Alcohol treatment: when faith-based options aren't enough. (THE CULTURE WAR).

With all the talk about federal support of faith-based initiatives within the Bush administration, it is time to take a look at how we treat alcohol problems in the United States. In many states, drunk-driving offenders continue to be mandated to attend twelve-step programs even though, at last count, four appeals courts have ruled that such practices violate constitutional rights because the programs are considered religious activities. Simply allowing offenders a choice of which support group to attend--offering secular as well as traditional options--would resolve this issue.

Although Alcoholics Anonymous, with its guiding twelve steps, is highly effective for many people, for too long the tendency in the United States has been to treat all people with drinking problems the same way. Too often AA is assumed to offer the only way out. For instance, when "Dear Abby" ran a quiz for assessing alcohol problems, the column concluded that those who appear to be in trouble should, "Run, do not walk, to Alcoholics Anonymous." And a recent issue of my health plan's newsletter, which had a cover story on its alcohol screening program, listed as the recommendation for people who have a problem: "Attend Alcoholics Anonymous." No other recovery programs are mentioned.

Studies confirm that it's often difficult for people who seek treatment to find an alternative to AA. The National Treatment Center Study conducted by the University of Georgia found that 93 percent of the more than 400 representative alcohol treatment programs surveyed were based on the twelve steps of AA.

In conducting a national search for people who resolved serious drinking problems, I heard from a physician who --under threat of losing his medical license--was required to attend AA for five years. Yet he repeatedly told colleagues who were "assigned" to monitor him that he found other approaches to be more helpful and that he felt worse after attending AA meetings. (After being subjected to this humiliation, it turned out he's not an alcoholic.) I also heard from a nurse who risked losing her nursing license unless she attended AA--even though she found an alternative recovery group to be far more beneficial. Recently, I was contacted by a midwestern social worker who informed me that his private practice--which offers alternatives to AA for court-referred clients with addictions--was all but forced out of business by an AA-member judge who won't recognize the social worker's practice as legitimate.

There's no question that AA has saved countless lives. In researching a book I was writing, I heard many AA success stories. But I also heard from scores of people who overcame their drinking problems in other ways: through Secular Organizations for Sobriety, Women for Sobriety, SMART Recovery, and Moderation Management --all respected programs that have philosophies very different from those of AA. Many other people who contacted me quit drinking completely on their own--as apparently George W. Bush did years ago. (Research suggests there are at least as many people who resolve alcohol problems independently as there are who recover after receiving formal help.)

Some people I located recovered with the help of a mental health professional who has expertise in addictions. Others had a religious experience--apart from AA--that led to their recovery. Some individuals had been told repeatedly that AA is the only route to sobriety, yet found themselves relapsing until they found another way to get sober. The point is, people who resolve serious drinking problems do so in many different ways--often with AA's help; often without it.

One of the reasons why recovery options are needed is that alcohol problems vary in degree. Quite a few people who contacted me were high-functioning problem drinkers who didn't identify with the twelve-step philosophy. Some who had quit drinking told me they never viewed themselves as alcoholics. (There's no scientific evidence that this is necessary for long-term sobriety.) Many never "hit bottom." People also have highly individual responses to different recovery approaches and philosophies. Some need to go to meetings forever while others don't and, instead, see themselves as recovered or cured. For quite a few, recovery has nothing to do with powerlessness or believing in a "higher power." In short, what works for one person doesn't necessarily work for another.

AA's own basic textbook, Alcoholics Anonymous (also known as the "Big Book") states: "Upon therapy for the alcoholic himself, we surely have no monopoly.... Our book is meant to be suggestive only. We realize we know only a little."

Let's hope that if greater federal funding of faith-based social services comes to pass, it doesn't strengthen our tendency to treat all drinking problems the same way in this country--nor distract us from our responsiblity to try to meet the needs of all alcohol-troubled people. Research suggests that only one in ten individuals who need help for alcohol problems actually receives any form of treatment. Of those who receive treatment, as many as half relapse at least once, and only a minority achieve long-term sobriety. Maybe if we offered more options, more people would seek and find a lasting solution.

Anne M. Fletcher is a medical journalist and author of Sober for Good: New Solutions for Drinking Problems--Advice from Those Who Have Succeeded (Boston: Houghton Mifflin, 2001). She is former executive editor of the Tufts University Health & Nutrition Letter.