Despite a lack of empirical evidence that 12-step programs work
Katie Herzog at The Stranger reports on a medication for alcohol addiction that – unlike 12-step programs – works.
Alcohol addiction is often thought of in recovery circles like AA as a moral failing, something that can be treated if you just try, and believe, hard enough. This, however, is contrary to what most research tells us about how alcohol works on human beings. Morality, if you ask scientists, has nothing to do with it.
Rather, alcohol is primed to be addictive. After it is absorbed into the bloodstream, it soon moves to the brain, where it impacts several chemicals, or neurotransmitters, including gamma-aminobutyric acid (or GABA), glutamate, and dopamine (the so-called “pleasure molecule”). The combined effect of these chemicals is that you let go of inhibitions, feel euphoric, and become relaxed but energized at the same time. It feels good in both your mind and body—at least in the beginning.
(Subjective aside – it doesn’t for me. A glass of wine is ok, but more than that is unpleasant, and euphoria is never really in the picture. I’m profoundly content with this situation, because alcohol addiction cut a wide swathe through my family.)
After repeated exposure to alcohol, things start to change: The brain starts to produce less dopamine and GABA and more glutamate. This tends to make people anxious, irritable, and depressed. You get sick and go through withdrawal. In time, you don’t drink because it feels good, you drink because not drinking starts to feel awful.
The physical effects of ongoing drinking are serious. Besides damaging major organs from the heart to the liver, long-term heavy alcohol use can do terrifying things to the mind.
Like destroying the ability to form new memories. Oh goody, artificial dementia!
Enter Naltrexone, which blocks endorphins from the brain.
The Sinclair Method, as the protocol is known, is simple: You take Naltrexone one hour before you start drinking, each and every time you drink (and preferably not on an empty stomach). Instead of feeling that familiar euphoric buzz, drinking just makes you feel kind of sloppy and muddy-headed.
…
With Naltrexone, “alcohol becomes non-reinforcing,” said Brian Noonan, a psychiatric nurse practitioner and the owner of Ballard Psychiatric Services. “With repeated trials of drinking without reward, the association of drinking with reward begins to extinguish.” The patient starts drinking less and less often. Some eventually stop altogether.
But AA still has a death grip on alcoholism treatment in the US, despite the fact that its success rate is abysmal.
AA and abstinence are still the only models most doctors in the US are taught, despite a lack of empirical evidence that 12-step programs work. Perhaps more would be interested in medicines like Naltrexone, but most have never even heard of the Sinclair Method—which, as far as I’ve been able to find, isn’t taught in any American medical schools. More than one Naltrexone patient told me they get their drugs through an online pharmacy based in India because their doctors just don’t know anything about it.
That’s millions of lives made worse that don’t need to be.
I’ve always been glad this is my experience, as well. One glass of wine with dinner, and that’s enough. And certainly not daily! But alcoholism did rear it’s ugly head among people I loved, and has had a bad impact on my life through living with addicts.
I’m glad they’re finding a treatment. Too many people struggle with the problem. I tried the AA-associated group for children of alcoholics once…I never went back. I felt ridiculous, and it seemed unlikely to make a difference for me. I have known people who swear by it, but most of them seemed to fall off the wagon sooner or later (usually sooner), and the AA groups they were in told them to cut all their loved ones out of their lives, because those were the people responsible for their addiction. Yeah, leave them alone and lonely, then they’re vulnerable, then swoop in with Jesus and slay any trace of resistance they might have.
There will be a lot of resistance to this. 12-step programs have the “virtue” of being terrific for price discrimination: free meetings in church basements with bad coffee for the masses, but extravagantly expensive (and profitable!) “treatment centers” with horseback riding and art therapy, etc. for those who can afford it. And of course, the cultists will vehemently resist the notion that taking a pill could replace allowing Jesus into your heart.
AA doesn’t DO ‘treatment.’ These articles plugging the latest wonder drug argue against a straw man. The established Treatment Industry’s practices seem mostly to be dictated by the requirements of insurance, not the actual needs of patients for 1. safe detoxing; 2. long-term rehabilitation.
Any time one of these pontificates about ’12 step treatment’ you can be sure they’re full of shit. Historically, almost all AA members had some experience of hospital detoxification. AA never built up an official position on Paraldehyde, or Antabuse, or even LSD for fuck’s sake.
Funny I’ve spent 30 years in AA (not some knockoff group) without hearing any such thing.
Do these Naltrexone fans even remember the old Raleigh Hills scheme? They ‘cured’ alcoholism by giving drunks booze laced with ipecac. Was that really different from ‘repeated trials of drinking without reward?’
There’s no shortage of bullshit in and around AA, the movement is under siege from evangelicals and the woo-woo crowd. The organization has no capacity to set and enforce policies. ANYONE can start a group and call it AA. But criticism of AA’s real defects is impossible when the actual fellowship is ignored for fantasy substitutes.
If AA doesn’t DO treatment then why is it so popular in the court system? In other words if it doesn’t do treatment why isn’t that universally known?
And what does a putative “Treatment Industry” have to do with anything? Herzog wrote about one specific medication.
You’ve spent 30 years in AA why? Because it doesn’t work? Because it does work? Because you like it?
Is there something wrong with using effective medication?
John, the problem is that many individuals are required to go to AA for “treatment” when they find themselves in the court system. You can say they don’t do “treatment”, but many people don’t see it that way. The individuals I mentioned above, my friends and family members, had not been to hospital detoxification, they had not been through any treatment of any kind, and they had no intention of getting treatment because they believed AA was treatment enough.
The hype around AA leads many people to believe it is some sort of miracle, but the actual record of its success is minimal. And the fact that you have been in there for 30 years? What sort of program to help individuals must be maintained for 30 years? I spent many years in therapy, but was ultimately recovered and able to quit going to my therapist. Closure. Another thing AA does not do, from every experience I have had with it, is closure.
And I don’t know that all AA groups suggest that your loved ones are the cause of all your problems. That’s another problem with AA. There is no real quality control.
JtD, this part of your post@3 puzzles me:
The first two sentences seem to contradict the third. If groups can vary so much, then you really have no basis for dismissing iknklast’s experiences as a “fantasy substitute” while yours is the “actual fellowship.” You’re essentially playing “No True Scotsman” while simultaneously admitting that Scots are a diverse group who put all sorts of things on their porridge.
One of the frustrations of discussing 12-step programs and possible alternatives is that AA defenders, in my experience, play a little two-step game.
When they’re refuting criticisms, they say, “well, MY group doesn’t [browbeat people about Jesus, engage in ’13th stepping’ sexual predation on newcomers, discourage people from taking medication for mental health issues, insist that anyone who got sober without AA is still a ‘dry drunk’, or that anyone who believes they’ve addressed their problem and is now drinking in moderation is either in denial or was never a ‘real’ alcoholic to begin with, etc.] There’s no centralized authority, every group is different, the 12 steps and the Big Book aren’t binding law, etc.”
But when they’re praising AA’s effectiveness, all those disclaimers and caveats and talk about a rich tapestry of diverse groups go away. It’s always “AA saved my life, and it can save yours, too!” and never “my particular group’s version of AA saved my life, and maybe if you’re lucky there’s a similarly effective group in your area.”
It becomes hard to know what we’re even talking about. What, in your view, makes something the “actual fellowship”? What elements are sufficient?
And another question: are we talking about AA as fellowship or as a way to stop being addicted to alcohol? I have zero problem with anyone who finds AA a good source of friendship and understanding and stays with it for decades for that reason. My problem is with people who brush off the very idea of medical treatment for addiction in favor of the 96% ineffective AA as normative in general.
AA is an overrated religion, and the government should not be forcing its ideology on anyone.
There are better alternatives that people do turn to, but AA fails to account for these walkouts.
A tragi-comic aside: A treatment centre for alcoholics in a town close to where I live used to issued ‘diaries’ for their clients to fill in. It was basically a sheet of A4 paper with hourly blocks printed on it, the idea being that the client would record not only the times at which they took each drink, but also the times they thought about having one but didn’t, and what they did to resist taking that drink.
The tragi-comic part? Some bright spark had decided – and obviously nobody within the organisation thought it a bad idea – to print the time-blocks over a background image of a foaming pint of beer. Just what an alcoholic needs when recording their thoughts of resisting a drink.
I’m actually surprised at the apparent success rate of the Sinclair Method. Who would take a drug shortly before drinking that’s going to ruin the effect of drinking? If you have that kind of willpower couldn’t you just not drink?
Antabuse makes sense to me, since that’s taken daily, at a time when you’re not tempted to drink, and then you can’t drink all day or you feel very sick.
But if it works, great.
AA does help some people but is statistically very ineffective. It’s just so embedded in the culture that 12 steps is how you treat drinking problems. If AA were to embrace new technologies like this that work, they could do a world of good.
I think who would take a drug shortly before drinking that’s going to ruin the effect of drinking is an addict who doesn’t want to be an addict. The thing about addiction is that will power isn’t the issue. Addiction is way too powerful for that. If I were addicted to alcohol and wanted not to be hell yes I would take a med that kneecapped the addiction.
“Skeletor-December 21, 2018 at 3:40 pm
Who would take a drug shortly before drinking that’s going to ruin the effect of drinking? If you have that kind of will power couldn’t you just not drink?”
I’m thinking it can be used to shut off a binge before a bender ensues. I think experienced alcoholics, and binge drinkers know well enough how dangerously unpleasant overdosing alcohol can be.