[QUOTE]
*Originally posted by dustMagnate *
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Right! And that’s great. But the fact that this model works for you does not mean that anyone for whom it does NOT work is simply WRONG. It just means that it doesn’t work for everyone.
Congratulations, by the way.
-L
But addiction is a real, chronic disease according to the American Medical Association and the DSM 4. And if you have it, you will never be ‘cured’. But you don’t have to get loaded, either. The steps and the fellowship of the program allow us to live without using dope and deal with life on life’s terms. Does it work for everyone? Maybe not. But does any treatment work for everyone it was intended for?
We share at meetings. We tell what our life was like in active addiction, how we found and applied the program, and how our lives are now. The program is open to all who want it. A person is a member of the fellowship when that person says they are. The only requirement for membership is a desire to stop using. And if you didn’t have the desire, you wouldn’t want to join up anyhoo.
Anyone who does not want to be involved with fellowship or work the steps doesn’t have to. They’re free to go elsewhere and try whatever they want to. We’ll be here for them if they want to try our way.
But I, personally, have never seen anyone truly and honestly work the program on a daily basis and not find relief from active addiction. What does that mean scientifically? Nothing. What does it mean to someone who is not an addict? Even less. But if you’re a junkie supporting a habit that’s killing you, what have you got to lose? Hell, most of us have been to doctors, clinics, shrinks, churches and jail. A 12 step program is usually the last house on the block, the place you end up after you’ve tried everything else. The last resort.
DoctorJ- I was also required to attend a few AA meetings as part of my (nursing) psychiatric rotation. I felt the same about the experience as you. The meetings took place in a psych ward (where they keep the actively psychotic and otherwise severely disturbed people) and the participants were forced to be there. Needless to say, they were less than enthusiastic and the whole thing was pretty depressing.
There was a lot of talk about God, but none about how mental illness (especially schizophrenia) relates to substance abuse and addiction. It seemed just too simplistic: just let God take care of it for you, and if you try hard enough (i.e. believe hard enough) God can keep you sober. I’ll emphasize here that the participants had attended essentially the same meeting dozens of times but only when compelled to do so during hospitalization. I’m sure it wasn’t your “average” AA meeting.
You obviously don’t work at my hospital. 
I think it’s appropriate for a doctor to make references to God if the patient and/or family expresses religious beliefs. For example, several times I’ve cared for patients with severe head injuries where no one has any clue what the outcome will be. I’m sure you’re familiar with how difficult it is to deal with the family under such circumstances: they want answers, but there are no answers to give. In such cases, if the family is religious, I’ll quite comfortably say “It’s in God’s hands now”. I help them deal with the tragedy by helping them relate it to their beliefs.
It’s one thing to talk about God within the reference frame of the patient’s own beliefs, but I agree it’s wrong for a health care worker to press his/her own beliefs onto a patient. Our job is to help and comfort, not to witness.
I’m not aware of any alternatives to AA in my area, which is very heavily fundamentalist Christian.
I think the best course of action for you, since you will no doubt need to make countless such referrals during your career, would be to find out what alternatives to AA exist in your area. Then, before recommending one, take a few minutes to talk with your patient (gasp! ;)) and lead him to the one(s) that would best meet his needs and coincide with his beliefs.
Thank you. And congratulations to you for your stepping. When addictions interfere it is helpful to talk with people who have been there.
Agreed. Those for whom the disease model doesn’t work aren’t simply WRONG. But it would appear they are still using. What to do? What have other users done?
The AA meetings I attended (all over town to make my 90/90) all had one thing in common: they were full of sober people who were still struggling, sober for a day or a decade. It was very helpful to notice that what I needed (sobriety) was doable. What took me a long time to come to grips with is that once alcohol was removed from the picture I still had problems. I knew I couldn’t blame booze for these problems, and early sobriety was especially painful because a lot of things happening that I thought would smooth out were in fact worsened by my heightened awareness (stark raving sober). It would have been much easier to continue drinking. If I had not publicly proclaimed that I was powerless over booze I might not have been able to make it through the physical withdrawal stage, much less the habit reforming stage (still going on: football games/Saturday nights/HOLIDAYS).
I am an agnostic. I believe that anyone’s personal version of God is fine, please don’t kill me or take away my vote if I don’t happen to believe. Listening to the 12-steppers go on and on about God is okay with me because there are bigger problems to worry with. AA works for people who want it to work, because quitting is deeply personal. No panaceas or easy fixes. No pill-based sobriety. Only yourself, in the middle of your own head, in the middle of a looong dark night.
A note to those sober folk who need to look in on meetings: there is no way to describe the fear and humiliation of admitting powerlessness over anything publicly. One draw of AA is right in the name: it is ANONYMOUS. No last names. The meetings themselves are a sort of anchor point in a week or a day that previously only held items regarding wasted, and it is a very tough time indeed.
Hi, I’m gigi and I’m a compulsive overeater and food addict. (hi gigi!)
It’s funny, though, what I hear from people in the OA meetings I’ve been to. The women there say that it’s remarkable how similar the feelings expressed by these men about alcohol in the the Big Book from the 30s are to their feelings about food today.
I would agree that Step 1 is not a detrimental thing. Admitting you’re powerless over the substance means that you need to change your life and always be vigilant about that substance, not that you can’t do anything about it. It means that if you go on as you are you will continue to engage in behavior which becomes more and more destructive. When I think about my complusive eating, I am in despair and wonder, what will ever change. I go through the same thought process I’ve heard expressed in OA: this will be the last time, tomorrow will be different. But it won’t be unless something fundamental changes.
As far as proselytizing, I think this depends on the meeting, and a patient can be encouraged to shop around. The OA meetings I’ve been to of course discussed a higher power, and some participants talked about their own beliefs, but I never felt like God was shoved down my throat. (Speaking of puns like that, the issue with food addiction is you have to eat something, you can’t go “cold turkey”. har, har) I would agree with spooje that the spirit and support of the meeting can be the higher power, the strength that lies outside yourself.
Well as too some of the other options I personally have seen work, see my post above. I am afraid my flatmate is in the middle of an essay for her masters so didn’t have time to write anything herself, but did give me the following information.
Motivational Interviewing is in fact a Rogerian model rather than a cognitive/behavioural one.
She normally starts with a psychodynamic model of treatment for eating disorders but has no direct experience of an addictive overeating pattern.
The study of human behaviour and the interactions between environment personality and biochemistry are still being worked on. Often radically different problems can cause the same end result, in this case an addictive behaviour pattern.
For many sufferers this behaviour is a defence to mask or control other issues that they do not feel ready to deal with, rather than the compulsion to drink/eat/etc alone.
The treatment models are outlines or frameworks in which an individual can be treated, that have been tested and proven to work for a significant proportion of the population that exhibits a certain set of symptoms. This does not mean that they will always work, and often means that they require a professional that understands the models to tailor them to the individual.
Everybody is making good points.
I would like to highlight a couple of attractive AA features:
It is FREE. Absolutely free. If you pound a bunch of the coffee you may want to put a couple bucks in the bowl. No therapist fees, no insurance number needed, no record of mental health visits. No recidivism based on lack of treatment cash.
It is available seven days a week in most cities in the US. Need a meeting? Check the yellow pages where you are.
According to my reading of the AA creed it is not God’s fault that one is hooked on booze. The responsibility is squarely on the user where it belongs.
Keep in mind also that AA was designed by and for the real low-bottom drunks, the ones that had tried everything else, and were willing to go to any lengths to escape their personal hell. For these people (of which I was one) AA is a lot more effective than for someone ordered to go to meetings by the courts or their family or boss. When you get desperate enough, and see someone managing to stay sober who used to be like you, you’ll do well to try doing what they say.
Myself, I’m not real at home with the Christian concept of God, so have self-selected meetings where the emphasis is on having a higher power, and people tend to not go on and on about their particular faith. I’ve also lost my knee-jerk hostility towards any and all prayer and ritual, and found I’m better for this type of tolerance.
And as a practicing physician, I can say anecdotally that I have seen more people with long-term recovery (over 2 years) thru 12 step programs, than I have with things like Rational Recovery, Moderation Management, and religious-based programs. Of course I may be only noting those things that agree with my personal experience.
Bottom line, if it works for you, great. If not, think about trying something else.
This issue is regularly debated in about.com’s alcoholism forum. It seems pretty clear from the discussions there that while AA works for very many people, it’s approach totally alienates many others.
Here is a listing of some non-step resources.
Personally, I believe that if a medical practitioner’s primary interest is in their patient’s health, they will recommend a broad range of options which may help their patient achieve/maintain sobriety - the end in this instance seems far more important than the means. Equally, just as the preferred way of treating other diseases may not be the most appropriate manner of treating a given disease in an individual patient, it needs to be recognised that while AA is extremely beneficial for many people it is not the only option available for dealing with alcoholism and nor is it the most appropriate option for all alcoholics.
I felt a little alienated when I first started attending meetings. What really put me off was there insistence on total abstinence from all drugs! I just wanted to get my life together, not stop using dope forever.
Unsolicited Personal Opinion Following
Those alcoholics and addicts that try to use ‘non-step’ therapies, do so in attempt to avoid the frightening prospect of a life without getting loaded. It’s got nothing to do with an aversion to the ‘God’ aspect of the programs, because members are free to define God as they see fit, or reject a concept God altogether, as evidenced by the atheist and agnostic members that have already posted in this thread. It has nothing to do with the narrow discipline of the program, because there really are no real rules. They just don’t want to stop using! They are looking for an easier, softer way.
And I can completely relate to that. It’s a frighteneing prospect. For an addict, using is like breathing. Something nessasary and pleasurable, and something whose absence is immediately and painfully felt. At first, it is nearly impossible to imagine life without it. But it must be done. Without total abstinence, there can be no recovery.
AA works for people that need that type of support. It is not a universal cure all for everyone. It is a good starting point for achieving sobriety at first, but shouldn’t be a long time thing for everyone.
Personally, I don’t like the programs. I went to AA, NA, rehab, did meetings, did work on my state level, local level, started new meetings, and none of it made me want quit anything.
It did make me lose my friends, my real friends who stuck by me when my program “friends” told me not to see them anymore. The whole cult feeling came from them telling me I had to lose all my friends.
Well, when the going got tough at my local meeting, and the program “friends” decided I wasn’t working the program correctly, they left my life. It was my old “evil” friends that stuck by me.
I hated the fact that any disagreement with the program brought on “Denial isn’t just a river in Egypt” and other slogans.
Shit, I was 20, got into drugs at college, and confused. I didn’t need to be told my whole life had to be rearanged, but I figured, these guys know what they are talking about.
All that said, I would still recommend it as a starting point. I’ve seen it work for others, it just wasn’t at all what I needed. I know my groups were screwed up by politicing, and old timers that were “dry drunks”, but like I said at the begining, its a starting point.
Bye the way, I finally quit drugs for good when my girlfriend got pregnant. We’re now married and have a wonderful 5 year old girl.
I still drink on occasion, and I know AAers think I’m waiting to fall off the wagon. Thats their opinion and I’ll respectfully disagree.
*** This is my story and my opinion. If anyone feels like these groups work for them, then good for you, they do work. I wouldn’t tell anyone NOT to try it out, and I respect their programs ***
I have been sober for 20+ years through AA. While it denies being “allied with any sect, denomination or institution,” it is clearly Christian in its roots and its antecedents. I live in a large city and would estimate that 30% of my home group (a Step Meeting) is made up of atheists or agnostics. There is no negative reaction when such views are expressed during a meeting. However, at the end of each meeting, the “Serenity Prayer” of Reinhold Niebuhr and the “Lord’s Prayer” or “Our Father” are both recited. After much thought and consideration of how I, an atheist, have benefitted from AA, I have re-written the twelve steps for my own use. NOTE: this is not approved AA Literature!
The 12 Steps of AA/NA, According to “Craig, An Atheist among Atheists”:
We admitted we were powerless over alcohol and other drugs - that our addiction to it was stronger than we were and that, as a result, our lives had become characterized by dishonesty and unmanageability.
We came to believe that AA/NA was a power greater than ourselves that could help restore us to sobriety.
We made a decision to turn our lives over to the care of the fellowship and members of AA/NA, to attend their meetings, to accept their goodwill and to listen to their suggestions. We selected a person to be our sponsor. We identified and volunteered for a service position.
We made a searching and fearless moral inventory of ourselves in writing.
We admitted to ourselves, to our sponsor and to other members of the fellowship what we had done wrong while drinking and drugging, and the consequences of these actions. Working with a sponsor, we searched for common elements or connections among these wrong actions.
We became entirely ready to do things differently and not to fall back into our tried and true methods of dealing with problems and strife in our lives.
We tried to be humble and to do things differently and more positively in all our dealings.
Working with a trusted sponsor, we made a list of all persons we had harmed and became willing to make amends to them all.
We made direct amends to such people whenever possible, except when to do so would injure them or others. We aimed to be able to meet any person on the street whom we had harmed, without having to avoid them.
We continued to take personal inventory of our actions and when we were wrong, promptly admitted it.
We sought through quiet and meditation to become mindful of our actions toward ourselves and others.
Once we felt comfortable in the regular practice of these steps in all our affairs, we tried to carry this message to other alcohol or drug-addicted individuals.
Your sobriety is only a few years older than this thread!
AA has never been shown to be an effective treatment and its religious basis is a major turn-off for many.
AA objects to being studied but what little evidence is available indicates it’s not an effective treatment. Most of the AA “truth” they teach about addiction and how it works has never been studied and is probably not true. It’s rooted in 1940s morals, not neuroscience.
Most support revolves around the very few AA attendees who claim it helped them; no one counts the extremely large number of people who attended AA and then immediately relapsed and never went back, or kept going back out of desperation but kept relapsing anyway. “Self-selection bias” is the technical term.
In my opinion, AA is a cult.
There are some promising studies on medications that might be useful in treating alcohol abuse. None of the therapy-based behavioral interventions seem to work very well.
You left out “it helped at the time but stopped going and didn’t relapse.” There must be SOME of us!
30% of your AA group is made up of atheists and agnostics, and none of you have complained about the overly religious tones of your meetings?
This is absolutely false.
See The Trials of Alcoholics Anonymous or Alcoholics Anonymous: Faith Meets Science.
The studies at this point show that A.A. and therapy combined is the most effective treatment option followed by A.A. alone. This is according to the National Institute on Alcohol Abuse and Alcoholism.
Don’t like A.A., fine. But do some research before you spout bullshit.
Slee
See a more comprehensive list of AA studies and see that the jury is still out on its effectiveness.
Ditto!
There’s plenty of variability in religiosity of AA groups, though to this atheist the religiosity was terribly obnoxious. I still found something worthwhile there, but also only used AA to a limited extent and mostly stopped drinking because I was NOT powerless.
The good hopeful feeling of the group and the anguish of many of the stories there are two great things AA often has to offer.
I think if the research bears out that AA is a relatively successful approach to fixing a terrible health (and life) problem, doctors can suggest it in good conscience – and it wouldn’t hurt to include the comments the OP did (lo those many years ago).
I opened the thread and read the OP without paying much attention to it, and it all sounded familiar…since it was written by me, in my third year of medical school. Asking tough questions and challenging the orthodoxy isn’t the easiest path through a medical education, but it’s the only one worth taking, IMO. (That’s probably why I’m a professor now and not in private practice.)
I still have the same reservations about AA that I did back then–moreso, in fact, since I live in a far more religiously conservative area now and I’d bet good money that the local AA meetings are a few hymns and an altar call from a standard Sunday service. I’ve also heard that the local NA meetings are overwhelmingly attended by people under court order to do so, which I think undermines the whole point of the organization.
But, as others have said, the options are limited, so I have recommended AA and NA to people who are having trouble staying sober. I don’t push it hard or present it as a clear solution, but as something that helps some people.
One thing that I’ve found is that a lot of the addicts that I know have big immediate barriers to changing their lives for the better outside of the substance abuse. Transportation issues, child and elder care responsibilities, untold life and family stressors, etc. I think it’s likely that the simple act of getting your shit together enough that you can attend a meeting on time a few times a week is a positive step. Then again, it could be that those who are able to get their shit together enough to attend a meeting on time a few times a week are the ones most likely to get themselves clean, regardless of what actually happens at the meetings.