In 2017, medical and clinical treatment for many diseases are in a new age. It is considered to be one of our society’s greatest areas of progress. Cures for some illnesses previously thought incurable have been discovered. Yet there is still at least one disease where treatment remains relatively unchanged and so many still suffer from it – alcoholism. Some of the reasons behind this are tied to the stigmas of weakness and failure that come with seeking help. Alcoholism afflicts over seventy-six million people worldwide (World Health Organization) and is responsible for hundreds of thousands of deaths worldwide. Alcoholism is more than a potentially lethal physical disease, it also too often leads to destructive alcohol-related behaviors such as drunk driving and domestic abuse. Along with the negative personal impact of the factors listed above, excessive drinking cost the United States $226 billion dollars in 2006(Allie Bidwell). Yet, medical progress in alcoholism treatment has resulted in only three drugs approved by the U.S. Food and Drug Administration. 

The most popular resource for alcoholism treatment is Alcoholics Anonymous (AA). Founded in 1935 by Bill Wilson and Bob Smith, the program has barely changed in its 82 years of existence. One of the first components of the AA program is the well-known open forum setting where the members can talk about their issues. AA’s strategy here is more than just group support.  AA forces the participant to publically admit they are powerless over their drinking. It also imposes itself on individual religious beliefs by forcing members to acknowledge some sort of higher being or God that must serve as their guidance throughout the process. These are just two examples of AA methods that are proving to be outdated and unsuccessful and leading to a dismal five percent AA recovery success rate (Dodes). AA has been proven to not be the best way to treat alcoholism.  The multiple reasons why will be explored further in this paper, as well as alternative forms of therapy, medical treatment, and personal care that may have much better results than AA.

There is a reason AA is so often the primary recovery path taken by alcoholics and it dates back to the 1950’s. When AA was created, there was initially little support behind it both in terms of medical research and membership. In order to bolster their program, Wilson and Smith tried to lure prominent public figures to support the program with publicity and/or money.. They eventually caught the eye of the Rockefeller family who donated money to give AA more resources and momentum. This approach worked.  As a result, AA was awarded a Lasker Prize in 1951 for its contribution to public health. The Lasker Award gave AA needed credibility and it became a much more accepted form of treatment in the mainstream. The early success of AA was rooted more in marketing than in research.  As its popularity has grown, even to the present day, AA has succeeded in getting people who were involved with the program to also align themselves with government organizations to further promote AA as the premier way to treat alcoholism. The strategy has not changed over time revealing a lack of innovation in AA even as new resources and ideas about treatment increased.

When it comes to evaluating alcoholism treatments, looking at the people authorized to treat it, is an important starting point.   There are multiple issues in this area.  First, addiction treatment is a widely ignored field by people looking to go into the medical profession.  Out of every one million doctors, only 582 are addiction specialists (Glaser, Gabrielle), so there are simply not enough professionals to provide the necessary services. And what makes someone a “professional” in alcoholism treatment?  The requirements and certification to provide professional treatment are actually very outdated Per Glaser,” many states require little more than a high-school diploma or GED.” Fourteen states have no license requirements whatsoever, even though they can be summoned to court or medical boards to testify as experts. In twenty-eight states, only a GED is required to become a licensed addiction specialist(Glaser). As a result of these low standards, most AA leaders lack important professional training and skills, which could undermine the treatment alcoholics seek out and need. This lack of enough qualified professionals and of professional standards is a key reason behind the failures of AA. 

The effectiveness of AA has been a source of ongoing debate. A study done by the Cochrane Group, a healthcare research group, stated how there was no clear AA recovery path that could be mapped and measured. AA acts as its own source for success rates in its “Big Book” that is distributed to new members. This misleads prospective members and gives them false hope in becoming sober. 

Dr. Lance Dodes, a former professor of psychiatry at Harvard Medical School, further debunk AA’s claims of success. In his article, “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry”, Dodes claims that the success rate of AA hovers around five to ten percent. This leaves up to ninety-five percent of people needing other kinds of treatment to overcome their alcohol addiction. This is a double-edged sword because it does not provide adequate help it can discourage more people from seeking other avenues of help because they think AA is the only option. 

One reason for the low success rates is that the AA model is very limiting as to how individuals can approach trying to overcome their addiction. Glaser states how AA “makes you think you must hit rock bottom to be able to find recovery.” That logic is extremely flawed because it might inadvertently push people away who need help but would not categorize themselves as hitting “rock bottom.”. 

AA’s “one-size-fits-all” approach to treatment is another flawed part of their treatment model. It can leave people who do not fit their mold feeling helpless and hopeless. Individualized treatment options or at least more than just one option would increase recovery rates and raise sobriety levels. In an experiment run by John Sinclair, he gave rats alcohol at regular intervals then cut them off without warning. After they were cut off for an extended period of time and then given alcohol again they drank more than they ever had previously. Why did the rats drink even more alcohol after being cut off? Sinclair’s experiment suggests that the AA method of zero alcohol consumption could actually lead to more severe relapses than if certain patients, when appropriate, still consumed certain amounts of alcohol.. 

In “Is Alcoholics Anonymous a Negativity Based Program?”, Laura Tompkins, a certified addiction expert, also speaks to the limitations of the AA zero alcohol model.  She argues that if someone can go from drinking too much to getting it under control they have succeeded in overcoming their alcoholism. Yet in the eyes of AA this member is a failure. This robs people of an important and motivating sense of progress and success.

Identifying the psychological drivers of drinking and exploring new ways to help stop the addiction mindset is a key area of treatment that is largely ignored by AA.  What motivates an alcoholic to drink even when they know it is destructive?  General psychotherapy and trying to understand the patient and their individual needs is critical, yet not central to AA programs.  In “How Alcoholics Anonymous Works” Michael Craig Miller, a peer reviewed author from Harvard Medical School, explores some of the alternate options to AA. The first one he talks about is cognitive behavioral therapy. He wants drinkers evaluated by a psychologist to find out what makes them want to drink and what parts of the brain are affected by that. Is it pleasure? Is it to forget?  He then suggests that patients follow that up with motivational enhancement therapy. He wants to find out what motivates someone to drink and then change their goals. If the person is motivated to drink because of doing poorly at work, then work on your work performance to help stop the drinking. It is not so simple, but identifying triggers and working on those can be part of a more thorough combination of recovery methods. By “working” on the patients work performance, the alcoholic must try and improve the environment around them and hopefully develop confidence that leads to better self-discipline to stay sober. He also suggested using other motivational tools like incentives or personalized family talks to help curb alcoholism. Through these therapies Miller has seen higher success rates than the ones from AA and a smoother recovery with long term success.

Sinclair went further than basic psychotherapy.  He ran studies and published a peer reviewed journal describing the positive effects of an opioid antagonist called naltrexone, an opioid “antagonist” that could block the endorphins that a body gets from drinking alcohol therefore decreasing perceived mental “reward” of drinking and the urge to drink. Sinclair saw a seventy-eight percent success rate in reducing the patients drinks to ten or less a week. This is one of the many examples of other treatment options that are available and could work better than AA. 

In Glaser’s article, she reflects on how Finland has put a version of Sinclair’s approach into action, treating alcoholics with a combination of psychotherapy and medicines, and how the US should take notes. Their usual course of treatment involves “six months of cognitive behavioral therapy with a clinical psychologist. As well as a physical exam, blood work, and a prescription for an opioid antagonist.” .  One additional note from Glaser on treatment in Finland is that the treatment is cost-effective compared to similar programs elsewhere and compared to the expensive, glitzy but ineffective “rehabs” available in the U.S, 

In Dodes’ article, he points out additional shortcomings of AA which include the fact that when a member does not find success in the program, it is the patient’s fault and not the program’s. The patient must not have attended enough meetings or put in enough work. Dodes also shares that in his interviews with former AA members, many  people who failed deeply disliked Step 1 which was to admit they were powerless over alcohol. This is the wrong way to look at it because then people think they may not be able to overcome their alcoholism. They must realize they do have power over their problems and can conquer them. The flawed logic of AA does little to help recovering alcoholics.

A critical part of AA is the requirement of members to share secrets and struggles with a stranger. While this may be helpful for some it can be extremely uncomfortable, and even traumatic, for others. Tompkins points out how sharing private issues could be hurtful to the addict’s effort because sharing sensitive, private issues with someone who is not an addiction expert or psychologist could lead to serious missteps

Tompkins also highlights how another uncomfortable and possibly limiting AA step  is requiring that members acknowledge a higher spiritual power and seek guidance through them. Some people do not feel comfortable doing this because they may not believe in a higher power or feel they are betraying their religion. In spite of this, AA has refused to acknowledge the presence of religion in their program, even though God is mentioned in the twelve steps. A group of behavioral psychologists studied a particular AA group and analyzed whether the extreme presence of religion was helpful in AA. Their findings said religion was not found to be a major factor (Swora,Michelle). 

In “5 Reasons People Can’t Stand AA”, by Martha Lockie, the director of a Community Outreach program, Lockie also finds evidence of misguided incorporation of religion into AA. She asks how AA can insist that their meetings are for everyone, but only if members incorporate the belief in a higher power that AA prescribes.  Not only is God present in the “big book”, states Lockie, but the reality is that religion is in AA’s roots.  The founders were devout Christians according to Lockie. Help can be achieved in many ways, most of which are better than forcing someone to believe in something or making them create a God. Lockie’s views also align with other authors who believe that members are powerless over their drinking is not the best way to go about recovery. She also states that interacting and receiving advice from strangers on something so complex and personal can lead to additional challenges such as disagreements and discomfort if non-related topics come up during AA meetings.

 The AA “bait and switch” is also present in how they claim to be a voluntary program, but this only holds true as long as the member is strictly following every rule or step.  This additional aspect of AA’s “all-or-nothing” model is one more reason why it does a disservice to many of those who join but who obviously are going to struggle.  They should not be given up on, but in “Why Rehab Fails” by Sacha Scoblic, a former alcoholic and participant in AA, Scoblic uses her own experience to demonstrate the negative impact of AA’s inflexible approach to overcoming alcoholism.  In her experience, the steps are not a suggestion. Any tweaking or bending of them and the member is deemed not a true follower. Scoblic said she was humiliated and rebuked when she did not follow the laws of AA perfectly.  In speaking with other AA members, Scoblic tells of a drunk driver who was ordered to either go to AA or go to jail.  The driver chose AA, of course, but “Three days before finishing the rehab program, the police came for her. The rehab had kicked Jessie out, claiming she’d ‘failed to accept a higher power’ “(step two). Freedom of religion was apparently not a valid excuse.” She believes the main flaw in AA’s framework is that when it does not work they say the member did not fit the program instead of the program not working for them. In additional interviews, Scoblic finds that some AA participants were actually punished for not following the rules by being forced to wear signs around their neck or having to share extremely personal secrets they did not want to tell.  

Scoblic’s research also addresses one of greatest weaknesses of the AA program – the lack of support, aside from going back to meetings, for those who have made it through the program.  Scoblic points out how people must be taught how to deal with distractions after finding recovery because after becoming sober they are usually just thrown back into the world. Some of the incentives mentioned that helped people stay sober without the help of AA included getting paid for testing clean on drug tests, psychiatry, and medication. Psychology experts say that a recovering addict should be treated with extreme attention and care yet they  do not receive this in AA setting even though AA strongly states that alcoholism is a lifelong struggle in Chapter 3 of their Big Book. Every person is different and needs personalized care during and after which AA does not provide. 

Based on evidence provided in this paper, Alcoholics Anonymous is clearly not the most viable solution for alcoholism. As if the success rates previously referenced of just five to 10 percent are not enough proof, the limitations are very clear when one considers the closed-mindedness to alternative treatments and views on treatment.   AA asserts their view over their members to the point that a member may miss key opportunities to recover if they believe they could participate in AA and benefit from the support they do provide but also explore options that can help even more.  Yet, as was discussed in this paper, there are a multitude of other options to choose from. Whether it be different kinds of therapy that help analyze why people feel the need to drink and how to eliminate or at least lessen those triggers.. Therapy can help create motivational enhancements and goals to reach to help find sobriety. As shown in Finland, a holistic combination of therapy, medication, and other treatments have been found to significantly improve an addicts chance at recovery. Overall, mounting research suggests AA is a misleading and ineffective program rooted in a narrow mindset based in a single view of religion and beliefs about how to become sober but no concrete science. More substantial investments by both public and private entities in improving alternative treatment options, access to those options, and professional training for those administering treatments, would reduce the unfortunate current reliance upon and false belief that the only possible answer is AA.
