A central question, particularly for critics, is why, exactly, does 12-Step recovery work? Read More
The assumption that this article is based on is that AA experience is positive. While finding a group of people which can feel empathy for one's problems is a huge relief for a newly sober person, as it was me; over time the constant self-devaluation brought on by constant adherence to the 12 steps as a guide to living, and child-like relationship with a "sponsor" can hinder growth. That was my experience. AA also holds the "recovering" person literally captive by telling them they can never leave AA meetings without experiencing either "jails, institutions, or death".
When sharing one's story in AA, that story is constantly honed and corrected by the influence of group members so it fits the story expected in AA. Eventually it may well bare no resemblance to what really happened in the individuals life, though they may at that point believe the edited and re-edited version. Trust me, this doesn't help a person's memory improve. I have spent the last few years trying to regain my actual story, which has become hard to find after being painted over and over with AA-ism for over 20 years.
I believe that good therapy from a professional would REALLY produce the neurological changes that the article tries to align with AA, I am currently experiencing this, I believe. AA believes that professionals can't understand alcoholics; many AAs are adamant that members should not take medications for mental illness.
The professional people criticize AA because real science refutes its claims of success; while other, proven, treatment methods are cast off due to AA members, often either employed in treatment centers or volunteering there, who believe that AA is the ONLY WAY God has provided for a person to get sober. If you had cancer and your Oncologist told you that the only God-approved method for treating cancer was developed in 1938; how fast would you beat a path out of his office?
I believe it is the cultish nature of AA that causes members to fight science constantly; rather than professionals having it in for AA, and members just defending this wonderful program. There is also the fear of AA/NA members losing jobs in treatment centers, since if more proven methods start being used, the treatment councilors whose entire resume boils down to being in a 12-step program themselves, might be out of their jobs.
This hydra has many heads. I am not a scientist, but I believe it's a defensive stretch to try overlay neurology onto the 12-steps as an assumption that hasn't scientifically been proven. And if any studies are done on this, I have no doubts that anyone harmed by AA would be ineligible to participate, and it would probably limit participants to those who have at a maximum being in the fellowship less than 5 years who still feel the relief of love bombing.
Arguably, 12 steps is an anachronistic dogmatic ideology with reference to empirical, evidenced based addiction medicine these days. AA is an ideology driven program that considers one in denial if you don't agree with them and you are destined to crash and burn. AA is a, "shame fueled," program in many ways. 12 Steps was founded in the 1930s in a post lobotomy era where there was no known cure for alcoholism. The Scientific method of the accumulation of observable data that conforms to the requirements of objectivity and reproducibility, is for the most part, the antithesis of AA.
I consider AA to be a very good band aide, as a means to an end. The fact that AA is free and a multi billion dollar rehab business is built around AA is a huge factor in continued referrals. The problem is band aides don't get to the cause of why people abuse and behave the way they do. A lay group is not designed to get to the etiology of one's displaced behaviors. Never the less, it is good start, ... in 1935.
Having said that, I appreciate Dr. Sacks' insight, rational and perspicacity with respect to, "How AA works at a neurological level." AA does have a temporary place in addiction therapy.
I find this article refreshing and encouraging. Rarely do I read a positive review of 12 step fellowships, and I do agree that this creates a divide. As a teacher who teaches AOD & mental health to prospective workers, I always encourage a positive approach in students towards these fellowships as a 'possible' option for clients struggling with addictions. I also cover the aspects that the previous commenters have highlighted, so they are aware and can address these with their clients. In my 24 years of recovery, and 15 years as a professional working in the field and undergoing university training, I am yet to discover a therapy that works as well for so many people.
Thanks for your comment!
As a 34 year recovering person with attendance at AA, I concur with the author about the importance of melding AA and science.
I have taught the nursing RN and LPN Addiction class at our local Community College for the past 6-7 years. I have found much of our society still carries the myths surrounding AA and recovery expectations, many times these myths are perpretrated by people who don't find AA "helpful" for them. This may be the smokescreen needed to not stay involved in a recovery program. The spiritualty part of the program is certainly more than Step 3, and is perhaps best understood when you use the first 3 words, "Made a decision..." I have never heard that telling one's story is "AA qualifying it." I also want to thank the author for this entire article and I do not want to explicate parts of it. I want to support this view, and the work that has gone into the HBO series, "Addiction, A brain disease." When we offer over and over again the research in how the brain responds to alcohol and drugs, and good feelings coinside, we have come a long way in helping the public in discoverying, "Addiction as a Disease of Learning and Memory."
Agreeably, AA is not for everyone! However, the self searching and analyzing of my behaviors and motives has helped me to live well with others and be at peace. Just as any other group things can go aray when some one pushes their beliefs,thoughts and feelings on another. Reading the AA Big Book, one will find passages of turning to professionals when needed or to your particular faith or none. When I have ceases fighting anyone or anything, then I am at peace. I have no problem reading Dr. Sack's article. It was interesting and good to know how the brain perceives and determines things. Thanks
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David Sack, M.D. is board certified in Addiction Psychiatry and Addiction Medicine and serves as CEO of Elements Behavioral Health and Promises Treatment Centers.
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