The Road to Recovery from Alcohol Abuse and Alcoholism
The Road to Recovery is "a landmark national study on public perceptions of alcoholism and barriers to treatment" that was conducted by Peter D. Hart Research Associates for the Rush Recovery Institute. The multi-phase nationwide study surveyed doctors, employers, clergy, counselors and therapists, and adults with a current or recovering alcoholic in their immediate family. The beliefs of over 2,000 people are represented in the report.
The Road to Recovery documents the highly stigmatized nature of alcoholism, a fact recognized among the various groups interviewed. This stigmatization leads to avoidance and denial on the part of all concerned, including alcoholics themselves. It's not surprising that well into the twenty-first century Alcoholics Anonymous still emphasizes anonymity.
Although all the groups except clergy said that they view alcoholism as a disease, their beliefs are actually inconsistent. In reality, most respondents view alcoholism as having components of both both disease and personal weakness.
The views of physicians regarding whether or not alcoholism is a disease are especially significant. When they were asked if they personally believe that alcoholism is mainly a disease or mainly a personal or moral weakness, 15% said that it was the latter. When the sample was asked what proportion of alcoholism itself is a disease and what proportion is a personal weakness, the average proportion that was believed to be personal weakness was 31%. Only 12% of physicians believed that alcoholism is 100% a disease. In addition, only 32% believe that alcoholics who receive treatment are successful in achieving lifelong recovery, a proportion lower than that found among counselors, clergy, employers or family members.
The implications of these and many other findings are discussed.
The document is reproduced here.
The Recovery Institute Survey Highlights at a Glance
Doctors, Employers, and Clergy Avoid Tackling Alcoholism
Millions of Americans have successfully recovered from the disease of alcoholism and are now leading healthy, productive, and sober lives. At the same time, millions of current alcoholics continue on the path to self destruction, while the people around them -- including those who are in a professional position to help -- continue to look the other way. This study reveals that:
- 82% of doctors admit that MDs avoid addressing alcoholism in their patients, and only 39% of family members of alcoholics say the alcoholic's doctor has raised the issue, but 72% of the rnaiority whose doctor has not intervened say they would want the doctor to do so;
- a 58% majority of employers acknowledge that managers avoid addressing alcoholism in their employees;
- 58% of clergy who counsel individuals and families make the same admission about their brethren; and
- even an alcoholic's immediate family members are likely to avoid the issue, with half revealing that they denied the problem to themselves for at least a few years.
These are among the findings from a first of its kind nationwide study conducted for The Recovery Institute by Peter D. Hart Research Associates. The surveys of medical doctors, employers, clergy, family counselors and individual therapists, and people who have a current or recovering alcoholic in their immediate family, go beyond documenting the avoidance of the issue to explore the reasons behind the avoidance and strategies to help people deal directly with the disease. The study quantifies the roles of denial, stigma and shame. and lack of knowledge as barriers that make people hesitate to reach out to help alcoholics find their way to treatment. Other key findings include:
- Only 3% of doctors see alcoholism as one of the health issues on which the nation has made progress.
- Nine in 10 members of all groups agree that there is a social stigma associated with alcoholism.
- Underlying this stigma is the perception of alcoholism as a mixture of both disease and personal or moral weakness. On average, MDs see alcoholism as 64% disease and of 1% weakness.
- Six in 10 family members say that efforts to reduce shame, embarrassment, and social disapproval would help remove key barriers to treatment.
- For all groups, lack of information hinders intervention. Indeed, 61% of doctors say their training in recognizing and responding to alcoholism is inadequate, and 57% say they would welcome continuing medieval education seminars on the subject.
Challenges and Hope
Overall, the results reveal both significant challenges for the alcoholism recovery community and real reasons for hope. The groups that could take a greater role in responding to alcoholism have many misgivings that must be addressed, but they also reveal an understanding that they are not now well trained to deal with alcoholism, an interest in learning more, and a willingness to take greater responsibility to help alcoholics find their way to recovery.
This report summarizes the findings from a multi-phase nationwide study conducted for The Recovery Institute by Peter D. Hart Research Associates. Five groups of Americans who are in a potential position to intervene with alcoholics were the subjects of this study, which includes surveys among:
- 711 adults who have a current or recovering alcoholic in their immediate family (randomly selected to match the national population):
- 400 medical doctors (in general practice. internal medicine, psychiatry, and OB/CYN);
- 400 employers in small, medium and large sized business enterprises (based on the number of employees);
- 201 clergy of various religious denominations (who provide individual and family counseling); and
- 200 family and individual counselors and therapists (including clinical psychologists,
psychotherapists, social workers, a.nd other counselors).
These telephone surveys were conducted in January 1998. They were preceded by extensive qualitative research, including 25 in-depth interviews with doctors and eight focus group discussions with members of the other surveyed groups. Finally, 20 one-on-one interviews were conducted to document the personal stories of individuals who have successfully recovered from alcoholism" In all, the views of more than 2,000 people are represented in this report.
Roadblocks to Recovery
One of the common themes that emerges from the stories of people who are in recovery from alcoholism is the significance of the role that others in their lives played, whether in helping them to realize how much harm their drinking was causing, persuading them to get into treatment programs, or steering them toward support groups to help them get and stay sober. In some cases. these may be family members, friends, coworkers, or employers. In other cases, the person who got involved may be a doctor, therapist, or counselor.
As important as these interventions may be for the alcoholic, however, this study documents the tendency of many people - including those who are in a professional position to help - to avoid addressing alcoholism. Although the various populations included in the study approach alcoholism from diverse perspectives.
their reasons for evading a confrontation or intervention are remarkably similar:
- avoidance and denial. both on the part of the alcoholic and on the part of others who could help but choose not to;
- stigma, shame, and embarrassment;
- lack of information and training to know what to look for, what to do, and where to go for help; and
- lack of confidence that treatment is likely to lead to long-term success.
Denial: A Two-Way Street
While it may not be surprising that denial emerges as a major reason why people tend to look the other way and avoid addressing alcoholism, the result of this study reveal just how dominant a role the alcoholic's denial plays in causing people to hesitate to help. For each of the surveyed groups, in fact, the most common reported reaction when someone raises concerns about alcoholism is denial (chosen from a list of seven possible responses - gratitude, denial, shame, bargaining, anger, avoidance, and relief).
The alcoholic's denial may be overt or tacit, and the silent phase of denial typically is of long duration. When asked to estimate the length of time from when they first recognized that their family member was an alcoholic to the time the alcoholic admitted it, 55% of family members assert that the alcoholic's denial went on for at least a few years (including 35% who say it lasted many years). According to one in four family members, the alcoholic still has not admitted the problem. Just 16% estimate chat the denial persisted only about a year or less.
While the alcoholic's denial plays a role in many people's hesitance to get involved, even those individuals who are closest to the problem - the family members - admit that they too tend to avoid acknowledging "the elephant in the living room," with half saying that their own denial lasted a few years or more.
"You see denial in the family... They keep it light at dinner, everybody jokes, they pretend there is no problem - it is an act. There is a secret in the house, and you don't let other people know what is happening."
Indeed, denial clearly is a two-way street. Not only do family members often turn a blind eye, but eight in ten doctors 82%) admit that doctors avoid addressing alcoholism in their patients; a 58% majority of employers acknowledge that managers tend to avoid addressing alcoholism in their employees; and 58% of clergy who counsel individuals and families make the same admission about their brethren.
Stigma, Shame, & Embarrassment
Part of the avoidance and the conspiracy of silence lies in broad societal attitudes toward alcoholism. There is virtually no debate about whether there is a social stigma associated with alcoholism; overwhelming majorities of the professional groups surveyed agree that alcoholism is stigmatized, in the Webster's Dictionary sense of the word as "something that detracts from the character or reputation of a person, a mark of disgrace or reproach." Among psychiatrists, in particular, who can be properly called experts when it comes to the social stigma associated with alcoholism, 96% say there is a stigma and 83% characterize it as a strong stigma.
"People still envision an alcoholic as somebody falling down, somebody alone, somebody with just nothing. And you don't want to be that person."
The study reveals clear evidence that past efforts to reduce the stigma and shame of
alcoholism through information emphasizing that it is a disease with generic causes have been only partially successful. While most people have heard the basic message, they have not internalized it completely.
When asked whether they personally think of alcoholism mainly as a disease, or mainly as a personal or moral weakness, strong majorities of every group (except clergy) say they view alcoholism as a disease. Further, when people call it a disease, they appear actually to understand it as such, and are not merely yielding to the pressure of political correctness, as evidenced in the finding that the leading perceived causes of alcoholism are genetics or inherited traits, followed by stress and anxiety.
While these results are encouraging to the recovery community, they overstate the degree to which the disease model of alcoholism has been adopted. Below the surface, perceptions of alcoholism and alcoholics are complex and often internally conflicted.
In fact, most people see alcoholism as having elements oF both a disease and a moral weakness. Given 100% to allocate in any proportion to the two models, fewer than one
in four say alcoholism is 100% disease, and majorities of nearly every group say it is at least 25% due to the moral or personal weakness of the alcoholic.
"l think that society still tends to see addictions and alcoholism as more of a willful thing, that if somebody were just a strong enough person they would be able to control it... So there is that stigma that you are a weak person, there's something wrong with you, and there's a lot of shame and guilt involved with that."
Moreover, majorities of all groups - including counselors and psychiatrists - share a belief that most alcoholics are capable of taking responsibility for getting help but just choose not to face reality and start dealing with the problem of alcoholism.
Lack of Knowledge & Training
A majority of family members (54%) note that one of the reasons they have hesitated to try to help their family member into recovery was simply the feeling of not knowing what to do or how to help. Family members themselves need support if they are to help the alcoholic, and many say that one potential ally may be their family doctor.
Though just 39% believe their alcoholic family member's doctor has raised concerns about drinking with the alcoholic, the vast majority of those who think the doctor has not stepped in indicate they would want the MD to do so (72%). Whether they turn to their doctor, minister, priest, or rabbi for help, however, they may findliess expertise than they expect.
In rating their own training, only 7% of doctors say that they have had extensive training in the recognition of and proper response to alcoholism. An additional 32% rate their training as adequate, leaving a 61% majority who view their training as less than adequate.
Nearly a quarter of docrors report that they had no addictions training in medical school
and residency, and half (48%) had eight hours or less.
"l think that doctors, and even psychologists and . . . social workers, are not well-trained in alcoholism, in terms of being able to see the signs of it and then make appropriate assessment and referral for it. I think that's lost in the academic training"
Among clergy, the story is similar, with just 13% having extensive training; while 52% say they have had some training, a full third have had little or none. Similar results apply to employers. These data lend credibility to the finding that majorities of each professienal group (including 67% of doctors, 58% of employers, 76% of clergy, and 81% of counselors and therapists would welcome further training to learn how to respond better to alcoholism.
Lack of Confidence in Treatment
Given the self-reported shortcomings in these professional groups' formal instruction in
dealing with alcoholism, the level of pessimism regarding treatrnent outcomes does not seem unusual. Lack of confidence in treatment, however, becomes an additional barrier to intervention and involvement on the part of individuals who may have an opportunity to
There are many different types of alcoholism treatment programs, ranging from simple
detoxification over a period of hours to comprehensive in-patient prograrns lasting weeks or months and usuaily including ongoing participation in recovery counseling. The success rates for different approaches may vary widely, but this research suggests that when the public and professionals think about alcohol treatment, the successful approaches
are not what comes to mind.
Without defining treatment or recovery, we asked all surveyed groups to estimate what percentage of alcoholics who do recieve treatment are able to achieve a lifelong recovery, and the answers for each group average between 41% for family members and 32% for docrors.
Signs of Hope
While this study details some substantial challenges facing the alcoholism recovery
community, it also identifies many signs of hope. The groups that could take a greater role in responding to alcoholism have serious misgivings or hesitations that must be
addressed, but they also show a willingness to take a greater responsibility to help alcoholics find their way to recovery.
In the workplace, for example, the survey uncovers the potential for greater involvement and intervention on the part of employers. A 70% majority of managers agree that because the employer is in a position to see signs of alcoholism, it is the employer's responsibility to recognize it and do everything possible to help their employee recover. And, though six in 10 (59%) admit they'd feel uncomfortable telling an employee that they believe he or she is an alcoholic, 50% say employers should take a great deal or quite a bit of responsibility to intervene and actively try to get an alcoholic employee into treatment, In terms of what's best for their bottom line, an overwhelming majority of managers (83%) say that it's better for their company to try to help an employee recover than to terminate the employee (9%).
The challenge and the opportunity will lie in providing more, better, and more concrete
information to employers on what to do and what support and programs are available, in
order to take advantage of their latent inclination to help.
Alcoholism is a disease that hits home for 43% of Americans - including alcoholics and their families.
"It's a family disease - everyone's going to be affected by it, whether you're the drinker or the enabler."
Significant numbers of the professional groups included in this study (31% of employers, 28% of clergy, 38% of counselors, and 19% of doctors) were willing to admit that there is an alcoholic in their own immediate family. It is little wonder, then, that large proportions of the groups surveyed suggest that public education messages aimed at de-stigmatizing alcoholism, increasing the public's understanding of it as a disease and not merely a weakness, acknowledging the pervasiveness of the problem, and focusing on treatment and recovery success stories would be helpful steps toward making progress on alcoholism and encouraging more people to intervene.
Recovering alcoholics themselves emphasize the importance of others' involvement.
"My first wife, along with a good friend and supervisor and a couple of other people I worked with, got into a confrontation with me, with counselors there and everything. They said, 'Your bag is packed. You're not going home. Bottom line.' . . . When the facts are laid out in front of you by people you really care for, it's time to really take a look at it."
And for the family members of alcoholics, a message of hope resonates powerfully: "There is hope in the battle with alcoholism. Millions of alcoholics are in treatment programs that really work, and they have their health, their families, and their lives back."
"The most important thing I lost was self respect. I have that today. I've gained inner peace, a love of life. l've gone back to school. Everything in my life has changed. I know it works - trying to get help. l'm an example of that. I celebrate getting sober practically every day"
Special thanks to Drew Brooks for his kind and generous assistance, which is greatly appreciated.
- Peter D. Hart Research Associates, Inc. The Road to Recover: A Landmark Study on Public Perceptions of Alcoholism & Barriers to Treatment. Conducted for the Rush Recovery Institute. Washington, D.C: January, 1998.
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