Canada Drug Rehab

“We Were Powerless Over Our Addiction”: Why Step One is So Controversial

By Daniel Jordan
General Manager
Sunshine Coast Health Center

Earlier this week, I had a thoroughly enjoyable discussion with Paul Murray, a private-practice psychologist based out of West Vancouver, British Columbia. Our discussion covered a lot of ground but one topic that I found particularly engaging was the notion of powerlessness. Both Paul and I marvelled at how two people declaring powerlessness over their addiction may have two very different treatment outcomes based on fundamentally opposing underlying intentions: one may reflect a preference for the status quo while the other could be ready to turn over a new leaf.

How Powerlessness Became Synonomous with Addiction

Obviously, this idea of powerlessness is not something that Paul and I invented. As friends of Bill W. will tell you, powerlessness lies at the heart of the 12 Steps of Alcoholics Anonymous and it’s first step: We admitted we were powerless over our addiction - that our lives had become unmanageable. Al-Anon has also consoled family members for years by telling them that they, too, are powerless over alcohol.

Over the years, however, Alcoholics Anonymous and other 12 Step programs have had their fair share of critics with powerlessness frequently at the heart of the dispute. For example, SOS, has created an alternative self-help group for “… those people who find that the ideas of reliance on a Higher Power or God, “powerlessness” and the emphasis on character defects to be an obstacle to recovery.”

The addiction treatment community has long since argued for and against the notion that individuals with addictions are ’powerless’. Powerlessness proponents tend to be traditional 12 Step treatment programs, physicians, and psychiatrists while those opposed tend to be psychologists, scholars, and mental health practitioners. The ongoing debate between these opposing camps has only hampered efforts by moderates to find common ground.

Furthermore, the debate over powerlessness and addiction is more than just a trivial concern judging by the vitriol one hears expressed on talk-back radio programs.

Defining Powerlessness

Let’s consider five different ways that powerlessness is understood in relation to addiction:

1) Powerlessness is a Choice

Recently, a book by Harvard psychologist Gene M. Heyman (*), Addiction: A Disorder of Choice, has suggested that individuals choose to be powerless. Dr. Heyman argues that addiction is voluntary rather than compulsory, and that addicts respond to incentives just like most other people. According to Dr. Heyman, interviews with drug users in recovery shows that quitting was preceded by such factors such as finances, family, career, and health.

People who suffer from diseases such as Alzheimer’s or schizophrenia, however, will rarely find improvement in their condition due to good intentions, even when followed by concrete steps. In other words, human beings are only truly powerless when faced with ‘real’ diseases.

One important difference between Dr. Heyman and other opponents to the concept of powerlessness, however, is that while Dr. Heyman believes that to remain powerless over an addiction is a choice, noone chooses to become an addict. As our Program Director, Geoff Thompson, often reminds our clients, children rarely tell their parents ”when I grow up, I want to be a drug addict.”

(*) Note: For more information, see Interview with Gene M. Heyman.

2) Powerlessness is a Lack of Willpower

Society often believes that, with a little bit of willpower, people can simply stop using drugs or alcohol or reduce their consumption to socially acceptable levels. This mistaken belief, however, is actually a failure to distinguish between the separate, progressive stages of compulsive use of chemicals or processes: abuse and addiction. As Carlton K. Erickson points out in his book, The Science of Addiction: From Neurobiology to Treatment, addiction is a failure to stop using in spite of negative consequences. Abusers of alcohol or drugs, most notably college students, will often stop excessive consumption when they are in a new environment where getting high or drunk is no longer encouraged, or when they experience negative consequences. For individuals with addictions, however, drinking or drug use will continue even after job loss, divorce, or illness.

Even for people who don’t struggle with addiction, however, it is arguable whether simply trying harder is an effective method for attaining any worthy goal. Most who have tried to lose weight or have implored their children to improve their grades know that trying harder may work, but only temporarily. Without an effective strategy and implementation plan, willpower is not enough.

3) Powerlessness is the Same as Helplessness

Helplessness can be understood as the tendency for some addicted individuals to assign blame to external forces and avoid taking personal responsibility. So, when someone says “I am powerless to stop my addiction” they could be actually saying, for example, “my drinking wouldn’t be a problem if only my wife would get off my case.” This lack of accountability is typically obvious to everyone but the individual with the addiction, including those of us working in the field.

However, while it may be easy to spot helplessness in another person, determining the root cause of why someone is so incapable of taking action is far more challenging. For example, helplessness could be a response to childhood trauma, a phobia or depression. Taped recordings of AA Founder Bill Wilson suggest that he understood the link between helplessness and addiction. Following the sudden death of his childhood sweetheart, Bertha Banford, Bill Wilson concluded that “He knew now …. His need, his loving, didn’t matter a good goddam. His wanting, his hunger and desire, meant nothing to the terrible ongoing forces of creation and he would never forget this truth which he saw and accepted that night.” * Helplessness, as illustrated by Bill Wilson’s recollection, may not simply be a result of laziness but a reflexive survival mechanism in respsponse to painful past experience.

(*) Source: Thomsen, Robert (1975) Bill W.

4) Powerlessness is a Symptom of a Disease

The disease concept of addiction found an early advocate in the recovery movement with Dr. William Duncan Southworth, physician to AA founder Bill Wilson. By providing a physiological explanation for why alcoholics are powerless over their use of alcohol and through his close affiliation with Bill Wilson, Dr. Southworth helped shift the balance of power in addiction from organized religion to medicine.

Dr. Southworth’s observation that alcoholism cycles between mental obsession and physical lack of control (or powerlessness) has stood the test of time. Defined this way, powerlessness is a common criterion used in the assessment of addiction. For example, Sunshine Coast Health Center recommends an addiction test, called the 3 Cs of Addiction: compulsion, control, and consequences. * What the 3 Cs test calls compulsion and control, Dr. Southworth calls, respectively, mental obsession and physical allergy. While the term ‘allergy’ may be arguable, alcoholics do appear to be physically powerless to stop drinking once the obsession to drink overpowers their decision not to drink.

(*) Note: see the Helplessness section above for information on the 3rd C - consequences.

5) Accepting Powerlessness is Critical to Lasting Recovery

First of all we had to quit playing God.
~ Alcoholics Anonymous, p. 62

This last example of powerlessness has been intentionally left to last since, unlike the first four definitions, this last definition will conclude this blog article on a hopeful note. Fortunately, many individuals have successfully come to terms with their addiction and have gone on to lead fulfilling lives in recovery. At Sunshine Coast Health Center, clients learn spiritual principles that often prove helpful as basic action guidelines in recovery. One spiritual principle, acceptance, seems particularly effective and is closely tied to the notion of powerlessness.

In his book, Not-God: A History of Alcoholics Anonymous, Ernest Kurtz suggests that “from the alcoholic’s acceptance of personal limitation [read powerlessness] - arises the beginning of healing and wholeness.” Furthermore, this message of “not-God” is, for Ernest Kurtz, an “affirmation of one’s connectedness with other alcoholics.” At Sunshine Coast Health Center, we wholly endorse the notion of connectedness, however, would extend it further to include family members, co-workers, and friends.

Conclusion

In the early days of Sunshine Coast Health Center, I will always remember how insistent one of our first clinicians was on the importance of making sure clients understand, at a gut level, Step One . As far as he was concerned, without a firm understanding of powerlessness, it is difficult, if not impossible, to properly work the remaining 11 Steps. However, I have learned over the years that words can often have multiple meanings and can trigger certain emotions depending on the perspective of the listener. By avoiding rigid absolutes, Sunshine Coast Health Center believes that it’s integrated approach allows clients to embrace multiple perspectives and, therefore, to appreciate the complexity that is inherent in any meaningful discussion on addiction.

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