Alcohol Addiction Treatment: 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 where I live 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  Alcoholics Anonymous (AA) or “going to rehab ” for alcoholism treatment. Over 90% of the addiction rehab facilities in North America operate based on principles from AA’s “Twelve Steps and Twelve Traditions.” The Alcoholics Anonymous 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 Alcoholics Anonymous, which maintains its strong position through television advertising, lobbying and the zeal of its adherents. And the multibillion dollar treatment center industry advertises its wares even more aggressively than AA.

However, in spite of the advertising, long-term abstinence following a residential twelve-step rehab program is about 5%, 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. Alcoholics Anonymous and the 12 steps treatment centers 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 twelve step model in their advertising. These facilities typically have a variety of licensed health professionals on their staffs 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 replace the notion that the alcoholic is a victim of a disease.

Permanent recovery is much more than simply stopping the use of alcohol. Current thinking is that alcoholics achieve successful, permanent recovery through self-reinvention or re-creation so as to make alcohol irrelevant to their lives. This has been my own experience and the experience of my clients.

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 to overcome alcoholism permanently.

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

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Dr. Neill Neill retired his psychology practice at the end of 2013. He maintains an active coaching practice via telephone or Skype with select clients dealing with alcoholic husbands or ex-husbands. Check out his book, Living with a Functioning Alcoholic: A Woman's Survival Guide.

15 thoughts on “Alcohol Addiction Treatment: From Twelve Steps to One Step

  1. Dear Dr Neill,
    I agree with your observation that there is a shift away from the traditional AA tenets.
    My partner is a recovering alcohilic (his own words)who has been nearly 3 years dry. He is a Buddhist/Shamanic Practitioner and is very unlikely to benefit from a Christianity driven programme! He now leads a peer-led self-help group every week. There is no mention of God, a higher power or any other external mover. It seems to work.
    Here in Scotland there is also a significant shift away from AA and it is now viewed as very patronising and condemning by a great many addicted drinkers. Of course, it still works for some – and all power to them but I feel the organisation has failed to move with the times and now actively repelling a growing proportion of prospective ‘customers’ with the narrow, Christian-only perspective.
    Thank you for a most useful site,


  2. Excellent post. My husband stopped drinking nearly two years ago. We are not religious, Aa was not an option. He did it on his own and he is achieving so much more in his work now. It empowers him. I think I can say that we are putting alcoholism behind us now

  3. My son & my husband attend AA & are doing very well. They have made so many friends & it has changed their / our lives. I have trouble with anyone degrading AA at all.

  4. Hi Rebecca,

    I’m glad your family is doing well with AA. Three of my children attended AA and AA-based treatment centers, and they benefited greatly. And there is no doubt that AA has helped many thousands of people. What I am challenging is the notion that AA can work for most people and that it’s the only way. If that is degrading AA, then I’m guilty.

  5. Dr. Neill – I am a little confused. When you say that alcoholism can be overcome forever are you saying that the alcoholic would be able to drink again?

  6. Hi Charlene,

    No, I’m not saying that. What I am saying is that a person in recovery can get past the recovery stage and and no longer be defined by his former addiction. You were a child once, but I’ll bet you don’t define yourself or think of yourself as a “former child.” I had a serious alcohol addiction and I recovered. Alcohol gradually became irrelevant to my life, and its use or non use disappeared from my identity.

    How long is forever? It’s been 34 years for me, but at least 30 of that has been struggle-free as far as alcohol is concerned.

    Charlene, I hope this has helped to clarify.


  7. Hi! Excellent Article! If an addict can overcome his/her addiction on his/her own, do you think it will be very effective? Or is entering rehabilitation a much more efficient and effective way to overcome addiction?

  8. I have been married to my husband for 11 years! He has a daughter who is a severe alcoholic! She lives in another state and recently reentered rehab! She keeps telling her father she wants to come home. I guess that means my house! I lived with this woman when my husband and I were first married, she was sober then, and every day was hell. I’m afraid if she moves in with us it could end my marriage and if I say she can’t my husband will resent me! What should I do?

  9. I would like to say that we really are at the end of helping my daughter. She is currently in a alcohol abusive program and AA classes twice a week and was due to graduate. Yesterday she just renewed her driver license and already has been driving under influence. She came back home in December 2013 to get her life together, at 28 years old, and has yet to show true signs or real effort on her part in this problem. I know we enabled her. What do we do?

  10. Hi Dr. Neill,
    Thank you for this extremely informative website, the links and download choices to your published material, not to mention the affordable price.

    Laura. 🙂

  11. I don’t know where to begin. My grandson is 22 years old and is a seriously bad alcoholic. He goes into a seizures without alcohol. I don’t know what to do. I have no money for a rehab so I cry myself to sleep at night wondering if he will die because I don’t have the money to help him. PLEASE tell me what to do. I love him with all my being. Signed LOST AND AFRAID

  12. I too am lost and afraid. My 26 year old daughter is in her room drinking heavily and has done so for over ten years. The only time she leaves her room is to work, which doesn’t generally last very long, before she is dismissed. The quantity of drinking around the clock scares me, but she scares me more. If we talk to her, we get abusive and foul language. And violence is not unknown. I am not looking for answers so much as support, I wish I could commit her, as her life seems miserable and pointless. I would rather she party hard in her life and drink than be lonely and isolated and disliked.

  13. My 30 year old son has been in jail for 3 years, for beating someone up, in a blackout. He will be getting out this September and needs to go into a drug and alcohol treatment program as part of his probation. If he drinks he has 3 years suspended, he will have to go back in to serve. I watched him lose everything, his home, job, girlfriend, health, car, etc. Since I am a recovering alcoholic, I did not enable him, because I have to take care of me to stay sober. I can see by talking to him on the phone that the disease is still in him. Watching me get sober, he knows what to do, but I don’t have as much fear and low self esteem as he has. He also has a lot of anger at my ex for how he treated him. Until he gets that out and works through it, I think he will use alcohol to cover up his feelings. I was diagnosed with lung cancer last year and I’m in remission now, but if it comes back I’m afraid he will fall apart. I am all he has as his Dad died when he was 4. It’s so hard to watch your child go down the tubes, but there is nothing I can do to save him. I had to want to get better before I could put myself in rehab and the same goes for my son. Al anon helped me a lot and I highly suggest it to anyone who loves an alcoholic. It teaches us to take care of ourselves not the alcoholic. It works and helped me so much. Good Luck!

  14. My 31-year-old daughter is an alcoholic. She is also addicted to prescription medication which she claims to need for anxiety and PTSD. As far as I can tell, these medications have not helped her at all and have only increased her anxiety after their effect wears off (thus she takes more). She also threatens suicide frequently because her life has cascaded so far downhill to ever deeper rock bottoms. She has been hospitalized twice on a suicide watch. After the last hospitalization she took her recovery seriously and began to go to AA after her release from the hospital. Her life began to improve while she lived with us for a month and attended her AA, counseling and NAMI meetings. We ultimately paid to get her car registered and insured, and we paid for a nice apartment for 3 months so she could focus on herself, rebuild her sense of purpose, and learn to be capable again. She hasn’t been employed for over 2 years and we rented the apartment to give her breathing room to job search and find a job outside of bartending (her last vocation). She was doing so well and within a week of living in her new place we sensed a shift in her and, ultimately, she started drinking again and when she drinks in combination with her medications it is horrendous. She won’t let me into the apartment I am paying for, she screams at me with so much hatred and profanity and deflects any questioning by attempting to point out how screwed up she perceives me to be. She is a mess and if I say anything to try to get her back on track she states she doesn’t want to live so what’s the point. I have tried to get her into in-patient treatment. We were on a 6 month waiting list for a local facility and she was finally admitted and I felt like the weight of the world was off my shoulders. But, when I came to visit at the end of the first week for family day, I found out she had checked herself out after 2 days in the facility. I, at this point, am at a loss. I almost feel she need to go to a mental institution. She is so self-destructive. What I have just written barely scratches the surface of the many details played out over the past 13 years. Needless to say it has affected my health and my ability to get ahead financially. I am still raising her two younger brothers and I need boundaries to keep them away from the worst of the harmful behavior. I am sure you all have similar stories. I am not sure why I am writing this. I did a google search about adult children alcoholics and it lead me to this site. I think one of the hardest things I experience with her (besides the fear I will find her dead at any moment) is the feelings of heart break for her while simultaneously feeling an incredible amount of anger towards her. My anger is twofold – I feel like I am angry at “my daughter” for constantly harming “MY DAUGHTER” and I am angry at her for always attacking me, causing my retreat and then reinforcing my sense of failure by saying I don’t care about her at all and that is why she is so messed up. My heart breaks for her and I also feel so frustrated and helpless.
    Thank you for hearing me! And I wish you all grace on your journey!

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