Therapy for alcoholics

June 10, 2005 9:21 AM

I need information about therapy for alcohol abuse/dependency.

I'm an alcoholic with a history of drug abuse, and it's at the point where I can't just laugh about it; it's interfering with my life. I have no interest in appealing to a higher power, and there aren't any Rational Recovery groups in my area, so I'd like to take advantage of the kinds of therapy services offered through Cigna Behavioral Health.

I understand how groups like AA & NA work, but I have no familiarity with one on one counselling. What should I expect with this type of therapy? Does it actually work? How do I find a trustworthy counselor?

posted by cmonkey to health & fitness (13 comments total)

I'm not an addict, but I've recently come across some things you might find helpful:

A Skeptic's Guide to the 12 Steps

Exdrunkalog, a podcast by an atheist man in AA. He seems smart and he's definitely not brainwashed. The few I've heard had really interesting interviews.

SMART Recovery. I don't really know anything about this one, but it's another secular alternative to AA.

This is one of many threads about AA on IIDB, a huge atheist web forum.

As far as Cognitive-Behavioral Therapy goes, I read an excellent book which uses it to treat depression: Feeling Good. Maybe you can get an idea of what CBT is like from looking at it. I know they have CBT-type books (and of course therapists) for addiciton, but I haven't read up on it.
posted by callmejay at 10:05 AM on June 10, 2005

My guess (and on preview, callmejay's guess) is that you could expect some kind of Cognitive Behavior Therapy (Google will show you much info about this type of therapy), which is pretty effective for treating alcoholism if you really want the treatment (as opposed to being sent to therapy against your will). I don't have personal experience with CBT, but it sounds fairly straight-forward and not touchy-feely.

Not sure about how to find a good counselor, but I think the personality of the counselor will matter less with CBT than with some other types of therapy. You won't be delving into conversations with your inner child, but you'll be learning tricks to change the patterns in your thinking that lead you to grab a drink. I guess I'd look for someone who has been doing CBT for a long-ish time.

Good luck, and congratulations on deciding to make a change. I think that's more than half the battle right there.
posted by nixxon at 10:18 AM on June 10, 2005

This is a conundrum. In my first hand experience, a therapist, even a good therapist who is not an addict will be able to give you behavioral modification tips but will also encourage or even mandate that you to go to AA - give it a try, because their statistics show that it works better than anything else, and if you won't go, then you are a difficult patient. They'll probably explore your atheism. Ask, "are you familiar with Buddhism. . .etc." If the therapist is a recovered addict, they are probably a member in good standing in AA or NA. These programs do not work for everyone (like an introverted atheist like me). I hated hated hated most every second of it all - the numerous therapists (even the good one), the AA. But. When I decided to walk away from it all, I found, upon reflection, that some things made sense and I do have a deeper understanding of my problems. My statistical physical health is recovered (blood pressure, liver function, weight). I'm a binge drinker now, which is, well, better than an everyday disgusting lush. And I take pills sometimes. So what - they keep me from drinking. The point is, I'm better. Not cured, but not in a cult, either. And I had to go through six months of hell to get there. (This was a few years ago)

It's like the debate of taking "one nation under God" out of the pledge. The language is still in there still because they say it's God as you understand God. There is no wiggle room for people who do not have a version of God, and because most people can't understand that world view, you'll be made to feel wrong about it, and try to be cured of it. They do mean well, they just don't understand.

It will suck, but it sounds like you have to try something. You never know what your experience will be, you'll just have to jump in and see what happens.
posted by rainbaby at 10:44 AM on June 10, 2005

If you can winnow down the Cigna list by using recommendations from friends, colleagues, etc., that might be helpful.

You need to interview the therapists (either in person or over the phone) about their experience working with addictions. In my experience, most therapists think they understand how to work with addictions, but very few actually do know how to do it well. So you want to find out from the therapists what special training they've had in dealing with addictions. If they say something like it's just a part of their general practice, it would raise red flags with me. Not to say they wouldn't be able to help you, but I'd have some caution about it.

Many therapists who do work with addictions will have positive thoughts about AA. It doesn't mean that you *have* to go to a 12 step meeting if you don't want to, but just know that at least some of us who work in this area have seen 12 step programs be effective. I probably would have some caution about a therapist who said you have to go if they're going to work with you, but do expect a therapist to be interested in your reservations about AA.

One final idea - if you're trying to find a good therapist, try going to an AA meeting - you don't have to talk during the meeting if you don't want. But just watch the people there, and if there's anyone who you feel you can identify with, approach them *after* the meeting. Let them know that you're not interested in 12 step programs at this time, but you are interested in a therapist, and might they have someone they can recommend. Be prepared - they might try to evangelize you about AA - if they do, just gracefully excuse yourself, maybe try someone else.

You don't say your gender in your profile, but a terrific addictions specialist I consult with down here in the Bay Area has just written a terrific self-help book for women in recovery.

Good luck!
posted by jasper411 at 10:45 AM on June 10, 2005

If you are considering pharmacological treatments:

There are currently three medications approved by the FDA for alcoholism:

1. Antabuse - makes you puke when you drink it, but you can just stop taking it. The oldest and least effective med.

2. Naltrexone - Originally developed for heroin/opiate addicts...eliminates the buzz from alcohol. VERY EFFECTIVE. Some side effects, such as (ironically) liver damage, but very rarely.

3. Acamprosate - Available in europe for a LONG time, but just recently (jan 2005) approved for use in the US. Reduces cravings for alcohol by rebalancing neurotransmitters* that you (probably) f'ed up by drinking to excess.

A combination of the latter two is purported to be EXTREMELY effective at promoting abstinence. And in the cases of relapse, patients on these meds generally get back on the wagon very quickly and without much difficulty.

*GABA and Glutamate if you're curious
posted by celibate_life at 10:54 AM on June 10, 2005

oops...Antabuse :"makes you puke if you drink while taking it"
posted by celibate_life at 10:56 AM on June 10, 2005

I am not an alcoholic or an addict, nor do I know anyone that is severely either. But after reading James Frey's A Million Little Pieces, I think it may be worth something to you. It reads quick, and he deals with some of the same problems that you seem to be dealing with, such as a distaste for a "higher power". A Million Little Pieces. Whatever road you end up taking, good luck.
posted by gastevens at 2:24 PM on June 10, 2005

I'd second jasper411's suggestion to ask people at AA meetings for recommendations. It's the only place I can think of where you will find a lot of people with direct experience for you to tap.
Just look for people who seem reasonably well balanced and explain your situation to them.
If they have no recommendations, they will likely know someone who does.
If you get too much evangelism, you can always remind them that its supposed to be 'a program of attraction rather than promotion'.
posted by yetanother at 4:52 PM on June 10, 2005

I'll second the SMART Recovery recommendation. It's a very good program, it is based on cognitive-behavioral principles, and from what I understand there is a pretty active and intelligent online community.

Moderation Management also fully supports abstinence as a choice for dealing with an alcohol problem. They maintain a list of "moderation friendly" therapists, any of whom would by definition not be 12-step "fundamentalists."
posted by Tholian at 5:09 PM on June 10, 2005

Another piece of advice if you decide to explore the group option (my father and brother both recovered in AA so I'm partisan I guess) - in a big city you can find groups which do not stress a religious or mystical angle, although the concept of a "higher power" is integral to the program. An Intergroup (coordinating group for AA groups) might be able to help you find a group with an Agnostic/Atheist/Skeptic-friendly approach. Here is an address for OR Intergroup contacts:

http://www.alcoholics-anonymous.org/default/US_CtrOffice/or.html

One thing about AA is that it is free, voluntary, and it is a community of people who know about quitting firsthand. I don't think there is one solution for anyone, however. I think the most important thing is to be committed to taking your life back and getting consistent support. Cliche as it is by admitting you have a problem you have made a huge and important step. Good luck.
posted by nanojath at 5:56 PM on June 10, 2005

nanojath gives sage advice.
I would only add this: please don't just write off AA because you hear that acquiring a 'higher power' is de rigeur. The 'therapy' offered is different for each individual. By fronting up regularly you are making a committment to yourself that you have a problem and that you are taking a consistent step towards rectifying it. At the meeting you should be listening to the stories and looking for factors with which you can identify -- and not things that stand out as different. In this way, you will learn that a great many other people go through similar thought patterns and stages and desires and it is by identifying with these similarities that you begin to hear how others have moved on to substance free happy lives. The god thing is there, but the people thing is the much more important element.
But by all means seek out a counsellor as that's the road you want to walk down. It's just that, if they suggest going to some AA meetings, as has been said above, it's because, anathema as it may be to the anti-god movements, the thing actually fucking works consistently, moreso than any other form of therapy and has done for about 80 years. Go with an open mind and an open heart and just listen. Let it wash over you. You'll be fine.
posted by peacay at 11:27 PM on June 10, 2005

Try everything, do what works for you.

I didn't have luck with many counsellors. The few I worked well with were not in my health plan (of course). Be prepared to walk away from incompetants, those obsessed with trivial issues, those with pet whacko theories and those you just don't seem to be able to communicate with. You may have to fight with Cigna about that (I used to work in the managed care behavioural field - don't take no for an answer).

Having said that, I've been clean and sober for over 17 years now. Spent the first 6 years or so in AA, in an area where people were very careful to not favour one religion (or even any religion) over another. Since then, I haven't gone to meetings (I moved, and AA is very Christian here). Still use a lot of what I learned in AA.

People get sober without AA, and are happy. Some people in AA never get sober, or are sober and miserable. I don't think there is a One True Way that works for everyone.
posted by QIbHom at 1:46 PM on June 11, 2005

I highly recommend the CBT approach, if you end up just doing therapy - and I also recommend the double-whammy medication approach suggested by rckites above. Whatever works for you. If you can find a therapist who does CBT, motivational interviewing, or solution-focused therapy, you might be less likely to get AA shoved down your throat.

Regarding SMART Recovery: if there aren't any face-to-face meetings near you, you can also try one of the online meetings (there are 17 a week) or the forums on the website. Please feel free to email me directly if you have any specific questions regarding SMART - I'm a facilitator and feel very strongly that it's a valid 12-step alternative for a lot of people. It's a science-based approach that is very similar to CBT.

By the way, Rational Recovery is at this website and is not a group program now. It has evolved into a totally different (for-profit) program. SMART broke off from Rational about 13 years ago. There's still some free material at the Rational website, and some of it may be helpful.
posted by acridrabbit at 8:57 PM on June 12, 2005