If you were a woman with breast cancer, you’d probably want to know that there were several treatment options you had: radical mastectomy, lumpectomy, radiation, chemotherapy, holistic services, nutritional approaches, some combination of these options, or doing nothing, with new options emerging continually. You might be inclined to let your physician decide what to do. However, most individuals would want to make a decision of this magnitude for themselves. So, you would want to know how successful each approach is, what it costs, the recovery period involved, the side effects, and the likely complications. You would want to talk to individuals who had used each approach. You would search the internet. You would get input from multiple sources. Your final decision would probably be made in consultation with your physician, and loves ones. It would be based on many factors, especially your own deepest beliefs and values.
Seeking addiction recovery in the US is a very different experience from seeking cancer treatment. Most people don’t know that there are a range of recovery options. Most professionals don’t volunteer information about these options (presumably because they don’t know this information). Most individuals considering getting outside assistance with recovery are told that there is only one effective approach, the 12 step approach.
Despite being given the misinformation that “AA is the only way” some people intuitively know there must be other options. How do they know? Based on prior life experience, apparently they know to ask some relevant questions.
1) Is AA effective? As it turns out, the effectiveness of AA is unknown. A little searching on the internet will reveal this fact. For instance, the National Registry of Evidence Based Programs (nrepp.samhsa.gov) doesn’t list AA. Of the seven experimentally tested and replicated alcohol treatments for adults, only one includes AA attendance.
The National Registry is a service of the US federal government. It states on the home page: “Welcome to the National Registry of Evidence based Programs and Practices (NREPP), a service of the Substance Abuse and Mental Health Services Administration (SAMHSA). NREPP is a searchable database of interventions for the prevention and treatment of mental and substance use disorders.
This site summarizes an evaluation of every randomized, controlled, experimental trial of alcohol treatment in the scientific literature available at the time, nearly 400 studies. Treatments are listed in order of the strength of the evidence supporting them. Of the 48 treatments listed, only the first 18 have sufficient evidence to be considered evidence based. On this list Twelve step facilitation and Alcoholics Anonymous are numbers 37 and 38.
2) Is attending groups necessary? Looking at either of the above two lists of treatments, most are provided to individuals, couples or families, not groups.
3) Is belief in a higher power necessary? Looking at the same lists, only one, Twelve step facilitation therapy, involves belief in a higher power.
Why would someone choose a non 12 step recovery approach? Based on just these three questions, we can see that someone who wanted to use an evidence based approach, didn’t want to attend groups, or didn’t want to involve belief in a higher power in his/her recovery, might easily choose a non 12 step recovery approach.
Is AA worth considering? Yes! Should it be the only option considered? No! If the approach to informing patients about their breast cancer treatment options is any guide, we may soon have addiction providers informing their clients about the full range of recovery options. It is unethical for cancer specialists to fail to provide information about treatment options when those options exist. It may soon be unethical for addiction treatment professionals to fail to provide accurate information about addiction recovery options.
A. Tom Horvath, Ph.D., ABPP, is a board certified clinical psychologist and president of Practical Recovery (http://practicalrecovery.com), an addiction treatment facility in La Jolla (San Diego), CA, focusing on collaborative care and self-empowerment.
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