We’re taking this week off – but still answering the phone – and we thought we’d take this opportunity to explain our views on AA and the 12 Steps.
We’re doing so because every month or two we get an e-mail or a call from someone who’s distressed about our comments.
First, we’re fine with AA as a voluntary, free, and occasionally helpful option. We are not fine with those who market AA as effective treatment – it isn’t.
Second, there are AA based programs that work. Beacon House, a free residential program for down-and-out and homeless men in San Pedro, CA is a model others should emulate. Notably, they are very picky in terms of who they admit. They know who benefits and screen accordingly. They’re the only program we know of that does.
Third, we object to programs making claims that have no basis in reality, while charging tens of thousands of dollars (sometimes hundreds of thousands of dollars) to load you onto a van and dump you onto the local AA community, and then having the nerve to call it treatment. That’s detrimental to you and to AA.
Fourth, it isn’t all that hard to sort potential clients into categories:
those who may benefit from AA;
those who are apt to be harmed by AA;
those who may benefit in the short term, but will soon outgrow AA;
those for whom AA is irrelevant.
We’ve been successfully making these distinctions for over 25 years and, yes, we refer appropriately identified individuals to AA. Evaluation takes an hour or two and others could learn the process, but that would hurt their marketing.
We believe that you have a right to make an informed decision about whether or not to seek help and this right includes knowing what the options are, how they may apply to you, and what the outcomes typically are.
AA, for example, has about a 3% success rate when it comes to helping people with alcohol problems. This rate is slightly higher for men and slightly lower for women.
Is AA for you?
That’s simple to figure out for yourself. You go to a half dozen different meetings in your area and see if it appeals and makes sense to you. If it does, you’ve found your free solution. If not, then you can also eliminate 98% of all treatment programs because that’s all they have to offer.
You also deserve to know that there are a lot of options, most of which are far more effective than AA for the people who read our newsletters and frequent our website.
That said, the second article in today’s newsletter again reviews what actually works.
Interested in learning about your options and how we can help you put together your own treatment package at a fraction of the cost of what the treatment mills offer? That’s what we thought.
What is the best alcohol treatment?
There are three prevailing myths about alcohol treatment according the foremost researchers in the area, led by psychologist William Miller (Handbook of Alcoholism Treatment Approaches).
The first myth, and possibly the worst, is that there is one and only one effective approach to addiction recovery. If you are seeking treatment and a facility tells you a version of this myth (i.e. “AA or the 12- steps are the only way”) look elsewhere for help.
Alcohol treatment research, and addiction treatment research generally, shows there is no single approach that is best for all individuals.
The first principle of the 12 Guiding Principles adopted by the Substance Abuse and Mental Health Services Administration (SAMHSA) is: There are multiple pathways to recovery.
The other two myths are that nothing works and everything works. Put another way, there is a popular but incorrect belief that all treatments for addictions are equally good or bad.
Drs. Miller and Hester have been comparing the research contrasting the various approaches. Their scientifically sophisticated review of alcoholism treatment outcome research demonstrates that some treatment modalities are especially effective for most people. The evidence is strongest for:
1. Receiving honest but non-confrontational one-on-one feedback regarding one’s alcohol- related health from a health care professional;
2. Non-confrontational strategic Motivational Interviewing;
3. A complex set of cognitive and behavioral methods called the Community Reinforcement Approach
4. The assigning of a Self-Change Manual, also called Bibliotherapy
5. The medication naltrexone;
6. Behavioral Self-Control Training (a moderation approach);
7. Behavioral Contracting for rewards given in exchange for clean drug test results:
8. Social Skills Training
9. Behavioral Marital Therapy
A common theme in all of these treatments is that they are delivered with empathy and without confrontation. These treatments are often mentioned in media articles about improving our deplorable record in helping people with alcohol abuse and dependence problems.
Please note that we employ an individualized mix of all of the above with each of our clients – a mix augmented by assertiveness training, diet and exercise recommendations, and whatever else seems appropriate.
Unfortunately, few addiction treatment centers offer any of them. As the medical director at one prominent Canadian facility said, “Why would we offer options that would lower our relapse, readmission, and recycling rates?” an opinion echoed by treatment programs across both the U.S. and Canada.
However, with the aid of the Internet one can find effective programs more easily than ever before by searching for “non 12 step” or “alternative alcoholism treatment.”
And What Are the Least Effective Alcohol Treatments?
Of the 48 approaches ranked, the least effective are:
37. Twelve-Step Facilitation Therapy, a one-on-one teaching and support of the 12-Steps.
38. Alcoholics Anonymous
39-42.These four included three medications and Milieu Therapy (meaning the therapeutic setting of the treatment facility will help cure you)
43. Videotape Self-Confrontation or watching oneself behaving badly while intoxicated
44. Relaxation Training;
45. Confrontational Counseling;
47. General Alcoholism (ie, AA based) Counseling;
48. Educational tapes, lectures and films, upon which much time is spent in most traditional rehabs;
Of course, even these treatments will be helpful to some. However, it would appear most sensible, if seeking treatment for oneself or a loved one, to start with a treatment that had a better record of success. Further, common sense would suggest that if one approach does not work, it is not necessarily the individual ‘s fault.
If an AA based treatment fails, as it does 97% of the time, try something else that will help you succeed by calling!
Odds and Ends
Alcohol Abuse, Alcoholism, and 12 Step Programs That Can’t Tell the Difference, don’t care, and will gladly burden you with inappropriate and damaging labels that will haunt you for the rest of your life.
Women and Alcohol – What To Consider In Treatment and why women need and deserve services built around women’s needs, not just another recycled (and failed) men’s program – which is all anyone else has to offer.
Confidentiality, why you want to avoid residential treatment and groups of all kinds.
The Bucket of Crabs or Why AA and Al-Anon are Bad For Your Health.