Consider a woman court-ordered to a 90-day residential rehab stay which, upon completion, would take the place of her jail sentence for driving while under the influence and criminal damage to property. Although her religious practices were unconventional and she so informed the rehab, she did her best to follow the 12 steps of Alcoholics Anonymous (AA), which encourages its members to use “whatever works” as their “higher power” to foster recovery.
She was abruptly taken to jail by police officers because she’d… “failed to accept a higher power that coincides with their 12-step program.”
To her astonishment, three days prior to graduation, she told me she was abruptly taken to jail by police officers because she’d been informed that she wasn’t abiding by the program rules and had “failed to accept a higher power that coincides with their 12-step program.” Having to leave the program early would have meant that the terms of the court order were unfulfilled.
The woman’s social worker intervened, however, and, after a great deal of contention, he was able to find treatment for her elsewhere. Her story so outraged the social worker that he urged the woman to share it with me for Inside Rehab as an example of, as the woman described it, “a total violation of my religious beliefs.” In the end, according to the social worker, the licensing department for addiction programs in their state agreed that the actions of the rehab were “absolutely inappropriate.”
Although the rehab was privately funded, this woman’s stay was financially covered by public (government) funds, putting into play a question about whether it’s legal for treatment facilities such as this one to require that people adhere to the 12 steps. Can they in turn kick people out if they don’t subscribe to what’s known as “the program”? AA’s own “traditions” guiding how groups operate suggest that the people should be engaged by “attraction.” Certainly, coerced or mandated attendance is anything but that.
Legal Rulings on Mandated 12-Step Attendance
“It is a violation of first amendment rights to require individuals in the judicial system – for instance, prison inmates or people on probation – to attend 12-step meetings…Shame on anyone working with folks struggling with addiction or in the business of training addiction counselors who isn’t familiar with (or who ignores) longstanding U.S. higher court rulings (beginning in the 1990s) that declare it is a violation of first amendment rights to require individuals in the judicial system – for instance, prison inmates or people on probation – to attend 12-step meetings or 12-step-based treatment.
So doing violates the Establishment Clause, guaranteeing that at a minimum, “government may not coerce anyone to support or participate in religion or its exercise, or otherwise act in a way which establishes a [state] religion or religious faith, or tends to do so.” (Lee v. Weisman, 1992, U.S. Supreme Court on school prayer.) In short, while not deemed an actual religion, AA – with the steps’ numerous references to “God” – is considered to contain enough religious components to make coerced attendance unconstitutional, despite the fact that attendees commonly argue that the 12 steps are “spiritual,” not religious.
In short, while not deemed an actual religion, AA – with the steps’ numerous references to “God” – is considered to contain enough religious components to make coerced attendance unconstitutional…
As time has passed, similar rulings have been issued in many but not all states, indicating that people in the criminal justice system who are required to be involved in 12-step groups must also be offered a secular alternative. (The SMART Recovery website has a summary of many of these cases.)
As recently as 2013, in the Ninth Circuit Federal Court of Appeals case of Hazle v. Crofoot, the atheist plaintiff was awarded monetary damages to compensate for the violation of his constitutional rights and wrongful imprisonment after being mandated to participate in a 12-step program without an alternative. (His parole had been revoked and his “fine” was to spend several extra months in jail.)
Similar rulings have also been issued against requirements to take part in programs that used non-12-step, faith-based approaches or used state funding for a faith-based program. Yet I interviewed one man who was ordered by a judge to attend a yearlong non-12-step treatment facility tied to a Christian program even though his social worker had arranged for him to go to a residential rehab stay followed by extended care and time at a halfway house.
According to AA’s 2011 membership survey, 14 percent of U.S. and Canadian members are “introduced” to them via court order or a correctional facility. Despite the court rulings, many individuals are still mandated to attend 12-step meetings. According to AA’s 2011 membership survey (the most recent one available at its website), 14 percent of U.S. and Canadian members are “introduced” to them via court order or a correctional facility. (In 2011, AA had an estimated 2,133,842 members worldwide; it’s unclear how many were from the U.S. and Canada.) Unfortunately, many in the criminal justice system don’t even know about these rulings or have the money to fight for their rights.
Can private addiction treatment programs, like the one described at the beginning of this article, rightfully require their clients to follow 12-step principles or go to meetings? I queried Martin Nicolaus, MA, JD, who is affiliated with the mutual help group, LifeRing and in 2009 wrote an excellent article titled, “Choice of Support Groups: It’s the Law!” He told me that employees of private programs operated with a significant amount of government funding and government oversight are likely to be held to the rulings. However, private facilities without public funding or professionals in private practice without government funding probably would not be. What’s most important is whether a government entity imposes sanctions for noncompliance with a religious program. (Whether the program is privately or publicly funded is secondary.)
If the state required someone to be at a facility, didn’t provide a secular option, and then punished him or her for non-participation, first amendment rights would be violated.-Martin Nicolaus
He added, “If the state required someone to be at a facility, didn’t provide a secular option, and then punished him or her for non-participation, first amendment rights would be violated.” (In a recent issue of Counselor, Nicolaus makes the point that the court decisions do not prohibit or restrict treatment programs from using 12-step programs. “What the court is saying is that other non-religious treatment options also need to be made available. Or else.”)
The Ethics of Suggesting AA is the Only Way – Or the Best Way
What about clients who go to an individual therapist or attend a treatment facility and are told that “AA is the only way” – or when providers refer them to AA, and fail to tell them about the numerous other groups for recovery support? (My next column will detail these groups.) Although private practitioners and rehabs that don’t accept public funds can do as they please, don’t they have a duty to inform clients about the many pathways to recovery? It’s certainly well documented in the scientific literature that people given choices tend to have better treatment outcomes. And we know that, while they help many, the 12 steps are not the solution for many people.
Consider what the following professional organizations say on this matter:
- The National Institute on Drug Abuse’s Principles of Drug Addiction Treatment states, “No single treatment is appropriate for everyone.”
- Faces and Voices of Recovery, a leading U.S. advocacy organization, states in its Recovery Bill of Rights opening paragraph, “…we must accord dignity to people with addiction and recognize that there is no one path to recovery.” The second of its 11 Rights is, “We have the right – as do our families and friends – to know about the many pathways to recovery, the nature of addiction and the barriers to long-term recovery, all conveyed in ways that we can understand.”
- The National Center on Addiction and Substance Abuse at Columbia’s (CASA Columbia) 2012 report on the state of addiction treatment titled Addiction Medicine: Closing the Gap Between Science and Practice states, “The research evidence clearly demonstrates that a one-size-fits-all approach to addiction treatment typically is a recipe for failure.”
In short, putting aside the legal issues, it’s sound, ethical treatment to inform clients about the many pathways to recovery.
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