Every now and then Alcoholics Anonymous (AA) catches a real and true ass whooping in the press. Recently and particularly this week, the volume of voices against AA reached a new height. The Atlantic published a painfully one-sided article by Gabrielle Glaser this week called The Irrationality of Alcoholics Anonymous. Then the article was highlighted on the All In with Chris Hayes on MSNBC.
Whatever you may feel about AA or 12 Step programs in general, there can be no argument that alcoholism and addiction is on the rise. Unfortunately, it is gaining on us, not the other way around. Since, addiction is an absolutely brutal disease this is a matter of great import to us all.
I'm speaking to you as a person in long-term recovery (23 years) who overcame severe drug addiction and alcoholism in great part due to the 12 Steps. While I absolutely believe that AA is far from perfect, please trust me when I suggest that we would not want to wake up tomorrow in a world without it. I cannot overstate the importance of the place these steps hold in our world, and yet, this is far from the full picture.
As I wrote in my book, Recovery 2.0: Move Beyond Addiction and Upgrade Your Life (Hay House, 2014)...
Usually, you hear from one of two extreme camps about the 12 Steps. In one group you have the people who cannot entertain a conversation where the 12 Steps and the fellowships that surround them are brought under scrutiny. In the other camp you have folks who argue vehemently against the efficacy of the 12 Steps for a variety of reasons. The fact is this: the 12 Steps are too effective to overlook, but not effective enough to place them beyond the possibility for improvement. Since we all agree that addiction is a very painful and costly disease, wouldn't it make sense to try to understand and build upon a system of healing that has actually worked to a considerable extent? One group refuses the possibility of improvement and the other group wants to throw the baby out with the bathwater.
There are four main issues that I will address from Glaser's article in the Atlantic: spirituality vs. science, the abstinence model of AA, the rehab industry and Naltrexone as a solution for alcoholism. I'll address these one at a time then I will provide some ideas for moving in a positive direction.
Spirituality vs. Science
As with debates about politics and religion is anyone seriously going to win a debate pitting spirituality against science? Those who lean more to the spiritual are as unlikely to change their opinions as those who rely on science. Yet, we are in a time now where it is not "either, or" it is "yes, and". Integration of science with spirituality is hopefully where we are heading. The question is how do we achieve this integration when it comes to AA, which is based on the 12 Steps, a self-proclaimed spiritual program in which one goes through a process of personal transformation. It does not lend itself well to scientific metrics. As Marianne Williamson wrote on Facebook yesterday, "Spirituality is not irrational; it is non-rational, and there is a huge difference. Many people are alive today because of AA, and that's a fact."
We do know that a huge number of people's lives have been turned around and that an incredible amount of healing has taken place in 12-Step rooms and through the 12-Step process. One of the reasons I found the Atlantic article to be misleading and unhelpful is because its premise was that since AA's effectiveness hasn't been proven through peer-reviewed scientific metrics and empirical data, it lacks all credibility. It also cites questionable statistical data, which is based on unclear metrics.
I've had a positive experience with the 12 Steps and over the past 25 years seen countless others have the same. For me, this kind of peer-reviewed evidence is hard to overlook. Glaser cites a report that states, "The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care." How much more evidence does one need? In the past 75 years, 12 Step programs have saved millions of lives. Perhaps the problem is that scientifically, we still cannot explain exactly how that has happened. The need to know how this happens seems to be a part of what troubles critics of AA.
In describing early perspectives about recovery that have become widely held beliefs in AA, Glaser explains the positive healing effect that people who struggle with addiction can have upon each other. She quotes a web site, "This led to a heartening discovery, one that's become a cornerstone of the Minnesota Model: Alcoholics and addicts can help each other." She continued by stating, "That may be heartening, but it's not science."
Does something have to be science in order for it to be useful? What about magic, inspiration, love, connection and spirit? We live in is a world of science and medicine, yes, but also of magic and beauty and possibilities that cannot be explained away by science and medicine. One important part of what is happening through the 12 Step process is impossible to measure. It is the kindness and love that is transmitted between people with a common life-threatening problem. I admit this is going to be tough for some people to accept, but just because something cannot be measured scientifically does not mean it is ineffective. And just because something can be measured scientifically does not mean it is effective.
Glaser writes, "No conclusive data exist on how well it [AA] works. In 2006, the Cochrane Collaboration, a health-care research group, reviewed studies going back to the 1960s and found that 'no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.'" This is such a pointless, empty statement that I won't take the time to unpack it, but it does prove one thing. The lack of empirical data and science behind AA and the 12-Step process, renders any "science-based" statement against it all the more powerful. When any study comes out showing a lack of tangible science behind AA, AA has very little to defend itself with to a person who needs scientific data to prove efficacy.
And by the way, AA has no desire to defend itself. It has a history of avoiding controversy and likes to stay out of debates about its own efficacy. Further complicating matters, it's membership base is "anonymous." The AA traditions were set down as guidelines to protect the organization and keep it on track with its primary purpose, which is to help the suffering alcoholic. As it states in tradition 11, "Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio, and films." This makes it difficult to learn about and understand what is actually going on in the rooms and society of AA unless you have been there yourself.
Of course AA is not perfect. There is a fair amount of dogma and misinformation floating around the halls of many 12-Step fellowships and this is absolutely off-putting and problematic. It is, in fact, fundamentalism and dogma that make the 12 Steps less attractive and less effective than they could be, but this is far from universal.
Nonetheless, let's remember that the lack of science behind AA does not prove anything other than we have not been able to figure out a way to measure its success. We have not even figured out a way to define success. Is abstinence success, and if so for how long? Is learning to drink moderately the goal? What is moderation? Does it vary? How does a person's happiness figure into the measurement of success? How do you quantify that?
People who cite statistics about success rates (or lack thereof) in AA miss a very critical point. There is the fellowship of AA and then there is the 12 Steps. The fellowship is the congregation or community of people who have come together because of their mutual challenges around alcohol. The 12 Steps is a defined spiritual program whose goal is to bring about a personal transformation in those who go through it with the help of a guide known in AA as a sponsor. I have never seen any statistics that indicate how many people within AA society have actually worked through the steps with a sponsor versus those who simply attend meetings for the community element of recovery. I can report that in my case and in the lives of countless people I know and have worked with directly, working through the steps makes a big difference in the life path of an individual. If these considerations are not being factored into any given study of the efficacy of AA, then that study will produce inaccurate results.
So, you can begin to see how this is a complex issue made all the more complex because it deals with spiritual matters that involve the word "God." It can be quite triggering for atheists, agnostics and those who have powerful prejudice when it comes to religion and/or spirituality. The fact remains though, if you have had personal success with the 12 Steps, that is all the evidence you need. Now what about those who do not take to the 12 Steps?
I do not believe that the 12 Steps are the only way. Do they work all the time? Of course they don't. We are talking about a group of people who are dealing with an ingrained pattern of behavior, which is reinforced in their brain chemistry as well as in their psychology. These patterns are very hard to break and it does take vigilance and hard work to change ourselves even in small ways, as we all know. The fact that some do not recover using the AA approach means that they should keep trying this or another approach or a combination of approaches. But to insist that AA and the 12 Steps are irrational and do not work is to overlook an astounding amount of evidence to the contrary.
Glaser explains what actually takes place at an AA meeting as told through the eyes of a woman named Jean:
Each member's story seemed worse than the last: One man had crashed his car into a telephone pole. Another described his abusive blackouts. One woman carried the guilt of having a child with fetal alcohol syndrome.
So, we are led to believe that this is the sum total experience one can expect at an AA meeting. How ridiculous. Are there meetings that can be a downer? Yes. I've been to many of them, but truthfully there was always something positive I took away. And most of the meetings I've attended over the past 25 years were positive, moving and supportive. There are 2 million people in AA across the world. There's a reason for that.
Remember that it is free to attend all 12-Step meetings and a sponsor will take you through the steps as a service to you. Of course, it will also be a service to him or her, for by giving in this way one benefits greatly. As it turns out, it feels good and is good for you to do things to help others. I'm thankful today that no one is asking for scientific proof of that.
Glaser seems to suggest that everyone in AA is like "The Borg" from Star Trek. "Resistance is futile." Nonsense! You think everyone in AA holds the same opinions about alcoholism and recovery? It's just not true. There are infinite approaches to the 12 Steps and these are being played out everyday as 2 million people get together to talk in a very deep and real way about how life is unfolding for them.
I do agree with Glaser that there is no one size fits all approach. Different people need different things at different times. However, in my case and in my opinion there are two things that everyone will need to recover from alcoholism -- some kind of transformational process and the support of a community of people who have been there. It just so happens that the 12 Steps offer both of these elements and that is part of the reason they have saved so many lives and helped so many families to heal.
The Abstinence Model of Alcoholics Anonymous
There is an unfortunate perspective that we have generally adopted as a society that it is somehow a tragic fate to live without drinking alcohol. There are few notions within AA that are so frightening and provoking for people than the notion of a lifetime of abstinence.
Indeed, the thought of living without drinking alcohol is so terrifying that Glaser reports that it is possibly more hurtful to be abstinent than having a few drinks a day. She writes,
I'm begging this readership to see this insane statement for what it is. Has alcohol now become a necessity for people who want to live an anxiety-free, fulfilling and healthy life? That's it? Alcohol is now a necessity for our well being? Has anyone considered the idea that we can live an extraordinary life without alcohol?
The prospect of never taking another sip is daunting, to say the least. It comes with social costs and may even be worse for one's health than moderate drinking: research has found that having a drink or two a day could reduce the risk of heart disease, dementia, and diabetes.
Glaser goes on to cite the research of an American Neuroscientist living in Finland named John David Sinclair, which concludes from experiments on rats that going cold turkey actually increases cravings. Therefore the suggestion is that abstinence-based approaches like AA make it harder for people to recover because their cravings will increase and in most cases overwhelm them into relapse. What about the possibility that these people's cravings were there to begin with and now faced with the terror of having to break an addiction and change their life their cravings show themselves just as they had before. Is it not basically understood in human psychology that the minute you forbid someone from doing something, they want to do it more? One important message AA imparts is to develop a "one day at a time" approach to life where one shifts one's relationship with time into a 24-hour perspective. It's not that you cannot drink forever. Who could handle such a thought? Of course, you would start freaking out. And it is not until someone explains that we are taking life one day at a time that the initial attempts to put a few days together become psychologically manageable.
Glaser argues that moderation is a saner and healthier road to "recovery." What this does demonstrate is the extent to which alcohol is ingrained into our psyche at the societal and individual level. At the very least most people feel that they will be missing something if they do not drink just a little. A thought might be, "Well I am going to want to drink when I get home from work, at weddings, funerals, on holidays and over the weekend hanging with my friends. What about my glass or two of wine at dinner?"
It appears that in Finland many folks have "had success reducing their consumption to a safe level." Alcohol can be a toxin and is a depressant. For people who are already depressed or sad or anxious, it is particularly unhealthy. In the short term it depletes us of our energy, dehydrates us and contributes to dietary issues since alcohol breaks down into sugars in the body. The detox off of alcohol for severe alcoholics requires medical supervision because it can kill you. The National Council on Alcoholism and Drug Dependence states that, "Alcohol is a factor in 40% of all violent crime today." What is a safe level? Of course, some people can drink alcohol and just... well... enjoy it, but from my perspective it almost always comes at a price.
I can remember the day in my recovery where I woke up to realize that I no longer thought about using drugs and alcohol. It was not a problem any longer. This is a big moment for someone who has really struggled around addiction. The irony is that had I not experienced addiction, I never would have gotten an opportunity to learn how to live an extraordinary life without needing or wanting drugs and alcohol.
Unfortunately, far outside the scope of Glaser's article is the idea that many people do succeed in AA and are not bogged down obsessing about drinking any longer. They are free from it. The obsession and the sickness of it have been relieved. These are the countless success stories of AA.
I am not anti-alcohol. I am anti-intoxication. I'm a success story in recovery and I'm 23 years away from my last drink. I have no thought of drinking today as to do so goes against my heartfelt desire to be aware and to experience whatever life has in store for me without intoxicating myself. At one point I stayed sober out of fear of what would happen to me if I didn't. Today, I stay sober out of love for the life I've created and the joy I feel to simply be free. And I reserve the right to hold space for the rare idea that one does not need to drink to have a full life.
The Rehab Industry
The Atlantic article is entitled, "The Irrationality of Alcoholics Anonymous," yet it spends a great deal of time attacking the rehab industry because the industry mostly adopts abstinence-based approaches like AA.
I'm the first one to agree that the rehab industry in general needs an overhaul. Everyone ought to have access to affordable, excellent treatment, and not just for drug and alcohol addiction, but also for food addiction, a killer in our society that leads to type 2 diabetes and obesity, codependency/sex addiction and gambling to name but a few.
As far as addiction medicine is concerned, I completely agree that our doctors are dreadfully under-educated. And there are also a large number of under-qualified people who have acquired addiction counselor credentials. In an interview I conducted with noted addiction specialist, Dr. Drew Pinsky, he explained that in four years of medical school there are fewer than 10 hours of study focused on addiction. How is this possible with a problem as ubiquitous as addiction? Hard to argue that point, but the treatment center that is based on medicine alone would be, in my opinion, doomed to failure. Addiction is a disease that happens at a variety of levels of a person's being. It is physical. It is mental. And yes, it is spiritual. It has to be treated on multiple levels. The purpose of a medical staff at a treatment center is to manage detoxification and administer to the medical and pharmacological needs of the patients. Of course, opinions about those needs vary greatly.
There is no arguing, however, that a treatment center is only as good as its personnel. Having a great medical and psychiatry staff coupled with therapy, 12 Steps or other modality of personal transformation are important aspects of a great treatment center. And great treatment centers do exist, but in most cases they are too expensive and lack strong aftercare programs, which make a big difference when it comes to achieving long-term sustainable recovery.
Naltrexone As A Solution For Alcoholism
I have no personal experience taking Naltrexone. What I understand is that it can, in fact, lessen and/or stop cravings for alcohol. I am into anything that can help liberate a person from addiction altogether. If a drug such as Naltrexone can help a person to get beyond cravings so that they can get some time between them and the last drink so that they can then do the work of self-inquiry guided by a therapist or group aimed at helping them to learn and grow, I am all for it. For some people, it may be the perfect thing.
However, if taken alone without any therapeutic program, Naltrexone will be no more than a Band-Aid for the deeper core issues of a person's life. As it says on the National Institute of Health's web site:
Naltrexone is only helpful when it is used as part of an addiction treatment program. It is important that you attend all counseling sessions, support group meetings, education programs, or other treatments recommended by your doctor.
Now, this begins to make some sense. But the trend we have seen with drugs such as Methadone, Suboxone and Naltrexone is that when they first come out they are presented as short-term measures to get a person off of drugs and/or alcohol.
If you struggle with drinking and cravings and you take Naltrexone to help you with your cravings so that you can continue to drink, how is that a victory? Without a commitment to a path of personal transformation (meaning your thinking and perspective on life changes) you will remain forever stuck and taking a medicine to cover a problem that you cannot get free from. You will not be able to get to the reasons why you drink in the first place. You will not have changed. You will have simply taken a drug, which suppresses your cravings.
I suppose we have to ask ourselves, "what's the goal here?" If the goal is to get onto prescription drugs long-term and to learn to drink in moderation long-term, you can count me out. We are always looking for a magic pill, but there just isn't one.
It is worth mentioning the potential side effects of Naltrexone, which can include nausea, vomiting, stomach pain, cramping, diarrhea, constipation, loss of appetite, headache, dizziness, anxiety, nervousness, irritability, tearfulness, difficulty falling or staying asleep, increased or decreased energy, drowsiness, muscle or joint pain, rash, confusion, and hallucinations (seeing things or hearing voices that do not exist).
What Is Actually The Problem With AA and Where Do We Go From Here?
Glaser states, "The problem is that nothing about the 12-step approach draws on modern science: not the character building, not the tough love, not even the standard 28-day rehab stay." This really is not the problem, but there are a few. AA presents a path that is often too difficult and/or confusing for many people to understand and embrace. It is often mistaken for religion and this can be off-putting. Some of its more dogmatic and extreme members tend to repel rather than attract. It is too hidden to know of its successes and so it is vulnerable to misunderstanding and attacks like this one by Glaser. And all of this is such a shame because there is real healing and a workable solution there.
The 12 Steps themselves, while a spiritual path, are filled with grounded actions that members take to improve their lives. I'm talking about actions like self-reflection, investigating and owning your part in the resentments of your life, looking at your behavior and making amends to people you have harmed. The goal of all this work is simply to heal a person to be happy, joyous and free and of service to others. And it works. With such a valuable opportunity, it would be helpful if there were more points of access and greater understanding of the process in order to serve the needs of millions of people still suffering in addiction.
In my opinion, the most powerful approaches to recovery are holistic and combine multiple modalities of healing including, but not limited to the 12 Steps, yoga, meditation, an overhaul of our relationship to food and the identification of our mission and purpose in this world. I wrote a book about this idea called Recovery 2.0.
In the book I suggest,
I have been happiest in my life at those times where I have felt a sense of devotion to a purpose greater than myself. The hardest times in my life were those points where I have had no clue why I am here and how I fit into the scheme of things. This is true of human beings in general. We thrive with a sense of purpose. It is therefore not a surprise that the happiest people I know in recovery are the people who are pursuing their mission and live in service to others.
There is a way to live in balance in this life. What is missing from the recovery process and our education system in general is real and true information about tapping into the greater intelligence within us. All these addictions and habits are simply keeping us stuck in avoidance of our own true nature and blocking us from our unique path of destiny. We are so quick to avoid ourselves that we default to destructive habits in search of our joy. Ultimately, our joy lies not in moderate drinking or even in abstinence, but rather in our ability to consciously face and transcend the challenges of our lives and to help others to do the same.
As states and insurance companies evaluate addiction and treatment methods, may they not be swayed by the negative press that AA and 12-Step programs have received of late. There are 75 years of success stories and many lessons to be learned. May we all come together and be open to improve upon the processes that have worked to such a great extent thus far.
Tommy Rosen is a yoga teacher and the author of Recovery 2.0: Move Beyond Addiction and Upgrade Your Life (Hay House, 2014).
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.