This was written rather quickly so if clarification is needed please supply a comment.

Recently I was in a discussion with someone regarding AA (Alcoholics Anonymous) and the 12 Steps. That is what prompted this analysis. I have already made a critique in a previous blog regarding AA. This is a bit different in that it strikes down the notion of support vs. treatment. I have heard many times and recently read a published article by a psychologist indicating that AA/12-steps was never intended to treat. As you can see below:

W., B., & B., D. (2019). Alcoholics anonymous: the big book : the original 1939 edition. Mineola, New York, Ixia Press, an imprint of Dover Publications, Inc.

“This first edition of Alcoholics Anonymous was intended to show any and all those afflicted with, or affected by, alcoholism that alcoholics could completely recover if they thoroughly followed this book’s suggested path. It was designed to tell alcoholics precisely how to proceed. The personal stories included in the book furnished the evidence that victory had been achieved by those who really tried and followed directions.” Page 2 or 3.

As you can see quoted verbatim above that is meant merely as support is completely false. It was intended to treat. This is especially true when they have a chapter labeled “There Is A Solution”. Also, they have the statement: “A pathway to a cure” I am unsure as to how someone escapes the first quote above and then escapes the concept of treatment when you have a chapter labeled “There Is A Solution” and a statement “A pathway to a cure”. These quotes are taken directly from the citation out of the book.

Also, I must point this out in relationship to concepts in religious/spiritual community when it comes to an individual’s interpretation. There are other communities as well. This is just a one example. Each individual will attach their own meaning to terms in religion. A person in the religious community will define what they mean by being Christian, Jewish, Muslim, etc. Each definition will be unique to the individual, and I have no issue with that. Individuals here regarding AA they will define its “support” status in the way that suites their needs. The one common factor that cuts across all religion and AA is the fact that these are all non-science. The troubling thing for a psychologist like myself is this concept of AA/12-Steps is supporters are putting their foot on both sides of treatment and what they call support or whatever other word they want to use. They shift the goal posts to suit their needs using “support”. This is to salvage something that was written in 1939 over 80 years ago. Keep in mind we have over 80 years of research since then on drinking treatments. The 12 steps have NOT changed with over 80 years of research, the question is why? Scientifically this is completely outrageous.

I realize that Alcoholics Anonymous has gone through numerous iterations. When people tell me it’s a support system it is a classic example of how people try to salvage from an ideology or concept just because they want to believe. Therefore, I can believe in leprechauns, the tooth fairy, Santa, unicorns etc. of which we all know are fictitious objectively. I can say “but it helps me to believe these things”. I can believe anything I may think helps me even if objectively to the outside world it does help and is not an accurate look at reality. I see it the same as how people try to salvage ideas from the holy books. With the holy books I typically hear people say it was an allegory or metaphor, not meant literally. NO not true when you talk to many ardent religious people. They get angry at this notion because it says unambiguously X, Y, or Z. In this case the 12-step model failed empirically, yet people try to salvage what they can. It literally has a chapter named “There is a Solution” this cannot be interpreted in some other way unless you are creating your own definition for what “Solution” in the English language means. The problem I have is how far from reality do we take things to create meaning as the example above about leprechauns etc. This is particularly true when psychologically we have far more accurate models and therapeutic interventions than 12 steps of which have not been modified in over 80 years of research on drinking! Come on, no modifications. I follow few complex interventions in psychology that go back to 1939, (I actually can’t remember any). Maybe classical conditioning from the 1890’s but it has been validated through research for over 120 years. As a couple examples behavior therapy and cognitive popular in the 1950’s have gone through modifications based on research. Even in the past 20 years they have. (Oh, by the way Alcoholics Anonymous was actually written in 1929, yet not published till 1939 when you do a deep dive).

What also pisses me off is that the 12 steps were intended for alcoholism, not other things. Now its extended to every drug. Yet with my limited understand of biology all drugs have different physiological effects on the body, withdrawal patterns, complications and so on. Plus, it’s now extended to eating disorders and who the hell knows what else! I did a quick google search not to waste my time on bogus treatments but found a bunch. I even found a website for anxiety and depression and the 12 steps. Holy shit! One of the first books I read was Aaron Beck’s “Cognitive Therapy of Depression” literally published the year I was born (1979). Which is actually based on solid research. Plus, he has a great book on anxiety. “Cognitive Therapy of Anxiety Disorders: Science and Practice” I mean come on people you think an easy 12 step model intended for a totally different disorder which is a drug can just be applied willy nilly to any problem a person has in the world of psychology.

What I think is going on (hypothesis) is people do not want to do the actual hard work regarding real psychological analysis in therapy of their issues. This is why when I was trained way back in my M.A. program you learn that you must ascertain from the patient what is their “Presenting Problem.” This is because it is from their perspective and may simply be a symptom of a way deeper psychological issue. This is actually why many people don’t go into therapy. They are fearful of what will be uncovered as was said in the movie Good Will Hunting in the park scene by Robin Williams, to Matt Damon regarding therapy. “But you don’t want to do that do you sport, you’re terrified of what you might say”. He is clearly referring to what therapists deal with all the time. Patients don’t want to divulge secret thoughts, feelings, emotions, beliefs etc. Whereas a 12-step model makes everything overly easy and stepwise and “safe” you don’t have go in depth. You get to go to a meeting, vent your trouble, see a bunch of heads nods and/or affirmations of some type then leave. You are not questioned critically by a trained professional who has seen these processes through a number of times. We question as professionals your core beliefs, sometimes erroneous, illogical and irrational. People don’t like that.

Now people inevitably say but it helps me. Well yippee skippy we should now go off what people think helps. As an example, outside of the drinking realm. If a patient thinks eating a certain food helps with their medical diagnosis say, of cancer or HIV are we to simply believe them? Yet they are still upon biological analysis showing high levels of each in their systems. Now empirically we know that chemotherapy works better than some particular food for cancer, or anti-viral medications better for HIV. The same goes for psychotherapy for drinking. We know through actual systematic unbiased research that therapy is far and away superior. Look at it this way there are hard-core AA attendees that go several times a week, for YEARS to meetings. If I am seeing a patient for even 30 or more 50 minutes sessions I need to be able to stand before the ethics board and justify why it is I am doing that many sessions. My cousin with a marriage and family therapy degree worked at an agency and had 90 minutes (2 sessions) to diagnose and come up with a treatment plan that would NEVER take years! Maybe it would be for a few months at best.

Plus, as an aside even the research on 12 steps is a biased sample of people who actually self-select to participate. This means the participants in the research volunteer to take part in the research. Automatically they have an agenda to say it works. 

In the end anyone with any drinking, drugging or other psychological issue needs to actually do the hard work of therapy for their unique issue. Sometimes the drinking or drugging is a symptom of an underlying issue. Don’t read a cheesy self-help book like Alcoholics Anonymous. For that matter any other issue… Depression, anxiety, work issues, child issues, school, marriage the list goes on. Go to a professional. Yes, some self-help books may be of a little value, yet a professional is trained to do a deep dive into your very personal and unique issue/s.