I’ve found that some people think it’s reckless or irresponsible of me to recommend that people stay away from conventional addiction treatment programs. I expect such a reaction from those who don’t know much about the state of the system, but I’m surprised when it comes from people who are already skeptical of 12-step programs. Many people are rightfully against the idea of pushing addicts into 12-step self-help groups for several reasons:
- These groups are religious in nature, and thus a form of faith-healing.
- They can be a case of “the blind leading the blind”.
- They can be cultish, and full of dangerous people.
- They disseminate self-defeating teachings.
- They aren’t professionally run or regulated, and are in fact insulated from public scrutiny.
I could think of plenty more reasons myself, but these are the common ones that come up. My question then is, if you understand these dangers, why would you advise anyone to go into the american system of addiction treatment? For as long as I’ve been alive, treatment has been 12-step based – and 12-step groups are a form of treatment according to various government bodies charged with overseeing treatment programs and leading the way in acceptable treatment methods. Don’t believe me? Here’s a few examples showing how they regularly refer to 12-step groups attendance as treatment.
National Institutes of Health / National Institute on Alcohol Abuse and Alcoholism
One of my favorite studies from the NIH/NIAAA, (which you can learn about here) divides alcoholics into 2 groups – those who have received treatment, and those who haven’t. They consider people who have been to 12-step groups as having received treatment – whether or not they’ve ever received any formal medical/mental health treatment. Here’s a quote from the “Measures” section of the report:
3 Treatment status: positive if respondents reported everhaving sought help for problems with their own drinking (followed by a list of 13 specific sources, e.g. Alcoholics Anonymous or other 12-Step organizations, out-patient clinics, etc.).
[my emphasis added] Not only do they count you positive for treatment if you’ve been to AA – that’s the first source of treatment they list in their description of the criteria! Self-help groups such as AA are subject to no regulation, they are not lead by licensed counselors or people trained in medicine – they are self-help groups! No one gets a mental health evaluation at an AA meeting (although they’ll definitely end up needing help if they keep going to meetings).
National Institute on Drug Abuse and Addiction
A list of FAQ’s in the NIDA’s Principles of Drug Addiction Treatment: A Research Based Guide, asks “Where do 12-step or self-help programs fit into drug addiction treatment?” – and their answer includes this:
The most prominent self-help groups are those affiliated with Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Cocaine Anonymous (CA), all of which are based on the 12-step model. Most drug addiction treatment programs encourage patients to participate in self-help group therapy during and after formal treatment.
To be fair, they preface that these groups “complement professional treatment”, but they still seem a little too comfortable attaching the extra label of “therapy” after “self-help group”. This elevates the profile of 12-step groups, giving them a clinical and official status they do not deserve. Most importantly, this statement from the NIDA confirms an important fact – that most treatment programs push you into 12-step groups, this is such a normal state of affairs that the term “after-care” will soon be listed in the thesaurus alongside “AA meetings”.
For further demonstration of the fact that treatment programs are simply selling you the 12-step brand of faith healing, check the NIDA’s booklet on “Approaches To Drug Abuse Counseling“. 98.6% of treatment programs use some form of substance/drug abuse counseling, of which this booklet lists and describes 11 prominent methods. Only 2 out of the 11 don’t involve indoctrination into the 12-steps! Just one of the methods, called “Twelve-Step Facilitation”, was used by 78.8% of all treatment programs in 2009!
Substance Abuse and Mental Health Administration
I was looking at a study from SAMHSA today that sparked off this line of thinking for me. They do an annual survey on drug use which provides data on treatment – how many people are getting it, and where are they getting it (among tons of other information). This is how they discuss where people got their “treatment” from:
This includes treatment received in the past year at any location, such as a hospital (inpatient), rehabilitation facility (outpatient or inpatient), mental health center, emergency room, private doctor’s office, prison or jail, or a self-help group, such as Alcoholics Anonymous or Narcotics Anonymous.
In 2009, among the 4.3 million persons aged 12 or older who received treatment for alcohol or illicit drug use in the past year, 2.5 million persons received treatment at a self-help group, and 2.0 million received treatment at a rehabilitation facility as an outpatient (Figure 7.7). There were 1.2 million persons who received treatment at a rehabilitation facility as an inpatient….
And they keep on referring to self-help group involvement as treatment, going so far as representing it in a bar graph:
These are just a few examples of how the major institutions overseeing the addiction “treatment” industry regularly refer to 12-step groups as a form of treatment, and these are not isolated incidences or mistakes. In my separate analysis of the NIAAA study referenced above, I found myself constantly stating “treatment or 12-step attendance” or some other phrase that separates the 2 – because in my mind, they should be distinct pathways. The reality is that they are not. You will be hard pressed to find a “treatment” program for addiction that fits the operational and regulatory/licensing mold of a medical service yet doesn’t simultaneously funnel you into a 12-step program. Such treatment programs are so far and few between that if you are opposed to the practice of selling people faith-healing and presenting it as “medicine” or “treatment”, you cannot, in good conscience, recommend that people get treatment for an addiction.
Tips
There are a teeny tiny minority of people working within the treatment system and trying to change it to offer effective psychological interventions for substance use problems – good luck finding them though. I have listed a few programs on my find help now page, that do conform to treatment regulatory standards – those are the Guided Self-Change Program in Florida, and the St Gregory Center in Iowa [Sorry, I can no longer recommend SGC]- and neither of these funnel people into 12-step groups. So if you are looking for a program which includes mental health professionals, these may be worth checking out. Generally though, the faith-healing of the 12-steps is too deeply entrenched in the treatment system for things to change significantly in the foreseeable future. Personally, I think people can be helped outside of the treatment/12-step system with self-help books on alternative models of addiction, or at educational programs like the St Jude Retreats, or through a coaching service like my own [I’m no longer offering this service – I’m now teaching the St Jude Cognitive Behavioral Education program]. I think some people see a danger in this, because addicts may often have severe co-existing mental health problems. This doesn’t have to be an obstacle. If you think you may have one of these mental health problems, yet you want to avoid the pitfalls of addiction treatment, don’t fret. You can see a mental health professional and ask for help with these issues, while addressing your addiction outside of the mental health framework – some may insist that you get involved in the 12-step world – they’re probably not a good match for you, so get out there and find someone who is right for you. There are plenty of good counselors out there who are informed by positive psychology and the techniques of cognitive behavioral therapy – they have a lot to offer. A good starting point is to read the book “What You Can Change, and What You Can’t”, by Martin Seligman (a former president of the American Psychological Association). He reviews the best methods for dealing with psychological problems, shows you when and where you should seek help, and offers advice on what to ask for from a mental health professional. If you’re looking for cognitive behavioral therapy, you can contact the Albert Ellis Institute in New York, and they’ll help you find a qualified practitioner in your area.
I am so relieved to see my view of our field being expressed by a colleague. I am an addiction focused psychotherapis for 25 yrs. in Manhattant, I was clinical director, until the end of 2009 at Beth Israels Comprehensive Treatment Program for 22 years. Finally the main portion of consulting has been, for the last 18 years, the program manager for the NFL’s drug program; managing the 9 teams in the northeast. I have recently partnered with Stanton Peele on a project tagging the incredible systemic problems because of the use of 12 step program philosophy, as the stated treatment in professional treatment facilities. From regulatory agencies in each states administering treatment services, to the research institutions like NIDA and SAMSHA, to the program administrators in charge of types of “professional” philosophies being ignored, to line and supervisory staff who mean well but can’t tell the difference between their own value system and the responsibilities and ethics of their profession. The entire system, including us, have never known the field without the unethical and inappropriate inclusion of non-professional suggestions as the paradigm that is exclusive and biased and does not ethically and legally provide “informed consent” on the treatment and create the compassionate atmosphere that ensures the patients “right to choose.” If an admission to one of these 12 step rehabs knows that the steps are there already, sees the posters and displays of 12 step literature, sits in 12 step meetings every night, be counseled by counselors self disclosing how the fellowship saved their lives, and if they have questions about or differences with some of the concepts, they are told to “put the cotton out of their ears to put in their mouths. Or maybe worse, try to convince that there is a God. Does the admission even have a chance to honestly be presented with an honest, detailed unbiased description of ALL the groups and respect their right to choose. Do the clinical staff make an effort to research ALL groups, call, invite to meet or speak, obtain literature, truly understand the concept, have this information available in an even fair balanced manner? Well the answer is
, NO, I ran one of these rehabs for many years, at least I can say we did remove the term “12 step” from our philosophy of treatment statement. Instead we used the term “self-help support.” In terms of this issue, I have written both Dr. Clark of SAMHSA and Dr. Volkow of NIDA questioning their funding of 12 ,step facilitation research for treatment. I told them that they have missed the inclusion of what could have been the best addition to treatment in 2 decades, and this is SELF-HELP FACILITATION GROUPS. that venue was perfect for the education, explanation and understanding of all these groups and their strengths. just eliminating all other groups is a little scary, because it is so obvious. Because either people are blind because its’ always been this way or they are conspiring to fill the world with a dominant “12 step culture (which I doubt) These leaders in new ideas are not getting how much cultural change has happened since the simultaneous births of our field and the fellowship. A good example is the usefulness of SMART RECOVERY is their website. Our culture has evolved to a dominant communication technology as the driving force of connecting people. AA’s website does not come close to providing concepts or metaphors of “folk wisdom (which would be great) to SMART.COM’S site that has TOOLS AND RESOURCES. Lets face the strengths of the fellowship are really useful, but first is availability of venues that are the essence of its program, SMART.COM will never come close to providing the number of meetings like 12 step groups. But it addresses the people, including the younger person who needed information the way it is predominantly provided, by GOOGLE!! Their site has so much solid guidance, MUCH OF IT DRAWN FROM THE TRIED AND TRUE COGNITIVE SKILLS OF RET.
ANYWAY, I WILL STOP THIS STREAM OF CONSCIOUSNESS RAP, THANKS FOR EXPRESSING A REFRESHINGLY SANE PRACTICAL WAY OF LOOKING AT TREATMENT. PLEASE RESPOND OR CALL; OFFICE 212-988-0266 OR CELL 917-407-8224.
PS- 12 steps-has strengths that I would describe, 5 or 6 major ones; but the one that helps the most is the one that’s overlooked; “Take what you need, and leave the rest.”
RESPECTFULLY,
ANDREW PARK LCSW
NIH/NIDAA have to divide “alcoholics” based on attending/not attending rehab groups. There is no physical/medical/scientific way to disprove the claim or accusation that someone is an alcoholic/addict – no infectious agent (bacteria, virus, prion), no toxin, no birth defect, traumatic organ damage, organ or hormone malfunction. All there is, as far as determining whether someone is an “addict” is words – claims and accusations.
Which makes rehab a perfect money-making scheme – since no one can be proven cured, the gravy train can never be ordered to stop ladling.