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Post by magdalena z. on Sept 29, 2017 9:29:35 GMT -4
A complete restructuring of AA’s outdated approach and a new perspective on treatment is evident. Hopefully, clinicians are aware of this problem and realize that AA is not for everyone.
Without a doubt AA was once a pioneer in dealing with alcoholism and helped many people. But as this article puts it “ AA thinks of alcoholism in binary terms”- you are a drunk or not. A thought likely established when AA first came to existence- nearly a century ago!- and no longer binding in today’s world, nor followed by the American Psychiatric Association. If addiction, as AA claims, is all or none thing, then a methadone program for heroin addicts should be a complete failure, which obviously it is not. Perhaps, things like these get overlooked…Perhaps the lack of oversight has something to do with it. It is easier to be stuck in old ways when incentive to change is lacking, monetary funds are short and no one is looking.
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Post by Kristen Richard on Oct 1, 2017 14:13:56 GMT -4
This article definitely brought to my attention that AA was not an evidence based program. However, I am not surprised that it falls short when it comes to helping those with alcohol use disorders because it is a very specific program with a one size fits all approach. It is interesting that the article began with describing J.G. in a way that is relatable to most people. He was someone in a high stress career who used alcohol as a coping mechanism starting off to help him sleep, then becoming dependent. Alcohol use disorders do have a wide variety of presentations and severity. In addition there are many different factors in the cause of these disorders whether hereditary, environment, or in conjunction with other mental health issues. They should not be all treated the same. AA is a program that works for some people and should be continued for this reason, but it cannot be the sole therapy for patients struggling with alcohol use disorder.
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Post by ahcush91 on Oct 1, 2017 18:17:38 GMT -4
In my experience with those in AA, I always found it curious that they had labeled themselves forever incapable of resisting their desires to drink irresponsibly. For myself, as an aspiring physician, this wasn't a good enough answer to the problem of alcoholism. If I had a patient with diabetes, I wouldn't feel that I had succeeded in treatment if he could never eat another carb again for the rest of his life and he had to stay far away from bakeries for fear of relapse. This article highlights the presence of alcoholism as a spectrum of both genetic and psychological problems that needs to be treated on a more empirical scale. Sure, there are those that are both genetically and psychologically predisposed to be the perfect storm every time alcohol touches their lips, but those people need to be treated as a particular circumstance separate from those who do have the capability to drink in a reasonable manner one day. The claim that abstinence only gives way to a stronger desire to binge is definitely a factor that undermines the very structure of AA. Knowing that there are those who have returned to drinking casually without fear of going out of control is hopeful to those many people struggling through abstinence in a 12 step program. With the emerging pharmacological understanding of addiction and modern treatments under the supervision of trained professionals, many of these people will no longer have to avoid social events in fear of crossing that line. With the ability to almost completely decrease the craving and relief from alcohol, it no longer needs to be that terrible force that controls the lives of so many. We have taken the first step in society to educate people on the mental disease of alcoholism and addiction. Now it's time to start treating it like a disease, giving physicians an integral role in the treatment of alcoholism and addiction. Ultimately, this is a complex array of disorders of the mind presenting themselves as alcoholism in everyday life. As we grow to understand the role of alcoholism in mental disease, we will be able to more effectively treat the underlying condition and relieve the need for alcohol as a coping mechanism in people's lives.
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Post by Savreet Singh on Oct 6, 2017 12:26:44 GMT -4
“Someone is an alcoholic? They should go to AA.”
I have always thought that AA was the go to management for alcoholics. It is the most popular and least invasive form of treatment. However, this article has brought forth much needed insight. AA is a faith based program. When the 12 steps do not work for someone, it is said that the person himself must be deeply flawed and must have been born that way. That in itself, is not a healthy approach to someone suffering from a disease. AA’s establishment was at a time when alcohol’s effects were not fully understood and so with its lack of scientific background, it surprises me that it is still the most popular and widespread form of treatment. With such knowledge of the chemical background of addiction, the effects of GABA, dopamine, glutamine, alcohols effects on the prefrontal cortex, it’s absurd to disregard that and only work with something established in 1932. It is evident that there needs to be more awareness spread about the far better results from a combination of medications and counseling, and more research done for other medications that can provide superior results when compared to the single digit percentage of success from AA. Other factors that AA fails to acknowledge, are underlying mental health issues that an alcoholic may be suffering from. AA is not equipped to deal with that. Another good point I noticed in the article was that, why should the goal only be abstinence? For someone who goes from drinking a bottle of hard liquor a day, to a drink a day, that should be considered a success as well. Overall, the underlying issue with AA that I think fails its success rate is that they believe alcohol dependence is a moral failing, and do not accept it for what it is, an illness.
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Post by Japneet Dhami on Oct 6, 2017 12:27:23 GMT -4
Although I feel it is important not to discourage any method to treat alcoholism, I think it is beneficial to focus on the more specific treatments of this disorder rather than a broad abstinence method. The reason why many feel like abstinence is the only method for treatment is because alcoholism is usually just associated with an individual who "drinks too much". It is easy to forget that there are many aspects of alcoholism. Alcoholism involves one who drinks to black-out, or one who drinks because they are struggling with it's after-effects, etc. I feel like focusing on the individual aspects of alcoholism and treating the condition more specifically to the individual is more beneficial and this does not always require for an abstinence method that AA seems to follow. Individual aspects of alcoholism could be treated medically, for example as mentioned in the article, taking Naltrexone before a night of drinking could help with someone who only drinks until they black out.
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Post by krchowdhury on Oct 8, 2017 0:15:16 GMT -4
This article is a great indicator of how one solution may not be the right one for everyone. Although AA has been around for a long time and it has probably helped many addicts, there is not much we can go off of to believe how effective this solution is. As the article mentions: "no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems". This is most likely due to the fact that AA is indeed anonymous, and it is likely difficult to keep track and study who attends these meetings, and how much progress individuals have made. I am sure that this program helps many people and I would not talk down on it, but there are so many people out there that don't share the same perception of the 12 steps as some other people do (eg believers in god). For example, the one man this article discussed J.G., he is an atheist. Things like "Sought through prayer and meditation to improve our conscious contact with god, as we understood him, praying only for knowledge of his will for us and the power to carry that out" will not encourage him as much as it would someone else who has a stronger faith in god/religion.
I believe that a more direct solution that has shown results and has scientific knowledge to back it up is a more effective approach to helping people abstaining from alcohol. Pharmacologic methods are indeed a proven method that can work, especially for those who Alcohol Anonymous may not be the right solution for them.
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Post by Kemar R Harewood on Oct 14, 2017 16:31:46 GMT -4
I found this article very interesting. Although having heard about AA even as a teenager I never actually knew what it entailed. Now that I have a better idea about the 12 step program, I was quite disappointed that at the end of it the persons had to avoid alcohol for life. In my opinion to be truly cured from alcohol addiction would mean that one should have enough control to have a drink and not go back to the extreme of addiction. This made me realise why they always used the term "recovering alcoholic". You never actually recover from alcoholism and now I wonder if that is a result of the approach/end goal of the 12-step program. Maybe it is more related to physiological dependence or the psychological component not being properly addressed by the 12 step program. Although no research could be immediately found its obvious that alcohol addiction is influenced by the these two factors. As the article suggests, more research is needed to determine which component contributes more to addiction. Additionally, it would help direct the approach to treatment whether it be counselling or medication.
What is encouraging though, is seeing the efficacy of the alternate treatments so far. Whether they be by pharmaceutical or by counselling therapy, I do hope these other strategies become more mainstream and more research is done in order to provide the best treatment to the patients who need it.
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Post by Hammad Haroon on Oct 14, 2017 18:46:31 GMT -4
It honestly comes as a shock to realize that what you once thought was a super effective and all inclusive program turned out to be a sham of a sort with little evidence to back up it’s claims. For year we had thought that the proper plan for treating someone with Alcohol Abuse Syndrome was to simply make them go to AA meetings paired along with family support and maybe some sort of medication to help them further. After reading this article, it’s quite refreshing to learn that the efficacy of the medications (when taken appropriately) has such a significant impact on the lives of the people who suffer from alcohol addiction.
One small point that bothered me about the AA approach/mantra was their ideation that you have failed if you have a drink ever, even if once small glass of wine at dinner. Although I am against alcohol consumption all together because of it’s various affects on the human body, from the macroscopic all the way down to the microscopic (ethanol being a mitochondrial poison), I am not irrational and do believe everyone should have the right to choose what they put into their own bodies and would always, like most people, always advocate for practicing “moderation”.
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Post by Jamil Amlani on Oct 20, 2017 8:48:00 GMT -4
I had always thought of AA as standard treatment for alcoholism, now alcohol abuse disorder. I would never have guessed that could be ranked so low as 38/48 in it's effectiveness in treating alcohol abuse disorder, or even approach the ridiculously low 5-8 % success rate suggested in the article. I also did not know that AA was so faith based. In this day and age, I believe a faith based model is less likely to be accepted by the populace. And if in following the 12 step program fully, one is required to surrender their autonomy up to God, I am sure many of this younger, less religious generation, would turn away from the 12 step program, or at the very least find it 'a little off putting'. What I found even more surprising was the success rate of patients using naltrexone. 78 % of patients cut down drinks to 10 a week at most. I do not think that most patients considering cutting down their drinking,who might be a positive on a CAGE questionnaire, are aware, at least before seeing a doctor, of the pharmaceutical approach to treating their disorder. Naltrexone and nalmefene show great promise and if they can be appropriately assimilated into the American system of treatment for alcohol abuse disorder, I believe they may eventually become the treatment of choice. I was also surprised to learn how effective Topirimate, Baclofen, and Verenicline may be. It was interesting to read how AA became the standard treatment, and how the term alcoholic grew to include those who did not feel they had lost control or that their lives had become unmanageable, but simply wanted to cut back out of a perceived decrease in quality of life. I was also surprised to learn that a regular 12 % of those attending AA were doing so due to a court order. This means that up to 12 % of those in any AA meeting may not even consider themselves alcoholics, an interesting point I think, seeing as AA prides itself on alcoholics helping alcoholics. One thing always found troubling with the treatment of alcoholism was the idea that in order to be free from the disorder, one must stpo drinking entirely. To me this always implied that recovery was never truly possible, that all control was lost one way or another, through drinking more than intended, or less than desired. I found it appreciable to read how Willenbring called having a single drink 'research', not 'relapse.' I also found it accurate, and I believe this is the appropriate mindset if we hope to alleviate the patients suffering. To not take them out of one box and put them in another, to not call them 'failure' for having a drink, but to let them see if they can stand on their own, to let them see if they can enjoy what they would perceive as a truer control over their drinking. Society portrays drinking as normal, but to excess or to abstain as abnormal. If the 'cure' to alcoholism is to never have another drink again, an alcoholic is doomed to lie always outside of societies norms the minute he declares himself an 'alcoholic.' As the article states, alcohol abuse disorder must be understood as a spectrum, and so too should be its treatment, resolution, and perceived 'cure'
Thanks for the great article, Jamil
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Post by NToor on Oct 22, 2017 12:05:06 GMT -4
I always thought AA was an effective approach towards Alcohol Abuse or dependence as it is recommended by the physicians quite often. Reading this article, was very educating how medicinal approach has been proved to be way more effective in people with Alcohol Abuse Disorder.
I believe in the mix approach of behavioural and medication treatment. One angle I always consider when I think about people who are alcohol dependent is "what lead them there?". I think if the root cause of the problem is figured out and helped with, I think the person can recover from it to a great extent, if not completely. People should be made more aware of the alternate treatments other than just AA program for alcohol abuse. But I don't think AA is completely inefficient, as for some people their faith and belief is a huge part of their lives. And it can be used concurrently with other treatments.
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Post by Eleazar Briones on Oct 24, 2017 20:39:39 GMT -4
A little tardy to this discussion thread, but I couldn't agree more that there is a place for AA and it's as an adjunct to therapy, not a stand alone treatment. Though the common goal of helping those with addiction is the same, I never considered AA as a treatment supported by the medical community and we should not be responsible for the shortcomings of a 12-step program. That said, clinicians have been blamed in the media and by patients for contributing to the opioid epidemic and whether or not it's fair, we should be well versed in the options available to those seeking help. We should not hesitate to inform patients that alcohol use disorder is covered by insurance, and that naltrexone is a suitable option for opioid addiction with several studies showing its safety as an opioid antagonist. With the myriad of treatment options and strategies, it is vital that we regain our patients’ trust by discussing what is safe and effective to help guide them to recovery.
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Post by medstudent89 on Oct 26, 2017 19:40:56 GMT -4
Brittany Assanah (UMHS)
In Gabrielle Glaser's The Irrationality of Alcoholics Anonymous she systematic shows how ineffective Alcohol Anonymous (AA) is as compared to the plethora of modern day treatments that are available. From various other therapy options to evidence based medication options Glaser refutes what has been AA monopoly on the alcoholic recovery business. Glaser's attempt to find the evidence that could possibly support AA however could have been improved if the information was researched differently. She is absolutely correct, AA as it's name states remains in the shadows for the privacy of it's participants, however I wonder what the research would have been mapping the success of patient's would are seeing psychiatrist and going to AA as their therapy. As therapy is one of findings that we record in the office we can map their success overall and how long and if they still attend meetings. Glaser's could be more right, in this day and age to think that one therapy option has dominion over all others for all patients is ridiculous and AA should be used in randomized controlled trials against patients on Naltrexone or Nalmefene.
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Post by Limaoneerm on Jan 23, 2022 15:27:53 GMT -4
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Post by Limaoneerm on Feb 9, 2022 18:08:02 GMT -4
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