I went to my first 12-step meeting in 1988. I was playing college baseball, and I had violated some team rules regarding the consumption of adult beverages. As penance, I was instructed to attend 3 AA meetings. That was 1988.

I got “sober” in 2001. Thirteen years between my exposure to recovery principles and my adoption of recovery.

In those years in between, I would (occasionally) attend meetings. I never put together any type of recovery. I never had any intention to recover. My purpose for attendance during those “in-between years” was to get the heat off. I would go to meetings when things got bad. I went to appease my wife or comply with sanctions from my college baseball coach. I did not go to meetings in search of recovery.

Despite my lack of interest in recovery, I did quickly pick up on “how things work” in 12-step recovery meetings. I listened, and I knew the right answers to the key questions.

For example, when your potential sponsor asks you “What are you willing to do for recovery?” the only acceptable answer was “Whatever you tell me to do.”  And it was also clear that the only way to recover was full commitment to total abstinence and 12-step programs. I wasn’t ready to even entertain those ideas. In my mind, it was easy to see what my options were.

Continue to drink and use opioids and kill myself on the installment plan.

Or stop drinking and using and go to meetings for the rest of my life. So I waited as long as possible. But eventually the “pain became great enough.”  And I took the plunge.

In 2001, I came into recovery with intention. I thank God everyday, for my 12-step recovery pathway. But make no mistake, the message was (and still is) clear: There is one way to recover. I heard that from people in the meetings, from the professionals that I saw along the way, and from the media. It all centered around 12-step recovery.

Of course, I was dead wrong. Over the years I have come to understand the fulness of recovery. I have come to embrace MULTIPLE PATHWAYS OF RECOVERY.  At Youturn Health we champion and celebrate all Pathways to Recovery.

Diverse Recovery Pathways

These pathways certainly include 12-step recovery meetings. We believe the fellowships of Alcoholics Anonymous and Narcotics Anonymous are a first option for many of our participants.  In many cases it is the first outside resource discussed via recovery planning. If people are “willing” to attend 12-step meetings, we run with it. However, we do not believe that recovery is a one-size-fits-all process and there are many ways to find recovery. All of these are worthy of celebration. We just want to see your life get better. We don’t care how you get better. Just get better.

When we shine light on the “one-size-fits-all” mentality that persists across our systems of care, we are not trying to detract from AA or NA. Rather, we are calling out the professionalization of 12-step recovery and a system that, in many cases, denies the patient access to information regarding alternative pathways of recovery.

The Minnesota Model remains the prevailing model in terms of residential settings. Twelve-step recovery is the cornerstone of the Minnesota Model. The 12-steps hang on every wall in every rehab in America. Rarely have I seen mention of any other pathways on those same walls. The same could be said for intensive outpatient and community-based programming. This is one of the most disturbing issues facing our behavioral health system. It’s the elephant in the room, and we need to call it out. As a system we remain committed to the legacy model of “hit bottom, become willing, get stabilized via acute care and then go to meetings.”

With all of that in mind I wanted to put forth some thoughts on multiple pathways.

Multiple Pathways Exist

Perhaps the most controversial thought is also the most fundamental thought. For many people, the fact that multiple pathways of recovery exist is hard to acknowledge. Conventional wisdom and traditional thinking carry the day. People just assume “hitting bottom, becoming willing, and diving into 12-step, abstinence-based recovery” is the only way to recover. The general public gets their information on “recovery” from television shows, news reports, and sensationalized documentaries. Because of the stigma and shame surrounding addiction, relatively little research has been done on addiction. There is even less interest in gaining scientific insight into the recovery process.

However, when one examines the available research the reality of recovery is far different than the perception of recovery.

In addition to 12-step recovery, The Recovery Research Institute (RRI) out of Harvard lists the following as “clinical” pathways which have been proven effective: pharmacology, Acceptance and Commitment Therapy, holistic-based recovery services, Community Reinforcement Approach, CBT-based approaches, Contingency Management, Relapse Prevention Therapy, Motivational Interviewing/MET techniques, 12-step Facilitation, Behavioral Couples Therapy, and Family Therapy.

Among “non-clinical” alternative services you find: Recovery Community Centers, Peer-Based Recovery Support, Education-Based Recovery Support, Employment-Based Recovery Support, and Faith-Based Recovery Support. Furthermore, alternative mutual support groups existing including: SMART Recovery, Rational Recovery, Women For Sobriety, HIP Sobriety, LifeRing, Secular Recovery Organizations, and many others.

How About Getting Better Without Formal Help?

Even more controversial is the idea that some achieve long-term recovery (“remission from the disease”) without any formal help.

From the RRI:

“Some individuals can achieve substance use disorder remission without formal help from professional treatment or mutual-help organization participation. Forty six percent of people report “did it on my own” as pathway to recovery.”

Back in the day, if I had proposed multiple pathways to my friends in recovery, I would have been excoriated and enrolled in a re-education program.

The Founder of AA Championed Multiple Pathways

It’s ironic to consider that the founder of 12-step recovery (Bill Wilson) knew there were many ways to recover. The following are a few quotes from the esteemed Mr. Wilson:

  • “AA has no monopoly on reviving alcoholics.”
  • “The roads to recovery are many… any story or theory of recovery from one who has trod the highway is bound to contain much truth.”
  • “Upon therapy for the alcoholic himself, we surely have no monopoly.”
  • “In no circumstances should members feel that Alcoholics Anonymous is the know-all and do-all of alcoholism.”

Multiple pathways of recovery are the norm. The Recovery Research Institute Survey on Recovery (2018) clearly illustrates the multiplicity of ways people “get better.” Not only do people get better via different pathways, people also get better “on their own.” This increases options even further. Noteworthy data from the Recovery Research Institute includes the following:

  • 46.1% of people in recovery report they did it on their own. “Did Not Use Assisted Pathway.”
  • Of the 53.9% who did identify a “pathway,” mutual support (groups) were most common pathway at 45.1%. This includes AA and NA, along with programs such as SMART Recovery and Women for Sobriety.
  • 6% report the use of medication as their pathway of recovery.
  • 3% of those getting help and 24% of those not getting help moderated use to a healthy level rather than embracing a total abstinence pathway.

It is clear that people get better in a wide variety of ways. Professional organizations, counselors, and addiction treatment centers should be held accountable to standards that include a full menu of recovery options. We must widen the doorway of recovery and embrace all pathways.

Substance use, recovery, and wellness in the US

It Is Likely That “New” Pathways Will Be Invented

As it currently stands, only 10% of those in need are engaged in services. It is logical to assume that some of this is the result of a one-size-fits-all approach. If we opened the door wider more people would walk into the recovery process. If we offer alternatives and programs that meet people where they are you will see improved engagement. We need to invent ways to connect. We need to think out of the box.

I believe there is a shelf life on the current approach. I do not think the model is sustainable. As we get a more educated and knowledgeable patient base, you will see widespread rejection of a prescriptive one-size-fits-all model. It’s already happening.

Many people see that “the way we have always done things” makes no sense. We will rise up and develop new protocols, payment systems, and norms. We will develop an entirely new culture of professional recovery services. Twenty years from now people will look back on this day and time as the transformation point. They will wonder why it took so long to make changes. Examples of these type of changes include:

Co-Occurring Recovery Will be One of the New Pathways

Double trouble or dual diagnosis groups have always existed. However, they are few and far between, and they are not available for many in need. We know that upwards of 60% of those with a substance use disorder also suffer from some type of mental health issue. The days of mental health issues being cleaned up via the natural progression of recovery are over. We can no longer just wait for the person to sober up and see if the depression goes away. Some studies indicate trauma is present in up to 80% of women in recovery. Trauma symptoms can be made worse if mishandled, and there will be a need for specialized support in these areas. This is all good stuff. We have advanced as a society. We are more informed and educated than we were in the past and our needs have changed. That is not unusual. It is predictable and healthy.

In addition, people with mental health issues sometimes struggle to fit into “regular recovery” groups. Medication is one reason. Social anxiety would be an example of another reason. It is likely that new recovery groups will spring up to meet the needs of participants with co-occurring disorders. This will be a positive development in the fight against addiction.

Medication Assisted RECOVERY Will be One of the New Pathways

Despite the best efforts of many people in recovery, many people on medication assisted treatment have felt alienated from recovery rooms. I have no interest in entering into that debate in this blog post. It would require much more time than I have at the current moment. Suffice to say, there is likely to coalesce a specific recovery program for people on medication replacement therapy. A place where they can talk and share openly on all matters including the use of Suboxone or Methadone. We know this is a very contentious subject in some recovery rooms. However, as time progresses Medication Assisted Recovery will become mainstream.

In closing I want to reiterate that at Youturn Health, we are big fans of 12-step recovery. However, we are also big fans of SMART recoveryWomen For Sobriety, Recovery Center, peer support, clinical recovery, medication assisted recovery, and any other recovery you can think of. Our interest is in seeing your life improve.

It’s your life.

It’s your recovery.

Don’t give up. If one pathway doesn’t feel right, find another.  If you want to learn more, check us out at youturnhealth.com.

Rich Jones is Chief Clinical Officer at Youturn Health. For more information on substance use disorder, please visit our Substance Misuse resources page.