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When is the 12 Step Approach to Recovery Not Enough?

Conquering an addiction can be a lifelong process. Recovery and treatment are the beginning of the journey but maintaining a clean lifestyle requires effort and the right set of tools. The ability to manage emotional and psychological wellbeing is for many the key to sustained recovery.

For this article, we’ll take a close look at both the 12 Step Facilitation (TSF) approach and a therapy-based approach to recovery in order to better understand the mechanisms for success for each. The goal of this article will be to shine some light on a new approach to treating addiction while paying our respects to the longstanding 80-year-old tradition of 12 Steps.

Several generations have turned to 12 Steps as the framework for sustained sobriety. The process involves surrendering to a higher power and leaning on a network of like-minded individuals through group meetings. One Harvard Medical School professor, Dr. Lance Dodes, estimates show that roughly than 5 million Americans attend an AA meeting at least once per year.

Over the past 25 years, new evidence-based theories have paved the way for a therapy-based approach to addiction treatment. The research has shown that this scientific approach is magnitudes more effective when one or more co-occurring disorders like depression, grief, shame, guilt, anger or fear is the root cause of the addiction. In particular, the use of Cognitive Behavioral Therapy (also known as CBT) can be life-changing.

What Is CBT?

Let’s start off with a breakdown of CBT and its core principles. Initially developed to treat depression; CBT is a research-based treatment modality which focuses on changing negative thought patterns through individual and group therapies. CBT involves a strict curriculum designed to address the root of a person’s addiction and to treat any co-occurring disorders they may be suffering from (such as trauma or mental health issues).

Through CBT, therapists are able to alter the pattern of thinking that drives a person’s addictive behaviors, ultimately changing the way they feel. CBT focuses on solutions, encouraging the patient to challenge distorted cognitions and let go of destructive habits.

cbt cognitive behavioral therapy addiction recovery

A 2010 study showed that “Cognitive behavioral therapy (CBT) for substance use disorders has demonstrated efficacy as both a monotherapy and as part of combination treatment strategies. An earlier study in 2004 focused on young addicts and found that CBT yielded “significant and clinically meaningful reductions in adolescent substance use.” Another study in 2013 found that women with comorbid psychiatric and substance abuse problems experienced improvement after partaking in a combined CBT and pharmacotherapy program.

How Does CBT Compare To The Traditional 12 Steps?

There is no denying that, since their introduction back in 1939, 12-step programs have helped many people cope with addiction. However, while the core structure and philosophies of 12-step programs have remained largely unchanged, the fields of psychology and neuroscience have developed dramatically over the past decades. As a result, a growing number of professionals within the recovery community have begun to acknowledge and embrace a therapy-based approach.

The Atlantic recently published a well-researched article that asks some pretty tough questions of the 12 Step Approach, offering some pause for thought for anyone considering their treatment options.

In the article, Atlantic staffer Jake Flanagin struggles with how exactly 12 Steps became so widely accepted and whether or not a program that has remained essentially unchanged for 80 years is still relevant today. Flanagin dissects AA in particular, looking at success rates, religious affiliation, and how it has been insinuated into our legal system.

Peer-reviewed studies have pegged the success rate of AA between 5 and 10%. Contrast this with AA’s own internal survey which reports that 33% of its members had stayed sober for more than a decade. The problem is that AA’s numbers don’t take into account the large numbers of people who don’t complete the first year, or completing the 12 steps (the definition of success by their standards).

TSF 12 Steps of AA

One 2008 study highlighted the difficulty in assessing the success rate for TSF and other support groups because of the “high attrition which critically affects the potential effectiveness of 12-step as a recovery resource”. In 2006 the New York Times published an article on TSF that found “no proof that they are superior to any other intervention in reducing alcohol dependence”. In that article, Dr. Edward V. Nunes, a professor of clinical psychiatry at Columbia, acknowledges that “A.A. has helped a lot of people”.

AA is a self-identified Christian organization. While references to God in the TSF are somewhat open to interpretation, the founding literature is clear: “Our real purpose is to fit ourselves to be of maximum service to God”. For nontheists “asking God to remove defects of character” for example (step #6) can be problematic.

Flanagin takes issue with the fact that AA very strategically gained legitimacy by publishing favorable news articles and establishing foundations like The National Council on Alcoholism and Drug Dependence (est. 1944) in order to “dictate the conversation”. By 1989, the first drug courts were sentencing offenders to 12-step programs, even though no science existed to back the efficacy of the approach.

Finally, Flanagin asks pointedly why addicts shouldn’t be given more powerful tools than blind faith. He also acknowledges that pills and therapy and data aren’t necessarily enough to treat a condition so closely tied to emotional well-being and self-worth, pointing out that humans crave community.

How Can We Bring The Best Of Both Worlds Together?

As is mentioned above, the goal of this article isn’t to bash the 12 Steps, for this method has certainly helped many people struggling with drug and alcohol addiction over the past 79 years. Clearly, there are components of the 12-step approach that provide an obvious benefit to addicts.

Both the camaraderie and group support offered by 12-step programs have proven to be invaluable to many recovering addicts. It stands to reason that for addicts, who often suffer in isolation, participating in a supportive and nurturing group of others who share similar challenges can provide huge benefits. Therefore it should come as little surprise that similar groups also play a central role in therapy-based treatment programs that utilize CBT techniques.

Cognitive Behavioral Therapy is typically practiced during both individual and group sessions. But instead of the structure of a typical AA meeting, therapy-based group sessions are led by trained professional therapists who facilitate conversations and guide group members with fundamental CBT techniques. In addition, there are times when family members and friends are brought in to contribute to the process.

CBT sessions include specific exercises designed to increase awareness and develop Mindfulness (such as breathing and tonal explorations). Another technique that is unique to CBT and which has shown great success is the Reframing Exercise. These exercises push people to challenge unhealthy beliefs about themselves or others. Yet another component of CBT, known as Somatic Experiencing, is a therapy designed to build awareness of buried traumas.

The Inneractions Experience

The outpatient program at our inneractions facility focuses on an evidence-based therapeutic approach that works to blend science, research, and emotions into the recovery process. What we ultimately believe is that an active change in beliefs and behaviors is what’s needed to acquire and sustain sobriety.

At inneractions, we help individuals establish healthy long-lasting lifestyles free from the destruction of addictive behavior. It is our belief that, with the proper therapeutic tools, anyone can achieve wellness and start the process of repairing personal, professional and family relationships.

To learn more about how inneractions can help, reach out via phone (818)-571-9841 or through our Website Contact Page.