The Value of the 12 Steps in Treatment Today
We appreciate journalist Gabrielle Glaser’s continuing efforts to raise awareness about addiction, treatment, and recovery. We see that she is passionate about making a difference and want to recognize the importance of elevating the dialogue about addiction. However, we at Caron Treatment Centers respectfully disagree with some of Ms. Glaser’s points in her recent story in The Atlantic. As the President and CEO of Caron, I would like to clarify some of the dangerous misconceptions included in the piece that may undermine the value of the 12 steps in today’s society.
In mentioning alternatives to the 12 steps that are “based on modern science,” Glaser implies that Alcoholics Anonymous is “old school” and describes its philosophy as one-size-fits-all. In reality, a number of leading centers such as Caron take a modern, personalized, and evidence-based approach to treating each patient while effectively keeping the 12 steps as a core part of recovery. In fact, it’s very difficult to find alternatives to the 12 steps that will sustain people for long periods of time. People who regularly attend meetings are still vulnerable to relapse, but not nearly as vulnerable as those who don’t because of the community and fellowship that meetings provide.
In fact, a new book by Dr. Joseph Nowinski If You Work It, It Works! The Science Behind 12-Step Recovery takes a strong position on the research behind the 12 steps. In the book, Dr. Nowinski discusses a study he conducted at Yale in the 1990s which showed that the 12 steps were reported to be as helpful to people with an alcohol abuse problem as it was for those with more severe alcohol dependence. Additionally, he points out that research has demonstrated that 12-Step support and formal treatment together tend to produce better results than either of the two alone. This is just one of a number of studies that support the role of the 12 steps in an overarching recovery plan.
Caron can also provide promising numbers, since we have measured the results of one of our aftercare programs, My First Year, which offers intensive support during clients’ initial year of sobriety when they are highly vulnerable to relapse. For example, patients and their families are provided with a structured, personalized tool in the form of a confidential online social platform to help them meet the challenges of early recovery. Clients sign a contract, are assigned a Recovery Specialist, and undergo random drug and alcohol screenings. They’re also provided with a 12-step meeting tracker and have frequent follow-up calls with Caron clinical staff. Additionally, select family members and a therapist may be included in the ongoing follow-up to continue to support well-being within the entire family.
We defined success as people who stayed in touch for a year and continued their recovery. In the program’s first three years, the success rate for a patient’s first year in recovery was 85 percent. 92 percent of drug screens were negative and of those who relapsed, 85 percent contacted us again and reestablished their recovery. And while the success is not entirely attributed to the 12 steps, we do know that they played an important role for these former patients.
Caron does not believe relapse points to the “failure” of the 12 steps or even the “failure” of an individual who relapses. Relapse speaks to the chronic nature of addiction, the powerful triggers that exist, the need to have a daily plan to maintain sobriety, and also the ability to thrive and enjoy life beyond just “staying sober.” We are fortunate to see that many individuals not only stay sober with the 12 steps and other ongoing support, but are also productive members of society living healthy and fulfilling lives.
Glaser neglects to mention that alcoholism affects the entire family and that AA takes this into account by offering Al-Anon for family members. In turn, these 12-step meetings effectively align with—and are promoted in—family programs offered by many treatment centers. Treating the entire family is essential because the entire family needs to recover and heal.
The author is misinformed in yet other areas. It’s well-known that many clinicians today don’t believe you have to hit “rock bottom” before you can recover; Caron and other experts believe in intervening as early as possible. Glaser also supports proponents of drinking in moderation. This is demonstrative of the perpetual societal misunderstanding about the importance of abstinence.
There is a difference in the brain chemistry of a person who abuses alcohol and a person who is addicted to it. Abusers may be able to drink moderately at times, but an alcoholic cannot. Many alcoholics wish they could drink in moderation and many have tried. Alcoholics can’t do it and it’s not a failure of willpower or a moral failing. Despite Glaser’s statement to the contrary, alcoholism is a chronic brain disorder that, if left untreated, is fatal. We believe there is no quick fix and/or middle ground if one is addicted. Abstinence is the only way to achieve long-term recovery. Unfortunately, we do also treat many former alcohol abusers who did eventually become addicted.
It’s also important to clarify Glaser’s point about 12-step meetings being ill-equipped to address mental health issues that accompany addiction. In reality, the 12-steps are designed as a support group and not as a replacement for certified mental health professionals. We at Caron agree that individuals must address co-occurring behavioral issues and mental health disorders along with their addiction and in fact, that is an integral part of our treatment. To this effect, we have worked hard to raise the standard of professional qualifications both within our system and within the industry. Addiction needs to be treated holistically, addressing all of the surrounding issues, in order to give people the best chance at recovery.
Today, the ideal Addiction Counselor holds a master’s degree as well as state and national licenses/certifications and has acquired knowledge and experience regarding addiction as well as other mental health issues. Our clinical team is compromised of Physicians, Psychiatrics, certified Multiple Addictions Therapists, Certified Co-Occurring Disorders Professionals, Certified Sex Addiction Therapists, Licensed Professional Counselors, Certified Relapse Specialists, Licensed Psychologists, Licensed Social Workers and Licensed Marriage and Family Therapists.
Glaser also suggests that any facility supporting the 12 steps would likely take an anti-medicine approach because of traditional doctrine associated with AA. But that is not always the case. In fact, Caron utilizes evidence based medication strategies to assist in our patients recoveries. Our board certified addiction treatment psychiatrist routinely treats co-occurring psychiatric issues, using evidence based medicine in an effort to support the patient’s wellness. We use Naltrexone (orally and in an injectable form (Vivitrol). Naltrexone blocks opioid receptors and has been found in clinical trials to be effective in treating Alcohol Dependence and Opioid Dependence. We utilize Buprenorphine, (Subutex or Suboxone) in opioid withdrawal management. We also prescribe Campral (Acamprosate) to help treat alcohol dependence. We do not proscribe medications that are shown to have addictive properties, such as benzodiazepines (e.g., Xanax, Librium and Klonopin) and opiates (e.g., Vicodin, Percoset).
Additionally, Glaser finds fault with the spiritual element of AA, referring to the experience of one addict who was “put off by the faith-based approach of the 12 steps, five of which mention G-d.” Reverend Jack Abel, says that spirituality is more about having a connection to yourself, others, nature, and universality, and that the word ‘G-d’ simply represents a connection to something universal. It’s the principles of spirituality that are important to recovery because addicts are isolated and disconnected. A big part of recovery is reconnecting.
I would be remiss if I didn’t mention the testimonials from our alumni. One former alumnus blogged about the issue in his piece “Why We Can’t Dismiss the 12-Step Model.” He says he has learned that there is no quick fix for alcoholism; it takes a comprehensive treatment program for both the addict and the family. He credits the 12 steps, part of his program, as helping him recover and stay sober and urges others to attend and participate in 12 step meetings.
Glaser is absolutely correct to say there is no one-size-fits-all model for addiction treatment. However, we ask critics to take a look from a different perspective and better understand that you can have a modern approach to treatment and still benefit from the community and support of a 12-step program.