Twelve Step Programs: An Update : Addictive Disorders & Their Treatment (original) (raw)

Original Articles

From the Department of Psychiatry, University of Texas Health Science Center at Houston.

Address reprint requests to Buddy Lile, MD, Clinical Assistant Professor, Department of Psychiatry, University of Texas Health Science Center at Houston, 1300 Moursund, Houston, TX 77030.

Abstract

Substance abuse, especially alcoholism, is a serious and long-standing problem that causes great personal, societal, and financial hardship. Although advances have been made in the medical treatment of these disorders, psychotherapeutic interventions are the current mainstay of treatment. In an effort to provide holistic treatment of addictive disorders, Alcoholics Anonymous was developed by two severe alcoholics in the 1930s. Alcoholics Anonymous (AA) has been adapted to the management of many different addictions and other chronic conditions such as HIV/AIDS, hepatitis, etc. since its inception; furthermore, twelve step programs and the related “disease concept of treatment,” including alcoholism and addiction, have heavily influenced inpatient and outpatient treatment.

The twelve-step approach differs from other addiction treatment strategies. First, the program emphasizes a comprehensive treatment approach for the disease of addiction, addressing mental, physical, and spiritual components. Moreover, participation in each other's treatment is critical to sustained sobriety. With intensive work in the program, the twelve-step approach offers management of the addictive behavior as well as improvement in handling “life on life's terms.”

Twelve step treatments have significant positives such as being widely available for little to no cost and promising success via a holistic treatment strategy. However, the twelve step approach has been criticized for being overly religious, inflexible, and controlling. It has also been accused of fostering a substitute dependency. Despite the plentiful anecdotal reports of positive treatment outcomes, rigorous examination of treatment efficacy has been challenging and has produced varying results. However, more recent and detailed studies have generated optimistic findings.

The benefits of enhanced knowledge regarding this treatment modality are readily apparent when serving chronically addicted clients in an increasingly managed-care environment. This article is a primer on the twelve-step model, with a history of AA, a brief examination of how a twelve-step program works, a review of research on this treatment modality, and a discussion of handling common issues reported by clients regarding this psychosocial approach.