Ninety percent and upwards of American substance abuse treatment programs derive from AA' s 12 steps. We need to expand our options based on (a) the evidence, (b) the 12 steps' religious nature, (c) their shortcoming in not teaching coping or emotional management skills. I have created an alternative residential program built on my Life Process Program.

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The Stanton Peele Addiction Website, December 1, 2008. This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

I've attacked the 12-steps' dominance in America with a new treatment program

Serenity prayer Ninety percent and upwards of American substance abuse treatment programs derive from AA' s 12 steps. We need to expand our options based on (a) the evidence, (b) the 12 steps' religious nature, (c) their shortcoming in not teaching coping or emotional management skills. I have created an alternative residential program built on my Life Process Program.

I'm not going to review the data showing that AA and 12-step programs are limited in their effectiveness, beyond repeating the summary from the respected Cochrane Collaboration's 2006 review: "The available experimental studies did not demonstrate the effectiveness of AA or other 12-step approaches in reducing alcohol use and achieving abstinence compared with other treatments."

And operating as though AA and the steps aren't religious can put you in legal danger. In a 2007 decision, the Ninth Circuit Court of Appeals declared in Inouye v. Kemna that a parole officer was not immune from liability for damages after he forced Inouye, a Buddhist, to attend AA meetings in violation of his First Amendment religious freedom. "This uncommonly well-settled case law (against coercing AA attendance). . .was sufficient to give notice to a reasonable parole officer."

Finally, AA meetings and 12-step treatment do little systematically to train people to cope with themselves, their urges, and their environments. They inspire some - evidence says a small minority - to quit drinking. The meetings do give people a place to go for human contact where drinking is not possible. But a ritual in which a group of laypeople or recovering counselors - many with obvious and persistent problems themselves - repeat the steps and tell their personal stories offers members little psychological basis for achieving sobriety.

In contrast to these empirical, civil rights, and clinical problems with AA, a body of evidence has developed that shows a number of psychological treatments - motivational interviewing, the community reinforcement approach, brief interventions, skills training, and solution-focused psychotherapy - to be effective for addressing substance abuse. As I have treated addicts in the decades since I wrote Love and Addiction, I have combined these techniques into the Life Process Program (LPP).

Working with a group of counselors at the St. Gregory Retreat Center in Des Moines, I have applied the LPP in an eight-week residential program. The first groups have completed LPP using these evidence-based techniques, proving that a group of nonspecialist instructors can be trained to administer the most advanced cognitive-behavioral therapies.

We must wait until long-term results demonstrate that people who complete the LPP are superior at overall life functioning - as well as at kicking addictions - as the efficacy of the underlying components of the program would predict. Nonetheless, I think people will find it valuable that an alternative to the 12 steps is now available for residential treatment.