Why I became a 'Non-Alcoholic Trustee' for Alcoholics Anonymous
‘Non-Alcoholic Trustee’ for Alcoholics Anonymous 2022 - Current
Government Alcohol Adviser 2000-2020
British Society of Gastroenterology Alcohol Lead 2009-2019
Consultant Gastroenterologist and Liver Specialist Royal Bolton Hospital 1990-2018
Mission Statement and Philosophy
‘We never give up on anyone, even if they give up on themselves’
Whenever I say these words, I become emotional. At my interview to become a Non-Alcoholic Trustee (NAT) on the General Service Board, I looked around the table and realised these words would resonate with members of the interview panel. I could not get the words out and started to cry. I was not alone.
My mission statement was inspired by Kathy (not her real name), a 27-year old lady who had drunk one bottle of vodka per day since her teens. In 1994, this was her 10th admission for alcohol-related cirrhosis, internal bleeding and liver failure. On the ward round, she looked up at me and said ‘I have had enough and I want to give up’. All I could think of to say was ‘Well, Kathy, we are not giving up on you’. Those words would have a profound effect on both of our lives. Kathy pulled through, left hospital, became abstinent, resumed care for her young daughter and became successful in work.
Collaborative Liver and Psychiatry Alcohol Care at Royal Bolton Hospital
In 1990, I was appointed Consultant Gastroenterologist and Liver Specialist at Royal Bolton Hospital. Typically, in most hospitals, patients were admitted with acute alcohol withdrawal, be given a 5 -7 days detoxification regime and then discharged with no follow-up, only to be readmitted soon after under another physician. I wrote to all the Bolton GPs and my consultant colleagues and asked them to refer all patients with alcohol use disorders (AUDs). They were more than pleased and I received a 660% increase in referrals!
Consequently, Wendy Darling, Consultant Liaison Psychiatrist in Substance Abuse, Stephen Liversedge, Primary Care Alcohol Lead, and our multidisciplinary team of nurses, therapists and social workers, established pioneering, collaborative liver and psychiatry primary, secondary and community person-centred alcohol care. Our teamworking ethos ensured that everyone felt valued. Historically, liver doctors (hepatologists) had worked in liver units and psychiatrists in addiction units and there was no joined-up care, especially at patient discharge. The key elements of our care evolved over 30 years. The Alcohol Specialist Nurses (ASNs) have a blend of alcohol, liver and mental health expertise. At 8.00h, 365 days per year, an ASN goes to the Acute Medical Unit (AMU) to help to identify patients with alcohol use disorders using an ‘AUDIT-C’ questionnaire (similar to the tick list in the AA ‘Starter Pack - Who Me?’). This detects the severity of heavy drinking, alcohol misuse or dependence with a high degree of sensitivity and specificity. This is then followed by a ‘Brief Intervention’ when a Healthcare Professional (HCP) identifies and discusses alcohol misuse with a person.
In 1999, I entered our team into the British Hospital Doctor Awards and remembered Kathy. Our mission statement deeply touched the judges and we won the Gastroenterology Team of the Year Award and I became the Overall British Hospital Doctor of the Year. In 2000, Sir Liam Donaldson, Chief Medical Officer for England, asked me to be a Government Adviser, and in 2002, he nominated me for the CBE. Kathy often reminded me that I owed everything to her.
What is an Alcohol Care Team?
In 2009, I was appointed the Alcohol Lead for the British Society of Gastroenterology (BSG). In a 2010 paper, we first coined the expression ‘Alcohol Care Teams’ (ACTs), which has resonated widely. ACTs, mainly developed in acute UK hospitals, reduce acute hospital admissions, readmissions and mortality and improve the quality and efficiency of alcohol care. Many hospital clinicians and managers, Public Health England and NHS England were impressed with the evidence for their efficacy and have funded and implemented ACTs widely.
I wrote a paper for a lay and professional readership and would encourage AA members, especially Health Liaison Officers (HLOs), to read it online.
See: Moriarty KJ. Alcohol care teams: where are we now? Frontline Gastroenterology Published Online First: 14 August 2019. doi:10.1136/flgastro-2019-101241
AA Cooperation with ACTs
I have been really encouraged by hearing from AA members and from liver and psychiatry colleagues about how AA is liaising with Emergency Departments (EDs), ACTs, ASNs in liver, psychiatry and general wards, Primary Care and in healthcare undergraduate and postgraduate courses, with Continuous Professional Development (CPD) accreditation being awarded. Students and doctors particularly value listening to AA members share. The Alcohol Assertive Outreach Team (AAOT), led by Professor Colin Drummond, Addiction Psychiatrist at King’s College London, has received excellent community support from AA members.
The AA Service Handbook for Great Britain 2022, chapter 6, ‘AA and Healthcare in the Community’, includes excellent suggestions about how HLOs, with support, can make contact with HCPs and start hospital and treatment centre groups. The AA Health Sub Committee (HSC) submitted an update on chapter 6 that will be discussed at the 2023 AA Conference. I am learning about the particular challenges, especially geographical, faced by members and HLOs in the Continental European Region (CER).
Alcoholism, Terminology and Stigma
Inspired by a friend of 50 years, I applied and formally became a NAT in April 2022. Sadly, in 43 years caring for patients with alcohol-related disease, I never once sought the help of AA and neither did they contact me about any patient. Many HCPs prefer the term ‘Alcohol-Related Liver Disease’, rather than ‘Alcoholic Liver Disease’, partly due to the stigmatising nature of the word ‘Alcoholic’, which has historically, and still today, led to inferior hospital treatment, denial of admission to intensive care or consideration for liver transplantation. Other terms include alcohol-dependent or misuser, problem drinker or person with lived experience. The World Health Organisation uses ‘Alcoholic’ and people in AA self-define as ‘Alcoholic’, which is fundamental.
AA and a Higher Power (‘God’)
There is a commonly held view that AA is a religious organisation and that many people, including healthcare professionals, may be put off by the use of the ‘God’ word in AA literature and discourse. This, however, is belied by findings from the most recent survey of AA members (the 2020 AA Membership Survey), which asked respondents (numbering 1694) about the foundations of their views on spirituality and their notion of a higher power (or God). 65% reported that these were based on a secular foundation, compared with 35% who reported that their views of the above had an overtly religious basis. My perception has changed since becoming a trustee.
AA 12-Step Facilitation Programs – What is the Evidence?
There is powerful evidence in the 2020 Cochrane meta-analysis of 27 research studies that showed that the AA/12-Step Facilitation Programs (AA/TSF) for people with AUD were superior to Cognitive Behavioural Therapy and Motivational Enhancement Therapy in maintaining abstinence from alcohol. In addition, AA/TSF produces substantial healthcare cost savings since all support from AA members is free, an important consideration when patients are being discharged from hospital and the difficulties in accessing Community Alcohol Services. Moreover, AA/TSF, potentially, is a lifelong commitment, rather than typically time-limited NHS treatment.
National Institute for Health and Care Excellence (NICE) Quality Standards - Alcohol-Use Disorders
The NICE Quality Standards are the gold-standard guidance for clinical care. Current guidance for both care staff and for people with alcohol misuse recommends giving information on the value and availability of community support networks and self-help and support groups, such as AA and SMART Recovery, together with helping people to participate by encouraging them to go to meetings, and by arranging support.
NICE also highlights evidence from many trials involving AA and patient testimonies as to the support and efficacy of AA.
Currently, there is a 2023 NICE Consultation Update. The AA Health Sub Committee has submitted the results of the Cochrane Review and the AA 2020 survey.
Aims and Suggestions as a Non-Alcoholic Trustee:
- Listen to, and learn from AA members and be guided by their experience
- Emphasise that AA is a rapid access, supportive and free resource
- Facilitate contacts with friends and former colleagues in the healthcare community
- Encourage AA members to engage GP practice managers and nurses to establish meetings in GP surgeries, as well as in community and voluntary sector care
- Encourage AA members to establish links with clinical leads of EDs, ASNs and AMUs, liver and psychiatry consultants and ward staff. HLOs may draw on experiences during the Covid-19 pandemic
- In hospitals, given the huge pressures and limited access, prioritise establishing AA meetings to engage inpatients and support them at discharge
Currently, the AA Health Sub Committee comprises 3 trustees and soon there will be just 1 other member of the Fellowship. If we are to be effective, we need more AA members. Please consider applying. Please refer the Health advert on page 19 below for a full list of qualifying critera.
I have been humbled to see how AA helps people to achieve abstinence, regain their self-respect, be reunited with their loved ones and flourish at home and at work, and to witness the selfless devotion to support, sponsor and help others to achieve and sustain abstinence with a commitment that is all-embracing and lifelong.
Kathy’s Legacy
Sadly, Kathy is no longer with us. Hopefully, in my service to AA, I will be faithful to her legacy.
Kieran Moriarty
Non-Alcoholic Trustee