The advantages of psychological therapy over 12 Step Programs

Problematic drinking is a touchy issue. Unlike the clear distinctions between ‘dependent’ and ‘sober’ that illegal substances such as heroin and methamphetamine can allow us to draw, alcohol is a part of most people’s lives in the UK on a daily basis, in the form of a pint or two after work, or a heavier night out on the weekend.

Definitions of ‘normal’ drinking patterns vary from person to person, on a scale that runs from total abstinence to daily consumption. One person’s definition of problematic drinking is another’s definition of ‘business as usual’. Though ‘binge drinking’ (drinking a lot over a short period of time for the primary purpose of getting drunk) is a common worry amongst teenagers and young people, an investigation by the Office of National Statistics reveals that this is not the only problem.Some problem drinkers can maintain normal daily activities and appear perfectly in control

‘Statistics on Alcohol: England 2012’ revealed that the number of 11 to 15 year olds reporting drinking has actually been on a steady decline in recent years. The people most likely to drink above recommended daily guidelines are actually in the 45-64 year old age bracket. Older, and more experienced at handling their drink, this demographic are more likely to be ‘high functioning alcoholics’, consuming an unhealthy volume yet managing to maintain their usual activities, including employment and relationships. It can be the hardest for this group to find help for their problem because they do not fit the common alcoholic stereotype – more often than not, they have succeeded or over-achieved throughout their lifetime. Also, because of their high achievement and the relatively low cost of alcohol compared to other vices, they are never forced to hit ‘rock bottom’ for financial reasons and reconsider their actions. It is harder for this group to realise they have a problem at all.

The symptoms and consequences of dependent heavy drinking are well known to most:

Symptoms:

  • Needing more and more alcohol over time to feel drunk
  • Craving or obsessing over the next drink in between consumptions
  • Behaving in ways uncharacteristic of their usual behaviour when drunk (increased anger, violence, sexual promiscuity, low mood etc)

Consequences:

  • Withdrawal symptoms such as depression, anxiety, tremors, seizures, hallucination, and even heart failure
  • Increased risk of cirrhosis, cardiovascular disease etc
  • Alcoholic dementia (alcohol is the second leading cause of dementia)
  • Alcoholic psychosis (a loss of contact with reality manifested commonly as delusions and hallucinations)
  • Exacerbation of existing mental health problems
  • Increased risk of legal problems through changed behaviour and drinking at inappropriate times (e.g. drink driving)

As evidenced by the existence of high functioning alcoholics, the symptoms and negative side-effects of problematic drinking vary hugely from person to person – as does the level of consumption that might be detrimental to their lives. Having said that, where should a person turn to for help once they have decided that they need it? Fortunately, though shame or embarrassment might be a major hurdle to jump in looking for help, our modern society is pretty ‘switched on’ to the support needed for alcoholics, and there are plenty of options available.

A popular treatment from the USA is the ’12 step program’ offered by Alcoholics Anonymous, among others. One of these steps involves “recognising a higher power that can give strength”. AA has been criticised for an overtly Christian bias, but argue that the wording of a “higher power” can refer to God as understood by any religion. But doesn’t this still exclude the huge numbers of agnostics and atheists who are either unsure or unconvinced of the existence of any higher power?

Eminent psychotherapist Stanton Peele has also argued that some AA groups apply the disease model to all problem drinkers, whether or not they are ‘full blown’ alcoholics. Because of this, AA operates according to ‘abstinence only’ principles, which cause them to expel from treatment anyone who relapses or would prefer instead to learn to drink in moderation. This principle essentially casts out anyone who struggles on their path to recovery or has a different understanding of what recovery is. This is obviously far from helpful and often actually makes matters worse. In a large study undertaken in 1980, it was found that the 12 step method was actually highly ineffective because two thirds of its members dropped out. (Larger studies estimate drop-out rates of 60 – 95%) There were so few people left that it was impossible to tell if they were doing better than the control group who had received no help at all. As Kenneth Anderson, former problem drinker and director of the alcohol harm reduction support network HAMS goes so far as to say, “There exists a multibillion dollar 12 step treatment industry… the bottom would fall out if the public knew that it is paying for something which is not merely totally ineffective but quite possibly did more harm than good.”12 step programs shun anyone who relapses or would prefer instead to learn to drink in moderation

Here at The House Partnership, we are reluctant to pathologise or diagnose anyone. We believe that a preoccupation with medicalised checklists is unhelpful and indeed unnecessary in psychotherapy, which should instead be tailored to each individual’s unique needs. We are more interested in helping people than labelling them.

Following the National Institute for Health and Clinical Excellence (NICE) review of the research and subsequent guidelines, one of the approaches which informs our practice at The House Partnership is CBT Cognitive Behavioural Therapy which they concluded is “significantly better than control at reducing heavy drinking episodes… and reducing the number of participants who lapsed and relapsed when assessed at 6 month follow up”.

The CBT approach to problem drinking is very much based in the here and now, in a solution-focussed way, rather than lingering on the past like psychoanalytical approaches. CBT influenced therapy concentrates on identifying and changing unhelpful thoughts and beliefs which may be maintaining the problem e.g. “Nobody will like me sober”, “I can’t relax without alcohol”. Our therapists are also experienced in helping clients with numerous related problems such as anxiety and depression, which may be fuelling the fire. In this way, a wide-spanning psychological approach such as that we offer can be more effective in allowing a person’s needs to be met as a whole, not only as viewed under the lens of addiction.

The House Partnership, 16th April 2013