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Mark Dombeck, Ph.D.Mark Dombeck, Ph.D.
Essays and Blogs Concerning Mental and Emotional Health

Have you come to understand the objections (to AA)?

Mark Dombeck, Ph.D. Updated: Mar 12th 2007

I got a comment from Jill today, concerning my essay titled "Alcoholics Anonymous is a Cult?", which has generated numerous comments, many agreeing with the thesis that AA is indeed a cult-like and negative place, and many disagreeing. Jill asks:

Dr. Dombeck,

After reading this thread, have you come to understand the objections that many of your patients have to AA? Have you come to understand that telling them to "find a better meeting" is like telling someone who doesn't like Big Macs to "find another McDonalds? Will you practice informed consent and inform your patients of the other recovery groups available?

Thank You


This thread and this topic of whether AA is a cult or not has been very active on Mental Help Net. Rather than post this as yet another comment to the original essay, "Alcoholics Anonymous is a Cult?", or the follow-on essay, "A Better Meeting", I thought I'd respond in the form of a fresh weblog entry. Here is my response:

Even taking into account that the particular essay that started this "thread" was born of my realization that there were some vocal and angry critics of AA, it has been a learning experience for me to realize just how strongly felt the anti-AA sentiment gets for some folks. The lecturing tone of your present comment contains an echo of that angry sentiment, but there is also a genuine wish to be heard present too, that I hope I can satisfy for you.

I get it. I don't agree with the sentiment, but I get it nevertheless. There is merit to some of what the anti-AA voices have written here, but I think it is not the whole picture. There isn't any conspiricy I'm aware of where all professionals are AA promoters and under the spell of the "cult". Professionals that I know, know that AA is not perfect, that there are a lot of rather ill and narcissistic/anti-social people to be found at meetings (and many helpful ones too), and that AA is not the only or necessarily the best way for everyone to pursue who desires long term sobriety. The selling points of AA from the point of view of the professional are primarily that AA is peer support for sobriety that is freely available and commonly found. Quality professional treatment is expensive and in shorter supply than it should be, and alternative peer support groups (in the SMART/rational recovery mode) are typically few and far in-between (unless you happen to live in a larger city). Sober peer support is important - vital - for most all addicts in early recovery and AA is a good way to find it, so we recommend it. We do so knowing, from the testimony of patient participants, that AA does indeed offer a framework for sustained sobriety that works for some of the people who choose to participate in it. It is important to not forget this in your anger. AA is helpful to many people. Not all people, but many.

It is perhaps important to distinguish between an addict who complains about AA becuase he or she is too blinded by their addiction to see how it might benefit them, and someone who complains about AA because they have basic beliefs that are incompatible with the way AA is practiced in their local areas. Making this distinction is very difficult, however. As professionals, we tend to assume that addict patients fall into the former category and not the latter category, generally becuase so many of the patients we work with are "in denial" early on and actively or passively working to deny the impact that addiction has on their lives. We assume a certain degree of self-centeredness in early patients, I think, and also that through the process of recovery and the gaining of insight into the damage done by addiction and the compulsive nature of addiction that this self-centeredness will dissolve to some extent. A person who is lacking in insight will easily claim to have AA-incompatible beliefs, but really just resent any external controls being placed on them - which is a very different thing. When someone cannot control their own behavior, and their behavior is self- and other-destructive, external restraint is necessary. Only when someone recognizes this fact can they be in a good position to choose which style of restraint suits them best.

Atheists, agnostics and science-minded people will probably have more difficulty with the AA philosophy than will people of faith becuase there are major elements of religion and faith built into AA. But some AA rooms are less rigid than others, and some AA participants are more open minded to diversity than others. There are "better meetings" and worse meetings in some cases and places, and attending those better meetings can produce a better result than either not attending at all, or attending the lower quality meetings (however that lower quality might be measured). Certainly, if a particular meeting is causing a participant to feel victimized or abused or substantially disrespected, there might be alternative meetings that might work out better. If someone in a meeting is trying to play psychiatrist and dictate what prescribed medications should be taken and which should not be taken, by all means get out of that meeting. If there are literally no "other meetings" available, (and I'm using the phrase "other meetings" liberally to include both AA and science-based AA analogs like SMART recovery/rational recovery - professionals should be educating about the existance of these groups in areas that have them), then I can see how not attending AA might start to make sense. But in such a case, it would become all the more important to find acceptable alternatives that will promote sobriety. To not participate in a treatment program would be the bigger mistake.

Mark Dombeck, Ph.D.

Mark Dombeck, Ph.D. was Director of Mental Help Net from 1999 to 2011. Presently, he is an Oakland Psychologist (Lic#PSY25695) in private practice offering evidence-based acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) and addressing a range of life problems. Contact Dr. Dombeck by calling 510-900-5123, send Dr. Dombeck email or visit Dr. Dombeck's practice website for more information.

Reader Comments
Discuss this issue below or in our forums.

regarding "no comment" - Mary - Apr 27th 2010

No comment said:  The question must be asked:  How does what is related below serve that purpose?

The purpose Mr. Dunn's comment serves is to provide an alternative experience, and considering that no two humans are exactly alike that could prove beneficial for others who have problems that the 12 steps of AA alone will not solve.

It takes quite a bit of anger to say that an expression of someone's experience staying sober serves no purpose in a discussion about how to stay sober.  One might feel that person's ideas would not work for them, and that's fine, but anger is involved with a desire to shut someone down.

AA - David - Sep 14th 2009

My question is a simple one....Are you a member of AA...

no comment - - Feb 25th 2009

All of that related by Nick Dunn is completely unnecessary.

The issue is to end destructive drinking.  And, acquiring the means to do that.  The question must be asked:  How does what is related below serve that purpose?

The behavior described needs no comment.

Time to speak up - Nick Dunn - Dec 19th 2008

Guys,

As a person who has been 8 years sober and been to hundreds of AA in my area. I agree with much of the anti- AA views on that were posted. I went to AA when I was 6 months sober so I could really get associated with sober people. Also, I felt terrible in sobriety, and I felt that might know something I didn't. I really enjoyed my first 6 months in AA. I got a job in my group and went on the commitments and got acquainted with a few good people.  The problems started around a year sober. I felt still pretty bad in sobriety and other members directed me to the Big Book step studies.  I was saying to others that I should get a therapist. I was pretty much laughed at. Again, I was looking for a solution to my problems and they seemed to have it. When I went to the meetings alot of members swore by it. This is where the brainwashing begins. After you are there awhile you start to notice the negatives opinions about therapists and the mental health community. I heard people say that Bi-Polar and ADHD didn't exist. Members claimed it was just a legal way to get stoned. I heard one of the gurus say that an Alcoholic always will take a pill before doing the steps.  They wanted an easier softer way.  People that have mental illness were just too self centerd. I was slowly getting convinced. Everyone was just raving about the steps. It seemed like a path to salvation, and if that was the way I was going to do it.  I grabbed a sponsor and got a couple of notebooks. I worked like crazy. I filled up 3 notebooks. I had a few hundred resentments. The problem was alot of times I couldn't see my part it. Alot of my resentments were about abuse and neglect. It seemed like a stretch to me.  I guess writing that that my parents were sick too didn't seem logical to me. If I caught a beating for not doing my homework, writing I put myself in that postion didn't seem legit.  I did my fifth step and I ceratainly did not receive the fifth step promises and neither did the 3 other guys that I did it  new and finished about the same time as me.  One of the guys, was so depressed that it didn't work for him that he went off drinking. I have not seen him since. Another guy, was traumitized from all of his horrific childhood traumas that came out in his fourth step, that he went into a psych ward. He ended up getting psychatrist and quit AA. He actually is doing better but is still not back to normal.

Anyway, I was convinced by my sponsor and other members of the group that if I did my ninth step I would get well. You have to go to any lengths , right. Well halfway through my amends, I did not receive any of the promisese but I did get something. I started getting panic attacks, which I never got before. Anyway, I still went to the meeting still felt peace and serenity was just around the corner. I got convinced by the thumpers if I just did another 4th step I'd be fine. I was told anyway that some guys need to do it a couple of times to get it. I did it again and again. I wrote 4th steps like 4 times and it never worked.  This went on for a few years.  Finally, I was at a meeting and some guy stood up and said you know " the steps don't work for a whole bunch of people. " that started my mind to deprogram. It still took me like a year to leave, but It was battle. How could this be true ? Had I been duped ? How could I waste years of my life  ? Anyway after quite a struggle I did seek professional help. After a few months, i was diagnosed with Adult Adhd and serious depression.  The wounds from childhood are healing a bit and I am getting a little better. I take medication and I can focus much better. It is common for ADHD to lead to substance abuse.  I can honestly say that through my experience that the 12 steps do not work for most people.  The reason is because most people who come to AA are not Selfish and self centered. Selfishness was not the root of my problem ADHD and abuse was. I got brainwashed from AA because that is THE ONLY MESSAGE in AA.  The Big Book is the only way and if you don't do this you will die. The 12 steps do work for some. I have seen it. It works for the " Ego maniacs" , if they work out. I never fit the model and since the only model in AA is about Selfishness, Self seeking, Fear, and Dishonesty everyone gets lumped in the " One Size Fit ALL" and are alcoholics are selfish then this is the only solution. AA would be a fine program if there was a detector at the door that said all egomaniacs to the right because you need to get torn down, and all others who need to be built up go to the left. But it isn't and I have seen go off their meds to do the faith healing and go crazy. In my opinion, this program has done alot of damage to people and I have lived it and seen it. It would be great if they said this won't work for everyone, and if you do the steps and you do not fit the profile you will may get hurt. They should read a warning before the Big Book is read like they do with cigarettes, that this program could be hazardous to your health. I would say the 12 steps work for 20 percent who try because those about the percentages who are Egomaniacs.  Mine was a terrible experience . I don't owe my sobriety to AA. I was long sober before I got there. I was looking for a solution and I got brain washed into believing I was gettiing one.

Nick

aa variations - John - Jun 24th 2007

I've been in AA 10 years, sober 8.  At first, I went to a "fundamentalist" group, because I really believed they knew something I didn't, and it was time to "surrender."  As my first sponsor used to say, "My best thinking got me here."  I was right, of course.  They did.  For awhile, all I really needed was for someone with half a clue to tell me what to do.

  However, the beliefs really did go against my grain, and I began having an increasingly difficult time with the single path the participants demanded.  I "spiritual" tendency leans more to the Buddhist thinking than the fundamentalist Christian.  

   Luckily for me, in my town (Olympia, WA), we have several "agnostic" groups.  In fact, I found a home group called "We Agnostics."  I'm guessing our approach is something like the alternative sobriety groups out there, although we still keep the basic AA framework.  There are a couple of sayings in AA, "The only step you have to do perfectly is Step One," and "The only desire for membership is a desire to stop drinking."  The difference between us and the groups of the fundamentalist Christian bent is that we really mean it.  My group consists of just about every religious stripe, including a good helping of athiests and secular humanists, and we're open to all, even the Christians until they start telling us we'll get drunk unless we do it their way.

  I think the whole bottom line about AA, and probably the non-AA groups, is association with people who are like me and are managing without continually dosing their nervous system.  I'm not an academic in the subject, so I really couldn't define it, but I know from experience that I can relate to another alcoholic on a deeper level - or maybe just intuitively understand their feelings - better than I can a non-alcoholic.  That, more than steps and slogans, is what has kept me sober.  I'm communicating with my fellow drunks, and I can remember what they said the next morning.  (Although of course there have been moment when one of the pithy slogans has been all that's stood between me and getting loaded.)

  As a side note, once I left the Christians and started reading some "non-AA-approved" literature, I think the program fits just fine with a Buddhist point of view. 

Ignorance concerning AA - Ralph Cox - Apr 1st 2007

I read your comments about AA and it became obvious very quickly that you had little if any information about the program.

I was a "member" for almost 30 years and have read almost every bit of literature on the subject so I know of what I speak.

For startings according the Professor George Vaillant from Harvard. AA does not work to keep people sober. He did an 8 year longitudenal study that tried to prove AA worked and at the conclusion he could not prove it so. As a matter of fact he proved that AA was killing people! The highest death rate amongst the study groups was among those attending AA.

There is no debate about whether or not AA is a religion. it is! And that has been upheld in numerous court cases.

In fact it is a faith healing fundamentalist New Age religion.

I daresay if you were to tell your patients to watch Benny Hinn on television everyday as part of their recovery they would get aprroximately the same results as those attending AA.

I find it difficult to believe that in this modern day and age that an educated person like yourself can support the type of primitive mumbo jumbo that goes on in an AA meeting.

There have been many many controlled scientific studies done on AA and it is rather obvious that you haven't taken the time to investigate or read any of them. I would suggest you do. Because at the present you are disseminating information that could be harmful to an individuals' health.

Incidentally, according to almost every properly run study the success rate of AA is about 2%. Turned around that is a 98% FAILURE RATE!.

And this is what you would recommend for people?

 

Ralph 

Same old song - Ray Smith - Apr 1st 2007

You wrote:

"There isn't any conspiricy I'm aware of where all professionals are AA promoters and under the spell of the "cult". "

Doctor, you are either a member yourself or you are taking the word of the those who are satisfied with the program. I believe, like many, you are a victim of mis-information. 95% of those who join AA will be gone within a year, that's by AA's own internal Triennial Survey. True, many return, but there are still more ex-members than members, and many of us are very dissatisfied and have felt harmed by the experience.

The Brandsma study showed that those exposed to AA are five times as likely to engage in binge drinking than those who received no treatment. A study done by George Vaillant, professor and researcher at Harvard and a member of AA's Board of Trustees showed that people attempting to quit using AA fared no better than those attempting to quit on their own, and the AA group had a mortality rate that was six times higher! His quote was "Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling."

The success rates of no treatment at all and AA are both factored to be 5%, but AA results in a higher rate of binge drinking and a higher death toll, how in good conscience can you promote a treatment that results in more harm than good?

well done! - regina - Mar 14th 2007
Dear Dr. Dombeck -


Beautifully explained.

I understand the vehemence many people project regarding their experiences with aa.

I believe many health care professionals can be every bit as didactic and overbearing as the more "enthusiastic" members of aa. It might be that you (personally) are in the smaller percentage of helping professionals who can maintain detachment while exhibiting a sense of care and warmth that many will never achieve.

Either you went to a really good school, had some great mentors, or were born for your profession.

That percentage variation (of altrusim vs. egotism) among the human population in general is upside down from what we would prefer it to be. I think the nature of the human being in society is controlling and full of morals (usually based on the individuals' supression or judgement of his own desires) - and, as such, his ego finds satisfaction in having other people (listen to and) follow his suggestions. It's kind of fascinating, if one is observing - but disheartening for the many who are seeking help and instead find themselves caught up in a web of deception and avarice.

Those are strong words - but I think Dylan said it best when he wrote: "I can't believe we've lived so long and are still so far apart." I think this simple truth can be quite heartbreaking for people (such as myself) who sought camaraderie and understanding in aa - and found only... humanity. aa is *not* a professional organization - and even many professionals will never act as such.

On a lighter note - it seems that people who would have (in the 70's and 80's) become therapists are now teaching yoga.
I'm sure there will be anti-ashram/yoga sites very soon...

yours
reggie

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