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“You crazy woman, I have decided to attend the A.A. (Alcoholics Anonymous) “.  These words spoken to me on a bright Sunday morning, over my cell phone all the way from Chaingmai were the sweetest words I had ever heard.  The year was 2006 and the man who spoke these words was my best friend Ryan, someone who had battled with substance abuse since the age of 15 and then later waged a failing war against his alcoholism.  He passed away three years after this conversation at the age of 43 due to liver cirrhosis.

How could he have died of something so acute when he was attending A.A. meetings?  Wasn’t A.A.  supposed to provide him with the much needed support and assistance that would have helped him stay clear of alcohol and lead a more fulfilling life  It was Ryan’s death that made me question the entire premise of Alcoholics Anonymous and its sister concern Narcotics Anonymous. It is not just Ryan I have lost but many other friends as well, men and women who were conditioned to believe that AA was the answer to all their prayers.  

A.A. was founded in the year 1935 in Akron, Ohio by Bill Wilson and Dr Bob Smith, who were alcoholics. The renowned psychiatrist Dr M. Scot Peck terms the founding of A.A., “as the greatest event of the 20th century”. Over the years, it has become a name to reckon with in the field of substance abuse. However, one needs to just dig a little deeper and go beyond the claims made by AA advocates to come face to face with reality.

The success rate of the treatment is enough to sow the seeds of doubt. On the one hand a number of researchers have made the claim that 95%[1] of new AA members leave within the first year;-that only 5% of new members remain. An eight year long survey was conducted by George E. Vaillant, a staunch supporter of AA. The survey findings were nothing if not startling.  The survey found that people who had not received any treatment   were just as likely to quit alcohol as people under the 12 Steps Programme .  Higher number of dropouts and significantly greater numbers of episodes of binge drinking were some of the other findings about the programme that is considered the “only hope” of people diagnosed with alcohol dependence.  . On the other hand, there are researchers that give contradictory evidence to show that AA/ NA has its own benefits and emphasises the fact that going to AA/ NA is better than seeking no help at all.[2]   There is a murkiness surrounding the empirical data and the evidence based approach of AA/ NA. Anything that claims to be a “treatment” needs to be empirically sound and based on evidence of its success rate

AA/ NA has been long touted as THE approach. It’s time to burst the bubble that has been surrounding the community which not only comprises recovering alcoholics but of medical and health care professionals.  If AA is not scientific and evidence based, what is it?  It is basically a philosophy which is rooted in experience oriented evangelical Christianity. Each of the Twelve Steps mentioned have a corresponding Biblical scripture. [3] A closer look at the entire philosophy of AA reveals its deep affiliation to Christian traditions of conviction of sin, conversion, yielding to God, self-assessment, confession, restitution, prayer, witness, etc.  

The fundamental problem for me lies in the fact that the 12 Steps Programme is treated as the substitute to Church and attending regular meetings as salvation instead of treatment. The followers of AA would be quick to add that even if the origins are rooted in Christianity, it has sufficiently modified itself, e.g. there is no mention of Jesus, to embrace people from other faiths. Even if this tiny step towards secularization is accepted, what about the people who are agnostic or just plain atheist? Where would they seek “salvation”? You would also come face to face with an argument of:

 “It’s not as much about belief in God but in your spiritual awakening”. What if I am not spiritual! 

Each AA meeting begins with a person saying “Hello I’m ABC and I am a recovering addict”. Do you see the problem that I see? The Programme brands a person as an alcoholic for life. Addiction becomes his/ her chief identity (if not sole) even if the person has not touched alcohol for many years.  I have friends who are life members of AA and still regard themselves as addicts. The moment I hear something like “ We addicts......”, all I want to do is scream & tell them “ but you have done a fantastic job staying away from alcohol/ heroine/ cocaine for the past 10 years!.

This brings me to the biggest flaw of the Programme, the entire “Disease Concept” and the total loss of self-control over it (Step 1: We admitted we were powerless over our addiction- that our lives have become unmanageable). No wonder it uses the term “relapse” as if alcoholism was akin to cancer or a Sexually Transmitted Infection. Addiction is behaviour and human behaviours are all about choices. Behaviours are not diseases but voluntary actions of free-will human beings.  The moment one chooses to pick up a glass of alcohol /snort/ sniff/ inject drugs, it is a choice that one makes. One cannot be exonerated from the choice that he/she has made.  Human beings are unique, they have free will, and they are responsible for their own actions.  A person should embrace the responsibility of results that his / her actions generate. From a “powerless” being described by the Programme the person needs to emerge as having control over his destiny, only then can addiction be tackled effectively.

AA’s one size fits all theory needs to be re-examined at greater length. It could be an answer to the prayers of a few, but definitely not all.  It is not a magic pill meant for all.  AA/ NA as a standalone therapy has shown comparatively less chances of success vis-a-vis combining the same with Cognitive Behavourial Therapy [4] Like most treatments, treatment for alcoholism and substance abuse also needs to find a way to marry the essentials of any treatment to the unique needs of the person seeking it or else   NA/AA philosophy would therefore only remain a paper tiger, toothless in reality.




Interesting Read

Heh Saathi Pragya,

I really liked the issue that you pressed. I have a friend who is a regular participant of NA. In spite of what you said he seems to be really doing well. Bearing in mind he might fall in the exception catagory, I was quite moved by the sharing he did. 

I believe people opt for alcohol and drugs due to some reason. Now as they carry on getting used to the substance, they get stuck with the issue that led them to it in the first place. As time goes on, to get rid of it looks like bigger than the reason. 

However, to my understanding unless one reflects back and share, they won't be able to get peace neither (in most people cases) could get rid of so called addiction easily. 

As my friend told me, the gathering is more like clearing their past and moving on for real and not just getting CLEAN. There might be different way of bringing them in that level, one used mostly is using bible's words. I think it's just a tool, but I am more interesting in the sharing they do and ultimately that is what would be most important for them to cleanse their past and move on.

And, I believe there is vast difference in becoming religious and spiritual, although connected they are not synonyms. In my opinion, an atheist can be spiritual.

Do keep writing. Cheers. :)


HI Saathi Rafael

HI Saathi Rafael

I'm glad you liked the issue taken up.  By your reply you prove my point to a great extent. AA/ NA should be looked upon as a Support Mechaism , a therapy, By this very logic, it needs to be combined with other treatments to be effective. 

My issue is not with AA/ NA per se but that it is propogated as " One size fits " all kind of a magic pill. I have friends who are regularly attending NA/ AA even after bing off drugs for 20 yrs. Other friends could not identify with it at all.  The sharing is important to feel that one is not alone, sharing helps but what's more imporant is one takes responsiblity of his/ her actions, that is lacking in NA/ AA to a great extent.

Lastly about sprituality, I agree with you completely. But then there are people who are not spritual. To each one his own. If something suos you great or else explore other alternatives. The effort should be to be away from drugs, isn't it saathi?




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