Wednesday, May 1, 2013

Docs, lawyers, judges: Go to AA before recommending it

Frequently, doctors suggest patients who are struggling with alcohol problems should attend AA.  A researcher doesn't dispute the suggestion, but encourages doctors give it a try themselves first, so they know precisely what course of recovery they are recommending, as noted in this article I posted this morning.

According to an April 30 news release by The Partnership at, doctors who encourage patients with alcohol use disorders to attend the 12-step program Alcoholics Anonymous (AA) should try it themselves so they know more about which they speak. A estimated 60 percent of emergency room admissions are alcohol-related and as many as 21 million adult Americans have an alcohol problem.

“Any doctor treating addicted people should go to at least a few AA meetings, so they can discuss it with patients in a knowledgeable way,” says Marc Galanter, MD, Professor of Psychiatry and Director of the Division of Alcoholism and Drug Abuse at NYU Langone Medical Center. “It’s very experiential, and doctors should have a sense of it. They should also learn the steps of AA.”

This could be helpful to doctors addressing one objection often plaguing AA: Is it spiritual? Or religious? Galanter says, “That’s a particular kind of experience that is not necessarily what clinicians would expect. It’s important for them [doctors] to appreciate it, because that’s what their patients will encounter.”

The same recommendation could be made for court officials who dispatch intoxicated driving or disorderly conduct offenders to the 12-step program.

Not all AA meetings are open to visitors, like physicians, who personally do not have a problem with alcohol abuse of the disease of alcoholism. On local listings of 12-step meetings, some will be listed as “closed,” meaning they are only for AA members with a desire to stop drinking. “Open” meetings do not close their doors to participation by non-alcoholics and generally welcome anyone – especially professionals – with an interest in learning more about the program of recovery. If a meeting is not designated as either open or closed, the assumption is that it is a closed meeting.

Galanter's soon-to-be-published research deals only with AA. There are other support groups for those with drinking problems as well. Women for Sobriety is one well-known alternative for women who prefer to recover with other women. Self-Management and Recovery Training (SMART) may be a more suitable secular alternative to those struggling with alcohol who also struggle with spirituality.
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Would a physician recommend a medication without knowing or studying its interaction with other things a patient is taking?  Unlikely.  If a patient has strenuous objection to spirituality and a doc recommends AA, he could be recommending a course of recovery with a negative interaction with other parts of a patient's well-being.  AA is the most well-known among support groups, and is often the recommendation of courts and doctors alike when they are faced with troubling alcohol cases.  The recommendation is well-intentioned.  But is it appropriate?  AA is not for everyone. SMART is not for everyone.  And some patients may not be ready (yet) for a course of action at all.  Instead of reaching for the quick solution to get a person out of the examination room or the court, the researcher is spot-on in suggesting that the professional recommendation (or sentence) be experienced in person by the professional first.