Terra Sigillata

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.

Comments

  1. #1 mad the swine
    July 3, 2010

    “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.”

    These are not mutually exclusive, you know :)

  2. #2 Sman
    July 3, 2010

    Addiction treatment has long been known as a sham to those that participate in institutional programs; hell, mention the works of Trimpey and it will get you booted.

    http://www.atforum.com/

  3. #3 Sman
    July 3, 2010

    It has been a while since I have posted on the ATforum website. It appears that its integrity might have been compromised??? I haven’t read through it.

    If you click the link, keep a critical eye.

  4. #4 Birger Johansson
    July 3, 2010

    What kind of treatment ideolgy does “the “Minnesota Model” adhere to? I am told airlines rely on it to rehabilitate pilots with drinking problems.

  5. #5 Jeremy Kitchen
    July 3, 2010

    I have been sober in AA for six years. I almost died when I read that you include Stinkin’ Thinkin’ as a reference point. This is not science either. You debunk AA and then use a blog that has no scientific merit. Weird.

    AA works in the same way that group therapy does. There is no religion involved, I believe in the common good. It seems dangerous to recommend Stinkin Thinkin to someone in a life or death situation with Alcoholism. Most people come into AA and succeed have run out of options. It does not work for everyone but it certainly worked for me.

  6. #6 Angelina
    July 3, 2010

    I find it telling that nowhere in AA meetings, literature or website is any other of the many alternatives mentioned; only official literature is allowed in AA.

    Curious.

  7. #7 Mona Lisa
    July 3, 2010

    Thank you so much for your article. In 1998, I went to a local hospital for treatment of a 25 year addiction to alcohol. My treating clinician–who was a member of AA, of course–assured me that membership in AA was an essential part of recovery and that I had no hope of recovery without it. He bluntly told me that I would die without AA.

    Once I made up my mind that I was done with alcohol, I had no trouble remaining abstinent, but I went to AA for 9 years, despite the fact that the philosophy of the program was clearly absurd (you have a medical problem, but you go to church basements to solve it?) and the behavior of group members was often bizarre or even dangerous (sexual predators, sponsors telling sponsees to stop taking medications for mental illnesses).

    However, after a particularly horrific experience in AA where I watched a mentally woman relapse and nearly die after going off her medications on her sponsor’s orders (many AA members think you aren’t really sober if you take psych meds), I gathered the courage to leave and started doing research on the question of whether I was actually going to die, like they assured me I would (a common slogan in the program is “it’s either AA or jails, institutions and death”).

    I found out that nearly everything I was told in AA was either a total or partial lie. Far from being “the only way” to get sober, most people who quit drinking do so without treatment or any program at all. AA’s success rate has never been shown to be higher than the rate of natural remission. It’s basically nothing but fear and distortion, and it wasted 9 years of my life.

    I value my sobriety as much as the next person and do feel I would have died had I continued to drink much longer. But AA did not get me sober; instead, it took me down a nasty, dysfunctional, and completely unnecessary path. It is time that the AA “miracle” is exposed for what it is: at best, a placebo; at worst, a cult.

  8. #8 Max Udargo
    July 3, 2010

    My father and my sister have been sober for years now, and there’s no doubt it is because of AA. There’s no doubt because, believe me, they tried everything else first, including some expensive treatments that bought them only a few weeks of sobriety. And for my father, even after he had learned that AA was the only thing that keeps him sober, his ego still convinced him a couple of times that he could do without it, and soon he was back where he started. I’m just glad he was willing to go back to AA and try again. He’s been sober over 10 years now.

    I know that’s anecdotal to you, to me it’s having loved ones back from the dead.

    Go ahead and bash AA and the other 12-step programs. Go ahead and recommend alternatives. And please continue serious scientific research into treating chemical addictions. But keep one thing in mind when you call AA a cult: Nobody’s getting rich off of AA. A collection plate is passed around at each meeting, but nobody has to put anything in it and most people just put in a dollar or two or some change. The groups I’m familiar with probably never have even a hundred dollars at their disposal at any given time. That money is spent on coffee, chips to mark anniversaries, and booklets and photocopies (the facilities are always donated).

    So be careful when you call it a cult. One of the characteristics we usually associate with a cult is that there is a hierarchy and money flows upward in a way that makes a small group of people wealthy and powerful. Cults usually have leaders who are revered and unquestioned. Whatever AA is, it isn’t Scientology or the Moonies. Some people may not like it. Hell, I don’t like some of it. It has definitely affected the way my father and sister think, and they’re not the same as they used to be. But I’m fine with that. I’ll work with that. At least I have them back. At least my family is whole again.

  9. #9 speedy0314
    July 3, 2010

    @ Jeremy Kitchen:

    “I have been sober in AA for six years. I almost died when I read that you include Stinkin’ Thinkin’ as a reference point. This is not science either. You debunk AA and then use a blog that has no scientific merit. Weird.”

    as a former regular contributor over at ST i can say with assurance that we never claimed scientific credentials. we did (and ftg & MA continue to do so) write opinionated, researched, documented posts that largely took AA & its uncanny ability to maintain a socio-cultural ubiquity (at least here in the US) to task without backing any of its own claims with even the slightest shred of scientific credibility.

    more to the point, we’re actually in the majority of people who’ve gone through the revolving doors of 12X12′s theological emptiness & scientific balderdash to find ourselves a hell of a lot better off (emotionally & physically) WITHOUT AA.

    the World Health Organization in 2006 estimated 140 million people worldwide to be suffering under the weight of ‘alcohol abuse’ or outright ‘alcohol dependence’. yet the organization that loves to hail itself as ‘the savior of millions’ (millions who have never, ever been quantified with even the vaguest scientific rigor) has managed for some 20-plus years now to manage a membership of 2 million — at least half of whom don’t maintain long-term abstinence, never mind AA’s absurd conflation of ‘sobriety’ with ‘spirituality’.

    perhaps you could forward your PhD. dissertation in biology, astro-physics, chemistry, or one of the other ‘sciences’ & all the groundbreaking ‘science’ & ‘research’ you’ve managed while 6 years sober in AA. perhaps you could explain to me how nearly 30 years AFTER einstein had postulated (& researchers just a few years later documented) a 4th dimension of ‘space-time’ & physicists were documenting the strange sub-atomic properties of “the prosaic steel girder” that great man of science bill wilson was nevertheless waxing moronically about [after 3 whole years of abstinence!] being “rocketed into a fourth dimension of happiness” & how the movement of free electrons was proof positive of … god.

    sorry, bub — AA doesn’t work in the same way that group therapy does. as even the author of the original piece in Wired conceded, at the macro level AA doesn’t work at all.

    and the “life & death situation” hyperbole? give it a rest, will ya? that horse won’t run any more. read AA board member Dr. George Vaillant’s “Alcoholism: A Natural History” (either edition): among its active membership, AA showed a higher mortality rate than those ‘alcoholics’ who chose go without it.

    but even with his own ‘scientific study’ in hand, Vaillant still went on to proselytize for AA & the Minnesota Model. now that’s weird.

  10. #10 Genegeek
    July 3, 2010

    If AA works for someone, great. But I agree that it won’t work for all. I’m not an alcoholic but grew up surrounded by them. Those who quit have done it because they have seen a world beyond themselves & discovering how their actions affect others. Most didn’t use the formal process of AA.

  11. #11 skeptifem
    July 3, 2010

    Max- cults are not defined by how much money they have. They are defined by the way that members are treated. There is a fanatical belief in the one true way and completing the steps in order and in your sponsors. People believe themselves to be permanently broken, only renewable through the twelve steps. Depleting self esteem (which many alcoholics don’t have much of in the first place) is one thing that cults have in common. I don’t think AA fits all of the criteria of a cult, but there are some similarities. There is plenty of cult literature out there for you to explore whenever you want so you can make up your own mind.
    One reason that I think it is dysfunction is that AA means putting a room full of people with fucked up emotional problems in varying positions of power and influence over each other. They are all pushing each other to do stuff that can be really painful and not necessarily needed for recovery (like publicly wading through everything you ever did wrong in the past, ugh). They claim to know stuff that no one does about addiction, too.

    I think part of the reason AA works for some is that it replaces the addiction. We all know that dude. The guy who spends his time at the meetings now instead of drinking, and he has almost nothing else to talk about. AA consumed their life in the same unhealthy way that alcohol used to. I guess AA won’t kill anyone like booze would, but it is still kinda sad when people can’t have lives of their own.

  12. #12 Ben Franklin
    July 3, 2010

    Jeremy Kitchen’s post says a lot.Stinkin Thikin’s blog has much more science in it than most other recovery blogs on the internet. I congratulate Mr. Kitchen on his recovery but he cannot prove that the principles of AA brought about that result.Using anecdotal evidence, with a sample size of one, we now have “expert opinion.”
    The quote “there is no religion involved” is hogwash and deserves no reply other than courts have ruled otherwise.The “you’re killing alcoholics” plea is familiar with AA critics and probably needs its own listing in logical fallacies. Whenever I “debate” with AA members an Ad Hominem usually is encountered along with logical fallacies that stagger the mind so much I get nauseous.I probably wouldn’t spend so much time on blogs being critical of AA, if science wasn’t dear to me. I am a student in a professional program studying pharmacy.AA is bogus treatment. I really did not want to come to that conclusion, but there is nothing-no study,no science nor anything other than anecdotal evidence(and this evidence goes both ways)- that points to AA as an effective treatment.

  13. #13 Jeremy
    July 3, 2010

    Never claimed I have a PhD in anything, I do not post on a blog called “scienceblogs” either.

    It was a matter of life and death for me. I was committed to a mental hospital and was having kidney failure.

    also i know hundreds of people who have 5 years sobriety in AA. how does that not work?

  14. #14 Jeremy
    July 3, 2010

    I am impressed how you throw around Einstein. He did not study AA however. Sounds like someone is a little resentful!

    Should have stuck around for the 4th and 5th!

    PS- I am an atheist, and I do not think of God as a being just people doing good. A figure of speech really.

    I also never claimed to be an expert on anything…

  15. #15 Max Udargo
    July 3, 2010

    @skeptifem

    The picture you’re painting of AA is not consistent with what I’ve observed.

    Nobody is “pushed” to do anything in AA. You can go to an AA meeting and sit there week after week and say nothing, if that’s what you want to do. Nobody is forced to speak or reveal things about their past. You don’t have to buy anything. You don’t have to get a sponsor. You don’t have to talk to anybody if you don’t want to. You may be encouraged to do any or all of these things, but nobody is in any position of power over you.

    I’m speculating, but I guess somebody you cared about got into AA and you saw how it changed his or her thinking and you don’t like it. Maybe you don’t understand how much damage addiction can do to people.

    Certainly your glib comparison of chemical addiction to “addiction” to meetings indicates you don’t take chemical addiction seriously. My father and sister spend a lot of time with AA and their friends in AA, and they sponsor people. It’s something they believe in and care about. If you want to call that a substitute addiction, fine. If AA keeps them sober by giving them a new addiction to 12-step programs, then that’s great. All I know is that I had lunch with my father yesterday and we had a good time and that I know where my sister and her son are and they are safe and warm. In fact, she starts grad school this fall.

    I’m sorry if AA steals your drinking buddies and makes them no fun anymore. But I don’t think you understand what’s really at stake.

  16. #16 Samantha
    July 3, 2010

    That’s the thing about anecdotes: for every one that someone has of something working, there’s another where it didn’t.

    My father in law was an alcoholic for 40 years. My mother in law tried to get him to stop – hell, he knew what it was doing to him and he wanted to stop. Went to AA, and it did nothing for him – his take was, he’d already surrendered to the higher power of alcohol, clearly that was a bad idea, why should he surrender to some other higher power? Anyway, 40 years of drinking, moments of sobriety mixed in… he had a heart attack, and was told if he didn’t change his ways, that was going to be the end of him. He dried out in the hospital, and hasn’t touched a drink since. No 12 step program, just a fear of something greater.

    Or my mother, who never did kick the drinking habit, despite being involved with AA numerous times over the course of her life. It was the smoking that finally killed her, but I’m sure the alcohol would have if the smoking didn’t. She’d tried AA, but no matter what happened, she always – whether it was sobriety for a week, or a month, or, at her longest, two months – went back to the booze.

    So yay for you if your friends or family or loved ones were able to get over that horrible addiction using AA. But guess what – with no actual, scientific evidence to prove it works, and equal numbers of anecdotal data proving it doesn’t – you could just as easily be arguing the existence of God.

  17. #17 DuWayne
    July 3, 2010

    Jeremy -

    You will not find me speaking out against anything that works for a given person, when it comes to substance abuse. Unlike a lot of harm reductionists, I don’t think it reasonable to dismiss AA out of hand. But I do think that AA deserves the reputation it has garnered over the last 75 years. Far too often it has been the only game around and failed far too many people.

    That in itself wouldn’t be so bad, but the prevailing AA wisdom would indicate that if you don’t succeed with AA, it is because you just won’t succeed. That is not consistent with all AA groups and has certainly become less prevalent in the last fifteen years or so. But it still bloody well happens and unfortunately some people actually believe it. So when AA, or another twelve step program fails them, they simply give up on sobriety.

    Worse, AA promotes the idea that all addiction is addiction is addiction. AA is based on the disease model of addiction, that fails to take into account the innumerable causes of substance abuse. And while I am well aware that this is far from universal, I have heard just a few too many times, from mentally ill persons who were heavily pressured into discontinuing psych meds.

    The other problem is that while many groups are just fine with people as they are – who they are, whatever religion or none, many others are extremely cult like. Or to put it more succinctly, you just never know what you are going to get, before you walk in the door. I guess the underlying problem is that while from the outside, judges and most of society assumes that AA is AA, there are sometimes very significant differences between groups and a great many groups are downright bloody dangerous.

    It seems dangerous to recommend Stinkin Thinkin to someone in a life or death situation with Alcoholism

    No more dangerous than recommending any other clearing house for information about addiction. Stinkin Thinkin doesn’t claim to be the solution to addiction – AA does. ST merely points the way to and discusses various addiction related issues. AA just talks about…AA. There are many substance abuse treatment methodologies that have actual science behind them – though none of them are fix alls, because my relationship with substances of abuse, for example, is very different from your relationship with substances of abuse. Given those differences, what works for me, is unlikely to work for you, is unlikely to work for the alcoholic rhythm player from my old band.

    I would never recommend my own blog as a place to learn how to manage substance abuse – in spite of the fact that I sometimes talk about the potential treatment methodology I want to research in grad school. I wouldn’t even recommend it as a place to learn about how I have dealt with my own substance abuse problems – though I love to share my experience and listen to others. I do however, also have a fairly reasonable listing of resources for people with substance use disorders, or people who think they might. And I am trying to finish putting together a site that will be entirely devoted as a resource to substance abuse.

    But even that will not be science based treatment, rather it will be a resource. A decent one if all goes well, but still a resource.

    Max –

    So be careful when you call it a cult. One of the characteristics we usually associate with a cult is that there is a hierarchy and money flows upward in a way that makes a small group of people wealthy and powerful. Cults usually have leaders who are revered and unquestioned.

    The former is definitely not always a factor in cults. Plenty of cults revolve around leaders who aren’t interested in the money, they are interested in people believing. And while the latter doesn’t apply to AA across the board, there are far too many groups that revere Bill and the big book, in a very similar fashion to the way that many Christians revere Jesus and the Christian bible.

    All that said, like I said at the beginning of my comment, I am all about whatever helps a person get sober. Because of that, I am not one for blanket condemnation of AA. But also because of that, the whole cult like atmosphere makes me very irritable, because it too often rejects anything not AA.

  18. #18 Scottk
    July 3, 2010

    I have no direct experience with AA, but I have been in 12-step recovery in another fellowship for almost three years. It seems that much confusion arises when 12-step programs are thought of as “therapies,” and then compared with other therapies for clinical effectiveness. It is this attitude which gives rise to the abomination of court-ordered participation in AA or NA. One can order a potentially violent schizophrenic to stay on his meds, but it is ludicrous to order somebody to have a spiritual awakening.

    It is very useful to look at overall success rates (say, in terms of five-year sobriety) of 12-step programs, but the fact that those numbers are low does not, it seems to me, justify the charge of quackery. There are many valid treatments for other diseases in which patient compliance rates are abysmally low. But the fact that most people do not maintain weight loss on a calorie-restricted diet or that most people with obstructive sleep apnea do not stay on CPAP does not mean that low-calorie diets and CPAP machines are quackery. In all these cases, success depends on patients making significant lifestyle changes. Most will not make them. Those who do make them will need support to do so. That’s what 12-step is about for me.

  19. #19 Elizabeth
    July 3, 2010

    See URL link, regarding your statement that the NIH for rethinking drinking does not mention AA.
    Also, contrary to the comments of “Angelina,” only an AA group (through the collective decision of the group members) can decide whether non-AA literature will be used at meetings. The larger organization leaves that decision up to the individual group, and that is only for meetings. Any individual member can use any literature they find useful.
    Also, there is an AA pamphlet that guards against anyone except a person’s doctor making recommendations on medications that are not being abused. It can be found here:
    http://www.aa.org/pdf/products/p-11_aamembersMedDrug.pdf

  20. #20 friendthegirl
    July 3, 2010

    I can’t say how much I appreciate seeing Stinkin’ Thinkin’ get some attention on Science Blogs.

    I want to make our position clear, because I think that, in light of Conventional Wisdom, we come off as cranks – even among the skeptic community.

    First, we don’t have an interest in seeing AA shuttered. It obviously has a place for people like Jeremy, who feel that working the program has saved their lives. We would, however, like to see AA occupy a more appropriate niche in our culture. If it is, as Jeremy says, just a support group, then it shouldn’t occupy such a position of authority, and it shouldn’t be the foundation of addictions treatment. You’ll notice that our focus isn’t strictly on AA, but on the entire 12-Step industry. Specifically, our interest is this:

    We highlight the rampant abuses that are fostered in The Rooms by the institutionalized lack of oversight and accountability. We’re talking about things like 13th Stepping, gaslighting, and isolating. Also, and more seriously, accepting people into the program who suffer from addiction and mental illnesses – from schizophrenia to depression – and pressuring these people to go off their doctor prescribed medications in order to be “truly sober.” In doing so, we hope to inspire some changes, and to help legitimize further research and alternatives.

    People arrive in AA upon the advice of their doctors, counselors or cultural icons like Ann Landers and Oprah (witness all the puff pieces that appeared in every major media outlet for AAs 75th); people are given ultimatums by their loved ones, or interventionists, to attend – and quotes, like the one Koerner used, from popular authorities like Dr. Drew, about how if someone’s unwilling to work the steps, they are just not ready to quit – just reinforce the imperative. The consensus is that AA is a place where you can and should trust the program. Further, the 12 Steps require you to replace your own self-will with that of a higher power – and often, it is suggested that if you don’t believe in God, you can believe in G.O.D. (Group of Drunks). So, people who are vulnerable, addled by addiction, and devastated will “let go and let God,” only to find themselves preyed upon sexually and financially. AAs will usually respond to this by telling these victims to “look at their part,” or will say, “Hey, there are predators everywhere. What made you think you’d be safer in AA than you would be in a barroom?”

    12 Step programs are considered the Gold Standard of addictions treatment in this country, and over 90% of treatment facilities are founded on the 12 Steps. Addiction counselors are trained in the 12 Steps, and not much else. It takes about 8 months to get certified. We often hear from AA members that “if it ain’t broke, don’t fix it.” But, it is “broke” — a fact that should be plain to anyone who ventures outside every day. Alcoholism – addiction in general – is an apocalyptic problem, that just keeps getting worse. And our standard approach to it is a program of spiritual awakening that has remained static for 75 years. We want to see aggressive innovation in a field of medicine that has almost entirely abdicated to faith healing. If you will advocate against teaching creationism in science class, then why not advocate against using spiritual awakening as the primary treatment for addiction?

    Courts routinely sentence people to AA. And one’s attendance in AA routinely serves to mitigate criminal sentencing. If you do a Google News search on Alcoholics Anonymous, on any given day, you will find story after story in which people are either sentenced to AA for things like domestic abuse and theft, or whose lawyers use their clients’ AA attendance as evidence that they have changed their ways or are taking responsibility for themselves. (You’ll also find a lot of stories about people getting a DUI after leaving a meeting.) Not only is medicine shunting off the problem, but the courts are using AA as a catch-all. Aside from the fact that this practice has been found to be unconstitutional, it also goes against AA’s own traditions.

    Lately, I’ve tended toward the position that it doesn’t matter if AA can be classified as a cult or a religion, just because what seems to matter is not whether it is, but that AA easily lends itself to cultish behavior and people do treat it with a religious reverence. (I sleep through arguments that have people quoting the dictionary.) However! Max Udargo argues that AA is not a cult because cults have a money trail, and AA is free. Now, I tend to think of AA as more of multi-level marketing outfit, like Amway. It might be helpful to consider AA as the revolving door of the treatment industry. Many AA members never see the inside of a treatment facility, of course, and many have seen the inside several times before they “get it,” but long term members cannot deny that many newcomers attend AA as aftercare when they’re done in the spin dry. It goes like this: DUI, AA, DUI, 12-Step Treatment, AA, DUI, Jail, AA in Jail, AA out of Jail, DUI, Treatment, AA… So, I want to say to Max that there is indeed a money trail. I’m not going to argue that it’s a cult, but the fact is that there is an industry that is financially invested in AA.

    Here’s another money trail: The publishing arm of AA (AAWS, Inc.) not only sells its materials to individual AA groups all over the country, but also to the treatment industry at large. It is a big business. There’s nothing benevolent about the fact that AA’s GSO won’t accept large donations from members. It’s just business. (By the way, the Minnesota Model, founded by Hazelden, is based on the 12 Steps. And their publishing business is also very lucrative.) There’s no benevolence – or even AA Tradition – that will prevent AAWS from suing your ass off if you threaten its bottom line.

    AA has something to offer certain people, and has a legitimate place. Goodghod, if it keeps a handful of people from driving drunk, then… one day at a time, by all means. I’m not going to try to talk you out of it. Many people honor AA for saving their lives – and I’ll never take issue with you. If AA were just a matter of choosing to go or not, like church, for instance, I’d be blogging about my dog. What we’re after is the 12-Step juggernaut that has grown around AA, the lack of accountability and oversight it fosters in The Rooms, the coercion, and the resulting stymieing of advancement in this field.

  21. #22 Elizabeth
    July 3, 2010

    Base certification as an addiction counselor in most states requires at minimum an associate’s degree and two years supervised experience in addictions counseling. National certification requires even more:
    http://www.naadac.org/index.php?option=com_content&view=article&id=424&Itemid=122#ncac1

  22. #23 skeptifem
    July 3, 2010

    Max- I don’t have drinking buddies that get stolen by AA. This is what I mean about fanatical beliefs- anyone who isn’t for AA must be way into booze somehow? Penn and Teller are extremely vocal critics of AA and haven’t ever drank alcohol. I am not going to talk about my life experiences regarding AA or alcohol because it is clear that you are intent on attacking me based on that information. Anyway, it is completely irrelevant to how the organization operates and how effective it is at treating alcoholism, or how cult like it is.

    As for me not taking chemical addiction seriously- is comparing alcoholism to say, sex addiction minimizing it? External chemicals aren’t needed to form serious addictions. Wasting life at meetings for ever isn’t a non-serious problem, either.

  23. #24 neurospasm
    July 3, 2010

    Food for thought: Many people wanting to get sober may think that AA is the only game in town. If they’ve heard the bad AA stories before, they might just keep drinking since many may not be able to find other treatments or not be allowed by law to find a non-AA group.

    Could the ubiquity and cultural dominance of AA as the only choice actually prevent many from achieving sobriety?

  24. #25 friendthegirl
    July 3, 2010

    Hi skeptifem, You point out that “part of the reason AA works for some is that it replaces the addiction,” which I think is spot on, and for people who need an addiction that will keep them alive to replace one that will kill them, that’s all right. Another couple of things I’d add to that are:

    1. For so many people AA is the only game in town. People who decide to quit drinking go to AA because that’s where they’re supposed to go. But, AA’s success rate is equal to the success rate of people who decide to quit drinking on their own, so it makes utter sense that it would be a wash.

    2. But then, some people need the structure and accountability. This could come from anywhere, as long as it feels legitimate. If they were aware of the options, they might have had the same success with another program.

    And Max Udgaro, your dismissal of skeptifem’s comment with this: “I’m sorry if AA steals your drinking buddies and makes them no fun anymore. But I don’t think you understand what’s really at stake” is some seriously uncalled-for ad hominem ugly.

    You’re implying that skeptifem values her drunken fun more than she values the very lives of her alcoholic playmates. The number of assumptions that you made about her, based on nothing more than her opinion of AA, is just outrageous.

    Similarly, Jeremy’s comment: “Sounds like someone is a little resentful! Should have stuck around for the 4th and 5th!” is just as personal and uncalled for.

    If I were to argue that AA is a cult, I would start with AA’s teaching that anger and resentment are dangerous. I mean, if I were to start a cult, the first thing I would do is turn anger and resentment into a big boogeyman. For AA members, an accusation of resentment or anger is enough to shut down their “stinkin thinkin,” and it is very telling that they will unselfconsciously taunt critics with the accusation, as if it could have the same effect on “normies” (as they call people outside AA). We have been called angry and resentful so many times, that I included the subject in our FAQ.

    Many of our readers have righteous, healthy reason for feeling anger and resentment toward AA, and, considering that some of them are emerging from years of indoctrination, these words (you’re angry; you’re resentful) are powerful in a Manchurian Candidate sort of way. They inspire enormous guilt, so I want to call it out here, where perhaps readers are not as aware of the lingo. Anger is a healthy, natural emotion — it’s your survival instinct kicking in; it inspires positive change. Honoring anger is what inspires women to leave abusive relationships, for instance.

    The 4th and 5th that Jeremy refers to are the steps that involve making a list of your wrongs and admitting them to God.

    While I’m at it, Max also used the term “ego” in reference to his father’s abandonment of the steps. This is another loaded word for AA members, because ego is a shameful characteristic. EGO = Edging God Out.

    I’m highlighting these things because they are so common, and because they illuminate they kind of abuses that we want to expose. The uncalled for questioning of skeptifem’s sobriety (which no one has any reason to even speculate about!) and, what’s more, her very humanity, the accusations of “resentment” and anger; the insinuation that we are killing alcoholics… Look, if you can see it here, on this public forum, imagine what it must be like in The Rooms, in a closed AA meeting, or between sponsor and pigeon.

    As skeptifem rightly points out: “AA means putting a room full of people with fucked up emotional problems in varying positions of power and influence over each other” — and I would add, without any oversight or accountability.

    We can do better.

  25. #26 AnyEdge
    July 3, 2010

    I am a Doctor of Science in Systems Engineering, working as a medical research scientist, and a member of AA. I have gone through the literature, and neither AA nor any other treatment system have any good success in treating alcoholism as measured by the standard means of medical testing. Our metrics for measuring success in treatment of addictions are miserable.

    The fact is, once addicted, most people will die of it. A very few will succeed in confronting the addiction, and remaining abstinant for a long period of time, or for the rest of their lives. We don’t know why, and our experiments are not designed to determine it. They focus on ‘sober at 6 months’ or ‘relief of symptoms’. What we truly need, is a longitudinal study that lasts for several hundred years.

    Good luck with that.

  26. #27 Ben Franklin
    July 4, 2010

    AnyEdge,
    Thank You for your honesty.I believe that more people would be “saved” if they had more than only one game in town. Adherence to medical regimens,as you know,is a huge problem in health care delivery. Many people just do not want to go to AA for whatever reason.Their reasons must not be invalidated by saying they couldn’t work a simple program or by saying they just didn’t want to get honest. Drugs can be delivered into the body by different routes of administration.Many times by using a different route,drug adherence rates can be increased. If people don’t like the taste of the medicine they are not going to take it. Maybe it is time that other methods become more available.

  27. #28 Kel
    July 4, 2010

    As a depressed teenager many years ago I was told by a psychiatrist that he would not treat me if I didn’t attend Al-Anon meetings (for family members of alcoholics) – this at the first visit when family history of alcholism was revealed. It sure seems cult like to me. I found a new doctor.

  28. #29 luna1580
    July 4, 2010

    i really don’t think that an atheist can participate in the traditional AA/12 Step model.

    all the people who say “the higher power need not be god” come off as hollow-sounding as the “intelligent design” proponents who say “the designer need not be god” -in both cases it is easy to see that those who would make such arguments can’t really empathize with what it’s like to be a non-believer. sure, you could decide that “your personal higher power” is the greater social good, or that “the designer” is an unknown non-supernatural space alien, but the concepts were clearly developed by theists and were designed to work (if they work at all) in that specific total worldview.

    for this reason alone, people seeking group-support-model help in addressing addictions need to know that AA is not the only option in existence.

    also, a court mandate to attend AA/12 Step treatment (vs. something like individualized psychiatric sessions or some other treatment that doesn’t need “a higher power”) must surely be seen as a violation of separation of church and state.

    as many above have said, if AA helps you or your loved ones that’s good, but it needs to be understood that it is not a program that will work for everyone.

    ordering someone in a court of law to complete a program that requires “[acknowledge and] submit to a higher power” is just as wrong as ordering them to “go to confession and say 50 rosaries as penance”. “spiritual awakenings” should not be ordered by the courts………

  29. #30 Weaver
    July 4, 2010

    AA’s “success” rate hovers around 5% – virtually identical to the spontaneous remission rate for the “disease”.

    It’s not only religion, it’s complete woo as well. State mandates should be refused on both grounds.

  30. #31 DuWayne
    July 4, 2010

    Elizabeth -

    Also, there is an AA pamphlet that guards against anyone except a person’s doctor making recommendations on medications that are not being abused.

    Which is bloody damned useless, when you have groups that ignore, or never even see said pamphlet. There are many “official” AA positions that are routinely ignored by various groups as a matter of course. This wouldn’t be such a problem, but most non-AA types don’t differentiate between groups – including judges who may be sentencing someone to meetings – and of course including people who are new to AA. Then there is also the problem of the availability of multiple groups in a given area, if one happens upon a particularly crappy one and lives in a small town.

    Base certification as an addiction counselor in most states requires at minimum an associate’s degree and two years supervised experience in addictions counseling.

    Unless of course, you are talking about an AA sponsor, or even someone moderating group. In most states, most addicts are unlikely to see a licensed addiction counselor more than a couple of times – if ever. And when they do, it’s likely that they will see interns who have minimal practical experience. Unless the resources are there for the addict to go into “pay as you play” treatment, licensed addiction counselors aren’t all that available.

    AnyEdge -

    The problem with many studies of addiction, is that they tend to assume that addiction is addiction – much like twelve step models do. This isn’t an easy factor to account for when designing a study either, longitudinal or otherwise. It is rather hard to determine exactly why addiction management is such a huge problem, when there isn’t a singular reason for it.

    Luna –

    There is a very mixed bag of court rulings on twelve step treatment as a violation of church and state. The biggest problem is that courts don’t necessarily mandate a twelve step program specifically, just a general requirement for treatment. That AA, NA or some other twelve step program is the only game in town becomes irrelevant. The rulings on even that are changing, but this is change that will come slowly.

    Weaver –

    While I am none too keen on defending AA, it is important to keep in mind the actual nature of those figures. Best evidence indicates that they actually hit on the three to four percent mark, which is actually less than spontaneous remission. But – and this is a big but, those figures also include a lot of people who were coerced into treatment. That is a very significant confounding variable.

    The metrics by which success is measured, is also often very problematic. Because of the nature of AA, it is hard to gauge their success rate. Because of the variety of metrics used, it is very hard to compare various treatment methodologies as well. In many studies, for example, the metric involves following people who have made it into the criminal justice system and following them – recidivism being measured by their reappearance into the system. Others rely on appearance into treatment and either their adherence to that specific treatment, or self-reported follow up. In those studies it is either assumed that they “failed” to manage addiction if they leave the treatment regimen, or if they simply fail to respond in the future.

    In other words, it’s complicated, like so much in life is. Across the board, addiction offers confounders and complications. Hell, addiction isn’t even particularly clearly defined. There isn’t a single, coherent clinical definition. Just perusing the NIDA (National Institute on Drug Abuse) web site will turn up four distinct and in certain ways, contradictory definitions. There really isn’t any damned thing about addiction that is simple or clear.

  31. #32 scottk
    July 4, 2010

    @Luna: “i really don’t think that an atheist can participate in the traditional AA/12 Step model.”

    I am an atheist, and I participate in the “traditional” 12 Step Model. I am “traditional” in that I take the steps at their word in encouraging me to follow my own understanding of “God.”

    My understanding of God is as a shorthand for my Higher Power, and my Higher Power is “a power greater than” myself. The spiritual principal involved is that I cannot rely solely on my own resources to recover from addiction — if I could, I would have stopped a long time ago. I must learn to let go of pride, distrust and isolation and reach out to others for help, support and insight — my group, my sponsor, my sponsee, my wife, my sober friends, my psychotherapist, my psychiatrist, etc. etc.

    Turning my will and my life over to this Higher Power means abandoning my ideas of what I should be, how things should be, and what the future needs to be like in order for me to be happy. It means accepting things as they are and realizing I can neither predict nor control the future. It means giving up trying to manipulate other people as a prerequisite for my own happiness. And it means I stop running from reality through my addiction.

    I realize that AA was formed on a Christian model, and that the language works best from the vantage point of traditional theism. The Big Book actually admits that the stance of seeing your group as your Higher Power is actually a bait-and-switch that will lure you into “seeing God and calling Him by name.” I fully recognize that it is easy to fit concepts like “powerlessness” into the Calvinist model from which they sprang.

    But while I honor the foundational literature of AA and of my own fellowship, I do not consider it to be inspired. While Step Three does involve abandoning cynicism and complacency, it does not demand that we abandon discernment and critical thinking, nor does it call upon us to abandon our boundaries. To do so is simply to trade one delusion for a more pious-sounding upgrade.

    So I am an atheist, and I am committed to 12-step work. The 12 steps are what they are. You are free (or should be) to take them or leave them. They certainly bear criticism, and nobody should be compelled to follow them. But to simplify them as merely some kind of cult and then to heap them with abuse suggest to me motivations other than a simple respect for truth.

  32. #33 luna1580
    July 4, 2010

    scott, you believe my short comment heaped AA/12 programs with abuse? and simplified them into “some kind of cult” despite not using the word cult or suggesting it? that’s interesting.

    also, why would an atheist want to structure their life around a group that openly admits in its own literature that its end goal is not about “curing alcoholism” but rather about changing the spiritual world-views of its participants to a theistic one that involves a personal relationship with an anthropomorphic god figure?

    as an atheist i don’t want to go to church and i don’t pray (having nothing to pray to….), and i don’t with to prevent those who wish to do so from their own lifestyles either. it’s nice that you are able to interpret the religious nature of AA in a way that works for you as a non-believer, but that’s not the same thing as magically turning AA into a secular group. without its religious ideas and structure AA ceases to exist. people have the right to be non-believers, so if they are going to ordered to join a group it can’t be a religious group.

    do you mind if i ask how long you’ve participated in the 12 step lifestyle? isn’t it annoying to know that the whole program was not designed to get you sober, but rather to get you to know god (the sobriety being a byproduct of your new spiritual world-view)? i personally find any efforts to convert people to “the true/best/correct” religion very distasteful, but perhaps you don’t mind it.

  33. #34 PalMD
    July 4, 2010

    Fascinating discussion—thanks, Abel.

    I agree wholeheartedly that there are many paths to sobriety, but also that each (and almost every) addict who wants to heal must at some point acknowledge that fear and disparagement of addiction help groups is often used as an excuse to keep using.

    Of course there have been many cults that have built themselves up partly on the hopes of addicts and the promise of sobriety, so not all groups are created equal, but there is a great of evidence-based assistance available.

    Economics are a huge problem though. AA is free—inpatient and intensive outpatient therapy are not. It’s a problem.

  34. #35 luna1580
    July 4, 2010

    scott, i re-read and see you have been associated with the 12 steps for 3 years, and not with a group calling itself AA, so perhaps the religious imagery is toned down in the phrasing your group uses, i don’t know. also that you are using many other resources like a psychiatrist, so you have a non-group place you could go to if you needed to address issues with the group itself, which must be beneficial. my apologies for forgetting your details.

    the problem is that almost all of the US’s “treatment” resources for addiction are currently 12 steps-based and for no good reason! I’m not arguing to eliminate AA, but it’s unacceptable that no/very few other option are available in very many places.

  35. #36 Abel Pharmboy
    July 4, 2010

    Thanks so much for everyone’s thoughtful comments on this topic. As DuWayne just said in comment #31:

    There really isn’t any damned thing about addiction that is simple or clear.

    And just to be clear: while I have a PhD in pharmacology, I have zero training in psychology or counseling for dependence on alcohol or other drugs. In fact, I probably break my own rules in writing anecdotally about AA given my father’s experience.

    But I do know many people for whom AA is not an acceptable support mechanism just as I know many who, like some of the commenters, credit AA with saving their lives.

    In that spirit, I truly appreciate comment #20 from friendthegirl about the purpose of the Stinkin’ Thinkin’ blog and the consideration of more research and openness in addiction treatment.

  36. #37 Abel Pharmboy
    July 4, 2010

    Oh, and PalMD @34 – I really appreciate your input that must’ve crossed in the ether while I wrote my above comment. As an internist on the frontline of all kinds of disease, your comment is really valuable, especially the point that alternatives are not a financial viability for many.

  37. #38 JJR
    July 4, 2010

    To those claiming “to many, AA is the only game in town”

    Pardon my French, but that, sir, is horsesh*t.

    Exhibit A, Rational Recovery:

    http://www.rational.org

    Worked for me; why? because it’s ultimately about 1) understanding how your brain & addiction work physiologically and 2) taking personal responsibility for your behavior.

    RR is available 24/7, worldwide. AA does not have a monopoly, and Jack Trimpey of RR questions even the necessity or efficacy of Group Therapy for addiction recovery. I have participated in AA, but only as a social ritual, since RR was all in my head, and I also had to demonstrate to my parents that I was “doing something” about my addiction problems. I appreciated some of the very real human stories that were shared in AA, as cautionary tales, but the “God meetings” where they hammered “the Steps”…those were far and away the most useless wastes of time for me.

  38. #39 DuWayne
    July 4, 2010

    With all the respect due to RR, AVRT is just as much horseshit as AA. I am glad that it helped you, just like AA has effectively helped others. But AVRT is just more spiritual mumbo jumbo, masquerading as a rational approach to addiction.

    1) We are not somehow divorced from our bodies, as human beings, we are animals.

    2) Addiction and addictive behaviors are most certainly not immoral, they are amoral. Claims that addiction and addictive behaviors are immoral drive harmful stigmas.

    3) There is no singular cause of addiction and addictive behaviors.

    4) Abstinence only non-sense makes it completely impossible for many addicts to achieve abstinence. For many addicts, successful treatment requires a period of adjusting. And depending on the nature of the addict’s relationship with substance abuse, abstinence may not even be necessary. People who become addicts because of a particular event. Working their lives past that event, is often all that it takes to lead their life as it was before their experience with substance abuse.

    5) Telling people to “come back when your sober,” is a great way to prevent many serious addicts from ever seeking treatment. Sometimes it is critically important to reach people where they are, even if where they are is intoxicated.

    RR and the AVRT system is little more than the very worse aspects of AA, with few redeeming qualities. I am not one for bashing anything that helps a person get sober, but I would recommend AA to an atheist substance abuser, before I would recommend RR. At least with AA you have the possibility of getting into a group that is far more rational than the psuedoscientific nonsense of AVRT.

  39. #40 DuWayne
    July 4, 2010

    PalMD -

    Economics are a huge problem though. AA is free—inpatient and intensive outpatient therapy are not. It’s a problem.

    In MI in particular, the easiest way to see a clinical therapist, (assuming you can’t afford one) is to go to jail for a substance related crime and wait to be released. And because insurance rarely covers much clinical therapy, if it covers any at all, even people with decent jobs and insurance can’t afford to see a therapist who is trained to provide evidence based treatment. Medications can also be useful, but without behavioral therapy and supervision, you might as well forget about it.

  40. #41 friendthegirl
    July 4, 2010

    @Elizabeth: “Also, there is an AA pamphlet that guards against anyone except a person’s doctor making recommendations on medications that are not being abused.”

    That pamphlet acts as a disclaimer, and its existence serves to confirm — in my opinion — that the practice of pressuring members to go off their medication is widespread.

    @weaver, you might find this recent story interesting: http://www.sacbee.com/2010/04/17/2685285/judge-backs-redding-atheist-who.html#Comments_Container

  41. #42 skeptifem
    July 4, 2010

    @Pal md (#34)- economics do not have to be a problem. The money spent fighting the war on drugs is used to sponsor violence and give handouts to companies that spray drug crops in latin america. It is a huge amount of money, and policy makers are aware of how their approach is by far the least effective for these problems. They argue over which state is going to get the contracts to build the planes and weapons and such, they don’t care about how this has zero chance of reducing drug abuse here. These are the routine bailouts that business gets from our politicians.

    Another reason why money will never be poured into giving away drug abuse treatment is that another huge industry relies on a large pool of drug users. Prison systems are increasingly corporate run for a profit, and legislators who manage to attract prisons to their area get tax benefits and job creation. It is an effective way of keeping some of the more dangereous oppressed people from having a chance at effecting change on a large scale by banding together. These systems are too valuable to people who want to perpetuate their power in society. They will not go anywhere without a lot of popular struggle. One thing is for sure though- the problem of cost could be easily solved if the goal was to actually reduce drug abuse in our nation.

  42. #43 Sharon Astyk
    July 4, 2010

    I’m torn on this one – I had a family member go through another 12 step program, and while it was effective in some ways in alleviating some pretty horrifying issues, an evil part of myself felt that what it replaced it with (a good deal of pontificating, self obsession, constant attendence at meetings) wasn’t always a huge improvement. I was a teenager at the time, however, so I may have been a jerk about it.

    While I really dislike AA’s philosopy, I think PalMD points out the central point – whatever you think of AA, for millions of people, AA was/is the only accessible option. There’s no RR organization nearby in my rural community. There’s no system of supports other than AA. The waiting lists out here for treatment programs are long – lifetime long if you are an addict. The same is true for many people.

    I agree with skeptifem that we don’t give a crap about reducing drug abuse, for the most part – there’s too much profit in things as they are. So I guess I’m left thinking that AA is stupid, and probably destructive in some ways – and if you are poor and isolated and you need to give up the booze, it is often all you are given, and so there’s only so much criticizing I can do.

    Sharon

  43. #44 Z
    July 5, 2010

    @scottk: “Turning my will and my life over to this Higher Power means abandoning my ideas of what I should be, how things should be, and what the future needs to be like in order for me to be happy. It means accepting things as they are and realizing I can neither predict nor control the future. It means giving up trying to manipulate other people as a prerequisite for my own happiness.”

    This is precisely the problem I had with Al-Anon: they wanted me to abandon my identity and goals, accepting things as THEY defined them, and giving up on the idea that one had a future. They wanted me to examine my soul and discover that I was trying to manipulate people as a prerequisite for my own happiness.

    But I’m not a manipulative person, and I had never claimed to be able to predict or control the future, and I had a very clear grasp of reality, and I liked who I was and what I was doing in life.

    Their idea was that because I had one or more alcoholic parents, I *had to* have a certain set of problems, and if I did not or did not think I did, it must be because I was “in denial.” They felt that any success or happiness not achieved via the 12 steps was illegitimate.

    This is why I do not like them.

  44. #45 raysny
    July 5, 2010

    Sharon,

    You won’t find any RR groups in your area because there are no RR groups. Rational Recovery is method for quitting. It can be found on their website or the book “Rational Recovery” by Jack Trimpey (many, if not most, public libraries have a copy).

  45. #46 raysny
    July 5, 2010

    Jeremy writes:
    “also i know hundreds of people who have 5 years sobriety in AA. how does that not work?”

    For every 1000 newcomers, about 16 will get a 5-year coin. You want to ignore the 984 that AA did not work for. I’m not saying that all those people went out and drank, but they did not stay in AA for some reason.

    If you know hundreds of 5-year people in AA, you’re talking about over 15,000 that didn’t make it.

  46. #47 Ben Franklin
    July 5, 2010

    I have about 100 people on my facebook account. I do not know if they drink,if they are sober and if they have been sober for 5 years. I have a problem with Jeremy’s “statistics”.

  47. #48 raysny
    July 5, 2010

    Scott writes:
    “I am an atheist, and I participate in the “traditional” 12 Step Model. I am “traditional” in that I take the steps at their word in encouraging me to follow my own understanding of “God.” ”

    But you choose to ignore every other place in Wilson’s writings that describe the God you’re to believe in? You may have found a way to dance around that particular bit, but who do you pray to Scott? The program demands prayer, which by definition, is the act of communicating with a deity. Atheists are unwelcome in AA, both Bill and Dr. Bob made pronouncements about non-believers that leave no room for doubt.

    As my sponsor explained to me, it’s “as WE understood Him”, not as you would like Him to be.

    The whole program is based on belief in a micro-managing, favor-dispensing God, one based on, but not quite the Christian God, a stand alone God.

  48. #49 ScottK
    July 5, 2010

    Z writes:
    “But I’m not a manipulative person, and I had never claimed to be able to predict or control the future, and I had a very clear grasp of reality, and I liked who I was and what I was doing in life.”

    I am genuinely happy for you. You have no need of the 12 Steps if that’s where you’re at.

    raysny writes:
    “But you choose to ignore every other place in Wilson’s writings that describe the God you’re to believe in?”

    No, I don’t ignore them. I’m actively critical of them. I have shared this criticism in my groups (which, again, isn’t AA, but like most 12-step groups tend to use the Big Book and the Twelve and Twelve as secondary literature. I don’t feel Bill Wilson’s spirituality is normative for me. I am sure there are people who treat AA literature as dogma and feel that the 12 Steps will not work without belief in a personal, Abrahamic God. Such people are wrong.

    “You may have found a way to dance around that particular bit, but who do you pray to Scott? The program demands prayer, which by definition, is the act of communicating with a deity.”

    I don’t pray “to” anybody; there’s nobody to pray to. I do repeat affirmations that help center me and remind me of my need to stay focused and mindful in stressful situations. I do meditate 30 minutes per day, something I was never able to do before I got into 12-step recovery. The 12 Steps do not define prayer for me, and in fact I’m not letting you define it for me either.

    “As my sponsor explained to me, it’s “as WE understood Him”, not as you would like Him to be.”

    It’s not that I wouldn’t _like_ my Higher Power to be a micro-managing, favor-dispensing God, it’s just that I find such a concept incoherent. If your sponsor was telling you that you had to adopt his/her notion of God, then get a new sponsor.

    It seems to me that limiting the notion of what the 12-steps can be to Bill Wilson’s conception of them is to make exactly the same mistake AA fundamentalists make. Bill Wilson was not God, he wasn’t even Moses. We are free to take what he propounded that works (and very much of it does) and leave the rest behind. More recently-founded 12-step groups tend to have more spiritually inclusive language. One of my regular groups closes with the Unity Prayer, which is addressed to the rest of the group and never uses the G word at all.

    My groups know where I stand spiritually, and I have never felt anything but warmth and acceptance from them. I have close friends in the program that are traditional theists. It is not my project to change their minds, nor is it theirs to change mine.

    I realize that not all 12-step groups are like that. But if you can’t find one that practices non-judgmental acceptance and spiritual openness, your are free to start your own. That’s very 12-steppy, too.

  49. #50 raysny
    July 5, 2010

    Scott writes:
    “I do repeat affirmations that help center me and remind me of my need to stay focused…”

    If you believe in affirmations, what do you think the constant repetition of “My name is Scott and I’m an alcoholic” does? It becomes your identity.

    The atheists I’ve met in the rooms in 20 years of on and off AA participation were less than truthful about their beliefs until they had enough time in the program that they were accepted. Then the group had a token they could point at and exclaim, “See? AA works for everyone!”

    As an atheist newcomer, I was shunned or berated by members. An atheist can survive in the program the same way an atheist could attend church, the question is, “Why bother?”

  50. #51 ScottK
    July 5, 2010

    Rasny writes:

    “If you believe in affirmations, what do you think the constant repetition of “My name is Scott and I’m an alcoholic” does?”

    Actually, I’m not in AA but I do repeat the standard formula during meetings. What it does (for me) is to remind me that 30+ years of active addiction has permanently changed my brain, and that I must conduct my life in mindfulness of that fact or I will probably relapse. The people I’ve met who have relapsed are frequently those who have established years — or decades — of sobriety and have come to the conclusion that addiction is no longer an issue for them.

    I accept the disease model of addiction and my reading of the neuroscience involved seems to back that up. Just as Type I diabetics must remember every day that they need to watch their blood sugar levels, I must remember every day to work my program. This does not make me feel ashamed of myself or like a second-class person. I don’t like having this disease but I do have it, and to act otherwise would be irrational.

    “As an atheist newcomer, I was shunned or berated by members.”

    I’m sorry to hear that. I cannot think of a more blatant betrayal of the 12 steps; such behavior is in straightforward violation of traditional meeting boundaries. All I can say is that my experience has been quite the opposite.

    “An atheist can survive in the program the same way an atheist could attend church, the question is, ‘Why bother?’”

    Why I bother is that I need support and guidance in cultivating some spiritual principals; among these are acceptance, forgiveness, equanimity, emotional openness, self-respect, and trust. Without those qualities I feel I will return to the place where my addiction looks like a pretty good option. I cannot achieve these things by wishing for them, or by working in isolation. This is what the program does for me.

    I am certain there are bad groups out there. They are human institutions, and each one is (by tradition) completely autonomous. It would be a miracle if some of them did not devolve into cultishness and cliqueishness, and I don’t believe in miracles.

    But I know there are good meetings there, and people whose lives are being saved through their participation in them. If the one you’re in isn’t working for you, you are absolutely free to try another. Or, as I say, start your own.

  51. #52 luna1580
    July 5, 2010

    i still don’t understand how an actual non-believer can make use of the 12 steps themselves, for example, in 6 & 7 “Were entirely ready to have God remove all these defects of character. [&] Humbly asked Him to remove our shortcomings.” how can that happen?

    i can’t humbly ask a nonexistent thing to fix my “shortcomings” by way of magic and expect a result! if i, as an adult, humbly and sincerely asked the tooth fairy to bring me a winning lottery ticket or make me grow taller and honestly expected this to occur it would be seen (rightly) as a strange delusion or sign of mental illness.

    nor could i say that 6/7 “really” meant i was asking my own better nature to assert itself or some such, as that would invalidate the very concepts of steps 1-3.

    to make steps 6 & 7 work, one must believe that their “higher power” is an actual force with the true ability to change one’s very nature and actively heal/remove any character flaws. that certainly sounds like an intervention from a supernatural force/god, not from a group of humans, a social ideal, an inanimate object, etc.

    and the last 2 steps are purely religious in nature, right down to having a deeper personal relationship with a personal god and then becoming a missionary for this god.

    again, the concept that makes the most sense to me as a nonbeliever is to understand 6/7 as an appeal to ourselves, to the better person we have the power to be, but how would that work if i’d already been made to embrace the ideas that i was powerless to change unless i abandoned free will and turned my recovery over an external “higher power” that even if undefined was certainly something outside of the self? if the first part of the steps is about learning “i can’t do this, i need outside help” then it makes no sense for the middle part to become “wait i can do this! i have the strength within me to be a better me all on my own!”

    the steps themselves aren’t a magical and natural way of being that wilson and others plucked prophet-like from the mind of god (even if you believe in god and think that is precisely what they are….), merely just what one damaged man and his friends thought could work after he personally experienced a hallucination that turned him into an admitted religious fanatic.

    does this mean that no one will ever be helped by things they learn in the AA/12-step programs? of course not, some will, but not all, or even most……

    the bottom line is that there is no evidence-based reason for the steps to have become “the way” that the entire US addictions treatment industry seeks to help people, and for many people this model will never help and may even harm. it is time to develop alternative “treatments” and to recognize that AA/12-stepping is not a mystical and divinely inspired cure.

  52. #53 SoberPJ
    July 5, 2010

    Great discussion! The treatment world needs more of this!

    The 12 Step, God-based treatment methods have an unacceptable failure rate. Even those in the industry know it and they are looking for alternatives. AA’s basic approach is that you are powerless over alcohol, people, places and things, you must give your life to a God ( who is the only one that can give you the power you need), then you document your negative aspects, make amends for your wrongs, continue to seek God and help others( to find God). Now does this sound like an acceptable, modern treatment regimen? Would you use it on yourself to cure cancer, diabetes, heart disease ? If you went to a real doctor for a real problem and they told you to do this for anything, what would you say? So, why do we accept it as a plausible treatment for alcoholism today? Especially when the real success rate investigations all point to massive problems, like a higher death rate, a higher severity of relapse binge drinking and a higher rearrest rate than other methods – including no “treatment” at all. AA will always be defended by the faithful, because that is what they are – faith-filled, not fact accepting. The 12-step treatment monopoly must be broken and replaced with modern treatment methods that have real, provable results. AA needs to be pushed aside and put in the class of historic, obsolete medical solutions that include faith healing, leeches and blood letting.

  53. #54 Abel Pharmboy
    July 5, 2010

    One thing I forgot to add to this discussion is the resource of a blogger friend who goes by The Discovering Alcoholic. I came across TDA last summer when writing about Buzz Aldrin on the 40th anniversary of Apollo 11.

    TDA hasn’t had a drink since Fall, 1994, and while I don’t want to put words in his mouth he’s pretty much open to anything that works for the individual. For those debating here about the God aspect of AA, TDA has a great post with an abbreviated 12 steps (six, actually) for “the spiritually challenged.”

    A related point – and just to show how prevalent alcoholism is – I just met a guitar builder who, I learned later, is 14 years clean from alcohol and harder drugs. He told me that he looks to Jimi Hendrix as his higher power – whatever works.

  54. #55 SoberPJ
    July 5, 2010

    Jimi Hendrix, a doorknob, a tree, an imaginary ________ (fill in the blank) for a higher power tells me that some amount of delusion is a required element for the 12 Steps to work. Put another way, I have to be delusional to believe that the steps actually work.

  55. #56 Z
    July 5, 2010

    ScottK: “You have no need of the 12 Steps if that’s where you’re at.”

    Here are the things, though:

    1. The reason I was even recommended to go to Al-Anon was that my parents (2000+ miles away) were having drinking related problems, and I didn’t have much experience with addicts, this having been a problem that had gotten severe long after I’d left home. I really did need some insight and information, but what I got were accusations about what I must “really” be like if the stain of alcoholism existed in my family, and recriminations because I didn’t believe in God. This kind of behavior really doesn’t seem very humane or evolved to me, and it’s hardly helpful. I think that even had my situation at the time been less happy and stable than it was, following the 12 steps, with all the abuse and self abuse they require, would not have been helpful, either.

    2a. They say that you can define God in any way you want. I think that’s flaky, you make up a God on the spot. I am not religious but religions are complex intellectual and cultural edifices with a lot of tradition behind them. It seems really egotistical to come up with a pick and choose “God.”

    2b. The fact is, they don’t let you define God in any way you want. It has to be one god, and it has to be above and outside you; it has to be a god that watches everything you do and answers prayers, and so on. So it’s a kindergarten style fundamentalist Christian God. You are allowed to call by any name you wish but you have to call upon them and relate to them in a certain way, and they have to have certain very specific characteristics.

    For example,I heard in the meetings I went to that you were supposed to practice praying by praying for a good parking spot! One: that makes a mockery of actual prayer or meditation. Two: it’s incredibly egotistical. Three: a good parking spot is just not that high on my list of desires – not getting one isn’t a big deal – if I were to pray I’d much rather it be for something significant, like for a big hurricane not to hit New Orleans this year.

  56. #57 SoberPJ
    July 5, 2010

    Two drunks in separate cars see the same empty parking spot in a parking lot. The first one prays to his doorknob to let him be the one that gets the spot. The second quickly prays to the tree in her front yard asking for the grace to be the one that gets the spot. So, the main question follows, Which higher power is the more powerful higher power? The door knob or the tree?

    Delusion is a required element of the 12 Steps….

  57. #58 Z
    July 5, 2010

    @SoberPJ yes, but part of why I’m as familiar with all this stuff as I am is that I’ve got an old, good friend, smart, fun, funny and perceptive on lots of things, but who has become a 12 step acolyte. I know what she’d say to this: we think it’s delusional because we take it too literally. A weak defense if you ask me; I’m not opposed to whatever it takes anyone to get through the night but it’s the abuse and quackery in the effort to universalize this stuff that bothers me.

  58. #59 luna1580
    July 5, 2010

    i think Z just made some very strong and realistic points that show how 12 step-style “help” is often totally inappropriate and non-helpful for many, even most, people.

    and able p. i’m really happy you took up this topic on your bog and here at science blogs particularly. and i did look at your “blogger friend’s” linked post, but it leaves me with more questions:

    -why are non-believers considered “spiritually challenged”? even if that title was purely tongue-in-cheek it still implies that all humans should aspire to a god-based/religious-type “spirituality”, and that those who don’t seek some form of exterior god entity are “challenged”…..

    -why are his “alternate steps” even based on the 12 step model at all?

    that itself seems an admission that “the steps” will work if we can just interpret them “better”. this alludes to the idea that “the steps” themselves are still some sort of genuine cure and we are simply challenged to adapt them to our own beliefs and “really honestly work them”, as if the method itself were both sacred and proven. well, it’s scientifically totally neither.

    -why not throw out “the steps” completely and try to use some other combination of support group, psychotherapy, cognitive-behavioral therapy, medication, etc. to help people? why not start from scratch and keep a legitimate scientific record of techniques that statistically have better “recovery rates” than “no treatment” and learn from that start point?

    just “modifying” the 12 steps is still working within the mindset that they are actually the best way to help people, when in fact we have no data to support this, and some data that directly contradicts their rate of “helping” people to live better lives, be less suicidal, be less prone to dangerous binges (as opposed to a reasonable glass or 2 of wine with dinner or total abstinence as the individual sees fit…), etc. and we have no evidence that “the steps” help more than a very few who try them achieve any of those things at all.

    so why not throw the steps out when searching for genuine ways to help people cope with addictions? why not start over and try to use evidence-based medicine and modern (vs. the 1930s) ideas of psychiatric theory?

    i am not trying to attack people who find solace in AA/12 step methods (i am happy that you’ve found a way that makes you live a happier life), but i think these are questions which need to be addressed.

  59. #60 luna1580
    July 5, 2010

    p.s. i didn’t mean “makes you live a happier life” i meant “helps you live a happier life.” my sincere apologies.

  60. #61 friendthegirl
    July 6, 2010

    Luna,

    Those are good questions… The idea that the 12-Steps is the standard toward which everyone should honestly strive, and that, if we can’t quite “get it,” we should at the very least try to get our toe in the door, with “Steps Lite,” doesn’t make any damn sense, especially since the 12 Steps are just Made Up.

    I think SMART Recovery has pretty close to what you might consider a more ideal foundation. It is based on science, and, even better, promises to evolve to incorporate new scientific research. They offer people an array of practical techniques, and support groups that focus on the present and future (setting goals and fielding challenges) rather than abasing oneself and sobbing through a drunkalog.

  61. #62 luna1580
    July 6, 2010

    FTG, thanks for your feedback. (and you run a great site.) i’m happy to know that real alternatives to “the AA model” at least exist, even if they aren’t widely recommended/available.

    i just hope that more research efforts and actual program alternatives to the “steppers model” will come to the forefront of international addictions treatment. there is no excuse for “modern treatment” options -court or family ordered or self-sought in desperation- to be held hostage to “the step model or nothing else”.

    there is no rational excuse for the whole industry being modeled after AA at this point. we should do better. we have the ability to move beyond “faith healing” in this modern world, and those who are deep in the suffering of addiction (to anything) deserve a better option than 1930′s faith-healing…….

  62. #63 friendthegirl
    July 6, 2010

    Thanks, luna. It’s true, there is no excuse for it… It drives me nuts trying to figure out how this happened. How did we shunt this off? And now, why does the medical world allow it to continue? I’ve been watching Intervention on and off today (there’s a marathon), and it’s really driving this point home to me. Addiction is an apocalypse. It’s such an enormous, complex, devastating, and rampant problem. And we act all serious and intense about it, but have nothing more to offer to addicts but the Hokey Pokey.

  63. #64 SoberPJ
    July 6, 2010

    Hey Z, your friends imagined response is interesting. Taking it too literally. Yep, those pesky words with their pesky literal meanings. The meanings of words really trip me up, especially when they don’t mean what they mean and then it is up to me to determine the meaning behind the word with the newly intended meaning. Like when somebody says, “my higher power is Jimi Hendrix.” The words don’t really mean what they mean, they mean something else. And that something else is purely sane and rational and certainly NOT delusional. I get it now, it means something else, certainly no rational person would claim Jimi Hendrix is actually their higher power. They just say it and mean something entirely different because that’s how they communicate in AA. They just say all kinds of things and don’t really mean them and it confuses those literal people that just don’t understand alcoholics. Delusional….

  64. #65 Abel Pharmboy
    July 6, 2010

    My reason for putting TDA’s post was to address those who may want to try AA but can’t get past the obstacle of belief in God. As I said, TDA tends to support whatever modality works for the individual. In other posts, he cites how approaches like Stanton Peele’s can be useful for others.

    But ftg raises an important point that I agree has not been fully explained in the evolution of medical treatment of addiction: if we know that no one approach works for every person dependent on alcohol or other drugs, why has medicine and the legal system embraced AA and the 12-step model? As I pointed out in the post what seems like many moons ago, we individualize treatment for cancers with different combinations of drugs since there are many different types of cancer. Why doesn’t the system embrace alternatives for treating substance abuse?

    Again, speaking as a citizen and not a medical professional, I wonder if it is a combination of prevalence and access of AA but also a lack of public understanding of alternatives. This is what I’m really hoping this blog post and comment thread does: start a wider discussion of recovery alternatives for those put off by AA.

    Since ftg mentioned SMART Recovery, their link is here:

    http://www.smartrecovery.org/

    Not as prevalent as AA but there are over 500 meetings in the US as well as in Australia, Canada, the UK, and a couple of other countries. SMART Recovery also has over a dozen weekly online and voice chats.

  65. #66 DuWayne
    July 6, 2010

    Luna –

    so why not throw the steps out when searching for genuine ways to help people cope with addictions? why not start over and try to use evidence-based medicine and modern (vs. the 1930s) ideas of psychiatric theory?

    Tradition and the fact that nothing really has what anyone would call a particularly reasonable success rate. Even behavioral therapies, the best option by far, only has a slightly more than completely shit success rate.

    Abel –

    Why doesn’t the system embrace alternatives for treating substance abuse?

    The biggest problem is cultural paradigm that moralizes addiction. I can’t even begin to count the times I have gotten into discussions about addiction and heard some jackass talk about how it’s all the addicts fault, why should I care?

    I damn near slugged a moron the other day, who interrupted a conversation I was having with someone who was talking to me about his problems with various substances of abuse, to tell us that. Mind you the person I was talking to has about every damned risk factor for substance abuse you can imagine, and feels like it is his fault for being so weak. For many addicts it was always virtually a foregone conclusion, there is plenty of evidence to support that assertion, yet even people who should damned well know better sometimes need to moralize it.

    AA fits exceptionally well into the moralizing addiction paradigm, though not quite as well as RR. Thus AA continues to receive the most attention – even among medical professionals. I think that PalMD’s relatively recent post on narcotics and doctors ended up providing a very good glimpse into how many health care providers feel about addiction. Not that I am singling them out – doctors and nurses are human beings too and thus aren’t immune to human biases.

    The other problem, of course, is that the development of science based treatments cost money. It doesn’t take a very strong strain of moralizing to prevent people from wanting to spend money on a problem.

    In the interest of both full disclosure and to explain the complexity of this problem of moralizing addiction, I am not nearly so immune to it as I would like to be. It is complicated and no matter how angry such moralizing makes me, sometimes I can’t help but look at someone who is abusing this or that substance with scorn. Never mind how damned many people have looked at me that way, because I was perpetually trashed – it is simply impossible to avoid sometimes.

    Even if you are me, an ardent advocate for persons with substance use disorder and the end of stigmas surrounding addiction and other psychological problems.

  66. #67 k8
    July 6, 2010

    “But ftg raises an important point that I agree has not been fully explained in the evolution of medical treatment of addiction: if we know that no one approach works for every person dependent on alcohol or other drugs, why has medicine and the legal system embraced AA and the 12-step model?”

    I’ve always wondered this myself. And I’ve come to a few conclusions that I’m willing to have altered, but at this point, this is what I see. No addictions treatment works with assurance. But what law enforcement officials like about AA is that you’re supposed to be accountable to other people in this program. When I go to court to testify for the women I work with in a sentencing alternative program, they ask me if they’ve “gotten a sponsor yet.” It’s the accountability they are looking for. Plus, many people of law think of AA as a moral program. You’re supposed to be “brutally honest” and “searching and fearless” in turning your life around. What more could society want from their addicts? They’re not just looking to solve the alcoholism riddle, they want you to be a “better person” so you don’t keep screwing up.

    I am troubled by the “sentencing” of alcoholics and addicts to a spiritually based program. And no matter what the TDA says, it really IS a spiritual program. You can’t get away from that. Where is the separation between church and state here? Sure, in AA, you don’t have to believe in one particular God, but this country’s freedom is based on NOT believing as an option as well.

    With that said, kudos to AA for helping the number of people that it has. It also says in the literature that AA does NOT hold the market on recovery and it specifically encourages participants to try out other programs as well and if they get sober as a result, all the better! That is what AA is founded on. It is not AA that says “if you don’t go to AA, you’ll die.” It’s PEOPLE who say that. I just got home from the International AA convention and well? It worked for me and for the 60,000 people that attended. And for the first time since I got sober, I felt much less like a statistical blight on society and more like I finally belonged.

  67. #68 friendthegirl
    July 6, 2010

    K8, I get what you’re saying about accountability. I mean, I understand that the conventional wisdom is that AA demands accountability, and that, perhaps, that’s why people generally support AA. But the conventional wisdom is not founded on reality.

    There is no accountability in AA. Sponsors are not trained. There are no prerequisites. Anyone can sponsor, and newcomers are encouraged to sponsor (because sponsoring reinforces one’s investment in the program).

    It’s an illusion of responsibility.

    The same people who want to tell us that that AA is awesome because “the inmates run the asylum,” are the same people who will say that the inmates can’t be trusted: “Well, that’s not AA!” AA does not take responsibility for what happens in meetings. It can’t simultaneously take responsibility and enjoy the position it does in our culture. So, when you say “It is not AA that says ‘if you don’t go to AA, you’ll die.’ It’s PEOPLE who say that,” you’re right. AA members say that to each other, but it’s rampant, and no one is accountable for the consequences. I believe that people are responsible for what they do to each other.

    Just because no one will claim responsibility doesn’t mean that no one is responsible, and I hold all AA members responsible for what happens in AA. If you know that this is happening, but sleep well at night by telling yourself “that’s not AA,” while knowing that AA will never step in to stop it, then you are accountable.

    Look, if you’re following this thread, and perhaps following the Koerner thread on Wired, then you can see very clearly how AA members treat people and each other. You can say that this isn’t “official AA,” but nothing is official AA. AA is as AA does.

  68. #69 jaycat
    July 7, 2010

    you’re a weirdo

  69. #70 DuWayne
    July 7, 2010

    K8 -

    Not to be a jerk and pile on, I have to rather agree with FTG. Official AA has little to do with the reality of AA. Yes, there are all sorts of pamphlets that explain that this practice or that isn’t acceptable. Yet the people who make up AA aren’t accountable to anyone when they engage in this practices anyways.

    I expect that most of us commenting on this thread are fully aware of just how vulnerable addicts are when they hit bottom. It is all fine and good to claim that practices such as telling an addict to refuse or even quit medications prescribed by a doctor are strongly condemned by “official” AA, that doesn’t change the fact that a lot of very screwed up, completely vulnerable people are told just that. Or are told that if they can’t succeed with AA they are never going to succeed.

    It is also easy to say, as ScottK does, that you can find other meetings, or form your own group. It is also absurd to expect that someone who has hit bottom to shop around and insane to expect such a person to start their own group. And of course in some locations options are extremely limited, no matter what some people would like to claim. As a midwesterner, I can name more than two dozen towns off the top of my head where there aren’t more than one group.

    Please understand that I am extremely glad that AA helped you and helped the 60,000 people you met with in San Antonio. I really enjoyed perusing your blog (though I only looked a little, because I should actually be doing homework now) and look forward to reading more about your successful sobriety and the joy you are finding with your new lease on life. I really am very excited for you, as the excitement of seeing addicts find that joy again is a driving force in my desire to help develop new and improved treatment methodologies for addiction.

    But AA is more than just people who do it “properly,” it is also made up of very nasty people who do a hell of a lot of harm sometimes.

  70. #71 k8
    July 7, 2010

    I would agree with you DuWayne. AA is full of jerks and ego and all kinds of crap just like any other organization. But full scale condemnation because of “some people’s” experiences is just as bad as blindly following it as well. I am by no means saying that it is the best thing evaaahhh for addiction. I think I made that quite clear. And yes, ftg. I am responsible for what happens in AA, but I can’t go around and police every group. I am responsible for MY group and the health and wellbeing of it’s members. For people struggling with addiction, having a vast array of options (because NOTHING works)is key. Look, I tried it all, CBT, group therapy for the borderline inclined, inpatient hospital treatment, outpatient treatment, church, the whole gamut. AA worked for me. Do I wish something else would have worked earlier? Probably. But to take it away as an option based on some people’s experiences is not right either. The abuses I suffered in group therapy for instance, were just as bad as what you’re saying people experienced in AA. Nothing works for addiction. Nothing gets more than a 5% recovery rate. So, I say leave it on the table as an otpion.

  71. #72 friendthegirl
    July 7, 2010

    @DuWayne “It is also absurd to expect that someone who has hit bottom to shop around and insane to expect such a person to start their own group.”

    People who speak out publicly about their terrible experiences in AA are often told to find a new meeting or a new sponsor — even though their experiences are terrible in very predictable ways, meaning that they’re very likely to encounter the very same things at another meeting.

    But, vulnerable newcomers have no way of knowing what’s Real AA or that their sponsor is batty. They’re told to trust the group (G.O.D. = group of drunks); that “their best thinking got them there,” (so don’t try to think); take the cotton out of their ears… etc. Yet it becomes their responsibility when they are steered the wrong way or taken advantage of. They are sent to AA by doctors or family or employers or the court, instructed not to question, because their alcoholic perceptions can’t be trusted — that, in fact, questioning the program or their sponsor means that they won’t get well — but then they are blamed for not using their common sense.

    AA could do something as simple as create a handout and web page for newcomers — or add a couple pages to the Big Book or the Introductory Pamphet — with some guidelines for navigating AA safely. But I guess that would be acknowledging that it’s not so safe.

  72. #73 DuWayne
    July 7, 2010

    K8 –

    Believe me, I am not interested in shutting anything down, unless it is overtly dangerous, as long as it helps people. What makes me so uncomfortable with AA is not the program itself, rather I am extremely uncomfortable with the lack of accountability at the local level. I am all for what works, but I am also all for accountability.

    A great example, is a program in Portland, OR; Union Gospel Mission. Keeping in mind that I am an atheist, I wouldn’t hesitate to recommend UGM to any Christian addict. They have an overtly Christian program, but it is also a program with an incredible success rate – for Christians. Mind you, they do not accept anyone into the program who isn’t a Christian – but they shouldn’t. There was a threat of a lawsuit against them a few years ago, because they are an approved option for court coerced treatment and are included in a program that allows inpatient treatment centers to use resident food stamps. I was more than happy to add my voice to convincing the group not to sue.

    My point being, I am all about what gets someone sober. What I get very irritable about is a lack of organizational accountability. UGM has a phenomenal program for a particular demographic, but they also have a great deal of accountability. When it comes to cognitive behavioral therapy, there should be more accountability and depending on the state, there often is – same with groups. I get particularly irritable about abusive group settings, because there is no excuse for it – anywhere.

    If I had the position to help change that (a definite goal of mine), I would. As a general rule, I would love to see more self-policing out of the APA.

    FTG -

    There are some sites that offer just such guidelines for safely navigating AA, but there are few of them. I am actually rather behind on my own blog, as I intended to create one myself – but I am going to be posting one to the addiction forum I am building right now. Unfortunately, rather than managing to get that set up six weeks ago as originally intended, my lack of HTML skills and nine credits for the half length summer semester have slowed that process.

  73. #74 friendthegirl
    July 7, 2010

    DuWayne, Will you keep me posted on the progress of your website? I would like to add a link to our list of resources.

  74. #75 SoberPJ
    July 9, 2010

    For an illustration of how entrenched the AA nonsense is in treatment centers, visit the Betty Ford Center http://www.bettyfordcenter.org/treatment/doctors-office/are-there-people-who-don\t-make-it-in-aa.php

    Wow, I can hardly believe my eyes. Someone is having trouble staying sober using a faith-based healing regimen and a DOCTOR at Betty Ford Center is recommending a reading from the textbook that is the basis to achieve the AA religious conversion and thereby receive the faith-based healing.

    Before this completely disrupts my confidence in medicine, I have to assume the doctor is simply uninformed. There is no way he can know that the opening sentence of that chapter is, at best, patently false and still recommend it and the text that follows. Why would a doctor recommend the reading of false text to a person in a potentially life and death situation? Is that the state of modern medicine at the Betty Ford Center?

    The opening sentence to chapter 5 is suspect for several reasons. But first, we have to decompose the sentence. “Rarely have we seen a person fail who has thoroughly followed our path” , can be condensed to “rarely fail if thoroughly follow path.” Or further, follow path = rare failure. My initial observation is that someone can supposedly follow the path and still fail. So, the doctor is recommending text that says even if you do everything you are told, you can still die a drunk. Not very reassuring. Next, what did the author mean by “rarely”? Rarely could be 10%, or less, or more. No one knows. And rare over what period of time? Surely there are some statistics behind this grand claim of success? Sadly, no. The anecdotal evidence is not good however. In the book Alcoholics Anonymous, there are stories written by some of the members of the original group. These stories extolled the life saving virtues of the program of AA. The unfortunate part of this is that half of those authors got drunk and some died drunk. There is no reason to assume that the general population of the early religious converts had any better luck at staying sober with the “path”. So, the “Rarely fail” statement is highly suspect, if not patently false.
    Further, what path was being referred to? What statistically proven regime was being proposed here? One that a Doctor at Betty Ford Center would be proud to recommend and endorse as a life saving methodology for relieving the horrendous symptoms of relapse in the program of AA? No one can really agree. The 12 Steps were written for the Big Book, they didn’t exist before the book was being written. There were six steps that were supplied by a religious organization called the Oxford Group, but they worked so poorly that Bill Wilson, the main author of the Big Book, expanded them. He turned the six steps of the Oxford Group into the 12 Steps of AA. The six steps of the Oxford Group were the “path” prior to the Big Book and probably the one he claimed had rare failures. Which was patently untrue and the early poor success rate is well known.

    Now we come back to the doctor and his professional recommendation. My lay person examination of the opening sentence of Chapter 5 of the book, Alcoholics Anonymous, hopefully shows that, at best, there is reason to doubt the accuracy of the claims made in the sentence. At worst, it is pure nebulous fabrication designed to make the religious faith-based healing approach look more successful than it is. On a spectrum with truth at one end and blatant deceit at the other, the sentence surely falls closer to the end with deceit than it does to truth. So, knowing all this, why would a doctor of medicine recommend the reading of a deceitful text as a solution to the very real problem of recurrent drinking in a faith-based abstinence program of recovery? Surely, modern medicine contains helpful alternatives for this type of situation? The best possible medical answer can’t be, to paraphrase, “ It would be too bad if you died drunk, others like you have made it, just read some text that begins with a sentence of dubious truth that contains unsupported claims and focus on rigorous honesty.”

    Is that medicine? Let me venture an answer, “NO!”

  75. #76 SoberPJ
    July 10, 2010

    And the situation gets more interesting when looking closely at certification. From another thread on a forum…

    Re: Betty Ford Center nonsense

    “Wow, so even addiction certification for physicians isn’t a typical academic/professional certification, but is awarded by “peers.” Hum, I can’t help but think some of the peers must also be steppers (i.e. steppers certifying other steppers similar to “addictionologist”, “interventionist”, etc.). Talk about a biased, loaded deck! The more you dig, the more slime you find. Incredible.

    >
    > Yeah, I think it is sadly appropriate that the “The American Society of Addiction Medicine” is based in Chevy Chase Maryland, it is a really bad joke.
    >
    > also this from wiki is interesting
    >
    > .. certificate from the American Board of Addiction Medicine following a peer-reviewed Board-type examination…. The American Board of Addiction
    Medicine is not currently a member of the American Board of Medical Specialties.
    >
    > so unlike other specialties the certifying board is not really certified and instead of specific training, testing, working at the specialty they just get a peer review by an unaccredited certification board to certify their treatment of addiction. ”

    I only pass this along as interesting. I have not verified the comments as correct.If you know this to be not true, please straighten us all out.

  76. #77 Angelina
    July 10, 2010

    I keep hearing things like ‘aa has saved millions of peoples’ lives’. I am not saying it has not; I do not know. But I don’t see how you can conjure up figures from an organisation so secretive, by its nature. I thought aa had around 2 millions worldwide, mostly in America, of whom approximately half are court-mandated to attend. Now out of thoses approximately 2 million, how many are sober, and how many are, like Sharon’s mother (above) going in and out of the rooms for years, on a constantly relapsing pattern. How many are forced there by work or family?

    I know several people who are glad to be out, and guilty that they helped to recruit. AA is very different once you have gone for about 3 months to when you first turn up. When the group see that you might just stay longer than just a few meetings, you get pressurised to find a sponsor, ring them everyday, CONFESS ALL YOUR SINS TO THEM, and come to unquestionningly accept everything the group accepts, under threat of subtle but effective social exclusion.

    I think aa should warn newcomers of its abymsmal success rate and psychological dangers. But then it would lose its mystique. AA members like asking people if they are ‘friends of Bill’, because it gives them a secret service buzz.

  77. #78 raysny
    July 11, 2010

    k8 writes:
    “Nothing works for addiction. Nothing gets more than a 5% recovery rate.”

    5% is the rate of natural remission, people quitting without treatment. Methods that improve on thee rate of natural remission are considered to be “evidence-based practices”.

    So what works?:
    “What works? A summary of alcohol treatment research” in R. K. Hester & W.R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives
    http://www.behaviortherapy.com/whatworks.htm

  78. #79 SoberPJ
    July 11, 2010

    As anyone can discern from the type of comments to the article, AA is under increased scrutiny and it really can’t defend its abysmal “success” rate. To further illustrate this point, here is an example of what is going on in the Addiction Treatment industry. This is from the website for an upcoming addiction conference -

    “Experts agree that the current systems for the treatment of addictions are inadequate in terms of policy, structure, methodology, and treatment efficacy. Only a small minority of addicted individuals receive the evidence-based treatment they need. This conference brings together policy makers, administrators, clinicians and researchers who will outline a new frontier in addiction services and discuss ways to adopt and implement a more expeditious, user-friendly, cost effective and evidence-based system. Speakers will be urged to brainstorm new ideas and think outside the box.”

    The “current systems for the treatment of addictions are inadequate” refers to 12 Step faith-healing, religious approaches. The world of addiction medicine is trying to break the stranglehold that the ineffectual AA monopoly has on addiction treatment. And rightly so.

    The web site: http://www.addictions-conference.elsevier.com/

  79. #80 researchibogaine
    July 12, 2010

    Here’s one for all the 12 steppers intentionally trying to take up all the space in this blog with their “miracle”. Did you ever watch the Disney movie Dumbo as a child? Remember how Dumbo thinks he can’t fly with his ears and is afraid to so the mouse gives him the “magic” feather? And then after receiving the feather he learns to fly but at the end he drops it and then realizes that it was ALL HIM THE WHOLE TIME AND HE WAS FLYING ALL ON HIS OWN? Beautiful ending wasn’t it? YOU ARE THE ELEPHANT THE FEATHER IS THE PROGRAM AND FLIGHT IS SOBRIETY. This should be some unifying shit for all you lonely, simple minded, anti-intellectual believers out there. Please drop the feather and stop proselytizing.I’m glad it worked for you and all your friends that spend all your free time at your church basement social clubs but drunks and drug addicts suffer everyday (you all should know this better then anyone)and there are people out there trying to find something that will hopefully really will work for MOST of them. All you are doing is standing in the way. And don’t try and say these people are devoid of spirituality or whatever, some of them believe in god or a higher power or the great beyond or whatever and some don’t period. This isn’t the issue, substance abuse is. :)

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