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Is All or Nothing the Best Approach for Sobriety? Why Some Doctors are Attempting to Medicalize the Recovery Process


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Anyone who has struggled with substance abuse problems is very familiar with the ‘cycle.’ A person develops a substance habit, recognizes that they have a problem, and then goes about totally eliminating all substances from their life. This either works for them, or it doesn’t. And when it doesn’t, the outcome tends to be pretty bad.

For most people who are in recovery, the options for substance abuse treatment are pretty limited. A person can go to a treatment clinic, and maybe spend a couple of weeks detoxing and watching reruns of the Transformers movies. Then they can join Alcoholics Anonymous and get themselves a sponsor, a 24 hour chip, and their very own copy of the Big Book— A.K.A. the Bible for alcoholics. They spend their nights drinking black coffee and pouring over the verses in the Big Book. Their only goal— to stay completely sober.

The Big Book has become a staple of the recovery process. But the question is, how well does it really work? Photo thanks to Verywell Mind.

Alcoholics Anonymous has become a staple of the recovery community. The only problem with this is that their system just doesn’t seem to be working. According to peer reviewed studies, only about 1 in every fifteen people who enter AA are able to stay sober, and the success rate of the program is somewhere between five and 10 percent. Furthermore, about 40 percent of new members drop out during their first year. So why does the program boast such a negligible success rate? And furthermore, why has it remained such a staple of the recovery community for so long?

AA takes a spiritual approach to addiction problems. The program has ubiquitous religious undertones, and advocates that abstinence and spiritual enlightenment are the only paths to full recovery. This abstinence based approach, which AA has popularized in the recovery community, has ultimately ended up being a barrier for those seeking treatment. The idea that the only option for seeking treatment involves quitting cold turkey has prevented many people from seeking treatment, particularly those with more mild cases of the disorder.

Barring all that, those who seek treatment through AA struggle with the all or nothing approach. The Big Book asserts that the only alternatives to AA and abstinence are: “jails, institutions, and death.” This rhetoric contributes to feelings of failure and despair for recovering addicts who relapse. And the abstinence approach ultimately can lead to spirals and binges for those who struggle with quitting cold turkey.

So with all of this in mind, why has AA taken over the recovery landscape? When the Big Book was first published in 1939, medical professionals were skeptical about the program. However, the program quickly found ways in which to validate itself within the medical community. The founders of AA became front and center in the addiction discourse of the 20th century, and by 1989, the American court system began sentencing non-violent drug offenders to mandatory 12-step programs.

Alcoholics Anonymous grew rapidly during the 19th century, as it was seemingly the only option for combatting substance abuse disorders during that time. Photo thanks to Alcoholics Anonymous Cleveland.

Now, AA seems to have totally engineered the addiction treatment landscape, which for the most part, treats alcoholism as a spiritual problem and not a medical one. However, in recent years, there has been a surprising push to medicalize the recovery process; pushing medical therapy instead of abstinence, and treating drinking disorders as what they are— neurological problems. Doctors have been focusing on helping people drink less, and develop a comfortable relationship with the substance— with far more success. Rather than prescribe AA meetings, doctors will prescribe patients with naltrexone, a medication that suppresses the urge to drink or take drugs. Instead of focusing on complete abstinence, doctors will focus on cutting back the drinking— even by just a couple of drinks a week. The success rates of these alternatives are far higher than AA’s numbers. In a recent Canadian clinical study, after 12 weeks of treatment with naltrexone, 39% of individuals had abstained from drinking, and 89% reported drinking far less. These numbers are indicative of the utility behind medicalizing substance abuse disorders. After all, doesn’t the doctor know best?

In the end, Alcoholics Anonymous have helped many people recover from substance abuse disorders. While their method seems to have its problems, it does provide something that is integral to the recovery process— a community. When someone is recovering from substance disorders, they oftentimes feel alone and isolated. AA provides a solution to this isolation— one that shouldn’t be completely discredited. Because after all, that’s one thing that a doctor simply can not prescribe someone.

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