Health Liaison Information Folders
Above is a template for an A5 presentation folder – that can be adopted for other uses. When used for Health Professionals there is a highlight sticker, to go on the front saying ‘for Dr’s & Professionals.
Alcoholics Anonymous – Infinite Cost-effectiveness
I have worked for 30 years in treatment services for people with alcohol problems. My main research has been in evaluating treatment approaches using the hallmark method in medicine, the randomised controlled study. Patients are asked to take part in a study where, at random, they are allocated to either the test treatment, or the ‘standard’. The standard in many NHS treatment services has been detoxification followed by an offer of group therapy or one to one counselling. In this way, several medications were shown to improve the outcomes for some patients.
To test the effectiveness of Alcoholics Anonymous in this way, patients in one group would be obliged to attend, and the control group would be told not to attend. That has never been deemed ethical. Instead, the test has been to randomly allocate one group of patients to standard treatment, and for the other group ensure that the staff specifically explain AA to the patient, make a link to help them get to their first meetings, and encourage them to keep attending. It is called 12-step facilitation (AA is known for its ‘12 steps’).
In each of the four published studies, 12-step facilitation improved the outcomes.
It has taken a long time for some NHS regions to appreciate the economics of this. NHS managers look for cost-effective treatments, where the arithmetic is: Efficacy divided by Cost to the NHS. But when a treatment costs nothing – like AA – cost effectiveness is Infinity!
AA is also the treatment that gives the longest lasting results. One reason for this is that AA is about more than stopping drinking. Alcoholism often leaves a person feeling damaged as well as sometimes leaving a trail of harm to others. The damage on all sides can take months, sometimes years, to heal – there may have been dishonesty, egotism, depression, selfishness. The healing takes time, so you have to stick at it. But the ‘spirituality’ tag puts some people off. But here is what our Royal College of Psychiatrists says about spirituality – it’s not about believing in any God in the sky! It’s about “being focused in the present, alert, unhurried and attentive; empathy for others; courage to witness and endure distress while sustaining an attitude of hope; improved discernment, for example about when to speak or act and when to remain silent; learning how to give without feeling drained; being able to grieve and let go.” These are qualities that I have watched, sometimes with wonder, evolving in our patients who attend AA.
By Jonathan Chick 2013
My take on some AA teaching:
Alcohol is a powerful drug….
Being ‘in control’ is a delusion.
Facts must be faced, honestly.
If you blame others, your problem persists.
Recovery is collaborative.
Professor Jonathan Chick, Psychiatrist, Edinburgh