If you or anyone you know has ever sought treatment for alcoholism or another addiction in the U.S., it’s almost a certainty they did so through some form of the 12 Steps—the faith-based treatment model behind Alcoholics Anonymous (AA), support groups in which addicts share stories and earn chips commemorating their sobriety.
You might conclude, therefore, that 12 Step programs are so widespread because they’ve proven to be among the most effective methods for tackling addiction. In fact, the only support for that theory comes from AA’s own “Big Book,” published in 1955, which states the program has worked for 75% of participants who “really tried.”
Another more recent, less biased estimate from a retired Harvard psychiatry professor was more conservative, placing the program’s success rate at between five and eight percent. An analysis of treatments for alcoholism conducted more than a decade ago ranked the 12 Steps as the 38th most effective option out of 48.
AA was among the first addiction treatment programs upon its founding in 1935, when it espoused a then-progressive view of alcoholism as a disease, not a moral failing. Unfortunately, that assertion was never reflected in the 12 Steps they presented as the sole path to recovery, which includes taking a moral inventory of oneself and admitting powerlessness before God.
“To confirm that one is powerless prevents them from making the changes needed,” argues licensed Chemical Dependency Professional (CDP) and mental health counselor Richard Sirotta. This unscientific treatment program reached its current pervasiveness through a combination of factors, including their lack of transparency regarding success rates and a cost-effective model that often employs minimally-qualified counselors—many of whom are in treatment themselves—in place of trained medical or mental health professionals.
“Without guidance to other methods, a person with addiction can stay stuck in the belief that nothing will work for them,” says CT, a Seattle-based CDP who wished to remain anonymous. “12 Steps does not encourage getting help for mental health issues, nor convey how common dual disorders are.”
Congressional funding to combat alcohol abuse was funneled into AA, and soon, CT states, “even being legally certified as a federal- or state-approved agency required the use of 12 Step methods.” This move overshadowed evidence-based forms of treatment that contradict AA truisms such as the need for total abstinence, which often intensifies cravings, contributes to the risk of relapse, and causes an estimated 81 percent of attendees to quit within their first month.
“This isn’t the case in Europe,” asserts CT, “where moderation is more likely to be a first step.” Also more common at European or non-12 Step addiction facilities are prescription drug treatments like naltrexone, an opioid antagonist proven to reduce drinking and opioid use by blocking the receptors that receive endorphins—in essence, cutting off the pleasant feelings associated with the object of addiction.
Though 70 to 80 percent of U.S. rehabilitation centers still adhere to the 12 Steps, facilities that ground their treatment in research and mental health are becoming more numerous, presenting an increasingly global view of addiction that evolves with existing evidence. Sirotta, for example, runs Rational Treatment Services; with locations in Seattle and Bellevue, they employ Cognitive Behavioral Therapy (CBT), aimed at altering the thinking patterns and personal problems underlying addictive behaviors for a more enduring form of recovery.
Schick Shadel, founded the same year as AA, advocates a 10-day program of counter-conditioning, or “aversion therapy,” to remove the physiological incentives of addiction. There’s also SMART Recovery, a science-based online program within which anyone can start their own support group to promote self-directed change.
A Positive Alternative in Wallingford, Seattle, teaches stress management, meditation and an improved relationship with oneself through separate programs for men and women, found to help in tackling the unique interpersonal issues that contribute to addiction for each gender. The Avalon Center follows the same approach, using dialectical behavior therapy to identify triggers of abuse and develop coping skills. Concerned loved ones can also do their part to help addicts through the Community Reinforcement and Family Training (CRAFT) model.
“More people understand that there is never only one answer to any problem,” remarks CT. “Unfortunately, the actual availability of choices in treatment is still very limited.”