Limits of the traditional twelve-step program for autistic folk

Anyone who is even vaguely familiar with the addiction recovery community will likely have come across the twelve-step program in one form or another. Alcoholics anonymous, cocaine anonymous, narcotics anonymous, the list goes on. There are many different groups employing the twelve-steps, and it is often what addiction treatment services suggest to service users to support their goal of recovery.

That last point is a problem for autistic folk. The big book of alcoholics anonymous claims that the program is suitable for anyone, but in my experience, the twelve-steps are quite inaccessible to those of us who are autistic.

So what makes the twelve-steps inaccessible?

The first issue I had was the talk of a “higher power”. I fall on the side of agnosticism and atheism, relying on a higher powers felt absurd to me. The twelve-steps involved a lot of praying, and I couldn’t reconcile that with my own beliefs. In my opinion, this also reduces accessibility to the LGBT+ community, of whom many are autistic, because of religious trauma that they may have experienced.

The social aspect was also incredibly difficult for me. Before and after meetings involved a lot of small talk and hugging. Those of us with a touch aversion will already understand my issues, and I can imagine that most, if not all Autistics can appreciate the horror of being faced with small talk. Just thinking about it used to make me anxious.

The rooms are often lit with bright white lights, in old buildings that smell weird, filled with extremely uncomfortable fold-up chairs. You are expected to sit in these rooms for an hour to an hour and a half, without being too fidgety. Leaving to go to the bathroom too often is regularly met with suspicion.

While the structure of the twelve-steps can be helpful for planning and goals, the homework set by sponsors as you work through the steps can often clash with executive dysfunction issues. Until these issues are addressed, the twelve-step program will never be fully accessible to Autistics.

The whole experience left me having regular panic attacks at meetings, and when I thought about meetings.

Of course, other Autistics may have a better experience of the program. As addicts, we must utilise all of our experiences to find recovery, and what ever works for us (and doesn’t cause further harm) is valid. It does concern me however that these programs are considered a “go-to” intervention by many treatment services. It’s especially problematic when you consider that twelve-step programs generally will not allow academics to study their efficacy (supposedly to protect the anonymity of its members).

For me personally, I learnt an awful lot about my addiction through the twelve-steps, but had to ultimately support my recovery through other means; but once again, if it works for you, I would never seek to take that away from you. My main issue is that the twelve-steps, like most addiction related things, does not account for autistic addicts, of whom I believe there are more than we realise.

Until the addiction community makes itself accessible, lives are in danger. It’s time for autistic addicts to declare their existence.

Published by David Gray-Hammond

David Gray-Hammond is an autistic mental health and addiction advocate living in the South East of England. He is in recovery from addiction and psychosis, as well as other complex mental health conditions. He was diagnosed as autistic seven months after achieving sobriety, and is resolved to share his experiences with the world in the hopes of being the person that he needed when he was younger.

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