There is a growing movement against the dominance of 12-step programs for addiction in this country, and the internet age has allowed those who are disenchanted with the 12 steps to become more visible, and to finally come together online to let each other know they are not alone.  Many reject the 12-steps because of it’s religious nature, and the fact that it is basically a form of faith-healing.  At the same time, we have been inundated with claims from the NIDA and others in the recovery culture that science has finally come through and proven that addiction is a disease which requires professional medical treatment.   These disease and treatment pushers are constantly complaining that those of us who challenge the disease concept are dangerous, and standing in the way of the help that science can provide through treatment.

Are we really standing in the way of science though?  Twelve-step programs, for all intents and purposes, are a form of faith-healing. Throughout the first 3 steps, you are supposed to admit that you are powerless over drugs and alcohol, believe you need a Higher Power to help you, and then give your  will and life to GOD. Fully six of the steps mention God, and it goes deeper than that, which you can easily learn if you give the AA Big Book a read or attend a meeting. Essentially, in AA, your cure is to pray for a miracle, and start living AA’s brand of spirituality, so that hopefully, you might be saved.

If some people want faith-healing, that is fine by me, they are welcome to have it – with my blessing!  But it is true intellectual dishonesty to  accuse those of us who point out the problems with the disease concept, and the regular institutionalized failure of conventional treatment programs, as standing in the way of science, progress, or medicine.  Science has provided many facts about addiction and “recovery” – and our institutions have ignored those facts.  Moreover, most of what goes on in treatment centers could barely be characterized as medicine or scientifically based. And while many people will portray 12-step programs as being open to any beliefs, the truth is these programs are pretty point blank about how it’s gotta be:

Unless each A.A. member follows to the best of his ability our suggested Twelve Steps to recovery, he almost certainly signs his own death warrant. His drunk- enness and dissolution… result from his personal disobedience to spiritual principles.

-from The 12 Steps and 12 Traditions

So, you better do the steps (which are centered on “spiritual principles”), or else. And if you do, here’s how it works:

We found that as soon as we were able to lay aside prejudice and express even a willingness to believe in a Power greater than ourselves, we commenced to get results, even though it was impossible for any of us to fully define or comprehend that Power, which is God.

-from The Big Book of Alcoholics Anonymous

This brings me to the point of this post.  Faith-healing is not derived from the scientific method.  The 12-steps, are faith-healing.  Most treatment programs employ methods based on the 12-steps.  Therefore, most treatment centers are providing faith-healing.  So please, do not ever accuse me of standing in the way of science because I criticize treatment centers.  Granted, some of them provide some scientifically justified services, but the main component of any treatment program is almost always a Substance Abuse Counseling method which involves the 12-steps.  There is no getting around this fact, here’s some science to back it up:

IN 2009 SAMHSA carried out the N-SSATS study which surveyed the 13,513 Substance Abuse Treatment facilities throughout the United States.  Fully 10,653 of those facilities reported that they used the 12-Step Facilitation model of Substance Abuse Counseling at that time.  That means 78.8% used this method (source).  So, when I discourage people from attending conventional addiction treatment programs, I am NOT standing in the way of science, I’m standing in the way of faith-healing.  But you still might say “hey, that leaves 21.2% of treatment centers that don’t use the 12-steps” – but you’d be wrong.

12-Step Facilitation is one specific method listed, but not the only method which uses the 12-steps.  The study also shows that 98.6% of treatment centers use some form of Substance Abuse Counseling.  They do not specify which models this includes, and if you search for an explanation of the method of Substance Abuse Counseling you will find nothing specific – you’ll only find hollow statements like “substance abuse is a biopsychosocial disorder which requires the counselor to address many facets of the clients life including family, work environment, social life, blah, blah, blah….”.  So, I found a manual printed and distributed in the year 2000 (and still available) by the NIDA titled “Approaches To Drug Abuse Counseling“.  The booklet promises in the introduction that:

This book is about treatment. In particular, it is about the basic component of most treatment programs – group and individual counseling. The intent of this book is to present information on various counseling approaches used in some of the best known and most respected treatment programs in the United States.

Each chapter was written by an authoritative spokesperson for the counseling model being described.

Then it proceeds with 11 chapters written by 11 different “authoritative” spokespeople describing methods of Drug Abuse Counseling.  Presumably, if they thought a particular method was important and widely used within treatment settings, they asked someone to write a chapter about it.  Of the 11 methods outlined in the book, only 2 do not specifically integrate, recommend, require, or encourage 12-step principles or meeting involvement.  So in the book “about the basic component of most treatment programs”, 9 out of 11 of the counseling methods described, heavily involve the 12 steps.  Drug/Substance Abuse Counseling, a component of 98.6% of US addiction treatment programs, as practiced today, is all about the 12 steps.  So, while a specific facility may not employ “12-step facilitation” they are most likely facilitating the use of the 12-steps through another model of Drug/Substance Abuse Counseling.  The claim that the world of addiction treatment is a bastion of science, is specious at best.  There is little science available on 12-step effectiveness, and what there is, tells us that it is not effective, likewise, the science available on treatment programs show that at best, it’s a wash, providing no better results than if the participant hadn’t received any treatment, and in some cases from some perspectives, actually provides worse results than no treatment at all.

Almost all addiction treatment available includes the 12-steps, it is hard to avoid, and while many tout their new scientific methods, they continue to employ the 12-steps right along side those new methods.  This point is relevant in almost every discussion of addiction and treatment.  They’re selling you faith-healing and calling it science and/or medicine.

Approaches To Drug Abuse Counseling

If you don’t believe my conclusions, then read on.  I have gone through each chapter of the NIDA’s treatment manual referenced above, and quoted passages which show each substance abuse counseling method’s relation to twelve-step programs such as Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, Al-anon, etc., so that you may see just how much treatment programs are employing the 12-steps (while claiming to be using science and medicine for treatment).  Here goes, chapter by chapter (I made a few bracketed notes within, and emphasized some quotes with bold italic text):

Dual Disorders Recovery Counseling

Self-help programs are very important in the DDRC model of treatment. All patients are educated regarding self-help programs and linked up to specific programs. The self-help programs recommended may include any of the following for a given patient: AA, NA, CA, and other addiction support groups such as RR or Women for Sobriety; dual-recovery support groups; and mental health support groups. However, this model does not assume that a patient cannot recover without involvement in a 12-step group or that failure to attend 12-step groups is a sign of resistance. The DDRC model also assumes that some patients may use some of the tools of recovery of self-help programs even if they do not attend meetings. Sponsorship, recovery literature, slogans, and recovery clubs are also seen as very helpful aspects of recovery for dually diagnosed patients.

The CENAPS® Model of Relapse Prevention Therapy (CMRPT®)

“The CMRPT has been under development since the early 1970s (Gorski 1989a). It integrates the fundamental principles of Alcoholics Anonymous (AA) with professional counseling and therapy to meet the needs of relapse-prone clients.

The CMRPT can be described as the third wave of chemical addiction treatment. The first wave was the introduction of the 12 steps of AA. The second wave was the integration of AA with professional treatment into a model known as the Minnesota Model. The CMRPT, the third wave in chemical addiction treatment, integrates knowledge of chemical addiction into a biopsychosocial model and 12-step principles with advanced cognitive, affective, behavioral, and social therapy principles to produce a model for both primary recovery and relapse prevention (RP).”

“Because it is based on a disease model and abstinence-based treatment, the CMRPT is designed to be compatible with 12-step programs. A special interpretation of the 12 steps was developed to help clients relate 12-step program involvement to RP principles.

Special self-help support groups called Relapse Prevention Support Groups (Gorski 1989b) were developed to encourage clients to continue in ongoing warning sign identification and management.”

The Living In Balance Counseling Approach

“RP is the single most important component of the LIB program. The first section of the program is devoted primarily to developing RP skills; RP sessions are scheduled strategically throughout the program.” [see relapse prevention connection to 12-steps and disease model above]

“Various social and environmental factors can also contribute to the triggering of drug hunger and relapse.”

Addiction is further viewed as a chronic, disabling condition in which relapses are common.”

“In general, clients are viewed as people with a compulsive disorder that often overwhelms good intentions and willpower.”

The LIB program views the 12-step programs of AA, NA, and Cocaine Anonymous (CA) as important components in the treatment and recovery process for cocaine addiction. The LIB manual introduces clients to this and other self-help programs and encourages clients to attend self-help meetings during and following the formal treatment program. In addition, the manual embraces alternative recovery self-help groups and promotes spiritual awareness. The LIB manual also incorporates 12-step program references and examples throughout the text.

Treatment of Dually Diagnosed Adolescents: The Individual Therapeutic Alliance Within a Day Treatment Model

“As previously discussed, special emphasis is placed on participation in AA/NA or CA for drug-abusing clients. Adolescent clients are informed before beginning treatment that they will be expected to attend at least three 12-step meetings a week outside of program hours. Again, their participation is encouraged through peer feedback and the behavioral techniques described earlier. Adolescent clients who have a drug-abusing parent are educated about Alateen groups, and parents of adolescent clients in the dual-diagnosis program are themselves referred to Al-Anon for additional support and education regarding self-care, boundary setting, and help in ending enabling behaviors. Essentially, adolescents readily attend 12-step meetings and use the groups on a variety of levels, including social support and normal ego-supportive socializing; for identifying positive mentors, role models, and parental figures; for educational help, support, and advice in remaining sober; and for enjoyment and stimulation. Adolescent clients are encouraged to obtain an AA/NA or CA sponsor, that is, a person with long-term sobriety who acts as a guide and who in general will be available for support 24 hours a day during the adolescent client’s active treatment and after discharge, thus providing continuity and direction.

[so this method puts you’re child’s life in the hands of an AA member – rather than a doctor or scientist – so much for the answers to addiction provided by science]

“For many adolescent clients, the 12-step programs serve as a surrogate family, where their original family system may be chaotic, devaluing, or nonexistent. The authors have witnessed many adolescent clients who were removed from their families and in various stages of foster care or surrogate care were able to use the 12-step programs as an effective means of obtaining nurture and structure.”

“Within the context of CCATS’ emphasis on the use of 12-step meetings, each adolescent client is encouraged to embrace a conceptualization of these groups and the spiritual focus of the 12-step philosophy that reflects his or her own personal values, [spirituality is a key component of the 12-steps, what if they don’t believe in mysticism? No answer] spiritual orientation, and individual preferences. The adolescent client is continually encouraged to examine and to express his or her ambivalence toward the 12-step programs without fear of consequence or reflection in privileges or status in the program. It is of clinical interest to note that in this environment, one that allows and acknowledges the importance of ambivalent feelings and their expression, there is very little behavioral resistance to 12-step attendance.”

Addiction Counseling Approach

“Participation in a self-help program is considered an extremely valuable aid to recovery. It helps recovering individuals develop a social support network outside of their treatment program, teaches the skills needed to recover, and helps clients take responsibility for their own recovery.”

In addition to encouraging clients to attend self-help groups at least three times a week and to locate a sponsor, the addiction counseling program educates clients about the 12-step program and incorporates many of its concepts into the content of the counseling. Breaking through denial; staying away from negative people, places, and things; taking a personal inventory; working on character defects; and spirituality in recovery are among the concepts addressed within the content of the counseling sessions.

“As to 12-step versus other programs, participation in any legitimate self-help program the client gravitates toward, such as Rational Recovery and Women for Sobriety, is supported. However, because the 12-step approach to recovery is well known, more widely available, and has been an integral part of many addicts’ recovery programs, it is this approach in addiction counseling that is drawn on.”

Description of the Solution-Focused Brief Therapy Approach to Problem Drinking

[first of the two non-12-step oriented models listed]

“The Solution-Focused Model neither encourages nor discourages clients from attending existing self-help programs.”

Motivational Enhancement Therapy: Description of Counseling Approach

[second of the two non-12-step oriented models listed]

“Drug problems are viewed as behaviors under at least partial voluntary control of the client, which are subject to normal principles of behavior change. Drugs of abuse are assumed to offer inherent motivating properties to the drug abuser, which by definition have overridden competing motivations. The task in MET is to elicit and strengthen competing motivations.”

“MET does not formally involve any self-help group, although participation in such groups may be part of a client’s chosen change plan. MET is wholly compatible with a 12-step approach.”

Twelve-Step Facilitation

[the name of this substance abuse counseling tells it all, but here are some quotes anyways!]

“Twelve-Step Facilitation (TSF) consists of a brief, structured, and manual-driven approach to facilitating early recovery from alcohol abuse/alcoholism and other drug abuse/addiction. It is intended to be implemented on an individual basis in 12 to 15 sessions and is based in behavioral, spiritual, and cognitive principles that form the core of 12-step fellowships such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). It is suitable for problem drinkers and other drug users and for those who are alcohol or other drug dependent.”

Participation in self-help groups is central to TSF and is regarded as the primary agent of change. Specific objectives within TSF include attending 90 AA or NA meetings in 90 days, getting and using members’ phone numbers, getting a sponsor, and assuming responsibilities within a meeting.

Minnesota Model: Description of Counseling Approach

“The assumption is that abstinence is the prerequisite.”

The philosophy of the Minnesota Model is based on Alcoholics Anonymous (AA).

Involvement in self-help groups (AA, NA, CA) is considered critical for long-term abstinence. In some cases, involvement in related self-help groups (e.g., Women for Sobriety) may be acceptable. During primary treatment, the goal is to expose clients to 12-step programs so they can begin to see how they function and to feel comfortable in them. After primary treatment, frequency of meetings depends on the individual. If a client is functioning relatively well and has a good support system, attendance one to two times a week may be recommended; for those whose hold on recovery is more tenuous, daily meetings may be recommended. Clients are urged to join groups that are most specific to their drug of choice.”

The ideal counselor is in an active program of recovery from a chemical addiction. Understanding and practicing the 12-step philosophy (e.g., self-help group attendance, AA/NA, Al-Anon, CA) in personal life are essential. All counselors must demonstrate good chemical health.”

A Counseling Approach

The approach to counseling is strongly based on the 12 steps of Alcoholics Anonymous (AA).”

“This approach is a balanced integration of 12-step programs and a solid counseling approach. NA, AA, and other self-help groups are key elements in this approach. Since NA and AA have abstinence as a primary goal, both are a part of the counseling approach. Using attendance at meetings as part of the treatment plan sets the groundwork for using meetings as a continued support after treatment.”

A Psychotherapeutic and Skills-Training Approach to the Treatment of Drug Addiction

[There is a nice caveat in the general description of the approach]

“Patient participation in self-help is encouraged but not mandated, and accepting the identity of addict or alcoholic is not required.”

[But later on, it becomes evident that while this approach doesn’t “mandate” 12 step involvement, it must strongly encourage it since most clients end up involved with 12 step programs]

Participation in Alcoholics Anonymous (AA) or other self-help programs is actively encouraged and is seen as helpful and highly desirable, but it is not mandatory.”

“The program actively encourages but does not mandate the client’s participation in AA, Cocaine Anonymous (CA), Narcotics Anonymous (NA), or other self-help groups. All clients are given a basic orientation to self-help and what it has to offer that professional treatment does not. They are also given a list of meetings in their community and provided with a buddy (fellow group member) if they feel hesitant or uncomfortable about attending self-help meetings alone. Clients are not threatened with termination from treatment for failure to attend self-help meetings, nor is their reluctance or refusal to attend self-help meetings seen as intractable resistance or denial. The overwhelming majority of clients in the program do, in fact, attend self-help meetings.

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