Hornbacher - Sane : mental illness, addiction, and the twelve steps

There are many poignant yet practical sayings in Twelve Step recovery. When it comes to choosing a sponsor, it is often advised to select a person who knows the way, goes the way, and can show the way. Each of these three ingredients would seem rather important in identifying a person to help with the daunting task of recovery from a co-occurring mental health and substance use problem.

Marya Hornbacher knows the way, goes the way, and shows the way. Sane is an excellent bridge to the remarkable and miraculous transformation that can take place through the fellowship and wisdom of the Twelve Step program of recovery. What Marya Hornbacher does in Sane is interpret these twelve suggested Steps for people with co-occurring disorders, making them understandable, while anticipating and addressing common concerns and questions. She translates recovery terminology that on the surface may seem at odds with having a mental health problem, and makes it accessible to anyone.

The evidence is in: peer recovery groups such as Alcoholics Anonymous and Narcotics Anonymous really work. Yet research shows that people with mental disordersparticularly severe ones such as bipolar disorder, schizophrenia, PTSD, or severe depression or anxietydont connect with AA or NA as successfully as people with more moderate emotional problems do. And even when they do connect, theyre not as successful in sustaining recovery over time.

There are probably many reasons for this. Some have to do with the nature of these mental health problems, which can be characterized by symptoms of avoidance, isolation, withdrawal, and negativity that can preempt action. Moreover, not all Twelve Step recovery groups are open to people with severe mental health issues. This is remarkable, if not paradoxical, given that groups such as AA were originally formed to offer social support and solutions to individuals who often felt ashamed and socially marginalized by their disease. The goal was to create a group that was inclusive and accepting, not exclusive and judgmental. Fortunately, most peer recovery support meetings retain the ambiance of acceptance and tolerance. The primary purpose remains, in essence, to try to get sober and help others in doing so.

Still, for the person with co-occurring disorders, the thought of going to a recovery support group meeting can be terrifying. In fact, the idea provokes anxiety for just about anyone, but in this case the prospect is so threatening that it is often avoided at all costs. So, since most alcoholics and addicts also have a mental health problem, how do any of them ever make it to a meeting, let alone stick around long enough to get clean and sober and engage in sustained recovery? We dont know. It may be a matter of miracles, willingness, desperation, social support, serendipity, timing, good luck, or simply the exhaustion of all other options.

In this book, Marya Hornbacher finds the way through or around these perceived barriers, debunking common mythologies about Twelve Step meetings. Reading Sane is akin to having an AA or NA sponsor. This book serves as the introduction, the guide, and the validation of personal experience. Sane offers ways of managing the complexity, of making it all seem okay.

Mark P. McGovern, Ph.D.
Department of Psychiatry
Dartmouth Medical School