Saturday, August 7, 2010

12-Step Alcoholism Recovery: "I Opt" Insights

By: Gary J. Salton, Ph.D.
Chief: Research & Development

Professional Communications, Inc.


INTRODUCTION
This blog looks at the Alcoholics Anonymous (AA) 12-Step process through the lens of Organizational Engineering theory. The analysis here relies on logic. That logic is founded on Organizational Engineering theory and “I Opt” measurement. These tools have met all 8-levels of academic validation. It is not speculative foray into opinion. It is guided by an articulated framework that can be challenged and tested.

This study is part of a three research blog series. The statistical
foundation
for the series can be found in the Evidence-Based research listing on www.iopt.com. A study of AA organizational factors is available in the Applied Research listing on www.iopt.com. A video summary of all three research blogs in this series can be found at www.iopt.com in the "Coffee Break Videos" section or by clicking the icon on the right.




RESEARCH FINDINGS
Evidence-based research found a systematic relation between the length of sobriety and the strategic profile being used. A strategic profile is the combination of strategic styles being used to navigate life. Graphic 1 replicates the central graphic of that study.

Graphic 1
STRATEGIC STYLE PROFILE BY LENGTH OF SOBRIETY


All of the systematic relationships shown in the graph are backed up by significance statistics. The general picture is a reduction in the spontaneous RS style accompanied by an increase in structured approaches. In Phase 1 the disciplined action-oriented LP increases dramatically in strength. In the next phase the analytical HA bounds to higher levels.

The modest decline in idea-oriented RI is seen as a derivative effect. The decline in RS and increase in LP/HA reduces the “raw material” (i.e., random input) needed to supply the RI. Effectively, the RI is “starved” into a lower level of usage.


THE 12-STEPS
The 12-steps are a core of the AA process. The “Big Book”(1) frames them in readily understandable colloquial terms. However, they can also be understood in the more dispassionate terms of Organizational Engineering theory and “I Opt” measurement technology.

Step 1: We admitted we were powerless over alcohol—that our lives had become unmanageable (2)
This step is a confession of the belief that biochemistry is in control of behavior. It is also an admission that the rational control mechanisms of navigating life have failed completely.

This step prepares the person for change. Accepting powerlessness and confessing unmanageably opens the individual to all options. This includes a complete change in the way they are navigating life—their worldview.

A willingness to abandon the existing way of navigating life is a precondition for recovery. The reason is that preserving any element of the failed behavior pattern may be creating a refuge for the biochemistry to regain control. There can be no sacred and untouchable areas.


Step 2. Came to believe that a Power greater than ourselves could restore us to sanity.
Step 1 opened the door into the unknown. Step 2 involves installing a belief that there is a way to control the biochemistry. This belief is the beginning of the needed change. Accepting the existence of a “way out” reduces the anxiety associated with the unknown. It becomes the motive for continuing the process.

The AA grounds this step on a widely accepted belief—a higher power. Referencing this authority cuts the time needed to install the needed belief. It also general. It applies to all educational levels, ages and genders. However, there will be cases where this does not work. When this happens other methods (e.g., scientific evidence, logic, referencing experience, etc.) might be used. The key is installing the belief that there is a way out. Without this belief there is no reason to change.


Step 3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
This step involves acceptance of an unspecified change to come. The vehicle used to establish acceptance is trust. Framing the impeding changes as coming from a higher power greatly eases acceptance for those who believe in a higher power. Who is going to argue with God?

The difficulty of this step is hard to overstate. Biochemical dependency creates a self-focus. This is often stated in pejorative terms like “selfish.” This may be true. However, anyone facing life-threatening circumstances is likely to take a self-centered posture with regard to the threat. For the alcoholic, an inability to satisfy their craving is the equivalent of a life-threatening situation. This self-focus makes it hard to relinquish control to any other party. God is one of the few parties that can be trusted

The AA uses God as their trustworthy source. The “brain washing” techniques used in the Korean War demonstrate that there are other ways of accomplishing acceptance. Further, there is a lot of variation in human psychology. Anything will probably work some of the time for some of the people. However, whatever is substituted for “God” had better be pretty powerful if it is to work on wide scale in civil society. No substitute comes readily to mind.


Step 4. Made a searching and fearless moral inventory of ourselves.
The issue of defining exactly what is to change begins with step 4—the moral inventory. A “moral inventory” defines behavior as “right” or “wrong.” This is not always an easy. For example, a behavior may be judged “right” if it is directed toward someone who as caused harm. Exactly the same behavior directed toward an innocent party might be declared “wrong.” Right and wrong are inherently relative judgments. The concept only exists in a social fabric and that social fabric changes by individual.

Step 4 overcomes the relativity of good and bad by focusing on actual past behavior rather than abstract concepts. The rights and wrongs identified will be relevant to unique circumstances of the particular individual. The result is that the framework arising from this process is “tailored” to the individual’s unique needs and circumstances.


Step 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
The moral inventory defined wrong behavior in general terms. This step requires defining the “EXACT” nature of wrongs. Outside of the hard sciences (e.g., physics) there is no such thing as an “exact” conceptual framework. That means that this step can only be satisfied by referencing hard, tangible behaviors. It is not yet time for abstract concepts.

The admission to God and oneself can be seen as taking responsibility. It might be possible to get away with avoiding the God part. However, admitting “to ourselves” is necessary. This admission locates the cause. The cause is the thing that has to be addressed. This step targets the needed changes precisely.

Step 5 is also the beginning of a social control support system. The person being told of the “wrongs” is not likely to be a stranger. This step places them in a position to exert positive pressure (i.e., support). Deviations can be met with sanctions (e.g., expressions of disappointment can be seen as mild sanctions). Both the positive pressure and sanctions are forms of social control. The individual is no longer alone in their quest.


Step 6. Were entirely ready to have God remove all these defects of character.
A willingness to accept change is not the same thing as a willingness to actually engage that change. To this point only things that should NOT be done have been specified. What is to be done is undetermined. It is the beginning of a trip into the unknown.

Taking this step is a statement of faith (i.e., trust) that the outcome will be favorable. It prepares the individual for the suffering to come. This makes them better able to withstand it. Without this step the odds of being overwhelmed by the coming difficulty increase.

God once again acts as AA’s reassuring figure. If God is omitted the step will probably require some substitute. The confidence that trust brings must be gathered from some other source. No general alternative source comes readily to mind.


Step 7. Humbly asked Him to remove our shortcomings.
Any “defect” believed to remain could become a refuge—a built in excuse. This step implies that an agency is going to act on behalf of the afflicted person. “Shortcomings” will be removed. What will be left is a blank slate on which a new structure can be build. Confidence is again enhanced.

What is important is that the person believes that they are fully positioned for change. The AA uses God to insure a clean slate. There are probably other ways to create this belief. However, the AA strategy has the merit of quickly reaching the vast majority of people who do not disbelieve. The remaining atheists might be convinced of the “clean slate” using other methods. The important thing is to leave no refuge (i.e. excuse) for avoidance.


Step 8. Made a list of all persons we had harmed, and became willing to make amends to them all.
In earlier steps the “wrongness” of behavior was admitted. This step adds to that the consequences of that “wrongness.” This strengthens the will to correct the condition. Agreeing to make amends further steels the individual to actually confront these consequences of their prior actions. Will power (i.e., commitment) is strengthened


Step 9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
This step translates a semi-private endeavor into a public one. Making amends also implies that the transgressions will not be repeated. This diminishes the probability of future retaliation by those who have been damaged. Earlier steps helped the individual clean their personal slate. This step helps clean the social slate.

Another affect of this step is to strengthen social controls. People that were harmed were close enough to actually be harmed. This strongly suggests the presence of social links. Making amends announces the coming of a new behavioral posture. The display of a new posture will likely meet with approval. Reversion to the old posture will likely produce sanctions. A network of social controls that support the recovery effort has been created.


Step 10. Continued to take personal inventory and when we were wrong promptly admitted it.
This is a maintenance function. It helps ensure that any slippage will be recognized and corrected. The typical AA response to slippage is to return to the step appropriate to its remedy. Retracing the steps from that point onward reinstalls or reinforces the framework and control system.


WHAT HAS HAPPENED?: Construction of a Positive Framework by Corollary
The focus of the first 10 steps was on things that should not be done. So where is the framework on what should be done? The answer can be found in the corollary (i.e., a natural consequence) of the things to be avoided.

Any “wrong” is produced by a behavior. Correcting that “wrong” requires that the offending behavior be replaced by another behavior (e.g., withdrawal is a form of behavior). For example, a wrong might have involved abusive behavior. Abusive behavior requires a relationship that must have been in place for that behavior to have occurred. If any relationship is to persist, that wrong behavior must be replaced by something.

Whatever replaces the wrong behavior is probably an improvement. Strategies that work are likely to be reused. Situations that repeat are likely to elicit a similar kind of response (e.g., kindness replacing abusive behavior). This generalization of behavioral options happens because it is an efficient approach. A person does not have to continually rethink and re-decide.

Reused behaviors become a pattern. They are logically connected by the fact these behaviors all occur within the same life. The patterns become a behavioral structure. They were built on the carcass of the old structure (i.e., the identified “wrongs.”). Therefore they automatically replace rather than modify or amend that old structure.

This process has not only changed behavior. It has changed a worldview. A worldview is created by the information processing strategy being used. It is determined by what is paid attention to (input), how that input is interpreted (process) and what is done with it (output).

Input>process>output is the general model for information processing. However, the model works equally well in reverse—different output (i.e., behavior) means that interpretation or understanding (process) must change. A change in process (e.g., understanding) can require that a person seek new kinds of input (e.g., attention to the feelings of others).

There is an “I Opt” strategic style (a pattern of behavior) that exactly matches the kind of change produced by the first 10 steps
the "I Opt" Logical Processor strategic style. Its input tends to be tangible facts—a behavior is a fact. It processes these using strong logical structures that provide a precise behavioral guide. Finally, its output is actual behavior—not sentiments, concepts or wishes.

This outcome is exactly what the first 10 steps call for. And this is exactly what the numbers in the evidence base research show actually happens. The “I Opt” Logical Processor (LP) style rockets up 43% in strength as a person matures from short to mid-term sobriety.

But there is a piece still missing. What about circumstances not yet encountered? How can the framework be generalized to equip the person to meet future challenges? This question is answered in Step 11.


Step 11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
This step turns the focus from behavior to knowledge. This requires using a new strategy. There are no facts and specifics that were used to feed the LP strategy. What is now needed are conceptual links broad enough to embrace any situation, anywhere and at any time.

Step 11 does not specify how this is to be done. However, the prior steps have laid a groundwork. A framework of “what to do” (the LP strategy) is in place. The mediation, reflection and deliberation called for by this step is likely to center on the principles contained in this behavioral framework.

These “principles” are the general properties that the elements of the structure have in common. For example, a more patient and less forceful attitude may characterize multiple parts of the structure created. A principle naturally flowing from this might be that patience achieves more than force.

The next step is to link the principles together into a system. Values are a logical way of accomplishing this. Values are just the rank order of beliefs. For example, one part of the behavioral structure might require diligence at work. Another part may involve honoring family commitments. In the case of conflict, a particular value system might call for work obligations be sacrificed in favor of family obligations.

The result of this process is a general conceptual map. The first 10 steps focused on the immediate. This step has created a framework for the future. To do this it drew on another tool for navigating life—the “I Opt” Hypothetical Analyzer (HA) strategy. This approach uses the relationships between things as input. Like the LP, it processes this input using well-defined logical structures. But its output is conceptual (e.g., plans, judgments, assessments, etc.) rather than action.

The evidenced-based research is compatible with this view. The analytical HA strategy jumps 36% as people move from mid to long-term sobriety. In this period the behavioral LP strategy does not move at all. This makes some sense. There is no need for additional LP strength. The present level is enough to produce behavior that maintains current sobriety. The HA leap is a response to the need to create a structure capable of handling the long-term future.

The combination of the LP handling the short to mid-term and the HA handling the long-term produce a completely new worldview. Many others have noted that this kind of change often accompanies recovery. “I Opt” technology is able to explain exactly why and how this change occurs as well as measuring its effects.


Step 12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

This step is both a refinement and maintenance activity. “Carrying this message” is a communication activity. The thing to be communicated is the desirability of and path towards sobriety. Every exercise of this step will involve confronting someone who has a different worldview (i.e., a different way of accessing and understanding the world). Getting the message across to a particular potential recruit requires talking their language.

The person who has progressed to Step 12 has developed their own worldview. To translate it into the language of the targeted alcoholic requires both clarity and depth of understanding. Every experience will act to further both. Step 12 has created a “built in” continuous improvement function.

Distinct from but closely tied to the refinement function is maintenance. Reaching out to others is a reminder of both the journey that has been traveled and the value of what has been learned. Every encounter offers a vivid picture of what had been the sponsor's pre-recovery circumstance. Offering counsel provides continual reinforcement of the value of the AA process—a maintenance activity.


SUMMARY
The 12-Step system is remarkable. It is a system of self-determination. There is no “preaching.” There is no pre-packaged formula. Following the steps leads a person to construct their own control solution.

In pure information processing terms the AA process functions to adjust all of the components of the “I Opt” model in a staged sequence. The immediate need for sobriety is met by methods that increase the capability in the disciplined, behaviorally oriented LP strategic style.

Then the steps change focus and direct the individual toward the analytical, thought-based HA style to provide for sustained sobriety over the long term. In this process the recovering alcoholic gains a new worldview that is compatible with conducting a sober and productive life. It is a remarkable demonstration of effective organizational design.

While the 12-Step model is the core of AA, taken alone it probably will not work. The process requires a particular environment within which to function. The 12-Traditions and the established processes of the AA provide this environment. These are the subjects of the companion application blog that can be read at http://garysalton2.blogspot.com.


REFERENCES
(1) Alcoholics Anonymous: The Story of How Many Thousand Men and Women Have Recovered from Alcoholism. Alcoholics World Services, Inc. 1939. p. xxvi. ISBN 1-893007-16-2. The “Big Book” is the Alcoholics Anonymous “bible”. It can be referenced free of charge at http://www.aa.org/bbonline/.

(2) Alcoholics Anonymous (June 2001). "Chapter 5: How It Works" (PDF). Alcoholics Anonymous (4th ed.). Alcoholics Anonymous World Services. ISBN 1893007162. OCLC 32014950. http://www.aa.org/bigbookonline/en_bigbook_chapt5.pdf.