The Last Addictions Memoir (Hopefully): An Evidence-Based Recovery Story Pt. 14

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The Last Addictions Memoir (Hopefully): An Evidence-Based Recovery Story Pt. 14

By Anne Giles 07/04/17

When I took myself to an AA meeting, I thought I was getting gold standard treatment for alcoholism. The evidence says otherwise.

Image: 
Big Book of Alcoholics Anonymous

The counselor I saw in Tampa when my first marriage ended in 1999 asked his clients to attend Co-Dependents Anonymous meetings. At CoDA meetings, participants are encouraged to attend meetings of the "mothership," Alcoholics Anonymous (AA). I was in my early 40s at the time, nearly a teetotaler. When I attended my first AA meeting in 2000, I cried. I'm still not sure why. Was I moved by the matter-of-fact candor? By the deep feeling of connection? Did a spirit move me? Was it just a brain thing? I estimate I visited approximately 100 open AA meetings, and felt moved to tears at most of them.

At a church I attended while living in Tampa, several members shared openly that they were in 12-step recovery. One church member held a series of 12 weekly lectures at the church, advertised and open to the public, on each of the 12 steps. The Franciscan Center in Tampa openly publicized 12-step retreats and I attended them frequently. I found working the steps with sponsors and fellow group members meaningful and enlightening. I treasured the open discussion among people attempting to discern principles by which to live enlightened lives.

When I lived in Tampa, I took a break from teaching to write full-time during a separation in my marriage. I write early and intently, then find myself rarely able to do so again for a second session in the afternoon. Passionate about the teaching and learning possibilities of the World Wide Web, I took a part-time, afternoon job in 1996 at a local Internet company to help create text for their hand-coded HTML web sites. I later started my own small business as a web site developer - crazily appearing, in those early days, on page one in Yahoo! search results - and became active in the Tampa technology community.

Once I moved back to Blacksburg and found myself no longer able to teach, I turned again to the technology field and started another company in 2008.

When the issue of Wired magazine arrived in 2010 with the article "Secret of AA: We Don't Know How It Works," I felt the deep thrill of the validated entrepreneur. I had seen AA work in Tampa! I knew it worked! I hadn't been a member, but I was a witness. And, now, here AA was covered in a mainstream magazine. Why would Wired cover something that didn't work? That wouldn't be news. AA must work.

In my mind, AA was the equivalent of a startup and its rogue team members, through toiling long hours in secret gatherings, had defied the establishments of science and medicine and succeeded! A defiant, rebellious, maverick streak in me reveled at this. I had always been such a goody two-shoes, so compliant, never feeling like I measured up. AA members seemed like lesser superheroes, not comic book material, but resolutely powerful nonetheless.

Nearly 10 years after attending my first AA meeting, while standing at the kitchen counter and pouring wine into measuring cups, I realized I had developed alcoholism.

AA has been considered the gold standard in treatment for alcoholism since reporter Jack Alexander wrote in a 1941 article about AA, for the highly circulated Saturday Evening Post, "This rate of success is exceptionally high." I believed I had seen the efficacy of AA with my own eyes at Tampa AA meetings. Besides, Wired magazine had confirmed in print that it worked just two years earlier. As Maia Szalavitz did, I assumed about AA that there was "strong science behind it." I knew I could trust AA to treat my alcoholism.

I felt my face burn as I searched online for local AA meetings. On December 27, 2012, I woke up early as always and worked on the computer from my home office. Then I felt some kind of terrible tearing within me. I became an automaton. I dressed, I got in my car, and I drove to the meeting. That night, I drank all the wine left in my house, a half-bottle of white wine, and a quarter-bottle of red, not enough, but it would do. The next day, I drove again to the meeting. I have abstained from alcohol since.

When "AA Is Not Evidence-Based Treatment" was published, I felt such sadness. I contributed to the report, but I didn't want its conclusions to be true. We just don't have bias-free data from which to conclude one way or another whether AA works. We definitely can't say that it works, but we can't say that it doesn't either. There does seem to be a correlation between people who attend meetings and abstinence, but we don't know whether those people would have been abstinent anyway because only people who want to go to AA continue to go to AA. Maybe those people are just more likely to recover regardless.

To be considered evidence-based, treatments need to be supported by research showing that the treatments actually work for most people most of the time, better than other treatments, or better than no treatment at all. Seeming to work some of the time for some people isn't good enough treatment, not when the illness causes premature death. Scientists still do not have evidence that AA works, in spite of decades of research.

Why are some people who have participated in AA abstinent? In terms of the scientific method, it's considered correlation, not causation. The events were associated in time. Further, what's present in an individual cannot be generalized to be present in a population. One person may attribute abstinence to AA participation, but the causal link between AA and abstinence cannot be validated scientifically for the many or the most.

Might the person who claims success in AA have simply benefited from social support and received the same result from participating in a book club or on a softball team? We don't know. One of most difficult concepts in addiction treatment is the idea of spontaneous recovery. Might the person who claims success in AA have already been on the way to becoming abstinent eventually, with or without AA? I, for one, do not want to step into a time machine and find out.

Even if I were able to step into a time machine and redo my recovery from alcoholism, drawing conclusions for the many from my personal experience would be scientifically invalid. When I was seeing people in AA meetings in Tampa who self-reported abstinence, and I thought AA was the reason, I was subject to selection bias. I was seeing the remaining minority of people attending meetings, not the entire pool of people who had tried AA, most of whom had dropped out.

Further, my observations from attending a few AA groups would be too small of a sample size to generalize to all AA groups nationwide or world-wide. When I repeated what I heard, "To get what I have, you have to do what I do," I wasn't realizing the fallacy in logic, much less the hubris, involved in believing my individual, anecdotal experience had meaning for the many. As Maia Szalavitz notes about her early years in recovery, "At the time, I thought that simply having experienced addiction qualified me as an expert and incorrectly relied on anecdote, not data."

One of the bitterest parts of having developed addiction is having to invalidate my own beliefs. As a trained addictions counselor, I believed addiction was a behavioral, mental and moral disorder. Addiction, however, is a medical disorder with symptoms manifesting behaviorally, cognitively and emotionally. I'm actually unqualified to deliver first-line addictions care because I am not a medical professional.

I believed by going to AA that I was engaging in top-tier treatment for myself. On the contrary, according to the latest recommendations based on decades of research, my treatment plan should have been an organic, individualized, evolving document which began, in priority order, with assessment for medications, individual counseling, and recovery support services, RSS, which may or may not have included AA based on my individual needs and preferences.

I passionately jettison one of my former beliefs and hurl it like a rock into the river. I believed developing alcoholism meant I had gone bad, rotting from within from some creeping, overlooked moral or spiritual depravity. No. A vicious no. I did partake of a risky substance of my own volition. But I'm one of a cohort of nearly 9 in 10 adult Americans who choose to drink alcohol. However, I then became one of the 1 in 10 unfortunate Americans  - expected to increase to 1 in 7 - who developed a medical disorder related to substance use.

We don't know exactly what causes addiction, but we do know what creates fertile soil in which seeds of addiction can germinate. Bucking society's moral codes isn't one of them. Trauma is.

The 1 in 10 Americans who developed addiction likely have stories similar to mine, although the details may differ vastly, especially for those who have served in the military. The precursors to developing addiction aren't moral problems. They're tragic and lamentable.

I am just one of the 6 out of 10 Americans with the medical condition of alcohol use disorder in need of evidence-based treatment. However personally saddened I might feel to learn this, however much I might wish it were otherwise, AA does not qualify as an evidence-based treatment for alcoholism.

But I thought it did.

The Last Addictions Memoir below:

Part 1 here  Part 2 here  Part 3 here Part 4 here  Part 5 here Part 6 here Part 7 here 

Part 8 here Part 9 here Part 10 here Part 11 here Part 12 here Part 13 here

Anne Giles, M.A., M.S., is a counselor, writer and business owner. She writes about addictions treatment, recovery and policy at annegiles.com. As of this writing, she has been abstinent from alcohol since December 28, 2012, and is in remission from alcohol use disorder.
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Anne Giles, M.A., M.S., is a counselor, writer and business owner. As of this writing, she has been abstinent from alcohol since December 28, 2012, and is in remission from alcohol use disorder. You can find Anne on Linkedin and Twitter.

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