Is Twelve-Step Recovery an antiquated concept or intervention? Many addiction specialist physicians contend that while the majority of continuing medical education in addiction, aimed at sharing novel breakthroughs and improving practice and outcomes, addresses pharmacotherapies, it is the psychosocial therapies which warrant at least equal attention. Some addiction medicine physicians are concerned that not only do biological interventions predominate in continuing education curriculums, but they dominate graduate medical education in addiction, and some of these physicians are concerned that fellowship training programs in addiction as well as residency programs in primary care, psychiatry, and other medical specialties should include training about and in Twelve Step Facilitation and on Twelve-Step Recovery in order for the physician to have an appropriately well-rounded educational experience and a full skill and knowledge base in the rapidly-growing specialty of addiction medicine.
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.
Many start their addiction recovery process with a period of detoxification (detox), where the body rids itself of the toxic influence of drugs and/or alcohol. Detox allows the body to restore itself to a stable starting point from which substance abuse treatment efforts may more effectively begin. While detox programs vary, medical detox programs may utilize certain medications to manage withdrawal, when applicable, and otherwise facilitate this early recovery step.1
While 12-Step facilitation programs don’t necessarily follow the steps, they promote the use of a 12-Step methodology, in the hope that clients will move to a 12-Step program after rehab to help maintain sobriety. In addition, certain treatment centers base their model for service around some of the ideas promoted through the 12-Step program. These centers can offer research-based services and promote a more scientific understanding of addiction treatment, but they incorporate some of the spiritual, psychological, and practical practices that the 12-Step program promotes. This results in an encompassing model of care designed to support clients through rehab and to give tools that they can use after treatment to maintain their recovery for the long-term.
One review warned of detrimental iatrogenic effects of twelve-step philosophy and labeled the organizations as cults, while another review asserts that these programs bore little semblance to religious cults and that the techniques used appeared beneficial to some. Another study found that a twelve-step program's focus on self-admission of having a problem increases deviant stigma and strips members of their previous cultural identity, replacing it with the deviant identity. Another study asserts that the prior cultural identity may not be replaced entirely, but rather members found adapted a bicultural identity.
Signs of a drinking problem include behaviors like drinking for the purpose of getting drunk, drinking alone or keeping it secret, drinking to escape problems, hiding alcohol in odd places, getting irritated when you are unable to obtain alcohol to drink, and having problems at work, school, home, or legally as a result of your drinking. Other warning signs of alcohol use disorder include losing interest in activities you used to enjoy, having blackouts because of heavy drinking, and getting annoyed when loved ones say you may have a drinking problem. Behaviors that may indicate that a person is suffering from alcoholism include being able to drink more and more alcohol, trouble stopping once you start drinking, powerful urges to drink, and having withdrawal symptoms like nervousness, nausea, shaking, or having cold sweats, and even hallucinations when you don't have a drink.
Women For Sobriety: Founded in 1975 for the purpose of creating a recovery program that was explicitly geared towards women, the goal of Women For Sobriety is not to be anti-male but to address the specific psychological needs that many women have during recovery. WFS operates under the belief that many women are already struggling with low self-esteem or shame that has been culturally instilled in them and don’t need more of it from their recovery program. Instead of the 12 Steps, WFS’s treatment program is based around the 13 Affirmations that point toward positive goals rather than admitting negative faults, such as “Happiness is a habit I am developing,” “Enthusiasm is my daily exercise,” and “I am responsible for myself and for my actions.”
Alcohol affects virtually every organ system in the body and, in high doses, can cause coma and death. It affects several neurotransmitter systems in the brain, including opiates, GABA, glutamate, serotonin, and dopamine. Increased opiate levels help explain the euphoric effect of alcohol, while its effects on GABA cause anxiolytic and sedative effects.
Alcoholism is characterised by an increased tolerance to alcohol–which means that an individual can consume more alcohol–and physical dependence on alcohol, which makes it hard for an individual to control their consumption. The physical dependency caused by alcohol can lead to an affected individual having a very strong urge to drink alcohol. These characteristics play a role decreasing an alcoholic's ability to stop drinking. Alcoholism can have adverse effects on mental health, causing psychiatric disorders and increasing the risk of suicide. A depressed mood is a common symptom of heavy alcohol drinkers.
WHO's ICD-10 "alcohol harmful use" and "alcohol dependence syndrome" Definitions are similar to that of the DSM-IV. The World Health Organization uses the term "alcohol dependence syndrome" rather than alcoholism. The concept of "harmful use" (as opposed to "abuse") was introduced in 1992's ICD-10 to minimize underreporting of damage in the absence of dependence. The term "alcoholism" was removed from ICD between ICD-8/ICDA-8 and ICD-9.
Addictions affect people from every walk of life. There are particular issues that make diagnosis, treatment and reentry challenging when addiction occurs in a physician, nurse, pharmacist, attorney, executive or other professional. Often there are highly developed defenses, as well as heightened senses of guilt and shame. Regulation and licensure issues can permanently threaten careers. Wyoming Recovery’s Professionals Program incorporates local recovering professionals, support groups, augmented psychological/psychiatric assessments, advocacy, and aftercare.
Short-term effects of alcohol abuse can be just as dangerous as long-term effects. For instance, drinking can impact your reaction time, causing you to have slow reflexes and coordination. That’s why drinking and driving is extremely dangerous. Getting behind the wheel of a car can alter your perception of speed and distance, putting yourself and others at risk.
Alcohol detoxification or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs, such as benzodiazepines, that have similar effects to prevent alcohol withdrawal. Individuals who are only at risk of mild to moderate withdrawal symptoms can be detoxified as outpatients. Individuals at risk of a severe withdrawal syndrome as well as those who have significant or acute comorbid conditions are generally treated as inpatients. Detoxification does not actually treat alcoholism, and it is necessary to follow up detoxification with an appropriate treatment program for alcohol dependence or abuse to reduce the risk of relapse. Some symptoms of alcohol withdrawal such as depressed mood and anxiety typically take weeks or months to abate while other symptoms persist longer due to persisting neuroadaptations. Alcoholism has serious adverse effects on brain function; on average it takes one year of abstinence to recover from the cognitive deficits incurred by chronic alcohol abuse.
Step 6 is about letting go of negativity and the past, and moving forward with the help of the higher power. Individuals pray, asking their higher power to remove their moral failings. People may go back to their lists of wrongdoings during Step 6 or choose to write a whole new list of specific character flaws. Individuals then choose something positive to replace these defects with. For example, lying and secrecy can be replaced with transparency and honesty. During Step 6, it may be helpful to write down several positive affirmations next to personal character issues, thus providing new and healthy methods for living in recovery.
Sponsors share their experience, strength, and hope with their sponsees... A sponsor's role is not that of a legal adviser, a banker, a parent, a marriage counselor, or a social worker. Nor is a sponsor a therapist offering some sort of professional advice. A sponsor is simply another addict in recovery who is willing to share his or her journey through the Twelve Steps.