Doctor's Assumptions Ignore 12-step Successes
By Gordon L. Hyde
Doctor's assumptions ignore successes of an approach that has helped millions of alcoholics
Recognizing that Dr. Bankhole Johnson is a renowned authority in the field of alcoholism and addictions, his Sept. 12 column, "Medicine needed to treat addiction," is the ultimate of intellectual arrogance. There are millions of recovering alcoholics and drug addicts living happy and productive lives who could challenge his assumptions.
He, like many academicians, assumes Alcoholics Anonymous doesn't work because there are no long-term controlled studies on the efficacy of AA. There will never be. These studies cannot be accurately performed because it is anonymous, which is one of the very strong reasons AA works. Also, AA is a recovery program and not a treatment program.
I have no problem with Johnson questioning the efficacy of treatment centers; some are good and some bad. I have observed over 32 years that all the good centers get their patients started on a 12-step recovery program.
Dozens of groups can tell doubters that AA works
Ever since a failed stockbroker named Bill Wilson had some kind of vision in a New York detox center 75 years ago, quit drinking and went on to help found Alcoholics Anonymous, there have been skeptics who claim there is no indication AA's 12-step model for recovery is effective.
Dr. B.A. Johnson, chairman of the department of psychiatry and neurobehavioral sciences at the University of Virginia, tells Herald-Leader readers "there is little compelling evidence that the AA method works, inside or outside a rehab facility," complaining that AA's emphasis on anonymity makes it difficult for outside researchers like himself to determine success rates.
Sex addiction fueled by shame
Of all the experiences we 21st century Americans crave, the biggest advertising idol we worship never was Tiger Woods — it's romantic intimacy. We long for a lively and loving, safe and sensual connection with a life partner. And when we aren't getting it, more and more Americans are finding cheap substitute experiences that provide more reliably immediate satisfaction.
These include such traditional sneaky thrills as affairs, prostitution and looking at pornography, but also new hybrids such as seductive texting, chat rooms and stripping by webcam. Wealthy, lonely and high-tech Americans can even have virtual sex with avatars if they want.
When do these behaviors constitute an addiction?
Millions go to drug addiction pill in tight times
Kentucky is spending millions of Medicaid dollars on a prescription drug used to help people with drug addictions while refusing to pay for the counseling necessary to complete the treatment.
Because of the cost, Kentucky's $5.5 billion-a-year Medicaid program for the poor and disabled does not cover most substance abuse treatment.
Suboxone, a narcotic used to help addicts ease drug cravings, cost the cash-strapped Medicaid program nearly $11 million last year.
Mental health experts are divided on sex addiction
Tiger Woods, who recently admitted to multiple extramarital affairs, said he is receiving treatment. David Duchovny, who plays a sex-obsessed professor on the TV show Californication , underwent rehab in 2008. Dr. Drew Pinsky has launched a reality series dealing with the subject.
Sex-addiction talk seems to be everywhere. But mental health experts are split on what underlies such behavior.
The American Psychiatric Association has proposed that out-of-control sexual appetites be included as a diagnosis in the next edition of the psychiatrists' bible, the Diagnostic and Statistical Manual of Mental Disorders , to be published in 2013.
North Carolina bars DWI courts from using ankle bracelets
North Carolina has prevented the state's drug and DWI treatment courts from using technology that has helped thousands of alcoholics stay sober.
Guidelines approved in 2007 prohibit those courts from using the ankle bracelets commonly employed to ensure that offenders don't drink.
That decision has puzzled and frustrated some officials, who question whether opposition to the technology was sparked in part by turf battles and personality conflicts.
It is unrealistic to think all patients are going to quit drinking with any treatment. Alcoholism and drug addiction are chronic diseases, subject to relapse, and need lifelong attention to maintain abstinence and healthful living — if they do the 12 steps. Many never get it and die.
I also would challenge Johnson to produce any long-term studies to show that psychiatry and behavioral medicine approaches have proof they work. It also is expensive; AA alone costs virtually nothing.
Many in AA have failed every form of known treatment and finally accept AA after exhausting all available resources. Johnson wants to treat them with a pill. What pill works over the same long-term follow-up he demands of AA?
While Johnson searches for a pill, he should visit Lexington's Hope Center recovery programs and observe the many restored lives and families for hopeless street alcoholics and drug addicts.
Alcoholics need lifelong attention to their problems, and they get that in AA, if they continue. The No. 1 cause of relapse is failure to continue in their maintenance program. These people are destined for death, prisons or institutions without help.
The Hope Center has 100 percent follow-up in our jail recovery program. Those completing the program are on probation, are required to report frequently and are subject to random drug screens.
With seven years of experience, 61 percent are sober, most are working and the return to jail rate has been cut by 60 percent with up to two years follow-up. It is a win-win program for the patients and society.
Fortunately, the University of Kentucky is more understanding and tolerant and has many research studies going on — some involving the Hope Center, Chrysalis House and other AA recovery programs in Kentucky.
They also have many millions of dollars of research into not only advanced neuropharmacology, which is Johnson's field, but many other behavioral, genetic and neuroscientific studies involving advanced neurobiology. This is facilitated by Dr. Carl Leukefeld, who occupies the Bell Chair in Alcoholism at UK and who supports AA because he has seen it work.
There is a real danger publishing a column like Johnson's; it may delay many in seeking help in 12-step programs. For example, a RAND study in the 1970s advocated controlled drinking, causing many to try it.
A study 10 years later of people following that study showed only one was able to control his drinking; over 90 percent had further severe problems with alcohol and 20 percent had died.
I do support Johnson's efforts to study these illnesses and develop treatment. We need more research and understanding of what goes on in the human brain. It should be remembered that much of Johnson's research is necessarily funded by pharmaceutical firms. But when he writes distorted accounts of AA, there is a conflict of interest.
Hopefully he will finally come to see (as do doctors at UK) that 12-step programs have a real place in the treatment of addiction diseases.
Dr. Gordon L. Hyde, professor emeritus at the University of Kentucky, is a Hope Center board member and past executive director of International Doctors in AA.
Read more: http://www.kentucky.com/2010/09/19/1441446/doctors-assumptions-ignore-12.html#ixzz101vadhGP
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