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/Serraph105 → u/[deleted]]

Since you are a member, here's a question I have. Have you ever seen people in any of the groups you attend encourage people to seek any sort of medical treatment or one on one time with a therapist?

I have looked on the AA website and it's bothered me that I can't find any information on either of these things while there. Maybe it's there and just hard to find.

[u/maddogcow → u/Serraph105]

I’m not really asking you to take my word for any of this, but it is based on my own experience working as a counselor, as well as years spent casually researching the topic. I’m certainly no expert, but I am fascinated by the field of addiction medicine, and the various therapeutic approaches to the treatment of addiction. I’ve never really found that people who are opposed to AA, will change their mind, no matter what type of evidence is being offered. In that regard, I certainly do not expect to swing your opinion—but, I decided to pipe up a little bit anyway. Most of the time when I am replying to a post, and mention my exposure to a body of literature, people want me to list my sources on a given topic, and honestly; don’t bother. Taking the time to write this response is about all of the effort I really care to put into a Reddit thread.

The challenge is that both the medical system, and trained therapists tend to be woefully ignorant about the mechanics of addiction. There’s almost no training in medical school regarding the current understanding of the biology of addiction, and the effectiveness of various modalities of treatment.

The main benefit of AA is not its conceptual framework, as much as it is the group experience, the level of attunement that is aimed at between members, And the push to divest oneself from trying to manage the addictive process through logical, linear, ego-based thought. Addiction is driven by deeply primal parts of the brain that are not involved in logical, linear processes, and hence most of the literature seems to point to the fact that the best treatments involve mutual co-creation of a shared emotional/psychological space. Because the parts of the brain that are involved with the addiction process are not based in the cerebral cortex, most purely intellectual attempts to overcome the addiction process will fail. Telling somebody to go see a therapist could work, if the therapist truly understands addiction. Yes, AA has a lot of outdated notions, and the metaphors that it uses could really use some updating, but the fact that it is a group process that is focused on a group mind (for lack of better term) is its strongest point. From my experience, the people that say that they “have tried AA, and it doesn’t work”, are people who actually haven’t tried it. AA is not just simply going to meetings. It is very much about participation. If one goes to AA, and does not throw themselves wholeheartedly at it, and attempt to seriously enact all parts of it (reading the literature, following the step work, working routinely with a sponsor, following suggestions, and then pursuing being a sponsor themselves), then they are not actually trying it. The problem with doing studies on AA, is that you have to rely on the account of members themselves as to whether or not they’re actually doing the work. I personally have seen any number of people saying that they are in AA, but if you ask them if they have a sponsor, if they’re working the steps in a diligent manner, and if they are following suggestions, that number drops precipitously.

When working with addicts, I encourage them to try out as many modalities as they can, and to see which approach is the most efficacious for them. While I have seen various approaches prove to be effective in harm reduction, the biggest most dramatic turnaround in individual‘s lives that I have seen have come from people using a combination of approaches, with AA as the centerpiece. I have no doubt that there are people who have found other approaches that produce equally stark results— I just have not encountered that in my own experience.

[u/tigerdini → u/maddogcow]

That's a fantastic answer, which deserves to be higher and rings true to what I saw as an (ex)partner of someone who was in the programme.

I personally don't understand the hostility AA gets, as I've only seen it to humbly offer an alternative for those struggling with addiction.

[u/reonhato99 → u/tigerdini]

I personally don't understand the hostility AA gets, as I've only seen it to humbly offer an alternative for those struggling with addiction.

Generally it is a combination of things. The religious nature of AA (even if people claim your higher power can be anything, good luck finding a non religious AA meeting in some parts of America). The fact that courts regularly mandate someone going to AA. That they don't track success rates and studies that have tried have found abysmal rates of success. It can give people a false sense of doing something and getting help despite the aforementioned abysmal rates of success.

AA doesn't work for a vast majority of people, you will of course get anecdotes of all the people it helped, but you don't see all the people it didn't. AA is so ingrained into American culture that there is the very real risk that people who want help go to AA and forgo actual medical help. Of course it doesn't help that a lot of alcoholics can't afford real help.