Alcoholics Anonymous

Great Debates
1

This discussion has taken place before around here, but with the push toward faith-based social services, I thought it might be worth having again.

Earlier this week, as part of my psychiatry rotation, I attended an AA meeting. The people there were very nice, and were very open to medical students coming in to observe. I have no doubt that this program has helped a lot of people, and the studies seem to back that up.

However, I have some reservations, two in particular:

–The meeting I attended was, essentially, a religious service. Sure, they go through some careful semantic gymnastics to refer to God “as He reveals himself to the individual”, and they try to de-emphasize their basis in Christianity.

However, they opened with a “moment of silence” and closed with the Lord’s Prayer. The speaker talked about how he was able to quit drinking only after he found God. (He started by talking about how he wasn’t a believer when he first started, and I thought I was going to hear about how a nonbeliever would get through AA, but he instead changed his evil ways.)

I’m sure not every AA meeting is quite the church service this one was, but the whole idea is still fairly confined to Yahweh. The idea of “asking God every morning to help you stay sober today and thanking Him at night” implies a God that takes a personal interest in people’s lives, a concept that Deists, among others, would disagree with. Atheists and agnostics (which I fall somewhere in between) have trouble with the idea of a “higher power” altogether.

I don’t consider this a problem in itself. However, I consider religious witnessing by physicians to be the height of unprofessionalism, and I could never envision telling a patient that he needs to go to church. Yet we tell them to go to AA or NA meetings all the time. Is that wrong? I feel uncomfortable sending a patient to such a religious environment, yet I know it’s one of the most effective ways to stay sober.

–On a similar note, I have a real problem with that first step. It seems to me that admitting you’re powerless over something is exactly the wrong thing to do. My inclination would be to help the patient realize that he does have the power to stop drinking, and to have an organization such as AA for social support and “positive peer pressure”. Then again, like I said, it’s hard to argue with AA’s success.

In short, sending a patient to AA or NA seems to me like saying, “You can’t solve this problem yourself. You need to turn it over to God.” I don’t like that attitude, for a variety of reasons. Am I incorrect in my assessment? And should a physician let such hangups prevent him from recommending a program with such demonstrable success?

Dr. J

2

What’s wrong, Dr. J? Haven’t you ever given a patient a placebo before? Which, as far as you know doesn’t do anything, but you don’t tell the patient that in the hopes that it will have a psycological affect. AA is just a placebo in non-pill form.

3

Very good questions Doctor J! I’ll try and give you a so-called ‘addict’s’ perspective.

When I was 20, I put myself into a local rehab center for a month in the hope that it would enable me to quit using several substances. The 12 step program was what was used. I took extreme offence at having to accept a ‘higher power’ to overcome addiction (being an atheist) and felt as if the group were brainwashing me into some kind of cult. Now, while it did help me to stop self-medicating for a while it definately did not help me resolve any of the problems that may have may have caused me to self-medicate and, if possible, made them worse in the long run.

I don’t think AA is the answer for everyone who has a drinking problem and I do think you’re justified in your assessment of AA, but I also realize that for some people (statistics vary on AA’s success rate), AA may be helpful for recovery. I feel that because of it’s widespread acceptance by our society at large that it tends to eclipse other possible methods of treating addiction.

Some links you may find helpful…
http://www.roizen.com/ron/cont-
http://www.rational.org/speak.out.html
(beware the testimonials)

These links deal mostly with controlled drinking, but I get the feeling from reading about this issue, that there needs to be more research on the process of addiction and that until then, no truly successful treatment will be devised.

4

Hi, I’m Laura and I’m an OA survivor.

“Hi, Laura!”

My response to this is that I really wish there WERE programs available for those of us who don’t want to have a deity shoved down our throat.

I personally do NOT think that a physician should have to recommend the current, typical 12-step program to his/her patients. But the problem is that there is no alternative. Or if there is, people are largely unaware of it.

My experience with OA (that’s overeater’s anonymous to you non-addictive type folks) was mostly a positive one. I mean that in the sense that sticking to a food plan devised by other OA members and considering how the experience others had could help ME ended up helping me change for the better. I managed this, by determining that I was going to take the useful things from the program and use them to help myself and discard the rest.

However, this was sometimes difficult to do. There is a great deal of time spent in OA meetings discussing how this is the ONLY way to health. Members will tell you that they used to think they were too smart to believe in God, but now they’re enlightened and soon you will be too. They make qualifiers for atheists and agnostics, and insist that you don’t have to be a “believer” in order to succeed. But in the same breath, they insist that you will have to find a “higher power.”

Meetings ARE essentially slogan-laden church services, in which each member testifies about how they let God into their lives and therefore succeeded or are currently succeeding. I personally, succeeded by taking to heart some of the lessons about serenity, examining where my eating disorder came from, and cutting the crap out of my diet. I also succeeded by exercising more than an hour a day…something that is NOT emphasized in any OA meetings or literature.

Also keep in mind, that my OA sponsor demanded that I go to THREE meetings a week. The way I see it, in many cases the members are replacing one obsessive/compulsive habit for another. Certainly, this isn’t always a bad thing. Replacing television with exercise is GOOD. But becoming dependent on a person or group of people to tell you what to take into your body has its pitfalls. Sitting in meetings is by NO means the ONLY way to health as they demand.

**

First of all, admitting I was powerless over food was a beneficial thing for me. I think if you look into it further, you’ll find a commonality amongst people with addictive habits: They always tell themselves they’re going to stop tomorrow. In my case, I was going to start a diet EVERY morning when I woke up. The old, “I can stop any time” attitude. Which of course, is not TRUE. You eventually have to admit that you CAN’T stop anytime and need help. It’s only after you admit to yourself that you can’t control it, that you’re able to honestly seek that help. I don’t think this is such a bad principle, though I understand your argument.

Consequently, AA and OA members think that a loss of self-esteem is not at issue either, which I STRONGLY disagree with. They contend that too much self-confidence can be harmful by convincing a person that they’re tough enough to take control. And I say, people who continually choose to ingest something that they know harms them…well…I think it’s clear enough.

In the end, you DO have to take control over that substance, I agree with you. OA does not…they think you should ALWAYS rely on AA for that control. Once you start goign to meetings, it’s a life sentence of trite, meaningless slogans such as “Let go and let god” which the members don’t even realize have lost any power eons ago.

**

Actually, I dont find it difficult to argue with AA’s success. So I will. :slight_smile:

The thing is, that if you GO to an AA meeting, you will only find relatively successful AA members. Ditto for OA, which is where my experience lies. The only people there are those for whom this approach works. However, you have to take into account how many people they chased out the door with their rhetoric, religious bent, and condescending insistance that you must accept their program or be damned. I suspect the “failure rate” is actually quite high. I suspect that a lot of people who want help, not a religious service high tail it out of there to the rehab clinic.

As for recommending this to patients, if you find anything else TO recommend, please let us all know! I for one, would love a support group for people with eating disorders that doesn’t involve proseletyzing and end in the Lord’s Prayer.

-L

5

I don’t see a problem with telling patients to go to church, as long as it’s presented as a suggestion, and you don’t tell people what church to go to. Presenting AA as an option is okay, as long as you don’t present it as the only option. Here’s one alternative. I’m sure there are others.

6

I’ll second some of what SexyWriter said. I found OA to be helpful at a time in my life when I needed people to understand what I was going through, but ultimately I decided that it wasn’t for me.

However, one of the most important lessons that I took away from OA was that first step. I spent 20 years of my life trying to fight my food issues by just trying harder, being more in control, etc. It didn’t work. If that approach had worked for me, I would have resolved my problems years before I did.

Any patient you have who is an alcoholic, drug addict, compulsive gambler, etc., does not have control over his or her problem. If he did, he would be able to just stop. What fundamentally makes it an addiction is that you are powerless over it. Learning that lesson was a huge step on my road to recovery.

I attended OA meetings in San Francisco, where many of the participants did not believe in a conventional god. There was certainly no overt Christianity in the meetings I attended, and many people who would have defined themselves as “humanists” or identified with new age spirituality rather than traditional religion. I don’t believe we even referred to “God” just to a “Higher Power” or a “spiritual source of strength”.

You can certainly ask your patients to visit an AA meeting just to see how they feel about it. Some of them may be comfortable with a more spiritual approach. As The Ryan pointed out, there are definitely non-spiritual alternatives. Depending on resources, therapy, either singly or in groups is also a great option for dealing with addictions.

A twelve-step program does not have to be the be-all and end-all of treatment for addiction. Many people combine it with rehab and/or therapy. Or, like me, they spend some time in a program and take away from it what will be most helpful to them.

Finally, I would ask you as a doctor to remember that for someone who is truly addicted, telling them to lose weight, or stop drinking, or stop doing drugs just isn’t going to work. Not every patient to whom you recommend AA is going to be helped. But there are a lot of people out there for whom it has been the road to recovery. The worst thing that can happen is that your patient says, you know, this is not for me.

7

I have been dragged to a lot of meetings. The room fills with smoke pretty fast & people get up for coffee every 2 minutes. That’s about all I can remember since I can’t hear the meetings; but I did learn what alcoholic skin looks like & can spot an alkie pretty fast these days.

8

Contrary to popular belief, AA is not particularly effective, largely because the dropout rate is very high. Brandsma et al. studied various treatment options. AA was more effective than no treatment at all, but it was the least effective of the 4 treatments studied.

**Brandsma, J. M., Maultsby, M. C., & Welsh, R. J. **(1980). Outpatient treatment of alcoholism: A review and comparative study. Baltimore: University Park Press.

9

Thanks for the hard facts. I knew SOMEONE would have them.

The interesting thing is that if you talk to “successful members” they will tell you that it doesn’t work ONLY if someone doesn’t follow the plan to the letter. Know what I mean? They refuse to admit that there are other ways, that the PROGRAM has failed, and steadfastly insist that the dropout just “doesn’t get it.”

I believe this is one of the reasons many assert that it’s a cult. “The one true way” is a cultish characteristic, no?

-L

10

IMO, AA works for some people. But I believe that it only works for the people that want it to work, and need the group support to for it to help. I think it’s a decent program, and it’s helped a lot of people.

I was a boozer way back when, and realized it without having to be told during a rare moment of lucidity. So I quit drinking for six months over the alternative, which was AA. I wanted no part of AA, not so much because of the religious stuff, but because I didn’t think I needed a support group, and in a setting like that, I’m much more likely to get beat to death for not keeping my mouth shut.

A few years later, I was “forced, aka volunteered” to go to AA, not because I had a problem, but because the military wanted me to “to set an example” for the troops that it’s not a bad thing, and “become educated” to help the troops should they need it, in a sensitive manner (since my sensitivity training didn’t help me). So I did.

Guess what? I nearly got beat to death for not keeping my mouth shut before I was asked to leave and not come back. I’m sorry, but some things that people say and do are just so incredibly funny that comments simply have to be made by someone, and I’m just the insensitive bastard to do it. I did however, find the religious aspect to be a little on the heavy side, which I didn’t like. If it works for some though, that’s all that matters, and I know I have a few friends that would probably be dead if it wasn’t for AA. They needed that type of thing.

11

SexyWriter wrote:

Maybe the Overeaters Anonymous people figure, hey, if we shove a deity down your throat, at least it won’t have any calories. :wink:

12

handy wrote:

Whoo … they’d have lots of trouble here in California, where smoking has pretty much become a Capital Felony.

13

My name is Robin and I’m an alcoholic (Hi, Robin!)

I’m also a recovering 12-stepper who decided to leave the fold last year. I got sick of having God shoved down my throat and I got sick of being treated like an outcast when I admitted that I wasn’t Christian.

What finally pushed me over the edge was when some Fundies took my group over and started sharing how they were sober because of Jesus, and wasn’t Jesus just so wonderful, and weren’t they so blessed to have Jesus as their Higher Power, and so on, ad nauseam. Fine, I said, and left.

I’ve been sober for a little over 8 years now, and in that time, I’ve had a lot of traumatic events, more both in number and in severity than is to be expected. I had to learn to censor myself so that I did not share any actual feelings or thoughts that might actually reflect on what I may have been feeling at the time. I was told more than once to shut up about my son already and JUST GET OVER IT! On the rare occasions where I’d ask to speak with someone privately, I was bombarded with slogans and told to do a 4th step inventory; that since I was still in so much pain, I must not have done a “good enough” inventory, whatever that means. I ended up going to counseling to deal with my problems and did not go to meetings at all for about six months, during which time, no one called me to see if I was even alive. When I returned, some people told me they’d assumed I’d relapsed. Nice. :rolleyes:

Since I’ve been meeting and stepless, I’ve felt much better about myself. I haven’t been constrained by a set of rigid constructs, I haven’t been judged by other people for what I may or may not believe in, and I certainly haven’t felt the need to witness to anyone or preach the gospel of AA.

And for that, I am truly grateful.

Seriously, though, for some people, AA works miracles. These people are in the minority. The AA program was created by two white men, who created this program for other men like them, who also happened to be alcoholics. We now know that substance abuse and other addictions are often related to other psychiatric disorders that are treatable by professionals, and that non-professional groups like AA aren’t really equipped to handle the underlying issues. In fact, I’ve seen people who have really needed serious psychiatric intervention who were told by non-professionals NOT to seek that help, because AA is all they need, and if they just trust God, all will be well. One of these people attempted suicide at the height of a deep depression; the other relapsed anyway and died of alcohol-related physical problems. So much for God, eh?

Robin

14

This is veering slightly off-topic, but does anyone know what the current status is with AA, those convicted of alcohol-related crimes and the First Amendment? I remember several jurisdictions’ mandatory-AA sentences coming under constitutional challenge (because of their religious aspect), but I don’t recall if the issue was ever settled at a national level one way or the other.

15

How can we tell if AA is effective at all if they don’t keep statistics? The most we know is that the program works when the program works, which is true of any program, including the most inane and ineffective programs.

16

Actually, now that I think about it I have another question. Consider nicotine. We all know about it being “the most addictive substance on earth” (allegedly), we all know it’s virtually impossible, except for a few rare lucky people, to be a casual smoker, etc etc., and yet you never hear about Smokers Anonymous programs (I’m sure they exist, but you never hear about them). Why is that? I realize the addictions are somewhat different in that smoking usually doesn’t wreck havoc on people’s lives in the way alcoholism or heroin addiction does, but what is it about the addiction itself that has allowed millions of smokers to quit without needing to “admit that they’re powerless over their addiction and turn themselves over to God”?

Frankly, it makes me even more suspicious that AA is really just a way of trying to indoctrinate Christianity into desperate people.

17

First let me state that I am not and expert in this area, I will try and get my flatmate (the A&D counsellor) to write something tonight.

There are three problems that sufferers have when trying to get treatment:
The publicity for AA type programs has drowned out the other options from the public’s perception.
Drug and Alcohol services have drowned out the other addictive behaviour programs.
The counselling profession has a very bad professional to idiot ratio and has yet to find a way to clearly differentiate between them.

There are however a number of alternatives that are available for the control of additive behaviour. Until I can get the dope from my flatmate here are some of the alternative programs that are set up for drug and alcohol that I know of:
Therapeutic Communities, residential programs set up using behavioural/structural methods.
Motivational Interviewing, a harm reduction program set-up on a cognitive/behavioural approach.

I would also like to point out that often addictive behaviour is often a symptom of some underlying trauma which often needs to be dealt with before they can become more than a ‘Dry Drunk’, which is what AA tends to end up creating. These problems usually requires the help of a trained professional counsellor, that knows what they are doing, and as I said before try to find one of these can be more than a little frustrating.

Step 1: Admit that there is something wrong
Step 2: Having failed to fix the problem yourself admit you need help.
Step 3: If a professional suggests you try something, try it as much as you possible can. (They are meant to know what will work even if you do not understand the whys)
Step 4: Keep asking until someone provides, something that does help you, as an individual. (Sometimes a program or therapist will not work for you or your particular problem; there will be another one out there somewhere that will).
Step 5 Good Luck and keep trying.

Britt

18

Question: Does the (1980) mean this study was done in 1980? If so, does anyone have any recent data?
I’m a recovering addict in NA. I’ve been clean for almost 14 years. And I’m an atheist. I attend NA meetings, but have attended AA meetings in the past. There are some differences, but not fundemental ones.

At meetings, you will here a lot of talk about God, as the individual speaker understands God. (In NA, we are discouraged, politely, from witnessing while sharing with the group) It is stressed that an indivuals concept of ‘God’ is up to that person. It could be the standard Christian God, Buddah, Allah, a door knob, your family pet or no God at all. It’s up to the indivual.

Admitting you are powerless over addiction is important. When we get to AA or NA we think(and have been told) we have a problem with willpower, that we just need to bear down and toughen up. And we are egomaniacs. We need to realize that we have a disease. Diseases do not respond to willpower.

The second step says we came to believe in a power greater than ourselves that can restore us to sanity. For me, it’s the power of the group and the process of one addict helping another. For somebody else, it could be whatever. It’s important for us to realize that the is a power greater than ourselves, because addicts are egomaniacs. We think the world revolves around us.

Here’s the thing: the program works if you work it. If you work the steps to the best of your ability, if you do what the program suggests, you can stay clean one day at a time. If you don’t want to, you can go get loaded, or look for another way. The doors at 12 step programs will still be open for you whatever you decide.

I was near death when I got to NA, but the program worked for me. I, personally, know a lot of people that have been clean for many years because of it. People who would be dead or in prison without it. I have spoken to thousands of clean addicts and there are meetings all over the world.

If you’re a normie(not an addict), the program doesn’t make a lot of sense. And that’s OK. Sometimes it doesn’t make sense to me. I just know that it works.

It’s a good thing.

19

[QUOTE]
*Originally posted by spooje *
**

I very much respect your success! And I respect the fact that you found something that worked for you and helps you continue that success.

However, this statement above is actually one of my big problems with these 12 step programs. In my experience, there’s a smug notion, held by those for whom it works, that if it doesn’t work for YOU, that means YOU’VE failed. If you think there’s something else that may be able to help you more or that there are other ways of going about this, YOU’RE just plain wrong.

This is not always true. It could be that a group setting is uncomfortable for a particular person. Or that they don’t feel it neceessary to listen to other peoples’ stories of misery three times a week or more in order to gain their own control. It’s not always as simple as saying, “It works if you do it right.”

For example, for some the disease model of addiction can be useful in considering ways to “treat” yourself as if you have a real disease. You may think to yourself, “If I’m diabetic, I have to take insulin to stay well, and if I’m an alcoholic, I have to do X to stay well.”

But for others, the notion of having a chronic disease makes them feel hopeless. It gives them the feeling that they will NEVER be “cured” no matter what they do, and makes them see no point in attempting to struggle against something they cannot rid themselves of no matter how hard they try.

Thus, using a disease model does not work for everyone. It’s not because that person is bad or flawed or isn’t “sticking with the program.” It’s because the theories of the program are not appropriate in that particular case.

-L

20

One point: AA worked for me because it helped me realize that I in fact ** would never be cured**. Disease, genetics, ‘bad humors’, left-handedness, whatever the theory of the day, I know I shouldn’t drink.

I did a ‘drive-by’ crash course in AA when I had to (not forced by anyone but me, though). They recommend against this, strongly. I did not pick a sponsor and did not work my 12 steps one by one. I went to 90 meetings in 90 days to help me kick alcohol. It was a big help and I couldn’t have done it alone. Nine sober years later I am glad I did.

The best thing AA hammered into my thick selfish skull is that every day, every hour, every minute I remain one drink away from being a drunk. I’m okay with that. Anyone need a designated driver?