Posts Tagged ‘Addiction Treatment’


A few years ago Sharp and Pointed posted “AA Is Religious Not Spiritual” in two parts. That was a bit inconvenient for readers, so here’s the text in full.

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Alcoholics Anonymous: Cult or Cure? front cover

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

AA’s Religious Origins

Members of Alcoholics Anonymous (AA) routinely assert that AA is “spiritual, not religious,” though even a cursory glance at AA’s practices and official (“conference approved”) literature reveals the opposite to be true.

One of the most widespread myths about Alcoholics Anonymous (AA) is that it has existed as an independent organization from day one, from the day in 1935 that Bill Wilson met AA’s other co-founder, Bob Smith, in Akron, Ohio. When they met, Smith and Wilson were both members of a Protestant evangelical group called the Oxford Group Movement (OGM), or more simply the Oxford Groups.

The Oxford Groups — which had nothing to do with Oxford University, nor the city of Oxford; they merely traded on the name — were founded in the 1920s by the Reverend Frank N. D. Buchman, notable for his lavish lifestyle, entirely financed by his followers; his right-wing views (in 1936 he described Heinrich Himmler as “a great lad”); his virulent prudery and homophobia; and his targeting of the rich, powerful, and prominent for recruitment. Smith and Wilson evidently found all this attractive, as they were both enthusiastic OGM members.

Convinced that Oxford Group principles were the key to overcoming alcohol abuse (and all other problems in life), they devoted themselves to carrying the Oxford Group message to other alcoholics. What they called the “alcoholic squadron of the Akron Oxford Group” remained as part of the Oxford Group Movement until 1939, and the group Bill Wilson founded in New York remained part of the Oxford Group Movement until late 1937.

The reasons that AA parted ways with the Oxford Group Movement had nothing to do with differences over ideology; rather, they had to do with personality conflicts, the fear that Catholics would be forbidden to join what was to become AA as long as it was part of a Protestant organization, and, quite possibly, embarrassment over OGM founder Frank Buchman’s statements in an August 26, 1936 New York World Telegram interview in which he said, “Thank heaven for a man like Adolf Hitler,” and in which he pined for “a God-controlled Fascist dictatorship.” This was a possible contributing factor to the split of what was to become AA from the Oxford Groups, though it was over a year before the New York group severed formal ties to the OGM, and approximately three years until the Akron group did so. (It’s worth mentioning as an aside that the manner in which AA treats this interview in its “conference approved” Wilson biography, Pass It On, is blatantly dishonest.)

One reason that this link between AA and the Oxford Group Movement is not more widely known is that during the years following the adoption of the name Alcoholics Anonymous, AA never credited the Oxford Group Movement for anything — even though AA took its central beliefs, program, and practices almost unaltered from the OGM. For instance, there is not a single acknowledgment of the Oxford Groups in Alcoholics Anonymous, AA’s “Big Book.” It wasn’t until the late 1950s, in Alcoholics Anonymous Comes of Age, that Bill Wilson and AA (partially) acknowledged AA’s debt to the Oxford Groups. Even today, most AA members know little if anything about the AA/OGM connection.

The Origin of the 12 Steps

Here are the steps, the backbone of the AA “program,” taken directly from AA’s “Big Book,” Alcoholics Anonymous:

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 the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

A common myth — even within AA — is that AA co-founder Bill Wilson wrote the 12 steps entirely independently, that they were completely his own invention. A closely related myth common in AA is that Bill Wilson wrote the 12 steps directly under divine guidance. Neither myth has any but the scantiest relation to reality.

The author of AA’s 12 steps and the text portion of AA’s bible, the “Big Book” (though not the personal stories in it), Bill Wilson, was a dedicated Oxford Group member who was convinced that the principles of the Oxford Group Movement were the only route to recovery for alcoholics, and the 12 steps he included in the “Big Book” are a direct codification of those principles. Indeed, in Alcoholics Anonymous Comes of Age, Wilson directly credits the OGM as being the source of the teachings codified in the 12 steps (pp. 58-63, 160-167). Further, in a letter to former OGM American leader Rev. Sam Shoemaker, Wilson stated:

The Twelve Steps of A.A. simply represented an attempt to state in more detail, breath, and depth, what we had been taught–primarily by you [Rev. Shoemaker]. Without this, there could have been nothing–nothing at all. (quoted by Dick B. in Design for Living: The Oxford Groups contribution to Early A.A., p. 10)

Wilson also stated publicly:

Where did early A.A.’s … learn about moral inventory, amends for harm done, turning our wills and lives over to God? Where did we learn about meditation and prayer and all the rest of it? … [S]traight from Dr. Bob’s and my own early association with the Oxford Groups … (quoted in the AA publication, The Language of the Heart: Bill W.’s Grapevine Writings, p. 198)

To be more specific, the Oxford Group principles of personal powerlessness and the necessity of divine guidance are codified in steps 1, 2, 3, 6, 7, and 11. the principle of confession is embodied in steps 4, 5, and 10. The principle of restitution to those one has harmed is embodied in steps 8 and 9. And the principle of continuance is embodied in steps 10 and 12.

There is not a single original concept in the 12 steps. They all came directly from the Protestant evangelical Oxford Group Movement. (see Twelve Steps and Twelve Traditions, pp. 48 & 97)

It’s noteworthy that alcohol is mentioned only in the first step, which strongly implies that alcoholics cannot overcome their problems on their own. The remainder of the steps implore alcohol abusers to engage in religious activities (prayer, confession) and to “turn [their] lives and [their] wills over to the care of God.”

Alcoholics Anonymous and 12 Steps and 12 Traditions

Much of the rest of the “Big Book” is just as religious, if not more so, than the 12 steps. In his comments immediately preceding the steps, Bill Wilson exhorts the reader: “Remember that we deal with alcohol — cunning, baffling, powerful! Without help it is too much for us. But there is One who has all power–that one is God. May you find Him now!” (p. 58) Wilson also devotes an entire chapter (Chapter 4: “We Agnostics”) to attacking atheists and agnostics as “prejudice[d]” or crazy, and to presenting belief in God as the only way to restore “sanity.” Wilson also recommends that AA members “work” the seventh step through prayer, and even provides the wording for a prayer to “My Creator.” (p. 76) It’s also worth noting that the “Big Book” is saturated with religious terms. There are well over 200 references to God, capitalized masculine pronouns that refer to God (“He,” “Him”), or synonyms for God (“Creator,” “Father,” etc.) in its 164 pages of text — and this doesn’t even take into account such terms in the personal stories that make up the bulk of the book.

AA’s second — and second most important –book, Twelve Steps and Twelve Traditions, also written by Wilson, is just as religious as the “Big Book.” For instance, the nine pages devoted to “working” step 2 contain at least 30 references to God, synonyms for it, or capitalized masculine pronouns referring to it.

Wilson also repeatedly exhorts the reader to pray, noting in one place that “Those of us who have come to make regular use of prayer would no more do without it than we would refuse air, food, or sunshine.” (p. 97)

And in his discussion of step 4, making “a searching and fearless moral inventory,” Wilson makes a truly extraordinary recommendation: that the list of one’s “moral defects” be based on “a universally recognized list of major human failings–the Seven Deadly Sins [!] of pride, greed, lust, anger, gluttony, envy, and sloth.” (p. 48) Contrary to Wilson’s assertion, these are not “a universally recognized list of major human failings”; rather, they are a specifically Christian list of sins enumerated by Pope Gregory the Great in the sixth century. (Even ignoring its origin, one wonders why this “universally recognized list” would omit such obvious “defects” as cruelty, hypocrisy, intrusiveness, exploitation of others, and sanctimoniousness.) That Wilson would make such an extraordinary recommendation underlines the Christian origins and orientation of AA and its “program.”

Common AA Practices

As for AA’s practices, most meetings open with a prayer to God, the Serenity Prayer: “God grant me the serenity to accept the things that I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Most meetings also feature reading (and often discussion) of the 12 steps, with their exhortations to pray and to turn one’s life and will over to God. And most AA meetings close with the reading of a specifically Christian prayer, the Lord’s Prayer.

AA and the Establishment Clause

Indeed, the religious nature of AA and its “program” is so obvious that three federal courts of appeal (the 2nd, 7th, and 9th circuit courts–the next level down from the Supreme Court), two state supreme courts (Tennessee and New York), and nine federal district courts have ruled that government-coerced attendance at AA and NA (Narcotics Anonymous — a clone of AA) is unconstitutional in that it violates the Establishment Clause of the First Amendment, because AA is religious in nature. (There have been no contrary rulings on the appeal level, but unfortunately there is no national binding precedent because the Supreme Court has refused to hear appeals of any of these rulings. Without this binding precedent, government-coerced AA and NA attendance continues on a piecemeal basis across the country.)

Given all this, it seems amazing that AA members routinely and vehemently assert that AA is “spiritual, not religious.” There are two primary reasons that they do this. The first is that AA is a very anti-intellectual organization, in which honest questions and skeptical attitudes are viewed as “disease symptoms,” and in which great emphasis is placed upon unquestioning acceptance of revealed wisdom. Three of the most common AA slogans embody this anti-intellectual attitude: “Utilize, don’t analyze,” “Let go and let God,” and “Your best thinking got you here.” So, in a milieu which demands blind acceptance and denigrates critical thought, AA members hear that AA is “spiritual, not religious” and repeat it like parrots (which is unfair to parrots).

AA members who own treatment facilities or work in them have an additional incentive to repeat the “spiritual, not religious” mantra: money. In 1990, over 93 percent of treatment facilities in the United States were 12-step facilities, and treatment was a $10-billion-a-year industry. Very probably even more money is at stake today. If 12-steppers who own or work in treatment facilities would honestly admit that their approach is religious in nature, that river of government and insurance-industry cash would dry up in short order.

Ultimately, one must ask that if a program based on faith in God and on prayer to “Him” isn’t religious, what is?

AA and Spirituality

One might also ask what’s spiritual about encouraging blind acceptance? What’s spiritual about discouraging critical thinking? What’s spiritual about disparaging those who ask honest questions? What’s spiritual about encouraging people to identify with destructive past behaviors? What’s spiritual about telling people that they’re “diseased” for life? “What’s spiritual about telling people that they’re “powerless” to solve their own problems? What’s “spiritual” about inculcating dependency? What’s spiritual about issuing destructive, self-fulfilling prophecies? What’s spiritual about telling vulnerable people that their only alternatives to AA are “jails, institutions, or death”?

These are things religions do. As for AA:

  • Blind acceptance? Check.
  • Discouragement of critical thinking? Check.
  • Ostracism of doubters (“heretics”)? Check.
  • Identification of self with sins (past behaviors)? Check.
  • Diseased (“sinful”) members? Check.
  • Personal powerlessness? Check.
  • Dependence on an institution for salvation? Check.
  • Fear-mongering about an inevitable downward spiral if one abandons the institution and its teachings? Check.

 

It’s time for some honesty. It’s time for AA to admit it’s religious, not spiritual.

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

AA’s supporters commonly trumpet AA as the best, if not the only, way  to deal with alcohol problems. To back their claims, they cite anecdotal evidence and uncontrolled studies; but they ignore the best scientific evidence–the only available controlled studies of AA’s effectiveness–as well as the results of AA’s own internal surveys of its membership.

There have been only two controlled studies (with no-treatment comparison groups) of AA’s effectiveness. Both of these studies indicated that AA attendance is no better than no treatment at all.

The first of these studies was conducted in San Diego in 1964 and 1965, and its subjects were 301 “chronic drunk offenders.”(1) These individuals were assigned as a condition of probation to attend AA, to treatment at a clinic (type of treatment not specified), or to a no-treatment control group. All of the subjects were followed for at least a year after conviction, and the primary outcome measure was the number of rearrests during the year following conviction. The results were that 69% of the group assigned to AA were rearrested within a year, 68% of the clinic-treatment group were rearrested, and 56% of the no-treatment control group were rearrested. Based on these results, the authors concluded: “No statistically significant differences between the three groups were discovered in recidivism rate, in number of subsequent rearrests, or in time elapsed prior to rearrest.”(2)

(As an aside, the results of this study were very close to being “statistically significant.” This normally means–as it did in this study–that there’s a 5% or less likelihood that random chance accounts for an outcome. In the case of this study,  there was a 6% or less  likelihood that the poor results of the AA group were the result of random chance. Hence, the authors classified the result as “no[t] statistically significant.”)

The second controlled study of AA’s effectiveness was carried out in Kentucky in the mid-1970s, and its subjects were 260 clients “representative of the ‘revolving door’ alcoholic court cases in our cities.”(3) These subjects were divided into five groups:  One was assigned to AA; a second was assigned to nonprofessionally led Rational Behavior Therapy; a third was assigned to professionally led Rational Behavior Therapy; a fourth was assigned to professionally led traditional insight (Freudian) therapy; and the fifth group was the no-treatment control group. The individuals in these groups were given an outcome assessment following completion of treatment, and were then reinterviewed three, six, nine, and twelve months later.

The results of this study were as follows: AA had by far the highest dropout rate of any of the treatment groups–68%;  the lay RBT group had a 40% dropout rate; the professionally led RBT group had a 42% dropout rate; and the professionally led insight group had a 46% dropout rate.

In terms of drinking behavior, 100% of the lay RBT group reported decreased drinking at the outcome assessment; 92% of the insight group reported decreased drinking; 80% of the professionally led RBT group reported decreased drinking;  67% of the AA attendees reported decreased drinking; and only 50% of the no-treatment controls reported decreased drinking.

But in regard to bingeing behavior, the group assigned to AA did far worse than any of the other groups, including the no-treatment control group. The study’s authors reported: “The mean number of binges was significantly greater (p = .004) (4) for the AA group (2.37 in the past 3 months) in contrast to both the control (0.56) and lay-RBT group (0.26). In this analysis, AA was [over four] times [more] likely to binge than the control [group] and nine times more likely than the lay-RBT group.(5)

It seems likely that the reason for this dismal outcome for the AA group was a direct result of AA’s “one drink, one drunk” dogma, which is drummed into the heads of members at virtually every AA meeting. It seems very likely that this belief all too often becomes a self-fulfilling prophecy, as it apparently did with the AA attendees in this study. Combine this with the million-plus people coerced into AA attendance annually in the U.S., and AA’s astronomically high dropout rate (95%, according to AA’s own triennial surveys), and it’s reasonable to speculate that AA contributes to binge drinking.

The third significant piece of evidence regarding AA’s effectiveness is that provided by AA’s triennial membership surveys. In 1990 or 1991 (there’s no publication date; I obtained the report in 1991), AA produced an analysis of its previous five triennial membership surveys, “Comments on AA’s Triennial Surveys.”(6) This document revealed that 95% of those coming to AA drop out during their first year of attendance. (7) Even if all those who remain in AA stay sober (which is not the case), this is still a poor success rate, even in comparison with the rate of spontaneous remission.

There have been many studies of spontaneous remission (sometimes called spontaneous recovery), and one meta-analysis of such studies indicates that between 3.7% and 7.4% of individuals with alcohol problems “spontaneously” recover in any given year.(8) In comparison with this, AA’s annuals 5% retention rate of new attendees is not impressive. And that 5% rate might be optimistic–it was derived from surveys conducted during the 1970s and 1980s, a period of very high growth in AA membership. In contrast, since the mid-1990s, AA’s U.S. membership has been almost flat. According to AA’s own figures, two decades ago it was roughly 1.2 million, and in January 2013 it was approximately 1.3 million.(8). This works out to a minuscule growth rate of under one-half of one percent annually. Even taking into account dropouts with “time” (in this “program for life”) and mortality, this means that AA’s current annual new-member retention rate could well be under 5%.

As for AA being the only way to beat an alcohol problem, it has been known for decades that alcoholism (alcohol dependence–as contrasted with mere alcohol abuse) disappears faster than can be explained by mortality after the age of 40.(9) Also a very large Census Bureau-conducted survey in the early 1990s found that over 70% of the formerly alcohol-dependent individuals surveyed (over 4,500 in all) had recovered without participating in AA or attending treatment of any kind, and that those who had not participated in AA or attended treatment had a higher rate of recovery than those who had.(10)

As well, in contrast to AA and treatment derived from it (the dominant mode of treatment in the U.S.), there are several types of treatment that are well supported by the best available scientific evidence (studies with random assignment of subjects and no-treatment control groups, and/or comparison groups using standard 12-step treatment). Among the best-supported therapies are those known as the community reinforcement approach, social skills training, motivational enhancement, and brief intervention.(11) All of these well-supported therapies are low-cost, cognitive-behavioral approaches in which alcohol abusers are reinforced in the belief that they have power over their own actions, and are responsible for them. (This is in direct contrast to the 12-step approach, which teaches alcohol abusers that they are “powerless.”) Unfortunately, none of these proven-effective, low-cost therapies is in common use in the United States, in which the ineffective 12-step approach dominates.

Finally, over the last third of a century, a number of “alternative” (non-12 step) recovery groups have arisen in the U.S., and many, many individuals have recovered through them. Abstinence-oriented groups include SMART Recovery, Secular Organizations for Sobriety, Lifering, and Women for Sobriety. Moderation-oriented groups include Moderation Management and Harm Reduction Network. Between them, they have hundreds of meetings across the country and all provide help via the Internet.

In sum, those who trumpet AA as the best (or only) way to deal with an alcohol problem do so only by ignoring well supported alternative therapies, the widespread “alternative” self-help groups, the best available scientific evidence, and the evidence generated by AA itself.

Endnotes

1. Ditman, K.S. et al. “A controlled experiment on the use of court probation for drunk arrests.” American Journal of Psychiatry, 124(2), pp. 64-67.

2. Ibid., p. 64.

3. Brandsma, J.M. et al.  Outpatient Treatment of Alcoholism: A review and comparative study. Baltimore: University Park Press, 1980.

4.  This means there was only a 1 in 250 chance that this was the result of random chance.

5. Op. cit., Brandsma et al., p. 105.

6.  “Comments on AA’s Triennial Surveys,” no author listed. New York: Alcoholics Anonymous World Services, n.d. (This document was intended for AA’s internal use only. It’s very crudely produced–mimeographed stapled sheets bound by a staple in one corner–and is not part of AA’s official “conference approved” literature. I first found mention of this document while digging through the reference shelves at AA’s San Francisco intergroup office in 1991, and I–and subsequently other researchers–obtained it by writing to AA’s General Service Office in New York and asking for it.)

7. Ibid., p. 12.

8. http://www.aa.org/en_pdfs/smf-53_en.pdf

9. Drew, R.D. “Alcoholism as a Self-Limiting Disease.” Quarterly Journal of Studies on Alcohol, 29, pp. 956-967.

10.  Dawson, Deborah. “Correlates of past-year status among treated and untreated persons with alcohol dependence: United States, 1992. Alcoholism: Clinical and Experimental Research, Vol. 20, pp. 771-779.

11. See Handbook of Alcoholism Treatment Approaches (3rd Edition), by William Miller and Reid Hester. Pearson, 2002.

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