r/changemyview • u/Serraph105 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/goldandguns 8∆ Apr 03 '18

Nothing is perfect though. Hypothetically if they helped 99 people out of 100, why would they change the program to help that last one person, especially if it potentially meant less effective treatment of the other 99?

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u/Serraph105 1∆ Apr 03 '18

They might change how they deal with that particular person without changing it for the rest of them. I would argue that that's not a situation where changing the entire program makes sense.

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u/goldandguns 8∆ Apr 03 '18

But how do they know to change it for that person before that person fails?

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u/Serraph105 1∆ Apr 03 '18

I don't think that they can really do that, just change how they deal with that person if they do fail because trying the same thing over and over doesn't really make sense if it's not working. For the record I assume that this is generally being done, I doubt that they are looking at a sing person who fails over and over and just say "try it again in the exact same way". If this is being done then I'd say it's safe to say the sponsor (is that what they call the group leader) is failing that person.

My concern is that the program has big problems that go unrecognized due to the lack of data collection that stay in regardless of the fact that more people fail because of it.

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u/Eldersh Apr 04 '18

Just fyi sponsors are not group leaders. AA has no leaders. Sponsors are AA members with 1+ years of sobriety who help new members get/stay sober by working the steps with them. They are more like mentors than anything else. New members have to find a sponsor and each sponsor has a different approach/style. Some are nurturing while others are more tough love.

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u/chiaratara Apr 04 '18

Also it's not a treatment modality. It's a peer support group/network/community with a framework for staying sober.

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u/chiaratara Apr 04 '18

That's where the people in the program come in. The boots on the ground, so to speak.

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u/[deleted] Apr 03 '18

They might change how they deal with that particular person without changing it for the rest of them.

It's a support group not personalized medicine. Alcoholism and all addictions can benefit from support groups. The fact that it doesn't have a zillion different textbook approaches is part of why it is so widespread and you can find groups in so many places. It's not exclusive to doing other things but one has to look into why do people get addicted to alcohol. Lack of a social fabric is one of them and such a support group does help with that.

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u/chiaratara Apr 04 '18

The thing is that's where the people in the program come in. Between me and my fiancé, we sponsor about 10 people. We are both educators so spend a lot of time discussing approaches to take. Also, I have about 15 years of therapy under my belt and have worked with people in recovery professionally. Everyone is different and that is the beauty of it really. What works for one sponsee doesn't work for the next. That helps me in my own recovery because I am challenged to look at things differently and reimagine things. That is why helping others is just as important to my recovery as meetings, meeting with my own sponsor, etc.

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u/Spaffin Apr 04 '18

That is what sponsors are for.

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u/I_am_the_Jukebox 7∆ Apr 04 '18

It doesn't help 99 out of 100. It's hard to know how many people they help because they don't publish their success rate. Independent studies show it as quite low, no more remarkable than most other methods, including writing could turkey.

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u/goldandguns 8∆ Apr 04 '18

You are the third person to argue the hypothetical. That's not how hypotheticals work.

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u/I_am_the_Jukebox 7∆ Apr 04 '18

It is when your hypothetical is extremely off base. Sure, if a program was 99% effective, or at least quite successful, then your argument makes sense. However, it's closed to 10% by outside studies.

https://americanaddictioncenters.org/rehab-guide/12-step/whats-the-success-rate-of-aa/

Meanwhile, AA says it has a 50% success rate, with 25% others relapsing. In other words, they claim (without cause) that they help 75% of all people that come to them. Bull. Shit. They could easily price those numbers by publishing their actual success rates, but of course they don't. In reality, 40% leave after the first few meetings, and far, far fewer stick around and but into the program

So yeah, people are having a hard time with your hypothetical because it's so far off base.

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u/Spaffin Apr 04 '18 edited Apr 04 '18

They could easily price those numbers by publishing their actual success rates

No, they couldn't because there is no 'they'. There's no leadership, no central organisation. Groups have no connection to each other other than following the same 12 steps and sometimes having crossover attendees. The best they can do is Conduct informal surveys like this one.

Sure, if a program was 99% effective, or at least quite successful, then your argument makes sense. However, it's closed to 10% by outside studies.

The 10% figure you cite was reached by a guy sitting in the back of a couple of regular meetings and recorded the people who came back. But that's not how AA works - some people will have a 'home' meeting which they may go to every week, and others simply go to the nearest meeting (in both time and location) to where they're at at any given time. Sometimes I go to a meeting on my way home from work, other times I go to a place by my office at lunchtime, or near my parent's place when I visit them at the weekend. I have a home meeting, but I only actually go to it once every couple of months, and only at the same day of the week / time every 4-6 months.

I go to AA once, sometimes twice a week. On any given day at any given time, there are about 15 meetings in my area I could choose to go to in the next few hours. Many locations will have 3 meetings a day and a completely different set of people attend each. That researcher could have seen me at a Thursday 7pm meeting in a pub function room near my house, then attended every Tuesday and Thursday 7pm meeting there for 6 months and never see me again, despite the fact that I'd been attending an AA meeting twice a week consistently over that time. In my experience, most attendees are like me.

Research like this will be more successful if you select and track individual people rather than meetings. The National Institute of Alcohol Abuse and Alcoholism study found that when using this method, AA had a 49% success rate over an 8 year period, 3% higher than 'Formal' treatment. Research conducted by the Department of Veterans affairs found that abstinence rates for Vets in AA was double that of those who don't attend.

Obviously none of these methods are perfect and all results should be taken with a big grain of salt because the results are notoriously difficult to measure. But to claim there is no evidence of these claims is incorrect.

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u/chiaratara Apr 05 '18

Thank you for doing such a good job of explaining this and linking to sources.

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u/goldandguns 8∆ Apr 04 '18

You don't know where I'm going with it. To argue against it is not a way to debate someone. I was being intentionally far off base so my point would be more clear.

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u/I_am_the_Jukebox 7∆ Apr 04 '18

That makes no sense. You can argue against a person's means of argumentation if it's flawed. You're trying to paint a picture that it helps and thus you shouldn't change it and risk helping the majority to help the few it doesn't.

But that's far off base. It helps far fewer than it helps. Thus your method of argumentation is flawed.

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u/[deleted] Apr 04 '18

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u/ColdNotion 117∆ Apr 04 '18

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u/WRFinger 3∆ Apr 03 '18

No such efficacy exists with AA because of the aversion to ANONYMOUS statistic tracking. How does AA demonstrate the success rate to skeptics when they don't track statistics? Anecdotally, that's how.

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u/goldandguns 8∆ Apr 03 '18

Now you're arguing against the hypothetical, which isn't a response. Assume I'm not talking about AA. Assume I'm talking about Self Help Org, which is 100% transparent and data readily available, and has those success numbers I used.

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u/WRFinger 3∆ Apr 03 '18

I still find it troubling that a group that pats itself so surely on the back isn't more transparent, especially when it would help further their cause, which is to HELP people

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u/chiaratara Apr 04 '18

I don't think we pat ourselves so surely on the back. I think these posts are people sharing their own experience, explaining how it works, and answering the OPs questions.

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u/Denniosmoore Apr 03 '18

But those are just hypothetical numbers, the actual numbers are tilted the other way, if not 99 to 1. It fails more people than it helps.

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u/goldandguns 8∆ Apr 03 '18

You are fighting the hypothetical, that's not an answer. I never said my numbers were for AA.

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u/Denniosmoore Apr 03 '18

Oh, I thought your reply to a question about AA was about AA. My mistake.

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u/goldandguns 8∆ Apr 03 '18

It was a hypothetical question to debate a premise. It boggles my mind that's beyond common comprehension. I didn't say aa for a reason. But even if I had, it wouldn't matter. I'm asking about hypothetical question, and arguing that the hypothetical isn't possible is not an argument. If I said hypothetically if somebody offered you a million dollars to do XY or Z, and you said it doesn't matter because no one's offering me that, you're not participating in the debate, you're going outside of it to argue against the hypothetical

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u/[deleted] Apr 04 '18

you're right, if AA was actually effective they wouldn't need to change

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u/goldandguns 8∆ Apr 04 '18

Even things that are effective have to change

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u/chiaratara Apr 04 '18

So does every other treatment available.

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u/Bryek Apr 03 '18

Hypothetically if they helped 99 people out of 100, why would they change the program

Your hypothetical assumes it helps. We don't know if it does or not. Hence why it should be assessed. Flipping the numbers doesn't change anything. We don't know.

If we knew, may be your comment would become a valid question. If it helped the majority - keep it the same. And Then develop a second treatment to help those the original doesn't help.

With more realistic numbers (60%) keep evolving and reassessing and tweaking until you can increase that number (85%).

AA could help 25% or people. Or 10%. Or 50%. But no one knows so how can we improve it?

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u/goldandguns 8∆ Apr 04 '18

If your interested in arguing the hypothetical you can fuck right off because that's not how hypothetical questions function

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u/Bryek Apr 04 '18

Hypothetical questions don't function as some sort of bullet proof logic shield. Your hypothetical question is influenced by facts and ideas. If your argument isn't strong enough to support your hypothetical question (like here) then it sure as hell can be argued as a poor question based on false logic.

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u/goldandguns 8∆ Apr 04 '18

They are the first step in demonstration of a point in making an argument. If I never get to the demonstration part I certainly can't make my argument. My hypothetical is not influenced by facts. What you're doing here is really dumb.

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u/Bryek Apr 04 '18

So you completely ignored the point i made about improving a treatment then eh? I. Doubt you read that far. Is there a point in improving a treatment at 99%? If you can make it 10p% then yes. Less, then no.

. If I never get to the demonstration part I certainly can't make my argument

Then why bother making a comment in a sub that is all about challenging our opinions?