Ninety percent and upwards of American substance abuse treatment programs derive from AA' s 12 steps. We need to expand our options based on (a) the evidence, (b) the 12 steps' religious nature, (c) their shortcoming in not teaching coping or emotional management skills. I have created an alternative residential program built on my Life Process Program.

I'm not going to review the data showing that AA and 12-step programs are limited in their effectiveness, beyond repeating the summary from the respected Cochrane Collaboration's 2006 review: "The available experimental studies did not demonstrate the effectiveness of AA or other 12-step approaches in reducing alcohol use and achieving abstinence compared with other treatments."

And operating as though AA and the steps aren't religious can put you in legal danger. In a 2007 decision, the Ninth Circuit Court of Appeals declared in Inouye v. Kemna that a parole officer was not immune from liability for damages after he forced Inouye, a Buddhist, to attend AA meetings in violation of his First Amendment religious freedom. "This uncommonly well-settled case law (against coercing AA attendance). . .was sufficient to give notice to a reasonable parole officer."

Finally, AA meetings and 12-step treatment do little systematically to train people to cope with themselves, their urges, and their environments. They inspire some - evidence says a small minority - to quit drinking. The meetings do give people a place to go for human contact where drinking is not possible. But a ritual in which a group of laypeople or recovering counselors - many with obvious and persistent problems themselves - repeat the steps and tell their personal stories offers members little psychological basis for achieving sobriety.

In contrast to these empirical, civil rights, and clinical problems with AA, a body of evidence has developed that shows a number of psychological treatments -- motivational interviewing, the community reinforcement approach, brief interventions, skills training, and solution-focused psychotherapy -- to be effective for addressing substance abuse. As I have treated addicts in the decades since I wrote Love and Addiction, I have combined these techniques -- along with ones specific to my approach, like values-oriented and purpose-driven recovery -- to create the Life Process Program (c), which I tested through several years' use at a residential treatment prgram.

I now have a strongly validated, successfully aplied CBT and values program that I match with any program available for addiction, and certainly any based specifically on medications and the 12 steps.

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