Let me begin this post by disclosing that I am not affiliated with AA, have never been in AA nor participated in any outpatient treatment center or program for alcohol use or abuse. Prior to reading about the faulty and scarce research about the efficacy of 12 Step Programs, I formulated my own opinions about the AA-model from my work in an outpatient substance abuse clinic in New York City.
Many of the men in treatment are homeless and have extensive histories with battling addiction. What came across in group sessions was a division between those individuals who subscribe to the 12 Step Program and those who cringe when they hear the language of “powerlessness” and “shortcomings.” I was first turned off from the ways of 12-Step because of the rigidity of the steps. They came across as finite and restrictive. Relapse was a black or white concept. No middle ground.
I began to think about the term addiction and place it into the overall context of mental health. Despite the evidence that addicts have fewer dopamine receptors in the brain’s reward pathways than non-addicts, it is hard to label someone’s choices as a disease that one cannot control. What is striking about the AA model is that there is little separation or distinction between someone who has been clean for 2 months or 20 years, a relapse is a relapse and that individual has to restart the steps from the beginning. This rigidity seems to assert that if an individual “slips up,” his disease has gotten the better of him.
AA’s rate of success is also relatively low. A Cochrane Collaboration study that ranged almost 40 years (1966-2005) found “no experimental studies unequivocally demonstrated the effectiveness of AA.” The success rate is somewhere between 5-10%. A 1991 New England Journal of Medicine study found addicts treated in hospitals fared better than those treated in an AA setting. This lack of success only prolongs an addict’s recovery, as most outpatient treatment programs in the country integrate a 12-step model.
In recent years, AA meetings have made room for atheist and agnostic members who are uncomfortable with step 2: “Came to believe that a Power greater than ourselves could restore us to sanity.” This inclusion is a sign of progress.
Much of AA’s evidence for success is anecdotal and thus, is prone to criticism. Although I am critical of the model as a treatment, I do believe AA offers a support system that does not discriminate based on any race, gender, income bracket or sexual identity. While an insight-oriented approach that helps the client/patient identify underlying thoughts and feelings is preferred, it is a timely and costly modality that might not yield a positive result.
Modernfreud.com 