The Irrationality of Alcoholics Anonymous

There’s a good article here on the myth of AA and how it is rarely questioned in mainstream culture. Everyone thinks, “You’re an alcoholic, go to AA” but it’s a faith-based (or at least informed) treatment that has no records whatever of success or failure, or indeed anything. AA claim that the success rate is about 75% or over. However:

In his recent book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, Lance Dodes, a retired psychiatry professor from Harvard Medical School, looked at Alcoholics Anonymous’s retention rates along with studies on sobriety and rates of active involvement (attending meetings regularly and working the program) among AA members. Based on these data, he put AA’s actual success rate somewhere between 5 and 8 percent. That is just a rough estimate, but it’s the most precise one I’ve been able to find.

A 5-8% success rate. That’s shocking, especially for a course of treatment that is held up as the sine qua non.

In fact, the very word ‘alcoholic’ is no longer apparently used by clinicians, who see matters very much more in nuanced terms:

We once thought about drinking problems in binary terms—you either had control or you didn’t; you were an alcoholic or you weren’t—but experts now describe a spectrum. An estimated 18 million Americans suffer from alcohol-use disorder, as the DSM-5, the latest edition of the American Psychiatric Association’s diagnostic manual, calls it. (The new term replaces the older alcohol abuse and the much more dated alcoholism, which has been out of favor with researchers for decades.) Only about 15 percent of those with alcohol-use disorder are at the severe end of the spectrum. The rest fall somewhere in the mild-to-moderate range, but they have been largely ignored by researchers and clinicians. Both groups—the hard-core abusers and the more moderate overdrinkers—need more-individualized treatment options.

One of the best books I’ve come across on the subject is “The Sophisticated Alcoholic” by David Allen. He explores, from his own experience, how one can slide into ‘heavy drinking’, alcoholism or whatever you want to call it, then gently guides you through a process (largely based on EFT) to help you through and out of it. His end point is to return one to a more normal pattern of drinking, where you can have a drink if you feel like it, even two or three, but then you can perfectly happily leave it. Or no drink at all for any length of time.

All of which seems to me infinitely more likely to succeed—and infinitely more humane—than AA.

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