
The Irrationality of Alcoholics Anonymous (2015) - iamjeff
https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/?single_page=true
======
sverige
My name is sverige and I used to be an "alcoholic." I have attended at least
2,500 AA meetings in various places since the early '80s, and probably many
more than that. I was fully indoctrinated in their literature and methods,
having read every book published by AA more than once, and some many, many
times. I am also very familiar with similar and related programs, such as Al-
Anon, Narcotics Anonymous, etc. I have also known people who have been
involved in even more fringe movements, such as Synanon. I have talked to
thousands of people "in recovery" over the years, and I have personally known
dozens who died as a direct result of their addictions.

The article is a pretty good summary of the sad state of alcohol and drug
dependency treatment in the U.S. The prescription is always abstinence, and
almost universally any suggestion that moderate drinking might be possible for
some is met with scorn and anxiety.

My objections to AA have little to do with their mention of God. I am
christian, so obviously that is not a problem for me. I will say that AA
theology is awful, basically implying that salvation comes from sobriety, but
worse is that it actually indoctrinates many with ideas that hinder their
ability to recover from addiction. Regardless of whether or not you believe
the way I do, I hate to see people needlessly suffering from this illness (or
perhaps, this group of related illnesses), yet the conclusion I came to after
25 years of involvement with them is that AA more often than not prolongs
suffering.

I am not saying that naltrexone or any other drug is the magic bullet, but I
am certain that it is well worth investigating alternatives to AA. If you or
anyone you are close to needs help, please take the time to explore all the
options. There is so much snake oil in this area that it can be difficult to
know which way to turn. It is worth the time and effort it takes to find the
right treatment, and if it is successful, it is probably even worth the
inflated cost of said treatment.

~~~
rmac
_The prescription is always abstinence, and almost universally any suggestion
that moderate drinking might be possible for some is met with scorn and
anxiety._

My understanding is abstinence programs are for those that have tried to
moderate and cannot.

To quote AA:

 _Ch. 3 More About Alcoholism... For those who are unable to drink moderately
the question is how to stop altogether.

Ch. 3 More About Alcoholism... We do not like to pronounce any individual as
alcoholic, but you can quickly diagnose yourself, step over to the nearest
barroom and try some controlled drinking. Try to drink and stop abruptly. Try
it more than once. It will not take long for you to decide, if you are honest
with yourself about it. It may be worth a bad case of jitters if you get a
full knowledge of your condition. _

It also seems strange to suggest naltrexone as an alternative to aa.

From living sober:

 _AA. members and many of their physicians have described situations in which
depressed patients have been told by AAs to throw away the pills, only to have
depression return with all its difficulties, sometimes resulting in suicide.
We have heard, too, from schizophrenics, manic depressives, epileptics, and
others requiring medication that well-meaning AA friends often discourage them
from taking prescribed medication. Unfortunately, by following a layman 's
advice, the sufferers find that their conditions can return with all their
previous intensity. On top of that, they feel guilty because they are
convinced that "AA is against pills." It becomes clear that just as it is
wrong to enable or support any alcoholic to become re-addicted to any drug,
it's equally wrong to deprive any alcoholic of medication which can alleviate
or control other disabling physical and/or emotional problems._

I'm having a hard time finding where it's suggested in their literature that
salvation comes from sobriety?

However, I strongly suggest, as do you, for those suffering to seek out help
and consider all options.

~~~
sverige
>My understanding is abstinence programs are for those that have tried to
moderate and cannot.

I hope I did not suggest that abstinence is not the correct answer for _some._
It just isn't the answer for _all,_ which is what is generally taught in AA.
And the quotes from Chapter 3 are not serious, in the sense that if a newcomer
to AA says something like, "Maybe I can drink moderately," the answer is
pretty much always, "How did you end up here then!?" (Frequently, the answer
is, "The judge told me I had to come in order to avoid jail.")

>It also seems strange to suggest naltrexone as an alternative to aa.

Living Sober was written before naltrexone was invented. I have known a number
of folks who were prescribed Valium and similar drugs in the '60s and '70s and
'80s who became addicted to both Valium and alcohol.

Further, the Living Sober quote suggests medication may be appropriate, but
"alcoholism" (or whatever the DSM-5 calls it now) is often the main diagnosis,
with any other diagnoses placed as subordinate to that main diagnosis. The
implication is, "Stop drinking and the rest will go away," which is frankly
bullshit. The Orange Papers (for all its many flaws) has a good section on
this.

>I'm having a hard time finding where it's suggested in their literature that
salvation comes from sobriety?

This is not from the literature, but rather from my observation over many
years. Many times I have heard it suggested that AA is "basically christian"
or "based on christian principles" but the reality is that it is based on what
is properly called "Buchmanism" (for Frank Buchman, the founder of the Oxford
Group). There is a tinge of christianity to it, but it is based on works
(staying sober) rather than on grace.

This is why many moral failings in AA are glossed over with, "Nobody's
perfect! Just stay sober and you'll be OK!" That is an appropriate response to
dealing with a medical issue -- for example, a heart patient may also be a
greedy, corrupt thief. The moral failing does not generally have any bearing
on the treatment of the cardiovascular issues. So why are alcoholics taking
moral inventories and making amends and confessing their shortcomings to
others?

In other words, is it a disease, or is it a moral condition? If it's a moral
condition, then let's not call AA's solution "christian," because it is not.
If it is a disease, then let's treat it like one rather than using the twelve
steps.

~~~
webnrrd2k
> sverige:

> In other words, is it a disease, or is it a moral

> condition? If it's a moral condition, then let's not call

> AA's solution "christian," because it is not. If it is a

> disease, then let's treat it like one rather than using

> the twelve steps

I think that in AA alcoholism itself is considered a disease, with at least
two components: an allergy of the body; and an obsession of the mind. The
disease of alcoholism is considered to have far-reaching effects which are
best dealt with by two things: staying sober and working the 12 steps and
thereby having a spiritual experience.

I'd say it's analogous to someone who's had a heart attack. The immediate
crisis needs to be addressed at an emergency room. Then there are lifestyle
and diet changes that need to happen, too. The heart attack might have been
the initial problem that precipitated the crisis, but the lifestyle issues are
the real cause.

AA is a big organization, and there are certainly different interpretations,
but I think it's fair to say that alcohol is certainly seen as the problem,
but the underlying cause of the problem is seen to be the lack of a spiritual
lifestyle. Hence the two-pronged approach. Very often Christianity is used
because it's what's familiar. But I'd hardly call AA a Christian organization.

------
eveningcoffee
>“Well,” he told me, “it’s 2,000 euros.” That’s about $2,500—a fraction of the
cost of inpatient rehab in the United States, which routinely runs in the tens
of thousands of dollars for a 28-day stay.

>I didn’t mention that some bare-bones facilities charge as much as $40,000 a
month and offer no treatment beyond AA sessions led by minimally qualified
counselors.

~~~
YSFEJ4SWJUVU6
I'd have to guess that even the Finnish model would be vastly more expensive
the US – it seems to be the rule when it comes to health care costs.

After all we also have AA-style treatments, and while I can't comment on their
features, a quick Google-Fu reveals that the cost for month's inpatient rehab
is 6500 €. (It's a fully private enterprise, and not a part of the public
health care.)

------
lemonberry
When I hit bottom a buddy of mine said the worst thing that can happen is that
you become "one of those AA assholes". There's truth there. You'll never kill
a family in your car because you've gone to too many meetings.

That said, I'm an atheist, my buddy is an atheist and here in the northeast
the religious part is really watered down, from what I hear, compared to other
parts of the country.

I go because hearing others stories and talking to others about the being an
alcoholic is really helpful.

I haven't drank in 4 years and AA was a crucial part. But I've never done the
steps ( I can't even call it a higher power, that's lipstick on a pig in my
book ). It's the talking to others that's helpful. People would say things,
especially in the beginning, that articulated things I'd felt but unable to
put into words.

In addition to speaking with other alcoholics I use philosophy, Eastern
thought and stoicism, and the occasional use of lsd and mushrooms to keep me
off the sauce. I never say I'm "sober" because of the latter part, but that
was never my goal. I just needed to quit drinking and I couldn't.

My biggest problem with AA is the religious side. Overall the program seems to
help people face their issues and take responsibility for their actions, but
the toolkit, in my mind, barely gets them above water. But it is better than
drowning. I'd love to see the organization revamp to catch up to the 21st
century. The big book is like reading an anthropology book from the 19th
century. It's sad how some people cling to it.

One feature of AA that I think a number of people fail to remember, though, is
that there are meetings everywhere at many different times. For those that
haven't lost everything you should certainly seek alternatives. But there's a
large population of people that are so messed up they've lost everything and
quite literally wouldn't know how to find help in other places.

Addiction sucks and is one of the most heartbreaking things for me to see. But
not everyone that uses is an addict, whether it's alcohol, marijuana, or even
cocaine.

To anyone wrestling with it: good luck, get help and know there is another
side to your life. The rest of it doesn't have to be spent feeling the way you
do now.

~~~
sharkweek
First, a big congratulations on your four years of being alcohol free. From a
random stranger on the internet, I applaud your success, and wish you the
best. It always puts a smile on my face to hear these types of things.

I've never gone through any programs but have had family who have. On the
religious stuff - my general interpretation has always been that it's less a
confession of faith in a higher power, but more a surrender of control, or in
some senses a selection of values above yourself that you adhere to. From a
bird's eye view, it kind of sounds like you already are doing that, with
philosophy/Eastern thought/stoicism.

~~~
lemonberry
Thanks for the comment. I appreciate it.

------
zafka
There are so many issues with this article, I am not quite sure where to
start. I guess at the beginning. The article starts with a title that is
leading to say the least. Another thing this author does throughout the
article is to insinuate that Alcoholics Anonymous it to blame for the sorry
state of how our health care system (U.S) pays for addiction treatment.

After stating how hard it is too verify statistics for positive results,the
author damns the guess made 50 years ago when Bill Wilson first wrote the
book, and most likely had a far better conversion record as they were then
dealing with highly motivated quitters. It is almost humorous that this author
is complaining about the success rate of this method, when a large number of
the pool of candidates are forced into treatment by either the law or parental
coercion. Now I would like to say mid- rant that I am biased. I stopped
drinking 33 years ago, and while I would not admit to membership in this group
in a public forum, I would suggest people who WANT to quit, to give it a try.

I would be one of the first to say that there are a lot of hokey parts to the
traditions they follow, and I do not agree with a lot of the premises of the
literature---- But that being said........It works! One interesting opinion
about AA comes from Charlie Munger, Warren Buffets business partner. Charlie
writes quite a bit about the psychology of business, and he gives his fairly
well thought out opinion of why AA works so well. I wonder whether the AA
bashing is just for controversy to better sell the article, or if perhaps the
author is helping to market the new version of naltrexone the is being quite
heavily promoted to judges recently.

~~~
dunmalg
>* I do not agree with a lot of the premises of the literature---- But that
being said........It works! *

From the article:

 _" Lance Dodes, a retired psychiatry professor from Harvard Medical School,
looked at Alcoholics Anonymous’s retention rates along with studies on
sobriety and rates of active involvement (attending meetings regularly and
working the program) among AA members. Based on these data, he put AA’s actual
success rate somewhere between 5 and 8 percent."_

According to that, about the best you can say is that "it works when it
works", which isn't saying much. I'm glad it worked for you, but the fact that
for evey one of you there are 10 who go back to drinking doesn't do much to
recommend the program as the legally mandated cure-all it currently is.

~~~
zafka
A quick search on Lance Dodes, shows he has an axe to grind and some books to
sell. Also, remember AA is suggested for people who want to quit. IF you take
100 kids who got caught smoking pot in high school, force them to go to AA
meetings, there is a good chance they will not stop drinking. Don't attack the
method because people misuse it. I really think there are a lot of other
things that do work, and I think the drug naltrexone can be very useful in
helping people quit from what I have read. What pisses me off is when shills
who really don't know what they are doing push a gimmick for profit. One of
the things that is giving AA a bad name are all the fly by night treatment
centers who say they are using 12 step methods, but actually all they are
really doing in collecting insurance and warehousing people for 28 days.

------
wojt_eu
One thing I've heard AA does right is asking attendees to talk about each
their recent drinking acts and what preceded them. This forces some to realize
their patterns and triggers for the first time.

~~~
humanrebar
It also provides opportunities for new relationships that aren't centered
around unhealthy behavior (i.e., not drinking buddies).

~~~
sverige
On the other hand, it provides opportunities for new relationships that are
even more toxic than those the attendees arrived with, since frequently this
group has (or would have, if they were examined by a competent doctor)
multiple diagnoses.

------
Aloha
AA is a wonderful tool to get sober - its enough to pull you back from the
brink and if you're mindful enough reevaluate your life and why you're self
medicating - it may not however be the tool you need to stay sober.

Look at AA as addiction transference - you're transferring your addiction from
Alcohol to AA - and for some, thats the best they can do, for others its the
start of the journey to moderate consumption.

------
burnerOh2125
I lost nearly everything in my life: my job, my apartment, my car, and very
nearly my life from drugs and alcohol. I used for years with few consequences,
but with the help of the dark net markets, got my hands on cheap and power
drugs my body and mind could literally not handle. I came to a point in my
life where I realized I had lost control over my ability to self-regulate
consumption of intoxicating agents, and the consequences were dire.

I underwent a pretty radical change getting sober, moved to a different part
of the city into a semi-supervised sober house, and started going to AA
meetings. What I found there was a diverse group of people, with even more
diverse problems (drugs, alcohol, violence, relationships) that had 1)
accepted the problem was of their own making and 2) collectively decided that
only through their own actions could they make themselves whole again. My AA
group is a little unconventional in that we are extremely accepting of
different types of addictions, and operate in an inner city area much
different than my suburban upbringing. For me, AA is about living a stoic
life, accepting what you can control, and disregarding what you cannot
control. Seeing these same problems, across race, class, gender and geography
was a pretty transcendental moment for me.

AA is just one part of what I'm doing to stay healthy: the other component,
which in a lot of ways I trust more, is cognitive behavioral therapy, and
group therapy. I think eventually more 'evidence based' group therapy systems
will take over, but you just can't beat AA's model: people helping people via
donated time and services.

When a new person walks into 'AA' with just a 'desire to stop drinking' their
entire experience comes from the individuals, qualified only through their
anecdotal experience in sobriety, that they meet. As a data scientist ready to
defend AA, it used to be hard for me to rectify the fact that 1) AA is not
effective as a prescribed intervention and 2) I'm in AA, and it works. How can
I recommend a treatment when I know doing nothing in some cases is often
better? Well, I don't know, and for me, AA is about staying sober, statistics
be darned, I have something that works.

Finally, getting sober, for me, was a long, difficult, and extremely
uncomfortable experience. If you are reading this, questioning if 'AA' is
right for you, I would strongly implore you to attend a few different meetings
in your area. Raise your hand, introduce yourself, and see what comes forth.
AA will not save you, you will save you.

------
chewz
I am more then 6 years sober through AA. Before I have tried a professional
help and it didn't work. My personality is allergic to psychotherapeutics
b..t, I cannot stand someone telling my about my flaws. What has worked for me
in AA? 1) The possibility to go to a meeting when I was starting feeling bad,
lonely, depressed, tense - which previously resulted in getting a drink 2)
Hearing the real stories from real people. I cannot stress how much it worked
on my, how its had changed my perspective.

I am sure AA won't work for everyone but it works for certain types of people.
In my humble opinion it works exactly because it isn't based on hard science
but on personal experience. Actually - "this is how it works" is something you
hear often at meetings.

Now regarding the financial side. 40k$ for bare bone AA meetings is something
very American.

In Poland AA is self-financing, meetings are open and free. If you can afford
you can make a voluntary donation to your group cash-box which is used for
coffee and tea. Like 2-3$. Local community or a church is providing place for
meetings. Everyone is welcome (if he is not under influence). In . city the
size of Warsaw there are meeting going every day and at different hours. So AA
is affordable to anyone and at any time while even public healthcare therapy
will involve some cost or long wait.

------
sizzle
Has anyone tried Naltrexone? I am about to try some after watching the
documentary, "one little pill." by Claudia Christensen. I implore anyone
suffering from alcohol addiction to watch the documentary and consider it as a
treatment that has helped many yet is not widely discussed as it is
unprofitable.

------
jupiter90000
That seemed like an overly long article to the point of having an unclear
evidence to its argument and seeming biased against AA. I'd be more interested
to see a summary of research about what is proven to be effective in treating
the problems than cherry picked study results and anecdotes.

------
apple4ever
I read the Big Book, and went to a couple of meetings. As a logical but also
religious person, what they said made no sense.

First, just "give yourself over to God" means nothing. Sobriety takes work.
One falls into a bad pattern, and you need conscious effort to break that
pattern. I found the SMART program, which uses Cognitive Behavioral Therapy.
That worked for me and made sense for my brain.

Also, my religion (Eastern Orthodox Christianity) teaches that God will throw
a life raft, but you gotta grab it, hold on, and swim to shore yourself.
Again, the same work ethic, not just "turning yourself over".

I really find AA makes it difficult to people to get sober. I'm sure it does
work for some, but I believe it may take longer for them.

------
YSFEJ4SWJUVU6
To be fair, also here in Finland some people swear by the “Minnesota Model”
(as it is called here) form of treatment – which I've come to understand is
very similar to the AA program in the US – almost religiously so, or maybe
indeed, so.

One way or the other, perhaps the saddest form is the most used – a very short
clinic stay coupled with benzodiazepines to help safely stop a prolonged
bender. Nothing wrong with that per se, but it's not really enough... but it's
a free world.

------
ameliaquining
Here's one guy's attempt at an actual literature review on the effectiveness
of AA: [http://slatestarcodex.com/2014/10/26/alcoholics-anonymous-
mu...](http://slatestarcodex.com/2014/10/26/alcoholics-anonymous-much-more-
than-you-wanted-to-know/)

TL;DR: The science around this is terrible so it's hard to know anything with
much certainty, but it looks as though AA isn't much better or worse than
other treatments. Whether it's more effective than no treatment at all is an
open question.

~~~
burnerOh2125
Thank you so much! This is what i've been looking for!

------
abrax3141
I wonder if acamprosate would work for internet addiction?

------
atomical
Does Naltrexone work better than AA meetings?

------
PeachPlum
[https://youtu.be/uYgdoecq-PE](https://youtu.be/uYgdoecq-PE)

Doug Stanhope has some insightful comedy on the subject (nsfw)

------
dogruck
One: A scientist told me that AA's efficacy cannot be proved.

Two: But it worked for my dad.

One: Another scientist told me the earth is doomed.

Two: That's good science. Let's get a drink.

~~~
sverige
Chemistry teaches us that alcohol is a solution.

~~~
carreau
A solvent.

~~~
zafka
A damn fine one too! It dissolves marriages, jobs, businesses and a host of
other things.

~~~
mythrwy
Even the soul is soluble in alcohol.

------
aaron695
> He told me that for years he had drunk to excess, sometimes having as many
> as 20 drinks at a time

Hmmmm that's not a lot when your talking problem drinking as an addiction.
That'd be typical in a frat house.

There's a lot wrong with the article and a lot right. Pick carefully.

There's no reason you can't go to AA and do the Sinclair Method. AA is full of
Atheists the god bit is misleading.

I'm not sure why they are putting down AA when AA is not against the Sinclair
Method. AA has found their way works for some people. It's also cheap
councling. Not everyone can afford well paid doctors.

If your drinking is that bad you need a pill to stop it wouldn't hurt to talk
to others about the problem as well. And AA is a meme/cult/religion that
allows that except they don't go to war and fight others over oil and
resources.

~~~
Freak_NL
>> […] sometimes having as many as 20 drinks at a time

> Hmmmm that's not a lot when your talking problem drinking as an addiction.

Twenty drinks at a time is not a lot? Don't most people draw the line way
before that? In the Netherlands drinking more than three drinks a day is
considered problematic drinking (for men); I wager that this won't differ that
much around the globe.

~~~
DanBC
20 drinks at one sitting is a lot, and it's firmly in the problem and harmful
drinking end of risky alcohol use.

People with alcoholism can drink a lot more than that.

A UK unit of alcohol is 10 ml of pure alcohol. You'd consider inpatient
residential rehab for someone drinking 30 units per day. There are roughly 40
units in a litre of spirits in the UK.

[https://pathways.nice.org.uk/pathways/alcohol-use-
disorders/...](https://pathways.nice.org.uk/pathways/alcohol-use-
disorders/assisted-alcohol-withdrawal#content=view-node%3Anodes-inpatient-or-
residential-programme)

~~~
0xcde4c3db
And just to be clear, it's rare that what people call "a drink" is only one
unit. What someone casually counts as "20 drinks" could easily be 50+ units.

------
R_haterade
I wonder what this article is submarining.

------
canthonytucci
AA is the Linux of therapies. Free, crowd sourced and rough around the edges
but for some people it works well enough to get the job done.

edit: maybe linux is a bit strong, php?

~~~
burnerOh2125
No, I like Linux.

