Since the introduction of the 12 Steps in the 1930’s, there have been two separate cultures in addiction treatment: the recovery community (12 Step being the most well known example of this) and the scientific community. On the one hand, the recovery movement has developed primarily from the real-world experiences of recovering addicts. In addition, it sees itself as a fellowship with an unknowable and immeasurable spiritual core. Scientists, on the other hand, have sought objective, verifiable results that can be replicated in randomized controlled studies.
For too long, these two groups have addressed addiction independently—at times they’ve even been at odds with one another. Science has largely overlooked the value of recovery. This, despite the fact that the recovery model been the single most successful movement in helping addicts over the past 75 years. Meanwhile, the recovery community has expanded the divide by viewing itself as a separate entity unto itself. Sadly, addicts and their families are the ones who have paid the price for this rift. In this blog post, I’ll provide further insight into the standoff, and illustrate how—working together—the two paradigms may provide new, more effective treatment approaches.
Dr. John Wallace, former director of the Maxwell Institute of St. Vincent’s Hospital, documented how segments of the scientific community have had a history of dismissing 12-Step treatment. In his keynote address titled, “The Two Cultures of Chemical Dependence Treatment: Time for Reconciliation?” and presented at the 2009 conference of the National Association of Addiction Treatment Providers, he described the conflicts between the two groups. He shared how science had tried to discredit the recovery movement, citing the following examples:
• Researchers have spent significant resources trying to prove the plausibility of so-called controlled drinking (as opposed to abstinence) for hospitalized alcohol-dependent patients. (Controlled drinking is rejected by many in the 12-Step community.) Even though the results of these studies were either misleading or disproven later, they continue to appear in psychology books and other publications. Meanwhile, several well-respected studies have shown that only patients who were abstinent achieved stable outcomes over time compared to moderate or controlled drinkers.
• Scientists have challenged the well-established concept within recovery circles of “addiction as a disease.” Instead, they’ve attempted to characterize it as a temporary and reversible “syndrome.”
• Despite a large body of research that reaches the opposite conclusion, scientists have questioned whether long-term treatment is more effective than brief interventions. They have also challenged evidence that points to how addicts use defense mechanisms, such as denial, rationalization, and minimization, to maintain their addictions.
• The scientific community has routinely overlooked studies demonstrating the effectiveness of traditional 12-Step programs, while at the same time focusing on approaches such as cognitive-behavioral therapy.
In addition, I’ll add one more point:
• Even among the small group of scientists that has acknowledged the benefits of 12-Step groups, their research has been limited to whether subjects attend group meetings or have a sponsor.
So how do we address widely cited research that is flawed and misleading? First and foremost, the answer is to conduct and promote better research. Studies need to be unbiased, properly designed and analyzed, have long-term follow-up periods, and they also must take into account the full range of treatment options.
Unfortunately, our growing understanding about what causes addiction still hasn’t resulted in a treatment that consistently works—this despite advances in brain imaging, breakthroughs in identifying the gene variants that may predispose people to addiction, and efforts to block the intoxicating effects of drugs. At the same time, cutting-edge research is providing evidence that the 12-Step process is, in and of itself, a complex neurophysiological process that reshapes the brain and counteracts the spiritual and moral impairments caused by drug abuse
Both 12-Step and science play essential roles in the bigger picture of addiction treatment. No doubt that we’re approaching a dead-end if we continue treating addition strictly as a biological disease that can supposedly be cured with a magic pill or 28 days in rehab. In fact, we need an approach that includes the latest scientific research, as well as one that is informed by what 12 Step and other peer support programs have to offer.
So rather than dismiss programs like Alcoholics Anonymous, the scientific and medical communities should be asking what makes it so effective. For instance, what are 12-Step participants doing to successfully achieve long-term sobriety? We also need to develop more effective medications, advance our understanding of the science of addiction, and continue to research the science of recovery.
It’s time to embrace different points of view and allow them to better serve the millions of addicts looking for reliable and unbiased answers. If the scientific and recovery communities became allies instead of adversaries, combined, they could usher in a new era in addiction treatment—one that focuses less on discounting one another and more on developing treatments that actually work.
David Sack, M.D., is board certified in Addiction Medicine and Addiction Psychiatry. As CEO of Elements Behavioral Health he oversees a number of addiction treatment centers. He served as a senior clinical scientist at the National Institute of Mental Health (NIMH) where his research interests included affective disorders, seasonal and circadian rhythms,and neuroendocrinology. You can follow Dr. Sack on Twitter.