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March 12, 2020 10:33 AM Subscribe
A Stanford researcher and his team evaluated 35 studies of the effectiveness of AA and found that the fellowship helps more people acheive sobriety than therapy does.
These studies were restricted to AA and did not look at other 12-step programs, although the author says their review is “certainly suggestive that these methods work for people who use heroin or cocaine.”
These studies were restricted to AA and did not look at other 12-step programs, although the author says their review is “certainly suggestive that these methods work for people who use heroin or cocaine.”
I'm skeptical. For one, they used "abstinence" and "sobriety" interchangeably. AA teaches that even a single drink is a failure. Therapy might teach someone to reevaluate and regulate their relationship with alcohol.
If someone drinks a beer per week with friends, they're a failure from the AA standpoint and a success from the therapy standpoint. By defining success in this study in AA's terms, it's unsurprising that it outperforms.
Additionally, it seems to be comparing apples to oranges. Of course social support structures matter! Psychotherapy *alone* might be worse than AA, but group therapy or psychotherapy with a support group might be better or comparable to AA. Of all of the criticisms I've ever heard of AA, I've never heard anyone claim the anonymity or social function was bad. It's the philosophy that's potentially faulty.
A comparison of AA with other 12-step or other group therapy programs would be much more apt of a study.
posted by explosion at 10:46 AM on March 12, 2020 [38 favorites]
If someone drinks a beer per week with friends, they're a failure from the AA standpoint and a success from the therapy standpoint. By defining success in this study in AA's terms, it's unsurprising that it outperforms.
Additionally, it seems to be comparing apples to oranges. Of course social support structures matter! Psychotherapy *alone* might be worse than AA, but group therapy or psychotherapy with a support group might be better or comparable to AA. Of all of the criticisms I've ever heard of AA, I've never heard anyone claim the anonymity or social function was bad. It's the philosophy that's potentially faulty.
A comparison of AA with other 12-step or other group therapy programs would be much more apt of a study.
posted by explosion at 10:46 AM on March 12, 2020 [38 favorites]
“certainly suggestive that these methods work for people who use heroin or cocaine.”
Especially given that "working" here seems to be entirely relative and, as far as I'm aware, the absolute rate of success for AA remains depressingly low, this statement seems irresponsible to me. If your choice as an alcoholic is between AA and talk therapy and AA is even relatively more successful, that's certainly an argument for AA (though one imagines that effectiveness might well vary between subgroups). The comparison for opioid abuse in particular, though, has to be against medication-assisted therapy, not talk therapy. Nothing that helps reinforce the mindless stigma against MAT is useful.
posted by praemunire at 10:46 AM on March 12, 2020 [8 favorites]
Especially given that "working" here seems to be entirely relative and, as far as I'm aware, the absolute rate of success for AA remains depressingly low, this statement seems irresponsible to me. If your choice as an alcoholic is between AA and talk therapy and AA is even relatively more successful, that's certainly an argument for AA (though one imagines that effectiveness might well vary between subgroups). The comparison for opioid abuse in particular, though, has to be against medication-assisted therapy, not talk therapy. Nothing that helps reinforce the mindless stigma against MAT is useful.
posted by praemunire at 10:46 AM on March 12, 2020 [8 favorites]
fellowship helps more people acheive (sic) sobriety than therapy does.
But does it work better then medications? Or any other evidence based program- which AA is not. I believe a meta study showed a 12-25% success rate of AA- which if anything shows that therapy is worse- not that AA is the best. AA was the creation of a religious fanatic who's belief that addicts were people was at the time (and still is) revolutionary- but it's stranglehold on the treatment market has harmed thousands. We need better options.
This review of the study is more measured. Here's a key quote from the link:
based on the evidence, the positive findings probably aren’t a result of anything unique to AA or 12-step treatment, but the kinds of traits more broadly applicable to mutual help groups in general, particularly the ability to bring people together and shift their social networks to better favor recovery.
posted by Homo neanderthalensis at 10:47 AM on March 12, 2020 [3 favorites]
But does it work better then medications? Or any other evidence based program- which AA is not. I believe a meta study showed a 12-25% success rate of AA- which if anything shows that therapy is worse- not that AA is the best. AA was the creation of a religious fanatic who's belief that addicts were people was at the time (and still is) revolutionary- but it's stranglehold on the treatment market has harmed thousands. We need better options.
This review of the study is more measured. Here's a key quote from the link:
based on the evidence, the positive findings probably aren’t a result of anything unique to AA or 12-step treatment, but the kinds of traits more broadly applicable to mutual help groups in general, particularly the ability to bring people together and shift their social networks to better favor recovery.
posted by Homo neanderthalensis at 10:47 AM on March 12, 2020 [3 favorites]
Mod note: I think there's a reasonable question to ask about what various folks want from a discussion centered on the efficacy of AA and other mitigation and harm-reduction approaches to alcohol and drug addiction; we do not need to have a discussion where criticism of AA is conflated with criticism of people who have gotten meaningful help from AA and find it valuable; we likewise can't expect to have a discussion where pushing hard on the idea of AA as a fundamentally flawed program isn't going to land hard on those people who have found it to be an important part of their life and experiences.
Discussing this research on its own terms, and talking about what it does and doesn't look at and how, seems like a reasonable and appropriate response to the post. If folks can take care to keep on focus there, great. If folks can avoid conflating criticism of the research with criticism of AA participants' lived experiences, great. But please everybody recognize the difficulty of this territory and be kind.
posted by cortex (staff) at 11:00 AM on March 12, 2020 [33 favorites]
Discussing this research on its own terms, and talking about what it does and doesn't look at and how, seems like a reasonable and appropriate response to the post. If folks can take care to keep on focus there, great. If folks can avoid conflating criticism of the research with criticism of AA participants' lived experiences, great. But please everybody recognize the difficulty of this territory and be kind.
posted by cortex (staff) at 11:00 AM on March 12, 2020 [33 favorites]
Long time AA guy here, It literally saved my life. But I don’t for one second conflate my anecdotal experience as any kind of evidence of mass efficacy. For what it’s worth the general consensus in the actual meetings I’ve been at is that it is a not good thing that people are compelled to attend AA (through court judgements etc.). I fail to see any intentional stranglehold, and knowing how important it is to me to help other people get sober, I get excited when I hear about new methods and effective evidence based treatments.
posted by Drumhellz at 11:26 AM on March 12, 2020 [28 favorites]
posted by Drumhellz at 11:26 AM on March 12, 2020 [28 favorites]
I don't know if there's an intentional stranglehold, but my time studying substance abuse in undergrad showed that oh man where else you gonna go? 12 step programs are so prolific as a panacea, at least in Texas.
posted by avalonian at 11:35 AM on March 12, 2020 [1 favorite]
posted by avalonian at 11:35 AM on March 12, 2020 [1 favorite]
As it says in the main text of Alcoholics Anonymous, AA does not have a monopoly on recovery for the alcoholic. I am glad it was & is there for me, and I hope anyone with a drinking problem will consider it as an option (and not be inappropriate dissuaded by false claims about AA). But there are other approaches, and if those alternate approaches work better for some people, then it is great that they are there.
This is a nice article about why AA seems to work better for some people than for others: Why some people swear by Alcoholics Anonymous — and others despise it
posted by neutralmojo at 12:16 PM on March 12, 2020 [13 favorites]
This is a nice article about why AA seems to work better for some people than for others: Why some people swear by Alcoholics Anonymous — and others despise it
posted by neutralmojo at 12:16 PM on March 12, 2020 [13 favorites]
Two problems I have always had when it comes to discussing the effectiveness of AA as compared to other methods.
1) I really dislike how AA is used as a crutch by the 'rehab' industry and the legal system. Forcing people to attend AA is counterproductive IMHO.
2) How the 12-step method is the most ubiquitous thing preached for all kinds of addiction: Not just opiates, cocaine, LSD, Meth, Cannabis etc (where we KNOW that these things all affect the brain differently and therefore may need different treatments); but also for things like sex,porn,food,gambling, etc.
So what started out as a way to get drunks sober has been used as a one-size-fits-all panacea for all kinds of things, because it is so cheap. I say this as a guy who has stayed sober in AA for 6+ years; it is NOT a panacea. Heck I am even willing to admit that AA may not be the best for treating alcoholism. But it is working for me; and I don't want to have to justify that everytime people talk about alcohol addiction.
The one nice thing about this study was they restricted it to alcoholism only. I see too many articles where it starts out with alcoholism and AA; and then veers away into other substances and says AA method does not work for those. And the line where it says; almost no study found AA to be less effective than anything else.
posted by indianbadger1 at 12:25 PM on March 12, 2020 [18 favorites]
1) I really dislike how AA is used as a crutch by the 'rehab' industry and the legal system. Forcing people to attend AA is counterproductive IMHO.
2) How the 12-step method is the most ubiquitous thing preached for all kinds of addiction: Not just opiates, cocaine, LSD, Meth, Cannabis etc (where we KNOW that these things all affect the brain differently and therefore may need different treatments); but also for things like sex,porn,food,gambling, etc.
So what started out as a way to get drunks sober has been used as a one-size-fits-all panacea for all kinds of things, because it is so cheap. I say this as a guy who has stayed sober in AA for 6+ years; it is NOT a panacea. Heck I am even willing to admit that AA may not be the best for treating alcoholism. But it is working for me; and I don't want to have to justify that everytime people talk about alcohol addiction.
The one nice thing about this study was they restricted it to alcoholism only. I see too many articles where it starts out with alcoholism and AA; and then veers away into other substances and says AA method does not work for those. And the line where it says; almost no study found AA to be less effective than anything else.
posted by indianbadger1 at 12:25 PM on March 12, 2020 [18 favorites]
Part of the disconnect might be that AA is really "for" people who cannot have a healthy relationship with alcohol -- but not everyone who has a problem with alcohol falls into this group, right?
I have known people who found themselves, for whatever reason, drinking too much and/or too often. Some of them were able, with therapy and careful re-evaluation, to return to a "loves wine with dinner and that's okay" kind of place. These people would have been out of place at AA.
I also know people who credit AA (or NA) with literally saving their lives. But of course not every person who needs to get sober and stay sober will find success there, either.
There's more than one path here, in lots of ways, but it also seems clear that AA's reach and ubiquity and community is a real advantage.
posted by uberchet at 12:39 PM on March 12, 2020 [13 favorites]
I have known people who found themselves, for whatever reason, drinking too much and/or too often. Some of them were able, with therapy and careful re-evaluation, to return to a "loves wine with dinner and that's okay" kind of place. These people would have been out of place at AA.
I also know people who credit AA (or NA) with literally saving their lives. But of course not every person who needs to get sober and stay sober will find success there, either.
There's more than one path here, in lots of ways, but it also seems clear that AA's reach and ubiquity and community is a real advantage.
posted by uberchet at 12:39 PM on March 12, 2020 [13 favorites]
Forcing people to attend AA is counterproductive IMHO.
Completely agree. Unsurprisingly, a capitalistic industry has formed around something and, much like for-profit prisons, it's significantly impacting disadvantaged communities in the name of profit.
... but also for things like sex,porn,food,gambling, etc.
My addiction of choice is not chemical. I've just gotten my 2 year sobriety chip from the 12 step program that is helping me recover and learn how to not use - in a compulsive, addictive manner - something people do every day. I absolutely credit the fellowship for its help - without that community, I probably would still be acting out, despite the accompanying years of therapy that helped me delve into my root causes.
Addictions thrive when we feel alone, unique, and ashamed.
"The opposite of addiction isn't sobriety. The opposite of addiction is connection."
posted by hanov3r at 12:42 PM on March 12, 2020 [14 favorites]
Completely agree. Unsurprisingly, a capitalistic industry has formed around something and, much like for-profit prisons, it's significantly impacting disadvantaged communities in the name of profit.
... but also for things like sex,porn,food,gambling, etc.
My addiction of choice is not chemical. I've just gotten my 2 year sobriety chip from the 12 step program that is helping me recover and learn how to not use - in a compulsive, addictive manner - something people do every day. I absolutely credit the fellowship for its help - without that community, I probably would still be acting out, despite the accompanying years of therapy that helped me delve into my root causes.
Addictions thrive when we feel alone, unique, and ashamed.
"The opposite of addiction isn't sobriety. The opposite of addiction is connection."
posted by hanov3r at 12:42 PM on March 12, 2020 [14 favorites]
@Hanov3r :I absolutely credit the fellowship for its help - without that community, I probably would still be acting out, despite the accompanying years of therapy that helped me delve into my root causes.
I agree with you that the fellowship is a useful concept. I am glad it is working for you. My questions is: does your program of choice have to be a AA type 12-step program? Or can this fellowship be developed in another way?
What I am wondering for myself is; if there was something like AA that offered fellowship without the 'spirituality', would I have tried that? Maybe. But since AA was the only thing available to me; I am making it work.
posted by indianbadger1 at 12:57 PM on March 12, 2020 [3 favorites]
I agree with you that the fellowship is a useful concept. I am glad it is working for you. My questions is: does your program of choice have to be a AA type 12-step program? Or can this fellowship be developed in another way?
What I am wondering for myself is; if there was something like AA that offered fellowship without the 'spirituality', would I have tried that? Maybe. But since AA was the only thing available to me; I am making it work.
posted by indianbadger1 at 12:57 PM on March 12, 2020 [3 favorites]
Seems like AA gets into the "grow a better life" thing. There are paths for that, with different pros/cons. And different paths are certainly suited better for different people (not to mention different *times* for the same person). But this does seem one of the better ones. And what's even more important, it's one of the few *here*. Do hope people work out other paths (and make them known). But until then...
posted by aleph at 1:01 PM on March 12, 2020
posted by aleph at 1:01 PM on March 12, 2020
I agree with you that the fellowship is a useful concept. I am glad it is working for you. My questions is: does your program of choice have to be a AA type 12-step program? Or can this fellowship be developed in another way?
The Catholic church has mass multiple times a day; we've got written records that at some times in the early church (when e.g. St. Augustine was writing one of the first recovery narratives), those masses were packed at every service, every single day. To me, that's a sign that at that time the Catholic church was likely serving a similar role to AA now.
Not that I'm recommending the Catholic church today: you won't find much community at Tuesday vespers, and the baggage is crushing. But part of developing community is finding concepts that allow you to put the community's interests above your own. This is why the "higher power" idea can be fiddled with quite a bit, to the extent that it doesn't look at all like the God that Bill W. no doubt intended, but never really done away with: if the only power you can trust in is yourself, then when push comes to shove you are going to act in your own interests first. That a lot of people explicitly make the community their higher power really puts a finger on the nose here.
posted by billjings at 1:16 PM on March 12, 2020 [5 favorites]
The Catholic church has mass multiple times a day; we've got written records that at some times in the early church (when e.g. St. Augustine was writing one of the first recovery narratives), those masses were packed at every service, every single day. To me, that's a sign that at that time the Catholic church was likely serving a similar role to AA now.
Not that I'm recommending the Catholic church today: you won't find much community at Tuesday vespers, and the baggage is crushing. But part of developing community is finding concepts that allow you to put the community's interests above your own. This is why the "higher power" idea can be fiddled with quite a bit, to the extent that it doesn't look at all like the God that Bill W. no doubt intended, but never really done away with: if the only power you can trust in is yourself, then when push comes to shove you are going to act in your own interests first. That a lot of people explicitly make the community their higher power really puts a finger on the nose here.
posted by billjings at 1:16 PM on March 12, 2020 [5 favorites]
The medication seems to help with the addict's "need-to(s)". They don't seem to help (much) with the "want-to(s)" that got them there (and keeps dragging them back) in the first place. The medication teamed with something else to work on that would be best. AA or whatever. Many ways.
(This seeing my brother go through heroin addiction for most of his life before finally OD'ing)
posted by aleph at 3:12 PM on March 12, 2020 [7 favorites]
(This seeing my brother go through heroin addiction for most of his life before finally OD'ing)
posted by aleph at 3:12 PM on March 12, 2020 [7 favorites]
Forcing people to attend AA is counterproductive IMHO.
A hundred times, this. AA absolutely hinges on beginning with a personal awareness that you have a problem that you cannot fix alone. Without that, it's useless. A court can demand someone attend meetings; they can't require a personal epiphany.
AA cannot bring awareness of the problem, nor the awareness that it needs help. Therapy and other programs might; they have different approaches.
posted by ErisLordFreedom at 3:29 PM on March 12, 2020 [9 favorites]
A hundred times, this. AA absolutely hinges on beginning with a personal awareness that you have a problem that you cannot fix alone. Without that, it's useless. A court can demand someone attend meetings; they can't require a personal epiphany.
AA cannot bring awareness of the problem, nor the awareness that it needs help. Therapy and other programs might; they have different approaches.
posted by ErisLordFreedom at 3:29 PM on March 12, 2020 [9 favorites]
All of the "paths" I've heard of for "grow a new/better life" *start* with the person *choosing* to walk that path. *Maybe* a forced march down the first part of the path (by a Court or whatever) *may* show them enough of the path to entice them to choose it themselves. But more likely it will just add to the crap of their life and automatically predispose them *against* that path.
Don't know.
The Court thing seems more like they don't know anything else so they're going to toss them in that direction and hope it sticks. (Barring the choices where it was just the cheaper option)
posted by aleph at 3:35 PM on March 12, 2020 [3 favorites]
Don't know.
The Court thing seems more like they don't know anything else so they're going to toss them in that direction and hope it sticks. (Barring the choices where it was just the cheaper option)
posted by aleph at 3:35 PM on March 12, 2020 [3 favorites]
When I was ready to get better I thought I was willing to do anything. I was like, "give me the pill or the vaccine or the electroshock, I'm ready. Or how about a lobotomy, would that help? I'll do it!"
And when they told me that I would have to low-key work on being a happier person on a daily basis I was like, "what are you people crazy!?"
But AA supported me until I got it, and other alcoholics had a credibility with me in my desperation that no one else had. That is why we can sometimes reach someone that can't be reached by other means. I don't know how you fit that human connection into a system that only wants to "fix" you so that you don't cost money and can go out and increase shareholder value.
Humphreys reports on his own early dismissal of AA for a pretty common reason, that it's non-professional, but honestly, that's the only way it works. Essentially, what put my alcoholism into remission was group therapy as many times a week as I wanted, almost any hour of the day, for as long as I needed it. My health plan doesn't cover that.
I'm grateful this article was written and that these things are being studied. And I don't think we can continue to categorically claim that AA is not evidence based when we have these studies reporting on its efficacy.
Man, I wrote a looong thing here, but I deleted it. I don't think a point by point rebuttal of misconceptions about AA needs to be said here, needs to be said now, or needs to be said by me. I will only say that there are more objective sources of information out there on this topic than r/atheism and the JREF, as much as I love the JREF.
posted by Horkus at 5:09 PM on March 12, 2020 [16 favorites]
And when they told me that I would have to low-key work on being a happier person on a daily basis I was like, "what are you people crazy!?"
But AA supported me until I got it, and other alcoholics had a credibility with me in my desperation that no one else had. That is why we can sometimes reach someone that can't be reached by other means. I don't know how you fit that human connection into a system that only wants to "fix" you so that you don't cost money and can go out and increase shareholder value.
Humphreys reports on his own early dismissal of AA for a pretty common reason, that it's non-professional, but honestly, that's the only way it works. Essentially, what put my alcoholism into remission was group therapy as many times a week as I wanted, almost any hour of the day, for as long as I needed it. My health plan doesn't cover that.
I'm grateful this article was written and that these things are being studied. And I don't think we can continue to categorically claim that AA is not evidence based when we have these studies reporting on its efficacy.
Man, I wrote a looong thing here, but I deleted it. I don't think a point by point rebuttal of misconceptions about AA needs to be said here, needs to be said now, or needs to be said by me. I will only say that there are more objective sources of information out there on this topic than r/atheism and the JREF, as much as I love the JREF.
posted by Horkus at 5:09 PM on March 12, 2020 [16 favorites]
Irrespective of any particular or personal thoughts about AA or other treatments, it's worth making some points about the research qua research. This study is a meta-analysis (a study of many studies) from the Cochrane Review. In layman's terms, the outcomes of such a study are basically the gold standard for evaluating aggregate data in the scientific literature. Each of their conclusions is not just stated clearly, but assigned a metric of "believability" in terms of how much weight should be given to them individually. As with any study, this one won't tell you which treatment is best for a particular person. That said, it provides very compelling evidence that AA is an effective treatment that is cost-effective compared to other treatments.
One thing worth highlighting is that only manualized AA/12-step facilitations were found to be more effective than therapy. That is, basically speaking, AA/12-step programs that were "quality controlled" by being administered in specific, prescribed ways. Now, most AA that the average Jane/Joe has access to will not be manualized. The study found that non-manualized AA (i.e., AA in the wild) is basically equivalent in its effectiveness compared to other forms of clinical intervention.
And just one small note: the study looked at not just abstinence, but also drinking intensity (drinks per day) and alcohol-related consequences, and found basically the same results across the board.
In short, in my estimation (I am a clinical psychologist who was trained in a research-focused PhD program), one would be hard pressed to poke holes in this study or argue against the basic conclusion that AA is an effective clinical intervention, and that there is little to recommend other treatments over it in the general, abstract case especially when cost-effectiveness is an important consideration.
posted by mister-o at 5:58 PM on March 12, 2020 [10 favorites]
One thing worth highlighting is that only manualized AA/12-step facilitations were found to be more effective than therapy. That is, basically speaking, AA/12-step programs that were "quality controlled" by being administered in specific, prescribed ways. Now, most AA that the average Jane/Joe has access to will not be manualized. The study found that non-manualized AA (i.e., AA in the wild) is basically equivalent in its effectiveness compared to other forms of clinical intervention.
And just one small note: the study looked at not just abstinence, but also drinking intensity (drinks per day) and alcohol-related consequences, and found basically the same results across the board.
In short, in my estimation (I am a clinical psychologist who was trained in a research-focused PhD program), one would be hard pressed to poke holes in this study or argue against the basic conclusion that AA is an effective clinical intervention, and that there is little to recommend other treatments over it in the general, abstract case especially when cost-effectiveness is an important consideration.
posted by mister-o at 5:58 PM on March 12, 2020 [10 favorites]
Thank you mister-o for pointing out that this is studying manualized implementations, which most people will not get in real life in addition to some of the qualifiers and limitations of the study..
One thing I noticed in the Author's Conclusion section of the paper and I think speaks to indianbadger1's question regarding fellowship - does your program of choice have to be a AA type 12-step program? Or can this fellowship be developed in another way?
From the Paper
If people with AUD [alcohol use disorder] are opposed to attending AA, despite the strong evidence for its potential to aid recovery, clinicians might consider linkage to alternative mutual-help organizations as they may confer benefits at similar levels of engagement. Alternatives might also be considered when a patient has made a sustained effort to engage AA, but not derived sufficient benefit from it.
So, from my own clinical experience as a substance use therapist, and apparently this paper, yes, you likely can obtain useful aid from non-AA/12-step fellowships. SMART Recovery, LifeRing, harm reduction groups, Refuge Recovery, Women In Sobriety. Whatever you find that works for you, keep at it.
What heals is community and social engagement (with a defined unified purpose). Much of the rest is fluff.
posted by flamk at 6:17 PM on March 12, 2020 [4 favorites]
One thing I noticed in the Author's Conclusion section of the paper and I think speaks to indianbadger1's question regarding fellowship - does your program of choice have to be a AA type 12-step program? Or can this fellowship be developed in another way?
From the Paper
If people with AUD [alcohol use disorder] are opposed to attending AA, despite the strong evidence for its potential to aid recovery, clinicians might consider linkage to alternative mutual-help organizations as they may confer benefits at similar levels of engagement. Alternatives might also be considered when a patient has made a sustained effort to engage AA, but not derived sufficient benefit from it.
So, from my own clinical experience as a substance use therapist, and apparently this paper, yes, you likely can obtain useful aid from non-AA/12-step fellowships. SMART Recovery, LifeRing, harm reduction groups, Refuge Recovery, Women In Sobriety. Whatever you find that works for you, keep at it.
What heals is community and social engagement (with a defined unified purpose). Much of the rest is fluff.
posted by flamk at 6:17 PM on March 12, 2020 [4 favorites]
An interesting comparison would be whether that "higher power" stuff is required. Is there an AA-like program with everything except the "belief in a higher power" that seems to be the sticking point for so many non- or anti-religious types?
Yes, yes, you can say the "higher power" isn't necessarily a god... but that seems to be a rather hot button issue. So it makes sense to ask: is it even necessary? If the outcomes are the same without, why not just drop it from the protocol and potentially reduce the friction?
posted by -1 at 9:22 PM on March 12, 2020 [3 favorites]
Yes, yes, you can say the "higher power" isn't necessarily a god... but that seems to be a rather hot button issue. So it makes sense to ask: is it even necessary? If the outcomes are the same without, why not just drop it from the protocol and potentially reduce the friction?
posted by -1 at 9:22 PM on March 12, 2020 [3 favorites]
There is an agnostic approach to AA, but I didn't end up needing it. Much to my surprise I was content with a spiritual approach as I avoided the dogma and practices that turn me off of organised religion.
There are several agnostic variants people have suggested. Here's the first three agnostic steps carefully avoiding any awkward 3 letter words:
1. Acknowledge that I cannot drink safely at any time, that bad shit happens to me every single time and it tears my life to shreds.
2. Come to believe I am a) worth living happily and sober b) that I have the power to do things differently—I can change maladaptive and destructive patterns of thought, behavior and action, and make wise choices to stay sober and happy.
3. Become willing to do things differently and make healthy choices in my thoughts, behaviors and actions through various methods, be it CBT, suggestion from wise friends, my sponsor, my father’s wisdom, a therapist, SMART meetings, meditation and the development of my own inner strength and wisdom.
Could I stay sober without AA? Don't know, don't currently want to find out. That's a bridge I'll cross with my eyes open and full of awareness should I need to.
posted by diziet at 3:51 AM on March 13, 2020 [3 favorites]
There are several agnostic variants people have suggested. Here's the first three agnostic steps carefully avoiding any awkward 3 letter words:
1. Acknowledge that I cannot drink safely at any time, that bad shit happens to me every single time and it tears my life to shreds.
2. Come to believe I am a) worth living happily and sober b) that I have the power to do things differently—I can change maladaptive and destructive patterns of thought, behavior and action, and make wise choices to stay sober and happy.
3. Become willing to do things differently and make healthy choices in my thoughts, behaviors and actions through various methods, be it CBT, suggestion from wise friends, my sponsor, my father’s wisdom, a therapist, SMART meetings, meditation and the development of my own inner strength and wisdom.
Could I stay sober without AA? Don't know, don't currently want to find out. That's a bridge I'll cross with my eyes open and full of awareness should I need to.
posted by diziet at 3:51 AM on March 13, 2020 [3 favorites]
If someone drinks a beer per week with friends, they're a failure from the AA standpoint and a success from the therapy standpoint.
That's... not really true. If you can limit yourself to one beer a week, you probably don't need AA in the first place.
posted by Halloween Jack at 10:08 AM on March 13, 2020 [4 favorites]
That's... not really true. If you can limit yourself to one beer a week, you probably don't need AA in the first place.
posted by Halloween Jack at 10:08 AM on March 13, 2020 [4 favorites]
It is always possible to generate a concept of a higher power that Isn't very metaphysical. Example: imagine a future version of yourself with perfect knowledge of the outcomes of your choices and actions. Try to do what that person would want you to do. Do they want you to give up on sobriety after, say, 6 months? Are they going to look back and say, man, I'm glad I went and bought that handle of vodka and drank it? No, that is not what your idealized better self wants for you.
I didn't get sober in AA, but the process made me understand what they are on about a lot.......for example, .there's going to come a time where you need an element of faith that you are now on the right path, even if, at the time, you cannot see the way.
posted by thelonius at 10:35 AM on March 13, 2020 [3 favorites]
I didn't get sober in AA, but the process made me understand what they are on about a lot.......for example, .there's going to come a time where you need an element of faith that you are now on the right path, even if, at the time, you cannot see the way.
posted by thelonius at 10:35 AM on March 13, 2020 [3 favorites]
Is there an AA-like program with everything except the "belief in a higher power" that seems to be the sticking point for so many non- or anti-religious types?
Whether AA's "higher power" can work for an agnostic or atheist depends a lot on
1) How hung up they are on the phrasing: whether they can accept that "higher power" doesn't have to mean "Christian God," and
2) How overtly religious their local AA groups are.
The "higher power" can be "the community of people helping me to get better." The point is, it's not you. You don't, personally, have the ability to get better. No amount of scheduling or self-set rules or CBT or meditation is going to make the changes that will let you stop wrecking your life with alcohol.
This may not be true for everyone. AA is not designed for those people. It is designed for the ones who can't get better on their own. It doesn't matter what they think is the not-me that helps them get better; what matters is that they understand they can't do it alone.
However, the ability to rephrase the religious materials to something that makes more sense to you, will not matter if your local group opens & closes with an overtly Christian prayer every meeting, if they encourage each other to go to church, if they include bible verses in their recovery stories. AA works by making community connections, and if you can't stand the local community, it won't work.
posted by ErisLordFreedom at 12:29 PM on March 13, 2020 [8 favorites]
Whether AA's "higher power" can work for an agnostic or atheist depends a lot on
1) How hung up they are on the phrasing: whether they can accept that "higher power" doesn't have to mean "Christian God," and
2) How overtly religious their local AA groups are.
The "higher power" can be "the community of people helping me to get better." The point is, it's not you. You don't, personally, have the ability to get better. No amount of scheduling or self-set rules or CBT or meditation is going to make the changes that will let you stop wrecking your life with alcohol.
This may not be true for everyone. AA is not designed for those people. It is designed for the ones who can't get better on their own. It doesn't matter what they think is the not-me that helps them get better; what matters is that they understand they can't do it alone.
However, the ability to rephrase the religious materials to something that makes more sense to you, will not matter if your local group opens & closes with an overtly Christian prayer every meeting, if they encourage each other to go to church, if they include bible verses in their recovery stories. AA works by making community connections, and if you can't stand the local community, it won't work.
posted by ErisLordFreedom at 12:29 PM on March 13, 2020 [8 favorites]
I've seen a number of ways to reframe the 12 steps in other, non-Judeo-Christian / non-monotheistic traditions. There's an excellent book, _One Breath At A Time_, which uses a Buddhist framework to examine the Steps, and there are a lot of Wiccans and other pagan groups creating their own 12-step communities based around their beliefs.
Nthing the things said above - the 'higher power' concept is there to remind you that you, the addict, do not have the answers. You cannot trust your own choices, because those choices are driven by the addiction.
Example: imagine a future version of yourself with perfect knowledge of the outcomes of your choices and actions. Try to do what that person would want you to do.
thelonius, thank you so much for this! That's a super useful framing.
posted by hanov3r at 12:42 PM on March 13, 2020 [6 favorites]
Nthing the things said above - the 'higher power' concept is there to remind you that you, the addict, do not have the answers. You cannot trust your own choices, because those choices are driven by the addiction.
Example: imagine a future version of yourself with perfect knowledge of the outcomes of your choices and actions. Try to do what that person would want you to do.
thelonius, thank you so much for this! That's a super useful framing.
posted by hanov3r at 12:42 PM on March 13, 2020 [6 favorites]
Friend of mine went to AA five, six years ago and has been sober ever since. He doesn't have any religious upbringing whatsoever, and he mentioned to me he's struggled with the "higher power" thing, but it's complicated. Things are not always as they appear. To struggle with addiction, as my friend has, is also to struggle with yourself. As the waves of compulsion overpower you again & again, they chip away at your faith in yourself. And without faith in the possibility of change, the whole ordeal just begins to seem like a bitter, Sisyphean joke. Your addiction is the overwhelming evidence of the fact that you can't & won't change. Faith is the idea that change is nevertheless possible, even if you yourself (as well as others around you!) can't quite see how right now. There is grace in accepting this limit.
posted by dmh at 7:09 PM on March 13, 2020 [4 favorites]
posted by dmh at 7:09 PM on March 13, 2020 [4 favorites]
Also, one of the most useful things that I've ever heard in the rooms of AA is that the most important thing to know and accept about my higher power is that I'm not it. Or what hanov3r said.
posted by Halloween Jack at 10:10 PM on March 13, 2020 [1 favorite]
posted by Halloween Jack at 10:10 PM on March 13, 2020 [1 favorite]
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