Slashdot Mirror
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
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?
You didn't just 'actually stop drinking' you got pancreatitis, which then motivated you to stop, your 2 step program is missing a couple.
Alcohol abuse is so socially acceptable most people don't even recognise it as abuse and it can take a massive upheaval of your social life to simply "stop drinking", as well as taking time to spot patterns of behaviour and triggers and then change them.
I do dislike the AA though, they say that if you stop drinking, you're just a dry drunk, so in their eyes even of 10 years sobriety you're still branded as an alcoholic, you still have to announce that you're an alcoholic, and that just reinforces the idea that you're weak, that you may slip up and that you need AA meetings to get by.
The problem with slashdot is that most of its users were bullied and stuffed into lockers as kids!
Well their terminology may be a bit off but the idea is actually correct: You can't, at this point, be "cured" of alcoholism. You can stop drinking and that is what you need to do, but the addictive nature is still there. If you start again, you'll overdo it and spiral down the addict path. If your brain/body is such that it will get addicted to alcohol, then it will always be that way, and no amount of time will change that.
That's really what they are saying and it is correct. You don't cure an addiction, as in become such that you won't get addicted to the substance, you just stop taking the substance.
As an example take a look at nicotine. There actually are people who do not become addicted to it, my mother is one of them, they are just very rare. Most people, if you use it more than a little bit you WILL get addicted. We all understand that, so those of us that don't wish to get addicted avoid it. Also once you've quit smoking, you recognize that you can't start again, you can't do it "just a little bit," you'll get hooked again.
Well for alcoholics, that is how alcohol works. Most people, 90%ish, aren't like that. They do not get addicted. However for alcoholics it works like nicotine, they do get addicted. So the only answer is avoidance. There's no amount of time after which you are "cured" and can no safely drink, you just need to stay away.
Same thing goes for any addiction. You are never "cured" you just stop taking the substance. You can't ever go back to taking it, or you'll head down the path of addiction again.
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.
You are defining an alcoholic as someone that can only stop drinking if they use the 12 step program. Someone who is able to stop for any other reason is not a true alcoholic.Therefore, Only the 12 step program can keep a true alcoholic sober. And the views of anyone who was not a true alcoholic and was able to stop drinking without using the 12 step program views are irrelevant. I think data obtained with these criteria will be somewhat biased.
Surprisingly little God in them? Have you actually read them? (http://en.wikipedia.org/wiki/Twelve-step_program) The OP is essentially correct in his summery.
Why is this modded down?
If you type "is AA" into Google, Autocomplete will give "is AA a cult" as the first suggestion. Their success rates are abysmal.
"Trying to fill the time" is an enormously important part of quitting the booze. The physical alcohol dependency quickly disappears, but your brains desire to kill some time by getting drunk never goes away.
It's very annoying when the best posts on Slashdot get nuked, while somebody theorizing (poorly) about quitting alcohol can get modded up to +5. When I don't have an expert opinion on a topic, I let other people do the talking ...
That's commonly true, although alcohol is a strange drug because of how it figures in so many social situations. There's a segment of what you might call "problem drinkers" who do successfully change from drinking excessively to drinking moderately, mostly caused by a significant change in their social setting. For example they change cities and have a different group of friends with different activities.
This strongly depends on the person and the nature of their excessive alcohol use, though. It's "easier" in a sense to be cured if it has a large socially situated psychological component, such as people who drink too much basically because their social life revolves around spending 5-6 hours each evening at the pub, and drinking is what you do at the pub. In that case, a change in social setting can significantly cut down on the amount they drink. But you could argue that these people were not truly addicted; rather they were drinking more than they wanted to because of social/peer/environmental pressure to do so, and then stopped doing so when the external pressure disappeared.
10 PRINT CHR$(205.5+RND(1)); : GOTO 10
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