For more than a decade, I’ve operated an evidence-based addiction treatment program that has helped people get their lives back from the devastation that addiction causes. I am frequently asked about whether it’s better to use a 12-step program like Alcoholics Anonymous (AA) or psychotherapy for recovery. Do 12-step programs have a place in a facility like ours? Are AA and psychotherapy mutually exclusive routes to sobriety? The truth is you’d do well to be in both. Let me explain why.
While we are not a 12-step based program, we introduce every client who comes to our facility to 12-step programs like Alcoholics Anonymous (AA), and even though 12-step program are not evidence-based treatment, we encourage every client to become involved with AA (or NA, etc.) after they leave our care. About half follow our advice.
On its own AA has a poor recovery rate; it is estimated that around 5-8% of people who use AA alone are sober one year later. AA is not an evidence-based therapy; it is nearly impossible to study. Because of the anonymous nature of the program and the way people float in and out of particular meetings, there’s not a lot of solid research on AA. However, the most important thing to know about AA is that AA was never meant to be used on its own as the only means of treating alcoholism. The Big Book, AA’s main text, is clear that individuals will likely need “outside help” for various issues and they should seek it. The program of recovery, as detailed in the Big Book, is emphatic that if you need psychological, medical, or spiritual support, seek a professional in that area. AA was designed to be combined with other treatments. Bill W., who founded AA, used many therapies in addition to AA to make his recovery come alive. He set a good example to follow.
AA offers something that no other form of therapy or treatment can – a global support network. Millions of people have gotten and stayed sober by using the AA program. The program is available anywhere in the world and can be accessed in person, by phone, or online anytime of the day or night. Those who use this network will be given an immediate support system of individuals who know what it’s like to abuse substances, harm your family and yourself, and overcome that problem. While not everyone enjoys the sharing of stories or what some have described as a “cult”-like atmosphere in AA because of the reliance on prayer and a Higher Power as a means of recovery, AA has a lot on offer for those who appreciate the camaraderie of other sober addicts. Addicts who need a support system should be in a 12-step program.
That said, using AA alone is not enough for most individuals to get and stay sober and there can be a lot of shaming in AA because of this. Retorts of, “You just didn’t work the program hard enough,” are common when a person relapses. In reality, where AA falls short is that it does not address the root causes of addiction, the “why you needed to drink/use so much in the first place,” issues. There is no step that works through child sexual abuse, being the victim of war crimes, witnessing atrocities, etc. The steps were not designed for those issues we had no part in creating, but that fuel our substance abuse nonetheless. For those problems, individuals benefit from quality, compassionate psychotherapy. Generally speaking, the best type of psychotherapy is adaptive to the needs of the individual, picking and choosing from cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and the creativity of positive psychology/Ericksonian therapy, though other modalities may also be used. For those suffering from trauma, somatic or animal based therapies might be added. Using psychotherapy, the individual is able to focus on and work through the pain caused by harms done to them, while using AA to focus on making right wrongs done to others.
There should be no tension between 12-step programs like AA and psychotherapy. Both in their own way serve the addict’s needs and support their efforts at creating a comfortable and meaningful life in recovery. If you want to get and stay sober and have a full life, use every means available to you. You’ll soon find the combination that works best for you.