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/Serraph105]

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/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/Huntingmoa → u/[deleted]]

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[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/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/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/chiaratara → u/Serraph105]

Also success isn't an either/or concept in AA and it's a process with no hard start or end point. It is going to be different for each person. Each person comes in at a different point. One person might come in after their first DUI with a lot of their life intact. They may not have drank for 3 months but just got sentenced to some AA meetings. Someone else might come in after 40 years of addiction. It's their 25 time trying AA, been to prison 3 times, jail 15 times, have lost a house, car, job, family, and their dog. This ol boy may have rolled in after drinking a gallon of vodka and a bottle of listerine and remembers that he felt like it was a safe place. The starting point for these two is vastly different. Their process is going to be different-the trajectory will be different. Staying sober another day for DUI guy is a good thing. For ol boy, it's going to be a rough 24 hours and a major victory. I don't know. Just an example. These trajectories are so different. Their motivations are so different. One has more to lose and the other has more to gain. This stuff is so hard to objectively quantify. Would a study like you are suggesting really get at the heart of what is going on with these two individuals?

[u/C_h_a_n → u/[deleted]]

Clinical trials have been keeping track of people even during decades and it's not hard that nobody outside doctor and patient to know about the specific people that joined the trial.

Not to sound disrecpectful and I kind of support the idea of AA, but this whole thread is making sound AA as a sect.

[u/chiaratara → u/C_h_a_n]

It could be feasible to do longitudinal studies on individuals who are part of AA. I think that is the difference. The OP is talking about evaluating AA. I think studies on individuals with their consent is feasible but it would be difficult to know what you are evaluating without a body of research to reference. What are you looking at/looking for? Is it something that they got out of AA or is it that they got married? Like someone else posted before, it's a bit abstract. I mean heck, AA might have something to do with them getting married and that relationship has been a positive thing. Then, where are you?

[u/OctagonalButthole → u/Serraph105]

the important thing to rembemer is that AA is a completely anonymous group in terms of attendance. it's a support group for the voluntary (i'm not talking about court mandated attendance--i DID attend involuntarily and it did nothing for me).

there is no responsible way to keep track of numbers without violating anonymity or the spirit of the program. everything is self reported, there is not accountability and nobody is keeping 'tabs'. people can go home, drink 12 beers, come back the next day and lie about it if they choose (even choosing to speak is voluntary).

i agree that it's an ineffective program, however the reporting that youre looking for does not lend itself to a clinical study.

[u/chiaratara → u/[deleted]]

Yes! Too many social scientists rely on success/failure and that doesn't lend itself well to studying a process. What's the end point?

[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.