What makes the 12 steps (and other social support groups) a good part of addiction treatment aftercare?

I’m not a devout 12-step believer, though I think that AA and the offspring programs have some serious merit, especially when it comes to addiction treatment aftercare. In this discussion, I’m talking about all group-support based programs, including Smart Recovery and others. I’m personally a fan of non-religious groups, but that’s just me.

Chronic conditions require long term care

I’ve already talked about my view of addiction as a long-term, chronic condition. Regardless of the “disease” moniker, I think it’s undeniable that, at least for some people, addiction treatment needs to continue long past their initial “quitting” phase, regardless of whether they went through an inpatient or outpatient treatment (or quit alone at home).

Without getting hung-up on my misgivings about 12-step programs (I have a few), I’d like to talk about some of the factors that make me believe in the system as a continuous aftercare resource:

  1. It’s free – Most people, especially given current insurance limitations, can’t afford ongoing outpatient help be it through a psychologist or an addiction-treatment provider. While the latter two are can be superior in their knowledge about recent developments in addiction, they cost money.
  2. It normalizes behavior – One of the difficulties many addicts share is in talking to non-addicts about their problems. They feel ashamed, misunderstood, or judged. Being with like-minded individuals can eliminate some of those issues. Nevertheless, people often find understanding only regarding the specific issue a program deal with and therefore find they need to attend many different support groups to address all their issues.
  3. It provides ongoing support outside of meetings – The social connections people make in meetings can often help them outside the rooms. Your psychologist isn’t likely to do the same.
  4. It keeps the focus on relevant issues – When following the 12 step rigorously, one is always working on bettering his/her program. That sort of attention can help catch problems early on before they develop into real difficulties.
  5. It keeps people busy – Some addicts need to stay occupied to keep out of trouble, especially in the transition from their acute treatment back to everyday life. Attending social-support meetings can make the time go faster while providing a relatively safe social environment.

Even with all these advantages, I can’t help but object to some of the AA dogma, especially when it comes to religion and to the unwavering resistance to adapt their system as it was handed down in the late 30s. We’ve learned a lot since and I think 12-Step programs could benefit greatly by incorporating recent knowledge. In fact, reviews of studies regarding the effectiveness of AA find it no more useful than other interventions overall. This is why I believe that 12-Step programs are best used along with, and no instead of, additional treatment options.

Citation:

Cochrane Review – Alcoholics Anonymous and other 12-step programmes for alcohol dependence

Philadelphia addiction help – Long term social support seems to work

Check out today’s article in the NY Times about a program in Philadelphia that is putting together a whole set of support structures to help addicts deal with life after drugs. At the center of the effort is the Philadelphia Recovery Community Center which offers groups, life-skills help, job training and more.

The article focuses on the peer to peer help (addicts helping addicts), which while important, takes away from the main message that addicts need more support than a simple short-term treatment stint.

About addiction: Exercise, stigma, marijuana, and friendhip.

Here we are again. I’ve been slacking on this, but check out the new crop of great articles about addiction. As usual, if you press the title of this post, you’ll be rewarded with our relevant posts!!!

MSNBC: Exercise may help prevent substance abuse – Here’s an article that reports on some of the findings I’d recently talked about here.

Addiction Inbox: Treating addicts like human beings – About the stigma and shame associated with addiction.

Addiction tomorrow: Marijuana – a gateway drug?

Addiction recovery basic: Friendship in recovery – Having social support and friends is important, especially when trying to make huge changes in lifestyle like quitting an addiction.