Alcoholics Anonymous

Alcoholics Anonymous Meeting               Alcoholics Anonymous is many things, and its role changes over time for those who remain involved in it long term.

Most importantly, AA can be a life line for those who are suffering from the potentially fatal illness of substance abuse. It is a way of achieving freedom from alcohol and drug addiction with the help of supportive peers who have “been there.” At these times AA is about dealing with urgent and basic struggles.

For most people going to an AA meeting evokes both a wish to achieve sobriety and a sense of distrust of any “authority”. This distrust can be enhanced by early experiences because some people deal with the stress of new sobriety by throwing themselves into AA as if it is a missionary religion. Those who are wary about this enthusiasm may feel as if they are the only ones with those doubts, but they aren’t. We have been surprised to find out how often long time AA members will talk about profound misgivings they had when they went to their first meeting.

In the long run, personal success in AA comes with some level of acceptance of the structure itself, which supports people in dealing with the impulse to do self-destructive things in response to psychic anxiety and pain. The supportive structure can be sustaining on a long term basis.

Sometimes AA is falsely felt to be at odds with therapy.

The truth is that AA can supplement therapy, as therapy can supplement AA.

The goal of AA is to achieve a genuine stability and relatedness to others that is essential for those with substance abuse issues and also to deal with overwhelming shame that can make it hard to take care of these problems.

The goal of therapy is to move beyond the negative and to find ways of recapturing the positive qualities that have been twisted or deformed through life experiences.

Both AA and therapy need very powerful grounding in a sense of hope and optimism, and a clear vision of possibilities that are “tailored” to individual needs, and to changes in those needs.

For more information we recommend these sites:

AASF – The AA website with the comprehensive meeting schedule for San Francisco and links to other Bay Area counties meetings. Very complete.

SFNA – The Narcotics Anonymous website for SF. Also a very complete meeting schedule. – We think this is really worth reading. Women for Sobriety is a peer support groups for women in substance abuse recovery. It is non-12-step oriented, but has a very empowering message.

Mindfulness Based Substance Abuse Treatment Works

substance abuseRelapse is common after substance abuse treatment, indicating that there is a clear need for effective followup options. A new study has found that cognitive-behavioral relapse prevention (RP) and mindfulness-based relapse prevention (MBRP) are both effective aftercare interventions for substance abuse treatment, but that the latter may have an especially enduring effect as far as reducing drug-use days and heavy drinking are concerned. The study was headed by Sarah Bowen, Ph.D., an assistant professor of psychiatry and behavioral sciences at the University of Washington. The results appear in JAMA Psychiatry.

RP helps patients identify situations that precipitate relapse and teaches them how to avoid such situations or cope with them. MBRP is based on some of the components of RP, such as identifying situations that precipitate relapse. However, it also includes mindfulness training—that is, it teaches patients how to become aware of emotional or physical states that might provoke a relapse, to learn to relate to the discomfort of such states more skillfully, and to identify underlying needs that might be driving a craving, such as a need for relief or comfort.

They study included 286 individuals who had completed treatment for substance use disorders. They were randomized to treatment as usual—that is, 12-step programming and psycho-education—RP, or MBRP. Between-group differences were not found at the three-month follow-up. However, at the six-month follow-up, both RP and MBRP subjects had a significantly reduced risk of relapse to drug use and/or heavy drinking compared with treatment-as-usual subjects. And at the 12-month follow-up, MBRP was found to be even more effective than RP in reducing drug use and heavy drinking.

“This is a very interesting study,” John Renner, M.D., associate chief of psychiatry at the VA Boston Healthcare System and an addiction psychiatrist, told Psychiatric News. “It provides a useful comparison of the efficacy of CBT-based RP treatment and MBRP. Previous studies of MB treatments for substance use disorders have been promising, but have provided only two- or four-month follow-up data. The 12-month follow-up data from this study are of particular importance, since longer-term efficacy is a critical issue for any intervention of substance use disorders.

Anxiety and Substance Abuse

substance abuseMatt Kushner, PhD discusses the issue of substance abuse in individuals with anxiety disorders. Because substance abuse is more common in those with anxiety in comparison to the rest of the population, Kushner has created a list of risk factors and screening tools to help doctors identify individuals experiencing both disorders.

Some risk factors for substance abuse in people who have already been diagnosed with anxiety disorders include using drugs and alcohol to deal with anxiety, a family history of anxiety and depressive disorders, binge drinking habits, being a male, or being younger.

Ways to screen for a substance abuse disorder is to look at a patient’s history of drug and alcohol abuse problems, the 4-item CAGE questionnaire, 10-item AUDIT, and a truncated 3-item version of the AUDIT. CAGE stands for cut down, annoyed, guilty, eye opener. AUDIT stands for Alcohol Use Disorders Identification Test.

An example of some questions included in CAGE are:

  1. Have you felt you should cut down on your drinking?
  2. Have people annoyed you by criticizing your drinking?
  3. Have you felt bad or guilty bout your drinking?
  4. Have you ever had a drink first thing in the morning?


For more information about screening questions and the association between anxiety disorders and substance abuse, check out the rest of Kushner’s article at this link: