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Written by Edward W. Wilson, Ph.D., MAC

Click here to contact Edward and/or see his GoodTherapy.org Profile

Non-traditional alcoholism treatment methods have always recognized that 12 Step models work for some individuals but not for most, at least not for very long. The problem is that nothing else seems to either. Designing effective treatment for individuals turns out to be a complicated business that must take into account many variables in ways that don’t easily lend themselves to any particular model. As a result most programs offer little beyond “don’t drink, go to meetings, work your program, and repeat – forever.”

It’s also difficult to remember that people have been quitting drinking for as long as alcohol has existed. Some individuals quit when their doctor suggests it’s time; others when spouses threaten to leave; a few when they collect their first DUI with all of the attendant costs and embarrassment; and still more just because they decide to. They quit with or without help or programs or meetings.

So, what happened?

Historically, most current treatment methods grew out of the experiences of two intractable alcoholics, Bill W. and Dr. Bob. They discovered a way that worked when nothing else had for them, thus giving birth to AA and the 12 Steps. And that way was generalized by treatment providers to individuals whose personal characteristics are far different from Bill and Bob, two white, male, middleclass, middle-aged, drinkers

Despite marketing to the contrary, alcoholism is not an equal opportunity disease. Its prevalence varies drastically depending on age, ethnicity, geography, income, education, religion, and many other factors. Treatment which fails to take these factors into account is far less likely to be successful than methods which do. As a result, 12 Step success tends to correlate to how closely the client matches the original Bill W./Dr. Bob profile.

Additionally, treatment programs which fail to address differences in how individuals process information will also suffer. In the 1960’s and 1970’s Dr. Jane Loevinger, at Washington University in St. Louis, developed a model of adult development. Working with Dr. Loevinger’s test protocol in Minnesota and Alaska in the 1990’s, Dr. Ed Wilson referenced developmental levels to 12 Step success, along with identification of those clients for whom traditional treatment was apt to be ineffective as well as those for whom it is frequently counter-productive.

As noted, the development of comprehensive and effective treatment stratagies for individuals is challenging and multi-faceted. Paradoxically, including developmental levels as another variable actually makes things simpler – if not easy. It allows the clinician to rapidly determine the client’s suitability for 12 Step programs; calculates the initial effective proportions of the cognitive/behavioral therapeutic mix; indicates the proper “half-stage” of distance to maintain so that the client feels neither patronized nor mystified; and the likeliest methods of avoiding relapse.

Developmental considerations do not, of course, offer any miracles. Effective treatment will still require conscientious therapists who are neither wedded to any particular model nor hampered by their own history. Additionally, with time and trust, clients are apt to reveal higher cognitive levels that necessitate continuous adjustment to the treatment plan. But that is, after all, the definition of “professional,” isn’t it?

Good therapeutic services are not static and neither are people. To suggest as much, as in never ending “recovery,” is to do a disservice to conscientious clinicians and clients alike.

©Copyright 2008 Edward W. Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Edward and/or see his GoodTherapy.org Profile

This entry was posted on Tuesday, January 1st, 2008 at 11:34 am and is filed under Addiction & Dependency, Psychotherapy: Approaches, Models, & Methods. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.