The landscape for alcohol and substance abuse recovery has been dominated for 80 years by Alcoholics Anonymous (AA) and its guiding principles The Twelve Steps which became the gold standard for recovery. While the program is credited with helping millions of people around the world, the gold is losing some of its luster.
The National Academy of Sciences in a 1990 report to Congress noted AA’s “lack of well-designed and well-executed studies that can be cited to support or negate the validity” of its claim to be “the most successful treatment for persons with alcohol problems.” To date, that scientific data remains elusive.
AA’s critics within the recovery world itself say it is outdated, sexist and too religious for a significant portion of today’s population that values personal empowerment, choice and secularism. Spiritual teachers, therapists and counselors while encouraging us to move beyond self-criticism and inner defeatist dialogue remind us, as Dr. Wayne Dyer noted, “The state of your life is nothing more than a reflection of your state of mind.” Yet 12-step models insist that participants, even those who have been clean for many years, continue to self-label, “I am an alcoholic/addict.”
For decades, the animal and human phases of clinical drug trials had been conducted primarily on males; those outcomes informed dosage recommendations. When 2013 research findings revealed that women respond differently than men to many drugs including simple aspirin, even the FDA was forced to rethink the “one-size-fits-all” approach to health treatments. Results showed that in many instances women metabolized a drug at half the rate of their male counterparts. Consequently, women have likely been experiencing higher incidences of severe side effects. Evidence now shows that not only gender, but ethnicity, age, weight, blood type, environment and personal history are all factors in determining individual responses.
Recovery, too, is personal. Experiences and traumas that lead to addiction in the first place are different for each person. To maximize an individual’s recovery journey, the tools and the path itself need to reflect this diversity. Simply put, no single program, no matter how successful it is with some or even a majority of its clients, can be expected to be equally effective for everyone. This is an important point to bear in mind when seeking a treatment program. AA and its 12-step support groups are not going away any time soon. They will continue to be available and in some locales may be the only option. AA is not a residential or outpatient recovery program; it is peer-to-peer support in small gatherings which people can attend as often as they want depending on the availability of meetings in their community. For many, AA will remain the program of choice and they will benefit from it.
But for those who do want an alternative, what is available? Fortunately, recovery has evolved toward a more conscious and calculated approach that serves the individual. Whether a peer support group, intensive outpatient or residential treatment program, many still incorporate the 12 steps but as one component of a larger and more inclusive recovery curriculum. The emphasis is on an “individualized treatment plan” that recognizes the intrinsic wisdom, strength and ability of an individual to make personal choices. Even within culturally-specific programs or previously underserved populations such as LGBTQ, Native American, Women Only, Men Only, Teens and Jewish, treatment is often further personalized.
Thousands of recovery entities have an online presence with varying degrees of helpful information. Some are available across multiple platforms offering interviews, online meetings, chat rooms, message board and 24/7 support. The website for an entity that may not in and of itself be an appropriate match might nevertheless hold extensive research data and relevant information. Recovery is a collaborative process; it is in everyone’s best interests – providers, clients, families and friends – to stay current with developments in the field.
Terminology can be confusing. Most used is the word “alternative” meaning a program other than AA even when it incorporates the 12 steps. More apt in most cases is “complementary” or “integrative” – a mixture of conventional and newer approaches. Many treatment plans take a “holistic” approach that embodies the physical, emotional, spiritual and mental aspects; in other words, the “whole” person. All incorporate some combination of cognitive behavioral therapy, motivational structuring, family therapy, coping with cravings, lifestyle balancing as well as meditation, yoga, guided imagery, acupuncture, massage, nutrition, aromatherapy, homeopathy, music and art.
Some plans incorporate Health Realization which focuses on the present rather than on past mistakes suggesting that an individual’s negative thinking has a direct impact on their reality. The key is learning to calm the mind in order to allow positive thoughts and feelings to emerge that are fundamental to restoring wellness.
Offered here are just some of the alternative approaches and just a few of the many programs for specific groups: women, Native Americans, LGBTQ. Others will be highlighted at a future date.
Promoting a harm-reduction approach to alcohol use rather than total abstinence is Moderation Management. It is based on research which suggests alcohol abuse (versus dependence) is a learned behavior for problem drinkers and not a disease and that related problems exist on a spectrum from moderate to severe; therefore, a reasonable early option for problem drinkers is moderation. Recognized by the National Institute on Alcohol Abuse and Alcoholism, its website offers a link to a booklet entitled “Rethinking Drinking: Alcohol and Your Health.”
LifeRing, a national network of peer-to-peer support groups, helps participants formulate an individual recovery path using the group as support. LifeRing differs from AA/NA in that it believes people can “get clean and sober regardless of your belief or disbelief in a ‘higher power.’” Thus religious and spiritual beliefs remain private and are not an issue at meetings. You are not required to label yourself as an “alcoholic” or “addict” to participate.
SMART Recovery (Self-Management and Recovery Training) offers world-wide mutual help groups. Relying on scientific research, it provides tools to help: sustain abstinence motivation; cope with urges and cravings; find rational ways to manage thoughts, feelings and behaviors; and balance short-term and long-term pleasures and satisfactions.
SOS (Secular Organizations for Sobriety/ Save Our Selves). Recognizing that 20% of the population (over 60 million people) is secular and not associated with a religion, SOS welcomes religious and nonreligious participants in a secular setting. The emphasis is on making sobriety the top priority and developing strategies to remain sober even when facing situations that might encourage old habits such as turning to alcohol or drugs.
Women for Sobriety was the first national self-help program to help women alcoholics create an addiction-free lifestyle. Participants focus on emotional and spiritual growth using the program’s 13 affirmations (rather than the 12 steps) that are designed to enhance self-image and encourage taking charge of one’s life; for example: I am a capable, competent, caring, compassionate woman. I am responsible for myself and for my actions; I am in charge of my mind, my thoughts and my life.
Wayside House in the Twin Cities offers “innovative, holistic, gender-responsive services that empower women most in need to recover from chemical dependency, trauma and mental illness while building stable, successful lives.” Providing treatment, housing and support, individualized treatments address core patterns that contribute to self-destructive behaviors; clients receive life-long support. One service is a Family Treatment Center where women can live with their children 11 and younger while in treatment. The Supportive Housing program provides safe, affordable permanent housing for families committed to sobriety.
Minnesota Indian Women’s Resource Center in south Minneapolis centers on empowerment of American Indian women to “achieve sustainable life ways” through the “principle of taking care of each other.” The center provides primary and relapse treatment, long-term sobriety maintenance support and referrals. The Center’s outpatient chemical dependency treatment program, Grandmother’s House, uses “traditional counseling methods provided by Elders in Residence and long-term sobriety maintenance support to assist American Indian women in healing from mental illness, sexual trauma, and chemical addiction.”
The Native American Community Clinic in Minneapolis offers counseling, stress management services and referrals helpful to someone moving into or through recovery: “Healing doesn’t mean the damage never existed; it means the damage no longer controls our lives.” The clinic honors native traditional practices; sage is available for smudging. Various weekly meetings are open to anyone in the community from “all cultural perspectives.”
PRIDE Institute in Eden Prairie provides residential, outpatient, detoxification and partial hospitalization through programs that focus on issues unique within the LGBTQ community. At PRIDE Institute “gay is understood; being LGBTQ+ is the norm not the exception.” Treatment plans address drug and alcohol addiction, sex addiction, depression, anxiety and HIV/AIDS-related stress and grief.
Out & Sober Minnesota is dedicated to reconnecting LGBTQ addicts and alcoholics with the community and helping build healthy, clean and sober networks. “We sponsor low or no-cost social, educational and informational events…including our flagship MinneSober two-day recovery event. We also maintain a list of LGBTQ friendly recovery meetings in the Twin Cities area on our website.”
Finally, comprehensive holistic treatment is the focus at Sanctuary at Sedona (Arizona), an addiction recovery and trauma healing center that “addresses ALL of you – your body, mind, soul and spirit.” The Sanctuary has been monitoring brain activity using neuroscience technology noting that healing the brain itself has “more fundamental and lasting effects than can be attained with only pharmacological or behavioral interventions.” They differentiate between being recovered and being in recovery: “Being recovered means you are no longer defined by or identified with a disease….You are NOT your disease or diagnosis. We focus on root causes not symptom or disease management.”
Clearly, there are many paths and many options for recovery, renewal and growth. Deepak Chopra said, “The most creative act you will ever undertake is the act of creating yourself.” It’s your choice.