HOW TO CHOOSE YOUR MOST EFFECTIVE DRUG OR ALCOHOL

TREATMENT PROGRAM (A Chapter from “AA Not the Only Way”

By Melanie Solomon
http://www.aanottheonlyway.com

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 Copyright 2009 Melanie Solomon
HOW TO CHOOSE YOUR MOST EFFECTIVE DRUG OR ALCOHOL
TREATMENT PROGRAM (A Chapter from “AA Not the Only Way”
By Melanie Solomon
http://www.aanottheonlyway.com

How do you know what you are getting when you choose a rehab program? There
are basically four types of programs:
• Moral
• Disease
• Behavioral
• Holistic
It is important to compare the different types of programs before making your
decision. Many of them, especially in the U.S., are based on old ways of viewing the
addicted person, and therefore their approach is often outdated.
In short, the moral model says that a person is bad if they make bad choices.
(This was the main view before the disease model came into play in the 1930’s.) The
disease model views addiction like having a disease, akin to diabetes; the addicted
person is completely powerless over their disease. The two models taken together offer
a very bleak outlook. Addicts are bad people who have no control over their own lives.
12-step programs lean more toward the disease model. After these models, the
behavioral model, or cognitive-behavioral model was developed. It says that each
person has the power to change him or herself by changing the way they think. The
newest model to emerge is the holistic model, which builds upon the good points of the
older models. This approach uses the cognitive-behavioral model as a core component
of its approach, and accounts for the many different contributing factors of the
individual’s unique addiction problem. This approach addresses the health of mind,
body and spirit, helping the individual to both prevent and respond to their problems. It
teaches self-management skills and techniques to prevent relapse and advocates a
multi-faceted approach to support the individual. Most importantly, the holistic approach
views individuals as competent to help themselves when given the right education, tools
and support.
Let’s look a bit deeper into the history and new developments in the addictions
field, especially since addiction may be the most controversial topic that has been
addressed in the public health and medical communities over the years. The addictions
field has evolved through several phases over the past 100 years. What follows is a
brief overview of some of the changes in belief regarding the basic nature of “addiction”
or substance dependence, how to prevent its occurrence and how to intervene once
dependence has become apparent. As shown above, addiction has been viewed as an
individual moral problem, a medical disease and a behavioral disorder and now there’s
an emerging holistic model.
The Moral Model is the belief based on a moral theory. According to this theory,
people are individually responsible for the behavioral choices they make, good or bad.
Those who choose good behavior should be praised, while those who choose bad
behavior need punishment. This leads to people with addiction problems to be
stigmatized, labeling anyone with a “bad habit” as a “bad person.” The downside of this
model has become increasingly clear over the years. People with addiction problems
are stigmatized and are therefore often demoralized by feelings of self-blame, guilt and
shame to the extent that they are unwilling or unable to seek any help or treatment.
In the 1930’s, the new Disease Model began to be formulated. This new view
was that addiction was a disease caused by genetic and biological factors. The addict
was then no longer held personally responsible for their ‘bad behaviors” since these
behaviors were now caused by biogenetic factors beyond their control. A strong
argument could be made that addicts were patients deserving treatment, rather than
criminals deserving punishment. The 12-step recovery movement with its
accompanying treatment system enthusiastically accepted this model. Now, officially,
addiction was a progressive disease for which there was no cure, and the only way to
put the disease “in remission” was by a lifelong commitment to total abstinence. Any
use of alcohol or other mind altering substances was considered a relapse, regardless if
it resulted in any harmful consequences. So whether it was one drink or 100, it was
treated the same.
Despite the wide acceptance and appeal of this disease model (over 90% of U.S.
alcohol and drug treatment programs adhere to it), a number of shortcomings and
limitations have emerged through years of research. Although these programs do work
for some people, there are certain contradictions and paradoxes that prevent others
from finding them helpful. The notion that the 12-step way of recovery is superior to all
others is not at all backed by the research. People can recover without AA or any other
12-step program and be just as healthy as those who find them helpful. Within
traditional treatment, there was a tendency toward a “one-size-fits-all” approach to
recovery, which contributed to high dropout rates. And by defining addiction as an
incurable, progressive disease, many people will find it difficult to change their addictive
behaviors or decide to give up alcohol or drug use on their own.
In recent decades, an alternative model has emerged that challenges the
traditional disease model and its “one-size-fits-all” approach to recovery. This model is
based on the assumption that addictive behavior has multiple components and that
individuals vary in risk depending on their unique bio-psycho-social history. Due to the
fact that both habit acquisition and habit change are primarily influenced by cognitive
and behavioral principles, this approach has become known as a cognitive-behavioral
model. A major emphasis in this model is placed in the reward consequences of
engaging in the addictive behavior, including both positive reinforcement, such as
enhanced euphoria associated with getting high, and negative reinforcement, such as
self-medication resulting in tension reduction or relief.
By bringing the attention back to the person with the substance abuse problem,
treatment goals now shift from being strictly set by a treatment program provider, with
abstinence as the only acceptable option, back to the consumer, (you), who now has a
choice in their own treatment goals. Individuals can choose from a variety of goals,
ranging from abstinence to reduction in harmful consequences, and by placing this
choice into their hands, there is now acknowledgment that most addictive behaviors
represent a problem in self-management that can be resolved by the individual. The
substance abuser is no longer “powerless” but is taking back power over his or her own
life. This model respects the client’s choice and tries to meet clients where they are in
the varying stages of behavioral change. This differs greatly from the traditional disease
model, where emphasis is on client confrontation and enforcement of abstinence as the
only acceptable goal.
The holistic model, or biopsychosocial model, is the emerging model, which
takes a more holistic approach to health and well-being and incorporates the strengths
of the various models of the past and uses those various insights to effect change. New
understandings from years of research are coming into play and the holistic model is
basing its approach on this important information. It is being discovered that social,
economic, cultural and environmental conditions, as well as behavioral choices, impact
both psychological and biological processes. In turn, psychological and biological
changes influence behavioral patterns.
Now, motivational techniques, brief interventions, cognitive-behavioral therapy
and pharmacotherapy co-exist with new approaches, including acupuncture, meditation,
good nutrition and stress management (see previous section for more details). What
has become clearer and clearer is the competence of individuals to manage their lives
when information, support and choices are available.
Since the best predictor for your success is your ability to choose your own
program and set your own goals, it is advisable to ask the following crucial questions to
ensure that an appropriate drug and alcohol program is chosen that will meet your
particular needs.
1. What kinds of treatment programs do they offer? Is it primarily 12-step based,
or do they offer other self-help options as well, i.e. SMART Recovery, SOS, or
Women For Sobriety? So they match treatment settings, interventions and
services to each individuals particular problems and needs, since this is
critical to one’s ultimate success in returning to productive functioning in the
family, workplace and society?
2. Does the program address multiple needs of the individual, not just his or her
drug use, such as any associated medical, psychological, social, vocational
and legal problems?
3. What types of credentials does the staff have, such as doctors, counselors,
and anyone else who has contact with the clients, and what is the ratio
between the staff and clients?
4. Is there a doctor on the treatment’s premises 24 hours a day, or just a couple
times a week to dole out medication?
5. What is the treatment program’s philosophy or theory towards addiction? Is it
religious, bio-psycho-social, psychological, neurological, physical and
psychological, trauma-based (addiction that has stemmed from a sole
traumatic event in one’s life), and does their particular approach suit your own
personality, beliefs and values, or is it one that you can believe in, and rebuild
your life based on it?
6. Does the treatment program detail positive approaches towards treatment,
using up-to-date methods, such as motivational therapy, cognitive-behavioral
therapy, stress personal responsibility, this is a disease/not a disease but a
choice among many others?
7. Do you think this approach resonates with you, or your loved one, that may
 need inpatient help?
8. Does the program offer counseling (individual or group) and other behavioral
therapies, where issues of motivation, building life-skills to resist drug and
alcohol use, relapse prevention, improving problem-solving skills and
facilitation of interpersonal relationships and ability to function in the family
and community often take place?
9. How does the rehab program assist an individual during the withdrawal
process, i.e. medical treatment for withdrawal provided, or must this be done
somewhere else, prior to entering the facility?
10. To what extent is the family involved in the treatment process?

If a treatment program is determined to be necessary, asking these critical

questions will at least give you the important information of whether or not they are
simply a traditional treatment center, only offering one option, the 12-step method, or
whether they have taken all the vital research into account and have now incorporated
many different alternative modalities into their program. Remember, the notion that “one
size fits all” in the treatment of alcohol and other drug problems has been completely
destroyed by the scientific evidence, and therefore, there can not be a “one size fits all”
solution.

About the Author:

Melanie Solomon is the author of the highly anticipated 2nd Edition of "AA-Not the Only Way;
Your One Stop Resource Guide to 12-Step Alternatives". Please visit
http://www.aanottheonlyway.com for more information on her book, as well as to see what
other products she recommends, or to sign up for your FREE discussion forum membership and
updates, or to visit and contribute to her brand new blog! To see what others have said about
“AA-Not the Only Way,” visit
http://www.aanottheonlyway.com/12stepalternatives/testimonials.php. She has also spoken to
teens at The Huntington Beach School District Drug & Alcohol Program, and led workshops at
The Learning Annex in California. Solomon offers a FREE first time 30 minute phone
consultation where you can discuss your greatest challenges and how to overcome them, as well
as your dreams and the outcomes you are trying to achieve. To schedule a free session, contact
her through her website at http://www.aanottheonlyway.com/contact-the-author/services.php.