“Since the inception of Alcoholics Anonymous — the progenitor of 12-step programs — science has sometimes been at odds with the notion that laypeople can cure themselves because the numerous spiritual references that go with the 12-step program puts AA on “the fringe” in the minds of many scientists. But there is an interesting read at National Geographic where Jarret Liotta writes that new research shows that the success of the 12-step approach may ultimately be explained through medical science and psychology. According to Marvin Seppala, chief medical officer at Hazelden [an addiction treatment facility] and sober 37 years, attending 12-step meetings does more than give an addict warm, fuzzy feelings. The unconscious neurological pull of addiction undermines healthy survival drives, causing individuals to make disastrous choices, he says. “People will regularly risk their lives—risk everything—to continue use of a substance.” Addicts don’t want to engage in these behaviors, but they can’t control themselves. “The only way to truly treat it is with something more powerful,” like the 12 steps, that can change patterns in the brain. Philip Flores, author of Addiction as an Attachment Disorder, says the human need for social interaction is a physiological one, linked to the well-being of the nervous system. When someone becomes addicted, Flores says, mechanisms for healthy attachment are “hijacked,” resulting in dependence on addictive substances or behaviors. Some believe that addicts, even before their disease kicks in, struggle with knowing how to form emotional bonds that connect them to other people. Co-occurring disorders, such as depression and anxiety, make it even harder to build those essential emotional attachments. “We, as social mammals, cannot regulate our central nervous systems by ourselves,” Flores says. “We need other people to do that.””
What you just read is an attempt to rationalize faith-based behavior as science.
Alcoholics Anonymous has helped some people, for sure. As I wrote about in ‘Bad Therapy, Good Therapy (And How to Tell the Difference),” AA is a mixed bag of both rational and unfounded ideas.
For example, AA encourages people to take a self-inventory and accept responsibility for their lives. It attempts to foster serenity, something I’ve defined as the emotional essence of mental health.
At the same time, and in total contradiction, AA tells people to hand over all responsibility for their drinking—and their lives—to a ‘higher power.’ Who’s in charge of your recovery from alcoholism—yourself, or your higher power? No answer is ever given. On top of it, AA insists it’s not a religion even though it upholds the central tenet of all religions, i.e. belief in a supernatural being controlling everything, or at least most things.
The above passage takes it for granted that AA helps nearly everyone involved. This isn’t true. People drop out of AA all the time. Others eschew AA, yet still stop drinking. Some people use AA to make themselves look good for legal conflicts. Reports of selling drugs at NA or AA meetings are not uncommon. Others replace or supplement AA with individual psychotherapy, something many AA sponsors, in my experience, severely criticize if the therapist is not a recovering alcoholic him- or herself. I’ve talked to people who feel guilty for going against some of the principles or practices of AA. They continue to abstain from drinking, but they don’t always like the groupthink or subtle social pressure to conform fostered by many AA meetings. It’s just like membership in any other community, where individualism and thinking for oneself are often frowned upon.
A lot of people struggle with emotional bonds with people. Some of them become alcoholics; others do not. There are all types of alcoholics: outgoing, quiet, self-confident, shy, retiring. Alcoholism, by definition, impairs whatever good or strong qualities a person has. But it’s simplistic and unfounded to suggest that all alcoholics are socially inhibited or awkward, and only the interaction of the group can cure their underlying problems and get them off alcohol. Neither the facts nor logic support this theory. None of my experience as a psychotherapist does.
AA can be a useful tool for stopping drinking for many people, without question. For an alcoholic to stop drinking means to entirely change his or her lifestyle. ‘Lifestyle’ refers not only to patterns of behaviors and social interactions, but also one’s core emotional and cognitive response system. When facing life’s daily challenges, an alcoholic must learn to stop responding with the thought, ‘I need a drink,’ and replace it with any number of other coping mechanisms. Any former alcoholic will tell you this is easier said than done. Some people find making such a massive change much easier to do when attending weekly or daily meetings with like-minded people who have similar problems. The capacity to call up an AA sponsor at any time is also useful in stopping drinking—for some, although not for all.
AA, unfortunately, enjoys an undeserved monopoly on the assumptions of alcohol treatment. Genuinely plausible alternatives, such as Rational Recovery, are largely ignored. For years I have been referring clients struggling with addiction to Rational Recovery, a self-help organization that does not require group membership or belief in God. Without exception, the response I receive is, ‘Why has no other mental health professional told me of this approach?’
Nobody to my knowledge, other than Rational Recovery, a few other organizations and myself, ever dares to question the possible harmful side-effects of group membership as a means of recovery. Is social or interpersonal pressure the best, and most effective, motivation for quitting drinking? Or must you ultimately do this for yourself? It’s an undeniable fact that you’re with yourself 24/7. You can go to AA meetings all you want; unless you are 100 percent committed, you’re never going to quit. At best, AA—or anything else, including a psychotherapist—are a means to the end of quitting drinking. In the end, you’re the only one who can do it.
It’s true that human beings desire and need interpersonal relationships, or some form of human connection. An emotional and interpersonal support system is an invaluable aide in any life crisis. This is no less true when quitting an addiction than with anything else. To claim that such a need is strictly biological is to reduce human life and human consciousness to a series of biochemical reactions. But consciousness exists, and has identity. In other words, we all have thoughts, ideas, emotions, beliefs and values. Those ideas, emotions and values can correspond to objective reality, or work against it; likewise, they can enhance our individual survival and well-being, or undermine it.
Claiming that everything is physiological—and that alcoholism, by implication, is simply a medical disease—undermines personal responsibility. When personal responsibility goes out the window, so do empowerment and enlightenment.
Therein lies one of the great dangers of AA. Replacing one set of faulty ideas—ones that leads you to abuse alcohol—with another set, making you unhealthily dependent on the group culture for learning how to think and act, isn’t the ultimate standard of mental health.
With or without AA, a person stops abusing a substance because he or she comes to believe that it’s destructive to one’s own well-being. ‘My life is important, and I deserve better than this,’ is the core of the resolution. This is not a medical illness, although alcoholism and substance abuse often have medical consequences. This is, at root, a crisis in values and self-esteem. The source for fixing this problem lies not in pretending that it’s a medical illness or that a supernatural being is in control of everything, or that the group knows all. The core of recovery lies in a commitment to loving life, and loving yourself, in the most consistent sense of this idea.
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