As Stanford University’s acclaimed psychologist Albert Bandura declared in a major research review, “alcohol abuse is not a monolithic condition with an inevitable progression” but rather, “a multi-determined pattern” varying from person to person in its severity and causation.

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• "Sick-Minded Soul" and the AA Recovery Paradigm

There are many interesting findings from the available literature that will help explain why the recovery industry has been marginally effective in the attempt to treat distressed individuals abusing, becoming dependent upon, or simply finding themselves caught up in problems related to their behavior. I will list them here.

1) Statistics show that as of 2008, of the 22 million people identified as having substance dependency, only 4 million were seeking treatment. This suggests that people that need help are reluctant to get it for reasons that may have to do with the type of treatment being offered and their lack of available information on any other options. 2) Statistics show that 93 % of the treatment available in the United States is 12 Step and Alcoholics Anonymous based, which therefore means that 100 % of the people that are treated in these settings are taught to believe that they have a progressive and incurable disease and that they are helpless and powerless over it. 3) Despite the use of words like "addiction" and "alcoholism" they do not even appear in the DSM-IV. In fact, the word addiction has come to incorporate substance dependence even though they are not the same thing. 4) The research shows that the disease model appears to be more of a historical and cultural construct then based on any scientific discovery. Therefore, the very foundation by which the mental health community views the problem can be questioned. In addition, Alcoholics Anonymous views the disease model as more of a spiritual and moral shortcoming. 5) Studies show the ineffectiveness of the 12 Step and A.A. approach and also suggest that the daily goal of abstinence, the repression of underlying issues, the dependency on the group, the life long knowledge and acceptance of helplessness and powerlessness produces significant psychological distress and contributes to relapse for the majority of people. 6) Studies that attempts to show efficacy of these approaches lack statistical significance because of questionable research designs. A.A. does not maintain statistical information on effectiveness, and most researchers that study 12 Steps and A.A. use questionable research designs that are unreliable and produce questionable validity. This research does not generalize, which therefore makes such studies scientifically limited in value. Because the 12 Step based approach and A.A. only use abstinence as the measure for outcome success, studies conducted to prove effectiveness might also be misleading.

For example, if a study was done comparing an inpatient 12 Step based approach and any other outpatient approach aside from A.A. and the measure for successful treatment outcome was abstinence, the study could conclude that the 12 Step based approach is more effective then any outpatient approach because by the very nature of being an inpatient, the person is going to be supervised and monitored at all times. If you did this same type of study where one group went to a 12 Step based inpatient facility and the other group went to a yoga retreat for thirty days where detoxification was supervised by an eastern medicine doctor and where no substances were allowed, after thirty days the researcher could conclude that both approaches were equally as effective in maintaining abstinence. But this is not the point. Once the person leaves the inpatient facility and now has been indoctrinated with the belief that they are incurable, the transition to daily life becomes difficult. Ask Lindsay Lohan. A.A. by espousing similar treatment ideology provides a constant reminder of this disempowering long-term prognosis. In a similar fashion, when studies used to prove efficacy are designed to compare two groups that share the same ideology in the first place, any conclusions are relative.

These studies are like the Greek syllogisms. Mr. Jones has a drinking problem. Mr. Jones goes to rehab. Mr. Jones stops drinking in rehab. Therefore, rehab is an effective way to stop drinking. That would be true if you lived there, 24/7, 365 days of the year, but that is not real life. It can also be stated like this. Mr. Jones has a drinking problem. Mr. Jones goes to rehab. Mr. Jones stops drinking in rehab. Mr. Jones goes to A.A. meetings and is still sober. Therefore, rehab and A.A. are effective ways to stop drinking. What is missing from this all or nothing, black or white type of thinking which is more important then whether or not the individual has been involved in addictive behavior, is how they are managing their lives when they are alone? Distress and problems in living are predicative of relapse. It is reasonable to assume that people that attend A.A. meetings and follow the 12 Step programs, not only had problems that resulted from their addictive behavior, but also had significant problems in living.

Therefore, it is also reasonable to assume that most, who remain sober, with the belief that they are helpless, powerless and incurable, also REMAIN impaired in other ways. Those people with substance problems that had attended meetings for years and had based their recovery solely on the success of not using would have to project that negative internal dialogue which would show up in cognitive and emotional impairment, not to mention physiological problems with sympathetic arousal and anger management. Further, most would have coping skill deficits, social skills deficits, and even more problematic, negative self-talk. Yet, they were sober and could profess treatment success.

Even for the many that remained abstinent for years and still attend these support groups, they will contribute their sobriety to working the program, but their distress in living is part of their character defects. These groups and meetings cannot have an effect on any other problem in living the person may have merely by their attendance.

In essence, an individual had perceived a life experience in a negative way, they never resolved it, and so they repressed it. That negative energy needing to be displaced is dealt with through self-soothing behaviors like drinking alcohol. This is the self-medicating. The alcohol produces unwanted behavior that is inappropriate. The inappropriate behavior is actually the by-product of the repressed energy. If the individual was troubled before the alcohol, they will be troubled after the alcohol whether or not they still drink or use other substances. Think Mel Gibson.

7) The NIAAA has determined that people can recover from physical dependency through controlled drinking which questions the validity of the "abstinence only" way to treat the problem and that once dependency takes hold it is chronic and progressive. 8) The religious nature of A.A. and the measure of success or failure of treatment to be solely about the ability to maintain abstinence contribute toward significant psychological distress and depressive states thereby repressing underlying issues and creating the conditions that contributes to relapse. Because rehabs never to responsibility for treatment failure, when the person is compliant and abstinent, they are working the program and the program is working for them. If they slip, they have failed and this failure is the proof that their problem is a biological disease. 9) Effective group dynamics promotes individual skills necessary to leave the group. The goal of group therapy is independence. In the A.A. group it is dependence. You can either maintain conformity or look to empower yourself through developing skill sets that will help you in other areas of your life like coping. 10) Legal cases have been shown to uphold the claim that A.A. is a religious organization and that when courts mandate A.A. attendance in lieu of punishment, they are violating an individual's constitutional rights. Yet, they are still mandated. 11) The one size fits all treatment approach offered in the United States through 12 Step based approaches and Alcoholics Anonymous does not take into consideration the unique qualities and characteristics of an individual with any type of addictive behavior nor do they determine what circumstances brought an individual into treatment in the first place. 12) 89 % of A.A. members are Caucasian, therefore little consideration is being given toward multicultural knowledge awareness and sensitivity. AA was originally created for white, Christian males. The concept of powerlessness can be destructive to a woman who has suffered through violence or abuse. 13) What is relapse? This defines the recovery industry. For 93% of the treatment facilities, it is a black and white issue. You are either abstinent or you have relapsed. But, it is known that criticism, anxiety and stress are warning signs of impeding relapse, and that A.A. does not provide the coping skills necessary to reduce day-to-day problems in living. In fact, A.A. uses criticism as a way to indoctrinate the individual into the program. The statistics and the available literature on the scope of the addiction problem, the effectiveness of the established treatments and the numbers of people that are not seeking help speak for themselves. Again, the NIAAA found that people that met the criteria for alcohol dependency, were experiencing partial or full remission of their symptoms one year later, many who continued to drink in moderation and many that received no treatment at all. This dispelled the conventional wisdom that dependency was chronic and progressive.

The most obvious questions seem to be lost amongst those who profit from relapse; after all, the recovery industry is really the relapse industry. Who goes to rehab once? What percentage of people have remained abstinent for long periods of time? How many of these same people are experiencing positive well-being and life satisfaction in all areas of their life? Furthermore, how does the medical community that subscribes to the addiction as disease model come to embrace a religious organization that defines disease in a spiritual and moral way, and that does not believe in medical practices? One only needs to observe a person in recovery to notice the psychological problems of anxiety and depression and the substitution behaviors for their addiction seen in anger management issues, coping and social skill deficits, and large consumptions of nicotine, sugar, coffee and other self-indulgent substances, which maintain the addictive personality. These members share an object relation's unconscious attraction to one another fueled by reinforcement and given acceptability by religious references. A.A. members through unconscious attraction bring familiarity to one another. Many will tell you that their sponsors and other group members have similar traits to their immediate family or significant people from their past.

What is also clear is that the medical community needs to classify in the DSM-IV the terms addiction, alcoholism and disease to express a common meaning. Probably the egregious assumption that is being made in the recovery industry is that you treat all substance related problems with A.A. and 12 Step based approaches. The literature clearly shows that almost all the studies on addiction have been conducted on alcohol, and drug studies on animals. Yet, there is a giant leap of generalization to assume that any of these findings can be directly applied to sexual conduct, gambling, Internet use, pornography, eating, shopping, or any other behavior done obsessively to warrant an addiction label.

The review of the literature can best be summarized by an analogy. Today the country suffers from its reliance on foreign oil. It creates all kinds of political and economical problems. But, the country is an oil-based economy and is dependent on those that produce and control it. This is the same oil that was being pumped out of the ground when Henry Ford was around. Politicians throughout the years continue to look for ways to drill for more oil in areas that our government would be able to control. Alternative fuels are not cost effective at this point even though they would be better for the country in the long run. As long as we are dependent on oil, and oil is easy, readily available and produces enormous financial gains for many people, then the well intentioned, reasonable alternatives will be ignored and be given mainly lip service.

So too, the recovery industry operates in a similar way, where 12 Step based and A.A. treatments are old commodities and where new options now need to be governmentally funded and advocated for from the highest ranks. The challenge of course to this point has been the fact that the policy makers solicit psychiatrists and other doctors to advise and help appropriate funding and resources. These expert advisers are subscribers to the addiction as disease model, and many sit atop the 93 % of the 12 Step based treatment facilities that refer patients to A.A. This would suggest that unless an independent government agency sets up an organization made up of mental health professionals that share a variety of evidence based treatment approaches to addiction and where equal representation of new theories and new treatments can be openly supported through government funding, reeducating the public, and retraining the mental health community to be well-versed, supportive and advocates for whatever methodology brings about the desired change, nothing will change in regards to the problem of addiction and substance dependence in the United States.

Nobody should ever be labeled or stigmatized as being sick or having a disease for the convenience of the established protocol.

The Recovery Industry
Everything You Need to Know To Get Your Life Back on Track

My position is an indictment on drug policies in the U.S. more than AA and 12 Step programs actual practices. But, since AA and 12 Step programs make up the greater majority of rehabs, social service agencies, non-profits, outpatient clinics, etc., and because the problem with addictive behavior appears to remain a big public health concern every year, it would only follow U.S. policies need to be scrutinized more closely. If every year the policies fail and nothing changes in regards to treatment, then it is important to understand how treatment may be part of the problem and not part of the solution.

Policies deal with the supply side and the demand side. The demand side is prevention, education and treatment. Hilary Clinton and many others for years have stated that the policies are ineffective. The reason most people have nowhere else to go besides 12 Step/AA is because in the U.S. there are over 10,000 rehabs, and over 93% of them are 12 Step/AA based. The government, the rehab facilities, much of our educational system and the courts mandate and support the 12 Step/AA philosophy. Again, it has helped thousands of people and definitely has its place for many. But, it is of limited value to the greater majority of people who find themselves in the system.

For the average American person alcohol and drug treatments are essentially synonymous with AA and 12 Step. This was a historic progression. After the Temperance Movements and Benjamin Rush, the moral and religious lobbyists continued to gain influence. Keep in mind that the 19th century brought out 2 Seventh Day Adventists , Dr. John Kellogg and Reverend Sylvester Graham. They both essentially believed that masturbation was responsible for mental disorders and that eating grains and cereals and not masturbating would be a viable treatment. Again, masturbation is a behavior. Some religious people believe that masturbation is an inappropriate behavior. Therefore, it is correlated with mental disorders, which means brain disorders because now this unacceptable activity can be explained. I am in no way criticizing religious beliefs. I was born Catholic, and still attend mass. But, when the attempt is made to control others behavior by creating correlational connections, it appears not very logical. For example, for years teenagers were thought to get acne because they ate candy, like chocolate bars. Therefore, chocolate bars cause acne, or French fries, and hamburgers. By the 20th century, following WWI and as part of the Treat of Versailles, the victorious and superior U.S. made other nations agree to prohibition laws making the growing, manufacturing and distribution of drugs illegal. These policies would find their way to controlling the inappropriate behavior of the roaring twenties and culminated with the 18th Amendment, Prohibition.

This failed of course, and the 21st Amendment would make alcohol legal again. But, during this time stockbroker Bill Wilson, not only bitterly struggled with alcoholism--and can be aptly summarized as: "You've got to hit rock-bottom and admit you're powerless" to overcome alcohol or any other source of dependency, which became the foundation of AA, but was also like most people during and after the Depression, feeling powerless, helpless and hopeless. Themes he would later use.

Here's something that few people know. When Bill Wilson and Dr. Bob first set out to help people, they also had a friend who rarely if ever mentioned named Tom Powers. In the beginning, these three men and others traveled in search of new recruits and made attempts to expedite the religious conversion experience by taking hallucinogenic drugs. Much like Freud who had become addicted to opium thought he could treat it with cocaine. The point being that even in its earliest days, the founders of AA were willing to try anything to produce a conversion experience and the creation of the 12 Steps and God came later.

Once AA and 12 Step programs took hold they became the foundation for the emerging recovery industry. For the past 50 years, the recovery industry has operated in a vacuum. Despite decades of scientific research uncovering new information about etiology and effective treatments, there has remained a gap between science and practice. The industry is dominated by the AA and 12 Step programs. These programs proclaim a unitary disease model of alcoholism: namely, that the majority of individuals with alcohol difficulties has the same chronic, lifelong illness, and that for them, moderate consumption is forever impossible. As E.M. Jellinek famously asserted in 1960 in his book The Disease Concept of Alcoholism, the condition is a disease that is "progressive, transmitted through heredity, and {marked} by a loss of control over consumption once drinking begins." Although Jellinek's claims were not scientifically validated, subsequently, volumes of research has shown that he was incorrect. Few Americans are aware of this.

All the majority of Americans know is that addiction is a disease and you go to AA and to 12 Step program no matter what brought you into the system. Teenager dealing with sexual orientation issues, drinks, does not cope, goes to rehab and receives the diagnosis….diseased. Teenager, being bullied, depressed, anxious, no coping skills, no good communication established with parents, uses to numb the pain, gets into trouble because off poor decision making, gets set off to rehab is labeled…diseased.

Evidence based support:

A. Dr. Mark Willenbring former Director of Research for Treatment and Recovery at The National Institute on Alcohol Abuse and Alcoholism (NIAAA) as part of their epidemiological and longitudinal research on drinking behavior concluded:

1. Although alcoholism can be a progressive brain disease, the majority of the time it is not. Therefore, we need to rethink what we know about heavy drinking.

2. The majority of people that met the DSM-IV criteria for alcohol dependence, (alcoholic), in a one year follow up, were either in partial or full recovery, many of whom were still drinking (moderately) and were not in any treatment. This specifically challenges the notion that alcoholism is progressive, uncontrollable, and that a person's only options are abstinence and faith based treatment.

3. Drinking behavior lies along a continuum. But, anyone can get a DUI after just a couple of drinks. That person would be considered diseased once in the system.

4. >70% of people that met the DSM-IV criteria for alcohol dependence, with an average onset of 21 years old, experienced this condition for 4 years and then it not reoccur. Lindsay is now 24. Her public problems began at 21. Proper care, and this may be a TYPICAL episodic condition. Treat her as diseased, and her recovery could be short lived.

5. 70% of people that will ever be abstinent do so without any treatment. We are not advocating no treatment. We are saying a more appropriate treatment for her addressing her underlying issues and eliminating the need to reduce her problems in living her life to a biological disease, and may be necessary but would never be mandated.

B. William Miller and his colleagues at the University of New Mexico for the past three decades have studied the effectiveness of alcohol treatment approaches. They have studied 381 clinical trials of 48 treatment approaches. The conclusions were that the least effective treatments are the very same ones being mandated by the courts and used in the majority of rehabs. They found that relapse was predictive of these traditional treatments because the people BELIEVED that they had a disease and lacked coping skills.

C. Dr. Thomas Horvath the Director of the American Psychological Association's Division 50, which was the largest body of addiction researchers in the U.S., that said that the disease model was based on dogma versus actual fact and that it did more harm than good, and that forcing acceptance of having a disease/illness actually delays or prevents people from dealing with their problems.

D. Half the states in the U.S are currently attempting to implement evidenced based treatment for addiction. These approaches are not diseased based. The current standard of care is disease and faith based. What does that tell you?

Each year, the governments own Substance Abuse and Mental Health Services Administration conducts surveys establishing that an estimated 22 million are diagnosed with substance dependence or substance abuse, but only 20% seek treatment. This is over 17 million people that answered the survey, and there are millions more who have problems, that made the decision not to seek help. Why?

Because the majority of people that come to rehab may or may not be a drug addict or a alcoholic, meaning, they are self medicating as a way to cope with something emotionally or psychologically distressing in their lives. This distinction is generally not made in 12 Step/AA philosophy. Also, the majority of people do not want to be labeled as diseased, a drug addict or an alcoholic who are powerless and who need to surrender to God in order to manage their problems. Remember, if you were a light social drinker that received a DUI, you would be mandated by the court to seek treatment and attend AA meetings. There you would be told that you were in denial for the reason you were there and that had you had a disease you needed to deal with.

The philosophy of 12 Step/AA is also outmoded. Let's assume for argument sake that addiction was in fact a biological disease. According to AA World Services internal data, people that begin AA and remain for one year is 5%, and the majority drop out within the first 30-90 days. Rehab counselors will tell people that their "disease" is like cancer or diabetes. So, let's logically explore that.

If you had cancer and your doctor said that chemotherapy had a 5% chance of working would you still go? Remember, AA is treatment. It is considered a support group and there is no therapy, but it is a mandated philosophy used in the treatment for addiction. If only 5% of the people are sticking around, how useful is it to the other 95%?

** If you had cancer would a doctor or support group tell you that you are powerless, helpless and need only to surrender to God and believe?

*** If you had cancer would you be assigned a sponsor who also has cancer and no medical background or training to support you by making sure you realize you are powerless and need to surrender to God, and forget about chemotherapy or radiation?

The addiction industry has generalized the word addiction. Now any undesirable behavior, too much shopping, too much sex, too much gambling, too much eating, too much Internet use are all diseases and require 12 Step/AA approaches to support the person. Tiger Woods cheating on his wife at least 14 times was not his fault, he had a sex addiction. He was not in control. So, off to sex rehab for several weeks.

12 Step/AA base success on abstinence. For the majority of people, abstinence is effective and even necessary when it is a conscious behavioral choice, not an ultimatum. Many people have gone to AA and have been abstinent for many years. These are the exceptions. The majority of people fail to abstain. Without addressing underlying issues and getting to the causes of the behavior rather than dismissing it as a disease which explains your behavior but distances you from your real problems, the real problems create life distress and these psychological and emotional states lead to relapse during trying times that trigger the individual. Also, for me, abstinence is not the goal unless it is a conscious behavioral choice based on what's best for an individual. For some, moderation works. For others, some form of harm reduction. The goal should be the quality of life, and the increase in joy, happiness and life satisfaction. If you are sober for 20 years but you are depressed, angry and inappropriate and immature, that is not real treatment success. Sobriety alone will not end suffering.

The solution: A movement geared to change government policies to incorporate a variety of evidence based treatments in addition to the 12 Step/AA approaches and allow people to choose the best option for themselves based on new assessments that determine where along the continuum the person's addictive behavior lies, and to differentiate whether the person has a chronic, progressive problem, an episodic problem, has chose to self medicate, has a pain management problem, has cultural differences, has been traumatized, violated, or experiencing sexual identity issues. I incorporate brief interventions, social skills training and motivational enhancement as well neuroscience, cognitive behavioral, family systems and solution focused approaches adapted for the person to help empower them, and encourage them to take personal responsibility for their life.

Amidst the reliance upon A.A and 12 Step based treatment, studies have been done on all available treatment used to treat substance related problems. In justifying mandatory A.A. attendance, the courts often note the "proven effectiveness" of A.A. and standard 12-step programs. However, research does not support this position. For example, a group of researchers working with William Miller, of the University of New Mexico beginning in 1980, reviewed all controlled clinical research on alcoholism treatment. 381 clinical trials of 48 different treatments for alcoholism. Did you know there were 48 treatments? Using a summing technique called "meta-analysis," they rated therapies by indicating the higher the score, the higher the indicated effectiveness. Keep in mind that the court system does not permit treatment options. Generally speaking, for a substance related offender in lieu of incarceration and sometimes early release the courts mandate A.A. and 12 Step based attendance. They continuously concluded that the current treatments used in the majority rehabs and mandated by the court are amongst the least effective. Further, they found that people who BELIEVED they were diseased and had no other coping skills were more susceptible to relapse.

Celebrity Rehab

Does Lindsay Lohan have an addiction problem. Who knows? Millions of girls her age are behaving the same exact way as she is, but she is famous and her life is under a microscope, so she is made and example of because of her ability to generate news and because of her ability to pay huge fees for mandatory compliance with sentence guidelines. She has been made to believe she has a disease. Would she have thought this if she decided to take a cab in 2007 when she made the poor decision to drive? The system likes celebrities because it is one big money grab. What did the four rehabs actually do to increase her well-being? If treatment is simply reduced to abstinence, is it any wonder most people fail in their efforts? When people are successful in one area, they usually transfer it to a preoccupation in other areas.

The addictive behavior is always present unless something more substantial is addressed. Keep in mind, the NIAAA states that most people that experience substance abuse have an episodic experience lasting about four years. They state that the age of abusive heavy drinking starts in the late teens and early twenties. Ms. Lohan may actually be part of the normal majority of young college types that overindulge between the ages of 18-25, and then moderate their behavior thereafter. Rather than possibly growing out of this abusive stage, she is being labeled with a brain disease that she will now need to deal with for the rest of her life. This is why treatment can be harmful. You cannot assess and diagnose everyone on an assembly line.

Also, the general public is not aware that celebrities are treated differently. It is hypocritical to suggest people are looking out for her best interests when clubs offer to pay her money to show up. Rehabs not only solicited Ms. Lohan to become a client of theirs, they also were willing to pay her to check in to their facility. A TV reality show had also offered to pay her to appear. I am affiliated with Summit Malibu, because they are not about special treatment. There is no quick fix or an easy stay. It is about helping someone that is suffering in any method that proves to be effective on that particular individual.