Recovery groups such as AA and NA rely heavily upon spiritual principles as well as supportive relationships between its members. These create an atmosphere in which recovering people can repair feelings about themselves and others that were damaged by addiction. Spirituality and supportive relationships also help recovering people replace the dysfunctional and addicted lifestyle that supported their substance use. Dysfunctional behaviors caused and supported by substance use can be replaced by a lifestyle based upon spirituality and relationships that are intimate and supportive. Because spirituality and relationships are foundational in 12 Step groups, individuals who have experienced traumatic relationships, particularly in childhood, can have difficulty participating fully in them. Common Effects of Childhood Neglect Neglect during childhood teaches children that significant others will not care for them. Emotional, psychological and physical needs of children are not met, or are only partially met, in situations of neglect. Neglected children may be exposed to dangerous people or situations because those individuals responsible for their protection do not keep them safe. Consequently, neglected children are vulnerable and prone to become victims of other adverse events. Unsupervised and unprotected children, for example, may be exposed to age-inappropriate and developmentally inappropriate experiences. They are more accessible to adults who prey upon and abuse children and they are at significant risk for multiple types of trauma. Psychologically, neglected children are prone to developing low self-esteem and a poor self-image. Having internalized others\u2019 disregard for them, these children are likely to believe themselves to be flawed, unlike others, unlovable and unworthy of positive experiences and healthy relationships. Anxiety, depression, feelings of emptiness and difficulties in forming healthy relationships are just some of the issues with which neglected children must cope. For some, these issues persist into adulthood and greatly complicate substance recovery efforts. Neglect, Trust , and Recovery Relationships Adults neglected as children can have many interpersonal boundary problems that impede their participation in recovery groups or endanger their efforts to remain sober. Such individuals develop significant trust issues which can manifest at both ends of the \u2018trust spectrum\u2019. They may trust inappropriately, allowing others to become too intimate too quickly. Conversely, they may have difficulty forming any types of attachments at all. Some, unable to trust even others who offer appropriate help and support, will avoid the recommended use of a sponsor and the support of other 12 Step members. Such relationships will feel too intimate, causing anxiety, mistrust and fear. Other adults neglected as children may form impulsive and unwise alliances with others that interfere with good 12 Step participation. Eager for intimacy and unable to discern appropriate interpersonal boundaries, these individuals may become overwhelmed with others\u2019 problems or become too involved with too many people. They are also particularly vulnerable to becoming enmeshed with individuals who relapse. Spirituality and Adult Neglected Children The 12 Step focus upon a Higher Power may also be difficult for adult neglected children because of their early and often profound betrayal by authority figures. Trust in and reliance upon a Higher Power can feel empty, unwise and even dangerous. They may be suspicious that others, like sponsors, for example, who offer guidance and encourage trust, offer only empty promises. Spirituality, trust and a relationship with a Higher Power may seem equally as empty, anxiety-producing and impossible. Childhood Abuse Survivors of abuse may find Step work difficult -- particularly that involving the relationship with a Higher Power, open disclosure to others and the use of prayer. For these individuals, such work can feel emotionally and psychologically threatening. \u2018Surrendering\u2019 to the support of others, and relying upon the process of recovery groups, can also feel like unattainable goals. Even though adults who were abused as children may desire to relinquish such barriers to intimacy, their anxiety, fear of being controlled and distrust may interfere. Many can have many overall misgivings about the spiritual aspects of a 12 Step program. Having experienced authority figures as abusive, they may believe that any higher power will misuse and abuse authority. Similarly, they may assume that a Higher Power would do the same. Having a sponsor and using the fellowship of 12 Step groups can result in feelings of distress, anxiety and fear for survivors of abuse. They may be avoidant and feel defensive and resistant in such relationships. At times, these individuals will engage in power struggles with their supports. This makes recovery efforts much more difficult and much less effective. Helplessness and Hopelessness The helplessness and hopelessness of victimization can feel insurmountable even in adulthood when independent and safe. Adults who were traumatized as children may believe that effective use of a 12 Step program is not possible. Deeply ingrained self-esteem and self-image problems may interfere as they are likely to have developed a generalized sense of helplessness and hopelessness that overshadows any recovery effort. Having had authority figures betray trust, emotionally abandon them and seriously violate their personal boundaries, need for nurturance, safety, protection and respect, these individuals tend to believe that they are powerless to effect significant changes even in their adult lives. Victims view personal power as residing within the hands of others and not attainable for themselves. Further, the 12 Step concept of powerlessness may be confused with the helplessness and hopelessness associated with childhood trauma and victimization. Prayer and Meditation 12 Step prayer and meditation practices can be problematic for both adult children of neglect and adult children of abuse. Many will have ambivalence about the effectiveness of prayer, their worthiness of a relationship with a Higher Power and the willingness of a Higher Power to love, protect and guide them. Adults who experienced significant traumatic experiences as children often wonder why their childhood prayers for protection were not answered. Also, many have come to believe that they were victims of abuse or neglect because a Higher Power abandoned them or punished them. These beliefs are often generalized to a belief that they are not lovable even in the eyes of a Higher Power. Recovery Individuals with these types of trauma-related issues can participate successfully in 12 Step programs. Therapy can supplement 12 Step work by identifying issues that persist from early experiences as well as practical strategies for overcoming them. Use of supportive counseling, dual diagnosis counseling and trauma specific treatment can diminish distress and enhance the coping skills necessary for an appropriate and comfortable use of recovery supports. Trust, intimacy and other relationship issues can be gradually improved through relationships with sponsors and others in the recovery fellowship. The structure of meetings and guidelines offered within them for participation and relationship building help members interact with others in safe and supportive ways. Further, working the 12 Steps can guide an individual through efforts to establish healthy boundaries and repair past relationship damage. Spiritual issues that have resulted from traumatic experiences can be addressed with a trusted sponsor and other 12 Step supports. Listening to the recovery stories of others gives hope, encouragement and ideas for how to obtain spiritual health. Additionally, 12 Step literature can provide inspiration and motivation to re-evaluate one\u2019s approach to spiritual issues that have been problematic. Further, opportunities to help others and rely on others can enhance one\u2019s sense of meaning, purpose, optimism and well-being.