Alcoholics Anonymous: One Man’s Analysis of the Criticisms

Posted on March 10, 2012 by Douglas Rudolph

Alcoholics Anonymous is no stranger to controversy. It has the tendency to evoke praise from many, and disdain from just as many. Despite the divide, whether you’re a believer or not, AA generally has the reputation of having helped millions of suffering alcoholics achieve sobriety. In 1935, at its birth, AA was revolutionary as the first of its kind to successfully synthesize parts of psychology, philosophy, theology, and democracy into a workable method of recovery from alcoholism without any knowledge of genetic or biochemical causes of addiction. For over 75 years, AA has more than just endured the test of time: it has permeated our justice system, the 12 Steps are implemented in public and private treatment centers, and there are over two million members world wide who volunteer to ensure that AA is accessible in a community near you. Needless to say, Alcoholics Anonymous is the most prominent support group for alcoholics in the universe. But prominence alone has not been able to shield AA from the sword of criticism.

Alcoholism is a complex illness which is caused by a jumbled mess of psychological, biological, and social factors. Because no two people are identical, alcoholism affects everyone differently. It can range anywhere from mild problem drinking to life-threatening physical dependence. The intensity of the illness hinges upon a varied mixture of the same forces that cause alcoholism. Different from most other illnesses, recovering from alcoholism can be demanding. For example, when people go to the doctor because of the flu, they generally just want to get better. They don’t necessarily want or need to anchor their lives around working to fix their illness. Alcoholics, on the other hand, may need to center their lives around getting better because of the all-encompassing nature of the illness. Alcoholism can debilitate an alcoholic’s entire life, such as the ability to function in their daily lives and in their relationships. Recovering from such an illness may require a level of motivation and commitment to work a program that reflects the intensity of the illness, which will vary from person to person.

AA allows for various types of alcoholics to work its program of recovery; however, because of the complexity and individualized nature of the illness, AA may not meet every single alcoholic’s needs. In AA, there is a strong emphasis on the group, and a time consuming commitment to AA’s program of recovery, which may not necessarily be what a successful recovery requires for all alcoholics or problem drinkers. Further, if a person doesn’t click with their group or find the tenets of AA useful, AA will not be effective. In a recovery program such as AA, an alcoholic needs to be motivated and committed to working such a program regardless of the severity of his or her illness, which may not work for all those afflicted.

Now, there may be perfectly legitimate reasons to criticize AA, especially after steering through 75 years of medical advancements since the dawn of AA. However, these criticisms would be much better served directed at treatment centers and court systems. As the treatment industry and the judicial system began utilizing AA, medical and legal issues arose. Despite nearly a century since AA was created, the 12 Step approach still continues to be prominent in treatment centers – since its debut at Hazelden in 1947. There are legitimate questions about whether a program of recovery that two drunks threw together in a kitchen in Akron, Ohio in 1935 should be used today as such a popular approach in treatment centers and medical facilities. Given alcoholism’s high rate of relapse in general, it’s no surprise that the sentiment toward the 12 Step approach began to sour over the last 75 years, in some circles of the recovery community, as treatment centers failed to meet the reasonable expectations of a paid service.

Legal criticisms over the Constitutional reach of the government arose as courts began sentencing offenders into AA, which led to a number of lawsuits. In Griffin v. Couglin, the New York Court of Appeals for the Second Circuit ruled that forcing inmates to AA is a violation of the First Amendment because of what the Court found to be the religious nature of the program, although the Court didn’t recognize AA as a religion. The ruling was based off of AA’s emphasis on a “Supreme Being” as seen in the 12 Steps and other readings. There are now a number of alternative and effective methods to the 12 Step doctrine.

Other criticisms arose as people simply discovered that AA just wasn’t for them. Given the varied and individualized nature of alcoholism, it isn’t shocking that not everyone with a drinking problem will personally find AA effective. Altogether, these criticisms have seemed to cast doubt on AA as a whole. However, 12 Stepping in treatment centers, legally coerced AA attendance, and unsatisfied customers are not the sum total of AA. Rather, the treatment industry, the government, and your local AA meeting down the street are not the same thing, and the unfortunate experiences of a few should not be used to degrade the personal successes of many.

Today, the widespread use of the world wide interweb has given every one under the moon with a computer and an opinion the ability to voice their objections to AA, which has blurred the impression of AA as a lowly and impoverished community-driven support group to an imperial evil mastermind. It’s easy for blogs and website commentators to recklessly spread extreme and uncompromising arguments that minimize a diverse group with over 75 years of members and over 2 million current members into a narrow one-size-fits-all stereotype, and to reduce the genuine and meaningful experiences of many to cancerous and destructive ways of thinking. Unfortunately, as in many other cases, these are the types of arguments that tend to drive the public debate.

One of the more popular arguments widely circulating on the net, that powerlessness over alcohol equals helplessness over life, comes from AA’s first step, which states: we admitted we were powerless over alcohol – that our lives had become unmanageable. Backed by the weight of an opinion, the argument takes a leap in logic to infer that admitting powerlessness over one substance will uncompromisingly result in helplessness over all choices in life. The problem with this logic is that there are many substances that will undoubtedly harm a human being. Admitting powerlessness over, for example, cyanide will not subliminally transform a person into a mindless monster who’s hell bent on consuming all-things-cyanide within reach because a person knows they will die if he or she drinks cyanide. Being aware of the toxic effects of cyanide, like alcohol, will probably save his or her life.

There is no language in the step to indicate that admitting powerlessness over alcohol translates into admitting helplessness over a person’s desire to drink, helplessness over the ability to choose to drink, or helplessness over life. Rather, the powerlessness takes effect once an alcoholic drinks alcohol by abnormally stimulating chemical reactions in the brain, which then triggers compulsive maladaptive drinking behavior. Thus, the first step can be and is used as a personal method to gain insight into the psychological and social relationship between the alcoholic and the alcohol to learn to avoid situations where not taking that first drink may be difficult. In fact, by admitting powerlessness over alcohol, the first step actually gives alcoholics the power to control their thoughts and behaviors to learn to abstain from drinking alcohol.

Another common argument against AA is that AA is a religious organization. This argument comes from AA’s emphasis on a higher power, which can be found in the 12 Steps, because depending on how you’re counting, five, six, or seven of the 12 Steps reference a Supreme Being in some variation. The claim is based on the notion that an alcoholic, to stay sober, must relinquish control of his or her life to a higher power of his or her understanding or God. While many people in AA can and do believe this, AA can and does work for alcoholics who don’t believe in God. The popular Recovery Model for treating mental health and substance abuse disorders has gained widespread use over the past 20 years. This approach to recovery gradually developed as a growing number of ex-patients, identifying themselves as either survivors of psychiatry or mental health, began to campaign for better services and user-led alternatives back in the 1980′s. The World Health Organization (WHO) conducted a string of studies from the 1970′s to 1990′s, which involved applying a patient-driven approach to treating mental health disorders based on the self-help nature of AA. Surprisingly high rates of recovery along with the grassroots campaign for better services led to agencies such as the National Association of Social Workers, the American Psychiatric Association, and the Surgeon General (to name a few) professionally recognizing the Recovery Model as an effective approach to treating mental health and substance abuse disorders, and advocating its use today.

The Recovery Model consists of a list of core elements widely shown to be essential to recovery, such as a sense of hope, sense of self, a secure base, supportive relationships, self-determination, coping strategies, and meaning. These elements vary in degree from person to person and may not all apply, but generally, as a practical approach to recovery, AA can be and has been utilized to satisfy these elements regardless of a belief in a higher power or God.

Some of the language found in AA’s writings must be taken in context with the time period in which AA was created. The language has never been updated, nor ever will be according to AA’s policy, which vowed to preserve its historical value. Despite some of the dated social references and general language, AA can serve a person’s recovery whether a person believes in God or not. Whether you’re atheist, agnostic, or deeply religious, there are several very separate working components to AA that are designed to be utilized as the user sees fit.

The first component of AA is attending meetings, which is widely considered to be the most important component because of the supportive relationships alcoholics gain from the therapeutic value of networking with like-minded people who share a similar experience – which also work to establish a sense of community. The reassurance and support found in a highly accessible established sober network of like-minded individuals who share a similar problem such as AA can serve to create a secure base, too. Meetings where people speak in front of groups can increase a person’s confidence and self-esteem. A person can find hope in meetings by listening to other individuals who overcame similar hardships. Meetings can easily be the extent to which a person in recovery utilizes AA.

The second component is motivation and commitment. Working AA’s program of recovery takes self-determination. And this isn’t referring to AA’s popular slogan “it works if you work it.” But for AA to be effective, there’s a real element that a person’s psychological, biological, and social experience must agree with AA in a way that such a person can find hope, meaning, supportive relationships, a secure base, and coping strategies relevant to getting sober. Regularly attending meetings and working the 12 Steps is an ongoing commitment which takes motivation that’s dependent solely on the individual.

Third, working with others is a component which can invigorate a sense of purpose and brings meaning to a person’s life, thereby reinforcing a sober lifestyle. People in AA commonly sponsor and work closely with one another, which is a way to role model sober behavior and establish meaningful and supportive relationships.

Fourth, service work is another component by which alcoholics model responsible behavior through taking on a wide-variety of commitments that they’re held accountable for – which can be as basic as just giving a ride, answering phones, or public speaking in front of groups. Service work can often involve working with other people, but can just as often not. This helps reintegrate a person into society, thereby establishing a sense of community.

The last component, the 12 Steps, are largely intended for personal use outside of meetings, and serve a formulaic purpose which can be utilized by people of all religions and of no religions to develop a sense of self and coping strategies for sober living. The 12 Steps follow a formulaic pattern: (1) steps one to three serve to acknowledge a problem and become ready to change it, (2) steps four and five serve to get to the root causes of that problem, which develops a sense of self, (3) steps six to nine serve to change destructive behavior patterns, which helps develop coping strategies, (4) steps 10 and 11 serve to maintain that change, and (5) step 12 serves to help others. The mention of God takes a back seat to the overall purpose of the Steps in their entirety, which is simply to not drink and learn to live a sober life. The “God Steps” can be about as involved in the separate working components of AA as you choose to involve any six Amendments of U.S. Constitution in your daily interactions with other people, places, and things.

Applying the current Recovery Model, the formulaic nature of the 12 Steps coupled with AA’s deliberately loose policy of “take what you need and leave the rest” allows for varying degrees of belief in a higher power, or lackthereof, to utilize the 12 Steps and the other components of AA as needed. And the manner and degree by which all of these components are carried out are as varied as AA’s two million members. There are many different brands of AA and not one outweighs the other. An alcoholic just needs to discover what brand is for them. A higher power or God can have as much or as little to do with recovery as needed.

AA has also been criticized of being a “cult” because of the strong emphasis on the group. This argument comes from the high level of importance that AA gives to the group and AA’s principles to a person’s sobriety. However, in the context of alcoholism, an illness largely influenced by psychological and social factors, it can in fact be crucial for alcoholics to center their lives around a set of guiding principles for structure and coping strategies to learn how to live sober lives. Basic decisions in life can seem overwhelming to an alcoholic when he or she is first getting sober, which can render him or her vulnerable to relapse. The structure of AA, as seen in simple rhetorical slogans and such, can be used as coping strategies within the context of the illness to recognize the antecedents to relapse, to help avoid it. Considering the degree to which alcoholism debilitates an alcoholic’s life, a sober healthy existence may be dependent upon closely adhering to a program of recovery. The weak argument is that this structure, coupled with the bonds people can form in recovery as a result of sharing a common traumatic experience, produces an unbending cult. AA as a support group, where people recovering from a difficult personal experience share their experiences, is no more a cult than support groups for domestic violence, grieving the death of a loved one, or cancer survivors.

The word “cult” isn’t exactly used as a constructive criticism either. The word is used to conjure up images of Jim Jones force-feeding Kool-aid laced with cyanide down the throats of his Temple followers in Jonestown, Guyana, not simply a group bound together in respect of the same ideal as “cult” is defined by your nearest dictionary. Put another way, the “cult” argument is telling people that AA will literally kill an alcoholic if drinking doesn’t kill them first. AA’s founder, Bill W., is commonly pointed to as the “Jim Jones” that members loyally worship, although he’s been dead since 1971. But the reality is, AA members don’t worship Bill W. any more than, say for example, Americans worship George Washington – they’re both celebrated for their contributions in history, but to say they’re worshiped would be an overstatement, to say the least. Rather, using such language to describe such a large diverse group creates nothing more than a prejudice. Labeling alcoholics who attend AA as cult members dehumanizes the wide range of people and beliefs found in AA, and creates a bigoted against stereotype, which is not reflective of AA membership.

Your local AA group is bound together by the same ideal of trying to get and stay sober, and nothing more. With two million members, AA is a microcosm of society. In it, you’ll find the full spectrum of personalities with varying degrees of belief in AA’s guiding principles no different than the types of personalities you encounter in your daily lives – some more extreme than others, but many more sane, moderate, genuine, and helpful people. No social group can escape deviance, and AA being such a large group is no exception. But the rare inappropriate or harmful actions of a few bad do not outweigh the helpful acts of many more, nor your local AA meeting down the street. The weak argument exploits these bad acts to lambaste AA as a whole.

AA’s large network of sober people is one of the most supportive aspects for recovery, but AA wields no power over its members or outside society. The way AA is set up as an organization prevents it from having such leverage. AA is ran from the ground up, meaning, each group is its own boss. AA’s central office in New York (AA World Services) wields little influence over any particular group because groups are completely autonomous from one another and the central office. To use an analogy, AA groups are like little countries, whereas AA World Services is like the United Nations. Groups are independent from one another and AA’s central office in New York, and are free to conduct their meetings in whatever manner they see fit, as long as AA as a whole isn’t affected. But if the group’s practices do happen to affect AA as a whole, like the United Nations, there isn’t much AA World Services can do about it anyway – except maybe write the group a letter expressing disappointment. Your lowly and broke AA meeting down the street is nothing more than an self-reliant and free of charge support group ran by alcoholics in your community.

Whether it’s for money or power, cults in the “Jim Jones” sense of the word usually have a sinister motive. The problem with money being such a motive is the fact that the maximum amount any member can contribute per year is $3000 – apparently to maintain some level of moral standing. But most of that money goes to paying for the autonomous practices of groups, such as rent and other related obligations, so AA the organization only gets (for money) what groups are able and willing to donate. The central office has no control over groups, and the control that groups have over each other is nonexistent, so ultimate power seems an unlikely motive. The reality is that AA is a disjointed entity where all you need to form a group is a coffee pot, two people, a meeting place, and, optionally, if you want the group to be in the AA directory, a form sent in to the central office. That can be the extent to which any group is connected to the rest of AA, which is typically what you’ll find at your local AA meeting down the street.

The last argument, that AA is no more effective than recovering alone, comes from a narrowly selected portion of science that shows a low success rate for “problem drinkers” attending AA. The problem is that the science has not been consistent, and program evaluation research in general is difficult. The science behind all this madness is better suited for an episode of Mythbusters than some random article snagged in the cobwebs of the internet such as this. In a scientific paper published in the British Journal of Psychiatry entitled “The Efficacy of Alcoholics Anonymous: The Elusiveness of Hard Data,” Paul Bebbington thoroughly outlined how it’s nearly impossible to gain accurate results of AA’s effectiveness because of the oversimplified criteria for success and significantly flawed methodologies.

Yet these arguments persist and use limited science as conclusive proof that AA should be destroyed. But any published peer-reviewed study ever done on the matter will highlight these difficulties in the section entitled “limitations.” Scientists explicitly stress that the results should not be taken as conclusive evidence of AA’s effectiveness because of the inherent difficulties and significant limitations faced in program evaluation research. Simply dismissing the limitations as some sort of nuance is similar to, say for example, dismissing evolution because it’s “just a theory.” And this isn’t to minimize the importance in studying AA, it’s to underscore a completely unacknowledged area by certain arguments.

The over-simplified criteria for success makes gaining accurate results for AA’s effectiveness difficult. Success in most studies is narrowly measured by total abstinence from alcohol. The problem: people coming into AA, and recovery in general, commonly struggle with sobriety for a period of time before achieving any extended length of sobriety; even seasoned attendees or members can periodically struggle with sobriety, having “slips,” after significant periods of abstinence. Yet in each case, a person’s life can significantly improve in conjunction with attending AA meetings as a result of gaining a support system and utilizing AA’s various components. But measured by total abstinence, AA would be ineffective when in fact there had been an effect. Measuring success by total abstinence in a program such as AA where relapse does not necessarily indicate failure may not accurately reflect AA’s overall effectiveness. This makes AA a difficult target to study for scientists, but a soft target for criticism.

There’s also a struggle to determine the number of meetings participants should attend to ensure a fair measure of AA’s effectiveness. Scientists have trouble determining whether sending participants to an AA meeting per day, per week, or per month will be adequate exposure to AA. Measuring the effectiveness of the 12 Steps is something else entirely. While there may be an ambiance of the 12 Steps in meetings, the Steps are largely meant for personal use outside of meetings. The Steps can be time consuming, and are mostly worked on alone or with a sponsor. Participants may never be adequately exposed to the 12 Steps, so studies just speak to the effectiveness of attending AA meetings, as opposed to the effectiveness of the 12 Steps. To date, scientists have had better luck in finding evidence of a Sasquatch in the hills of northern California than getting a measure of the 12 Steps, which in no way favors the Steps being neither effective nor ineffective.

Participants’ motivation or desire to quit drinking also plays a big part in gaining accurate results. Despite using the gold standard by which program evaluation research is measured, randomized control trials (RCT’s), scientists have no way of determining participants’ motivation or desire to quit drinking. Scientifically speaking, it’s a crapshoot. Therefore, scientists don’t know whether they’re measuring AA’s effectiveness or a person’s motivation, or lack thereof, to get sober. Participants have ranged anywhere from court-ordered bitter attendees to zealous volunteers, which can skew an accurate measure of AA. Without question, a prerequisite to getting sober is at least a desire and commitment to do so, unless, of course, critics would like to fault AA for not making people want to quit drinking, too.

Whatever you think of AA, recovering in a vacuum (without help) can be dangerous. People in recovery and healthcare professionals both recognize that an important part of recovery is the sober support network, which is probably why AA has endured and is still so popular today. But AA does not own a monopoly on psychosocial behavior. Human beings are social creatures by nature – we thrive by interacting with one another. Alcoholism can sever an alcoholic’s social ability to purposefully interact with their environment, which can damage meaningful relationships and lead to social isolation. In other words, sober or not, alcoholics have a tendency to withdraw from society – and that doesn’t necessarily mean physically. Re-establishing and maintaining a social connection through a network of like-minded people who share a similar experience can be paramount to recovery. Whether it’s AA, Smart Recovery, Secular Organizations for Sobriety, LifeRing, internet groups, or anything else, a support system can be crucial. Even these extreme arguments ironically exploit this essential element of recovery by leaning on “exposing” AA as the harbinger of death to any one who will listen and sympathize with their cause. That’s not to say that a person can’t recover on their own, but that would be the exception, not the norm, which healthcare professionals don’t generally recommended.

The reality is, despite it’s misgivings, AA is mostly just a lowly and impoverished support group that meets once a week in your local church, alano, or John’s basement. It does not have any power over court-ordered treatments, nor do members claim to be medical experts. There is no “AA lobby” flexing its deathgrip on the U.S. government nor the treatment industry. At your local AA meeting, you’re more likely to find nine dollars in the donation basket than a conquest for power. AA is similar to support groups for domestic violence, grieving the death of a loved one, AIDS, or cancer survivors. Members of these groups are intentionally seeking nonprofessional help for a shared problem that’s difficult to deal with alone, and they find help in talking about their problems with other people who’ve been there. That’s it. Support groups don’t administer medicine, nor wield legal power. It’s talk therapy where the power of simply empathizing with another human being outweighs stereotyped AA dogma. There can be a support group for just about anything as long as no laws are broken. As long as there are people who find reassurance, comfort, and support in AA, it isn’t going anywhere. AA doesn’t have to work for everyone, or anyone for that matter, other than those who find refuge in it. People have the right to help themselves in whatever legal manner they see fit regardless of whether such a method is scientifically proven, which is why a dog literally makes better use of his time chasing his tail than certain criticisms waste on “exposing” AA. Criticisms would be much more productive and effective directed at the proper authorities which regulate treatment centers and laws.

The magnitude of alcoholism and its dim recovery rate in general renders AA and other recovery groups martyrs of sorts given the task. Whether you’re a 12 Step zealot or not, the important thing is that alcoholics recover – not that AA “did or didn’t do it” for them. Not everyone who experiences some sort of trauma in life will deal with it the same way. What may work for one, may not work for another. Alcoholism is a complex problem with many biological, psychological, and social factors influencing it. It will vary from person to person, meaning, so will treatment. Your local AA meeting is one of many ways to help achieve and maintain sobriety, but its prominence should not be mistaken for some sort of promise or guarantee to do for alcoholics what they need to do for themselves. Many people have found and will continue to find success in AA, while many have and will not, and that’s okay. But the unfortunate experiences of a few, or even many, do not speak for the successes of many more. Your local neighborhood AA group that meets down the street once a week will not be for everyone, but just like support groups for domestic violence and grieving the death of a loved one, in general, AA has been and will continue to be a valuable community resource.

This entry was posted in Editorials.

One Response to Alcoholics Anonymous: One Man’s Analysis of the Criticisms

1. Roger says:

   April 30, 2012 at 8:47 am

   What a wonderful tour de force of recovery Doug has written! I’m very impressed with the attention to detail and the comprehensiveness of the paper.

   I do have an observation though that might stir some controversy. In the piece, Doug wrote, “There is no language in the step to indicate that admitting powerlessness over alcohol translates into admitting helplessness over a person’s desire to drink, helplessness over the ability to choose to drink, or helplessness over life.”

   I believe there is language in Step One that translates into admitting that we who are addicted are powerless over not only the desire, but also over our ability to drink…it is in the word “powerless”.

   I have been accused in the past by recovering friends and patients with the idea that I am too rigid about the Steps of recovery. This may be a case in point, but I offer this as an alternative view that agrees with the premise of Doug’s piece while hopefully expanding it.

   Powerless means without power. It does not mean “maybe without power in some circumstances and not in others”, or “no power today and maybe power tomorrow”, or “only powerless when I am actually drinking or taking drugs.” For me, the word means I am entirely without power and completely and utterly at the mercy of the drug and all of its manifestations.

   For me, the debate hinges on the word “choice”. In fact, according to my understanding of Step One, I do not have choice because I am powerless. “Powerful” implies choice and I am definitely not powerful over alcohol or any other drug. Therefore, I have no choice…I have no choice over whether I will experience cravings or urges, obsess over the drug, and I have no choice as to whether I drink or take drugs.

   I do have choice over whether or not I am helpless in the face of life in general, and this is where Doug and I agree. In fact, this idea is the foundation for where I do have choice: I have the choice as to whether or not I believe there is a power greater than myself that can help me not use (Step Two). I have no choice over using alcohol or drugs, but I do have a choice as to whether I believe. And, that is where the power comes from to allow me to avoid drinking or taking drugs… It’s not my power, it’s my Higher Power’s power.

   Step One never kept me clean. I knew I was an addict about 7 years before I got clean. I knew I was powerless over all drugs (even those I had never taken) and the manifestations of drug addiction that occur even when I was not actually putting them into my body. This awareness continues to this day, many years after my last use. I, Roger, am totally powerless over drugs despite my apparent ability to run many other parts of my life by choosing in a healthy way how to live. It’s just this one, nagging area of drug use that I will always be powerless about.

   But, there is a seeming paradox here. How is it that one can stay clean for so long if it is not for the exercise of willpower over the drug? Here’s how…Steps 2-12. That is where choice rests. And this is the basis of my recovery today.

   For those who wonder about this, please check out a fantastic video about the disease of addiction produced by the Institute for Addictions Studies in Utah. Their video, “Pleasure Unwoven,” makes the point that all addiction is a disease of choice. We are systematically robbed of our ability to choose whether to drink or take drugs by the drugs themselves. Sure…we start out thinking that we choose to drink today, or choose to get loaded today, or choose to not drink today…in the FIRST stage of our addictive journey into dependence. But, gradually, the drugs take control and our ability to choose (despite our protestations to the contrary and rationalizations that we engage in when clean) gets eroded.

   It is a feature of relapse that we believe we have thus far chosen, during our abstinence, to stay clean.

   So, for me, the belief I have choice and implied power over whether I drink or take drugs is a dangerous gambit. At stake is not only my wellbeing, but my life. Today, I choose to believe that, despite my weakness for alcohol and other drugs because I am uniquely powerless over them and the various ways they are presented to me, there is a power in my life I can draw upon to help me. Gradually over the years this looks more and more like willpower has been restored to me. But, the truth is that the only thing that sanity has brought me is the ability to choose to believe.

   And, for that, I am eternally grateful.

   All the best,

   Roger W.

   Log in to Reply