Alcohol Addiction Treatment: From Twelve Steps to One Step

In the 1950's and 60's most adults in North America smoked cigarettes or other tobacco products. We thought nothing of it.

However, increasing research evidence of tobacco health risks began to overpower the tobacco industry's portrayal of smoking as safe and cool. As the evidence mounted, increasing numbers of people quit smoking or never started. The voices of those wanting smoke-free workplaces and restaurants got louder than the chorus of smokers shouting, "It is my inalienable right to smoke whenever and wherever I want to."

The tide had turned. Now in British Columbia where I live only about 15% of the population smokes tobacco. The clock cannot be turned back. Societal thinking about cigarette smoking has made a radical shift.

A parallel shift in our collective thinking is taking place with regard to the treatment of alcohol addiction…

Ask almost anyone what to do about alcoholism and they will suggest going to Alcoholics Anonymous (AA) or "going to rehab" for alcoholism treatment. Over 90% of the addiction rehab facilities in North America operate based on principles from AA's "Twelve Steps and Twelve Traditions." The Alcoholics Anonymous movement starts with the assumption that alcoholism is a progressive, incurable disease that can be managed, but the victim of alcoholism will be "in recovery for life."

A 1990's Gallup poll in the US found that almost 90% of people believed that alcoholism was a disease.

There is no doubt that many people have been helped by Alcoholics Anonymous, which maintains its strong position through television advertising, lobbying and the zeal of its adherents. And the multibillion dollar treatment center industry advertises its wares even more aggressively than AA.

However, in spite of the advertising, long-term abstinence following a residential twelve-step rehab program is about 5%, the same rate as achieved by quitting drinking without any outside help.

There is increasing awareness that AA is simply inappropriate for many people. In a US study, it was estimated that of all the people with serious alcohol problems, about 1 in 25 will ever go to an AA meeting. Alcoholics Anonymous and the 12 steps treatment centers don't reach those with major privacy issues, because exposure could impact their health insurance and professional licensing. US courts have ruled AA to be Christian religious in nature; so many people won't attend for religious reasons. Thousands more cannot afford the $15,000-plus tuition fees at the rehab centers. And what woman needs to hear yet another organization telling her she is powerless?

Are there any signs of a societal attitude shift about alcohol treatment? And does the evidence suggest alternative, more successful approaches to dealing with alcoholism? The answer to both questions is yes.

In contrast to the Gallup poll results with the general public, a survey of physicians found that 80% of responding doctors perceived alcoholism as simply bad behavior. And doctors are opinion leaders.

Furthermore, increasing numbers of treatment centers are distancing themselves from the twelve step model in their advertising. These facilities typically have a variety of licensed health professionals on their staffs because they operate from the principle that alcoholism can be overcome, not just managed.

The hard research evidence of more successful alternatives is solid and growing, but still limited.

The societal shift in attitude about alcoholism treatment will see an emphasis on personal choice and full recovery replace the notion that the alcoholic is a victim of a disease.

Permanent recovery is much more than simply stopping the use of alcohol. Current thinking is that alcoholics achieve successful, permanent recovery through self-reinvention or re-creation so as to make alcohol irrelevant to their lives. This has been my own experience and the experience of my clients.

As that more hopeful perception of the recovery process takes hold in society, many will refuse to stay stuck in their alcoholism and will seek to overcome alcoholism permanently.

One-step recovery replacing twelve-step addiction management would represent a major shift in the way society thinks about alcoholism. And it's underway!