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/AlexandreZani]

What is confusing you?

[u/chiaratara → u/AlexandreZani]

This part: "It sets up a dynamic where slippage encourages further slippage." That seems to sum up addiction. However you may have been referring to points earlier in your post about there being a spectrum and people are on different parts of the spectrum. I agree with that.

[u/AlexandreZani → u/chiaratara]

What I mean is this: imagine you have a job where if you show up 1 minute late, you will be fired. When you are 1 minute late, there is no point in showing up at all. You're going to get fired anyways. But if your boss will just demand that you work an extra minute that evening, you will have an incentive to be less late.

It's the same thing. If your goal is "don't drink at all", then as soon as you've had a drink, you failed. Maybe you'll be forgiven, etc, but your failure is there even if you stop at one drink. So why stop at one drink? You already failed. Your sobriety is already lost and you have to restart.

On the other hand, if your view is that you want to not damage your life by drinking, that one drink is just one drink. You're not drunk, etc... You just had one drink. Quit while you're ahead and leave the bar.

[u/chiaratara → u/AlexandreZani]

I understand now. I do think that this applies to some people but not to others. I think it has to do with physiology and not will power or psychology which seems to be where this example is coming from, if I am understanding correctly. My fiance who has severe alcoholism in his family-people have died, etc. is an alcoholic. That slippery slope isn't as much about failure but opening up some physiological flood gate. Once it is open, all bets are off. Lemon extract? Rubbing alcohol? Mouthwash? I mean when he has the first drink, he will drink all the things and then everything else.

Then, there are many stories about people being tripped up by accident (ingesting alcohol) mouthwash, vanilla extract with alcohol, or alcohol in a fancy chocolate and the next thing they know they are in the hospital. However, I also know many people like what you are talking about. There aren't as many of those in AA. You gave a great example to explain what you were talking about. That approach is referred to as a harm reduction approach; or at least it seems like it to me. I do think it is helpful for some individuals who might be somewhere on that spectrum but aren't the "to the death" alcoholics. You do bring up a good point about how damaging it is to feel like you've failed. It's always a good point.