Conflict between 12-Step Anonymous Groups and Science Continued
A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.Meanwhile, the fields of psychology and psychiatry were still in their infancy during the 1930s. By the 1950s, psychology had established itself as a legitimate science in the United States. However, scientific addiction research was delayed until the early 1970s. During this time, the federal government established the National Institute on Alcohol Abuse and Alcoholism in 1970. In 1974, the National Institute on Drug Abuse came on the scene.
It was not until the 1960s that professional alcohol treatment became widely available. At this time, health insurance began to reimburse for alcohol treatment. These developments during the 1960s and 1970s placed addiction research and professional treatment well behind the growth of Alcoholics Anonymous and other 12-step groups. In the public's mind, the 12-step approach was THE approach of choice addiction (White, 1998).
AA's success as an organization has not been matched by a research record. After 75 years of existence, scientific study had been unable to confirm AA's effectiveness. There certainly is a correlation between attendance at AA meetings and success in recovery. However, what remains unknown is whether these successes would have occurred anyway (Hester & Miller, 2003). Although the idea that "success would have occurred anyway" may seem unlikely, recent research would suggest otherwise. Research indicates that most individuals who recover from alcohol dependence do so independently; i.e., without attending treatment or a support group. The National Epidemiological Survey on Alcohol Related Disorders (National Institute on Alcohol Abuse and Alcoholism, 2012) found that:
"Twenty years after onset of alcohol dependence, about three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptom of alcohol dependence. About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol (rehab) programs and AA. Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment."
Many individuals who attend 12-step programs, such as AA, naturally attribute their success to their participation in the 12-step program. Stated differently, they attribute their recovery to membership in their 12-step group and usually to a higher power. Note, in these groups the only requirement for membership is a desire to stop the unwanted behavior (drinking, drugging, masturbating, and gambling).
However, successful recovery may have occurred for other more generic, non-specific reasons (besides attendance and 12 steps). We still don't know what causes members' recovery. Scientists call this the "mechanism of action." The mechanism of action might include the social support they receive at meetings. It might be the availability of a personal coach (called a sponsor). It might be due to an increased sense of hope caused by observing other recovering people. It could be due to the distraction from addiction that meeting attendance provides. It might be due to the motivation that hope inspires. Or, it might be due to an unseen benevolent force. As scientists, we cannot responsibly ignore the "mechanism of action." To clinicians, the sheer fact that people get well is great. To researchers, we need to know why- the mechanism of action.
Unfortunately, we do not yet know which of these ingredients, if any, are responsible for recovery. Moreover, these ingredients are not unique to 12-step groups. Research has demonstrated that each of these ingredients (social support, hope, motivation, and religious/spiritual practice) can contribute to people's ability to change. Someone's personal recovery experience may lead to the conclusion that AA membership "caused" their recovery. That's great. However, scientists know any of these other variables associated with change could have caused it. If so, these other variables would account for the positive correlations between AA and recovery. Why do we care? Because we want to know what these ingredients are, so that everyone can have a successful recovery!
Although AA itself is of unknown effectiveness, research has scientifically validated the effectiveness of "12-step facilitation." This is approach supports and encourages AA attendance and the principles of the 12-steps. This research suggests 12-step facilitation is comparable in effectiveness to other well-established and effective psychotherapies for addictions treatment. Project MATCH published the first evidence of the effectiveness of 12-step facilitation in 1997 (Project MATCH Research Group, 1997).
Thus, history provides us a better understanding of the polarization that emerged between devotees of 12-step programs, and devotees of science. What it does not explain is why this polarization continues. At one time, 12-step programs were the only option available for someone struggling with addiction. We appreciate anything that helps someone to recover. At the time of the historical emergence of these AA, science at that time had nothing to offer. Such is not the case today. Nonetheless, because people were successful using 12-step programs, while other methods had failed, these programs became the primary means of recovery in the absence of any scientific support. Twenty to thirty years later, science has begun to catch up and has much to offer. Yet, the contributions of addictions research have had little impact upon the addictions treatment field.
The failure to rely on scientific research is rather unique to the addictions field. Most people with a serious disease or disorder would be outraged if their doctor recommended a treatment that had no scientific evidence for its effectiveness. Insurance companies will not pay for treatments that are unproven or experimental. Similarly, most people with a serious disease or disorder do not rely solely on God for help, regardless of their beliefs. They seem able to integrate their personal beliefs about God with scientific information. We see no reason this integration should not be standard within the addictions treatment.
Resources
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Articles
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What is Addiction?
- Introduction to What is An Addiction
- Definition of Addiction
- Definiton of Addiction Continued
- The Addiction Definition Compared to Other Addiction Terms
- How Do I Know if I Have An Addiction?
- Why Don't They Just Stop? Addiction and the Loss of Control
- Is Alcoholism a Disease?
- Addiction Statistics: How Big of a Problem Is It?
- A Brief History of Alcoholism
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What Causes Addiction?
- Introduction to Causes of Addiction
- The Many Causes of Addiction and Bio-Psych-Social-Spiritual Model
- Biological Causes of Addiction
- Disease Model of Addiction and Recovery Implications
- Evolutionary Model of Addiction and Recovery Implications
- Psychological Causes of Addiction
- Learning Theory of Addiction and Recovery Implications:
- Social Learning Theory of Addiction and Recovery Implications
- Cognitive (Expectancy) Theory of Addiction and Recovery Implications
- Educational Model of Addiction and Recovery Implications
- Developmental Model of Addiction and Recovery Implications
- Sociological Causes of Addiction and the Temperance Model
- General Systems Theory of Addiction and Recovery Implications
- Sociocultural Model of Addiction and Recovery Implications
- Public Health Model of Addiction and Recovery Implications
- Moral and Spiritual Causes of Addiction
- Addiction and Personal Responsibility: A Fundamental Conflict
- Personal Responsibility and Locus of Control
- Controversies in the Addiction Field: Change Versus Acceptance
- Conflict between 12-Step Anonymous Groups and Science: A Historical Perspective
- Conflict between 12-Step Anonymous Groups and Science Continued
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How Do You Get Addicted?
- Introduction to How Do You Get Addicted?
- The Biology of Addiction and Recovery
- How Does Addiction Affect the Brain?
- Addiction Changes the Brain's Chemistry
- Addiction Changes the Brain's Communication Pathways
- Addiction Changes Brain Structures and Their Functioning
- Impaired Decision-making, Impulsivity, and Compulsivity: Addictions' Effect on the Cerebral Cortex
- Drug Seeking and Cravings: Addictions' Effect on the Brain's Reward System
- Habit Formation, Craving, Withdrawal, and Relapse Triggers: Addictions' Effect on the Amygdala
- Stress Regulation and Withdrawal: Addictions' Effect on the Hypothalamus
- The Good News: The Brain Also Helps to Reverse Addiction
- The Psychology of Addiction and Recovery
- Learning Theory and Addiction
- Classical Conditioning and Addiction
- Operant Conditioning and Addiction
- Social Learning Theory and Addiction
- Cognitive Theory and Addiction (Thoughts, Beliefs, Expectations)
- Cognitive Theory and Addiction Continued
- Cognitive-Behavioral Therapy: Improving Coping Skills
- Addiction and Other Psychological Disorders
- Developmental Theory and Addiction
- Recovery from Addiction: The Psychology of Motivation and Change
- Addiction: Social and Cultural Influences
- Addiction and Sociological Influences: Culture and Ethnicity
- Recovery from Addiction: Becoming Aware of Cultural Influences
- Recovery from Addiction: The Powerful Influence of Families
- Recovery from Addiction: Social Support
- The Spirituality of Addiction & Recovery
- The Spirituality of Addiction & Recovery Continued
- Incorporating Spirituality into Recovery from Addiction
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Signs and Symptoms of Addiction
- How Do You Know If You Have An Addiction?
- The Diagnostic Criteria for Substance Use Disorders (Addiction)
- The Diagnostic Criteria of Substance-Induced Disorders
- Alcohol-Related Disorders
- Caffeine-Use Disorders
- Cannabis-Related Disorders (Marijuana)
- Hallucinogen-Related Disorders
- Inhalant-Related Disorders
- Opioid-Related Disorders (Heroin, Oxycontin®, Vicodin® and other pain medications)
- Sedative-, Hypnotic-, Or Anxiolytic-Related Disorders
- Stimulant Use Disorder: Amphetamine Type (e.g., methamphetamine)
- Tobacco-Related Disorders
- Other Substance-Related Diagnosis and Unspecified Other Substance-Related Disorder
- Activity Addictions (Behavioral Addictions)
- Gambling Disorder (Addiction)
- Sexual Addiction and Pornography Addiction
- Other Activity (or Behavioral) Addictions: Internet Gaming Disorder (Addiction)
- Other Activity (or Behavioral) Addictions: Food Addiction
- Addiction and Other Psychological Disorders
- Addiction and Eating Disorders
- Addiction and Personality Disorders
- Addiction with Depression, Anxiety, and Compulsive Disorders
- Summary of the Diagnostic Process
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Treatment for Addiction
- Treatment for Addiction
- Natural Recovery: Recovery from Addiction Without Treatment
- Natural Recovery Continued
- Choosing An Effective Treatment Approach: Evidenced-Based Practices
- What Makes An Addictions Treatment Effective?
- Biological Approaches to Addiction Treatment: Medications
- The Role of Medication in Addictions Treatment
- Pharmacologic Medications for Addictions Treatment
- Pharmacologic Medications for Addictions Treatment: Part II
- Psychological Approaches to Addiction Treatment
- Motivation for Change: The Stages of Change Model
- Motivation for Change Continued
- Types of Evidenced-Based (Effective) Treatments for Addiction: Motivational Interviewing
- Relapse Prevention Therapy
- Contingency Management
- Cognitive-Behavioral Therapy
- Dialectical Behavioral Therapy
- Acceptance and Commitment Therapy
- What The Pros Know: The Practical Recovery Model
- Social Approaches Addictions Recovery
- A Cultural Approach to Addictions Treatment: Harm Reduction
- Family Approaches to Addictions Treatment: CRAFT, Intervention And Al-Anon
- The Social Support Approach to Addictions Recovery: Recovery Support Groups
- Self-Empowering Support Groups for Addiction Recovery: Smart Recovery
- Moderation Management
- Women for Sobriety
- LifeRing Secular Recovery
- Summary of Self-Empowering Support Groups
- Spiritual Approaches to Addiction Recovery
- 12-Step Support Groups: Groups That End With "Anonymous"
- 12-Step Support Groups: Part II
- 12-Step Support Groups: Part III
- Expanding Addiction Treatment Choices in the United States
- Developing a Personal Action Plan for Addiction Recovery: Part I
- Developing a Personal Action Plan for Addiction Recovery: Part II
- References
- Resources
- Frequentlly Asked Questions about Addiction
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What is Addiction?
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Questions and Answers
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Tests
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Book & Media Reviews
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Self-Help Groups
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Links
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Videos
- Technology Addiction
- Why People Can Become Addicted to Opioids
- The Swiss Cheese Model of Drug Addiction
- The 7 Skills for Addiction-Free Living: Alternatives to Substance Abuse
- Teen Drug Use: 2014 Monitoring The Future Survey Results
- Sex and Gender Differences of Importance to Addiction Science
- How to Tell if a Loved One is Abusing Opioids
- Why Addiction is a “Disease” and Why Is It Important
- NIDA Emerging Drugs-Methylone and Molly
- Designed to Drink? The Genetics of Alcoholism
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39 more
- Women and Addiction: Why Gender Matters
- Designed to Drink? The Genetics of Alcoholism
- Gaming disorder: questions and answers
- ADHD & Risk of Adult Drug Use
- Energy Drink Sparking More ER Visits
- Why are Drugs So Hard To Quit
- Anyone Can Become Addicted to Drugs
- Substance Use: Addiction Theories New Treatments and the Role of Doctoring in Society
- The Impact of Changing Social Behaviors on Teen Drug Use
- Teen Substance Use
- Cannabis Effects on Driving Performance
- Epidemiology of Tobacco Use
- Addiction: Learning to Forget
- Addiction: What Can I Do About It?
- Addiction: Treat It Like a Disease
- Addiction: What Is It?
- One in 4 People Prescribed Opioids Progresses to Longer-Term Prescriptions
- NIDA’s Dr. Phil Skolnick discusses intranasal naloxone
- "Eyes On" Research in Drugged Driving
- How Will Anti-Drug Vaccines Be Used? An Interview With Dr. Thomas Kosten
- Opioid Use in Pregnancy: A Community’s Approach
- Naloxone Rescue Kits
- Living Without Fear
- What You Need to Know About Internet Addiction
- Hooked, Hacked, Hijacked: Reclaim Your Brain from Addictive Living
- The Neuroscience of Internet Addiction
- Internet Addiction: Signs You Need to Shut Down
- What the Internet is Doing to Our Brains
- Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment
- The Reward Circuit: How the Brain Responds to Cocaine
- The Reward Circuit: How the Brain Responds to Methamphetamine
- The Reward Circuit: How the Brain Responds to Marijuana
- The Reward Circuit: How the Brain Responds to Natural Rewards and Drugs
- Mindfulness-Based Relapse Prevention (MBRP) for Addictions Video (vol. 1)
- Mindfulness-Based Relapse Prevention for Addictions (vol. 2)
- Prescription Opioid Misuse
- Substance Use Disorders/Addictions - Clinical Overview
- Addiction in the Elderly
- Teenagers, ADHD, and Substance Abuse
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