Alcoholics Anonymous: the Science, Law, and Secular Alternatives by Patrick Hinsel

“12-Step recovery programs do more harm than good.”

This statement, though it can be passionately argued for or against, with emotional resolve and with anger, cannot even come close to being discredited by evidence. That is because good evidence regarding the efficacy of programs like Alcoholics Anonymous eludes us. Most estimates place it at approximately a 10% success rate, or equivalent to cold turkey.  In his recent book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, Lance Dodes, MD, a retired psychiatry professor from Harvard Medical School, measured AA’s retention rates along with studies on sobriety and rates of active involvement (attending meetings regularly and working the program) among AA members. Based on this research, he put AA’s actual success rate closer to 5-8 percent. By definition, AA is anonymous, so honest and reliable statistics are difficult to come by. But insurance companies pay for the 12-Steps. The medical community endorses AA, NA, and the 12-Steps.  Governments sanction AA and NA. Therefore AA is ubiquitous, to the exclusion of more reasonable alternatives.

Untold numbers of people find AA off-putting because of the religious aspect. Yet, AA enjoys a monopoly in the recovery community. Secular alternatives are not available all day, everyday, at multiple locations in every city and town in America like 12-Step meetings are. Secular meetings, even in large cities, may only meet once a week, if at all. So the overtly religious 12-Steps, unacceptable to so many, preclude countless individuals from getting the help they seek and need. They suffer for it, and their families suffer too. When we hear about a celebrity relapsing or a rock star overdosing, why should the assumption be that they failed to work their 12-Step program? It is more likely the 12-Step program failed them.

To be clear, AA is religious.

The courts say so, at least.[1] And then there is the fact that most meetings are held at Christian churches. Meetings begin and end with a Christian prayer, usually the Serenity Prayer or the Lord’s Prayer. And seven of the 12-Steps deal with God, Higher Power, Prayer, and Spiritual Awakening. Only five do not:

  1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
  2. Came to believe that a Power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take a personal inventory and when we were wrong promptly admitted it.
  11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
  12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

These Steps are read at the beginning of every meeting, along with statements like, “There is One who has All power, that One is God. May you find Him now!” and, “Probably no human power could have relieved our alcoholism…God could and would if He were sought.”[2]

The courts have returned their verdict as well. Between 1996 and 2007, five high-level US courts (three federal circuit courts and two state supreme courts) each ruled on this issue. AA is religious and therefore the State cannot force people to go. Because the cases involved the Establishment Clause, they reached the highest level of judiciary scrutiny, only one level below the US Supreme Court.

While AA and its members may deny that it is grounded in religion, these high court rulings clearly explain that when newcomers are told that they should accept the existence of God as a requirement for continued sobriety, and tell them to seek their God through prayer, confess all wrongdoings to Him, and ask Him for removal of shortcomings, and then expect the newcomer to recite the Lord’s Prayer at the end of meetings, the fellowship is indeed practicing “religion.”

Separation of Church and State

Bill W. and Dr. Bob are the Patriarchs of AA, dating back to the program’s Judeo-Christian roots in the 1930s. With other AA members, they were able to influence medical decision makers well into the 1950s and 60s and made presentations to Congress and Medical Societies that had clout at the time. Physiologist E. M. Jellinek collaborated with early AA member Marty Mann, and published the results of a survey mailed to 1,600 AA members. Only 158 were returned. Jellinek and Mann culled 45 that had been improperly completed and another 15 filled out by women, whose responses were so unlike the men’s that they risked confounding the results. From this small sample (98 men) Jellinek drew sweeping conclusions, and his “medical literature” became AA gospel, leading to the medical community’s eventual acceptance of the 12-Steps as the Gold Standard method of treating addiction.[3] With Medicine’s blessing, government and insurance companies began paying for 12-Step based treatment, opening the door for religion and removing the wall between church and state.

“You’re in terrible shape, you need to get yourself to an AA meeting”.

AA manipulates people when they are at their most vulnerable, desperately seeking guidance. Even agnostics and atheists go to AA looking for help in early recovery, because they cannot find any alternatives to the 12-Steps in their area. Some manage to get sober in spite of God, not because of Him. Criminals, including pedophiles and sex offenders, anonymously mix into the groups. Fragile newcomers are easy prey. The manipulation even extends to a “13th Step”, in which male AA members with some clean-time in the program will befriend a female newcomer, ostensibly to offer guidance and support. But in reality the goal is to sexually exploit, or “13th Step”, the female newcomer.[4]

Secular Alternatives to AA and 12-Step Programs

Insanity is doing the same thing over and over again and expecting different results. If this is true, why would repeated returns to the 12-Steps be the solution to repeated relapses? It stands to reason that people have better treatment outcomes when they’re offered choices and not coerced to accept one thing or another. In a 2012 report on addiction treatment in the U.S. by the National Center on Addiction and Substance Abuse at Columbia, researchers concluded: “Evidence clearly demonstrates that a one-size-fits-all approach to addiction treatment typically is a recipe for failure.” In her book Inside Rehab, Anne M. Fletcher illustrates a science based perspective on recovery and takes a thorough look at the state of affairs of addiction treatment in the US. To be fair, she acknowledges 12-Steps can be helpful for those who willingly pursue it. But other options do exist. Unfortunately, most in the recovery community are unaware or unfamiliar with secular options due to the glaring eclipse that is the 12-Steps.

Refuge Recovery is a mindfulness based recovery program designed by Noah Levine in California. This program is becoming more popular across the US. It emphasizes meditation and Buddhist philosophy, practicing compassion and empathy in the day to day lives of members. In-person group meetings create a social community and support network. Like the other secular groups listed here, Refuge Recovery welcomes people looking to address all spectrums of addiction, including alcohol, food, sex, opioids, meth, and process addictions. There is no mention of any God or Gods as a part of Refuge Recovery. It also has a robust online community.

LifeRing Secular Recovery is an abstinence-based, worldwide network of individuals seeking to live in recovery from addiction to alcohol or to other non-medically indicated drugs.

SMART recovery is science based, and it is probably the largest 12-Step alternative today, world wide. It teaches self-help and common sense with a goal of empowerment.  Rational Emotive Behavioral Therapy (REBT) techniques are used to achieve positive, lasting changes in the lives of its members.

SMART Recovery evolves as scientific knowledge of addiction evolves. It welcomes change when there is an improvement. By contrast, The Big Book of AA was written in the1930s and the AA community adamantly resists changing or adapting it. The Big Book’s chapter “To Wives” reflects an overtly sexist worldview that is increasingly considered unacceptable in modern times. Chapter 4, the “Chapter to the Agnostic” is not an argument of persuasion, it is an arrogant line in the sand, “There either is a God, or there isn’t”  (the implied answer is that there is, just one).  SMART Recovery has wider popularity in Europe than in America right now. Also, an interesting difference in Europe is AA meetings traditionally do not say the Lord’s prayer, and the religious aspects are toned down in AA meetings compared to the USA.

SMART meetings are for all addictions and are facilitated by a moderator experienced with cognitive behavioral techniques and who has significant clean time. In-person meetings can be hard to find in most American cities. For the techniques involved, on-line and chat based meetings are not usually ideal.

Secular Organizations for Sobriety (SOS) is a nonprofit network of autonomous, non-professional local groups, dedicated solely to helping individuals achieve and maintain sobriety from alcohol and drug addiction, food addiction and more.

Women for Sobriety A non-profit organization of women, for women, dedicated to helping women discover a happy New Life in recovery from Substance Use Disorders. It encourages emotional and spiritual growth and is endorsed by the American Humanist Association as a secular or religious-neutral option for recovery. WFS has certified moderators and chat leaders leading mutual support groups online and in person, as well as phone volunteers available for one-on-one support. Any woman seeking an abstinent New Life is welcome to join WFS.

Agnostic AA is a website for agnostics, atheists, and freethinkers who are involved with AA but desire a non-religious, safe place to engage in fellowship. It is a great location to find recovery literature, materials, and books that are secular in nature.

Pharmacotherapy is an underutilized, evidence-based option to treat addiction. Experienced  physicians, trained in addiction medicine, help alcohol dependent patients with prescriptions like Topamax (topiramate) and Antabuse (disulfiram). Naltrexone (vivitrol) has shown efficacy in the treatment of opioid maintenance of sobriety, as well as alcohol long term sobriety. A wide spectrum of treatment options exist, depending on the individual and the substance(s) to which they are addicted. The difficulty is finding physicians who are able to handle this, and getting the treatment covered. The American Medical Association recently estimated that out of nearly 1 million doctors in the United States, only 582 identified themselves as addiction specialists.

Therapy.  Counsellors experienced in the treatment of addiction offer hope to those with the means to access this type of care. Unfortunately, in many instances, insurance does not cover mental health treatment like this, or patients find the cost beyond their means. The Secular Therapy Project arose to help secular individuals having a hard time matching with a counsellor in a faith based world. Many offer sessions via confidential Skype-type arrangements with special software. See SecularTherapy.org as an example.

All of these secular groups will help you if you are interested in starting a new group in your area. The costs of attending these groups are the same as the cost of AA:  free or donation only.

The Dalai Lama says, to paraphrase, “Listen to what I say, and keep what you want. If something I say is helpful, great. If something I say doesn’t fit with your experience, disregard it.” The secular recovery programs listed above are all in keeping with this line of reasoning. They don’t require faith. AA has a motto, “Take what you want, and leave the rest.” Many people in AA do modify their program to their personalities and it works for them. But AA and the Big Book’s statements about God are unequivocal. Some nonbelievers may be able to overlook this for a while and get sober. Countless others are not comfortable with this. They cannot square the fabrication of a “God” in which they don’t believe with a “program of rigorous honesty,” so they either never attend AA, or they cut their losses. They end up aborting the misadventure of AA, and go on suffering while they search for that elusive secular alternative.

Progress 

Just in the past couple of years, the American Board of Family Medicine began making changes to its board exam questions, phrasing them to better reflect secular options in recovery. Instead of the answer being simply “AA,” a broader option was given, to the effect of “a recovery meeting,” or “an AA or secular recovery meeting.”  The label “Person in long term recovery from alcohol” is emerging to replace “Alcoholic.”  It’s slow progress, beginning in academic medicine. Physicians practicing in the real world lag behind. Insurance and politicians will eventually begin to follow. It is a step in the right direction.

But still, religion permeates. Can you imagine a world in which a doctor says,“You have a primary brain disorder. It’s called Parkinson’s. You need to get on your knees and pray to God. That’ll be $200.” We wouldn’t accept this for Parkinson’s. Why on Earth do we accept this for the most common primary brain disorder, addiction?[5]

No doubt there is benefit to be found in group solidarity, working through a common struggle. It is hard to dispute the upside of support from like-minded individuals who have been through similar circumstances and can offer general advice and guidance. It is comforting to have a place to go where others believe the same as you do and want the best for you. It is helpful to have an old, well established book to refer to in times of doubt. It is reassuring to hear familiar sayings and chants at every gathering. What does this sound like? It sounds like a church. It reflects a religion because that’s what it is. And like religion, it is comforting and reassuring for its adherents. But that does not mean its faith claims are true, and it doesn’t make the claims of AA/12-Steps superior “efficacy” true either. In the words of the late Stephen Hawking, “It is not necessary to invoke God.” He was speaking on other things, but the words ring true in addiction treatment as well. Bringing God into it just complicates things and slows progress. Bill W. was right about one thing, though, when he said, “We are engaged upon a life-and-death errand.” The recovery community deserves better than faith healing.

 


 

[1] See Griffin v. Coughlin (1996); Kerr v. Farrey (1996); Arnold & Evans v. Tennessee Board of Paroles (1997); Warner v. Orange County Dept. of Probation (1999); and Inouye v. Kemna (2007).

[2] https://www.aa.org/assets/en_US/p-10_howitworks.pdf

[3] http://www.a-1associates.com/aa/testimony.htm

[4] http://www.the13thstepfilm.com

[5] https://www.asam.org/resources/definition-of-addiction

  • Recent Articles
Author Details
Contributor , Reason Revolution
Patrick Hisel is an independent Family Physician. He graduated from Texas A&M with a BS in Biomedical Science and earned his MD from the University of Texas Medical School at San Antonio. His interests are medicine, sports, politics, popular culture, and religions. He wants to do the work it takes to believe as many true things as possible and as few false things as possible. He enjoys painting and piano. You can find him at hisel13.deviantart.com and on Twitter @Liberty_Doc.
  • Alcoholics Anonymous: the Science, Law, and Secular Alternatives by Patrick Hinsel
    Alcoholics Anonymous: the Science, Law, and Secular Alternatives

    “But that does not mean its faith claims are true, and it doesn’t make the claims of AA/12-Steps superior “efficacy” true either. In the words of the late Stephen Hawking, ‘It is not necessary to invoke God.’ He was speaking on other things, but the words ring true in addiction treatment as well. Bringing God into it just complicates things and slows progress. Bill W. was right about one thing, though, when he said, ‘We are engaged upon a life-and-death errand.’ The recovery community deserves better than faith healing.”

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply