AA’s role in society – More negative than positive?
What is the legitimate role of AA in the recovery of individuals from addiction?
AA has a role for those who naturally gravitate towards it, or who — when told about AA or exposed to it — think they could benefit from it. The United States is a country which accepts religious freedom, and so anyone who chooses may go to AA. In the same vein, absolutely anybody is justified in rejecting AA. More people have quit drinking without AA than with it (as even an AA booster like George Vaillant showed in his book, The Natural History of Alcoholism.)
In absolute numbers quite a few people have benefited from AA. However, in terms of percentages of those exposed to AA, the number helped by AA is small — about 5% remain in AA as long as a year, according to AA’s own surveys. Of course, those who drop out may also be helped, even if they reject the long-term commitment that AA itself encourages.
On the other hand, AA has become increasingly coercive, either literally so — through court sentences (such as for DWI convictions) — or through alternative sentencing (in which the person has a choice of prison time or AA attendance, perhaps accompanied with formal therapy), through social service agencies that require attendance in order for a person to receive benefits, through prison attendance requirements for parole and other benefits, or else through private employers that direct employees suspected of having a drinking problem to AA.
AA spokespeople (like the AA survey analysts) blame AA’s high drop-out rate on the large number of coerced (or at least involuntary) referrals. I don’t actually think that retention in AA would be much higher even if all those who came to AA were volunteers. The two randomized studies in which AA treatment was assigned found AA to yield worse outcomes than other forms of treatment — or no treatment at all. (See Brandsma et al., The Outpatient Treatment of Alcoholism: A Review and Comparative Study, Baltimore: University Park Press, 1980; Ditman et al., “A controlled study on the use of court probation for drunk arrests,” American Journal of Psychiatry, 124:160-163, 1967.) But Walsh et al. (“A randomized trial of treatment options for alcohol-abusing workers,” The New England Journal of Medicine, 325:775-782, 1991) allowed alcoholics limited choices, and those who chose AA still did worst (about as bad as those assigned to AA).
Moreover, forcing people into AA is a generally unrecognized constitutional violation, overstepping the bounds of control that a state, employer, and therapy may exert on the individual. In fact, in a growing number of states, courts have rejected compulsory AA attendance. The decisions are based on the fact that AA is inherently religious, despite its claims otherwise, thus violating the first amendment guarantee of freedom of religion. In 1996, New York’s highest court rejected participation in a prison substance abuse program — one based on the 12 steps and which required AA/NA attendance — as a condition for inmates to be eligible for a family reunion program. (See Griffin v. Coughlin, Commissioner of New York State Department of Correctional Services, Court of Appeals of New York, 88 N.Y.2d 674, 673 N.E.2d 98, June 11, 1996; D. Pines, “Probation department liable for suggesting AA,” New York Law Journal, Sept. 11, 1996, p. 1; J. Barron, “Saying A.A. is religious, court lets inmate skip it,” New York Times, June 12, 1996, p. 6; “AA and religion,” Mental Health Law Reporter, June 1996, p. 41.)
A Maryland Court decided that even telling people that they must declare that they are alcoholics was an impermissible intrusion on individual freedom of choice and conscience. (See E. Luff, “The first amendment and drug and alcohol treatment programs,” In A.S. Trebach & K.B. Zeese, Drug Policy 1989-1990: A Reformer’s Catalogue, Washington DC: Drug Policy Foundation, pp. 260-266.) Thus, what has become the most popular response to DWI convictions in the U.S. is increasingly being declared unconstitutional. (See F.J. Murray, “Courts hit sentencing DWIs to AA, fault religious basis,” The Washington Times, Nov. 4, 1996, p. A10.) In general, the courts’ remedy is that alternative, non-theistic treatments must be offered in addition to AA.
Finally, AA has introduced a strong degree of irrationality, intolerance and hatred into the alcoholism field. AA attendees, who dominate treatment in the United States (more so than anywhere else in the world) as a group do not accept alternative treatments, alternative goals (such as moderation), and alternative providers (those without AA backgrounds). Even today, their role in alcoholism treatment is repressive and totalitarian, and continues to retard progress in dealing with alcoholism in an effective, sensible way that respects the freedom and conscience of the individual.
Several works have now examined the internal workings of AA, its impact (often negative) on its members, and its hazardous role for the larger society, particularly since it is universally accepted as being well-meaning and effective. These books are all moderate in tone and balanced in their presentations of the value of AA, while coming down at different points on a continuum of anti-AA sentiment. Although the consensus is probably that AA does not qualify as a full-blown cult, the books in toto give an impression of a mind-controlling organization often gone amok. (See Charles Bufe, Alcoholics Anonymous: Cult or Cure?, San Francisco: See Sharp Press, 1991; Ken Ragge, More Revealed, Henderson, NV: ALERT!, 1992; David Rudy, Becoming Alcoholic: Alcoholics Anonymous and the Reality of Alcoholism, Carbondale, IL: Southern Illinois University Press, 1986.)