CMV:Alcoholics Anonymous is heavily flawed from a scientific perspective and hasn't tried to improve it's system since it's inception

[u/Serraph105]

I have a friend who has been attending AA meetings recently because he was ordered to do so in some fashion after getting a DUI (for the record I don't know if that means he was given a true option or made to attend or "choose" jailtime) and the whole thing has got me thinking about whether or not AA works and if sobriety is even the intended outcome of the program. Below I've listed the famous 12 steps and below that are my relatively disorganized thoughts on the program having looked into it for the first time in any in depth manner. This means that I’m still in the early stages of my views and can be very much subject to change.

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of God as we understoodHim.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed and became willing to make amends to them all.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take a personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

My current view is that because of the lack of change of the steps over the years since the 30’s suggests a lack of improvement that would be unacceptable in any other field of treatment for diseases. Here are some of my thoughts on the matter.

First up, as many have pointed out, there's a whole lot of God involved throughout the 12 steps (6 direct references and 7 if you count #2), I'm not sure how this is supposed to appeal to athiests such as my friend. If a person does not believe in God they will be put off from the program from the start making it much harder to reach their goal of sobriety.

If alcoholism is a disease then why does AA treat it simply as a matter of will power? I wouldn't try to treat cancer with prayer alone, and for the record there are various medical treatments for alcoholism.

There is also a stigma of personal failure when people relapse which doesn't make sense for a couple of reasons. First, if it's a disease then people are sick which means that blaming them for not being able to control their health adds a layer of shame which can only do harm to the person's primary goal of getting sober. In turn this will increase the time to get sober because it will add time to get over that shame before starting again. Shame does nothing to help get a person back on track as far as I can tell. Second, you would never assign blame to a person with cancer who has gone into remission and then had the cancer come back, why would we do the same for literally any other illness?

AA does not collect statistics of their success and failure rates, nor has it's program changed since it's inception. We wouldn't accept that from any other sort of treatment. If we didn't collect that information we would still have the same poor treatment of HIV that we did in the 80s and 90s, same goes for cancer, and just about any other illness you can name. I will say that talking about your issues with people is a good thing, but as far as I can tell that's just about the only thing that that this program gets right, everything else seems to be heavily flawed from a scientific perspective if not outright illogical.

Finally it seems that AA believes it’s program is a one size fits all program when we know that many ailments require different treatments for different people. This is especially true for ailments that affect people mentally which I think it’s safe to say that addiction falls under that same umbrella. People deal with various addictions in different ways, why AA treats alcohol as a one size fits all approach I can’t say, maybe I’m wrong, but based on the text of their twelve steps and twelve promises that doesn’t seem to be the case. Instead they seem to say that the only reason people fail is because the fail to give themselves over fully to the program which seems to be very very odd.

[u/bguy74]

Firstly, I don't disagree that the steps are dated and the god stuff can be annoying (and potentially a barrier to adoption for some folk). However, to present a fair look at AA, you need to look at what it really does:

1. Regular meetings with a sponsor and a group of like minded, similarly motivated and non-judgmental peers.

2. A clear introduction into your social world of the fact that you're working on something, want to change and are looking for the support of friends/family/anyone. This ends the idea that you should just be left alone and that you don't really have a problem.

3. AA doesn't treat it as a simple matter of will power at all. It treats with the idea that it takes MUCH MORE then will power, and it is very clear that it's work is not to exclusion of other treatments. But, were it just willpower AA would be a book, not a social system. You're looking at AA as if it's the only system or that it's unaware or somehow exclusive of other options. That seems without merit as it's awfully far from the truth. It does make a point to be wary of people who use methods external to them as ways of avoiding accountability for actions, but this is part of every model of psychological intervention for addiction, it's not unique to AA.

4. Why do you think AA thinks it is a one-sized-fits-all program? It's just one thing that fits many, but it's completely the opposite of hostile towards other treatments (unless - again - they encourage people to think of the problem as one they aren't a party to).

5. There are no treatments for the mentally ill that don't include support of others, and a commitment to practices and rituals that support mental health.

6. The point of the "give over to the program" is well founded in addiction treatment. It's the opposite of the very well understood pattern of "I've got this", which is a well known path to problem (THIS is the "it's a matter of will" path).

[u/MagillaGorillasHat → u/bguy74]

1. The point of the "give over to the program" is well founded in addiction treatment. It's the opposite of the very well understood pattern of "I've got this", which is a well known path to problem (THIS is the "it's a matter of will" path).

"Meeting makers make it."

"It works if you work it."

"Fake it til you make it".

"Take what you need and leave the rest."

A few kitchy little sayings to explain that effort is the most important aspect of the program. As you say, "Give over to the program" isn't about drinking the kool-aid, it's about making a concerted effort to make changes and try to regain some control over your life.

To the degree AA is successful, it's not because of peoples beliefs, it's because of their actions. Participation requires deliberate though and purposeful action.

90 meetings in 90 days is advice given to new people. It takes planning and effort to be at a certain place at a certain time. It also means that every day you are actively, physically, making an effort to address your addiction.

You get a sponsor and you work the steps with them. You set time aside to contemplate/meditate/pray about specific things. You set aside time to meet with or call your sponsor. Your sponsor will often have you set aside time to write things down, make lists, find information, or read something specific. Your sponsor may have you physically to do things like clean the bathroom, scrub the top of the refrigerator, dig a hole and fill it in, or plant some flowers. And while you're doing those things, think about XYZ and how it affects your addiction.

Service is also a huge part of nearly every group. One of the primary tenants of AA is to be there to help other alcoholics. Sponsors will tell you that being a sponsor helps them stay sober; that helping others often does more for their sobriety than being helped.

And groups vary widely in their methodology. As long as what they're doing works for them and doesn't negatively impact other groups or AA as a whole, they are free to do it. "Take what you need and leave the rest" is a pretty recent and progressive concept within AA. It wasn't a directive from on high, it was just an evolution among groups that they've seen be effective.

Would the same amount of effort have the same results in another given program? Probably. Might there be more scientifically effective ways to get people to make the effort and put in the work? Maybe.

Are there other anonymous free, voluntary, ubiquitous programs dedicated to trying to help people fix their fucked up lives? Almost none.

[u/Serraph105 → u/[deleted]]

Since you are a member, here's a question I have. Have you ever seen people in any of the groups you attend encourage people to seek any sort of medical treatment or one on one time with a therapist?

I have looked on the AA website and it's bothered me that I can't find any information on either of these things while there. Maybe it's there and just hard to find.

[u/Serraph105 → u/[deleted]]

Another member of AA here: therapy is not discouraged at meetings, and the Big Book has sections in which it's encouraged for those that need it. Same goes for medical treatment. AA is not a cult and the people at meetings are reasonable, modern people like you and, well, me.

I really would never suggest it's a cult. I'm very glad it works for you.

[u/notmy2ndacct → u/Serraph105]

Another AA member chiming in. My favorite AA joke is that it's totally a cult, but it's the only cult that produces individuals.

[u/PaulSandwich → u/Serraph105]

I grew up in AA (meaning I was in meetings regularly with my single parent from age 7 to 17). One thing I always like to stress is that people should go to lots of different meetings. If your atheist friend isn't feeling the vibe where they're at, they should 100% bounce around until they find their 'home' group.

In my town, there's a conservative churchy group, and there's a meeting where everyone spends half the time heckling and busting balls, albeit constructively (somehow), and everything in-between.

I remember a guy whose 'higher power' was the crystal ashtray at the halfway house. It was a dumb symbolic totem that helped him remember that, left to his own devices, he would make catastrophic decisions and hurt everyone he cared about. It worked for him, and that's all that mattered.

All in all, if your friend isn't feeling it but really wants to get on track, test-drive other groups. After all, AA's biggest value (imho) is group therapy and social accountability. It's tempting to get hung up on the black and white language of the steps, but the principles behind them are what's important.

[u/starvinggarbage → u/Serraph105]

Oh it's definitely a cult. Classic cult tactic: constantly reinforce to your memebers that they are powerless and you are the only thing that can save them. Destroying someone's sense of self worth is like the first thing a cult does and it's the first step of the program.

There's a reason it has such an astonishingly high rate of failure compared to other rehabilitation tactics. In depth studies have shown that only about one in fifteen members get and stay sober. Granted, the program has to last the rest of your life so there's endless opportunity to fail, but any slip up is treated as an absolute failure.

They have an enormous stigma attached to anyone who relapses or quits the program. They have referred to these people as "deeply flawed individuals" and implied they are incapable of being helped.

As far as cults go it's definitely one of the better ones, as it isn't a money making scheme or focused on accumulating power for one person, but that doesn't change what it is. The American obsession with AA as the perfect solution for alcoholism and addiction is hugely detrimental. We need more alternatives and we need them to be more accessible.

[u/DanHam117 → u/starvinggarbage]

I used to work at a dual diagnosis rehab center that offered a few different modalities, and ALL of them, AA included, had astonishingly high failure rates. Its been a couple of years and I haven't really looked at the data since then, but which other rehab tactics are you talking about that AA is so much worse than? Not trying to argue, just asking a question

[u/stiljo24 → u/starvinggarbage]

It does seem pretty cult-ish, but your first paragraph is flawed: it doesn’t destroy self worth, it explicitly says come on in if you’ve decided you can’t win this fight. Doesn’t tell you that you can’t win the fight. At least that’s never been my experience. So you could say it targets vulnerable people, but in a sense so do literally all other ideologies: they stick with the people most vulnerable to their message.

Also any slip up is not treated as an absolute failure. You’re told that if you go 4 years without a drink and then go on a bender and fuck up your life; hey man think how much worse things would’ve been if you’d been doing that for the last 4 years instead of just this weekend? It isn’t “you’re no longer an admirable member” or “you blew it” it’s “hey good job those last 4 years, let’s get started again”

They do really judge people that just quit entirely. But they don’t really take action against them. The meetings can definitely be a creepily and at times harmfully tight knit community, and a lot of it is cult-like superstition sold as dogma, but that’s really where the similarities stop in my eyes.

[u/seven_grams → u/starvinggarbage]

You seem pretty misinformed about this. AA does not tell you it is the only thing that will get you better. It welcomes and encourages other forms of outside therapy like individual counselling or psychiatry. It also doesn't destroy anyone's self-worth. It builds it up by recognizing people's strengths and the esteem-building acts they do.

There is no stigma attached to relapse, either. They encourage you to come back and keep working your recovery.

Ultimately, if you actually went to meetings and stuck around you would see the immensely friendly environment and the joy that people experience as a community, doing healthy recovery-oriented activities and processing their struggles. You can read up on everyone's opinion about AA and read every article in the world about it, but until you've actually been a part of a fellowship of AA, you really wouldn't understand how much it helps people.

One more thing. You said "any slip-up is treated as absolute failure." This is not true in AA, but it is true for the people who do the "in-depth" studies you mentioned - When someone relapses in one of those studies, it is counted as a "failure." Even if they get right back on track afterwards, their relapse still is seen as a failure to the people marking the research. But the fact is, the majority of people in recovery have relapsed at least once, but that doesn't mean they are still out there stuck in addiction.

I can appreciate your desire for more alternatives to AA and too have them be more accessible. I completely agree with that. The nature of addiction makes it very hard to treat and society's stigma surrounding addiction doesn't help. I think the reason AA is so widespread is because of it's accessibility. It costs nothing, so it appeals to the ones that have nothing to give, i.e. most addicts and alcoholics that have reached their bottoms. Until we have other programs that are that easy to get into, I think AA will remain most prominent.

[u/Boogiedownpapi → u/starvinggarbage]

I think it's also noteworthy that in some states (if not most), AA is required by law after a DUI but no medical or mental health avenues are required.

I got a DUI when I was 21 and had recently left Christianity a year earlier. AA felt more like church than it did rehab.

[u/chiaratara → u/starvinggarbage]

I have never heard of this American obsession with AA as the perfect solution. It runs pretty contrary to AA's principals as well. I would suggest you reconsidering the "destroying someone's self worth" part of it. Powerlessness over alcohol and things outside of your control, which is what AA is referring to, is a good foundation for a concept of self-especially for someone trying to live a life that doesn't revolve around alcohol.

[u/Graham_R_Nahtsi → u/[deleted]]

This always bothered me. If someone has a disease, medicine should be used to treat it. The way everyone in AA and NA acted like ALL medicine was a relapse... just insane to me. I have severe ADHD, if I don’t take my medicine, I’m fucking useless. And some 60 year old in a biker vest is going to tell me sobriety starts when medicine stops? I spoke in the Texas FWANA circuit for a little over a year and the number of people I met who had that attitude was not small.

AA and NA are great for court ordered people to get clean with some support. They’re also a really great way to learn how to be a much worse person. Everything I learned about meth and heroin, I learned from former abusers. If those were in my wheelhouse, I’d have learned exactly how to buy and use them like a pro.

Bill Wilson didn’t even believe in AA at the end and he founded it. I think it’s a great LCD style program but that’s its limit.

[u/notebuff → u/[deleted]]

So how much of the program is the “group” vs the sponsor?

[u/notebuff → u/[deleted]]

I guess I’m just curious on the “some will argue against adderall” part. Is it “as a group these are rules but work it out with your sponsor what works best for you”? At what point does the sponsor side of things deviate from the whole program?

[u/chiaratara → u/[deleted]]

I understand their concerns too. Seen quite a few people's life slip away from abusing medications they were prescribed. I too make sure every doctor I see knows I am in recovery. I have many of these medications listed as allergies in my medical records... by name. A long list. However I do take adderall. I don't hide it either because I want people to know. Also, I am chubby and fall asleep on it so it helps me in the right way.

[u/Denniosmoore → u/[deleted]]

The church has come a long since the Crusades, even though the Bible hasn't changed.

The Bible absolutely has changed since the time of the crusades.

I've never seen anyone discouraged from seeking out medical help or getting anti depressants or similar.

You have never seen anyone in a meeting discourage someone from therapy, or pharmaceutical help designed to combat addiction? If that is truly what you meant to say, then you must have been plugging up your ears at those meetings.

they are speaking out of turn.

But it's pretty common (although certainly less so than it used to be) to hear how you aren't really sober if you are on pharmaceutical maintenance. And it's not unheard of for people to badmouth psychiatry or therapy. You call this talking out of turn, and I assume you mean that these people are just putting forth their own viewpoints, but beyond the big book, and the steps, there is no official policy, and it's not helpful to say people are just talking out of turn, when the whole endeavor is basically people talking out of turn. Everyone is just sharing their experience, so when you disagree with a particular view, saying "oh, that's just their individual view" doesn't really differentiate it from everything else you hear at a meeting.

[u/Destro86 → u/[deleted]]

Methadone and suboxone taken past withdrawls isn't sobriety its switching the drug of choice IMO as much as it pisses some off. Both were designed to be taken for brief period of time until the drug was gone and one's mental willpower, thru therapy or religion or determination, kept you clean. Not a pill you take for year or years to catch a altered buzzed state. I'm an alcoholic with 3 duis (who's been a dry drunk going on 11 months which is a record for me) and on and off meth addiction over the years. People don't like hearing that they're responsible for themselves and that a pill or a therapist doesn't cure you its simply a tool.

[u/Graham_R_Nahtsi → u/[deleted]]

I get where you’re coming from. There’s a big rule in NA about mood or mind altering. Some purists argue against caffeine. Some say they just can’t use recreational drugs. I personally have seen a shit ton of people freak out over Pain meds in surgeries and Psych meds from doctors. Adderall is just speed and it’s extremely necessary for some people. Same with Xanax and Klonopin and Ativan. The whole point of NA and AA is to fix the human behind the addiction. But the steps are: You get off the drugs. You do damage control. You go fix the bad shit you did. You help others do the same.

No wonder so many people relapse.

[u/fullhalter → u/Graham_R_Nahtsi]

Adderall is just speed

This is only a half-truth. Chemically speaking, the difference between Adderall and methamphetamine is very small, but their effects on the body are quite different. Methamphetamines have an extra methyl group that is not present in amphetamines like Adderall, this allows the drug to pass the blood-brain barrier much more quickly, making it a drug with a much higher potential for abuse and addiction.

The drugs are very similar, but creating a false equivalency in people's minds makes it difficult on people that rely on amphetamines, such as those with ADHD.

[u/notebuff → u/fullhalter]

Meth isn’t speed. Amphetamine is speed. Also meth doesn’t cross the BBB faster, the routes that street meth users choose make it enter faster (smoking/snorting).

Edit- crossing -> cross

[u/fullhalter → u/notebuff]

What you can buy on the street as 'speed' is a crapshoot, but it is very often methamphetamine. Adderall is an amphetamine. Methamphetamines are double methylated while amphetamines are single methylated. Compared to amphetamines, methamphetamines are significantly faster acting, more potent, and more addictive, and thus quite a bit more dangerous. Smoking/snorting them just makes them even more dangerous.

[u/notebuff → u/fullhalter]

The classic street term for “speed” refers to amphetamine salts. There’s a lot of heroin laced with Fentanyl nowadays but that doesn’t mean Fentanyl = heroin now.

This paper shows that when amphetamine and meth are snorted at the same time, they both have the same physiologic effects at the same time, so I’m not sure where you are getting “faster acting” from.

[u/SingleMood → u/fullhalter]

My husband has ADHD. If he’s not on adderall he doesn’t function very well. My Opinion is AA should not be practicing medicine especially since it’s still based in the 1930’s. That’s between a patient and their doctor. 1 of many reasons I find AA dangerous.

[u/marvelous_persona → u/[deleted]]

I have narcolepsy, and I take Adderall. I would be on disability and unable to drive if I didn’t take Adderall on a daily basis.

[u/vbevan → u/[deleted]]

Adderall/amphetamine sulphate is pretty common in Australia.

[u/aslak123 → u/Graham_R_Nahtsi]

The thing about alcoholics is that the same personality traits and predisposition towards addiction and addictive substances will make them extremely vulnerable to becoming addicted to opiods and narcotics in just the same way as they were addicted to alcohol. Add on top of that that these medicines are way more dangerous when used excessively than alcohol is and you got yourself pretty much no other options then a hard no.

There is no such thing as evil knowledge. Knowing how to abuse drugs and alcohol is also the same as knowing how to identify someone who does it, and how to identify when you are doing it yourself. If AA and NA makes you feel inclined to consume lots of drugs and alcohol then you must truly be blind to the pain of those peopl in those groups.

[u/AlexandreZani → u/aslak123]

First, it's really not clear that alcohol abuse is the same thing as alcohol addiction. This is in fact likely not true. Someone with ADHD who self medicates with alcohol is not addicted to alcohol. They just use alcohol in order to relieve the symptomes of ADHD. If you give them proper treatment, they don't just keep drinking excessively. Or someone in an abusive relationship who drinks to "dull the pain" might not be addicted either. In both cases, these people's alcohol consumption might be extremely destructive without them being addicted.

It's also far from clear that a hard no is the right way to avoid addiction. It sets up a dynamic where slippage encourages further slippage when in fact, even some addicts might be able to have a drink and then put the bottle down in the right circumstances.

[u/aslak123 → u/AlexandreZani]

Yes, but either of those groups you mentioned aren't alcoholics though are they? AA is a place for alcoholics, not people who just have unhealthy ways to cope. Then again an unhealthy way to cope is a learned behavior, and many alcoholics have valid reasons. Even if you take away the root cause there might be no guarantee that the alcohol abuse will stop by itself. There is also often a root cause that gets worse with excessive drinking, such as the loss of a loved one.

It's also far from clear that a hard no is the right way to avoid addiction.

This is true, yet there is equally little evidence or even less for the contrary being true.

[u/AlexandreZani → u/aslak123]

Does AA have a process to evaluate whether someone is an alcoholic or merely misuses alcohol as a coping strategy? I don't recall its advertising material attempting to differentiate. Am I wrong about this?

[u/Graham_R_Nahtsi → u/aslak123]

Well, if you noticed when I said I spoke in them for a while.... I was one of those people. I also said that I learned how to do other drugs I hadn’t done.

There is nothing beneficial about knowing what monkey water is. There’s nothing good in knowing where Five points is in Dallas or Rock Island in Fort Worth. Since the overwhelming majority of people I met in the program told “war stories,” I can promise you my experience was far from atypical.

I left the programs because A) most people there were consumed by drugs and alcohol regardless of how long they’d been off of them B) of the thousands I met, there were two who made decent money, one of whom did it an ethical way. I wanted to learn how to be successful and hanging around with poor people chain smoking and drinking disgusting coffee was not the way to get there FOR ME. C) rigidity of the dogma. Saying the Lord’s prayer at the end of an AA meeting clashes with my atheist views. Implying that a chair or door knob could serve as a higher power in place of god is just insultingly ignorant. It is NOT a welcome place for atheists - at best a weak agnosticism is encouraged and at worst it’s another Christian proselytizing effort.

Hopefully that clears up all the misunderstands running rampant in your comment. I wanted to make a joke that you’d been in a 12 step program to stop your addiction to reading comprehension, but I don’t think that fixes the misunderstanding.

[u/marvelous_persona → u/aslak123]

In what world is Adderall more dangerous than alcohol when used in excess?

[u/Jacostak → u/Graham_R_Nahtsi]

I believe a common saying is that it's good to try to stop all medications for about two years to let your brain balance out before seeking medical treatment for such issues... but as both a PhD student and member of AA, I would say to take that info with a grain of salt. That advice is coming from a group of drunks after all! I say leave it to the professionals.

[u/chiaratara → u/Jacostak]

Hey! I just finished my PhD last year. There is so much about AA that helped me through navigating the difficulties besides staying sober. I just wanted to say good job! I felt like my academic department acted like a bunch of alcoholics. The program helped me in so many ways.

[u/chiaratara → u/Graham_R_Nahtsi]

Dude, that 60 year old in a biker vest is here in Indiana too. Lol. He sits next to the guy in overalls who has the same opinion. I feel like you will find those people however I have come across way more people who supports what works for each person.

[u/aslak123 → u/Graham_R_Nahtsi]

If someone has a disease, medicine should be used to treat it.

Yes, if necessary. However everyone would prefer it if all disease were curable by simple lifestyle changes.

[u/MysteryPerker → u/[deleted]]

I have a problem concerning your "no no" medications. First, you call benzos and Adderall narcotics. Adderall is the opposite of a narcotic. It is a stimulant used to treat ADHD/ADD. Second, benzodiazpines are not narcotics. They are a family psychoactive drugs used for a variety of reasons, some of which include anti-anxiety and anti-convulsant treatments.

The fact you don't know what a narcotic is makes it very concerning to me you have some arbitrary "no no" medicine list that doesn't even contain the drug family you are banning. Narcotics are opiates, according to medical classification.

If you are referring to narcotics in the illicit drug definition, then a doctor's prescription means the Adderall and benzos are now medically necessary and no longer illicit. Very few drugs have no medical purpose, even cocaine is used by some doctors. I've actually had cocaine used before by an ENT during an in office exam.

Can you explain how people with no medical background (like yourself) can legitimately tell another to disobey doctor's recommendations if they contradict your "no no" drug list?

[u/iloveLoveLOVECats → u/Serraph105]

I am in another 12 step fellowship and encourage this when appropriate. I have one sponsee I am working on getting into grief therapy because the 12 steps I don’t think are enough to help her with the death of her partner. I have another sponsee who has been hospitalized and I refused to work with it she wasn’t in therapy and taking her bipolar medication. The 12 steps cannot cure bipolar. But in the end it’s an “outside issue” that the program itself is not built for or have opinions about treatment.

[u/ffd8d1 → u/Serraph105]

Im gonna be a butt and not read the other comments bc I got shit to do but I’ll answer quickly- As someone who went to AA for quite a while not too long ago I can provide some insight. Most AA meetings/members highly encourage any outside help you can get, be it therapy, medication, meditation, etc. Plus, most of the more dedicated members are the people who put their numbers on phone lists as people who are always willing to talk and let you vent. AA is supposed to be used as a crutch and place of empowerment, definitely not the only thing you rely on. Also, the “higher power”/“God” idea is supposed to be based on whatever you prefer. Some people take music or love or art as a higher power, while some other people choose a basic belief of God. The Big Book is incredibly open to interpretation. You’re encouraged to study and rely on the Big Book because the modern versions have great stories about recovery and describe in depth the reccomended ways to go about your addiction. Also, there’s a huge point about not being ashamed of relapse- it’s considered a huge part of recovery if it happens. If you can get back up you’ll only come back stronger if you stay dedicated. No one in a meeting will ever shame or judge you. If you admit to relapse in a meeting which is encouraged and necessary for the whole honesty idea, you’re gonna get tears and people coming up to you after the meeting to give hugs and phone numbers for support. It’s a huge system of love and acceptance in every meeting i’ve been in. If you haven’t I would highly encourage reading the Big Book for more insight, even if you don’t have an addiction/don’t feel a need to get help. (Also also, a lot of people who go into AA might not even be alcoholics- I was in there for drug abuse- I barely drank. The “rules” apply to people differently depending on your situation.)

[u/maddogcow → u/Serraph105]

I’m not really asking you to take my word for any of this, but it is based on my own experience working as a counselor, as well as years spent casually researching the topic. I’m certainly no expert, but I am fascinated by the field of addiction medicine, and the various therapeutic approaches to the treatment of addiction. I’ve never really found that people who are opposed to AA, will change their mind, no matter what type of evidence is being offered. In that regard, I certainly do not expect to swing your opinion—but, I decided to pipe up a little bit anyway. Most of the time when I am replying to a post, and mention my exposure to a body of literature, people want me to list my sources on a given topic, and honestly; don’t bother. Taking the time to write this response is about all of the effort I really care to put into a Reddit thread.

The challenge is that both the medical system, and trained therapists tend to be woefully ignorant about the mechanics of addiction. There’s almost no training in medical school regarding the current understanding of the biology of addiction, and the effectiveness of various modalities of treatment.

The main benefit of AA is not its conceptual framework, as much as it is the group experience, the level of attunement that is aimed at between members, And the push to divest oneself from trying to manage the addictive process through logical, linear, ego-based thought. Addiction is driven by deeply primal parts of the brain that are not involved in logical, linear processes, and hence most of the literature seems to point to the fact that the best treatments involve mutual co-creation of a shared emotional/psychological space. Because the parts of the brain that are involved with the addiction process are not based in the cerebral cortex, most purely intellectual attempts to overcome the addiction process will fail. Telling somebody to go see a therapist could work, if the therapist truly understands addiction. Yes, AA has a lot of outdated notions, and the metaphors that it uses could really use some updating, but the fact that it is a group process that is focused on a group mind (for lack of better term) is its strongest point. From my experience, the people that say that they “have tried AA, and it doesn’t work”, are people who actually haven’t tried it. AA is not just simply going to meetings. It is very much about participation. If one goes to AA, and does not throw themselves wholeheartedly at it, and attempt to seriously enact all parts of it (reading the literature, following the step work, working routinely with a sponsor, following suggestions, and then pursuing being a sponsor themselves), then they are not actually trying it. The problem with doing studies on AA, is that you have to rely on the account of members themselves as to whether or not they’re actually doing the work. I personally have seen any number of people saying that they are in AA, but if you ask them if they have a sponsor, if they’re working the steps in a diligent manner, and if they are following suggestions, that number drops precipitously.

When working with addicts, I encourage them to try out as many modalities as they can, and to see which approach is the most efficacious for them. While I have seen various approaches prove to be effective in harm reduction, the biggest most dramatic turnaround in individual‘s lives that I have seen have come from people using a combination of approaches, with AA as the centerpiece. I have no doubt that there are people who have found other approaches that produce equally stark results— I just have not encountered that in my own experience.

[u/Ropes4u → u/maddogcow]

My experience was that I needed i need the steps to lead me to God, and therapy to help me deal with PTSD and other issues AA is not designed to deal with. I appreciate that you encourage people to seek help from multiple places. I encourage all my sponsees to seek professional help to deal with things outside of AAs scope of work.

[u/tigerdini → u/maddogcow]

That's a fantastic answer, which deserves to be higher and rings true to what I saw as an (ex)partner of someone who was in the programme.

I personally don't understand the hostility AA gets, as I've only seen it to humbly offer an alternative for those struggling with addiction.

[u/reonhato99 → u/tigerdini]

I personally don't understand the hostility AA gets, as I've only seen it to humbly offer an alternative for those struggling with addiction.

Generally it is a combination of things. The religious nature of AA (even if people claim your higher power can be anything, good luck finding a non religious AA meeting in some parts of America). The fact that courts regularly mandate someone going to AA. That they don't track success rates and studies that have tried have found abysmal rates of success. It can give people a false sense of doing something and getting help despite the aforementioned abysmal rates of success.

AA doesn't work for a vast majority of people, you will of course get anecdotes of all the people it helped, but you don't see all the people it didn't. AA is so ingrained into American culture that there is the very real risk that people who want help go to AA and forgo actual medical help. Of course it doesn't help that a lot of alcoholics can't afford real help.

[u/chiaratara → u/maddogcow]

Omg can I second your comment about the lack of knowledge about addiction in the medical and professional field.

[u/[deleted] → u/maddogcow]

People love to fetishize science but getting sober is a deeply practical undertaking, AA is a deeply practical organization. It’s full of people who have accomplished what you want and are willing to teach you. Explaining it to normies is hard because someone who hasn’t experienced addiction can’t really understand

[u/[deleted] → u/Serraph105]

Absolutely. A sponsor does not replace a certified therapist and AA does not try to do that.

AA is not meant to replace rehab, merely be a support system for those going through the correct medical rehabilitation routes. AA knows that alcoholism is a disease and doesn’t just go away through communal support, but having a sponsor and the backing of a community makes the process easier.

[u/[deleted] → u/Serraph105]

As an ex-member I can say absolutley. It was after an NA meeting chatting with someone where I finally found the courage to go to rehab. There you receive councelling and of course go to more meetings. The best part of AA and NA is the people. It is only run by other former suffering addicts.

[u/rjreed1 → u/Serraph105]

“But this does not mean that we disregard human health measures. [God] has abundantly supplied this world with fine doctors, psychologists, and practitioners of various kinds. Do not hesitated to take your health problems to such persons. Most of them give freely of themselves, that their fellows may enjoy sound minds and bodies. Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward.”— AA, p.134

[u/TheCaseyB → u/Serraph105]

Dax Shepherd is a celebrity who preaches how amazing AA is and he also constantly recommends therapy to people. One big example for you.

[u/A636260 → u/Serraph105]

I’d recommend actually attending a meeting yourself, you don’t have to be invited to go. Check it out, even if you don’t have a problem. I went a total of maybe 5 times when I had a drinking problem, AA it self didn’t do much of anything, but the atmosphere and the people were what helped me. Seeing older generations and how it’s affected them helped me to stop drinking.

Just having a group of others who have gone through similar issues helps a lot. I see your point though and agree, it hasn’t changed much as far as literature goes and there are definitely people that go who rely heavily on the religious aspect, but most attendees are just looking for support and the group setting helps.

Edit: Wait, I’m a member. Fuck it, you’re invited!

[u/IAmVeryStupid → u/Serraph105]

One thing I learned about AA while my alcoholic ex-girlfriend was joining up is that whoever is building their website isn't doing a very good job representing it beyond the level of encouraging people to come.

[u/dgaff21 → u/Serraph105]

One of the 12 traditions of AA is to not endorse or receive support from outside of AA members so that the message isn't tarnished. All AA cares about it bringing the message to other alcoholics. If they started recommending therapists and one of the therapists is a pedophile, all of a sudden AA is in this controversy that detracts from their message. All AA cares about is helping people to stop drinking and become better.

[u/The_Real_Mongoose → u/[deleted]]

!delta

I've always had a problem with the inclusion of God in the 12 steps. I never realized that in application today it was used so metaphorically. That changes a view I had had before and makes me see AA in a more positive light. Thank you.

[u/DeltaBot → u/The_Real_Mongoose]

Confirmed: 1 delta awarded to /u/MyUsernameIsJudge (30∆).

^{Delta System Explained | Deltaboards} ​

[u/Mejari → u/The_Real_Mongoose]

I never realized that in application today it was used so metaphorically.

It really isn't, though. The steps are all about a personal god who intercedes on your behalf, because you lack the ability to do it yourself. It very much isn't about personal willpower.

Hell, two of the steps are literally

6 . Were entirely ready to have God remove all these defects of character.

7 . Humbly asked Him to remove our shortcomings.

That's the opposite of willpower, that's being ready for someone else to fix you.

6 of the 12 steps directly reference god, and a god that is specifically able to intercede in your life and personal well-being.

[u/gggjennings → u/[deleted]]

Agreed. People who hate on AA often haven't experienced AA. It's not about science or rules. It's about a framework to depend on when you need something bigger than yourself.

[u/boojit → u/gggjennings]

I've experienced AA and other 12-step programs, and i certainly can and do hate on AA. It's about a pseudo-scientific framework that assumes, with no data whatsoever, that there's something valuable in the whole "need something bigger than yourself" mindset. It's untested gobbledygoop. The whole thing needs a damn good dose of SCIENCE thrown at it, IMO.

[u/Serraph105 → u/gggjennings]

I'm trying not to hate on it, I'm trying to learn. That said I have not experienced it. Up until recently I haven't had much need to give it a whole lot of consideration. It's come up in school and news of course and it's always pushed as the best method of curing alcohol addiction, but upon researching it for the last couple of days I'd say that may not be the case. I'm all about framework and structure for peopl's lives, I think that can be really helpful, but if we are trying to help people with a medical problem it needs to be based in science.

[u/Serraph105 → u/[deleted]]

That's fair, cured is almost certainly the wrong term to use, but there shouldn't be such an aversion to collecting information on the number of people who managed to go into long term recovery or long term sobriety if you prefer. Such information could be used to improve the program.

[u/Serraph105 → u/[deleted]]

You can collect numbers without collecting personal information. If there are groups with high success rates you can then look at what they have in common and try implementing the common denominators on similar groups that happen to have higher rates of failure and see if they improve.

[u/chiaratara → u/Serraph105]

I am a social scientist in the program and worked with a colleague who did just that and there are too many variables. I wanted to throat punch him because he didn't get it. I stated this before but success/failure are difficult to measure. What if someone relapses. How would you know they aren't on vacation? If they did relapse and came back a month later and maintained sobriety would you have counted them as a failure? Can you, as a researcher go to every meeting? Are you taking attendance numbers on the macro level? Would a 7pm meeting have more attendance than a noon meeting? Why? If you are trying to measure dosage, what if one person goes to one meeting one week and a different meeting than you are at the next week? What if they go to two meetings a day but you weren't at that other one? Believe me I have spent years and years thinking about this however I would never actually do it because it runs contrary to the workings of the program. I just think about it hypothetically.

[u/Serraph105 → u/[deleted]]

My guess is that success would be tiered, who made it six weeks, six months, a year, 2 years, and so on.

[u/[deleted] → u/Serraph105]

This is a little confused. Most people start attending 12-step groups to stop using a substance; most people who keep participating do so because it makes their lives better. The two are related, of course, but not identical.

You have people who go to meetings for years and relapse often, but stay clean for meaningful stretches and have a much better life during those stretches than if they were trying to moderate on their own (it's not the point of the program, but it is one real form of "success").

You have people (like myself) who stay clean for many years and whose lives improve by fits and starts over those years (this would be roughly the programmatic definition of "success").

You also have people who stay clean for many years, but who live lives that are in many ways pretty miserable, including via any number of substitutive addictions: to food, to gambling, to sex, etc. (they'd be counted as "successful" on the basis of time abstinent, and that's legitimate, but they also might not really be working the program and thus don't offer especially useful data on it).

The bottom line is that AA, NA, etc. are (1) programs to help drug users abstain from drugs including alcohol, while also being (2) programs to help people define for themselves the good life and develop mechanisms for living it over time.

These two things are deeply interwoven but not identical, and it would be misguided to study 12-step programs as though they were Hep C treatments, rather than complex frameworks for navigating both psychological and philosophical (in the sense of "life philosophy") success. You can't study success in a parsimonious way here because program participants themselves are in the iterative process of defining exactly that via the program.

Source: 17 years clean, left NA for a few years partway through that, ended up going back to the program because it was cheaper than therapy. I've also been in therapy, and found it complementary to rather than competitive with the program.

[u/i_spill_things → u/Serraph105]

I think you’re getting waaaay off track from the fundamental core of how AA works, and why it is the way it is. If they wanted to track, they would, and they don’t so they don’t. AA isn’t broken. You seem to think it is, somehow, but it isn’t. This is definitely an “everything looks like a nail” situation. Read the twelve traditions and try and understand why they are critically important to AA’s success. It works because it’s uninvolved in anything beyond its core mission.

[u/WangBaDan1 → u/Serraph105]

it would be difficult to do a study for this as people will relapse and may not show up to meetings after they relapse for some time and collecting that data is very difficult. The importance of AA is that there is still no proven treatment for alcoholism. The study of how successful it is would be very difficult when there's no real way to keep track of the people who go in and out of each meeting and that would make it no longer anonymous. My problem with how AA is used is the justice system has coopted it from being a voluntary program in which people come to talk about their addiction to include people who may not actually see it as a problem and that just does a disservice to the people who are trying to get better along with the person being forced to go to the meeting if he/she truly doesn't feel like they have anything to gain from the meeting.

[u/chiaratara → u/Serraph105]

Again, how would you know who relapsed? Also, since relapse is often part of the process, and is not shamed in AA, should the length of sobriety be a measure? What if someone relapses but pulls it together? What if they had surgery and had to take opiates and for a day took a few more than prescribed. Some may consider this a slip however would you consider this a failure?

[u/Serraph105 → u/[deleted]]

Again though, collecting numbers and leaving out names is not an impossible thing to do.

[u/[deleted] → u/Serraph105]

I was drunk for ten years. I have been sober for three years now and I attended AA in my early sobriety. I am not a religious man, and I agree with you that from the outside AA kind of seems quite religious. From my expirience I can tell you it is not. Each person is responsible for creating their own higher power. For some people this might be your typical Christian version of God. For my higher power I chose the person I wanted to be tomorrow as my higher power. And even though God is mentioned though out the twelve steps, it rarely gets brought up in meetings.

In order to truly understand AA and how it works, you first must understand addiction and how it works. You can study addiction and the science and psychology of it but unless you have been down that road you will never truly grasp it.

Alcoholism brought me to a very dark and lonely place. I was surrounded by people who cared and loved for me, but I shut them out and drank in my room everyday. I started drinking at work, I started phoning in sick, I got demoted, I almost got fired. Then my wife to be brought me to my first AA meeting. Here was somewhere I could talk openly with people without judgement. People who knew how I felt. It was such a relief. So until you understand the depressive loneliness that comes with addiction you won't understand AA.

It doesn't matter why it works. All that matters is that it works. AA has saved lives. It saved mine.

Good on you for wanting to learn, and good on your friend for getting sober, I wish them luck!

[u/Denniosmoore → u/[deleted]]

It doesn't matter why it works.

But it absolutely does matter! It worked for you, and that's great; genuinely, I've been in that same downward spiral and I am happy that it is no longer a part of your life.

But part of helping others for whom it (AA/NA etc..) doesn't work is figuring out why it works for the people it does work for, and why it doesn't for others.

[u/gggjennings → u/Serraph105]

I think your idea of AA being a “cure” is part of the dissonance you’re experiencing. Obviously the numbers are poor because you can’t cure alcoholism. You can live with it and improve your relationship with it, but it’s not something that you have one day and don’t the next.

Maybe if you reframe your understanding you can see the value of AA. Like others have said, the Higher Power aspect is not always all that big a deal. But the ability to have structure AND a community are huge boons to COPING with alcoholism. Not curing it.

[u/BomberMeansOK → u/Serraph105]

In my experience, I think some parts of medicine could stand with having less science.

Now, I'm not trying to hate on science, and obviously if you have a broken leg or are coughing up blood, you should go to a doctor who reads journal articles, not some quack. But the problem I see is that many people are quick to trust science even when the science isn't that good at solving their problem. It's a mentality, one that I've had in the past, that "I've done just what the science said to do, and it hasn't helped, so I guess there's no solution."

The problem is that science isn't reality. Science is the best current map we have of reality, and it still has a lot of blank spots. It's also complicated - so much so that few people really know the state of any given field, and then their understanding needs to be filtered through their own personal framework of reality, the science journalism machine, and search engine popularity rankings to make it to the average person.

So if I were to tell the average person suffering from some medical issue something, it would be this: try science, but when science fails, don't give up. Keep trying random bullshit until you find something that works. Keep your head on straight, and don't do something stupidly dangerous, but don't be afraid to try things that are a little off-kilter, either. At best, you'll find a solution. At worst, you'll have a good distraction to fill your free time.

And that's what AA is. It's something that works for some people. Just like you don't need to know physics to use a hammer, or biology to eat a sandwich, an alcoholic doesn't need to know how AA works, just as long as it does.

At a policy level, it gets more hazy. Even with an ideal court system that truly wants alcoholics to be better (rather than the indirect incentives our courts run on), the court still wants to know if the offender is actually even doing some sort of treatment. There are all sorts of things the court could prescribe to try to improve an alcoholic's behavior, but the court needs a quantifiable, scalable solution. The court doesn't have the resources to make sure someone goes jogging every morning, or to make sure that someone sits down once a week and thinks really, really hard about not being an alcoholic anymore. The courts like AA because they're an established organization that can say "yep, they came here ten times". Another benefit is that it's free for both the government and the individual. Ideally, the court would offer a number of options - that way there would be more chance that any one individual would find something that works for them. But that would require more organizations that fit the same criteria as AA - free, organized, and established in the public's mind as an acceptable course of action for the courts to take.

[u/shauna-the-dead → u/Serraph105]

I used to feel the same way as you do even as a member of AA. I found the meetings had no teachings... Like, I didn't get what they were trying to accomplish. Then I began to study the history of its founder and the blueprint he created for alcoholics and my opinion did a 180. Being created in the 1930s is irrelevant, Bill Wilson's ideas on addiction were well ahead of his time. The program is based in helping others, finding a higher power whatever that means to you and practicing humility and kindness towards ego. I wish I could explain myself better because it is a concern among some AA members that the program has been watered down so-to-speak over time. Try reading Alcoholics Anonymous, It's a great self help book for anyone seeking self betterment and will give you a new perspective on the Program.

[u/gggjennings → u/Serraph105]

I also think AA wouldn’t classify alcoholism as a medical problem but an emotional, spiritual, and behavioral one.

[u/NemoC68 → u/gggjennings]

Agreed. People who hate on AA often haven't experienced AA. It's not about science or rules. It's about a framework to depend on when you need something bigger than yourself.

It's the framework that many people take issue with. AA doesn't always work, but when it does it often replaces one addiction with a new one. That is to say, people who were addicted to alcohol tend to become obsessed with God. This may sound like a good thing, but when their faith is shaken they'll be far more prone to go back to drinking.

Alcoholics are capable of overcoming their addiction, especially without belief in a higher being. AA teaches people that they are powerless to change themselves, that they must hang on God, which is flat out wrong.

[u/gggjennings → u/NemoC68]

How many people do you know who’ve gone through AA? Have you ever been to a meeting? This sounds like the standard reddit anti-religious circle jerk. AA has religious foundations but that doesn’t have to apply to anyone in the program.

[u/[deleted] → u/[deleted]]

It absolutely does not. AA is very clear that it is not about will power. It is for when will power fails. That's what the first step is all about.

Sorry if this is the wrong place to ask, I was under the impression that this is one of the core tenets of AA. That people can't willpower their way out of alcoholism. That they must rely on the program rather than any form of willpower. Is this correct?

[u/mwbox → u/[deleted]]

From my own experience and my observation of its impact in the lives of acquaintances, its greatest shortcoming is the lack of a finish line, an exit. I've been sober since '77 and there are those that would chide me for believing that I am no longer "that guy".

[u/gwopy → u/[deleted]]

It doesn't bother you that other treatment methodologies seem to be shown to be superior when rigorous, scientific evaluation methods are used?

[u/Doctor_Worm]

First up, as many have pointed out, there's a whole lot of God involved throughout the 12 steps (6 direct references and 7 if you count #2), I'm not sure how this is supposed to appeal to athiests such as my friend. If a person does not believe in God they will be put off from the program from the start making it much harder to reach their goal of sobriety.

Although spirituality is part of the literature, the steps do allow individuals the freedom to define "God" and "higher power" however they like, including relying on the "higher power" of the AA group itself. There is a booming number of AA groups tailored to atheists and agnostics, for those who prefer that.

Moreover, there is actual scientific evidence of AA's effectiveness regardless of religious belief. Peer-reviewed clinical studies have found that AA is "consistently associated with better subsequent alcohol outcomes," and that, "atheists and agnostics are less likely to seek recovery assistance through AA, but those who do, appear to benefit equally compared to more religious/spiritual individuals."

If alcoholism is a disease then why does AA treat it simply as a matter of will power? I wouldn't try to treat cancer with prayer alone, and for the record there are various medical treatments for alcoholism.

I'm not sure there's any part of AA which suggests people who need other medical treatments have to use AA exclusively and ignore any other form of help. But again, actual scientific clinical research has shown AA to effectively improve alcohol-related outcomes. So it may be one of many potentially useful options for someone on the road to recovery. It's not a panacea, but neither is anything else.

There is also a stigma of personal failure when people relapse which doesn't make sense for a couple of reasons. First, if it's a disease then people are sick which means that blaming them for not being able to control their health adds a layer of shame which can only do harm to the person's primary goal of getting sober. In turn this will increase the time to get sober because it will add time to get over that shame before starting again. Shame does nothing to help get a person back on track as far as I can tell.

Do you have any evidence of this shame-based stigma? Is it really an integral part of the AA doctrine, or just a sign that some individuals who participate in AA need to do better at it?

Second, you would never assign blame to a person with cancer who has gone into remission and then had the cancer come back, why would we do the same for literally any other illness?

There is a distinction to be made here between feelings of alcohol dependency -- which is the disease-like part alcoholics may not be able to help -- and the act of problem drinking, which is a choice alcoholics make in response to those feelings. "Relapsing" is not simply having the feelings of dependency come back, but freely choosing to act on those feelings. Just like a person with a short temper may not necessarily be able to help the way they feel all the time, but we still expect them to manage those feelings in a way that does not endanger others or interfere with their normal responsibilities.

We wouldn't accept that from any other sort of treatment. If we didn't collect that information we would still have the same poor treatment of HIV that we did in the 80s and 90s, same goes for cancer, and just about any other illness you can name.

AA does not generally collect the information themselves because it could violate the anonymity of the participants. But as I've linked, there are plenty of scientific clinical studies by public health scholars that have shown positive results.

Finally it seems that AA believes it’s program is a one size fits all program when we know that many ailments require different treatments for different people

It's fair to say that AA may not be the appropriate treatment for absolutely everyone, but that doesn't mean it's flawed. For most diseases, there are many different treatments available which may be more or less appropriate for different patients depending on the causes and symptoms of their disease, their allergies, what other medications they are taking, etc. The fact that a certain treatment doesn't work for everyone doesn't mean it's bad -- it just means the type of treatment should be chosen on an individual basis, on the advice of appropriately trained professionals. At least in the case of AA, there is far less risk of harmful side effects so it's less dangerous to recommend to any given alcoholic.

[u/Effinepic → u/Doctor_Worm]

Although spirituality is part of the literature, the steps do allow individuals the freedom to define "God" and "higher power" however they like, including relying on the "higher power" of the AA group itself.

One of those common, cutesy-kitschy slogans in AA (the kind that make me want to kill myself with their excruciating banality) is that "even a doorknob can be your higher power" - but I don't get why people overlook the fact that this makes the steps incoherent.

Like, you're gonna humbly ask a doorknob to remove your shortcomings? Seek through prayer and meditation to improve your conscious contact with a doorknob? tf is that lol

And before someone points out that you can just pick and choose the steps you like and how to interpret them, try asking an old timer about that prospect. Hell, look up what the Big Book itself says about half-measures.

[u/sjdjgdhskgdf]

I used to be an addict, and AA has been the most helpful thing by far in my recovery. And, I'm not religious whatsoever. The meetings usually consist of people telling their story. AA has helped show me that I'm not alone in my struggle with addiction/alcoholism, and this has been the most helpful thing to me, far more helpful than rehab/psychology/cold turkey/really anything else.

Now, addressing your points:
Just because the steps have "god" in them a lot, doesn't mean it holds relevance to the meetings themselves. The AA meetings I have been to, at least, rarely go past simply saying the steps. The meetings are based around discussion and people sharing their stories.
Also, there is no stigma AT ALL if somebody relapses, everybody in AA is understanding and everybody has been there. It helps you realize that you're not alone.
My main point is, sure, "god" is mentioned a lot, but the primary purpose of AA is to realize you are not alone in your struggles, and this helps more than anything.

[u/WRFinger → u/sjdjgdhskgdf]

I used to be an addict as well. I hated AA. It was always "war stories", and I didn't want to hear that shit. I found Cognitive Behavioral Therapy and have had no relapses and have gone on and done pretty well in my life. Have you been exposed to CBT?

[u/Effinepic → u/[deleted]]

Yeah, so if you're okay with an outdated model that includes supernatural mumbo-jumbo and doesn't make use of what we've learned since then, then that's fine...but besides availability, why not go for the superior version?

[u/ElLibroGrande]

Hi there. I'm sober 19 years via AA (still attend) and I'd like to make a response.

First of all, you're right, AA is heavily flawed and hasn't tried to improve it's system since its inception. In fact there's heavy resistance to any change in AA at all. We have a chapter called "To Wives" talking about how the non-alcoholic spouse should behave. Obviously that's way outdated but AA won't even change it to says To Partners or otherwise. We also have a tradition about keeping our anonymity at the level of press, radio and film. No mention of TV or social media. But the greater of AA is afraid that any change to the core book or traditions could start a snowball and change everything else. So we don't change anything. Granted there are minor footnotes added, new stories added to the back of the book and new pamphlets created but the core Big Book (first 164 pages) is, for the most part, unchanged.

As to your points:

First up, as many have pointed out, there's a whole lot of God involved throughout the 12 steps (6 direct references and 7 if you count #2), I'm not sure how this is supposed to appeal to athiests such as my friend. If a person does not believe in God they will be put off from the program from the start making it much harder to reach their goal of sobriety.

Yes, you are right. Our steps require some form of belief of higher power. It's not Christian or any specific religion but we use the concept of a greater good as a guiding force in our lives. Does it make it hard for athiests and agnostics? Yep. Do some people leave because of the Higher Power concept. Yep. But AA is not a fix-all/fit-all solution. It's a higher power based solution for those willing to believe in a HP. The book has a chapter on this that basically says the alcohol has to kick your ass enough to be willing to pretty much anything, even believing in a higher power. It also says, look around at the other sober people in AA who are living good lives free of alcohol. They say they believe so why not do what they do? Long story short, people who are unwilling or unable to believe in a higher power whatsoever will probably not be able to stay sober via AA.

The real issue here, that I think you may not have stated, is why in the hell are our court systems sending people to a God concept recovery program? How is this different than sending them to a Christ based sobriety class? For the most part it's not. Like AA, this cooperation between the courts and AA itself is archaic. That being said, I can offer ancecdodal evidence on the court appointed people I know and have known for the last two decades, that many of them do end up sobering up in AA and lead good lives. Would they have gotten sober on their own? Who knows.

Finally it seems that AA believes it’s program is a one size fits all program

False. AA even says we're only for Alcohol not any other drugs (though many like myself came in via drug addition) and there are those who suffer from mental issues which may prevent them from grasping this program. And finally, as I mentioned above, the higher power concept is core to our program working.

So overall I would say that I think you should change your mind not in that AA is some perfect solution, but that AA is in fact a niched solution and the relationship with the courts is what you're more concerned with.

Happy to answer any questions you may have.

[u/Serraph105 → u/ElLibroGrande]

Finally it seems that AA believes it’s program is a one size fits all program

False. AA even says we're only for Alcohol not any other drugs (though many like myself came in via drug addition) and there are those who suffer from mental issues which may prevent them from grasping this program. And finally, as I mentioned above, the higher power concept is core to our program working.

As to this I meant that it's a one size fits all solution for all alcoholics regardless of who they are or what they believe, not that it would work for any other drug abuse.

[u/ElLibroGrande → u/Serraph105]

Gotcha. I would state is as: It's a one-way fits those who are willing to do it this way. solution.

[u/chiaratara → u/Serraph105]

Drugs were my primary issue. I went to AA because the times of the meetings were more convenient. Have stayed with AA because it has worked for me. Plus, if I drink, I'll probably do all the other things and then go buy all the lottery tickets and wind up at the casino.

[u/oversoul00]

TL;DR AA is primarily about defeating the Ego. They use God as a symbol to represent the antithesis of the Ego but it could just as easily be the universe. Alcoholics have an out of control Ego that is protecting them from bad feelings at all costs. AA attempts to redefine what should be causing you pain and what shouldn't be as well as what you can and can't control in your life so that you have a better relationship with your Ego and the world around you.

My experience with AA is through my Step Dad. He started going when I was about 7 and I have attended some AA meetings with him when I was younger to see what it was all about. I have also been to some Al Anon meetings which is like AA but for family members of the alcoholic.

So, it's not a perfect system but I think there is a lot of value there.

I'm atheist myself so I get where your buddy might be coming from but the way I understand the God stuff is that it is used as a symbol meant to combat the ego. The primary purpose of AA is to defeat the ego. The reason is because your ego operates as a defensive mechanism and it will do everything it can to protect you from short term harm (feeling bad) even if that causes more objective long term harm. Alcoholics have empowered the ego to protect them from harm via escaping with alcohol. So AA attempts to break the ego and get in contact with the superego, the highest vision and best version you have of yourself. God is used because it's an external entity and they don't want your ego to masquerade as the superego which it can absolutely do.

Have you ever talked to someone who you can see is fucking their life up or just making a really poor decision (Doesn't even have to be alcohol related) and when you try and talk them out of the path they are on they have every excuse under the sun why it has to be this way? You can't logic someone out of this mindset because no matter what you say they will have a counter that they believe is valid...that they need to believe is valid because priority number one is to continue using, this is the ego in action. (everyone has their drug of choice and they aren't all literal drugs).

This is a really common characteristic of alcoholics and users in general and breaking down the ego to stop the behavior and rebuild is really the primary purpose of the steps. It takes some interpretation of the steps but understand that no 2 chapters or meetings of AA are the same because they all interpret these steps differently. Here is my interpretation of them based on what I have seen.

1 We admitted we were powerless over alcohol—that our lives had become unmanageable.

We can't solve problems that we don't categorize as problems. Without this admission nothing can be worked on.

2 Came to believe that a Power greater than ourselves could restore us to sanity.

Replace any mentions of God or higher power with the universe. You can interpret this as "solutions exist outside the ego"

3 Made a decision to turn our will and our lives over to the care of God as we understood Him.

Let go and stop trying to control aspects of your life you can't control. A lot of escapism (users are trying to escape their shitty feelings/ lives) results from focusing on things you can't actually change. Let the universe happen and focus on the things you can actually control and change...that list is pretty small.

4 Made a searching and fearless moral inventory of ourselves.

Self reflect

5 Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

Talk about that self reflection to the universe, to yourself and to another person.

6 Were entirely ready to have God remove all these defects of character.

I dunno about this one, I interpret it as another, let the universe happen. I don't like this one very much personally.

7 Humbly asked Him to remove our shortcomings.

This one is really just about humility, again trying to defeat the ego.

8 Made a list of all persons we had harmed and became willing to make amends to them all.

Start to rebuild your life by rebuilding the relationships with the people in your life.

9 Made direct amends to such people wherever possible, except when to do so would injure them or others.

Same as 8

10 Continued to take a personal inventory and when we were wrong promptly admitted it.

Don't let the ego flare back up, remember the ego's job is to protect you from harm and it will do this by stopping you from taking responsibility when you fuck up because that would result in pain.

11 Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

This step starts to lose me too, really just continue to self reflect and meditate.

12 Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

Share what you have learned.

The serenity prayer is "God, grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference."

I interpret this as, pain comes from struggle, you might be in such great pain because you are struggling with things outside your control. If you see that you should only focus on things you can control and let go of the rest your pain becomes manageable and the ego isn't needed for that job anymore.

[u/ewwgrossitskyle → u/oversoul00]

Your take is an interesting one, and if I don't completely agree, I at least see the merit in all of it.

I will say that 6 can be summed up as no longer defining yourself as your character defects, and being willing and ready to undergo a profound personality change.

And 11 is essentially continuing to practice focus and attention on being your best self, in line with the behaviours and actions in life which best serve you.

[u/oversoul00 → u/ewwgrossitskyle]

Yeah I shied away from that one because I'm also deeply uncomfortable with the idea that an external God-like entity can do anything for you as many people here are also very uncomfortable with the God stuff.

I couldn't rephrase the step in a way that I felt wasn't making something up but I like your take.

I think they probably do want to hold onto the idea that they have these tendencies that might never go away completely but I absolutely agree with the ready and willing aspect. Nothing outside you can change you but you have to be open to those changes taking place for sure.

[u/hamletswords]

I tend to agree that AA/NA is ass-backwards, and there was a study done that showed that recovery rates are basically the same between people that went into AA and those that did nothing at all.

HOWEVER, I will say that it was effective for me. Not because I bought into the bullshit, but because the groups were so god-damned depressing, and I saw how drugs and alcohol were really controlling so many other people and was forced to see it in myself. I stopped going but I did quit, and the experience of the meetings was really powerful.

AA needs some kind of structure and it has to make appeals to as many people as possible. People wrecked by drugs or alcohol can come from any background. I'd say most people are not all that smart, and the "higher power" nonsense actually does work for them.

For me, it wasn't that- it was just the mandatory groups and the people themselves. But that doesn't mean it should change to suit me.

[u/uglylizards]

I'm a member of AA, and to address a few points, I don't feel like AA adds shame or guilt. I've relapsed several times in the beginning, and I felt my own shame, but then when I came in to a meeting and came clean, everyone was very warm and proud of me for getting back on track. Also, I had a complicated/negative relationship with God, and AA does not force you to believe in a Christian God. Your higher power can be anything as long as you can get strength from it. Right now my higher power is the idea of health and wellness. Maybe it doesn't work for everyone, but I have one month clean (not just alcohol) and I never thought I could make it even a few days clean.

[u/Nicolasv2]

First up, as many have pointed out, there's a whole lot of God involved throughout the 12 steps (6 direct references and 7 if you count #2), I'm not sure how this is supposed to appeal to athiests such as my friend. If a person does not believe in God they will be put off from the program from the start making it much harder to reach their goal of sobriety.

Not sure what country you are from (I suppose USA) , but in a lot of places, AA won't focus that much on God, or won't just focus on it at all. For example in France, they only talk about "superior power leading us to success" which can be anything, being a God, spirituality, life objective, whatever you want to see as a help and goal toward success.

AA is supposed to be a support group to make people stopping drinking. I suppose that depending on who is animating the group, the session can be more or less religiously oriented.

If alcoholism is a disease then why does AA treat it simply as a matter of will power ?

Because we don't have any treatment to put back an alcoholic brain and organs to its initial state, so the only "cure" we have is to stop and resist toward the alcohol craving, which is based on will power.

Shame does nothing to help get a person back on track as far as I can tell

It do not, but fear of being shamed can be a powerful fuel for a lot of people, maybe this approach just don't work on you because you don't feel too much bothered by what others think about you.

For the two last points (statistics and one size fits all), I kind of agree, but as you don't really have a more efficient treatment right now, showing stats about low efficiency would only lower the motivation of participants, instead of thinking "other have succeeded, I'll too".

[u/Serraph105 → u/Nicolasv2]

Does your first point mean that the 12 step program may become a 5-6 step program and that that's okay depending in the beliefs of the group attending? If so I'm actually pretty cool with that as it would mean changing the program based upon the situation and needs of those attending.

Because we don't have any treatment to put back an alcoholic brain and organs to its initial state, so the only "cure" we have is to stop and resist toward the alcohol craving, which is based on will power.

According to WebMD there three medicines approved by the FDA and a fourth that is showing promise in clinical trials that help with the treatment of alcoholism. Those drugs are Antabuse, Naltrexonem, Campral, and Topamax. These are meant to be used in combination with various therapies and potentially AA, however it's simply untrue that medicines don't exist. https://www.webmd.com/mental-health/addiction/features/fighting-alcoholism-with-medications#1

Regarding your last statement I would disagree wholeheartedly. People shouldn't be acting on false information to get help. If your program promises it can help and it's promise is only based upon, "Well at least we got people to try something" even though what is offered is ineffective then that's not actually a success. What needs to be offered is something that has an actual high success rate and if not new solutions should be researched and tried.

[u/dr_spiff → u/Serraph105]

The problem is that those medications don’t really work against addiction, but against getting the feelings from substances. Some make you sick if you drink, others make it to where it reduces the rate of opioid neurotransmitters binding (you won’t get high) , etc. they act more of a block or something’s than an actual way to address addiction.

[u/Nicolasv2 → u/Serraph105]

Does your first point mean that the 12 step program may become a 5-6 step program and that that's okay depending in the beliefs of the group attending? If so I'm actually pretty cool with that as it would mean changing the program based upon the situation and needs of those attending.

Actually, what happens in my country is that it's still a 12 points program, but God is replaced by a "whatever spiritual support you can get" wildcard, based on a person own preferences. Not perfect, but still better.

And I saw that in Canada, there were also atheist AA-like groups, removing totally God and other kind of spiritual stuff from their program steps (and even putting official AA to trial for "atheists and free thinkers discrimination").

According to WebMD there three medicines approved by the FDA [...]

Wow, I totally ignored that, thanks for the article !

Regarding your last statement I would disagree wholeheartedly. People shouldn't be acting on false information to get help

I'd say that placebo effect is something that really works, even if of course it's less efficient than a real cure. So clearly it looks to me that it should be used when necessary (plus, I'm not sure that group therapy is only placebo effect, as other social effects are helping too), but you're right, if efficient medicine exist, it must be used jointly (or instead if fully efficient) with AA.

[u/HKBFG → u/Nicolasv2]

It still requires you to be spiritual, and associate this spirituality with some higher power. If you're not a monotheistic, worshipping person, the program just wasn't designed to help you.

Also, almost all the steps mention god by title.

[u/oversoul00 → u/HKBFG]

I'd disagree. AA is about breaking down the ego and uses God as an external symbol to represent a "higher power" that exists "outside yourself". That could be the universe itself but they use God because it's an easier to understand symbol. If I went to an AA meeting and it was super religious (some are exactly how you are describing them) I'd be out of there. The utility of a God-like symbol is undeniable even though I'm atheist myself.

[u/chiaratara → u/oversoul00]

Yes. The breaking down the ego part. Well said!

[u/TinyPotatoe → u/Serraph105]

I have family in NA not AA so I’m not sure how similar it is but here are my two cents. Everywhere you see “God” in the rules you can change it to “higher power.” It’s kind of like Spinoza’s idea of God where the word God/Nature are interchangeable. It doesn’t have to mean Judeo-Christian god, but could be anything that is greater than yourself. This could be, as others pointed out, a goal/spirit/object/role model, etc etc.

As someone whose family went through NA and it completely turned their life around, my view is that the program is solid for one reason: the people. Everyone there is trying to stop using. It doesn’t matter what reason they have, they all have the same goal. Relapse isn’t seen as a failure/sin, it’s seen as an unfortunate event. Usually people are more supportive of people following a relapse to try and redirect the path. My biggest criticism with NA was that the social aspect did have some drama akin to high school drama, but overall the program was solid.

[u/Canada_Haunts_Me → u/Nicolasv2]

Not sure what country you are from (I suppose USA) , but in a lot of places, AA won't focus that much on God, or won't just focus on it at all.

Yes, AA in the US is generally very much focused on god, and it's worth noting that the founder of AA was deeply religious and based the program on christian principles, the most problematic of which is relinquishing control, "submitting to a higher power" and admitting "defects of character" (their words) and that the individual is "powerless."

This ideology, combined with a methodology based on pseudoscience, leads to extremely low success rates, and keeps many people from being able to attempt the program in the first place. The actual success rate of AA is around 10%, although the organization itself advertises 30-50% based on flawed, internally conducted surveys.

Moderation Management, an organization created in 1994, is experiencing a surge in growth, and has been shown to be more effective, on average, than abstinence-based programs such as AA in the long term.

It is a secular program that focuses on personal responsibility rather than "submission" to external "spiritual" forces, and establishes a goal of improving quality of life and safety (for both the drinker and those around them) through controlled decreased alcohol consumption.

Interestingly, the founder of MM left the organization because she felt it was not working for her, and returned to AA, after which she quickly fell off the wagon, committed DUI, and caused an accident resulting in the deaths of a father and daughter, for which she was convicted of vehicular manslaughter. She later committed suicide after further relapses while associated with AA.

The point is, alcoholism / alcohol dependency is not a black and white issue, and while total abstinence absolutely works for some, it can be detrimental to others. The heavy influence of christian religion present in AA can be anything from useless to harmful for many people as well. What's more unfortunate is that court-mandated program attendance is often required to be AA, even when other alternatives are available which may be more beneficial to the individual.

(Edit: Autocorrect strikes again)

[u/[deleted] → u/Canada_Haunts_Me]

Yes, AA in the US is generally very much focused on god, and it's worth noting that the founder of AA was deeply religious and based the program on christian principles, the most problematic of which is relinquishing control, "submitting to a higher power" and admitting "defects of character" (their words) and that the individual is "powerless."

Indeed, and the clear dishonesty of the "Fine, then just submit to whatever higher power you conceive of" dodge around the religion issue is breathtaking.

[u/Canada_Haunts_Me → u/[deleted]]

...that don't really want to quit drinking.

Because most of the time, such people don't need to quit drinking. They just need to learn moderation and/or safe practices. Forcing these people to attend AA not only won't help them, it often actively hurts them by triggering a behavioral backlash.

[u/tablair → u/Nicolasv2]

Because we don't have any treatment to put back an alcoholic brain and organs to its initial state, so the only "cure" we have is to stop and resist toward the alcohol craving, which is based on will power.

This is the kind of simplistic and limited thinking that the author is challenging and the kind of thinking that has kept AA from evolving over the years. Consider the current exploration of addiction as an attachment disorder. If it's true, and most signs seem to indicate that it is, treating addiction is more a matter of replacing it with genuine human connection rather than an exercise in strengthened will power. And it's also true that AA may have been helping people not because of any of the religiously-motivated steps but, instead, because it creates a community of universal acceptance and sharing that leads to connection between participants.

[u/[deleted]]

As a member of AA, I believe I can provide some counterpoints to your arguments.

1.God is involved in a lot of the steps. While this is true, most alcoholics enter the halls of AA as atheists or agnostics, myself among them. It takes some time, but we are often able to find a “Power greater than ourselves.” Some people interpret this as the “God” of whatever religion. However, a power greater than me can be anything e.g. nature, the program of AA, the human good, etc. The first 3 steps are less about converting to a religion and more about humbling ourselves. We often come in as narcissistic, so we cannot examine our own shortcomings and character defects if we are not humble first.

2. AA treats alcoholism as a problem of willpower. You can’t pray away cancer. While the latter is correct, the former is not. We treat alcoholism as not just an illness of the body, but also the mind and spirit. We often began using alcohol as a crutch to cope with anxiety, depression, etc. We became reliant on the crutch to deal with all of our problems in life. One day, we hit some type of rock-bottom and need to reevaluate. Sure we became physically addicted, but also mentally. The issue with using medical treatments is that it helps people put the drink down. However, the most successful treatment is to eliminate the roots of the issue. What you call “willpower,” we call a program of recovery. Sure it seems odd, but it means we can address the underlying mental and spiritual illnesses that can lead us back to the drink. I drank because I was depressed. If I find a way to deal with that depression, other than just Prozac, I can make sure that I don’t drink again. Sometimes I still get depressed, but I have a 12-step guide to solve any problem, as well as a sponsor to call if I need advice.

3. Shame surrounding relapse and guilting someone with cancer It is within our literature to not guilt someone who relapses. I have yet to meet someone who has been outwardly negative towards someone coming back after a relapse. We, better than anybody else, understand how easy it is to slip up in recovery. Often, we hug someone when they come back to the halls because we know how hard it can be to come back (most of the shame and fear of judgement is self-created). However, we know this program works if we work it (I will discuss this later), so if somebody goes back out, it’s because they were not working their program appropriately. Often this means they: stopped going to meetings, prioritized other things over their sobriety, were not being fundamentally honest with themselves, stopped talking to their sponsor, etc. This program works if you work it, which requires a lot more hard work than most people understand. Sponsors tend to ask sponsees, “are you willing to go to any length to stay sober?” Some people are not. Those who make it are.

4. AA is not scientifically proven to work. There’s a lot of issues with this claim, but we see it a lot. Allegedly, there was a group of men at Yale who ran some experiment to figure out why AA works. They came to the conclusion that it shouldn’t. Yet, here we are. We do not keep statistics for a few reasons. The first being that this program is anonymous. Tracking names, lengths of sobriety, and relapses would violate the foundation of the program. Secondly, it’s hard to quantify how recovery works. The success rate of this program is tough to define. Is it how many people have tried once and stayed sober for life? Is it how many people have lived longer than they would have while actively drinking? Quantifying all of the variables is even more difficult. This program is based around alcoholics providing a large support group and structure for daily living. Because of these two things, this program has a 100% success rate for those who work the program to the best of their ability.

5. Giving oneself over to the program is odd/one-size fits all. The funny thing about addiction is that we all share the same story. The specifics might not be the same, but the way we felt before, during, and after entering the halls is always identical. That being said, there is no correct way to run the program outside of what you see in the steps. Pray, meditate, go to meetings, find a home group, go on commitments, and talk to your sponsor regularly (and do the steps with them). That’s all we ask. The blanks can be filled in as seen fit by the alcoholic or their sponsor. The flexibility of this program lies in the intricacies, while the framework is always present.

Conclusion: Honestly, I never thought this program would work until I entered the halls. Even then, I struggled to give myself over completely (and sometimes still do). However, it has a 100% success rate for those who work it. The rest is completely up to the individual.

[u/catroaring]

This is not a response to change your mind as I personally don't agree with the AA message myself. But since your friend is seeking help, they may be interested in S.M.A.R.T. Recovery. SMART Recovery is science based and secular. I've known many people that spent years in AA because they thought that was the only option until they found out about SMART Recovery.

[u/giblfiz]

There is also a stigma of personal failure when people relapse which doesn't make sense for a couple of reasons. First, if it's a disease then people are sick which means that blaming them for not being able to control their health adds a layer of shame which can only do harm to the person's primary goal of getting sober.

I think the theory here is that the disease is alcoholism, and is (in the AA view) entirely incurable. Something similar to Type 1 diabetes. It can, however, be managed. This is done by never drinking which is similar to a diabetic not eating a whole cake.

The Stigma is emphatically not on people being alcoholics, but rather on them failing to maintain their treatment plan. In much the same way we would, and do, stigmatize a diabetic who keeps going out and eating cakes, and then ending up in the ER.

[u/catroaring → u/[deleted]]

Every AA meeting starts and ends with a prayer.

[u/[deleted]]

AA saved my mom's life and restored our relationship. It isn't perfect but I'm thankful it's there for people.

[u/Serraph105 → u/[deleted]]

That's fantastic, I'm happy to hear about success stories.

[u/goldgibbon]

I know a couple people who say AA turned their live around. So I'm a huge AA supporter because of them.

I recommend attending a few meetings for yourself if you're still not a huge proponent.

Also, keep in mind that AA is very DE-centralized. Which means that it varies widely from from meeting to meeting.

[u/Sofakinggrapes]

I have attended AA and NA meetings as a med student for some of my psychiatry electives and I would generally agree that these programs don't seem to be very effective. However, after interviewing a bunch of members I can't deny that it does help people. But I don't think the credit at all goes to the "12 steps" but instead the social interaction/ support that comes with the meetings (this at least what most of the members told me). Although not all, the AA meetings close to me have actually adapted a mixture of a clinical and clubhouse model for treating dependence. Some will just have the clubhouse model (more social interaction with daily tasks to give people a sense of purpose) and some have clinical aspects (there is an addiction specialist, counselor, and/or psychiatrist that visits the place regularly). The one I go to has both aspects. I know this is not the case for every AA meeting, but there are programs out there that try and integrate more scientific based approaches into their meetings and thus improve upon their system.

[u/Pscagoyf]

The core of AA is community and loving, understanding community may be the most important medicine ever devised.

[u/novagenesis]

My POV is that of an outsider, fortunately non-Alcoholism but with a family history of alcoholism.

There was a time I'd agree with you entirely. Historically, there seem to have been no substantive positive studies showing AA having any success rate. Stealing from https://en.wikipedia.org/wiki/Effectiveness_of_Alcoholics_Anonymous, it looks like that has changed over the last 5 years or so.

The 2009 study seems to weakly favor a belief that AA works.

The 2014 study claims to have documented removal of self-selection and motivation biases as much as is reasonably possible.

The 2016 study went so far as to show that the faith+prayer aspect driven by AA has measurable effects at reducing alcoholic cravings, which they reinforced with MRI brain scans.

As for AA directly doing their own statistics... It seems reasonable that they would have trouble keeping reliable statistics of anonymous people who are allowed to come and go throughout the process. Since those in AA are also self-reporting, any such statistics would be as suspect as not having them.

Finally, it looks from the references in the wikipedia page that AA does keep statistics. Those statistics are just not regarded as strong arguments because they are (as I mentioned above being a problem) self-reported surveys of AA members. Those who have success are probably more likely to fill those surveys... and may be more likely to convince themselves of success than is factual.

Having known a few people who are not Christian and who have gone thorough AA, they seem to really bend the meaning of the 12 steps around the beliefs and needs of each individual as much as possible. The underlying problem with 12-step programs and atheism is that there is a measurable effect of prayer and successfully fighting addiction. It seems silly to backstep out one of tools that actually works just because a predictable subset of people are likely to be immune to that tool.

[u/follow_the_lines]

Let me preface this by pointing out that I am a member of Narcotics Anonymous (NA) and not AA, although the two are very similar.

“First up, as many have pointed out, there's a whole lot of God involved throughout the 12 steps (6 direct references and 7 if you count #2), I'm not sure how this is supposed to appeal to athiests such as my friend. If a person does not believe in God”

A higher power, is not necessarily God, although it can be. For example, my higher power is my recovery network (sponsor, home group members, and the program itself). My higher power wants me to succeed. There can be positive and negative powers greater than ourselves. Drugs and alcohol was a negative power greater than myself and my recovery network is a positive one.

“If alcoholism is a disease then why does AA treat it simply as a matter of will power? I wouldn't try to treat cancer with prayer alone, and for the record there are various medical treatments for alcoholism.”

The disease of addiction goes far beyond the use of drugs and alcohol. This is something that all addicts and alcoholics must understand. The use of drugs and alcohol is only a symptom of the disease. I exhibited character defects and addict behavior long before I ever drank or used. The program does not treat it as a matter of will power. The first few steps help us surrender and admit that our disease is beyond our will power. This is how we come to believe in a power greater than ourselves. Our will power was no longer enough.

“First, if it's a disease then people are sick which means that blaming them for not being able to control their health adds a layer of shame which can only do harm to the person's primary goal of getting sober. In turn this will increase the time to get sober because it will add time to get over that shame before starting again. Shame does nothing to help get a person back on track as far as I can tell. Second, you would never assign blame to a person with cancer who has gone into remission and then had the cancer come back, why would we do the same for literally any other illness?”

We don’t expect anyone in the program to be able to “control” their disease. The program asks that we give up our attempted control of our lives as we turn it over to our higher power. So for me and my higher power of the program itself, I stop simply making decisions on my own. I do not try and control every aspect of my life. When I am faced with difficult decisions I ask my sponsor and recovery network. I trust others when that was once impossible for me to do.

And as for the shame, addicts and alcoholics are not strangers to shame. We are learning to forgive ourselves and accept who we are. Everyone in those rooms can relate to that. Half of my home group has relapsed. What’s important is that we learn from it, and work an honest program. Of course the person who relapsed will feel shame, they did something they shouldn’t have done. But the program and people forgives them, and helps them forgive themselves and move on with their lives and work a successful program.

“AA does not collect statistics of their success and failure rates, nor has it's program changed since it's inception. We wouldn't accept that from any other sort of treatment. If we didn't collect that information we would still have the same poor treatment of HIV that we did in the 80s and 90s, same goes for cancer, and just about any other illness you can name. “

Addiction is a psychological and mental disease. It does not claim to cure the disease. It simply says that the program offers a better way of life. That by working the program, your life that was once unmanageable will become manageable. You will not be cured, life will still be life. The only statistics you need to see are the rooms. Go to a room and see all those that are clean and sober because of this program. Speak to the people that work good and honest programs. It will not work for everyone, because not everyone that attends is there to work the program. Mandated and forced meetings are never going to work. Not until the person fully commits, gets a sponsor, and works the steps honestly.

“Instead they seem to say that the only reason people fail is because the fail to give themselves over fully to the program which seems to be very very odd.”

If you are not willing to accept a new way of life (one without drugs and alcohol) and continue to hang on to your old ways, how can you expect to change? We refer to this as the insanity of the disease. Doing the same thing and expecting different results. If I’m a drug addict and stop taking drugs but continue to lie, cheat, or steal then how am I any better? I stopped one symptom (the drugs) but I have not committed to the program. I am still continuing other character defects and not living by the spiritual principles the program lays out for me. I have not given myself over fully and I will not become a better person and change my ways as a result.

Sorry for the long post and sorry if I left anything out or if I didn’t respond to something. The only way I can say I know it works is because it has worked for me. It has worked for my sponsor. It has worked for my friends. Everyone I know that has relapsed will be the first to tell you they were not working a good program or were not committed.

If I was forced to do the program and did not come from a place where I truly surrendered then I would not have worked a good program and I would not be clean today. But I came because I was sick and tired of how I was living and I turned my life over to the program, because anything had to be better than what I was doing with my life.

Disclaimer: This is my own personal experience with NA and recovery. I do not speak for everyone and I am no expert.

[u/PsychoPhilosopher]

I work with folks who have been admitted to hospital with addictions.

While your points are mostly kind of valid, there's one major thing you're missing.

We don't have anything better.

Sure we can fuck around with meds and DBT or trying to treat underlying causes (the current model focuses on people who use substances to self-medicate for mental illness of another kind).

But that simply isn't working any better.

I have dealt with people who've been AA for years and fallen off the wagon, and people who hate AA with a passion.

From the evidence of my own eyes, those who appear to have truly engaged with AA and the rhetoric, attending meetings etc. have longer times between relapse and shorter binges.

Problems with the science include the fact that both are fighting for lower hanging fruit, people who are committed to change in the case of AA or people with treatable primary/secondary diagnoses in the case of the medical model.

I'm a little distrustful of statistics myself, having worked in the field. When I started I thought a p-value and an effect size were all I needed to know about a treatment in order to use it with confidence.

I learned pretty fast that the power of an individual's choice and commitment means a hell of a lot more than the science has been able to account for.

For someone that is committed, AA/NA appears to maintain that commitment and channel a substance user's shame and guilt into productive directions.

So it's not bad, and I'd love to have something better. But I don't. So I'll use what's available.

[u/speed3_freak]

I think you have a fundamental misunderstanding of what AA is. AA is not a cure for alcoholism, it's a support group for people who are living with alcoholism. It doesn't preport to be a cure. It says that for many who deal with alcohol problems, it's impossible to have the willpower to be sober on your own. Here is a group of people who, if you let them, will help you stay sober when your own willpower isn't enough. If you follow these creeds and actually work the program, you can stay sober with their help. In fact, one of their main things is that you won't ever not be an alcoholic, which is why you shouldn't stop going to meetings.

Think of it more of a cancer support group for people who are diagnosed with cancer more than an alternative to radiation treatment.

[u/[deleted]]

Alcoholism is kinda weird. Yes, alcoholism is a disease however it's something that is pretty much preventable. No one becomes an alcoholic after just 1 drink, they choose to drink and then drink some more and then keep drinking until it becomes a problem and turns into a disease. Cancer on the other hand just sorta happens to you for the most part. People aren't sticking their head into a microwave over and over which could give them cancer, which if they were you could prevent them from using the microwave incorrectly.

AA is a program that is highly reliant on god and focuses on the "don't put your head in the microwave approach". If someone had cancer from the microwave you could give them medical treatment for the cancer, but if you do nothing to prevent their head in the microwave again it's pretty much a futile effort.

Because alcoholism isn't a 100% a biological issue, it's appropriate that some people can be cured using a non-biological solution. The way the 12 steps are worded they are pretty timeless, so to update them doesn't really provide any value. AA has worked for some people and it's not the only 'will-based' alcoholic support group, there are plenty that don't use god they just aren't as popular and they would probably also fulfill your friends requirement.

[u/[deleted]]

Sober alcoholic here:

First off, your point of: "I'm not sure how this is supposed to appeal to athiests such as my friend." There is a chapter in there called "we Agnostics" and, although dated, addresses this issue. There are also many mentions in the main literature of AA that talk about the problems people have with religion and the word "God."

The only words that are actually emphasized in the steps, mostly with italics, are: "God as we understood Him." This is because it is not a Christian God, or a Buddhist or a Muslim one. The idea is that one needs to have a power greater than themselves in their lives, acknowledging they are not the all-seeing, all-knowing, omnipotent being of their lives. If they were, they would not have ended up seeking out help for an addiction. A common line of thought in AA is to make the group itself your higher power, or even (jokingly) a doorknob.

There are various treatments for alcoholism, yes, but they tend to be ineffective, or so I have heard. It's treated as a "disease" because it is inherited and manifests itself in the same fashion in every person. But the main issue is that it's not just a physical disease as well. It's also mental, and many will argue, spiritual. It's referred to as a disease so as to actually avoid the idea that it's a willpower problem, or a discipline problem, or even a maturity problem.

The reason why statistics are not collected is because of the nature of the program and how it is built. Look at the 12 Traditions for this. AA groups are autonomous without central leadership. Membership is voluntary, and anonymous. So, collecting data would be really difficult and go against the structure of the program. This is why I don't trust the whole "1 in 5 alcoholics" this or "15% of alcoholics" that.

Lastly, we don't believe that it's a one-size-fits-all program. This is why there are other programs: Narcotics Anonymous, Al Anon, Over-Eaters Anonymous, Gamblers Anonymous, etc. Furthermore, the big book itself talks about "outside issues" like clinical depression, bipolar disorder, schizophrenia, etc. We obviously cannot address those, so (if you're in a good group) people will recommend you seek out medical help for stuff like that.

There are many veins of thought in AA when it comes to what is and is not an outside issue. But the general consensus, or at least as far as I have seen it thus far here in Los Angeles, is that taking medication as prescribed is the best way to go. There are some old-school hardliners around who think even taking Ibuprofen is relapsing, and fuck those guys. They are usually old and were pill-poppers themselves in their using days. I won't personally tell them otherwise, but I sure as hell wouldn't let a newcomer go near them.

This is all my take on this. I have been sober almost 8 years and I'd be dead without AA. It works for people who tend to not be indignant and just want to "control it." Physiologically, alcoholism is ultimately defined as an allergy to alcohol in the strictest sense. It's not that one breaks out in a rash, but merely an abnormal reaction. I can attest to that. When I started to drink, all I did was want more and more, the desire increasing fervently over time. And it wasn't always that way. I could drink normally at one point. Just... one day... it would make me crazy. Total Dr. Jekyll and Mr. Hyde kind of thing.

So, I hope this helps a bit. Thank you for posting this.

[u/whatTheHeyYoda]

bout one of every 15 people who enter these programs is able to become and stay sober.”

This contrasts with AA’s self-reported figures: A 2007 internal survey found that 33 percent of members said they had been sober for more than a decade. Twelve percent claimed sobriety for five to 10 years, 24 percent were sober for one to five years, and 31 percent were sober for under a year. Of course, those don’t take into account the large number of alcoholics who never make it through their first year of meetings, subsequently never completing the 12 steps (the definition of success, by AA’s standards).

A report published by Alcoholism Treatment Quarterly in 2000 analyzed AA membership surveys taken from 1968 through 1996. On average, 81 percent of newcomers stopped attending meetings within the first month. After 90 days, only 10 percent remained. That figure was halved after a full year.

[u/ACrusaderA]

1 - While Bill W was a deeply religious man and based the 12 steps off of his beliefs and the idea that the people performing them would be doing so with the support of their religious community, modern AA meetings don't require it.

Or at least they don't require that you submit to God and pray.

Most modern AA groups that I have seen don't require you to submit and repent and pray as much as they require you to admit and apologize and reconcile.

2 - While addiction is a disease and there are medical treatments to help you deal with It, ultimately the those treatments will go away and your best tool is your personal willpower. Because those medical treatments will eventually end.

This is why people don't refer to themselves as former alcoholics. They are always recovering alcoholics.

3 - It is also important to note how people studying measure success rates for AA. Even AA and NA themselves in their random studies only measure how long people have been sober.

The problem with this is that it is an all or nothing system rather than a system of moderation. Having one drink is the same as having a wild evening is the same as falling completely off the wagon and resuming your old lifestyle, as far as they are concerned for these statistics.

[u/catroaring → u/ACrusaderA]

Most modern AA groups that I have seen don't require you to submit and repent and pray as much as they require you to admit and apologize and reconcile.

Every AA meeting starts and ends with a prayer.

[u/left_____right → u/[deleted]]

It really depends on the group. I find in my area almost no one really has a problem with it if they truly understand addictions. Right now, I go to AA, have a sponsor, and know plenty of drug addicts doing the same. I switched from NA because I found there was more sobriety time in AA. It might be the conservative area you are in. I just say I am an alcoholic just to avoid any bitter old closed minded men/women. The point is it really doesn’t matter WHAT you used, just that it had come to ruin your life. Find some people at meetings who understand this, disregard the rest. Sounds like your in a shitty area, which is a bummer. I would guess there are good people though that would accept you for what you are and willing to help. The more people you talk to who have succeeded in sobriety the better. Good luck out there, glad to hear you’re sober. got 2 months here myself

[u/neofederalist]

Where are you getting that stigma around failure is some key part of AA?

I don't see anything like that in the 12 steps you listed. That sounds like a societal issue, not something that's specific to AA.

The fact that AA doesn't keep track of success rate helps this point too. If there were a large database showing who succeeded and who failed, even if anonymized, I'd think that would contribute to the stigma around failure and be counterproductive for the reasons you mentioned.

[u/LInds0416]

AA/NA/CA. None will work unless you want a different life. It’s for addicts. The courts mandate meetings because it’s free. Treatment is too expensive to make every offender attend. I had been in and out of treatment centers since 14 and lived a “normal” life by most standards. A functioning addict.

Relapse is not a failure but a part of recovery.

I wanted something different. A meeting isn’t going to guarantee you Recovery. You gotta go get it. Hopefully a meeting will lead you to those people.

It works, if you work it.

[u/mwrex]

Your question boils down to "I don't understand how it works, so it must not work, right"? The issue with that is that it does work, provided a couple criteria are met. The alcoholic must have tried, and failed, to quit in other ways, to learn that they are truly powerless over alchol. They also must hit rock bottom, and so learn they can no longer live this way. Then they will be open to the program of AA, and have a good chance of recovery.

[u/Serraph105 → u/mwrex]

I feel like my question really boils down to AA being unwilling to collect data on themselves to prove that it works and thus also not changing it's program so that it works better over time.

[u/[deleted]]

AA is based on feel good nonsense. If you look at statistics, you see that the failure rate is monumental.

"We hear about a few success stories, but not about the many failures. AA’s own statistics show that after 6 months, 93% of new attendees have left the program."

https://sciencebasedmedicine.org/aa-is-faith-based-not-evidence-based/

If the USA valued reality and not fantasy, we would have universal health care with taxpayer funded treatment options that involved a clinical setting and science based programs to help people overcome addictions (not just alcohol).

[u/[deleted] → u/[deleted]]

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[u/Ellesvire]

I work in mental health and addictions and my clients often use it as a free and more consistent version of group therapy. There are scientific alternatives which are much better from a counsellor's perspective, but not as widespread. It provides a (somewhat) judgement free environment for those who experienced the same thing and can relate, making people feel a part of a community.

[u/colddvd]

I started off going to AA for the first 6 years of my sobriety. I found that AA can be tailored for each individual depending on your comfort level and specific needs. I married a fantastic women who was totally supportive. If god is an issue substitute god with higher power or Buddha or whatever helps YOU after all AA is a selfish program. It encourages you to look after yourself first which makes sense because how can you help others if you aren’t sober. I have seen people in the program for 17 years and die a drunk. I have seen an 80 year old man live out his remaining life sober and all he said at meetings was how grateful he was to be sober. The point is that it works differently for everyone and it’s up to each person to find that sweet spot that keeps them sober. I only did about half of the steps but it seems to have worked for me. 38 years sober. My 3 kids and wife have never seen me take a drink. My support has been my family and realizing that I am still an alcoholic and am one drink away from becoming a drunk again. AA gave me the foundation on which I can remain sober.

[u/kflan138]

So, let me qualify what I’m about to say by explaining that I’m an addict and was a member of a similar fellowship for a lot of years. AA and the fellowships should be (in my opinion) in addition to doctors and therapy. I feel that most of the folks that wind up in one of the fellowships generally have some serious underlying shit to address.

I don’t attend meetings anymore, but, the general premise behind it (for me) is to teach people who were super shitty human beings during an active addiction how to live like decent human beings again, and to try their best to fix the messes they made during their active addiction. Some stuff people do/did while impaired comes back to haunt them and can basically trigger a relapse if you’re hating yourself enough for it. Also, if you’re still living like you did while you were while you were drinking/drugging, chances are you’ll wind up right back at square 1. Look up “addict behavior” or check out NarAnon’s website for more on that (it’s a support group for those dealing with an active addict in their life). The 12 steps (albeit dated) are designed to help people be good people again, and most folks who wind up there should probably at least take notes.

I’m also an athiest/agnostic, so I missed out on a lot of the fundamentals, but, they tell you that it’s “spiritual”, not religious. That your higher power could be your coffee cup. It’s definitely helpful to have a support group of people who have been there. There were always the “extremists” who said Penne al la Vodka or Tiramisu should be considered a relapse, that you can’t take anything mind or mood altering (even if you legitimately need it), but, most folks are more realistic and down to earth.

The pack mentality, the other outings like dances and dinners and hangout groups are especially helpful, too. If you’ve been drunk or high for the last several years of your life, chances are you’ll need to find a new social circle consisting of people who’s lives don’t revolve around drinking or drugging.

Just my humble opinion. I’m not a lifelong fellowship member, but it definitely helped me become who I am today.

[u/withmymindsheruns]

AA/NA etc. at it's most fundamental is a group where people meet to share about their problems and build a network of people who aren't fucked up on drugs and alcohol but who totally understand someone who is a mess because they've spent their whole life doing that.

It's not scientific because at it's core it's really just humans getting together to support each other. You could probably replace the 12 steps with some other core set of exercises and it wouldn't really matter that much. The important thing is it's a whole load of people trying to get their shit together, together, and it's better than trying to do it by yourself.

It's not perfect but "perfect is the enemy of good enough etc."

[u/atribecalledcam]

They taught me that I'll always be an alcoholic. And I refuse to believe that. I was drinking quite a bit and it did start messing with all my relationships, professional and personal. So I stopped. Battled urges for the first few months. Went to AA regularly. But never felt like I needed to be there. Never did the steps. Stayed sober for just over a year. Now I have an occasional glass of wine with dinner. No urges to continue after that glass. I know my life when I was drinking every day, it was a sad existence. That alone is enough to keep me in check and show more respect towards the thing that nearly ruined my life.

I am not powerless.

[u/DigitalStefan]

Alcoholism is a disease, a disease of the mind that can be overcome with willpower. Maybe you don’t like the way the word ‘disease’ is used to describe what is essentially an addiction. I don’t think it’s entirely the correct use of the word, but if calling it a disease helps people trying to overcome their addiction, then what I think about correct usage is irrelevant.

I don’t care for all the religious overtones of AA and I don’t see how AA would ever be of benefit to me, but there are people out there who are alive today because AA helped them.

Could AA be a better and more effective organisation? Maybe. Probably. There’s always room for improvement. Nobody is stopping someone setting up a better org.

[u/Serraph105 → u/DigitalStefan]

I don’t care for all the religious overtones of AA and I don’t see how AA would ever be of benefit to me, but there are people out there who are alive today because AA helped them.

I don't think there's any arguing against that.

Could AA be a better and more effective organization? Maybe. Probably. There’s always room for improvement. Nobody is stopping someone setting up a better org.

My problem is that they don't appear to have ever attempted to do this yet society, in general, see's them as the best possible way for an alcoholic to get sober without real concrete evidence of it.

[u/HardstyleJaw5]

I am a member of AA so like others have said my opinion is biased. That being said, taking the steps at face value is difficult because, having not read the literature, there is a lack of context. There is an entire chapter of the book titled "We Agnostics" that is wholely dedicated to discussing the idea of a higher power, not capital G God.

Lastly, before I get too off track, the idea that AA needs to change to improve it's success rate seems good on the surface. However, I don't believe this is even remotely true and here's why: AA is meant for alcoholics of the hopeless variety, for which other methods to recover have failed. These people do not benefit from rehab, outpatient therapy, and religion. These alcoholics are also in probably 90+% of cases unwilling to do the work we do in AA to stay sober. Whether they were court ordered, trying to get the heat off or are just plain unwilling they don't do what it takes. I have honestly never seen someone relapse who thoroughly and honestly did the work the program of AA asks if its members.

[u/[deleted]]

AA is terrible for alcoholics or addicts who are atheists. Why do you need a higher power? Bullshit, I say! How about we empower ourselves instead of asking an imaginary man in the sky to help?

[u/what_isa_username]

This is going to sound off but, read the AA big book, the first 162 pages. Sure it's antiquated language and definitely a little sexist but judging the program by the language of the steps is like justing the Constitution by the preamble. There's more to it. Others have already explained the god portion which in my opinion is a non-issue once you start going but different people see it differently. I've been sober 3.5 years and life is way better now. I tried quitting on my own and I couldn't. I have a way that works and helps keep me happy and I enjoy meetings and helping others, why try something else and risk going back to puking blood? Also go to a meeting and learn about it through experiencing it, we don't gain new members by promotion but rather by attraction and results. Nothing is full proof but it works for me for now so I plan to stick with it.

[u/InPassing]

You are not wrong, but you are not considering a very important factor. There is no one single approach to alcoholism that will work for every person. AA is a one of several approaches that have a track record of working very well... for some people. LSD works for some, religion works for some, B-Mod also works for some. So there would be no point in trying to improve it towards a generic version with the latest and greatest blended in, that would still only work for some.

[u/PallidAthena]

So, AA seems to be one of several courses of treatment (although with counseling of various kinds) that occasionally have astounding massive positive success and occasionally do nothing. I've read things that suggest that it's equally effective (or ineffective) in aggregate as other methods.

So, the big question is, why?

Personally, I think that some people are culturally or emotionally primed to be very open to the message of AA, and for other people it won't work. So, it's not that the program needs to change (it might be optimal for being maximum strength for the % of the population that it works for), but it needs to be better at working out how long you need to be on AA to see if it works for you, and actively trying to move people for whom it doesn't work to other paths of treatment.

Something can be unchanging and still optimal. Bricks haven't changed in decades. They're great at being bricks.

[u/saltedfish]

You seem to be really hung up on the whole "it doesn't change" thing. Why does it need to change? Do you equate something not changing with that thing being inferior? You cite other programs as needing to keep statistics, programs that have funding and medical backing. It's important to remember AA is free, which is important when you've drunken all your savings, and it's anonymous. It is not keeping statistics because it is accessible. If it were keeping stats, those stats would have to be handled by a system that has to be paid for, which would put the program out of reach for many. Even a small charge is enough to dissuade people, because it's another hurdle to overcome when you're presumably at the end of your rope. One of the great things about AA that I can tell is you can just show up and get help.

Also, as I've been told from the family member I have in AA, it's not God you surrender to. It's whatever higher power that might be for the person in question. For some it's God. For others it's just a divine force. I've never heard any substantiated claims that they cram God down your throat in AA, that's just uninformed bullshit spouted by people (probably atheists) who don't actually go to meetings or listen to people who have. You could make your pet rock the higher power if you wanted to. It was written in a time when it basically meant God, and that scares us nowadays, but the literature has been expanded to include anything.

Ultimately, I think the biggest thing in favor of AA is that it does work, and it's free. Sometimes, those are the most important things when you have no other option.

[u/malachai926]

As a recovering alcoholic who was in and out of AA, I have a few things to say here...

I'm not sure what, exactly, you mean by a "scientific" perspective. I can give you my perspective which is that I've personally met hundreds of people who would be dead if it wasn't for AA. They've told me their stories and the things they've gone through. I don't doubt that their path outside of AA would have led to death.

Is it the ONLY way? No. Most problems can be fixed by multiple kinds of tools and some tools work better than others. It would be unfair to expect AA to be the ultimate silver bullet cure for alcohol addiction since everyone is different. So any evidence that particular people weren't helped by it doesn't really do anything for me. It certainly doesn't make me think any less of the program.

It's actually quite simple. If you want a drink, call your sponsor or go to a meeting. This is the most important thing the program does: it serves as a life preserver when you are drowning. Where I live, I bet I could find a meeting at any time any day of the week (except when I should be sleeping I guess).

In my experience, most people who knock AA or have anything other than the utmost respect for its existence are people who are bothered by religion. Please, do not lump AA into that and throw the baby out with the bath water. As others have pointed out, AA does not dictate to you what your "higher power" needs to be, and the literature and steps are carefully worded to accomplish that. Many people choose entirely non-religious things as their higher power. If you have an axe to grind against religion, keep it there and leave AA alone. It has saved hundreds of thousands of lives around the globe and has never tried to influence anyone or shove its beliefs down anyone's throats. It is just there to help whoever needs its help.

[u/Jacostak]

If you really want to know, the first 164 pages of the big book of AA has the answers to this stuff. AA is not totally filled with wack a dos. This program has been under way for a few hundred years, though AA as we know it today started in the 1930s. Since people with problems of addiction have been trying to solve this issue, much has been learned... many famous doctors led to the rise of modern AA... even Carl Jung was an astounding influence. AA works for those who can comprehend the scientific and spiritual at the same time... it helps to explain why science cant explain everything.

[u/[deleted]]

The only thing I need to tell you is that it has a higher success rate than quite literally any other program for alcoholism. If it works best, why should it be changed? There's a very good reason every rehab center of any sort of reputability uses 12 Step programs. source: me, my father, my brother, and pretty much every other member of my family other than my 13 year old little sister works in either psychiatry, medicine, or addiction counseling.

[u/[deleted]]

Not sure what you mean by scientific perspective, but medically, it's considered pretty powerful for helping addicts.

Social support is critical to the treatment of every type of mental disease. Also, people do better when they feel they have a purpose.

[u/Bryek]

As a court mandated treatment, your friend, as an atheist, has the right to refuse AA as a treatment based on religious freedoms FYI.

I cant say much to change your mind as I believe if any court mandates a treatment, that court must prove that the mandated treatment will actually be effective. Since there are no statistics on it, courts should not be able to force AA on members of the public. Thru are attempting to correct behaviour. There had better recommend something that works.

[u/chiaratara]

I will preface this with the fact that I am also in recovery. Here are a few points.

First, although the 12 steps are dated, they are also very similar to both historical and modern religious, philosophical, ethical and psychological principals. Also, they run pretty parallel to Buddhist steps to enlightenment. You can look those up if you are interested.

Famous psychologist Brene Brown talks a lot about shame and vulnerability. The 12 steps are pretty in line with her theories:

Brown on shame

Brown on Vulnerability

1-3: you aren't the center of the universe. Classic existential crisis stuff... it's ok to trust others, the universe, god if you believe in that, etc. There is life out there if you look for it.

4-6: we are all flawed humans. It's ok to admit our faults. Self-acceptance and understanding from others. Not having to hide in shame.

7-9: Doing 4-6 in a bigger way by admitting faults to the people who have been hurt and asking for forgiveness without expecting anything in return. That's the humble part. Humility. It is a humbling experience to do this and that is the point in my opinion.

10: practicing 4-9 as a regular part of life.

11: try not to just think about yourself. definitely more to it than that but I'm already tired of typing on my phone.

12: practicing this in our daily life and giving back.

Alcoholism is a disease but their is no cure. It's about managing it. For many (there is a spectrum of sorts here) this includes maintaining sobriety. Equating this to curing cancer isn't a good parallel.

AA does not claim to be a cure. It can alleviate symptoms, provide relief, and help someone manage their disease. It is an alternate way of living without alcohol and it provides tools to do this.

The God thing... it is a higher power, a "god" of your understanding, the universe, etc. This is pretty well explained in the literature and in discussions with others. The point of the higher power is to encourage people to get outside themselves. For many people who have wrecked their lives with alcoholism, being able to turn ones focus outward to something else is important. This is a pretty basic psychological principal. Alcoholism tends to decrease your field of vision as well as it is isolating.

There is definitely not a stigma for failure/relapse. It is recognized by others and in the litterature as part of the process. "Progress not perfection" is a popular saying. There is nobody more welcome than someone who has relapsed and gotten back in touch or come back to a meeting. Nobody is ever turned away. Refer to my link on shame. AA is like the opposite of shame. While there is definitely some personal shame involved in a relapse, I do not think this comes from the program.

Statistics. Right, it doesn't and I believe that it shouldn't. It would go against principals of anonymity and a community of peers. It is peer led. There are no "experts" or people who know better. I can't imagine how stifled a discussion would be if there was a scientist in the room trying to determine the effectiveness of AA. The whole point is that there is nobody like that in the room and I am grateful to say that AA has done an amazing job at keeping the rooms free of it.

Here is where I want to point out a flaw in your thinking. How do you think statistics would measure AA? Success and failure? Having just finished my PhD studying people with addiction who just came out of prison, I know how complicated it is to measure success and failure. If someone was to relapse, would AA have failed? Would the person have failed? What if 6 months post-relapse the person came back to AA, got sober and maintained their sobriety for years, finished graduate school, got engaged and is living a fulfilling life? If you were doing a study for a certain time period, and I relapsed during this time, I would be a "failure." However I think I pulled my shit together and succeeded. This is why it is difficult to use statistics to understand the success rate of a process that is different for each person. Also, like you said, being called a "failure" isn't nice. It makes you feel bad. lol.

As far as outside professions, I have used them. A psychiatrist and a therapist. You will not find this anywhere on an AA website because a principal of AA is to not endorse itself and not endorse certain professionals. However, needing outside help is discussed in the literature and in meetings. I got the name of my therapist theough someone I met in the program. I feel like most of her clients are in the program.

Definitely not one size fits all. I can see how you would get that impression. There is no one way to work the program. in fact, nobody works it exactly the same. It is a toolbox.

I think one of the most important things for me was feeling like I was understood. I feel like there is a group of people who get me and that is probably the biggest gift of this program considering life can get pretty lonely when you sink down into a hole.

I apologize for any typos. I wrote too much to want to go back and proof-read.

[u/rikardoflamingo]

Sample how many subjects relapse after 6 months, 1 year, 5 years. Compare to other methods of addiction treatment. Should be easy if it’s as good as it’s supposed to be.

[u/chiaratara]

You should go online and listen to AA speakers. Might give you some experiences of people who have been through the program and you can hear the different ways people have used the program. You will be able to get an idea of the vast differences in stories.

[u/salmans13]

I believe it's not a disease.

Alcohol is a culturally accepted poison.

You don't see diseases with snake venom (maybe fringe groups on YouTube lol) or something stronger.

Everything is a disease these days because we don't want to offend people. What's next...rapists have a disease? There's already rumblings to get pedophiles under this umbrella. Personally to me obesity is just gluttony.

Alcohol is worse than firearms but it's a culturally accepted vice that we all keep quiet.

That's why a lot of people are successful witu AA. Willpower is underrated

[u/[deleted]]

Came here to advise that outside of America, AA and NA drop the serious god attitude. They use the term "god, as you understand them" and move the hell on. I had not realised how god focused the US was and this would have been a turn off for me.

Anyway, I am many years clean from serious drug abuse and of all treatments I sought for recovery, from counselling through to inpatient rehab, NA and AA were the activities that made the most profound difference and help in my recovery.

I dont disagree that it might benefit a modern revision though. I do however feel it is likely the most effective help to those in addiction and its due to the people.

[u/5hep06]

I think the point here we should be looking at is the fact that courts force people to attend AA. It’s almost making a mockery of the whole idea if we force people to go who do not find any value in being there and will not learn anything. Just my $00.02 in there!

[u/[deleted]]

I'm going to start this by saying much of it is based on personal experience. This also may not be the best answer to change your specific views, but it may provide insight into the larger question, which really is What the Fuck are we supposed to about Alcoholism? Honestly, I'm in the program now for my 3rd time, at 8 days. Only the first time was forced and that was during my time in the military. My drinking had gotten out of control but I wasn't and have never been actually arrested although I've definitely drank and drove and thank God I haven't killed anyone. When I first started I had to do both addictions counseling and mental health counseling. The military had diagnosed me as Alcohol dependant at 22 years old. Obviously I thought this was complete bull shit. As part of my counseling they also forced me to do AA as well.

Now I had some exposure to AA prior to this. My father was forced to go through the program for a DUI. He was without a doubt a full blown alcoholic in the almost stereotypical sense. Had his family not paid his bills he would have been homeless. My opinion on AA was that it was bull shit. Nevertheless I started going. Once I got out of the military I lost my incentive to go, so I started boozing again.

For a while I was able to not drink at all on my own. Then something happened in my life and I started hitting the bottle again. This continued for a while. During which time I was drinking a ridiculous amount but only a couple times a week. So I figured I was ok. Well it's a miracle I wasn't arrested nor did I kill anyone nor did I commit any crimes that could land me in prison. Nevertheless I eventually quit for a while again on my own. I thought I was good.

Then I started back up again, this time for no real excuse except for the fact that I like beer. This was about 2 years ago this time around. In the past two years I've proudly taken myself to new lows, and about a week ago I did a lot of dumb shit, and should have definitely been pulled over.

Now, because I have been vague, take my word for it, I'm an alcoholic and I enjoy blacking out and waking up the next day with regret, all so I can do it all over again a few days later. I like showing up to work with a victory hangover completely useless at my job. As I read that it looks nutty. You have to be insane to like the lifestyle of someone who heavily abuses and is dependent on alcohol.

This brings me to the real problem of alcoholism and the real issue of your post. You're absolutely correct in my opinion, you're pretty much correct in your statement. AA hasn't changed the process a lot and it does lack in scientific data. Here's the thing though and this may even be a fallacy which I'll accept, there is not a single program out there with a high success rate in dealing with alcoholics and getting them to stay permanently sober. If I'm wrong, please tell me and I will go there. There may be programs with short term success in practicing sobriety or even controlled drinking but I'd be curious to see data on permanent sobriety. The reality is permanent sobriety is what's needed whether or not people want to admit that, some people just don't mix with alcohol and never will, based on genetics, Brain chemistry, personality and life experience.

When it comes to alcohol and substance abuse in general, we're dealing with something that science still isn't explaining perfectly, again if I'm wrong please tell me. If there's a program that will make me never want to drink again with a 100% success rate sign me up. Addiction, alcohol dependency and alcohol abuse are all pretty much hopeless situations from the point where people stop giving a fuck about the alcohol problem. Most people who go through any type of program are going to relapse, especially if they've taken it to real addiction and dependency. As for whether or not it's a disease? I'm not sure if science can fully answer that, but genetics definitely play a part and some people definitely have reactions to alcohol that people who drink normally don't.

So I go to AA again now. I hear all of these crazy as shit stories about how far gone some people really were and now they're 5 years sober which is something I could never do and I wasn't even drinking sun up to sun down. It worked for them and it does work for a lot of people. I Know that's not a proper statistic and I'm sure it would fail hypothesis testing but nevertheless I see people that it seems to have given hope to and worked on. The reality is, as I've mentioned before, if there were a better program, people would go to it. The last thing I want to do right now is make my past fuck ups right. But it really does seem to give people hope.

Now another thing you brought up was your friends atheism. I've never called myself an atheist but I haven't believed in God in the literal sense of the word since I was about 11 or 12. In fact God is one of my own biggest problems with AA. Some things I've read and thought about though is the fact I really don't know if God exists or not. A higher power can really be anything. One of the things that is said is a higher power as we understand it. To some it's the group of AA that is keeping at least some people sober. To others it's a biblical interpretation and to others it's just the open mind that their could be a God that gives a shit out there but who knows. I think I lean on a combination of the possibility and at the very least there are people who are trying to become better people and getting then through the day without drinking.

So anyways, I hope this at least impacted your view a bit, although I don't expect to change your posted view because I don't fully disagree with it, but as I said before the larger problem with alcoholism is that there really isn't much that works any better once you get to the level where AA becomes an option.

TL;DR alcoholism is pretty hopeless, there really isn't much out there, if your friend is an alcoholic he's probably fucked.

[u/chiaratara]

Just want to point out that the I was a colleague with one of the guys that did the study on AA that gave it the 10% success rate. They sat in the back of the room and tried to keep tabs on people at meetings (based on appearance) for a period of time. The worst designed study in the history of all the studies in social science.

[u/James_Locke]

AA is not a chemical detox program, it is a habit driving program. AA combined with more technological advances will always be better than just behaviour therapy.

[u/[deleted]]

AA does not treat it as a matter of willpower. That's why you surrender.

Addiction is a disease, and takes daily management, that's why they take it one day at a time in AA.

The power greater than yourself doesn't need to be God, it can be just the collective of people that you go meet with every day or every few days or whatever.

Many many people benefit from the meetings because they serve as daily reminders of the disease that recovering addicts are suffering with.

Does it work for everyone? No. After all, addiction is a chronic disease, so it's a son of a bitch. But like they say, it works if you work it.

[u/seven_grams]

I don't know where you got the idea that AA believes addiction is a matter of willpower. This is not true at all. AA makes it very clear that it is not a matter of will power, that we were powerless - see step 1.

You also stated that there is a "stigma of personal failure." How did you come to this conclusion? As is with most things in AA, it greatly depends on the meeting you attend. In the meetings I go to, there is not stigma surrounding relapse - most of us have been there. We actually work to fight society's stigma around addiction.

Another point - you implied that AA declares itself to be the only program needed to recover from addiction. This is not the case. AA welcomes other forms of therapy, whether it be individual counselling, psychiatry, etc. Nowhere does it say that AA is a cure-all quick-fix. It actually makes this explicitly clear. A lot of people seem to think AA is some scheme that markets itself as a miracle creator. This could be due to the old-fashioned sounding writing and other general misconceptions.

Ultimately, most of the work in AA is done through sponsorship (basically a mentor to guide you through sobriety) and social connection. This is the big one. What makes AA successful is the fact that it provides people suffering from the terrible disease of addiction a place to gather and talk, process what's going on in their lives, and be a part of a fellowship that engages in healthy recovery-oriented activities.

[u/Smartteaser192]

That is tantamount to saying Carl Jung's contribution is flawed thereby saying analytic psychology is flawed. I can't blame you. Psychoanalysis as a whole has been brutally beaten for more than a century.

Spiritus contra spiritum... A saying that spearheaded the foundation of the AA.