If you think we aren’t apes, how do you explain the popularity of Alcoholics Anonymous? Lance Dodes takes a sobering look at the data behind the success of 12-step programs. The short answer: they don’t work, and they do harm.
There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent. Most people don’t seem to know that because it’s not widely publicized. … There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine.
It’s not only that AA has a 5 to 10 percent success rate; if it was successful and was neutral the rest of the time, we’d say OK. But it’s harmful to the 90 percent who don’t do well. And it’s harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. AA is never wrong, according to AA. If you fail in AA, it’s you that’s failed.
I was most entertained by the commenter on that article who attempted to rebut those claims. Read this, and wonder:
I’m a recovering addict/alcoholic with over 5 years of continuous sobriety. I attend AA meetings regularly, and I take exception to Dr. Dodes statement, “AA is never wrong, according to AA. If you fail in AA, it’s you that’s failed.” I have never attended a meeting where this sentiment was expressed. The AA Big Book says, “Rarely have we seen a person fail who has thoroughly followed our path.” It does not claim any infallibility on the part of the 12 steps. I’ve heard it said around the tables many times that the success rate is around 5%.
So he’s actually confirming exactly what Dodes said: low success rate, and AA says the 95% failures don’t count because they didn’t “thoroughly follow” the path.
AA should be a subject of great interest to atheists, because it demonstrates a common phenomenon: vast numbers of people gladly and even desperately following a pattern of behaviors that do nothing to help them, and are even proven ineffective. Sound familiar?
There’s a method that works much better than AA. It has a 100% success rate, and it has only one step: Don’t Drink Alcohol.
That’s it! And it has a 100% success rate. No one who has thoroughly followed this system has ever lapsed.
Everyone who did fall off the wagon obviously failed to adhere to the system’s one rule.
This is a lot like the “if you were thinking positive properly, you wouldn’t have gotten cancer” crowd. (Positive thinking can be interchanged with prayer and belief.)
There’s a lot of stealth christianity in the 12 step programs, too. “Get in touch with your higher power” is goddy code for ‘accept that you are a miserable sinner and let jesus into your heart’
The 12 step programs probably work about as well as other forms of shaming or prayer. I.e.: not much.
The AA Big Book says, “Rarely have we seen a person fail who has thoroughly followed our path.”
The Big Book of True Scotsmen says that, too!!! I know, I have a copy (somewhere)
Yup, in more ways than one. Religion and a great deal of the ‘self help’ movement share victim blaming as a core feature. Both use hope as selling feature so when that hope is shown to be false the blame must be shifted away from the system. How else can they keep the fresh wallets rolling in? This sacrifice of the damaged and the vulnerable to preserve the undeserved reputation of these groups angers me in a way that few other things do. I rarely feel the urge to violence anymore, aging has its uses after all. But this sort of thing still fills me with cobble throwing rage.
#1 Pieter Droogendijk
Spoken like a true Murican Heartland sex ed teacher!
My love life?
This quote from the article struck me as having a familiar ring to it:
Sounds like “prayer” specifically and “religion” generally.
Before dismissing out of hand, has anyone read the research by Stanford Professor of Psychiatry Keith Humphreys? (@KeithNHumphreys – twitter). He went into his research of AA expecting to find it to be ineffective, as you have, but has come to the conclusion that it is effective.
Link to NYTimes article on his work: http://www.nytimes.com/2015/04/07/upshot/alcoholics-anonymous-and-the-challenge-of-evidence-based-medicine.html?_r=1&abt=0002&abg=1
The evidence for/against AA is not conclusive, and at least some well-designed studies have found positive effects. But measuring sobriety is a difficult thing for a medical research, because there’s no endpoint. It’s not like the flu, where one can say when it’s “over”, and traditional measures like time-to-relapse are problematic, because even if an intervention extends time-to-relapse, there’s still a relapse at the end. Is that successful?
Additionally, it’s difficult to ascertain who gets help/does not get help in AA because the lost-to-follow up problem is especially complex. Normally, in epidemiology studies, it is assumed that those lost-to-follow up have the worst possible outcome (i.e., death). But with addiction in general, that’s not a representative assumption. They may simply be sober and no longer participating (this is true for any treatment, not just AA).
Finally, AA keeps no data, and people arrive and depart for all kinds of reasons, many not associated with a desire for recovery (i.e., criminal sentencing). So most studies are based on self-report, which is considered among the worst epidemiological data sources. (I’ve done federally-funded epi research, but not about addiction.)
There are good reasons to object to AA, and especially to courts sentencing offenders to AA. But as of yet, the data showing effectiveness/ineffectiveness of AA as a treatment program – even the scientific evidence – remains almost wholly based on personal anecdotes of individuals and study subjects. As such, a responsible researcher (and skeptic!) should retain uncertainty as to its value.
Addictions are addicting, and a high failure rate may be expected. What I have consistently heard about AA includes both a positive and an negative. On the positive side they emphasize that if you fail, to try try again. The narratives of those who have been successful are full of stories where the person repeatedly failed, but got up to try again. They provide a support system, with mentors and peers who will not judge you but will instead encourage you and relate your problem to theirs. I have never heard of victim blaming, but I could easily be wrong on that.
On the negative side, they are too damn religious, with an emphasis on relying on a higher power. I suppose their argument for their (limited) success is that by doing so they give hope to the helpless, and succor to the down and out. But the higher power trope is straight out of the ’50s and one would think they might try something else.
Marcoli @ 10:
I would say the ‘make amends’ one is too. Having grown up Catholic, much of AA’s formula strikes me as fitting well into Catholic dogma – Confess, Repent, Do Penance. And so on.
I lived in a town which was great fun but a dipsomaniacs paradise. Several of my friends fell prey to alcoholism. The success rate outside of AA seemed better than those that were in it. The two who stayed in AA are dead and 3 who never joined are alive but with occasional relapses but those relapses tend to be short lived where the AA ones kinda gave up and just drank themselves to death feeling they’d lost all hope.
Is it just an evil money making scam? I never thought to ask it cost to go..
Among other criticisms of AA is that it fosters a sense of helpless dependency as a core part of the self. You will never recover. You will never do well on your own. You’re incapable. You’re a loser and always will be. But if you acknowledge this and “give” your weakness over to an all-powerful, all-knowing Higher Power which is perfect, you can relax and feel good about yourself again. Amazing grace will save a wretch like you.
Given how low the bar is for “knowing” that God exists and “experiencing” the positive results of prayer (the system is set up so that neither one can lose), asking advocates of a dependency program which is modeled on religion whether or not they think it worked is dicey.
as in a nonchemical form of methadone? To withdraw from one addiction, substitute it with another, less harmful, addiction. [Thinking of smokers switching to lollipops.]. That is, to eliminate alcohol addiction:substitute with addiction to going to meetings, on a fixed, regular, schedule to announce ones prior addiction, that one is not cured, only asymptomatic at the moment. Announcing is not just to self-aggrandize. There is some other weird psychological effect that occurs when one speaks vocally rather than internally only.
The problem I see, is the fixation on a fixed schedule of meetings. And, like portrayed in Days of Wine and Roses, that a single drink will ruin an attempt at recovery. I agree that total restraint is the best approach, but to portray it as the only possibility is … not~quite~right.
They do have a reasonable strategy of “coaches” (or “mentors”, or “buddies”, or… IDK what the formal term is) where two team up so when one sees temptation, can call on the other to lend support at resistance.
yet one clever aspect of their approach does not apply to their entire strategy.
…
sorry, I’m rambling…
Oh, for Pete”s sake. I love Pharyngula, but why on earth make AA one of your targets? It works for some people. It’s FREE. It doesn’t recruit, it doesn’t pick your pocket, it doesn’t break your leg. It doesn’t do anything to anyone. Attacking it is ridiculous — it’s like attacking a barbershop, or a swinger’s club. If you don’t like it, don’t go there. If you are forced to go, then blame the courts/judge/state — whomever is making you go. It’s not AA’s fault.
And just as there are overtly religious groups, there are also atheist groups that work just fine and are treated the same as any other group. Find a group that works for you.
jennyjfwlucy @ 15:
That would make sense if there was even one major, widespread secular program. There isn’t.
I see you’re yet another person with bad comprehension skills. There’s no target, and there’s no attack. PZ highlighted someone else’s work in this area. Everything is open to critique, and because something is criticised, it’s not being fucking attacked. Over the years, a lot of people have brought up AA’s flat refusal to update, to reformulate their program to not only reach more people, but to be more effective. Yes, AA helps some people. They could be helping a much higher percentage of people, though, and there isn’t one thing wrong about pointing that out.
jennyjfwlucy: Except AA doesn’t discourage judges from forcing participants to attend meetings, even though such is obviously going to result in unmotivated attendees who are probably the least likely to benefit from the program. They are not passive participants, here.
And AA overinflates their success rate by blaming anyone who doesn’t succeed with their method as being insufficiently sincere (instead of the program being a poor match for their situation). That’s directly harmful, because it keeps people from realizing that there’s a host of options out there, and that some are better than others, and that which ones are best are often going to rely on the individual.
Among other things, AA has enough of a chronic problem with people who join the program in part or entirely to find vulnerable people to abuse (or to abuse the children of) that they have a name for them – “13th Steppers” – but no real way of dealing with them that I’ve ever heard of.
“Every year or so I get a call from a journalist who wants me to come on some show with “Someone who is saying that there is no evidence that Alcoholics Anonymous works!”.
“I have learned to respond by asking “How much is their new book selling for?”.”
– Prof. Keith Humphreys
In this case, the answer to Prof. Humphrey’s question is $21.24.
I attended AA meetings for a couple of years. I’ll admit I internalized some of the fear the program tries to instill—if you stop coming you’ll relapse, etc. In my first year this really worked me over.
I haven’t been to a meeting in five years or so and had only attended sporadically for the three before that. I’ve been sober almost eleven years now.
It took some time for me to realize how unhealthy the program was (at least for me). By constantly restating my helplessness I couldn’t effectively move on with my life or effect the changes I needed to make to want to be sober.
I don’t drink now because my life is fulfilling without alcohol.
Not to say I didn’t meet some nice people there, but the overtly religious (Christian, really–especially in the Southern US) nature of the program was always a turnoff. The whole program derives from the Oxford group, an overtly Christian movement.
I can’t tell you how many people (many of whom subsequently relapsed themselves) told me that ‘the literature’ stated no one could stay sober and remain an atheist. I even had people angrily confront me about my lack of belief it if I spoke honestly about it in meetings (hey, they said to be honest, right? They didn’t mean it most of the time).
I finally left after a ridiculous lecture from my first sponsor about how I wasn’t going to enough meetings and would definitely end up drinking. The lecture was delivered when I visiting him while he was in jail after he started shooting heroin again–lost fifteen years of sobriety, his home, got a felony conviction out of it, dragged his wife down with him, etc. Ugly. Of course, in the AA way he felt entitled to lecture me about my behavior from the middle of all of this garbage.
Oddly enough, not one of the people I knew in AA continued to speak to me after I left.
As far as I’m concerned it’s a cult.
joel @ 19:
Besides taking time to come up with a retort, does your professor ever bother to answer criticisms, such as those quoted in the OP? There’s no claim AA never works – it does work, it just doesn’t work well, and it does harm to people, also. How about a good look at those difficulties, answered with something other than a mediocre retort.
I’m stuck in moderation – someone playing with stuff again?
Caine@16:
Well, there’s Secular Organizations for Sobriety, but it’s true that they’re not nearly as well known or widespread as AA. We should try to change that.
catbutler @ 20:
Thank you for relating your experiences. I think people like yourself simply get tossed to the side when someone decides to evaluate AA, in favour of “well, look at all these successful
drunkspeople!The dependency aspect of it leaves me chilled, because it sounds to me as if they are trying to instill a belief that there is simply no way for a person to be in control of themselves. I’d never be able to work on an addiction problem in that environment.
Also, my secondhand experience with AA was that there was quite a bit of pressure applied to join the confusingly named “Al-Anon” group for friends and ostensibly-loved ones of alcholics, which, from the literature, emphasized a similar theme of “powerlessness” and dependence on
God“a higher power.” And my ex-wife, for a time, would bring up my disinclination to attend and imply that it was the reason we got divorced (rather than the proximate cause of “after more than three years of AA meetings, she drove drunk with our daughter in the car and then stole her college savings so she could move out with another man” – she eventually settled on “I got sick, and you abandoned me” as the story she told herself). People in AA are encouraged to invite people to AA who they think might need it, often with quite a bit of pressure. “Doesn’t recruit” is bullshit.This is another case of a phenomenon I’ve noted – namely, that people attached to AA have the habit of reflexively trying to rebutt any statement that could possibly be construed as critical of it. Even if it means contradicting the program’s literature. In other cases, even if it means contradicting things they just said. It makes it very hard to have an honest conversation about it, though…
Inquisitiveraven @ 23:
Several years ago, there was a person who posted for a bit in the lounge, looking for help with alcoholism, but only secular help. I did find S.O.S., and linked, but it wasn’t anywhere near this person, and options for secular help were pretty damn dismal. I agree that we should try and change that, in any way we can. I’d be happy to help.
@12 – Considering AA is free, and self organized, with hardly any parent org involvement, it would be a really terrible monetary scam if it indeed was one.
Have you considered that there might be some selection bias in your anecdata? There is a reason for the Anonymous in Alcoholics Anonymous. Alcoholics rarely admit to themselves that they have a problem until they absolutely hit rock bottom. The ones who admitted it to themselves and went to AA (thereby admitting it to the world…) were probably pretty far gone and/or already thought they were unable to help themselves.
#3 – “There’s a lot of stealth christianity in the 12 step programs, too”
There is nothing stealthy about this. It’s well known that this refers to a God, and originally a Christian God. However, many AA groups (especially in metro areas) have made massive efforts to deemphasize the fact that the “higher power” refers to a god and instead ask people to choose what their higher power is (including, maybe, the laws of physics). Of course, there are terrible AA groups where they force their own particular brand of Christianity on you, but those are not very common, and at least in bigger cities, it’s easy enough to go to a different meeting.
Here’s a list of agnostic AA groups
http://www.agnosticaanyc.org/worldwide.html
Here’s a NY Times article about the growth of agnostic/atheist AA groups (there are probably already more of these than anything traditional atheist/agnostic groups have offered, which isn’t surprising considering how busy they are insisting that atheism is little more than “Not God”)
http://www.nytimes.com/2014/02/22/us/alcoholics-anonymous-without-the-religion.html
@23 – Besides the agnostic AA groups, there is also SMART Recovery, which claims to base itself heavily on scientific knowledge, and is free of all the religious baggage a lot of AA carries.
The problem with AA and NA isn’t necessarily the organizations, if they were directed to a particular subset of addicts, but they aren’t. In this country there is only one response to addiction permitted: religious based abstinence. And yes AA and NA are absolutely religious based. Higher Power is always capitalized and the High Power is always referred to as Him, or He.
There are programs that are set up with the 12 Steps that are specifically not religious and don’t require belief in a higher power, but those are strongly frowned on by old timers. And at any rate they just jump through the same steps without requiring that you believe in god.
AA and NA do provide a place for people to go who have a problem with addiction. They are supportive and although they do say that no one fails who has thoroughly followed their program. In about 10 years I’ve never seen anybody rejected who has come back to the rooms after going out on a run, no matter how many times it happens. The problem is that people then are told to do the same stuff that didn’t help them in the first place.
The problem is that there really isn’t any other choice offered to people in this country.
#30 – The religious and learned helplessness aspects of AA are definitely problems. But you are right in that the biggest problem is that secular society has failed to provide any decent alternatives.
Fortunately, the religious aspects is being greatly undermined, and there are a large number of non-religious AA groups to choose from. The learned helplessness is still a problem, and needs to be eliminated. In the meanwhile, AA does a great job of providing fellowship which has a positive effect.
one of the oddest things about 12 step programs is the always present concept is “take what you like and leave the rest”. I know of no other organization with that as a principle.
the thing you will hear is that it is about honesty with yourself and everyone else. The problem is “self will run riot”.
The 12 step programs are made up of people who are all equal with no authorities “ruling” anyone, though people being people there are always ass-holes showing up telling you how it should be done, hence take what you like and leave the rest and thanks for sharing.
what does it take to start a new AA meeting?
a resentment and a coffee pot!
we are social animals and the fellowship of people who suffer in similar ways from similar problems and are honest enough to admit it to themselves is helpful in changing often self-destructive compulsive behavior.
it is similar to what goes on here at freethought blogs and the various skeptics conventions.
uncle frogy
uncle frogy
The “path” can be actually harmful, I do know someone who recovered after seeing an AA affiliated program but she told them to shove it after they tut tutted her for taking psych medication.
She did recover, ditched AA and thankfully did not shelve the medication that was helping her function.
vaugelurker@9:
I looked at the NYT article and it’s very enlightening. I have come away with a deep and abiding unease with Prof Humphreys’ interpretations. Without going into too much statistical detail, I think it’s fair to say that he has published an interesting finding, but is hellbent on presenting it in the lay press as cast-iron proof of AA’s effectiveness.
While in grad school in the 80s, I took a course on addiction recovery, and the class visited each of the treatment centers in the town of about 50,000. All were exclusively 12-step programs, except for one. All also took in folks who had been sent there as a result of court judgments, so had no choice in the matter. At each, I challenged the ‘higher power’ steps, asking, ‘What if I don’t believe in a higher power?’ At each, again, except for one, I was told, almost verbatim, the same thing: ‘Everyone believes in a higher power of some kind.’ To which I responded, ‘I don’t.’ Then, several responded with something I found really weird: ‘Well, anything could be your higher power. This table could be your higher power!’ When I then asked, ‘Really? I’m supposed to turn my problems over to this table (step 3); humbly ask this table to remove my shortcomings (step 7); etc? (Six of the 12 steps mention this higher power.) One person, a representative of the State Mental Hospital, said straight out that it was either that or stay in the program until you do.
The one place that did offer a different choice, oddly enough, was the Catholic hospital. We talked to a priest there, and the 12 steps were on a big poster behind him. No mention of a ‘higher power’ on that poster. It said GOD in red, capital letters. But the priest, when I asked, what if people don’t believe in god (and, wow, did others in the class look uncomfortable when I did), just said, ‘Well then, obviously, a 12-step program wouldn’t make sense for them. We have another program for folks who are not comfortable with the AA model. ‘
It pissed me off then, and it still does now, that these programs get public funding. Even if AA is free, lots of the treatment programs based on it, are not. It’s been years since I’ve known anyone who’s gone through residential addiction treatment, so maybe things have changed, but not that I’m aware of. The only way some folks I knew were able to get out was to ‘get with the program’, whether they bought it or not.
@Caine ”
That would make sense if there was even one major, widespread secular program. There isn’t.”
And that is AA’s fault how?
What I see several people doing here is conflating the behavior of some bad actors with AA itself. That’s just like claiming all atheists act like Michael Shermer. Yes, AA has its share of thirteenth steppers, people with all kinds of emotional and social baggage (would hardly work if it did not), hypocrites, scammers, etc. In one group I know of, there was even a pyramid scheme. Please show me, however, any organization or belief system with thousands of members in which everyone is 100% trustworthy.
The lack of trustworthy data on AA/its success rate is very frustrating, I agree. But in the absence of that, many people seem to be using their own misinformation, prejudices, and anecdotes to confirm their own anti-AA biases here. Which would seem to be the opposite of what skepticism is all about.
Here’s another piece of data for you. I’m a committed atheist. I attend and have attended many different AA meetings in cities all over the country over the past 14 years. Never ONCE have I been made to feel pressure to be Christian, or felt that I would be shunned if I drank, or that I should be less outspoken about my atheism.
Yes, I agree that more overtly secular sobriety organizations should exist. But don’t blame AA for not creating them.
Bullshit. There is NO credible study of AA success rates. Anyone who says AA is %-(un)successful is full of shit and is trying to sell you something. Prove me wrong and show me a methodologically-rigorous double-blind study (spoiler: the only “studies” you’ll find are anecdotal or severely flawed methodologies).
Anyone who says AA is the only way to stop drinking is full of shit and trying to sell you something.
@36 – A common trend in a lot of the comments is that many don’t even seem to understand how AA operates. A lot of people seem to think AA is this monolithic organization sending its acolytes to start meetings all over, when in reality, the central AA organization is little more than a publishing house. Every group is different and the way it operates depends almost entirely on the members of that particular group.
This is also another reason to suspect studies which make claims about AA as a whole, because AA groups differ so drastically. It’s also why most studies of AA (including the linked one based on the interview…I haven’t read he book) are actually studies of 12 step programs in general, and they conpletely ignore the fellowship aspect of AA, which IMO is most important.
So it’s like Abstinence Only “education”? 100% fail proof in a world where people aren’t made out of humans…
I once looked for a group that would support family members of alcoholics but got pissed off because AA was the only game in town and christianity was painted big on their internet frontdoor.
+++
You know, I’m not very convinced of this. Because it sounds to me like people kidding themselves about how successful they are when they fucking aren’t. Why do I think this? My mother’s an alcoholic and for the last couple of yeras that’s exactly what she’s been doing (without the AA): stay sober for a while and convince herself and dad that “now she made it”. When my sister and I say “look, now that you’re sober and able to think rational again, why don’t you go and see a professional?*” we are the baddies because we don’t believe in her and her success. She did it! She made it! She’s been sober for a full Insert Timeframe Here. Until she gets drunk again, which inevitably happens.
You know, if you keep doing X and you fail and fail and fail again then somebody encouraging you to keep doing X instead of trying something else is actually doing harm.
*This is Germany. Universal health insurance. No excuses
I’m a little surprised to see AA mentioned on pharyngula. But then again, it seems like anything with religious overtones is fair game here. So I understand why it might be a topic of contention.
Speaking as an ex-addict who actually went through the AA program: I feel like I might have something to say.
AA helped me immensely. And I saw it helping those around me. If you’ve never actually completed the steps, then it’s very easy to criticize the program…
Speaking to the 5% success rate ( I doubt it is as high as 10%): It is my understanding that the success rate percentage is based on the relapse rate of it’s participants. As mentioned in previous comments, these figures come from self-reporting of addicts / alcoholics, state and county figures (as in when a previous offender gets arrested again, etc.) and other sources. There’s no way to accurately gauge the program’s success rate based on such estimated numbers.
To my mind it is common knowledge (in AA at least) that most, if not all people struggling with substance abuse will relapse at some point. Cold Turkey doesn’t work well for most. Just like with cigarette smoking, studies show that people who quit smoking most often struggled with it. They had episodes of falling back into the smoking behavior. It’s very common. How often do you meet someone who says they just quit smoking cold turkey, and that was that?? My point being: if you use the criteria of whether a person relapses to create data… then the AA success rate would be less than 5 %. The thing is: AA works very well for those who stick with it and keep trying. AA has a much higher success rate over the long haul. And the sad truth is: that measly 5% figure is actually much higher than the success rate for other programs. What other programs you ask? Precisely. There are expensive rehab centers where wealthier individuals can go. They have acupuncturists and tennis courts. They have beaches and meditation. And they have horrible success rates. Other than that, there is not much to choose from in the way of recovery. The difference with AA? Well, it’s essentially free and available to everyone. Donate what you can, if you can, when you can. Just enough to keep the meeting space open. No one is getting rich off of AA.
AA provides an environment where one can educate themselves about their addictive behavior patterns. And a program that helps you change. If it sounds a little brain-washy, well the joke in AA is “your brain might benefit from a little washing, lol.”
I struggled mightily with the God (Higher Power) concept. Luckily I fell in with an atheist sponsor / mentor. He told me the god stuff was all bullshit. But if I followed the “principles” of the program I’d have a chance at staying clean. The principles are all about self-awareness and personal growth. I learned how to be a grown-up in AA meetings. I learned to take responsibility for my actions. I was able to model healthy behaviors from my sponsors and friends. Things like going out to eat after meetings. Going to the beach as a group. Helping other addicts in the throes of withdrawal. Calling my sponsor, or someone in AA when I was deeply struggling. Talk about a support system. I never had relatives or friends that I could speak to about my addiction. “Normal” people don’t understand addiction. And there is a huge stigma associated with it. It’s common to see people sneering “addicts are weak, with no self control.” That may be true. But where is someone supposed to go when they are in that state?? Just walking away from substance abuse is not a realistic solution. People need help from others who have been there before.
I’m not trying to say AA is the only way out there. Or that it is a be-all cure for what ails you. I’m just trying to give a little balance to all the negative comments I was reading. Someone who is suffering might be reading your comments. And it could lead them away from a potentially life-saving option of assistance.
“They say I drink too much, but I know I’m not an alcoholic. The alcoholics go to those meetings.”
A joke quite common in Ireland: “Definition of an alcoholic: someone who drinks more than their doctor”
(National stereotypes notwithstanding, per-capita consumption of alcohol in Ireland was quite low for much of the 20th century– in fact, there was a significant percentage of the population who took “the pledge” and abstained from alcohol for religious reasons. The pubs still close here on Good Friday)
I guess I should first say that I attend AA meetings, but am fairly new. That being said, of course the program should be open to critique. What confuses me, I suppose, is how one measures the “success” of these programs. I fully believe there is no cure to chemical dependency. If someone is sober for ten years, but then starts using again, is that a “failure?” Or are the ten years some form of success? And how short do we make the term? I know that AA has stopped me from drinking in the past. Will it stop me in the future? I have no idea. I know that I don’t know what else I could do at the moment.
As someone who has struggled with alcohol issues in the past, I think there are two main problems with the AA approach, as well as the general more secular approaches.
1. The assumption that once an alcoholic always an alcoholic
2. The assumption that complete abstinence is the only solution.
When one’s life is consumed by alcohol to the point that it has a detrimental effect on their health, relationships career etc… it is invariably because they are consuming too much alcohol too often. It is not the consumption in isolation that is the problem.
Furthermore, the addiction is usually a symptom of a larger problem, not the problem it’s self, which most treatment programs, especially 12 step, fail to recognize. I went to a lot of therapy to uncover the root causes for my need to engage in self destructive behavior, of which copious consumption of alcohol and all of the negative side affects associated with it was just one, and I can now comfortably drink in moderation with out feeling like a failure for doing so.
Addiction is complicated. Complete abstinence is a blunt bludgeon for a problem that requires surgical precision to extract.
I’ve been through the whole range of opinions about AA. I couldn’t stand the religious angle – and it is Christian. It is based on a Christian program, but I found worth by sharing that I’m an atheist, and that alone drew many hopeless people to feel less alienated, for many people there assumed the opinion that AA couldn’t help them because they were not religious.
It’s to bad that the fundamental basis of the program is that you are powerless and that you need this higher power to SPIRITUALLY heal you. For me, the definition of spirituality is a sense of being alive and belonging, having a purpose.
They put great emphasis on helping people, by contributing where you can starting out with making coffee and setting up the chairs etc. These little efforts creates a situation where you feel some worth at doing something constructive, no matter how small the effort, and it brings you closer to people that take the time to say thanks, and more so, start a mild conversation – ‘what’s your name,’ your new here, how do you find it,’ and it opens a door to relating to people on a non asocial manner. It is a bridge to become more inclusive in this group of people that seem (some are) genuinely concerned about your well being. This isn’t for everyone for some are very far gone when it comes to social skills, but that fact is rthat it helped me, if only for the moment and the length of the meeting, to get a sense of hope that I actually felt good contributing my little chore. When I was living on the street, I hung around with some very socially inept (read emotionally and socially immature and badly hurting with anger and or other unpredictable shit like dishonesty and never knowing whose going to rip you off or kick your head in next).
And it didn’t matter, once I started AA (I was a pretty irregular attender) I had one option to utilize when I needed to get away from the despair and fucking fear and completely unsettled and chaotic atmosphere I inhabited the rest of the time.
AAA provides a structure. It is as simple as that. I had no structure but to live minute by minute, hour to hour just trying to find some place to spend time besides walking around – which actually was a purposeful endeavor in itself. Trying to find a meal, a place to sit without getting kicked out for falling asleep, and lining up at a shelter to get a mat to sleep on and a sandwich.
Yeah, I got into AA and always felt a place to call home – for a while, until I started getting bent out of shape with resentments at some of the fools and what they said in meetings, the cloying atmosphere of fucking religion and listening to people wax on about how they needed to try harder to get in touch with their higher power – an almost inevitably futile endeavor because hey, there is no such thing. No wonder people struggled with that.
I tried doing the steps when I was in several or other treatments centers, and I could see the point behind them. Step three is little more than making a New Years resolution to live a sober and productive life, and we all know how successful resolutions are. But at meetings I was surrounded by people trying to achieve the same thing – become hopeful and purposeful individuals, no matter how stunned I thought their thinking was, personally. There is something about being with people that not only have a purpose, but a common one at that, just as a foil to the unending hopelessness and futility of the rest of the people I knew and hung around with.
I grew to really despise AA, because it all started to seem so phony and contrived, but of course I was exhibiting confirmation bias and it was really an expression of the program not helping me, or more importantly, I wanted to get fucking shitfaced on alcohol, heroin, and IV cocaine because I was one of the ones that deep down loved getting high more than anything possible and no matter how much “effort” I put in, in my heart I absolutely wanted to get high, even though I repressed that desire deeply, I thought, it remained the motivating factor that I could always count on. People can say they want to quit, they can see the allure of a healthy life, both socially and financially or of helping others, but when you feel slightly out of control, or stressed, or bored, or have free money, or your friends want to get together – these things are perhaps the most deeply ingrained aspect of your personality – of your being. It is your self identity.
You usually become very strongly disillusioned that AA can ‘save’ you because it is not a magic bullet like it is portrayed at first, and many people have that expectation here right now. It is a completely unreal expectation that you can change such a fundamental part of your being in less than many years of practice and behavioral work. Even repeated relapsing (there is a stigma of this being failed, be some people and yourself) and continuing back into treatment and AA is almost inevitable, but it creates a sense of futility alienation, and I’d figure that almost everyone gives up at some point as perceiving the program isn’t going to work.
And it isn’t going to work. The gigantic attitude around drug treatment and expectations of the addict going in is that just by attending, and following some steps(many of them bogus) is that the program – THE PROGRAM – and merely attending, with ‘cure you
I read somewhere that people quit because all of a sudden, or in a certain time frame, they just grow out of it, they finally reach a point where they’ve had enough, and drinking and using loses it’s appeal and all the hassle (I mentioned above) is to much hassle and you become unwilling to subject yourself to that any more. I hears that more people quit that way than through, although I’d sure like to know exactly how they compare the strength of addictions, and other numerous variables.
Personally, that is 100% what happened to me. I woke up in the hospital and had only skimpy shorts to wear, a t-shirt, jacket, worn shoes, and it was cold and rainy outside. They said they were releasing me, and I didn’t want to go, partly because my bed was comfy and they had food, but mostly because I couldn’t stop thinking, “Here we go, back to the same old shit. I have nowhere to go, and the fucking street has no food and shelter forme, and they people, the people, I could not handle any more of the mountainous quantities of immature dolts, and suddenly it all seemed so terribly immature – I mean I realized I wasn’t cool, just some fucks thought I was. We were all so fucking cool with the handshake shite and wassup lingo and blech!
Anyways, this is getting to be a bit much about me, but I will get to the point.
So I got out of the hospital, and I walked straight to a homeless shelter where they also offered a recovery treatment program that was a years long. I went and applied, because I wanted to, I wanted to genuinely do what it takes and I knew it would work because I had my power to make decisions, not what AA teaches.
You want to know how dedicated I was to getting into a program? Largely it was a place to stay, but I wanted to do all the work.
I decided to listen to everything they had to teach and not be judgmental, just learn what I could, do assigned work without complaint, in fact enjoy doing a good job (sometimes cleaning toilets LMAO – but were they ever clean when I was dome har har) , go to all the fricken meetings as AA was a part of the program, 3 meetings a day.
Now everybody get this: it was an Evangelical program, christ is that ironic! Man, I had to bite my tongue a lot, but I also tried to get the meaning of some of the bible we studied. I pointed things out, of course, but it was a blast, and an exquisite opportunity to learn the bible!
That place was the same. I think it held between 30 to 60 people, and they would get about let’s say 3 – 5 newcomers every week. Maybe about 4 or 5 times a year, they had an informal ceremony where someone would a 1 year pin for completing the program that long (there wasn’t really a specific endpoint, just that you had participated). Thing is, that when people relapsed, they had some Church restoration meeting to see if the guy could come back into the program. These happened within a couple days of transgression and virtually everyone was restored to full status and continued on with the program.
Let’s do math. Say three people join a week, that’s ~1000 people. Many are repeats so let’s say 600 new people. Say then that 6 people get their medallion = 1% success rate. BUT, I’m guessing 2 – 4 also relapsed, because I recall they never said they pin was for a year of sobriety in the program, just for a year in good standing.
(Yes, I got mine – I had to wait two months(usually it’s three days) to get into the program and get a note from my doctor because they really didn’t think I was dedicated) and I didn’t get my pin for 16 months. It was clean and sober, and I fucking loved the idea that an atheist lived by Christian principles (well, honesty, respect, helpful, just socially decent, oh, didn’t chase women or talk about bitches all the time, etc) was one of the few to get recognized. On a side note, I would get into discussions about the bible with a pastor or somebody who though he was smarter than anyone, and he ended up recommending me for teaching a class on philosophy in the Bible! LMAO!!
In conclusion, I doubt very much that AA has a greater success rate than people just quitting on their own. The positive thing about meetings is that it can give a glimpse to experience a warm and trusting environment, and a place to go to relate to people about the most important personal characteristic and the most confounding and destructive. It gives you a sense of hope and camaraderie. But it teaches you that you are hopelessly weak WHEN IT COMES TO YOUR ADDICTION, and not your whole life. I wanted to make that distinction.
Ultimately, the steps are all a bunch of virtually nonsensical flim flam, and AA does not have success because these steps are ultimately provincial and higher power reliant, and are not really more than a band aid approach.
In fact, I very, very, very highly doubt there is any treatment, Betty Ford etc., than can create a lasting change in a persons character and personality. This takes years – 5 – 8 on average I’ve heard.
I have read that people up and deciding on their own have a better success rate than 12 step programs and treatment, but that doesn’t take into account the relative level of addiction and motivation and financial situation. Most people in AA and treatment can be from the bottom few percent of the population in terms of social standing and emotional maturity, whereas the rest of the population – 95% has varying abilities and many that would have the skills to quity on their own, just as a matter of probability.
Shit, I’ve been away for 1 or 2 years and I stll talk a lot. Sorry!
I could go into a lot of flaws and analysis about the negative aspects of AA, but everyone has done a fairly good job of that already.
I’m curious why the Sinclair method is not mentioned more frequently, in general, as a viable solution for alcoholism. According to Wikipedia, the use of opiate antagonists like Naltrexone as specified by this method “has been found to be successful in about 80% of alcoholics.” I’d say that’s a pretty interesting number.
Marcelo, that would imply that addictive behavior is a medical/public health issue, and not a moral one. Goes right against what society at large has come to believe, possibly due in part to the influence of 12 step principles.
The lack of discussion in the recovery and medical fields about medicinal ways of recovery is a little surprising to me as well. I believe one of the Scandinavian countries has adopted Naltrexone as an integral part of their alcohol addiction treatment (it’s not the Sinclair method though) but I cannot find the article I had read mentioning it and searching the Internet has been fruitless so far.
I suspect some sort of Pavlovian treatment, where your body is taught to associate alcohol consumption with bad things would be the most effective way of dealing with alcoholism and the Sonclair method seems to aim for that. It would be impossible to recommend to someone in the US at the moment simply because I wouldn’t know where to send them to get help with t.
VP @47:
I think nothing of the sort is involved. Claudia Christian describes the method in her biography, and she simply says that she takes her pill one hour before starting to drink when she knows she’s going some place where she knows she will, and he drinks a couple of glasses but the urge she felt when he wasn’t under medication doesn’t appear at all. And no Pavlovian conditioning is needed; is all brain chemicals. She enjoys those glasses she drinks; she doesn’t need to get wasted anymore.
Of course, this is no miracle cure; the dose needs to be adjusted to each case, and in some cases doesn’t work at all (hence the 80%).
She drinks, of course. (Is there any chance to enable the comment system to edit after posting? Damn.)
I’m late to the party, but just wanted to add that the phrase”If you don’t like it, don’t go there” or similar should die. Fast. It’s one of the most idiotic phrases used to shut down debate or sceptical inquiry.
In any discussion about AA, sooner or later we see some version of what I call the AA Two-Step by certain AA defenders. On the one hand, these defenders insist, AA is great, it works, it saves lives, why it saved their (or their spouse’s, relative’s, or friend’s) life, and what alternatives are you offering, etc. But on the other hand, when responding to specific criticisms, they insist that there’s no specific dogma, the Big Book and the 12 Steps are merely guidelines, take what you want and leave the rest, every group is different, etc.
Well, if AA is so amorphous and variable, then how can anyone make a statement about whether “it” works? How come these same defenders never limit their praise of AA to “well, my particular version and interpretation of AA, with the particular group or groups I attend, has worked”?
Pharyngulites will recognize this as being very similar to the religious apologetics often practiced by the more liberal believers: their definition of God is like nailing a jello to a wall, but somehow He’s still effective!
Screechymonkey. Does exercise work? Does gardening work? Does yoga work? Acceptable answers can include, “it worked for me!” “sometimes yes, sometimes no” “it’s a load of BS”, etc. Each person or “defender” of these practices HAS to rely on her own particular version and interpretation of what that activity entails because of the very nature of the activity. AA is the same.
jennyjfwlucy
No. This is exactly why we need data. Good data, lots of data. Because “it worked for me” is not a reasonable basis for public health decisions. If the AA works, for whom does it work? Do people whose feet are larger than average* for their height have a 10% success rate but people with smaller feet only a 2% chance? And is there maybe a different treatment that is better for small foot people? Does it work better than doing nothing?
If we really want to improve treatment for addicts we need to know what helps whom. Unless you think that since it helped you the other 95% can fuck off and die, because that’s usually the end of alcoholism.
Look, nobody says there’s an easy solution. We know that treatment for alcoholism has abysmal failure rates. I know from actual professionals that they are calculating with an average of TEN attempts. If all that data doesn’t say to you “we need to know better, we need better treatment and therefore we need to look at ALL approaches critically” I can’t help you.
*I’m making up nonsense criteria ‘Cause I don’t want to speculate
Data would be fantastic. Data is great. I love data. All power to those who collect data. I also support alternative programs. I was responding directly to screechymonkey’s query about the nature of an “it” that “works.”
And it’s kind of a stretch to imply that just because AA works for some people that said people no longer care about those for whom it doesn’t. Having heard many and lived a few addiction nightmares, I don’t think there are any people in AA who would mind dozens of other options being offered.
ALL of us know an alcoholic who desperately needs help, but won’t come into the rooms “because of the God thing.” Try as we might to explain that “the God thing” is 100% optional, they won’t believe us.
And frankly, the misrepresentation of AA as uniformly religious/Christian by people who don’t know what they are talking about or who rely on anecdata from a few select sources pisses me off no end.
So, yeah, bring on the data! Whatever works for anybody. Please.
Well perhaps that’s because the first three steps of the 12-step program suggest that that claim is utter crap:
If you don’t want people refusing the help you think you can offer “because of the God thing”, then take God out of the program.
You’ve typed this without, I think, understanding it.
“a power greater than ourselves . . . [T}hose working the steps are free to choose whatever higher power works for them.”
This does not say Christian God. There are lots of powers greater than one person. A group of many people, for instance. Nature. Reality itself.The concept of rationality. The concept of kindness, or good. The concept of humanism. ANY of these are available to a person seeking a higher power.
Step 3’s crucial words, then, are “God AS WE UNDERSTOOD HIM.” My personal understanding of God is that there is no God or gods. There is no magic, only science. There is no external, intelligent, supernatural force guiding my life. And yet I have no problem using the program. This is also true of THOUSANDS and THOUSANDS of other people.
http://aaagnostica.org/2012/08/12/an-atheists-guide-to-12-step-recovery/
http://religion.blogs.cnn.com/2011/08/28/my-take-an-atheist-at-aa/
http://www.nytimes.com/2014/02/22/us/alcoholics-anonymous-without-the-religion.html?_r=0
Anyone still reading this thread, please take a look at these links. Secular AA is a real thing. It works for some people, and as I said earlier in the thread, it just kills me to see people who need and want help with their alcohol issues be scared off of AA by people who don’t really know what they are talking about.
jennyjfwlucy@57,
All you’re really saying is that the words don’t mean what they naturally appear to an outside observer to mean – they require the kind of tortured “interpretation” Christians apply to embarrassing biblical passages in order to be “understood” correctly. That’s the fault of the writer, not the reader.
Then change the wording so it’s not so readily misunderstood. Or is that, perhaps, not open to those oh-so-autonomous local groups to do?
Atheist with personal experience with AA.
The Higher Power part always made me crazy. Never did the steps. Was always told to use the group as my “higher power”. Never discouraged or told I would fail because of atheism. All meetings are local. Nobody has to give ANY money.
It is a place to go where you are welcomed with your problems, and not made to feel ashamed, guilty or blamed for addiction or relapse. This is a revelation to a newcomer. The “way it worked” for me is the telling of stories and the sharing of problems. AA meetings are essentially FREE THERAPY. How often does cognitive therapy work and by what measure? It is the only option for mental health that many people have. People are not allowed to interrupt for a reason when someone shares–they are allowed to tell their story, PERIOD. The commonalities of experience are the connections, and provide safe social friends, especially early in sobriety.
I ultimately stopped going after 5-6 years because I had my feet on the ground and sober friends. The Higher Power crap drove me out, especially when I moved to the south.
There should be other options than AA. But it is ubiquitous, free, and while you are in a meeting you are not drinking.
“Then change the wording so it’s not so readily misunderstood. Or is that, perhaps, not open to those oh-so-autonomous local groups to do?”
Actually it would be logistically very hard to do so. AAs are a super diverse and generally hard-headed group of people and coming to an agreement on revisions to the literature would be close to impossible, which is why there are still a lot of very sexist parts and obscure slang/cultural references in the Big Book and elsewhere.
jennyjfwlucy@60,
Then stop moaning about being misunderstood.