Suppose your doctor came to you tomorrow and said:
“I’m so sorry to tell you this, but you have a cancerous brain tumour and need to consider treatment. Of course, there is the option of doing nothing, which has a 25% chance of spontaneous remission over a 5yr period. There is a really popular treatment dating back to the 1930s that may offer you about a 37% chance of beating this and then a modern option that will offer you a 78% chance of survival.”
Which one would you pick?
For an article on Calgary Addictions Counselling and how to get free of addiction, I admit that this is a strange place to start. But, those are literally the percentage chances and options presented to people struggling with addiction today. To map out a path to freedom, it’s essential to understand how solutions that are so simple and obvious have been so well hidden from the general public – and why a relatively ineffective addiction treatment industry has kept it that way.
Going back to that doctor for a minute, suppose that doctor told you that he wanted you to consider taking the 37% successful treatment. He hoped that you would participate in a study researching if the same death rates seen in the 1930s still apply in today’s more comfortable hospital beds?
I’m guessing your reaction would be: “Are you insane? This is my life we’re talking about, and I want a new doctor NOW!”
Isn’t it strange how we don’t apply that kind of clear thinking to the subject of addictions, where almost everyone ends up in a 37% success-rate treatment?
Calgary Addictions Counselling: Life-changing steps to freedom, without Alcoholics Anonymous
Before you read any further, first go through this web story to get a little context.
Click here to view Intimate Freedom’s Web Story: Still trapped in addiction? in a separate window.
Over the last few months, both clients and other Calgary Psychologists have repeatedly been sending me a meta-analysis done by the Cochrane Collaboration on Alcoholics Anonymous or 12 step programs claiming they have finally been validated as effective and should now be considered an essential part of Calgary Addictions Counselling.
It’s annoying.
It’s also a brilliant example of why North America is still awash in addiction and only getting worse. If we’re ever going to understand the solution, it’s critically important we know what the opposite of such looks like.
The Cochrane Collaboration first began studying Alcoholics Anonymous/12 step programs in 2006 and swiftly reached a stark and blunt conclusion:
“No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems.”
Anyone taking the time to go through their assessment details found conclusions that were thorough and ultimately damning. They found no compelling evidence that AA or TSF helped people accept or remain in treatment, demonstrate any higher retention rates, change the number of drinks or drinking days, reduce the severity of the addiction, limit the degree of negative consequences, prevent dropouts or promote complete abstinence from drinking. The authors closed with a call for further research, indicating that they desired even more conclusive results.
Naturally, results of this nature sent shock waves through the then twelve million dollars per year industry that was Alcoholics Anonymous. They began to aggressively push for and, some have suggested, likely funded research on their program to try and dispel the stain of this finding. And, a flood of studies were done!
Meanwhile, Cochrane Collaboration began to go through extensive internal turmoil. Allegations began to leak out about improprieties in finances and funding. The Canadian Institute for Health Research pulled the +2million funding they were pouring into the group some years back, after revelations that a “drug company with a stake in a Cochrane review provided funding for the review” of their drug.
Then things completely exploded: (Note: Cut and pasted from Wikipedia – though it keeps being taken down.)
“During its 2018 annual meeting, the Cochrane board expelled Peter C. Gøtzsche, board member and director of Cochrane’s Nordic center, from the organization, telling Nature that it had received “numerous complaints” about Gøtzsche after he co-authored an article in BMJ Evidence-Based Medicine alleging bias in Cochrane’s May 2018[21] review of HPV vaccines. Gøtzsche’s expulsion led four elected board members to resign in protest, which in turn led the board to cut two appointed members in order to comply with the ratio of elected to appointed members required by the organization’s charter.[22] Gøtzsche announced that this had happened via an open letter, in which he said there is a “growing top-down authoritarian culture and an increasingly commercial business model” taking root at Cochrane that “threaten the scientific, moral and social objectives of the organization”. Gøtzsche remains an outspoken critic of Cochrane’s relationship with the pharmaceutical industry.”
To their credit, Cochrane finally did ban drug companies and other research subjects from “funding” studies of themselves. However, the damage was already done to what was once considered the gold standard of objective medical research assessment.
Meanwhile, the desperate search for proof that AA/12 step programs work continued, with almost a religious fervour. Eventually, in 2020, so much had been published that Cochrane decided to do another assessment. However, contrary to what is being reported in the popular press, this assessment also IS NOT an assessment of AA or the 12 step program.
To make sense of this assessment, it’s critical first to understand just what they were evaluating. The AA program itself has been set in stone or manualized since the 1930s. Every week in every community center and church basement, they essentially do the same thing all over the world.
The TSF abbreviation stands for “Twelve-step Facilitation Therapy.” The NIDA describes it as:
“Twelve-step facilitation therapy is an active engagement strategy designed to increase the likelihood of a substance abuser becoming affiliated with and actively involved in 12-step self-help groups, thereby promoting abstinence.”
In short, it is a form of therapy where a psychologist works directly with an individual client, convincing them to go into an AA group, providing extensive supplementary teaching of the materials and walking them through the challenging elements of recovery. The goal is to keep them in the AA group and, once they have recovered to the point that they just need ongoing social support, entirely handing them off to the AA community with options for follow-up if required.
What people really wanted to know was, “Does AA work?” That question was never addressed. Instead, they set out to answer a question no one was asking. To date, no member of the general public has ever asked,
“Will going to the local 12 step group in my Church’s basement work if rigorously supported by a complex manualized system of parallel psychotherapeutic interventions I’ll never be able to access anyway?”
That, however, was the question Cochrane answered.
Again, the AA program has remained virtually unchanged for over 80 years. Considering that the 2006 Cochrane study also studied the AA/TSF model, finding no evidence that it worked and then, in 2020, found that AA/TSF model did have some effect, then the only thing that could have changed in that time is the TSF component.
If we further drill down into their 2020 study, we find that the Cochrane researchers went through over 12,000 published articles and could only find 27 studies of sufficient scientific validity to even include in their research. (If that doesn’t suggest over a decade of some form of academic astroturfing, I’m not sure what ever would…)
Of those 27 studies, only three of them directly studied the AA or 12 Step program, and they didn’t include those studies in their evaluation! (Only one of them was even partially included, and only as part of their assessment of financial costs.) The remainder of the studies assessed the TSF model’s success, which the researchers portray as the AA model’s success.
And what did they find? They found that TSF was not meaningfully better than other treatments except for promoting complete abstinence from alcohol, and then only for defined periods. It was mostly good at keeping people in AA programming. (Considering that many of the studies evaluated included participants forced to be there by the legal system, it ultimately makes sense that TSF would produce a more substantial positive result.)
Another way of reading the results is to simply say: “AA plus the psychotherapeutic intervention that is TSF worked about as well or only a little better in almost all areas as did various other psychotherapeutic interventions without AA.”
This is what the statistics-challenged journalists at the New York Times somehow managed to reinterpret as, “An updated review shows [Alcoholics Anonymous] performs better than some other common treatments and is less expensive.” This is the fragile basis for AA’s still ongoing marketing as now having been “scientifically proven” and a public relations campaign to match.
This little saga is a perfect example of the state of addiction treatment in North America, particularly in the United States. In the United States alone, addiction treatment is a 196 billion dollar per year industry when treatment and associated health care costs are added together. In Finland, a full course of addiction treatment will run you about $2500-$3500. In the United States, you are looking at around $40,000.00 for a 28-day stay at a facility like The Meadows and others, which primarily offer the 12 Step program. And, $40K starts to look like a bargain if you consider the price tags on celebrity-focused clinics.
When scientists shine a light of truth on the ineffectiveness of these exorbitantly priced programs, you rarely, if ever, see those programs changing. Instead, you see the executives behind them scurrying around – trying to obfuscate, deny science, ignore international evidence and whitewash the situation. Why? So nothing ever interferes with their ability to make money.
And, both inside and outside of that system, people are dying due to their inability to get clear and meaningful information about what will help them break free of addiction’s prison.
Let me be very clear on one thing: No one denies that AA has worked for many people. That, however, was never the question. If naked Bungee jumping at -20 degrees with 10 of your closest friends will keep you forever free from substance abuse, then we’re good with that as well. Most Calgary Addictions Counselling therapists, Christian Counsellors and Psychologists are entirely agnostic in this respect and will use anything they can to help people get out of their addictions.
What we all really want to know is, “What works best?”
Just for a moment, let’s ignore all of the financial irregularities at Cochrane, assume that this study assessed only Alcoholics Anonymous and the 12 Step program instead of TSF, ignore the court-ordered participant ratio, deny any spontaneous recovery numbers and fully accept their 37% success rate as valid not just in a few areas but all across the board. All of this still begs the question:
Why should we care?
Even if we can prove Alcoholics Anonymous works at this low level, there already are far better options that render that fact irrelevant. That such a disingenuous marketing campaign was even done is clear evidence of how little this whole debate has to do with helping people and how much it is tied to how culturally embedded the Alcoholics Anonymous program is within North American culture. It demonstrates how enmeshed it is with the dominant religious persuasion and how overwhelming the resistance is to treatments developed by other peoples and cultures, even if that resistance is literally killing people.
And, let’s go back to our initial doctor example for a moment. Suppose your doctor informed you that a fourth option combined the best elements from all of the other approaches and was even more effective than the sum of the parts?
Wouldn’t you decide to use every tool at your disposal to ensure you return to health?
One of the foundational principles we were taught right from the beginning of graduate school was that:
“Competent care is multifaceted care.”
The meaning of that line is simple: It doesn’t matter if you are a medical doctor, a psychologist, a psychiatrist, an addictions counsellor, a 12 Step group or a rehab clinic; by yourself, you are not enough to fully help anyone. To quote the old saying, “Healing always takes a village.”
Nowhere is that more true than working with the complexity that is addiction. Of course, purists like the St. Jude’s treatment centres that achieve an independently verified 62% success rate in treating drug and alcohol addictions solely through Cognitive Behavioural Therapy are incredibly useful, and we can learn so much from them. Purists demonstrate the power of a single element of therapy in ways that little else can, but they are fundamentally incomplete. Our culture’s entire approach to addiction is just that: fundamentally incomplete.
Sadly, if you live in North America, likely the only way you will ever find a holistic and integrated approach to healing addiction is if you create it for yourself. The good news is, that’s not at all difficult to do.
Calgary Addictions Counselling Guide: Building Your Treatment Plan:
See your Family Doctor:
One of the first suggestions I give to nearly all clients is getting a full medical checkup and talking through anything they plan to address in individual psychotherapy or Couples Counselling. So many times, clients come back and say things like, “My doctor says I may not really be depressed because my Thyroid numbers are way off,” or, “My doctor thinks the weird blotches all over my skin may be Addisons disease – which probably is a better explanation for why I’m so exhausted than my annoying boss.”
People abuse alcohol for a variety of reasons, not all of them addiction-related. Many clients turned out to be getting blackout-drunk every night because they had an untreated sleep disorder, struggled with chronic pain or found that doing so was the only way to make their anxious thoughts stop. Often, as soon as sedatives, pain management or anti-anxiety medication is prescribed, the drinking ceases. Even if this is not the case, health, wellness and balanced functioning of the human body can eliminate so much of the drive to numb out. People with addiction usually struggle with attending to internal signals of disease and need a second pair of eyes to monitor their health.
Get into community:
Much of my internship after graduate school was spent leading AA groups. AA is not an addictions treatment program; it’s a social network. The one thing that AA does well is that it creates a safe environment for people to practice sharing thoughts and emotions. Those meetings are highly structured affairs where people identify themselves and then speak in turn. They are not interrupted by cross-talk or subjected to the slightest judgment and are always thanked at the end for having the courage to share.
For people who have spent their entire lives silencing their emotions, this can be priceless and life-changing. There are plenty of safe communities where the same kind of sharing is possible such as faith communities, SMART Recovery groups or service organizations intelligent enough to care for their people. Many people simply take the risk of forming their own group. But, unless people with addictions begin to practice taking risks in safe and healthy community, they rarely, if ever, heal.
Break the grip of alcohol with medication:
The Contral Clinics of Finland (and now several other countries) boast a 78% success rate using Naltrexone alone. Others have found that the smoking-cessation medication Varenicline, Topiramate, a seizure medication, and a muscle relaxant named Baclofen can also help control drinking. The FDA has formally approved three drugs: Antabuse (which creates nausea when combined with alcohol), Acamprosate (which reduces cravings) and Naltrexone/Vivitrol. (Vivitrol is an injectable form of Naltrexone.) In a skilled practitioner’s hands, all of these medications can dramatically reduce consumption levels and sometimes even bring alcohol abuse to a sudden stop.
Most anyone could replace the dome light in your car while driving down a highway. A skilled mechanic would probably be able to replace the stereo in your dash while in motion, and a complete daredevil might survive changing your tail light while leaning out of your hatchback. But to undertake any serious mechanical repairs, your vehicle needs to be stationary. The same thing is true of addiction – unless you can get it stopped, it’s tough to fix the underlying problems. These drugs can get it stopped.
Cognitive Behavioural Therapy:
Cognitive Behavioural Therapy is a psycho-social psychotherapeutic intervention that seeks to heal and restore mental health by challenging and replacing unhelpful thinking patterns and behaviours, teaching emotional regulation skills, and developing personal coping techniques directed towards solving life and relationship problems. Because addiction rests on a complex foundation of cognitive distortions, emotional/relational immaturity and flawed reasoning, altering those patterns is essential to healing.
One of the greatest gifts the Calgary addictions counselling community ever received was when SMART Recovery was set up in our city. I can teach people through the CBT strategies needed to alter addiction, but it will cost them thousands of dollars. SMART will offer most of the same for pennies – freeing my time and our client’s financial resources for psychological counselling to tackle much more complex problems than CBT could ever address. You can explore Matthew Leichter’s detailed analysis of SMART for more information.
Couples Counselling Calgary:
The title of this site is Intimate Freedom. It’s not just a cute name – it’s the foundation of healing addictions. When people get into a couple relationship, the relationship almost immediately begins taking on a life of its own. It becomes endowed with both persons’ hopes and dreams, and it also begins to operate out of a foundation of their expectations and cultural norms. So much of the addictions counselling Calgary has to offer ignores the simple fact that within only a few months, the relationship begins to play an active role in maintaining the status quo – which in many cases involves addiction.
One of the most damaging beliefs emerging from the Alcoholics Anonymous movement is that, in every marriage touched by addiction, there is always the inflictor of pain (The addict) and the victim of that pain (The codependent.) The codependent is seen as suffering from the addict’s behaviours and just needs to be protected until the addict gets it together. In the real world, we always marry a person who functions at the same level of emotional regulation as ourselves. We both play an equal role in the bargaining of a collective agreement of marriage that is highly unlikely to change unless both persons work to change it. If you want freedom, you will have to replace the intimate relational foundations of bondage with something so much better.
Trauma therapy:
Addiction is the result of trauma. Simply put, no one ever woke up one morning and said to themselves, “You know, I think I’ll commence wrecking my health, destroying my finances and obliterating my chances of enjoying a healthy relationship today.” Instead, people finally reach a point where they no longer have the skills to deal with the pain and seek relief. Addiction happens as the pain grows to the degree that the “relief” becomes necessary to function at all.
Trauma comes in two separate flavours: Some trauma is the result of getting what you should not have gotten (Abuse, rape, physical violence, etc.), but the vast majority of it is the result of not getting what you should have gotten (Love, acceptance, stability/belongingness, attuned emotional coregulatory experiences with a loving caregiver etc.) We tend to ignore that second flavour, but most addiction is the result of it. Learning how to deal with and then heal trauma is essential to not just stopping the addiction, but also healing its roots.
Emotion-Focused Addiction and Marriage Counselling Calgary:
Contrary to popular lore, addiction is neither a choice nor is it a disease. It results from chronically mishandled emotions, mostly of a distressing nature, usually rooted in denied pain and trauma. Animals can reach adulthood in a year or so — people take about 25yrs to accomplish the same, and most of that time is learning how to deal with emotions and communicate them in relationships with others.
When a person is faced with emotions that they can not manage and seek relief in addiction instead of facing them, they essentially cease growing up. Oh, they may go off to university or get a great job, but they cease to develop emotionally. As the years go by, that arrested development causes greater and greater distress necessitating ever higher doses of an addictive substance to cope.
Emotion-focused therapy is a means of getting persons and couples back in touch with their emotions and then teaching them how to handle them in a way they never could before. Thus, emotions become a means of getting their needs met instead of a reason to consume alcohol.
Other interventions:
The above list is by no means exhaustive. Just a few of the other elements involve addressing cultural systems of control, breaking stereotypes that devalue people, replacing religious systems awash in shame, fear and guilt and a host of life, mood and stress management techniques. Sometimes even career counselling can transform addiction.
Calgary Addictions Counselling: Choose your path!
Whenever any type of therapy becomes a multi-billion dollar business, the shareholders of that business start to drive the narrative in a way that science rarely overcomes. It almost goes without saying that alcohol and drug rehabilitation in North America passed that threshold a long time before most of us were even born and definitely hasn’t looked back since.
At least in North America, anyone who wants to beat addiction will need to take responsibility for researching and mapping their own treatment plan. Because no two people are alike, taking ownership and designing your own path of healing usually creates a better plan and a higher level of success anyway.
And, if you’re struggling, reach out! Intimate Freedom’s Calgary Addictions Counselling can help you choose what’s right for you!