Twelve-Step and Mutual-Help Programs for Addictive Disorders
This important statement was made after an extensive review of outcomes research on addiction treatment. It reflects the conclusions of recent scientific reviews that alcohol and other drug addictions are chronic, relapsing diseases of the brain.
The Minnesota Model, which throughout the 1980s featured 28 days of intensive inpatient and residential treatment, has more recently evolved to a longer continuum of care and greater reliance on outpatient treatment. Brief detoxification establishes abstinence, and patients move to successively less intensive levels of care from inpatient, to partial, to intensive outpatient, to less frequent outpatient visits. The model of chronic illness, which O’Brien and McLellan used in comparing addictive disorders to diabetes mellitus, bronchial asthma, and hypertension, prepares physicians for longer periods of care and a broader range of services, emphasizing relapse prevention and rapid-relapse response. Twelve-step and mutual-help programs are major allies for psychiatrists who are treating patients with addictive disorders.
The older view of addiction defined the central clinical problem as physical dependence. Therefore, the primary focus of treatment was to detoxify addicted patients. The newer view of addiction, based on a growing understanding of brain biology, defines the central problem of addiction as reward, not withdrawal, and focuses treatment on lifetime abstinence. This paradigm shift in the understanding of addiction puts 12-step programs into clearer focus. They are not treatment, and they do not compete with any form of addiction treatment. Rather, 12-step programs are spiritually based fellowships supporting not only the achievement and maintenance of abstinence from alcohol and other drug use but also lifelong character development.
Regardless of the short-term addiction treatment used, addicted patients, sooner or later, have to confront the real threat of relapse without professional treatment. To prevent relapse to addiction, every physician must be familiar with 12-step programs and able to help addicted patients find and use these unique programs to promote recovery.
Psychiatric Clinics of North America, Volume 22, Issue 2, Pages 425-446, John N. Chappel MD and Robert L. DuPont MD
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