Cold Turkey Not the Only Solution

Cold Turkey Not the Only SolutionGoing cold turkey and giving up drinking alcohol altogether is the long-established route to abstinence in many countries. This is all due to the wide-reaching international success of the Alcoholics Anonymous and their famous version of the 12-step program of recovery.  For some eighty years now, AA has been the go-to therapy of choice for those who are determined to free themselves from drink dependency.  Out and out quitting, and the resolve to never touch a drop again underscore the system, which is supported by group meetings, emotional support and, of course, the reliable anonymity.

The anonymity is the protective screen that allows members to participate on first name terms and without judgement, but it also means that no data is collected and no analysis done on the outcomes, whether short or longer-term.  A review by the Cochrane Library in 2006 evaluated 3,417 AA members.  They concluded it could not be “unequivocally demonstrated” that AA or TSF (Twelve Step Facilitation) could be shown as effective.

The final one of the 12 Steps is the admission of powerlessness in the face of whatever the attendee wishes to call his or her “Higher Power.”  This comes from the assumption that alcohol dependence is in large measure a spiritual sickness as well as a medical condition.  Now some experts are calling into question the dated theories behind AA. They are proposing that the methodology of AA has become so entrenched into popular culture, not to mention the huge industry that has grown up around treatment, that is has become inviolate.

Many will have resolved again this New Year to reduce their drinking. This pertains especially to women, who are now the biggest consumers of wine in the U.S., and who are imbibing at far higher rates than the past twenty years. However, attempting to go cold turkey will put lots of people off. What about that wedding next month? The ski trip with friends? The special birthday? With drinking so socially acceptable and widely available it is often impossible to resist “just the one.”

But not all drinkers need to go cold turkey to control their habit.

“We are wedded to the abstinence model as the goal,” says Bankole Johnson, who is the Chair of the Department of Medicine at the University of Maryland. He says there is evidence there can be “many successful outcomes.”

Going cold turkey is such a huge challenge – one slip and back to square one – that some suggest management techniques to control and to moderate drinking could work better. Rather than insist on absolute abstinence, recognizing the trigger to over-drinking and learning to manage it may prove more effective. This is the antithesis to the “powerlessness” of the AA submission of the ego.

In Finland, the prescription of naltrexone, a drug commonly used to encourage total abstinence, is used differently.  It works by blocking the feel-good receptors released on consumption of alcohol. Rather than use it as a complete deterrent, it comes with the instruction to take it an hour before drinking.  This dramatically reduces the reward of the drink, and cravings are diminished.

John David Sinclair, an U.S. psychologist, has been a pioneer of this approach, citing a 78% success rate.  Writing in the journal Alcohol and Alcoholism, he said that naltrexone, and similar drugs, naloxone and nalmefene, were all effective when paired with drinking, yet ineffective when used to prolong a period of abstinence.  This is because, he opined,”extinction only weakens responses that are made while reinforcement is blocked.”  He goes on to say that clinical trials show naltrexone used in this way is both safe and effective.

Gabrielle Glaser, author of Her Best Kept Secret: Why Women Drink  – and How They Can Regain Control, says while men outnumber women in AA by 2:1, the majority of women are not severely dependent drinkers.  She recommends an app called, which employs moderation management to set limits.  As Glaser notes that cancer or other serious conditions are not treated with the same tools as used in the 1930s, so why continue to do so with alcohol problems?

By Kate Henderson

NY Times


Chicago Tribune

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