Some Criticisms and Some Positives of AA/12 Step Programs
I want to begin by saying that I want to make it clear that for people who like AA/12 Step programs and find them effective, I have no problems with that and am happy for them. Also, if I had a client who really liked AA and said that they found it effective, I would not suggest that they stop going or anything like that. Also, in case readers may wonder, I am not espousing an atheistic viewpoint (although I respect people’s rights to their views who are atheists). I identify as spiritual but not religious. Anyway, my main concern here is a bit different.
Alcoholics Anonymous/12 Step based programs have been well known in the United States for a long time now. They seem to have a very strong following and many people seem to say that they are very effective for them (although from looking, I don’t think there is really any good strong scientific research on the effectiveness of AA), which I think is great. However, there are also some criticisms that I have. If a person is looking for a recovery program that is religiously themed, I think that a 12 Step/AA Program could be a great fit for them. However, if a person does not want to attend a religiously based program, I argue that the situation gets trickier. While it does appear that there are alternatives to AA/12 Step, for whatever reason, in my view they seem to be overshadowed by AA/12 Step. The real problem, in my view, comes up when we talk about mandating people to AA/12 Step. First of all, I don’t believe that government or any other organizations should be able to mandate anyone to anything (with exceptions of course). The main exceptions in my view would be situations where a person is infringing upon the rights of others, causing harm to others, etc. Those are the only kinds of situations where I argue it is acceptable for the government or other organizations to mandate someone to treatment. I argue that it’s ok to offer help to someone who is struggling with alcohol addiction, drug addiction, etc., but I don’t believe that it is the government’s right or any other agency’s right to mandate someone to a program, if they are not causing other people harm.
The situation becomes further complicated in the case of mandated AA/12 Step programs because not only is the government or agency mandating someone to a program, where that person has potentially not caused any other person harm, but they are mandating them to what I would argue is a religiously based program. This, in my view, is an even bigger problem because I argue that it is against that Establishment Clause of the First Amendment of the Constitution of the United States. According to Lee v. Weisman, 505 U.S. 577, 587 (1992), “The fundamental rule of the Establishment Clause is this: “It is beyond dispute that, at a minimum, the Constitution guarantees that government may not coerce anyone to support or participate in religion or its exercise, or otherwise act in a way which ‘establishes a [state] religion or religious faith, or tends to do so.’”. While some people may argue that AA/12 Step programs are not religious in nature, from the research I have done, in my view there is definitely enough there to say that it is a religiously based program. The arguments that I just mentioned were corroborated in recent reading that I did, which showed that indeed there have been a number of court cases where the mandating of AA/Step treatment was found to be a violation of the Establishment Clause of the First Amendment. However, I believe that this is still an ongoing issue that comes up in courts now and again.
In addition, another criticism I have of the program is that in some ways I would argue that it disempowers some people them instead of empowering them. One example of this would be the first step, where people say that they were powerless over alcohol and that their lives had become unmanageable. To me, this already seems to not be the best approach because people are basically saying that they are weak and powerless and cannot help themselves. Perhaps for some people, this may be true, but I argue that there are also plenty of people who go to the meetings who are capable of helping themselves, even if it does involve some kind of outside help. In addition, to my knowledge, the AA/12 Step programs eliminate the possibility of overcoming an addiction on one’s own, which I disagree with. Although I would argue that it is quite difficult, there are also people who are able to successfully overcome their addictions on their own. One example would be Jean-Claude Van Damme, who at one point had a strong cocaine addiction and for whom attempts at drug rehabilitation didn’t go well (Godfrey, 2012). He ended up resorting to cold turkey and exercise to resolve his addiction (Godfrey, 2012). Of course he is just one example, but I would argue that there are probably a fair number of others just like him.
Additionally, another criticism I have is that, to my knowledge, generally when people attend AA/12 step meetings, they introduce themselves and say that they are an alcoholic. At least this was the case when I attended an online AA meeting for educational purposes. From what I remember, everyone introduced themselves by name and then said that that they are an alcoholic. I believe one person referred to themselves as a drunkard. While this may be true, I don’t think it is necessary or even useful for a person to place this label out loud on themselves over and over again. I again feel that this is disempowering and it also feels a little demeaning to me.
Finally, in terms of scientific backing, the actual level of effectiveness of the AA/12 Step Programs is also questionable. When I looked a while ago, there did not seem to be any solid reliable scientific information about the effectiveness of the AA/12 Step programs. I’m not saying that they are ineffective for some people. In fact, at least from anecdotal evidence, they seem to be very effective for some people, and if that is the case and people are fully happy with them, why not do them? If that is the case for those people, I would just encourage them to continue doing them.
However, it does not seem to be the case that AA works for everyone. I have heard a good number of accounts now of people who did not like the approach, did not find it helpful, etc. For these people, I think it would be doing them a great disservice to just assume that AA is a one size fits all model and that if it doesn’t work for them, that they failed the program, not that the program failed them. If the effectiveness of AA had a very strong scientific backing, perhaps it would be a different story, but the problem is that from the research I did, it does not appear to have anything close to that.
In addition, my understanding is that AA does not view moderation as a possibility, instead of total abstinence. If this is the case, I think it can be problematic because it assumes that none of the people who come to AA can develop the ability to drink in moderation. I believe this to be false. I do think that there are indeed people who may never be able to have control over their drinking and perhaps total abstinence is the only way for them, but I don’t think this is the majority of people who have a problem with alcohol. Having said that, I think that in a general sense, all of the various recreational substances, such as alcohol, marijuana, tobacco, cocaine are bad for you. I think though it is important to be open to potential medicinal uses of various substances, if indeed they can be used safely and effectively to help people. But again, in a general sense I don’t think any of them are good for you.
One thing that I do like about AA is that if the approach fits well with a person, they can ideally have access to a supportive community of people who have gone through something similar to themselves, and I feel that this has a lot of value. In addition, I think the faith aspect of it can also be very powerful for some people. My understanding of AA though is that it has its roots in more of the “sinner” and “repentance” type dogmatic religious approach, which I am not a fan of. My understanding is that at least some of those elements are still present in the program to this day. If some people like it and find it effective for them, that is fine, but I am not a fan of that approach. I think if the approach was perhaps tweaked to something different from that, the program could be greatly improved and would maybe not turn certain people away.
I want to wrap up by saying again that I want to make it clear that for people who like AA/12 Step programs and find them effective, I have no problems with that and I really am happy for them. However, one of my main concerns is regarding mandating someone to a religiously themed program, who does not want to take part in it (or mandating them to any program for that matter, if they have not harmed anyone else). I argue that this needs to change. In addition, I have pointed out some other criticisms of AA and some positives that I see as well. I believe that much more research needs to be done to determine how effective or ineffective AA really is. In addition, I think it is important that more research is done regarding other potential treatments for alcohol use disorder and other substance use disorders. Finally, I think it is very important that AA be just one of a number of options that are available to people and not the only big gold standard program in town.
References
- Godfrey, Alex (10 August 2012). “Jean-Claude Van Damme: ‘I tried to play the system; I was blacklisted'”. The Guardian.
- Lee v. Weisman, 505 U.S. 577, 587 (1992)