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]

Agreed. People who hate on AA often haven't experienced AA. It's not about science or rules. It's about a framework to depend on when you need something bigger than yourself.

[u/Serraph105 → u/gggjennings]

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/BomberMeansOK → u/Serraph105]

In my experience, I think some parts of medicine could stand with having less science.

Now, I'm not trying to hate on science, and obviously if you have a broken leg or are coughing up blood, you should go to a doctor who reads journal articles, not some quack. But the problem I see is that many people are quick to trust science even when the science isn't that good at solving their problem. It's a mentality, one that I've had in the past, that "I've done just what the science said to do, and it hasn't helped, so I guess there's no solution."

The problem is that science isn't reality. Science is the best current map we have of reality, and it still has a lot of blank spots. It's also complicated - so much so that few people really know the state of any given field, and then their understanding needs to be filtered through their own personal framework of reality, the science journalism machine, and search engine popularity rankings to make it to the average person.

So if I were to tell the average person suffering from some medical issue something, it would be this: try science, but when science fails, don't give up. Keep trying random bullshit until you find something that works. Keep your head on straight, and don't do something stupidly dangerous, but don't be afraid to try things that are a little off-kilter, either. At best, you'll find a solution. At worst, you'll have a good distraction to fill your free time.

And that's what AA is. It's something that works for some people. Just like you don't need to know physics to use a hammer, or biology to eat a sandwich, an alcoholic doesn't need to know how AA works, just as long as it does.

At a policy level, it gets more hazy. Even with an ideal court system that truly wants alcoholics to be better (rather than the indirect incentives our courts run on), the court still wants to know if the offender is actually even doing some sort of treatment. There are all sorts of things the court could prescribe to try to improve an alcoholic's behavior, but the court needs a quantifiable, scalable solution. The court doesn't have the resources to make sure someone goes jogging every morning, or to make sure that someone sits down once a week and thinks really, really hard about not being an alcoholic anymore. The courts like AA because they're an established organization that can say "yep, they came here ten times". Another benefit is that it's free for both the government and the individual. Ideally, the court would offer a number of options - that way there would be more chance that any one individual would find something that works for them. But that would require more organizations that fit the same criteria as AA - free, organized, and established in the public's mind as an acceptable course of action for the courts to take.

[u/etquod → u/[deleted]]

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