If They Try to Make You Go to Rehab, Say No, No, No

A therapist who’s treated alcohol- and drug-dependent patients for three decades says a successful recovery doesn’t require AA or a pricey stay in rehab.

Almost half of people who become alcohol-dependent do so by age 21, and two-thirds do so by age 25. (Getty Images/ericsphotography)

May 16, 2013

You hear a lot of bad news about alcohol abuse, so it’s always a relief to here something good, right? Earlier this year, the National Institute on Alcohol Abuse and Alcohol (NIAAA) reported on several hopeful findings that, in their words, “challenge past perceptions of the nature, course, and outcome of alcoholism.” What does that mean, exactly? Among other things, NIAAA noted that most people do overcome alcohol dependency, and that “about 75 percent of [those] who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol (rehab) programs and AA.” 

This is especially good news for young adults, since alcohol dependence is most prevalent among people 18 to 29. The 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) had actually pinpointed 22 as the mean age of the onset of alcohol dependence; and nearly half of people who become alcohol-dependent do so by age 21, with two-thirds doing so by age 25. (If you’re wondering what constitutes “alcohol dependence,” the NESARC used the American Psychiatric Association’s criteria: “preoccupation with drinking, impaired control over drinking, compulsive drinking, drinking despite physical or psychological problems caused or made worse by drinking, and tolerance and/or withdrawal symptoms.”)

So if three-quarters of alcoholics who recover somehow manage to get better basically on their own, how do they do it? As a clinical psychologist who’s worked with alcohol-dependent people for nearly three decades, my experience has been that those who recover do seven key things:

1. They focus on successes and don’t dwell on failures.

2. They keep in mind that all improvements count, even the small ones.

3. They take ownership of a recovery plan they believe in, and don’t just passively go along with someone else’s approach.

4. They acquire life skills that increase their self-confidence.

5. They learn not to overreact to their emotions.

6. They don’t have people in their lives who “enable” their problematic behaviors (those are people who make it easy for the alcohol-dependent person not to take responsibility for the consequences of their behaviors).

7. They have people in their lives who help motivate and energize them to change their behaviors. 

William Miller, Ph.D., emeritus distinguished professor of psychology and psychiatry at the University of New Mexico, who’s affiliated with the Center on Alcoholism, Substance Abuse, and Addictions, analyzed all available controlled studies of alcoholism treatment to see what works and what doesn’t. According to Miller’s analysis, least effective are confrontational approaches (such as interventions; these routinely end in resistance on the part of the alcoholic) and passive approaches, like films and lectures (these typically fail to energize any sort of change). Unfortunately, these ineffective approaches continue to be used in some expensive rehab treatments.

Most helpful, Miller found, are approaches that create motivation for the alcohol-dependent person to take constructive actions. Sometimes this approach can be as brief as a doctor informing a patient of the results of a liver function test and then explaining the negative consequences of continued drinking and the positive consequences of stopping.

In general, the most effective are approaches that enhance motivation. One such approach is what Miller calls “motivational interviewing” (MI).  In MI, the counselor communicates empathy; “rolls with resistance” rather than arguing with a client who is resisting; and supports self-efficacy, which is a person’s ability to overcome challenges and the belief that he or she can succeed and become more competent. One of the most important aspects of MI is genuine empathy— “seeing the world through the client’s eyes,” as Miller writes. Empathy on the part of the therapist for a patient diminishes defensiveness and denial of problems.

That said, the MI approach holds the alcohol-dependent person responsible for choosing and carrying out actions to change, and this type of counseling directly supports a person’s capacity to create their own effective plan of action. It can also be done by those who aren’t mental health professionals. In fact, long before MI came into existence, MI tactics have been used, sometimes most effectively by “helpers” with no mental health professional training at all. When ex-football star Jim Brown saw the life of his friend, comedian Richard Pryor, being destroyed by cocaine addiction, Brown didn’t scold Pryor or preach to him. He simply asked Pryor, “What you gonna do?” And with each of Pryor’s evasive answers, Brown repeated the question; Pryor gave Brown great credit for motivating him to change his behavior.

In my clinical experience, what is most critical to recovery from alcohol and drug dependence is acquiring confidence that one can in fact change one’s behavior, and having a genuine commitment to an approach that one has taken ownership of, rather than passively going along with another’s program. And it can be beneficial to have a motivating and energizing helper—professional or nonprofessional.

What do you think helps someone overcome alcohol or drug addiction best? What has worked for you or someone in your life?

Bruce E. Levine, Ph.D., is a practicing clinical psychologist who writes and speaks on how society, culture, politics, and psychology intersect. His latest book is Get Up, Stand Up. Earlier books include Surviving America’s Depression Epidemic and Commonsense Rebellion. TakePart.com

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