This post is part of a series of guest posts on GPS by the undergraduate and graduate students in my Science vs. Pseudoscience course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Pseudoscience.” To that end, each student has to prepare a 1,000ish word post on a particular pseudoscience topic, as well as run a booth on-campus to help reach people physically about the topic.
Alcoholics Anonymous: Origins and Effectiveness by Kaitlyn McElroy
Alcoholics Anonymous (AA) is a self-help group, a fellowship of individuals who have drinking problems. Their self-help 12-step recovery method has been deeply ingrained in society as the key method for treating addiction since the program’s inception in 1935. The effectiveness of this program is so widely accepted that courts will mandate that people with alcohol abuse disorders attend AA meetings. Individuals attend group meetings and work to straighten out their lives by following and practicing the 12-steps developed by the founders of the group Bill W. and Dr. Bob. Unfortunately the public’s belief that 12-step programs are the way to cure addiction is founded on shaky science and anecdotal evidence.
The founding principles of AA are religious in nature and derived from the teachings of the Oxford Group of which Bill W. and Dr. Bob were members. The Oxford Group was a Christen sect started by the evangelical minster Frank Buchman in the 1920’s. Their six main tenants remain at the core of the 12-steps that Bill and Dr. Bob later developed. These are:
- The sharing of our sins and temptations with another Christian life given to God, and to use sharing as witness to help others, still unchanged, to recognize and acknowledge their sins.
- Surrender of our life, past, present, and future, into God’s keeping and direction.
- Restitution to all whom we have wronged directly or indirectly.
- Listening to, accepting, relying on God’s Guidance and carrying it out in everything we do or say, great or small.
- Taking a moral inventory.
- 6. Working with others to spread the word.
The 12-steps of AA continue on this religious path, with 7 of the 12 step referencing God or (Him). So, while AA claims to be agnostic, the founding principles of the 12 steps are deeply religious, frequently referring to God and one’s relationship with God as central to recovery. Multiple steps tell you to give yourself over to God in order to be healed. There is no sound scientific medical practice in the 21st century that says you need to give yourself up to God for recovery to work. Yet, regularly, this is what people with substance use disorders are told to do if they want to get better. Recovery based on religious principles and prayer may be important for some, but can leave many uncomfortable and inadequately equipped with tools to remain or become sober. One survey showed that 66% of former AA members disliked the religious aspects, and over half found it to be the least helpful aspect of the program.
According to the AA triennial survey, 76% of their membership has been sober for over a year. Unfortunately, outside research on AA indicates a significantly different picture with success rates only between 5-20%. Keep in mind spontaneous recovery happens in 26.2% of individuals with alcohol abuse disorder. Even with this low success rate, 40% of its members were referred to AA by a health care professional and 12% were court mandated to attend. This begs the question do the courts and health professionals truly understand the recovery model that they are sending people to.
In addition to the religious aspect of the AA there are several other fundamental problems with the 12- steps that run counter to what is established as good therapeutic practice. According to AA their program never fails.
Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves…
This is simply not true. Given the low recovery rate of individuals in AA and overall recovery rates of individuals in different treatment approaches, it is evident that alternative treatment methods are effective even where AA failed. In most of medicine if one treatment method fails you try another. In AA this is not so. If you are unsuccessful in the program you are a failure. People who leave the program or who may voice their reservations are often told that they just may not be ready to stop drinking, or that they just haven’t hit bottom yet. In the program people are often warned that without AA they will inevitably return to self-destructive drinking and ruin what’s left of their lives. So when people leave AA, and a large percentage do, it is with the knowledge that they are a failure and are doomed to a life of alcoholism. This does not seem like the best therapeutic combination.
The next problem of the 12 steps lays in step one in which a person must admit that they are powerless. Yet self-efficacy has been shown through science to lead to improved recovery outcomes. Self-efficacy is a person’s belief in their power/ability to succeed in certain situations. One example would be a person’s belief in their ability to meet the challenge of overcoming addiction.
Instead of relying on the 12-step model of recovery it is time that medical and legal professionals look to scientifically validated models of treatment. Current treatment options for alcohol use disorders range from cognitive behavioral therapy and contingency management to psychopharmacological treatments such as naltrexone. This way people’s chance of success would be better than spontaneous recovery and their sense of self worth may remain intact.