12-Steps for the 21st Century

July 8, 2012 4:54 PM

Alcoholics Anonymous and similar 12-step programs have recently attracted calls to review their long-standing policies: supporting young people, rethinking transphobia, welcoming agnostic viewpoints, and challenging the need for anonymity.

Related: even sobriety and abstinence are being reconsidered, with some places trying out "wet houses" as harm reduction for alcoholics.

posted by divabat (149 comments total)

My first thought is, if you're experience any of this, you've found the wrong AA group. Go try another one.

“No!” a discouraging voice bellowed from the back of the room. “This is a meeting for alcoholics!”

Never experienced anything like that. Never experienced any negativity towards those who are queer in any group I've attended, including those populated mostly by retirement-aged working-class men. And have always seen nothing but support and tolerance for those who are agnostic ("God can stand for Group Of Drunks if you want it to.")
posted by Jimbob at 5:04 PM on July 8, 2012 [15 favorites]

WP article has a paywall after the first two pages. What I got out of reading that much was the impression that the problems lay within the individual meetings. If I went to a meeting where my "share" was met with eye rolling and scoffing, I'd find a different meeting. (Granted that some young people don't have the mobility, due to car/no car or being in a treatment setting, to pick and choose.)

On preview: great minds, divabat. Anyway, yelling across the room is cross-talk and not allowed, which the facilitator should have brought to everyone's attention. So yeah, kid, find another meeting.
posted by scratch at 5:07 PM on July 8, 2012

Sorry, I meant great minds, Jimbob.

no offense, divabat.
posted by scratch at 5:08 PM on July 8, 2012 [1 favorite]

Try the print option of the WP (young people) article.
posted by divabat at 5:09 PM on July 8, 2012

Besides choosing the right group (which for young people may be impossible, as noted) it is problematic to require an individual, at the point in their life when their identity is still forming, to label themselves with a harmful, negative identity in order to get any sort of help. For older people it's vital that they confront the truth about what they have become, but for adolescents, they haven't become anything yet. Adolescent addiction isn't an easy problem and there are no easy answers. Addiction in women is also its own can of worms that needs its own solution.

For whatever reason we're just now coming to realize that just because a certain model has had success with one cohort doesn't mean it can be applied universally.
posted by bleep at 5:21 PM on July 8, 2012 [12 favorites]

I'm not an addict, but I can imagine how "find a different meeting" would be a disappointing response to the many, many problems mentioned just in the first article.

One important factor of AA is that it's decentralized - just people helping people. The other side of that coin is that there's no centralized hierarchy to fix problems like the ones mentioned in these articles - the onus has to be on individuals who are attending meetings. And that means welcoming criticism, not shutting it down.
posted by muddgirl at 5:25 PM on July 8, 2012 [3 favorites]

Yeah, finding a different meeting can be a crapshoot - especially if it involves energy you don't have and if you're marginalised in society already.
posted by divabat at 5:26 PM on July 8, 2012 [2 favorites]

My first thought is, if you're experience any of this, you've found the wrong AA group. Go try another one.

No true Scotsman?
posted by vidur at 5:38 PM on July 8, 2012 [3 favorites]

As a young adult (20-26), I drank problematically. I had a couple drunken blackouts and many, many hangovers and next-day regrets. Most of my friends and acquaintances behaved the same way at that age, and I don't think any of us considered ourselves alcoholics. For that matter, I don't know that any of us *are* alcoholics--I for one grew up and decided that one or two drinks was plenty, thanks. It would have been nice, though, if there was an organization for young people that encouraged responsible drinking. Why is responsible drinking something we grow into in the US?

US society seems to implicitly condone this sort of behavior. Drunken stupidity is a routine part of the college experience. Iowa City (home of the University of Iowa) changed the law and separated "indecent exposure" from "public urination/defecation" because of pressure from students concerned about future employers' reaction to the indecent exposure charge. Seems to me that's tackling the wrong end of the problem.
posted by epj at 5:41 PM on July 8, 2012 [2 favorites]

That is not the "no true Scotsman" fallacy. Not everything is the "no true Scotsman" fallacy.
posted by thelonius at 5:42 PM on July 8, 2012 [13 favorites]

I've hit a lot of different meetings. Some were downright insane, including the ones I found most helpful. I find something reassuring about hanging out with schizophrenic street people, people with bipolar disorder, criminals, advertising executives, and art students all trying to help each other get sober. Some meetings were so sedate and reasonable and loving that they gave me the creeps. Suburban meetings were way too normal for me. Some meetings I didn't go back to. Others were my regular weekly home for years.

When you have an organization that doesn't have a bureaucracy, isn't even a non-profit because it doesn't have much in the way of employees, and is largely run by tradition, volunteerism, people showing up, and custom, it's going to be quirky.

I just didn't want to have to drink again. I know what a lot of people want is some way to win over alcohol, which is why so many people keep fighting the good fight to control their drinking, but I just didn't want to have to deal with it any more. Seems to have worked.

Yeah, AA is quirky, but I never had to be anyone but who I was, and I didn't even have to say I was an alcoholic if I didn't want to, or say I believed in God when I didn't. We always had members in the meetings I attended who were of various gender and sexual orientations. It was more inclusive than any other organization I've ever belonged to.

It always strikes me as funny that people are always trying to explain why AA's all wrong, when so many other methods and movements have come and gone and flared up and failed, ever since I stopped drinking using AA in 1973.
posted by Peach at 5:43 PM on July 8, 2012 [29 favorites]

No true Scotsman: When faced with a counterexample to a universal claim

The articles are making the "universal claim" - that AA is nasty to young people, queers, agnostic. I'm providing counter-examples that negate that claim.
posted by Jimbob at 5:43 PM on July 8, 2012

When mandated by the court, then appealed on constitutional grounds, in every instance higher courts have found A. A. to be a religious organization. It may work, it may not, but no one should pretend it's a rational treatment program.
posted by clarknova at 5:44 PM on July 8, 2012 [14 favorites]

The articles are making the "universal claim" - that AA is nasty to young people, queers, agnostic. I'm providing counter-examples that negate that claim.

The correct response to "a lot of people have had bad experiences" is not "well some people haven't, so there".
posted by Pope Guilty at 5:44 PM on July 8, 2012 [12 favorites]

The articles are making the "universal claim" - that AA is nasty to young people, queers, agnostic. I'm providing counter-examples that negate that claim.

Well, I saw the "universal claim" to be something along the lines of "AA is great", and when faced with counter-examples of "well, not to these people", a response that was essentially "well, that's not real AA". It sounded like No True Scotsman to me. But I guess YMMV applies.
posted by vidur at 5:51 PM on July 8, 2012 [3 favorites]

I briefly did the whole 12-step-tango, and I met some wonderful people there who I'm sure were(literally) saved by the AA program, so I won't wholesale dismiss it. But, it's a big world and obviously nothing works for everybody. What makes AA work, when it does, it has more to do with the support community than anything else.

FWIW. IMHO etc
posted by jonmc at 5:52 PM on July 8, 2012 [2 favorites]

Well, I saw the "universal claim" to be something along the lines of "AA is great"

By the very fact that I said "you're in the wrong meeting", am I not saying "some meetings are crap"?

AA very explicitly states it does not work for everybody - there's nothing wrong with trying something else if it doesn't work for you. It also very explicitly states that politics, religion, everything else is to be left at the door - the only criteria for "membership" is a desire to stop drinking. Therefore, by its own rules, if an AA meeting excludes someone who is queer but who wants to stop drinking, they aren't an AA meeting. That's not No True Scotsman, that's the rules of the game, as far as I can see.
posted by Jimbob at 5:57 PM on July 8, 2012 [10 favorites]

Therefore, by its own rules, if an AA meeting excludes someone who is queer but who wants to stop drinking, they aren't an AA meeting.

I've been at AA meetings where queer people were giving the evening's 'qualification.' I remeber when one woman referrred to her 'wife.' A few people said afew things later privately, including a guy who said to me 'did she say her
wife?' And I said "Yeah, she did, but she's good people, dude." and he nodded his head repeatedly and said 'yeah, she is."

Which means there's weird mixed feelings abouyt queer stuff in AA, just like the rest of society, but that people will put it aside for certain purposes, FWIW.
posted by jonmc at 6:03 PM on July 8, 2012 [5 favorites]

By the very fact that I said "you're in the wrong meeting", am I not saying "some meetings are crap"?

My apologies for misreading you, Jimbob. I guess my comment had a fair bit of personal baggage to it. You were not the first person to have said "find a different meeting" to me. I've been trying to help a colleague, but he seem to be running into - weirdly enough - racist folks at AA meetings. Anyway, let me not derail this further.
posted by vidur at 6:08 PM on July 8, 2012 [1 favorite]

It seems like there's two different sets of problems: AA itself and the attendees. There's a difference between fundamental challenges to AA's precepts and individuals learning to be less shitty to each other. Young people, women, and agnostics/atheists have legitimate issues with how AA is not necessarily structured to meet their unique needs. Transgender/gay/queer people have issues with other people being unkind to them in what should be considered a safe place.
posted by bleep at 6:09 PM on July 8, 2012 [3 favorites]

I spent some years in a 12-step program, and went to a bunch of different meetings. Some had problems; some just didn't work for me. "Find another meeting" absolutely is the best advice, because there's no monolithic "IT" that works the same way regardless of who the members of a meeting are.

Think of it this way: if you went to a therapist, and that therapist just wasn't helping you, despite being educated and licensed, you could either try another therapist or you could declare that therapy was nonsense and the therapeutic community should fix that shit. The former has a good chance of giving you a better outcome than the latter.
posted by Kirth Gerson at 6:09 PM on July 8, 2012 [6 favorites]

What if the likelihood of finding a meeting or group that suited you was low because structurally society was built against people like you?
posted by divabat at 6:12 PM on July 8, 2012 [1 favorite]

AA itself and the attendees

AA is the attendees. There's no platonic AA.
posted by muddgirl at 6:13 PM on July 8, 2012

That's not what it said in any of the articles that were about people running up against what it said in the book.
posted by bleep at 6:16 PM on July 8, 2012

Why is responsible drinking something we grow into in the US?

IMO the absurdly high legal age is a big problem. It encourages binge drinking, for starters. Prevents young adults from going to the pub, forces them to parties. Prevents them from learning normal public drinking social skills. Etc.

It is particularly idiotic that voting, marrying, and soldiering are a-ok years and years before drinking is ok.
posted by five fresh fish at 6:29 PM on July 8, 2012 [17 favorites]

If you haven't encountered this way of thinking in meetings, you are lucky and are witnessing the exception instead of the norm.

Okay, there's got to be some kind of geographic bias going on here because, once again, never seen that where I am. Maybe it's like the Boy Scouts, you know? Like how I get the impression that in the US, the Scouts are a vicious, right-wing militarist homophobic youth-indoctrination society, while elsewhere in the world it's just a club where kids go camping...
posted by Jimbob at 6:44 PM on July 8, 2012

AA is the attendees. There's no platonic AA.

If AA were the attendees and nothing more, then it wouldn't be a twelve-step group, because where do the twelve steps come from? Not from the attendees. AA is clearly an ideological organization with a particular dogma, and the idea that there's no such thing as AA-itself is part of that ideology.
posted by vorfeed at 6:44 PM on July 8, 2012

AA is regularly attended by people wanting help with other problems besides alcohol, and as a tradition tries not to pretend to be all things to all people. I knew a lot of addicts who used it successfully nonetheless; I also knew a few people who used AA instead of Al-Anon because they wanted someone else to get sober or because they wanted to accompany a friend or family member to meetings.

As for drinking age, I don't know too many people who are affected by it particularly. I started drinking when I was twelve or so.
posted by Peach at 6:45 PM on July 8, 2012

There have been young people's groups and young people's conventions, groups that call themselves "We Agnostics," after a chapter in the book and there have been women's groups within the AA umbrella for at least the 39 years I have been sober in AA. This was an old argument when I arrived. I have attended conventions where speakers included young people who started drinking at age 9. There are many groups for gay men and for lesbians and for women and for lawyers and for doctors, etc..

I have in my reading stack just now, a biography, Mrs. Marty Mann, the first lady of Alcoholics Anonymous. She was ". . . one of America's most important public-health policy reformers, and is credited with introducing the terms alcoholic and alcoholism into the standard lexicon, laying the groundwork for treatment programs, reducing the stigma surrounding alcoholism, and securing a place for women in treatment and recovery." She founded and led the National Council on Alcoholism as part of her self-assigned task to shift public opinion on the subject.

Marty was not anonymous but never broke anyone else's anonymity. Anonymity as a tradition is not as carefully practiced today but should be respected, I believe. If for no other reason than it does no one any good for a newcomer to proclaim his or her sobriety in AA only to fall drunk the following weekend. In addition, I was told that it was a lesson in humility for me to practice anonymity. Marty Mann is only one person who said and believed, "It is amazing what you can accomplish if you don't care who gets the credit." That is a lesson in humility straight from AA for me.

I've attended AA meetings that accepted "cross-addicted alcoholics" and those that despised addicts and told them to go to N.A.. An AA group is run by the group itself presumably within the guidelines of the 12 steps and 12 traditions. The groups reflect its members. If you don't like the group, dig in and change it or go find another group. Fortunately for city people, there are many groups these days. Or you can always start your own--but do please get sober first.

I've seldom worked with a new person--or a young person--who didn't have suggestions for improving AA. AA has improved as a reflection of the changes in the face of its membership over the years and this is a good thing. The group should reflect its members. A few things have not changed. The steps. The need to be sober before you can effect change.

AA was never meant to be all things to all people. The book actually suggests that sometimes a very great love can cure an alcoholic (sometimes I think, in some essential way, love is the only thing that does heal people with this disease.) Most alcoholics, however, have lost all touch with love and cannot find their way back alone. AA never claimed to be the true religion--that is nonsense. AA says, here is what worked for us. Give it all you've got and see if it works for you. The book says "Half measures availed us nothing." If you don't have a drinking problem, maybe you don't belong in AA. If you just want to find out, you can go to open meetings as much as you like. They are clearly marked in the Central Office directory of meetings and I recommend them for those who want to see if AA is the place for them. AA is not recruiting members.

I remember the furor in my home town when the court started sentencing young DWI offenders to attend AA meetings. Many felt that no one should be there unless she or he wished to be. I remember the days before there were detox centers everywhere when old timers kept a half-pint in the glove compartment for twelfth-step call duty in case they found their alcoholic having DTs. I wonder if anyone makes twelfth-step calls anymore--with or without an emergency half-pint.

The debate has raged for the entire history of AA about how religious it is meant to be and the influence of the Oxford Group on its early formation. Yes, there were extremely religious proponents who were overruled by others of the founding group. What is left in the steps is some ethical and psychological guidance and some principles that are also found in many religions.

@ peach Hello from another of the class of '73!
posted by Anitanola at 6:49 PM on July 8, 2012 [14 favorites]

Alcoholics Anonymous has no opinion on outside issues, hence the AA name ought never be drawn into public controversy.
posted by joedanger at 6:51 PM on July 8, 2012 [7 favorites]

To the majority of members, the only Higher Power that can truly help you is the old white man with a beard whose son is Jesus Christ.

Could this be because you live in a place where the majority of non-members believe the same thing?
posted by Jimbob at 6:52 PM on July 8, 2012 [9 favorites]

Yeah, AA meetings have a HUGE variance from meeting to meeting and while saying "find a new meeting" is correct, I kind of think a person has to have some knowledge of the program to know that. I mean, for a person who doesn't really know anything about the program, there is no reason why they wouldn't believe that meetings are relatively consistent from place to place. And if they happen to stumble into a shitty meeting with a bunch of judgey, uptight members that's their whole opinion of AA, right there. Why would they think other meetings might be different?

I've been in AA since I was 14 and I've seen all the old controversies come and go several times. I think the general principles work but there are some problems that they really need to address. Like almost every meeting I go to now, in 2012, they are still saying the Lord's Prayer. This fight has been around since at least the 90s and there are some meetings which have adapted and switched to just the Serenity Prayer or maybe the third step prayer. AA can say it's not religious, and I know from being involved deeply in service for many years that it theoretically isn't, but I am still going to meetings regularly where people are talking about the bible. I know there are atheists in AA but I don't think they really speak up because while everyone knows that you can't kick atheists out, there are other ways of cold shouldering members who do not fall in lockstep with the accepted norms. Again, not all AA meetings do this (I would say that the majority of them don't), but enough of them do and enough of the big, very visible and popular meetings do that it is a real problem.

People are very, very devoted to AA. And for good reason - it literally saved their lives. And I do understand the fear of some old-timers that the program not be "watered down". But there has got to be a middle ground. We need to stop the fucking bullshit of telling members that they shouldn't take antidepressants or any other pharmaceuticals (which is NO WHERE in the AA approved literature - the big book in fact states the contrary. There are a few members that have taken it upon themselves to say that and it is ABSOLUTELY WRONG). We need to seriously look at honestly welcoming people of any or no religion, instead of giving lip service to it. We need to stop the nonsense of telling people they can't introduce themselves as addicts. It's a really good thing we have, but this program and more importantly, its individual members need to really be willing to open themselves up to criticism and be willing to honestly examine it.

I should note that despite these problems, I still think that the majority of AA meetings are open and welcoming to all people, as they should be, and that a person should be able to find a good meeting if they keep looking around. But, I think that there are some serious issues that need to be addressed and I've kind of been out of the loop of the hard core AA people for awhile, so I don't know where they stand with this.

I'm kind of thinking of posting these articles on my Facebook to see how my AA friends react. A lot of them are the hard core long term members and many are involved at as high a level as the GSO office in NY. People love AA and get really defensive about it so it's hard to tell, but I may go ahead and do it and risk getting defriended just to see what the overall reaction is.
posted by triggerfinger at 6:53 PM on July 8, 2012 [8 favorites]

Nope.

Your profile says you're in Texas. Surveys I've just read say 75% of people in Texas consider themselves Christian.
posted by Jimbob at 6:55 PM on July 8, 2012 [1 favorite]

I was prepared for my first A.A. meeting as a newly sober 16 year-old in 1980:

Old-timer: "Boy, I've spilled more on my tie than you've drank in your whole life!"
Me (slightly terrified): "Sorry to hear you were so sloppy, sir."
(everyone laughs)

I think this is a hopeful sign that A.A. is trying to change with the times. Granted that change has been glacial but still a good sign.
posted by KevinSkomsvold at 7:00 PM on July 8, 2012 [5 favorites]

Pharyngula's ongoing "why I am an atheist" series recently featured a really interesting account of growing up in an AA household.
posted by misfish at 7:03 PM on July 8, 2012 [2 favorites]

Jimbob, what is your point, that item should move in order to find a decent meeting? Or could it be possible that AA needs to address some long-standing issues?

I haven't drank for over a decade, but it wasn't due to AA, which I tried multiple times. My issues with it were the same as others are bringing up here.
posted by krinklyfig at 7:04 PM on July 8, 2012 [1 favorite]

I think, as I said above, there is a major geographical distinction here, that's all, so I'll try to leave it along except to say it doesn't have to be like that. I've never heard the Lord's Prayer in a meeting. Never heard Jesus mentioned. Never seen a bible, only the Big Book. About 50% of the people also have a non-alcohol addiction, which they mention as part of their story. Young people are celebrated explicitly by the older members. Mention your atheist/agnostic feelings, and you'll be swamped by people afterwards who feel the same, and want to tell you how they've been thinking things through. The level of homophobia I've witnessed in meetings is less than I witness outside in the society as a whole.

But I've only attended meetings in one little part of the world (one that isn't, however, known for its tolerance and liberal ideas) - if things are really this bad elsewhere, I'm saddened.
posted by Jimbob at 7:13 PM on July 8, 2012 [1 favorite]

I spent my junior high years accompanying my mom and her fella to their AA meetings -- this, once she finally decided to get sober, after I'd had to go live with a friend for about a year since we got evicted from our apartment. This was 1984-1987.

There was a place called The Club East, in Irvington -- this was Indianapolis. And it was a very specific sort of Club, very different from the one on the South side, which had brunches and whatnot. The Club East was very working class, very hard living, very unpolite society -- but they were nice folks, overall.

Anyway, what even I managed to pick up on as a kid tagging along, was that the presence of strangers made the regulars nervous. And once you sat through discussions and people's leads (this is when one person gets up and tells their own personal alcoholism story), you understand why: you go in, feeling like shit every second of every day, and tell your story, share your sorrows and regrets -- that's a really hard thing to do.

There's very much a culture of come on in, but most people are going to be wary until you start talking. Even in Indianapolis, there were all sorts of meetings: for men, for women, for gays, for people who had both drug and alcohol problems, for various ethnicities. So yes: find another meeting. That's AA culture and it has worked.

There are even online meetings now: http://aa-intergroup.org/
posted by gsh at 7:17 PM on July 8, 2012 [1 favorite]

But I've only attended meetings in one little part of the world

That sounds like a great reason to not make assumptions about the way things are or are not in other areas based on a "survey".
posted by hugandpint at 7:24 PM on July 8, 2012

I think, as I said above, there is a major geographical distinction here,

I think there is too. While I heard some religious stuff attending meetings when I lived in the UK, it wasn't near as much. And the AA and CA meetings mixed interchangeably - I was asked to speak at a CA meeting and when I said I had never done cocaine, they were like - oh no big deal, lots of AA people go there - it's the same thing. Treating programs as interchangeable like that is kind of anathema in my current area.
posted by triggerfinger at 7:26 PM on July 8, 2012

As a member for double decades, I came to AA to not drink and stuck around because I found its egalitarian, post-modern nature a perfect fit with a my personality and a good place to hang out. That being said, the basics of AA will never change, the big books first 154 pages will remain sexist, the traditions will mean a continues focus on alcoholics not addicts, the word god isn't going away anytime soon, and anonymity will continue to play a role in keeping it an organization where we are equal in our alcoholism and there are few big shots or big egos in most meetings though there are characters and fundamentalist AA's but, they can be ignored.

However today, change has arrived in AA, there are few if any pure alcoholics showing up in AA these days. 90% are on some psychiatric medicine. The word god is used carefully and sensitively in some of the meetings I attend with knowledge that some are turned off by it. We don't force you to believe anything. Young people are welcome and are showing up as a new generation and are heartily welcomed.

Many of the comments above remind me of an AA speaker I heard a few years ago. He was talking about how had taken him a long time to get to AA because "all the people at the bar said it didn't work."

One of the things I love about AA are some of the the phrases, "take what you need and leave the rest", "fake it till you make it", and "the AA wrench fits all nuts."

Lastly, I stick around AA for some of the same reasons I don't leave MetaFilter, it's diversity, the caring beneath the gruffness, and a weird bizarreness just below the surface of every thread/aa meeting.
posted by Xurando at 7:54 PM on July 8, 2012 [15 favorites]

My mother died a few weeks ago. She was 43 years sober. My father is on his 41st year. At the visitation I saw a diverse group - younger people, guys who came in their motorcycle gear, now hobbled friends of my parents who I haven't seen since I was a teenager, Native people (in small-town Canada Natives can be the most visible Other), couples who I would identify as lesbian, and all seemed very important to my father at this time. My parents are a working-class couple who lived their entire lives in a small city that has always seemed very homogeneous to me. Both my parents could probably say some things that sound abrupt and closed to the ears of the people of Metafilter, especially my dad, who I suspect is opinionated about certain policies at meetings, but I was constantly told that night that my mother has helped many people. I've had others tell me that about my dad before. I believe those statements. And others helped my parents. My mother's sponsor from 43 years previous came everyday to sit at her bedside. I know from what my mother left to be read at the service that after her family what was most important to her as she looked back upon her life was that she had overcome the hardship of her twenties, that together with the organization and their friends there her and my father rescued themselves - and, I guess, myself and my siblings - from a very rough downward cycle. I haven't read the articles because AA is only part of my life by extension, and I'm not really interested in the nitty-gritty of its politics. I know it has flaws, but I also know most people can live a life and never encounter something that has as essential an impact for themselves as AA has had for my parents.
posted by TimTypeZed at 7:59 PM on July 8, 2012 [6 favorites]

I haven't read all the comments yet, but after reading through all the links here during a dreadful boring Rangers "pitching duel" I'll say that I'm 15 years sober, attend an AA meeting or two every week, and I agree with all the articles.

It shouldn't be about catching the Jesus, and being a recovering addict is certainly nothing to be ashamed about. I'm open about it with anyone who asks, though I don't go around volunteering it, as it would seem boorish.

I know people who were hard drinkers who sobered up in AA for several years, then went back to drinking moderately without it killing them, and I suppose for them that's great. I have no interest in testing that theory, as I really don't miss being inebriated in any way shape or form, but that's just me.

About 3 years ago, we had an old coot at a noon meeting (heavily attended by retirees, due to the time of day -- I just happened to be able to take a long lunch that day) go off on a young kid who was there for his pot addiction, drove him out of the room, then got into a yelling match with a bunch of other members who didn't take well to him having done so, others piped up in the old coot's defense, and the meeting descended into a pretty awful open verbal brawl that had permanent repercussions for the group, and resulted in a long string of "group conscience" meetings. I haven't seen the old coot since, and I'm glad.

That said, if you're an AA member and your group does things that make you uncomfortable, get involved. Individuals can have an effect on how a group's meetings are run, and eventually the old coots will die off, anyway. Quite a few folks who chair meetings around here will close the meeting with the serenity prayer instead of the Lord's prayer, for reasons outlined in a couple of the links.

AA, especially at the group level, can change incrementally for the better, and I'm glad these writers are pushing these ideas forward.
posted by Devils Rancher at 8:00 PM on July 8, 2012 [4 favorites]

Oh yeah, one more thing about god, these acronyms work for me:
Group of drunks
Gift of desperation
Good orderly direction
Good old dog
Get over drinking
Get over drugs
Gratitude over drama
posted by Xurando at 8:01 PM on July 8, 2012 [2 favorites]

I always liked what my friend's sponsor, an old gay Irish pipefitter, used to say when certain people in AA got on his nerves: "Pray for the bastards, they ain't wrapped too tight."
posted by Peach at 8:05 PM on July 8, 2012 [4 favorites]

I meant to add that there's a transsexual woman who has gotten her annual chip at the same birthday night as me for the last several years, and I'm really damn proud of her.
posted by Devils Rancher at 8:09 PM on July 8, 2012 [1 favorite]

Sure, it's fine if you're atheist/agnostic, "God" can be whatever you want it to, etc. etc. but then why am I holding your hand and saying the Lord's Prayer and why is Chapter 4 of your scriptures dedicated exclusively to how wrong I am? AA is a Christian religious organization that really wants you to believe it's not for some reason, and yes I speak from experience.
posted by DecemberBoy at 8:23 PM on July 8, 2012 [7 favorites]

The word god is used carefully and sensitively in some of the meetings I attend with knowledge that some are turned off by it.

I get a kick out of some of the more enlightened rednecks around here who refer circumspectly to their "Har Par."
posted by Devils Rancher at 8:38 PM on July 8, 2012 [5 favorites]

If my father hadn't sobered up 25 years ago with with the help of AA, he would have been dead a long time ago.

The third step says something about turning your life over to God as you understand him. My Dad is a nominal Christian. I'm an atheist. I think the whole point is not so much about conforming your beliefs to some rigid definition of God. I think that the idea is to understand that your life is out of your control and you need someone or something to take the wheel. It's an exercise in humility, which helps the alcoholic with the self-reflection required to break their addiction.

For what it's worth, my Dad freely dispensed homophobic and racist jokes when I was young. After he stopped drinking, he chose, much to our surprise, a man who was gay and proud for his mentor. When I asked him about that, he said that it didn't matter to him that his mentor was gay. He chose his mentor because he wanted to model the serenity and sobriety that man had.

He's become addicted to pain pills in the last couple years. It sickens me to see him falling back into the rabbit hole again. I'm certain it's going to kill him soon. I think he had started seeing himself as an old-timer and lost that vital sense of humility.

Its unfortunate people have had bad experiences in meetings. AA is far from perfect, but I'm grateful for the extra 20-odd years we were given to build a real father-son, man-to-man relationship that didn't exist when I was a kid and he was drinking.
posted by double block and bleed at 8:39 PM on July 8, 2012 [5 favorites]

I am in the class of 1976. I was 23 years old and addicted to just about everything. While hospitalized and on a conservatorship I was sent to in-hospital AA meetings. I went so I could smoke. It changed my life. After I was discharged I went to what I would call an old-style recovery house for women and was told to never mention drugs. I didn't for a very long time.

I have seen terrible things happen in AA. I have also seen the most loving, accepting, go-to-any-lengths help offered to others trying to stay sober. AA is full of humans, which is its biggest problem, in my opinion.

Where I currently live, not where I became sober, meetings are very reflective of the culture of each town. The college town AA meetings are open, never say the Lord's Prayer and very tolerant of each person's specialness. Not so much in the working class town. My home group has a very vocal christian base and they occasionally flip out. The biggest business meeting in the history of the group was over the possibility of using the Serenity Prayer instead of the the Lord's Prayer at the end of the meeting. I voted in their favor because they need that prayer more than I need the meeting to change. The reason I was so supportive of them was I could clearly see how filled with fear they were. Myself and about 7 other people in the meeting has just finished a private book study using Kevin Griffiths One Breath at a time, Buddhism and The Twelve Steps and it really helped us treat others in the meeting with love and tolerance.

Why do I still go? Cause it works for me. I really don't need AA to change. My sponsor is, I believe, a born-again christian. I am an unidentified pilgrim. She is not a 100% comfortable with my choice but so what. If she is working the program the way it is written then it is not her decision to make on what I believe. I still have sponsor because I find it helpful.

AA is not for everyone. It really is only for people who want it. Or as a really old saying goes, you take what you want and leave the rest behind.
posted by cairnoflore at 8:39 PM on July 8, 2012 [3 favorites]

When you have an organization that doesn't have a bureaucracy, isn't even a non-profit because it doesn't have much in the way of employees, and is largely run by tradition, volunteerism, people showing up, and custom, it's going to be quirky.

funny, this describes to a T the Occupy Wall Street movement.
posted by liza at 8:53 PM on July 8, 2012 [2 favorites]

The "questioning anonymity" link was naive. They seem to believe that insurance and job security wasn't an issue, and ignored that there aren't companies that track everything we do and rank us accordingly.
posted by Brian B. at 9:04 PM on July 8, 2012 [1 favorite]

Can I ask two questions:

a) what, in AA tradition or custom, is the difference between an Alcholic and an Addict?
b) what is the problem with pharma?

thanks
posted by PinkMoose at 9:06 PM on July 8, 2012

Penn & Teller did an episode of Bullshit about this and, it's very interesting. Americans live in a world where AA is often court-mandated for people convicted of alcohol related offenses. God is baked into the 12 steps. Doesn't seem fair to make that mandated.
posted by inturnaround at 9:14 PM on July 8, 2012 [2 favorites]

> "a)what, in AA tradition or cusstom, is the difference between an Alcholic and an Addict?"

The book talks about "unhappy drinkers" and problems with alcohol and people who want to stop drinking but cannot. It is a custom for people who have taken the first step, admitted they are powerless over alcohol, to call themselves alcoholics. No one in AA is supposed to label another person. AA is not intended for the treatment of addictions other than to alcohol.

"b)"what is the problem with pharma?"
The book recommends that members who have been prescribed medication by a doctor take that medication as directed. That is all.
posted by Anitanola at 9:22 PM on July 8, 2012 [1 favorite]

thelonius: "That is not the "no true Scotsman" fallacy. Not everything is the "no true Scotsman" fallacy."

So, the "No True No True Scotsman" fallacy?
posted by symbioid at 9:22 PM on July 8, 2012 [7 favorites]

What does someone who is cross addicted, but feels more comfortable in an AA group, do when they are no supposed to talk about being an Addict in that AA Group?

If the big book says that, and I know it does, what is the tension then described by some people here and in the articles, about pharma?
posted by PinkMoose at 9:28 PM on July 8, 2012

When you say "pharma", do you mean medication prescribed by a doctor that someone may be on, or do mean an addiction to non-alcohol drugs?

In the first case, there is an attitude some members have that people are often unnecessarily prescribed, say, anti-depressants when the real problem is their drinking, and they shouldn't need the anti-depressants once they stop drinking. The book disagrees, and this is not a majority-held belief.

In the second case, in my experience, people are free to talk about other drug use, with the recognition that other drugs are other drugs, and they are unlikely to establish "identification" with other members who are there due to alcoholism.
posted by Jimbob at 9:47 PM on July 8, 2012

PinkMoose, see your MeMail.
posted by Anitanola at 9:53 PM on July 8, 2012

Plenty of people identify in meetings as "an alcoholic and an addict." I had other substance abuse problems besides booze that also seemed to stem from the same font of anxiety & self-loathing as the alcohol problem, and they also developed into physical cravings that were extremely hard to surmount. Maybe it's just the hippie town I live in, or the era in which I sobered up, but pretty much all my classmates had alcohol+substance x addiction when they came in as well. I was fortunate that I was able to walk away from the cocaine six years before I quit drinking, but addiction is addiction to me. My hand is out to anyone asking for help with either problem.

I've since been prescribed anti-anxiety meds, so when I was sizing up my most recent sponsor, I asked him what he thought about AA members who said you aught to avoid any type of prescribed pharmaceuticals, and he said "Fuck 'em. They're not your doctor."
posted by Devils Rancher at 9:53 PM on July 8, 2012 [4 favorites]

There is a small but vocal contingent that think anti-depressives are "mood altering" and should not be taken for that reason. In my experience, these people also kind of are of the opinion that depression or other mood disorders aren't a real medical thing and wouldn't be a problem if people just worked the steps. The book explicitly contradicts this and people who say this kind of thing should be ignored.

Now I think this is really a small and minority opinion and attitudes have only improved from the time I was really involved back in the 90s. Despite these problems, I still think that AA as a whole is a good and welcoming place and I would always encourage people to attend different meetings until they find one in which they feel welcome and comfortable. But as with any other groups, these problems exist.
posted by triggerfinger at 9:54 PM on July 8, 2012 [1 favorite]

But why is God necessary if alcoholism is a disease? Why, if it is a disease, is it most popularly treated with a spiritual-based solution?
posted by inturnaround at 9:56 PM on July 8, 2012 [1 favorite]

The short answer to your question that AA gives is that alcoholics have always relied upon themselves (or their willpower) in the past and that got them nowhere, so they have to find a power greater than themselves (which does not have to be God) to rely on.

Taken directly from the AA big book (pdf):

If a mere code of morals, or a better philosophy of life were sufficient to overcome alcoholism, many of us would have recovered long ago. But we found that such codes and philosophies did not save us, no matter how much we tried. We could wish to be moral, we could wish to be philosophically comforted, in fact, we could will these things with all our might, but the needed power wasn't there. Our human resources, as marshalled by the will, were not sufficient; they failed utterly.

Lack of power, that was our dilemma. We had to find a power by which we could live, and it had to be A Power Greater Than Ourselves.
posted by triggerfinger at 10:05 PM on July 8, 2012 [1 favorite]

Thanks everyone, that makes sense.
posted by PinkMoose at 10:11 PM on July 8, 2012 [1 favorite]

But that's so not a medical solution.

And what's the evidence, not anecdotal, that it even works more than just deciding to not drink anymore? I mean, if someone had a complusion to jump into traffic or do something else destructive to themselves (cutting, perhaps?), we don't tell them to admit that they're weak against the compulsion and give it over to a higher power. We get them professional counseling and maybe psychiatric medications.

And if it doesn't have to be God...why is he mentioned so much? The idea that it doesn't matter who the higher power is then kind of means that it probably doesn't matter if God is there at all.
posted by inturnaround at 10:16 PM on July 8, 2012 [1 favorite]

The short answer to your question that AA gives is that alcoholics have always relied upon themselves (or their willpower) in the past and that got them nowhere, so they have to find a power greater than themselves (which does not have to be God) to rely on.

The long answer to your question is that the radiator, the doorknob, or a Group of Drunks obviously cannot be greater than oneself in the specific spiritual way which is described in the Big Book, so it's about God. Or, as the very same Big Book puts it:

"[alcoholics are] suffering from an illness which only a spiritual experience will conquer. To one who feels he is an atheist or agnostic such an experience seems impossible, but to continue as he is means disaster, especially if he is an alcoholic of the hopeless variety. [...] We found that as soon as we were able to lay aside prejudice and express even a willingness to believe in a Power greater than ourselves, we connected to get results, even though it was impossible for any of us to fully define or comprehend that Power, which is God."

Seriously, the idea that this is not about God is ridiculous. "As soon as we admitted the possible existence of a Creative Intelligence, a Spirit of the Universe underlying the totality of things" -- does that describe a radiator, now? Or a Group of Drunks? Is the mere need not to "rely on oneself" the reason why this chapter is an explicit attack on the very idea of atheism and agnosticism?

Alcoholics. Anonymous. Is. A. Religious. Organization. I cannot understand how anyone reads this book and comes to any other conclusion, given that a certain kind of spiritual awakening is very clearly described as the heart of the system.
posted by vorfeed at 10:31 PM on July 8, 2012 [1 favorite]

You're right. As far as I'm concerned it's not "God" that matters. It's the recognition of lack of control. The acknowledgement that you need help in the literal sense. That you can't rely on "inner strength", that you can't figure this shit out on your own.

As for the usefulness of anecdotes, well, the andcdotes are coming form people who are (according to simple statistics on deaths attributed to alcohol) likely alive due to AA. Therefore it has worked for them.
posted by Jimbob at 10:33 PM on July 8, 2012 [1 favorite]

I mean, if AA were simply about finding a Group of Drunks to believe in, then this chapter would be about lonely drunks and their refusal to reach to others for help, not about atheists and agnostics and their refusal to admit that God made electrons.
posted by vorfeed at 10:36 PM on July 8, 2012

Who cares, if it's a useful conceit? Maybe people are more concerned with getting their lives back than theological debate.
posted by Jimbob at 10:37 PM on July 8, 2012 [1 favorite]

I want to second misfish's recommendation of the Pharyngula guest post from an ex-AA member. She goes into a great deal of detail (both in the post itself and in the comments section) about how the things about AA that hurt her relate to AA as an organization.
posted by Proofs and Refutations at 10:38 PM on July 8, 2012 [1 favorite]

Who cares, if it's a useful conceit? Maybe people are more concerned with getting their lives back than theological debate.

Bill Wilson wasn't, which is my point.
posted by vorfeed at 10:45 PM on July 8, 2012

I dunno. All I can tell you is I'm pesonally doing better as a sober radiator-worshipper than as a drunk athiest, so this plate of beans can stay as it is.
posted by Jimbob at 10:48 PM on July 8, 2012 [2 favorites]

But that's so not a medical solution.

And what's the evidence, not anecdotal, that it even works more than just deciding to not drink anymore? I mean, if someone had a complusion to jump into traffic or do something else destructive to themselves (cutting, perhaps?), we don't tell them to admit that they're weak against the compulsion and give it over to a higher power. We get them professional counseling and maybe psychiatric medications.

There is actually a pretty long, detailed and interesting history behind your question on the medical aspect of alcoholism. First of all, is there really a surefire medical solution for alcoholism? There are more options today then there were when AA was founded, not all of them are based on abstinence but there still is no "cure" for alcoholism. AA treats alcoholism as a disease with spiritual, mental and physical components. Back in the 30s when AA was founded there were no options for alcoholics and a lot of things had been tried (see The Oxford Group and Washingtonians) with little success. AA was actually founded based on the mistakes and lessons learned from their predecessors (the Twelve Traditions are kind of the rulebook based on what they had learned).

Anyway, back to the medical issue. A good chapter to read in the big book is The Doctor's Opinion, written by Dr. William Silkworth, who treated the founder of AA, Bill Wilson. Dr. Silkworth was one of the first people to put forward the idea that alcoholism was not a moral failing, but that it was a disease. He also said that alcoholism needed to be treated with total abstinence and that an "entire psychic change" was necessary:

Men and women drink essentially because they like the effect produced by alcohol. The sensation is so elusive that, while they admit it is injurious, they cannot after a time differentiate the true from the false. To them, their alcoholic life seems the only normal one. They are restless, irritable and discontented, unless they can again experience the sense of ease and comfort which comes at once by taking a few drinks—drinks which they see others taking with impunity. After they have succumbed to the desire again, as so many do, and the phenomenon of craving develops, they pass through the well-known stages of a spree, emerging remorseful, with a firm resolution not to drink again. This is repeated over and over, and unless this person can experience an entire psychic change there is very little hope of his recovery.

On the other hand—and strange as this may seem to those who do not understand—once a psychic change has occurred, the very same person who seemed doomed, who had so many problems he despaired of ever solving them, suddenly finds himself easily able to control his desire for alcohol, the only effort necessary being that required to follow a few simple rules...

...I do not hold with those who believe that alcoholism is entirely a problem of mental control. I have had many men who had, for example, worked a period of months on some problem or business deal which was to be settled on a certain date, favorably to them. They took a drink a day or so prior to the date, and then the phenomenon of craving at once became paramount to all other interests so that the important appointment was not met. These men were not drinking to escape; they were drinking to overcome a craving beyond their mental control.

There are many situations which arise out of the phenomenon of craving which cause men to make the supreme sacrifice rather than continue to fight.

The classification of alcoholics seems most difficult, and in much detail is outside the scope of this book. There are, of course, the psychopaths who are emotionally unstable. We are all familiar with this type. They are always “going on the wagon for keeps.’’ They are over-remorseful and make many resolutions, but never a decision.

There is the type of man who is unwilling to admit that he cannot take a drink. He plans various ways of drinking. He changes his brand or his environment. There is the type who always believes that after being entirely free from alcohol for a period of time he can take a drink without danger. There is the manic-depressive type, who is, perhaps, the least understood by his friends, and about whom a whole chapter could be written.

Then there are types entirely normal in every respect except in the effect alcohol has upon them. They are often able, intelligent, friendly people.

All these, and many others, have one symptom in common: they cannot start drinking without developing the phenomenon of craving. This phenomenon, as we have suggested, may be the manifestation of an allergy which differentiates these people, and sets them apart as a distinct entity. It has never been, by any treatment with which we are familiar, permanently eradicated. The only relief we have to suggest is entire abstinence.

And finally, before I write a book, a few excerpts from the medical view on AA:

Since Dr. Silkworth’s first endorsement of Alcoholics Anonymous, medical societies and physicians throughout the world have set their approval upon us. Following are excerpts from the comments of doctors present at the annual meeting* of the Medical Society of the State of New York where a paper on A.A. was read:

Dr. Foster Kennedy, neurologist: “This organization of Alcoholics Anonymous calls on two of the greatest reservoirs of power known to man, religion and that instinct for association with one’s fellows . . . the ‘herd instinct.’ I think our profession must take appreciative cognizance of this great therapeutic weapon. If we do not do so, we shall stand convicted of emotional sterility and of having lost the faith that moves mountains, without which medicine can do little.”

Dr. W. W. Bauer, broadcasting under the auspices of The American Medical Association in 1946, over the NBC network, said, in part: “Alcoholics Anonymous are no crusaders; not a temperance society. They know that they must never drink. They help others with similar problems . . . In this atmosphere the alcoholic often overcomes his excessive concentration upon himself. Learning to depend upon a higher power and absorb himself in his work with other alcoholics, he remains sober day by day. The days add up into weeks, the weeks into months and years.”

Dr. John F. Stouffer, Chief Psychiatrist, Philadelphia General Hospital, citing his experience with A.A., said: “The alcoholics we get here at Philadelphia General are mostly those who cannot afford private treatment, and A.A. is by far the greatest thing we have been able to offer them. Even among those who occasionally land back in here again, we observe a profound change in personality. You would hardly recognize them.”

The American Psychiatric Association requested, in 1949, that a paper be prepared by one of the older members of Alcoholics Anonymous to be read at the Association’s annual meeting of that year. This was done, and the paper was printed in the American Journal of Psychiatry for November 1949.
posted by triggerfinger at 10:48 PM on July 8, 2012 [1 favorite]

Alcoholics. Anonymous. Is. A. Religious. Organization. I cannot understand how anyone reads this book and comes to any other conclusion, given that a certain kind of spiritual awakening is very clearly described as the heart of the system.

Two things: first, the text as it was written in the 1930 is seen as kind of a sacred thing and members will never, ever want it to be changed. Second, the general consensus as I see it at meetings is that people know that it was written in the 1930s and likely would be different if it were written by Bill Wilson today. Most people seem to give some of the language in there a "grain of salt" treatment.

On the one hand, I think not updating the language to be more inclusive is problematic for reasons you've mentioned. On the other hand, I do understand that starting to allow for changes in the language can be a slippery slope kind of thing where eventually the whole spirit of the program that has helped so many is totally altered. It doesn't really sit easy with me precisely because I don't want anyone to be scared away by the outdated language but personally? I just try to be as inclusive as I can at meetings and make clear to any people attending who have any doubts that they are absolutely welcome now and always as long as they have a desire to stop drinking, which is the one and only true, clad in stone, requirement for membership. Not money, not spirituality, not even a belief that you are an alcoholic. A desire to stop drinking. And that's it. I think the majority of members feel the same.
posted by triggerfinger at 11:03 PM on July 8, 2012 [3 favorites]

It is easy to discredit the actions of individuals who practice a version of the AA program loaded with quirks of their own ranging from overt rudeness in meetings by people who are following their own agenda to the truly abusive behavior of the mother in the Pharyngula guest post--for one thing, no member of AA who is actually working their program could conceivably accuse another person of causing them to drink or interpret the principles of the program to include the abusive rules of her so-called sponsor.

This irrational non-religious "religion" works because it is tailored for those desperate people who simply cannot stop drinking. That is the heart of the matter. If that is not you, there is not way to understand how it works or see any need for so bizarre an organization or a philosophy with such sloppy construction. It probably doesn't make any sense except to the people who actually need it and then only because, somehow, it does work. In my opinion it won't do anything but frustrate the hell out of anyone else.

I always seemed to find groups full of brainy people where such discourse can be intense at times. The first Christmas I was sober I sat in a noon meeting with three other people facing their first Christmas sober--a multiple degreed Yale man, a Harvard PhD and a psychologist--agnostics or atheists, all. That day, we had a great meeting--we didn't talk about God at all but we stayed sober. The Yalie stayed sober the rest of his life, the Harvard man drank the following week while the psychologist was secretly working on a system of controlled drinking which he pursued for two more years while attending meetings every day. He then disappeared for a time, only to return and announce the failure of his experiment, saying he now meant to begin working the steps.

If you are alcoholic, you have to give up the idea that you can drink. If you must have some concept of a deity that you are turning your will and your life over to, then so be it, but a lot of people don't have that understanding--don't think in those terms but, perhaps, in larger or smaller ones. We get sober, too.
posted by Anitanola at 11:44 PM on July 8, 2012 [3 favorites]

Is there actual evidence, beyond anecdote, that AA is an effective treatment program for alcoholism and other substance abuse? I mean, does going to meetings and following the program and attempting abstinence actually work to prevent people from using substances in ways that harm their lives? Does it work as well as or better than other available options, either structured or self-directed? Because a quick Google search is indicating that it's not any better than any other sort of treatment and may not be better than no treatment at all. I guess I'd want to see some evidence that it actually works before funneling ever more people into it on the assumption that it's the best or only way to deal with substance abuse.
posted by decathecting at 11:49 PM on July 8, 2012 [4 favorites]

in every instance higher courts have found A. A. to be a religious organization. It may work, it may not, but no one should pretend it's a rational treatment program.

is alcoholism (addiction in general) a rational disease? is it even a disease? what is it? jury's still out apparently. meanwhile, AA seems to be profoundly useful to many who find themselves overwhelmed by it.

Thank God for that.
posted by philip-random at 12:27 AM on July 9, 2012 [1 favorite]

> "Is there actual evidence, beyond anecdote, that AA is an effective treatment program for alcoholism and other substance abuse?"

No, I don't believe conclusive evidence of effectiveness to whatever significant degree you might have in mind exists for any treatment program.

If you are funneling people to programs and Google, in which we trust, says they're all equally effective, then take your pick. All AA really has going for it in that case is a lot of anecdata and the fact that is is completely free. That matters to some people. To others it might count as evidence that it can't be worth much.
posted by Anitanola at 12:30 AM on July 9, 2012 [1 favorite]

Is there actual evidence, beyond anecdote, that AA is an effective treatment program for alcoholism and other substance abuse? I mean, does going to meetings and following the program and attempting abstinence actually work to prevent people from using substances in ways that harm their lives?

I'm only familiar with the research in respect of drug dependence, not so much alcoholism. But in that respect, it says that people who attend any mutual aid support group as an adjunct to treatment will do better than people who do treatment alone.

However, there's no evidence that 12 step fellowships alone have any better outcomes than plain vanilla treatment. Also, other mutual aid groups like SMART recovery or your local user involvement programme or whatever are likely to be just as effective as a support.
posted by PeterMcDermott at 12:36 AM on July 9, 2012 [2 favorites]

I guess I'd want to see some evidence that it actually works before funneling ever more people into it...

Amen. Please do everything in your power to stop the courts from funneling people who don't want to be there into the AA rooms. It doesn't help the individual and it doesn't help AA.

AA might be effective for those who want to be there. AA is highly unlikely to be effective for those who are forced to be there against their will.
posted by netbros at 3:30 AM on July 9, 2012 [5 favorites]

It worked for me in this way: I knew, if I didn't stop drinking, I'd have to go there.
posted by thelonius at 3:52 AM on July 9, 2012

And what's the evidence, not anecdotal, that it even works more than just deciding to not drink anymore?

Cochrane suggests there is currently no unequivocal evidence for AA as an intervention in alcoholism. It does, however, note the lack of quality studies. There is a real and significant possibility that AA is no more effective, on a population level, than just deciding to give up. This, of course, does not mean that it has not worked in any individual case.

However, this does suggest that we should continue to look for better interventions. One might wonder whether AA's dominant position has stifled the development of more effective means of treatment, possibly incorporating those aspects of AA that are evidentially supported better than the programme as a whole.
posted by howfar at 4:57 AM on July 9, 2012

There is a real and significant possibility that AA is no more effective, on a population level, than just deciding to give up.

This seems like a strange metric, since people who claim success in AA are people who failed "just deciding to give up".
posted by Jimbob at 5:25 AM on July 9, 2012 [3 favorites]

people who claim success in AA are people who failed "just deciding to give up".

Well, anyone who is presenting themselves to a doctor or other support service (how else would the researchers know of them?) has, presumably, failed in the same way, or previously failed to drink reasonably under their own steam. Hence we're probably comparing like with like, alcoholics with alcoholics. One would need to look at the studies actually included in the meta-analysis, as I've only read the abstract. It's worth noting that Cochrane is the world's most respected producer of medical meta-analyses, and will exclude studies that are methodologically flawed.
posted by howfar at 5:44 AM on July 9, 2012

One might wonder whether AA's dominant position has stifled the development of more effective means of treatment, possibly incorporating those aspects of AA that are evidentially supported better than the programme as a whole.

That's possible. One might wonder also why addiction in general is so goddam resistant to treatment of any sort. I really don't think it's for lack of trying on the part of the medical community, and I don't see how AA as an organization has actively stymied development of alternatives. The "recovery industry" has evolved a bit over the last 30 years -- there are a lot more inpatient options now than there were in the 70s, as some in this thread have pointed out, and i would hope that the professionals in those institution are earnestly trying the things that work best for their patients.

It breaks my heart to see people grapple with their addictions and fail to climb out over and over again -- there are people very close to me right now who I just don't see any real hope for. I wish there was a pill or an operation or something, because this shit has been a freight train wreaking havoc through my personal sphere my entire life.

I came in to AA because I was utterly out of options and ideas, and it was initially the group support that gave me the strength to stay sober that first day, and that second day, and after a while, it began to look like I could string a few of those days together, and really you don't even think about why at first -- you just keep showing up and looking for a hand to hold. I'm probably the textbook definition of an agnostic, but if there's a little bit of G*d in that somehow, I'm okay with it. A room full of people saying "it's okay, we felt the way you feel, and we're okay now, and you can be okay too" is a powerful enough thing that it was a power greater than myself those first few months. I've since expanded my idea about what that higher power might be, but hell, I'm just a puny human on a puny planet in some out of the way galaxy trying to even contemplate why gravity holds all this together.
posted by Devils Rancher at 6:05 AM on July 9, 2012 [4 favorites]

But why is God necessary if alcoholism is a disease? Why, if it is a disease, is it most popularly treated with a spiritual-based solution?

Man, I seem to recall reading that, in the US, alcholism got redefined as a medical disease primarily when doctors realized most people needed their health insurance to pay for rehab, but I've only read that once.
posted by Snarl Furillo at 6:12 AM on July 9, 2012

Old-timer: "Boy, I've spilled more on my tie than you've drank in your whole life!"
Me (slightly terrified): "Sorry to hear you were so sloppy, sir."

Good one, but that best comeback to that is: "Maybe if you hadn't spilled so much you would have got here when you were a little younger."
posted by marxchivist at 6:27 AM on July 9, 2012 [1 favorite]

Remembering that I'm also an atheist, I'll pose this question about how God is baked-in to AA:

If you were drowning, wouldn't you take a life-preserver thrown to you by even your worst enemy? Is your pride that important to you?

Don't make the perfect the enemy of the good.
posted by double block and bleed at 6:32 AM on July 9, 2012 [5 favorites]

One might wonder also why addiction in general is so goddam resistant to treatment of any sort.

Absolutely. The most obvious answer is that the disease model doesn't reflect reality terribly well in many cases. Addiction probably isn't really a single issue but a typically a symptom of a variety of problems. Treating those problems is probably a social and emotional task as profoundly complex as making someone happy. Such a view argues in favour of the social and spiritual approach adopted by AA, the difficulty being that the data we currently have are hard to square with an expected increase in recovery rates.

I do wonder if we're missing something vital. If not, does addiction recovery end up as simply an existential choice? That would be quite depressing, really, as so many of the things that lead to addiction are about as far from existential freedom as can be imagined.
posted by howfar at 6:38 AM on July 9, 2012

I think it's more a case of people wanting to throw more life-preservers in the water on the principle that one size does not apparently fit all.
posted by CBrachyrhynchos at 6:43 AM on July 9, 2012 [2 favorites]

If you were drowning, wouldn't you take a life-preserver thrown to you by even your worst enemy? Is your pride that important to you?

Don't make the perfect the enemy of the good.

Of course, but I'd also resent the idea that I'd have to say that I'd have to acknowledge that I am addicted to drowning, admit that I was helpless to the water and submit to a "higher power" in order to be part of the group of people who were saved.

No one is saying that it doesn't work for some. But hell's bells...some people just don't want to stop drinking. The people who *are* successful with AA are people who wanted to stop in the first place...and even then, there's apparently a tremendously high rate of relapse.

I mean, there are medical solutions to the problem, but most people don't know about them and, if they do, it seems that some people don't trust them. Things like Antabuse and naltrexone.
posted by inturnaround at 6:45 AM on July 9, 2012 [1 favorite]

I have a family member who has been prescribed Antabuse. He knows exactly how many days it takes to get out of his system so that he can engage in a good bender. He's never given it long enough to see if he could actually overcome the craving, which who knows how long that would take. Apparently the craving is bad enough that he'll give in to it 4 days in advance of a drunk, anticipating it all the while. Won't have anything to do with those "Christian motherfuckers" at AA, Ration Recovery was "full of zombies" ... it goes on like that, apparently forever.
posted by Devils Rancher at 6:51 AM on July 9, 2012 [2 favorites]

If you are drowning, you are helpless to the water and need a higher power (the person with the life-preserver). After you get out of the water, then you can decide whether you should get back into the water, stay out of the water, get some swimming lessons or take a friend with who's a better swimmer. That decision will vary greatly from person to person.

I'm using my son's kindle fire right now. Typing onnthis thing is murderer.
posted by double block and bleed at 7:19 AM on July 9, 2012

I'm really not sure this metaphor is very useful.
posted by howfar at 7:24 AM on July 9, 2012

Ok, I'll drop the metaphor. Even though I am personally uncomfortable with the religiosity of AA, it worked for w long time for my dad. If I fell into alcoholism and wanted to quit, that is where I would go. I would then work on the spiritual dissonance after I dried out a bit.
posted by double block and bleed at 7:38 AM on July 9, 2012

I mean, there are medical solutions to the problem, but most people don't know about them and, if they do, it seems that some people don't trust them. Things like Antabuse and naltrexone.
posted by inturnaround at 6:45 AM on July 9 [1 favorite −] Favorite added! [!]

There are also secular support groups like Lifering which offer the same group support that seems to be the most helpful part of AA but without the requirement that you submit to a "higher power". Lifering talks about empowering the "sober self" which I think is a healthier mental attitude than submitting to a "higher power" - something outside of yourself, which somehow can be anything you want (ie a doorknob) if you don't want to call it "God"- a notion which I find offensive and nonsensical.

"LifeRing works through positive social reinforcement. The meeting process empowers the Sober Self within each of us.

I think this positive social reinforcement combined with medical therapies like Antabuse, naltrexone (and others) would be more effective that AA alone. I think the real problem is that AA or 12 step programs are seen as the ONLY option in so many places and so it becomes an all or nothing proposition. Fortunately programs like SMART recovery and Lifering have been started specifically to address this need. AA was developed in the 30's, Lifering was developed in 2001 and seems to have a more scientific approach.

This video does a good job of explaining how Lifering specifically works, but you can see that this model (empowering the sober self, socializing with sober people) can be applied elsewhere.

Alcoholism is absolutely a medical disease and not a moral failing. HBO has a great series on addiction (alcoholism is an addiction to alcohol) that really does a lot to remove the stigma of addiction while providing lots of information on ways to get help.

"The Addiction Project is produced by HBO in partnership with the Robert Wood Johnson Foundation, the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Understanding Addiction

Addiction is a chronic relapsing brain disease. Brain imaging shows that addiction severely alters brain areas critical to decision-making, learning and memory, and behavior control, which may help to explain the compulsive and destructive behaviors of addiction.
posted by smartypantz at 7:40 AM on July 9, 2012 [2 favorites]

There are currently no good medical solution for alcohol abuse, although there is promising research on some drugs or substances that provide relief for some people. For instance, Niacin has helped some people. (Antabuse isn't really along those lines.) Finding peace in life to reduce the desire to hide from life's viscisitudes in chemicals is what a 12 step program is all about. Finding that peace is not just for addicts and can help anyone face life. Al-anon uses the same program essentially. The key is humility, the reduction of one's own ego. This is the essence of all spiritual growth. Spiritual growth is sought by many religions, be they Eastern type (Buddhism, Hinduism, etc.) or Western (Chistianity, Judaism,Islamism etc.) but organized religion and/or God have no monopoly on spiritual growth and secular spirituality is found by many. How to reduce ego and seek humility? Finding something greater than yourself helps to find humility by comparison. Perhaps you are alcoholic and have failed to stop drinking. In the rooms of AA you find a group of people who have succeeded in stopping. In that respect they are a higher power. Submission to their wisdom on that issue gives you a start on humility. Perhaps you have no issue with alcohol, drugs or other addictive behavior but like many people you seek the serenity that comes from spirituality yet do not believe in God and have an issue with any organized religion including Buddism etc. The wonder of nature, the cosmos, and even the sub-atomic, can help to put into perspective our own personal significance or insignificance. I like how Albert Einstein described it: "A human being is a part of the whole, called by us Universe, a part limited in time and space. He experiences himself, his thoughts and feelings as something separated from the rest-a kind of optical delusion of his consciousness. This delusion is a kind of prison, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free from this prison by widening our circle of compassion to embrace all living creatures and the whole nature in its beauty.."
posted by caddis at 7:54 AM on July 9, 2012 [8 favorites]

I think peer support and the community created by peer support, both focused toward a common goal, are incredibly powerful. Peer support and community are useful (and have shown empirically to be useful) for a range of experiences and conditions -- e.g. depression, diabetes, drug & alcohol abuse. Peer support and community underlie countless social institutions -- from churches to fraternities to lending circles to grief support groups to AA to LifeRing to DBSA, etc., etc.

From my view AA has many of the elements of a religion. E.g. scripture (the big book), call and response, explicit references to God, rites and rituals, redemption. And countless people are absolutely fine with these elements, and find them empowering, comforting, healing, strengthening, etc.

What I sometimes find to be odd is when people state that AA is not religious, or if it is religious, you can ignore the religious aspects. I am not sure this is always a helpful response -- for some people the religious elements are deeply alienating, while the peer support and community are absolutely needed. Which puts those folks into a Catch-22.

Shorter: Stable, geographically dispersed, and non-religious peer support alternatives to AA are super important.
posted by ClaudiaCenter at 7:59 AM on July 9, 2012 [5 favorites]

Antabuse is to an alcoholic like a "No Swimming" sign is to a drowning person; i.e. not exactly a solution.
posted by achrise at 8:12 AM on July 9, 2012 [3 favorites]

(trying to stay on topic, but this thread has so many branches. apologies for any derailing and rambling)

I really don't think it's for lack of trying on the part of the medical community, and I don't see how AA as an organization has actively stymied development of alternatives.

The problem lies in the hordes of people who have anointed the 12 step process as some sort of perfect solution to addiction. The simple fact is that it is not and never really was. It was and is simply one way to approach one's addiction issues. Sure there are fervent evangelists of "the steps" and who are within the step world and all that. However, I think the larger problem is those persons who are not in recovery who find the whole 12 step process as a nice, neat, simple answer to getting other people sober. The xxxx-Anonymous groups achieved a bit of a notoriety that has been co-opted by non-addicted people who do not have a clue about what addiction is like, but love the convenient idea of a 12 step path - maybe almost a guarantee - to sobriety. The worst part is that it is these same co-opters who also believe in the infallibility of the 12 step process.

So if there is any "stymying" that is going on, I see it as coming from people who are trying to us the 12 Step process as band-aid not for addiction, but in for not being able to come up with a viable medical process and be able to sell it. Sure it is a tough thing to get people to buy into, but until the medical community begins to treat addiction as a medical behavior, and maybe a behavior based in a mental health problem, these ineffective religious methods will continue on and all sorts arguments will be waged as to their effectiveness.

But if you think God will keep you away from the bottle, the needle or the pipe, then that is cool. Whatever works for you.

AA gets a bad rap when it comes to the whole religious question. They really don't do all the pushing of it on people who do not come to meetings. I mean, don't go to a meeting and it is highly unlikely an AA person will kidnap you and make you recite the Lord's prayer. Here you have this relatively modest organization (AA) and all the groups that have been sprung out of it getting slammed for their religious push, when in fact, they are relatively passive about the whole issue. Sure, the word God is plastered all over their literature and stuff, but that is their choice and right to do so. If you go into an xxxx-Anonymous meeting and expect it to be different, it is the attendee who has not only the problem of their addiction, but also the problem of presuming that an established group is going to change their feathers because a newcomer has a different sensibility.

For my part, I am of the Yoda-Anon group that meets and chants "Do or do not. There is no try." I did the AA routine and it was not for me. So be it. But for others it is a real blessing and for those oft cited 5% of the people who try it and stick with it, I say good for them. At least 5% of the addicts out there are on the right path. I could care less if they hum Kumbaya 24/7. At least they are not driving drunk, sharing dirty needles and all that other crap that goes on in the crap world of addiction. For those for where it did not work, they just gotta keep trying until they find a path they can walk down and remain sober. However, blaming the religiosity of the xxxx-Anonymous groups is pointless and won't result in a sober life. It is just a distraction from getting down to actually dealing with their problem.
posted by lampshade at 8:19 AM on July 9, 2012 [6 favorites]

Antabuse is to an alcoholic like a "No Swimming" sign is to a drowning person; i.e. not exactly a solution.

It's part of a treatement regimen. It's not a complete solution in itself. And it won't even work on most people, especially those who don't want to stop drinking.
posted by inturnaround at 8:22 AM on July 9, 2012

Antabuse was never intended to be a magic no drinking pill. The point is there needs to be many factors: a willing attitude, therapy, peer group support, lifestyle change and then something like Antabuse might help someone in that situation keep their focus on their recovery.

From the HBO website:
"Scientific studies demonstrate that the right mix of behavioral therapy, medication (when available) and personal support can help addicted people navigate the road to recovery.

My point is that AA has had a monopoly on the peer support part of that equation, and I'm glad there are now more options like Lifering and a recognition that the 12 steps aren't necessarily the only thing that works. Statistically AA recovery rates are the same as people who decide to quit drinking on their own. It's the intention to stop drinking that is the key factor in success for both groups, and if AA helps some people then that's great but I'm glad there's other options.
posted by smartypantz at 8:44 AM on July 9, 2012

THe late Harry Crews took Antabuse for about 20 years, which is not, I think , how it is intended for use. This worked for him, however, to stay sober.

I've been told by several AA people that the meetings are not the important part of the program, that doing the 12 steps with a sponsor is. I'm not sure how to take that; many people seem to find that the community and support they get at meetings is inestimably important to their continued sobriety.
posted by thelonius at 8:51 AM on July 9, 2012

Alcoholism is absolutely a medical disease and not a moral failing.

Please let's not speak in absolutes. They don't leave any room for discussion. In this case, it's the insistence that there's nothing between A. medical disease, B. moral failing, which are both powerfully loaded wordings.

One notion about A.A. that's always stuck with me is the degree to which it never presents itself as a cure to alcoholism, just a strategy for not letting alcoholism destroy you -- kind of like playing a game of chess to stalemate. Which doesn't mean you can't have a damned fine life on the side while you're playing that stalemate. What you can't do is ignore the game. Hence, the whole one-day-at-a-time thing.
posted by philip-random at 9:01 AM on July 9, 2012 [2 favorites]

Ok then, the scientific evidence seems to suggest that "Addiction is a chronic but treatable brain disorder in which people lose the ability to control their need for alcohol or other drugs." . AA / 12 step programs seem to treat alcoholism as a problem of the will, or as a moral failing in need of forgiveness and redemtion (see steps 4-12). In fact, most of the 12 steps are centered around moral redemption and only one or two at the most have anything to do with addressing alcoholism as a physical problem (ie step 1). I personally feel treating a brain disorder as a problem of the will can be problematic.

I am also a recovering Christian, and now have a hard time with systems of guilt. AA's religious like structure (steps 2-12) systematically reinforces guilt while at the same time absolving one of any of the credit or responsibility of recovery (ie you are submitting to a higher power because you are a weak immoral person, and if you are successful, the higher power gets credit). This is why I am glad there are finally more science based approaches like Lifering and SMART recovery out there that don't presuppose you have to do a moral inventory or ask God to "remove all these defects of character" in order to not drink or use drugs. To be clear, this does not mean I'm arguing personal introspection and reflection aren't an important part of recovery.
posted by smartypantz at 10:06 AM on July 9, 2012 [7 favorites]

I personally feel treating a brain disorder as a problem of the will can be problematic.

Turn this around and it doesn't get any less problematic (ie: treating a problem of the will as a brain disorder). The problem, I guess, is that "the will" is unavoidably subjective, while the brain disorder is sort of the opposite. Which gets to my overall thinking on addiction etc -- it's an issue of both self (what you believe morally, ethically etc, the experiences that have molded you) and genetics (the physicality you were born with, the ongoing complex chemistry by which you function).

Bottom line. I'm glad A.A. exists. I'm glad that other alternatives are being explored. I'm glad that the scientific research continues.
posted by philip-random at 10:41 AM on July 9, 2012 [3 favorites]

Finding peace in life to reduce the desire to hide from life's viscisitudes in chemicals is what a 12 step program is all about. Finding that peace is not just for addicts and can help anyone face life. Al-anon uses the same program essentially. The key is humility, the reduction of one's own ego. This is the essence of all spiritual growth. Spiritual growth is sought by many religions, be they Eastern type (Buddhism, Hinduism, etc.) or Western (Chistianity, Judaism,Islamism etc.) but organized religion and/or God have no monopoly on spiritual growth and secular spirituality is found by many. How to reduce ego and seek humility? Finding something greater than yourself helps to find humility by comparison.

I could just as easily claim that one can find spiritual peace by looking within rather than without -- to find the strength to reject wrongs, to find one's own reasons to reach out to others, to build a healthy, balanced ego by accepting responsibility for one's own actions while rejecting false notions of blame and helplessness. I could synthesize this into an alcohol-treatment program in which people help each other develop said ego (it would look much like LifeRing plus a strong dash of Alan Carr's method), and I could connect it to religion, too: all you have to do to get sober is find your own Inner Luciferian Spirit... which doesn't have to be Lord Satan, of course, it could be your own pancreas as long as it's both within you and a Spirit! Anyone who claims to have a problem with this will be told that their reluctance is pointless, and just a distraction from getting down to actually dealing with their problem... which necessarily involves taking Lord Satan (I mean, one's Inner Spirit! Sorry if the words "Lord Satan" are all over the book, but they mean nothing!) as one's ultimate master.

And there's the rub: just as my version of spirituality is not a great fit for absolutely everyone, neither is yours. Those who are unwilling to reach for my life preserver should not be surprised when others balk at reaching for theirs.
posted by vorfeed at 11:01 AM on July 9, 2012

Bottom line. I'm glad A.A. exists. I'm glad that other alternatives are being explored. I'm glad that the scientific research continues.

I've got way too many friends who owe their long term recovery to the 12 step fellowships to be completely dismissive of AA/NA/CA/etc, but I can't think of another 'disease' in which a large number of purported experts claim that the only viable treatment ignores all of the research that's been conducted since the 1930's in favour of a moral/spiritual programme.

Can you imagine if somebody tried to argue this in the case of schizophrenia? Or heart disease? There's no place for medication. The only viable cure is abstinence from certain behaviours, and a programme of moral self-examination. We'd say that they were nuts.

Yet not is there a large body of 12 step advocates who argue precisely this, there are also a bunch of know-nothings who appear to take them seriously.
posted by PeterMcDermott at 12:07 PM on July 9, 2012 [2 favorites]

Thanks for linking my piece on wet houses, above. I have been reiterating these points for decades, ever since I started writing about needle exchange for the Village Voice in 1990.

Here's my first piece calling for ending anonymity in terms of public advocacy in the Washington Post from 1993 [sorry paywall], another one making the case against AA-based treatment as the primary treatment from 2002 [again, paywall from Post]

Again, in 2010 for TIME about why forcing teens into 12 step programs and making them accept the addict/alcoholic label is bad (yay no paywall). And once again for The Fix, this week.

Rather sad that we've made so little progress. My Fix article directly challenges the idea that 12 step ideology should be used in treatment at all: basically, it's against the traditions of the group to do that (you are not supposed to get paid for sponsoring people or teaching them about the steps) and it's bad for treatment because it creates the "one true way" business by populating the counseling world with people whose primary expertise is the steps. I do think recovering people have a lot to offer in addiction treatment, but if the only thing they've got is their own experience, well, that's not treatment for any disease I've ever seen.
posted by Maias at 1:32 PM on July 9, 2012 [5 favorites]

Again, in 2010 for TIME about why forcing teens into 12 step programs and making them accept the addict/alcoholic label is bad

Yeah, I was a bit depressed to read about people in this thread who had been coerced (presumably) into adopting the addict/alcoholic role as teenagers, and told that they had a life-long disease that made it impossible for them to ever drink/drug again.

Though I don't want to dismiss how those people might feel about their own experiences, outside the USA, most addiction medicine rejects the idea that teenagers will be 'addicted' in this sense of having an immutable condition or 'disease'. They might have a drug problem, but that's often something that is determined by other people's reaction to their behaviour and for large numbers, will spontaneously resolve itself as their life and social situation changes.
posted by PeterMcDermott at 4:59 PM on July 9, 2012

From what I've read, most addiction medicine is floundering for an answer and teenage addiction, often enough, doesn't spontaneously resolve itself when people turn twenty-one. Often enough it does. At any rate, I wasn't really a different person in my teens than in my twenties, and I knew I was an alcoholic from the time I was about twelve, so it wasn't as if I was having one of those youthful stages when I stopped drinking at twenty two.
posted by Peach at 7:44 PM on July 9, 2012 [1 favorite]

There is a certain type of problem drinker who has indeed crossed the line and become an alcoholic. There are also heavy drinkers who are not alcoholics. There are people who are alcoholics from practically the first drink and people who drink for years and never become alcoholics. There are many studies trying to explain or predict this.

Still AA doesn't label people alcoholics. AA asks. AA says you have to be the one to decide if you are an alcoholic. AA never claimed to be a treatment for anything but the people who could not quit drinking no matter how much they might want to and pretty much had no other hope--and AA never disapproved of medical care; encouraged it quite definitely.

The type of drinker described by AA is not your average frat boy who is acting out and going through a wild phase. For good or ill, there is a lot of money to be made in the rehab business, just as in any health care field, so this low-key, anonymous program of drunks helping drunks to get sober and find a way to live has been ripped off in whole or in part, packaged as part of everybody's expensive treatment center and marketed rather aggressively. Probably not a good idea. I don't believe you can't make people work the program.

It is not AA that has done this. AA still says you have a choice: anybody can be here and nobody is forced to be here. Rehab seems to be something else. That's why many members object to courts sentencing people, especially kids, to AA meetings.
posted by Anitanola at 10:42 PM on July 9, 2012 [2 favorites]

Still AA doesn't label people alcoholics. AA asks. AA says you have to be the one to decide if you are an alcoholic.

In official AA literature, sure..........

That is a great line that gets trotted out all the time. Yes, as an organization, AA does this (or doesn't depending on the claim). What goes on in meetings with individuals is far different. It is not much different than the "we are not religious" line right after the prayers are recited. It is fine for AA and the other groups to make an official claim of things like this, but what happens in meetings is a different story.

AA can be whatever it wants and run its meetings like it wants. However, it should drop the innocent act bullshit a bit. Reality simply does not mesh with the PR ad copy. Please. Just admit to it and be done with the issue. Walks/quacks/duck/etc.

This is one reason I stay away from 12 step groups because they all do this. It is either simple denial or dishonestly. You figure out which.
posted by lampshade at 11:55 PM on July 9, 2012 [1 favorite]

In official AA literature, sure...It is fine for AA and the other groups to make an official claim of things like this, but what happens in meetings is a different story.

So what are you going to do? Meetings are run by individuals who run meetings the way they individually run meetings. There's just a book to guide you, and the people around you. And some meetings are run by old codgers who have got set in their ways, their own interpretation, have lost sight of what it's all supposed to be about. And what's the General Service Office supposed to do about that (apart from, in extreme places, preventing people using the name "AA", which has happened)? These meetings tend to be self selecting - you get the same old bastards who don't welcome newcombers. Fortunately, the traditions ensure the main message and function continues elsewhere.

If you go to play for your local town soccer club and find out they're a bunch of pricks, do you lambast soccer as an awful, harmful, dishonest, hypocritical sport? Do you demand FIFA take action against them? Pushing analogies too far, once again. But, as I said, I've never heard the Lords Prayer in a metting. Ever. Or heard anyone tell anyone else they're an alcoholic.
posted by Jimbob at 2:08 AM on July 10, 2012 [1 favorite]

I've never heard the Lords Prayer in a metting. Ever. Or heard anyone tell anyone else they're an alcoholic.

Well, then, we must be talking about alternative universes then because in every AA mtg that I have been to in multiple states, over multiple years, in multiple locations and with multiple groups, this has been the case. So it is not something I have imagined.

I grow tired of groups that espouse a certain policy then allow individuals within that same group to act in the exact opposite way. Just like in politics when a person from a political party makes some obnoxious remark about say minorities (like the recent Gov Lepage gestapo comment), then the party claims to have absolutely no control over them, yet they foster an environment of intolerance by not actively working against it. The same holds true for AA. Yes, the literature is rather benign overall, but then they allow individuals to twist their policies to abuse the often fragile state of a new member by not monitoring those policies. And this happens over and over and over yet nothing is done except the recitation of the typical disclaimers and what boils down to corporate style doublespeak. I wish AA members would stop it with the statements of purpose that, on paper are correct, but in real life simply are not the way things go down.

A simple example is the "AA never disapproved of medical care" line. Sure, maybe AA HQ doesn't disapprove, but try talking about your prescribed meds in a meeting and see how the conversation goes. More often than not, the person on medication who admits it will be criticized and often ostracized by the no-meds purists who, while maybe not part of the AA official staff, still play a big role in the meeting environment and have an enormous impact on a person's experience. Those people are the de-facto AA staff and are what the group personality is based on. Often in a very negative way. And yet, AA HQ does nothing about it. So please stop with the AA-Never-Does-XXX crap, because in practice, it is simply not true.

Oh, and don't worry about it driving away members. At a 5% retention rate, I am pretty sure those few who stick with the program are there for the long haul and the number won't go much lower. For the newcomers, just be honest about what is going on. The ones who can deal with it will stay and the others will move on.

AA can do whatever it wants. It would just be nice if they were honest about how things really are as opposed to reading from the corporate script when scrutinized. This has always been one of the main reasons that I shy away from any 12 step group. The experience as it is described/written and what it is like in practice are 2 different things.
posted by lampshade at 2:30 AM on July 10, 2012 [1 favorite]

So what are you going to do?

And to answer your question – I just move on and let it go. Have it your way. I won’t be picketing in front of your meeting site or making anti-AA webpages, but in a forum where statements are made that run so completely counter to my experiences, I am going to speak up because this is not like embellishing a dinner review at a friend’s new restaurant, this is a major point in a person’s life who may be new to reco and they should know the score. The real deal, not some recitation of a press release from HQ.

And that is all I have to say on this.
posted by lampshade at 2:42 AM on July 10, 2012

There is a certain type of problem drinker who has indeed crossed the line and become an alcoholic. There are also heavy drinkers who are not alcoholics. There are people who are alcoholics from practically the first drink and people who drink for years and never become alcoholics. There are many studies trying to explain or predict this.

What's the medical criteria for being an alcoholic, anyway? As far as I can tell, there aren't any, in the sense that there are diagnostic criteria for other diseases. There is no category for "alcoholism" in the DSM; instead, there are "Alcohol Abuse" and "Alcohol Dependence". The AMA has a definition of alcoholism, but it seems pretty vague ("Each of these symptoms may be continuous or periodic"). Many AA people seem to have an essentially metaphysical concept of "alcoholism", as a spiritual state of the self that is quite independent of the actual over-consumption of alcohol.

I personally did not make any progress with alcohol until I withdrew from engagement with this issue, and started thinking of myself as a person who really, really needed to stop drinking.
posted by thelonius at 3:21 AM on July 10, 2012 [2 favorites]

For good or ill, there is a lot of money to be made in the rehab business, just as in any health care field, so this low-key, anonymous program of drunks helping drunks to get sober and find a way to live has been ripped off in whole or in part, packaged as part of everybody's expensive treatment center and marketed rather aggressively.

Also, those making money in the rehab business have a vested interest in the low-key, anonymous program being devalued. It seems likely that those profit-takers are the source of a lot of badmouthing of 12-step programs.
posted by Kirth Gerson at 4:39 AM on July 10, 2012

Maybe I spoke too hastily on the No True Scotsman thing. If EVERY criticism of AA is met with, "oh, that's not REALLY AA, that's just a bad group", then perhaps the shoe fits.
posted by thelonius at 6:06 AM on July 10, 2012 [1 favorite]

This thread makes me sad. I'm an atheist and all-round skeptic, but I've stayed sober in AA for over 20 years. My home group says the Serenity Prayer. The first word is "god". If I'm leading the prayer, I ask someone else to start it, cause god has nothing to do with my recovery. Lots of the criticisms here from people who have actually been to meetings are nitpicky and lead me to believe they don't really want to stop drinking, or cannot understand that AA is the next best thing to anarchy - that fallible humans are part of all meetings and sometimes are assholes or bullies or just plain wrong. We have chased a few assholes and bullies out of meetings in my area because they were disturbing the meetings and sometimes were endangering member's sobriety. I suppose they then became another meeting's problem, unfortunately. We can't fire or exclude anyone, except in the most extreme cases, but public shaming and shunning seem to have worked for us.
We try to make the groups we belong to the best in AA. We revel in the progress of newcomers who we have watched and helped and listened to as they move away from hopelessness and into a new life of possibility. You can't imagine the joy of celebrating the one year anniversary of a young mother who is about to regain custody of her daughter because she is now able to be a good mother, a sober mother.
It's not a cult and one needn't swallow Christianity to become and remain sober in AA. Ignore the assholes and find the good people. They are everywhere.
posted by Hobgoblin at 7:42 AM on July 10, 2012 [2 favorites]

I'm going to get lambasted for this, but here goes...my personal experience is that the folks who become lifelong AA ambassadors have just replaced one addiction with another. Once you stop drinking and recognize that sobriety is a better path for you, I'm not sold on why you have to attend AA meeting forEVER. But I have to admit...I have never found someone who USED to go to AA meetings.
posted by Kokopuff at 8:56 AM on July 10, 2012

What's the medical criteria for being an alcoholic, anyway? As far as I can tell, there aren't any,

Well, as the old joke goes, "I'm not an alcoholic. I don't go to the meetings. I'm just a drunk."
posted by philip-random at 9:06 AM on July 10, 2012

I'm going to get lambasted for this, but here goes...my personal experience is that the folks who become lifelong AA ambassadors have just replaced one addiction with another.

Even if you think going to AA for the rest of one's life is a bad thing, surely it's far less of a bad thing than continuing to be a drunk. AA does not cause highway accidents, financial ruin, physical deterioration, or any of a raft of other disasters that alcoholics routinely suffer. I don't see why the exchange is in any way a downside of AA.
posted by Kirth Gerson at 9:11 AM on July 10, 2012 [1 favorite]

my personal experience is that the folks who become lifelong AA ambassadors have just replaced one addiction with another.

dude, that's like saying taking medicine is just replacing the pain of sickness with the pain of swallowing pills... Some treatments are just continuous. A lot of people are on prescriptions they don't expect to ever get off.
posted by mdn at 10:10 AM on July 10, 2012

oops, meant to preview... as for the god thing, as I understand it some people find recognizing they have a problem the most important step, and an important part of that can be really "getting" what a problem is. It's something beyond your control, something you can't handle, and something you need help with.

It's not just something you need to pay more attention to. The point of a "higher power" is to remind you that you're the lower power, or that you are not fully in charge of everything. Some things are just too much for you to handle. It is more about humility than a specific religion.

The rational recovery route suggest that you can figure out how to take care of things, but if you could do that, would you have gotten into this mess in the first place? AA is for people who could not take care of things rationally. It got out of hand. They can be super smart, rational people in other parts of life, but somehow, this part of life just didn't work that way for them. I think the idea of "god" can be pretty abstract (ie, it can be pretty much anything as long as it is their higher power) to the attendee - but it is a stand-in for something important.
posted by mdn at 10:22 AM on July 10, 2012 [3 favorites]

The rational recovery route suggest that you can figure out how to take care of things, but if you could do that, would you have gotten into this mess in the first place?

No, the rational recovery route encompasses peer support groups like Lifering that offer the same idea of peer support as AA, but without the inherent shaming of participants through the step process. They provide sober places of mutual support from people on the same path, which is what AA meetings are at their essence.

AA isn't the only game in town anymore, it just has been the only option for 60+ years which is why I guess it's hard for some people to wrap their minds around the idea that there are other equally effective support groups available now.
posted by smartypantz at 10:32 AM on July 10, 2012

a long story made short ...

Old friend of mine (call him Tom), a rather brilliant artist, but he was always at least a bit dangerous if ever got past about his fourth drink -- the classic "sudden personality change".

We lost touch for a while (due in part to my not enjoying his sudden personality changes) but I kept on top of Tom's story via various friends. Married, then divorced. Married again, separated. Meanwhile, his career was going well enough for him (better than mine anyway). I did run into him every now and then, and he seemed to be doing fine. But then I suddenly got an email from him (a group thing) in which he announced his alcoholism and urged everyone he knew to NOT EVER DRINK WITH ME AGAIN. But he wanted no part of A.A (I'm guessing because of the Higher Power thing -- Tom was firmly non-theist).

Anyway, maybe two years go by and I'm traveling out east when I run into a mutual friend. The subject of Tom came up and the friend (call him Bill) sort of shook his head and revealed a recent incident at a house party Bill was throwing. Tom was in town for some work and so Bill invited him. Tom showed up plastered and looking for trouble. Oddly enough, one of the party guests was a big deal expert on alcoholism, addiction in general (an academic). He got Tom settled down, drinking coffee etc, eventually lucid enough for something approaching rational discussion, at which point he said to Tom, "Well, if you're remotely serious about dealing with your alcoholism, step one is A.A. The whole twelve steps. Until then you're just wasting everyone's time."

This is just one anecdote, but it tells me we've got a long way to go before anything is going to replace A.A.
posted by philip-random at 11:05 AM on July 10, 2012

"You can't get sober without help, and help means AA" has become one of those things that everyone "knows", but which is not really true.

I have actually gotten a lot more open-minded about AA since I quit drinking. I'm seriously considering going to some meetings to see what I think of them. My starting point was, let's say, distaste for the entire idea, and not just because they talk about God in their book. I refused to just accept the postulate that it was impossible for me to simply stop, until I tried - I mean, really tried. I didn't drink every day, and wasn't in danger of physical withdrawal. (When I did drink, which was 2 or 3 times a week, fire for effect). Believe me, it was an open question whether or not I could succeed for more than a few days. If I couldn't, I was prepared to do whatever I needed, but my preference was very much to avoid going to the EAP and doing in-patient rehab, if possible. So, heading off to AA would probably have been my next step. This was 8 months ago, and I have not had a drink since. I really don't even want one - most of the time. I've done nothing except participate in online support, engage in personal emotional work, and simply not drink, no matter what.

So that's my story, and I of course realize that it has no universal applicability. I just want the same courtesy in return: if someone else quit via the 12 steps, daily meetings and sponsor calls, etc., I'd quite appreciate it if they didn't think that this means that people like me are "dry drunks" or "merely abstaining".

I think what happened to me is I got scared, really scared of ending up a sick, broken down drunk, dying alone. I'm old enough that life does not offer too many second chances, you know? So the voice that said: I know I really need to deal with this, but later - it suddenly didn't seem so persuasive. It IS later, you fool, I said, and NOW is the time to deal. Also: I could feel the next stage coming on. Drinking was becoming less pleasurable and more of a need. That's not good. How much longer before I was drinking every day? 6 months? A year? Also, I was utterly miserable, and I knew that things were going to get worse, not better, unless I changed what I was doing.
posted by thelonius at 11:43 AM on July 10, 2012 [3 favorites]

This is just one anecdote, but it tells me we've got a long way to go before anything is going to replace A.A.

This story has nothing to do with AA and everything to do with a man who isn't ready for help. Perhaps if he had entered therapy, at the same time he sent out the mass email he might have got a start on it. More than likely the email was sent after a particularly bad night, and his resolve to quit didn't last longer than a short while. AA's success rate is 5%, the same as those who decide to do it without AA. This means it is the intention to quit drinking that is so important, not necessarily going to AA meetings. If he doesn't like AA, but really wants to quit, there are other options.

The fact that your friend the addiction specialist's only suggestion was to go to AA just reinforces the fact that people in the medical field has not caught up with the science. If AA has been the only option for so long, as I said, some people still think that it's the only option.

It isn't.
posted by smartypantz at 11:48 AM on July 10, 2012

The rational recovery route suggest that you can figure out how to take care of things, but if you could do that, would you have gotten into this mess in the first place?

Is God really, literally, personally reaching down to fix things for each and every one of the abstainers in AA? If not, then they are figuring out how to take care of things together, just as in Rational Recovery. The fact that they do so through a framework of "humility" rather than "rationality" doesn't seem to matter much... at least not with respect to success rates. And the scientific literature suggests that many people do quit on their own:

"The findings suggest that a substantial number of people recover from alcohol dependence in spite of its chronic characteristics. This should provide a positive incentive for people seeking treatment and for providers working with these clients. Second, a considerable number of people appear to recover without professional intervention. [...] Third, some people seem able to go back to drinking without experiencing their previous alcohol-related problems."

The idea that people can't quit without AA is an unsupported tenet of AA, not a reflection of reality. Which leads me to...

Even if you think going to AA for the rest of one's life is a bad thing, surely it's far less of a bad thing than continuing to be a drunk.

These are not the only two options, as I've shown above. Lifetime participation in AA may be better than continuing to be a drunk, but it may not be better than living a life in which you neither drink nor live in constant apprehension of drinking.
posted by vorfeed at 1:01 PM on July 10, 2012

What's the medical criteria for being an alcoholic, anyway? As far as I can tell, there aren't any, in the sense that there are diagnostic criteria for other diseases. There is no category for "alcoholism" in the DSM; instead, there are "Alcohol Abuse" and "Alcohol Dependence".

Seems to me this is a feature, not a bug: anyone who feels they have a problem with alcohol and wants to quit is welcome to self-label as "alcoholic" and join AA (at least in theory, YMMV on actual groups as attested to by some of the anecdotes here) without worrying about whether they meet the technical criteria for alcohol abuse or alcohol dependence.
posted by DevilsAdvocate at 2:52 PM on July 10, 2012

anyone who feels they have a problem with alcohol and wants to quit is welcome to self-label as "alcoholic" and join AA

I think the problem is that many AA groups and members and, to some extent, the organisation as a whole, have a view of alcoholism that may not relate to the experiences of many individuals with a problem with alcohol. The disease model of alcoholism is quite possibly accurate in an unknown number of cases. The problem is that there are undoubtedly people experiencing problems with alcohol whose lives (not just sobriety) would benefit from a different model. It seems likely that there are many people who should stop drinking for good who do not need to spend the rest of their lives defining themselves as alcoholics.

Given that AA appears to work no better than any alternative, there doesn't seem to be a strong argument for encouraging people to identify themselves through the terms and concepts it commonly uses.
posted by howfar at 3:25 PM on July 10, 2012 [1 favorite]

There is no shaming in working the 12 steps. There is no shaming in any part of AA I've been a part of. Nor am I or any of my friends who are more than a couple of years sober "in constant apprehension of drinking". We just live our lives and attend a few meetings where we are reminded of the follies and dangers of the way we used to drink. The steps are there for us to refer to in case we lose our way.
The vehement negativity I read in this thread is entirely misplaced. I know that people quit on their own. I did it, my old High School friend did and he continues to lead a full and alcohol-free life without AA. I found, after 2 years of not drinking, that I was still missing some tools for dealing with life. I found them in AA. I hope that anyone with a drinking problem finds the help they need somewhere. I don't care if they join AA or RR or meditate or become the first person ever to use willpower to not only stop drinking but to remain sober and to lead satisfying, enriching lives. Anything is possible, but AA is surely one of those ways.
posted by Hobgoblin at 4:04 PM on July 10, 2012 [1 favorite]

"The idea that people can't quit without AA is an unsupported tenet of AA"

This is not a tenet of AA.

I am not at all disagreeing that people can get sober in other ways--AA (the book) says as much and I personally have known people who did. I also have known people who went to AA for a couple of years and never drank again nor attended another meeting. One such person entered medical school, graduated, has been a practicing physician for well over a decade, and has stayed in touch with me for the last twenty years.

If you are an alcoholic who cannot stop and who has no other options and who wants to live just marginally more than you want to drink, maybe AA will work for you. And if, while you are trying to get sober there, some old fogey tells you lies about what AA is, call them on it and tell them to look it up in the book. You have a right to be there if you say you do. Don't let some pretentious s.o.b. stop you just because he thinks his length of sobriety gives him some rank. Find someone you can respect and listen to that person.

Just a word about the medical diagnosis. I credit a doctor with saving my life. I had pneumonia in the depths of my drinking and my mother came and took me to the doctor. He told me I was very sick and I could die and he added, "Lady, you are a lush and I won't even treat you unless you go to a psychiatrist or go to AA. You drunks break my heart and waste my time. We patch you up and you come back worse than before." I'd had ten years of psychiatry by that time and knew that more of the same wouldn't help. I had already started drinking daily, drinking in the morning, driving drunk, even through a school zone in the morning on my way to work, completely drunk--I didn't want to kill anybody and I didn't want to die, so I decided on the spot I'd go to AA.

Other doctors, years later, were less willing to say that to my son, even though many treatment options existed and even though he drank a quart of vodka every day by the time he was hospitalized and there was a family history of alcoholism. No doctor applied that label to him until the coroner did, less than a year later. He wrote it on his death certificate.

Anyone who has a drinking problem and can quit on their own or in some other program has my respect. I applaud them and have no quarrel with them. Some people who drink, however, have crossed over into a kind of drinking that is not amenable to rational measures and they don't have the resources to pay for expensive treatment centers or they've given up on the genteel options. Some of those people still have a chance, thanks to AA. To them I say, be there for your own purposes and don't let anything or anyone stop you getting sober.

One last thing. After a period of time, which varies for people, most of us find that we no longer want to drink. Without any effort or trouble at all, we just don't want to anymore. Most of us do fear that if we were to experiment and try to drink a little that we risk the possibility that we'd soon be drinking a lot. That now seems a bad idea, so we don't do it. It is, as the book says, that in this regard we have been restored to sanity. Even that is not the main reason we stick around AA. We do that because we have come to love the company of the people we find there and we find a great joy in helping others, even if just a little bit, to get sober and find their life again.
posted by Anitanola at 4:07 PM on July 10, 2012 [5 favorites]

the first person ever to use willpower to not only stop drinking but to remain sober and to lead satisfying, enriching lives.

And you were doing so well at pretending to have an open mind! But seriously, what you're encountering is, in the main, not vehement negativity. I think people are mainly interested in why one approach to addiction treatment has come to largely dominate many medical responses and broader societal thinking. Given the ineffectiveness of addiction treatment in general, discussing AA and whether our societies are better off using it and concepts associated with it as the main paradigm for addiction treatment seems both reasonable and proper.

Some people have also had bad personal experiences with AA, and wish to share them in a thread about that organisation. These experiences provide insights just as valid as your own, and to characterise them as "vehement negativity" seems unhelpful.
posted by howfar at 4:26 PM on July 10, 2012

Without going into it--seriously, I am not willing to go into it--I just want to say that there are a very very very very large number of people who have been hurt (either just a little or severely) by the things that commonly go on in 12 step rooms.

If an individual wants to go to a 12 step thing, that's fine. But the people touting this 12 step stuff should really stop with the "what's to criticize?" schtick, and AA adherents in particular should really stop lobbying judges and other criminal justice workers to have people funneled into the rooms.
posted by broadway bill at 4:46 PM on July 10, 2012 [2 favorites]

MetaFilter: Provocative or ambiguous statements of indeterminate truthfulness posted publicly in order to stimulate response.
posted by netbros at 4:53 PM on July 10, 2012 [1 favorite]

@netbros That's Metafilter? I thought that was trolls!
posted by Anitanola at 4:57 PM on July 10, 2012

AA adherents in particular should really stop lobbying judges and other criminal justice workers to have people funneled into the rooms

Roger Ebert recently published a column about his years in AA; I think he said that, in Chicago, they refuse to sign attendance cards for people legally coerced into attendance, which means, I suppose, that judges and probation officers there can't coerce people, since there is no mechanism of verification. Does anyone know if that's true? I may have misunderstood him on this point.
posted by thelonius at 5:14 PM on July 10, 2012

"The idea that people can't quit without AA is an unsupported tenet of AA"

This is not a tenet of AA.

The Big Book says the following:
"If you are as seriously alcoholic as we were, we believe there is no middle-of-the-road solution. We were in a position where life was becoming impossible, and if we had passed into the region from which there is no return through human aid, we had but two alternatives: One was to go on to the bitter end, blotting out the consciousness of our intolerable situation as best we could; and the other, to accept spiritual help."

That says there are but two alternatives for "serious" alcoholics: alcoholism, or spiritual transformation a la AA. It also says that these people are beyond human aid. The same idea can be found throughout the book: "we know that no real alcoholic ever recovers control", "Those who do not recover are people who cannot or will not completely give themselves to this simple program", etc. The most the Big Book has to say about people who quit outside the program is that they exist in "a few rare cases" -- everyone else's defense against drinking "must come from a Higher Power".
posted by vorfeed at 5:33 PM on July 10, 2012 [1 favorite]

MetaFilter: Provocative or ambiguous statements of indeterminate truthfulness posted publicly in order to stimulate response.
posted by netbros at 4:53 PM on July 10

That's Metafilter? I thought that was trolls!
posted by Anitanola


netbros and Anitanola: if either of these comments are directed at me, please read this. If not, disregard (I might be misreading things here):

Nothing that I wrote is particularly provocative or ambiguous, and it certainly wasn't written in order to stimulate a response. I don't like talking about this stuff much because, frankly, I have had really serious issues with substance abuse and I don't really like to dwell on that or trot it out in a public forum, hence the brevity of my earlier post. I'm not sure why you would consider me a 'troll' or question the 'truthfulness' of my post or experience. I've written in detail about my 12 step experiences online before, and I've regretted it every time because it's just too personal to put out there like that.

If you were, in fact, attempting to address my post, that's the wrong way to go about it.

Like I said, I might have misread you. If I did, mea culpa.
posted by broadway bill at 6:57 PM on July 10, 2012 [1 favorite]

I have never found someone who USED to go to AA meetings.

Yeah, you probably have, because oddly enough they are indistinguishable from people who have never gone to AA meetings. For instance, I don't think my husband has been to one in fifteen years or so. I occasionally remember to go on my yearly anniversary of quitting drinking, just to remind myself. There are a lot of people out there who went to AA, got sober, spent a few years reorganizing themselves, and stopped going. I would damn well hope I would head for a meeting in a flash if I felt like drinking, though (I was just remarking to my daughter today that I ought to check out the local clubhouse, and she told me she bummed a cigarette from a guy outside the clubhouse recently by asking if he was a "friend of Bill W."), and the ten years or so that I was a very active member were a lot of fun for me.
posted by Peach at 9:10 PM on July 10, 2012 [2 favorites]

broadway bill, if you were, in fact, attempting to add something to the discussion, that's the wrong way to go about it. It's a drive-by comment - all innuendo; no actual content. What's the very large number of people who were harmed? How were they harmed? How common is it? We can't tell, because you don't want to go into it. How, then, are we supposed to evaluate what you're claiming?
posted by Kirth Gerson at 4:14 AM on July 11, 2012 [4 favorites]

Is God really, literally, personally reaching down to fix things for each and every one of the abstainers in AA? If not, then they are figuring out how to take care of things together, just as in Rational Recovery. The fact that they do so through a framework of "humility" rather than "rationality" doesn't seem to matter much..

I didn't mean to suggest that AA would be the only way to go - as you put it, a framework of humility or a framework of rationality may not matter if the attendees find one or the other more useful for their recovery. All I was trying to get at was that it isn't really a framework of religion. The humility thing is central to AA as a methodical component of their treatment plan, not as a belief for its own sake.

No, the rational recovery route encompasses peer support groups like Lifering that offer the same idea of peer support as AA, but without the inherent shaming of participants through the step process.

I agree peer support in any form can be a great tool, and I didn't mean to suggest that AA was the only game in town - sorry to be unclear. Still, I think what you're calling "shaming" is useful to some people. It can be hard to see how bad things have gotten when you can rationalize everything as fitting into a context that you can control. For some people, it is important to just be able to admit that something is out of their league. It's a psychological angle - should I take charge? Or should I not let myself be in charge of certain things?
posted by mdn at 6:36 AM on July 11, 2012 [2 favorites]

All I was trying to get at was that it isn't really a framework of religion. The humility thing is central to AA as a methodical component of their treatment plan, not as a belief for its own sake.

I would say that it's both, personally. The fact that it's at the heart of the system doesn't make it any less religious.
posted by vorfeed at 8:35 AM on July 11, 2012

> "I would say that it's both, personally. The fact that it's at the heart of the system doesn't make it any less religious."

In the broad Wikipedia sense, even atheism or "pure" science is a religion--every culture, every thinking person has a system of beliefs about spirituality (it exists or it does not) or a set of moral values, I should think. Where do we find the human being without cultural values of any kind? Do we shun Plato or Shakespeare because they used the word "god"?

I think this is a philosophical argument and, as such, is interesting primarily to those who enjoy such things. At it's heart, the argument over whether AA is a religion seems to me to miss the point entirely. It is definitely a system of beliefs but they are far more about the human spirit and apply to drunks of a certain type than they are about God. There is no definition of God, no worship other then that a person chooses for himself or herself but it decidedly does come from an early twentieth century U.S. culture and uses terms common to those people and times. If one sees that higher power as pragmatism or quarks, it simply doesn't matter in AA. Are there people there who speak offensively? Yes, and they probably did so at bars and parties before they wore out their welcome and had to consider coming to AA.

If one only accepts help from those who believe strictly according to one's own "religion" (or illusion they do not have anything that can be termed a religion or 'system of beliefs') then one is apt to be a bit poorer for it, I think.
posted by Anitanola at 9:43 AM on July 11, 2012 [2 favorites]

1) When national addiction "experts" make claims like the only serious help is AA, they are disqualifying themselves from being actual experts. The data doesn't now and never has supported this claim. The fact that 90% of American treatment relies on the 12 steps is deeply problematic, and I explore why in that column for The Fix I linked above. Bottom line: 12 steps are great when done genuinely voluntarily, but when imposed in a medical setting via attacks meant to break denial and create humility, you get dangerous and often cultlike treatment, which sometimes (indeed the first time it was ever tried: Synanon) becomes an actual cult.

Synanon, of course, best known for putting a snake in an enemy's mailbox, stockpiling weapons and making men get sterilized and then swap partners. Oh yeah, it was supposed to cure heroin addiction too— before the wacky stuff came out, it was replicated in NY as Phoenix House and Daytop, in California as Delancey Street and many others. Until very recently, these "mainstream" programs used intense confrontation and humiliation as a key part of treatment. Now, that stuff is much toned down but we still have most public addiction treatment in America based literally on a bona fide cult (that isn't AA but was based on it).

And the rest simply forces confession and other aspects of the steps less forcefully. Still, it's bogus to claim that treatment doesn't force people to accept an addict or alcoholic identity: this is (despite evidence showing it backfires) a key aspect of much 12-step treatment, including at very famous programs.

Btw, DSM defined alcohol dependence is the equivalent of alcoholism.
posted by Maias at 10:22 AM on July 11, 2012 [1 favorite]

It is definitely a system of beliefs but they are far more about the human spirit and apply to drunks of a certain type than they are about God.

If this were true then the chapter entitled "We Agnostics" would reassure such people that the program is really about "the human spirit" and "drunks of a certain type", rather than insisting that atheists and agnostics have to accept God.

The idea that an explicitly religious, Christianized system is just "about the human spirit" is tiring, given that many people around the world aren't spiritual in this particular way. There are many views of the "human spirit", and many of them are incompatible with the view AA espouses. This was the point I was trying to make when I pointed out that I could just as easily claim that other beliefs are "just about the human spirit".

If one only accepts help from those who believe strictly according to one's own "religion" (or illusion they do not have anything that can be termed a religion or 'system of beliefs') then one is apt to be a bit poorer for it, I think.

The problem is not that people in AA merely believe differently than I do, the way folks at the soup kitchen believe differently but still dish out soup which anyone can eat. The problem is that the Big Book claims that I cannot believe as I do (I do not believe in a "Higher Power", radiator, quarks, or otherwise) and still get help -- and not just from AA, but from anywhere.

Again, the claim made by AA is that alcoholism is beyond human help. "Accepting help from people who believe strictly according to one's own 'religion'" != "accepting help from a higher power", which is what AA is explicitly about. You can claim that "there is no definition of God in AA" all you like; personally, I can't see "a Creative Intelligence, a Spirit of the Universe underlying the totality of things" which you can "connect with" to "get results" as anything other than a definition of God. "On one proposition, however, these men and women are strikingly agreed. Every one of them has gained access to, and believes in, a Power greater than himself. This Power has in each case accomplished the miraculous, the humanly impossible" -- how is that about quarks or pragmatism, especially when the rest of the chapter makes it absolutely clear that pragmatism is insufficient because it can't do miracles?

There are many concepts of god(s) which do not look like AA's "Higher Power", including some conceptions of the Christian God (and, of course, no god at all). It's insulting to the breadth of human experience to suggest that this isn't a definition, or that it has universal applicability.
posted by vorfeed at 10:59 AM on July 11, 2012 [3 favorites]

It seems that early AA was explicitly aimed at helping people who were written off as hopeless alcoholics by doctors, churches, etc. I think they went out actually searching for these people, people who had been through multiple detoxes, and had horrifying losses, but still drank. Perhaps that's where the ideology of alcoholism being something beyond the scope of human intervention or will comes from. Then the program that worked for (some) of this hardcore alcoholic population was perhaps taken as the paradigm for helping any one, with any drinking problem, at any stage or severity. Speculation on my part - I am no expert on the history of AA.
posted by thelonius at 11:27 AM on July 11, 2012