A. Thomas Horvath, PhD, has advanced alternatives to 12-Step based treatment for the past quarter-century, and he has to admit that perceptions of his work have changed some. This year he was pleased to be invited to participate in a high-profile, moderated panel discussion on alternatives to 12-Step scheduled for the National Conference on Addiction Disorders (NCAD; an event sponsored by the publisher of Addiction Professional). Back in 1986, he spoke before members of a National Council on Alcoholism and Drug Dependence (NCADD) state affiliate and didn't feel nearly so welcomed.
“If the audience members had had rotten fruit and vegetables available there, they would have pelted me,” says Horvath, founder and president of the outpatient treatment organization Practical Recovery in San Diego and president of the SMART Recovery network of non 12-Step support groups.
Yet in another sense, the small cluster of people who have established treatment and support options for individuals who have resisted participating in or have failed with 12-Step formats say old habits die hard among the field's traditional voices. Alan Meyers, founder of the Clearwater, Fla.-based residential treatment facility Alternative Treatment International, Inc., says he knows
that 12-Step facilities encounter many clients who for various reasons aren't seen as a fit for that approach. But he never finds those individuals arriving at his center via a referral from a 12-Step based facility.
Meyers says he asks managers of these centers all the time, “What do you do with the calls from people who don't want your treatment?” He says he never gets a direct answer.
Of the addiction treatment facilities across the country that offer therapeutic services beyond medication management alone, those that market themselves as alternatives 12-Step remain a scant fraction of the total. Even the prominent organizations of support groups that adhere to a philosophy separate from that of Alcoholics Anonymous (AA), Narcotics Anonymous (NA) and similar organizations number just about half a dozen. Among these groups are Horvath's SMART Recovery and the organizations LifeRing Secular Recovery and Secular Organizations for Sobriety (SOS).
Horvath cites a laundry list of reasons why some individuals who receive outpatient counseling at his center report having had a negative experience with 12-Step treatment. Some rejected having the label “addict” or “alcoholic” attached to them, and disagreed with the disease concept of addiction in general (Horvath's program does not use disease language and spends much time addressing underlying issues such as trauma, anxiety and depression).
He says others reported that they wanted to explore these underlying issues but found that the staff in the 12-Step based programs they attended didn't have the expertise to do so. Others find that the treatment in 12-Step organizations is more group-oriented than what they're looking for.
Most importantly, Horvath says, many 12-Step based organizations tend to take a rigid approach that forces all individuals to conform to a set program structure with a predetermined schedule of activities and number of days in treatment.
“From a customer service perspective, most treatment programs are a disaster,” says Horvath. “They are demanding and confrontational.” He says major field leaders such as William White and others have argued these points in national forums for years, but while the field reveres these recognized voices as individuals, treatment programs don't seem to adjust their practices in accordance with the leaders' urgings.
Horvath describes his program as espousing a “self-empowerment approach.” He says Practical Recovery strives for maximum collaboration with the client-about the only strict requirement for clients is a 48-hour notice rule for canceling an appointment for services. Practical Recovery currently offers only outpatient services but is scheduled to open a residential component this summer; it had offered residential services in the past.
The self-empowerment strategy means, for example, that while Horvath would not recommend moderation management as a strategy for a person on the path to recovery, he also would not reject it out of hand if the client wanted to pursue it. “What I'm promoting is a resolution of problems,” he says. “They get to pick how to get there. There will be false starts.”
He adds that this is the same reason why he would never dissuade a client from attending a 12-Step meeting. “I don't think any one approach is any better than any other,” he says. The idea is that everyone should have access
to the treatment option that matches their needs.
But he adds in regard to meeting attendance, “By the time [clients]
get to us, that's the last thing they're looking for.”
Interestingly, when Horvath lists the factors that he believes turn some clients away from 12-Step programs, he doesn't mention the programs' spiritual focus and emphasis on a Higher Power. “Most of our clients believe in God; there are not many atheists and agnostics in the world,” he says. “But is it a God involved in your life, or is it about helping yourself?”
Meyers says he does find that some of the individuals seen in his program have objected to the spiritual focus of 12-Step based programs. He says about half of his clients have been in treatment before and the other half are first-time treatment seekers.
Meyers says his 24-bed, Joint Commission-accredited residential program takes care to avoid the shaming language that he sees as characterizing many traditional treatment programs. “What you tell yourself about yourself is what you believe,” he says in explaining his disdain for labeling individuals.