sauerkraut

Hi,

I value people's personal experiences and have learned a lot from what people share on these boards. In addition, I'm wondering if research has been done that tries to codify such experiences into an analysis of what seem to be the most effective means of achieving sobriety.

Have any of you found research on the efficacy of various approaches to recovery? Certain approaches say that they are "evidence based," but the evidence provided seems somewhat weak. It would seem to me, given the scope and severity of alcoholism, that comparative studies should have been done, yet I'm not finding anything like that. I know some of you work in the field of substance abuse therapy--do you have any leads to share?

Thanks in advance--

SoloMio

I just saw Dr. Christiane Northrup on a Public Television drive and she was talking about exercise and she made the great point: "What is the most effective form of exercise? The one you will DO!"

I think the same is true of recovery approaches. Whatever works, for whatever reason, and it's hard to determine what will work.

There are studies out there, and some don't sound encouraging--basically because it still all goes back to the alcoholic WANTING to get better. There is no real effective way to make that happen, IMHO.

My newly-recovering AH talked to me about disappointing AA numbers--he had heard that something like 5% of the people maintain long-term sobriety through AA, but I told him, what difference does it make as long as YOU'RE in the 5%?

BlueChair

Id say why try to reinvent the wheel yourself, why not look to the experts on what works best. And by experts your asking about research, and this is what all these people devote their lives to doing.

http://www.drugabuse.gov/publication...tive-treatment

For me, one of the most important things to understand is different things work for different people based on their individuality. I think its important for people to know there are options because what we think and feel about certain approaches is important for individual motivation.

Stung

There are a lot of sources that will show you "evidence" to back up their theories on how to treat alcoholism. However, just like not all alcoholics have the same motivations to drink, not all alcoholics are successful with the same recovery methods. Recovery really is "one size fits one" rather than something that can be treated with a blanket cure. It's a mental health disease and it's a disease that does not have a cure. Some people have long term success and others do not and some die from it.

LexieCat

The most important ingredient to ANY recovery program or method is the commitment of the individual to get sober and stay that way.

AA was a hundred percent successful for me and my first husband. My second husband got sober briefly after almost dying of liver/kidney failure (alcohol-related). I don't believe he ever truly committed to recovery. He thought he was too smart for it, I think. I know many, many happily sober people in AA. I also know many people (most of them on these forums and one other group without a single focus) who got happily sober on their own. I can't speak to statistics, and they really don't impress me. What impresses me is what I observe and experience.

cynical one

Studies are long and boring to read, but it's very important to look at the full study to assure that they are done by independent research oriented scientists and for the abstract to match the actual data. For it to be considered "evidence based", studies by authors are not permitted. The Match Studies are sorta interesting. They tested clients with 3 types of treatments and the results were pretty much the same.

And, there is a difference between "evidence based" and "research based".

sauerkraut

Very interesting, Cynical. Thank you for helping me to sort this out.

What seems disconcerting in the data I have found is how little follow-up research seems to have been conducted. A study might seem to show that a certain program was more beneficial in the short term, but I have found very little about longer term sobriety.

Also, from my own field, I'm aware that any behavioral study is going to be vexing. As soon as you change the practitioner/teacher, you invariably affect the outcomes. So, it's complicated.

That said, it remains surprising to me that more research and analysis hasn't been done. For example, in the few months I've been reading these boards, I keep reading the same stories--different people, different specifics, but very similar stories. Old timers chime in to explain just how common these patterns are. Yet so much remains unresolved, even the categorization of alcoholism--is it a disease or a habit? [That's a rhetorical question--it's clear from people's postings that people believe both answers.]

Again, I appreciate everyone's insights and experiences. In fact, I find them so helpful that it seems like someone should collate the collect wisdom of this board into a book, a new Big Book for research nerds like me.

NYCDoglvr

HBO did a wonderful series, "Addiction", input from the top doctors, and you can watch all of it on their website. When it comes to recovery, it isn't one size fits all, frequently it's a combination of things.

MIRecovery

At least today I'm a 5 percenter. Yes it based on what I do not what I think

happybeingme

Here's how I see the problem. AA is all about the anonymous. So, you can't study those groups. Then you have the rehab. Under federal law they can't disclose specifics. Then you are talking humans are really the test subject. To quote Dr. House "people lie". Then you have the study length. The only way to know for certain if a program is successful is to follow the subjects until their death.

Me. I haven't followed a formal program. I just knew I had to do whatever I had to to get and stay sober. 3 years and 8 months later and I haven't so much as had a single accidental sip of alcohol. So, am I a success? Not a real alcoholic? Or something else? In the end I think whatever works for an individual is a successful program.

LBrain

The first and the last replies are it. solo, and happbeingme answered it as true as possible.

When I was leaving rehab they told us that only 3% of us would make. I really felt sorry for those in the 97% group because I was not one of them. I was not gonna let myself be one of them - no matter what.

DesertEyes

Hello sauerkraut, and pleased to "meet" you

I think you have been looking in the wrong places. Let me give you the high level view of current research, and some links to get you started.

First off, "alcoholism" is the lay persons term. Researchers use two different medical concepts; chemical addiction and chemical dependency. A good place to start on these terms is here:

NIAAA Publications

NIAAA Publications

The medical community has done a _huge_ amount of research on the biological side of chemical dependency. A very good portal for all of it is here:

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

The medical community uses the word "recovery" in the _medical_ sense, and they don't care at all about the behavioral aspects. The reason is quite simple, the biological aspects of "dependency" are completely unrelated to an individual's psychology. Which is why the "disease concept" is so important.

For example; some people develop cancer. Whether that person is a decent human being or a total jerk is _irrelevant_ to the cancer or the treatment. Likewise with chemical dependency, some people are jerks, and some people are decent. Some jerks have "dependency genes" and some don't, some nice people have the "dependency genes" and some don't.

Which brings us to the lay person's definition of "recovery". To the lay person, and that would be most of the 100,000 members of this website, "Recovery" is defined as: "when will this person stop being a jerk?". Using that definition there is no possible way to conduct _any_ kind of research.

The "treatment programs" so in vogue today are all the same. There is a 3 week medical period needed to stabilise a persons blood pressure and "de-tox" from the chemicals. That is all that is needed from a medical perspective. The remainder of the "programs" is just various different techniques for people to use in getting their personality "de-jerk-ified" ( if I may invent a word ).

The fundamental question is the root of the research problem, there is no way to "measure" the "jerk level" of a person, so there is no way to determine which program, if any, will change a person's attitude.

The only answer that seems to work is this: If the person is decent, they will rectify their behavior on their own and find whatever "tools" or "program" they might need. If the person is a jerk, they will not.

Mike
Moderator, SR

LBrain

well said Mike - twice

cookiesncream

Agreed wholeheartedly with everyone else's responses. Upon my "graduation" from outpatient rehab the counselor admitted to me in front of the group that he thought that I would not be one that would make it through rehab because quite frankly I wasn't exactly thrilled to be there, I was pretty much forced to. Yet I had proven him wrong and was in his words an A+ student. That said I was at the point over the holidays as I approached my first year sobriety of either having a nervous breakdown or relapsing. I found my recovery "home" in a non twelve step women's recovery group. I was forced to get sober and that will carry you for only so long. I dug deep and at my year mark decided I would no longer stay hostage to other peoples desires and made a renewed commitment to sobriety but this time for myself. That is that thing known as inner motivation which statistics can't quantify. As for my outpatient program they do NO followup so they have no clue as to how well or how how badly their program is working. Once you get sober for yourself and take relapse as an option off the table its amazing how well people can channel their inner resources. Personally I think all programs work if you're willing to stick with them, just like dieting.

FeelingGreat

Great post cookies. I think that sums it up for me. Whatever program you like, or none, + commitment.

sauerkraut

Whew; thank you. From the NIAAA publication Desert Eyes linked to, in the explanation of Alcohol Use Disorder, which is the current terminology:
"Approximately 7.2 percent or 17 million adults in the United States ages 18 and older had an AUD in 2012. This includes 11.2 million men and 5.7 million women. Adolescents can be diagnosed with an AUD as well, and in 2012, an estimated 855,000 adolescents ages 12–17 had an AUD." Wow; this is a problem of large magnitude indeed.

I wonder if the emphasis on researching the biological aspects of dependency is because that's the side with potential payback to the pharmaceutical industry. (Sorry if I'm stepping on any toes here; personally I'm grateful to whomever developed Antabuse as it's given our home more peace in the last few months than we've had in the last few years.)

I take the point that the person has to be motivated, first and foremost. And that an individual's psychology ("jerkiness") will affect his/her prognosis. And that the second "A" in AA prohibits analysis of its efficacy. How interesting that other recovery programs don't do follow-up, either.

I much appreciate the leads and insights.

BlueChair

Im not sure sauerkraut, when I read about the recommendations for treatment it says that all aspects of a persons life need to be treated, but its specific to the individual as to what they need. This is one of the principles of effective treatment:

Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.* To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture.

There are studies on various behavioral therapies, studies breaking down the components of AA within control groups and such. Have you visited samhsa?

I have to say however, my husband was never a jerk or needed a major attitude adjustment. He used a substance to fill a hole more or less and the drugs he used altered his brain and changed his behaviors. When he stopped using hes gone back to normal. He hasnt ever needed to alter his personality to stop his jerkiness. What he did need in his case was to deal with some underlying emotional issues and enhance his coping skills.

I think there is a stigma wrongly attached to ALL people who use substances and how they ALL require some major overhaul of their personality, beliefs, overall being. Whats needed is very specific to the individual.

I feel the individual aspect of whats needed for recovery is very important, and its also why its hard to measure the behavioral or emotional side to recovery. Even substance abuse is broken down into stages, meaning some people are more advanced than others. In a way, I think research should be broken down and analyzed like cancer treatment. Stage 0, 1, 2, 2a,2b, 3. and what works best as the addiction creeps deeper into the various areas of a persons life. I dont see much of this happening in the research however because I think its hard to create a baseline. If youve found any please pm me as Id like to look it over.

DesertEyes

Hold on a sec Things get even murkier in that part of the research world "Alcohol Use Disorder" is the term used by the _Psychology_ field, _not_ the medical field. In addition, the psychs use it only in their "DSM" manual. Said manual is intended as a guide for the shrink to figure out which insurance company code can be used for billing purposes.

In turn, that means all the research done under the "Alcohol Use Disorder" is intended for the _insurance companies_ as a means of getting them to pay for treatment by a _shrink_. None of this has anything to do with the biological aspects of chemical dependency.

Yes, research into addiction and treatment is a mess. And that is being charitable.

The pharma industry does their own research, and you won't see any of that in the NIAAA site.

No worries, your questions are perfectly valid.

Actually, that is not the cause of the problem. All such research has to be anonymous anyway, regardless of what treatment / program is addressed. The challenge is that there is no way to measure "efficacy".

Mike
Moderator, SR