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But it has taken on new urgency with the passage of the Affordable Care Act, which requires all insurers and state Medicaid programs to pay for alcohol- and substance-abuse treatment, extending coverage to 32 million Americans who did not previously have it and providing a higher level of coverage for an additional 30 million.Nowhere in the field of medicine is treatment less grounded in modern science.(The Columbia report notes that there may be additional doctors who have a subspecialty in addiction.) Most treatment providers carry the credential of addiction counselor or substance-abuse counselor, for which many states require little more than a high-school diploma or a GED. The report stated: “The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.”Alcoholics Anonymous was established in 1935, when knowledge of the brain was in its infancy.It offers a single path to recovery: lifelong abstinence from alcohol.A 2012 report by the National Center on Addiction and Substance Abuse at Columbia University compared the current state of addiction medicine to general medicine in the early 1900s, when quacks worked alongside graduates of leading medical schools.The American Medical Association estimates that out of nearly 1 million doctors in the United States, only 582 identify themselves as addiction specialists.By necessity, it keeps no records of who attends meetings; members come and go and are, of course, anonymous. In 2006, the Cochrane Collaboration, a health-care research group, reviewed studies going back to the 1960s and found that “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.”The Big Book includes an assertion first made in the second edition, which was published in 1955: that AA has worked for 75 percent of people who have gone to meetings and “really tried.” It says that 50 percent got sober right away, and another 25 percent struggled for a while but eventually recovered.According to AA, these figures are based on members’ experiences.
After four or six weeks dry, he’d be back at the liquor store.
He’s a fast talker and has the lean, sinewy build of a distance runner.
His choice of profession seems preordained, as he speaks in fully formed paragraphs, his thoughts organized by topic sentences. started drinking at 15, when he and a friend experimented in his parents’ liquor cabinet.
During that time, I encountered disbelief from doctors and psychiatrists every time I mentioned that the Alcoholics Anonymous success rate appears to hover in the single digits.
We’ve grown so accustomed to testimonials from those who say AA saved their life that we take the program’s efficacy as an article of faith.