Beautiful Blends of Therapy: How 12 Step Programs & Evidence-based Practices Align

We identified synergies between different therapeutic modalities in our previous exploration of beautiful blends. But what about non-clinically based options? Where do they fit in with evidence-based practices? The subject can spark heated debate, with people understandably passionate and protective when it comes to the solutions that have worked for them. At Workit Health, our stance is one of unconditional respect and recognition for individuals' unique paths towards overcoming addiction.  This ethos is baked into virtually everything we do and produce as a company. Whether those in our program rely on it as their sole source of help, or combine it with other options out there, our mission stays the same: to inspire and empower them to find and pursue their personal path to thriving.

Critical to this mission is understanding how different options for addiction services intersect. When it comes to “non-medical” solutions versus evidence-based practices, we’ve found there’s often a lot more overlap than initially meets the eye. To illustrate this, here's a simple comparison of a few well established therapies to  twelve step oriented programs.

Dialectical Behavioral Therapy (DBT) DBT emphasizes mastering “the dance between change and acceptance”1, which strongly aligns with underpinning philosophy of twelve step. For example, the “Serenity Prayer” that is popular in twelve-step meetings encourages mindfulness of what can and cannot be changed, and autonomy over the former and acceptance of the latter. The steps themselves also balance change and acceptance – with the first requiring admission to being powerless, and subsequent steps requiring continual self-monitoring and making amends.2

Varied modes of delivery and access are important to both 12 step programs and DBT. This helps people generalize learnings during therapy sessions and meetings to the rest of their lives. DBT often provides clients with a combination of individual sessions, group sessions, and phone consultations, while 12-step programs provide both a wide variety of group meetings, and a framework for  1 on 1 support via sponsorship. 

Rational Emotive Behavioral Therapy (REBT) Both twelve step programs and REBT strive to help people see change as an ongoing process that requires hard work and practice. REBT’s founder Albert Ellis was adamant that insight into one’s self and problems was not enough for change; rather, he insisted it must be  paired with continuous action and vigilance to be effective.3   Likewise, 12-step programs encourage the perspective of maintaining change to be an ongoing, lifetime effort. Members even say they are in “recovery” rather than “recovered” to reflect their mindfulness of never being “finished” with the steps and their self-progress.

Solutions-focused Therapy (SFT) SFT and twelve step program are similar in that they cultivate the belief that change is possible. SFT tactics towards this end include guiding clients to reflect on what has worked for them in the past, and helping them to create a positive vision for the future.4 12-step programs are similarly optimistic about the hope for change, and affirm it via testimonies during meetings and sponsors, and celebrations of progress such as rewarding members of chips representing different lengths of sobriety on their "birthdays."

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As providers and former patients, our team at Workit knows firsthand that there is no one size fits all recourse for addiction prevention, treatment, and recovery (as the Surgeon General's new landmark report confirmed!). We believe the best way to help people overcome addiction is to facilitate their discovery of what works for them. In the wise words of Chrissy, our Director of Counseling, "If a good program knows anything, it is that they don't know it all."

1 Dimeff, Linda, and Marsha M. Linehan. "Dialectical behavior therapy in a nutshell." The California Psychologist 34.3 (2001): 10-13. 2 Wallace, John. "Theory of 12-step oriented treatment." Treating substance abuse: Theory and technique 2 (1996): 9-30. 3 Ellis, Albert. "Early theories and practices of rational emotive behavior therapy and how they have been augmented and revised during the last three decades." Journal of rational-emotive & cognitive-behavior therapy 17.2 (1999): 69-93. 4 O'Connell, Bill. Solution-focused therapy. Sage, 2005.