Alcoholics Anonymous

[[File:Logo AA.svg|thumb|right|165px|AA's ([[Illuminati|suspiciously triangle-shaped]]?) logo.]]
{{christianity}}
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'''Alcoholics Anonymous''' is a religious cult that masquerades as a "treatment" for alcoholism.<ref group=note>AA's fifth tradition: "Each group has but one primary purpose-to carry its message to the alcoholic who still suffers." Note that the primary purpose is not to help people stay sober, but to promote AA.</ref> To some extent, certain meetings of the program have come to accommodate all people struggling with substance abuse, and, in some cases, mental health issues; however, this is the exception rather than the rule, which has necessitated the creation of a laundry list of duplicate programs for other problems. Alcoholics Anonymous draws a distinction between sobriety and abstinence, the former being largely defined by participation in AA and the latter being defined by not drinking, hence drawing a wedge between AA and the outside world that allows the dismissal of alcoholics who get sober outside their program. The primary model of the program consists of attending support groups and going through a process known as the "Twelve Steps", which, despite the name, is a tediously long endeavor full of convoluted concepts that really have nothing to do with alcohol at all. Instead, the fundamental principle of the Twelve Steps has something [vaguely] to do with how to live a [[Spirituality|spiritual life]].

"Twelve Step" jargon blatantly states that Alcoholics Anonymous is of a Christianist ethos. Alcoholics Anonymous is a splinter sect of the Oxford Group, a World War II-era Christianist cult started by a failed minister named Frank Buchman, who claimed to cure various vices through the "five C's": confidence, confession, conviction, conversion, and continuance; and the "four absolutes": absolute honesty, absolute purity, absolute unselfishness, and absolute love. Buchman and his cult's actual practices were the opposite of all of those. AA's fundamentally Christianist nature is further confirmed by the fact that meetings usually end with the Lord's Prayer, and the earliest AA literature states that the group's accommodation of atheists and agnostics primarily serves the purpose of helping them find Jesus.<ref>See the chapter on the Third Tradition from the classic ''Twelve and Twelve.''</ref>

In the United States, court sentences which mandate AA attendance violate the [[establishment clause]]; central to the twelve steps of AA is the assumption that a supreme deity ("[[God]]") is an inseparable part of the program. It has been ruled that the distinction between spirituality and religion in AA is legally meaningless.<ref>https://ffrf.org/legal/item/14012-court-ordered-participation-in-aa</ref><ref>https://terrygorski.com/2013/10/21/is-a-a-legally-a-religion/</ref><ref name="bufe"/><ref>[http://www.morerevealed.com/library/resist/r_chap_4.htm See this summary of case law in "Resisting Twelve-Step Coercion" for more.]</ref>

In spite of such, atheists and agnostics have been able to stay sober within AA (and outside AA) without God for many years, and oftentimes the notion of a "higher power" is capable of being rationalized in such a way that it represents some sort of basic purpose, philosophical outlook, or, in many cases, the group itself.<ref>https://www.recoveryranch.com/alcoholism/atheist-alcoholics-anonymous/</ref> This may be particularly useful in small communities where no alternatives exist (if you can avoid [[drinking the Kool-Aid]]), since the primary benefit to AA appears to be that it is a place to be social without alcohol. Be aware, however, that Charles Bufe has suggested the primary reason for a lack of alternatives in many places is that AA itself does not play fair and does everything it can to keep out competing recovery programs.<ref name="bufe"/>

==The 12 Steps==
The 12 Steps themselves are as follows:<ref>"The Twelve Steps of Alcoholics Anonymous". Alcoholics Anonymous. http://www.aa.org/en_pdfs/smf-121_en.pdf.</ref>

{{sbs|title=1|The 12 Steps|RationalWiki comments}}

{{sbs|'''Step 1.''' We admitted we were powerless over alcohol — that our lives had become unmanageable.
|Mental addiction is caused by feeling powerless.<ref>https://www.psychologytoday.com/blog/the-heart-addiction/201010/the-psychology-addiction</ref> If you feel powerless over alcohol, you have no hope of overcoming it.}}

{{sbs|'''Step 2.''' Came to believe that a [[Higher Power|Power greater than ourselves]] could restore us to sanity.
|Hoping for a higher power to ''save'' you, when the very previous step established that being rendered powerless was the problem to begin with. Switching the almighty bottle for the almighty God. Also, the initial promise was for them to help you stop drinking; now, they're saying that you need a deity because you're insane. Only two items into their list, and they've already [[Moving the goalposts|moved the goalposts]].}}

{{sbs|'''Step 3.''' Made a decision to turn our will and our lives over to the care of God ''as we understood Him''.
|Have they any evidence that a "God" which let us get into this state will make an effort to get us out of it? Especially a "God" whose [[Ten commandments|first commandment]] expressly forbids that "as we understood Him" bet-hedging?}}

{{sbs|'''Step 4.''' Made a searching and fearless moral inventory of ourselves.
|Striving for moral insight is a worthy process (and one notoriously never undertaken by [[Yahweh|the God of the desert]]).}}

{{sbs|'''Step 5.''' Admitted to [[God]], to ourselves, and to another human being the exact nature of our wrongs.
|...focusing on the innumerable "wrongs", and never on the rights. [[Original sin|We are all wretched little things, you see.]]}}

{{sbs|'''Step 6.''' Were entirely ready to have God remove all these defects of character.
|Leaving the question as to [[Problem of evil|why we were ''created'' sick and ''commanded'' to be well — as opposed to just created well — open to interpretation]]. Furthermore, how does being "ready" to take a "step" constitute a "step"? This is AA founder William Wilson padding his list to get it to 12; he chose the number first, to emulate Christianity's 12 Apostles, and then cobbled together his list to match.}}

{{sbs|'''Step 7.''' Humbly asked Him to remove our shortcomings.
|"Grovel and squirm or you get the cane!"}}

{{sbs|'''Step 8.''' Made a list of all persons we had harmed, and became willing to make amends to them all.
|Doing good, even though there's already an {{wpl|Omnipresence|omnipresent|,}} [[omnipotent]], ''and'' [[omnibenevolent]] God just hanging about, who could — we dunno — [[Problem of evil|take care of all evil in one flick of his finger]]?}}

{{sbs|'''Step 9.''' Made direct amends to such people wherever possible, except when to do so would injure them or others.
|Rather harmless.}}

{{sbs|'''Step 10.''' Continued to take personal inventory and when we were wrong promptly admitted it.
|...except regarding questions of [[theology]]. Also, make sure not to steal any of the credit from God when you happen to be right.}}

{{sbs|'''Step 11.''' Sought through [[prayer]] and [[meditation]] to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
|Basically a prescription on upping your intake of "[[other ways of knowing]]".}}

{{sbs|'''Step 12.''' Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
|[[Correlation is not causation|In case taking the above steps coincide with actually getting sober]], make sure to badger other people to join!}}

The ‘13th step’ is AA slang for seducing a newcomer; as there are no names, there is no vetting for sex offenders.<ref>[http://www.theguardian.com/society/2015/nov/29/alcoholics-anonymous-saved-my-life-but-i-lost-my-faith 'Alcoholics Anonymous saved my life, but now I’ve lost my faith']</ref> Yikes. Newcomers who are taken advantage of by more experienced members are often told that [[blaming the victim|it was their fault]].<ref>[http://www.morerevealed.com/library/horror-stories/ "12-Step Horror Stories,"] Rebecca Fransway.</ref>

==Religion in AA==
As you can see in the above section, 7 of the 12 steps mention God, prayer, a spiritual awakening, etc. However, the "God" of AA, which they claim will control your life for you, runs counter to the common beliefs in such a deity. In addition, AA's "''Big Book''" (the main book of AA writings) includes an essay addressing those who are not religious, "We [[Agnostic]]s", which essentially states that there is no way around belief in a supreme deity if you want the AA "program" to work and that agnostics and atheists will need to draw on enough faith to believe in God, who in turn will reveal himself.<ref>[http://www.aa.org/bigbookonline/en_bigbook_chapt4.pdf "We Agnostics"], Chapter 4 in ''Alcoholics Anonymous''</ref> Despite such, many in AA have since deemed this section as being either irrelevant and outdated, or have interpreted it from a more revisionist standpoint.

For these reasons, among others, AA is not for everyone. However, there are nonbelievers who are prepared to publicly defend AA on the basis that [[Pragmatic fallacy|it "works for them"]] — Roger Ebert and Sir Anthony Hopkins being such examples.<ref>Roger Ebert. [http://blogs.suntimes.com/ebert/2009/08/my_name_is_roger_and_im_an_alc.html My Name is Roger and I'm an Alcoholic.] Roger Ebert's Journal, ''Chicago Sun Times'', Aug. 25 2009.</ref>

AA claims to be non-sectarian as to which conception of "God" each member holds, and in practice AA groups and individual members may vary widely as to what extent they emphasize religious belief, as opposed to the emphasis official AA literature places on it. So, if one's conception of a higher power happens to be the [[Flying Spaghetti Monster]], that's perfectly okay. However, [[Fun:Flying Spaghetti Monster#Afterlife|Pastafarian heaven contains a beer volcano]], and pirates are frequent consumers of rum. This would understandably give rise to a [[conflict of interest]], at least in the afterlife.

===Is AA really religious?===
{{hatnote|Note that in this particular case, [[Betteridge's law of headlines]] does '''not''' apply.}}
AA maintains that it is a "[[spiritual but not religious|spiritual, not religious]] program." However, this seems to be a [[distinction without a difference]], as the structure of the AA program makes clear. Still, if you would like to hear various forms of [[deepity]], ask them what the difference is.

As noted above, the "steps" repeatedly mention God. Meetings begin with recitation of the "Serenity Prayer" and can include more prayer, and the AA literature is overtly infused with religiosity. AA also sprang out of the [[Christian]] Oxford Group movement. As a consequence, a number of courts have ruled that enforced AA attendance violates the [[Establishment Clause]] such as in the cases of Griffin v. Coughlin<ref>[http://www.law.cornell.edu/nyctap/comments/i96_0137.htm Griffin v. Coughlin, 88 N.Y.2d 674 (June 11, 1996)]</ref> and Warner v. Orange County Dep't of Probation.<ref>[http://caselaw.findlaw.com/us-2nd-circuit/1132790.html Warner v. Orange County Dep't of Probation,827 F.Supp. 261 (S.D.N.Y.1993).]</ref><ref>For more legal cases, see Derek P. Apanovitch, [http://scholarship.law.duke.edu/dlj/vol47/iss4/3/ Religion and Rehabilitation: The Requisition of God by the State], 47 Duke Law Journal 785-852 (1998).</ref> While some atheist, agnostic, and humanist-oriented AA groups sprang up in response to AA's religious nature,<ref>Roger C. [http://www.americanhumanist.org/HNN/details/2011-11-a-history-of-agnostic-groups-in-alcoholics-anonymous A History of Agnostic Groups in Alcoholics Anonymous.] ''Humanist Network News'', Nov. 2011</ref> they are usually not available outside of major urban areas. There has also historically been tension between these groups and organizational AA writ large -- for example, two atheist/agnostic groups in Toronto were de-listed for failing to adhere to AA religious ideology.<ref>Leslie Scrivener. [http://www.thestar.com/news/article/1002750--fight-over-god-splits-toronto-aa-groups?bn=1 Does religion belong at AA? Fight over 'God' splits Toronto AA groups.] ''Toronto Star'', Jun. 3, 2011</ref>
In actual fact, AA is attended by many non-religious people. For them, "GOD" can mean just "Group Of Drunks" (which AA encourages, as it keeps focus upon the group itself).

===Is AA a cult?===
{{hatnote|Note that in this particular case, [[Betteridge's law of headlines]] does '''not''' apply.}}
Many critics (and, surprisingly, a few supporters) have labeled AA as a "[[cult]]".<ref>L. Allen Ragels. [http://www.csudh.edu/dearhabermas/aacultbk01.htm Is Alcoholics Anonymous a Cult? An Old Question Revisited.]</ref> One way AA can be likened to a "cult" is its origins in the Oxford Group movement (later re-named Moral Re-Armament). William Griffith Wilson ("Bill W.") and Robert Holbrook Smith ("Dr. Bob") were the original co-founders of AA. Both were involved in the [[Lutheran]] Christian Oxford Group, a movement somewhat popular among the rich in the 1920s and 1930s, which stressed personal conversion and surrender to God. It targeted successful businessmen, doctors, and other upper-class pillars of the community, and was often described as a "[[Salvation Army]] for snobs".<ref group=note>Not to be confused with the earlier Oxford Movement in the [[Anglican]] church</ref> Frank Buchman, the founder of the group, courted the rich and powerful. His tight grip on the movement led it to be known pejoratively as "Buchmanism." Bill W. reworked the Oxford Groups' six principles into the "Twelve Steps".<ref>Dick B. [http://www.dickb.com/articles/oxford_roots_dsb.shtml The Oxford Group and Alcoholics Anonymous.] Alcoholics Anonymous History
A.A.'s Oxford Group Roots: Article 12</ref> He also later took a lifelong interest in [[spiritualism]] and even participated in [[seance]]s and early [[LSD]] experiments even as he remained sober (from alcohol, at least).

Charles Bufe makes a distinction between "communal AA" (i.e., generic AA meetings) and "institutional AA" (i.e., AA as employed in rehab facilities and prisons). He argues that AA is not a cult, but it does have cultic trappings, with institutional AA being more cult-like than communal AA. Bufe describes the organization of communal AA as [[anarchy|anarchic]] while claiming institutional AA to be coercive.<ref name="bufe">Charles Bufe. (1998) [http://www.morerevealed.com/library/coc/index.html ''Alcoholics Anonymous: Cult or Cure?'' (2nd ed.)] Tucson Arizona: See Sharp Press</ref>

Jeffrey A. Schaler, Ph.D., cites Galanter among others in that "As in the [[Unification Church]] workshops, most of those attending AA chapter meetings are deeply involved in the group ethos, and the expression of views opposed to the group's model of treatment is subtly or expressly discouraged". "AAers seek a relationship with the [[supernatural]] in order to cease managing their own lives....The AA concept of control differs significantly from the concept of control presented to drunkards by the rest of society....AA...tells the newcomer that his life is unmanageable and that it is ridiculous for him to try to manage it."<ref>Schaler, Jeffrey A "Cult Busting" VOLUME 2, ISSUE 5 THE INTERPSYCH NEWSLETTER JUNE, 1995[http://www.schaler.net/fifth/cultbusting.html]</ref>

Reading the approved addiction literature of A.A. and Al-Anon provides no definition of a healthy, mature "recovered" person. One is always an alcoholic/addict, forever dependent on 12 step groups, and always at the brink of relapse if he or she doesn't follow certain directives and trust external authority, that is the God of one's understanding and the 12 step teachings. The locus of control is outside himself/herself.

Other ways in which AA is cult-like:
*Its meetings have features of religious services, such as plenty of sermonizing, and group recitation of the Serenity Prayer at the end of most meetings. Ironically, the Serenity Prayer's author called AA's predecessor "a religious expression of a decadent individualism" and a "Pollyanna religion," and considered that it had been based on "a Nazi social philosophy" from the beginning.<ref>Niebuhr, Reinhold (1936). ''Christianity and Power Politics,'' Chapter 29: "Hitler and Buchman." Reprint of Niebuhr's criticism that first appeared in ''The Christian Century'', October 7, 1936, pages 1315 and 1316. An online version can be read at [http://thearidsite.tripod.com/12NIEBUH.HTM http://thearidsite.tripod.com/12NIEBUH.HTM].</ref>
*It makes financial demands on its members, such as publicly soliciting donations at the end of each meeting and strongly encourages people to purchase AA literature.
*It competes with other groups for its members' time, with attendance being psychologically enforced by the group (the standard demand is "90 meetings in 90 days").
*It had central authority figures in William Wilson and Robert Smith, who also lived off of other AA members.
*It exerts control over other aspects of members' lives (another common demand: "Dump your spouse and marry the AA group").
*It expects its followers to recruit more people into it (see that 12th "step").
*It insists to its followers that if they leave AA, they will DIE.<ref group=note>See also [https://www.youtube.com/watch?v=U5xkxTfVLSA Mean Girls].</ref>
*It makes absolutist demands (total abstinence, total honesty, no resentments, etc.), which are used to control members who slip up and further indoctrinate them into the program. ("You weren't being 100% honest, which is probably why you had that drink at the wedding. You need to work the steps rigorously or you will face jails, institutions, and death.")
*Much like Catholicism denying the communion to active sinners and encouraging confessions in a non-soundproof chamber, it makes use of tokens and encourages people to track their days of sobriety, so even a single drink a month will automatically reset the "counter", even if it's a very substantial improvement. 
*It makes use of [[thought-terminating cliché]]s in order to actively discourage critical thought, such as "quit your stinkin' thinkin'" and "your best thinking got you here."
*It tells members [[Bullshit|there is no other way to get sober]]. Because AA expresses an almost dogmatic belief that alcoholism is some sort of "incurable disease" that ends in death unless arrested by their 12-step program, members treat disagreement with AA doctrine [[Appeal to fear|as a serious threat to their lives]], and when a more evidence-based method is brought up, they literally accuse people of "killing alcoholics".
*A scary number of members believe the Big Book to be divinely inspired. For example, Charles Bufe cites an AA service worker as saying, "I consider the Big Book as an inspired text, written by Bill under the guidance of the spirit." This strengthens their belief that they are the only way of getting sober and their treatment of all deviations from the doctrine as mortal threats.

==Effectiveness of AA treatment==
As a general disclaimer, claims about the success rate of AA should generally be taken with a grain of salt. They ultimately pose a problem due to the following reasons:
*AA doesn't conduct research on itself besides a membership survey.
*AA's tradition of anonymity makes it difficult or impossible in many cases to track participants in studies.
*AA meetings may vary by locale. The heterogeneity of AA meetings may make comparisons difficult.
*Data may be self-reported, causing it to be biased.
*The definition of "success" may vary, e.g. is moderation or abstention (or near abstention) considered a success?
*Some AA attendees may be discouraged from seeking evidence-based medical treatment for alcoholism in favour of concepts from AA theory, literature, and the opinions of other members. 
*Not all AA attendees necessarily meet the medical criteria of alcoholism, as excessive alcohol use can have a wide variety of potential causes other than addiction. This is not acknowledged or considered by AA and the suggested method of self-diagnosis is based primarily on attempting to abstain and observing the result; aside from being medically unreliable, a risk exists of potentially fatal {{wpl|Delirium tremens|withdrawal seizures|.}}
*The attrition rate of AA is so high that most people who try it don't stick around long enough to be factored into any account of a success rate.
*Attendees who fail are [[blaming the victim|blamed for not following the program]], which is a form of [[just world hypothesis|just world fallacy]], is psychologically damaging, and encourages further relapse.<ref>[http://freethoughtblogs.com/pharyngula/2016/08/13/gods-stealing-the-credit-again/ God’s stealing the credit again]</ref> It would be one thing if there were any evidence to suggest that anything about AA was evidence-based and was independently verifiable or reproduceable; since nothing in AA can be measured or tested, it is simply [[magical thinking]], and the vast majority of people whose lives do not improve as a result of it are [[gaslighting|told that it's their own fault]].
*AA is often promoted by members in professional positions or other positions of authority who are encouraged by AA's twelfth tradition to lie about their glaring [[conflict of interest]].<ref name="bufe"/>

===Alcoholics Anonymous leads to increased binge drinking===
It is difficult to run a [[randomized controlled trial]] on AA for these reasons. AA claims, based on its most recent (2007) survey, that 69% of its members have been sober for more than one year.<ref>[http://www.aa.org/pdf/products/p-48_07survey.pdf Alcoholics Anonymous 2007 Membership Survey]</ref>

However, studies have been conducted. A study published in book form under the title Outpatient Treatment of Alcoholism (Brandsma et al., 1980), was an NIAAA-funded study of AA and three alternative therapies: lay-led Rational Behavior Therapy (similar to today's SMART Recovery program); professionally conducted one-on-one Rational Behavior Therapy (today called Rational Emotive Behavior Therapy); and professionally conducted one-on-one, traditional (Freudian-based) insight therapy.

The study came to a number of conclusions:

The study showed that alcoholic men who went to Alcoholics Anonymous became 9 times more likely to subsequently “binge drink” than those who used a cognitive behavioral approach. What’s more, they were also 5 times more likely to binge than a control group who received no help with drinking. "Our study suggests further confirmation of this in our severe dropout rate from this form of treatment {Alcoholics Anonymous}. It is probable, as Ditman et al.'s (1967) work suggests and ours confirms, that AA is just not effective as a coerced treatment with municipal court offenders. (Brandsma et al., 1980, p. 84)"

Peele and Bufe assert, "The increase in binging behavior among those exposed to AA in this study militates against coercing DUI offenders into AA attendance. One very possible reason for the increase in binging is the emphasis in AA upon inevitable loss of control after even one drink, as codified in the AA slogan, "one drink, one drunk." (As we saw in Chapter 1, this assertion is not true, except to the extent that drinkers believe it to be true.) What likely happens is that for those exposed to AA, this inevitable loss-of-control belief becomes a [[self-fulfilling prophecy]]. So, when a true-believing AA member slips and has a drink, or even eats a rum ball or ingests a bit of mouthwash containing alcohol, he or she could be provoked to embark on a full-bore binge." Given this, one can't help but be alarmed at the common practice of coercing DUI defendants into AA attendance and 12 step treatment.<ref>Peele,Brodsky,Bufe: "Resisting 12-Step Coercion" Chapter 2 Sharp Press [http://www.morerevealed.com/library/resist/r_chap_2.htm</ref>

Steven Slate concurs with Peele's and Bufe's assessment of this study, commenting that standard 12-step based treatment teaches people that they have no control over alcohol use, that their ‘disease’ is progressively getting worse (whether or not they’re currently drinking), and that a single whiff or sip of alcohol will send them on an uncontrollable rampage of drinking. It is commonly said within the recovery culture that if you start drinking again after a period of abstinence, you will go right back to your most extreme levels of drinking, and then quickly go far beyond that. In stark contrast to the foundations of cognitive behavioral approaches, the purveyors of conventional treatment and average 12-step members alike, vigorously oppose any suggestion that problematic substance use is a freely chosen behavior.<ref>The Clean Slate: Alcoholics Anonymous leads to increased binge drinking [http://www.thecleanslate.org/alcoholics-anonymous-increases-binge-drinking-brandsma-study/</ref>

Don McIntire of Burbank CA was given access to the AA membership surveys from 1968 through 1996. His article showed that 81% of first timers attending AA meetings drop out in the first 30 days and at the end of 90 days, 90% of them have left AA. At the end of the first year, only 5% remained in AA. He suggested that those who leave AA in the first 90 days be excluded from the survey sample in determining retention rates, thus increasing the retention rate percentage to 50% from 5% by only considering those newcomers, the 10% who remain in AA past 90 days.<ref>McIntire, Don : "How Well Does A.A. Work? An Analysis of Published A.A. Surveys (1968-1996) and Related Analyses/Comments" in the Alcoholism Treatment Quarterly (Vol 18, No. 4, 2000) centers on the 5 per cent one-year retention rate AA itself reports a figure of 95% in a review of the AA trienn of members dropping out by the first year</ref><ref>Lifering Convenor "Once again on the AA drop out rate" [http://liferingconvenor.blogspot.ca/2007/12/once-again-on-aa-dropout-rate.html</ref> A Cochrane Review of eight trials found that none unequivocally supported the efficacy of AA.<ref>Marica Ferri, Laura Amato, Marina Davoli. [http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005032.pub2/abstract Alcoholics Anonymous and other 12-step programmes for alcohol dependence.] Cochrane Database of Systematic Reviews 2006, Issue 3</ref> A 2009 metanalysis (Kaskutas 2009) found two trials to be supportive of AA, one null, and one negative trial.<ref>Lee Ann Kaskutas. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746426/ Alcoholics Anonymous Effectiveness: Faith Meets Science.] J Addict Dis. 2009; 28(2): 145–157.</ref> Based on meta-analysis, the ''Handbook of Alcoholism Treatment Approaches'' ranks AA as the 38th most effective treatment for alcoholism out of a list of 48 treatments<ref>[http://www.behaviortherapy.com/ResearchDiv/whatworks.aspx What works? A summary of alcohol treatment research], in R. K. Hester & W.R. Miller (Eds.), ''Handbook of Alcoholism Treatment Approaches: Effective Alternatives'' (3rd ed.), 2003, Allyn & Bacon.</ref>

==AA and sexual assault==
AA has become controversial for issues with sexual assault or exploitation.<ref>[https://www.vice.com/en/article/7x4m8q/sexual-assault-alcoholics-anonymous] Sexual Assault and Alcoholics Anonymous</ref> There is also the rather cynical euphemism “13th Stepping” which describes long time sober members sexually exploiting newly sober and vulnerable members, often jeopardising their sobriety.<ref>[https://www.recovery.org/exposing-the-shocking-truth-about-13th-stepping/] Shedding Light on the Issue</ref> The vulnerable party is often blamed for the fallout, being told to “look for their part”,<ref>[https://aabeyondbelief.org/2018/03/07/episode-83-sexual-harassment-and-predation-in-aa/] Sexual Harassment and Predation in AA</ref> and there is a culture of preserving anonymity, even of predators,<ref>[https://whyileftaauk.wordpress.com/2014/06/25/13th-stepping-or-get-her-on-her-back-before-she-gets-on-her-feet/] get her on her back before she gets on her feet</ref> with rape survivors being discouraged from talking about their experiences in case it puts other members off.<ref>[https://www.thefix.com/13th-step-inside-aas-subculture-sexual-predation] Inside AA’s Subculture of Sexual Predation</ref>

Some AA supporters have challenged this view, and have objected to members trying to warn others of the potential dangers at AA meetings. This includes author Anna David, who insists it isn’t AA’s fault that women get assaulted through its meetings. She failed to examine how the sponsorship structure, court ordered attendance, culture of blame / shame and double faceted anonymity (good for privacy, bad for accountability) might contribute to rape culture. Instead she repeats the AA mantra that criticising the program in any way - in this case, attempting to warn women about a culture that may facilitate sexual assault - will put women off the program, and thereby inevitably harm them.<ref>[https://m.huffpost.com/us/entry/us_5a0b6c18e4b06d8966cf336a?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvLnVrLw&guce_referrer_sig=AQAAACm8sVpiG5OiAqoyD0Z31Ci7BDbEo9m0qnhjfSSUv3Ri4S0C2QasqiUunZCuWSLCUqtbM1GBoj00eZ9WJNz_u8x-Mg71z7LqsAjVqeb-bAnxF-Tyzr8Z9WdK2SqfuzdSXuM8fJXNgGSkfLnfVESPPiAlq4ltsGAhJ0Yds6P0-8xS] I’m So Sorry You Were Assaulted. But It’s Not AA’s Fault</ref>

Other AA advocates have examined this situation in a more nuanced and sympathetic manner, discussing how the 12 steps can and should be adapted for trauma survivors<ref>[https://www.thefix.com/are-12-steps-safe-trauma-survivors] Are the 12 Steps Safe for Trauma Survivors?</ref> and how to make meetings safer. Some national groups have released conduct guidelines, and the American branch has explicitly clarified that reporting members’ who engage in criminal or threatening behaviour to the police is *not* a violation of anonymity.<ref>[https://www.rehabs.com/pro-talk/alcoholics-anonymous-finally-addresses-the-issue-of-safety/] AA Addresses the Issue of Safety</ref>

==The Big Book==
AA's Bible, The Big Book, may begin with a glowing "doctor's opinion," but the 1939 [[peer-reviewed]] Journal of the American Medical Association had less favorable things to say about it:<ref name="JAMA">[http://silkworth.net/bbreviews/01007.html Big Book Review, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION]</ref>

{{quotebox|The book under review is a curious combination of organizing propaganda and religious exhortation. It is in no sense a scientific book, although it is introduced by a letter from a physician who claims to know some of the anonymous contributors who have been "cured" of addiction to alcohol and have joined together in an organization which would save other addicts by a kind of religious conversion. The book contains instructions as to how to intrigue the alcoholic addict into the acceptance of divine guidance in place of alcohol in terms strongly reminiscent of Dale Carnegie and the adherents of the Buchman ("Oxford") movement. The one valid thing in the book is the recognition of the seriousness of addiction to alcohol. Other than this, the book has no scientific merit or interest.<ref name="JAMA"/>}}

Another highlight of the Big Book is a chapter called "To Wives," which claims to be written by Bill W's wife Lois for the wives of alcoholics (presumed to all be male and heterosexual), but was actually written by Bill W himself, against Lois's expressed wishes.<ref>[http://www.aa.org/pages/en_US/frequently-asked-questions-about-aa-history#tres Alcoholics Anonymous: Frequently Asked Questions About A.A. History]</ref><ref>[http://aaagnostica.org/2014/10/01/bill-wilson-and-other-women/ Bill Wilson and Other Women]</ref>

==Other twelve-step programs==
There are numerous other twelve-step programs for other addictions and social issues based on the AA blueprint. Narcotics Anonymous<ref>See [http://www.na.org/ na.org.]</ref> (no relation to the [[Scientology]] [[front group]] [[Narconon]]), founded in 1953, is probably the most famous of these. It should be noted that the steps are exactly the same except "alcohol" is replaced with "addiction."

Disorders and addictions covered by twelve step programs include the following (and more): [[Tobacco smoking|cigarettes]], [[gambling]] & betting, co-dependency, sex addiction & [[pornography]], eating disorders, and even cluttering/hoarding.

Controversially, 12-step programs have expanded into support programs for conditions not even remotely characterized by addiction, such as for victims of child abuse or rape survivors. These programs use the existing 12 steps in the original AA form, often merely replacing the wording "alcohol" with "child abuse" or "rape" while keeping the entirety of the 12 steps process intact. Such programs are questionable at best, as the making-amends and admitting faults part of the 12 steps were ostensibly intended for people who had done wrong, not the victims of wrongdoings.<ref>[http://www.siawso.org/page-158755 Survivors of Incest Anonymous]</ref><ref>[http://www.asca12step.org/ASCAA-12steps.htm Adult Survivors of Child Abuse Anonymous]</ref><ref>[http://usatoday30.usatoday.com/news/health/2002-10-14-rape-survivors_x.htm usatoday]</ref>

Regarding the "Rape Survivors Anonymous" program, USA Today writes:

''Although the RSA "steps" say rape is not a victim's fault, participants are invited to list all people "our actions had harmed as a result of our being raped" and then make amends to those people. The steps also include taking personal inventory, "and when we were wrong promptly admit(ting) it," as well as "humbly ask(ing) God to remove our shortcomings."''

==Rehab==
Most inpatient rehabs in the United States use the 12 step program, requiring attendance to meetings of either Alcoholics Anonymous or Narcotics Anonymous. Other models include Scientology's unscrupulous version, Narconon, as a basis for treatment. It is very rare in the United States that rehabs would not be entirely based on 12-step programs. When potential patients ask if the program is religiously based or 12-step based, generally they will opt to call it a spiritual program. This seems to be the case due to the idea that 12-step programs can work for everyone, a dubious claim at best.

Bankole Johnson, Chairman of the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia, noted that the 12 step rehab centers are divorced from state-of-the-art medical knowledge, expensive, and that spontaneous recovery (without meetings or treatment) is 24%. He asserts that the AA retention numbers are very poor when compared against this percentage. Recent advances in neuroscience have led to a greater understanding of how alcohol and other drugs affect the brain. There is no need to separate an addicted person from family and friends and shut them away. Many proponents of AA cite Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), however, the 2005 article in the journal BMC Public Health that reanalyzed the data from Project MATCH reported that almost all of the effect of treatment was achieved after attending a single session. It was the person's initial decision to try to get better that mattered, and what followed was of little consequence.

He also states that the AA message as contained in their literature the "Big Book" can be harmful for many: "AA maintains that when an alcoholic fails, it is his fault, not the program's." The AA Big Book states: "Those who do not recover are those who cannot or will not give themselves completely to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates… they seem to have been born that way."<ref>Johnson, Bankole A. "We are addicted to rehab and it doesn't work" The Washington Post August 8, 2010, [http://www.washingtonpost.com/wp-dyn/content/article/2010/08/06/AR2010080602660_2.html</ref>

Stanton Peele and Charles Bufe assert:
"The Vaillant study is probably the single best piece of evidence on 12-step treatment. It had several components, including a long-term longitudinal study of a group of "100 alcohol-dependent men and women followed for eight years after being admitted to a clinic for detoxification" (Vaillant, 1995, p. 2). (This clinic was the Cambridge and Somerville Program for Alcohol Rehabilitation, CASPAR, a 12-step inpatient/outpatient program, for which Dr. Vaillant worked as a psychiatric consultant.) Vaillant compared the outcomes of these 100 patients with those of alcoholic members of two comparison groups, subjects of two long-term longitudinal studies begun by other Harvard researchers: a group of 456 "Core City" Boston men, who had been followed since they were school boys; and a group of 204 former Harvard students, who had been followed since their college days. Vaillant also compared the outcomes of the 100 CASPAR patients with those of treated alcoholics in other studies, and with the outcomes shown in studies of untreated alcoholics. Vaillant's results were that the 12-step hospital treatment he helped to provide was utterly ineffective, as judged in comparison with studies of untreated alcoholics. As Vaillant remarked, "Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling" (Vaillant, 1995, p. 352). He continued, "our results were no better than the natural history of the disorder." (i.e., no treatment)

Vaillant is a strong supporter of Alcoholics Anonymous. (He is currently a member of AA's General Service Board.) While reporting these "appalling" results, Dr. Vaillant commented, "if we have not cured all the alcoholics who were detoxified over 8 years ago, the likelihood of members of the Clinic sample attending AA has been significantly increased" (pp. 357-358). But did Vaillant really find that AA is that helpful? Actually, greater attendance at AA by the alcoholics he helped to treat did not enhance their treatment outcomes relative to untreated groups. Furthermore, in the Core City group which was followed for 50 years, 48 men among the alcohol abusers achieved what Vaillant termed "stable abstinence." Of these, about a quarter (27%) relied on AA (defined by having at least 30 AA visits by the age of 48 that is, well less than a year's attendance). In other words, even among those seeking abstinence, the large majority in Vaillant's untreated sample succeeded without AA."<ref>Peele, Brodsky, Bufe "Resisting 12 Step Coercion" Chapter 2 "The Efficacy of 12-Step Groups and 12-Step Treatment" Sharp Press [http://www.morerevealed.com/library/resist/r_chap_2.htm</ref>

Even more so than alcohol addiction (and tobacco addiction), it has been shown that drug addicts tend to "age-out" of addiction on their own without any treatment.<ref>[https://www.sciencenews.org/article/addiction-paradox The addiction paradox]</ref>

===12 Steps are too many===
In 1997, addiction specialist William Miller co-authored a paper 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.

In 2009, 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. The results showed that those who received spiritual guidance reported being significantly more anxious and depressed after four months than those who received secular help. Miller asserted that there is a high incidence of suicide among substance abusers, therefore the conclusion was the non-faith-based treatments like [[cognitive behavioral therapy]] or mindfulness-based acceptance and commitment therapy are the better choices for treatment.<ref>Time Magazine: "Battling Addiction Are 12 steps too many" January, 27th 2009 [http://www.time.com/time/health/article/0,8599,1872779,00.html</ref><ref>In British Colombia as of 2016 only AA is recommended to people who need it. Other more evidence-based systems are not recommended. [http://www.patheos.com/blogs/friendlyatheist/2016/07/14/british-columbia-legislator-says-prayer-can-help-people-with-all-kinds-of-disorders/ British Columbia Legislator Says Prayer Can Help “People With All Kinds of Disorders”]</ref> The steps themselves are of varying lengths — an admission to self of being helpless is fairly simple, but inventory and restitution take far longer.

There is also the phenomenon of "Two Steppers". These are people who go through step one and step twelve, i.e. helping others. Not surprisingly, this is controversial.

==Secular alternatives==
Those looking for secular support groups and programs dealing with addiction have a number of alternatives to AA. Some include:
*[https://secularaa.org/ SecularAA]
*[http://www.smartrecovery.org/ SMART Recovery]
*[https://rational.org/index.php?id=1 Rational Recovery]
*[http://www.cfiwest.org/sos/index.htm Secular Organizations for Sobriety (SOS)]
*[http://womenforsobriety.org/beta2/ Women for Sobriety]
*[http://lifering.org/ LifeRing Secular Recovery]
*[http://www.moderation.org/ Moderation Management]
*[http://www.patheos.com/blogs/friendlyatheist/2016/07/23/michigan-radio-segment-highlights-secular-alternatives-to-alcoholics-anonymous/ Michigan Radio Segment Highlights Secular Alternatives to Alcoholics Anonymous] ''A discussion about many alternatives''
The, 'submit to a higher power' part Alcoholics Anonymous does not always suit people without religious beliefs. From time to time people without religion are pressured to attend AA and even punished for not taking part in AA despite secular alternatives being available.<ref>[http://www.patheos.com/blogs/friendlyatheist/2016/10/06/canadian-atheist-files-human-rights-complaint-after-being-forced-to-attend-alcoholics-anonymous/ Canadian Atheist Files Human Rights Complaint After Being Forced to Attend Alcoholics Anonymous]</ref>

SMART Recovery utilizes [[cognitive behavioral therapy]] techniques that are at least as effective as the 12 Step programs<ref>https://www.smartrecovery.org/smart-recovery-president-gerstein-responds-new-research-finding-smart-mutual-support-groups-work-well-aa/</ref> and meetings are open to everyone regardless of views on religion.

==Medication alternatives==
{{wpl|Nalmefene}} is an opioid antagonist first produced in the 1970's. Evidence suggests nalmefene is sometimes effective both as a rapid treatment for isolated cravings and as a long-term countermeasure. It is "out of patent", however, and pharmacies have no reason to promote it if no profit is to be made.<ref>https://www.theguardian.com/society/2014/nov/26/nalmefene-pill-reduce-desire-drink-alcohol-nice-prescription</ref>

The "Sinclair Method" involves pharmacological extinction - the patient takes an opiate-blocker called Naltrexone an hour before drinking and ideally, the desire to drink should be eliminated.<ref>[https://www.thefix.com/actress-claudia-christians-mission-spread-word-about-naltrexone]</ref>

==See also==
*[[Conversion therapy]]
*[[Faith healing]]
*[[Self help]]
*[[Synanon]]
*[[Teetotalism]]

==External links==
*[http://www.aa.org Official website] of Alcoholics Anonymous.
*[http://www.morerevealed.com/ More Revealed]: Website with free access to publications critical of AA.
*[http://www.orange-papers.info Orange-pages.info (formerly Orange-papers.org)]: Anti-AA site with extensive history and critical analysis.
*[http://silkworth.net/ Silkworth.net]: Massive archive of AA material and studies on AA.
*[http://skepdic.com/sat.html Substance abuse treatment] in [[The Skeptic's Dictionary]]
*[http://www.agnosticaanyc.org/worldwide.html Find atheist AA groups]

==Notes==
{{notelist}}

==References==
{{reflist|2|80%}}

[[Category:Booze]]
[[Category:Organizations]]
[[Category:Pseudoscience promoting organizations]]
[[Category:Religion]]
[[Category:Self help]]
[[Category:Woo]]

Categories: Booze, Organizations, Pseudoscience promoting organizations, Religion, Self help, Woo