The Irrationality of Alcoholics Anonymous

http://www.theatlantic.com/features/archive/2015/03/the-irrationality-of-alcoholics-anonymous/386255/?src=longreads

Nowhere in the field of medicine is treatment less grounded in modern science. A 2012 report by the National Center on Addiction and Substance Abuse at Columbia University compared the current state of addiction medicine to general medicine in the early 1900s, when quacks worked alongside graduates of leading medical schools. The American Medical Association estimates that out of nearly 1 million doctors in the United States, only 582 identify themselves as addiction specialists. (The Columbia report notes that there may be additional doctors who have a subspecialty in addiction.) Most treatment providers carry the credential of addiction counselor or substance-abuse counselor, for which many states require little more than a high-school diploma or a GED. Many counselors are in recovery themselves. The report stated: “The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.”

This begs the question:  Dr. Kolodny, are you a drug addict in recovery?

Alcoholics Anonymous was established in 1935, when knowledge of the brain was in its infancy…

A meticulous analysis of treatments, published more than a decade ago in The Handbook of Alcoholism Treatment Approaches but still considered one of the most comprehensive comparisons, ranks AA 38th out of 48 methods…

AA truisms have so infiltrated our culture that many people believe heavy drinkers cannot recover before they “hit bottom.” Researchers I’ve talked with say that’s akin to offering antidepressants only to those who have attempted suicide, or prescribing insulin only after a patient has lapsed into a diabetic coma…

Part of the problem is our one-size-fits-all approach…

Sinclair called this the alcohol-deprivation effect, and his laboratory results, which have since been confirmed by many other studies, suggested a fundamental flaw in abstinence-based treatment: going cold turkey only intensifies cravings. This discovery helped explain why relapses are common…

I didn’t mention that some bare-bones facilities charge as much as $40,000 a month and offer no treatment beyond AA sessions led by minimally qualified counselors…

In 1934, just after Prohibition’s repeal, a failed stockbroker named Bill Wilson staggered into a Manhattan hospital. Wilson was known to drink two quarts of whiskey a day, a habit he’d attempted to kick many times. He was given the hallucinogen belladonna, an experimental treatment for addictions, and from his hospital bed he called out to God to loosen alcohol’s grip. He reported seeing a flash of light and feeling a serenity he had never before experienced. He quit booze for good. The next year, he co-founded Alcoholics Anonymous…

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…

Still, science can’t yet fully explain why some heavy drinkers become physiologically dependent on alcohol and others don’t, or why some recover while others f[l]ounder…

What if it’s in the tastebuds?  Part of the reason some people don’t drink is because of the taste of alcohol, which could be described as an “acquired” taste.  And one reason some people love beer and wine is because, to them, they taste good.  But people like different foods and have different tastes — I dunno, there seems to be some kind of connection there…

There is no mandatory national certification exam for addiction counselors. The 2012 Columbia University report on addiction medicine found that only six states required alcohol- and substance-abuse counselors to have at least a bachelor’s degree and that only one state, Vermont, required a master’s degree. Fourteen states had no license requirements whatsoever—not even a GED or an introductory training course was necessary—and yet counselors are often called on by the judicial system and medical boards to give expert opinions on their clients’ prospects for recovery…

“What’s wrong,” he asked me rhetorically, “with people with no qualifications or talents—other than being recovering alcoholics—being licensed as professionals with decision-making authority over whether you are imprisoned or lose your medical license? …

Reid K. Hester, a psychologist and the director of research at Behavior Therapy Associates, an organization of psychologists in Albuquerque…

It seems like New Mexico is a state where all forms of treatment for addiction can be found, and yet that hasn’t made the problems of alcohol and drug addiction any better.  I guess it all comes down to affordability and easy access to treatment, along with the biases some patients have about their own addictions.  Of course, sustainable jobs is one of the only things that really makes a difference in how people use and abuse drugs.

13 thoughts on “The Irrationality of Alcoholics Anonymous

  1. Interesting read. It made me think about a friend of mine who has bipolar disorder and she’s addicted to gambling and shopping, so much so that she will only have $1 in her bank account. Which is very bad considering she has a 10 year old. I have tried to help her, she has counsellors. It’s VERY frustrating to see someone whose addictions are causing so much havoc.

    And the thing is I can’t help her. So I agree that substance addictions among other kinds of addictions need a more comprehensive treatment plan. It all seems to be pointing in the direction of neuroscience.

    Liked by 1 person

  2. The worst is the dumbing down of psychiatry as a result of the failure to actually “integrate” substance abuse treatment into mental health. Or was it dumbed down because people who enter psychiatry for profit are just stupider than the men and women who are curious about the mind
    and actually want to learn how to heal people.

    I’ve decided that I have nothing but disdain for what I see as the laziness of Behaviorism.

    Any psychiatrist who thinks that pushing pills and the 12 steps is the same as practicing psychiatry is an idiot.

    Liked by 1 person

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