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Sigh. As someone who’s had success in 12-step recovery since 1998, I find these sorts of “debunkings” incredibly disappointing. Firstly the measurement of succe

Sigh. As someone who’s had success in 12-step recovery since 1998, I find these sorts of “debunkings” incredibly disappointing. Firstly the measurement of success rate entirely misses the point. The 12-step view is that there isn’t a “once and done” cure. If I were to use an analogy it’s more like having lifelong diabetes. You gotta keep taking that insulin. It’s the continuity that forestalls the disease/ keeps you in remission. Yes, 12-step programs have issues, and a big one is the whole “higher power”/god thing. Maybe this is more of an issue in the USA which is far more religious than other countries. But even that is addressable for atheist 12-steppers. I should know - I am one. If you are interested in a different take by a psychologist expert in the field, check out the writing of Dr. Patrick Carnes. https://www.drpatrickcarnes.com/ https://www.drpatrickcarnes.com/

labrador 4y ago
Yes, I get the feeling to. I just posted a comment I hope anyone reading this will find helpful
KingMob 4y ago
> The 12-step view is that there isn’t a “once and done” cure. If I were to use an analogy it’s more like having lifelong diabetes. You gotta keep taking that insulin. It’s the continuity that forestalls the disease/ keeps you in remission. This is actually one of the things that many psychologists are dubious about. It's entirely possible that self-labeling as an alcoholic forever makes it harder, not easier, for some people to remain abstinent. To the extent that it keeps you vigilant and involved in a supportive community, it can be good. But it could also make it harder to get back on the wagon if you have a single drink if you think you're "an alcoholic", and not "a sober person who made a mistake". Due to the anonymous and heterogeneous nature of AA, good data and studies of its efficacy are very hard to come by, so we have little idea if it's actually better than non-AA or pharmaceutical alternatives.
- phs318u 4y ago
  Identifying as an alcoholic or gambling addict or drug addict etc, is no different than saying "I'm a diabetic". It's the label of a chronic disease. Applying that label to self is about acceptance of that as a fact of life that you can then work with. If you've ever been unfortunate enough to see e.g. a diabetic who did not accept the reality of their illness - it's not pretty. Acceptance is the price of vigilance. I also believe you've misunderstood how we view ourselves (and each other) when we fall of the wagon/bust/slip. I'm not a "sober person who made a mistake". I'm an addict who made a mistake. Most of us in 12-step programs have tried psychology (and counselling and hypnotherapy and...) before the despair was enough that we'd admit defeat and join *A. Admittedly, there's a cohort of people mandated to turn up. It should surprise no one that this cohort sees very high rates of recidivism. But I'd suspect the same to be the case for people mandated to attend psychotherapy. If you don't want to change, nothing can make you. Pharmaceuticals are interesting. I believe that LSD has been trialled to help those with substance addictions but I'm not sure of the state of research regarding behavioural addictions. Fundamentally though, the evidence is pretty clear that there's a neurological basis to most addictions including the behavioural ones. e.g. check the research of Mira Fauth-Buhler. https://www.researchgate.net/profile/Mira-Fauth-Buehler https://www.researchgate.net/profile/Mira-Fauth-Buehler
  - specproc 4y ago
    People can choose to identify as they wish, and I'm not for one second diminishing that identification. But problematic drinking is very different to diabetes, it's also highly varied in its expression and not as deterministic as the label suggests. I totally understand why it's a helpful framing for some people, but it really isn't for others.
    - vorpalhex 4y ago
      To extend this, there have been programs that have attempted to fix the problems of alcohol addiction but not require patients to remain sober. The core concept being that there is an underlying cause to the alcohol problem and the alcoholism is an expression of that problem, not itself a root. Thus once the root cause is fixed, the alcohol is no longer a trigger. Another form allows participants to drink but uses a medicine which induces unpleasant effects from alcohol. Thus participants self train an avoidance pattern and break the positive feedback loop. These should not be seen as contrary to the AA abstinance approach. For some people that appears to be the most effective means. For many other people, AA is not. I suspect as we advance our understanding we'll come to find distinct subdiagnoses in alcoholism and alcohol abuse that suggest different treatment strategies. Right now our understanding feels very rudimentary.
JamesBarney 4y ago
Yeah one of the issues is that much of the 12-step recovery community does not condone alcohol abuse disorder medication. So to extend your analogy it would be like a community that focuses exclusively on curing diabetes through a ketogenic diet, but also tells people they shouldn't take their insulin. Maybe ketogenic diet works, but we do need good data to figure out how it compares to taking insulin.
- rootusrootus 4y ago
  I think GP was talking about type 1 diabetes, which is an entirely different disease than type 2, and certainly not treatable with diet.
deleted 4y ago
[deleted]
gray5 4y ago
[flagged]
ChrisMarshallNY 4y ago
Yeah...been hearing this stuff for 42 years. I could probably make an entirely convincing argument as to why you shouldn't try it. That's because I've heard it all. If you don't want what we have ... no worries. You won't get it. The problem is when we make decisions for other people. Things look very, very different, when it's our own butt on the line.
- bbatha 4y ago
  > The problem is when we make decisions for other people. Things look very, very different, when it's our own butt on the line. Which is precisely what this article is complaining about. AA both as a program and as cultural push "abstinence first" is harming addicts for which the AA method is not successful. Which is most people. For instance drug therapies are slow to be given approval, people are sent to AA programs through court orders, etc. As an individual if it works for you that's wonderful. But governmental policy and cultural norms should be based on what's effective.
  - readthenotes1 4y ago
    What is more effective than AA?
    - ChrisMarshallNY 4y ago
      If you are looking at raw numbers, lots of things. MAT (Medically Assisted Treatment) is considered more effective, numbers-wise. There's a huge amount of money being made in the field. Also, AA and NA don't collect much, in the way of data. It's actually hard to tell how truly effective they are. Something to do with the second "A," I would guess... That brings up another point that people have been avoiding, here: Desperate people can be squeezed hard. A lot of folks are making a lot of money, from people with their lives in tatters. Some of the therapies are effective, but a lot of them are definitely not. Since people like to cast addiction (and alcoholism is simply addiction to the sedative-hypnotic drug ethyl alcohol) as a moral failing on the part of the addict, it's easy to blame them, and say that "they got what they deserved." It's really pretty hard to feel sorry for many addicts. Pick up the paper, on any given day, and you'll likely see some horrific stories of crimes committed by addicts. That's why programs like AA and NA work. The only people that actually care about addicts, are other addicts. It's also important that they not be in a position to profit from their treatment. 12-Step programs live on a regimen of enforced poverty. They love to fight about money, but the amounts are chicken feed, compared to what the for-profit orgs make. Which begs the question: If someone makes money by selling treatment to desperate, ostracized, people, is it surprising that they don't like organizations that provide highly effective treatment for free?
paxcoder 4y ago
[dead]
deleted 4y ago
[deleted]

labrador 4y ago

Yes, I get the feeling to. I just posted a comment I hope anyone reading this will find helpful

KingMob 4y ago

> The 12-step view is that there isn’t a “once and done” cure. If I were to use an analogy it’s more like having lifelong diabetes. You gotta keep taking that insulin. It’s the continuity that forestalls the disease/ keeps you in remission. This is actually one of the things that many psychologists are dubious about. It's entirely possible that self-labeling as an alcoholic forever makes it harder, not easier, for some people to remain abstinent. To the extent that it keeps you vigilant and involved in a supportive community, it can be good. But it could also make it harder to get back on the wagon if you have a single drink if you think you're "an alcoholic", and not "a sober person who made a mistake". Due to the anonymous and heterogeneous nature of AA, good data and studies of its efficacy are very hard to come by, so we have little idea if it's actually better than non-AA or pharmaceutical alternatives.

phs318u 4y ago
Identifying as an alcoholic or gambling addict or drug addict etc, is no different than saying "I'm a diabetic". It's the label of a chronic disease. Applying that label to self is about acceptance of that as a fact of life that you can then work with. If you've ever been unfortunate enough to see e.g. a diabetic who did not accept the reality of their illness - it's not pretty. Acceptance is the price of vigilance. I also believe you've misunderstood how we view ourselves (and each other) when we fall of the wagon/bust/slip. I'm not a "sober person who made a mistake". I'm an addict who made a mistake. Most of us in 12-step programs have tried psychology (and counselling and hypnotherapy and...) before the despair was enough that we'd admit defeat and join *A. Admittedly, there's a cohort of people mandated to turn up. It should surprise no one that this cohort sees very high rates of recidivism. But I'd suspect the same to be the case for people mandated to attend psychotherapy. If you don't want to change, nothing can make you. Pharmaceuticals are interesting. I believe that LSD has been trialled to help those with substance addictions but I'm not sure of the state of research regarding behavioural addictions. Fundamentally though, the evidence is pretty clear that there's a neurological basis to most addictions including the behavioural ones. e.g. check the research of Mira Fauth-Buhler. https://www.researchgate.net/profile/Mira-Fauth-Buehler https://www.researchgate.net/profile/Mira-Fauth-Buehler
- specproc 4y ago
  People can choose to identify as they wish, and I'm not for one second diminishing that identification. But problematic drinking is very different to diabetes, it's also highly varied in its expression and not as deterministic as the label suggests. I totally understand why it's a helpful framing for some people, but it really isn't for others.
  - vorpalhex 4y ago
    To extend this, there have been programs that have attempted to fix the problems of alcohol addiction but not require patients to remain sober. The core concept being that there is an underlying cause to the alcohol problem and the alcoholism is an expression of that problem, not itself a root. Thus once the root cause is fixed, the alcohol is no longer a trigger. Another form allows participants to drink but uses a medicine which induces unpleasant effects from alcohol. Thus participants self train an avoidance pattern and break the positive feedback loop. These should not be seen as contrary to the AA abstinance approach. For some people that appears to be the most effective means. For many other people, AA is not. I suspect as we advance our understanding we'll come to find distinct subdiagnoses in alcoholism and alcohol abuse that suggest different treatment strategies. Right now our understanding feels very rudimentary.

JamesBarney 4y ago

Yeah one of the issues is that much of the 12-step recovery community does not condone alcohol abuse disorder medication. So to extend your analogy it would be like a community that focuses exclusively on curing diabetes through a ketogenic diet, but also tells people they shouldn't take their insulin. Maybe ketogenic diet works, but we do need good data to figure out how it compares to taking insulin.

rootusrootus 4y ago
I think GP was talking about type 1 diabetes, which is an entirely different disease than type 2, and certainly not treatable with diet.

deleted 4y ago

[deleted]

gray5 4y ago

[flagged]

ChrisMarshallNY 4y ago

Yeah...been hearing this stuff for 42 years. I could probably make an entirely convincing argument as to why you shouldn't try it. That's because I've heard it all. If you don't want what we have ... no worries. You won't get it. The problem is when we make decisions for other people. Things look very, very different, when it's our own butt on the line.

bbatha 4y ago
> The problem is when we make decisions for other people. Things look very, very different, when it's our own butt on the line. Which is precisely what this article is complaining about. AA both as a program and as cultural push "abstinence first" is harming addicts for which the AA method is not successful. Which is most people. For instance drug therapies are slow to be given approval, people are sent to AA programs through court orders, etc. As an individual if it works for you that's wonderful. But governmental policy and cultural norms should be based on what's effective.
- readthenotes1 4y ago
  What is more effective than AA?
  - ChrisMarshallNY 4y ago
    If you are looking at raw numbers, lots of things. MAT (Medically Assisted Treatment) is considered more effective, numbers-wise. There's a huge amount of money being made in the field. Also, AA and NA don't collect much, in the way of data. It's actually hard to tell how truly effective they are. Something to do with the second "A," I would guess... That brings up another point that people have been avoiding, here: Desperate people can be squeezed hard. A lot of folks are making a lot of money, from people with their lives in tatters. Some of the therapies are effective, but a lot of them are definitely not. Since people like to cast addiction (and alcoholism is simply addiction to the sedative-hypnotic drug ethyl alcohol) as a moral failing on the part of the addict, it's easy to blame them, and say that "they got what they deserved." It's really pretty hard to feel sorry for many addicts. Pick up the paper, on any given day, and you'll likely see some horrific stories of crimes committed by addicts. That's why programs like AA and NA work. The only people that actually care about addicts, are other addicts. It's also important that they not be in a position to profit from their treatment. 12-Step programs live on a regimen of enforced poverty. They love to fight about money, but the amounts are chicken feed, compared to what the for-profit orgs make. Which begs the question: If someone makes money by selling treatment to desperate, ostracized, people, is it surprising that they don't like organizations that provide highly effective treatment for free?

paxcoder 4y ago

[dead]

deleted 4y ago

[deleted]