You would think that after thousands of years of dealing with alcoholism, we would have the problem neatly wrapped up by now. At the very least you would think that we could point to the perfect course of therapy, to a specific approach that yields the best results.
At present that is not quite reality. Instead we have a few different treatment options and no hard and fast solutions. The overwhelmingly popular recommendation is for people to simply attend AA meetings. But is that really the best path for everyone? Is it the best path for anyone? What does the ideal alcohol addiction treatment really look like?
Is alcoholics anonymous really the best path for alcoholism recovery?
Alcoholics Anonymous is the default suggestion these days. Technically it is not “therapy” per se, but rather an informal gathering of meetings and a written program according to the Big Book of AA. This is not necessarily a good or bad thing, but it is not really professional therapy. In some ways this is actually a good thing, however (for example, it is certainly cheaper than professional therapy!).
AA is a form of group therapy. Some people do well in groups because they tend to be very outgoing anyway. Others do not respond as well to groups because they are introverted. I am in the latter group of introverts and so group therapy is not really the best path for me. I endured quite a bit of it but ultimately it was not to be a lifelong path for me. During my second year of AA I slipped quietly away from the meetings and left them behind forever, going off to find my own path in recovery. This worked really well for me and proved to me that you do not have to rely on others for your sobriety.
What alternative therapies exist to treat addiction?
There are a few alternate programs out there but none of them the popularity that AA has. There are even a few programs that attempt to forego the abstinence based model of recovery and instead they attempt to teach you how to moderate. I do not believe these are the best therapies available and I am not encouraged by the data that I have seen from these moderation approaches. In my opinion the ultimate solution for alcoholism and the best addiction therapy is always going to be based on total abstinence. In effect, my addiction is “cured” today so long as I don’t drink or take any drugs. I know that if I took even a little bit of an addictive substance and put it into my body today that it would start a massive chain reaction that would lead to bad things. Therefore I do not see how moderation could ever work out in the long run. The negative effects build up and then snowball into a monster. This is how addiction works; things spiral out of control and get worse over time.
Since the 12 step model is the default solution, we might also consider alternatives to that specific program. One alternative is Christian based recovery. These are people who are using religion and the Christian faith in order to overcome their addiction and remain clean and sober. Many of the same principles that apply to the AA model also apply to a Christian based approach. For example, you may have strength in the fellowship because you will have a community of people to help support you in church, just as you would have a community of support in AA. Keep in mind though that the support that you get in AA is a bit more pointed and specific, whereas the support that you get in a religious based program may be slightly more general (not as addiction-specific). This is not good or bad, simply different. It may or may not work for you.
One of the bottom lines that you are going to find in addiction recovery is that you have to test things. Don’t take my word for anything, don’t believe anything you read necessarily, but instead go out there and test every assumption that you have, test every method for recovery in your own life, and find what truly works for you. What does it matter what I say about recovery, if it does not help you? What does it matter if someone tells you that your method is flawed if it is actually helping you and working for you? The best alcoholism therapy is the one that is actually useful and producing good results in your own life today.
So more than anything else, I want you to test all assumptions. Test things out and find what works. So many people have blind faith in methods that are not yet proven in their own life. Just because AA works for others does not mean it is the perfect solution for you. Likewise, just because Christian based recovery works for some does not mean it should be forced on you as a solution.
Are certain treatment methods better suited to certain people based on personality type?
There was a large study done in the past that attempted to match individuals up to the proper treatment approach. The study was called “project Match” and the results of it can sort of be skewed to support whatever viewpoint you currently hold. What they did in that study was to try to match individuals up to the therapy that suited them best. I believe in the study they used the 12 step program, a cognitive thinking therapy, and also a motivational behavior therapy.
The ultimate conclusion of that study was that the chosen therapy type does not really matter, because statistically all three therapies were equally effective. However if you are a strong supporter of AA then you would look at the data and say that AA was the most effective therapy. In truth the lead that AA enjoyed in that study was so small that it was not statistically great enough to call it a “winner.” So you can certainly get whatever you want out of Project Match depending on your beliefs: you can say that AA is the clear winner, or you can say they are all statistically equal. Both are basically true!
I believe that there is a very good reason that Project Match turned out the way that it did.
If you take 100 people who are on the brink of recovery you will find that a certain percentage of them who are truly at a point of full surrender. If you take those 100 people and you expose them to various treatment types, I don’t really think it matters much which form of therapy you expose them to. The ones who are at the point of full surrender are going to embrace recovery and do well, while the others are going to relapse.
Therefore it is not the therapy chosen that makes or breaks your recovery, but instead it is the depth of your surrender.
In other words, some people just aren’t ready to get sober yet.
Ultimately you have to find a path that works for you, based on surrender
Basic alcohol therapy is going to be pretty much the same regardless of who it is implemented. Any abstinence based approach is going to produce similar results to people who have reached a point of full surrender.
There is a selection bias at work here and anyone can expose their own selection bias if they are willing to take a step back and look at the bigger picture.
For example, I know and have met dozens of people in AA who believe that no other program for recovery possibly exists, and that AA is the only real solution. They defend this stance rather vehemently for no apparent reason (other than their own internal fear).
So what is really going on here? Selection bias. The recovering alcoholic has had a lifelong struggle with alcoholism in which they have tried several times to get sobered up. They attribute all of their failures to selecting poor therapies, which is a huge error on their part. They did not fail in the past because they selected poor therapies, they failed because they had not yet surrendered. So maybe someone goes to see a counselor and that therapist tries cognitive behavioral therapy with them. Because they have not yet surrendered this causes them to relapse and so they write off cognitive behavioral therapy as being useless. Years pass and they try other things and they struggle with alcoholism. Finally they surrender fully and they arrive at an AA meeting. Suddenly they have found sobriety and in their mind the answer was AA all along, they just had not discovered it and embraced it yet.
So while they remain sober they have this story, this past history that justifies the AA program to them. They believe that everyone should try AA and give it a chance because it is what finally worked for them. Now that they are in AA they surround themselves with other people who have also found sobriety in AA, so their experiences only serve to reinforce each other. They become a self selecting group of people who found sobriety in AA, and they go on to believe that no one outside of this group could ever find sobriety or happiness.
So it is not that AA is the best therapy available, it is simply that people who attend AA meetings are part of a self selecting group. They don’t ever see the evidence of alcoholics who have found sobriety through other methods, so they believe that AA is the “one true path to recovery.” I don’t actually have a problem with this so long as they basically keep it to themselves and not push it on others as the ultimate solution.
Someone else who is struggling to overcome alcoholism may find that a different form of alcoholism therapy works better for them (such as cognitive behavioral therapy). In fact it is not so much that something else works better, but instead it is that no one should be force to have a certain solution thrust upon them, especially when some of these solutions carry spiritual and/or religious undertones to them. It is not that AA would not work for someone (because I believe it will work for anyone who is in a state of total surrender), but that it should not be forced on others as the default solution to recovery. Any default solution should be far more neutral in my opinion.
Solutions based on personal growth and development
Is there a therapy for alcohol addiction that is based on personal growth and development? From what I have observed I believe the answer to this is “no,” which is a darn shame.
My experience in recovery is that alcoholism is best overcome through the use of positive action. The point is that you must rebuild your life after addiction and in order to do that you have to take lots of positive action.
Long term treatment and transitional housing is the closest thing that I have found to this. A sober living environment that does not push a specific program of recovery is probably the most flexible and powerful method of recovery that is available in my opinion. Unfortunately this is not necessarily going to be extremely effective in terms of success rates for recovering alcoholics because it is probably not structured enough. In other words, if you can introduce a bit more structure than this (such as demanding daily AA meeting attendance) then you will get slightly better rates of success. Forcing compliance is generally better than total freedom when it comes to early recovery. This is why rehab works better than nothing.
In my world the best form of treatment is personal growth.
Think about it.
If you are trying to overcome alcoholism then you have these behaviors that you are desperately trying to avoid. You go out and get drunk and that is screwing up your life. So you want to stop getting drunk and for me that meant I could not put any alcohol at all into my body.
But the problem with that solution is that I believed that abstinence would kill me from sheer boredom and frustration. I believed that if I were sober for the rest of my life that my life would not be worth living. Of course this turned out to be false but I still had to walk through some serious pain in order to discover the truth.
So in early sobriety I had to surrender completely. It did not really matter what or who I surrendered to, because the idea was that I just had to get out of my own way for a while. I was trying to pursue happiness through self medicating, and this was no longer working. So I had to find a new angle, I had to find a new way to rebuild my life in recovery.
It all starts with positive action. I had to do something different. I had to do a lot of things different.
I had to take direction from others. I had to take advice from other people. This in itself was a crushing blow to the ego. But I had to admit that my own ideas had created misery due to my drinking. My own path was killing me. I had to try something else.
You do not have to take advice forever. You don’t have to completely succumb to other’s ideas and live like a robot forever. You just have to do it for a few months. If you can squash your ego and follow this path for a few months then you will gain all of the freedom in the world back.
Eventually you can create positive momentum in your life with your own ideas. Taking positive action and pursuing personal growth will allow you to rebuild a life that you are actually excited to live. This is a daily thing that you strive for. The days add up quickly in recovery. Before you know it you will have ten years sober. The time just flies. And what will you do with those days? Each day is a new opportunity. Each day is an opportunity for growth, to improve your life, to make it better.
Some people don’t want to improve their life. Some people just want to be sober, to avoid misery and pain. They want the easy way out. The least amount of thinking. These are the people who want addiction cured with a pill.
Others want to grab recovery by the tail and build this awesome new life for themselves. They want to create a new reality. They want to experience joy, passion, and excitement in recovery. They don’t need the pill that cures addiction, nor do they want it.
Therefore you need to find the method that works best for you after you have surrendered fully to your disease. You have to decide how much control you want over your recovery method. If you want to create your own path in recovery then you can certainly do that, but the responsibility will be all yours. If you want to slide through recovery on auto-pilot then you can sit in AA meetings every day and do that too–there are many people who remain sober this way.
There is no right or wrong way here, that is for sure. We know so little about how addiction and recovery actually work. If AA works for you then it is your responsibility to pursue that as your solution and dedicate your life to growth in AA. Don’t just casually accept the program, embrace it fully and learn and grow using those principles. If AA does not work for you then you have to take on the full responsibility that your sobriety is entirely up to you, and that you need to take positive action.
I have heard many people in AA who gave up after they found that the program did not really work for them. They are operating under the impression that AA is the only way to stay sober in the whole world, and that no other solution exists. So when they relapse they give up all hope and do not believe that they have any sort of chance at sobriety. This is crazy! You do not have to believe in the myth that there is only one recovery solution today. Instead, take responsibility for yourself and realize that your sobriety is entirely up to you, and that your future happiness is something that you have to create with positive action.
The program that you choose to follow is almost irrelevant. It still all comes down to taking positive action. If you are not willing to put in the work then it matters very little which therapy you choose to follow.
A new life in recovery has to be built with one positive action layered upon another. Our lives improve as we make changes on a daily basis. Consistent action is the key to a new life in sobriety.