Resisting 12-Step Coercion: How to Fight Forced Participation in AA, NA, or 12-Step Treatment

By Stanton Peele, Charles Bufe, with Archie Brodsky

Stanton and his colleagues respond to the overwhelming use of coercive referrals to substance abuse treatment (read "12-step treatment") in the United States with a primer on the legal, ethical, and clinical aspects of such treatment. The authors find that the empirical basis for claims that 12-step treatment is useful is weak at best. Important research has found no benefits — or even negative results — from assignment to AA and related treatments, and certainly other treatments are at least as effective. Moreover, a personal resolution to participate in a particular treatment is an important component in effective therapy.

From here, the authors review legal and ethical issues surrounding compulsion to go to 12-step groups. A number of higher courts have made clear that government-agency or court coercion to attend AA violates the first amendment's separation of church and state, since AA has uniformly been found to be religious in nature (both the legal and factual basis for this finding are part of this book). A separate chapter evaluates chemical dependence treatment in terms of current standards of medical informed consent, and finds such treatment highly deficient in this regard. The strange, sad case of G. Douglas Talbott, the founder and past president of the American Society of Addiction Medicine, is discussed. Talbott, who for years has been criticized and sued for force-feeding the 12 steps to physicians, was recently found liable for malpractice and fraud in an unfortunately typical case of American substance abuse treatment.

Finally, the authors summarize their material in a ready-to-digest form for submission to policy makers who are considering making people go to AA or related therapies. Since court challenges are a last resort, the authors instead suggest gently informing decision-makers that such policies are unwise and illegal. Effective alternatives are outlined and discussed, along with references to alternate support groups. This book is a critical aid for combat in the emerging war over treatment as a part of intrusive and punitive drug and alcohol laws, which are made to seem more palatable by the inclusion of treatment provisions, but which are actually even more coercive and repressive than simple punishment for using drugs or drinking in ways that AA doesn't like.

Questions about Resisting 12-Step Coercion

1. Is alcoholism a disease?
   No. It's a behavior. Once you begin to call behaviors "diseases," where do you stop?
2. What are the key beliefs in the disease concept of alcoholism?
   There are several key beliefs —
   1. The "disease" is progressive—it inevitably gets worse if it goes untreated;
   2. It's an entity unto itself, existing independently of family, social, and economic situations;
   3. Alcoholics cannot recover; all that they can hope to do is arrest the disease;
   4. Alcoholics are powerless to deal with their situation without outside help;
   5. Alcoholics lose control if they drink any amount of alcohol—"one drink, one drunk";
   6. Alcoholism is characterized by "denial."
3. Are those beliefs supported by the available research evidence?
   No. Every single one of them is contradicted by the available scientific evidence.
4. You say that pretending alcoholism is a disease is harmful. How so?
   It's harmful in several ways. The most obvious is that it convinces people that they have a lifelong, inbred, progressive disease, when in reality they have a behavioral problem which they can overcome. What would all the people who have quit smoking — a majority of smokers — do if they believed they could never quit smoking on their own? In addition, by claiming that individuals are "powerless" and that substances are "powerful," the disease concept provides the rationale for all sorts of government intrusion into people's lives.
5. What is the key element in AA's approach to alcoholism?
   It's basically a religious program, and its key element is that individuals are powerless to deal with their drinking problems through their own efforts and that, in order to do so, they must turn their "lives and will over to God."
6. How effective is AA?
   Not very. The best available research evidence, and evidence from AA's own triennial surveys, indicates that AA's results are no better than the rate of spontaneous remission, that is, that it's no better than no treatment at all. One problem is that we generally only hear about AA's successes. And when someone, like Darryl Strawberry (who traveled the country speaking on behalf of AA) fails, the blame is laid on him and not the program.
7. How big is the 12-step treatment industry?
   According to the Substance Abuse and Mental Health Services Administration, there are about 15,000 treatment facilities in the country, and well over 90% of them are 12-step facilities. Both the Department of Health and Human Services and the Institute of Medicine have estimated that treatment is a $10-billion-dollar-a-year industry.