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Doctors, AA Struggle to Find Common Ground

Posted in Alcoholism Treatment

Doctors, AA Struggle to Find Common GroundFor nearly 80 years, Alcoholics Anonymous (AA) has been seen as the ultimate authority on alcohol abuse and addiction recovery in the United States. The organization has inspired worldwide popularity of the 12-step recovery model, which has been adapted and applied to many kinds of addiction over the years.

However, AA has never been free of criticism. Since its early days, some patients and doctors have felt that the frequent invocation of a God or a higher power in the 12 steps makes the program less accessible and effective for alcoholics who do not have compatible beliefs. These critics feel that an addiction recovery program should be free from religious bias.

In more recent years, some doctors have also begun to criticize other tenets of the AA philosophy. They have protested that AA discourages the use of medications for treating addictions, and they have also begun to push back against the idea that complete abstinence is the only solution for all alcoholics. These doctors feel that AA refuses to adapt when it comes to these approaches, and thereby discourages some alcoholics from receiving the best treatment.

In reality, AA may not be quite as inflexible on the topic of medication as its detractors sometimes claim. Recent surveys of the more than 1 million AA members in the United States have found that only 20 percent oppose prescription medications as a component of addiction treatment. Recovery without medication is not absolutely ingrained in the AA approach to recovery. However, opponents of prescription medications in the AA community are vocal and influential, so resentment on the part of doctors about resistance to what they hope will be revolutionary approaches is also understandable.

A Reasonable Lack of Trust?

Whether the voices in AA that disapprove of anti-addiction medications represent a minority, their distrust of the medication approach is not without foundation. Science and the medical profession have a long history of using different medications to fight addiction, and most of their historic attempts have been spectacular failures. Ranging from the merely ineffectual to the genuinely harmful, addiction medications as recently as the 1980s were not shining moments for modern medicine.

The once famous, now infamous, Dr. Leslie Keeley treated patients in the late 1800s with his Double Chloride of Gold cure, intended to treat alcohol, tobacco and drug addictions. The treatment became so well known that over 500,000 patients submitted to the cure, despite the fact that it was entirely ineffective. Many of Dr. Keeley’s patients ended up going insane, and a cause-and-effect relationship was strongly implied if never proven.

Throughout the 20th century, doctors tried drugs such as morphine, marijuana, cocaine, steroids and barbiturates to treat alcoholism or the symptoms of alcohol withdrawal. Patients treated with drugs like Valium – wrongly believed to be non-addictive – often ended up with multiple addictions instead of a cure for their alcoholism.

However, proponents of prescription medications point out that scientific understanding of addiction has improved immeasurably in the last 30 years. They claim that evidence-based approaches and long drug trials are now used to ensure, as much as possible, the efficacy and safety of drugs before they are approved for certain uses. Science now understands much about the mechanisms of addiction, and can target different aspects to disrupt the addiction cycle.

The three drugs currently approved by the Food and Drug Administration for addiction treatment are disulfiram, acamprosate and naltrexone. These drugs have been found to be non-addictive, eliminating the risk of creating a second layer of addiction in alcoholics. Disulfiram prevents the body from breaking down alcohol, causing patients to feel ill whenever they drink. Acamprosate helps to ease the often-painful symptoms of withdrawal. Naltrexone interferes with the receptors in the brain that make drinking alcohol feel good.

Abstinence vs. Moderation

The argument over whether some alcoholics can continue to drink in moderation is even more hotly contested. Unlike opposition to medications, a total abstinence approach has long been a fundamental element of the AA philosophy. The organization promotes the idea that alcoholics will always be alcoholics, and can only control their drinking by staying away from alcohol completely.

However, many doctors now believe that some alcoholics can continue to drink moderate amounts with the help of a drug like naltrexone. Without the high that alcohol normally creates, these patients should, in theory, be able to regulate their drinking.

The reality is that the world of alcohol addiction and abuse treatment probably needs AA and other group support programs, as well as the latest advances in medicine. Neither approach, so far, has been able to demonstrate that it has all the answers. AA has many devoted members and tremendous anecdotal support for its methods, but little hard data from studies that prove its effectiveness. Meanwhile, studies on the effectiveness of the three approved medications have shown statistically significant but otherwise modest improvement among patients who have taken them.