Omeprazole and Alcohol: What It Does and Does Not Cover

A non 12 step rehab is a residential programme built on clinical therapies rather than the twelve steps of Alcoholics Anonymous. Treatment is delivered through CBT, DBT, EMDR and trauma therapy. It is not a rejection of the fellowships, which help many people. It is a different route for those the 12-step framing does not fit.

If you are in crisis or thinking about suicide, contact your local emergency services now. In the UK and Ireland, Samaritans answer on 116 123, free, day or night. In the US, SAMHSA’s National Helpline is 1-800-662-HELP (4357), free and confidential, 24 hours a day. In Thailand, call 191 or 1669 in an emergency, or 1323 for mental health support, 24 hours a day.

What “non 12 step” actually means

The twelve steps came out of Alcoholics Anonymous in the 1930s. They involve, among other things, admitting powerlessness over the substance, turning to a power greater than oneself, taking a moral inventory and making amends. Narcotics Anonymous, Cocaine Anonymous, Gamblers Anonymous and others adapted the same twelve.

A treatment centre can relate to those steps in three quite different ways, and the difference matters more than the label.

Plenty of centres describing themselves as “non 12 step” belong in the middle row. Ask which row a centre is in before you assume.

The evidence on the 12 steps, stated fairly

This is the part most pages on this subject skip or misrepresent, so here it is straight.

The 2020 Cochrane review by Kelly, Humphreys and Ferri examined AA and clinically delivered 12-step facilitation for alcohol use disorder. On continuous abstinence at 12 months, manualised 12-step facilitation improved rates compared with other active treatments including cognitive behavioural therapy, and the review rated that finding high-certainty evidence. The effect held at 24 and 36 months. On drinking intensity and on alcohol-related consequences, it performed about as well as other clinical interventions. Four of five economic studies found it probably reduces healthcare costs substantially.

That is a strong result and we are not going to pretend otherwise. Anyone telling you the 12 steps do not work is arguing with the best available evidence.

Two things sit alongside it without contradicting it. The review concerned alcohol use disorder specifically, not every substance or every co-occurring condition. And a programme only helps someone who stays in it.

Who tends to want a non 12 step approach

The honest case for non 12 step treatment is about fit and engagement, not efficacy. Four groups come to this search for real reasons.

People uncomfortable with the spiritual framing. The steps ask for reliance on a higher power. Many members interpret that loosely, and AA states it is not allied with any religion. It still does not land for everyone. Research on this is more interesting than the arguments about it: in an analysis of Project MATCH data by Tonigan and colleagues, atheist and agnostic clients attended AA significantly less often than clients who described themselves as spiritual or religious, and lower religiosity predicted dropping out. Yet among those who did attend, benefit did not depend on belief in God. The framing appears to affect whether people stay, not whether it works for those who do.

People who do not accept the disease or powerlessness model. Some find “powerless” accurate and freeing. Others find it undermines the sense of agency they are trying to rebuild. Neither reaction is wrong, and the question of whether addiction is a disease is genuinely contested among clinicians, not settled.

People who have already been through 12-step treatment. If you have done it twice and it did not hold, repeating it a third time is a decision that should be made deliberately rather than by default.

People for whom the language of the steps does not fit. The steps carry their own language and assumptions. Whether those sit comfortably with a particular person’s beliefs, religious or secular, is an individual question rather than something that can be predicted from their faith or background.

What the clinical alternatives actually are

If a programme is not built on the steps, it has to be built on something. These are the main foundations, and each has its own evidence base and its own limits.

Cognitive behavioural therapy. Identifying the thoughts and situations that precede use, then changing the response. NICE guidance on alcohol use disorders recommends CBT-based interventions focused on alcohol-related cognitions, behaviour, problems and social networks.

Dialectical behaviour therapy. Skills for distress tolerance, emotion regulation and interpersonal effectiveness. Useful where use is driven by emotional dysregulation or where borderline traits are in the picture. The trial evidence in substance use is promising but thinner than for CBT, with small samples and few head-to-head comparisons.

EMDR and trauma-focused therapy. Where trauma sits underneath the substance use, treating the addiction alone tends not to be enough. NICE recommends EMDR and trauma-focused CBT as first-line treatments for PTSD in adults. Our EMDR explainer covers how this works in an addiction setting.

Motivational interviewing. A collaborative style for resolving ambivalence. The 2023 Cochrane review drew on 93 randomised trials with 22,776 participants and found MI may reduce substance use compared with no intervention in the short term, with moderate to very low certainty across outcomes. It is a way of working, not a whole programme. We cover it further in our piece on motivational interviewing for addiction.

Alongside these sit group therapy, family work and dual diagnosis treatment where a mental health condition sits alongside the substance use.

Mutual aid without the twelve steps

Residential treatment ends. What supports you afterwards is a separate question, and it does not have to be AA.

SMART Recovery uses cognitive and behavioural tools rather than steps, is secular, and runs meetings online and in person in many countries. LifeRing and Women for Sobriety are two further secular alternatives.

A longitudinal study led by Sarah Zemore, published in the Journal of Substance Abuse Treatment in 2018, followed adults with a lifetime alcohol use disorder over 12 months and found comparable benefits from involvement in 12-step groups, Women for Sobriety, LifeRing and SMART Recovery, with involvement mattering more than which group it was in. One detail cuts against the convenient reading and belongs here: the same study found abstinence rates statistically lower for SMART Recovery at six and twelve months, and for Women for Sobriety at twelve. Benefit and abstinence are not the same measure, and we would rather you saw both than only the one that suits us.

The UK’s clinical guidelines for alcohol treatment take the same line, directing practitioners to know the full range available locally, naming AA, Narcotics Anonymous, Cocaine Anonymous and SMART Recovery among them, and to help people find what fits.

Avoiding the 12 steps is not a treatment philosophy

This is the point we would most want you to take away.

“Non 12 step” describes what a programme is not. It tells you nothing about what it is. A centre can drop the steps and replace them with nothing much, and the marketing will read exactly the same as a centre that replaced them with a properly structured clinical programme.

So the question to ask is not “are you non 12 step?” It is “what is your programme built on, who delivers it, and how often?”

Ask any centre you are considering, including this one:

1. Which specific therapies form the core of the programme, and how many hours a week of each?
2. Are the steps used at all, in any part of the programme or in optional evening meetings?
3. Who delivers the therapy, and what are their qualifications?
4. Is there a psychiatrist on site, and how often would I see them?
5. What happens if I want to attend a fellowship meeting anyway?
6. What does aftercare consist of, and what is it built on?
7. Is the programme accredited, and by whom?

Question seven matters. Some Thai centres hold CARF accreditation. We do not, and we would rather tell you that than have you find out later.

What our programme is built on

The Orchid Recovery is a private residential addiction and mental health treatment centre in Hang Dong District, Chiang Mai, Thailand, serving international English-speaking adults. One site, a maximum of 20 clients, and a full-time on-site psychiatrist in Dr Suttipan Takkapaijit, with an arrangement with Chiang Mai Ram Hospital for anything needing hospital care.

The therapies we deliver are CBT, DBT, EMDR and trauma therapy, in individual, group and family formats, alongside holistic work including yoga, meditation, mindfulness and Muay Thai. The programme does not employ the 12-step approach, but clients are taken to off-site 12-step meetings weekly, which places us in the middle row of the table above rather than the bottom one. You can read the clinical team’s actual credentials on the team page and judge them for yourself.

Programmes run four, eight or twelve weeks. Where the substance requires it they open with five to seven days of medical detox, drug or alcohol, then residential treatment, then two months of complimentary aftercare once you are home. Aftercare is remote and does not replace a clinician where you live. We do not run outpatient or detox-only programmes and we do not admit anyone under 18.

Fees start at USD 10,900 for four weeks including that aftercare, with flights extra. We are not the cheapest centre in Thailand and do not claim to be. Some charge less, some close to double. We sit mid-market for Thailand, well below UK, Australian and US private rehab. There is more detail on what rehab in Thailand costs.

Still deciding? Put those seven questions to us directly and we will tell you which row of that table we are in, without the marketing word, including the questions about what we do not have. Talk to us, message +66 985 245 093 on WhatsApp, or email admissions@orchidrecoverythailand.com.

Sources

• Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programmes for alcohol use disorder. Cochrane Database of Systematic Reviews, 2020
• Tonigan JS, Miller WR, Schermer C. Atheists, agnostics and Alcoholics Anonymous. Journal of Studies on Alcohol, 2002
• Zemore SE, Lui C, Mericle A, Hemberg J, Kaskutas LA. A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD. Journal of Substance Abuse Treatment, 2018
• Schwenker R and colleagues. Motivational interviewing for substance use reduction. Cochrane Database of Systematic Reviews, 2023
• NICE CG115, Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence
• NICE NG116, Post-traumatic stress disorder: recommendations
• UK Office for Health Improvement and Disparities, Clinical guidelines for alcohol treatment: psychosocial interventions
• National Institute on Drug Abuse, Treatment and Recovery
• SAMHSA, National Helpline
• Samaritans