By Melanie Solomon

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Copyright 2009 Melanie Solomon
By Melanie Solomon

How do you know what you are getting when you choose a rehab program? There are basically four types of programs:
• Moral
• Disease
• Behavioral
• Holistic
It is important to compare the different types of programs before making your decision. Many of them, especially in the U.S., are based on old ways of viewing the addicted person, and therefore their approach is often outdated.
In short, the moral model says that a person is bad if they make bad choices. (This was the main view before the disease model came into play in the 1930’s.) The disease model views addiction like having a disease, akin to diabetes; the addicted person is completely powerless over their disease. The two models taken together offer a very bleak outlook. Addicts are bad people who have no control over their own lives. 12-step programs lean more toward the disease model. After these models, the behavioral model, or cognitive-behavioral model was developed. It says that each person has the power to change him or herself by changing the way they think. The newest model to emerge is the holistic model, which builds upon the good points of the older models. This approach uses the cognitive-behavioral model as a core component of its approach, and accounts for the many different contributing factors of the individual’s unique addiction problem. This approach addresses the health of mind, body and spirit, helping the individual to both prevent and respond to their problems. It teaches self-management skills and techniques to prevent relapse and advocates a multi-faceted approach to support the individual. Most importantly, the holistic approach views individuals as competent to help themselves when given the right education, tools and support.
Let’s look a bit deeper into the history and new developments in the addictions field, especially since addiction may be the most controversial topic that has been addressed in the public health and medical communities over the years. The addictions field has evolved through several phases over the past 100 years. What follows is a brief overview of some of the changes in belief regarding the basic nature of “addiction” or substance dependence, how to prevent its occurrence and how to intervene once dependence has become apparent. As shown above, addiction has been viewed as an individual moral problem, a medical disease and a behavioral disorder and now there’s an emerging holistic model.
The Moral Model is the belief based on a moral theory. According to this theory, people are individually responsible for the behavioral choices they make, good or bad. Those who choose good behavior should be praised, while those who choose bad behavior need punishment. This leads to people with addiction problems to be stigmatized, labeling anyone with a “bad habit” as a “bad person.” The downside of this model has become increasingly clear over the years. People with addiction problems are stigmatized and are therefore often demoralized by feelings of self-blame, guilt and shame to the extent that they are unwilling or unable to seek any help or treatment.
In the 1930’s, the new Disease Model began to be formulated. This new view was that addiction was a disease caused by genetic and biological factors. The addict was then no longer held personally responsible for their ‘bad behaviors” since these behaviors were now caused by biogenetic factors beyond their control. A strong argument could be made that addicts were patients deserving treatment, rather than criminals deserving punishment. The 12-step recovery movement with its accompanying treatment system enthusiastically accepted this model. Now, officially, addiction was a progressive disease for which there was no cure, and the only way to put the disease “in remission” was by a lifelong commitment to total abstinence. Any use of alcohol or other mind altering substances was considered a relapse, regardless if it resulted in any harmful consequences. So whether it was one drink or 100, it was treated the same.
Despite the wide acceptance and appeal of this disease model (over 90% of U.S. alcohol and drug treatment programs adhere to it), a number of shortcomings and limitations have emerged through years of research. Although these programs do work for some people, there are certain contradictions and paradoxes that prevent others from finding them helpful. The notion that the 12-step way of recovery is superior to all others is not at all backed by the research. People can recover without AA or any other 12-step program and be just as healthy as those who find them helpful. Within traditional treatment, there was a tendency toward a “one-size-fits-all” approach to recovery, which contributed to high dropout rates. And by defining addiction as an incurable, progressive disease, many people will find it difficult to change their addictive behaviors or decide to give up alcohol or drug use on their own.
In recent decades, an alternative model has emerged that challenges the traditional disease model and its “one-size-fits-all” approach to recovery. This model is based on the assumption that addictive behavior has multiple components and that individuals vary in risk depending on their unique bio-psycho-social history. Due to the fact that both habit acquisition and habit change are primarily influenced by cognitive and behavioral principles, this approach has become known as a cognitive-behavioral model. A major emphasis in this model is placed in the reward consequences of engaging in the addictive behavior, including both positive reinforcement, such as enhanced euphoria associated with getting high, and negative reinforcement, such as self-medication resulting in tension reduction or relief.
By bringing the attention back to the person with the substance abuse problem, treatment goals now shift from being strictly set by a treatment program provider, with abstinence as the only acceptable option, back to the consumer, (you), who now has a choice in their own treatment goals. Individuals can choose from a variety of goals, ranging from abstinence to reduction in harmful consequences, and by placing this choice into their hands, there is now acknowledgment that most addictive behaviors represent a problem in self-management that can be resolved by the individual. The substance abuser is no longer “powerless” but is taking back power over his or her own life. This model respects the client’s choice and tries to meet clients where they are in the varying stages of behavioral change. This differs greatly from the traditional disease model, where emphasis is on client confrontation and enforcement of abstinence as the only acceptable goal.
The holistic model, or biopsychosocial model, is the emerging model, which takes a more holistic approach to health and well-being and incorporates the strengths of the various models of the past and uses those various insights to effect change. New understandings from years of research are coming into play and the holistic model is basing its approach on this important information. It is being discovered that social, economic, cultural and environmental conditions, as well as behavioral choices, impact both psychological and biological processes. In turn, psychological and biological changes influence behavioral patterns.
Now, motivational techniques, brief interventions, cognitive-behavioral therapy and pharmacotherapy co-exist with new approaches, including acupuncture, meditation, good nutrition and stress management (see previous section for more details). What has become clearer and clearer is the competence of individuals to manage their lives when information, support and choices are available.
Since the best predictor for your success is your ability to choose your own program and set your own goals, it is advisable to ask the following crucial questions to ensure that an appropriate drug and alcohol program is chosen that will meet your particular needs.
1. What kinds of treatment programs do they offer? Is it primarily 12-step based, or do they offer other self-help options as well, i.e. SMART Recovery, SOS, or Women For Sobriety? So they match treatment settings, interventions and services to each individuals particular problems and needs, since this is critical to one’s ultimate success in returning to productive functioning in the family, workplace and society?
2. Does the program address multiple needs of the individual, not just his or her drug use, such as any associated medical, psychological, social, vocational and legal problems?
3. What types of credentials does the staff have, such as doctors, counselors, and anyone else who has contact with the clients, and what is the ratio between the staff and clients?
4. Is there a doctor on the treatment’s premises 24 hours a day, or just a couple times a week to dole out medication?
5. What is the treatment program’s philosophy or theory towards addiction? Is it religious, bio-psycho-social, psychological, neurological, physical and psychological, trauma-based (addiction that has stemmed from a sole traumatic event in one’s life), and does their particular approach suit your own personality, beliefs and values, or is it one that you can believe in, and rebuild your life based on it?
6. Does the treatment program detail positive approaches towards treatment, using up-to-date methods, such as motivational therapy, cognitive-behavioral therapy, stress personal responsibility, this is a disease/not a disease but a choice among many others?
7. Do you think this approach resonates with you, or your loved one, that may need inpatient help?
8. Does the program offer counseling (individual or group) and other behavioral therapies, where issues of motivation, building life-skills to resist drug and alcohol use, relapse prevention, improving problem-solving skills and facilitation of interpersonal relationships and ability to function in the family and community often take place?
9. How does the rehab program assist an individual during the withdrawal process, i.e. medical treatment for withdrawal provided, or must this be done somewhere else, prior to entering the facility?
10. To what extent is the family involved in the treatment process?

If a treatment program is determined to be necessary, asking these critical questions will at least give you the important information of whether or not they are simply a traditional treatment center, only offering one option, the 12-step method, or whether they have taken all the vital research into account and have now incorporated many different alternative modalities into their program. Remember, the notion that “one size fits all” in the treatment of alcohol and other drug problems has been completely destroyed by the scientific evidence, and therefore, there can not be a “one size fits all” solution.

Author's Bio: 

Melanie Solomon is the author of the highly anticipated 2nd Edition of "AA-Not the Only Way; Your One Stop Resource Guide to 12-Step Alternatives". Please visit AA Not the Only Way for more information or to sign up for your FREE discussion forum membership and updates. She has also spoken to teens at The Huntington Beach School District Drug & Alcohol Program, and led workshops at The Learning Annex in California. Solomon offers a FREE first time 30 minute phone consultation where you can discuss your greatest challenges and how to overcome them, as well as your dreams and the outcomes you are trying to achieve. To schedule a free session, contact her through her website at aa alternatives