Sigh. As someone who’s had success in 12-step recovery since 1998, I find these sorts of “debunkings” incredibly disappointing. Firstly the measurement of success rate entirely misses the point. The 12-step view is that there isn’t a “once and done” cure. If I were to use an analogy it’s more like having lifelong diabetes. You gotta keep taking that insulin. It’s the continuity that forestalls the disease/ keeps you in remission.
Yes, 12-step programs have issues, and a big one is the whole “higher power”/god thing. Maybe this is more of an issue in the USA which is far more religious than other countries. But even that is addressable for atheist 12-steppers. I should know - I am one.
If you are interested in a different take by a psychologist expert in the field, check out the writing of Dr. Patrick Carnes.
> The 12-step view is that there isn’t a “once and done” cure. If I were to use an analogy it’s more like having lifelong diabetes. You gotta keep taking that insulin. It’s the continuity that forestalls the disease/ keeps you in remission.
This is actually one of the things that many psychologists are dubious about. It's entirely possible that self-labeling as an alcoholic forever makes it harder, not easier, for some people to remain abstinent.
To the extent that it keeps you vigilant and involved in a supportive community, it can be good. But it could also make it harder to get back on the wagon if you have a single drink if you think you're "an alcoholic", and not "a sober person who made a mistake".
Due to the anonymous and heterogeneous nature of AA, good data and studies of its efficacy are very hard to come by, so we have little idea if it's actually better than non-AA or pharmaceutical alternatives.
Identifying as an alcoholic or gambling addict or drug addict etc, is no different than saying "I'm a diabetic". It's the label of a chronic disease. Applying that label to self is about acceptance of that as a fact of life that you can then work with. If you've ever been unfortunate enough to see e.g. a diabetic who did not accept the reality of their illness - it's not pretty. Acceptance is the price of vigilance.
I also believe you've misunderstood how we view ourselves (and each other) when we fall of the wagon/bust/slip. I'm not a "sober person who made a mistake". I'm an addict who made a mistake.
Most of us in 12-step programs have tried psychology (and counselling and hypnotherapy and...) before the despair was enough that we'd admit defeat and join *A. Admittedly, there's a cohort of people mandated to turn up. It should surprise no one that this cohort sees very high rates of recidivism. But I'd suspect the same to be the case for people mandated to attend psychotherapy. If you don't want to change, nothing can make you.
Pharmaceuticals are interesting. I believe that LSD has been trialled to help those with substance addictions but I'm not sure of the state of research regarding behavioural addictions.
Fundamentally though, the evidence is pretty clear that there's a neurological basis to most addictions including the behavioural ones. e.g. check the research of Mira Fauth-Buhler.
People can choose to identify as they wish, and I'm not for one second diminishing that identification. But problematic drinking is very different to diabetes, it's also highly varied in its expression and not as deterministic as the label suggests.
I totally understand why it's a helpful framing for some people, but it really isn't for others.
To extend this, there have been programs that have attempted to fix the problems of alcohol addiction but not require patients to remain sober. The core concept being that there is an underlying cause to the alcohol problem and the alcoholism is an expression of that problem, not itself a root. Thus once the root cause is fixed, the alcohol is no longer a trigger.
Another form allows participants to drink but uses a medicine which induces unpleasant effects from alcohol. Thus participants self train an avoidance pattern and break the positive feedback loop.
These should not be seen as contrary to the AA abstinance approach. For some people that appears to be the most effective means. For many other people, AA is not.
I suspect as we advance our understanding we'll come to find distinct subdiagnoses in alcoholism and alcohol abuse that suggest different treatment strategies. Right now our understanding feels very rudimentary.
> To avoid strong side effects such as nausea and vomiting, practitioners typically wait until after the alcohol detox process before administering naltrexone.
If you take one or two drinks, yeah it will just be not good. If you binge, you be puking your guts out.
This is not true. I have had ~15 drinks on Naltrexone which definitely qualifies as a binge although I never "truly" binged as I never blacked out after starting treatment via The Sinclair Method. It wasn't a great time especially the next morning but I didn't get sick at all.
I think I understand your point of view just fine. I have friends, family, and exes in AA and NA. I just disagree that the best way to treat addiction is a settled matter.
What I think is still up for debate is whether AA's framings are a net benefit, due to the lack of good research.
Your comment brings up standard AA doctrine, and I'm glad it's worked for you. But by your own admission, a lot of people fall off the wagon. You blame it on being court-mandated, but it doesn't seem to occur to you that another program may have worked better, court-ordered or not.
There's no consideration in your comment for survivorship bias in who remains in AA. Perhaps AA works great for a small subset of people, who stick with it, but is worse for a larger majority, who would be better served in a different program.
> Fundamentally though, the evidence is pretty clear that there's a neurological basis to most addictions
Uh, I'm not disagreeing. Not sure why you think I was? I used to chat about this stuff with Dr. Carl Hart, who studied meth addiction, when I was in grad school. He was also of the opinion that AA's efficacy was a black box, and said that he'd recommend Scandinavian outpatient facilities over AA, based on the research he'd seen.
Yes, the one thing we can do that we will surely bring us closer to curing alcoholism, is researching it extensively and coming up with a massive body of literature, and defining a system of taxonomic subclassifications of various alcoholism diseases.
Yeah one of the issues is that much of the 12-step recovery community does not condone alcohol abuse disorder medication. So to extend your analogy it would be like a community that focuses exclusively on curing diabetes through a ketogenic diet, but also tells people they shouldn't take their insulin. Maybe ketogenic diet works, but we do need good data to figure out how it compares to taking insulin.
Yeah...been hearing this stuff for 42 years. I could probably make an entirely convincing argument as to why you shouldn't try it. That's because I've heard it all.
If you don't want what we have ... no worries. You won't get it.
The problem is when we make decisions for other people. Things look very, very different, when it's our own butt on the line.
> The problem is when we make decisions for other people. Things look very, very different, when it's our own butt on the line.
Which is precisely what this article is complaining about. AA both as a program and as cultural push "abstinence first" is harming addicts for which the AA method is not successful. Which is most people. For instance drug therapies are slow to be given approval, people are sent to AA programs through court orders, etc.
As an individual if it works for you that's wonderful. But governmental policy and cultural norms should be based on what's effective.
If you are looking at raw numbers, lots of things. MAT (Medically Assisted Treatment) is considered more effective, numbers-wise. There's a huge amount of money being made in the field.
Also, AA and NA don't collect much, in the way of data. It's actually hard to tell how truly effective they are. Something to do with the second "A," I would guess...
That brings up another point that people have been avoiding, here: Desperate people can be squeezed hard. A lot of folks are making a lot of money, from people with their lives in tatters.
Some of the therapies are effective, but a lot of them are definitely not.
Since people like to cast addiction (and alcoholism is simply addiction to the sedative-hypnotic drug ethyl alcohol) as a moral failing on the part of the addict, it's easy to blame them, and say that "they got what they deserved."
It's really pretty hard to feel sorry for many addicts. Pick up the paper, on any given day, and you'll likely see some horrific stories of crimes committed by addicts.
That's why programs like AA and NA work. The only people that actually care about addicts, are other addicts. It's also important that they not be in a position to profit from their treatment. 12-Step programs live on a regimen of enforced poverty. They love to fight about money, but the amounts are chicken feed, compared to what the for-profit orgs make.
Which begs the question: If someone makes money by selling treatment to desperate, ostracized, people, is it surprising that they don't like organizations that provide highly effective treatment for free?
This is also true with psychiatry. Many people with ADHD being bilked out of 10s of thousands of dollars with useless, sometimes harmful medications, while there's something effective on the shelf.
As someone who's been on his own journey with alcohol and hung out in a few sobriety forums (/r/stopdrinking is brilliant), I've seen a very clear difference between the 12-steppers and other people who are quit/quitting/moderating.
I found the framing of the AA folks to be a lot more extreme. Problematic alcohol use is frequently described as an incurable, progressive disease. There's also this heavy focus on guilt and shame (see steps 4, 5 and 8) which I've always found a little uncomfortable and well, culty.
I'm not saying it's not helpful, it's saved many a backside. Nor am I saying that it's success-rate is oversold, I've not gone into the evidence. It was just definitely, clearly not for me.
I think AA "accidentally" provides people with strong community support - a basic need, the lack of which often leads people to... well, drink. AA fulfills that need, and maybe the 12 steps themselves don't work, but the community does. That's why so many people swear by it and have success with it.
So yes, it'll be a little culty, because those are the principles of this particular community, but I think it's far more valuable than say, a therapist, or trying to stop on your own.
My main problem with it is that people I know in AA can't seem to live without it. They depend on it so much that they're terrified of not following the 12 steps, for fear of getting "excommunicated", or worse: going back to drinking.
Unlike malicious cults, AA doesn't seem to be dedicated to exploiting its members for the benefit of cult leaders.
I think you are on to something, which is that providing connection can help people to overcome addiction. (Or perhaps the reverse - that addiction can help people cope with a lack of connection.)
If AA is the only source of connection, then I imagine losing it might very well result in relapse simply from losing the connection itself (not to mention the encouragement to remain sober.)
You can edit/delete for 2 hours. You cannot delete a comment that's been replied to. Unless you somehow convince your respondents to delete their comments within your edit window, which never seems to work.
Yeah, I should have replied to your original message so that you could delete the follow-up. As sibling comment points out, you can't delete once someone replies to your message. I knew better, I just didn't think it all the way through. Anyway, now you know.
No one is saying that 12 step doesn't have any successes, but:
1. The data is somewhat overwhelming that the rates of success aren't 25-30% as you said, but closer to 7%.[1] This puts it in roughly the same category as no
2. No one is dismissing the idea of doing 12 steps, but 12 steps is often court mandated.
3. 12 Step has more than passing connections to "faith-based" treatments. This is a problem when it's court mandated.
4. Instead of a problem with the program, they categorize inability to complete them as moral failures on the part of the person in treatment.
No one thinks that 12 step treatments shouldn't be an option, but they're not effective evidence based treatment options.
The concern I have with making it overly analytical like the HN crowd tends to do, we ignore a good chunk of psychological impact that purely data-driven statements can have. Instead of framing the discussion of "this doesn't work, we need to do something else" the conversation really should be "this works for some people but we can do better - we need to invest in it and figure it out."
That simple flip is easy and acknowledges that people have had success with this and people will continue to do so. It also sends the message that there's no reason to skip this entirely if you are looking for help.
"But unlike AA, I would never claim that what I've suggested is right for everybody. But ... let's say I had nothing better to offer: It wouldn't matter — we still need to change the system as it is because we are harming 90 percent of the people."
It is difficult to tell if those are the words of the NPR author or Lance dodes who wrote the book, but it directly contradicts your statement
"2. No one is dismissing the idea of doing 12 steps"
Changing the system doesn't have to mean getting rid of the 12 steps: it would change the system to make other options equally accessible and respectable.
"Alcoholics Anonymous, the worldwide fellowship of sobriety seekers, is the most effective path to abstinence, according to a comprehensive analysis conducted by a Stanford School of Medicine researcher and his collaborators."
Not meaning to diminish the role that 12 step recovery plays in the lives of many but given the impact that alcoholism medication had on my own life I can't help but mention it here. I used Naltrexone through The Sinclair Method and rewired my brain by continuing to drink for a year using the medication. I'm now multiple years sober. It took some extra time to deal with some emotional stuff, 12 steps will help you more there. But addressing the chemical addiction first worked well for me. See my comment history for more details.
I think most 12 step people who find success actually acknowledge what the psychiatrist is saying. Addiction isnt just one thing, often it can be a bunch of things, a big one being un-treated mental health problems like depression, anxiety, or even add/ADHD. It can be as he said feelings of powerlessness and displacing problems, like chemical procrastination of emotional processing. If that is a source of the issue it would make sense that addiction would be more common in society where emotions are not discussed or stigmatized but alcoholism is not.
This is all to say 12 steps isn't enough by itself and as far as I know most addicts in recovery stress that. I have known heroin addicts who are in recovery who go to meetings, but they also take meds, changed where they live, who they hang out with, media they consume, I even think they went to behavioral health therapy for a while to help change how they approach problems like stress, anger, communication, etc.
I have a friend in AA. I'm not sure how to measure if she's been "successful" or not.
After completing the steps the first time, she relapsed after a few months. After the second time, she went a bit longer, but didn't quite make a year.
She's on her 3rd time now. It's been over a year since she last drank. She's made significant positive life changes and this time feels different.
The last two times she constantly talked about fighting the urge to drink. This time she has no urges and nothing to fight.
So I guess she's successful now? We'll never really know until she dies, right? Because she could relapse 10/15/20 years from now. I assume they have some arbitrary cutoff of sobriety as "success", but how many people relapse after that cutoff?
I'm proud of my friend and hope she stays sober forever, but I also check in with her often to make sure she's staying on track (She has asked me to do this). She says this accountability helps.
I'm not sure what my point is, just that "success" when it comes to sobriety is very complicated and not just yes or no.
Recovery is almost never a straight line. If habits are hard to break, addiction is far more so. I’d guess the real benefits are in the support network of people who have first hand experience.
Disclosure: not an alcoholic, not married to one, either.
This is not a debunking. There are "support groups" for almost everything (watch Fight Club to see examples of that).
>The reason that the 5 to 10 percent do well in AA actually doesn't have to do with the 12 steps themselves; it has to do with the camaraderie. It's a supportive organization with people who are on the whole kind to you, and it gives you a structure. Some people can make a lot of use of that. And to its credit, AA describes itself as a brotherhood rather than a treatment.
I don't know about the 5-10% figure; let's assume that's valid. But saying the other 90% are harmed is a big overstep. The only way that would be true is if there were some other treatment that's more effective, and the 90% could have gone to that instead of AA. But he doesn't claim there is.
I'd propose that someone who goes to AA and doesn't like it probably then tries drugs, psychotherapy, and anything else. Or just continues on his own.
Harmed in the sense there is little reason to think this approach will work for them, and in choosing it (or being forced upon it, i.e. via a court order), we're not using more effective methods. Or just doing nothing.
I remember reading a William Burroughs interview where he talked about getting over nasty addictions by just writing "I will not smoke a cigarette" on a piece of paper everyday. This stupid process worked incredibly well for me. Broke a bad smoking habit. Anytime I felt the urge I'd re-write the statement. I could see how the same thing could work with drinking if and when you get triggered (grilling in the backyard, restaurant, etc).
I stopped drinking 30 years before this article was published. A 12 step program played a big part in it. Since then I have been an amateur student of the field, and I feel these gentlemen are more wrong than right. AA is an easy target because when you read the text there is a lot of BS in it---But the organization created by it does work better than anything before it, and most things since. I am not sure if the record is 5% or 30% or whatever, but it is surely more than zero. One of the best defenses AAs methods I have seen is the opinion of Charlie Munger, who talks about how AA uses several common human tendencies that are hardwired into most of us all at the same time in a synergistic way.
I'm a recovering alcoholic who has worked the 12 steps. To get this out the way, I agree that courts should not be sending people to AA. It's no good for anyone.
The reason that the 5 to 10 percent do well in AA actually doesn't have to do with the 12 steps themselves; it has to do with the camaraderie.
I agree with the second half of the that sentence, but the reason the reason many people including researchers don't think the 12 steps is because so few people understand them to do them properly.
Actually, the are a remarkable piece of mental technology based on thousands of years of wisdom
1 - Admit you have a problem. You can't fix a problem you refuse to recognize.
2 - Recognize you've tried to solve it by yourself and have failed. You need help from others.
3 - Humble yourself enough to ask for help and be ready to follow direction
4 - List all the complaints people have about you and analyze what you might be doing wrong
5 - Share your failings, no matter how embarrassing, with a trusted other on the principle that confession is good for the soul and sunlight is the best disinfectant
6 - Ask yourself if you're really willing to change. That's not a given. Maybe you aren't.
7 - If you are then do what it takes to change. This is going to be different for everyone.
8 - Look at step 4 and see who you need to apologize to
9 - When you feel you are ready and sufficiently reformed, apologize and make restitution to those on the list you made in step 8. To those that aren't willing to talk, let it go and don't bother them.
10 - Make it a practice to do steps 4 through 9 as needed. We believe in progress not perfection.
11 - We need to remind ourselves daily that we have a problem that we can't solve alone and that we may need the help of others on any given day. I've heard it called a disease of forgetfulness. We may need to wake up in the morning to read and pray if so inclined. As one person told me, "carve out a little piece of each day for the 12 steps"
12 - Carry this message to others who are still suffering, which I am doing here
Edit: I almost forget: Notice I haven't mentioned God. There were atheists in early AA that insisted that Bill Wilson insert the phrase "God of our understanding" in the book Alcoholic Anonymous so people could be free to use the concept of God or not.
The steps are good advice and can be helpful for some people. That does not mean people who fail (80+% from the data I saw) are doing them wrong.
Why is it so hard for people to accept that some things work, for some people. My personal experience of success is not a reasonable blueprint for literally anyone except me. Our experiences are shared but not useful to proscribe behavioral interventions for anyone except us.
AA works for some people. It does not work for others.
My steps aren't even Alcoholics Anonymous or about alcohol, although derived from what Bill W wrote. In my case, my personal step 7 to change was Cognitive Behavior Therapy, Dialectic Behavioral Therapy, Cognitive Processing Therapy and Jungian Therapy plus Psychiatric diagnosis and medication. Nothing about this negates the 12 steps I have outlined.
Alcoholics Anonymous as it exists today is not what it used to be. It started out with people who had lost everything or were about to, people that society had given up on, "low bottom" drunks and the like, people who were desperate to stay alive like Bill himself.
Today's AA I'm afraid after all the court ordered people and all the people who use it as a social club because their doctor told them that 4 glasses of wine a day was too much so they should stop. Well, it's too watered down for me and I don't go. I'm not surprised people think it doesn't work. If you want to test this, to a meeting and try to get people to try to talk about how the steps work in their lives and how they recovered and stop using their time as a gripe session and try to find sponsors who will stick to just taking you through the steps and not try to be your therapist. I've seen enough, but ymmv
The interesting thing about the 12 steps is that, really, they're what many, many people do anyways.
Basically, they can be summed up as "take responsibility, get help when you need it, and help others when you can." This is what most emotionally mature adults do anyways.
Unfortunately, the disease of alcoholism can lead people quite far from this type of otherwise normal behavior. (And not just for the drinkers!)
I wish there was far more education in North America about alcoholism, especially for teenagers and pre-teens. Considering the epidimic level of damage being inflicted by the disease, I don't think it would be unreasonable to have required classes in middle school or high school on the topic.
However none of that addresses or even attempts to discover the underlying cause(s) of the addiction - instead it assumes it's 'all your fault' and you just need to 'change' to fix it. Perhaps it is external factors that created and continue to drive the addiction (e.g. bad relationships, too much responsibility, unfulfilling work, feeling trapped, boredom, loneliness). Addiction often starts as self medication, before it becomes physical/physiological dependence.
Actually, that assumption is very much not part of AA, and very much not part of the 12 steps as they're usually understood.
For example, take step 1. "Admit you have a problem." You seem to be saying that admitting a problem is the same as blaming oneself. NOT TRUE.
In fact, one of the most important things to acknowledge is that it's not your fault. It's just a disease. And, like any disease, there are idiosyncrasies to treating it that will be different from other diseases.
but 4) 5) 6) are exactly blaming yourself. Indeed, they seem to focus on the bad things you have done (to others) as a result of your addiction, but with nothing about the cause of the addiction itself.
Agree with step 1) - and 2) in many cases - but perhaps 3) should be about figuring out what's been behind it and trying to remove that stressor. And then maybe another step can consider the disease paradigm, as a self-reinforcing cycle (failure, self-loathing, self-medication, failure...)
> 4 - List all the complaints people have about you and analyze what you might be doing wrong
That's not blaming yourself for alcoholism, which I think is the point your missing.
> 5 - Share your failings, no matter how embarrassing, with a trusted other on the principle that confession is good for the soul and sunlight is the best disinfectant
Again, this isn't about blaming yourself for your alcoholism AT ALL. This is about taking responsibility for bad behavior, which is often a very important catalyst for deciding to the the hard work of change.
> 6 - Ask yourself if you're really willing to change. That's not a given. Maybe you aren't.
Deciding whether or not you're ready to change is certainly not "blaming yourself."
Most alcoholics have to spend quite a lot of time forgiving themselves and letting go of blame -- which is, I think, generally very well known to people in recovery communities, but perhaps not as well known outside of them.
You may not be blaming yourself for the addiction itself, but certainly you are blaming yourself (i.e. deciding that you are the problem and you need to change) for your actions under the addiction.
I suspect for many that fine distinction would be lost, and it would be easy to fall into thinking that this is all my fault (and that I could do with a drink to get over it).
Perhaps one of the steps should be to separate the causes of the addiction, from the effects of the addiction. Then it becomes much easier to come to terms with what you have done, as you can separate things that you had a choice over, vs things you did not.
Of course I am taking the (modernist?) approach of 'to understand something is to control something'. Maybe that won't work for everyone, but I'd like to think it would work for many.
Great! I was talking to a friend about it and came up with a couple additional thoughts:
I always felt hesitant about rewriting Bill Wilson, because he's a Saint to some people, but knew I would someday. I'm aware he's just a guy like me and if he were alive today he'd see the need for it.
I think Bill W put too much emphasis on his steps causing a "spiritual awakening" because it set the bar too high. My feeling is that if people quit drinking or drugging or whatever it is that has captured them and do the work of getting better then they will naturally be in better spirits, which is a good enough spiritual awakening. Some will go further and have a Bill Wilson spiritual awakening. All the better.
Oh, let me hear the psychiatrist who has a new plan to overcome addiction with his bag of tricks.
People worship modern psychiatry/psychology as this scientific insight into the human mind that has finally done away with superstition and religion, and can accurately (and repeatably) tell us what's happening with people suffering from various mental ailments, and how to fix it.
But for some reason, every time a shooting spree happens, we all scratch our heads and ponder who could have seen this coming, and bury the fact that the majority of the shooters are on SSRI's and a host of other medication.
What happened to our superior understanding of the human mind? Shouldn't modern psychiatry and psychology be able to identify people at risk of shooting sprees? Or at least point back at the missed signs? Why are they so silent on this?
It's because when you peek behind the curtain, you find they're just a form of culturally acceptable medicine men. "Here, take these pills and it will solve all your issues! No we don't have any idea what 'chemical imbalance' is happening, or even if it's happening, but that's beside the point! Do not question the great and mighty Oz!"
If you ask me, they aren't fixing the problem with young men, they're perpetuating it. Maybe address that before throwing mud on 12 step programs.
>... and bury the fact that the majority of the shooters are on SSRI's and a host of other medication.
Can you please cite a source for this?
>It's because when you peek behind the curtain, you find they're just a form of culturally acceptable medicine men. "Here, take these pills and it will solve all your issues! No we don't have any idea what 'chemical imbalance' is happening, or even if it's happening, but that's beside the point! Do not question the great and mighty Oz!"
This is an incredibly broad blanket generalization that is not accurate.
>Sounds like "sources" serve two purposes: 1) validate what people already want to hear...
"Sounds like" and "is" are two different things. I'm actually quite open-minded and happy to be shown that that is actually the case. I have no opinion one way or another whether or not it is, but it's quite a tall claim and I'm simply curious as to it's accuracy. Knowing whether or not it's true would absolutely help to improve my understanding of that issue.
>... and 2) provide a road block for opposing arguments to prevent having to discuss them.
See above, regarding open-mindedness. Data's data - if your claim is right, your claim is right.
I've been in recovery for a long, long time. AA/NA was the only option when I started. I had my problems with the program - no cross talk, the depressing nature of each meeting, the sponsorship piece of the program. I ended up trying a different program called SMART recovery. It fit me much better. Just throwing this out there for anyone looking for options. There are different recovery programs that might work better if you're turned off to AA/NA.
As the article says, the core problem here is that the AA/12 step step definition of success and failure basically means that it is close to impossible for 12 step programs to ever fail. They definitionally treat any reversion/falling off as being a failure of the patient not the treatment. This is the same as saying “this chemo isn’t working due to your personal failures” and then reporting a near 100% success rate for said drug. The resultant “high” success rate then leads to courts imposing generally religiously affiliated “programs” that claim to not require god, but sure as heck make it difficult to avoid. While I’m sure many aren’t making use of this system to gain coercive power over people who aren’t in a great place it’s very clear that many do.
I think that's one of the practical problems both with AA itself and with criticisms of it. It occupies this space in the cultural milieu as the main or even only system to address alcoholism. You have judges sending drunk drivers & domestic abusers to AA and shit, atheists in there freaking out needing help they're not gonna get because they didn't know what they were getting into and the steps very clearly are not for them.
I would recommend AA to someone who is already or wants to be religious. It has many or all of the characteristics of a religion in its own right, and the emotional stance of seeking help from god is an explicit prerequisite.
AA itself doesn't even think AA is the only approach that works. The writings are very clear that other ways work for many people, and if one works for you you should prefer it because AA is exhausting, endless, and humiliating. That is part of why it works for those it works for, but if you can find another way you'll have a better time.
> exhausting, endless, and humiliating. That is part of why it works for those it works for, but if you can find another way you'll have a better time.
I see what you did, there.
I think the word you are looking for is "humbling." Completely different animal from "humiliating."
It's not "exhausting," either. Not sure where that came from.
Of all the places I comment online this is the only one where I'm routinely told I meant to say something other than what I said. I used to think I was just an unclear writer but it continues to only happen on HN.
Anyway I'm not anti-AA, I've been in it for years and am happy with it. I've also engaged extensively with what I perceive to be its limitations and constraints. I said what I meant to say and I meant what I said.
I meant humiliating. There are recovery programs that emphasize your courage and strength in confronting a highly stigmatized mental illness, that encourage reflection on the routine frailty of the human mind, its susceptibility to this sort of failure, the capriciousness of who falls into addiction and who doesn't. Does that sound like AA to you? AA encourages you to think of yourself as permanently faulty in an irreparable way and to choose your actions with that fault in mind. This is rather practical in preventing relapse, but it's not a resounding message of self-actualization.
The "confession of sins" in steps 5, 8, 9 are inevitably going to be experienced as shameful and yes, humiliating. This is effective! It's a powerful deterrent to that behavior in the future.
I meant exhausting. There is never a point in AA where you are cured, where you are free of AA, free of the burden of thinking of yourself as an alcoholic. Again this is very pragmatic: it reminds you that readdiction is always possible, it keeps you from letting your guard down even years into recovery. It also means the vigilance is eternal, exhausting.
Everyone who has grappled with addiction agrees that sobriety is a better way of life. But that doesn't mean AA is the only way to get to it, or the most pleasant among the options. "We thought we could find an easier, softer way." We could not, but some others can, and those who can will have an easier, softer time than we do in here.
My apologies, then. I do understand your point. I may have a bit to say, but you know, that ol' Tradition Eleven, and whatnot. Just be aware that there are others, on their own journeys.
I found that using was exhausting. I don't think that having addiction under control, is exhausting at all. Others have far worse crosses to bear, and all the good things that have come, have more than made up for any issues that I may have, as a result of a .44 magnum, pointed at my head, all the time. It's definitely "endless," but so are many things.
I've found that the Fourth, Fifth, Sixth, Seventh, Eighth, Ninth, and Tenth Steps are about losing the shame of of active addiction. In fact, their most practical use, is to have us become so comfortable with our pasts, that we can routinely recount them, to people looking for help. What It Was Like, What Happened, and What It's Like, Now.
That "What it Was Like" part is real important. If we're not comfortable telling some shaking newcomer that we used to rob church poorboxes, then we're kinda useless.
But what do I know? I'm just some Internet rando. I wouldn't have even written this, if this story hadn't been shoved to the back of the broom closet in record time.
I don't know much about AA, but whatever the case may be, I wonder if measuring effectiveness based on success rate numbers is all that meaningful. That is, does it makes sense to view it in medical terms? While it seems to be the case that some are more prone to alcoholism than others based on genetic factors, whether one actually becomes an alcoholic is not a matter of deterministic factors like a disease might be. There is a huge component of assent. Thus, it is related to character, virtue, and habit. Temperance is, at bottom, a matter of "orderliness" (vs. disorder) of the faculties and appetites moderated and ruled over by reason and a will that conforms to the truth as known by reason. This entails restraint, moderation, self-denial, and the ability to suffer well when illicit desires surface, such as the desire for a drink when you know, rationally, that you ought not drink, that it is harmful and wrong to do so. Indeed, for all of us, to be able to suffer is essential to being a good human being; those who cannot suffer cannot live well and cannot love well. Practices of self-denial, like fasting, and self-sacrifice help cultivate this self-mastery. Sacrifice is always that of the lower for the sake of the higher.
My point: perhaps success rates are to be understood also in light of personal commitment, understanding, and what makes commitment possible. Most people struggle with bad habits and addictions of all sorts and sizes. Alcoholism is just one of them and one that happens to be conspicuously destructive. Perhaps the "success rates" for the others are comparable because most people simply prefer to keep the bad habits and avoid (or lack the basic knowledge of the need for) the suffering they must endure to be made free of such things. Why assume alcoholics and alcoholism are any different than most people and most habits, mutatis mutandis?
> Why assume alcoholics and alcoholism are any different than most people and most habits
I think it'd be a mistake to think there's no difference between physiological addiction and "most bad habits" since most bad habit's don't have a risk of killing you when you simply stop doing them (https://www.psychreg.org/cold-turkey-alcohol-dangerous/). I think looking at addiction in medical terms is far more appropriate than looking at it as a moral failing or as a lack of desire to change or an unwillingness to "endure suffering" (many addicts I've known were certainly no stranger to suffering and sacrifice).
Treating addictions like a medical problem makes it harder for non-addicts to look down on people afflicted with them so a lot of people will resist the idea and continue to think that it's nothing more than a personal shortcoming and that dealing with the problem should be no harder than avoiding any other undesirable behavior. I really don't think telling people that if only they were more orderly and had a stronger character that they wouldn't have an addiction is true or helpful.
Doctor sells vulnerable people a dependence on his brand of snake oil, “debunks” one of the valid, well-studied, and free paths to recovery; NPR unquestionably parrots hot air on their weekly hot air power hour.
The sad truth is that we just don't know how to treat addiction very well. We don't even define "success" well. Is it sober after 3 months? 6? 1 year? 5 years? 10? Does that still count if one has to continue to get treatment/go to meetings/take medication/etc.? There aren't a lot of good, consistent answers. AA isn't without its faults, but it is readily available, anonymous, and free (that's a big one -- too many anti-AA people are selling something).
"Little is known about the spiritual mechanism underlying the relationship between involvement in AA and subjective well-being. The aim of this study was to test the beneficial role of existential well-being in the indirect relationship between involvement in AA and the subjective well-being in a sample of individuals with alcohol dependence from Poland. In the literature, there is a lack of research regarding predictors of subjective well-being among participants of self-help groups. Most researchers have focused on abstinence duration or reduced drinking as a recovery indicators. Contrary to most recent studies, subjective well-being was used as a recovery indicator instead of abstinence duration or reduced drinking. It is due to the fact that abstinence is not the same phenomenon as sobriety. Abstinence exclusively refers to the symptoms of the disease, while sobriety is something deeper, manifesting in emotional and mental dimensions, being an expression of sobriety [16]. Existential well-being [17,18] is another construct than subjective well-being [19], but both of them are strictly related. It finds reflections in Seligman’s [20] model of happiness approaches for a meaningful and purposeful life as one of three ways to achieve subjective well-being. Additionally, in Frankl’s conception [21] finding meaning in life facilitates fulfillment and satisfaction."
read more:
"The Beneficial Role of Involvement in Alcoholics Anonymous for Existential and Subjective Well-Being of Alcohol-Dependent Individuals? The Model Verification"
For anyone who does not like AA - definitely check out "Smart Recovery". Many find it much better and it there is a similar comaraderie component but much more science based and no religious aspect.
12-Step Programs have been shown to work within academia.
12-Step Programs are believed to work by most doctors and people in the industry.
12-Step Programs work on a theoretical level, it fits within the frameworks on addiction.
12-Step Program are said to have saved their lives by many people in them (antidotal)
The dirty secret why these contrarian articles keep coming out (Or linked back to [2014]) is all addiction programs fail at massive rates. Over 95% failure rates are normal for all 'solutions' depending on how you measure it.
It's not good to know this. It will increase your failure rate.
If you go down this road you will probably use a mix. Psychologists, rehab, 12 step, drugs like Naltrexone. You might end up on 12 step or it might come first you leave and end on psychologists. Or you might go back. Or around the loop many times. Many end on willpower, after other solutions like 12 step help get them there.
Whatever works.
12-Step Programs also have the best stories. That alone makes them worth popping into. You'll see Fight Club in a different (better) light.
Yes, 12-step programs have issues, and a big one is the whole “higher power”/god thing. Maybe this is more of an issue in the USA which is far more religious than other countries. But even that is addressable for atheist 12-steppers. I should know - I am one.
If you are interested in a different take by a psychologist expert in the field, check out the writing of Dr. Patrick Carnes.
https://www.drpatrickcarnes.com/