Efficacious Treatment Strategies for Alcoholism

Alcohol: Benefit or Problem?

Although it has been nearly a century since Prohibition ended in the United States in 1933, the same arguments that resulted in its passage of the 18th Amendment and the Volstead Act in October 1919 in the first place remain salient today. For instance, then as now, opponents of alcohol cite the increased incidence of domestic and other types of violence, the diminished ability to earn a meaningful living and a host of health-related problems as evidence that even moderate consumption of alcohol is dangerous and an enlightened society would seek to prohibit its use to the maximum extent possible. Conversely, researchers have identified some diseases and health disorders that can benefit from low levels of alcohol consumption, and social drinkers who are able to enjoy a few drinks without adverse effects simply do not understand what all the fuss is about in the first place. The purpose of this paper is to describe the health benefits that are associated with alcohol consumption, including some of the most recent findings to emerge in the last year as well as an assessment concerning whether the alcohol industry behaves responsibly in marketing their products. In addition, a discussion concerning how American society should treat alcoholism and alcoholics and what Americans, as a society, can do to reduce the problems associated with alcohol use is followed by an analysis as to whether Alcoholics Anonymous (AA) works and what alternatives are available. Finally, the paper provides a summary of the research and relevant findings concerning these issues in the conclusion.

Are there any health benefits to alcohol consumption? If so what? Has this changed in the past year or so?

Not surprisingly, there has been intensive research over the past several decades concerning the potential health benefits of alcohol consumption since many people are clearly going to drink anyway and the alcohol industry is always eager to find any new evidence of such beneficial effects to help promote their products to American consumers. The research to date indicates that the consumption of low or moderate levels of alcohol is beneficial for ischemic heart disease, peripheral vascular disease, gallstones and even diabetes (Ashley et al. 2000). In addition, some studies have also shown that habitual alcohol consumption is associated with reduced cerebrovascular disease responses (Jones et al. 2013).

According to recent research by the Harvard School of Public Health, though, the various benefits that have been associated with alcohol consumption are typically dependent on the amounts that are involved. For instance, these authorities emphasize that, “It’s safe to say that alcohol is both a tonic and a poison. The difference lies mostly in the dose. Moderate drinking seems to be good for the heart and circulatory system, and probably protects against type 2 diabetes and gallstones” (“Alcohol: Balancing Risks and Benefits” 2022: 3). In sum, drinking a glass of wine with a meal once in awhile may provide some health benefits, but consuming large amounts such as two or three bottles at every meal will invariably have some profoundly serious health implications over the long term (Lown et al. 2007). Complicating the challenges that are associated with treating alcoholism is the fact that the alcohol industry itself regularly abrogates its responsibilities to market its products responsibly as discussed further below.

Does the alcohol industry behave responsibly in marketing their products?

Given the enormous social, economic and health burden that alcoholism causes, some critics might suggest that if the alcohol industry acted completely responsible, they would not market their products at all (Coomber 2017). It is also reasonable to suggest that absent legislation to moderate their marketing practices, that alcohol industry would be far more aggressive in selling its products to consumers of all ages, including underaged drinkers. Indeed, although the alcohol industry routinely cautions consumers to “drink responsibly” or “enjoy their products in moderation,” they fail to communicate the risks that are associated with the consumption of their products (Smith et al. 2014).

A study of the various strategies that are used by the alcohol industry by John Hopkins Bloomberg School of Public Health identified several constraints that underscore their lack of responsible marketing behaviors. For instance, Smith et al. reports that, “Most of the ads analyzed (87 percent) incorporated a responsibility message, but none actually defined responsible drinking or promoted abstinence at particular times or in certain situations” (3). Moreover, even in those cases where this type of responsibility message was used, it was almost always far smaller than the products’ slogan or tagline (Smith et al.). This lack of responsible marketing practices on the part of the alcohol industry is just part of the problem, however, and American society as a whole should treat alcoholism and alcoholics differently than at present as discussed further below.

How should society treat alcoholism and alcoholics?

The ongoing Covid-19 pandemic makes it clear that treating widespread diseases, including alcoholism, involves a number of obstacles that are difficult to overcome. Alcoholism, however, is particular intractable to treatment and understanding since many alcoholics may refuse to recognize they have a problem in the first place and the profound stigma that is associated with the disease further inhibits sufferers from seeking help from others. In addition, as with all addictive drugs, stopping drinking after a long period of time can cause painful withdrawal symptoms, some of which can even be life-threatening. These constraints mean that American society should treat alcoholism and alcoholics for what they really are: a destructive disease and victims of the disease that require more than just self will to overcome and these issues are discussed further below.

What can we, as a society, do to reduce the problems associated with alcohol use?

Far too many Americans either do not understand or simply disagree, at least on some level, with the notion that alcoholism is a disease. This is perhaps understandable since most people who are capable of enjoying social drinking rarely if ever suffer from the wide array of adverse life outcomes that are commonplace with alcoholism, and it is far easier to blame alcoholics for their poor choices in life than it is to muster the understanding and compassion that is needed to address the problem. By very sharp contrast, few Americans would blame diabetics for their insulin deficiencies or cancer patients for their disorders, and most are sympathetic and supportive of public health measures that are intended to help these populations.

The same cannot be said of alcoholism, though, despite its recognition by the American Medical Association and other national and international healthcare organizations and associations as a legitimate disease beginning in the mid-20th century. Given its centrality to treating alcoholism, this issue represents one of the major stumbling blocks to reducing the multiple problems that are associated with alcohol use today. Therefore, public education initiatives that are designed to better inform the American public concerning the truth about alcoholism represents an important first step in directly addressing these problems in the future. Likewise, despite the widespread publication of information concerning the adverse health consequences of alcohol consumption, many consumers do not fully understand or appreciate the negative implications of their long-term use of alcohol products (Khauli et al. 2021).

More importantly, reducing the problems that are associated with alcoholism means that non-alcoholics must make the effort to not only understand this disease condition, but to avoid harshly judging those who suffer from it. Indeed, alcoholism shows no favorites, and men and women of all ages, socioeconomic condition and ethnic groups can develop the disorder. While research has consistently shown that some demographic groups suffer from higher incidences of alcoholism, the disease can still affect members of the most resilient populations. It is little wonder, then, that free and readily accessible in the community that are designed to help people of all walks of life recover from alcoholism as discussed with respect to Alcoholics Anonymous (AA) below.

Does AA work? Why or why not? With the ACA laws now in place, what are alternatives?

With more than 100,000 chapters and 2 million members, AA is the most frequently used intervention by alcoholics in the United States and abroad (Young 2011). Although AA and other peer-led 12-step programs differ from evidence-based interventional strategies such as motivational interviewing and cognitive-behavioral therapy, they all have demonstrated effectiveness for many alcoholics (Young 2011). Members of AA, however, are quick to advise newcomers to the organization that, “It works if you work it.” In other words, the AA program is effective – and only effective – when people attend meetings even when they do not want to and actively complete all of the program’s steps. This guidance, though, could be made more accurate by emphasizing that, “It only works if you work it and not always the first time you try.” In this regard, Young (2011) reports that, “Researchers have failed to comprehensively identify AA’s therapeutic mechanisms or to definitively link them to recovery outcomes. This failure may result from the false assumption that AA frames identity in the same way evidence-based psychological treatments do” (213).

This limitation means that it is difficult or even impossible to recruit long-term members of AA for studies to evaluate its actual efficacy in promoting total abstinence from alcohol (Young 2011). This is an important consideration because alcoholism is an insidious disease that is never cured, only abated. This harsh reality means that the limitations of attendance at AA must be recognized and that many alcoholics will require long-term and even inpatient evidence-based treatments in order to achieve optimal addiction treatment outcomes. Moreover, the main tenets of AA have not been universally embraced by potential new members due to this lack of scientific evidence and its overarching reliance on the spiritual dimension of human life. For instance, according to Young, “AA emerged from a religious movement and developed into a ‘fellowship.’ It did not, in short, follow the usual route of evidence-based public health interventions, and its spiritual component, in particular, has proven problematic for potential members” (213).

While attendance at AA meetings is usually completely voluntary, some individuals may be ordered by courts of competent jurisdiction to attend meetings for a specific amount of time as part of their rehabilitation for crimes that were committed while under the influence of alcohol. Nevertheless, none of the provisions of the Affordable Care Act (ACA) require or prohibit attendance at AA or other 12-step programs, and people are free to attend as often as they see fit and cease their participation entirely when they feel it is appropriate or necessary for them to do so. This aspect of AA may be a dual-edged sword for many alcoholics who are desperate to find help but who are otherwise unconvinced as to the program’s actual effectiveness. The only viable alternatives to AA and similar 12-step programs are community-based in- and outpatient facilities that use evidence-based interventions; in many cases, however, such treatment strategies are supplemented and reinforced by obligatory participation in an AA program.

Conclusion

Despite the wide array of negative health consequences that are associated with even moderate alcohol consumption, the research showed that there are also some corresponding health benefits for certain conditions, including ischemic heart disease, peripheral vascular disease, cerebrovascular disease, gallstones and diabetes. Recent published within the past few months indicates that these benefits largely depend on the amount of alcohol that is routinely consumed, and no research suggests that imbibing large quantities of alcohol confer any health benefits whatsoever. The research also showed that the alcohol industry regularly trots out a health warning on its products, but these marketing messages are of limited value given their nebulosity and comparative size. One of the more noteworthy findings to emerge from the relevant literature was the need for Americans to understand and accept the fact that alcoholism is caused by a disease rather than a lack of willpower and that alcoholics should be regarded in this light. Consequently, educating the public concerning this issue represents one of the most important steps that American society can take to improve the manner in which these victims are treated. Finally, the research also showed that although Alcoholic Anonymous is not an evidence-based treatment strategy, it is still the most widely used intervention in the United States and abroad at present and many alcoholics have succeeded in abstaining from consuming alcohol, even after a lifetime of heavy drinking despite a dearth of scientific evidence to support this treatment strategy.