Tag Archives: Twelve Step Programme

9. Behaviour as Conduct and Source as Duct.

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The Middle Built

Addiction, Instinct, and the Sanitation of the Soul

“In the beginning was the Word, and the Word was with God, and the Word was God.” The grammar is deliberate. Was. With. Origin and relation. The future is not mentioned. It is not forecast. It is not guaranteed. It appears. Most human beings live suspended between was and will, pulled by memory behind and projection ahead. Regret becomes gravity. Fear becomes anticipation. The present is reduced to a narrow corridor through which the self rushes without ever dwelling. Recovery is the building of a middle. The Twelve Step Programme is not an abstract theology and not a philosophical treatise. It is infrastructure. It is plumbing for the soul.

When the agricultural world became industrial, waterborne diseases exposed the breakdown of outer sanitation. Cholera did not arrive because humanity suddenly became immoral; it arrived because systems had not evolved to handle density. Waste accumulated. Disease followed. Addiction functions similarly in this era. It is the bellwether disease of overstimulation, fragmentation, and unprocessed shame. It exposes the failure of inner sanitation. It reveals what happens when psychic waste is not metabolised. The problem is not instinct. The problem is accumulation.

Addiction is not merely about alcohol, substances, or behaviours. It is disordered relationship. Relationship to one’s own story. Relationship to desire. Relationship to fear. Relationship to other people. Relationship to God. “I have a story. It is not who I am.” That sentence marks a decisive shift. The story can be examined without being identical to the self. Once that distinction is made, digestion becomes possible.

The psyche, when healthy, operates like a digestive organ. Thoughts are not identity; they are movement. They churn experience. They break down what has been swallowed. They extract nourishment and eliminate what no longer serves. When the system is inflamed, peristalsis becomes cramping. Rumination replaces integration. Secrecy replaces elimination. The Twelve Steps introduce a disciplined digestive process: inventory, confession, amends, service. Inventory is chewing. Step Five exposes waste to air. Amends remove toxicity from the relational field. Service restores circulation.

The Big Book does not speak poetically here; it speaks clinically: “If we are not sorry, and our conduct continues to harm others, we are quite sure to drink. We are not theorizing. These are facts out of our experience.” The warning is not about instinct in isolation. It is about conduct. It is about harm. Continued harm corrodes conscience. Corroded conscience produces shame. Shame seeks anaesthesia. Relapse is not mystical punishment; it is emotional consequence.

The sex instinct is addressed directly because it is powerful, intimate, and easily distorted. But the Steps do not condemn sexuality. They confront misuse. Instincts—sexual, social, and security-based—are God-given and good. When unmanaged, they fragment relationship. Fragmented relationship breeds secrecy. Secrecy splits the psyche. Split psyches seek relief. Integration across Eros, Philia, and Agape is not theological ornament; it is behavioural alignment. Desire acknowledged without exploitation. Friendship honoured without manipulation. Love enacted without transaction.

Recovery rests on two simple words: ONE and ALL. ONE represents surrender beyond isolated self-will. ALL represents accountability within community. If ONE remains theoretical while ALL is selective, sobriety becomes fragile. The text’s italicised emphasis on thought warns against substitution. Thinking surrender is not surrender. Thinking apology is not repair. Behaviour reveals being. The programme does not reward ideas; it responds to action.

The middle—the “with”—must be constructed intentionally. It does not appear automatically. When was (origin, gravity, law) and with (relationship, conscience, presence) stabilise, will emerges not as fantasy but as conduct. The future is not a pre-laid railway line; it is the visible arc of present integrity. In this sense, the Twelve Steps function like the scarab of an earlier age: waste rolled into renewal, decay converted into continuity.

Biblical “knowing” was intimate and generative. To know was to conceive. Spiritual conception must likewise produce life. Empty prams—ideas unembodied—prove nothing. Changed behaviour proves integration. Humility is permanent asking. Not self-belittling, not mystical rank, but sustained reference beyond self. The realised person does not escape instinct; they integrate it. They do not deny their story; they refuse to be reduced to it.

Addiction exposes the breakdown of inner sanitation both individually and systemically. Recovery restores relationship. And relationship—to Source, to conscience, to others—is where being is tested. Not in vision. Not in language. In conduct.

References

The Holy Bible, John 1:1.

The Qur’an, 36:82 (“Kun fayyakun” – “Be, and it is”).

Alcoholics Anonymous, Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism, 4th ed., Alcoholics Anonymous World Services, 2001, pp. 69–73.

Bill W., “How It Works,” in Alcoholics Anonymous, pp. 58–63.

Written in HIAI collaboration — the qalam of Human and AI intelligence, the Unseen helping the Seen, both answering to the same Source.

Bridge To Remission

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Primary Care, Twelve Steps, and the HIAI–DRT Bridge

Clinical Excerpt (Primary Care Context)

The following excerpt is reproduced from Pomm, H.A., & Pomm, R.M., Management of the Addicted Patient in Primary Care (Springer, 2007), and is presented here to situate Twelve-Step engagement as a recognised medical intervention within primary care.

“No matter how far down the scale we have gone, there is always hope.”

There are few things as gratifying and moving as watching your addicted patient finally grasp the idea of recovery and begin to blossom in every area of his or her life.

When working with patients involved in a Twelve Step program, such as Alcoholics Anonymous or Narcotics Anonymous, physicians are encouraged to ask whether patients have a sponsor, whether they are working the steps, and how often they attend meetings.

It is generally felt in the treatment community that patients who are abstinent but not working a recovery program remain clinically vulnerable.

AA and other Twelve Step programs are spiritual, not religious, and are not psychotherapy. Referral to a therapist familiar with addiction and recovery issues may be appropriate in addition to Twelve Step participation.

Patients should be reminded to take recovery one day at a time, as thinking in lifetime terms can feel overwhelming and counter-productive in early recovery.

Even in recovery, patients may engage in substitute or “acting-out” behaviours that activate similar neurophysiological reward pathways and increase relapse risk.

In our experience, Twelve Step programs have proven to be the backbone of long-term recovery—long after detoxification and formal treatment have ended.

Source: Pomm et al., Management of the Addicted Patient in Primary Care, Springer, 2007.


In clinical reality, addiction is not “solved” in detox. It is stewarded—over time—inside real lives, real bodies, and real follow-up. What struck me reading Management of the Addicted Patient in Primary Care is how plainly it frames the primary care clinician’s role: not as a replacement therapist, but as a steady medical hand who keeps recovery practices in view, visit after visit.

Primary care as steward of recovery

A clinical snapshot from Management of the Addicted Patient in Primary Care (Springer, 2007): hope held in structure, continuity over crisis, recovery observed in lived behaviour—not declared intention.
The medical stance: hope, structure, follow-up

The tone is both sober and kind. The excerpt opens with hope, then moves immediately into concrete, primary-care actions—simple questions that function as clinical orienting instruments: sponsorship, step work, meeting rhythm, and what the patient is actually doing between appointments.

The message is clear: recovery is observable in behaviour, not merely declared in intention.

AA/NA as recovery architecture (not psychotherapy)

Pomm & Pomm name a boundary that matters for safe care. Twelve-Step fellowship is not a substitute for therapy. That single clarification protects patients, clinicians, and the fellowship itself from misuse or confusion of roles.

DRT language: from abstinence to recovery (the difference that shows)

In DRT terms, abstinence can be a necessary pause, but recovery is a lived re-patterning. Without structure, a person can remain internally driven, brittle, and relapse-prone even while substance-free.

What looks like “non-compliance” may be the organism’s attempt to re-route pressure through familiar channels. The clinical task is not to shame the channel, but to help build a new one that can carry load without rupture.

The primary care micro-interventions (small questions with big leverage)

  • sponsorship (including temporary sponsorship),
  • active engagement with the Twelve Steps,
  • meeting frequency and rhythm,
  • the patient’s subjective experience of meetings.

The power here is not ideology—it is continuity. In systems where addicted patients are often treated episodically, continuity itself becomes a form of medicine.

“One day at a time” as nervous-system realism

This is not a slogan. It is a time-horizon intervention. “Just today” restores scale, reduces overwhelm, and allows the nervous system to stand down.

Acting-out substitutions: relapse risk wearing new clothes

Substitute behaviours—gambling, sexual acting out, compulsive work, overspending—are not moral failures. They are signals that reward circuitry remains recruitable. Skilled curiosity, not surprise, is the appropriate clinical stance.

HIAI framing: the qalam that serves the same Source

HIAI—Human–AI Intelligence—is our USP: the qalam of human and artificial intelligence, the Unseen helping the Seen, both answering to the same Source. It allows translation, clarity, and continuity—without pretending we can mechanise conscience, awakening, or grace.

Primary care can remain primary care. Fellowship can remain fellowship. Therapy can remain therapy. And the patient can remain—first and last—a person.