Alcoholics Anonymous is often referred to as a “cult,” “sexist,” “faith-based,” “false,” or any other combination of terms that serve it up as a method people use to get and stay sober that is ineffective and even destructive. The first step “We admitted we were powerless…” is where the snag happens and after that it is all downhill. At that point there are too many mentions of God and too few licensed professionals leading meetings for it to have any scientific muster. If that isn’t enough, the statistics will then come out suggesting a less than 10% success rate and not going to any meetings and getting sober on one’s own are just as effective. Finally the real kicker: AA will say that it is your fault rather than the program’s if you go out and get drunk again. Talk about a punch to the ego.

The Atlantic offers up another addition to this narrative with Gabrielle Glaser’s article, “The Irrationality of Alcoholics Anonymous.” In this she asserts that AA is essentially anachronistic and its ideas of powerlessness and a higher power perpetuate an outdated and ineffective method for treating addiction. The simple idea that healing from alcohol addiction can happen with an abstinence only approach as AA is complicated by some who argue that “going cold turkey only intensifies cravings” or “likely deters people with mild or moderate alcohol-use disorder from seeking help.” If you talk to any alcoholic newly separated from booze, the idea of abstinence sucks. However, if you talk with anyone with long-term sobriety, it was the best decision they ever made.

Glaser does point out that addiction treatment in the US does not get the attention it needs to be more effective and that too many rehabs and treatment centers rely on AA to do the work for them. I do agree with her here, but for different reasons. AA and rehab were never supposed to be married this way. Bill Wilson, co-founder of AA, had an idea of setting up hospitals to take in alcoholics, but that idea was quashed before the first edition Alcoholics Anonymous was ever published. It was always understood as something dangerous that would pull people away from the mission of the group itself. As Bill Wilson writes regarding the non-professional nature of AA in Tradition Eight: “Every time we have tried to professionalize our Twelfth Step, the result has been exactly the same: Our single purpose has been defeated.” It’s a relationship that does not produce the best results and has skewed the core of what AA is to those who have recovered from alcoholism in its steps. People in AA know this already.

Glaser’s “AA” is Straw

The AA program was intended to work only among those who has a desire to stop drinking and then to move forward with the entire program. The program itself starts with cessation of drinking. That’s just Step 1. Every step after that has to do with achieving and maintaining a “spiritual experience” which is also called a “psychic change.” Glaser talks about one small piece of AA and ignores the rest of it which would conveniently address her subsequent criticisms. Her solution is that there are ways to help addicts to drink moderately with the use of drugs among other solutions that are available. She’s right, and no literature in AA disputes this. There are other methods and AA is not for everyone.

Moreover, AA’s program teaches that drinking itself is a symptom of a deeper psychological problem. But in good straw-man building fashion, she does not take us there in the article.

Though our decision was a vital and crucial step, it could have little permanent effect unless at once followed by a strenuous effort to face, and to be rid of, the things in ourselves which had been blocking us. Our liquor was but a symptom. So we had to get down to causes and conditions. (Alcoholics Anonymous, p. 64)

Glaser talks about alternatives. Among them, “motivational enhancement, a form of counseling that aims to help people see the need to change.” Or, that AA is not equipped to address issues of other mental health issues. This is where she shows that she has done some extraordinarily shoddy research into AA itself. The literature in AA is very clear about how to work with physicians and the importance of working with the medical community.

We recognize that alcoholics are not immune to other diseases. Some of us have had to cope with depressions that can be suicidal; schizophrenia that sometimes requires hospitalization; bipolar disorder, and other mental and biological illnesses. Also among us are diabetics, epileptics, members with heart trouble, cancer, allergies, hypertension, and many other serious physical conditions. Because of the difficulties that many alcoholics have with drugs, some members have taken the position that no one in A.A. should take any medication. While this position has undoubtedly prevented relapses for some, it has meant disaster for others.

She also describes the AA program consisting of “attending meetings, earning one’s sobriety chips, and never taking another sip of alcohol.” In fact, if you present this to anyone in AA who has long-term recovery under his or her belt they will laugh at you and tell you that AA approached this way is a recipe for relapse! The examples she gives are simply examples of people who may have had bad experiences in AA. But to someone with long-term sobriety, these examples are of people who did not do the work to change their lives in a way where the cravings desisted. Glaser fails to talk about all of the stuff in the steps that restructure life and redirect behaviors in ways that are exactly the opposite of the self-seeking behaviors of the active addict.

“J.G.” in Glaser’s article, who rationalizes his way into “a cycle of bingeing and abstinence,” is not a new character in AA lore. Again, the person sober for a while will tell him that he might not be done researching his own drinking and is probably not ready for AA just yet. That guy doesn’t want to get sober, he wants to drink. But no one in AA is stopping him. Abstinence is not the cause of his bingeing, his alcoholism is.

Trading One Dependency for Another?

Words such as “retention” and “success” are frequently thrown out in articles such as Glaser’s without any description of what they the measure of them is. Is someone who gets sober in AA for a decade, then goes out for a night of binge drinking a failure? What does it mean to “get better?” Perhaps to Glaser dependence on pills in order to resist cravings is the way to go.

She plans to keep taking naltrexone indefinitely, and has become an advocate for Sinclair’s method: she set up a nonprofit organization for people seeking information about it and made a documentary called One Little Pill.

That might work for some people, but without working through all the other shit that alcoholism brings with it, you are just slowing down the physical cravings. Alcoholics destroy the lives of those around them, not only their own. Unless you can clean up that mess, nothing will really change. If you just want to slow down your drinking, AA is just not the place for you. But if your drinking has been the primary cause in what you perceive to be a majorly fucked up life, a pill is not going to resolve that – even if it takes away your physical cravings to get lit.

The core problem with Glaser’s article is that it focuses on the physical problem of alcoholism which the Big Book talks about, but then ignores the majority AA program which is primarily a pragmatic method to radically change one’s thinking not just to stay abstinent from alcohol, but then to become a more honest and helpful person than what one was before hand. It is primarily a program about solutions rather than problems. It is about replacing one set of behaviors and environmental conditions with another in order to produce different behavior outcomes after recognizing the root causes for one’s drinking – causes that are discovered in steps 4-9.

Seen in its fullness, AA is about as rational as any program of recovery can get. When you see the rational work done between a sponsor and a sponsee you can see how rational it is and how striking it is compared to many of the modern programs of behavior and cognitive therapies used in other addiction treatment theories.

As one of Glaser’s critics says, “What keeps me in the AA rooms despite this is, first and always, the people–a community whose impact is hard to grasp unless you are part of it (which the self-proclaimed non-alcoholic Glaser most definitely is not).”