When science stops
December 18, 2022 Comments Off on When science stops
AA is maddening. On the one hand it provides a therapeutic social support group that clearly helps some people stop drinking and live happier, productive lives. On the other hand, the reasoning behind its methodology is contradictory, mostly made up, and fundamentally unsound. It’s my opinion that AA fails to help most people because it intentionally rejects the scientific principles that it pretends to embrace.
What, then, is the science behind AA? The Big Book itself only mentions the word science a handful of times, and only to repudiate science as a means for treating alcoholism. “Science may one day accomplish this [making a non-drinker out of a drinker], but it hasn’t yet.” (Chapter 1, p. 31). The chapter on atheism/agnosticism explicitly derides science as a means for answering end questions about knowledge, and oddly ends up arguing that the Wright brothers’ invention of the airplane was somehow a triumph of religious faith over science. This chapter is a hodgepodge of nonsequiturs and exhortations to embrace faith and reject science; the final “clincher” is a trite retelling of the Prodigal Son about how an alcoholic minister’s progeny, in an epiphany, fell down on his knees, rejected science, and received god with this intellectual tour de force: “Who am I to say there is no god?”
AA’s book that details its methods, “Twelve Steps and Twelve Traditions,” is similarly scornful of science, referring to it in Chapter 2 as a failed method for treating alcoholism, in Chapter 3 as a way of thinking upon which we are dependent, and therefore analogous to religious faith, and in Chapter 7, as a guaranteed way for alcoholics not to be cured. The sum total reasoning in these texts, which are the foundation for all that AA does, is that science cannot cure alcoholism.
At the same time, AA emphatically rejects the notion that alcoholism is a moral or personal failing, or that people fail to abstain because they somehow lack willpower, and describes it as an illness. “We have come to believe it is an illness,” “the alcoholic illness,” “in the grip of a progressive illness.”
It seems like AA actually does support a scientific definition of alcoholism, but the bait-and-switch comes early. In Chapter 2 of the Big Book, AA specifically states that alcoholism is an illness that “only a spiritual experience can conquer.” It further admits that its use of the concept of illness is merely a front to win alcoholics over to the AA method, which of course is spiritual. Getting people onto the AA program involves ostensibly treating alcoholism as an illness, even resorting to medical advice and treatment to detox, but ultimately seeking the “cure” of sobriety through religion. “You are betting, of course, that your changed attitude plus the contents of this book will turn the trick [convince the alcoholic to stay sober],” p. 144.
One of the religious testimonials to AA in the Big Book (p. 336) makes clear that despite repeated references to disease and illness, AA itself has zero interest in pursuing, understanding, or dealing with medico-scientific treatments or their reality. “I understood that it was not the world’s job to understand
my disease; rather it was my job to work my program and not drink, no matter what.”
Once in recovery, alcoholics are encouraged to proselytize to other people with the disease by pretending to agree that it’s an illness, all the while leading them to a spiritual remedy. It’s an explicit endorsement of fraud and deception because the ends supposedly justify the means.
“Continue to speak of alcoholism as an illness, a fatal malady. Talk about the conditions of body and mind which accompany it. Keep his attention focused mainly on your personal experience. Explain that many are doomed who never realize their predicament. Doctors are rightly loath to tell alcoholic patients the whole story unless it will serve some good purpose. But you may talk to him about the hopelessness of alcoholism because you offer a solution. You will soon have your friend admitting he has many, if not all, of the traits of the alcoholic. If his own doctor is willing to tell him that he is alcoholic, so much the better. Even though your protégé may not have entirely admitted his condition, he has become very curious to know how you got well. Let him ask you that question, if he will. Tell him exactly what happened to you. Stress the spiritual feature freely. If the man be agnostic or atheist, make it emphatic that he does not have to agree with your conception of God. He can choose any conception he likes, provided it makes sense to him. The main thing is that he be willing to believe in a Power greater than himself and that he live by spiritual principles.” Chapter 7, pp. 92-93.
Essentially, AA’s manual mandates that you dupe the alcoholic with references to illness and disease and the medico-scientific certainties of his condition, but lead him to a moral-spiritual-theistic solution. Yet none of these fragments, despite their plain aversion to science, carry any of the punch contained in AA’s Tenth Tradition, which is one of the twelve core principles upon which the entire organization rests.
“TRADITION TEN — long form: No A.A. group or member should ever, in such a way as to implicate A.A., express any opinion on outside controversial issues—particularly those of politics, alcohol reform, or sectarian religion. The Alcoholics Anonymous groups oppose no one. Concerning such matters they can express no views whatever.”
On its surface this seems like a sound approach to keeping AA focused on its mission, which is to help people abstain from alcohol. Yet what AA considers “outside controversial issues” includes the definition and treatment of alcoholism itself. AA’s stance on what alcoholism is and the best way to treat it remains unchanged from 1939, and with good reason. AA does not endorse or propose any scientific approach to alcohol addiction, it is strictly religious, and like most religions it requires foundational texts that are inviolate, that cannot be updated or amended, and that are immune to new discoveries or change of any sort. If there is a definition of religion, this is it: We are The Way, singular.
It’s astounding that an organization devoted to alcohol addiction doesn’t even acknowledge that the word “alcoholism” has no medical definition and that modern views, based on neuroscience, chemistry, biology, and psychology, recognize that alcohol use falls on a spectrum with some people mildly addicted, some severely, and some not at all. AA’s origins as a religious offshoot of the fundamentalist Oxford Group, its bait-and-switch with an illusory “illness” being treated by prayer, and its insistence that no progress is possible without dog and a rejection of science all explain why, in order for AA’s methods to work, you have to give up and accept that science is helpless and hopeless as a means for curing alcoholism.
And lest you miss the point, AA’s Big Book hammers it home with a bone-chilling accusation in Chapter 5: If you can’t recover from alcoholism, it’s your fault because you are “incapable of being honest with [your]self.” From what seems like an awful judgment, that you’re a pathological liar and you have a strange alcoholic disease caused by lying, AA retreats just a little ands says don’t worry, such human failures “seem to have been born this way.”
This paragraph alone makes science helpless, but if you think about it, it also condemns religion. What god makes people incapable of honesty from birth, such that their dishonesty condemns them to death by alcoholism? And from whence comes this determination that people “seem to have been born this way”? Genetic studies? Observational studies? Review of the offspring of alcoholic mothers? The bible? Leaving aside the glaring fact that “honesty” isn’t defined and that it’s somehow the key factor in the disease’s pathology, that the authors are neither scientists nor researchers who have based their conclusions on anything other than anecdotes, this foundational paragraph, repeated at thousands of AA meetings weekly, concludes that people with “grave emotional and mental disorders” have “less than average chances [of recovery],” but then it does a 180 and says that even these poor souls can recover if they have the capacity to be honest. None of it makes any sense, because the Big Book repeatedly defines alcoholism as a form of insanity, and repeatedly describes the severe emotional and mental disorders resulting from alcoholism. The basic message is something that AA participants learn, relearn, and relearn again, namely that if you succeed it’s because you did the program right, but if you failed, well, re-read the Big Book and try again.
Modern ideas of addiction need not apply. Drugs like naltrexone have no place here. Neuroscience is a chimera. Statistical comparisons of various treatments are meaningless. Randomized, controlled studies evaluating the effectiveness of AA are inapposite. Either you are capable of rigorous honesty and therefore going to succeed, or you’re a genetic pathological liar and doomed to a horrific death by alcohol poisoning. This is how god set it up.
When you add these things together—religion, dogma enshrined in an unchanging text, victim blaming, the perfection of the method, contempt of science, and outright deception—you can better understand why AA works for some and not for others. A lot of others, as it turns out. Even AA admits that they only work for about half of the people they treat. I’ll write later in detail on scientific studies regarding the effectiveness of AA, but for now let’s accept their assertion that at least half of people with severe alcohol use disorder get nothing from AA except more alcoholism. Unsurprisingly, science doesn’t lay the blame at the feet of some nebulous flummery called genetic dishonesty or at severe mental disorders.
Instead, science says something else, and it’s a lot more hopeful than “you just didn’t work the steps,” “you were born this way,” or “you’re dishonest.” If AA were open to incorporating science with religion, it would reach more people and succeed with more of the people it already has. I just finished reading a book called “This Naked Mind” by Annie Grace, one of the countless how-to-stop-drinking books that appeal to those who have been left high and dry by the mental contortions, victim blaming, and inconsistencies of AA. Although not strictly scientific, it’s a very good book and it shows how alternate approaches toward alcoholism can help people. Most importantly, it doesn’t reject AA, religion, pharmacological interventions, cognitive behavioral therapy, psychotherapy, or anything else. It simply views alcoholism through a treatment lens that doesn’t resort to religion.
According to Grace, borrowing heavily from the work of John Sarno, M.D., and from the book “Liminal Thinking” by Dave Gray, alcohol addiction results from a combination of chemistry and socialization. It’s interesting that AA doesn’t ever discuss alcohol addiction, but instead separates it from narcotics and other drugs with a separate organization, also based on the Twelve Steps, called Narcotics Anonymous. There’s no explanation anywhere in AA, even in 2022, about why “drugs” are separate from alcohol when every scientific review of any worth whatsoever unequivocally defines alcohol as a drug, and not simply any old drug, but by any measure the most addictive drug known to man. With twice the addictiveness of heroin, and far greater addictiveness than crack cocaine or meth, you’d think that the science of addiction might interest AA. But it doesn’t.
In “This Naked Mind,” the author begins with what should be common sense. If alcohol is an extremely addictive drug, we should look to that fact to explain why people abuse it. Rather than pointing to people’s congenital dishonesty or ill-defined emotional/mental disorders, why not start with the properties of alcohol itself? And if alcohol is in fact the most addictive drug known to (wo)man, doesn’t it make sense that addiction can happen to anyone if they use it often enough and in sufficient quantity? The clinical answer is “absolutely,” and this is Grace’s first and most compelling argument. Alcoholism isn’t some failing of people who can’t be honest, it’s a condition resulting from ingesting an addictive and toxic chemical that will affect everyone who uses it. Whether you wind up in the gutter or live happily ever after sipping a shot of whiskey after dinner depends on your finances, your socialization, your psychology, and the random dumb luck of your genome, but the alcohol itself is constant: it’s toxic and it’s addictive.
Grace believes that alcohol consumption is unnatural, and she points to the fact that every drinker was once a non-drinker, and the process of becoming one involves socialization. Ethanol, the stuff that makes you drunk, will kill you if drunk pure, something you can’t say for water or orange juice, and the only way to make ethanol potable is with additives such as sugar, spices, flavorings or various types, and oh, yeah, sugar. Dilution is also mandatory because drinks extremely high in alcohol content, consumed straight, will make you go blind, burn your internal organs, and/or kill you on the spot.
Animal models closest to humans will not touch alcohol in any form, and either have to be genetically modified, or have to be presented with death from thirst in order to imbibe it. In short, this is toxic shit, akin to ingesting radiator fluid, motor oil, or radium. Yes, you can package it so that it doesn’t kill “you” immediately, but there is no way to eliminate its toxicity on the underlying “you,” a/k/a your blood, organs, cells, and genes. The most recent comprehensive, global study on alcohol published in The Lancet tells you exactly how much alcohol you can drink risk-free: NONE.
This idea, that alcohol is a poison and should not be consumed under any circumstances, dovetails perfectly with AA’s approach, which is complete abstinence, and it’s an example of how AA fails to serve a lot of people who might take issue with the religious mumbo-jumbo, but who would certainly latch onto the scientific toxicity of this supposedly fun and relaxing drink as a reason to quit drinking it.
And it’s this aspect of “This Naked Mind” that takes the most careful aim at drinking, the socialization that forms our beliefs about alcohol and that ultimately explains why we rationalize irrational behavior. Using the concept of liminal thinking, which simply says that our beliefs stem from experiences that may or may not be true, Grace deconstructs each belief we have about alcohol that undermines our attempts to quit. The theory that our reptilian brain directs our prefrontal cortex once certain experiences have become unconscious memories is the basis of this approach.
By examining our true beliefs about alcohol and reviewing why we have those beliefs, Grace argues that it’s possible to let go of the psychological part of addiction, that is the wanting, the feeling that you’re missing out, the desire to be back in bed with your best friend Mx. Alcohol. These unconscious beliefs, created by experience and observation, include things like “drinking is fun,” “drinking makes me sexy,” “drinking makes me social,” “drinking dissipates stress,” “drinking isn’t that bad for you,” “drinking in moderation is fine,” “everyone drinks,” and “I can quit anytime I want.”
Taking only one of these beliefs, that drinking is fun, and deconstructing it so that you understand how it motivates your conscious behavior, requires you to look at why and how you came to the belief that drinking is in fact fun. In the advanced stages of alcohol addiction, no one describes the experience of severe hangovers, liver disease, brain dysfunction, unemployment, poverty, isolation, homelessness, and mental disorder as “fun.” No one.
To the contrary, even people who are just being socialized to drink immediately run into the harsh realities of alcohol toxicity in the form of headaches, vomiting, falling and getting hurt, and that most enjoyable of alcohol-induced fun, the DUI, or better yet, the traffic collision resulting in severe injury to some innocent bystander or worse, to yourself. Even if alcohol were fun, you’d think that these outcomes, all of which are perfectly obtainable your very first time out, would convince you that the fun of alcohol is akin to a beginner trying cliff diving into shallow water.
The fun of alcohol of course comes from observing, as a child, the antics of drunken adults and their asseverations that it’s fun. You see people enthuse about wine or beer or whiskey. You see them liven up, laugh, and have fun at parties. You see that no social gathering can possibly take place without prodigious quantities of alcohol. You hear folk wisdom about the health benefits, and you soak in the cultural wisdom that wine is the elixir of life, the coaxer of truth, the drink of humanity. This socialization, with all its obscure references to received wisdom, continues throughout youth until you imbibe your first drink and you realize that the elixir of life tastes like shit. But by that time you’ve purchased the idea that it’s an acquired taste and, like rats in the lab, you’ll eventually learn to love it.
The even greater socialization, if there can possibly be something more powerful than the endorsement of mother, father, siblings, relatives, and friends, is the socialization through advertising. I’m not going to go on a screed about how we are literally marketed to regarding the fun of alcohol thousands of times, over and over, throughout our lives, but if there’s one thing advertisers can agree on, it’s that portraying drinking as fun works. When people associate the ingestion of a carcinogenic toxin as the key to enjoying all social activities, it normalizes consumption at the unconscious level. You see people enjoying it, you hear them enjoying it, so your unconscious concludes that it’s enjoyable.
Importantly, your unconscious isn’t absorbing the negative aspects of alcohol in the same way, if at all. One of AA’s classic examples about the insanity of drinking that supposedly makes it unique is the example of someone “addicted” to jaywalking who incurs repeated injuries after being hit by cars but somehow can’t stop jaywalking. A more realistic example would be putting one’s hand in a fire. Your unconscious mind has fully absorbed the lesson that fire will destroy your hand. There is no global marketing campaign to convince you that hand-in-fire makes you handsome, sexy, smart, fun, the life of the party, relaxed, or anything other than “burned.” So for virtually everyone on earth, willingly burning yourself is not considered fun.
But I said virtually everyone. There are people who have evaluated skin burns and concluded that it leads to a higher consciousness, and they engage in fire-walking, or at least they appear to. These people have not accepted the socialization that fire burns your feet and instead “learn” to walk on hot coals. Although fire-walking doesn’t actually involved building up a resistance to fire and is a complete scam, people can be induced to believe that not only are they doing it, but that it’s good for them. Footnote: lawsuits have resulted when the initiates have mistakenly actually walked on the hot coals. The point is that people will do what they believe, and what they believe may be incredibly bad for them. But burned fire walkers, when confronted with the assumptions they have made, and then looking critically at their own observations/experiences, can re-wire their beliefs and conclude that walking on fire results in burns. In the same vein, if it’s proposed repeatedly in media and through socialization, people can be re-taught to believe that drinking alcohol isn’t fun because sickness, injury, slobbering on yourself, waking up with STDs, prison, and being broke aren’t fun.
The reason we have no epidemic of jaywalkers or fire walkers is because socialization promoting those things is more difficult; neither activity ignites neurochemical processes that release dopamine or anything else except pain. With alcohol, however awful the consequences, there are undeniable chemical reactions that stimulate the desire to have more. No one ever woke up in the burn unit asking the nurse to please light the other half of their body on fire.
When AA learns that alcohol is a toxic, addictive drug, and that combined treatment modalities including religion can effect extremely positive outcomes, especially for those who abuse it severely, it will be on the path of non-judgmental scientific inquiry, seeking answers that can be observed, tested, and whose outcomes can be repeated.
In short, it will no longer be AA.