Building on an essay in Wired magazine by Brendan Koerner, New York Times conservative columnist David Brooks lauds to the sky AA and its founder, Bill Wilson. Both Brooks and Koerner point out the worldwide spread of AA (although it is limited mainly to the U.S. and like-minded countries), and the spread of the 12 steps to nearly all areas of behavior change, indeed, to how we approach social problems of all sorts.
Along the way, Brooks makes the good points that there is no scientific way to program behavior change -- that it is indefinite and rooted in individual choice. He points out the benefits of the social networks AA provides its members, and the decentralization of the AA movement, so that individual chapters are able to organize as its own members see fit. These are strong organization and psychological pluses.
But, unfortunately for a rational conservative, Brooks misses a few downsides to the AA movement.
1. The view AA conveys of alcohol and alcoholism is associated with abstinence-binge tendencies that already dominate America and other temperance nations. AA's approach is completely abstinence oriented. In fact, temperance cultures like America, which are highly suspicious and fearful of alcohol, are characterized by many individuals who restrict their drinking, but then go on benders. Similar Northern European cultures, for example, have several times the death rates due to alcohol of Southern European countries, because the former tend to monumental binges (think Ireland, England, Finland) while in the Southern countries, people drink alcohol causally with meals (think Italy, Spain, Greece, France). All indications are that the latter is much healthier. More particularly, the majority of AA members fall off the wagon. When they do so, they very often return to drinking without restraint.
Brooks, a great trend-spotter, has missed the worldwide movement -- including in the United States -- towards harm reduction. Harm reduction has an opposite approach to substance use and addiction from the 12 steps. It assumes many people will fail to achieve abstinence, and instead works in every possible way to curtail the problems associated with use: infections (through needle exchange), eliminating accidents (through safe driver programs), healthier use (through cutting back drinking, providing shelter, food and medical care for alcoholics and addicts, and, in the drug area, using safe injection methods or substitutes for injectibles).
Just as Brooks and Koerner were announcing their discovery that AA is great, the National Institute on Alcohol Abuse and Alcoholism was announcing that "alcoholism isn't what it used to be," that most people cut back alcoholic drinking without going to treatment -- that is, that most of the benefits of self-improvement occur outside the walls of AA for people who specifically violate the fundamental principles of AA. Brooks rejects science in this area: i.e., the idea "that we will someday find a scientific method that will allow us to predict behavior and design reliable social programs." But let's not reject science that tells us how the majority of people actually behave. That's ignorance.
2. Sorry, AA doesn't work. The goal of AA and comparable methods is to get people sober (which does NOT, outside of AA, mean total abstinence for everyone). But, according to Koerner: "Wilson's success is even more impressive when you consider that AA and its steps have become ubiquitous despite the fact that no one is quite sure how -- or, for that matter, how well -- they work." In other words, Wilson's and AA's triumph has been in marketing, not therapeutics.
In other areas, Brooks is not so quick to jump on the bandwagon of approaches that aren't proven to be successful. Given that AA started in 1935, that it is still not proven to be successful is beginning to be a bit worrisome. Do drinking and drug problems, alcoholism and addiction, seem to be improving in the United States? (Hint: according to the National Survey on Drug Use and Health, 25 percent of 21-year-old Americans have a diagnosable drug or alcohol problem -- far and away most often an alcohol problem.) Don't you think we might be doing a little better in this area after 75 years?
3. American AA is coercive. Brooks wisely notes, in acknowledging that AA doesn't work particularly well, "There is no single program that successfully transforms most people most of the time." But virtually everyone who ends up in AA in the United States is sent (forced) to attend AA or comparable programs -- for example through drug courts, or even municipal traffic courts after a DUI. Why does this occur? Because the AA movement is spearheaded by true believers who believe what was good for them is good for everyone, as Brooks himself hints: "There are millions of people who fervently believed that its 12-step process saved their lives." Naturally, these people are inclined to "recommend" that others follow their one truth path. This, even though Brooks notes, "the majority, even a vast majority, of the people who enroll in the program do not succeed in it."
4. The government, especially, should not be involved in spiritual salvation and identity change. As Brooks correctly states, people become sober when they "achieve broad spiritual awakenings, and abstinence from alcohol ... [is then] a byproduct of that larger salvation." Fair enough, but how does this go with point three, that people are routinely sent to AA by courts and social agencies? Four of nine federal circuit courts (as well as New York's and several other states' highest courts) have ruled that people with religious objections (Buddhists, atheists, Jews) cannot be compelled to attend AA or a 12-step program, and must be permitted alternatives. I know, I know ... AA isn't religious, and Step 3, "Made a decision to turn our will and our lives over to the care of God as we understood Him," isn't really about that God -- you know, the Christian one. But those dang courts keep begging to differ -- forcing people to bow to any form of God is just not part of the Constitution.
5. We need to be encouraging alternatives to AA. Brooks does not make the proper deduction from noting that, "There is no single program that successfully transforms most people most of the time." Since AA and the 12 steps are used in over 90 percent of American treatment programs, we need to provide more ready alternatives to AA, not inject more resources and energy into the system that has been around three-quarters of a century, will little noticeable society-wide improvement in our drinking. 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.
And, while I'm at it, let me mention that I have recently written a foreword for Amy Lee Coy's From Death Do I Part, which is the story of a 34-year-old woman's quitting drinking after two decades of alcoholism (and assorted other addictions) and a dozen, at least, exposures to AA and 12-step rehab. She did so when she finally took ultimate responsibility for her own life.
P.S. Dave, read the comments, especially the ones that say any alcoholics who read this will die.
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I work at an MMPT Methadone Clinic. I intuitivel
I wrote you last year and you mentioned that I should introduce your works to my fellow MMPT workers. After reading your work they ask me the same questions as I have asked, "Why after being a counselor for years has no one introduced me to these ideas?" "Why have I been in some cases been abused by staff and administra
Best comments by AAers on Ms. Coy's story of how she finally quit drinking (going on five years now) after 20 years of failure at AA and 12-step rehab, starting at age 14:
(You haven't read the Book right!, from deartoni70
(You're not really sober, like me!, from bobmom) "...and you've been sober how long?"
(You only tried the 12 steps for 20 years - you need to keep at it!, from 2888897) "I wish that she had given AA another look before assuming she knew how it works and declaiming it, when she had clearly misunderst
These comments can be summarized
http://www
http://why
I think I've learned a lot from the anti/XAers though;
No one should be forced (offered) into the A.A. program. They should be offered, er... forced into their choice of secular and non-secula
In light of recent controvers
Accountabi
Give A.A. a chance to take care of actual concerns, but to not be told how to do the program or work the steps. The A.A. program works fine for those who qualify as alcoholic and are willing to take the spiritual approach. Maybe the definition of religion vs spiritual could be reconsider
Other programs can work recovery out as they see fit... but with the same accountabi
I did not stop drinking because of AA, or RBT or CBT or my family, the law, or the best treatment money could buy. I stopped drinking because I wanted to.
What AA has given me, and what it appears to me is the entire point of AA, is a life worth living, such that it I no longer have the desire to drink.
Is AA religious? Probably. Does AA cure any alcoholics
I am highly skeptical that any medical or academic strategy, or any other spiritual group (except maybe Narcotics Anonymous) can give that to me, and all my experience suggests that they not only cannot give me a good life, that is not even their goal.
The real clincher about AA is that AA asks absolutely nothing in return. I volunteer about $300 and about 30 hours of work per year; the former is considerab
And your comment encapsulat
You start out open-minde
You progress to (my paraphrase
And you end up with (my paraphrase
In fact, I made no statements about any evidence other than my own experience
In a post below, however, I do address some of the broader scientific issues, in a reply to your post which states, inter alia, that 75% of all those who are "dependent
I reject that model. The evidence suggests that people do recover. They don't need to go to meetings for the rest of their lives. Many don't even need to totally abstain.
That said, I have two relatives that are long time AA members. I'd never criticize to them and I think AA is good for them because they are shy and AA has provided them a structured social life.
I will probably go to A.A. here and there because I like it. I actually have a group that I'm committed to. That means, I said I'd be there so I go there... once a week... unless I'm out of town on a job. But guess what? God's there too.
If you're gonna bash A.A., at least pick up a book and read what it says in there. It says, "recovered
For example, from the website of a large AA group:
Why do A.A.s keep on going to meetings after they are cured?
We in A.A. believe there is no such thing as a cure for alcoholism
The rest of what Wilson wrote, even in the first 164, supported the "recovery for life" angle.
http://www
And, of course -
http://www
http://www
based on Cognitive Behavioral Therapy, a proven scientific set of tools to manage behaviors and emotions. belief in a "higher power" is not necessary, but won't hurt either
It can and does hurt those who are of a secular nature seeking answers and treatment.
But wait! Here, on page 130 of the 12&12, it says that "the AA member has to conform to the principles of recovery. His life actually depends upon obedience to spiritual principles
See, I think the "death warrant" stuff kind of flies in the face of the idea that AA doesn't say it's the only way. It seems to me that what AA is really saying is "do whatever you want, but if you don't do it our way, you'll die." Which isn't so nice and open-minde
In terms of the costs - SMART Recovery is free, self-direc
If "alcoholis
What's wrong with exploring alternativ
Craig
Within our own family success has been achieved in harm reduction or abstinence with therapeuti
The vulnerable state I was in at that time, I would have vervently believed that I was 'powerless over alcohol'. (Step no.1). For starters, how can any person rebuild their life and self-estee
I was told repeatedly that AA was not a 'spiritual
The shame that is associated with drinking and even recreation
I still aim to reduce my drinking. With the support and basic common sense of HAMS I have done so. Because better is better.
Through Harm Reduction which I found in HAMS in the US, I have learnt to manage my alcohol intake so that I damage no one else nor myself. Were I to believe I was an 'alcoholic
Could you be specific? What studies, what do they say about A.A.? How do they qualify a "failure"? How do you qualify "alcohol problems"?
In the final analysis, are you in agreement with those who say, "A.A. does not work"? If so, I rebuke that as a false and wreckless statement. A.A. works wonderful for me I've seen it work with many many others. Many who have gone back out and drank, got back into A.A. and are succeeding now. Where does that weigh in your assessment of the failure/su
Let's say A.A. is a religious program. Does that mean you must qualify as religious to even consider A.A.? Do all scientific
Brandsma JM, Maultsby MC, & Welsh RJ. (1980). Outpatient treatment of alcoholism
Dodes, LM. (2002). The Heart of Addiction: A New Approach to Understand
NIAAA Five Year Strategic Plan FY07-11
Vaillant GE. (1995).The natural history of alcoholism revisited. Cambridge, Mass. Harvard University Press.
In particular
It is your constituti
I wasn't a fan of that depiction of an alcoholic.
But most alcoholics get inspired and rebuild thier outlook and their circumstan
I've got a pretty good sense for these things. I think I've become a field expert on what alcohol does/doesn
Many people go to A.A. and don't even need it. What do we do about that? Anything? Sit around and accept bunk stats?
We've got a number of people who attend A.A. and they don't do the program whatsoever
We are alcoholics helping alcoholics
The "people who attend A.A. and they don't do the program whatsoever
And just how do they do that? Silly me, I always took it seriously and endured endless guilt, fear, and misery on account of that cheap cult.
You can mock and trash the A.A. program all you wish. That's your problem. If there's any cult going on here, it's your hatred for A.A. You are in the anti/XA cult. Good luck with that.
We do this work and God helps us stay sober by positionin
I don't belong to a cult. It's a choice... each and every day to be a part of A.A. If I wanted to walk away from A.A. now, I surely can. I'm not afraid of walking away from A.A. Most of what happens in A.A. happens outside of the meetings btw. We do steps.