A few simple things AA could do (but probably won’t) to make AA more of a help to alcohol abusers

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

Over the years, I’ve written a lot about AA, mostly about the negative things that are lost in the avalanche of pro-AA testimonials.

Let’s take as a given that AA’s own statistics (AA’s 1989 triennial survey) are correct: 5% of those who walk through the door are still there (and probably sober) a year later. That’s about the rate of spontaneous remission.

My very strong suspicion is that if you’d take away the million-plus people coerced into AA attendance every year in the U.S. (mostly via DUI sentencing and employee assistance programs), the percentage who recover with the help of AA would be a lot higher — that is, if you’d only count those who voluntarily come to AA for help, the recovery rate would probably be twice, maybe three times the rate indicated in AA’s summary report on the 1989 AA triennial survey. (I have to stress here that this is only my own entirely scientifically unsupported estimate, though I suspect that my friends and family who have been in AA for decades would tend to agree.)

Why would this be? Two reasons come to mind: 1) once someone has decided to change, almost any helping hand will increase their chances of recovery; 2) there’s evidence that AA works especially well for religious people, for whom AA’s religiosity isn’t a problem, and is likely an aid.

This brings up the first way that AA could be of more help to alcohol abusers and the alcohol dependent: AA should stop aiding and abetting the coercion of alcohol abusers into AA attendance. This could be easily done by having meeting secretaries stop signing attendance slips. AA’s annual general service conference could easily declare such a policy.

The second way AA could be of more help is if it (okay, the true believers at most AA meetings) would admit that there are other routes to recovery. There’s good evidence that cognitive behavioral therapy (CBT) approaches are the most effective treatment option, and CBT self-help is the foundation of the second-most common alcohol self-help group, SMART Recovery.

That leads to the third way AA could be of more help: AA has an official “take it or leave it” approach (not that this reflects real-world AA), which means that AA could help more people by referring them to SMART Recovery, Lifering, Moderation Management (and other harm-reduction groups), Secular Organizations for Sobriety, Women for Sobriety, and other non-religious recovery groups. These groups can and will help many of those repelled by the rigidity and religiosity of AA.

A fourth way AA (again, the true believers at AA meetings) could be of real help is if AA would stop repeating unscientific, destructive dogma.

Go to almost any AA meeting and you’ll hear that without AA “alcoholics” will inevitably descend into the hell of “jails, institutions, or death.” Abundant scientific research indicates that this simply is not so: most alcohol-dependent persons (not just alcohol abusers) either improve significantly or quit entirely without participation in AA or any other type of treatment program.

So, if AA (the hardcore members) would simply stop repeating the “jails, institutions, or death” mantra, it would help huge numbers of people to take the first step to taking responsibility for their own behavior and recovery (or at least improvement). AA should admit that it is possible to recover independently or simply reduce self-harm, and that doing so is possible and important.

A fifth and very significant way AA could help alcohol abusers is if it (again, the hardcore fanatics at almost every meeting) would stop insisting that “alcoholics” inevitably lose control after a single drink (“one drink, one drunk”). There’s good scientific evidence that this is a self-fulfilling prophecy, and that those having no exposure to AA are significantly less likely to binge than those exposed to AA.

Of course, when those with alcohol problems drink it’s at least to some extent Russian roulette. So, it makes sense not to drink. But pretending that even a single drink inevitably leads to a bender is a horrible, destructive, self-fulfilling prophecy.

If AA (oookay, once again the hardcore believers) would stop insisting on all this pernicious nonsense and would instead present AA honestly as a religiously based recovery program that works for some people, AA would be a real help to people with alcohol problems.

As is, AA does more harm than good. I hope AA changes so that it helps more people, but I’m not optimistic.

 

 

Alcoholics Anonymous Does More Harm Than Good

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

Alcoholics Anonymous (AA) is, arguably, America’s most sacrosanct institution. Its promoters (often AA members hiding behind “anonymity” while they promote AA) present it as an unalloyed good: effective, “spiritual not religious,” supportive, nonjudgmental, purely voluntary, based on “attraction not promotion,” and leading to personal growth (being “better than well”). Some even state that AA has no negative aspects whatsoever and that AA with it’s 12-step approach is the only effective approach to addictions problems.

All of this is wrong. The rate of recovery via AA is no greater than the rate of spontaneous remission. AA was part of a Protestant evangelical group for the first several years of its existence, and its 12-step program is blatantly religious by any reasonable definition of the word. AA is supportive — as long as you parrot its party line. It’s nonjudgmental–again, as long as you parrot the party line. AA is not purely voluntary; over a million Americans per year are coerced into attending it via court orders and employee assistance programs, as a condition of avoiding jail or keeping their jobs; and many of AA’s promoters insist that AA doesn’t promote itself, even as they do exactly that. As for AA members being “better than well,” attend any meeting and judge for yourself. And AA does have serious negative aspects, both for its members and those merely exposed to it.

Let’s first look at the harm AA does to its members, those who come to it voluntarily for help, and those who are coerced into attending it.

Even for the small percentage of attendees for whom AA “works” (approximately 5% according to AA’s own triennial surveys–roughly the same as the rate of spontaneous remission), there are negative effects. The first of these is that many AA members adopt “alcoholic” as their primary identity. They identify their very beings with a past, self-destructive behavior. They stay stuck — focused on the past. It’s both strange and sad to see someone who hasn’t drank for twenty years identify him or herself as an “alcoholic.”

(What would we think of someone who gave up cigarettes twenty years ago, yet still identifies him or herself as a “smoker”? The only reason it doesn’t strike us as equally bizarre for long-time nondrinkers to identify themselves as “alcoholics” is the constant self-referential use of that term by AA members. Endless repetition desensitizes us to the  strangeness of this very odd usage.)

Another negative aspect of AA is that it keeps members dependent upon it. According to 12-step dogma, “alcoholics” are always “recovering,” and the only way they can maintain sobriety is to attend AA for the rest of their lives. The way my late friend Vince Fox defined alcoholism and 12-step alcoholism treatment neatly encapsulates the 12-step approach: “Alcoholism is a phenomenon characterized as physical, mental, and emotional, and treated in medical settings by nonmedical personnel with a religious program in which the patient is admitted as diseased, discharged as diseased, permanently recovering, and never recovered.”

So, AA members consider themselves “diseased,” adopt the “alcoholic” label as their identity, and (at least in theory) remain dependent upon AA for life. Many “old timers,” who have been sober for twenty or thirty years, still go to several meetings per week, some daily. This, of course, is a severe time drain. The amount of time wasted by American AA members on AA meetings is probably second only to the amount of time wasted in the U.S. by Mormons — in another lifelong “program” — on LDS meetings.

Another major downside of AA for its longtime members, those who come to it for help, and those coerced into attendance, is AA’s insistence that “alcoholism” is a “progressive disease,” that drinking inevitably worsens barring abstinence, and that “alcoholics” have no control once they start drinking — that their only alternatives to AA are “jails, institutions, or death.” Leaving aside the absurdity of labeling a behavior as a disease, all of this is simply wrong. But for those who buy the assertions that drinking inevitably worsens and that they have no control, the results can be disastrous. These pernicious assertions often become a self-fulfilling prophecy. Other AA assertions — notably that, according to AA’s “Big Book,” alcohol is “cunning, baffling, powerful!” and individuals “powerless” — only exacerbate this problem. So, when AA members start to drink, they think they have no control, so they don’t even try to control their drinking — they binge.

Research seems to bear this out. What is still probably the best scientific study of AA’s effectiveness (Outpatient Treatment of Alcoholism, by Jeffrey Brandsma, Maxie Maultsby, and Richard J. Walsh, Baltimore: University Park Press, 1980) reported that those assigned to the AA group (with its “one drink, one drunk” dogma) binged more than four times as often as the no-treatment controls. (That this study is nearly four decades old matters not a whit, because in the years since it appeared AA’s “program” has changed not a whit.)

As well, since AA meetings are so unattractive that only (again according to AA’s own triennial surveys) five percent of those who “walk through the door” are there a year later, millions of people have been exposed to AA’s pernicious assertions and, at least in some cases, their drinking likely worsened as a result — and many undoubtedly don’t even try to find alternatives, because of AA members’ insistence that AA is the only thing that works.

These are only the most obvious negative effects of AA upon those exposed to it.

Related Posts

• Alternatives to AA — and Why They’re Needed
• Alcoholics Anonymous is not Effective
• Alcoholics Anonymous is Religious, not Spiritual
• Why is Alcoholics Anonymous Sacroscanct?

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• Alcoholics Anonymous is Religious, Not Spiritual (Part II)
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