Posts tagged Alternatives to AA

“That Isn’t AA!”

    AA is NOT treatment centers. AA is not and never will be affiliated with treatment centers. AA has NOTHING to do with treatment centers.

Jeez. No wonder ppl think AA has gone down the pan. I am astonished that the public have been conned into thinking that 5000 dollar a week hotels have any meaningful similarity to an AA meeting or how AA meetings operate. How sad. The greedy fatcat treatment centre owners have eclipsed the public profile of AA meetings to such an extent that the ordinary public has no clue which is which.
Whatever. Nothing surprises me anymore. AA is frequently misperceived, so nothing new there. But it is still very sad that the fake ‘AA’ in treatment centers is passing for the real AA in AA meetings. The only reason I care is because fake AA doesn’t keep people sober for very long at all. Which is sad, but there is nothing I can do about that. I just stick to what I know, which is listed AA meetings as opposed to poorly hijacked AA methods in treatment centers.”

One of our readers, “Irish Friend of Bill”, wrote the above in our comment section. I wanted to highlight it, and post a link to a post we made a few months ago, “The Knickerbocker Complex and the Evolution of 12-Step Quackery”, which explains the evolution of addiction treatment, and how AA was an integral part in creating what we now have in terms of treatment.  The book Slaying the Dragon, which is referenced in this post, is a very good history of the alcohol addiction treatment industry, and is actually written by an AA apologist. It glosses AA little, but it is a fair account. I would recommend it to anyone who really interested in this subject, particularly Irish.

Anyone who has been in a 12-step treatment centre, which represents the overwhelming majority of facilities, would find the idea that these aren’t “really AA” to be laughable. Many are run by ‘recovering’ AA members, and meetings within the facilities are chaired by local AAs who volunteer their time. AA literature is used, including the ‘Big Book’, and AA supplies the “aftercare” for released patients. Not surprisingly, their success is the identical 5%, which is a zero percent effectiveness rate. The only thing to distinguish this from “regular AA”, is the name – Twelve-Step Facilitation (TSF). This is done only because AA does not “lend its name” to any other organization. It’s simply a slick way to push AA without calling it AA. Here is the description taken from the TSF manual for the Project MATCH study:

“Twelve Step Facilitation Approach. This therapy is grounded in the concept of alcoholism as a spiritual and medical disease. The content of this intervention is consistent with the 12 Steps of Alcoholics Anonymous (AA), with primary emphasis given to Steps 1 through 5. In addition to abstinence from alcohol, a major goal of the treatment is to foster the patient’s commitment to participation in AA. During the course of the program’s 12 sessions, patients are actively encouraged to attend AA meetings and to maintain journals of their AA attendance and participation. Therapy sessions are highly structured, following a similar format each week that includes symptoms inquiry, review and reinforcement for AA participation, introduction and explication of the week’s theme, and setting goals for AA participation for the next week. Material introduced during treatment sessions is complemented by reading assignments from AA literature (p. x)….The therapeutic approach underlying this manual is grounded in the principles and 12 Steps of AA (p. xi)….The program described here is intended to be consistent with active involvement in Alcoholics Anonymous….It adheres to the concepts set forth in the “Twelve Steps and Twelve Traditions” of Alcoholics Anonymous….The overall goal of this program is to facilitate patients’ active participation in the fellowship of AA. It regards such active involvement as the primary factor responsible for sustained sobriety (“recovery”) and therefore as the desired outcome of participation in this program (p. 1)….This treatment program has two major goals which relate directly to the first three steps of Alcoholics Anonymous (p. 2)….The two major treatment goals are reflected in a series of specific objectives that are congruent with the AA view of alcoholism (p. 3)….Central to this approach is strong encouragement of the patient to attend several AA meetings per week of different kinds and to read the “Big Book” (“Alcoholics Anonymous”) as well as other AA publications throughout the course of treatment (p. 4)….The goal of the conjoint sessions is to educate the partner regarding alcoholism and the AA model, to introduce the concept of enabling, and to encourage partners to make a commitment to attend six Al-Anon meetings of their choice (p. 5)….[P]atients should be consistently encouraged to turn to the resources of AA as the basis for their recovery (p. 6)….Suggestions made by the 12-Step therapist should be consistent with what is found in AA-approved publications such as those that are recommended to patients (p. 8)….Encouraging patients to actively work the 12 Steps of Alcoholics Anonymous is the primary goal of treatment, as opposed to any skill that the therapist can teach (p. 10)….The therapist acts as a resource and advocate of the 12-Step approach to recovery (p. 11)….In this program, the fellowship of AA, and not the individual therapist, is seen as the major agent of change (p. 14)….The 12-Step therapist should not only be familiar with many AA slogans but should actively use them in therapy to promote involvement in AA and advise patients in how to handle difficult situations (p. 15)….In approaching alcoholic patients using this program…[t]here is…no cure for alcoholism; rather, there is only a method for arresting the process, which is active participation in the 12-Step program of Alcoholics Anonymous (p. 33). (Nowinski et al., 1995)” (Schaler, Jeffrey  “Addiction is a Choice”)

Edit: Here is an article on the history of Hazledon that DeConstructor linked in the comment section.

Edit Edit: From Mona Lisa –

Treatment Facilities Workbook (for AA members who work in treatment centers): http://www.aa.org/pdf/products/m-40i_TFWorkbook.pdf

Cooperation with the Professional Community Workbook (for AA members who want to “carry the message” to the alcoholism treatment community):
http://www.aa.org/pdf/products/m-41i_CPCWorkbook.pdf

Back to Baclofen

Here is an article from The Guardian on Dr. Olivier Ameisen and baclofen: “The little pill that could cure alcoholism”. From the article:

“It’s not that there is much argument over how baclofen might work. Recent advances in brain imaging have increased knowledge of the function of the pleasure and reward systems, and suggested that addiction interferes with the balance of the neurotransmitters dopamine, glutamate and gamma- aminobutyric acid (GABA). “What baclofen does is stimulate the GABA-B receptors, and you see the release of dopamine and glutamate is slowed, so the reward system is normalised,” says Ameisen. It is even widely accepted that baclofen in low doses treats withdrawal from alcoholism, though no more effectively than several other medications. What proved more controversial was Ameisen’s theory of the “threshold dose”, which he says is “needed to break the cycle of addictive craving, preoccupation and obsessive thoughts” and which moves baclofen from treatment to cure.”

A couple of years ago, Scientific American ran a series of stories on “self-experimenters”, including this one on Dr. Ambeisen. There is good information in the story. We have also written here before about Dr. Ambeisen and his use of baclofen to treat himself. What is as interesting as the story itself, is the comment section. There are a couple of nice snippets of AA dogma, including this gem below, which I thought I would highlight for those in need of a daily chuckle:

“It is regretable [sic] that AA did not work for this man. From my experience, he could not get out of self long enough to let it. Ego is the main target of alcoholismn [sic] and and the only remeidy [sic] I have ever seen is true spiritualism. Unfortunately, you have to get out of self long enough to gain the proverbal [sic] high ground perspective of spiritual intervention. I guess this is the reason that AA is not for everyone. Some sorry souls are so wound up with self, they cannot alter their perspectives, even momentarily. I feel very sadened [sic] for this man and can only think of the quote, “heal thy self physician.” This must be true for anyone who will not let God do it.”

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We are often asked to post alternatives to AA, or what our opinion is in terms of treating  addiction, beyond simply quitting. My opinion of using baclofen to treat alcohol addiction is no different than it is of naltrexone, campral,  CBT or any other treatment option. Subject it to proper, scientific, peer reviewed research – and if it shows to be effective in treating addiction, it should be looked at as a possibility for treatment. If it is unwilling to subject itself to the scientific method, and is unwilling to change or improve upon itself (as is the case with AA); or, if it has shown itself to be ineffective by objective research (also AA and Twelve Step Facilitation) – then it is most likely snake oil.

I have no idea whether or not baclofen is an effective treatment for alcoholism. I read Dr. Ambeisen’s book, and would recommend it to anyone interested in the subject of addiction recovery. My guess is that it most likely is effective, but my opinion is not what matters, which is the beauty of science. What does matter is what the science says, and there is currently research being done on the effectiveness of baclofen, including a study at the University of North Carolina on the use of baclofen in conjunction with naltrexone. These are controlled, double-blind studies on which science thrives, and AA avoids like the plague.