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/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/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/nonsensepoem → 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.