12 step programs and BPD

[maxsterling]

Question - can 12 step programs be counterproductive to those with BPD?

First, I am a big advocate of 12 step programs to help people with their addictions.  Anything that helps people stop drinking or using drugs I consider positive.  And I recognize that any long term help for BPD will require sobriety, as drug and alcohol abuse is a failed coping mechanism for those with a personality disorder.

That said, I'm noticing a few potentially destructive things about the 12-step programs for people who have personality disorders:

-  From what I have observed, stopping the substance abuse is the number one goal in these programs, and other bad behaviors are looked over as "well, at least I am sober."  I think it leads to a justification that now that they are sober, other people are the problem.

- They seem to seek out other 12-step friends and use them as examples of how to live.  The "addict" behavior is viewed as normal.

-  They use the addiction, or blame the "disease", and justify bad behavior.

-  They use 12-step programs in replacement for therapy. 

It just feels to me sometimes that the 12-step groups can be a "validation fest", a group of people validating bad behavior.  I think for the non-BPD, I they can spot the bad behavior in others and apply it to themselves and grow, but for the pwBPD, it can turn into validating the invalid. 

For example, suppose someone shares that they are struggling with anger issues towards their spouse.  Another person says, "Yes, I struggle with that too.  I just have to remind myself (insert healthy anger management mechanism)."  A nonBPD hears that advice, and tries to apply it to their situation.  A pwBPD hears, "oh, it's okay to be angry at my spouse sometimes, because spouses can be annoying."

It just feels that black and white thinking may not work together with 12-step type programs.  Thoughts?

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[Grey Kitty]

Thought #1: All you say sounds reasonable/plausible.

Thought #2: I've heard from someone in AA the comment that being sober doesn't make everything work right--it just stops THAT problem from hitting you. So the "danger" probably varies from group to group.

Thought #3: Learn from 12-step programs like Al-Anon / CoDA: Your partner's growth/recovery/etc. is her own. Let her make her own choices. Let her learn how they work for her on her own schedule. (I'm assuming she isn't directly asking you for advice on this very issue!)

[Slartibartfast]

So 7 years on, I wonder if any more thoughts have come up on this matter regarding the intersection of the various 12 step programs (AA, Alanon, ACA, CODA, etc) with people that have BPD? My wife, who suffers from severe BPD, is rather addicted to these programs and has been attending various meetings almost daily for years now.  I should note that we have no substance abuse issues in our immediate family, but 12-step is sort of seen as this panacea and frankly the idea of the "validation fest" that happens at meetings is something that scares me a bit.   Eventually though, she even starts to fight with her sponsors, so I don't really know what to think. But somewhere in my gut, it just gives me the heebie-jeebies. Like it's just making things worse.

Any new thoughts?

[Notwendy]

As someone who has been in these groups for a while for codependency- CODA, I have found them to be helpful when dealing with the enabling side of things. I don't have experience with substance abuse and so didn't ever attend an AA meeting- from that perspective. However, some recovered addicts/alcoholics are in these groups too- dealing with that side of the situation.

So from being around these groups for a while, I have seen that the group attendance as well as the focus of the group can vary. Keep in mind these are volunteer lay groups and so don't take the place of professional therapy. In some groups there may be some seasoned "veterans" attending who know not to enable. I was fortunate to attend some of them. I've also been in some that seemed less effective. Also keep in mind that the members vary from those that are seriously working on recovery and others who are not- and who also may have a mental illness.

I think from the family dynamics, enabling partner perspective, these groups can be effective. From the substance abuse perspective- I think they can be helpful if the person who attends is committed and willing to do the work to change.

I don't think one gets enough by just attending meetings. The work comes from working one on one with a sponsor. The meetings are an ongoing reminder and support group for recovery work, not for enabling the unwanted behavior. Just attending meetings alone is not actually doing the work of the 12 steps. Now also consider there's variations in sponsors, as they too are lay volunteers. I was fortunate to have one that didn't coddle or enable. In fact, it was quite tough to have someone turn the mirror on me and show me where I was participating in enabling behavior. While she was also supportive, it was tough love, uncomfortable, but I kept at it because I was motivated and willing to look at myself.

There's the contrast to BPD. How does one get a pwBPD to be insightful, look at their own part in dysfunction, tolerate constructive and sometimes critical guidance that could cause emotional discomfort? BPD is considered to be a challenge for even a trained therapist. It makes no sense to expect a volunteer lay support group or sponsor to be effective with BPD. That doesn't mean 12 step groups are ineffective in general.

Sometimes we do have connections in the group, socially, but just like the real world, we gravitate towards those who we may have some affiliation with and we need to be aware that we may not "click" with everyone in the group. One may think these groups are composed of people who have problems but in actuality some of the people I have met in these groups are the most "together" people I have known- because they have been willing to face their issues and work on them. Some are not and either leave or don't make progress. Your wife may gravitate towards certain people and identify with their stories and/or be resistant to the attempts of the more experienced members to not enable her.

Bottom line though- if a person has a mental health condition such as BPD that is a challenge for a trained therapist, don't expect a lay volunteer group to be any more effective, or effective at all. Also, it is possible to attend a 12 step group and not do any of the personal work and make no progress and a sponsor can only work with someone willing and capable of doing their own personal work. They are more of a guide and support person, not a therapist.

[Notwendy]

Another question is that, you don't know what your wife is saying in these groups. It would make sense that a person would share their story from their own perspective. Also, how someone perceives the feedback is seen from their perspective.

Addict or co-dependent behavior is not considered to be the norm for these groups but if someone chooses to see it that way, there's not much anyone can do.

It's actually not a validation fest, or it should not be. Obviously it wouldn't be productive to be too forceful about it but the intent of the program is to have the addict look at themselves. You should read the 12 steps- "take a moral inventory of ourselves", " admit to ourselves and another person the nature of our wrongs". "be willing to make ammends". This is not a self flaggelating process- but it's meant to make the person take a look at themselves and clear the slate of their past behaviors so they can feel positive and make changes.

The idea of being "powerless" over the addiction isn't to blame it for behaviors. It's to let go of the denial. How many people think " I have control of this" when it comes to a certain behavior. Once you can let go of the denial, then you can begin to work on it.

I don't think the 12 steps are for everyone. I think people should have a choice and if someone thinks it's not for them, they don't have to do it. But they are one resource that has been helpful and I think are a valid choice- among all the choices for treating addiction. They don't take the place of therapy but can be an additional resource. That said, a person can misuse them, come to groups looking for validation and get nothing out of it if they choose to do that too.

Max, I wonder if you are grasping for reasons- some reason that your wife isn't improving beyond the fact that she has a mental illness. If she's at the point of trying Ketamine, then a lot of intervention has not been effective. People abuse drugs and alcohol for many reasons. One is to self medicate for the emotional discomfort of the mental illness. Stopping the substance that is abused doesn't change the reason they are abusing it in the first place and the 12 steps aren't a treatment for mental illness. Could they make her situation worse? Maybe if she's using them for her own validation but that's not the fault of the program. It's only as effective as the person is able to and willing to work with them honestly. That's also likely true for any therapy as well.

[maxsterling]

My W has been involved in 12-step programs off and on since she was about 16.  She credits 12-step for getting her off Heroin.  She was continuously "sober" for about 12 years, when technically she relapsed on Marijuana and Alcohol.  She now has used Medical Marijuana for about the last 3-4 years.

W will occasionally go to Narcotics Anonymous meetings online, and has recently attended a few ACOA meetings.  She mostly rejects the 12-step programs right now because she feels they are "shame based".  From the 12-step perspective, W is having issues "letting go".

I see W's point here, from a BPD black/white perspective.  To her right now, the 12 steps say she is powerless and has made many mistakes, and her interpretation is that she must then be all bad and can't handle the emotion (all black).  However, when she was active in 12 step programs, the "validation fest" analogy was definitely true, and she was "all white".  95% of her close relationships were with other program members and I think that normalized other destructive behavior.

The problems I see with these programs is that there are no "professionals" to lead them, and you can wind up with some very destructive meetings and personalities that influence those that are hurting.  An example would be the many instances of "old timers" beginning romantic relationships with newcomers.    I saw this happen over and over again, and the newcomer would wind up damaged as a result (happened to my W where older program members preyed upon my W as a newcomer teenager).  Same goes for Alanon/Narnon.  I attended a Naranon meeting for awhile, and one young woman would come in tears every week.  The reality is she was in a very dangerous abusive relationship, and it required other members to "break" the anonymity in order to get this young woman help (probably saved her life).  Had it not been for that intervention, she would have been told to "clean up her side of the street" and all would be better - the program had made her feel like she was part of the problem.

Another issue is that some feel that taking medication makes them not "sober".  I see this as dangerous.  At times W stopped taking helpful medication because a sponsor or peer questioned it. 

The program does recognize that people with mental illness may not be a good fit for the program.  In my time going to meetings with my W, I estimate that 25% of them have some kind of personality disorder, and the rest have other mental illnesses that need professional help.  I think the 12-step model is basically good, but I think for those with serious problems it should not be a replacement for therapy.  For too many of them, I think it is.

[Notwendy]

There were a few pairings off in my groups as well. I wasn't looking to do that, but I also don't think it's a wise decision to do that either.

Yes, there are no professionals there, but the more savvy sponsors I know caution people to not get into a relationship ( if they are single) during their initial recovery work as it can distract them from their own focus as well as distract them from making progress. The "coupling" I noticed didn't last long. However there were some long time couples choosing to go together and these were long term relationships.

People have free will Max and these programs are completely voluntary and yes there can be some old timers and new comers who are questionable. I think the groups, like any relationship, require some judgment on the part of people attending. If someone is disordered to begin with, they are going to bring this into the group because it is a part of them and it impacts everything they do. Nobody is claiming these groups have any professional qualifications.

I am not surprised that your wife feels these groups are shamed based. It's not easy to look at oneself, even without BPD. Honestly, I am not sure these would be effective at all with someone who has BPD because that's an area of difficulty for them.

I have sat in groups with people who I think have benefitted from this work and seem more "together" and yes there are people in the group who are disordered.  We have to use our own judgment and work with it in the capacity that we can, and if someone has a mental illness, they may not be able to do it. But nobody has the authority to tell anyone to leave if they are not being disruptive. It's not a selective group.

I have personally never heard anyone in these groups tell someone to not take their prescribed medication or claim they aren't sober if they do take medication.

I don't think there's a program with a 100% success rate. I have spoken to someone at a DV center and despite having people in a shelter, with counseling and support, some return to their abuser. Addicts are known to relapse. 12 steps won't have a 100% success rate either. I do agree with you that for some people with mental illness, they may not benefit at all- because their mental illness prevents them from working with insight to themselves. That's a hallmark of BPD and one reason why therapy isn't always successful either.

For the success stories though- the 12 step groups are a choice of many choices. I agree it may not work for your wife as other interventions have not worked for your wife. If it's making things worse for her, then it may be better for her to not go. One example is that therapy has not been effective for my BPD mother, because she can not look at herself. She also would go to therapy to feel validated. I imagine some people go to 12 step groups for that as well, but just doing that doesn't lead to change. But looking at the 12 step groups for the reason your wife didn't respond well may not be the main reason.

[Notwendy]

I will make a parallel with this board. It's not a group led by professionals. Everyone here is a lay person. It's moderated but the moderators are also lay people. There are many boards/internet sites about PDs but this one is a bit different- why?

I have read several internet sites where the focus is on the disordered person. People focus on all the things they do, with the conclusion that the only solution is to get far away from them. It does feel validating to vent and have others vent too and say yeah- you poor thing that person's terrible, you don't deserve this. Yes, there's a place for this, where people can understand the situation and how tough it can be. The problem is, people get stuck and there's little space for change.

We do some of that here but don't say "leave, it's hopeless". "Nothing is your fault". Many of the longer term members will gently, or not so gently, urge the poster to look at their part in it. The tools are for us to change- not for the pwBPD to change- a style of communication. Some  posters have chosen to work with this and others have not, some don't respond to messages to  look at their part in it. Posting, reading messages is voluntary, and there's no obligation. There's a range of posters giving their own advice and posters respond or take it or leave it according to how they respond.

Same with a 12 step group. The advice is there, but not everyone "hears" it the same way. For some it might feel empowering to have aspects of their behavior that is causing issues discussed, and for others that might feel shaming. And yes, there are disordered people who might attend- I have been in one group where people stopped attending due to one person's behavior.

But the intent of any intervention is to help- including this group, 12 steps, therapy with a professional and many times it does. But if it doesn't- then there's the choice to not continue.

[ThanksForPlaying]

I found a great 12-step group on Zoom that I love attending myself. I'm codependent and have had issues with alcohol that are under control now but I enjoy the comraderie and discussion in these groups. I personally always try to focus on the "grey area" and others in my group discuss that too. Alcoholism, as with BPD, is not black/white. There are good times and bad times, no one is perfect or totally evil. That's what makes bpd so hard to handle - there are good times along with the chaos! I don't think 12-step groups are detrimental to bpd thinking - you hear what you want to hear I guess.

[maxsterling]

Really, really good thoughts here, Wendy.  The analogy to here is appropriate, although one could argue that those of use here have more control over our emotions and can approach solutions more rationally.  Advice here also usually steers members toward T of their own.  

I recognize I started this thread some 6 years ago.  Wow.  

So 6 years ago I was concerned that my W was "stuck" with the 12-step program she was in.   She wasn't seeing a T at that time, was not on meds.  Many of the people in the program she associated with had serious issues.  W would use that as a reason to justify her behavior - "I am okay because everyone struggles with (xyz issue)", when in reality most people do not struggle with (xyz issue).  Because it was normalized, she didn't feel like it needed attention.  Or maybe she did, just was scared to look at it.  In the reality, I was probably foreseeing a normal pattern that happens before a "relapse".  

Fast forward 3 years, and sure enough it happened.  Right now I would very much say she is "addicted" to marijuana.  W has awareness of it, but does not want to look at it because it causes her shame.  I struggle with this because I know she has trouble regulating her use, but on the other hand it may be the safest, healthiest coping mechanism she has.  Many of the other prescribed meds she has been given she has abused or attempted suicide with.  I did get her to stop watching the news on her phone while she uses.  It does give her a "break" to go outside, watch the birds, etc.  I just wish she could take the same "break" doing something else.  

She does attempt 12-step programs every now and then.  But after a few meetings she feels depressed and doesn't want to continue.

[Notwendy]

Could it have been your wife's need to see her behaviors normalized that led her to gravitate to the more disordered people in the group and also her need to see herself validated that led her to interpret what she heard as "normalizing"?

Shame is a terrible feeling in general and I think overhwhelmingly terrible for someone with BPD. I think the addiction is a form of self medication, to help deal with overwhelming difficult emotions. Yes, a 12 step group might get someone to stop the drug or alcohol, but what about the feelings? It's likely she already feels bad about herself doing these drugs, but she probably doesn't want to feel worse and knows she would if she stopped. I think to get something out of 12 steps someone probably really needs to want to stop, and she may want to, but stopping might just be too much for her.

I can only imagine how hard it is to be expected to function like many people and just not be able to. I'm going to bet your wife is probably doing the best she can. I don't think it's wise to think she can't improve or that all is hopeless but all this focus on her issues and her getting better might also be felt as pressure. Not that you should condone abusive behavior, but maybe taking some of this focus off her and on you getting some rest, some space to work, some self care- even a little bit of this might be more effective. If she's found that smoking pot is a way to get some relief- maybe she's doing the best she can at the moment.

[Slartibartfast]

I'm going to go out on a limb (also my wife has stated as much) that the universal acceptance and unconditional love that people in the 12 step programs feel is a very alluring and powerful thing. She often has stated that "I can drop in to pretty much any city and find a group and know that the people there will accept me and take me in." and I believe it, and there's the thinking (although I'm not sure it's a rule, but I've heard it said) that "only a drunk can help another drunk" or something to that effect. I've sat in on a fair share of meetings (to see if they were for me) and looking back it's certain that everybody there really struggles with SOMETHING, else why would they be there? (Aside from a court order, depending in the laws of your state, but I digress) and to think that only a BPD can truly understand what another BPD struggles with isn't that far of a reach. A lot of things in life are like that. Parenting for example, or being a waitress, or getting your PhD.

On the other hand, the normalizing of troubling behaviors is quite different than recognizing that others also share your plight. One ought to keep an eye on that line and which side they lean towards today.