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If you consider addiction as a psychological and physical dependence on a chemical what healthcare professional would design a program like AA? Seven of the 12

If you consider addiction as a psychological and physical dependence on a chemical what healthcare professional would design a program like AA? Seven of the 12 steps involve God. It also reinforces the 'moral failure' stigma attached to the person. You drink too much for a reason, not because you are a bad person. It's likely due to genetic and environmental factors. ohh and you can die from withdrawal (unlike most other addictions). https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2008.02203.x https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.... https://www.aa.org/assets/en_US/smf-121_en.pdf https://www.aa.org/assets/en_US/smf-121_en.pdf https://www.theatlantic.com/health/archive/2014/03/the-surprising-failures-of-12-steps/284616/ https://www.theatlantic.com/health/archive/2014/03/the-surpr... https://www.inspiremalibu.com/blog/alcohol-addiction/7-things-you-might-not-know-about-delirium-tremens/ https://www.inspiremalibu.com/blog/alcohol-addiction/7-thing...

derefr 8y ago
The AA steps were constructed in a culturally-Christian environment, for people who are also culturally-Christian, even if they’re atheists. (I.e., they are people who were taught Christian messages and then maybe rejected them, and who also have a mostly-Christian community around them.) Thus, they have to be read through this lens. Basically, if you want to “translate” the AA steps for the modern era where things aren’t so culturally-Christian, try replacing “God” with “a Church congregation-community”, where a “Church” is any social technology designed for taking a group of average people and trying to extract the best, most empathetic/humanist/“moral” group behavior out of them. When AA says to rely on the “power of God” which is “strong” while your own willpower is “weak”, what they’re really saying, stripping away the culturally-Christian assumptions, is to rely on the social technology of a Church-like organization to amplify and backstop your willpower in various ways. • Most Church-like organizations, regardless of religion, have a membership that strive to practice moderation in things like drinking, so switching your “community” to be that of the Church-like organization means switching your friends (maybe people who love to go out and get drunk?) for people who don’t. (This is a similar idea to why some people say prisoners are better off paroled: the last people you want prisoners around are other prisoners. You want them around good role-models, not bad ones, if you want them rehabilitated.) • Most Church-like organizations provide access to a confidant and therapist (in Christian churches, that’d be the priest.) If you bond with this confidant-and-therapist figure, you’ll feel less bad about temporary failures, because you’ll have someone to tell who will help you get back on the horse, rather than shunning you for your failure. • In most Church-like organizations, if you don’t attend the regular community meetings, the community members will get worried about you and check up on you. This will help prevent you from degenerating further after falling off the wagon. AA is already a bridge between two worlds; although it is constructed under a culturally-Christian lens, it assumes that its attendeees are not necessarily members of any Church-like organization. So one of the goals of AA group meetings is to be a Church-like organization, for people who don’t attend Church. It pushes you “back” toward the Christian Church because it knows it can’t help you forever and wants you to find a more permanent Church-like organization to help you. This is similar to how psychiatrists encourage people who are stable on a maintenance dose of some drug to stop seeing them, by instead getting a family doctor (if they don’t already have one) and getting the family doctor to perscribe the maintenance dose of the drug. I think that, while AA could be rephrased to not be culturally-Christian, it’d be very hard to replace its insistence on accepting some kind of religious Church-like organization into your life... because there really just aren’t that many non-religious Church-like organizations. If there were, maybe there’d be fewer alcoholics.
- dragonwriter 8y ago
  > It pushes you “back” toward the Christian Church because it knows it can’t help you forever AA very specifically does not push you off on some other organization for support, and very specifically does not see or bill itself as being unable to provide lifetime support. It's designed as “you come, you stay, you evangelize”, not “you come, you get some value, you go back to some other support system”.
- DoreenMichele 8y ago
  The AA steps were constructed in a culturally-Christian environment I've read the origin story. It was constructed by a group of people who had been terrible, hard core alcoholics for decades who had failed all efforts to get off the alcohol and were still drinking even though it was literally killing them. "Giving it up to God" helped these folks get sober when nothing else had. Now, we call every college kid who goes on a bender an alcoholic, blame every personal problem they have on the alcohol and refer them to AA. Reality: Most people naturally drink less over time without any intervention whatsoever. Generally speaking, young people drink a lot more than old people, and not because all young people go to AA and get "cured." One guy explained it thusly: "When I was young, it felt great to get drunk. I had fun for hours and then the hangover wasn't too bad. Now, I get a short term pleasant feeling, followed by a terrible hangover. It's just not fun like it used to be. It's simply not worth it anymore."
  - deleted 8y ago
    [deleted]
- drdeadringer 8y ago
  How do you feel and what do you think about Lilith Starr's opinion and experience that a religion at-least partially focused on self responsibility was more helpful on achieving sobriety than AA?
coleifer 8y ago
> You drink too much for a reason I don't think that's right. More than anywhere else, it seems like on HN there's an idea of the infallibility of human rationality. Would anyone in their right mind a) shoot dirty dope filtered through a cigarette butt, b) gamble themselves into debt with the mafia, c) overeat to the point they can't leave the house, d) play videogames compulsively for days on end, etc?
- Tushon 8y ago
  I think that was the point of OP's comment, since you cut the rest of the statement > You drink too much for a reason, not because you're a bad person. the reason here being predisposition, environmental factors, genetics, and/or current illness
  - getsugablitz2 8y ago
    So those factors listed essentially encompass your personality and dictate why a person does any action. In that case, how do we hold anyone personally responsible for anything considering that the reason a person does any action is a result of their genetics and the environment they grow in? Not criticizing, just wondering how others reconcile this.
    - adontz 8y ago
      Human being is fundamentally weak. The worst and mostly uncontrollable factor leading to addiction is not having a friend when you really need someone. It's not someone's fault. If person is assole and that's why can't befriend anyone, maybe it's because that person was traumatized by cruelty or ignorance in the past. We are weak and can't handle our lives alone at all.
    - DoreenMichele 8y ago
      My dad drank heavily while he was in the army. He swore off alcohol when I was seven, but I never saw him drink to alcoholic levels. I think he drank to suppress the nightmares from serving in the front lines of two wars. I think he began tapering off when he left the army when I was three. I think he did so with no conscious plan. He just didn't need as much alcohol to push away his personal demons so he could sleep and he probably just naturally reduced it over time without really thinking about it. I've got a serious medical condition. I used to take a lot of prescription medication. I've gotten off all the drugs. It's really normal for me to stop doing X slowly over time and not really notice it until later. It's common for me to only really notice a change precisely because I talk a lot about my medical stuff with my adult sons, so we periodically go over "Oh, yeah, you used to do X, Y and Z and you don't anymore." I also spoke once with someone who had a lot of shame surrounding a DUI on their record. One of the stories they told me: They had surgery for something and when the doctors opened them up, they found one of the organs necrotic. This was unexpected and they expressed surprise that this individual was still alive. They removed the organ in the process of doing this other surgery. The individual quit drinking after that, but still saw themselves as a bad person and an alcoholic rather than someone who was managing a terrible and life threatening medical condition with alcohol until surgery happened to resolve it. I'm convinced that this type of thing is much more common than is generally recognized.
whiddershins 8y ago
There are any number of persistent myths attached to the popular conception of 12 step programs. I am in no way an expert on AA, but I have researched various addiction treatment methods fairly extensively and am close to people who work professionally in recovery programs. The idea that AA reinforces the "moral failing" aspect of addiction seems contrary to everything I've ever read, heard, or seen in regards to AA. There may be a sense in which what you wrote is true, depending on defining very hard to define words such as "moral" ... I say that to apply the principle of charity to your comment as liberally as possible. My problem with you writing what you wrote is that it could discourage someone from seeking help. AA is free and nearly ubiquitous. It is decentralized and the implementation varies considerably from group to group. People can relatively easily find meetings and just walk in. Whether or not it is the best fit for any given addict, it is often the first step someone takes on a very difficult road. I don't think it in any way serves the common good to make discouraging comments about it. Especially if they are potentially misleading, which IMO yours is.
- taurath 8y ago
  > The idea that AA reinforces the "moral failing" aspect of addiction seems contrary to everything I've ever read, heard, or seen in regards to AA. The entire insistence on the belief in a higher power, along with insistence that one is "powerless over your addiction" is intrinsically talking about a moral failing, and more specifically adherence to a christian-worldview where all from birth are morally failed. They are offering a solution, in the form of rewiring your entire worldview (and deeply held beliefs) to the idea that you are powerless, there's an all powerful deity, and all good things are because of said deity. Step 4 is literally "Made a searching and fearless moral inventory of ourselves." [1] It may be effective for some, and some may have issues or resistance to such a thing. Having a conversation about the methodologies is impossible without potentially discouraging someone from seeking help - but we should not hide the negatives, or else there'll be no way to actually get to better solutions. My feeling is that religion and giving up to a higher power can work for some people, but for others it can be a betrayal of their deeply held principles and values - my fear is that places like AA in an effort to evangelize their own principles and values take people who are rock bottom and offer up theirs as a solution rather than something that might work well for the person. 1: https://12step.org/the-12-steps/ https://12step.org/the-12-steps/

derefr 8y ago

The AA steps were constructed in a culturally-Christian environment, for people who are also culturally-Christian, even if they’re atheists. (I.e., they are people who were taught Christian messages and then maybe rejected them, and who also have a mostly-Christian community around them.) Thus, they have to be read through this lens. Basically, if you want to “translate” the AA steps for the modern era where things aren’t so culturally-Christian, try replacing “God” with “a Church congregation-community”, where a “Church” is any social technology designed for taking a group of average people and trying to extract the best, most empathetic/humanist/“moral” group behavior out of them. When AA says to rely on the “power of God” which is “strong” while your own willpower is “weak”, what they’re really saying, stripping away the culturally-Christian assumptions, is to rely on the social technology of a Church-like organization to amplify and backstop your willpower in various ways. • Most Church-like organizations, regardless of religion, have a membership that strive to practice moderation in things like drinking, so switching your “community” to be that of the Church-like organization means switching your friends (maybe people who love to go out and get drunk?) for people who don’t. (This is a similar idea to why some people say prisoners are better off paroled: the last people you want prisoners around are other prisoners. You want them around good role-models, not bad ones, if you want them rehabilitated.) • Most Church-like organizations provide access to a confidant and therapist (in Christian churches, that’d be the priest.) If you bond with this confidant-and-therapist figure, you’ll feel less bad about temporary failures, because you’ll have someone to tell who will help you get back on the horse, rather than shunning you for your failure. • In most Church-like organizations, if you don’t attend the regular community meetings, the community members will get worried about you and check up on you. This will help prevent you from degenerating further after falling off the wagon. AA is already a bridge between two worlds; although it is constructed under a culturally-Christian lens, it assumes that its attendeees are not necessarily members of any Church-like organization. So one of the goals of AA group meetings is to be a Church-like organization, for people who don’t attend Church. It pushes you “back” toward the Christian Church because it knows it can’t help you forever and wants you to find a more permanent Church-like organization to help you. This is similar to how psychiatrists encourage people who are stable on a maintenance dose of some drug to stop seeing them, by instead getting a family doctor (if they don’t already have one) and getting the family doctor to perscribe the maintenance dose of the drug. I think that, while AA could be rephrased to not be culturally-Christian, it’d be very hard to replace its insistence on accepting some kind of religious Church-like organization into your life... because there really just aren’t that many non-religious Church-like organizations. If there were, maybe there’d be fewer alcoholics.

dragonwriter 8y ago
> It pushes you “back” toward the Christian Church because it knows it can’t help you forever AA very specifically does not push you off on some other organization for support, and very specifically does not see or bill itself as being unable to provide lifetime support. It's designed as “you come, you stay, you evangelize”, not “you come, you get some value, you go back to some other support system”.
DoreenMichele 8y ago
The AA steps were constructed in a culturally-Christian environment I've read the origin story. It was constructed by a group of people who had been terrible, hard core alcoholics for decades who had failed all efforts to get off the alcohol and were still drinking even though it was literally killing them. "Giving it up to God" helped these folks get sober when nothing else had. Now, we call every college kid who goes on a bender an alcoholic, blame every personal problem they have on the alcohol and refer them to AA. Reality: Most people naturally drink less over time without any intervention whatsoever. Generally speaking, young people drink a lot more than old people, and not because all young people go to AA and get "cured." One guy explained it thusly: "When I was young, it felt great to get drunk. I had fun for hours and then the hangover wasn't too bad. Now, I get a short term pleasant feeling, followed by a terrible hangover. It's just not fun like it used to be. It's simply not worth it anymore."
- deleted 8y ago
  [deleted]
drdeadringer 8y ago
How do you feel and what do you think about Lilith Starr's opinion and experience that a religion at-least partially focused on self responsibility was more helpful on achieving sobriety than AA?

coleifer 8y ago

> You drink too much for a reason I don't think that's right. More than anywhere else, it seems like on HN there's an idea of the infallibility of human rationality. Would anyone in their right mind a) shoot dirty dope filtered through a cigarette butt, b) gamble themselves into debt with the mafia, c) overeat to the point they can't leave the house, d) play videogames compulsively for days on end, etc?

Tushon 8y ago
I think that was the point of OP's comment, since you cut the rest of the statement > You drink too much for a reason, not because you're a bad person. the reason here being predisposition, environmental factors, genetics, and/or current illness
- getsugablitz2 8y ago
  So those factors listed essentially encompass your personality and dictate why a person does any action. In that case, how do we hold anyone personally responsible for anything considering that the reason a person does any action is a result of their genetics and the environment they grow in? Not criticizing, just wondering how others reconcile this.
  - adontz 8y ago
    Human being is fundamentally weak. The worst and mostly uncontrollable factor leading to addiction is not having a friend when you really need someone. It's not someone's fault. If person is assole and that's why can't befriend anyone, maybe it's because that person was traumatized by cruelty or ignorance in the past. We are weak and can't handle our lives alone at all.
  - DoreenMichele 8y ago
    My dad drank heavily while he was in the army. He swore off alcohol when I was seven, but I never saw him drink to alcoholic levels. I think he drank to suppress the nightmares from serving in the front lines of two wars. I think he began tapering off when he left the army when I was three. I think he did so with no conscious plan. He just didn't need as much alcohol to push away his personal demons so he could sleep and he probably just naturally reduced it over time without really thinking about it. I've got a serious medical condition. I used to take a lot of prescription medication. I've gotten off all the drugs. It's really normal for me to stop doing X slowly over time and not really notice it until later. It's common for me to only really notice a change precisely because I talk a lot about my medical stuff with my adult sons, so we periodically go over "Oh, yeah, you used to do X, Y and Z and you don't anymore." I also spoke once with someone who had a lot of shame surrounding a DUI on their record. One of the stories they told me: They had surgery for something and when the doctors opened them up, they found one of the organs necrotic. This was unexpected and they expressed surprise that this individual was still alive. They removed the organ in the process of doing this other surgery. The individual quit drinking after that, but still saw themselves as a bad person and an alcoholic rather than someone who was managing a terrible and life threatening medical condition with alcohol until surgery happened to resolve it. I'm convinced that this type of thing is much more common than is generally recognized.

whiddershins 8y ago

There are any number of persistent myths attached to the popular conception of 12 step programs. I am in no way an expert on AA, but I have researched various addiction treatment methods fairly extensively and am close to people who work professionally in recovery programs. The idea that AA reinforces the "moral failing" aspect of addiction seems contrary to everything I've ever read, heard, or seen in regards to AA. There may be a sense in which what you wrote is true, depending on defining very hard to define words such as "moral" ... I say that to apply the principle of charity to your comment as liberally as possible. My problem with you writing what you wrote is that it could discourage someone from seeking help. AA is free and nearly ubiquitous. It is decentralized and the implementation varies considerably from group to group. People can relatively easily find meetings and just walk in. Whether or not it is the best fit for any given addict, it is often the first step someone takes on a very difficult road. I don't think it in any way serves the common good to make discouraging comments about it. Especially if they are potentially misleading, which IMO yours is.

taurath 8y ago
> The idea that AA reinforces the "moral failing" aspect of addiction seems contrary to everything I've ever read, heard, or seen in regards to AA. The entire insistence on the belief in a higher power, along with insistence that one is "powerless over your addiction" is intrinsically talking about a moral failing, and more specifically adherence to a christian-worldview where all from birth are morally failed. They are offering a solution, in the form of rewiring your entire worldview (and deeply held beliefs) to the idea that you are powerless, there's an all powerful deity, and all good things are because of said deity. Step 4 is literally "Made a searching and fearless moral inventory of ourselves." [1] It may be effective for some, and some may have issues or resistance to such a thing. Having a conversation about the methodologies is impossible without potentially discouraging someone from seeking help - but we should not hide the negatives, or else there'll be no way to actually get to better solutions. My feeling is that religion and giving up to a higher power can work for some people, but for others it can be a betrayal of their deeply held principles and values - my fear is that places like AA in an effort to evangelize their own principles and values take people who are rock bottom and offer up theirs as a solution rather than something that might work well for the person. 1: https://12step.org/the-12-steps/ https://12step.org/the-12-steps/