The Atlantic The Irrationality of Alcoholics Anonymous
Here is a link to piece by Gabrielle Glaser in the Atlantic called “The Irrationality of Alcoholics Anonymous” http://www.theatlantic.com/features/archive/2015/03/the-irrationality-of-alcoholics-anonymous/386255/ I feel it is a generally good piece that highlights the fact that the 12 step method first used in AA, is still dominant, especially in the USA, despite being ineffective for many people. She mentions the statistics that are available about AA are lacking scientific value and that there is no major proof that 12 step treatment works for most people. I am certainly not a fan of sending everyone to 12 step rehabs, which have grown out of AA, I simply saw AA as a support group not a treatment. She talks about how useless many counsellors are, especially in the USA, where they are often ex addicts with little training with a strong bias towards the method they feel helped them, rather than being experts in a variety of solutions which they could discuss with a patient. I do have a bit of an issue with the “powerless” account at the start, as I would expect an atheist lawyer would certainly have the ability to find other solutions for his problems than believe everything said in AA. I think some people are looking for excuses such as the “Powerless idea”, when they were not motivated to stop by the support method they attended. I do however think mentally ill people or those from a religious background who are gullible can have problems by taking everything in the “Big Book” literally, and the “Powerless concept” can cause problems for them. I am not a fan of the powerless concept, although made use of it in my early days, when cravings were high. I have experienced the “pull of drink” when I relapsed prior to attending any support group so think blaming all problems on an AA concept, is inaccurate, alcoholism is the main reason alcoholics drink.
She also mentions the Sinclair Method using Naltrexone which is a great way for many to control drinking and is effective for about 80% of people that use it. I think this method could certainly help a lot of people although some may need some additional counselling or therapy to deal with other issues that turn up in recovery. She discusses the relative costs of treatment with doctors from Finland, and the cost is far less for the Sinclair Method than a spell in rehab (and makes less profit!). This could actually help the method getting accepted in the UK. She carries out a crude “experiment” on herself which I did not like because it does not reflect the experience of most people who use the Sinclair Method. She claims she had lost the desire to drink after 10 days, which is not the case for most people, who can take the pill for several months before the changes happen. I think people should really be aware of this, as they may simply give up after a couple of weeks, if there is not a dramatic change after reading something like this. Gabrielle does not have a drink problem as far as I’m aware, so I think it would have been better for her to stick to the evidence that has been provided by scientific research in this case, rather than this type of anecdotal type “experiment”, which is at the same level of many anecdotes bythe people pushing AA as a solution. I think it is dangerous to criticise statistics about AA and then include a non scientific experiment to support the section on the Sinclair Method. To be fair she does say
I was an n of one, of course. My experiment was driven by personal curiosity, not scientific inquiry. But it certainly felt as if I were unlearning something—the pleasure of that first glass? The desire for it? Both? I can’t really say.
She then goes on to mention Claudia Christian and “One Little Pill” which is a great way to find out more about this approach.
Having said that, I am glad that she is talking about alternatives to AA and she also gives a good background to where AA came from and how the treatment industry grew. The piece is well worth reading and I really like the following quote from it, which sums up many of the problems with addiction treatment.
Bill Wilson, AA’s founding father, was right when he insisted, 80 years ago, that alcohol dependence is an illness, not a moral failing. Why, then, do we so rarely treat it medically? It’s a question I’ve heard many times from researchers and clinicians. “Alcohol- and substance-use disorders are the realm of medicine,” McLellan says. “This is not the realm of priests.”
Gabrielle wrote a good book “Her Best Kept Secret” which I mention here http://www.recoveringfromrecovery.com/best-kept-secret/
I have a section on the Sinclair Method and Naltrexone http://www.recoveringfromrecovery.com/category/sinclair-method/
Other Articles mentioning the Atlantic Story.
Here is a link to a piece which is largely supportive of the piece Gabrielle Glaser wrote for the Atlantic http://www.usnews.com/news/articles/2015/03/18/investigation-questions-effectiveness-of-alcoholics-anonymous
Here is a response that takes a more defensive stance on the effectiveness of AA http://nymag.com/scienceofus/2015/03/why-alcoholics-anonymous-works.html
The above link disputes the statistics that Gabrielle has used. I am not a fan of how these surveys are done myself and I think that the scientific community does need to come up with some better models, to test how different solutions work. It is certainly true that AA will not motivate everyone, but then that is the case of every support programme. We need to understand why some people do better in one group that another and how to advise people, on which solution will help them. “The Handbook of Alcoholism Treatment Approaches” by Miller and Hester, which Gabrielle mentions in her original piece does mention this, and does not simply imply that AA is useless, it does suit the people who join in and are active in the group. However a lot of people are simply put off by the God stuff, or some of the creepy members, and do not look elsewhere. Others are like myself, and use it for a bit then move on. I was motivated enough to stay sober to look for alternatives, that suited me and have talked about them on this blog.
What do I think.
I think that there needs to be reform in the treatment industry, and that people should not just be shunted into AA regardless of their issues. Many will progress better using “Harm Reduction techniques”, “CBT” and of course the “Sinclair Method”. That does not mean that AA is useless. It has a huge infrastructure that cannot be matched by other groups and is attractive to people who do not wish to tell their doctor that they have problems (I was like that at first). AA is certainly the method in the public eye, as a result of celebrity endorsement and TV and Film. This certainly helped build it at first and now reflects the popularity of the 12 step model, as most people are not hearing about other solutions. Other groups need to do more to get the word out and I am glad pieces that discuss recovery are starting to happen. People need to look at the ridiculous state of some 12 step rehabs that are staffed by people with little training, other than their own recovery in the 12 step world, which has led to blind faith in the programme. We need decent surveys that look at who is suited to which solution, and why. We also need to look at how people do when they leave a support group, and if they consider themselves recovered,or if they have gone back to drinking. We need studies that look at abstinent and non abstinent solutions, to help decide which is appropriate. Someone like myself who drank very heavily for 25 years should probably stay abstinent, and will have different feelings about powerlessness and the struggle of addiction than somebody who was sent to rehab as a teen, after some teenage stupidity (which happens a lot in USA). They will need a different type of support. We also need to look at what drives addiction and the way that society has evolved. People drink for different reasons today than in the 1930’s and that was something Gabrielle put across really well in “Her Best Kept Secret”.
I think things will change, but it won’t happen overnight. Hazelden is looking at other methods along side the 12 step solution and I think that pressure from health organisations will change things. AA is probably big enough to keep going, but needs to evolve a bit and at least look at some of the problems that members can face. People need to be made aware that not all the advice you will hear in the rooms is good, and that some members can be crazy. There are also those who are not interested in the programme, not working it in a spiritual way and who are there to pick people up. The social side of AA has positives and negatives! This is certainly an emotive subject and people tend to take sides and attack each other. That often divides people more and stops support groups finding common ground.