The Irrationality of Alcoholics Anonymous (2015)
theatlantic.com
theatlantic.com
The article is a pretty good summary of the sad state of alcohol and drug dependency treatment in the U.S. The prescription is always abstinence, and almost universally any suggestion that moderate drinking might be possible for some is met with scorn and anxiety.
My objections to AA have little to do with their mention of God. I am christian, so obviously that is not a problem for me. I will say that AA theology is awful, basically implying that salvation comes from sobriety, but worse is that it actually indoctrinates many with ideas that hinder their ability to recover from addiction. Regardless of whether or not you believe the way I do, I hate to see people needlessly suffering from this illness (or perhaps, this group of related illnesses), yet the conclusion I came to after 25 years of involvement with them is that AA more often than not prolongs suffering.
I am not saying that naltrexone or any other drug is the magic bullet, but I am certain that it is well worth investigating alternatives to AA. If you or anyone you are close to needs help, please take the time to explore all the options. There is so much snake oil in this area that it can be difficult to know which way to turn. It is worth the time and effort it takes to find the right treatment, and if it is successful, it is probably even worth the inflated cost of said treatment.
I'm often reminded of the David Foster Wallace passage from Infinite Jest when I think about people who need to break 100% free from their addictions:
“--and then you're in serious trouble, very serious trouble, and you know it, finally, deadly serious trouble, because this Substance you thought was your one true friend, that you gave up all for, gladly, that for so long gave you relief from the pain of the Losses your love of that relief caused, your mother and lover and god and compadre, has finally removed its smily-face mask to reveal centerless eyes and a ravening maw, and canines down to here, it's the Face In The Floor, the grinning root-white face of your worst nightmares, and the face is your own face in the mirror, now, it's you, the Substance has devoured or replaced and become you, and the puke-, drool- and Substance-crusted T-shirt you've both worn for weeks now gets torn off and you stand there looking and in the root-white chest where your heart (given away to It) should be beating, in its exposed chest's center and centerless eyes is just a lightless hole, more teeth, and a beckoning taloned hand dangling something irresistible, and now you see you've been had, screwed royal, stripped and fucked and tossed to the side like some stuffed toy to lie for all time in the posture you land in. You see now that It's your enemy and your worst personal nightmare and the trouble It's gotten you into is undeniable and you still can't stop. Doing the Substance now is like attending Black Mass but you still can't stop, even though the Substance no longer gets you high. You are, as they say, Finished. You cannot get drunk and you cannot get sober; you cannot get high and you cannot get straight. You are behind bars; you are in a cage and can see only bars in every direction. You are in the kind of a hell of a mess that either ends lives or turns them around.”
My understanding is abstinence programs are for those that have tried to moderate and cannot.
To quote AA:
Ch. 3 More About Alcoholism... For those who are unable to drink moderately the question is how to stop altogether.
Ch. 3 More About Alcoholism... We do not like to pronounce any individual as alcoholic, but you can quickly diagnose yourself, step over to the nearest barroom and try some controlled drinking. Try to drink and stop abruptly. Try it more than once. It will not take long for you to decide, if you are honest with yourself about it. It may be worth a bad case of jitters if you get a full knowledge of your condition.
It also seems strange to suggest naltrexone as an alternative to aa.
From living sober:
AA. members and many of their physicians have described situations in which depressed patients have been told by AAs to throw away the pills, only to have depression return with all its difficulties, sometimes resulting in suicide. We have heard, too, from schizophrenics, manic depressives, epileptics, and others requiring medication that well-meaning AA friends often discourage them from taking prescribed medication. Unfortunately, by following a layman's advice, the sufferers find that their conditions can return with all their previous intensity. On top of that, they feel guilty because they are convinced that "AA is against pills." It becomes clear that just as it is wrong to enable or support any alcoholic to become re-addicted to any drug, it's equally wrong to deprive any alcoholic of medication which can alleviate or control other disabling physical and/or emotional problems.
I'm having a hard time finding where it's suggested in their literature that salvation comes from sobriety?
However, I strongly suggest, as do you, for those suffering to seek out help and consider all options.
The message is the opposite. It's sobriety comes through salvation.
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 understood Him.
I hope I did not suggest that abstinence is not the correct answer for some. It just isn't the answer for all, which is what is generally taught in AA. And the quotes from Chapter 3 are not serious, in the sense that if a newcomer to AA says something like, "Maybe I can drink moderately," the answer is pretty much always, "How did you end up here then!?" (Frequently, the answer is, "The judge told me I had to come in order to avoid jail.")
>It also seems strange to suggest naltrexone as an alternative to aa.
Living Sober was written before naltrexone was invented. I have known a number of folks who were prescribed Valium and similar drugs in the '60s and '70s and '80s who became addicted to both Valium and alcohol.
Further, the Living Sober quote suggests medication may be appropriate, but "alcoholism" (or whatever the DSM-5 calls it now) is often the main diagnosis, with any other diagnoses placed as subordinate to that main diagnosis. The implication is, "Stop drinking and the rest will go away," which is frankly bullshit. The Orange Papers (for all its many flaws) has a good section on this.
>I'm having a hard time finding where it's suggested in their literature that salvation comes from sobriety?
This is not from the literature, but rather from my observation over many years. Many times I have heard it suggested that AA is "basically christian" or "based on christian principles" but the reality is that it is based on what is properly called "Buchmanism" (for Frank Buchman, the founder of the Oxford Group). There is a tinge of christianity to it, but it is based on works (staying sober) rather than on grace.
This is why many moral failings in AA are glossed over with, "Nobody's perfect! Just stay sober and you'll be OK!" That is an appropriate response to dealing with a medical issue -- for example, a heart patient may also be a greedy, corrupt thief. The moral failing does not generally have any bearing on the treatment of the cardiovascular issues. So why are alcoholics taking moral inventories and making amends and confessing their shortcomings to others?
In other words, is it a disease, or is it a moral condition? If it's a moral condition, then let's not call AA's solution "christian," because it is not. If it is a disease, then let's treat it like one rather than using the twelve steps.
> In other words, is it a disease, or is it a moral
> condition? If it's a moral condition, then let's not call
> AA's solution "christian," because it is not. If it is a
> disease, then let's treat it like one rather than using
> the twelve steps
I think that in AA alcoholism itself is considered a disease, with at least two components: an allergy of the body; and an obsession of the mind. The disease of alcoholism is considered to have far-reaching effects which are best dealt with by two things: staying sober and working the 12 steps and thereby having a spiritual experience.
I'd say it's analogous to someone who's had a heart attack. The immediate crisis needs to be addressed at an emergency room. Then there are lifestyle and diet changes that need to happen, too. The heart attack might have been the initial problem that precipitated the crisis, but the lifestyle issues are the real cause.
AA is a big organization, and there are certainly different interpretations, but I think it's fair to say that alcohol is certainly seen as the problem, but the underlying cause of the problem is seen to be the lack of a spiritual lifestyle. Hence the two-pronged approach. Very often Christianity is used because it's what's familiar. But I'd hardly call AA a Christian organization.
Also, I feel you're misunderstanding the "moderation" that the article speaks of. The AA literature you quote is about someone who is actively dependent in a bad way trying to moderate themselves. The "moderate drinking might be possible for some" line is about returning to a life of moderate drinking in the future.
In addition to AA and NA, I have also taken various medications for depression and mania, and have been through all sorts of talk therapy. I have not taken any of those medications for over a decade, I no longer go to meetings or therapy, and, among other things, I have found that I can drink in moderation. I drink very occasionally, maybe once every few months, at social occasions.
I cannot claim that anyone who becomes a christian would have the same experience. I do not know that. And I am aware of weaknesses in those areas that used to cause me so much trouble, but I can also say that they are not debilitating the way they were previously.
When I left AA and NA, I went around to all my old meetings and told my friends there why they would not see me any more. There were some very interesting conversations, to say the least. I wish them no ill will, but as I said above, I would not recommend those groups to someone in trouble. I wouldn't say not to go there, but I would not send them there as a first option.
I don't really have any pat advice to offer anyone struggling as I did, beyond, Don't give up. Yes, it's painful, but don't give up looking for solutions. (And as someone else said here, taper taper taper if you're trying to detox.)
>I didn’t mention that some bare-bones facilities charge as much as $40,000 a month and offer no treatment beyond AA sessions led by minimally qualified counselors.
After all we also have AA-style treatments, and while I can't comment on their features, a quick Google-Fu reveals that the cost for month's inpatient rehab is 6500 €. (It's a fully private enterprise, and not a part of the public health care.)
That said, I'm an atheist, my buddy is an atheist and here in the northeast the religious part is really watered down, from what I hear, compared to other parts of the country.
I go because hearing others stories and talking to others about the being an alcoholic is really helpful.
I haven't drank in 4 years and AA was a crucial part. But I've never done the steps ( I can't even call it a higher power, that's lipstick on a pig in my book ). It's the talking to others that's helpful. People would say things, especially in the beginning, that articulated things I'd felt but unable to put into words.
In addition to speaking with other alcoholics I use philosophy, Eastern thought and stoicism, and the occasional use of lsd and mushrooms to keep me off the sauce. I never say I'm "sober" because of the latter part, but that was never my goal. I just needed to quit drinking and I couldn't.
My biggest problem with AA is the religious side. Overall the program seems to help people face their issues and take responsibility for their actions, but the toolkit, in my mind, barely gets them above water. But it is better than drowning. I'd love to see the organization revamp to catch up to the 21st century. The big book is like reading an anthropology book from the 19th century. It's sad how some people cling to it.
One feature of AA that I think a number of people fail to remember, though, is that there are meetings everywhere at many different times. For those that haven't lost everything you should certainly seek alternatives. But there's a large population of people that are so messed up they've lost everything and quite literally wouldn't know how to find help in other places.
Addiction sucks and is one of the most heartbreaking things for me to see. But not everyone that uses is an addict, whether it's alcohol, marijuana, or even cocaine.
To anyone wrestling with it: good luck, get help and know there is another side to your life. The rest of it doesn't have to be spent feeling the way you do now.
I've never gone through any programs but have had family who have. On the religious stuff - my general interpretation has always been that it's less a confession of faith in a higher power, but more a surrender of control, or in some senses a selection of values above yourself that you adhere to. From a bird's eye view, it kind of sounds like you already are doing that, with philosophy/Eastern thought/stoicism.
I'm very open about my alcoholism. Primarily it's to help other addicts see past the shame almost all of us experience. Secondarily it is to help non-addicts understand the addicts in their lives.
After stating how hard it is too verify statistics for positive results,the author damns the guess made 50 years ago when Bill Wilson first wrote the book, and most likely had a far better conversion record as they were then dealing with highly motivated quitters. It is almost humorous that this author is complaining about the success rate of this method, when a large number of the pool of candidates are forced into treatment by either the law or parental coercion. Now I would like to say mid- rant that I am biased. I stopped drinking 33 years ago, and while I would not admit to membership in this group in a public forum, I would suggest people who WANT to quit, to give it a try.
I would be one of the first to say that there are a lot of hokey parts to the traditions they follow, and I do not agree with a lot of the premises of the literature---- But that being said........It works! One interesting opinion about AA comes from Charlie Munger, Warren Buffets business partner. Charlie writes quite a bit about the psychology of business, and he gives his fairly well thought out opinion of why AA works so well. I wonder whether the AA bashing is just for controversy to better sell the article, or if perhaps the author is helping to market the new version of naltrexone the is being quite heavily promoted to judges recently.
From the article:
"Lance Dodes, a retired psychiatry professor from Harvard Medical School, looked at Alcoholics Anonymous’s retention rates along with studies on sobriety and rates of active involvement (attending meetings regularly and working the program) among AA members. Based on these data, he put AA’s actual success rate somewhere between 5 and 8 percent."
According to that, about the best you can say is that "it works when it works", which isn't saying much. I'm glad it worked for you, but the fact that for evey one of you there are 10 who go back to drinking doesn't do much to recommend the program as the legally mandated cure-all it currently is.
Look at AA as addiction transference - you're transferring your addiction from Alcohol to AA - and for some, thats the best they can do, for others its the start of the journey to moderate consumption.
I underwent a pretty radical change getting sober, moved to a different part of the city into a semi-supervised sober house, and started going to AA meetings. What I found there was a diverse group of people, with even more diverse problems (drugs, alcohol, violence, relationships) that had 1) accepted the problem was of their own making and 2) collectively decided that only through their own actions could they make themselves whole again. My AA group is a little unconventional in that we are extremely accepting of different types of addictions, and operate in an inner city area much different than my suburban upbringing. For me, AA is about living a stoic life, accepting what you can control, and disregarding what you cannot control. Seeing these same problems, across race, class, gender and geography was a pretty transcendental moment for me.
AA is just one part of what I'm doing to stay healthy: the other component, which in a lot of ways I trust more, is cognitive behavioral therapy, and group therapy. I think eventually more 'evidence based' group therapy systems will take over, but you just can't beat AA's model: people helping people via donated time and services.
When a new person walks into 'AA' with just a 'desire to stop drinking' their entire experience comes from the individuals, qualified only through their anecdotal experience in sobriety, that they meet. As a data scientist ready to defend AA, it used to be hard for me to rectify the fact that 1) AA is not effective as a prescribed intervention and 2) I'm in AA, and it works. How can I recommend a treatment when I know doing nothing in some cases is often better? Well, I don't know, and for me, AA is about staying sober, statistics be darned, I have something that works.
Finally, getting sober, for me, was a long, difficult, and extremely uncomfortable experience. If you are reading this, questioning if 'AA' is right for you, I would strongly implore you to attend a few different meetings in your area. Raise your hand, introduce yourself, and see what comes forth. AA will not save you, you will save you.
I am sure AA won't work for everyone but it works for certain types of people. In my humble opinion it works exactly because it isn't based on hard science but on personal experience. Actually - "this is how it works" is something you hear often at meetings.
Now regarding the financial side. 40k$ for bare bone AA meetings is something very American.
In Poland AA is self-financing, meetings are open and free. If you can afford you can make a voluntary donation to your group cash-box which is used for coffee and tea. Like 2-3$. Local community or a church is providing place for meetings. Everyone is welcome (if he is not under influence). In . city the size of Warsaw there are meeting going every day and at different hours. So AA is affordable to anyone and at any time while even public healthcare therapy will involve some cost or long wait.
First, just "give yourself over to God" means nothing. Sobriety takes work. One falls into a bad pattern, and you need conscious effort to break that pattern. I found the SMART program, which uses Cognitive Behavioral Therapy. That worked for me and made sense for my brain.
Also, my religion (Eastern Orthodox Christianity) teaches that God will throw a life raft, but you gotta grab it, hold on, and swim to shore yourself. Again, the same work ethic, not just "turning yourself over".
I really find AA makes it difficult to people to get sober. I'm sure it does work for some, but I believe it may take longer for them.
One way or the other, perhaps the saddest form is the most used – a very short clinic stay coupled with benzodiazepines to help safely stop a prolonged bender. Nothing wrong with that per se, but it's not really enough... but it's a free world.
TL;DR: The science around this is terrible so it's hard to know anything with much certainty, but it looks as though AA isn't much better or worse than other treatments. Whether it's more effective than no treatment at all is an open question.
Doug Stanhope has some insightful comedy on the subject (nsfw)
Two: But it worked for my dad.
One: Another scientist told me the earth is doomed.
Two: That's good science. Let's get a drink.
Hmmmm that's not a lot when your talking problem drinking as an addiction. That'd be typical in a frat house.
There's a lot wrong with the article and a lot right. Pick carefully.
There's no reason you can't go to AA and do the Sinclair Method. AA is full of Atheists the god bit is misleading.
I'm not sure why they are putting down AA when AA is not against the Sinclair Method. AA has found their way works for some people. It's also cheap councling. Not everyone can afford well paid doctors.
If your drinking is that bad you need a pill to stop it wouldn't hurt to talk to others about the problem as well. And AA is a meme/cult/religion that allows that except they don't go to war and fight others over oil and resources.
> Hmmmm that's not a lot when your talking problem drinking as an addiction.
Twenty drinks at a time is not a lot? Don't most people draw the line way before that? In the Netherlands drinking more than three drinks a day is considered problematic drinking (for men); I wager that this won't differ that much around the globe.
People with alcoholism can drink a lot more than that.
A UK unit of alcohol is 10 ml of pure alcohol. You'd consider inpatient residential rehab for someone drinking 30 units per day. There are roughly 40 units in a litre of spirits in the UK.
https://pathways.nice.org.uk/pathways/alcohol-use-disorders/...
I find it a strange case for a male person with an addiction problem (which is what we are talking, AA style intervention) thinking 'sometimes as many as' 20 drinks to be a statement of supprise.
Pretty sure that's not a good measuring stick for healthy behaviors.
edit: maybe linux is a bit strong, php?