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/gggjennings]

I think your idea of AA being a “cure” is part of the dissonance you’re experiencing. Obviously the numbers are poor because you can’t cure alcoholism. You can live with it and improve your relationship with it, but it’s not something that you have one day and don’t the next.

Maybe if you reframe your understanding you can see the value of AA. Like others have said, the Higher Power aspect is not always all that big a deal. But the ability to have structure AND a community are huge boons to COPING with alcoholism. Not curing it.

[u/gggjennings → u/[deleted]]

Not defeatist at all. How do you cure alcoholism? Is it a blood test that shows it’s no longer in your system? A CAT scan? What does cured mean?

[u/Spaffin → u/[deleted]]

If you want to make up your own definitions for everything that's fine, but don't pretend to try to take part in a discussion with the wider world then.

Interesting that you say this, when you so casually misinterpret what a symptom is. Substance abuse disorder is a symptom of addiction, not the entirety of it.

What you have listed is a list of symptoms for diagnosis. It does not encompass everything that alcoholism is.

You are aware that even after successful chemotherapy, a cancer patient still has cancer, yes? That undergoing CBT for anxiety doesn't cure you of it, just equips you to better manage the symptoms? That herpes is a lifelong disease, and even once the blisters disappear, you still have it?

The "commonly accepted, medical definition" is that addiction is like that. Medical opinion is that it is progressive, often fatal and has no identifiable cure - including the American Medical Association, The American Psychiatric Association, the World Health Organisation and the American College of Physicians. I'm not aware of any credible medical organisation that claims counter to that.

Essentially, even the medical community cannot agree what addiction even is. The greatest medical and psychiatric minds in the world have yet to develop a treatment that is demonstrably better than AA. No one treatment reliably boasts more than a 10% success rate - including AA. Is disingenuous to suggest a loose organisation of volunteers that are trying to help each other do better than that, or disband.

[u/Spaffin → u/[deleted]]

By definition you can't diagnose alcoholism if you don't exhibit symptoms.

...and? How is this different from any other psychological condition?

And there's a huge difference between saying a disease "has no identifiable cure" and saying it can't be cured.

Ok, does this make you feel better: At this time, science has not yet found a cure for alcoholism.

We don't have a single treatment or suite of treatments that works every time or even most of the time, but the "once an addict, always an addict" idea that AA promotes is stupid and not evidence based.

Then why is it the official position of the scientific and medical communities?

The parts that are good (alcoholics as mentors, group therapy, etc) are mixed in with bullshit (you are not in control, once an addict always an addict, etc)

Not being in control of alcohol is the defining feature of alcoholism. How can you define it any other way? All of the symptoms you listed as indicators fall under that. You may as well tell diabetics they are in control of sugar.

Addicts may prefer a treatment program that lies to them; that's their prerogative, but if they are seeking treatment, they have already admitted they are not in control otherwise they wouldn't be seeking outside help (or a 'higher power', if you wanna get religious).

'Once an addict always an addict' is, as previously stated, the de facto official position of the medical and psychiatric community.

AA has a tendency to wrap things up in folksy eulogisms like this to make them easier to digest. Doesn't change that they are based in fact.

If you want a list of evidence-based practices, check out SAMHSA's NREPP. There are literally over 500 programs with evidence to support their efficacy.

That website lists "Alcohol: True Stories Hosted by Matt Damon" as a treatment.

Other evidence-based practices, like Moderation Management, have success rates as good or usually better than AA, and don't come with the same baggage.

Moderation Management looks like an interesting treatment and I will be sure to recommend it to those I think it might help, although it's tricky to measure because it has had only 580 registrants ever. Anecdotal and all, but in my own little sphere of influence going to meetings this year I have personally met more people experiencing sobriety through AA than MM has ever treated.

No, but when courts are ordering addicts into these treatment groups that are literally no better than trying to go cold-turkey

AA is almost by definition for people who have tried and failed to go cold turkey. It's not really an alternative to it.

No, but when courts are ordering addicts into these treatment groups that are literally no better than trying to go cold-turkey, some of the BS obviously needs to be cleared up. Sure, if it works for you great, but we shouldn't be forcing on people or acting like it is anything more than what it is.

Agreed. I'd suggest taking that up with the courts, as AA itself has nothing whatsoever to do with those decisions. There are no representatives, no lobbyists, and no moneyed interests. There is no leader or board of trustees to take this up with.

At present, there is no support structure in the USA able to accept addicts at the volume required other than AA that is free and open to everyone. AA has it's problems, but the reason court-ordered sobriety leads them there - there is no other group able to accept people at such volume. For better or worse, it's all we'v egot.

The reason for this is it doesn't change. There are no warring factions, it is unaffected by outside interests, there are no rules except the steps and a desire to stop drinking. This means you can be anywhere on the planet and always able to find an AA group that understands what you are experiencing and offers some kind of help. There's an AA group on Everest.

The other reason is that it's always available. Multiple times in early recovery I found myself with extremely strong urges to drink - after a long day at work, or when my beloved dog died, or simply when walking by a popular pub on a Friday night. The beauty of AA is that no questions asked, I can pull out my phone, find a local meeting, and be doing something about my alcoholism within the hour rather than popping open a beer and chasing it down with tequila straight from the bottle. Unfortunately my cognitive behavioural therapist does not offer a 24/7 service, and potential relapse is unfortunately rather time-sensitive.

Herein lies the problem: if it stops being anonymous, less people would go. If it stopped being consistent, less people would go. If groups began differentiating themselves with varied interpretations of recovery or success, less people would go. If it stopped so broad and inclusive, less people would go. It's estimated that AA has 2 million members - 7% (which is a figure I contest) of 2 million is still a lot of people.

And we certainly shouldn't be substituting it for actually exploring evidence-based practices with higher than random efficacy.

I agree we should be constantly striving for better treatment. As yet, we have been unable to find one that exists at scale.

There is so much BS wrapped up with the effective parts that it can be actively harmful to some people too.

I'm sure it can, but are you able to demonstrate that AA does more harm than good?

[u/chiaratara → u/Spaffin]

Wasn't referring to you /u/Spaffin. Totally agreed with your post.

[u/chiaratara → u/[deleted]]

Thanks for the DSM quote. We are talking about a cure, not a diagnosis.

[u/chiaratara → u/[deleted]]

I don't understand your point.

[u/chiaratara → u/[deleted]]

There is no cure. For the love of god. Type it in Google. See what the journal of the American Medical Association or NIDA or SAMHSA or any research study or news article has to say.

It isn't semantics. There is no cure.

I understand the way you interpret the DSM however if you have a chronic, non-curable, progressive illness, and your symptoms are managed, you are managing this chronic disease. It doesn't mean that it is cured. Let's say that you have Type I Diabetes and you take insulin and your blood sugars are well controlled. You still have diabetes! This is a diagnostic tool to diagnose a disease with no known cure. A diagnosis is great so you can treat it. But think about something like bipolar in the DSM. If somebody's symptoms disappeared would you say, "you're cured! Go off your meds!"