Some people don’t like or are not interested in the 12-Step model, even with the variations above or through organizations that facilitate the 12-Step model. Some people don’t like basing their recovery on the idea that they cannot control their addiction, when there is evidence that there are ways of practicing internal control over the recovery process.
Binge drinking statistics from the CDC estimate more than 38 million US adults binge drink an average of 4 times a month and the most drinks they consume on average is 8. The report found that binge drinking is more common among households with incomes ≥$75,000, but the largest number of drinks consumed per occasion is highest among households with incomes of < $25,000. [11]  According to the 2015 National Survey on Drug Use and Health (NSDUH), 26.9% of people ages 18 or older reported that they engaged in binge drinking in the past month; 7% reported that they engaged in heavy alcohol use in the past month. [8]
Long-term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive problems are common; approximately 10 percent of all dementia cases are related to alcohol consumption, making it the second leading cause of dementia.[40] Excessive alcohol use causes damage to brain function, and psychological health can be increasingly affected over time.[41] Social skills are significantly impaired in people suffering from alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. The social skills that are impaired by alcohol abuse include impairments in perceiving facial emotions, prosody perception problems and theory of mind deficits; the ability to understand humour is also impaired in alcohol abusers.[42] Psychiatric disorders are common in alcoholics, with as many as 25 percent suffering severe psychiatric disturbances. The most prevalent psychiatric symptoms are anxiety and depression disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence.[43] Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia.[44] Panic disorder can develop or worsen as a direct result of long-term alcohol misuse.[45][46]
During Step 5, a trusted support person should be selected, after sins are confessed to the higher power, who can help individuals to move forward and leave the past behind them. Addiction can be isolating as individuals shrink into themselves, and Step 5 is often the first step toward opening up to others. It can be difficult to admit to oneself any wrongdoings and even harder to then share them with others. During Step 5, individuals are often humbled and then feel cleansed moving forward, leaving negativity in the past.
Michael M. Miller, MD, FASAM, FAPA, is the medical director of the Herrington Recovery Center at Rogers Memorial Hospital-Oconomowoc. He is a board-certified general psychiatrist and addiction psychiatrist. Dr. Miller has practiced addiction medicine for more than 30 years and is certified in addiction medicine by the American Board of Addiction Medicine. Dr. Miller is also an at-large director of the American Board of Addiction Medicine and The ABAM Foundation. He is a past president of ASAM.
For every addiction, there are recovery programs and support groups to help those looking to kick their habits. Generally speaking, these programs can be grouped into one of two big buckets: those following a 12-step approach, and those that do not. Which you choose will be a matter of personal preference and – to some – whether you believe in a higher power, which 12-step programs typically promote. Either way, these resources can help you stay happy, healthy and social after your course of recovery from drug addiction or alcoholism treatment.
n the continued extreme dependence on excessive amounts of alcohol, accompanied by a cumulative pattern of deviant behaviors. The most frequent consequences are chronic gastritis, central nervous system depression, and cirrhosis of the liver, each of which can compromise the delivery of dental care. Oral cancer and increased levels of periodontal disease are also risks.
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The term alcoholism is commonly used amongst laypeople, but the word is poorly defined. The WHO calls alcoholism "a term of long-standing use and variable meaning", and use of the term was disfavored by a 1979 WHO expert committee. The Big Book (from Alcoholics Anonymous) states that once a person is an alcoholic, they are always an alcoholic, but does not define what is meant by the term alcoholic in this context. In 1960, Bill W., co-founder of Alcoholics Anonymous (AA), said:
What's to know about alcoholic liver disease? Alcoholic liver disease is the primary cause of chronic liver disease in the U.S. and can be fatal. It occurs as a result of chronic excessive consumption of alcohol. The first step of treatment will be to remove alcohol from the diet, but a liver transplant may also be necessary. Learn more about the disease here. Read now
One review warned of detrimental iatrogenic effects of twelve-step philosophy and labeled the organizations as cults,[41] while another review asserts that these programs bore little semblance to religious cults and that the techniques used appeared beneficial to some.[42] Another study found that a twelve-step program's focus on self-admission of having a problem increases deviant stigma and strips members of their previous cultural identity, replacing it with the deviant identity.[43] Another study asserts that the prior cultural identity may not be replaced entirely, but rather members found adapted a bicultural identity.[44]
Since the 1950s, alcohol addiction has been treated as a separate addiction from that of other illicit drugs under the AA program, meaning that drug abuse disorders are considered to be a different struggle, so a separate 12-step program is recommended. Chemical dependency is considered the most life-threatening addiction disorder and addicts are advised to address this addiction first and prior to other addictions such as gambling or sexual addiction, until abstinence is established and recovery has begun. Drug dependency is sometimes considered the root addiction, causing the individual to develop other addictive tendencies and therefore should be addressed first.
Gastrointestinal system. Alcohol causes loosening of the muscular ring that prevents the stomach's contents from re-entering the esophagus. Acid from the stomach flows backward into the esophagus(acid reflux), burning those tissues, and causing pain and bleeding. Inflammation of the stomach also can result in ulcers, bleeding, pain, and a decreased desire to eat. A major cause of severe, uncontrollable bleeding (hemorrhage) in an people with alcoholism is the development of enlarged (dilated) blood vessels within the esophagus, which are called esophageal varices. These varices develop in response to liver disease, and are extremely prone to bursting and hemorrhaging. Hemorrhaging varices are often fatal. Diarrhea is a common symptom, due to alcohol's effect on the pancreas. In addition, inflammation of the pancreas (pancreatitis) is a serious and painful problem in many people who abuse alcohol. Throughout the intestinal tract, alcohol interferes with the absorption of nutrients, which can result in a malnourished state. Alcohol is broken down (metabolized) in the liver and interferes with a number of important chemical reactions that occur in that organ. The liver begins to enlarge and fill with fat (fatty liver). Fibrous scar tissue interferes with the liver's normal structure and function (cirrhosis), and the liver may become inflamed (hepatitis).
A cross-sectional survey of substance-misuse treatment providers in the West Midlands found fewer than 10% integrated twelve-step methods in their practice and only a third felt their consumers were suited for Alcoholics Anonymous or Narcotics Anonymous membership. Less than half were likely to recommend self-help groups to their clients. Providers with nursing qualifications were more likely to make such referrals than those without them. A statistically significant correlation was found between providers' self-reported level of spirituality and their likelihood of recommending AA or NA.[87]

12-Step has also been criticized for putting vulnerable folks new to recovery into the hands of untrained "sponsors" who often give unsound advice and make unduly onerous demands.  Meetings have also recently been criticized for sometimes being unsafe; with no organizational supervision (every meeting is "autonomous"), there have been numerous reports in the news of sexual harassment, and even assault, occurring in the program.
Some of the divide between 12-Step recovery and academic addiction medicine came about because of resistance by some AA members to the use of any pharmaceuticals whatsoever. Newcomers were told to abandon any and all medications. While this attitude is receding, stories of members with advanced cancer refusing opiates are still told with admiration in meetings. 

Ten health risks of chronic heavy drinking A wide range of factors determines how the body responds to chronic heavy drinking. A single binge-drinking episode can result in significant harm, and excessive consumption of alcohol is the fourth-leading preventable cause of death in the U.S. Learn about the ten diseases most commonly linked to heavy drinking here. Read now


One review warned of detrimental iatrogenic effects of twelve-step philosophy and labeled the organizations as cults,[41] while another review asserts that these programs bore little semblance to religious cults and that the techniques used appeared beneficial to some.[42] Another study found that a twelve-step program's focus on self-admission of having a problem increases deviant stigma and strips members of their previous cultural identity, replacing it with the deviant identity.[43] Another study asserts that the prior cultural identity may not be replaced entirely, but rather members found adapted a bicultural identity.[44]
Alcoholism formerly called alcohol dependence or alcohol addiction, is the more severe end of the alcohol use disorder spectrum. It is a destructive pattern of alcohol use that includes tolerance to or withdrawal from the substance, using more alcohol or using it for longer than planned, and trouble reducing its use or inability to use it in moderation. Other potential symptoms include spending an inordinate amount of time getting, using, or recovering from the use of alcohol, compromised functioning, and/or continuing to use alcohol despite an awareness of the detrimental effects it is having on one's life.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The first few sips of an alcoholic beverage can lead to pleasant feelings. When alcohol is metabolized into the bloodstream and enters the brain, it binds to the gamma-aminobutyric acid (GABA) receptors, which are involved in the stress response. If a person has active production of GABA, which is absorbed by receptors rapidly, they may experience several conditions, from anxiety to seizure disorders. Alcohol slows this neuron firing down, so even people without anxiety or stress feel relaxed. The substance also inhibits glutamate absorption, which further reduces stress or anxiety.

Addictions affect people from every walk of life. There are particular issues that make diagnosis, treatment and reentry challenging when addiction occurs in a physician, nurse, pharmacist, attorney, executive or other professional. Often there are highly developed defenses, as well as heightened senses of guilt and shame. Regulation and licensure issues can permanently threaten careers. Wyoming Recovery’s Professionals Program incorporates local recovering professionals, support groups, augmented psychological/psychiatric assessments, advocacy, and aftercare.
NIAAA says a relapse typically follows a predictable path. The person in recovery is placed in a high-risk situation, and the person isn’t able to handle that situation effectively. That lack of effectiveness can prompt the person to feel somehow vulnerable or weak, and it can lead to a craving for alcohol. After a weak moment, people just begin to attribute life’s good things to alcohol. They then have a lapse and drink just a bit. In time, they start to drink more and more.

But Twelve-Step Facilitation therapy is still a tried-and-true proven approach. It is far more than advising a patient to “go to AA” and providing them a list of meeting locations and times. In Twelve-Step Faciliation, the therapist actively probes and nudges, encouraging not only attendance, but participation, in meetings; it explains the potential benefits of working with a sponsor and promotes the individual developing a relationship with a sponsor; it explores problems or psychological resistances to attendance, participation, actual “working the steps,” and the development of a sponsor-sponsee relationship; and it opens the door to “AA-related activities” such as volunteer service to one’s AA “home group” or AA “clubhouse” and involvement with AA-related social events, retreats, and local and state conventions.
Twelve-Step Recovery addresses the psychology of the person with addiction as well as the individual’s spirituality--his/her values, his/her connectedness to others, and his/her willingness to engage with others and humbly ask for help. The process of change in Twelve-Step Recovery starts with an acceptance that when friends or loved ones point out that things are amiss in one’s life, they are likely correct, and things have likely become unmanageable. And while taking personal responsibility and accepting accountability for one’s actions are considered key steps, Twelve-Step Recovery outlines that excessive self-reliance and the firm stance that “I can get myself out of this,” and “I know what to do about this,” will be roadblocks to recovery from addiction. “Getting out of oneself” and recognizing that one doesn’t have all the answers, and humbly asking for help from another human being—from a health professional or from a lay person—are behaviors and behavioral styles that are promoted by Alcoholics Anonymous and related “Twelve-Step” programs of peer support.
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I am surprised that along with the detailed description of the utility of CBT in aiding recovery from addictions that no mention was made of the SMART Recovery Self-Help Network. The SMART Recovery Program (Self-Management And Recovery Training) which is grounded in CBT along with several other evidence-based tools. There are about 1,500 free SMART Recovery meetings available in communities & prisons around the world. smartrecovery.org is an interactive website which receives about 120,000 unique visitors per month and has over 135,000 registrants. 30 online SMART Recovery meetings per week are available online. 160 SMART facilitators per month are being trained via an interactive online program; many are professionals. About 1/3 of regular SMART Recovery participants also attend 12-Step meetings, at least occasionally, There have been >25,000 SMART meetings in MA where 2/3 of participants are professionally referred and the majority of meetings occur in hospitals. SMART Recovery has no objection to appropriate, medically-prescribed pharmaceuticals being used in the course of recovery from an addiction.
With a U.S. economy inching laboriously back from recession with a flagging job market in tow, we should be sensitive to hidden costs of this “lifestyle choice.” In a perfect world, we would weigh the right to drink excessively against the $94.2 billion in tax dollars that we spend every year to pay the costs of alcoholism. We should weigh the collective choice against the 1.9 million public school teachers we could hire with that $94.2 billion — or the million public parks that money could build for communities across the country, or the million students we could put through school. And we’d think hard about what cultural shift could moderate this “lifestyle choice” before it becomes disease.
Once a person is addicted to alcohol, to stop it may take hospitalizations, rehabilitations, and re-rehabilitations all of which hemorrhage expenses — not to mention destroy relationships and property. The estimated cost to the system of this specialized addiction care is $24.6 billion. Since addiction is a disease that rewires the brain, the individual is unlikely to quit through “willpower” alone, and it often takes something dramatic (or “hitting rock bottom”) before they will make changes. There are costs associated with these dramatic scenarios. In the case of car accidents caused by driving drunk, costs include not just hospitalization, but the cost to insurance companies, car owners, municipal employees responding to the accident, and a continued chain reaction of costs that could ultimately include vehicular homicides and funeral expenses.

AA meetings do not exclude other alcoholics, though some meetings cater to specific demographics such as gender, profession, age, sexual orientation,[44][45] or culture.[46][47] Meetings in the United States are held in a variety of languages including Armenian, English, Farsi, Finnish, French, Japanese, Korean, Russian, and Spanish.[48][45] While AA has pamphlets that suggest meeting formats,[49][50] groups have the autonomy to hold and conduct meetings as they wish "except in matters affecting other groups or AA as a whole".[4] Different cultures affect ritual aspects of meetings, but around the world "many particularities of the AA meeting format can be observed at almost any AA gathering".[51]

Alcohol use disorder (which includes a level that's sometimes called alcoholism) is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect, or having withdrawal symptoms when you rapidly decrease or stop drinking.

Gastrointestinal system. Alcohol causes loosening of the muscular ring that prevents the stomach's contents from re-entering the esophagus. Acid from the stomach flows backward into the esophagus(acid reflux), burning those tissues, and causing pain and bleeding. Inflammation of the stomach also can result in ulcers, bleeding, pain, and a decreased desire to eat. A major cause of severe, uncontrollable bleeding (hemorrhage) in an people with alcoholism is the development of enlarged (dilated) blood vessels within the esophagus, which are called esophageal varices. These varices develop in response to liver disease, and are extremely prone to bursting and hemorrhaging. Hemorrhaging varices are often fatal. Diarrhea is a common symptom, due to alcohol's effect on the pancreas. In addition, inflammation of the pancreas (pancreatitis) is a serious and painful problem in many people who abuse alcohol. Throughout the intestinal tract, alcohol interferes with the absorption of nutrients, which can result in a malnourished state. Alcohol is broken down (metabolized) in the liver and interferes with a number of important chemical reactions that occur in that organ. The liver begins to enlarge and fill with fat (fatty liver). Fibrous scar tissue interferes with the liver's normal structure and function (cirrhosis), and the liver may become inflamed (hepatitis).
Applicants must certify that they have "buy recycled" by-laws, ordinances or policies in place; indicate whether their purchasing function is centralized or decentralized; certify that everyone with purchasing authority is aware of the "buy recycled" requirement and reminded of it annually; and attach a copy of this communication. See below for examples of qualifying "buy recycled" policy notifications.
Although all forms of problem drinking are getting worse in the US, not everyone who drinks too much meets the criteria for AUD. The CDC found, in 2014, that 90 percent of those who drink too much alcohol, even frequently, are not physically dependent on the substance to feel normal. Although one in three adults drink to excess, meeting the criteria for heavy or binge drinking, nine out of 10 do not meet the criteria for AUD from the DSM-5.
No conversation about alcoholism or substance abuse recovery is complete without mentioning Alcoholics Anonymous. The group has become synonymous with the concept of addiction rehabilitation in general, and it was instrumental in changing the conversation in how people with drinking problems came to be understood and regarded. As the science and psychology of addiction evolves, the role of Alcoholics Anonymous is also changing, but it remains a cornerstone of the aftercare experience.
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