In the December, 2015, edition of this Science Update we responded to a recent article appearing in The Atlantic.1 Its author, Gabrielle Glaser, claimed that AA and its 12-step programs lack scientific foundation, asserting that “nothing about the 12-step approach draws on modern science …..” We presented the data supporting the opposite case, citing several published scientific reports that she did not mention. In the present installment, we review the basis on which she asserts her claim that the success rate of AA is only 5-8 percent. Relying on a single secondary source2 for this claim, Ms. Glaser writes, “That is just a rough estimate [of AA’s effectiveness], but it’s the most precise one I’ve been able to find.” Because flawed science can cause harm, we offer a critique of the scientific basis she cites for her claim. At the outset, Ms. Glaser’s source presents neither new data nor any of...

Alcoholics Anonymous is the most widely used treatment for alcoholism in the world, yet it continues to come under attack by popular media ignorant of the science behind its success. A recent high profile attack appeared in the April 2015 issue of The Atlantic, in the form of an article by Gabrielle Glaser titled, “The Irrationality of Alcoholics Anonymous.”   In this article, Ms. Glaser boldly states that 12-step programs lack a scientific foundation and that most professional treatment programs fail to provide scientifically supported treatment, largely because they are 12-step oriented. Ms. Glaser writes, “The problem is that nothing about the 12-step approach draws on modern science: not the character building, not the tough love, not even the standard 28-day rehab stay.” Contrary to Ms. Glaser’s sweeping statements about the lack of science concerning AA, a significant body of research has been conducted on this organization and its impact on drinking...

Developed in the late 1940's(1, 2), disulfiram (Antabuse®) is the oldest of the three agents currently approved by the US Food and Drug Administration (FDA) for the treatment of alcoholism. In the presence of ethyl alcohol (ethanol), it occasions an immediate and profoundly uncomfortable physical sickness known as the disulfiram-alcohol reaction(D-AR). This includes facial flushing, a significant drop in blood pressure, severe headache, and markedly severe nausea and vomiting. First confirmed when early investigators tested it on themselves(3), the D-AR lasts from 30 minutes to several hours depending on the amounts of both ethanol and disulfiram in the body. Disulfiram inhibits aldehyde dehydrogenase, the enzyme that changes acetaldehyde--ethyl alcohol's first breakdown product-- into carbon dioxide and water; it raises the acetaldehyde level in the blood resulting in the D-AR. Early clinicians saw this as a conditioning tool and would provoke the D-AR in active drinkers to demonstrate the drug's aversive qualities....

Models of Alcoholism: Medical / Physiological Causes Medical Illness Model: Near the end of the Second World War researchers and leaders in the recovery community jointly formulated the problem of uncontrolled drinking into what is now known as the Disease Model of alcoholism. This model postulates that, like medical illnesses, alcoholism--more specifically alcohol dependence, or addiction—can be diagnosed, its course observed, and its physical causes understood. Further, scientific trials can be undertaken to identify the best treatments for those who suffer from it. The diagnosis of Alcohol Dependence, in this model, rested on four symptoms: 1) a tolerance to alcohol in which a person needs to drink ever greater amounts to reach a desired effect, 2) withdrawal symptoms, such as "the shakes" and others, on stopping use, 3) the Loss of Control phenomenon in which affected persons lose the ability to control how much they drink at a sitting and thereby...

The National Council on Alcoholism and Drug Dependence (NCADD), in cooperation with the Research Society on Alcoholism (RSA), is proud to provide Research in Alcoholism: Models and Science as the first article in the new NCADD Research Update. The 5 Part series provides background information on the different ways of thinking about alcoholism that contribute to our understanding today. Following Part 1, The Introduction, Part 2- Models of Alcoholism: Belief Structure / Individual Choice, Parts 3 and 4 will review, different models of alcoholism, and the final Part 5 will respond to reader questions and comments. Because science, like prevention, treatment, and recovery, depends on the health of the community, we invite questions and comments from readers (click on Add New Comment at the end of the article). Habit Models With the advent of modern psychology over the course of the 20th Century, models derived from other animal species began to...

The National Council on Alcoholism and Drug Dependence (NCADD), in cooperation with the Research Society on Alcoholism (RSA), is proud to provide Research in Alcoholism: Models and Science as the first article in the new NCADD Research Update. The 5 Part series provides background information on the different ways of thinking about alcoholism that contribute to our understanding today. Following Part 1, The Introduction, Parts 2, 3, and 4 will review, different models of alcoholism, and the final Part 5 will respond to reader questions and comments. Because science, like prevention, treatment, and recovery, depends on the health of the community, we invite questions and comments from readers (click on Add New Comment at the end of the article). Individual Moral Failure Models: Over the most recent centuries, and some would argue for many centuries before, alcoholism has been regarded as a personal moral failing that required a courageous moral choice...

The National Council on Alcoholism and Drug Dependence (NCADD), in cooperation with the Research Society on Alcoholism (RSA), is proud to provide Research in Alcoholism: Models and Science as the first article in the new NCADD Research Update. The Five Part series provides background information on the different ways of thinking about alcoholism that contribute to our understanding today. Following the Introduction, Parts 2, 3, and 4 will review different models of alcoholism, and the final part will respond to reader questions and comments. While Research in Alcoholism: Models and Science provides a frame of reference, future NCADD Research Updates will maintain a clear focus on how scientific knowledge can impact and improve everyday practice in prevention, treatment or recovery. The NCADD Research Update will discuss topics that have practical application in the community, training program, clinic or treatment center, rather than on theoretical issues best left in the research laboratory....