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The Science of 12-Step Programs
Hugh Pickens DOT Com writes "Since the inception of Alcoholics Anonymous — the progenitor of 12-step programs — science has sometimes been at odds with the notion that laypeople can cure themselves because the numerous spiritual references that go with the 12-step program puts A.A. on "the fringe" in the minds of many scientists. But there is an interesting read at National Geographic where Jarret Liotta writes that new research shows that the success of the 12-step approach may ultimately be explained through medical science and psychology. According to Marvin Seppala, chief medical officer at Hazelden and sober 37 years, attending 12-step meetings does more than give an addict warm, fuzzy feelings. The unconscious neurological pull of addiction undermines healthy survival drives, causing individuals to make disastrous choices, he says. "People will regularly risk their lives—risk everything—to continue use of a substance." Addicts don't want to engage in these behaviors, but they can't control themselves. "The only way to truly treat it is with something more powerful," like the 12 steps, that can change patterns in the brain. Philip Flores, author of Addiction as an Attachment Disorder, says the human need for social interaction is a physiological one, linked to the well-being of the nervous system. When someone becomes addicted, Flores says, mechanisms for healthy attachment are "hijacked," resulting in dependence on addictive substances or behaviors. Some believe that addicts, even before their disease kicks in, struggle with knowing how to form emotional bonds that connect them to other people. Co-occurring disorders, such as depression and anxiety, make it even harder to build those essential emotional attachments. "We, as social mammals, cannot regulate our central nervous systems by ourselves," Flores says. "We need other people to do that.""
I would suspect that programs such as these do work, because they provide a means of seeking help, support and resisting temptation, instead of having no direction to go but down.
Donte Alistair Anderson Roberts - hi son!
Karma: Chameleon
had to quit it due to pancreatitis. fuck twelve steps, fuck the AA, fuck the higher power, fuck the addiction treatment industry.
you see what's wrong with for example the AA 12 steps? 8 of the steps are "whee I'm a christian now and can't be judged for raping my cousin" and the rest are pretty much "It's not my fault I am/was an asshole". it's bullshit.
not fucking one of the steps is to ACTUALLY STOP DRINKING! and half of the steps are practically just setting up that it's not their fault if they drink!
here's my two step program.
1) stop drinking.
2) try to fill the time with something to make things feel as fun as when drinking.
step two is hard, because, hey, drinking is highly enjoyable.
(* due to having stopped drinking, I find myself unable to stop posting obnoxious poorly spelled comments to slashdot, but hey, it works. btw if you drink, don't be an asshole. AA is geared for people who are so big assholes they can't even go to the corner shop sober because they know they're such dicks when they drink, which makes for a sorry loop).
world was created 5 seconds before this post as it is.
The problem with 12 step programs isn't the people who they work for, the problem is that so often they are presented as the only option. Not everyone who has ever used any addictive substance has no control over themselves.Some people used them for different reasons, and those people are often forcefully pushed into these 12 step programs right along side the people who need them.
Most schools are trying to come to terms with the fact that people learn differently, when will treatment programs come to terms with the fact that people recover differently?
As a former heavy smoker I can tell you, I did want to smoke. Hell yeah. It felt good. It was relaxing, it was soothing, it was great. Don't give me that "I don't want to smoke but I can't stop" bull. You want to smoke. At least admit it. You may not like the coughing and the shitty taste in your mouth in the morning (no, really...), you may not like how people react to you, but you do like the cigarette (or in my case, cigar), the moment you light that fire you WANT it. Don't gimme any of that crap that you light it with remorse, you don't. You lean back, you put it in your mouth, you light it, you inhale, you enjoy it. Face it, that's the truth. Lie to yourself if you prefer, but that's simply how it is.
Was I an addict? I guess yeah. Did I like to stop? Yeah, I did. But mostly because for some odd reason from one day to the next the craving stopped. I lighted the cigar and it was not enjoyable. I did not like it. I simply didn't. I put it down and that was a few months ago now. The cigar is still lying where I put it, ready to be smoked at any time. I just don't want to.
Pretty much at the same time some important changes came to my life and I think it's pretty much how you described it. The drug was a substitute. Once it's no longer needed, it will cease to provide the enjoyment that it once did. That certainly doesn't work for everyone, but nobody should give me the bull that he doesn't like his drug. If he didn't, he'd simply drop it. Addiction is nothing but a craving that you want to fulfill. A quite heavy craving, I may add, but it's still you that decides whether or not you give in or whether you look for other ways to relax and enjoy.
We used to have a Bill of Rights. Now, with the rights gone, all we have left is the bill.
My father managed to get out of several decades of drug and alcohol abuse (and criminality) via the 12 step. He got an education in treating addicts and now work since a number of years treating others with the 12 step. It works (but that's not news).
Seeing this pretty close and talking to my father about many details, I can state this with absolute certainty that it is 100% exactly the same as any "mind-controlling" cult, but for a different purpose. It works the same, looks the same, everything - and it even has a lot of "god" in it, although many people choose to interpret that in other ways. Especially it is formed to teach you that you are powerless and must trust whatever higher power. It turns the addicts into addicts for meetings instead of drugs.
I have many many problems with the treatment as it is done today, especially since it forms a life-long dependency on something new (this is the trick!) instead of the drug, and the breaking down of the mind. But, on the other hand, it's better than the alternative. I just can't help thinking that there must be a better way than switch addiction for addiction. My father disagrees, of course, simply because for him, this is not how he views it, he sees himself as free from addiction, but he gets all jittery if he can't go to a meeting for a few days...
If we are gonna reprogram humans (it's similar to NLP?), I'm sure it would be possible to reprogram them in a better way than this.
Addiction is a habit that has developed a chemical dependancy. Try taking a regular coffee drinker's coffee away from them for a couple of weeks. It is down right scary to watch the withdrawal.
Some have a hard time stopping others enjoy it so much they really don't want to stop. you can break the habit but because of the chemical dependency it is much much harder.
Also Habits are only a choice in the beginning. once they get going you have to choose to stop, to break the habit.
i thought once I was found, but it was only a dream.
It trades one addiction for others: religion, caffeine, and nicotine. It trades personal responsibility for not drinking, and thus drinking, to an imaginary higher power.
There is no "-1 offended" or "-1 you don't agree with me" mod options for a reason.
There is a lot of evidence to suggest that 12-step programs are nothing more than window-dressing. That they take credit for spontaneous remission - the percentage of people who just quit on their own.
For example, alcoholics have a spontaneous remission rate of roughly 5% - so if an AA program has a 5% success rate (including the people who give up on the program - the AA people don't like to count them) then AA is just a no-op.
Here's one of many analyses making the argument that 12-steppers are just bad at math.
http://www.orange-papers.org/orange-effectiveness.html
When information is power, privacy is freedom.
My AA story...
In college, I attended an AA meeting as a requirement for a Psychology class. I wan't an alcoholic or even on the path to alcoholism; I just needed to fulfill the requirement and "attend an AA meeting" was the easiest way to do that.
The first thing I noticed was that all the people in the meeeting (there were maybe 40 attendees) had replaced alcohol with coffee and cigarettes. The second thing was that all of these people seemed to care about each other. A lot. It wasn't anything explicit or obvious; it just seemed to radiate from everybody and it generated this vibe that was incredibly warm and fuzzy. I didn't announce why I was there, so unless they asked me the other attendees just treated me like another anonymous alcoholic. And they treated me like I was their son or their brother. It felt really, really comfortable and nice. At one point, I actually thought to myself "it's too bad I'm not an alcoholic, because it would be great to hang out with these people every week."
I left that meeting on an emotional high. The only way I can describe it is that it was like finding out you had a whole branch of your family that been searching for you for years, and now you've been reunited and your new family just accepts you with -- not just open arms -- but with a tangible joy that you've finally joined them. It was awesome! And then I got about 50 feet out the door and said to myself "You just got hooked by a cult!"
I was shocked because I had always assumed that I was 100% absolutely immune to cults. I had read stories about people who were brainwashed into joining them and thought that I -- with my intelligence and my skepticism and my stable family life -- could never fall for something like that. But I had only been there for two hours and they had hooked me. Had I been less intelligent or cynical or more lonely maybe I wouldn't ever have realized what was happening.
But more importantly (at least for the report I had to write for my Psychology class), I understood how AA works. It's a cult. A brain-washing, mind-controlling cult that uses the same psychological techniques as Jim Jones or Heaven's Gate to control people, and then uses that control to help them conquer their addiction demons. It's atomic fission harnessed to light up a city rather than to destroy it. And it works because we're social animals and our brains normally respond to social cues at a level far beneath our concious thought. Unless we're actively guarding against it, we can all be manipulated this way. Even you.
Please note, I'm not in any way claiming that AA is bad or that they use social power to do anything other than try to help people. People's need for social interaction is just a fact, and AA uses this knowledge as the starting point to help people stop drinking. Knowing that you have several dozen people who care about you, who would be disappointed if you had a relapse, who look to you as an example of success, or who would be happy to talk to you if you just need help resisting the urge; that knowledge might make the difference between you giving in to your addiction and you staying sober for another day. That's a good thing and if AA works for somebody then that's great.
So I completely agree with AC's suggestion that AA is a cult; but I disagree that this is in any way a bad thing.
There was an AA meeting group in the civic center I volunteered at. A loved one and friend of mine also attended AA meetings.
Though I am an atheist without a drinking problem I helped set up and clean up, and became tangentially involved with 12 step programs over the years.
One major compulsion to attend AA and other 12 step addiction programs, especially for teen and young adult members, is the unwritten "13th Step": Sex and/or relapse into addiction with other members. Some have related to me that they were introduced to hard drugs or "milder" drugs like cigarettes and caffeine via AA... When I asked if trading one vice for another wasn't just as bad (smoking packs of cigarettes a day is very bad and severely addictive), "One addiction at a time," they would say. One need only look at the coffee expenses nearly all AA meetings have to realize the effectiveness at combating addictions are quite subjective... A cyberneticist might even say: They have changed from sating their tendency via physiological addiction into sociological addictions, either can be severely harmful; Please enjoy addictions responsibly; Everything flows, moderation is the key.
I can believe that addictive personalties may favor a certain substance or habitual activity above others (drug of choice), but I can also acknowledge that there is no such binary as "AA works" -- It's more like: AA has some success and a lot of failures: Success more likely only if you've "Hit Rock Bottom" first however, which I find quite ridiculous. Either it does or doesn't work, the belief in AA that a cathartic event that nearly destroys a person be practically a prerequisite for recovery is dangerous, reckless, and foolish -- Not based in empirical study, for certain; Only anecdote.
There was a teen 12 step program my friend was in, "Lifeway", and "PDAP", before that. These were largely modeled after AA's 12 steps, but Lifeway mushed the "you believe in a higher power" in with some other step so that it could squeeze in a step about abandoning your friends since they will cause you to fall back into addiction again... Even abandoning me because I wasn't "a winner" in life enough to help my friend "work a program". This is a common cult tactic.
The safety net gone, when my friend could not "work a program" due to being as atheist and thus incompatible with the "higher power" step, my friend's parents (upon advice from the parent meetings they attended) kicked my friend out of the house. They said the other families wouldn't let them stay with them, even though such was the apparent practice, and instead they were shown, "Tough Love". My friend became a 16 year old homeless person and flunked out of high school. My friend said they still attended the meetings, because they were too ashamed and afraid to contact an old friend like me -- they said that if the group, family, or "sponsor" found out about the contact it could mean prolonging the homelessness. Though they had been without drugs while failing to "work a program" for over a year, they started using drugs again once on the street... Of course! That was my friend's first encounter with harder drugs... This before the 3rd step of the program could even be attempted, they said.
AA and other 12 step programs do not provide the housing aspect a teenage kid requires to survive, so they were of no help, "Keep coming back, it works if you work it," is the literally ignorant motto. After months of homelessness and abject prostration before the parents of Lifeway my friend was allowed to stay with another family, but not their own family; It was more "Tough Love" they said. I saw my friend with the new family around town and was quite puzzled because they'd never hung out before, and I was given the cold shoulder when I tried to say Hi.
Later, my friend had said they had to earn back the right to live in their home, and couldn't take any chances... Meanwhile they were instructed to attend "outpatient" meetings, which my friend described as exp
First of all, there's no (official) 'Christian' angle in 12-step programs. The higher power is nothing more than a technique for letting go of trying to control things yourself.
I refer you to steps 2, 3, 5, 6, 7 and 11 all of which explicitly invoke a diety of some kind. Claims that the twelve steps do not involve religion hard to swallow and frankly a bit disingenuous. It's pretty hard to buy the claim that those steps collectively are somehow independent of christian teachings. Those steps collectively are little different in function from confession in the christian tradition. Furthermore the founders of the twelve step programs themselves come from a christian tradition.
If 12 step programs clearly worked I would have little problem with that fact. If some prayer genuinely helps someone get their life together and stop drinking, who am I to judge? Anything that helps without harming others is fine with me. The problem is that it is not at all clear if they are actually effective. Some evidence points towards them being helpful for some people, much indicates that they provide little benefit and in occasional cases might have actually proved harmful. It's hard to study their effectiveness because the nature of twelve step programs tends to be secretive and there are other problems such as lack of a control group. The evidence supporting AA as an effective treatment is scientifically quite weak. Most evidence seems to show that at best it has a success rate barely better than those who do not take the program. I have a problem with the notion of prescribing religion as a treatment regimen in light of the fact that there is no compelling evidence that it actually has the desired outcome.
Since there are tens of thousands of groups that are all different, I can't say that anything in particular is true of every group, but the book "Alcoholics Anonymous" tells us what it's designed to be. The book is abundantly clear. Drinking can be replaced by service to others. As I write this, I'm caring for a severely autistic young man while his parents are in church, instead of getting drunk with my brother. Here with me is my beautiful wife, who wouldn't have married me if I were still living like I used to. It works for me.
You say that you suspect that they work. But there is no data to support that. In fact, most 12 steppers fail, and the success rate for 12 steppers is as low as the success rate for people just deciding to quit without using the 12 step program. Penn and Teller did an episode of their show "Bullshit" that talked about 12 step programs and gave some interesting data on its success. I'll suggest that you may want to see it before telling more people why you think 12 step programs work. They do not. You can usually find copyright infringing episodes of this show on You Tube. This supposed report is just more Bullshit.
I'm an American. I love this country and the freedoms that we used to have.
The article is propaganda, plain and simple. In the first few sentences the author is already using words like “success” and “a miracle” to describe 12-step programs. I was interested in the article at first because the headline seemed to promise coverage of a genuine scientific assessment into the efficacy of the 12-step approach, something that is badly needed here in the USA where the 12-steps are frequently treated as The One True Religion by the established addiction treatment community. But the piece is just fluff, apparently written by a true believer who seems only interested in research aimed at retroactively determining just how 12-step programs accomplish such great things... The greatness is just assumed to already be a settled matter. The fact that AA and especially NA don’t work for the overwhelming majority of addicts is something that is just glossed over.
And that’s really too bad, because AFAIK most studies find only marginally better outcomes when evaluating 12-step program performance, on the order of a couple of percentage points when compared with alternative treatment methods, particularly over the long term where the numbers are barely statistically significant. The sad fact is that something like 99% of the addicts who walk in to a NA meeting for the first time will relapse in a matter of weeks or even days, and often just hours. As for the long term outlook, there are studies showing no measurable difference in sobriety levels after 5 years of NA versus no treatment at all. Even when the 12-step rules are scrupulously adhered to and all meetings are faithfully attended by the recovering addict, it remains a method of dealing with addiction that works only for very, very few people, although admittedly when it does work it can be a godsend. The question that needs to be asked in the USA, a country still obsessed with the patently un-winnable War On Drugs, is this: why is a program with such abysmal success rates still considered the gold standard in addiction therapy by treatment providers? Too bad you won‘t find any such question in the article.
It trades one addiction for others: religion, caffeine, and nicotine. It trades personal responsibility for not drinking, and thus drinking, to an imaginary higher power.
Quite glib; your implied point is "it" is worthless because it just swaps addictions.
I haven't seen a definition of addiction yet, so I'll suggest this:
Someone is addicted if they repeatedly make damage-causing choices, to the point where normal life is unsustainable (e.g. cant hold a job, arrested, or maybe death).
Now instead of a question of "Addiction" it becomes a question of Sustainability: how long can somebody carry on?
Some people carry on for a full lifetime with whatever. No problem, I'd say they're not addicted.
Other people have trouble sustaining after a while.
As for "trading one addiction for another", think of it as damage control.
Different behaviors have different time frames to their consequences.
Some things, like meth or heroin, can lead to severe consequences quickly (think Trainspotting).
Alcohol tends to be longer-term maintainable; often drinkers can sustain for years, possibly even decades. Eventually health issues (like liver damage, possibly fatal), judgement issues (drunk driving, possibly fatal), and other "consequences" (getting fired, divorced, passing out in risky situations) tend to make life unsustainable.
Marijuana is perhaps more sustainable than alcohol and other drugs.
Now, let's talk about some of the other "addictions" that you're concerned about.
Coffee? (Oh noes, they iz addixted to caffeen!!) WTF! Coffee is arguably completely sustainable, it doesn't cause damage to the user or to others.
Cigarettes? *shrug* I don't know about that one but damage-wise, but it is probably safer for somebody to smoke than to routinely make poor decisions because they're blackout drunk.
Sex? (Oh noes, they are sleepn roundz!) This is pretty sustainable; arguably healthier than lots of alcohol / chemical "entertainment" options. Do actually you have a problem with people engaging in sex?
Look... whatever behavior you're thinking about, try thinking of it in terms of sustainability. Maybe some of these things are "just" substitute addictions"... but is that really so bad?