He recalls that October morning, coming down from a three-day cocaine binge. "I was sitting in my car in a parking lot trying to figure out how the hell I got here, hating myself and thinking I was never going to be able to quit," says Keith, now 38. "My family didn't deserve the pain and grief that I was putting them through. ... I thought that killing myself would be a gift to them because they would be free of me."
For several years Keith had struggled with addiction. When he landed in a rehab center in 1994, he learned about the 12-step treatment program pioneered by Alcoholics Anonymous (AA) in 1935; the method has become a model for spin-off recovery programs including Narcotics Anonymous (NA).
"I started going to NA, as that was presented to me as the only option," Keith says. "For the next six years I would stay clean for a while and then I'd fall right back into my old habits. I'd return to NA meetings and think 'this time I'm serious,' and each time I had the same trouble accepting the philosophy." Keith's lapses got progressively worse -- until he logged onto the Internet to search for a way out.
To Keith's surprise, "a lot of Web sites popped up. I looked at some of the programs out there and I began to get more hope that maybe I could quit," he says. "The one I focused on at first was Rational Recovery. That night, I went out and bought the book and by the time I was halfway through the book I had made my Big Plan for life ... No more cocaine, ever." He says he hasn't touched the drug since.
Rational Recovery is one of a host of addiction treatment programs that have emerged as alternatives to the 12-step method. Their philosophies vary from the 12-step approach and from one another. Some, like AA, have a basis in spirituality or religion. Others, such as SMART Recovery (Self Management and Recovery Training), SOS (Secular Organizations for Sobriety/Save our Selves) and Lifering Secular Recovery are decidedly secular.
"We get folks through here who have also tried the 12-step groups, and it just hasn't worked for them, so they come here," says John Carmody, the director of the New Orleans-based alternative program In Process. "I'm not saying for some people the 12-step programs are not successful. They are. But there are folks who it's not going to work for."
In Process, which began as an adolescent program, has expanded to include adults. Carmody uses "motivational enhancement therapy," a psychological technique that helps individuals identify their own personal reasons for change and to set goals. Carmody incorporates other life-skills training, including how to deal with stress through a physical outlet: in this case, boxing.
In the program, Carmody uses the boxing ring as a metaphor for life: "If you will build good work habits and believe in yourself, life will never defeat you, inside the ring or outside of it."
For Julia Orlando, help also came via an Internet search engine. "A link for Women For Sobriety came up. I clicked on it and saw the 13 statements of acceptance and I said 'This is for me.' I printed it out and I joined."
Orlando, now 39, had begun drinking heavily to cope with the loss of her 3-year-old daughter Julianna, who was born with a chromosomal deficiency and died in 1999. "I didn't want to quit (drinking)," she recalls. "I wanted to hang onto the good part, the fun part of drinking, and get rid of the bad part."
For the following year, Orlando couldn't find that balance. She kept returning to the Women For Sobriety (WFS) program, though, which persuades members to live by 13 positive affirmations including "The past is gone forever" and "I am responsible for myself and my actions." She vacillated between seeking encouragement from WFS and falling into a vicious cycle of drinking and depression.
In late 2000, a friend confronted Orlando about her drinking. "I could hear her talking, but all I could hear in my head was 'This is your chance. Yes or no,'" Orlando says. "Yes, I went to treatment 24 hours later."
For the next year, Orlando relied on frequent AA meetings and WFS support to avoid drinking. AA was a key factor in her abstinence for a year, but after that "I felt like I outgrew it," she says. "I was a married woman with a husband, home, three kids and pets. I didn't have time for meetings. The real world is outside the meetings, and I couldn't function going to meetings all the time." Orlando delved into the Women for Sobriety program: finding support online, becoming a certified WFS moderator and working to start a WFS support group in southern Louisiana.
Orlando recently made a presentation about WFS to her local court system. "They called me because the (treatment) programs in place are not working for women," she says. "It's not the women that are failing, but the program -- it's not for them."
Most local treatment centers use the 12 steps, though counselors acknowledge there are other methods. Social worker Robyn Dewhirst, the director of assessment services for the Council on Alcohol and Drug Abuse of Greater New Orleans (CADA), says that "the 12-step and 12-step-related programs have proven most effective, although they're not for everybody."
There is scant data available on the effectiveness of 12-step programs in helping addicts to maintain abstinence, which Dewhirst acknowledges. "I wouldn't even venture to guess."
Attending meetings is a crucial component of the 12-step program. One thing counselors like about this approach is the abundance of meetings available around the world. "We know the 12 steps are not for everybody, but we want [clients] to be exposed to it, because for many of them it will be their support when they leave," says Gaynell Kronenberger, assistant clinical director of Family Services of Greater New Orleans.
Her facility works with the Orleans Parish Criminal Court Drug Court's program to treat drug offenders. Since the drug court's inception in 1997, 1,385 people have entered the program. About 700 have graduated, says Magistrate Gerard Hansen, who presides over drug court.
Family Services incorporates the 12-step approach into a plan that includes other facets such as individual, group and family counseling, education, and life skills training. "I would say it is a holistic approach," Kronenberger says.
Most treatment centers espouse the concept of addiction as a complex disease caused by genetic links, abnormal alcohol or drug metabolism, social and environmental factors, or a combination of any or all of the above. The American Medical Association endorses "the dual classification of alcoholism under both the psychiatric and medical sections of the International Classification of Diseases." The Centers for Disease Control and Prevention calls addiction "a chronic and complex, but treatable, brain disease."
The disease concept has been challenged by some in the medical, psychological and psychiatric fields. Many alternative treatment methods are based on the view of addiction not as a disease, but as a destructive behavior that can be changed. On his program's Web site, Rational Recovery founder Jack Trimpey invites evidence "that would make it clear to a reasonable person that addiction is or is caused by a disease, or that a specific treatment exists for addiction." He promises to post the evidence and a public retraction; so far, he says, he's had no takers.
Many people who have opted out of 12-step programs call the reliance upon a higher power a turn-off. Some critics of Alcoholics Anonymous call it a religious cult, though AA supporters say that's not an accurate description.
"It's not a religious program; it's a spiritual program," says Brian, an AA member for seven years. "People talk about AA as being a cult -- a lot of brainwashing going on -- but I have not found that to be true. No one tells you that you have to conform to a particular higher power -- you have to find a higher power, whether it's a doorknob, or a group of drunks. Whatever works for you."
However, when mandated AA meetings are challenged on separation of church and state, courts have sided with those who call AA religious. One decision, handed down by the New York Court of Appeals in 1996, found that, "In 'working' the 12 steps, participants become actively involved in seeking such a God through prayer, confessing wrongs and asking for removal of shortcomings. These expressions and practices constitute, as a matter of law, religious exercise."
Keith particularly disliked the "higher power" aspect of the program. "Half of the 12 steps are based on 'the God of your understanding,' and if you don't believe in a God-like character, then the steps don't make much sense," he says.
Keith responded to the self-help approach of Rational Recovery, which says that recovery group meetings contradict with the goal of putting the addiction behind you. However, Keith recalls that initially he did want to talk to peers about his experience. He joined online meetings of SMART, a program once aligned with Rational Recovery. Keith says he no longer needs outside support.
"I can go for several days now without even thinking about cocaine, which may not sound like a big deal -- but if you knew how obsessed I used to be, you would realize it is a very big deal," he says. "I never thought I could be this free of it. No more 'white knuckling' ... I have my life back. I don't consider myself an addict, I'm just a regular guy who doesn't use cocaine anymore. How much more normal can that be?"
RESOURCES: Alcoholics Anonymous (www.alcoholics-anonymous.org or 885-6700); Council on Alcohol and Drug Abuse of Greater New Orleans (www.cadagno.org or 362-4272); In Process (486-9737, 485-0240 or firstname.lastname@example.org); Rational Recovery (www.rational.org or 530-621-2667); SOS (www.sossobriety.com or 323-666-4295); SMART Recovery (www.smartrecovery.org or 440-951-5357); Women For Sobriety (www.womenforsobriety.org or 215-536-8026)