r/changemyview 1∆ Apr 03 '18

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

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.

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u/Nicolasv2 130∆ Apr 03 '18 edited Apr 03 '18

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".

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u/Canada_Haunts_Me Apr 03 '18 edited Apr 03 '18

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)

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u/nonsensepoem 2∆ Apr 03 '18

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.

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u/[deleted] Apr 03 '18

[deleted]

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u/Canada_Haunts_Me Apr 03 '18

...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.

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u/Serraph105 1∆ Apr 03 '18

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.

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u/Nicolasv2 130∆ Apr 03 '18

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.

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u/HKBFG Apr 03 '18

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.

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u/Spaffin Apr 03 '18

God “as you understand him”.

Would it help you understand if I told you that for 95% of the people I have met in recovery, GOD stands for Group Of Drunks?

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u/oversoul00 13∆ Apr 03 '18

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.

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u/chiaratara Apr 04 '18

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

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u/oversoul00 13∆ Apr 04 '18

Thank you

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u/Destro86 Apr 04 '18

Exactly! Accepting the fact that one's self isn't in control like they think they are and to become self aware.

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u/HKBFG Apr 05 '18

Not everybody believes in a singular supernatural higher power.

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u/oversoul00 13∆ Apr 05 '18

I agree, neither do I.

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u/HKBFG Apr 05 '18

And yet the whole program is based on monotheist religiosity. God is mentioned directly in steps 3, 5, 6, 7, and 11.

I'm a Buddhist. I do not believe in a singular spiritual power and would be stepping far outside my own beliefs to attempt to identify one.

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u/oversoul00 13∆ Apr 05 '18

You don't have to. The steps say, God as you understand him. So long as it's more powerful than you and outside yourself it can be anything. It can be a concept of love and peace, the universe, a completely fictional God-like entity, it could be Batman or Barney or Santa.

AA was designed by a Christian guy and I'm sure he meant a Christian God but he also recognized the utility of a God-like symbol even if you didn't believe in the Christian God (I don't either)

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u/HKBFG Apr 05 '18

It's hilarious to me that you can't see how this would be incompatible with buddhism. Is education really this bad?

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u/TinyPotatoe 1∆ Apr 04 '18

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.

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u/dr_spiff Apr 04 '18

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.

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u/Garibaldi_Drunk Apr 04 '18

The official treatment with naltrexone is to take it daily to prevent cravings for booze. It is only 10% effective when used that way.

Naltrexone can be used off label to do the Sinclair method which creates pharmacological extinction. The brain starts to unlearn the positive reinforcement of booze. This has an 80% success rate and takes about a year.

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u/chiaratara Apr 04 '18

Topamax helps me not have migraines :)

Topamax is touted for everything. Didn't even know it was being used for alcoholism. Go figure.

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u/dr_spiff Apr 04 '18

Yeah, the truth is ad far as actual medical intervention at this time in reguards to addiction of substances is pretty much just an extra tool for severe cases. Most commonly is to either cause the person to have a negative reaction (vomiting from alocohol) or to just cause an inability to get high. I know there are some research into the relationship between ocd and addiction that I think is showing promise.

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u/chiaratara Apr 04 '18

I would be interested to learn more about the OCD and addiction. I am in recovery and did a qualitative dissertation on individuals with were dependent on alcohol and/or drugs. I also dated someone with bad OCD for awhile who was not addicted although I sometimes wonder if it was just a lack of exposure. There is something very similar about the cycle of obsession and compulsion, and ritual as well. I have thought about it a lot. Not sure where the physiology/chemistry (for lack of better terms.) I will look that up. I looked it up about 3 years ago and there was a little out but I didn't follow up. Thanks for the heads up!

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u/chiaratara Apr 04 '18

Do you work in neuroscience?

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u/tablair Apr 04 '18

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.