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Who Answers?In this article:
- Differences between Peer Support and Therapy
- What Can You Discuss in Peer-Led Groups?
- Benefits of Therapy
- Topics That Should Be Discussed with a Therapist
- Considerations for Integrating AA and Therapy
Alcohol use disorder (AUD) can be a lifelong struggle. However, with the right combination of support and tools, you can manage AUD. If you have AUD, conventional recommendations may include medication management, case management, Alcoholics Anonymous (AA), and therapy.¹ There is no standard of when you should attend therapy while in AA, but you should consider certain factors when considering your needs in each setting, and how AA and therapy combined can strengthen your recovery experience.
Differences Between Peer Support and Therapy
While peer support does not replace the possible need for formal treatments like therapy, AA and therapy can be complementary, as they interact to help someone in recovery better understand their unique needs and vulnerabilities.¹ However, AA and therapy also have different functions and benefits in meeting the needs of someone in recovery.
Benefits of AA
Research has shown that 12-step programs, including AA, are one of the most common referrals from providers treating someone with a substance use issue.¹ AA is a free, empirically supported, and peer-led support group fellowship designed to help individuals struggling with alcohol misuse achieve and maintain sobriety. AA uses the 12 Steps, 12 Traditions, and the Big Book to guide and support the mission of AA and the individuals participating.² Because AA is peer-led, it is nonclinical in its process and uses a community reinforcement approach.
Actively participating in mutual support groups, like AA, has proven a key indicator of higher rates of continuous abstinence and sustaining recovery.1,3,4 This is likely due to several facets of the program, including:
- Ease of accessibility and availability
- Peer-led structure
- Shared experiences between members
- Challenges from members
- Use of sponsors
- Motivation based on observed successes
- Opportunities for anonymity and confidentiality
These components may allow individuals to feel safe sharing their alcohol-related challenges.
International Accessibility
AA group support is internationally accessible almost 24/7, 365 days a year, especially now with the increased online support meetings since the start of the COVID-19 pandemic. This availability can be helpful, as you may sometimes experience a long wait to receive inpatient or outpatient treatment for an alcohol use disorder. Various meetings tailor to specific subgroups, including LGBTQ+, gender-specific, and Spanish-speaking.⁴
A Sense of Belonging
A sense of camaraderie and belonging is a key component in AA. Oftentimes, if you have struggled with alcohol use, you may appreciate being able to identify with others who share similar struggles and can process and identify challenges as a group. The fellowship AA provides helps increase your social circle to include other individuals abstaining from alcohol.⁴
Further, having a sponsor in AA seems to deepen that sense of belonging.⁵ A sponsor not only provides a personalized guide for the AA process but also shows you success is possible by engaging with someone who has completed the 12 Steps and maintained significant sobriety.
Therapy is Evidence-Based, Professional Care
Unlike Alcoholics Anonymous or any other mutual support groups, which are peer-led, therapy is facilitated by a mental health or substance abuse professional, such as a psychologist, a licensed clinical social worker (LCSW), a marriage and family therapist (MFT), or licensed professional counselor (LPC).
In therapy, your counselor first conducts an assessment to learn more about your alcohol and drug use, mental health, family history, medical history, and more. They use the information from this evaluation to help guide your treatment planning. They also integrate your personal goals into the treatment plan to ensure it is a collaborative and productive process.
Unlike AA, substance addiction counseling is an individualized approach to recovery, in which your treatment plan is tailored to meet your unique needs. Further, therapy offers an opportunity to build new coping skills and relapse prevention strategies, as well as address underlying issues that may have motivated your alcohol use.
What Can You Discuss in Peer-Led Groups?
Peer-led groups, like AA, provide individuals with the opportunity to learn from others’ coping skills and receive support from others who know what you are experiencing. The 12 Steps are a structured view of the recovery process and offer the space to discuss and process current step work.⁴ In AA, discussions can vary, including discussing feelings about recovery, 12-step work, and more.
Complex Feelings about Recovery
Oftentimes, addiction occurs because of various life events and factors. Others in AA meetings may have had similar experiences, thoughts, or feelings surrounding their substance use. It is also common for an individual in AA to simultaneously not want to give up drinking and still want to drink. Individuals who have had similar experiences can relate.
12-Step Work
In AA, there are the 12 Steps and the 12 Traditions of AA. Some groups may be on a specific step, or an individual may want feedback from other members regarding a particular step.
Motivators for Continued Abstinence from Alcohol
Being around other individuals who are in recovery is beneficial to recovery. Seeing others who have been in your situation succeed in recovery and abstinence can be motivating to continue your own sobriety.
Impact on Personal and Professional Relationships
Substance use and addiction can take a toll over time on relationships both personally and professionally. Some individuals may have lost loved ones or jobs due to their drinking or misuse. There can be significant grief related to these losses, and having group support to get through those losses can be vital in the recovery process.
Benefits of Therapy
When you notice the AA format isn’t working, or is not as effective as it once was, it may be time to see a therapist. Therapy is an opportunity to receive nonjudgmental, evidence-based treatment tailored specifically to you and your unique situation from a licensed mental health professional.
Individual therapy sessions provide confidential one-on-one sessions. While anonymity is requested in the attendance of an AA meeting, confidentiality from those in group therapy can never be guaranteed.
Therapists, however, are legally and ethically bound to confidentiality. The exceptions to this confidentiality are if someone discloses abuse or neglect of any child, elderly person, or person with a disability. Additionally, confidentiality is not held if an individual discloses they actively want to hurt themselves or someone else.
Oftentimes, individuals dealing with problematic alcohol use also have underlying co-morbid conditions, such as depression, anxiety, or personality disorders.⁶ While AA may touch on these topics within the group, having a therapist to talk to outside of a 12-Step program allows for greater individual processing. Twelve-Step support, like AA, tends to be more structured advice or suggestion-driven, based on the personal experiences of the group members.
While AA is an opportunity to hear others with similar struggles tell their story, receive feedback, and listen to others’ self-examination, time is limited to share and reflect. Therapy is designed to be more interactive. More time, generally 45-60 minutes, is given for an in-depth reflection of an event, challenge, or trigger. Additionally, in 12-step group settings, talks about alcohol misuse are limited due to the possibility of triggering another member or glorifying its use. In therapy, you are free to detail your experiences and process in whatever way you feel best.
Topics That Should Be Discussed with a Therapist
While many may feel open to disclosing in a group like AA, there are some limitations to what may be discussed due to time constraints and considerations of other members’ sobriety. Therapy is a safe and appropriate place for you to process some of the underlying causes of alcohol misuse or other past or present mental health difficulties. These may include:⁷
- Family dysfunctions
- History of physical, emotional, or sexual abuse or neglect
- Self-harm or suicidal thoughts
- Thoughts of wanting to hurt others
- Symptoms that are causing significant impairment in general functioning or interpersonal relationships
- Specific recounts of substance misuse
Considerations for Integrating AA and Therapy
When looking for a therapist, it is beneficial to find one who is knowledgeable about AA and can integrate the 12 Steps into your therapy sessions to provide a deeper understanding of your healing and recovery.⁸ You may find these professionals by checking out mental health directories and searching for specific qualities related to substance use, addiction, and recovery experience. Some individuals may also want a therapist in recovery themselves. Addiction-informed therapies include:⁸,¹⁰
- Cognitive behavioral therapy (CBT): CBT is a structured and goal-oriented, problem-focused treatment that prioritizes developing new skills and practicing these skills to reduce thoughts and behaviors associated with use.
- Motivational enhancement therapy (MET): MET focuses on identifying an individual’s readiness for change and aims to help individuals reach a place where they are motivated and focused on accepting recovery.
- Marital and family counseling: Oftentimes, addiction impacts the entire family unit, not just the person struggling with the addiction. In marital and family counseling, a therapist can work with the family unit to help with communication issues, heal hurts from past experiences, and problem-solve so that each member of the family unit is heard.
If individual therapy and peer-led support groups are not feeling helpful in your recovery, other supportive options may include rehab facilities and demographic-specific group therapy.
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Help is standing by 24 hours a day, 7 days a week.Who Answers?Rehab facilities offer a more intensive recovery experience. Normally, this would involve treatment at the facility where an individual would stay for a specific period (i.e., 30, 60, 90 days). Group therapy, while also normally comprising individuals struggling with similar issues, is not peer-led. Group therapy is facilitated by a licensed mental health professional. These groups may provide some psycho-education, as well as group processing.
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Resources
- Tracy, K., & Wallace, S. P. (2016). Benefits of peer support groups in the treatment of addiction. Substance Abuse and Rehabilitation, 7, 143-154.
- Alcoholics Anonymous. (n.d.). What is A.A.?
- Kelly, J. F., Humphreys, K., & Ferri, M. (2020). Alcoholics Anonymous and other 12-step programs for alcohol use disorder. The Cochrane Database of Systematic Reviews, 3(3), CD012880.
- Donovan, D. M., Ingalsbe, M. H., Benbow, J., & Daley, D. C. (2013). 12-step interventions and mutual support programs for substance use disorders: an overview. Social work in public health, 28(3-4), 313-332.
- Stone, D. A., Conteh, J. A., & Francis, J. D. (2017). Therapeutic factors and psychological concepts in Alcoholics Anonymous. Journal of Counselor Practice, 8(2), 120-135.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing.
- Substance Abuse and Mental Health Services Administration. (2015, November). Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice.
- Substance Abuse and Mental Health Services Administration Advisory. (2021, January). The Substance Use Disorder Counseling Competency Framework: An Overview