Information on Non-Twelve-Step Substance Abuse Treatment

Created On Friday, 05, August 2016
Modified On Friday, 17, September 2021

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Twelve-step treatment is one of the most common approaches used for treating substance abuse and addiction. The principles of the 12-step process are based on Alcoholics Anonymous, which was developed in the 1930s. Twelve-step treatment has been integrated into many addiction treatment programs across the nation. Alcoholics Anonymous has upheld its mission of providing free, confidential help to people struggling with addiction. However, the 12-step program and process is not the only option for people struggling with addiction.

Non-twelve-step rehabilitation is generally classified as any rehabilitation form that does not incorporate 12-step methodologies or anything from the original Alcoholics Anonymous teaching. However, some programs may also be faith-based treatment centers but do not utilize the 12-step method. Non-12-step programs still incorporate medical detox or conventional detox, individual counseling, family counseling, group therapy, and other treatment forms. Some of these programs are also considered non-traditional approaches to rehabilitation, such as wilderness and adventure programs, holistic treatment, or other experiential treatment forms.

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For many people struggling with addiction, 12-step programs are not the best option, or they have been through multiple 12-step programs before. Many people enter addiction treatment specifically for a non-12-step approach. However, 12-step programs are common because they represent readily available no-cost community-based resources, yet there are common barriers to attendance and engagement. A journal article published in Social Work and Public Health outlined the prominent factors that represent barriers to 12-step involvement.

The author points out there are fluctuations in readiness and commitment to change. Along with this, there is a high degree of spirituality or perceived religiosity for individuals who are atheist or agnostic. Moreover, people avoid 12-step support because of the need to surrender, the sense of powerlessness, and the lack of compatibility between personal and treatment belief systems and philosophies. Also, there tends to be a lack of comfort or perceived support in the group due to membership in a special population combined with social phobia or social anxiety. However, many individuals view 12-step groups as helpful resources in recovery, but participants fluctuate in their readiness and commitment to change.

When is Non-12-Step Drug and Alcohol Treatment the Best Option to Consider?

There are numerous behavioral therapies to consider, whether traditional or not. Most addicts consider non-12-step approaches after attending twelve-step rehabilitation and feeling that it was not the right fit. If they struggle with chronic relapse and have not had any success with 12-step treatment, they should consider a non-twelve-step rehabilitation program. Drug and alcohol rehabilitation should help a person stop using drugs, stay drug-free, and be productive in the family, work, and society. The National Institute on Drug Abuse outlines some principles of effective treatment.

For example, no single treatment is right for every, and people need to have quick access to treatment. Twelve-step programs are usually more accessible and affordable, which is why they are common. However, they are not the best method of treatment for every person. Effective substance abuse treatment addresses all of the patient's needs, not just their drug use. Staying in treatment long enough is critical—most short-term treatment centers are 12-step, whereas longer programs provide more therapy options.

Counseling and or behavioral therapies are the most commonly used forms of treatment. Moreover, treatment plans must be reviewed often and modified to fit the patients changing needs. Non-twelve-step rehabilitation programs are usually more equipped to review treatment methods and adapt services to the patient's needs. Finally, treatment does not need to be voluntary to be effective. Family intervention or even court-ordered treatment is a common and successful approach to get an unwilling addict into rehab.

The Effectiveness of Non-Twelve-Step Substance Abuse Rehabilitation

According to research, most behavioral therapies have comparatively strong empirical evidence and support for treating addiction successfully. For example, brief interventions for alcohol addiction have been shown to have powerful effects on a patient's alcohol use. In this case, an intervention consists of screening, assessment, advice, and a greater frequency of follow-up visits. Cognitive-behavioral therapy was found to be effective in reducing alcohol and drug use and supporting improvement in other life domains.

Contingency management has been an effective approach producing positive outcomes for people struggling with opiate or cocaine addiction, alcohol addiction, and marijuana addiction. Contingency management is a treatment approach that involves reinforcing abstinence with a reward. Motivational enhancement therapy has been found effective with alcohol addiction and overall has yielded positive substance abuse treatment outcomes. Individual and group therapies are still used as part of non-12-step approaches and also yield positive outcomes.

Substance Abuse Treatment Admission Trends

According to Treatment Episode Data taken from 2005 to 2015, in 2015, there were over 1.5 million treatment admissions of people 12 or older reported to TEDS. Between 2005 and 2015, the US population grew about 10%, but the number of annual treatment admissions was 19% lower in 2015 than in 2005. Per the 2019 National Survey on Drug Use and Health, among people 12 or older, 7.8% of the 21.6 million people addicted to drugs or alcohol received any form of substance use treatment in 2019. The estimates in 2019 were similar to those estimated from 2015 to 2018.

Per the TEDS report, in 2015, the treatment admission rate was higher for primary alcohol abuse than for any illicit drugs. The primary alcohol admission rate was 189 per 100,000 population. The highest rates of illicit drugs were for heroin at 146 per 100,000 and marijuana, with 77 per 100,000 population. According to the Surgeon General, only about one in ten people with a substance use disorder receive any speciality treatment. The findings state that well supported scientific evidence shows that behavioral therapies can effectively treat substance use disorders. Treatment using these evidence-based practices have shown better results than non-evidence-based treatments and services.

How Do Non-12-Step Drug and Alcohol Rehabilitation Programs Operate?

Non-twelve-step rehabilitation programs operate the same way as 12-step programs, but the methodologies of treatment differ. Many non-12-step options are effective, like traditional forms of therapy and experiential therapy approaches. Overall, it should include a range of care with a tailored treatment program and follow-up options for a successful outcome. The rehabilitation process begins with an assessment, which could be done over the phone or in-person. The purpose of an addiction assessment is to determine the extent of addiction, underlying medical problems, addiction history, and treatment history.

The information is gathered, and a qualified professional help the addict or family determine what approaches are needed to treat the addiction. Assessments and screenings have proven effective and contributed to better long-term outcomes because the proper treatment was matched to the client's needs. The first step with rehabilitation is detox, which treats the initial cravings and withdrawal symptoms. Different drugs and alcohol create unique withdrawal symptoms. Typically, two common types of detox are medical detox or conventional detox.

Medical and Conventional Detox with Residential or Outpatient Rehabilitation

Medically supervised detox uses medication and withdrawal management techniques that help suppress withdrawal symptoms during detox. According to the National Institute on Drug Abuse report mentioned above, one study of treatment facilities found that medications were used in almost 8-% of detoxifications. Conventional detox programs do not typically administer medication because most patients are detoxing from common street drugs. It is important to note that detox should not be considered the only treatment approach because it will not provide adequate counseling and therapy.

Residential and outpatient substance abuse treatment programs across the nation provide various behavioral therapies to treat addiction. Behavioral therapy aims to modify the clients' attitudes and behaviors related to drug use, increase healthy life skills, and persist with other forms of treatment like peer support or sober living. There are countless settings for people to receive non-twelve-step rehabilitation, such as outpatient behavioral treatment. Most programs involve group or individual counseling or both and provide a variety of behavioral counseling.

Common therapy approaches are cognitive behavioral therapy, multidimensional family therapy, motivational interviewing, and motivational incentives. The treatment is sometimes intensive at first, and a patient may attend multiple outpatient sessions each week. Inpatient or residential treatment is also very effective for addicts with more severe problems. There are numerous licensed residential treatment facilities across the nation, providing 24-hour support.

Residential drug treatment provides various therapeutic approaches and is generally aimed at helping the patient live drug-free and crime-free after treatment. Along with the behavioral therapies mentioned above, there are different residential treatment settings. Therapeutic communities are highly structured programs where patients remain at a residence typically for 6 to 12 months. Shorter-term residential treatment usually focuses on detox and intensive counseling and preparation for treatment in a community-based setting.

Additionally, there are numerous experiential therapeutic methods used to treat addiction. These methods are designed to recreate real experiences that promote feelings, attitudes, and beliefs to help a person increase awareness. Some of the common therapy types are drama therapy, music therapy, drama therapy, animal-assisted therapy, and adventure or wilderness therapies. Experiential therapy is commonly used in combination with behavioral therapies.

What Are the Alternatives to Non-12-Step Substance Abuse Treatment?

The alternative to non-12-step substance abuse treatment is twelve rehabilitation, or someone could consider faith-based rehabilitation as an alternative to non-12-step therapy. The twelve-step philosophy was pioneered by Alcoholics Anonymous and is used by most residential and outpatient treatment programs across the nation. However, the average facility provides various approaches to ensure the right one is applied to the patient.

The basic premise of 12-step rehabilitation is that people can help one another achieve and maintain abstinence from drugs and alcohol. The healing and or recovering from addiction cannot come about unless the person with the addiction surrenders to a higher power. Twelve-step programs and support are an effective approach used by millions of addicts. Overall, 12-step approaches to treatment continue to remain a commonly recommended and used treatment modality for most addictions.

Faith-based rehabilitation incorporates spirituality into the treatment process. These programs help patients connect with a higher power to overcome substance abuse. The spiritual elements focus on treatment, but traditional approaches are used and play a crucial part in treatment. Certified spiritual advisors are present for counseling and guidance during treatment. Faith-based programs also allow addicts to include worships and scripture as part of their recovery plan. For example, spaces for prayer are available on-site to host religious services. Scripture readings, discussions, and even meditation are common within a faith-based treatment center.

Common Terminology with Non-12-Step Drug and Alcohol Rehab

Term Definition
Behavioral Therapy these are therapy approaches that are designed to help patients modify their attitudes and behaviors related to drug use. CBT also helps patients modify healthy life skills and shows them how to persist with other treatment forms such as recovery housing.
Cognitive Behavioral Therapy CBT is a form of therapy that helps patients recognize, avoid, and cope with the situations in which they are most likely to use drugs. Cognitive-behavioral therapy is one of the most common approaches used to treat addiction.
Multidimensional Family Therapy the therapy was developed to help adolescents struggling with addiction and their family members. The therapy addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning.
Motivational Interviewing the therapy takes advantage of the person's readiness and willingness to change their behavior and enter treatment. The approach is commonly used during the family intervention and during the initial stages of treatment.
Motivational Incentives the therapy is part of contingency management and uses positive reinforcement to encourage abstinence from drugs and alcohol.
Therapeutic Communities used in a residential treatment setting- are highly structured programs in which patients remain at a residence for 6 to 12 months. The entire community, including the staff and those in recovery, act as key agents of change.
Recovery Housing considered aftercare support, provides supervised short-term housing for patients, often following other inpatient or residential treatment types. Recovery housing helps people transition to an independent life and is an effective form of aftercare support.
Medication-Assisted Treatment MAT is the use of medications combined with counseling and behavioral therapies, which is effective in the treatment of opioid use disorders and alcohol addiction.
Medical Detoxification these are detox methods that do not use cold turkey detox or rapid detox but use medication as part of withdrawal management. Medically supervised detox is common for opioid addiction, prescription drug abuse, and alcohol addiction.
Experiential Therapy is a therapy technique where patients use expressive tools or activities to re-enact and recreate situations from past and present relationships.

CONTRIBUTORS TO THIS ARTICLE

Marcel Gemme, DATS - Author

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Marcel Gemme has been helping people struggling with addiction for over 19 years. He first started as an intake counselor for a drug rehabilitation center in 2000. During his 5 years as an intake counselor, he helped many addicts get the treatment they needed. He also dealt with the families and friends of those people; he saw first-hand how much strain addiction puts on a family and how it can tear relationships apart. With drug and alcohol problems constantly on the rise in the United States and Canada, he decided to use the Internet as a way to educate and help many more people in both those countries. This was 15 years ago. Since then, Marcel has built two of the largest websites in the U.S. and Canada which reach and help millions of people each year. He is an author and a leader in the field of drug and alcohol addiction. His main focus is threefold: education, prevention and rehabilitation. To this day, he still strives to be at the forefront of technology in order to help more and more people. He is a Licensed Drug and Alcohol Treatment Specialist graduate with Honours of Stratford Career Institute. Marcel has also received a certificate from Harvard for completing a course entitled The Opioid Crisis in America and a certificate from The University of Adelaide for completing a course entitled AddictionX: Managing Addiction: A Framework for Succesful Treatment.


Michael Leach, CCMA - Medically Reviewed on September 17, 2021

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Michael Leach is a Certified Clinical Medical Assistant, who has over 5 years of experience working in the field of addiction. He spent his career working under the board-certified Addictionologist Dr. Rohit Adi. His experience includes working with families during their loved one’s stay in treatment, helping those with substance abuse issues find treatment, and teaching life skills to patients in a recovery atmosphere. Though he has worked in many different areas of rehabilitation, the majority of his time was spent working one on one with patients who were actively withdrawing from drugs. Withdrawal and the fear of going through it is one biggest reason why an addict continues to use and can be the most difficult part of the rehabilitation process. His experience in the withdrawal atmosphere has taught him that regardless of what approach a person takes to get off drugs, there are always mental and emotional obstacles that need to be overcome. He believes having someone there to help a person through these obstacles can make all the difference during the withdrawal process.