A really beautiful and serious thing

[Mark]

The most commented article of all time on Mental Help Net lives in our Alcohol and Substance Abuse topic center. It is titled, Alcoholics Anonymous (AA) is a Cult? and there are literally hundreds of responses made to this article. The article itself is rather simply about my experience coming to understand how much anger there is out there focused towards AA. It was, frankly, a shock for me to realize that there are numerous people out there who have found the AA experience to be completely toxic. Or, rather, I should say, not really so much a shock that people didn't like AA as a shock that there were people who didn't like AA who seemed to have in some cases quite legitimate reasons behind their opinions. In hindsight, it makes more sense to me, and I'm more able to accept the notion that a diversity of individuals requires a diversity of problem solutions. AA being a prominant solution to be recommended for it does benefit many, but by no means the only one recommended. I only wish that there were more secular and science-based self-help programs out there for alcoholics and other addicts.

At any rate, the debate rages on and I don't see that there is any resolution. On the one side are people who have found AA to be helpful and who come to AA's defense when it is criticized. As sobriety is literally life-saving in many cases, who can blame these people for wanting to defend something that has helped them (in their estimation). On the other side are people who have been harmed in their estimation by predators they met in AA, or who are secular in orientation and who cannot stomach the religiousity practiced in many AA settings. I don't believe that AA must be practiced in a religious context, but I do know that it frequently is. And who can blame these people who perceive themselves to have been abused for wanting to warn others about the danger? The two sides will never meet I don't think. In some cases they are talking about two different AAs which are run differently. AA is not a uniform insititution though it does have its unifying steps and traditions. In other cases, people's differing backgrounds lead them to be more or less comfortable in the same setting. One man's poison is another's dinner, that sort of thing. I do note that more than a few commenters don't realize this diversity of experience is occuring and talk as though their personal experience of Twelve Steps is the same experience everyone has or will have. Not true, but an easy mistake to make for some people.

Inasmuch as the debate will continue, I hope to shift it over to this forum simply becuase this forum system is a far better environment for having a debate than the comment system on Mental Help Net. If you wouldn't mind, perhaps you can help us accomplish this task by writing about your own AA experience (or any other experience you are having or have had with regard to alcohol and other substance abuses and addictions). This stuff is a hotbutton issue. If you write something and stake out your position, I feel rather confident that someone from the other camp will come along and take issue with what you've said. It would be funny almost if people weren't speaking from their hearts about such a serious issue as addiction. That's what makes it not funny - that the discussion is about life and death and avoiding damage. that's the part that makes the discussion rather noble from all directions. The urgency comes from people trying to help other people avoid mistakes. That's a really beautiful and serious thing.

Perhaps through further discussion, some people can begin to understand how to integrate the positions in a way that makes sense and not have to feel so polarized and urgent. That would be a benefit to all who achieved it, I believe, becuase accompanying that new understanding would be a greater sense of inner peace.

What do you think?

[xenophon]

First things first, AA is religious in nature. Three Fedral Courts of Appeal have ruled such. I agree with and accept that judgment.

There is a level of bad conduct within AA that renders it suspect. The fact that bad conduct occurs elsewhere is not relevant.

Sponsors have no qualifications and are not accountable. No adult leadership. There can be no expectation of confidentiality. The concept of the wounded healer is invalid.

AA is a dumping ground. The courts use AA as an adjunct; an alternative to incarceration. Mentally ill are sent to AA by practioners using triage. "I can't treat you unless you stop drinking." And, so it goes.

The 12 steps are an act of faith; that is, revealed truth. The 12 steps arose from the Oxford Group, run by Buchman.

I am glad, sir, that you have learned something about AA and 12 step. It is time to grow beyond AA. It is not good enough.

[John Rutledge]

deleted .....

Edited October 29, 2009 by John Rutledge

[Mark]

I didn't come up with the idea that AA could be practiced outside the context of a religious system. An anthropologist and "cyberneticist" by the name of Gregory Bateson (husband to Margaret Mead, I've read) did. I have on my desk from a while back a book called "steps to an ecology of mind" which is a collection of Bateson essays from the 60s and 70s. In one of the essays, "the cybernetics of "self": a theory of alcoholism" (published in the journal "Psychiatry", in 1971) which is worth reading, Bateson suggested that the power of AA resided primarily in the surrender and overthrow of the self-concept that thinks it is in control of things. The way I read that article, Bateson is saying that the underlying movement is correct and can be understood in an entirely secular manner by thinking of it as a philosophical conversion rather than a spiritual one. Here's a quote from the article if it helps:

"The first two steps of AA are as follow:

1. We admitted we were powerless over alcohol - that our lives had become unmanagable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

Implicit in the combination of these two steps is an extraordinary - and I believe correct idea: the experience of defeat not only serves to convince the alcoholic that change is necessary; it is the first step in that change.

To be defeated by the bottle and to know it is the first "spiritual experience". The myth of self-power is thereby broken by the demonstration of a greater power.

in sum, I shall argue that the "sobriety" of the alcoholic is characterized by an unusually disasterous variant of the Cartesian dualism, the division between Mind and Matter, or, in this case, between conscious will or "self" and the remainder of the personality. Bill W's stroke of genius was to break up with the first "step" the structuring of this dualism.

Philosophically viewed, this first step is not a surrender; it is simply a change in epistemology, a change in how to know about the personlity-in-the-world. And, notably, the change is from an incorrect to a more correct epistemology."

I'm not saying that AA is practiced secularly; I'm just saying it could be.

[xenophon]

There are a lot of interesting questions about the social and psycho dynamics of AA/NA.

1. Who are the people who buy into the doctrine of AA and become believers/ advcates. What is the pyschodynamic of that process?

2. Who are the people who actively dislike AA? What is the dynamic which leads to that?

3. Who are the people who seem unaffected -- either way - by AA. There are people who use AA as a talking shop. Why?

4. People have quit drinking prior to attending AA. Why do they attend?

5. What goes on inside AA? What are the dynamics of the interactions that occur there?

6. Who prospers in AA? Do people with narcissistic PD do well there? Anti social PD? Depressives? Who are the gurus? What is their psycho dynamic?

Very little is actually known about the workings of AA/NA behind the closed door. Does anyone want to know?

[Mark]

Who are the people who buy into the doctrine of AA and become believers/ advcates. What is the pyschodynamic of that process?

Who are the people who actively dislike AA? What is the dynamic which leads to that?

People complain about two broad themes in my experience. The god/religious aspect, and the sociopaths/predators. I'm thinking these are unrelated complaints.

We've got atheists/agnostics or just plain non-christians who have a personal experience in AA where they feel invaded/colonized and push back against it. This is an identity thing. "I want help, but I don't want to have to compromise my core beliefs about the world and myself in order to obtain it". "I don't want to compromise my independence." Perhapse some people who benefit from AA don't feel their independence is compromised, while others do. If this is so, the interesting question is why do some people feel compromised while others don't. Would having a religious background where you are raised in an environment with a higher power have something to do with it?

We've got people who go to AA and get involved with someone who takes advantage of them. This is an abuse complaint. Seems to me most anyone might make such a complaint based on how they have been treated.

Maybe a third common complaint too, which is that people don't like the lack of a scientific program, or lack of accountability.

[xenophon]

I understand; what you are saying makes sense.

Why have a support group at all?

I would think that such a group about alcohol abuse/alcohol dependence would be mostly educational.

Tips on how to quit; the mechanics of doing that. Such as: How to replace the drinking behavior with other behaviors;

how to divert the urge to drink -- thought stopping, CBA, behaviors which rule out drink, etc.

perhaps some morale/confidence building comes in.

A support group run by and for deeply troubled people does not seem a healthful venue. Is it not much better to socialize with balanced people who behave appropriate to the circumstance? A group based upon common interest, rather than a common problem?

How could a support group based upon drinking deal appropriately with issues such as depression, anxiety, etc? That seems a difficult proposition.

[Guest ASchwartz]

Both you and Dr. Dombeck make a very good point when you state that many people are bothered by the lack of accountability in support groups such as AA. It does seem difficult to understand how people struggling with sobriety can be helped with their emotional problems as well because that takes professional guidance.

For most of my career I had a private psychotherapy practice in New York City. One day a young man referred himself to me to help him deal with his depression. As it happened, he was a full member of an AA group in Manhattan and was sponsor for several AA members.

As a result of the help he got in psychotherapy he referred some of the other members from AA that he knew of. Before long I was doing individual psychotherapy for a small group of people who participated in that particular AA group. As it turned out, the psychotherapy became an important means for them to work out their depression, anxiety and family problems, while continuing to use AA to help them maintain sobriety.

I do not know if all AA groups around the country work in this way. I do know that AA now accepts the fact that many people must be on psychiatric medications of one type or another.

I agree that there are many misgivings that people have about AA. However, in my experience its benefits seem to out weight its weaknesses.

What do you and others think?

Allan Schwartz

[John Rutledge]

deleted .....

Edited October 29, 2009 by John Rutledge

[xenophon]

It is difficult to know what goes on AA. There is no real interest.

As for the abuse, it is unlikely that will be discussed in any venue. If it is discussed, it is unlikely that it will be taken seriously. Religious belief is a private matter. It should not be the concern of AA, nor anyone in AA.

The question is: why have a group at all? people solve the problem on their own on a regular basis. It is done on your own 100% of the time -- group or no group.

[Mark]

The question is: why have a group at all? people solve the problem on their own on a regular basis. It is done on your own 100% of the time -- group or no group.

Many people benefit from group support is why. People need to be witnessed and appreciated by other people. Not everyone, but most. So, even if group support is not something you need, there will be people out there who will do better with it than without it.

[xenophon]

Perhaps. Perhaps not.

It depends, to a large extent, upon the group; the values of the group; the pyscho and social dynamics of the group.

Neither one of which may be life affirming.

Also, there is a time to leave a group founded upon a common problem.

[Abbadun]

First let me say that I still go to AA meetings in fact I will go to a "As Bill Sees It" at Noon today. I enjoy most of the people that I meet at meetings, but I still see a lot of problems with AA and similar groups.

As a Secular person I do not mind the God Talk in AA, but I wish Secular statements were not a automatic reason for the membership to re-qualify the speaker's sobriety.

I find the Literature the biggest let down, too many negative statements about the faults of Secular people because of their lack of faith. AA Literature has too many statements about Spiritual belief that tells the reader that he/she must do this or that. I know that in other statements that the AA Founders state that they do not know everything about Alcohol, but each statement must itself be truthful to create a aggregate AA message that is consistent.

I find AA's refusal to upgrade the Literature worrisome. What other Literature or Doctrine (except that thought to be guided by some God) is unchangeable? All that I have learn in College and before is that organizations (and people) must change and react to society. It is not healthy that AA is so fixated on writings from the 1930's.

I do readings and talks with destitute men in Rehabs and I use some of Hazelden's newer Literature which is spiritual but does not need to be demeaning to Secular People. I like Hazelden's older Literature also.

I get be in AA by not attending meetings using the "Big Book", "12x12" and and similar Literature.

AB

[Guest ASchwartz]

Thank you for your comment. To me, your approach makes sense. In other words, an individual can make use of AA without subscribing to its religious approac in a literal way and, from people I know who do attend, that is a common approach. The particular meeting makes a big difference, an since there are many meetings, one does not have to attend one that over emphasizes religion. At least, that is my thought.

Allan

[Gene S.]

Indeed interesting discussion.

Should this topic be named: The Effectiveness of Placebo Effect?

In this case should we broad this topic to 12 step placebo effect vs Pastoral counseling vs Professional counseling?

Most of the time when MentalHelp.Net makes a referral to 12 steps mutual help groups, a few reasons are given:

1. Cost effective. 12 steps are free (donation based) to attend. Pastoral counseling, some self help peer groups are also free (donation based).

2.12 steps groups are wide available. Pastoral counseling is also wide available. Self help groups have web based network which is accessible if person has a computer and Internet access. (all public libraries have computers and Internet access).

Religious aspect is not the one, that degrades the placebo effect of 12 steps. Contrary, the rest of mambo-jumbo is a determining factor of low effectiveness of 12 steps.

[John Rutledge]

deleted .....

Edited October 29, 2009 by John Rutledge

[xenophon]

AA, or 12step does not fit all. If the shoe does not fit, do not wear it. It is a spiritual [ religious] solution.

It is, basically, revealed truth.

AA and the 12 steps are a tool, which some people may find useful. It is important to to understand that 12 step is just that -- a tool. It is not a way of life, unless you want it to be a way of life.

AA can be useful as a sounding board, a place to ventilate. AA can be a place to hang out until you get better, get worse, or stay the same.

As I stated earlier joining a group focused upon a problem is a choice. People have the right NOT to join such a group, if they deem it unnecessary.

[Mark]

I get the objections to AA that our many secular contributers are talking about. No one likes to be bullied, or evangelized to. And therapists by and large don't have in mind that they are trying to convert someone to a religious point of view when they recommend AA by the way. They are trying to help someone get support to become sober.

Here's the issue I can't resolve. I have seen addicts lie to me so many times and continue lying to me even when it is clear that they are lying - they know it and so do I and yet they still lie. It's safe to say that many addicts are not in their right minds (at least initially during treatment). When someone comes to me who has a substance abuse problem, and they say, "I don't like AA becuase i don't have an interest in being converted to the AA brand of religion", how do I know when they are simply making excuses to avoid pressure to stop drinking/drugging and when they are making a legitimate and rational objection. And what if it is both at the same time? It's a dilemna.

I see lots of complaining about how AA sucks or is an ill fit, but few people talking about how they are finding alternative ways to meet their support and therapy needs (which most addicted people surely have). I hear a lot of talking about how it is important to be able to "go it alone" and some macho talk about how if you want to stop, you will and you don't need assistance to do that, but while that may work for a very few people, I know from experience that it simply doesn't work for the majority. Addicted people are often trapped in a mindset that causes them to reject the help they need.

Which brings me to a related and perhaps more fundamental issue, namely when is it ever appropriate to compel someone into treatment?

Many of the "cutting edge" treatments for borderline personality disorder have elements of cohersion built into them, although not the variety of cohersion that courts practice. For instance, a DBT therapist might say to a chronically suicidal patient, "you can call me before you have a suicidal episode and we'll talk about it, but if you call me during the episode, I will help you resolve the immeidate crisis and then remove you from therapy for X number of months". The idea is that without some leverage on the patient - without being able to threaten the patient with some consequence that he/she doesn't want to experience, it is hard to get them to take therapy seriously. One important aspect of this sort of cohersion is that it is imposed by the patient him/herself - he/she is motivated to avoid breaking the rules, and not by outside consequences like the threat of imprisonment. This same logic does apply to the treatment of addictions but I'm not sure entirely how just now.

Is anyone following me in my thinking (I hope)? Not all cohersion is a bad thing; some of it is necessary sometimes for motivating people to get better. Which isn't to justify abuses that may occur in AA, but simply to say, its not just about AA being a secret hotbed of religious fundamentalism; there may be a reason for the presure in the program that actually is useful. ??????

[John Rutledge]

deleted .....

Edited October 29, 2009 by John Rutledge

[Mark]

Hmmm. Clearly, there are situations in which coercing people into treatment may be necessary for their own good and that of others. Whether coercing people into faith-based programs that do not square with their personal convictions is perhaps another matter.

Intellectually, I understand that point very well. Emotionally, I'm resisting it. Not becuase I'm interested in converting people to any particular faith. Because if I accept that principle, (speaking as a generic therapist), then I have patients who are dictating to me what their therapy needs are. This is not so bad in itself if I have a range of options to offer the patient, but in this case I often don't. SMART/Rational Recovery, I suppose, which is more available than in the past via internet, but these groups are not widely available in face to face format. We (therapy profession) know beyond a shadow of a doubt that social support is very important for healing and recovery in general (not for all perhaps, but for the vast majority - people need to be witnessed and supported - that is a lot of what therapy and none-sick family is about) There is a hole where an important support ought to be.

Perhaps AA ought to fork (split) into orthodoxy and reform movements, the reform movements re-writing the founding book with the aid of what is now known from scientific study of addiction therapies, but still preserving what I think is a vital part of the recovery process from a philosophical point of view - the notion of surrender to a higher power - which we can simply restate as a surrender to benign social influence - the stopping thinking (privately and publically both) that you have all the answers and are self-contained and don't need other people or can operate without impacting them and involving them in your problems. This would be the birth of an ecological self of self rather than a selfish one - the birth of humbleness inside what was perhaps before a very egotistical persona.

The re-writing of the book could be done online - in wiki format perhaps. We could do it here. It would be an interesting exercise at any rate, and maybe it would prove to be useful in practice too. Would that be worth pursuing here does anyone think?

Mark

[John Rutledge]

deleted .....

Edited October 29, 2009 by John Rutledge

[Mark]

John,

Not pointless, but maybe not what you are wanting to hear either. We're all individuals here, and each of us starts from different places. My own position on AA has shifted over the past two years pretty dramatically, as a result of my being open to talk on the site. I personally am not ready to throw the entire enterprise of AA out the window at this point, however, despite my becoming more aware of the serious problems that exist there for some people. I've seen too much good come from it. You don't have to agree with me (God knows, many people don't ).

I like the idea of rewriting the book, myself, the more I think about it. These problems so many people are having come from the religious attitudes encoded in that book. If the book was something that could be re-written to not be revealed truth, but rather rely on humanistic and scientific principles, it might influence a few meetings and make some change possible that would be harder to happen otherwise. The only people who might find a revised book appealing would be those who are dissatisfied with the original, but hey, there is no shortage of folks like that, are there. And a wiki format would help insure that all dissatisifed (online) voices had an opportunity to participate in the new shape.

Anyway, truly not trying to upset you. Just speaking out loud about a difficult issue.

Mark

[Mark]

By the way, I do not note any response to the comment that "rigorous honesty" may, in some small way, conflict with "giving oneself completely to this simple program" in many cases. Yes, Life is, indeed, too short.

I didn't respond to that quote specifically, becuase I agree with it and do see what you and others have spoken about as problematic. My wish for some alternative to offer people is for one that won't cause them to have an identity crisis they can't relate to (as occured for you in AA) but still have some of the benefits of a peer program like AA.

[John Rutledge]

deleted ....

Edited October 29, 2009 by John Rutledge

[xenophon]

I am not, in principle, against, reformulating the ideas of AA.

Doing that will be very difficult.

No two drunkards are alike. There are generalizations about the characteristics of the various sorts of drunkards that may be useful. That would involve an entirely new DSM, dedicated entirely to dunkards and drunkism.

Rather than call 'alcoholism' a disease, it is more useful to call it a behavior. A behavior that may be changed; replaced with more life affirming behaviors. It is more useful to make a list of those behaviors. As in: instead of drink, I will ____.

Making a list of priorities will help. One will see that all must be done sober.

And, so on.