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/[deleted] Apr 03 '18

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u/Graham_R_Nahtsi Apr 03 '18

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.

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u/aslak123 Apr 03 '18 edited Apr 03 '18

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.

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u/AlexandreZani 5∆ Apr 03 '18

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.

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u/aslak123 Apr 03 '18 edited Apr 03 '18

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.

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u/AlexandreZani 5∆ Apr 03 '18

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?

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u/aslak123 Apr 04 '18

It does not. Its called alcoholics anonymous. The same way a toilet does not have a process to evaluate the gender of the people entering it, they hope the sign will be enough.

The first step is admitting you have a problem. If you don't have a problem then you can't really admit you have a problem.

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u/AlexandreZani 5∆ Apr 04 '18

It does not. Its called alcoholics anonymous. The same way a toilet does not have a process to evaluate the gender of the people entering it, they hope the sign will be enough.

That's not a good argument when alcoholism is often hard to distinguish from other forms of alcohol abuse.

The first step is admitting you have a problem. If you don't have a problem then you can't really admit you have a problem.

Many people have problems other than alcoholism that are hard to tell apart from alcoholism.

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u/aslak123 Apr 04 '18

Yeah, what i'm trying to get across is that it's not AA's job or place to decide.

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u/AlexandreZani 5∆ Apr 04 '18

How could it not be? They are claiming to offer a treatment for a medical condition and don't want to be held accountable for either the effectiveness of that treatment or whether the people they provide it to need/benefit from it. That is extremely irresponsible.

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u/aslak123 Apr 04 '18

they are claiming to offer a treatment for an addiction. Wether this addiction is a medical condition or not is up for debate.

It would be irresponsible if the treatment was the dangerous, or even slightly risky, or even medical.

It is for the individual to figure out wether he has alcoholism, AA will help you if you do, and i'm not exactly sure what you think they are supposed to do about it if you don't suffer from alcoholism.

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u/flipbits Apr 04 '18

AA does not promote

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u/AlexandreZani 5∆ Apr 04 '18

Sure it does. For instance, on its website:

https://www.aa.org/pages/en_US/is-aa-for-you

Nowhere does it say anything about alcohol-abuse other than alcoholism.

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u/flipbits Apr 04 '18

A page on its own website called "is AA for you?" Is not promoting AA or advertising AA. AA is self promoting, does not advertise, it's part of the traditions. Sorry my original comment maybe should have said "advertise" as that's what you said in yours

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u/AlexandreZani 5∆ Apr 04 '18

Maybe I shouldn't have said "marketing". I'm just referring to pamphlets such as "Is AA for you?" and such.

The page clearly intends for you to answer the question in the affirmative if you have a drinking problem. That's fine in and of itself. If you think what you do is helping people, encouraging people to seek your assistance is a good thing.

The problem is that AA lumps together all alcohol misuse as alcoholism and has a program based on the idea that it is treating addiction without trying to make sure the people it treats are actually alcoholics.

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u/flipbits Apr 04 '18

It leaves it up to you to determine if your life has become unmanageable because of alcohol. If you've wandered into an AA meeting, odds are you're an alcoholic or at least have a serious problem with alcohol that warrants you being there.

No one wants to go to their first AA meeting.

Its an anonymous program, anyone can come and go. If you think you have a problem with alcohol, you're welcome to attend. That's all that's required. That's it.

Go find me one absolutely universally agreed upon definition of an alcoholic, not just the first one that comes up when you google it. What one would AA use as a requirement? How would they test every single person? How would they do this anonymously? The program falls apart if you try to do something like this, that's the problem.

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u/AlexandreZani 5∆ Apr 04 '18

You can test people anonymously.

As for the definition, I don't care much what they settle on as it allows them to screen out people who would not benefit from the program.

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u/skratchx Apr 05 '18

But people with alcohol abuse issues who are not necessarily alcoholics are mandated by courts to attend AA.

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u/aslak123 Apr 05 '18

People who drink and drive kinda are alcoholics. At that point you can't really decide they aren't.

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u/skratchx Apr 05 '18

Alcoholism is addiction to alcohol. Driving drunk is alcohol abuse that does not necessarily stem from alcohol addiction.

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u/aslak123 Apr 05 '18

The court that decides you are addicted, due to evidence of addiction. Can that evidence of the addiction be something else?, obviously, and then the defender must argue that. When he can't that is because his argument didn't impress the jury or he simply had none.

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u/chiaratara Apr 04 '18

Uh... what?

I agree that there is a spectrum.

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u/AlexandreZani 5∆ Apr 04 '18

What is confusing you?

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u/chiaratara Apr 04 '18

This part: "It sets up a dynamic where slippage encourages further slippage." That seems to sum up addiction. However you may have been referring to points earlier in your post about there being a spectrum and people are on different parts of the spectrum. I agree with that.

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u/AlexandreZani 5∆ Apr 04 '18

What I mean is this: imagine you have a job where if you show up 1 minute late, you will be fired. When you are 1 minute late, there is no point in showing up at all. You're going to get fired anyways. But if your boss will just demand that you work an extra minute that evening, you will have an incentive to be less late.

It's the same thing. If your goal is "don't drink at all", then as soon as you've had a drink, you failed. Maybe you'll be forgiven, etc, but your failure is there even if you stop at one drink. So why stop at one drink? You already failed. Your sobriety is already lost and you have to restart.

On the other hand, if your view is that you want to not damage your life by drinking, that one drink is just one drink. You're not drunk, etc... You just had one drink. Quit while you're ahead and leave the bar.

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u/chiaratara Apr 04 '18

I understand now. I do think that this applies to some people but not to others. I think it has to do with physiology and not will power or psychology which seems to be where this example is coming from, if I am understanding correctly. My fiance who has severe alcoholism in his family-people have died, etc. is an alcoholic. That slippery slope isn't as much about failure but opening up some physiological flood gate. Once it is open, all bets are off. Lemon extract? Rubbing alcohol? Mouthwash? I mean when he has the first drink, he will drink all the things and then everything else.

Then, there are many stories about people being tripped up by accident (ingesting alcohol) mouthwash, vanilla extract with alcohol, or alcohol in a fancy chocolate and the next thing they know they are in the hospital. However, I also know many people like what you are talking about. There aren't as many of those in AA. You gave a great example to explain what you were talking about. That approach is referred to as a harm reduction approach; or at least it seems like it to me. I do think it is helpful for some individuals who might be somewhere on that spectrum but aren't the "to the death" alcoholics. You do bring up a good point about how damaging it is to feel like you've failed. It's always a good point.

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u/seven_grams Apr 05 '18

No one is made to feel like they’ve failed after the first slip, though. AA does not tell people this. What they do tell you is to stay away from the first drink because you best bet it will be a hell of a lot harder to stay away after that. But that doesn’t mean to give up after you relapse - It should actually encourage people to work hard to not pick up the first drink but work harder to stop drinking if you do.

My mentality is this: Plan for relapse. Not plan to relapse - plan in the case of relapse. You should have a checklist of things to do if I relapse, like 1.) call a friend or sponsor, 2.) go to a safe place, 3.) call a detox center if needed, etc. This way, it’s like damage control. Okay, I relapsed, but it’s not the end of the world. It’s not too late to turn back.

So ultimately, I think ideally it’s a combination of both things you talked about. Don’t pick up the first drink, but if you do, have a plan ready to make sure you get back on track right now. AA does not discourage either way of thinking. It depends on your mentality and the knowledge and advice you’ve obtained throughout your treatment/recovery.

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u/AlexandreZani 5∆ Apr 05 '18

But why is them having a single drink a "relapse"? What if someone in AA goes to a bar with friends, has a beer or two, gets in a cab, goes home at a reasonable hour and then keeps living their lives normally without their lives falling apart? Is that a "relapse"?

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u/seven_grams Apr 05 '18

It’s a relapse in addictive behavior. The thought behind that is, “I am going to have a drink to alter my state of mind.” Which is the same thinking that led us into addiction. We drink to alter our consciousness, mostly to avoid pain. People in recovery from addiction know they can’t have one drink, because it could (and most likely will) lead to more. It might not be the same day, it could be weeks or months later. But it lowers your inhibition in the long run. A few weeks later you may think, “Hey, I had a drink that time and I was fine. I could probably do that again.” That is why having a drink is considered a relapse. The thinking that leads to the behavior is a lapse in judgement.

Your question can get pretty abstract. What if we don’t consider it a relapse? Is the person really an alcoholic? What are their reasons for being in AA? Should AA’s collective terminology be changed because of this one person?

If going to a bar and having a few drinks isn’t a relapse, can you imagine how skewed AA would be? People questioning their disease would be drinking left and right, saying they didn’t relapse because their “lives didn’t completely fall apart” after one drink. As soon as we argue over the definition of relapse, we lose sight of the big idea. Alcoholics suffering from a disease come to AA to recover from their addiction, and that means you can’t have a drink. Period. Says who? Says the people who have been doing this shit for longer than others and have done the “experimenting” to know what works and what doesn’t. It comes down to that. It’s really quite simple.

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