by Loren Seibold
Those of us who have never struggled with a chemical addiction, but who work with those who do, have long taken it for granted that 12-step programs are the only answer to alcohol addiction. I’ve recommended them, and I suspect most physicians, counselors and ministers have. But recently I’ve come across researchers who say that Alcoholics Anonymous may not be all we think it is. Gabrielle Glaser summarizes the problems in an article in the April 2015 Atlantic magazine:
- There's been little empirical research to show that AA works. The organization uses its “anonymous” descriptor to avoid doing comprehensive studies of effectiveness—which would involve knowing people’s names, contact information, and doing follow-up. Handbooks continue to say that 50% will become sober immediately if they really try, and another 25% may struggle but prevail. But in The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, Lance Dodes, a retired psychiatry professor from Harvard Medical School says it’s closer to 5-8% who use AA treatment who stay sober.
- Alcoholics Anonymous sessions are uneven in their effectiveness: it requires no professional training beyond that given by participation in the program.
- Some researchers believe that AA’s claim that even one drink brings an alcoholic back to full-blown alcoholism sets up a binge-purge cycle: “If I take one drink, I might as well go completely back into full-blown alcohol abuse.” Other treatments teach patients to manage alcohol, rather than eschewing it.
- The Handbook of Alcoholism Treatment Approaches, a comprehensive comparison of treatments worldwide, ranks AA 38th out of 48 methods.
- To say, as AA does, that you have to “hit rock bottom” before you can overcome is, according to addiction psychiatrist Mark Willenbring, equivalent to telling “a guy who weighs 250 pounds and has untreated hypertension and cholesterol of 300, ‘Don’t exercise, keep eating fast food, and we’ll give you a triple bypass when you have a heart attack.’”
- Some European countries have had success (a claimed 78% in one study in Finland) using an opioid antagonist called naltrexone, combined with therapy. Unlike the American abstinence approach, Finnish researchers suggest the drinker take it before he plans to drink, to reduce his craving and subtly teach him how to be happy drinking less.
The Affordable Care Act has expanded the availability of addiction treatment, and HHS is currently evaluating treatments. The automatic recommendation of AA as the treatment of choice may soon be questioned. Says addiction psychologist Tom McClellan, “This is going to be a mandated benefit, and insurance companies are going to want to pay for things that work.” They’re unlikely to be content with single-digit results.