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Rational Alternatives to Alcoholics Anonymous
- By Marc F. Kern
- Published 08/6/2008
- What Are Your Recovery Options
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Marc F. Kern
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Wise Counsel Interview Transcript: Marc Kern, Ph.D. on Rational Alternatives to Alcoholics Anonymous
David Van Nuys, Ph.D.: Welcome to Wise Counsel, a podcast interview series sponsored by mentalhelp.net covering topics in mental health, wellness and psychotherapy.
My name is Dr. David Van Nuys. I am a clinical psychologist and your host.
On today's show we will be talking about addiction with my guest Dr. Marc Kern.
Founder of Addiction Alternatives, Dr. Marc F. Kern has over 30 years of experience as a clinical psychologist and addiction 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 of life management skills and tools to manage their negative behaviors and live happier lives. Now here is the interview.
Dr. Marc Kern, welcome to Wise Counsel.
Dr. Marc Kern: Thank you very much David. Thank you for having me.
David: You specialize in the treatment of addictions. How did you manage to get into this particular area?
Marc: Well, that is really quite a long story and you probably do not have enough time. But the bottom line is that I had my own addiction. I graduated from Ohio State in architecture, had joined a fraternity and learned how to drink and use drugs sufficiently enough to develop an addiction by the time I had graduated, in several substances. So that is what ultimately led me to this profession; specializing here.
David: You know, I remember when I was an undergraduate, which was like a long time ago. I was an undergraduate at an Ivy League school and I remember that there were guys in the dorms who probably were well on their way to becoming alcoholics at that point.
Even though I don't think that at that point in time that I, you know, I don't think we identified or thought in those terms. But as I think back about it, you know there were people who had things that probably very clearly later turned out to be big problems.
Marc: Absolutely. I mean there was a naiveté back when, not speaking of either of our ages here, about the role of substances and elixirs. I will use that term throughout our discussion because I see addictions as all various forms of elixirs. And again, there was a naiveté and there was no intention to harm people but many people graduate from college with a total degree in addiction of some sort, so yes.
David: It is probably more of a problem, today with all the various substances that are available that were not available back when I was there. I mean it really was all about alcohol at that time. And I remember there was one guy who was very charismatic and who might have had a larger impact on me than he actually did.
But he was a charismatic guy and I remember he got into a period of getting cough medicines, you know, for the codeine. At the time I think were over the counter. And...
Marc: Correct. Right, right. They were, as many drugs were over the counter at one time.
David: Yes. So he was kind of raving about how great that was and fortunately I didn't follow him in that.[laughter]We might not be here talking about this, today. So most people immediately assume that a twelve step program is the way to go in treating addictions. I gather that you don't agree.
So that is why I wanted to talk to you, to get your perspective on that.
Marc: Well, I by far am not an entire twelve step individual.
I just found when I was diagnosed with an addiction, actually several simultaneously, and was sent to a psychologist one of their recommendations was to go to a twelve step meeting.
And you know I tried it. I went two or three times. I just didn't feel that it clicked with me. I didn't understand it.
Being trained as an architect in undergraduate school, things made sense.
They were logical, one thing, you know, was built upon another.
The twelve step program did not fit that mindset; that prototype. And so I started on a journey to find out if there were other ways to recover other than the twelve step program.
And almost to my surprise there were hundreds of different ways. And actually twelve steps was just one small part of the addiction treatment community.
David: Well, do you recall what aspect of it was that just didn't quite click for you? Was there some part of it that was 'off putting'?
Marc: The most, there were many parts that were 'off putting'. I was very high functioning. Even at the beginning of all my treatment I was working full time in an architect's office. But the biggest part was the religious emphasis, the higher power, powerlessness, just didn't 'synch' with how I looked at life at that time, nor today. And I just couldn't integrate it and if I couldn't integrate it I couldn't utilize it.
David: Now you say that there are hundreds of alternatives. But it seems that the twelve step approach is about all that we hear about and wonder is there in fact any good research data on the twelve step approach? Somewhere I have gotten the idea that maybe AA doesn't release any data.
Marc: Well, they do release data; not a lot. It is very difficult to do solid research on a program such as AA. It is very organic. It is a community. But there is research and the research isn't all that hot. The research suggests something between, depending on which piece you read, and this actually comes out of AA, somewhere between five and fifteen per cent of the people who walk in the door are still attending at the one year mark.
And as we go down to the two year mark, it is even less. Now obviously with those kinds of numbers, those people are not about to promote it. The research is available and there has been other pieces of research. But it doesn't suggest that, you know, the bulk of the people that walk in really are that successful in the long run.
David: Well, that is interesting. I think, somehow it has such an aura of success. I think lots of the psychologists and so on that I know, they get somebody who is suffering from addiction, they feel like they are duty bound to refer that person to AA or some other kind of twelve step program.
Marc: Yeah, and I feel that is a very unfortunate position for most psychologists to be with. And again, this is not to say that twelve step approach isn't right for some clients those in particular who don't have a social community that they can turn to that is not based on alcohol or drugs and some other variables. But this is really a function of the sort of the politics of addiction in this country.
For example, this issue of the twelve steps being the only way is really an American phenomenon. I mean if we would walk up just, excuse my language there, up into Canada we would find literally the reverse. Twelve steps are hard to find. Traditionally in Canada it is all harm reduction based. We can talk about what harm reduction is.
Similarly in Europe, England, France, Scandinavian countries, Australia, I mean it is pretty difficult to find a twelve step program. Their societies have not taken on the twelve step program as gospel.
And of course since the twelve step program seems to lean heavily into the disease model, the medical community in this country and the twelve step community have sort of befriended one another and reinforced the idea that there is a one size fits all. Or this is the way to go if you have an addiction.
David: Well, that is interesting. You refer to the politics of addiction, is that what you are talking about, this alliance between the medical community and twelve step organizations?
Marc: Absolutely and the politics goes very deep to the philosophical underpinnings of this country. I was just reading last night the percentage of people in the US that believe that there is a god, and I don't want to get too far into the religious side of this all, but that this country was built on religion and religious freedom and the value of it.
Where a lot of other countries were not and therefore they haven't taken to their bosom this idea that a higher power is going to save them from this "disease".
David: I guess you would say that the Puritan ethic somehow cuts deep into our psyche and is still with us. So maybe, is expressed in this idea of 'once you are an alcoholic, you are an alcoholic forever.'
Marc: Correct, but that statement leads into the whole idea of it is all about being a disease. It is still very kind of curious if you really stand back as a rational individual and say, 'Well if it is a disease, why are we sending him to a religious or spiritually based sort of recovery program?' I don't send people with cancer or for a broken arm to a religious based support group. It doesn't even make sense even on the most superficial levels.
David: I was interested in your remark that the twelve step movement is not as strong in other countries. I wasn't aware of that and you say that elsewhere the emphasis is on harm reduction. That is a new concept to me. What do mean by harm reduction?
Marc: Well, I am going to step back on that term a little bit. Harm reduction is what I believe is the paradigm of the future and harm reduction in the most general sense is something that we all are very familiar with.
If someone goes into a treatment center for cancer, depression or whatever, they are not really trying to eliminate cancer or depression. They are trying to reduce the harm or the frequency of the problem associated.
We are a country built on harm reduction. Seat belts are for example, a form of harm reduction. We are not going to not get in a car. It is very dangerous to drive an automobile. But we are going to reduce the harm or the danger associated with driving by wearing a seat belt.
If we look around this entire country, the world is built on a harm reduction paradigm but there is something very unique that they seem to suggest that in the addictions we cannot approach it from a harm reduction approach. We have to approach it from black and white.
Now, if someone was depressed we would say, 'You can never get depressed again.' That is the black and white sort of notion of the American sort of disease model. Where, Harm reduction in Canada or throughout the world is just the idea that our goal, the therapist's let's say goal, is to reduce the harm associated with the substance, or the elixir these people are involved with and not necessarily get caught up in the black and white notion that the goal must be abstinence.
Yet abstinence may be a harm reduction approach but it is not the only sign of making progress. If you are drinking a six pack a day and you go down to two or three beers a day, are you not making progress? Well, that would be considered a harm reduction approach.
David: OK, and in fact you believe that an alcoholic can become a controlled moderate drinker. Is that right?
Marc: That is a very tricky question and the truth is I believe that everyone who has an alcohol problem is not an alcoholic. First of all, I do not even know what an alcoholic is. There is probably 1, 001 definitions and if you look in the DSM4, which is our book which we use to diagnose people, there isn't the term alcoholic in the entire volume. It is a lay term. It is just a general term that people use to call people with problems with alcohol.
I am a believer that many people who have problems with alcohol would be considered alcohol dependent. Let's say even all of my fraternity brothers. Are they all destined to become full blown alcohol dependent alcoholics where they can never drink again?
Well, the research suggests that most people mature out of it. Most people have a single involvement of excessive let's say alcohol use and they mature out of it due to a variety of forces. And most people return to a non-problematic ways of drinking in spite of their indoctrination into the disease model.
There was even a piece of research earlier around 2000 where they followed classically defined alcoholics for five years and found that the vast majority of them returned to non-problematic drinking without being endorsed by their treatment involvement. So it is a very controversial topic. So I am going to be a little picky on the semantics of it all.
David: OK. Well, hearing you talk about that reminds me that I guess I grew out of that. I mean I can remember when I was a young person in the years of college and I guess early graduate school as well, there were times when I got so drunk I can remember staggering around and falling down on the lawn and not being able to get the key into the keyhole in the door. And at this point in my life I probably we have liquor in the house that doesn't get touched in a year. [laughter]
Marc: So what does that mean to suggest that you have never had a drink since college days?
David: No. No, not at all. I will drink on occasion, but the impulse to drink for me is very rare. It is a social thing usually, and the occasions where I will drink are just very rare. What really got me out of it was a pretty quick--well, it wasn't totally quick-- but I did learn that my body just didn't handle it well and that I hated the feelings of hangover and just that feeling of just being wrecked.
Marc: Right. Right.
David: I also learned that continued drinking, that after reaching a certain point of feeling high and that wonderful feeling of euphoria that drinking more wasn't going to prolong it or make it feel any higher. I would kind of reach a peak, and at that point it was time to stop because it's not going to get any better.
Marc: Well, I appreciate your openness. I sincerely do, but you are an example of someone who would at one time give your college a description of being an alcoholic who has learned to become a non-problematic consumer. It is some interesting points you have made about what you have learned.
Lots of people that I see that truly do have problems with alcohol later in their life don't learn many of those things. Many of them don't suffer severe hangover effects that you described, and it is more difficult for them to sort of make that cause benefit analysis and say alcohol is not working for me.
Continued - see rest of transcript and hear audio podcast at
Wise Counsel
David Van Nuys, Ph.D.: Welcome to Wise Counsel, a podcast interview series sponsored by mentalhelp.net covering topics in mental health, wellness and psychotherapy.
My name is Dr. David Van Nuys. I am a clinical psychologist and your host.
On today's show we will be talking about addiction with my guest Dr. Marc Kern.
Founder of Addiction Alternatives, Dr. Marc F. Kern has over 30 years of experience as a clinical psychologist and addiction 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 of life management skills and tools to manage their negative behaviors and live happier lives. Now here is the interview.
Dr. Marc Kern, welcome to Wise Counsel.
Dr. Marc Kern: Thank you very much David. Thank you for having me.
David: You specialize in the treatment of addictions. How did you manage to get into this particular area?
Marc: Well, that is really quite a long story and you probably do not have enough time. But the bottom line is that I had my own addiction. I graduated from Ohio State in architecture, had joined a fraternity and learned how to drink and use drugs sufficiently enough to develop an addiction by the time I had graduated, in several substances. So that is what ultimately led me to this profession; specializing here.
David: You know, I remember when I was an undergraduate, which was like a long time ago. I was an undergraduate at an Ivy League school and I remember that there were guys in the dorms who probably were well on their way to becoming alcoholics at that point.
Even though I don't think that at that point in time that I, you know, I don't think we identified or thought in those terms. But as I think back about it, you know there were people who had things that probably very clearly later turned out to be big problems.
Marc: Absolutely. I mean there was a naiveté back when, not speaking of either of our ages here, about the role of substances and elixirs. I will use that term throughout our discussion because I see addictions as all various forms of elixirs. And again, there was a naiveté and there was no intention to harm people but many people graduate from college with a total degree in addiction of some sort, so yes.
David: It is probably more of a problem, today with all the various substances that are available that were not available back when I was there. I mean it really was all about alcohol at that time. And I remember there was one guy who was very charismatic and who might have had a larger impact on me than he actually did.
But he was a charismatic guy and I remember he got into a period of getting cough medicines, you know, for the codeine. At the time I think were over the counter. And...
Marc: Correct. Right, right. They were, as many drugs were over the counter at one time.
David: Yes. So he was kind of raving about how great that was and fortunately I didn't follow him in that.[laughter]We might not be here talking about this, today. So most people immediately assume that a twelve step program is the way to go in treating addictions. I gather that you don't agree.
So that is why I wanted to talk to you, to get your perspective on that.
Marc: Well, I by far am not an entire twelve step individual. I just found when I was diagnosed with an addiction, actually several simultaneously, and was sent to a psychologist one of their recommendations was to go to a twelve step meeting.
And you know I tried it. I went two or three times. I just didn't feel that it clicked with me. I didn't understand it.
Being trained as an architect in undergraduate school, things made sense.
They were logical, one thing, you know, was built upon another.
The twelve step program did not fit that mindset; that prototype. And so I started on a journey to find out if there were other ways to recover other than the twelve step program.
And almost to my surprise there were hundreds of different ways. And actually twelve steps was just one small part of the addiction treatment community.
David: Well, do you recall what aspect of it was that just didn't quite click for you? Was there some part of it that was 'off putting'?
Marc: The most, there were many parts that were 'off putting'. I was very high functioning. Even at the beginning of all my treatment I was working full time in an architect's office. But the biggest part was the religious emphasis, the higher power, powerlessness, just didn't 'synch' with how I looked at life at that time, nor today. And I just couldn't integrate it and if I couldn't integrate it I couldn't utilize it.
David: Now you say that there are hundreds of alternatives. But it seems that the twelve step approach is about all that we hear about and wonder is there in fact any good research data on the twelve step approach? Somewhere I have gotten the idea that maybe AA doesn't release any data.
Marc: Well, they do release data; not a lot. It is very difficult to do solid research on a program such as AA. It is very organic. It is a community. But there is research and the research isn't all that hot. The research suggests something between, depending on which piece you read, and this actually comes out of AA, somewhere between five and fifteen per cent of the people who walk in the door are still attending at the one year mark.
And as we go down to the two year mark, it is even less. Now obviously with those kinds of numbers, those people are not about to promote it. The research is available and there has been other pieces of research. But it doesn't suggest that, you know, the bulk of the people that walk in really are that successful in the long run.
David: Well, that is interesting. I think, somehow it has such an aura of success. I think lots of the psychologists and so on that I know, they get somebody who is suffering from addiction, they feel like they are duty bound to refer that person to AA or some other kind of twelve step program.
Marc: Yeah, and I feel that is a very unfortunate position for most psychologists to be with. And again, this is not to say that twelve step approach isn't right for some clients those in particular who don't have a social community that they can turn to that is not based on alcohol or drugs and some other variables. But this is really a function of the sort of the politics of addiction in this country.
For example, this issue of the twelve steps being the only way is really an American phenomenon. I mean if we would walk up just, excuse my language there, up into Canada we would find literally the reverse. Twelve steps are hard to find. Traditionally in Canada it is all harm reduction based. We can talk about what harm reduction is.
Similarly in Europe, England, France, Scandinavian countries, Australia, I mean it is pretty difficult to find a twelve step program. Their societies have not taken on the twelve step program as gospel.
And of course since the twelve step program seems to lean heavily into the disease model, the medical community in this country and the twelve step community have sort of befriended one another and reinforced the idea that there is a one size fits all. Or this is the way to go if you have an addiction.
David: Well, that is interesting. You refer to the politics of addiction, is that what you are talking about, this alliance between the medical community and twelve step organizations?
Marc: Absolutely and the politics goes very deep to the philosophical underpinnings of this country. I was just reading last night the percentage of people in the US that believe that there is a god, and I don't want to get too far into the religious side of this all, but that this country was built on religion and religious freedom and the value of it.
Where a lot of other countries were not and therefore they haven't taken to their bosom this idea that a higher power is going to save them from this "disease".
David: I guess you would say that the Puritan ethic somehow cuts deep into our psyche and is still with us. So maybe, is expressed in this idea of 'once you are an alcoholic, you are an alcoholic forever.'
Marc: Correct, but that statement leads into the whole idea of it is all about being a disease. It is still very kind of curious if you really stand back as a rational individual and say, 'Well if it is a disease, why are we sending him to a religious or spiritually based sort of recovery program?' I don't send people with cancer or for a broken arm to a religious based support group. It doesn't even make sense even on the most superficial levels.
David: I was interested in your remark that the twelve step movement is not as strong in other countries. I wasn't aware of that and you say that elsewhere the emphasis is on harm reduction. That is a new concept to me. What do mean by harm reduction?
Marc: Well, I am going to step back on that term a little bit. Harm reduction is what I believe is the paradigm of the future and harm reduction in the most general sense is something that we all are very familiar with.
If someone goes into a treatment center for cancer, depression or whatever, they are not really trying to eliminate cancer or depression. They are trying to reduce the harm or the frequency of the problem associated.
We are a country built on harm reduction. Seat belts are for example, a form of harm reduction. We are not going to not get in a car. It is very dangerous to drive an automobile. But we are going to reduce the harm or the danger associated with driving by wearing a seat belt.
If we look around this entire country, the world is built on a harm reduction paradigm but there is something very unique that they seem to suggest that in the addictions we cannot approach it from a harm reduction approach. We have to approach it from black and white.
Now, if someone was depressed we would say, 'You can never get depressed again.' That is the black and white sort of notion of the American sort of disease model. Where, Harm reduction in Canada or throughout the world is just the idea that our goal, the therapist's let's say goal, is to reduce the harm associated with the substance, or the elixir these people are involved with and not necessarily get caught up in the black and white notion that the goal must be abstinence.
Yet abstinence may be a harm reduction approach but it is not the only sign of making progress. If you are drinking a six pack a day and you go down to two or three beers a day, are you not making progress? Well, that would be considered a harm reduction approach.
David: OK, and in fact you believe that an alcoholic can become a controlled moderate drinker. Is that right?
Marc: That is a very tricky question and the truth is I believe that everyone who has an alcohol problem is not an alcoholic. First of all, I do not even know what an alcoholic is. There is probably 1, 001 definitions and if you look in the DSM4, which is our book which we use to diagnose people, there isn't the term alcoholic in the entire volume. It is a lay term. It is just a general term that people use to call people with problems with alcohol.
I am a believer that many people who have problems with alcohol would be considered alcohol dependent. Let's say even all of my fraternity brothers. Are they all destined to become full blown alcohol dependent alcoholics where they can never drink again?
Well, the research suggests that most people mature out of it. Most people have a single involvement of excessive let's say alcohol use and they mature out of it due to a variety of forces. And most people return to a non-problematic ways of drinking in spite of their indoctrination into the disease model.
There was even a piece of research earlier around 2000 where they followed classically defined alcoholics for five years and found that the vast majority of them returned to non-problematic drinking without being endorsed by their treatment involvement. So it is a very controversial topic. So I am going to be a little picky on the semantics of it all.
David: OK. Well, hearing you talk about that reminds me that I guess I grew out of that. I mean I can remember when I was a young person in the years of college and I guess early graduate school as well, there were times when I got so drunk I can remember staggering around and falling down on the lawn and not being able to get the key into the keyhole in the door. And at this point in my life I probably we have liquor in the house that doesn't get touched in a year. [laughter]
Marc: So what does that mean to suggest that you have never had a drink since college days?
David: No. No, not at all. I will drink on occasion, but the impulse to drink for me is very rare. It is a social thing usually, and the occasions where I will drink are just very rare. What really got me out of it was a pretty quick--well, it wasn't totally quick-- but I did learn that my body just didn't handle it well and that I hated the feelings of hangover and just that feeling of just being wrecked.
Marc: Right. Right.
David: I also learned that continued drinking, that after reaching a certain point of feeling high and that wonderful feeling of euphoria that drinking more wasn't going to prolong it or make it feel any higher. I would kind of reach a peak, and at that point it was time to stop because it's not going to get any better.
Marc: Well, I appreciate your openness. I sincerely do, but you are an example of someone who would at one time give your college a description of being an alcoholic who has learned to become a non-problematic consumer. It is some interesting points you have made about what you have learned.
Lots of people that I see that truly do have problems with alcohol later in their life don't learn many of those things. Many of them don't suffer severe hangover effects that you described, and it is more difficult for them to sort of make that cause benefit analysis and say alcohol is not working for me.
Continued - see rest of transcript and hear audio podcast at
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