American health care policies are driven by personal testimony rather than by science. In the case of alcoholism, such testimony is invariably from alcoholics who have recovered through AA. There are many such people. But they are still a tiny minority of those who experience alcohol problems, including those who recover on their own, those who are harmed by AA or 12-step treatment, and others for whom the 12 steps are ineffective or offensive.
The Stanton Peele Addiction Website, November 25, 2009. This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.
I Just Want to Testify (about my alcoholism)
American health care policies are driven by personal testimony rather than by science. In the case of alcoholism, such testimony is invariably from alcoholics who have recovered through AA. There are many, many such people. But they are still a tiny minority of those who experience alcohol problems, including those who recover on their own, those who are harmed by AA or 12-step treatment, and others for whom the 12 steps are ineffective or offensive.
America is a country that worships personal tales of redemption . If public figures are caught out drunk or on drugs, cheating on their wives, then they quickly head off to Betty Ford or Hazelden, apologize to their families and constituents, and promise not to stray or drink again. And we forgive them.
This process derives from America's religous revivalist tradition. At the revival meeting, people rise and denounce the evil of their former ways, declare themselves saved, and commit themselves to God.
This was the format of the Temperance lecture that dominated the nineteenth century American landscape. And the Temperance confession is still with us in the form of Alcoholics Anonymous. For those of you who have been missing your 12-step meetings, here are selected steps to practice at home (note the presence of God, and the absence of alcohol):
- 3. Made a decision to turn our will and our lives over to the care of God as we understood God.
- 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
- 7. Humbly asked Him to remove our shortcomings.
Although such penitence is repeated nightly around the country, these stories conflict with rational public policy. According to the latest government research (called NESARC), 30 percent of Americans at some point in their lives qualify for an "alcohol use disorder." But, within four years, 70 percent recover without AA's or Betty Ford's help.
Others take longer. But only 1 percent of Americans fit the model of the AA members whose drinking carries them to the doors of hell and from which only God can rescue them. Among 300,000,000 Americans, that's 3 million people. But 90 million Americans develop a different sort of drinking problem.
Many entertainment figures had bad drinking periods (Bing Crosby, Robert Redford, Steve Martin) and cut back - the typical problem-drinking profile. We don't hear much about them because they - and millions of others with similar stories - don't go on lecture tours to tell their tales. Craig Ferguson's compelling testimony about his dead-end alcoholism on You Tube, on the other hand, has had a million-and-a-half views. How can you top that?
Nonetheless, for the first time - due to the NESARC research - government officials are questioning received opinion. Dr. Mark Willenbring , director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, declared: alcoholism "can be a chronic, relapsing disease. But it isn't usually." Thus, intensive treatment addresses a small - albeit important - part of America's substance abuse problems. (Disclosure: I have created a non-12-step abstinence-oriented treatment program for this group.)
The limits of public testimony for determining American health policy is also apparent in yet another declaration of a learned council that cancer screening is overutilized. Up to 1,900 women must be screened ten years in their 40s in order to prevent one death from breast cancer. But, along with all that irradiation, 1,000 false warnings will be generated from such testing leading to biopsies and other procedures that create their own dangers.
If you talk to the one in 1,900 women whose life was saved by screening - there are plenty, and I can't compete against them - you determine that there is no way America can better spend its finite health care allotment. But there are actually many more productive , less harmful, more life-saving ways to spend that money - including even for cancer prevention.
Someone has to make these choices. America can listen to one of two groups - health economists and oncologists and internists like those making up the government panel recommending scaling back breast cancer screening, or people who swear that screening is the best use of our health care budget because it worked for them.
While we're at it, we can treat every kid caught with a reefer or who gets drunk as though he or she had a lifetime disease. After all, you can find very moving and convincing stories of people who claim that being forced into AA at age 15 saved their lives. But it's craziness to do so, even though we won't hear the far more frequent stories of people who were scarred by such experiences.
P.S. NESARC changes everything. Apropos of the yet-to-be-fully realized significance of NESARC, consider the year-end summary by the president of the Linnean Society following the presentation of the work of Wallace and Darwin on evolution (although others had outlined evolution earlier): “The year which has passed has not, indeed, been marked by any of those striking discoveries which at once revolutionize, so to speak, the department of science on which they bear.”
P.S.S. As to my alcoholism: Commenters frequent diagnose my mental disorders - the current favorite being that I am bipolar. On the drinking front, I can go wrong one of two ways. Either I am in denial about my alcoholism, or I am not alcoholic and so I can't possibly understand alcoholism. In other words, if I don't share the experiences and outlook of testifiers, I can't enter the Kingdom of Alcoholism. For the record, I struggle to drink as much as I should for my health.