From Twelve Steps to One Step

In the 1950s and 60s most adults in North America smoked cigarettes or other tobacco products. We thought nothing of it.

  However, increasing research evidence of tobacco health risks began to overpower the tobacco industry’s portrayal of smoking as safe and cool. As the evidence mounted, increasing numbers of people quit smoking or never started. The voices of those wanting smoke-free workplaces and restaurants got louder than the chorus of smokers shouting, “It is my inalienable right to smoke whenever and wherever I want to.” 

  The tide had turned. Now in British Columbia only about 15% of the population smokes tobacco.   The clock cannot be turned back. Societal thinking about cigarette smoking has made a radical shift. 

  A parallel shift in our collective thinking is taking place with regard to the treatment of alcohol addiction. 

  Ask almost anyone what to do about alcoholism and they will suggest going to AA (Alcoholics Anonymous) or “going to rehab.” Over 90% of the addiction rehab facilities in North America operate based on principles from AA’s “12 Steps and 12 Traditions.” The AA movement starts with the assumption that alcoholism is a progressive, incurable disease that can be managed, but the victim of alcoholism will be “in recovery for life.” 

  A 1990s Gallup poll in the US found that almost 90% of people believed that alcoholism was a disease. 

  There is no doubt that many people have been helped by AA, which maintains its strong position through television advertising, lobbying and the zeal of its adherents. And the multi-billion dollar treatment center industry advertises even more aggressively than AA.

  However, in spite of the advertising, long-term abstinence following a residential twelve-step rehab program is about 5% successful, the same rate as achieved by quitting drinking without any outside help.

  There is increasing awareness that AA is simply inappropriate for many people. In a US study, it was estimated that of all the people with serious alcohol problems about one in 25 will ever go to an AA meeting. AA and the 12-step rehab don’t reach those with major privacy issues, because exposure could impact their health insurance and professional licensing. US courts have ruled AA to be Christian religious in nature, so many people won’t attend for religious reasons. Thousands more cannot afford the $15,000-plus tuition fees at the rehab centers. And what woman needs to hear yet another organization tell her she is powerless? 

  Are there any signs of a societal attitude shift about alcohol treatment? And does the evidence suggest alternative, more successful approaches to dealing with alcoholism? The answer to both questions is yes.

  In contrast to the Gallup poll results with the general public, a survey of physicians found that 80% of responding doctors perceived alcoholism as simply bad behavior. And doctors are opinion leaders. 

  Furthermore, increasing numbers of treatment centers are distancing themselves from the 12-step model in their advertising. These facilities typically have a variety of health professionals on staff because they operate from the principle that alcoholism can be overcome, not just managed.

  The hard research evidence of more successful alternatives is solid and growing, but still limited. 

  The societal shift in attitude about alcoholism treatment will see an emphasis on personal choice and full recovery replacing the notion that the alcoholic is a victim of a disease. 

  Permanent recovery is much more than simply stopping the use of alcohol. It now appears that successful, permanent recovery requires self-reinvention or re-creation so as to make alcohol irrelevant to their lives. 

  As that more hopeful perception of the recovery process takes hold in society, many will refuse to stay stuck in their alcoholism and will seek permanent recovery. 

  One-step recovery replacing 12-step addiction management would represent a major shift in the way society thinks about alcoholism. And it’s underway!


Dr. Neill Neill is a registered psychologist in Qualicum Beach. He helps capable people who feel stuck… trauma, relationships, addictions.