tag:theconversation.com,2011:/au/topics/aa-4903/articlesAA – The Conversation2022-07-25T05:55:34Ztag:theconversation.com,2011:article/1841372022-07-25T05:55:34Z2022-07-25T05:55:34ZIs there really such a thing as an ‘addictive personality’?<figure><img src="https://images.theconversation.com/files/472003/original/file-20220701-26-4q2h90.jpg?ixlib=rb-1.1.0&rect=12%2C0%2C4268%2C2843&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>We’ve all heard of someone referred to as having an “addictive personality”. Some even say it about themselves. But you may be surprised to know there is no such thing. </p>
<p>Despite decades of research, <a href="https://www.nature.com/articles/522S48a">no-one has been able to identify</a> a consistent set of personality traits or a single personality type that can reliably predict whether someone will have problems with alcohol or other drugs.</p>
<p>The development of alcohol or other drug problems is a complex and difficult-to-predict mix of factors. The “addictive personality” is, in essence, just a stereotype.</p>
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<p>
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Read more:
<a href="https://theconversation.com/alcohol-problems-arent-for-life-and-aa-isnt-the-only-option-8-things-film-and-tv-get-wrong-about-drug-and-alcohol-treatment-180946">Alcohol problems aren't for life, and AA isn't the only option. 8 things film and TV get wrong about drug and alcohol treatment</a>
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<h2>Where did the idea of an addictive personality come from?</h2>
<p>Nearly 90 years ago, around the time of the birth of the Twelve Step movement and <a href="https://theconversation.com/does-alcoholics-anonymous-actually-work-179665">Alcoholics Anonymous</a>, there was a move away from thinking about alcohol problems as a moral failing and towards taking a more medical approach.</p>
<p>The first step in this transition, based on the relatively little that was known about alcohol and other drug problems in the 1930s, was seeing these problems as a personality flaw. It was the best explanation at the time of why some people develop problems with alcohol and others don’t.</p>
<p>Later those ideas further developed into a broader “<a href="https://theconversation.com/viewpoints-is-addiction-a-disease-63113">disease model</a>”. The disease model and the later “brain disease” model viewed alcohol and other drug problems as a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14400">lifelong and incurable disease</a> of the mind, making abstinence the only option.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/472005/original/file-20220701-14-pm4umi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="People in a room sitting on chairs in a circle" src="https://images.theconversation.com/files/472005/original/file-20220701-14-pm4umi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472005/original/file-20220701-14-pm4umi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472005/original/file-20220701-14-pm4umi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472005/original/file-20220701-14-pm4umi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472005/original/file-20220701-14-pm4umi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472005/original/file-20220701-14-pm4umi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472005/original/file-20220701-14-pm4umi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The disease model views alcohol and other drugs as a lifelong and incurable disease of the mind.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>Why is the idea of an addictive personality a problem?</h2>
<p>The term “addictive personality” generally conjures up negative images: weak, unreliable, selfish, impulsive, lacking control. It’s a stereotype that increases stigma about alcohol and other drug problems and reinforces the idea change is difficult or impossible. And <a href="https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/Reducing%20stigma%20and%20discrimination%20for%20people%20experiencing%20problematic%20alcohol%20and%20other%20drug%20use.pdf">stigma prevents people from seeking help when they need it</a>.</p>
<p>The addictive personality idea can also lead people to believe they are either destined for problems, or completely protected from them, neither of which is true. For those who do experience problems, they may have a sense of helplessness about managing their use.</p>
<p>It’s a shorthand way of saying, “I can’t do anything about it”.</p>
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<p>
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Read more:
<a href="https://theconversation.com/does-alcoholics-anonymous-actually-work-179665">Does Alcoholics Anonymous actually work?</a>
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</p>
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<h2>Is there <em>any</em> truth to the addictive personality idea?</h2>
<p>We now know some people who have problems with alcohol or other drugs <a href="https://pubmed.ncbi.nlm.nih.gov/33188563/">can return to regular use</a>. And most people experience problems <a href="https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/alcohol-other-drug-treatment-services-australia/contents/drugs-of-concern">with only one drug</a>, using other drugs in non-problematic ways. Both of these things contradict the addictive personality theory because they suggest there is a level of control.</p>
<p>But there are some traits that are more likely to be found in people who have problems with alcohol or other drugs.</p>
<p>There are two main personality clusters that seem to increase risk of problems: <a href="https://link.springer.com/article/10.1007/s40473-013-0001-y">risk-taking or impulsiveness</a>, and <a href="https://link.springer.com/chapter/10.1007/978-3-319-89842-1_23">sad or anxious temperaments</a>. Or a combination of both. Both <a href="https://www.sciencedirect.com/science/article/abs/pii/S0376871615003841">risk takers</a> and high achievers are more likely to develop alcohol or drug problems.</p>
<p>The common thread to these seemingly unrelated traits is difficulty regulating emotions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/472437/original/file-20220705-24-i7ylpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hand holding a cigarette" src="https://images.theconversation.com/files/472437/original/file-20220705-24-i7ylpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472437/original/file-20220705-24-i7ylpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472437/original/file-20220705-24-i7ylpk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472437/original/file-20220705-24-i7ylpk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472437/original/file-20220705-24-i7ylpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472437/original/file-20220705-24-i7ylpk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472437/original/file-20220705-24-i7ylpk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Drug and alcohol dependence are more common among those who struggle to regulate their emotions.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<p>This partly explains why people who have experienced trauma have a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051362/">higher risk of developing alcohol or other drug problems</a>, and why there are <a href="https://pubmed.ncbi.nlm.nih.gov/34265320/">higher rates of dependence among people with ADHD</a>. Both these conditions increase activity in the <a href="https://qbi.uq.edu.au/brain/brain-anatomy/limbic-system">limbic system</a>, the part of the brain responsible for emotional reactions, and decrease activity in parts of the <a href="https://qbi.uq.edu.au/brain/brain-anatomy/lobes-brain">prefrontal cortex</a>, the logical part of the brain that helps regulate emotional responses.</p>
<p>There is some genetic component to personality – <a href="https://pubmed.ncbi.nlm.nih.gov/30283034/">between 30% and 60%</a>. And there is also some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549168/">genetic component</a> to the development of alcohol or other drug problems – <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056340">45%-65% for alcohol</a>. But inherited personality traits are a result of more than 700 possible gene interactions and there’s no single “personality gene” that leads to alcohol or other drug problems.</p>
<h2>A better explanation</h2>
<p>We now know the development of alcohol and other drug problems is influenced by a number of factors.</p>
<p>Many <a href="https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.64.12_Suppl.38">US troops in Vietnam</a> in the 1970s developed a dependence on heroin and used it regularly while they were in Vietnam, but they stopped quickly once they returned home. So it’s not just the drug itself or the person using it, but also where it’s being used.</p>
<p>Some drug experts refer to this as “drug, set and setting”: the qualities of drug itself, individual traits, and the context in which the drugs are used.</p>
<p>But how do these combined factors lead to problematic drug use and dependence?</p>
<p>After many decades of behavioural and neuroscience research we now know the brain is <a href="https://www.youtube.com/watch?v=LNHBMFCzznE">very plastic</a> and continues to learn and shape itself with new experiences right throughout our lives.</p>
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Read more:
<a href="https://theconversation.com/trying-to-cut-back-on-alcohol-heres-what-works-179664">Trying to cut back on alcohol? Here's what works</a>
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<p>Here’s how it works: any time we do something pleasant, we get a little burst of dopamine in the brain. The dopamine makes us feel good and says to our brain “you should try that again sometime”.</p>
<p>Alcohol and other drugs release a lot of dopamine. Some drugs release more than others.</p>
<p>Our brains quickly connect the dots between action (taking the drug) and reward (feeling good). That pathway is strengthened each time the drug is used. If we add strong emotions like intense pleasure or relief then <a href="https://pubmed.ncbi.nlm.nih.gov/14629927/">the connection gets even stronger</a>. This is called <a href="https://www.verywellmind.com/operant-conditioning-a2-2794863">operant conditioning</a>. The more you use, the more those associations are likely to form. Some people’s brains naturally release more dopamine than others so their pathways are formed faster and stronger.</p>
<p>Our brain also notices <a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2793124">cues</a> in the environment that become signals for drug use and can trigger a desire or craving to use. If you use the same special glass every time you have a drink or sit in the same chair every time you smoke a joint, the brain notices that connection. So when you see that glass or sit in that chair you might feel a little urge to use even when there is no drug. This is called <a href="https://www.simplypsychology.org/pavlov.html">Pavlovian conditioning</a>.</p>
<p>So rather than a fixed personality trait, the motivation to use alcohol or other drugs is driven largely by our brain learning associations between the effects of a drug (drug), our individual response to the drug (set) and the environment in which the drug is used (setting).</p>
<p>It’s great news because what is learnt can be unlearnt. And it means alcohol and other drug use and problems are not inevitable, even if you have a genetic or personality predisposition.</p>
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<p><em>If you are worried about your own or someone else’s alcohol or other drug use, you can contact the National Alcohol and other Drug Hotline on 1800 250 015 for free, confidential advice.</em></p><img src="https://counter.theconversation.com/content/184137/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She currently and has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into alcohol and other drug prevention and treatment.</span></em></p><p class="fine-print"><em><span>Paula Ross is a psychologist with a drug and alcohol consultancy and maintains a private practice.</span></em></p><p class="fine-print"><em><span>Steven Bothwell is a consultant for a drug and alcohol consultancy.</span></em></p>Despite decades of research, no-one has been able to identify a set of personality traits or a personality type that can predict whether someone will have problems with alcohol or other drugs.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityPaula Ross, Sessional psychology lecturer, Australian Catholic UniversitySteven Bothwell, Consultant, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1796652022-04-04T19:58:58Z2022-04-04T19:58:58ZDoes Alcoholics Anonymous actually work?<figure><img src="https://images.theconversation.com/files/456020/original/file-20220404-24-6gyhmw.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5455%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Alcoholics and narcotics anonymous are 12-step peer support groups where people who have alcohol or other drug problems are supported by others who have had similar problems (“peers”), rather than professionals. They are called 12-step programs because there are 12 steps members are expected to work through.</p>
<p>The 12 steps <a href="https://www.hazeldenbettyford.org/articles/twelve-steps-of-alcoholics-anonymous">have a strong religious element</a> including commitments to prayer, making a moral inventory of yourself, making amends to people you’ve harmed, and, once you’ve achieved your “spiritual awakening,” promoting the program to other people in need of help.</p>
<p>Originally designed for people with alcohol and then later other drug problems, they have now expanded to <a href="https://en.wikipedia.org/wiki/List_of_twelve-step_groups">dozens</a> of other compulsive behaviours, including overeating, gambling, sex and hoarding.</p>
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Read more:
<a href="https://theconversation.com/trying-to-cut-back-on-alcohol-heres-what-works-179664">Trying to cut back on alcohol? Here's what works</a>
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<p>One of the upsides of AA and NA groups is they are very accessible. There are groups running every day in many locations.</p>
<p>But do they really work?</p>
<h2>How the 12-step movement started</h2>
<p>Twelve step programs <a href="https://www.aa.org/aa-history">started in the 1930s</a>. The founders, a stock broker and a surgeon, developed a system of peer support and then formalised the 12 steps, largely drawn from their own and others’ experience of recovery.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/456025/original/file-20220404-14-lo9va.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="People sitting in a group talking" src="https://images.theconversation.com/files/456025/original/file-20220404-14-lo9va.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456025/original/file-20220404-14-lo9va.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456025/original/file-20220404-14-lo9va.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456025/original/file-20220404-14-lo9va.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456025/original/file-20220404-14-lo9va.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456025/original/file-20220404-14-lo9va.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456025/original/file-20220404-14-lo9va.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The 12-step program in Alcoholics and Narcotics Anonymous has a strong religious element.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<p>The model has remained largely unchanged since then, despite significant advances in our understanding of the brain and of alcohol and other drug problems and their treatment.</p>
<p>It was one of the very early formal treatment options for alcohol problems. It was started around the time of <a href="https://en.wikipedia.org/wiki/Prohibition_in_the_United_States">prohibition</a> and the <a href="https://www.britannica.com/topic/temperance-movement">temperance movement</a> when alcohol problems were considered a moral failing.</p>
<p>The 12-step movement took a step beyond the moral view and introduced the idea alcohol and other drug problems were a health issue by framing the problem as a disease.</p>
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Read more:
<a href="https://theconversation.com/health-check-what-makes-it-so-hard-to-quit-drugs-69896">Health Check: what makes it so hard to quit drugs?</a>
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<p>The movement believed “alcoholism”, as it was commonly known then, was a progressive disease that could never be cured. That meant abstinence was the only solution.</p>
<p>But there have been no serious candidates for gene, brain or personality differences that reliably predict the development or severity of alcohol or other drug problems. Many people who meet the AA definition of an “alcoholic” have successfully returned to <a href="https://pubmed.ncbi.nlm.nih.gov/33188563/">controlled drinking</a>.</p>
<h2>We know more about alcohol and other drug dependence now</h2>
<p>We now know a range of risk factors contribute to the development of alcohol and other drug problems. Genetics only accounts for about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345133/">50% of the risk</a> of developing an alcohol disorder. And although people who have alcohol or other drug problems do sometimes have significant cognitive deficits they generally occur after alcohol and other drug use begins, and they are usually temporary.</p>
<p>There are now newer models, based on decades of research, that are better at explaining the development of alcohol and other drug problems. So this has put the theoretical basis of the 12-step model into question.</p>
<p>The movement has a lot of dedicated fans but there has also been <a href="https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/">a lot of criticism</a>.</p>
<p>Many people find the program difficult to complete because of the requirements of participation.</p>
<p>There is a strict adherence to abstinence in the program and for this reason some find the process disempowering (<em><a href="https://www.hazeldenbettyford.org/articles/twelve-steps-of-alcoholics-anonymous">Step 1</a>: “We admitted we were powerless over alcohol - that our lives had become unmanageable</em>”).</p>
<p>There is also a strong religious flavour which reflects the movement’s origins at a time when Christianity was much more part of daily life (<em>Step 2: “We came to believe that a Power greater than ourselves could restore us to sanity</em>”).</p>
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Read more:
<a href="https://theconversation.com/thinking-about-taking-a-break-from-alcohol-heres-how-to-cut-back-or-quit-130952">Thinking about taking a break from alcohol? Here's how to cut back or quit</a>
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<h2>What’s the evidence base for 12-step programs?</h2>
<p>It has been difficult to work out how effective AA and NA are because there has not been a lot of good quality research into them. Many of the results are published by the “fellowship”, as the 12-step movement refers to itself. </p>
<p>And because the 12-step fellowship is by definition anonymous, some members don’t want to participate in studies that might breach the anonymity of the group. The fellowship itself has been, until recently, cautious about allowing interviews or data to be collected by researchers.</p>
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<a href="https://images.theconversation.com/files/456026/original/file-20220404-25-9az0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hand with AA chip in the pam reading '10 month recovery'" src="https://images.theconversation.com/files/456026/original/file-20220404-25-9az0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456026/original/file-20220404-25-9az0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456026/original/file-20220404-25-9az0f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456026/original/file-20220404-25-9az0f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456026/original/file-20220404-25-9az0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456026/original/file-20220404-25-9az0f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456026/original/file-20220404-25-9az0f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">AA promotes abstinence, when evidence shows many alcohol dependents can go back to controlled drinking.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>It’s also difficult to compare 12-step groups to mainstream treatments, such as cognitive behaviour therapy and motivational interviewing because it is now rare for contemporary treatment to be longer than two to three months at a time. Because alcohol and other drug problems are seen by AA/NA as an incurable disease, participation is a lifetime process.</p>
<p>From what we do know, success at maintaining abstinence is fairly low, even according to the fellowship’s own data. One <a href="https://www.aa.org/sites/default/files/literature/assets/p-48_membershipsurvey.pdf">AA study</a> found only 27% of participants were alcohol-free for up to a year (73% <a href="https://adf.org.au/reducing-risk/relapse/">relapse</a> rate) and only 13% maintained abstinence for more than five years. These figures are best case because they only include people who were still members of AA, not people who dropped out of the program. Another <a href="https://www.amazon.com/Sober-Truth-Debunking-Programs-Industry/dp/0807033154">analysis</a> estimated a 5-10% success rate at best (90-95% relapse rate).</p>
<p>This is compared to an estimated <a href="https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery">relapse rate</a> of around 40-60% for mainstream treatment.</p>
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Read more:
<a href="https://theconversation.com/want-to-quit-a-bad-habit-heres-one-way-to-compare-treatments-109144">Want to quit a bad habit? Here's one way to compare treatments</a>
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<p>One of the other criticisms of 12-step groups is that the drop out is quite high – estimated at <a href="https://pubmed.ncbi.nlm.nih.gov/12810145/">around 40%</a> in the first year. Mainstream treatment in Australia has a dropout rate of <a href="https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/alcohol-other-drug-treatment-services-australia/contents/treatment-referral-and-completion/completion-of-treatment">around 34%</a>.</p>
<h2>12-step facilitation therapy</h2>
<p>A new type of therapy, with the goal of getting people engaged in 12 step programs and reduce drop out, was developed in the 1990s as part of a <a href="https://pubs.niaaa.nih.gov/publications/projectmatch/match01.pdf">large research project</a>.</p>
<p>It’s called 12-step facilitation therapy and is delivered by trained treatment professionals. It shouldn’t be confused with AA, which is a self-help program, rather than being therapist-led. They are quite different.</p>
<p>Research shows when delivered according to a strict manual, it’s as effective as other established therapies for <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1530-0277.1998.tb03912.x">alcohol</a> and <a href="https://doi.org/10.4073%2Fcsr.2017.2">other drug</a> problems. </p>
<p>It has been found to be slightly more likely to <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012880.pub2/full">result in continuous abstinence</a> compared to other treatments. This may be because the goal of 12-step facilitation therapy is always abstinence, while other therapies may support a goal of controlled drinking or harm reduction for some heavy and dependent drinkers.</p>
<h2>So do 12-step groups work?</h2>
<p>If the ideals and goals of 12-step programs appeal to you, it may be able to help maintain abstinence for a period of time. But if not, there is not enough evidence of effectiveness to compel someone to attend.</p>
<p>It is likely the key ingredient in 12-step groups is the peer support, rather than the 12 steps themselves. We know from other types of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047716/">peer support</a>, and anecdotally from people in recovery, this type of support is helpful and highly valued.</p>
<p>There are other peer support programs now available like <a href="https://smartrecoveryaustralia.com.au">SMART Recovery</a> and <a href="https://hellosundaymorning.org">Hello Sunday Morning</a>, as well as individual peer support workers. These may better suit those who are not aligned with the values and philosophy of AA.</p>
<hr>
<p><em>If you are worried about your own or someone else’s alcohol or other drug use, you can contact the national Alcohol and other Drug Hotline on 1800 250 015 for free, confidential advice.</em></p><img src="https://counter.theconversation.com/content/179665/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into alcohol and other drug prevention and treatment. She is a member of the Board of Directors of Hello Sunday Morning. She is a Fellow if the Australian Association for Cognitive and Behaviour Therapy and was previously president.</span></em></p>Alcoholics and Narcotics Anonymous have been a mainstay of drug and alcohol treatment since the 1930s. But is there actually any evidence for their effectiveness?Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1796642022-03-28T19:14:50Z2022-03-28T19:14:50ZTrying to cut back on alcohol? Here’s what works<figure><img src="https://images.theconversation.com/files/454562/original/file-20220328-21-9jrkmq.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5751%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>With everything going on over the past couple of years, many people have <a href="https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/impact-of-covid-19-on-alcohol-and-other-drug-use">changed their drinking habits</a>. </p>
<p>We’ve seen an increased <a href="https://fare.org.au/wp-content/uploads/Alcohol-use-and-harm-during-COVID-19.pdf">demand for support</a>, suggesting more people are trying to cut back or quit.</p>
<p>There are so many options for cutting back or quitting alcohol it’s hard to know what will be most effective.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australians-are-embracing-mindful-drinking-and-the-alcohol-industry-is-also-getting-sober-curious-160931">Australians are embracing 'mindful drinking' — and the alcohol industry is also getting sober curious</a>
</strong>
</em>
</p>
<hr>
<h2>What works depends on how much you drink</h2>
<p>Most people successfully quit or cut back their alcohol consumption <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643818/">on their own</a>. </p>
<p>People who drink more frequently are much more likely to have <a href="https://www.betterhealth.vic.gov.au/health/servicesandsupport/alcohol-and-drugs--dependence-and-addiction">symptoms of dependence</a> and might find it more difficult.</p>
<p>You might be dependent if:</p>
<ul>
<li><p>you can’t easily go a day without drinking alcohol, or find it hard to cut back</p></li>
<li><p>a lot of your social activities include or are based around drinking</p></li>
<li><p>you find yourself thinking about or wanting alcohol a lot</p></li>
<li><p>you find it difficult to control the amount you drink once you start</p></li>
<li><p>you need to drink a lot to feel the effects</p></li>
<li><p>you experience withdrawal symptoms, even mild ones, such as feeling unwell or a slight shaking in your hands when you go a day or two without alcohol.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/454563/original/file-20220328-17-1uef4qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Friends clinking glasses." src="https://images.theconversation.com/files/454563/original/file-20220328-17-1uef4qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454563/original/file-20220328-17-1uef4qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454563/original/file-20220328-17-1uef4qk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454563/original/file-20220328-17-1uef4qk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454563/original/file-20220328-17-1uef4qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454563/original/file-20220328-17-1uef4qk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454563/original/file-20220328-17-1uef4qk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If all of your social activities revolve around alcohol, this could be a sign of dependence.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The more of these signs you have and the more severe they are, the more dependent you’re likely to be. You can check your risk of dependence <a href="https://auditscreen.org/check-your-drinking">here</a>.</p>
<p>If you have a mild dependence on alcohol, you may be able to cut back on your own. But if you are moderately dependent, you may need to get some kind of support.</p>
<p>If you are severely dependent, you should seek medical advice before you make any change to your drinking because stopping suddenly can cause severe health problems, including seizures and even death in some people.</p>
<p>For people who are severely dependent, the usual recommendation is to take a <a href="https://www.health.gov.au/sites/default/files/quick-reference-guide-to-the-treatment-of-alcohol-problems.pdf">permanent or temporary break</a> from alcohol. It may take six months to a year or more before you are able to start drinking again. Some people find it’s better for them not to drink again at all. With severe dependence, there’s a high risk of quickly going back to heavy drinking if you just try to cut back.</p>
<p>If you experience any symptoms of dependence, once you stop or cut back your drinking, you might need <a href="https://adf.org.au/path2help/">specialist treatment</a> or <a href="https://www.health.gov.au/contacts/national-alcohol-and-other-drug-hotline-contact">ongoing support</a> to prevent going back to heavy drinking.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heavy-drinkers-increased-their-alcohol-consumption-the-most-during-lockdown-new-research-175174">Heavy drinkers increased their alcohol consumption the most during lockdown – new research</a>
</strong>
</em>
</p>
<hr>
<h2>‘Cold turkey’ or reduction?</h2>
<p>If you’re not dependent, you should be able to either reduce the quantity or frequency of drinking or quit altogether. You may do this on your own or choose to get some support. If one method doesn’t work, try a different way.</p>
<p>If you experience mild to moderate dependence, every time you have a drink it can become a trigger to drink more. So it’s sometimes easier to increase drink-free days, rather than reducing the quantity on drinking days, or to quit altogether for a period of time.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/454564/original/file-20220328-21-j95dc1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/454564/original/file-20220328-21-j95dc1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454564/original/file-20220328-21-j95dc1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454564/original/file-20220328-21-j95dc1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454564/original/file-20220328-21-j95dc1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454564/original/file-20220328-21-j95dc1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454564/original/file-20220328-21-j95dc1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454564/original/file-20220328-21-j95dc1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you think you have an alcohol dependence, speak to your GP.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>People who are severely dependent usually require some kind of withdrawal support to stop drinking. It is usually better to stop altogether (“cold turkey”) as long as you have medical support. You can undertake <a href="https://adf.org.au/reducing-risk/withdrawal/">withdrawal treatment</a> in a hospital, at home with the help of a <a href="https://adf.org.au/reducing-risk/withdrawal/home-based/">GP or nurse</a>, or via <a href="https://www.cleanslateclinic.com">telehealth</a>. <a href="https://www.healthdirect.gov.au/addiction-withdrawal-symptoms">Alcohol withdrawal</a> typically lasts about five to seven days.</p>
<h2>Zero-alcohol drinks</h2>
<p>Zero-alcohol drinks are alcoholic drinks with the alcohol removed but which retain a taste similar to the alcoholic version. There is now a huge variety of options for spirits, beer and wine.</p>
<p>If you are not dependent but are trying to reduce your alcohol intake for health or other reasons, these can be a good option. By replacing some or all of your usual alcoholic drinks with zero-alcohol drinks, you can still enjoy the social aspects of drinking without the health risks of alcohol.</p>
<p>If you are dependent on alcohol, the smell and taste of zero-alcohol drinks can act as a trigger for drinking alcohol. They might make it more difficult to make permanent changes to your drinking.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-young-people-drinking-less-than-their-parents-generation-did-172225">Why are young people drinking less than their parents’ generation did?</a>
</strong>
</em>
</p>
<hr>
<h2>Treatment apps and online support</h2>
<p>A range of <a href="https://www.racgp.org.au/download/Documents/Guidelines/e-Mental%20health/e-mentalhealthguide.pdf">computerised, web-based, and mobile apps</a> have been developed to support people cutting back or quitting alcohol. They have shown <a href="https://pubmed.ncbi.nlm.nih.gov/28394729/">promising results</a> in early trials. The benefit of these apps is accessibility, but the outcomes are modest and they seem to work best in conjunction with <a href="https://www.tandfonline.com/doi/full/10.1080/16506073.2019.1663258">professional support</a>.</p>
<p><a href="http://www.hellosundaymorning.org">Hello Sunday Morning</a>’s Daybreak program is a large online alcohol support community, accessed through a mobile and desktop app. It’s designed for moderate drinkers who want to cut back or quit. Early research suggests it’s effective in <a href="https://hellosundaymorning.org/wp-content/uploads/2019/05/Final-report-NDRI-Coaching-April-2019_newcover.pdf">reducing drinking</a>, as well as improving psychological well-being and quality of life.</p>
<p>Some previously face-to-face support groups like SMART Recovery and Alcoholics Anonymous have moved online, which has increased accessibility. These are typically more suited to people who are dependent on alcohol.</p>
<h2>Psychological interventions</h2>
<h3>Brief interventions</h3>
<p>As little as five minutes of <a href="https://pubmed.ncbi.nlm.nih.gov/29476653/">advice from a GP</a> can reduce alcohol consumption by 30%, especially for people who are in the mild to moderate dependence category. So it’s worth chatting to your doctor if you need a little help getting started.</p>
<h3>Counselling and psychological therapy</h3>
<p>The main treatment type to help with alcohol issues is counselling. Sessions are usually once a week with a qualified professional, such as a psychologist. Sometimes they are delivered in group settings. Counselling is suitable for any level of drinker who is trying to make changes.</p>
<p>Some of the main evidence-based counselling treatments in Australia are behavioural and cognitive therapies, such as cognitive behavioural therapy and mindfulness-based relapse prevention. These types of treatments have been shown to be at least <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6760932/">as effective as medication</a> </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/454566/original/file-20220328-27-1k35omx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/454566/original/file-20220328-27-1k35omx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454566/original/file-20220328-27-1k35omx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454566/original/file-20220328-27-1k35omx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454566/original/file-20220328-27-1k35omx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454566/original/file-20220328-27-1k35omx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454566/original/file-20220328-27-1k35omx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454566/original/file-20220328-27-1k35omx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Group programs such as Alcoholics Anonymous don’t have much research supporting their effectiveness.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h3>Intensive group programs</h3>
<p>A number of more intensive group programs are suited to people who are dependent on alcohol or who are having significant problems, including:</p>
<ul>
<li><p>residential rehabilitation, which is usually for people who have tried other treatments unsuccessfully or who may be unsuitable for non-residential treatment because their home life is not supportive of making changes. It has been shown to be <a href="https://www.sciencedirect.com/science/article/abs/pii/S0376871619301875">effective in increasing abstinence</a> in dependent drinkers</p></li>
<li><p><a href="https://www.health.vic.gov.au/aod-treatment-services/therapeutic-day-rehabilitation-services">day programs</a>, which are similar to residential rehabilitation programs but participants live at home and go in each day. These are a relatively new treatment type and there is limited good quality research on their outcomes.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/four-reasons-why-your-tolerance-for-alcohol-can-change-159662">Four reasons why your tolerance for alcohol can change</a>
</strong>
</em>
</p>
<hr>
<h2>Medication</h2>
<p>A number of <a href="https://pubmed.ncbi.nlm.nih.gov/31579824/">medications</a> can help people who are moderately to severely dependent on alcohol. They tend to work best in conjunction with counselling.</p>
<ul>
<li><p><a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/25f9d50042a806808829ba80c298878e/Disulfiram+patient+information+sheet+2020+FINAL.pdf">disulfiram</a> is an older medication that works on the alcohol metabolism system and induces nausea and vomiting if alcohol is taken at the same time</p></li>
<li><p><a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/b7823552-b611-44b2-b735-affbf96089c6/Acamprosate+in+alcohol+dependence+-+FINAL+2019.WR_2.pdf">acamprosate</a> can help prevent relapse in people who have already been through withdrawal</p></li>
<li><p><a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/72b3ac8040898bdc85f7bf222b2948cf/Naltrexone+information+sheet+2020+%2800483%29.pdf">naltrexone</a> reduces cravings in heavy drinkers.</p></li>
</ul>
<h2>Self-help groups</h2>
<p>Alcoholics Anonymous’s 12-step movement has a long history dating back to the 1930s, when there was very little available in the way of real alcohol treatment. There is relatively little research on AA and much of that has been conducted from within the organisation. The <a href="https://americanaddictioncenters.org/rehab-guide/12-step/whats-the-success-rate-of-aa">known outcomes are modest</a> – the success rate is estimated to be around 10% and the dropout rate appears high.</p>
<p>AA can be helpful for some people and also provides a very well-established peer support network if you need support. It seems to be more effective in conjunction with professional treatment.</p>
<p>There are many options if you are trying to reduce your drinking and no single strategy works for everyone. The best approach is to start with something that looks appealing and feasible to get the outcomes you are looking for. If that’s not effective, try something else or seek professional help.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/another-round-what-really-happens-when-you-microdose-alcohol-166433">Another Round? What really happens when you microdose alcohol</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/179664/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into alcohol and other drug prevention and treatment. She is a member of the Board of Directors of Hello Sunday Morning. She is a Fellow of the Australian Association for Cognitive and Behaviour Therapy and was previously President.</span></em></p>There are many ways to reduce or quit alcohol. What works best for you will depend on your situation.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.