Posts Tagged “12 step”

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.

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AA in SL5BI’m going to bring up a topic which I haven’t yet addressed here, which desperately needs to be examined critically and brought to heel. And that’s substance abuse treatment, aka SAT.

I bring it up because (via the Skeptic’s Dictionary) I came across a site/blog called Stinkin’ Thinkin’. It critiques most forms of SAT, but focuses on Alcoholics Anonymous (AA) and its associated “12-step philosophy” which is followed by many other groups. In the process of reviewing the site, I noticed, on this page:

I’ve spent a lot of time on this blog throwing tantrums about the fact that addiction gets no play among the skeptic and new atheist writers out there – people who actively combat quackery and religious influence in public policy. How does it escape these people that a whole branch of public health has already been handed over to the faith healers?

The author is absolutely correct that this topic has been neglected by skeptics … and I agree that has to change, because the field of SAT is — overall — a vast, festering cesspool of woo, nonsense, and even fraud, and most of it is predicated on religious notions about human nature.

It’s not as though no skeptics have tried to go after this field. The Skeptic’s Dictionary has had an entry on the subject for a long time. And it was the target of a season-two episode of the show Penn & Teller: Bullshit!. But it’s true that nowhere near enough critical attention has been paid to SAT.

As for why prominent skeptics haven’t addressed its many faults, I can only speculate … and that would be a waste of time. I can say that I haven’t covered it, because quite honestly, it just wasn’t something I focused on. I should have brought it up before, but didn’t. That neglect ends now.

The problems with SAT are myriad. I can’t even begin to address them all. But most of them are all based on two basic premises, which lie at the heart of most forms of SAT: First, that all “addictions” are “diseases” that require treatment; and second, that “addiction” is a “condition-for-life” which can never be eliminated, only transcended — usually with the help of God (which in the language of AA and most related “12-step groups” is euphemistically called “a Higher Power”).

It may seem strange for me to say that not all “addictions” are problems requiring treatment, but it’s true. There are lots of people who indulge in substances like alcohol or recreational drugs, sometimes compulsively, but they have jobs and families and friendships, and otherwise function just fine (aside maybe from the occasional hangover or bout of “the munchies”). Of course, there are some folks who can’t control themselves, and who screw up their lives. They may need some help to get back on track … but not everyone who uses substances will reach this point.

As for the idea that addiction is something that can’t be cured, obviously the intention behind this assertion is to set up a dependency. The “addict” can never be free; s/he will forever after rely on “the Higher Power” and the 12-step group in order to function. This premise serves the same purpose in 12-step programs as the notion of “original sin” does in Christianity.

The real problem with all of this is that the notion that “addiction” is an incurable condition has seeped into psychiatry generally, and a reliance on 12-step programs has become entrenched in it. It’s common for “addicts” to be told by their doctors, therapists, social workers, etc. to attend 12-step meetings. The problem is that such programs haven’t been demonstrated effective (WebCite cached article), and most professionals are either aware of this, or ought to be but aren’t. My guess is that a lot of these professionals are well-meaning, and just looking for ways for their “addict” patients to occupy their time, in a setting in which their problems are taken seriously by others they can relate to. In other words, they don’t really view it as “treatment,” therefore, and don’t care that outcomes are poor.

But the poor outcomes are precisely why professionals should stop recommending 12-step programs to their patients. These groups are more than just a venue to socialize; they keep repeating to their members that they cannot ever be truly “well,” and that message, once absorbed, will forever keep them from getting over their “addiction.”

Of particular interest to me is the tendency of courts to order addicted offenders into 12-step programs. Most of them are religious in nature, and this means that judges are essentially forcing people to adhere to religious notions against their will. But even the small number of such groups which aren’t explicitly religious still keep telling addicts that they’re forever defective and can never be fixed. It would be much better if courts put people into programs that are not only not religious, but which have demonstrable records of success. AA and its relatives in the 12-step world have not managed this.

At any rate, I intend to discuss this topic in the future; it’s long past time the floodlight of critical thinking has been cast on SAT.

Photo credit: john-norris.

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