Posted by Hemant Mehta in I’ve written about the topic before: Alcoholics Anonymous and other 12-step programs which require participants to submit to a higher power (PDF).
You would think that, because AA is so famously known and its program so widely used, it would at least be effective… right?
So what works better than AA’s 12 steps?
In last month’s Journal of Substance Abuse Treatment, University of New Mexico addiction specialist William Miller and his colleagues presented findings from two controlled trials in which patients underwent drug treatment. Some of the patients received spiritual guidance as part of the treatment — learning such practices as prayer, meditation and service to others, all of which are central to 12-step programs. Others received secular psychotherapy. Because of the enduring popularity of AA and similar programs that involve a spiritual component, Miller and his team expected the patients in the spiritual group to do better than those in the secular group. They were wrong — at least in the short term.
While both groups eventually benefited relatively equally from their treatment — abusing substances on fewer days — it took longer to see improvement among those in the spiritual group. What’s more, those who received spiritual guidance reported being significantly more anxious and depressed after four months than those who got secular help. Those problems abated at about the eight-month point, but because substance abusers are at high risk for suicide, some worry that it may not be a good idea to put them through demanding spiritual calisthenics in the early months of their recovery.
Simply put, programs without God/superstition worked better than programs with God/superstition.
Miller’s previous research has also shown that religious solutions don’t end up helping addicts as much as society would have you believe:
This study amplifies a fascinating paper Miller co-authored in 1997, which found that patients who reported knowing that someone was praying for them used significantly more substances after leaving treatment than those who didn’t know someone was praying for them. Taken together, Miller’s studies suggest that spirituality can be demanding — even when others are being spiritual on your behalf — and that many addicts may simply not be up to the pressure.
There are secular alternatives for anyone trying to overcome an addiction.
God seems to just make the problems worse.
(Thanks to Bunny for the link!)
Probably because God = Guilt and you have enough to deal with overcoming substance abuse without piling on the guilt.
I would hope that the 1997 experiment controlled sufficiently for those in the praying group who were not “true” Christians.
Ok, some caveats here:
1. Long term “recovery” is rare under any treatment.
2. Much of the benefits from the 12 step programs come from rather secular interaction with others.
Yeah, there is lots of god talk in much of the literature, but it is possible for an agnostic or atheist to benefit from a 12 step program while remaining an agnostic or atheist; in fact, I have.
I started 12 step as an agnostic and, because I did search for a higher power, I ended up realizing that I am an atheist.
You said, “God seems to just make the problems worse.” AA says that one can “make a decision to turn our will and our lives over to the care of God as we understood Him.”
The first problem is God has not made any problem worse, but one’s understanding of Him. If one “understands God” to be one way and someone else “understands God” another way and both are wrong, then that is not a failure on God’s part.
Also, please make certain that athiests who also attend these meetings and choose to disbelieve (a god of their own understanding)are also caught up in the same failure rate.
AA does not work because of the absence of God as Objective Personality.
Another problem is that mere decision does nothing for any individual for he can make one decision one day then decide another day to do something different. Is it God’s fault that a person decides (for some reason or other) to quit drinking, yet he intentionally decides to look in his wallet, count his money, get in the car, purchase the drink, drive back home (if that’s where he goes), put the drink to His lips and get drunk? Hardly. If the individual obeyed God, there would be no problem–God is not the one to blame.
God conforms to no one. This is idolatry. Including so-called atheism. The reason for the failure rate is this: unless one surrenders to the true and living God, there will be 100% failure rate.
Thanks for thought-provoking posts!
Right, because if you recover, that’s god’s work; but if you relapse, it’s your own damn fault.
All of the credit, none of the blame.
I went to AA when I hated God. This was before I was an atheist of course.
In AA, they say “Higher Power” and it is explained that, if you have a problem with that, think of anything greater than yourself, like the AA meeting itself. There is no need for a “god” or “goddess” to be above you or to grovel too, the group works to help you get and stay sober, kind of like group therapy, but that is NOT what they claim to be, that is the closet I can come to describe it to something that people may understand.
Also, I used to attend many meeting, for many of years, and each one is different.
It’s like me says “I hate all Christians”.
But I really only hate “fundamentalists” of all religions and actually support many interfaith and religious motivate organizations that support secularism.
I have to say that, AA not only helped me with my “substance abuse” it helped me not to hate god, which allowed me to accept him, then look at the guilt I had as a gay man and being brought up Catholic, then moving through that and beyond that, I learned more about myself and I have been a happy Atheist for many years.
Not to say the AA was the only reason I am were I am, but It surely had a lot to do with me moving past being an angry person who hated religion, to someone who doesn’t spend all day trying to explain to myself why I hate god…because now I know, there is none.
Any questions or clarifications, feel free to ask.
Corey
If you quit booze, smokes, drugs, whatever without religion then you do it entirely on your own. There is no-one to blame and no-one to help you but yourself. That’s what makes it so much more powerful and meaningful. Relying on imaginary friends is never going to work in the long run.
Except many people who manage to overcome addiction don’t believe in God and haven’t surrendered to him. So it seems your 100% failure rate was quite an overestimate.
This topic always compels me to speak.
James, you said:
Let me guess. And that “Objective Personality” is only described in the Good Book, right? But we do have to have that description filtered through a human being’s subjective interpretation, right? Someone like perhaps………..you?
Then you said:
When you say “no one,” does that include you? Or do you mean God conforms to no one except for your favorite set of concepts and descriptions? How can you claim to possess the knowledge of the “true and living God” if he conforms to no one?
You are also ignoring the details of the study. By saying that there will be 100% failure rate without surrender to your favorite “true and living God,” you are disregarding the people who do gain on-going recovery without doing whatever you mean by surrender. People do recover without using your method. They exist. Making your assertions with your eyes closed does not make those people disappear.
I provided addiction counseling to ten thousand patients for ten years. I was very good at my job, testified by both my patients and my colleagues. We tried everything and anything we could; Psychotherapy, 12-step programs, secular programs, pastoral counseling, church-based support groups, medical treatments. NOTHING WORKED WELL. Most of the patients eventually failed and eventually died. From where I was I could see no difference in the outcome based on the method. Generally, addiction treatment is like picking through bodies in a blasted building and stumbling upon a few live ones.
I am very glad that more serious research is being conducted. The field is sorely underfunded. I don’t care what method is found to actually work even a little better than others, as long as at least some of the suffering and death is reduced.
I used to work with dually-diagnosed people and from what I saw they were merely transferring their addictions from the substances to religion/god with AA. Not at all helpful. It’s not a wonder that secular programs are found to be more effective.
there is something similar here in ACT, australia for depression.
i was all set to join the help program until i realised step 6-12 were religious…and there’s no way being forcibly subjected to religious rants and prayers would ease my depression. more, it’d increase it.
(Step 6. was “open your heart to god”)
i can just imagine how fun that section would be. oh boy.
thankfully, my secularist help has helped me.
James, I think you took Hemant’s comment a little too literally. No atheist here is literally blaming any gods here. Things that do not exist do not deserve any blame. What we really mean when we say “God just makes things worse” is that God-related activities (such as prayer and meditation) apparently do not help.
As many others have posted, this subject hits home personally. My late husband was among those that AA couldn’t reach with it’s “higher power” mumbo jumbo. It made me very angry that therapy had to come in the form of prayer and surrending oneself to this “higher power”.
My husband was a “lapsed Catholic”. The AA counselor actually informed him that he could use a tree in our backyard to concentrate on–if he was unable to focus this “submission of will” to a diety figure. It didn’t matter. Very frustrating. Near the end (liver failure@46), he did end up going to church and finding religion again (or maybe it was just soothing and calming for him, not sure) and had the full Catholic rites at his funeral service. Very tragic. I wish there had been some better cognitive-behavioral therapies available in our town but it’s hard to know if those would have changed the course of events either.
My clients are all HIV pos. I do a support group on the weekends re: disclosure and the most recent group was at a substance abuse center. I couldn’t believe that none of the participants would take credit for their strength, they had to give it up to god. It was hard because they put no value in themselves, which only increased their self-esteem issues, and BONUS, if they relapse they’ve also lost the light of god. They all felt so good about their religion, but it was hard for me to see the lasting positive effect.
How about a 12 step program to help those ready to give addiction to god?
James: God does not make the problem worse, you are right. Nor does he make the problem better. “God” cannot be shown to have altered any event that ever occurred, no matter how big or how small.
This is not due to not surrendering oneself to the true god, or to misunderstanding god. It’s due to god being an invention of mankind, existing only in the minds of humans.
First of all, AA does not “require” that anybody believe anything. It is clearly stated that the steps are “suggested”. The only requirement for membership is a desire to stay abstinent – but one can still attend meetings without such a desire.
As an atheist, alcoholic, and addict, I have been an AA member for over thirty years. I also worked as a therapist in substance abuse, as a licensed clinical social worker, for a decade. Early on, I reconciled my atheism with the steps, and have found a way that works for me. The key is in recognizing that I’m not the center of the universe.
I am also aware that there are many effective alternatives to twelve-step recovery. But, in spite of the study you cite, the fact is that most alcoholic and other addicts resolve their addictions without any help at all. There have been thousands of studies and nobody’s proven that anything is better than anything else. For those who seek help, what seems to work best is an individualised combination of things, different for each person.
As an atheist, I’ve grown damned weary of “new” atheists grabbing hold of every little tidbit to prove that “atheism is better.” Stick with separation of church and state, nurture your own beliefs, tolerate others, and get a damned life.
Huge!
I struggled with alcohol for a long time but always had problems with AA. I just don’t seem to be able to believe in a higher power absent evidence. And the fucking praying that goes on — I’ve been to church services that invoke the name of God less often than some of the AA groups I’ve visited. It’s a total crock and they can repeat the mantra of “it’s a spiritual program, not a religious program,” until they’re blue in the face, all one has to do is read the “Big Book” to see how integral God is to their belief structure.
What is really appalling is the way that the AA methodology has taken over the addiction treatment industry — without a scintilla of evidence that it works better than doing absolutely nothing.
The more money is poured into AA style treatment, the less is available for secular alternatives.
The religious nature of AA is amply demonstrated by the various appellate court decisions in the U.S. holding that a court cannot order a person to attend AA because it violates the whole church/state separation thing.
Amazing isn’t it. Millions and tens of millions of dollars are spent on a treatment methodology that lacks all evidence of its efficacy.
I too would like to see something that worked and serious studies looking into what does work and why. For some people AA does seem to work so one question might be for which people will it work and for which people might other options work better.
I lost my brother to alcoholism/depression (suicide), and, I know he had trouble with some of the programs because he was an atheist.
As a general rule, it’s good to be wary about short-term studies. They have a tendency to conclude very strange things.
Also, I’m interested in how they assigned the groups. I don’t have access to the article itself, but they’re probably using either a simple random distribution or a case-control (i.e., people pick which group they want to be in). In the first case, you end up with nonreligious people in the religious program (and vice-versa) which might skew the results. In the second case, you end up with selection bias. So, you need to be very careful controlling for variance in the groups in a study like this and perhaps break the results down into subgroups (e.g., did religious people do better than nonreligious in the religious program?)
“God seems to just make the problems worse?”
Eh? Sorry, no where in the quoted article did I see any indication that referencing a spiritual power actual served to aggravate alcoholism, or drive a person deeper into substance abuse.
I thought the article noted that modern, recently developed (secular) techniques function better at the 4 month mark (which, incidently would indicate that both techniques are ‘working’), but that the programs level off after about 8 months.
Granted, I have no first hand experience w/ AA, but I have seen the feedback on a similar 12 step program in KY for teenage substance abusers (primarily Crack or Cocaine), and it has served to reduce recidivism by 12-15% compared to the typical programs in the surrounding counties. I’d say that’s ‘beneficial,’ not ‘making the problem worse.’
Would a secular program work better? Maybe. Maybe not. However, saying one program works better doesn’t mean that another program aggravates the problem.
“DSL connects to the internet faster! That means your Dial-up program prevents you from ever access the web!!!”
A friend recently emailed me a post from the “friendly atheist” blog. In it, a recent study comparing secular to spiritual treatment options for substance abuse was references, along with a Time magazine article which referenced the same study. Both references to the article claim that it shows that AA performs poorly compared to secular treatment plans. And that therefore, AA (which they claim, erroneously, requires faith), is “making it worse.”
The problem is, the study shows no such thing, nor anything even remotely close. What the study shows is that a “treatment as usual” program enhanced by a 12 session manual-guided workshop of spirituality performs slightly worse, according to self reported factors like depression (but not use of substances), than “treatment as usual” alone, over the first 8 months of the study, after which results were the same.
Well shit. That’s not surprising. You’re going through a secular treatment program and they make you do God homework? Sounds hideous. No wonder they were depressed. I’d probably have done worse in that study too.
In medicine, we use Quality Adjusted Life Years, or Goal Adjusted Life Years, as basic measures of outcomes for major interventions like a substance abuse treatment. That way, we can measure not only how long a person lives, but how livable that life is. This study, making an analysis over an 8 month period, fails one of the most basic concepts of life long treatment studies.
Miller, the researcher, based on looking at his other work, seems like a decent scientist. But he seems impatient. Unless he’s also engaged in long term (10-20 year) studies that haven’t been published yet, this is just a guy who can’t hold hid wad. Studying substance abuse intervention on a timeline measured in months is pure folly. And people are making egregiously specious jumps to conclusion based on not understanding his work. I would also argue that a cohort of 80 patients, 40 in each program, is much too small to draw a meaningful conclusion.
Since Richard Wade left some good thoughts, but did not provide any contact information, I responded on my blog here: http://headdibs.blogspot.com/2009/02/follow-up-from-yesterdays-post-at.html
James, you can contact me right here, on this thread. Here is the link:
http://friendlyatheist.com/2009/02/04/alcoholics-anonymous-not-as-helpful-as-secular-alternatives/#comments
AA is free, treatment programs cost big $$$. If AA is about as effective as a Big $$$ program over the long term, then why waste your money on a treatment program when you could spend next to nothing on AA?
The religious aspect of AA varies tremendously group by group. I know one addict with more than 20 years of sobriety that is a hardcore atheist whose “higher power” is the law of probability (always said with a smile and an explanation of what probably will happen if he starts drinking again.)
For him AA is a support group with no religious aspect. The biggest thing it did for him is, like ddjango said upthread, is that it helped him realize that he wasn’t the center of the universe.
Some groups are going to be full of bible thumping lunatics. If that’s the case, look for another group.
That sounds like the best plan. Unfortunately sometimes AA is the “only game in town”. And time is so important in the stages of alcoholism. The sooner treatment takes effect, the better. If a treatment isn’t working, other options need to be considered and available for those that are so chemically addicted that prayer and “surrendering oneself to Jesus” are the least effective strategies.
I know that a lot of people think that alcoholism is a problem of will-power; not a disease. That’s a commonly held opinion.
But in cases of chemical dependency to alcohol, will-power isn’t enough. A team appoach tends to be most effective: family members, loved ones, therapists, physicians, clergy. Community approach. Intervention.
Being alone is the worst possible thing for an alcoholic near the “rock bottom” stage.
Hello. I want to say I think the AA programs are totally wrong. I think the court systems that use them are abusing our constitutional rights. No one, should be forced to have to publicly say they believe in a higher power. NO way, NO how! In my family we believe in self mastery. We believe we each should strive to find our inner peace and not to allow or accept something outside of ourselves to be controlling our emotions, feelings, etc. We believe in being good and finding the good in ourselves. There is NO higher power than can do that for us anyways. My son, in the past drank a lot! Unfortunately, he went out with some friends and celebrated New Years way too much. He had 3 beers and was driving! Well, yes he got caught. He hadn’t drank by personal choice for 7 years before this. He quit from his own personal strength. He went back to our church who gladly excepted him back. We don’t believe in God as you put him. We don’t believe its right to worship, trust, something else to be your higher power. Now the court is forcing him to go against our religion. He has to tell lies and goes to these meetings or go to prison. What type of society have we now? It’s about money! The mental health did a drug and alcohol review and decided he had the “possibility” of a returning problem. So, now he must endure lying about his beliefs, denying his religion, all to obey the courts of this land!
This AA was built on the teachings of an Oxford minister/professor?(The big book!) This minister was removed from his church! He had personality disorders, mental illnesses, and not to mention he liked small boys!
Sure, in maybe 100 years we shall compare this program to burning of the witches, but what about its victims now? This is a cult, imposing, demanding its beliefs on others. There is nothing anonymous about it. There is a “captain” who must sign your papers. She was out at the same bar my son was. But there she is–The God of the AA.
I’m trying not to be angry but its very hard. This is supposedly against the American way and rights.
Oh I forgot my other biggest complaint! “he must admit he’s powerless against alcohol…” OMG you have to be joking. Every day now I talk to him and re-confirm him he is not powerless. I’m terrified he will fall for this type of what I call brainwashing! He assures me he isn’t buying into any of it. But he has to go 3 times a week. It’s so dangerous and scary. I’m so happy he’s no longer a teenager. They told him this when he got into trouble at school. He was in high school and was with friends and they went out and got drunk. Then the courts made him go several times a week. They told him over and over he was powerless. I believe he bought into it. He didn’t manage to get over it for about 5 years! This is wrong! NO one is powerless. You are a person with feeling, strength, character, and choices you can make. I am told cigarettes are much more addictive than alcohol. I have never heard anyone tell a cigarette addict they are powerless to quit.
I’m sorry if I offend anyone…maybe I’m not. I don’t want to insult you is true. This is just wrong. Very Wrong. Dangerous!
Libby
Hi. i have spent many years in AA. After too many relapses to count, three years ago I decided to stop believing AA teachings and do it my own way. I have been sober ever since.
AA can be extremely dangerous to some. The disease theory, powerlessness and the god thing can send people into a mental downfall, resulting in binge drinking, depression and or suicide. But it does seem to work for some. Then there is the argument that these people would have stayed sober with or without AA.
My biggest argument with AA has always been the god thing. I was never comfortable relying on a god to keep me sober and happy while there were other people in the world suffering, even at the hands of man. That never made sense to me. But, me, like others, had no where else to go. AA has been marketed so well in the past that it’s the only house on the block. Up until now, we are starting to hear more about alternative support groups.
I left three years ago and it was a tough move. I lost a lot of people I considered friends. People that knew very intimate details of my life turned their shoulder to me. I would hear things from other people that the members in the group were telling people that I was crazy. I would also hear things like “he is going to drink and die.” Most “true believers” will only accept you based on the acceptance you have for the program. It is safe to say that AA does more harm than good to most of the people that come in contact with it, either by bad advice or being pushed into belief in god. Once you truly believe the AA doctrine, it is very hard to grow beyond that. It’s like being in a box, so to speak. You are in your own little world. You start to view most of the world as sick and distorted, besides your AA world, of course. If you ever question the AA dogma, you are told you are not working the steps hard enough or you are told to pray about it.
I am glad to see that people are starting to wake up to the negative side effects of AA. Let the truth come out!
Michael T. McComb
Alcoholics can get sober without god, since there is none. Bill was wrong about self-will; but we must direct our will toward what keeps us sober. A higher power must necessarily be something that exists, or it is no power at all. This is a support group for atheists in Alcoholics Anonymous.
I have been in AA 20 years.
My “sobriety” came 17 years later after I stopped trying to force the beliefs of others to my own.
I didn’t stop using, and really started to enjoy my sobriety until I removed GOD from the program.