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Some Old With the New

December 1, 2006
by Michael Levin-Epstein
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Many of the latest entrants to the treatment business incorporate 12-Step approaches

Although addiction treatment agencies increasingly are incorporating nontraditional or alternative approaches in their practices, from drug therapy to acupuncture to yoga, the traditional 12-Step approach is not being abandoned in the least.

Even when practitioners turn to newer treatment modalities, they almost without fail provide clients with information on the decades-old 12-Step approach to help them deal with their addictions and maintain sobriety. The reason, according to addiction professionals, lies in accumulating evidence-based research supporting the effectiveness of the 12-Step process as well as its value in enhancing other treatment strategies.

The 12-Step approach is clearly a brightly colored staple in the spectrum of treatment options available to today's providers, according to many practitioners. The McLean Hospital Alcohol and Drug Abuse Treatment Program (ADATP) in Belmont, Massachusetts, as well as McLean's new residential treatment facility in substance abuse, the McLean Center at Fernside in the community of Princeton (the latter officially opened last summer), offers a prime example of an operation committed to providing that spectrum of options, according to Shelly Greenfield, MD, MPH, associate clinical director of ADATP. “We provide a full continuum of care, including both on-site and off-site programs,” says Greenfield. “And we take an evidence-based approach to addiction treatment, which, of course, recognizes the value of the 12-Step method.”

The new mclean center at fernside emphasizes a variety of research-based approaches

The new McLean Center at Fernside emphasizes a variety of research-based approaches

The McLean ADATP's basic tenet toward addiction, explains Greenfield, is to provide treatment based on research and empirically tested methods. “We try to find the latest methods that have been shown to be effective and then individually tailor the treatments according to the individual's clinical needs,” she says. That can include medication therapy as well as psychiatric treatment and behavioral therapy, she notes. Center programs use both cognitive-behavioral therapy and dialectical behavioral therapy techniques, and incorporate group treatment and families into the client's care.

The treatment approach, therefore, isn't simply a reflection of the 12-Step method, but what Greenfield calls “12-Step facilitation,” which involves explaining to clients the method's importance in recovery and relapse prevention.

Photos courtesy of McLean Hospital

McLean's incorporation of other treatment modalities includes aggressive use of medication options. For example, says Greenfield, if either an inpatient or outpatient is “ready to launch herself into recovery” from opiate addiction, the program might attempt to detoxify the patient by administering a course of Suboxone, one of the brand-name formulations of buprenorphine. Some patients in the Suboxone program may complete a short detox program while an inpatient. Others might need a longer stabilization period and be referred to the outpatient Suboxone treatment clinic.

The program also uses the medications naltrexone and acamprosate for treatment of alcohol dependence, and continues to look for other effective medication options, says Greenfield. However, she adds, there's a limit to what medication can do. The program also treats co-occurring psychiatric conditions such as depression, bipolar disorder, and post-traumatic stress disorder (PTSD) in patients with addictions; in these cases, both psychotherapy and medication may be utilized. “Most of the literature and studies show that if those [mental health] disorders are appropriately treated, people have a better chance of staying sober,” Greenfield says.

When it comes to treating disorders with approaches other than 12-Step, a treatment technique that continues to gain traction among addiction treatment professionals is Motivational Interview-ing, a client-centered approach that generally helps individuals explore and resolve ambivalence. This approach allows clinicians to “get to issues more quickly” and enables clients to see those issues more clearly, explains Shirley Beckett Mikell, deputy executive director of NAADAC, The Association for Addiction Professionals. “It also provides a faster connector, and builds the security of the client with the clinician more quickly than some other approaches,” Mikell says.

But, she adds, that process may not be entirely comfortable for the client. “Therapy never is comfortable,” she says, regardless of what techniques are employed.

Eclectic approaches

Recognizing the potential shortcomings inherent in any therapeutic technique, practitioners at the English Mountain Recovery program in the Smoky Mountains of east Tennessee are employing a more eclectic, holistic approach without abandoning the bedrock 12-Step technique, according to David Cunningham, LADAC, NCAC I, clinical outreach director.

“I have found that there is an ongoing evolution at treatment facilities in becoming more open-minded to other scientific, evidence-based approaches that are useful in recovery,” Cunningham says. Clients at the 56-bed English Mountain Recovery may be exposed to a variety of counseling therapies as well as to alternative therapies such as acupuncture, yoga, nutritional therapy, and equine-assisted therapy—all enhanced by the tranquility of the facility's setting.