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The Pros and Cons of AA (& 12-Step) in 2019

Any drug Marques could get his hands on; he either used or sold. That was until two years ago when his parents sent him to an inpatient substance abuse treatment center, which was followed up by enrollment in a unique high school where Marques is learning to live sober while he studies toward a diploma. In addition to classes in math, language arts and physical education, Marques and about 20 other students at the high school meet regularly with a counselor and attend daily support group meetings modeled after the 12-steps of Alcoholics Anonymous.

Martin Walsh credits those 12-steps along with going to meetings and taking sobriety one day at a time for changing his life and making him the man he is today. As the mayor of Boston, Walsh is still among AA’s biggest advocates, but if the 12-steps could change his life, maybe the program changed his mind a bit as well. Now, Walsh is rethinking his position on recovery to the point where he is considering a pathway to sobriety that involves supervised injections to wean Boston addicts off of opioids.

That option is a far cry from the abstinence-based 12-steps of Alcoholics Anonymous, which for decades has been a prescription used by doctors, therapists, substance abuse experts, and the judicial system to condition alcoholics to live without a drink. For alcoholics and substance abuse patients who enter hospitals, outpatient clinics, and rehabilitation facilities, the chance that they will not be exposed to the 12-steps of AA or Narcotics Anonymous is highly unlikely.

Consider one study found that nearly 80 percent of the clinicians surveyed had referred patients to 12-step groups, and another report claimed approximately five million people in the United States aged 12 or older attended a self-help group for substance use issues. 

In fact, anyone who confronts addiction is usually referred to an abstinence-based program, despite some research that shows the 12-step formula to be no better or worse than other alternative treatments. Unlike Alcoholics Anonymous, some of these lesser-known methods are based on science that has been proven in randomized, controlled studies.

Yet, in the face of some criticism, AA boasts an estimated 1.4 million members in the United States and Canada, and 2.1 million worldwide including as many as 114,000 groups as well. While those numbers continue to grow, the main point sticking point for individuals who walk away from AA is the program’s one-size-fits-all approach to addiction, which some believe is out of touch in light of the emerging science-based approaches.

Others question the lack of evidence to prove 12-step programs actually work, which is made all the more difficult to uncover because not only is success difficult to achieve regardless of treatment method, but the anonymous nature of AA offers only anecdotal affirmation about the people who have been helped. Beside unreliable success rates, some critics of AA can’t get past the amount of time involved in 12-step programs and the “spirituality” element or relationship with a “higher power” that is highly suggested a path to recovery.  

Despite such issues, advocates of AA contend that the program’s widely accessible support groups and the promotion of common principles are critical components of recovery that more scientific models still lack.

In the face of these arguments from both advocates and faultfinders of AA, the truth is that 12-step programs have worked for many alcoholics and drug addicts. That can hardly be denied. But, for others, especially those who continue to struggle with addiction, AA has left a bad taste that, hopefully, another attempt at sobriety in, perhaps, another mode of treatment can reverse.

After all, the most effective of those modes remains to be whatever program the alcoholic or drug addict is willing to take part. What is most important is that individuals who abuse alcohol, or any drug for that matter, face up and realize they have a problem.

That is the first step whether or not AA is the chosen path toward recovery or not. Without this admission, treatment, no matter how successful to others it may be, will not be propitious to the alcoholic or addict, expecting anything less than a miracle cure.

What is AA?

Alcoholics Anonymous is a fellowship of alcoholics, open to men and women, who share their experience, strength and hope with each other to solve their common problems with alcohol and help others to recover from alcoholism. The only requirement for AA membership is a desire to stop drinking. In other words, AA is free.

What are the 12 Steps of AA?

The 12-steps outline a plan of recovery to overcome addiction, which involves submitting to a higher spiritual power and admitting that alcoholism is an ongoing problem that has become unmanageable.

Other recovery groups, such as Gamblers Anonymous, Narcotics Anonymous, and Food Addicts in Recovery Anonymous, have applied the 12-steps of AA to treat their specific addictions.

What are the Pros of AA?

  • 12-Steps provide ongoing structure as a basis for recovery.
  • AA is a self-sufficient organization that does not require dues or fees from its members. The only requirement is a willingness to stop drinking.
  • Alcoholics discuss their issues in an anonymous, yet open environment that presents a practical application of 12-steps from group members; thereby, fostering a sense of community.
  • A more individualized level of support is encouraged through sponsorship, typically with another member of the group.
  • Testimony from sober members in the group provides evidence for long-term effectiveness of the program.
  • Meetings are available in most areas, along with a widely accessible social network of support aimed at preventing relapse.

What are the Cons of AA?

  • Members are encouraged, although not required to rely on a “higher power” as the most effective means of recovery.
  • Lack of concrete evidence associated with outcomes.
  • Emphasis on complete abstinence.
  • Reliance on a higher power presents religious undertones, a problem sometimes for atheists.
  • The first step is to admit powerlessness over alcoholism, which may minimize any reliance on willpower.
  • 12-steps are time-consuming; 90 meetings in 90 days are strongly recommended upon entrance into the program.

 Why Should I Detox?

Anyone who is a problem drinker can expect uncomfortable symptoms that can be dangerous when alcohol is abruptly removed from the body. That’s why detoxification is highly recommended for alcoholics who have decided to put the drink down. Withdrawal from alcohol should not be attempted alone. 

Detox services traditionally are performed at a hospital or residential treatment facility, where a doctor can prescribe anxiolytic medications, sedatives and vitamins to help alleviate painful withdrawal symptoms and, if necessary, IV fluids, to restore balance to the blood system. During this period, certified healthcare staff will also monitor your vital signs and prevent any potential health complications.

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What Is the Next Treatment Step?

Advocates of AA believe the program works for anyone willing to do the “work.”  That means, although sobriety begins the moment an individual stops drinking, a lifetime commitment is expected. An extended stay at a residential treatment center can provide the tools to sustain this pledge. Here, following detox, you will be fitted with a personalized recovery plan that will support your unique circumstances and solidify your chances of long-term sobriety. These plans, administered by a counselor, typically will include group and one-on-one therapy, educational lectures and workshops and, in most cases, exposure to 12-step groups.

Sources

National Library of Medicine, National Institutes of Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753023/

American Society of Addiction Medicine. Retrieved from https://www.asam.org/resources/publications/magazine/read/article/2015/02/13/the-relevance-of-twelve-step-recovery-in-21st-century-addiction-medicine

National Library of Medicine, National Institutes of Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978172/

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613294/

Alcoholics Anonymous. Retrieved from https://www.aa.org/

American Psychiatric Press. Retrieved from https://www.mentalhealth.va.gov/providers/sud/selfhelp/docs/4_moos_timko_chapter.pdf

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