Is there anybody who hasn’t heard about Alcoholics Anonymous? It’s unlikely since AA is the best-known mutual-help group for people struggling to control their drinking. Everybody knows at least one person who is going to or has gone to “meetings”, is connected with a “sponsor”, reads the “Big Book”, or recites the “Serenity Prayer”… or maybe even works the structured program of AA called the“12 Steps”. And as soon as people think there is a “problem” with the use of any substance, one quickly gets the advice: “Why don’t you go to an AA meeting!” There are tens of thousands of AA meetings across the country and many more world-wide. From its humble beginnings in Akron, Ohio, where Alcoholics Anonymous was founded in 1935 by Bill Wilson and Dr. Bob Smith it has grown to dominate the field of recovery, from self-help and mutual aid groups to institutionalized addiction treatment.Along with the success of the 12 Step program a choir of voices has arisen that point to many aspects of the AA philosophy and practice as deserving a more critical deliberation. However, despite the many criticisms there is some solid scientific evidence that engaging in a 12 Step program can help individuals gain freedom from alcoholism and drug addiction. The key to success appears to consist of three critical factors: First, the commitment to really “work” a program as opposed to just going through the motions; followed by the right “dose”, which appears to be a minimum of 4 days a week; applied with consistency for an extended period of time, ideally 3 years or more. These three keys are imbedded in an evidence based treatment technique called Twelve Step Facilitation (TSF).While there is no doubt that AA and the 12 Step program has helped millions of individuals it is not the only way to recovery. It is not for everyone, and having difficulties accepting all of its tenets is not necessarily a sign of obstinacy, “self-will run riot”, unreadiness or unwillingness to change.There are however some steps that most researchers and treatment professionals agree on to help curb negative behaviors and achieve a lasting change in lifestyle:
1. Motivation: Many people enter treatment by a “nudge from the judge”, the physician, the spouse,or the HR department. Consider this an external motivator. Many people with this type of motivation see treatment as an obligation, at best, and at worst as black mail or punishment. They want to get this annoying burden over with so that they can go back to living their life.Anybody who wants to see change must have a willingness to change. This willingness can be influenced by outside forces, but ultimately it must come from an internal desire. It must be genuine, authentic, and move a person to strive to be better. Research shows that finding this intrinsic motivation is the key to successful and enduring behavior change.Motivational Interviewing (MI) is a scientifically validated approach to help clients discover and activate their intrinsic motivation. Since its publication in 1991 by Miller and Roll nick it has been proven in many scientific studies to be so effective that it has become the gold standard in behavior change protocols.
2. Proven Approaches: Extensive academic and scientific research into the causes, development, and treatment of Substance Use Disorders (SUD) has identified several approaches that are proven effective. They are often labeled as evidence based treatment (EBT) or evidence based practices (EBP). Here several examples:Cognitive-Behavioral Therapy (CBT),is a collection of techniques that aims to change thoughts and behaviors by identifying where and how the undesired behaviors are triggered, reinforced, and sustained. Then plans to avoid triggers and coping skills to deal with triggers that are unavoidable are developed and practiced. New thoughts and behaviors to replace the undesired or dysfunctional thoughts and behaviors are constructed and rehearsed until they become habits.Community Reinforcement Approach (CRA),integrates CBT with couples and or family therapy, communication training, job and recreational counseling, and the monitored use of Antabuse (a medication that produces drastic discomfort if alcohol is consumed).Motivational Enhancement Therapy (MET),combines the above mentioned Motivational Interviewing (MI) with detailed feedback based on an extensive battery of assessment instruments, coaching in developing a change plan, and support in monitoring its implementation.Dialectical-Behavioral Therapy (DBT),was originally developed for the treatment of Borderline Personality Disorder(BPD) but its exhaustive toolbox of emotion regulation and interpersonal skills training techniques has been shown to be helpful with SUDs.
3. Support: We love stories of the “under dog” who overcomes almost impossible odds with rugged individualism and hard work to achieve success. And while there certainly are men and women that have lived that story, for most of us life is much more complex and complicated. In real life, most of us need a little help from our friends to get by. Restoring old or developing new relationships with trust and faith at its core is important for recovery.Support for behavior change and recovery can present itself in many ways. It can mean mentorship, allowing oneself to be guided toward a new way of life. It can mean meeting with others to work towards a common goal or pursue a common interest. It can mean recognition and encouragement from people that are dear to us. It can mean finding a group of like-minded individuals that are willing to listen to the report of personal struggle without judgement or giving unsolicited advice.Most treatment centers and many outpatient treatment providers build their programs around the powerful dynamics that can be utilized in groups. And there are of course a multitude of mutual help groups with AA the best known one.However there are others like SMART Recovery, Moderation Management, Women for Recovery, LifeRing, Celebrate Recovery, and SOS; to name a few.
4. Medications: There is no magic pill or one-size-fits-all treatment to cure substance use disorders.The pharma industry has developed a handful of medications can help individuals in their struggle to overcome the unhealthy, risky, or dangerous use of substances.Antabuse, Naltrexone, and Campral are the only meds that have been approved by the FDA for the treatment of alcohol use disorder (AUD). There are other medications like Topamax, Gabapentin, and Baclofen that have been FDA approved to treat different conditions but have shown some efficacy for AUD. However, their use is strictly “off label.”For Opiate Use Disorder the FDA has approved three medications, Methadone,Naltrexone, and Buprenorphine (Suboxone).Many individuals that want to change their alcohol or drug use also smoke or use tobacco products and this can become a trigger for relapse. There are two medications with FDA approval to help with tobacco cessation. They are Varenicline(Chantix) and Bupropion (Zyban), which is also known under the trade name Wellbutrin and is widely used as an antidepressant medication.As mentioned above there is no pill alone that can cure or eliminate substance use disorders. Often they have unpleasant side effects that prohibit their use or induce patients to stop taking them. However these medications, when combined with psychological and social interventions (counseling and treatment programs) can provide significant additional help… better than treatment programs alone.
5. Rewarding Lifestyle: In order for behavior change to endure it must become a lifestyle and it must be fun.Being responsible and productive is honorable and a powerful source of identity and self-esteem. Providing for one’s family and being a dependable team member are manly virtues deserving respect. But the stress of trying to wear too many hats or striving for perfection whether self-imposed or forced on by others can lead overtime to life becoming dangerously unbalanced. And like an unbalanced wheel on a vehicle it doesn’t make for a smooth ride and it may even cause a serious crash.Regaining this balance often takes considerable soul searching, deliberation,prioritizing, planning, trial and error implementation, evaluation, and reassessment.The burgeoning field of Life-coaching is proof for the necessity and the growing awareness of a balance in life. Being able to effectively manage the unavoidable stress of modern life and a commitment to an authentic and rewarding work-life balance are must have elements to make life and recovery joyous, happy, and free.
About C.A.R.I.: C.A.R.I. provides guidance on intervention, detox, drug and alcohol rehab options in North County of San Diego, including the cities of Oceanside, Carlsbad, Encinitas, Vista, San Marcos and Rancho Santa Fe. We help not only the people who struggling with drug and alcohol abuse, but also their families and loved ones. Our program accepts PPO insurance from insurance providers such as Cigna, Aetna, UBH, Optum, Magellan and Value.