iCope: Alternatives To A 12-Step Program: A Path To Recovery

By Anthony R. Ciminero, Ph. D.

Based on almost a decade of my experience working intensively with addictive problems on an inpatient program and the past 30 years of professional work as a psychologist in other settings, I have a broader perspective about recovery than the typical 12-Step Model’s approach that is commonly accepted as the standard way to treat addictions. Some of this perspective is based upon clinical experience with a diverse patient population and flexibility in how we can choose various therapeutic approaches, but most of this view is based upon research throughout the country on evidence-based practices. All of the specific skills covered in this book have been found in extensive research by hundreds of professionals throughout the country to be effective for a wide variety of problems, not just addictions.

Many individuals struggling with an addictive problem cannot accept the basic philosophy of the 12-Step approach or have tried it and failed. These individuals should be encouraged that there are other successful options available to them. This iCope book first summarizes the history of addiction treatment and why it might not be best for everyone. The book then looks at alternatives and takes a more empirical, flexible, and broader view of the individual and the methods that can be successful. The objective of this book is to provide additional tools that could be beneficial in controlling or eliminating a troublesome addictive type of problem. This book is aimed specifically at those who have found that the 12-Step approach does not work for them and those who for various reasons never enter this or similar types of treatment. The principles taught here would also be helpful for those who are succeeding in their 12-Step Program or individual therapy, but want additional coping skills to deal with emotional, psychological, or relationship issues that are not being adequately treated.

The emphasis in the book is to provide an overview of specific coping skills that can help individuals deal with various emotional issues, negative belief systems, and problem solving situations without having to rely on the use of alcohol, drugs, or other addictive types of behaviors. Many of these basic skills fall under the rubric of stress management or coping skills training. Other skills such as assertiveness and anger management often are seen as relationship skills. Also covered are enhancements to a person's sense of well-being and resilience through improved self-esteem, positive psychology, and mindfulness training. Other relevant topics such as relapse prevention, genetic factors in alcoholism, and even the controversial controlled social drinking options are covered in separate supplemental chapters. The book is also supported with a variety of resources on our free website.

Author Information:

Anthony R. Ciminero, Ph. D. is a clinical psychologist and corporate consultant with over 40 years of professional experience including faculty positions at major universities. He has published extensively including self-help books as well as textbooks in psychology. In addition to working with individuals with various alcohol, drug, and gambling addictions in outpatient settings, Dr. Ciminero also worked on an inpatient addiction unit for six years where he was responsible for developing the behavioral coping skills program for patients in recovery. These core skills form the foundation for this book for individuals struggling with any type of addictive problem. Dr. Ciminero presents a concise summary of the basic coping skills that are needed to manage the various challenges faced in recovery.

• Language: English
• Publisher: Anthony R. Ciminero, Ph. D.
• Release date: Oct 17, 2015
• ISBN: 9781311693952

Anthony R. Ciminero, Ph. D.

Anthony R. Ciminero, Ph. D. is a clinical psychologist and corporate consultant with over 30 years of professional experience including faculty positions at major universities. He has published extensively including self-help books and textbooks in psychology. In addition to working with numerous individuals with various stress-related disorders, Dr. Ciminero has also conducted stress management programs for many large companies. His firm provides various professional services including post-traumatic stress debriefings worldwide.

Book preview

PROLOG

In the 1970's I had my first opportunity to work extensively with patients suffering from various alcohol and drug problems who were being treated at a major Veterans Administration hospital. After doing research and teaching psychology in a doctoral training program at the University of Georgia for five years, I returned to the same VA Hospital for six years to expand the behavioral/psychological components on their addiction unit. The basic features of the inpatient program were similar to many others in the country at the time with a heavy emphasis on group therapy, educational classes, individual therapy, and exposure to the 12-Step AA and NA model which held separate group meetings run by recovering alcoholics and addicts in the evenings. This professional experience and exposure to a patient population that had various addictions such as alcoholism, drug addiction, and compulsive gambling gave me the opportunity to develop various behavioral skill components into their treatment program. These skills included stress management skills such as relaxation training, cognitive restructuring, and proactive problem solving as well as components to improve social skills, self-esteem, assertiveness, and better ways to cope with anger. These same core skills have also been used by psychologists for the past several decades in treating many other problems including anxiety, post-traumatic stress, depression, and various health related problems.

Based on almost a decade of that experience working intensively with addictive problems and the past 30 years of professional work as a psychologist in other settings, I have a broader perspective about recovery than the typical 12-Step Model’s approach that is commonly accepted as the standard way to treat addictions. Some of this perspective is based upon clinical experience with a diverse patient population and flexibility in how we can choose various therapeutic approaches, but most of this view is based upon research throughout the country on evidence-based practices. All of the specific skills covered in this book have been found in extensive research by hundreds of professionals throughout the country to be effective for a wide variety of problems, not just addictions.

If we look at any individual with any type of addictive problem as having a singular problem with only one legitimate treatment approach, we would have a narrow view of the individual and the problem. Unfortunately this also leads to a more narrow approach to therapy in which "one size fits all". This is essentially what has happened in the evolution of the Twelve Step Programs that were first developed for alcoholism in the 1930's and later were adopted as the treatment of choice for other addictive problems whether those were drugs or behavioral patterns like compulsive gambling or even sexual addictions. Sadly, even though these programs have helped many people over the past 75 years, the overall independent research finds that the vast majority of those treated exclusively in a 12-Step Model do not succeed in treatment (Dodes & Dodes, 2014). Unfortunately, those who do not succeed in these programs might be demoralized and discouraged from seeking any other treatment options, especially if they have been led to believe this was the only option. No other major medical or behavioral problem is treated the same way today as it was in the 1930’s. Therefore, at a pure rational level, other potentially successful treatment options should not be ignored.

This iCope book looks at alternatives and takes a more empirical, flexible, and broader view of the individual and the methods that can be successful. The objective of this book is to provide additional tools that could be beneficial in controlling or eliminating a troublesome addictive type of problem. Some of these tools are based on the same skills initially developed in our inpatient unit 35 years ago. This book is aimed specifically at those who have found that the 12-Step approach does not work for them and those who for various reasons never enter this or similar types of treatment. The principles taught here would also be helpful for those who are in a 12-Step Program or individual therapy, but want additional coping skills to deal with emotional, psychological, or relationship issues that are not adequately treated.

The emphasis in the book is providing an overview of specific coping skills that can help individuals deal with various emotional issues, belief systems, and problem solving situations without having to rely on the use of alcohol, drugs, or other addictive types of behaviors. Many of these basic skills fall under the rubric of stress management or coping skills training. Other skills such as assertiveness and anger management often are seen as relationship skills. Also covered are enhancements to a person's sense of well-being through improved self-esteem, positive psychology, and mindfulness training.

Because the approach here is more flexible based on the uniqueness of each person's situation, many more options might be needed to increase an individual's success in treatment. For example, not everyone who has abused alcohol or drugs in the past is an alcoholic or drug addict needing in-patient care or a 12-Step Program. Some individuals could benefit from medications and/or psychotherapy which are strongly discouraged in AA, NA, and GA.

As discussed above, many of the coping skills covered in this book fall into the category of stress management which is a significant factor in the treatment of addictive problems. Stress is a popular topic by itself because its impact is fairly universal in so many ways. Extensive research has been conducted on the serious effects of stress on our health and well-being. iCope presents an efficient yet comprehensive approach for anyone who wants to learn positive coping skills to manage stress, build resilience, and provide a core strategy to avoid the use of alcohol, drugs, or other addictive behaviors as a coping mechanism. Because stress is linked to the leading causes of death (e.g., heart disease, cancer, accidents, suicide, and cirrhosis of the liver), there are other major health benefits in learning to cope with stress beyond helping control addictive behaviors.

In spite of the demonstrated success of the strategies described in this book over the past several years with a wide range of problems, there are still some cautions for anyone struggling with some type of addictive behavior. Although you will hear some unflattering discussion of the 12-Step approach in the next chapter and in greater detail in the recent book by Dodes & Dodes (2014), each person has to find the right approach for their history, current situation, and treatment goals. If you are in a 12-Step Program and it is working well for you, continue working your steps. You would be wise not to abandon a program if it is working for you. However, you could still maximize your chances of continued success and relapse prevention by learning the coping skills in this book. If you have tried a 12-Step Program and have not found it to be successful, it could be that you do need to try something new. This is especially relevant if you have had multiple unsuccessful attempts within a 12-Step format. For those who know they will never be comfortable with getting into a 12-Step Program, then learning the skills taught in this book would be even more important. You can also tailor this approach by combining it with some individual therapy or one of the other programs that provide support groups.

CHAPTER 1

Addiction, Recovery, and Coping Skills

Addiction to alcohol and/or drugs has been one of the most prevalent problems throughout history. In more recent years, behavioral addictions like compulsive gambling, sexual addictions, and internet/gaming addictions have gotten considerable attention as well. Although there has been tremendous research on the causes and treatment of these problems over the past several decades, a universally accepted and proven method of treatment has not emerged. One problem has been that some treatment approaches such as the 12-Step Programs of AA, NA, and GA have a relatively rigid format that precludes the involvement of other professionals who have supplemental strategies that could prove beneficial in treatment. This limitation by excluding other methods could very well diminish the success of these approaches. In order to understand the current limitations in treatment, we need to talk briefly about the history of addiction treatment in the US.

In the early part of the 20th Century, the problem of alcohol abuse was so prevalent that a major prohibition movement began in an effort to make alcohol illegal. The effort succeeded with the passage of the 18th Amendment in 1919 which made manufacture and sale of alcohol illegal. This approach proved to be very ineffective and eventually because of its failure, the repeal of the Amendment was enacted in 1931. Clearly the alcohol problem was as serious as ever and there were no generally accepted treatments available at the time. Still, the accepted belief then was that alcoholics were diseased and suffered from some moral weakness that left them with no self-control when it came to alcohol. In essence, this situation left the country with a relatively large population of afflicted individuals and there was a major void of any successful strategy waiting to be filled.

Bill Wilson, who struggled with various addictive problems, and Bob Smith, M.D. who were both alcoholics began Alcoholics Anonymous (AA) and their 12-Step Program in the 1930's. This was heavily influenced by a strong religious foundation based on a fundamentalist organization known as the Oxford Group. At the time there was great need for a treatment option after prohibition failed and the Great Depression led to a great escape into alcohol abuse and addiction.

Regardless of the fact that AA had strong religious overtones and virtually no scientific evidence of success (Dodes & Dodes, 2014), this model became quite popular as the treatment of choice for alcoholism and later for other addictions. Various factors influenced the acceptance of the AA model including some high profile articles in popular magazines several years ago by non-scientists who believed like Bill Wilson and Dr. Bob that Alcoholics Anonymous was the successful treatment of choice.

SIDEBAR:

IS AA BASED ON A RELIGIOUS APPROACH?

Despite many disclaimers, it is difficult not to see the heavy emphasis on a religious foundation that could be incompatible with many potential alcoholics and addicts who cannot relate to the religious overtones of a 12-Step Program. Below are the 12 Steps, with the seven that have a strong religious component in bold italics.

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.

9 Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Copyright 1952, 1953, 1981 by Alcoholics Anonymous Publishing (now known as Alcoholics Anonymous World Services, Inc.) All rights reserved.

In essence, since there was no competition, AA became the only easily available and virtually free game in town. Although the AA model was not statistically successful, there were still many individuals who did benefit from the program over time. Those who did well with the program were a good, but biased, sample of success stories throughout the US and other countries as the program model spread. However, two