NPR did this piece on AA last March but I’m not sure I saw it then, and if I did I forgot about it, so I’m looking at it either again or for the first time.
The punchline? For 90% of people who try it, it fails.
AA and the many 12-step groups it inspired have become the country’s go-to solution for addiction in all of its forms. These recovery programs are mandated by drug courts, prescribed by doctors and widely praised by reformed addicts.
Dr. Lance Dodes sees a big problem with that. The psychiatrist has spent more than 20 years studying and treating addiction. His latest book on the subject is The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.
Dodes tells NPR’s Arun Rath that 12-step recovery simply doesn’t work, despite anecdotes about success.
Because guess what: we don’t hear the anecdotes about failure.
There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent. Most people don’t seem to know that because it’s not widely publicized. … There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine.
It’s not only that AA has a 5 to 10 percent success rate; if it was successful and was neutral the rest of the time, we’d say OK. But it’s harmful to the 90 percent who don’t do well. And it’s harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. AA is never wrong, according to AA. If you fail in AA, it’s you that’s failed.
So that’s crap for morale, self-respect, hope – lots of things. Bad news.
The reason that the 5 to 10 percent do well in AA actually doesn’t have to do with the 12 steps themselves; it has to do with the camaraderie. It’s a supportive organization with people who are on the whole kind to you, and it gives you a structure. Some people can make a lot of use of that. And to its credit, AA describes itself as a brotherhood rather than a treatment.
So as you can imagine, a few people given that kind of setting are able to change their behavior at least temporarily, maybe permanently. But most people can’t deal with their addiction, which is deeply driven, by just being in a brotherhood.
And it’s a terrible shame that AA has such a great reputation; it’s tragic that most people think it does work, and that courts tell addicts to go there.
Interesting. For me, at least, it’s also educational because of the big difference between actual stats and anecdata. I’ve known three or four people who went through AA. They all stopped boozing, and have stayed off the stuff. For the oldest one, that’s over thirty years.
The program itself sounds fairly weird, what with all the talk of putting yourself in the hands of a higher power and the whole confessional nature of it. But, hey, whatever works, I thought. Now I hear it doesn’t work. I can’t say that surprises me because my only thought when my friends were telling me about it was, “Ewww. That would never work for me.”
I’ve known some people who went through AA. They went to AA meetings three to four times a week, and the minute they stopped going, they fell off the wagon.
Plus, one guy I was dating, who had been alcoholic for 20+ years before he met me, was told to get rid of me, because I was the cause of his drinking. Why? Apparently it was always family – they were bad for you, they caused you to drink. This might only be the particular group he was in, but it seems it is bad advice to tell someone to get rid of the only stable thing in their life (yes, I’m stable. Haven’t always been, though). He bawled like a baby, i went, good riddance.
My observation has been that AA simply becomes another addiction for a lot of people. It takes the place of the alcohol, and they have to go constantly. There is no closure. Real rehab has closure.
My mom went to AA off and on for as long as I can remember. She had long period of sobriety followed by pretty destructive periods of heavy drinking that sort of cycled through. It may have had something to do with her bipolar disorder which went undiagnosed until later in her life, but even once she was being treated she still had issues. It wasn’t until she very nearly killed herself that she suddenly quit cold turkey and hasn’t felt the need to drink in years (the difference from previous times of sobriety being that she used to always feel that need). She goes to AA regularly, still, and credits it with her continued sobriety, but I think this well may be a rationalization. After all, it didn’t work all those other times, so why would it be that in particular that helped her and not some more profound psychological change (like almost dying, switching medication, etc.)?
The biggest immediate problem with AA is the anonymity. In your AA group, you might be sitting next to a violent criminal who has been sentenced to AA as a condition of his parole or to avoid incarceration. And because of the anonymity, you’ll never know it until too late. There is no oversight, no protections for the vulnerable people who go there simply seeking help. Since criminals are often manipulative and predatory, there have been tragedies, but of course AA accepts no responsibility.
So if a treatment program is claiming a 5% success rate, that means that they simply aren’t making people WORSE. AA can’t even make THAT claim (honestly).
The Harvard Medical School found that 80% of former alcoholics who quit drinking for a year or more do it without assistance of any kind. A paper from the Oxford University Press Journal, Alcohol and Alcoholism, found “Untreated remission is not a transient phenomenon” and “This is the first study focusing on untreated remissions from alcohol dependence on grounds of longitudinal data. Findings clearly show, that remission from alcohol dependence without utilization of formal help is very stable.” http://alcalc.oxfordjournals.org/content/41/3/311
Notice that this absolutely contradict’s AA’s rhetoric about the impossibility of recovering on one’s own, without AA.
The National Institutes of Health’s National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health performed the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, interviewing over 43,000 people. They found:
“About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol (rehab) programs and AA. Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment.“ http://www.spectrum.niaaa.nih.gov/features/alcoholism.aspx http://www.orange-papers.org/orange-secrets.html
Wouldn’t it be something if AA were honest about such studies and AA’s own irrelevance?
AA was actually *impeding* people’s recoveries. From a Cambridge Hospital study:
In that study, they followed an initial population of alcoholics for 8 years. During that time, 29 of them died – the highest mortality rate of any treatment program ever studied. AA members are far more likely to engage in binge drinking as well (which could be related to the mortality rates, of course).
AA is not a “cure”, it is replacing one addiction with another; it doesn’t solve the problem, it only changes its form. It makes relapse more likely than by going cold turkey.
There are (via a quick search) few or no definitive numbers on the success rates of people who quit on their own without treatment. But I suspect that’s because no one has bothered to do any serious research on the subject, not because people can’t kick addictions on their own. You can’t quit unless you really want to – and if you really do want to quit, do you really need treatment?
http://www.scientificamerican.com/article/can-you-cure-yourself-of-addiction/
http://www.psychologytoday.com/articles/200407/the-surprising-truth-about-addiction
Last I checked (years ago for a college course), no support system at all was several times more effective than AA (ah, yes, I see several other people have linked studies). Granted, the studies I found were surveys based on self-selection, so potentially the people who opted for trying to quit drinking without support were the sort of people for whom it was more likely to succeed, but it’s still pretty damning.
Also, the most addictive drugs there are – heroin, nicotine, cocaine – only have long-term addiction rates of at most 1 in 6, irrespective of interventions aimed at quitting. Most of our ‘knowledge’ concerning drug addiction is pure Drug War propaganda. This includes the scientific research, much of which is biased in favor of the outcomes the funding sources (frequently NIDA and NIMH) would like to see. Our popular models of addiction are seriously flawed. Carl Hart at Columbia, for one, has been doing research that’s upending established models for addiction for the past couple of decades (there are others; he’s one of the most prominent). This article examines some of the competing views of addiction; I tried to find the longitudinal study that showed a lifetime addiction rate for heroin at a little below 1 in 8, but I can’t remember the search terms I was using. :-/
my brother IS an addict, and I can tell you from many many years of experience, it’s not the nature of AA that succeeds at anything, in fact, it is downright enabling. lots of addicts go to AA and basically use it as a dating service to find other addicts who will enable them in relationships.
no, what happens is, that when you’re first desperate enough, or forced, to go to AA, is the time you start to at least be confronted with the fact you really do have a problem, and many then actually start to at least try to do something about it.
AA was just the convenient excuse.
like going to the gym is the excuse to eat better and lose weight, even if all you do at the gym is watch TV.
no, AA is nothing more than a scam.
Scott Alexander did a post about the research on 12 steps a while ago: http://slatestarcodex.com/2014/10/26/alcoholics-anonymous-much-more-than-you-wanted-to-know/
John @8: The address is missing from the link you supplied. Could you try posting it again?
The other thing is that a lot of AA devotees seem to be taught to see everything as alcoholism.
My sister is in AA, as we my brother-in-law (until he died of a treatable cancer because he preferred to go to faith healers and reiki and whatnot…) and they were both convinced, my sister is even more convinced now (with her 2nd AA husband) that I am an alcoholic.
Because I have depression, etc.
I don’t drink. I’ve never been a drinker.
But I’m apparently an alcoholic.
(as was)
AA has many of the defining characteristics of a cult.
“sonofrojblake” is quite correct. Recently saw a show on it (one of the network “news” shows) that had how AA can be a hven for sexual predators.
There is a current play about the founders of AA called “Bill W. and Dr. Bob”. It’s a benefit to small theaters since it makes an automatic audience. Unfortunately, it is a lot of nonsense. I did see it and found it hilarious that some of the Christian audience members were “shocked, shocked” that there was cursing in it.
AA and the Twelve Step program was created by a fundamentalist Christian, and it strongly echoes the fundamentalist mentality. Three of the steps (8, 9, 10) are atypical and emphasize personal responsibility and accountability, something that is at direct odds with standard fundamentalist Christianity, but the rest could have been taken right out of a Southern Baptist church member brochure.
Ouch.
Blanche Quizno@6:
That might have something to do with AA’s message that — at least for “alcoholics,” there is no such thing as moderate or controlled drinking. The teaching is that if you have one drink, you’re going to have 10 or 20 or whatever. Which may well be true for many or most, I’m just skeptical of a one size fits all approach.
Discussions of AA seem to involve a lot of goalpost-shifting and special pleading by the hard-core AA defenders. The only solution for an alcoholic is complete abstinence: if a former problem drinker manages to cut back to a moderate amount, he or she is either lying, heading for a crash, or was never a “true” alcoholic in the first place.
It’s difficult to even pin them down on what AA is. They object to you quoting from the Big Book or other AA publications as evidence of what AA is about/believes/practices; they insist that AA is a ground-up organization, so it’s about what happens in the group, not some set of rules laid down by Bill W. But if you provide examples of behavior of a particular group (e.g. preaching Christianity, creepy “thirteenth-stepping” predation on new members), well, that’s just a bad group and they’re doing it wrong. (“Wrong” by what standard? Crickets.)
And of course, there’s lots and lots of anecdotal and emotional evidence brought forth. “How dare you criticize AA! AA saved my/my spouse’s/my parent’s/etc. life! I/he/she/they would be dead in a ditch if not for AA!” They also have a set of insults ready for their critics (e.g., people who get sober without “working the steps” are “dry drunks,”).
My unscientific hunch is that AA probably does “work” for some people. Even if it is substituting an “addiction” to meetings for an addiction to alcohol, that’s almost certainly an improvement. And it is generally cheap/free and easily available. But as the OP points out, its reputation as the One and Only Solution For Everyone is a problem (as is the still-ongoing practice of some courts or prisons sending people to what is — sorry, AAers — a religious program).
I think that one of the main reasons that 12-step programs enjoy continued support despite such a lame success rate, is that there is so little discussion of any alternatives that work better. Take this very thread, for example: I just read the whole thing, and while I have no reason to dispute any of the damning facts presented here about AA’s lameness, at the end of the thread I’m left with only two options — AA, or nothing. So who could blame ordinary people for choosing AA over nothing? Drug addiction is bad, so “nothing” isn’t really much of an option.
This is an even bigger problem for addicts who end up in the court system: if a judge wants to send an addict to treatment, he can’t just say “get some kind of treatment” (that would be a bit like saying “spend some time in jail”); and he’s not necessarily competent to recommend specific treatments in the mental-health department; he has to have a particular policy he can apply more-or-less equally for equal situations, and what else is there but the nationally-known one-size-fits-all 12 steps?
So does anyone here have any alternative treatment programs with better success rates than AA that they’d like to recommend? If you want to dump AA once and for all, you’ll need something to replace it with.
My first job out of college was a haven for alcoholics, and my boss and my mentor were both in the same AA circle, so my first year on the job, I went to a lot of AA celebrations and met a lot of people in that group. I’m not really a drinker; I can count on one hand the number of drinks I down in a year. My mother can’t drink–it makes her physically ill–so it wasn’t something we had in the house when I was growing up, either.
I was accused of being an alcoholic because I…loved going to aerobics class (this was the 1980s and I was 22 years old). I went 2 or 3 times a week, so therefore I…was an alcoholic. I didn’t get the connection, either.
I also noticed that the people in the circle were not drinking alcohol, but their addictive behavior spilled out into other areas of their lives. Many ate compulsively, and others shopped compulsively. I came away from that group believing that AA just shifted the addictive activity from alcohol into something else. Nobody ever seemed to be cured.
Another problem here is affordability: there may be far better treatment regimens than AA, but can most addicts afford any of them after they’ve lost their jobs, exhausted all their credit, blown their life savings and hit the proverbial rock-bottom? AA at least is cheap or free, depending on how much you voluntarily donate to each meeting.
In North America at least pop culture doesn’t help. Lots of TV and movie characters with substance abuse problems are shown as members of AA or a similar 12 step program. So we get used to the idea that the solution to such problems is AA, and that other alternatives don’t exist, or don’t work.
The 5-10% claim is actually promoted by a Christian subculture IN AA. It is uncritically quoted by journalists in the absence of any real trustworthy numbers. AA keeps no records and does not participate in research. So the 5% claim is based solely on a deliberate misreading of a chart in an AA pamphlet from 20 odd years ago.
AA has NO PR departnment and does not make public pronouncements. When news stories declare that ‘AA says X’ or ‘AA insists upon Y’ they are pulling it out of their ass.
There is an immense amount of problems with AA, and even more with the ghastly industry of ‘addiction treatment.’ But a lot of anti-AA propaganda is self-contradictory to the point of incoherence. You cannot reasonably criticize AA for its lack of central authority, and inability to control the behavior of individual groups or members while simultaneously insisting that AA is some ‘elders of Zion-ish’ organization with a vast connection to power and authority.
The treatment industry, and the creeping religious right, have had a pernicious effect on AA in practice. This has been a growing problem in the 26 years I’ve been a sober member.
http://www.aacultwatch.co.uk/
Is a group of members in England who document, and oppose, these influences.
One paper on ‘success rate’ claims:
https://archeralcoholismstudies.wordpress.com/article/pathways-to-abstinence-impact-of-33nxpux3imfog-6/
A couple of members, also professional statisticians, follow the misrepresentation of success rates:
https://drive.google.com/file/d/0B0cW38yqky8uSVZZdmozRDZqOXM/view
Alcoholics Anonymous is not a ‘treatment,’ is not a therapy, is not a church. ‘The Steps’ are only a reverse-engineered attempt to duplicate the activities of about 68 early members. They are, in fact, optional and suggested only. If you encounter an AA member, or a treatment center, that insists upon some ritual conformity around The Steps, walk away for your own safety.
There are a couple of million people (though who can count them) who stay sober together as a fellowship. ‘It’ works remarkably well. Treatment does not.
@johnthedrunkard
Isn’t all of this exactly what is so problematic about AA? Like reiki and homeopathy and prayer, the claims are so vague and untestable as to be meaningless. “Success” is placed on the individual not the method, so that people who don’t succeed are the problem, not the system used for success. You haven’t even described what AA is, just what it isn’t. It’s not treatment and it’s not therapy and it’s not church, it’s duplicating activity (?) and any chapter of AA that does otherwise isn’t adhering to the original intent of AA. Sound familiar? Sounds a lot like, “_____ is a religion of peace and any harm done in its name is no reflection of the religion itself.” Insert religion of your choosing, above.
AA is happy to have people believe they are a treatment and therapy program. They do nothing to regulate what their chapters do and make no attempt to determine whether or not their program actually works nor how to improve it. They cannot both refuse to regulate what is done by programs using their name and claim to be harmless if those programs aren’t following their intent.
johnthedrunkard, if AA keeps no records and participates in no research, how do you know how well it works or doesn’t and how it compares to other options?
One thing I can say that AA and NA are, is a new social setting, where people can meet, make friends and more, and party together in an environment pretty much guaranteed not to have any alcohol or drugs present. This, with or without the 12 steps, is an important part of recovery, since an addict who wants to get free of drugs has to get away from all of the friends, relationships and social rituals in which he became a regular drug user, and form a complete set of new friends, relationships and social rituals. So AA and NA may not be effective as an overall treatment, but they do provide at least some important ingredients for recovery.