Treatment approaches and philosophies

Treatments to help people stop drinking use very different approaches, and have different philosophies behind them.

It can get very confusing. In order to help you make sense of it all, I've divided these into two camps:

  1. Cognitive Behavioural
  2. Twelve Step

Cognitive Behavioural

How we think, feel and behave are all closely linked. Cognitive-behavioural therapies work by trying to alter the way you think, in the belief that the way you think about yourself, your feelings and your drinking comes before your decision to drink. So if you can change how you think, you can change your response to your thoughts and feelings, and change your drinking.

These approaches are non-confrontational, and often include social components, in that they can involve your partner and family, and may include elements of social skills training.

There are different techniques for clients who are unsure if they are ready to stop drinking, and for those who are clear about wanting to stop.

There is a comprehensive amount of evidence that these types of therapy work very well in the treatment of alcohol problems1

12 Step

The 12-step programme is one that many are familiar with from AA meetings, and is used in particular in most residential rehabilitation.

The twelve steps are:

  1. We admitted we were powerless over alcohol�that our lives had become unmanageable.
  2. Came to believe that a Power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed, and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take personal inventory and when we were wrong promptly admitted it.
  11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
  12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Whilst the 12-step programme is often seen as an ideology2, it has at its heart some excellent ways of changing how you view yourself, the way you think, and the way you relate to other people. Working through the steps gives a structured and coherent philosophy for people.

The evidence3 is that it is effective for people who are suited to it - indeed it's worked for millions of people around the world. Not everybody find the 12 step approach acceptable, however, and coerced participation is unlikely to work.


1 Review of the effectiveness of treatment for alcohol problems: Chapter 9

2 Griffith Edwards, The Treatment of Drinking Problems 2nd edition page 261. Blackwell Scientific Publications

3 Review of the effectiveness of treatment for alcohol problems: Chapter 12