For more than 60 years, the Twelve Steps of Alcoholics Anonymous have worked for many people with alcohol and other drug problems. Today, the therapeutic value of the steps extends far beyond the field of addiction.

Physicians, therapists and other health care professionals are finding that the steps can help people with other chronic illnesses (eg, cancer, heart disease, diabetes and mental illness) find hope and healing. There is increased recognition that a spiritual component, such as the Twelve Steps, is important in addressing mental and physical illness.

One of the first things people realize when they have a chronic illness is, "Oh my God. I'm going to die and I don't have the ability to heal this myself." In any sort of chronic illness, people must face the fact that there's a large measure of their illness that is outside their control.

They respond in a number of ways. They may deny the problem; they respond with shock, helplessness, depression, anxiety, grief, guilt, shame, anger, resentment, self-pity or defiance. They may delay seeking treatment or completely avoid seeking help, or they may become preoccupied with trying to control their fate.

People with a chronic illness face the same basic challenges as those with addiction: 1) accepting the reality of their disease; 2) tapping into help, resources and a power greater than themselves; and 3) maintaining hope as they live each day with their illness.

"The Twelve Steps can be conceptualized as a powerful behavior-change model that can be applied to many health problems, such as anxiety, depression and eating disorders," said Tim Sheehan, PhD, a licensed psychologist for Hazelden in Minnesota. "In Step One (We admitted we were powerless over alcohol -- that our lives had become unmanageable), the emphasis is on recognizing what I do and don't have control over. Step One involves becoming a better observer of reality, taking stock of ourselves, and eventually empowering ourselves. As we admit that we are powerless over some things, we begin to recognize what we do have power over. We have power to cope with our current feelings and change our behavior.

Steps Two and Three focus on a solution and empower us to take action, added Sheehan. Step Two says I can be restored with the help of "a Power greater than ourselves." That power can be anything that prompts a fundamental change in thinking and action. Step Three involves making a commitment to using the resources and other powers that are available to us.

Mental health professionals in particular are increasingly recognizing the power of the Twelve Steps in treating a variety of mental illnesses, including anxiety, depression, personality disorders and schizophrenia. "The steps coincide with the process of recovery for any chronic mental illness," says Kenneth Minkoff, MD, Chief of Psychiatry at Choate Health Systems, Inc. in Woburn, Mass., and assistant professor of psychiatry at Harvard Medical School. "The second step involves asking for help from a power greater than yourself. That could be medication, a doctor, a spiritual being, a support group or something else."

Keeping hope alive is an important part of living, with any type of illness. Research supports that our state of mind directly affects our body's ability to heal and fight disease. For instance, David Spiegel, MD, a psychiatrist from Stanford University, studied a random sample of 86 patients with advanced breast cancer and found that the group assigned to weekly support-group therapy had a more positive mental attitude and survived nearly twice as long as the patients who didn't receive the psychosocial intervention.

Recovery is not just about arresting the disease, but about learning to live with a chronic illness over time. What do we need to do to make our lives manageable? Alcoholics have a diet: no mood-altering substances. From there, they need to go on to deal with the rest of the illness in terms of how they live with life's pressures. They take inventory of their lives (Steps 4-9) and they grow spiritually through prayer and meditation and by getting with people who share their vulnerability (Steps 10-12). They also live the paradox of recovery: To keep the Twelve Step program, we must give it away.

--Published June 8, 1998