I was invited to the UK and Denmark to speak by harm reduction activists who are worried about the impact of AA and the 12 steps in their countries. Both Patrick O'Hare, who founded in Liverpool the organization now called Harm Reduction International, and Nanna Gotfredsen, founder and director of Copenhagen's Street Lawyers, who run a clean needle program and other services for drug users and addicts, watch with alarm as the gains they have made dealing with addicts over previous decades erode. You see, both the British and the Danish governments are increasingly buying into the AA line that abstinence is the best and most achievable goal, both for individual addicts and for their nations.
Oddly, in Denmark, the newly-elected socialists are most susceptible to AA's abstinence uber alles message, while in Britain it is David Cameron's conservatives who seem to be swallowing the AA message hook, line and sinker. Politicians of all stripes tend to like magic bullet solutions, especially ones that hold out the promise that their constituents will stop taking drugs. Drinking is a thornier matter, since politicians and public health savants themselves drink, and the issue there is obviously over-drinking. (Of course, in reality, drugs present the same problem.)
Here are four reasons AA is harmful and will hurt their societies.
AA denies reality. I present data generated by the American government's own research showing that each age cohort after the 18-25 age group has a substantially lower percentage of problematic drinkers and drug users -- including alcoholics and addicts. Yet, the large majority of former abusers do not enter treatment or join AA -- they have simply "matured out." Since the 12-step mantra is that substance use problems only grow worse without their intervention, AA members must deny this reality ("All the youthful drug users have died!"). I then ask how many members of the audience have quit smoking -- which they acknowledge to be the hardest drug addiction to quit. Of the large number who raise their hands, I then ask how many did so due to medical treatment (e.g., nicotine gums and patches) or support groups. If 1 in 10 former smoking addicts present raise their hands, it's a lot.
AA overemphasizes its own success. As these sorts of interactions reveal, AA-ers always overestimate their own role in recovery, both its pervasiveness (only their members quit) and their success rates. Although, in the latter case, not really. If you ask what percentage of people who attend AA stick with the program, AA-ers themselves will usually guess the correct 5-10 percent figure. Their argument is that those who depart are bound to fail altogether, since theirs is the only road to recovery. Within AA groups themselves, people who leave the program are ostracized by their former "soul mates" who predict -- some might even say they hope for -- the prodigals' failure and demise. That is, unless they return to the fold.
AA rules out other, often more effective, approaches. AA is a jealous lover. A body of research has grown that investigates the efficacy of alcoholism and addiction therapies with names like motivational interviewing, life skills training, community reinforcement, brief interventions, harm reduction, etc. These therapies share a number of general characteristics relative to AA and its 12 steps: They are more pragmatic and impact addicts' functioning and life situations, they often permit reduced or less unhealthy use in addition to abstinence, they tap into users' personal value systems rather than imposing their own, and they don't rely on a "higher power." And they generally demonstrate greater success than AA (no clinical study of AA has ever found it superior to any alternative offered to randomly selected alcoholics). And how do AA-ers feel about such alternatives? Disinterest is probably too positive a way to describe their reaction.
AA's underlying temperance message actually creates alcoholism and addiction. The American temperance movement anticipated every aspect of the 12-step approach (keep this in mind when reviewing Ken Burns' documentary on Prohibition). These include the claims that drinking problems inevitably progress to death or other forms of self-destruction, the permanence and irreversibility of human substance abuse problems (which in turn leads to the fixation on abstinence and disbelief in moderation), the need for divine intervention and the reliance on God and a higher power, etc.
But this type of black-and-white thinking is actually associated with the greatest drinking problems -- think Irish-style versus Italian-style drinking. (Pat O'Hare, with his Irish and Liverpool background, says with amazement, "In my 12 years in Rome, I never saw a drunk person -- not even a tipsy one.") In other words, the cultural outlook underlying the 12-step model is the one likely to lead to the most excessive drinking/alcoholism/addiction. This is particularly true when, in the same society -- as is true in contemporary America -- people are ubiquitously exposed to the very intoxicants whose use they are taught that they are incapable of controlling. Consider that a higher percentage of American youth disapprove of those 18 and older having 1-2 drinks daily than disapprove of weekend binge drinking.
The ascendance of AA and the 12 steps in the UK, Denmark and elsewhere in the world won't be associated with greater abstinence or relief from addictive problems (has it had that effect in the U.S.?). It is a self-fulfilling philosophy -- that is, its own failures feed its claims for its own necessity (ask someone in AA if the rate of alcohol and other substance use problems has declined or increased in America since AA was formed in 1935). Most important of all, the 12-steps deprive people -- societies -- of the belief in their own ability to manage substance use. And this loss of personal efficacy is not likely to be a good thing in the coming century.
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