July 21, 2018

The Irrationality of Alcoholics Anonymous

Gabrielle Glaser—The Atlantic:

The 12 steps are so deeply ingrained in the United States that many people, including doctors and therapists, believe attending meetings, earning one’s sobriety chips, and never taking another sip of alcohol is the only way to get better. Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment. But although few people seem to realize it, there are alternatives, including prescription drugs and therapies that aim to help patients learn to drink in moderation. Unlike Alcoholics Anonymous, these methods are based on modern science and have been proved, in randomized, controlled studies, to work.

This excerpt from a fascinating article about an alternative alcoholism treatment points to Americans’ white-knuckled grasp on the eighty-year old AA twelve-step program and its attendant dismal results.

Finnish therapists use a science-based approach that provides a high success rate by blocking opiate receptors in the brain. The result is reduced interest in alcohol as the comfort it provides evaporates. Conditioned craving ebbs.

The opioid antagonists used are naltrexone and a more contemporary drug, nalmefene:

Among other effects, alcohol increases the amount of GABA (gamma-aminobutyric acid), a chemical that slows down activity in the nervous system, and decreases the flow of glutamate, which activates the nervous system. (This is why drinking can make you relax, shed inhibitions, and forget your worries.) Alcohol also prompts the brain to release dopamine, a chemical associated with pleasure.

Over time, though, the brain of a heavy drinker adjusts to the steady flow of alcohol by producing less GABA and more glutamate, resulting in anxiety and irritability. Dopamine production also slows, and the person gets less pleasure out of everyday things. Combined, these changes gradually bring about a crucial shift: instead of drinking to feel good, the person ends up drinking to avoid feeling bad.

Sinclair theorized that if you could stop the endorphins from reaching their target, the brain’s opiate receptors, you could gradually weaken the [alcohol-strengthened] synapses, and the cravings would subside. To test this hypothesis, he administered opioid antagonists—drugs that block opiate receptors—to specially bred alcohol-loving rats. He found that if the rats took the medication each time they were given alcohol, they gradually drank less and less. He published his findings in peer-reviewed journals beginning in the 1980s.

Subsequent studies found that an opioid antagonist called naltrexone was safe and effective for humans.

This was a good long read about an aspect of substance abuse that’s always around us: recovery. The upshot is that for most patients this drug therapy provides potentially life-long benefit. The only thing standing in the way of applying this promising therapy is America’s infatuation with twelve-step programs, specifically AA.

Maybe we should use science to combat addiction, rather than misplaced faith.

#alcoholAbuse #substanceAbuse #sobriety #scientific #evidenceBased

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