Alcoholism is a growing problem worldwide. Addiction to alcohol can have serious consequences, both for the alcohol addict, and for those around them. The consequences range from health issues for the alcohol dependent individual, to the destruction of family and social relationships, and an inability to function effectively in the world of business and employment.
There are a number of definitions of what alcoholism is. Some medical professionals regard alcoholism as a disease, which can be treated by various therapeutic interventions, either in the form of medication or counseling. Others prefer to focus on the individual rather than the addiction, seeing alcohol abuse as but one example of the kind of negative or self-abusive behaviors that result from deeper psychological causes. In a recent survey of US physicians only 20% of those surveyed actually regarded alcoholism as a disease in itself, seeing it rather as symptomatic of a patient’s deeper personal problems. The same survey also revealed that 55% of physicians believed that there was essentially no cure for alcoholism.
Because there is no agreed common approach to the treatment of alcoholism that has ever emerged, there are questions around the most effective treatment. But the fact remains that there is a definite need for a range of treatments for the range of patients who suffer this serious problem.
So, what other treatments are available, do they work, and what is the evidence supporting this assertion? Apart from the AA’s 12-Step Program there are various other treatments on offer. Some of these treatments are offered in the setting of a residential rehabilitation program, and others are offered to out-patients. The advantage of residential rehabilitation is that it provides the round-the-clock care and the structured environment that can be very important to a recovering individual at this time. The advantages of outpatient alcohol rehab are that the individual can still maintain some kind of presence at work or school during the treatment; and he or she can still be near sources of support provided by family and friends. However, the treatments offered are, in many cases, the same.
For an example of an alternative approach, one promising area of ongoing research is into various drug treatments for alcoholism. The drugs are of two kinds: those that work by altering the brain chemistry so that the brain’s chemical rewards for consuming alcohol, the endorphins, do not arrive; and those that create a disturbing or uncomfortable physical response to alcohol consumption. Examples of the former are Naltrexone, which has been used for the last couple of years, and Acamprosate, undergoing trials, but not yet available for sale in the U.S. The most well-known example of the latter type is Antabuse, also known as Disulfiram. For the future, studies are now underway to try and identify the genetic make-up of receptor cells in the brain. This will help pharmacologists to tailor such drug treatments to an individual’s particular genetic inheritance. Of course, the major objection to such treatments is that they do not address an individual’s underlying reason for his alcohol abuse. In fact, most researchers agree that such treatments should form only part of a program that would include counseling and other therapies.
Another treatment that forms the backbone of most rehab programs is some form of behavioral therapy. This gives the individual a chance to come to terms with the root causes of their addiction, and to find strategies for moving forward to a healthier and more positive lifestyle. The 12-Step method promoted by groups like Alcoholics Anonymous is one sort of therapy, but the most common type used is some form of Cognitive Behavior Therapy. Cognitive Behavior Therapy focuses on the individual rather than the addiction. It aims to get the recovering addict to recognize the choices and behaviors that led to their addiction, and to develop strategies by which the individual can once more regain control over their life.
How effective are these different approaches? In their Handbook of Alcoholism Treatment Approaches: Effective Alternatives, R. K. Hester & W.R. Miller summarize the various methodologies and their effectiveness, including different alcohol rehab success rates. The top six for efficacy were: brief interventions from a trusted health professional, motivational enhancement through counselling, use of the drug Acamprosate, the community reinforcement approach (co-opting the patient’s social networks), the use of self-change manuals, and the use of the drug Naltrexone. The 12-Step approach came in 37th on this list.
It is evident that the treatment has to be tailored to the individual. There are many treatments on offer, and the choice is not always easy. What is important is for the individual concerned to get good advice and to do some research of their own first. AA is often the first port of call, and although it undoubtedly works for some people, for others, probably the majority, it may not be the best approach. For such people, it is important to know that there are alternatives available.
Furthermore, although some rehabilitation centers may make claims to the contrary, it is obviously apparent that the various different treatments do not have equal efficacy with all individuals, with some patients responding much better to alternative treatments. In fact, what data there are does not provide any incontrovertible evidence that any one treatment is better than another, at least for all patients. For example, figures compiled by Alcoholics Anonymous, probably the world’s most high-profile treatment program, reveal that 64% of their members drop out in the first year. They also reveal that 84% of AA members do not exclusively rely on the AA’s 12-Step Program promoted in its group sessions, but supplement this with outside help from various sources. In fact, 31% of AA members have been referred to AA by other treatment centers. The many people who have been cured of their alcohol addiction through AA tend to be zealous in their support for the organization, but this cannot mask the fact that, for most people, it has not worked.