12-Stepping And "Cures" For Addiction

The young man was 25, with a bunch of tattoos. His face and body and even his shaved head had a strange quality I would call "pudding-y." He was missing the muscle tone one would expect in someone of that age; he laughed when I asked about exercise.

He told me he had "experimented" with drugs in the past. I held myself back from telling him that in my world it was not experimentation unless somebody was collecting data according to a protocol that had been approved by an ethics committee.

"Now all I do is pot and alcohol." Again, I had to refrain from rolling my eyes. He thought these were not drugs! Caffeine and aspirin would need FDA approval as prescriptions if they had been "invented" in the last ten years, and this young man was telling me that pot and alcohol were not drugs.

I was admirably patient and explained to him that anything that affects the chemicals in your brain and nervous system was a "drug," as far as I was concerned. I just did not wait for government agencies to tell me what a drug was.

"Yeah. Too much government is no good." I was relieved, at least we agreed on something.

"Power to the people," I responded. Apparently as an expression, it was before his time, but at least I got a smile.
Both pot and alcohol could make people feel certain ways, I explained. So we would just talk about how he was feeling.

Well the young man was living in a board and care, on a little anti psychotic. (200 mg. of Seroquel, known generically as quetiapine. It helped him sleep.) He did indeed sleep; most of the day. He didn't like leaving bed or going to any kinds of group or of treatment. He said life was too boring.

I recognized it was an amotivational syndrome. It was the pot. He admitted to using it most days. And alcohol, whenever it was available.

He told me that he was beset by cravings for both substances. As I talked to him, it appeared that the cravings were not physiological, no feelings-in-the-pit-of-the-stomach. He seemed to be, and said he was, "bored." He simply thought of nothing besides his substances of choice, and they were easily available, so he got them.

I asked if he had ever been to AA or NA. I got a reaction from him I often get. "Talking about the stuff all the time makes me want it more. Alcohol and pot both. So a bunch of us go out together after the meetings and we get the stuff."

Maybe I just see the patients for whom AA and NA do not work, but there are plenty of them. Or the ones who backslide. Maybe it is because they are told to expect this sort of thing as part of the illness. It is easy to wonder what is going on. Some meetings are closed, other meetings are open, and at the height of my training when I was working in parts of hospitals that used the AA model, I tried going to some open meetings.

"My name is Estelle and I am a doctor." I remember vividly when I said that aloud at the first open meeting I ever attended, in the Midwest, I was booed. Other people started telling how doctors are horrible and addict people to drugs, and had helped starting them on the road, by saying everything from " a little wine is good for you" to "Xanax ( a drug usually given for anxiety) won't get you addicted if you use it right (I strongly disagree) and all kinds of other things which their doctors may or may not have said. But somehow, medicine seems to have been at odds with the twelve step view of life for a long time.

People who do research in science usually take as the "gold standard" what they call a double-blind placebo controlled study. Obviously, nobody is going to do this with an illness such as alcohol or drug addiction. People always have the right to choose their own treatment, and nobody is going to take that away. Still, I have seen plenty of patients for whom 12 step, for one reason or another, simply does not work.

The most elemental one, I think, is this: I often tell patients to think of anything they want to except a blue horse. Then I ask them whether the image in their head is a powder blue horse or a Navy blue one. This alone might explain why some people get cravings from meetings. I know perfectly well that people can talk about everything in meetings including the kitchen sink. But it is still a place people go to get away from a substance, so it is understandable if they think about and crave that substance.

But back to scientific research; plenty has been done, and here is the link to an excellent review.

Right now, I do not care terribly much about what the twelve step system is. If people are sober and swear by it, I am not going to rock their boat. To many, twelve-stepping is a force of nature. If my patient is in a different place, I will work with them in another way. I am all for a medicine that is individualized, and treats each person according to his or her individual need to avoid suffering and improve quality of life. I want only the single most effective treatment for the person who is sitting in front of me.

There are other models, and I have used some.

I have worked with addiction treatments that involve natural substance protocols. I have worked with the "receptor" model; the idea that some people get addicted and some do not, in a world where "experimentation" with drugs is practically an adolescent rite of passage, because of chemical predisposition in their brains. So we use either natural substances or prescription drugs to treat the "receptors." There are plenty of ways to work on the addict in this manner. It takes a lot of motivation on the part of the addict. It takes some kind of money because insurance does not pay for these kinds of treatments. These treatments do generally seem to work, on the biochemical level and at least on the shorter term. They seem to be able to make physical cravings disappear. Socially, people with long periods of addiction may have missed some crucial stages of maturity, are tough to treat, and even when they say they have no symptoms of cravings, they may have recidivism for psychosocial reasons. It just takes work, both chemical and social.

People have tried to commercialize these kinds of treatments and have gone broke.

As for my young man, He and his family had neither the motivation nor the finances to try alternative "models." He is currently on a positive reward system. I went nuts trying to figure out something professional or educational that he could like or want. He did admit one job that might be all right some day was developing video games. As a matter of fact, the only thing in life he seemed to like was video games. Not much, but a beginning. A complex reward system has been worked out for him to be rewarded for sobriety and attendance at various programs with points good for video games.

It is working so far, but like they say, "one day at a time."