The 12-Step Program – 12 Answers in 12 Months
James Krah is a licensed drug and alcohol counselor at American Addiction Centers where he serves as Director of Desert Hope Outpatient. His direct, simple approach makes him an ever-popular 12-Step facilitator among those in treatment.
12-Step – Is it science?
One of the things science is bringing to the fields of addiction and mental health is the realization that the best treatment is highly individualized.
“Our field has traditionally seen the problem… as something we can do on a mass scale. However, the actual problem is addiction, a chronic illness, which, like all chronic illnesses, requires an individual treatment plan based on the patient’s goals.” – Dr. Howard Wetsman, Chief Medical Officer, Townsend Treatment Centers In alcoholism, for example, researchers using MRI and PET scanning look at brain activity and the chemistry of the disease. They look at how the brain changes under alcohol use, over the short and long-term. Meanwhile, ongoing genetic studies link differing reactions up to individual markers. Study of the dopamine system zeroes in on the development of medications for better treatment in alcoholism and drug addiction. This research will discover more about brainwave markers such as P300 that correlate with the incidence of alcoholism. We are unlocking the genetic explanation for why some people can drink all their lives and not develop the disease of alcoholism, while others will launch a predictable trajectory toward alcoholism with their first drink.
Understanding the chemistry, brain activity, and genetics of alcoholism and other addictions will help develop much more effective treatments for the disease of addiction.
Used in combination, they will help professionals put together treatment suites that will vary from person to person.
We are not there yet.
Unfortunately, there is no “magic bullet” for treating alcohol-related problems. It is unclear why some people respond well to certain medications, but others do not. However, exciting new research is helping scientists learn more about how alcohol affects different people. – National Institute on Alcohol Abuse and Alcoholism (NIAAA)
12-Step – is it the only way?
No.When people ask for AA’s scientific credentials, they have often been put off by an “all or nothing” aspect to the from12-Step presentation – 12-Step is the only path; abstinence is the only goal. They point to individuals they know who have gotten sober and gone on to become successful at “casual drinking.” They point to others who live normal lives on medication and never set foot in a 12-Step group. All these possibilities can be true – on an individual basis. There are medications, long-term clinical therapies, and varying combinations of both.
Charged with making recommendations based on the latest research, the NIAAA encourages treatment that focuses not on the relapse, but on the ability to bounce back from relapse.
“Recovery is characterized by continual growth and improvement in one’s health and wellness that may involve setbacks. Because setbacks are a natural part of life, resilience becomes a key component of recovery.”
And 12-Step programs have become a key tool in the cause of bouncing back.
12-Step detractorsOne of the most vocal critics of 12-Step programs, Harvard University’s Lance Dodes points to the harm caused when someone in recovery takes a drink and judges himself a “failure.” While it’s true that the 12-Step program is set up to support abstinence as a goal, it also doesn’t judge people for relapsing. Individual groups or people may place more tension around this issue than the 12-Step program itself.
In an interview for an Atlantic article, Dodes cites the case of J.G. who was harmed, according to Dodes, by 12-Step principles. “Evening would fall and his heart would race as he thought ahead to another sleepless night. ‘So I’d have one drink,’ he says, ‘and the first thing on my mind was: I feel better now, but I’m screwed. I’m going right back to where I was. I might as well drink as much as I possibly can for the next three days.’
There are many important things going on in this story that can mean nothing for some individuals or turn into recurring land mines for others, especially in early recovery.
“We’re both close and far,” says Dr. Wetsman, a leader in personalized medicine for addiction treatment.
“We’re close in that we understand a lot about the neurobiology of the illness and about how to tailor treatment to overcome individual’s barriers to progress. But we’re far away in getting patients, practitioners, insurance companies, treatment centers.” – Dr. Howard Wetsman
Does 12-Step offer anything scientific?In general, the program is one of the largest providers of key components of a comprehensive recovery plan, as deemed by the latest science.
Community – A sense of not being alone, of acceptance and belonging Support – Having someone to turn to when addiction challenges arise Understanding – People with a shared experience; less self-explanation and more practical learning and strategy Modeling – to see a way through by observing others and gain hope for improvement
According to Substance Abuse and Mental Health Services Administration (SAMHSA) Recovery support is provided through treatment, services, and community-based programs by behavioral health care providers, peer providers, family members, friends and social networks, the faith community, and people with experience in recovery.
Peer providers, support, social network, a faith community, people with experience in recovery – 12-Step programs accommodate all these recovery-supporting ingredients.
In addition, the 12-Step program is non-judgmental and confidential. It is also ubiquitous – no matter where you are and when you’re available, you can usually find a 12-Step group (though individual 12-Step groups can vary in personality). This makes the math, if not the science, pretty simple: it may be easier to find a way to incorporate 12-Step into one’s recovery plan than to try to assemble individually all the proven support components it offers.