February 2002 • Volume 8 • Number 2 |
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It's early January in Leawood, Kan., and some 30 people are sitting in a meeting room of a church basement. Those gathered for the noon meeting include men in business attire, homemakers in casual clothes and the unemployed wearing sweat suits.
"Remember, who you see here ... stays here," intones a sign hanging from the ceiling. The meeting starts. "I'm Kevin, and I'm an alcoholic," begins one man. "Hi, Kevin," the group replies in unison. Kevin continues, "I'm grateful for my sobriety, and I'm grateful for everyone around this table. It's just great to start a new year sober." So begins a session of Alcoholics Anonymous.
POWER OF PEER GROUPS
One by one, each person at the meeting takes a turn, describing daily joys such as driving without fear of being pulled over, not being an embarrassment to their families, not wondering what happened during a blackout.
A few people have struggled in recent days: One woman, choking back tears, tells her supporters that she was denied an auto loan but vows to somehow endure the crisis without resorting to drinking. Several in the group write their phone numbers on a card and pass it to the woman. When the meeting's over, they clasp hands and recite the Lord's Prayer. Alcoholics Anonymous is clearly benefiting people such as these.
But not everyone agrees with AA's 12-step approach.
"Although AA works well for many alcoholics, there are a few people who don't do well in that sort of group," says Sharon Sweede, M.D., chair of the Commission on Public Health's subcommittee on addiction. She should know: Sweede works at the Julian F. Keith Alcohol and Drug Abuse Treatment Center in Black Mountain, N.C. In particular, victims of abuse and people with a dual diagnosis -- addiction plus mental illness -- may not thrive in Alcoholics Anonymous, says Sweede.
And some people object to the religiosity of many AA groups. Indeed, groups such as Rational Recovery and the Secular Organization for Sobriety, or Save our Selves, were formed by former AA members who sought an alternative. These organizations are great -- if you can find them in your area, says Sweede.
In addition, some women may object to the paternalism of AA's tenets. Sweede says she has found a 16-step program, advocated by Charlotte Kasl in her book Many Roads, One Journey, to be a more feminist-friendly alternative. Kasl, in the introduction to her book, writes that the 12-step model can perpetuate the victimization of persons whose egos are already fragile. Herself a veteran of 12-step programs, Kasl says she modeled her steps on AA's but used more empowering language. For instance, AA's first step is to admit being powerless over alcohol; Kasl's first step is to affirm that the addict has the power to take charge and not be dependent on a substance or another person for self-esteem.
"COLD TURKEY" VS.
CONTROLLED DRINKING
Adding to the debate over quitting addictions is the controversy over whether it may be possible to moderate, not stop, drinking. Sweede dispels this notion when it comes to hard-core addicts. "The ones who have the disease really don't have the choice," she says.
Sometimes, she concedes, it's difficult to distinguish an abuser from an addict. "Problem drinkers can cut back, recreational drug users can cut back. It's worth a try," Sweede says. "But if they're addicted, then by definition, they'll find cutting down gradually is extremely difficult."
When trying to differentiate the abuser from the addict, Sweede looks for four things: impaired control over alcohol/drug use, compulsion to use, continued use despite harm and demonstrated craving when not using the substance.
She offers this caveat: "I think it's important for FPs to not feel they have to know for sure whether it's abuse or dependence. Their talking to patients about it is more powerful than they realize. Brief intervention does help."
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.