December 18, 1998

An innovative three-year project to develop and implement a curriculum to train psychiatrists and primary care residents in how to use both a biomedical and an Alcoholics Anonymous (AA) spiritual model to treat addiction was launched November 1 with $175,000 in annual funding from the Josiah Macy Jr. Foundation in New York.

The project is headed by Marc Galanter, M.D., professor of psychiatry and director of the division of alcoholism and drug abuse at New York University, in collaboration with David Mactas, president of the Hazelden Foundation in New York. Galanter is also the president-elect of the American Society of Addiction Medicine, while Mactas is a past director of the federal Center for Substance Abuse Treatment (CSAT).

"There's been a dearth of research on the psychological mechanisms underlying AA," Galanter told Psychiatric News. By raising awareness of AA among physicians and scientists, the new program may spur research into those mechanisms, he added.

AA is one of the oldest alternatives to the biomedical approach, Galanter observed. The new program will provide one model for bridging the gap in research and training between alternative medicine and conventional medicine, he noted.

Neither general practitioners nor psychiatrists have much "formal acquaintance with the issues underlying AA and how to deal with them in relation to their patients," Galanter pointed out. "Because alcoholism and substance abuse is a problem of such high prevalence, and because AA and other 12-step approaches enter into the treatment of most substance abusers, there is a great need to bridge the gap between biomedical training and the AA experience."

The lack of knowledge about AA among physicians has adversely impacted clinical care of patients with alcoholism, Galanter said. "There's a considerable weakness among academically trained clinicians in terms of dealing with the community of substance abusers who are attuned to AA," he noted. A related problem is that physicians are reluctant to refer to AA and to consider AA as "a component of the treatment armamentarium that they employ."

Politically, the program may help advocates of parity for substance abuse make headway, according to Galanter. There has been "very little in the way of vocal lay support for providing better [substance abuse] treatment," he noted. Galanter attributes this in part to the failure of mainstream medicine to understand and embrace AA, a program that is familiar to and respected by many politicians and other policymakers. While many legislators and other influential people are familiar with AA as a component of treatment, professionals, "particularly physicians, and even more so psychiatrists, have not been sufficiently involved with people who have recovered through AA," said Galanter. This lack of contact between physicians and people who have relied on 12-step programs has worked against insurance parity for substance abuse treatment and against more generous funding of substance abuse treatment in general, according to Galanter.

At press time, Hazelden's Mactas told Psychiatric News that he could not comment pending further conversations with Galanter regarding their collaboration.

The program will be conducted at four sites. These are the addiction psychiatry fellowship at New York University (NYU) in Manhattan; the general internal medicine residency program at NYU; the psychiatry residency program at NYU; and the Hazelden physicians in residence program in Manhattan.

The national advisory council for the project will include professors of medicine Anderson Spickard, M.D., Vanderbilt University School of Medicine; Jeffrey Samet, M.D., Boston University School of Medicine; Patrick O'Connor, M.D., Yale University School of Medicine; and Barry Stimmel, M.D., Mt. Sinai School of Medicine. Also on the council are Kathleen Brady, M.D., Ph.D., professor of psychiatry at the Medical University of South Carolina in Charleston and John Chappel, M.D., professor of psychiatry at the University of Nevada School of Medicine in Reno.