How much do you know about Alcoholics Anonymous and other 12 Step programs? It’s a support group, right? It’s safe to say it’s widely regarded as the most successful recovery program for addiction. Then again, accupuncture is widely regarded as a successful treatment for all kinds of illnesses but anyone familiar with science-based medicine knows it simply doesn’t work. So, why should 12 Step programs be treated with any less skepticism? After all, AA makes claims regarding the causes of and treatments for alcoholism. What evidence, if any, is there to support these claims?
“Undrunk: A Skeptic’s Guide to AA”, by A.J. Adams, seems anything but skeptical. That is, the word ‘skeptic’ seems to be used in the “I was skeptical, at first” kind of way…rather than referring to a person who evaluates claims based on evidence and the scientific method. Has AA escaped the attention of the science and skepticism community? Certainly, the 12 Step industry must be one of the most successful quackery organizations out there–embedding themselves into the medical industry as successfully as any alternative medicine woo–and branding themselves as secular more successfully than intelligent designers.
AA and its counterparts (there’s a 12 step program for just about any addiction) are anything but secular. Of course, any program member will tell you that atheists and agnostics are welcome…but the program is chuck-full of religion; only about four of the twelves steps make no use of god or spirituality. Dr. Harriet Hall wrote a great article over at Science-Based Medicine about AA and the lack of evidence for it’s effectiveness: AA is Faith-Based, Not Evidence-Based. Another resource I found is a blog called Stinkin Thinkin:
…[W]hat we’re doing is muckraking, in the time-honored sense of the word. AA and 12-Step is has a monopoly. Sure there are some alternatives, but none of these alternatives are offered in your general addictions treatment facility. And none of these alternatives have the power to lobby in Washington the way that AA does…to get insurance money
There is a group called SOS (Secular Organizations for Sobriety, or Save Our Selves) which provides non-religious support for alcoholism and drug addiction. I found some interesting articles about AA by browsing their site:
AA, as a doctor once told me, is “an evangelical movement about saving souls”. At its core it has a good heart – it wants to save people from their demons. But, as with the death penalty, McCarthyism, the Conquistadors and other such crusades against evil, the pious ambitions of AA make the movement blind to its own hooliganism. As disinterested in individuality as the SS, and unaccountable for its actions as the KKK, AA preaches, bullies and lies to achieve its ends, and it does so with all the righteous impunity of a secret sect. Unlike other religious cults, however, AA’s victims are those who escape from its grip and return to society, their brains so laundered by fundamentalist claptrap that a glass of beer can take on the menace of a loaded pistol. That I eluded such a fate myself is thanks to nothing but sheer good luck – those not as fortunate as I can’t tell us about it, their stools at the bars and chairs in AA inhabited by new people entirely disinterested in tales of the dead ones who went before them.
I know there’s a lot of woo for skeptics to deal with, but I think the 12 Step industry deserves more criticism from the skeptical community. AA isn’t an effective treatment, never mind the most effective treatment for alcoholism, and those suffering due to substance abuse deserve treatments which are evaluated for their safety and efficacy.
April 22nd, 2010 at 5:59 pm
Its unfortunate that there are ppl like you out there that really have no clue what AA IS about. A monopoly, an industry, hardly…AA supports itself through donations, $1 per meeting, that hardly a profitable industry. It is not a religious movement, it asks its members to find a higher power, that can be anything. I met a woman once who said trees were her higher power. Hardly evangelical. My husband has been sober 8 years, no hospitals, no detox…just AA. This SOS group that you quote sounds like the real scam. AA doesn’t care who you are, where you come from. You are not bullied into anything. This other blog you quoted is also grossly misinformed, AA stays out of politics and never lends its name to any political group or figure. It does not lobby Congress. AA does not preach that alcohol is evil, only that some people cannot handle it and cannot function with alcohol in their lives, it is trying to help those people. Of all other sober-programs, AA is the ONLY one that has endured throughout the generations, that in itself is proof of its success. The ONLY requirment to join AA is the desire to quit alcohol. Any alcoholic who is fooled into these other groups that teach you to drink responibility deserve the fate they will inevitably fall into. The alcoholic does not know and never will know how to drink responsibly. I have met dozens of people who tried sobriety their way and always went back to hard core life ruining drinking. They eventually come back to AA and that is how they stay sober, and happy, and healthy.
April 22nd, 2010 at 11:01 pm
AA and other 12 step programs are controlled by Alcoholics Anonymous World Services, Inc., the company that markets the programs and runs a business off of merchandise and the program support materials, the “Big Book” being just one publication that the corporation profits from.
If you read my other post, here, you will find that it is clear in the Big Book that the higher power it speaks of is God. Regardless, a “higher power” is invoking the supernatural, even if it is directed towards a physical object. There is no need to rely on faith healing or supernatural nonsense for any medical disorder, including addiction to alcohol.
AA spreads misinformation about addiction and its members are shielded from medical based information. The “evidence” you invoke are all based on anecdotes. Personal experience is not evidence, especially when AA rooms are filled with self-selected individuals–AA members will never hear about the vast number of people who recover from addiction without the dogma of AA or the members who leave and recover anyway, because those people aren’t at meetings. The stories in the meetings are inquivalent to cheery-picking: you’re only going to hear anecdotes about the programs success, never the huge amount of failures. This gives meeting attendees a warped perspective on the statistics: AA has a failure rate of over 90%, addiction to alcohol has a spontaneous remission rate of about 50%.
It is a fallacy to claim that the program must have proven efficacy simply because it has been around a long time.
Dr. Harriet Hall has an article here showing the medical based data on AA: http://www.sciencebasedmedicine.org/?p=490
April 23rd, 2010 at 9:52 pm
AA is NOT the only way to get sober. In fact AA encourages people to try any means to acheive sobriety.But why are there so many meetings ? Why do the courts and treatment centers send so many people to AA? Why are there so many 12 step programs? Wasn’t AA the FIRST 12 step program ? Why are there so many people that are dying from untreated cases of alcoholism? And why in the hell did they write a book on how they recovered from alcoholism? I can only assume that they wrote down precisely what they did to recover so that you could do what they did if you wanted to.But you can try other means if you like.In fact aren’t there a bunch of books about alcoholism out there besides the “Big Book”? (for sale)AA’s 12 steps are suggestive ONLY. If followed can enable the user to become happily and usefully whole. Is that so bad ? There is a bar against all information which cannot fail to keep a man in everlasting ignorrance, that bar is contempt prior to investigation.Though you may come to scoff. I hope you come to stay.
August 12th, 2010 at 3:06 am
I’ve reposted below the best explanation of the take it or leave it nature of spirituality in the rooms. It’s a difficult hump to get over and I’ve found that religious fervor varies regionally. I’ve attended meetings all over the US and in 7 countries. The most “religious” by far were in the southern states of the US. I take what I want and leave the rest. It works for me but that’s not evidence of anything other than my anecdotal success fighting addiction.
You don’t have to like the way the book is written, but your lack of true skepticism (investigation from properly conducted research and use of the scientific method) is a danger to people who may want/receive help from these programs. A bad skeptic is worse than a peddler of hokum, mainly due to the self righteousness. How many of the 12 step texts have you read thoroughly? Each program differs greatly in the description of the “spiritual” portion of the program. The NA and GA texts are vastly different from the AA text though the underlying steps are essentially the same. Additionally, the AA Big Book has not changed since the thirties; mainly due to tradition and continuity. Like Doug Stanhope says “Would you still be a Christian if they elected a new Jesus every 4 years?”
How many meetings have you attended in various fellowships to conduct observational research? All fellowships have open meetings that anyone can attend.
How do you accurately survey the success of people in an anonymous program? This has proven difficult for scientists as well as the fellowships themselves. I guess the bottom line is to do the work yourself and not just infer from internet posts what you think you know. Confirmation bias can bite a sloppy skeptic too.
As promised:
My name is ____________ and I’m an atheist.
I am addressing this to the alcoholics who have had trouble with the religious overtones in the AA program. To those who do not accept the idea of a supernatural being, let me assert that it is always people who have strengthened me when I needed help.
I have a deep belief in human morality. I believe that evil impulses can be subordinated by decent actions. AA brings out impulses for good, and this has tremendous force. In my opinion, this sum total of good actions is the “higher power.”
In the words of a Unitarian minister: “In a world that has lost, or is losing fast, any convincing concept of divine providence at work, of a personal God ordering the affairs of humanity, it is not necessary to assume that the only alternative to a human-cherishing universe is a hostile or satanic universe. There is the much more likely alternative of a neutral universe where people live, hammering out salvation without hope of heaven or dread of hell. People can find that life has value, not because a divine being so ordains, but because the achievements of good men and women, laboring together with love and self-respect, are self-validating and self-rewarding.”
I was not able to accept AA or the very real help it could give until I made a rationalistic interpretation of the program. I am still an atheist, but I am a grateful atheist.
I don’t want to change AA It works for me. I just want it to be effective in attracting rationalists. Their membership will help AA tremendously.
August 12th, 2010 at 3:31 am
“How do you accurately survey the success of people in an anonymous program? This has proven difficult for scientists as well as the fellowships themselves.”
This is a common argument against the program’s lack of proven efficacy and demonstrates a misunderstanding of what is involved in conducting a well run study. Anonymity is a key feature of double-blinded studies.
Again, as I believe I mention in the post…or rather, it is meant to be the point of the post…that arguments like the ones you present aren’t any different than the arguments used to try and defend any other pseudoscientific treatment–whether it be acupuncture, homeopathy, reiki, or faith healing (AA is simply a popular form of faith healing). These treatments simply do not have proven efficacy, lack plausibility, and do not follow any standards of evidence-based medicine.
September 16th, 2010 at 7:20 pm
GOD= Group Of Drunks
GOD= Good Orderly Direction
a higher power of your own understanding. nothing forced a program of suggestions.
October 29th, 2010 at 10:32 am
Thanks for the article, Sara. Most people who attend one or even a few AA meetings leave and do not return. My experience is that AA feels very cult-like. I attended on and off for 30 years because it was the only game in town but I could never really feel comfortable there. It felt like sitting in a fundagelical church to me. Thanks to the internet, I am now able to communicate with rational people who have had problems with addiction and are perfectly willing to skip all the God stuff, the powerlessness stuff (as well as all the smug, snarky stuff!)
February 15th, 2011 at 3:40 am
If it is “the most” effective treatment for something that is largely untreatable and poorly understood, I think it should be accepted and supported by the Skeptical community until another, presumably more science-based approach can be developed and proven. If I remember correctly, the efficacy rate for AA is around 20% which is not very good, but since a) nothing else is as effective and b) both the disease and the relief provided to some people by AA is is not very well understood, we should tread lightly since many people literally depend on it for their lives. It also has the advantage of being intellectually accessible, affordable and widely available. I would have more of an objection to the judeo-christian overtones in the literature, except that I really have never heard of anyone being talked out of atheism by a 12-step program. Atheists really are encouraged to have trees be their higher power or whatever, even expressly in the material which is pretty progressive for something developed in the thirties.
Debunking magnets or homeopathy is appropriate because they often keep people from getting real, effective treatment for diseases. Debunking AA is inappropriate because there is no more effective known alternative.
February 15th, 2011 at 6:30 am
Colleen, you demonstrate what AA is actually good at: advertising itself as the only option. This is untrue. There are proper support groups like SOS, which don’t spew misinformation, guilt, and cult-like techniques. There are medical interventions like medication, which help people deal with quitting. And if anyone who comments here would bother to click any links I post, they’d find that no treatment at all actually has a the highest success rate. http://www.sciencebasedmedicine.org/?p=490
AA has the potential to serious damage peoples mental health. People think that just because someone has a substance use disorder that they can be treated with lower standards in care. Debunking AA is important because it is faith-healing garbage which, unlike magnets and homeopathy which are considered alternative to evidenced-based care, has successfully convinced the populace that it is the best and standard treatment. It is not, and is preventing people from getting better treatment and information about behavior disorders.
April 1st, 2011 at 11:52 pm
I could not shake a compulsive behavior (addiction, whatever your word of choice is) until I left 12 step programs. Of course, this is anecdotal as well, but I’ll give a little background. For someone like me, who is naturally skeptical and an atheist, the 12 step program caused stress and guilt. You are told, basically, that if you do not do certain things then you are hopeless. You are also talked to about God. You can insert some concept like a tree or the group as your higher power, but really this makes the message of the program even more incoherent. The book also tells you all the characteristics you are supposed to have as an addict. The group generally reinforces all of this and, from my experience, is not filled with skeptically-minded people. The problem with the “take what works, leave the rest” philosophy for me is that once you take out the parts that aren’t ridiculous blanket statements or only sensible embedded within a traditional god concept, then the only thing left of any value is fellowship with people who understand your struggles. This is valuable, but it is a shame it is not easily accessible elsewhere. The stress comes in when you realize that the message is actually illogical and you feel like you must try to believe it and you are surrounded by people you care about and are a support system that all believe it and are encouraging you to work the program. I think 12 step programs would be useful for people who either already believe in a god or are very open to the idea. I was neither. I stopped going to the groups and my stress and guilt levels dropped and I naturally entered a stage of abstinence and then moderation with the behavior. Many 12 step folks will not want to believe this, but I am no longer an addict and still occassionally indulge. Their closed minds (and perhaps secret jealousy) will make them feel that what I have described is not possible, when it is not in general but maybe it is for them.
December 21st, 2011 at 2:08 pm
Sara, I couldn’t agree with you more! My husband (soon to be ex) is an alcohol abuser who has been in and out of AA. I have been to Al-anon and as I heard many say there, “that’s how the alcoholics are–they go in and out (of AA)”. I do not agree with all of the 12 steps, not because of the references to God or a higher power, but because ALCOHOLISM is a disease. So why would working the steps and turning their “defects”over to God “cure” them. Gee, wouldn’t it be nice if one were to have cancer that working a 12 step program would put the cancer into remission as long as they kept working the steps!? If alcoholism is a disease recognized by the AMA, then shouldn’t it be treated medically?? Even if you’d like to categorize it as a mental illness, still, there are medications for that. I like the concept of AA as a support group and a source of ideas and sharing with others with similar issues, but I’m sorry the 12 steps are a bunch of BS if you ask me. It’s sad that AA is the main (and in certain cases) the only option for alcoholics. How a Medical Doctor, whose belief is based on SCIENCE, will send patients to AA, a group whose belief is based on FAITH is completely beyond me. I am a woman of science. I am a registered nurse and I look at things like the the pathophysiology of the disease. There are, to put it into layman’s terms, genetic differences in the make up of an addict’s cells and metabolism. How will working the 12 steps change the chemical make up of a human being? In my opinion, non-medical 12 step programs and Alcoholism being termed a disease are complete contradictions.
January 29th, 2012 at 3:10 pm
thanks for the laugh…this is some funny shit…i used to be just like you…i knew everything about anything…and the fact is I know nothing about AA until I get there and stay there…i could attempt to tell you about it but you’d be short changed…your ass has to be in the seat to EXPERIENCE the emotion…Now AA is a program of suggestion…like it is suggested you pull the rip cord if you jump…its no cult or anything of that sort and it is proven that it does work ask the millions of people who have successfully remained sober because of it…If you have a problem drinking check it out give it say 90 days if you dont feel better you’ll have a lot money to go get drunk with…WE are self supporting through OUR own contributions AA is not allied with any SECT,DENOMINATION,POLITICS OR ORGANIZATION we wish not to engage in controversy OUR PRIMARY PURPOSE IS TO HELP THE ALCOHOLIC WHO STILL SUFFERS….anything said prior to that fact is hear say,guesstamation,speculative….and sadly probably from an alcoholic who still suffers…so good luck buddy…you be ready when your ready…p.s. thanks for the laugh its always the smart ones who are to stupid to get this simple program.
January 29th, 2012 at 3:16 pm
To Layla…I came in and out of AA because i didnt work the program…simply…i didn’t want it…the solution to OUR problems are ALWAYS very very simple…the reason it works is because…I SUFFER A MALADY AND THE ONLY SOLUTION IS A SPIRITUAL ONE…in the big book it states…AA is a spiritual program of ACTION…in other words just do it…1.Dont drink 2.Got meetings 3.get a sponsor 4. be grateful….and 5. Help another person who need it…thats it after 27 yrs of drinking and drugging and hell i do the 5 things suggested here by AAers and my life is beyond my wildest dreams…but for some just not drinking is as good as it gets…not me…but remember I DRINK…..WE DONT that why i keep coming…i wish you well in your endevours…