How Far Can 12 Steps Go? ; Thousands Attest to the Power of 12-Step Programs in Breaking the Hold of Addiction. but Might the Popular Programs Be Wrong for Some?

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Americans have a penchant for 12-step programs. The original beacon for a path out of addiction - Alcoholics Anonymous - has grown past 50,000 groups in the US (and twice that worldwide). And its message is being reincarnated in self-help fellowships to fight drugs, gambling, overeating, sexual addictions, smoking, and even indebtedness.

Conventional wisdom has it that the 12-step approach - in which an individual acknowledges his or her powerlessness before the addiction, turns to a higher power, and takes specific steps to change - is the most effective route out of addiction. Its popularity seems to support that. Some 90 percent of residential and outpatient treatment programs draw directly on its principles.

Yet there are many who question not that it helps thousands, but whether its predominance may get in the way of some people finding their freedom. There are issues, some critics say, related to its quasi-religious nature, its definition of addiction as an incurable disease, the creation of long-term dependence on the program, and the way courts and other agencies mandate addicts' participation. Are some with alcohol or drug problems being coerced to follow a path that may not be suited to their needs and beliefs?

"The problem is that people think AA is the only correct treatment," says Lance Dodes, assistant clinical professor of psychiatry at Harvard Medical School. "That's true only for a subset of the population, and many people are harmed by it."

An AA representative declined to respond, saying it is the group's tradition to refrain from controversy and not comment on what others say about alcoholism or about AA.

Over the past 70 years, AA has helped huge numbers to find sobriety and a new lease on life. "If you look at the number of groups and 2,000,000 members worldwide, it's clearly got longevity and appeal," says Barbara McCrady, clinical director of Rutgers University's Center of Alcohol Studies. Yet AA's own surveys show that of the people who attend a meeting, 9 out of 10 drop out within the first year. Research hasn't yet been done on its siblings, Narcotics Anonymous (NA) and others, she says.

For many who stay with it, the benefits can't be overestimated. A big-time drinker who turned to drugs after a family tragedy, "Alan" was in denial about his situation. Near the end of college, though, he was weary and tried unsuccessfully to quit. It was only when he tagged along with a friend to an NA meeting that his turnaround began.

"Listening to people's stories, I knew I was an addict and these were people I could relate to," he says. "Going to meetings, I'd stay clean for a while and then use. It took six months 'til I got clean for the last time." He's been free for six years but attends meetings several times a week.

"Once you stay clean for a while you realize drugs were only the tip of the iceberg," Alan adds Alan who asked that his real name not be used. "You also need to change your compulsive behaviors and how you react to situations. There's a wealth of knowledge in that room."

Keith Humphreys at Stanford University's School of Medicine sees this kind of "instillation of hope" as a crucial factor in changing addicts' lives. "Most people feel defeated and have a frightening sense they can't control their own behavior," he says. "They go to a group and see others who've had the same problem now doing well, and that instills a lot of hope."

Twelve-step groups provide a valuable public health benefit, says Dr. Humphreys. Not only are they widely available, but one cost study showed that people going to the groups require $5,000 less per person from the healthcare system annually. "Multiply that by more than a million people getting treatment each year, and they are taking an extraordinary burden off the system," he adds.

At the same time, the very limited research done so far doesn't back up the conventional wisdom. …