Gary S. Fisher, Psy. D., C.A.D.C.

healing, integration, authenticity

Step 1: We admitted that we were powerless over alcohol - that our lives had become unmanageable.

Principles: Honesty vs. Denial

Without an honest admission that a problem exists, it is virtually impossible to begin the recovery process, regardless of one’s beliefs about addiction and what it takes to overcome it. Contrary to many people’s belief that powerlessness is the principle involved in this step, in virtually all cases of addiction, the powerlessness has existed for some time and it is the admission that has changed. Honesty is the essential ingredient for building a foundation for the development of integrity, authenticity, self-respect, trustworthiness, and real emotional intimacy, and like all the principles in the steps and other spiritual disciplines, is completely aligned with the true nature of us as human beings. Without it one develops an internal conflict that leads to further disconnection from oneself and others, diminishes self-respect and causes a great breach in trust from other people, and cannot help but alienate those that are most needed for support, thus driving the person deeper into their addiction.
Evidence for honesty being a part of our nature as humans can be observed and experienced whenever one starts to get close to another person, the closer you wish to get, the more one wants to reveal themselves to that person, thus secrets cause us to go against that nature. It is also observable in children who had not yet developed the defenses of manipulation dishonesty, and although children do make things up, I believe it is part of how they learn about creativity, imagination, and playfulness, and does not come from a conscious attempt to deceive or from any malice. Parental response to the use of imagination, or what my son calls, fooling, is what determines if the child learns that it is okay or not to be dishonest.
Although powerlessness is not the primary principle that I focus on in this step, the admittance of it also creates a paradox in that whatever the person is powerless over, s/he inevitably will have to stop it (whether it be using a chemical and any other addictive behavior, simply something the person truly wishes to change in their life), and surrender their illusion of control, which has kept that individual behaving in the same way, long past the time it was fun or recreational.
The unmanageability component is simple mathematics, in that as the addiction takes center stage, it increasingly consumes time, energy, and resources, until there is nothing left to give to work, family, friends, or even self-care. To manage is to direct with skill towards an ultimate goal, and virtually no one sets out to be an addict whose life has gotten so out of control, therefore, the unmanageability is an inherent component of addiction in that the individual winds up in places they never intended to be.
For the Mental Health Professional/Worker:
Many of the people seeking therapy are not able to see the role their use of chemicals and other/or their behavior(s) has played in their current situation. This is not an exclusive trait of the addict. The lack of insight and/or the inability to acknowledge that there is a problem is inherent in many of the disorders listed in the DSM-IV, e.g., Borderline Personality Disorder (APA, 1994), and is extremely important to the overall treatment prognosis for any ailment, be it physical or mental. In those cases where denial is still very strong, the role of the therapist is to aid the client in his or her admission of the need for help. An in-depth history will help in this endeavor, providing the clinician with ample information with which to confront the client’s denial. Whatever process that’s used to gain the historical information (e.g., interviewing, questionnaires, etc.), it can also be combined with the use of the many Step 1 workbooks available that seek specific answers to pertinent questions surrounding the client’s problem.
Although many therapists may not wish to be placed in the position of confronting the addicted individual insisting that the addictive behavior stop, for fear that they will create a paradoxical reaction in their patient (Steiner, 1971) or fail to establish rapport, it will be virtually impossible to make any progress as long as the addictive behavior continues. This is true whether the person is in individual or group therapy, or in a treatment program designed to address the problem. I’m not to suggesting that the therapist shouldn’t see the client unless the behavior stops, it only means that they must not co-sign the client’s denial by virtue of their silence. In addition, the confrontation of the addict by the therapist may aid in creating the type of crises usually needed to facilitate surrender (Hidas, 1981), a vital component in the first step in particular, and the recovery process as a whole. (see Dr. Tiebout’s article on surrender versus compliance in the treatment of addiction)
In order to be effective with addicted populations, the counselor or therapist must truly like the addict and be able to convey that, even while confronting the behavior.
By the time alcoholics reach our clinics or our offices, they have long been scorned or rejected. Worse, they have internalized this scorn and rejection, and however defended by bluster and bravado, they hate themselves. Further, they have usually become experts at provoking rejection by others, thus confirming their worthlessness and providing a rationale for more drinking. The therapist’s unconditional acceptance at least provides a possibility that the vicious cycle will be broken, and lends itself to the person trusting what the therapist is trying to get them to see.
In addition, although this may go without saying, the counselor or therapist must be clear about any issues they may have either with an active addiction they themselves may be dealing with (especially codependency), and/or any unresolved emotions they may have if they come from a chemically dependent, or codependent, home. The addict will be able to pick up on any unresolved conflicts or resentments, and the therapy will most likely be ineffective.