My last post caused quite a stir. I gave up replying after 30 or 40 comments came in. Then I gave up even reading the comments (except for briefly scanning some threads) by the time the number hit 80. This morning the number was 141 — I think that’s huge for any post on PT.

marclewisConclusions? Some people really love the 12-step program and some people really hate it. Got that. Many have had intense positive or negative experiences that determine their views. A few have done in-depth research, looking at things such as success rates, often through studies that compare 12-step approaches with spontaneous recovery rates or rates associated with other programs. But even those who’ve done a lot of fact-finding are still often driven by their personal biases. Which isn’t surprising. In the real world, scientific data generally takes a back seat to opinion, and the studies and stats concerning AA are such a jumble that you almost need a bias to provide you with some direction. I think the best conclusion to draw from the whole debate is that there are many many different kinds of 12-step groups. Some intentionally promote warmth and support, others fall into the use of “scare tactics” and even “bullying“. We simply can’t think of all 12-step groups as being the same, and we can’t judge them all with a single standard.

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So much for my summary. Now let me try to resolve the conflict I raised in a different way: by taking another look at my claim that some 12-step groups promote abstinence by invoking a kind of PTSD — keeping members in a frozen state of anxiety, lest they even THINK about having another drink (shot, pill, or whatever). According to this claim, the emotional state created by (at least some) 12-step groups is one of stasis, where you continue to label yourself an addict and try NOT to change the sense of fear that comes with thoughts of relapse.

But can anybody actually recover from anything by remaining in a static state?

In my home blog, this issue was raised and argued very cogently. What I came away with was the realization that recovery, like addiction, has to be a developmental process. Change — not stasis — must be foundational for people to continue to grow: to grow out of their addiction, and even to grow out of the emotional conflicts that helped to create and maintain it. According to this definition, pure stasis simply cannot correspond with recovery.

The term neuroplasticity has been bandied around a lot lately. Well before Doidge’s influential book came out, Dr. Eric Kandel of Columbia shared a Nobel Prize in 2000, reflecting decades of research on how the brain changes when learning occurs. In a nutshell, Kandel showed that the connections among neurons – synapses – must change physically if memories are to be formed. He showed this at a molecular level, validating Hebb’s famous insight from the 40s: What fires together wires together. Learning = neuroplasticity.

Neuroplasticity is greatly amplified when people are highly motivated to change, probably because of the neurochemical flood that accompanies strong emotions. In her wonderful book, Barbara Arrowsmith-Young describes the many cognitive exercises she devised in order to overcome her severe learning disabilities. They worked. She went from being a high-school student who could not comprehend history, who even had a hard time understanding simple sentences, to a writer and teacher who has set up roughly 70 schools for learning-disabled children in North America. Barbara has a delightful phrase for neuroplasticity dedicated to replacing bad habits with good ones:

What fires together wires together, and what fires apart wires apart!

In 1993, Mogliner and colleagues looked at the brains of people who had been plagued with webbed fingers. That means that some of their fingers could not operate separately – they functioned as an assembly, in unison. After surgery was performed to allow the fingers to move independently, these authors looked at changes in the (somatosensory) cortex. What they found was that the synaptic wiring of neurons in the corresponding brain regions had changed substantially, within weeks after people started to control their fingers independently.

The parallel with addiction seems striking. You “learned” your addiction through neuroplasticity, which is how you learn everything. You maintained your addiction because you lost some of that plasticity. As if your fingers had become attached together, you could no longer separate your desire for wellbeing from your desire for drugs, booze, or whatever. Then, if you did indeed recover, whether in AA, NA, or standing naked on the 33rd floor balcony of the Chicago Sheraton in February, that means you got your neuroplasticity back. Your brain started changing again – perhaps radically. You started to separate one set of desires from another and to act on them independently. And just as in Mogliner’s study, your brain began to regrow its synaptic patterns – to allow the change to take place, to hold onto the change, and thereby to achieve a new stage of personal development.

The take-home message is simple: All recovery is developmental. Without developmental change in mind and brain, you would stay exactly the way you are.