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Are professionals open to alternatives?

April 6, 2012
by Gary A. Enos, Editor
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 National leaders in addiction talk about multiple paths to recovery and about patient-centered treatment at industry conferences, and audiences rise as one with overflowing praise. But how many in the enthusiastic masses take that message home? Will we ever stop seeing professionals draw a line in the sand with views such as:

“The 12 Steps aren’t proven.”

“Only AA works.”

“Medication-assisted treatment isn’t recovery.”

“Herbal products are snake oil.”

The other day we received an e-mail from a hospital-based reader who objected—vehemently—to an advertisement on our site for a nutraceutical product offering an opiate withdrawal option outside of traditional detox. “Where is your professional credibility when you accept advertising of clear quackery?” asked the reader.

 I went to the product maker’s website to learn more about the object of this reader’s ire. There I found, among more typical anonymous testimonials for the product, some comments from a physician who serves as clinical director of an inpatient drug treatment program. He apparently doesn’t see the product as an example of quackery, saying he now recommends it to patients to combat physical and mental symptoms of withdrawal.

The product’s founder, who has experienced addiction to pain medication, clearly finds fault with what he considers the limited detox options available to most. But he also does not portray his product as the “cure” or “solution” that our reader referred to multiple times when contacting us. He markets his product and the additional information on his website as “a first step” in getting one’s life back from pain medication addiction.




There are a lot of different paths to recovery. If only one way worked all the time we would have much better outcome rates. The field would be wise to keep its eyes and ears open to new ideas and opportunities, as our field is still so new.

There are as many paths to recovery as there are folk awakening to their need to find some way out of addiction. All of us have biases and prejudices as a matter of human/animal instinct. Professionals may have more education than others--but they are no less susceptible to instinctual drives than the remainder of the population. That is why we, each of us, favor one or another path. I favor 12-Step recovery because it is affordable, available, unending, and provides outlets for "safe" social interaction--as long as the Thirteenth Step remains out of the lineup. That said, I believe that prejudice is an instinct and recovery (not to mention development into a 'human being') challenges all of us to lay aside prejudice in favor of open-ness to others, to change, to stability based on ethical principles. In the end, each person must "do it on my own" and decide for himself or herself the best ways to maintain and sustain recovery. Peace! Jim @ mijsold@hotmail.com

I agree! there are several paths to recovery. My intention as a clinician is to learn new strategies & offer best practices to those in need.

Meet the client where they are in the moment. If a client says to me "I don't believe in the 12-steps & I will not incorporate 12-step meetings in my recovery"...Then it's time for me to figure out how to help this client. It's Time for me to get creative & use my skill set to help the client. On the other hand, if the client wants to utilize meetings as part of the recovery process;I will point them in that direction.

It is not about MY agenda. It's about what will work for the client. Reasonable & rational is always the best practice!

As a Master's level Credentialed Alcohol and Substance Abuse Counselor and current administrator, I have to say that years ago I believed mostly in the 12 Steps of AA as the best support for those suffering from addiction, but over the years I have opened my eyes to see many other paths to recovery. I still believe AA "works the best for most" however, I began to get involved in alternative medicine a number of years ago for some of my own health issues and I have been so grateful that I was open to looking at these alternatives. There are so many other options for people today besides pharmaceuticals and traditional therapies. Herbal supplements, Homeopathy, various body work such as massage, yoga, kinesiology, etc. etc. all have been proven to be beneficial to many people for many "issues". Dr. Daniel Amen uses Amino Acid Therapy in his clinics and has had much success with treating addiction and mental illnesses. There are a number of alternative rehab programs as well as outpatient clinics that utilize alternatives and they help many people. Calling it "quackery" is being judgemental and closed-minded to therapies that might be extremely beneficial to so many clients. After all -- what happened to Honesty, OPENMINDEDNESS, and Willingness?


I cannot comment on the product referred to but I am one of those that believes in multiple pathways. I also believe in evidenced based practices as well as promising practices. As professionals, communities look towards us to make sure that we do not endorse programs, models of treatment, even products that can cause potential harm. I think that endorsing promising products is acceptable but difficult due to lack of a standardized means of evaluation of all ingested products. Let's all just be careful in what we endorse.

The twelve-step treatment model has earned its right to be smug about its place in the continuum of care. The earliest treatment programs were, essentially, twelve-step programs. And while the professional treatment community appears to be open to alternative treatments, the implementation of such models is agonizingly slow. Having been in the profession for decades, I don't foresee an imminent embracing of other models in my lifetime. As your article (Gary A. Enos, Editor, April 6, 2012) suggests, the treatment community at large endorses new ideas, but individual practitioners, more often than not, fall back on the safe alternative--twelve-step programs.
Philosophical differences in relapse prevention models, such as Gorski versus Marlott; one focusing on abstinence and the other on harm reduction (each ultimately targeted toward a better quality of life) are at the heart of the two opposing camps. Ironically, there are far more similarities in their models than differences.
With all the revenue currently invested in treatment research, the twelve-step vs. alternative treatment argument, regretfully, lingers on. While there is no single culprit in this lack of progress, the single-state agencies own much responsibility. Only in relatively recent times have they begun to encourage alternative program development. Let’s hope I’m proven wrong and we increasingly begin to see alternative treatment approaches become mainstream recovery models. WALTER F. SCANLON, PhD, CASAC

So far I have not discovered how to actually" know"/"measure" what works and what doesn't work for t people who pass through professionally identified recovery treatment programs over time. Seems like relapsers become increasingly visible to professionals, while recoverers melt into the "mainstream" of functioning people. Seems like the media is attracted to extreme stories, positive or negative. Seems like tracking "systems" come and go with vicissitudes of opportunity.

Given that perspective, I like to continually advance/practice/ clarify/evaluate my personal/professional skills when encountering any aspect of recovery work, in community with peers. Thank you for offering a subscription to this newsletter.

A wide range of services, and a wide range of approaches, should be available to individuals seeking recovery services. Almost any of these services will be helpful to individuals who are informed about them and freely choose to use them. As long as someone wants to do yoga, massage, meditation, or Reiki, etc. (holistic services not proven but apparently not harmful), or 12-step, SMART Recovery, Women for Sobriety, etc. (support groups not proven but apparently not harmful) or CBT, DBT, or ACT, etc. (all evidence based) I see no reason to object. Products such as nutriceuticals raise more questions, because they have the potential to harm in ways services may not. However, yes, we need to be open to them as well. If they are over-the-counter with luck they will also fall into the category of "not proven but apparently not harmful" and if nothing else elicit a helpful placebo response.


Gary Enos


Gary Enos


Gary A. Enos has been the editor of Addiction Professional since its inception. He also...

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