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AA is Faith-Based, Not Evidence-Based

Alcoholics Anonymous is the most widely used treatment for alcoholism. It is mandated by the courts, accepted by mainstream medicine, and required by insurance companies. AA is generally assumed to be the most effective treatment for alcoholism, or at least “an” effective treatment. That assumption is wrong.

We hear about a few success stories, but not about the many failures. AA’s own statistics show that after 6 months, 93% of new attendees have left the program. The research on AA is handily summarized in a Wikipedia article.  A recent Cochrane systematic review found no evidence that AA or other 12 step programs are effective.

In The Skeptic’s Dictionary, Bob Carroll comments:

Neither A.A. nor many other SATs [Substance Abuse Treatments] are based on science, nor do they seem interested in doing any scientific studies which might test whether the treatment they give is effective.

In the current issue of Free Inquiry, Steven Mohr has written a thorough and incisive article “Exposing the Myth of Alcoholics Anonymous.”

Mohr characterizes AA as a religious cult. The founder, Bill Wilson, had a religious experience while under the influence of strong psychotropic drugs.

He had a vision of a bright light and the revelation that he could be saved only by giving his life completely and fully to God – and that an important part of his recovery would be to bring the news of his epiphany and recovery to other suffering alcoholics.

The 12 steps of AA refer repeatedly to God. They require admitting you are powerless, accepting that only a Higher Power can help you, turning your will and your life over to God, taking a moral inventory, admitting your wrongs, being ready to let God remove your shortcomings, making amends to those you have harmed, improving your conscious contact with God through prayer and meditation, and spreading the word (proselytizing).

Criticism of the religious orientation led AA to switch emphasis from “God” to any “higher power.” One member allegedly designated a doorknob as his higher power and believed that praying to the doorknob helped him maintain sobriety.

There are other options for treatment. Inpatient programs, various medications, Secular Organizations for Sobriety. Curiously, the best treatment may be no treatment at all.

The 1992, the National Institute on Alcohol Abuse and Alcoholism’s National Longitudinal Alcohol Epidemiologic Survey studied 42,000 Americans. 4500 had been dependent on alcohol at some time in their lives. Of these, only 27% had had treatment of any kind, and one-third of those who had been treated were still abusing alcohol. Of those who had never had any treatment, only one-quarter were still abusing alcohol. George Bush is a well-known example of someone who stopped drinking on his own without attending AA and without admitting that he was an alcoholic.

According to Stanton Peele in Psychology Today,

the most successful treatments are nonconfrontational approaches that allow self-propelled change. Psychologists at the University of New Mexico led by William Miller tabulated every controlled study of alcoholism treatment they could find. They concluded that the leading therapy was barely a therapy at all but a quick encounter between patient and health-care worker in an ordinary medical setting. The intervention is sometimes as brief as a doctor looking at the results of liver-function tests and telling a patient to cut down on his drinking. Many patients then decide to cut back—and do!

A Cochrane systematic review confirmed the effectiveness of brief interventions.

Instead of telling people they are powerless, wouldn’t it make more sense to empower them and build on their strengths? Why not tell them they are stronger than alcohol and they can choose not to let it control them? Even if you prefer a religious approach, you could pray for God to support your strength to change your own life, taking full personal responsibility rather than passively turning over the responsibility to a higher power. The old adage “God helps those who help themselves” applies.

Instead of the religious model of sin, confession and absolution, what if we avoided harping on the past and started fresh, concentrating on the patient’s behavior today and in the future? Sure, make amends to those you have harmed for the bad things you have done, but why not put the emphasis on doing good things for other people today and tomorrow? Instead of being “ready to let God remove your shortcomings,” how about taking active steps to improve your own behavior? Why not build self-esteem instead of re-visiting past experiences that damaged self-esteem?

There have as yet been no scientific studies of Secular Organizations for Sobriety, but their approach seems more promising than AA’s. More and more physicians are routinely screening all patients for alcohol abuse: every time I go to a doctor’s office I am asked “Do you drink” and “How much?” By asking everyone these questions we may help prevent some cases of full-blown alcoholism by catching problem drinking early. More and more doctors are offering the brief interventions that science has shown to be effective.

Surely we can do better than AA. If three-quarters of alcoholics can stop drinking on their own with no treatment, we should be looking for ways to help them succeed rather than imposing a treatment that has not been proven effective and that may actually make things worse.

Posted in: Faith Healing & Spirituality, Science and Medicine

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78 thoughts on “AA is Faith-Based, Not Evidence-Based

  1. Mojo says:

    There was a thread about AA’s religious aspects in the Guardian’s “Comment is Free” section last month.

  2. Jojo says:

    I have always wondered about how successful AA is. I’ve known a number of people who have gone through it, and I’ve never understood how passing the responsibility to god was supposed to work. I have a close friend that is one of their success stories and anytime he comments that god helped him do it I always want to tell him that he really should be giving himself credit for making such big changes in his life.

  3. Scott says:

    Interestingly, the characterization of AA as non-religious is fundamentally the same thing as rebranding creationism as intelligent design. “Oh, it’s not REALLY God we’re talking about! *wink, wink, nudge, nudge*”

    Frankly I’m a bit surprised that there haven’t been lawsuits about court-mandated AA meetings violating the 1st Amendment. Or maybe there have, in which case I’m surprised I haven’t heard about them.

  4. fergie34711 says:

    Ha, I thought I was alone in seeing AA as way too faith-based. Guess I’m not.

    AA’s faith-based core is not a good idea. One thing that concerns me the most is that the courts can order a drunk driver to attend these meetings as a part of their punishment. While I have no problem with the courts ordering drunk drivers to go to rehab I do have a problem with the courts ordering people to rehab centers or support groups based on religious ideas.

    There are non-religious rehab centers that help and we should be using them.

  5. Harriet Hall says:

    It gets worse. In Albuquerque the Metropolitan Court is using taxpayer money to fund acupuncture as part of DWI treatments.

  6. fergie34711 says:

    Oh, why did you have to tell me that? Great more madness. I do not mind people going to AA and getting acupuncture if they want but why, oh, why are the courts getting involved with this? As I said there are better treatments that work that don’t have craziness involved. Is there a reason the courts are not using proven treatments instead of oddness?

  7. addiejd says:

    This system is unfortunately being adopted by therapists for treatment for other ailments as well. A few years ago I had a serious bout of depression and sought an intensive outpatient program. In one of the first group sessions I had I was told that I was unable to control my feelings and I needed to accept a higher power to help me treat my depression. In this program we were supposed to have daily goals, and my goal for that day was to be open minded about what I was hearing, as I am a very skeptical person (especially about psychology, as a lot of it is not scientifically proven to work), so I asked question after question trying to get this “higher power” to fit a definition that would jive with my non-theist, non-supernatural, non-spiritual view of the universe. The psychologist was unable to do so.

    I then asked the psychologist to explain why I was helpless to control my emotions, and that I didn’t enter this program to become powerless. I entered the program to gain the skills necessary to deal with my depression so I would not need to seek outside assistance again, and having a mindset of powerlessness was counterintuitive to that.

    He then replied that my higher power could really be anything I wanted it to be, even energy. I replied that energy is in everything and I thought it was idiotic to believe that a lump of coal or a gallon of gasoline could help motivate me to get out of bed in the morning and make me start eating again.

    I can quote what he said next because I loved the delicious contradiction in his sentence “You know, this is probably the most open-minded group you will ever be in, and you can NOT speak to us that way!” I believe he was getting a bit incensed.

    That was also the wrong thing to say to an Aspy, since I simply replied “Well, if you’re so open-minded, maybe you should be more open-minded to my alternative modes of communication.”

    At this point his face turned bright red, but, alas, he did not get a chance to respond since there was a fire drill.

    When the drill was over I went to the administration office instead of back to the group session to report what had happened.

    I love how I got a religious wackjob psychiatrist to completely lose his cool in front of his entire group therapy session; it’s one of my proudest moments. Unfortunately, that was really the only part of that intensive treatment program that was going to be of any use for me, so it was my last day; but I was smiling for the rest of *that* afternoon.

  8. Awesome article Harriet!

    I only wish that you’d posted it last year when we were required to shadow an AA meeting for our addicition medicine module. Why? Because the doctor teaching the module attends AA herself, so of course it works.

    It was disappointing to say the least.

  9. David Gorski says:

    It gets worse. In Albuquerque the Metropolitan Court is using taxpayer money to fund acupuncture as part of DWI treatments.

    The City of Baltimore is using acupuncture on inmates with addictions to try to cure them. The program has zero evidence that it makes a difference:

    http://scienceblogs.com/insolence/2009/03/subjecting_prisoners_to_quackery.php

  10. Joe says:

    Social critic Wendy Kaminer has a chapter on this in her excellent book “I’m Dysfunctional, You’re Dysfunctional” (Addison Wesley, 1992).

  11. MBoaz says:

    Great article.
    If anyone here likes South Park, they did an episode about AA that, as I recall, touched on some of the issues addressed here.

    http://www.southparkstudios.com/guide/914/

  12. Dr Benway says:

    At the APA reporting in. The Wi-Fi has epilepsy so I must type rapidly.

    Too bad there’s no printer. It might be fun, planting a few copies of this article near the AA booth.

    The AA booth is near the Anti-Aging booth where you can learn your Real Age.

    Thursday at 11:00 am, our friend Dean Ornish will be giving the “Frontiers of Science” lecture on The Power of Personalized Lifestyle Changes. Can’t decide if I ought to make myself sit through the science-lite or not.

    Feels like junior high here. Last night, hundreds of MDs were turned away from the single industry symposium on depression. People qued up 1-2 hours prior to the talk to get in. At the last San Fran APA, 3-4 or these events ran at the same time so no one was turned away.

    I’m told our British colleagues cleaned all pharma sponsorship out. Consequently, their most recent meeting completely sucked ass (in contrast to this APA, which only half sucks).

    Let’s face it: pharma’s got the bucks. They can afford quality AV equipment, seating, and a polished presentation. Without their money we’re gonna be brown bagging it at some dingy hospital with mics that cut out.

    I haz rage.

    Time for the anti-pharma humiliation to hit the interventional radiologists, ophthalmologists, orthopods, and cardiologists. Let those guys deal with it for a change.

    On a happier note: the titmouse got up during a Q&A and invited people to visit sciencebasedmedicine.org. Hopefully y’alls will get some new visitors.

  13. Jules says:

    Addiction is an imprecise science at best. Someone who has a “problem” with taking one too many highballs isn’t necessarily an addict. They may simply not realize how many highballs they have in any given week. I would argue that the person who is incapable of functioning without his daily glass of wine has a bigger problem. Someone may decide that they are, in fact, drinking too much, and they may decide to seek AA for help in cutting back, only to realize that they’re not at that stage where they’re weeping into their cats, and all they need to do is dump out the brewskies. I actually think most people who attend their first AA meeting are at this stage, but of course I don’t really know. I do know that the AA meeting I was required to sit through consisted mostly of long-time drinkers who’d also been sober for 2, 3 months–and one guy who slipped the night before (and he was a wreck).

    It’s been shown time and again that the most effective treatment for addiction (such as can be said to exist) is also not science-based. It’s having the support of friends, family–and someone who’s gone through the trial before. This, I think, is what AA offers for 99% of the people who go to the meetings, and continue to go. Given that we have an extremely limited understanding of addiction mechanisms, and an even more limited selection of drugs and therapies available, I find it hard to fathom why anybody would be against AA. Yes, it’s “cure rate” may be pitiable–but at least it’s there (by your own numbers, 70% of those who seek treatment stop drinking, which is fair enough for me). You would have addicts try a non-faith-based remedy/therapy, when there’s no evidence that it works? Because there has to be something better? Now that sounds like wishful thinking.

    But let’s consider: what else is out there? Drug therapy, and treatment centers–which run the gamut from state-of-the-art to places I wouldn’t trust with a pet rock. Drug therapy is largely ineffectual (I remember 40% as being the “cure” rate for cigarette smoking–and that was in conjunction with therapy), and treatment centers are costly if you have insurance for them, and unthinkable if you don’t. If you have insurance, then they will pick and choose the criteria by which you are judged to be “cured”, even if you’re not. The one advantage to AA meetings is that it’s so constant. A meeting in Budapest will have the same elements as a meeting in San Francisco. There will always be someone who knows what you’re going through, and someone you can talk to. That’s more than a lot of people have–never mind if they’re alcoholics.

    Undoubtedly there are individual chapters that are a sight more creepy than others. But generally speaking that’s not what AA is about. The meeting I had to attend offered a listening ear and a calm environment and a quiet ritual that reminded the alcoholics of their ultimate goal: sobriety.

    And y’know what? Trading the hallucinations and blackouts induced by alcohol/drugs for a door knob god that keeps you sober sounds like a fairly sweet deal to me. Addiction, by any standard, is far worse than a pet eccentricity.

    PS: You did the math wrong. 27% of 4500 is 1215–people in treatment. Meaning 3285 never sought treatment. Of those, 821 were still using. Meaning that 2464 of them stopped drinking on their own, without treatment. This amounts to 55% of alcoholics who were able to stop drinking on their own, without treatment. It’d have been more precise to say “if 75% of alcoholics who didn’t seek treatment can stop”.

  14. fergie34711 says:

    Oh, well I personally am not against AA. Just the court ordered approval of it for drunk drivers and the like. AA is faith-based totally and completely. This does not mean it does not ‘work’ or help people. It just means I don’t want the courts ordering people to faith-based rehab centers when there are plenty of totally secular rehab centers that can do the job that AA does just as well.

  15. DarwynJackson says:

    I remember asking similar questions of the AA director when sitting in on meetings as part of a Psych rotation. I was surprised by how quickly the AA proponents became defensive, if not completely enraged, at the idea that someone would question the need for religious slant or inquire about evidence-based studies.

    I distinctly recall struggling to restrain laughter when I read that one of the “signs” of needing AA intervention was “When I think that I can think for myself, I need a meeting.”

  16. Harriet Hall says:

    Jules said, “It’s been shown time and again that the most effective treatment for addiction (such as can be said to exist) is also not science-based. It’s having the support of friends, family–and someone who’s gone through the trial before.”
    That sounds very reasonable, but I couldn’t find any evidence to that effect. Do you have citations?

    My biggest objection to AA is that they tell members they are “powerless.” Why not combine supportive friends, someone who’s gone through the trial before, and telling people they are strong and can take control of their own life, encouraging them to identify their strengths and build on them, and to change their behavior in the here and now, getting positive reinforcement at every step?

  17. crescentdave says:

    Harriet Hall has made so many factual mistakes, it’s hard to tell where to start. There are so many factual mistakes in the comments section, it’s hard to tell where to stop.

    I’ll just point out one, from the very beginning of her post, from her citation in Wikipedia which supposedly summarized studies showing AA didn’t work: “Another study compared data from eleven of Project Match’s clinical sites in regards to AA attendance. Increased AA attendance was associated with increased abstinence, reduction in alcohol-related consequences, and psychosocial improvement.”

    Let’s ignore that. ‘Nuff said. Except … studies do seem to show, high levels of involvement in AA seem to lead to more favorable outcomes in terms of abstinence and/or alcohol dependence. FYI, project MATCH was the largest metastudy on this particular issue, ever undertaken.

    But what type of alcoholic are we talking about? Fully 90% of the topography of what is referred to as alcoholism is situational or short-term or developmental. A point is reached, a line is crossed and alcohol no longer makes any sense. That leaves somewhere between 8-10% of that population … a minority of a minority, who seem to do better under AA than other approaches. And even here … there are conflicting studies. People willing to do research (as opposed to “internet cut & paste kludgery” will seen numerous examples of conflicting mini-studies.

    To refer to this entity you call “alcoholism” as some sort of unitary phenomenon is absurd. To ignore the increasing number of rulings from state supreme courts to district circuit courts that AA can be considered religious and therefore cannot be court ordered is an absurdity. The writing is on the wall. Even in states where the issue hasn’t been litigated, county/city jurisprudence is backing away from court ordering anyone into AA.

    Oh yeah … that 93% of people leaving AA figure culled from AA research? It wouldn’t be that mythical figure conflated by Melanie Solomon and others, citing unscientific, voluntary, internal questionnaires supposedly taken from 1977-1989, would it? 5 unscientific self-surveys over 12 years, the last being 20 years ago is proof of … ? This is the best you’ve got? Have you ever had to do reputable research? Guess not.

    Congrats on cherry picking data. Pharmaceutical companies do it all the time and make a lot of money while avoiding, hopefully, too many lawsuits or government action. But let’s not kid around here … this was a shoddy article with much too broad of a subject. As if “alcoholism” were a narrowly, scientifically defined subject. As if there weren’t an emerging judicial consensus of AA being regarded as a religion.

    I am an atheist. I am also an alcoholic. AA’s approach does not provide me nor many others a lasting solution. It does, however, provide some people with a safety net. Why do some courts still refer people to AA? Maybe because it has some salutory affect … mostly, I suspect, because it doesn’t cost the state any money. And when it comes to treating humans in this society, the less money the better.

    The real culprits here are the courts, the big business of recovery and people who haven’t read what appears on most introductions to AA meetings: “If you have decided you want what we have and are willing to go to any length to get it-then you are ready to take certain steps.”

    By all means don’t want what they want. By all means don’t take any “certain steps.” But if you have a problem with the courts telling you to go … then it’s a violation of the separation of church and state and can be contested. BTW, you’ll win. This argument has been fought on both coasts and having reached the state supreme court, hasn’t lost yet. It’s been held in at least two circuit courts.

  18. pec says:

    About half the research described in the Wikipedia article showed AA to be at least as effective as other treatments. I would not expect people ordered to AA by the courts, or atheists. to benefit from AA. The 12 steps — which are really just a distillation of ancient mystical traditions — are helpful for many people, as long as they are spiritually open.

    “My biggest objection to AA is that they tell members they are “powerless.” Why not combine supportive friends, someone who’s gone through the trial before, and telling people they are strong and can take control of their own life, encouraging them to identify their strengths and build on them, and to change their behavior in the here and now, getting positive reinforcement at every step?”

    You don’t know anything about generic mysticism or the philosophy underlying the 12 steps. It depends on the idea that our “self” has more than one level or aspect. The “higher power” or “higher self” is our better, wiser aspect, not something separate from us. It can also be thought of as a god, or Jesus, or guiding spirit — but these are not considered separate from us, on a higher level.

    In your limited materialist view of reality, the 12 steps would not make any sense. This kind of philosophy would never appeal to atheists, or to people who are extremely down to earth and without spiritual feelings.

  19. Bookman says:

    AA is indeed faith-based (though some cities have Atheist/Agnostic/Freethinker groups). It is galling that courts force people to go to AA for their treatment when it is really a support group, not rehab.

    I don’t quite understand the objection to admitting one is powerless over the addiction — isn’t ‘powerlessness’ the very definition of addiction? The goal, I think, of admitting powerlessness is to get the individual to realize they need help and should stop trying to do it on their own. One of the biggest roadblocks in treating an addict it getting them to admit they have a problem in the first place. It seems to me to be one of the 12-steps that actually makes a lot of sense. Unfortunately, AA then says you have to seek a the help of god. You could say that ‘god’ is the methadone of AA — simply replacing one addiction with another. Not very healthy, and I know that the religion turns off a lot of people who really need help and support for their problem.

    More science-based programs are needed, but they don’t seem to be widely available.

  20. sleepycat says:

    To label AA as a “religious cult” is a gross misrepresentation. I am an atheist and attend AA meetings. The concept of higher power is simply an acknowledgment that the world is a bigger place then simply yourself; addicts and alcoholics have always been extremely focused on their own self interest and instant gratification, and part of the process of recovery is realizing that you are not the center of a world that you perceive as having wronged you or owes you anything. There is absolutely no prerequisite for religion or God, it is not expected, nor is it suggested. As the majority of the population is religious however, many will use that. But to suggest that there is some proselytizing, secret understanding that this is a Christian organization (even if some misguided Christian members believe that, and that is a small minority), or expectation of a “seeing the light” moment is rubbish and reflects only a fabulous ignorance regarding how AA works. For whatever reason people seem to be threatened by AA, and among those who are not familiar with it there is a tremendous amount of misunderstanding.

    AA does work for some, and has completely changed lives. It’s success rates are miserable, but other forms of treatment are just as or even more wretched, which attest to the difficulty in treating addiction. As yet there is no strictly science based treatment that offers any real efficacy. The 12 steps are nothing new, but simply a reorginaztion of basic concepts that have been used in therapy and cultures for ages to help people.

    The comment in the article condemning “powerlessness” does not understand what is even meant by it in the context of that step – it refers to the understanding that as an alcoholic you are not going to simply be able to “will” yourself to stop drinking by yourself – that you need support – and here it does not automatically refer to God, but even to just the people you meet through the meetings, social activities and new friends that understand where you are coming from and struggles you are going through. Even if one gets nothing from the meetings themselves, being able to be around others and enriching their lives with sober friends is tremendously helpful, and is not available through other forms of treatment.

  21. Harriet Hall says:

    They are not powerless over the addiction. They have the power to change their behavior and to refuse to drink. They exercise that power in AA; isn’t that what it’s all about?
    Even if they believe God is deciding for them and helping them refuse that next drink, they are the ones who are actually carrying out the behavior. What’s wrong with emphasizing that?

    Admitting you have a problem is not synonymous with admitting you are powerless. Neither is asking for help with your problem.

  22. Basiorana says:

    I have never met anyone for whom AA worked, and I’ve met a LOT of people who thought it was BS. Many of them did stop drinking in the program, but they said getting out of the program once they were no longer having problems with alcoholism was met with severe resistance– even if they originally intended to come back if they slipped.

    I will say, though, many people need a lesson in powerlessness, particularly in mental health. I would give anything to teach one person I know that he is not always in control, because when he’s not in control but thinks he is he blames himself for things he could not control (like tripping over something or an allergic reaction), and then he’ll spiral into depression and stop eating. And he will never, ever ask for help. A lot of people need to learn that powerlessness is okay, asking for help is okay. It doesn’t have to mean God is in control– sometimes it’s as simple as “you can’t stop having a mental illness, stop blaming yourself for being a sinner and get to work changing it.”

  23. Harriet Hall says:

    Basiorana,

    I think you and I basically agree except for semantics.
    You said
    “sometimes it’s as simple as “you can’t stop having a mental illness, stop blaming yourself for being a sinner and get to work changing it.”
    and that is essentially the approach I was recommending for alcoholism. Of course you don’t have the power to change your genes or your history or prevent the workings of chance – but you do have the power to play your best game with the cards you have been dealt. (And that may include asking for help).Guilt feelings, taking the blame, and obsessing over past sins are all counterproductive.

  24. nhs76 says:

    The only thing worse than the “higher power” claptrap is people who chatter incessantly about their “demons”. How they gave in to their “demons”. How they overcame their “demons”. How they accepted that their “demons” are part of them.

    Talk about avoiding responsibility. Crikey.

  25. Harriet, this was a great article. I’ve always had a feeling that recidivism of alcoholic was small and constant across therapies. Now I know that my feeling is now justified by a scientific study.

    However, learning that AA is really a religious exercise is just wrong. I agree with one of the earlier comments, judges sentencing individuals to AA are obviously in violation of the Establishment Clause of the First Amendment of the US Constitution.

  26. @crescentdave. Once you invoke that you got your knowledge from Wikipedia, you have failed. Wikipedia is about as useless a reference source as one can find for anything medical.

    And using the old “Big Pharma” argument as a strawman makes no sense to me because a) Big Pharma does not cherry pick data, and b) neither does Harriet.

    I appreciate the fight you have with alcoholism. But a doctor telling you to stop drinking apparently works better than AA. It’s a behavioral issue, not a religious one.

  27. Basiorana says:

    Harriet,

    Yes, I agree, but I think that’s why AA appeals to people at first. Alcoholism was traditionally not considered a disease, but rather a character flaw (like most mental illnesses), and I think a lot of people still believe it’s 100% in their control, so they don’t need to talk about it or get help. It’s just too bad that that relatively good idea– teach people that it IS something to get help for, and they AREN’T always able to do it all themselves– was warped into weird religious ideas about how it’s all God’s decisions.

    nhs76,

    Replace “demons” with “character flaws.” They’re just personifying their weaknesses and their struggle to overcome them.

  28. Jules says:

    @ Harriet:

    They are not powerless over the addiction. They have the power to change their behavior and to refuse to drink.

    See, that’s where you’re wrong. Addiction is an insidiously difficult concept for people to grasp, because it involves a kamikaze’s attitude towards the substance you’re abusing, and the wiliness of a Cold War double agent to get it. From the firsthand accounts of many addicts that I’ve read (all after-the-fact) it’s not going too far to call them insane. To suggest that someone can just “switch it off” is to completely misunderstand the processes and neuropathology that underlies addiction.

    Eventually, you are right–they do have the power to change their behavior. But it’s not a matter of exercising that power. It’s a matter of getting them to “see the light”.

  29. recoverylibrary says:

    There is no cure-all for alcoholism, and your article fails to point out that statistics for scientific treatment methods are just as grim.

    The AA program doesn’t believe in proselytizing…it is actually against the program to do that.

    Alcohol is defined as a chronic illness, meaning it doesn’t go away. So the people mentioned in the article who stopped drinking on their own were not alcoholics. Dependence on drinking can occur temporarily based on trauma or other factors.

    A study from the scientific (“evidence-based”) journal Addiction (Volume 98 Issue 8, Pages 1043 – 1051, Published Online: 8 Sep 2003) followed the drinking habits of 456 socially disadvantaged men and 268 Harvard undergraduated for 60 years. The reason why most of them stopped is because they had died:

    “First, by age 70 chronic alcohol dependence was rare; this was due both to death and to stable abstinence. By age 70, 54% of the 72 successfully followed alcohol-dependent core city men had died, 32% were abstinent, 1% were controlled drinkers and only 12% were known to be still abusing alcohol. By age 70, 58% of the 19 successfully followed college alcohol-dependent men had died, 21% were abstinent, 10.5% were controlled drinkers and only 10.5% were known to be still abusing alcohol. Secondly, in both samples alcohol abuse could persist for decades without remission, death or progression to dependence. Thirdly, among both samples prior alcohol dependence and AA attendance were the two best predictors of sustained abstinence. Fourthly, few life-time symptoms of alcohol abuse were the best predictor of sustained return to controlled-drinking.”

    As for “catching cases of alcoholism early,” no alcoholic would answer any patient questionnaire honestly.

  30. Scott says:

    “The AA program doesn’t believe in proselytizing…it is actually against the program to do that.”

    Entirely untrue. It’s explicitly one of the steps (#12):

    “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.”

    Carrying the message of a spiritual awakening is quite precisely proselytizing.

  31. Bookman says:

    “More and more doctors are offering the brief interventions that science has shown to be effective.”

    I am skeptical that brief interventions are very effective for treatment of addiction and I hope that not many doctors believe that. While I don’t think that AA is the answer, I have found that many non-addicts just don’t understand the power of addiction. Obviously people sometimes do have the ability to stop, as long as they get help, but most people sadly are unable to maintain abstinence from their drug. A simple doctor’s visit may be the beginning of recovery, but staying clean/sober is a lifelong project.

  32. Harriet Hall says:

    Recoverylibrary said, “The AA program doesn’t believe in proselytizing.”
    The 12th step says “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics.”

    “Alcohol is defined as a chronic illness, meaning it doesn’t go away. So the people mentioned in the article who stopped drinking on their own were not alcoholics.” This statement would get an F in Logic 101. By your reasoning, people who stopped drinking with the help of AA were not alcoholics either.

    Chronic illnesses can go away. The Chronic Illness Alliance defines a chronic disease as “…an illness that is permanent or lasts a long time. It may get slowly worse over time. It may lead to death, or it may finally go away. It may cause permanent changes to the body. It will certainly affect the person’s quality of life.” You have no way of knowing whether it went away in those who stopped on their own. And it might not have gone away; it might still be present but be under control and asymptomatic as long as the person doesn’t ingest alcohol.

    Your logic is equivalent to “All dogs are brown. If your dog isn’t brown, he isn’t really a dog.”

    As for “catching alcoholism early” there are validated questionnaires like the CAGE questionnaire that have proven useful.

  33. Prometheus says:

    Harriet,

    Of course, AA is faith-based and not science- or evidence-based – they say so right in their book! However, their book also has some claims to effectiveness that cannot be supported by data.

    The very idea of gathering useful data from a society that is founded on anonymity (it’s the second “A” in “AA”) is laughable. For any AA member or officer to claim that they have any idea of their effectiveness is ludicrous.

    AA may “work” for some people. I have no argument with that. Other religions may “work”, as well, but I haven’t heard of the Baptists (for instance) claiming that they are the only way to treat alcoholism. AA does.

    The gradual insinuation of AA into the legal system – as evidenced by court-mandated AA meetings – is disturbing on many levels.

    First, of course, is the idea of court-mandated attendance at religious services, which is what an AA meeting is. The fact that AA is (or claims to be) non-denominational does not change its inherently religious nature. Whether they call it “God”, “Higher Power” or “Flying Spaghetti Monster”, it is all religion. For those who reject the notion of a “God” or “Higher Power”, this is forced religious education.

    Second is the idea that attending the meetings of any group, be it AA or the Rotary Club, can give someone a “Get Out of Jail Free” card to avoid the consequences of a DUI or other intoxication-related crime is questionable at best. If mere attendance at AA (or the Rotary Club) meetings were shown (with data) to prevent recidivism, I could support it, but there is no data showing this.

    As a result, we are essentially hoping that the hassle and humiliation of having to attend AA meetings (and the other aspects of DUI “diversion” programs) will dissuade a sufficient number of people from re-offending more than a hefty fine or jail time would.

    If it is simply the hassle and humiliation that does the trick (as I suspect), society would be better off putting them in orange jump-suits and having them pick up litter along the highway for a number of weekends. At least we’d get clean roadsides out of it.

    I also question the willingness of the AA member and their officers to be a part of this farce. Surely, having people forced to go to their meetings cannot be to the benefit of AA members who are there because they believe “the program” is “working” for them. Why would they want a group of surly, resentful people cluttering up their meetings?

    Finally, there is nothing preventing people arrested for DUI or other intoxication-related crimes from attending AA meetings if the so choose. Most jails and prisons have internal AA meetings they could attend, even if they are incarcerated.

    One point about the “CAGE” questionaire – it only works if the patient gives honest answers. A person who is unaware that their drinking has reached a dangerous level may answer frankly, but someone whose drinking has led family or friends to express concern may not be always so open and honest. While the CAGE questionaire is useful, it cannot – by itself – detect an alcoholic who is trying to remain hidden – as many are.

    Prometheus

  34. Joe says:

    Comic Paula Poundstone was sentenced to AA on Court TV. According to her, that kinda blows the meaning of the second A.

  35. cdog46 says:

    I can’t stand it; so many people say AA is cult & frankly_I’ll show ome of my AA tolerance- anybody who thinks AA is a “cult” is ignorant, stupid, a bigot or worse.

    AA works for those who let it work. How hard is that for any of you morons to understand.

    That 93% rate may well be correct. So any of morons know the kill rate of full blown alcoholism? About 9 out of ten, Don’t mention that though. If you do AA’s rate starts to look very good.

    That of course is beside the point. I wopuld even start to debunk your notion of the AA cult BS because those who say it is are just plain stupid-and I mean really stupid.

    If AA saves peoples lives-which it happen to do better than any other treatment available-why would anyone be so stupid & ignorant to criticize judges who tell people convicted of alcohol related crimes.

    Do these morons think judges recommend AA because it’s a waste of tie. Hardly. I have never seen them order these people to go watch 3 stooges movies.

    And all AA recommends is that you find a higher power other than yourself. They don’t care w hat or who it is-some cult

  36. cdog46 says:

    And-if as this blog says we must do better than AA-why don’t you first answer the question of why no one has done “better than AA” in the last 60 years????!!!!!

    Don’t bother to try to answer or let facts get in your way> No organization INCLUDING organized medicine has done better.

    Wonder why I am so acerbic? It saved my life & I can’t stand to see ignorant people talk about an organization about which they KNOW NOTHING! They demonstrate this fact by calling it a faith group & the more they open their mouth the more they demonstrate this.

    How about a little AA principle. If you can’t help someone-don’t hurt them. Sort of like the Hippocratic oath-isn’t it!

    May be it’s time for some MD’s to retake that oath,

  37. laursaurus says:

    AA and the related 12 step programs are really only the effective, widely available treatment. This is a chronic, fatal condition with no realistic quick fix. The only thing one must accept he is “powerless” over is alcohol. Before you can resolve the condition, it is necessary to acknowledge the problem. Relapse is a defining aspect of chronic illness; the average sufferer will likely not achieve success immediately. Insurance benefits are usually will have a limit to the number of treatments they will cover. AA on the other hand, offers unlimited and ongoing treatment for free.
    I know countless sober alcoholics who came to AA as a result of court order. Although most don’t achieve soberity initially they are aware of an available avenue.
    Reading the article, it is clear the author has a very naive, hearsay opinion of AA. The doorknob “God” is a cliche; nobody would have their intelligence insulted in such a way! Think about it!
    The recovery I have finally achieved was through AA. I’ve spent years with therapy and medical interventions with negative outcomes.
    Since nobody races to AA on a winning streak, I am not all that concerned your opinion piece will be that harmful. But I caution anyone who reads this, to treat it just as that, an opinion piece.
    Little effort is required to find flaws in any system, but the author fails to find a better solution.
    AA’s policy is to cooperate with outside entities to acheive the goal of recovery. Participation will not hinder science at all, but objective scientific inquiry could learn quite a bit from AA. Afterall, they have all the practical experience with this specific condition.
    I need to admonish that taking this angle on the problem, could only exacerbate the problem of dealing with addiction in our society. Most DUI convicts would find sitting through an hour long meeting preferable to jail time. Cheaper for the tax payer, too.

  38. Harriet Hall says:

    For the record, my knowledge of AA is a bit more than hearsay. I attended many, many meetings during my training and in my role as medical advisor to alcohol abuse programs.

    When I wrote this piece, I knew we would get comments saying “AA worked for me.” That kind of comment is only a testimonial, unsupported by the kind of evidence required by science-based medicine. I understand the emotion, and I would never try to stop someone from attending AA who feels it is helpful. Quite often there are no other options. Nevertheless, the evidence for effectiveness just isn’t there. Without controlled studies, we can never be sure that the successful AA attendee wouldn’t have been successful without AA.

  39. wordswinker says:

    AA has ruined many a fragile psyche with its paternalistic absolutism, its insistence on abject humiliation and obedience to a stern “sponsor,” and an insistence that the minute you think for yourself is the beginning of an inevitable decline to a drunken death. These become self-fulfilling for all too many, and it’s become the recycling center for treatment centers, and it’s free.

    It is illegal to mandate AA attendance. Case law is clear. I wouldn’t send anyone I loved for the kind of psychic evisceration, sexual predation, petty fiefdoms and godammned absolute certainty in the infallibility of Bill Wilson.

    Read the brilliantly researched Orange Papers online. Learn about the Oxford Group from whose disgraced fall held the seeds of a movement that’s, yes, a cult.

    Just try to leave.

    Any angry post: http://itsinthewristdoll.blogspot.com/2009/01/wtf-motherkiller.html

  40. pec says:

    “Without controlled studies, we can never be sure that the successful AA attendee wouldn’t have been successful without AA.”

    According to the wikipedia article you cited AA is often effective, except when people are ordered to attend by the court. And it probably is not effective for devout atheists. It makes no sense to ignore the positive evidence for AA when you are promoting evidence-based treatments.

  41. Harriet Hall says:

    pec,

    Yes, there is positive evidence, but it is outweighed by the negative evidence.

  42. crescentdave says:

    Again, people are citing a mythical article in terms of “success” rates. I’ve already spoken to people using this percentage as citing a review of 5 unscientific surveys conducted over a 12 year period, taken 20 years ago. Yeah, that really constitutes “proof.”

    Here’s an independent (as well as objective review of those surveys): Epidemiologic Survey (NLAES) Findings on
    Alcoholics Anonymous Membership

    Estimated Alcoholics Anonymous Membership 1991-1992

    *New members during past year – 0.9 million
    *On-going members – 1.5 million
    *Total membership – 2.4 million

    Continuation Rate in Alcoholics Anonymous

    In 1991-1992 4.8 million respondents reported
    ever attending an Alcoholics Anonymous (AA)
    meeting, for reasons related to their
    drinking, prior to the last 12 months.

    *31% reported continued AA attendance during
    the last 12 months

    Rate of continued AA attendance was associated
    with years since first AA meeting

    *1-4 years since first AA meeting – 36% remained
    *5-9 years since first AA meeting – 30% remained
    *10-19 years since first AA meeting – 29% remained
    *20 years or more since first AA meeting – 32% remained

    Comparison of Past Year Drinking Status -
    Dropouts and Continuing AA Members

    DROPOUTS:

    *Abstinent 33%
    *Low risk drinking 14%
    *High risk drinking 53%

    CONTINUED AA ATTENDANCE:

    *Abstinent 62%
    *Low risk drinking 9%
    *High risk drinking 29%

    low risk drinking = never exceed 4 drinks per
    day (male) or 3 drinks per day (female)

    high risk drinking = exceeds 4 drinks per day
    (male) or 3 drinks per day (female)

    Data Source:
    NIAAA 1991-1992 National Longitudinal Alcohol
    Epidemiologic Survey (NLAES)

    It should be noted this study dates back (again, almost 20 years) to the survey data collected by an “anonymous” organization with over a million members.

    Then there’s the citation coming from MATCH. It’s based on a disingenuous misreading of the MATCH study, the largest done to this date which provides comparative data on all sorts of approaches to alcoholism treatment. I’ve already quoted from that which clearly states level of involvement in AA positively correlates to increased rates of abstinence.

    Like I said, I’m an atheist. I would no more prescribe a moral inventory as a partial cure for diabetes than I would for someone suffering from substance dependency.

    Finally, there is no such thing as one entity, one type of entomology called alcoholism. There are at least 5 distinct types, of which 3 may be completely inappropriate for AA … by their own, somewhat hazy definition of alcoholism. Loss of control or powerlessness is something accepted as primary aspect of addiction. Try reading from some of the sources/organizations found on this link page: http://www.hbo.com/addiction/understanding_addiction/resources.html

  43. PostSynaptic says:

    Dr. Hall,

    Could you further explain the following?

    “…there is positive evidence, but it is outweighed by the negative evidence” -HH

    “I would never try to stop someone from attending AA who feels it is helpful”. -HH

  44. timely16 says:

    I spent 90 days in a residential treatment center which was heavily based on the 12 Steps (most of them are), and I’ve attended hundreds of AA meetings. As a nonreligious person, I struggled for a long time with the religious nature of the program (which they call “spiritual”, but anyone who has read the Big Book knows that Bill W. was talking about a personal God. He repeatedly refers to an Intelligent Creator. This is something other than a chair, the AA group, or your sponsor being the “higher power”).

    AA relies on a simple tautology. Their program is infallible, and if you relapse, that means you weren’t following the program to the extent that you need to. You just have to try harder, and if you relapse again, you have to try even harder. The less the program works for you, the more firmly you must be committed to it. You could make the same argument for ANY program, therapy, treatment, etc. Every failure validates the efficacy of the program.

    I stopped attending AA meetings, and like 80% of people who stop abusing drugs, I did it on my own.

  45. sparty says:

    Dr. Hall,

    Why was the success rate of AA so much higher back in the early days of the program?

  46. Harriet Hall says:

    Could you further explain the following?

    “…there is positive evidence, but it is outweighed by the negative evidence” -HH

    “I would never try to stop someone from attending AA who feels it is helpful”. -HH

    I explained the first statement in my article. In particular, see the Cochrane review I cited.

    Even though there is no good evidence that AA is effective, many people believe in it and use it as a crutch. I don’t knock crutches out from under people, and I don’t try to talk people out of religious or similar beliefs that they find comforting. It is useless to argue with a “true believer.” If someone takes a quack remedy and feels it has helped them, I wouldn’t try to talk them out of continuing to take it (as long as it isn’t dangerous). The most I would do is point out the lack of scientific evidence to support the remedy – just as I have done in this article.

  47. Harriet Hall says:

    Sparty asks,
    “Why was the success rate of AA so much higher back in the early days of the program?”

    Was it? How do you know?

  48. Prometheus says:

    Timely 16 points out the circular reasoning in AA and many other faith-based treatments (such as many autism treatments). Allow me to expand on that theme.

    [1] If the person keeps going to meeting (or keeps trying the “alternative” treatment) and gets better, it’s a “win” for the “program”.

    [2] If the person stops going to meetings (or stops the treatment) and gets worse, it’s a “win” for the “program”.

    [3] If a person keeps going to meetings (or keeps trying the treatment) and doesn’t get better (e.g. keeps drinking or keeps “relapsing”) they are told to “keep coming back”, “keep trying” and they are counted as a “win” for the “program” because they keep on trying (and it is often speculated that they would be worse without the “program”).

    [4] And what about the person who stops going to meetings (or stops the treatment) and gets better (e.g. stays sober or drinks responsibly)? They are also counted as a “win” for the “program” because the “program” (AA or the “alternative” treatment they tried) “got them started on the road to recovery”.

    Given these “interpretations”, it is not surprising that AA and other “faith-based” remedies have convinced people that they are more successful than they really are.

    Prometheus

  49. sparty says:

    Sparty asks,
    “Why was the success rate of AA so much higher back in the early days of the program?”

    Was it? How do you know?

    way to avoid the question.

  50. sparty says:

    thank God AA is faith-based. If we were to rely heavily on man alone, we would be doomed to fail. Rehab fails. AA does not.

  51. sparty says:

    AA is not afraid to tell you that their success rate was much higher early on, and that it is terrible now. That is because AA became deluded and less rigid through the years, because therapists kept telling their alcoholic patients to go talk about their problems in AA meetings. the meetings (which are not discussed in the Big Book) is not the what keeps you sober. the intention of meetings are to show newcomers that working the steps are will help towards keeping you sober. that is it. The Big Book is not something that is open to loose translation, like denominational churches have done with the bible. AA’s horrible success rate is because people don’t follow what the Big Book teaches. Like is said, it is faith-based. That is why it works. But yeah, if you are going there to just bitch about that divorce one more time, I will be the first to buy you a drink.

  52. Harriet Hall says:

    Sparty said,
    “Why was the success rate of AA so much higher back in the early days of the program?”

    I asked “Was it? How do you know?”

    Sparty said “way to avoid the question.”

    No, I am not avoiding the question, I am questioning your data. I don’t know of any evidence that the success rate was higher back in the early days. If you know of such evidence, please show it to us.

  53. Harriet Hall says:

    Sparty said, “thank God AA is faith-based. If we were to rely heavily on man alone, we would be doomed to fail.”

    Science relies on man alone; do you think it is doomed to fail? Do you think faith is a better guide to truth than the scientific method? This is a science-based medicine blog; it seems you are in the wrong place.

  54. weing says:

    I was told AA meetings are a great place to pick up chicks. Any studies on that?

  55. sparty says:

    Science relies on man alone; do you think it is doomed to fail?

    Yes.

    Do you think faith is a better guide to truth than the scientific method?

    Yes. How is that Big Bang Theory working out? It is Thursday evening, has it changed again?

  56. sparty says:

    Because it seems to be getting so much closer to the description that the Bible teaches each time it does.

  57. Prometheus says:

    Sparty comments:

    “Yes. How is that Big Bang Theory working out? It is Thursday evening, has it changed again? Because it seems to be getting so much closer to the description that the Bible teaches each time it does.”

    I’m not a biblical scholar, but I seem to remember that the biblical version of creation started with a “void” (so far, just like the Big Bang theory) and then “…God created the heavens and the earth…”. Did I get that right?

    In the Big Bang theory, the Universe starts as an incredibly dense, incredibly small, incredibly hot mass. It doesn’t address what preceded the Big Bang. In fact, that question is irrelevant, since the Universe didn’t exist prior to the Big Bang – no space, no matter, no energy. And no place for God to sit while he created it all.

    The similarity between the biblical story of creation and the Big Bang theory is no greater than the similarity between Jules Verne’s De la terre à la lune (From the Earth to the Moon – 1867) and the Apollo program.

    According to the biblical account, the earth was created before the sun. Even worse, the biblical account says that the stars were created after the earth.

    In contrast, the Big Bang theory has the first stars forming about 100 million years after the Big Bang (13.6 billion years ago), while the sun formed about 4.6 billion years ago (9 billion years after the first stars began to shine).

    So, how similar is the biblical account of creation to the Big Bang? As far as I can tell, not in the slightest.

    Prometheus

  58. Spito says:

    Hmmm … maybe are AA overestimated and unscientific, but a reason that 93% have left the AA after 6 months do not mean that they started drinking again. They may well be that the AA’s treatment is successful and that they leave AA for a new sober life? Or have I missed something?

  59. Harriet Hall says:

    Spito,

    There is no evidence to support that hypothesis, and plenty of anecdotal evidence suggesting that it is not true.

    Perhaps some people who leave AA do stop drinking – but perhaps it is not because of their AA experience but because once out of AA’s influence, they manage to stop drinking on their own.

    The point is that we don’t have enough evidence to justify prescribing AA. If it had been a drug, it would never have been approved by the FDA.

  60. Spito says:

    Anectodal evidence is no evidence. If you don’t know if this 93% went back to drinking or to a sober life, you should not refer to this number at all. If you don’t know, don’t use it.

  61. khan says:

    Anecdotal evidence does support AA

    Anecdotal evidence does not support AA

    Which to accept?

  62. Harriet Hall says:

    I referred to the 93% only to say that they left the program; the statistics are from AA itself.

    Which anecdotal evidence to accept? Neither. Anecdotal evidence is only useful as a guide to research. My whole point is that appropriate research has not been done.

  63. discontented says:

    The reality is many alcoholics get sober on their own, some in treatment centers, individual therapy and other programs or any combination of them. Some come to AA for awhile leave and stay sober, others don’t. AA is spiritual but that doesn’t mean we have to throw reality out the window. Alcoholism is just baffling as hell and no one has a perfect cure. I have a lot of gratitude for the care, research and assistance the medical/ scientific community provides.

  64. Spito says:

    Harriet, you didn’t referred to the 93% only to say that they left the program. You put it in a context of failure.

    “We hear about a few success stories, but not about the many failures. AA’s own statistics show that after 6 months, 93% of new attendees have left the program.”

    And that’s not a conclusion you can draw until you know if these 93% went back to drinking or if they left for a new sober life.

    Maybe we need more research, but that’s just another reason to be more careful in drawing conclusions from the few empirical observations we have.

  65. Karl Withakay says:

    “And that’s not a conclusion you can draw until you know if these 93% went back to drinking or if they left for a new sober life.”

    By AA’s own standards, doesn’t leaving the program constitute failure? If so, is that standard evidence based or not?

    “Maybe we need more research, but that’s just another reason to be more careful in drawing conclusions from the few empirical observations we have.”

    Doesn’t that apply equally well to AA’s conclusions?
    Is the conclusion that the methods and practices of AA are effective drawn from scientific evidence or uncontrolled empirical observation and anecdote (or other)?

  66. Spito says:

    Karl:
    “By AA’s own standards, doesn’t leaving the program constitute failure?”

    Maybe for AA but not necesary for sobriety in it’s self.

    Karl:
    “Doesn’t that apply equally well to AA’s conclusions?”

    It does. There is no conclusions that wins by default.

  67. GregN says:

    I had remembered reading about LSD treatment for Alcoholism, so I did a search and found a bunch of articles, I grabbed one at random. Does anyone know anything on this?

    there are lots of articles, this is the one I grabbed:
    http://www.scienceblog.com/cms/lsd-treatment-for-alcoholism-gets-new-look-11680.html

    ~G

  68. Karl Withakay says:

    GregN
    Sounds like something we’ll see in the next season of House, MD. :)

  69. Dr Benway says:

    It does. There is no conclusions that wins by default.

    In medicine, novel treatments are not accepted until sufficient evidence supporting the treatment has been provided. The onus for providing evidence always rests upon the party promoting the therapy.

    AA asserts that it offers an effective treatment for alcoholism. However, AA have not provided sufficient evidence in support of their intervention. Therefore AA’s claim must be rejected as “unproven.”

    The default position for any claim is “unproven.”

  70. hockley says:

    Dr Hall — I think that you should keep doing what you are doing. We do need better methods. Those better methods will come from good solid work in research and good solid scientific logic.
    At the end of the day, that will be what matters. So, keep it up.

  71. speedy0314 says:

    sorry i’m late in adding to this discussion, but after 6 years of grueling, utterly fruitless years of trying to square the circle in AA i’m frankly dumbfounded but the utter lack of attention paid by both the larger medical & scientific communities on this issue.

    if alcoholism/drug dependency is indeed a public health problem of widening proportion then shouldn’t the most visible & widely promoted ‘solution’ be one that has at least a modicum of scientific data to support its popularity? the case that AA/12X12 is indeed religious in nature has been settled in at least 5 separate US circuit courts & the nature of ‘anonymity’ does not preclude rigorous scientific testing. in fact, anonymity, control groups, & unbiased third-party evaluation is the basis of sound scientific testing.

    AA — much like Oprah (who takes a [not unwarranted] helluva pounding on this site) — is more a triumph of public relations & sensationalist testimonial claims that it is medicine or science. where exactly is the inarguable statistical proof for the “millions saved by AA” claim so often bandied about in meetings?

    it doesn’t exist.

    there is the public face of AA (i.e., the “big tent” position of its preamble — “a fellowship of men & women who share their experience, strength & hope with each other so that they might solve their common problem & help others recover from alcoholism”) & then there’s the absurd, free-mason-like inner-workings of the ‘fellowship’ & ‘program’ (a ridiculous mish-mash of pseudo-science, bad philosophy, & even worse theology).

    let me be clear, i’m not advocating shutting down AAWS & locking the doors on the AA meetings around the world. if it works for you then fine, have at it. but just as a recent post on this blog called for responsibility from (of all people) Oprah Winfrey, i think it’s high time that AA offer up some responsibility & transparency of its own. after all, if it’s a program where “rarely have we seen a person fail” — then it has nothing to fear from being exposed in the light of day.

  72. moloko5 says:

    Wow, what a refreshingly sensible article – thank you so much for writing it!

    As a formerly alcohol dependent atheist who has been highly active in AA for over six years, this really hit home.

    My experience is that to get sober one needs to come to a firm decision to be done with all that drinking nonesense and continually reaffirm it. That’s pretty much it. However you go about maintaining abstinence, whether by attending meetings for six years as I have, or on one’s own as the majority of problem drinkers is pretty much irrelevant. I’m not sure whether evidence would support my view, but it’s no less valid than someone who claimed that god granted them sobriety.

    I will say that I found the steps to be mostly a waste of time, apart from the advice to forgive those who I may have resented and making reasonable ammends (i.e. credit card companies rather than ex-girlfriends from 10 years ago). I also found practical advice helpful, such as finding new activities to fill in for my time spent drinking and focussing on staying sober today rather than worrying about future sobriety.

    Early on I generally took the advice of others and tried to “relate” or shape my experience to the program. I did step 3, for example, by “turning my will over to good orderly direction by deciding to do the rest of the steps” which is a very round about way of skipping the whole god thing. I did a lot of mental gymnastics to avoid criticism or condescension, which I’d usually get when being direct and honest about my experience.

    Recently, I’ve been a bit more vocal about my views on addiction and sobriety. I’m no longer a newcomer and feel more empowered by my long-term sobriety. What I have found interesting is that many people in AA who accepted me as an “alcoholic” when I kept my views hidden from the groups now claim that I must not have been an alcoholic to begin with.

    “All dogs are brown. If your dog isn’t brown, he isn’t really a dog.” Exactly!

  73. E says:

    While not in agreement with everything you speak about, I do think there are some strange things about AA that often never get talked about.

    First off, in defense of AA, they are faith and/or spiritually based and I don’t think they have ever conveyed their program as being any other way.

    The statistics of a 93% drop out rate could be true. But any numbers would be almost impossible to keep on a program like that – since it’s anonymous. Hence, it would be impossible to conclude any “systematic review” as evidence. AA, to my knowledge, doesn’t even use words like evidence. Bottom line: There probably will never be any accurate data that AA is effective; there probably will never be any accurate data that AA is ineffective.

    Some things you suggest they should do, they already do. For instance, AA’s messages do include conveying that, “…they [members] are stronger than alcohol and they can choose not to let it control them…” Also, they do propose, “…concentrating on the patient’s [members] behavior today and in the future…”

    As for the suggestion to “…build on their strength…” When one is constantly drunk, are there really any ‘strengths’ to build on?

    One more defense I have of AA is that they did not minister to the courts and create a situation where AA is mandated; I believe it was the other way around. So it’s up to the courts to undo all that – not AA.

    Now having said all that, there is a weird cult-like bent to AA that never gets spoken about. And it mostly involves the founder himself, Bill Wilson. It seems like, while no one worships him per-se, they do seem to see him as the perfect model of a great man who got sober and went on to live a perfect sober life. In reality, this was not the case.

    For instance, it never gets talked about that Bill Wilson went on to seek ‘medicinal cures’ for alcoholism and in the process experimented with LSD – in the company of his acquaintance, Timothy Leary.

    More importantly, it never gets talked about that Bill Wilson cheated on his wife Lois over many years – many sober years. In fact, the estate of Bill Wilson included that a portion of it be given to his longtime mistress. No one wants to talk about any of that. No one wants to talk about how Lois, the founder of Al-Alon, stayed true to Bill for all those years only to find out this is the legacy he left her – sharing with the mistress. And Lois outlived Bill by twenty years, so she had lots of time to think about all that. Also, it should be noted that the value of the estate, including a home (Westchester County, NY), was acquired through stipends given by AA. Those stipends came through monies collected from the pass-the-basket donations of regular members.

    If anyone wants to get a good insight in AA and Bill Wilson, read up on Lois Wilson and her experiences. Then, if anyone wants to get into an argument with an AA member, bring up that subject.

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