It called for the establishment of the National Institute on Alcohol Abuse and Alcoholism, and dedicated funding for the study and treatment of alcoholism.
In , for instance, the Rand Corporation released a study of more than 2, men who had been patients at 44 different NIAAA-funded treatment centers. The report noted that 18 months after treatment, 22 percent of the men were drinking moderately. The authors concluded that it was possible for some alcohol-dependent men to return to controlled drinking.
Researchers at the National Council on Alcoholism charged that the news would lead alcoholics to falsely believe they could drink safely. Rand repeated the study, this time looking over a four-year period. The results were similar. After the Hughes Act was passed, insurers began to recognize alcoholism as a disease and pay for treatment. For-profit rehab facilities sprouted across the country, the beginnings of what would become a multibillion-dollar industry.
Hughes became a treatment entrepreneur himself, after retiring from the Senate. If Betty Ford and Elizabeth Taylor could declare that they were alcoholics and seek help, so too could ordinary people who struggled with drinking.
Today there are more than 13, rehab facilities in the United States, and 70 to 80 percent of them hew to the 12 steps, according to Anne M. Fletcher, the author of Inside Rehab , a book investigating the treatment industry. T he problem is that nothing about the step approach draws on modern science: not the character building, not the tough love, not even the standard day rehab stay.
Marvin D. Alcohol acts on many parts of the brain, making it in some ways more complex than drugs like cocaine and heroin, which target just one area of the brain. Among other effects, alcohol increases the amount of GABA gamma-aminobutyric acid , a chemical that slows down activity in the nervous system, and decreases the flow of glutamate, which activates the nervous system.
This is why drinking can make you relax, shed inhibitions, and forget your worries. Alcohol also prompts the brain to release dopamine, a chemical associated with pleasure. Over time, though, the brain of a heavy drinker adjusts to the steady flow of alcohol by producing less GABA and more glutamate, resulting in anxiety and irritability.
Dopamine production also slows, and the person gets less pleasure out of everyday things. Combined, these changes gradually bring about a crucial shift: instead of drinking to feel good, the person ends up drinking to avoid feeling bad. Alcohol also damages the prefrontal cortex, which is responsible for judging risks and regulating behavior—one reason some people keep drinking even as they realize that the habit is destroying their lives. Why, then, do we so rarely treat it medically?
W hen the Hazelden treatment center opened in , it espoused five goals for its patients: behave responsibly, attend lectures on the 12 steps, make your bed, stay sober, and talk with other patients. No other area of medicine or counseling makes such allowances.
There is no mandatory national certification exam for addiction counselors. Mark Willenbring, the St. Paul psychiatrist, winced when I mentioned this. Perhaps even worse is the pace of research on drugs to treat alcohol-use disorder.
The FDA has approved just three: Antabuse, the drug that induces nausea and dizziness when taken with alcohol; acamprosate, which has been shown to be helpful in quelling cravings; and naltrexone.
There is also Vivitrol, the injectable form of naltrexone. Reid K. Hester, a psychologist and the director of research at Behavior Therapy Associates, an organization of psychologists in Albuquerque, says there has long been resistance in the United States to the idea that alcohol-use disorder can be treated with drugs.
For a brief period, DuPont, which held the patent for naltrexone when the FDA approved it for alcohol-abuse treatment in , paid Hester to speak about the drug at medical conferences. Many patients wound up dependent on both booze and benzodiazepines. There has been some progress: the Hazelden center began prescribing naltrexone and acamprosate to patients in But this makes Hazelden a pioneer among rehab centers. And now that naltrexone is available in an inexpensive generic form, pharmaceutical companies have little incentive to promote it.
The drug helped subjects keep from going over the legal threshold for intoxication, a blood alcohol content of 0. Naltrexone is not a silver bullet, though.
Other drugs could help fill in the gaps. So, too, have topirimate, a seizure medication, and baclofen, a muscle relaxant. It was here that J. After his stays in rehab, J.
In his desperation, J. Then, in late , J. During those sessions, Willenbring checks on J. I also talked with another Alltyr patient, Jean, a Minnesota floral designer in her late 50s who at the time was seeing Willenbring three or four times a month but has since cut back to once every few months.
At age 50, Jean who asked to be identified by her middle name went through a difficult move and a career change, and she began soothing her regrets with a bottle of red wine a day. When Jean confessed her habit to her doctor last year, she was referred to an addiction counselor. The whole idea made Jean uncomfortable.
How did people get better by recounting the worst moments of their lives to strangers? Still, she went. Another described his abusive blackouts. One woman carried the guilt of having a child with fetal alcohol syndrome.
Surely, Jean thought, modern medicine had to offer a more current form of help. Then she found Willenbring. During her sessions with him, she talks about troubling memories that she believes helped ratchet up her drinking. In his treatment, Willenbring uses a mix of behavioral approaches and medication. Moderate drinking is not a possibility for every patient, and he weighs many factors when deciding whether to recommend lifelong abstinence.
He is unlikely to consider moderation as a goal for patients with severe alcohol-use disorder. Nor is he apt to suggest moderation for patients who have mood, anxiety, or personality disorders; chronic pain; or a lack of social support.
The difficulty of determining which patients are good candidates for moderation is an important cautionary note. But promoting abstinence as the only valid goal of treatment likely deters people with mild or moderate alcohol-use disorder from seeking help. The prospect of never taking another sip is daunting, to say the least.
Using this booklet. Staying away from the first drink. Using the hour plan. Remembering that alcoholism is an incurable, progressive, fatal disease. Getting active. Using the Serenity Prayer. Changing old routines. Eating or drinking something—usually, sweet. Availing yourself of a sponsor. Getting plenty of rest. Fending off loneliness. Watching out for anger and resentments. Being good to yourself. Looking out for overelation. Remembering your last drunk. Avoiding dangerous drugs and medications.
Eliminating self-pity. Seeking professional help. Steering clear of emotional entanglements. Being wary of drinking occasions. Letting go of old ideas. Reading the A.
Going to A. Trying the Twelve Steps. Finding your own way. The Twelve Steps of Alcoholics Anonymous. The Twelve Concepts Short Form. That was not a funny thing that happened to you.
As an atheist, she always struggled to define her higher power. AA says people can define it however they want — even use a doorknob if they need to.
Betsy tried to define her higher power as her cat, but it just never clicked. After her struggles, she found a different, secular mutual support group, LifeRing — and that seemed to work much better in helping her address not only her drinking but the underlying problems that led her to drink so much in the first place.
Does Steward show that they do work? Does Roger show that the 12 steps maybe do something but not all that much? My goal was to see whether the 12 steps really do help people overcome their alcohol addictions. The simplest explanation is that step treatment and AA meetings work for some people but not for others. Getting to the bottom of this is crucial to dealing with a big public health problem.
Based on federal data , more than 20 million people have a substance use disorder, and within that group, more than 15 million have an alcohol use disorder.
Excessive drinking alone is linked to 88, deaths each year. So whether one of the most common types of treatment for this disease is actually effective could be a matter of life or death. The 12 steps, first established in the s by Bill Wilson , have now become a powerhouse in the addiction treatment world, with millions of attendees worldwide each year in AA meetings alone. AA has also spawned a network of affiliated groups like Narcotics Anonymous, Marijuana Anonymous, Al-Anon for family and friends of people with alcohol addiction , and more.
Years of evidence show that the 12 steps, on average, really can help treat alcohol addiction. But that comes with some major caveats. For one, studies typically focus on outpatient, one-on-one professional settings.
This is different from typical AA meetings in a church basement, which are free and therefore most accessible to people in recovery. The best research also only focuses on alcohol use disorder.
So whether the 12 steps work for other kinds of addiction — and whether non-AA programs like Narcotics Anonymous are effective at all — remains an open question in the research. As such, this article focuses on the research and experiences of people using the 12 steps for alcohol addiction.
For decades, there was a lot of bad research into the 12 steps, riddled with methodological problems that made it difficult to evaluate whether the approach is effective. The randomized clinical trial placed patients into a step program, cognitive behavioral therapy, or motivational enhancement therapy.
Since then, other studies have produced similar results. A study on adolescent alcohol use disorder found that step treatment fared similarly to both cognitive behavioral therapy and motivational enhancement therapy.
A study found that people facilitated into higher AA attendance also reported more days of abstinence. A study similarly found that intensive referral to step help groups like AA led to more meeting attendance and better alcohol and drug use outcomes.
Every person involved in AA has been through it before, cultivating a unique feeling of community and understanding among those in recovery. Attendees of an AA meeting will be welcomed into the group. Discussion among new attendees is encouraged but not required. In this circumstance, individuals may need to be vulnerable about how their addiction has impacted their loved ones. Attendees may share stories and include commentary surrounding their journey of sobriety.
Individuals can make friends and gain new perspectives. AA understands some people may not feel comfortable sharing intimate details during their first visit. As time goes on, most people find great healing and therapy through the open and honest discussions these meetings provide.
In a closed AA meeting, the only people who may attend are those who are recovering from an alcohol use disorder AUD or those interested in learning more about overcoming their addiction. Open meetings allow the attendance of friends, spouses, and family members. This is beneficial for those who wish to remain connected to friend and family members and feel family members support creates feelings of safety.
Closed meetings could protect privacy, allowing limited or no outside involvement. Some people would rather keep their recovery separate from the rest of their life, hence closed meetings. Others thrive on the support that loved ones can provide during meetings, hence open meetings. While the 12 Steps originated in Alcoholics Anonymous, they are now the standard for nearly all addiction recovery groups, The steps are presented in linear fashion, but participants see them as an ongoing circle.
Steps may be revisited until the individual feels comfortable with that stage of their recovery process. The first step requires admitting you have a problem and need help overcoming it. Because of the popularity of the 12 Steps, other groups began to surface— Narcotics Anonymous , Gamblers Anonymous and several other variations, each representing 12 Steps or a different version of it.
Additionally, 12 Step programs allow for self reflection and growth in order to change for the better. Make a Call There are some who do not believe in the transformative knowledge of AA meetings. Because of the discomfort associated with attending an AA meeting, many people will come up with reasons not to attend. In other cases, self-doubt or a lack of belief in the recovery process can hinder someone from attending a meeting, and as a result, someone can create excuses or hold an oppositional reason to avoid attendance.
Some of the common oppositions people have are:. Although these excuses may seem huge to people who are already nervous about attending a meeting, the real object to focus on is why you were considering going in the first place.
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