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Understanding the Difference between Abstinence-Based Clinical Treatment and 12 Step-Based Treatment

Understanding the Difference between Abstinence-Based Clinical Treatment and 12 Step-Based Treatment

September 20, 2016
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There is an ongoing misconception regarding addiction treatment and is a misconception that often occurs from society at large as well as from professionals in the field of healthcare, mental health, and substance abuse treatment. For many years the term “12 Step-based treatment” has been synonymous with “abstinence-based treatment” and over the years the misconception that has taken hold is that the two are interchangeable. They are not. While most if not all 12 Step-based treatment centers are abstinence-based certainly not all abstinence-based treatment centers are 12 Step-based.

To understand why this disconnect or misunderstanding has occurred, it’s important to go back several decades and realize that for many years treatment facilities and recovery centers were dominated by individuals who got clean and sober through the 12 Steps, opened rehabs and thus incorporated them into the treatment program at those centers. However, as the stigma of addiction and alcohol decreased, addiction was more understood and more people began working in the field of addiction treatment, the lens by which addiction treatment was viewed started to shift away from the 12 Steps and instead began looking more towards clinically effective processes to treat addiction and the underlying symptoms and behaviors that patients exhibited. It’s been many years since a treatment center was a place someone went to “dry out” and then spend a month learning about the 12 Steps, doing step working packets and getting lectured to in groups about a Higher Power, character defects and amends. Although those things certainly still play a role in addiction treatment, it has been years since those were the focus of an individual’s treatment during their time in rehab.

Instead, today we have highly educated mental health and addiction professionals who utilize numerous clinical approaches, therapies and tools at their disposal to assess and treat clients on an individualized basis. The addiction treatment industry has learned that high-quality addiction treatment is not and cannot be a cookie-cutter, one-size-fits-all approach. Instead highly effective approaches and therapies such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), motivational interviewing, psychodrama and experiential therapy, trauma therapies such as EMDR, neurofeedback and brain mapping, holistic approaches such a meditation, yoga, exercise, acupuncture and nutrition, psychiatric medications and intuitive clinical intervention strategies are all now used when clinically appropriate to treat a patient in a full mind-body-spirit approach.

This misconception regarding the difference in abstinence-based clinically-driven addiction treatment and 12 Step-based addiction treatment even occurs within the addiction treatment field. Over the last few years, a movement has been taken place pushing for Medically-Assisted Treatment (MAT), often meaning utilizing medications such as methadone, Suboxone or Vivitrol within the treatment milieu. Often times, individuals in support of MAT in articles or interviews demonize abstinence-based treatment by calling it old and antiquated. They paint pictures of addiction treatment industry failures and say things like “addiction treatment needs to be evidence-based and scientifically-driven. It should not be charging a family $30,000 so a loved one can get lectured to about God and the 12 Steps.” On one hand, they are absolutely correct. Addiction treatment needs to be evidence-based and scientifically-driven. What they fail to recognize is that the clinical approaches mentioned in the previous paragraph are all evidence-based approaches. Medicine is not the only approach that is “evidence-based.” It is probably important to point out that 12 Step facilitation as an approach to treating addiction is also an evidence-based approach, but that’s a point for another blog. Overall, this painted picture of addiction treatment is a bunch of misinformation, making laypeople believe addiction treatment is just a bunch of people from AA and NA charging you $30,000 for 30 days and lecturing to you about God while you read the Big Book. It is nonsense. Years ago, when addiction and alcoholism were so stigmatized that nobody was doing anything to treat it other than throwing addicts and alcoholics away in psych wards, maybe that was a true representation of treatment. However, that is no longer the case.

There is nothing wrong with 12 Step-based addiction treatment. The 12 Steps as a program of recovery have grown from AA in 1935 to hundreds of different 12 Step fellowships that have in turn helped millions of people recover from maladies too numerous to count. There is absolutely a benefit to the 12 Steps and incorporating the 12 Steps and the principles of recovery into an addiction treatment environment is great. However, it is not for everyone and nor is it how the majority of abstinence-based treatment centers approach treating addiction. Unfortunately, the public still has this misconception that any abstinence-based treatment center equates to a 12 Step-based treatment center. Typically that is not the case. While many abstinence-based treatment centers believe in and support the 12 Steps, the majority of the TREATMENT work taking place there is not 12 Step education or facilitation. Most abstinence-based addiction treatment facilities are utilizing multiple clinical approaches of evidence-based therapies in an effort to individualize treatment for each patient.

What those in need of addiction treatment and their families need to do when reaching out for help and speaking with a treatment center is ask questions. Ask about their therapeutic approaches and clinical philosophy. Ask how treatment is done and what type of treatment takes place. Don’t simply assume that a place that supports the 12 Steps is a place that teaches or directly incorporates the 12 Steps into therapy. Find out more about the treatment center by engaging with the admissions team or even the clinical team if necessary. Don’t simply assume and instead explore and find out for yourself. What you’ll find is that there has been some really impressive growth and innovation in addiction treatment over the last few decades and most treatment centers are doing what they can to leverage those approaches to providing quality treatment for those in need.

If you or someone you know is in need of help because of drug and/or alcohol abuse or addiction, please give us a call. Maryland Addiction Recovery Center offers the most comprehensive dual diagnosis addiction treatment in the Baltimore, Maryland, Washington, DC and Virginia area. If we aren’t the best fit for you or your loved one, we will take the necessary time to work with you to find a treatment center or provider that better fits your needs. Please give us a call at (410) 773-0500 or email our team at info@marylandaddictionrecovery.com. For more information on all of our drug addiction and alcohol addiction services and recovery resources, please visit our web site at www.marylandaddictionrecovery.com.