Three Addiction Treatment Myths

Posted on January 15, 2013

What Is the Best Alcohol Treatment?
~A. Tom Horvath, Ph.D., ABPP

Choices in Addiction Recovery Treatment
There are three myths about alcohol treatment, according to some of the foremost researchers in the area, led by psychologist William R. Miller (Handbook of Alcoholism Treatment Approaches: Effective Alternatives, 3rd edition, edited by Hester & Miller, published in 2003 by Allyn & Bacon). The first myth, and possibly the worst, is that there is one and only one effective approach to addiction recovery. If you are seeking treatment and a facility tells you a version of this myth, it would be better to look elsewhere for help. Alcohol treatment research, and addiction treatment research generally, shows there is no single approach that is best for all individuals.

Many paths to addiction recovery

The first principle of the 12 Guiding Principles adopted by SAMHSA’s Center for Substance Abuse Treatment’s National Summit on Recovery is: There are many pathways to recovery. Their list was generated by leaders in treatment and recovery, and included recovering individuals, treatment providers, researchers, faith-based providers and state and federal officials. A similar document of 10 principles, addressed to the problems of individuals with co-occurring mental health issues, produced at a Substance Abuse and Mental Health Services Administration (SAMHSA) conference, stated: There are multiple pathways to recovery.

The other two myths are that “nothing works” and “everything works.” Put another way, there is a popular but incorrect belief that all treatments for addictions are equally good or bad.

What works?

Drs. Miller and Hester have been comparing the research contrasting the various approaches.* Their scientifically sophisticated review of alcoholism treatment outcome research demonstrates that some treatment modalities are especially effective for most people. Rank ordered, the evidence is strongest for:

1. Receiving honest but non-confrontational one-on-one feedback regarding one’s alcohol- related health from a health professional;
2. Non-confrontational strategic Motivational Interviewing;
3. The medication acamprosate;
4. A complex set of cognitive and behavioral methods called the Community Reinforcement Approach
5. The assigning of a Self-Change Manual, also called Bibliotherapy
6. The medication naltrexone;
7. Behavioral Self-Control Training (a moderation approach);
8. Behavioral Contracting for rewards given in exchange for clean drug test results:
9. Social Skills Training
10. Behavioral Marital Therapy

A common theme in all of these treatments is that they are delivered with empathy and without confrontation. These treatments are often mentioned in media articles about improving our poor record in helping people with addictions. Unfortunately, few addiction treatment centers offer them. However, with the aid of the internet one can find them more easily than before.

Alcohol treatment with weak evidence of effectiveness

Of the 48 approaches ranked, the evidence is weakest for:

48. Educational tapes, lectures and films, upon which much time is spent in some rehabs;
47. General Alcoholism Counseling;
46. Psychotherapy;
45. Confrontational Counseling;
44. Relaxation Training;
43. Videotape Self-Confrontation or watching oneself behaving badly while intoxicated;
42-39.These four included three medications and Milieu Therapy;
38. Alcoholics Anonymous
37. Twelve-Step Facilitation Therapy, a one-on-one teaching and support of the 12-Steps.

Of course, even these treatments will be helpful to some. However, it would appear most sensible, if seeking treatment for oneself or a loved one, to start with a treatment that had a better record of success. Further, common sense would suggest that if one approach does not work, it is not necessarily the individual’s fault. If an alcohol treatment does not help much, try something else!

Source: Practical Recovery Reprinted with permission

* The complete list, including the criteria for ranking all 48 treatment approaches may be found here.

9 thoughts on “Three Addiction Treatment Myths

  1. Friscosan

    Hi good people,
    Glad you are searching for recovery from Hell. Try everything you can find including medications, formal rehabs, therapy, religion and all the rest. Remember that recovery is a big and growing industry that supports lots of employees, management and investors as well as government bureaucrats and politicians. Try to keep an open mind. Stick to what works for you and move on when it doesn’t. Try not to let the God thing rule out 12 step programs because you can take what you need and leave the rest. The main thing is to focus on your recovery not your likes and dislikes or preconceptions. Remember it is your old beliefs and selfish thinking that got you here. My own recovery depends on trying to help others to recover. Just trying to get help does not work well from what I have seen. Trying to give help does wonders for those that do it. Many new to recovery think that the services they pay for will bring the desired result. The truth I know is that recovery is free of charge but must be freely passed on. Where does this free recovery come from? Oh, out there somewhere is where it comes from. That is why some people call recovery a spiritual gift. It just comes to those open to receiving it and willing to pass on even what little they have to another suffering human being. The truly scientific method is to try something and judge by the results. But others must be able to replicate the results. I have tried this scientific experiment with AA and it works when I work it, so I work it, because I am worth it. But whatever you do, keep working at it and keep the focus on yourself until you are blessed with recovery. You too are worth it.

  2. James

    Where I live the only option for decades has been AA/NA and I have been unsuccessful with both. In my opinion, this is because it conflicts with my belief system…I am an atheist for lack of a better label. However, I am a person that responds to peer support. I attended two 12 step meetings this week because I need some support. At this time, I am going to start going back to 12 step meetings for the peer support and just ignore the god issue. Since I believe this will assist me in my recovery, then it has a chance. Belief in my opinion is a huge part of how I respond to any treatment protocol – because belief is powerful.

    I am also going to intensive outpatient substance abuse treatment 3 times a week for 3 hours a session. I will also be seeking mental health counseling at the county clinic. And best of all there appears to be a new local SMART meeting 5 miles from my home. The only one in the state – talk about luck! I agree with the premise that there are multiple pathways to recovery and I am going to explore all pathways available to me. Just found this blog will explore that now.

  3. Harvey D.


    I am a clean coke head. I’m also a Unitarian, writer and humorist. At the last NA meeting I went to a well respected member told a story about how a cat had shown up and then how he’d almost shot his neighbor. But happily he could now see how God had sent that cat and stopped his .357. I left that meeting thinking, ‘I’d rather be puking face down in the gutter than ever say anything that sounded half that stupid’. Then I did what they insist is impossible. I stopped using drugs without 12 steps.

    I think I should be involved with SMART. I like everything I have read about it. Many more people could benefit from SMART. Perhaps I could even be of use to the organization. I’m a good speaker. And I conceal my contempt for fundamentalism fairly well for a guy from Fresno County.

    I’m in Houston two more days. Perhaps I should attend my first SMART meeting here. I’ll be back in Fresno on Wed, Jan 30. I’d like to learn and help.

    1. Admin Post author

      Hi Harvey:

      Thanks for your comment. You may have already found the link, but just in case, here’s a list of our face-to-face meetings: You can use that list to find meetings in Houston and in Fresno.

      We also have almost 30 online meetings each week: so if there are no face to face meetings that fit your schedule you may be able to find one online.

      As for volunteering, we are a volunteer organization with many opportunities for members to make meaningful contributions to health and growth of the organization. We hope you enjoy getting to know more about SMART and we look forward to your participation for as long as you find it helpful.

    2. Adi M.

      Kudos, Harvey D.! I hope you do, it is a great alternative to the programs out there, and I believe it’s the only program that evolves with research & science. Best to you in bringing SMART recovery to Houston. Good luck!

  4. BBCK

    Having tried everything else the Big Book of AA helped me the most and along with frequent meetings with alcoholics in recovery,I am now sober 38 years this year.(a day at a time)
    Very best wishes to you all.

  5. grigora

    I’ve recently been exploring other options in my recovery. The rehab I attended had a nice array of treatments, anything from twelve-step to individual counseling to acupuncture. Now that I’ve been out of rehab and struggling with sobriety, I turn to the twelve-step program…which I’m growing less fond of with every meeting I attend. I’m glad to read that not every treatment is right for every individual…this article highlights exactly how I’ve been feeling/thinking.


    Very interesting information that I never heard. Guilt and shame is how I live right now. Lets not forget regret and depression..

  7. Frank Lavario

    That last paragraph is important. “It’s not necessarily the individual’s fault.” Unfortunately, so many patients blame themselves, feel guilt and shame and then drink even more than before.

Comments are closed.