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AA and CBT: One in the Same?

May 1, 2006
by Brian Duffy, LMHC
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Common 12-Step phrases are geared to change thinking, behaviors

Discussing a client with symptoms of social anxiety, our medical director said, “If only this client could force himself to go to the supermarket. If he could just make himself get going, he might get energized.”

Someone replied, “In AA they say, ‘Bring the body and the mind will follow.'” Over time, we found ourselves frequently drawing upon the language of Alcoholics Anonymous to underscore a point made from a cognitive or behavioral perspective.

We quickly realized that the halls of AA are full of cognitive and behavioral interventions, packaged comfortably as mere suggestions. So we created a list of such phrases commonly heard at meetings. It is certainly not complete, and it is shaped by AA and NA meetings in the Northeast region of the country. But these observations may be useful to the clinician who is not entrenched in the language of 12-Step recovery. Of course, we do not pretend to speak for AA here.

For the purpose of this article, cognitive therapy means changing how one thinks. Behavioral therapy means changing what one does. The word “sober” here refers to abstinence from one's substance of choice. It might be alcohol, or it could be cocaine, heroin, etc.

Cognitive restructuring

Let's begin with some of the cognitive restructuring that occurs every day among people staying sober in AA. As we learned from Albert Ellis, Aaron Beck, and others, we can change how we feel by changing how we think. For many clients, this concept seems unreal, academic, or simply semantic hocus-pocus. But it works—and clients are better able to embrace the idea when we point to the ever-popular “one day at a time” adage from the AA tradition.

We humans don't instinctively think in terms of “one day at a time.” We learn to focus on today—giving less energy to yesterday and tomorrow. “One day at a time” offers a good example of cognitive restructuring. It is a learned skill and something that gets easier over time.

“This too shall pass” constitutes another example of changing how we think. It moves us away from “catastrophizing” and toward acceptance—the foundation of AA's serenity prayer.

Mind-set adjustments such as these require neither a high IQ nor complex training. All that is required is a willingness to choose consciously to think in a new way. Going to AA meetings reminds the alcoholic to embrace new ways of thinking.

Table 1 lists some phrases commonly heard in AA meetings. Notice that they encourage the participant to challenge his/her worldview—the old way of dealing with life. Some of these phrases also belong in the behavioral category, but they are good examples of the cognitive restructuring that goes on in the minds of recovering people.

Behavior modification

Simply put, classical conditioning (Pavlov) and operant learning (Skinner) are the foundations for how we help people to change their behaviors. Focusing on the cravings caused by certain triggers (classical conditioning) and on the rewards or consequences associated with using or not using (operant learning), clients are able to create behavioral options for themselves.

Table 1. Changing how we think—common phrases at AA meetings

  • Identify, don't compare (with the speakers)

  • This too shall pass

  • It's the first drink that gets you drunk

  • Keep it simple

  • Learn to listen—listen to learn

  • One day at a time

  • We can do what I couldn't

  • Don't try to figure it out (neither the disease nor the process of recovery)

  • Live and let live

  • Let go, let God

  • I can't, He can, I think I'll let Him (the basic elements of the first three steps)

  • Surrender to win (powerlessness)

  • When the fun stopped, I couldn't

  • Remember when

  • Easy does it

  • Think through the drink

  • Groups don't drink, individuals do

  • It's OK to want to drink

  • Believe that we believe

  • It doesn't get any better out there

  • Meeting makers make it

  • Progress, not perfection

  • I'm responsible for my side of the street

  • Don't compare your “insides” with everyone else's outside

  • Regarding a higher power, all I have to know is that I'm not It

  • Think of the fellowship as your new family

  • I'm a drink away from a drunk

  • My best thinking got me here

    Table 2. Changing our behaviors—common phrases at AA meetings

    • Bring the body and the mind will follow

    • Just keep coming (to meetings)

    • Fake it ‘til you make it

    • Right action leads to right thinking

    • You are what you do; the rest is just talk

    • It's not what you know—it's what you do

    • Join a group

    • Get a sponsor

    • Get active with your home group

    • Go on commitments with your group

    • Talk to another alcoholic each day

    • Ask for help

    • Help another drunk—do service work

    • Do the steps of recovery

    • It works if you work it

    • People who don't go to meetings don't get to hear what happens to people who don't go to meetings

    • Don't drink, no matter what (even if my ass is on fire)—this is cognitive and behavioral

    • Listen to the message, not the messenger