The Twelve Traditions encourage members to practice the spiritual principle of anonymity in the public media and members are also asked to respect each other's confidentiality. This is a group norm, however, and not legally mandated; there are no legal consequences to discourage those attending twelve-step groups from revealing information disclosed during meetings. Statutes on group therapy do not encompass those associations that lack a professional therapist or clergyman to whom confidentiality and privilege might apply. Professionals and paraprofessionals who refer patients to these groups, to avoid both civil liability and licensure problems, have been advised that they should alert their patients that, at any time, their statements made in meetings may be disclosed.
Alcoholics may also require treatment for other psychotropic drug addictions and drug dependences. The most common dual dependence syndrome with alcohol dependence is benzodiazepine dependence, with studies showing 10–20 percent of alcohol-dependent individuals had problems of dependence and/or misuse problems of benzodiazepine drugs such as valium or clonazopam. These drugs are, like alcohol, depressants. Benzodiazepines may be used legally, if they are prescribed by doctors for anxiety problems or other mood disorders, or they may be purchased as illegal drugs. Benzodiazepine use increases cravings for alcohol and the volume of alcohol consumed by problem drinkers. Benzodiazepine dependency requires careful reduction in dosage to avoid benzodiazepine withdrawal syndrome and other health consequences. Dependence on other sedative-hypnotics such as zolpidem and zopiclone as well as opiates and illegal drugs is common in alcoholics. Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as barbiturates, benzodiazepines and nonbenzodiazepines. Dependence upon and withdrawal from sedative-hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of psychosis or seizures if not properly managed.
This is the rarest group, accounting for 9% of American alcoholics, and the most severe. Most people in this subtype are usually men, and are associated with a high rate of divorce, financial problems, clinical depression, and the use of other drugs. These are people whose lives have been all but completely taken over by booze. Alcoholism truly is a sad disease.
Moderate alcohol consumption (1–2 drinks/d) reduces the risk of cardiovascular disease in men and women by approximately 30%. [13, 14, 15] The effect of heavy alcohol consumption on the risk of cardiovascular disease varies in different studies. The person's drinking pattern appears to have an effect on cardiovascular disease. Drinking with meals may reduce the risk, while binge drinking increases risk (even in otherwise moderate drinkers).
In my 30 years as an addiction counselor I've been amazed by the practically obsessive attempts to push the 12-step philosophy to the forefront of treatment methodology, and to ignore research. Does anyone remember that Bill W. once remarked that he never considered AA to be a panacea for addiction? In fact, few people know he considered the nutritional therapy of Vitamin B3 to be perhaps the most effective means of treating symptoms of depression he found closely linked to alcoholism. He wanted to be remembered more for promoting B3 therapy than AA itself. The point is, support is support, and science is science. I've never had any qualms whatsoever about my clients attending AA or NA meetings. It's their free time; they can attend or not. If my role is to teach or persuade them to go, why do I need a clinical license and a Master's Degree? Why did I need to take exams? (Which, by the way, never 'assessed' my ability as AA promoter.) I take my work more seriously than just encouraging support group concepts or involvement. I see my role alternately as providing up-to-date information about behavioral therapies, relapse prevention approaches, and being a force for connection and inspiration. We should be appalled by the slow transfer of research to practice. There's a lot more we can do for our clients, and we're not doing it. I think it's high time for the traditionalists in our field to recognize that our clients need the benefits of science, not more AA instruction and orientation.
There are many clues which can lead a doctor to suspect a patient is alcohol dependent, and will not usually require a physical examination. For example, a doctor may suspect alcohol dependence if a patient often asks for a medical certificate for time off work, has a mental health problem (e.g. depression) or physical conditions associated with alcohol consumption (especially liver cirrhosis). In such cases, a good doctor will ask the patient questions about their alcohol consumption patterns, or ask them to complete a questionnaire about alcohol, to assess whether or not their alcohol consumption is presenting a health risk.
Prioritizing coping over healing. While AA obviously wants its members to avoid relapse and maintain sobriety, the means of doing so is heavily focused on using skills to cope with addictive behaviors rather than addressing the underlying issues that are causing them. Because of this, many people find the 12-Step program might help them stay sober, but leave them still struggling with the problems that led to becoming alcoholics in the first place.
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