Dear Grace, 

12 step is better first but can be combined with CBT also. Best  works  the meeting with Christ, being born again. 

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I hope you don't mind if I begin with some points I think are important in this discussion. First, it's important to make the distinction between 12-Step meetings and treatment programs based on the 12-Steps. 12-Step meetings are not considered treatment, although many treatment programs are based on the steps. Second, each approach will not be beneficial for everyone (see Project Match) and while this is a needed and relevant question, it calls for generalizing which is not a good idea (with one exception I will mention later). Third, I am biased towards 12-Step meetings and mutual support groups. They often produce recovery and a sober lifestyle without formal treatment. However, I believe formal treatment with 12-Step attendance is a great combination.

The 12-Steps are essentially cognitive-behavioral. However, formal CBT might not be effective for everyone. I also have had success using MI in combination with CBT and 12-Step meeting attendance. I know my response was limited, but and there is much more that can be said about all the approaches.

If you ask people in 12-Step groups, who have long-term recovery, what recovery is, you will get answers that academics has just recently started to study.  The one qualification to not generalizing the benefits of one approach over another is Recovery Management. It is not just one approach, although it is an inclusive philosophical foundation. I wrote about this a while ago on this site. With it's emphasis on system approaches and systems thinking, I believe Recovery Management provides many components lacking in other treatment.  I attached a great monograph and also encourage you to visit the web site provided. Both are provided by William White who most of us in the field of addiction know as the major historian of addiction. His web site is an amazing collection of addiction related resources of many different kinds.

http://www.williamwhitepapers.com/

When bias is considered I don't there is no data to support that one particular brand of treatment is better than any other. Everything works some of the time with some of the people and nothing works all the time. Some therapists get much better results than others but there is little data to indicate that this is model driven.

Harry Korman

Cognitive Behavior Therapy (CBT) is widely used among many substance abuse facilities and therapists. However, Motivational Interviewing (MI) can be used directly/indirectly to influence the behavior of individuals who are suffering from Substance Use Disorder (SUD). These clients make bad decisions based on their behavior (i.e., low-self-esteem, poor judgement, inadequate resources, spiritual discontent). Motivating these individuals can assist the therapist with helping them believe they are the only ones that can become empowered to change their situation. The support from their therapist, family members, spouse, or any other individual(s) who are willing to be supportive is prevalent to their success in treatment. I use Servant Leadership, CBT, and Motivational Interviewing simultaneously. Always remember addiction affects the mental state and altering substances play a major role in dysfunction. Reversing the roles of behavior is never easy but, it can be done with the right tools, resources, individuals, and support.

Sincerely,

Gatt R. Ware Sr., M.S. CADC, BIP  

Great contribution to you all on this wonderful question raised. I will lean toward Steve's comments due to my own exposure as a Mental Health and addictions as well as a clinical therapist. Having worked with both groups and individuals struggling with addictive behaviors in the past years, has enabled me recognize the importance of targeting certain behaviors but also addressing psychological aspects such as trauma; which in some cases contribute a great deal of one's thought process, feelings and actions or behaviors. I also agree that,  the 12-Steps program has it's strengths and weakness but I must add; it's not for everyone, however I have witnessed some successful stories as well.

Dear Grace, 

No doubt both are very important , there are individual variation , for the illiterate substance abuse CBT was not the appropriate also , from my clinical experience the Arabic substance abuser need elements of religious and spiritual involved in the treatment process

Dear,

Both are import for treating durg abuse but if you used 12 steps in appropriate well defined to them would be beneficial as well,you must take start from 12 steps program. 

In Our clinic we use all methods. We try to evaluate which patiens will profit from which treatment. Generally, 12- step based treatment is in Groups ( both in-patient and out- patient Groups) and out-patient treament would be based on combinations of CBT, solution- focused and Learning- based treatment. MI will be practised in the preliminary phases; before action phase according to Proschaska et al`s Wheel of Change. The question could be re-phrased to : Which treatment is best for whom?

Helga Tveit, clinical psychologist

A helpful resource is a book entitled, "The Heart and Soul of Change" edited by Duncan, Miller, Wampold, & Hubble (2010). The editors and contributors make a compelling case that common factors (e.g., therapeutic relationship/alliance, collaboration in goal setting, hope, empathy, etc.) are far more important than specific factors (i.e., techniques and interventions associated with treatment models such as CBT, MI, or 12 Step Facilitation). A chapter devoted to substance abuse and dependence treatment summarizes research from Project MATCH, COMBINE, and the Cannabis Youth Treatment Study and conclude, essentially, that all treatments are equally effective. My takeaway - Treatment effectiveness hinges less on which treatment is provided and more on establishing a collaborative relationship, seeking feedback about the effectiveness of interventions, and altering the treatment course based on the feedback.

CBT is preferable.

Following 30 plus years in active addiction I am now a Twelve Step practitioner with almost 5yrs clean and sober so obviously I will have a bias to this form of recovery. I have accessed recovery networks and support systems for a number of other modalities, however was never successful until I truly surrendered. I feel that it is what is right for the individual at that moment of 'absolute surrender' maybe if I had been exposed to CBT at that particular time then my recovery would have perpetuated in a different direction. I feel that there are good cases for ALL forms of recovery and however an individual 'gets well' is to be seen as something of a miracle. If we were to look at evidence , in relation to numbers successful for each modality, then we would probably see that 12 Step recovery to be the most successful with a number of fellowships evolving since the inception of AA in 1934. If one were to take a more cursory look at 12 Steps then it would be apparent that CBT is actually a big part of this modality. Whatever works for that particular individual at that particular time is obviosly the most successful form of recovery and no amount of figures or research will ever convince them otherwise.

The by far biggest research project comparing CBT and AA was the MATCH project. Unfortunately its focus is on alcohol addicts not drug addiction. If you are interested see:

http://findings.org.uk/docs/Ashton_M_13.pdf

http://pubs.niaaa.nih.gov/publications/ProjectMatch/matchIntro.htm

 I liked very much Schneider's response. First, it's important to make the distinction between the voluntary and user-based 12-Step groups and treatment programs based on the 12-Steps. Second, the Project Match used manual based interventions; 12-step facilitation, CBT & MI. However, in clinical practice there are a great deal of overlap, e.g., there is much use of CB techniques in 12-step based treatment, and as argued for above; one can see the 12-steps as cognitive-behavioral in a change-theoretical paradigm.

In some countries, e.g., in my own, Norway, the 12-steps are much less known and used in the professional community than for example in the U.S. One obvious reason is that the 12-step treatment model has few advocates and less than 5% of the treatment modalities would say that their treatment is 12-step based (the situation is quite different in the U.S.; 60 - 75% of the treatment program would say they are 12-step based). Thus, I've argued that in Norway, the 95% of the programs that are NOT 12-step based  should also become aware of the voluntary 12-step groups as a resource for their patients and refer patients. AA and NA do not consider which type of treatment modality a person comes from, their only concerns is whether the person wants to stop using drugs. Then you are more than welcomed into the fellowship!

In countries like Norway, where the mutual-help groups are less integrated and less used by the treatment system; professionals should take this challenge  and more systematically refer patients to these supportive peer groups. 

You might find these, evidence-based, NICE guidelines helpful (UK National Institute for Health & Care Excellence):

https://www.nice.org.uk/guidance/cg51

http://www.nice.org.uk/guidance/cg51/evidence