The average approach to substance abuse treatment for the past several decades has been a crash course on the 12 steps. There is no doubt that 12 step groups provided a much-needed solution to issues related to alcoholism, however, AA’s stated intention was not to discount or deny the importance of treating core issues as an adjunct to the 12 steps. Moreover, Alcoholics Anonymous was to be forever non-professional, with the stated primary purpose “to stay sober and help other alcoholics to achieve sobriety.”
The vast majority of the treatment industry has been teaching the 12 steps as the primary approach to 30-day treatment programs. Treatment usually consists of working the first three steps, learning about the disease concept, defining powerlessness and acceptance, assistance with the attainment of an AA/NA sponsor, internal and external triggers, and relapse prevention. Why is teaching the 12 steps the focus of treatment when AA does a superb job of handling this responsibility and providing this service for free? The second issue is whether it is ethical to charge for a service that is seemingly free.
Assume that an addict who has been drinking and using drugs for many years enters treatment at age 35. Also, let’s assume that this individual grew up in a family system whereby the father worked 70 hours a week, and the mother was a stay-at-home mom, alcoholic, and a participant in multiple affairs. Mom was lonely and used the patient as a surrogate spouse and confidant; thus, stressing the importance of maintaining her secrets. Moreover, the patient was a victim of sexual abuse by a relative from ages 6 to 12 and has never disclosed this abuse to anybody.
This person may enter treatment and AA with warped definitions of the principles espoused in 12 step groups. If this individual begins to work steps with their prior definition of concepts such as honesty, faith, courage, willingness, and humility, the work they complete will be severely diminished. If the individual’s definitions have been defined via their family of origin, as is the case with most individuals including alcoholics and addicts, how can they be expected to have a foundation for healthy definitions of the aforementioned definitions? The answer, it is impossible!
Unless this individual identifies the dysfunctional definitions they have been taught, as well as how these definitions have negatively impacted their lives and thereafter has assistance re-defining these concepts, physical and emotional sobriety will be tenuous. It is likely this individual suffers from issues related to abandonment, trust, lack of healthy attachments, anger, and severely warped definitions of love and intimacy; thus, arguably, a host of issues related to the need to numb via alcohol and drug addiction.
It begs the question as to whether providing education and teaching this patient about the disease concept and the intricacies of the 12 steps is a valuable first step in treating the patient as opposed to processing the patient’s trauma and abuse (core issues) for the purpose of identification and re-defining dysfunctional and destructive definitions of life. The first approach seems to put the cart before the horse and quite possibly has been a root cause of poor treatment outcomes of treating substance dependence.
This type of approach creates a revolving door of repeat business beneficial to the industry and potentially life-threatening to the patient. The other approach, that of defining dysfunctional core issues, re-defining these issues/ definitions, and thereafter or simultaneously incorporating the 12 steps seems to provide a much more comprehensive approach; thus, providing more successful outcomes. The lack of connection between core issues as a root cause of substance dependence creates a fallacy that treating substance dependence is as simple as removing the substance (acute stabilization). If this were a reality, it would only be necessary to place the patient in detoxification and that should be the end of the problem.
Another argument against treating core issues as a root cause of substance dependence is that the person may not be ’emotionally ready’ to handle these issues. If the direct cause of a person engaging in addictive behavior – alcohol, drugs, sex, relationships, gambling – is to avoid pain and dealing with abuse and trauma from their past, how can they get sober without addressing the direct cause of the problem? Alcohol, drugs, sex, relationships, etc. are the solution to the problem, not the problem. The theory that an individual should deal with one addictive issue at a time has proven to be a dismal failure. If all of the substances (drugs, alcohol, sex, relationships, etc.) are a means of avoiding the pain of the core issues, how will the person ever get well merely dealing with the faulty solutions, one at a time, as a means of solving the problem, given that the patient will substitute one addictive behavior for another as a means of avoiding the problem?
Without a holistic, core issues-centered approach to treating substance abuse, 12 step groups alone will likely fail. The absence of a truly multi-disciplinary approach that addresses biological, social, and core issues, coupled with a 12 step approach, is a set-up for a revolving door into present-day treatment and the ultimate failure of the patient to get well. It is time that professionals in the industry stop accepting failure as the only means of treating an individual suffering from substance dependence