The following FAQs were originally written by Dr. Ed Wilson for non12step.com. We feel our readers may identify with these questions and that the answers provided by Dr. Wilson will resonate with some individuals. Below are a curated list of FAQs from non12step.com. Please note that the opinions expressed are those of Dr. Ed Wilson and not necessarily endorsed by Practical Recovery.

1. What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy, or CBT, is based on a few simple principles:

• You are responsible for your own emotions and actions
• Your harmful emotions and dysfunctional behaviors are the product of your irrational thinking
• You can learn more realistic views and, with practice, make them a part of you
• You’ll experience a deeper acceptance of yourself and greater satisfaction in life by developing a reality-based perspective

A difficult part of the recovery process is learning how to be happy without the use of alcohol or drugs. To assist individuals in this, we find that the tools of Cognitive Behavioral Therapy (CBT) address the psychological and social components of alcohol dependence. These tools are designed to assist individuals in their recovery process. They include, but are not limited to:

• Enhancing motivation to quit drinking and to remain abstinent
• Risk/Reward Analysis (costs/benefits of drinking/quitting)
•  Setting sensible, measurable, achievable, reasonable, and timed goals, and working towards achieving them
• Learning how to refuse to act on urges when they arise
• Understanding triggers and where they come from
• Understanding “slippery” social situations and how to deal with them
• Learning how to manage life’s problems in a sensible and effective way
• Using CBT to identify irrational beliefs
• Learn self-acceptance and other-acceptance
• Developing a positive, balanced and healthy lifestyle
• Recognizing the importance of exercise and nutrition in the recovery process
• Replacing destructive habits with constructive habits
• Avoiding replacing one bad habit with another bad habit

2. How do I decide on an alcohol treatment program?

Deciding on an alcohol treatment program that’s right for you is a decision-making process.

First, should you select an outpatient alcohol treatment program or a residential program? Research suggests that outpatient programs are both much cheaper and much more effective than residential treatment programs.

Second, all treatment programs can be divided into those that are 12-Step/AA-based and those that are Non-12-Step or research-based. Those based on AA have, of course, the same “success” rate as AA – about 3%. Those based on research can have rates as high as 70%, depending on how closely their program matches their client demographic.

Third, as we alluded to above, you need to pick a program that matches your circumstances in terms of age, needs, presenting problems, and so on. Finally, there are the matters of price. Outpatient treatment is far less expensive than residential “rehab” and confidentiality. Which programs using groups or accepting insurance, are not. Neither of those are matters of small consideration.

3. My therapist told me I had to go to an alcohol treatment program before she could work with me. Why?

Most therapists still believe that alcohol abuse is a “disease” rather than recognizing it as the symptom it is. They therefore want you to fix the disease before addressing other factors in your life.

Of course, the reality is that if they helped you address the anxiety, loneliness, boredom, and imbalances in your personal relationships and marriages that cause you to drink, then the drinking would go away on its own.

This is a case of the symptom –  alcohol abuse – being mistaken for the cause and the effective order of treatment being reversed.

4. My family said that AA is the only thing that works? Is this true?

Not only is AA not the “only thing that works,” it’s not even close to being the most effective. According to AA’s own research, the 12 Step approach has a long-term effectiveness rate of less than 3%! Consider that the “spontaneous remission” rate, people just stopping, exceeds 5%, you can see that AA not only doesn’t work well, it actually prevents people from getting over their alcoholism.

What does work is: brief counseling, individual therapy, cognitive behavioral therapy, motivational enhancement, medication support with Naltrexone, diet, exercise, and improved social, recreational, and marital relationships – all of which AA actively opposes.

5. Are non-12-step alcohol treatment programs better for women than 12-step programs?

Women seeking help for alcohol abuse are already, for the most part, feeling powerless and victimized. To be told that you are a powerless alcoholic, which isn’t ever the case, and told to label yourself as such, repeatedly, and in front of others, is counter-productive in the extreme – unless what you really want is to keep on drinking.

Good research-based alcohol treatment programs, on the other hand, build on women’s strengths, interests, and abilities and develop these.  It’s not hard to see that an alcohol treatment program that focus and encourages weakness is going to do more harm than good, while one that focuses on developing strengths is going to improve women’s lives all around.

Wondering what to do? Pick services that treat you as the competent individual you are, not as a label – an alcoholic, a mythologically diseased latter-day leper, or a moral degenerate.

You drifted into alcohol abuse for understandable reasons, and you can work your way back out just as systematically.

6. Don’t people need to go away for 30 days or more in order for alcohol treatment to really work?

“Going away” is another of those profit-enhancing but results-diminishing myths that the alcohol treatment industry has perpetrated on people across the country over the past 50 years. 95% of the time it’s nonsense and research has repeatedly shown that outpatient treatment is far more cost- effective and has far better outcomes (See Anne Fletcher’s “Inside Rehab” for details).

It is true that in a few cases, going off for awhile can help stabilize an individual who is too deeply enmeshed in the habits, culture, and fog of alcoholism to be able to get enough of a grip to begin to emerge. But that’s rare and about the only reason for a person to “go off to treatment.”

Remember that most treatment programs have nothing to offer beyond AA, which is available to you for free at a church near you, and the only follow-up these programs offer is AA, and the end result is a long-term success rate of less than 5%.

AA alternatives, the non-12-step research-based programs, can have success rates exceeding 65% and with a far better quality of post-treatment life.

7. Residential alcohol treatment programs use a lot of group therapy. Is this because it is better for alcohol treatment than individual therapy?

Individual and couples therapy are far superior to group therapy in the treatment of alcohol abuse. Residential rehab programs use group therapy because it is exceedingly cheap to provide, especially when the groups are “led” by volunteers and poorly trained para-professionals.

The bottom line is the bottom line.

Again, as with most of the activities in residential treatment programs, the motivations are to fill time as cheaply as possible while pretending the activities – equine therapy, ropes courses, helicopter therapy, etc – are beneficial. Let’s be clear, these are fun, diverting, time-fillers. But effective services, the Non 12 Step Alternatives – CBT, Motivational Interviewing, Individual and Couples Counseling, Assertiveness Training – are expensive, are best delivered one-on-one, require skilled professional staff, and actually work. 

8. What should I look for in selecting an alcohol treatment program?

When selecting an alcohol treatment program, and assuming you do not require medically supervised detox, look for research-based outpatient programs that employ the proven effective components:

• Short-term intensive individual counseling
• CBT
• Anti-craving medication support
• Motivational enhancement
• Assertiveness training
• Couples counseling
• Social, vocational, and recreational considerations
• Age-appropriate staffing
• Professionally-trained and experienced staff

If they recommend, or you request, group support, look at programs that recommend AA Alternatives such as Smart Recovery or Women for Sobriety. Avoid those that refer you strictly to AA or Alanon, if you don’t find such groups helpful. 

9. Are alcohol treatment programs for women different than alcohol treatment programs for men?

The best treatment programs will address the differences in women’s alcohol treatment needs from those generally more commonly found in working with men. While the differences are not always gender specific, the two most common ones are:

Women need more support in actually doing the things that work rather than simply talking about doing them

Men need more help in sorting out what it makes sense to do

Obviously, AA alternative programs that deal with individuals have a much easier time doing this than programs that deliver treatment in groups.

Don’t be fooled, however, by programs that describe themselves as “women-only” as these programs tend to perpetuate the myth that women are weak and unable to deal with a world where half the population is male. As with couples counseling, the best and most effective programs use a team of counselors, regardless of the client’s gender, to provide balanced, supportive, and realistically focused services that are the opposite of the disempowering AA/12 Step models.

10. How do I go about finding a Non 12 Step Treatment Program?

To find a non 12 step program, or an AA alternative program, use the search phrases “Non 12 Step” or “AA Alternative” or look at the preferred provider recommendations at the following organizations and/or websites:

Smart Recovery

Moderation Management

Life Ring

Harm Reduction

Women for Sobriety

11. You seem really down on AA but it has helped millions of people get and stay sober. Why are you being so harsh in your criticism?

We doubt that there is a more deeply-ingrained myth in our culture than the one that “AA has helped millions to get and stay sober.” The reality is probably more along the lines of “AA has helped some people to get and stay sober, but it’s a tiny percentage of those who have tried it – maybe 3% – and it has certainly prevented even more people from getting sober by doing the things that actually work.

The first very real problem with AA is the claim that AA is the only thing that works – it isn’t. It’s not even in the top 30!

Secondly, we have no complaint about people trying AA and seeing if it works for them, but we do object to people being ordered to AA as punishment by the courts or under the false notion that it’s an effective solution.

Third, we really object to traditional Minnesota Model alcohol treatment programs that sell AA as “treatment.” Selling you something, at $1,000/day or more, that’s available for free at many locations near you, is a con game, not treatment, even if it “worked,” which, mostly, it doesn’t.

12. I don’t know the terminology used in the treatment industry. What search terms would I use to find good, research-based alcohol treatment programs?

If you’re looking for effective alcohol treatment, not AA or 12 Step based rehab, then use the search terms associated with AA alternative or non 12 step based programs. These terms would include:

• Non 12 Step
• Smart Recovery recommended providers
• Moderations Management recommended providers
• Life Ring recommended providers
• Alternative outpatient alcohol programs
• 12-step alternative rehab
• AA alternative rehab
• Intensive alcohol outpatient – not AA
• Intensive alcohol outpatient treatment – non-12-step
• Research-based alcohol treatment programs

13. Why do so many educated, intelligent women develop alcohol abuse problems?

Smart, educated women – whether professionals or stay-at-home wives/mothers – develop alcohol problems for much the same reason we all do – it works.

Whether the underlying problem is anxiety, loneliness, boredom, diet management, unbalanced personal relationships, or a myriad of other problems, women drink to ease the frustrations of these and other conditions.

But let’s also face the fact that educated and intelligent women are also driven to excel and exceed, both at home and professionally, in ways that neither most men nor more traditional women are. More pressure equals more reasons for the fast effective short term relief alcohol offers.

Additionally, professional women also face the pressure to keep up with male colleagues, role models, and mentors and that includes matching them drink for drink. But women’s bodies can’t handle the same amounts of alcohol nor can they endure the alcohol‘s assaults over the same period of time.

Finally there is always the behavior habit factor – we tend to keep on doing what we’ve always done, no matter how smart we are.

14. Why don’t you take medical insurance as payment in your treatment program, like other programs do?

We do not accept insurance for the following reasons:

Insurance records are not confidential, regardless of what others claim, and we do not want you to create permanent records that will come back to haunt you

Third Party payments sap motivation and your motivation needs to be enhanced, not diminished

We would have to triple our fees in order to stay in business at insurance company reimbursement rates, slow pays, and paperwork requirements (which would also jeopardize your confidentiality)

Remember, you want outpatient alcohol abuse treatment that is confidential, effective, affordable, and individually focused.

15. Is binge drinking different from other types of alcohol abuse? Do you treat it differently?

Binge drinking is essentially the “pressure cooker release valve” method of alcohol abuse. The binger manages the frustrations or anger of the underlying “heat source” (i.e., loneliness, anxiety, boredom, etc.) until they become too great and then they explode, the pressure is released for a week or a month or more, then the cycle repeats itself.

This pattern will continue until the underlying causes that fuel the binges are identified and addressed. In this case, binges tend to have less of a “ habitual behavior” component, but solutions still tend to come down to resolving underlying issues and replacing old dysfunctional day-to-day activities with new behaviors that actually reduce the flame under the pressure cooker or which create new and better release valves.

As an example, many women find kick boxing to be an excellent pressure reduction and self-esteem enhancing activity. We help you find your own mosaic of personally effective ways of controlling your own emotional heat.

Dr. Wilson is no longer in practice. If his approach to addiction treatment is appealing to you, you may find Practical Recovery to be a great alternative.