Dangers of AA's Addiction Recovery Program: 12-Steps Back
There are a lot of reasons that I chose to get into the field of addiction treatment, and my beliefs in the danger of AA's addiction recovery program (and others modeled on it) was the main reason. Why do organizations such as Alcoholics Anonymous retain such a glorious public perception, all the while having success rates of approximately 5 per cent after one year? Even AA's own Comments on A.A.'S Triennial Surveys, which is difficult to find, and even more difficult to decipher, does in fact state these dismal results.1
AA's Addiction Recovery Program Presents Many Barriers to Recovery
I have many reasons for thinking the way I do. AA enforces some barriers to recovery that won't benefit a recovering addict. Here are some of those dangerous barriers.
Uses Self-Deprecating Descriptions
As a mental health stigma blogger, I often speak about the labels that people use to describe themselves and how it affects their self-esteem and confidence. If you constantly refer to yourself as your illness, or your condition, you create a dangerous self-fulfilling prophecy that will time and time again lead you down the same road.
If you sit around in a circle and call yourself an addict or alcoholic enough times, you are going to start viewing yourself as solely an addict or alcoholic. And that doesn’t leave much room for growth.
I broke my thumb once. But I don’t walk around telling people ‘Hi, I’m Chris and I’m a broken thumb.’ It doesn’t define me any more than someone who has coped with their mental health challenges by over-drinking or using drugs.
The first step of 12 step programs such as Alcoholics Anonymous or Narcotics Anonymous is to ‘admit that you are powerless over alcohol and that your life has become unmanageable.’ I get the unmanageable part, but if someone is truly powerless, then what hope is there for recovery?
Drugs and alcohol are inanimate objects and inherently can’t have power over a person. It is our thoughts that lead us to drugs and alcohol, not the alcohol itself. The first thing I try to teach my clients is that they do in fact have the power to overcome their addiction. For many, it's the first time anyone has ever told them that they aren't powerless, and that's incredibly frightening.
Creates a Replacement Addiction
Think about this. If you gave up drinking 20 years ago, but still spend all of your free time in the ‘fellowship’ of AA, then are you really recovered? I know countless people who go to literally hundreds and hundreds of meetings every year. They go to these meetings, talk about drinking, talk to others about drinking, and rehash their past drinking lives. It doesn’t sound very recovered to me.
Relapse Is a Self-Fulfilling Prophecy
Members of 12 Step groups are told that ‘one [drink] is too many and a thousand is never enough.’ This creates another dangerous self-fulfilling prophecy that I see on a daily basis in the treatment center I work at. The clients who do not endorse AA may have a slip one night and get back on track. Others who believe in AA are convinced that they have no control over their actions, and therefore spiral further and further into addiction. They believe 1,000 drinks are never enough, so since they're relapsing, they may as well live by the saying.
Ignores the Possibility of a Dual Diagnosis
Any certified professional in the field of addiction treatment can tell you that heavy drinking or drug use is most often times a signal of an undiagnosed mental health issue such as depression or anxiety. There is rarely, if ever, any talk about mental health in the rooms of AA. Therefore, someone who is self-medicating their depression with alcohol and who attends AA will be told that they have a ‘disease, for which there is no known cure’ and that the only solution is for them to attend meetings for the rest of their life.
The reason I took the job at the long-term treatment center that I work at is that they were changing from AA's Disease Theory approach to the Community Reinforcement Approach.2 I got to see both sides of the spectrum and can see, on a daily basis, just how much happier, productive and empowered clients are now that they no longer have to refer to themselves as an alcoholic and attend mandatory meetings.
Their self-esteem has sky-rocketed, so when they slip, they slip for shorter periods of time. Most importantly, they no longer feel as though they have a death sentence looming over their heads. We are still going over the statistics, but since changing formats, our graduation rates have more than tripled.
Uses an Unproven Addiction Recovery Theory
As this article in the New York Times states, many addiction practitioners are essentially committing medical malpractice by continually using a method that is not scientifically proven, does not take into account individuality and does not address mental health.3
All this to say, if AA worked for you, then great. But if it didn't, don't despair because there are other ways. SMART Recovery is an evidence-based community addiction group that is becoming increasingly popular. In addition, look into any approach that uses either cognitive behavioral therapy or rational emotive behavioral therapy, which are both evidence-based practices for the treatment of addiction.
You don't have to go to AA to beat your addiction. There is a great deal you can do on your own to overcome your addiction. Do your research, make sure that whatever you are reading is evidence-based, and don't buy into a program simply because it is the most well-known.
Curry, C. (2013, February 25). Dangers of AA's Addiction Recovery Program: 12-Steps Back, HealthyPlace. Retrieved on 2021, October 20 from https://www.healthyplace.com/blogs/survivingmentalhealthstigma/2013/02/one-step-forward-twelve-steps-back
Author: Chris Curry
I think your view is great. I know this is an old "thread" but it's really validate the doubts and alarms I've been having about AA. I hope this message finds you well.
I agree totally with the opinion in the article also. I have a resentment towards AA for its stuffy closed mindedness. I was force fed AA for almost 8 months straight, DAILY, and remained miserable with no hope. Articles such as this do give me hope however...maybe I'm not the loser AA wants me to believe I am. Of course i knew better...since I'm NOT easily brainwashed I had an inckling of my own worth. Thank God other treatment options are being discussed more.
I sat beside one woman in a late night meeting who had been very quiet. There were only five people in the meeting, so we all got to share twice, but this woman never said a word. Finally, the moderator asked her and, after a brief pause, the woman broke down almost hysterically and told how she had less than a week clean and her sponsor had told her that she was not allowed to speak in meetings! I don't think I've ever wanted to strangle someone as much as I wanted to find and strangle that womans sponsor. This poor woman was dying to share and both NA and AA literature talks about the therapeutic value of sharing, but her egomaniac of a sponsor had denied her this basic and fundamental tool of recovery!
I think people like you are extremely arrogant. If the 12 steps works for people, and I'm not saying it's going to work for all, leave it be. Don't go and say practitioners are using medical malpractice. That's outrageous and completely ridiculous. For me, I personally believe that the twelve steps are what we ALL need. The 12 steps aren't just for people who suffer from addiction, it's for people who want to live a healthy lifestyle. Turning your life over to a Power greater than yourself and giving Him your problems, writing down your resentments and seeing your part, admitting you have character defects and working to fix them, making amends to people in your past, and sharing these steps with others and helping the ones who are struggling are amazing ways to keep you on track in life. And in fact, we ARE powerless over what we're addicted to. In the match between heroin and I, heroin was always winning. I have a mental obsession. I have an allergy to drugs and alcohol. I don't believe I'm powerless over drugs/alcohol until AFTER I take that first drink, AFTER I shoot up. Yes, using/drinking is a choice. A bad choice, actually. I'm powerless over them once they're in my body. I always say that my drug of choice is more. Because I can't have just ONE drink or ONE line of coke, or ONE shot of heroin; I have to have more. You're certainly entitled to your own thoughts and opinions but what AA believes is powerlessness, though, is clear: it's complete powerlessness, including before you put alcohol in your body. Until, that is, you've discovered a power that relieves that problem. The powerlessness I have is that I can't change the effect of alcohol, but can change putting it in my system. And that's why I'm sober today. Because I'm working the 12 steps and the 12 steps are just one way to keep me from making a bad decision.
I have been clean from heroin for 8 years and used NA to this end. I still attend about once weekly. I disagree with your tske on "powerlessness". The program only states you are powerless over your drug, not over our lives and choices. My problem with the program is it is one size fits all and doesn't focus on an individual's psychological make-up. I had a sponsor who told me that to feel better I should go out and help people " because addicts are self-centered people". She did not recognize that I was spending 8-10 hours a day managing the needs of hospice patients. I am an RN. This represents the gross labeling in NA as addicts being essentially self centered people. I wholly agree that the drug is used to self treat an underlying psych issue. I have seen people suffer with depression or personality disorders go untreated professionally. There is a stigma attached in NA to talking about "outside help" and that if you are working your program fully than you shouldn't be suffering. I hear people beat themselves up because they have a lot of clean time but still feel depressed etc.Being vocal about my opinions has also been an alienating experience. I have achieved tremendous personality growth and emotional change through twice weekly psychodynamic therapy. NA definitely helped in the early stages by giving me a place to go and talk about such a stigmatizing issue. I don't have a sponsor and am not working the steps and members see this as "not real recovery" and almost like being a "dry drunk" who abstains but doesn't change the behaviors that led to the addiction. Fortunately I have strong insight and am not very impressionable. But those who are nsive and vulnerable can be misled or damaged.
Hi, came across your blog from Orange's website. Interesting and valid points. One thing I would quibble about from my own experience in AA is that most hard-core AA members would probably say that the "12 Steps" even more than meetings were what kept them sober. The most sacred cows in AA are the steps, even more than believing in a "Higher Power" (which is really only there to facilitate work on the steps) or the meetings themselves, which often come across more like canned, slogan-filled infomercials for AA than honest sharing of "experience, strength and hope". The whole program is centered around the steps and the meetings are often basically rah-rah sessions designed to keep up people's motivation to work the steps.
Interesting read, I am 'in' recovery and also have a Master's degree in Social Work. I have found that there is no method that works with every person, just as there is no one anti-depressant that works with everyone for example. I think calling it a disease or a condition or illness is somewhat irrelevant. Calling it 'my' fault leads to the stigma of mental illness. I'm responsible for the solution, not reaction my body has to alcohol. I believe that any approach to research in this needs to take into account the acuity of the addicted person. Heavy drinkers and problem drinkers being sent to AA in a dis-service to both. In the past 12 step programs have been a dumping ground for mental health professionals. There has always been divide between mental illness and addictions. It's so important we work together and support one another. I've seen people suicide in AA possibly because they had too much pride or were told to stay away from psychiatrists. I've seen it the other way as well, people only going to therapists because they didn't want to expose themselves in a meeting only to die of their addiction. So let us keep an open mind on both sides of the issue.
I beleive we state in NA Hi my Name is____ and I'm a RECOVERING addict. NA was the thing that helped me. If you talk about the steps solutions and sprirtual principles instead of your past maybe you can see some results. I've been clean for 15 years and I have a mental illness. I work for a mental health facility. I deal with dual diagnois consumer or peers. If you apply the NA program in your life than you don't just go to meetings. You live a productive and responsible life. I'm not knocking your program, but to bash NA and AA like that upsets me. These 12 step programs has been working long before doctors or treatment centers were formulated, because we had no place else to go.I live in Detroit and we have a high success rate because we talk about Steps, mental health, health problems. But we also offer solutions. We own bussiness, go to school, have degress, become good mothers. I know because i've done it. Oh and I take my medication faithfully.
Thank you. Even after 20 years sober in AA, and currently fighting all the self deprecation I have absorbed; I am so grateful and relieved to read anything from a professional that points out the negatives of 12 step methods. I got sober in AA but completely stagnated for years not treating my depression and anxiety. Proper treatment instead of "you're just a garden variety drunk, go to meetings, people who take anti-depressants aren't really sober" could have saved me quite a bit of pain. And I am one of the fortunate people, I'm alive.
As I was saving this page to disk, I noticed that Healthy Place and Higher Power have the same HP initials. How's that for a wacky thought?
By the way, Chris, you are right on with all of your points. I can only agree and wish you a good day.
Thank you Mr. Orange,
I must admit, I have read a great deal of your work on the subject. Would love to pick your brain about it sometime. I'll see if I can find your email address, but if you read this, feel free to drop me a line at firstname.lastname@example.org
Thanks for the kind words and have yourself a fantastic day!
Discussion of therapeutic models to address complex issues like addiction can be very generative. I'm afraid though that this blog fails to provide a reasoned account to malign 12 step programs.
Identification as addicts reduces self esteem? ...For whom? The folks I surround myself with have found courage and hope in that recognizing themselves as addicts separates addictive behaviours from who we are when we don't use. "I am an addict," is not the same thing as saying "I am addiction"' as you suggest.
Meetings are places where addicts revel in their glorious using days?... Is that what is really going on in most meetings? Or, are there some people still hanging on to the past and lots of others moving productively into their clean and sober futures?
A disease or condition like addiction is akin to breaking your thumb?... Is this what you tell your clients?
I hope your clients are aware that 12 step meetings are a highly effective, free, and accessible means to help identify addictive thought and behaviours, and learn how to move through these diseased thoughts and live a diverse, fulfilling life.
AA and NA can be restrictive or unwilling to include mental illness as part of the treatment. I am a Consumer Advocate/Peer Mento, and DRA facilitator. In my travels I found Duel Recovery Annyonmous, DRA, is based on the 12 step process but the big differance is including Mental Illness Recovery. This takes care of a few good points the author raised.
The Powerless piece is actually an afirmation that MI or SA is not your fault. As Carl Yung said in conversations with Dr Bob, it is a sickness of the mind that includes as a base that Mental Illness and addiction can be closely linked, but neither are a fault of the sufferer.
People need to do what works for them and there is no one size fits all solution. Several alternatives were mentioned. If your affected by both addiction and MI, Look for a DRA support group near you and check it out. If there is not one find a group that doesn't sit around telling "war stories" and is open to you bringing up your connection between addiction and MI. There are also several diff types of AA's. Book reading and recovery oriented groups, working 12 step meetings that takes you thru all 12 steps.
The bottom line is to take care of yourself and work with appropriate treatments.
Following is a link on my site to a post that references your webpage:
AA co-founder Bill Wilson freely accepted the potential of other alcoholism/ addiction recovery methods (even to the point of researching such concepts as vitamin therapy).
Admittedly, AA's "model" of anonymity, surrender, disclosure and emphasis on a non-restrictive spiritual component, participation in group meetings, seeking & finding a mentor and helping fellow alcoholics doesn't easily lend itself to scrupulous scientific analysis.
The upside to me is that AA's stubborn endurance against modifying its tenets, textbook and aforementioned framework to meet the evolution of psychosocial, scientific, cultural and global shifts gives it a stability and consistency rarely found, even in seemingly established institutions.
Of course, I acknowledge I speak from the POV of recovery in AA, having been saved from the grave more than once, and a life that's enabled me to comment with some degree of lucidity (hopefully) on your POV.
Chris, I agree with your analysis pretty much 100 percent. I see so many similarities in your logical approach to mine. I am posting a link to my website that will show my take on all of this:
I hope I am not violating your rules by posting this.
i agree w/your article. im supposed to go toa 30day treatment program & i know it is primarily "a.a."baased. id prefer a "smart recovery" instead.
AA is not mandatory nor has it ever professed to be THE only treatment. In my case, meetings help me remember just what could happen if I take that first drink. I do, however, appreciate your article because the more methods of staying sober that are out there the better. That's all I want ... for other addicts to find a way out of their own personal hell.
I've seen the difference that AA and NA has made in a few people. Others have found that surrounding themselves with other 'addicts' and 'alchololics' made them feel doomed or trapped because meetings were a trigger for them, reminded them of using and made them want to go back there.
My opinion, and I'm not saying it's fact, that those I know who took a more holistic approach to recovery were more successful. Those who really set small goals for themselves, took care of both their physical and mental health were the ones who were able to keep sober and recover from relapse quicker when it happened.
Thank you for your comment Valerie. I would definitely have to agree that a holistic approach that addresses the 'whole person' is bound to be more successful. Thank you for reading!
I totally agree. I got sober without AA, but through other methods such as out-patient group therapy for addiction, individual therapy that treated my addiction AND depression, and medication for depression. I have been sober for over 8 years (actually lost track) with a minor relapse, and my depressive episodes are miniscule compared to what they were in the past. AA may work for some, but I am proof that it is not the ONLY way.
And thank YOU Lisa. I'm so glad to hear that you have gotten over your troubles. 8 years sober is something to be proud of. And that was YOU that did that.
So happy for you. You are a fine example.
Until you can provide proper statistics for your approach you are actually being anecdotal and not evidence based which I find problematic as we are not comparing apples with apples.
You mention other methods but then omit to mention their long-term recovery rate which again makes it difficult to compare.
Looking forward to a fully evidence based argument.
I do believe it was Amy Winehouse who famously agreed with the 'You do not have to go to treatment to treat addiction 'No, no, no'(My little anecdote)
Thank you so kindly for reading and commenting on the post. As this is a blog and not a peer-reviewed paper, I admit that I did not include all of the evidence. But as an evidence-based addictions counsellor, I would never publicly share anything that cannot be proven with facts. I have all of the evidence for this approach at my office and will graciously post it tomorrow when I get to work.
Here is one piece of literature that goes into detail about the success rates and efficacy of the CRA Approach.
Well thank you for reading nonetheless Cathy. Have a great day!
Totally agree with your article. Whoot!
Thank you so much Christie! Glad you liked it
I have been in recovery from several powerful drugs for aprox 3 years now...I really don't keep track, sobriety is the name of the game, harping on it isn't.
I could NEVER do NA. Going to a meeting and listening to people tell stories about using, recounting what essentially boiled down to "the glory days" till the crap hit the fan was a MASSIVE trigger for me.
I was actually told by my rehab counsellor not to talk about my usage because when I decided to get clean I was still very much in a romantic relationship with it and to avoid NA and meetings at all cost. Talking, listening would have sent me straight back to my drug(s).
I can completely understand how there is so much of a relapse problem.
Thank you for sharing your personal experience Christa. And congratulations on kicking the habit!!