Programs like AA and other 12-Step groups provide a healthy community of support and solidarity filled with individuals who are all seeking to remain sober on a long-term basis. Individuals who regularly attend AA meetings are about twice as likely to remain abstinent over those who don’t, per the Journal of Addictive Disorders. The 12 Steps can go a long way in providing individuals in recovery with the support they need.
Prior to entering any inpatient or outpatient rehabilitation program for alcohol use disorder, the possibility that the person with this disorder could suffer from physical symptoms of alcohol withdrawal needs to be addressed. People who have a pattern of extensive alcohol abuse are at risk for developing a potentially fatal set of withdrawal symptoms (delirium tremens or DTs) that may include irregular heartbeat, sweating, high fever, shaking/tremors, hallucinations, and even fatal seizures, three days after withdrawal symptoms begin. Those individuals will need to enter a detoxification (detox) program that includes the use of close medical support, monitoring, and prescription of medications like chlordiazepoxide (Librium) or clonazepam (Klonopin) to help prevent and ease the symptoms of alcohol withdrawal.
Alcoholism is a chronic, progressive behavioral disorder characterized by a strong urge to consume ethanol and an inability to limit the amount of drinking despite adverse consequences, including social or occupational impairment and deterioration of physical health. The disorder includes both physical dependence (withdrawal symptoms such as nausea, sweating, tremors, and delirium resulting from abstinence) and tolerance (the need to increase alcohol intake to achieve the desired effect). Excessive drinking may occur daily or during binges separated by intervals of sobriety lasting from days to months. About 30% of U.S. adults drink to excess at least occasionally, and 3-5% of women and 10% of men have chronic problems of excessive drinking. In approximately 40% of those who habitually abuse alcohol, a pattern of inappropriate drinking is evident before age 20. Alcoholism is frequently accompanied by addiction to nicotine and other drugs, anxiety, depression, and antisocial personality. It tends to run in families, but personal history and environmental factors are apparently at least as important as genetic predisposition. Behavioral traits that are typical of alcoholism include solitary drinking, morning drinking, lying about the extent of one's drinking, and maintenance of a secret supply of liquor. Alcoholism costs the U.S. approximately $200 billion yearly. Chronic alcoholism decreases life expectancy by about 15 years. It is associated with an increased incidence of cardiac arrhythmia, hypertension, stroke, acute hepatitis, cirrhosis, gastritis, pancreatitis, syncope, amnesia and personality change. Because ethanol is a rich source of nonnutritive calories, heavy drinking often leads to malnutrition and vitamin deficiency. Degenerative central nervous system disorders associated with alcoholism include Wernicke encephalopathy (due to thiamine deficiency) and Korsakoff psychosis. Alcoholics are more likely than nonalcoholics to be involved in automobile accidents (more than 25% of all traffic deaths involve alcohol) and to commit violent crimes, including spousal and child abuse and homicide. A child born to an alcoholic mother may suffer the stigmata of fetal alcohol syndrome, characterized by low birth weight, facial dysmorphism, cardiac anomalies, and mental retardation. The treatment of alcoholism requires intensive counseling of patient and family. Cognitive-behavioral therapy, motivational enhancement therapy, group therapy, and support groups are all of proven value. Administration of benzodiazepines during withdrawal and use of topiramate or naltrexone to maintain abstinence are often effective. Disulfiram taken regularly can lower the risk of relapse by inducing severe malaise and nausea if alcohol is consumed. Detoxification programs for the management of acute alcoholic intoxication include withdrawal of all alcohol consumption and provision of nutritional, pharmacologic, and psychological support.
One review of AA warned of detrimental iatrogenic effects of twelve-step philosophy and concluded that AA uses many methods that are also used by cults. A subsequent study concluded, however, that AA's program bore little resemblance to religious cults because the techniques used appeared beneficial. Another study found that the AA program's focus on admission of having a problem increases deviant stigma and strips members of their previous cultural identity, replacing it with the deviant identity. A survey of group members, however, found they had a bicultural identity and saw AA's program as a complement to their other national, ethnic, and religious cultures.
When an individual has been struggling through an addiction, it is usually not simply the substance abuser who needs support. Family members' lives are often closely connected with, and deeply affected by, the loved one who has been abusing a substance. Thankfully, there are also support groups to help carry these loved ones through the difficult times and questions that may arise in these circumstances.
There are numerous individual psychotherapeutic treatments for alcohol addiction. Relapse prevention uses methods for recognizing and amending problem behaviors. Individualized drug counseling specifically emphasizes short-term behavioral goals in an attempt to help the individual reduce or stop the use of alcohol altogether. Cognitive-behavioral therapy techniques, like helping the individual with alcohol use disorder recognize what tends to precede and follow their episodes of alcohol use, are often used to address alcohol abuse. Some treatment programs include drug testing. Twelve-step recovery programs like Alcoholics Anonymous are individualized drug-counseling methods. Motivational enhancement therapy encourages the person suffering from alcohol use disorder to increase their desire to participate in therapy. Stimulus control refers to an intervention that teaches the alcohol-use disordered person to stay away from situations that are associated with alcohol use and to replace those situations with activities that are alcohol-free and otherwise contrary to using alcohol. Urge control is an approach to changing patterns that lead to drug or alcohol use.
Alcoholics Anonymous (AA), founded in 1935, was the first twelve-step program ever created. The steps, which are very similar to ones already mentioned, were put in place at that time. In 1946, twelve traditions were created that governed how groups functioned and related to each other as membership was quickly growing. Traditions included the practice of anonymity by only using one’s first name and the tradition of “singleness of purpose.” The latter tradition meant that AA would have “but one primary purpose – to carry its message to the alcoholic who still suffers.” As such, this precluded attendance by anyone who did not suffer from alcohol misuse and resulted in the formation of other 12 step programs.
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AA is a faith-based program where, in order to succeed in their recovery and progress through the 12 steps, members are instructed to admit their lack of control over both alcohol and their own lives and turn themselves over to a higher power. While the foundations of AA are based in Christianity, the 12-Step program is meant to be nonspecific regarding religion and focus more on a spiritual awakening.
There are three oral medications that have been FDA-approved to help people remain sober: disulfiram, naltrexone, and acamprosate. They are prescribed for those who have indicated their intention to abstain from alcohol but require some reinforcement. Disulfiram causes unpleasant symptoms such as nausea, vomiting, and flushing with any amount of drinking. Naltrexone limits the cravings a person may get from drinking but can cause severe withdrawal symptoms in people who are also dependent on opiates. Acamprosate helps reduce the craving for alcohol. An injectable, long-acting form of naltrexone is also available. All of these medications are meant to be used in combination with counseling.
Once a person is addicted to alcohol, to stop it may take hospitalizations, rehabilitations, and re-rehabilitations all of which hemorrhage expenses — not to mention destroy relationships and property. The estimated cost to the system of this specialized addiction care is $24.6 billion. Since addiction is a disease that rewires the brain, the individual is unlikely to quit through “willpower” alone, and it often takes something dramatic (or “hitting rock bottom”) before they will make changes. There are costs associated with these dramatic scenarios. In the case of car accidents caused by driving drunk, costs include not just hospitalization, but the cost to insurance companies, car owners, municipal employees responding to the accident, and a continued chain reaction of costs that could ultimately include vehicular homicides and funeral expenses.
Steps one through three deal with the individual’s acceptance of their inability to control their addiction alone and the need of support to remain abstinent. Steps four through nine teach the individual to take responsibility for their own actions and characteristics in order to create change in their life. Steps four, six and eight require self-reflection while steps five, seven and nine are the application of those reflections. The focus in steps 10 through 12 is on maintaining recovery. Each step builds upon the previous step in a progressive course of action.
NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.
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Alcohol use is the fourth leading cause of preventable death in the United States (after smoking, high blood pressure, and obesity). According to a 2018 report from the WHO, in 2016 the harmful use of alcohol resulted in about 3 million deaths, or 5.3% of all deaths around the world, with most of these occurring among men. [1, 2] The economic costs of excessive alcohol consumption in 2010 were estimated at $249 billion, or $2.05 a drink. 
Alcohol dependency occurs on a continuum. Many Australians are only moderately or mildly dependent on alcohol (e.g. they may find it difficult to stop drinking once they start). They do not exhibit physical withdrawals like those with severe alcohol dependence, and do not consider their drinking patterns problematic. This may be because the major health and social consequences of alcohol dependence (with the exclusion of violence) do not begin when an individual first becomes alcohol dependent. For example, it may take years for an individual who is alcohol dependent to have financial or relationship problems as a result of drinking. In many cases chronic excessive drinking may have no immediate health and social consequences.
Twelve-step recovery programs aren’t the answer for every addict. But these principles of behavior have helped a lot of people face their addiction honestly and rebuilt their lives on a more solid, stable foundation. At Axis, our approach to recovery is based on the guidelines of the 12 steps. We use these principles as a framework for developing personalized treatment plans that address each client’s individual needs. If you’re struggling with a drug or alcohol problem, we encourage you to call our intake counselors to find out how our philosophy of care can make positive changes in your life.
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Parents may also inadvertently contribute to children’s alcohol problems, especially if they model bad drinking behaviors. Kids who grow up in homes with a great deal of drinking may come to see the behavior as normal. If their parents drink as a coping mechanism for stress or anxiety, kids may come to do the same. In this case, the genes aren’t at the root of the problem; it’s the behaviors parents model that causes concern.
The diagnosis of an alcohol problem is best made by the history. Screening instruments for alcohol problems include the CAGE ([need to] cut down [on drinking], annoyance, guilt [about drinking], [need for] eye-opener) questionnaire and the AUDIT (alcohol use disorders identification test). The CAGE questions should be given face-to-face, whereas AUDIT can be given as a paper-and-pencil test.
If someone in your family is living with an active alcohol use disorder, you and your family are not alone. The Substance Abuse and Mental Health Services Administration (SAMHSA) 2015 National Survey on Drug Use and Health (NSDUH) found that more than 15 million Americans over the age of 18 were living with an alcohol use disorder and about 623,000 young people between the ages of 12 and 18 were struggling as well.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has modified some of the criteria involved in the medical definition of an alcohol use disorder. There are 11 criteria listed to help clinicians determine if their patient has AUD and how serious the problem is. A mild AUD involves experiencing two or three of the 11 symptoms for one year; a moderate AUD involves four or five of the symptoms; and a severe AUD involves six or more of the listed criteria.
During Step 8, people commonly resort to writing lists again, and this step is about forgiveness. Often, two lists are formed during this step: The first is a list of those who the person needs to forgive and the second is a list of those from whom they need to seek forgiveness. There will likely be crossover people on both lists. Individuals are encouraged to be honest and write down names of anyone who elicits strong emotions like resentment, shame, guilt, anger, fear, etc.
To conduct its business, Area 37 meets in assembly four times per year. Each assembly consists of elected officers, district committee members (DCMs), individual group service representatives (GSRs) and the chairpersons of several standing committees. Area 37’s standing committee structure is closely aligned to that of the General Service Conference committee structure. In assembly, reports are heard and area affairs are discussed. Who may attend and vote? All A.A. members are welcome, but only those elected or appointed as a District Committee Member (DCM), General Service Representative (GSR), Officers/Alternate Officers, past Delegates, and Area Standing Committee Chairs may cast a...
Not all alcohol abusers become full-blown alcoholics, but it is a big risk factor. Sometimes alcoholism develops suddenly in response to a stressful change, such as a breakup, retirement, or another loss. Other times, it gradually creeps up on you as your tolerance to alcohol increases. If you’re a binge drinker or you drink every day, the risks of developing alcoholism are greater.
Auxiliary groups such as Al-Anon and Nar-Anon, for friends and family members of alcoholics and addicts, respectively, are part of a response to treating addiction as a disease that is enabled by family systems. Adult Children of Alcoholics (ACA or ACOA) addresses the effects of growing up in an alcoholic or otherwise dysfunctional family. Co-Dependents Anonymous (CoDA) addresses compulsions related to relationships, referred to as codependency.