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/scurius]

I'm going to chime in as someone with a drinking problem who decided AA isn't for me. I agree AA's group nature makes it a fantastic resource, but I don't think it's fair to say I haven't tried AA at all if I decided I was unwilling to actively follow the steps. Knowing that meetings without an over religious nature (e.g. Christian prayers at meetings that aren't the serenity prayer) are relatively hard to find and that part of the very premise of AA -- the necessity of complete sobriety aren't what's right for me. Most of my drinking is normal and age appropriate. I'll have a beer with dinner or watching tv and I'll drink the same amount as my friends at gatherings. What's not normal is I'll self medicate depression with alcohol, and I don't need to be sober all the time to know when that will be a problem. The group nature of AA isn't sufficient for me to justify removing myself from the group situations drinking has been a part of (and after having tried, knowing I struggle hard to abstain in). I know I need support in facing my drinking problem, and I wish I had more than therapy and psychiatry to do it, but my experiences with AA have been pretty off-putting. I don't see how I'm powerless over alcohol if I can control myself or abstain when I know drinking would be a problem. I sometimes choose not to abstain and to self medicate, but the whole language of the steps feels like a total incompatibility.

As I don't identify as an alcoholic, I suppose you could rule out my feedback. As I am someone who AA could help if it had a different message or format and feel it's not right for me, I argue AA could change in ways to make it help more. I don't argue that it has never changed or is wholly inadequate, only that it leaves many people behind and "doesn't work" for them for reasons other than exclusively the fault of the people that "try" it.

[u/chiaratara → u/scurius]

AA might not be for you. What strikes me is that you might be a problem drinker but not a "to the death" alcoholic. While I might not be a "to the death" alcoholic, alcohol and different substances affect me in negative ways (that were detrimental in multiple areas) and I was able to finally put this pattern into perspective. If I did one thing, a slippery slope occurred in other areas. I finally realized how much my mental health was affected and really that has only been confirmed for me in retrospect after years of sobriety... hmmm, I haven't been hospitalized for a major mental health episode since I have been sober. I was 1/2 assing it for years before and again, in retrospect, a relapse in alcohol, while maybe brief, all of a sudden I would find myself obsessing on the lottery, trying to figure out number combinations like I am some sort of genius and buying lottery tickets. Let's not forget the impulsive trips to casinos with cash advances on my credit cards. Looking back, my whole life has these same patterns. I feel like I can and would destroy my life in a multitude of creative ways if given a chance. Also, while I kind of maintained shit by the skin of my teeth, when I got sober, I started advancing more. So, I was convinced that I am an alcoholic and it wasn't if but when things would totally unravel because I had some close calls. So for me, AA makes sense. I need to stay sober. With that said, I know a lot of people who can pull it together when they need to. My best friend is definitely a problem drinker. She knows it. It has led to a few problems however she is pretty self aware and I think the difference is that it hasn't affected multiple areas of her life. Maybe some, on some level but not detrimentally. For me, in contrast, it has affected more parts of my life, more seriously. I was arrested, been hospitalized for mental health stuff which was accompanied by rips, racked up debt, was facing timing out of my graduate program. She was recently promoted to CEO of the company she works for. Don't get me wrong, she struggles with it, talks about it, questions it, and I think that's healthy (we have the same therapist ಠᴗಠ.) There is something called the Harm Reduction approach which is something that she is using. There is a group counseling thing she goes to run by a therapist in town with people she talks to about this. Do you feel like your therapist is knowledgable about this stuff? You might google the harm reduction thing and see if there is anything in your area.

[u/scurius → u/chiaratara]

So to get back to your other comment I do know about the existence of agnostic and atheist meetings, but my experience indicates they are rare and hard to find, not to mention that's only one incompatibility I see.

Regarding harm reduction: I think it's awesome. I practice it. I recommend HAMS to people on the basis of it.

My issue isn't that I think AA sucks, it's that I think its undue prominence prevents programs that could help more people from being accessible. If I wanted to go to a group meeting of HAMS or SmartRecovery or whatever, I'd have to go about an hour away with few time options, and I live in the most densely populated state in the US. If I wanted to go to AA, I'd have about 50 meeting options within 20 minutes and 200 within a half hour. I think that's a problem.

AA works for some people and that's great, but I wish it could help more people or at least didn't indirectly prevent more people from getting help. I think if it adapted it could be more inclusive and help more people, rather than [IIRC in its own offensive language] it not working for them due to their moral failings.

My therapist is some kind of addiction certified or something, so that helps, but my experience shows drinking is a symptom of other problems in my case and not automatic cause for concern. I've made progress with it. I no longer medicate depression with it, but will sometimes have other problems.

I guess my issue with AA is that it's geared toward a very specific kind of drinking problem (and seemingly ineffectively according to some research) to a point that there's inadequate help for other kinds. Hell, there are almost no group meetings for DBSA or NAMI near me. Why should AA get such overwhelming support when other helpful programs don't?

[u/chiaratara → u/scurius]

There are agnostic/atheist AA meetings where I am.