Background of The Road to Recovery
The Road to Recovery is “a landmark national study on public perceptions of alcoholism and barriers to treatment.” Peter D. Hart Research Associates conducted it for the Rush Recovery Institute. The nationwide study surveyed doctors, employers, clergy, counselors and therapists. Also surveyed were adults with a current or recovering alcoholic in their immediate family. The study reports the beliefs of over 2,000 people.
The Road to Recovery documents the highly stigmatized nature of alcoholism, a fact recognized among the groups interviewed. This stigmatization leads to denial and avoidance 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. They were asked if they personally believe that alcoholism is mainly a disease or mainly a personal or moral weakness. In response, 15% said that it was the latter.
The sample was also asked physicians what proportion of alcoholism itself is a disease. And what proportion is a personal weakness. The average proportion who believed it 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. This proportion is lower than that found among counselors, clergy, employers or family members.
The Road to Recovery discusses the implications of these and many other findings.
Below is The Road to Recovery.
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. Yet the people around them continue to look the other way. That includes those who are in a professional position to help. This study reveals that:
- 82% of doctors admit that MDs avoid addressing alcoholism in their patients. Only 39% of family members of alcoholics say the alcoholic’s doctor has raised the issue. Yet 72% of the majority 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.
- Even an alcoholic’s immediate family members are likely to avoid the issue. Half revealed 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. Peter D. Hart Research Associates conducted it for the Recovery Institute. It surveys doctors, employers, clergy, counselors, therapists, and people who have a current or recovering alcoholic in their immediate family.
It goes beyond documenting the avoidance of the issue. The study 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. These are barriers that make people hesitate to reach out to help alcoholics find their way to treatment.
Other Key Findings
Other key findings of The Road to Recovery are these.
- 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 said that alcoholism has a social stigma.
- 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 reducing shame, embarrassment, and social disapproval would help remove 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 in The Road to Recovery reveal both challenges 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 who are in a potential position to intervene with alcoholics were the subjects of this study. It 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/GYN);
- 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, and other counselors).
These telephone surveys were conducted in 1998. They were preceded by extensive qualitative research. That included 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
A theme from the stories of people who are in recovery is the important role that others played. Be it 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. 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.
These interventions may be very important for the alcoholic. However, The Road to Recovery documents the tendency of many people to avoid addressing alcoholism. This includes those who are in a professional position to help. The various populations included in the study approach alcoholism from diverse perspectives. Yet 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.
- Stigma, shame, and embarrassment.
- Lack of information and training to know what to look for, what to do, and where to go for help.
- Lack of confidence that treatment is likely to lead to long-term success.
Denial: A Two-Way Street
Denial is a major reason why people tend to look the other way and avoid addressing alcoholism. Yet this study reveals the dominant a role the alcoholic’s denial plays in causing people to hesitate to help. For each of the surveyed groups the most common reported reaction when someone raises concerns about alcoholism is denial. (When 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. We asked people 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. In response, 55% of family members assert that the alcoholic’s denial went on for at least a few years. That included 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.
The alcoholic’s denial plays a role in many people’s hesitance to get involved. That includes those who are closest to the problem – the family members. They admit that they, too, tend to avoid acknowledging “the elephant in the living room.” Half say that their own denial lasted a few years or more.
Indeed, denial clearly is a two-way street. Family members often turn a blind eye. And 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. And 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.
The Road to Recovery 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.
Disease or Weakness?
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. They are not merely yielding to the pressure of political correctness. The leading perceived causes of alcoholism are genetics or inherited traits, followed by stress and anxiety.
These results overstate the degree to which people accept the disease model of alcoholism. 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.
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%) said one of the reasons they have hesitated to help their family member was not knowing what to do or how to help. Family members themselves need support if they are to help the alcoholic. Many say that one potential ally may be their family doctor.
Just 39% believe their alcoholic family member’s doctor has raised concerns about drinking with the alcoholic. Yet 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 doctors report that they had no addictions training in medical school and residency. And half (48%) had eight hours or less.
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. Majorities of each professienal group say they would welcome further training to learn how to respond better to alcoholism. That includes 67% of doctors, 58% of employers, 76% of clergy, and 81% of counselors and therapists.
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.
There are many different types of alcoholism treatment programs. They include simple detoxification over a period of hours. But also comprehensive in-patient prograrns lasting weeks or months. They usuaily including ongoing partcipation in recovery groups.. The success rates for different approaches may vary widely. Yet when people think about alcohol treatment, they usually don’t think about the successful approaches.
We asked all surveyed groups what percentage of alcoholics who do recieve treatment are able to achieve a lifelong recovery. We did so without defining treatment or recovery. The answers for each group average between 41% for family members and 32% for docrors.
Signs of Hope
The Road to Recovery details some substantial challenges facing the alcoholism recovery community. But it also identifies many signs of hope. The groups that could take a greater role in responding to alcoholism have serious misgivings or hesitations. But they also show a willingness to take a greater responsibility to help alcoholics find their way to recovery.
In the workplace, The Road to Recovery uncovers the potential for greater involvement and intervention by employers. A 70% majority of managers agree that it is the employer’s responsibility to help their employee recover. Six in 10 (59%) admit they’d feel uncomfortable telling an employee that they believe he or she is an alcoholic.
Yet 50% say employers should take responsibility to intervene and actively try to get an alcoholic employee into treatment. Most managers (83%) say that it’s better for their company’s profits to try to help an employee recover. Only 9% say it’s better to terminate the employee (9%).
The challenge and the opportunity will lie in providing more, better, and more concrete information to employers. They need to know what to do and what support and programs are available.
Alcoholism is a disease that hits home for 43% of Americans – including alcoholics and their families.
Significant numbers of the professional groups included in The Road to Recovery had an alcoholic in their own immediate family. The numbers were 31% of employers, 28% of clergy, 38% of counselors, and 19% of doctors. 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
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 ready. You’re not going home. Bottom line.’ When the people you really care for lay the facts in front of you, it’s time to really take a look at it.” And for the family members of alcoholics, there’s a message of hope. “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.”
” I lost self respect. That’s the most important thing. I have that today. I’ve gained inner peace, a love of life. And 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. Practically every day I celebrate getting sober.”
Reference for the Road to Recovery
Peter D. Hart Research Associates, Inc. The Road to Recovery: A Landmark Study on Public Perceptions of Alcoholism & Barriers to Treatment. Washington, D.C: 1998. The Road to Recovery was conducted for the non-profit Rush Recovery Institute.
Thanks go to Drew Brooks, who kindly gave generous assistance with The Road to Recovery.