I want to begin by saying and making it clear that for people who like AA/12 Step programs and find them effective, I have no problems with that and am sincerely happy for them. Also, in case readers may wonder, I am not espousing an atheistic viewpoint (although I respect people’s rights to their viewpoints, 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 be very popular and many people seem to say that they are very effective for them. Again, if some people are truly happy with the program and find it effective for them, I don’t have any problems with that, and I am sincerely happy for them. However, there are also some criticisms that I have. If a person is looking for a recovery program that is at least quasi-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 program that is at least quasi- religiously themed, the situation becomes more complex. While it does appear that there are alternatives to AA/12 Step, for whatever reason, they seem to be overshadowed by AA/12 Step. The real problem though comes up when we talk about mandating people to AA/12 Step. First of all, the government or any other organizations should not be able to mandate anyone to anything (with exceptions of course). The main exceptions 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 it is acceptable for the government or other organizations to mandate someone. It’s ok to offer help to someone who is struggling with alcohol addiction, drug addiction, etc., but it is not 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 is at least a quasi-religious type program. This is an even bigger problem because it is against the 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, there is definitely enough there to say that it is at least a quasi-religious program. The arguments that I just mentioned were corroborated in some 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 I argue that in certain ways, it disempowers people 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 it starts with an assumption that these people are weak and powerless and cannot help themselves. Perhaps for some people, they really won’t be able to overcome their addiction on their own, and in some situations it may indeed be useful to admit that your life has become unmanageable and that you need some help. However, 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 there are probably many 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. It is not necessary, useful, or healthy for a person to place this label out loud on themselves over and over again. This is disempowering and demeaning. I remember at some point a while ago someone telling me that people are not actually required to say that they are an alcoholic etc.. However, I also spoke with a client of mine who has mixed feelings about the program, and he described that there is a social pressure of sorts to say that you are an alcoholic. Again I don’t see how it is healthy and useful to constantly label yourself as an alcoholic out loud. It’s like somebody struggling with severe depression constantly saying “Hi, my name is so and so, and I’m severely depressed”. Another example would be someone who is having trouble finding a job constantly saying something like “Hi, my name is so and so and I’m a loser”. There are better and healthier ways to approach these situations.
It is also important to acknowledge that this program does not work for everyone, some people do not like the program, and a “one size fits all” approach does not work here. 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, 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. In addition, to my knowledge, the scientific evidence for the effectiveness of AA/12 Step programs is still lacking. I’m not saying for sure whether it is effective or ineffective, but a program that is this widely used and “prescribed”, should be thoroughly scientifically studied to understand whether it is effective or not, and if it is not, it should be modified or replaced completely with something else.
In addition, my understanding is that AA/12 Step does not view moderation as a possibility, instead of total abstinence. It would not be right to assume 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, in a general sense, all of the various recreational substances, such as alcohol, marijuana, tobacco, cocaine are bad for you and are not conducive to a healthy lifestyle, so I can completely understand someone just preferring to be completely abstinent from alcohol (for example), instead of trying to learn to drink in moderation. I basically view alcohol as a poison of sorts. It may be important, however, to be open to potential medicinal uses of various substances, if indeed they can be used safely and effectively to help people.
One thing that I do like about AA/12 Step 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 this can have a lot of value. In addition, I believe the faith aspect of it can also be very powerful for some people. My understanding of AA/12 Step though is that it has its roots in at least a quasi-religious and kind of moralistic 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 that is the case and some people like it and find it effective for them, that is fine, but I am not a fan of that approach. I believe that if the approach was perhaps tweaked to something more truly spiritual and less quasi-religious and moralistic, (which, at least in my understanding, it currently is), and it had more of an empowering approach, it 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 what is at least a quasi-religious 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). This needs to change. In addition, I have pointed out some other criticisms of AA/12 step 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/12 step really is. In addition, it is important that more research is done regarding other potential treatments for alcohol use disorder and other substance use disorders. Finally, it is very important that AA/12 Step be just one of a number of options that are available to people and not some kind of towering gold standard “one size fits all” program.
- 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)