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):
ALCOHOL
ABUSE |
ALCOHOL
DEPENDENCE |
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:
Tolerance.
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:
http://www.addictionalternatives.com/
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.
Al-Anon/Alateen:
http://www.al-anon.org/
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:
http://www.alcoholics-anonymous.org/
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:
http://behaviortherapy.com/
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:
http://www.bettyfordcenter.com/
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:
http://www.samsha.gov/csap/index.htm
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:
http://www.med.umich.edu/drinkwise/
www.med.ecu.edu/pharm/frwise.htm
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:
http://www.hazelden.com/
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:
http://www.moderation.org
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:
http://www.health.org
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:
http://www.niaaa.nih.gov/
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:
http://practicalrecovery.com
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:
http://www.samhsa.gov/csat/csatp2.htm
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:
http://wwwdasis.samhsa.gov/ufds/welcome_m.htm
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:
http://www.womenforsobriety.org/
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 |
|
|
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 .”
-Cini3
9:45 AM PDT, June 9, 2000
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W
E B L I N K S
Addiction
Alternatives
Al-Anon/Alateen
Alcoholics
Anonymous
Behavior
Therapy Associates
Betty
Ford Center
Center
for Substance Abuse Prevention
DrinkWise/Michigan
DrinkWise/North
Carolina
Go.com
Alcoholism Web Directory
Hazelden
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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