Alcoholics Anonymous (AA) and other 12-step groups are the leading U.S. approach to addiction recovery. Millions have attended these meetings and "worked the steps." Popular media include countless references to AA-oriented recovery. Many scientific studies show that attending these meetings is associated with recovery.
However, many individuals will not attend these meetings, or will not attend them long enough to solidify change. Their reasons include not wanting to accept the labels "addict" or "alcoholic," not wanting to attend groups of any kind, not wanting to consider oneself powerless, not thinking of oneself as having a disease, or not wanting an approach that encourages lifelong attendance.
Perhaps we should encourage these individuals to set aside their objections and attend AA anyway? When such strong encouragement is given it probably works in some cases. However, the reality is that only a small percentage of those who have addiction problems attend AA. We need to have additional approaches.
Actually, other approaches already exist, but they are not well-known. There is a range of mutual aid groups in addition to 12-step groups, as well as a range of treatments in addition to 12-step-based treatment. The non-12-step mutual aid groups include SMART Recovery, Moderation Management, Women for Sobriety, LifeRing Secular Recovery and Secular Organizations for Sobriety. Each group has an active presence on the Internet. Through their websites, one can also find information about non-12-step based treatments.
These non-12-step groups can be more positively defined as self-empowering groups. Self-empowering groups encourage individuals to take charge of their lives and leave addiction (and eventually recovery) behind. In contrast to the 12-step approach, self-empowering groups support individuals in taking charge of their lives rather than accepting powerlessness and turning their lives over to a higher power.
The Serenity Prayer, often used at AA meetings, provides a framework for understanding a fundamental difference between powerlessness and self-empowering recovery:
"God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference."
The 12-step approach is a serenity approach to recovery. The self-empowering approach is a courage approach. As the Serenity Prayer suggests, we all need both serenity and courage. However, most of us prefer one approach to the other. To use the language of scientific psychology, some of us tend toward external locus of control (serenity) and others tend toward internal locus of control (courage). Locus of control refers to our expectation about what in the future will shape our lives more (e.g., what controls us, or who is in charge): What happens to us, or what we do about it.
Self-empowering approaches to addiction recovery are well-suited for individuals who have an internal locus of control. Rather than thinking they have lost control of their lives because they have a disease, these individuals want to learn how to build motivation, control craving, resolve their underlying problems, and move on with creating meaningful and purposeful lives.
Two addiction treatment facilities I am aware of offered both the powerlessness and self-empowering approach. Clients were allowed to choose the approach they preferred. The choice was about 50/50 in each facility (one outpatient, one residential).
SMART Recovery is the best-known and most widely available of the self-empowering recovery groups. With fewer than 1,000 meetings, it is about 100 times smaller than AA. The SMART Recovery website and its activities and community could be a substitute for face-to-face meetings for many individuals and locations. Many SMART Recovery participants include 12-step meetings in their recovery plans, either to have a sufficient face-to-face component, or because they find aspects of both programs helpful.
Consistent with the overarching self-empowering perspective, SMART Recovery:
- Teaches tools for recovery based on evidence-based addiction treatment
- Does not use the labels "addict" or "alcoholic"
- Encourages participation only for as long as it is perceived to be useful,
- Allows for truly anonymous participation via a screen name on the website
- Allows participants their own perspective on whether addiction is a disease
- Teaches tools for recovery that are useful regardless of what the participant believes (or not) about God
- Accepts the validity of appropriately prescribed addiction and psychiatric medication.
In addition to providing free, science-based, self-empowering addiction recovery mutual aid groups, SMART Recovery advocates for choice in recovery. All individuals seeking recovery support or treatment should be informed of the full range of options available, and be free to choose among them.
Disclosure: Tom Horvath, Ph.D., serves as president of SMART Recovery.
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