Joanna tried some coed and women's A.A. meetings, but she never felt comfortable exposing herself to strangers. Her concerns were not unfounded: A.A. members talk about the tendency of old-timers to take sexual advantage of fragile newcomers, an act known as the 'Thirteenth Step.' Questioned about the sexual abuse of young women by one of its own trustees, the A.A. board's Subcommittee on Vulnerable Members responded in 2009 that it could not do anything to oversee tens of thousands of meetings each day. The public-information officer at A.A.'s central office in New York had no comment.
喬安娜嘗試過一些不限性別的A.A.聚會，也參加過女性A.A.聚會，但她總不適應把自己暴露在一群陌生人面前。她的顧慮并不是沒有根據：A.A.成員提到有些老成員愛占脆弱的新成員的便宜，這種行為被稱為“第13步”。2009年，A.A.董事會弱勢成員小組委員會(Subcommittee on Vulnerable Members)一位受托人對年輕女性實施性虐待，當被問及此事時，委員會回應說沒辦法做到每天都監管數千場的聚會。A.A.紐約中央辦公室的公共信息官員表示無可奉告。
A.A.'s membership surveys reveal that 12% of members are ordered to attend by the courts. Though most have been charged with drunken driving, some are sex offenders and other felons with violent backgrounds. In Hawaii in 2010, a veteran with a history of violence, ordered by authorities to attend meetings after a stay in a psychiatric hospital, killed a woman he met in A.A. and her 13-year-old daughter before shooting himself.
A.A.的會員問卷調查顯示，12%的成員是被法院要求參加互助會的。雖然大多數人都被指控為醉酒駕駛，但有些是性侵犯及其他有暴力背景的重罪犯。2010年，一名有暴力史的老兵在精神病院待了一段時間后被政府要求參加互助會，他殺害了一名在A.A.認識的女性及其13歲的女兒，然后自殺。
A.A. views the thousands of meetings that take place each day as the work of autonomous groups, responsible for supervising themselves. A group based on anonymity, board members argued, could not do anything to screen members without undercutting its basic principles.
A.A.把每天舉行的數千場互助會看作是匿名組織的工作，認為這些組織有自我監督的責任。董事會成員表示，一個匿名建立的組織無法拋棄自己的基本原則去篩選成員。
Joanna searched for new options and found the website of Dr. Barnes and her practice partner Ed Wilson. The two offer five days of intensive personal counseling. The idea is to examine what triggers a woman's drinking and to help her decide how she might design a healthier life. 'Most of our female clients slip into harmful drinking in their 40s and 50s, masking the discomfort of fluctuating hormones, the adjustment to an empty nest, the death of parents and other role losses,' Dr. Wilson says.
喬安娜開始尋找其他辦法，她發現了巴恩斯的網站和她的合伙人艾德•維爾森(Ed Wilson)。二人為喬安娜提供了五天的集中個人咨詢。巴恩斯的理念是找到引起女性飲酒的根源，幫助她決定如何規劃一個更健康的生活。維爾森說：“大多數的女性客戶都是在40多歲或50多歲開始酗酒，借此隱藏由于荷爾蒙波動、適應空巢生活、父母的過世及其他角色喪失帶來的不適。”
For many such women, the problem is learning how to moderate their drinking rather than stopping completely. Decades of research show that it is possible, Dr. Wilson says, and it has been his practice's experience. Clients visit a family doctor who conducts a physical exam and prescribes naltrexone. Once clients return home, they may follow up with the psychologists by phone for several months.
對許多這樣的女性來說，問題在于學習如何節制飲酒，而不是完全戒掉。維爾森說，數十年的研究顯示這是有可能的，而且也是他執業多年的經驗。客戶可以去看家庭醫生，醫生進行體檢，然后開一些納曲酮?？蛻艋氐郊乙院?，她們可以在隨后的幾個月里與心理醫生保持電話聯系。
To Joanna, the treatment, which costs $8,750, offered brevity, privacy and encouraging results. Dr. Wilson said that his practice's 240 clients reported a 70% success rate after six years, having achieved their desired goal of moderation or abstention.
喬安娜的治療花費8,750美元（約合人民幣53,637元），對她來說，這種治療過程簡單、隱私有保證，而且效果令人欣慰。維爾森說，診所的240名客戶經過六年的時間達到70%的成功率，都達到了她們預期的節制或戒酒的目標。
Joanna, who decided it would be easiest to quit booze altogether, hasn't indulged in nearly four years. She credits her therapy and three months of naltrexone, which in some small studies has been shown to reduce alcohol euphoria most effectively in women, as well as meditation, for her success. 'It's liberating,' she says. 'I remember what I read at night now.'
喬安娜認為徹底戒酒應該是最容易的，她已經有將近四年沒有酗酒了。她將自己的成功歸功于自己的理療和三個月服用納曲酮，還有冥想。一些小型研究已經表明納曲酮對減少女性飲酒的快感最有療效。她說：“我解脫了?，F在我能記得晚上看得什么書。”
Mark Willenbring, a psychiatrist in St. Paul, Minn., and a former director of treatment research at the National Institute of Alcohol Abuse and Alcoholism, believes that the new drugs, along with others in development, will lift the stigma of alcohol-use disorders, much as Prozac changed views of depression.
明尼蘇達州圣保羅(St. Paul)心理醫師、曾任美國國家酗酒與酒精中毒研究所治療研究主任的馬克•維綸布林(Mark Willenbring)認為，新藥物及其他正在研發的藥物會抹去酒精使用障礙的污點，就像氟西汀(Prozac)改變了人們對抑郁癥的看法一樣。
Notwithstanding the well-publicized trips of celebrities to rehab, fewer than 10% of the estimated 20 million Americans with harmful drinking habits ever receive specialized treatment. That could change, Dr. Willenbring argues, if primary-care doctors were trained to administer antirelapse drugs and counseling to those on the less troubled end of the spectrum.
盡管媒體時常曝光明星進入康復中心，但在大約2,000萬有有害飲酒習慣的美國人中，只有不到10%的人接受過特殊治療。維綸布林認為，如果初級保健醫生們能學習如何開抗復發藥物并為較輕患者提供咨詢，那么這種情況是可以改變的。
That would be good news for the many women who have crossed beyond a controlled sipping point but are unable to spend a month in rehab and uncomfortable with the notion of powerlessness.
對那些已經越過可控飲酒標準但不能在康復中心待一個月、而且對無力狀態感到不舒服的女性來說，這或許是個好消息。