People who have a spiritual conversion, stop drinking or using drugs, and start attending church without professional help or AA attendance sometimes run into snags. In some churches a stigma is associated with addiction that makes it difficult to talk honestly about day-to-day problems. Some churches have legalistic doctrines, and the addict is tempted to adopt a set of rules that substitutes for actual recovery.

Long-term abstinence in this situation can be difficult, and relapse can damage the addict’s faith. There are addiction and mental health professionals who can work effectively with religious beliefs, and most religious doctrines dovetail nicely with the principles of 12-step recovery. For example, church attendance and Bible study along with regular 12-step meetings is a good combination. As one AA member put it, “I go to church to save my soul. I go to AA meetings to save my behind.” Crudely put, maybe, but useful advice.

But what if you are agnostic or atheistic? A number of solutions are available. The reference to “a power greater than ourselves” in step 2 offers the possibility of accepting a “higher power” - not necessarily God - to help with recovery.

Sometimes people begin with just the awareness that the addiction is beyond their personal power, and they rely on the support of the group as a higher power.

One woman, early in recovery, was told by her AA sponsor that she needed to pray if she was to have another sober day.

She had been raised Catholic but had turned away from the church in her teens. She started out not believing in God, but she knew she had no option other than to try and do what her AA sponsor told her to do. She began praying to “Howard” - and got sober for the first time in her adult life. She later explained that she prayed to Howard because of how she had first heard the Lord’s Prayer as a child: “Our father, which art in heaven, Howard be thy name . . .” Another woman in treatment had a small rubber ball that she kept with her at all times. She explained that this was her higher power. She did not believe in God, but she had started out on the road to recovery.

Of course, the “God thing” remains problematic. Atheists and agnostics may object to the emphasis on God in 12-step recovery (contrary to popular belief, the Big Book unapologetically refers to “God” again and again, and not just to the concept of a “higher power”). Conservative religious people sometimes object to the lack of emphasis on doctrine. Some people have characterized AA as a type of cult religion that comes to substitute for the original addiction.

Various research approaches have attempted to define and analyze what the effective factors are in 12-step recovery. An increase in a sense of self-efficacy, renewed connection with others in the context of the group, and the repair of attitudes and relationships are some which have been studied. But many recovering people and addiction professionals consider the activity of a loving God in the recovering person’s life to be a real and effective factor in successful recovery. A lot of the addicts I’ve seen in my practice who are unable to stay sober for more than a few weeks or months have trouble with the “God thing,” and they use their discomfort with the spiritual aspects of AA to avoid getting involved. Sometimes this is a symptom of denial, sometimes it comes from deepseated hurts and disappointments that have occurred in their lives, and sometimes it indicates an unwillingness to admit that there is something going on with them that they cannot control.

Does this mean that being atheistic or agnostic makes it impossible to get sober and bring the addiction into remission? No. The concepts within the 12 steps can be adapted, and behaviors changed through strategies like cognitive-behavioral or reality therapy - approaches that encourage you to look at your behaviors, your basic assumptions, and the consequences of your actions, and begin to make better choices. Rational recovery is a program available in some urban areas which provides group support within a nonspiritual context. If you are atheistic or agnostic these programs may work for you. But if you have struggled with staying clean, and nothing seems to be working, you may need to reflect carefully on the spiritual aspect of your life. A section in “Alcoholics Anonymous” entitled “We Agnostics” is worth reading.