The NHS Endorses Alcoholics Anonymous

The British Government has an excellent website but if you type “Alcoholics Anonymous” into their search engine you get no relevant results — just reports about domestic violence, crime, victims and fraud (presumably alcoholism was the common factor in all these cases).

I’m not surprised by this — ever since working for Castle Craig Hospital I’ve known the NHS doesn’t officially encourage AA and other self-help groups that help people recover from addiction. The NHS position is a paradox: they officially endorsed AA and NA some years ago, in the Models of Care documents, but they never followed through by implementing these recommendations.┬áMost psychologists, GPs and psychiatrists seem to take a rational approach that can’t accept the spiritual element of the 12-steps, and as a result the whole movement tends to be dismissed.

Gradually things are changing. Public Health England, an NHS policy making body that has the mission to “protect and improve the nation’s health”, issued a briefing document at the end of last year which encourages GPs to make use of “mutual aid” groups like AA.

The report mentions 7 studies which all have good things to say about these groups and has the following recommendation:

“If a person who misuses drugs has expressed an interest in attending a 12-step self-help group, staff should consider facilitating the person’s initial contact with the group, for example by making the appointment, arranging transport, accompanying him or her to the first session and dealing with any concerns.”

All this might sound innocuous to an outsider, but considering that the NHS has effectively ignored the 12-step approach it’s big news within our sector. The first AA group took place in 1935, in the USA, and by the 1950s the “Minnesota Model” of addiction treatment (the 12-steps in a clinical setting) was widespread in the USA. Now there are thousands of 12-step based rehab clinics around the world.

One psychiatrist who has been advocating closer links with 12-Step groups is Professor Jonathan Chick, the new Medical Director at Castle Craig. Back in 2003, Dr Chick contributed to a Scottish government study about the Prevention of Relapse in Alcohol Dependence.

The study recommended that “Specialist services must make themselves aware of non-NHS agencies (such as Councils on Alcohol and Alcoholics Anonymous) operating in their area and co-ordinate their approach, making this information available to individuals within their care. Informing people about these agencies should be part of the overall relapse prevention strategy.”

Public Health England’s champion in the long struggle to get the 12-steps accepted by the medical profession is Mark Gilman. He believes that mutual-aid groups such as AA are an underused resource.

Following an international conference on addiction, Gilman told the Guardian about his enthusiasm for the 12-steps: “I bet those doctors wondered what the hell I was talking about: ‘What, Public Health England thinks the answer is to go to meetings which have been going since 1935? That are free? Duh! But actually, yeah.”

Gilman admits the fellowships are “something that we, as treatment professionals, have tended to see as rather unscientific, folky, kind of interesting-but-quirky”. NHS commissioners and GPs tend to be sceptical because of the lack of clinical evidence, and the religious overtones, which jar with more secular approaches to treatment.

During a time of widespread budget cuts, and reduced health budgets, Gilman says that the support provided by mutual aid groups “is available 24 hours a day, 365 days a year, and is completely free of charge”.

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