In this final article of my series, I address two more reader’s comments that raise questions about the ethical responsibilities of mental health (and medical) professionals with regards to AA.
The reader’s comments are shown in italics and quotes, and my response follows.
Comment 1: “I am hoping, as a medical provider and therapist, that those who are critical of AA are not bringing these biases into their patient treatment recommendations. We are ethically required to provide information on all recovery options, not just the ones we like, so that the consumers themselves can decide…Please keep your biases at home folks…”
My response: We are not ethically required to provide information on “all recovery options.” We are only ethically required to recommend recovery options that we think are potentially most effective for our clients. AA has not been shown to be an effective recovery option. It is not ethical to recommend a treatment option just because it exists. For example, there are hundreds of different types of psychotherapy, but only a handful (e.g., cognitive therapy, prolonged exposure) that have been empirically shown to be effective for treating anxiety disorders. Why would I recommend an anxiety treatment to my clients if it hasn’t been shown to be effective? I wouldn’t, because that would be unethical. It’s our jobs as clinicians to be biased—biased towards treatments that have been proven to be effective, and against those that have not.
Comment 2: “…It’s interesting to note that a non-alcoholic/addict “clinician” would embark on an veiled attack on the one organization to which the VAST majority of his colleagues refer their clients. Is it really possible that treatment centers, clinicians and doctors nation-wide refer sufferer’s to AA upon discharge from care because AA works? Or do you really mean to suggest that your entire profession is acting unethically by recommending ineffective treatment when they refer clients to AA?…”
My response: Actually, it’s not a “veiled attack” but an unveiled critique. Unfortunately, many mental health professionals and organizations do refer their clients to AA, but it’s not because AA works (because there’s no scientific evidence to support this claim). I also don’t think it’s because they’re unethical (although I’m sure there are some that are unethical, just as in any profession). I think there’s actually a couple different reasons why clients are so often referred to AA by mental health (and medical) professionals: 1) Many clinicians (clinical psychologists, social workers, MFTs) do not receive much (if any) training in substance abuse/dependence as part of their basic graduate training (unless they specialize in this area). I come from an APA-accredited program and I wasn’t required to take any courses in addiction (although I chose to). It was only offered as an option. The California Board of Psychology only requires a brief pre-licensure course in addictions as part of licensure as a clinical psychologist. Because of this, many clinicians are uninformed about AA (myself included before I did my research), and they think (mistakenly) that AA is effective. As a result, they refer clients to AA truly believing it’s a good option. (I am not familiar with the training MDs receive in addiction, but I would guess that it’s also limited and more medically focused unless they specialize); 2) Because of how ubiquitous AA is and because it’s free, it is generally the most convenient and affordable place for people to get referred (but let’s not confuse convenience and affordability with effectiveness). AA is so saturated in the media (TV, movies, etc.) that most people (mental health professionals, MDs, and consumers alike) think it works. My hope is that this series of articles will make a tiny dent in that mistaken perception.
(Originally appeared on Examiner.com)
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