Where Therapy Meets the Steps: Integrating Clinical, Medical, and Self-Help in Addiction Recovery.

Larry Keating, Founder of Transitions Counseling Services, Smithtown, NY- When addressing addiction, there appear to be three prominent methodologies: the medical model, the clinical model, and the self-help model. Often, treatment is administered by a therapist or a physician aligned with one of these approaches. In my 30 years of experience treating addiction, I have found that combining all three models is the most effective approach.

Addiction originates in people—not in food, gambling, sex, alcohol, or drugs. Given this, it becomes logical that we must treat the individual and the underlying pathology. Most clinicians agree that people struggling with addiction often suffer from low self-worth and low self-esteem. This has no bearing on their intellect, achievements, or social standing. Addiction can, and does, affect individuals across all social and economic backgrounds.

The Clinical Model

The clinical model addresses the way patients view the world. In my experience, those suffering from addiction tend to see life through a negative lens. They have perfected the ability to extract negativity from people, places, and things. Their minds have developed a default mode of survival that thrives on negative thinking. Clinically, this is referred to as ego-syntonic, which means being comfortable with a distorted or unhealthy way of thinking.

In this model, efforts are made to shift thinking from negative to positive using tools such as meditation and gratitude practices. Eckhart Tolle, in his book A New Earth, offers a powerful explanation of this concept when he describes “pain bodies” in the mind connecting with other pain bodies—what I believe contributes to the desperation that leads to relapse. Louise Hay coined the phrase, “We become our own reality.” Her message was clear: if we can shift from negative to positive thinking, we can move from desperation to joy.

Dr. Daniel Amen’s work with brain imaging also supports this idea. He shows that different parts of the brain are activated depending on whether one is having positive or negative thoughts. This is why I named my agency Transitions—my goal as a clinician is to help clients transition their thought patterns from negative to positive. When this occurs, low self-worth and low self-esteem are gradually replaced with a purposeful and productive life.

This transformation is accomplished through one-on-one clinical work over time. Without the clinical component, the patient often remains unchanged. As the saying goes: When you sober up a drunken horse thief, you still have a horse thief. In other words, nothing changes if nothing changes.

The Self-Help Model

The third model is self-help. While there are many other models we’re not addressing here, self-help often doesn’t get the attention it deserves because its members remain anonymous. The traditions of these groups dictate that they stay out of controversy and refrain from engaging with the media, including press, radio, television, and social media.

That said, the Veterans Administration has found tremendous value in veterans helping other veterans. Similarly, in 12-step recovery programs, one addicted person shares their experience, strength, and hope with another—and both benefit. There are now 12-step programs for many different forms of addiction, all using the same core steps. These steps guide individuals to examine where their addiction has taken them and the impact it has had on themselves and their families. They focus on continuous growth and positive change.

Many find deep meaning and gratitude in being part of someone else's recovery. This is something the VA has also observed: peer-to-peer support, even outside of a formal 12-step structure, can be transformative. Empirical evidence from a scientific perspective suggests that the widespread success of 12-step programs—used by millions—proves their effectiveness. Gratitude impacts not only the person receiving the gift but also the one giving it, and even those who witness the exchange.

Final Thoughts

Each of these models has its flaws. If we focus only on the flaws, we miss the benefits. When individuals speak with little knowledge of recovery, they tend to operate from the negative side of the brain. No one has all the answers when it comes to addiction. But for those who exhibit contempt before investigation, I ask you to consider these three models and the potential they offer when used together.