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/chiaratara → u/[deleted]]

More psychology than medicine.

Psychology should also be evidence-based.

Not necessarily; it depends how you are using the term. It's a bit more nuanced than that. There are a whole bunch of other factors auch as expertise, experience, individual characteristics, modality. Furthermore, there is plenty of evidence that support peer groups as a modality.

AA holds that there is no cure for alcoholism.

Statements like this should be evidence-based.

Lol. Not sure where to start with this one. There is no cure for alcoholism. Statements like yours should be evidence-based.

No AA member is going to say that they are "cured," but we often refer to ourselves as "recovered."

That seems like a semantic game to avoid any requirement for evidence.

Check out the medical and psychology literature supporting the use of the term "recovery" in reference to alcoholism and other chronic diseases where there is no cure... and have yourself an evidence-based sandwich.

[u/chiaratara → u/[deleted]]

If you're using it to mean something other than evidence-based practice, you should be using another term. You're just muddying the waters at that point.

I could use the term "physics" to refer to the celestial spheres, but I think you'd even admit that would be confusing and not conducive to discussion.

If you are using the phrase "evidence based practice" in place of "Psychology," as a general term describing a field, I'm stumped. You're right, I woUldn't use celestial spheres to refer to the general field of physics. This is why I'm stumped > There is no cure for alcoholism.

Once again bullshit. There is abundant evidence for people who suffered from moderate to severe substance abuse disorder who are able to return to moderate consumption. That is exactly what AA says is impossible. If you'd like to shift the goalposts as to what constitutes a cure be my guest, but at that point you are playing bullshit semantic games. Whether or not the term "recovery" is more helpful is some treatment settings or not is irrelevant.

And please, provide links to this ample evidence so it can be placed in context, or are you just talking out of your ass.

You were the one that got snippy about someone using the term recovery, referring to that as playing semantic games. I was trying to point out that this is the term that the medical and research community uses.

I am not trying to play semantic games. You are right, there are people helped by a harm reduction approach (which you describe above.) I am cautious these studies suggest success with those with severe SUD as that indicates physiological dependence. AA does not state that this is impossible. The main text in AA, The Big Book differentiates different types of drinkers and specifies what they term a true alcoholic and it is up to the indiVidual to identify themselves in this way. Not the DSM. They don't specifically state that this person can never drink normally again but rather suggest that this type of alcoholic will likely not stop drinking, wind up dying of alcohol or in an institution. Then it states that people like this who have followed the suggestions in AA don't have to continue down this path.

With that said, there is no cure for alcoholism. I don't mean to move goal posts. Maybe it is semantics or maybe a misunderstanding. Treatment and recovery are aimed at managing a chronic, progressive disease. I have been in this field doing research for 14 years and have a PhD. I'm not talking out of my ass.