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Who Answers?The science of Step 9 AA, or Alcoholics Anonymous, indicates that making amends is positively correlated with the brain’s reward center, natural dopamine release, and impacts on friendships and relationships. This, in turn, enhances recovery outcomes, as do the other 12 steps of AA.1
What is Step 9 AA?
Step 9 states: “Made direct amends to such people wherever possible, except when to do so would injure them or others.”2,3
Making amends is different than apologizing. Apologizing means acknowledging a failure or an offense done verbally. It includes verbalizing being sorry or having remorse.4
Amends means making minor changes through action.5
How Making Amends Positively Affects the Brain
The molecular neurobiological aspects of Step 9 AA alter the brain’s neurotransmitters. This creates a physiological change in the body. Being aware this occurs may contribute positively to your recovery.1
Research shows that having an understanding of the molecular neurobiological underpinnings of Step 9 AA can serve as motivation to remain clean and sober.1
The part of the brain where you experience a sense of well-being is called the Mesolimbic System. It is also known as the brain’s reward center and where chemical messages synergize to release neurotransmitters into the Nucleus Accumbens (NAc).1
The NAc is the site of craving behavior in the brain. The neurotransmitters that are involved include:1
- Dopamine (DA)
- Serotonin
- Enkephalins
- γ-aminobutyric acid (GABA)
By partaking in a pleasure triggering behavior, the “The Brain Reward Cascade” begins. The start of this cascade releases dopamine. The rest of the cascade entails your brain utilizing dopamine which enhances feelings of pleasure and comfort. Depending on the amount of dopamine released, it can create a feeling of extreme euphoria.1
The process of making amends in Step 9 AA can act as a positive, healthy triggering behavior of The Brain Reward Cascade.1
A breakdown in the cascade leads to dysfunction and dysregulation of the reward cycle. Any reduction in dopamine release can lead to substance or mood-altering seeking behavior.1
Research shows that when you are actively participating in 12-step recovery, connections between the Pre-Frontal Cortex-Cingulate (the brain’s side of decision making) and the NAc are made. This strengthens the connection between the decision-making and the craving behavior parts of your brain. As a result, making recovery-related decisions and doing recovery-related behaviors such as making amends allows the brain to make healthy neuronal connections. This serves as a positive physiological reinforcer.1
On the other hand, if an illicit substance is used to trigger The Brain Reward Cascade, you are physiologically reinforcing the use of the substance to the brain.1
Why AA Supports the Idea of Making Amends
When you make amends, your actions and values start to align. You are not only admitting wrongdoing, you are taking steps to correct it. By taking steps that are consistent with your value system, you are beginning to live in integrity.2, 3
Living in integrity decreases feelings of guilt. Recovery literature states that having too much guilt can be a trigger to relapse. By making amends, you are fixing mistakes that you made before starting your recovery program, and by fixing your mistakes, you are building self-esteem.2, 3
Research shows that aligning your actions with your personal ethics helps to build self-esteem. As a result, improved self-esteem leads to enhanced recovery rates.6,7
Furthermore, there is a saying that “the steps are in order for a reason.”2,3
Step 9 AA precedes Step 10, “Continued to take personal inventory and when we were wrong promptly admitted it.” Step 10 is considered to be one of the first maintenance steps.2,3
By completing Step 9, you will tend to have a solid footing on your recovery. You will move forward in the 12-step program and focus on maintaining your new, healthier lifestyle.2,3
Similarly, there are eight steps before you reach Step 9 AA. It is recommended to complete those steps first, preferably with a sponsor before completing Step 9 AA. Also, part of the ninth step states, “except when to do so would injure them or others.” It is encouraged to make sure that, before making amends, it would not be injurious to yourself or others.2,3,7
When you make amends that can injure yourself or others, it can negatively trigger the same cascade, putting you at risk of returning to cravings and seeking mood-altering substances.1
If you have a solid fellowship and recovery support system and are mindful to do Step 9 AA in order, research shows you are likely to have a positive experience. Thereby doing this step aids your recovery progress.2,3,7
How Living Amends Positively Impacts Recovery Outcomes
You can make living amends by discontinuing the behaviors you did before starting your recovery program.2,3
This is important if you are unable to reach a person you want to make direct amends to or are not ready to do it just yet.2,3
For example, if you took something without permission and are not ready to return it or pay the owner back, or if it would adversely affect your recovery by making direct amends, you can make living amends by discontinuing the behavior (taking without permission).2,3,7
Another example is if you have a history of being inconsistent with your words and your actions. By discontinuing this behavior, you would be making living amends.2, 3, 7
Positive Psychological Effects of Step 9 AA
Step 9 AA is the achievement of making amends and is therefore subject to correlations among friendships, genes, and relationships.1
Relationships and happiness are based on neuronal hard wiring. So, the degree to which you can make amends to others is influential on having a healthy recovery and attaining happiness. As stated earlier in this article, triggering the natural release of DA to the reward center is one way to do this.1
DA has been credited in research as the neurotransmitter responsible for modulating the activation of the reward system of the brain. It is referred to as the anti-stress, pleasure molecule. When DA gets released into the neuronal synapse of receptors D1-D5, they are stimulated. This creates feelings of well-being and raises the rate of stress reduction levels.1
There is another mechanism at play as well. It has to do with the hormone Oxytocin. This hormone is produced in the hypothalamus and then released by the pituitary gland into the bloodstream. It is known as the “love hormone” or “cuddle hormone.”7
While its main function is to facilitate childbirth, it can also be released when you fall in love, do something enjoyable (playing music) become excited by your sex partner, or have a positive interaction with another person. The latter tends to happen quite often when making amends during Step 9 AA.7
Completing Step 9 AA creates a preferential release of oxytocin and research shows it may create a “synaptic change,” which in turn leads to a degree of newfound happiness. Recovery literature refers to this as a vital “Psychic change,” which is directly correlated to successful recovery rates.3,7
How Step 9 AA Reduces Drug-Seeking Behavior
There is a functional Reward Deficiency Syndrome (RDS) hypothesis that was coined in 1996. RDS refers to behaviors that are associated with a common genetic variant involving DRD2 Polymorphisms.1
Polymorphisms are when multiple (two or more) forms of a single gene exist in an individual or among a group of individuals. The term comes from Greek with “poly” meaning multiple and “morph” meaning form.1
These DRD2 polymorphisms create a situation where dopamine is in a state of hypofunction (less than optimal functioning) in your brain. This is a predictor of addictive behaviors that lean towards the impulsive and compulsive sides.1
The RDS hypothesis reports that there is a dopamine deficiency due to genetic DRD2 polymorphisms. These induce hypodopaminergic functioning and are the main cause of the predisposition to chronic use of illicit substances and relapse.1
Step 9 AA offsets hypodopaminergic functioning because of its DA activation of the brain’s pleasure-reward circuit or The Brain Reward Cascade. Preliminary research and discussion of the RDS hypothesis states that long-term utilization of approaches that gently activate DA might positively impact recovery rates and provide a safe way to offset hypodopaminergic functioning.1
Evidence-Based Addiction Treatments and Step 9 AA
Research shows that if you attend treatment for a full continuum of care, the risk for relapse decreases, and the chances for sustained recovery increase.8
The full Continuum of Care refers to:8
- Medically monitored detoxification (for safety)
- Inpatient and/or residential treatment
- Partial hospitalization program (PHP) and/or intensive outpatient treatment (IOT)
- Continuing care (CC)
- 12-step program and/or other community-based programs
Research on the effectiveness of AA shows that abstaining from the illicit use of substances is twice as high for AA attendees than non-AA attendees. Also, an increased level of attendance (the more you go to AA) is related to higher rates of abstaining. Attendance of AA meetings has also been positively correlated with theories of behavioral change. Step 9 AA involves changing behaviors by amending old ones that hindered your recovery to new ones that support your recovery.7
How Step 9 AA Affects Relationships
By making amends to loved ones, they will notice that you are taking responsibility for your recovery and the misdeeds done when you were not in recovery.2,3,6
This tends to result in enhanced relationships and repairing ones that were injured.
By having enhanced and repaired relationships, there are observable effects to making amends. Science of Step 9 AA states that if you have healthy social support and relationships in recovery, you will have a more positive outlook on life. This enhances the quality of life which reduces levels of cortisol and raises testosterone (to a healthy level, even in women). Lowered rates of cortisol are positively correlated with lower stress levels. Raised testosterone rates are positively correlated with confidence. 1,6,7
Having lowered stress rates and increased confidence are two predictors of success in recovery. By cleaning up the “wreckage of your past,” you will tend to feel relief and start to enjoy your recovery. This has also been shown to be a positive predictor of a sustained recovery.2,3,6,7
How Taking Responsibility Improves Recovery
Making amends involves a process that contributes to developing life skills that are transferable to areas such as school and occupation. By doing Step 9 AA, a certain level of maturity occurs.6
With this level of maturity, your pre-frontal cortex, which is responsible for your judgment, thoughts/cognitions, decision making, and moderating social behavior is being utilized to make responsible decisions. This is a positive physiological reinforcer to your brain.1
Applying these life skills to your recovery improves your ability to have long term abstinence.1,6
SAMSHA states there are four significant dimensions of recovery:6
- Health: Making informed, healthy choices, supportive of emotional and physical wellbeing, overcoming and managing your recovery
- Community: Having relationships and social networks providing friendship, support, hope, and love
- Home: Stable and safe place to live
- Purpose: Participating in meaningful daily activities, such as volunteering, an occupation, school, caregiving, or creative pursuits, and the income, independence, and resources to productively participate in society
By making amends, you would be enhancing each of those four areas and continuing to utilize your pre-frontal cortex in a healthy and recovery-oriented manner. Your pre-frontal cortex communicates with your hippocampus which is responsible for learning and memory. The more you practice enhancing these areas, the stronger the new connection between making healthy decisions and memory becomes. Thereby helping you make positive choices and supporting healthy recovery outcomes.1,6
You would also be improving your communication and interpersonal skills. This will help you to maintain long-term healthy relationships with not just loved ones but also members of your community, your home group, or any volunteer organizations to which you belong or may join down the road. These are people who can help you when you face challenges and struggles in your recovery.2,6
If you or a loved one feels treatment is the right fit, or you are unsure of where to start, contact a treatment specialist at
800-948-8417
Who Answers?
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Resources
- Blum, K., Thompson, B., Demotrovics, Z., Femino, J., Giordano, J., Oscar-Berman, M., Teitelbaum, S., Smith, D. E., Roy, K. A., Again, G., Fratantonio, J., Badgaiyan, R. D., & Gold, M. S. (2015). The Molecular Neurobiology of Twelve Step Program & Fellowship: Connecting the Dots for Recovery. Journal of Reward Deficiency Syndrome, 1(1), 46-64.
- Wilson, B. (1981). Twelve Steps and Twelve Traditions: A co-founder of Alcoholics Anonymous tells how members recovery and how the society functions. Alcoholics Anonymous World Services, Inc.
- Wilson, B. (2001). Alcoholics Anonymous. Alcoholics Anonymous (Fourth Edition). Alcoholics Anonymous World Services, Inc.
- Merriam-Webster Dictionary. (n.d.) Apology.
- Merriam-Webster Dictionary. (n.d.) Amends.
- Substance Abuse and Mental Health Services Administration. (2022). Recovery and Recovery Support.
- Kaskutas, L.A. (2009). Alcoholics Anonymous Effectiveness: Faith Meets Science. Journal of Addictive Diseases, 28(2), 145-157.
- Center for Substance Abuse Treatment. (2006). Clinical Issues in Intensive Outpatient Treatment: Chapter 4. Treatment Improvement Protocol (TIP) Series, No. 47. Rockville (MD): Substance Abuse and Mental Health Services Administration (US).