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Does AA Work?

Google AA (Alcoholics Anonymous) and you find a lot of negative opinions about it online. “AA is a cult.” “AA only has a 5% success rate.” “AA is an irrational “faith based” program.” “AA is a dangerous playground for violence-prone members.” “AA doesn’t work.” “The pseudo-science of AA.” So, if it does not work then why has it been so successful? What’s the story?

The modern movement of recovery from addictions did not start with medical science but rather it started with two guys, Bill Wilson, a stock broker, known as Bill W, and Bob Smith, MD, a physician, known in AA as Dr. Bob. These two guys suffered from severe alcoholism. The fact that these two addicts are the ones that came up with any kind of plan for helping other alcoholics is pretty incredible. Their accounts have been told and validated.

In 1935 when they both found relief from their severe chronic addictions there was little hope offered for “chronic inebriates.” Bill W had been admitted to the hospital many times. His physician had recommended he be committed to an asylum because he was essentially end-stage. Dr. Bob, a surgeon, had essentially lost his medical practice and was known to be a chronic drunk in his community.

So, what happened? As the story goes, Bill W, had a visit from an old drinking buddy who had found relief from his drinking problem through a religious experience. When Bill found out that this was what his old friend was “selling” he wanted nothing to do with it. Bill was an atheist. Nevertheless, some months later when he was again in the hospital Bill, in utter despair and hopelessness, he prayed to a God, he didn’t even believe in, to help him. Something happened that changed his life. He felt his obsession to drink lifted, at least temporarily. He told his physician, Dr Silkworth, about the experience and the doctor encouraged him to go with it.

So, Bill W became obsessed with trying to help others find a similar experience. His efforts were a total failure at first. Dr. Silkworth told him to stop trying to help people find a spiritual experience but instead just tell people his own story, what he had experienced. So, Bill W then happened to be in Akron Ohio trying to facilitate a business deal. The deal fell through and he was tempted to drink again and this time somehow, he sensed that he needed to talk to another drunk to avoid drinking. He got on the phone and started calling people to find another drunk who might need help. He called churches and eventually was referred to someone who referred him to Dr. Bob Smith. He called and arranged to meet him.

Bob related later that he was not at all interested in meeting with someone peddling sobriety but his wife arranged the meeting. Bob was actually drunk when they met and Bill W surprised him, not by trying to get him to quit drinking, but by telling him he needed another drunk to talk to in order to avoid drinking himself. He ended up telling Bob his entire story, blow by blow, of all his trouble from alcohol and the misery he’d gone through, the spiritual experience he’d had and then the temptation he’d recently experienced that led him to seek out another drunk. Bob found the whole thing intriguing. Bill ended up moving in with the Smith’s and after a few false starts Bob Smith also became sober.

So, this was the founding of what would later become known as Alcoholics Anonymous. In 1939 they published a book about it. Writing the book prompted them to come up with what they saw as the steps they’d taken. At the time of the publication of the book in 1939 there were about 100 men in AA.

It is interesting that today the same process is at play. Most people with addictions are not religious. Many are atheists or at least agnostic. The healing process involves talking with other alcoholics or addicts who have had similar terrible experiences but they got better and they often talk about some type of spiritual experience. Many find this idea abhorrent at first. Many are determined that religion is not of any interest to them. But it often seems that doesn’t matter and if they just participate they tend to get better. Many have very vague notions of what a spiritual experience actually is. Some find it in the community of AA or similar programs where they hear others talk about their addictions. Others do have some type of mystical experience. Some find this experience slowly and others have a sudden experience of healing.

The twelve steps are actually sound principles for any type of healing or change. The first three steps are the most profound, in many ways. Profound but simple.

The first step is acknowledging there is a problem. Admitting you have a problem. This would seem simple but for many it is actually incredibly difficult. Admitting the problem is a fundamental step toward change to acknowledge there needs to be a change. So, the principle of the first step is said to be “honesty.” Mostly, honesty with oneself. Honestly admitting the troubles in one’s life associated with alcohol or drug use.

Once one admits they have a problem, especially if they’ve tried to fix it many times and failed, it can feel hopeless. Hopeless because we’ve tried to quit. We’ve tried to cut down. We’ve promised. But we always seem to fail. So, the principle of the second step is hope. It is the step where we see others have succeeded so why can’t we. We couldn’t seem to stop on our own power but maybe there’s a “higher power,” whether it be the community of AA or some spiritual power, that can help us.

The third stop simply follows from the first two and is the principle of commitment. Commitment to do what others have done who got better.

That is pretty much it. The next 6 steps are very helpful to reduce shame. Many people with addictions have a lot of shame.

And then the last 3 steps are called the maintenance steps. They involve an ongoing commitment to honesty, surrender to getting help, admitting problems and finally talking with other alcoholics and addicts, which seems to be a very helpful process for many.

Is there scientific evidence that AA works? Anecdotally, there is powerful evidence. Millions of people have participated and claim benefits. Does it work as a treatment methodology?

There is data that suggest a low response to AA when people are referred there by doctors or courts or others. The exact numbers are uncertain. One thing is clear that if someone checks out AA and does not participate it does not work. But what treatment works if you don’t use it. Penicillin has a very low benefit for someone if they don’t take it. So, the study that measures AA’s benefit should be conducted among those who attend and participate for some period of time.

AA really has no position on whether it works or not. It is just a program of people who have had success, often against terrible addictions, who have done what Bill and Bob did.

In my practice, I encourage people to try AA. People who say they don’t like it I have found have not participated. It makes a big difference to go to an AA meeting and just observe versus speaking up and telling the truth. It works much better if you participate. I tell my patients that AA is free and it is everywhere so give it a try. It is a worldwide program and there is a reason it has flourished.

So, ignore the archaic language. Ignore the online negativity. Ignore the media’s opinion about AA. Try it for yourself. In AA they say, “Give it a try and if you aren’t satisfied we will gladly refund your misery.”

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