Exploring Non 12-Step Addiction Therapy Options That are Affordable and Effective
Dr. Stanton Peele, founder, Life Process Program for harm reduction coaching
In the addiction field all we may ever hear about are the 12 steps and not the 12 steps. In fact there are a panoply of nondisease, non-trauma based therapeutic options.
The entire class of non-medical, nondisease treatments is called cognitive-behavioral therapy, or CBT. CBT grew out of behavior therapy, which initially consisted of rewarding approved behaviors and punishing undesired ones. It was opposed to Freudian or psychoanalytic approaches in that it was based on laboratory experiments, starting with animals.
But this framework was eventually recognized as being both too limited and too passive in that it did not incorporate people’s own thinking (cognitions), values, initiative, and self-efficacy. People were capable of guiding themselves by using their own thinking. At the same time, people’s thought patterns could create negative psychological conditions, like depression and anxiety. One crucial aspect of people’s thinking is called their self-efficacy, or their belief that they can direct their lives in a positive direction.
CBT is a talk therapy (no shocks involved!). But unlike directive 12-step treatment or free association in Freudian therapy, CBT therapists work through open exploration and planned pathways. Helpers proceed through nondirective, collaborative interchanges in which clients (not called patients) play an active role.
CBT is a present-oriented therapy geared towards addressing current, conscious problems clients have. In this way it differs from both psychoanalytic therapy and its close relation, trauma-based therapy. In these two therapies, clients are presumed to be unaware of both the causes and nature of their psychological disorders. The alternative is seeing people as being able, with assistance, to recognize dysfunctional behaviors they display and to conceive of changing these patterns in more constructive, functional directions. Hence, “solution-focused.”
CBT — unlike disease therapies — assumed that people can control and direct their own behavior in pursuing larger goals. The underlying concept is “self-efficacy,” which is essentially the opposite of powerlessness. That is, people are able to gain control of their lives — or display agency — by being self-aware. The process of identifying harmful behaviors and drawing connections between thought patterns are examples of mindfulness. Placing a positive spin on such thinking, mindfulness allows people to achieve desired ways of being through awareness of themselves and their situations.
All of the elements discussed so far: focusing on the present and being intentional, pragmatic and results-oriented, relying on self-initiated thinking, and — most especially — believing in one’s personal empowerment, called agency, have been developed in motivational interviewing, or MI.
MI therapy is often identified by the nonjudgmentalness of the helper, who asks clients clarifying questions to help them identify their own values and goals. MI conceives that the motivation for change comes most powerfully from people’s own realizations of the discrepancies between their goals and values and their actions. MI understands that the desire and ability to resolve such discrepancies is the primary tool in people’s ability to change.
Family systems therapy
The above approaches focus on the individual and the individual’s relationship with a coach, helper or therapist. Yet people generally come to therapy as part of a family system, whether their home of origin or their current nuclear family. These families comprise systems of interlocking members whose behaviors feed into one another — e.g., a parent being overly directive and a child either being passive and lacking initiative, or acting out as a reaction to parental dominance. Therapy in this approach involves first recognizing these connections and, often, working with family members together to address dysfunctional interpersonal and family patterns.
Community reinforcement therapy
It is a short way from seeing the connections between family members’ impacts on one another and a broader perspective in which people’s larger settings — work, schools, social networks, community environments — direct and sustain people’s behaviors both for better and for worse. In the most obvious cases, adolescents who belong to antisocial gangs drive one another to increasingly dysfunctional, and perhaps criminal, behavior.
Likewise groups reinforce different levels of health behaviors. At one end of the spectrum some social groups practice and reinforce good nutrition, exercise and moderate, healthy consumption of food and other substances. At the other end, some groups push members towards destructive and addictive health behaviors often involving substances including food, smoking, excessive drinking and unproductive drug use. Joining groups and finding settings in which healthy, rather than self-destructive, behaviors are practiced is a very basic form of community reinforcement therapy.
What is generally evident in all of these types of therapy is the role of optimism and positivity, the possibility of self-control and self-direction, and the value of thinking about yourself and trying to improve your life situation. These are, in fact, the fundamental elements of the Life Process Program.
If you enjoyed this blog, you may also enjoy Dr. Peele’s interview with Dr. Tom Horvath. Tom is our friend and colleague from SMART Recovery – a NON-12-Step option for overcoming addiction.
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