Non 12 step rehab programmes

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The non 12 step rehab programmes are an alternative for those who do not wish to follow the traditional 12 step programme.

Some feel that the 12 step rehab programme is not ideal for several reasons: 

  1. It's religiously-centred as it denotes a higher power. The belief that the alcoholic is powerless and needs assistance from a higher power does not suit other people's lifestyles. 
  2. It's based on the idea that 'once an addict, always an addict.' 
  3. Requires the addict to admit that they are completely powerless and cannot overcome addiction alone. 
  4. It views addiction as the core problem. 

The 12 step programme is a practical approach. It has been associated with positive long-term outcomes. This programme has also served as a source of behaviour change for many drug and alcohol users [1].

Aside from Alcoholics Anonymous, the 12 steps have been integrated into similar programmes such as: 

  • Narcotics Anonymous 
  • Gamblers Anonymous 
  • Sex Addicts Anonymous 

The support groups, Al-Anon and Nar-Anon, which support friends and family members of addicts, also incorporate the 12 step programme. 

Some feel that the 12 step programme is out of date. Some struggle with what they perceive as a strong religious element of the rehab programme. The good news is that there are many secular programs for addiction treatment. 

Some non 12 step programmes include: 

  • SMART Recovery 
  • Refuge Recovery 
  • Evidence-based treatments 

What is non 12 step rehab? 

A non step rehab is a conventional approach to addiction treatment that has secular programs in place.

Unlike the AA's 12 step program that emphasizes spirituality and its role in addiction recovery, the non 12 step program prioritizes secular recovery. 

Some of the non 12 step rehab programs include: 

a) SMART recovery 

SMART (Self-management and recovery training) recovery is an alternative addiction treatment option. This non-profit organization aims to empower the addict by equipping them with the right tools to overcome the addiction. 

SMART recovery leverages four treatment components:

  1. Building and maintaining motivation. 
  2. Coping with urges 
  3. Managing emotional responses, thoughts, and behaviour. 
  4. Living a balanced life. 

Similar to 12 step programs, members attend face-to-face meetings or daily online meetings [2]. 

b) Refuge recovery 

Refuge recovery is an alternative to 12 step and is found in many non 12 step residential rehabilitation centres. This program is based on Buddhist teachings that believe a person can overcome suffering.

It emphasizes craving and attachment. The program aims to help the addict understand the working of the mind to achieve complete abstinence. 

The underlying belief of refuge recovery is that recovery is possible and available. Its core tenets are: 

  • Meditation 
  • Compassion 
  • Forgiveness 

Unlike the SMART recovery that emphasizes Scientifically supported concepts and attachment, this program focuses on using mindfulness to conquer the addiction. 

c) Evidence-based Treatments 

Scientific research supports several evidence-backed treatments. Most residential rehabilitation facilities offer different therapies. They include: 

a) Cognitive behavioural therapy (CBT):

 CBT is one of the most widely used addiction treatment therapies. It aims to help the addict unlearn the thinking patterns and behaviour that contribute to the substance abuse.

It leads the patient in changing negative thought patterns and seek to create healthy ones. 

b) Motivational Interviewing: 

The motivation to change is one key factor for managing cravings. This technique seeks to strengthen a person's motivation and commitment to maintaining abstinence.

In addition, it explores the ambivalence that people may have concerned their behaviour that impedes change. This therapy is primarily used in behavioural healthcare as It seeks to make people want to change. 

c).  Interpersonal therapy:

This therapy also aims to help the addict change their harmful way of thinking and behaving. In addition, it also imparts communication tools that will help them mend their relationships. 

d) Multi-systemic therapy:

This approach to therapy focuses on multiple risk factors that fuel the addiction. They may include individual or family issues, work, College, Community, or peer group factors. 

e) Dialectical behaviour therapy (DBT): 

This is a variation of CBT commonly used for women with alcohol abuse disorder. In addition, it's used for women with a dual diagnosis of alcohol addiction and borderline personality disorder. 

f) Group therapy:

Resembles a peer support group, but the difference is that a trained therapist guides the meeting.

The therapy aims to help the individual enhance their social functioning through purposeful group experiences to cope more effectively with their challenges. 

Medication for Addiction Recovery 

Although many addiction experts support the use of medication-assisted treatment (MAT) to treat addiction, there's still considerable resistance to these treatment options [3].

Since there's a lack of understanding that alcohol disorder is a treatable medical disorder, people struggling with alcohol addiction continue to be socially excluded. 

Medication for addiction recovery usually works in combination with therapy. These drugs include: 

  • Disulfiram:Helps patients manage withdrawal symptoms and remain in a state of enforced sobriety. The medication paves the way for psychotherapeutic treatment and recovery support. 
  • Naltrexone (Vivitrol):This drug reduces cravings for alcohol or opioids, thus lowering the chances of a relapse. It can also help an alcoholic moderate their drinking. 
  • Acamprosate calcium: Helps alcoholics maintain abstinence. It can help them abstain entirely. 

Alcohol rehab 12-step program

Founders of Alcohol Anonymous designed The 12-step program as a general guideline for overcoming alcohol addiction. It is generally known for its emphasis on spiritual recovery. 

Firstly, people who enrol in alcohol rehab 12-step programme have to admit they are powerless over alcohol and believe a greater power is needed to restore them to sanity. 

While this programme may be unsuitable to non-Christians, one study found that after 16 years, 67 per cent of people who attended 27 weeks of AA remained sober, compared to only 34% of those who did not participate in AA.[4]

How do non-12 step rehab programmes differ from the 12 steps? 

Non-12 step rehab programmes differ from the 12 steps because they are a secular approach to treatment.

These secular programs emphasize self-empowerment as some people don't like the idea that they cannot control their addiction. 

Similar to the 12 step model, the non 12 step model promotes abstinence from drugs and alcohol. The difference is that the non 12 step model doesn't acknowledge a higher power.

Furthermore, many non 12 step programs avoid labelling addiction as a "disease." 

The non-step approach is more of a self-help program. There's no idea of surrender, as it's the case in the 12 step model. Programs such as SMART Recovery and Moderation management are mainly cognitive-behavioural.

These programs focus on imparting coping skills to the addicts. The idea is that the individual has a personal responsibility to build internal control over the recovery process. 

The 12 step programme, on the other hand, has a spiritual focus. The 12 steps entail: 

  1. Admitting powerlessness over the addiction 
  2. Believing that you need a Higher Power (in whatever form) to help you recover. 
  3. Deciding to hand control over to the higher power 
  4. Taking a personal inventory 
  5. Admitting to the Higher power, to oneself, and others, the wrongs done 
  6. Being Open to the Higher power to correct any shortcomings in your character 
  7. Asking the Higher power to remove any shortcomings 
  8. Making a list of wrongs done to others and seeking to make amends 
  9. Contacting those who have been hurt, unless doing so would result in harm 
  10. Continuing to take a personal inventory and admitting when one is wrong 
  11. Seeking enlightenment from the higher power via prayer and meditation 
  12. Carrying the message of the 12 steps to others in need. 

Some argue that the 12 step program offers strict guidelines that push people into recovery.

But it fails to accommodate the complexity of substance abuse. Moreover, the model fails to focus on physical recovery, including withdrawal or detox period. 

Other addiction treatment options, such as medication-assisted treatment, identify alcohol addiction as a chronic condition requiring professional medical attention.

In addition, there are psychological reasons why people struggle with it, and treatment options such as CBT seek to get to the root of the psychological causes of the disease. 

Are non-12-step recovery approaches effective?  

The effectiveness of non 12 step recovery has been significantly under-researched.

But a 2018 study on the efficacy of some of the non 12 step options, including SMART recovery, showed that these programs were as successful as alcoholics anonymous [5]. 

The study proposed that those dissatisfied with aa could opt for the non-12 step drug addiction treatment.

Some experts suggest that alcohol rehab programs should base their addiction treatment on customized programs to meet the individual's needs [6]. 

Some people choose the 12 step rehab program because: 

  • It's free 
  • It's widely available, and in major communities, you can find local meetings daily. 
  • The support groups are beneficial in helping addicts overcome the urge to hang out at the bar. 
  • Anonymous. People suffering from drug addiction often feel ashamed or persecuted because of their addiction. Anonymity helps them acknowledge their problem. 
  • It offers a judgment-free environment. 
  • It's a famous program, and most people have heard about it and tried it. 
  • Ideal for people who want a spiritual/religious-based programme. 

A recent review reported that alcoholics anonymous performs better than other common treatments.

The research by John F Kelly, Keith Humphreys & Marica Ferri showed that aa leads to increased rates and lengths of abstinence compared to some other drug and alcohol rehab treatments [7].

Other people opt for the non 12 step treatment option because: 

  • It aims to empower the individual by imparting them coping skills that will help them overcome substance abuse. 
  • Secular programs place responsibility on the addict to do the work and maintain vigilance against relapse. 
  • The program focuses on self-worth and self-control. 
  • They don't view addiction as the core of a person's problems. Instead, they look at underlying issues such as job problems, environmental issues, mental illness, trauma, unresolved anger, peers, e.t.c. 
  • Although they prioritize personal responsibility, they also incorporate family and support systems. Most also include family counselling as they take on a holistic approach to treatment. 
  • They don't view drug and alcohol addiction as an incurable disease. Instead, they believe that you can get to the root cause of the disease and work towards recovery. 

Cognitive-behavioural therapy is one approach that has been adopted in non 12 step rehabs. It is widely considered the preferred psychotherapy treatment for substance abuse.

This approach is practical as it aims at changing the negative self-talk (also called negative automatic thoughts) that lead to problem drinking. 

CBT is effective because: 

  • It's accessible. Mental health professionals are trained in cognitive behavioural therapy. 
  • It's problem oriented. Structured to focus on certain problems and provide healthy solutions. 
  • Collaborative. You work together with your therapist to solve current issues. 
  • Self-driven. It aims to help you identify and solve your problems. 
  • Present-day focused. Focuses on current thoughts and actions instead of past issues. 

CBT also stands out from other therapies because it uses a variety of intervention approaches such as: 

  • Relapse prevention 
  • Exposure therapy 
  • Relaxation and stress reduction 
  • Roleplaying 
  • Contingency management 

CBT is universally accepted as the leading, evidence-based psychotherapy with the most success [8].

It can significantly improve a person's life by empowering them to use critical thinking to solve their problems and develop coping strategies to deal with the issue. 

Overall, the 12 steps and the non 12 step approaches are effective. You can opt for either one of these programs, depending on your needs.

For example, if you want a more spiritually oriented program, you have the refuge recovery option or 12 steps. 

Other rehab programs try to adapt to the needs of the individual by incorporating some of the non 12 step programs such as CBT with spirituality [9]. 

Individual counselling is another approach that's widely being used for its efficacy in treatment. 

Both 12 and non 12 approaches are effective treatment options. You can reach out to your preferred treatment centre so that they can help you identify the best option for you, depending on your needs.

Most rehabs are behavioural treatment facilities as they offer medication for addiction recovery combined with therapy (either individual therapy, group therapy, or CBT). 

Final Remark: 

Non 12 step treatment options offer an alternative to treatment for those who, for one reason or the other, do not want the 12 step option.

However, most people find the 12 step approach as being out of date. In addition, its focus on a higher power does not suit the lifestyles of some people. 

Moreover, there's little research on the effectiveness of anonymous alcoholics. The American addiction centres organization points out that 40% of those attending AA meetings drop out [10].

Therefore, some experts suggest the need for a holistic treatment approach that's more person-centered. 

The difference between the AA's option and the non 12 step approach starts from the definition of addiction.

The AA's approach views addiction as the outcome of bad decisions made by the person. However, this is different for some of the non 12 step options as they view addiction due to multiple factors. 

The medical treatment program views addiction as a chronic disease that, if left untreated, worsens over time. Thus, the disease model of addiction has led to its inclusion in the DSM-5 manual. 

Overall, all treatment options do not 'cure' addiction. Instead, they seek to help you manage the adverse consequences of addiction. 

Speak to the treatment provider today to see if they offer non 12 step options. Then, you can begin treatment within 24 hours once the insurance provider confirms that you're covered for the treatment option you choose. 

About the author

Peter Szczepanski

Pete has been on the GPhC register for 29 years. He holds a Clinical Diploma in Advanced Clinical Practice and he is a Clinical Lead in Alcohol and Substance Misuse for Abbeycare Gloucester and works as the Clinical Lead in Alcohol and Substance Use in Worcestershire. To read more about Pete visit his LinkedIn profile.