The controversy and collision of addiction science and spirituality

Scientifically speaking, arresting the disease of alcoholism is very simple: Stop drinking alcohol. No one, regardless of genetics can ever be an active alcoholic without alcohol. A person can be an alcoholic-in-wait – or one in remission – with the genetic foundation for alcoholism. But in strictly medical terms, one will never know if he's alcoholic if he never drinks, and through abstinence an alcoholic can arrest the disease. As of today, there is no cure, similar to other diseases like cancer.

The condition the person is in following abstinence is viewed by addiction professionals as sobriety and, possibly, recovery. The difference between the two terms is a chasm filled with controversy because it reflects a difference in mental and emotional well-being. One school of thought is that there is no “recovery” without acknowledging and attaining spiritual growth. Quite a different line of thinking seeks to assure long-term sobriety by behavior change and retraining.

Take the categorization of a person as a “dry drunk” for example. The person isn't drinking, so he's sober. But the mental and emotional side may still be as bad or worse than while he was drinking, continuing odd or, oftentimes, antisocial behavior. The alcoholism was arrested but the alcoholic is still getting arrested, or flagged for being a jerk. That's far from “recovered.” In fact, some around him may prefer he was still drinking because then they'd know what his problem is, according to alcoholism relapse and recovery book Every Silver Lining Has a Cloud.

Advocates of spirituality in recovery, 12-step programs among them, say emotional and mental stability can only return to the alcoholic when he embraces in concept or in daily practice the presence of a higher power. According to research by Project MATCH, a program of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), spiritually focused addiction treatment programs have resulted in up to a 10 percent greater abstinence rate than other forms of treatment. Conversely, an infographic from Alternatives in Treatment's ebook Spirituality and Addiction acknowledges programs that focus on the negative and not a spiritual foundation have a lower lifetime sobriety rate.

For some that spiritual entity is god, God or some life force like nature. A growing proportion of 12-steppers are pagan, agnostic or don't recognize a Judeo-Christian concept of God. But the higher power could be extraterrestrials for that matter, as long as a belief system has sufficiently refilled the void in life and coping that alcohol was used to fill until the person became physically dependent upon the legal drug. These practices include meditation or prayer and strengthen (or establish) self-control and focus attention.

Research illustrates how including spirituality in a recovery program increases the individual's chances at long-term remission of the illness. Even in medical illnesses where the treatment of the illness involves some form of cognitive behavior therapy (CBT), spirituality aids recovery. Within the medical profession, health care workers have noted that individuals with a strong spiritual background recuperate more quickly from their health crisis.

This intricate web of spirituality and its influence on the recovery of individuals has spurred increasing research focusing on how issues related to spirituality, religion, and faith are incorporated into the treatment of individuals and their clinical outcomes. The 2004 clinical studies in the manual, Handbook on spirituality and worldview in clinical practice, report that spiritual people are less depressed, less anxious and less suicidal than nonspiritual people. They also cope better with events that are considered alcoholism relapse triggers, such as illness, divorce and grief.

TIME magazine, in it's Jan. 17, 2005 issue, concluded that the more people incorporated spiritual practices into their daily living the more frequently they had positive emotions and an overall sense of satisfaction with life. A separate study reported in the Journal of Substance Abuse Treatment in 2000 found higher levels of spirituality predicted more optimistic life orientation, great perceived social support, higher resilience to stress and lower levels of anxiety.

Spirituality works for many as a component of a counseling and/or a sobriety program, but it doesn't work for all. It's too far of a leap for many seeking to end their chemical dependence. Some say they've tried that and failed, others have a reluctance for faith (mistaking spirituality for organized religion), and yet others seek an entirely empirical answer to the perplexing disease and its associated behaviors.

For alcoholics in that mode of thinking, there are alternatives to 12-step-based treatment and self-help groups. Self Management and Recovery Training (SMART... four “points”), Secular Organizations for Sobriety (SOS... nine “principles”), Women for Sobriety and Men for Sobriety (WFS and MFS... 13 “statements”) all have reported successes and established footholds in the world of recuperative options. Redwood Cliffs, a Watsonville, Calif. Facility, has been offering long-term non-12-step rehabilitation services for more than 20 years. Late night and cable advertising for a high-end Malibu, Calif., facility uses “not a 12-step program” as a central theme of its commercial. It also claims to have a “cure.”

Alternatives to spirituality in recovery have neither the history nor the status of the intentionally media-shy Alcoholics Anonymous (AA...12 steps). Twelve-step methods are used in conjunction with 90 percent of the nation’s treatment facilities. But that doesn't mean they're 100 percent effective. God or god won't do all the work. No program – spiritual or secular – will be even one percent effective without a willing patient. Coercion doesn't work either.
-- (see full article)
www.alcohologist.com

Visit alcohologist.com for a replay of the Bringing Inspiration To Earth show feature with Scott Stevens. Lucy Pireel's "All That's Written" included a feature on Every Silver Lining Has a Cloud called "When alcohol doesn't work for you anymore."  Details on the third literary award for Every Silver Lining Has a Cloud also can be found on www.alcohologist.com, plus an interview with Scott Stevens on Health Media Now and one at Christoph Fisher Books.  Mr. Fisher is an acclaimed international author from the UK, among his works is the Alzheimer's book "Time to Let Go."  

World Stroke Day: New Finnish study ties alcohol use and hangovers to stroke risk

World Stroke Day  is Oct. 29, bringing attention to how to spot a stroke and how to prevent one. On the prevention front, a new University of Eastern Finland study shows excessive alcohol consumption increases the progression of atherosclerosis and the risk of stroke in middle-aged men. The findings were reported as part of the FinnDrink Study Oct. 21 and mirror earlier data showing an increased stroke risk for drinkers of both genders regardless of age, even with only moderate consumption.

The Finnish research found that progression of atherosclerosis over an 11-year follow-up was increased among men who consumed six or more drinks on one occasion. Stroke risk also increased among men who had at least one hangover per year. Drinking large quantities of alcohol more than twice a week also increased the risk of stroke death in men.

And strokes aren't only a concern for older adults. Early in 2013, a separate study at the University of California at San Francisco (UCSF) concluded that one of every five strokes occurs in people between 18 and 44 years of age. That's men and women.

"When a young person has a stroke, it is probably much more likely that the cause of their stroke is something other than traditional risk factors," such as hypertension and obesity, according to one of the lead researchers in the study. (See the entire examiner.com article)

The UCSF researchers say long-term changes in the heart as a result of alcohol abuse or the disease of alcoholism may put younger users at higher-than-average risk earlier in life. "Substance abuse is common in young adults experiencing a stroke,” according to the research team. "Patients aged younger than 55 years who experience a stroke should be routinely screened and counseled regarding substance abuse.”

Neither study offers evidence that patients' drug or alcohol use directly caused the strokes. It's possible, for example, that people who abuse alcohol or have the disease of alcoholism also see their doctors less often or engage in other risky behaviors that increase the chance of stroke.

Stroke disables more people in the United States than breast cancer or the war in Afghanistan. According to the Centers for Disease Control and Prevention (CDC), nearly 800,000 people in the United States have a stroke every year. Strokes (either ischemic or hemorrhagic) are the most common causes of serious long-term disability. Ninety percent of strokes are ischemic, where a clot blocks blood flow to the brain.

Additional statistics from the National Stroke Association reveal:

• Stroke kills almost 130,000 Americans each year—that’s 1 in every 19 deaths.
• On average, one American dies from stroke every 4 minutes.
• Fewer than 20 percent of hospitals are stroke certified.
• One fourth of strokes are recurrent strokes.
• Stroke costs the United States an estimated $38.6 billion each year.

Stroke risk is heightened by even a small amount of alcohol according to an Oct. 26 study posted on Canadian medical news website Tele-Management. Just one drink of alcohol was found to double stroke risk immediately after consuming the beverage. After two hours, the risk of stroke is increased 1.6 times when compared to the risk before having the drink.

The research was not based on any specific type of alcoholic beverage.

The World Stroke Day campaign emphasizes the importance of seeing a physician regularly and quickly recognizing the signs of a stroke. The American Stroke Association and American Heart Association use the acronym FAST, encouraging people to be on the lookout for weakness in one side of the Face or Arm weakness or Speech difficulty as signs it is Time to call 9-1-1. Some stroke treatments can only be used during a short "window of opportunity" after the stroke, just like has been commonly accepted as a window of opportunity for getting help to someone who’s had a heart attack.

-- from examiner.com (see complete article)
www.alcohologist.com



Please read the new interview with Scott Stevens at Christoph Fisher Books.  Mr. Fisher is an acclaimed international historical fiction novelist from the UK.    

SATURDAY REWIND: Impaired driving, what 53 feet means

There will be increased enforcement of drunk driving laws this month and through the remainder of the year. It is an act of courage on behalf of law enforcement, with many officers waging a never-ending and usually dangerous battle of tagging intoxicated drivers.  The following article from the alcohol research news archive demonstrates what a couple of drinks means to avoiding collisions.

Most alcohologists prefer the term “Operating While Impaired” over “Drunk Driving” because often drinkers don’t feel drunk, but they are impaired. No distinction is ever assessed whether the driver is an alcohol abuser or has the disease of alcoholism: If you are impaired, you are under arrest.

 

Drunk or buzzed driving is the act of operating or driving a motor vehicle while under the influence of alcohol or drugs while motor skills are impaired. In the United States, the point of impairment is pegged at .08 Blood Alcohol Concentration (BAC). However, studies have demonstrated that motor-skill impairment begins at much lower BACs. Reaction time is 1/5 of a second for an unimpaired driver. With alcohol in the system, reaction time is slowed to 4/5 of a second at .06 BAC. At 60 mph, a second means 88 feet. A fifth of a second is 17.5 feet, 4/5 of a second is 70.4 feet. The Jetta slamming on the brakes in front of an impaired driver is 53 feet closer, reaction-time wise, compared to an unimpaired driver.

 

The specific criminal offense is usually called driving under the influence (DUI), and in some states driving while intoxicated (DWI), operating while impaired (OWI), or operating a vehicle under the influence (OVI). In the United States the National Highway Traffic Safety Administration (NHTSA) estimates that 10,000 people died last year in alcohol-related collisions, representing 40 percent of total traffic deaths. One out of every 10 arrests for all crimes in the U.S. were for OWI, compared to 1.9 million such arrests during the peak year in 1983, accounting for 1 out of every 80 licensed drivers in the U.S. NHTSA is a sponsor of National Drunk and Buzzed Driving Awareness Month along with Mothers Against Drunk Drivers (MADD) and the Governors’ Highway Safety Association.

 

The first jurisdiction in the U.S.to adopt laws against drunk driving was New York in 1910, with California and others following. Early laws simply prohibited driving while intoxicated, requiring proof of a state of intoxication with no specific definition of what level of intoxication qualified. The first generally-accepted legal BAC limit was .15. In 1938, the American Medical Association created a "Committee to Study Problems of Motor Vehicle Accidents". At the same time, the National Safety Council set up a "Committee on Tests for Intoxication". In the US, most of the laws and penalties were greatly enhanced starting in the late 1970s, and through the 1990s, largely due to pressure from groups like MADD, leading to a national standard of .08 as the definition of impairment.
-- from examiner.com

Among recommendations from the National Transportation Safety Board earlier this year:  An even LOWER BAC threshold of .05.  While it has met some resistance, the NTSB this week reinforced its commitment to a lower limit for U.S. drivers.  Keep in mind, it took two decades to lower the BAC limit to .08 from .10.
www.alcohologist.com

Details on the third literary award for Every Silver Lining Has a Cloud, plus the new radio interview replay is available at alcohologist.com... and please read the new interview with Scott Stevens at Christoph Fisher Books.  Mr. Fisher is an acclaimed international historical fiction novelist from the UK.

 

SUNDAY SNIPPET, June 2

There are several reasons Every Silver Lining Has a Cloud notes in favor of attending some sort of self-help group. Attendance can help stave off relapse, but on a more basic level it provides a place to talk and to be heard and to be understood. It doesn't have to be the 12-steps. There are other alternatives, some are quite effective and might be a better fit given a person's location or belief system. The fact is regardless of belief system, we need a place to talk about The Things We Don't Talk About.

 

 

"I’m no shill for AA. The slogan factory drives me nuts. More about this in a moment. I hate the coffee. The Higher Power thing is tough for some people to swallow. Some people stay away from 12-step meetings because they don’t see themselves in the people around the tables or hear their stories told in the tragic stories of others. That is the point in going: To make sure you’re communicating what is stressing you before you go back to the drinking and become those tragic stories. You go because you don’t want to become The Alcoholic You Don’t Want To Be.

 

I screwed that one up, big time.

 

When I first went to a 12-step meeting, I was Alcoholic. No Doubt About It. But I didn’t hear myself as I presently was in the stories. I heard the horror stories. I was a functioning, maintenance drinker with a great job, two cars, etc. I didn’t have this low bottom I heard in the other stories. So I walked away, not realizing that that day could have been my bottom. Their stories of grief and shame weren’t me. I had great empathy for their ordeals. What I failed to see was that they were a gift, showing me where I was headed, not where I was. That these ordeals of theirs were mine if I didn’t make that day my bottom. They were the Alcoholics I Didn’t Want To Be.

 

At the dawn of AA in the 1930s, the makeup was men and women with low, low bottoms. Over the years, that changed mainly because those who had hit low bottoms were able to raise the bottom to a level where it applies to Alcoholics-in-training like me who hadn’t had a low bottom. Yet. I failed. I didn’t listen . . . there’s that communication thing again . . . to what they were saying that they, too, were one day in the same shape I was. And then I became the Alcoholic I Didn’t Want To Be a few years down the road. While we have to talk about the stuff we don’t talk about, it pays to listen. A lot. I go to 12-step meetings for this, but there are other options out there, too. Use them. Most are free.  All are free of excuses not to attend."

--from Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety, pgs. 104-105

www.alcohologist.com

 

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 examiner.com article I posted this morning.


According to an April 30 news release by The Partnership at Drugfree.org, 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.
-- from examiner.com


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.