AA and Therapy: When Should I Talk to a Therapist while in AA?

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Differences Between Peer Support and Therapy

AA and therapy can work together to help you better understand your unique needs and vulnerabilities when it comes to AUD. However, AA and therapy also have different functions and benefits. Let’s take a closer look.

Benefits of AA

Substance use treatment providers commonly refer clients to 12-step programs like AA.

This is a free, empirically supported, and peer-led support group fellowship designed to help individuals struggling with alcohol misuse achieve and maintain sobriety. AA uses the 12 Steps, 12 Traditions, and the Big Book to guide and support the mission of AA and participating individuals.

Because AA is peer-led, it is nonclinical and uses a community reinforcement approach.

Actively participating in mutual support groups, like AA, has proven to be a key indicator of higher rates of continuous abstinence and sustaining recovery.

This is likely due to several facets of the program, including:

Ease of accessibility and availability
Peer-led structure
Shared experiences between members
Challenges from members
Use of sponsors
Motivation based on observed successes
Opportunities for anonymity and confidentiality

These components may allow individuals to feel safe sharing their alcohol-related challenges.

International Accessibility

AA group support is internationally accessible almost 24/7, 365 days a year, especially now that online support meetings have become more popular since the start of the COVID-19 pandemic.

This availability can be helpful, as you may sometimes experience a long wait to receive inpatient or outpatient treatment for an alcohol use disorder. Various meetings are tailored to specific subgroups, including LGBTQ+, gender-specific, and Spanish-speaking clients.

A Sense of Belonging

A sense of camaraderie and belonging is a key component in AA. If you struggle with alcohol use, you may appreciate being able to identify with others who share similar challenges and can process and identify challenges as a group. The fellowship AA provides can increase your social circle to include other individuals abstaining from alcohol.

Having a sponsor in AA can deepen that sense of belonging. A sponsor not only provides a personalized guide for the AA process but also shows you that success is possible. Sponsors are individuals who have completed the 12 Steps and maintained significant sobriety.

Benefits of Therapy

Unlike AA or any other peer-led support groups, therapy is facilitated by a mental health or substance abuse professional.

This may include a:

Psychologist
Licensed clinical social worker (LCSW)
Marriage and family therapist (MFT)
Licensed professional counselor (LPC)

In therapy, your counselor first conducts an assessment to learn more about your alcohol and drug use, mental health, family history, medical history, and more. They use the information from this evaluation to help guide your treatment planning. They also integrate your personal goals into the treatment plan to ensure it is a collaborative and productive process.

Unlike AA, substance addiction counseling is an individualized approach to recovery. Your treatment plan is tailored to meet your unique needs. Further, therapy offers an opportunity to build new coping skills and relapse prevention strategies, as well as address underlying issues that may have motivated your alcohol use.

Targeted, Tailored Support

When you notice the AA format isn’t working, or is not as effective as it once was, it may be time to see a therapist. Therapy is an opportunity to receive nonjudgmental, evidence-based treatment tailored specifically to you and your unique situation from a licensed mental health professional.

Confidentiality

Individual therapy sessions provide confidential one-on-one sessions. While anonymity is requested in the attendance of an AA meeting, confidentiality from those in group therapy can never be guaranteed.

Therapists, however, are legally and ethically bound to confidentiality. The exceptions to this confidentiality are if someone discloses abuse or neglect of any child, elderly person, or person with a disability. Additionally, confidentiality is not held if an individual discloses they actively want to hurt themselves or someone else.

Support for Co-Occurring Conditions

Individuals dealing with problematic alcohol use also have underlying co-morbid conditions, such as depression, anxiety, or personality disorders.

While AA may touch on these topics within the group, twelve-step support, like AA, tends to center on structured advice based on the personal experiences of the group members.

One-on-One Interaction

While AA is an opportunity to share with others and receive feedback, time is limited to share and reflect. Therapy is designed to be more interactive. More time, generally 45 to 60 minutes, is given for an in-depth reflection of an event, challenge, or trigger.

Additionally, in 12-step group settings, talks about alcohol misuse are limited due to the possibility of triggering another member or glorifying its use. In therapy, you are free to detail your experiences and process in whatever way you feel best.

What Can You Discuss in Peer-Led Groups?

Peer-led groups, like AA, give you the opportunity to learn and receive support from others who know what you are experiencing. In AA, discussions can vary, with topics that may include feelings about recovery, 12-step work, and more.

Complex Feelings about Recovery

Oftentimes, addiction occurs because of various life events and factors. Others in AA meetings may have had similar experiences, thoughts, or feelings surrounding their substance use.

For instance, it’s common for an individual in AA to simultaneously not want to give up drinking and still want to drink. This can feel like an isolating emotion, but individuals who have had similar experiences can relate.

12-Step Work

There are the 12 Steps and the 12 Traditions of AA. Some groups may cover a specific step, or an individual may want feedback from other members regarding a particular step.

Motivators for Continued Abstinence

Being around other individuals who are in recovery is beneficial to recovery. Seeing others who have been in your situation succeed in recovery and abstinence can be motivating to continue your own sobriety.

Impact on Personal and Professional Relationships

Substance use and addiction can take a toll on relationships, both personally and professionally. Some individuals may have lost loved ones or jobs due to their drinking or misuse.

There can be significant grief related to these losses, and having group support through those losses can be vital in the recovery process.

What Can You Discuss with a Therapist?

While many may feel open to disclosing in a group like AA, there are some limitations to what may be discussed due to time constraints and considerations of other members’ sobriety.

Therapy is a safe and appropriate place for you to process some of the underlying causes of alcohol misuse or other past or present mental health difficulties.

These may include:

Family dysfunctions
History of physical, emotional, or sexual abuse or neglect
Self-harm or suicidal thoughts
Thoughts of wanting to hurt others
Symptoms that are causing significant impairment in general functioning or interpersonal relationships
Specific recounts of substance misuse

Integrating AA and Therapy

When looking for a therapist, it is beneficial to find one who is knowledgeable about AA and can integrate the 12 Steps into your therapy sessions to provide a deeper understanding of your healing and recovery.

You may find these professionals by checking out mental health directories and searching for specific qualities related to substance use, addiction, and recovery experience. Some individuals may also want a therapist who is in recovery themselves.

Addiction-informed therapies include:

Cognitive behavioral therapy (CBT): CBT is a structured and goal-oriented, problem-focused treatment that prioritizes developing new skills and practicing these skills to reduce thoughts and behaviors associated with use.
Motivational enhancement therapy (MET): MET focuses on identifying an individual’s readiness for change and aims to help individuals reach a place where they are motivated and focused on accepting recovery.
Marital and family counseling: Oftentimes, addiction impacts the entire family unit, not just the person struggling with the addiction. In marital and family counseling, a therapist can work with the family unit to help with communication issues, heal hurts from past experiences, and problem-solve so that each member of the family unit is heard.

If individual therapy and peer-led support groups are not feeling helpful in your recovery, other supportive options may include rehab facilities and demographic-specific group therapy.

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