BROOKE GLADSTONE: A lot’s changed since 1991, when Morley Safer consecrated our wine, as long as it’s red. But since 2000, hospitals have seen a 50% increase in emergency room visits related to binge drinking. Considering the amount of deserved coverage the opioid crisis gets, it’s worth noting that alcohol kills even more Americans each year. But whereas prescription pills and heroin often kill their victims quickly, death by drink can proceed by inches, taxing the body slowly, pawning off its mortal effects onto other ailments or addiction.

[CLIPS]:

FEMALE CORRESPONDENT: Experts say drinking alcohol may contribute to almost 20,000 cancer deaths every year.

FEMALE CORRESPONDENT: It can lead to health issues, including liver and heart disease, and is responsible for 88,000 deaths in the US each year.

[END CLIP]

BROOKE GLADSTONE: When it comes to helping Americans drink less, Hollywood and the media aren’t helping. Addiction recovery in our popular culture is largely framed around the idea that a 12-step program like Alcoholics Anonymous is not only the best choice, it’s the only choice.

We spoke in 2015 and also this week to Gabrielle Glaser, investigative journalist and author of Her Best-Kept Secret: Why Women Drink And How They Can Regain Control. She says that AA works far better on big and small screens than in real life.

GABRIELLE GLASER: Researchers from the University of New Mexico analyzed data from dozens and dozens of different clinical trials, and what they found is that Alcoholics Anonymous ranked 38th in its efficacy among more than 50 different treatments.

BROOKE GLADSTONE: AA is hard to study since members are anonymous and, therefore, impossible to track, right?

GABRIELLE GLASER: Right but every three years, AA comes out with its own Triennial Surveys, and the data that were released in the late 1990s, a gentleman named Don McIntyre analyzed them and he published them in a peer-reviewed journal. Don McIntyre, himself, was in AA and, again, these are AA’s own statistics that showed of 100 people who show up for a meeting on January 1^st, only 5 will be there on December 31^st.

BROOKE GLADSTONE: But that was back in 2000.

GABRIELLE GLASER: Right but AA has not released similar figures since that time because there was such an uproar.

BROOKE GLADSTONE: But I personally know so many people who have used the program and have done well.

GABRIELLE GLASER: Exactly but you also know a lot of people for whom yoga works really well. That’s not science. That’s anecdote. That’s narrative. We, in this country, adore redemption narratives, and that is also AA’s narrative.

Early in the bible of Alcoholics Anonymous, the book that was first written and published in 1939, here's what AA tells readers and potential members: “Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves.”

BROOKE GLADSTONE: If only 8 out of 100 succeed in this program, why does it have such a fantastic rep?

GABRIELLE GLASER: In the early 1940s, there was a Saturday Evening Post story about AA, and interest really took off throughout the 1940s and ‘50s. At dinnertime, when everybody was watching the news, people who were members of AA were on local TV stations wearing Lone Ranger masks, describing their experiences. And it was very helpful for the organization and it was, no doubt, helpful for people who needed help with their drinking. It was an important milestone culturally and clinically.

BROOKE GLADSTONE: But I think even more the big screen, right? There’s lots of movies that AA appears in.

GABRIELLE GLASER: So we have the Thin Man movies in the 1930s, where alcohol was just a giant caper. Myrna Loy at one point sits down at the table and says, I can drink as much as he can.

[CLIP/MUSIC UP & UNDER]:

MYRNA LOY AS NORA CHARLES: Yeah, how many drinks have you had?

WILLIAM POWELL AS NICK CHARLES: This will make six martinis.

NORA CHARLES: All right, will you bring me five more martinis? Leo, line them right up here.

WAITER: Yes, ma’am.

[END CLIP]

GABRIELLE GLASER: AA hit Hollywood in 1945. There was a woman who was one of the first women in AA to become sober long term. He name was Marty Mann, and she was a PR genius. She worked at Marshall Fields in Chicago. She came from a very wealthy family. Her family lost money during the stock market crash. She had a decade of really wandering and she drank way too much, and she found AA when she was in a sanitarium; a doctor gave her a book, the Big Book. And initially. She rejected it as being far too religious. But she had had a suicide attempt and somehow she picked it up again and thought, okay, I’ll try this.

It worked for her and she wanted to get the message out. She started reaching out to radio producers. She worked with newspapermen, television writers, movie producers, screenwriters, and it really, really worked.

[CLIP]:

ANNOUNCER: The Lost Weekend starring Ray Milland.

[MUSIC UP & UNDER]

GABRIELLE GLASER: And that depicted a harrowing journey of this, this guy who was a writer trying to fix his writer’s block.

[CLIP]:

RAY MILLAND AS DON BIRNAM: Come on. I need that liquor, I want it and I'm going to get it, understand. I'm going to walk out of here with that quart of rye, one way or another. 

[END CLIP]

GABRIELLE GLASER: And that was written by a member of AA whose name was Charles Jackson, to portray what happens in an alcoholic’s downfall in a depiction onscreen. And then AA itself was depicted in a movie called The Days of Wine and Roses. It featured Jack Lemmon, Jack Klugman and Lee Remick. Jack Lemmon has a drinking problems. He brings his girlfriend/wife along with him for the ride. She doesn’t like the taste of alcohol but he quickly produces brandy alexanders which are sweet.

[CLIP]:

LEE REMICK AS KIRSTEN CLAY: Oh, no thank you, I --

JACK LEMMON AS JOE CLAY: No, that’s all right, that’s fine.

KIRSTEN: But I --

JOE: They’re special for you, chocolate .

KIRSTEN: Oh, it's good.

JOE: Mm.

KIRSTEN: It is!

[END CLIP]

GABRIELLE GLASER: They slide into this terrible descent

of alcohol dependence, themselves. And in that film, AA was a protagonist. It’s got spooky music during the drunken scenes, out-of-control scenes. And then when the Jack Lemmon/Joe Clay character goes to AA, suddenly there are these triumphant violins. Jack Klugman appears. He is the sponsor of Jack Lemmon and brings him to meetings. You see these meetings portrayed for the first time on the large screen: “My name is blank and I’m an alcoholic.”

It’s easy to forget that enormous numbers of people went to the movies in the 1950s and ‘60s, so everybody was consuming that at the same time.

BROOKE GLADSTONE: And AA is still popping up on the big scream now?

GABRIELLE GLASER: Okay, so there’s this film called Flight in which Denzel Washington plays a heroic pilot and he has a drinking problem. There’s a scene in which he does this daring move on a plane that he saves the passengers from pure destruction but he had been drinking within the prescribed time limit. I think it’s eight hours that the FAA requires you’re abstinent from alcohol.

[NTSB HEARING CLIP]:

MELISSA LEO AS ELLEN BLOCK: -- October 11^th.

DENZEL WASHINGTON AS WHIP WHITAKER: October 11^th. October 12^th and 13^th and 14^th I was intoxicated. I drank all of those days. I drank, in excess.

ELLEN BLOCK: On the morning of the accident.

WHIP WHITAKER: I was drunk. [PAUSE] I’m drunk now. I’m drunk right now, Ms. Block, because I’m an alcoholic.

[END CLIP]

GABRIELLE GLASER: The term “alcoholic,” it got into popular in the early 1940s with the publication of Alcoholics Anonymous, The Big Book. And it indicates that you are either an alcoholic or you’re what Alcoholics Anonymous refers to as a “normie.” And if you’re in the category of what we perceive to be alcoholics, the only way forward is with this faith- and abstinence-based program that was developed in the 1930s.

BROOKE GLADSTONE: Now, for some people, they just have a genetic predisposition to full-out alcoholism, right?

GABRIELLE GLASER: Yes, we know that there are about 100 genes that express themselves when people drink. People who have vulnerability to develop drinking problems have what’s really considered to be a faulty shut-off valve.

BROOKE GLADSTONE: But you're saying it isn't just a binary proposition, that that’s something that the media depictions seem to miss.

GABRIELLE GLASER: Continue to miss. For example, the DSM, which is the psychiatric bible, the one that came out in 1980 really distanced itself from the terms “alcoholic” and “alcoholism,” the new terms for alcohol abuse and alcohol dependence. Researchers, clinicians have been trying to get away from this word for almost 40 years, and yet, fast forward to the DSM-5, which came out in 2013. That came up with the term called “alcohol use disorder,” which is super clunky but really denotes a spectrum of severity. You can be like the Denzel Washington character in Flight, drinks to excess every single night, drinks despite negative consequences. It’s entirely possible that they are not candidates for moderating their behavior.

BROOKE GLADSTONE: You’re saying not everyone who has a problem with drinking has to cut it out entirely.

GABRIELLE GLASER: Absolutely not. We use AA’s yardstick of abstaining for the rest of your life, going to meetings; you know, you can’t even have a bite of rum frosting at Christmastime or you’re gonna go on a bender. But the science has shown us really bulletproof scientific studies, since the 1970s, the possibility of even the most severely dependent drinkers learning how to moderate, learning new coping skills, being taught cognitive behavioral therapy. There are anti-craving medications that are used to great effect in countries elsewhere.

When I did the story for The Atlantic in 2015, and, again, this is three years ago so maybe it's increased, but only 12 medical schools out of more than 400 even offered courses in addiction medicine.

BROOKE GLADSTONE: As you’ve written, something like 10% or more of the people in AA have actually been mandated to go there by a judge.

GABRIELLE GLASER: So, for the past 30 years, about 12% of AA’s own membership are people who don't necessarily want to be there. There are some data that show that 12%, they fare worse than if they were just sent home. I spoke to several judges in my reporting who sheepishly told me, yeah, you know what, I know it really doesn’t work for that many people but we don't know what else to do with these folks.

BROOKE GLADSTONE: The last time we spoke, you said you had high hopes for the Affordable Care Act.

GABRIELLE GLASER: You know, I thought that that was going to be one of the first things that was going to be yanked, was the coverage for substance abuse and alcohol treatment, which was an essential benefit. And it hasn’t been, in my opinion, in part because the opioid crisis has hit red states very hard. However, many insurers who are federally mandated to cover treatment, if you go on their website they don't list anybody who actually does that. We’re in the middle of a major crisis and we have a huge lack of people to treat it.

So I do have hopes. We’re not in 1935. Our knowledge of the brain of addiction has evolved immensely since that time. So I have hope in the science. I also have hope in the number of medical school students saying, hey, I want to learn about this, tell me more. Hope in Hollywood? Not so much. There’s a character in the Robert Altman movie, The Player, who says he's on his way to an AA meeting, and one of his friends says, oh, I didn’t know you had a problem. And the character responds, I don’t but that’s where all the deals are made.

BROOKE GLADSTONE: [LAUGHS] Yeah, yeah.

GABRIELLE GLASER: And I think it’s ever thus. I hear from my friends in Los Angeles and in Hollywood, itself, that, you know, it’s got a lot of devoted members there.

[MUSIC UP & UNDER]

BROOKE GLADSTONE: Gabrielle, thank you so much.

GABRIELLE GLASER: Thank you so much for having me. It was really fun.

BROOKE GLADSTONE: Gabrielle Glaser is an investigative journalist and the author of Her Best-Kept Secret: Why Women Drink and How They Can Regain Control.

Coming up, Dr. Nutt’s case for solving our alcohol problem, once and for all. This is On the Media.