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July 6, 2010 3:58 PM Subscribe

Secret of AA: After 75 Years, We Don’t Know How It Works. "There is evidence that a big part of AA’s effectiveness may have nothing to do with the actual (12) steps. It may derive from something more fundamental: the power of the group. The importance of this is reflected by the fact that the more deeply AA members commit to the group, rather than just the program, the better they fare."

"As dependence grows, alcoholics also lose the ability to properly regulate their behavior. This regulation is the responsibility of the prefrontal cortex, which is charged with keeping the rest of the brain apprised of the consequences of harmful actions. But mind-altering substances slowly rob the cortex of so-called synaptic plasticity, which makes it harder for neurons to communicate with one another. When this happens, alcoholics become less likely to stop drinking, since their prefrontal cortex cannot effectively warn of the dangers of bad habits.

This is why even though some people may be fully cognizant of the problems that result from drinking, they don’t do anything to avoid them. “They’ll say, ‘Oh, my family is falling apart, I’ve been arrested twice,’” says Peter Kalivas, a neuroscientist at the Medical University of South Carolina in Charleston. “They can list all of these negative consequences, but they can’t take that information and manhandle their habits.”

The loss of synaptic plasticity is thought to be a major reason why more than 90 percent of recovering alcoholics relapse at some point. The newly sober are constantly bombarded with sensory cues that their brain associates with their pleasurable habit. Because the synapses in their prefrontal cortex are still damaged, they have a tough time resisting the urges created by these triggers. Any small reminder of their former life—the scent of stale beer, the clink of toasting glasses—is enough to knock them off the wagon."

In Alcoholism: The Frontal Cortex, Jonah Lehrer discusses one of the most important changes that occurs in addicts having to do with how they process "prediction error" signals.

"AA, it seems, helps neutralize the power of these sensory cues by whipping the prefrontal cortex back into shape. Publicly revealing one’s deepest flaws and hearing others do likewise forces a person to confront the terrible consequences of their alcoholism—something that is very difficult to do all alone. This, in turn, prods the impaired prefrontal cortex into resuming its regulatory mission. While it’s (the brain) on the mend, AA functions as a temporary replacement—a prefrontal cortex made up of a cast of fellow drunks in a church basement, rather than neurons and synapses."

posted by netbros (140 comments total) 24 users marked this as a favorite

Have I missed the discovery of evidence that AA works?
posted by cmoj at 4:00 PM on July 6, 2010 [12 favorites]

Yes, you apparently have missed it.
posted by netbros at 4:04 PM on July 6, 2010 [7 favorites]

Did you RTFA, cmoj? That is addressed.
posted by small_ruminant at 4:17 PM on July 6, 2010

It doesn't work great, but it works a lot better than just about everything else.
posted by infinitywaltz at 4:19 PM on July 6, 2010 [2 favorites]

Also nobody who needs it gives a shit why it works they'd just rather not die.
posted by Potomac Avenue at 4:22 PM on July 6, 2010 [16 favorites]

Penn & Teller went through this on an early BullSh*t!.

I love "The Frontal Cortex" so thanks for the link, netbros. Additionally, I'm always curious about the X-percent of people who do not seem to get better no matter what and what might be hopping down the bunny train that could/might/sort of help them.
posted by Lesser Shrew at 4:28 PM on July 6, 2010

That's the thing - for a lot of people, nothing is going to work at all.

Someone close to me is in the program and we were discussing this article a couple of days ago. After his nearly four years of sobriety, he told me that based on his experience, most of the people who walk through the doors don't stick around. It doesn't work for the majority. Maybe that's because the program is flawed, or maybe it's because addiction is too powerful for a lot people to defeat, no matter how they try. But for the people AA does help, it really, really helps. It's always annoyed me that there is such a movement to denounce 12-step programs as quackery. So we don't know how it works or what the statistics are, and even for those who are successful at staying sober, it's not an easy or quick fix. The reality, though, is that is does help quite a lot of people get their lives together and stay sober, people who were not able to get clean and sober any other way. And I feel like that's a good thing.
posted by something something at 4:31 PM on July 6, 2010 [19 favorites]

AA: Cult or Cure is a really good full discussion of the organization, and its effectiveness. It's quite evenhanded (and has a lot of praise for the organizational principles of the organization).

The book also has a good discussion on the characteristics of a cult. (spoiler warning: conclusion is that AA is neither a cult nor a cure).
posted by el io at 4:33 PM on July 6, 2010 [3 favorites]

So we don't know how it works or what the statistics are, and even for those who are successful at staying sober, it's not an easy or quick fix.

And unlike every other treatment option besides "cold turkey", it's free.

If we had adequate, free mental and medical health care in this country, we might not need AA any more. But we don't.
posted by muddgirl at 4:35 PM on July 6, 2010 [10 favorites]

We have no evidence either that it works or that it works better than something else since there are never any statistics to show how successful it has been for how many (or percentage) of those making use of it. How do we know it works? Where is the evidence other than this or that one who says he attends and he is sober?

Well, it sure worked for me, and I don't give a shit about proving that statistically. As far as I'm concerned, it's proven to be a very effective way for me to develop new friendships, learn new ways to cope with life without falling back on a crutch, and how not to worry about the little things that used to drive me nuts, like trying to prove AA works to people that don't believe that it does.
posted by disclaimer at 4:37 PM on July 6, 2010 [18 favorites]

Burhanistan, meetings are generally designated "open" or "closed", and anyone is free to go to any meeting listed as open.
posted by something something at 4:38 PM on July 6, 2010

AA is in this great place where they can make any claims they like and there's no way to falsify any of them due to the nature of the organization.

There's a word for making objective claims that can't be falsified, isn't there?
posted by Pope Guilty at 4:40 PM on July 6, 2010 [6 favorites]

Based on most of the comments here, the original post could just as well have been "Hey guys, AA is a thing that exists!", with no link. Which is a pity, because the link was actually interesting, and the rehashed AA debate, well, not so much.
posted by moss at 4:49 PM on July 6, 2010 [4 favorites]

Publicly revealing one’s deepest flaws and hearing others do likewise forces a person to confront the terrible consequences of their alcoholism—something that is very difficult to do all alone.

Without wading into the AA debate per se, I did want to note that posting my pledge not to drink for a month to MeTa (and the warm round of genuine support and well-wishing that it prompted) was one of the big things that helped me power through my month of not drinking booze. Whenever I felt the urge (which, honestly, only happened rarely after the first few days and usually after reading a Tea Party-themed post to MeFi or when hanging out with friends) I would just hop back to that thread or re-read the kind messages of encouragement that folks sent me and it soon passed. Something about putting a public pledge out into the world also gave me the incentive not to look like a poseur or an attention-whore if I failed to follow through. I imagine group meetings IRL serve a similar function.

As a secular humanist I have issues with the higher power rhetoric of AA (I know, it can be whatever you want it to be, but as a philosopher I also know that words actually mean things, but that is a separate conversation), but as a pragmatist, if it works, well then: it works. I am happy to report that the month off experiment went very well and I feel all the better for it. So thanks to you all for providing the sort of social support group that helped me accomplish changing my habits for the better.
posted by joe lisboa at 4:50 PM on July 6, 2010 [16 favorites]

We now return to your regularly scheduled thread, please read the link(s): the brain is a pretty amazing thing.
posted by joe lisboa at 4:52 PM on July 6, 2010

I wish we spent that trillion on addiction research rather than Iraq.
posted by bottlebrushtree at 4:54 PM on July 6, 2010 [5 favorites]

Really it sounds like the cure for Bill W. was being lectured (while out of his head on tropane alkaloids, i.e. a highly suggestible state) that his life wasn't right and that there was one clear way to fix it, which he took. At which point his decision was confirmed by his (entirely typical for the drugs he was on) vision of a "higher power".

Now, I have no gripe with AA per se (except for the part where their philosophy tends to encourage full-on backslides rather than isolated relapses and entirely excludes the possibility of moderation which I believe to harm more people than it helps) but it's methodology seems rather superstitious relative to what actually probably (almost definitely) happened to Bill W. to actually cure him.
posted by Matt Oneiros at 5:04 PM on July 6, 2010 [1 favorite]

As far as I'm concerned, AA has a 100% success rate. It worked really really well for me. Last September was 36 years without a drink. I don't really care whether it's reshaping of the prefrontal cortex, social pressure, voodoo, the steps, or something else, and I have never had any desire whatsoever to drink in moderation. I don't see the point, frankly. Never did.
posted by Peach at 5:09 PM on July 6, 2010 [14 favorites]

Part of the premise behind AA is that for the Alcoholic, nothing in the past they've tried has worked. It's hard to explain in a few sentances, but the reason AA does work is that it does not address alcoholism (as odd as that sounds). And it does not treat being sober as a goal to be obtained. Rather, it builds a support group that iniates a change in one's life, and values they hold themselves to. It doesn't promote rejection of alcohol, but rather acceptance of alcoholism. The reason being, once a person is able to stop fighting alcoholism, they are more able to let go of it. The support group in turn helps in keeping that changed lifestyle intact, by helping create an environment that is less prone to cause relapse.
posted by samsara at 5:10 PM on July 6, 2010 [6 favorites]

The methods used at Delancy Street would be my choice for study.
"Researchers have numerous objective ways to measure impact. Delancey Street has been viewed and reviewed by a wide variety of people. Dr. Karl Menninger (the founder of the Menninger’s Clinic and often considered the grandfather of the American mental health movement at its height) conducted a long-term study on Delancey Street graduates that demonstrated a phenomenal success rate of 98%. He summarized his findings with the statement, “Delancey Street is an incredible mixture of hard practicality and idealism. It is the best and most successful rehabilitation program I have studied in the world.”
posted by vapidave at 5:17 PM on July 6, 2010 [1 favorite]

Why are people so hostile towards AA? Because it's religious?
posted by smackfu at 5:28 PM on July 6, 2010

Psychology Today had an interesting companion article about relapse in their most recent issue.
posted by drezdn at 5:28 PM on July 6, 2010

For those of you saying it worked for you, understand that there are thousands if not millions of people who say the same thing about homeopathy.
posted by Pope Guilty at 5:29 PM on July 6, 2010 [8 favorites]

I did about 7 months succesfully in AA about 6 years back, and my insights on how it works is this, for people who truly want to quit, (and I did not and do not) it offers a supportive community and an alternate socializing routine to bars. And even though it didn't work for me, I would never want to take it away from anyone it did work for.
posted by jonmc at 5:29 PM on July 6, 2010 [3 favorites]

David Foster Wallace in Infinite Jest spends hundreds of pages and dozens of footnotes exploring just this phenomenon.

"....the Crocodiles say they can't even begin to say how many new guys they've seen Come In and then get sucked back Out There, Come In to AA for a while and Hang In and put together a little sober time and have things start to get better, head-wise and life-quality-wise, and after a while the new guys get cocky, they decide they've gotten `Well,' and they get really busy at the new job sobriety's allowed them to get, or maybe they buy season Celtics tickets, or they rediscover pussy and start chasing pussy (these withered gnarled toothless totally post-sexual old fuckers actually say pussy), but one way or another these poor cocky clueless new bastards start gradually drifting away from rabid Activity In The Group, and then away from their Group itself, and then little by little gradually drift away from any AA meetings at all, and then, without the protection of meetings or a Group, in time--oh there's always plenty of time, the Disease is fiendishly patient--how in time they forget what it was like, the ones that've cockily drifted, they forget who and what they are, they forget about the Disease, until like one day they're at like maybe a Celtics-Sixers game, and the good old Fleet/First Interstate Center's hot, and they think what could just one cold foamer hurt, after all this sober time, now that they've gotten `Well.' Just one cold one. What could it hurt. And after that one it's like they'd never stopped, if they've got the Disease. And how in a month or six months or a year they have to Come Back In, back to the Boston AA halls and their old Group, tottering, D.T.ing, with their faces hanging down around their knees all over again, or maybe it's five or ten years before they can get it up to get back In, beaten to shit again, or else their system isn't ready for the recurred abuse again after some sober time and they die Out There--the Crocodiles are always talking in hushed, 'Nam-like tones about Out There--or else, worse, maybe they kill somebody in a blackout and spend the rest of their lives in MCI-Walpole drinking raisin jack fermented in the seatless toilet and trying to recall what they did to get in there, Out There; or else, worst of all, these cocky new guys drift back Out There and have nothing sufficiently horrible to Finish them happen at all, just go back to drinking 24/7/365, to not-living, behind bars, undead, back in the Disease's cage all over again. The Crocodiles talk about how they can't count the number of guys that've Come In for a while and drifted away and gone back Out There and died, or not gotten to die."
posted by vito90 at 5:30 PM on July 6, 2010 [9 favorites]

Jeez, PG, why so hostile? Unlike homeopathy, AA does not make medical claims (though perhaps this article does). No one is forced to go.

And yeah, ok; I have a relative who was helped. He went 30 years sober until his death from colon cancer (when I can tell you, no one would have blamed him for drinking again). His memorial service, in fact, was held by his AA buddies.

Before AA, he would disappear on benders for months at a time. After AA, he worked and got his family back together. He was far from well in many ways, but he stopped drinking.
posted by emjaybee at 5:37 PM on July 6, 2010 [3 favorites]

Why are people so hostile towards AA? Because it's religious?

Because there's no good evidence that it's any better than cold turkey, because it's the only religious organization you can be legally compelled to go to, because AA lies about alcoholism, because it encourages people to believe in their own powerlessness, and because AA members spread the kind of anti-rationality (as can be seen in multiple comments in this thread) that the adherents of every kind of psuedoscience depend upon. As soon as you start trusting anecdotes over statistics, as AA members must to believe in AA, as soon as you start privileging "it worked for me!" over the numerous studies that can't find a good reason for anybody to expect results, you surrender your mind and start encouraging others to do the same.
posted by Pope Guilty at 5:38 PM on July 6, 2010 [34 favorites]

:) But see, I don't care whether my evidence is anecdotal. It's my story, not yours, and if homeopathy had somehow made it possible for me not to drink I would be telling that story.
posted by Peach at 5:40 PM on July 6, 2010 [4 favorites]

PG: I freely admit that it didn't work for me, and I realize that it dosen't work for other people either, but I do realize that what makes it work for some people (and I really really don't mean that condescendingly) is the support group aspect more than anything else.
posted by jonmc at 5:40 PM on July 6, 2010

I'm completely chill with support groups. I'm not chill with support groups that lie about the condition they support sufferers of, support groups that suggest (as demonstrated in that vile DFW excerpt above) that the options are the group or death or worse, or religious groups which accept members who are legally obligated to attend.
posted by Pope Guilty at 5:44 PM on July 6, 2010 [1 favorite]

My opinion about why AA works for the people it works for (which, in all of the research I've read as a clinician, is a TINY percentage of the people who actually use it) is that it combines structure (meetings at specified times, rules to live your life by, stuff you can/can't do in the program) plus social support. Most of the time, people who have problems with addiction are phenomenally lacking in those two basic things that get mostly everyone else through tough stuff.

I lack a favorable attitude toward AA and 12-steps because they were based on subjective experiences of TWO PEOPLE, instead of scientific data or any kind of tested methods that predated it. Science certainly existed in the 1930s, so why ignore it? I feel the same way about EMDR, for the exact same reason. I also hate the idea that you have to make people feel ashamed of themselves and their "diseases", and repentant for them, in order to cure them, which AA is huge on doing. My own approach to helping people involves boosting them from their strengths, not beating them down into submission from their weaknesses.
posted by so_gracefully at 5:47 PM on July 6, 2010 [3 favorites]

I'm completely chill with support groups.

It'd break everybody's fat old heart if you disapproved. ;>

that the options are the group or death or worse,

Dude, some of the people I encountered needed that level of (admittedly) shock tactics to wake them up. And the court mandated 12-step stuff is mainly out out there on the off-chance it will take, which can't hurt.
posted by jonmc at 5:50 PM on July 6, 2010 [1 favorite]

Because there's no good evidence...

As this article reports, evidence about success, or failure, rates of AA are elusive. Because of the nature of addiction, and those affected, the ability to have controlled long-term study that would meet scientific muster has proven very difficult. Therefore, reporting is unfortunately limited to anecdotal evidence.

I very much agree that courts should not require people to go to AA. That defeats the only requirement for membership, "A desire to stop drinking."
posted by netbros at 5:51 PM on July 6, 2010 [2 favorites]

I'll take a stab at how it works: it's positive peer pressure and accountability to a group, forming a routine of attendance, humble acceptance (rather than denial) of one's past habits, pride in one's ability to form new habits, continual exposure to positive exemplars, and demonization of the negative behavior. It's one of the standard models of "how to make humans do a thing". Similar processes work for church membership, academia, fitness training, etc.

Unless what is meant by "how it works" is "what are the neurochemical processes involved', in which case that's a question that's far broader than this.
posted by aeschenkarnos at 5:54 PM on July 6, 2010 [3 favorites]

Yeah, PG, I'm with Peach on this one. It's not anecdotal, its my very real life and experience and well, that's just the way it is.
posted by disclaimer at 5:55 PM on July 6, 2010

In my admittedly limited experience, AA is for those who have hit bottom, and works because of mutual support and belief in the system.

Unfortunately, also in my experience, some people do not actually hit bottom, in that they just keep going lower and lower until their financial means and friendships are wrecked. As long as there's an enabling person or situation, they'll continue.

Acting like there's no in-between can definitely be harmful. The comment upthread that drinking in moderation never made sense? Well, for some people, that's true. For others, drinking in excess makes no sense, and for yet others, drinking at all makes no sense. AA tends to not acknowledge that the drinkers who drink to excess can successfully transition to casual drinkers, mostly because people come to their program as a last resort so those people hardly ever come through the door.
posted by mikeh at 5:56 PM on July 6, 2010

It's not anecdotal, its my very real life and experience
posted by Pope Guilty at 5:58 PM on July 6, 2010 [11 favorites]

People tend to trust their own experience more than anything else. Sorry.
posted by jonmc at 6:00 PM on July 6, 2010

I think PG is pointing out that telling a story about an experience, even if it's your own, is the dictionary definition of an anecdote. I had the same reaction he did, but shook my head slowly instead of quoting.
posted by mikeh at 6:02 PM on July 6, 2010 [6 favorites]

As for my own reaction, since I feel like it's going to seem shortly that I'm anti-AA: that's not the case. I just feel that while it can have great results, it's not the only way, and probably not the best way. And really, we should have the best options available in our health system, and they should be available when needed. Addiction is an ugly, mental and physical dependency.
posted by mikeh at 6:09 PM on July 6, 2010 [1 favorite]

It didn't work for me. I identified as atheist early, and I am fully willing to more than consider that this is a brain-wiring issue, not an intellectual conclusion. I had some resources for talk therapy and brief detox, and I used them, and when I tried to explain why AA wasn't working for me, I heard "it's the best we've got." When I told my transient professionals that praying feels like lying, and lying feels bad (US-ian AA), they aren't able to quite parse that, like most members of the gen-pop.

But I'm with jonmc. On two fronts. First, stating in an open forum that it didn't work for me. Brave of you, jon, because I bet no matter what the math, it's easier to chime it that it did work than didn't. Second, good for people it did help. Why? Because some of these people are my friends. Who love me. Even though I still drink. Yes, they are long sober, but they accept me and do not pressure me. How many? Three and a half? Doing the math between IRL, used to be IRL and OL. Cool, clever, smart, caring, funny, free people who don't judge me. If they pray for me, that's their business, I know nothing about it.

Did it feel like a cult in the rooms? Well, it felt like a Church, which felt bad. To ME. But these people - friends of mine I'm happy for, don't come close to trying to cult me, even though they know I'm in the target demographic.

Mandates for it are wrong. More research = good. muddgirl is right, too - free is good.
posted by rainbaby at 6:13 PM on July 6, 2010 [5 favorites]

I have personally seen hundreds of cases where AA "worked," insofar as "worked" means stopped drinking. There's a statistic for you: 100+ successful cases. I'm sure there are other things that "work" too. I'm sure there are other things that "work better" in terms of efficiency. But to those 100+ people, whom I have directly observed, other methods and better methods are, at this point in their sobriety, inconsequential. For them, those 100+ people whom I have directly observed, it worked.

So I conclude that AA can work in some cases, because I observed it working in some cases.
posted by MarshallPoe at 6:15 PM on July 6, 2010

For those of you saying it worked for you, understand that there are thousands if not millions of people who say the same thing about homeopathy.
posted by Pope Guilty at 8:29 PM on July 6

so what?

can't you just be happy for people who are well and better, especially after nothing has worked for them?

what do you gain by mocking and insulting MeFites who use AA or use homeopathy to make their lives better?

DO YOU KNOW HOW INSULTING YOU ARE WHEN IT COMES TO THESE TOPICS?

you go frothing at the mouth about Homeopathy as if it were some terrible evil. it's not. it works some people, it doesnt work some people. and HOW DARE YOU tell recovering alcoholics that their well-being is false because it happened through AA. WTF!

i've never heard of homeopaths having an evil master plan to take over the world by all means necessary. and yet, when it comes to pharma, you hear of Vioxx or all they different ways they rush medications and vaccines to market and kill people and yet people like you insult and denigrate others because we're supposed to trust them bindly because they're the only real science.

honestly PopeGuilty, it gets tiring that it's either all or nothing when it comes to how MeFites like you deal with alternative/complementary therapies. you dont understand it so you feel the need to insult people for your lack of understanding and ignorance.

ENOUGH!
posted by liza at 6:16 PM on July 6, 2010 [12 favorites]

Putting people in a highly suggestible state, berating them about things they do they know are bad, then giving them an out with a transcendent experience contingent on acceptance is probably a great treatment for all sorts of horrible chronic behavioral problems.

Add in a support framework, like the Oxford Group, that will be entirely positive and congratulatory about your experience and new lease on life and your new behavior will probably stick.

Seems fairly obvious ya?

The whole traumatic dark night of the soul washed away by light thing. It worked for Bill, and he did his best to build a ritual around his experience.

This sort of "re-imprinting" is rather well documented in numerous accounts of cult and political group brainwashing -- those guys get some results insofar as behavior change goes!

The problem with so many programs is that they're rather unforgiving in how they create the dark night of the soul, if you buy the (N|A)A story then you are intrinsically bad and will always have this problem and if you ever leave their vale then surely you are doomed... well, if you buy in and don't follow the program, then surely you are doomed and you'll follow that portion of the program instead.

It seems quite likely addiction is a learned behavior that can be revised by further learning. This can be done a number of ways, including completely unrelated rituals, and though I know AA itself is favorable to "any other method that works" bits of it's philosophy seem to edge out any other competition (i.e. their assertions of intrinsic/permanence) in ways that may be detrimental to the large portion of people who simply don't fit the 12-step mold.
posted by Matt Oneiros at 6:17 PM on July 6, 2010 [1 favorite]

because it encourages people to believe in their own powerlessness

and this is a problem, because...

and because AA members spread the kind of anti-rationality that the adherents of every kind of psuedoscience depend upon.

and Alcoholics Anonymous claims to be a science, where...

you surrender your mind and start encouraging others to do the same.

Surrender (and acceptance) are underlying thoughts that can be found in Christianity, Hinduism, Buddhism and Islam, to name a few "pseudosciences," of which there are millions (if not billions) of adherents having an "anti-rational" experience. You make AA sound like an outlier.

because AA lies about alcoholism

would you be kind enough to explain which lie or lies you are referring to? is it the whole "alcoholism is incurable" deal? If that's the case, maybe you can point me to some cures for alcoholism and provide evidence, which I will happily go to town on.

because it's the only religious organization you can be legally compelled to go to

Also, Alcoholics Anonymous does not require anyone to attend anything. That, my friend, is a precedent set by the secular courts.
posted by phaedon at 6:20 PM on July 6, 2010 [2 favorites]

Why? Because some of these people are my friends. Who love me. Even though I still drink. Yes, they are long sober, but they accept me and do not pressure me.

Heh. I'm pushing 40 and at my job I'm surrounded by kids in their early 20's, they're good kids, but when I go out drinking with them I feel like the 'cool' teacher hanging out with the kids after class which kind of sucks. A few years back we had a guy in his mid thirties get hired. He liked sports, music and literature and he had a goofy persoanlity and I figured he could be my new buddy. One day we were unloading crates together and I mentioned a tasty beer I'd discovered and reccomended it to him and he said "I'll have to check with my sponsor first.." Inwardly, I cursed, but as I got to know him, I learned that quitting was literally a life and death thing for him and thankfully he's never pressured met to rejoin AA.
posted by jonmc at 6:22 PM on July 6, 2010

And for the record, I did RTMFA and found it interesting.
posted by rainbaby at 6:25 PM on July 6, 2010

while out of his head on tropane alkaloids, i.e. a highly suggestible state

I hadn't realized he "converted" during a belladonna trip. There's actually a lot of evidence for use of certain psychedelic drugs to cure (or at least treat) addiction. Ibogaine is one that comes up a lot.
posted by infinitywaltz at 6:28 PM on July 6, 2010 [1 favorite]

Why are people so hostile towards AA? Because it's religious?

While that would doubtless be enough for some folk around here, I've run into plenty of people who (like Pope Guilty above) see it as going somewhat overboard in its rhetoric, and using types of pressure - in a good cause, as they no doubt see it - that seems a bit too intrusive and forceful.

can't you just be happy for people who are well and better, especially after nothing has worked for them

I don't think anyone here is unhappy because it worked for some people. The question is whether it can be trusted to work for a statistically large enough number of people to fulfill the hype that sometimes surrounds it, and how it works - I've met people whose conversion to strongly fundamentalist denominations helped them pull their life together - it also cost them a lot in terms of narrowing their lives down and surrendering agency.

Which isn't to say that AA is a fundamentalist faith, or that people shouldn't be able to make that call if they choose. But we're allowed to examine the questions, nonetheless. Doing so doesn't mean that PG or anyone else is hateful or unhappy that a few (perhaps not statistically significant, however vitally important they are as individual friends, family, etc.) have been helped.

Frankly, the articles here provided food for thought, but I remain not entirely convinced.
posted by AdamCSnider at 6:28 PM on July 6, 2010 [4 favorites]

"For those of you saying it worked for you, understand that there are thousands if not millions of people who say the same thing about homeopathy."

The difference is AA is much more falsifiable. Are you in AA? Did you have a drink today? Yes and No? It's working. The kind of people being helped by AA are rarely the kind of addicts who will go into spontaneous remission.

Some one close to me went thru quiting and has been sober now for a couple decades. They had tried to quit or be more moderate (not a very high bar when you are drinking yourself into a stupor 7-365) and failed numerous times by numerous methods including two rounds of AA. The third time clicked. Their experience was that a good AA group provides a social circle that replaces the one you lost when you quit cold turkey and that is the key element of success. Dovetails a bit with the brain stuff being discussed: the group provides the desired positive feedback that your brain isn't providing.

Pope Guilty writes "Because there's no good evidence that it's any better than cold turkey, because it's the only religious organization you can be legally compelled to go to, because AA lies about alcoholism, because it encourages people to believe in their own powerlessness, and because AA members spread the kind of anti-rationality (as can be seen in multiple comments in this thread) that the adherents of every kind of psuedoscience depend upon."

The legally required bit I agree is stupid. I'm not sure if that happens here; you see a lot of people in AA that are having trouble with the law but I'm not sure if a judge or their lawyer told them to attend. And if someone finds that attending meetings helps them become a, in their opinion, better person why the heck would we judge them or the program any more than some one who joins a lodge or golf club.

And I don't perceive AA as being all that religious though that could be a cultural thing; Canadians seem on average to be less beholden to religion than Americans.
posted by Mitheral at 6:28 PM on July 6, 2010

liza, I despise con men, frauds, and quacks. It drives me frothing with rage to see human beings lie to each other and trick each other in order to make money, and it especially pisses me off to see people defending frauds and swindlers and spreading their lies so they can continue to make a living not by producing anything real or performing any real services, but by swindling people out of their money and in the process causing them real harm up to and including death.

So no, I'm not going to be nice to people who work as the cheerful, friendly-faced spreaders of lies and fraud. I'm not going to just shut up and let them work as though there weren't lies on their lips and blood on their hands. I'd be a monster if I did.
posted by Pope Guilty at 6:30 PM on July 6, 2010 [6 favorites]

As this article reports, evidence about success, or failure, rates of AA are elusive.

The article also reports:

Yet a growing body of evidence suggests that while AA is certainly no miracle cure, people who become deeply involved in the program usually do well over the long haul. In a 2006 study, for example, two Stanford psychiatrists chronicled the fates of 628 alcoholics they managed to track over a 16-year period. They concluded that subjects who attended AA meetings frequently were more likely to be sober than those who merely dabbled in the organization. The University of New Mexico’s Tonigan says the relationship between first-year attendance and long-term sobriety is small but valid: In the language of statistics, the correlation is around 0.3, which is right on the borderline between weak and modest (0 meaning no relationship, and 1.0 being a perfect one-to-one relationship).

“I’ve been involved in a couple of meta-analyses of AA, which collapse the findings across many studies,” Tonigan says. “They generally all come to the same conclusion, which is that AA is beneficial for many but not all individuals, and that the benefit is modest but significant … I think that is, scientifically speaking, a very valid statement.”

That statement is also supported by the results of a landmark study that examined how the steps perform when taught in clinical settings as opposed to church basements.

The conclusions are rather measured, but at least marginally positive, and certainly suggest that an actively hostile stance towards AA isn't particularly SCIENCE!.
posted by weston at 6:31 PM on July 6, 2010 [4 favorites]

I think the point of concern about "Yay AA, it worked for me" is that, if there were something out there more effective than AA, we wouldn't hear about it, because AA is very big on telling everyone that only twelve step programs can help, that's just the way it is. Another choice bit, if you stop drinking and you didn't go to AA, you're a "dry drunk." AA evangelism drowns out any other potential approaches because of the ongoing insistence that they and only they have The Truth, which is why the religious comparisons arise.

And we don't know why it works because the system is inflexible. What if we omit a step? Have we done any studies on omitting a step? It could be that skipping, say, step eleven reduces incidence of relapse. We won't get to know that, though, because of the insistence that this is a package deal, received from Bill, graven on big stone slabs. Or while he was tripping his brains out on freakin' belladonna. Stevie Nicks aside (or maybe included), that's not exactly the stuff you want in you when you'd like to make serious, rational decisions. We have twelve steps because there are twelve apostles. Yeah, read the article. Neat, eh?

AA has influenced even the yardstick by which success is measured, that's how pervasive it is. Get this: "It was more effective for alcoholics without other psychiatric problems, and it did a better job of inspiring total abstinence as opposed to a mere reduction in drinking." That's right, it's not about having moderate and statistically normed drinking behavior, but about rejecting alcohol entirely. That's how we are measuring success here, and it's quite sticky because that measurement assumes one of the classic insistences of AA: that, if you are an alcoholic, you can never again drink in moderation.

It would be nice if our society could take a few steps back from Twelve Steps and re-evaluate treatment in light of so many new medications, therapies, and discoveries we have made, but like the prefrontal cortex article says, even if the success rate is poor, some folks just get stuck with one approach and one approach alone.
posted by adipocere at 6:33 PM on July 6, 2010 [17 favorites]

Characterizing AA as a religion is a stretch. Nobody ever gets encouraged to give 10% of their income to AA, (let alone more, which many religions do). I also never got proselytized at my door by an AA member. The concept of "God" in AA is about the least doctrinare version of theism as I can think of. I know atheist 12-steppers who have found a way to make the concept of humility toward something greater be the thing that is the catalyst for the "higher power" parts of the steps. I would consider 12-step programs to be a spiritual practice more than anything

I used to get my panties in a bunch about anything for which there was only anecdotal evidence. "There is not a falsifiable claim, so I can't prove it!" Fine. Truth is, some things aren't quantitative. Loyalty, love, art, friendship, beauty, all subjective, and yet profoundly real things in life. I can still enjoy having a great conversation with my friend even if I can't prove to you that I enjoyed it.

It sounds like AA is being dismissed as a religious, involuntary, cultish unscientific enterprise. The flipside, of people's ACTUAL experiences, positive and negative expressed here and profoundly across the web, seem to express a much more nuanced reality of 12-step groups. As far as the article, it's pretty good. The common thing is that behavior and habits, when changed, cause behavioral and habit change. Those changes are more profound when one discovers one is not alone.
posted by artlung at 6:37 PM on July 6, 2010 [6 favorites]

If someone's addictive behavior is in any way related to an authority problem, including rejecting help from an authority, then group therapy is essential. A significant amount of dysfunctional behavior is classified in early stages as simple defiance, and as they enter adulthood, addiction is out there waiting to kick their asses. There are other aspects about group therapy that are notable, especially the conforming aspects of it.
posted by Brian B. at 6:42 PM on July 6, 2010 [1 favorite]

if there were something out there more effective than AA, we wouldn't hear about it, because AA is very big on telling everyone that only twelve step programs can help, that's just the way it is.

I usually don't make categorical statements, but this (alas) is 100% false. I can't speak for all meetings in all places, but everywhere I've been the suggestion has been do do whatever works, whatever that happens to be.
posted by MarshallPoe at 6:43 PM on July 6, 2010 [1 favorite]

It seems quite likely addiction is a learned behavior that can be revised by further learning.
posted by Matt Oneiros at 9:17 PM on July 6

i dont know about that. i've been dealing with a lot of medical problems in the last 3 years and allergies/intolerances has been a big part of that. what i have learned through all this process is that some of the foods that are most damaging to my health are also some of not just my favorite but ones "i can't live without".

you can have withdrawals of the very foods that you are allergic too. somewhere in my readings i seem to remember that addictions like alcoholism are being looked at as part of a whole continuum of immunological and neurological failures as opposed to an independent disease. changing your life around to avoid things like wheat, eggs and cow milk can be as difficult as trying to stop drinking. am not saying it has the same devastating life effects, but wheat allergies/celiac disease can be pretty devastating to your body (even cause cancer).

there's really a quiet "continuum" revolution happening within the US medical community; of MDs and scientists thinking outside the box and looking at things like AA, ayurveda, homeopathy and other "non-traditional" healing traditions. i am lucky to have an awesome team in my family MDs & nutrionist who are also experts in what they call complementary therapies that are looking at addiction, immunological syndromes, etc beyond the conventinal wisdom of "learned behaviour" and helping my family find the path to well-being after years of failure in managing our chronic illnesses the conventional way.
posted by liza at 6:45 PM on July 6, 2010

I have witnessed AA from the sidelines for many years (close relative very active). For a long time I thought it was a cop out - trading one addiction for another. Then I realized that addiction can't be cured so one that doesn't destroy your life is certainly preferable to the other. Then I witnessed the unbreakable bond that those who support each other in AA have - they are there for each other no matter how painful, no matter how hard and they never give up on each other. And now I have immense respect for these people who bond together to lift each other up.
posted by double bubble at 6:45 PM on July 6, 2010 [3 favorites]

And more relative to the post at hand - I'm always amazed at the complexity of the human brain.
posted by double bubble at 6:48 PM on July 6, 2010

Pope Guilty: by swindling people out of their money and in the process causing them real harm up to and including death.

You know, that link might be worthwhile if it actually addressed what we're talking about.

I'm not going to just shut up and let them work as though there weren't lies on their lips and blood on their hands. I'd be a monster if I did.

To be honest, you come across as someone who's overly concerned with melodrama and thinking that you're "right" than you are with actually alleviating human suffering. It's fundamentally dishonest and, frankly, just not very nice.
posted by dhammond at 6:53 PM on July 6, 2010 [13 favorites]

Do we know what causes alcoholism? We understand the subjective experience of an alcoholic to alcohol because people can describe it (ecstasy, profound relaxation), but aside from the mere presence of the syndrome in the human population and some putative neurophysiological state of affairs, it seems that we don't really know, on the most fundamental level, why one person is an alcoholic and another person isn't. Is that not true?
posted by clockzero at 6:54 PM on July 6, 2010 [1 favorite]

dhammond, I made the comparison to homeopathy, liza expanded that to the whole of alt med, and I responded to that. Reading all the posts and not skipping around aids in comprehension.
posted by Pope Guilty at 6:54 PM on July 6, 2010 [1 favorite]

too many cheap shots/volte faces in the article to enable much of a discussion here really.
posted by sgt.serenity at 6:55 PM on July 6, 2010 [2 favorites]

The legally required bit I agree is stupid. I'm not sure if that happens here; you see a lot of people in AA that are having trouble with the law but I'm not sure if a judge or their lawyer told them to attend.

In the US at least, judges frequently make attending AA/NA a condition of probation for crimes that are somehow related to alcohol/drug use. That said, if a defendant said "No judge, I can't go to AA, I'm an atheist," the judge would probably be satisfied with another treatment option.
posted by Bulgaroktonos at 6:56 PM on July 6, 2010 [1 favorite]

Another difference between AA and homeopathy: as far as I know, there's nobody making millions writing a book peddling AA as an alternative to therapy TPTB don't want you to know about.
posted by l33tpolicywonk at 6:57 PM on July 6, 2010 [1 favorite]

Then I realized that addiction can't be cured

You know there's plenty of people who were addicted and no longer are, right?

See, this is part of why AA is so corrosive- the "addiction can't be cured" meme's popularity in our culture is in large part due to the fact that it's AA dogma and AA has been very vocal in spreading it. Meanwhile, in reality, people get cured of addictions all the time, whether to hard drugs, alcohol, nicotine, or even caffeine. But we have a large and influential group in the addiction treatment community- and a group, no less, which has no science underlying its methods and which is based on a set of religious practices- and they have far more influence than any of the rehab clinics or detox centers that productively get people off far more addictive drugs and whose treatment regimens are based on science and modern medicine. It's baffling that people don't see a problem with that.
posted by Pope Guilty at 7:00 PM on July 6, 2010 [14 favorites]

AA can't stop courts from forcing people to attend; the organization is resolutely anti-organization. They don't have "people in charge," they just have members who are serving for a while, and rotation out of office is required. People show up with papers they are supposed to get signed, and whoever is chair that month generally signs it, but the signature doesn't mean much when there is no authority behind it.

That unfortunately means that since you don't have any real enforcers and no real power structure, sometimes manipulative power-hungry wackos move in and take over groups, and sometimes meetings barely survive or go out of existence, but the organization as a whole seems to survive anyway.

As for swindling people out of their money, AA doesn't accept contributions over a certain amount, sells no services, and pursues a strategy of keeping group treasuries below a certain maximum. It also doesn't have much of a doctrine; you can believe what you want and still belong.
posted by Peach at 7:01 PM on July 6, 2010 [13 favorites]

which has no science underlying its methods and which is based on a set of religious practices- and they have far more influence than any of the rehab clinics or detox centers that productively get people off far more addictive drugs and whose treatment regimens are based on science and modern medicine. It's baffling that people don't see a problem with that.
posted by Pope Guilty at 3:00 AM on July 7 [+] [!]

please name these methods and centres of which you speak, o wise one.
posted by sgt.serenity at 7:04 PM on July 6, 2010 [3 favorites]

swindling people out of their money and in the process causing them real harm up to and including death.
posted by Pope Guilty at 9:30 PM on July 6

so you're saying there's so many people dying of the following which i've used at some point in my life:

Acupuncture
Applied kinesiology
Ayurvedic medicine
Chiropractic
Cranio-sacral therapy
Detoxification
Herbal remedies
Home childbirth
Homeopathy
Naturopathy
Osteopathy

and by Vitamin megadoses am going to say you also would include

Nutriotional Therapy

that they need to be STOPped because they're Hannibal Lechters of Healing?

Really? There's that many people dying of accupuncture and Chinese herbology that we need to

STOP.

THEM.

NOW!

and yet you can't stop yourself from insulting people like me and every single person here that has used AA because we just don't understand how right you are about all these practices that you havent studied in the first place because we are blind to

ALL.

THE.

DEAD.

PEOPLE!

that these alternative therapies are unscientifically genociding?

really.
posted by liza at 7:05 PM on July 6, 2010

Reading all the posts and not skipping around aids in comprehension.

No need for condescension, Pope Guilty. It's possible to disagree with people without being kind of a dick about it.
posted by dhammond at 7:09 PM on July 6, 2010 [3 favorites]

You should try working in a psychotherapy office sometime, with some staff (both behind the desk and behind the door) who were in AA — hoo-doggie, talk about your one size fits all gang. The twelve steps became the lens through which all else was viewed. Some days I thought that if I heard the phrase "take inventory" just one more freakin' time it would retroactively ruin about all of the D&D I ever played. This was such a prevalent attitude that one therapist peeled off of the bunch because he would not stick with the "?A is the only option for addiction" dogma.

Nor was this the only AA-converted crowd who had handed me the same old chants.

While the loved ones might be desperate for any option that worked, any at all, that doesn't mean that those in AA who have been evangelized do not go forth and evangelize in turn, and do so with the very words they have heard so often. Tell you what, next time you run across someone in AA, suggest that AA might not be the only effective treatment option. Be interested to know what you hear.

Maybe they need a thirteen step, one for Jesus: "Lighten."
posted by adipocere at 7:10 PM on July 6, 2010 [5 favorites]

Someone is addicted to hokum.
posted by unSane at 7:27 PM on July 6, 2010 [1 favorite]

Acupuncture, Applied kinesiology, Ayurvedic medicine, Chiropractic, Cranio-sacral therapy, Detoxification, Herbal remedies, Home childbirth, Homeopathy, Naturopathy, Osteopathy

liza, you do realize that the majority of these are either fairly neutral, have no major difference with a placebo effect, or are alternatives for medical treatments that aren't 100% effective, right?

It's not that these things don't work for some, it's that they have a much lower efficacy rate due to the fact that they're much less effective or, in many cases, a placebo. I've personally had some good chiropractic experiences, but if I had serious back problems, I'd go for surgery. I have two parents who had ruptured discs and have had a world of difference after surgery. Some people? They say that surgery is an unnecessary medical procedure, get some relief from acupuncture or further chiropractic care, but really end up with limited motion or even chronic pain from seeking alternative treatments.

Homepathy? It costs money, and show me a single study that gives it a higher-than-placebo rate of effectiveness. That's true of a number of these. If you feel you've had some benefit, go for it by all means. But do it knowing that there's no strong factual or scientific basis for this, and there's no "science" out there to rail against. So Vioxx fails, and some drugs are overprescribed or misprescribed and some bad ones make it through. There's a process, though, and not so much of one out there in the "natural" field where anything goes.

Pope Guilty may be sounding preachy or as a naysayer for things that have done well for people, but it's because he wants better. Wanting scientifically-documented and institutionally-proven treatments available and recommended as a first stop for everyone? That's a general good.
posted by mikeh at 7:28 PM on July 6, 2010 [10 favorites]

There is an astonishing amount of truly, deeply unqualified opinion in this thread from people have 0.0% experience in dealing with a serious addiction. You do not need to be an internet expert on on everything, folks.
posted by GilloD at 7:32 PM on July 6, 2010 [5 favorites]

At first I was a little upset that this thread was veering so severely off course.

Then I remembered that I'm really entertained by vitriol.

My perspective on AA is that it works for a small percentage of the population. Evidence not actively obscured by AA indicates that rates of relapse after 12 months are similar to "cold turkey" and other methods. That said, different methods may work for different people.

I do wonder about the potential for abuse in AA, in terms of predators and con men trying to find you when you are most vulnerable.
posted by poe at 7:32 PM on July 6, 2010

(Sigh)

I've been around the rooms for nearly 13 years. It's not a religion. Not a cult either, although quite a few groups have tried to set themselves up that way. Some jackass who has assumed the position of ranking bleeding deacon in a group might tell you that you need to go to a certain church for his own selfish reasons, but you don't have to. You can feel free to ignore this person, and moreover, to rebut him (as a gay, liberal pagan, I find it to be great fun!). The fellowship "takes no opinion on outside issues". Means just what it says. No one in any official capacity tells an alcoholic in AA to do anything. You can't kick an alcoholic out, either. They'll just find another group anyway. Reminds me of the old saying "You can always tell an alcoholic, but you can't tell him much".

Members are also, contrary to what I seem to be reading here, encouraged to contact a mental health professional should they feel, in their opinion, that they may need the services of one. Or a lawyer, or medical doctor, or any other professional. The book, "Living Sober", an official AA publication, mentions this. And again, some jackass may tell you instead of taking medication as prescribed for your depression or your bipolar that you need to just work the steps a little harder and get on, as one jackass I know insisted, "the right side of the Lord". I just tell him that isn't in the book, and so he probably hasn't got any business telling people who want to get sober things that aren't in the book.

Science? As a reader of Pharyngula, I have a great deal of respect for rationality and science. But not everything is science, nor can it always be measured. By no means is everything spiritual either.

AA is a strange thing. It does work for me. If I hadn't gotten into the rooms, I would never have progressed any further in my life past the lying stealing jerk I had become. I am not by any means the person I was 13 years ago. I cannot account for this transformation in any rational way, and if you had known me back then, the only thing you could really say about the change is that it's profound (and when I say "profound", I'm really thinking like a shot out of a cannon).

I participate in a couple of AA groups, and also work closely with some addiction and mental health professionals. The science around alcoholism and addiction is stronger than it ever has been, and I have come to understand the complex relationship between the brain chemistry and the neurotransmitters surprisingly well. But there is more than just a chemical soup going on up there in my head, and it's not just about my head, it's also about my heart. AA helped me find a connection to my heart, and to the rest of the human race as well.
posted by cybrcamper at 7:39 PM on July 6, 2010 [13 favorites]

A.A. seems to operate on two planes. There's the part where, when you attend your first few meetings as a newcomer, you hear things like "If you don't want to stop drinking, we'll gladly refund your misery." and "Stinkin' thinkin' leads to stinkin' drinkin!'" You are slowly, insidiously broken down and made to feel like your way didn't and isn't going to work. Your first thoughts are "Fuck this....These assholes couldn't care less!"

On this other plane, everybody there is nearly in the same boat as you. Some worse than others but as you start to hear the stories, the little voice in your head nods in agreement. You realize the same person who said they'd refund your misery is the same person who is going through a nasty divorce or just got out of rehab or whatever. None of these realizations come with any external displays of realization. Most newcomers may seem outwardly resistant and or just quiet. That's fine. As long as they are able to hear the message.

I used to "sentence" patients to "90 in 90" (ninety meetings in ninety days) because I knew that their 30 days of rehab would not be enough for them to hear the message, start internalizing it and bringing their own narrative to the story. Three-fourths of my patients seemed more than happy to attend as many meetings as possible. Of those three-fourths, half of them were out and out bull-shitting and had no intention of staying sober. The other half seemed to go on and for the most part, lead happy lives.

The interesting part of this is that the one-fourth of my patients who I had no real hope for, a lot of them seemed to find their own way, whether it was through A.A., N.A., individual therapy, etc., Yes, some did die but not a lot. A few stayed in the throes of addiction. I have no hard numbers to back all that up but in retrospect, this how it seemed to break down.

How do we measure success? At 30 days of sobriety? 6 months? A year? Longer? To me and to my patients at the time, it was a quality of life issue. Quality of life goes out the door when you are drunk, high and have no cognitive control over yourself. One story that always stays with me goes back to my very first job in the addictions field as a detox technician in Denver. My supervisor, Jose, was in A.A.. and the guy was, to my four-year sober eyes, a fucking saint. He was a little Buddha to me. Always knew the right things to say to defuse hostile situations and gave me a ton of sage advice. He was That Guy that everyone went to if they needed guidance. He had 20+ years of sobriety. One night, a cop car pulls up at our back door and rings the buzzer to the intake room. I open the door and there stands Jose. He's in cuffs, drunk as hell and swearing up a storm. We got him into a bed like he had taught us all how to do so many times before and started doing our intake on him. I was floored. My little Buddha was now a patient. It took me a long time to process that night. He went on to stay sober and live a great life and that bump in the road didn't deter him from having a quality life. So he taught me something, even in his relapse.

I agree with PG on some level. The hard evidence just isn't there to support any type of success rate except for what we see in our personal struggle with addiction and the struggle of others. I do have the feeling from knowing what the alternative are, that A.A. is definitely the lesser of many evils in sobriety in terms of what works and what doesn't. The religious aspect of A.A. does seem to appeal to those with some sort of Christian background but it also leaves many atheists and agnostics in the dark. But on the other hand, I know many atheists who flourish in A.A. because they are able to separate the wheat from the chaff. Go figure. The bottom line, I used to tell my patients is "you have to go to meetings to find out what happens to people who don't go to meetings." Eventually they get their own brains our of hock.
posted by KevinSkomsvold at 7:47 PM on July 6, 2010 [9 favorites]

This thread disappoints me. It took 27 comments before somebody mentioned Infinite Jest.
posted by MattMangels at 7:51 PM on July 6, 2010 [4 favorites]

@floam

which in the list are harmless, which are silly and which are unsafe? and have you done any of these that you are rating and judging as an expert?

because that's really the point: what expertise do you have that gives you an advantage to sit in jugement of AA and alternative healing therapies and call them silly & unsafe? they may not have worked for you or for me but for those who these worked, it works.

i haven't had a homebirth (the idea of clean-up afterwards would drive me nuts) but was denied at a birthing center because i was a VBAC. and that was fucking hell & half, me wanting to walk away the pain of labor and the hospital staff insisting i needed to have monitors up the ass. ugh.

but i know women who were so averse to a hospital that a home-birth was just exactly the safe and sound solution for them. and the protocol for having home-births, at least in NYC, is such that honestly, if i can't find a birthing for a 3rd or 4th kid, i'll have them at home (which i can now by law because i had a successful VBAC).

the article is fascinating for how it tries to explain how the social/emotional impact of the group meeting has a plausible neurological explanation. the way people in AA respond to the group meeting might be a window into understanding healing as a whole.

and this is why the derail into homeopathy by PopeGuilty is interesting because he can't understand it, doesnt practice it, has never studied it and yet froths at the mouth when people say it works without even considering for a moment that it has more to do with lack of understanding of evidence than lack of evidence itself.

healing happening outside of certain traditional medical parameters is scary for some people due to its seeming randomness. yet there is a lot about the mind and body that we know we just dont know.

that blog post is fascinating. reminds me of that HBO special about the brain and what i've read related to the Nun Study and Alzheimer's disease.
posted by liza at 7:54 PM on July 6, 2010

Pope Guilty: AA member here. Your anger at AA is misplaced. I don't know who you think is gaining from "swindling other people out of their money" but it ain't me or any other member I have met in 20 years of sobriety and 18 years of AA. All donations are used for coffee, rent, literature, and the like, and for the support of a few central offices. Nearly all of the real work of AA is done by volunteers and is unpaid.
I'm an atheist and am accepted as such in AA. Somehow, the program still works for me.
Lots of individual groups have, indeed, refused to sign documents for the court-ordered.
There are some zealots in AA. Some of the "accepted truth" may be wrong, but on the whole, AA has helped a lot of people and I hope it will continue to do so, along with whatever else works to help the suffering alcoholic.
Pope, I see more blood, death and lies outside of AA than in. Our only gain, as AA members, is a new way of life for ourselves and the opportunity to help others find a new life without booze. Believe me, it is a wonderful thing, watching people heal and grow.
posted by Hobgoblin at 7:57 PM on July 6, 2010 [8 favorites]

I know a lot of people IN A.A. like PG, the ones who stand around arguing the structural integrity of a fence while a tornado swirls above. The thing is, I get PG too. For purposes of this conversation, and without nearly the same hyperbole, I get it, PG. You do have some great points. I just wish they weren't couched in OMGAAISKILLINGTHEPEEPLE!!!!1
posted by KevinSkomsvold at 8:01 PM on July 6, 2010 [1 favorite]

and this is why the derail into homeopathy by PopeGuilty is interesting because he can't understand it, doesnt practice it, has never studied it and yet froths at the mouth when people say it works without even considering for a moment that it has more to do with lack of understanding of evidence than lack of evidence itself.

You seriously believe this.
posted by Pope Guilty at 8:15 PM on July 6, 2010 [6 favorites]

was trying to look fr the correct word: am interested in seeing if anybody makes a connection between AA meetings and social and spirital life of elderly people, especially those suffering from Alzheimer's and dementia inre: COGNITIVE RESERVES.

it was Snowdon's book that immediately came to time after RTMFA. i seem to remember a chapter where they look into the brain of one of the recently diseased nuns and find she had massive brain damage due to Alzheimer's yet had shown no signs of it. she had a very social life and was very active with the other nuns, etc.

as my father died of dementia, i read quite a bit about the subject. fascinating to know that alcoholism, dementia, Alzheimers, depression, heart disease, diabetes are all related. it's fascinating to see how research like the Nun Study has opened up a lot of understanding into the actual health benefits of social interaction, word puzzles and, related to AA, forgiveness, humility and a positive outlook on life.

thanks for the FPP.
posted by liza at 8:20 PM on July 6, 2010

You know there's plenty of people who were addicted and no longer are, right?

Could you please expand on this? Because the only people that I know of who are not addicts no longer take the drugs in question, which is what AA says is necessary, so I don't see the conflict.

I've got no horse in this race; my Dad quit drinking cold turkey decades ago, while his best friend chose the AA route. You could say that I would say AA has no value because my Dad didn't need AA. But he had a family to support him. His best friend was divorced and alone. Support groups help people, and if AA is nothing else, it's a support system that caters specifically to addicts and alcoholics. Support groups are accepted by the medical community as beneficial. This is not holistic medicine and chicanery.

it's the only religious organization you can be legally compelled to go to
Something like 12% of those who attend AA are court-ordered to do so. To my knowledge, the higher power referred to in AA is self-defined; admitting they are powerless takes the pressure off the addict or alcoholic so that they can concentrate on fighting the addiction. This is in direct contrast to your contention that AA shames and berates the members, btw. Getting the whole blaming and shaming issue out of the way is addressed in the meetings. I know you must be familiar with the whole, "Hi, I'm so-and-so and I'm an alcoholic..." speeches, having at least seen them on TV. People are encouraged to stand up and detail their experiences in an effort to remove the shame, show others that they are not alone, etc. Also, they are anonymous. You could say your name is Barack Obama or Glenn Beck if you want.

As far as the "lies" about alcoholism, I'm not sure where you're coming from there either, Pope Guilty. If someone disagrees with you about the nature of alcoholism and addiction, that makes them a liar? Where are your facts backing this contention up?

I just don't understand the vitriol against AA if it helps any people--which it seems to me it can and does.
posted by misha at 8:30 PM on July 6, 2010 [4 favorites]

If AA wasn't okay with it- and they've had decades to notice that not everybody showing up to meetings is doing so of their own volition- they could certainly say something. Instead they remain silent, complicit in the coercion.

AA does not turn people away.
posted by marxchivist at 8:36 PM on July 6, 2010

Or what misha said.
posted by marxchivist at 8:38 PM on July 6, 2010

It seems like there was a MeTa thread about "why do people get all grar about AA?" some time back, though maybe I'm misremembering, but I'm glad to see the grar tempered by a wide range of anecdotes of experience with AA and addiction. I'm thankful folks are taking the time to share.
posted by artlung at 8:40 PM on July 6, 2010 [1 favorite]

Pope Guilty: "If AA wasn't okay with it- and they've had decades to notice that not everybody showing up to meetings is doing so of their own volition- they could certainly say something."

I don't know who you expect to make this statement. AA is famously led and administered by no one, and both of its recognized founders have been dead for quite some time.
posted by l33tpolicywonk at 8:48 PM on July 6, 2010

It's pretty simple. AA seems to work pretty well for those people who do not drop out. But most people drop out. I hadn't previously seen any suggestions about WHY or HOW it works for the people who stay.

Anyhow, see chapter 10 of SCIENCE AND PSEUDOSCIENCE IN PSYCHOTHERAPY, edited by Scott Lilienfeld et al.

Google Books link: http://is.gd/dibUt
posted by PsychoTherapist at 8:49 PM on July 6, 2010 [2 favorites]

AA does not turn people away.

AA started out as a religious conversion vehicle, which apparently involved one of the founders finding himself cured by psychotropic drugs, which involved a religious experience of sorts. The fact that it still uses religious methods, instead of the psychotropic ones that were key to its founding, would raise the question of turning other treatments away rather than other people. I think they're fair game for this reason. Non-addictive psychotropic drugs have long been demanded for use in drug and alcohol treatment, but remain outlawed in America under threat of long-term incarceration. This is plainly due to a conservative religious ideology that shuns people from using mind-altering drugs no matter how useful to their treatment. This attitude is precisely in tune with AA's parent, The Oxford Group.
posted by Brian B. at 8:52 PM on July 6, 2010 [2 favorites]

Pope Guilty: For those of you saying it worked for you, understand that there are thousands if not millions of people who say the same thing about homeopathy.

The homeopathy card? Really?

I'm no fan of AA, but it's group therapy, not pseudoscience. It's not making scientific claims. There's a big, big difference.

liza: ...about Homeopathy as if it were some terrible evil. it's not. it works some people, it doesnt work some people

Yes, homeopathy works for some people. Curiously, it works just as well as drinking some water and having a session of psychotherapy.
posted by qxntpqbbbqxl at 8:54 PM on July 6, 2010 [2 favorites]

It doesn't work great, but it works a lot better than just about everything else.

Actually, it's about as effective as anything else, around 5% by the best studies. It's really up to the person who has a problem whether they're successful or not. Group therapy can work great for many, not so great for others.

AA never worked for me. A very intense psychedelic experience did work, however.
posted by krinklyfig at 9:00 PM on July 6, 2010 [2 favorites]

I hadn't realized he "converted" during a belladonna trip. There's actually a lot of evidence for use of certain psychedelic drugs to cure (or at least treat) addiction. Ibogaine is one that comes up a lot.

Actually, all the evidence points to LSD, not belladonna. This came up recently on the MAPS list.
posted by krinklyfig at 9:15 PM on July 6, 2010

In the US at least, judges frequently make attending AA/NA a condition of probation for crimes that are somehow related to alcohol/drug use. That said, if a defendant said "No judge, I can't go to AA, I'm an atheist," the judge would probably be satisfied with another treatment option.

Often there is no other option in the area, and some courts see AA as the only viable option.
posted by krinklyfig at 9:18 PM on July 6, 2010

I'm no fan of AA, but it's group therapy, not pseudoscience. It's not making scientific claims. There's a big, big difference.

But we do have scientific knowledge of psychology, addiction and therapy. AA was not designed with scientific knowledge backing it. It happens to work because of the combination of religion and group therapy provides a familial structure and support, but the actual science shows it's hardly the only way, and it's no more effective than any other treatment. The problem is all too frequently people who are alcoholics don't hear this. Some of them will walk out of an AA meeting really believing if they don't come back they're doomed, and then they might go to a bar. But they probably won't go back to that meeting again for a long time, if ever. All options should be on the table, is all I'm saying. AA sometimes is too narrow in recognizing other paths.

because that's really the point: what expertise do you have that gives you an advantage to sit in jugement of AA and alternative healing therapies and call them silly & unsafe? they may not have worked for you or for me but for those who these worked, it works.

Well, we do have some scientific evidence of what those alternative therapies actually do. There's nothing wrong with evidence-based inquiry, right? Shouldn't we use all the tools we have to make sure what we're doing to help ourselves is actually working? Correlation is not causation, but you have to do some scientific inquiry to find out which is correct.

BTW, in certain contexts there is nothing wrong with most alternate therapies. But pretending as if scientific research were some sort of evil or nonsense is willful ignorance and can result in real harm. If you put your head in the sand when you're shown factual evidence, you're not helping yourself.
posted by krinklyfig at 9:35 PM on July 6, 2010 [2 favorites]

PsychoTherapist's Google Books link: http://is.gd/dibUt is pretty good for its description of some of the trouble spots with regards to quantifying and reproducing the effects of AA.
posted by artlung at 9:43 PM on July 6, 2010

I'm no fan of AA, but it's group therapy, not pseudoscience.

Well, no, it absolutely is NOT group therapy. It is a support group. Therapy is practiced by qualified professionals, not volunteers.
posted by so_gracefully at 9:51 PM on July 6, 2010 [5 favorites]

AA works for some people, some times. Its free. It has no leaders, spokespeople, or anyone making money off of it. Countless thousands, possibly millions, over the years lead a better life because of it. Doesnt work for lots of folks.

You ever watch a show about something that you actually know something about and come to realize how much of the media is sensationalized self serviing bullshit? See Penn & Teller. Fun magic act, entertaining guys though,,,

In some sense, AA is a reasonably functional anarchy, which is werid, because functional anarchy is sort of self cancelling in my observation. Though not an AA member, I happen to have known many hundreds who are clearly the better for having experienced. I suppose there are some who are the worse for AA, but the scale would seem to be massiviely tipped towards AA. The people who dont like it seem to fall into one of the following camps: dont understand it, dont like it because it involves some conception of god, dont like it because it is free and not run by professionalys, or it didnt work for them or someone they knew...
posted by jcworth at 10:02 PM on July 6, 2010

I was just talking about AA today, oddly enough, as it is a topic near and dear to my heart that I had not considered for quite some time. I (ANECDOTE HERE!) was a severe drug and alcohol addict. I smoked base and rock cocaine for the better part of 10 years, and drank heavily for the better part of 14 years. I tried AA and NA. I tried them a LOT and I tried hard at them, and in the end it did damn near as much damage as my substance habits did.

For me, and for a huge group of others around the world, the steadfast dogma of AA/NA was an absolute nightmare. After so many years of hearing that it was, basically, "the only way to avoid jails or death" from nearly everyone I talked to about my problems, I believed it. And, when it did not work--time and time again--I figured that jail or death was the only other option. Thankfully, I eventually dug a little deeper and found and connected with people who were interested in helping me clean up for more than the sake of their own "sobriety," and I got myself better. I got myself better. No program "worked," because it was something I had to do. Sure, people helped me plenty, but no one other than me did it.

I feel like an important thing that is often overlooked in these discussions is that AA/NA/12 Step Stuff actually ends up hurting a good amount of the people that try it. Sure, there is anecdotal--and some empirical--evidence that it works. But, there is also plenty of evidence (both anecdotal and empirical) that it hurts too many people for me to feel comfortable with AA's status in the world. Of course, some groups operate differently than others (that is a problem in itself, to me, because it allows for a "wellll, that wasn't US..." defense from the organization as a whole), so I am not about to say that genuine abuse happens in all the rooms, but it does happen in some. I know (ANECDOTE!) a lot of men and women who were abused physically, sexually and emotionally by people in their AA groups. It happens.

And, of course, I have people close to me who went through AA or NA and eventually found a solution to their substance issues. But, I must say, often times that solution is found at the expense of every relationship they have outside of the rooms. Hell, I lost my fiance from what I later realized was basically a huge AA clusterfuck of manipulative and uncaring personalities. She herself came out of the program after 2 years of emotional torment and left it behind (while giving it the proverbial finger) and remains happily "sober."

And, since we are doing a good amount of anecdote sharing here, let me say this: I know more now-recovered addicts than I can count. Nearly everyone in my family and life has had a serious issue with addiction (I mean serious, too) and most of them are now doing well. A few of them attended AA or NA regularly until they found success, or still do attend. A few... the rest? The majority? Those people found their help outside of the rooms of AA.

I guess that for me, the bottom line is that I feel like AA is just too entrenched as a method of recovery. Nearly all of the vocabulary surrounding addiction is straight from the AA idea of substance abuse. I do not even use the term "sober" to describe the people I know who do not drink or use drugs, because the word is so AA branded. I have issues with what I feel is AA's over-medicalization of drug and alcohol abuse. And I have issues with the programs insistence on labeling addiction medically and trying to treat it "spiritually." These things do not sit well with me, and it is frustrating to see how society accepts them as fact. It frustrates me that within AA, all credit for my improvements went to the group, while all blame for my failings went to me (where else is the patient blamed when the medicine does not work?). It frustrates me that most people who have no experience with addiction or AA will guess that AA has some incredibly high success rate. And, it frustrates me that there are so many out there who will ask me if I am a "friend of Bill" when I tell them that I was a severely addicted cocaine smoker a few years back and that I got my act together and now I am all better.

So, should AA be outlawed? No, I do not think so (not that that is the question at hand, it just seems to be the one we have been dancing around). I am completely fine with AA existing. I just wish that the adherents were honest enough about certain aspects of the situation that they could allow for a little more realistic public knowledge. I also wish that people in the drug courts would not be sent to AA (and, someone earlier in here said that they assumed that if someone told a drug court judge they were an atheist and could not attend AA, the judge would give them another option; when that happens, the other option is usually jail. Most judges have no interest in crediting defendants with time in non-AA systems).

There is a boatload of information out there for every conceivable side of this argument. The input is endless. Both sides are fraught with emotion and anecdote. Both sides have their heroes and their enemies. And, unfortunately, all too often both sides seem to forget that what is ultimately at stake is the future of people who need help. I think that any honest assessment made from inside or outside the rooms of AA will ultimately land on the fact that AA represents an aging model devoid of medical or psychological value, and that as such it should not be regarded as the panacea that it currently is.

Here are some links, covering my side of this thing:

Orange (a very thorough "anti AA" site. Loathed by adherents, but often the first stop for people on their way out of AA)

Steven Hassan's site, a good and even handed look at AA.

Stanton Peele's site, critical of AA but mostly well thought out.

Secular Organization for Sobriety, an organization with the same goals as AA, but with a more secular approach.

And, for the record, I found the article posted by netbros to very interesting. I always enjoy reading any articles or literature that are insightful and well written when it comes to the science of addiction and recovery.
posted by broadway bill at 10:03 PM on July 6, 2010 [16 favorites]

@liza

I fear you are misunderstanding me. I would not suggest the effects of a condition such as celiac disease are learned behaviors, I would however note that eating foods which exacerbate it's expression is a learned behavior. You can learn not to eat these once discovering the deleterious effects on your health.

"changing your life around to avoid things like wheat, eggs and cow milk can be as difficult as trying to stop drinking"

Changing any behavior has the potential to be very difficult. Especially learning to avoid something that you have engaged in your whole life and is commonly engaged in by your peers. Especially something which is not in the least harmful to most.

That said, you will almost certainly succeed in mostly (if not entirely) avoiding things which trigger your health problems. But if there were an establishment completely unpalatable to you shouting "we're the only way to stop eating this and that and anyone who does not use our technique is in horrible peril and will die from their disease" and if this were the prevailing societal attitude your outlook for yourself would likely be rather bleak and I would consider your challenge greater than it would be in a different society.

What we should be able to learn from drug addiction -- how to stop doing deeply entrenched behaviors which are deleterious to our health -- is obscured and less attainable because of an unscientific one-size fits all cargo-cult constructed around one man's experience and reinforced by the visible minority of AA participants who are successful.

AA has many successes, and there's a lot we can learn from them, but AA must not be the end of our developments in behavior changing techniques. We must not blindly follow a recipe. We can do better, but only if we learn from it's strengths and move forward with evidence based treatments.

To anyone who has ceased a harmful or otherwise undesirable behavior: I am so glad you succeeded with whatever methodology or un-methadology or combination you found! But please realize one size does not fit all and if you make it all or nothing you may be imperiling everyone for whom your methodology does not work.

To anyone who has a harmful/undesirable behavior and a wish to change: you're halfway there. Seek help early and often if you find you can't quit on your own. A fresh set of eyes (or a whole ton of fresh eyes) can give you the insight and guidance you need to change yourself into the person you want to be. Most importantly remember: your investment in changing yourself is key, whichever approach(es) to change you take.
posted by Matt Oneiros at 10:23 PM on July 6, 2010

MeFi AA threads are always epic. And I love when Wired crowdsources my cortex.

I've known persons who have tried/failed/succeeded/ran screaming from AA. I get the idea that a bunch of people bound in a very loose grouping sprinkled with God language sounds hinky, and there are probably some bad meetings out there.

And it appears to be true that AA is good for whom it works for, and the rest are left to fend for themselves. But how else could it be? Should AA abandon what works for the large number of people who feel better in the hopes of grabbing a larger number? Should Planet Fitness be more aggressive in reaching the people they fail to make feel better about themselves? How about WeightWatchers?

I've seen a lot of cold-turkey cases that never became happier, just less hungover. And while there are gullible types in AA there are plenty of other types too, including atheists and fulltime skeptics for whom it must be proven effective every day or else.

AAs that seem to be happy campers aren't in it to quit drinking per se, they are in it for a personal transformation and fellow travellers. Booze is a symptom and catalyst but not the sole cause of their misery. So yeah AA is tailor made for them. For folks like Broadway Bill above, there are too many changes to make, or for other reasons, AA fails for them. Personally the folks that I know are not opiate addicts, so I have no feel for NA. From what I've seen folks do it or don't, not sure what harm can be done by trying but there may be pitfalls. I guess I could do some reading about those Bdway.

For a person who feels very well adjusted to the world but wishes he/she drank less, that person can probably find a drug soon that will fix that for them, like a headache from too much reading. When that comes along there will be plenty of real life cases in the meetings and those who swear by it will say so, those who found it inadequate will say so too, leaving the individual to choose. Much like other therapies are endlessly debated by AAs pro and con.

What the state/medical professions choose to do with alcoholics is another matter. Would I want state funded rehabs and hospitals to offer 12 step programs with no science behind it? No. Do I want society to stop looking for better ways and settle for a God centered program? No. Like Matt is saying, society can't settle for AA. But I don't think AA should stop being AA.
posted by drowsy at 10:32 PM on July 6, 2010 [2 favorites]

Quit without AA.

For as ubiquitous as they are, you'd think they would try to stay fresh instead of relying on a tradition made once.
posted by thoughtslut at 10:32 PM on July 6, 2010

AA represents an aging model devoid of medical or psychological value, and that as such it should not be regarded as the panacea that it currently is.

Not to cherry pick but you sort of undermine your comment with that statement. The one thing A.A. is guilty of is it's seeming inability to change and adapt with time. Even then, an A.A. meeting in rural Minnesota is a far different beast than an A.A. meeting at St. Marks in Greenwich Village. Both teach the same basic tenets but urban A.A. meetings seem far more open to gays, blacks, atheists, etc,. As a reflection of society at large, I think, from a psychological standpoint, A.A. adapts and serves it's members rather well.

Medically, I agree. Having worked in A.A. based non-medical detox settings, I have come to the conclusion that coming off alcohol by drinking honey-infused orange juice is barbaric at best.
posted by KevinSkomsvold at 11:02 PM on July 6, 2010

thoughtslut: "Quit without AA."

The medical world eagerly awaits your stunning findings.
posted by KevinSkomsvold at 11:04 PM on July 6, 2010 [1 favorite]

"changing your life around to avoid things like wheat, eggs and cow milk can be as difficult as trying to stop drinking"

*snort* As a woman with celiac disease, and mother to a child with multiple food allergies and intolerances, I would say that while our lives can be a little more challenging around mealtime, actually comparing our minor but annoying issues to the life-or-death struggles of an alcoholic to keep away from the booze is needlessly drama-rama. If I fall off the no-gluten wagon and eat a slice of pizza, I get a stomachache and a few days of fuzzy-headedness for my troubles, with maybe a touch of cystic acne. If a hardcore alcoholic falls off the wagon and goes on a bender, he may well end up dead, or may kill someone else if he's behind the wheel. Slight difference there.
posted by Asparagirl at 11:19 PM on July 6, 2010 [5 favorites]

The medical world eagerly awaits your stunning findings.

I don't understand- are you saying there's no other way but AA?
posted by Pope Guilty at 1:22 AM on July 7, 2010

Pope Guilty: You know there's plenty of people who were addicted and no longer are, right?

PG, I'm a little confused. Do you believe there are programs/organizations that can "cure" an alcoholic and teach him or her to drink like a normal person?
posted by belvidere at 3:15 AM on July 7, 2010

I don't understand- are you saying there's no other way but AA?

No. I'm saying "present an alternative." But then you already knew that, didn't you?
posted by KevinSkomsvold at 6:16 AM on July 7, 2010

Well, to pop back in and look a little less like a moron, I said:

It's not anecdotal, its my very real life and experience

...which should have said:

It's not a statistic, its my very real life and experience

I should lay off the...never mind.
posted by disclaimer at 7:14 AM on July 7, 2010

There are at least two potentially harmful things about AA:

1) The abstinence-only message may increase binge drinking and alcoholism itself in many people. There is some evidence that this is true, if I recall correctly. Other messages like the dry-drunk thing and the way you have to make amends or find God or whatever may also be harmful.

2) It may prevent people from finding more helpful (statistically or for them) treatment modalities.

All the studies and metastudies seem to indicate that AA is not more helpful than traditional psychology, non-AA support groups, or even going it alone.

If it worked for your or your loved one, great. Just realize that maybe it wasn't the only thing that could have helped you or them.

As for all the homeopathy stuff, Jesus Christ. We wasted thousands of years with non-empirical bullshit. It's just water, people.
posted by callmejay at 7:31 AM on July 7, 2010

And to further clarify things and provide more anecdotal data, I would also like to point out that while I got sober in AA, and I believe it taught me some very valuable life lessons, I haven't attended meetings or been around the rooms in around 5 years, and I don't see the need to return (but if I ever feel the need, I know where they are).

There's a dogma within AA that says "if you don't stay around the meetings, you'll drink again" and that's crap. The truth of it is that an AA member that wants to drink again will stop going to meetings to ease their guilt and this has metastasized into the belief that avoiding meetings = gonna drink again.

My point is that I'm not a dogmatic member and that yeah, it's very possible to stay sober without AA, but for me, it was impossible to quit without it.

Also, on some of PG's points:
- The only amount of money I ever contributed to a meeting was a dollar a meeting, and once I contributed to the purchase of some emergency coffee.
- I never felt any pressure to embrace a religious higher power, in fact I was and am an atheist. The only "higher power" I ever accepted was the belief that I'm not one.
- At the AA meetings I ran, I'd sit outside the meeting at a picnic table and ask the "sheet signers" for their attendance sheets. I'd sign them and send them on their way, unless they truly wanted to attend the meeting. Court-sentenced AA is a very bad idea for the meeting and for the attendee. "Running" an AA meeting usually involves setting up chairs and making coffee. There's not a lot of leading going on.
posted by disclaimer at 7:35 AM on July 7, 2010 [1 favorite]

Works for me. Doesn't work for everyone. I cannot count the times another member will acknowledge to a newcomer that AA doesn't work for everyone, but it works for them. I can't remember the exact phrase, but there is something in the literature about "we are not the only way" to recover. People who say otherwise are just giving their opinion.

Last weekend I went to the every-5-years international conference. People came from Iran, Afghanistan, Haiti, and every continent but Antarctica. People who love the program REALLY love it and are willing to travel great distances just to be with 65,000 other drunks for a weekend. Not bad for a washed-up, unscientific, dated program.

Just to reinforce some salient points:

We are financially self-supporting and accept no dues or fees; all contributions are voluntary and go toward maintaining the service structure (books, coffee, and the work of the head office in NYC);
Our leaders do not govern, they are "trusted servants";
We have no opinion on outside issues, & affiliate with no religious or political groups;
The program is not religious, but spiritual. Members are encouraged to form their own definition of what this means for them. Athiests and agnostics are welcome;

Many members resent court-ordered attendance. The program works for people if they want to take part, and are willing to do the footwork (ie: all 12 steps, in order, with the help of a sponsor). The court-ordereds are welcomed, but mostly left alone because it's obvious they want no part of it.

There are people who view themselves as all-knowing, dogmatic leaders. They tell their sponsees really dangerous bullshit. We're dealing with alcoholics, and there are ones that act just as nuts sober as when drinking. In my experience, they are the exception that proves the rule. Most AAs I know are sane, reasonable people with an amazing capacity to show up for total strangers asking for help. If you want help from AA, it's free for the taking. If you decide it's not for you, you're free to go.
posted by wowbobwow at 7:45 AM on July 7, 2010 [3 favorites]

See, this is part of why AA is so corrosive- the "addiction can't be cured" meme's popularity in our culture is in large part due to the fact that it's AA dogma and AA has been very vocal in spreading it. Meanwhile, in reality, people get cured of addictions all the time, whether to hard drugs, alcohol, nicotine, or even caffeine. But we have a large and influential group in the addiction treatment community- and a group, no less, which has no science underlying its methods and which is based on a set of religious practices- and they have far more influence than any of the rehab clinics or detox centers that productively get people off far more addictive drugs and whose treatment regimens are based on science and modern medicine. It's baffling that people don't see a problem with that.

Nothing works 100% of the time. Every AA group is different. Some are religious, some aren't. All they say is to submit to a higher power. That higher power can be anything, including the "power" that is in the addict's brain that causes them to drink uncontrollably.

I'm all for science and using the scientific process to improve life, but some things work in spite of a lack of scientific evidence. We don't need to know how magnetism or gravity works to be able to rely upon it.

Maybe addiction can be cured and people can go from being alcoholics to casual drinkers. But for the people that AA works for and is designed for, they need some absolutes in their lives beyond drinking. When you are addicted to something, you need something to cling to besides the addiction, and small steps to take to be able to return to a functional life. It is a place to go when someone has nowhere else to go.

I've seen AA work for people who try the program and fail. But the idea is out there that people can give up drinking and be happy. That's helpful, even if the group or the steps aren't.

AA, when practiced as intended, CANNOT harm people. It can only do nothing, or help. They (aren't supposed to) take money from people who don't want to give, you can leave whenever you want, you aren't encouraged to take pills/vitamins/snakebites or anything. I'm pretty sure they don't discount or unincourage people from seeking other treatments. I'm pretty sure if someone walked into a meeting and started having the DTs, they would call an ambulance or drag to poor SOB to the hospital.

I've seen it work. We have all probably seen it work. Maybe it doesn't work any better than going to a daily or weekly meeting about Pokemon cards. But if that is what it takes to help some people and harmlessly not help others, go for it.

This thread is an example why atheists and skeptics annoy me. Don't believe all you want- I don't. But don't shit on someone else's parade if they do.
posted by gjc at 7:47 AM on July 7, 2010 [5 favorites]

This thread is an example why atheists and skeptics annoy me.

Quite a conflation, here!
posted by muddgirl at 7:55 AM on July 7, 2010

Tell you what, next time you run across someone in AA, suggest that AA might not be the only effective treatment option. Be interested to know what you hear.

You have your opportunity right now. I would say: "AA is the only thing that I personally have had work for me. I tried a lot of things to stop drinking and none of them worked until I tried AA. Since AA worked (and it worked very VERY well in many areas of my life that I did not think I was even addressing) I stopped trying other things. If you are a suffering alcoholic and you have found something that eases your suffering without harming yourself or others I am genuinely happy for you. If you are a suffering alcoholic who is still searching for something that may ease your suffering come along with me and I will show you what I did and maybe it can help you. If you do not want my solution or find that my solution does not work for you I urge you not to give up - please keep looking for something that does work, there are lots of option out there. I wish that I could tell you more about them but the ones I tried didn't work for me and I didn't bother trying the rest."
posted by Bango Skank at 7:58 AM on July 7, 2010 [6 favorites]

Don't believe all you want- I don't. But don't shit on someone else's parade if they do.

and I don't think I can favorite this comment hard enough.

As someone who does believe in an idea I refer to as "God" but does not buy into organized religion and especially does not buy into fundamentalist-evangelical-Christian bullshit the ire that spills over from one to the other sometimes really turns me off Metafilter.
posted by Bango Skank at 8:05 AM on July 7, 2010

Don't believe all you want- I don't. But don't shit on someone else's parade if they do.
and I don't think I can favorite this comment hard enough.

Yeah. Particularly when most of the claims that are getting made in STRENUOUS opposition to AA are equally tenuous. The persons with the most credibility in this thread are ones who seem to have had more than just an intellectual experience of AA.

Put another way, this thread reminds me that I like my movie critics to have actually seen the movie. It seems to produce higher quality criticism.
posted by artlung at 8:41 AM on July 7, 2010 [7 favorites]

The persons with the most credibility in this thread are ones who seem to have had more than just an intellectual experience of AA.

Yeah, and the people with the most credibility to comment on whether health supplements are good are health supplement salesmen, and the people with the most credibility on whether acupuncture works are acupuncturists, and so on and so on as we elevate anecdotes and emotional attachment to the subject matter above empirical assessment and rational critique.

Metafilter prefers lies when they're prettier, so I'm done.
posted by Pope Guilty at 10:50 AM on July 7, 2010

The hard part about quitting any kind of substance is getting away from the social circle of people that you do substances with. I think AA is probably good for that for a lot of people. Just having a circle of people that you can spend time with that don't drink, and who more or less are always available when you need htem.
posted by empath at 11:08 AM on July 7, 2010

"Yeah, and the people with the most credibility to comment on whether health supplements are good are health supplement salesmen, and the people with the most credibility on whether acupuncture works are acupuncturists, and so on and so on as we elevate anecdotes and emotional attachment to the subject matter above empirical assessment and rational critique."

There are several people in this thread who attended or were close to AA and ended up with critical and ambivalent opinions of AA.

You say those people are comparable to health supplement salespeople. I don't know any such salespersons whose sales technique is "this didn't work for me, and I think it ended up detrimental for some, but maybe it will work, please buy and buy often!"

The whole line of of AA to various psuedoscientific healing movements is one you keep harping on, and several people have indicated where that metaphor falls over. It seems like that gambit fails to convince. What might be valid criticisms: the possible downsides of expecting people to claim powerlessness, the fact that meetings are so variable in quality and dependent on highly fallible human beings, the unstructured nature of 12-step groups, these are interesting topics to discuss.

There are plenty of things that are only pseudoscientific. Hell, fiscal policy with regards to economic theory is pseudoscientific. There are learned people in that field that STILL disagree about what got us out of the great depression. That we can't have certainty about the conclusions we can draw from empirical assessment and rational critique, which I assure you, is being done, based on the OP's article, well, sometimes we don't have certainty.

But then, you say I'm just believing pretty lies, so it's possible I'm just wrong.
posted by artlung at 11:51 AM on July 7, 2010 [2 favorites]

Because I think several people have alluded to it - the actual quote from the AA book regarding other forms of treatment is as follows (in the chapter "Working With Others" which is about - among other things - how we should conduct ourselves with people who are new to the program):

"You will be most successful with alcoholics if you do not exhibit any passion for crusade or reform. Never talk down to an alcoholic from any moral or spiritual hilltop; simply lay out the kit of spiritual tools for his inspection. Show him how they worked with you. Offer him friendship and fellowship. Tell him that if he wants to get well you will do anything to help...

...If he is sincerely interested and wants to see you again, ask him to read this book in the interval. After doing that, he must decide for himself whether he wants to go on. He should not be pushed or prodded by you, his wife, or his friends. If he is to find God*, the desire must come from within.

If he thinks he can do the job in some other way, or prefers some other spiritual approach, encourage him to follow his own conscience. We have no monopoly on God; we merely have an approach that worked with us. But point out that we alcoholics have much in common and that you would like, in any case, to be friendly. Let it go at that." (emphasis mine)

Other than that, I thoroughly agree with everything wowbobwow said.

*Before people get upset about the use of the word "God", it should be pointed out that early on in the book it states:

"When, therefore, we speak to you of God, we mean your own conception of God. This applies, too, to other spritual expressions you may find in this book."
posted by triggerfinger at 11:51 AM on July 7, 2010 [4 favorites]

"The whole line of comparing of AA to..."
posted by artlung at 11:52 AM on July 7, 2010

And folks, you can say that AA doesn't require people to go, that it's the state, but that's pretty much like Ron Paul saying he's not responsible for the pork his district gets because he votes against it every year after inserting it into the bill knowing full well it'll pass. If AA wasn't okay with it- and they've had decades to notice that not everybody showing up to meetings is doing so of their own volition- they could certainly say something. Instead they remain silent, complicit in the coercion.

Have you ever seen a court card? You could fill it out at your house without ever going to a single meeting. I can say that AA doesn't require people to go, because it doesn't. I think what you fail to understand is that not only does AA not have any opinion on "outside issues," but that "the only requirement" to attend a meeting is "a desire to stop drinking." This low bar for attendance, you confuse with complicity involving ulterior motives, which in turn you (right or wrongly) seem to attribute to all forms of organized human activity.

I think what you would like to see are "the leaders" of AA awake from their "complicity" in regards to court-mandated attendance so that at the very least they can dispel your insinuation that they are an evil cult. Or an inappropriate marriage of state and religion, perhaps. When, in order to take such action, they would first have to turn into the evil cult you purport them to be.

I could illustrate this point further by pointing to the AA tradition of "anonymity on the level of press, radio and film." When Roger Ebert came out and discussed his membership in the program, a relatively "clear" violation of the 11th tradition, there was no retribution handed down by anyone, no position taken to the contrary by any purported leader, no clarification issued by any type of office. The position that there is no position, by the way, is something I am extremely comfortable with, and is something I think makes AA special and distinct from forms of "organized religion" that I've had the pleasure of being a member of.
posted by phaedon at 12:24 PM on July 7, 2010 [2 favorites]

Heh. I think the same thing about therapy in general, Pope Guilty.

And man, when I hit bottom, I would have given anything I had left to not be an alcoholic. I would have given more to not go to AA. I knew I was a mess: the last thing I wanted was to hang out with people like me without booze to make it more tolerable.

Drunks, recovering or no, tend to lie, exaggerate, preach, inflate and justify their own bad behaviour. Wander into a group of them and you quickly understand that you're not in a hot bed of mental health.

It was a case of life or death for me. I am an example, good or bad, of someone who needed whatever it is that AA has on offer. If I had been able to get sober some other way, I would have. (I certainly have never told anyone mine was the best way or only way to get sober themselves).

Snake oil? Sign me up for 50 cases. Rose tinted glasses? Put them on me. And show me the cult secret handshake while you're there, cause I'm a lot better off with AA than without.
posted by katiecat at 12:27 PM on July 7, 2010 [3 favorites]

Metafilter prefers lies when they're prettier, so I'm done.

Which brings up a philosophical question I've often considered: is it wrong to believe something that is not true if a) it helps you a lot and b) doesn't hurt anyone? I think a lot of things we believe--or rather I believe--fall exactly into this category.
posted by MarshallPoe at 12:42 PM on July 7, 2010 [2 favorites]

"as we elevate anecdotes and emotional attachment to the subject matter above empirical assessment and rational critique."

I don't think you are arguing in good faith here PG, and trust me, quackery like chiropractors make my head asplode too, and charlatans need to be exposed, but where in the thread have you offered anything but anecdotal evidence or your own personal bias? Can you show me any evidence that other "scientific" treatments show better results than AA? And to be clear, I don't care about AA either way. The only person I ever knew who attended meetings it didn't work for (it was heroin dependency rather than alcohol), but the multiple treatment centers and psychiatrists didn't do a thing either, and they cost, I'm guessing, hundreds of thousands of dollars as opposed to a dollar at the end of a meeting when they pass the hat. Do you think Dr. Drew has the answers? Is there some secret therapy that cures addiction we have never heard of that is being suppressed by AA? Can you give me anything but empty rhetoric to back up your claims?

from what I have read, all treatment modalities including AA have about a 5% success rate. That is pretty pitiful any way you look at it. So does it make sense to use tax money to build more treatment centers? I mean, south america and the golden triangle still pump their poison into america at astonishing rates, so it's not like we are going to run out of addicts anytime soon. So can you offer any type of solution? What is your plan? My friend is dead despite trying all possible avenues to get well. What would you have done differently?

(and to the aa members who commented above - great comments, thanks for sharing)
posted by puny human at 1:16 PM on July 7, 2010 [1 favorite]

AA evangelism drowns out any other potential approaches because of the ongoing insistence that they and only they have The Truth, which is why the religious comparisons arise.

It's funny how AA is being attacked in this thread for being both totally anecdotal and yet overly prevalent. For me this folds quite neatly into pragmatism, as someone else stated above.

I thought it was interesting you used the phrase "they and only they have The Truth" when the Big Book preaches something quite different:

"We ﬁnally saw that faith in some kind of God was apart of our make-up, just as much as the feeling we have for a friend. Sometimes we had to search fearlessly, but He was there. He was as much a fact as we were. We found the Great Reality deep down within us. In the last analysis it is only there that He may be found. It was so with us." (p. 55, my emphasis)

So it turns out that this evangelical quality you attribute as fundamental to the teachings of AA - come with us, you sinner, only we have the answer - is actually wrong. You have the answer. Which is not to say that some alcoholics, burnt to a crisp, don't have resentments towards others for not attending meetings regularly. But this is like saying, because Catholic priests like to fuck young boys, then fucking young boys is central to Catholicism.

It would be nice if our society could take a few steps back from Twelve Steps and re-evaluate treatment in light of so many new medications, therapies, and discoveries we have made, but like the prefrontal cortex article says, even if the success rate is poor, some folks just get stuck with one approach and one approach alone.

It would also be totally tits to acknowledge that the set of guiding principles known as the 12 steps have given rise to Al-Anon, CA, CMA, NA, GA, DA, OA, CoDA, SLAA, and NicA, to name a few. Funny how this type of treatment that you say requires "re-evaluation" has blossomed exponentially in an era where new medications and therapies are almost completely unregulated and in equal abundance.
posted by phaedon at 1:17 PM on July 7, 2010 [2 favorites]

Lots of god points going every which way in here.

As for this: "So it turns out that this evangelical quality you attribute as fundamental to the teachings of AA - come with us, you sinner, only we have the answer - is actually wrong."

phaedon: I know you were not pointing out something I had written earlier, but I am going to take a stab at it all the same. I would not argue that those evangelical qualities are fundamental to the teachings of AA, but that they are, in fact prevalent (if not fundamental) to the practice of 12 step groups today. Of course, not everyone in AA is going to have that attitude, but my experience tells me that there are very strong undercurrents of that thought stream within modern AA. And, furthermore, a healthy dose of that sort of thinking can be found in several parts of the 12x12, most notably the line that ""Each AA member is to follow the 12 steps to the best of their ability or face jails, institutions or death." I know that that specific quote does not exactly say that AA is the only way, but it sure as shit scares a lot of folks who are not exactly thinking rationally.

The thing I am always surprised by when talking about this stuff with AA adherents is that they are so often unable to handle it when people ask whether or not something as simple as a "re-evaluation" may be in order. I have many times been shocked to find out how resistant some people are to the idea of other options... and anyone who has spent time in a 12 step group knows that there are an endless amount of domineering people in the rooms that are very opposed to any other means of treatment. I can not count how many times I have been called a "dry-drunk" by people who knew nothing about me other than that I had cleaned up my act outside of the AA/12 Step system.

Personally, I have no interest in taking AA away from anyone. However, I would like to see a little more transparency, and a little more attention and credence given to other methods. I would also very much like to see an end to the court mandated stuff, for everyone's sake. I would happily pay more taxes if it meant that suffering and criminal addicts could go through a medical detox, instead of subjecting them to a non-medical treatment, especially considering that their presence so often takes away from the experience of those that are there voluntarily.

As for all of the other 12 Step programs (NA, CA, Al-Anon, SAA, etc...), I have the same issues with them that I have with the granddaddy. The only one that I feel is perhaps more harmful than the rest is Al-Anon. Here is why (ANECDOTE TIME!): I have met countless AA and NA people, and most of them have had some really great qualities, and a real desire to be good, well-adjusted people. I can not say the same for the Al-Anon folks.
posted by broadway bill at 2:09 PM on July 7, 2010

The issue of court-mandated AA attendance keeps coming up, and it's some measure of the failure of the drug war and of treatment programs in general that we pawn off a major "treatment" part of drug enforcement to an entity which has no accountability other than the accountability the person sentenced has him or herself already. I believe pro, neutral, and anti-AA folks in this thread can all rally around the notion that the government is failing on that score.
posted by artlung at 2:52 PM on July 7, 2010 [1 favorite]

BB: AA has always been by and for alcoholics. AA does not claim to work for drug addicts. Some say "A drug is a drug is a drug", implying that one method treats all. My experience is that drug addicts are different than alcoholics, and need a different approach, though not invariably.
The way I understand that quote about jails, institutions and death is that those are the results of drinking, not of leaving the halls of AA.
AA is constantly re-evaluating itself through what we call "taking an inventory" (sorry, whoever was sick of hearing that). We do it at the group level, the area level, the international level, and the personal level. All but the first 165 pages of our main text (we call it The Big Book) have been changed through four editions in an attempt to remain relevant to a changing society. There's a lot I would change about AA, but there is also a lot to keep and to love. I'm sorry it didn't work for you.
A common saying I hear and repeat in AA is, "take what works and leave the rest".
Nothing to fear in Alcoholics Anonymous except living without a drink.
posted by Hobgoblin at 3:17 PM on July 7, 2010 [1 favorite]

This thread turned out alright. I was pretty hot about some of the comments in here last night and had a hard time composing a non-GRAR response so I walked away. One thing I told myself was: "AA is 75 years old and doesn't need me to defend it." That is still true, but I like the way some folks stood up and stated (based on their experience) what AA is and what it is not. And they weren't assholes about it, which I certainly would have been last night.
posted by marxchivist at 6:44 PM on July 7, 2010 [2 favorites]

"BB: AA has always been by and for alcoholics. AA does not claim to work for drug addicts. Some say "A drug is a drug is a drug", implying that one method treats all. My experience is that drug addicts are different than alcoholics, and need a different approach, though not invariably."

While I agree that a different approach is needed for different problems, my personal experience is with both AA and NA. That does not really change any of my points or opinions, and I imagine it does not change any of yours. Just wanted to be clear there.

And most of my issues with both programs come from the 12x12. I have read both the Big Book and the 12x12 a lot, and I find myself a bit sickened by both of them, but the 12x12 is the one that I really am put off by. And, as you likely know, both books are used widely in NA (although I never encountered an NA group where the Big Book was "required reading," it was always suggested, and the 12x12 was mandatory).

Also:

"I believe pro, neutral, and anti-AA folks in this thread can all rally around the notion that the government is failing on that score."

I can definitely agree there, although I will expand the failure to include our view of drug treatment as a society.

I really enjoy this topic, and the discussion going on here. This conversation so often leads to a complete shutdown in communication as all the zealots rush in. There has been an impressively low amount of that here.
posted by broadway bill at 9:06 PM on July 7, 2010 [1 favorite]

hmmm i was told the difference between an alcoholic and an addict was an alcoholic would steal your tv - but an addict would steal your tv and then help you look for it : )

Agreed alanon can be pretty bad as a relapse is almost invisible to the naked eye and the belief that its just an all men are bastards kind of get together. Someone soaking up the adulation while complaining about her terrible husband as he progressed into a wheelchair through his drinking immediately spring to mind.
posted by sgt.serenity at 9:50 AM on July 8, 2010

Damnit. I'm late to the party again. I'm surprised we got here without mention of Rational Recovery, an AA alternative.
posted by mikelieman at 2:31 PM on July 8, 2010

the belief that its just an all men are bastards kind of get together. Someone soaking up the adulation while complaining about her terrible husband as he progressed into a wheelchair through his drinking immediately spring to mind.

You need to check out different meetings. Jeez.
posted by small_ruminant at 12:02 PM on July 9, 2010

I always felt that AlAnon was dealing with a slippery concept very unlike alcoholism, and that AA's model was less suited to it, but that might just be me. My mother divorced one man (my father) because of his drinking after nearly 20 years of strenuous denial and enabling, and promptly married another one. Is that an addiction? Or is it just neurotic, or cultural? Further, I'd say using the model for things like that that you can't give up completely (overeating is another) gets really complicated. Perhaps it works best for some kind of abstinence, where you can just give up the endless struggle to control something by letting go of it, which was what worked for me with alcohol.
posted by Peach at 12:26 AM on July 10, 2010

When I said she married another one, I meant another alcoholic. One-finger typing on an iPad, geeze.
posted by Peach at 12:28 AM on July 10, 2010

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