Rand repeated the study, this time looking over a four-year period. The results were similar. After the Hughes Act was passed, insurers began to recognize alcoholism as a disease and pay for treatment. For-profit rehab facilities sprouted across the country, the beginnings of what would become a multibillion-dollar industry. Hughes became a treatment entrepreneur himself, after retiring from the Senate. If Betty Ford and Elizabeth Taylor could declare that they were alcoholics and seek help, so too could ordinary people who struggled with drinking.
Today there are more than 13, rehab facilities in the United States, and 70 to 80 percent of them hew to the 12 steps, according to Anne M. Fletcher, the author of Inside Rehab , a book investigating the treatment industry. T he problem is that nothing about the step approach draws on modern science: not the character building, not the tough love, not even the standard day rehab stay.
Marvin D. Alcohol acts on many parts of the brain, making it in some ways more complex than drugs like cocaine and heroin, which target just one area of the brain. Among other effects, alcohol increases the amount of GABA gamma-aminobutyric acid , a chemical that slows down activity in the nervous system, and decreases the flow of glutamate, which activates the nervous system.
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This is why drinking can make you relax, shed inhibitions, and forget your worries. Alcohol also prompts the brain to release dopamine, a chemical associated with pleasure. Over time, though, the brain of a heavy drinker adjusts to the steady flow of alcohol by producing less GABA and more glutamate, resulting in anxiety and irritability.
Dopamine production also slows, and the person gets less pleasure out of everyday things.
Combined, these changes gradually bring about a crucial shift: instead of drinking to feel good, the person ends up drinking to avoid feeling bad. Alcohol also damages the prefrontal cortex, which is responsible for judging risks and regulating behavior—one reason some people keep drinking even as they realize that the habit is destroying their lives. Why, then, do we so rarely treat it medically?
W hen the Hazelden treatment center opened in , it espoused five goals for its patients: behave responsibly, attend lectures on the 12 steps, make your bed, stay sober, and talk with other patients.
MORE IN LIFE
No other area of medicine or counseling makes such allowances. There is no mandatory national certification exam for addiction counselors. Mark Willenbring, the St. Paul psychiatrist, winced when I mentioned this. Perhaps even worse is the pace of research on drugs to treat alcohol-use disorder. The FDA has approved just three: Antabuse, the drug that induces nausea and dizziness when taken with alcohol; acamprosate, which has been shown to be helpful in quelling cravings; and naltrexone. There is also Vivitrol, the injectable form of naltrexone.
Reid K. Hester, a psychologist and the director of research at Behavior Therapy Associates, an organization of psychologists in Albuquerque, says there has long been resistance in the United States to the idea that alcohol-use disorder can be treated with drugs. For a brief period, DuPont, which held the patent for naltrexone when the FDA approved it for alcohol-abuse treatment in , paid Hester to speak about the drug at medical conferences.
Many patients wound up dependent on both booze and benzodiazepines. There has been some progress: the Hazelden center began prescribing naltrexone and acamprosate to patients in But this makes Hazelden a pioneer among rehab centers. And now that naltrexone is available in an inexpensive generic form, pharmaceutical companies have little incentive to promote it. The drug helped subjects keep from going over the legal threshold for intoxication, a blood alcohol content of 0.
Naltrexone is not a silver bullet, though.
Other drugs could help fill in the gaps. So, too, have topirimate, a seizure medication, and baclofen, a muscle relaxant. It was here that J. After his stays in rehab, J.
In his desperation, J. Then, in late , J. During those sessions, Willenbring checks on J. I also talked with another Alltyr patient, Jean, a Minnesota floral designer in her late 50s who at the time was seeing Willenbring three or four times a month but has since cut back to once every few months. At age 50, Jean who asked to be identified by her middle name went through a difficult move and a career change, and she began soothing her regrets with a bottle of red wine a day.
When Jean confessed her habit to her doctor last year, she was referred to an addiction counselor. The whole idea made Jean uncomfortable. How did people get better by recounting the worst moments of their lives to strangers?
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Still, she went. Another described his abusive blackouts.
Addiction Is Different in America
One woman carried the guilt of having a child with fetal alcohol syndrome. Then she found Willenbring. During her sessions with him, she talks about troubling memories that she believes helped ratchet up her drinking. In his treatment, Willenbring uses a mix of behavioral approaches and medication.
Denial as a Symptom of Alcoholism
Moderate drinking is not a possibility for every patient, and he weighs many factors when deciding whether to recommend lifelong abstinence. He is unlikely to consider moderation as a goal for patients with severe alcohol-use disorder. Nor is he apt to suggest moderation for patients who have mood, anxiety, or personality disorders; chronic pain; or a lack of social support.
The difficulty of determining which patients are good candidates for moderation is an important cautionary note. But promoting abstinence as the only valid goal of treatment likely deters people with mild or moderate alcohol-use disorder from seeking help. The prospect of never taking another sip is daunting, to say the least. No one knows that better than Mark and Linda Sobell, who are both psychologists.
In the s, the couple conducted a study with a group of 20 patients in Southern California who had been diagnosed with alcohol dependence. Over the course of 17 sessions, they taught the patients how to identify their triggers, how to refuse drinks, and other strategies to help them drink safely. In a follow-up study two years later, the patients had fewer days of heavy drinking, and more days of no drinking, than did a group of 20 alcohol-dependent patients who were told to abstain from drinking entirely.
Both groups were given a standard hospital treatment, which included group therapy, AA meetings, and medications. The Sobells published their findings in peer-reviewed journals. In , the University of Toronto recruited the couple to conduct research at its prestigious Addiction Research Foundation. In , abstinence-only proponents attacked the Sobells in the journal Science ; one of the writers, a UCLA psychologist named Irving Maltzman, later accused them of faking their results. The Science article received widespread attention, including a story in The New York Times and a segment on 60 Minutes.
Over the next several years, four panels of investigators in the United States and Canada cleared the couple of the accusations. Their studies were accurate. The late G.
The Role of Acceptance in Coping With Alcohol Addiction
Alan Marlatt, a respected addiction researcher at the University of Washington, commented on the controversy in a article in American Psychologist. They also run a clinic. Like Willenbring in Minnesota, they are among a small number of researchers and clinicians, mostly in large cities, who help some patients learn to drink in moderation. We can change the course.