Alcoholics Anonymous



Alcoholics Anonymous is a religious cult that masquerades as a "treatment" for alcoholism. To some extent, certain meetings of the program have come to accommodate all people struggling with substance abuse, and, in some cases, mental health issues; however, this is the exception rather than the rule, which has necessitated the creation of a laundry list of duplicate programs for other problems. Alcoholics Anonymous draws a distinction between sobriety and abstinence, the former being largely defined by participation in AA and the latter being defined by not drinking, hence drawing a wedge between AA and the outside world that allows the dismissal of alcoholics who get sober outside their program. The primary model of the program consists of attending support groups and going through a process known as the "Twelve Steps", which, despite the name, is a tediously long endeavor full of convoluted concepts that really have nothing to do with alcohol at all. Instead, the fundamental principle of the Twelve Steps has something [vaguely] to do with how to live a spiritual life.

A lot of Twelve Step jargon blatantly suggests that Alcoholics Anonymous is of a Christian ethos. Historically, its program is a fleshed-out version of that of the Oxford Group, a World War II-era Christian sect led by a minister named Frank Buchman that sought to cure various vices through the "five C's": confidence, confession, conviction, conversion, and continuance; and the "four absolutes": absolute honesty, absolute purity, absolute unselfishness, and absolute love. The earliest AA meetings were specialized Oxford Group meetings for alcoholics. Its fundamentally Christian nature is further confirmed by the fact that meetings usually end with the Lord's Prayer and the earliest AA literature states that the group's accommodation of atheists and agnostics primarily serves the purpose of helping them find Jesus.

In the United States, court sentences which mandate AA attendance violate the establishment clause; central to the twelve steps of AA is the assumption that a supreme deity ("God") is an inseparable part of the program. It has been ruled that the distinction between spirituality and religion in AA is legally meaningless.

In spite of such, atheists and agnostics have been able to stay sober within AA (and outside AA) without God for many years, and oftentimes the notion of a "higher power" is capable of being rationalized in such a way that it represents some sort of basic purpose, philosophical outlook, or, in many cases, the group itself. This may be particularly useful in small communities where no alternatives exist (if you can avoid drinking the Kool-Aid), since the primary benefit to AA appears to be that it is a place to be social without alcohol. Be aware, however, that Charles Bufe has suggested the primary reason for a lack of alternatives in many places is that AA itself does not play fair and does everything it can to keep out competing recovery programs.

The 12 Steps
The 12 Steps themselves are as follows:

The ‘13th step’ is AA slang for seducing a newcomer; as there are no names, there is no vetting for sex offenders. Yikes. Newcomers who are taken advantage of by more experienced members are often told that it was their fault.

Religion in AA
As you can see in the above section, 7 of the 12 steps mention God, prayer, a spiritual awakening, etc. However, the "God" of AA, which they claim will control your life for you, runs counter to the common beliefs in such a deity. In addition, AA's "Big Book" (the main book of AA writings) includes an essay addressing those who are not religious, "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. Despite such, many in AA have since deemed this section as being either irrelevant and outdated, or have interpreted it from a more revisionist standpoint.

For these reasons, among others, AA is not for everyone. However, there are nonbelievers who are prepared to publicly defend AA on the basis that it "works for them" — Roger Ebert and Sir Anthony Hopkins being such examples.

AA claims to be non-sectarian as to which conception of "God" 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 interest, at least in the afterlife.

Is AA really 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. Still, if you would like to hear various forms of deepity, ask them what the difference is.

As noted above, the "steps" repeatedly mention God. Meetings begin with recitation of the "Serenity Prayer" and can include more prayer, and the AA literature is overtly infused with religiosity. AA also sprang 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 and Warner v. Orange County Dep't of Probation. While some atheist, agnostic, and humanist-oriented AA groups sprang up in response to AA's religious nature, 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. In actual fact, AA is attended by many non-religious people. For them, "GOD" can mean just "Group Of Drunks" (which AA encourages, as it keeps focus upon the group itself).

Is AA a cult?
Many critics (and, surprisingly, a few supporters) have labeled AA as a "cult". One way AA can be likened to a "cult" is its origins in the Oxford Group movement (later re-named Moral Re-Armament). William Griffith Wilson ("Bill W.") and Robert Holbrook Smith ("Dr. Bob") were the original co-founders of AA. Both were involved in the Lutheran Christian Oxford Group, a movement somewhat popular among the rich in the 1920s and 1930s, which stressed personal conversion and surrender to God. It targeted successful businessmen, doctors, and other upper-class pillars of the community, and was often described as a "Salvation Army for snobs". 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". 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.

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."

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.

Other ways in which AA is cult-like:
 * Its meetings have features of religious services, such as plenty of sermonizing, and group recitation of the Serenity Prayer at the end of most meetings. Ironically, the Serenity Prayer's author called AA's predecessor "a religious expression of a decadent individualism" and a "pollyanna religion," and considered that it had been based on "a Nazi social philosophy" from the beginning.
 * It makes financial demands on its members, such as publicly soliciting donations at the end of each meeting and strongly encourages people to purchase AA literature.
 * It competes with other groups for its members' time, with attendance being psychologically enforced by the group (the standard demand is "90 meetings in 90 days").
 * It had central authority figures in William Wilson and Robert Smith, who also lived off of other AA members.
 * It exerts control over other aspects of members' lives (another common demand: "Dump your spouse and marry the AA group").
 * It expects its followers to recruit more people into it (see that 12th "step").
 * It insists to its followers that if they leave AA, they will DIE.
 * It makes absolutist demands (total abstinence, total honesty, no resentments, etc.), which are used to control members who slip up and further indoctrinate them into the program. ("You weren't being 100% honest, which is probably why you had that drink at the wedding. You need to work the steps rigorously or you will face jails, institutions, and death.")
 * It makes use of thought-terminating clichés in order to actively discourage critical thought, such as "quit your stinkin' thinkin'" and "your best thinking got you here."
 * It tells members there is no other way to get sober. Because AA expresses an almost dogmatic belief that alcoholism is some sort of "incurable disease" that ends in death unless arrested by their 12-step program, members treat disagreement with AA doctrine as a serious threat to their lives, and when a more evidence-based method is brought up, they literally accuse people of "killing alcoholics".
 * A scary number of members believe the Big Book to be divinely inspired. For example, Charles Bufe cites an AA service worker as saying, "I consider the Big Book as an inspired text, written by Bill under the guidance of the spirit." This strengthens their belief that they are the only way of getting sober and their treatment of all deviations from the doctrine as mortal threats.

Effectiveness of AA treatment
As a general disclaimer, claims about the success rate of AA should generally be taken with a grain of salt. They ultimately pose a problem due to the following 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 (or near abstention) considered a success?
 * Some AA attendees may be discouraged from seeking evidence-based medical treatment for alcoholism in favour of concepts from AA theory, literature and the opinions of other members.
 * Not all AA attendees necessarily meet the medical criteria of alcoholism, as excessive alcohol use can have a wide variety of potential causes other than addiction. This is not acknowledged or considered by AA and the suggested method of self-diagnosis is based primarily on attempting to abstain and observing the result; aside from being medically unreliable, a risk exists of potentially fatal.
 * The attrition rate of AA is so high that most people who try it don't stick around long enough to be factored into any account of a success rate.
 * Attendees who fail are blamed for not following the program, which is a form of just world fallacy, is psychologically damaging, and encourages further relapse. It would be one thing if there were any evidence to suggest that anything about AA was evidence-based and was independently verifiable or reproduceable; since nothing in AA can be measured or tested, it is simply magical thinking, and the vast majority of people whose lives do not improve as a result of it are told that it's their own fault.
 * AA is often promoted by members in professional positions or other positions of authority who are encouraged by AA's twelfth tradition to lie about their glaring conflict of interest.

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.

However, studies have been conducted. A study published in book form under the title Outpatient Treatment of Alcoholism (Brandsma et al., 1980), was an 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.

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, vigorously oppose any suggestion that problematic substance use is a freely chosen behavior.

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. A Cochrane Review of eight trials found that none unequivocally supported the efficacy of AA. A 2009 metanalysis (Kaskutas 2009) found two trials to be supportive of AA, one null, and one negative trial. 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

AA and sexual assault
AA has become controversial for issues with sexual assault or exploitation. There is also the rather cynical euphemism “13th Stepping” which describes long time sober members sexually exploiting newly sober and vulnerable members, often jeopardising their sobriety. The vulnerable party is often blamed for the fallout, being told to “look for their part”, and there is a culture of preserving anonymity, even of predators, with rape survivors being discouraged from talking about their experiences in case it puts other members off.

Some AA supporters have challenged this view, and have objected to members trying to warn others of the potential dangers at AA meetings. This includes author Anna David, who insists it isn’t AA’s fault that women get assaulted through its meetings. She failed to examine how the sponsorship structure, court ordered attendance, culture of blame / shame and double faceted anonymity (good for privacy, bad for accountability) might contribute to rape culture. Instead she repeats the AA mantra that criticising the program in any way - in this case, attempting to warn women about a culture that may facilitate sexual assault - will put women off the program, and thereby inevitably harm them.

Other AA advocates have examined this situation in a more nuanced and sympathetic manner, discussing how the 12 steps can and should be adapted for trauma survivors and how to make meetings safer. Some national groups have released conduct guidelines, and the American branch has explicitly clarified that reporting members’ who engage in criminal or threatening behaviour to the police is *not* a violation of anonymity.

The Big Book
AA's Bible, The Big Book, may begin with a glowing "doctor's opinion," but the 1939 peer-reviewed Journal of the American Medical Association had less favorable things to say about it:

Another highlight of the Big Book is a chapter called "To Wives," which claims to be written by Bill W's wife Lois for the wives of alcoholics (presumed to all be male and heterosexual), but was actually written by Bill W himself, against Lois's expressed wishes.

Other twelve-step programs
There are numerous other twelve-step programs for other addictions and social issues based on the AA blueprint. Narcotics Anonymous (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.

Controversially, 12-step programs have expanded into support programs for conditions not even remotely characterized by addiction, such as for victims of child abuse or rape survivors. These programs use the existing 12 steps in the original AA form, often merely replacing the wording "alcohol" with "child abuse" or "rape" while keeping the entirety of the 12 steps process intact. Such programs are questionable at best, as the making-amends and admitting faults part of the 12 steps were ostensibly intended for people who had done wrong, not the victims of wrongdoings.

Regarding the "Rape Survivors Anonymous" program, USAToday writes:

''Although the RSA "steps" say rape is not a victim's fault, participants are invited to list all people "our actions had harmed as a result of our being raped" and then make amends to those people. The steps also include taking personal inventory, "and when we were wrong promptly admit(ting) it," as well as "humbly ask(ing) God to remove our shortcomings."''

Rehab
Most inpatient rehabs in the United States 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 in the United States 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, 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 person's initial decision to try to get better that mattered, and 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."

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."

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.

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. 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.

Secular alternatives
Those looking for secular support groups and programs dealing with addiction have a number of alternatives to AA. Some include: The, 'submit to a higher power' part Alcoholics Anonymous does not always suit people without religious beliefs. From time to time people without religion are pressured to attend AA and even punished for not taking part in AA despite secular alternatives being available.
 * SecularAA
 * SMART Recovery
 * Rational Recovery
 * Secular Organizations for Sobriety (SOS)
 * Women for Sobriety
 * LifeRing Secular Recovery
 * Moderation Management
 * Michigan Radio Segment Highlights Secular Alternatives to Alcoholics Anonymous A discussion about many alternatives

SMART Recovery utilizes cognitive behavioral therapy techniques that are at least as effective as the 12 Step programs and meetings are open to everyone regardless of views on religion.

Medication alternatives
is an opioid antagonist first produced in the 1970's. Evidence suggests nalmefene is sometimes effective both as a rapid treatment for isolated cravings and as a long-term countermeasure. It is "out of patent", however, and pharmacies have no reason to promote it if no profit is to be made.

The "Sinclair Method" involves pharmacological extinction - the patient takes an opiate-blocker called Naltrexone an hour before drinking and ideally, the desire to drink should be eliminated.