As she approached her 50th birthday, Joanna, a Pennsylvania information-technology specialist, grew tired of hiding her 1.5-liter empties from her husband. Joanna (who asked that her name be changed to protect her privacy) began attending meetings of Alcoholics Anonymous at the suggestion of her psychiatrist. In the U.S., the 12-step abstinence- and faith-based program is embraced by the nation's courts, much of the medical establishment, insurance companies and popular culture as a one-size-fits-all approach to harmful drinking.
快过50岁生日时，宾夕法尼亚州信息技术专家乔安娜(Joanna，她要求隐瞒真实姓名以保护隐私)厌倦了向丈夫隐瞒自己1.5升的空酒瓶。乔安娜开始在心理医生的建议下参加“嗜酒者互诫协会”(Alcoholics Anonymou，简称A.A.)聚会。在美国，这个12步戒酒及建立信心的项目受到了国家法院、大部分医疗机构、保险公司及流行文化的欢迎，其被视为是应对酗酒问题的通用方法。
A.A. was founded in 1935 by two men who believed that alcohol dependence could be tamed by regular attendance at group meetings with other recovering alcoholics. Its doctrine calls for members to tame their egos, abstain from all drinking and acknowledge they are in the grip of a force they can combat only with help from a 'higher power.''
A.A.于1935年由两位男士创立，他们认为对酒的依赖可以通过定期参加与其他正在恢复的酗酒者的聚会而得到抑制。其宗旨是号召成员控制自我意识，完全放弃饮酒，并承认他们正被一种力量所控制，只有在一种“更高力量”的帮助下才能与之抗衡。
It doesn't take an advanced degree in gender studies to realize that this approach─which has worked well for millions of people─may not be perfect for women whose biggest problem is not an excess of ego but a lack of it. Women are twice as likely to suffer from depression and anxiety as men─and are far more likely to medicate those conditions with alcohol.
不需要在性别研究领域取得多高的学历就能意识到，虽然数百万人已经通过这种方法得到很好的效果，但对那些其最大的问题是自我意识太强而非缺乏自我意识的女性来说，这种方法并不完全适用。女性得抑郁症和焦虑症的几率是男性的两倍，而且用酒精来治疗这些症状的可能性也大得多。
Many women who drink heavily are also the victims of sexual abuse and have had eating disorders. The idea of being powerless can underscore a woman's sense of vulnerability, researchers say. 'Women need to feel powerful, not like victims of something beyond their control,' says Dr. Barnes. 'It gives women power to feel they themselves can change.'
许多酗酒的女性同时也是性虐待的受害者，并患有进食障碍。研究人员说，无力感会加强女性的脆弱感。巴恩斯说：“女性需要感到有力量，而不受制于超出自己控制的东西。酒精赋予女性力量，让她们觉得自己能够改变。”

Scientists are continuing to explore the biochemical differences in the way that alcohol affects men and women. Studies show that after drinking, men report feeling more powerful, often overstating their capabilities and accomplishments, while women say that it makes them feel more affectionate, sexy and feminine.
科学家们正继续探索酒精对男性和女性在生物化学上的不同影响。研究表明，在饮酒后，男性表示感觉到更有力量，通常会夸大自己的能力和成就，而女性则表示饮酒后她们觉得自己更感性、性感和有女人味。
In Europe, Hong Kong and elsewhere in the industrialized world, clinicians treat alcohol-use disorders with a variety of techniques developed in the nearly eight decades since the founding of A.A. (Researchers favor the term 'alcohol-use disorder,' which encompasses a range of severity, over 'alcoholism.') Many combine different behavioral therapies with medications such as naltrexone and topiramate, which help block cravings. Both drugs have proved to be effective in helping patients abstain or moderate. Studies around the world have found that for those who are not severely alcohol-dependent, controlled drinking is possible. Advocates of the 12-step program reject these findings and continue to maintain that abstinence is the only remedy.
从A.A.创立后的近八十年以来，欧洲、香港及其他发达国家的临床医生运用各种不同的方法治疗酒精使用障碍。（研究人员觉得用“酒精使用障碍”比“酗酒”要好，前者可涵盖各种程度饮酒。）很多医生将不同的行为疗法与纳曲酮(naltrexone)和托口酯(topiramate)等抑制酒瘾的药物相结合。这两种药物均被证明能够有效帮助病人戒掉或节制酒瘾。世界各地的研究发现，对酒精依赖不是很严重的人来说，控制性饮酒是有可能的。12步戒酒项目的倡导者对这些研究结果表示排斥，继续坚持认为戒酒是唯一的治疗方法。
For Joanna, wine was a nightly antidote for her pressure-filled job. It also provided a respite from a decade of depression after her parents' deaths.

对乔安娜来说，葡萄酒是晚上从压力重重的工作中解放的良药，它也能对自己自父母去世后已患十年的抑郁症起到缓解作用。

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.
乔安娜尝试过一些不限性别的A.A.聚会，也参加过女性A.A.聚会，但她总不适应把自己暴露在一群陌生人面前。她的顾虑并不是没有根据：A.A.成员提到有些老成员爱占脆弱的新成员的便宜，这种行为被称为“第13步”。2009年，A.A.董事会弱势成员小组委员会(Subcommittee on Vulnerable Members)一位受托人对年轻女性实施性虐待，当被问及此事时，委员会回应说没办法做到每天都监管数千场的聚会。A.A.纽约中央办公室的公共信息官员表示无可奉告。
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.的会员问卷调查显示，12%的成员是被法院要求参加互助会的。虽然大多数人都被指控为醉酒驾驶，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时间后被政府要求参加互助会，他杀害了一名在A.A.认识的女性及其13岁的女儿，然后自杀。
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.把每天举行的数千场互助会看作是匿名组织的工作，认为这些组织有自我监督的责任。董事会成员表示，一个匿名建立的组织无法抛弃自己的基本原则去筛选成员。
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.
乔安娜开始寻找其他办法，她发现了巴恩斯的网站和她的合伙人艾德•维尔森(Ed Wilson)。二人为乔安娜提供了五天的集中个人咨询。巴恩斯的理念是找到引起女性饮酒的根源，帮助她决定如何规划一个更健康的生活。维尔森说：“大多数的女性客户都是在40多岁或50多岁开始酗酒，借此隐藏由于荷尔蒙波动、适应空巢生活、父母的过世及其他角色丧失带来的不适。”
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.
对许多这样的女性来说，问题在于学习如何节制饮酒，而不是完全戒掉。维尔森说，数十年的研究显示这是有可能的，而且也是他执业多年的经验。客户可以去看家庭医生，医生进行体检，然后开一些纳曲酮。客户回到家以后，她们可以在随后的几个月里与心理医生保持电话联系。
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.
乔安娜的治疗花费8,750美元（约合人民币53,637元），对她来说，这种治疗过程简单、隐私有保证，而且效果令人欣慰。维尔森说，诊所的240名客户经过六年的时间达到70%的成功率，都达到了她们预期的节制或戒酒的目标。
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.'
乔安娜认为彻底戒酒应该是最容易的，她已经有将近四年没有酗酒了。她将自己的成功归功于自己的理疗和三个月服用纳曲酮，还有冥想。一些小型研究已经表明纳曲酮对减少女性饮酒的快感最有疗效。她说：“我解脱了。现在我能记得晚上看得什么书。”
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.
明尼苏达州圣保罗(St. Paul)心理医师、曾任美国国家酗酒与酒精中毒研究所治疗研究主任的马克•维纶布林(Mark Willenbring)认为，新药物及其他正在研发的药物会抹去酒精使用障碍的污点，就像氟西汀(Prozac)改变了人们对抑郁症的看法一样。
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.
尽管媒体时常曝光明星进入康复中心，但在大约2,000万有有害饮酒习惯的美国人中，只有不到10%的人接受过特殊治疗。维纶布林认为，如果初级保健医生们能学习如何开抗复发药物并为较轻患者提供咨询，那么这种情况是可以改变的。
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.
对那些已经越过可控饮酒标准但不能在康复中心待一个月、而且对无力状态感到不舒服的女性来说，这或许是个好消息。