It's also not a loaf of bread.

"Alcoholics Anonymous is a fellowship of men and women who
share their experience, strength and hope with each other that
they may solve their common problem and help others to recover
from alcoholism."
https://www.aa.org/assets/en_US/smf-92_en.pdf

I think a lot of people are talking past each other, or focusing on side comments or irrelevancies. Let me see if I can perhaps clarify a couple things from the anti-AA crowd.

1. When someone says "AA does this" or "AA doesn't do that", it'a a meaningless statement. Because each group/meeting is essentially run by whoever set it up, with their own interpretation of how it should be run, there is no standard. Some meetings will be pushing religion. Some may not. Anyone on either side that says "AA does this" is committing a generalization fallacy.
2. Point 1 being said, the basis of it absolutely does include overtly religious overtones. Some of those have been toned down over time, but you're still more likely to find a lot more religion in AA simply due to the nature of it's history and origins. There are overtly religious meetings that try to coerce that behavior in others, and there are meetings that aren't.
3. None of that is an issue; the organization is free to structure itself however it likes.
4. From the organizational stand point, success rates are over-stated. Very little hard data is kept by AA as a whole, simply due to it's distributed and de-centralized nature. The only actual studies I'm aware of show a success rate no better than people simply trying to quit on their own, yet it's always talked up as being effective. That is a problem.
5. Keeping in mind points 2 and 4, this becomes problematic. Judges and employers get an inaccurate idea of the effectiveness, and try to force the program on everyone, with no concern for whether the employee can access a meeting that is compatible with their beliefs.
6. A better solution would be to mandate some treatment program, rather than specific program that, while there are exceptions, leans towards religious ideas and that has not been shown to be as effective as evidence-based programs.

I think AA makes more sense as a support group than a treatment program. If you're looking to get cured of alcoholism, AA won't be much help. If you're the kind of person who benefits from group activity around a shared goal or value, AA may be a huge benefit to you.

AA probably works best for people who are in a position to quit drinking, and who are able to do so with the support of a like-minded community. Some people aren't going to be able to quit, no matter how many meetings they go to. They'll need something else to treat their addiction. But even they can still benefit from going to AA meetings. Even if they never break their addiction, just having regular contact with other human beings who are in a similar situation, who accept you as you are, who don't judge, but just listen, can be a help.

So I wouldn't expect the success rate to be very high.

Conversely, I'd expect that programs with a high success rate tend to be much more exclusive in their admissions policies.

---

A friend of mine had bariatric weight loss surgery a few years ago. The surgery was very successful for my friend. A lot of the success can be attributed to the fact that the clinic they went to has a very high success rate.

But the clinic has a very high success rate because they demand concrete demonstrations of commitment to success, before they admit anyone for surgery. Aspiring patients must attend training courses. They must spend a year on a doctor-supervised diet and weight loss plan. Etc. You can't just come in and give surgery a try. So they're weeding out anyone who might screw up their success rate, right at the beginning. AA doesn't do that.

AA isn't a treatment. It's a support group. It's open to everyone, no questions asked. It works for some people, and it doesn't work for some people. If you're struggling with addiction and you think being in contact with other people going through the same struggles will help you, give it a try. Even if you don't think it'll help, you might want to give it a try anyway. Maybe going through the Twelve Steps, with support from others, is really just your first step towards getting treatment for your addiction.

I agree that confusing it is. Confounding also, that a doctor can direct someone to attend meetings of a group, that is so ill defined. The doctor needs help I think, maybe has been hitting the bottle a bit too hard.

Given this, is there anything stopping someone who's been court ordered to attend AA meetings from starting their own "meeting" and then "attending" it? (Other people might show up because it goes on the publicly available schedule, so they'd have to really have a meeting and not just pretend to, but being the organizer of the meeting would seem to give them some power over e.g. whether or not the Lord's Prayer is recited.)

Would that be like the catechumen in catholicism? Or the level 1 thetan in scientology? The philosopher in anglicanism? The acolyte in buddhism, the profit in evangelism?

How about the jihadist?

Should all of these have an equal seat at the religious table in your view? Where do you stand on zorostrians? Ba'hai?

All of these hate each other and think that the only seats at the table should be their own

And I have not yet started on the eastern traditions.

What do you think is the correct course of action given all these diverse deities?

nt

The great thing about AA is that its by alcoholics for alcoholics. Its folks who have been there, done that.

A doctor might suggest a patient go to AA because there is evidence that it can be helpful.
https://www.scientificamerican.com/a...rk/?redirect=1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746426/
https://en.wikipedia.org/wiki/Effect...lics_Anonymous
https://www.thefix.com/content/the-r...tics-of-aa7301
As far as I know there isn't anything that has been proven to be more effective.

This might provide some balance to the discussion.

I have no idea how effective AA is or if it's better or worse than other methods. It works for some and if anyone can get help in my mind it's a good thing.

My discomfort is with the mandated part. Partly for the government connection to the religious aspect and partly because the thing that makes it work - anonymity - is a way to get around the requirement.

I worked with a guy who got a DUI and part of his sentance and a requirement for him to get back his drivers license was to attend so many AA meetings during some period of time. Worked out to two or three a week. They gave him a sheet to fill out - meeting time/date/location and a blank for someone to sign. He simply filled them out himself and put in random names or initials or combinations but never attended any meetings. It's easy to check the meeting times and locations just as it was for him to find them but who attended and what their names were and get them to verify he was there? It was a travesty really.

Upthread someone asked about starting your own meeting. Probably anyone could do just that and he probably would have had he thought of it.

I have a soft spot for Zoroastrians but am not that well-informed about Ba'hais Bahá’ís. I'm curious where you get your impression that Ba'hais Bahá’ís are intolerant of other faiths.

Maybe it's like the question of whether Donald Trump can pardon himself. It hasn't been tested (yet) and until then we just don't know. Doesn't sound right but who knows, it might work.

I just wanted to let you know, the effort that you made with this post has not gone unnoticed. I don't know how familiar you are with AA but for various reasons the program has a policy of not stepping up to defend itself. So these conversations tend not to conform to expectations of those who want to see the pros and cons laid out side by side. I can tell you that having been there, the idea of a higher power removing the compulsion to drink/drug is not alien to me. But I also don't know how to tell anyone else to get to that point. It sounds frustrating because it IS frustrating.

Do you have any examples of meetings "pushing" religion or "coercing" religious behavior? Is it a particular religion? Which religion?

AA's literature and meetings frequently reference "God" or a "Higher Power".
Those concepts are important part of the AA program. However, AA stresses that each person should choose their own concept of a higher power. I fully understand that there are people here on ISF that object to any concept of a higher power. I get it.

There actually is a rationale for AA's appeal to a higher power. Many alcoholics have tried for years to moderate or quit drinking for years without success. Willpower doesn't work. Logic and reason don't work. If you have lost all power over alcohol, a higher power may be your last resort.

Many people in AA draw a distinction between spirituality and religion.

I've posted links above to evidence-based studies showing that AA is effective.

This is a great (in my opinion) essay on the tension between science/spirituality/skepticism in AA and other approaches to recovery.
https://thepointmag.com/2016/examine...he-insane-idea

But if it is all different social clubs why use the same name?

But I'm assuming there is no requirement for that.

But the issue I have is that there doesn't appear to be any way a Dr or a judge can know anything about the AA meeting their patient or prosecuted will be attending.

What is the program? And by program I mean who you are refering to when you say " the program has a policy of not stepping up to defend itself."?

For a program with little formal structure it seems to do well enough to rent a regional HQ in town. My uncle found a way to make it his job of sorts, he wasn't volunteering his time without a little return for it.

I suspect there is an upper level in some areas that keeps the street level groups more or less on the same trajectory. Someone has to pay to get books made that seem to appear in most chapters.

Nothing that big and multinational just exists spontaneously.

I remember hearing a number of years ago that a study showed that AA didn't work for the majority of women who participated. Now I can't find it anywhere. Does anyone else remember hearing this?

Personally, I don't think it would work for me if the religiosity were at all flagrant. It'd turn me off and make me resistant to anything else they were trying to push.

Oh boy that is a big article!

Haven't read it all as yet but can see it is not a ringing endorsement of AA. I can recall reading something similar a few years ago, quoting similar statistics and concluding AA was not effective in practice. As I recall the assessment was made that AA's success rate possibly less than zero, because a reasonable percentage of alcoholics just managed to fix themselves. The argument being, that AA might stop folk from taking the more effective self fix approach, and therefore be in the negatives for helping with a cure.

That is a long article, but it is well written and details its reasoning. I am shocked by how many people I have spoken to who don't know anything about AA except someone they know/heard about swears by it -- and these people will now swear by AA and won't listen to arguments explaining the problems with AA. I've spoken to social workers who recommend AA to every client with addiction problems they meet yet don't know how AA works, have never been to a meeting and never read the big book. Many female social workers I know would be shocked at how sexist that big book is but they never took the time to read what they have been recommending.

The people I have spoken with at AA meetings will never engage in listening to anything negative about the program. They are quick to say "Your best thinking got you here, just shut up and listen." They smirk about all the wisdom in the years the old timers have for being long-time sober. Logic is antithetical to AA. That article is antithetical to AA.

Yes I read a great deal more and found the information quite compelling. Nothing vague about it and lots of well documented evidence. Some others here would benefit from reading it. The following was most interesting and disturbing:

A good part of the article targets one Professor Vaillant who is a hard core A.A. supporter, although he shows research clearly demonstrating the in-effectiveness of the program, and appears to be driven by a compulsion to promote A.A. as a cult.

I don't think the point is the quality of a given meeting - attending might just be a proxy for demonstrating your commitment to rehabilitation. If you drank or used every day, then perhaps recovery is something you should do every day. Also, since social support is widely viewed as helpful, maybe you should get social support every day. Mandated AA meetings are one way to do that. Also, there are probably specialized meetings for doctors, nurses, cops etc.

And meetings aren't the only component of a treatment plan. Typically they also include professional counseling, random drug tests and possibly a medication regimen.

Some people will say it's just the steps, or the steps and the Big Book, but there's another critical component, which is personal contact with other people in recovery.

So this is program in a different sense. As an institution, AA does not comment on controversies. There's no spokesperson that I know of.

Well that Professor Vaillant dude, introduced to us in the article Senex linked, would seem ti fill that role. You would do well to read that article Minoosh. :)

It seems to me you are trying to convince people for whom AA is working that it doesn't work. Is that logical to you?

Do you have any evidence to support recommending another approach?

There are people who think many things work with positive results. Unfortunately massive amounts of evidence disproving their thoughts, often leave not the slightest dent in that belief.

AA was founded by alcoholics in large part because of failure of medicine at them time to help alcoholics. Unfortunately, medicine has not made a great deal of progress on treating alcoholism in the last 80 years.

Alcoholic Anonymous Tradition 3 - The only requirement for A.A. membership is a desire to stop drinking.

There are not many non-alcoholics hanging around AA meetings. So pretty much, yes, AA is alcoholics with sobriety helping other alcoholics. That's it.

If you are faced with a significant problem in life, wouldn't you find comfort in getting help from someone who has faced the same problem and is overcoming it? Seems reasonable to me.

If someone is sober in AA, they're sober in AA. Those are the positive results. You want to convince someone whose sober in AA that they're not sober? Or just that it's not AA? How do you know AA is working for them? What makes you so sure? Do you often believe that you know what is or isn't working in other people's lives?

Vaillant was not speaking for AA. I don't know if that's something you can grok.

I have read through Agent Orange's postings. Some of the points he makes are obscured by his rhetoric, such as:

He's passionate, I'll give him that.

If you want to argue in good faith, an apology for falsely accusing me of dodging your questions might help. It might not, though, for reasons that have nothing to do with you.

One of Agent Orange's hypotheses is that people in AA mistakenly assume causality: They went to AA, they got sober, therefore AA got them sober. But really it was that AA attendance merely proved they were motivated, and that it's motivation that gets people sober.

He quit drinking permanently after a doctor gave him a stern lecture and he extrapolates from there.

There's a monster, moderated thread from a few years ago that should be accessible through a search if you have basic search skills ;). People looked up source material and we had a lively discussion.

When someone tells me that their homeopathic headache remedy is as effective as aspirin, or that they've found that someone's astrological sign is a good indicator of their character, I can be pretty sure that they're mistaken. Objective scientific research always trumps any amount of subjective experience, no matter how convinced by that experience the individuals in question are. So I think it's reasonable to ask if there is any objective evidence that alcoholics who join AA really do have more success remaining sober than those who don't.

You make a valid point, however would you agree that the situation might be a bit different if someone tells you that they drank to excess daily for x number of years and now haven't had a drop for y weeks/months/years?
AA is not a product of scientific/medical research. It is a response to the failure of medicine at the time to help alcoholics.
I've posted links to scientific evidence supporting the effectiveness of AA. That evidence is in line with the personal experience of millions(?) of people.

"In an interview with NPR's Audie Cornish for All Things Considered, Glaser discusses her story, the heat she's getting and why she believes people with a drinking problem should consider options beyond AA. NPR contacted Alcoholics Anonymous for comment, but the organization declined."
https://www.npr.org/sections/health-...ck-of-evidence

https://onlinelibrary.wiley.com/doi/...1111/add.13809

https://www.ncbi.nlm.nih.gov/pubmed/28910209

https://www.ncbi.nlm.nih.gov/pubmed/29255338

https://www.ncbi.nlm.nih.gov/pubmed/29845709

This is an interesting analysis of prior studies:

Alcoholics Anonymous effectiveness: Faith meets science

The title is odd, because it doesn't have much to do with faith.

So the old alternative medicine canard about how if their treatment didn't work you didn't want it enough?

Like with medicine, for something to actually work, it needs to be better than doin1g nothing, and also superior to placebo. Otherwise both you and the people doing the treatment are really just wasting time and money on something that doesn't improve peoples' chances.

If I as a hospital administrator or mayor have the choice between doing nothing, and having 5% of alcoholics recover, and funding and staffing AA meetings, and having 5% recover, the latter seems like a waste of money.

It's easy to look at cherry-picked anecdotes and go "a-ha! Kenny and Hilde and Karen took homeopathic pills and their cancer went into remission, so homeopathy works!" for then to handwave the failures by saying that obviously it doesn't work for everyone. In order to know if something is effective, though, you need to look at as many participants as possible, including those who didn't improve, or who got worse. Only then do you know if something is better than doing nothing, and, more importantly, if it does more harm than good.

If I slap a hundred cancer patients across the face with a cod, some of them are going to recover from their cancer. Should I say that cod-slapping "worked for them"? If they're healthy after cod-slapping treatment, they're healthy after cod-slapping treatment. Are you going to claim they really have cancer? How do you know if cod-slapping works for them? What makes you so cock-sure you know what works for other people than yourself?


ETA: if you're going to post links, it's often a good idea to write something about what they are and why you're posting them.

AA certainly requires some buy-in from an alcoholic if they are going to get sober. What approach wouldn't?
For any medical condition, medicines don't work unless you take them. Physical therapy will have a much better outcome if you follow through with the assigned exercises.
What alternative do you imagine? Someone walks into an AA meeting and is magically struck sober? Someone walks into an AA meeting and is forced to stay sober? Is there some other realistic alternative?
AA certainly doesn't work for everyone, but I believe that is not appropriate to criticize AA because it only works if its participants participate.

AA does not accept funding from hospitals or governments.

The only support for the notion that AA is not effective that has been posted on this thread is a link to an old site written by someone named "Agent Orange". It's up to you if you choose believe what is written there. I've posted numerous links to scientific literature supporting the notion that AA is effective - not 100% effective - but beneficial. It's up to you if you read them or not. Is it appropriate to put forth the idea that AA doesn't work without being willing to actually look at the evidence and discuss it?

One of the links I provided specifically discussed the cost-effectiveness of AA.
https://onlinelibrary.wiley.com/doi/...1111/add.13809

If you had a friend, spouse, or child who came to you and said they were an alcoholic and needed help would you suggest that they do nothing and hope for a spontaneous remission?

Step 4: Made a searching and fearless moral inventory of ourselves.

Why doesn't AA do this?

There's a massive difference between "Doesn't work if you don't put effort into it" and "Doesn't work if you don't believe in it." Don't pretend there isn't.

Also, I wonder what AA actually claims.

Its success as a support group is probably measured very differently from its success as a treatment.

Some people can self-treat their addictions. Those people, when they attempt the treatment, have a phenomenal success rate. Other people, attempting the same thing, have an abysmal success rate. Since the abysmal success rate of self-treatment seems to be more prevalent, we generally counsel people to get help for this sort of thing, rather than trying to deal with it on their own.

Some people can self-treat, with the help of a support group. Again, those people, when they attempt self-treatment and join a support group for that purpose, have a phenomenal success rate. The group can't take a lot of credit for their treatment, but for those people that benefit from it, it's good that the group exists and offers support.

But for people who can't self-treat even with support, the success of the support group as a treatment is going to be very low. On the other hand, its value as a support group for people struggling with addiction, who haven't yet sought out treatment from others, may still be significant. Not everybody gets well. Not everybody seeks out the treatment they need. That doesn't mean that supporting them in their time of need is a failure.

I think there's probably some equivocation about what AA is and what it actually offers, both among its advocates and among its detractors.

Well, yes, that goes without saying. I'm talking about the cop-out where something doesn't work regardlessly, and when it doesn't, they use (implied) lack of patient motivation as an excuse.

Which might make the patient worse, given now they have their original problem as well as a feeling of having been given a chance, and failed to properly make use of it.

Lots of lifestyle coaches, diet peddlers, and alternative pill and woo pushers do this. I wouldn't be surprised if AA did it also.

I imagine some treatment that actually improves your chances of the outcome you're after, compared to doing nothing.

You know, the way you're actually less likely to be infected if you disinfect a wound and put on a band-aid, or how you're actually far less likely to contract measles if you get the MMR shot, or how sexual abuse survivors who undergo therapy have a far better prognosis for PTSD recovery than those who don't.

You mean like the millions of people who got better after bloodletting, homeopathy, or exorcism?

Of course not. Nor would I recommend something I didn't believe had any effect.

"It's gotta be better than doing nothing" has been used to justify all sorts of ineffective or destructive "help" throughout history. I prefer finding out what works, and taking action based on that.

What makes you think it hasn't?

AA explicitly discourages debate in one specific area - the internal debate by alcoholics who argue that they are "not that bad." Its literature even encourages people to self-diagnose by trying controlled drinking over time.

By the time people voluntarily get to AA they have probably had this internal debate multiple times, which is why "How It Works" can elicit such a sometimes humorous response by people who have tried all these things.

Nevertheless, I agree the excerpt from "How It Works" may very well be obsolete and I have suggested measures to acknowledge and address this issue. It might not be obsolete if one is talking about self-selected folks who have had no success with other measures, which is AA's original audience. I suspect, but do not know, that these points have been brought up multiple times within AA. I would not conclude on the basis of evidence that "AA" has not considered these arguments.

I may have other responses to other posts but may address only one point at a time for personal reasons.