https://www.usatoday.com/story/opinion/voices/2018/10/30/addiction-treatment-support-medical-evidence-alcoholics-anonymous-column/1809737002/
My brother died alone in a cheap Long Island motel this past July from a disease commonly treated by unlicensed caregivers using nearly century-old, faith-based practices rather than modern medicine.
Tim was
a successful businessman, loving husband, and adoring father of two young girls
until alcoholism reduced him to a tormented shell of an addict. When he died at 49 he was in what is called the End Stage, a
living hell where withdrawal symptoms are so severe that the alcoholic has to
drink incessantly just to mitigate the anguish.
Tim was incapable of helping himself, and family members and friends were
either disengaged or offered ill-advised support, both due to ignorance or
misconceptions about the disease.
One
misconception is that addiction is caused by lack of willpower or character
flaws. Not true. It is a medically-recognized, chronic disease
of the brain. Dr.
Nora Volkow, Director of the National Institute on Drug Abuse, explains
that this misconception “arises from a false belief that they have
willfully abandoned their responsibilities in favor of a search for pleasure.” In fact, she notes that alcoholics have a
diminished ability to feel pleasure from alcohol.
Even
Alcoholics Anonymous’s (AA) 12-steps ignore this medical wisdom. They advise members to surrender to “God” who
will, in turn, remove any “defects of character” and “shortcomings,” and
restore them to “sanity”. Given AA’s
messaging, it’s no wonder that certain loved ones watched passively from the
sidelines believing Tim’s fate was out of their hands.
Having
been raised by a recovering alcoholic, we heard inspiring stories of AA, but
they were anecdotal. No formal,
comprehensive study has ever been conducted by AA in their 83 year history and
outside, peer-reviewed studies estimate a five to ten percent success
rate.
According
to the National
Institute of Health approximately 88,000 Americans die annually from
alcohol related causes. Yet, Columbia
University’s 2012
study on addiction medicine found that “only a small fraction of
individuals receive interventions or treatment consistent with scientific knowledge
about what works.”
Neurobiology
has found that not every alcoholic responds favorably to any particular
treatment as with any chronic disease. It’s
no surprise then that Tim failed to find sobriety in any of the 16 treatment
facilities endorsing the 12-steps that he entered in his last three years. Although medical professionals generally
recommend that hardcore addicts spend 90 to 180 days in an inpatient facility,
he usually stayed about 30 days.
Last
winter, my brother became a “snow bird” addict and entered a “Florida Model”
treatment center. Originating in its
namesake, these low-overhead facilities offer walk-in, addiction counseling by
day and separate group homes at night.
They are proliferating all over the country, particularly in the Sun
Belt, because the insurance companies favor their inexpensive approach and no business
licensing is required in many states.
Making
matters worse, many of those treating this potentially fatal disease are also
not licensed or hold college degrees.
According to the Columbia University report only six states require
counselors to have at least a bachelor’s degree. Absolutely no licensing is required in 14
states.
Physicians
can’t compete with individuals and facilities charging far less because of far
less formal training. According to the
Columbia report only 1,200 U.S. physicians out of nearly a million are even trained
in addiction medicine and until 2016 only psychiatrists could get
board-certified.
Just
before my brother died, I was investigating New York State’s Kendra’s Law which
can involuntarily commit an individual to a treatment facility if they are
“mentally ill” and cannot safely live on their own. Unfortunately, the law is ambiguous when it
comes to alcoholics. And it didn’t help
matters that only one other family member was supportive of the idea, neither
of us being the next akin. Although Tim
was clearly on death’s doorstep having been treated for serious medical issues
at no less than nine emergency rooms in his last year, I could not find anyone
who could advise me on how to use the law to save him.
In
hindsight I don’t believe Tim let us down, so much as the village failed
him. No addict should be exploited by
caregivers and insurance companies, neglected by government authorities, or
left to their own devices by family and friends. They are loved ones suffering from a painful
and dehumanizing disease, and should be tirelessly afforded our support and all
the appropriate, evidence-based, medical treatment to help them get well. This may not have saved Tim, but I believe it
would have given him a better fighting chance.
