The controversial addiction therapist: the role that an alcoholic who has been clean for a year can play

The controversy is brewing. An alcoholic in recovery who hasn't had a drink for over a year can work as an "addiction therapist." No prior formal medical training is required. This controversial position originated in the United States with the Minnesota Model —a trend toward treating addictions that emerged in the mid-20th century—and is now present in many private detox clinics in Spain, despite arousing great suspicion among experts in our country.

In Spain, there are several academies that offer this pseudo-specialty for around 2,000 euros. According to their own curricula, it allows "you to practice as an expert addiction therapist." Some clinics, meanwhile, define it as "a key element in the recovery process. An addiction therapist not only helps you overcome addiction but also provides emotional and practical support throughout the process."

The requirements for these qualifications are simple: "be over 18 years old," "be able to read , write, and hold a fluent conversation in Spanish," and "have the knowledge to work on an online platform." Regarding prior knowledge to qualify, only one of the following is required: a university degree, proven professional experience, people who can prove the necessary qualifications, or " anyone related to the world of addictions —family members of addicts and people in the process of overcoming the disease." Regarding this last profile, they do make a distinction: "Addicts in recovery who have not used substances for more than a year ."

When I contacted an academy that offers at least three different courses associated with different clinics, to find out if it would be possible to enroll without a university degree and simply declare myself "recovered" from alcoholism, the answer was clear: "If you've been recovered for more than a year, you can take the course." They also guarantee internships at a prestigious clinic in Madrid, which has this type of professional on staff.

El Confidencial has contacted Florida Universitaria—not the only institution offering these courses, but the one behind several of these degrees— without receiving a response.

Can a "therapist" treat addicts?

The position is widespread in Spain's private detox clinics , among more healthcare professionals, as can be seen from a glance at the staff of dozens of them. However, despite its high number of professionals, the title of specialist in addictive behaviors "is just another option being offered, raising false expectations because, clearly, it is not a profession," José Tenorio, a clinical psychologist specializing in addictive behaviors and secretary general of the General Council of Psychology, told El Confidencial.

Tenorio emphasizes that "we must not forget that we are talking about a mental health problem, and in addictive disorders, we must apply the biopsychosocial approach, which is the one that characterizes this type of problem. There is always a very important biological, psychological, and social aspect. Therefore, we believe that we must work in multidisciplinary teams composed, basically, of psychologists, doctors, and social workers, in some cases. Everything else is extraneous to the composition of these teams ." At the same time, she adds that "this situation is not new and is occurring in many areas. People are talking about 'addiction therapists,' 'early intervention therapists,' 'eating disorder therapists,'... creating false expectations because the word 'therapist' means healthcare activity, and if there is no prior qualification, it is not appropriate . And the term 'specialist' is completely gratuitous. It's simply an expression insofar as it is not a specialty, by any means."

At the Dr. Rodríguez Lafora Hospital in Madrid, a leading public center with an Alcohol Addiction Unit, they emphasize that " prior qualifications should be required to access a position of this type," their head of Psychiatry, Ignacio García Cabeza, told this newspaper.

The Spanish Scientific Society for the Study of Alcohol, Alcoholism, and Other Drug Addictions (Socidrogalcohol) has a similar view. " Ideally, there would be formal training for this profession," its president, Benjamín Climent, told El Confidencial.

How does this figure arise?

Manuel Penella, author of The Dark Night of Alcoholics Anonymous (a self-published book whose proceeds go to the Red Cross), dates its origins to the 1940s in the United States . “A group of people observed that the dynamics of Alcoholics Anonymous worked well and decided to recreate its atmosphere in a closed center. This would be a prototype of today's private clinics. They then began hiring, and continue to hire to this day, staff who came from Alcoholics Anonymous,” he says.

He says that the founders of the clinics ran into a problem, since due to the "traditions" of Alcoholics Anonymous (the main rules that govern these groups) "they couldn't share their experience in exchange for money. So, from Hazelden [one of the first modern private detoxification clinics] they saw the business and invented the figure of the therapist , so they could 'charge for their services' and not 'for being a recovering addict.' This led them to create a study center, where they combined the Alcoholics Anonymous program with a very aggressive therapy." An evolution and tensions due to the transfer of people that are also collected in the book The Minnesota Model: The Evolution of the Multidisciplinary Approach to Addiction Recovery .

This is how the first training sessions began, which he explains are similar to those offered by other centers in Spain today: "These combine the traditions of Alcoholics Anonymous with elements of behavioral psychology . The goal is to formalize them so that they can provide future clinic clients with rapid results through rapid cognitive restructuring."

On this subject, Penelleda notes ironically that "there's one thing that's striking: a psychologist can apply cognitive-behavioral therapy, but a guy who only takes a short course... I don't think he's authorized to do this." Thus, he explains, "The therapist operates on the basis of 'I'm an alcoholic or recovering Narcotics Anonymous, and I have this training,' which is a tiny course lasting a few months. And this is the business, because it's cheaper than a psychologist . Besides, they probably come from an irregular or chaotic life and suddenly feel empowered to treat an alcoholic. So there's duplicity and a scam, because they're going to use a method on the client that wasn't used on them."

Although most clinics promote them as a support element, some define them as "a key element in the recovery process," and Penella even speaks of centers where they are the primary therapist for addicts.

In addition to the functions they may have within the clinic, the author explains that they are sometimes also used as recruiters: “Some also go to Alcoholics Anonymous groups, which by definition are free, and try to recruit newcomers who appear to have money. In fact, in the book I tell the story of a young man who was a construction worker and could barely read, who took this course and was then paid 300 euros for each person he brought to the clinics.” “These individuals try to turn the Alcoholics Anonymous groups into an extension of the clinics,” he adds.

El Confidencial has contacted Alcoholics Anonymous to find out their position on the matter, but has received no response. This organization does not usually participate in matters of this type, citing one of its principles: not to enter into controversy .

The head of psychiatry at Dr. Rodríguez Lafora Hospital explains how the alcohol addiction unit works. It has been open since the 1980s and offers two programs aimed at weaning patients off alcohol: “The first is a detoxification program with 12 beds , followed by a rehabilitation program with 20. Until recently, patients requested admission individually, but since last year, we have also had an agreement with the addiction treatment centers in the Community of Madrid so that they can refer patients to us.”

In the detoxification program, "which is the acute phase, during which consumption is stopped," patients remain hospitalized for a period of two weeks. During this phase, a series of measures (pharmacological, psychological, and environmental) are used to ensure that the patient safely discontinues their usual consumption, with minimal discomfort, and to avoid complications associated with withdrawal symptoms.

Regarding the alcohol dependence program, patients remain in a specialized psychotherapy center for four weeks to begin the recovery process from alcohol use disorder. Most patients complete both programs, remaining at the center for six weeks.

At this center, there's no trace of an addiction therapist ; all of its professionals are specialists: "There's an internist, three psychiatrists, a psychologist, an occupational therapist, and the nursing team ." And in any case, he notes that they have a "first-person experts" program in which recovered addicts come to give their testimony once a month, "but we don't use them as therapists. They come to provide information and share their experiences, because it can help patients." In line with the president of the psychologists, the psychiatrist emphasizes how the term "therapist" has spread across many disciplines, even though there is no formal training behind it regulated by public institutions.

Socidrogalcohol lists the same professionals. “Detoxification units should be staffed by physicians with training in addictions, and they are typically psychiatrists, family doctors, and internists . It depends on the idiosyncrasies of the unit and community. Ideally, a multidisciplinary approach would be essential. Psychologists are also important in a detoxification unit, as is nursing,” explains Climent.

Is it always necessary to log in?

For the president of Socidrogalcohol, who has dedicated his entire life to detoxification within the public system, " admission to a specialized unit isn't always necessary for detoxification." "We have a series of criteria to determine which patients require hospitalization, as there are specialized doctors who can help with outpatient treatment," Climent points out.

In this regard, he exemplifies that generally those recommended for admission during detoxification—during which there may be risks due to withdrawal symptoms—are patients with illnesses such as cirrhosis, seizures , or other physical conditions "that make it preferable to do so in a supervised environment." There are also times "where the reasons are social," such as a patient with a serious disorder without a caregiver.

Along the same lines, the head of Dr. Lafora Hospital emphasizes that "for a large percentage of patients, treatment is basically outpatient ."

Beyond how to treat it, both professionals insist that there is a lack of public resources to treat addiction disorders, which "are very prevalent in Spain," Climent points out, adding that "alcohol consumption in our country is very high, and it is also associated with cocaine consumption."

"The public system often lacks the capacity to offer places for everyone who needs treatment, which is why detox clinics emerge . But it must be clear that detoxification is not a cure, but rather a first step that must be followed by withdrawal, and that detoxification can have very serious complications," insists the president of Socidrogalcohol.

At the same time, he suggests that private care could be complementary, but that patients should know that "they can't expect any guarantees for addictive disorders." " Even if you pay a high amount of money for detox, that doesn't guarantee anything at all. You pay, but you won't be cured. Let's imagine a patient with a serious disorder who requests voluntary discharge despite having paid for treatment; they won't continue with it. I know patients who have gone privately, and I try to make them understand that detox isn't a guarantee of anything. If you invest all your money in a treatment of this type, it's a bad investment. Because then you have to follow a withdrawal treatment that can be very long," he concludes.