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  • Michael

    Thank you so much for your effort, this was a great read.

    Did you look into government-funded substance abuse treatment in your research? There is a similar divide growing in that field, I believe. Many counselors are recovering alcoholics or addicts, and intuitively expound the steps, principles, and maxims of Alcoholics Anonymous. However, funding requires more and more documentation of Individual Treatment Plans, proof of Relapse Prevention classes (i.e., rational thinking), and other “evidence-based” methods of recovery. In short, when taxpayers are footing the bill, the same argument is intensified. Just wondering if you stepped in that swamp at all.

  • Magenta

    Quote: In reply to the observation that AA has worked for a lot of people, she said, “But that’s not science. That’s anecdote.” Then she resorted to anecdote herself: “Hundreds of people have written to me to say that they were ordered off their meds by their sponsor for their mood disorder.”

    It is at this point that one may dismiss this whole too-long article: What is on display here is the tu quoque fallacy. This is no rebuttal to the fact–the utter fact–of AA’s low success rate and its reliance on superstition.

  • Robert Powell

    very interesting, as a researcher and policy analyst I was critical of AA , the disease model which continues to be refined by the new panacea of neuroscience is a false metaphor, there might be correlations between certain in ate factors and addiction however many alcoholics stop drinking on there own, entire swaths of Ireland , Russia and aboriginal lands seemed to be populated by individuals with this disease which is embedded emergent and actualized through multiple factors the disease model also provides the individual with a narrative that locates the behaviour firmly within the subject and can lead to resignation , howeebr the most important ant variable in treatment success is not type or length of treatment but access to aftercare, AA with it’s somewhat unsavory assumptions produces results is ubiquitous and has begun to adapt for example in Aboriginal communities the 12 steps include social determinants

    any professional who would discard AA with such contempt is obviously more concerned with their needs and not those suffering from addictions, I put aside my intellectual discomfort with AA in order to provide a range of appraoches, I a sidebar I would add that in terms of cost be if it it also very reasonable

  • Scott S

    If you go to an AA meeting and don’t follow the suggestions and work the program and go back out and relapse, you really should not count against the success rate. People who haven’t given AA or CA a shot have no idea what they’re talking about. I’m a recovered heroin, meth, benzo addict as well as an alcoholic, and I couldn’t have done it without AA. Until science can explain why someone will drink or get high when every bone in their body is telling them that they shouldn’t, or why someone does not genuinely want to get sober when they’ve lost everything in their life, then this argument is a rather pointless one. And if your sponsor tells you to quit your meds, get a new sponsor. It’s that simple. I have a friend in recovery who got injured, was prescribed opiates, took them as directed, and is still sober. AA works if you work it.

  • lee michael

    Alcoholism is a behavior not a disease. Period

  • Mark

    Great article, I normally laugh at these types of articles of people trying to figure out AA but yours was very insightful I agree that people find it hard to admit they are powerless over something but we here it all the time with celebrities that they have been battling their addiction for years which implies they are in a fight for their life when. In fact a better approach is surrender to win .I read the big book at 17 years old because i was out of control with drinking and drugs but i did not read it to get sober because at that point in my life I enjoyed being out of control I read it to find out what the CATCH was and in the 15 years i attended AA meetings I never found one.they never asked me to do or believe anything, what I did find were people trying to be better than they were yesterday thats it no mystery no secret handshakes nobody wrote down my information and i was able to witness that not everyone stayed but as Bill Wilson learned that by helping others he stayed sober and there is a promise in the big book that if you stay sober you can one day move in to the mainstream of life and 15 years ago I chose to stop attending meetings only because my life has become so “mainstream” it just felt natural to leave and with what I was able to learn there January 11th 2016 I was able to celebrate 30 years of a sober life something I never dreamed was possible I only share that in hopes it can inspire hope in someone who feels hopeless right now and I could not have done it if I thought I had to stay sober for 30 years but I did what was suggested. One day at a time and the only thing my sobriety affords me is to have a shot at a good life because I got sick of drugs and booze making all my decisions for me evety day like where I would sleep who I would associate with wether or not I would keep my freedom I was not behind bars but I was definately a prisoner of my addictions and just wanted to publicy share my gratitude that AA was there when I needed it because nothing before that had opened my eyes ,no counselor or pill in my opinion is as effective as one drunk talking to another drunk. Best Regards Mark M. Rule 62

  • Calaverasgrande

    I’m a former alcoholic. I’m also an atheist.
    Due to some legal entanglement I was for a period of time required by a judge to attend AA and NA.
    I found the higher power talk nonsense. But as I was genuinely trying to be clean I found the barely concealed substance abuse and criminal behavior very distracting. I also did not think it was very cool how some people with 10 year coins prey on newbies for sex.
    AA/NA date to a different time. They are outdated and frankly corrupt.
    The recidivism rate is no surprise when half of the meetings I have ever been to are a great place to score meth.
    But what really drove me away from AA was that once I was over alcohol (yes you get to a point when you can imagine life without it) I no longer could buy into the AA victimology.
    I am not an alcoholic. I am a FORMER alcoholic.

  • Daniel Morgan

    This is one of the most brilliant articles I’ve ever encountered, period. As the son of an alcoholic father and al-anon mother, I never was able to understand the helplessness which AA brought, even nurtured in members minds. I think the entire program is pathetic and wish instead of abstinence persons would learn self-control and all this entails, ie coming to terms with themselves, being honest about every aspect of their (likely failed) lives and owning them as their own faults and no one else. I am happy my father gave up the sauce for my brother and I but I am sure it was not the only way, for it cost him his friends and entire social life, much less his marriage and financial freedom. Is that really the best he could ever have hoped for, starting some 30 years ago.

  • Malik

    What strikes me is that much of the criticism of AA avoids squarely addressing what lies at the root of the AA method. Typically, the addict is utterly self-centered and self-justifying, which is what leads to their destructive behavior. Acknowledging a “higher power” is not about endorsing any particular form of theology or metaphysics. It’s about cultivating what I suspect most addicts most desperately need: humility. None of us is the center of the universe.

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Last April, the Atlantic published a feature-length takedown of America’s longest-standing mutual-aid fellowship. “The False Gospel of Alcoholics Anonymous” was the work of Gabrielle Glaser, who delivered the bad news in dry and dismal statistics. According to modern studies, AA’s success rate is between 5 and 8 percent. Glaser claimed she was surprised by the numbers (“I assumed as a journalist that AA worked”), though the article betrayed a longstanding skepticism. Over the past few years, Glaser has been advancing the message in major news organs that twelve-step programs are bad for everyone, including women (Wall Street Journal), teenagers (New York Times), heroin addicts (Daily Beast), South Africans (Marie Claire) and doctors (Daily Beast again). But at eight thousand words, the Atlantic article was longer and received far more attention than her earlier publications. It also offered the most complete formulation of her case. “The problem is that nothing about the 12-step approach draws on modern science,” Glaser wrote, “not the character building, not the tough love, not the 28-day rehab stay.” If alcoholism is truly a disease, why is the default treatment a spiritually oriented support group run by nonprofessionals?

The story brought to the surface long-harbored suspicions about the idiosyncrasies of AA: its tent-meeting lexicon, the curious symmetry between the twelve steps and the twelve apostles, the whiff of secrecy and anonymity, the catacombic meeting spaces. During Glaser’s media tour following the article’s publication, news anchors and radio hosts were eager to connect the dots in places where the article had doubtlessly been constrained by fact-checkers. (“Let’s go conspiracy theory just for a moment,” said one radio host.) Glaser played her part by referring to the text Alcoholics Anonymous as AA’s “bible” and by claiming that members were ordered off their psychiatric drugs and forbidden from consulting doctors. When one host asked her to impart some closing words, she spoke as though voicing a public service announcement: “If you are concerned about your drinking, it is really helpful to say to yourself, You can change your drinking yourself. You have agency, you have control over it.”

When Glaser’s interviewers began citing counterarguments, Glaser responded with science: not, that is, with statistics or data, but literally with the word “science.” “Epiphanies are not science,” she remarked in response to the claim that AA’s religious focus could be helpful. In reply to the observation that AA has worked for a lot of people, she said, “But that’s not science. That’s anecdote.” Then she resorted to anecdote herself: “Hundreds of people have written to me to say that they were ordered off their meds by their sponsor for their mood disorder.” On NPR’s All Things Considered, she dropped her voice and spoke in a breathless, confiding tone: “Someone sent me an email this morning about a younger brother who committed suicide last night with a Big Book and a glass of scotch next to his bed.”

All of this might be dismissed as simply feeding our wolfish hunger for seeing respected institutions tarnished by scandal and exposé. But attitudes toward addiction, which Aristotle called one of the “irrational passions,” have long offered a revealing window into cultural assumptions about human behavior. And although Glaser often presented herself as a voice in the wilderness, she is not the only one who has felt compelled to deliver the inconvenient truth about AA. Last year, Dr. Lance Dodes, a retired Harvard psychiatry professor, published The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, which he co-wrote with his son Zachary. More recently, Dr. Markus Heilig, of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), echoed Glaser’s call for more “evidence-based” treatment in The Thirteenth Step: Addiction in the Age of Brain Science. AA has attracted critics since its inception, but these authors constitute something of a new breed, and their work shares a central thesis: while AA maintains a special place in the American imagination, the data is clear that it simply doesn’t work.

This charge is, it turns out, easy enough to refute; what makes these books worth pausing over is the sensibility that motivates them. Beneath the number crunching and the medical jargon lies the conviction that AA is not just ineffective but incoherent, repellent even. In the end, the most recent skirmish in the long quarrel between AA and its “scientific” critics hinges upon a question of human agency: Can the individual reallyas Glaser allegeshelp herself?

Alcoholics Anonymous’s recent critics are united in presuming that science has not yet been harnessed for the treatment of addiction. In fact, scientists have been probing at alcoholism since before the Progressive Era. In 1870 inebriety was officially pronounced a “disease” by the American Association for the Study and Cure of Inebriety, an institution that declared, somewhat prematurely, that alcoholism was “curable in the same sense that other diseases are.” Of course, the “cures” were rarely effective; some were actually dangerous. For nearly a century, hydrotherapy was the leading treatment for alcoholism. Nurses would wrap the detoxifying patient in cold, wet sheets, swaddling him for many hours. If that didn’t work, the drunkard might be subject to an electric light bath, a method used by almost all of the leading hospitals of the world. This technique required locking the patient in a steel box, the inside of which was lined with plate mirrors, dozens of light bulbs and steam coils to produce a sauna-like atmosphere. Medical authorities believed the light would purge “alcoholic germs” from the patient’s cutaneous tissue. This is to say nothing of prefrontal lobotomies, spinal puncture, colonic irrigation therapy or the dozens of other addiction treatments carried out over the last century in the name of science.

 Medication, likewise, is hardly a new proposal for alcoholics. Throughout the nineteenth and early twentieth centuries, newspapers advertised a panoply of commercial tonics: the Fittz Cure, the Bellinger Cure, and the Tiplicuro. The most famous was Dr. Leslie Keeley’s Double Chloride of Gold Cure, a remedy composed of strychnine, cocaine, codeine and morphine that was given to over half a million alcoholics between 1880 and 1920. Many of these medications were the products of charlatanscountry quacks hoping to get rich off the curesbut the drugs recommended by the leading medical institutions offered little improvement over the commercial remedies. The Progressive Era was characterized by a frantic search for an alcoholism “vaccine”one was made from the blood of horses that had been fed buckets of whiskeyand the twentieth century witnessed faddish experiments in “aversion therapy,” giving alcoholics drugs that would make them violently ill when they drank. Some of these aversion drugs are still on the market today (Antabuse is the most popular), though there is little evidence of their efficacy.

From the beginning, some alcoholics sought alternative routes to recovery. In his history of addiction treatment in America, Slaying the Dragon, William L. White notes that throughout the nineteenth and early twentieth centuries many alcoholics banded together and offered one another support through a variety of mutual-aid societies like the Washingtonian Total Abstinence Society, a fellowship of working-class men founded in the 1840s that held gatherings resembling a contemporary AA meeting. Members signed an abstinence pledge and told the story of their reform from a podium, drawing from the camp-meeting tradition of “experience sharing.” At the height of the movement there were more than 600,000 members throughout the United States; Abraham Lincoln, though a lifelong abstainer, was a vocal supporter of the program.

Some fellowships, like Dr. Henry A. Reynolds’s clubs, were offshoots of temperance societies for those “addicted to strong drink.” Others grew out of fraternal orders. The Sons of Temperance, as one member explained, was formed to address the need for mutual accountability and moral support. “A society was, therefore, needed which should offer a refuge to reformed men and shield them from temptation.” These were far from sparsely populated fringe movements: during the 1850s, the Sons of Temperance boasted 250,000 members, with chapters in every state. Like the Washingtonians, these groups emphasized experience sharing and provided a haven for reformed drinkers within a culture that still stigmatized addiction as a moral vice. Many of the personal testimonies demonstrate a surprisingly contemporary understanding of alcoholism as neither a moral deficiency nor a sign of poor education. In his speeches, Dr. Reynolds would often call attention to his knowledge as a physician, on the one hand, and his inability to control his own drinking, on the other. “I am a graduate of Harvard College, and received a thorough medical education, but I have been drunk four times a day in my office, and if there is any worse hell than I have suffered I don’t want to be there.”

The popularity of such fellowships was undoubtedly fueled by the fact that professional medical treatments were so unhelpful. But these societies also sought to address addiction in ways that extended beyond the scope of medicine. Many were viewed as part of a “continuum of care.” While medical treatment was naturally isolating, taking patients away from their families, the fellowships provided a community to belong to once the work of the hospitalsdetoxification and stabilizationwas finished. The goal was to equip the alcoholic with the moral clarity needed to set things right with themselves and their social circles. Some, like the Washingtonians, even maintained a pool of money for the purpose of helping newcomers pay off their debts and court fees.

Many of these organizations dissolved during Prohibition, and by the 1930s there were few remaining mutual-aid societies. Like many wealthy alcoholics of that era, Bill Wilson, AA’s founder, spent much of his adult life receiving the latest and most expensive medical treatments, including hydrotherapy and the famous belladonna cure, an acrid cocktail of prickly ash and the hallucinogen nightshade. It was while taking belladonna at Towns Hospital in Manhattan that Wilson underwent his famous conversion experience. He saw a bright light and felt he was in the presence of God. “Scales of pride and prejudice fell from my eyes,” he remembers. “A new world came into view.”

During the early months of his sobriety, Wilson often returned to Towns Hospital and asked to speak to the patients. It was there that he realized his urge to drink subsided when he was talking to other suffering alcoholics. “It was not just a case of trying to help alcoholics,” he said. “If my own sobriety were to be maintained, I had to find another alcoholic to work with.” As he began to sober up fellow patients, they too followed his method of working with other alcoholics. By 1939 there were a hundred men and women involved in this informal fellowship, and Bill began to devise a program of recovery based on the principle of “one alcoholic working with another.”

Alcoholics Anonymous is notoriously difficult to evaluate scientifically. Several observational studies have been quite favorable to the programfinding, for instance, that the longer people attend twelve-step meetings, the more likely they are to achieve long-term sobriety, or that engagement in meetings, as opposed to mere attendance, can be correlated with sobriety. But for many such studies are innately compromised by the fact that their members self-select. In The Sober Truth, Lance Dodes dismisses the observational studies wholesale. The kinds of people who go to AAmoreover, the ones who stick aroundare those who find it useful. What about everyone else? To really understand the effectiveness of AA, Dodes suggests, we must consider everyone who walks into the rooms, including those reluctant attendees who sulk into the back rows of speaker meetings, nod off during the Serenity Prayer and never return. AA’s literature claims that those who fail to fully participate in the twelve steps tend to relapse, but for Dodes such warnings are little more than community propaganda, a way of blaming the participant when the program fails them. “Imagine if similar claims were made in defense of an ineffective antibiotic,” he writes.

As the comparison makes clear, Dodes conceives of AA as a “treatment” for alcoholism, a term that assumes patient passivity and is at odds with how members often describe the programas a spiritual discipline that requires its participants to engage in a series of actions and rituals. Yet it is the discussion of attendance versus participation that lays the groundwork for Dodes’s conclusion about AA’s inefficacy. Citing data from the NIAAA that claims up to 31 percent of people who go to AA stick around for a year or more, Dodes then modifies those numbers to reflect attendance rather than involvement. If we include all the people who have attended at least one AA meeting but failed to get “actively involved”according to one study, that number is around 79 percentthe success rate becomes significantly smaller. And because the NIAAA data does not specify how many of those attendees remained sober during their year of engagement, Dodes decides to dock the number an additional several percentage points for good measure. It is this gerrymandered set of data that leads Dodes to the conclusion that just “5 to 8 percent of the total population of people who enter AA are able to achieve and maintain sobriety for longer than a year.”

AA’s low success rate compels Dodes to look for alternative treatment paths, and The Sober Truth is ultimately an argument for his specialized brand of “psychodynamic” therapy, which is built on the proposition that the addictive impulse can be traced back to a single source: the desire to reverse a sense of “overwhelming helplessness.” According to this theory, AA’s poor statistical showing should come as no surprise, given that the program reinforces the addict’s sense of helplessness as opposed to combatting it. The process of making amends, for instance, involves needless self-flagellation. Equally disturbing is the notion that addicts must rely on a higher power to stay sober, even if the step is interpreted, as it often is by AA’s more secular members, as making the group itself into the higher power. “The problem persists,” he writes. “Why can’t this ultimate power lie within the addict?”

Glaser, who cites Dodes’s research several times in her Atlantic article, asks the same question in her book-length treatment of the subject, Her Best-Kept Secret: Why Women Drinkand How They Can Regain Control. The book, which bills itself as a clarion call for “evidence-based” addiction treatment, insists that the twelve stepssuch as admitting “powerlessness” and submitting one’s will to a higher powerare particularly damaging to AA’s female members. Glaser tells the stories of several affluent suburban women who summon the courage to attend a meeting only to discover that it’s a massive downer. They don’t like that abstinence is non-negotiable. They are horrified by the prospect of uttering the words “I’m an alcoholic.” They balk at the terms “powerlessness” and “surrender.” In her Atlantic article Glaser tells the story of Jean, a floral designer whose physician recommends she try AA:

The whole idea made Jean uncomfortable. How did people get better by recounting the worst moments of their lives to strangers? Still, she went. Each member’s story seemed worse than the last: One man had crashed his car into a telephone pole. Another described his abusive blackouts. One woman carried the guilt of having a child with fetal alcohol syndrome. “Everybody talked about their ‘alcoholic brain’ and how their ‘disease’ made them act,” Jean told me. She couldn’t relate. She didn’t believe her affection for pinot noir was a disease, and she bristled at the lines people read from the Big Book: “We thought we could find a softer, easier way,” they recited. “But we could not.” Surely, Jean thought, modern medicine had to offer a more current form of help.

Much of AA’s philosophy is built on the principle of “identification”seeing yourself in the stories of otherswith newcomers like Jean being encouraged to “look for the similarities.” But according to Glaser, identification is precisely the problem. One of her favorite ways to criticize AA is to refer to its “one-size-fits-all” approach. Evidence-based treatment, in her view, should treat each alcoholic as a unique case, helping her discover the cause of her own drinking and developing customized recovery goals, whether abstinence or moderation. And it is this mode of treatment that distinguishes Your Empowering Solutions (YES), a treatment center in Palos Verdes, California, for which Glaser reserves her most ebullient praise.

The chapter on YES, entitled “Twenty-First-Century Treatment,” follows the story of Joanna, a mezzo-soprano who enrolls at a time when she has been drinking roughly three liters of chardonnay a day. Joanna is immediately impressed by the “bright, modern office,” the friendly staff and the positive vibes (“even the magazines were upbeat”). She’s given a personalized therapy regime, which consists mostly of discussing her life goals with her psychiatristsa technique called “motivational interviewing”though she also takes a lot of long walks on the beach, listens to meditation CDs, and eats big salads at local cafes with her two psychiatrists. “There was no dining hall, no other patients she had to make small talk with: just Joanna and her two shrinks.” During her treatment, Joanna comes to a series of realizations, including the epiphany that drinking is preventing her from using her leisure time efficiently. “In addition to adding more exercise and eating better, she wanted to finish decorating her master bedroom, organize her belongings better, and hang pictures that had been sidelined next to the wall for years.” She leaves the center at the end of the week with a customized treatment plan and a prescription for naltrexone, an opioid antagonist Glaser claims can help alcoholics drink in moderation. “As she returned to Pennsylvania, she felt armed with knowledgeabout herself, her personal development, and the vision she had for her life.”

The reader is left to wonder why a woman who decided to spend $10,000 on addiction treatment needed a doctor to help her realize drinking was interfering with her life. But Glaser’s case studies are rife with simplistic moments of revelation. Many of the women she writes about find help via online recovery programs that rely on cost-benefit analysis to show users how their drinking is irrational. Fully autonomous and empowered by data, these women rigorously check their stats and make adjustments accordingly, sometimes aided by doctors who are less figures of medical authority than hired number crunchers or benign spirit guides, facilitating their personal journey. When Jean, the floral designer, returns to the bottle, Glaser proudly notes that her doctor “calls this ‘research,’ not ‘a relapse.’” (Members of twelve-step programs also refer to relapses as “doing more research,” though the tone is notably less sunny: “I saw Bob’s car outside the liquor store this morning. Guess he went out to do some more research.”)

If addicts are engaging in behavior that is detrimental to their interests, Glaser insists, it must be because they lack the information or insight to make educated choices. The same conviction lies behind a spate of new mobile apps for addictsprograms like recoveryBox, a toolset that allows users to track their behaviors each day, rating their anxiety and depression levels and categorizing each action as either “green” (taking medication, exercising), “yellow” (engaging with triggers) or “red” (relapse). Based on these self-reported actions, the application will alert the user when he or she is entering a risk zone. “Breaking habits requires knowing why we do what we do, when do we do it and coming up with goals to break unhealthy behaviors,” reads recoveryBox’s website. A similar assumption underlies A-CHESS, a smartphone app for alcoholics that can track when the user is nearing a bar or tavern and alert their counselor. The app is said to reduce the risk of relapse by offering reminders that “encourage adherence to therapeutic goals” and providing users with “individualized addiction-related educational material.”

For all the bluster about modern science, though, such approaches to addiction are far from original. Throughout early American history, alcoholics were exhorted to overcome addiction through willpower and sedulous self-monitoring. In fact, the charts and cost-benefit analyses Glaser recommends resemble nothing so much as puritan temperance tracts. These pamphlets, which bore titles like “Practical Facts for Practical People,” sought to reform addicts with ample doses of logos, arguing that drunkenness interfered with one’s health and productivity. Some, like “The Cost of Beer,” laid out the economic costs of drinking in precise dollar amounts, demonstrating that drunkenness was inefficient. These pamphlets and lectures amounted to little more than pep talks, but they were girded with the authority of science. Preachers peppered their sermons with quotes from scientists and doctors, while one of the leading early temperance organizations was called the Scientific Temperance Federation of Boston. The idea was that if people were informed about the costs of their bad decisions, then they would have no choice but to turn their lives around. It was precisely the failure of such methods that caused addicts to gravitate toward mutual-aid societies like AA in the first place.

The promise of self-mastery has long occupied the American imagination. In “The Way to Wealth,” a collection of maxims eventually added to his best-selling Autobiography, Benjamin Franklin offered rigorous self-scrutiny as a method for curtailing vice and achieving commercial success. A century later the transcendentalists, led by Emerson and Thoreau, would privilege the virtues of “self-reliance” over ties to any community, tradition or institutional authority. (“Trust thyself,” boomed Emerson, “every heart vibrates to that iron string.”) Closer to the time of AA’s founding, the American individualist creed had trickled down into the works of popular self-help gurus like William Walker Atkinson, whose 1906 book Thought Vibration held that “every man has, potentially, a strong Will … all he has to do is train his mind to make use of it.”

It is no accident that Alcoholics Anonymous originated during the 1930s, at a time when the deprivations of the Great Depression caused Americans to question many of their long-held assumptions about such matters. The sociologist Robin Room has noted that the program’s philosophy deeply resonated with the generation of men whose motto “I am the master of my fate, I am the captain of my soul” had failed to protect them from economic calamity. AA’s founder, Bill Wilson, was a stockbroker whose personal nadir coincided with the crash of the market, and in his autobiographical writings he often conflated the failure of this national ideology with his inability to master his own drinking. “A morning paper told me the market had gone to hell again,” he wrote of a relapse in 1932. “Well, so had I.”

Shortly after his spiritual transformation, Wilson read William James’s The Varieties of Religious Experience, a book that offered a humble alternative to the prevailing ethos of self-determination. James believed that American life was marked by “over-tension,” a vestige of the Protestant work ethic. “Official moralists advise us never to relax our strenuousness,” he writes. “‘Be vigilant, day and night,’ they adjure us; ‘hold your passive tendencies in check; shrink from no effort; keep your will like a bow always bent.’” For James, this obsessive self-monitoring leads to an impasse of the will, a continuous battle between the spirit and the flesh. It was not modern science but rather ancient religion that provided James with the imagery he would use to describe these warring desires. He found in the works of spiritual writers repeated examples of the condition he called “the divided self.” The words of the Apostle Paul were emblematic: “For I do not understand my own actions. For I do not do what I want, but I do the very thing I hate.”

James held that for individuals who were enslaved by such a condition, no amount of rationalizing could help: “Peace cannot be reached by the simple addition of pluses and elimination of minuses from life.” The divided self, he argued, could be made whole only through an anti-moralistic method, a process of surrender that reoriented the attention onto an external objective, thereby transcending the old, rigid patterns of thinking:

Give up the feeling of responsibility, let go your hold, resign the care of your destiny to higher powers, be genuinely indifferent as to what becomes of it all, and you will find not only that you gain a perfect inward relief, but also, in addition, the particular goods you sincerely thought you were renouncing. This is the salvation through self-despair, the dying to be truly born … To get to it, a critical point must usually be passed, a corner turned within one. Something must give way, a native hardness must break down, liquefy; and this event (as we shall abundantly see hereafter) is frequently sudden and automatic, and leaves on the Subject an impression that he has been wrought on by an external power.

The idea of the sundered self resonated with Wilson, who had been baffled by his own “incredible behavior in the face of a desperate desire to stop.” His own Iliad of addiction, which appears in the first chapter of Alcoholics Anonymous, reverberates in the personal narratives that appear in the book’s subsequent pages. The alcoholic comes up with rational theories about his drinking and embarks on experiments designed to master it: drinking only beer, exercising more, going to psychoanalysis. “But there was always the curious mental phenomenon,” Wilson writes, “that parallel with our sound reasoning there inevitably ran some insanely trivial excuse for taking the first drink. Our sound reasoning failed to hold us in check. The insane idea won out.” To be an alcoholic, Wilson argues, is to confront the essentially irrational side of one’s nature. Looking deeply into the self only draws one further into the realm of the absurd.

 In order to escape the endless cycle, the addict had to train his or her gaze away from the self, directing it toward a higher power and the still-suffering alcoholic. This concept was, as much as the program’s spiritual emphasis, an application of James’s ideas (later in life, Wilson would claim that James was “a co-founder of AA”): rather than focusing on one’s own internal war, the alcoholic externalized that struggle by working with another man who was worse off. Those who complain that the program is run by “nonprofessionals” often miss the fact that, according to Wilson’s model, the primary beneficiary is the provider of aid, not its receiver. AA has often been labeled a “self-help group,” but it is in fact the opposite: a fellowship for people who have utterly failed in their attempts to help themselves.

When Alcoholics Anonymous was published in 1939, the American Medical Association declared it to have “no scientific merit or interest,” while the Journal of Nervous and Mental Disease called it a “rambling sort of camp meeting confession of experience.” Such perspectives, which resemble those taken by Dodes and Glaser, continue to find a sympathetic audience today, when confessing to being powerless over anything is regarded as a defeatist attitude starkly at odds with the mandate to better oneself through insight and information. In fact, belief in the mantras of scientific self-empowerment is so strong that it often persists even when science itself seems to indicate what AA has always suggested: that the conviction that we can take control over our lives isespecially for addictslargely an illusion.

Indeed many neurologists now believe alcoholism is a brain disease that inhibits precisely the sort of “rational” thinking Glaser and Dodes insist upon. This is the contention of Markus Heilig, the chief of clinical studies at the National Institute on Alcohol Abuse and Alcoholism. Heilig holds a Ph.D. in psychiatric neurochemistry and has spent two decades working with alcoholics. Although there’s no indication that he has read Dodes or Glaser, the first chapters of his book The Thirteenth Step read like a bald refutation of their theories. Heilig thinks it is a mistake to encourage alcoholics to moderate or psychoanalyze their behavior; the whole point is that the addict lacks self-control. In fact Heilig goes further, dismissing the very notion of free will in a breezy eight-page chapter relaying the “astonishing” hypothesis that human beings are “no more than the behavior of a vast assembly of nerve cells and their associated molecules.”

One would think that Heilig’s biological materialism would make him partial to drug-related treatments for addiction. But while much of Heilig’s book is spent discussing the promise of such pills, he argues that medication is a long way from being able to address alcoholism in its full complexity, since (unlike other addictions) it does not interact with a specific brain receptor. Until the drug situation improves, Heilig recommends cognitive-behavioral therapy. This includes strategies such as “fishbowl reinforcement,” in which clean urinalyses are rewarded by granting the addict the privilege of reaching into a glass fishbowl to retrieve a slip of paper that says “Good job!” or promises a small cash reward, and other methods like encouraging the addict to write a “set of screenplays” to help her avoid “relapse triggers.” “Use your creativity to develop what that alternative plot will be,” Heilig advises, “because it has to be one that works for you, and you are the expert on your own life.”

Aside from the sheer silliness of such methods, a paradox lurks in Heilig’s logic. Aren’t such strategies a contradiction in terms for someone who doesn’t believe in free will? Heilig has considered this objection. While personal choice remains an illusion, he argues, recovery depends, conversely, upon the patient’s belief in their ability to choose, a concept he calls “self-efficacy”: “To get to their goals, people need to feel that they have an ability to influence the course of their lives.” Of the inconsistency in this reasoning, Heilig writes:

I don’t know how to theoretically reconcile an understanding of the brain as a machinery that produces behavior based on the laws of nature, on one hand, with a view of the brain’s owner as an agent endowed with free will to choose one behavior over another, on the other. It does not seem that anyone else knows the answer to this dilemma either, so I have decided not to worry too much about it for now.

Heilig’s honesty is commendable, but it raises an obvious question: If the leading scientific experts contend that recovery from addiction depends upon belief in a fictional entityfree willwhy is it any more “irrational” to believe in YHWH, the spirit of the universe, or the community of fellow alcoholics? If a fundamental barrier to recovery is distrust of one’s “self-efficacy,” wouldn’t it make perfect sense for the addict to mentally project that fictional power onto an external entity to whom she can then appeal for help?

After his spiritual awakening, Bill Wilson was seized with fear that he was going mad. He had lost his desire to drink and felt he had experienced the presence of a higher power, but he also considered the possibility that he’d had a hallucination. When he described the experience to his doctor, the physician responded with an air of suspended disbelief. “Something has happened to you I don’t understand,” he told Wilson, “But you had better hang on to it.” It was this momentrather than the spiritual experience itselfthat Wilson would credit with saving his life. “If he had said ‘hallucination,’” he wrote years later, “I might now be dead.”

That physician, Dr. William D. Silkworth, would become a lifelong advocate for AA. When the Big Book was published, he wrote an introduction entitled “The Doctor’s Opinion.” The introduction is offered as a medical perspective on alcoholism, but Silkworth spends much of the chapter speaking of the limits of his own profession when it comes to curing addiction. “We doctors have realized for a long time that some form of moral psychology was of urgent importance to alcoholics,” he wrote. “But its application presented difficulties beyond our conception. What with our ultra-modern standards, our scientific approach to everything, we are perhaps not well equipped to apply the powers of good that lie outside our synthetic knowledge.” While Silkworth’s classification of AA as a form of “moral psychology” betrays some uneasiness with the program’s spiritual rhetoric, what ultimately convinced him was the evidence of the lives he’d seen changed. “We feel, after many years of experience, that we have found nothing which has contributed more to the rehabilitation of these men than the altruistic movement now growing up among them,” he wrote. The sentiment shares a bloodline with the pragmatism of William James, who held that “we cannot reject any hypothesis if consequences useful to life flow from it.”

So useful were the contributions of AA that, by the early 1960s, the program had grown to a membership of over 120,000 in the U.S., with over eight thousand groups around the world. Perhaps these numbers gave Wilson the confidence to seek out another luminary in the scientific communityCarl Jung. Wilson noted in his first letter to Jung that the psychiatrist’s writings were popular among AA members. “Because of your conviction that man is more than intellect, emotion, and two dollars’ worth of chemicals, you have especially endeared yourself to us,” he wrote. But Wilson was writing primarily in regards to a mutual acquaintance named Rowland H., a former patient of Jung’s who had been pronounced “incurable.” Wilson announced that Rowland had since undergone a spiritual awakening, gotten sober and played a prominent role in the founding of AA.

Jung responded to the news with enthusiasm. He’d long suspected that experiences of this kind could have such an effect on alcoholics, but the nature of his profession prevented him from prescribing a spiritual solution. “The use of such words arouse so many mistakes that one can only stay aloof from them as much as possible,” he writes. “These are the reasons why I could not give a full and sufficient explanation to Roland H., but I am risking it with you.” Jung proceeds to describe, in halting terms, the path by which one may experience such a transformation, led by “an act of grace, or through personal and honest contact with friends, or through a high education of the mind beyond the confines of mere rationalism.”

Jung admits that these concepts don’t roll easily off his tongue, that the language of his professionof modernity in generalisn’t adequate to his curiosity. “How,” he asks, “could one formulate such an insight in a language that is not misunderstood in our days?” Perhaps Jung was speaking from experience. His own work often fell outside the boundaries of what was conventionally accepted as science, and he was no doubt familiar with his colleagues’ tendency to marginalize what they did not understand. But his reluctance to dismiss AA embodies the very skepticism that is supposed to lie at the heart of the scientific endeavora willingness to interrogate one’s own methods and, when necessary, to admit their limitations. When it comes to a province of human nature so elusive and vexed, we might do well to embrace such sobriety.

Art credits: John Reuss

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  • Michael

    Thank you so much for your effort, this was a great read.

    Did you look into government-funded substance abuse treatment in your research? There is a similar divide growing in that field, I believe. Many counselors are recovering alcoholics or addicts, and intuitively expound the steps, principles, and maxims of Alcoholics Anonymous. However, funding requires more and more documentation of Individual Treatment Plans, proof of Relapse Prevention classes (i.e., rational thinking), and other “evidence-based” methods of recovery. In short, when taxpayers are footing the bill, the same argument is intensified. Just wondering if you stepped in that swamp at all.

  • Magenta

    Quote: In reply to the observation that AA has worked for a lot of people, she said, “But that’s not science. That’s anecdote.” Then she resorted to anecdote herself: “Hundreds of people have written to me to say that they were ordered off their meds by their sponsor for their mood disorder.”

    It is at this point that one may dismiss this whole too-long article: What is on display here is the tu quoque fallacy. This is no rebuttal to the fact–the utter fact–of AA’s low success rate and its reliance on superstition.

  • Robert Powell

    very interesting, as a researcher and policy analyst I was critical of AA , the disease model which continues to be refined by the new panacea of neuroscience is a false metaphor, there might be correlations between certain in ate factors and addiction however many alcoholics stop drinking on there own, entire swaths of Ireland , Russia and aboriginal lands seemed to be populated by individuals with this disease which is embedded emergent and actualized through multiple factors the disease model also provides the individual with a narrative that locates the behaviour firmly within the subject and can lead to resignation , howeebr the most important ant variable in treatment success is not type or length of treatment but access to aftercare, AA with it’s somewhat unsavory assumptions produces results is ubiquitous and has begun to adapt for example in Aboriginal communities the 12 steps include social determinants

    any professional who would discard AA with such contempt is obviously more concerned with their needs and not those suffering from addictions, I put aside my intellectual discomfort with AA in order to provide a range of appraoches, I a sidebar I would add that in terms of cost be if it it also very reasonable

  • Scott S

    If you go to an AA meeting and don’t follow the suggestions and work the program and go back out and relapse, you really should not count against the success rate. People who haven’t given AA or CA a shot have no idea what they’re talking about. I’m a recovered heroin, meth, benzo addict as well as an alcoholic, and I couldn’t have done it without AA. Until science can explain why someone will drink or get high when every bone in their body is telling them that they shouldn’t, or why someone does not genuinely want to get sober when they’ve lost everything in their life, then this argument is a rather pointless one. And if your sponsor tells you to quit your meds, get a new sponsor. It’s that simple. I have a friend in recovery who got injured, was prescribed opiates, took them as directed, and is still sober. AA works if you work it.

  • lee michael

    Alcoholism is a behavior not a disease. Period

  • Mark

    Great article, I normally laugh at these types of articles of people trying to figure out AA but yours was very insightful I agree that people find it hard to admit they are powerless over something but we here it all the time with celebrities that they have been battling their addiction for years which implies they are in a fight for their life when. In fact a better approach is surrender to win .I read the big book at 17 years old because i was out of control with drinking and drugs but i did not read it to get sober because at that point in my life I enjoyed being out of control I read it to find out what the CATCH was and in the 15 years i attended AA meetings I never found one.they never asked me to do or believe anything, what I did find were people trying to be better than they were yesterday thats it no mystery no secret handshakes nobody wrote down my information and i was able to witness that not everyone stayed but as Bill Wilson learned that by helping others he stayed sober and there is a promise in the big book that if you stay sober you can one day move in to the mainstream of life and 15 years ago I chose to stop attending meetings only because my life has become so “mainstream” it just felt natural to leave and with what I was able to learn there January 11th 2016 I was able to celebrate 30 years of a sober life something I never dreamed was possible I only share that in hopes it can inspire hope in someone who feels hopeless right now and I could not have done it if I thought I had to stay sober for 30 years but I did what was suggested. One day at a time and the only thing my sobriety affords me is to have a shot at a good life because I got sick of drugs and booze making all my decisions for me evety day like where I would sleep who I would associate with wether or not I would keep my freedom I was not behind bars but I was definately a prisoner of my addictions and just wanted to publicy share my gratitude that AA was there when I needed it because nothing before that had opened my eyes ,no counselor or pill in my opinion is as effective as one drunk talking to another drunk. Best Regards Mark M. Rule 62

  • Calaverasgrande

    I’m a former alcoholic. I’m also an atheist.
    Due to some legal entanglement I was for a period of time required by a judge to attend AA and NA.
    I found the higher power talk nonsense. But as I was genuinely trying to be clean I found the barely concealed substance abuse and criminal behavior very distracting. I also did not think it was very cool how some people with 10 year coins prey on newbies for sex.
    AA/NA date to a different time. They are outdated and frankly corrupt.
    The recidivism rate is no surprise when half of the meetings I have ever been to are a great place to score meth.
    But what really drove me away from AA was that once I was over alcohol (yes you get to a point when you can imagine life without it) I no longer could buy into the AA victimology.
    I am not an alcoholic. I am a FORMER alcoholic.

  • Daniel Morgan

    This is one of the most brilliant articles I’ve ever encountered, period. As the son of an alcoholic father and al-anon mother, I never was able to understand the helplessness which AA brought, even nurtured in members minds. I think the entire program is pathetic and wish instead of abstinence persons would learn self-control and all this entails, ie coming to terms with themselves, being honest about every aspect of their (likely failed) lives and owning them as their own faults and no one else. I am happy my father gave up the sauce for my brother and I but I am sure it was not the only way, for it cost him his friends and entire social life, much less his marriage and financial freedom. Is that really the best he could ever have hoped for, starting some 30 years ago.

  • Malik

    What strikes me is that much of the criticism of AA avoids squarely addressing what lies at the root of the AA method. Typically, the addict is utterly self-centered and self-justifying, which is what leads to their destructive behavior. Acknowledging a “higher power” is not about endorsing any particular form of theology or metaphysics. It’s about cultivating what I suspect most addicts most desperately need: humility. None of us is the center of the universe.

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