Bridging the Gap: The Compatibility of CBT-Based Approaches with Twelve-Step Programs in the Treatment of Substance Use Disorders

Abstract

Background: Cognitive-behavioral therapy is an umbrella term which encompasses a wide range of distinct, yet related interventions, several of which have been shown to be efficacious in the treatment of substance use disorders. However, 12-Step programs (including Alcoholics Anonymous and Narcotics Anonymous) are traditionally the most widely known and commonly used approaches to managing alcohol and substance abuse. Objectives: Therefore, this paper attempts to offer a summary of the compatibility of CBT-based approaches and 12-Step philosophy, in order to assist clinicians who work with patients with a strong adherence to 12-Step ideology. Results: Specific passages from AA’s Big Book, NA’s Basic Text, and ancillary 12-Step literature will be highlighted where appropriate. Moreover, common roadblocks to synthesis (e.g. belief in a “higher power;” acceptance of one’s “powerlessness”) will also be addressed. Conclusions: Clinicians who are committed to evidence-based, CBT-related practices are ultimately advised to adopt flexibility when working with patients who identify with the cultural values of 12-Step programs.

Keywords:

• Cognitive-behavioral therapy
• cognitive-behavioral theory
• Alcoholics Anonymous
• Narcotics Anonymous
• 12-step programs
• theoretical compatibility

Acknowledgements

The author wishes to thank the Clinical Psychology post-doctoral fellowship program at the South Texas Veterans Health Care System, for providing the support necessary to complete this work. A special thank you as well to Dr. Mary Kaye Johnson and Dr. Amanda Wetegrove-Romine for their supervision and consultation on this project.

Role of funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Contributors

The sole author is responsible for the entirety of this work, including the literature search, as well as the drafting, editing, and preparing of the manuscript itself.

Declaration of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the article.