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

A Better Meeting

Mark Dombeck, Ph.D. Updated: Jul 1st 2006

This essay is an attempt to continue the dialog that got started up around my previous essay "Alcoholics Anonymous is a Cult?". That former essay concerned the notion that many people have that AA is a cult-like organization that does more harm to its members than good. A whole lot of responses were generated to that essay, many lending support to the notion and others speaking against it. Clearly, AA is at least polarizing if it is nothing else. I'm still in the middle of my essay series on Psychotherapy Technique, but we'll continue holding off on that for a while until this interesting thread has run its course.

man holding I'd like to take the discussion in what I hope is a productive direction by addressing the question "What would a useful alternative to AA look like?" What parts of AA are useful and should be incorporated into this new alternative, and what parts need to be left behind? What reforms and innovations should be added so that the resulting program is more useful to its members? Constructive answers to these questions (rather than rants) can contribute to a plan, and perhaps someone can work with that plan to create constructive change.

I'll start by restating the major objections to AA that were raised in discussion of the previous essay. Here is my short list; hopefully, I've not missed anything important.


  1. AA is a thinly disguised religious program (atheists, non-Christians don't fit in)


  2. It is ridiculous that your higher power can be a thing (like a motorcycle, etc.). This makes a mockery of the concept of higher power.


  3. AA attracts and retains sociopaths in their organization. They are not self-policing and therefore set newcomers up for abuse.


  4. People are mandated by the courts into AA. This sucks for personal liberty reasons, and also because of reasons #1 and #3.


  5. AA is ineffective as a treatment (only 5% stay sober within a given year). I've not verified this figure and am not sure how I could, but let's go with it for now.


  6. AA is fundamentally disempowering. It encourages you to distrust your own thinking. It does not support your efforts to think on your own. There is no way out; no way to graduate.


  7. Many AA sponsors prescribe bad, sometimes dangerous advice to sponsees. Among this dangerous advice is advice that people should stop taking doctor-prescribed medication. Many sponsors are hypocrites. They want you to "do as I say, not as I do".

We could start to describe an alternative group by saying that these "abuses" (if that is what they are) should be corrected. The alternative group might be:

  • secular in orientation
  • self-policing (on the lookout for sociopaths and abusive behavior)
  • empowering
  • open minded with regard to professional treatments.
  • based on some system (yet to be described) that produces a better sobriety outcome than is typical of AA groups. Minimally, we'd want more than 5% of participants (or whatever the proper figure is) to be sober at the end of the year.

I personally feel stronger about some of these points than others.

It seems to me that helping the group to self-police is important and imperative if that group is going to be maximally supportive for its members. I have run psychotherapy groups in my work as a psychologist, and I have run an online community as well. There are always members who try to dominate groups, and there must always be an 'immune system' for any group that exists to minimize abuses. In a psychotherapy situation, that immune system is called the therapist. In an online group, it is called the moderator. In an anonymous group with no real leader, the group itself has to have a way to keep itself in check. Now – I have no idea how AA groups perform this function, or if they do. I can only suggest that it would be a good idea that they figure out a method for doing this sort of thing in order to keep the group healthy. One way to do this, without compromising anonymity, would be to use a "reputation" system such as exists on eBay. Group members would get a handle, and periodically, members could vote on how each other member was behaving. The system would need to get sophisticated in order to keep it from being spammed and gamed. Some members would be framed, even as real problem members would be brought to the attention of the group. Such a system would never satisfy all members, but it might go some distance towards helping the group to know who its potential abusive members were so that their 'sponsorship' privileges might be suspended or something like that.

The matter of being open minded to professional treatments is a no-brainer. No member of a peer support group (or religious group for that matter) should be in the business of advising someone to ignore the medical advice of their doctor. Anyone who does this sort of thing is clearly giving bad advice. It's not that doctors are all-knowing beings who never make mistakes. In fact (as we all know), many of them have their own narcissism problems. They are, however and most importantly, properly trained to give medical advice, while group members are not. Medicine is not perfect, but it is better than most people's unfounded opinion (no matter how dear that opinion may be), and the stakes are way too high to play games. So far as I am concerned, any support group member who gives medical advice or contradicts medical advice is doing a terribly dangerous Bad Thing and should stop doing so immediately. This much is true even if the member is him or herself a doctor. Only someone's personal doctor should be giving medical advice.

The matters of secularity and effectiveness can be combined by saying that the group should be based on scientifically established treatment principles, such as Relapse Prevention. The problem with this sort of statement is that relapse prevention works best when a trained professional group leader is present, and this sort of thing costs money. Making this group cost any amount of money will make it impractical. For that matter, declaring the group to be secular in nature will probably be just as alienating as declaring it to be religious. Alcoholics come in all religious and non-religious varieties and no one wants to be excluded. Scientifically derived principles can be used on a self-help basis, but this is frankly difficult to accomplish, and we're looking for something that will work better than AA's method of surrender to a higher power. I'm not sure what the right response is here.

The matter of whether the support group is best off being empowering or not is debatable too. It sounds, on the surface of things, that encouraging people to think for themselves is a good idea. And it is, within limits. Teaching people the principles of relapse prevention so that they can become responsible for recognizing that they are in danger of relapse is important, for instance. However, encouraging people to surrender their judgment also has a lot going for it. Many addicts are good at lying to themselves and to other people; they are not always the most mature people, and they can be **selfish**. If such people are encouraged to think for themselves, they are going to rationalize more selfish behavior, quite frankly. Encouraging such people to look beyond their own judgment to a "higher authority" is a good thing, IMHO. This is what we ask of naturally selfish children, who look to their parents for a higher authority; and if parents do their job reasonably well, those children are helped to grow into more mature, self-governing adults. I think the 12 steps are trying to perform the same sort of function for alcoholic addicts. Maybe the proper solution is that both empowerment and "surrender" are important and neither should be discouraged in our new group.

It is entirely possible to work the 12 steps I think and gain nothing in the way of maturity. It is also possible to work them and really undertake a "spiritual" transformation. Or, if you don't like that work spiritual, try this one on for size: "Epistemological". Epistemology is the branch of philosophy that has to do with how people understand things: their theory of knowledge. When you undergo what is usually known as a spiritual transformation you are also undergoing an epistemological transformation. That is to say, your way of knowing what is right and wrong, true and false changes. When an addict shifts from a mind set and way of knowing that says "I am the center of my universe" to a way of knowing that says "I have only limited control even over myself; there are larger forces at work that I am subject to", this is a change in epistemology and spirituality (even if you are not spiritual). You can't make this sort of mental switchover without a certain amount of submission occurring; but it is ultimately submission to a more mature picture of the world (vs. a less mature one) that is happening, not submission to a sponsor or a set of principles.

The question of coercion needs to be addressed. I'm thinking that this is not something that really is within AA's control (whether or not people are mandated to join them). This is a legal issue, instead. Personally, I'd like to see a whole lot more public money be put into professional treatment programs based on sound scientifically based principles, and for courts to mandate people into such programs. This isn't entirely practical, however. This money is just never made available at the level where enormous numbers of people can be helped on a daily drop-in basis, and hence AA is pushed because it is ubiquitous. I can see how it can be a procrustean bed for some, but it is perhaps a better fate than jail for most. Of course, if drinking persists and people get hurt, jail time may follow anyway. There should be some sort of scientific evaluation of the efficacy of the programs available to addicts if they are to be mandated, or at least people ought to be able to choose from amongst approved programs if they are to be mandated in this fashion. But apparently, this is an area for further advocacy and not yet a reality.

As a sort of final statement for this essay, I'll note that there are groups out there, including SMART Recovery, Rational Recovery, and a host of others that have some of the characteristics I've described above. These groups are available online or in select communities only, however. They aren't as well known as AA or as easy to access, but they do exist.

Anyway, those are my thoughts for what they are worth. I'll put the questions to you again, because I am interested in your answers to them more than my own: What would a useful alternative to AA look like? What parts of AA are useful and should be incorporated into this new alternative, and what parts need to be left behind? What reforms and innovations should be added so that the resulting program is more useful to its members?


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.

that is ridiculous - - Apr 1st 2013

Half of my family has been in AA and I a studying to be a psychologist.  The notion that AA is a cult is completely ridiculous and offensive for the millions of people it helps.  Even though I do feel you may get more out of individual counseling it should be a dual relationship.  Counseling and AA together because in my opinion the AA meetings are a bit stale and repetitive and boring.  But it is not a cult!!  And it can be very helpful for a place to go when you feel the need to drink and if you actually work your program it is beneficial.  If you don't believe me ask the millions of people AA has helped.

Individual truth - Cheryl - Jun 28th 2012

I have been a member of Alcoholics Anonymous for 22 years, although I am not a Ph.D. I have found my experiences and education work for me and contribute to my opinions or, "individual truths" uplifting my own life. I walked into my first meeting knowing that I was headed for trouble. I had alcoholic seizures, been raped in blackouts, had assault charges from fighting when intoxicated, had two children from different fathers, depended on my mother to be the other parent and half the parent I wasn't being. I reached out and what I learned from the "Big Book" was, I was entirely accountable for my life, even if i did not want to be responsible. I was directed that AA may not have all the answers to my problems, that I could seek help from the medical community, that counseling was a good thing if I decided I needed it. I was told be careful, AA  wasn't perfect but many had found it to be helpful for the disease of Alcoholism. I learned many things that I saw completely as opinion, and I learned suggestions that would either work for me or wouldn't. AA had turned into a vehicle for me. I came to places in my life that I traveled through analyzing at times, sometimes making great discoveries, sometimes discovering I could put a spin on just about anything and many times end up with the same simple conclusion. AA works for many, not everybody, not even the majority but it does work. My religion; I believe in people, I believe in community and the sense of contribution. I believe the world need not be made up of people going through life alone. When many of us had been cast aside and given up on, the community of AA has been there for us. We can say, that's great I'm so happy that works for you but that does not mean it has been the answer for eveyone. True, but the AA fellowship knows that. We also initially let the courts send people to only help but the government and many professionals have abused this ultimately sending people who want nothing to do with it. As an AA member I feel those sent have every right to not be there. We are all allowed that. I never felt coerced or shamed and I can only speak for me.

"My Thoughts" - Allan N. Schwartz, PhD - Oct 5th 2011

Hi Charlie,

Obviously, I do not agree with you. In my opinion and experience, AA is very helpful. However, it is true that it's not a cure. At this point there is no cure. Addiction brings with it lots of relapse and that is very unfortunate. Yes, some people in AA are sociopaths but that is no different than society as a whole. It does not mean that all people are sociopaths.

It seems to me that AA is something for people to hold onto in their search for sobriety.


my thoughts - Charlie B - Oct 5th 2011


  1. AA is not a drinking cure. It offers abstience and a spiritual program as an alternative to drinking. It is not and never was for everyone. It will not prevent anyone from drinking - prospective members are encouraged to seek medical attention and sober up before coming to meetings.  
  2. A higher power can not be a motorcycle, that is rediculous. However, while there is no requirement to believe anything, obviously some kind of healthy God concept is encoraged.
  3. AA attracts and retains sociopaths in their organization. They are not self-policing and therefore set newcomers up for abuse. This is the sad truth and AA would do well to pay attention to it's critics on this point.


  4. People are mandated by the courts into AA. The courts should not be allowed to mandate people to AA. AA has no ability what so ever to rehab criminals and since AA tries to be echumenical, not secular, it seems to be a clear violation of their rights.


  5. AA is ineffective as a treatment (only 5% stay sober within a given year). Again, AA is not, and never was, for everyone - there are far to many people going to meetings for whom it will never work. They could be better helped elsewhere.


  6. AA is fundamentally disempowering. It encourages you to distrust your own thinking. I do hear that "don't trust your own thinking' in meetings at times - I have an idea where they are pulling it out of. In reality Step 11 is about learning to trust your own thinking. Learning to trust your thoughts and intuition is an essential part of the actual program.
  7. Many AA sponsors prescribe bad, sometimes dangerous advice to sponsees. Yes, this is an unfortunate truth. Some sponsors hit their head when they fell off the stool and now think they know everything. Many people in AA are very, very sick and one has to be very careful when choosing a sponsor. 


Alcoholics Anonymous, Where Are You? - Allan N. Schwartz, PhD - Oct 4th 2011

I have noticed that the lively discussion by the pro and anti AA people seems to have stopped.
The issue has not stopped as the addiction problem has greatly worsened world wide. I suggest and urge all of us to return to this important issue.

By the way, I can now say that I am an advocate of AA.

Dr. Schwartz

My Arguments - Bo - Oct 3rd 2011

Argument One
Obviously freedom of religious practice at the individual basis is a flexibility that you are unwilling to allow. There is clearly an ignorance that God is maintained within any religious practice, when the reality is all religions have incoorperate a concept of God that is followed in their discipline. God is and has never been within any man constructed system of belief based on the simple attribute of purity which is a characteristic instantly removed upon mans involvement. AA is clear in it's open and tolerant stance with respect to all matters including religious practice so long as they do not affect the fellowship at the group level. How one can extrapilate such biased uninformed notions regarding AA position while expressing unfounded extrapilated conclusions through identifying same or similar qualities found in a particular religion or your concept of a religion ( Christianity) and (Atheism) which has absolutely no connection with religion as God neither has by definition. Impure man made creations are incapable of purity is logic that is to date irrefutable. Contempt before investigation is a ceretain fallacy with this comment as is your rigid inflexibility based upon your pre determined notions and ideas about matters you have little understanding from experience.

Argument Two
When one person, group of persons, faction, tribe, nation, or other is allowed to define anothers focus of power, higher power, God, Diety, on and on... they have commited another fallacy. Who but power weilding fear based persons looking to control others and their reality through fear and domination would be intolerant of anothers choice of belief. Only ego driven wanton fearfull soles need define or disavow anothers belief system with the assumption that they are right in their defining of God or higher power which instantly negates their argument logically.

Argument Three
The ignorance and fear that is contained in this particular statement borders on the ridiculus. To believe that all of the creatures of the earth are not capable of both Sin (socio pathy) and Virtue ( Right & Good) is as heretical a statment as there possibly could be.

Argument Four
Although at a core level I agree with the statement made I will argue from the point of society and its aggregate decision to obey the laws civil and legal of the land that we reside within. I think that upon breaking the law it is at the descretion of the Judge of any court of law to impose any corrective or rehabilatative action deemed conducive to remedy the malady which led to the law being violated.

Argument Five
If the goal or purpose of AA was to keep drunks from drinking then the program is actually 100% successful. The purpose as defined in the Tweleve Traditions is to carry the AA message to the Alcoholic who still suffers. Suffering occurs in alcoholics who have stopped ingesting alcohol as it occurs in those who are not alcoholic. Also in the Twelve Traditions it say's "memebership is determined by a desire to stop drinking", again when one thinks logically not habitually or from ignorant surface level bias they must agree that upon ingesting the first drops of alcohol with knowledge they have certainly rescinded their membership prior to the intake of alcohol, one cannot have a desire not to drink and drink concurrently one must preceed the other or we need to redefine our language or become more honest individually one of the key tennents of recovery. The suggestion of AA is to continue to attend meetings, which may occure at 5% annually, but of the 95% who stop attending within the next few years some come back, and some of those leave and come back later, while more from the first 95% make a return and so on and so forth. Looking at AA as a static entity is so fallicious as to cause discomfort in addressing the ignorance from one who has been given to credintials of PH.D

Argument Six
Does one graduate from Life, other than in death; diabetes? M.S.? Dysthemic Depression, Mental Illness, Alzheimers, Parkinsonism? AA as a fellowship of principals does not demand any renounciation of beliefs or thinking. I have proven with logic from experience that your first 6 fallicious statements are such feel the 7th will be as well but prefer to suspend judgment until I have considered it objectively, and maintain no desire or intention to ask you to change them in any form. Members of AA are members of AA, they are not representative of the AA fellowship. Any individual AA group operating as AA is not AA the fellowship they are autonomous group conducting meetings as AA. It would be an absurd idealic fallacy to believe that human beings who are fallable creatures would never act say or do wrong, even in AA. Hopefully you have more compasion with those who are in error as you clearly are among them

Argument Seven
Most people are hypocrites whether in AA or not. Most people have prescribed bad advice, I am responding to some horrendous advice currently, and that is o.k. I understand that people feel they must validate themselves through any means necessary. My sponsor was one of those you mention he denounced medications in my early sobriety and guess what? I agreed with him. However after 7 years I adopted a new disposition on medications in fact it is one of my major recovery adaptations. My sponsor was ignorant for whatever reason?? People often are, but the love, compassion, and diligent work he provided for me will never ever be reduced because of a few pieces of the solution he had incorrect.

I feel convinced that should one have read these responses they will Honestly ignore the clearly adverse attempt your unbased, unfounded slander might have had, rather they Willingly may attend a meeting for themselves.


I beg to differ! - Bernadette - Nov 5th 2010

I have been trying to get sober my whole life.  I have tried *everything* mentioned in "the big book" that alcoholics have tried, and many, many more, to simply try to "not take that first drink."  I even tried AA... but I didn't really.  I never phoned my sponsor and I never even began to work the steps.  This last time around I was so desperate, I thought I'd REALLY give AA a try, sincerely working the program.  Well, I am blessed to have a wonderful, healthy sponsor who is fast becoming a good friend.  Today is my 68th day of sobriety and TOTAL abstinence from alcohol, and I can hardly believe it.  I live in a small town, too, so I do not have access to daily meetings; yet, the fellowship of Alcoholics Anonymous is still working for me.  All that to say, please don't discourage alcoholics from giving AA a go-- it just may be the one thing that can help them!  My Priest had been gently urging me to join for years; I am SO thankful I finally listened to him and gave AA another go!

Traditioal AA is stagnant it does not allign itself with possibility thinking. - Jim Manning - Sep 20th 2010

An Open mind is crucial to overcoming substance abuse yet AA has a collectively closed mind when it comes to proven scientific research that has great vaule in helping the substance abuser gain new and helpful knowledge that contributes to his or her well being. I have always found it helpful to gain insight to how addiction can be conquered by simple realizations such as creating new thought processes throught repetition in the brain [Meditative self affirmation tapes for example] to strengthen resolve for example. If I shared such a Idea at an AA oldtimers meeting I would get blasted but at the same time society is crumbling and addiction is a leading cause Result closed mindedness how sad.

Only a part of the solution - - Apr 27th 2010

AA is only part of the solution to sobriety. What others fail to admit is alot of addiction is caused by mental disorders and tragic life events (like child abuse)..i would be happier if AA heavily encouraged its patrons to seek PROFESSIONAL help in addition to meetings..I am glad that meetings are there for people who need them and they do help some people on some level.

     On another topic, but one that always intrigued me, isnt it ironic that AA was started by a guy who was loaded/high out of his mind and had a "vision" regarding god  while high?!... this is where i take issue with the with the people who hold the big book as some sort of bible and the word of god. Kinda how all sham religions are started. I am all for sobriety but i am highly suspect of someone who says they are in direct connect with god or god told them to do something... no matter what religion. So since god spoke to them you have to listen to them.. I  call it the "right hand of god syndrome"..i am not wrong and i can do anything i want because god told me to do much bad has come to world because of people like these. This is why AA is a are following a preacher who created his own bible regarding HIS relationship with his god. And i get sick of people using the "well your motorcycle can be your higher power"..come on! Too bad Bill W didnt meet my god, who gave every person so many gifts and does not feel that faith in him would restore us to sanity. He understands life is work...that humans are strong and he gave us the tools to help ourselves...we are not enslaved to him.

depends on the attendees - - Apr 26th 2010

Yes. there are better meeings.  And, there are worse meetings, as AA is quite variable.  It depends upon the attendees.  In a big city, you can pick and choose.  A noon meeting during the week will be different from an evening meeting at the Alano Club.  That is just one example of a difference.  There are open and closed meetings as well.   It depends upon what you want.

AA - - Apr 15th 2010

AA is not suppose to be something that is easy....its goin to be the hardest thing that you will have to do but its something that you will have to do to be a better person for yourself and everyone you know.....Its goin to be hard because their makeing it so that you dont want to return and that you wont be like the person you were when you came in there and that when your done with your treatment you will not want to return to the things that got you in there!

AA - - Apr 15th 2010

AA is a great program and its only bad if you look at it as a religious mom has been an alcoholic all of her life......i was taken away from her when i was 5 we still aren’t with her 8 years later because she refuses to go to them.......all she has to do to get her to kids back is got to the meetings but she refuses and says that it’s like a religion.......If people would just comply with what they are to do they wouldn’t even have to take these meetings. If addicts really wanted help they would take it and not make excuses for a reason not to help themselves.

Better Education - Mickey - Mar 30th 2010

Isn’t it time that we looked at the issues we are not addressing here? I see a whole lot of scapegoating going on here and yes I have been a participant.

One of the main concerns of the anti-A.A. side is the concept of the term “Powerless.” Why is that? What is it in the big picture that we are not looking at?

I am going to propose an idea here and I am sure I will be told I am paranoid or a whack job but I can live with that so here goes.

We live in a society that is by nature abusive. How many of you can say you get up and go to a job where the employees are not scapegoated for the incompetence of the employer or management? How many can say that the employer recognizes and values that the employee knows their job better than the owner or employer? How many can go to work and say they are not seeing someone else being scapegoated in an attempt to avoid being blamed for the managements incompetence?

Have we not desensitized ourselves from abuse by referring to layoffs or being fired as downsizing? If you complain about someone’s abuse you are told that you are too sensitive or even worse you become insubordinate and a troublemaker.

Does the family that has lost their home because of economic hardships and have to live out of an old abandoned car need to be told they are powerless; I think they already know that. Does the child that has been abused by the very people that are supposed to trust need to be told they are powerless; I think not.

Alcohol is advertised as a necessity to have fun. Drugs are advertised as a quick fix to all our problems and gambling is advertised as a quick way to become wealthy. It seems to me that these ads are addressing the very people with the very problems we are trying to fix. Isn’t it time we started looking at educating ourselves rather than blaming each other. What right do we have to blame the mental health professional for all our problems when Dr. Dombeck himself has explained that funding is limited and their hands are tied in providing much needed resources?

My idea may be way out of whack here but I challenge you to come up with other explanations for the following statistics:

Every day, 500,000 Canadians are absent from work due to psychiatric problems.
Mental Health is the number one cause of disability in Canada, accounting for nearly 30% of disability claims and 70% of the total costs.xix

xixInsurance Journal 2003 as cited by the Government of Canada in The Human Face of Mental Health and Mental Illness in Canada, 2006, pg. 41.


help me find a balance - - Oct 26th 2009

help me find a balance.  i am SO normal most of the time but i live in the extreem and when i drink i don't stop.   i'm on the dean's list and going for my post-bacc but i'm way self-destructive.  i want someone to help me because i think i need it.  i'm not your typical girl.  if you talked to me you would know.  PLEASE  respnd to me asap



I accept the authority of the court - - Sep 2nd 2009

AA is a religion.   The 12 steps are revealed truth.  Belief in them is an act of faith.  Several courts have ruled that court mandated attendance is unconstitutional on First Amendment grounds.  I accept the authority of the court.

"Suggestion"; yoked to death threat ... - JR - Aug 31st 2009

... equals "command".  Of course there are AA "rules".  Even as a member, one may accept them all - or choose to reject some that do not suit.  Or, perhaps, choose to reject ones that do not suit in the context of a particular argument.  That's religion for you !

If there can be "a la carte Catholics", why not "a la carte Bargain-Basement Buchmanites" ?  You know it makes ... er ... nonsense ...

Yours from the Stoa,


response to AA discussion - - Aug 31st 2009

First and foremost, AA rules do not exist.  There are no dogmas, creeds or commandments. The whole program is a suggestion only and the steps are merely guides to what people in AA feel is progress--progress away from self-centeredness toward humility.”

Yes, AA literature states that its 12 steps are “suggestions” (Big Book, p. 59) and that “AA does not demand that you believe anything.”  (12&12, p. 26).  But it also says that “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.”  (12&12, p. 174).  

Usually, the penalty for not following a "suggestion" isn't death.

“There are far more walk-ins to the program than there are court ordered attendees. “

According to AA’s 2007 triennial survey, 14% of attendees were court ordered or in a correctional facility.  But an additional 33% came through treatment facilities—and many people enter “treatment facilities” rather than lose their jobs.  There's lots of coercion going on.  And counting only those percentages, 44% of people came to AA through the legal or medical community--they weren't attracted to the program, they were sent.  So much for the 11th tradition. 

“The AA program is good if it works for you.”

I'm not going to get into the stats here, except to say that even the most favorable research indicates that it doesn't help most of the time.  And little or nothing else is available.  Nothing else is even mentioned as a possibility in most treatment centers.  Around 90% of treatment available in the US (100% where I live) is based on 12 step methods. 

“What has been said about sponsors' giving 'bad advice' is partially true-sometimes it may occur.  However, I do not believe that it happens more often in AA advice than it does in many other situations in life. "Do as I say, not as I do" is not inherent in AA philosophy alone; it is a widespread concept.”

I think bad-advice-giving happens WAY more in AA than in healthy populations, but even if I’m  wrong, let’s not forget that AA is not just any group.  It is, at least allegedly, a recovery support group that attracts (or which the legal and medical community sends) an extremely vulnerable population.  Each new member is encouraged to admit to personal powerlessness and to “take direction” from his or her sponsor.  If this sponsor is crazy or gives bad advice (“stop taking your Depakote" is very bad advice, for example, if the sponsee has bipolar disorder) then the potential for harm is enormous.

"As far a religion goes, AA is not religious; it is a spiritual awakening.  If someone believes a motorcycle is a higher power, then that is their prerogatory [sic]."

Surely you aren’t suggesting that someone’s recovery could depend upon his or her belief in motorcycles?  No, AA is talking about God.  God is mentioned—specifically—four times in the steps.  This "spiritual not religious" thing just doesn't make sense.


AA Rules - Jack W., Recovering AA, Boston, MA - Aug 28th 2009

First and foremost, AA rules do not exist.  There are no dogmas, creeds or commandments. The whole program is a suggestion only and the steps are merely guides to what people in AA feel is progress--progress away from self-centeredness toward humility.

One of the group's philosophies is to "...take what you need/want and to leave the rest."  In other words, if you hear, at a meeting (a group of two or more AA's communicating in person, on the phone or on line), a person say something that you feel will benefit your life then, cool.  If you hear something you feel is BS, then leave it there.

AA Meeting attendance also helps to remove from isolation those suffering from the depressive effects of a depressent-alcohol.  A realization of "you are not alone" is a by-product of meeting attendance.  At meetings you learn that you are SICK, not bad,evil or sociopathic (though, as in any subgroup of society, some may be).

If a member or an attendee feels they are being helped by the program then the program works--FOR THEM.  There are far more walk-ins to the program than there are court ordered attendees.  Numerous members who are introduced to the program, through compliance with mandatory court orders, choose to continue in the program even after their required attendance period has expired.

The AA program is good if it works for you.  Most AA's feell it is but a prong in a multi-prong attack fending off life's vicissitudes. 

What has been said about sponsors' giving 'bad advice' is partially true-sometimes it may occur.  However, I do not believe that it happens more often in AA advice than it does in many other situations in life. "Do as I say, not as I do" is not inherent in AA philosophy alone; it is a widespread concept.

As far a religion goes, AA is not religious; it is a spiritual awakening.  If someone believes a motorcycle is a higher power, then that is their prerogatory.  I ride and sometimes I get a high from riding.  However the bike ride is the source of my joy--not the bike in and of itself it is not.  As long as my 'higher power' is something or someone more spiritually powerful than I, then I'm OK with that belief.  It will do me no harm.

Just a few thoughts--Happy Day!! jack

doing the following - Abbadun - Jul 24th 2009

I am able to make use of AA meetings by doing the following:

1. Never going to meeting that focus on the worse ideology of AA and if I find myself in such a meeting, I have no problem walking out of the meeting.

2. There are some AA groups that I never visit.

3. I replace most of AA Literature with Lifering and Buddist Literature and Self Improvement material.




secular recovery - - Jul 1st 2009

I cut and paste this from  seems reasonable.  

The "Three-S" Philosophy

"Three-S" is short-hand for the fundamental  principles of LifeRing Recovery:  Sobriety, Secularity, and Self-Help.  

Sobriety.  "Sobriety" can mean different things in dictionaries, but in LifeRing it always means abstinence. The basic membership requirement is a sincere desire to remain abstinent from alcohol and "drugs."  LifeRing welcomes alcoholics and addicts without distinction, as well as people involved in relationships with them.  Please look elsewhere for support if your intention is to keep drinking or using, but not so much, or to stop drinking but continue using, or stop using but continue drinking.  The successful LifeRing participant practices the Sobriety Priority, meaning that nothing is allowed to interfere with staying abstinent from alcohol and "drugs."  The motto is "we do not drink or use, no matter what." 

Secularity.  LifeRing Recovery welcomes people of all faiths and none.  You get to keep whatever religious beliefs you have, and you are under no pressure to acquire any if you don't.  Neither religion nor anti-religion normally come up in meeting discussion.  Participants' spiritual or religious beliefs or lack thereof remain private.  Participants are free to attend both LifeRing and Twelve-Step meetings, but LifeRing supports recovery methods that rely on human efforts rather than on divine intervention or faith-healing. 

Self-Help Self-help in LifeRing means that the key to recovery is the individual's own motivation and effort. The main purpose of the group process is to reinforce the individual's own inner strivings to stay clean and sober.   LifeRing is a permanent workshop where individuals can build their own personal recovery plans.  Cross-talk is permitted within limits set by each meeting.  LifeRing does not prescribe any particular "steps" and is not a vehicle for any particular therapeutic doctrine.   LifeRing participation is compatible with a wide variety of  abstinence-based therapeutic or counseling programs. 

AA means self-empowerment - Richard - Jul 1st 2009

Interesting artcile and comments.

It's always been explained to me, and been my personal experience, that AA means self-empowerment and the ability to trust a sane, sober self.

I live in Leeds, UK, and in my 5 years of sobriety have only ever received love and support from the people in my home group and sponsers. People are free to offer me advice, and in turn I am free to ignore it!

I'm currently travelling the world for year with my partner, and as such have no issues with stepping outside of my home group and no attending meetings regularly. I carry my programme and extremely vague notion of God with me.

Working the steps has enabled me to mature and do this. You should have seen me 5 years ago!

It has been a joy to visit AA meetings in New York, California and on the north and south islands of New Zealand so far.

The ability to walk into an AA meeting almost anywhere in the world and feel accepted and at home is a gift and delight to me.

That's been my experience so far. I wish everyone on here the best of luck with their personal journies.

Richard, 34.

Too many meetings - Rosie - Jun 19th 2009

Hi, this article is great and looks at different positions which is rarely found these days in regards to AA.  There are some who believe that going to many meetings even if they're sober for 19 yrs + that it is what they need.  To help others perhaps, that's great, but aren't there hundred of people awaiting to be helped but instead they are ignored.  For example, people awaiting parole and ready to go out to the real world after 20 yrs of being sentenced.  There is so much to do with how a sober feels and what the 'many' meetings are giving to him/her.  In the meantime, the world goes around, others need help elsewhere and it all turns almost into a 'selfish' reason why to go to AA meetings.  The alternate type of support groups online or face to face can make a great difference and I support the idea.  The ability to think positively and act rationaly on your own without 'an sponsor' who may be a good match or not is possible and not going to AA meetings is not the end of the sobriety, and other people who need help are awaiting for that even more so these days. 

People turning a blind eye - AB - Jun 7th 2009

Hi Claire

AA is too strong in my area, I am close to one of the areas where Bill W. got started and alternative meetings have just made to the fringe of the area, may be when I get a new car I will check them out and go into NYC for some Secular Meetings.

If a person is not bashing AA there is nothing wrong in pointing out the unethical practices and teachings that are part of that program. People turning a blind eye to the real AA is one of the reasons the program has lasted so long as it is.




Where is this site? - hannah - Jun 7th 2009

So where is this site for an option to AA?  Tried so many times....just can't hack them.

A better meeting... - Claire - Jun 7th 2009

As a sort of final statement for this essay, I'll note that there are groups out there, including SMART Recovery, Rational Recovery, and a host of others that have some of the characteristics I've described above. These groups are available online or in select communities only, however. They aren't as well known as AA or as easy to access, but they do exist.

It's true that the other groups are less well known, but they are not necessarily more difficult to access.  All are available online, and there are a growing number of face to face meetings as well. 

There's no need for people to twist themselves into pretzels trying to "get" AA if it isn't working for them!  Just do something different.  As they say (in AA, no less): the definition of insanity is doing the same thing over and over, expecting different results!

AA is dangerous to some - another recovered addict - Apr 14th 2009

It’s a relief to me to find more and more information available about the counterproductive and destructive aspects of Alcoholic’s Anonymous.  This question is very important to people such as myself who have struggled for years in AA while also having a mental or mood disorder.  “More has been revealed” as I have spent more time “in the rooms” that most of AA is a cult intent on indoctrinating people into believing ideas that have no real basis in fact or reality.  Not only have I spent 10 years attending many hours of meetings that are filled with nothing but slogans, mind-control platitudes and demeaning put-downs of my own powers and abilities, but it has worsened my relationships and mental health.  Thanks for making this information available and easily findable!  Now that I understand that I DO have power and the ability to make positive choices and think clearly and rationally, I can quit wasting so much time, quit worrying about other people’s opinions, and do real work helping this sick world, rather than pretending there are some “tools” or “steps” that will magically make my life better!

federal courts have so ruled - - Apr 10th 2009

12 step is a religion.   12 step is revealed truth.  It is accepted via an act of faith.  12 step is, perforce, a religion.

And, federal courts have so ruled.  I stand under their authority.

"Spiritual, not religious"? - JR - Apr 3rd 2009
<p>The problem with this oft-repeated slogan is that it runs counter to what the Big Book, &quot;12 Steps and 12 Traditions&quot; and other AA texts actually &quot;suggest&quot; - which is a program for a very specific type of personal religious &quot;change&quot;, of which giving up drink is a component - perhaps even a beneficial side-effect.&nbsp; I think that many of us who have parted with the Fellowship have done so when we &quot;came to believe&quot; AA in its own terms, and found it inconsistent with our personal convictions and beliefs.&nbsp; </p><p>I have no objection to anybody who truly accepts the AA religion, or can accommodate themselves to it on the basis of &quot;taking the best and leaving the rest&quot;.&nbsp; If the Fellowship works for them, in terms of divorcing them from the Demon Drink, well, I wish them the very best.&nbsp; It becomes a problem, however, where the program is effectively forced on so many people who cannot make this accommodation, on the basis that it is &quot;the only way&quot;.&nbsp; A combination of learned helplessness and self-betrayal scarcely seems like a good basis for long-term sobriety.</p><p>Best regards,</p><p>JR</p>

Can faith healing ever NOT be religious? - Claire - Apr 2nd 2009

The word "God" is mentioned 64 times in the first 164 pages of the Big Book, and here are a few random quotes from the same text:

--"When we became alcoholics, crushed by a self-imposed crisis we could not postpone or evade, we had to fearlessly face the proposition that either God is everything or else He is nothing. God either is, or He isn't. What was our choice to be?"

--"God restored us to our right minds."

--"God has either removed your husband's liquor problem or He has not."

--"Faith has to work twenty-four hours a day in and through us, or we perish."

--"We are not cured of alcoholism. What we really have is a daily reprieve contingent on the maintenance of our spiritual condition."

--"If you think you are an atheist, an agnostic, a skeptic, or have any other form of intellectual pride which keeps you from accepting what is in this book, I feel sorry for you."

The entire philosophy of AA, as expressed in the Big Book, is that God gets you sober.  You are powerless on your own; it's God that provides the power to heal you.  You get to choose your own conception of God--it can be the proverbial doorknob--but make no mistake about it, it's God that does the job

This is, by definition, faith healing.  Can faith healing ever NOT be religious?  Isn't the mere notion that a power outside yourself is keeping you sober...a theology? 

not a religious program - - Apr 1st 2009

The first comment by the author(s) on AA being a thinly veiled religious program is incorrect.  There are many agnostics and atheists in it.  Of course, there is every other kind of religious background in it as well as every kind of person.  A majority of the people in there come from a judeo-christian background, as it is outside of AA.  AA was put together mostly from christian ideology in the thirties.  A visitor could easily get an idea that it is a religious organization, except no one forces religion on anyone else.  It is stated throughout the meetings and literature that is in not a religious program. 

How nice to read these comments - Ann Q - Mar 12th 2009

What a nice collection of varied comments.

I'm 24 years sober and haven't regularly attended AA meetings in about 19 years.  However, I am still profoundly grateful to AA for being there when I needed it, and for a certain Freethinkers AA group for being part of my whole collective AA experience.  However, as a rationalist and probable atheist, I believe I would have found my way through AA without a formal group of "freethinkers".

Although there are elements of AA which I might prefer to change, as the sort of loosely formed group that it is, it seems to function pretty well.  When I was very active in it I saw people bringing in their experiences in other avenues of treatment and incorporating this into the group consciousness.  I expect that will continue to happen.

Yes, there is no formal way to "graduate", and some of the most senior and loudest speakers in the meetings are not the wisest of the group.  But there are a lot of meetings and a lot of members out there to learn from.

- - Feb 12th 2009
It really should not be necessary to 'find a better meeting'.  AA ought to have better training and better guidelines than it has.  There really should not be a 'better meeting'. 

Feedback in AA Meetings - AB - Sep 28th 2008


I always thought about raising my hand and giving direct feedback in a AA meeting. When a reader passes the part of 12 x 12 about how belligerent and savage minded a Atheist is wouldn't be great and ethical for someone to publically disagree with that blanket statement?

There are plenty of other statements in AA Literature that are just as bad and it will never change until it becomes too big of a problem for groups to handle


To gil - unhappy with CA - JR - Sep 12th 2008

I was not clear - are you court-mandated to attend these meetings, or is it a "requirement" imposed by an independently-engaged counsellor or treatment facility ?  If it is the latter, it might be time to look for an alternative counsellor or treatment facility, since you seem uncomfortable with the patent 12 Step orientation of the present one.

Why are the "Old Timers" still attending meetings after, say, 15 years "clear" ?  Well, it is because the 12 Step movement does not believe in "recovering" from addiction - it believes in "Recovery", a process that proceeds One Day at a Time, perpetually.  In such a context there is, and can be, no exit strategy.  This approach may suit some people, but certainly not all.  Forgive me if I presume, but it does not strike me that you a the sort of person who will find it easy to "surrender" to this, and perhaps other, aspects of a 12 Step program.  Only you can really decide following considered reflection - so keep your counsel for now, and do not let others decide for you.

I do not know what your intentions are regarding your future relationship - or lack of one - with The Substance in Question.  If you do wish to give it up, alternative group-based supports may be available, although again, it does not seem to me that you are any more "groupy" than I am myself.  Some form of individual - or at least less group-dependent - therapy might be an option.  Another alternative you might have a look at is Rational Recovery (a Google on "Rational Recovery" and "Trimpey" should find it - on principle, I do now wish to put up the actual link). Rational Recovery, in its own way, can seem a rather absolute approach to revovering from addiction.  By contrast with "Stepping", RR is essentially non-therapeutic (at least in the conventional sense) and is very much based on the responsibility of the individual.  It will by no means be for everybody (any more than 12 Stepping is) but, if you find group-based recovery programs uncongenial, it may at least be worth a look.

Very best wishes,


Cult - gil - Sep 11th 2008

I have been attending CA cocain meetings this past week for something for work. I failed a drugtest and now i have to attend 8 of them, ive done 4 so far and i dont like it.

 My first impression 30 minutes into the first meeting was that scene from Fight Club Movie where people are addicted to self help meetings. There were people there that had been sober for 18 years and still attending these meetings? Is it because they are addicted to basically comes down to free counseling? Maybe they like controlling people or having an authority figure sense on other people. One of the 15 year sober guys approached me in a fashion that made me very uncomfortable, I would have told him i had a place to go or something, but he approached like he was a boss or authority at the meeting and it was my first meeting so i put up with him. He told me the meeting I had just attended was crap and that I was not really sober after 60 days cause it was nothing compared to his 15 years. He asked me about a sponsor and stuff, but i started to blow him off when i got the vibe that he was a homosexual. I got that strange vibe from alot of people inthat meeting, either that or just really really attempting to be friendly. So i went home after making an excuse i had to be somewhere as i wanted nothing to do with thesepeople.

 Later tht night i got a harassing call from someone i had given my number to cause i thought they were the leader of the class, not some self proclaiming know it all. Of course i didnt answer it but it went along the lines of wanting me to call othr people and socialize reaching out, HELL NO was i gonna do this. 75% of the peoople in there gave me bad vibes and no way i wanted to get to know them or have them know where i live .   He latered called back and left another message asking " Do you think im Crazy?" and upset that i hadnt callled him back yet. To say the least i didnt want to go back and kinda wanted to tell that guy that i was gonna kick his ass if he didnt stop harrasing me. 

 CA and AA to me are cults in disguise for people who need counseling and have no "self" control. They gotta rely on "higher power" on there sponsor, on other members, on other members attendance even. I heard some woman whining and crying the other day about people not being at the meeting that were regulars cause it told her they didnt care about her recovery and didnt want her to get better. REDICULOUS!

 I hope i never have to attend another freak show again am gonna beg my counsler to stop with the meetings as i feel they are more harmful than good, as i dont really want to tell her how i feel about them. REDICULOUS

Re: AA - Mountains and Molehills - AB - Sep 3rd 2008


There are lots of good people in AA and going to meetings is a good way to stay sober for many. Still the basic fact is that as long as AA meetings continue to use the AA Books as they were written each meeting that uses the ideas from the texts has the potential of spreading  prejudiced, untrue and unethical ideas about people who do not use a Higher Power. Who knows how many of them did meet with a Alcoholic Death because of the AA message.





AA - Mountains and Molehills ? - JR - Jul 31st 2008

Before declaring that there is no need to make a mountain out of a molehill, we should recall that it was Bill Wilson (or perhaps Frank Buchman) who created the mountain.  And not everybody finds it very easy (to put it mildly) to live on that mountain.

If you can accept that mountainous environment, or somehow accommodate yourself to it so that you really can take what you want and leave the rest (a matter of ignoring the mountain-ness of the whole business, perhaps), well, great, and good luck in your Recovery.  If not - you might be better off seeking recovery (in lower case) somewhere else.

People differ, I suppose.

Best regards,


unnecessary complications - H - Jul 30th 2008

No need to make a mountain out of a molehill.  Sponsors, 12 steps and "god as we understand him"  are unnecessary complications.

The good of AA comes from face to face contact and replacing drinking with participation in AA.  The imporatnt thing is to cut it out.  Replace the drinking behavior with better behavior.  And, some common sense to deal with illogical thoghts and feelings.

AA and - JR - Jul 2nd 2008

I am afraid that a search for the underlying causes of a person's problem drinking involves thinking - and this can be something of a problem for AA True Believers.  If you believe that such drinking is (in some unspecified way) a product of "defects of character" (or "Sin"), and that the only solution is to do the 12 Steps and turn your will and your mind over to the care of God, whose Will is manifested in "meditation" (interpreted, where necessary, by sponsors), then looking for underlying issues will not seem just superfluous, but threatening to the program.  And also, of course, threatening to the position of the same True Believers.  One should, from this standpoint, forget about forming a rational understanding of the problem, and just "Let go and let God".

Of course, it would be far from true to say that all AA members - or indeed anything like a majority of them - share AA True Belief in its full form.  However, it is prevalent (at least as a posture) among the True Believer/Old Timer types who tend to dominate even "Lite" AA groups.  Such people will resist attempts on the part of less conditioned members to "get intellectual" about the problem.  When I first entered the Fellowship, I thought that slogans such as "Stop your Stinkin' Thinkin'" referred only to particular patterns of thought that impelled one towards drinking.  Over time, I learend that the prohibition went a lot further than that ...

Best regards,


Underlying Issues - Cal D - Jul 2nd 2008

I have become disillusioned with CA which is as we all may know, a splinter group from AA. Firstly let me put my hands in the air and thank AA,CA & NA for being there when I started my recovery a few years ago and undoubtedly contributed information and offered encouragement to me that saved my life. However as a free thinker I have continued to read literature from other sources and conclude I have a disease which stops me from saying no to my second drink, line, joint etc. Let me add that I am not particularly concerned about the 'why's' of not being able to stop and say no.The medical world and anyone else who feels inclined are welcome to debate the definition of alcoholism and addiction until their all blue in the face as far as I am concerned because it is not relevant to my recovery whether an actual allergic reaction or mental obsession is triggered from my first or whether it is just bad behaviour I do not care about the reason so much as the reality that for whatever reason I could not say no to the next and next and so on. My solution was to understand I could not have my first and learn why I wanted my first and reverse or resolve that issue. Simply put, deal with whatever underlying issue was causing me to seek oblivion. So my question is 'As chairman of a meeting in CA I suggested to some newcomers that they must get to the underlying reasons for using in the first place and remove the want or need to use mind altering substances' After the meeting I was unpleasantly challenged by an individual who said I should not have suggested that underlying issues could be the reason for drinking or drugging. He was quite unpleasant. Was he right to tell me that I was out of order? Cal D  

More Wrong Ideas about AA ? - JR - Jun 18th 2008

Sorry, Tim, but you start with a pretty basically "wrong" idea about AA yourself - that it does not recruit. Have you forgotten the Twelfth Step ?

"Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics ("others", in the case of Al-Anon), and to practice these principles in all our affairs."

Of course AA recruits. Bill W and Dr. Bob were mad about spreading their "message", and present-day Twelve Step programs do still recruit - it is part of their "Mission Statement". Indeed, I am not sure that AA itself is the most active in this respect - Al-Anon, which cannot rely on therapy centers and the courts to supply Newbees, is particularly vigorous in spreading its "message" to just about anyone who comes within its ken.

I completely agree with many of your comments about court-mandated attendance. It is worth noting, however, that AA (in the US at least) positively collaborates with this process - see "AA Guidelines - Cooperating with Court, DWI and Similar Programs (AA GSO). This document, by the way, includes a rather mealy-mouthed endorsement of the practice of providing the coercing authority with proof of attendance at meetings, indicating some of the means by which this may be achieved.

There are so many reasons why AA should positively reject all forms of coerced attendance at meetings - but I cannot see it happening. Much too useful a way of finding people to whom the "message" can be carried.

By the way - it is unwise to assume that people who participate in these debates have "very little knowledge of how AA works and operates". Those without such knowledge and/or experience tend to turn the other way.

Best regards, and continued prosperity in your Recovery,


Wrong Ideas About AA - Tim - Jun 17th 2008

Many who post here seem to have lots of ideas about AA that aren't true. AA doesn't recruit. Many induviduals who become sober in AA at first may feel they want to go out and drag people to AA so they can experiance the same success, but as my sponser pointed out to me, the program is set up to be available to folks who are attracted themselves because they have: a) reached a point of despair in their alcoholism where they really are determined to seek help regarding their problem; and b) find AA because they are attracted to it as a possible solution because of the people they see or know who have gotten help through the program. My sponser suggested to me to help others who want the help and come looking for it on their own volition.

The court ordering of people to AA is an annoyance to many of us in the AA program as it really goes against the very concept outlined above but their is nothing we can do about it. In the program we encounter "court dumping" all the time where a confused DUI person has been ordered to AA by the court. Most of them assume the program is then responsable to sign their court card, and listen to him bitch about how he was made to go and help him fullfill all the legal requirements he faces. We quietly listen and remember why we came to AA and what it has done for us and also realize that the "court dumped" person may get some good out of being there even though the program was not designed by the founders to be used by the government as a way to solve their problems with rehabilitation. AA as an organization can not stop this because it has no governing board and no opinion on outside issues. AA is also set up to avoid public controversey and avoid lawsuits. We are used by the courts for this reason. Nothing we can do about it.

Personally, I feel it is completely wrong to order people to attend AA, and a large percentage of long sober AA members agree. AA as a group really doen't gain anything by these people being sent in against their will. Thing is, the only requirement for AA membership is a desire to stop drinking. There is nothing that can be done to "regulate" this. AA does very little "regulating" and "controlling" and has done a wonderful job of keeping the program going for years and years with out someone "in control". You can even attend open meetings to find out more about AA without having a desire to stop drinking. Closed meetings are just for people who can actually admit openly that they are an alcoholic and want to quit drinking.

Generally speaking, AA as a whole is a very open and free organization that helps many, many people live wonderful lives. Are there abuses that take place from people getting involved with the wrong people who they meet at AA meetings? Of course there are! Just as there are in all aspects of life! This is just a group of folks who have decided to try this program and keep it in place as best they can and all are free to come and go as they like.

Any manditory attendance is from a faulty justice system who has found an easy way to remove their responsability to an area that doesn't cost them anything and actually works quite well. Almost all seasoned members of AA who have experianced success in AA don't agree with "court dumping". Rehab centers also abuse AA by using it as a free "after care" facility. Nothing AA can do about it but the fault is not the AA program, it's the rehab center that wants to save money and let AA fill the bill for them.

Again, these comments I have read in this blog seem to be from people who have very little knowledge of how AA works and operates or have had a bad experiance with a situation in AA that they now can't be objective and instead, paint all of AA with the same negative brush. Come on people! Take a little reponsability for your own actions! If you go to a meeting and you don't like it, don't go back! Find another or do something else! If someone there annoys you or gives you the creeps, stay away from that person or don't go back. I give you the same advice if you go to a movie theater or out shopping! At AA meetings they don't hog tie people and force this program on anyone! It is entirely the opposite. If some one tries to do that, you have the option of not agreeing with that person and you don't have to go back!

Those opining here, including the good doctor, need to know a little more and have a little more expericiance before the start beating the drum about AA and all its supposed faults!

I'm a grateful member of AA!

shame on you - cannae1 - Jan 15th 2008

"shame on you".

That is correct. You should know better, I suspect that you do know better. But, you do it anyway.

I do not need to know why you bahave badly. All that I need to know is: that you do behave badly. Shame on you.

- Sam - Nov 2nd 2007
Shame on you.

Where is the science? - Mark - Sep 8th 2007

Alot of personal anecdotes, very little data.

"Our book is meant to be suggestive only. We realize we know only a little." Alcoholics Anonymous, pp. 164.

I have been in recovery in and out of AA for 23 years. I have not taken a drink or drug during those 23 years. I would not claim that my recovery has been perfect. I spent 10 years away from AA during the middle of my recovery. I left AA because I saw it as a waste of time being in a room filled with "whining drunk hypocrites." I felt compelled to go back to the program after a maritial collapse and returned feelings of suicide. I have now been active member again for about five years. I did not change my soberity date but feel that many of my recovery years were spent as a "Dry Drunk".

I have also sought out talk therapy and medication for my moderate depression. I have tried EMDR, Regressive therapy, CBT, group therapy. I spent 45 days in an inpatient Drug and ETOH treatment center followed by 8 month stay in half way house. All of these modalities helped me to feel more sane.

I certainly believe in the "disease concept" of addiction. I am not ashamed of my alcoholism or depression.  I was raised by addeled alcoholic parents who were negelectful and sometime abusive. My childhood experiences warped my self concept somewhat.

I am happily married, have two succesful children whom I have never abused, graduated from college with honors, pay taxes, have a wonderful group of recovering and no need to have recovery friends. I am religous but have many close friends who are not. Have respect of my peers and co-workers. I am happy most of the time. My parents would say that my life is better than theirs.

That is the point. We all have the choice to participate in whatever "therapy" works for us.  I have chosen to use AA as a foundation to achieve soberity and maintain soberity. AA does not subsitiute for my small dose of Paxil, does not substitue for my community service work, does not substitute for my religous devotion, substitute for my "inner child" work, or substitute for self awareness and accountablity for my emotional well being.

My questions to the discussion and the AA naysayers is where is your proof. Just as I can say that AA works for me anectdotally, you say that it does not work for you. It is all a question of willingness to believe in whatever method works. This is not science. Where are the case controlled studies with solid statistical basis. They do no not exsist. Where is your proof that any other recovery methodology works.

When do most recovering alcoholics relapse? first 30 days, 60 days, etc.

What is the measure of relapse? Drinking, thinking of drinking, depression, etc.

Why are so many rationalists threatened by the "Higher Power Concept"? prayer is a personal thing, do not do it if you do not want to.

I have worked as a RN for 15 years. My experience is that the mainstream medical establishment treats active addicts and alcoholics horribly. The usual mode is to shame and ridicule the patient into submission. If cardiac and cancer patients were treated in the same way the offenders would lose their jobs and face lawsuits.

I have never felt coerced by any member of AA. I have attended 2000 meeting in many different cities. I am sponsered and sponser. I work steps and have felt recovery. The meetings work for me because 1 to 2 hours a week I can reflect on my character and its relationship to the world. My hope is that during this very low tech, low concept group work my shared experience will help someone else. I do not aspire to control anyone.

I think that a discussion led by a Phd prepared therapist would be more evidence and outcome based if we are going to be comparitive. Otherwise it looks like sour grapes that your "profession" can not make a buck off the back of some addict.  I wonder if during your therapy you only ask for a dollar donation like most AA groups do. And for the anti AAs if you chose to go to any kind of recovery meeting and give away your personal choice and freedom then that is on you. No one has a gun to your head.

Bring on your intellectual barbs.


Another post - June R. - May 11th 2007

I come from the perspective of one who experienced a traumatic indoctrination attempt by other AAs into a cult-like group of AA and assigned a controlling nazi-sponsor. I left that group and sponsor and found another group and sponsor(s) which suit me and who also follow the simplicity of the 12 Steps of AA. I often wonder why AA is working for me and not others... and my answer (like my answer to similar puzzles) is "me".

Whereever I go, there I am. I have followed and NOT followed suggestions given to me by people with more "time". I also don't believe God is ever going to swoop down and take a drink out of my hand. I don't believe people who have more "time" are necessarily more "sober", nor are many as good at their jobs, or as organized, or as "whatever" as I am. But I respect their time and when I have had a day where I needed to be reminded of how to not drink, they've had the answer, usually: "Don't drink and go to a meeting." And "Don't drink and go to a meeting" is maddening advise but it kept me from drinking for that day... which was all I needed so that I can soberly address the underlying issue next.

Just as I am better at some things than others, other people are too. When I need advise on job-stress, I seek out someone who has job stress and successfully handles it. If I need help with tenant-issues, I seek out someone who also is a landlord. When I need help staying sober, I seek out someone who is successfully staying sober that day. But with each encounter, the commonality is "me" and what I'm bringing into the exchange... Do I want a solution? Do I have reasonable expectations of the other person? If I didn't get a reasonable suggestion, do I seek out a second (or third) opinion? If they've given me irrelevant advise, can I take what I needed and leave the rest without getting insulted and resentful over the excess? Those are things that are my own responsibility.

When I am in a good space, I seek out others who aren't and try to help - although no matter how "bad" a space I'm in, I can always just listen to someone else. Now that I have a little sobriety time, I try to give more of myself back to others. We have a little AA clique and are quite protective of it. It is a safe haven of women friends of a variety of experiences and backgrounds. We don't always agree with each other. And our little support group wasn't formed FOR us. We observed each other's attitudes and actions and found them to be positive and productive. We banded together in a small group (which, being a painfully shy person, suits me much better than the AA collective). We saw and claimed our similarites, not our differences.

I believe my initial negative AA experience is valuable in bringing positive influence to the AA fellowship. As in most things, it's in how we use our negative experiences to help others (and in the process, help ourselves). Sometimes it just takes not bailing out, but being present as a positive influence and continuing to grow rather than stagnate in the negative. When I find myself being overly critical, it usually means that I'm harboring a resentment somewhere. And a commitment to my recovery means a commitment to looking at my own part in my resentments, not someone else's part... their part is that which I can not change.

I said this elsewhere, but it sums it up - If you look at the AA principles (read the Big Book), and not just people's bad behavior, mostly you've got a good thing, not something inherently harmful. But if you only look at the human fallibilities, you're definitely going to find sufficient fault to discredit the whole thing. I have to often ask myself "What am I looking for?" If I look hard enough, I'm very likely to find it.

CONTROL - David - Oct 27th 2006
I have been attending AA for the past 30 years & have shared my own recovery from alcoholism on a regular basis. Lately, quite a few Steppers have been triggered & sometimes walk out when I am sharing, which I think is a good thing, because I imagine they are having a reaction, which I imagine, is part of recovering. I have mentioned, that I don’t think alcoholism is a disease and that AA did not get me sober. A group conscience was called & the decision they came to was that I would not be called to share if I continued to be anti AA. I feel pain because I imagine the Steppers are not recovering and calling a group conscience when one is "triggered", does not help that person or persons to recover. What I have learned from my own recovery process is that when I am "triggered,” it is an opportunity to stay with the feelings that surface & realise that what I am feeling is probably from my childhood. I imagine AA shuts people down and by staying sober they think they are recovering. In the AA preamble it says at the end.... “and help others recover from alcoholism”. It does not say, “that we will continue to recover for the rest of our lives.” I am not anti AA, if anything, AA has helped me to recover because it has been a good “trigger” for me to deal with my fear, pain, guilt and shame and realise, that was why I drank in the first place. My therapist helped me understand that AA was very much like my childhood (controlling & oppressive). How else does one recover? It certainly is not by reading the Big Book, or AA literature, which I imagine, keeps one in their “heads” and cut off from ones body. Today, I am happy, joyous and free. What else is there! I am a recovered alcoholic and I have recovered that "little boy,” who was lost for many years as a practising alcoholic.

Response to AA article - - Sep 21st 2006
AA is the most tried and true program to recover from alcohol abuse. True it may be somewhat inabling,but you should see what some of these people look like when they enter the program. While AA may be used as a crutch by some, it has turned hundreds of thousands of lives around and probably saved thousands more innocent one's. (drunk driving deaths, etc) Yes, there should be other alternatives. Yes, there should be more funding for alcohol addiction in the medical field. There are many that can't afford these types of services. AA is free and turns no one away. There are those in the medical proffession that love cashing in in gold plated drunks. What is thier success rate ???

useful alternatives to AA - Ray Smith - Aug 9th 2006
SOS, SMART, WFS, MFS, LifeRing are all abstinence-based groups that can be beneficial. Most people only use them for a short time, then get on with their lives. The downside of that is the face-to-face meetings tend to come and go, but are available on the web. Rational Recovery is a personal recovery methods that many have used with great success. Kathleen Sciacca, a leader in the treatment of dual diagnosis ( ), has had success using harm reduction methods, more of her clients achieve total abstinence than those who use traditional 12step, and most of those who choose to moderate report an increase in their quality of life. People who have a dual diagnosis can contact their local NAMI office to find the closest ACT (Assertive Community Treatment) program.

Willpower alone - - Aug 8th 2006
Willpower alone may not be enough, especially not if everyone is telling you it isn't. However, the vast majority of people who realize that they have a problem stop on their own or learn to moderate. One of the major problems I see with AA is that they undermine a person's sense of self. They teach people their thinking is diseased, that they must turn over their will to a "higher power" and if you have no higher power, to AA. They also teach it is impossible to quit without them, a person is expected to conform to the group. When issues like religion or lack of it, mental health, medication, and therapy come into play, a person is expected to tow the party line or be shunned or worse. For those who suffer from a mental illness, this can be a devastating blow. In my opinion, a person with mental health issues needs self-empowerment and coping skills, not believing that God will provide simply on the basis of going to meetings. This sounds like miracles on demand to me, something the God of my childhood did NOT provide. (One NAMI study states that 37% of all alcohol abusers and 53% of all drug abusers have at least one serious mental illness, I have seen other studies that give higher numbers). My PRIMARY problem was depression which always turned into major depression in the rooms. As a peer advocate for the dually diagnosed and during my times in the rooms, I have seen many others who have experienced the same thing: told to throw away medication, quit therapy, then shunned if they relapse or become needy. I have seen several suicides during my times in the rooms and have often wondered how much is untreated mental health issues that were left untreated BECAUSE of AA. In a study done by AA Board of Trustees and Harvard researcher, George Valliant, AA had a MORTALITY rate of 3% a year, a figure he called "appalling". It is 4 times higher than no treatment at all, and both yield a 5% success rate. AA and several pro-AA medical and mental health professionals insisted that my depression would magically go away if I worked a good program (impossible for this atheist), despite the fact that I had been diagnosed with chronic depression BEFORE I started drinking. I'm no professional, but I can definitely see a lapse in logic here. The medical and mental health professionals all told me that THEY knew what they were talking about and treated me like another stupid drunk. They said a RELIGIOUS group that discounted mental health help, that told me to question nothing in the program was my only hope. (I qualify for MENSA, and I live in my own skin, but they knew best?) AA is used as an excuse by many doctors and people in the mental health field to NOT provide the help that many need. When a person has problems keeping clean and voices negative opinions about 12step groups, IT'S BECAUSE HE'S NOT TRYING, not that the group is inappropriate for the individual. But of course, that might mean LISTENING TO THE CLIENT for the professional.

AA works - David G. - Aug 2nd 2006
It may have been around for a long time, and it may be a bit quirky, but it works, and I ignored the " it works if YOU work it " slogan at my peril. AA got me sober to start with, and then after one year, I relapsed. Why? Well, I didn't have a sponsor, I thought I could control my drinking, I thought the Higher Power thing was a bit of a joke, and I definately didn't think I was ill. In summary, I did what I thought was right. Three months later, I was on my uppers, only this time I really lost the plot. I returned to AA but no one made me feel ashamed, and everyone said, " its up to you, nobody can force you , but welcome back ". My now sponsor has been sober over 30 years, and yes, he goes to meetings twice, maybe three times a week, and not because he is frightened to relapse, but because the programme truly helps him to manage and enjoy his life, and that is what I am learning to do. I don't see the spiritual part of the Higher Power, but it's a way to control my inner demons, and I had and have plenty of them. People who become substance dependant generally have. Show me a happy and carefree Alcoholic. That said, I also object to people being prescribed AA as a conditon of some punishment of rehabilitation programme, and I definately agree that people with an aversion to medication or, more dangerous still, those who coerce others to to avoid it, are nothing less than ill informed charlatans, and their view is not that widely shared. I think your concerns are confined to a tiny minority of AA members, generally the programme is beneficial for its many members.

For shame Doctor - Ray Smith - Jul 31st 2006
"The matter of whether the support group is best off being empowering or not is debatable too. It sounds, on the surface of things, that encouraging people to think for themselves is a good idea. And it is, within limits." If you're in a position of power over a person, as a doctor or as an elder member of a support group group, you should not make the the assumption that the person you are dealing with is too stupid to think for themselves. If you believe they may be, EDUCATE THEM! A child who understands "why" is better off than the one who hears from the parent, "Because I said so". Problem is, in AA, the only teaching that is done isn't scientific, it's dogma. If it is a medical problem, why is it the only one that requires a spiritual solution? As far as the 5% figure, many people here have talked about AA's own Triennial Survey, George Valliant's (Harvard researcher and AA Board of Trustees member) studies, and other studies that all reach the 5% number and have posted many links. Here's one you may not have seen: Belief that a person NEEDS a group in order to get sober is part of the AA dogma that has slipped into "common knowledge" even though this is totally unsupported. MOST people who realize that they have a problem with drugs or alcohol quit on their own or learn to moderate. If a person believes that a peer support group is necessary, I would suggest SOS. They believe that addiction is a separate matter from religion. So what does work? :

Editor's Note: My point was not to discourage people from thinking on their own, but rather to acknowledge what few seem to want to acknowledge - that willpower alone is frequently less than adequate for stopping addictions, and that it can help people tremendously to be actively encouraged to not drink by other people.

Felt like I was being punched - - Jul 28th 2006
Dr.: A portion of one of your editor's comments reads: ""About that rationality. I have repeatedly seen people lie to my face about their continuing substance use. Such a person might easily confuse a sincere limit setting sponsor for someone trying to control them inappropriately. This is the biggest danger I see in these criticisms of AA. Often the alcoholic/addict is not in a good position to know what is beneficial and what is not. Some things that look like control attempts are actually beneficial limit setting. Think of little kids resisting their parents beneficial limit setting with temper tantrums and you'll know more about what I'm thinking here. I've seen some temper tantrums that have said more about where a particular alcoholic person is at than where their group experience is at."" I know that it was probably not your intention, but I feel that with this statement you just negated all the comments about the hurt I and others have felt in the hands of AA and AA sponsors. It felt I have been compared to a spoilt child who is not able to distinguish between rightful limits and abusive behavior. Let me assure you I have the capacity to make that distinction. Though, strangely enough it is only in hindsight I see just how abusive it all was. While I was in the midst of it all I felt horribly guilty for even suspecting anything wrong. For I had been taught, very well I might add, that questioning anything about the program or those with more time could lead to relapse. This terrified me. Oh, I assure you I was the most docile of �children.� I bought the whole thing hook line and sinker. I think the ones who have really been hurt were the most submissive. It was only when my sponsor suggested that I break up with my fiancé�a man who was supportive and had never had a problem with drinking�because he was interfering (in her mind) with my 6 day a week meeting schedule (I had been sober 2 years at this point) that I was able to even to begin thinking objectively. I could say much, much more about some of her other wonderful �suggestions�, but it makes me a little sick to my stomach to think about. Partly it makes me sick to think how I could have let myself be treated in such a manner. But you see I was never in �denial� about my drinking�I knew it had almost destroyed me and those I loved. The thought of doing anything to jeopardize my sobriety scared the hell out of me. That is a pretty powerful deterrent. Also, the program teaches that the reason we became alcoholics is because we were self-centered and selfish. I see that �theory� now as complete bunk as a one size fits all notion. I think I became an alcoholic because I had a shitty life and few coping skills and alcohol became a way of self-medicating/numbing. However, while in the program , the doubts I had made me worry even more (and this was the message too of my sponsor and program) that I was just being selfish and self-centered. It took all the courage I could muster to get out of there. And, no, I am not drinking and yes, my yes, do I feel better and more centered. But to have you, at the most docile and self-doubt ridden time of my life, compare me to a child having a tantrum feels like a punch in the gut.

Editor's Note: It was certainly not my intention to make anyone feel badly with my statement. Let me say for the record that I am sorry for any hurt feelings as a result of my comment. I was not so much trying to suggest that any given individual person is not able to distinguish right from wrong or truth from fiction with regard to an addiction, as I was trying to explain what I have seen and how difficult it can be from the perspective of being a therapist to know who can be "trusted" (for lack of a better word) to have insight and who cannot. In the absence of x-ray vision and mind reading abilities (neither of which therapists have), it behooves us to act conservatively and assume that more limit setting rather than less will be beneficial. The more a history and a successful sober track record between a therapist/limit setter and a recovering addict can be established, the less external limit setting is going to be absolutely necessary, and the more the addict should be encouraged to handle it on their own. Ultimately, personal responsibility is the goal, anyway, and a big part of my own criticism of any AA-like group that doesn't allow for "graduation". Limit setting is supposed to be a weaning process and something protective; not a punishment. It is imperative that a limit setter be ethical and compassionate, precisely because people who come under their influence are so vulnerable; that is why therapist professions make such a big deal about ethics.

Question - Jill - Jul 27th 2006
Dr. Dombeck, Thank you for your response. I agree that support is a very good thing for people with addiction. However, I disagree that it must be found in "recovery groups". If a person doesn't have a family or friends to support them, then one of these groups may be appropriate. However, if one has these other types of support, a "recovery group" is not necessary. Would you agree or disagree with that statement? As a matter of fact, the Harvard study found that support of a stable spouse is one of the biggest indicators of success, especially for women. And with all due respect, you revert back to sterotyping people with addictions as liars, cheaters and needing adult supervision. People with addiction are not children, they are not all in denial, they do not need "boundaries" set. Especially by a "sponsor", who by their own admission ,can't run their own lives and don't know if they will drink that day or not. SMART recovery would be a better fit for many. I am aware there are few meetings to attend, but consider this........ I believe that SMART meetings are not in abundance because the only people who attend SMART meetings are those who wish to quit an addiction using group support. Nobody is mandated into SMART. As a matter of fact, I asked to start a SMART group myself and use that as my attendance. I was told no, it had to be 12-steps. I was told that the 12-steps were the only "proven" thing that worked. I kid you not! This is what I was told, I almost choked to death. Either this person was very ignorant, or a true believer. Anyway, the reason there are so many AA meetings is because so many people are forced into them. If you removed all of the mandated people from AA meetings and mandated them into SMART meetings, you would see a reversal in the number of meetings available. Remove the people from AA who are mandated and meetings would not survive. I don't think anyone has said that AA couldn't or should'nt be offered as an alternative, however, it needs to be just that, one choice of many. Instead, it is touted as the "only proven way". Thank you for listening, but alas, I still don't think you have heard.

Help - Rubina Saleh - Jul 26th 2006
Hi Dr. Dombeck, I am E.Indian from E.Africa (and a woman to boot). I went to A.A for a couple of years as long as I stopped thinking I could stay sober, however I was utterly misrable. I am a very outgoing person and assertive. I was told I am egotistical and aggressive. I have seen it work for other people, however it didn't work for me. Is there any other program that u could recommend, as I still suffer with gambling, food, T-3 addictions. I have also been diagnosed with clinical depression and I am on effexor. English is my second language and I am not as elequant as the other letters and comments that I read, however if u could take the time to response, I would appreciate it very much. I haven't had a drink in 2 years yet I am more in my other addictions then I ever was.

Question - Jill - Jul 25th 2006

Dr. Dombeck, It would appear perhaps this topic has ran its' course. So the question is....will this change the way you practice? If a client tells you that they do not like AA or that it doesn't work for them, will you still tell them to find a better meeting or will you explore other options with them? Thank You

Editor's Note: My eyes have certainly been opened to a vein of anger and resentment that I did not know about before. I'm not sure I buy all the arguments made here as for why AA is so bad, but I do understand and accept some of them. I've articulated most of my concerns in the "A Better Meeting" essay. For example, I do have problems with mandating people to a group like AA. Better to manadate someone to a more formal science-based substance abuse treatment run by mental health professionals. It is a good thing that courts are willing to experiment with mandated treatment when the alternative is jail time. I'm not sure that AA fits the bill as an equal treatment up there with relapse prevention and motivational interviewing however. As people have pointed out, the quality control of the overall experience can leave something to be desired.

What AA and similar groups are good at is providing a constant environment where people can go to be supported in their work on remaining sober. The support of another human being is so critical to someone struggling with substance abuse. I would still strongly encourage people to check out AA for this reason alone, although I would not encourage them to forfit their rationality while doing so.

About that rationality. I have repeatedly seen people lie to my face about their continuing substance use. Such a person might easily confuse a sincere limit setting sponsor for someone trying to control them inappropriately. This is the biggest danger I see in these criticisms of AA. Often the alcoholic/addict is not in a good position to know what is beneficial and what is not. Some things that look like control attempts are actually beneficial limit setting. Think of little kids resisting their parents beneficial limit setting with temper tantrums and you'll know more about what I'm thinking here. I've seen some temper tantrums that have said more about where a particular alcoholic person is at than where their group experience is at.

I am not at all sure how to help a person understand when their sponsor or group is making unreasonable demands, or when patients are making unreasonable demands and their sponsor or group is just trying to set appropriate limits. It's not hard for an objective outsider to tell the difference, but when you are in denial about your problem (as so many addicts and alcoholics are) it can be very hard to see what it looks like form the outside.

Bottom line is that if AA doesn't work for someone, and they've given it a good chance, and maybe tried a few different meeting places and people, then it will be perhaps reasonable for that person to try something else. That something else should be demonstrably therapeutic and soberizing, however. Not liking AA is not a good reason to leave it when the alternative is to leave yourself unsupported.

Getting yourself supported in your recovery is the real name of the game. If you don't like the religous underpinnings of AA philosophy, and are more attracted to something like SMART Recovery groups which work on more scientifically derived principles, then by all means start with SMART Recovery and bypass AA altogether. Being biased towards "empirically based treatments" myself, I would suspect that something like SMART Recovery would probably work well for a great deal of people. It would be wonderful for them to be more available than they are. But if you have no access to a SMART Recovery group (they seem to only exist in the big cities), no money for professional ongoing treatment with a scientifically trained psychotherapist (that gets expensive quickly), and only AA to provide you with support, then most likely it will be best to stay with AA unless your experience is truely intolerable/abusive. You just don't want to become unsupported in your recovery if you can avoid it.

Support Groups - Jill - Jul 19th 2006
Dr. Dombeck, Thank you for responding. However, I must take issue with your comment about people who are "bound and determined not to benefit from a group". You have answered a question that was not asked. What I asked was, "What about people who don't like support groups?" You see, this is exactly the black and white thinking that I am talking about that pervades the "recovery industry". You appear to assume that people who do not benefit from a group setting, or just don't like a group setting are "bound and determined not to benefit". This is the same tactic AA uses for those for whom AA doesn't work, or for those who do not like AA. "If you don't like AA or if it doesn't work for you, it's because you weren't open minded enough to grasp this simple program." I need to reiteriate that when I entered "drug treatment" I entered willingly, thinking it would be a good thing. I went to AA willingly thinking it would be a good thing. I had red flags from the beginning because I kept thinking "when does the treatment start?" It took me about a month to see what was really being passed off as medical treatment and I was shocked and appalled! I will reconsider my stance on public funding for mental health initiatives WHEN the treatment centers start to implement some outcome based treatment. It's out there, but it is remains in the Ivory Towers because the Clinicians REFUSE to implement new treatment. In the face of all of the new research and treatments for addiction, they INSIST on using a "treatment" almost 80 years old. What other illness do we treat with treatment from the 1930's? And in my opinion there are only 3 reasons it could be 1) they are incompetnet 2) they are lazy or 3) they are true believers prosletyzing and getting paid to do their 12th step work. And I always voted Yes on these same initiatives UNTIL I learned what really went on. Thank You for letting this debate continue without censorship. This is rare indeed from a person who treats addiction.

Support Groups - Jill - Jul 16th 2006

Dr Dombeck, What about people who do not like group settings? Wouldn't it be a better "fit" for that person to have a one on one for a prescribed amount of time and then utilize family and friends for support. What is the evidence that support from groups of strangers help a person more than support from friends and family? The mantra of AA is to "change people, places and things". Well, that is not applicable to everyone. This is why it is so important for treatment to be individualized! A "better meeting" will not help if one is opposed to the theology of the program. All meetings are the same in that respect. I personally would have benefited from a brief intervention without all of the drama. The overkill I received is what has turned me against treatment and opened my eyes to the con that is addiction treatment. And I know that I received the overkill becaue I have health insurance. I vote no everytime a mental health agency goes to the taxpayers for increased or replacement funding. I do this because I know that the main portion of these places are drug and alcohol rehab. And all they do is indoctrinate people into AA and then send them off to free ,unmonitered, unregulated meetings while collecting the taxpayers money. They also staff much of their so called "treatment" with AA volunteers, again collecting taxpayer money. For people with true mental health issues, they don't receive any care for that because they are all dumped into the drug and alcohol rehab. The "theory" is, they have to quit drinking before they can address their mental health issues. Well, that is false. Many people drink because of mental health issues, the drugs and alcohol are secondary. It is no wonder these people can't quit. Thank you

Editor's Note: Support groups can be of benefit to people who are not terribly social; this is the case with people dealing with depression, and with many men, and it is not different for addicts/alcoholics. If someone is bound and determined to not benefit from a group, well then, it is futile to demand that they attend (from a treatment perspective anyway). You can lead a horse to water, but you can't make him (or her) drink, and such.

I wish you'd reconsider your position towards public funding of mental health facilities. I think you are letting your personal anger towards conventional addiction treatment get in the way of helping to fund treatment for the truly needy. It's not like there is a lot of money in these systems for public mental health. In fact they are more or less working on as shoestring a budget as local governments can get away with. The police and their jails have become the new mental health hospitals becuase of this sad situation. My thoughts on the matter, for what it is worth.

Do you feel it is healthy to attend a support group several times a week for 10-20 years - Jill - Jul 15th 2006

Dr. Dombeck, I'm wondering if the next time you have a client tell you that AA doesn't work for them, or if they tell you they have concerns about AA meetings, are you going to tell them to "find a better meeting", or are you going to tell them about other groups? Do you believe that support groups are always necessary. I thought that a goal of therapy was to get the client independent and able to function in society. Do "normal" people in society attend the same support group 3-7 times a week, or do they utilize it in a healthy manner such as once a month or so? Also, do you feel it is healthy to attend a support group several times a week for 10-20 years even if it doesn't help you just because you believe that if you quit going you won't be able to control yourself? Thank You

Editor's Note: It's a good question you raise. Different individuals do have different needs and there is no single one-size-fits-all approach that will work best for everyone. In the begining of any large behavioral/lifestyle change more support is better than less. As a person matures into new habits and the intrisic reinforcements of those new habits come to control behavior (rather than older habits), the need for support is lessened but never goes away entirely. People tend to regress to older patterns of behavior when they are under stress, and it is helpful to have a "safety net" to fall into (of social supports) if and when you fall. Relapse is a part of the human condition, unfortunately. Nobody is perfect, or ever was. In sum, there needs to be a way to "graduate" from AA or similar groups for those people who are capable of doing so, but nobody should ever get so proud that they will refuse a "booster shot" now and then either (mixed metaphors, I know).

Critical Thinking and Skepticism - Jill - Jul 11th 2006
Dr. Dombeck, I don't think that Hoyt said sponsorship would never be helpful but it indeed should be scrutinized. If someone willingly enters into a relationship and wants someone to sponsor them, then that is what they should do. However, it is another matter entirely when someone is forced to have a sponsor. And as we all know, there is no critera other than "time" to be a sponsor. And in my experience, those with "time" have more dysfunction and are the biggest predators in the organization. They do background checks for people to work at McDonalds, but none on so called "sponsors"? And having someone to talk to and help out when one first quits using a substance can be very helpful. But please explain to me why it has to be someone who is a member of AA. Why can't it be a close friend or relative? It appears to me, if the support of another is what is required, it shouldn't matter what organization that person is a member of. It is my opinion that another AA member is required as a sponsor so people will be properly indoctrinated into the group. This is why when AA markets to people they insist that sponsorship must be fulfilled by an AA member. They want to make sure people assimilate. But what they have created is an angry group of coerced participants. This is probably a good thing though, because with this growing angry group coupled with the internet, the death knell has been rang for AA. Yes it is hard to quit using a substance once you've become addicted to it. As lofty a goal as total abstinence is, it is not always obtainable. The problem with the zero tolerance approach is that there are many people who do not receive any help at all if they do not totally abstain. Harm reduction is a legitimate goal and it is gaining acceptance. Another problem with the zero tolerance approach is it goes to extremes. For example, in AA if you use mouthwash or eat food that is prepared in alcohol there is much wringing of hands and gnashing of teeth over the feared "relapse". People are discharged administratively from rehabs all of the time because they are on prescription meds that the rehab doesn't accept because the person "isn't sober". Also, if someone quits drinking for several months, then one night has a drink, that person is guilted and shamed and must declare themselves a failure and start all over at day one. This is ridiculous. If someone got drunk every night, now they drink one or two nights a month, that is progress. And for all of the PC talk about addiction being a disease, the person is treated as a sinner. Can you name any other disease that you would treat with a moral inventory to an unregluated sponsor? Think about it.

Critical Thinking and Skepticism - Hoyt - Jul 11th 2006

Dr. Dombeck, On the cult thread you speculated about the possibility of AA opponents using multiple identities to make it seem that they had broader support than they really did. I don't think that's what was really going on. Certainly you are justified in questioning a lot of what you see on the internet. I don't doubt for one minute that you've had patients relapse and lie to you about it. So what were you doing when you expressed this skepticism? Using critical thinking skills, that's what, and using critical thinking skills is exactly what AA discourages. The internet has empowered people who oppose the twelve step recovery philosophy. One poster mentioned Yahoo anti-AA groups with hundreds of members. Even the AA article on the Wikipedia notes anti-AA articles and groups and, in my opinion, the anti-AA forces have the better arguments. There's really no way for AA to refute many of the things brought up. Some of it comes straight from AA sources, specifically the religious roots of AA, AA's association with Frank Buchman's Oxford Group, and Buchman's pro-Hitler comments and his obssession with masturbation. The legal cases cannot be refuted. The information regarding AA's ineffectiveness comes straight from a study conducted by Dr. George Vaillant, a member of the board of AA World Services. Regarding the comments made by the psych doctoral student concerning whether or not AA is a cult, I would refer to Charles Bufe's Alcoholics Anonymous: Cult or Cure. Bufe does not claim that AA has all the characteristics of an abusive cult, but it does have many of them, and institutional AA is more cultish and more abusive than the free, church basement AA meetings. For me, the better meeting involves more than simply making it more secular and getting rid of prayers and the Higher Power as an invisible supernatural friend. It involves getting rid of, or at least calling into question, some of the other quasi-religious dogmas. For example, no longer telling people that they are powerless. Treat alcoholism as a behavior rather than a disease. Don't tell people that "our way is the only way" and predicting doom (basically cursing and anathematizing them) if they leave the group or doubt the group's philosophy. Get rid of holy works like the Big Book. Don't pressure people to recruit new members. Other concepts which perhaps should be called into question are sponsorship and the notion that an alcoholic can never resume drinking in moderation under any circumstances. I understand that the latter may be risky and total abstinence may apply to more highly addictive subtances like cocaine, but alcohol is legal and drinking one glass of red wine per day is actually healthy.

Editor's Note: I (Dr. Dombeck) strongly disagree with your characterization that sponsorship is an unhelpful thing or that people struggling to maintain sobriety should be encouraged to think that they'll be able to drink again in the future. It's not that people cannot change themselves over time (some people can indeed), but more that anything less than 100% abstainance as a goal for the newly sober is only going to be only confusing or tempting and generally unhelpful. When you are struggling to maintain sobriety, temptation is something you want to avoid, not leave built into your lifestyle. Similarly, having people play a guiding and limiting role (and reality testing role) for you when you are newly sober is a good thing (provided those guides are themselves sober and beneficient). It is hard to stop drinking when it is a habitual means of coping and a lifestyle, and external guides and limiters can be the difference between relapse and maintainance of sobriety.

what the medical profession needs to do - Jill - Jul 8th 2006

In a nutshell, here is what the medical profession needs to do

1. INDIVIDULAIZE Treatment. The middle aged soccer mom who gets hooked on her prescription pain pills needs different intervention than the person who has been in and out of prison their entire life for violent crimes. The mistake made is they lump everyone together and pretend they are all the same. People with addiction are all '"unique" individuals. Treatment centers refuse to look at some of the underlying problems with addiction and just blame it all on "character defects and self will run riot". And I contend this is because they are either lazy or incompetent, or both. What about the person in and out of jail their entire life? They really don't have anything to lose do they? Why have they resorted to a life of crime? Nobody cares or wants to know. So lets put Grandma who takes too many Xanax in the same group and have her start hanging out with the child molester armed robber so she can "learn how to live sober". Give me a break.

2. Give people options for recovery groups, or none at all. If someone doesn't want to participate in group therapy, don't force it. Perhaps some would benefit from one on one counseling or none at all. Do not make people associate with people they don't want to associate with. If a person has a supportive family and friends, why are they forced to find support outside of their own circle? It is a myth that only those who have been addicted can help. It is a myth that you must help others to maintain recovery. Most people with drug or alcohol problems never see the inside of a treatment center nor an AA meetings. Yet most people with addiction quit on their own. Brief interventions by a Physician, a scary incident, medication to curb cravings are but a few of the other things available.

3. Treatment centers need to practice better ethics. I could not believe the personal things brought up about people in a group setting by the counselors themselves. Some people confided to a counselor in confidence only to have said counselor throw it in their face during a group session. I don't know but I think this would violate some sort of code. People had their meds adjusted by a Dr. in front of a group of people. Many times the groups were led by "volunteers" who were nothing more than AA members from the community. We all had to sign in with our first and last name and pass the paper around the room. That way, everyone knew your name. The volunteers would then go to their AA meetings and talk about the people in the treatment centers.

4. Recognize harm reduction and non abstinent recovery as legitimate.

5. Understand that addiction occurs for a myriad of reasons. And please scrutinize the fact that you are treating people with a physical condition with a religious conversion. Would you tell someone with any other type of ailment to congregate in a room full of others with the same affliction and pray to a doorknob?

6. Listen to people when they tell you AA doesn't work for them. Do not just assume they want to get drunk. Listen to their concerns for I guarantee you, they have legitimate concerns. Listen to people when they say they do not want to participate in group confession but would prefer one on one. Listen to people who want to use their friends and family for support rather than other people with addiction.. Stop propagating the myth that people with addictions are sneaky, lying , cheating losers who lie about everything. (Some are as evidenced by the clientele of AA. However, for most of the people in AA, drugs and alcohol are their secondary problem, they are first and foremost criminals and predators and would be without the drugs and alcohol) And STOP CALLING PEOPLE ADDICTS. That is a derogatory term that labels someone for life. Stop making people call themselves that for it is a self fulfilling prophecy.

I know this is long, but please post it. I don't know if I gave any helpful information, however, I do know one thing. Treatment and AA were the worst things that ever happened to me in my entire life. My faith in the medical profession has been shattered and altered forever.

AA Reform - Colonel Kurtz - Jul 6th 2006
A lot of essense of what you are suggesting is covered in the 12 Traditions. The problem is that the 12 Traditions seem to be forgotten by a lot of groups. Some of the key issues: - "leaders... do not govern." This says explicitly that no one can demand that anyone else do something. Hence, no sponsor CAN EVER tell a sponsee what to do. - "The only requirement for AA membership is a desire to stop drinking." Yet every meeting I go to, some Einstein tells me that in order to stay sober I must work the 12 steps, must read the big book, must call my sponsor, and so on. This is the most widely ignored yet crucial tradition. Another note: now that I'm sober a year, they stopped telling me I'm in danger of a relapse (unless I do so and so). Now they tell me I may be sober, but not happy! - "AA... is forever nonprofessional" Anybody can plainly see that given this, bad advice is not only a possibly but a de facto given. Meetings are loaded with nonprofessional, bad advice. So beware. - "AA is based on attraction rather than promotion." What the 'f' are people being sentenced into AA for then? That's not "attraction" at all. In summary, a lot of what you are suggesting that needs to be fixed is rather a problem in that THE TRADITIONS ARE WIDELY IGNORED OR GLOSSED OVER WITH SLEIGHT OF HAND.

Solutions - Jill - Jul 5th 2006
Thank You Dr. Dombeck. I will respond in a day or two. I want to speak to some solutions rather than post a rant. I admit freely that I HATE AA and everything it stands for. But it is important to know that prior to my forced AA participation and treatment, I believed it was a good thing. It is sort of like beef liver. It smells so good when it's cooking and it looks so good, but when you take that first bite...................................

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