The Science of 12-Step Programs 330
Hugh Pickens DOT Com writes "Since the inception of Alcoholics Anonymous — the progenitor of 12-step programs — science has sometimes been at odds with the notion that laypeople can cure themselves because the numerous spiritual references that go with the 12-step program puts A.A. on "the fringe" in the minds of many scientists. But there is an interesting read at National Geographic where Jarret Liotta writes that new research shows that the success of the 12-step approach may ultimately be explained through medical science and psychology. According to Marvin Seppala, chief medical officer at Hazelden and sober 37 years, attending 12-step meetings does more than give an addict warm, fuzzy feelings. The unconscious neurological pull of addiction undermines healthy survival drives, causing individuals to make disastrous choices, he says. "People will regularly risk their lives—risk everything—to continue use of a substance." Addicts don't want to engage in these behaviors, but they can't control themselves. "The only way to truly treat it is with something more powerful," like the 12 steps, that can change patterns in the brain. Philip Flores, author of Addiction as an Attachment Disorder, says the human need for social interaction is a physiological one, linked to the well-being of the nervous system. When someone becomes addicted, Flores says, mechanisms for healthy attachment are "hijacked," resulting in dependence on addictive substances or behaviors. Some believe that addicts, even before their disease kicks in, struggle with knowing how to form emotional bonds that connect them to other people. Co-occurring disorders, such as depression and anxiety, make it even harder to build those essential emotional attachments. "We, as social mammals, cannot regulate our central nervous systems by ourselves," Flores says. "We need other people to do that.""
So you need to get over your alcohol addiction... (Score:3, Insightful)
in order to get back to the healthy, socially expected addiction to people. Makes sense.
quit drinking (Score:4, Insightful)
had to quit it due to pancreatitis. fuck twelve steps, fuck the AA, fuck the higher power, fuck the addiction treatment industry.
you see what's wrong with for example the AA 12 steps? 8 of the steps are "whee I'm a christian now and can't be judged for raping my cousin" and the rest are pretty much "It's not my fault I am/was an asshole". it's bullshit.
not fucking one of the steps is to ACTUALLY STOP DRINKING! and half of the steps are practically just setting up that it's not their fault if they drink!
here's my two step program.
1) stop drinking.
2) try to fill the time with something to make things feel as fun as when drinking.
step two is hard, because, hey, drinking is highly enjoyable.
(* due to having stopped drinking, I find myself unable to stop posting obnoxious poorly spelled comments to slashdot, but hey, it works. btw if you drink, don't be an asshole. AA is geared for people who are so big assholes they can't even go to the corner shop sober because they know they're such dicks when they drink, which makes for a sorry loop).
It works? (Score:2, Insightful)
It's been said in the comments on the NGS web site, but it's worth repeating here: The article starts from the presumption that 12 step programs are effective, based on the fact that they are popular. The actual science on twelve step programs says something else entirely.
http://www.nytimes.com/2006/07/25/health/25drin.html?_r=1&
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005032.pub2/abstract
Coming up with a "scientific explanation" for how AA "works" without any demonstration that it actually DOES work seems like a load of horseshit, not to put too fine a point on it.
Re:quit drinking (Score:5, Insightful)
You didn't just 'actually stop drinking' you got pancreatitis, which then motivated you to stop, your 2 step program is missing a couple.
Alcohol abuse is so socially acceptable most people don't even recognise it as abuse and it can take a massive upheaval of your social life to simply "stop drinking", as well as taking time to spot patterns of behaviour and triggers and then change them.
I do dislike the AA though, they say that if you stop drinking, you're just a dry drunk, so in their eyes even of 10 years sobriety you're still branded as an alcoholic, you still have to announce that you're an alcoholic, and that just reinforces the idea that you're weak, that you may slip up and that you need AA meetings to get by.
Re:quit drinking (Score:4, Insightful)
Step 0.5 is to stop drinking. They won't let you in if you are actively drinking at the moment, so they assume you have quit, even if it's one day sober (while not sober).
You had a need to stop, you did stop. That proves you are not an alcoholic. So your views on it are irrelevant.
And they are all giving power to a higher power because the addicted can't stop themselves. So having an imaginary friend who's always there looking over your shoulder gives you some accountability when you'd otherwise have none. There's surprisingly little God in it, despite it being Christian God-based. It's psychological, giving help when needed.
Re:More nonsense (Score:5, Insightful)
As a former heavy smoker I can tell you, I did want to smoke. Hell yeah. It felt good. It was relaxing, it was soothing, it was great. Don't give me that "I don't want to smoke but I can't stop" bull. You want to smoke. At least admit it. You may not like the coughing and the shitty taste in your mouth in the morning (no, really...), you may not like how people react to you, but you do like the cigarette (or in my case, cigar), the moment you light that fire you WANT it. Don't gimme any of that crap that you light it with remorse, you don't. You lean back, you put it in your mouth, you light it, you inhale, you enjoy it. Face it, that's the truth. Lie to yourself if you prefer, but that's simply how it is.
Was I an addict? I guess yeah. Did I like to stop? Yeah, I did. But mostly because for some odd reason from one day to the next the craving stopped. I lighted the cigar and it was not enjoyable. I did not like it. I simply didn't. I put it down and that was a few months ago now. The cigar is still lying where I put it, ready to be smoked at any time. I just don't want to.
Pretty much at the same time some important changes came to my life and I think it's pretty much how you described it. The drug was a substitute. Once it's no longer needed, it will cease to provide the enjoyment that it once did. That certainly doesn't work for everyone, but nobody should give me the bull that he doesn't like his drug. If he didn't, he'd simply drop it. Addiction is nothing but a craving that you want to fulfill. A quite heavy craving, I may add, but it's still you that decides whether or not you give in or whether you look for other ways to relax and enjoy.
Re:quit drinking (Score:5, Insightful)
Having watched a close friend spiral downwards and end up in a sober living home after a trip through the state mental hospital + inpatient rehab, the 12 step program is a system that is flexible and allows you to modify (although not fix, for a lot of people) some deep rooted behavioral problems so that when they go off the rails, it's a one or two day bender, not a two week "I haven't showered in 9 days and are these even my pants? where am i hey can i have some money i lost my wallet letsgogetsomebeermanthatsoundsgreat" binge that only stops because their liver has shut down and they end up detoxing in the hospital.
I'm glad for you it's not a big problem and you had something more pressing to get you off of alcohol, but for a lot of people a day job is a great excuse to drink. Go hang out at an AA or NA meeting center some time, listen to their stories about how alcohol has been a lifelong struggle. For a lot of those people, the 12 steps is the only thing they have going for them, and they're grateful for what they have. It's a very well designed program for a certain subsection of people, and if you aren't one of them, you shouldn't knock it, because it doesn't apply to you.
Re:quit drinking (Score:5, Insightful)
Gah, the point of the article is that what is in the 12 steps don't matter. The steps could be "impersonate an orangutan in heat". What works is that people hang out together and fulfill a social need.
Social beings engage in social methods. (Score:4, Insightful)
I am a strong advocate of whatever works.
It doesn't matter who is right or if its the best way or stupid or God or placebo effect. I think the issue is that human beings effect one another and that people with problems of any kind do have an affect on the people around them. These problems may be the result of their experience of the people around them. Whether or not addiction is a choice or a disease or a spiritual or a social disorder really does not matter. What matters is that those who may be afflicted with this dilemma attempt to engage with society in a way that will help to resolve behavior that is inevitably harmful to the self and to the people around them. I don't mean to judge others, each individual can make that determination for themselves. But if it seems that there is wreckage and damage to themselves and to others, and if it is difficult to ascertain how to get a handle on the situation, then its a pretty good bet that engaging with other human beings might be a good starting place.
While it is also true that 12 step programs derive from a spiritual, albeit even Christian flavored template, that in no way limits an individuals personal approach or beliefs. Its just a social venue in which to engage with fellow addicts. And yes there are all kinds of people out there, from the weird to the mundane. Some with "fight club" agendas and some working on a date for Saturday night. Many are addicted to 12 step groups and some are stoned and court mandated to attend. Whatever. It doesn't matter. Its like the rest of the world - there are all kinds. But if you try to do SOMETHING, try to engage with others in a way conducive to new behavior, or another perspective, then its a good place to start.
Why a 12 step? Because its all around, in pretty much every town in the western world. It is anonymous. It is inclusive of anyone who can just be present and listen. It costs nothing. You can leave at any time. If you don't like the kooks or freaks or holy rollers or drunks then just go and find a group that is normal like you. Or blow it off. Nobody will stand in your way. Just know that it is available to you, even if its not particularly useful or interesting to you, it remains an option. And the possibilities are as varied as the human beings that comprise our world. Some are even Scientologists lurking in narc-anon.
Like most things you get out of it what you put into it. If you spend more time drinking you'll spend more time dealing with those consequences, whatever they are. For some, it just means better wine, for others its a DUI or health concerns or anything else you can imagine. If you spend a lot of times doing something else instead, then you will get other results. It may not make you happy or solve your problems, but it will take time away from drinking or gambling or eating a gallon of ice cream or it doesn't matter what else.
My point is perhaps best stated by the immortal Tom Leher. He once said,
"Life is like a sewer.... What you get out of it depends on what you put into it"
And as with most things that goes for the 12 or 13 steps as well. Let the farce be with you.
Re:More nonsense (Score:2, Insightful)
You guess you were an addict? That's a pretty good sign you weren't.
Though I've never been addicted to anything chemical, there was a point I started becoming OCD. I had to prewash my hands before I washed them (don't laugh, it seemed right at the time). Then I needed to post wash them. I had to unlock the doors to prove they were actually locked when I left the house. Which meant I had to lock them again, which brought the need to unlock them to prove it really was locked. I knew this was odd behavior, but it felt right. I was only about 12 years old then this started, and by 14 it was really annoying me, so I started forcing myself to not do those things. It was torture. Imagine putting your hand into water you know is very hot. Maybe you know it won't actually blister your skin, but you know it is hot, and it will hurt. But you override your instincts and force yourself to do it. Eventually you can break then bad instincts, but most people don't understand this because they've never gone through it. To this day I don't know why I developed those instincts. All I can say it it seemed like I should do them, and once I started, it seemed like I should more.
There were others as well, though I don't know if they are as common for other people with OCD. I felt the need to hide around corners and jump out at people. Even when I knew there was no chance I was going to scare them. I barely thought about it, I just felt myself doing it. It all went away when after I forced myself to stop the hand washing and lock resetting (I don't recall how long it took, but it felt like months because it sucked, but was probably more like one month (being over 20 years ago my memory of the situation isn't perfect).
Re:More nonsense (Score:5, Insightful)
Addiction is a habit that has developed a chemical dependancy. Try taking a regular coffee drinker's coffee away from them for a couple of weeks. It is down right scary to watch the withdrawal.
Some have a hard time stopping others enjoy it so much they really don't want to stop. you can break the habit but because of the chemical dependency it is much much harder.
Also Habits are only a choice in the beginning. once they get going you have to choose to stop, to break the habit.
Re:Gotta have a plan (Score:3, Insightful)
That is why, when you go to an AA meeting, the folks have been sober for months or years and yet are chugging coffee and chain-smoking at 8 p.m. with angry and impatient scowls on their weathered faces.
Heh, it's so true. Someone may carry a medal how you are not drinking, but never tell that they have picked up some other vice. For example Penn Jillette has often mentioned how he has never touched drugs, but looking at the shape of him I bet he likes to guzzle down some junk food.
Re:quit drinking (Score:5, Insightful)
You are defining an alcoholic as someone that can only stop drinking if they use the 12 step program. Someone who is able to stop for any other reason is not a true alcoholic.Therefore, Only the 12 step program can keep a true alcoholic sober. And the views of anyone who was not a true alcoholic and was able to stop drinking without using the 12 step program views are irrelevant. I think data obtained with these criteria will be somewhat biased.
Surprisingly little God in them? Have you actually read them? (http://en.wikipedia.org/wiki/Twelve-step_program) The OP is essentially correct in his summery.
Re:quit drinking (Score:5, Insightful)
That's commonly true, although alcohol is a strange drug because of how it figures in so many social situations. There's a segment of what you might call "problem drinkers" who do successfully change from drinking excessively to drinking moderately, mostly caused by a significant change in their social setting. For example they change cities and have a different group of friends with different activities.
This strongly depends on the person and the nature of their excessive alcohol use, though. It's "easier" in a sense to be cured if it has a large socially situated psychological component, such as people who drink too much basically because their social life revolves around spending 5-6 hours each evening at the pub, and drinking is what you do at the pub. In that case, a change in social setting can significantly cut down on the amount they drink. But you could argue that these people were not truly addicted; rather they were drinking more than they wanted to because of social/peer/environmental pressure to do so, and then stopped doing so when the external pressure disappeared.
How it works (Score:5, Insightful)
Re:quit drinking (Score:2, Insightful)
"No True Scotsman" involves moving goalposts. Alcohol abuse is a well-documented, well-defined medical condition; the only "goalpost-moving" here is movement from the OP's self-diagnosis.
Or are you honestly trying to defend all the first-hand accounts of users of homeopathy, chiropractic, faith healing and the like?
Re:12stepping is just a blameshifting game (Score:2, Insightful)
You know, people don't wake up and say, "This is a good day to become a drunk/addict!"
If an addict read your post, they would think "Yeah, what's the point! Fuck it! I'm no good!" and then go out, get high and possibly die or kill someone.
What these 12-Step programs do is help deal with the shame and blame. The drunks feel all that guilt. They do ask themselves "WTF did I take that first shot?!"
They are numbing out feelings. Go to an open meeting sometime and you will hear story after story of childhood abuse and other horrible things that happened to those folks. Many were brought up to feel defective and worthless. So worthless that no one could possibly love them - many times they're isolated. Some started being a drunk because that were the only friends they thought they could have - the drunks they hooked up with just wanted a drinking buddy. Drugs and booze are the only thing that makes them feel good.
Many never developed proper coping skills and many had drunks for parents. When you grow up in an environment like that, you think that's normal.
The 12-Steps and other recovery groups like SOS allow these folks to connect and belong somewhere - and considering society's hangup and judgements - it's the only place where they can feel they belong. They also start to learn about the dysfunctional thinking and living. There's nowhere else to learn those things.
On the surface, 12stepping does the same. In fact, though, it never acknowledges that YOU and YOU ALONE are responsible for whether or not you drink. Not some "higher power" and you certainly are not "powerless to stop". That's prime grade bullcrap. You and you alone are responsible for your life and what you do. And you and you alone can pull yourself out of the gutter. Friends can be a boon here, whether fellow sufferers are is debatable if you ask me. But in the end, it's your choice.
Many folks need that "higher power" stuff to deal with their own hatred about themselves. "It's really not me - I have a "disease" and it's up to me deal with it." Get it? How many folks feel guilty about having colon cancer? Not many. But they take charge of their lives to get treated. Same idea here.
Granted it gets a bit tiresome -even condescending at times. (One poor guy had a tree for a higher power. The DOT took it down - snickers from all the Jesus/God believers in the room. Not a single expression of sorrow for the guy.).
But that's the thing, when you're an addict, you have no real friends - just other addicts who more than likely don't want to change. These programs give support for change and positive role models - mostly.
There are a LOT of problems with AA - some have accused it of being a cult which I sympathize with - but never the less, it does help folks from drinking and I'd rather have them being there than staying a drunk.
Re:So you need to get over your alcohol addiction. (Score:3, Insightful)
...purely materialistic explanations for every phenomenon.
In my business, it's called troubleshooting. Find the problem and fix it.
The only faith required is the belief that you can do it. - Mark 10:52
Steps 2,3,4,5,6,7 and 11 (Score:5, Insightful)
First of all, there's no (official) 'Christian' angle in 12-step programs. The higher power is nothing more than a technique for letting go of trying to control things yourself.
I refer you to steps 2, 3, 5, 6, 7 and 11 [wikipedia.org] all of which explicitly invoke a diety of some kind. Claims that the twelve steps do not involve religion hard to swallow and frankly a bit disingenuous. It's pretty hard to buy the claim that those steps collectively are somehow independent of christian teachings. Those steps collectively are little different in function from confession in the christian tradition. Furthermore the founders of the twelve step programs themselves come from a christian tradition.
If 12 step programs clearly worked I would have little problem with that fact. If some prayer genuinely helps someone get their life together and stop drinking, who am I to judge? Anything that helps without harming others is fine with me. The problem is that it is not at all clear [washingtonpost.com] if they are actually effective. Some evidence points towards them being helpful for some people, much indicates that they provide little benefit and in occasional cases might have actually proved harmful. It's hard to study their effectiveness because the nature of twelve step programs tends to be secretive and there are other problems such as lack of a control group. The evidence supporting AA as an effective treatment is scientifically quite weak. Most evidence seems to show that at best it has a success rate barely better than those who do not take the program. I have a problem with the notion of prescribing religion as a treatment regimen in light of the fact that there is no compelling evidence that it actually has the desired outcome.
real alcoholics already know they're beaten (Score:4, Insightful)
If you personally haven't been through that, I'm sure it's hard to comprehend. The fact is, for a real alcoholic, it's like diabetes - it'll always be part of your makeup, though it can be controlled with daily vigilance. That's fundamentally different from someone who simply has a sugar crash from eating too many sweets, or a hangover from too many drinks.
suspect all you want (Score:5, Insightful)
More Drug War Propaganda (Score:5, Insightful)
The article is propaganda, plain and simple. In the first few sentences the author is already using words like “success” and “a miracle” to describe 12-step programs. I was interested in the article at first because the headline seemed to promise coverage of a genuine scientific assessment into the efficacy of the 12-step approach, something that is badly needed here in the USA where the 12-steps are frequently treated as The One True Religion by the established addiction treatment community. But the piece is just fluff, apparently written by a true believer who seems only interested in research aimed at retroactively determining just how 12-step programs accomplish such great things... The greatness is just assumed to already be a settled matter. The fact that AA and especially NA don’t work for the overwhelming majority of addicts is something that is just glossed over.
And that’s really too bad, because AFAIK most studies find only marginally better outcomes when evaluating 12-step program performance, on the order of a couple of percentage points when compared with alternative treatment methods, particularly over the long term where the numbers are barely statistically significant. The sad fact is that something like 99% of the addicts who walk in to a NA meeting for the first time will relapse in a matter of weeks or even days, and often just hours. As for the long term outlook, there are studies showing no measurable difference in sobriety levels after 5 years of NA versus no treatment at all. Even when the 12-step rules are scrupulously adhered to and all meetings are faithfully attended by the recovering addict, it remains a method of dealing with addiction that works only for very, very few people, although admittedly when it does work it can be a godsend. The question that needs to be asked in the USA, a country still obsessed with the patently un-winnable War On Drugs, is this: why is a program with such abysmal success rates still considered the gold standard in addiction therapy by treatment providers? Too bad you won‘t find any such question in the article.
addiction = fn(sustainability) Re:How it works (Score:5, Insightful)
It trades one addiction for others: religion, caffeine, and nicotine. It trades personal responsibility for not drinking, and thus drinking, to an imaginary higher power.
Quite glib; your implied point is "it" is worthless because it just swaps addictions.
I haven't seen a definition of addiction yet, so I'll suggest this:
Someone is addicted if they repeatedly make damage-causing choices, to the point where normal life is unsustainable (e.g. cant hold a job, arrested, or maybe death).
Now instead of a question of "Addiction" it becomes a question of Sustainability: how long can somebody carry on?
Some people carry on for a full lifetime with whatever. No problem, I'd say they're not addicted.
Other people have trouble sustaining after a while.
As for "trading one addiction for another", think of it as damage control.
Different behaviors have different time frames to their consequences.
Some things, like meth or heroin, can lead to severe consequences quickly (think Trainspotting).
Alcohol tends to be longer-term maintainable; often drinkers can sustain for years, possibly even decades. Eventually health issues (like liver damage, possibly fatal), judgement issues (drunk driving, possibly fatal), and other "consequences" (getting fired, divorced, passing out in risky situations) tend to make life unsustainable.
Marijuana is perhaps more sustainable than alcohol and other drugs.
Now, let's talk about some of the other "addictions" that you're concerned about.
Coffee? (Oh noes, they iz addixted to caffeen!!) WTF! Coffee is arguably completely sustainable, it doesn't cause damage to the user or to others.
Cigarettes? *shrug* I don't know about that one but damage-wise, but it is probably safer for somebody to smoke than to routinely make poor decisions because they're blackout drunk.
Sex? (Oh noes, they are sleepn roundz!) This is pretty sustainable; arguably healthier than lots of alcohol / chemical "entertainment" options. Do actually you have a problem with people engaging in sex?
Look... whatever behavior you're thinking about, try thinking of it in terms of sustainability. Maybe some of these things are "just" substitute addictions"... but is that really so bad?
Re:Steps 2,3,4,5,6,7 and 11 (Score:2, Insightful)
WTF? This is the logic of a child. It encourages a kind of delusion that could be hazardous to individuals themselves or those around them. Maybe a good step would be realizing that it was you that caused your problems and you that can change them instead of this intellectually dishonest out that also leaves a blameless path back into your problems.
The failing of 12 step programs ... (Score:4, Insightful)
There is a lot of logic in taking people who have broken self control mechanisms and telling them that they need to rely on some external source of judgment. Fine. When they craving for a drink, teach them to call a sponsor or other group member to talk me down. Because their brain is too broken to make correct decisions in this area. But that should be the end of it. If this becomes a foot in the door to sell a story of some invisible guy up in the sky who is all powerful, well they may not be that screwed up. And attempting to make this sales pitch is often caught, even by people lacking excellent judgment as a con. Eventually, they see through the BS and reject not only the imaginary guy with the beard, but the useful support structure keeping them away from abusing substances.