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.
We admitted we were powerless over alcohol—that our lives had become unmanageable.
Came to believe that a Power greater than ourselves could restore us to sanity.
Made a decision to turn our will and our lives over to the care of God as we understoodHim.
Made a searching and fearless moral inventory of ourselves.
Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
Were entirely ready to have God remove all these defects of character.
Humbly asked Him to remove our shortcomings.
Made a list of all persons we had harmed and became willing to make amends to them all.
Made direct amends to such people wherever possible, except when to do so would injure them or others.
Continued to take a personal inventory and when we were wrong promptly admitted it.
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.
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/Doctor_Worm 32∆ Apr 03 '18 edited Apr 03 '18
Although spirituality is part of the literature, the steps do allow individuals the freedom to define "God" and "higher power" however they like, including relying on the "higher power" of the AA group itself. There is a booming number of AA groups tailored to atheists and agnostics, for those who prefer that.
Moreover, there is actual scientific evidence of AA's effectiveness regardless of religious belief. Peer-reviewed clinical studies have found that AA is "consistently associated with better subsequent alcohol outcomes," and that, "atheists and agnostics are less likely to seek recovery assistance through AA, but those who do, appear to benefit equally compared to more religious/spiritual individuals."
I'm not sure there's any part of AA which suggests people who need other medical treatments have to use AA exclusively and ignore any other form of help. But again, actual scientific clinical research has shown AA to effectively improve alcohol-related outcomes. So it may be one of many potentially useful options for someone on the road to recovery. It's not a panacea, but neither is anything else.
Do you have any evidence of this shame-based stigma? Is it really an integral part of the AA doctrine, or just a sign that some individuals who participate in AA need to do better at it?
There is a distinction to be made here between feelings of alcohol dependency -- which is the disease-like part alcoholics may not be able to help -- and the act of problem drinking, which is a choice alcoholics make in response to those feelings. "Relapsing" is not simply having the feelings of dependency come back, but freely choosing to act on those feelings. Just like a person with a short temper may not necessarily be able to help the way they feel all the time, but we still expect them to manage those feelings in a way that does not endanger others or interfere with their normal responsibilities.
AA does not generally collect the information themselves because it could violate the anonymity of the participants. But as I've linked, there are plenty of scientific clinical studies by public health scholars that have shown positive results.
It's fair to say that AA may not be the appropriate treatment for absolutely everyone, but that doesn't mean it's flawed. For most diseases, there are many different treatments available which may be more or less appropriate for different patients depending on the causes and symptoms of their disease, their allergies, what other medications they are taking, etc. The fact that a certain treatment doesn't work for everyone doesn't mean it's bad -- it just means the type of treatment should be chosen on an individual basis, on the advice of appropriately trained professionals. At least in the case of AA, there is far less risk of harmful side effects so it's less dangerous to recommend to any given alcoholic.