Recovering alcoholics can benefit from Al-Anon

R.J. has been clean and sober and an active member of Alcoholics Anonymous for 20 years. He lives the Twelve Step program each day, one day at a time. He attends AA meetings faithfully, reads the literature, meditates, and asks his Higher Power for guidance. He has told his story many times and listened with loving acceptance to the stories of others, as AA members are encouraged to do. He thought nothing about addiction could surprise him at this point in his life and recovery.

Then he discovered his 20-year old son had a drug and alcohol problem. "I felt so stupid," he said. "I know this stuff, and it never entered my mind that my son was using. He was the good boy, the one who got straight A’s. He knows I’m a recovering alcoholic and that his mother (my ex-wife) is a practicing one. I thought knowing about us would keep him sober. But he got to a point where he seemed paralyzed; he couldn’t stay on track. One day I said, sort of in passing, ‘You act like you’re on drugs.’ He said, ‘I am.’ When I asked what kind and he said he’d tried ‘just about everything,’ I was stunned. I didn’t know what to do."

Not knowing what to do, R.J. did nothing the night of his son’s revelation except listen. "I told him I wouldn’t preach or yell, but I asked him if I could tell him when I heard him giving me the ‘standard’ addict’s lines like, ‘I have it under control.’ He said I could, and we talked until 4 a.m."

Next, R.J. sought help from others. His first impulse was to issue an edict telling his son not to come around until he got straight, but a counselor at work cautioned that things could get worse if his son felt abandoned, with no safe places or safe people to turn to. "She suggested I establish clear rules so he wouldn’t come here high or use here, but let him know that I love him and I’d do whatever it takes to help him when he’s ready."

When a long-time friend (also a recovering alcoholic) suggested going to Al-Anon, R.J. said he was "blown away" by the idea. Like many recovering alcoholics, he had always viewed Al-Anon as a Twelve Step mutual-help group for "them"–the family and friends of the alcoholic–and AA as the Twelve Step group for "us"–the alcoholics who affected their lives.

R.J. and his friend went to an Al-Anon meeting where they were the only men. He confessed that he was very nervous at first but said the familiar Twelve-Step meeting structure eased his anxiety. "Then I said, ‘I’m an alcoholic–the reason you’re here–but now I need help.’ It broke the ice, and they welcomed us with so much warmth and generosity."

Because it is not unusual to have more than one problem drinker in a family, it makes sense that recovering alcoholics can also be affected by another’s alcohol or drug use, and that they could benefit from the fellowship and support of Al-Anon. Except for one word in Step Twelve where Al-Anon has substituted the word "others" for AA’s word "alcoholics," the Steps of the two groups are identical.

"At AA we learn that we’re powerless over alcohol. At Al-Anon you discover that you’re powerless over others," explained R.J. He thought the Al-Anon members he met also gained by meeting two recovering alcoholics who embrace the same Twelve Step philosophy they do.

R.J. said it was a profound experience to view addiction "from the other side of the fence" at Al-Anon. "It struck such a chord when a woman there told me I’ve got my story, but my son is still writing his. I can tell him about my path and show him a path exists, but I can’t walk it for him."

Al-Anon meetings are held in 115 countries, and there are over 24,000 Al-Anon groups worldwide. For more information visit http://www.al-anon.alateen.org/.

Alive & Free is a health column that provides information to help prevent substance abuse problems and address such problems. It is created by Hazelden, a nonprofit agency based in Center City, Minn. "Copyright © 2003 Hazelden Foundation. All rights reserved." Any other use of the Web site or the information contained here is strictly prohibited.

At Amazon; How Al-Anon Works for Families & Friends of Alcoholics

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2. AA Can Help Most Alcoholics
3. Al-Anon offers new life
4. Alcohol and Anxiety
5. Alcoholic Defense Mechanisms
6. Alcoholics Anonymous and Nursing
7. Alcoholism Treatment in a Nursing Home
8. An Introduction to Medication for Alcohol Dependence
9. Anti-craving Drugs
10. Binge Drinking & Brain Damage
11. Brief Intervention in Emergency Room is Effective
12. Brief-TSF Description
13. Characteristics of Children of Alcoholic
14. Common Problems in Recovery
15. Counseling and the 12 Steps of AA
16. COUNSELOR CHARACTERISTICS
17. Craving Reduction
18. Depression & 12-Step Programs
19. Developing Willingness to Change
20. Dropout from 12-step self-help groups
21. Effects of gambling addiction
22. Foetal alcohol disorder linked to crime:
23. Free Training Alcoholism Anti-craving Medication
24. Gender Matching Hypothesis in Alcohol Treatment
25. Helping Alcoholics
26. Humility and Surrender
27. New Zealand’s spiritual aspects in 12-Step Treatment
28. Painkiller abuse
29. PTSD and Alcohol Addiction
30. Recovering Alcoholics Effective in Helping Others
31. Recovering People Working in the Recovery Field
32. Recovery through the Twelve Steps
33. Research Evidence for TSF
34. Risky Partners and Domestic Violence
35. Self-help Reduces Healthcare Demand
36. Sleep problems affect alcoholism recovery
37. Slogans for everyday life in AA
38. Spiritual assessment
39. Stages of an Eating Disorder
40. Strategies for Dealing with Common Problems
41. Strategies for Dealing With Crises
42. Strategies for Dealing With Denial
43. Symptoms of alcoholism
44. The 12-Steps Promote Acceptance of Addiction
45. Treating Alcoholism as a Chronic Disease
46. TSF Description
47. Twelve step programs
48. What about partners of alcoholics?
49. What About This Spiritual Awakening Thing
50. Women and the Twelve Steps of AA
51. World view change in Adult Children of Alcoholics

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Working with Substance Misusers

The 12-step programs are discussed. It is noted that 12-step programs consist of a range of self-help groups, which have their origins in the recovery philosophy of Alcoholics Anonymous.

The Minnesota Model is an adaptation of the 12-step program that is used in some specialist treatment settings.

There is a lack of knowledge and training regarding 12-step methods among professional groups, and misunderstandings are common.

The program does offer a resource which is widely available, free, open to anyone, and that provides support at times when other agencies are unavailable.

The approach may be a useful alternative or adjunct to other treatments for some clients.

Williams, C. Twelve step approaches. In: T. Petersen and A. McBride, Eds., Working with Substance Misusers, London, UK: New York, NY: Routledge, 2002. 362 p. (pp. 134-144).

Brief-TSF satisfies these guidelines

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Alcoholics with cirrhosis of the liver have more brain damage than noncirrhotic alcoholics

• Cirrhosis of the liver is one of the most common and serious medical complications linked to alcoholism.
• Heavy alcohol use can also cause brain damage.
• Cirrhotic alcoholics appear to have even more impaired brain function than non-cirrhotic alcoholics.

Sustained exposure to alcohol can cause scarring and dysfunction of the liver, referred to as cirrhosis. Heavy alcohol use can also cause brain damage. An examination of gene expression in the frontal cortex has found that brain function is even more impaired in cirrhotic than non-cirrhotic alcoholics.

Results are published in the September 2007 issue of Alcoholism: Clinical & Experimental Research.

“The liver’s main function is to remove poisons from the blood,” explained R. Dayne Mayfield, research scientist at the Waggoner Center for Alcohol and Addiction Research at The University of Texas at Austin. “It also helps the body absorb certain nutrients like fats and fat-soluble vitamins. You cannot live without a functioning liver.” Mayfield is also the corresponding author for the study.

He added that about 10 to 20 percent of heavy drinkers develop cirrhosis. It is the seventh leading cause of death among young and middle-aged adults in the United States; approximately 10,000 to 24,000 deaths from cirrhosis each year may be due to alcohol consumption. “Cirrhotic patients [have] dysfunctional livers that cannot remove poisons from the blood stream,” he said. These poisons are able to move into the brain and disrupt normal function.

“When a gene or deoxyribonucleic acid (DNA) is ‘turned on,’” said Mayfield, “it serves as a template for synthesis of ribonucleic acid (RNA), which in turn produces protein, the key element in cell function. These ‘genes’ hold the key or code for the ultimate production of proteins that control all functions of the brain. We know that heavy alcohol drinking changes the regulation of genes in the brain. We predicted that alcohol-related changes in brain genes would be magnified in alcoholics with cirrhosis.”

Researchers obtained brain samples from the Brisbane Node of the National Health & Medical Research Council Brain Bank and the Tissue Resource Centre at the University of Sydney, Australia. They compared roughly 47,000 element cDNA microarrays taken from two groups (n=21): seven cirrhotic and 14 non-cirrhotic alcoholic cases.

“We found that the levels of many important brain genes changed in the cirrhotic patients,” said Mayfield. “These genes are important in regulating cell death and how individual cells in the brain talk to each other in a meaningful way.”

“The level of gene expression differed significantly between tissue from cirrhotic and non-cirrhotic alcoholics,” added John H. Krystal, Robert L. McNeil, Jr. professor of clinical pharmacology and deputy chairman for research in the department of Psychiatry at Yale University School of Medicine and the VA Connecticut Healthcare System. “Out of 1,125 genes, 482 genes showed increased expression and 643 genes showed reduced expression in the cirrhotic individuals. With the levels of so many genes changing, this study suggests widespread effects in many cellular pathways related to cirrhosis in the alcoholic group.” Krystal is also a principal investigator at the NIAAA Center for the Translational Neuroscience of Alcoholism and the VA Alcohol Research Center.

More specifically, those genes involved in neurite growth, neuronal cell adhesion, and synaptic transmission showed greater inhibition at the mRNA level among the alcoholic cases.

“Cells in the brain have to maintain connections in order to operate,” explained Mayfield. “This is similar to the way the internet works to transmit information across the globe. The internet would slow down or stop if enough connections are interrupted or changed. Similarly, the genes outlined above are responsible for proper connections and communication between cells in the brain. Without them, normal function would not be possible.”

Krystal suggested several possible interpretations of the findings. “One, alcoholics who develop cirrhosis likely drink more heavily than those alcoholics who do not develop cirrhosis,” he said. “Therefore, some of the findings may be related to the effects of heavy drinking upon the brain. A second contribution could be the effects of impaired liver function upon the brain. The liver plays a major role in the production and metabolism of a large number of substances that influence brain function, and impaired liver function would be expected to affect the brain. A third possibility is that cellular processes that are stimulated by alcohol consumption might influence both liver and brain. That is, the cirrhotic and non-cirrhotic groups differ in their cellular resilience to the toxic effects of alcohol rather than differences in their level of alcohol consumption. A fourth possible contributing factor could be changes in diet. If patients with cirrhosis have a more profound disruption of their nutrition than patients who do not develop cirrhosis, differences in brain damage may be related to nutritional deficiencies.”

Both Mayfield and Krystal said that the central message of the study is that alcoholism, especially when accompanied by a serious medical complication such as cirrhosis of the liver, can produce widespread changes in the body and brain.

“One hopes that a better understanding of the cellular processes related to the destructive impact of alcoholism upon the brain may help to guide the development of treatments that might protect people from neural damage related to alcoholism, and help them to recover from alcoholism,” said Krystal. “Important questions are: ‘How reversible are the changes in gene expression in the brain when alcoholics stop drinking"’ and ‘How dependent is the recovery of the brain upon the recovery of the liver"’"

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A Few Basic Facts About AA

Alcoholics Anonymous is well-known as an organization for people who want to stop drinking. At the same time, there are some points about A.A. that may be unclear to the general public and even to professionals working to help problem drinkers.

Founded in the United States in 1935, when one alcoholic discovered he could stay sober by helping another alcoholic, Alcoholics Anonymous now has more than two million members in some 180 countries.

A.A.’s sole purpose is helping people recover from the disease of alcoholism, and it has no affiliation with any other group or organization. Members anywhere in the world can come together to form an A.A. group, of which there are an estimated 106,000 worldwide.

Among other facts about Alcoholics Anonymous are:

Membership is free. A.A. groups usually pass a basket around at meetings to cover the cost of renting the meeting room and for other incidental expenses, such as coffee.

A.A. is not a religious organization; it is not allied with any religious organization, and requires no religious belief as a condition of membership. Members include Catholics, Protestants, Jews, Muslims, Hindus, agnostics, and atheists.

A.A. does no recruiting. The only requirement for membership is a desire to stop drinking. There are no other requirements to be met, no initiation fees to be paid, and no forms to be filled out. It is completely up to anyone considering joining A.A. to determine if they have a problem with alcohol and whether they will deal with it in Alcoholics Anonymous. A person becomes a member of A.A. simply by deciding they want to be a member.

A.A. groups are autonomous and run by the members themselves.

A.A. is not a temperance society. Members acknowledge their inability to drink safely but have nothing to say about the drinking of others. It is a principle of A.A. that it has no opinion on what are termed outside issues.

A.A. is not affiliated with any hospital or rehab, or any other such facility. No professional services of any kind are offered or performed under A.A. sponsorship.

A.A. meetings take several forms, but at any meeting there will be alcoholics talking about how drinking affected their lives and what life as a sober member of A.A. is like.

Anonymity is respected. Newcomers can turn to A.A. with the assurance that their attendance at meetings will be kept private.

“Open” Meetings of A.A. are meetings which anyone may attend to observe how A.A. works. “Closed” meetings are reserved for those with a drinking problem.

Contacting A.A. Information on how to find local A.A. meetings can be found in telephone directories and at numerous Internet sites, including www.aa.org.

From; About AA; A newsletter for professionals, Spring 2007.

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Alcoholic is good and sober; Sentiment change in AA.

An alcoholic is a stigmatized, deviant identity.

This longitudinal study of 55 Alcoholics Anonymous (AA) participants found that even chronic alcohol abusers viewed alcoholics negatively, in keeping with normative understandings.

However, following mandated AA attendance, there was significant change in social sentiments for alcohol-related concepts and meanings for feelings and objects related to drinking, as sentiments became similar to AA subculture understandings.

In AA "an alcoholic" is good.

Sentiment change, AA ideology, and the implications for identity and normative behavior are discussed.

Section headings in this article include:

(1) theoretical background in the development of meaning;

(2) alcoholism and AA; and

(3) sentiments and sentiment measurement.

Research report; Thomassen, L. Alcoholic is good and sober: Sentiment change in AA. Deviant Behavior, 23(2):177-199, 2002.

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The AA Recovery Program

The relative success of the A.A. program seems to be due to the fact that an alcoholic who no longer drinks has an exceptional faculty for “reaching” and helping an uncontrolled drinker.

In simplest form, the A.A. program operates when a recovered alcoholic passes along the story of his or her own problem drinking, describes the sobriety he or she has found in A.A., and invites the newcomer to join the informal Fellowship.

The heart of the suggested program of personal recovery is contained in Twelve Steps describing the experience of the earliest members of the Society:

1. We admitted we were powerless over alcohol – that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

Newcomers are not required to accept or follow these Twelve Steps in their entirety if they feel unwilling or unable to do so.

They will usually be asked to keep an open mind, to attend meetings at which recovered alcoholics describe their personal experiences in achieving sobriety, and to read A.A. literature describing and interpreting the A.A. program.

A.A. members will usually emphasize to newcomers that only problem drinkers themselves, individually, can determine whether or not they are in fact alcoholics.

At the same time, it will be pointed out that all available medical testimony indicates that alcoholism is a progressive illness, that it cannot be cured in the ordinary sense of the term, but that it can be arrested through total abstinence from alcohol in any form.

From the AA FACT FILE. This document also is available on G.S.O.’s A.A. Web site: www.aa.org

Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism

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Principles of management of substance-abuse disorders

With empathy and positive management, many alcohol and drug dependent people can be liberated from their addictions.

• Establish a working/therapeutic relationship
• Identify the patient’s current level of drug use (drug type, daily dose, frequency of use); check for multiple drug use
• Determine the patient’s “readiness for change”
• Help the patient weigh up the costs (and benefits) of their continued drug use (affordability, health effects, legal consequences, effects on relationships, job, family)
• Contrast with the benefits of a drug-free lifestyle
• Establish an “environment of safety”
• Encourage the patient to cut down or stop using drugs
• Negotiate appropriate (and attainable) goals with the patient
• Discuss strategies to achieve these goals
• Identify the situations in which the patient is likely to use drugs and the factors that will make it difficult to change the pattern of use
• Provide positive reinforcement for goals achieved and arrange appropriate social supports
• Discuss HOW to cease substance use (i.e., detoxification)
• Inform the patient of the symptoms that are likely to occur and discuss strategies for ameliorating them
• Facilitate working through grieving for the losses sustained due to former lifestyle choices
• Discuss strategies for coping without drugs, including involvement with self-help groups
• Remember that relapse is common
• Identify any gains made during the previous attempt and encourage the patient to try again
• Examine the factors that led to the relapse and discuss strategies to deal with them
• Discover why the substance-oriented lifestyle developed (optional)

Research extract from; Tobie L Sacks and Nicholas A Keks. Alcohol and drug dependence: diagnosis and management. Medical Journal of Australia Practice Essentials #14.

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Alcohol consumption and the CAGE questionnaire in Korean adults: results from the Second Korea National Health and Nutrition Examination Survey. J Korean Med Sci. 2008 Apr;23(2):199-206. Park JT, Kim BG, Jhun HJ.

We evaluated alcohol consumption and alcohol-related problems in Korean adults by evaluating alcohol consumption and responses to the CAGE questionnaire obtained from the second Korea National Health and Nutrition Examination Survey.

• The age-adjusted prevalence of males who consumed 0, 0.1-20, 20.1-40, or >40 g/day of alcohol were 28.0, 51.5, 12.5, and 8.0%, respectively;
• 26.9% of male drinkers were CAGE-positive (> or =2 affirmative responses to the CAGE).
• The age-adjusted prevalence of females who consumed 0, 0.1-10, 10.1-20, or >20 g/day of alcohol were 67.7, 26.6, 3.9, and 1.8%;
• 11.9% of female drinkers were CAGE-positive.
• The risk factors for high alcohol consumption were old age, low education level, smoking, and drinking onset at young ages in male drinkers, whereas low education level and smoking in female drinkers.
• The risk factors for a positive CAGE were young age, marriage, low education level, smoking, high amount of alcohol consumed on a single occasion, and high drinking frequency in male drinkers,
• whereas high household income, ex-smoking, high amount of alcohol consumed on a single occasion, and high drinking frequency in female drinkers.

Our results suggest that high alcohol consumption and alcohol-related problems in Korean adults are not negligible and require intervention.

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• 12-Step Treatment More Effective than Alternative
• Address the drinking problem directly
• Subscribe to Twelve Step Facilitation by e-Mail

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Alcohol and drug dependence approach

Synopsis – diagnosis and management

An empathetic and non-judgemental attitude to the patient is required when managing drug dependence problems.

Careful assessment to establish the nature and extent of drug use must precede any attempts at management (more than one consultation is likely to be necessary).

The active cooperation of the patient in any management plan is essential, as the patient’s readiness for change will be a powerful influence on the success of any intervention.

Goals for stopping or reducing drug use must be agreed with the patient and must be attainable. Abstinence from drugs will not be every patient’s goal; harm reduction (through education to avoid collateral risks or efforts to cut down on drug consumption) is a worthwhile objective.

Detoxification is only part of the process. Many lifestyle adjustments are required to maintain a drug-free existence, and these changes may require social support and/or psychological therapies.

Relapse is common but can be used as a learning experience. Patients who relapse into drug use should be encouraged to try again.

With empathy and positive management, many drug dependent people can be liberated from their addictions.

Research extract from; Tobie L Sacks and Nicholas A Keks. Alcohol and drug dependence: diagnosis and management. Medical Journal of Australia Practice Essentials #14.

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