Are the 12 Steps the Only Way?
By Cheryl Steinberg
As much as 90% of the drug and alcohol rehabs in America endorse the 12 Step approach to treatment and recovery and yet, research shows that there’s a better way: combining therapy and medication.
If you are a member of a 12 Step fellowship, you might know quite well the bias against the use of medications in recovery – and I’m not talking about narcotics. I mean things like antidepressants and medications designed to support abstinence, such as opioid blockers. The FDA has approved two different medications for use in the treatment of an alcohol use disorder.
So what are these FDA-approved medications and how effective are they?
The first medication is called acamprosate (brand name Campral) and it has been used for alcohol use disorder treatment since the 1980s in Europe; it was accepted by the FDA in 2004. The way Campral works is this: it stabilizes the initial depression as well as reducing cravings by quieting the feelings of being restless, irritability, and discontent that alcoholics experience when they first quit drinking. Acamprosate is meant to be taken daily for the first 12 months of abstinence.
The second medication is Naltrexone. Although Naltrexone is an opioid inhibitor, is has been FDA approved as a daily medication to be taken at a low dose for the treatment of alcohol abuse. Naltrexone is best if used as an emergency relapse drug. Alcoholics who take it prior to a relapse have reported significantly less negative impact of their relapse. For those who want to be abstinent, naltrexone works as a great emergency relapse drug in combination with acamprosate.
It also functions as a supplement to be taken prior to a planned drink. In fact, naltrexone works so well to reduce relapse that many alcoholics use it to successfully drink on a regular basis with very few reports of high binge drinking. Therefore, it might be entirely possible in the near future for alcoholics to simply carry a bottle of naltrexone with them for drinking occasions instead of attending an AA meeting when the urge to drink hits.
Putting It Into Perspective
If you think of these drugs being used to treat an ongoing disease like asthma, which alcoholism is, then it might make more sense. So, in this example, consider that the majority of asthma sufferers have both a daily inhaler and an emergency inhaler. Therefore, for people with alcohol use disorder, acamprosate is their daily medication and naltrexone is their emergency relapse drug.
Epidemiological Studies and Findings
Currently, clinical trials show that the combination of acamprosate, naltrexone, and cognitive-behavioral therapy have the highest rates of recovery of any system used in drug and alcohol treatment. In fact, this conglomeration of treatment approaches has been studied thoroughly over the past 10 years, revealing abstinence rates of greater than 65%. No other program, not Alcoholics Anonymous, nor SMART Recovery®, comes close to producing these rates of abstinence, and yet very few treatment programs in the U.S. are engaging in this practice.
Treating Nicotine Addiction: A Case for Medication
Abstinence rates for nicotine are at an all-time high of 82% in the United States according to the CDC. Nicotine addiction treatment has been the only drug treatment program to have significantly impacted drug use in recorded history.
So what’s happening in nicotine addiction treatment that isn’t happening in the drug rehabilitation industry?
The answer is pharmacological assistance in quitting addiction, which is to say, involving the use of medication(s) as a vital part in helping people overcome their addiction. First of all, it’s now widely known that nicotine is one of most addictive drugs in existence. Considering just how addictive this drug is, how then have smoking rates decreased so dramatically?
The answer to that is this: the use of a medical-psycho-social model of recovery. A comprehensive study from the Western Journal of Medicine in 2002 made two conclusions after scrutinizing over 6,000 articles on nicotine cessation. The first conclusion was that taking FDA-approved medication for the cessation of nicotine more than doubled success at quitting smoking. The second was that the likelihood of successfully quitting increased even further when anti-smoking medication was combined with evidence-based therapy for behavioral modification, such as cognitive behavioral therapy (CBT).
There is no study that exists showing that therapy or 12-step programs alone are as effective as a combined therapy and medication program. Knowing this, it’s safe to say that any program that does not prepare recovering alcoholics with the tools of both therapy and anti-addiction medication that can lessen the impact of a relapse is unrealistic and negligent.
Consider this: of those who are attempting life-long abstinence, over 99% will drink at least once within a 20-year period. Therefore, healthcare practitioners are ethically responsible to prepare their patients with alcohol use disorder by providing them with essential information on how to mitigate relapse if it occurs.
Are you seeking recovery for an alcohol or drug addiction? Do you need help finding out where and how to start? Our Addiction Specialists are available around the clock to take your calls and answer your questions. Let us help you. You are not alone.