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Why Some People Swear by Alcoholics Anonymous—And Others Despise It

© john van hasselt via getty images

Getting to the bottom of this is crucial to dealing with a big public health problem. Based on federal data, more than 20 million people have a substance use disorder, and within that group, more than 15 million have an alcohol use disorder. Excessive drinking alone is linked to 88,000 deaths each year. So whether one of the most common types of treatment for this disease is actually effective could be a matter of life or death.

For some people, the 12 steps really do work

The 12 steps, first established in the 1930s by Bill Wilson, have now become a powerhouse in the addiction treatment world, with millions of attendees worldwide each year in AA meetings alone. AA has also spawned a network of affiliated groups like Narcotics Anonymous, Marijuana Anonymous, Al-Anon (for family and friends of people with alcohol addiction), and more.

–> Read this inquiry into the current research on AA, from


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In your comments, please show respect for each other and do not give advice. Please consider that your choice of words has the power to reduce stigma and change opinions (ie, "person struggling with substance use" vs. "addict", "use" vs. "abuse"...)

  1. Prior to Alcoholics Anonymous and the 12 Steps, there was nothing that helped with the hopelessness of alcoholism, a problem rampant in society for centuries. Prohibition was evidence of this. Since 1935 AA has given hope to alcoholics and the people who live and work with them that abstinence is not only possible but can be maintained for a lifetime. Mr. Lopez incorrectly describes the steps [sic] by stating one “submits” to a higher power and makes amends for past problems. There is no submission to anything. One makes amends for wrongdoings. In fact, the 12 Steps are but suggestions. Nothing is required in AA. If one doesn’t want to do what others have done to get and stay sober, h/she is welcome to look elsewhere. Keep in mind, the people in AA are human. If one wants to find something wrong, it is easy. It works both ways. If one wants an excuse, they’re readily available. AA as a whole cannot be blamed for Betsey’s conflicts. Any woman who goes alone into a house with a man she doesn’t know takes a risk. My mother warned me about this from a young age! That was her stupidity. Mr. Lopez devotes an entire paragraph to this incident which has nothing to do with Alcoholics Anonymous. If Betsy couldn’t find a sponsor, Betsy had an issue. One has to ask and sometimes has to ask more than once to be sponsored. Again, getting a sponsor is only a suggestion. The practice has shown it helps one stay sober.

    Alcoholics Anonymous goes to great pains to state they are not “affiliated” with anything. The Preamble states “AA is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy, neither endorses nor opposes any causes.” AA does not lend its name to anything. If treatment centers are using the 12 Steps, or DUI Courts are sentencing offenders to AA, they have not done so with any cooperation of AA. They do it on their own. AA’s Traditions state AA does not promote itself. It makes no claims to be the gold standard for sobriety.

    Alcoholism is a fatal disease. Contrary to Ms. Szalavitz’s argument, prayer and meditation have found their way into modern medicine.

    That this misinformation would keep one person from trying AA and send them to their grave bothers me. The second part of the article mentions the fellowship of Alcoholics Anonymous. Changing people, places and things to get sober is a must and made easier in the company of like-minded people. As the article says, it’s cognitive behavioral therapy with a fellowship. Alcoholics Anonymous does not require pledges, dues or fees. It’s a simple solution but it’s hard work. Most meetings end with the rejoinder “it works if you work it.”

    One alcoholic helping another, being sober and happy does not warrant despising.

    1. Thank you Jnana. In addition to hearing cognitive behavior therapy in AA meetings, you would hear relapse prevention skills training, and be provided opportunities for empathy and support through positive reinforcement for sober living. You could also make new friends who are trying to stay sober and would have a place to go every day to hear these important messages, and to pause and reflect on addiction in your life. There is also the feeling of purpose one gets from giving back to others, whether it be shaking hands with someone attending their first AA meeting or washing the coffee pot after a meeting. The feeling of belonging to a group of like-minded people, who also struggle and are working to transform their lives, is itself transformative. Meditation, prayer, and spirituality are there if you want it in AA and help many; they are not, however, a precondition for recovery or for membership in AA. All you need is a desire to stay sober to claim your seat in AA. Peer support, whether through AA, LifeRing, Rational Recovery, Smart Recovery or another group adds an important dimension to the recovery process. When you’re making that list of treatment options for your Loved One, make sure to include a variety of local support groups in your area.

  2. My son is currently thriving in a sober house that follows the 12 steps. He has bonded tightly with the other guys in the house & finds the community that AA provides in his house and at all the meetings he attends to be the cornerstone of his sobriety. He admits he has trouble buying into all the spiritual elements, but doesn’t see them to be so rigidly required that they get in the way of the positive elements of the program. He was on suboxone during a prior period of sobriety but relapsed in part because he didn’t change friends, habits, and ways of thinking and admits he relied on the medication rather than do all of that hard work.

    From my perspective, different things work for different people, and different things work at different times in their lives and the course of their addiction. There doesn’t seem to be much research on the effectiveness of various options based on age, length of substance use, life experiences, personality, genetic inheritance, etc. We have a long way to go.

    1. Agreed, we have a long way to go in understanding what treatments or approaches work best based on the characteristics of a Loved One.

      One large study that attempted to do so was Project Match. For 8 years starting in 1989, a group of people with alcoholism were assigned to three types of treatment: Cognitive Behavioral Coping Skills Therapy, Motivational Enhancement Therapy, and Twelve-Step Facilitation Therapy.

      While the subjects weren’t assigned to one treatment over another randomly, they were tagged by a list of possible characteristics they had going in: level of anger, gender, social networks, etc. Here is a good write-up of Project Match.

      Read Dominique Simon-Levine’s full response to Momdog, including the results of the Project Match study here: