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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

On Alcohol and Alcoholics Anonymous: A Sober Conversation

Allan N. Schwartz, LCSW, Ph.D. Updated: May 13th 2009

 My goal in writing this article is to have a "sober conversation" about the treatment of alcohol addiction but without the bitter feelings that permeates those who argue for and against AA on this site. I also want to recommend a new site, run by the National Institute of Health (NIH.gov) and it is NIAAA.nih.gov and can be found at this link:

http://www.niaaa.nih.gov/

Among the many things that will be found at this site are useful sources for help  in addition to AA for those who are may have doubts about AA.

However, it is also part of the goal of this article to present an opinion in favor of AA while not rejecting or devaluing the anti AA opinions of many of our readers.

Dr. Dombeck's article on alcoholism and Alcoholic's Anonymous certainly stirred a lot of heated debate, with much of it centering around whether or not AA is a cult. People have come down on both sides of the debate and with a lot of passion and even a certain amount of hostility and intolerance. However, I have wondered why this topic generates so much controversy? I have spoken to a number of people about this, all of them long standing AA members and all in full recovery for many years. They are fully aware of the disagreement and here is a summary of some of their opinions.

Before launching into this article I want to make clear that it's purpose is not to convince or convert those of you who are anti AA but only to point out that there are other points of view. I know that there are those who have expressed frustration that their pro AA views seem to be drowned out by the anti group on the Internet. I  want to appeal to everyone for mutual respect and remind all of the right, in a democracy, to have differing and even divergent points of view. At the very same time, there is no intent to devalue or negate any of you who have had negative and unfortunate experiences.

Conversation 1:

A woman states that she has been in AA for twenty years and continues to attend because it gives her a way to remain in recovery despite the other pressures she has faced in her life. Among those pressures were the fact that her son became addicted to drugs for many years. It took a long time to come to that place in his life where he no longer wanted to be addicted to pain medications and cocaine. At that point he signed himself into an inpatient detox program and continues in recovery. Her understanding is that a person will not enter recovery until they want to and make that decision. Both she, in her life, and her son, in his life, each arrived at that place and each remains in recovery.

From her point of view and in her experience, AA gave her the means to move away from a preoccupation with herself so that she could work in areas where she is helping other people. She has been very involved in helping troubled children and adolescents who end up in institutional foster care facilities because they cannot live at home but need help in getting an education, psychotherapy and a place to live. At age 70 she remains sober and optimistic about her life.

This woman responds to the controversy over AA in the following way: "It is not for everybody and there are always people who will find fault with it. But, it has helped her and it continues to help many other people who she knows quite well. She does not want those who are disillusioned for any reason to discourage others who could benefit. Her attitude is that it is there if someone wants it and that is the very reason it is not a cult. Her understanding is that it is completely voluntary and people can attend or not as they wish."

This woman is someone I know as a friend. However, I have met other AA members through the many years of my private psychotherapy practice. While all of them did not continue to attend after they achieved sobriety, while others did, they were all optimistic and enthusiastic about the orgnization and it's twelve step program. All of them pointed out to me that, not only did AA not discourage them from psychotherapy but actually asked some of them if they would go. At one point, when I had my office in New York City, there was one meeting who referred one another to me, and these included well known and successful sponsors. While many of them did "buy into a higher power," none of them felt forced to believe in God and even the Jewish members in recovery felt no pressure to believe in the Christian version of God as opposed to Jewish version.

Conversation 2:

I have attended AA meetings in various places both in and out of the United States. I have also seen the working of 12 step programs in a variety of inpatient settings across the United States. I have met people who were in the latest phase of recovery, marred by serious relapses inbetween. In some of these cases, people had been to prison because of a variety of offenses committed while addicted. Almost all of those offenses were in the nature of some type of robbery in an effort to purchase drugs. All of the people I met were enthusiastic about AA, some even stating that it had saved their lives.

However, no program is for everyone. For example, people who are at least somewhat at ease with other people and who like to have group support are more likely to enjoy AA. Those who do not like the spiritual message in AA are likely to find a lot of discomfort there. Of course, anytime a person gets involved in any type of group anywhere it is important that they use good judgement about the people they choose to associate with. Naturally, AA meetings have their share of people whom it is best to avoid because of socipapthic tendencies. On the other hand. large numbers of the members are family people who are trying to get their lives together.

It is a good idea to combine AA with psychotherapy, either with a certified alcohol and substance abuse specialist or with a licensed clinical social worker or licensed clinical psychologist, both with specialties in drug and alcohol treatment.

Conversation 3:

One of the adult ADHD patients I worked with had a drinking problem and was resistant to the idea of attending AA. However, he read everything on other types of programs and tried them. Ultimately, he opted asking his medical doctor for medication. His MD was more than happy to accomodate and prescribed one of the new medications used to block the craving for alcohol. Combined with his psychotherapy, the patient was able to put a stop to his drinking.

Conversation 4:

By going to the link mentioned above, and here it is again, 

http://www.niaaa.nih.gov/

you will be able to find lots of information and websites for all the types of treatment available, in addition to AA. I would even say that they are not biased to any treatment method and provide lots of forms and exercises to help people help themselves. They also clearly define how much alcohol is too much but in a way that is individualized. They seem to avoid the use of the perjorative word, "alcoholic." Rather, they center on those for whom functioning at home, at work and is social situations, has become impaired. They also have a free manual that is easilty printed or downloaded and that is helpfull and worthwhile.

While not asking any of our readers to stop criticizing AA, I do want to ask that everyone not discourage or disparage those who want to attend or who attend and find it helpful.

And, so, your comments and observations are encouraged, but, in ways that are respectful of one anothers opinions.

Allan N. Schwartz, PhD

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    A.A. has helped me... - Eileen H. - Mar 28th 2012

    I just wanted to say that I will be sober 7 yrs. tomorrow (Mar. 29)..this is a miracle for me (Age 68)..I was dying every day and living in guilt,shame ,remorse and without hope for along time. with absolutely no self esteem..I know that going to A.A. has helped me..No human power could relieve my alcoholism...I am grateful to be sober..A.A. is not perfe3ct and the people that go are far from perfect.So, alcoholism is a fatal, progressive Dis..Ease..I never grew up.. I am learning to grow up today and face reality..NO matter where I go.in A.A. or out of A.A. there are dysfunctional people..all over the world.even in churc. I am also a co-dependent..But, one day at a time..I have made 7 yrs. and will be doing what it takes to stay sober. All I can say is A.A. has worked for me..it is not easy..but better than all those horrible years of drinking and self-destruction..God, has given me a second chance..and I thank Him...mvf9xx

    AA Ruled Religious, etc. - Allan N. Schwartz, PhD - Oct 25th 2010

    John and others,

    This endless debate over AA is totally irrelevant for a simple reason. The problem is not AA or other methods of getting support with an addiction: The problem is addiction, how to prevent it, how to cure it, whether its alcohol or other drugs? I am not aware of any program anywhere at all that is ending this dreadful problem.

    All of you on both sides of this obsessional debate are exhausting yourselves while overlooking the problem of drug addiction and relapse. The problem is at epidemic proportions all over the world.

    Dr. Schwartz

    AA ruled religious - john - Oct 25th 2010

    Alcoholics Anonymous has been ruled as religious by the U.S. Supreme Court. It is relatively ineffective, yet is showered with positive publicity and public relations. Most in AA are guaranteed they will hear how "church" can't help them.

    There are many of us who see AA as polytheistic at best.

    http://www.mywordlikefire.wordpress.com

    ignoring all the negative issues - Abbadun - Aug 29th 2010

    I know that there is good in AA, there is no need to argue that point with me.

    What people who disagree with the Anti-AA are guilty of doing is ignoring all the negative issues and operational mistakes in AA's culture and ideology.

    Years of management classes has taught me that healthy organizations can not and do not tolorant bad practicies. AA seems to have a culture that celebrates their worst ideas with slogans.

    To Rather Not. - JR. - Nov 20th 2009

    Hello, Rather Not,

    I agree with Allan's comments.  If i may add - I think it is key question as to whether you husband shows any willingness to engage with you as to the problems in your relationship and situation.  If he does not - there is a strong case for saying that you should take the fuzzies and leave.  I know that this is a difficult option - but there it is. 

    A question of interest to me - was the proliferation of indoor cats a joint decision, your decision, or something that just happened ?  We have two indoor cats ourselves, and that poses its share of problems.  I know it will sound a bit strange to say but - the view between partners as to the acceptable level of pet prescence is significant.  This needs to be addressed seriously but - if agreement cannot be reached, it may suggest more serious problems that need to be addressed at the  appropriate, higher level.

    May I wish you all my best regards in resolving your problems,

    JR

    Alcoholic Husband - Allan N. Schwartz, PhD - Nov 20th 2009

    Hello Rather Not,

    Given the amount of fear that you mention: fear of your husband killing the pets, fear of his burning the house down and the awful type of life you describe, it certainly makes sense for you to take your pets and move out, going to your mother's house or to a friend. In addition, following through with the divorce lawyer also makes sense.

    Of course, doing these things takes courage and determination. You need emotional support and I suggest psychotherapy. From your description, it seems urgent, at least to me, that you get away from the house and from him. This, of course, is my opinion and only an opinion and that opinion is based soley on what you have written here.

    Best of Luck

    Hubby is alcoholic and has conversations with himself - Rather not - Nov 20th 2009

    I have been married 31+ yrs. My husband is an alcoholic. Our kids drink also and I drink very little. My husband is getting to the point of I think exploding - he is an introvert. I mostly raised the kids while he was in the Navy and I stay alone while he works on a rig, boat or in another state. He pops a beer in the am. Gets  very angry when I want to cook him a meal and at supper time, is 3 sheets to the wind and says, I don't need to eat 80 times a day like I do, which of course is nonsense. He is mad, I have 11 indoor cats that are fixed, and 3 outside dogs. His work has been slow due to the economy. I suggested that I sell some pets and he got mad. I already went to a divorce lawyer. My husband has said I am stuck where we live like chuck due to the economy. He has supported me through operations, seizures, etc. I have by the same token been at his side and the kids - I made a grave mistake. I didn't replenish me and now at nearly 50 and VERY petrified at his coming home at Thanksgiving and ALWAYS bah humbug attitude I don't know what is going to happen! My mom lives in another state many hours away. I was told by the lawyer that I should leave and take all the animals and I cannot afford this. I want to take 2 felines, sell the rest but he has to agree. Because my neighbors got in a nasty fight 2 weeks ago we were on our way to a cheap nearby restaurant - he told me if i didn't like being here and with him anymore, i could leave too. i should have turn my truck around, dropped him off and went out alone. I am not able to work here, due to surgery but not bad enough for disability. I wish I could get a job. I feel so very pathetic for putting up w/his emotional cruelty to me, looking at porn and ignoring me - not very nice. I just want this process to be quick and I have to get someone to be here when I tell him I want out. I already will have my truck packed up. I am afraid he will kill the pets out of anger and burn the house. Please advise me as I am so very desperate & scared.

    Unconscious Bias in Recovery Non-Profits - ttfcam - Oct 6th 2009

    This quote demonstrates the recovery movement founders struggled to overcome unconscious bias or racism:


    "We were biased then...'We whites, if we preach brotherly love, must practice it. And should a Negro appeal to us for help and guidance, it is our Christian duty to give the best that is in us, recognizing that a human soul is given into our hands to help or destroy.'" Dr. Bob and the Good Oldtimers, page 248 Minorities within AA gain acceptance


    Since their inception more than seventy years ago, very few of these groups attract and retain a substantial portion of black, Hispanics or other people of color, when it appears members of these ethnic groups suffer as much, if not more, from the addictions these groups aim to alleviate.

     

    More evidence that AA is ineffective.

     

    randomized longitudinal controlled studies - Ray Smith - Sep 17th 2009

    Hi Allan,

    You wrote:

    While I am pleased that studies have been found that find fault with AA there are also studies that do not.

    The studies I listed were randomized longitudinal controlled studies, I don't know of any that show AA in a good light.

    Thanks, Doc. Point well taken. - Seth - Sep 17th 2009

    I do understand that people are swayed by their experiences and when two people, such as you and I, have opposite experiences, the reality or truth for each of us, is also opposite.  I personally know far more people who have been harmed, further conflicted and who have even died from the depths of shame, self-disgust, and powerlessness they were expected to embrace at AA or 12 step.  Although for some, those painful feelings may have pre-existed their AA or 12 Step experiences, those were precisely the feelings which they needed to change to be free from alcohol or drugs, but instead, the AA philosophy did not allow them that option and in fact, confirmed and deepened those feelings.  Sad - true - common.  (based on my experience, which is vast and plentiful)

    Obviously you have feedback which contradicts my own.  Perhaps we can both be accurate and honor our respective truths, while also expanding our perspectives.  I always shake my head when the democrats and republicans spend and waste such a monumental amount of time defending themselves, focusing on, pointing out and even fabricating stories about what the other does "wrong", all the while, missing the opportunity to better themselves, be more honest with themselves and be more respectful and humble toward each other so that an environment where they can learn from each others strengths, insights, strategies, and general perspectives is created and mutually benefitted by.  

    Congrats on your new grandson.  My personal belief is that regardless of what sort of drugs and treatment will be available over the next few decades, it need not be specifically relevant to the well being of your grandson if throughout his upbringing, a strong and fundamental sense of who he is is instilled in him and he is shown, most significantly by example, that he has it within his power and ability, to face life head on, confidently, and triumphantly.  Granted those are merely words and broad ones at that.  My point is that we, as parents (or grandparents), sometimes lose sight of the most basic and fundamental tools, beliefs, practices, boundaries, concepts, etc., which will keep our children safe and happy in all areas, by being distracted by or focusing too specifically on the things which we fear the most, such as alcohol and drugs and in some instances, that backfires, especially if as we address such issues, we are riddled with or motivated by fear, rather than coming from a place of unquestionable faith, love and confidence. Food for thought.  

    Thank you for being honest about your specific experiences while remaining open to the experiences of another. 

    Seth

     

    Discussion Topics - Allan N. Schwartz, PhD - Sep 16th 2009

    Hi Seth and Others,

    Seth, I believe you have identified the difference between the way I view AA (and there are many who agree with me) and the way you (meaning all anti AA people) is that I do not view AA as dangerous.

    While I am pleased that studies have been found that find fault with AA there are also studies that do not. I have to read and think about the studies that Ray was good enough to submit (I took a brief glance) and read them. In all studies, there are many variables that are examined and that need to be considered. That is why it is all too easy to reach the incorrect conclusion. In my opinion, it is too soon to reach any conclusions froms so many and conflicting studies.

    Please understand, I fully respect your expiences Seth, as well as others, and those negative experiences are too serious to be dismissed. But, also try to understand that I have a backlog of vast numbers of people whose experiences and opinions are directly opposite to yours.

    This is the problem. This web site and Dr. Dombeck and myself have absolutely no vested interest in AA or twelve step programs. If anything, I could tell all of you how some of those twelve step programs (and some of them advertise on TV) are downright harmful. But, my experience with this has been not in the philosophy of twelve steps but in the harmful ways some of these programs are run. There is more and, perhaps I will write an article about it.

    So you (the greater numbers of you) and I must disagree at this only on one issue: That AA is dangerous. Yet, and to repeat, I respect you and take what your report seriously.

    As I said before, I (just myself) am very worried about how to deal with the problem of drug and alcohol abuse in our society. I am a new grandfather of a ten week old baby boy and I worry about what he will face when he is a young teenager.

    Allan

    Unfortunately it is necessary to spend time on AA - Seth - Sep 16th 2009

    Dr. Schwartz says, "I still believe that much time and energy is being wasted here on this endless discussion of AA rather than on the problems of addiction."

    I do understand that position, Dr. Schwartz and under different circumstances I think it would be a progressive and accurate assessment.

    Unfortunately, people's understandable, yet inaccurate perception of or conclusions about AA/12 step and the multiple ways AA/12 steps often represents itself, the public image of AA is dangerously enticing and inconsistent with the truth.  

    It is common practice for some people to become unnecessarily and deeply conflicted and guided down a potentially dangerous path when exposed to AA/12 step.  While that may not apply to those who claim to be compatible with AA/12 step, it is painfully clear to those of us who know by deep, personal experience that it is true for many others.  It is vitally important for people who are currently suffering addiction - people who are incompatible with AA/12 step to have a path free, clear and unobstructed by the message that AA is the only answer.  

    So while I completely agree with you that the solution to addiction is the most important thing to focus on, I also believe that including permission, if you will, for those who suffer, that it is perfectly acceptable to dismiss, deem themselves incompatible and look outside of AA/12 step toward their successful freedom from those struggles, is an important contributor to achieving that noble goal.  

    Studies - Allan N. Schwartz, PhD - Sep 16th 2009

    Well, good, now we have a list of some solid studies that found evidence against AA. I have no problem with that and am pleased by the information. In addition, I am pleased that the list of research was posted without bitterness or recriminations or a spirit of "I told you so." I have not read these studies, as yet, but I will. This is the first time they were brought to my attention.

    I still believe that much time and energy is being wasted here on this endless discussion of AA rather than on the problems of addiction.

    Today, more than ever before, poly substance abuse is more the problem because people are mixing their substances. For example, (I am sure there are some pure alcoholics), people are abusing alcohol along with cocaine, or heroin, or pain killers and, of course, mehempatamine, etc. This is also happpening at younger and younger ages. I find that particularly alarming.

    One more thing: I agree fully and 100% that cour remanded AA partication or any program participation, is doomed to failure. No one can be forced to stop their addiction!!!

     

    I did not fail to find critical studies - Ray Smith - Sep 16th 2009

    Dr Schwartz,

    I did not fail to find critical studies of Alcoholics Anonymous on Google/Scholar:

    1) Dr. Brandsma found that A.A. increased the rate of binge drinking:

    http://scholar.google.com/scholar?hl=en&q=Brandsma%2BAlcoholics+Anonymous&btnG=Search


    2) Dr. Ditman found that A.A. increased the rate of rearrests for public drunkenness

    http://scholar.google.com/scholar?hl=en&q=Ditman%2BAlcoholics+Anonymous&btnG=Search

    3) Dr. Walsh found that "free A.A." made later hospitalization more expensive

    http://scholar.google.com/scholar?hl=en&q=Walsh%2Bfree+Alcoholics+Anonymous&btnG=Search

    4) Doctors Orford and Edwards found that having a doctor talk to the patient for just one hour was just as effective as a whole year of A.A.-based treatment.

    http://scholar.google.com/scholar?q=Orford+and+Edwards%2BAlcoholics+Anonymous&hl=en&btnG=Search

    5) Dr. George E. Vaillant, the A.A. Trustee, found that A.A. treatment was completely ineffective, and raised the death rate in alcoholics. No other way of treating alcoholics produced such a high death rate as AA.

    http://scholar.google.com/scholar?q=George+Vaillant+%2BAlcoholics+Anonymous&hl=en&btnG=Search

    (But really for Vaillant, you need to read the book or at least selected sections available on Google.)

    Dry? I'd call some of these concise. The entire summary  for the Oford & Edwards study reads:

    "Two groups of alcoholics received either one counseling session or several months of in- and outpatient treatment. One year later there were no significant differences in outcome between the two groups."

    several were listed - Mike BD - Sep 16th 2009

    Allen states: "However, I must report that, if anyone does a search on Google/Scholar, they will fail to find articles critical of AA."

    Odd, since I went to the site, entered "AA triennial survey" and several were listed.

    Anyone has it within himself to quit on their own - Seth - Sep 15th 2009

    Dr. Schwartz says, "There are people who can stop drinking and drugging on their own. But, there are others who cannot and who do not."

    The same statement applies to AA.  There are people who stop drinking and drugging through their experience of AA.  But, there are others who cannot and who do not.  

    Either way, I don't believe that anyone can help someone with a problem by convincing them that they "can't do it alone" or "need help".  That position is completely and thoroughly contradictory to one's objective, which is seemingly to help or support someone.  The way to help someone is to draw out and nourish the strength and capability within that individual to do whatever it is they are setting out to achieve - whether it be to stop drinking, drugging, over eating, stealing, or some other issue.   It is impossible to genuinely help someone by attempting to convince him that he is incapable, powerless, or diseased.  In reality, true success comes from a person's recognition and implementation of his power, strength, and ability and the understanding that there is no outside force or or separate entity, such as a disease that needs to stand in the way or distract him from his ability to create freedom.  A person (or group of people) can only genuinely help someone if he/she/they are simultaneously honoring someone's ability and potential to ultimately do it on his own.  

    I have three small children.  Each time one of them went through the stages of learning to walk. I helped them.  It would never occur to me to tell any of them that he or she is incapable of doing it on his own - that would have obstructed my ability to help them and potentially obstructed their ability to do it on his or her own.  Although I supported them throughout the process, they were always fundamentally capable of walking without my help, yet that didn't stop me from providing it for them.  Same thing applies to people with one of many challenges in this lifetime.  If someone is fundamentally incapable of doing something on his own, such as overcoming struggles with drugs or alcohol, even though I have never met such a person and I am not sure they exist, I would wonder the point in trying to help him.  I would also question the integrity and motive of a person/group/organization who insists they "need help" and claims to be that person's only hope, or only answer or worse, his only alternative to death

    Alcoholism - Allan N. Schwartz, PhD - Sep 15th 2009

    Hi Mike and everyone else, including the person I found delightful because he started his comment with "oyyyy." He did not agree with me but I enjoyed the "oyyyy." He then asked for "evidence, evidence, evidence." Well, who can blame him or others?

    As Ray Smith has correctly pointed out, there is little or nothing available in terms of long term, longitudinal studies about the effects of AA and other 12 step programs. However, I must report that, if anyone does a search on Google/Scholar, they will fail to find articles critical of AA. In point of fact, the articles are all controlled studies, reported in dry, uninspiring, non judgemental and non partisan ways that clearly neither support nor criticize AA. But, I have yet to find an article where the research was solely and only on AA. So, all I have to go on is what is called "anectdotal (spelling?). What I have experienced in practice and with acquaintences is to hear reports of great satisfaction with AA.

    What I must point out, as I have tried before, is that I am not an advocate of AA. Instead, I am not anti AA. I have attended meetings in many places including other countries. I have also read some but not all of the literature, including parts of the Big Book.

    What I have asked for consistently is that, when this issue is discussed, that people tone down the rhetoric. Some have done so but others have not. Therefore, I have chosen to retreat and not participate to the extent that I did before. At one point I became quite angry with one person in particular and realized that it is not good for my health or temperament. I do not like it when my competence and credentials are questioned for the sole reason that they do not agree with me or falsely believe that I disagree with them.

    The truth is in the middle and both myself and Dr. Dombeck have tried to say: There are some things that each of you reveals about AA that we agree with or want to know more about. There are other points that we disagree with. I certainly agree that some well constructed studies are needed on AA and other twelve step programs.

    I am also knowledgable and experienced enough to  know that the problems of addiction to alcohol and other drugs does form a disease process: but not for everyone. There are people who can stop drinking and drugging on their own. But, there are others who cannot and who do not. Addiction to alcohol, and other drugs, is, in my professional opinion, part of a disease process. It is a disease of the brain. For those people who are affected to that degree, there is more going on than they are able to control without help.

    I know there are those of you who are convinced that AA is harmful. I have not as yet seen that. But, I do not doubt that you had harmful experiences and have good reason for your opinions.

    However, it seems to me that the real problem is addiction. It is addiction that causes relapse. In fact, relapse is a major problem that seems to accompany addiction. Some of the studies I have read try to address that problem and I invite all of you to do that search on Google/Scholar.

    What I want to get across to all of you is that we hear you and are very empathetic. We are not against you as you at times seem to believe.

    Allan Schwartz, PhD

    I found your facts - Mike BD - Sep 14th 2009

    Mike I found your facts. - Rick Glaser - Sep 4th 2009

    http://www.drugabuse.gov/infofacts/treatmeth.html

    I checked the site, which stated not "facts", but an estimate. Big difference. Let me rephrase it a bit:  what concrete evidence supports the assertion regarding the returns on the treatment investment dollars?

    Further reading on the same link reveals another dubious "fact", the one about 23 million Americans "needing" treatment. The implication is that there are millions standing in line for treatment which isn't available. Says who, and based on what criteria?

     

    Mike I found your facts. - Rick Glaser - Sep 4th 2009

    http://www.drugabuse.gov/infofacts/treatmeth.html

    "It is estimated that for every dollar spent on addiction treatment programs, there is a $4 to $7 reduction in the cost of drug-related crimes. With some outpatient programs, total savings can exceed costs by a ratio of 12:1."

    I apologize that the website actually said roughly 7:1 instead of 12:1

    This was from research the we did and continue to execute as a group of professionals. Not only from this single article but a few different articles.

    If you need any more factual information on the topic you are discussing feel free to email me and I will help you.

    Rick Glaser

    Rick @ thelastresortpa dot com
    http://www.rehabilitation-center.org

    My Experience with AA - Donald Todd Quinn - Jul 23rd 2009

    My experience with AA lasted for 18 years.

    Throughout those 18 years, I was never able to put together more than a few months of sobriety. These relapses were always attributed to charachter defects, or the inability to get honest with myself by sponsors and members of the groups that I was attending.

    I spent years trying to understand what was so wrong with me that God would not relieve the cravings and confusion associated with my drinking problem. When I spoke optimistically of my commitments to sobriety, group members reminded me that I was not powerful enough to make it happen. When I grovelled and humiliated myself before the group, I was praised and rewarded with attention.

    In the end I found that AA was a really bad idea, not only for me, but also for the many scores of people whom I watched coming and going over those hopeless years.

    I originally went to AA because I had been referred by healthcare professionals. Now that I look back, I have to question the ethics of handing a patient off to a group of people who have absoloutly no credentials, and no emperical evidence to support the claim that their methods could help someone to stop drinking.

    AA created a whole bunch of confusion in my life. When I finally looked the program and the fellowship square in the eye and rejected all of it, I was able to muster up the self determination I needed to stop drinking. It's been three years.

    I would not recommend AA to anyone. I believe that AA is a religious cult that poses as the "only" answer to a healthcare crisis.

    oyyy ... - speedy0314 - Jul 6th 2009

    dr schwartz,

    your continued 'support' of AA (in dr. dombeck's blog site & here) without citing a shred of evidence of the program's 'solution' (effectiveness) is just ... i don't know -- i can't think of a civil term with which to describe it.

    "it works because i've seen it work for some people" is hardly a solid stance for someone who considers himself a professional in the mental health field &, frankly, a totally unconvincing professional 'vote of approval'.

    you refuse to engage the discussion with facts, statistics, or studies, yet promote the daylights out of a program whose 'real world', studied outcomes have shown themselves to be far less than even 'acceptable' by most medical standards.

    if you read this as 'angry', then you're right.  but don't for a second delude yourself into thinking that this 'anger' is irrational or unjustified.  i am completely at ease with my rejection of AA/12X12's utter irrationality & penchant for crushing the human spirit.  your explicit endorsement of it is sickening.

    having been through the drinking/drug abuse AND 12-step arena's i am well glad to have them both far behind me.

    at least a drink or a drug never explicitly promised me a 'personal' relationship with god (a mindf**k of the most grandiose proportions if there ever was one).  if that's the extent of your 'professional' opinion, i am more than grateful i never went to you for advise on the matter.

    AA is snakeoil -- and, rather than tracking the real research on addiciton (e.g., willenbring, volkow, bankole, etc.), you just mumble the empty 'go to AA' prescription for people genuinely wrestling with a problem of enormous magnitude.  pardon the language, but you are an empty-headed fool.

    so, label this 'angry', 'irrational', 'demeaning', 'shaming' -- all words out of dr. dombeck's playbook.  but read it & take it to heart.  faith-healing is not the answer for people who are suffering.

    and, in the end, faith-healing is what you recommend.

    Evidence, please. - - Jun 30th 2009

    Evidence, please.

    Telling comment.

    Helping Helen - speedy0314 - Jun 10th 2009

    in response to helen's comment / question, it would appear that the answers are (in order):

    i - yup

    ii - yup

    iii - yup

    AA as a methodology, as a treatment (or adjunct to treatment), or faith-based 'solution', needs to provide no proof of its efficacy in any vaguely scientific manner at all in order to get dr. schwartz's and (implicitly) www.mentalhelp.net's stamp of approval.

    this is the extent of the "sober discussion" about AA.  dr. schwartz knows people for whom AA has 'worked', therefore it works.

    Help me understand - Helen W - Jun 8th 2009

    I must be missing something here.  Please help me understand.  Are you saying that you (i) realize that there is no evidence that AA works, (ii) have sympathy for critics of the program (provided they are nice about it), but (iii) defend it anyway?

     

     

    Missing the CONTEXT? - Claire Johnson Saenz, JD - Jun 7th 2009

    Something is very wrong when a physician who writes to comment on the lack of evidence that AA works is told that she is "missing the context".  What other context is there? 

    If we were talking about a treatment for any other health issue, a clinician who questioned whether the treatment worked, and pointed out the lack of evidence that it did, would never be told she was missing the context. 

    People who complained that they were forced into treatment that didn't work and had negative side effects would never be denigrated as engaging in "black and white" thinking.

    I, for one, thank Dr. Hall for her comment and her devotion to a principle that is too often forgotten in this discussion: Primum non nocere.

    "some" - Ray Smith - Jun 7th 2009

    "...is to point out that AA does help some people, emphasis on the word "some".

    But what about the people that it harms? 95% of all new members drop out within the first year, doesn't that say anything about the program? If AA actually worked, why would so many leave?

    About 5% of people stay sober with AA, about 5% of people get sober with no program or treatment, except that AA has a higher mortality rate. If one figures in the mortality rate, AA has a negative success rate compared to spontaneous remission.

    George Vaillant, Harvard professor, researcher, and (now former) member of AA's Board of Trustees set out to prove that AA worked, compiled forty years of clinical studies and performed an eight year long longitudinal study of alcoholism treatment. He wrote of his findings:

    "Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling."

    AA is a placebo.

    "John Doe does not usually realize that most ailments are self-limiting and improve with time regardless of treatment. When a symptom goes away after he doses himself with a remedy, he is likely to credit the remedy with curing him. He does not realize that he would have gotten better just as quickly if he had done nothing! Thousands of well-meaning John and Jane Does have boosted the fame of folk remedies and have signed sincere testimonials for patent medicines, crediting them instead of the body's recuperative power for a return to well-being..." -James Harvey Young-

    I find Dr. Schwartz's comment "I have spoken to a number of people about this, all of them long standing AA members and all in full recovery for many years." disturbing. If he was looking for balanced information, why speak only to true believers? Self reporting and testimonials from only one side while asking for "mutual respect"?

    The very idea that pro-AA people are being "drowned out by the anti group" is absurd. AA has dominated the recovery field for decades, at least in part because the pro-AA people attempt to silence and ridicule those who raise valid objections.

    Evidence, Please - Harriet Hall, MD - Jun 6th 2009

    All you offer is anecdotes and opinions.  If I am going to recommend a treatment to a patient, whether it is a pill or a program, I require more than that. I require evidence that the treatment is effective. I want to know the NNT, the risk/benefit ratio, and I want to know if there are other, better treatments.  A recent Cochrane systematic review of all the published medical literature found no evidence that AA or other 12 step programs are effective. If AA were a prescription drug, it would not have been approved by the FDA.

    I am not "anti-AA" - I'm just "pro" science-based medicine. Evidence, please.

    Editor's Note: Valid points, of course, but maybe you're missing the context here.  Mostly, what Dr. Schwartz is trying to do in this particular essay, I believe, is to point out that AA does help some people, emphasis on the word "some".  The context is that many commenters on this site are very black and white when it comes to AA.  They hate it with a passion and tear it down at every turn.  Dr. Schwartz is not so much suggesting that AA has scientific merit, I don't think, but simply that it is not always the demon that so many who comment here find it to be. 

    How about just an 'open' conversation? - speedy0314 - Jun 5th 2009

    with all due respect, dr. schwartz: in characterizing any & all lay critique of Alcoholics Anonymous as some monolithic "anti AA" movement or manner of rhetoric, you marginalize & co-opt those often very cogent & often very diverse forms of criticism.  much in the same way the 'pro life' movement would have abortion rights proponents reflexively viewed as 'anti life', it seems you would apply the same fallacious & inflammatory technique to the discussion regarding AA.

    i'm not buying into your categorization & i would suggest others who might rightly critique AA at any level reject the categorization as well.  whether your choice of words was conscious or not, it is still marginalizing & insulting.

    as for having a 'sober' discussion about AA -- 'bitterness' is in the eye of the beholder.  as the old saw goes, squeaky wheels get greased.  it wasn't until dr. dombeck saw a significant number of well-argued, detailed rebukes of his naive endorsement of AA, that further blog posts were generated & this forum created.

    your anecdotal experiences with AA & AA members aside (& the relating of a pharmacological sample of one), the onus is not on AA's critics to prove its inefficacy.  rather, it is AA that states unequivocally "rarely have we seen a person fail ..."; it is common parlance in AA meetings that the organization has "saved millions"; it is AA that states (again unequivocally) "unless each AA member follows to the best of his ability our suggested 12 steps to recovery, he almost certainly signs his own death warrant. ... [this results] from his personal disobedience to spiritual principles. "

    the onus, then, is on AA to substantiate these rather extraordinary claims with some equally extraordinary evidence.  the kind of evidence that can be verified & replicated.  the kind of evidence that leaves the door open to new evidence & new techniques & new avenues of 'real world' research.

    the onus is on AA/12X12 because of its virtual monopoly in the therapeutic/treatment industry, because of its entanglement in the arenas of justice, social services, & the insurance industry.

    asking AA to account for its 'solution' in valid scientific terms, to offer public transparency to its inner workings & historical grounding is most definitively not 'anti AA'.  it is Pro Public Health & Welfare.

    alcoholism is a public health issue.  like it or not, AA has put itself in the position of being the primary authority in providing a 'solution' to that issue.  it's far past time for it to become publicly accountable.  that, or for the organization to actively & completely disengage from all public & private associations.

    excellent quote - Kate - Jun 3rd 2009

    Just want to share with You excellent quote with probably know well but there is something about an author, and there's always better to know more.... http://www.thotspot.ca/?p=2062 all the best to all of You Kate

    discovery vs. recovery - Mary S. - May 26th 2009

    I come from a more traditional, solid AA background and my sponsors and support all agree that 'treatment is about discovery, AA is about recovery'. Simply put, AA and treatment are not the same thing at all. Treatment is a great place to start; oldtimers say that 'you have to sit still long enough for the miracle to happen' Treatment does that for people. But they can also create a human dependence with things like 'compliance', dangling the carrots of housing, etc. to keep people hooked into the system. I was taught that no human power could relieve my alcoholism and placing too much dependence on humans could be fatal. I have to admit, I get tired of treatment center people coming into AA meetings and telling us 'that's not how WE do it at **** Center". So many AA's today are afraid of making a newcomer mad by teaching them respect for someone else's traditions and way of doing things. So, they get mad!?! If they leave, where else are they going to go? If they have a decent sponsor, that sponsor will strongly suggest that they sit down, shut up, and listen, that they know NOTHING about staying sober, only about drinking. Things are much less complicated in AA as well, three columns rather than 30 pages. I also take exception to the 'andas'; people who the treatment centers have told they need to emphasize their dual addiction or 'terminal uniqueness' in AA meetings. My sponsor taught her sponsees that it was disrespectful to refer to yourself as anything other than 'an alcoholic' in an AA meeting--period, and that admitting to it OUT LOUD was key to acceptance of it down the road. I heard one of them later on thank her because they said she was right--it was their ego; they did not want to be an alcoholic and they kept going out as a result, which nearly killed them. That lurking notion....Thank goodness for AA's Singleness of Purpose and the 12 Traditions to point the way and that someone else worked through all of this murkiness so that we can find our way to a better way of life. I never felt like AA was a cult, I was never pressured, never felt anything but the love and care and had people warn me that AA was like anywhere else, not everyone was there for the right reasons, predators abound there just like anywhere else. But people have loved me until I learned to love myself. I learned that I am responsible to help someone who asks for help in AA; I am responsible for my own recovery today as well. It is not someone else's job to do it for me. I have to do the work and walk the walk.

    Treatment Center co-opting AA - - May 26th 2009

    I have left comments on the other message board and am glad to find this one.  I am a 16 year sober AA member that doesn't mind criticism of AA.  The organization saved my life and I continue to attend meetings in an effort to maintain a connection to where I have been and stay humble in providing some service.  But I have seen abuses.  I was in long term treatment for a year in 92-93 and the treatment center itself would have qualified as a cult.  I lived in fear of weekly "community" where people could accuse others of wrong doing or even just being upset and then that person would be punished or even sent to a doctor who would put them on more psychotropic medications.  I stayed scared I would piss off the women that the counselors of the center thought highly of.  And it was like that center was also creating their own religion, the two head counselors were treated as Gurus and we were all spyed on to the point that paranoia set in for me.  I once told my counselor I enjoyed reading and preferred the Fantasy genra and her response was "Do you think you are living in a fantasy world?"  I struggled to protect my right to be seen with a book in that session, and tried not to be seen with one quite so often after that.  The counselors would also force us to expose private things from our sessions in community.  I appreciated the help I got there but was very happy to finish the program and have the freedom of AA.  But looking back, being an introvert, I wonder if my mental health wasn't set back by all that fear I experienced combined with the need to conform and not express feelings during my first year sober or be punished.  I eventually got good counseling but not for several years because I absolutely did not trust mental health professionals after that year in rehab.  If I hadn't married a man in recovery (Gasp! Sin! getting married and to an AA member, women in AA can't go and do that!) who urged me to get good help and promised me I didn't have to go if I didn't like the guy, I might have never made the progress I have made.  Our counselor was a God-send.

    In AA I have seen some abuses as well, but people can escape those more easily, except for those poor souls who are new and not well protected by sane older members.  I get very angry with the emphasis on sponsorship as well.  Sponsors are not God and they don't own us.  The purpose of a sponsor is only to assist the new person in understanding the 12 steps, but sponsor deification is something that I find disturbing.  I also am not in favor of certain famous alcoholics being Gurus for AA everywhere through being shuttled around from one big speaker conference to another.  Human Gods aren't particularly healthy for anyone to follow.  And too often newcomers expect the sponsor can magically make their lives better when only steady progress and not drinking can do that.

    At this point I attend some very good meetings in Chuches in areas that the folks in the (now) 3 long term treatment centers in my city don't find particularly accessible.  It appears to me that a lot of problems in AA come from the bastardization of the program by treatment centers; who teach the steps in a black and white kind of way.  These treatment centers demand loyality from their clients, and they even keep them captive longer by providing apartments for them once they finish long term treatment (in a drug infested area).  Black and white thinking and special catch phrases combined with chanting and confrontation are not helpful to my sobriety, and they can easily become ingrained in a meeting.  I believe most of those things have been added on to recovery by the treatment centers, who often employee "assistant staff" who are short on recovery time but long on ego and control.

    question on 766% ROI claim - Mike - May 16th 2009

    Mr. Callahan,

    You provided a link (www.TheLastResortPa.com) in your posting which claims...

    "A recent study has shown that an investment in sobriety pays a return of 766%."

    Can you cite this study?  Thanks  Mike

    totally different - - May 15th 2009

    Hello Jim,

    If you go to the hotlink below this as well as in the article you will find lots of information about recovery using either AA or any number of other methods.

    Please keep in mind that there are now medications available that block the craving or impulse to drink. They are proving very helpful and are totally different from Antabuse, in fact, totally different.

    http://www.niaaa.nih.gov/

    Dr. Schwartz

    it is a reason - - May 15th 2009

    I do want to point out that someone who drinks destructively is doing so for a reason.  It may be a bad reason.  But, it is a reason.  Who - person or organization - is best equipped to deal effectively with those reasons -- whatever they may be ? 

    Thank you - Daniel Callahan - May 15th 2009

    Our nature is to search for meaning we seem to have a necessity to define sometimes the indefineable.  Recovery is simple but not easy, it takes hard work especially in the early stages of recovery. 

    We suggest keeping an open mind in the "Discovery" process.  Until you have gathered all of the information on a personal basis you are short changing yourself.

    Recovery is worth it because Life is Goooooood!

    Dan Callahan, LMSW

    www.TheLastResortPa.com

    How does any of this help anyone quit drinking - Jim - May 15th 2009

    You guys go back and forth about whether or not its a disease and who does what to who at meetings and whether or not AA is a cult.  How does any of this help anyone quit drinking.  AA doesnt work for everyone.  They even tell you that in the rooms.  So why is it the only choice.  I know in my area it is.  There are 5 rehabs.  All 12 step. I volunteered at one once.  The counselor just screamed at the patients about going to meetings and would not let me talk unless I told them the same thing. 

    one-size-fits-all - Mike - May 15th 2009

    Dr. Dombeck

    Thanks for the reply.

    I agree that some people are more susceptible to addiction than others. My problem with 12-step programs is that they claim a cure through one method: the 12 steps.

    If all people are not created equal in their addiction then they should not be referred to a program that applies a one-size-fits-all approach (which incidentally has not been shown to work) to the problem of addiction.

    It's not a disease - Mike - May 14th 2009

    The NIH site was ok until I hit the FAQ.  They claim alcoholism is a disease.  This is not true.  It is a personal choice.  There may be other factors that cause one to make bad decisions regarding the use of alcohol.  Anxiety, an anti-social disposition, loneliness, boredom, and low self-esteem are a few that I can think of.  But disease, no.  Are gambling, sex, and eating disorders also diseases?  If so, are they the same disease, just a different manifestation?  Or underneath it all are we really talking about a "spiritual illness" that is all encompassing?  After all, the bottle was only a symbol, wasn't it?

    Editor's Note: I (Dr. Dombeck) am not sure I believe the classic disease model is the very best way to describe addictions either, but it surely is not a mere "personal choice" as to whether someone will end up having substance abuse problems or not.  People are born with, and individual's various environments shape different vulnerabilities to problems with alcohol and the like.  For some people, it is a simple personal choice to use or not; for others, it is much harder to resist. Don't diminish that differential vulnerability please, even if you want to hold on to a sceptical position.  People are not created equal in this capacity.

    personal and informed choice - - May 14th 2009

    I believe in personal and informed choice.  That applies to this matter, as in other matters.  People ought to be informed of their options; and, to make a free choice amoung them.  AA is one of those options. Several otions include:  Quit on your own; with little or no formal support group.  With a support group, there are several groups available.

    SMART Recovery;  LifeRing; SOS; Women for Sobreity; Moderation Management; AA.    People should investigate them and make their free choice.   I do believe that competent professional help should be used if needed.

    Destructive drinking can be very harmful; to oneself, and to others.  It is best to get it under control before it gets serious.  Early intervention is quite important.

    AA Positives - Evelyn - May 14th 2009

    Here is my list of positives in regards to AA. It gave me a community to belong to where I was accepted as I was at that time, a drunk. It gave me friends who showed me how to have fun without alcohol. It introduced me to spirituality - as opposed to the religion I grew up with (a huge gift). It made me think about my actions and how I have an affect on others by what I say and do. It taught me to take responsibility for my own life. I am truly grateful to AA. But for me, I believe I stayed too long. Because I am not someone who believes in the sponsorship part of AA there really was no reason for me to stay in AA past the approx. three year mark. If I am not there to give back by helping others then why am I going to meetings past the point where the alcohol was definately not an issue in my life? I did not feel good sharing at meetings (I had a way of saying things that made others uncomfortable), I didn't get coins on my anniversary (thought that was unnecessary). I wasn't really doing the program. What I was doing was trying to use AA as a social club. And finally I have learned that that does not work for me either because eventually I find that myself and members of AA have different values and basic views about life. True friendship cannot happen with those differences. Butting of heads eventually happens.

    I don't really care that AA is a cult now that I am out and not butting heads with the members. I do care about the people in AA and I wish that there was some way that the organization could take some feedback and make changes that would help ensure member's safety especially the vulnerable newcomers. I wish that sponsor's went through some sort of training and were held somewhat accountable for their actions. Not in regards to whether or not their sponsee stays sober but in how they treat their sponsee.

    The last thing I want to mention is that being uncomfortable in AA and leaving because of what goes on or because it just doesn't feel right is a huge deal. Once one leaves that highly controlled atmosphere and gets in touch with the feelings around their personal experience with AA and especially if they were a "victim" of unheathy behavior by another member, they need help. A support group for people who choose to leave AA, for whatever reason (usually negative), is necessary and will help a lot of people. I know I could have used a place to process all those feelings and I knew trying to find a therapist who could be unbiased was next to impossible.

    Peace.

    My perspective - Claire - May 14th 2009

    With due respect, Dr. Schwartz, I ask you why you defend AA.  It needs no defense.  At this point, it holds all the cards, or nearly all.  It is difficult and in many cases impossible to obtain treatment in the US that is not based on 12 step principles.  

    The reality, however, is that 12 step principles do not resonate with everyone, and there is no reason why other approaches should be shut out.  

    For myself, when I speak out about my own negative experiences in AA and decision to leave the group, it is not with the intent of trying to have AA wiped off the planet and done away with.  We live in a free country, and I believe AA is as entitled to its place in the marketplace of ideas as is any other group.  

    But AA is not entitled to monopolize the marketplace of ideas, and by continuing to promote AA to the exclusion of other groups or fresh ideas, the "treatment industry" does a great disservice to the population they are supposed to serve.

    I do appreciate your posting of the new niaaa website, which thankfully does seem to take a more balanced approach to treatment approaches than it once did.  I see this as a very positive development.

     

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