The 12-step program used by Alcoholics Anonymous has little basis in science, critics allege.
Investigation Questions Effectiveness of Alcoholics Anonymous
An investigation by The Atlantic shows other treatments are more effective at combating alcoholism.
Author and award-winning journalist Gabrielle Glaser has a message for people who struggle with alcohol dependence: It might be time to abstain from Alcoholics Anonymous.
The 12-step program has little basis in science, she says, after having done extensive research on the program and reporting her findings for a story in The Atlantic titled ” The Irrationality of Alcoholics Anonymous.”
“I assumed as a journalist that AA worked,” Glaser said at an Atlantic-hosted event Wednesday at the Ronald Reagan Building and International Trade Center in Washington, D.C. “But then when looking at the empirical evidence I found there wasn’t any.”
The effectiveness of AA’s approach has long been debated. But addiction treatment is likely to be even more carefully scrutinized as payment for programs materializes under coverage provided by President Barack Obama’s signature health care law, the Affordable Care Act.
Obamacare provides alcohol and substance abuse treatment to 32 million people who didn’t have it before by requiring state Medicaid programs to pay for it and by requiring private insurance plans to cover it, extending coverage to an additional 30 million people. Obamacare also allowed for behavioral health treatment, which encompasses addiction and mental health services, to be reimbursed in a similar way as primary care.
A recent analysis by U.S. News showed that the law has not yet resulted in adults going in droves to behavioral health providers.
The AA program involves admitting powerlessness over alcohol, believing in a higher power, apologizing and making amends to those wronged and abstaining from drinking. Television helped popularize the program – which had risen out of the Prohibition Era – during the 1950s. The organization has about 2 million members, and inpatient treatment facilities use many of the tenets of its 12-step program as part of their approach.
Data of its effectiveness, however, aren’t tracked.
“There is no other realm of medicine that is so segregated,” Glaser said of addiction treatment and the research around it. NA Daytona Meetings Have court mandates.
She points to other approaches that have worked and are based in scientific analysis, including therapy and medication. Glaser said she hopes people are able to find other approaches to treatment. ” Yoga works for a lot of people, Catholicism works for a lot of people … but it isn’t based in science,” Glaser said.
The National Institutes of Health estimates that 11.2 million men and 5.7 million women had an alcohol use disorder in 2012, the latest year for which data are available. Among teens, that number is estimated at 855,000. Beginning to drink at a young age can be a risk factor for developing dependence later in life. Genetics are also thought to play a role, and people who have anxiety or depression can turn to alcohol for self-medication, though it often makes symptoms worse. Excessive use of alcohol is a risk factor for cancer and heart disease. Of adults in need of treatment for alcohol abuse, 8.4 percent are admitted to a facility, according to the NIH 2012 data.
A recent report by the Centers for Disease Control and Prevention found that six people a day die of alcohol poisoning – the majority of whom are middle-aged, white men.
Officials with AA said the organization does not comment on reports like Glaser’s and declined to address other approaches to treatment. AA Daytona Dangerous Meetings.
“Alcoholics Anonymous is guided by its Twelve Traditions, one of which suggests that AA express no opinion on outside issues, in order to avoid being drawn into controversy,” the public information coordinator at the General Service Office of AA said in an email. “This includes expressing opinions on what others may say about AA.”
The National Institute on Alcohol Abuse and Alcoholism, part of the NIH, points to various approaches to treatment, including support groups like AA, behavioral therapies, medication or a combination of these. The same is true for the Substance Abuse and Mental Health Services Administration, which is part of the Department of Health and Human Services.
“SAMHSA does not advocate one program over another, since we believe there are many paths to recovery,” an agency representative said in an email.
Other methods of treatment for addiction, such as medication or cognitive behavioral therapy, have shown some empirical evidence for success. In reporting her story, Glaser decided to try naltrexone, a medication that prevents endorphins – the feel-good hormone – from reaching the brain, making the experience of drinking alcohol unenjoyable. The Food and Drug Administration approved the drug in 1994 for the treatment of alcohol abuse.
Glaser, who said in her article that she did not have a drinking problem but that she bought the drug online and tried it for research purposes, found it to be effective. “[A glass of wine] was about as appealing as drinking a glass of Dimetapp,” she said.
Doctors prefer not to prescribe naltrexone because it can result in liver toxicity if someone drinks heavily and takes more than the recommended dose, she told U.S. News after the event. “Fewer than 1 percent of people who have alcohol problems are on any form of medication, and so few doctors prescribe it,” she says.
Scott Stossel, editor at The Atlantic magazine who interviewed Glaser at the event, pointed out that alcoholism appears to be on a spectrum.
There is a problem with the one-size-fits-all approach, Glasser said of AA’s abstinence rule. “Some need to learn to moderate better, others can’t drink again,” she said.
U.S. health officials recommend typical adults over the age of 21 limit themselves to no more than one drink a day for women, and two for men. “I think our safe guidelines make people feel worse. They say, ‘What the hell!’ and people drink more,” she tells U.S. News.
Glaser points out that other countries, such as Italy, have different alcohol guidelines – as well as better health outcomes.