vodka nips

Alcohol Use Disorder: Where are we today?


Alcohol misuse is increasing, especially among women, minorities and older adults (Grant et al. 2014).  Given current treatment options, we lack adequate means to address this significant mental and often physical health issue.  I’ve discussed in previous articles how training in graduate programs is extremely limited. Preparing clinicians to treat substance abuse disorders is comprised of recommendations to screen, diagnose and refer to 12-step.  This is not an exaggeration of what is taught in clinical skills courses that cover addiction. If alcohol use is increasing we cannot conclude our existing treatment model is effective? Today, the COVID-19 pandemic has our country on a virtual lock-down.  The local and federal government is watching the numbers and waiting for a decline in cases and deaths before we can relax restrictions.  Substance use disorders are not decreasing and yet there is a sense that what we are doing is working when in fact it is not.

My concern with treatment for substance abuse disorder in our country is because it is not tailored to the individual. We have a one size fits all approach.  The main stream treatment model as offered in America’s leading treatment centers and private clinics is to have short term therapy focused on adherence to 12-step meetings (TSF is what this is known as) and let the free of charge community based 12-step programs take over from there. If this does not work, refer to inpatient (also 12-step focused) and upon discharge enroll in TSF outpatient treatment.

Recently, in March 2020, Harvard Medical School researchers put out a study that a treatment model that has existed for 80 years and has not changed at all in that time has been finally proven to work.  This recent study concludes we are on the right track and boosters of 12-step oriented treatment are once again vindicated.  The study was published in a number of newspapers and online. We are doing great, let’s stay the course is the take away from this study.

The study has several flaws.  The most glaring is the report that 12-step treatment works because it leads to the longest period of abstinence (consecutive). The study does include data that shows people who used other treatment approaches were abstinent just as long but not consecutively (cumulative). This means someone could have been abstinent for the longest consecutive period to affirm 12-step treatment success and someone else who tried another form of treatment may have been abstinent longer (cumulative) but this did not count as successful. Weird, huh?  Here is one other issue not covered. The premise of 12-step treatment is that people cannot control their drinking and must stop.  This leads people who engage in this type of treatment that drills people with the idea they have a disease and will die if they drink again to have relapses that are far worse than people who engage in more humane approaches (Miller et al).

Today, as I write this, with the COVID-19 stay-at-home orders in full effect, alcohol sales have increased tremendously (over 240% by some measures).  The photo posted above was taken from a bike ride I went on 4/12/20.  At the height of the COVID-19 people are turning to alcohol to soothe their nerves, manage their emotions and dull their boredom. The problem of alcohol misuse is not going away and it is not improving. Something needs to change in our treatment model.

One staggering statistic is that 75% of people who qualify for a diagnosis of alcohol use disorder never seek treatment (Dawson, 2005). 3 out of 4 people who have problems with alcohol never make it into the faulty treatment model I describe above.  How are we addressing the needs of those people? These are the people that either get better entirely on their own or with support of family and friends or in psychotherapy (or both). Additionally, I would guess many of the people who do make it into treatment and get better, in spite of the treatment model, do so using psychotherapy that is focused on themselves as an individual.

Given the magnitude of this problem, it is important that someone continue with any approach that is effective in reducing their alcohol consumption. However, since what we offer now works poorly for so many people the effort should be focused less on building and supporting the existing options and more on funding and bolstering other potentially more effective options.




Dawson, D.A., Grant, B.F., Stinson, F.S., Chou, P.S., Huang, B., and Ruan, W. J. 2005.
Recovery from DSM-IV alcohol dependence, United States, 2001–2002. Addiction 100:281–92.

Grant, B. F., Chou, S. P., Saha, T. D., Pickering, R. P., Kerridge, B. T., Ruan, W. J., Huang, B., Jung, J., Zhang, H., Fan, A., & Hasin, D. S. (2017). Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA psychiatry, 74(9), 911–923.