Addiction and Alcoholism: Beyond 12 Steps

Although addiction and alcoholism treatment research has advanced tremendously since Alcoholics Anonymous was founded in 1935, many people do not know that equally effective alternatives to 12-step programs exist—nor do they know how to find them.  In popular culture, AA is often portrayed as the only way.

Worse, while reality TV spotlights tough family “interventions” as a way of getting people to enter treatment and often shows rehab as a “boot camp” or exercise in humiliation, research finds that both these approaches have significant risks, and other less risky tactics have equivalent or superior benefits.

So, how can you find evidence-based addiction and alcoholism treatment for yourself or a loved one instead of—or as an addition to—12-step approaches?

Here are five “dos” and five “don’ts” that can guide you to the best treatment.

1.  Do start your search for treatment with a full psychological or psychiatric evaluation from an M.D. psychiatrist or Ph.D. psychologist.

At least 50 percent of people with alcohol or other drug addictions have an additional mental illness, such as depression, anxiety, attention-deficit disorder or bipolar disorder. But unfortunately, many addiction counselors do not have the expertise to diagnose these disorders—let alone treat them.

“If you go to a barber, you’re going to get a haircut,” says William Miller, Ph.D., emeritus professor of psychology and psychiatry at the University of New Mexico, a leading expert on addiction treatment. “If you go to a substance abuse treatment center you’ll get substance abuse treatment, but they may not be well-equipped to deal with the other things that come along with it.”

Adds Alan Marlatt, Ph.D., Professor and Director of the Addictive Behaviors Research Center at the University of Washington: “If you get a proper diagnosis and evaluation, someone may be able to offer integrated treatment to deal with both without having to be shunted back and forth between substance abuse and mental health centers.”

Since people with mental illness often self-medicate with addictive drugs, treating those conditions can be critical to starting and sustaining recovery.  However, in many cases, that isn’t enough:  Once someone has developed an addiction, even if the problem that the person was trying to medicate away has been solved, the addiction may continue.

Avoid the chicken-and-egg debate—treat both simultaneously for the best results; also, look for providers who specialize in “dual diagnosis.”

2. Do look for therapists who use “empirically supported” or “evidence-based” treatments like cognitive behavioral therapy or motivational enhancement therapy.

Although many people believe that treatments must be proven to work before they can be used in practice, this is not the case for talk therapies like those used for addictions.  In many states, an addiction counselor doesn’t even need a high school degree—and some inpatient programs for teens are completely unregulated in terms of staff qualifications and basic health and safety requirements.

Fortunately, there are several talk therapies that have been proven to help with addiction.  These include cognitive behavioral therapy, motivational enhancement therapy (sometimes called motivational interviewing) and 12-step facilitation for those who are involved in 12 -step programs.

Cognitive behavioral therapy involves understanding and changing the thinking patterns that produce urges to use psychoactive substances as well as altering habits that drive the addiction.  Motivational interviewing helps people increase their ability to change their addictive behavior, by helping them achieve the goals they personally consider important.  12-step facilitation introduces people to 12-step programs like AA and Narcotics Anonymous and helps them affiliate with these support groups.

Matters are complicated by the fact that some people who claim to use specific techniques know all the right buzzwords but haven’t been trained in the therapy, or don’t apply it correctly.  Ask about specific training; ideally see a practitioner with a master’s degree or higher and for teens, look for such qualifications in those who treat them day-to-day at any program.