I’m unsure of the situation in other countries but getting adequate treatment for substance use disorder in the U.S. is terribly difficult (nearly impossible for some) and faith-based 12 step programs such as AA/NA dominate the landscape and effectively replace mental healthcare in many situations. The poor utilize 12-steps because it’s free social support which is great, but for-profits do the same thing (because it’s very cheap to just implement 12 step thinking) and rehab patients are often handed a “big book” (AA/NA’s main text) well before they get a psych evaluation, if they get one at all
In short, substance use disorder is treated as a primary condition here, there’s a massive high-profit industry built around it and specifically treating it using faith-based 12 step methodology so a lot of mentally ill people who use drugs never receive proper treatment
I remember telling my mother in the 90s that my 'substance abuse' was a symptom, not the problem itself. I was self medicating. No one wanted to hear it.
In the time since, it often feels like we've gotten worse at recognizing this. Meanwhile, proper treatment for mental health issues continues to be difficult to find (many if not the majority of so-called professionals are anything but), as well as increasingly expensive and inconvenient. To say nothing of how much of psychiatry has devolved into pinning you to a DSM category and throwing drugs at you in as short of a session as possible-- "come back in 2 months and we'll just as quickly throw some different drugs at you if those aren't working"... rinse and repeat ad infinitum. Anyone struggling to get through each day is not going to be well served by this.
We need at least 10x more therapists willing to spend time with patients and address their many intertwined issues, using logical, rational, evidence based methods. Right now, I don't see how we even start to get there from here.
12 step can be a lifeline for people at the end of their rope who have no other options, but it also inevitably fails anyone who doesn't buy into the narrative about a higher power. [I would argue it fails even those who do, as it teaches powerlessness.] Some may benefit from such an extreme approach, but it is deeply, deeply flawed. The main strength it does have is connecting you with other people and being very accessible. But we can & should do better.
>12 step can be a lifeline for people at the end of their rope who have no other options, but it also inevitably fails anyone who doesn't buy into the narrative about a higher power. [I would argue it fails even those who do, as it teaches powerlessness.] Some may benefit from such an extreme approach, but it is deeply, deeply flawed. The main strength it does have is connecting you with other people and being very accessible. But we can & should do better.
oh indeed. I found myself in the rooms of AA/NA at the age of 19, still very foolish in my youth, confused, pretty desperate. Even in that state I had such a hard time buying into just the first few steps. it all seemed so utterly nonsensical to me and I realized believing in god was a prerequisite I could never meet. for those unfamiliar with the 12 steps of alcoholic anonymous this is how they begin...
1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
Note that I don’t have a dog in this fight as I’m no longer in AA, but I have to nitpick: “a power greater than yourself” can be a pretty big umbrella, especially depending on the meetings you attend.
It doesn’t have to mean “God”, and it certainly doesn’t have to be the Judeo-Christian definition of God. It just has to mean “something other than yourself”. It can be the meetings themselves, the cute dog you saw in the dog park the other day who let you rub his belly, the Flying Spaghetti Monster, or whatever.
The idea behind it is that, if your best thinking brought you to rock bottom, and you’ve tried everything you could think of to stop drinking without success, then maybe it’s time to let something else take the wheel.
Again, let me stress that I don’t have an opinion on this one way or the other, I am simply correcting the record here. It wasn’t for me, and I certainly don’t think AA/NA has a monopoly on sobriety. But I had 5 good years of being clean and sober before going back out, and when I finally did start drinking again, it was in a MUCH healthier way. It also helped a lot of good friends, and I’m grateful for that.
While this is in theory true, and as much as the literature of AA attempts to separate itself from Christianity or any other religion, the reality is that the 12 steps of Alcoholics Anonymous were derived from the 4 steps of the Oxford Group- an Evangelical Christian organization. The word god is constantly thrown around in meetings and throughout the literature and, make no mistake, that is a Christian god they are talking about. Christian prayers are fairly common in meetings as well, especially the Lord’s Prayer- and 12-step meetings are typically held in churches.
> the 12 steps of Alcoholics Anonymous were derived from the 4 steps of the Oxford Group
This is true. It's also true that AA broke off from the Oxford Group ("kicked out", according to Lois W, the wife of founder Bill W) for being too agnostic. Apparently it was pretty dramatic- see "AA Started In Riots" by Roger C. for more. [1]
> The word god is constantly thrown around in meetings and throughout the literature and, make no mistake, that is a Christian god they are talking about.
The meetings I went to were quite secular. I'm vehemently agnostic, and I never once felt like the people there were proselytizing to me. If they had, I would have left real quickly and not gone back.
Most of the meetings I went to were in SF, LA, NYC, Shanghai, etc.), making it easier to find secular meetings that were run by people like me. Someone living in small-town America might have a different experience from mine. Hopefully with the advent of Zoom meetings, this is now less of an issue, but I can’t say since I left AA before Zoom became a thing.
Each meeting is meant to be independent from the others, and each has its own bent. You'll find meetings for Christians but also meetings for atheists, just like you'll find mens' meetings, womens' meetings, young peoples' meetings, etc.
> 12-step meetings are typically held in churches.
I've been to meetings in church basements and Sunday school rooms, but I've also been to meetings at American Legion halls, recreation fields, City Halls, even the basement of a donut shop.
Consider the cost of running a meeting. Literally their only revenue source is donations from attendees. Giving a donation might be hard for someone who has just hit rock bottom, and it can be expensive to rent a room for use as an Alano Club. Churches might be more likely to cut AA groups a break on the rent.
I don't want to be accused of promotion by either HN or AA, so I won't link to them, but secular AA meetings are plentiful and pretty easy to Google. Secularism is part of AA’s "12 Traditions", as well. [2]
All that said, if AA still feels too religious for someone, there are other groups out there which don’t make use of the “higher power” concept in any capacity. Again, I maintain that AA doesn’t have a monopoly on sobriety.
My background is I used to run a national harm reduction org and I’ve also spent countless nights and mornings in AA and NA meetings in cities and towns throughout the country- places like Baltimore, Miami/Dade County, Tucson, Santa Ana, Denver/Boulder, Newport Beach and nearby suburbs of all these places
That’s great you were able to access secular meetings in SF/LA/NYC, but the reality for most Americans is that those meetings you attended might as well not exist, they are elusive, infrequent, and make up a tiny percentage of the total meetings online or otherwise
Having said all that. and while we are nitpicking- it’s probably worth mentioning that “secular” meetings still have 12 steps and still involve handing your will and life over to a higher power of some more palatable flavor (such as “the program”)- so definitionally we are still talking about faith-based treatment. This will never work out well for atheists and that’s the point me and others are making.
This is blatantly false. It’s stated very plainly in the traditions spoken every meeting that the 12-based programs don’t align with any sect denomination or religion.
The programs are faith based and widely supported by medical professionals. Plenty of folks have problems with anything being faith based, but unfortunately there aren’t better alternatives for alcoholics and addicts.
This is offensive and a blatant violation of the HN rules.
12-step programs are definitively unrelated to any religion and well respected by the professional medical community. Various religious institutions around the world host the meetings altruistically, and it has no influence on the fundamental content and purpose of the 12-step programs.
God is mentioned in 4 of the AA 12 steps, as an example. Spirituality/Him or a "higher power" referenced in 7 of them.
Don't get me started on the others.
It may be respected by the US medical community (and we know how uncommercial and trust worthy that is!) elsewhere we go by science backed systems that aren't just relapse setups.
The US health care system has some of the worst statistics in developed nations for prescription addiction, post natal death, infant mortality, death during pregnancy and lots more. Forgive me for thinking you are infact, willfully ignorant. That's my opinion and I can hold it.
The psudo-psychology nonsense these schemes peddle is nothing short of 1800s "you've got ghosts in your blood" nonsense.
Your mention of the dismal US healthcare system is ad hominem and irrelevant.
12-step programs are empirically superior to any alternative; established by comprehensive literature review [1]. Your “science-backed” implication is utterly false.
12-step literature repeatedly, to exhaustion, emphasizes that the spiritual nature of the program is as the person understands it.
>12-step programs are empirically superior to any alternative
...
You'll want to reread your study there. For most of the criteria they measured, the conclusion was that AA performed as well as other interventions. Not better. It certainly doesn't establish AA as the superior treatment. The author's conclusion seems to be that it might be about as good and it's free.
Ah, now I can reply. It wasn't letting me for a while there. Probably because you repeatedly edited your comment.
The study you linked says that for a certain measure, it works better according to a grand total of two studies they looked at. For the rest, the conclusion was that AA performed as well as other interventions. It's also a review study, which can sometimes be helpful, but often cannot draw clear conclusions due to the studies being reviewed not necessarily measuring the same parameters. They also rejected about half the papers they found due to apparent bias.
It's certainly not the kind of paper that establishes something as settled science and even at that, it doesn't say what you claim it does.
The deeper a comment is the longer you have to wait to reply. I’ll improve your day by telling you that you can always click on a comment’s time stamp to reply immediately :)
The purpose of my comment was refuting that 12-step programs aren’t science-backed, which is blatantly false. As you’ve stated, the entirety of literature on the subject shows that it’s at least as good.
> 12-step literature repeatedly, to exhaustion, emphasizes that the spiritual nature of the program is as the person understands it.
That has no place in the treatment of psychological issues such as addiction. It'd be like trying to pray your way out of schizophrenia or use meditation to get rid of a tumor. Or like asking a pastor to cure your ...
Actually, Americans do that a lot. I saw a senator asking parents to pray that no more school shooting happen (there have been 19 in 2023 alone in America[1]).
Keep praying, but a better strategy might be actual addiction treatment and stopping people carrying guns. Anything else is just enabling suffering. Other governments have worked this out. It isn't a mystery anymore. It doesn't require prayer or spirituality or faith.
> Those places, let's not forget, deliver care often with a motive of indoctrination in to religion. It really is taking advantage of people who are vulnerable.
Because I think i've provided more to backup my claim than your "nuh-huh!" replies. You changed target from _my_ claim they are used for indoctrination to their validity in science.
Both refutations are dubious at best, it seems you have taken a position and are sticking to it, out of dogma. A bit like those who blindly follow religion.
Like those people, I don't debate with them. It is pointless. Have a good day.
I haven’t shifted my target since my first comment, and you have failed to argue against it. You have instead raised “America has problems” straw men and posited that 12-step philosophy is wrong.
Pointing out your false statement that there’s no science behind 12-step programs was in direct defense of my original comment/argument’s claim about them being recommended/supported by the medical community. My previous source only denotes 12-step programs as “at least as good” instead of “superior”, but labeling a literature review as “dubious at best” implies science denial that would make this a worthless discussion.
My “nuh-huh” reply regarding your use of the word indoctrination was in fact citing the AA preamble read every meeting: “AA is not allied with any sect, denomination, politics, organization, or institution … neither endorses nor opposes any causes”.
AA is technically a religion (in the US at least). In the positive sense, indoctrination is a correct word to use regarding what goes on in meetings. The common negative sense in which you’re aggressively using the word, implying hidden agendas/motives, is entirely false. Saying 12-step programs act directly opposite to the stated preamble would be a conspiracy theory also making this discussion worthless.
The research you cite doesn’t refute criticism of the poor state of US healthcare. It also doesn’t refute the criticism being presented here, that treating the issue as an individual failing doesn’t work for everyone and we need more collective “whole community” approaches, such as decriminalisation, ending the war on drugs rhetoric, serious pushback against excessive force use on cognitively impaired individuals under the influence of drugs who are cooperative but having difficulty complying… and basically an all around general effort to try and stop me the stigmatisation of “drug users” as scum… Because worldwide, on average: most of us drink alcohol or coffee at least occasionally and many do so with regularity; many smoke cigarettes or cigars or hookah’s; some overuse pain medication unnecessarily to keep up with gym routine when they should let their body heal; some smoke weed and others mix the active ingredients into food and drinks for the same sorts of desired reaction; there’s a thriving trade in male sexual enhancement pills which range from unnecessary viagra prescriptions to illegal imports from overseas vendors of otherwise normal pharmaceutical products to “herbal” supplements illegally laced with pharmaceutical grade ingredients not listed on the packaging if the packaging even has a list of ingredients at all; there’s a statically significant number of people who use amyl nitrate for sexual purposes; there’s many people with various medical conditions, such as Narcolepsy and ADHD where the prescription is pharmaceutical grade amphetamines, and they go about their days routinely consuming medicine that were they not prescribed it, would categorically make them under present attitudes towards drug use “drug addicts with serious dependence issues”, I’ve more than once heard a story to the effect of “I thought I was addicted to dex, even tried rehab, turns out I just had ADHD”; there’s people with anxiety and other psychiatric disorders who are prescribed things like benzodiazepines which again have thriving off label use by people without prescriptions when they’re able to get them…
We as a species have embraced the idea that you can live “better through chemistry” and that’s not going away because it has roots so deep they stretch back to tribal practices and into prehistory. The idea that there’s a magical list of drugs that are ok and not ok and you should punish people that like the not ok ones, is stupid fairy tail morality and translates about as well to the real world as prohibition of alcohol did in America, except this has worked longer because we exported around the world via treaties and we made a smaller group of people than “everyone who likes to drink alcohol” into the villains of our fairy tale narrative. There are obviously going to be things that should be illegal and laws will need to exist and be enforced, my point is that by encouraging the fairytale morality we’ve had generations of people concentrating power into the hands of groups of people we all have blatantly seem abusing it, and that’s not just about the police it’s about the organised crime and their victims. The whole system is in a slow spiral and it will not get better until we break they pattern.
And as for the researchers you cited , they were pretty specifically comparing focused treatment programs that are aimed at the individual not at any sort of social interventions like changing drug policy at the state/national level.
I was a cocaine addict. It turned out, I had ADHD. Through science and evidence led medicine, I was treated for ADHD and this gave me the foundation to leave cocaine behind.
I'm pretty sure the self-shaming, placebo based 12-steps programme wouldn't have led to an ADHD diagnosis that actual therapy with a qualified psychiatrist found.
Modern medicine is amazing. Using group support sessions whose framework was invented before we knew any better as the primary source of addiction treatment is like refusing to use cars because a horse and cart do the same job.
America's obsession with puritan, white Christian conservative values keeps it in the dark ages (in terms of mental/physical health) and no amount of psudoliberalism will counter that.
What's the point in telling yourself it's the "greatest country on earth" if your population are one of the most unhealthy?
sirsinsalot says <">That's not even getting to the fact that the leading cause of death in children and teenagers is guns[1]
I can't really understand it.
> Rockefeller and Johns Hopkins researchers said that when analyzing the leading causes of death among "children," infants are typically not included because of certain fatal conditions unique to children under a year old.
Yes OK, excluding those under a year old. So guns are the leading cause of death in America for those between 1 and 18 years old.
Is that OK now? Defensible now? Did that undermine my entire point? Or are you nit picking to detract from the toxic state of the country?
This comment implies that faith-based 12-step programs aren’t proper treatment, and that is false. Any medical professional will tell you that there’s no alternative that produces better results. The problem is abysmal: both faith-based and non-faith-based approaches perform poorly, but 12-step programs are the industry standard because they are the best we have.
Personally I think the non-faith-based centers only exist as a result of severe religious trauma. I’ve met plenty of 12-step alcoholics who make jokes about how bad things like SMART recovery are. It’s a trope on recovery meme sites.
Thankfully times are starting to change, with places like http://boulder.care prescribing Subutex as an easier rung to reach while climbing the ladder on addressing opiate use disorder (OUD).
yeah Bicycle and Ophelia are a few other U.S. suboxone telehealth startups that seem to be doing good work as well (if anyone is interested, it's worth checking each of these out as their coverage varies in terms of which states, last I checked)
In short, substance use disorder is treated as a primary condition here, there’s a massive high-profit industry built around it and specifically treating it using faith-based 12 step methodology so a lot of mentally ill people who use drugs never receive proper treatment