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75 Years Later, We Still Don't Know How AA Works


AA doesn't work for everybody, but when it does, it can be transformative. Members receive tokens to mark periods of sobriety, from 24 hours to one month to 55 years.
Photo: Todd Tankersley

In 1935, in the dark days of the Great Depression, a broken-down drunk named Bill Wilson founded Alcoholic Anonymous, an organization that would help millions of people combat alcoholism. Seventy-five years later, we still don't know how AA works.

Brendan Koerner of Wired has a fascinating look at the founding and inner working of AA, and why some alcoholics' brains may be wired to be receptive to its methods:

It’s all quite an achievement for a onetime broken-down drunk. And 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. The organization is notoriously difficult to study, thanks to its insistence on anonymity and its fluid membership. And AA’s method, which requires “surrender” to a vaguely defined “higher power,” involves the kind of spiritual revelations that neuroscientists have only begun to explore.

What we do know, however, is that despite all we’ve learned over the past few decades about psychology, neurology, and human behavior, contemporary medicine has yet to devise anything that works markedly better. “In my 20 years of treating addicts, I’ve never seen anything else that comes close to the 12 steps,” says Drew Pinsky, the addiction-medicine specialist who hosts VH1’s Celebrity Rehab. “In my world, if someone says they don’t want to do the 12 steps, I know they aren’t going to get better.”

Wilson may have operated on intuition, but somehow he managed to tap into mechanisms that counter the complex psychological and neurological processes through which addiction wreaks havoc. And while AA’s ability to accomplish this remarkable feat is not yet understood, modern research into behavior dynamics and neuroscience is beginning to provide some tantalizing clues.

Link


Alas, the numbers show that AA doesn't work any better than cold turkey. Both have a 12-month success rate of around 5%, according to AA's own numbers.

So the question becomes, why *doesn't* AA work? Perhaps because it insists on calling alcoholism a disease (highly debatable) while refusing to treat it as one (the only cure is turning your life over to God)? Or because it preaches self-victimization rather than empowerment? Or because it's really kind of a cult?

And yes, I have first-hand experience with 12-step programs. There is value in 12-step, for sure, and some good ideas. Also some very bad ones.
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The 5% comparison would be more informative with some context. Is the cold turkey 5% based on total number of alcoholics, total number of alcoholics who attempt cold turkey, or total number of former AA participants who attempt cold turkey? Is the AA 5% based on total number of alcoholics, total number of alcoholics who attend one AA meeting, or total number of alcoholics who attend meetings daily for a year, working the steps with a sponsor?
A more apt comparison would be AA's success rate compared to other programs for alcoholics per, say, 1,000,000 alcoholics who participate fully in the programs, daily for one year. A more accurate comparison would be the success rate, per 1,000,000 alcoholics per year, of programs that cost the government, private industry, and the participants nothing.
There are published scientific studies, including genetic studies, that support the proposition that alcoholism is a disease or the manifestation of a disease, e.g. depression or bipolar disease. Treatment of a disease costs money that was not available during the Depression, and often not available to alcoholics, then and now, who are too impaired to hold a job (much less budget for the cost of treatment), andare uninsured or under-insured. AA’s Higher Power, from a different perspective, is not the god of Abraham, but rather the power of the AA community. Attending some meetings of AA or ALANON provides at least anecdotal evidence that no preaching of religion occurs, nor any organized discussion of any particular religion. Organized religion does not invade the meetings, and religion is not a topic -- beyond the reference to a Higher Power that each participant is called upon to identify for themselves -- unless a participant choses to describe their experience with organized religion, which seems to be as often bad as good. A cult is comprised of followers of an unorthodox, extremist religion who live outside of conventional society under the direction of a charismatic leader to serve the purposes, including self-aggrandizement, of the leader. Respectfully, AA doesn't fit the definition, in my opinion.
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Dr. Drew you are wrong. Twenty years ago I stopped drinking on my own. I do not buy that crap that I am helpless in the face of my drunkeness. I am the cause of my drunkeness and no "higher power" was going to knock the drink from my hand. AA works in some cases because it substitutes one addiction for another. The addiction of the group, the meetings, the cachet of being a sainted former drunk.
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I would say there is ONE good thing about AA and other 12-steps: having a person that you can choose to call, if you need support.

I would also posit that the onus is on AA to demonstrate effectiveness. Which it hasn't.

In general, if you talk about the lack effectiveness in a system to a believer in that system, the standard response is to say that those who failed 'weren't doing it right'. Until it becomes a tautological absurdity, where those who succeed were, by definition, the only ones doing it right.

While it certainly creates a lot of extra problems, substance abuse, imho, is more of a symptom than a root cause.
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*sigh* Another article on this kind of stuff that isn't defencive enough. As some readers may know, Dr. Drew would agree that there is OFTEN exceptions to these kinds of things. Plus, people are misguided what the whole higher power thing means. Its vague FOR A REASON. Staunch atheists go to AA and continue going for very long periods of time. Tell me, how does THAT make sense if you say it has to do with god?

As for the whole disease thing, it all depends on your definition(i stopped using official definitions. People seem to not give a shit). One thing is pretty damn certain: alcoholism can be and often is genetic, at least to some degree. More to the root though, dependence on drugs is generally something easily passed down even if said child is immediately adopted, it just happens.

Dr. Drew swears by 12 step because he has treated many thousands-not just a few celebrity's going through this kind of stuff. He has talked with many thousands that HAD gone through this stuff too. Every time someone asks him what to do and that they tried AA or other similar things and that they didn't work, it ALWAYS turns out that simply put they were doing something wrong, were forced into it, or in general weren't at their breaking point yet for wanting to get better.
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I agree with Mary B in some ways, it really is replacing an addiction in an already addictive personality, one for another, which is why it does work for some people who have that personality.
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Despite many attempts, I couldn't get sober on my own, and other programs that I tried didn't work for me
(rational recovery, smart recovery, counseling, etc.). I honestly didn't think AA would work either, mainly because I was a hardcore agnostic. However, I was desperate enough to give it an honest try, so I got a sponsor and worked the steps, and it's worked 100% for me ever since (2+ years).

Since AA believes in attraction, rather than promotion, the onus to demonstrate its effectiveness is not on AA as an organization. If individual members want to espouse its effectiveness, that's up to them.

I don't really care to spend my time in debate and negativity, so I'm really not here to sell somebody on something they don't want anyway. If you've got doubts about AA being anything less than an altruistic movement, show up at any open meeting (you don't have to be alcoholic to attend) and decide for yourself.
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Despite many attempts, I couldn't get sober on my own, and other programs that I tried didn't work for me (rational recovery, smart recovery, counseling, etc.). I honestly didn't think AA would work either, mainly because I was a hardcore agnostic. However, I was desperate enough to give it an honest try, so I got a sponsor and worked the steps, and it's worked 100% for me ever since (2+ years).

Since AA believes in attraction, rather than promotion, the onus to demonstrate its effectiveness is not on AA as an organization. If individual members want to espouse its effectiveness, that's up to them.

I don't really care to spend my time in debate and negativity, so I'm really not here to sell somebody on something they don't want anyway. If you've got doubts about AA being anything less than an altruistic movement, show up at any open meeting (you don't have to be alcoholic to attend) and decide for yourself.
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I believe there was an episode of Penn and Teller's Bull**** that addressed the effectiveness of AA. That was a pretty good episode.
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According to the book "Pass It On: The Story of Bill Wilson..." (1984) written by A.A. *wait for it*
Bill Wilson, the co-founder of Alcoholics Anonymous used the Ouija Board to contact spirits. Wilson claimed that he received the twelve step method directly from a spirit without the board and wrote it down. (page 196-197). That pretty much tells me everything I need to know.
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Say 5% of alcoholics went cold turkey, successfully, in the last twelve months, and 5% of alcoholics were successful in AA in the last twelve months. AA has doubled the number of recovering alcoholics in the last twelve months.
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