Editorials

editorial

Alcoholics Anonymous not the only treatment option

Members of Alcoholics Anonymous took part in a meeting in Moscow.
AFP/Getty Images/file 2012
Members of Alcoholics Anonymous took part in a meeting in Moscow.

For decades, Alcoholics Anonymous has been the standard program — and indeed, the only widely known option — for problem drinkers in this country. Its 12 steps, which include completely forswearing alcohol, are widely seen as the best way back to sobriety.

But the centrality AA’s approach enjoys is far firmer than its efficacy or the science behind it, writes Gabrielle Glaser in a thought-provoking article in the April Atlantic magazine. Glaser, author of “Her Best-Kept Secret: Why Women Drink and How They Can Regain Control,” says AA’s predominance has limited the attention given to other treatment options.

For example, in Finland, the drug naltrexone is prescribed to help problem drinkers reduce their craving for alcohol. By curbing those cravings, it has let many heavy drinkers reduce their intake markedly, without forcing them to do without alcohol altogether. That’s known as the Sinclair Method, after John David Sinclair, the American neuroscientist who popularized the treatment in Finland. Another anti-craving drug, acamprosate, was also shown to be effective in a meta-study done last year by the University of North Carolina.

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Naltrexone is not without side effects. It can produce nausea and headaches, though those symptoms appear in 10 percent or fewer of users. There’s also a possibility of toxic liver effects, which is why the drug should only be used under a doctor’s supervision. Acamprosate has more minor side effects.

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The larger point, however, is that there are effective treatments for alcohol abuse that don’t rely on the all-or-nothing approach of AA. Indeed, a recently released documentary, “One Little Pill,” is devoted to spreading the word about the success that problem drinkers have had in addressing their issues with naltrexone. Still, though naltrexone won FDA approval as a treatment for alcohol abuse in 1994, fewer than one percent of those treated for alcohol problems in the United States are prescribed the drug, according to Glaser.

Now that substance-abuse treatment is a required part of health care coverage, thanks to the Affordable Care Act, it’s time for physicians, insurance companies, and treatment programs to thoroughly investigate the efficacy of other approaches. Although AA clearly works for some people, it’s not a success for others. That alone suggests the need for greater awareness of other options.