AA’s declining dogmatism

Although it might seem surprising to say so, responses to my post “Addiction Myth #4: moments of clarity lead ONLY to AA” actually indicate a decline in the dominance and dogmatism of AA in the 21st Century.

When I entered the addiction field in the 1970s teaching in the University of California’s continuing education alcohol certification program – which served largely as a way for AA members to get jobs as counselors – my views stunned most class members.

Most had never even HEARD of any other way of thinking about addiction than the AA way. My reception was rocky in that environment – I still remember the woman who said she would have to leave class before she killed either herself or me.

The nadir in America for non-traditional approaches was the Mary Pendery-Sobells case, in which alcoholism counselor Pendery published an article inScience claiming Mark and Linda Sobell, a husband-and-wife team of behaviorists, committed fraud when they found controlled-drinking therapy superior to standard AA-abstinence approaches to alcoholism.

My review of the scandal for the first issue of Psychology Today after it was bought by the American Psychological Association created a furor. Pendery lectured about me at National Council on Alcoholism and Drug Dependence conferences around the country. I was disinvited as the keynote speaker to the famed University of Texas summer school on alcoholism and, although I was reinstated when I threatened to sue, I lost my lucrative presence on the national addiction speaking stage.

At that point, through the 1980s, questioning the AA-disease story – that we can solve addiction in the United States by getting every addict and alcoholic into a 12-step group – was to invite ostracism and possibly to end your career.

I then became involved with the drug reform movement, led by Ethan Nadelmann, who gave a voice to harm reduction – the idea that we needed policies to aid and preserve the health of all of the active substance users and abusers in the United States. Despite AA, there remain a few addicts and alcoholics, and probably always will. (In fact, it’s hard to claim that the period of 12-step dominance has led to any diminution in addiction in the U.S.)

Don’t get me wrong – the twelve steps remain the main game in town, and probably always will. While drug policy reformers objected to the suggestion that Minn. Congressman Jim Ramstad become Obama drug czar, since as a 12-stepper he opposes needle exchange and methadone maintenance, their voices have been drowned out by well-intentioned reform groups who admire Ramstad’s support for insurance parity for addiction treatment.

Nonetheless, as I am uniquely qualified to say, the voices of addiction are more diverse than ever before. This is in part because of the work of Ethan Nadelmann and his colleagues, in part because of the acknowledged success of therapeutic techniques such as motivational interviewing and brief interventions, and in part because of the growing presence of non-12-step treatment programs, such as my Life Process Program at the St. Gregory Retreat Center, Tom Horvath’s Practical Recovery Services, and Passages, for the well-heeled Hollywood set.

Of course I still get e-mails like this one from M yesterday, which are sweet and desperate at the same time:

Do you think that the U.S. will ever accept your ideas and method of treatment? I read your book, The Truth About Addiction and Recovery, and it totally makes sense to me. I was reading it while in an outpatient 12 step program. I wish your ideas were more widely accepted because it is very frustrating trying to explain to people that addiction is not a disease. Most people that I have tried to explain what I read in your book just CAN NOT understand and always refer back to the “easier” disease model. I am labeled “in denial” blah, blah, blah because I don’t believe that 12 step programs truly work.

Don’t worry, 12-steppers – people who agree with M will never be a majority in the U.S., and my approach will never become the new dogmatism. We just seek parity.

P.S.  Welcome to Sarah Allen Benton’s new blog — The High-Functioning Alcoholic!