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What to Do When Just NA, CA, AA or SMART Isn’t Enough

Sign at a doorway to an Alcoholics Anonymous meeting place. AA is an international aid fellowship whose stated purpose is to enable its members to stay sober and help other alcoholics achieve sobriety

So, you have decided that your drink and drug use is becoming a problem, or you have had a conversation with someone you care about indicating your concern about your drinking or drug taking. Either way the good thing is that the decision has been made to get help and you are now looking at your options and up pops the option of peer support services such as Alcoholics Anonymous (AA), Cocaine Anonymous (CA), Narcotics Anonymous (NA), and SMART recovery.  The AA model, as with CA, NA, and now SMART recovery has a lot going for it. First of all, they are open to all, free and where AA, NA & CA are concerned, pretty much spread everywhere around the globe. In fact, AA has over 2 million members in 180 nations and more than 118,000 global groups.

Furthermore, there is a strong evidence base of their effectiveness in supporting long term abstinence. After evaluating 35 studies — involving the work of 145 scientists and the outcomes of 10,080 participants — Keith Humphreys PhD, CIGH Fellow at Stanford Centre for Innovation in Global  Health, professor of psychiatry and behavioural sciences, and his fellow investigators determined that accessing AA actively helps in achieving abstinence.

For many, peer support serves are a pivotal part of their relapse prevention, and countless people say that they would not be where they are today had it not been for the structure and support of their local groups.

But while peer support services may seem like the natural place to begin the abstinence journey, standalone peer support participation is not always the solution that many people hope for. Without being accompanied by psychological therapies, relapse is common, as many of the issues that underlie the reasons for using alcohol and drugs in the first place remain unaddressed; even when you are faithfully working the Steps.

It can be very discouraging to be doing all you can by going to meetings but still finding that you are relapsing. Over time this can damage both someone’s belief in their ability to remain abstinent and their trust in the recovery process itself.

Understanding The Role Of Peer Support Groups

Problematic alcohol and drug use is a complex and chronic disease of the brain. It is often also intimately intertwined with a host of psychosocial factors that act as the impetus for substance use in the first place; you use because you’re depressed, you use because you’re angry, you use to erase the pain of trauma such as abuse or a bereavement, you use because you have no self-esteem, you use because you never established healthy coping skills, you use because you don’t know why!

In some situations, the use becomes so bad that a physical addiction takes place. As such, treatment can be a complicated journey that requires comprehensive treatment in the form of evidence-based medical interventions to deal with the withdrawals. Even if this is not required then there is the need of professional psychological support to help provide a deep insight into the roots of someone’s use, understand the feelings associated with these and equip people with new coping strategies to face these and the challenges of the present and the future.

Peer support meetings are great, but they are they are not psychotherapy and none of the people chairing the meetings are trained addiction therapists. Peer support meetings like AA, NA, CA etc. are a fellowship of men and women who share their experience, strength, and hope with each other that they may solve their common problem and help others to recover from addiction. What peer support meetings can offer is in many ways remarkable: a sense of belonging and connection to others who struggle with a highly stigmatised illness and meaningful support in the fight against addiction. No drug and alcohol service alone can provide the kind of group support that AA; NA et al. makes available. When in need anyone can pick up the phone or log onto the internet and find instant support and assistance and as a resource to support long term abstinence everyone embarking on this recovery journey should consider their access as part of their relapse prevention plans.

However, peer support meetings were never designed around a clinical framework of addiction, nor are they designed to provide the kind of professional interventions we now know as critical to the recovery process. While there is much collective wisdom within peer support groups, they should not be a substitute for evidence-based treatment. As such, it cannot and should not be the only part of recovery and should be used in conjunction with evidence-based therapies, therapies proven to provide successful treatment outcomes to those in need.

For those who find the philosophy of AA, NA & CA appealing and meaningful, it can also serve as a kind of philosophical foundation for recovery in which many find comfort and purpose. For those who do not find the 12-step process appealing or meaningful, it can be important to know that are other forms of peer-to-peer support, such as SMART Recovery.

But for many people lasting recovery only came when they understood that their problems ran deeper than could be addressed in peer-to-peer support meetings. Peer-to-peer support meetings will not deal with trauma, they will not treat depression and a host of other issues which are often the underlying reasons for someone’s use in the first place.

Alongside of dealing with the problematic alcohol and drug use itself psychotherapy led drug and alcohol treatment programmes will also help address so many other things that often drive the drug or alcohol use or are associated with it:

  • Conflicts with partners or other people in your life
  • Anxiety or stress due to work or other situations
  • Self-esteem issues
  • Coping with major life changes, such as divorce, the death of a loved one or the loss of a job
  • Learning to manage unhealthy reactions, such as passive-aggressive behaviour and anger
  • Coming to terms with an ongoing or serious physical health problem, such as diabetes, cancer or long-term (chronic) pain
  • Recovering from physical or sexual abuse or witnessing violence
  • Coping with sexual problems, whether they’re due to a physical or psychological cause
  • Sleep issues

In some cases, intensive drug and alcohol psychotherapy led treatment programmes can be as effective as medications, such as antidepressants. However, depending on the specific situation, psychotherapy alone may not be enough to ease the symptoms of a mental health condition. Individuals may also need medications or other treatments.

Peer support services but so many people find that they are not enough. Here are some comments from some of our clients that have found this.

  • “Without dealing with my depression, I don’t think I would have ever gotten sober”
  • “Without learning how to deal with my feelings, I don’t think I would have stopped using”
  • “Without understanding how to deal with conflict in a healthy way, I don’t think I would have stopped drinking”
  • “Without tackling my self-esteem issues, I wouldn’t still be sober”
  • “Without dealing with the death of my partner I could never have stopped drinking by just going to meetings”
  • “I had no idea why I was drinking and using coke, I’d go to meetings and that was ok but would still use. It wasn’t until I had help from my therapist and the group psychotherapy that I was able to identify and figure out what was going on and equally importantly what to do about it. For me AA & CA has been a constant part of my journey, but it could not be the only part.”

Time to make a change

New methods of drug and alcohol treatment are changing. If you or someone you care about keeps relapsing there are options for you. Help Me Stop’s intensive non-residential face-to-face Dayhab programme is an effective solution that also offers accessible aftercare and family support options to minimise the risk of relapse and to maximise the support of friends and loved ones that is so important to long-term success.

Our 6-week evening online drug and alcohol treatment programme is an excellent choice for adults who are working and can’t access services in the day or get to our centre in Central London. Families can also access support online.

If you would like to learn more about why you, or someone you care about, keeps relapsing and want to do something about it then call us now on 0208 191 9191 or jump onto Live Chat/ email us directly.

Chris Cordell is Help Me Stop’s General Manager and is a senior associate member of the Royal Society of Medicine, Certified International Recovery Specialist, member of the International Society of Addiction Medicine and a member of the Federation of Drug and Alcohol Professionals.

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