Twelve-step programs, at least for me, are a bunch of hooey.

[JacksinPA]

I'd assume an atheist or agnostic would choose different program.

The courts don't give you a choice when you're being sentenced for DUI.

 

[NolanVoyd]

The courts don't give you a choice when you're being sentenced for DUI.

They can't force you. It's unconstitutional.

"that it is illegal in the U.S. for a person to be compelled by a court or a government agency to participate in Alcoholics Anonymous or similar support groups or in 12-step rehab when the 12-step philosophy, or its references to God, violates their beliefs. (This has been held by federal courts, for example, for people who are atheists, Buddhists, or Jewish.)"

See post 13.

 

[JasperL]

To have an atheist or agnostic join in a chorus of strangers reading the Lord's Prayer is hypocrisy, knowing or unknowing.

Or you can skip that part.... Or just join hands in a circle of others, and say nothing. If you want to call it 'hypocrisy' I guess that's fine, but to me it's kind of like someone saying the pledge of allegiance, "under God". And some meetings the AA 'true believers' and the very religious are the leaders, and so I don't go to those.

 

[JasperL]

Actually, psychedelic therapies are showing significant promise in curing addiction -- meaning that a small number of doses, in a controlled environment, breaks the addiction long-term.

Medication-Assisted Treatment (MAT) is not a "cure" in that sense, as the patient needs to stay on medication (just like any other chronic condition). It's showing much better success than 12 step programs, and more importantly, the treatments are actually based on a scientific understanding of the physiological components of addiction.

12 step type programs also are not a cure, because you need to stay in them permanently -- e.g. proclaiming "I am an alcoholic" for the rest of your life, even when you haven't had a drink in 20 years. As noted above, the camaraderie is the part that apparently works, meaning that if you stop, you're escalating your chances of relapse.

There's no requirement to attend AA for a lifetime. I've been sober for 15 years and go to maybe a handful of meetings a year, none since COVID started, and the only reason I'll return is to catch up with some friends that I enjoy being around. Some other 'old timers' do attend regularly well into 10-20 years, but they attend for lots of reasons, and keeping sober is one, but there's also the helping others part, and the being around old friends part. It's comparable in some ways to church, I guess. Church in my experience - I don't go really at all anymore - is as much social and community as it is religion. Point is I am not sure the old timers would be white knuckling it if they had to skip meetings.

FWIW, I'm a huge believer in alternatives to AA. I've known plenty that it failed completely, multiple times, and are dead from the addiction. And I'm convinced that there is a chemical or metabolic disorder at the core during active addiction. In part because the withdrawals are in fact life threatening for some heavy drinkers, quite literally. So the cravings aren't just to get high, but to keep from.....dying, when in full blown addiction stage. I had two withdrawal seizures that sent me to the ER, both times traveling when I couldn't get my 'hit'.

I did sort of a 'nutrition' treatment based on a book by a woman who was disillusioned by the failure of AA for her son, who committed suicide. Worked for me and after a month or so cravings ended. I don't want to get into that, but it could have been 'real' or me just believing it would work, but the core 'treatment' was medical not the AA experience. The AA helped with being held accountable.

 

[Rawley]

The courts don't give you a choice when you're being sentenced for DUI.

That would be a problem to those without faith.

 

[Cardinal]

That would be a problem to those without faith.

It could be considered a deterrent all on its own: "Drink and drive, get lectured to by smarmy Christians. Don't drink and drive."

 

[Visbek]

So absolute sobriety until death is how you define success?

How did you get from my writing "1 year, 5 year, 10 year" to "lifetime?"

I got sent off to rehab as a teenager because I was a ****up who did a lot of drugs. I stayed sober in the program for about 4 years, and then I started drinking and smoking pot again. I still do both, 20 years later - and since then, I've a full and productive life. I finished my high school diploma, got a B.A. from Cal, a J.D. from George Washington, and passed the Bar. I'm happily married and financially secure. Am I a "failure?"

Different studies and organizations will use different standards for success. Some studies use "alcohol use disorder" (AUD) as the standard; e.g. if your drinking doesn't impair your life, you no longer have AUD, even if you had it in the past.
(Definition of AUD: https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder )

Other standards are stricter. Some studies measure total abstinence over 6 or 12 months as success. My understanding is that AA's own standard is total abstinence from drugs and alcohol; "controlled drinking" or casual marijuana use is not seen as success. This may be seen as part of the problem, as AA may be demanding too much from participants, while often presenting itself as the only option.

There are no "medical approachs" that have a "high success rate." Everyone who says differently is trying to sell you some snake oil.

The evidence so far indicates that MAT is often quite effective.

An early study on psychedelic therapy for alcoholism showed an 83% success rate, defined as either the cessation of drinking, or reduction to the point where the individual is no longer classified as having AUD.

Cessation and reduction in alcohol consumption and misuse after psychedelic use - PubMed

Although results cannot demonstrate causality, they suggest that naturalistic psychedelic use may lead to cessation or reduction in problematic alcohol use, supporting further investigation of psychedelic-assisted treatment for AUD.

pubmed.ncbi.nlm.nih.gov

Behavioral and MAT therapies for alcoholism have around a 30% success rate, defined as 1 year of abstinence. While that is not good, it's at least 3 times better than AA.

Studies of MAT for opioids -- methadone, buprenorphine, and naloxone -- show very different success rates, but all are at least 40% effective.

How effective are medications to treat opioid use disorder? | National Institute on Drug Abuse

Abundant evidence shows that methadone, buprenorphine, and naltrexone all reduce opioid use and opioid use disorder-related symptoms, and they reduce the risk of infectious disease transmission as well as criminal behavior associated with drug use.15 These medications also increase the...

nida.nih.gov

Preliminary studies indicate that psychedelic therapy has over a 70% success rate of stopping opiod and nicotine addictions, defined as 6 months of abstinence, and 67% rate of 12 months of abstinence.

Associations between classic psychedelics and opioid use disorder in a nationally-representative U.S. adult sample - Scientific Reports

Opioid use disorder (OUD) is a major source of morbidity and mortality in the U.S. and there is a pressing need to identify additional treatments for the disorder. Classic psychedelics (psilocybin, peyote, mescaline, LSD) have been linked to the alleviation of various substance use disorders and...

www.nature.com

Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction - PubMed

Despite suggestive early findings on the therapeutic use of hallucinogens in the treatment of substance use disorders, rigorous follow-up has not been conducted. To determine the safety and feasibility of psilocybin as an adjunct to tobacco smoking cessation treatment we conducted an open-label...

pubmed.ncbi.nlm.nih.gov

Long-term follow-up of psilocybin-facilitated smoking cessation - PubMed

These results suggest that in the context of a structured treatment program, psilocybin holds considerable promise in promoting long-term smoking abstinence. The present study adds to recent and historical evidence suggesting high success rates when using classic psychedelics in the treatment of...

pubmed.ncbi.nlm.nih.gov

The key here is that there isn't one and only one treatment option, and if you fail that one option you're doomed. There are alternatives, with a better success rate than 12 step programs.

 

[grip]

AA is a lifesaver for many. It doesn't have to be done indefinitely but is a good starting point on the way to sobriety. Didn't cost my friend a thing.

Addiction is more common in people with mental difficulty and impulse control, so follow-up care can also be necessary.
It takes years for people to accept that substance abuse is never going to be worth it.

 

[JasperL]

There most certainly are ways to determine success rates of 12-step programs. All you need to do is determine how many people are still sober after they enter the program (e.g. 1 year, 5 year, 10 year etc). That's how we know that they are largely ineffective.

Cochrane did a review and found AA to be in fact effective.

New Cochrane Review finds Alcoholics Anonymous and 12-Step Facilitation programs help people to recover from alcohol problems

www.cochrane.org

I mean, really. The programs were not developed using anything remotely scientific. There was no rigorous testing at all. It wasn't formed based on an extensive understanding of the physical or psychological causes of addiction. It doesn't try to address those causes either. And, of course, it puts a bunch of drug addicts in the same room, and has them tell war stories over and over again -- how is that supposed to fix things?

There is some of that, but there's also "what worked for me" in those meetings. And "war stories" do have a point. It's very often, "here's how bad drinking ****ed up my life" and admitting that, really internalizing that, how many lies we had to tell, who we hurt, is perhaps the biggest 'step' of all, or was for me. And it provides someone new a before and after view of the person sitting there.

And just speaking for myself, I did find value in some of the steps, as I've said.

Are there other options? Is the treatment painful? Will it incapacitate me more than the illness during the time I have remaining? Will it only delay death by a few months? Will it bankrupt me? Was that 10% success rate worse than placebo? If I'm in the 90%, will it hasten my death? Why did the FDA approve such an ineffective drug? What do my doctors say?

It is a free and voluntary program, at least ideally. If your objection is to compulsory attendance, I won't argue with you.

We should also note that there are potential harms resulting from 12 step and similar talk-therapy approaches, mostly in how they dominate resources and expectations. For example, if a legislator opposes medical approaches that have a high success rate, because they believe that 12 step programs are far more effective than they really are, then that's going to cause serious issues.

I'm not aware of, e.g. treatment centers, sticking with the AA approach when there are other options available that work better. What are those options, and can you cite literature documenting the superior success rate?

 

[Visbek]

Cochrane did a review and found AA to be in fact effective.

Not quite. That metastudy only found that 12 step treatments were more effective at continuous abstinence than two types of talk therapy, namely Cognitive Behavioral Therapy and Motivational Enhancement Therapy. However, in terms of percentage of days abstinent, and number of drinks per day, all 3 therapies had roughly the same success rate. (12 steps are obviously cheaper than months of therapy.)

They did not review any comparisons whatsoever of 12 steps to any other therapies, including MATs. Just those two.

FYI, current research indicates that 10% of Americans with a substance abuse disorder seek treatment per year, and 40-60% relapse within a year. That seems much more effective than you'd assume, given how media routinely portrays addiction -- I guess trying and failing is more dramatic? Anyway, with that said...

The closest the gets to mentioning an actual success rate is buried in the conclusion, where they cite Project MATCH. That was a large study which ran in 1990-1997, and claimed a 24% success rate for AA (vs 15% for CBT and 14% for MET). That's not exactly stunning. It doesn't help that some have drawn different conclusions from MATCH data.

Are alcoholism treatments effective? The Project MATCH data - BMC Public Health

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...

bmcpublichealth.biomedcentral.com

We can also look at some of the other studies they reviewed. I picked two at random.

Vederhus did a survey of 114 AA/NA participants after 6 months, and only 66% replied to the survey -- i.e. a very tiny group. Success rate for total abstinence was anywhere from 15% to 30%. The authors were clear that their methodology was problematic, and only went as far as to say that AA/NA should be part of a treatment plan, and isn't for everyone.

Or, the Bowen study (286 participants) checked relapse rates at 3, 6 and 12 months. That study actually found that CBT-based relapse prevention (RP) and mindfulness-based relapse prevention (MRBP) were more effective than 12 step at the 6 and 12 month markers. If I'm reading the paper correctly, 12 step increased abstinence rates from 30% at the start of the program to 46%. (MRBP went from 41% to 63%.)

I don't know if I am sufficiently interested to read 25-50 papers on the topic. But even their best estimate, of 24%, doesn't sound so hot. Nor does it support the commonly-held idea that 12 steps is the only game in town.

I'm not aware of, e.g. treatment centers, sticking with the AA approach when there are other options available that work better. What are those options, and can you cite literature documenting the superior success rate?

Please see post #32 above. MAT seems to be the most effective method.

We should note there's a lot of resistance to using medication to treat addiction in most of the US; we even see it in this thread. As a result, MAT is often underfunded, defunded or openly discouraged. That said, interest in psychedelic therapy is picking up.

 

[Manc Skipper]

The US resistance to drug therapy (Methadone) in treating opioid/fentanyl addiction is at odds with the evidence. Canada, the UK and Australia all have (Dr's) office based/specialist treatments operating in concert with a fair success rate for literally years, but the US is only now considering a "First of it's kind" study to consider expanding Methadone access!

 

[Lisa]

12 step programs are so ineffective that they will not publish that rate of success of failure over 5 years. There are better ways to treat people who self-treat their trauma with drugs or alcohol.

 

[JacksinPA]

There's no requirement to attend AA for a lifetime. I've been sober for 15 years and go to maybe a handful of meetings a year, none since COVID started, and the only reason I'll return is to catch up with some friends that I enjoy being around. Some other 'old timers' do attend regularly well into 10-20 years, but they attend for lots of reasons, and keeping sober is one, but there's also the helping others part, and the being around old friends part. It's comparable in some ways to church, I guess. Church in my experience - I don't go really at all anymore - is as much social and community as it is religion. Point is I am not sure the old timers would be white knuckling it if they had to skip meetings.

FWIW, I'm a huge believer in alternatives to AA. I've known plenty that it failed completely, multiple times, and are dead from the addiction. And I'm convinced that there is a chemical or metabolic disorder at the core during active addiction. In part because the withdrawals are in fact life threatening for some heavy drinkers, quite literally. So the cravings aren't just to get high, but to keep from.....dying, when in full blown addiction stage. I had two withdrawal seizures that sent me to the ER, both times traveling when I couldn't get my 'hit'.

I did sort of a 'nutrition' treatment based on a book by a woman who was disillusioned by the failure of AA for her son, who committed suicide. Worked for me and after a month or so cravings ended. I don't want to get into that, but it could have been 'real' or me just believing it would work, but the core 'treatment' was medical not the AA experience. The AA helped with being held accountable.

I found the ultimate abstinence support program. It involves only yourself. I started losing a lot of weight after I stopped drinking chilled vodka. I thought it was just my body adjusting. But an MRI resulted in the GI MD telling me I had chronic pancreatitis. IOW, my drinking had negatively affected my pancreas & it was no longer supplying the digestive enzymes needed to get nutrition from my food. If I kept drinking, Type 2 diabetes would be next IMO.

Stating that AA welcomes atheists & agnostics & then joining hands with strangers to recite the Our Father made me very uncomfortable. And the info that the author of The Book used some of his royalties to support a dissolute life style just put a cherry on the top of the hypocrisy involved.

DUI judges send their cases to AA because there is nothing else to stop your drinking until you come close to killing yourself as I've done.

Pot is legal where I live so I enjoy taking THC in capsules. My lung MD told me to stop smoking. It's a good sub for alcohol but they'll still send you to AA if you get caught driving while stoned. If my wife can tell, so can cops.

My new GI doc ruled out that condition & had the opinion that a cyst in my pancreas was blocking the duct that gets those enzymes into my small intestine. So I have a needle biopsy of that cyst coming up. He didn't think it was cancerous. But this is what abusing alcohol did to me. Next step would be surgery (laparoscopic) to remove that cyst.

 

[JacksinPA]

I found the ultimate abstinence support program. It involves only yourself. I started losing a lot of weight after I stopped drinking chilled vodka. I thought it was just my body adjusting. But an MRI resulted in the GI MD telling me I had chronic pancreatitis. IOW, my drinking had negatively affected my pancreas & it was no longer supplying the digestive enzymes needed to get nutrition from my food. If I kept drinking, Type 2 diabetes would be next IMO.

Stating that AA welcomes atheists & agnostics & then joining hands with strangers to recite the Our Father made me very uncomfortable. And the info that the author of The Book used some of his royalties to support a dissolute life style just put a cherry on the top of the hypocrisy involved.

DUI judges send their cases to AA because there is nothing else to stop your drinking until you come close to killing yourself as I've done.

Pot is legal where I live so I enjoy taking THC in capsules. My lung MD told me to stop smoking. It's a good sub for alcohol but they'll still send you to AA if you get caught driving while stoned. If my wife can tell, so can cops.

My new GI doc ruled out that condition & had the opinion that a cyst in my pancreas was blocking the duct that gets those enzymes into my small intestine. So I have a needle biopsy of that cyst coming up. He didn't think it was cancerous. But this is what abusing alcohol did to me. Next step would be surgery (laparoscopic) to remove that cyst.

My new GI MD told me the opposite of the last guy: I don't have chronic pancreatitis because I only have weight loss. No bathroom runs or belly pain. They've been looking at my pancreatic duct for years. Does that mean I'm tempted to go back on drinking chilled vodka straight? I don't think so. Bad medical results from your drinking habits trumps AA.

 

[Trippy Trekker]

Tidbit of my 12-step story: complications resulted from juggling relationships and fathering children with three baby-mommas.

Two women filed restraining orders against me. After getting kicked out of my nice country club home via one of the restraining orders, I filed for divorce; married first time 22 years, 1989 - 2011. At some point in close succession, my life intersected with CPS, DCF, Family Court and Child Support Hearings. A counselor recommended the State withhold my contact with a minor daughter unless I attended Al-Anon meetings 3 to 5 times per week. I reluctantly went 3 times per week. After a few years, I actually tuned in! I don’t believe, on a personal use level, I have ever had a problem with alcohol or drug addiction issues. Nonetheless, I call 5/5/14 my CLEAN DATE.

Today, I still go to a once-a-week STAG meeting; about a dozen old men, oldest 90. Members include a 71 year old circuit court judge. Most of us have a net worth of at least several $MIL.

-very affordable, donate or not any amount $$.
-easy and enjoyable.
-attendance always optional.
-take what you like; leave the rest.
-usually, only one hour in length.

I recommend an abbreviated 4-STEP program to some of my sponsees:

1. GIVE UP. Admit you might improve managing your life affairs. Open your mind to a new way of living.
2. FESS UP. Take some introspective time to reflect on your life. Fess up to the good, bad and in-between.
3. MAKE UP. Attempt to make reasonable amends to yourself and others you care about.
4. KEEP UP. In T.I.M.E (Things I Must Earn), you adapt to a Program-based life; quality of life improves.

My 2nd wife currently works at a private treatment center. In-patient rate: $18,000/month.

 

[Cardinal]

I'm not in the program either - nor am I "sober," or in recovery at all. But I had a lot of exposure to AA/NA and knew a lot of addicts and alcoholics, and even spent a few years working at a rehab as a counselor/tech.

The part of AA/NA that works is the community of support - not the rules and regulations. The rules and regulations - the steps, the slogans, the rituals of the meetings - those are there to keep people engaged with the community, and to define the structure of that community.

It always struck me that the steps were props for human connection and support, which are very tangibles things. Whether they're especially effective props is another matter.

 

[Super Chief]

Understanding 12 Steps Of AA | PA | Silver Pines Treatment Center

The 12 steps of AA can be confusing, especially if you've never attended a meeting. Learn more about these steps and how they can help you get sober, call Silver Pines Treatment Center at 267.719.8689.

silverpinestreatmentcenter.com

If you've ever been to an AA or similar substance abuse rehab program, you may understand why I consider them to be a bunch of hooey. These, and the 'Book', were creations of a guy who used the resulting money to support his mistress.

It all starts as the meeting comes to order. You raise your hand & ask the moderator if non-Christians are welcome in this group. He answers 'Yes they are.' But after the meeting concludes everyone in the room, stands, joins hands & recites the Lord's Prayer, which makes you either a hypocrite or a liar unless you really believe in this stuff.

If the prayer doesn't get your goat, their 12-point path back to sobriety will knock your socks off:

1. Admitting powerlessness over the addiction
2. Believing that a higher power (in whatever form) can help
3. Deciding to turn control over to the higher power
4. Taking a personal inventory
5. Admitting to the higher power, oneself, and another person the wrongs done
6. Being ready to have the higher power correct any shortcomings in one’s character
7. Asking the higher power to remove those shortcomings
8. Making a list of wrongs done to others and being willing to make amends for those wrongs
9. Contacting those who have been hurt, unless doing so would harm the person
10. Continuing to take personal inventory and admitting when one is wrong
11. Seeking enlightenment and connection with the higher power via prayer and meditation
12. Carrying the message of the 12 Steps to others in need

Reference Step 1, go see a good psychiatrist.

Step 2, believe in the unknowable.

Step 3, see Step 2.

Step 4 OK

Step 5, the higher power I dealt with in Step 2. Go back to Step 2.

Step 6, see Step 2.

Step7, see Step2.

Step 8, Why?

Step 9, Step 9, I'll wait for those who have wronged me to apologize first.

Step 10. OK

Step 11, See Step 2

Step 12, OK if you skip the religious stuff.

You sound very angry. Is this about you trying to get help for an addiction, or just generic rant in general?

If a 12 step works for some people, you aren't against that are you?

 

[JacksinPA]

You sound very angry. Is this about you trying to get help for an addiction, or just generic rant in general?

If a 12 step works for some people, you aren't against that are you?

I believe it works for fewer addicts than you might think. But I understand there is a shortage of psychiatrists, one of the few alternatives. But it is still pseudo-religious hypocrisy.

 

[Pippi Longstock]

Understanding 12 Steps Of AA | PA | Silver Pines Treatment Center

The 12 steps of AA can be confusing, especially if you've never attended a meeting. Learn more about these steps and how they can help you get sober, call Silver Pines Treatment Center at 267.719.8689.

silverpinestreatmentcenter.com

If you've ever been to an AA or similar substance abuse rehab program, you may understand why I consider them to be a bunch of hooey. These, and the 'Book', were creations of a guy who used the resulting money to support his mistress.

It all starts as the meeting comes to order. You raise your hand & ask the moderator if non-Christians are welcome in this group. He answers 'Yes they are.' But after the meeting concludes everyone in the room, stands, joins hands & recites the Lord's Prayer, which makes you either a hypocrite or a liar unless you really believe in this stuff.

If the prayer doesn't get your goat, their 12-point path back to sobriety will knock your socks off:

1. Admitting powerlessness over the addiction
2. Believing that a higher power (in whatever form) can help
3. Deciding to turn control over to the higher power
4. Taking a personal inventory
5. Admitting to the higher power, oneself, and another person the wrongs done
6. Being ready to have the higher power correct any shortcomings in one’s character
7. Asking the higher power to remove those shortcomings
8. Making a list of wrongs done to others and being willing to make amends for those wrongs
9. Contacting those who have been hurt, unless doing so would harm the person
10. Continuing to take personal inventory and admitting when one is wrong
11. Seeking enlightenment and connection with the higher power via prayer and meditation
12. Carrying the message of the 12 Steps to others in need

Reference Step 1, go see a good psychiatrist.

Step 2, believe in the unknowable.

Step 3, see Step 2.

Step 4 OK

Step 5, the higher power I dealt with in Step 2. Go back to Step 2.

Step 6, see Step 2.

Step7, see Step2.

Step 8, Why?

Step 9, Step 9, I'll wait for those who have wronged me to apologize first.

Step 10. OK

Step 11, See Step 2

Step 12, OK if you skip the religious stuff.

Isn't this the outfit that says "once an addict always an addict" that's the part I don't like. Seems like just a way to keep you addicted to the group.

 

[notquiteright]

Thinking a program must be successful 100% of the time sets up the first fail.

Not changing your friends, dropping fellow addicts, places where you go to engage in your addiction is setting up to fail.

Not learning ways to have fun and enjoy life without the icebreaker or crutch is setting up to fail.

Many drugs are extremely difficult to break the addiction. I don't know if any plan would have a high success rate with meth, heroin, fentanyl, etc. I've seen heroin addicts with stunning blisters, infected veins, weakened immune systems so they are constantly sick, not so much from the drug itself but from the crap the street level dealers cut it with.

Yet the addict continues. Even law enforcement forced withdrawal doesn't break the addiction, many addicts head straight back to the needle when released from jail/prison.

I get not wanting to get too religious if not a believer. However, the prayer acts as a bonding rite for the group. I don't believe there is a God, I have however sworn oaths, and carried a St. Jude my brother gave me back in the day.

IMO a hypocrite is someone who beats someone over the head with the 10 commandments while breaking a few of the bigger ones themselves.