Self photographed figure of the Alcoholics Anonymous, via Wikimedia CommonsI’ve blogged before about the religious organization Alcoholics Anonymous, which has virtually hijacked the treatment of alcohol dependency in the U.S. and promulgated a religious model (known as “12 steps” or “12 stepping”) that’s been applied to other forms of substance abuse. Its chief premise is that alcoholics are slaves to booze and can never, ever touch it, because if they do, they will definitely relapse.

The problem with this, as I’ve noted, is that neither A.A. nor the “12 step” philosophy has been shown to be effective in treating substance abuse. It is, instead, a treadmill upon which people are dumped sometimes against their will (e.g. when a judge orders a defendant into A.A.) and which they’re expected to stay on for life. All too often they’re unable to do this, which leads to the predicted relapse, and the treadmill of A.A. becomes a revolving door they continually keep going through repeatedly.

Because of this I’ve long advocated more rational treatment methods that coincide better with human nature. In an op-ed piece in the New York Times, author Gabrielle Glaser offered alternatives based not on abstinence from alcohol, but moderation (WebCite cached article):

The cold-turkey approach is deeply rooted in the United States, embraced by doctors, the multibillion-dollar treatment industry and popular culture. For nearly 80 years, our approach to drinking problems has been inspired by the 12 steps of Alcoholics Anonymous.

Developed in the 1930s by men who were “chronic inebriates,” the A.A. program offers a single path to recovery: abstinence, surrendering one’s ego and accepting one’s “powerlessness” over alcohol.

But it’s not the only way to change your drinking habits.

Bankole Johnson, an alcohol researcher and consultant to pharmaceutical companies who is also the chairman of the Department of Psychiatry at the University of Maryland School of Medicine, puts it this way: “We are wedded to the abstinence model as the goal, despite evidence that there can be many successful outcomes.”

Because of the promise of anonymity, A.A. doesn’t track its members or conduct research. Some studies have found that many members find support for healthier habits from a like-minded group of nondrinkers. But a systematic review [cached] found “no conclusive evidence to show that A.A. can help patients to achieve abstinence.”

Glaser describes an approach that combines moderation, rather than teetotaling, with the drug naltrexone, as well as a support organization called Moderation Management, and an Internet application, Moderatedrinking.Com.

What’s notable about Glaser’s essay and these other tools, is that none of them purports to be the sole answer for everyone. Glaser, Moderation Management, and Moderate Drinking all admit there are some folks who would be better off abstaining from alcohol rather than attempting moderation. This is, of course, in contrast to A.A. itself, which claims to offer the one and only valid path to sobriety for true alcoholics.

Fanbois of A.A. are sure to go after the Gray Lady for having published this piece. It’s natural they will do so. They don’t like being told they’re wrong or that their way isn’t the only way. They will also no doubt use their own personal testimonials as “proof” that A.A. works whereas nothing else does. They will no doubt accuse Glaser and the Times of imperiling people’s lives by giving them advice that’s sure to destroy them. Unfortunately for them, their testimonials are “proof” of nothing whatsoever, and their scaremongering merely a childish reaction to news they’d prefer not to read or hear.

The bottom line here is that, if A.A. works for you, wonderful! Stay with it. Just don’t deprive other people of other approaches to alcohol merely because you dislike them.

Photo credit: Wikimedia Commons.

Tags: , , , , , , , , , , , , , , ,

  • Diogenes

    The problem with a statement such as "The problem with this, as I’ve noted, is that neither A.A. nor the “12 step” philosophy has been shown to be effective in treating substance abuse" is that it ignores an extensive body of well-designed research literature empirically demonstrating the opposite. While posting ill-informed opinions on an obscure blog frequented by like-minded individuals isn't really likely to do much harm, Glaser's book – a polemic disingenuously posing as thoughtful analysis that also ignores the abundant contradictory evidence easily available to any interested person via such legitimate sources as the National Library of Medicine's PubMed site – and her itinerant hawking of it, does have the potential to do much harm by packaging her distortions in a product that will attract vulnerable people desperately in need of helpful information. Having access to mass media carries with it a burden of responsibility of which Glaser seems blithely indifferent.

    • The problem with your claim that I "ignore[d] an extensive body of well-designed research literature empirically demonstrating the" effectiveness of AA is that, in fact, I did no such thing, and neither did Ms Glaser. She included a link to a systematic review of several studies investigating AA and found it wanting. It's OK if you want to accuse me or Ms Glaser of "ignoring" whatever it is you demand we pay attention to in preference to everything else … but if you do, you lie.

      Oh, and I love your little snide comment about this being "an obscure blog frequented by like-minded individuals." I do hope you realize that dishing out an insult like that isn't very likely to sway me to see things your way. Or did you? I suspect not. Well, now you know.

      Concerning "the abundant contradictory evidence easily available to any interested person via such legitimate sources as the National Library of Medicine's PubMed site," I went there myself and found this: http://www.ncbi.nlm.nih.gov/pubmed/16856072:

      No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed.

      Oh but, by all means, please continue accusing me of not having done any research. Again, you lie when you do, but that's fine by me. If the only way you can defend AA is by lying about it and lying about me, then you will have already proven my point, without me having to say or do much of anything.

      Lastly, if Ms Glaser is somehow "indifferent" to all this damage you claim she's doing, I'm sure she'd dispute that. In fact, as it happens, she has documented the damage AA itself has caused. So again, please, by all means, keep telling us how virtuous and perfect AA is, and how unreasonable I am … because after all, I'm the owner of "an obscure blog frequented by like-minded individuals" who can't possibly be expected to know a fucking thing about anything.