Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states
Here at Mental Help Net and elsewhere on the Internet there is a stormy controversy over the issue of Alcoholics Anonymous (AA). The two major sides in this oftentimes contentious debate view AA either as a religious cult that does a lot of damage or an effective and helpful medium for those struggling with their addiction. All sides report their personal experiences as well as things they have read through their own researches. Now, there is additional evidence for everyone to consider in this hot debate.
Alcoholism is an extremely serious problem in the United States and worldwide. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA)nine percent of the U.S. population match the criteria for alcohol dependence and alcohol abuse. Of those who receive treatment, more than 50% relapse two to four years after treatment.
As NIAAA states, it is also an extremely complex problem with multiple variables that determine why people become addicted. Some variables include: severity of alcohol involvement, cognitive impairment, psychiatric severity, gender, meaning-seeking, motivational readiness to change, social support for drinking versus abstinence, sociopathy, and typology of alcoholism.
John F. Kelly, PhD, associate director of the Massachusetts General Hospital (MGH) Center for Addiction Medicine led a team of researchers in the study of AA participants. The results showed that those participants who attended AA more frequently experienced a reduced incidence of depression and a reduced amount of drinking. “Perhaps the social aspects of AA helps people feel better psychologically and emotionally as well as stop drinking,” according to Dr. Kelly.
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The research team also used data collected from a large project done by National Institute on Alcohol Abuse and Alcoholism (NIAAA) called “Project Match.” In the Project Match study, it was found that most of the participants experienced high levels of depression at the outset. However, the depressive symptoms were greatly reduced soon after the study began and remained low afterwards.
The purpose of the Project Match study was to see if matching an individual’s psychiatric diagnosis to a specific type of alcohol treatment would improve the results in terms of maintaining sobriety. This did not prove correct. However, it was found that the quality of treatment has a lot to do with recovery from addiction.
It must be pointed out the Project Match was very careful to say that AA is NOT a treatment for alcohol addiction. According to Project Match, “Alcoholics Anonymous, is a mutual support fellowship rather than a formal treatment.”
At the same time, they stressed the point that there are treatment programs that use the 12 step process started by AA. A twelve step process was one of the treatment modalities used in Project Match. The others were Cognitive Behavioral Therapy based on Social Learning Theory, and Motivational Enhancement Therapy.
All participants in the study improved with fewer symptoms of depression and longer years of abstinence. However, those who participated in the 12 step treatment program showed the highest level of improvement including abstinence. Still, the researchers believe it was the overall quality of treatment in all three categories that made the biggest difference. All participants attended AA meetings.
To quote Dr. Kelly, “Some critics of AA have claimed that the organization’s emphasis on ‘powerlessness’ against alcohol use and the need to work on ‘character defects’ cultivates a pessimistic world view, but this suggests the opposite is true. AA is a complex social organization with many mechanisms of action that probably differ for different people and change over time. Most treatment programs refer patients to AA or similar 12-step groups, and now clinicians can tell patients that, along with supporting abstinence, attending meetings can help improve their mood. Who wouldn’t want that?”
Studies of alcoholism are not over. Among the problems that will be studied are the combinations of treatments along with the new medications designed to treat this addiction.
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There are those who state that alcoholism eventually cures itself without any intervention needed from anyone. This is said by those who were able to reach and maintain abstinence by themselves. However, there are some real dangers connected with this philosophy. Even if there is truth to this assertion, there are too many people who die of alcohol related diseases and accidents. Alcohol harms the liver, brain and increases the risk of various cancers. The addiction makes life difficult not only for the individuals with the addiction, but for their friends, families, wives and children as well. There are multiple cases of domestic violence traceable to having been drunk and out of control at the time of the violence. Finally, there continue to be too many cases of DUI and fatal crashes due to the misuse of alcohol.
It seems logical to me that, if a person is getting treatment in the form of psychotherapy and needs the added support of something like to help remain abstinent, then it is worth the time and investment. Since AA costs nothing, the investment becomes even more meaningful.
I know this article will stir controversy. Once again, my hope is that people will be respectful while submitting their opinions and experiences with this important issue.
Your comments are welcome and encouraged.
Allan N. Schwartz, PhD
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