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Study says AA most effective to beat drinking problems

Meet Your Doctor

By Barbara Pierce

Dr. Maria Gesualdo

Alcoholics Anonymous, the worldwide fellowship of sobriety seekers, is the most effective path to abstinence, according to a comprehensive analysis conducted by a Stanford School of Medicine researcher and his collaborators.

After evaluating 35 studies — involving the work of 145 scientists and the outcomes of 10,080 participants — Keith Humphreys, Ph.D., professor of psychiatry and behavioral sciences, and his fellow investigators determined that AA was nearly always found to be more effective than psychotherapy in achieving abstinence. In addition, most studies showed that AA participation lowered health care costs.

AA works because it’s based on social interaction, Humphreys said, noting that members give one another emotional support as well as practical tips to refrain from drinking.

“If you want to change your behavior, find some other people who are trying to make the same change,” he said.

The review will be published March 11 in Cochrane Database of Systematic Review.

Although AA is well-known and used by millions around the world, mental health professionals are sometimes skeptical of its effectiveness, Humphreys said. Psychologists and psychiatrists, trained to provide cognitive behavioral therapy and motivational enhancement therapy to treat patients with alcohol-use disorder, can have a hard time admitting that the lay people who run AA groups do a better job of keeping people on the wagon.

Early in his career, Humphreys said, he dismissed AA, thinking, “How dare these people do things that I have all these degrees to do?” Humphreys noted that counseling can be designed to facilitate engagement with AA — what he described as “an extended, warm handoff into the fellowship.” For the review article, Humphreys and his colleagues evaluated both AA and 12-step facilitation counseling.

AA began in 1935 when two men in Akron, Ohio, were searching for a way to stay sober; they found it by forming a support group. They later developed the 12 steps, the first being accepting one’s inability to control drinking; the last, helping others sustain sobriety by becoming a sponsor of a new member. The AA model — open to all and free — has spread around the globe, and now boasts over 2 million members in 180 nations and more than 118,000 groups.

Though the fellowship has been around for more than eight decades, researchers have only recently developed good methods to randomize trial participants and measure its effectiveness, Humphreys said.

Dr. Maria Gesualdo has joined Hospice & Palliative Care as associate medical director. Hospice & Palliative Care provides quality, compassionate and end-of-life care to those in the Mohawk Valley.

Q.: What led you to take the position of associate medical director of Hospice & Palliative Care?

A.: For the past eight years, I had the opportunity to work as both a clinician caring for pulmonary and critical care patients while at the same time growing and developing my administrative skills both at Slocum Dickson Medical Group in New Hartford and the Mohawk Valley Health System.

Recently, my administrative responsibilities were coming to an end. When I learned of the position at Hospice & Palliative Care, I was immediately interested. I saw this as a great opportunity to incorporate my clinical and administrative skills with my vast experience dealing with the sensitive matters associated with critically ill patients and their families.

I always admired and appreciated the wonderful services and dedication provided to my patients by Hospice & Palliative Care and saw this as an opportunity to be part of that team. I just knew that I would feel very comfortable in this role.

Q.: What is the mission of Hospice & Palliative Care?

A.: For hospice, the mission is to provide quality, compassionate endof-life care.

For the Advanced Illness Management: Palliative Care program, the mission is to help alleviate patient and family suffering and to promote patient quality of life for chronically and seriously ill patients.

Q.: How do the two programs differ?

A.: Hospice patients require a physician’s prognosis of six months or less to live.

For these patients, care is aimed at managing distressing symptoms, especially pain and anxiety, and improving quality of life. These patients are no longer seeking life-prolonging treatments. In other words, the patient wishes to allow a natural death. Our A.I.M: Palliative Care program focuses on managing distressing symptoms and improving quality of life. Unlike hospice, it does not require a prognosis of six months or less to live. Patients may continue life-prolonging or curative treatments.

Like hospice patients, palliative care patients can call 24 hours a day, seven days a week to receive guidance and support from a registered nurse.

group including registered nurses, licensed practical nurses, certified home health aides, social workers, a spiritual care coordinator, bereavement counselors, and support staff along with administrators who work closely with myself and our medical director, Dr. Deborah Lang, to assure patient needs are met.

We are also fortunate to have trained volunteers who support our mission.

Q.: What is your role as associate medical director?

A.: I work closely with Dr. Lang to assure patient needs are met and to facilitate a smooth transition to hospice. Once a hospice referral is made, I assure that the patient meets hospice criteria and has a comfort care plan in place. Once a patient is admitted, I provide documentation for his or her admission and medication coverage. I make recommendations to their primary care provider to comply with standards of care. If the PCP cannot be reached, I am available to prescribe any medications necessary.

Additionally, I oversee interdisciplinary group meetings to discuss every patient and the services they are receiving.

Q.: Do you feel the community is aware of Hospice & Palliative Care and the important role it plays in the lives of many?

A.: We certainly strive to get the word out, but there is always room for improvement. Hospice & Palliative Care does a great job with education. Fundraisers throughout the year are helpful in raising funds to support patient care and getting community members more engaged.

I would like to see our community view Hospice & Palliative Care as an extension of the excellent health care being delivered to patients by their providers. Excellent care shouldn’t end as the patient deals with an advanced illness or faces end-of-life decisions.

Patients should feel reassured that there are services available through Hospice & Palliative Care to better assist them and their families with improving quality of life or coping with terminal illness.

Lifelines

Birth year: 1969 Birthplace: Livingston, New Jersey Current residence: New Hartford Education: Doctor of Osteopathic medicine degree, New York College of Osteopathic Medicine, Old Westbury; internship and residency, St. Luke’s Hospital in Bethlehem, Pennsylvania; fellowship in pulmonary, allergy and critical care medicine, Penn State Health System, Hershey Medical Center, Hershey, Pennsylvania Affiliations: Mohawk Valley Health System, St. Luke’s, St. Elizabeth’s, Rome Memorial Hospital Personal: Married, three teenagers Hobbies: Baking, traveling, reading mystery novels, watching scary movies, enjoying quality time with family, friends and my dog Buddy