Does AA work, or are there better programs or treatments available?
Alcohol and substance abuse disorders cause untold misery in the lives of people living with addictions and those they impact. It is critical that we find programs that are effective in helping people with addiction achieve long-term sobriety.
Is Alcoholics Anonymous the best treatment option for alcohol addiction?
The debate over 12-step programs has been around for decades. Since the passage of the Affordable Care Act, there has been increased debate among medical professionals over what works best for the substance abuser because the ACA requires alcohol and substance abuse treatment to be covered by insurance. Alcoholics Anonymous and other treatment options are essential to a person’s long-term sobriety.
The American Medical Association estimates that out of nearly 1 million doctors in the United States, only 582 identify themselves as addiction specialists. There are many more that call themselves addiction specialists as a subspecialty. Most treatment providers are credentialed as addiction counselors. Some states only require little more than a high school diploma to be a counselor. Many counselors are still in recovery themselves.
Alcoholics Anonymous has been around since 1935
In 1935, there was limited knowledge about brain function. AA instructs members to surrender and accept that they are powerless over alcohol and, make amends to those they have wronged and pray. Because of the anonymous nature of the program, it is impossible to see data to determine how well the program actually works. Lance Dodes, a retired Harvard Medical School psychiatry professor, in his book entitled The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, looked at AA retention rates along with studies on sobriety and rates of involvement in the program. Based on the data he evaluated, he put AA’s success rate between 5 and 8 percent. We have grown so accustomed to people raving about AA saving their lives that we take it on faith that the program is successful. We never hear about the people not being helped when participating in a 12-step program.
According to The Handbook of Alcoholism Treatment Approaches, AA ranks 38th out of 48 methods. A certified substance abuse expert can discuss Alcoholics Anonymous and other treatment options with someone considering treatment and a life of sobriety.
Do you have to hit rock bottom for Alcoholics Anonymous and other treatment options to work?
No. Researchers say that the AA truism that rock bottom must be hit before recovery can start is not true for everyone. It has been described as “offering antidepressants only to those who have attempted suicide, or prescribing insulin only after a patient goes into a diabetic coma.” A former director of the National Institute on Alcohol Abuse and Alcoholism says rock bottom is “absurd.” Although Alcoholics Anonymous and other treatment options work for some, research is being done to make treatment more effective, and hitting rock bottom is unnecessary.
Alcoholism = Alcohol-Use Disorder
The newest edition of the American Psychiatric Association’s diagnostic manual (DSM-5) uses the term “Alcohol-Use Disorder” instead of alcohol abuse or alcoholism.
Do you have to believe in God to participate in AA?
You do not have to believe in God to participate in Alcoholics Anonymous (AA). AA is a program with spiritual elements, and its famous 12-step program does include references to a “Higher Power.” However, this concept is open to individual interpretation and does not necessitate belief in a traditional God or religious doctrine.
Key points about AA’s approach to spirituality and belief include:
- Higher Power as You Understand It: AA allows members to define the “Higher Power” as they understand it. This can be a spiritual but non-religious understanding, a personal sense of a higher purpose, or even the AA group. The emphasis is on finding a power greater than oneself to aid recovery, regardless of religious belief.
- Inclusivity: AA aims to be inclusive and supports people from all backgrounds, beliefs, and walks of life. The primary focus is on the shared goal of overcoming alcoholism, rather than specific religious convictions.
- Personal Interpretation: Members are encouraged to interpret the steps in a way that aligns with their personal beliefs and values. This flexibility allows people of various faiths, agnostics, and atheists to participate in the program.
- Spiritual, Not Religious: AA is often described as a spiritual program rather than a religious one. This distinction is important because it underscores the focus on personal growth and moral principles over adherence to a specific religious doctrine.
- Community and Support: The strength of AA often lies in the community and mutual support it offers, rather than in specific spiritual or religious beliefs. Members’ shared experiences and understanding play a crucial role in recovery.
For those who are uncomfortable with any spiritual content, there are also secular alternatives to AA that offer a non-religious approach to recovery from alcohol addiction. Each individual needs to find a program or approach that aligns with their beliefs and makes them feel supported on their journey toward recovery.
New Theories and Possible Treatments, Including Alcoholics Anonymous
John David Sinclair is an American neuroscientist living in Finland. Sinclair ran an experiment with rats, giving them alcohol for extended periods and then removing the alcohol entirely for several weeks. It was expected that the rats would lose their desire for alcohol. The opposite was true. They drank far more than they did previously. This was called the “alcohol deprivation effect,” which suggests that complete abstinence only increases cravings. Alcoholics Anonymous and other treatment options are essential to achieve long-term, life-long sobriety in most cases.
Sinclair came to believe that people develop drinking problems through a chemical process. Each time they drink, the endorphins released in the brain strengthen specific synapses. The stronger the synapses grow, the more likely the person will think about alcohol and eventually crave it until almost anything can trigger a thirst for alcohol, and drinking becomes compulsive.
The thought was that if you could stop the endorphins before they reach the target, the process could weaken, and cravings would subside. He began giving the drug naltrexone (opioid antagonist) to the rats to block the endorphins and found that they drank less and less.
Naltrexone has been deemed safe for humans and heavily studied with a track record of success in Europe as a way to help someone with an alcohol-use disorder. The problem that some people have is justifying the use of an opiate to deal with a substance abuse problem. The connection between an opiate and the treatment of an alcohol-use disorder is puzzling. However, the research does appear to be promising.
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