Reading about … self-help books on alcohol problems

There is a large market for self-help books about problematic use of alcohol. A simple search of the catalogue of a large bookseller such as Amazon.co.uk reveals nearly 400 titles under the overall heading of ‘alcoholism self-help’. These include books targeted at older adults (Colleran & Jay, 2002), women (Jersild, 2001; Najavits, 2003), teenagers (Dolmetsch & Mauricette, 1987), and the children and families of problem drinkers (Ackerman, 2002). The majority of the books are written for an American audience, and use the 12 Steps of Alcoholics Anonymous as the basis of their therapeutic strategies. This review will attempt to summarise this literature, but also highlight books relevant to the UK market and in particular those using other evidence-based techniques.

General information about alcohol

There are a variety of readily available sources of information about the potential medical, psychological and social problems caused by alcohol. Two of the best books are Alcohol: The Ambiguous Molecule (Edwards, 2000) and Alcoholism: The Facts (Goodwin, 2000). Both are easy to read and go beyond the simple facts and figures by developing the historical context and explaining the implications of the latest research findings. Personal stories of battles against the effects of alcohol may be another helpful first step for a person uncertain about the severity of their problem with alcohol. Such books are written by a range of people and vary in quality (Day & Smith, 2003 describe the range of literature). However there are a number of well-written accounts in this area, not least A Drinking Life (Hamill, 1994) and Drink: A Love Story (Knapp, 1996). John Sutherland, a professor of English literature in London is another notable contributor to this genre (Sutherland, 2001).

Alcoholics Anonymous

The most used model of therapy for alcohol problems worldwide is probably the 12 Steps, as practised by Alcoholics Anonymous (AA). A vast literature exists around this process, and it can be difficult to know where to start. It is unlikely that reading a book will act as a substitute for attending AA meetings and becoming actively involved in the therapeutic process, but several useful personal accounts of how individuals used the 12 Steps to turn around their problems exist. One example is The Thinking Person’s Guide to Sobriety (Pluymen, 1999), which uses personal stories to illustrate the development of alcohol problems and ways of tackling them. The 7 Points of Alcoholics Anonymous (Walker, 1989) is a more formal introduction to the fundamentals of 12-Step recovery, and reviews the history and practice of AA. The Big Book of Alcoholics Anonymous (Alcoholics Anonymous World Services, 2001), now in its fourth edition, is a key text in introducing a person to the Fellowship. Originally published in 1939, it contains an analysis of the principles that led to the sobriety of the earliest members, together with a selection of updated personal stories of AA members. Twelve Steps and Twelve Traditions (Alcoholics Anonymous World Services Office, 1953) commonly accompanies the Big Book and contains a detailed interpretation of the principles of personal recovery and group survival by Bill W., co-founder of the Fellowship. Alcoholics Anonymous also produces practical booklets and pamphlets aimed at problem users of alcohol, their families and friends. One particularly useful book is Living Sober (Alcoholics Anonymous World Services, 1975), sub-titled ‘some methods AA members have used for not drinking’.

Other approaches

One of the problems with the AA approach is that it is difficult to dip into without taking on board the whole treatment philosophy. Although extremely popular in the UK, many treatment services prefer to use a variety of other treatment strategies and many of these are supported by a growing evidence base (Miller & Wilbourne, 2002). Furthermore, a central tenet of the AA process is abstinence from alcohol, and yet much of the book market is targeted at people who are concerned that they are drinking too much and want to cut down or control their consumption. If the individual is uncertain about their relationship with alcohol, a useful introductory book is Let’s Drink to Your Health (Heather & Robertson, 1996). This contains a good information section about alcohol, and a range of exercises to help the user to evaluate their drinking patterns and modify them accordingly. Much of the material is consistent with the evidence-based strategy of brief intervention. Responsible Drinking (Rotgers et al, 2002) has similar aims, but the ‘Moderation Management’ programme that it presents offers a larger menu of practical ideas in the form of modules and worksheets.

Other psychological treatment models have been applied to the problem of alcohol misuse. Rational Emotive Behaviour Therapy was originally developed by Albert Ellis as an approach to self-change and is outlined in the book When AA Doesn’t Work For You: Rational Steps to Quitting Alcohol (Ellis et al, 1992). Similar principles are used in Overcoming Your Addictions (Dryden & Matweychuk, 2000), one of a large series of books designed to help readers tackle a variety of emotional and behavioural problems. Both are easy to read and the ideas contained within are readily applied in practice. Another popular and innovative technique is Solution-Focussed Therapy, and The Miracle Method (Miller & Berg, 1996) is a clear and accessible account describing the process. Finally, Corinne Sweet’s book Overcoming Addiction (Sweet, 1999) uses a variety of cognitive and behavioural techniques within a general counselling framework.

Two further approaches are worthy of mention. Vernon Johnson’s books (Johnson, 1990, 1993) outline strategies developed at the Johnson Institute in Minneapolis, and are based on a comprehensive ideology using ‘interventions’ and other treatment to stop the ‘downward spiral toward death’ faced by many drinkers. Allen Carr runs a chain of clinics throughout the UK and the rest of the world that promote his own theory of controlling addictive behaviours. The approach is called Easy Way (Carr, 2003) and attempts to undo the ‘brainwashing’ that most people have been exposed to around the issue of alcohol. Both approaches are based upon abstinence and produce impressive figures about their levels of success, and will no doubt appeal to some readers.

Internet sites

Not surprisingly, there is also a huge amount of information available about alcohol on the Internet. For UK users, a good place to start is the Alcohol Concern website (www.alcoholconcern.org.uk). This is the national umbrella body for 500 local agencies tackling alcohol-related harm, and offering help to the families and friends of those with alcohol-related problems. The website provides an excellent range of printable factsheets, a searchable services directory and a comprehensive list of useful links. Other good resources are Patient UK (www.patients.org.uk), which has a section on self-help for alcohol and drug problems, and www.wrecked.co.uk, a National Health Service (NHS)-linked site providing information about alcohol and its effects.

There are a range of sites linked to Alcoholics Anonymous. The main site (www.alcoholics-anonymous.org) contains a large amount of introductory information about the Fellowship and its aims and methods, although www.alcoholics-anonymous.org.uk is more relevant to UK users. Al-anon and Alateen, AA’s sister organisations (for friends and families of problem drinkers and young people aged 12–20, respectively) have their own site at www.al-anonuk.org.uk. Individuals trying to find a local AA meeting may find www.aa-uk.org.uk the best starting point, and the site also contains other valuable information, such as tips and advice from contributors on ‘staying sober’. The popularity of sites belonging to individual AA members is demonstrated by one of the best UK sites (www.aamolly.org.uk) which has received over 180 000 visitors in 6 years.

A final group of sites is dedicated to providing therapy on line. Down Your Drink (www.downyourdrink.org) is an online course developed by the NHS and funded by the Alcohol Education and Research Council that aims to provide the information needed to learn how to stay drinking at a safer level in 6 weeks. However, the future may lie with organisations such as eGetgoing (www.egetgoing.com), which provide live interactive group treatment online. Users who sign up (and pay) for one of the treatment packages receive a microphone and headset, allowing them to interact with a professional therapist and other group members.