This Drug Could Change Alcohol Addiction Treatment Forever

It's called Naltrexone and, unlike AA, it works for most people.

Comments

1

"Alcohol addiction is often thought of in recovery circles like AA as a moral failing."
Frau Herzog, this is not correct. I am an AA and I can tell you that AA does not view addiction as a moral failing.

2

@1- I work in treatment and recovery, and I can tell you that 100% of my folks who are in AA feel that is how it is viewed. AA, while being cheap and simple, is not very effective by any metric. People who succeed in the model are people who would likely succeed in many models. The ultimate goal is to get people to a place where they are functional and not doing harm to themselves or others. If we can harness some actual science to help, so much the better.

3

Jesus. This is absolute half truths and garbage. How do you have a job? Did you even try to speak to any local doctors or clinics? Walk down the street to HMC? Lack of research showing Efficacy of AA? Really? We dispense naltrexone like candy. It’s hardly a cure all and guess what. They still drink themselves to death.

4

@2 lol where do you work? you are simply wrong - 100% of your folks? believe something that isnt true? Lol. I'm also a clinician in the are and there are myriads of studies showing the principles of AA work - yes you can live/find those principles outside of AA but its the easiest way for people to be exposed to them. You must not have a job in "treatment and recovery" that required an advanced degree...

5

"You take Naltrexone one hour before you start drinking, each and every time you drink (and preferably not on an empty stomach)."

Sounds like willpower is involved with the Sinclair Method.

6

lol my bad you spoke to some uneducated nurse hahahaha god youre trash katie

7

2 ~ So, you have no point to make.
"I work near an office of lawyers, so I speak for all of them!"

8

This article would have been strengthened by talking to some additional medical professionals and the researchers at UW who do world-class alcohol research. Additionally it is important to point out that our current court system often mandates AA attendance after DUIs, and often does not provide the option of more evidence-based medical treatment to satisfy probation. That many peoples first brush with serious consequences from drinking doesn't lead to evidence-based treatment is ridiculous and needs to change.

9

Now is as good as time as any to remind holiday party hosts to serve an assortment on non-alcoholic beverages (whom some of us can squirt our cannabis products into).

10

It's so depressing that The Stranger effectively replaced several excellent investigative journalists with a scientifically illiterate clickbait troll. I'll leave it to others to actually do the boring, necessary work of debunking this hot garbage but let's just note that the howlers begin early. "Alcohol addiction is often thought of in recovery circles like AA as a moral failing" is just flat wrong; anyone who knows anything about it, including actual, non-troll critics of AA and the AA approach, know this. But there it is, flatly stated, without any supporting evidence or interpretation. This is a huge embarrassment for The Stranger.

11

Several comments here seem to shout "squirrel" and point to a side issue of whether AA is effective or not. I see the point as whether Naltrexone is effective - or not. If this treatment works, even for a small percentage of sufferers, I say GREAT.

12

AND I strongly disagree with @10 - Thank you Katie for bringing this up, and perhaps someone now will check out this type of treatment after repeated, unsuccessful attempts (including AA), and see if it works. A throwaway comment about AA doesn't poison the well here...

13

I am reminded of hearing Danny Bonaduci on the radio talking about a drug that made him vomit if he drank, kept him sober, and “saved his life”.

I think I was a teenager.

I’m a workaholic, in what I assume was the original use of the term. It started when I had absolutely no time for recreation between travel, work, interning, and study. I had so little time that I bought black shirts to save myself the ten seconds in the morning it would take to determine the color.

This went on for well over five years until I hit my head really, really hard after deciding to run home at a dead sprint while, you guessed it, shitfaced in the wee hours of the morning.

A few weeks later I had colored shirts.

I’d drink in black while interning(openly, at night, in a capital firm downtown, no less) and life had some amount of joy.

I’m sure I drank over 360 days last year.

But still, I don’t understand allowing it to rule your life. I don’t drink until the evening, I turned down an additional drink last night, and I can sit there eight beers in pulling in a mighty fine hourly wage. I exercise, I know a lot of people.

I do turn down opportunities for dates to “work”, for what that is.

So what do you do with an original workaholic, someone who is stuck with a coupling of alcohol and productivity?

Muddy my head? ;[

14

I can understand why a treatment method, like this medication, that requires one continue drinking to get better can be disconcerting to some people.

15

Anyone looking for a knowledgeable assessment of the issues Katie failed to bother to research in any meaningful way here should consult the twitter feed of that uncomfortable reminder of the days when The Stranger employed serious journalists, Erica Barnett.

16

@11

"Several comments here seem to shout "squirrel" and point to a side issue of whether AA is effective or not."

My comment wasn't about that at all, if you're referring to me. Getting a "success rate" for AA is hard, and it's flawed, but I was merely using Katie's howler as an example of how poorly researched this piece is. One thing is very clear--the study she's using to cite the Sinclair method's high success rate and the "AA is 5% successful" factoid use wildly different measurement techniques, and it's journalistic malpractice to imply otherwise.

17

@4/7- If people who participate in AA (about 1/4 of the people I see) all believe it is a system based on morality and shame, then it isn't up to me to explain to them otherwise, it is up to the system in question to figure out why. If that isn't their intent, then they need to exercise more control over the process, as interpreted by the thousands of folks who run meetings every day.

You might want to look into a more promising modality of practice around substance abuse (at least with youth) called Seven Challenges. It avoids the catch 22 of expecting a person to be clean before they can enter a program (which is a monumental barrier for so many folks who would like to get clean or cleaner).

18

@17: No, they are NOT expected to be clean/sober before entering a program.

AA's Tradition Three: "The only requirement for AA is a desire to stop drinking."

19

Rather than arguing about whether or not the article is flawed, I say thanks for bringing this option to the fore. The AA model, with its quasi-religious overtones, was something I couldn't stomach, so I opted, very successfully, for something I REALLY couldn't stomach: aversion therapy at Schick-Schadel (I think that's what Bonaduce was shilling). Not that the point of the article was to address all available options, but aversion was a good one for me and, based on the people they follow, for many others too. While the notion of a drink isn't generally appealing, I have to say that the idea of a Negroni at a nice restaurant or a gin and tonic on a hot afternoon sounds good sometimes, and I wonder if this drug would make that possible without undoing the aversion response.

20

I'm agnostic on AA and its assorted 12-step brethren. At any particular meet that you go to you will find people there that have many years of "clean time." That's great!

I also spent enough time around the rooms to know that at any given meeting, there will be people there who are "the most important ones in the room" picking up that very first chip or key tag or whatever. My observation was that many of those people stay for a meeting here and there then disappear off back into whatever it was they were doing. Some might show up routinely to satisfy a court order, only to disappear once that commitment is satisfied. If all of those people are included in 12-step's success rate, then I would imagine that 5-8% is probably spot on.

That's not meant as a denigration of *A. For those whom it works, it works quite well. And for a long time, there were no other options.

One thing *A can do well is to provide people with a circle of friends to replace people who use. Research has shown that you are who you hang out with, and if you hang out with people who are in recovery, you will tend to be that way too. Personally, I found that once we got past the commonality of having been drug users, I found it difficult to relate to many people in the rooms. I particularly found it hard to make friends with people in recovery.

That probably says more about me than about them, but there was one thing that I did notice: while everyone was invariably polite, there was always a look in the eyes that seemed to be saying, "How much should I invest in you? Will you still be here in six months?" Seeing people come and go all the time, such a reaction is quite natural. But it might contribute to the feelings @1 is talking about.

My own experience has taught me that the 12-step method probably isn't meant for me. At this point some *A members usually conclude I wasn't really committed to the program. All I can say is that I went to meetings multiple times per week, took on service positions, had a sponsor with whom I actively worked steps to the best of my ability. ¯(ツ)/¯ That's OK! Not everything works for everyone.

My own suggestions for people are to do whatever works. If that's *A, perfect. If that's a prescription like Naltraxone (or Suboxone or whatever), also perfect. If that involves talk therapy, also perfect. If it's religion, that's just fine too. And if the best you can manage for right now is harm reduction then go for that. Progress is progress and not everything needs to be perfect, nor does anyone have all the answers.

21

I gotta echo the comments of @1 and others. Despite whatever you may think about AA's approach or successfulness, it most certainly does not promote the idea of Alcoholism as a moral failing. It very explicitly encourages addicts, recovering addicts, and their family and friends to view alcoholism as a disease and to research the psychological and physiological causes/effects of this disease. It's also the opposite of "white knuckling" sobriety.

22

Many of these comments are a little TL;DR, but I'll throw my comment on the pile:

I am also a person in long-term recovery (8 years abstinent) who just so happens to be a credentialed counselor, MSW and bona fide harm reductionist who works in harm reduction programs doing harm reduction. Two issues I take with this article: First, I have never EVER heard alcoholism described as a moral failing in AA, and I have a LOT of issues with AA. One of those issues is not that it's viewed as a moral failure, or that recovery is an act of willpower. I'm not sure where the writer is getting that idea.

Second, Naltrexone does work, but there is a major limitation that wasn't mentioned. I've had clients (and other people I sponsored in AA, btw) have great results on Naltrexone. The article neglects to point out that Naltrexone is also an opioid antagonist. Like Suboxone, or naloxone (Narcan for opioid overdoses), if a person is taking Naltrexone, pain medication is rendered ineffective. Thus, a person who suffers an acute injury or who has chronic pain, cannot take Naltrexone.

Just to encapsulate all this, I agree that AA has an abysmal success rate when you hold it to the impossible standard of total abstinence. That standard is the same we hold treatment agencies to, and it's a standard devised and driven by the insurance industry. If you broaden your definition of success, you find that AA is as successful as anything else at REDUCING drinking. The most recent literature on the study finds that, like a lot of things, it's different strokes for different folks. CBT, Naltrexone, AA... It's different for each of us.

Okay, there's my own TL;DR.

23

In "How to Change Your Mind" by Michael Pollan, his research suggests guided psychedelic journeys allow patients to reprioritize addiction out of their lives, with trials showing 50%+ effective rates and low remission rates. Obv. the author didn't read this, but worth contrasting as another means to help Simon.

24

Pollan also covered coevolution, which means that, if we are but one organism, T-cells should eliminate the diseased.

No?

25

First, anyone interested in an article that honestly looks at rates of recovery among various approaches to solving the problem of addiction can click here:

https://www.vox.com/policy-and-politics/2018/1/2/16181734/12-steps-aa-na-studies

The upshot: AA helps about a third of people who try it, and other treatment approaches may have about the same success rate.

Second, I love what Corydon @20 says. AA doesn’t claim to work for everybody. If you find recovery (however you define it) elsewhere, more power to you. As the Big Book says (pardon the sexist language), “If anyone who is showing inability to control his drinking can do the right about-face and drink like a gentleman, our hats are off to him.”

26

@ 25 yep. Any serious look at this subject shows a bunch of murky data and mediocre success rates from AA and other leading approaches. No miracle cure, no silver bullet, no opportunity to sneer at advocates of other approaches for their alleged "moralism." But that doesn't work as trolly clickbait, so....

27

To add to what other people have said, the author of this piece was completely inaccurate when she talks about “a lack of empirical evidence that 12-step programs work”—there is plenty of evidence that 12-step programs help people stay abstinent.

The author got her numbers from one of the most biased sources out there. Instead of looking at the peer reviewed science on the subject, she takes her numbers from a non-peer reviewed book by one Lance Dodes called “The Sober Truth”. Addiction experts universally panned this book: Khantzian and Roth called it a “pseudostatistical polemic”; Beresford criticizes the “three separate, questionable, calculations that arrive at the 5-8% figure”; The New York Times found the book “deeply flawed”.

Here is an article which came out at the time of Dodes’s book which details why Dodes’s figures are so wrong:

https://www.wbur.org/commonhealth/2014/04/07/defense-12-step-addiction

In terms of the real figures for AA’s success, they vary, but here’s one from a peer reviewed paper: Moos and Moos 2006 (PMC2220012) saw that, of the alcoholics who took the AA program serious in teir first year sober, 67% were sober 16 years later.

28

Just addressing this part (to be even more redundant to previous postings) the idea that AA sees alcoholism or relapse as a “moral failing” is patentently false. I’m sure it differs in different regions, but any group I have attended (where I reside and while traveling) treat a person who has returned after a relapsed as a person who has a disease and are on the path to recovery. And even for those who are not back, they are prayed for (or if you don’t believe in prayer, just wishing them safety and that they are doing what is right for them). Statistics on AA are not available and while anonymity is def part of it, another factor is that “success” is a loose term. Never drinking again until the day a person dies is not the only way to measure success. I have nothing against this particular drug and if it works for those who take it, awesome. But this article is simply irresponsible.

29

Do you guys draw straws each week to see who's going to offend Erica C. Barnett and cause her Twitter feed to briefly turn from highlighting Safe Seattle's daily content to enumerating your journalistic sins? Talk about "disgruntled former employee."

30

I have never heard of Erica Barnett before I read this article and my concerns about its accuracy w.r.t. AA effectiveness have nothing to do with her. That said, Ms. Barnett also believes in the 5% success figure, but her figures at least were believed by experts in the treatment industry until a little over a decade ago.

Back in 1990, Alcoholics Anonymous internally published a confusing and poorly labeled graph showing how many members, in their first year of sobriety, had a given number of months clean. As it turned out, about 5% of members in the graph were in their 12th month, instead of the 8.3% we would see if AA had a 100% retention (“success”) rate.

For years, a myth circulated among treatment experts that this meant that only 5% of people in AA make it to their 12th month sober. Finally, in the mid-2000s, three members of AA looked at the graph and its description and realized it was a frequency distribution graph, not a retention graph, and calculated the correct 1-year retention number: 26% (which, for the record, is in line with the 25% or so of subjects in Moos and Moos 2006 who underwent the most AA treatment):

http://hindsfoot.org/recout01.pdf

Ever since this paper was published, treatment experts now concede that the old graph always showed a 26%, not 5%, retention level; even Lance Dodes concedes that the 26% figure is correct.

As for the Sinclair method, I am very skeptical about any treatment which claims an alcoholic can engage in controlled drinking again. Those kinds of treatments tend to not work over the long term, but it takes a 10-year followup before it’s obvious the controlled drinking is not working (e.g. Pendery 1982). Ms. Barnett claims that problem drinkers simply stop taking Naltrexone and relapse to problematic drinking after a while; while I have not seen a study showing that per se (but PMC3970823 hints this could very well be the case), I will remain skeptical about Naltrexone’s benefits until we have studies with 10-year or longer followups.

31

INTERESTING ARTICLE. THANKS, KATIE.

32

As someone who attended AA meetings for a good five to seven years (it slowed down the last two years), I found a lot of AA to be helpful (community, fellowship, structure) and some not helpful (the constant focus on the thing I was trying to live without, the cult-like aspects, watching people fail over and over again and come back to beat themselves up, all that damn cigarette smoke). If it is working, use it. But for most folks - and settle down you more cult-like members who can't take any criticism of your program - it does not work. The figures are all over the place and based on all different definitions of success, but to quit drinking for more than a year? Probably single digits. At the most liberal definition you never get close to 50%.

I drink. Not a lot. I have been "drunk" once in the last 24 years since I started drinking again and that was a pretty wild and fun night and I regret nothing. It reminded me how much I hate hangovers. "Alcoholism" is not nearly as clear-cut as AA would have you believe.

If I was diagnosed with cancer, an actual disease, I wouldn't want treatment that has been ineffective and unchanged for 80 years, unless it was the only thing available. Folks would not be happy if cancer treatment remained unchanged for 80 years. But suggest a new approach to treating problem drinking and folks freak out. Totally freak out.

Plus, in this situation the ones who have decided that Herzog is the Devil (or "trash" as the ignorant are fond of saying in Seattle, but it is the exact same type of moralizing) because she dare write articles that make one look at things from a different perspective if one were to actually READ her articles instead of the headlines and the summary their peers write on Facebook and Twitter, they might be enlightened. But I'm not holding my breath. I'll just have some tea and sip quietly. Might even add a splash of whiskey. I hope whatever one does it brings them health and happiness. I hope folks realize that what is right for one person isn't necessarily right for another be it with cancer treatment, relationships, social stances or drinking. As the kids have taught me: You Do You.

33

Before coming to AA I decided to give the Sinclair method a try. What could be more enticing to an alcoholic than a solution that allows you to continue to drink? As advertised, it's a pill that sucks the joy out of drinking. It also sucks the joy out of most other things in life. After a while I thought, how about I skip the pill this one time? In fact, how about I skip it every time.

The fundamental problem that addicts must deal with, and the problem that AA addresses and pills do not, is that the addict does not know how to deal with life sober. Just simply existing in a sober state after a lifetime spent using chemicals to deal with life is boring, painful, and borderline intolerable. It takes a lot of work to figure out how to do it, and support is essential.

Debates about AA's success rate are not very productive. For one thing, they don't open their books (for very good reasons), so there's not much good data. For another thing, it's impossible to pin down the definition of success and failure, who was actually making a good try of it, who was just there to get their spouse off their back, who was sent by the courts, an so on.

The one thing that is known is that there are dozens of AA meetings in every city in the country every day of the year, they are all free, and they are all full of people who have been there and done it, and who are ready to help you if you need it.

That's not to say don't try the sinclair method, or antabuse or campral, or any other solution. If they work for you, then that's wonderful. If it doesn't work for you, then AA will be there. It's full of people, like you, who tried everything else and failed.

34

I disagree with the concluding sentences of the article-- Naltrexone is too magic! Despite all the weirdly defensive comments about AA above, I know full well that that is not a method that would work for me. I certainly have the impression that it's pretty moralistic, and have no desire to worry about any Higher Power, even one I get to make up for myself. On the other hand, Naltrexone is GREAT for me, because my main problem with drinking is that I cannot stop once I start. Naltrexone, though, makes it so I can. I can have one glass of wine with dinner. I can have no glasses of wine with dinner and feel totally okay with that. If that's what you need, and if Naltrexone works for you, it's great.

@23 makes some excellent points. I've never had any problems with general blah from the opioid antagonist aspect myself. It is true about pain medication, but as I understood it when I got the prescription, if you are able to tell a hospital that you're on Naltrexone there are non-opiate methods which can be used as well. I've also never had chronic pain, so that's definitely something worth looking into for people who do.

Just wanted to throw in a little bit about Naltrexone, the subject of the article, rather than whether AA is good or bad. The rest of y'all seem to have that covered.

35

turns out when you troll AA by saying it’s judgy and doesn’t work some 12-steppers get really offended, who could have guessed

36

AA has been calling alcoholism a disease for over 75 years. Did you even do any research?? Also A.A. has never claimed to be the only way to get sober. If it’s not for you don’t go but please don’t bash something that has helped literally millions of people. AA promotes love, tolerance, kindness, helpfulness to others, paying restetution to people and places that have been harmed and an altruistic lifestyle. Things that our culture could use, does that pill do that?

37

WOW. This is really bad journalism. It's a PR piece. This is a disservice to the community and more harmful than helpful. This is evident from the clear lack of understanding, research, and balance. Sensationalism? Damn, the stranger really let me down here. I hope y'all try to fix this. You would think a paper that attempts to be "Seattle" would have more depth and perspective when covering addiction. Please do right by your community and try to publish something better to follow this up, and you will seem less like pill pushing reactionaries.

It would seem zero effort was put into understanding AA or the treatment industry and the difference between them. (As big as the difference between anarchism and capitalism.) Also, there was zero consideration of the research that shows how people who get sober/ treat their alcoholism by treating the symptoms w/ a drug very often stop taking the drug and return to using because they want to feel the thing they used to feel. This has been documented.

38

@34 - If you're taking Naltrexone and not having that glass of wine then you are using the medication incorrectly.

39

Hey guys! I hear you! There's some questionable points made in this article, but then again AA is extremely complex for those non-AA-affiliated to understand. She doesn't get it. It's not her job to get it, she doesn't have to. She is allowed to have her stance.

Principles before personalities,
Attraction rather than promotion,
Live and Let Live,
Don't take yourself so damn seriously!!!

If AA were to fold every time someone wrote a scathing article about it, it would've happened DECADES ago. We know it works if you work it

Thanks for starting a conversation, Katie.

40

It can also cause you to throw up until you're just vomiting blood and bile after 24 hrs. Be careful with this one. (Ask your local ER staff.)

41

For those of us that actually have read the Big Book Bill does not see see alcoholism as a moral failing. It's considered an illness that the person needs to commit themselves to a "higher power" which most people in the program see as whatever god they worship. The gist is that the person is helpless until/unless they have the higher power help them. Many that do go to meetings consider it a moral failing but that's not official AA dogma (though some meetings sure seem like it...). I'm a secular humanist so I consider my inter well being as my higher power. That said I haven't been to a meeting in years. Not my thing. The pushback you do get at AA meetings from some so called "purists" is when you use means like medication to treat your addiction. Some consider that just as bad as drinking.

I got clean using a medical program that also used 12 step as a tool for support and spirituality. Abstinence and step programs alone usually do not work. That's why you see so many relapses among AA only participants. Medication to treat alcoholism isn't something new nor is Naltrexone going to "revolutionize" treatment. I used it to ward off cravings initially. I also used Campral right out of detox (both times) to reduce withdrawal. Those came from the addiction doc but my primary care doc wanted me to use Antabuse which makes you sick as hell consuming any alcohol. That's the old school barbaric way.

I'd caution implying that Naltrexone is some sort of wonder drug. While it reduces cravings and mitigates the feeling from being drunk the alcohol still damages your body. So the guy only drinks 5 drinks every day instead of 13. That's still far too much alcohol to be healthy. You may not get buzzed but you're harming your organs and general health in a big way. There is a point where it is so bad that unless you stop consuming alcohol altogether you're only speeding up your death. It may take you 15 years instead of 5. An article such as this that is poorly researched is a disservice to addicts and alcoholics everywhere.

42

It is so odd to see people say that AA doesn’t identify substance use disorders as a moral issue, there is a fair amount of talking about deficits of character in the Big Book. Also, from Chapter 5 “So our troubles, we think, are basically of our own making. They arise out of ourselves, and the alcoholic is an extreme example of self-will run riot, though he usually doesn’t think so. Above everything, we alcoholics must be rid of this selfishness. We must, or it kills us.” I was so done with AA years ago when I read the “We, Agnostics” part of the Big Book and it basically said Get God. Participates can try to couch this stuff in what ever you like and the meetings are different but if your foundational texts have a clearly stated view you are just fooling yourselves.

43

I am one of the users of Sinclair method or TSM as it is called, seven months now. It definitely works for me. My drinking has reduced about 75 percent to about one vodka bottle per week.

The method is based on solid science, clinical trials, laboratory rat test, the whole shebang. David Sinclair moved to Finland in the 70's to research how to cure alcoholism in the Finnish state alcohol monopoly laboratory and become of the leading researchers.

They had the world famous AA line laboratory rats that were bred to drink alcohol. With the monopoly money they had pretty much unlimited budget to try everything. Eventually he discovered that the AA rats lost interest with Naltrexone when drinking alcohol in about a week and proceeded to test it with humans with great results. Many clinics today offer this treatment in Finland. A newer drug today is called Selincro, based on even better sister medicine, Nalmefene.

The TSM has about 80 percent long term cure rate and it is based in the Pavlovian principle of changing behavior. The medicinal term is called neuroplasticity, look it up. Your brains are rewired basically by drinking alcohol with Naltrexone and only taking the pill one hour before drinking. No pill if no drinking that day, you need to drink alcohol, otherwise no effect in the long term. Another pill if still drinking after 10 hours.

Over time, on average in 6-9 months, the brains lose gradually the interest of drinking alcohol. Many describe the feeling as drinking awful tomato or some other juice you do not like at all. You go through the alcohol bottle section at a supermarket, you just think those are bottles with stuff I am not interested in. As long as you take a pill one hour before the drinking and do not start drinking without it for weeks, the addiction will not come back.

AA people are still obsessed with alcohol through talking and it is like trying to cure diabetes by talking about and trying to avoid sugar! TSM users have lost interest in alcohol so much that it has no control over them anymore, cured from the addiction in their brains. AA people are just trying to white knuckle it and for over 90 percent of people it does not and will not work.

Btw, even the AA founder himself said that science might some day find a cure and one of the working cures today definitely is TSM! There are also other methods but this has still the best cure rate in the field today.

44

@30 a %26 success rate for AA is still a huge embarrassing failure.

45

@20 @43 To believe in 2018 that AA has a 5-10% success rate requires disregarding the relevant science on the matter. [1] [2] Perhaps the science is wrong, but studies have shown a 75% success rate. [3]

@44 26% is not the success rate of AA, unless we define "AA success" as "Continued to go to meetings 12 months later". According to one study [1], 55% of people who went to one or more AA meetings over a 12-month period were sober 16 years later, in contrast to the 33% of people who didn’t go to AA at all. I will assert this: Those 74% of dropouts chose to stop going to AA meetings, and would be more likely sober today if they chose to remain in the fellowship. It’s amazing how many alcoholics voluntarily choose to stop engaging in an effective life-saving treatment.

Anyway, AA does not appear to be the problem: We don’t have anything with a higher long-term success rate [4]; it is telling that there are no Sinclair Method studies with a 10-year followup. The evidence indicates that, based on a meta-analysis of naltrexone and acamprosate, that the Sinclar method loses effectiveness the longer one uses it for treatment [5]

I would love to see something which effectively keeps alcoholics sober over a 10-year period with a higher than 30% retention rate, but there is nothing out there (again, I remain skeptical about the Sinclair method until I see studies with 10-year followups).

I welcome further discussion on this matter, but will probably ignore posting containing assertions which do not link to scientific studies.

[1] Moos, Rudolf H.; Moos, BS (June 2006). "Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated Individuals". Journal of Clinical Psychology. 62 (6): 735–750. doi:10.1002/jclp.20259. PMC 2220012. PMID 16538654. This paper shows that, of people were serious about AA, 67% were sober 16 years later. Of people who tried AA at all over a one-year period, 55% were sober 16 years later. Only 33% of people who did not go to AA at all were sober at the 16-year follow-up.

[2] Humphreys; Blodgett; Wagner (2014). "Estimating the efficacy of Alcoholics Anonymous without self-selection bias: an instrumental variables re-analysis of randomized clinical trials". Alcoholism: Clinical and Experimental Research. 38 (11): 2688–94. doi:10.1111/acer.12557. PMC 4285560. PMID 25421504. shows that AA efficacy is not caused by self-selection.

[3] Fiorentine, Robert (1999). "After Drug Treatment: Are 12-Step Programs Effective in Maintaining Abstinence?". Am J Drug Alcohol Abuse. 25 (1): 96–116. PMID 10078980. This study showed that 74.8% of regular attenders of 12-step meetings were sober two years later.

[4] Loveland, D., & Driscoll, H. (2014). Examining attrition rates at one specialty addiction treatment provider in the United States: A case study using a retrospective chart review. Substance Abuse Treatment, Prevention, and Policy, 9, 41.

[5] “Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: When are these medications most helpful?” by Natalya C. Maisel, Janet C. Blodgett, Paula L. Wilbourne, Keith Humphreys, and John W. Finney. PMC3970823 “Although only two studies provided data, the naltrexone-placebo effect sizes for craving at the last follow-up point were close to zero”

46

Hey you AA doubters, don’t you know that on the 7th day god said: “let there be 12 steps” and then he faxed them to Bill, the AA founder-word for word. To doubt this is anathema. Naltrexone doesn’t require a belief in a higher power, how can it possibly work?

Snark aside, why wasn’t it mentioned that the once a month injection performs better than the pill. Why wasn’t it mentioned that naltrexone can be used for other addictions.

48

@47 well you've certainly proven your point, Johnson. Great work. You're very intelligent! Bravo! Your mom will print this post out and stick it on the refrigerator with a magnet.

49

@48 When we do ten-year or longer followups of “Moderate” drinkers, we find the majority of them drinking again. [1] [2] There are a number of alcoholics out there for whom moderate drinking plain simply will not work over the long term; to deny this is to deny the science on the topic.

[1] M.L. Pendery, I.M. Maltzman, and L.J. West. "Controlled Drinking by Alcoholics? New Findings and a Reevaluation of a Major Affirmative Study" Science 217(1982):169-175. “Only one [subject], who apparently had not experienced physical withdrawal symptoms, maintained a pattern of controlled drinking; eight continued to drink excessively—regularly or intermittently—despite repeated damaging consequences; six abandoned their efforts to engage in controlled drinking and became abstinent; four died from alcohol-related causes; and one, certified about a year after discharge from the research project as gravely disabled because of drinking, was missing”

[2] G. Edwards. "D.L. Davies and 'Normal drinking in recovered alcohol addicts': the genesis of a paper" Drug and Alcohol Dependence 35.3 (1994): 249-259. “5 of the 7 subjects [who supposedly were drinking moderately] had shown evidence of alcohol misuse both during the period of Davies’s original follow-up and subsequently [Davies’ original paper claimed these 7 subjects were drinking moderately]. Of the remaining 2 patients, 1 had never been heavily dependent on alcohol (Case 6). while for the one patient (Case 1) who remained as a potential candidate for return to normal drinking a previously alcohol-dependent subject, the outcome
data were not entirely persuasive.”

50

For me what worked was abstinence and ant-depressants.

If I had three drinks, I could have 10 and a blackout.

So, I stayed out of bars, and anti-depressants allowed me to keep a bottle of Scotch in an upper kitchen cabinet untouched for so many years, the alcohol evaporated. (And I never liked Scotch, anyway.)

The correct cocktail of anti-depressants now means I can enjoy a couple drinks of something I like -- champagne, dessert wine etc. ---without drinking myself into a blackout.

But maybe that's just me and my body chemistry.

51

@22 " I agree that AA has an abysmal success rate when you hold it to the impossible standard of total abstinence."

I agree that AA has a bad success rate, but I believe their success rate is up there with top of the line addiction programs, which shows how difficult it is to treat the disease of addiction. The most important thing about AA, by far is the peer support.

About the "impossible standard of abstinence", abstinence is the pretty much the best way to treat the disease fo addiction. The problem is trying to get the patient to change their ways, and not be tempted by their environment. Abstinence is truly the goal and not an impossible standard. I do think Naltrexone works, but I also think it shouldn't be used along with drinking..

52

@45 "To believe in 2018 that AA has a 5-10% success rate requires disregarding the relevant science on the matter. [1] [2] Perhaps the science is wrong, but studies have shown a 75% success rate. [3]"

AA has the same success rate as top rated Drug and Alcohol Rehabilitation program, around 5-12%. Your #(3) study you quoted states 74.9 % of people who regularly attend, Most people who go to AA drop out after a couple meetings. AA isn't bad, peer support groups are still one of the best way to treat addiction. However, it is still shitty numbers, with a horrible success rate and a horrible recidivism rate. Most people who go through 28 day re hab, start their addiction right up after they are done for example.

53

@51 and @52

Acamprosate works better than Naltrexone when abstinence is the goal. [1]

I observe that you have not linked to any studies when bringing out the 5-12% figure. Those numbers are low, to the point of being inaccurate (they come from nonsense like misreading an old confusing graph AA made back in 1990, or by multiplying unrelated numbers from multiple studies together). Let me give you the numbers from one study [2]:

58% of the subjects went to one or more AA meetings. Of those subjects, 55% were sober 16 years later: 32% overall. Compare this to the success rate (sober 16 years later) of people who did not try AA at all: 33%, or 14% overall. Someone who went to three AA meetings and then stopped going did better than someone else who didn’t go to AA at all. If we define success as AA’s literature does—“rarely have we seen a person fail who has thoroughly followed our path”—AA has a 67% success rate 16 years later.

You’re right in the sense that AA is about as effective as any other treatment we have come up with [3] [4], and you’re right that we need to continue to search for other treatments with a lower drop out rate, but the claims that AA has a 5% success rate or that AA is no more effective than spontaneous remission are inaccurate and not helpful for someone who needs to hunker down and take responsibility for their addiction.

[1] “Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: When are these medications most helpful?” by Natalya C. Maisel, Janet C. Blodgett, Paula L. Wilbourne, Keith Humphreys, and John W. Finney. PMC3970823 “Although only two studies provided data, the naltrexone-placebo effect sizes for craving at the last follow-up point were close to zero”

[2] Moos, Rudolf H.; Moos, BS (June 2006). "Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated Individuals". Journal of Clinical Psychology. 62 (6): 735–750. doi:10.1002/jclp.20259. PMC 2220012. PMID 16538654.

[3] Other abstinence based fellowships are as effective as AA. See this paper: Zemore, Sarah E; Lui, Camillia; Mericle, Amy; Hemberg, Jordana; Kaskutas, Lee Ann (2018). "A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD". Journal of Substance Abuse Treatment. 88: 18–26. doi:10.1016/j.jsat.2018.02.004. PMC 5884451. PMID 29606223

[4] "Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH posttreatment drinking outcomes". Journal of studies on alcohol. 58 (1): 7–29. 1997. PMID 8979210. Archived from the original on 2013-01-27.

54

Let me correct footnote 1 above:

[1] “Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: When are these medications most helpful?” by Natalya C. Maisel, Janet C. Blodgett, Paula L. Wilbourne, Keith Humphreys, and John W. Finney. PMC3970823 “Acamprosate had a significantly larger effect size than naltrexone on the maintenance of abstinence”

(I bring out this study a lot when the subject of naltrexone is brought up, because it’s a meta-study of some 64 studies)

I should also mention: Yes, there are a lot of studies showing that naltrexone helps a lot with controlled drinking over the short term. This reminds me a lot of Sobell and Sobell 1973, which also showed that controlled drinking treatments appeared more effective than abstinence treatments over the short term, but in the long term (10-year followup), the subjects supposedly controlling their drinking (with only one exception) either died from drinking, had out-of-control drinking, or stopped drinking altogether (Pendery 1982).

55

Yes. The fact are these:
* AA is rooted in Protestantism
* AA is not evidence based.
* AA's recovery rate is abysmal
* Depending on the person, recovery may or may not entail abstinence.

Happy New Year, Katie, and thank you!!

56

@53 "I observe that you have not linked to any studies when bringing out the 5-12% figure. Those numbers are low, to the point of being inaccurate (they come from nonsense like misreading an old confusing graph AA made back in 1990, or by multiplying unrelated numbers from multiple studies together). Let me give you the numbers from one study"

it is pretty common knowledge that AA has the same very bad rates of success as 28 day rehab programs. Sadly, it is still the best out there for this type of peer guidance, whether it is AA or NA or Weight Watchers.

https://www.theatlantic.com/health/archive/2014/03/the-surprising-failures-of-12-steps/284616/

57

Happy New Year! May everyone have a happy and prosperous 2019.

@55 And your evidence? You may as well claim the earth is flat and the moon is made of green cheese.

@56 The article you link to reuses old discredited nonsense: Misreading an old confusing graph AA made back in 1990 [1] and multiplying unrelated numbers from multiple studies together [2]. It has no real evidence (i.e. numbers from a peer reviewed study) to back up its claims.

[1] There is no 81% first month dropout rate; this is a myth caused because someone misread a confusing graph and no one double checked the figures until 2008 in http://hindsfoot.org/recout01.pdf While this paper is not peer reviewed, peer reviewed sources consider it reliable: Adrian, Manuella (2012). "Can Failure Carefully Observed Become a Springboard to Success?". Substance Use & Misuse. 47 (13–14): 1384. doi:10.3109/10826084.2012.706178. "the Alcoholics Anonymous triennial surveys from 1977 through 1989 found that one quarter (26%) of those who first attend an AA meeting are still attending after 1 year"

[2] Lance Dodes can not point to a peer reviewed study with a 5% success rate for AA, because there is none. Instead, he multiplied unrelated numbers together to synthesize this artificially low figure. See https://www.ncadd.org/blogs/research-update/alcoholics-anonymous-call-for-better-science

58

Young Stranger reporters have been sneering at AA with a superior air for at least the last 25 years. So, this article is nothing new, but the hubris involved in this weak overview of the state of treatment for excessive drinking and alcoholism is beyond the usual cool kid snickering at the weaklings who hang out with the bums in the basement.

I mean, yeah write about Naltrexone, (or other substance abuse cessation alternatives).
If it works for people who aren't down and out enough to want to try AA, or works for any who are desperate for an alternative because they are unable to successfully deal with their alcohol abuse through AA, then that's great.

But how is mischaracterizing AA necessary to tell that story? Your article reads more like a pharmaceutical brochure than a news story.

59

@39 turtlebonnet ftw

60

@49 hey dumbitch, it's not as if this treatment is replacing anything else. If it works for some folks, what's your issue? Would you rather they remain alcoholics in order to preserve your worldview?

61

I have been sober for 23 years and I have never once heard in all that time someone refer to alcoholism or addiction as a "moral failing".