Disclaimer: AA works for many people. I am certain many lives have been saved by 12-step programs in the decades since they began. However, this model does not work for everyone – and may not work for the majority of people experiencing an addiction problem. When AA doesn’t feel right for them, many people struggling with addiction think the problem is with themselves – that they do not have what it takes to beat their addiction.
There are many reasons AA does not work for certain people.
For many people it triggers past experiences in organized religion.
Admitting to being “powerless” over ones addiction does not sit well with some.
Many people resist of taking on the label of “alcoholic” or “addict”.
Starting with abstinence without addressing the issues in someone’s life that lead them to use can leave them in worse emotional shape.
The principals I use to work with addiction come from a Harm Reduction approach. This model does not preclude AA or abstinence, but leaves open other possibilities on the road to recovery. Some people are able to moderate their drinking. Moderation could be an end-goal or a step on the way to abstinence. If someone is able to successfully moderate, this opens up space to think about the role alcohol (or drugs) play in their life and why it became a problem in the first place.
Addiction is a complicated mix of biological, psychological, and sociological factors. This article in The Atlantic takes an in-depth look at some of the criticisms of AA. One being that in peer reviewed studies only about 5% to 10% of people who enter 12-step based treatment are able to remain sober. There are some studies that show better results – but at best 30% are able to remain sober. That leaves a lot of people for whom AA does not seem to work.
When someone comes to me with an addiction problem or with a question on whether they have an addiction problem, I look at what purpose that substance is serving for them. Often times there is something missing in their life. That can be basic security (in the instance of homelessness), or a lack of connection and purpose. It’s possible that drinking too much is the only way someone can relax enough in a social situation to actually feel connected to others. My goal in therapy for addiction is to boost the client’s social resources in order to give them something to live for. If this can happen, dropping an addiction may not be so difficult.
There is much more to say in future posts on the subject of addiction, but I will end for now with this quote from Johann Hari about his new book “Chasing the Scream: The First and Last Days of the War on Drugs”:
The opposite of addiction is not sobriety. It is human connection.