AA, Alcoholism and Medical Science
AA never really opened up a channel for two way communication with the medical community.
By Brent P.
My name is Brent and I’m an alcoholic, crack addict and opioid addict. So, in a nutshell, nobody special. But in qualifying as an alcoholic and addict (one in the same in my experience) I have done a lot of homework on the subject in a desperate effort to stop relapsing.
Almost 6 years clean and sober as I write this in April of 2016, I was, and I stress “was”, one of those unfortunates who felt worse the longer he stayed sober. Worse in what ways? Damned if I knew but what I did know was, in 30 years of going in and out of AA, somewhere in and among the five one year medallions and two fivers, there was a part of me that couldn’t live sober.
Call me a slow learner but the truth was, in addition to the obvious, I was suffering from crippling anxiety that was going untreated in AA not to mention those periods where, for months on end I’d stay in bed 22 hours a day consumed by the overwhelming existential question, What’s the point? But I didn’t know what to call these things that saw me perpetually self medicating in an effort to appear and feel normal. Trouble was, I eventually over shot the mark and I was so addicted to different substances, my mind was so distorted, that pouring a glass of water seemed impossibly difficult to execute.
Today I know I have an anxiety disorder with panic, ADD and depression. So with my sobriety being reinforced and supported by AA, it is with great joy that I report, the past six years have seen me grow stronger, happier, more serene, more tolerant and conscious of others.
And I believe the reason for that is, I go to an addiction doctor who works at a facility at the forefront of Addiction & Mental Health treatment and research. There I’ve developed a strong doctor/patient relationship with an addiction M.D. who herself is an admitted addict/alcoholic and member of AA. After numerous tests I now receive medication for anxiety and depression, those things that made life unbearable unless I medicated myself. The drugs I had chosen, however, caused me brain damage and a liver that was verging on a shut down.
FULL DISCLOSURE: I am not secretly a physician or research scientist. I flunked math and chemistry in high school.
Putting AA into Context
AA’s been helping alcoholics achieve sustained abstinence from alcohol since 1935. It was born of the most simple premise; one alcoholic helping another to put the bottle down and then, through regular attendance at meetings, be supported enough not to take one drink, one day at a time. An infallible recipe for success if adopted and practiced.
Each alcoholic who got sober following those simple directions lent credibility to AA meaning AA eventually counted, in the fold, millions of desperate alcoholics, worldwide, who’d sought relief from their life and soul destroying relationship to alcohol. By 1939, the publication of Alcoholics Anonymous, better known as The Big Book, saw the codification of The 12 Steps that today are universally recognized.
While God had always had a place in the program, by 1939, with mere hundreds sober and too many failures to count, God had become central to the essential spiritual experience that apparently explained this small knot of incorrigible drunks in and around New York City and Akron, Ohio, who’d stopped and stayed stopped. Though this in no way represented what might be deemed a medical or psycho-social approach to treating alcoholism, physicians still regularly referred their alcoholic patients to AA.
Perhaps AA Just Wasn’t Enough
For countless alcoholics AA’s modest approach to addressing a disorder that had otherwise confounded our greatest minds, was the only medicine they required. For many though the AA approach sounded far too simple. Don’t drink for one day, every day – uh, duh, right. If it was that easy I wouldn’t be here. While AA would suggest an alcoholic with that attitude really wasn’t ready – it was entirely possible they recognized their drinking was abnormal but they also might have sensed there was a little more to what was bothering them than just the drink – so they didn’t stick around long enough to give it a try.
As time went on however, even seriously committed sober alcoholics questioned AA’s insistence on members accepting God as their Higher Power and this “spiritual experience” so essential to lasting sobriety. What long time members had simply come to accept, despite certain silent misgivings, others saw as the narrowing of the gateway to AA.
Failing to stay apace with growing secularism and the contributions medical science was making to our understanding of our lethal disorder, desirable candidates for membership were being turned off and away. Citing chapter and verse of the Big Book, many argued the language of the Book itself was capable of conjuring images of medieval times when priests believed the alcoholic so morally corrupt the only explanation for his behavior was that he was possessed by demons or by Satan himself.
Needless to say, otherwise intelligent, discerning alcoholics giving AA a test drive simply wouldn’t or couldn’t accept the proposition, “no human power could have relieved us of our alcoholism”, especially when many knew alcoholics who had gotten sober without achieving a spiritual experience or seeking God. Who’d gotten sober without AA. The secular bedrock that AA had been built on, one alcoholic helping another to not take one drink one day at a time, had lost out to the conversion process that were the 12 Steps. The irony is, one alcoholic helping another is a timeless, ridiculously simple and irrefutable equation while anything to do with God and religion* is always contentious and open to speculation and conjecture.
*As much as AA refutes any religious associations it is nigh on impossible for the word God to be used as frequently as it is in AA’s only text and expect readers to grasp that the organization is only using that word as a metaphysical reference point. God is a Judeo/Christian construct, the Almighty Creator of everything. An awe inspiring deity who deserves our reverence and complete devotion. With God and the religions and religionists so central to the histories of Europe and North America, one cannot, in the cavalier, not to mention, sacrilegious manner AA does, suggest that if God is too hard for you or me to accept, that, in a pinch, a door handle will do. Does that mean an alternate designation for AA might be, The Church of the Divine Dipsomaniacs of the Door Handle?
When Religion was Medicine
Worth noting is, starting in ancient times, the priest, man’s conduit to the Almighty Power, was, de facto, the one who could petition God on our behalf to commission miracle cures. On the other hand, the earliest practitioners of “medicine” within pagan communities were shamans, men whose deep knowledge of the spirit world led them to the natural world of plants, roots and berries, substances that could be used in potions and compresses to treat the sick.
In retrospect, the shamans had it all over the priests because, in addition to the ritualistic summoning of spirits (the church had one, the pagans had hundreds), they also relied on the healing properties of nature with its abundance of natural medicines. Shamanism was the unintentional forebear of medicine as a distinct and ever more scientifically based approach to curing illnesses.
There are few today, including men of the cloth, who don’t accept that doctors and scientists have made the greatest strides in treating and, in some cases, curing disease. It is the rare individual who is so staunch in her faith that she would trust her life threatening heart arrhythmia to God rather than the proven-effective pacemaker a surgeon would install. But they do exist. In 2016, some religions, practicing in modern society, strict in their beliefs and practices, would have children die rather than receive a life saving blood transfusion.
AA & The Shaming of the Alcoholic
With millions sober within AA and who knows how many who’d achieved the same abstinence by other methods, society still looks down on alcoholics and addicts as self destructive, debauched, lowlifes, believing all that was required to stop with the drinking was a good tug on the boot straps and the assumption of personal responsibility. This was the decades old, prevailing attitude towards alcoholics that AA claimed to disavow.
However it did so with little success since anybody who bothered to seriously investigate its claim that alcoholism was indeed a disease, were confused by words and phrases like “taking a moral inventory”, “we were entirely ready to have God remove all our defects of character”, “spiritual awakening” and a “conscious contact with God”. Nobody made alcoholism sound more like a moral/spiritual failing, with its “defects of character” and “shortcomings” than AA itself.
These were the ingredients for a séance in a dark room rather than something that would lead to a deeper understanding of ourselves and what ailed us. It was, in fact a conflicting proposition: Alcoholism is a disease not a moral failing but our suggested treatment is the acceptance of God, confession, the acceptance of our moral defects and atonement by identifying each person we’d ever resented and paying them a visit to admit that we are alcoholics living in a different way. Even though there were many credible folks willing to defend and explain AA, it was nigh on impossible for the most open minded outsider to view the program as anything but a sort of moral/religious form of voodooism.
Change is Inevitable When You Decide You’re Not Changing
As time marched on we entered a new millennium, one that was being marked by such prolific and, often, overwhelming advances in access to information and the technology that provided warp time access to that information. Now some resist change right down to the last cell of their being. And sometimes they were right to resist.
But the kind of change that really was a succession of Big Bangs in the 1990’s and the early 2000’s was impossible to resist and somehow it seemed foolish to try.
Regardless, we either had to reconsider the world we lived in, how we were going to live in it while, at the same time, figure out what adjustments we personally needed to make to ensure that we got the most out of the dawning of a new age.
By virtue of AA making no concession to change in accordance with the times, it actually did change, but not for the better as it remained entrenched in 1939. If members were starting to feel it, others openly held AA up as a relic, a perfect example of the collateral damage that change could inflict on those not open to it.
Fewer people were joining and its overall numbers showed a decrease.
Not a single word in the book that once was the last word on alcoholism, changed.
One might have thought that at least ,“The Doctor’s Opinion”, written by the long suffering, saintly Dr. William Silkworth, in the early thirties in the very first edition, might have been replaced in each subsequent edition with a new Doctor’s Opinion, the opinion of a doctor who was practicing at the time the new editions were released. But AA liked the sentiments Dr. Silkworth expressed even though he admitted he really didn’t know what exactly was up with AA, if it was getting people sober it was alright by him.
Addiction, as it is now generally recognized by a majority of the scientific/medical community dedicated to understanding and treating the disorder: It is a biochemical and neurological disorder that resides in the brain. A disorder the essential doctor’s text, (the DSM V – Diagnostic & Statistical Manual, edition 5), states is preponderantly accompanied by the mental/mood disorders of crippling anxiety, depression and even bi-polar disease – there are likely more but these are among the most common.
That discovery, the fact that almost all people suffering from alcoholism/addiction are also suffering from a mental/mood disorder is the first insight to provide a possible A + B = Alcoholism style equation. That means the possibilities for effective treatment increase exponentially.
To be fair this is a broad conclusion for such things like the reduced numbers of neuro-receptor sites common in the alcoholic, how the brain gets deceived by the abundance of neurotransmitters that booze and drugs stimulate and how that deception explains craving beyond the alcoholic’s control. The deceived brain believes drugs and alcohol are as essential to our well being as food and water. Described in that fashion, it’s evident that “craving” understates the demand order the brain sends out to the alcoholic/addict, for more.
Nevertheless it could appear that all science and medicine have done is give names and explanations to what we all know remains a vexing problem. But in knowing what is happening in the brain of the alcoholic, particularly if much of his/her drinking is self medicating concurrent mental/mood disorders, separate and specific treatment for each of those disorders can do wonders in helping the alcoholic remain sober.
The only people who can make those determinations and treat them are physicians and/or psychiatrists. And it is they who decide whether medication (a very contentious issue in AA) is a key component in treatment.
However, with respect to AA and what it believes is true about alcoholism and how it ought to be treated, this fact is underscored, AA is not a diagnostic service. AA does not dispense any sort of medical advice but it’s members aren’t always as restrained. Well meaning though they may be, it is key that any and all physiological and/or psychological complaints be evaluated by a doctor, ideally a doctor who either specializes in Addiction Medicine or is well educated to the signs and signals. Do not accept solely the advice of any AA member when it comes to issues of your physical and psychological health.
Concurrent Disorders & Treatments
Now it’s time to turn to the experts. We’ll start with a definition of addiction (which includes alcoholism) as supplied by the National Institute of Drug Abuse (NIDA). Heavily endowed by the US government, NIDA, whose mission is, “To bring the power of science to bear on drug abuse and addiction”, primarily supports and contributes to active, credible addiction research projects throughout the world while also originating its own research efforts. The Institute’s Director is Dr. Laura Volkow.
Addiction: Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug (alcohol) seeking and use, despite harmful consequences. It is considered a brain disease because drugs (alcohol) change the brain; they change its structure and how it works. These brain changes can be long lasting and can lead to many harmful, often self-destructive, behaviors. (per NIDA)
There are two breakthrough scientific insights I’ve more than alluded to. They are:
- Common neurological anomalies in the brain of the alcoholic/addict
- The high probability of concurrent mental/mood disorders the alcoholic/addict is likely to display in addition to their alcoholism.
My story of alcoholism and drug addiction, as I’ve already stated, didn’t turn around until I was diagnosed with and treated for Anxiety w/Panic Disorder and Clinical Depression. The treatment I receive from my doctor at the Addiction & Mental Health Institute I attend, the treatment that works for me, comes in the form of medication. I also engage in Talk Therapy with my doctor, meditate and, to really buttress my abstinence and remain positive, I attend my AA group with regularity.
And, nearly six years on, I believe I’ve never been better in my life, but that comes courtesy of a professional recognizing and treating all that has been wrong with me in addition to just my addictions.
So in an effort to be more specific about how professionals now perceive the addict/alcoholic and treat them, I turn once again to NIDA. It explains the phenomenon of concurrent disorders under the broader title of comorbidity.
Comorbidity – To help explain this comorbidity, we need to first recognize that drug/alcohol addiction is a mental illness. It is a complex brain disease characterized by compulsive, at times uncontrollable drug/alcohol craving, seeking, and use despite devastating consequences— behaviors that stem from drug/alcohol-induced changes in brain structure and function. These changes occur in some of the same brain areas that are disrupted in other mental disorders, such as depression, anxiety, or schizophrenia. It is therefore not surprising that population surveys show a high rate of co-occurrence or, comorbidity, between drug addiction and other mental illnesses. While we cannot always prove a connection or causality, we do know that certain mental disorders are established risk factors for subsequent drug abuse— and vice versa. It is often difficult to disentangle the overlapping symptoms of drug addiction and other mental illnesses, making diagnosis and treatment complex. Correct diagnosis is critical to ensuring appropriate and effective treatment. Ignorance of or failure to treat a comorbid disorder can jeopardize a patient’s chance of recovery. We hope that our enhanced understanding of the common genetic, environmental, and neural bases of these disorders—and the dissemination of this information—will lead to improved treatments for comorbidity and will diminish the social stigma that makes patients reluctant to seek the treatment they need.
– Nora D. Volkow, M.D. Director National Institute on Drug Abuse
NIDA & Treatment for The Comorbid Alcoholic/Addict
NIDA breaks treatment down into two broad categories that themselves can overlap.
The first is Medication Therapies and the second, Behavioral Therapies.
With medications there is general agreement between the communities of Science & Medicine that while there has been great success with certain medications as they relate to certain addictions and a concurrent mood disorder, much more work remains to be done in this area.
Behavioral Therapies like, for example, CBT (Cognitive Behavioral Therapy) on its own, or combined with medication, have been the cornerstone of successful outcomes for patients with Anxiety and Depression on their own. The same cannot be said for behavioral therapies and substance abuse. There have been times when substance abusers have responded well to CBT, but until the idea of comorbidity came along, the very general approach of “talk therapy” with addicts didn’t seem to work particularly well.
Here are some newer Behavioral Therapies that have shown great promise:
- Therapeutic Communities (TCs) – These are “re-socialization” homes, where facilitators help the marginalized – former inmates, the homeless, women who need protection from especially harsh conditions, vulnerable youth – get everything from access to vocational training to proper health care.
- Active Community Treatment (ACT) – ACT programs integrate the behavioral treatment of severe mental disorders like schizophrenia and substance abuse disorders. It is a very personalized treatment model that allows for smaller caseloads for doctors meaning a more assertive approach to sustaining contact with patients.
- Dialectical Behavior Therapy (DBT) – This therapy is designed specifically to reduce “self harm” behaviors like cutting, self mutilation, suicide attempts, thoughts or urges. It is effective for people who meet the criteria for borderline personality disorder.
- Exposure Therapy – For patients with anxiety and panic, PTSD and trauma, Exposure Therapy repeatedly exposes that person, in a tightly controlled and contained clinical setting, to the feared situation or object, traumatic event or memory, in an effort to desensitize the patient to the frightening stimuli. It is most effective when the patient is exposed to the real thing rather than visualized, simulated or imagined versions. But that is not always possible.
- Integrated Group Therapy (IGT) – IGT is a new treatment devised specifically for patients diagnosed with bi-polar disorder and drug/alcohol addiction. It is designed to address both problems simultaneously.
There are many more Behavioral Therapies and more and more being developed and tested. While you are not advised to try and self diagnose and choose the therapy you believe would be best for you it is never wrong to be armed with knowledge and awareness of the different options that might be available to you.
In Canada the Centre for Addiction & Mental Health (CAMH) is a huge research and treatment facility that encourages inquiries from the public. Its website is right here, CAMH.
No matter where you live you have access to credible information and help. Visit your national Doctors and Physicians Professional Organization and/or Governing Body. Every major University in the world, every teaching hospital, every credible treatment facility has a website.
Don’t fail to educate yourself to the degree that you can draw hope from knowing that regardless of your diagnosis, there are contemporary treatments from medications to all manner of behavioral therapy that can be applied to address your specific needs.
Couple that with attendance at AA or another support group and know you are not alone. As alcoholics and drug addicts we are finally getting the attention that’s been sorely lacking which means we can look forward to lives that are happy, productive and free of the chemical pests that made it so untenable before.
I’ll Drink To That
Not so fast there Hoss. Our understanding of alcoholism under the broader category, addiction, is reaching the point where the word “cure” may be entirely misapplied. Successful treatment does not equate to the over inflated word “cure”. Though some want to argue the disease model for addiction, it is being better understood as a lethal symptom of all the mental/mood disorders that have already been discussed. And that’s why, if you believe that you or somebody you know and care about is seeming to drink alcoholically, the first place you might want to take that person is to a doctor, clinic or institute dedicated entirely to the diagnostics and treatment of addiction and mental health.
After centuries of medicine’s seeming indifference to “lowlife addicts and alcoholics”, it now would appear to provide the evidence based understanding, so sorely absent in the past, that’s leading to individual, comprehensive treatment strategies that can help ensure that each and every one of us achieves and enjoys the immeasurable benefits of contented sobriety.
In Summing Up
All of us no matter where we’re at in our lives came to AA because we sought hope. And for all who’ve made an honest effort, our hope, to one degree or another, was rewarded. But there have been many among us who, though sober, suffered in silence. In my case that meant I would eventually relapse.
For others, whatever hope they’d realized in AA, it dissipated ending far, far too many times in suicide. I shudder when I think of the many suicides among long term (5+ years) sober people I knew or knew of. AA simply couldn’t address nor provide the comprehensive treatment some of us required. And for some reason, it never really opened a channel for two way communication with the medical community and the possible deeper insights into the alcoholic that would have helped those of us for whom sobriety alone didn’t solve our problems. AA once believed it had to educate the world, including doctors, on the true nature of alcoholism. Today AA could learn much from a persistent dialogue with the medical communities.
The Immeasurable Value of Fellowship
Today that existential angst is being diagnosed, has clinical names and is being treated. But that doesn’t mean that AA has outlived its usefulness. I go to meetings because I never know what I might hear or learn but, primarily, I go for the fellowship. If you want to find the most interesting assembly of people in any city on any given day or night, it’s at an AA meeting. AA still has a key role to play in the life of the sober alcoholic.
AA satisfies one of our greatest needs, community. As people who’ve endured an intimate relationship with loneliness, who’ve always struggled to fit in, to feel a part of but never quite being able to connect, AA can feel like home, in some cases, almost instantaneously. It’s an elite community dedicated to our sobering up and making us feel genuinely needed and wanted. We are among ‘our people’, those who, at minimum, know what it feels like to be condemned to a life of uncontrollable drinking. There is no substitute for that.
But now, for the first time in history, personal addiction doctors can be a key adjunct to our full recovery. And that’s such a bonus for the alcoholic or drug addict who continues to yearn for relief even after having made the break from the bottle. And statistically, abstinence alone, does not touch all of what rendered us unable to responsibly cope with life.
I now believe we get the “sobriety” we deserve.
For me it took decades to be able to get sober, stay that way and every day feel better about it. It was only when I decided I was going to explore every and all possible treatments did I finally avail myself of the services at a large, mental health and addiction facility that is at the forefront of treatment modalities born of their and others’ qualified research. After six years with a doctor there I’m on medication to treat my mood disorders, going to AA and generally feeling very positive about myself and the road I’m on.
Note from the Author
I’m tremendously grateful to have had the chance to make a contribution to this book that’s helping to guide you on the most rewarding and important journey you will ever embark on. You may agree, disagree, feel unsure or outright dismiss the ideas I’ve presented here. I’m not an expert on anything but my own experience.
Nevertheless, I can categorically say I love the addict/alcoholic who despite fear of failure (and a million other things!) continues to put one foot in front of the other. Each step represents a bold and courageous commitment to get better. So I’d just like to leave you with these personal thoughts and perceptions on alcoholics, addicts and those who are trying to get better.
A chronic alcoholic or drug addict who gets clean and sober, and stays that way, is a rare and remarkable creature. From the outside it’s easy to see just a guy or gal who has stopped drinking. But that is so far from the truth of the matter that it’s an expression of how little anybody but the alcoholic alone understands. Change for the alcoholic amounts to a total overhaul of the brain.
That’s why the necessary motivation has to be present before the change begins to manifest.
Nobody can predict when that “enough is enough” moment arrives. Sometimes it comes early, particularly among those for whom the stakes they’re playing for are high. Could be keeping your family together, saving a profession or business, a particularly important relationship, something very valuable to you.
But, the bulk of the time, the willingness to change arrives when the pain of drinking overwhelms the reward. In other words the family is long gone as is the job/profession, relationship, everything. It’s when doctors are showing us that our bodies and brains are damaged and that persistent use cannot last very long before we’re staring death square in the eyes.
That was me so I had no trouble, after 30 years, accepting my drinking and using days were over. The one thing I couldn’t do was determine if life was really worth living. Between one member of AA and 5 doctors I finally arrived, about 3 years into my sobriety, at a place where my life had value to me.
So knowing what I went through to care enough for myself that my life was precious again, I had to, when in a room in and among other alcoholic/addicts, assume each had gone through their own version of hell, survived it and were living proof that change, at a cellular level, could be achieved.
Today, when I’m with my people, alcoholics and addicts trying to save their lives, I know I walk among giants.
Bless us all.