While I believe either 12-step or Rational Recovery can be useful in supporting clients in recovery, my own approach is based on the research and clinical practice of attachment theory.
The 12-step model is spiritual and group focused. The goal is complete elimination of the addictive behavior.
Millions of people have gained sobriety by working The 12 Steps and taking part in the 12-step fellowship.
Many would have died of their addictions without the program.
The first steps are:
- Step 1 – We admitted we were powerless over our addiction, that our lives had become unmanageable
- Step 2 – Came to believe that a Power greater than ourselves could restore us to sanity
- Step 3 – Made a decision to turn our will and our lives over to the care of God as we understood God
Those with a scientific perspective complain there is no standardized research on 12-step programs because the nature of the program does not allow for it. Researched or not, it is clear that 12-step groups work for a great many.
12-step programs are the choice for the vast majority of people seeking treatment.
The most popular alternative to AA is the SMART recovery program, which makes use of cognitive behavioral therapy.
SMART programs are more cognitive than spiritual, and affirm the person’s power over their addictions rather than requiring the person to acknowledge that they are powerless.
In some situations, alternative programs will work with a goal of reducing the addictive behavior to the point where it is no longer causing harm.
The SMART program uses cognitive-behavioral techniques. SMART groups meet frequently at various locations, just like the 12-step models. However, how the meetings are conducted is very different from 12-step meetings. For instance, there are no testimonials, or tokens.
Like many cognitive-behavioral approaches to addiction, the SMART program has been well researched. The research shows these programs work well.
The SMART program focuses on four areas which are vital to recovery.
1. Building and maintaining motivation
2. Coping with urges
3. Managing thoughts, feelings and behaviors
4. Building a safer, happier and balanced lifestyle.
There are several in-patient alternatives to 12-step programs. The largest local organization is Practical Recovery, which has both outpatient services and excellent residential facilities. Both individual and group therapy is used. Practical recovery was founded by Dr. Tom Horvath, who is still actively in charge of the organization. Practical Recovery looks carefully at how our beliefs – both conscious and unconscious – lead to self-defeating behaviors like addiction. Many of these beliefs were adopted in response to painful situations during childhood, before we were able to logically think things through.
Another residential alternative to the 12-steps is Passages in Malibu. Passages takes a very eclectic view of treatment, but strongly disagrees with the 12-step or disease models of addiction. The Passages approach looks at addiction as a symptom of the problem and not as a cause or a disease. In his book about the program founder Chris Prentiss emphasizes: “At Passages, we have never found it to be otherwise – at the bottom of every person’s dependency, there is a always a deep pain. Discovering the pain and healing it is an essential step in ending dependency.” (p 141). “…Continuing sobriety requires understanding the sources of pain and addressing them rather than finding a quick way to mask the pain” (p. 233). Prentiss claims a remarkable success rate: “of the people who have graduated from Passages, fewer than 16 percent have relapsed.” (p. 160)