For more information call: (614) 448-4055 or email

Alcohol & Depressant Drug Specific Concerns

Mark Dombeck, Ph.D.

The descriptions above constitute a good general introduction to what a treatment program for drug or alcohol dependence might look like. The exact nature of treatment will be different for different sorts of substances being abused. In the discussion below, we've outlined some of the substance-specific issues in treatment.

Alcohol and CNS Depressant Drugs

  • Detoxification from alcohol or other depressant drugs should not be done cold turkey - the risk of seizures and even death is too high. Rather, detoxification should take place under the supervision of a physician, who can help the addicted individual to detoxify gradually over a period of days via the administration of increasingly lower doses of benzodaizapine or related medicines.

  • Teaching the disease model of addiction is a good idea: The patient and the family should be educated that addiction is an medical illness - not a moral failing. An alcoholic can never go back to drinking. In general, controlled drinking (e.g., one drink per weekend) carries a high risk of relapse. Any treatment for alcoholism must be based on total abstinence. Likewise, ALL addictive drugs should be avoided (unless they are clearly indicated for acute pain or time-limited acute anxiety).

  • Antabuse or Naltrexone may be helpful medicines to keep the alcoholic from relapsing.

  • Underlying psychiatric/psychological disorders should be treated in their own right. Depression and anxiety are common conditions.

  • If an alcoholic is to remain alcohol-free, follow-up treatment, usually with psychiatric help and resort to community resources, is often vital. The patient must be seen regularly to monitor continued abstinence and adjustment. Research is showing that patient factors such as having a stable family, stable job, less sociopathy, less psychopathology, and a negative family history for alcoholism are more powerful predictors of positive outcome that is the type of treatment (Frances et al. 1984). This research could be interpreted to mean that follow-up treatment is most needed for alcoholic patients with an unstable family, unstable job, more sociopathy, more psychopathology, and a positive family history for alcoholism.

  • The best way to confront the patient's denial of addiction is to challenge him to "prove" that he's not addicted by going on a one month trial period of abstinence. A successful trial period of abstinence may help the patient feel so much better that continued abstinence becomes easier. An unsuccessful trail period of abstinence proves that the alcohol use is out of control, and the therapist must then confront the patient's denial more vigorously.

  • Focus psychotherapy on the patient's addiction: Psychotherapy is most successful when it focuses on the alcoholic's drinking. The drinking itself - past, present, and future consequences - must be given firm emphasis. Patients who insist that they need to solve their emotional problems before they stop using alcohol must be told that the alcohol is the main problem, and that other emotional problems can not be adequately treated until they first stop using alcohol.

  • Involve family and friends: The therapist must involve the patient's family or friends as allies in the patient's treatment. Family and friends are often aware of relapses that are concealed by the patient. Research has shown that patients that are encouraged or even coerced into treatment by family or friends are more likely to remain in treatment and have a better outcome than those who are not so pressured.

  • Therapists should routinely refer alcoholics to A.A. as part of a multiple treatment approach.


Reader Comments

for those who knock aa - Alex - Feb 8th 2011

addiction is cunning baffeling and really really powerful for those who arnt adddicted it is easy to say that someonee should just quit drinking . AA saves lives. people can self destruct without help from other people with the same problem. WHen I say can I mean will when it comes to me! wish me luck im lost and dont work a good program. I know what I need to do . Its a matter of wanting it. Noone has to go through this alone.

AA in the South of Ireland. - JR - Feb 23rd 2009

I endorse Gene's comment on this.  The AA approach enjoys a virtual monopoly on alcohol addiction treatment here.  Apart (possibly) from a very small number of exclusive private treatment centres, formal treatment facilities, both public and private, embody the 12 Step approach in their programs, and routinely pass their patients on the AA, effectively, as part of their aftercare programs.  Having done a 12 Step-based rehab program in a private, religious-run hospital here, I was chanelled into an aftercare environment including both AA attendance and formal group therapy-based aftercare run by the hospital.  I dropped the latter long before I dropped AA, because what it amounted to was a highly "directed" (indeed, intimidating) variant on the AA format - just because we did not say the Lord's Prayer at the end of "therapy" sessions did not make this any less so.

My AA home group was of the "AA Lite" variety and so, I suppose, I saw relatively little of the sort of abusive behaviour towards the non-compliant to which he was subjected in that group.  I have, however, seen this sort of thing in meetings of several other groups which I attended.  AA is clearly not a positive environment for all alcohol addicts - but very, very many are offered no alternative by the treatment industry.

Opponents of AA in the US, in particular, are inclined to believe that the problem of the "AA dominant position" is a uniquely American thing.  Believe me, it is not.  I have experienced it here in Ireland, and the position appears to differ in other European countries only in degree, and not necessarily to a very great extent.

Best regards,


- - Feb 22nd 2009

people can do better than AA.  There are other organizations available.  People should know about those other organizations so they may check them out. And, decide for themselves. 

If they want an organization.  A person can quit on their own.  That is quite 'doable'.  Rational recovery is on your own with a plan. 

a dumping ground - Gene - Feb 16th 2009

In the south of Ireland members bless themselves at the end of meetings. When I went to AA I was put down, treated as stupid, told I was sick & it would take years to get well. All these things were done by long term members. I realised that they were the sick ones. AA is a dumping ground for the mental health services. I will never go back.

they should just stop - Shanequia - Jan 13th 2009
AA doesn't help you at all. they tell you the same things that your parents talll youwhenyou are growing up. its all a bunch of bull. if people wanted to stop drinking so badley they should just stop && quit making other people suffer from what they're doing

Just be careful... - Lee - Aug 19th 2008
... and don't let it become a replacement addiction. I went to a couple of AlAnon meetings and became uncomfortable with the whole thing. I realized that for many in the group it had become an just another version of the dysfunction present in their relationship with someone with an addiction. (What do you mean, get sponsored? Is it another codependant relationship? Thanks, but I can't risk that on with someone I don't know.) I couldn't see the value of trading the relationship with an alcoholic loved one for a roomful of people talking about their dysfunctional relationships. I didn't want to trade for another issue, I wanted to deal with the issue and have it be done. While it was very therapeutic for me to talk about what was happening with people who understood it (what, like I'm going to tell my mom I love an alcoholic?), I came to not be able to bear the sadness of the stories that brought people to the meetings. I already had enough of that in my life.

A.A. as a Religion - Richard G. Burns, J.D. - Mar 27th 2008

As people fire shots at A.A. and talk about cults, Buchmanism, spirituality, and higher powers, it would be well to study it for what it was and what it is.

As you can learn from my title When Early AAs Were Cured and Why, early Akron pioneer A.A. was a Christian fellowship. It had five simple points--abstinence, reliance on the Creator, obedience to His will be eliminating sinful conduct, growing in fellowship with God through Bible study and prayer and quiet time, and helping others get straightened out. Call it what you like. That is what it was. No Steps. No Big Book. No Traditions. Just basic ideas that came from the Bible.

Today just about every court that has been called upon to rule on the question of A.A.'s religiosity has decided that A.A. is a religion. What kind of religion? Christian? No. Oxford Group? No. Roman Catholic? No. Protestant? No. Jewish? No. Today's A.A. has about 16 well-springs, almost all of which had a religious base. Its Big Book mentions God over 400 times. It quotes verses from the Bible. And it invites atheists and agnostics to "come to believe." That's a plan for recovery through moving to a "spiritual awakening"--however you label it.

Note: Richard G. Burns (writing as dickburns) has commented on this issue in our online support community. Click here for a list of dickburns' community posts

AA and dual diagonois - "to be fair ..." - JR - Mar 13th 2008

"... there are dual diagnosis (AA) meetings organised in some cities ..." - key phrase, "in some cities".  In others - at least in the US - the dual diagnosed will be at the mercy of the local AA culture which, in many cases, will at least echo the early AA approach that even the taking of an aspirin (let alone a psychoactive medication) constitutes a sin against Sobriety.  In my part of the globe, this tends to be less of a difficutly, as "AA Lite" (light on Buchmanism, light on antidrug mania etc.) is the norm.  This is another case of where health care professionals should reflect before encouraging/referring people to AA without discrimination, and without any forewarning about what AA might actually require the referee to do (or not do), in terms of their course of treatment prescribed by a doctor.

I do try to be "fair" to AA - but, well, fair is fair ...

Have a good St Patrick's Weekend, all,


AA and Dual Diagnosis - Ron - Mar 13th 2008

I am Dual Diagnosis (alcoholism, and I have been sober 9 years without AA) and Bipolar Disorder. I had to get a new therapist recently and just happened to get one whose specialty is addictions. He was appalled that I had not been to an AA meeting in nine years and told me I was going to relapse and die.

Someone with a mood disorder doesn't stand a chance in AA. In their myopic, "founded in 1939" view, behaviors associated with bipolar disorder (irritability, depression, etc.) are "character defects" which must be confessed away by working the twelve steps. Even the Big Book tells readers to dismiss psychiatric medications ("The Missing Link", page 282, Fourth Edition). In 1992, the AA GSO issued a memo to AA groups asking them not to tell members to stop taking their medications, but some groups continue to anyway.

The freedom of information available on the Internet is finally breaking the stranglehold AA has on the treatment industry.I challenge addiction treatment professionals to look beyond the pro-AA propaganda of ASAM, NCADD, and NAADAC and read some of the excellent AA criticism out there. Just Google "Alcoholics Anonymous".

Editor's Note: To be fair Ron, we should mention that there are dual diagnosis AA meetings organized in some cities where co-existing mental health disorders are recognized. 


AA is just a Cult - - Mar 7th 2008
AA is a reliqious cult.  Pure and simple.  13 stepping, fundamentalist ignorance, con artists, AA has them all.  If a person wants to get sober.  All you have to do is not drink.  That is the definition of sobriety.  If you tell a person with Cancer that they have a disease that only a spiritual experience will conquer, they would probably knock the crap out of you, and rightly so.  AA is just nonsense. 

AA Nonsense - Bill - Aug 13th 2007

AA has a 90%+or - drop out rate. Do all those people go on to die of alcoholism?? That is what AA would have you believe. It's total nonsense.

AA reminds me of the same mindset as the Spanish inquisition or the Salem Witch Trials. If you say you are a heretic you are and if you say you aren't a heretic you are, your're just in denial.

I sat through 6 months of idiotic platitudes and metaphoric gibberish and I must say it was the most humiliating and embarassing experience in my life.

Any Alcohol counselor who recomends AA, should have to do 90 meetings in 90 days so they know what it's like. YOU better get to a meeting.


It's not so bad - Allie - Jul 24th 2007
I am sober 2 years and was very active in AA for a year and a half. In the last 6 months I have dropped my meetings from 5-7 a week to 2-3 because I'm getting back into life, or getting a life more accurately. I always belived in God, so adopting a "religion" was not something I had to deal with when I came into the program. There are many people who do not have a higher power and may never have a higher power and I think it is sad that a great number of people come in the door and leave because of the religious aspect of the program. While I do believe in God and pray and always have...I say to people - I don't think you have to believe to stay sober if thats your view. AA provides a fellowship of people who have experienced all the same horrible times. It's a network of people in which to draw support. It provides a new and different structure especially in the first year and hell, you might even make a friend or two. I can't say for sure what it was for me, why I'm still sober...because I want to, because I made a decision that no matter what happens, can't drink, but it hasn't hurt me. First year, give it a try and then use it as maintenance among other things to keep you on a great new path.

AA as another Religious Institution - - May 19th 2007

I see AA as another Religious Institution not unlike Catholicism...go to confession, confess your sins and you are saved! then go out and sin again and confess again! Don't take responsibility for your life rather continue to harm other people,,, then promptly admit it..then promise to make amends..turn your will over to God...pray for his knowledge of His will,etc...then go out and harm people again...then start at step 1 and go through step 12...around and it!

Editor's Note: This may be how you see AA but it is not how AA is when AA is practiced according to the 12 steps and 12 traditions.  Learning to take responsibility for your actions is a vital part of what AA is about. 

routinely? - Ray Smith - May 17th 2007

"Therapists should routinely refer alcoholics to A.A. as part of a multiple treatment approach"?

Why should a RELIGIOUS program (every higher court that has heard arguments has declared AA at least "religious in nature"), one that is largely anti-medication, anti-therapy be *routinely* suggested for anyone, let alone those who suffer from mental health issues? Statistics show that 12step treatment is ineffective at best and for those with a dual diagnosis, the success rate too small to be accurately measured according to Kathleen Sciacca, a leader in the treatment of co-morbid disorders.

95% of those who join AA are gone within one year, according to AA's internal Triennial Survey. Many of those who leave have serious objections to the program; their objections are often dismissed by those who blindly refer them to AA.

I fail to see how it is therapeutic to send send someone to a program that teaches them that they are diseased, that they will never be cured, and that only God can grant them a daily reprieve. I believe that people respond better to being EMpowered, helped into believing that they DO have some control in their decisions and their lives.