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Tuesday
Aug052014

12-Steps Is Not Treatment

Thank goodness for innovation. Where would we be if not for those who think outside of the box; people coming to situations with a new set of eyes and a passion for understanding and people who question the status quo. Particularly at this time in history, information and knowledge is exchanged, research is performed and ideas are expressed in a more instantaneous and widespread manner than any previous time.

It is against this back drop that idea of “Non-12-step” treatment has grown in the recovery community, which unfortunately, has spread into “Anti-12-step” offshoots. I’d like to clarify two points:

1-      That 12-step recovery is not treatment.

2-      That in order to be non-12-step you don’t necessarily have to be anti-12-step.

First, a very brief overview and history lesson:

At the time of AA’s founding and beginning growth (mid to late 1930’s) there was no such thing as substance abuse treatment, nor psychiatric treatment, as we know it today. Psychiatry was (and often still is) considered the step child of medicine and substance abuse treatment a step child to it. Though psychoanalysis was in its heyday, those who could not afford daily time on the analyst’s couch or had severe mental health or substance abuse issues were typically put in a hospital or “sanitarium” for long periods of time, sometimes for life. Therefore, the “first generation” AA’rs who became sober were often the first group of people that had severe addiction issues and were able to maintain sobriety without being locked away in a sanitarium. As medical science developed, mental health (and to a lesser degree) substance abuse treatment became less stigmatized and more widely available. The individuals who developed and facilitated treatment programs early on came to sobriety though 12-step recovery and so their treatment models were built upon the same principles.

Since AA was developed by and for severe alcoholics who literally were on the brink of death or lifetime hospitalization, understandably, it is abstinence based. There is an AA slogan “Jails, Institutions or Death” that comes directly from this. Substance abuse treatment was built upon this idea and for much of the 1960’s through1990’s this was the only option. Thankfully science, research and treatment have grown and there have been great leaps forward which have led to different options for people seeking treatment. Not everyone who uses drugs or alcohol, even to excess, is an “addict” and not everyone needs to go to “rehab” for treatment. And 12-step meetings are not the same as treatment.

The reason for this confusion, I think, is because for almost 30 years almost all treatment centers used some form of the 12-step model (often called the Minnesota Model) for assisting people. During this time most of the counselors who worked at these programs were themselves in recovery and almost always they gained their sobriety though the 12-steps. It is easy to understand how the erroneous belief of “If I got sober through AA, then the only way you can get sober is through AA” permeated treatment during this time.

Today there is a difference between 12-steps and treatment. The basic idea of any 12-step meeting is for people in similar circumstances to share their experience, strength and hope with each other to support each other in living healthy sober lives. Treatment should be science and protocol based and professionally run.   The people providing the treatment should have advanced degrees and professional experience as the basis for their “authority” to provide a service for a fee. The only qualification to attend an AA meeting is a desire to stop drinking.

Quite often people are told to “go to a meeting” because of finances and geography. Treatment may be expensive, far away or not covered by insurance. 12-step meetings are everywhere and don’t cost a dime to attend, however this should not be construed as treatment. It is disheartening to read statistics that compare 12-steps to treatment because they are misleading and they compare two different things. I recently read a statistic comparing a specific form of family treatment called CRAFT (Community Reinforcement and Family Training) to Al-anon. CRAFT is a wonderful and effective form of treatment but it is completely different than al-anon. CRAFT is a treatment model designed to support family members in encouraging loved ones to enter treatment or discontinue unhealthy behaviors, Al-anon is a mutual support group of loved ones effected by alcoholism which focuses on sharing experience strength and hope in maintaining  health in the face of alcoholism. The focus in each is completely different, and yet their outcomes were compared.

This leads to my second point: anti-12-step approaches can be quite dangerous, particularly to the uninformed. From my experience I have seen anti-12-step folks fall into two categories; ones that erroneously compare 12-steps to treatment and then take issue with the 12-steps because of their “unfavorable” outcome, and ones that have had difficulty in maintaining abstinence (if that is the goal) and may find it easier to blame the process rather than look at themselves. In my opinion the former are ill informed and the latter have an axe to grind.

What to do?

Here is my thought. Become an informed consumer, learn what you can and experience what you can. Then do what works for you.

It is human nature (and by extension absolutely acceptable) to desire the least amount of intervention to obtain the maximum amount of change. Define what your problem is-in essence, do you want to cut back, or stop and if you are capable of making this change on your own, more power to you. Time will tell and numbers don’t lie. If you continue to struggle and negative consequences stack up, ratchet up your plan. This may include redefining your goal, or seeking some professional help, it may also include mutual support or all three.

Luckily we live in a time in which there are lots of different options; it is not the 1960’s anymore. I would caution against exclusive and in favor of inclusive thinking. No one way is better than another, bad or good, old school or new. You don’t have to be against something in order to be for something else. What works for me might not work for you. What is often most effective, as studies have shown, is buffet style, a little of this and a little of that, more of this and less of that.

Bon Appetit!

 

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