Posts Tagged ‘12 step treatment’

Alcoholics Anonymous: Cult or Cure? front cover

by Chaz Bufe, author of Alcoholics Anonymous: Cult or Cure?

There are direct connections between the beliefs underlying Alcoholic Anonymous and those underlying the “war on drugs.” The most fundamental is that alcohol and other drugs are “cunning, baffling, powerful!” (to quote AA’s  “Big Book”) This belief is reflected in the common “drug war” term “dangerous drugs” in reference to illegal drugs, which combined, until recently, to kill about 5% of the roughly half-million Americans killed annually by tobacco and alcohol; today, about 50,000 are killed annually by overdoses, the vast majority by opioid overdoses. In other words, alcohol (roughly 100,000 deaths) and tobacco (roughly 400,000 deaths) kill ten times as many Americans as all illegal (and misdirected pharmaceutical) drugs combined.

To put this in further perspective, “drug warriors” almost never refer to alcohol and tobacco as “dangerous drugs,” while they do routinely refer to marijuana, which has never killed a soul, as a “dangerous drug.” Some of them might actually believe that it is.

The concomitant belief, that human beings are “powerless” over “cunning, baffling, powerful!” drugs, is shared by both AA and drug prohibitionists. In AA and its clones (NA, CA, etc.) that belief is enshrined in the first of the 12 steps. It’s also part of the bedrock of the “drug war”: if people are powerless and drugs are powerful, the only way to stop the harm of drug addiction is to cut off the supply of drugs.

The other underlying “drug war” belief is based in punitive Christian morality: the belief that the only way to deal with prohibited (sinful) behavior is through punitive measures–in the case of drugs, that it’s necessary to lock people in cages for using drugs and for making drugs available to others.

Another aspect of this belief system, common to both AA and the “drug war,”  is the belief that drug use and abuse are an individual matter, that individual drug users and abusers are either victims of a “disease” (according to AA — never mind the absurdity of labeling behaviors as “diseases”) or are criminals (according to “drug warriors”). What ties these two seemingly disparate beliefs together is that they both divorce drug use and abuse from their social and economic contexts.

A moment’s reflection shows that this is an absurd approach. If drug use and abuse were entirely the result of individual immorality or individual powerlessness over drugs,  the rates of drug use and abuse would not vary drastically (if at all) from one nation to another, nor would the rates vary wildly within nations over the years. But they do. Neither “disease” advocates nor “drug warriors” can explain these variances. To explain them, you need to consider social and economic contexts.

A case in point is a study published in Proceedings of the National Academy of Sciences by Princeton researchers Anne Case and Angus Deaton on the increased mortality rate among middle-aged white, especially male, Americans aged 45 to 54 from 1998 to 2015, with the increase being .5% per year. During the previous two decades, 1978 to 1998, the mortality in that age range had been decreasing by about 2% per year–as indeed it’s continued to do so in all of the other developed countries since 1998. Why? The researchers posit that, while there’s no definitive proof, these increases are likely due to an increased suicide rate and increased drug and alcohol abuse triggered at least in part by increased financial stress.

If 12-step advocates and drug prohibitionists were correct that the use and abuse of alcohol and other drugs is a result only of individual “disease” or inherent “criminal” (sinful) tendencies, this increase in drug and alcohol abuse would not have happened. But it did. The solution advanced by 12-step advocates is treatment, and by “drug warriors” is a combination of imprisonment and treatment. In both cases, the treatment offered is almost exclusively 12-step treatment, which does not consider social or economic contexts nor social or economic solutions, but rather focuses exclusively on individual “wrongs,” “shortcomings,” and “defects of character” (respectively, steps  5, 7, and 6), with the solution to alcohol/drug abuse being “prayer” (step 11), taking a “moral inventory” (step 4), and “turn[ing] our will and our lives over to the care of God” (step 3).

As one would expect, the 12-step religious program does not work very well. As covered in  a previous post, Alcoholics Anonymous is not effective, both AA’s own statistics (“Comments on AA’s Triennial Surveys”) and controlled studies report that the recovery rate in AA is no better than the rate of spontaneous remission, about 5% annually. Controlled studies of formal 12-step treatment have been even more dismal, with some components used in such treatment, e.g. confrontational “counseling,” having negative outcomes.

So, what do AA advocates and “drug warriors” lean on for scientific support?

One of the standard studies cited — quite possibly the most commonly cited — by 12-step advocates and prohibitionists was conducted in the 1960s. It involved placing rats in Skinner boxes (small boxes with no toys or other amenities–essentially solitary confinement for rats in an ultra-deprived environment) and then giving the rats the choice of either plain water to drink or water laced with morphine. Surprise, surprise — the rats chose the water with morphine. This study was widely cited by both drug prohibitionists and the mass media as “proof” that rats, and by extension people, are powerless over irresistible drugs.

In the 1970s, researchers at Simon Fraser University conducted a similar study, but with the rats in a much larger cage filled “with things that rats like, such as platforms for climbing, tin cans for hiding in, wood chips for strewing around, and running wheels for exercise. Naturally we included lots of rats of both sexes, and naturally the place soon was teeming with babies. The rats loved it and we loved it too, so we called it ‘Rat Park.'” The results? The Rat Park experiment showed that in this rich environment the rats ignored the morphine-laced water and drank plain water instead. The initial study was published in 1978 in the scientific  journal Psychophramacology. The mass media, government, and disease-concept advocates ignored it, and AA, 12-step treatment, and the “war on drugs” rolled on, leaving millions of ruined lives in their wake.

The lessons of all this are obvious: It’s time to stop blaming those who are self-medicating, and to stop looking at drug use, abuse, and addiction as the result of individual sinfulness or “disease.” It’s time to stop locking people in cages.

It is time to start looking at, and addressing, the environmental, economic, and social reasons why millions of people find life so intolerable that they — like rats in a deprived environment — feel the need to seek solace in drugs, alcohol, and illegal drugs. And it’s long past time to start doing something about the environmental, economic, and social reasons for drug use, abuse, and addiction.

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For more information on Rat Park, see lead researcher Bruce K. Alexander’s 2010 book, The Globalization of Addiction: A study in poverty of the spirit. 

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Alcoholics Anonymous: Cult or Cure? front coverby Chaz Bufe, author of Alcoholics Anonymous: Cult or Cure? and co-author, with Stanton Peele and Archie Brodsky, of the now-out-of-print Resisting 12-Step Coercion

Last week, Barry Hazle, a victim of religious coercion received a $1.95 million settlement from the institutions which first coerced him and then imprisoned him:  the WestCare corporation, a contractor which delivers 12-step treatment, and the State of California.

In 2004, Hazle was convicted of possession of methamphetamine and was placed on probation. In 2006, he was imprisoned for violating his probation by using meth, and subsequently spent a year in jail. After his release, he was ordered to attend a WestCare treatment facility in Shasta County. When he told his parole officer he was an atheist and objected to 12-step treatment–and the California Department of Corrections and Rehabilitation order mandating that inmates and parolees be given the choice of religious (12-step) or nonreligious treamtnet–his parole office ordered him to attend the WestCare facility anyway.

According to the Sacramento Bee, Hazle went, but was subsequently kicked out of the 12-step program for being  “disruptive, though in a congenial way, to the staff as well as other students.”  That almost certainly translates to  being polite but refusing to toe the 12-step line (turning one’s life and will over to God, and praying to God to remove one’s character defects). That was enough for the Westcare facility to kick Hazle out, sending him back to jail for another 100 days.

He subsequently sued, and following a jury trial (which found for him, but which awarded him no damages) and the appeals process, he reached a $1.95 million settlement with WestCare and the State of California. Revealingly, WestCare maintained during the trial and appeals process that it had never received the Department of Corrections order, which is very hard to believe, and that it didn’t understand the meaning of “alternative non-religious program,” which is astounding. WestCare is a national organization active in 17 states and worth, presumably, in the tens of millions of dollars; and it’s supposedly a professional organization.

And professionals providing addictions treatment of any kind in 2006 would certainly have been familiar with the most important academic/professional work on the topic, University of New Mexico researchers Reid Hester’s and William Miller’s encyclopedic Handbook of Alcoholism Treatment Approaches, 3rd edition (2003), which provides very detailed information on the practice and effectiveness of many types of “alternative non-religious program[s].” (It also provides detailed information on the practice and ineffectiveness of 12-step treatment.) As well, the Internet was around in 2006, and even the briefest search for “alternative non-religious addiction treatment program” would have resulted in at least several hundred thousand results. (I just googled that phrase and came up with 3,130,000 results.)

On the other hand, religious zealots masquerading as addictions professionals would feign ignorance, and maintain that they have no idea of the meaning of “alternative non-religious treatment.”

Today, coercion into 12-step groups and treatment is still routine in piecemeal form across the country, and many, many people are punished unjustly for resisting it. Despite three U.S. courts of appeal, four state supreme courts, and nine federal district courts ruling that 12-step groups and treatment are religious, and that mandates to such groups and treatment are unconstitutional because they violate the First Amendment’s “establishment clause,” there’s no national binding precedent forbidding such mandates: the Supreme Court has refused to hear any of the cases.

One can only hope that many other courageous victims of 12-step coercion will step forward and file lawsuits against their coercers.