This article originally appeared in The Skeptic, Volume 20, Issue 4, from 2010.
If you have had a serious drinking problem in the United States of America you might have had serious troubles to go along with that problem. You might have a drunken driving conviction, or landed in a hospital or detoxification facility by court order. If any of these things have happened to you, it is almost a certainty that you have been introduced to the programme of Alcoholics Anonymous otherwise known simply as AA. If you have been fortunate enough to have avoided jail or hospitals but have, on your own, sought professional help to stop or to moderate your alcohol consumption, the odds are still very, very high that you have been advised to attend meetings of AA.
The programme of Alcoholics Anonymous, known as a 12-Step Program, is the number one treatment for alcoholism in the US as imposed by the courts and supported by the medical community for the last forty years. Very few health insurance companies will cover alcohol or drug addiction treatment that is not 12-step based. It would be reasonable to assume therefore, as most do, that AA is not only a successful treatment for the alcoholic but is probably the best available today.
Both assumptions are completely unfounded and unsupported by scientific or historical evidence. The truth is that the available evidence strongly suggests that treatment under the AA programme provides very little or no long-term help at all for active alcoholics. Further, there is ample evidence that long term repeated exposure to this programme is actually dangerous to many alcoholics who would have fared better if left on their own.
This is a truly appalling and frightening state of affairs for millions of alcoholics and their loved ones. It means that the medical profession and the court system in the U.S. are directing thousands of sick people each year into a religious-based programme that has little or no merit as a treatment for their illness. It also implies that few serious alternatives are routinely brought to the attention of the troubled alcoholic.
What is Alcoholics Anonymous? Who are its adherents? What are its methods? How has AA become so deeply inculcated into public and professional thinking vis-à-vis the treatment of alcoholism? If it doesn’t work, as I have suggested, why not? What in the world could actually make it dangerous? Is there medical, therapeutic, or psychological treatment involved? Is it entirely based on religious beliefs? What makes it a religious cult?
Alcoholics Anonymous claims to be: “… a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking…. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.” (A Brief Guide to Alcoholics Anonymous, 1972). These words sound positive and hopeful but they do not describe the true workings or intent of AA.
To be plain, there is ample evidence that Alcoholics Anonymous is in reality a religious cult masquerading as a self-help group. Its adherents actively indoctrinate newcomers to their way of thinking using overt and subtle misinformation, intimidation and false promises. They routinely prey on a population subset of sick people at their weakest, namely, desperate alcoholics. Through ancillary groups like Al-Anon and Alateen, AA also attempts to bring the families of alcoholics into their cult. Unless AA has something tangible, verifiable, and repeatedly helpful to offer these people, this makes them not just deceitful but dangerous.
This might sound like an astounding accusation to anyone who has not been maltreated by AA or studied them carefully. Likewise, you may know seemingly happy recovering alcoholics who swear by the benign and benevolent nature of the AA program. You may be one yourself.
Those who believe they have remained sober solely by strict adherence to the programme of Alcoholics Anonymous, and there are thousands, will generally never have anything but praise for the program. But if thousands have recovered when millions have tried, then the best that can be said is that the success rate is low. The worst that can be said I have already written. For every happily recovering anonymous alcoholic there are hundreds who have found the programme at best worthless and at worst a curse or even a death sentence. Ironically, I have often heard it said in AA meetings that to be successful in one’s recovery, one must “… step over the bodies”.
The first thing one is asked when initiated into AA is to keep an open mind. I agree wholeheartedly. If you are currently trying to remain sober through AA or are of the opinion that it is a good and necessary support programme for alcoholics, I implore you to keep an open mind to the premises already mentioned and the following substantiated facts. They may save your life or that of someone you know. At the very least this knowledge may save you a lot of time and let you find real help sooner.
A Brief History of AA
Alcoholics Anonymous is a largely decentralized organization – a random collection of smaller groups, cofounded in 1935 by Bill Wilson, an unsuccessful stock trader, and Doctor Bob Smith, a surgeon. Bill had suffered for years with ever-advancing and debilitating alcoholism, having lost all ability to earn a living and having been repeatedly institutionalized for detoxification to save his life. By his own account and that of his wife and others, he was a hopeless case destined for death by prolonged alcohol poisoning or commitment to an insane asylum for alcohol-induced dementia known medically as Korsakoff ’s syndrome or wet brain.
One day an old friend and self-admitted fellow drunk, Ebby Thatcher, called and came over to visit Bill at his house. Ebby was clean and sober and told Bill that he had overcome his alcoholism by finding religion. Specifically, he had joined a small sect of evangelical Christians called the Oxford Group founded by Frank Buchman. Though sceptical, Bill attended some church meetings, but still lapsed back into destructive drinking.
During a last-ditch effort to save him, his wife and his brother-in-law sent Bill once again to a medical sanatorium to dry out and receive a multiple drug treatment common in the day that involved administration of various sedatives along with the psychotropic, even hallucination-inducing, drug belladonna.
While under the influence of strong psychotropic drugs, Bill Wilson had a vision of a bright light and the completely and fully to God, and that an important part of his recovery would be to bring the news of his epiphany and recovery to other suffering alcoholics. By all accounts, he never drank alcohol again and spent the rest of his life building and advocating the organization of Alcoholics Anonymous. He is known to have suffered massive depressive episodes during his life but remained sober. He died in 1971 at the age of 75.
Bill Wilson is credited with authoring the eponymous fundamental text of Alcoholics Anonymous generally called The Big Book (Wilson, 1939/2001). In The Big Book, Bill tells his story of recovery and outlines twelve steps by which he believes any alcoholic can recover. In a second book, titled Twelve Steps and Twelve Traditions (Wilson, 2003), Bill elaborates greatly on the twelve steps and adds twelve principles for maintaining the organization of AA. The 12 steps and some of the 12 traditions will be presented here as we examine the methods of AA.
Bill Wilson met Dr. Bob Smith early in his recovery and Dr. Bob also successfully found sobriety by giving his life to God and particularly to Jesus Christ through the Oxford Group. They were two men to whom their personal recoveries were nothing short of miraculous. They set out immediately and with great urgency to spread the word to other alcoholics. As they gathered recruits to their method of alcoholic salvation, regular attendance at highly ritualized meetings of their fellows became an essential aspect of the AA doctrine.
Their recruitment success rate was nearly zero at first. By the time of the writing of The Big Book around 1938-1939, they claimed an active membership of roughly 100. There is scant or little evidence for the general success of the early adherents other than that they regularly attended meetings and kept trying the programme when they relapsed. Still, it appears that there was a substantial dropout rate such that Bill and Dr. Bob had to constantly recruit new members.
By 1939 The Big Book had been published and both Bill Wilson and Dr. Bob were vigorously promoting their programme in other cities with the income from book sales. A glowing account of their efforts by Jack Alexander appeared in an article in the Saturday Evening Post in 1941 after which they began to receive national attention. Around this time they also found support in the person of John D. Rockefeller Jr. With his enormous resources and influence, Rockefeller did much to help keep the fledgling organization alive.
Evidence and Propaganda
These historical facts are not in dispute. The same basic story is available from AA literature or their website http://www.alcoholics-anonymous.org. What is not mentioned but noteworthy is that the medical community at large rejected the AA “cure” for alcoholism at the start. This is understandable because, as we will see, the supposed cure involved appeals to a supernatural agency and all reports of success are entirely anecdotal. Nonetheless, The Big Book opens with a ringing endorsement by one Dr. Robert Silkwood who had worked with alcoholics for years and knew Bill Wilson personally.
Dr. Silkwood was duly impressed with Bill’s recovery and contributed the only medical opinion in the book. Dr. Silkwood also developed a personal theory that alcoholics had acquired an allergy to alcohol – something that is still offered as fact within AA, but has never been endorsed by the medical community. There seems to be no evidence at all to support the allergy theory of alcoholism. Alcoholism was not even medically recognized as a disease until the American Medical Association declared it so in 1956.
Today Alcoholics Anonymous boasts 2 million adherents in over 120 countries worldwide; this from the Fourth Edition, 16th printing in 2005 of The Big Book as well as their website. How they have arrived at this number is unclear, as is their reporting of their rates of success in getting and keeping alcoholics sober. Reliable statistics are notoriously difficult to come by when dealing with drug addicts. Aside from being incarcerated, caught in the act of using, or from reports of associates, or forced chemical tests, one has only the word of the user as to whether or not he or she has remained sober. AA has the additional problem of not keeping track of those who come and go through its meeting doors. Still, in order to find support in the medical community AA has needed to compile some form of statistics on success rates.
Starting in 1964 the Alcoholics Anonymous General Service Organization (GSO) began conducting its Triennial Surveys of their current population and compiling the results. The 1983 report claimed to be the first to use scientific statistical sampling techniques. In that year AA finally employed a professional consultant who introduced them to the statistically valid stratified sampling technique. This indicates that any survey results prior to 1983 were unreliable. Though AA had never before 1983 used valid statistical methods they regularly reported success rates from 25% to 50% or even higher (Comments on AA’s Triennial Surveys, 1990). Thus, for the first 48 years of their existence AA members were simply inventing numbers and spreading them as propaganda throughout the American public consciousness. Ironically, AA is a self-described programme of “rigorous honesty” (Wilson, 1939/2001).
Still, the introduction of valid statistical methods if done properly could have yielded reliable data beginning in 1983. I have had no luck finding continued surveys after 1989, but in that year AA reported that on average, after 6 months, 93 percent of new attendees had left the programme and that after one year only five to seven percent remained (Comments on AA’s Triennial Surveys, 1990). It is unclear whether or not this takes into account those who leave and rejoin the programme repeatedly over years.
The five to seven percent reported for a steady year of sobriety is usually counted as the short-term success rate of the Alcoholics Anonymous program. Taken out to five years it is exceedingly difficult to estimate. Members with decades of sobriety are hard to find and greatly valued as speakers at meetings. Some travel extensively promoting the cause. Others become licensed addiction counsellors and work in facilities that include 12-step initiation. In this way the intra-programme perception of having many old timers is perpetuated.
Independent Investigation
Their own unfavorable statistics do not, however, dissuade AA from continuing to claim great success for their programme. Bill Wilson wrote in The Big Book that, “Rarely, have we seen anyone fail who has thoroughly followed our path. 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” (Wilson, 1939/2001) On his deathbed he is reported as saying he wished he had written never instead of only rarely. The argument is that many may come through the doors of AA and most may not come back, but those who truly practice the 12 steps always succeed. This is, of course, an argument that can be neither proved nor disproved. It is in no way scientific and, as we shall see, the methods of AA are non-rigorous and subjective because the “cure” involves appeals to supernatural agencies.
A brief history of AA now in place, we turn to the obvious question of independent attempts to validate the success of the treatment scientifically. There have been surprisingly few over 70 years. Still, more and more evidence has come to light that AA simply does not help alcoholics. The Harvard Medical School reported in 1995 evidence that a significant number of problem drinkers recover on their own. They wrote in the Harvard Mental Health Letter in October, 1995: “One recent study found that 80% of all alcoholics who recover for a year or more do so on their own, some after being unsuccessfully treated. When a group of these self-treated alcoholics was interviewed, 57% said they simply decided that alcohol was bad for them. Twenty-nine percent said health problems, frightening experiences, accidents, or blackouts persuaded them to quit. Others used such phrases as ‘Things were building up’ or ‘I was sick and tired of it.’ Support from a husband or wife was important in sustaining the resolution” (Treatment of Drug Abuse and Addiction, 1995).
It is most useful here to present evidence from one of the first large reliably validated scientific studies of its kind, which targeted the programme of Alcoholics Anonymous directly and exclusively. It was performed by Dr George Vaillant, MD, a Harvard psychiatrist and noted authority on the disease of alcoholism, and an open proponent of Alcoholics Anonymous. Dr Vaillant is the author of The Natural History of Alcoholism, a seminal work in the field published in 1983.
Dr Vaillant conducted a study whereby he followed 100 alcoholics consecutively admitted for detoxification to an alcoholism clinic in Cambridge Mass, with which he was associated. The subjects were followed for a period of eight years with status obtained annually after discharge from the clinic.
Though he expected great success through the AA program, he was instead greatly disappointed. His honesty and candor, though, are commendable. Dr Vaillant wrote:
It seemed perfectly clear… by turning to recovering alcoholics [AA members] rather than to PhD’s for lessons in breaking self-detrimental and more or less involuntary habits, and by inexorably moving patients… into the treatment system of AA, I was working for the most exciting alcohol program in the world.
In Orange, no date
But then came the rub. Fueled by our enthusiasm, I and the [clinic] director, tried to prove our efficacy. Our clinic followed up our first 100 detoxification patients… every year for the next 8 years. The clinic sample results [were] also contrasted with three studies of equal duration that purported to offer no formal treatment. After initial discharge, only 5 patients in the clinic sample never relapsed to alcoholic drinking, and there is compelling evidence that the results of our treatment were no better than the natural history of the disease. […] Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling.
Note carefully that in this study of 100 subjects, 3% of these individuals died every year for eight years while actively participating in AA. This means that at the end of the 8th year only 76 of the original test sample remained alive – 24 had died. The random population sample used in the experiment should have been little different than that of the general US population of adults in which approximately 1% die a year from all combined causes (roughly 900 deaths per 100,000 people in 1985). Even taking into account that chronic alcoholics may be in poorer health than the average citizen, 24 dead in only eight years or over 3 times the national average, is an extremely depressing statistic.
Note also that when Dr. Vaillant refers to AA as being no better than the natural history of the disease he means that his studies and others have shown that chronic alcoholics left to their own devices with no intervention at all still recover at the rate of about five percent a year. Interestingly, and what I find confounding, Dr. Vaillant is a secular (non-alcoholic) member on the Board of Trustees of Alcoholics Anonymous World Services, Inc. Despite his failure as a scientist to prove any efficacy whatsoever to the programme, he remains an ardent supporter of Alcoholics Anonymous.
Misdirection, Mind Control and a Higher Power
But the doctor’s attitude is really quite typical of the AA supporter. There are undeniably thousands of individuals within AA at any given time that used to drink chronically but are at present clean and sober. We have seen, though, that many of these would probably have recovered with no help at all. AA members tend to give the credit for their success entirely to the programme. The recovering alcoholic is taught by AA to give all credit to God and AA. They generally oblige, regardless of any other external or internal factors that tend to keep them sober such as an honest desire to be healthy again, or the love and support of their families. AA denies these influences and The Big Book even admonishes AA devotees to put family third after God and AA, and to put everything else in life last.
It is a flawed argument to use a snapshot of the reported success of a population sample to claim overall long-term success for the larger population. The more rigorous and statistically sound approach of Dr. Vaillant and others has repeatedly provided scientifically sound statistics that belie any claims made by those with a vested prejudice for the programme.
This brings us to the next set of fundamental questions. Whether or not AA has ever been shown to work reliably or repeatably, how is it even supposed to work? Is it really a religious cult instead of a cure for alcoholism?
Alcoholics Anonymous claims to be a spiritual, not a religious programme of alcoholic recovery. They claim that the disease of alcoholism is one of Body, Mind, and Spirit. But they focus entirely on the Spirit. Since the 12 steps are essential to understanding the AA philosophy, I present them here as taken directly from The Big Book.
The 12 Suggested Steps of Alcoholics Anonymous
1) We admitted we were powerless over alcohol – that our lives had become unmanageable.
2) Came to believe that a Power greater than ourselves could restore us to sanity.
3) Made a decision to turn our will and our lives over to the care of God as we understood Him.
4) Made a searching and fearless moral inventory of ourselves.
5) Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
6) Were entirely ready to have God remove all these defects of character.
7) Humbly asked Him to remove our shortcomings.
8) Made a list of all persons we had harmed, and became willing to make amends to them all.
9) Made direct amends to such people wherever possible, except when to do so would injure them or others.
10) Continued to take personal inventory and when we were wrong promptly admitted it.
11) Sought through prayer and meditation to improve our praying only for knowledge of His will for us and the power to carry that out.
12) Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
I will not attempt to analyze each of these steps in detail. Taken as a whole they are offered as a “suggested” programme of recovery. It is often said to newcomers in AA that they should take what they can use and leave the rest; at least they are told that at first. There is no doubt, however, that the teachings of the 12 steps are intended to be a complete and wholly necessary set of instructions (dare I say Commandments?) for the alcoholic to achieve a lasting sobriety. It is completely obvious by inspection that the steps are a recommended path to theological enlightenment not just sobriety.
These steps are a direct expansion of the principles taught by the Oxford Group founded by Frank Buchman, of which Bill Wilson and Dr. Bob Smith were devoted members. The Oxford Group, incidentally, had no affiliation with the University of Oxford and later changed its name to Moral Re-Armament and later again to Initiatives of Change.
The Oxford Principles
To seek Divine Guidance in all aspects of life
To humble oneself to God and surrender completely to Him
To acknowledge any offenses against others
To make restitution to those sinned against
To promote the group to the public in an evangelical manner
By examination of the existing evidence, if not by their own admission (AA insists it is not a religious programme), AA seems to be a religious sect. They encourage their members to actively seek a personal relationship with God. They advocate intercessory prayer and the confession of sins, and they promote evangelicalism. I and others have gone further and called AA a dangerous religious cult. How do we justify this more pernicious interpretation? Find out in From the archives: Exposing the myth of Alcoholics Anonymous – cult not cure.
References
- A Brief Guide to Alcoholics Anonymous (1972).
- Comments on A.A.’s Triennial Surveys (1990). Alcoholics Anonymous World Services, Inc., New York.
- Orange, A. (n.d.).
- Treatment of Drug Abuse and Addiction: Part III. (1995). Harvard Mental Health Letter, 12(4), 3.
- Vaillant, G. (1983). The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery. Cambridge, MA: Harvard University.
- Wikipedia (n.d.).
- Wilson, B. (1939/2001). Alcoholics Anonymous: The Story of How Many Thousands of Men and Women have Recovered from Alcoholism. 4th ed, new and revised. New York: Alcoholics Anonymous.
- Wilson, B. (2003). Twelve Steps and Twelve Traditions. New York: Alcoholics Anonymous.
