An Alternate Approach
The most widely used approach to addiction treatment in the US emphasizes (with some variation) that the individual (possibly called an “addict” or “alcoholic”) is powerless over the substance(s) of concern, has a disease, must abstain, must attend 12 step meetings, should attend intensive treatment at the beginning (possibly to include residential treatment), and should view their change process as “recovery for life.”
Let’s call this approach the “traditional US approach.”
Elements of the traditional US approach are offered around the world, but to a much lower degree. (Unfortunately, there are also places where there is no treatment, only punishment, sometimes severe punishment.) In the US there is increasing interest in alternative ways to thinking and responding to addictive problems. Nevertheless, it appears that the majority of US treatment fits the traditional approach.
This approach can indeed be effective, but for various reasons some individuals object to it. One way to respond to their objections is to attempt to overcome or overpower the objections. Perhaps that effort works in some cases. In other cases, it may harden resistance, perhaps even to getting any outside help.
A better way to respond to objections about the traditional approach is to offer an alternative, such as the self-empowering approach.
The Self-Empowering Model
In the self-empowering approach, it is assumed that the individual can change their thinking and behavior such that, even if they choose abstinence, they feel more powerful rather than powerless.
Labels would be avoided (unless the individual wanted to use one). Instead of describing the individual, descriptions would emphasize positive change (“I want to stop having alcohol problems”).
Similarly, whether the individual has a disease would be a decision left up to the individual. In my experience most individuals who opt for the self-empowering approach do not view themselves as having a disease. Some individuals immediately choose abstinence (many people begin treatment with a personal history of unsuccessful moderation attempts). Others want to explore moderation. The provider is prepared to support moderation.
Moderation is a course of action even AA’s Big Book supports for some (as noted at the top of page 21). It is unfortunate that moderation has been so controversial. In self-empowering treatment the individual chooses their own goals, which include abstinence, moderation, or harm reduction.
The individual in treatment might also attend a mutual help group, but probably not 12-step ones, because they are powerlessness based. Other options include SMART Recovery (the largest of the non-12-step groups), Moderation Management, LifeRing, Women for Sobriety, HAMS, Recovery Dharma, or others.
The self-empowering approach recognizes that attending treatment or mutual help groups is not essential for change. Many of those who have successfully changed have done so without these services. When treatment or mutual help is used, it should support the natural change process.
For some that change process is ongoing, but many also move on so that their “recovery plan” is the new life they are leading, without any specific recovery supports.
If the individual’s problems have been substantial, rather than residential treatment they might consider intensive outpatient rehab. This approach can be highly flexible. Some approaches to intensive outpatient treatment rigidly require three groups of three hours each, plus an individual session, per week. This standard has apparently been established by insurance requirements. If the individual can move beyond those requirements, options like an individual session per day (or less), possibly with mutual help groups or treatment groups in addition, can be considered.
If you are an addiction professional, or an individual using substances problematically, and you’re thinking “I’ve never heard of what this guy is talking about,” I believe you! I’m glad you read this article. I hope you are more flexible in thinking about addiction treatment and recovery.
Dr. A. Tom Horvath, founder of Practical Recovery, is an internationally recognized expert on addiction treatment. He is a past president (1990-91) of the Society of Addiction Psychology (Division 50 of the American Psychological Association; the world’s largest organization of addiction psychologists), the author of Sex, Drugs, Gambling & Chocolate: A Workbook for Overcoming Addictions (2nd ed.), and a fellow of the San Diego Psychological Association, Association for Behavioral and Cognitive Therapies, and the American Psychological Association. Dr. Horvath is the co-founder and past president of SMART Recovery, and owns and operates a non-12-step addiction treatment facility in La Jolla, California.