Dangers of AA's Addiction Recovery Program: 12-Steps Back
There are a lot of reasons that I chose to get into the field of addiction treatment, and my beliefs in the danger of AA's addiction recovery program (and others modeled on it) was the main reason. Why do organizations such as Alcoholics Anonymous retain such a glorious public perception, all the while having success rates of approximately 5 per cent after one year? Even AA's own Comments on A.A.'S Triennial Surveys, which is difficult to find, and even more difficult to decipher, does in fact state these dismal results.1
AA's Addiction Recovery Program Presents Many Barriers to Recovery
I have many reasons for thinking the way I do. AA enforces some barriers to recovery that won't benefit a recovering addict. Here are some of those dangerous barriers.
Uses Self-Deprecating Descriptions
As a mental health stigma blogger, I often speak about the labels that people use to describe themselves and how it affects their self-esteem and confidence. If you constantly refer to yourself as your illness, or your condition, you create a dangerous self-fulfilling prophecy that will time and time again lead you down the same road.
If you sit around in a circle and call yourself an addict or alcoholic enough times, you are going to start viewing yourself as solely an addict or alcoholic. And that doesn’t leave much room for growth.
I broke my thumb once. But I don’t walk around telling people ‘Hi, I’m Chris and I’m a broken thumb.’ It doesn’t define me any more than someone who has coped with their mental health challenges by over-drinking or using drugs.
The first step of 12 step programs such as Alcoholics Anonymous or Narcotics Anonymous is to ‘admit that you are powerless over alcohol and that your life has become unmanageable.’ I get the unmanageable part, but if someone is truly powerless, then what hope is there for recovery?
Drugs and alcohol are inanimate objects and inherently can’t have power over a person. It is our thoughts that lead us to drugs and alcohol, not the alcohol itself. The first thing I try to teach my clients is that they do in fact have the power to overcome their addiction. For many, it's the first time anyone has ever told them that they aren't powerless, and that's incredibly frightening.
Creates a Replacement Addiction
Think about this. If you gave up drinking 20 years ago, but still spend all of your free time in the ‘fellowship’ of AA, then are you really recovered? I know countless people who go to literally hundreds and hundreds of meetings every year. They go to these meetings, talk about drinking, talk to others about drinking, and rehash their past drinking lives. It doesn’t sound very recovered to me.
Relapse Is a Self-Fulfilling Prophecy
Members of 12 Step groups are told that ‘one [drink] is too many and a thousand is never enough.’ This creates another dangerous self-fulfilling prophecy that I see on a daily basis in the treatment center I work at. The clients who do not endorse AA may have a slip one night and get back on track. Others who believe in AA are convinced that they have no control over their actions, and therefore spiral further and further into addiction. They believe 1,000 drinks are never enough, so since they're relapsing, they may as well live by the saying.
Ignores the Possibility of a Dual Diagnosis
Any certified professional in the field of addiction treatment can tell you that heavy drinking or drug use is most often times a signal of an undiagnosed mental health issue such as depression or anxiety. There is rarely, if ever, any talk about mental health in the rooms of AA. Therefore, someone who is self-medicating their depression with alcohol and who attends AA will be told that they have a ‘disease, for which there is no known cure’ and that the only solution is for them to attend meetings for the rest of their life.
The reason I took the job at the long-term treatment center that I work at is that they were changing from AA's Disease Theory approach to the Community Reinforcement Approach.2 I got to see both sides of the spectrum and can see, on a daily basis, just how much happier, productive and empowered clients are now that they no longer have to refer to themselves as an alcoholic and attend mandatory meetings.
Their self-esteem has sky-rocketed, so when they slip, they slip for shorter periods of time. Most importantly, they no longer feel as though they have a death sentence looming over their heads. We are still going over the statistics, but since changing formats, our graduation rates have more than tripled.
Uses an Unproven Addiction Recovery Theory
As this article in the New York Times states, many addiction practitioners are essentially committing medical malpractice by continually using a method that is not scientifically proven, does not take into account individuality and does not address mental health.3
All this to say, if AA worked for you, then great. But if it didn't, don't despair because there are other ways. SMART Recovery is an evidence-based community addiction group that is becoming increasingly popular. In addition, look into any approach that uses either cognitive behavioral therapy or rational emotive behavioral therapy, which are both evidence-based practices for the treatment of addiction.
You don't have to go to AA to beat your addiction. There is a great deal you can do on your own to overcome your addiction. Do your research, make sure that whatever you are reading is evidence-based, and don't buy into a program simply because it is the most well-known.
Curry, C. (2013, February 25). Dangers of AA's Addiction Recovery Program: 12-Steps Back, HealthyPlace. Retrieved on 2019, September 16 from https://www.healthyplace.com/blogs/survivingmentalhealthstigma/2013/02/one-step-forward-twelve-steps-back
Author: Chris Curry
I sat beside one woman in a late night meeting who had been very quiet. There were only five people in the meeting, so we all got to share twice, but this woman never said a word. Finally, the moderator asked her and, after a brief pause, the woman broke down almost hysterically and told how she had less than a week clean and her sponsor had told her that she was not allowed to speak in meetings! I don't think I've ever wanted to strangle someone as much as I wanted to find and strangle that womans sponsor. This poor woman was dying to share and both NA and AA literature talks about the therapeutic value of sharing, but her egomaniac of a sponsor had denied her this basic and fundamental tool of recovery!
By the way, Chris, you are right on with all of your points. I can only agree and wish you a good day.
I must admit, I have read a great deal of your work on the subject. Would love to pick your brain about it sometime. I'll see if I can find your email address, but if you read this, feel free to drop me a line at firstname.lastname@example.org
Thanks for the kind words and have yourself a fantastic day!
Identification as addicts reduces self esteem? ...For whom? The folks I surround myself with have found courage and hope in that recognizing themselves as addicts separates addictive behaviours from who we are when we don't use. "I am an addict," is not the same thing as saying "I am addiction"' as you suggest.
Meetings are places where addicts revel in their glorious using days?... Is that what is really going on in most meetings? Or, are there some people still hanging on to the past and lots of others moving productively into their clean and sober futures?
A disease or condition like addiction is akin to breaking your thumb?... Is this what you tell your clients?
I hope your clients are aware that 12 step meetings are a highly effective, free, and accessible means to help identify addictive thought and behaviours, and learn how to move through these diseased thoughts and live a diverse, fulfilling life.
The Powerless piece is actually an afirmation that MI or SA is not your fault. As Carl Yung said in conversations with Dr Bob, it is a sickness of the mind that includes as a base that Mental Illness and addiction can be closely linked, but neither are a fault of the sufferer.
People need to do what works for them and there is no one size fits all solution. Several alternatives were mentioned. If your affected by both addiction and MI, Look for a DRA support group near you and check it out. If there is not one find a group that doesn't sit around telling "war stories" and is open to you bringing up your connection between addiction and MI. There are also several diff types of AA's. Book reading and recovery oriented groups, working 12 step meetings that takes you thru all 12 steps.
The bottom line is to take care of yourself and work with appropriate treatments.
Admittedly, AA's "model" of anonymity, surrender, disclosure and emphasis on a non-restrictive spiritual component, participation in group meetings, seeking & finding a mentor and helping fellow alcoholics doesn't easily lend itself to scrupulous scientific analysis.
The upside to me is that AA's stubborn endurance against modifying its tenets, textbook and aforementioned framework to meet the evolution of psychosocial, scientific, cultural and global shifts gives it a stability and consistency rarely found, even in seemingly established institutions.
Of course, I acknowledge I speak from the POV of recovery in AA, having been saved from the grave more than once, and a life that's enabled me to comment with some degree of lucidity (hopefully) on your POV.
I hope I am not violating your rules by posting this.
My opinion, and I'm not saying it's fact, that those I know who took a more holistic approach to recovery were more successful. Those who really set small goals for themselves, took care of both their physical and mental health were the ones who were able to keep sober and recover from relapse quicker when it happened.
So happy for you. You are a fine example.
You mention other methods but then omit to mention their long-term recovery rate which again makes it difficult to compare.
Looking forward to a fully evidence based argument.
I do believe it was Amy Winehouse who famously agreed with the 'You do not have to go to treatment to treat addiction 'No, no, no'(My little anecdote)
Thank you so kindly for reading and commenting on the post. As this is a blog and not a peer-reviewed paper, I admit that I did not include all of the evidence. But as an evidence-based addictions counsellor, I would never publicly share anything that cannot be proven with facts. I have all of the evidence for this approach at my office and will graciously post it tomorrow when I get to work.
Here is one piece of literature that goes into detail about the success rates and efficacy of the CRA Approach.
I could NEVER do NA. Going to a meeting and listening to people tell stories about using, recounting what essentially boiled down to "the glory days" till the crap hit the fan was a MASSIVE trigger for me.
I was actually told by my rehab counsellor not to talk about my usage because when I decided to get clean I was still very much in a romantic relationship with it and to avoid NA and meetings at all cost. Talking, listening would have sent me straight back to my drug(s).
I can completely understand how there is so much of a relapse problem.