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Doctors Treating Alcoholics Should Go to Some AA Meetings: Expert

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Clinicians who treat patients dealing with alcohol abuse often refer them to Alcoholics Anonymous (AA), but many have never gone to a meeting and are not familiar with what goes on there, according to an expert on Twelve-Step programs.

“Any doctor treating addicted people should go to at least a few AA meetings, so they can discuss it with patients in a knowledgeable way,” says Marc Galanter, MD, Professor of Psychiatry and Director of the Division of Alcoholism and Drug Abuse at NYU Langone Medical Center. “It’s very experiential, and doctors should have a sense of it. They should also learn the steps of AA.”

Dr. Galanter, who has studied the long-term outcomes of AA and Narcotics Anonymous members, says his findings are encouraging. He discussed them at the recent American Society of Addiction Medicine annual meeting.

Marc Galanter, MD, Professor of Psychiatry and Director of the Division of Alcoholism and Drug Abuse at NYU Langone Medical Center

Marc Galanter, MD, Professor of Psychiatry and Director of the Division of Alcoholism and Drug Abuse at NYU Langone Medical Center

In one study, published last year in the Journal of Addictive Diseases, he found that among 266 highly committed young adult AA attendees, the average length of abstinence was 44 months. They had attended an average of 233 AA meetings in the previous year. He found 66 percent had served as sponsors, and 92 percent reported experiencing an AA “spiritual awakening” which decreased the likelihood of alcohol craving. “Their craving for alcohol was inversely related to their involvement in the group, and the degree of spiritual awakening they reported,” he notes.

In a soon-to-be-published study, Dr. Galanter found similar results with a group of physicians who were long-term members of AA. He noted that unlike most studies of the AA fellowship, which tend to focus on people who have recently come out of treatment, his research centers on people who are long-term stabilized AA members. “They have been abstinent on average for five years and they go to an average of five meetings a week. Most serve as sponsors for other members. Almost all of them work the AA steps.”

“Long-term members constitute the majority of people who are at an AA meeting at any given time—they are the core of the fellowship,” Dr. Galanter observes. “They make AA work because they set the tone for it, and they are very stable.”

Doctors should understand the types of people their patients will meet at AA, who will serve as their sponsor, and the nature of the group’s spiritual orientation, he says. “We found that the majority of members we asked said they experience God’s presence on most days—that’s a particular kind of experience that is not necessarily what clinicians would expect. It’s important for them to appreciate it, because that’s what their patients will encounter.”

18 Responses to this article

  1. Avatar of Betsy Longoria
    Betsy Longoria / May 8, 2013 at 3:35 pm

    I was surprised when a therapist who counsels drug and alcohol abusing adolescents and their families told me he had never attended an Alanon meeting. Plenty of AA meetings, thank goodness for that, but practitioners are missing alot of insight they could be getting from groups for families of addicts as well … especially if they are counseling them.

  2. Avatar of Chuck Tucker
    Chuck Tucker / May 8, 2013 at 2:11 pm

    Ya think??

  3. Avatar of John Fox
    John Fox / May 5, 2013 at 11:32 am

    One problem with studying the effectiveness of AA/NA is that these institutions have enjoyed predominance in addiction treatment for so long and are the defacto cheap treatment option, that treatment providers and physicians recommend them without thinking about other options that might appeal to people who do not ascribe to Judeo-Christian belief. It’s like asking the people of Cuba, “Who was your country’s most effective leader?” Chances are, they would say Castro for lack of any other predominant political figure or other option. There are also no studies unequivocally proving the effectiveness of AA.

    Good treatment should offer universality and AA marginalizes nonbelievers, offering condescending invitations to the nonbelievers (in the 12 and 12) who they pejoratively reference as people who are yet to have a spiritual awakening.

    Furthermore, AA has been around since the 1930′s (which predates the true inception of psychopharmacology) and a case could be made that it follows traditions that prevent critical updates based on new scientific data. Most quality medical treatments undergo dramatic revisions and are sometimes discarded entirely based on scientific data. AA, however, remains stuck in the timewarp of the 1930′s. If addiction treatment is every to evolve, I think that we’re going to have to graduate from AA to something better, and stop extolling its virtues simply because it’s there.

  4. Avatar of Stephen Grinstead
    Stephen Grinstead / May 3, 2013 at 9:40 pm

    In the Psy D course I teach for future psychotherapists I have my students attend 12-Step meetings and then come back to make reports to the class on what they learned that will make them better therapists. Many of my students are reluctant at first but are surprised to find how much the can learn at these meetings.

  5. Carlos / May 3, 2013 at 4:59 pm

    Yes, medical doctors should go to meeting, so that they learn exactly what not to do in treatment. Most treatment facilities who use the 12 Step approach avoided to be scientificly study for safety and effectivenss for over 50 years. Much less find out what is it about AA/NA that may actually work, rather than assume that all of their claims are written in stone and brought down to earth by Moses.

    As of 2003(the last publication of Handbook of Alcoholism Treatment Approach, Reid K. Hester and William R. Miller
    They both have teamed up and have done reveiws of the literature on Alcholism and Substance Use Disorder since about 1974 at University of New Mexico. They were only able to find TWO research studies that actually meet scientific standards.

    And by the way, they should violate the traditions while they are at it. What is it about the word anonymous that it is not understood.

    I have not problems with AA?NA as a fellowship. In fact, I do attend the Free Thinkers groups, but they are actually a lot more open than most other group and perhaps have the highest number of years clean within them. I just have a lot of difficulty calling it treatment because it has not being study and supported by science.

  6. Avatar of Patti
    Patti / May 3, 2013 at 11:49 am

    I work as a CADC in a Primary Care office. Many of our physicians are in their residency years. While I agree that some doctors would benefit from attending all the various support groups (SMART would also be on my list), I think simply more training in medical school and during residency would go a LONG way.

  7. Avatar of Kathryn Furst
    Kathryn Furst / May 3, 2013 at 1:12 am

    Dr.s going to AA meetings would give them additional insight especially if they have been receiving clinical information on alcoholism and drug abuse. And the best thing about this, is this would be one more person to be supportive to the alcoholic/drug addict whether they get help or not, the addict needs information about his or herself and encouragement. At the same time, Dr.s experience the alcoholic/drug addict talking about their lives. And the Dr./patient would be much more likely to have understanding that otherwise wouldn’t take place unless the Dr. had experienced the meetings of AA.
    The Dr. also mentioned the ‘craving that was inversely related to the group and the degree of their spiritual awakening.’ I would like to add some additional information to this. The disease of the addiction starts in the mind and unless the alcoholic/drug addict is in recovery and reaches out for help when his/her thinking becomes negative or begins racing, he will pick up his drug of choice, because he has no defense against not doing so, he/she is active in their disease. So in taking the drink or doing that drug, it sets the craving in motion each time. Where as in recovery, they learn to listen to their thinking and do what is suggested in recovery in order to remain clean and sober. They are given a spiritual way of life that must be practiced to avoid picking up that first drink or drug that will set off that craving.
    There is some good information here. I didn’t know that the average length of sobriety was 3 yrs. I know that seldom do you see people with much more than 7 yrs. or more. Yes, and some other things were good to know. So thanks everyone. I enjoyed the article and the comments.

  8. doogiem / May 1, 2013 at 2:57 pm

    Yes! to Dr. Wartenberg’s note. (I would add LifeRing Secular Recovery, and AAagnostica as two other secular options). And I am continually amazed with and frustrated by providers like Dr. Galanter who write articles that continually mistake the forest (all self-help groups, be them secular, spiritual, or religious) for the trees (12-Step groups).

  9. Avatar of Miko
    Miko / April 30, 2013 at 2:31 pm

    As a long time member of AA I can say that it is religious and it does meet the definition of a cult. AA will drill into the head of every newcomer that walks through the door that they will never be emotionally healthy enough to leave and they will never be intelligent enough to run their own life, and AA is the only solution that will deliver them from the gates of hell.

  10. Doug / April 30, 2013 at 1:40 pm

    I think the doctors who make it through the haze of cigarette smoke that veils most AA doorways will be even more appalled when they hear how their patients should stop taking their medications which still happens a lot “in the rooms.”

  11. Alan Wartenberg MD / April 30, 2013 at 12:36 pm

    I fully agree with my esteemed colleague Dr. Galanter that physicians need to become more aware of what 12 Step mutual help meetings are like, and what they may offer to our patients. However, I would go further to add that physicians need to be aware of the full range of mutual help meetings, and to be aware of the limitations of 12 step meetings, as well as their strengths.

    I have now passed 100 patients who either walked off methadone or buprenorphine treatment programs, or demanded detoxification, because of what they heard and were told at meetings, particularly by their sponsors. I was able to influence about a quarter of these patients to change course and stay, but the vast majority in fact left appropriate treatment. I had follow-up on most of them, and it involved their relapses.

    While it is widely quoted that 75% of people who stick with AA/NA remain clean and sober, it is NOT as widely known that fewer than one out of four patients remain in AA for as much as a year, and even fewer in NA.

    Many people have objections to the spiritual and, in fact, quasi-religious flavor of 12 step treatment, and some very religious patients even will eschew this treatment because it appears to them to be another form of religious observance. I have seen this not infrquently with fundamentalist Christians and Orthodox Jews.

    There are other forms of mutual help, such as SMART Recovery, Secular Organizations for Sobriety, Women for Sobriety and others which physicians and other helping professionals need to become more in tune with the strengths and limitations of various group approaches, so as to make an appropriate
    “prescription” for the most appropriate modality.

    Alan A. Wartenberg MD, FACP, FASAM

  12. Wendy Beck / April 30, 2013 at 12:21 pm

    I would also encourage those in the Prevention field to attend. I have been in Recovery for 24+ years and know that many in prevention are not aware of the vast wealth of insight these meetings hold. I think that it should also be noted that there are many Open meetings and what that means so that those wishing to attend have a basic understanding of what they might encounter. Thanks for your work. My belief is that “Recovery is Prevention” ( I work for a Communities That Care Coalition with adolescent substance use prevention as our mission)

  13. Avatar of melissa weiksnar
    melissa weiksnar / April 30, 2013 at 12:14 pm

    How about going a step further (no pun intended) and say that any medical professional who deals with drug misusers / addicts attend some NA meetings. And any professional who deals with a patient whose loved one is affected by alcohol or drugs attend an al-anon or nar-anon meeting so they can credibly refer those affected loved ones to such meetings to obtain support vital to dealing with a family disease. If the professional deals with teens, see if they can attend an alateen (or the rare narateen) meeting. Of course, many medical professionals may already be attending an AA/NA meeting or a family group support meeting due the fact that substance abuse does not discriminate.

  14. Joshua / April 30, 2013 at 12:09 pm

    how about, instead of going to AA meetings, doctors stop prescribing that their patients join a cult to cure themselves of a “disease”

  15. Scott Smith / May 1, 2013 at 3:33 pm

    At 21 years in recovery, practicing Buddhist and Native American, I have had quite the opposite experience and have attended meetings all over the country, on a cruise ship through the Mediterranean and still found the opposite of what you have shared re your experience. Namaste’

  16. Avatar of ellen whited
    ellen whited / May 6, 2013 at 7:03 am

    My daughter has 17 years in recovery. She began her recovery at 16 and for the most part has attended NA meetings. At her invitation, I’ve also attended many meetings with her and have made many friends in the rooms. Speaking to professionals in the addiction field, I’d like to say that it is a great idea to attend some meetings, and to mix it up a lot. Different meetings have different personalities, and Na has a different feel from AA. The twelve step base is the same in all of them, but to a certain extent it is possible to “shop” different meetings in your area to find one that fits your needs. Also, in the meetings I have attended, three years is not the average length of recovery. My daughter’s sponsor has 25 years, her sponsee sister has 22 years. These numbers are not the norm, granted, but the average is higher than three years, especially in AA. ellen whited

  17. Carlos / May 6, 2013 at 5:47 pm

    What sort of things are your studentes learning?

  18. Avatar of Kevin
    Kevin / May 12, 2013 at 5:56 am

    Without a doubt, physicians and others treating addictive disorders are woefully undertrained in this area. I personally work with social workers (LICSWs) who have never attended a substance abuse class or a psychiatric medication class. This is ridiculous in this day and age. Regarding attending AA or other 12 Step Meetings, I attend a meeting at Mass Gen’l Hospital in Boston that frequently features medical students as observing guests. Good idea – but it falls short. There are so many group and individual treatment modalities that, to be fair, each one needs to receive credit due. Not sure what the solution would be; maybe more education on the variety of options for treatment available to persons affected with substance use disorder would help. This would have to include Medication-Assisted recovery (Suboxone, methadone, benzodiazepine agonist substitution, naltrexone, etc.) to be fair in its approach.

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