The Ecumenical Approach to Alcohol Problems
The dictionary defines ecumenism as "the principles or practice of promoting cooperation or better understanding among differing religious faiths". If such contentious entities as religious faiths can learn to get along together, can't differing approaches to alcohol abuse and alcohol dependence learn to do the same thing? It isn't just a nice idea--lives depend on a willingness to help each individual with an alcohol problem find the approach which is right for him or herself.
If we genuinely care about helping people with alcohol problems then we should all work together. We should do our best to match each individual with the approach which will be most beneficial to him/her. Some people do great with the 12 step spiritual approach, but the research clearly shows that this approach fails to help the vast majority of people with drug or alcohol problems (Brandsma 1980, Vaillant 1995). Many are unwilling or unable to achieve total abstinence, and AA's version of spirituality violates many people's most deep-seated religious beliefs. The US Federal government tells us that only 7 percent of people with Alcohol Use Disorders will seek treatment (NIAAA Five Year Strategic Plan) and research shows that 2 out of 3 people who undergo 12 step spiritual based treatment drop out without completing it (Brandsma, 1980)
I know many 12 step members who work in needle exchange. Even though NA's message is one of completely abstinence, these members realize that saving the lives of drug users has to come before any dogma. These NA members have learned to offer clean needles without proselytizing for abstinence, because experience has taught that such proselytizing only drives people away and leads them to share needles again.
We need to meet people "where they are at", and for some, this may involved a trade-off between using a substance more safely versus not using the substance at all. Not everyone is willing or able to achieve 100% abstinence, yet they still need to be helped. I look forward to the day when I will see AA members seeking to save the lives of people who drink alcohol by introducing them to harm reduction strategies, just as these brave NA members have learned to cast dogma aside and save the lives of drug users by introducing them to safe injection techniques without driving them away by preaching the virtues of abstinence to them.
If we can save the life of a person who has life threatening withdrawals seizures when they drink by getting them off of alcohol and onto a medical marijuana maintenance program then we should do so. Alcohol withdrawal kills; there is no comparable marijuana withdrawal syndrome.
If a person wants to be a safer drinker then we need to encourage this and not try to force them to "hit bottom" if they find AA's notion of a "Higher Power" offensive to their religious beliefs. Many people who are told that they need to "hit bottom" wind up dead instead of in AA.
People who wish to reduce their drinking should also be encouraged to do so. Many will decide to pursue alcohol abstinence if they find themselves unable to control their drinking to their own satisfaction. And they will manage to abstain from alcohol successfully whether they choose to do so with AA, or with a secular and non-religious group such as SMART instead of AA, or on their own, or with the help of a psychotherapist, or even relying on a regular church to do so. The paths to alcohol abstinence are myriad and there are many different ways to succeed. Likewise the pathways to reducing or eliminating a problem with alcohol are myriad, and can range from the pursuit of safer drinking to reduced drinking to total abstinence from alcohol.
Research shows that many people are more successful using psychotherapy to change their drinking than using a spiritual approach to change it (Brandsma 1980, Dodes 2002). We need to encourage such people to pursue the psychotherapeutic route rather than demanding a conversion to 12 step spirituality if this is the route which will benefit them the most. Demanding that people become totally abstinent and forcing them to accept the religious views of 12 step programs as a condition of getting psychotherapy is a sure way to ensure that the majority of these people never get help with either their alcohol problems or their psychological issues.
Working on alcohol issues and psychological issues simultaneously can be far more successful than demanding that the alcohol issue be totally resolved before allowing the client to address psychological issues. It is more than good therapeutic policy--it is part of a patient's basic right to proper treatment.
Hence I make this appeal to all people in AA and to all people working in traditional 12 step treatment approaches--as well as to all people working in or participating in non-traditional approaches--to band together and to help the individual find the best solution for him/herself. We need to rise above dogma and join together to save lives; because one size does not fit all.
The goal is not to get everyone to join AA and practice AA's version of spirituality. AA's spiritual approach is fine for those who like it, but AA's spiritual approach can actually be damaging to some people and lead them to drink more or stand in the way of their quitting or otherwise changing their drinking for the better.
I know that this was true for me personally; AA led me to drink more than I ever had before in my life and to have life-threatening withdrawals from alcohol. I was only able to get better by leaving AA. Many acquaintances of mine have had similar experiences. If AA works for you that is great! If it does not work for you then the sooner that you find something which does work for you the better. The life you save may be your own.
Hence let us all join together and support each individual in finding their own best path to overcoming problems with alcohol abuse or alcohol dependence: whether the path is spiritual or secular, and whether it revolves around abstinence or harm reduction.
Brandsma JM, Maultsby MC, & Welsh RJ. (1980). Outpatient treatment of alcoholism: A review and comparative study. Baltimore: University Park Press.
Dodes, LM. (2002). The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors. New York: HarperCollins.
NIAAA Five Year Strategic Plan FY07-11
Accessed June 5, 2010
Vaillant GE. (1995).The natural history of alcoholism revisited. Cambridge, Mass. Harvard University Press.