Addiction Treatment is Addiction Treatment & Alcoholics Anonymous is Alcoholics Anonymous

Over 20 years ago I walked into my first substance abuse course at Nova University.

The professor walked into the room, waited for silence and said, “Addiction treatment is addiction treatment, and AA is AA, period.” The professor was John Mullen. John had been a member of Alcoholics Anonymous for almost 40 years at that time, and a substance abuse counselor for decades. He was admired in both roles.

It’s interesting that John made this pronouncement as his opening statement. It’s interesting that he felt that he had to. During the last 20 years working in the field of addiction treatment, I have understood why he did: using the setting of an addiction treatment center to attract people to the fellowships of AA and NA is a violation of the best practices of addiction treatment, and the principles of AA, and NA.

I agree with John, the treatment of addiction must focus on the drug and alcohol abuse of the addict and alcoholic, but must equally focus on delivering powerful therapy interventions that treat the compulsion, depression, and anxiety that are integral parts of the disease of addiction.

My colleagues in the addiction treatment field, of course, may want to dispute my claim that they are using an addiction treatment approach that is composed of 12 Step instruction-as-therapy. However, their protests will be met by the experience of most people that have been to an addiction treatment center in the past 40 years. Most people that have been through addiction treatment know, and report, that most drugs and alcohol addiction treatment centers, in existence today, practice an approach to treating drug addiction and alcoholism that is dictated by the philosophy of Alcoholics Anonymous, and Narcotics Anonymous.

Furthermore, It is a fact that most of the treatment activities of most treatment centers are focused on getting people to internalize and practice the methods outlined by the 12 Steps of Alcoholics and Narcotics Anonymous. This approach is evident in most addiction treatment centers’ schedules of activities, in their promotional materials, and in their websites. In most addiction treatment center’s schedule of treatment activities you will find: 12 Steps instructional lectures, group therapy based on 12 Step instructional materials, and treatment plans that outline goals like “completing steps 1, 2, and 3. ” (of the 12 Steps of Alcoholics or Narcotics Anonymous).

To be sure, there is nothing wrong with the 12 Step programs of Alcoholics Anonymous and Narcotics Anonymous, millions of people have obtained sobriety. However, as any member of Alcoholics Anonymous, or Narcotics Anonymous knows, these fellowships are not in any way involved in mental health treatment. Alcoholics Anonymous and Narcotics Anonymous see the problems of alcoholics and addicts as being directly related to the abuse of drugs and alcohol. As stated before, the conflict that John Mullen was warning about is created when addiction treatment centers use the methods of the 12 Step fellowships of AA and NA to people that, according to the philosophy of AA and NA, need more intense mental health treatment than these fellowships are committed to provide. Here are the examples:

Narcotics Anonymous proclaims that addiction is “One disease” and the solution is “One Program” (Narcotics Anonymous). The “Big Book” of Alcoholics Anonymous clearly explains the difference between people that can benefit from the programs of recovery from alcoholism based on the 12 Steps, and those that need mental health treatment: in Chapter 5 of the book of Alcoholics Anonymous, it says that:

“Those who do not recover are people who… are constitutionally incapable… seem to have been born that way… who suffer from grave emotional and mental disorders, and cannot or will not completely give themselves to this simple program”

In other words, the 12 Step programs are for people who have the capacity to completely give themselves to this simple program (AA). According to the philosophy of AA, engaging in this program to gain sobriety demands a capacity, and ability, that is lacking in people who are constitutionally incapable (Book of Alcoholics Anonymous, Chapter 5). The book of Alcoholics Anonymous (Chapter 5), also include a definition of people that may not be able to gain sobriety through their program: “people who suffer from grave emotional and mental disorders”. In summary, the 12 Step programs of AA and NA clearly identify people for whom the 12 Step programs don’t work. Who are these people? These are the people that need alcoholism and addiction treatment.

So I (and probably John, if he would still be with us) ask my colleagues in the addiction treatment field: how can you succeed in treating addicts for whom the 12 Steps did not work, by instructing them to practice the 12 Steps? The practice of turning addiction treatment into 12 Step treatment, violates the integrity of the 12 Step fellowships, and the best practices of clinical addiction treatment. The two, as John taught, have to be practiced separately, so that they complement each other, but don’t violate their separate integrity and effectiveness.

John died of cancer years ago. Those of us who listened to his message are still going against the common practice of turning treatment centers into 12 Step training facilities. We do so because we uphold the basic principles of the 12 Steps, and our principles as Clinicians. Addiction treatment is addiction treatment, and Alcoholics Anonymous is Alcoholics Anonymous. Period.