For several decades, people unquestioningly believed that Alcoholics Anonymous was the solution to a drinking problem. Doctors and therapists have no qualms recommending AA to alcoholic patients, and an overwhelming majority of addiction treatment programs used the 12-step program.
But recent studies are challenging the long-held beliefs on the efficacy of AA.
If you suspect that your employees have alcohol abuse problems, you may thinking Alcoholics Anonymous for employees could be the answer. But the research into this notoriously secretive organisation have yielded some surprising results.
The 12-Step Program
Alcoholics Anonymous (AA) was established in 1935 by Bill Wilson and Dr. Bob Smith. Its purpose is to help alcoholics achieve and maintain sobriety through a 12-Step Program of spiritual and character development. Throughout the years, it has expanded its presence to countries outside the United States, such as Canada, Australia, the UK and Russia.
The 12-Step Program’s central message is this: in order to be treated, one must accept that he is powerless over alcohol and will need to surrender himself to a “higher power”. Lifelong abstinence from alcohol is the only solution, and if the program does not work for you, it’s your fault to bear for being deeply flawed.
AA’s founding came at a time when very little was known about addiction, the brain and how the brain works. In fact, even until now, nowhere is the treatment less grounded in science than in the field of addiction medicine. But that missing link to actual science doesn’t seem to matter since most treatments of alcoholism today still consist of AA meetings and nothing much else.
What the numbers say about AA
By virtue of its being anonymous, it is incredibly hard to study the organisation. It does not record attendance and the attendees are, of course, anonymous. AA is very protective of its members’ anonymity and therefore restricts researchers from conducting studies on its millions of members. There really is no data that thoroughly analyses the program and conclusively shows its effectiveness in reducing alcohol dependency.
The very scant data available comes from AA’s triennial surveys, which claims that 95 percent of new AA members leave within the first year. This means that only 5 percent remain within the program, not taking into account the attrition after the first year. A study by Lance Dodes, retired Harvard Medical School psychiatry professor, also put AA’s success rate at a number between 5 and 8 percent.
Another study, this time by Dr. George E. Valliant—also a Harvard psychiatry professor, but a strong supporter of AA—followed up with 100 people who went through the 12-step program. He compared them to an untreated control group and found that between the two, there is no significant difference in the likelihood to quit and continue drinking.
This is very surprising to even doctors and psychiatrists who react with disbelief whenever they’re presented with these numbers. AA’s 12-step program has been taken as gospel truth that to speak of it so skeptically is viewed as dangerous and blasphemous.
But the fact that many people who undergo the program have had to go back to rehab multiple times and that nobody really knows if the program works at all make it worth investigating. Is it really is the best/only way to treat alcohol addiction?
The problem with AA
In The Handbook of Alcoholism Treatment Approaches (a book containing comprehensive and meticulous analysis of treatments), AA ranks only 38th out of 48 methods in effectiveness. Methods such as brief interventions by a medical professional, motivational enhancement and acamprosate (a drug that lessens cravings) top the list and yet, because of criticisms of using drugs to treat alcoholism, these methods have not gained much traction.
The AA meetings considered as treatment are structurally problematic. It’s been shown that alcohol abusers tend to suffer from mental health issues such as depression or anxiety, but AA is ill-equipped to address this.
Support group meetings are led by people who lack the professional training to be able to spot and help members suffering from these associated illnesses. The heavy focus on God also turns off people who are secular or those who do not subscribe to any faith.
AA also thinks of alcoholism in all or nothing terms—you’re either an alcoholic or you aren’t. Because of this philosophy, members are likely to binge, thinking that there is no difference between one drink and ten—in their minds, they’ve already failed anyway.
This is a problem found in any “quit cold turkey” approach: people are expected to be able to immediately stop and control the impulses they’ve honed for a long time. But high user relapse rates have shown that abstinence-only methods are ineffective in treating alcohol abuse. In fact, quitting cold turkey only intensifies the cravings.
Experts now describe alcohol abuse as existing in a spectrum. Only about 15 percent are at the severe end, but AA’s one-size-fits-all approach lumps even mild- to moderate drinkers in the same category as the hardcore abusers. This discourages people with mild- to moderate alcohol use disorders from seeking help as they are afraid of being judged and labeled as alcoholics. Also, the small percentage of really heavy drinkers who actually need individualised treatment do not get them because most addiction treatments only consist of AA.
The Sinclair Method
Despite the ubiquity of AA, one European country stands out in its effective (and at the time of introduction, controversial) approach to treatment.
Finland is a country with a culture of heavy drinking and is one of the top OECD countries in total alcohol consumption per capita (Finland ranks seventh; Australia is second).
About a million people in Finland suffer from the effects of alcohol abuse, directly and indirectly. This number is staggering considering Finland has a population of only five million. It also makes one wonder about Australia.
Finland’s alcohol abuse treatment model was largely the result of the work of American neuroscientist John David Sinclair. Sinclair moved to Helsinki to further his research in alcohol. He thought that alcohol addiction is the result of a chemical process involving endorphins. Endorphins are neurotransmitters that act like your body’s own narcotic: they help relieve pain and cause feelings of pleasure.
He hypothesised that each time one drinks, endorphins are released. These endorphins strengthen synaptic connections to opiate receptors until cravings and compulsive drinking are developed. He thought the synapses would weaken if you could block the receptors, causing the cravings to subside. He tested this out by administering opioid antagonists–drugs that block opiate receptors–to rats that were specially bred to prefer alcohol to water. In this experiment, it was found that if the rats took the drugs each time they were given alcohol, they drank less and less.
One opioid antagonist, naltrexone, was found to be safe and effective for humans. Sinclair started working with clinics in Finland, suggesting they prescribe naltrexone to patients. If regularly taken an hour before drinking, naltrexone can successfully help patients drastically reduce their drinking, and in some cases, stop drinking completely.
Sinclair co-founded the Contral Clinics, a private treatment center in Finland which utilised his research and subsequent studies on opioid antagonists in their treatment program. Contral Clinics’ outpatient treatment program incorporates the use of medication (naltrexone or nalmefene) and cognitive behavioral therapy. They have operated for nearly 18 years and boast a seventy-eight percent success in reducing their patients’ drinking to safe levels.
Change is possible
It’s strange to think that better treatments have already been developed and are already being used for decades, yet people still cling to the one that is not rooted in science. Some private rehabilitation clinics even charge tens of thousands of dollars for treatments that offer nothing more than AA sessions.
But this is changing as more scientists and doctors are leading the charge. In spite of the resistance from traditionalists and therapists who view AA as the panacea to alcohol abuse disorders, the scientific community is raising the awareness of science-based treatments.
There should be more options for people suffering from alcohol-use disorders because abstinence-only self-help methods do not work for everyone. The Australian government, in its guideline for the treatment of alcohol problems, already describes a combination of psychiatric, psychosocial and medical interventions in its treatment planning. This is great for Australia.
How to deal with alcohol at work
Do you have reason to believe some of your employees may have an issue with alcohol consumption? Contact us today for a confidential discussion on how we can help discover any alcohol related problems at your workplace, so they can be dealt with effectively for all parties involved.