“When the winds of change blow, some people build walls and others build windmills.”

-Chinese Proverb

12-step support groups and philosophies can be a helpful resource and tool for individual’s seeking sobriety or changes to their problematic substance use. However, the 12-steps are not the only way for people to make changes. Some have attacked the 12-step model itself for its approaches and philosophies. The problem is not with the 12-steps themselves, which have helped numerous amounts of people change their lives, but in the way the 12-steps are used and promoted by supporters of our traditional substance treatment system.

The 12-steps have come to dominate our treatment of addictive behaviors,  as if this is the only alternative to long term treatment success. Whether through TV, the media, the government, or through consultation with a medical professional, it appears as if the only way to change is by committing to 12-step groups, obtaining a sponsor, and attending 90 meetings in 90 days.

The above mentality can lead those who fail to acheive abstinence to internalize relapse from the perspective of moral fragility and a lack of will power. A pervasive sense of hopelessness about change is often observed, which further leads these individual’s to becom stuck in a self destructive  pattern of substance use. Rather than examining the treatment approach, its relative effectiveness, and goodness of fit, the individual assumes complete responsibility. The 12-steps may provide valuable support and are proven to be effective for a percentage of people. However, as research has shown traditional 12 step approaches have an insanely high drop rate and fail to adequately address the needs of most individuals. Its curious why this would be a mandated form of treatment when the treatment itself is so widely ineffective.

Over the previous decades, through greater attention to the problems of substance use in our society, psychology and the medical field have developed alternative treatments to the 12-steps. Much like 12-step approaches, these treatments do not work for everyone, but offer alternative forms of treatment and improve the overall effectiveness of substance abuse treatment.

Motivational Interviewing (MI) assists individual’s develop their own change strategies and increases motivation to change, a critical factor in sustaining change. Cognitive-Behavioral interventions help individuals identify the often complex reasons for substance use and the many factors influencing and maintaining its powerful influence. CBT teaches clients how to cope with cravings, helps develop more adaptive responses to problematic behaviors, and guides them in modifying unhelpful ways of thinking.  Craft family therapy assists family members change their behaviors to facilitate a process of change for their loved one suffering from substance abuse problems. Mindfulness based approaches help people cope effectively with relapse triggers and the pay attention to factors influencing relapse.

Harm reduction and moderation approaches help people reduce the negative consequences of their substance use and are often very helpful for those individuals who are not yet ready to give up their substance use.  New pharmacotherapies help with curbing cravings and withdrawal symptoms. This is just to name a few, but these interventions provide a multitude of methods and choices for those who have not found recovery in the 12-step approaches.

Our challenge as treatment professionals is to individualize our treatment approaches, supporting each individual’s choice to determine their path toward recovery. From a scientific perspective, we must develop of range of empirically supported interventions and better identify what works, for whom, in what context, and at what time. Please support efforts to educate the general treatment community of the scientific advancements in the field of addiction treatment.