Don’t Mistake Zeal for Effective Addiction Treatment

I want to start off by saying that I have many good friends and colleagues in needle exchange and other harm reduction programs who are members of 12 step groups and I totally respect their right to choose this for themselves. If AA works for you, great! Go for it. However, I also know a large number of people who were damaged by the AA program and whose drinking or drug use got worse as a result of attending AA meetings. Some committed suicide. Some only got better after they left AA and found something that worked for them. My drinking got so bad when I was in AA that I nearly died from alcohol withdrawal. Only leaving AA and finding harm reduction saved my life. So my message is that if your loved one likes AA and finds it helpful then by all means be supportive of that. But if your loved one objects to AA or a 12 step treatment program, then trying to force him/her to get involved with one can potentially do far more harm than good.

You might have heard that Alcoholism is a 100% fatal disease which can never be cured but can only be arrested by going to AA. This statement is 100% false. US government studies by the NIAAA show that the vast majority of people with a Substance Use Disorder–which is a fancy name for Alcoholism or Drug Addiction–get over it on their own without going to AA or a 12 step treatment program (NIAAA 2009). Study after study has shown that coerced AA attendance (Ditman 1967) or 12 step group treatment programs (Brandsma 1980) are no more effective than doing nothing at all.

The good news is that there are evidence-based treatment approaches to Alcoholism and Addiction which are far more effective than 12 step programs. Cognitive Behavioral approaches to addiction are about twice as effective as AA (Brandsma 1980) and Motivational Enhancement Therapy and Harm Reduction approaches are also highly effective substance abuse interventions. Twelve Step Facilitation Therapy, which is done one-on-one with a counselor, is also far more effective than standard 12 step group therapy (Project MATCH Research Group 1997, Peele et al 2000)–unfortunately it is also far more expensive and most chemical dependency treatment facilities are more concerned with maximizing profit than saving lives.

The fact is that 12 step programs are far more effective at creating zealots than they are at curing addictions. This really should not be so surprising when we recall that the 12 steps of AA are directly derived from the 5 C’s of Frank Buchman’s Oxford group. 12 step groups require an admission of personal powerless, an acknowledgement that alcohol is more powerful than human beings, and rescue by a higher power which one turns one’s life and will over to. Moreover AA itself is identified with this higher power. Although AA says that the steps are “merely suggestions” it also states that anyone who fails to work the steps “surely signs his own death warrant.” And step 12 tells you to “carry the message”–in other words go out and get more members. The simple fact is that the 12 steps are a formula for creating religious zealots and not a formula for curing drug or alcohol problems.

When people quit addiction on their own without AA, they usually want to forget the past and get a life. Moreover, the longer one has been free of an addiction the less one thinks about it and the less likely one is to go back to it, AA actually keeps people constantly tottering on the verge of relapse by constantly reminding them of their addiction. This is why we hear about people who are 20 years sober in AA relapsing and going back out and picking up the drug or drink again. People who have quit additions on their own are unlikely to do this because they forget about the addiction totally at the end of 20 years.

AA can also keep people so hung up on meeting attendance that they fail to get a life.

This is not true for everyone–as I said, many of my colleagues are members of 12 step groups and they realize that there is more than one way to approach addictions and that a needle exchange is not the place to proselytize for AA unless you want to drive your clients away.

In conclusion–the fact that 12 steppers are the loudest does not mean that they are the most effective. Sometimes instead of giving the squeaky wheel the most grease you are better off just getting a new wheel.


Brandsma, J.M., Maultsby, M.C., & Welsh, R.J.. (1980). Outpatient treatment of alcoholism: A review and comparative study. Baltimore: University Park Press.

Ditman, K.S., Crawford, G.C., Forgy, E.W., Moskowitz, H., & MacAndrew, C. (1967). A controlled experiment on the use of court probation for drunk arrests. American Journal of Psychiatry, 124(2), 160-3.

NIAAA (2009). Alcoholism Isn’t What It Used To Be. NIAAA Spectrum. Vol 1, Number 1, p 1-3.

Peele S, Bufe C, Brodsky A. (2000). Resisting 12-Step Coercion: How to Fight Forced Participation in AA, NA, or 12-Step Treatment. See Sharp Press, Tucson, AZ.

Project MATCH Research Group. (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes. Journal of Studies on Alcohol.


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