Sunday, September 19, 2010

Opinion: Doctor Ignores 12-Step Success

Lexington Herald

Recognizing that Dr. Bankhole Johnson is a renowned authority in the field of alcoholism and addictions, his Sept. 12 column, "Medicine needed to treat addiction," is the ultimate of intellectual arrogance. There are millions of recovering alcoholics and drug addicts living happy and productive lives who could challenge his assumptions.

He, like many academicians, assumes Alcoholics Anonymous doesn't work because there are no long-term controlled studies on the efficacy of AA. There will never be. These studies cannot be accurately performed because it is anonymous, which is one of the very strong reasons AA works. Also, AA is a recovery program and not a treatment program.

I have no problem with Johnson questioning the efficacy of treatment centers; some are good and some bad. I have observed over 32 years that all the good centers get their patients started on a 12-step recovery program.

It is unrealistic to think all patients are going to quit drinking with any treatment. Alcoholism and drug addiction are chronic diseases, subject to relapse, and need lifelong attention to maintain abstinence and healthful living — if they do the 12 steps. Many never get it and die.

I also would challenge Johnson to produce any long-term studies to show that psychiatry and behavioral medicine approaches have proof they work. It also is expensive; AA alone costs virtually nothing.

Many in AA have failed every form of known treatment and finally accept AA after exhausting all available resources. Johnson wants to treat them with a pill. What pill works over the same long-term follow-up he demands of AA?

While Johnson searches for a pill, he should visit Lexington's Hope Center recovery programs and observe the many restored lives and families for hopeless street alcoholics and drug addicts.

Alcoholics need lifelong attention to their problems, and they get that in AA, if they continue. The No. 1 cause of relapse is failure to continue in their maintenance program. These people are destined for death, prisons or institutions without help.

The Hope Center has 100 percent follow-up in our jail recovery program. Those completing the program are on probation, are required to report frequently and are subject to random drug screens.

With seven years of experience, 61 percent are sober, most are working and the return to jail rate has been cut by 60 percent with up to two years follow-up. It is a win-win program for the patients and society.

Fortunately, the University of Kentucky is more understanding and tolerant and has many research studies going on — some involving the Hope Center, Chrysalis House and other AA recovery programs in Kentucky.

They also have many millions of dollars of research into not only advanced neuropharmacology, which is Johnson's field, but many other behavioral, genetic and neuroscientific studies involving advanced neurobiology. This is facilitated by Dr. Carl Leukefeld, who occupies the Bell Chair in Alcoholism at UK and who supports AA because he has seen it work.

There is a real danger publishing a column like Johnson's; it may delay many in seeking help in 12-step programs. For example, a RAND study in the 1970s advocated controlled drinking, causing many to try it.

A study 10 years later of people following that study showed only one was able to control his drinking; over 90 percent had further severe problems with alcohol and 20 percent had died.

I do support Johnson's efforts to study these illnesses and develop treatment. We need more research and understanding of what goes on in the human brain. It should be remembered that much of Johnson's research is necessarily funded by pharmaceutical firms. But when he writes distorted accounts of AA, there is a conflict of interest.

Hopefully he will finally come to see (as do doctors at UK) that 12-step programs have a real place in the treatment of addiction diseases.

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