"The pseudo-science of Alcoholics Anonymous" [Salon]

[Totenkindly]

AA and rehab culture have shockingly low success rates, and made it impossible to have real debate about addiction

Alcoholics Anonymous is a part of our nation’s fabric. In the seventy-six years since AA was created, 12-step programs have expanded to include over three hundred different organizations, focusing on such diverse issues as smoking, shoplifting, social phobia, debt, recovery from incest, even vulgarity. All told, more than five million people recite the Serenity Prayer at meetings across the United States every year.

Twelve-step programs hold a privileged place in our culture as well. The legions of “anonymous” members who comprise these groups are helped in their proselytizing mission by TV shows such as “Intervention” (now canceled), which preaches the gospel of recovery. “Going to rehab” is likewise a common refrain in music and film, where it is almost always uncritically presented as the one true hope for beating addiction. AA and rehab have even been codified into our legal system: court-mandated attendance, which began in the late 1980s, is today a staple of drug-crime policy. Every year, our state and federal governments spend over $15 billion on substance-abuse treatment for addicts, the vast majority of which are based on 12-step programs. There is only one problem: these programs almost always fail.

Peer-reviewed studies peg the success rate of AA somewhere between 5 and 10 percent. That is, about one of every fifteen people who enter these programs is able to become and stay sober. In 2006, one of the most prestigious scientific research organizations in the world, the Cochrane Collaboration, conducted a review of the many studies conducted between 1966 and 2005 and reached a stunning conclusion: “No experimental studies unequivocally demonstrated the effectiveness of AA” in treating alcoholism. This group reached the same conclusion about professional AA-oriented treatment (12-step facilitation therapy, or TSF), which is the core of virtually every alcoholism-rehabilitation program in the country.

Many people greet this finding with open hostility. After all, walk down any street in any city and you are likely to run into a dozen people who swear by AA—either from personal experience or because they know someone whose life was saved by the program. Even people who have no experience with AA may still have heard that it works or protest that 5 to 10 percent is a significant number when we’re talking about millions of people. So AA isn’t perfect, runs this thread of reasoning. Have you got anything better?....

article continued here:
The pseudo-science of Alcoholics Anonymous: There’s a better way to treat addiction - Salon.com

My personal experience with AA comes through my father's chronic alcoholism, along with his two brothers. All three grew up to be chronic drinkers, and two of them died from the long-term effects of alcohol, as well as suffering (and projecting on family) all the misery that goes along with it. Interestingly, the third brother went to AA and has been sober for a few decades now... although he has also been the most difficult of the three personality-wise for people to interact with.

Despite multiple DUIs, job losses, and a 30-day jail stint, my dad refused to accept that he had an alcohol issue until he almost died in 2005 from alcohol-related causes (he was comatose for two days) and had to attend weekly AA meetings as well as months of physical therapy to recover. He only attended for 7-9 months (and that period of his life was striking in his productivity, as he was actually sober), but then he decided that he didn't have an alcohol problem and the AA folks were all despicable holier-than-thou jerks, so he spent the last 7-8 years of his life back in a drunken stupor until his body finally gave out. [official cause of death: Chronic effects of alcohol poisoning. Shocking.]

My ex-aunt (who eventually divorced the uncle some years before he died of alcohol-related causes) was herself kind of the "librarian teetotaler religious zealot" type and proselytized me for Al-Anon back when I was in college -- and although I'm pretty easy-going, and although I totally acknowledged that my dad had a drinking problem that had created a lot of suffering in our family (issues I wanted to resolve with him), I remember being so pissed off as how obnoxious she was about it... there was a lot of condescension when she would talk about my dad and my uncle, even if I was frustrated with their unwavering addiction to the bottle.

So what's described in the article seems to generally follow my prior thoughts -- I think the program can be effective for certain types of people and not effective for others, and that it's not the only way one can work through the problems. I can see how gaining an awareness of the underlying psychology could be helpful for some (including myself).

(Addiction is horrendous to claw your way out of regardless, honestly. I think my dad's issue was two-fold, at least -- AA wasn't the kind of program that was effective for him, it wasn't flexible enough; and he also had too much pride/self-insecurity to admit he had a problem that had destroyed his family, career, and generally his life.)

Thoughts?
Experiences?

(On even just 12-step style programs in general?)

 

[prplchknz]

I don't like 12 step programs. I left started drinking again (though now I only drink like once or twice a month with friends and don't drive) but it felt very cultish to me i was told this is the only way. I left I became happier and more productive. it's good that i didn't drink for almost two years as I lost my dad and grandpa in a 9 month span and lot of shit happened. so now my approach to problems is do what I can to solve them once i've solved them or done all i can at the time maybe drink not always. I've also just not wanted to get drunk as much anymore. I can have booze around and lot of times it just sits there. I think people can through periods of heavy drinking and end up fine ultimately while others don't. I have friends in the program and it works for them I would never tell someone to leave aa if it works. I would tell people though it's not for everyone if it doesn't work for you leave. I pretty much agree with the article. I don't have a resentment against the program, I left it was my decision. I'm happier overall and more motivated. I agree with despicable holier than thou jerks in the program there's a lot of those.

 

[ceecee]

The only experience I have with it at all is, from my ex-husband. He called me to atone for, what he felt, were the wrongs he committed concerning me. The only feeling I got (with the exception of pure rage, but that's a whole other thing), was that everything he was apologizing for was now being put in my lap. That the responsibility of the things he did to me were now something I needed to carry for, I assume, all time. How much of this mindset is his and how much is AA isn't really clear, he certainly seemed happy to have been relieved of such a heavy burden, no matter what the impact was on others, true to form.

I feel like I'm rambling and this is due to how much anger I have about the incident. I'm sure AA works for some people. I'm also sure it's creates a whole other type of addiction and crutch in Christianity.

 

[Bush]

It's amazing how questioning specific tactics like AlAnon is quickly met with "WELL I GUESS YOU DON'T CARE ABOUT THE KIDS OF ALCOHOLICS THEN"

I have jack in terms of hands-on experience with this subject matter, and I haven't read much material on it. But word on the street is that evidence-based practice methods (e.g. cognitive behavioral therapy, group therapy) are much more effective than those that rely upon instilling a sense of powerlessness ("You are an alcoholic, and you're basically screwed if you don't submit.").

 

[prplchknz]

It's amazing how questioning specific tactics like AlAnon is quickly met with "WELL I GUESS YOU DON'T CARE ABOUT THE KIDS OF ALCOHOLICS THEN"

I have jack in terms of hands-on experience with this subject matter, and I haven't read much material on it. But word on the street is that evidence-based practice methods (e.g. cognitive behavioral therapy, group therapy) are much more effective than those that rely upon instilling a sense of powerlessness ("You are an alcoholic, and you're basically screwed if you don't submit.").

one of the concepts is the reason you're able to not drink while in the program and will only work if you stay. is because of some invisible higher power. I came to the conclusion I didn't drink because I decided not to there is no higher power. basically they're saying to give up your will. and this was my impression and apparently a lot of others everything good that happens in your life is because of the program or a higher power (doesn't matter how much work you put in you had nothing to do with it) while anything bad that happens is completely your fault.

 

[Totenkindly]

The only experience I have with it at all is, from my ex-husband. He called me to atone for, what he felt, were the wrongs he committed concerning me. The only feeling I got (with the exception of pure rage, but that's a whole other thing), was that everything he was apologizing for was now being put in my lap. That the responsibility of the things he did to me were now something I needed to carry for, I assume, all time. How much of this mindset is his and how much is AA isn't really clear, he certainly seemed happy to have been relieved of such a heavy burden, no matter what the impact was on others, true to form.

That's interesting to me.

I mean, I think the ideal is that the people are supposed to take responsibility for their behavior and also humble themselves by asking others to forgive them, but depending on how they do it and the context, it could easily come off as -- after all those negative experiences of dealing with this addict -- having the issue dumped in the lap of the wronged and they are now somehow obliged to process further and forgive / empower the addict to continue to fix his life.

I read an article recently criticizing how (more overtly) some people in the church push "forgiveness" on victims of rapists or abusers. IOW, once the victimizer comes and apologizes for their behavior, suddenly if the victim doesn't choose to forgive them right away, then they are harboring a spirit of bitterness, sitting in judgment over the abuser, not having a "right heart with God" in some ways... but in a sense, these victims are just being victimized even further by the abuser. Not only did the abuser abuse them, but now (through the endorsement of the church doctrine) he's forcing them to forgive him, even if the issue was never resolved or where the issue can't really ever be resolved. [Note: This isn't a criticism of the church in general for me, just how I've seen the issue pursued at times by people in that institution without much experience with addicts.]

I think forgiveness can be a powerful, positive thing, but sometimes the context can twist it into something ugly. I don't know how I would feel if my father would have come to me and asked for forgiveness. It's not that I was sitting there holding it over him, but our relationship was very complicated and painful, and not so easily worked through just because someone suddenly decided he wanted to be free of his addiction. In a sense, his asking for forgiveness would have still just been about him trying to fix his life, without really considering the impact of it on others.

.... word on the street is that evidence-based practice methods (e.g. cognitive behavioral therapy, group therapy) are much more effective than those that rely upon instilling a sense of powerlessness ("You are an alcoholic, and you're basically screwed if you don't submit.").

Yeah, that's a good angle to examine. Is the 12-step system empowering the addict or disempowering him?

 

[Tellenbach]

In the last 3 months, I've read of two treatments for alcoholism, one using megadoses of niacin and one using a product called Bionar or Perse. I can't find much information on Perse; there was an alleged Congressional hearing on it and Charlie Rangel allegedly raved about it. I did find a study on niacin.

Alcoholism - A Five-Year Field Trial of Massive Nicotinic Acid Therapy of Alcoholics in Michigan

Some of the key findings:

"A five-year longitudinal field trial of nicotinic acid was conducted on 507 known alcoholics to determine what effects and benefits might result. Our experience strongly suggests that:

1. Nicotinic acid can benefit 50 to 60 percent of alcoholics in the organic stage.

2. Nicotinic acid can benefit about 30 percent of the total alcoholic population.

3. Benefit ran be measured in terms of:
Reduction of insomnia.
Mood stabilizationReduction of sedative tolerance.
Restoration of nontoxic sensorium Reduction of drinking recidivism.
Enhanced ability to use other treatment resources.
Enhanced social and emotional function.
Reduction or absence of the need to use other forms of medication."

 

[indra]

three words: lsd

 

[Totenkindly]

In the last 3 months, I've read of two treatments for alcoholism, one using megadoses of niacin and one using a product called Bionar or Perse. I can't find much information on Perse; there was an alleged Congressional hearing on it and Charlie Rangel allegedly raved about it. I did find a study on niacin.

Yeah, my dad was diagnosed as niacin-deficient back in his 2005 hospitalization. I don't know whether he was taking it for the last portion of his life, although I'd assume he'd be.

 

[Mal12345]

I experimented with a few self-help groups when I was in my depressed 20s. Depression has been a life-long issue for me. I got more help from books than I did from those groups.

The small group I attended the most, with a constant attendance of about 10 members, started out well but then turned negative from the influence of two women there. One of them, an INFJ e4 (who tested as such), had always liked to complain about men in general. But then after I left town for a while and came back, another man-eater had joined the group in my absence. The gender-split had been about 50/50 at one time, but now the males were dropping out one after another. One of the guys even stated that he already had an abusive wife at home (she was his main topic of discussion) and didn't need anymore of it, stating that this was no longer a safe place to discuss his marital problems. He then stood up and left the group forever.

This is why, in some cases, self-help groups need to be gender-specific. This is especially the case with SA (this came from an SA attendee I knew at the time) who said females never lasted long there because they always felt like they were being leered at in a sexual manner (probably because they were being leered at in a sexual manner).

Part of my purpose for attending groups was not so much to find a "cure," but to keep me nailed down. I had no family or steady job. I thought that attending groups would help with my stability issues (to be like a family). I also thought that exposure to other people in a safe environment would be beneficial to me. Those man-eaters should have just gone and joined a feminist coven or something, or maybe started one of their own.

 

[Mal12345]

three words: lsd

You mean "three letters."

 

[Thalassa]

Narcotics Anonymous did not save my sister, no matter how religiously she attended, no matter how much coffee she drank or cigarettes she smoked, or friends/acquaintances she made. She simply traded one addiction for another and fell off the wagon eventually into an even worse state.

AA though was extremely effective for my grandfather.

I wonder how much type has to do with it. My grandfather was an ISTJ and took to church and sober life like a champ, so much so that he was rigid and unyielding.

My sister is likely ESxP.

 

[prplchknz]

Narcotics Anonymous did not save my sister, no matter how religiously she attended, no matter how much coffee she drank or cigarettes she smoked, or friends/acquaintances she made. She simply traded one addiction for another and fell off the wagon eventually into an even worse state.

AA though was extremely effective for my grandfather.

I wonder how much type has to do with it. My grandfather was an ISTJ and took to church and sober life like a champ, so much so that he was rigid and unyielding.

My sister is likely ESxP.

this is usually the case. but the problem is the claim it works for everyone when it doesn't. if it was like this might work for you it might not that be different

 

[Thalassa]

one of the concepts is the reason you're able to not drink while in the program and will only work if you stay. is because of some invisible higher power. I came to the conclusion I didn't drink because I decided not to there is no higher power. basically they're saying to give up your will. and this was my impression and apparently a lot of others everything good that happens in your life is because of the program or a higher power (doesn't matter how much work you put in you had nothing to do with it) while anything bad that happens is completely your fault.

Honestly the only two methods I think work are Higher Power or Cognitive Behavioral Therapy, because both create perspective and internal centering if authentic. My sister won't sit still for CBT though. A therapist outright told my mother, your daughter doesn't want help, she doesn't want to change and she doesn't care about anyone but herself and she will likely always be this way. I so wish I had been there for the actual discussion because my mother isn't well versed on personality disorders but that's essentially what my sister has.

 

[prplchknz]

Honestly the only two methods I think work are Higher Power or Cognitive Behavioral Therapy, because both create perspective and internal centering if authentic. My sister won't sit still for CBT though. A therapist outright told my mother, your daughter doesn't want help, she doesn't want to change and she doesn't care about anyone but herself and she will likely always be this way. I so wish I had been there for the actual discussion because my mother isn't well versed on personality disorders but that's essentially what my sister has.

oh yeah, haha I accidently told you to read the post you quoted. I agree, mostly maybe i dunno i don't think there's just one way for anything well some things. but most things no.

 

[xisnotx]

i feel like...and trust me, i'm somewhat an authority when it comes to abusing alcohol...it's more about wanting to change than anything.

if a person doesn't want to be sober, it really doesn't matter what you say or do, s/he'll find a way to not be sober. sure, intermittent periods of sobriety are possible...but alcohol is too readily available to force someone to not imbibe.

and the reverse is the key. if the person wants to be sober...not much will get in their way. it's not easy...but if you really want it, you'll find a way to pull through.

not surprised that these programs are ineffective...from what i've gathered, it's more about the social environment anyhow. like in fight club, how the lead went to sessions because he was bored. it's a form of cognitive dissonance...lying to yourself that you're trying to help yourself to ease your own guilt.

at the end of the day...and it's something i've realized relatively recently...you can not help someone who doesn't want to be helped. you can't help the helpless. you can drag a mule to a trough, but bet your ass (get it?) you can't get him to drink.

 

[prplchknz]

I was looking up something completely different when I found this little diddy. Someone is using enneagram for addiction treatment. Kind of cool The Enneagram Center for Transformation and Change I know it's not aa or even criticizing aa but I don't think it deserves it's own thread.

 

[johnnyyukon]

I'm also sure it's creates a whole other type of addiction and crutch in Christianity.

I don't know about Christianity (though it was founded on a Christian model) but yes, AA, in and of itself I think it can be another addiction, though certainly better than alcohol.

I thought I knew what an alcoholic was until I became reaquainted with an old High School buddy who's promising college Soccer scholarship, and possibly related career path was pissed down the toilet because of his Alcoholism, probably caused by his severe social anxiety.

#1 star player in a D1 High School, he'd had 3 DUIs by the age of 22, flunked out of college, getting pills and mescaline cacti mailed to our apartment without us knowing because he lived with his parents, and drinking every drop of alcohol left in our apartment after me and my roommate would go to sleep, then passing out on our couch.

His upper middle class parents, one who was a professor, paid $30,000 for a yearish long rehab that seemed to help. Though a couple of relapses followed, one started with an innocent puff of weed and ended 3 days later with empty jugs of whiskey, dozens of empty beer cans, crack pipes, and things he can't even remember, strewn about his place.

One of the smartest guys I've ever known too.

I don't think I've ever had a bad substance abuse problem, but have definitely been in situations where it seemed that fate was out of my hands and I can only begin to imagine how this poor bastard felt and the appeal and maybe even necessity of a belief in a higher power was.

All in all, AA seemed to help him, but I can't help but see it as another crutch (which is fine for a while) but I think eventually, if you truly want to be whole, you have to find the root of the cause and address it. But that can be a lifelong journey in some cases and someone might be dead from an overdose by then, so ya know, whatever works, or helps you cope.

I've heard that ibogaine and ayahuasca (POWERFUL psychoactives), when done in a proper ritual setting (mostly in Peru or Africa) have had permanent, documented success stories for many people. But I don't think you can go down to the Quick Clinic for it.

 

[miss fortune]

I've been to court mandated AA and I went to a few meetings on my own to see if they would make things any easier around my one year mark and I really didn't like it

my major problems were that I didn't feel like it held me accountable for my decisions and I didn't like all of the god stuff

I guess that my thoughts are that it's my choice to take that first drink and I know where it tends to head (another won't kill me... I need to let loose a bit) and I still made that decision on many, many occasions. I knew what would happen but thought that maybe this time I could do it better and it usually turned out that I couldn't. The idea that I was powerless in my situation and had to put my fate in the hands of something I wasn't even sure that I believed in seemed like a terrible idea.

And the prayers... there's so much praying and hugging and thanking god and everything during meetings that it made me incredibly uncomfortable... which, coincidentally made me really, really want a drink to reassure me that everything would be ok and the scary people would be made less scary

Also, I take some issues with always having to introduce yourself as an alcoholic every time you mention who you are. If you put in the effort and DON'T drink then you deserve to put recovering or former before the word... what's the point of putting the effort into changing if you keep the same label? It's like getting a promotion in work but not title or pay.

The meetings were depressing, overly huggy, people pried into my personal life way more than I had any desire to and everything was about how you have no power in your life and have to put your fate in the hands of god... eww!

Plus, the whole making amends thing? Apologizing isn't shit... make a change and stick to it and then you've shown that you're sorry. Talk is cheap and they've already heard every excuse or apology in the book and another isn't going to make a difference because you've let them down every single fucking time. If you mean it just change, don't say it.

That's my two cents. I've been sober over 3 years and I've done it by challenging myself, not by putting my fate in someone else's hands

 

[ceecee]

Plus, the whole making amends thing? Apologizing isn't shit... make a change and stick to it and then you've shown that you're sorry. Talk is cheap and they've already heard every excuse or apology in the book and another isn't going to make a difference because you've let them down every single fucking time. If you mean it just change, don't say it.

In my case, he feels that he did a great job of parenting our kids. Great job = paying minimal court ordered child support and having just enough contact to fuck with them. It only makes me want to take a brick and smash his face over and over and over because he will never grasp that he caused any damage, let alone how much.