A frequently overlooked phenomenon within the recovering community, aka 12-step oriented fellowships, is a true understanding of the difference between compliance and acceptance with respect to one’s addiction[s]. As most professionals and addicts themselves have come to understand, addiction is a disease with a common set of symptoms and characteristics that cut across all flavors of dependency – whether we’re speaking of alcohol, drugs, eating disorders [including compulsive overeating, food addiction, bulimia, et al], compulsive gambling, or codependency. When we look beyond the substance, or for that matter, the particular compulsive behavior[s], we begin to see what separates those who enjoy long-term abstinence / recovery from those who tend to repeatedly relapse. What follows comes in large measure from the original works of Harry Tiebout, M.D., and William Silkworth, M.D., both pioneers in the field of alcoholism and professionals for which Alcoholics Anonymous might not exist were it not for their support and guidance.

Let me begin by clarifying these concepts and elaborating upon the practical implications of each of these states of mind. Let’s begin with the notion of compliance. To paraphrase Dr. Tiebout, compliance refers to an individual agreeing, going along with, but in no way implies enthusiastic, wholehearted approval. Usually there is a willingness not to argue or resist and although cooperation exists, it comes with some reservations. In other words, one is not entirely happy about agreeing or following “the party line.” The willingness to, let’s say abstain from certain foods or drink, is somewhat shaky. Suffice it to say it doesn’t take much to shift from compliance to relapse. Although the good doctor speculates this is an “unconscious” phenomenon, I would disagree. Most people in early recovery have some reservations about their “lack of power” and inability to step back into the ring. Perhaps we can say compliance is a close cousin to denial.

Understanding the specific dynamics of acceptance is tantamount to understanding what separates those with long term recovery from those who experience only brief periods of remission. Borrowing from our friend Dr. Tiebout:

“Acceptance appears to be a state of mind in which the individual accepts rather than rejects or resists: he is able to take things in, to go along with, to cooperate, to be receptive. Contrariwise, he is not argumentative, quarrelsome, irritable or contentious. For the time being, at any rate, the hostile, negative, aggressive elements are in abeyance, and we have a much pleasanter human being to deal with. Acceptance as a state of mind has many highly admirable qualities as well as useful ones. Some measure of it is greatly to be desired. Its attainment as an inner state of mind is never easy.” – Harry M Tiebout, M.D.

In my experience the transition from compliance to acceptance is a process rather than an event. As such the period of time from which a person moves from a compliant stance to an acceptance state of mind varies greatly. However, I would add to Dr. Tiebout’s observations that getting from point A to point B is quite similar to what we’ve come to understand as the stages we all go through upon suffering a loss. Letting go of our primary “reward” or “feel good” thing is no easy task. To be sure, it is a great loss if you suffer from the disease of addiction. The experience of transitioning to acceptance, and to that of total surrender, will encompass the following stages:


As with other losses, one can expect to negotiate these in a sometimes back and forth pattern, vacillating between stages until arriving at the final stage of acceptance. It is coming to rest at the acceptance level that one can understand and experience the act of surrender. It is here one can sense a lifting of the obsession, no longer needing to struggle with abstinence but rather finding a comfort and rhythm to recovery. Ambivalence about recovery dissolves and intervals of serenity and acceptance of “life on life’s terms” begin to increase.

Over the years Tiebout believed this “conversion experience” from compliance to acceptance and surrender is exemplified by:

• A switch from negative to positive behavior vis-à-vis the act of surrender
• A suspension of defiance and grandiosity and attaining a semblance of humility
• The act of surrender being synonymous with a marked change in behavior[s].
• A State of surrender, when maintained, exerts a positive influence on all spheres of life: physical, emotional, and spiritual.

In effect, getting to this stage in recovery can be viewed as the precise moment when the tendency toward defiance and ego driven self-control cease to function effectively. With this, the individual is totally open to accepting reality. Honesty, open-mindedness, and willingness replace the negativity and grandiosity often characteristic of addiction. As the good doctor reminds us, “the act of surrender is an occasion wherein the individual no longer fights life, but accepts it.”

Marty Lerner, PhD.

Author's Bio: 

Dr. Lerner is the founder and executive director of the Milestones in Recovery Eating Disorders Program located in Cooper City, Florida. A graduate of Nova Southeastern University, Dr. Lerner is a licensed and board certified clinical psychologist who has specialized in the treatment of eating disorders since 1980. He has appeared on numerous national television and radio programs that include The NPR Report, 20/20, Discovery Health, and ABC’s Nightline as well authored several publications related to eating disorders in the professional literature, national magazines, and newspapers including USA Today, The Wall Street Journal, New York Times, Miami Herald, Orlando and Hollywood Sun Sentinels. An active member of the professional community here in South Florida since finishing his training, Dr. Lerner makes his home in Davie with his wife Michele and daughters Janelle and Danielle and their dog, Reggie. www.MilestonesProgram.Org

Professional Memberships:

- American Psychological Association [APA]
- Florida Psychological Association [FPA]
- National Eating Disorders Association [NEDA]
- National Association for Anorexia and Associated Disorders [ANAD]
- Binge Eating Disorders Association [BEDA]
- National Association for Anorexia and Bulimia [ABA]
- Florida Medical Professional Group [FMPG]
- National Association of Cognitive Therapists
- International Association of Eating Disorder Therapists [IADEP]