Addiction is the Symptom, Not the Problem

By Dr. Rosemary Brown with Laura MacKay 03/10/16

Reworking the Twelve Steps to address the underlying issues in addiction.


The 12 steps are considered sacrosanct by many​, yet high relapse rates among people in AA and other step groups ​are problematic. ​While some treatment professionals dismiss the steps entirely, Dr. Rosemary Brown instead has endeavored to make them better by shifting their focus from the individual symptoms of addiction—i.e. the individual drugs or behaviors—to what she suggests is the core emotional-spiritual deficit common to all forms of addiction. A past member of AA herself, Dr. Brown uses the traditional 12 steps as a springboard for a radically different “spiritual therapy.” One that empowers clients to reject addictive behavior through the recognition of the spiritual self, not the addicted self, as the authentic self...Richard Juman, PsyD

The list of recognized addictions is long and growing. Naturally, the treatment industry is growing to keep up with it all—and to profit from it. In the United States, it's a $35 billion business, and our 14,000-plus treatment centers can't meet the demand. The 12 step universe, too, is ever expanding. The latest step group that I know of is ITAA, Internet & Tech Addiction Anonymous.

Meanwhile, as media reports and some new books have publicized in the last few years, step-based, single-addiction treatment that continues to dominate the industry doesn't work very well. The more generous studies of Alcoholics Anonymous, for example, show that at least 7 out of 10 participants relapse.

This tragic state of affairs is due, I believe, to the field's failure to recognize addictive behaviors as the myriad symptoms of a single problem. A problem that, consequently, goes untreated: emotional dependency.

It is emotional dependency, the cause—not such symptoms as alcoholism or overeating or workaholism—that I have been treating in private practice and as a sponsor, with good results, for three decades. My method is my own cause-focused modification of the spiritual process that is the 12 steps.

Symptom Substitution, aka Relapse

The fundamental sameness of addictive behaviors is indicated by their interchangeability. A classic example of this symptom substitution, as I call it, is sugar for alcohol. Years ago, while focused on relapse and 12-step treatment as part of pursuing my PhD, I came to recognize the substitution of a different addiction, including a nonchemical for a chemical one, as a form of relapse. The substitution may be less (or more) immediately life-threatening, but logically, any substitution indicates that the underlying problem has not been addressed.

The phenomenon had been all too apparent in my personal experience. Addicted to alcohol for many years, I had joined AA, relapsed, returned, and found long-term abstinence from that drug. But much to my dismay, I continued to feel like an active alcoholic much of the time.

Even as I continued to work the program—which saved my life—I substituted (i.e. relapsed into) sugar, then cigarettes, then yo-yo dieting, followed by exercise, work, sex, relationships and AA itself. In an attempt to deal with each addiction as it surfaced, I found myself going from one 12-step group to another, where I met many others who were doing the same thing. (Imagine what the relapse statistics would look like if substitutions were accounted for.) Finally, after 18 years of this brand of “abstinence,” I found myself checking into a treatment center for the first time—for codependency.

Once I started my private counseling practice, I saw the same phenomenon in my clients.

For example, my client Chris, like me, had a history of alcoholism but really hit bottom with codependency. “I didn’t think I’d have to commit suicide, because I thought my pain would kill me,” he writes in a testimonial. “I was at that point without a job, without a home, without an ounce of hope. Hadn’t I done everything correctly up to then? I had gone to AA meetings, done service, worked the steps, not drank or drugged for 13 years.”

Or take my client Alex: “I had been sober for more than eight years, going to AA meetings and sponsoring as well as having a sponsor. In addition, I had attended Overeaters Anonymous, Debtors Anonymous, Al-Anon, and Codependents Anonymous. All the 12-step programs I experienced never healed me from my using; it was only sublimated. The drink or drug I abstained from, but in its place came overworking, sex, shopping, relationships, and the list goes on.” As long as single-addiction treatment is the norm—whether through the steps or some other method—relapse in both the traditional sense and by substitution will also be the norm. “Relapse is part of recovery” is the institutionalized rationale for this ongoing failure.

The Roots of Addiction: Parenting

And where does emotional dependency come from? My conclusion: an all but universal parenting system based—unconsciously and to varied degrees—on control, not love.

I posit that emotional dependency is learned and passed from generation to generation and reinforced by our educational, religious, cultural, and political institutions. The goal of much parenting, consciously or unconsciously, is obedience, i.e. control. And what better way to establish control than to condition emotional dependency?

Most of us never learn how to meet our own emotional needs. Rather, when we are literally dependent on our parents for our very lives, we become survival experts. Experts at figuring out what they want, so we can earn rewards and avoid punishment or abandonment. A complex of fear, control, and manipulation is continually at work. The extent to which we experience this conditioning (all of us experience some) is the extent to which we become emotionally dependent and consequently engage in increasingly intense forms of fear, control, and manipulation—i.e. addictive behavior. This, then, is our model for all relationships, including the one we have with ourselves.

An apt way to put it is that we develop a using mentality. We use other people and things in an attempt to get our emotional needs met. As Alex puts it, after eight years of sobriety and AA meetings, “I still had the addict’s mind.”

The reality is that nothing and no one outside ourselves can fill the emotional-spiritual void left by getting obedience training when we needed love. And so we fail, repeatedly, and resentment and feelings of helplessness grow, which only intensifies our misplaced efforts.

Treating the Cause

If emotional dependency is learned via parenting, then it can be unlearned. And I have found in my practice that a modification of the 12 Steps—I simply call it the Brown Method—effectively does exactly that. My method is outlined in complete detail in my book Addiction Is the Symptom, but in brief:

The first key modification that I’ve made to the traditional 12 Steps is to Step One, traditionally practiced as, "We admitted we were powerless over alcohol—that our lives had become unmanageable." My modified step method calls on us to accept the condition of powerlessness as applying not merely to our drug of choice, but to all of life.

The traditional step, by focusing on the symptom, immediately sets people up for failure, i.e. relapse. My modification shifts the focus from symptom to cause—to the underlying control issues. This is important in part because it is ultimately quite empowering. Once we recognize our powerlessness over other people and things, we have taken the first step toward personal power, self-control, and healthy independence. So Step One, practiced in this way, is the beginning of the end of emotional dependency.

The heart of my method, my "Fourth Step Algorithm," builds on this foundation. Traditionally, Step Four is a “searching and fearless" (yet haphazard) "moral inventory of ourselves.” But my modification systematically brings to consciousness the conditioning of emotional dependency through an exhaustive, professionally facilitated inventory of all relationships. In addition, while the traditional focus is on the harm we have done to others, the focus here is our own accumulated pain and trauma, the purging of which in Step Five is also key.

As the work of the algorithm makes clear, it takes two to play the game of control and manipulation—just one to end or prevent it. With this awareness of co-creation comes the capacity to take personal responsibility for many of our hurtful experiences, and for refusing to engage any longer in the addictive behaviors and thought processes that caused them.

This is greatly assisted by another result of the process: the recognition of the spiritual self, not the conditioned/addicted self, as the authentic self. Further, it is the commitment to a self-defined daily spiritual practice of reinforcing and expanding this realization that finally results in healing—as opposed to symptom management and relapse.

A New Mode of Working

Not only are the steps different here, so is the whole mode of therapy. The Brown Method is about working, not talking about problems, and that work is largely self-guided. It is meant to be short-term, from three to eleven months. And the relationship between client and therapist/facilitator is secondary—more important is their mutual commitment to the process outlined in the algorithm. This commitment is key, in part because it is not a single component of the process, but rather the whole, that determines the result.

The client commits to working for 20 to 30 minutes a day, which means writing in a notebook per the algorithm’s simple instructions. The phases of the algorithm build on each other, much like the 12 steps themselves, making the process more emotionally manageable than the traditional Step Four. The client also commits to a brief daily phone or Skype check-in with the therapist (many times, even a text message might do). This provides accountability, motivation, support, and the opportunity to ask any questions that might come up.

As a protection for the client, a lapse of three days in the work results in termination of the relationship. In my experience, such a lapse strongly indicates an inability and/or unwillingness to complete the process. To proceed would be a waste of the client’s time and money. The lapse may occur because deep exploration of the past is truly more than the client is ready to bear, in which case it is self-preserving; it could be damaging to proceed.

The therapist’s role expands in Step Five, which entails an intensive series of in-person meetings. The therapist serves as witness to the inventory of trauma and assists the client, as needed, in viewing the recorded incidents through the lens of emotional dependency. Therapists who have done the work themselves—we all have control issues, so "physician, heal thyself"—will easily be the most effective in facilitating it.

A Return to Spiritual Therapy

In the short term, it's always easier to deal with the overt drama of symptoms than with cause. The resulting repeat business is more lucrative as well. And it is neater to locate cause in something that can be measured or scanned or looked at under a microscope. Spiritual deficits do not show up on fMRIs, as far as I know. So it is not fashionable these days to talk about addiction and spirituality.

This is probably another reason why AA has come under so much scrutiny lately. In AA circles, after all, alcoholism is often referred to as a “spiritual disease.” But to my mind, AA, whatever its flaws, can be credited with recognizing addiction’s spiritual component from the beginning. It was Carl Jung who pointed AA founder Bill Wilson in the right direction. In an exchange of letters, Dr. Jung wrote of a client, "His craving ... was the equivalent, on a low level, of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God."

Let's remember, too, that psyche is Greek for "soul," and that the term psychiatry—first coined by the German physician Johann Christian Reil in 1808—literally means “the medical treatment of the soul.”

The Brown Method represents a return to these roots. Only by the treatment of our whole beings can we achieve wholeness. In other words, healing.

Dr. Rosemary Ellsworth Brown, a psychologist, is the author of Addiction Is the Symptom: Heal the Cause and Prevent Relapse with 12 Steps That Really Work. She graduated from Smith College as an Ada Comstock Scholar in 1989 and completed her doctorate in counseling psychology at the Union Institute in 1993. Her academic research focused on relapse, in particular on why AA and its myriad 12-step offshoots proved ineffective for the majority of their members. She ultimately developed a modified, cause-focused step method and has been using it in her private practice and with sponsees for upwards of 30 years. To learn more, click here.

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