Having read Gabrielle Glaser’s book, Her Best Kept Secret: Why Women Drink and How They Can Regain Control, as well as a number of other articles by Glaser, I knew what to expect from her article in the April 2015 issue of the Atlantic, “The Irrationality of Alcoholics Anonymous.” A vocal critic of AA, Glaser’s newest article focuses heavily on medication and/or moderation as the solution to alcoholism, or alcohol abuse disorders, the clinical term for alcoholism.
Unfortunately, Glaser’s valid points about the need for more alternatives to AA are overshadowed by her critique of Alcoholics Anonymous as “just as damaging and dangerous” as drinking for those who don’t find success with AA. In a March 26th interview with NPR about the Atlantic piece, Glaser goes so far as to tie AA to a specific tragedy, saying, “Someone sent me an email this morning about a younger brother who committed suicide last night with the [AA] Big Book and a glass of Scotch next to his bed.” Her insinuation that AA is to blame for addicts who don’t recover from their addiction demonstrates a woeful lack of understanding about both Alcoholics Anonymous and the disease of addiction.
One of Glaser’s assertions — that alternatives to 12-step recovery programs should be more readily available to people who need or want them — is accurate and an important observation. As a recovering alcoholic who credits 12-step programs for my sobriety, I absolutely agree. Simply put, what works for me won’t necessarily work for someone else. Addiction is a dangerous and deadly disease, so whatever helps someone overcome it is a good thing. In fact, one of AA’s many slogans could apply to any form of addiction treatment: “If it works, work it.”
Unfortunately, Glaser does too much cherry-picking when discussing the program. She bases a number of assertions on the notion that AA believes that it is the only way to recover from alcoholism; in fact, what the Big Book says on the subject is this: “If anyone who is showing inability to control his drinking can do the right-about-face and drink like a gentleman, our hats are off to him.” AA might not endorse other programs, but anyone is, of course, welcome to try methods other than the 12 steps. Glaser’s email response from the administrative headquarters of Alcoholics Anonymous states, “AA neither endorses nor opposes other approaches and we cooperate widely with the medical community.” Immediately after noting this in the Atlantic article, though, she asserts that this isn’t the organization’s true stance on the subject: “Many in AA and the rehab industry insist the 12 steps are the only answer.”
There are people in AA who believe that the 12 steps are the only answer to alcoholism; I’ve met some of them. As Glaser concedes, AA works for “many people” and I consider myself to be among those who have stayed sober as a direct result of 12-step meetings. I believe AA is a great program, but an imperfect one. There are legitimate criticisms to be made against it but, for the most part, they are not the claims that Glaser makes in this article. There’s nothing in the organization’s literature that disparages or discourages other forms of treatment for addiction. Like psychotherapist Robi Ludwig, PsyD, who was interviewed along with Glaser on MSNBC’s “All In with Chris Hayes,” I know many people in AA who also seek psychotherapy and alternative forms of treatment as part of their efforts to maintain sobriety. AA can, and often does, coexist with other support groups and treatments for addiction. When Dr. Ludwig notes this, though, Glaser dismisses addicts seeking multiple forms of treatment as something that mostly happens “in New York [City], where psychotherapy is accepted.” That’s a thin rebuttal at best. The Atlantic article also doesn’t include interviews with anyone currently in or affiliated with AA who believes the 12 steps are the only way to get sober.
A Case Against AA
Glaser’s critique of Alcoholics Anonymous is four-fold:
- There are not enough alternatives to AA and too little awareness of the AA alternatives that do exist.
- The benefits of AA are not scientifically proven.
- AA is not run by trained professionals.
- The rehab industry should not be using the 12 steps as part of their treatment program, as they are not scientifically proven.
Glaser has a point with her first criticism. People for whom AA doesn’t work too often feel as though there aren’t other options to which they can turn. Add to that the criminal justice system’s common practice of sentencing people with drug and alcohol charges to attend AA, primarily because it’s the best-known recovery program. Both factors have worked to create an over-reliance on the 12 steps as the first, and often the only, approach to finding lasting sobriety.
Blaming AA for either of these scenarios, however, simply isn’t logical. As the organization clearly states, it doesn’t endorse or oppose any other program or treatment. To do so would be irresponsible, as AA can only offer guidance about AA. One of Glaser’s points of contention is that it is not run by trained professionals. In the same NPR interview, Glaser says, “AA doesn’t refer anybody out. It doesn’t tell anybody that AA is not for them. It’s very unlike other professional organizations which refer people to second opinions.” When would it be appropriate for a support group to tell someone that the group “isn’t for them”? AA specifically states that “the only requirement for membership is a desire to stop drinking.” If an individual has that desire, they will always be welcomed. Isn’t that something that should be celebrated?
Court-mandated attendance at meetings is a controversial outcome of AA’s popularity and success. However, the organization is open and free to anyone who wants to come and this openness would be sacrificed if the organization were to bar people who’d been ordered by the justice system to attend. The onus here is on the courts to come up with better sentencing alternatives.
Glaser’s second and third claims show a lack of understanding of Alcoholics Anonymous. The Big Book refers to AA as a “spiritual program” or, if you prefer, a support group. Membership doesn’t exclude an addict from receiving treatment elsewhere; many of the people I know who are members also seek alternative treatments like psychotherapy. The organization’s literature explicitly states, “AA is in competition with no one. Our ability to help other alcoholics is not based on scientific or professional expertise. As [members], we are limited to sharing our own firsthand knowledge of the suffering of an alcoholic, and of recovery.” Meetings are free to attend, though members can contribute a dollar or two at the meeting to help pay for rent for the room, coffee and literature, if they desire.
If Glaser is taking aim at Alcoholics Anonymous now because she believes Obamacare will somehow financially benefit AA (the Affordable Care Act, which largely went into effect in 2014, now requires coverage of mental health and substance abuse services, including counseling), she is simply incorrect. If she is asserting that expensive rehabs shouldn’t rely so heavily on the 12 steps because it is not a scientifically proven methodology, then a more appropriate target would be those centers, not AA, which has no financial interest in treatment centers adopting or not adopting a 12-step approach.
Glaser raises important questions about the clinical and educational qualifications necessary to become an “addiction counselor” (there are literally dozens of titles and credentials in the addiction field, along with varying requirements across U.S. states). There’s no question the addiction treatment industry could benefit from standardizing the qualifications and credentials required for various jobs, but deciding and regulating this is clearly outside of AA’s scope.
The Idea of Moderation
AA was founded on the premise of one alcoholic talking to another alcoholic and it has maintained this central tenet for over 80 years. Regardless of how Glaser believes AA should operate, nearly every statement made about the organization in the Atlantic piece is directly contradicted by AA literature (print and/or online and widely available) or simply has little or nothing to do with it.
Glaser focuses much of the article on ways in which people with mild to moderate alcohol use disorders can continue to drink moderately. In discussing the use of naltrexone, an opioid antagonist drug that weakens the craving for alcohol, Glaser notes that in Finland people are encouraged to take the drug when they drink, so they will drink less. In the U.S., when naltrexone is prescribed, Glaser laments, doctors instruct their patients to abstain from alcohol.
Personally, I support pretty much anything that helps loosen addiction’s grip. If that can be achieved through the use of drugs like naltrexone, great. But Glaser’s perception that all or most people struggling with addiction can continue to use the substance to which they are addicted is at best odd, and at worst frightening. She writes:
“[For someone with an alcohol use disorder, the] prospect of never taking another sip is daunting, to say the least. It comes with social costs and may even be worse for one’s health than moderate drinking: research has found that having a drink or two a day could reduce the risk of heart disease, dementia, and diabetes.”
I had to read these lines several times to take in their meaning. Is Glaser asserting that the “social costs” — by which I believe she means feeling left out of work and social events where people are drinking — of abstaining from alcohol could be worse for someone struggling with an alcohol problem than not drinking at all? If so, this statement signifies a lack of understanding about how devastating addiction can be and offers a disheartening commentary on the cultural value placed on alcohol. This is not a moral stance, but instead comes from the deep empathy I feel for those who are struggling to control their drinking and especially for anyone who could believe that a life without alcohol would be worse than lingering in the purgatory of a mild to moderate substance abuse disorder.
While drinking while taking naltrexone does conflict with AA’s belief that abstinence from alcohol is essential to recovery, the implication that the organization disapproves of all medication is patently false. On “All In with Chris Hayes,” Glaser says she’s heard from “hundreds of people” telling her that someone in AA (typically their sponsor) encouraged them to stop taking medication of some kind. While it’s unfortunate that anyone (within AA or not) would offer such advice, it’s important to understand that giving medical advice of any kind is not traditionally part of AA, as Glaser suggests, but in fact a deviation from strict guidelines. AA’s literature specifically states, “We are not doctors; all medical advice and treatment should come from a qualified physician.” The Big Book of Alcoholics Anonymous backs this up. Any large, decentralized organization will, of course, have members who go their own way and either fail to follow protocol or are simply unaware of it; there’s little question that AA is no exception to this phenomenon. But it’s irresponsible to claim that those who deviate from guidelines are representative. Doing so is akin to holding the followers of an entire religion responsible for the acts of extremist groups.
Does ‘Working It’ Work?
Glaser recognizes that it’s virtually impossible to clinically study success rates among those who attend Alcoholics Anonymous meetings because they are, of course, anonymous and no records are kept of who attends. Still, she quotes Lance Dodes, MD, author of The Sober Truth and Training and Supervising Analyst Emeritus of the Boston Psychoanalytic Society and Institute, who says that AA’s success rate hovers somewhere around 5% to 8%. One study does not a scientific proof make, of course. A recently published book, If You Work It, It Works!: The Science Behind 12-Step Recovery, by Joseph Nowinski, PhD, cites a number of studies that point to the effectiveness of 12-step programs, as does a recent article in New York magazine that directly refutes Glaser’s claims.
Given the way AA is structured, it probably won’t ever be possible to quantify in scientific terms the organization’s success rate. What’s more, there will likely always be different ideas about what constitutes “success,” or sobriety. The sole purpose of Alcoholics Anonymous is to support people who want to get sober. That’s it. For many people, it simply won’t work as the only source of recovery. But it has saved the lives of many, many people.
In reading the Atlantic piece I wished that Glaser had spent more space focusing on alternatives to AA and trying to increase the public’s knowledge about other programs, like LifeRing and SMART Recovery®. The story might then have been more useful to those who are struggling with a substance use disorder for whom AA is not an option or did not work. Instead, she spends the bulk of the article, and much of her career, denigrating a program that, by her own admission, has helped so many people break free from the tormented, destructive life that is active addiction — a program that gives so many the support they need to live happy, productive and healthy lives.