The April, 2015 issue of the Atlantic published “The Irrationality of Alcoholics Anonymous.” The author, Gabrielle Glaser, is an award-winning journalist who specializes in covering addiction, mental health, and social issues. She notes that one result of the Patient Protection and Affordable Care Act (“Obamacare”) is that all MCOs, including Medicare, are mandated to cover treatment for substance use disorders (SUD), but there is a shortage of trained SUD professionals and also a shortage of solid research in support of the most common SUD treatment program, Alcoholics Anonymous.
AA claims a 75 percent success rate, but one researcher found AA’s actual success rate to between 5 and 8 percent. She also notes that people with SUD suffer from a higher than average rate of mental health problems, but, “A is not equipped to address these issues—it is a support group whose leaders lack professional training—and some meetings are more accepting than others of the idea that members may need therapy and/or medication in addition to the group’s help.” She also challenges AA’s belief that heavy drinkers cannot recover until they “hit bottom”:
Researchers I’ve talked with say that’s akin to offering antidepressants only to those who have attempted suicide, or prescribing insulin only after a patient has lapsed into a diabetic coma. “You might as well tell a guy who weighs 250 pounds and has untreated hypertension and cholesterol of 300, ‘Don’t exercise, keep eating fast food, and we’ll give you a triple bypass when you have a heart attack,’ ” Mark Willenbring, a psychiatrist in St. Paul and a former director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, told me. He threw up his hands. “Absurd.”
Ms. Glaser goes on to critique the “binary” approach of AA – “once an alcoholic, always an alcoholic,” reviews research that finds a significant portion of problem drinkers ARE able to learn to drink in moderation, and visits treatment programs that teach reduction of drinking, not abstinence, and a detailed history of SUD theory and treatments.
mhconcierge.com’s take: This very thorough and well-written article may provide a helpful review of the issues about SUD treatments and the limited evidence-based treatment options.
This article comes to our attention courtesy of Jeffrey Wigren, MHP, MHA, Director of Operations at Natalis Outcomes.