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Post by Admin on Sept 20, 2017 11:56:09 GMT -4
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Saravanan Kannapiran
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Post by Saravanan Kannapiran on Sept 20, 2017 21:19:07 GMT -4
This was an interesting article. I never knew that Alcoholics Anonymous ("AA") was not based on evidence based research, but rather rose to prominence because at the time it was the only option to treat chronic alcoholism. I always felt that AA was very efficient as a treatment mode because the media would often trump AA’s high success rate. Indeed, AA's parent organization says it has a 75% success rate. However, current research done by an independent third party shows that AA only has a success rate between 5-8%. With such a low success rate, and with treatment centers often charging very high fees, a better and more efficient treatment must be found. Also, AA has the drawback of its philosophy being "all or none" whereas alcohol treatment as viewed by M.D addiction specialists views it as a disease with a wide spectrum. Medical doctors now realize that alcoholism can be treated with far more effective methods. Motivational enhancement and drugs such as acamprosate and naltrexone have much higher success rates. Addiction specialists feel that treating the underlying depression and anxiety that drives people to alcohol abuse is far more effective than just forcing people to give up alcohol cold turkey, like AA does. I agree with this view. After reading about the success Dr. Sinclair had in Finland using naltrexone to treat patients, it seems a better use of limited resources than forcing people into AA and having them repeat AA if they fail with it.
Though the evidence based research backs modern treatments for alcoholism such as with naltrexone, there are some drawbacks. Treatment with naltrexone does involve taking a pharmacological substance for life. There is also the expense involved for the drug. Whereas AA at some places does not cost any money and there are no drugs being taken for life. Personally, I think it would be best to have someone try AA first, and if it does not work or the person relapses, then have him or her try naltrexone.
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Post by Renee Frederick on Sept 20, 2017 23:48:33 GMT -4
From family members to friends to patients, I’ve had my share of knowledge of Alcoholics Anonymous through their experiences. AA has become to standard choice in the public’s eye for struggling addicts whether be it alcoholism, gambling, drugs etc. However, I did not know that such a highly recommended program is not based on evidential research. According to the article, alcoholism was labeled as a disease in the 1950’s and the development of AA came to fruition because there were not any other options available. Fast forward more than 50 years, medicine has improved as well as more evidential research is available. When studying for the USMLE Step 1, whenever the management of an alcoholic came up Naltrexone, Disulfiram and Acamprosate comes to mind. Rarely, unless in the ethics section, has AA been a solid answer. Although AA has its accolades, many people like J.G (mentioned in the article), fall through the cracks. Not every patient is as persistent and tenacious as J.G. was. While AA has a 12-step program that many have successfully completed, they need to be more open other management of the disease. Just like any other disease, there are different presentations and manifestations. What worked for Sally may not necessarily work for Paul, therefore, what happens to those patients that relapse? It is unfair that AA attributes one’s failure of the program to them being “constitutionally incapable of being honest with themselves”.
According to the article, AA has a success rate of approximately five percent whereas there was a 78 percent success rate in those that used Naltrexone. Naltrexone and other pharmacological agents are costly and with the rising cost of healthcare insurance, insurance has no longer become a priority. Therefore, although naltrexone is very efficacious, many may not be able to access it. I agree with my colleague above in that there should be joint efforts in helping those addicted to alcohol. They should start off with AA’s 12 step program and if failed on multiple attempts, pharmacological agents such as Naltrexone should be considered in individuals who are determined to get better.
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Post by Blessing Osa on Sept 21, 2017 22:23:03 GMT -4
According to the 2015 National Survey on Drug Use and Health (NSDUH), 86.4 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 70.1 percent reported that they drank in the past year; 56.0 percent reported that they drank in the past month. Of the 3.9 million Americans who received treatment for a substance abuse problem in 2005, 2.5 million of them were treated for alcohol use. Alcoholics Anonymous was declared the correct treatment for alcoholism since 1935 without scientific evidence to support the 75% effective or success rate claimed over a decade ago.
Naltrexone blocks these endorphins from binding to the brain's receptors and the alcohol drinking behavior is extinguished. Taking naltrexone before drinking alcohol is highly effective in cures Alcohol Dependence than giving it and tell them to abstain from drinking. Naltrexone is effective at reducing alcohol cravings than in those who abstain from alcohol. Since is a better protocol to start any disease treatment with a minimum Pharmacotherapy, it will be advisable to start with AA program and add naltrexone if multiple relapse occur.
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Post by nwarnick on Sept 23, 2017 19:56:57 GMT -4
Alcohol addiction, which is classified in the DSM-5 as a type of substance use disorder, is a disease just like bipolar disorder, diabetes, peptic ulcer disease, or hypothyroidism. When determining the course of management or treatment of a disease, the physician works with the patient and any other necessary members of the care team to come up with the best course of action. When making this determination, the physician takes in to account many things including the patients religious preference, treatment history, support system, and co-morbidities. These are all necessary factors. For instance, a Jehovahs Witness patient might elect to not use blood products or a Jewish patient might refuse a porcine heart valve. The pros and cons of each treatment are weighed using empirical evidence and a determination is made. Further, if a treatment is not successful at treating or managing any other disease, the treatment plan is re-evaluated and a new plan is made. The patient is never told that the "failure is his alone."
Alcoholics Anonymous and other similar 12 step programs, in one way or another, blame the program's failure on the patient, which has the potential to decrease the patient's motivation to seek other types of treatment for their addiction or abuse if they view themselves as the failure. Further, from what I have found, AA is the only treatment for a disease that forces a view of religion on a patient. Four of the 12 steps refer to God in some way. This is great for patients who have that relationship with God, but seems problematic for patients who refer to their god in a different way, or who do not believe in God. To the point I made earlier, we would not tell a Jehovahs Witness patient that they must utilize blood products (with very few clear exceptions, such as a minor needing emergent care).
In addition to clinicians using 12 step programs as a means of treatment, many defendants who go through the court system or drug or alcohol related charges are ordered to attend x-number of meetings in a certain time period. Again, this is helpful if the defendant believes in God, however if they believe in a different god or no god, the court is ordering them to accept a religious being that they do not believe in.
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Post by cemsarihan on Sept 24, 2017 16:49:34 GMT -4
Another interesting read on the misperception of the effectiveness of alcoholics anonymous. Before I became a medical student I was always under the perception that Alcoholics Anonymous was a good and only option for recovering alcoholics. There was no other data to disprove that belief at the time at my disposal. Now having more familiarity with medications and other treatments available to help alcoholics ween off of drinking alcohol altogether, there are clearly better options out there to choose from. Although I would not completely be against trying the program, it should provide some help to recovering alcoholics given the group environment. Social support and acceptance from your peers would definitely help one going through such a difficult time in their life. With the help of AA and other pharmaceutical treatments, alcoholics now have the proper tools to get them back on the right track.
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Post by Chiamaka E. on Sept 25, 2017 17:29:16 GMT -4
Great thing articles like this are available to the general public, I sure have seen another side to alcoholism. I knew there were different techniques to help with curbing alcohol abuse but Alcoholics Anonymous has always been at the top of my list. Here's what I think: I believe that the best or most favorable approach concerning treatment in Medicine, is therapy. Something less invasive as opposed to a method that leaves a patient opened up on the operating table. What do I mean? The use of drugs to help curb alcohol intoxication sounds almost 'invasive' to me. These drugs bind to certain receptors and alcohol binds to certain receptors and although these drugs have been fully researched on, anything can go wrong. I mean the human body is still very much complicated notwithstanding how far we have come in trying to figure it out.
In as much as there was only a single figure(5-8%) success rate with AA, it still feels like the best approach to me. As a medical student and a human being, I have come to realize that talking about 'it' aids in the recovery process. I have to know what is going on, what triggers it and how it makes you feel. Once we as humans get comfortable enough to let others in on what's going on, we tend to feel better-recovery begins. There's nothing greater than having a good support system which is what AA gives.I mean this is a system where you have people that are just like you, you can relate entirely with them so chances of you feeling judged are almost infinitesimal. It may be really expensive but I think it is worth it. I've met people who just like me,love to keep trophies. With AA and the sobriety chips, its a 'plus plus' for me. The other methods may seem less expensive with higher success rates, but AA provides something that they may not-- A support system.
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Post by A J Samson Jr on Sept 25, 2017 19:16:59 GMT -4
The article was a real eye opener. I, for one had no idea that the AA program was faith based and had always assumed that the program was the primary treatment option for individuals who abuse alcohol. Being faith based already raises questions of inclusivity in ones mind. The article also illustrated AA program’s shortcomings in dealing with alcohol abuse, mainly, that it’s not based on science. The AA organization is ubiquitous and is pervasive in American culture. This “visibility” gives the AA’s 12 step program dominion over an individual’s choice of treatment options and has even affected how doctors attitude in managing the condition. This is evidenced on how Naltrexone, an approved treatment, is prescribed by doctors in the US vs Finland. Fortunately, researchers and addiction specialists have long questioned the efficacy of their 12-Step program. This question on efficacy is more relevant now with the passage of the Affordable Care Act, whilst it provides funding for substance abuse treatment it also mandates that such treatment options be evidenced based and be cost effective. These criteria, is where the AA’s program falls short. The claimed success rate of 75%, published by AA in 1955, is questionable because it is notoriously difficult to substantiate hence almost impossible to establish. This is due to several factors as mentioned in the article: Participants records are not kept, attendance and follow-up after discharge are not tracked and by its nature “anonymous”. In addition, this figure was also based on member’s experiences, hence are subjective. A more precise estimate was made by a retired Harvard psychiatrist and put the actual success rate at 5-8%, a figure that even psychiatrist and doctors were surprised to hear. The article pointed out that comparing overall effectiveness AA ranked 38th out of 48th treatment methods. More effective were: brief interventions by medical professional, motivational enhancement, cognitive behavioral therapy, and use of Acamprosate, naltrexone and antabuse to ease cravings and help reinforce behavior that promote sobriety. The author also pointed out the lax qualifications of AA counselors which does not inspire confidence in AA’s continued operation in the present evidenced based and cost effective healthcare environment.
Flaws on AA’s 12 step program are increasingly apparent as new research data is published. Current data supports that alcoholism is a spectrum, where only 15% is at the severe end and majority fall in the mild to moderate range of the spectrum. These severe individuals are the most likely to seek treatment but also need a more personalized regimen, which AA’s one-size-fits-all program doesn’t address. Another is the AA’s strict adherence to its central tenet of: ”Lifelong abstinence from alcohol is the single path to recovery” which contributes to high relapse rates as proven by latest experimental data with mice showing abstinence intensify cravings. Add to this AA’s view that relapsing patient moral constitution are defective, a burden that most suffering from the disorder can definitely do without.
Although AA has categorically stated that they don’t oppose working with and integrating medically sound practices they have not proven this in practice. I concur with the author’s findings and is of the opinion that continuing on its current path, the AA organization and its 12 step approach will surely transition from being an irrational choice to an irrelevant treatment option. I predict that The Affordable Care Act will accomplish this sooner rather than later.
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Post by Lois Olumuyiwa on Sept 25, 2017 20:41:07 GMT -4
This was indeed a very insightful piece and i'll be honest, i didn't know very much about AA prior to now but from reading this article to reviewing the comments posted as well, i feel that AA meetings are better as an adjunct to pharmacological therapy, than a treatment option on it's own. We're all different beings and definitely what works for one person might likely not work for the other and to a large extent i feel AA meetings would only help the struggling alcoholic if he/she is willing and determined to change. In the event that the patient is not disciplined enough or strong willed, just like any other thing, this method might not work. However, in the case of pharmacological therapy, alterations are being made in the body to bring down the craving of this substance and that might just be what the patient needs. In addition to taking these meds, it can then be advised that the patient attends these meetings as a source of encouragement to abstain from alcohol but attending meetings alone and expecting one to stay away from something they're addicted to, in my own opinion, isn't very realistic, even the article states that the effectiveness of AA meetings ranked 38th out of 48 treatment options so why are we still opting to this as a first line of treatment at all. I'm for the option that this be used alongside other treatment options but alone, in my opinion wouldn't be very beneficial.
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Post by peggy7777777 on Sept 27, 2017 10:20:55 GMT -4
This was indeed a very insightful piece and i'll be honest, i didn't know very much about AA prior to now but from reading this article to reviewing the comments posted as well, i feel that AA meetings are better as an adjunct to pharmacological therapy, than a treatment option on it's own. We're all different beings and definitely what works for one person might likely not work for the other and to a large extent i feel AA meetings would only help the struggling alcoholic if he/she is willing and determined to change. In the event that the patient is not disciplined enough or strong willed, just like any other thing, this method might not work. However, in the case of pharmacological therapy, alterations are being made in the body to bring down the craving of this substance and that might just be what the patient needs. In addition to taking these meds, it can then be advised that the patient attends these meetings as a source of encouragement to abstain from alcohol but attending meetings alone and expecting one to stay away from something they're addicted to, in my own opinion, isn't very realistic, even the article states that the effectiveness of AA meetings ranked 38th out of 48 treatment options so why are we still opting to this as a first line of treatment at all. I'm for the option that this be used alongside other treatment options but alone, in my opinion wouldn't be very beneficial.
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Post by peggy7777777 on Sept 27, 2017 10:46:23 GMT -4
The article "Irrationality of Alcoholics Anonymous" made me feel hope. Quickly, I want to say that the time honored AA meeting approach is and has been a lifeline for many. However, it is enlightening to read the other now proven pathways that can bring hope to a very dark area. In my life, I grew up with no knowledge of alcohol at all. Never did see it or hear about it. I did not even know it was out there as I was from a very back woods farm family with no TV or telephone and little deep connection with others. It was only my family and eight siblings that were my basis for life along with many farm animals. Although, I have never known drink, it it amazing to me that even with that protected childhood, that so many in my family have been or are lost to alcohol and substance abuse including the death of my family. As a person that has worked in missions for many years, my faith is strong but I have long been perplexed about how alcohol and substance can totally alter the course of many well intended people, including children, homes, and careers. As a missionary, I have spent thousands of hours working with the spouses, families and children of remnants of alcohol and substance in the inner cities of the United States and 23 foreign countries. The therapy provided might be assistance with where the next bowl of rice is coming from or how to let go and move on. It is so wonderful to hear the encouraging news of the medications and other theories that might bring results. I do believe in prayer. I do believe that alcoholism is an illness and that it may open the door for other issues. I do not discount AA and am grateful for all of its effectiveness. There is room for everyone here at the base of the cruelty of this disorder. A famous book I read says, ""Hope deferred makes the heart sick". This article brings hope. Respectfully submitted, PSpears
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Post by peggy7777777 on Sept 27, 2017 10:47:56 GMT -4
Including the death of one family member.
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Post by bwright on Sept 27, 2017 14:52:08 GMT -4
This AA article shines a light on a very major problem in America. Alcoholics are not seeking treatment with evidence based medicine. As told in the article, Alcoholics Anonymous was founded and is still conducted based on one man’s success story with battling alcoholism- the notorious 12 Step Program. This method has helped millions struggling with addiction since its introduction into society, including the for-profit organizations. With those that the program has helped, there have also been even more that have failed, and where do those that have failed turn to? The last 30 years has lent itself to new treatments that are backed by research: CBT, antabuse, naloxone are a few options out there, not as alternatives, but as first line use indicated for alcoholic use disorder. Surprisingly, AA states they cooperate and agree with the medical profession but many members frown on prescriptions. An individual suffering from substance abuse then turns to who or what? Per the article, the individual that fails must start once more with the program, because if you failed then obviously it’s not the program at fault, it’s the user. So it this indeed true?
So herein the problem lies not exclusively on AA, but also on the medical profession. I believe we should look not at who to blame, but instead on creating a solution. Why is it that many believe that AA is there only option? Does the commoner know there is more than AA available? Why are people so put-off to seeking help by medical professional? Finally, why do only 582 physicians out of 1 million polled by AMA consider themselves specialized in addiction? Alcoholism isn’t nuanced. Treatment options are taught in the beginning years of most medical students’ training. We ought to dust off the cob-webs and help those in need and increase public knowledge that there are more efficacious treatments out there. Additionally, we should work with AA to promote a multifaceted approach. The AA name is a brand, and by using an established widely accepted group, the face of treatment of alcoholic abuse could incorporate group settings of social encounters for patient support meanwhile individually meeting with patients in office to discuss personalized treatment.
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Post by awalker9 on Sept 27, 2017 15:23:27 GMT -4
As much as an attitude to completely elminate alcohol use is helpful in alcoholics, I do believe that is sort of all or nothing approach is detrimental to the overall treatment approach. The article referenced a patient who felt that once relapsing with just one beer, all previous progress had been lost and he might as well "make the relapse count" in a way and go on a full blown 3 day binge. The fact that he felt that he must now begin from scratch is almost being used as a sort of scapegoat or excuse, providing him with an excuse for his behavior and a clear conscience afterwards. The article also goes onto say that of people who had alcohol dependence in the past, 20% were able to drink at low levels without it impacting their lives negatively. Furthering my point that an all or nothing approach is not entirely needed.
Alex walker
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Soren Estvold - UMHS
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Post by Soren Estvold - UMHS on Sept 28, 2017 11:40:42 GMT -4
I'm sure, that AA started out with the best of intentions. At the time of its inception a program was created to help those with addiction. The principles of AA were created with the best knowledge at the time, meaning that with advances in addiction medicine should create changes in the program itself.
AA in itself is a good baseline program. Because of its reputation, someone with addiction and little resources knows that it is one of the first options for addiction therapy. Like any program there are drawbacks. The faith-based concept will immediately alienate those not of faith, one turn off to the program. Secondly, not everyone fits into a 12 step program.
On the surface, when combined with the guidance of a psychiatrist AA can be a very effective tool to combat alcohol addiction.
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