The 75th anniversary of Alcoholics Anonymous has brought out a spate of legacy media articles about the organization, most singing the praises of an unscientific movement begun during The Great Depression that still forms the basis of many clinical drug and alcohol addiction treatment programs.
My post Thursday on Brendan Koerner’s Wired article brought out a very thoughtful commenter and sharp writer, friendthegirl. I learned that ftg writes the blog, Stinkin’ Thinkin': Muckraking the 12-Step Industry.
Stinkin’ Thinkin’ was started with the intention highlighting the quackery and abuse that is the foundation of the addictions treatment industry – with a view toward building community among people who are questioning the only game in town.
We will post news stories; expose how the inmates treat each other in their asylum, provide resources and information. While Stinkin’ Thinkin’ is not specifically an addictions recovery support board (we don’t endorse any methods), we support you wholeheartedly in your quest to find your way.
For those readers unfamiliar with addictions treatments of various types, Alcoholics Anonymous is one of the most polarizing organizations out there. Some people, like Robert Ebert, hold that their decades of sobriety are due to AA while others, like my Dad, despised AA as some sort of brainwashing cult.
ftg has also made me think about another point: many of us in the science and medical blogging communities routinely take apart pseudoscience movements in vaccine paranoia and dubious cancer therapies, yet I don’t know of one of my compatriots who’ve looked closely at pseudoscience in the addictions treatment industry. [Addendum: I'm wrong - Harriet Hall had a great post in May 2009 at Science-Based Medicine entitled, AA Is Faith-Based, Not Evidence-Based.]
Stinkin’ Thinkin’ has some great articles with pithy writing and revealing experiences of those who tried AA but found it not to be for them – some funny, some devastating. I recommend that one start reading from their greatest hits page.
As another example of the value of this site for alternative thinking about AA, ftg commented here and posted there about a rebuttal by addictions psychologist Dr. Stanton Peele to and David Brooks’s NYT commentary on AA that was seeded by Koerner’s Wired piece.
The rebuttal, AA Isn’t the Best Solution: Alternatives for Alcoholics, appeared Thursday at The Huffington Post. That it appeared there is noteworthy simply because HuffPo heavily leans toward pseudoscience in their health coverage. But Peele’s essay raises five critical points of science and public policy that I rarely see addressed. Beyond the coercive nature of AA, Peele notes a point that should have my atheist blogger colleagues in a total froth: “The government, especially, should not be involved in spiritual salvation and identity change,” in essence, by court orders for AA attendance for alcohol-related offenses.
Most importantly, Peele stresses that AA alternatives should be considered in treatment plans.
Therapeutically, providing choice is a powerful tool, since it turns around many people’s resistance to AA’s Step 1 — acknowledging that you are powerless. People tend to do better pursuing programs they believe in.
The most promising trends in alcoholism treatment are motivation enhancement (developed by psychologist William Miller), which avoids dictating to clients and instead allows them to express and pursue their own values, and mindfulness (developed by psychologist Alan Marlatt), the Zen Buddhist technique of meditation and focusing on inner states and needs. I use these techniques in my Life Process Program, which provides a non-12-step alternative that many people welcome, and in fact do better at.
So, yes, he is espousing his own program but there are several others out there including (SMART Recovery, Rational Recovery, Moderation Management) as well as other mashups offered by academic medical center-based programs. But with alcoholism being such a heterogenous disease in terms of magnitude and co-morbidities, it’s logical that no one program will work for everyone. Since I took my first substance abuse elective course offered by a colleague of mine about 15 years ago, I was struck by the observation that we have a variety of drug and therapy approaches for depression and a variety of drug-diet-exercise approaches for diabetes and obesity – why is the prevailing wisdom that alcoholism can only be treated one way?
In fact, USN&WR Senior Writer (and fellow UNC Sci/Med Journalism Program advisory board member), Nancy Shute raised this very issue in a 1997 article, The Drinking Dilemma: By calling abstinence the only cure, we ensure that the nation’s $100 billion alcohol problem won’t be solved.
Why should you care?
Alcoholism is a debilitating chronic illness that directly affects in the ballpark of 15 to 20 million Americans with a multiplier effect on people like me, an adult child of an alcoholic. About 40 million Americans are considered “problem drinkers”: men who consume more than 21 drinks per week, women more than 14 drinks per week. The Centers for Disease Control and Prevention notes that alcohol accounts for approximately 79,000 deaths annually in the US, more than for illicit drugs combined. The World Health Organization estimates that there are 140 million alcoholics worldwide.
The NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA) runs a great site called Rethinking Drinking that gives non-judgmental advice to evaluate one’s own drinking habits and approaches one might take it you want to cut down or quit. I find it telling that nowhere on the site is Alcoholics Anonymous mentioned. (Addendum: I’ve now found a page there where AA is mentioned but it is among a list of mutual self-help groups with the caveat, “You may need to try out several groups before finding one that’s comfortable for you.”
And if you are interested in cutting down or eliminating your own drinking, or have had negative experiences with AA and think there is nowhere else to go, check out Stinkin’ Thinkin’ as well for resources and conversation.