The Irrationality of Alcoholics Anonymous

I hope alternatives do come up - that's why I'm supporting one of them (see my previous post). If AA became unnecessary, that would be fabulous.

A lack of credible alternatives isn't AA's fault, is it? It was never their bailiwick.

As for courts sending people to AA, ask the courts about that. It's not a recruiting drive, and AA doesn't pay commissions for new recruits.

If you don't like the only game in town, start another game. AA isn't there to squeeze anyone out, and AA certainly wasn't the first approach to alcoholism treatment.

What is the funding model for AA?

I mean, with lay volunteers doing a lot of the work, there wouldn't be THAT much expense, but there must be some. Do they rely on donations? Are members charged?

Partly I'm just curious, but partly the cynic in me always wants to follow the money to understand the system.

Captcha said:

What is the funding model for AA?

I mean, with lay volunteers doing a lot of the work, there wouldn't be THAT much expense, but there must be some. Do they rely on donations? Are members charged?

Partly I'm just curious, but partly the cynic in me always wants to follow the money to understand the system.

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This site might help you with some of those questions:

http://www.aa.org/assets/en_US/mg-15_finance.pdf

The seventh tradition, in particular, speaks to how groups should be self-funded/self-sufficient and decline outside contributions. Members are not charged, there are no required dues, and in fact, AA specifically states that none should be excluded due to money. They are asked to contribute if they can--most often a basket is passed during a meeting. Many groups meet in churches or other non-profit meeting spaces, and don't have to pay a rental fee for a room, so costs are typically low. Members will donate Big Books or step books to newer members who may not be able to afford them.

poetinahat said:

A lack of credible alternatives isn't AA's fault, is it?

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I'm not sure. Is it?

I think the pertinent question is: credible to whom?

Scientifically, there are alternatives far more credible than AA and other 12-step programs.

But — in the US at least — most people won't admit or believe that.

Very good question, Captcha: skeptics are vital! If an organisation can't answer those questions, there's a problem. If they won't answer those questions, it's a bigger problem.

Volunteers and contributions only ("no dues or fees, only expenses"). Prudent reserve (~three months' rent, or something). No outside contributions, no property ownership, IIRC. Don't know whether board members are remunerated.

More on contributions and self-support here.

General Service Office financial overview

kuwisdelu said:

I'm not sure. Is it?

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Do you suggest that AA operates as a monopoly and intends to put competition out of business?

What would their motivation be?

Scientifically, there are alternatives far more credible than AA and other 12-step programs.

But — in the US at least — most people won't admit or believe that.

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Cite, please.

poetinahat said:

Do you suggest that AA operates as a monopoly and intends to put competition out of business?

What would their motivation be?

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Honestly, I think many of them simply truly believe their way works best.

Cite, please.

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The article in the OP?

poetinahat said:

Do you suggest that AA operates as a monopoly and intends to put competition out of business?

What would their motivation be?

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It may not be AA itself's doing but the copycats who do the treatment for profit. 12-step programs have low expenses and anyone can start them up and if you have a charismatic individual, you can convince the ones with money to pay large sums of money for their treatment. That has been what I have noticed in the various abusive drug treatment programs.

Great if other methods can work. I know many people who would benefit from that. But I highly doubt that they're as cost effective (as in, free), or, as accessible (as in available almost every single day at all times during the day, or, 24 hours online).

AA is trending toward more secular structure. It's evolved a lot. I'm reluctant to call it "Christian," especially since atheists, Buddhists, agnostics, Wiccans, and many others utilize the model without having to convert or show allegiance/belief in a deity. (Arguing about Step 3 and "the higher power" is a pretty stock point these days as anyone familiar with the current program knows this is not a requirement and anyone can google "atheist step 3 AA" and find thousands of hits and many alternatives to that.)

But, all of that said, it's difficult to expect everyone to be up-to-date on AA trends and new paradigms. People tend to assume that it's all Jesus talk and proselytizing. And it's very difficult to get the proverbial dog to drop its bone on that point of contention. AA PR and Marketing would really do well to clarify these things in a very overt and public manner.

Also, I think that for some people abstinence is the only path. For others? Moderation might be possible. If we could (as a society) drop the negative stigma about addiction, AND at the same time, find a way to provide affordable assessment tools so that we could help an addict find the BEST PATH possible, then we could feasibly get a lot done.

The issue is, how? How many chances do you think an addict is willing to take to find the perfect method? Two times? Five? Ten? There are so many other methods out there. Where to even begin?

AA is the go-to method because it has that built-in support system, the ease of access, and the price is unbeatable. And it's not perfect. But until we find a way around these obstacles (price, accessibility, and constructive assessment), it's the best option for many. And I know that's not necessarily a good thing. It's likely keeping a lot of people away based on preconceived biases about how they think the program runs. Or, the idea of giving up a substance forever.

There is no easy answer. And while I think it's great to consider options, it's counterproductive to assume that addicts are going to have a great deal mental resources, patience, and finances in order to find "that other method" that works better at this point.

Xelebes said:

It may not be AA itself's doing but the copycats who do the treatment for profit. 12-step programs have low expenses and anyone can start them up and if you have a charismatic individual, you can convince the ones with money to pay large sums of money for their treatment. That has been what I have noticed in the various abusive drug treatment programs.

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That's a great point. Many for-profit rehab centers use a 12-step approach, and it may be them rather than AA that are primarily responsible for the current lamentable state of addiction recovery.

CrastersBabies said:

AA is the go-to method because it has that built-in support system, the ease of access, and the price is unbeatable. And it's not perfect. But until we find a way around these obstacles (price, accessibility, and constructive assessment), it's the best option for many. And I know that's not necessarily a good thing. It's likely keeping a lot of people away based on preconceived biases about how they think the program runs. Or, the idea of giving up a substance forever.

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Personally I think I could have probably benefitted from a support group-like community similar to AA, but without the 12 steps or the higher power or the long-term goal of abstinence.

kuwisdelu said:

Honestly, I think many of them simply truly believe their way works best.

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Perhaps it does work best for them, and in that sense they'd be right. Even if it's not best for everyone, it might be best for some, right? I mean, if we're agreeing that there's no one-size-fits-all solution.

And if they do believe that, wouldn't it make sense that they do? I mean, if a treatment saved your life, wouldn't you be pretty much in favor of it?

And, if people who had no experience with it questioned its efficacy, would you not want to respond?

The article in the OP?

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What I see there is possibilities, which is great. And not pursuing the other possibilities would be a shame.

Again, I'd say try anything before AA. The thing I don't get is when people attribute darker motives to AA or people who follow it.

I agree that the wholesale, institutionalised assumption that AA is the first resort and the only solution is, if not incorrect, then counterproductive.

I would also say that, if a program's good, it should be able to withstand questioning - moreover, it shouldn't shy from that questioning. So have at it.

.

Like any take-all-comers community, AA members are all kinds. Some do indeed have darker motives, and many are wonderful and well-meaning people. I don't mean to attribute darker motives to AA. I am only speaking from my frustration at how AA has impacted addiction recovery in general. Because, yes, everyone close to me thought I was in denial when I said I could get better without abstinence. (Except my brother, because he went through the exact same thing.)

Fortunately, when it came to court orders, I was allowed to continue the therapy I was doing, rather than a 12-step program, which I think would have done me more harm than good.

I don't think AA has any trouble with people asking questions! And thanks Erin for that link, as yes, each group is sef supporting by voluntary contributions of those who attend.

AA is thrilled if someone can successfully drink moderately! If someone can do that and does not need AA that is a good thing!

As Poet said, AA is for those who have proven they cannot drink moderately.

AA is certainly not making money off its members, does not have any kind of agenda. I don't think it would say "religious" but rather "spiritual" although there are those who attend for other reasons and don't "do" the spiritual part of the program.

Definitely a program of attraction rather than promotion; either you like what it has to offer or not.

That's AA.

That is not treatment. Treatment is a whole other issue. No treatment should be one size (and if it is that is not the "fault" of AA). That's a poor program. "Professional training" does not mean "and I've been sober two years myself so i'll just use my life story".

But poor training is not the fault of AA either. As I said, I would totally support getting rid of "addiction specialists", "licensed addition counselors" and all that. Either you are a competent, trained professional provider or not.

But poor, overpriced, unavailable treatment is not the fault of AA.

And I agree that assessments can be done poorly (see above about inadequately trained counselors). Good assessments would also cut down on "everyone goes to AA" approach.

Psychoeduction is extremely helpful. Many do not know what a standard drink is, do not know what "low risk drinking" is and do not know what changes they could make to reduce their personal risk. With this information, many, many people can do quite well!

I could not agree more that there is not a lot out there for courts to refer people, that is FREE and easily available! no wait lists! It's a cheap way for someone to behaviorally demonstate "Hey I'm doing something". AA is certainly not lobbying for that though, many AA'ers find it disruptive.

And actually, there are those who attend who do NOT do the 12 steps, do NOT see a Higher Power and don't pursue abstinence. It isn't the AA program, but they like the social support. it can be very helpful, regardless of one's commitment to abstinence.

bombergirl69 said:

As Poet said, AA is for those who have proven they cannot drink moderately.

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As far as the judge was concerned, I had proven that I could not drink moderately.

Edit: Certainly abstinence is the best solution for some people. It just wasn't for me.

Edit 2: This is one example from the article I can relate to very well:

Everyone there warned him that he had a chronic, progressive disease and that if he listened to the cunning internal whisper promising that he could have just one drink, he would be off on a bender.

J.G. says it was this message—that there were no small missteps, and one drink might as well be 100—that set him on a cycle of bingeing and abstinence.

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If just one drink is all it takes, then if I end up drinking one drink, I might as well drink a lot more.

It took me a long time to shake off that message.

And there you would have my giant frustration with the judge (although I understand his or her predicament) and my total support for finding whatever resource worked for you, to get where you wanted to go. That's the key part.

My frustration is that I feel like the prevalence of AA thought made it more difficult for me to get over my own problem. (See above example.)

Im not sure it was AA or an uninformed judge that did not consider alternatives but I see your frustration. I certainly would not like to be forced into something I know isn't going to be helpful. I don't know many people who do.
I don't think that works well with other issues either

kuwisdelu said:

That's a great point. Many for-profit rehab centers use a 12-step approach, and it may be them rather than AA that are primarily responsible for the current lamentable state of addiction recovery.

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From what I've seen of AA and other non-profits is that while they may not work, their capacity to exploit the attendees is limited.

bombergirl69 said:

Im not sure it was AA or an uninformed judge that did not consider alternatives but I see your frustration. I certainly would not like to be forced into something I know isn't going to be helpful. I don't know many people who do.

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It was neither specifically. It was everyone around me. AA's influence is strong in how everyone in the US thinks about recovery from alcohol abuse.

Pyekett said:

bombergirl69 said:

There is plenty of research to show that for those with severe substance use disorders, AA enhances sobriety rates.

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Is that research something you can provide citations for? Not asking to be a dick, just that I haven't been able to find "plenty of research" on it myself--partly for reasons you mentioned.

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bombergirl69, I'm reposting this question because I think it got lost at the page turn.

Perfectly happy if you'd rather not respond, just really interested in the answer if you're so inclined. When wearing a different hat, I've looked very hard for such research and found myself left wanting.





Added: I don't blame AA for not being research evidence-based or for its model dominating the US model for risky drinking response pathways in the legal and medical systems. It's a shame that there hasn't been more attention paid to approaches that are more evidence-based in the research sense and have substantial research behind them in other countries. Those approaches are designed as pathways for more widespread use across the entire population.

Being evidence-based is also critical for quality assessment and improvement if it is part of a court-mandated response, or if it is being promoted by organizations that use tax dollars for their support structure even if not directed towards AA, or if it is being recommended by physicians. In those cases--and in other contexts--having solid numbers matters. It matters a lot.

Not important to AA, and not their mission. I get that. But yes, important for external reasons, even if not internally important to AA or those who find it does serve them well.

kuwisdelu said:

That's a great point. Many for-profit rehab centers use a 12-step approach, and it may be them rather than AA that are primarily responsible for the current lamentable state of addiction recovery.

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Remember, most people working at such centers (virtually all of them at 12-step-based centers) are themselves AA members, yet both they and AA says their work at treatment centers has no connection with their AA membership.

A judge who is an AA member who tells a DUI defendant to go to AA is "doing so solely as a judge, not as an AA member." A judge I knew decades ago would order defendants to attend the Saturday morning meeting at NABA in Atlanta, where he was also a regular attendee. They didn't have to get an attendance slip signed, because he could see for himself if they were there or not.

All I heard in AA was "AA is the only thing that works." There was once or twice I heard about SOS (Secular Order of Sobriety, one of the earlier "alternative" meetings) in an AA meeting, and it was always that it doesn't work, it can't possibly work, or at best "they're a bunch of dry drunks." When I was at SOS I heard of members asking to put SOS meeting flyers on treatment center bulletin boards and not get permission, or get it and five minutes later the flyers were gone.

Of course, in public, like on this forum, AA members will say yeah, go ahead and go to SOS if you like. Between each other they'll say sobered up, locked up, or covered up, and if they're a Real Alcoholic their only hope is AA (the True Scotsman thing again).

Indeed, on another forum where I was criticizing AA, I was accused of "killing alcoholics."

kuwisdelu said:

If just one drink is all it takes, then if I end up drinking one drink, I might as well drink a lot more.
...
It took me a long time to shake off that message.

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Drinking is SO demonized in AA that for members it is the worst possible thing that one could do or that could "happen" to one. Thus it's not surprising that many long-term members who drink again end up committing suicide. AA members interpret this as "the progression of the disease," that even as you're absinent and working the steps, the disease progresses, and that if you drink again your drinking will be at the point where it would have been had you been drinking all along. So in an AA member's mind, it's no surprise that "this disease" kills you.

kuwisdelu said:

It was neither specifically. It was everyone around me. AA's influence is strong in how everyone in the US thinks about recovery from alcohol abuse.

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Yes, exactly.

AA members underestimate the program's influence, yet are constantly saying how wonderful it is.

AA cannot stop judges from sending people to AA meetings, but AA meetings CAN choose to stop signing "court slips" that courts give to defendants for meeting chairpeople to date and sign, verifying meeting attencance. I had heard of some meetings and chairpersons who chose not to sign such slips, but they weren't very common.

If you want to know what the research shows works for risky drinking, the US CDC (Center for Disease Control) comes out strongly in support of SBI (Screening and Brief Intervention) in general and CHOICES ("A Program for Women About Choosing Healthy Behaviors") for women of reproductive age in particular. This is supported by the US Preventive Services Task Force and other public health initiatives relying on evidence-based approaches that are tested on a population-wide basis. It is not sufficient for addressing all risky drinking, but it is structured to screen for those needing more intensive therapy as an initial part of the process.

http://www.cdc.gov/ncbddd/fasd/alcohol-screening.html

Risky drinkers include both the 4% of U.S. adults who are dependent on alcohol (alcoholic) and the 25% who are not dependent. Both groups drink in ways that put themselves and others at risk of harm. ... Alcohol SBI Works—Over thirty years of research has shown that alcohol screening and brief intervention (SBI) is effective at reducing risky drinking. Based on this evidence, the U.S. Preventive Services Task Force and many other organizations have recommended that alcohol SBI be implemented for all adults in primary health care settings. The Community Preventive Services Task Force recently recommended the use of electronic alcohol SBI (eSBI). ... CHOICES Works for Women of Reproductive Age—This extended intervention aims to reduce the risk of an alcohol-exposed pregnancy among non-pregnant women who are drinking at risky levels and not using contraception effectively or consistently. CHOICES helps women reduce risky alcohol use, increase contraceptive use, or change both behaviors. ... Yet What Works Isn’t Used—CDC believes that alcohol SBI and CHOICES could reduce the consequences of risky alcohol use and its related harms if they became standards of care. Despite their efficacy, however, they have not been broadly adopted or integrated into clinical settings. [bolding not added]

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The WHO (World Health Organization) agrees:

http://www.who.int/substance_abuse/activities/sbi/en/

There are many forms of excessive drinking that cause substantial risk or harm to the individual. They include high level drinking each day, repeated episodes of drinking to intoxication, drinking that is actually causing physical or mental harm, and drinking that has resulted in the person becoming dependent on alcohol. ... Brief interventions are those practices that aim to identify a real or potential alcohol problem and motivate an individual to do something about it. Brief interventions have become increasingly valuable in the management of individuals with alcohol-related problems. During the past 20 years, there have been numerous randomized trials of brief interventions in a variety of health care settings. Studies have been conducted in Australia, Bulgaria, Mexico, the United Kingdom, Norway, Sweden, the United States and many other countries. Results from these studies show that there is clear evidence that well-designed brief intervention strategies are effective, low-cost and easy to administer. [bolding added]

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SBI is a structured, tested, reproducible, and evidence-based primary approach in Canada, Great Britain, the Nordic countries, Australia, and many other parts of the world--except for the United States.

That is not the fault or the responsibility of AA.

It is, however, a shame.