Drinking: Are You In Control?
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There is no debate that alcoholism is an enormous problem in this country, devastating to those who suffer from it, those who live with it in their families and to society in general. But there is question as to what alcoholism is and how to treat it. Most Americans readily accept that alcoholism is a "disease" and that the only treatment is abstinence. But now, those views are being challenged and the means of treatment questioned.
Alcoholics Anonymous and other 12-step programs are virtually the only treatment options available to alcoholics; of those who seek help, more than 90% drop out after one meeting, some because they are turned off by the AA philosophy. In an eye-opening report, ABC News medical correspondent Dr. Nancy Snyderman challenges the established beliefs and conventional theories about drinking, opening the door on a heated and often hostile debate within the medical and treatment communities.
The special, one-hour edition of "20/20" looks at bold new ways to approach the problem and calls for a re-examination of long-accepted views about one of our country's most urgent and costly problems. Dr. Snyderman's report will air WEDNESDAY, JUNE 7 (10:00-11:00 p.m., ET), on the ABC Television Network. Editors please note: Photos of Dr. Nancy Snyderman will be available via www.abcmedianet.com.
The American Medical Association labeled alcoholism a disease more than 50 years ago. But according to many experts, there was no solid medical evidence behind the decision. Now there are many people from a variety of disciplines charging that our unwavering devotion to the "disease theory" has left us with a one-size-fits-all approach to drinking that may leave out many more than it includes.
Although the 12-step approach has undoubtedly saved lives, many question whether the program -- virtually the only method of treatment offered in the U.S. -- is helping enough of the millions of Americans with drinking problems. "I wouldn't have a life without it," says recovering alcoholic Curtis Burke, of the Alcoholics Anonymous in which he has participated for over a decade.
He is among millions of alcoholics who have been saved by AA and similar programs. Alcoholics Anonymous is considered by many, including Dr. Enoch Gordis, head of the National Institute of Alcohol Abuse and Alcoholism, to be one of the "incredible genius creations of the 20th century." In Alcoholics Anonymous, founded in 1935, the three important steps to sobriety are admitting powerlessness to alcohol, turning yourself over to a "higher power" and never drinking again. But a growing number of researchers, including Dr. Alan Marlatt, psychologist and alcoholism expert at University of Washington, believe, not that the old remedy is wrong, but that it only helps a small segment of the population. Considering more than 90% of those who seek help drop out after one meeting of AA and similar 12-step programs, he explains, "We could say they're all in denial, or we can say from a consumer's perspective that we haven't reached them with the right message about how they could get help."
Psychologist Marc Kern argues that AA's treatment has not kept up with current research and moreover that the "disease" label was not established for medical reasons but to take away the shame of being an alcoholic. "There's nothing medical being conveyed there. [AA] is a social, psychological support group. What kind of disease is treated that way?" Some who advocate alternative treatments point out that calling alcoholism a disease was done for insurance purposes -- if it is a disease, insurance pays for treatment. Referring to the seven-billion-dollar-per-year treatment industry (excluding Alcoholics Anonymous) in the U.S., Dr. Nick Heather, one of England's top alcohol researchers, explains: "There's a huge treatment industry in the USA which will have a great deal to lose by a move away from the disease concept."
Psychologist Dr. Marc Kern, who struggled with severe alcohol and drug addiction for years, believes he is living proof that AA's abstinence philosophy is not the only answer. Advocating a behavioral model, Dr. Kern believes some alcoholics can learn to drink responsibly. Dr. Kern and others agree that millions more problem drinkers would seek help if they had options; claiming that abstinence, the very essence of 12-step programs, turns off a great number of people. He reveals he enjoys an occasional glass of wine and thinks his patients deserve the same choice in treatment. Dr. Alan Marlatt tells Dr. Nancy Snyderman that the very idea of abstinence keeps most alcoholics out of treatment: "All they think of, it requires me to be 100 percent abstinent starting day one, and I'm not ready for that." He says the goal should be to reduce the amount of damage alcohol causes in a person's life. Richard Banton, who followed the AA program for six years, felt like a social outcast while in treatment. Although sober, he was uncomfortable with the methodology. "[With AA], you are terrorized to fall into line . . . Anytime you say anything that conflicts with their model, then you're in denial."
Searching for his own solution, he found experts who considered his problem a behavior that could be changed vs. a lifelong disease. Feeling "free[d] of the label of 'alcoholic'," Mr. Branton says he has been drinking occasionally for the last three years without ever getting drunk. Additionally, the report explores the strikingly different attitudes Europeans have about drinking. It also probes the problem of teenage alcoholism and what many consider our na?ve approach to young drinkers. It shatters the myths surrounding alcoholism -- that it's caused by a difference in metabolism, that there is an "alcohol gene," and that there is something called the "craving brain." Dr. Snyderman asks that we as individuals and as a country open our minds to a new way of thinking about a searing problem that is not going away. Meredith White is the executive producer. Carol Berczuk is the senior producer. Resa Matthews is the producer. (CLOSED-CAPTIONED) ABC News Media Relations: Dahlia Roemer 212-456-7243