William C. Hale, PhD, LICDC-CS Glenbeigh Hospital

1. Integrating Strengths-Building into 12-Step Recovery How Positive Psychology Can Facilitate Spiritual Development in Treatment for Substance Dependence William C. Hale, PhD, LICDC-CS Glenbeigh Hospital

2. Today we will... • Increase our sensitivity to the struggle inherent in clients without a belief in the traditional concept God or higher power, but who are attempting to find recovery through traditional 12-Step programs. • Understand the development, philosophy, structure and uses of Positive Psychology (PP) and recognize how its use can facilitate clients’ participation in 12-Step or other recovery programs. • Learn how to integrate PP principles in our work with recovering clients who struggle with the concept of higher power to explore creative, meaningful ways to understand this concept, including finding it within themselves and their support network, while recognizing the goal of a better life as the central and cohesive element of their recovery. • Learn how to use principles of Positive Psychology to help recovering clients who do have traditional understandings of God or higher power to enhance their recovery through self-empowerment to reach their goal of a better life.

3. Albert Einstein once said… Imagination is more important than knowledge. For knowledge is limited to all we now know and understand, while imagination embraces the entire world, and all there ever will be to know and understand. When it comes to understanding spirituality and the nature of higher power, perhaps wisdom comes from learning to live with the questions, rather than demanding the answers…and being open to continuous exploration. And the mystery itself is the doorway to all understanding. from the 1st verse of the Tao Te Ching – Lao Tzu

4. Origins of Alcoholics Anonymous • Principles based on the Oxford Group – Christian-based organization founded by Frank Buchman (Lutheran) • Founders met in 1935 • Bill Wilson & Dr. Bob Smith • Both in Oxford Groups (NYC, Akron) before meeting • Catalyst for the meeting: Bill W was looking for another alcoholic to help, in order to keep himself sober. • They discovered an effective way to stay sober: • Reach out to help each other stay sober.

5. Mission of the Oxford Group “The secret is God Control. The only sane people in an insane world are those controlled by God. God-controlled personalities make God-controlled nationalities. This is the aim of the Oxford Group.” Frank Buchman – Founder of the Oxford Group and Moral Rearmament Movement upon which the 12–Step program of AA is based.

6. 5 Cs and 5 Practices of the Oxford Group • Confidence – Trust in the “Life Changer” • Confession – Sharing all one’s sins with the LC • Conviction – Readiness to turn from sin • Conversion – Turning one’s life over to God • Conservation (Continuance) – Working constantly to accomplish God’s will. • (Revised and expanded to create the 12 Steps)

7. THE TWELVE STEPS OF ALCOHOLICS ANONYMOUS 1. We admitted we were powerless over alcohol—that our lives had become unmanageable. 2. Came to believe that a Power greater than ourselves could restore us to sanity. 3. Made a decision to turn our will and our lives over to the care of God as we understood Him. 4. Made a searching and fearless moral inventory of ourselves. 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. 6. Were entirely ready to have God remove all these defects of character.

8. 7. Humbly asked Him to remove our shortcomings. 8. Made a list of all persons we had harmed, and became willing to make amends to them all. 9. Made direct amends to such people wherever possible, except when to do so would injure them or others. 10. Continued to take personal inventory and when we were wrong promptly admitted it. 11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out. 12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

9. Making AA More ‘Spiritually Inclusive’ • 12 Steps were written to try to distance AA from organized religion to increase acceptance. • Still rooted heavily in Judeo-Christian tradition. • God was described as “Higher Power” – AA members encouraged to understand ‘Him’ as they needed to. (Paradox / Potential Conflict) • AA referred to as “Spiritual” but not “Religious”. (Source of controversy in and out of AA)

10. If AA is Spiritual (vs. religious)…then what is Spirituality? First, what it is not… • Religion of any sort…although it is often practiced within one’s religious tradition • Universal in definition, form, function, intention or purpose (It has many manifestations) • Something that can necessarily be taught or imitated effectively

11. What is Spirit? • Latin word - Spiritus: Breath – invisible, but necessary to sustain life. • The ‘animating principle’ or “that which makes us alive” • An intangible presence or energy present individually and collectively in all living things • Consciousness – Awareness of and seeking of life

12. So, What Could “Spirituality” Be? • Awareness of ourselves and our place in the universe? • Will to live and create a better life? • Urge to experience connection with others? • Urge to understand a higher power? • An aspect of the Self that is intangible, but very real? • The nurturing of that silent force in us? • What else…?

13. Other Thoughts on Spirituality Sometimes people get the mistaken notion that spirituality is a separate department of life, the ‘penthouse of existence’. But rightly understood, it is a vital awareness that pervades all realms of our being. Wherever we may come alive, that is the area in which we are spiritual. David Steindl-Rast, Catholic Theologian (Notable for his active participation in interfaith dialogue, and his work on the interaction between spirituality and science)

14. Spirituality exists wherever we struggle with the issue of how our lives fit into the greater cosmic scheme of things. This is true even when our questions never give way to specific answers or give rise to specific practices such as prayer or meditation. We encounter spiritual issues every time we wonder where the universe comes from, why we are here, or what happens when we die. We also become spiritual when we become moved by values such as beauty, love, or creativity that seem to reveal a meaning or power beyond our visible world. An idea or practice is "spiritual" when it reveals our personal desire to establish a felt-relationship with the deepest meanings or powers governing life. (from…Spiritual but Not Religious: Understanding Unchurched America) Robert C. Fuller, Ph.D. – Bradley University

15. Spirituality of Atheists/Agnostics • The Center for Spiritual Atheism offers this statement… • “While atheism tends to lean towards skepticism regarding supernatural claims and the existence of an actual "spirit", some atheists define "spiritual" as nurturing thoughts, emotions, words and actions that are in harmony with a belief that the entire universe is, in some way, connected; even if only by the mysterious flow of cause and effect at every scale.” • Atheists do not believe in the existence of an entity external to the universe that created and rules the universe. • Spiritual Atheists generally feel that as they go about their lives striving to be personally healthy and happy, they should also be striving to help the world around them be healthy and happy. (“Holistic Ethics")

16. A wise Rabbi once said… “When we define God, we kill God.” What did he mean? It locks the concept into a 3-dimensional box that our brains can grasp. The concept of God is turned into an anthropomorphic projection of the human ego and experience. Leaving the God concept open to wonder, exploration, doubt and imagination allows it to live and flourish, and allows us to connect with it more fully in whatever way we may need to. This is especially important for those who struggle with traditional conceptualizations of God or Higher Power. To him, ‘God’ was a ‘lifetime of manifestations’, taking many different forms throughout daily existence.

17. Theological Paradox in AA… • In AA, members are encouraged to see ‘God’ any way they need to in order to make it meaningful for them. (God as we understand Him) • Then, it is suggested that they turn themselves over to God and to pray to Him for removal of faults and knowledge of His will. • If God is to be surrendered to and prayed to in this way… • A discreet, monotheistic entity seems to be implied. • It is assumed that this entity hears and responds affirmatively. • Thus, a paradox is established if people are encouraged to see God/Higher Power within their own understanding, yet it is recommended that they interact with it in a particular way. • For people with differing ways of understanding the concept of God/Higher Power, or are struggling to find any way at all, this can create a conflict. • So…how can the paradox be resolved?

18. God as Potential…Just Letting It Be • Most of the atom is nothing but empty space • God has been described as the nothingness inside the atom… • …or the silence between notes of music • …or the silence between words of a poem • Pure Potential – Neither defined nor assigned

19. Framing ‘GOD’ as an Acronym…(Thoughts from AA/NA Members) • Good Orderly Direction A plan for living a better life in recovery and the conviction to engage in it. • Group Of DrunksNot used derogatorily, but in reference to people who understand the struggle of addiction because they have lived it, have found healing and hope, and can help others heal and find hope as well. • Gift Of Desperation Reaching an existential turning point at which a higher purpose must be sought. (An addict’s bottom is the point at which the next thing that is about to be lost is valued as more important than that next drink/hit.)

20. Impact of Addiction on Spirituality • In active addiction, the effect of a drug(s) becomes a person’s primary relationship, and seeking/using the drug becomes the primary focus. • Things naturally manifested in a spiritual life – connection with others, love, kindness, unselfishness, honesty, purity, peace, social consciousness, etc., are merely secondary, if not impediments to a drug-seeking lifestyle.

21. Impact of Spirituality on Addiction • When sober and seeking a spiritual center, one’s mind and heart become open to intuitive seeking and receptive to spiritual insight. • In recovery, people can become motivated to find something better than what they had in active addiction. • The spiritual quest – whatever form it takes – can replace the quest for addictive substances and behaviors over time.

22. What could be meant by “Spiritual Awakening” referred to in Step 12? • Newly sober, a few people report having a sudden ‘awakening’ and are motivated to begin a spiritual quest. • Others find themselves moving into this experience, whatever it is for them, gradually. They realize over time that they are becoming the persons they wanted to be – making positive changes while accepting and working with their imperfections and setbacks. • This realization is what William James refers to as the ‘educational variety’ of the spiritual experience/awakening. People can naturally gain insight into the seriousness of the problem they were living with and the power they are finding to change.

23. What does AA have to say about Religious Belief? In response to this question, The General Service Office of AA published a pamphlet entitled Members of the Clergy Ask about AA in which they make the following statement about religious belief or lack of religious belief as it relates to recovery in the program of Alcoholics Anonymous:

24. AA does not inquire into alcoholics’ religious beliefs—or lack of them—when they turn to the Fellowship for help. However, the A.A. program of recovery is based on certain spiritual values. Individual members are free to interpret these values as they think best, or not to think about them at all.  Most members, before turning to A.A., had already admitted that they could not handle their drinking—alcohol had taken control of their lives. A.A. experience suggests that to get sober and stay sober, alcoholics need to accept and depend upon a spiritual entity, or force, that they perceive as greater than themselves. Some choose the A.A. group as their “Higher Power”; some look to God - as they understand Him; and others rely upon entirely different concepts. Numerous alcoholics, when they first turn to A.A., have definite reservations about accepting any concept of a Power greater than themselves. Experience shows that, if they maintain an open mind on the subject and keep coming to A.A. meetings, they will in time find an answer to this distinctly personal dilemma.

25. Introducing Positive Psychology to help struggling people define a Higher Power • For addicted persons who struggle with the concept of God, but have been told that they need to find a higher power, when they experience that ‘distinctly personal dilemma’… • What do they do? • Where do they turn? • How do they re-think or interpret this concept? • That could be where Positive Psychology could come in…

26. What is Positive Psychology? • A relatively new branch of psychology • The goal is to “make normal life more fulfilling…rather than just treating mental illness” - Finding what’s RIGHT with us. • Roots in Humanistic Psychology Movement • Emphasis on positive emotions and human strengths. “Fix what’s wrong, but also Build what’s Strong” • Purpose is to complement rather than replace traditional psychotherapeutic approaches. • Wellness is more than the absence or remission of disease.

27. Previous versions of the DSM used a 5 Axis Diagnosis System • What if there had been Axis VI: Strengths & Coping Skills ? • What are the qualities/resilience factors that keep GAF > 0? • What are the positives that mitigate/balance the negatives? • APA offers: Diagnostic & Statistical Manual of Mental Disorders • In contrast, Positive Psychology offers: Character Strengths and Virtues: A Handbook and Classification (Peterson & Seligman, 2004)

28. What Are the Goals of Positive Psychology? • Pleasant Life (Feeling Good) • Engaged Life (Flow) • Meaningful Life (Doing Good) • Positive Emotions • Positive Individual Traits • Positive Instititutions

29. Human Strengths/Positive Characteristics WISDOM • Creativity • Curiosity • Open-Mindedness • Love of Learning • Perspective COURAGE • Integrity • Bravery • Persistence • Vitality

30. HUMANITY • Social/Emotional Intelligence • Love • Kindness JUSTICE • Teamwork • Fairness • Leadership

31. TEMPERANCE • Mercy • Humility/Modesty • Self-Control • Prudence TRANSCENDENCE • Appreciation of Beauty • Spirituality • Gratitude • Hope • Humor

32. The FLOW Experience • In Positive Psychology, Flow is described as the experience of being fully absorbed in what one is doing, feeling very good about it, and having a sense of mastery related to the activity. • It is related to the practice of Mindfulness in terms of the full engagement in the activity of the moment. • The experience can facilitate integration with oneself and integration with others when engaged in shared endeavors.

33. Supporting Theories • Broaden and Build Theory • Positive emotions propagate positive attitudes, behaviors, moral reasoning, openness to others, resilience, relationships. • This, in turn, results in more positive emotions. • Upward Spiraling: Positive begets positive • Self Determination Theory: Integral Components of Well-Being • Autonomy • Freedom of choice – doing something because we want to • Competence • Ability to do something successfully – perceived self-efficacy • Relatedness • Sense of shared experience – having support and connection in one’s efforts in recovery

34. Does Positive Psychology Work? • Various Positive Psychology interventions have been found to be as effective (or more so) than traditional forms of treatment (mainly CBT). (Frisch, 2006, Seligman, et. al., 2005) • Most powerful interventions in Positive Psychology have involved the application of Personal Strengths, with Gratitude being especially powerful in terms of effectiveness. (Seligman, et. Al. 2006) • Positive Psychology interventions are effective in treating depression – alone and in combination with other interventions. (Sin & Lyubomirsky, 2009) • Optimism can have a significant effect on success in meeting goals. (Seligman, 1992) • Positive emotions have been consistent predictors of leadership effectiveness. (Burns, 2004) • Early positive emotions have been predictors of longevity. (Danner, et. al., 2001)

35. Strength Building Strategies • Develop a Language of Strength - Use words reflecting positive aspects and capacity • Reversing the Focus from Negative to Positive • Realistic Balancing of Positives and Negatives (Serenity Prayer in action) • Build Strategies that Foster HOPE • Seeing opportunities for change & growth • Creating a new sense of purpose

36. How does this relate to identifying a higher power? • For those who struggle with the concept, it offers practical and understandable ways of looking at it. • There is no need for religiously oriented language, if someone chooses not to frame it in that way. • The ‘power’ is found within a person’s • Intentions and Life Purpose (as defined in recovery) • Newly Recognized Attributes/Capacities (Untapped Strengths) • Support/Guidance from Others(Social Support & Accountability) • These concepts can be used in recovery even by those who do have a traditional understanding of God as higher power. They conflict with nothing in 12-Step philosophy or practice.

37. Higher Purpose as part of Higher Power • Desire and Intention to create a life better than the hell of active addiction in which a person was living. • “Gift of Desperation” can signal time for a 180º turnaround – a resolve to head in a new direction. • Getting one’s life back – re-establishing trust, respect, responsibility, self-esteem, consistency… etc. • Steps 6 & 7 reflect higher purpose – inviting and engaging in positive change…new ways of thinking and behaving.

38. Higher Self as part of Higher Power • The better person in each individual which can be recognized and expressed in active recovery. • Newly identified strengths and potential which were previously untapped or suppressed in active addiction. • Connection with a life force or spirit which can be seen as within oneself, between oneself and others, and/or with whatever someone perceives a Higher Power to be - in a way that had not been manifested in active addiction. • Anything more positive that a recovering person can find within him/herself which can bring hope and determination to change.

39. Positive Relationships as part of Higher Power • A Key Feature in Active Addiction…Isolation and Alienation • A Key Feature in Positive Psychology & Recovery…Social Connections & Positive Relationships • Now we are at the moment where we need to consider ourselves as full members of humanity, responsible and answerable to the human community. We are no longer living as addicts, operating under a solitary morality of isolation, self-destruction and fear…The world of the spirit, the one in which we live, is the present place where we stand. The most salient fact of this spiritual world, the starkest difference between this world and our old world of addiction, is this: we are not the only ones here…Where we lived before in absolute isolation, now we live in context. This is none other than what we always longed for, always lacked: a community of which we can be, and must be, an integral, active part. MaryaHornbacher – Waiting: A Nonbeliever’s Higher Power (pgs. 73, 97)

40. AA Statement on Positive Relationships in Recovery It would be unrealistic to assume that all AA members are spiritually inspired. Many, too, are not committed to a formal body of religious doctrine. But innumerable A.A. members - including those of no orthodoxy - say that they have experienced the transforming power of sharing, caring, trust and love. from… Members of the Clergy Ask about AA AA General Service Office

41. RECOVERY ≠ Not Drinking/Using • It is about … CREATING A LIFE WORTH LIVING Recovery can be seen as “…a way of thinking, acting, and relating to others that promotes continued physical, psychological, social, and spiritual health. The skills necessary for long-term sobriety are all directed at finding meaning and purpose in life”. Terence Gorsky • When an addicted person’s life is filled with positive, meaningful, life-enhancing goals, values and activities, “not drinking/using” - although the bedrock for a recovering life - becomes just a detail. • The focus is on developing activities and coping strategies based on goals and values that make staying sober what one wants to do to have the life they are seeking – not what one must do to avoid further consequences.

42. Recovery is oriented towardPOSITIVE, PROGRESSIVE ACTION The way to remove darkness from a room is simply to light a candle. In the same way, to rid yourself of any difficulty, concentrate on the solution, rather than the problem… Zen Proverb • Focus is on what to create or replace in one’s life (not on what to stop doing). • Focus on behavior, not states of being. Lasting behavior changes will, in turn, result in new states of being. • Focus is on setting POSITIVE LIFE GOALS. Not stating: “I will stop/not” or “I will be”

43. Increasing Self-Efficacy to Enhance RecoveryWhether you think you can, or think you can’t - you’re right … Henry Ford “Perceived self-efficacy is the foundation of human agency. Unless people believe they can produce desired effects by their actions, they have little incentive to act. Self-efficacy beliefs promote desired changes through cognitive, motivational, affective, and choice processes. Perceived self-efficacy exerts its effects on every phase of personal change—the initiation of efforts to overcome substance abuse, achievement of desired changes, recovery from relapses, and long-term maintenance of a drug-free life.” Albert Bandura

44. AA Slogan: “Fake it ‘till you make it”(Act ‘as if ’ and it will become) • Think and behave as though what you intend to manifest in your life is already here. • Begin action in the direction of what you want - even when you are not sure how – and 3 things happen: • The focus on what you want (rather than what you don’t want) becomes your mindset. • You begin to see results. Even small ones are significant, due to the reinforcement factor. • You affirm that you are not ‘stuck’ – that change is possible and is happening now.

45. Thinking Success can Create SuccessYou are what you think. Think it today – become it tomorrow. Nothing can help you or hurt you as much as the thoughts you carry in your head…Zen Proverb • There is no need to ‘fear’ relapse. • Fearing the consequences of relapse is realistic, but fearing the lack of capacity to choose recovery and make new daily decisions is unrealistic. • Fearing relapse is rehearsing relapse. It can make failure, rather than success, the focus…and the unconscious goal. • Each recovering person has choice and free will. It is either claimed or forfeited, depending on the beliefs one holds about oneself. • Acknowledging the capacity for change increases the awareness of freedom of choice and the likelihood that it will be exercised.

46. Rethinking Step 2… • Came to believe that a power greater than ourselves… • God (Whatever that may mean to an individual) • The power of group support • A Higher Purpose (aspirations for a better life) • One’s Higher Self (that better person & unrealized potential) • Every addict certainly had a higher power while in active addiction – the high from drugs/addictive behaviors. • Could restore us to sanity… • Learning to think, feel and act in more life-enhancing ways – especially around addiction.

47. Rethinking Step 3… • Made a decision to turn our will and our lives over… • Asking for help with / advice on what we have not been able to do successfully on our own. • Accepting help and following advice when we get it. • To the care of God as we understood Him… • Many simply exchange ‘God’ for Group of Drunks (Support System) or ‘Higher Power’ for Higher Purpose /Higher Self. • Remembering what one has chosen to call a higher power and ask how this can be more powerful than active addiction.

48. Rethinking Steps 4 & 5… • 4th Step: Made a searching and fearless moral inventory of ourselves… • Taking a complete inventory – of both negative and positive – to see what holds us back, and what could move us forward. • 5th Step: Admitted to God, to ourselves and to another human being the exact nature of our wrongs… • We simply have a witness to our humanity – We see that we are accepted, and can in turn, accept ourselves, releasing shame and guilt. • We can get feedback and clarity on patterns that keep us stuck, in order to facilitate change.

49. Rethinking Step 6… • Were entirely ready to have God remove all these defects of character… • Developing the Willingness to create change by: • Accepting challenges that bring about wanted change • Stepping outside of comfort zones to try on new ways of thinking and behaving in daily living • ‘Entire Readiness’ can be determined by how one begins to make changes on a daily basis.

50. What are “Character Defects” ? • Tendencies toward doing ‘wrong’……? • Bad habits……? • Destructive ways of acting or reacting……? • ‘Sins’……? (Note the origin of this word: In Classical Greek, ‘sin’ (hamartia), meant ‘to miss the mark’ . It was also used in English archery as a term for ‘missing the bullseye’ .) • What if we simply look at “character defects” as: • Long-standing patterns of thinking and behaving that no longer work for us … old patterns which have become liabilities that get in our way and cause pain.