Integrating Neurobiology, Self Psychology and Social Work Concepts in Understanding the 12 Steps of Alcoholics Anonymous

This report describes interactive workshops at two conferences in 2025 for professional and student Social Workers and professionals from other disciplines. The authors modeled linking selected Social Work concepts, Self Psychology concepts, and Interpersonal Neurobiology concepts to each of the 12 Steps of Alcoholics Anonymous (AA) followed by the participants practicing doing the same and then sharing with the group. Each of the 12 Steps of AA was examined for the belief that the step addressed and for the nervous system function(s), the Social Work and Self Psychology concept(s) and treatment implications, including certain relevant cultural and ethical issues. For example, Step 1 is ”Do It Yourself” which reflects the following: denial [1] that life has become unmanageable [2]; employing self regulation strategies with substances instead of people [3] as a way to manage separation distress, loss, and panic [4] leading to extreme self dependence to the exclusion of developmentally appropriate reliance on others [5]. Attunement from others may have become anxiety/ fear-producing (i.e., examine cultural belief of toxic individualism) rather than tolerating small doses of tending and empathy designed to correct emotional experiences of depending on imperfect others to maintain sobriety [6] and ethical value of the importance of human relationships [7]. Another example is Step 2: “No One is Coming” that may be the originally-adaptive belief of the danger from involvement with others [8] that is supported by the amygdala’s danger-detection of powerful others with bad intentions [9]. Over-compensation via grandiosity, i.e., extreme self-dependence [5], is reflected in Maslow’s [10] hope vs. despair stage of development and Panksepp’s seeking others as one of the in-born emotional circuits [4]. Extreme ambivalence toward depending on more-powerful, potentially hurtful others may have resulted in the belief that the road to sanity is not to count on others under any circumstance, but rather depend on a substance, over which one has the fantasy of complete control. Dignity and Worth of a Person [7] are the focus of the repair of the experience of isolation as is the examination of cultural pressure to use substance for ease of relating to others [3]. Briefly reviewed for workshop attendees were concepts that informed the hand-outs and the chart material used to speculate on the associations among the above concepts that are linked in some way to each of the 12 Steps (see figures throughout this report). The clinical goal is to contribute to case conceptualization and treatment planning for appropriate interventions, thereby providing a focus on the underlying dynamics holding in place the belief that each step is addressing. This workshop format is easily replicated, as all handouts (including relevant literature) and the charts are contained in this report. The format is described in detail. Some reflections are offered for incorporating the factors that are influential, but invisible in their contribution to both being an obstacle to change and part of the effort to address achieving and maintaining sobriety.