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It’s a dry argument: abstinence versus management in addictions

27 December 2014 213 views No Comment

AT this time of year, many Australians find themselves in trouble with the booze. But the silly season merely accentuates what is already a massive problem.

Why, then, do our governments respond so inadequately to helping people addicted to alcohol and other drugs?

Private, non-government org­anisations and government-funded treatment centres don’t have the capacity to deal with the demand for intensive alcohol and drug treatment.

This is despite the fact governments at all levels know that funding such treatment saves the community much more than it costs. Sadly, there are few votes in ­government-funded alcohol and drug treatment so it will be often in short supply.

Not a huge proportion of people with a severe alcohol or drug problem recover from addiction. But research shows that, as well as medical and psychiatric help, many do improve by using self-help groups that are non-­judgmental and based on mutual aid — for example, by alcoholics and addicts helping each other.

Alcoholics Anonymous, whose aim is total abstinence, has a long track record of helping men and women to get sober and free of other drugs, and to stay that way.

But while AA has the numbers, not all alcoholics who attend their meetings achieve long-term stable recovery.

This is why it is important that Australians know about other non-government agencies such as SMART Recovery.

The letters S M A R T stand for Self-Management and Recovery Training.

Having begun in the US 20 years ago, SR, like AA, is a group-based program of mutual aid. But unlike AA — which was founded in Akron, Ohio in 1935 — it is not abstinence-oriented.

It also rejects the disease concept of alcoholism and addiction, and replaces it with a notion of individual choice.

Hence, to help people help each other to manage their addictive behaviours, SR uses tools derived from cognitive behavioural therapy.

In this it is quite different from AA’s traditional 12-step model of recovery.

While AA is a totally non-professional, lay organisation, SR tries to have its groups run by trained professionals. However, the level of expertise seems unclear.

Moreover, many weekly SR groups in Australia, of which there are 102, are also facilitated by people who are themselves recovering from addictions.

In this it resembles AA, which holds more than 2500 weekly meetings throughout Australia. Unlike SR, AA works well for people who are illiterate. This is important because a significant number of men and women — inside and outside prison — cannot read or write.

SR stresses that it is evidence-based. But there is also clear evidence of the efficacy of AA. This is to be found, for example, in the work of George Vaillant, and especially in his book The Natural History of Alcoholism Revisited, published by Harvard University Press.

Vaillant’s path-breaking longitudinal study of a cohort of Americans across many decades demonstrates that, in the long term (that is, five years or more), the notion that alcoholics and addicts can control or moderate their drinking and other drug use is a mirage. Indeed, as a result of observing his own evidence, Vaillant actually changed from being a supporter of controlled drinking to advocating abstinence as a therapeutic goal for alcoholics and for those addicted to other drugs. Vaillant also became a strong supporter of AA and its approach to alcoholism and other addictions.

While SR concedes that total abstinence from alcohol or other drugs causing the addiction is ideal, this is not its aim.

“If someone who drinks for seven days a week is able to change to drinking five or six days, that’s success, says Josette Freeman, SR Australia’s national program co-ordinator.

Indeed, at SR, each attendee identifies their individual goals and draws practical and emotional support from the group to help achieve them.

According to its chief executive, Ryan McGlaughlin: “SR is a very effective and economic alternative to current options for people affected by addictions.

The stark reality is that men and women struggling with serious alcohol and drug problems often find it very difficult to get effective help. For many decades AA, and its offshoot Narcotics Anonymous, has effectively assisted those addicted to alcohol and other drugs.

These days, SR provides more choice for people seeking other forms of self-help.

According to Sydney-based drug reformer Alex Wodak, who was instrumental in bringing this program to Australia: “It’s not better or worse than AA. It just provides a different approach.

The primary difference is that SR sees drug and alcohol abuse as a failure by the individual to learn how to manage the use of these substances, rather than regarding alcoholism and addiction as a complex physical and mental ­disease.

My experience as a long-term member of the Queensland Parole Board and then of the NSW State Parole Authority is that both AA and SR can help parolees and other people in trouble with booze and others drugs.

Nonetheless, this experience also tells me that, for those men and women who have crossed the line into chronic addiction, lifelong abstinence has the runs on the board for effectiveness.

Ross Fitzgerald has written 36 books, including his memoir, ‘My Name is Ross: An Alcoholic’s Journey’, which is now available as an e-book and a talking book with Vision Australia.

The Weekend Australian, December 27-28, 2014, Inquirer, p 18.

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