Cognitive-behavioral therapy is based on the idea that irrational feelings and/or behaviors are caused by a person’s thoughts not external events such as situations and events. When specifically dealing with alcoholism, the goal of this therapy is for an alcoholic to be able to identify and avoid situations where they are most likely to misuse the substance as well as to possibly cope with problems that lead to the misuse. There are many approaches to this type of therapy such as rational emotive therapy, rational behavior therapy, etc. but I will be talking about what is known as Cognitive-Behavioral Coping-Skills Therapy (CBST). CBST is based on the concept that deficits in a person’s ability to cope with stress lead to alcoholism and that failure to cope with alcohol-related stimuli maintain the misuse. CBST’s treatment firstly involves the identification of situations where a person is unable to cope efficiently and turns to alcohol misuse. After identification, individual coping skills training is used to attempt to address the person’s deficiencies in coping through the use of tools such as instruction, modeling, role play, and behavioral rehearsal.
Numerous studies have confirmed the effectiveness of CBST and it is and is becoming increasingly popular. Several comprehensive reviews of treatments for alcohol-related problems have ranked CBST approaches among those having the most evidence for clinical and cost effectiveness (e.g., Holder et. al. 1991; Finney and Monahan1996; Miller et al. 1995). Despite the proven effectiveness of CBST, it has been found out that the superior effectiveness of CBST greatly depends on the context in which CBST was used (Longabaugh and Morgenstern 1998) such as if it is used as a stand-alone treatment, as component of a more comprehensive treatment, or as aftercare following a prior treatment. So for some people in a certain set of circumstances, CBST may not be as effective. For example, it was found that in stand-alone treatment, CBST was less effective than 12-step facilitation therapy when it came to the percentage of patients who maintained total abstinence in the year following treatment (Longabaugh and Morgenstern 1998).
12-step facilitation is a program created by the founders of Alcoholics Anonymous (AA). People who participate in this program are required to believe that they are powerless to fight alcoholism alone and that alcoholism should not be considered a character flaw, it should be considered a disease. Members of AA and participants of the program convene and attend meetings to as part of the treatment. The treatment is quite spiritual with frequent mentions of God and other aspects of Christian spirituality. This form of treatment is extremely popular and it is said to be very effective with frequent reference to a study conducted by the Project Match Research Group in 1997 looking into various treatments and their effectiveness.
Despite the popularity of 12-step facilitation, it has not particularly been documented in well-controlled studies and studies utilizing randomized trials. Thus, it can be said there is a lack of totally concrete and sound empirical evidence. A disparity exists between the popularity of a treatment and its demonstrated effectiveness (Hester and Miller 1995).
In conclusion, even though both treatments are shown to be proven effective in one way or another I believe that CBST is more effective overall as a generalized treatment of alcoholism over 12-step facilitation. CBST has a stronger basis in the field of Psychology and has more documented studies that verify its effectiveness. More research simply must be done to identify the most effective context in which to administer CBST. 12-step facilitation has its advantages and is very popular but its effectiveness isn’t as well documented as other treatments in terms of studies. In addition, it may not work for many people because of its nature; it requires membership and life-long commitment to the organization and it is spiritual, which some people may not be able to identify with.
