Addictions report calls for reduced reliance on 12-step programs, but some stand by their effectiveness

A long-awaited report on mental health care and addictions treatment in Manitoba released this week included criticism of 12-step-based programs from multiple people working in the health system.

Addictions experts working in both public and private treatment services say the programs are less effective for some patients, including youth and people with certain drug addictions, but not everyone is ready to scrap the model.

The report from Virgo Planning and Evaluation Consultants, released Monday, recommends that the province review "the appropriateness of the current heavy reliance on 12-step facilitation in [Addictions Foundation of Manitoba] residential programs."

Author Dr. Brian Rush noted a common theme that emerged from consultations with stakeholders: a key challenge facing the system is the perceived reliance on abstinence-based programs.

One Winnipeg addictions expert who has been on the front lines of the city's meth crisis agrees.

"We need to bring our treatment models more in step with the current realities of today's treatment needs," said Marion Willis, executive director of Street Links St. Boniface and founder of Morberg House.

Many drug treatment programs follow a model used to treat alcohol addiction, including a detox phase before moving into a 12-step program — which focus on acknowledgment of a higher power and making amends for past mistakes — and that simply doesn't work for some patients, Willis said.

"The level and the type of intervention that is required for methamphetamine and maybe even some of the opioid addictions, requires a very different approach," she said.

Those interventions include secure drug stabilization units and harm reduction programs that enable health care workers to detain someone in the grips of drug-induced psychosis, Willis said.

Recent research has called into question the effectiveness of programs like Alcoholics Anonymous, with one researcher pegging the success rate as low as five to 10 per cent. 

12 steps have worked for many

While there are calls for addictions treatment programs to explore alternatives to the 12-step model, one expert cautions against moving away from a philosophy that he says has helped millions.

This Sunday marks 15 years of sobriety for Paul Melnuk, founder of Aurora Recovery Centre, a private drug rehabilitation centre in Gimli, Man., who went through Alcoholics Anonymous to deal with his addiction.

"I'm a huge believer in 12-step recovery," Melnuk said. "My own personal experience is that I've seen a lot of people who thoroughly follow the program do have success, and those who don't do the work don't have success. So it's really a question of those doing it."

On its website, Aurora Recovery Centre says its "primary treatment of addictions is holistic and spiritually based on 12-step philosophy."

Melnuk acknowledges that the 12-step model might not work for everyone, but he says there are multiple ways of combating addictions that still focus on core elements of 12-step philosophies, particularly an emphasis on spirituality.

"That's effectively what 12-step philosophy is. It's putting people on a path towards … a more spiritual way of living, and there's multiple ways of getting to that same endpoint."

One successful approach incorporates traditional Indigenous teachings into recovery programs — something the Virgo report also recommends, he said.

"Every addict's disease is unique and there's just not one way of approaching this problem. It's a matter of meeting each individual where they are," he said.

Willis agrees that 12-step programs shouldn't be abandoned, but suggests they shouldn't be the starting point for everyone on the road to recovery.

"Any kind of 12-step program, I think, perhaps has a place but it's quite a ways along the continuum," she said.