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Drug Addiction

An Interview with Marc Kern, Ph.D on Rational Alternatives to Alcoholics Anonymous

David Van Nuys, Ph.D. Updated: Jul 3rd 2008

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Marc F. Kern, Ph.D.

In this episode of the Wise Counsel Podcast, Dr. Van Nuys speaks with Psychologist Marc Kern, Ph.D. on the topic of addiction treatment with an emphasis on alternatives to Alcoholics Anonymous and twelve step programs.

Dr. Kern became interested in treating addictions as a result of his own experience dealing with addictions that he had developed while in college living in a fraternity environment that encouraged substantial substance experimentation. Part of the treatment he was prescribed for his addiction involved referral to Alcoholics Anonymous. He did attend AA multiple times, but ultimately found that it was not a good fit for him. He objected to the religious nature of AA's philosophy of treatment, their promotion of a general view of the alcoholic self as essentially powerless, and their salvation oriented view promoting the idea that the only path available to the alcoholic through which he can become powerful again is through submission to a higher power. He also objected to the lack of logical rigor he found, which irritated and alienated him. His realization that AA was not for him caused him to look for alternative ways that addiction could be treated. He was surprised to find that there were many alternatives. Having found his mission in life (to help himself and others recover from addictions), he went on to return to school, became a clinical psychologist, and has worked as a therapist, coach and consultant ever since.

Kern does not count himself an anti-twelve-step person and notes that it is helpful for some people looking to recover from addictions. However, he makes clear that he believes that AA controlling as much mind share as it does in America is unfortunate, for several reasons.

He notes that what research exists that describes AA's treatment outcomes suggests that few people (between 5% and 15%) will remain attending AA meetings beyond the first year, making it unlikely that AA can help the majority of people across the long term.

He also notes that AA's dominance helps to keep the idea that alcoholism is a disease popular, and he thinks this is a mistake, and a paradox, because if alcoholism is indeed a disease, it is curious that we choose to treat it with a spiritually based remedy.

Finally, he notes that AA promotes the idea that the sole useful treatment goal with regard to alcoholism is abstinence, and that this idea is definitely a mistake, and a very rigid "black and white" way of approaching a treatment goal. In place of abstinence only approaches to treatment, Kern favors a graduated "harm reduction" approach recognizing that any progress an addict makes towards lessening the negative impact their addiction has on their lives, such as learning to drink in moderation, is useful and beneficial.

Kern speaks on the subject of the politics of Addiction in America. He relates America's early identity as a haven for people fleeing religious persecution as setting the stage for the widespread acceptance of Alcoholics Anonymous, which similarly promotes the idea that the only salvation for addiction is submission to a higher power. He notes that in Canada and most of Europe, AA is not nearly so dominant as it is in America, and instead these countries tend to take a harm reduction approach. In contrast to the American abstinence-only treatment philosophy, harm reduction approaches to addictions treatment seek to reduce the impact of harmful substance abuse behavior to manageable levels. If a person's drinking can be reduced to the point where their relationship and employment are no longer in active jeopardy, that can be counted as a treatment success, even though the person may continue to drink. People who cannot learn how to control their drinking may ultimately need to become abstinence, and abstinence may still become a treatment goal in such cases, but abstinence is not the only successful outcome.

Dr. Van Nuys asks whether Dr. Kern believes that controlled drinking is possible for an alcoholic person to achieve. Dr. Kern's reply makes clear that he believes that controlled drinking is a real possibility for many but not all alcoholic persons. He cites research showing that many people who meet criteria for a substance dependence diagnosis at one point in time will go on, over the course of several years, to "mature out of" their addiction, and stop drinking to excess. He also talks about groups like Moderation Management (MM) that remain popular and well trafficked despite high profile episodes such as when MM founder Audrey Kishline was involved in a fatal car accident after drinking and driving in 2000.

Dr. Kern describes the Stages of Change approach he uses with alcoholics and other addicted people he works with. This model, due to Prochaska and DiClemente, describes the mindset that people have at different stages of their recovery from addictions. It is important to keep this model in mind at all times when working with addicted people, he believes, because it helps you to know how to talk to people at different stages of recovery. It is best to meet people where they are. If they are in a precontemplation stage, it is not a good idea to sell them heavily on all the things they need to do to make a change. Instead, discussion will be most profitable when it focuses on helping them recognize that a problem is happening at all.

In the first stage of change, Precontemplation, the addicted person has not yet decided that they have a problem. The second stage, Comtemplation, occurs when people realize that they do have a problem, and terminates when they decide to do something to change that. The Preparation stage occurs when an addicted person decides to do something about their addiction and starts making preparations to do so. This is followed by the Action stage, where they actually do something to work on their addiction, and then by the Maintainance stage, in which they do what is necessary to keep themselves changed. Successfully handling Relapse is an important and vital part of Maintainance. Though undesirable, relapse is common, and usually can be recovered from. Handling relapse is far harder when it becomes something to be ashamed about, such as Dr. Kern believes frequently occurs in the context of AA. Dr. Kern adds a final stage, Transcendence, to suggest that the active act of maintainance as a struggle against backsliding does not last forever in all cases, but rather can ultimately give way to a new stage of life in which the former addictive struggle is simply no longer an issue.

Dr. Kern's harm reduction approach to treatment causes him to take a flexible approach to the question of abstinence, fitting treatment goals for addiction to the individual strengths and weaknesses of each client he addresses. If people want to be abstinent, he helps them to do that, but if they want to look into controlled drinking, he helps them to do that as well, and helps them monitor their progress in that regard so that if it becomes apparent that they can't make that work, they are supported in the goal of abstinence thereafter. He recognizes that AA will appeal to some people, but also emphasizes that there are many alternative programs people may choose to utilize including Smart Recovery, SOS, Women for Sobriety and LifeRing, among others.

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About Marc F. Kern, Ph.D.

Marc F. Kern, Ph.D.Founder of Addiction Alternatives™, Dr. Marc F. Kern has over 30 years of experience as a clinical psychologist and addictions specialist in his private practice in Los Angeles, helping people overcome self-defeating, problem habits with alcohol, street drugs, prescription drugs and other excessive behaviors involving gambling, pornography, shopping, overeating, sexual addiction and Internet addiction. He has shown clients how to use a wide variety life management skills and tools to manage their negative behaviors and live happier lives.

Dr. Kern draws on his own personal and painful experiences with addictions and the life problems that arose from those addictions. When he realized that the Alcoholics Anonymous approach did not work for him, he knew he was not alone. Although A.A. obviously helped many people, others, like Dr. Kern, were turned off by A.A.'s central philosophy of personal powerlessness, a required belief in a higher power, and the need to attend meetings for the rest of your life.

Although he was a professional architect when his alcohol and drug problems began to affect his life and his marriage, Dr. Kern returned to college to pursue his new passion to find alternative psychological approaches for the treatment of addictions. He earned his degree as a licensed clinical psychologist in California. He further honed his skills and became a Certified Addiction Specialist, a Certified Rational Addictions Therapist, and earned certification in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders, as recognized by the American Psychological Association.

Reader Comments
Discuss this issue below or in our forums.

My clients want something empowering! - Marilyn O'Malley - Sep 2nd 2009

I have a lot I could comment on here in agreement and I will only make a short comment.

I am a recovery coach with clients that just don't feel AA supports them moving forward.  With what we, now, know about how the mind works, compared to 1937 when AA was started, the first thing to change is the statement "Hi, I'm a alcoholic, drug addict..." because what you focus on expands and that statement just reinforces what they are trying to change. It also emphazises the Being as an addict rather than a person with an addiction.  

I find that helping my clients learn how to manage their life and learn coping skills, as well as, participating in activities that they have a passion for helps them to make healthier choices.

Changing their habits of thinking and acting are valuable keys to their happiness, fulfillment and health!  

AA's true role - Ray Smith - Jun 6th 2009

I came across this quote in an interview with Gene Heyman, author of Addiction: A Disorder of Choice that explains AA's true role:

"AA has been notorious in research circles for two reasons. One is because of the emphasis in its language on faith—‘God grant me the power’ and so on. The other is that they have not been at all interested in tracking how well they do. I don’t know whether they’re anti-research, but they’ve done nothing to measure their record. In the last few years, people have been able to get some data, and it shows they’re as successful as any other program. Personally, I think AA has intuitively developed a program that does exactly what we’ve discussed. It rewards sobriety. You know: somebody gets up and says, ‘My name is Ralph, I haven’t had a drink for three weeks,’ and everybody claps. It also creates a social life that is alcohol-free.

One of the biggest fears for alcoholics is that they won’t have a social life, that their social life is embedded in the consumption of alcohol. AA creates a social alternative that involves role models and sponsors, and there are people who get up and talk who are like them and have stopped drinking."

If one could accept AA as just a social club of sober people, it could be a tool for recovery. Unfortunately, AA has many beliefs that are counterproductive to sobriety. It's difficult, if not impossible to "take what you need and leave the rest" if you don't know what parts are helpful and which are harmful. If you did, you probably wouldn't be in AA in the first place.

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