A CURE-ALL FOR ADDICTION?: Some scientists are arguing for a re-imagining of rehab, suggesting that pairing pharmacological treatments with more classic cognitive ones is the best recipe for success in treating addiction.
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Singer Amy Winehouse's fame and infamy have now been forever linked to one word: rehab. She is only one of many recent high-profile cases in which attempts at rehabilitation from substance abuse failed. Amidst strange public outbursts earlier this year, actor Charlie Sheen asserted that it was not rehab, but rather he, himself, that had been his secret weapon against abusing cocaine and booze.
And celebrities are not the only ones with untreated substance abuse problems. More than 20 million Americans ages 12 and older needed—but were not receiving—treatment as of 2007, according to the Substance Abuse and Mental Health Services Administration.
The cause of the 27-year-old singer's July 23 death is still unknown. Initial autopsy results were inconclusive, and toxicology tests will likely take at least two weeks. But the Grammy Award–winner had a recent history replete with physical health problems, psychological difficulties, and drug and alcohol abuse. In 2007 Winehouse was admitted to the hospital after overdosing on a combination of alcohol, cocaine, ecstasy, heroin and ketamine. She had at least a few stints at in-patient rehabilitation clinics but did not entirely stay clean afterward.
In her 2007 hit "Rehab" Winehouse repeatedly shrugged off the suggestion with the refrain ("They tried to make me go to rehab, but I said, 'no, no, no,'") in her dark, bluesy voice. Was she right to be skeptical of this classic treatment? Many of these programs, including 12-step plans such as Alcoholics Anonymous, often embrace at least some aspects of an abstinence-only approach and reliance on a "higher power." At least one overview of decades of research on AA's effectiveness suggests it works for many problem drinkers in conjunction with professional help. Nevertheless, the majority of people who enter more formal treatment centers suffer relapses.
Scientific American spoke with Bankole Johnson, a professor of neuroscience at the University of Virginia (U.V.A.) School of Medicine. He is also the editor of the new text Addiction Medicine, and has worked on the development of new pharmacological approaches to treating addiction.
[An edited transcript of the interview follows.]
Are there differences in trying to treat alcoholism versus other drug addictions or combinations of addictions?
There's no general difference. You use the same approach of determining what the patient needs. A lot of addictions do have a pharmacological component. We don't have a good drug for cocaine addiction, but we have drugs for alcohol addiction, opiate addiction and a wide range of addictions.
How well does traditional rehab work?
I don't believe that traditional rehabilitation using self-help methods is effective. In fact, the data suggest that they're not much better than spontaneous rates of recovery. For alcoholism, up to a quarter of people respond on their own, and a lot of recovery centers have rates that are not even that high. So-called rehabilitation centers should publish their rates of improvement, and they should be required by law to do so. Cancer centers do. But rehabs are just this black box.
Is it fair to generalize across different rehabilitation centers and programs? Are they all black boxes or do many of them use similar approaches?
Most rehabs in the United States are based on the Minnesota model. They have a lot of groups, they follow 12-step self-help programs. They tend not to be medication-based.
The myth is that people have to reach rock bottom to get treatment, but that is not the case if they are being provided with evidence-based medicine.
Is there a way to know what sorts of rehab approaches will work best for which people?
Sometimes you can tell by the patient's profile. Then you can combine what you think are the essentials for what you might need psychologically and medically.
There have been treatment-matching programs. Project MATCH aimed to determine whether different types of psychotherapy would be better. After the study there was not that much difference in the psychotherapies. It might mean that they do work well—and that the dose-effect is very small.
In another study, COMBINE, people received behavioral intervention, cognitive therapy, family therapy—every therapy they could think of. And those patients did worse than a brief intervention and a placebo pill.
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36 Comments
Add CommentFunny you should ask this question. As of this Wednesday, July 27th... I will be a 25-year recovering alcoholic, and it's all because of a 12-step AA-based rehab facility in Hawaii called Hina Mauka. I'd tried to stop drinking on my own, attended non-12-step programs... and nothing worked. It was only because that rehab program was there, that I am here now. I was in extremely bad shape (blackout drinking virtually 24-hours-a-day) and would likely have been dead within a year. Because of that wonderful program, I was able to rebuild my life, get married, have kids, and become a productive, and much more pleasant, member of society. Yes, rehab programs work... not all the time, or even the first time. But they are an extremely important resource helping many tens-of-thousands out of the horror of addiction and chemical dependency. I am proof of it.
Reply | Report Abuse | Link to thisI, too, am a happily recovered alcoholic/drug user who succeeded in AA. The success rate isn't high but I don't think anyone is truly succeeding in addiction treatment. Integrated Dual Diagnosis Treatment for mentally ill and addicted has better results than traditional methods but even that fails more than it works. I work in mental health and our institution says it will only use "evidence based practices."I'm starting to wonder, maybe doubt, the integrity of "evidence based." With treatment providers delivering any number of treatments based on both the literature and their personal opinion it's starting to be a buzzword rather than a solid definition of what works. Our chief treatment person is a behaviorist so every behavioral treatment is evidence based and everything else isn't. I wish people would stop bashing AA. To those of us who survived because of AA it's painful to have it thrashed by know it alls who want to narrow the definition of "evidence based."
Reply | Report Abuse | Link to thisThanks for this article! This is very important to me. I for one went through standard, 12 step rehab twice and I spent 5 years trying to work the program of AA. It never worked for me as hard as I tried. I was anxious and depressed in meetings and found them spun in negativity. I was very frustrated to not find any other "treatment" methods available. After 5 years of relapsing in AA I finally gave up on the powerless aspect (as 12 step teaches) and tried to focuss more on my strenths as opposed to weaknesses. It's been difficult, but having cbt therapy and using medications to help curb my cravings,in the beginning, has finally helped me build a solid foundation of consistent sobriety. I have courage, and faith in myself with the ability to overcome a strong addiction. Having options is very important, and can mean life and death for many. I certainly have a life now :=) and a much more positive outlook.
Reply | Report Abuse | Link to thisI am an ex-alcoholic. I tried the 12 step program as an in patient at a rehab facility and it didn't work. Subsequently I went through an aversion therapy hospital in Burien, Wa. It worked well for me. They have upgraded their program to now include live call-in meetings 7 days a week and much more therapy to go along with the aversion therapy. I was treated with a lot of respect; just a person with a problem which they fixed. They have a 70% success rate which they publish. I highly recommend them. Just search for aversion therapy on the internet.
Reply | Report Abuse | Link to thisWhy not ask if chemotherapy works for curing someone of cancer...the answer is sometimes chemo eliminates the disease and sometimes it doesn't. Sometimes Rehab works, it worked for me. My life since 1995 is better than I could ever have imagined. BUT, just like someone who has had - for instance, breast cancer - I have a disease. And, just like cancer, my disease could return. I'm no more able to wish my disease away than someone suffering with cancer can wish cancer away. Addiction isn't my punishment for having insufficient will-power or morals just as someone with breast cancer wasn't stricken because he or she deserved to suffer. I'm so grateful there are now pharmaceutical interventions for certain types of Addiction, just as some types of cancer are treated with medicines. But, in my opinion, as long as our media continues to perpetuate the idea that Addiction as anything other than the serious, deadly disease that it is, society as a whole will suffer.
Reply | Report Abuse | Link to thisRefreshing to read such thoughtful and intelligent comments. I am so far a successful rehab attendee having celebrated 26 years recovery in June. I know others who have failed, and still others who have done it without rehab. For me, rehab, combined with other therapies (no medicine) seems to have been the right choice. AA was instrumental in helping me discover myself, and when the meetings would dive into negativity, I would change meetings. I am better at achieving balance today, and I credit without a doubt a higher power for helping me find it.
Reply | Report Abuse | Link to thisThe bigger question was brought up in a good documentary I heard on CBC.CA radio - White Coat / Black Art with Dr. Brian Goldman. His question to other professionals was actually related to eating additions and found that most people who are addicts are found to be self-medicating serious mental health issues through their addition.
Reply | Report Abuse | Link to thisMeaning for up to 90% of those who are alcohol, drug, food, and gambling addicts have serious mental health issues. They mask it through the addiction - or 'self medicate' - but it's the wrong treatment.
Something to think about.
We need more articles like this willing to look critically at the addiction treatment industry in the U.S. The best available evidence we have establishes that treatment based on 12-step practices is at best ineffective for 85 – 90 % of participants and at worst is more harmful than no treatment at all: International Journal of Mental Health and Addiction. 2008. (6) 568-576.
Reply | Report Abuse | Link to thisTrying to get a "higher power" out of the process of recovery from addiction seems to partly stem from a misapprehension over how that concept works. Though an alcoholic may or may not believe that the higher power is the answer to life, the universe and everything, that's not the essential belief. The crucial idea is that the alcoholic is not the center of the universe, and that he or she is not in control of the addiction. This is anathema to many, and particularly to scientifically minded people, but continuing to drink in spite of terrible damage done to others is supremely selfish.
Reply | Report Abuse | Link to thisAA teaches that extreme selfishness is the main problem an alcoholic faces, drunk or sober. A mechanism for breaching this wall of ego, and for maintaining a sane perspective on the alcoholic's place in the world is hard to find. For a significant percentage of people who give it an earnest try, relying on a higher power works. It can also bring other benefits, such as reintegration into social support networks, greater peace of mind generally and so forth. That this solution isn't easy to rationalize and is impossible to reproduce in pill form is not something that much concerns people who have benefitted from it.
At some point it may be possible to work out the mechanisms in the brain that underly this uniquely useful treatment for alcoholism. When that happens, then perhaps a medical treatment can be developed that can reliably produce the same salutary effects in sufferers. But I'm convinced that a pill to cure alcoholism would necessarily aid the patient in having a spiritual experience. Maybe then scientific people could stop sneering, thinking that the metaphysical aspects had been dealt with.
Three 'items' catch my attention is this somewhat 'age old' battle of which treatments work or do not work.
Reply | Report Abuse | Link to thisThe first is about how AA is always presented as not working.
The second is about what is NOT taught in Rehabs.
And the third is the word Higher Power/God/god.
Let me begin with AA and the MANY off-shoot groups such as CA, NA, Coda, RA, FA etc. The 12 steps of AA were derived from the work, writings etc of William James, CG Jung, the Oxford Group etc. And in turn became the basis for much of modern psychology, even though it receives little credit. Modern group therapies probably would not exist without AA's formation and successes.
And if one looks closely; one will find inside those 12 steps; ancient Spiritual Alchemy coming from the Greeks Egyptions Sufi's etc. If one does some research; I would make a bold assumption that every method of treatment owes it existance to these principles in one way or another.
Let me skip to the third..Higher Power. EVERYONE has a HIGHER POWER. It depends what one worships, and/or allows to control their life. An addict's Higher Power is probably the drug(s) they consume. One could say many Wall Street Bankers worship the money they accrue. For others it may be Love or Family. A Higher Power is whomever or whatever they will allow to control their actions and thoughts. Even the modern alchemists with their SSRI's: are worshipping; giving credence too....as well as behaviorists...their philosophy, their methods, and these too become their gods.
Now the second thought of what is NOT taught in Rehabs nor in much of modern psychriatry, and that is that PAIN is a normal human trait/feeling. For every addict of any sort there will be a POINT of PAIN that creates a RESPONSE. No one acknowledges this Point; so the addict (of whatever sort) will usually GO BACK to the behavior/habit that in the past had however temporarily had relieved that pain. AND are WILLING to PAY THE PRICE for that 'relief'. This is what is NOT taught by virtually any modality of treatment. People are not taught that to overcome these points of pain; that another pain will emerge in the process of overcomng. If one really studies the 12 steps, or ancient spiritual alchemy; this 'new' pain is a necessary part of transformation.
And an additional thought here, is that the "bottom" that is so attached to the AA processes; is because that those who had reached their bottoms were seemingly more WILLING to sit though the NEW PAIN to get to the other side. But I will say that Bottoms can be raised through education etc.
"AA teaches", egbokalaka. By dint of what right does it claim to "teach"? Perhaps you subscribed to the commonly-held and absurd (not to say heretical) belief of its members that Bill Wilson's semi-literate, cliché-riddled and evasive writings are divinely inspired?
Reply | Report Abuse | Link to thisI attended my first AA meeting over 40 years ago and for me, a well educated atheist from a good family, and having recently drunk myself out of an excellent career and nearly my marriage, it was a revelation and a lifesaver. I have not had a drink since and life is good. I became and have been an alcoholism counselor for more than 35 years and learned this above all things: we know almost nothing about addiction and even less about recovery.
Reply | Report Abuse | Link to thisI tend to think that addiction is a disease of the brain that has terrible effects on the entire person. I have come to realize that each person who has addiction has their own, personal disease and no one treatment will help everyone.
I believe that, for all that the neuro-sciences have learned over the years, we are still barely scratching the surface when it comes to understanding the human brain, much less treating its illnesses.
The medications that have been developed in the last few decades, while so much better than the nothing that we had before, are still like swatting mosquitos with sledge hammers; not nearly as specific and well targeted as we need them to be. It's still way too much a guessing game played by trial and error. But it's a little better than the nothing that we used to have.
So we do the best that we can with what we've got right now, just as they do in any other field of physical and psychological medicine. And we continually hope that better interventions and treatments will come along; sooner rather than later.
So no, AA, aversion, medical, psychotherapy, you name it, will not work for everyone. And yes, most addicts will die as a result of their addiction. But many more of us recover today than 50 years ago and in another decade--who knows?
We just keep on plugging, hopefully with open minds and lots of flexibility. As with any field of medicine, we will get better but right now I have to do my best to help the next addict that needs my help, right now.
AA teaches to those who are in a place to listen. Not all are ready. AA doesn't work for everyone. I'm always suspicious when I read tirades like yours. What about AA injured you so that you get on a public forum and denigrate it in the presence of others who have benefited from it?
Reply | Report Abuse | Link to thisIsn't it amazing how many people think drug therapy will treat drug addiction. I would like to see his statistics.
Reply | Report Abuse | Link to thisAmy Winehouse stayed in the Priory for ONE week and then left to go on tour. She was then treated as an outpatient in London. It's hardly fair on all the rehabs out there who turn addicts' lives around if you use her as an example because she never really gave rehab a chance.
Reply | Report Abuse | Link to thisWhat about Baclofen?
Reply | Report Abuse | Link to thisWELL, FOR WHATEVER IT MAY BE WORTH , I THINK THAT MAYBE THIS YOUNG WOMAN WAS ON TO SOMETHING THAT THE SO-CALLED EXPERTS MAY HAVE MISSED , SHE THOUGHT THAT SHE WAS A " MANIC- DEPRESSIVE " , HOWEVER , SOME VERY CREATIVE PEOPLE SIMPLY OPERATE AT A DIFFERENT LEVEL THAN OTHERS , FOR EXAMPLE MANY GREAT JAZZ ARTISTS NEVER GET UP BEFORE THREE O'CLOCK IN THE AFTERNOON AND YET THEY PERFORM MAGNIFICENTLY " IN THEIR WORLD " AND MOST " REGULAR " PEOPLE WOULD NOT !MAYBE THESE REHAB EXPERTS SHOULD STOP TRYING TO PUT ROUND PEGS IN SQUARE HOLES !
Reply | Report Abuse | Link to thisThis article is excellent! After years of experience in treatment people who have addictive behaviors I've come to the conclusion that “everyone can overcome any kind of addictions”, to overcome addiction is a skill that every body can learn it. The one important characteristic of the art of recovery addiction is its specificity. The fact that no two people are exactly alike, they have different bodies, beliefs, values, feelings, behaviors, and environments. Accordingly, they will have different treatments. Each plan of get rid addiction is custom tailored to fit the individual characteristics of each client. Every person's addiction is a particular problem that needs unique solution. Each person who has addictive behaviors is a unique individual and that a successful gets rid from addiction is dependent upon a tailored plan strategy. Going to rehab center without clear strategy is like drug administration before the diagnosis.
Reply | Report Abuse | Link to thisBankole comes out of the woodwork when celebrities get into trouble behind their drinking.
Reply | Report Abuse | Link to thisBecause he's paid by pharma companies to develop meds for alcoholism you can expect he'd pump that approach at every opportunity.
I imagine if he ever finds one that works it's likely that he'll go ahead and say something about it. In the meantime all he can give is generalities that meds are a great way to go for alcoholism.
The next time the interviewing reporter hears that meds work really well and are evidence based treatment, perhaps the reporter will ask to be shown the evidence that these meds are working as well as BJ and his pharma buddies want us to believe.
Next time, maybe.
I may be the only person writing here who lacks any known addiction. I respect the complexity of the issue. My father, my sister and several uncles and aunts have been alcoholics. My father basically drank himself to death at age 43. My sister struggles with it with mixed success.
Reply | Report Abuse | Link to thisI don't have the gene. I can only view the problem as an outsider, but I've been too close to blame it on a simple lack of will power. I can only guess from what I've seen as an outsider.
Why does a person do anything, especially if that person believes that the action is bad for them? Why does a person choose to do anything?
When I wake up, I have all the memories of my life informing me of who I am, influencing all the decisions I will make today.
If I want to change something as essential as an addiction, I have to decide that I am now a different person than I was when I had the addiction. There needs to be a boundary. The past doesn't inform the future. The personality that drank too much, took drugs, ate too much or whatever -- that personality is dead. I have to be willing to leave that behind.
I am now a new person. I build this new person out of the best parts of what I know of the old one, adding new parts that I know will be healthier than the older person I was. I have to love myself enough to do that. I have to love the NEW self enough to do that.
Part of this new person may require a new environment. Friends of the old person will pull me back to behave in a way that is familiar and comfortable for them. It has to be more important to me to be a new person than it is for me to make these old friends comfortable. I don't need to convert them. I would then rely on their conversion, and their failure would become my failure, and I'd be the old person again.
It's really hard to become a new person. Most people don't try. The world doesn't give most of us a place to go to in order to change our personality. Whatever environmental elements that helped shape us into the old person will usually push us back toward the same shape, including the addiction.
Suffering, to varying degrees, is the human condition; the condition for all living beings. Choosing short-term stress aimed at easing long-term suffering is hard to do, though it is important. If you don't make that choice as an essential part of a new personality, then I don't see how any form of treatment can be effective.
AA is a place for those who "listen" because it's not a place where ideas are advanced or debated but simply presented as fact, though no scientific process has ever been performed to prove this, only personal testimonials. A field such as addiction medicine needs as many new ideas as possible whereas AA only presents one outdated model based on personal "powerlessness" and submission to a "Higher Power" in order to get well (and no, the alternative ISN'T that you believe that you are the "center of the universe" as was earlier asserted). AA seems to do well with providing some people support and structure and perhaps that what "works" about AA but there is a larger discussion about what to do all of those for whom AA does not work (which is MANY more than the numbers of those it does). The typical response for those failures by "successfully" recovering AA members of "they weren't ready" or "honest" or "weren't willing", "didn't go to any lengths", "weren't humble", "weren't teachable" (really, teachable?), "they didn't listen", "couldn't get their ego out of the way" and all of these other pitiful justifications simply aren't good enough for those who honestly care about helping as many people as possible get better. Active AA members usually seem more interested in promoting and defending AA's methods rather than seeing what might help the largest number of people.
Reply | Report Abuse | Link to thisI went to a treatment facility that was 12-step based but also had 2 physicians on staff as medical directors. They got me back on my medication for bipolar disorder and introduced me to AA, which has worked for me, although I still see a physician to manage my meds. AA can't provide "success statistics" because tracking its members is antithetical to the principle of anonymity. Anyone who quotes AA's success rate is guessing or citing a number that supports their position. The problem with other statements about success rates or effectiveness is defining success (completing treament, 1 year sober, 5 years sober) and getting meaningful data from folks who are under no obligation to report on their sobriety and under no compulsion to tell the truth. And without a standard reporting protocol its impossible to compare one program to another. Having said that I think having additional treatment options for addiction is a good thing. I think AA is a great option, but not everyone does and medication may work for them. Participating in AA doesn't preclude investigating other options and combining treatment approaches may work. While medications may be a promising option, their efficacy over the long term has yet to be proven. This is a complex, chronic disease and discovery of a single magic bullet seems unlikely.
Reply | Report Abuse | Link to this"Active AA members usually seem more interested in promoting and defending AA's methods rather than seeing what might help the largest number of people."
Reply | Report Abuse | Link to thisRather broad statement, could it be true? If AA members are indeed focusing on their recovery instead of seeing what else instead of AA might work for the large number of people who can't/won't get sober their way, should they do that?
Perhaps they should attend several meetings each week, do their jobs, talk with new alcoholics, spend time with their families, have the usual normal activities and also spend time seeing what else is out there that might help alcoholics?
Nah. Sober AAs have plenty enough on our plates, thank you. You're confusing people who want to continue staying sober with those who want to save the world's drunks.
How 'bout you save the world's drunks instead of believing we are obligated to take that on. No pharma company is paying our bills like Bankroll here. We'll see all we need to see, and of those in trouble with booze some will stay sober doing as we do. Those with a better idea can stay home and pursue that, or go see if their Dr. has a cure he's hiding from the rest of the world.
The idea that we are responsible for the alcoholics who refuse to put in the same effort we did and wind up drunk again is ridiculous. If they prefer another answer, then the door is always open. Let them find one. We put our efforts into those who want to take our steps, and that always seems to be a few out of the new crowd instead of many. Too bad for them, but they are always the ones responsible for being unwilling to take what we always and everywhere offer freely.
DEFUND 12 STEP NOW! End the sentencing of children to 12-step for their own safety!
Reply | Report Abuse | Link to thisNot only are rehab and religion-based 12-step programs unnecessary, but, for women (especially young women) these places can be very dangerous. I was in AA for 10 years, and was conditioned to think that older men preying upon younger, newly-sober women (and men) was normal. Then I found out a friend was being repeatedly raped by someone in AA, and another friend who was not even 18 had to run from a car when a male AA tried to sexually assault her.
I myself was repeatedly harassed during AA meetings by three or more men over the course of my 10 years in Alcoholics Anonymous, even though I was in a committed relationship the entire time I was part of AA. These men even harassed my husband! Neither of us left AA at the time because we believed what we were told: "if you don't work the program, you will drink, and if you drink, you will die." Call me gullible and vulnerable, but so are many young people who are newly sober! Parents, don't send your kids to 12-step rehabs or to 12 step programs!
Everyone should also know that AA, through it's "Public Information" office, "teaches" kids about AA in high schools. They call it education, but it is really recruitment. Then, through their "Cooperation with the Professional Community" program, AA officially encourages judges, attorneys, and other legal professionals to sentence convicts to AA. This means that there are sex offenders in the same meetings with young kids! Young People's AA meetings do not have a maximum age set for attendance, so their meetings are full of older men stalking young women and men. There is a sex offender that attended my home group until recently, when he was outed.
I have seen men as old as 50 and children as young as 12 at the same YP AA meeting, with no oversight by anyone. I tried to protect the young ones, but was given very little support, and no official support. So, I left.
This needs to stop NOW. Call your congressperson and tell them to DEFUND 12-step recovery programs, research, and councils now!!
Yes, rehab helps, and helps a lot
Reply | Report Abuse | Link to thisI don't think it's possible to generate a statistically valid measure of AA's "effectiveness" since the relevant population (AA members) cannot be identified (that's the anonymous part) or randomly sampled. Surveys of self-selected respondents are inherently unreliable. If someone really wants to stop drinking, there's only one program that's free and has been around for 76 years. If it works, great; if not, try other options.
Reply | Report Abuse | Link to thisI like this article because he is taking on the 12 step rehab evangelicals. When people ask for professional help, he is advocating for medication and/or psychotherapy.
Reply | Report Abuse | Link to thisDr. Valiant advocates for 12 steps. Is this because he really thinks it works or because he is on the corporate board of AA?
Medication and psychotherapy worked for me. I worked very hard at my job and at my therapy. I did not find AA/NA helpful. It had nothing to do with not "being ready" or "self-will run riot". I believe in hope and empowerment and responsibility and supportive not confrontational therapy. I found the dogma of AA disempowering.
And people without addiction, including family, friends and colleagues, helped me greatly. No surprise there. People have been helping other people with their issues or illnesses since the beginning of time.
Continued from prior post
Reply | Report Abuse | Link to thisAt the individual level, I am for whatever works. I am pro-choice. I have no problem with AA/NA at the grassroots level. I just don't believe it is the only way or the way for me.
I am against the 12 steps as medical treatment or as the dominant paradigm. They are one type of peer support group that may or may not be helpful for some people. And since some people who attribute their success to AA/NA have dominated the conversation- see their 12 step
Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
http://www.aa.org/en_pdfs/smf-121_en.pdf-
I see a need for an anti 12 step rehab patient advocate movement. I am unofficially a member.
My 6 month association with AA/NA was a neutral to negative experience. I have read the AA bible and the NA bible. I will be kind by simply saying they added nothing significant to my recovery.
My first week at an AA meeting, I was told to stop taking my meds. I didn't listen. I was also told things like: you can make your doorknob your higher power....but then you have to pray to the doorknob to relieve you of your insanity and character defects and surrender your will to the doorknob......on a daily basis... and just maybe the doorknob will grant you sobriety.
At least the God of the church of my childhood could remove the desire to drink and use for good. All one had to do was have the elders pray over you, sing gospel music and read a few scriptures-talk about a simple program. And yes, it works. I have seen it work for many people!
And if self-help and the spiritual program of your choice dosen't work, try
HAMS is a peer-led and free-of-charge support and informational group for anyone who wants to change their drinking habits for the better. The acronym HAMS stands for Harm reduction, Abstinence, and Moderation Support. http://hamsnetwork.org/
or cognitive-behavioral techniques http://www.smartrecovery.org/resources/toolchest.htm
It's also funny that this place is called 'ask the exprrts' eventhough the comments are filled with expert on subjective experience. A particular figuration: a certain state of body and pschology in a certain environment. That said I don't believe in the myth of hitting the bottom first. It is certainly not good for all.
Reply | Report Abuse | Link to thisIn my little humble experience with a thyroid problem I've seen almost every strange psychological phenomena. Even though I have never been addicted I touched it slightly with havy cravings. It gave me valuable insight because I also have a self solving constraint. That means I can't get full addicted because my body tells me to stop and goes into the direction of aversion. And I can't take the food or drink or medicine I took before.
One of my alocohol cravings I counter attacked by eating chrome. Thus if one of the experts is reading this.
Can chrome be helpfull in reducing alcohol abuse?
Stress is a metabolic hyper engine and it requires a huge amount of energy; like running without actually moving. The bottom line it helped me to control alcohol use. Especially because it is said that long distance runners often suffer from alcohol abuse. They just need pure fuel!
So I believe a personal treatment is okay. And I also say that drugs can be helpfull even if that drug is an placebo or a mineral. People eat a lot of bad food; it is remarkable that healthy food is never considered as an important integral part of overall treatments.
Addiction for me is imbalance. I've been addicted to Spa green. Had to buy it to relieve something I could not explain. Than I tried icy wather with lemon and it helped lowering my Spa water use and increase my use of tapped water; something I could not use before that. It only shows there is more to addiction and we have to explore with an open mind. After all that's why we call that exploration 'science'.
I'm what you might call an AA basher, but I feel compelled to say that I know more "know-it-alls" in 12-step groups than anywhere else. AA people for years told me that I could not get sober without AA. They told this to other members as well. People bash it because they're ticked off. For all you know, you could change your mind about AA some day--It's happened to many people. And many of them stayed sober and therefore decided it was not AA that saved them after all. It's a growth process. People just grow out of AA. If they had never had AA, they probably would've have started growing much sooner. Some of us are eager for alternatives to AA. For those who want AA, that has never been a problem. All AAs have to do is "keep coming back" and keep tossing those dollars on the table. For those of us who want something more, just let us have it instead of trying to convert us to a religion we never wanted. "Live and let live," remember?
Reply | Report Abuse | Link to thisAs an editor of a major journal, I would be sincerely surprised should any reputable journal accept for publication an article such as "12-Step Treatment for Alcohol and Substance Abuse Revisited: Best Available Evidence Suggests Lack of Effectiveness or Harm" by John Clark Miller (International Journal of Mental Health and Addiction. 2008. (6) 568-576). The article presents NO evidence of "Harm". Miller only SPECULATES that alcohol addiction MAY be substituted by nicotine addiction.
Reply | Report Abuse | Link to thisMoreover, the speculation is irrelevant. The two addictions are not comparable, since alcohol is immediately debilitating and poses a direct threat to others (entirely beyond the effect of secondhand smoke). If the poor addict had only a choice between these two addictions, there would be little quandary.
Miller betrays his wild bias in stating that the 12-Step program depends on "magical power or force". Anyone who has studied the 12-Step program realizes that the "higher power" concept has nothing to do with sleight of hand or black magic. For some people, the higher power may refer to faith in a deity. For others, including the many atheists in AA, there is simply acknowledgment that aspects of the universe are broader than any individual.
Again, the statement "Lack of effectiveness or outcomes less beneficial than no treatment are thus not unexpected for courses of treatment infused with 12-Step elements" is supported by NO evidence given and simply reflects insufferable bias. The claim, "The disease model of addiction, central to the 12-Step approach, pathologizes individual clients, and in doing so distracts attention and efforts from social and intrapsychic stressors that may underlie addictive impulses", belies no familiarity whatsoever of Miller with any people afflicted with alcohol addiction. "The structure and ritual of 12-Step group experience inhibits openness, interaction, and spontaneity; and the past-centered storytelling and step work provide emotional and cognitive distance from immediate experience" is evidence that Miller has either NO experience with AA meeting structure, or has forgotten. Why would Miller adopt such a virulent attitude?
Who has decided to re-coin the expression "evidence-based" to mean "higher power in a pill"? Do we really start believing the propounded dogma if the expression is said as a mantra? Where is this pill? Does Professor Johnson seriously not realize that the 12-Steps' supernatural or "superhuman higher power" can be perfectly natural and human?
Reply | Report Abuse | Link to thisThe Professor states, "For alcoholism, up to a quarter of people respond on their own, and a lot of recovery centers have rates that are not even that high." Certainly Johnson has encountered a statistics course that would caution against comparing two groups of people with totally different characteristics. For many people in AA, the recidivism rate is irrelevant in comparison to the death rate were AA non-existent.
Speaking as one who have worked in a rehab centre and who still work particularly with crack cocaine adddicts, I want to agree with those who say that no therapy, no matter how "successful" works for every addict.
Reply | Report Abuse | Link to thisI know many addicts who have gone through the same progam several times, and some who have had to go through several different or combined treatments before finally discovering the road to recovery. I also know persons who, after being in recovery for up to fifteen years, returned (unfortunately)to their drug of choice.
To me it serves no useful purpose to denegrate a particular therapy or to exalt one therapy above another or others.
Experience has taught me that up to this point drug rahabilitaion is not a science and there are no "one size fits all" therapies.
As a physician with an interest in neuroscience... i agree with essentially everything opined by the physican at UVA who is an expert in the medical field of addiction. I particularly liked his reference to the utter lack of "power" ascribed to a "higher, lower or will" power entity... since all of that is simply folklore. The interesting thing about all the myriad addictions that are part and parcel of the evolved moderen human animal is they are perhaps "exhibit A' for the childish notion that we possess contra-causal "freewill".
Reply | Report Abuse | Link to thisAnway, i was not aware of the COMBINE study which lends even more evidence to the bogus claims of various behavioral or psychological "therapies"... versus addressing the neurochemical cues that drive all behavior primarily. The other therapies have a chance only when the underlying biochemical disorder is addressed. Dupont was correct: "Better Living Through Chemistry"!
A pharmacologist is going to say "medicate," just as a surgeon is going to say "cut." Likewise, people who become sober with the help of a 12-step program will argue their sobriety is a result of that program, particularly when previous efforts to stop drinking on their own have failed.
Reply | Report Abuse | Link to thisCap locks and punctuation strings aside, many people overcome alcohol dependence without medication or program participation of any stripe. That is not to say they do it without any support (although some do); but that support is neither organizational nor medical. I'm one of them.
The only thing that can be stated emphatically with this disorder is that one size does not fit all when it comes to freeing ourselves from it. Contempt for an approach that works for one individual simply because it didn't work for another, or the myopia that results from immersion in a medical treatment model for such a Gordian knot of a health issue, is polarizing and counterproductive.
According to the evidence base, we are all right. And we are all wrong.
I do believe that some programs may work better than others and that many people do find 12 step programs to be very helpful, however, I believe that the ultimate solution is through the legalization and state control and regulation of most drugs because if some people need to be on a medication witch may be more harmful to an addict(as many have liver disease hep c or cirrhosis)they should have a choice to get what they want as the do in quite a few countries. This kind of state regulation would also curb a lot of the drug related crimes and save the state the money that is spent on prosecution, and imprisonment of drug offenders.
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