Kelly noted the positive results likely stem from the mutual support AA provides as well as the program's ubiquity—and not necessarily one of the program's unique traits.
If you're treating a chronic illness, you want to link people to something that can help sustain that gain made initially in treatment, but over time. Kelly added that, "The fact that AA is free and so widely available is also good news.
It's the closest thing in public health we have to a free lunch. Other experts noted the challenges of fully assessing the effectiveness of AA. Those who do so may be more motivated to abstain from drinking than those who don't.
Scott Tonigan, a researcher at the University of New Mexico Center on Alcoholism , Substance Abuse, and Addictions , said a "rule of thirds" applies to programs like AA, which means a third of patients will recover from their AUD, a third may experience benefits but not recover, and another third will not experience any benefits.
Further questions we need to investigate are whether particular groups of individuals — women or men, young or old people, those with or without accompanying psychiatric disorders — benefit from AA in the same or in different ways.
New research shows that some old stars, known as white dwarfs, might be held up by their rapid spins, and when they slow down, they explode as Type Ia supernovae. Thousands of these "time bombs" could be scattered throughout our Galaxy. In this artist's conception, a supernova explosion is about to obliterate an orbiting Saturn-like planet. When old stars slow down. New study points to social contacts as crucial to successful recovery. The AA-based approach seemed to work and compared favorably with the other therapies.
In all three groups, participants were abstinent on roughly 20 percent of days, on average, before treatment began, and the fraction of alcohol-free days rose to about 80 percent a year after treatment ended. What is more, 19 percent of these subjects were teetotalers during the entire month follow-up. Because the study lacked a group of people who received no treatment, however, it does not reveal whether any of the methods are superior to leaving people to try to stop drinking on their own.
Other research suggests that AA is quite a bit better than receiving no help. In psychologist Rudolf H. Moos published results from a year study of problem drinkers who had tried to quit on their own or who had sought help from AA, professional therapists or, in some cases, both. Of those who attended at least 27 weeks of AA meetings during the first year, 67 percent were abstinent at the year follow-up, compared with 34 percent of those who did not participate in AA.
Of the subjects who got therapy for the same time period, 56 percent were abstinent versus 39 percent of those who did not see a therapist—an indication that seeing a professional is also beneficial. These findings might not apply to all problem drinkers or AA programs, however.
Furthermore, the abstinence rates reported might apply only to those with less severe alcohol problems, because the scientists chose people who sought help for the first time, excluding others who had done so in the past. 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. To many, though, the idea of non-abstinent recovery is anathema.
No one knows that better than Mark and Linda Sobell, who are both psychologists. In the s, the couple conducted a study with a group of 20 patients in Southern California who had been diagnosed with alcohol dependence.
Over the course of 17 sessions, they taught the patients how to identify their triggers, how to refuse drinks, and other strategies to help them drink safely. In a follow-up study two years later, the patients had fewer days of heavy drinking, and more days of no drinking, than did a group of 20 alcohol-dependent patients who were told to abstain from drinking entirely.
Both groups were given a standard hospital treatment, which included group therapy, AA meetings, and medications. The Sobells published their findings in peer-reviewed journals. In , the University of Toronto recruited the couple to conduct research at its prestigious Addiction Research Foundation.
In , abstinence-only proponents attacked the Sobells in the journal Science ; one of the writers, a UCLA psychologist named Irving Maltzman, later accused them of faking their results. The Science article received widespread attention, including a story in The New York Times and a segment on 60 Minutes.
Over the next several years, four panels of investigators in the United States and Canada cleared the couple of the accusations.
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