How does AA stack up in comparison to therapy?

Pretty well, according to this article.

From the Washington Post Wonkblog:

A watershed in scientist’s views of the value of AA occurred in the 1990s with Project MATCH, the largest study of alcohol dependence treatment ever undertaken.   Two well-validated professionally-developed psychotherapies were evaluated head to head against “twelve-step facilitation counselling.”  This counselling approach adapted AA ideas and goals into a 3-month long psychotherapist-delivered outpatient treatment protocol and also strongly encouraged involvement in community-based AA groups.

AA skeptics were confident that by putting AA up against the best professional psychotherapies in a highly rigorous study, Project MATCH would prove beyond doubt that the 12-steps were mumbo jumbo.  The skeptics were humbled: Twelve-step facilitation was as effective as the best psychotherapies professionals had developed.

Here is the best part:  Alcoholics Anonymous is free, and there are meetings near you, at all hours of the day.  Here is a link to find a meeting in the Chicago area.

Trying something new: DUI Treatment Court

The front cover of today’s Chicago Tribune had a story about a DUI treatment court in Peoria.  The program is for people who have been charged with a second or third DUI.  They are required to wear a SCRAM bracelet or go for alcohol testing twice a day.

The SCRAM bracelet, known in the industry as Secure Continuous Remote Alcohol Monitor or in slang as the “Lindsay Lohan bracelet,” is a plastic device about the size of a cigarette pack strapped above the ankle of a repeat drunken driver. Every half-hour, SCRAM screens for alcohol in the wearer’s perspiration.

The bracelet is the central component of a court program that begins when a motorist is arrested for DUI in Peoria County and is screened for alcohol addiction tendencies. If those are evident or if a motorist has been convicted of a second or third DUI, they move to DUI treatment court.

For a year to 18 months, an offender agrees to abstain from alcohol and drugs; wear the SCRAM device and/or undergo rigorous, random alcohol and drug testing; and attend treatment sessions and therapy groups such as Alcoholics Anonymous.

If the participant drinks alcohol, ingests drugs or misses treatment or therapy sessions, he or she often pays with a stint in jail. If participants follow the regimen, they are complimented along the way — much like Kelley’s avuncular exchange with Duncan, who is close to finishing the program successfully.

The most powerful aspect of the DUI treatment court experience was hearing other people’s accounts of beating their alcohol and drug habits, Duncan said.

“To hear other people who opened up, saying that they need help and things like that,” Duncan said, “it made me think if they can be honest with themselves, why can’t I?”

An outgrowth of the drug treatment court model started in the late 1980s in Florida, the first DUI court was created in 1994 near Las Cruces, N.M. Peoria County established its court around 2005, after Kelley’s predecessor, Rebecca Steenrod, attended a conference where experts noted that the drug court protocol worked for DUI cases and obtained a state grant to get the court started.

As of June 2012, there were 208 courts dedicated exclusively to DUI treatment, the National Center for DWI Courts says. Research suggests they work.

An Arizona study from the late 1990s to the early 2000s showed that 3.6 percent of DUI treatment court “graduates” had gotten arrested for DUI two years after completing the program, compared with 5.4 percent of standard probation graduates. A NHTSA multiyear study of DUI treatment courts in Georgia found that “graduates” had a recidivism rate 38 to 65 percent lower than offenders in traditional programs, and a 2007 Michigan study concluded that DUI courts there had a significant effect in reducing recidivism, drug and alcohol use and criminal justice costs.

But apart from the salaries of the judge and a probation officer, funding for Peoria County’s DUI court largely hinges on participants’ ability to pay for services, and that presents problems. Bracelets are available to those who can pay $5 to $22 per day for one, which often leaves indigent hard-core drunken drivers with no choice but jail. Treatment also can be difficult to obtain for those unable to pay.

I have previously endorsed this idea before (click here to read), even though I am sure that many of my clients would vehemently object to being placed in such a court and being required to wear a SCRAM bracelet or have to report to a probation office twice a day to take a breath or urine test.  Certainly, doing so is embarrassing, inconvenient and expensive.  And I am concerned that DUI treatment court might be pushed on people who really don’t need it.

But I think a DUI treatment court is a good idea because a DUI arrest is not so much a crime as much as it is a symptom of a person’s alcohol abuse or dependency.

For example, I have represented people who have gone through a bad period and picked up multiple DUIs in a short period of time.  This can mean that they can end up as a convicted felon and barred from ever getting a license again, even if they can later prove years or decades of sobriety.

So I am all for a different approach, one that treats repeat drunk drivers not as hardened criminals, but as people with an addiction that has impaired their ability to control their actions, but with help, can regain control of their life and become productive citizens. But this can’t happen so long as we permanently mark them with a “scarlet letter” that keeps them from being able to legally drive, work, support their families and develop positive self-esteem.

I think it would be better to pull these people out of the criminal system and instead give them an intensive alcohol and drug use treatment program with the possibility of avoiding a criminal record or permanent license revocation.

What do you think?


A Great Blog Post by Roger Ebert about Alcoholics Anonymous

ebertI have read and watched Roger Ebert for over thirty years, and like so many others, I was shocked and saddened to hear of his passing.

In his memory, I would like to link to a great blog post that he wrote a few years ago, about his alcoholism and his membership in Alcoholics Anonymous.  From time to time, I have quoted this or sent copies of this blog to clients.

Here is part, and you can read the rest it in its entirety here:

In August 1979, I took my last drink. It was about four o’clock on a Saturday afternoon, the hot sun streaming through the windows of my little carriage house on Dickens. I put a glass of scotch and soda down on the living room table, went to bed, and pulled the blankets over my head. I couldn’t take it any more.

On Monday I went to visit wise old Dr. Jakob Schlichter. I had been seeing him for a year, telling him I thought I might be drinking too much. He agreed, and advised me to go to “A.A.A,” which is what he called it. Sounded like a place where they taught you to drink and drive. I said I didn’t need to go to any meetings. I would stop drinking on my own. He told me to go ahead and try, and check back with him every month.

The problem with using will power, for me, was that it lasted only until my will persuaded me I could take another drink. At about this time I was reading The Art of Eating, by M. F. K. Fisher, who wrote: “One martini is just right. Two martinis are too many. Three martinis are never enough.” The problem with making resolutions is that you’re sober when you make the first one, have had a drink when you make the second one, and so on. I’ve also heard, You take the first drink. The second drink takes itself.That was my problem. I found it difficult, once I started, to stop after one or two. If I could, I would continue until I decided I was finished, which was usually some hours later. The next day I paid the price in hangovers…

This woman [an alcohol treatment counselor], I will call her Susan, had an office on Lincoln Avenue in a medical building across the street from Somebody Else’s Troubles, which was well known to me. She said few people stayed sober for long without A.A.. I said the meetings didn’t fit with my schedule and I didn’t know where any were. She looked in a booklet. “Here’s one at 401 N. Wabash,” she said. “Do you know where that is?” I confessed it was the Chicago Sun-Times building. “They have a meeting on the fourth floor auditorium,” she said. It was ten steps from my desk. “There’s one today, starting in an hour. Can you be there?”

She had me. I was very nervous. I stopped in the men’s’ room across the hall to splash water on my face, and walked in. Maybe thirty people were seated around a table. I knew one of them. We used to drink together. I sat and listened. The guy next to me got applause when he said he’d been sober for a month. Another guy said five years. I believed the guy next to me.

They gave me the same booklet of meetings Susan had consulted. Two day later I flew to Toronto for the film festival. At least here no one knew me. I looked up A.A. in the phone book and they told me there was an A.A. meeting in a church hall across Bloor Street from my hotel. I went to so many Toronto meetings in the next week that when I returned to Chicago, I considered myself a member.

That was the beginning of a thirty years’ adventure. I came to love the program and the friends I was making through meetings, some of whom are close friends to this day. It was the best thing that ever happened to me. What I hadn’t expected was that A.A. was virtually theater. As we went around the room with our comments, I was able to see into lives I had never glimpsed before. The Mustard Seed, the lower floor of a two-flat near Rush Street, had meetings from 7 a.m. to 11 p.m., and all-nighters on Christmas and New Years’ eves. There I met people from every walk of life, and we all talked easily with one another because we were all there for the same reason, and that cut through the bullshit….

I’ve been to meetings in Cape Town, Venice, Paris, Cannes, Edinburgh, Honolulu and London, where an Oscar-winning actor told his story…

There are no dues. You throw in a buck or two if you can spare it, to pay for the rent and the coffee…

As to those who criticize A.A., Ebert said:

Sober. A.A. believes there is an enormous difference between bring dry and being sober. It is not enough to simply abstain. You need to heal and repair the damage to yourself and others. We talk about “white-knuckle sobriety,” which might mean, “I’m sober as long as I hold onto the arms of this chair.” People who are dry but not sober are on a “dry drunk.”

A “cult?” How can that be, when it’s free, nobody profits and nobody is in charge? A.A. is an oral tradition reaching back to that first meeting between Bill W. and Doctor Bob in the lobby of an Akron hotel. They’d tried psychiatry, the church, the Cure. Maybe, they thought, drunks can help each other, and pass it along. A.A. has spread to every continent and into countless languages, and remains essentially invisible. I was dumbfounded to discover there was a meeting all along right down the hall from my desk.

It prides itself on anonymity. There are “open meetings” to which you can bring friends or relatives, but most meetings are closed: “Who you see here, what you hear here, let it stay here.” By closed, I mean closed. I told Eppie Lederer, who wrote as Ann Landers, that I was now in the program. She said, “I haven’t been to one of those meetings in a long time. I want you to take me to one.” Her limousine picked me up at home, and we were driven to the Old Town meeting, a closed meeting. I went in first, to ask permission to bring in Ann Landers. I was voted down. I went back to the limo and broke the news to her. “Well I’ve heard everything!” Eppie said. “Ann Landers can’t get into an A.A. meeting!” I knew about an open meeting on LaSalle Street, and I took her there.

Sobriety Courts? An idea that is worth pursuing

Today I saw an interesting article from Denver about their “sobriety court” which is an alternative way to dispose of a DUI case for serious alcoholics.  Here is part of the article:

In Courtroom 3C, Judge Brian Campbell presides over Sobriety Court, modeled after Denver Drug Court. Campbell says this type of program reduces the usual 90 percent relapse rate by 8 to 12 percent.

“The ultimate thing that you’re preventing is loss of life. When you start to sit there and think about the 8 to 12 percent and the people who might have died as a result of that, it’s a sobering experience,” Campbell said.

The program requires offenders to spend hundreds of hours and thousands of dollars.

Bauer estimates the total cost to her and her parents is $15,000, the cost of daily drug and alcohol testing, weekly counseling, bi-monthly trips to the court and probation office.

The judge, prosecutor, public defender, and others hold a meeting before each session. Offenders who meet the strict requirements get praise and prizes.

Those who don’t meet the requirements can end up back in jail, which has critics like Denver DUI attorney Jay Tiftickjian concerned.

“It could lead to a much longer sentence down the road,” Tiftickjian said.

In my experience, most DUI offenders are not alcoholics — they are either social drinkers or, worse, alcohol abusers.  What makes these people different from alcoholics is that they have the ability to control their drinking.  Oftentimes, the combination of a DUI arrest, prosecution and alcohol treatment is enough to wake them up to their reckless behavior.

But there is a small percentage of drunk drivers who are serious alcoholics — these are people who typically need to drink on a daily basis, are unable to cut back or quit drinking, and have allowed alcohol to take over their lives to the point that their lives are unmanageable.  These people need serious intervention — and a stint in jail or prison won’t do it.  All that does is keep them from drinking for a while.

I believe that our justice system should attempt to rehabilitate people instead of warehousing them.  And I believe that a “sobriety court,” if done right and not abusively, as has sometimes occurred with drug courts, can be a way to help people and protect the public.

It is definitely something that Illinois should look into.

Worth hearing: Molly Shannon talking about her alcoholic father

Molly Shannon

If you have ever listened to Marc Maron’s “WTF” podcast, you will know that he has an amazing ability to get his guests to open up about parts of their personal lives that they normally don’t discuss.

That happened again last week when he interviewed Molly Shannon, who is probably best remembered for her years on Saturday Night Live.  It turns out that after her mother passed away when she was four, Molly and her sister were raised by a single father, who had a serious alcohol problem.

Molly clearly has great love and affection for her father, who is now deceased, despite the trauma that he caused, and she had a very difficult time talking about one particular incident that occurred when she was very young.  I don’t want to spoil anything further.  Go here to download or hear the podcast.  Maron usually leaves his new podcasts up for a few months before he takes them down behind a paywall for subscribers.