Is AA the Best Solution?: Alternatives for Alcoholics

Are there other ways besides Alcoholics Anonymous?

Are there other ways of staying sober besides Alcoholics Anonymous?

by Stanton Peele addiction expert, psychologist, raconteur, Huffigton Post

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 already 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.

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