psychiatrist with notepad talking to patient

Why It’s Important to Have 12-Step Alternatives

By Robert Matylewicz, DO, ABAM, Medical Director at Clarity Way

Twelve-step alternatives are just as effective as the 12 Steps, according to a recent study by the Alcohol Research Group. As the first of its kind, the study looked at over 600 participants’ self-reported outcomes of support group involvement and substance use and severity over 12 months.

While much more research is needed to make any definitive claims, I’m not surprised these initial findings showed similar outcomes between 12-step groups and alternative 12 steps such as SMART Recovery, LifeRing and Women for Sobriety.

12 Steps vs. 12-Step Alternatives 

At their core, mutual help groups have more similarities than differences. Both approaches offer aspects we know help people in recovery such as social support from others with similar circumstances, accountability in sobriety, and a safe space for open, honest sharing.

The 12 Steps put emphasis on a higher power, the importance of a sponsor and “working the steps.” Non 12-step recovery programs take a secular approach that is grounded in self-empowerment. They don’t have sponsors or steps, but overarching philosophies and fundamental principles interwoven into their teachings, exercises and groups. The 12-step alternatives also evolve their guidelines and philosophies as new research on addiction and mental health issues surfaces.

I don’t think there’s a right or wrong way. I say whatever approach helps the client stay sober and live a healthy life is fine.

What Attracts People to 12-Step Alternatives?

Mutual help groups, like Alcoholics Anonymous and Narcotics Anonymous, are tried-and-true recovery programs. We know they work. They also have a reputation of being rigid and strict. Whether that’s warranted or not, some people prefer a different approach to sobriety. They may be turned off by the higher power aspect of the 12 Steps or want more tolerance around the “rules of recovery.”

That being said, there’s a misconception that groups like SMART Recovery, Refuge Recovery and others don’t teach abstinence. In reality, these groups do recognize abstinence as the only way to long-term sobriety. They’re just more flexible about meeting people where they are in any particular moment in time.

For instance, some 12-step groups aren’t as accepting of people using medication-assisted treatment for opioid use disorders or those who are in one of the earlier stages of change – not yet ready to give up all of their “vices” yet for instance. The non 12-step recovery programs are more open to these types of situations.

Why Meeting People Where They Are Is Important

While I don’t advocate for one approach over the other, I do believe that being more accepting of where people are on their way to abstinence is a big draw for the 12-step alternatives. It’s important to look at the endpoint. Is the goal to be abstinent and miserable and unable to function, or is the goal to live a healthy life?

Often the thought of never using substances again is too overwhelming to grasp at the beginning of recovery. Time and time again patients ask me, “When can I drink again? Can I ever be a social drinker?” I tell them no, you crossed that line. You drink or do a drug, and you go back into active addiction. People don’t like that answer. A lot of them still hold out that hope that they can drink again.

It’s a controversial topic, but harm reduction is real. Some people are looking for harm reduction, and sometimes addiction and healthcare professionals must consider that. I always like to compare substance use disorders to other medical conditions.

We don’t turn someone away from the ER who’s in cardiac arrest just because they don’t want to go to cardiac rehabilitation. We don’t refuse to treat someone with diabetes because they want to have their pancakes or dessert once a week. Some people are the same way with addiction. In these cases, we need to get them to wherever they’re willing to start.

The big confusion in our industry right now is we always want to “fix” people to perfection, whether that be cancer, diabetes, addiction or other chronic conditions. My personal opinion is the goal should be abstinence, but know that realistically people may relapse.

Some research indicates heroin relapse rates around 90%. The odds are that people with an alcohol use disorder will experience at least one relapse in the four years after getting sober. Methamphetamine relapse rates hover around 60% within a year of treatment. We can’t ignore the possibility of relapse. The hope is that people learn from those relapses.

I find that far more often than not, providers are doing much more work than the patient is willing to do. For example, if I have a client who says they’re ready to give up alcohol, but they’re not coming to drug rehab if they can’t take Xanax, it’s difficult, but I say, okay, come on in. I won’t strip a client of their meds if they’re legally prescribed. Yes, I’ll explain to them why those meds are harming them in similar ways as alcohol, I’ll try to start a slow taper, but it’s difficult for a patient to understand why they must give up a legally prescribed medication. In many cases, as they go through treatment and talk to other clients, they realize on their own why it’s necessary to discontinue use of a medication given their history and propensity to addiction. We work with them though, because at the end of the day, some addiction treatment is better than none.

Choosing Between 12-Step and Non 12-Step

Only the individual knows whether a 12-step approach or one of the alternative 12-step approaches is best for them. At my work, that’s been our motto since we opened – we meet clients where they are and let them decide the path that’s going to get them sober. For people who’ve relapsed, we make sure they explore the “whys” and learn from those lessons. It isn’t that the 12 Steps or another group is better or to blame. If a client comes in who’s been sober for 20 years and relapsed, it’s not necessarily time to quit AA. Obviously, a lot about AA was working for them.

Treating addictions and relapses is about getting to the root causes of the symptoms, which show up as substance abuse and other destructive behaviors. Next is putting the work into maintaining recovery by doing the things we know support it like practicing healthy self-care, attending therapy, and participating in support groups like the 12 Steps or an alternative. They’re a means to the same end.


Posted on April 23rd, 2018 in Blog


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