What options are available if AA isn't the right fit for me?
When it comes to addiction, our country is in a public health crisis: 45 million American families are affected by the condition, 20 million people have substance use disorder, and 17 million people have alcohol use disorder. It is heartbreaking to look at the statistics that show a staggering 64,000 Americans die from drug overdoses each year and over 88,000 die from alcohol-related causes. But what is particularly harrowing is that less than 10 percent of people suffering with substance use disorder, and less than 7 percent of those with alcohol use disorder, get the help they need.
The way recovery is organized within the United States has been heavily dominated by 12-step programs over the last (near) century. Our courts can mandate that someone attend Alcoholics Anonymous to avoid prosecution. Even our physicians refer to 12-step programs. It’s easy to see why people often feel such programs are the only option. This belief is perhaps exacerbated by some misrepresentations that if a 12-step program doesn’t work, it’s the person who isn’t thoroughly working a program, or that they are incapable of being honest with themselves. These messages are simply untrue.
While these programs are sometimes successful, their success rate fluctuates between 20 and 60 percent. That means this type of pathway doesn’t suit everybody, and that’s okay. We’re not here to suggest that one pathway of recovery is better than another. Rather, we want to provide you with a realistic picture of what recovery looks like for different people and give you alternative options. We want to see you succeed in defining a pathway that works for you.
How People Recover from Substance Use Disorder in the U.S.
Looking at the broad picture of recovery in the United States, a leading study shows that tens of millions of Americans have successfully resolved an alcohol or drug problem through a variety of traditional and nontraditional means.
Nearly 55 percent had assistance through mutual-aid groups, such as AA, recovery support services, and treatment.
Around 45 percent recovered without any formal assistance or recovery supports.
A recent study that compared 12-step groups to alternative support groups in terms of attendance, participation, and recovery outcomes found that groups like LifeRing, SMART Recovery, and Women for Sobriety were just as effective as the 12-step groups. Study author Dr. Sarah Zemore and her team reported that “findings for high levels of participation, satisfaction, and cohesion among members of the mutual help alternatives suggest promise for these groups in addressing addiction problems.”
What’s clear from this picture of recovery in the U.S. is that we all recover in a variety of ways, so we don’t need to push someone toward one pathway. With an understanding of options available, we are better placed to provide the support and resources that person needs.
Pathways of Recovery
The main pathways of recovery can be categorized into three areas:
Clinical pathways of recovery
There are a range of pathways that involve healthcare providers, clinician, or credentialed professional. These are used in instances where people are on the severe end of substance use disorder, requiring detoxification and medical assistance. They include:
Inpatient or outpatient treatment. There are four levels of clinical care that vary depending on the severity of the disorder. They include medically managed intensive services, clinically managed low-to high-intensity residential services, intensive outpatient and partial hospitalization, and outpatient care.
Pharmacotherapy. Commonly referred to as medication-assisted treatments, these include taking prescribed medication that reduces the severity of withdrawal, reduces cravings, and decreases the risk of returning to drug use. This type of therapy has been shown to improve rates or survival, increase retention in treatment programs, and improve outcomes. There are three classes of medication: agonists, antagonists, and mixed agonists-antagonists. Medications include naltrexone, acamprosate, gabapentin, methadone, buprenorphine, and naloxone.
Holistic therapies. These unconventional types of treatment promote overall well-being and can be used in isolation or to support more conventional pathways. They include: massage, aromatherapy, hypnosis, meditation and mindfulness, reiki, reflexology, yoga, art therapy, music therapy, drama therapy, dance and movement therapy, equine and canine therapy, and wilderness therapy.
Psychotherapy. Otherwise referred to as talking or behavioral therapy, this kind of treatment involves working with a therapist to work through the psychological aspects of substance use disorder, learning how to recover the capacity to self-regulate and cope with stress in order to live in a long-term recovery. Types of psychotherapy include: Acceptance and Commitment Therapy, Cognitive Behavioral Therapy, Eye movement desensitization and reprocessing (EMDR), Motivational Interviewing and Motivational Enhancement Therapies, Family Therapy, and Couples Therapy.
Non-clinical pathways of recovery
Community-based pathways that utilize peer support fall into this category. They are accessible to anyone and most of them are free, making them a popular option. They include:
Peer-based recovery support groups. These are alternative mutual-aid or support groups like 12-step groups. They include:
Recovery community centers. The Alano Club of Portland is a community center, housing many different types of mutual-aid groups, plus a series of workshops and meetings throughout the year that give people the tools to sustain their recovery. These are free to anyone attending the club.
Educational-based recovery services. The Association of Recovery in Higher Education and the Association of Recovery Schools represent collegiate recovery programs. In plain English, that means schools and colleges that specifically support people in recovery. Oregon is in the process of launching its first Recovery HighSchool.
Faith and culturally based recovery supports. There are specific support groups for those who follow a particular religion, like Jewish Alcoholics, Chemically Dependent Persons, and Significant Others, or Milati Islam. For those who identify with a particular culture, there are also supportive groups such as White Bison and Wellbriety Movement.
Recovery housing*. Also referred to as sober living homes, Oxford Houses, or halfway houses. These are a great stopgap for those who are leaving the structure of residential treatment, but who still need peer support. It’s important that recovery houses are certified by the National Alliance of Recovery Residences, which adheres to strict guidelines to ensure that those staying in residences are living in a safe environment that prioritizes their safety, and that the organization sticks to a code of ethics.
* Please note that many homes require attendance at 12-step groups, some monitor drug use, and they vary in length of stay, and they typically require payment.
This essentially refers to people who recover without any formal supports or recovery groups. Even though many people believe that you need to work through some program in order to recover, that isn’t actually the case, with as many as 45 percent of people recovering in this way. What is common in these people however, is that they have a strong sense of who they are, they are typically able to set and achieve goals, and they already have a supportive family, partner, and friendship group.
Whichever pathway you choose, we want to convey that there are many options out there. You just have to try some out to find what works for you.