Alcoholics Anonymous: A critique of the twelve-step model
According to a 2004 report from the National Institutes of Health, an estimated 17.6 million American adults (8.5 percent) meet standard diagnostic criteria for an alcohol use disorder.
The most widely known option in the world for people who want to quit drinking is Alcoholics Anonymous (AA), with an estimated membership of over 2,000,000 people in 180 countries.
However, is AA the best and only option for recovery from an alcohol problem?
In this four-part article, I will provide a critique of AA's 12-Step model, and provide alternatives to AA that are not as widely known, but have been very effective in helping many people recover from an alcohol problem.
Part One: Steps 1-3
Step One: We admitted we were powerless over alcohol-that our lives had become unmanageable.
If one is powerless over alcohol, how can one ever stop drinking? If AA means by this that a person needs to accept that alcohol is destroying his life, this makes perfect sense.
But accepting that one has a problem and saying that one is powerless against that problem are two different things. In fact, those who attend AA are not powerless.
They take many actions within their own power, such as attending the meetings, reading the AA literature, and eventually, refraining from drinking.
As a clinician, both theoretically and clinically, I would never hold the view that a client is powerless.
Even quadriplegics can accomplish many things through their own free will, even though they are paralyzed from the neck down.
To communicate to a client that he or she is powerless, whether it's to depression, anxiety, or drinking, is to communicate to them that they have no control over their lives and that they are fated to their current condition.
Not only is this untrue, it would be extremely damaging to a client's self-esteem and his ability to help himself get better. The fact is, countless people have quit drinking using AA and other approaches (including quitting on their own), which means they did exert power over their problem.
Step Two: Came to believe that a Power greater than ourselves could restore us to sanity.
AA says that you must give yourself up to a Higher Power in order to overcome your drinking problem. However, the concept "Higher Power" is not clearly defined. AA says that a Higher Power does not necessarily refer to God or religion, but it is described as a "Power greater than ourselves," which means in essence, something non-human.
This sounds like hair splitting to me, and I wonder why AA does not just say that Higher Power refers to a mystical force based on faith, instead of trying to distance itself from God and religion.
Whichever way AA defines Higher Power, the idea requires one to give up his own personal power to a "power" outside himself that will stop him from drinking. How is this actually accomplished? This is not stated clearly in the AA philosophy.
>> Continued in original article Part 1
In my previous article, I provided a critique of steps 1-3 of AA's Twelve-Step Model. In part two, I continue with my critique, focusing on Steps 4-6.
At the end of this article I provide the first (of several) alternative approaches to recovery from a drinking or other substance abuse problem. These approaches differ from AA's Twelve-Step model in that they emphasize self-reliance over powerlessness and rationality over spirituality (among other differences).
I will provide more alternatives in parts three and four.
Step Four: Made a searching and fearless moral inventory of ourselves.
This is a positive message in the Twelve-Step Model, because it requires a person to evaluate his or her own moral system in order to become explicitly aware of it.
However, this step does not explain how to judge whether one's moral system is healthy or unhealthy, rational or irrational, consistent or contradictory.
Does AA believe in a rationally defined morality based on how a person needs to live in order to survive and thrive? Or is it based on a religious (or other mystical) morality, which requires one to blindly follow the morality of one's chosen deity on faith?
The vagueness of this step would make it difficult for someone to utilize in a practical way.
>> Continued in original article Part 2
In this article, the critique continues with steps 7-9. I also provide several more alternatives to AA. As a special note, because of the many comments this series of articles has generated on this site and on many of the LinkedIn mental health group sites, I plan to add a part five to this series to respond to these comments.
My primary purpose for writing the articles is to create better awareness of the inherent problems and contradictions within the 12-Step approach, and to provide several alternatives to AA that many people (including within the mental health field) are not aware of.
The articles have generated a strong and passionate reaction both in support of the critique and in disagreement with it.
Some comments suggest AA's 12-step approach shouldn't be criticized, as if it's above rational analysis. However, I believe it's only through this type of analysis that we can truly understand the benefits and/or faults of any and all treatment approaches within the mental health field.
Step Seven: Humbly asked Him to remove our shortcomings.
Like Step Six, this step requires the individual to ask God or one's Higher Power to "remove" his problems.
I assume this is to be done through prayer. But how does one's Higher Power actually remove one's shortcomings?
Again, I see a problem with asking a mystical power to change one's flaws for the same reasons I noted in Step Six.
Step Eight: Made a list of all persons we had harmed, and became willing to make amends to them all.
This step seems to be a very positive aspect of the twelve-step model, because it requires the individual to take responsibility for the actions he has taken that have harmed others.
In order to accomplish this, he has to examine the actions he has taken while an alcoholic, and then judge which of these actions were harmful to others in his life.
It also requires him to be willing to pay restitution to others for any wrongs he has done to them. What I like most about this step is the requirement of self-responsibility, which I think is vital in making any kind of change in one's life.
If one cannot take responsibility for the actions he has taken, then he can never really be in control of his life, because he can always blame something or someone else (his parents, his genes, the alcohol) for his problems.
What is important, though, is for the person to make a distinction between what is and is not his responsibility, so that he is not trying to make amends for things he did not cause.
Dr. Michael Hurd, in his excellent book Effective Therapy (which also includes a detailed and reasoned critique of the twelve-step approach), refers to this as distinguishing between earned and unearned guilt.
"Earned guilt involves taking responsibility for something which one directly caused. Unearned guilt consists of taking responsibility for something which one did not directly cause"
For example, a recovering alcoholic should take responsibility and feel guilty for beating his wife. He should not, however, take responsibility for the sobriety of his peers at AA or feel guilty if they fall off the wagon. Hurd emphasizes, "Most people, and particularly most addicts, do not distinguish between earned and unearned guilt."
>> Continued in original article Part 3
Step Ten: Continued to take personal inventory and when we were wrong, promptly admitted it.
This positive step continues from previous steps by encouraging personal responsibility, honesty, and taking action when necessary. .....
In summary, while AA's 12-Step approach contains some positive aspects, such as encouraging self-responsibility and making amends; it also conveys (more predominantly) the contradictory message that problem drinkers are powerless over alcohol and dependent on an external Higher Power for attaining and maintaining sobriety.
In addition, not mentioned in this critique (although somewhat implied) is AA's view that alcoholism is a disease, which in essence means: once an alcoholic, always an alcoholic, no matter how long you've been sober.
AA also uses an abstinence-only approach to recovery. Addressing these latter two points requires another article (or two), so I will leave it to readers to ponder these additional aspects of AA on their own (or you can go to Stanton Peele's website for in depth information on these points and many more).
Stay tuned for part five of this series in which I will respond to several of the comments posted by readers about this series of articles critiquing AA and the 12-Step model.
>> Continued in original article Part 4
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Alcoholics Anonymous: A critique of the twelve-step model