Bipolar and Alcoholism: Is AA the Only Game in Town?

Patient Expert

The Irrationality of Alcoholics Anonymous, reads the provocative title to an article by author Gabrielle Glasser in the April Atlantic. The piece is attracting quite a bit of attention. Before we get into it, a little background "

One-half of those with bipolar experience alcoholism at some stage in their lives, far more than the general population. Four in ten experience other substance use issues. This extra burden comes at a huge personal and family and social cost. As if bipolar weren't bad enough, already.

Walk into any bipolar support group and you will hear talk of self-medicating. Many of these same people attend AA groups. There, they are more likely to talk about cravings.

The main point to Ms Glasser's article is that, contrary to what people in AA would have you believe, its all-or-nothing approach to recovery may only work for a minority of those with a drinking problem.

Ms Glasser notes that there is no scientific evidence to support AA's claims, and that its meetings are run by amateurs. This is a bit harsh. Bipolar support groups, for instance, are run by patients and are an invaluable resource. Yes, we need medical science, but medical science also needs us.

Having said that, it is ludicrous to think that AA should be the only game in town. Ms Glasser notes that for a good many people, probably the majority, it may be more helpful to set a goal of moderating one's drinking rather than give it up, altogether.

In other words, one size doesn't fit all.

Ms Glasser cites studies done on rats showing that total abstinence can militate against recovery, what one scientist calls the "alcohol-deprivation effect." Essentially, going cold turkey may only build up an insatiable craving, to the point where people seek relief by going on benders.

Kind of a self-fulfilling prophecy.

Ms Glasser makes it clear that we're still in the dark ages. More so, I would contend when this involves "dual diagnosis." The mood clinicians farm out the alcohol-rehab side of treatment to other specialists. And vice-versa, often not communicating, often at odds with each other.

And there's the poor patient, falling through the cracks.

To conclude: I do not take Ms Glasser's condemnatory approach to AA. I've encountered far too many people who swear by it to be persuaded by her lack-of-evidence claims. At the same time, other recovery models need exploring.

Too much is at stake to take any one person's word for it. I do encourage you to check out the Atlantic article and do your own research. As always, we need to be our own experts. Be smart, live well "