Full disclosure: I was a drunk for fifteen years, gave up eight years ago, and have adopted a policy of total abstinence ever since. I went to AA meetings for a few months; more than anything, they irritated me for their poorly concealed religiosity. Why I have yet to relapse is the central, enduring mystery of my life; but I can guarantee AA has nothing to do with it.
Alcoholics Anonymous is sacrosanct among its members – and it's understandable, too. In many cases, their lives have been saved by sticking to AA's twelve-steps. "The program" has worked for a lot of people who are utterly convinced, beyond all persuading, that it will work for everyone else – and that it represents the only hope for addicts. AA's true believers have the zeal and self-certainty of religious zealot. Sadly, in many respects, their claims are no less fanciful.
In a tour de force in April's The Atlantic, Gabrielle Glaser tackles "The Irrationality of AA", explaining how its scientifically dubious 12-step approach has gained ascendancy in the US:
The 12 steps are so deeply ingrained in the United States that many people, including doctors and therapists, believe attending meetings, earning one’s sobriety chips, and never taking another sip of alcohol is the only way to get better. Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment.
Glaser critically examines AA's claims for itself, and explores how concerted public relations and lobbying efforts have enshrined its preeminence:
In 1970, Senator Harold Hughes of Iowa, a member of AA, persuaded Congress to pass the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act. It called for the establishment of the National Institute on Alcohol Abuse and Alcoholism, and dedicated funding for the study and treatment of alcoholism. The NIAAA, in turn, funded Marty Mann’s nonprofit advocacy group, the National Council on Alcoholism, to educate the public. The nonprofit became a mouthpiece for AA’s beliefs, especially the importance of abstinence, and has at times worked to quash research that challenges those beliefs.
Since AA was founded in 1935 (when, as Glaser writes, "the knowledge of the brain was in its infancy"), there have been great advances in the scientific understanding, and medical treatment, of addiction. Glaser looks in particular at the surprising efficacy of Naltrexone, a drug designed to suppress cravings (a moderate drinker, she even tries it herself), and travels to Finland where efforts to moderate drinking behaviour, as opposed to total abstinence, have proven successful.
The article won't trick me into experimenting with moderate alcohol consumption – Glaser acknowledges that abstinence is the only viable option for hardcore boozehounds like me – but it should prompt public health officials to examine whether their dependence on AA and its unscientific methods hasn't become a problem.