Daniel Carlat, MDDr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
By now, it is clear that the most effective treatment for alcoholism is consistent attendance at AA (Alcoholics Anonymous) meetings. Not only have outcome studies shown that AA attendance promotes abstinence, but in addition, therapy aimed specifically at encouraging AA attendance has been shown to robustly increase the chances that patients will actually go to meetings and get sponsors (Alcohol Research and Health, 1999;23:93-98).
OK, fine. You know this, but if you are like many psychiatrists, you have only the barest sense of what happens at AA meetings and how to knowledgeably discuss them with your alcoholic patients.
The colorful history of AA begins in 1935, in Akron, Ohio, when a stockbrocker (named “Bill” in AA literature) met “Bob”, a local surgeon. Both had been alcoholics, though Bill was sober when they met. Bill discussed the (at that time) new idea that alcoholism was a disease, and this struck a chord with the surgeon, who became sober, and the two formed a group that eventually became AA.
An AA meeting generally begins with the leader giving a short presentation, and then asking if anybody at the meeting has achieved an anniversary of sobriety. Attendees can receive 90 day "chips", 6 month chips, and one year chips. (Your patients may mention these, and you will come across as remarkably savvy if you ask, "Hey, have you gotten your 90 day chip yet?") After this, the floor is open to others, and attendees will stand up, identify themselves as alcoholics, and share something.
Encourage your patients to be active participants in their meetings. Optimally, they should arrive early, make the coffee, meet at least three people, sit in the front row, speak at least once during the meeting, and be the last one to leave. The other extreme is the patient who arrives late and sits in the back without saying anything. This hardly qualifies as “going to a meeting.”
Encourage your patients to get a sponsor who can be supportive during tough times. Of course, it is up to the "sponsee" to be proactive and to call their sponsor when the urge to drink strikes.
In any urban or suburban area, there are bound to be plenty of AA meetings available, and your patients should try out several until they find one or two where they feel most comfortable. If your patient resists attendance because the other people aren't "like" her (too blue or white collar, too ethnic, too severely alcoholic, etc...), remind her that there are likely dozens of alternative groups within driving distance.
Some patients will balk at the apparent religiosity of the 12 Steps (eg., Step 3 says, "We made a decision to turn our will and our lives over to the care of God as we understood Him.") Indeed, in some meetings, the "Higher Power" is portrayed as "God", but in other more secular groups, it is viewed more as a recognition that we are not the be-all and end-all, and that we often cannot control ourselves without “higher” help.
A wonderful way to help a freshly sober patient get over his AA jitters is to offer to introduce him to one of your patients who has been sober for a year or more and has served as a sponsor. Collect names and numbers of such patients (with their permission) and facilitate a meeting.
Doctors are welcome at meetings, except at those identified specifically as "closed meetings." Simply show up, identify yourself at the meeting by standing up and saying something like, "I'm Danny (use your first name), I'm a physician and I treat patients with alcohol issues, and I've come to learn." And learn you will.
TCR VERDICT: Become AA-Savvy:Your Patients Will Gain