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Medicine is an Important Part of Addiction Recovery
See update below.
Alcoholics Anonymous (AA) is such a part of American culture that even those of us untouched by alcoholism [1] know some of the basic principles of the AA approach. In fact AA is popular enough that the Church has modeled its Addiction Recovery Program (ARP) after it, as stated in the ARP guide. So The Atlantic got my attention when I saw the title of a new article, The Irrationality of Alcoholics Anonymous, and I was a little surprised by what I read. Here are a few excerpts that, together, summarize the article.
The problem is that nothing about the 12-step approach draws on modern science: not the character building, not the tough love, not even the standard 28-day rehab stay.----------
The 12 steps are so deeply ingrained in the United States that many people, including doctors and therapists, believe attending meetings, earning one’s sobriety chips, and never taking another sip of alcohol is the only way to get better. Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment. But although few people seem to realize it, there are alternatives, including prescription drugs and therapies that aim to help patients learn to drink in moderation. Unlike Alcoholics Anonymous, these methods are based on modern science and have been proved, in randomized, controlled studies, to work.----------
Bill Wilson, AA’s founding father, was right when he insisted, 80 years ago, that alcohol dependence is an illness, not a moral failing. Why, then, do we so rarely treat it medically? It’s a question I’ve heard many times from researchers and clinicians. “Alcohol- and substance-use disorders are the realm of medicine,” McLellan says. “This is not the realm of priests.”----------
Although AA claims a success rate of 75%, another estimate suggests it is closer to 5 - 8%.
We’ve grown so accustomed to testimonials from those who say AA saved their life that we take the program’s efficacy as an article of faith. Rarely do we hear from those for whom 12-step treatment doesn’t work. But think about it: How many celebrities can you name who bounced in and out of rehab without ever getting better? Why do we assume they failed the program, rather than that the program failed them?
In the October 1989 General Conference, Elder Boyd K. Packer said the following:
It is my conviction, and my constant prayer, that there will come through research, through inspiration to scientists if need be, the power to conquer narcotic addiction through the same means which cause it. I plead with all of you to earnestly pray that somewhere, somehow, the way will be discovered to erase addiction in the human body.
As discussed by the article, there are several medical drugs available that can help relieve the urge to drink--or to drink heavily--although they are not effective for everyone. Unfortunately, however, I am unable to find any encouragement in the Church's ARP guide for afflicted persons to seek medical treatment. That seems to me like an important omission. Tackling addiction issues using Gospel principles is great, but as Elder Dallin H. Oaks has reminded us,
Latter-day Saints believe in applying the best available scientific knowledge and techniques. We use nutrition, exercise, and other practices to preserve health, and we enlist the help of healing practitioners, such as physicians and surgeons, to restore health. The use of medical science is not at odds with our prayers of faith and our reliance on priesthood blessings.
I'm not qualified to render judgment on 12-step programs; they obviously do help some people. For its part, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (part of the National Institutes of Health (NIH)) recommends social support, including joining AA or a similar program, as a part of recovery efforts.
I guess the bottom line is this: People with substance addictions should, by all means, join support groups like AA or the Church's ARP program. But chances for improvement are best if medical help is also sought. Chemistry caused the problem; it can also be part of the solution.
[3/21/15] Update: For some push-back on the Atlantic article, see Why Alcoholics Anonymous Works.
Notes:
1. Disclaimer: To my knowledge, nobody close to me has (or has had) a substance addiction, so I have little personal experience with these issues.
7 comments:
Interesting essay. I think the one thing that really stood out to me was the statement that these medicine based therapies "help patients learn to drink in moderation." I have not personal experience with addiction programs, but they have always seemed to come across as aiming for "complete abstinence". While I completely agree with the LDS practice of aiming for complete abstinence from alcohol, I sometimes wonder if our emphasis on abstinence creates too much of a dichotomy -- either you are completely abstinent or you must be addicted. Perhaps our view of what constitutes "addiction" needs to be separate from our view of the WoW which calls for complete abstinence.
Jared and Dave both make great points. Section 89 allows for the use of beer. Complete abstinence was a later innovation that has done a disservice to later generations of Mormons who take an all-or-nothing approach and struggle with guilt and relapse when perfection isn't achieved.
There are so many things wrong with the church's ARP that I wouldn't know where to begin. Among these are the fact that it takes a therapy for a particular problem, which hasn't even been shown to be efficacious in the treatment of that problem, and applies it to a variety of different problems. It's like someone seeing that blood-letting is used by some people to treat bubonic plague, so he decides to use it to treat typhoid and syphilis as well. And then there's the irksome tendency to define addiction broadly as any bad habit...
Dave, I agree with you. A moderate drinker may not be ready to get a temple recommend, but they are surely better off than a heavy one. I would guess that if you can move someone from heavy to moderate, the heaviest lifting has been done.
Paul, good points. I have no reason to doubt that ARP can be helpful, but if people don't use all the tools available they are handicapping themselves.
I think people handicap themselves if they settle for the placebo effect. It inhibits the search for better solutions. Then there's always the possibility that the therapy does more harm than placebo. Unlike you, Jared, I have many relatives with alcohol or drug addiction. Some of them have participated in AA with no obvious benefit. In the case of my sister, AA became a cult.
My dad did the whole AA/rehab thing and it never came close to working. One theory is that he was self-medicating for another mental condition (bipolar?). When he stayed sober, the underlying condition remained untreated, perhaps resulting in unbearable psychological pain, leading him to drink again. AA isn't trying to cure bipolar disorder, so its approach can't possibly succeed under such a scenario. A medical treatment of bipolar disorder, however, could work wonders.
So what do you do if somebody gets addicted to the drugs treating the addiction?
I don't think addiction, per se, is an issue with the alcohol drugs. But even if it were, dependence on a drug that enables you to get out of the grasp of more harmful drugs is still an improvement. Further, people are dependent on all kinds of drugs for all kinds of different diseases. If we accept that alcoholism is a real disease, then taking medicine to keep away from it is no different in principle than any other mental illness drug.
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