Do 12-step programs lead to cults? We think we're finding help, but we could be submitting ourselves to a unique form of trauma

Twelve-step programs—with their clichéd language, frequent meetings and religious mien—are cults. So say many critics. But in fact, the traditions of AA, NA and the other As are intentionally structured to prevent their members from crossing that line. Nonetheless, there is a reliable way to use the steps to create a full-fledged destructive cult.

Cults are not simply weird or dangerous religious groups, according to those who study groups that have had disastrous outcomes, like Jim Jones’ People’s Temple, which ended in mass member suicide, and the Branch Davidians, which ended in a fiery siege by federal agents. Instead, cults are self-enclosed organizations that use a well-defined set of coercive persuasion tactics.

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These typically include isolating people physically and emotionally from friends and family, breaking them down emotionally and taking total control over their environment, movement and finances. Because these procedures can also characterize rehab, residential treatment itself without proper oversight carries a risk for creating cultlike behavior.

However, since 12-step programs in the community aren’t residential, can’t physically isolate people or take their life savings—and because they are formally leaderless—they have little risk of becoming the next Jonestown, Guyana, or Waco, Texas.

But the repeated development of cults or near-cults—from Synanon to Straight Inc. to today’s Washington, DC, Midtown Group—based on the steps is not coincidental. The reason is a toxic compound created when AA’s voluntary steps are twisted so that they can be imposed by force, especially in settings where people cannot escape. Chuck Dederich, the founder of Synanon, was the first to recognize the power of this recipe for subjugating people and creating followers. Indeed, Synanon was the model for every “therapeutic community” (TC) in the US, including mainstream leaders like Phoenix House and Daytop.

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Originally hailed in the 1950s as a tough, peer-pressure-based cure for heroin addiction, by the late 1970s it was stockpiling weapons, forcing couples to get sterilized and swap partners and, perhaps most notoriously, had placed a de-rattled rattlesnake in the mailbox of a lawyer who had begun winning cases against it on behalf of former members who had been abducted and abused. When Dederich was arrested for conspiracy to commit murder in the snake incident in 1980, the charismatic leader was dead drunk.

By then, however, the Synanon model had already spread across America and around the world. In addition to Phoenix House and Daytop, the best known include Delancey Street, Walden House, Gaudenzia, Gateway House, Marathon House, Odyssey House, Samaritan Village, Amity, CEDU, the Seed and Straight Inc.

Following Synanon, these TC programs are or were residential, typically lasting from 90 days to 18 months. Originally, the idea was to break initiates through strict rules and daily humiliation and confrontation, and then rebuild them as they work their way up a structured hierarchy.

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To rise through the levels toward graduation, participants have to demonstrate compliance by imposing the rules on others and emotionally attacking their fellows to help break them. These days, many TCs have abandoned the marathon attack therapy sessions and tried to reduce or eliminate the use of humiliation—but they retain the strict rules and hierarchical systems.

So how do the use of attack therapy and forcing the steps on people inspire cult formation?

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Step 1: It starts with the first step. Voluntarily admitting you are powerless is relatively harmless (although there’s some evidence that this belief as part of the disease model of addiction is linked with worsening relapse). By contrast, however, being forced into a position of absolute powerlessness is what defines a traumatic experience, and so it can cause post-traumatic stress disorder (PTSD) and related psychological problems, like depression. And traumatizing people is an excellent way to break their will and turn them into compliant followers.

Research into PTSD repeatedly confirms that at the heart of all trauma is the feeling of being completely vulnerable and out-of-control in a frightening situation, in a word, powerless. Whether well-intentioned or not, any program with the capacity to disempower participants by blocking their contact with the outside world and controlling their access to food, sleep and social support is potentially dangerous. This dynamic—in connection with the way power itself corrupts staff—explains why institutions ranging from orphanages to hospitals to prisons, where vulnerable people are subject to total control by others, constantly have abuse scandals and why they need to be subject to intense oversight.

Steps 2 and 3: When imposed coercively, these principles make matters worse. Again, voluntarily surrendering to a “higher power” can feel healing for many—but being forced to submit to human beings who make themselves and their program into your higher power is far less benign. Believing that surrendering your will and even your life to the leadership is the only path to recovery results in overwhelming vulnerability.

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Not only is this dangerous for the victims, but it is also risky for leaders who are convinced that they “know best” and their program is so effective that they are justified in using any means necessary to “help” people. Once staff embrace the belief that breaking people to fix them is acceptable, once they “know” that they are absolutely righteous even when being emotionally cruel, the corrupting nature of this total power is intensified.

This elevation of staff and dehumanization of patients is the opposite of treating people with dignity and respect: the word of the “healers” is law and those in need of healing are powerless.

At rehabs, for example, when staff believe that they have all the answers, including which patients are “in denial” or “faking” or lying or, for that matter, telling the truth, there is a great potential for serious health and psychiatric complaints to be ignored. This can have—and has had, in dozens of cases—fatal consequences for those who are physically detained in programs. It also allows power to run amuck.

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Steps 4, 5 and 10: Now, add in the demands for the confession of sins and for an ongoing moral inventory and you have an additional method of controlling people. Most religious cults focus on confession because knowing members’ darkest desires and most shameful secrets increases the power of the leaders. Not only can frequent confessions enable the blackmail dissenters, but they can also train participants to focus so relentlessly on their own failings that they have no energy left for criticism or resistance of the group itself.

Steps 6 and 7: And these principles add an even more poisonous element: when imposed by force, humility becomes humiliation and defects of character become weak spots to attack. Public humiliation and emotional barrages aimed at humbling people can be traumatizing. When employed explicitly to break someone, such attempts to “remove” a person’s “shortcomings” makes him or her even more vulnerable to the leaders’ influence.

Step 11: While they may seem utterly harmless, prayer and meditation sadly further aid this type of coercion: For one, forced meditation can exacerbate conditions like depression. While voluntary meditation is liberating, coercive isolation in imposed silence is known to quite literally drive people crazy. The repetition of prayer can also be used to create trancelike states.

Step 12: Topping off the process is the demand to “carry the message” to others. Social psychology research shows that trying to convert other people to your perspective is only rarely successful in attracting followers— but it is incredibly good at convincing the person doing the proselytizing that their own cause is correct. Even when people are made to argue a side with which they disagree, studies show that with enough repetition they often come to believe what they’re saying.

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One further ingredient makes this stew even more toxic. It is an inconvenient truth that in the addicted population, people with antisocial personality disorder (ASPD) and outright psychopathy are over-represented. These people enjoy wielding power over others and quickly learn to use the hierarchy and the emotional attacks to their advantage. The most charismatic rise to the top and become the leadership, often being assigned to run new branches of the program or leaving to open dangerous programs of their own.

This problem even occurred in the US government's Lexington, Kentucky, narcotics farm, which was the first federal attempt to provide addiction treatment. When it modeled one of its programs on Synanon in the 1970s, the "inmates running the asylum" who were made staffers got so out-of-control in their abuses of power—including sexual abuse—that the administration had to call in the FBI and abandon the program.

This destructive pattern has recurred with grim frequency. The Elan School—notorious for its violence, such as putting teen residents who disagreed with the leaders in a simulated boxing ring with fresh opponents until they surrendered—was founded by a graduate of Daytop in its early days of intensive confrontation.

Elan was open from 1970 to 2011 and, in cult-like fashion, created true believers who attacked critics relentlessly and tried to hide dangerous practices rather than improving them as a legitimate healthcare facility would.

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Florida-based Straight Inc., which operated from 1976 to 1993, forced youths to restrain one another on the floor without bathroom breaks until they wet or soiled themselves, gagged them with Kotex and practiced other intense humiliation. The chain of rehabs repeatedly ignored attempts by regulators to reform its practices and tried to conceal them from authorities. It claims to have “treated” 50,000 teens and also left behind many supporters who are so fervent in their belief that the program was right that they cut family members who disagreed out of their lives forever.

Straight led to New Jersey’s KIDS, which was founded in 1984 by its national clinical director, Virgil Miller Newton. It was at least as brutal. When KIDS finally lost its Medicaid funding in 1998, staff actually went underground and secretly continued the “treatment” (including beatings, restraint, sleep and food deprivation) without a license until at least 2001. Following its leader in seeing itself as above the law, it met every criteria necessary to define a cult.

Uncovering a pattern of 12-step therapeutic communities that evolved into cults and caused grave damage to participants is in no way to imply that 12-step programs themselves—or every rehab that requires working the steps—are cults. But the evidence shows that the steps provide an unfortunate guide for unethical people who want to control others via coercive tactics.

Forcing these spiritual principles that were designed to be voluntary on unwilling people in recovery always carries the risk of descending into cultish behavior. Research demonstrates that such coercion can backfire, worsening addiction and that kinder, gentler methods that respect self-determination are more effective.

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If someone chooses to climb Mount Everest and face dauntingly cold temperatures, sleep and food limitations, isolation and painful levels of exertion under low oxygen conditions, the challenge—although dangerous—can be an occasion for personal growth. Forcing someone to endure that situation, in contrast, is not only a form of torture but as likely to produce trauma as to lead to enlightenment.

That some people find meaning in triumphing over great suffering does not mean that deliberately causing pain is therapeutic or acceptable. The addiction field needs some humility of its own. It must recognize that voluntary actions and forced ones have an entirely different psychology. Even the physiology of being out of control is different from that of being on top: studies show that the same degree and kind of stress can either damage your immune system or have no effect at all, depending on whether you feel in control.

The 12 steps truly are for people who want them, not for those who we limited humans (who are assuredly not higher powers) believe need them—unless your goal is to start a cult. In that case, study up!

Maia Szalavitz is a columnist at The Fix. She is also a health reporter at Time magazine online, and co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010). She broke the story of abuse of teens at rehabs nationwide in her book, Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006).