The Resilience of Alcoholics Anonymous

Hooked

By Bill White and Ernie Kurtz

Attacking Alcoholics Anonymous (A.A.) and 12-step oriented addiction treatment has become a specialized industry with its own genre of literature, celebrity authors and speakers, single-focus websites, and promoted alternatives.  Collectively, these critics suggest that A.A. is an anachronism whose effectiveness has been exaggerated and whose time in the sun has passed.  A.A.’s institutional response to these criticisms has been a consistent pattern of private self-reflection (e.g., Bill Wilson’s “Our Critics can be Our Benefactors“) and public silence (e.g., no opinion on outside controversial issues, personal anonymity at level of press, and public relations based on attraction rather than promotion–as dictated by A.A.’s Traditions).

The concept of organizational resilience suggests not just an institution’s longevity, but the capacity to survive in the face of significant threats to its character and existence.  Such threats faced by A.A., including the intensity and endurance of polemical assaults on A.A., raise the question of how A.A. survived these challenges to become such a dominant cultural force.  We have investigated the history of a broad spectrum of secular, spiritual, and religious frameworks of addiction recovery, and we believe there are several factors that contribute to A.A.’s vitality and survival that warrant the attention of those interested in the resolution of alcohol and other drug (AOD) problems.  We discuss below some of the more important of such criteria.

Attraction

Will those experiencing AOD problems be attracted to seek help from this solution?  A.A. meets this criterion, as evidenced by its pattern of growth over the past eight decades.  The primary mechanism of attraction has been the power of mutual identification experienced through an endless chain of one alcoholic telling his or her story to another alcoholic.  The personal transformations and social fellowship that flow from such exchanges are at the core of the A.A. experience. A.A. also draws prospective members by promising protection from social stigma via its membership criteria (“a desire to stop drinking”), its closed meeting structure, and its encouragement of personal anonymity.  Put simply, the first point of accountability for any addiction recovery support program is the number of people with AOD problems who choose it.  It is only their votes that ultimately matter.

Accessibility

Is the proffered solution locally available, culturally acceptable, personally accessible (at high risk times, e.g., evenings, nights, and holidays), and affordable?  A.A. has met these criteria through its sustained national, international, and transcultural growth (including growth within communities of color and other historically disempowered groups), its 24-hour availability (via the mechanisms of sponsorship, phone number exchanges, and its 12th Step service ethic), and its policy of no dues or fees.  At present, A.A. and other 12-step programs represent the most accessible addiction recovery support framework in the world.  While recovery mutual aid alternatives to A.A. have a much shorter history, each must pass this accessibility litmus test if it is to survive as a viable recovery support option.

Engagement

Is the proposed remedy capable of sustaining involvement for a sufficient duration of time to achieve recovery stabilization, transition to sustainable recovery maintenance, and enhanced quality of personal/family life in long-term recovery?  The greatest challenge of all health management programs, particularly those addressing problems distinguished by severity and chronicity (e.g., obesity, cancer, diabetes, and heart disease) is sustaining commitment to daily recovery management practices.  A.A. enhances such adherence through its “one day at a time” philosophy, Step-guided prescriptions for recovery maintenance, its rationale for sustained A.A. participation, and using small-group affiliation and its resulting friendships as a medium and motivational fulcrum for sustained involvement.   A.A. has  been more effective than many of its mutual aid alternatives (as measured by average duration of participation) and more effective than addiction treatment in sustaining involvement for the 4-5 years researchers have found to be the best predictor of lifetime recovery. Any reference to A.A. drop-out rates must be balanced by comparison of such rates to other addiction recovery mutual aid groups, addiction treatment and allied health management frameworks, e.g., health clubs, weight loss programs, and smoking cessation support groups.

Adaptability

Is the proposed solution adaptable across evolving cultural contexts and applicable to the variability of AOD problems and the needs of diverse individuals seeking recovery?    A.A. has stretched the boundaries of its inclusion via the growth of A.A. meetings within diverse cultural settings, by the growth in specialty meetings of people with AOD problems who share another defining characteristic, e.g., age, gender, ethnicity, sexual orientation, religious orientation (or its absence), primary language, problem severity (low-bottom versus high bottom groups), co-occurring disorders, occupation, etc.  The varieties of A.A. groups and varieties of A.A. experience suggest that A.A. has made substantial progress in meeting this criterion.

Organizational Viability and Longevity

Can the organizational framework within which the recovery solution is nested withstand the forces that have led to the self-destruction of recovery mutual aid organizations (and addiction treatment organizations) for more than 150 years?  Many of A.A.’s predecessors offered a viable program of personal recovery but failed to survive as an organization.  A.A. found creative solutions to the forces that had limited or destroyed its predecessors.  Through the principles imbedded in its Twelve Traditions, A.A. forged solutions to the pitfalls of charismatic and centralized leadership, mission diversion, colonization by other organizations, ideological extremism and schisms, professionalization, commercialization, and relationships with other organizations and the media.   A.A. created a historically unique organizational structure (a blend of anarchy and radical democracy relying on rotating leadership, group conscience, intentional corporate poverty, etc.) that even its most devoted early professional allies believed could not work. That structure and those principles have protected A.A. through eight decades.  A.A. offers a case study in organizational resilience.

Scientific Validity

Are claims of success in the resolution of alcohol and other drug problems validated by scientific study?  Studies of A.A. have grown in number and methodological rigor in recent years.  Though continuing to focus primarily on A.A. participation during and following addiction treatment, these studies confirm that:

  • A.A. participation enhances long-term abstinence, global health, and social functioning;
  • these benefits can be amplified when combined with professionally-directed addiction treatment;
  • A.A. oriented-treatment is as effective as its alternatives (e.g., cognitive behavioral therapy, and motivational interviewing) and superior in elevating post-treatment abstinence outcomes;
  • the benefits of A.A. participation extend to diverse populations, including women, youth, people of color, people with co-occurring disorders, and people without religious or spiritual orientation;
  • the mechanisms of change in A.A. include  problem recognition, enhancement of motivation and self-efficacy, exposure to sober role models, social support, increased coping skills, enhanced spiritual orientation, and helping others;  and
  • the response to A.A. (like responses to other addiction recovery mutual-aid groups and to addiction treatment) is not uniform, with responses varying from optimal effects, partial effects, to no effects.   (For a review, see White, 2009).

Cultural Contribution

Does the recovery support option offer any added value to the culture beyond its contribution to the recovery of the individual?   A.A.’s cultural prominence derives from areas in which it adds social value:

First, participation in A.A. has been found to reduce social costs of AOD problems at no cost to the society: A.A. refuses to accept any outside funds for support of its organization.

Second, A.A.’s Twelve Steps have been widely adapted to address other problems of living, extending A.A.’s social benefit far beyond the arena of alcoholism recovery.

Third, Robin Room and others have suggested that A.A.’s unique organizational structure and its principles of organizational management (Twelve Traditions and Twelve Concepts) may be as historically noteworthy as its solution to the problem of alcoholism.

Fourth, A.A.’s model of “fellowship” based on shared experience marks a new form of social affiliation and a new source of “community” among people lacking ties of blood, geography, faith, or profession.

Finally, A.A. merits recognition within the history of ideas for its disentanglement of spirituality from religion, its assertion of limitation and imperfection as the essential human condition, and its elevation of transcendent experience and helping others as antidotes to human isolation and shame.

It would be well to apply criteria such as these to any proposed solution for alcohol and other drug problems.

———-

The featured image at the top of this post is by the Polish artist, Pawel Kuczynski.

This article was originally published on the website, William White Papers, and is re-published with permission.

About the Authors:  Bill White is author of Slaying the Dragon: The History of Addiction Treatment and Recovery in America. Ernie Kurtz is the author of Not-God: A History of Alcoholics Anonymous.

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Comments

The Resilience of Alcoholics Anonymous — 24 Comments

  1. “A.A. oriented-treatment is as effective as its alternatives (e.g., cognitive behavioral therapy, and motivational interviewing)…”

    Even if the above statement is true, none of the other approaches have a “supernatural being” as their curative agent so logically they should be at a disadvantage.

  2. ….”the first point of accountability for any addiction recovery support program is the number of people with AOD problems who choose it. It is only their votes that ultimately matter.” Who chose it! This phrase jumped off the page for me as being the key to the whole matter of “success” or effectiveness. So many are here by a nudge from the judge or some other authority in their lives, that to sort out those that are truly attracted and when the attraction takes place might be difficult. And really, to what end? Outside criticism is an outside issue and is answered pretty well by the article aforementioned, Bill Wilson’s “Our Critics can be Our Benefactors“. Thanks to Bill, Ernie and the editors here for more educational and insightful discussion.

  3. After being here for some time I have seen AA attacked, bashed, criticized and it has survived and might even thrive, as long as we remember Tradition Five: “Each Alcoholics Anonymous group ought to be a spiritual entity having but one primary purpose – that of carrying its message to the alcoholic who still suffers”. Cheers, Daniel.

  4. Attacking AA is easy. It doesn’t take an Einstein to see the contradictions that are rife throughout the dogma. Meetings often have the atmosphere of a fundamentalist revival meeting with everyone agreeing with everyone else, and praising them for their powerful testimony demonstrating the proof of the effectiveness of “the program.”

      • Or for a large part anything pertaining to free thought or intellectual discourse related to the 12 steps or the BB.

  5. “How it Really Works”

    There’s little evidence that AA works better for sobriety than doing nothing. So why are AA meetings so ubiquitous and considered the mainstay for addiction treatment by the courts, the medical establishment and society at large? Between the courts, rehab centers, spouses, bosses, self referrals, etc, AA gets about 800,000 newcomers a year. When that many people are put in the program a few are going to get sober. Again, about as many as may of gotten sober anyway. The people who are not filtered out by AA dogma and get sober tend to attribute AA for saving them. So you are left with a core of true believers who have a narrow interpretation of what’s needed to get sober. Of course if you don’t “thoroughly follow this path” it is your fault if the program fails you. Not that you were filtered out by AA rigidity.

    AA may be a great program for some. For the vast majority of people who leave, not such a great program.

    • Everything I’ve read indicates AA numbers have been remained the same, there’s been no “increase” over the years. And if it works, logic says the numbers should be growing. But they’re not. Unless you want to believe they are. ;-)

  6. Thanks for a direct and cogent analysis and summary.
    Although I did note that the piece referred not only to A.A. but also to “12-step oriented addiction treatment,” I’m concerned that the frequent use of the term “AOD” (and other drugs) will be misinterpreted by those who would turn A.A. into “Addictions Anonymous.” This trend, I believe, is a serious and increasing threat to A.A.’s “singleness of purpose.”

  7. Okay, everyone knows I WORSHIP Ernie Freaken Kurtz because, well, because he’s ERNIE FREAKEN KURTZ. Mr. Kurtz, by the way, has a new book just out, “EXPERIENCING SPIRITUALITY – Finding Meaning Through Storytelling.” (I have it right here)

    Now, EVERYBODY, get yourself Mr. White’s INCREDIBLE tome, “SLAYING THE DRAGON!!” It’s freaken INCREDIBLE!!!! It’s written by William Freaken White!!!

    WILLIAM FREAKEN WHITE!!!!!!!!!

  8. Such a cogent, well reasoned and effective answer to those outside of AA as well some of us within AA, who severely criticize AA either for being too “religious” or not “religious” enough. Thank you, Roger, for reprinting it . . .

    A common characteristic I notice about AA bashers whether from without as well as from those within AA is that both tend to be woefully ignorant of the history of AA, how it evolved, coalescing many various, sometimes even conflicting, voices for the successful recovery of individuals, as well as in the evolution of our Traditions and Concepts through which we “govern” ourselves.

    I think Bill Wilson once best described AA as a “benign anarchy”. The noted social commentator Aldous Huxley, as pointed out in yesterday’s Beyond Belief musing from Joe C., described Bill as “the greatest social architect of the twentieth century.” Huxley’s assessment was due not to Bill’s writing of the 12 Steps, but for his conceiving of and writing effectively about AA’s 12 Traditions and 12 Concepts — they save us from our our still at times too egotistical and arrogant individual selves, regardless of how long we may have been “recovered” . . .

    • I agree totally and I want to add something so I am going to plagiarize a little here, Thomas, and just change a few words. “A common characteristic I notice about AA” fundamentalists is that they “tend to be woefully ignorant of the history of AA, how it evolved, coalescing many various, sometimes even conflicting, voices for the successful recovery of individuals, as well as in the evolution of our Traditions and Concepts through which we “govern” ourselves.

  9. This blog from The White Papers came out on the tails of The Sober Truth launch. I couldn’t help myself, either; my next Rebellion Dogs Radio podcast was on the history of those who line up to take pot-shots at AA: Episode 4 Sober Truth & Other Rants.

    Both Dodes and Penn & Teller grossly misconstrue survey results about recovery outcomes that helped make their point (if no one takes a closer look at the data). It seems hard not to say something.

    The 1963 Grapevine article that is referenced here, “Our Critics Can Be Our Benefactors” hits the higher-ground nail on the head. That response was to the Dr. Cain article in Harpers Magazine “AA: Cult or Cure?” bit that had members in an uproar. But just as violence begets violence, any reaction is joining in on a game that can’t be won. Restraint of pen and tongue is such a discipline and an example that I strive to live up to.

    That said, this Resilience offering never did take the bait and made its point without giving the Dodes book any free press. Nice.

  10. I truly enjoyed this part,

    Through the principles embedded in its Twelve Traditions, A.A. forged solutions to the pitfalls of charismatic and centralized leadership, mission diversion, colonization by other organizations, ideological extremism and schisms, professionalization, commercialization, and relationships with other organizations and the media. A.A. created a historically unique organizational structure (a blend of anarchy and radical democracy relying on rotating leadership, group conscience, intentional corporate poverty, etc.) that even its most devoted early professional allies believed could not work. That structure and those principles have protected A.A. through eight decades. A.A. offers a case study in organizational resilience.

    How wonderful is that? A “blend of anarchy and radical democracy”, defying the traditional models of leadership yet it is successful because it redefined leadership to serve the needs of it membership first and foremost!

    Thank you Mr. White and Mr. Kurtz for a clear to the point description of what makes AA still a viable, living organization by and for those who suffer from alcoholism.

    I look forward to meeting everyone in November at WAFT IAAC!

  11. Although I can only claim 35+ years of recovery, it took me a long time to filter out all of the religious language and ideas expressed in AA literature and meetings. Learning to truly and faithfully practice the process of the 12 Steps, senza the magical thinking of the 30′s, hasn’t always been easy. However, in at least trying to do so, many of us have found and celebrate the “unsuspected inner resource” or “Great Reality deep within” that at least Bill Wilson alluded to. For me, learning to let go of disempowering dependence upon something outside of myself was the priceless gift I needed to be and accept my authentic self.

  12. Thanks for that analysis. I see little irony in all the twists, contradictions and seeming paradox involved in AA and addictions treatment in general. Addiction is a really weird and twisty thing after all, where one’s brain tries to kill itself with delusionary pleasure. Something I mention to critics who manipulate unreliable stats and use misconceptions to criticise the AA “organisation” is that just about everybody knows somebody who goes to AA and almost nobody knows anybody who sobered up on their own. I can be very critical of the directions some have taken their AA but ultimately I use AA as part of my sobriety program because I like it.

  13. The traditional AA member and group in my opinion only acknowledge “us” in a derogatory manner. I often mention secular AA and the positive effects I receive as a member and the response is ambivalent and we are more tolerated than accepted as a positive membership with the majority. I was at a meeting and our groups were mentioned and suggested as a study on how AA doesn’t work. It got a good chuckle, as it stimulates their ignorance and academic challenges. Also the closed-minded follow the leader philosophy of most people who allow other people to think for them. All the best my friends.
    PS. we do our best, but it’s similar to urinating into the wind. Thanks, john k.

  14. The last paragraph appealed to me:

    Finally, A.A. merits recognition within the history of ideas for its disentanglement of spirituality from religion, its assertion of limitation and imperfection as the essential human condition, and its elevation of transcendent experience and helping others as antidotes to human isolation and shame.

    I’m amazed when reading content from the “single interest” anti-AA websites. Most of these attackers don’t understand the traditions or that at the end of the day, after the people go home, the only thing left to blame in AA is a wall with words on it. AA as a whole isn’t anything but a wall with words. FUBU

    I used the quote given here from Bill W, about the steps being suggestions and different interpretations not being grounds for disqualifying from AA. I shared it in a meeting about tolerance and the 3rd tradition. I shared and was heard and thanked, even after expressing my atheism. This isn’t always the norm (there’s always the dude in the back saying “Amen” after every relating phrase he hears like we’re in church)

    I’d love to see an article addressing the spectrum of ridiculous attacks; from the classic “AA is a cult” to “AA kills more than it saves.” I know we’re not in the business of defending AA but from what I’m seeing lately, poor AA is getting roasted. Some of us humble atheists are sad to see it, even when we disagree with the dogmatic flavor. I wont mention the sites by name, but they’re insulting to say the least, and likely making reservations for newcomers, easier than ever.

  15. An important reminder, in the context of all the criticisms (from myself as much as from anyone) of AA, that what we here most want is for AA to thrive.

  16. As usual, one expects an historically valid and unhysterical analysis and response from Ernie Kurtz and Bill White — and we get that here!

    Some traditionalist AAers may see WAFT members as basically outsiders or as parasites on the body of AA. We, of course, see ourselves as part of the resiliency of AA that the article does such a nice job of narrating.

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