An Alternative View of Addiction and Recovery Online Conference Transcript - Is 12-Step Addiction Approach Effective

Written by HealthyPlace.com Staff Writer

David: The 12-step approach is: an addict is an addict for life. If you stop ingesting the substance, you can't ever have it again or you will become addicted again. Do you believe that's true?

Dr. Peele: No. This kind of thinking is, in most cases, harmful and self-defeating. Not that there are not many people who should not avoid certain behaviors, certainly in the near-term. But virtually all alcoholics drink again -- the question is only how they view that drinking, how they cope with it, and where they proceed from taking that next drink.

David: So you're saying, "if you can handle it, fine. If not, then don't do it." Am I correct?

Dr. Peele: Not exactly, but good try. I say, "How are you going to make progress over the way you may previously have handled it." Remember, at any given moment, a microscopic number of people are quitting any addiction entirely. For the rest, we start at the worst outcomes -- how are you going to avoid killing yourself or others (as Audrey Kishline did)? This may involve turning your keys over to others, drinking in your basement, etc. I then turn towards the goal or minimizing all-out relapse, by getting people to cut off their binges, or returning to their goal of abstinence --meanwhile increasing the time between negative outcomes and the severity of these outcomes. In this larger picture, some people will quit altogether, and some will actually succeed at being controlled users, but if we limited our successes to just these people, we could not justify virtually any therapeutic effort.

You know, the government (through the NIAAA) just spent the largest amount of money ever on a clinical trial of psychotherapy. This was project MATCH, where 12-step, coping skill, and motivation enhancement therapists developed manuals, supervised training, and scrutinized therapy with a selected group of skilled therapists.

The ultimate result was declared a success by Enoch Gordis, director of the NIAAA. However, in order to do so, he was forced to rely on the fact that, overall, these alcoholics reduced their drinking from 25 to six days a month, and from 15 to 3 drinks per occasion of drinking. Gordis hates controlled drinking, and often puts it down, but with this large, alcoholic population, improvement is the only way to see any progress -- the amount of absolute abstinence is bound to be minimal and discouraging.

sheka2000: What happened to admitting you have a problem, taking responsibility for that problem, and working on that problem.

Dr. Peele: I'm for that. But there are actually therapeutic techniques for assisting that process, called motivational enhancement. In brief, this involves exploring the individual's values, calling attention to conflicts between what that person him or herself considers important and their behavior, and then assisting them to channel this unpleasant realization in the direction of ameliorating the problem behaviors in which they are engaged.

sheka2000: That still comes from personal admission to a shortcoming, correct?

Dr. Peele: No, I wouldn't call it a shortcoming. I would call it a deficiency in realization of one's goals and values. Perhaps this sounds like semantics, but I don't find people do best when others emphasize their weaknesses. Have you ever watched a daytime talk show where they bring in children who are acting out and then assign them to boot camp instructors who shout at and demean the kids? I don't believe people are best ready to change when they are assaulted like that. Rather, they do best when they feel the best about themselves.

joslynnn: In my experience, there is no sanity and no control once an addiction is in action. Do you consider this an extreme case?

Dr. Peele: Yes, and even in the most extreme cases -- of insanity as well as addiction--people frequently have moments of cogency and control. I think much is justified by claiming people have no control or ability to be aware of themselves. But this is rarely the case with most people, and never the case all the time with even the worst addicts.

scottdav: Would quitting of alcohol altogether, without some kind of taper in the amount being drunk beforehand, not be dangerous since the body has developed a physical need for the alcohol?

Dr. Peele: If you are looking for reasons why people might want to abstain, there are many. However, when someone has been drinking for years and decades, the idea that all of a sudden they must totally abstain seems alarmist, even when they are doing themselves considerable harm. Rather, we can avoid panic and try different approaches when we can realize that we cannot gain in several weeks what a person has failed to demonstrate for many years or several decades. Nonetheless, it may well be best for this person to aim for abstinence, or virtual abstinence, for their best health outcomes. But let me also remind you that, believe it or not, overall drinkers outlive abstainers. Of course, there are some drinkers who bring that average way down. But, and here is the strange contradictoriness of human existence, abstinence is a mortality risk factor.

David: Here are a few audience comments on what's been said tonight, then we'll take a few more questions:

Biancabo1: I have been involved in counseling people with substance abuse problems for the past 7 years, and I still find the most difficult aspect is letting go and trusting in the process, especially as it applies to the family members.

Xgrouper: Thanks for being here tonight. I am a big fan and visit your website for accurate and up-to-date information on today's issues. Keep it up, you are doing great things.

sheka2000: The 12-step approach has saved many lives, and created direction for many. My thought is, if it works, why fix it? As a recovering addict, I gotta say that I disagree that there are moments of cognitive choices in the midst of addiction.

David: Here's the next question:

Steve1: Why is alcohol such an issue? So many other drugs are thrown at us to help us, but if you drink a beer--it's bad?

Dr. Peele: You may be a little different in your experience from most participants at this site. They are people involved, either personally or professionally, with alcoholic excess. Given that, we do not minimize the damage that many people suffer from alcohol. I did just say that much drinking is not only not harmful, but, ironically, has substantial benefits. I just published a massive research paper (in the current issue of Drug and Alcohol Dependence) finding that in a number of key areas of psychological functioning, including mental health and cognitive acuity, moderate drinkers are in better shape than abstainers, even lifelong abstainers (that is, not people who quit drinking).

scottdav: Would it not be more likely that the person would achieve better results by breaking down, giving up alcohol in steps, rather than aiming for the goal of giving up completely?

Dr. Peele: Often, yes, but not always, and it is hard to dictate that sort of thing. Of course, I might ask you, do you think most people do best by quitting smoking altogether, or by trying to cut down. The conventional wisdom is quitting altogether is necessary. I think this is overstated, even with tobacco, but it certainly seems to be pertinent for many people.

David: I know it's getting late. Thank you, Dr. Peele, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com. You will always find people in the chatrooms and interacting with various sites.

Please feel free to stay and chat in any of the other rooms on the site. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com/. Thank you again, Dr. Peele, for being our guest tonight.

Dr. Peele: I welcome and appreciate this opportunity. People seemed to feel free to speak with a range of viewpoints. I hope they benefited from my views, and I know I enjoyed and benefited from theirs. Please do not hesitate to call on me again.

David: Good night, everyone..

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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