On March 11, 2023, The New York Times ran a commentary by Maia Szalavitz titled “People Have a Right to Nonreligious Rehab” questioning the connection between religion/spirituality and recovery, and we felt it was important to present The Retreat’s view on the issues raised in this article.
In the piece, Ms. Szalavitz states that real progress in treating alcoholism and addiction is only possible by separating medical care from religion in treatment, and that Twelve Step treatment models should give way to newer modalities of care such as medically assisted treatment (MAT), harm reduction and cognitive behavioral therapy. In doing so, she ignores a significant body of research that validates the Twelve Step approach when compared to others modalities of care.
Ms. Szalavitz challenges the spiritual dimension to AA, yet the physiological and biological benefits of meditation and prayer are well documented. Addiction is a multidimensional illness that affects the physical, psychological, social and spiritual aspects of one’s life. In practice, Twelve Step models of care are less solitary spiritual exercises than guided, collaborative and communal practices that reinforce the behaviors and attitudes that are core to recovery.
And community is key. A landmark study published in the influential Cochrane Library by Dr. John Kelly of Harvard Medical School, Massachusetts General Hospital and the Recovery Research Institute looked at AA and Twelve Step Facilitation (TSF) treatments. This study reported higher rates of success, lower health care costs, and up to 60 percent better outcomes, when compared to cognitive behavioral theory models. Dr. Kelly states that shared experience and the positive social identity that role models in recovery can offer are powerful motivating factors that help transition individual identity from an actively addicted person to a recovering one.
Access and cost are important considerations too, both from a personal and public health perspective, and particularly at a time when managed care and pharmaceutical costs cast such a long shadow over all aspects of health care. There are 100,000 open AA meetings attended by 1.5 million people every week. According to Dr. Kelly, AA might be the closest thing to a free lunch we have in the public health space in our country.
Treating addiction isn’t a zero-sum game, and opiate addiction in particular can sometimes necessitate the use of medication. But in addressing addiction, we shouldn’t ignore the long-term value of abstinence-based approaches, both in outcomes and cost-effectiveness. It’s also fair to question the long-term cost and health impact, as well as the wisdom, of substituting one drug for another, which is what MAT and harm reduction does.
In fact, the Twelve Steps may be more timely than ever. Impugning an effective and affordable model of care because it includes a spiritual dimension is to deny the recovery journeys of literally millions of people – observant, agnostic, and atheist alike – who have found sobriety, and true life in recovery, through the Twelve Steps.