AA makes alcoholics' problems `worse'


AA makes alcoholics' problems `worse': Pro-moderation rival slams rigid approach

The rigid abstinence preached by Alcoholics Anonymous makes the problem of alcoholism worse, according to rival group Moderation Management.

"My belief is, actually, the abstinence world of AA has caused alcoholism to get worse," said Marc Kern, a California psychologist and board member of Moderation Management. "People are told in an AA meeting `If you don't buy us 100 per cent, go out there and drink and when you hit bottom come back.' "

Mr. Kern's comments escalate the war of words between the moderators and the abstainers, the two camps in the alcoholism treatment world. According to Mr. Kern, the abstainer camp has been playing dirty, exploiting the tragedy involving the founder of the Moderation Management movement.

Last month, Audrey Kishline, who started the movement in the mid 1990s, was charged with double manslaughter in Washington state after killing a father and daughter while driving drunk.

Officially, Alcoholics Anonymous has said nothing about the case because, as a matter of policy, the organization never comments on outside issues.

"And believe it or not, Moderation Management is an outside issue," said AA spokesman Bill A., who, as an anonymous alcoholic, asked that his surname not be published.

But the National Council on Alcoholism and Drug Dependence (NCADD), an organization with close though unofficial ties to AA, has commented. Its president, Stacia Murphy, said Ms. Kishline was in "denial," and "this tragedy might have been avoided if (she) had come to this realization earlier."

Mr. Kern called Ms. Murphy's organization "nothing more than an extension of AA," and said her comments are an example of the way AA's powerful influence stifles dissent. "They have historically pounded on anybody who wants to speak against the gospel. It's like we're in the dark ages."

AA has two million members -- an estimate made conservative by the anonymity of the program. Moderation Management has about 1,000 members.

The fact that AA won't speak directly to the issues, Mr. Kern said, is deceptive. "That's what's difficult about combatting this fundamentalist movement. They're designed in such a way as to be very slippery. You can't really press against it like you could a corporation or an individual."

Mr. Kern also sees the recent resignation of Dr. Alex DeLuca from his post as director of New York's Smithers Addiction Treatment and Research Centre as the outcome of AA pressure. Dr. DeLuca had come to accept the idea that moderation was appropriate in some cases.

In apparent agreement with Mr. Kern on one point, Jeffrey Hon, spokesman for the NCADD, said of his own organization "Yes, in fact, (we) have a history of intolerance toward moderation programs."

Philosophically, the abstainers believe that once people lose control of their drinking the only way to travel the road to recovery is on the wagon.

Step one of their 12-step program is the admission that "we were powerless over alcohol -- that our lives had become unmanageable." Step five is the admission "to God, to ourselves and to another human being the exact nature of our wrongs."

The moderators agree that outright alcoholics should abstain completely, but contend that a far greater number of people with less advanced drinking problems can improve their lives greatly by learning to moderate.

The moderators also say that their more attractive approach can also serve as a stepping stone for eventual abstainers who find quitting cold turkey too daunting a prospect.

The abstainers counter that while it is possible for some individuals to moderate, it is too difficult to distinguish between problem drinkers and true alcoholics, and the safest course is to quit altogether.

In Ontario, services like the Alcohol and Drug Assessment Referral Service do offer a moderation program, the Guided Self- Change Program, to selected clients, in addition to its abstinence- based programs.

A drug that lowers the activity of serotonin and other chemical messengers in the brain may boost the effectiveness of psychological treatments for a severe form of alcoholism, at least over a short time period, a new study finds.

Ondansetron, a medication currently prescribed to quell nausea and vomiting in chemotherapy patients, helps to reduce drinking and foster abstinence among adults who developed alcoholism before age 25, report psychiatrist Bankole A. Johnson of the University of Texas Health Science Center in San Antonio and his colleagues.

"We think we're dealing with a biological trait that creates a predisposition to early-onset alcoholism and perhaps other addictions," Johnson says.

The researchers recruited volunteers seeking alcoholism treatment at either of two substance-abuse centers in Texas between 1995 and 1999. A total of 271 participants-many of them middle-age, white men-were assigned at random to receive one of three daily dosages of ondansetron or a placebo pill for 11 weeks. All volunteers also attended weekly group-psychotherapy sessions aimed at teaching them strategies to avoid alcohol use.

About 60 percent of people in each treatment group completed the trial. During the study, alcohol consumption was established through self-reports and chemical analyses of blood and urine. All groups exhibited noticeable drops in alcohol intake by the end of treatment and a greater tendancy to abstain from drinking.

Among the 161 patients with early-onset alcoholism, those who received ondansetron consumed less alcohol and spent more time abstinent than did those who got the placebo, Johnson's team reports in the Aug. 23/30 JOURNAL OF THE AMERICAN MEDIcAL AssocIATION.

For example, volunteers taking the middle dose of ondansetron spent 70 percent of study days abstinent and imbibed an average of 1 1/2 drinks daily; those in the placebo group were abstinent 50 percent of the days and averaged nearly 3 1/2 drinks daily.

Participants with alcoholism that began later in life exhibited no greater improvement on ondansetron than on the placebo.

Ondansetron blocks the activity of serotonin directly, which leads to reductions in other neurotransmitters, including dopamine. However, the physiological mechanism that creates a disposition to early-onset alcoholism remains unknown.

Henry R. Kranzler, a psychiatrist at the University of Connecticut School of Medicine in Farmington, says the new results herald rapid progress in finding medications that help specific sets of patients with alcoholism.

John S. Searles, a psychologist at the University of Vermont School of Medicine in Burlington, disagrees. He regards ondansetron's effects on alcohol use as "pretty small and inconclusive" compared with those elicited by group psychotherapy alone. Further research should track patients with early-onset alcoholism who get ondansetron without group psychotherapy, Searles says.

Successful psychotherapy for depression and other mental ailments hinges on the establishment of a working alliance, also known as a therapeutic alliance. Most definitions of this concept emphasize a collaborative relationship between therapist and client that includes an emotional bond and shared opinions about the tasks and goals of treatment.

Alcoholism treatment, at least in outpatient programs, may also benefit from the establishment of a working alliance, according to a study in the AugustJOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY.

The results come from a national study that previously found comparable improvement in alcoholics completing any of three 12-week treatments (SN: 1/25/97, p. 62).

For 992 alcoholic outpatients, a strong working alliance--as documented by a 36-item questionnaire completed by both clients and therapists--was reported more often among those who attended therapy sessions regularly and drank smaller amounts of alcohol a year after therapy ended, psychologist Gerard J. Connors of the Research Institute on Addictions in Buffalo, N.Y., and his colleagues found.