Alcoholics Anonymous

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Alcoholics Anonymous was the first "12-step" recovery group, with the aim of helping alcoholics stop drinking and stay alcohol-free. While AA has undoubtedly helped many alcoholics to recovery, it is problematic for many atheists, because AA relies on a belief in a supreme deity ("God") as an inseparable part of the program. It is also problematic for deists who don't believe in an interventionist god.

Contents

[edit] Anonymity

Despite the fact that the AA is perhaps the biggest secret society in the world and many well-known people have been involved in it, AA almost never turns up in conspiracy theories. We have to ask why. Or why not.

But seriously, as bad comedians say, the anonymity is a key aspect of the group, and allows shyer people to turn up. And there is a lot less ritual involved than the Shriners and Illuminati.

[edit] The 12 Steps

The steps are:

  1. We admitted we were powerless over alcohol — that our lives had become unmanageable.
  2. Came to believe that a Power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed, and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take personal inventory and when we were wrong promptly admitted it.
  11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
  12. Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.[1]

[edit] Religion in AA

As you can see in the above section, 7 of the 12 steps mention God, prayer, a spiritual awakening, etc. In addition, AA's "Big Book" (the main book of AA writings) includes an essay addressing this issue, "We Agnostics", which essentially states that there is no way around belief in a supreme deity if you want the AA program to work and that agnostics and atheists will need to draw on enough faith to believe in God, who in turn will reveal himself.[2]

For this reason AA is perhaps not for everyone. However, there are nonbelievers who are prepared to publicly defend AA on the basis that it "works for them" — Roger Ebert being one such example.[3]

AA is non-sectarian as to which conception of deity each member holds, and in practice AA groups and individual members may vary widely as to what extent they emphasize religious belief, as opposed to the emphasis official AA literature places on it. So, if one's conception of a higher power happens to be the Flying Spaghetti Monster, that's perfectly okay. However, Pastafarian heaven contains a beer volcano, and pirates are frequent consumers of rum. This would understandably give rise to a conflict of interests.

[edit] Is AA religious?

AA maintains that it is a "spiritual, not religious program." However, this seems to be a distinction without a difference as the structure of the AA program makes clear. As noted above, the Steps repeatedly mention God. Meetings also usually include prayer and the AA literature is overtly infused with religiosity. AA also sprung out of the Christian Oxford Group movement. As a consequence, a number of courts have ruled that enforced AA attendance violates the Establishment Clause such as in the cases of Griffin v. Coughlin[4] and Warner v. Orange County Dep't of Probation.[5][6] While some atheist, agnostic, and humanist-oriented AA groups sprung up in response to AA's religious nature,[7] they are usually not available outside of major urban areas. There has also historically been tension between these groups and organizational AA writ large -- for example, two atheist/agnostic groups in Toronto were de-listed for failing to adhere to AA religious ideology.[8] In actual fact, AA is attended by many non-religious people. For them, "GOD" can mean just "Group Of Drunks".

[edit] Is AA a cult?

Many critics (and, surprisingly, a few supporters) have labeled AA as a "cult."[9] One way AA is cult-like is its origins in the Oxford Group movement (later re-named Moral Re-Armament). William Griffiths Wilson ("Bill W.") and Robert Holbrook Smith ("Dr. Bob") were the original co-founders of AA. In keeping with AA's tradition of anonymity, they are better known as Bill W. and Dr. Bob. Both were involved in the evangelical Christian Oxford Group, an evangelical movement popular in the 1920s and 1930s, which stressed personal conversion and surrender to God. It targeted at successful businessmen, doctors, and other upper middle class pillars of the community and often described as a "Salvation Army for snobs".[10] Frank Buchman, the founder of the group, courted the rich and powerful. His tight grip on the movement led it to be known pejoratively as "Buchmanism." Bill W. reworked the Oxford Groups' six principles into the Twelve Steps.[11] He also later took a lifelong interest in spiritualism and even participated in seances and early LSD experiments even as he remained sober (from alcohol, at least).

Charles Bufe makes a distinction between "communal AA" (i.e., generic AA meetings) and "institutional AA" (i.e., AA as employed in rehab facilities and prisons). He argues that AA is not a cult, but it does have cult-ish trappings with institutional AA being more cult-like than communal AA. Bufe describes the organization of communal AA as anarchic while claiming institutional AA to be coercive.[12]

Jeffrey A. Schaler, Ph.D., cites Galanter among others in that "As in the Unification Church workshops, most of those attending AA chapter meetings are deeply involved in the group ethos, and the expression of views opposed to the group's model of treatment is subtly or expressly discouraged". "AAers seek a relationship with the supernatural in order to cease managing their own lives....The AA concept of control differs significantly from the concept of control presented to drunkards by the rest of society....AA...tells the newcomer that his life is unmanageable and that it is ridiculous for him to try to manage it."[13]

Reading the approved addiction literature of A.A. and Al-Anon provides no definition of a healthy, mature "recovered" person. One is always an alcoholic/addict, forever dependent on 12 step groups, and always at the brink of relapse if he or she doesn't follow certain directives and trust external authority, that is the God of one's understanding and the 12 step teachings. The locus of control is outside himself/herself.

However, there are a number of ways in which AA is not cult-like. It does not hold religious services (other than the serenity prayer at the end of every meeting), it does not make increasing financial demands on its members, it does not compete with religions, attendance is not forced by the group (but is occasionally by groups outside the AA such as prisons etc), it has no central authority figures, and does not try and control other aspects of members' lives such as sex (it does not discriminate against homosexuals, for example).

[edit] Effectiveness

As a general disclaimer, claims about the success rate of AA should generally be taken with a grain of salt. Determining AA's success rate is problematic for a number of reasons:

  • AA doesn't conduct research on itself besides a membership survey.
  • AA's tradition of anonymity makes it difficult or impossible in many cases to track participants in studies.
  • AA meetings may vary by locale. The heterogeneity of AA meetings may make comparisons difficult.
  • Data may be self-reported, causing it to be biased.
  • The definition of "success" may vary, e.g. is moderation or abstention considered a success?
  • Many AA attenders are on, or are encouraged to get, medical treatment for alcoholism.
  • Not all AA attenders are alcoholics to begin with, for various reasons.


[edit] Alcoholics Anonymous leads to increased binge drinking

It is difficult to run a randomized controlled trial on AA for these reasons. AA claims, based on its most recent (2007) survey, that 69% of its members have been sober for more than one year.[14]

However studies have been conducted. A study, published in book form under the title Outpatient Treatment of Alcoholism (Brandsma et al., 1980), was a carefully designed, sophisticated, NIAAA-funded study of AA and three alternative therapies: lay-led Rational Behavior Therapy (similar to today's SMART Recovery program); professionally conducted one-on-one Rational Behavior Therapy (today called Rational Emotive Behavior Therapy); and professionally conducted one-on-one, traditional (Freudian-based) insight therapy. The study came to a number of conclusions:

The study showed that alcoholic men who went to Alcoholics Anonymous became 9 times more likely to subsequently “binge drink” than those who used a cognitive behavioral approach. What’s more, they were also 5 times more likely to binge than a control group who received no help with drinking. "Our study suggests further confirmation of this in our severe dropout rate from this form of treatment {Alcoholics Anonymous}. It is probable, as Ditman et al.'s (1967) work suggests and ours confirms, that AA is just not effective as a coerced treatment with municipal court offenders. (Brandsma et al., 1980, p. 84)"

Peele and Bufe assert, "The increase in binging behavior among those exposed to AA in this study militates against coercing DUI offenders into AA attendance. One very possible reason for the increase in binging is the emphasis in AA upon inevitable loss of control after even one drink, as codified in the AA slogan, "one drink, one drunk." (As we saw in Chapter 1, this assertion is not true, except to the extent that drinkers believe it to be true.) What likely happens is that for those exposed to AA, this inevitable loss-of-control belief becomes a self-fulfilling prophecy. So, when a true-believing AA member slips and has a drink, or even eats a rum ball or ingests a bit of mouthwash containing alcohol, he or she could be provoked to embark on a full-bore binge." Given this, one can't help but be alarmed at the common practice of coercing DUI defendants into AA attendance and 12 step treatment.[15]

Steven Slate concurs with Peele's and Bufe's assessment of this study commenting that standard 12-step based treatment teaches people that they have no control over alcohol use, that their ‘disease’ is progressively getting worse (whether or not they’re currently drinking), and that a single whiff or sip of alcohol will send them on an uncontrollable rampage of drinking. It is commonly said within the recovery culture that if you start drinking again after a period of abstinence, you will go right back to your most extreme levels of drinking, and then quickly go far beyond that. In stark contrast to the foundations of cognitive behavioral approaches, the purveyors of conventional treatment and average 12-step members alike, violently oppose any suggestion that problematic substance use is a freely chosen behavior.[16]


Don McIntire of Burbank CA was given access to the AA membership surveys from 1968 through 1996. His article showed that 81% of first timers attending AA meetings drop out in the first 30 days and at the end of 90 days, 90% of them have left AA. At the end of the first year, only 5% remained in AA. He suggested that those who leave AA in the first 90 days be excluded from the survey sample in determining retention rates, thus increasing the retention rate percentage to 50% from 5% by only considering those newcomers, the 10% who remain in AA past 90 days.[17][18] A Cochrane Review of eight trials found that none unequivocally supported the efficacy of AA.[19] A 2009 metanalysis (Kaskutas 2009) found two trials to be supportive of AA, one null, and one negative trial.[20] Based on meta-analysis, the Handbook of Alcoholism Treatment Approaches ranks AA as the 38th most effective treatment for alcoholism out of a list of 48 treatments[21]

[edit] Other twelve-step programs

See 12-step program for a general description.

There are numerous other twelve-step programs for other addictions and social issues based on the AA blueprint. Narcotics Anonymous[22] (no relation to the Scientology front group Narconon), founded in 1953, is probably the most famous of these. It should be noted that the steps are exactly the same except "alcohol" is replaced with "addiction."

Disorders and addictions covered by twelve step programs include the following (and more): cigarettes, gambling & betting, co-dependency, sex addiction & pornography, eating disorders and even cluttering/hoarding. Obviously some of these are more serious than the others. Sex addiction sounds ridiculous (it's sent up in Blades of Glory), but does include overuse of prostitutes etc. which at the very least represent a financial drain.

[edit] Rehab

Most inpatient rehabs seem to use the 12 step program, requiring attendance to meetings of either Alcoholics Anonymous or Narcotics Anonymous. Other Models include Scientology's unscrupulous version, Narconon, as a basis for treatment. It is very rare that rehabs would not be entirely based on 12-step programs. When potential patients ask if the program is religiously based or 12-step based, generally they will opt to call it a spiritual program. This seems to be the case due to the idea that 12-step programs can work for everyone, a dubious claim at best.

Bankole Johnson, Chairman of the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia, noted that the 12 step rehab centers are divorced from state-of-the-art medical knowledge and expensive and that spontaneous recovery (without meetings or treatment) is 24%. He asserts that the AA retention numbers are very poor when compared against this percentage. Recent advances in neuroscience have led to a greater understanding of how alcohol and other drugs affect the brain. There is no need to separate an addicted person from family and friends and shut them away. Many proponents of AA cite Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), however the 2005 article in the journal BMC Public Health that reanalyzed the data from Project MATCH reported that almost all of the effect of treatment was achieved after attending a single session. It was the persons initial decision to try to get better that mattered what followed was of little consequence.

He also states that the AA message as contained in their literature the "Big Book" can be harmful for many: "AA maintains that when an alcoholic fails, it is his fault, not the program's." The AA Big Book states: "Those who do not recover are those who cannot or will not give themselves completely to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates… they seem to have been born that way."[23]

Stanton Peele and Charles Bufe assert: "The Vaillant study is probably the single best piece of evidence on 12-step treatment. It had several components, including a long-term longitudinal study of a group of "100 alcohol-dependent men and women followed for eight years after being admitted to a clinic for detoxification" (Vaillant, 1995, p. 2). (This clinic was the Cambridge and Somerville Program for Alcohol Rehabilitation, CASPAR, a 12-step inpatient/outpatient program, for which Dr. Vaillant worked as a psychiatric consultant.) Vaillant compared the outcomes of these 100 patients with those of alcoholic members of two comparison groups, subjects of two long-term longitudinal studies begun by other Harvard researchers: a group of 456 "Core City" Boston men, who had been followed since they were school boys; and a group of 204 former Harvard students, who had been followed since their college days. Vaillant also compared the outcomes of the 100 CASPAR patients with those of treated alcoholics in other studies, and with the outcomes shown in studies of untreated alcoholics. Vaillant's results were that the 12-step hospital treatment he helped to provide was utterly ineffective, as judged in comparison with studies of untreated alcoholics. As Vaillant remarked, "Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling" (Vaillant, 1995, p. 352). He continued, "our results were no better than the natural history of the disorder." (i.e., no treatment)

Vaillant is a strong supporter of Alcoholics Anonymous. (He is currently a member of AA's General Service Board.) While reporting these "appalling" results, Dr. Vaillant commented, "if we have not cured all the alcoholics who were detoxified over 8 years ago, the likelihood of members of the Clinic sample attending AA has been significantly increased" (pp. 357-358). But did Vaillant really find that AA is that helpful? Actually, greater attendance at AA by the alcoholics he helped to treat did not enhance their treatment outcomes relative to untreated groups. Furthermore, in the Core City group which was followed for 50 years, 48 men among the alcohol abusers achieved what Vaillant termed "stable abstinence." Of these, about a quarter (27%) relied on AA (defined by having at least 30 AA visits by the age of 48 that is, well less than a year's attendance). In other words, even among those seeking abstinence, the large majority in Vaillant's untreated sample succeeded without AA."[24]

Even more so than alcohol addiction (and tobacco addiction), it has been shown that drug addicts tend to "age-out" of addiction on their own without any treatment.[25]

[edit] 12 Steps are too many

In 1997 Addiction specialist William Miller co-authored a paper which found that patients who reported knowing that someone was praying for them used significantly more substances after leaving treatment than those who didn't know someone was praying for them.

In 2009 William Miller and his colleagues presented findings from two controlled trials in which patients underwent drug treatment. Some of the patients received spiritual guidance as part of the treatment — learning such practices as prayer, meditation and service to others, all of which are central to 12-step programs. Others received secular psychotherapy. The results showed that those who received spiritual guidance reported being significantly more anxious and depressed after four months than those who received secular help. Miller asserted that there is a high incidence of suicide among substance abusers therefore the conclusion was the non-faith-based treatments like cognitive behavioral therapy or mindfulness-based acceptance and commitment therapy are the better choices for treatment.[26] The steps themselves are of varying lengths — an admission to self of being helpless is fairly simple, but inventory and restitution take far longer.

There is also the phenomenon of "Two Steppers". These are people who go through step one and step twelve, i.e. helping others. Not surprisingly this is controversial.

[edit] Secular alternatives

Those looking for secular support groups and programs dealing with addiction have a number of alternatives to AA. Some include:


[edit] See also

[edit] External links

[edit] Footnotes

  1. "The Twelve Steps of Alcoholics Anonymous". Alcoholics Anonymous. http://www.aa.org/en_pdfs/smf-121_en.pdf.
  2. "We Agnostics", Chapter 4 in Alcoholics Anonymous
  3. Roger Ebert. My Name is Roger and I'm an Alcoholic. Roger Ebert's Journal, Chicago Sun Times, Aug. 25 2009.
  4. Griffin v. Coughlin, 88 N.Y.2d 674 (June 11, 1996)
  5. Warner v. Orange County Dep't of Probation,827 F.Supp. 261 (S.D.N.Y.1993).
  6. For more legal cases, see Derek P. Apanovitch, Religion and Rehabilitation: The Requisition of God by the State, 47 Duke Law Journal 785-852 (1998).
  7. Roger C. A History of Agnostic Groups in Alcoholics Anonymous. Humanist Network News, Nov. 2011
  8. Leslie Scrivener. Does religion belong at AA? Fight over 'God' splits Toronto AA groups. Toronto Star, Jun. 3, 2011
  9. L. Allen Ragels. Is Alcoholics Anonymous a Cult? An Old Question Revisited.
  10. Not to be confused with the earlier Oxford Movement in the Anglican church
  11. Dick B. The Oxford Group and Alcoholics Anonymous. Alcoholics Anonymous History A.A.'s Oxford Group Roots: Article 12
  12. Charles Bufe. (1998) Alcoholics Anonymous: Cult or Cure? (2nd ed.) Tucson Arizona: See Sharp Press
  13. Schaler, Jeffrey A "Cult Busting" VOLUME 2, ISSUE 5 THE INTERPSYCH NEWSLETTER JUNE, 1995[1]
  14. Alcoholics Anonymous 2007 Membership Survey
  15. Peele,Brodsky,Bufe: "Resisting 12-Step Coercion" Chapter 2 Sharp Press [http://www.morerevealed.com/library/resist/r_chap_2.htm
  16. The Clean Slate: Alcoholics Anonymous leads to increased binge drinking [http://www.thecleanslate.org/alcoholics-anonymous-increases-binge-drinking-brandsma-study/
  17. McIntire, Don : "How Well Does A.A. Work? An Analysis of Published A.A. Surveys (1968-1996) and Related Analyses/Comments" in the Alcoholism Treatment Quarterly (Vol 18, No. 4, 2000) centers on the 5 per cent one-year retention rate AA itself reports a figure of 95% in a review of the AA trienn of members dropping out by the first year
  18. Lifering Convenor "Once again on the AA drop out rate" [http://liferingconvenor.blogspot.ca/2007/12/once-again-on-aa-dropout-rate.html
  19. Marica Ferri, Laura Amato, Marina Davoli. Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database of Systematic Reviews 2006, Issue 3
  20. Lee Ann Kaskutas. Alcoholics Anonymous Effectiveness: Faith Meets Science. J Addict Dis. 2009; 28(2): 145–157.
  21. What works? A summary of alcohol treatment research, in R. K. Hester & W.R. Miller (Eds.), Handbook of Alcoholism Treatment Approaches: Effective Alternatives (3rd ed.), 2003, Allyn & Bacon.
  22. See na.org.
  23. Johnson, Bankole A. "We are addicted to rehab and it doesn't work" The Washington Post August 8, 2010, [http://www.washingtonpost.com/wp-dyn/content/article/2010/08/06/AR2010080602660_2.html
  24. Peele, Brodsky, Bufe "Resisting 12 Step Coercion" Chapter 2 "The Efficacy of 12-Step Groups and 12-Step Treatment" Sharp Press [http://www.morerevealed.com/library/resist/r_chap_2.htm
  25. The addiction paradox
  26. Time Magazine: "Battling Addiction Are 12 steps too many" January, 27th 2009[http://www.time.com/time/health/article/0,8599,1872779,00.html
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