# Finally! A critical article of AA in a mainstream publication! **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [March 25, 2015, 7:47pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964 "2015-03-25T19:47:48Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [March 26, 2015, 3:43pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/21 "2015-03-26T15:43:11Z")
> [@Enright3](#): > > I’m not sure I understand all the hatred. It’s pretty easy to say how stupid something is; but what do you propose instead? Addicts are addicts; and one thing addicts do is fall off the wagon. Much like cigarette smokers start smoking again, and over eaters continue to over eat. I don’t care what individuals do. But I do care a lot when [people ordered by the court into treatment can choose AA](http://alcoholism.about.com/od/dui/a/How-Court-Ordered-Alcoholics-Anonymous-Works.htm), if AA does not in fact work to rehabilitate alcoholics. What I propose instead is actual research into treatment of alcoholism and finding interventions that \*do \*work, and restricting court ordered treatments to those evidence based interventions. ---
**Author:** ![SciFiSam](https://avatars.discourse-cdn.com/v4/letter/s/47e85d/32.png) [@SciFiSam](https://boards.straightdope.com/u/SciFiSam)\ **Post date:** [March 26, 2015, 3:47pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/22 "2015-03-26T15:47:57Z")
> [@Enright3](#): > > I’m not sure I understand all the hatred. It’s pretty easy to say how stupid something is; but what do you propose instead? Addicts are addicts; and one thing addicts do is fall off the wagon. Much like cigarette smokers start smoking again, and over eaters continue to over eat. A version of A that doesn’t require “complete submission” (like in the quote in the article), acknowledges that some people have drinking problems but aren’t alcoholics, and they need help too, and getting rid of the higher power thing. So basically a support group that takes the good parts of AA, like most of the steps and the mentoring scheme. Currently it alienates some (many?) people. That wouldn’t matter if attendance weren’t sometimes made compulsory by courts; it is a bit off that, in the US, you can be obliged to attend a religious organisation against your will. And yes, some local chapters are less religious (and many aren’t; you’d be obliged to attend even if all your local chapters were very religious), but anyone who claims the central tenets of AA aren’t religious is kidding themselves. ---
**Author:** ![friedo](https://avatars.discourse-cdn.com/v4/letter/f/8edcca/32.png) [@friedo](https://boards.straightdope.com/u/friedo)\ **Post date:** [March 26, 2015, 3:48pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/23 "2015-03-26T15:48:57Z")
> [@Enright3](#): > > I’m not sure I understand all the hatred. It’s pretty easy to say how stupid something is; but what do you propose instead? Addicts are addicts; and one thing addicts do is fall off the wagon. Much like cigarette smokers start smoking again, and over eaters continue to over eat. RTFA. There are several treatment protocols, involving actual medical science, which rejects the absolutist recovery rhetoric of 12-step programs. Finland’s program is profiled in some detail in the article, for example. ---
**Author:** ![SpoilerVirgin](https://avatars.discourse-cdn.com/v4/letter/s/4491bb/32.png) [@SpoilerVirgin](https://boards.straightdope.com/u/SpoilerVirgin)\ **Post date:** [March 26, 2015, 4:02pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/24 "2015-03-26T16:02:35Z")
> [@Enright3](#): > > I’m not sure I understand all the hatred. It’s pretty easy to say how stupid something is; but what do you propose instead? Addicts are addicts; and one thing addicts do is fall off the wagon. Much like cigarette smokers start smoking again, and over eaters continue to over eat. Although I am not an alcoholic, I have long been a supporter of AA, although I recognized its limitations. The Atlantic article linked above has finally changed my mind. The article discusses alternative treatments, including naltrexone, a drug that is the primary treatment for alcoholism in Finland, and appears to be far more successful than AA. The “an addict is an addict” model comes from AA, but it may not be accurate. My personal experience with addiction is with overeating. Among the many treatments I tried was a brief stint in Overeaters Anonymous. I did come to believe that I was powerless over my eating, and that I would probably spend my life on and off the wagon. I was finally able to resolve my issues through therapy. It has now been over seven years since I have had a problem with overeating. People often compliment my willpower, but it’s not about willpower. I no longer need willpower because I am no longer an addict. The mechanism for food addiction may be entirely different from the mechanism for alcoholism. But based on the scientific evidence, including the evidence concerning naltrexone, I no longer think that the AA model of permanent addiction and lifelong abstinence is correct. More research needs to be done into naltrexone and other alternative treatments, because AA clearly is not working to resolve the alcohol addiction problem. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [March 26, 2015, 4:10pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/25 "2015-03-26T16:10:28Z")
An interesting [article](http://www.sciencedirect.com/science/article/pii/S0740547206000857) exploring the why developing evidence based approaches have been such slow going in the field. (And how to improve upon it.) > [@](#): > > Historically, there has been relatively little overlap between treatment methods commonly used in community practice and those with scientific evidence of efficacy. One review (Miller, Wilbourne, & Hettema, 2003, p. 41) concluded that “[t]he negative correlation between scientific evidence and treatment-as-usual…could hardly be larger if one intentionally constructed treatment programs from those approaches with the least evidence of efficacy.” > > This gap is partly caused by the unique development of American addiction treatment, which evolved in relative isolation from mainstream health care (Guydish, 2003 and White, 1998). Through the middle of the 20th century, little or no professional help was available for these socially stigmatized disorders, which most practitioners and hospitals refused to treat. Consequently, there arose an alternative system of care, provided primarily by compassionate peers who were themselves in recovery. Although a disease model was advanced for alcoholism and subsequently for drug dependence, treatment remained segregated in specialist treatment programs with little connection to medical and mental health services. Treatment practices thus continued to be guided by the folk wisdom of recovering people, particularly through the perspectives of Alcoholics Anonymous and related 12-step programs (Alcoholics Anonymous, 1976 and Jellinek, 1960). Individual providers, programs, and systems developed strong allegiance to particular treatment models, often regardless of scientific evidence for efficacy or lack thereof (Morgenstern, 2000). ---
**Author:** ![Balance](https://avatars.discourse-cdn.com/v4/letter/b/ccd318/32.png) [@Balance](https://boards.straightdope.com/u/Balance)\ **Post date:** [March 26, 2015, 4:15pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/26 "2015-03-26T16:15:41Z")
> [@Enright3](#): > > I’m not sure I understand all the hatred. It’s pretty easy to say how stupid something is; but what do you propose instead? Approaches to treatment based on actual evidence. For example, the article (if you read it) goes into some detail about an approach that uses a combination of behavioral therapy and medication with an opioid antagonist to block reinforcement of the craving/reward cycle. The treatment has around a 75% success rate. AA claims a similar success rate…but only for people who “have gone to meetings and ‘really tried’”, which is not something I would consider a scientific way to filter data. (More bluntly, they’re cherry-picking, even insofar as they’re able to collect data at all.) External analysis suggests that their actual success rate is in the single digits. AA-based rehab commands a highly disproportionate amount of rehabilitation spending, with little evidence that it actually works. AA pushes religion as medicine and opposes attempts to publicize alternatives. How would we regard someone who recommends going to a faith healer for appendicitis? ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [March 26, 2015, 4:40pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/27 "2015-03-26T16:40:37Z")
> [@Slithy\_Tove](#): > > especially if the demons don’t take showers right before Ow. I think I snorted roast beef sandwich into my nose. That’ll teach me to peruse the SDMB while eating lunch. ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [March 26, 2015, 4:50pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/28 "2015-03-26T16:50:04Z")
> [@SpoilerVirgin](#): > > Although I am not an alcoholic, I have long been a supporter of AA, although I recognized its limitations. The Atlantic article linked above has finally changed my mind. The article discusses alternative treatments, including naltrexone, a drug that is the primary treatment for alcoholism in Finland, and appears to be far more successful than AA. Agreed. I have long been leery of the AA philosophy and feel that it’s made its way into a lot of other groups around “addiction”. (I once compared a Weight Watchers meeting to AA, and there wasn’t much hyperbole going on there. It was in the Bible Belt and people prayed away their overeating.) Anyway, I also found the Atlantic article to be very good, up to the point I had to stop reading because I was getting worked up thinking about all the wasted money, all the people forced to give lip service to belief in a higher power because AA is all that was sanctioned by the courts, and so on. It was too late in the evening for that level of annoyance. > [@](#): > > More research needs to be done into naltrexone and other alternative treatments, because AA clearly is not working to resolve the alcohol addiction problem. From what is being reported, it sounds that naltrexone isn’t an “alternative” treatment for long. (But I get why you used the word.) Now to get my mum to talk to her doctor. ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [March 26, 2015, 4:53pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/29 "2015-03-26T16:53:38Z")
> [@HotDogWater](#): > > Well, that degenerated quickly. 😛 It’s all the damn degenerates around here! ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [March 26, 2015, 4:56pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/30 "2015-03-26T16:56:44Z")
Say what you will about them, but when it was 15 below zero and my battery was shot, they arrived in 30 minutes, sold me a new battery, and got me on my way. ---
**Author:** ![TriPolar](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tripolar/32/3008_2.png) [@TriPolar](https://boards.straightdope.com/u/TriPolar)\ **Post date:** [March 26, 2015, 5:25pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/31 "2015-03-26T17:25:57Z")
> [@WhyNot](#): > > I don’t care what individuals do. But I do care a lot when [people ordered by the court into treatment can choose AA](http://alcoholism.about.com/od/dui/a/How-Court-Ordered-Alcoholics-Anonymous-Works.htm), if AA does not in fact work to rehabilitate alcoholics. What I propose instead is actual research into treatment of alcoholism and finding interventions that \*do \*work, and restricting court ordered treatments to those evidence based interventions. Yup. I know specifically of a couple ordered to go to AA where they found another drunk couple to hang around with. Judges may require some evidence that they attend the meetings but don’t do anything to determine if they’ve stopped drinking. I don’t think that provides much motivation to actually deal with a problem. In another case someone I have actually met and know of her obvious drinking problem was on the road 60 days after a drunk driving arrest. She was severely drunk by her own admission. She attended AA meetings but I never saw even a break in her drinking habits at the bar. The people I do know that stopped drinking after being long time heavy daily drinkers did it on their own when they suffered the health effects of all that alcohol, pancreatitis in one case and cirrhosis in the other. ---
**Author:** ![The\_Second\_Stone](https://avatars.discourse-cdn.com/v4/letter/t/bbe5ce/32.png) [@The\_Second\_Stone](https://boards.straightdope.com/u/The_Second_Stone)\ **Post date:** [March 26, 2015, 5:35pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/32 "2015-03-26T17:35:24Z")
The only people I know who have quite abusing have done it through AA. I know a lot of people who have been to rehab and other methods, they still ruin their lives with alcohol. As for The Atlantic being the first, Salon ran an article several months back. ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [March 26, 2015, 5:55pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/33 "2015-03-26T17:55:55Z")
> [@The\_Second\_Stone](#): > > The only people I know who have quite abusing have done it through AA. I know a lot of people who have been to rehab and other methods, they still ruin their lives with alcohol. > > As for The Atlantic being the first, Salon ran an article several months back. Did you read the article linked in the OP? ---
**Author:** ![eschereal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eschereal/32/18939_2.png) [@eschereal](https://boards.straightdope.com/u/eschereal)\ **Post date:** [March 26, 2015, 5:56pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/34 "2015-03-26T17:56:50Z")
> [@kayaker](#): > > Say what you will about them, but when it was 15 below zero and my battery was shot, they arrived in 30 minutes, sold me a new battery, and got me on my way. That is triple-A. They are slightly smaller than double-As. Amazing that you can start your car with one. ---
**Author:** ![Doctor\_Jackson](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/doctor_jackson/32/32_2.png) [@Doctor\_Jackson](https://boards.straightdope.com/u/Doctor_Jackson)\ **Post date:** [March 26, 2015, 5:59pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/35 "2015-03-26T17:59:53Z")
> [@kayaker](#): > > Say what you will about them, but when it was 15 below zero and my battery was shot, they arrived in 30 minutes, sold me a new battery, and got me on my way. Hmm, seems as if you picked up an extra “A” somewhere along the way. Let me remove that for you. … There, all better now! ---
**Author:** ![Sage\_Rat](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sage_rat/32/399_2.png) [@Sage\_Rat](https://boards.straightdope.com/u/Sage_Rat)\ **Post date:** [March 26, 2015, 6:10pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/36 "2015-03-26T18:10:07Z")
**Qadgop** posted a link to a review of the various methods for ending alcohol dependency some years ago (which included a review of AA-like programs, I believe). As I recall, the upshot of it was that no program was particularly successful if you took a random sample of the population, but that certain approaches might work better for certain people, so making the determination of which to send a person to was the larger factor than the methodology. I’ll see if I can find Qadgop’s post… ---
**Author:** ![The\_Second\_Stone](https://avatars.discourse-cdn.com/v4/letter/t/bbe5ce/32.png) [@The\_Second\_Stone](https://boards.straightdope.com/u/The_Second_Stone)\ **Post date:** [March 26, 2015, 6:22pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/37 "2015-03-26T18:22:39Z")
> [@Czarcasm](#): > > Did you read the article linked in the OP? Unfortunately yes. ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [March 26, 2015, 6:26pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/38 "2015-03-26T18:26:45Z")
> [@The\_Second\_Stone](#): > > Unfortunately yes. Why unfortunately? ---
**Author:** ![Sage\_Rat](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sage_rat/32/399_2.png) [@Sage\_Rat](https://boards.straightdope.com/u/Sage_Rat)\ **Post date:** [March 26, 2015, 6:29pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/39 "2015-03-26T18:29:21Z")
> [@Sage\_Rat](#): > > **Qadgop** posted a link to a review of the various methods for ending alcohol dependency some years ago (which included a review of AA-like programs, I believe). As I recall, the upshot of it was that no program was particularly successful if you took a random sample of the population, but that certain approaches might work better for certain people, so making the determination of which to send a person to was the larger factor than the methodology. > > I’ll see if I can find Qadgop’s post… It looks like there was a followup thread a few years later, so I will link to that one, which has more information and a bunch of links to studies: > **[Alcoholics Anonymous: Good? Bad? Indifferent?](https://boards.straightdope.com/sdmb/showthread.php?t=558599)** > > I have been in a conversation regarding the efficacy and overall usefulness of Alcoholics Anonymous (AA). Unfortunately the info on this seems to be all over the place from opinions they are cult-like and do more harm than good to people who think... ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [March 26, 2015, 6:32pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/40 "2015-03-26T18:32:05Z")
> [@Czarcasm](#): > > Why unfortunately? I’m guessing he read in poor lighting, resulting in eye strain and headache. [Previous page](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964.md?page=1) [Next page](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964.md?page=3)