In a scathing article in The Atlantic, Gabrielle Glaser, author of Why Women Drink, dissects the methodology behind Alcoholics Anonymous, pointing out the program’s flaws and advocating for a more medical-based approach to treating alcoholism. I read the 8,000-plus-word piece so you don’t have to and I’ve got to say, while she’s makes some valid points, I hardly believe her assessment of the AA program.
The piece contains some interesting factoids:
- Americans spend $35 billion a year on substance-abuse treatment.
- Heavy drinking causes 88,000 deaths per year.
- There are more than 13,000 rehabs in the US and 70-80 percent of them rely on AA as a model for treatment, according to Anne M. Fletcher, author of the 2013 book Inside Rehab.
Glaser calls AA a faith-based program – a point with which I disagree. I’m an agnostic and I participate in the program. In AA, we alcoholics are supposed to have a “higher power of our understanding” that will “restore us to sanity” in step two. As an agnostic, I have a higher power, something from which I find my strength and inspiration, but it isn’t God.
“The 12 steps are so deeply ingrained in the United States that many people, including doctors and therapists, believe attending meetings, earning one’s sobriety chips [coins given out on an individual’s sobriety anniversaries], and never taking another sip of alcohol is the only way to get better,” she writes.
She’s right about the ubiquity of AA. It clearly dominates the dialogue when it comes to how to get sober.
But is AA the only way?
Glaser also delves into the drug naltrexone, a once-a-day pill that is supposed to deter cravings. People taking naltrexone are still allowed to drink.
“Patients on naltrexone have to be motivated to keep taking the pill,” she writes. “They’ve tried not drinking, and controlling their drinking, without success — their cravings are too strong. But with naltrexone… they’re able to drink less, and the benefits soon become apparent: They sleep better. They have more energy and less guilt. They feel proud. They’re able to read or watch movies or play with their children during the time they would have been drinking.”
Studies indeed show that naltrexone is effective in treating alcoholism.
Criticizing AA’s 12 steps, Glaser believes that science is missing from alcohol-treatment plans.
“The problem is that nothing about the 12-step approach draws on modern science: not the character building, not the tough love, not even the standard 28-day rehab stay,” she writes.
She interviews alcoholics who reportedly have “successfully” curbed their drinking habits.
Glaser talks about meeting P., an alcoholic in Finland who used to knock back as many as 20 drinks at a time.
“From his first dose of naltrexone, he felt different — in control of his consumption for the first time,” she writes. “P. plans to use naltrexone for the rest of his life. He drinks two, maybe three, times a month. By American standards, these episodes count as binges, since he sometimes downs more than five drinks in one sitting. But that’s a steep decline from the 80 drinks a month he consumed before he began the treatment — and in Finnish eyes, it’s a success.”
In the interest of full disclosure, I haven’t drunk the AA Kool-Aid. I don’t go around quoting the Big Book of Alcoholics Anonymous. I believe it works for some people, but not for others.
And it’s true that there is no credible data about the success rate of alcoholics who choose to join the AA program.
All I can offer is anecdotal evidence about the effectiveness of AA. Alcoholics Anonymous keeps no records of its members. There isn’t even a number out there for how many people actually participate in the program. There is no data directly from Alcoholics Anonymous. Why? Because it would destroy the anonymity of the program and the idea that “what you say here, stays here.”
“By necessity, [AA] keeps no records of who attends meetings; members come and go and are, of course, anonymous,” Glaser says. “No conclusive data exist on how well it works.”
In a recent book titled The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, an author and former psychiatry professor from Harvard Medical School outlines the actual success rate of Alcoholics Anonymous. He says it’s somewhere between 5 and 8 percent.
According to Alcoholics Anonymous, however, there is a 75-percent success rate among those who actively participate in the program and work the 12 Steps.
The overwhelming majority of scientific studies I can find, refute the idea that AA is very effective.
However, one 1999 study by R. Fiorentine and colleagues at UCLA did score AA’s success rate highly.
“The findings suggest that weekly or more frequent 12-step participation is associated with drug and alcohol abstinence. Less-than-weekly participation is not associated with favorable drug and alcohol use outcomes, and participation in 12-step programs seems to be equally useful in maintaining abstinence from both illicit drug and alcohol use,” the study says. “These findings point to the wisdom of a general policy that recommends weekly or more frequent participation in a 12-step program as a useful and inexpensive aftercare resource for many clients.”
Therefore I only have anecdotal evidence.
I find it hard to believe given the large number of people I see every week at my home group of Alcoholics Anonymous. These are dozens of people I see every single Friday night. Mine is one of 2,500 meetings every week in my hometown of Chicago. All clean and sober.
I’m surprised that AA is constantly lambasted by the scientific community.
With the large number of AA groups around the country and courts mandating attendance at meetings, it seems unlikely that the organization has helped only a comparative handful of souls.
And the scientific argument that a drug like naltrexone can curb our drinking seems unlikely to me. The truth is, none of us can drink just one. That’s the nature of our disease. We are creatures of heavy consumption.
Glaser’s principal message in this article is that AA isn’t as much of a cure-all as people think. I respectfully disagree. AA works for me and my friends and many of my readers and my Facebook community. No matter what the detractors have to say about it… AA is here to stay.
