Will AA or other approaches dominate alcoholism treatment in the future?
Hi, I am writing a thesis (due in in three weeks!!) on disease model vs social learning theory on alcoholisim. I was wondering where you think AA and the disease model is heading in the future. Some say we are heading into a "post modern" period, where the strength of the church etc is weakening. Do you think this will weaken any of the popularity for AA? Also It has been claimed that since we know controlled drinking does occur with alcoholics, modern reseach will focus on whether controlled drinking actually "improves" alcoholics. What is your thoughts on this? Does it improve them, or make them less likely to relapse, and is this what recent research focuses on? Thank you very much, I know you must often be told this, but your work is excellent and very inspiring.
My answer is U.S.-centered, so you will have to check local conditions on your own.
I believe that, rather than entering a post-modern period in which religion will be less important, we are entering a period where religion and spirituality are on the rise. This goes along, strangely enough, with enhanced expectations that science (particularly biology and genetics) will solve emotional and life problems.
In the alcoholism field, AA will always dominate in the U.S. (and may continue to grow worldwide). But controlled drinking and social learning theory approaches will gradually increase. Of course, currently, 93% of American treatment programs practice the 12-step approach, while 99% are abstinence-oriented (according to Paul Roman's National Treatment Center Study). So any change toward moderation and social-learning approaches will still not overcome the overwhelming American fixation on AA and abstinence.
At the same time, research continues to flood in indicating that the U.S. MUST change its approaches. Even the fabled Project MATCH, which found for the first time that the 12-step approach can work (if enough training and control of therapists are artificially imposed), the brief-intervention/motivational-enhancement treatment condition produced equivalent results with one-third the number of sessions. In any other area of therapy, this would result in third-party payors demanding that providers switch to the more cost-efficient approach. Likewise, court decisions (1) forbidding government agencies — such as prisons and the courts — from requiring AA or 12-step treatment participation without offering nonreligious alternatives, (2) finding the founder and past president of the American Society of Addiction Medicine, G. Douglas Talbott, liable for millions of dollars after his prestigious physician alcoholism program forced a doctor into treatment based on a false diagnosis of alcohol dependence, (3) supporting the growing acceptance of informed consent requirements in which treatment providers are obligated to enumerate the advantages and disadvantages of various treatment options, will all push American treatment towards a more pluralistic and sensible set of alcoholism treatment alternatives.
And, God willing, I will be one of the principal beneficiaries of this shift! (Stanton, Charles Bufe, and Archie Brodsky have written a book, Resisting 12-Step Coercion, that illuminates these data, rulings, and trends.)