community of people that meets every Wednesday. Started by a few people 10 years ago, the only rule is bring your best, because once you bring them they can come forever (and bring their best) . There's about 100 or so people, and usually about 30 every week. There's no reason to gather, besides the community. And everyone has become extended family. Need a ride somewhere? Someone's got you. Having a hard time? Someone will take you out to dinner. Throw a party? Well here's 40 people that will come and have a blast. And now that I have a community, a real community, I can't imagine how so many adults live without one.

Friends make the best medicine indeed.

SD: regarding the sobriety thing - I think it gets really interesting when you start talking about psychiatric drugs and where they fit into a model of abstinence. I was horrified when I tried to join a co-counseling group that was meeting in my neighborhood and it turned out I couldn't do it because I take lithium! And on the other end of the spectrum there are all the programs (like the one I work for) that are encouraging young people diagnosed with psychotic disorders to take "antipsychotic" drugs - and of course the way worse one where people are forced to take the fucking drugs in order to keep their housing and services etc. anyway, such a range of human experiences related to substances.

MC: Sascha, you started by writing that you were always struck by the level of support and camaraderie you feel in the room of an AA meeting and that someone is there too to talk on the phone whenever you want.

For me, that’s the core genius of the AA and the other 12 step programs that originally brought them to life before the steps even got formulated-

If a person was in need those folks who were able, would go be with them no matter when or where- to see them in jail, on psych wards, on the streets or at 4am anywhere. That’s still the spirit I feel-

If I’m losing my shit at 4 in the morning and can’t handle another minute of the emotional pain, some hard core AA person will come to my house and be there with me with no questions asked and no judgements passed.

LN: And that you would do the same for someone else. Mutuality. Being of service to others. Unconditional high regard for another alcoholic. And....it's forever amateur and free. The idea of "helping another drunk" worked at combating one's self-pity and selfcenterdness. Regardless of orientation, reading the "Twelve and Twelve" may be most insightful.

SB: I also think that's part of the success of the Steps, the call to service. It gives purpose where previously purpose had been lost or never found.

DV: I think MC hit the crux of it above - the need to design an entry point that identifies the mentoring relationship as standard.

I am resistant to any processes that feel authoritarian, power-over, or 'churchy', or anyone touting a 'Method'. I am cynical about gurus with sales pitches. Both my parents rejected Judaic orthodoxy and I knew nothing about jewish ritual until I was in my thirties. But I also see how much people desire to surrender to a process for the sake of a sense of belonging. My mother joined an ashram in the eighties and became a life-long convert to Hinduism, the vedic path being an incredibly sophisticated method to self-knowledge and healing developed over thousands of years. Only slowly has she come back to acceptance of jewish practice as valid.

Imagine a space that mimicks AA process - when people come to a meeting, what are the first three questions to be shared that would be most relevant to people in a mentally distressed state and needing support? What kind of common practice would have the right smell and flavour that it could become a 'method' of loving acceptance?

LN: I think one of the brilliant and cool things about AA is there are no demands on newcomers. No questions. No answers. A person does not even need to be sober. I think that was part of the magic. Drunks were like, "Cool. Attention from others, free coffee and in the old days cigarettes." No requirements whatsoever beyond a desire to stop drinking. No dues. No rules. The 12 x 12 being suggestions. It only takes two people to make it a meeting. Pretty simple.

KM: that makes sense. just a space to witness other people living the 12 steps and a newcomer watching them and learning and feeling in community. icarus meetings also allow people to just witness without speaking and be in community.

DD: I absolutely love this thread. Being in both peer roles and practicing the 12 steps along with sponsoring people has always been a parallel for me it’s something I had to keep in mind when I was a peer not to fall into that sponsorship role (mostly due to the boundaries required for the job), having that background as a sponsor tho was invaluable as a peer…The core of the steps, for me at least was never about addiction, it was about underlying why I kept repeating the same harmful behavior over and over. The steps (esp the 4th step) is all encompassing in my opinion more then just substances (plus lets be real when is it ever just one thing?!)

CW: The need for Mutual aid groups: I don't care if it is called Icarus or something else -- it depends on the individuals involved. But it is so clear that we need to work on fundamental group models that are alternatives to the traditional top-down medicalized approach for mental health. If Fireweed isn't doing this, it needs to be done some other way. We have plenty of time to work on the details of this model while we are not meeting in groups....

I've been working in traditional mental health for years, and it is a lifeless, failing system. I would like to participate in something that empowers people to do self-help and mutual aid processes themselves.

Recreating a "self help" movement isn't what I would like to do, but organizing a transient political movement that is ignorant of interpersonal and intra-personal issues isn't effective and doesn't work either. It seems that people get together in a ad-hoc groups or actions such as protests during which emotions and personal experiences are expressed but they do not lead to interpersonal and ground-level change.

Sometimes I believe in the value of professional knowledge and insight that is grounded in research, for example people like Bessel van der Kolk. But in principle, I don't accept the dynamic of professionals self-promoting themselves as experts. I believe that we can do this ourselves and we don't need experts or leaders to control a dialogue about mental health.

We have a tremendously alienating and competitive society which professional mental health services seem to be complacent in promoting our "adaptation" to rather than organizing opposition to and organizing alternatives to. I think that this is where I would like my life work to be.

It seems absurd that while AA, NA, Refuge Recovery, etc seem to have worldwide movements that there is not comparable movements for addressing the combination of social disintegration and alienation that I see around the world and certainly in my own life. These movements have their own issues, but at least they exist.

There are a lot of models out there. But basically I think it comes down to some simple principles. I suggest these...

1. We are voluntary participants who want to reach out to support each other.

2. We want to do it without fees and the medical system overseeing our efforts.

3. We come together in these groups for the purpose of mutual aid, which doesn't mean advice or coercion.

4. We are willing to examine our own privilege and blind spots and know that we are speaking only from our own experience.

5. The nature of experience seems to be limitless and our individual experiences are limited. But by practicing empathy and compassion we can learn about others' experiences other than our own and thus learn about ourselves and our interpersonal lives.

6. We don't have to limit the concept of group to just "support group" where we sit talking. We can do a lot of things in groups such as physical exercise and trust building. Political discussions can be grounded in sharing of personal experiences. We can have concrete mutual aid such as sharing of resources.

7. It will be inevitable that there will be personal differences that manifest as philosophical differences and basic differences of power. These are probably inherent in the matrix of society and culture in which we live. So anything that is present in the society is bound to occur within our own group. At times we will have our feelings hurt and there will be times when people feel marginalized or insulted in some way. This only seems natural in a group of people who have been sensitized to the injustices and inequalities in society; we are primed to see aspects of these experiences wherever we are. Consequently I think that there needs to be a structure that is stable and concretely defined that can withstand personal and social divisions.