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This TIME magazine reprint illustrates several important themes common
to recent media articles about addiction and addiction recovery. See my
comments after the article. The links and hilights below
are mine. - Peter Gerlach, MSW
+ + +
"This story has been updated
from its original version."
a big month for winter sports and post-Christmas sales. It's also - as
people who treat substance abuse know - a big month for drinkers who want
to quit. The holidays are over and bank accounts are thin, but addicts can't
stop partying. Many choose January to ask, at long last, for help. But what
sort of help is the most useful? (See TIME "The Year in Medicine 2008: From
A to Z.")
For decades, the primary approach to (addiction)
rehabilitation in the U.S. has been 12-step programs like
Alcoholics Anonymous (AA).
Twelve-step doctrine defines addiction in a contradictory way: as a medical problem,
like a lifelong illness, with a spiritual solution (surrendering to a higher
power). The model has become so culturally
hegemonic that it's hard for many
to imagine any other way to stop getting drunk or doing drugs - or gambling,
overeating or watching porn, for that matter.
When we see Anne Hathaway's character in the film Rachel Getting Married at
a 12-step meeting or when we watch D-list celebrities work the steps on
VH1's new reality show Celebrity Rehab Presents Sober House, it's easy to
think 12-step is not only the best way to get well, but the only way.
There's a growing body of evidence, however, that suggests that's not so.
(Read a 1940 TIME article about Alcoholics Anonymous.)
In last month's (12/08)
Substance Abuse Treatment, University of New Mexico addiction specialist
William Miller and his colleagues presented findings from two controlled
trials in which patients underwent drug treatment. Some of the patients
received spiritual guidance as part of the treatment - learning such
practices as prayer, meditation and service to others, all of which are
central to 12-step programs.
received secular psychotherapy. Because of the enduring popularity of AA and
similar pro-grams that involve a spiritual component, Miller and his team
expected the patients in the spiritual group to do better than those in the
secular group. They were wrong - at least in the short term.
While both groups eventually benefited relatively equally
from their treatment - abusing substances on fewer days - it took longer to
see improvement among those in the spiritual group. What's more, those who
received spiritual guidance reported being significantly more anxious and
depressed after four months than those who got secular help.
problems abated at about the eight-month point, but because substance
abusers are at high risk for
suicide, some worry that it may not be a good
idea to put them through demanding spiritual calisthenics in the early
months of their recovery. (Read a 2007 TIME cover story, "How We Get Addicted.")
This study amplifies a fascinating paper Miller co-authored
in 1997, which found that patients who reported knowing that someone was
praying for them used significantly more substances after leaving treatment
than those who didn't know someone was praying for them.
together, Miller's studies suggest that spirituality can be demanding - even
when others are being spiritual on your behalf - and that many addicts may
simply not be up to the pressure. For those people, non-faith-based
treatments like cognitive behavioral therapy or mindfulness-based acceptance
and commitment therapy might be better.
These challenges to addiction orthodoxy come along as
scientists and sufferers alike continue to look for a faster fix for
substance abuse. New York cardiologist Dr. Olivier Ameisen - who now lives
in France but remains a visiting professor at the State University of New
York - has authored a new book describing his recovery from alcoholism,
which was achieved with the aid of a common drug called baclofen, a
muscle-relaxant designed to prevent the spasms behind a range of conditions
from hiccups to multiple sclerosis symptoms.
is drawing a lot of attention, but it is too soon to say how effective the
drug will be for other alcoholics or how widely it will be embraced by the
addiction community. (Read a 1974 TIME cover story, "Alcoholism: New
Victims, New Treatment.")
Last month, investigators in the U.S. reported good test
results for a monthly dose of the common antidrinking drug naltrexone
- a medication that currently must be taken every day to be effective. But
naltrexone is controversial because for some, it doesn't do anything to
reduce the craving for alcohol until those addicts actually take a drink,
whereupon it helps them resist taking more - a twisted bit of physiological
irony if ever there was one. Twelve-step believers say the only proper
response to alcoholism is total abstinence, and that a drug that allows you
to drink a little puts you on a slippery slope to drinking a lot.
About 1 in 5 people with alcohol dependence stop drinking
without any treatment, according to the Diagnostic and Statistical Manual of
Mental Disorders (DSM), the field guide mental-health professionals use to
diagnose illnesses. That means we have to figure out a way to help the 80%
who won't get better through willpower. The latest evidence suggests that
those who think that spirituality or a pill alone can save them are wrong. The answer almost certainly lies
deeper inside ourselves.
This article doesn't speculate on the cause of addiction, tho it refers
to other TIME articles that may do so. It also doesn't define what "recovery
from addiction" means. It basically questions whether the traditional way
to attain sobriety thru adopting the spiritually-based 12-step philosophy is
the only way. It notes the reality that for most addicts, "willpower is not
enough" to break their toxic compulsion.
Based on research by William Miller, the article suggests that the 12-steps' reliance on belief in a Higher Power may put too
much "pressure" on some addicts compared to "secular" (non-spiritual)
therapy or some drug treatments. The article ignores a major benefit of
traditional 12-step programs, which is the world-wide fellowship and support provided
by regular non-denominational meetings
This lay article, like many in the public media, does not mention
the current clinical view that addiction is a sign of serious
just a personal problem. Currently, 12-step programs, pills, and
most conventional therapies do not treat the family - so
sobriety success rates are relatively low and relapse rates are
high. Note the article's last two sentences.
The anonymous author's suggestion that "spirituality can be demanding"
in the context of 12-step addiction recovery goes unexplained - and (in my
opinion) demonstrates the author's ignorance of his subject. Turning over
life-stressors that promote addiction to a benign, caring Higher Power is a
keystone to relieving anxiety, shame, and guilt. Note that AAAA (Atheist and
Anonymous) is practically unknown, suggesting limited recovery benefits
By not challenging the "Anonymous" label attached to most 12-step programs,
the article's author misses a chance to dispel the 5oxic old myth that addiction
is a shameful "character flaw" or "weak will." This Web site proposes that
addiction is neither of these - it is an unconscious attempt to
reduce relentless inner pain (shame + guilts + fears + hurts + hopelessness
+ confusion + overwhelm) by self-medication and/or distraction.
nothing shameful about trying to reduce inner pain!
Premise - "inner pain" results from a toxic social environment
(e.g. a dysfunctional family) and inherited psychological "wounds" from unaware
ancestors. Intentionally reducing psychological wounds
(Lesson 1 here) and
raising coping skills by applying the knowledge in
Lessons 2 thru 7
can help to pre-vent and reduce addictions.
this for more detail.
This YouTube clip proposes an updated version of the traditional 12 Steps
for Grown Wounded Children (GWCs):