Cycling in the South Bay

“If you want AA to work,” the wisdom goes, “you have to work the steps.”

The wise are referring, of course, to the twelve components of AA therapy, which begins with admitting you’re an alcoholic. The other eleven components aren’t steps in that they follow each other like a staircase. They are admonitions about ways of thinking, and the adoption of those ways supposedly leads to the cure.

I have to say that my brief experience with AA was overwhelmingly positive. It’s the only community or club I’ve ever joined with so little judgment, so much acceptance, and so much mutual support. If you attend positive AA meetings and can’t see the goodwill and warmth, you have a heart of stone.

But back to the steps that I never “worked.” I stumbled over the first one and really never made it any farther. The third step requires you to invoke dog as the solution to your problems. I’m an apatheist, and drinking is supposedly a medical condition, so no thanks, and the rest was pre-history.

AA would point out it’s not that AA didn’t work for me, it’s that I didn’t work the steps. They would say that my failure is like claiming that an antibiotic didn’t work which you refused to take, and they have a point. It’s a bad point as I’ll explain, but it’s the one they build into the daily morning reading: the inability to be helped by AA is due to the patient’s inherent moral failings. “Some people are incapable of being honest with themselves. They seem to have been born that way.”

Before I get to why AA didn’t work for me, it’s instructive to note that it didn’t seem to work for many people. There were the regulars at the meetings, but I’d say that half of them were still drinking on and off. A few came to meetings high or drunk. But far more noticeable were the unnoticeables, people who showed up once and never returned. Even the people who stuck it out for a couple of months were the exception. The meetings were a revolving door of people with substance abuse problems for whom AA had no answers.

The hardened cadre of people who were able to beat their drinking problem came in various flavors. The kindest and most empathetic people with long-term sobriety were the women. The men generally preached and mansplained it to you, whereas the women were far more reflective and less didactic.

But whatever.

My anecdotal observations were surprisingly accurate when you look at the scientific research regarding AA’s effectiveness. Controlled, randomized studies show that AA doesn’t work. Even the most favorable research, which concludes that AA is effective, only follows members for a few years. Of course by AA’s own definition of sobriety, you’re either sober for life or you’re a drunk. One ill-advised shot of tequila after 40 years of sobriety is just as big a failure as a 4-day binge after your first week. So studies affirming AA, but that only look at results for a few years, are performing a bait-and-switch because in AA you have to quit drinking completely, forever or you have failed.

Twenty-seven studies meeting the rigorous standards for a Cochrane Review were analyzed in 2020, finding that Twelve Step programs in conjunction with AA were effective.

The authors found high certainty evidence that clinically delivered and manualized TSF programs designed to increase AA participation can lead to higher rates of continuous abstinence over months and years, when compared to other active treatment approaches such as cognitive behavioural therapy. The evidence suggests that 42% of participants participating in AA would remain completely abstinent one year later, compared to 35% of participants receiving other treatments including CBT. This effect is achieved largely by fostering increased AA participation beyond the end of the TSF program.

https://www.cochrane.org/news/new-cochrane-review-finds-alcoholics-anonymous-and-12-step-facilitation-programs-help-people

This sounds like a ringing endorsement, and the study’s lead author, John Kelly of Harvard, has long been a vocal cheerleader for AA. But when you read the actual study results, they conclude that AA’s effectiveness is measured only one year later to achieve the best outcomes, with abstinence dropping off significantly after that, and measurement eventually ceasing after seven years. Anyone with severe alcohol use disorder knows that continuous abstinence for seven years is great, but if you resume the severe abuse at year eight you are right back where you began. What’s also misleading is that the studies use AA as a treatment modality but ignore AA’s measure of success, which is complete and permanent sobriety. To truly measure AA’s effectiveness you’d have to look at the number of people who are completely “cured.” Since the timeline is too long, the studies invariably redefine AA success, but make no mistake, AA does not. One drink and you’ve lost all the gains of a lifetime of sobriety.

What’s also left to the reader to figure out is that the best outcomes, which occur after a year, are only 7% better than other treatment modalities, including no treatment at all. In other words, your chances of getting sober by simply going cold turkey aren’t that much worse than a lifetime committed to AA meetings. And when you look at the time suck, the requirement that if you’re an atheist you change your entire worldview, and the demeaning necessity that you daily call yourself an alcoholic, the benefits are slim, indeed.

Perhaps the worst indictment of this seemingly positive assessment is that it only occurs when you have received clinical, manual teaching of the fundamentals of Twelve Step systems, and are then released into the wild of AA treatment. In other words, for AA to have even the small benefit shown in the Cochrane Review, you have to be hospitalized and inculcated in AA methodology.

Of course very few people come to AA in this way compared to the vast majority who, like me, simply show up, recognize the religion when we see it, and leave. AA is no more effective than anything else.

In my case, I’m back to drinking. Since quitting AA I have a drink, sometimes two, about five days a week. This is very close to my pre-AA level, and as I’ve written before, one or two drinks for me has a stronger effect that than that small quantity might suggest. However, there are some very positive changes, and frankly, I chalk them up to AA.

First, there’s no way I can drink more than two of anything. There is no trend to drink more, which was always the end game for me after a couple of years: way too much drinking that I couldn’t control. Since going to AA, listening to all the stories, reading extensively, and examining my drinking habits, I’ve developed an internal limit. This is incredibly significant because in the past I always became more dependent over time, which is what you’d expect from a drug that is ten times more addictive than heroin. Part of this I attribute to the process of liminal thinking I’ve discussed in other posts, in which you have to deconstruct what you believe and rebuild it according to a different set of experiences and observations. If you haven’t read “This Naked Mind” and the book “Liminal Thinking,” on which most of the former was based, they are excellent reads and may help you reduce and manage your alcohol dependency. I would have never discovered these two books unless I’d gone to AA, though their concepts are completely rejected by AA.

Second, my favorite form of alcohol now doesn’t taste very good to me. To say I drink it reflexively is a perfect statement. Wine doesn’t taste as bad, but I can’t have more than a couple of small glasses, and I think I owe these reactions to AA. By listening to the havoc that alcohol creates, and by reading about its toxicity and inherent bad taste, the belief that alcohol is somehow fun, yummy, enjoyable, or a way to unwind has left me.

AA influenced this because each meeting was so redolent with struggle. The people at the meetings, whether sober or intoxicated or somewhere in between, were battling a truly destructive addiction that seemed to consume their every waking moment. Even the people who had been sober for decades were struggling, not perhaps with the desire to drink, but with the aftereffects and with the daily reminder that they’d be “rebuilding” forever. It’s melodramatic to compare it to visiting a war zone, but the daily emotional beatings that came from watching people win, lose, and draw really affected me.

Third, going to AA affected what I considered to be alcohol’s hold over me. I’ve had so many bad experiences with it, and in addition to self abuse, those experiences almost always involved being abusive to others. Although AA’s message is that we are powerless over alcohol, I learned the opposite by attending the meetings. I learned that people do in fact have choices, and when it comes to alcohol, there is free will. You can control it or be controlled by it, and studies bear this out, again and again: some people get better, and some get worse because it occurs on a use spectrum and because different approaches work for different people.

AA’s insistence that I give my life up to dog, submit to alcohol’s mastery, and confes powerlessness didn’t work for me, at least not in the way they intended. But whatever problems I’ve had drinking, attendance at AA meetings has reduced those problems to an astonishing degree. By reading other perspectives and understanding it as a disorder rather than an incurable, semi-moral, semi-physiological affliction, I’ve been able to get out from under alcohol’s allure and see it for what it is. And in case you missed it, alcohol is a toxic, extremely addictive drug. The most recent research emphatically concludes that the only safe amount you can consume is none.

Best of all, AA taught me that you don’t have to be perfectly sober, though that’s their goal. It’s okay to drink now and then, at least for me, and each drink doesn’t represent some kind of “reset to zero” that erases all of the previous gains. My last bout with sobriety lasted seven-and-a-half years, and the resumption of drinking didn’t eliminate the gains of that time.

For me, AA’s methods were a failure, but there are a lot of drugs you don’t take even though they can cure your condition because the label warns you of side effects and contraindications. Not taking a drug that helps your heart condition because it will kill you doesn’t mean you’ve failed to follow the drug’s protocol, it means that you’ve followed the instructions, and it means that not all drugs work for all people.

AA’s that way. I’d rather keep my belief in free will and a random, uncaring universe than buy into the more frightening reality that everything is directed by an Invisible Friend whose orders for how I have to live were transcribed by a bunch of goatherd mystics, even if that means I have a drink now and then.

The biggest hurdle to working AA’s steps, believing in dog, I actually got over by going to the pound and getting one. He’s asleep right now, and though I don’t believe in him as a higher power, he does appear to be a source of happiness and peace. So maybe they were right after all.

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