So far the comments have been about people's prior experiences with the topic (which is great), or prior opinions about the topic (which is ok). But the more interesting story is being overlooked: this is heavy-duty new research that overturns previous conclusions, including the prior expectations of at least one of the lead authors. It would be good to discuss the specifics of the article and the new study.
Do you think you could elaborate why you believe this is "heavy-duty" new research (or even new research at all, rather than a new meta-analytic synthesis of old research)?
My quick read of the study suggests that they examined several outcomes, got null or low powered results on most of them, and chose to highlight the single result which did show a significantly positive effect on recovery; that result was based on a meta-analytic estimate of the pooled sample of just two studies. In particular, my understanding is that this study found a null on "percentage days abstinent", a null on "longest period of abstinence", a null on "drinks per drinking day", a null on "alcohol-related consequences". For alcohol addiction severity they report the results of one study without doing any original analysis. And for "rates of continuous abstinence" they found a positive effect. In most cases these are graded as "low certainty evidence". The positive effect is claimed to be "high certainty evidence", but the CI / p-value for the positive effect is not adjusted for multiple comparisons -- I don't think that's fatal, but it does speak to the fragility of the outcome.
The other concern I have is that they separate "manualized" treatments (e.g. AA treatments administered according to a protocol) from "non-manualized" (e.g. ad hoc administration of the AA treatment) treatments. This is fine -- we would expect to see that if something about the protocol was useful, the non-manualized treatments would display an attenuated version of the same effect. Instead we get a null on the original positive effect, and a positive effect on one of the original nulls
Finally, the authors seem a little loose with what the comparison groups are. They claim they recruited studies which compared AA to no treatment, but the results are all motivated as being AA versus CBT. What happened to the no treatment studies? Perhaps these are buried in the full text. The rate of spontaneous remission of addiction is believed to be fairly high and most of the past criticism of the efficacy of AA has been motivated by comparison to spontaneous remission.
It strikes me that there is significant distortion of the study findings from the Cochrane write-up to the Stanford press release, and from the Stanford press release to the NYT piece, and that in both cases the distortion is in favour of claiming the study has found affirmative evidence that AA works better, rather than just no evidence to claim it works worse. For instance, one of the thrusts of the NYT piece is that the past Cochrane review was based on a limited number of studies... but the operative finding in this review is based on an even more limited number of studies, even if the pool of studies from which they drew has become larger over the last 15 years.
All of this is from a quick read of the review -- I am off campus right now and don't feel like VPNing or pirating the full text to deep dive the analysis.
> And for "rates of continuous abstinence" they found a positive effect.
It’s been a while since I reviewed the literature for substance abuse disorder, but if I remember correctly it was highly disputed whether complete abstinence was necessary (or even beneficial) for treatment. Has this changed?
The argument was that by focusing on abstinence you are setting a significant part of your patience up for failure with all the psychological harm involved in knowing that they’ve failed, which might result in severe and frequent relapses.
EDIT: To conclude. I find it hard to draw conclusions if success is measured in “days of abstinence”. That means that a patient that has recovered from cognitive behavior therapy (CBT) that uses occasionally and non-detrimentally is not considered a success! Further AA or other 12-step programs do often stress abstinence while CBT does not, this creates a counting bias in favor of 12-step programs.
I'm a recovering information addict, food addict, sex addict, and love addict.
Doing the same behaviors in a mindful way instead of out of a desire to mask/numb/avoid matters.
Also, I stopped counting my various abstinence stretches because it's not actionable information. I don't assess my recovery that way. I take a look at my needs and identify how I'm doing meeting them.
That initial honeymoon period? It’s like it fixes everything. I’m a whole different person.
Then the honeymoon period ends and I get bored and irritated and nasty. I need to find another one to fix me. Because the current relationship is clearly where the problem lies.
Repeat ad infinitum.
That’s my experience of it. Others may have a different experience.
I am very skeptical about claims that heavy alcoholics can ever moderately drink over a significant period of time again. There are a lot of studies showing successful moderate drinking over the short term, but the studies are always short-term studies using self-reporting data.
Active alcoholics are downright dishonest about how bad their alcoholic drinking is; they will claim it is moderate drinking to anyone who asks them (including scientists making a study) and lie about the amount of alcohol they actually consume.
The most famous study refuting the claims that alcoholics can moderately drink again is probably Pendery 1982, which showed that people who were reported as successfully moderately drinking in an early 1970s study were, a decade later, either not drinking at all, engaging in out of control drinking, or dead from alcohol-related complications.
The question is not whether “heavy alcoholics can moderately drink”, which you claim skepticism over, and I—for the record—claim ignorance.
The question is: “is complete abstinence necessary for some cases of substance abuse disorder?”
We have ample observational evidence that complete abstinence does relieve many people from the symptoms of substance abuse disorder. We also have some anecdotal evidence that that is not true for everyone.
I also have a problem with the term moderate drinking. I’m sure—although here I’m ignorant as well—that patients aren’t encourage to moderately drink. Rather they are—again I’m guessing—not told to have failed if they do drink.
Say a recovering alcoholic has a night out of heavy drinking, but that does not further negatively impact them, i.e. they won’t relapse into a constant drinking habit. I would hold on calling that a failure. In fact it might be actively damaging for their psychological well being to say that they failed, which might actually cause a severe relapse.
The statement “by focusing on abstinence you are setting a significant part of your patients up for failure” sounds like advocating “moderate drinking” to me.
If we’re not telling alcoholics that abstinence is the goal, we’re telling them they can “moderately drink”. “moderate drinking”, simply put, is what we call non-abstinence for alcoholics.
This is very different from saying that a one-day relapse is a complete failure, and, yes, I agree that Alcoholics Anonymous is too focused on raw sobriety time.
> The statement “by focusing on abstinence you are setting a significant part of your patients up for failure” sounds like advocating “moderate drinking” to me.
Sorry, that was not my intention. Like I stated earlier in the thread, it’s been awhile since I reviewed the literature. I’m not a psychologist, and I’m neither a recipient nor a practitiner of Cognitive Behavior Therapy for Substance Abuse Syndrome.
That said I’m sure therapists have a way of negatively reinforcing the damaging drinking behavior in such a way that a single night out is not considered a failure. I don’t know how they do it, but they are experts and I’m sure they know how to.
Thanks! That's a fabulous comment. By "heavy duty new research" I was just referring to this from the article:
In the last decade or so, researchers have published a number of very high-quality randomized trials and quasi-experiments. Of the 27 studies in the new review, 21 have randomized designs. Together, these flip the conclusion.
That sounds impressive. If it turns out not to be so impressive, that's definitely on topic.
This reply will probably be ignored, since it has been two days and ycombinator has a pretty short attention span, but I have skimmed over the full study.
There are about 10 findings, and the only “high” quality finding is that there appears to be a significant increase in abstinence, especially long term abstinence from people who get treatments which get them in the rooms of AA (“TSF” treatments).
We can dive down in to the details about this finding (percent abstinent) on pages 88 and 89 of the report. They actually use six different studies, but only two of them provide information at the one-year follow-up, so only those two get listed in the summary on page 4 of the report.
Considering that they compared a number of things, and only percentage of subjects abstinent showed, with high confidence, a difference between AA/TSF and other treatments, I’m a little worried we may be seeing a multiple comparison fallacy. Then again, this is unlikely: They are seeing P values of 0.02 and 0.03 (1-in-30 to 1-in-50) for the abstinent numbers, but only look at about 10 factors.
Humphreys 2014, another meta-analysis of multiple studies, showed AA effectiveness which can not be attributed to self-selection, but it saw something different: A fairly small but significant increase in the percentage of days abstinent. While they did see in the 2020 Cochrane review, they did not see it with a high level of confidence (see pages 89-90).
Percentage days heavy drinking — I don’t have a copy of Brandsma 1980 handy, but I think that’s what the “Brandsma 1980 shows that AA results in increased binge drinking!!!111!!!!!” claim parroted by the usual anti-AA crowd talks about — might be increased in the short term after starting AA treatment, based on the one study which has 6-month follow-up figures for this; Brandsma 1980 only saw it at the 3-month follow-up and not later. Then again, the Cochrane study of those numbers show a pretty high P value (0.79, just glancing at those figures), which means we still don’t really know if Brandsma 1980 actually saw something. Scott Alexander dismisses it as an example of a multiple comparison fallacy, and the P values for it in Cochrane 2020 means we probably didn’t actually see something, but this may merit additional investigation.
Cochrane 2020, of course, didn’t look at the longitudinal studies showing really high abstinence rates for people who self-select to go to a lot of AA meetings, but even using only randomized studies, we are seeing a significant increase in number of subjects who get and stay sober when they engage in treatment which encourages AA attendance.
Another thing: There are no recent high-quality studies comparing AA to no treatment (“spontaneous remission”, an expression I see used mainly by people with a pretty strong anti-AA bias) because it’s been established for a long time that AA (or any other treatment you can think of) is better than no treatment. Even Brandsma 1980 saw that going to their AA-like meetings was significantly better than getting no treatment at all.
In summary, with some caveats, we are seeing solid scientific evidence that AA really helps alcoholics get sober and stay sober. Ten years ago, someone could still say “AA does not have a higher success rate than no treatment” with a straight face; today, to claim something like that requires ignoring a lot of scientific evidence.
Sorry for going on a rant here, but I dislike the framing implicit in "spontaneous remission".
Addiction does vanish spontaneously with a wave of a wand. These are people of flesh and blood and free will that managed to overcome their addiction. They are making attempts at treating themselves. They might be reading blog posts with advice. They may avoid buying alcohol for fear they'll drink it all. They be taking detours around bars. They may be meditating or even self-administering cbt.
It's spontaneous because it is not caused by the external treatment. It's not a misnomer so much as a difference in usage. When you say a person did something spontaneously, it means it was impulsive, not caused by anything, and has connotations of being a sudden or easy action. When you say an event was spontaneous, there is no reference to meaning or intensity of the event - it simply means that there was no external cause.
Still, if my physiotherapist tells me to strengthen my core muscles with daily bodyweight exercises and I instead strengthen my core muscles with weekly free weights exercises, if I am cured it would seem odd to call it spontaneous.
The statistical question is whether you would have done those exercises regardless of whether you consulted a physiotherapist. If you would have done those free weights exercises anyway, then it's unreasonable to credit the physio with your recovery; if you wouldn't have done them of your own accord, then it's reasonable to credit the physio even though the precise causal mechanism wasn't what we would expect. We're not trying to address philosophical questions, but find out whether particular treatments have a meaningful effect.
This meta-analysis isn't ground breaking. What has been known for awhile is that AA works very well for some, but not at all for others. This has always been the dilemma with AA in research as well as clinically. It won't affect treatment because no one was ever discouraged from trying it at least in my experience.
Bill Wilson[1], co-founder of Alcoholics Anonymous, believed LSD could help alcoholics achieve a "spiritual experience" that was crucial to them attaining sobriety[2] (incidentally, that a spiritual experience could help alcoholics was an idea he got from Carl Jung[3]). Wilson's own experiences with LSD are discussed in detail here: [4]
In the 50's and 60's there was research in to using LSD to treat alcoholism, with promising results:
"Osmond treated more than 700 chronically alcoholic patients with LSD and ended up with around a 50 percent overall success rate. One of Osmond's most compelling studies took place in the late 1950s with a cohort of subjects from the group Alcoholics Anonymous. This cohort was comprised of individuals that had failed the famous 12-step program, and again Osmond hit his 50 percent success rate, this time with a 12-month follow-up period."[5]
In 2012 a meta-analysis of studies with a total of 536 participants found "evidence for a beneficial effect of LSD on alcohol misuse".[6]
I just finished Michael Pollan's How to Change Your Mind and found this bit of history to be one of the most interesting pieces of an overall super interesting book. So frustrating that a moral panic essentially wound up locking away this research for 50 years.
Ibduilast, which is a drug that has been on the market in Japan and safely used for 30 years, has also been used to treat alcohol and opioid addiction.[1][2]
Isn't ibogaine that one drug where you have to go to West Africa to find it due to its being illegal and inaccessible everywhere else and trips last for literal days?
It is available in Brazil, at least in a research capacity. I almost tried it to work on an alcohol addiction but regrettably decided against it at the time.
A year ago, for two weeks, I binged on five grams of some drug. It seems it saturated the NMDA receptors (my own uninformed explanation) so for six months alcohol was same as water to me. Cannabis and benzos were also useless.
Now alcohol does make its effect again, but I just drink some beer occasionaly, no more hard liquors. I haven't had any mj in a year, the best part. Oh, and the drug in question... I tried it again a month ago and found it unpleasant, and keeps building that crappy cross-tolerance.
I won't name the drug because I wouldn't like to encourage anyone to try this kind of "treatment", I'm pretty sure my reaction is not typical at all. But it would be nice if there was research about this.
Jungian psychology (shadow work) and the occult have been absolutely critical for me to work through the internal contradictions that led me to seek out drugs in the first place.
The AA way was described in The Power of Habit as one of the examples of successful habit change. Basically: keep the habit's cue(e.g. feeling depressesed) and the reward(social interaction) but replace the bad habit(drinking) with a better one(meeting with the sponsor).
My alcoholism (if it can be called that - it is a spectrum) is driven in part by the social interaction of fellow drinkers. The predictability of seeing each other at the bar, of hanging out and not worrying about the day.
I've talked to one or two of them about doing tea on Tuesdays, or some other thing that could get us from drinking 3-7 stouts a night.
recovering addict here. some words for those who may be struggling.
i tried a number of things over many years (life coach, therapy, meditation retreats, ayahuasca, ibogaine, etc).
i reached a bottom, and nothing i had tried really worked or stuck. kept relapsing after a few months of sobriety at most.
ultimately it was going to AA that i largely credit to my successful transformation into a happy life of sobriety.
if you're not sure if it's right for you and struggling with addiction, i highly recommend having an open mind, and trying 90 meetings and 90 days. see how you feel after. it's the daily practice that is transformative.
there is something powerful about being focused on a purpose with a group of similarly motivated people.
the people in the rooms of AA understand the challenge you're facing in a way that friends and family often don't.
you quickly realize that the 'higher power' thing is a pretty easy to move beyond, regardless of your religious orientation. a 'higher power' can even be a conceptual device - e.g. the wisdom of the people in your meeting who have achieved a life of sobriety.
it's also not to say that AA in itself is a savior. it's a healthy component to integrate as part of a balanced recovery of body, mind, and spirit.
eating well, exercising often, and finding ways to be helpful are other important pillars to incorporate along your journey.
I had other experiences. The friendships I had in AA were superficial. Once, when I was struggling and needed help and people to talk to, I was completely ignored by the people around me. They didn't want to help the struggling - just to have this toxic positivity that nothing is wrong.
I later moved out of state. I came back to visit family, and went back to a meeting to find out that there were rumors that I had relapsed after I moved and continued using until I was homeless. It was a drama fest. Absolutely ridiculous.
When I moved, the meetings I encountered were extremely hostile to atheists.
I wouldn't be so quick to call him an outlier. His experience is far from uncommon. You can find plenty of people who've had the same or other problems.
sorry that you had these experiences, i can relate to aspects of them as well.
each meeting can be quite different. i had to try 10-20 of them in my city to find a few that were on my wavelength.
i don't attend aa meetings as often as i used to in early sobriety, but i still go if i have a friend that's struggling and want to open this resource to them.
at every meeting, there are things that people say that resonate and things that are cringe-worthy or even inflammatory.
part of the meditation and process is being able to be hear and react to everyone's words with equanimity.
> ... and went back to a meeting to find out that there were rumors that I had relapsed after I moved and continued using until I was homeless. It was a drama fest.
I obviously don’t have your unique and nuanced understanding of the situation, but this seems like a common occurrence with all humans when they lack information.
In my experience when we don’t have information, our group tendencies lean towards filling gaps with the outlandish and dramatic.
Again, I don’t know much about AA but I’d question whether that situational behavior was driven by something unique to AA.
Though, their hostility to atheism is a problem they should have addressed long ago.
The relapsed part sure, but having a story that detailed is absurd. He stopped coming to our meeting? Must be homeless and turning tricks on corner... Absolutely ridiculous
Oh I certainly did not mean to imply it’s natural or OK...
To be more clear, this type of toxicity is seen all over the place and I think this behavior is likely caused by something that isn’t unique to any rehabilitation programs.
We see this toxic behavior in everything spanning from job workgroups to community planning committees and yes, it even manifests in extreme ways in many many communities.
I’d be the very last person to fall back on some “oh X is natural, so we should always accept X.” so if I gave this impression, huge apologies. It definitely was not my intention.
And I really don’t want to come across as if I’m stanning for AA as I’ve heard much more negative about them than positive.
> When I moved, the meetings I encountered were extremely hostile to atheists.
In my experience there are two types of atheists who go to AA: those for whom religion “isn’t their thing” and those who are actively hostile to religion.
I think the latter group should find an alternative to AA.
Consider that you did suggest it was their own fault because they did something bad and you have all the reason you need for their "hostile" response. You've been fairly unpleasant about something that was obviously a big thing in their life and that yields you responses like this. Turning that around and (again) blaming them and suggesting their negative response is entirely their fault goes beyond that into the fairly toxic. That's not a healthy way to communicate with other people.
> Consider that you did suggest it was their own fault
No I didn’t. My original post was for anyone seeking help with substance abuse - that AA is a good option for atheists who are friendly to religion and a bad option for those who are hostile.
If I had wanted to put the parent into the hostile to religion group then I would have said so.
Edit: I also never said anything about being hostile to religious people which is the way the parent decided to interpret it so they could take a swing at me.
Former addict of opiates here, I've attended a lot of AA/NA meetings in the long ago past (8+ years ago).
They may not claim to be religious, but every single step mirrors the idea that you are to give up to a 'higher power' and to 'faithfully' follow the steps...etc...etc.
It's as religious as it can be while still trying to claim otherwise...in reality its a thin veneer for a truly religious/faith based system. It's got religion all up in its business...the claim to irreligiosity is a fig leaf, in my experience.
I also truly hated their angle of making you feel like you are forever a victim/failure to addiction...that is not how you promote a prosperous and good outlook on life. In fact it's a good way to make you feel like shit and use again.
What I learned later on is that yes, you can let your past be your past...no I don't want to take opiates...but I also am no longer an 'addict'. I am me, and I don't consume addictive pills anymore.
Also, as an anecdote, over 8 years clean here...and that didn't happen till I gave up on AA/NA.
If religion just "isn't your thing" I'm pretty sure that makes you an agnostic not an atheist.
However the majority of atheists in my exerience are a bit more mellow. You can fully believe there is no grand deity without being "hostile" to the belief.
As an example (that maybe is more generally relatable): I believe the world is round. I don't think I am hostile to the flat earthers. I think they are wrong based on evidence, but their ideas don't disgust me. I don't want to burn them at the stake or harass them. If they leave me alone I am content to leave them alone. So I dont think i am hostile to their beliefs. However i would never describe my relationship to the flat earth "theory" as "just not my thing".
The AA treatment has a component that many atheists may interpret as religious or spiritual. If that's your interpretation, and you are actively hostile to that belief, then your own world view is not compatible with either the treatment path or the social group you will encounter. That is not going to be a high probability scenario for recovery, and it may interfere with others' recovery, and that's why you should find another group.
Which other group? That's a different question. There doesn't have to be an alternative for AA to be a bad option. Though as it turns out, there are many options. A little searching shows there are AA for athiest groups which, presumably, use a modified protocol.
> When I moved, the meetings I encountered were extremely hostile to atheists.
That's unfortunate, and mostly in line with other experiences I've heard from friends, etc. AA seems like just another bullshit Christian recruitment/retention facility, that sometimes accidentally helps people who buy into it recover from addiction. Too bad.
> My current sponsor’s higher power was once an imaginary vagina.
> It spoke to him and everything.
That made me laugh audibly, and next time I need to refer to a higher power in any sort of conversation, I fully plan to work that in.
If you ever have the occasion to tell your sponsor that this story inspired such a reaction from a random person on the internet, I hope it amuses him.
I shouldn't have to make up a higher power and do anything with that imaginary construct to make it through the steps of a sobriety program, though. The fact that I'd have to lie about it in the first place is the issue - it doesn't matter if other people's higher power is something non-christian or not. I cannot just be myself.
"AA seems like just another bullshit Christian recruitment/retention facility, that sometimes accidentally helps people who buy into it recover from addiction."
This is essentially false, and borderline bigotry.
I always fancied the stoic concept of “higher power” basically a combination of the Universe and “reason”. This is what I turn to in any theological discussions.
It’s great you’re willing to overcome the technicalities for a greater good. Too many people are restrained by their own ego. Keep up on your righteous path.
After 15yrs of a-abuse, 4 bottles of alcover (sodium oxibate? i believe available - prescription only - only in one country) cured me. I bought 2 cases of xtra-strong beer 'just in case', have had 2 cans on my desk for months now. 0 interest in drinking.
Sodium Oxybate (ie: incredibly expensive GHB) is on the market elsewhere, but not indicated for alcohol abuse and usually heavily controlled (ie: special doctors and pharmacies only).
The heavy control always surprised me while other powerful sedatives flow freely with little control.
I obviously cant speak for the OP, but theres something to be said for putting yourself in a situation that requires discipline and resistance of temptation (though you're absolutely correct, in this case, most certainly not a good idea for everyone). Completely tangential, but I've come to think of Gandhi's celibacy tests with naked women in this way.
I can't speak on alcohol and think any alcohol addiction is more difficult to quit, but: I quit smoking and nicotine a year and a half ago. I still have ecigs about: I kept them in case I just couldn't. Just in case. For peace of mind. I never really saw it as temptation. I don't mind getting rid of them now, mind you, I'm just lazy and they are stored away.
AA's 12 Steps use the word God four times. They also refer to "Him" three times, to a higher "Power," a "spiritual awakening," and prayer.
Nearly every step has a reference to spirituality of some kind and most of them are laced with Christian undertones.
More generally the idea behind the 12 steps is to place yourself in the hands of this higher power and allow it to guide you. Basically it requires a belief in prayer.
AA has worked for many many people--which is wonderful and it is demonstrably a great tool for them! But an atheist, humanist, or more generally someone who doesn't believe in spirituality is going to have to go through significant mental gymnastics to deal with the 12 Steps.
It seems to me that if someone doesn't believe in God or a higher power of any kind, there are probably better first line treatments for alcohol addiction. It isn't necessary for an atheist to change their spiritual or religious beliefs in order to recover. Therapy, medication and secular support groups all exist.
I came here to say the same (but undoubtedly not nearly as well as yourself).
It was the religious stuff that put me off completely. Being in a group of people all there with a common cause I felt was quite powerful. Hearing shared experiences from the community was helpful. I just couldn't pretend I was OK with peddling any form of faith.
You can take God as an euphemism for nature or more general something beyond your control. If he exists he probably wouldn't hold it against you. You don't have to deceive yourself to a degree to believe it. You probably can watch a Batman movie without believing in Batman.
I would be skeptical too and it can certainly have a negative impact on addiction groups. Although I would think these negative factors to be worse for people actually believing it. Some people classify them as a sect, but I wouldn't go that far to be honest.
But if it doesn't work for you, I think there are other groups or those that set the focus elsewhere.
I drove someone close to me to a 12 step program, and stayed with them for a session. It was a remarkably positive group of people helping each other through problems.
> Keith Humphreys, Ph.D., professor of psychiatry and behavioral sciences, and his fellow investigators determined that AA was nearly always found to be more effective than psychotherapy in achieving abstinence.
This does not appear to include other programs like pharmacological extinction or the Sinclair method.
> We included randomized controlled trials (RCTs), quasi‐RCTs and non‐randomized studies that compared AA or TSF (AA/TSF) with other interventions, such as motivational enhancement therapy (MET) or cognitive behavioral therapy (CBT), TSF treatment variants, or no treatment.
Ok, I've edited the title to mention psychotherapy, since that's the alternative that the submitted article (at least) focuses on. Which is still an interesting finding.
Outsider's uninformed opinion: if you attend AA then regardless of any official narrative or agenda this means you're spending important time with people who (a) used to drink, and (b) don't drink any more. Their example plus hearing what they've got to say seems like an excellent approach.
I didn’t do AA but did AlAnon for children of alcoholics recovering from trauma. Despite what people think, the 12 step program is super light on the spirituality stuff and very atheist friendly. As a recovery group AlAnon was super useful for getting some closure on the hell my parents dragged me through and just leaving that stuff behind.
Edit:I guess I should have qualified that I’ve only done support groups in SF that have been great and usually hosted by churches.
> the 12 step program is super light on the spirituality stuff and very atheist friendly
This is highly dependent on where you are. I experienced verbal abuse and was made to feel unwelcome at meetings when people found out I'm an atheist. People have told me, verbatim, "You don't belong here if you're denying God".
Needless to say, I am no longer a part of that little cult. I'm doing fine without it.
You know, I've gone to these meetings with a number of people (my mother, who unfortunately lost her battles with it, and other family members/friends). I'll note that I've done this worldwide, to some degree - Japan, USA (east and west coast). I'm saying this to point out that I'm in there as an observer for these people attempting recovery, so this experience is cultivated from multiple viewpoints/locales/etc.
I have witnessed _exactly_ what you're saying, and I've seen people feel so unwelcome that it hurts them more than helps them. It blows my mind the stranglehold that AA has on this industry, given how demeaning it can be to people who are looking for help.
I've seen more success with people going to SMART recovery meetings, which focus on providing a space to talk and seek help without the judgement level associated with AA.
I reached a point where I realized I needed help to quit drinking. I looked into AA and a coworker whom I knew had gone through the program gave me a little red book. It felt very dogmatic and turned me off to the program. I never attended a meeting.
Instead I read a different book that could be summarized as "There are lots of good reasons to stop drinking and lets go over them." I also used r/stopdrinking as a support group for daily check-ins.
I can't say whether Alcoholics Anonymous would have helped me had I gone to the meetings but the literature was really unattractive. My understanding of SMART is they don't let you refer to yourself as an "alcoholic" or "addict". I feel that framing was much better for me than what I read in the Alcoholics Anonymous pamphlet.
Not the person you were replying to, however for me it mainly helped me understand that my loved ones' drinking was not something I could control, and it allowed me to let go of the anger and resentment (easier said than done).
My understanding is that they don't even need you to acknowledge a God, just that "there is cosmically something bigger than you and you have no power to govern it"
While that is touted as being the case, many groups make use of the Serenity Prayer[1]. Most of the time, it directly invokes the use of "God" or "Father" which can turn off non-believers. Some groups use a variation that omits direct reference to a religious entity, while a few groups are committed to avoiding the prayer altogether.
The experience varies from group to group, and even between different meeting times at the same group. They all have their own interpretations and subcultures.
I suppose but as an existentialist/atheist there are dice rolls that govern my entire life and most are not under my control. Using that belief as a tool to cleave apart guilt, shame, and blame is handy.
The same “dice roller” in the sky that brought me trauma also brought me a high affinity with math and science, some pathway to a great tech career so acknowledging a higher power is really about saying “shits gonna happen, good and bad”
Same here, been to Al-Anon meetings in London UK, all hosted in church basements and with zero religious nonsense being spouted... just the Serenity Prayer and tbh that one is just plain good advice so I did not mind :)
I have nothing but praise for the 12-step system as I experienced it
If you're one of those for whom AA didn't work I would encourage you to look at the The Sinclair Method. It has changed many lives for the better (including mine).
This is how I quit and it's a profoundly disappointing and discouraging thing that this is not more broadly known. I should have quit 15-20 years before I actually did and had I known about The Sinclair Method the first time I was subjected to AA and did that instead, I'm convinced I would have been able to quit then. However, I wasn't aware of this and continued drinking for another 17 years.
What worked for me is developing an esophagus condition that makes drinking alcohol or coffee result in instant burning pain. It was so easy to stop drinking, multiple times, when that surfaced.
This is a significantly-incorrect, surface-level understanding of the "Sinclair Method". As another poster noted, naltrexone (or similar) prevent one from feeling much of anything from alcohol (though you'd still be physically impaired...). Without any dose (drink) --> response (pleasant-feeling) relationship, users tend to stop drinking significantly (because drinking doesn't really do anything)...
The "Sinclair Method" is, basically, to promise to take naltrexone (or similar) 30 minutes or so before you ever take a drink. That way, if/when you drink, you never feel the "drink" and your mind can return to normal.
No drug will "make you stop drinking" (though disulfiram may make you want to do so); the Sinclair Method attempts to remove your interest in drinking.
It's the community. Half the members of AA can't even name all the steps, but in AA they find kinship with other people with similar experiences and similar struggles.
Humans are hyper-social. We live better, grow better, heal better, and confront difficulties better when we have others. This is true for introverts too. Introverts are not anti-social, they just have a more muted less intense social style.
I’m unsure about this meta analysis because it’s presumably based on AA publications.
The thing is That numerous prior AA publications have treated “falling off the wagon” or missing one of the steps to mean that you weren’t doing AA properly, and so they dont report it as a failure.
Essentially they end up getting close to just filtering out all the treatment failures, which inflates their success rate.
Based on the OP and two other articles (see below), I believe your presumption is mistaken. It's hard to say for sure, because the list of studies included in the meta-analysis hasn't been published yet (that I can find). (Edit: it looks like the study is available at https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...) But the articles make it clear that this was a rigorous meta-analysis done by qualified researchers. Surely they didn't just toss in AA publications uncritically. What they're saying is that, after careful review, the studies that have been popularized in the past as showing that AA was less effective are the ones that turn out to be wrong. From the NYT link:
The 2006 Cochrane Collaboration review was based on just eight studies, and ended with a call for more research to assess the program’s efficacy. In the intervening years, researchers answered the call. The newer review also applied standards that weeded out some weaker studies that drove earlier findings.
In the last decade or so, researchers have published a number of very high-quality randomized trials and quasi-experiments. Of the 27 studies in the new review, 21 have randomized designs. Together, these flip the conclusion.
The measure of success should be relapse after treatment, but AA doesn't have the concept of stopping, and more importantly does not consider relapse after ceasing attendance to be a failure of their 12 step program.
This ignores the moral corruptness of praying on, and essentially mandating indoctrination, of people in need of help.
The debunking you're quoting has presumably been superseded by the much higher-quality randomized studies reported on in the article. At least, if that's not the case, then the researchers who've published the new meta-analysis lack even basic competence, which seems unlikely.
That old 2015 article is out of date, and the brand new Cochrane review presents evidence which downright contradicts a number of its findings. Notably, that old article claims AA has a 5% success rate, but the new Cochrane review sees a 41.8% success rate for people who got treatment which got them in the rooms of AA.
And here I was just thinking the finding makes sense to the extent that AA is (probably) more involved than (most) psychotherapy. To extend my point, I think when people consider the benefits of things like therapy, that--because their attention is on the therapy at that moment--they don't realize that if therapy is 1 hour a week, there are 167 hours left in the person's week that can either help or harm them with respect to their goal.
So I got sober in AA just as pagers were becoming a thing. I was lucky and found a young people’s group in Pasadena.
If you have problems with Meetings, that’s cool. Find another one. Nothing is going to be handed to u cause you want to get sober. It took a little while before I found the right meetings. Or you can find a sponsor, no where in the big book does it say that u have to go to meetings.
But if anybody is telling what you can and can’t do then, start talking to Someone else... that’s just nonsense.
I’m always suspect of people with a grudge against AA. I’m here to help and if it’s not for you that’s cool to. I’m not Christian but if works for some and doesn’t hurt other then who am I to judge.
I am 7 years sober via the AA path after trying just about everything else.
I really, really didn't want to go into an AA room the first time and even when I mustered the courage to try it I almost drove out of the parking lot :).
The decision to walk into the room changed my life.
There are many paths to recovery but if you are at a point or have questions you would like to ask privately please reach out to me anonymously.
I set up an email recoveredtoday@mail.com to go with this anon account.
There's a lesser known study in which someone who is optimistic about their behavior performs worse. The people who think they have the most willpower are likely to give in. The more people lose will, the more they view that failure as an anomaly, work harder at it, and spiral worse.
When smokers were asked to smoke the same number of cigarettes every day, and explicitly told not to smoke less, they gradually smoke less.
The people who are pessimistic about their odds often do well. It's likely that AA's approach of making people to feel powerless is what ironically gives them more willpower.
Sources: Howard Rachlin, The Science of Self-Control; Kelly McGonigal, Maximum Willpower.
Interesting. I was never a fan of AA and I was very critical in the lack of science and rigor in addiction treatment, and actually for mental health in general. I always felt there were better treatments, but CBT-based group therapy / 12-step alternatives are pretty rare. All you really need to start a chapter of AA is to not have one nearby and a place to host it. It's comforting that AA at least doesn't make things worse, on average, even if its not amazing. I'm still not comfortable with the fact that the government will require people to attend what is essentially a religious service as criminal punishment, and there are certain aspects of AA that they should probably at least de-emphasize.
"I'm still not comfortable with the fact that the government will require people to attend what is essentially a religious service as criminal punishment"
Maybe there's some kind of slippery slope there, where they eventually start sending you to church for a parking ticket. But we don't seem to be sliding to that conclusion very quickly; so if it works, just go with it.
If you want to make a big federal case out of it, you could probably win it. But I honestly don't see how anyone wins with that outcome.
A few homeless shelters are "open", even when they don't have beds. They require mandated participation in multiple religious activities per day.
Boise statutes say "If a homeless shelter is open, you can be arrested and jailed for sleeping on the streets", and "but I don't want to be subjected to mandatory religious activities for only the _potential_ of a bed at the end of the day" is not considered an excuse.
It's one thing to criticize religious impositions on a secular activity (like addiction recovery). What you have just done is criticize religious people as a group, and claim that they are abusive.
Criticize ideas and policies; not groups of people.
The OP is saying a lot more than "AA at least doesn't make things worse". It's making much stronger claims about what the evidence now shows, for example that AA is not only more effective than CBT, but requires half as much time (let alone money). They're saying that a new wave of stronger, randomized studies has completely overturned the previous weak consensus.
Those interested in A.A.'s official position on atheism and agnosticism should check out the pamphlet[0] Many Paths to Spirituality published recently by AA World Services, the legal entity responsible to North American A.A.. The link is to a product page - click on the picture of the pamphlet to download a pdf. There are sober atheists in AA. To anyone who gets a bad reaction to professed atheism in an AA meeting, remind the offenders of AA's Tradiion 3: "THE ONLY REQUIREMENT FOR AA MEMBERSHIP IS A DESIRE TO STOP DRINKING". If they persist, find or start another meeting.
I completely agree with the message that people-helping people is super effective.
But I'd like to point out that one of the core tenants of AA is to surrender to a higher power.
I'm not advocating in favor of religion. But rather highlighting that maybe people who accept 'surrender' of their own will are more likely to get better. There's something to the concept that seems powerful.
Anecdotally, I've known someone who used to be stressed out and controlling. Last time I saw him he was not so stressed. He said his life changed once he surrendered and accepted his destiny. He didn't go religious or anything, just 'accepted' his fate.
It reminds me of the old saying: The reasonable man adapts himself to the world, the unreasonable man adapts the world to himself, therefore all progress is due to the unreasonable man.
I think there's a major understanding of this part of AA. This DOES NOT mean acknowledging that you believe there is a god. The concept of a "higher power" can mean anything you want it to mean. You can imagine your higher power is Gandalf, Sauron, elves at the bottom of the garden, or even some aspect of your "best self." You could imagine it to be the spirits of your ancestors or even something like the energy of the universe.
The point is surrendering to something "bigger" than yourself. Don't get tied up in militant atheist perspectives.
I think this depends on your specific AA. In bigger cities this is largely indeed the case. However, in smaller towns it’s not as true.
That being said, these smaller towns already pressure people to believe in a higher power in most social settings, so it’s less a case of AA imposing it and more society, which is kind of to be expected in a people driven effort.
I suspect that's a YMMV scenario that may differ enormously from AA group to AA group.
My son's in Cub Scouts and we take this approach with the "duty to God" requirements (he doesn't have a duty to God, so duty fulfilled!) but some troops require a bit more than that.
Please describe a 'militant' atheist perspective unironically. :)
When you contrast it to any other type of 'militant', there is typically violence involved..
However, personally, I think the closest thing I could believe in is a "best self". Not that anyone chooses their beliefs, but the rest would be pretty hard to digest for any good reasons.
Honestly, I just think giving up on the idea that you can do this by yourself (in the long term) is counter-productive. Especially if you have an existential crisis later in life and that 'higher power' was the only thing that kept you moving forward.
Learning how to embrace self-respect/love/understanding/esteem would go so much further in the long run and would help in all aspects of your life. With each success, and learning to accept each failure -- you will be strengthening productive habits.
> Please describe a 'militant' atheist perspective unironically. :)
I think of militant as unyielding and confrontational. This isn't some pejorative assigned to others, it is a term forwarded and embraced by proponents of that ideology. For an unironic perspective I suggest this New Yorker article "All Scientists Should be Militant Atheists" by Lawrence Krauss [1].
The first usage of militant atheist out there is in quotes.
Which clearly indicates that the author doesn’t actually believe that’s an appropriate term, but is rather saying that if what is described by some as militant atheism (an adjective the author doesn’t agree with, hence the quotes) then all scientists should be atheistic enough to be described as militant by those people.
Well... I did met violent militant atheists, so they DO exist.
Thankfully that was many, many years ago, but stuff that happened to me:
1. Atheist stealing my bible then proceeding to play "soccer" using it as ball.
2. And Atheist + Vegan being physically threatening because I was eating meat and was christian.
3. I got hit on the back of my head with a chain, in middle of a university class, completely out of the blue, some time after an atheist classmate found out I was christian (he waited until I was busy reading something to attack me).
4. Had a group of atheists constantly bully me (for example stealing stuff, damaging my property, graffiti, etc...)
All of that happened near "highly educated" people, for example inside school, academia, white-collar workplaces...
After I started to interact with "normal" people (the average person of my country, that doesn't have college education, have blue collar work, or work in service industry directly in contact with people, etc...) this all stopped.
If you wanna trade stories I can tell you about growing up atheist in South Carolina, but I don't think it's a productive or effective use of this forum.
I usually, don't talk about these situations, was only replying to the guy directly above me, that DID asked for that.
In my country the population is mostly followers of african religions, although they don't know that (they all claim to be catholics, but don't go to mass, but often go to african-based holidays, festivals, etc... and often believe in african supersticions), atheists are a tiny minority, but they are important, "elite" places, like Academia, politics, mainstream media and so on, have lots of them, and many are blatantly militant, although I cited some anecdotes, during cold war we had atheist guerrilas and violence that needed to be handled by the army (that in turn commited their own atrocities).
I wish people believed more in certain freedoms, for example atheists I know often interpret separation of church and state to mean "freedom from religion", instead of "freedom of religion", but "freedom of religion" should also mean freedom to not believe in anything at all.
Also I wish people would stop conflating some things, for example many atheists I know are biologists (there is a important state-backed biology course in my metro area, often students are sent to MIT, Harvard, etc... in exchange programs), and many believe that biologists that have a religion are evil people that believe in fantasies... meanwhile had leadership in some churches I visited insist that science is evil because evolution and whatnot is not in the bible.
I believe this is part of why we ended in the situation we are discussing on this thread: many atheists intentionally want to dismantle all forms of belief on higher powers, no matter what kind of powers they are, because they conflate being religious with evil.
> Don't get tied up in militant atheist perspectives.
Not that you're saying its not, but I'd grasp onto this to add a point that its valid and useful to debate whether that surrendering is the best path.
In my mind, what you're being asked to do is abstract and make a virtual externalization of your ego. The benefit is you can get some of the benefits of ego-depletion or ego-loss, but the side effect is that it risks further use of that mechanism to explain or stop caring about things that are more easily under one's control. This can lead to a cycle of ignorance - if every event that happens is "God's Plan", then why not give into nihilism? Its ends up being the answer to every question - if you don't understand something, then its not due to lack of effort, it must be ungodly.
Note that plenty of religious people don't fall into this trap. They don't have a problem expanding their knowledge, and they leave the dieties in the periphery of understanding. Growing up amongst some extreme fundamentalist people though and seeing the downsides of dealing with all problems through faith alone, I am really lax to recommend the surrendering that AA espouses as a universal/sole truth.
all that and you entirely missed the point. surrender as a broad concept is necessary because alcoholism is an illogical, slippery disease. to get sober, you have to accept that you cannot do something that it seems like everyone else can
Or.... get some distance from the problem, then work on addressing the underlying reasons you go to it, while practicing not doing it. There are many paths.
I'm with you - whenever a non-demoninational event goes down, or when someone says "take the higher power of your choice, could be Gandalf, it doesn't matter!" I can't help roll my eyes. It's an ignorant thing to say. Assuming a religion is "invalid" or not a "religion" if it doesn't have a godhead at all. Many don't, named or otherwise. "Higher Power." And lord forbid your chosen godhead is someone else's religion fallman. When I was growing up in SC and we'd do these school classroom prayers (public school, unconstitutional, but who's keeping score?), me being a cringy little 13 year old atheist would say shit like "hail satan" and raise ire of pretty much the entire school. So no, they don't really mean "your higher power of choice," they mean "your given godhead that I can convince myself is actually mine just under a different name."
I mean, if we're talking about people who actually do imagine that their higher power is Gandalf, then we're talking about some pretty cheeky people here.
There are people who have gotten “Jedi” on the official lists of religion. I would presume that one of them going through AA would simply surrender to the Force. Seriously or ha-ha-only-seriously, it doesn’t matter.
Sure, you can surrender to the top name of whatever religion dominates your surroundings. Or you can surrender to the top name of the one your parents raised you in counter to the surroundings, or the top name of the one you found yourself drawn to as you grown up.
Or you could surrender to the Invisible Pink Unicorn, blessed be Her invisible mane. Or the Flying Spaghetti Monster or anything else made up to mock the idea of religion. I wouldn’t recommend surrendering to Cthulhu for healing via the AA but if you think that sounds like a good idea then go for it.
Whichever deity works. If all you know is the default for your culture and you’re not down with that one, then it’s time to do some research.
>The point is surrendering to something "bigger" than yourself. Don't get tied up in militant atheist perspectives.
There are people that can just say "from tomorrow I will believe in God/afterlife/spirits etc. It would be so easy to live knowing that your loved ones are not gone or that if you are good enough your problems will be solved soon but for some people(like me) it is like trying to convince me that 2+2=5 and giving cancer to children has a higher purpose that we are to stupid to understand but we still should worship that "bigger" thing.
People come to AA when their lives have completely fallen to shit. They need something, even if it's something that they have to completely make up for themselves out of whole cloth. They'll believe it because they need to believe it.
People who can quit cold turkey, or manage their alcohol consumption, should do so. AA is a last resort, when you're so desperate that even an atheist is willing to give up something of themselves in order to stop drinking. For atheists there are ways to make that "higher power" palatable, but it's still going to be horrible.
Most people will never have to do that, and they should happily pass that by. Just be aware that there are people whose lives are that bad that they'll try to force themselves to believe. Even so, many will fail. Addiction is a terrible, awful thing.
Sometimes I think that spirituality is something people either "get" or they don't.
For me, to consider the very fact of existence rather than non-existence, the beauty and order of it, the people around me who have somehow manifested as conscious beings from chaos... (and on and on)...
none of those things require a supreme being or intelligent creator, but the sense of awe after giving sufficient consideration is difficult to differentiate from feeling god.
Carl Sagan and his fans (me among them) understand your sense of awe. I do think it's important not to forget that when you lose religion. I also think it's important, as Sagan probably did, for the secular world--for humanity--to reclaim it as part of being human (whether you call it spiritual or not).
> but the sense of awe after giving sufficient consideration is difficult to differentiate from feeling god
Do you think that, in a universe with a proven-real, interventionist diety—picture, say, the Architect in the Matrix—that "feeling god" would really be a feeling of awe?
I'd personally expect it to be mostly a feeling of fear, at how insignificant and easy-to-accidentally-kill you are.
Imagine the feeling of being made aware of an entire galaxy, one containing quadrillions of lifeforms, getting sucked into a black hole.
Imagine the feeling of knowing that if you ask a question, a million consciousnesses might be created and then destroyed in order to answer it.
In short, imagine the feeling of someone else having an omnipotent magical genie.
Feeling at one with the flow of the universe is, to me, the exact opposite of "feeling god." It's feeling that we're operating in a system with a static set of rules; a feeling that nobody has the capacity to declare humanity forfeit by fiat (but instead has to "work for it" through regular physics, in a way that we might be able to defend against through other physics); etc. It's a feeling that the universe is a fair game rather than a rigged one, at least on the quantum-chromodynamics level.
I agree the fact we exist and we can consider our existence is something special but still it won't help me with believing that things will be better tomorrow or that there is an afterlife.
when I was a child I wanted to become a priest, I read all the books and I was a believer, the giant mistake the priests and religion teacher made is to be dogmatic, like to still consider that "creation happened as it is said in Bible, that the world is 5000 years old and avoiding though questions with a story where X did Y and then God done Z. I seen on YT interview with smarter clerics that are not as dogmatic and acknowledged some issues and if my teachers were like that maybe I would have kept my faith.
At least the priest/teachers are paid from taxes to tell our children stories and contradict science /s (this is in Romania btw)
Don't blame 'religion' in general for such things when frankly only a tiny group of people actually believe that; mostly American frankly.
And also contemplate that there might be reasons why spiritual affiliations have a tendency towards dogma - it's a powerful social instrument. Almost all groups of every kind are dogmatic, it's what we use to 'fill in the blanks' and for most of illiterate or semi-literate history it was 'good enough'. It can be used for good or evil surely, but it's pragmatic.
Everyone seems to be arguing about religion but not focusing on what aspects of it might relate to the ostensible success of AA.
Suppose you had brain damage and a doctor prescribed some tongue-twisters for you to recite in order to exercise specific parts of your brain. Would you object based on the semantic content of the tongue-twisters? If one of the tongue-twisters was "Our father who art in heaven, hallowed be thy name", would you object to reciting it because you disagree with what it means? What if clinical trials had found that particular phrase to cause the necessary brain exercise, and no-one had discovered any alternative ways to achieve the same exercise?
As a current and active member of AA, let me re-affirm that this battle over a "higher power" exists inside the rooms of AA just as everyone is arguing about it here. A great many alcoholics let them selves get hung up on the concept of a higher power, or more specifically, the word "God". The word God appears 134 times in the first 164 pages of the Big Book. For many non religious people as well as non Christian people this presents a huge problem; how can we alleviate the burden of alcoholism without believing in God?
Within the 12 steps of AA, Bill W clearly laid out the answer to this very question. Below I've copied over the first 3 steps of AA.
1. We admitted we were powerless over alcohol - that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
The gist of step 1 is acceptance. Acceptance that our lives are controlled by alcohol. This one is pretty easy for any true alcoholic to admit.
The gist of step 2 is surrender. Step 2 states, "Came to believe a power greater than our selves could restore us to sanity." Coming to believe in something is not the same as flipping a light switch and a light coming on. Surrender here in step 2 deals with admitting that we need the help of something greater then ourselves to restore us to sanity. That power could be the love of your family, wife/husband, kids, the energy that moves the cosmos, or a fucking Zagnut bar. As long as it is a power greater then self, you're good.
The gist of step 3 is faith. The key to not getting hung up here is the statement "God as we understood him". This ties directly back to "a power greater than ourselves". Seeing how the Big Book was initially written in the 1930's, and Bill W himself was a Christian, the word God appears a lot. Before the first edition was published, there was an internal fight between the founding members and contributors to the Big Book on the wording of step 3 in particular. They made a deliberate decision to say "God as we understood him" to include as many people as possible.
I share this with you all because I have been and always will consider myself a non religious person. I have needed to work on the concept of a higher power time and time again. When I first started attending AA meetings I let the God/higher power thing get in the way of my recovery and relapsed many times. Only once I surrendered to the idea that a power greater than myself could alleviate my suffering, was I able to start the road to content sobriety. I hope this helps clear the air for some of you, and if there is anyone out there suffering from alcohol or drugs please find a local AA or NA meeting raise your hand and ask for help.
> That power could be the love of your family, wife/husband, kids, the energy that moves the cosmos, or a fucking Zagnut bar.
So, either you actually believe that a Zagnut bar is an agent that can help you out of your desparate situation by using its special powers. Or you are intentionally obfuscating the rather obvious fact that indeed, people do not need to surrender to anything or anyone, because obviously it's not the Zagnut bar doing the work, but rather exclusively they themselves.
I'm not an AA person, and frankly, from what I know about it, I find it somewhat off-putting . still, I will try and be charitable here.
I have a hard time going to the gym consistently. I know it's good for me, but I just don't like going very much. so I make plans with other people to go to the gym together. if I flake, often they say something about it the next day, which is annoying but ultimately helpful. acknowledging that I can't (or at least probably won't) go to the gym consistently on my own, I have voluntarily created a system where there is a social cost to not going. I still have to do all the work myself, but the other people help me stay on track.
The point here is that there is no "higher power" involved. It's other people or you yourself, or possibly both, neither of which in any meaningful sense qualifies as a "higher power", and either of which has a completely unambiguous, non-confusing term to refer to it: "Other people" and "yourself". The point is that it is dishonest to then pretend that somehow a Zagnut bar could plausibly be an agent helping you instead of simply saying the obvious: It's most certainly not the Zagnut bar, so what's left is you yourself and/or other people.
tbh I always feel like AA people are shooting themselves in the foot with these silly examples of a "higher power", especially on forums like this one. I doubt anyone earnestly surrenders themselves to a candy bar or fire extinguisher, but I'm certainly not knocking it if it helps someone.
I think the point is that you need some sort of mind hack to escape the paradigm of will vs. desire which has been a losing battle thus far for most addicts. it is ultimately your will that prevails, but you have to trick yourself otherwise for it to work.
> I doubt anyone earnestly surrenders themselves to a candy bar or fire extinguisher, but I'm certainly not knocking it if it helps someone.
No, of course, noone does, that's the point. Possibly, some people somehow think that they do (and even that seems a bit unlikely to me), but it just is a nonsense concept: You can, as a matter of semantics, not surrender to something that doesn't exercise power. You might as well be saying that you need to wash yourself, but you can also do so by looking at a horse. Looking at a horse makes you washed as much as following instructions of a candy bar makes you do anything, for lack of any washing effect in one case, for lack of any instructions in the other.
> I think the point is that you need some sort of mind hack to escape the paradigm of will vs. desire which has been a losing battle thus far for most addicts. it is ultimately your will that prevails, but you have to trick yourself otherwise for it to work.
That might well be the case, yep. And I see two big problems with not clearly stating that that is what's (likely) going on: In more than one place, it seems to cause harrassment of atheists, and I am not so sure it's actually helpful for mental health when people externalize the credit for the work that they have done themselves. And also, even if that's a hack that is needed in the "therapeutic context", a discussion about the scientific evidence of the efficacy certainly is not a place for such intentionally onfuscating language.
If you think logic is so powerful, why don't you use it to cure alcoholism instead if spending it in HN comments? :) The use of surrender is to admit you don't know how things work. At least not to the point to actually cure yourself of addiction.
A sane rational logical person has an addiction. The sane rational logical tools he has do not help him to get rid of it. This means he cannot trust them. There's a flaw somewhere and he doesn't know where. They are not good for any conclusion, including the agency and power of that bar. The best he can do is to drop them and admit he knows nothing. Then there's a chance to learn something new that may help with that addiction.
The point is, you find a power greater than yourself that you can surrender your will to. That "higher power" is different to everybody. A lot of people let them selves get hung up on the higher power bit because they can't abstract the idea of surrendering to a non quantifiable or tangible thing (hence the Zagnut bar for those who can't surrender to the idea of love or the ideas of forces of nature). Believe me, I was one of those people for a long time. But my suffering got so great that I eventually had to admit to myself that I cannot do it on my own and I need to find something I hold sacred and dear. And if a Zagnut bar is that higher power for you...then so be it. It's better to believe a Zagnut bar could restore me to sanity, then to continue to kill myself with alcohol and drugs.
Again, the point is surrender. I am in no way saying the Zagnut bar is doing anything but inspiring hope in the alcoholic. And you are 100% correct that the work comes from inside, not a candy bar. But without the surrender of self-will, nothing else is possible. Steps 1, 2, 3 are saying I am powerless over alcohol, that I cannot stop on my own, and need to have faith in a higher power of my own understanding to make it through this thing alive.
> The point is, you find a power greater than yourself that you can surrender your will to.
So, you think that a candy bar is a power, in any way whatsoever?
> A lot of people let them selves get hung up on the higher power bit because they can't abstract the idea of surrendering to a non quantifiable or tangible thing
Because it's nonsense?
> (hence the Zagnut bar for those who can't surrender to the idea of love or the ideas of forces of nature)
Which makes it only more nonsensical?
> Believe me, I was one of those people for a long time. But my suffering got so great that I eventually had to admit to myself that I cannot do it on my own and I need to find something I hold sacred and dear.
... and then you did it yourself, thus demonstrating that you were simply wrong about not being able to do it yourself.
> It's better to believe a Zagnut bar could restore me to sanity, then to continue to kill myself with alcohol and drugs.
Only if that actually "restores you to sanity". And if it does, it was still you who "restored yourself to sanity".
> Again, the point is surrender. I am in no way saying the Zagnut bar is doing anything but inspiring hope in the alcoholic
Yes, you are. You are saying it's "a higher power". It's not. It's a candy bar. Possibly a candy bar that is inspiring hope in an alcoholic.
> And you are 100% correct that the work comes from inside, not a candy bar.
So, why all this dishonest mumbo-jumbo about a "higher power"? Mind you, this is not a therapeutic setting, this is a discussion about scientific evidence of efficacy.
missing the point entirely. alcoholism is illogical. alcoholism is not something one can control. surrender is a key part of the program because to get sober the alcoholic must accept that they cannot do something that it seems everyone else can (drink)
People often get hung up on the contemporary Western conception of a higher power, not realizing that the personal, anthropomorphic God is but one flavor of the concept. Scientific laws or forces are in some sense, a "higher power" - clearly we all surrender to the power of gravity every day.
There is no shortage of meetings where you're expected to submit to the Christian God, where the people will be hostile to someone they find out is an atheist.
They'll still use the "your higher power can be the door knob!" bit, too.
That seems like a fairly unconvincing suggestion. I'm fairly convinced that if I was to show up at the psychologist saying that I thought a fire extinguisher was a higher power that controls the world over which I have no control they would be concerned. What would it even mean if the fire extinguisher was a higher power?
The various results for "atheists removed from AA" or "atheists kicked out of AA" on Google tell me AA works with the personal god version, not the others ones.
A study found an association between an increase in attendance to AA meetings with increased spirituality and a decrease in the frequency and intensity of alcohol use. The research also found that AA was effective at helping agnostics and atheists become sober. The authors concluded that though spirituality was an important mechanism of behavioral change for some alcoholics, it was not the only effective mechanism.[54] Since the mid-1970s, a number of 'agnostic' or 'no-prayer' AA groups have begun across the U.S., Canada, and other parts of the world, which hold meetings that adhere to a tradition allowing alcoholics to freely express their doubts or disbelief that spirituality will help their recovery, and these meetings forgo use of opening or closing prayers.[55][56] There are online resources listing AA meetings for atheists and agnostics.
Google results can drum up anything you like. I've never personally or through second hand seen or heard of any AA group that would kick out an atheist.
That there are results to validate that this happens on some occasions, doesn't mean it's universal or even common. I suggest trying another 'google search' and you'll find there are plenty of AA meetings for which the 'higher power' element is more agnostic, and plenty for which is almost not relevant.
The problem with invoking that part of the solution that helps is the surrender to a higher power, is that there isn't a lot of group therapy solutions that don't have that involved.
We can't effectively say for certain whether there's a correlation with throwing in a higher power or just group therapy on its own in this circumstance, and I know for a fact there are many that will not join an "* Anonymous" group because of the more religious overtones. This creates a dichotomy that is hard to separate when talking about groups like AA, as it reinforces the thought that their process is important over the comradarie and support of a shared experience.
> We can't effectively say for certain whether there's a correlation with throwing in a higher power or just group therapy on its own in this circumstance
The higher power is not "thrown in" to AA, it is the critical foundation.
Also the people who are most critical of this concept or most aggressively reject AA based on a perceived religious foundation also tend to be the ones who have the poorest understanding of what the higher power means.
I'll admit it's not an easy concept to grasp. For many/most fellows AA the principles of AA take a good amount of time to begin to understand, and alcoholics sometimes bumble their way in and out for years before this happens. It's a learning process. Pushing back on these principles, especially the existence of one's higher power, correlates highly with continued active drinking. Acceptance of this is the whole point of the program.
If it helps people, I'm glad; but to say that the people that it doesn't help "just don't get it" is pretty disingenuous. And since this was in response to my interest in correlation between the higher power and improved outcomes, I'm sure you've got a study lying around that I could take a look at; anecdata is nice, but group therapy on its own has also been shown to be helpful, and none of the studies that I've seen so far use general group therapy as a control group over an Anonymous group (Gaming, Marijuana, Alcoholics, Gamblers, etc).
I have been going to AA for a while now, mostly because it is the only type of group meeting regularly available. The part that I cannot come to grips with is not so much the recognition of a higher power, but the fact that you have to believe that you are "powerless" to your addiction. This whole notion of pushing off fault and that you cannot change your behavior without the higher powers intervention is not something I will ever agree with. But group meetings are awesome and effective, and in most areas AA is the only choice, so no wonder AA works.
The idea of admitting you're powerless is to admit that the worldview you've been holding so far doesn't seem to work against addiction. Which means it's not entirely correct. Which means some things you think you know are not so.
Sure, but I’ve always interpreted it in the sense that you have to surrender to the fact that you are powerless under the influence of alcohol, that you are incapable of doing something that it seems everyone else can (drink)
> Anecdotally, I've known someone who used to be stressed out and controlling. Last time I saw him he was not so stressed. He said his life changed once he surrendered and accepted his destiny. He didn't go religious or anything, just 'accepted' his fate.
That's something I think about slightly. A lot of adult life is anxiety based on seeking optimal something. After years it feels like fear of death causing over analysis and cramping. Then you just go back into average life and maybe (at least my belief) realize it's ~peak. The anxiety is maybe even a nature trick to make us learn adult life complexity and maybe improve the status quo a bit.
Yeah, I mean, this is a core Christian belief. Hitchens even described it as objectively immoral. :) Jesus tells us that we don't really know the future so it's kind of pointless to be planning to hard, speculating and being anxious over it. You might just have a heart attack tomorrow: so much for your plans. Jesus says instead to trust that God takes care of the birds so surely he will take care of you too, his Beloved children—to just trust that if you try to bring Order to this world’s Chaos and be authentically There, then everything will turn out OK.
My uncle Guus plays viola in an orchestra and once noted to me that there is something similar that happens in attitudes towards other people who are dissatisfied with us. When we are young we ask “what is wrong with me, how can I change myself?” and as we grow older we start to ask instead “What's wrong with them?” but without trying to change anybody. They will find their way—or not; and we may be able to help them—or not.
>> Anecdotally, I've known someone who used to be stressed out and controlling. Last time I saw him he was not so stressed. He said his life changed once he surrendered and accepted his destiny. He didn't go religious or anything, just 'accepted' his fate.
> But rather highlighting that maybe people who accept 'surrender' of their own will are more likely to get better.
There's a correlation/causation trap here. It can be very reasonably hypothesized in the opposite direction: people comfortable with surrender to higher power are more likely to respond to AA as a treatment.
Explaining away the majority of life's existential questions (surrender to higher power) and then surrounding yourself with a community that supports you (weekly groups), is a pretty tried and true method for happiness.
That assumes happiness/contentment/stability is the goal.
> The reasonable man adapts himself to the world, the unreasonable man adapts the world to himself, therefore all progress is due to the unreasonable man.
Yes and no. There is value in recognizing the things that can't be changed (at least at the time).
From Musashi:
"What a fool I’ve been,” he exclaimed aloud. “I tried to make the water flow where I thought it should and force the dirt to stay where I thought it ought to be. But it didn’t work. How could it? Water’s water, dirt’s dirt. I can’t change their nature. What I’ve got to do is learn to be a servant to the water and a protector of the land."
There aren't any rules, there are just suggestions... that being said, a higher-power is something that's "not you", could be the group, yoda, the universe, a light bulb. Seriously...
I wonder if maybe the externalization of will helps to ...reset? the perception of ones self. I'm not sure if I'm wording that the best way.
Example: Sometimes I'll tell people "I'll have this done by X time" in order to externalize the goal. Now, it's not on my own willpower to finish this, it's now an externalized obligation that I need to do or <insert negative consequences here>. That externalization makes me push harder to complete things.
Societies have been driven by religion and spirituality for ages. Of course we have now been enlightened by science buts it's probably one of the challenges of culture to come up with an effective replacement. One that not only not contradicts scientific commonsense but that is also not considered as mumbo jumbo.
There's definitely a void left by the demise of religion. Also this leaves the question open whether that is not the reason have actually turned alcoholics ;)
The fallacy I can't help but point out here is that thinking because of our science we are better off and have somehow been "enlightened" when all evidence points to the contrary, at least not to the things that truly matter: the human condition, life, love, family, relationships: can't say our science and techology has made these things better on a whole, but at least we can binge watch Netflix and play Minecraft together I guess.
Sure, we can crunch numbers and test hypotheses faster, but they were doing that with far more primitive instruments, in most cases even without writing and simply using their minds, for centuries well before the so called Enlightenment period. It seems the more "enlightened" we become the worse off the condition of the human soul becomes, and the more we favor vices and all the things our fathers and mothers tried to warn us against for centuries. Our Science, which in of itself has become a religion, in my view has lead us all to cultures of indulgence, where utilitarianism is the only value to be regarded. I wish you could say at least we aren't slaughtering ourselves anymore in the name of Religion, but sure enough, human slaughtering has increased by entire factors these past two centuries, than the previous 100 combined, "Enlightenment" or not.
The notion of man gaining reason and "growing out of" religion during this period is in of itself such a hilariously cliche, Western-centric viewpoint of history but this is another issue of itself.
Tell that to your grandparents who had to live through polio, small pox, and other terrible diseases that have been eliminated or significantly reduced to near nil.
While you're at it, ask them what it was like trying to keep in contact with someone far away before the internet. Maybe ask them about birth complications and childhood death rates.
People who pine for the past are ignoring the facts in their face. Life has never been better.
Great, so we are living longer, less full lives. Yes every time this point is brought up, medical technology is always pointed to as the big "gotcha!." Let's concede that medical technology indeed has done us all a great service, and set that aside. Now what? Social media has made keeping in contact easier? That's all you got? Really?
> People who pine for the past are ignoring the facts in their face. Life has never been better.
For the very temporary moment. There's many hypothesizing that our mostly sterile lives we've lived in the past 50 years was not a good idea, that your immune system needs practice, and that when the next superbug comes along, not only will we not be able to handle it, we won't have effective antibiotics to combat them, but I digress.
Sorry if it's a little glib, but the first thing that came to my mind after reading this post was:
"But apart from medicine, effective sanitation, drastically higher chances of living a long life, material welfare, peace and declining violence, and a near end to famines and legal slavery, what has the Enlightenment ever done for us?"
Sure, WWII claimed 3% of the world population, but Tamerlane got 5% and Genghis Khan 10%.
if all the God and higher power stuff bothers you can always go to a secular meeting. the best thing about aa is that there is a group that fits you :)
I'm not saying whether this is a good or a bad thing, but religion has done a lot over the millenia to teach people how to be productive in society. Religion is first and foremost a tool to keep people in line. The fact that part of it happens to incorporate a belief in the afterlife is an implementation detail.
Sure, it might be obsolete now, but if someone is in bad enough shape (such as an alcoholic), even an obsolete religion may still be a better tool for the job than something like psychotherapy. Psychotherapy doesn't directly add any sort of community to a person's life. I had a drinking problem for some time and a big reason for that is I hated the people I was surrounded by (who were often not much different from myself at the time) and needed to tune out somehow.
Feel free to downvote, but the results of this meta-analysis of 145 scientists and 10,080 participants speaks for itself. Sometimes the outcome doesn't match your worldview and that should be okay.
Does anyone else feel like this study is a bit tautological in that it's measuring attributes that are valued by the AA method? Many other methods don't preach abstinence so of course they're going to get less total abstinence duration. But I wonder if there are better ways to measure overall effectiveness and well-being. Some people learn to manage their drink and would fare poorly on that metric.
I agree, but having attended AA meetings to support my significant other I can really see how the groups and meetings help. For the people like you and me who can work through it ourselves, there will be a hundred who can't and where the program helps. Personally I have an issue with giving up control absolutely as it is worded, since I like to be in control of my destiny, but I respect and appreciate the wonders that AA can work for people.
It’s been established for a long time in the treatment field that AA (or pretty much anything else) works a lot better than no treatment.
Brandsma 1980 is the only study I can think of off of the top of my head comparing AA (and a few other therapies) to no treatment; AA (and everything else) did significantly better than getting no help.
What this new Cochrane study demonstrates is that AA is more effective at giving alcoholics long-term abstinence than traditional psychotherapy treatments.
I really take issue with this characterization. Please have some respect and humility: addiction is a serious matter, and this characterization of addicts as weak-willed and immoral is inaccurate and misleading for anyone out there who is seeking a way out.
Modern medicine treats alcohol abuse and addiction as similar to other chemical dependencies.
I don't know what to tell you. Your callous dismissal of the seriousness of alcohol dependency is an ideological position, not one based on reason or science.
I don’t consider alcoholism to be a moral failing. It’s more of a life hurdle. In general, the benefits of alcohol are overrated, and the drawbacks are underrated in our popular culture. Alcohol consumption increases anxiety and depression. This doesn’t get enough attention.
I don’t agree with either of these characterizations. It is not a disease because the cure comes instantly by a decision from within. It is not a moral failing because the substance subverts moral reasoning. I am not religious, but I find the religious view to be accurate: a good soul fallen, that needs to be saved.
Source: a lifetime of addiction in my family and loved ones. Some made it out. That transformation is astonishing. Others didn’t. When you think it can’t get any worse, it can. It’s made me realize that we are all addicts. There is always some void in life that becomes deeper by the behavior used to fill it. Everybody.
I'm sorry, but I sincerely question your understanding of addiction, the program, those closest to you if you genuinely believe "the cure comes instantly by a decision from within." If this were true then chronic short term sobriety followed by relapse wouldn't be so common.
My impression is reinforced with, imo, your trite "we're ALL addicts" platitude. Yeah, we all get distracted sometimes and get hung up on the bit of cleaning. That doesn't mean we all have ADHD and OCD. There are ways to establish a middle ground without downplaying legitimate disorders.
Almost certainly, anyone who calls themselves "alcoholic" should probably give Alcoholics Anonymous a try. However, alcoholism is not a disease and AA isn't the only answer.
You left out the phrase "in my opinion" from your very strong opinion statement that alcoholism is not a disease. You could qualify your opinion, such as "in my professional opinion as a psychologist", or "in my layperson opinion through my experience with people who believe they are alcoholics". Or even better perhaps "in my opinion as someone who thought I was addicted, I solved my problem this way...".
The studies in this space are notoriously bad(AA has a lot of true believers, which can lead to publication bias, and psychotherapy research in general is pretty poor). And one the best and largest studies(MATCH) on the topic show that pretty much every non-pharmacological treatment is the same.
But Cochrane reviews are notoriously good. They're always spoken of as the standard in meta-analysis. What's interesting here is that new research is contradicting previous findings.
The 2006 Cochrane Collaboration review was based on just eight studies, and ended with a call for more research to assess the program’s efficacy. In the intervening years, researchers answered the call. The newer review also applied standards that weeded out some weaker studies that drove earlier findings.
In the last decade or so, researchers have published a number of very high-quality randomized trials and quasi-experiments. Of the 27 studies in the new review, 21 have randomized designs. Together, these flip the conclusion.
Users post workarounds in the threads. There's one in this thread. I realize finding it is a chore when there are a ton of comments, but that's a small price to pay for a significantly better article.
Its possible cultivating those beliefs, even if false, is a powerful tool in overcoming addiction. It may actually be the case that cultivating some belief in a higher reason / order to the universe is beneficial in recovery. There are dedicated circuits in the brain for religious / spiritual thinking and feeling, and when activated may play a role.
As a counter-point, its possible to imagine a scientific discovery that while true, would cause mass suicide and depression upon discovery (e.g. an asteroid will hit the planet in 10 days). While implausible, suppose that we "found scientific proof" the god exists and is the christian god, and eternal life / punishment awaits us after death. This knowledge / belief would probably radically alter the behaviors of society (lower crime, suicide, depression, etc).
Another good example is a healthy self confidence. For most people, this is incredibly beneficial (stave off depression, get a stable life, eat right, avoid addiction), but could be seen as a false belief. Most people's contributions don't "matter" in any real cosmic sense, their lives won't be remarkable, and they aren't more talented / qualified than most people. The insignificant experience we gain in a few years on this tiny dust speck isn't enough to make confident opinions on life or the universe. Most people are cogs in the machine, generating waste heat, and their death would hardly be noticed, and soon forgotten. But embracing those facts as "true" would have a markedly negative effect for most people, so perhaps its better to falsely believe the opposites of these (and we have dedicated circuitry to help us do just that, ignore all evidence to the contrary).
My basic takeaway is that this entire AA thing is an experiment to ask that very question: does cultivating this set of thought patterns prove effective? Is it more effective than the thought patterns of other approaches? Even if the beliefs are "forced" or "false", are they effective?
> Its possible cultivating those beliefs, even if false, is a powerful tool in overcoming addiction. It may actually be the case that cultivating some belief in a higher reason / order to the universe is beneficial in recovery.
Also - these beliefs may be soothing, which decreases stress level and helps with depression and addiction.
Great point. I think we evolved these types of thinkings because it helped with tribal cohesion, self-soothing, and the ability to deal with adversity. The thought "everything happens for a reason" comes to mind.
How is it even possible to study AA meetings when they can vary so much everywhere in the world? Some have been horrible with horrible people while others were fine...some were good. I just never saw actual consistency even in the same meetings.
No-cost-to-member, and overall cost, are two different notions. bAs are financial and nonfinancial costs, e.g., time, travel or transport, facilitator, meeting space, training or. materials.
I lost one of my best friends to alcoholism about a month ago. My friend was 54 years old.
AA is good. It does help, but it's not an absolute cure. It does seem better than most (all?) of the other methods.
The very best way forward is simply to not take the first drink, ever. (This is what I am hypocritically telling my children. I drank to excess in my younger days, but I've been dry for about 20 years.) I hope they listen. Booze works for many people, but it's absolutely disastrous for some.
The best way to avoid dying in a car crash is to never get into a car, ever, but we're not advocating that, are we? Car crashes kill more people in the US than alcohol abuse.
I get that you're afraid that your kids will end up abusing alcohol, but I think you do them a disservice by painting the world so black-and-white. Avoiding alcohol can have many good effects, but it can also leave people out of many valuable social (and in some industries) business experiences, as much as it's a shame that that's still the case. Better to let them make their own decisions when the time comes without unduly influencing them with an absolute. (And many prohibitions that you lay on kids end up backfiring greatly with opposite effect, so there are no guarantees.)
Meanwhile, there are lots of more likely ways that they could screw up their life. Alcohol is just an easy bogeyman to shake a stick at.
Alcohol qua alcohol is a pretty terrible drug, toxic in reasonable doses, very addictive, affects judgement, and so on and so forth. I happen to think in a culture with a sane attitude towards drugs in general, alcohol wouldn't be a favorite.
Mormons, Muslims, straight-edgers, teetotalers, and alcoholics, all manage to socialize and conduct business just fine while never touching alcohol. Literally all you have to do is order soda water. Anyone who gives you crap for not drinking is going to turn out to have other bad habits, bet money on this.
GP is right: the absolute best way to avoid problems with alcohol is to not drink it. Considering GP was a problem drinker, and that has a genetic basis, you are being arrogant as hell telling him how to raise his children.
"for each additional A.A. meeting attended, health care costs fell by almost 5%"
Wow. It's really quite stark to see it in such austere terms.
The cost nature of this is quite exceptional if you think about this.
Without even unpacking anything to any degree, it would seem that dragging oneself to a meeting, socializing with others in the same plight, re-affirming one's commitment to 'getting better' probably really goes a long way to changing behavior.
AA is great. It saved my Dad's life. For a while, I was going too. Ultimately I began drinking again and things are much better now. I also know that if things ever get rough for me I can rely on AA. Really great group of non-judgmental people in there. As an agnostic, the "God" stuff wasn't a problem for me, it's pretty light and on your own terms.
Someone else mentioned this and I agree wholeheartedly. I think unless you have a physical addiction to something, you just need to discard it and "forget" about it.
For drinking, I think the new Heineken 0.0 is a game changer. You can go out to a bar and hold one and drink, get the placebo effect.
just remember everyone that there are other 12 step and recovery focused programs and out there. so adventure out, explore, meet people, find where you fit and heal :)
https://secularaa.org/meetings/
Secular AA - same thing as AA except they don't pray nor require a belief in a higher power (no God stuff)
https://whitebison.org/WellBriety.aspx
Wellbriety - Wellbriety means to be sober and well. Wellbriety teaches that we must find sobriety from addictions to alcohol and other drugs and recover from the harmful effects of drugs and alcohol on individuals, families and whole communities. The ‘Well’ part of Wellbriety is the inspiration to go on beyond sobriety and recovery, committing to a life of wellness and healing everyday.
https://www.smartrecoverytest.org/local/
SMART Recovery - Self-Management And Recovery Training (SMART) is a global community of mutual-support groups. At meetings, participants help one another resolve problems with any addiction (to drugs or alcohol or to activities such as gambling or over-eating). Participants find and develop the power within themselves to change and lead fulfilling and balanced lives guided by our science-based and sensible 4-Point Program®.
one other thing... just because you might have had a bad experience at one aa or recovery meeting doesn't mean that recovery in general sucks. i always say, there is a reason why most 5:30 pm meetings are called Happy Hour. most trade the room for the bar and although they aren't drinking or using they are still jerks and aren't doing the same stuff they use to do. the old saying is a sober horse thief is still a horse thief. i find that people who are serious about getting sober usually go to morning meetings or smaller meetings (like church meetings). also... men with men, women with women seems to work for most.
A fantastic book and complete alternative to the AA approach is Allen Carr's Easy Way to Control Alcohol. It focuses on the reasons TO drink which is unusual. And it does a good job of dismantling them.
I realize this might not be a popular approach, but I figured I would share my experience here in case anyone else is helped by it:
I was an alcoholic for over 10 years. I would drink multiple liters of vodka weekly. It was not uncommon for me to drink an entire 375 ml bottle of vodka in an evening.
I never really considered myself to be an "alcoholic" in the traditional sense though, because I didn't let it affect my day-to-day life as a programmer. I was young and healthy, and I didn't usually have much of a hangover because I only drank high end vodka, and I always drank a lot of fluids. Whenever I got a hangover, I would just pop an ibuprofen and the hangover would disappear after about an hour. I would literally set my alarm an hour before I wanted to wake up, and when that alarm went off I would wake up, pop an ibuprofen, drink half a glass of water, then go back to sleep. By the time my second alarm went off an hour later, I was as good as new.
I literally did this for years, while often working 12 hour days as a programmer. Nobody could tell, and it didn't seem to affect me too negatively, so I didn't see a reason not to. It helped me relax at the end of a long day, and it made movies and television more fun and enjoyable to watch. It was also fun to go out to bars and hang out with friends.
Eventually, though, it caught up to me, and I started to get reports from doctors about abnormal liver test results. They were still just borderline, but it was enough to scare some sense into me. I had just recently had a son, and I realized I wanted to be alive for when he grew up.
So I tried to stop drinking. I didn't want to go to alcoholics anonymous (I didn't consider myself to be an alcoholic after all, and I'm an atheist and didn't want to deal with all of their religion/higher power 12-step stuff).
Quitting cold turkey worked for about 3 months, but as I'm sure you know, the alcohol drinking culture in the programming startup world is extremely prevalent.
It was only a matter of time until I ended up in a social scene where I felt pressured to drink, and I had a beer along with everyone else. It was all right, I told myself. It was just a beer! No big deal! I had quit drinking before and I have it under control now, so it's ok! Nope. Once I got a taste and a reminder of the stress relief offered by alcohol, I started right back into it. Next thing I knew, I was drinking vodka every night again.
After a couple of more false attempts to stop (with each one being thwarted by my having a beer and getting sucked back in), I finally came to terms with the fact that I simply can't drink. I can't touch the stuff or I will get sucked back in. I realized I was an actual alcoholic.
So I stopped. I carefully tapered off my heavy alcohol consumption over the course of a week, and that was it. I've now been sober for a year and a half. Whenever I'm in social situations where other people are drinking beer, I simply order a diet coke or something and I sit and enjoy their company. I might even shoot the breeze and chat about all my favorite types of scotch or whatever. But I absolutely do not allow myself to have even one sip of alcohol, because I've learned the hard way what it leads to.
As a side note, during that year and a half, I also managed to get completely out of $50,000 worth of debt, pay off my car, and diet my way from 245 lbs all the way to 180 lbs (still have another 20 lbs to go before I reach my goal of 160).
And I did it all without alcoholics anonymous or medication or therapy or anything. I simply accepted ownership of the problem, made a decision, and stuck with it.
With that said, however, there was a catalyst and a "higher power" that lead to the change and kept me on track:
I had a kid, and I realized that I wanted to stay alive long enough to see him grow up and have kids of his own.
I realize this might not be a magic bullet for anyone (and I hope you get help if you need it), but my point is simply that sometimes it is in fact possible to do on your own (given the right circumstances and motivation), although this fact is something that is not very popular to mention.
FYI: the best meetings are the speaker meetings. Less drama, higher quality of people who want to get sober. Also most of the groups goes out to coffee or dinner after the meeting.
I wonder if there are any studies about how religion in general works for alcoholism? It would be interesting to study how much of AA's function comes from religion.
Trying to find sources to confirm this, but I've repeatedly heard that cognitive behavioral therapy dominated AA in effectiveness. I would take this more as an indictment of psychotherapy than an endorsement of AA.
Edit: I found a review of Project MATCH[1].
> Background
> Project MATCH was the largest and most expensive alcoholism treatment trial ever conducted. The results were disappointing. There were essentially no patient-treatment matches, and three very different treatments produced nearly identical outcomes. These results were interpreted post hoc as evidence that all three treatments were quite effective. We re-analyzed the data in order to estimate effectiveness in relation to quantity of treatment.
>Results
> The results suggest that current psychosocial treatments for alcoholism are not particularly effective. Untreated alcoholics in clinical trials show significant improvement. Most of the improvement which is interpreted as treatment effect is not due to treatment. Part of the remainder appears to be due to selection effects.
As someone who is been in psychotherapy and an arm-chair psychology enthusiast, not every kind of therapy will be effective for everyone. This also goes for psychiatric medications.
CBT is often oversold as a cure for every kind of mental health issues. New meta-research has found that the effectiveness of CBT has been decreasing for quite some time and long-term effectiveness of CBT is arguable.
Regarding effectiveness of AA, I think it makes sense. Lot of people with addiction suffer from childhood trauma, emtional neglect, and abandonment. In psychological term it is called attachment injury. A community where you are not shamed, validated, understood, and accepted would give corrective emotional experience, which would in turn heal your attachment trauma. I've heard this phrase somewhere: "what cures people in therapy is love". So it's not surprising that finding a community where you are accepted would help you treat your addiction.
> not every kind of therapy will be effective for everyone
That's pretty problematic though, isn't it? At some point, you're dropping below placebos, not everything works for everyone, but should we still put weight on it? Homeopathy and intense praying works for some as well, but we don't say "I guess it's not effective for everyone". Psychotherapy (not the behavior therapy kind) gets a pass for some reason.
It makes sense to take a lot of these numbers with a healthy amount of skepticism.
That second 'A' means something. AA has no membership, no census, no graduation. Additionally, I doubt the people who stay involved are a random sample, so identifiable 12-steppers are going to be a skewed distribution.
I'm sure at least some of that can be controlled, but claims about their efficacy have been all over the map, I think, because of this.
I'm positive you can find many therapies and other methods that end up working better than AA.
I went through some of those methods and they are very effective. It also cost me around $10k, and that's after very good insurance.
Many (most?) alcoholics are not in a position where they can spend 10k on treatment. So it's really a moot comparison. Further confounding many of the studies is that AA is filled with people who are there by court order or other reasons. It's not at all a fair comparison. In most of these studies, someone who slips up and has a single drink after 2 years of sobriety is bucketed in with someone who only has a week of sobriety total.
I've actually talked to my addictions therapist about this, and is his opinion, every single study done surrounding AA has been absolute garbage.
Cognitive behavioral therapy is a form of psychotherapy obviously, so if the article is representing the Cochrane analysis accurately, it contradicts what you've repeatedly heard.
It's noteworthy that all but one of the studies quoted in that meta-review were conducted in the United States. The usual criticism levied against AA is that it takes a religious approach, but that's not even true, it it built on evangelicalism. If you are in the US, you are either evangelical or you at least understand evangelicalism because that's what your friends and colleagues profess. You wonder how AA would fare in other countries, where their approach would meet with bafflement or hostility because the background is not understood.
Even in the US, it heavily depends on where you live. If you are in one of the big west coast cities, I would imagine you can observe a situation similar to Europe.
I felt like that joke from one of the more recent seasons of Silicon Valley, where the episode revolved around one of the characters "being outed" as a christian, was very on point, from what I have personally observed both in SF and Seattle. A bit of background on the episode: one of the CEOs of partnered companies owned a gay dating site. No one had any concerns or issues with that, but as soon as some people found out that the CEO was christian, all hell broke lose and the following quote was dropped "You can put micro doses of LSD in your cereal and people will call you a pioneer. But the one thing you cannot be is a Christian."
P.S. The show is obviously pretty tongue-in-cheek, no one seriously claims you cannot be Christian in those areas or that you would face hostility due to it. But people will definitely be questioning it a bit.
Another noteworthy aspect that is somewhat specific to the US is that AA is often the only available treatment that doesn’t add a significant financial burden on the patient. I can imagine that while one is dealing with substance abuse issues, adding the stress of figuring out how one will finance treatment might prove detrimental to the treatment.
Note that I haven’t read this study (can’t access) so it might have to control for the effects of the cost of treatment.
> If you are in the US, you are either evangelical or you at least understand evangelicalism because that's what your friends and colleagues profess.
That's very much not true. Evangelicals (even if one also includes Fundamentalists in that category which is wrong) are about half of US Protestants, which are in turn between just over a third and just under half of the population, depending on the specific study.
This is probably not going to be a popular thing to say but total abstinence isn't necessarily the goal that everyone who has a drinking problem is aiming for.
Just as those who over eat want to control their appetite for food rather than simply stop eating so do some who have a drink or drugs problem. In many cases the drink is a symptom not a cause. Remove the cause and for some people at least the drink problem will subside.
I worry also that the AA members are also a subset of those who have a drinking problem, are we sure that they are a comparable subset to those who took other paths? How do the studies account for people who drop out of either AA or some other program and did the studies follow up years later to find out if people had fallen back into addiction?
The article was a bit light on details.
And lastly the article mentions relative efficacy but doesn't say anything about how efficacious any of the programs were leaving me wondering if any of them are worthwhile.
Yup, clicked through here to see if anyone was talking about this.
I always hear people throwing around things like "the only way is abstinence". As if addiction is a binary thing, and is always caused by "a predisposition to addiction" itself, and can never have any other causes. I think marketing of programs like AA has pushed this narrative, with little to no evidence to back it up.
Until I see a study that definitively shows that any further alcohol consumption after treatment will nearly always devolve back into abuse, I'm not buying it.
Did they keep track of any people who went through any programs (AA or otherwise), and ended up with only occasional consumption without the abuse? Doesn't seem like they even took down any data on this.
I see a sibling comment condescendingly hand-waving these questions away, with no evidence to back it up, and it makes me sad that our ability to treat alcohol abuse is so hobbled by hearsay.
Sure, and I’ll add that one understated strategy in dealing with addiction is harm-reduction. Relapses basically occur when you pull the rug out from under you and just go full abstinence. Phasing down the dosage can be an effective strategy. If you drink 500ml of Vodka a day, could you go for 350ml for awhile? Crazy thing to suggest because at those levels you’re dealing with a full blown alcoholic, but it is definitely a strategy.
Just because it isn't true for all doesn't mean we should eshew it. Yes, some folks find out they can't drink at all, ever. Others will do just fine being without for a bit, then learning how to drink moderately. It isn't dangerous advice, merely truthful and we can be honest about it not being right for everyone.
> total abstinence isn't necessarily the goal that everyone who has a drinking problem is aiming for
I guess you're technically right. But statements like these make me chuckle. They are very common, and a dead giveaway that you are not very familiar with addiction. Switch out drinking for shooting heroine or smoking crack, and see if the statement still makes sense.
The rest of your comment is dead on though. The studies are very bad at making any sort of distinctions like you mentioned. They also ignore the astounding costs of some of these other programs, whether a person is there by choice or not, whether they are trying to quit for the first time or 20th, types and severity of relapses, and many other factors.
throwaway account obviously. this got long but here's my (five) cents.
I'm an addict in recovery. In the past alcohol and then switched to opiates (sadly all to common story of getting pills from MD unnecessarily). I haven't faced many consequences and have been still successful in tech. still not 'out' about opiates to work or friends, just my peers in recovery.
I have found the underlying hypothesis of this - group support - has been a really big help for me. I found a group for those in recovery that participate in sports (the Phoenix) which has a double punch of great community and also physical activity which is super beneficial.
For me, I think this has been the second biggest contributor to success.
But my #1 - with opiates in particular - is medicine replacement therapy. I tried so many times to get off myself. I finally got on buprenorphine which has been a lifesaver and successful to date on first try [one year!]. There are also some drugs now for alcoholism but unfortunately stimulants seem to not have great options.
It seems a shockingly low amount of rehabs use replacement therapy [1] [2] or even know about it (or even as a short term withdrawal taper tool). There are also a scary amount of overdoses from relapse post rehab.
I think the science is pretty convincing - there are studies showing even if relapse after maintenance therapy the period of abstinence before relapse is longer [3] - and also just seems like MUCH higher success rate [4].
BUT this is still an opiate! My doctor has patients who have been on for years. A lot struggle to get off. I personally don't have a problem with very long term use - personally I see parallels with SSRIs/SNRIs where many users report problems getting off and withdrawal, but obviously who would say you should get off something like prozac - a mind altering drug that has clear benefit?
The most FU part of this for me - it still takes a special license to dispense buprenorphine replacement therapy, patient numbers are capped per MD, and there is a ton of stigma all around even at pharmacies who dont blink twice doling out opiates. Pisses me off when looking at how most MDs can dole out opiates with far less training/license requirements. also pharma definitely profits - though there are now generics. i've found at least for the strips it's basically the same price. The pills without naloxone are cheaper - but for addicts struggling that gets rid of the back stop and overdose preventer.
Plus having only a few Drs in many states (or none) that charge cash or medicare only makes it in-accesible for many of the downest and out addicts. It should be free (or covered by the worst pharma co s) and FAR more MDs should be able to write script.
I've heard that part of the motivation for the escalation of opiate strength (fentanyl and carfentanil) is because so many people have begun seeing success with these new therapies. The illegal marketplace has probably been losing profits.
Maybe replacement therapy isn't perfect, but I've seen it help a lot of people who are in a bad place. I wish there was more motivation for finding exit strategies, but there doesn't seem to be any profit in that.
my dr mentioned that he's had success with the sub cutaneous thing. it lasts a month and it seems like it's a good way to slowly taper down. and he said the bupe stays in your body for a LONG time when doing that - longer than a month after the 30 day period
it's really hard to taper down! it takes a lot of willpower not to just take more since you have it sitting around. i wonder if would be more successful with like a 1 month taper for in patient program.
I tapered off of my Suboxone prescription gradually over a long period of time. By the end of it, I was taking very tiny pieces of the film. They were small enough that at some point, it was probably more mental than anything.
I wish you all the best! After getting off of it, the hardest part for me was still maintaining a clean lifestyle while avoiding the types of people and behaviors that lead to scoring or abusing other drugs (alcohol included) as well.
How long of a taper did you do? im not on a very high dose but was still thinking about like 3 months. but I also am 50/50 like I'm worried about the after effects you have - this is working so well now I see very little downside to long term use and the upside is really big imho - except probably harder to eventually taper off the longer I'm on.
By not high, do you mean around 2-4 mgs? If so, 3 months is probably a good timeline for taking a 25%-50% reduction every 1-2 weeks or so. I might have even taken longer for the last few doses. I think the big thing is not to rush it and take a pace you're comfortable with. Like you say, taking buprenorphine is much preferable to turning to alternatives.
My first experience with a taper was at rehab as they were pushing me out the door. They rushed it, and I was dopesick as I left. You can imagine that didn't turn out well.
Another thing I credit my recovery to is having strong support along the process. Also, building new lifestyle habits like going to the gym helped me improve my self-image. I don't know how much making that sort of change would apply to you but thought I'd mention it.
great advice - thank you. it's helpful hearing success, and triple from those who have successful business lives especially tech/engineering/etc
yup on on 4mg.
i go to the phoenix snd got into my preferred sport again! something i gave up while using that was a huge part of my life. and it's been so good to get it back both community, new friends, and just getting back into shape.
Dear Dang, what does your admin toolset look like? Have you written about that anywhere? I'm curious, is this post of yours at the top because it has the most upvotes, or because you are pinning it here?
When I post a procedural comment about a thread, we sometimes pin it to the top. Usually it's about trying to dampen flamewars. In this case it was in the hope of getting the thread more on topic, but that's less common.
That post is no longer pinned. It's still at the top of the thread because of upvotes. Normally we'd downweight it now, but https://news.ycombinator.com/item?id=22552120 is so good that I don't want it to sink along with it.
Yet at the same time I think dang has the ability to move any post up or down/re-prioritizing or re-ranking based on his intellect, instead of a natural, organic ranking. It becomes a forced therapy session by dang. We also cannot know if this happens, since those moves would be invisible to everyone else on the site (except to other admins/moderators). I do not think it’s far fetched to think he has this power, seeing as karma scores are conveniently hidden for all posts (except for the author of each individual post).
I’m a little disturbed that dang seems to ‘steer’ conversations based on his own interests. There’s a bunch of smart people here and I don’t understand why he goes past his role as administrator to interject into certain threads. It’s ‘bad hosting’ in my eyes.
With my questions I’m trying to understand what the rules of the game are, to see whether I like them or not and whether I want to keep playing (engaging on HN).
We're not in every thread moving things up and down, but HN is a curated site, and that involves judgment and interpretation. For example, if there's an offtopic comment, especially a generic one [1] sitting at the top of a thread collecting upvotes as they tend to do, it's a standard moderation move to downweight it.
The idea of HN is intellectual curiosity. Sadly, upvotes alone don't optimize for that; the voting system optimizes for indignation and repetition. Countervailing mechanisms, such as software and moderation, are needed. We use software to do what we know how to automate and humans to do what we don't know how to automate—though I wish we did, because most of the human intervention at this level is tedious.
What's more interesting is since "The Irrationality of Alcoholics Anonymous" (2015)[1] HN thinks they are experts in how AA doesn't work.
These meme bugs that infect people are the on ongoing issue you see a lot here.
They make no sense, but that's why the meme works. AA is free and you talk to people about your issues, it's hard to see why it's wrong, which is why people love the meme.
Throw in some other regulars -
Inefficiencies mean people actually use more because of "Jenkins paradox" so don't make things efficient!
You are supposed to wake up every night in the middle because some researcher in the arts read it in 300 year old documents.
People are more afraid of losses than gains.
Dumb people think they are smart.
People rise to their level of incompetence... Actually this ones true. But it does mean Impostor Syndrome is more complex than people say.
> They make no sense, but that's why the meme works. AA is free and you talk to people about your issues, it's hard to see why it's wrong, which is why people love the meme.
this isn't a very charitable take. there are a lot of legitimate reasons to be skeptical about AA. to an outsider, the tone and content of the twelve steps can seem pretty weird. why abstinence only, and why don't coffee and cigarettes count? why are people prohibited from identifying themselves as a drug addict in some AA meetings (as if alcohol is not itself a drug)? why does AA itself collect essentially no data that could be used to determine the efficacy of the program? why do courts mandate attending AA but not other similar support groups?
the old adage "it's hard to beat free" certainly applies here, but I wouldn't casually discount all the negative stories in this thread from addicts that tried AA.
The Cochrane meta-analysis has arrived at opposite results to that debunking, based on 21 recent randomized studies. It's interesting how many comments in this thread are pointing to the older results as if they debunk the newer ones.
That information is, at best, out of date. The new Cochrane study links to a number of studies which show a far higher rate of abstinence than 5% for subjects randomly assigned to undergo treatment which encourages them to be part of the AA fellowship. It reports a 41.8% success rate — actually abstinence from alcohol rate — 12 months after treatment.
That's a fine success rate for any addiction for any treatment.
You can go down multiple paths multiple times before things start to stick. You also have harm minimisation to think about.
How many celebs who go to 'rehab' with the best money can buy then relapse? You don't just write off their rehab, you get them to go again or they might try something different.
It's refreshing to see people helping people in programs like AA.
I'm curious to see if the success of these programs change in the coming decades, as younger generations seem to be moving away from social interaction in favor of social MEDIA interaction. Will this have an impact on the success of programs like AA? I hope not.
AA may be the most effective of the options studied but that doesn't mean it is a successful program. It just means it is the most effective of what are generally non-successful programs.
Chronic Alcoholics had limbs (hands) cut off during early history. It wasn't very successful comparatively or maybe it wasn't "the best". The best known behavioral solution is the best behavioral solution qualitatively (which is a mix of programs, statistically). But calling such a program (as AA) something non-successful means you've using different criterion than the bar of sustained sobriety and reduced frequency of relapse. It's not clear what differentiates successful from non-successful in your estimation?
My own impression is that AA would not have worked for me. Too preachy. Too pessimistic. For me, what helped was psychotherapy, joining a meditation group, an antidepressant, and solving the underlying root cause of my drinking (a failing relationship). I haven’t had an alcoholic drink in 4 years, and I don’t miss it.
Are you aware that you're arguing in bad faith throughout this thread, or do you think these are strong points you're making? "Someone must've quitted drinking before AA existed" => "the silent majority of quitters do so via self-help" is nowhere close to a valid conclusion. Particularly for someone who's prided themself on their rationality elsewhere..
That's an interesting point. I think that's a different sense of the word "anonymous," though.
There's a strict sense of the word "anonymous" that is from the tradition of writing: an anonymous letter, for example, or the sense in which 4chan users are anonymous. It means "this person has no unique identity at all, other than what one can infer from this written word." This is the kind of anonymity that e.g. Facebook has fought against with their policy that accounts should have real names.
There is another sense in which "anonymous" is used that is common to all kinds of secret societies, though, and that is simply public anonymity as a member of the society. You don't wear a pin or make it known that you are an active member, except maybe to specific individuals that have need of that knowledge. But within the society itself, you very much have a distinct identity.
That isn't how the anonymous part of alcoholics anonymous works. The twelve traditions lay out a better explanation, I think, but you are not totally anonymous in the group meeting, use of first names only when speaking and interacting, but friendships evolve from that.
i feel like it would be easier to retain anonymity in VR vs a physical location where you could be recorded in, or have your car spotted, or have any of the other participants remember your face.
"Anonymity is the spiritual foundation of all our Traditions, ever reminding us to place principles before personalities."
While it is easy to take the word anonymity at face value, in my opinion as an alcoholic active in AA, anonymity as it is mentioned here in tradition 12 deals more with ego and pride. When you walk into a meeting, you leave "what you are" at the door and walk in as "who you are." This translates into practices of not using honorifics. A judge isn't "Your Honor" at a meeting. A priest isn't "Father." All are equal, and all are just one drink away from being drunk. Thus, placing AA's principals before our own personalities.
Last I google-researched, AA-style treatment was really the ONLY effective treatment against long term dependence/addiction. Psychotherapy and others almost always failed.
It probably is related to the social network effect that was described with Vietnam vets dumping heroin addiction when they returned home to their old social groups that didn't accomodate the behavior. AA et al provide a new social group that actively tries to stop the addiction.
For those who AA doesn’t work for, I would recommend psychotherapy, joining a meditation group (for the social benefit, not for counseling), and practicing regular meditation, particularly loving-kindness meditation, which you can google and is easy to practice. A good psychotherapist can help you learn how to talk to yourself in a more supportive way. Meditation can help you to break out of your mental ruts and pause before taking habitual action.
is there an HN flagbot randomly flagging posts for opaque reasons?
will smearing blood on this post keep it from getting flagged or is this comment already suspect and targeted by the Reaper XNPQ3 due to it being a reply to a previously flagged post?
does it cost you any points in heaven to flag a post?
May I simply feel free to flag posts containing adjectives in lieu of adverbs?
I've noticed that all of the 50 states I'd visited featured grammatically incorrect street signs advising one to "drive slow"... must be related to sign painters being grown up "slow children playing" also from grammatical butchery sign infamy...
