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:

  1. These groups are religious in nature, and thus a form of faith-healing.
  2. They can be a case of “the blind leading the blind”.
  3. They can be cultish, and full of dangerous people.
  4. They disseminate self-defeating teachings.
  5. 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:

Treatment Sources - NSDUH - 2009

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.

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