Practical Recovery aims to offer ideal addiction treatment for any substance or activity addiction. We describe our approach as “collaborative addiction care.” Because each client is unique, and we are fully collaborative, no two treatment plans are alike. Hence we do not offer a “program.” Our treatment intensity can be as high as alcohol and drug rehab or our treatment-in-residence program and can range downward to brief outpatient services. The treatment-in-residence program is a combination of day-long intensive outpatient services and residence either in our six-bed sober living facility or an adjacent hotel. Our services work best for local clients, who can begin with high-intensity treatment (if needed), then transition to gradually decreasing collaborative addiction care over wh...

Unfortunately, Practical Recovery does not yet have any long-term follow-up data on our clients. The task of designing the data collection is daunting. No two clients do the same treatment! However, we are in the process of designing a basic data collection system. We expect it to reveal that our clients do about as well as clients in well-run studies. Our lack of data should not be surprising. We are a for-profit facility in a highly competitive market. We are also blazing a trail that few others seem to be following on (so far). Blazing this trail has kept us fully occupied. Raising fees to cover the cost of extensive research (because it would require additional staff) would make our approach even more expensive.  We are hopeful that as “collaborative addiction care” becomes more ...

Why consider a collaborative addiction treatment relationship with someone who, by definition, is making very bad decisions?  Addicts and alcoholics keep using and drinking and are often irresponsible in other ways.  How could they meaningfully contribute to treatment decisions?  Don’t they need to be told what to do, and be made to do it long enough for changes to last? Not necessarily.  At Practical Recovery we suggest that 1) supporting recovery is about engaging motivations that are more fundamental than the motivations to use or drink and 2) we best engage these motivations when we collaborate with (rather than confront, direct or “motivate”) our clients.  To support this suggestion these articles will 1) review scientific findings about treatment, 2) place treatment in the larg...

A psychotherapy team involves multiple therapists who meet successively with the same client for individual therapy. Leading edge psychotherapy teams have begun to emerge, in varying degrees, in a few state-of-the-art addiction treatment facilities. Their emergence may have occurred somewhat serendipitously but as Pasteur remarked “chance favors the prepared mind.” To my mind, the experience with the leading edge psychotherapy team format highlights the illusion of believing that a client exists as such and that the client’s problems or difficulties exist as such. By “as such” I am referring to the idea that the client and his or her difficulties can be apprehended or discovered as they “really” are, objectively, in pretty much the same way that a physician (with the help of lab test...

As more addiction treatment programs treat comorbidity it seems likely that client confusion about treatment approach will increase.  Comorbidity is here defined as having both a mental health disorder (such as anxiety or depression) as well as an addictive disorder.  Client confusion might arise because CBT (cognitive behavior therapy) has become the treatment of choice for many mental health disorders, but 12-step based treatment remains the most widely available treatment for addictive disorders.  Clients receiving CBT for their mental disorders can be confused when they compare the self-empowering strategies of CBT with the emphasis on powerlessness in a 12-step approach.  Although 12-step treatment now often incorporates relapse prevention and other CBT components, there remains a ...

Alcoholics Anonymous (AA) and other 12-step groups (e.g., Narcotics Anonymous, Cocaine Anonymous, Marijuana Anonymous, etc.) suggest that to recover from addiction you must accept that you are powerless to recover on your own.  Only with inspiration from a higher power, recognition of your character defects, and fellowship in the group, among other steps, will you be successful.  If this perspective makes sense to you, then 12-step groups may be just what you need.  But the higher power concept is not acceptable to many, and it probably isn’t the foundation of the limited success AA achieves. Let's discuss how and why social support can be more important than a higher power. AA was established in 1935.  Other groups have followed, with several hundred types of 12-step groups now in e...

There are many effective alternatives to the 12-step addiction recovery approach.  This article will describe the major treatments and support groups that one might choose if interested in and answer the question: are non-12-step recovery approaches effective?  These alternatives need to be widely known because individuals who might never attend an AA (Alcoholics Anonymous) meeting might attend treatment or a support group with a different approach.  What might not be possible for them in AA might be possible elsewhere.  It would benefit everyone if the alternative approaches were as widely known and as easily available as AA and other 12-step groups.  Even AA would benefit from the individuals who chose to go elsewhere.  Those remaining in AA would know that they were attending because...

Should individuals who need help have choices when it comes to treatment and recovery from addiction?   Imagine talking to your child or partner, who is obviously drinking or drugging too much. “Why don’t you get it?  It’s SO obvious!  You are becoming addicted!  Look at the damage you are causing, to yourself, to me, and to everyone who cares about you.  YOU NEED TO STOP!  I’m arranging to send you to treatment.” And imagine an angry response, perhaps something like “This is my life, I’ll live it the way I want…You just don’t respect my lifestyle…You are blowing this way out of proportion…Just because you are a prohibitionist doesn’t mean I have to be one…You can take your treatment program and…” Looking in from the outside, we could say that this drinking/drugging indi...

The primary myth about AA is that “it is the only thing that works.” Of course, like other myths, there is some truth in this one. Many people assert that AA saved them or others they know well from alcohol problems. They may be correct. However, no one knows. From a scientific perspective, the effectiveness of AA is unknown. Furthermore, what is known to be effective alcohol treatment, from a scientific perspective, is not very similar to AA. Therefore, what should be said about AA is that “it might work—many people claim based on personal experience that it does—but other approaches are known to work, and they are rather different than AA.” An introduction to the complex scientific literature on AA can be found here: http://en.wikipedia.org/wiki/Effectiveness_of_Alcoholics_An...

Debunking the myth about AA Should people who need addiction recovery have choices? Are non-12-step recovery approaches effective? Why choose a non-12-step recovery approach? In AA social support is more important than a higher power Treating psychiatric and addiction comorbidity with a cognitive-behavioral (non-12-step) approach  Leading edge psychotherapy: The psychotherapy team