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New Roads to Sobriety
In Trouble With Alcohol?
A Controversial Look at Alcohol Abuse and Treatment Options

Find out if you may have a problem with alcohol. Click on the image to select an interactive quiz. (ABCNEWS.com)

By Rebecca Raphael
June 7 — Most Americans believe that the only way to control the devastating addiction of alcohol is total abstinence.
    But now those views are being challenged and the means of treatment re-examined. In a special 20/20 hour, Dr. Nancy Snyderman offers an unconventional perspective on the 50 million Americans who struggle with alcohol, as she raises these questions: Is it a disease or a behavior? Is it possible that for some, it can be treated with moderation rather than abstinence? Are Alcoholics Anonymous and other 12-step programs the only way to sobriety?
     According to a growing number of researchers and others who have struggled with alcohol, the long-held views of AA and other 12-step programs are only helpful to a small segment of the population. Abstinence, these experts and recovering alcoholics say, may be the only remedy for some people, but not necessarily for others.

Alcoholism as a Disease
More than 50 years ago, the American Medical Association labeled alcoholism a disease. But there is no single key to determining who suffers from alcoholism nor is there a known underlying biological defect in alcoholism. The American Psychiatric Association, in its Diagnostic and Statistical Manual of Mental Disorders, does not use the term “alcoholism.” Instead, it lays out several sets of criteria for alcohol abuse and alcohol dependence (commonly called alcoholism):


A diagnosis requires that a person exhibit a pattern of alcohol use that leads to clinically significant impairment or distress, as demonstrated by at least one of these traits:
 Continued use despite social or interpersonal problems caused by drinking.
 Recurrent drinking when alcohol use is physically hazardous.
 Recurrent drinking results in a failure to fulfill major obligations at work, school or home.
 Recurrent alcohol-related legal problems.
A diagnosis requires that a person meet at least three of these criteria in any 12-month period:A diagnosis requires that a person meet at least three of these criteria in any 12-month period:
 Withdrawal syndrome.
 Drinking larger amounts over a longer period of time than intended.
 Persistent desire to drink or unsuccessful efforts to control drinking.
 Giving up or reducing important social, occupational or recreational activities in favor of drinking.
 Spending a great deal of time obtaining alcohol, drinking or recovering from drinking.
 Continuing drinking despite knowledge of having a persistent or recurrent physical or psychological problem caused or exacerbated by drinking.

     For decades, Alcoholics Anonymous and most other 12-step treatment clinics have operated on the assumption that people seeking help have a disease characterized by physical dependency and a strong genetic predisposition. The goal of such treatment, therefore, is total abstinence.
     Indeed, millions of alcoholics who have attended AA and similar programs have found that the only treatment for their chronic and progressive disease is to follow the 12 steps of sobriety. All the steps, including admitting powerlessness over alcohol, support the ultimate goal of a lifetime of abstinence.
     “I work a very strong 12-step program,” says Laura Baugh, 44, a recovering alcoholic. “If I don’t do that, I die. In my opinion, I have a disease. A brutal, brutal disease. It’ll kill you slowly, 100 percent it’ll kill you.”
     “AA has literally given me a new life,” says Eddie A., a recovering alcoholic for eight years who adheres to the AA tradition of anonymity. “AA has allowed me to take control of my work, my social life and I have regained my dreams. I have gained serenity. I’m happy inside my skin. Maybe for the first time in my whole life.”
     Dr. Enoch Gordis, who heads the NIH’s National Institute of Alcohol Abuse and Alcoholism, says AA deserves all the praise it gets for transforming lives and saving millions. “The 12-step program, that is AA essentially,” he says, “is one of the really incredible genius creations of the 20th century.”

Alternatives to Abstinence
But many who try 12-step programs often don’t stick with them. Even AA estimates that 95 percent of those who begin going to meetings drop out. In other clinics, the relapse rate ranges from 50 to 70 percent.
     Dr. Alan Marlatt, psychologist and alcoholism expert at the University of Washington, says such programs are too rigid and outdated. “They’re a little resistant to those of us who are doing scientific research that might challenge or question some of the basic assumptions that they have come up with,” he says. “It would be like trying to challenge the Ten Commandments or something.”
     After struggling with severe alcohol and drug problems, Richard Banton followed the AA program for six years. “They told me that I had a disease and that I was powerless over alcohol and drugs and I could never drink again,” he says. Although sober, he was uncomfortable with the AA methodology and the “alcoholic” label. “I just thought it was ridiculous,” he says. “Any time you say anything that conflicts with their model, then you’re in denial.”
     Searching for his own solution, Banton found some experts who did not subscribe to the disease theory of alcoholism. Instead, they considered alcoholism a behavior that could be changed.
     “I strongly believed that I would be able to control myself,” says Banton, who has been drinking occasionally for the last three years without getting drunk. “People can change behaviors. People do and I have,” he says. “That’s an empowering message.”
     Likewise, Marc Kern, whose alcohol dependence and drug problems began in college and continued for 10 years, tried AA. For him, it was not the solution.
     “There’s nothing medical being conveyed in there,” he says of AA “It’s a social, psychological support group — what kind of disease is treated that way?”
     One sip at a time, Kern found that he could devise his own way out of his problem. For the past 20 years, he has been enjoying an occasional glass of wine — living proof, he says, that some, although not all, alcoholics can learn to drink responsibly. Kern, who went back to school for a Ph.D., has started a new career helping others with addictions, providing them with alternatives to 12-step programs that advocate abstinence.
     Dr. Fred Glaser, an expert in addiction medicine at East Carolina University, says the one-size-fits-all abstinence approach to alcoholism — virtually the only method of treatment offered in the United States — may be hurting people’s chances for recovery and driving away people who need help. Glaser, who runs a course that teaches problem drinkers to reduce their drinking, says his program appeals to people who might otherwise not seek treatment at all. An approach that advocates controlled drinking, he says, can reach a larger number of alcoholics and is preferable to “trying to shove abstinence goals into everybody who comes in for help with a drinking problem.”
     But Eddie A., who continues to go to AA meetings twice a week, says that for an alcoholic, drinking in moderation is a “ticket to suicide.” The 61-year-old says, “I’ll tip my hat to people who come up with an effective way for an alcoholic to drink moderately. But I’ll tell you something, I don’t think I’ll be touching my hat for a long time.” Referring to an AA proverb, Eddie A. says simply, “If you want to stop drinking, you’ve got to stop drinking.”

For Help and Information

Addiction Alternatives:
Addiction Alternatives, based in Los Angeles, practices the philosophy that one can learn how to overcome addiction and move on to enjoy life without stopping to drink forever. Marc F. Kern, Ph.D, uses personal experiences with addiction and his professional training to bring answers to people suffering with addictions and unwanted habits.

     With meetings in 112 countries, Al-Anon helps families and friends of alcoholics recover from the effects of living with a problem drinker. Alateen is a recovery program for young people. The program of recovery is adapted from Alcoholics Anonymous and is based upon the 12 Steps, 12 Traditions and 12 Concepts of Service.

Alcoholics Anonymous:
     Alcoholics Anonymous is an international fellowship of men and women who share their experience, strength and hope with one another to solve their common problem and help others to recover from alcoholism. AA is nonprofessional, self-supporting, nondenominational, multiracial, apolitical and available almost everywhere. There are no age or education requirements.

Behavior Therapist Associates:
Behavior Therapy Associates is an organization of psychologists providing clinical services, research, training for health care and mental health providers and consultation to organizations and businesses. Its software programs teach moderate drinking skills and its Web site offers a list of therapists across the country who practice moderation training.

Betty Ford Center:
     The Betty Ford Center in Southern California provides an interdisciplinary treatment team that includes a physician, nurse, dietitian, activities therapist, counselors, continuing care counselors, case managers, pastoral care counselors, family counselors, a clinical psychologist and a psychiatrist, if needed. Gender-specific treatment and support groups are available. Groups include grief groups, senior needs, peer groups for gay and lesbian patients and reasonable accommodations for people with disabilities. Patients are encouraged to work and learn the program of living through the self-help movement of the 12 Steps.

Center for Substance Abuse Prevention:
     CSAP’s mission is to provide national leadership in the federal effort to prevent alcohol, tobacco and illicit drug problems. These problems are intrinsically linked to other serious national problems such as crime, violence, rising health care costs, academic failure, HIV/AIDS, teen pregnancy and low work productivity. CSAP connects people and resources to innovative ideas and strategies and encourages efforts to reduce and eliminate alcohol, tobacco and illicit drug problems. CSAP fosters the development of comprehensive, culturally appropriate prevention policies and systems that are based on scientifically defensible principles and target both individuals and the environments in which they live.

     DrinkWise is a brief, confidential educational program that helps you eliminate drinking problems by reducing your drinking or stopping altogether. You decide which is better for you: moderation or abstinence.The program is for people with mild to moderate alcohol problems who want to eliminate the negative consequences of their drinking. DrinkWise is not for those who are severely dependent or alcoholic and requires treatment approaches rather than educational ones. DrinkWise, offered in Michigan and North Carolina, has the ability to deliver the program throughout the United States using its telemedicine capacities.

     Hazelden is a nonprofit organization dedicated to helping people recover from alcoholism and other drug addiction. Hazelden, based in Minnesota, provides residential and outpatient treatment for adults and young people, programs for families affected by chemical dependency and training for a variety of professionals.

Moderation Management:
     Moderation Management (MM) is a recovery program and national support group network for people who have made the healthy decision to reduce their drinking and make other positive lifestyle changes. MM empowers individuals to accept personal responsibility for choosing and maintaining their own recovery path, whether moderation or abstinence. MM promotes early self-recognition of risky drinking behavior, when moderation is an achievable recovery goal. Individuals who are not able to successfully reduce their drinking either find a local abstinence-only program to attend or remain in MM and choose abstinence as their goal.

National Clearinghouse for Alcohol and Drug Information:
     The National Clearinghouse for Alcohol and Drug Information (NCADI) is the information service of the Center for Substance Abuse Prevention of the Substance Abuse and Mental Health Services Administration in the U.S. Department of Health and Human Services. NCADI is the world’s largest resource for current information and materials concerning substance abuse.

National Institute on Alcohol Abuse and Alcoholism:
     The National Institute on Alcohol Abuse and Alcoholism (NIAAA) supports and conducts biomedical and behavioral research on the causes, consequences, treatment and prevention of alcoholism and alcohol-related problems. NIAAA is one of 18 institutes that make up the National Institutes of Health (NIH), the principal biomedical research agency of the federal government.

Practical Recovery Services:
     Practical Recovery Services offers customized, private, brief or intensive treatment for any type of addictive behavior or related problem. It views addictive behavior as a bad habit not a disease. It supports both moderation and abstinence and bases treatment services on the latest scientific knowledge. Addictive behavior is learned — and that means you have the power to change it. Though based in La Jolla, Calif., it provides long-distance addiction counseling services by e-mail or telephone.

Substance Abuse and Mental Health Services Administration:
     The Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration works across the private and public treatment spectrum to expand the availability of effective treatment and recovery services for alcohol and drug problems. CSAT’s initiatives are based on research findings and the general consensus of experts in the addiction field that, for most individuals, treatment and recovery work best in a community-based, coordinated system of comprehensive services. CSAT supports the nation’s treatment effort to provide specific services, evaluate treatment effectiveness and utilize evaluation results to enhance treatment and recovery approaches.

Substance Abuse Treatment Facility Locator:
     SAMHSA’s online version of the most recent National Directory of Drug Abuse and Alcoholism Treatment Programs lists federal, state, local and private facilities that provide drug abuse and alcoholism treatment services that meet your specifications.

Women for Sobriety:
    Women for Sobriety is a nonprofit organization in Quakertown, Pa. dedicated to helping women overcome alcoholism and other addictions. The “New Life” program, based on a philosophy of positivity that encourages emotional and spiritual growth, helps women to overcome their alcoholism and learn an entirely new lifestyle to sustain ongoing recovery.

Other Hotlines:
Alcohol Treatment Referral Hotline: 1-800-ALCOHOL
Center for Substance Abuse Treatment Referral Service: 1-800-662-HELP
1-800-662-9832 (Español)
1-800-228-0427 (TDD)
National Council on Alcoholism and Drug Dependence: 1-800-622-2255
Secular Organizations for Sobriety: 310-821-8430

For Help and Information

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Y O U   S A I D

“The AA halls are filled with stories about the sober person who thought he could control his drinking. Thousands have ended up dead .”
9:45 AM PDT, June 9, 2000
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W E B  L I N K S

Addiction Alternatives


Alcoholics Anonymous

Behavior Therapy Associates

Betty Ford Center

Center for Substance Abuse Prevention


DrinkWise/North Carolina

Go.com Alcoholism Web Directory


Moderation Management

National Clearinghouse for Alcohol and Drug Information

National Institute on Alcohol Abuse and Alcoholism

Practical Recovery Services

The Center for Substance Abuse Treatment

Substance Abuse Treatment Facility Locator

Women for Sobriety


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