AA Isn't the Best Solution: Alternatives for Alcoholics

Building on an essay in Wired magazine by Brendan Koerner, New York Times conservative
columnist David Brooks lauds to the sky AA and its founder, Bill Wilson. Both Brooks and Koerner
point out the worldwide spread of AA (although it is limited mainly to the U.S. and like-minded
countries), and the spread of the 12 steps to nearly all areas of behavior change, indeed, to how we
approach social problems of all sorts.
Along the way, Brooks makes the good points that there is no scientific way to program behavior
change -- that it is indefinite and rooted in individual choice. He points out the benefits of the social
networks AA provides its members, and the decentralization of the AA movement, so that individual
chapters are able to organize as its own members see fit. These are strong organization and
psychological pluses.
But, unfortunately for a rational conservative, Brooks misses a few downsides to the AA movement.
1. The view AA conveys of alcohol and alcoholism is associated with abstinence-binge tendencies
that already dominate America and other temperance nations. AA's approach is completely
abstinence oriented. In fact, temperance cultures like America, which are highly suspicious and
fearful of alcohol, are characterized by many individuals who restrict their drinking, but then go on
benders. Similar Northern European cultures, for example, have several times the death rates due to
alcohol of Southern European countries, because the former tend to monumental binges (think
Ireland, England, Finland) while in the Southern countries, people drink alcohol causally with meals
(think Italy, Spain, Greece, France). All indications are that the latter is much healthier. More
particularly, the majority of AA members fall off the wagon. When they do so, they very often return
to drinking without restraint.
Brooks, a great trend-spotter, has missed the worldwide movement -- including in the United States - towards harm reduction. Harm reduction has an opposite approach to substance use and addiction
from the 12 steps. It assumes many people will fail to achieve abstinence, and instead works in every
possible way to curtail the problems associated with use: infections (through needle exchange),
eliminating accidents (through safe driver programs), healthier use (through cutting back drinking,
providing shelter, food and medical care for alcoholics and addicts, and, in the drug area, using safe
injection methods or substitutes for injectibles).
Just as Brooks and Koerner were announcing their discovery that AA is great, the National Institute
on Alcohol Abuse and Alcoholism was announcing that "alcoholism isn't what it used to be," that
most people cut back alcoholic drinking without going to treatment -- that is, that most of the
benefits of self-improvement occur outside the walls of AA for people who specifically violate the
fundamental principles of AA. Brooks rejects science in this area: i.e., the idea "that we will someday
find a scientific method that will allow us to predict behavior and design reliable social programs."
But let's not reject science that tells us how the majority of people actually behave. That's ignorance.
2. Sorry, AA doesn't work. The goal of AA and comparable methods is to get people sober (which
does NOT, outside of AA, mean total abstinence for everyone). But, according to Koerner: "Wilson's
success is even more impressive when you consider that AA and its steps have become ubiquitous
despite the fact that no one is quite sure how -- or, for that matter, how well -- they work." In other
words, Wilson's and AA's triumph has been in marketing, not therapeutics.

In other areas, Brooks is not so quick to jump on the bandwagon of approaches that aren't proven to
be successful. Given that AA started in 1935, that it is still not proven to be successful is beginning
to be a bit worrisome. Do drinking and drug problems, alcoholism and addiction, seem to be
improving in the United States? (Hint: according to the National Survey on Drug Use and Health, 25
percent of 21-year-old Americans have a diagnosable drug or alcohol problem -- far and away most
often an alcohol problem.) Don't you think we might be doing a little better in this area after 75
years?
3. American AA is coercive. Brooks wisely notes, in acknowledging that AA doesn't work particularly
well, "There is no single program that successfully transforms most people most of the time." But
virtually everyone who ends up in AA in the United States is sent (forced) to attend AA or
comparable programs -- for example through drug courts, or even municipal traffic courts after a
DUI. Why does this occur? Because the AA movement is spearheaded by true believers who believe
what was good for them is good for everyone, as Brooks himself hints: "There are millions of people
who fervently believed that its 12-step process saved their lives." Naturally, these people are
inclined to "recommend" that others follow their one truth path. This, even though Brooks notes,
"the majority, even a vast majority, of the people who enroll in the program do not succeed in it."
4. The government, especially, should not be involved in spiritual salvation and identity change. As
Brooks correctly states, people become sober when they "achieve broad spiritual awakenings, and
abstinence from alcohol ... [is then] a byproduct of that larger salvation." Fair enough, but how does
this go with point three, that people are routinely sent to AA by courts and social agencies? Four of
nine federal circuit courts (as well as New York's and several other states' highest courts) have ruled
that people with religious objections (Buddhists, atheists, Jews) cannot be compelled to attend AA or
a 12-step program, and must be permitted alternatives. I know, I know ... AA isn't religious, and Step
3, "Made a decision to turn our will and our lives over to the care of God as we understood Him,"
isn't really about that God -- you know, the Christian one. But those dang courts keep begging to
differ -- forcing people to bow to any form of God is just not part of the Constitution.
5. We need to be encouraging alternatives to AA. Brooks does not make the proper deduction from
noting that, "There is no single program that successfully transforms most people most of the time."
Since AA and the 12 steps are used in over 90 percent of American treatment programs, we need to
provide more ready alternatives to AA, not inject more resources and energy into the system that
has been around three-quarters of a century, will little noticeable society-wide improvement in our
drinking. Therapeutically, providing choice is a powerful tool, since it turns around many people's
resistance to AA's Step 1 -- acknowledging that you are powerless. People tend to do better pursuing
programs they believe in.
The most promising trends in alcoholism treatment are motivation enhancement (developed by
psychologist William Miller), which avoids dictating to clients and instead allows them to express
and pursue their own values, and mindfulness (developed by psychologist Alan Marlatt), the Zen
Buddhist technique of meditation and focusing on inner states and needs. I use these techniques in
my Life Process Program, which provides a non-12-step alternative that many people welcome, and
in fact do better at.
And, while I'm at it, let me mention that I have recently written a foreword for Amy Lee Coy's From
Death Do I Part, which is the story of a 34-year-old woman's quitting drinking after two decades of
alcoholism (and assorted other addictions) and a dozen, at least, exposures to AA and 12-step rehab.
She did so when she finally took ultimate responsibility for her own life.
P.S. Dave, read the comments, especially the ones that say any alcoholics who read this will die.

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