This paper briefly compares and contrasts two different approaches to treating alcoholism or alcohol dependence: the disease and abstinence model of Alcoholics Anonymous (The 12 Step Programme) and SMART Recovery (Self Management and Recovery Training), using cognitive-behavioural and motivational-enhancement therapy, based on Rational Emotive Behavioural Therapy.
Alcoholics Anonymous and alternative addiction approaches.
Analogous to a Swiss Army Knife, alcohol is employed by individuals in a number of contexts for purposes such as socialization, relaxation, sedation, and medication (Nevid & Rathus, 2010, p. 181). It helps curb negative feelings such as anxiety, depression, and loneliness (Nevid & Rathus, 2010, p. 181). However, when used in place of functional, healthy, coping mechanisms, alcohol dependency or alcoholism has a variety of negative consequences, such as loss of career, family, and in many cases, life.
Treatment approaches to alcoholism vary. One such approach widely used in North America originating from the disease model of addiction blended with a faith-based approach is the abstinence model, more commonly recognized in the form of Alcoholics Anonymous (AA) (Nevid & Rathus, 2010, p. 183). Other models exist, such as cognitive-behavioural or motivational-enhancement therapy (Nevid & Rathus, 2010, p. 183). These alternative therapeutic approaches to addiction include the life-process model, and one such programme, SMART Recovery (Self Management and Recovery Training), uses a combination of motivational, behavioural, and cognitive methods, concentrating on secular, science-based, non-confrontational methods, far better suited for short-term interventions. This does not take into account 60% of alcoholics who spontaneously recovery (Peele, 1996, para.22).
These two methods for coping with alcohol dependence employ fundamentally different approaches which will be briefly examined here, bearing in mind that rates of recidivism are generally consistent regardless of approach, at least when comparing cognitive-behavioural and AA after 1 year of discharge (Ouimette, Finney & Moos, 1997, p.239).
AA also commonly known by its alias, the “12-Step Programme”, looks at addiction from a medical or reductionist standpoint, yet at its core uses a faith-based or spiritual component. Although officially this standpoint is absent from their literature, AA functions by viewing addiction as a disease with a guaranteed path of progression and end-result. Being that an individual has a disease for which he or she is not responsible, feelings of shame are to be reduced as well as avoiding labelling the individual as dysfunctional, instead placing any responsibility squarely on the shoulders of the disease. AA participants are first made to admit their alcoholism; to do otherwise is to be in a perpetual state of denial. Ironically, this reinforces the labelling concept instead of avoiding it, as an individual must indentify as an alcoholic. AA participants also must learn to develop an external locus of control, by recognising that their alcoholism, their disease, is greater or more powerful than they are; they then must turn over control to a power greater than themselves. Typically, this refers to the God associated with a wide and varied range of Christian doctrines, but it can in reality be any symbolic representation of a power greater than oneself. AA also tends to focus entirely on the disease and recovery process, requiring participants to limit their social circle to other recovering addicts. Moderate alcohol or drug consumption is strictly forbidden; only complete abstinence is permitted, although it is recognised that relapse is often on the road to recovery. Despite its widespread adoption, while AA or 12-Step based initiatives has positive outcomes with its participants, it has not proven to be superior to other approaches. In fact,…