4 ms·

The thing that has always bothered me about the 12-step program is that the end goal seems to always be abstinence, at least in the context of alcoholism. It s

by kelnos 10mo ago

The thing that has always bothered me about the 12-step program is that the end goal seems to always be abstinence, at least in the context of alcoholism. It seems very strange to me that we treat the symptom, here, not the underlying disease. Abstaining from alcohol certainly does have positive affects on the life of an alcoholic, but the abuse of alcohol is a symptom, not the root issue. Do we just not yet understand addiction enough to treat it properly? Are we able to treat addiction (so, for example, someone could successfully limit themselves to low levels of social drinking that don't cause them harm), but doing so is so difficult and hit-or-miss, that we give up and only promote full abstinence as the solution? I also wonder if abstaining from alcohol can have negative affects on life for some people. Some people use alcohol as a social lubricant; abstaining might mean (detrimentally) less social interaction. In some cultures/environments, not drinking can be career-limiting (I think this is toxic, but fixing that can take generations). I think it's fair to say that, on balance, the pros of not drinking to excess all the time will (nearly?) always outweigh any cons of abstinence, but can we do better than either extreme? I poked around at some studies, and what I found was interesting. It does seem that 12-step programs tend to outperform things like cognitive behavioral therapy (though there is some disagreement here). But also many of these studies are about whether or not a given treatment achieves abstinence from alcohol, not if it treats the underlying disorder. So I'm not sure what conclusions (if any) can be drawn. (Ultimately, though, if the 12-step program worked for you, and you're happy with the results and with your life now, that's all that matters! I don't mean to demean what you've accomplished or throw shade on the life you have now. I just think this is a very high-profile societal/health issue that we seem to deal with in a very different way than we deal with others, and that seems strange to me.)

hahahahhaah 10mo ago
I think Naltrexone can help.
- emmelaich 10mo ago
  Katy Herzog has written a book about her successful experience: https://www.drinkyourwaysober.com/ https://www.drinkyourwaysober.com/
rayiner 10mo ago
> The thing that has always bothered me about the 12-step program is that the end goal seems to always be abstinence, at least in the context of alcoholism. This is where religion reflects cultural technology that gets lost in the secular translation. Secularists vastly overestimate man’s control over himself and his world. Most people lack the impulse control to partake in their vices responsibly. That’s why most Americans are fat. We have a world surrounded by temptation—snacks available everywhere—and we tell people to partake responsibly but they can’t do that. Most people don’t have that same relationship with alcohol or cigarettes, but for the many people who do it’s unrealistic for them to think they can just drink responsibly.
- PaulDavisThe1st 10mo ago
  > Secularists vastly overestimate man’s control over himself and his world. I'd prefer if you didn't generalize here, especially since there is no "secularist bible" that lays out what "secularists" believe (or do not believe).
  - ggggffggggg 10mo ago
    There’s no more a Christian bible in that sense — something that lays out what Christians believe. “X believes Y ” almost invariably just means “I think most X I’ve come across seem to believe something like Y”. Read it as such.
    - PaulDavisThe1st 10mo ago
      There's a book that describes what Christians believe about the life of Jesus Christ, and is used by most Christian priests to illustrate and reinforce their homilies and lessons to their lay folk. The same book is widely read by many denominations of Christians as a source of insight into the religious intent of Jesus Christ, even if the conclusions they draw from it may vary. There are also other books written by both lay authors and those with theological credentials that seek to describe what a "good" Christian should believe and do, though to be fair, none of them are universal across the Christian faith (*). No such work exists for "secularists". (*) though fair enough, even "The Bible" doesn't entirely meet that standard given disagreements between both the high level denominations (Orthodox, Catholic, Protestant) and the subdivisions within each.
jonahx 10mo ago
I am not saying this to be mean, because these feel like good faith questions. But they also sound like questions rooted in a purely logical view of the world, divorced of experience. That is, I don't believe it is possible that you've had real world experience with alcoholics, because if you had, it would be obvious why it doesn't work the way you are asking about. Some addictions are just too powerful. It is not a matter of having failed to treat the root cause. It's a matter of acknowledging that, for some people, the only solution to alcohol is not to consume any. It doesn't mean they don't also try to treat and understand deeper emotional reasons for their drinking.
- magicalhippo 10mo ago
  There's lots of research that points to that the brain after addiction just isn't the same as before addiction[1][2]. So while there might have been a root cause before, the effects of addiction is still present even if the root cause isn't an issue anymore. [1]: https://med.stanford.edu/news/insights/2025/08/addiction-science-human-brain-ancient-wiring.html https://med.stanford.edu/news/insights/2025/08/addiction-sci... [2]: https://www.rockefeller.edu/news/35742-newly-discovered-brain-pathway-sheds-light-on-addiction/ https://www.rockefeller.edu/news/35742-newly-discovered-brai...
chiefalchemist 10mo ago
I recently exited an LTR with someone who was in The Program and 6 - 9 yrs sober. The daily meetings routine was certainly help but, to your point, it never addressed the root problem. Tho to be fair, I’m not sure AA was designed for that as the spectrum of underlying problems is many. In short, my key takeaway (as an outsider) is that with AA it’s helpful to get people sober and there’s value and comfort in that. Unfortunately that comfort has diminishing return. People (e.g., my ex) put in the time (in a comfortable sorta way), but then don’t put in the work (read: progress to address the root problem). Finally, as an unrelated / random side note, my theory is that if you evaluated late in life alcoholics (read: 30 yo and up) most would test positive for NPD. In the hands of someone suffering from NPD, alcoholism is one hell of a weapon (e.g., manipulation, avoid accountability, etc). Also, within the context of The Program you will never be encouraged to seek help for your NPD.
- fn-mote 10mo ago
  > test positive for NPD NPD = Narcissistic Personality Disorder ? >> overblown levels of self-importance, arrogance, and selfishness, as well as a lack of empathy for others. Googled the term, but couldn't exactly see the connection. Fortunately, I currently only interact with a few people I consider alcoholics. AA definitely addressed the lack of empathy, at least.
  - chiefalchemist 10mo ago
    Look deeper. There are two types of NPD. You found the typical / cliche version. Either way, NPD is ultimately a defense mechanism, which leads to a control mechanism. If you suffer from NPD then “alcoholic” is a great cover and a great weapon. In fact, “alcoholism” is known to correlate with those with NPD.
celeries 10mo ago
If you've ever tried to stop doing something, going 90% of the way (e.g "I'll drink one soda per week") is often much harder than quitting entirely. This is particularly true with addiction where neural pathways need to be changed.
samsolomon 10mo ago
12-step programs do treat the underlying illness—fear, resentment and negative coping mechanisms for dealing with those things. That’s why basically all 12-step and addiction-recovery programs are the same. Life is hard. People fall back on bad habits and many won’t even realize that it’s happening until it their life is in ruins. If that has happened to you there are often no more second chances. So for some they may be able to recover and have a drink every now and then. However, if your life has become upside down enough to enter a 12-step program, it’s often because there were no other options.
colechristensen 10mo ago
>The thing that has always bothered me about the 12-step program is that the end goal seems to always be abstinence, at least in the context of alcoholism. It seems very strange to me that we treat the symptom, here, not the underlying disease. Abstaining from alcohol certainly does have positive affects on the life of an alcoholic, but the abuse of alcohol is a symptom, not the root issue. For some people the root problem is simply that their biological reward/motivation system with regards to a substance is just too much. If they drink they can't stop drinking and there's no deeper issue to solve and no cure besides abstinence. Very few people can get high on heroin or meth and not have it be a permanent problem. When you do it you get addicted and when you get addicted there's no deeper problem than using the substance and needing to stop. The only advice for people is to never touch these things. Different people have different reactions to different substances. For many, they just need to never do things and that's that. Alcohol is a "never touch" substance for some people.
- fragmede 10mo ago
  > Very few people can get high on heroin or meth and not have it be a permanent problem. Why do you think that's true?
  - colechristensen 10mo ago
    >Why do you think that's true? Medical literature and talking with people who have done these things and knowing about their usage afterwards. Particularly people who have done lots of different drugs and isolate a few things as just different. One of the disservices done to young people being taught about drugs is the misrepresentation of the addictive quality of various drugs and lumping everything together.
  - port11 10mo ago
    Sibling comment explains it well enough, but from my own experience: you don’t mess with a few, select drugs. You just don’t. There’s potent synthetics that you can rid yourself of despite their addictive nature. But I don’t know anyone that wasn’t messed up by CM. Honestly, there’s a few drugs you simply shouldn’t bundle with the rest, they’re not even drugs anymore, but pure brain hijacking material.
BurningFrog 10mo ago
> the abuse of alcohol is a symptom, not the root issue You say that as if it's obviously true. Not even a hint at an argument for it. Nor a mention of what you consider the actual root issue.
PaulDavisThe1st 10mo ago
I've read articles that suggest that the GLP-1 (Ozempic et al.) drug class tends to drastically diminish addictive desire. The problem is that is reduces all desire (including that for food), which can be a bit of an issue. I would imagine that if there was a drug that removed the addictive desire for alcohol (and/or some other drugs, perhaps), all of us would know its name. We certainly have drugs that can almost immediately terminate the effect of, for example, opiates, but that has nothing to do with ending addiction to them.
- kelipso 10mo ago
  Naltrexone reduces cravings by blocking the reward effect of drugs. Pretty well known I think.
  - Rendello 10mo ago
    There's also disulfiram (branded as Antabuse), which impedes your body's ability to fully break down alcohol. If you drink, you basically get an instant and devastating hangover (which can even kill you). Apparently it's proscribed in conjunction with naltrexone. https://en.wikipedia.org/wiki/Disulfiram https://en.wikipedia.org/wiki/Disulfiram I learned about it on Reddit while clicking the (now removed) "random subreddit" button. I believe it was this subreddit: https://old.reddit.com/r/Alcoholism_Medication/ https://old.reddit.com/r/Alcoholism_Medication/
jalapenos 10mo ago
I think there are treatments too though. I think there's some drug that can be prescribed that blunts the pleasure of it for those predisposed.

by kelnos 10mo ago

hahahahhaah 10mo ago

I think Naltrexone can help.

emmelaich 10mo ago
Katy Herzog has written a book about her successful experience: https://www.drinkyourwaysober.com/ https://www.drinkyourwaysober.com/

rayiner 10mo ago

> The thing that has always bothered me about the 12-step program is that the end goal seems to always be abstinence, at least in the context of alcoholism. This is where religion reflects cultural technology that gets lost in the secular translation. Secularists vastly overestimate man’s control over himself and his world. Most people lack the impulse control to partake in their vices responsibly. That’s why most Americans are fat. We have a world surrounded by temptation—snacks available everywhere—and we tell people to partake responsibly but they can’t do that. Most people don’t have that same relationship with alcohol or cigarettes, but for the many people who do it’s unrealistic for them to think they can just drink responsibly.

PaulDavisThe1st 10mo ago
> Secularists vastly overestimate man’s control over himself and his world. I'd prefer if you didn't generalize here, especially since there is no "secularist bible" that lays out what "secularists" believe (or do not believe).
- ggggffggggg 10mo ago
  There’s no more a Christian bible in that sense — something that lays out what Christians believe. “X believes Y ” almost invariably just means “I think most X I’ve come across seem to believe something like Y”. Read it as such.
  - PaulDavisThe1st 10mo ago
    There's a book that describes what Christians believe about the life of Jesus Christ, and is used by most Christian priests to illustrate and reinforce their homilies and lessons to their lay folk. The same book is widely read by many denominations of Christians as a source of insight into the religious intent of Jesus Christ, even if the conclusions they draw from it may vary. There are also other books written by both lay authors and those with theological credentials that seek to describe what a "good" Christian should believe and do, though to be fair, none of them are universal across the Christian faith (*). No such work exists for "secularists". (*) though fair enough, even "The Bible" doesn't entirely meet that standard given disagreements between both the high level denominations (Orthodox, Catholic, Protestant) and the subdivisions within each.

jonahx 10mo ago

I am not saying this to be mean, because these feel like good faith questions. But they also sound like questions rooted in a purely logical view of the world, divorced of experience. That is, I don't believe it is possible that you've had real world experience with alcoholics, because if you had, it would be obvious why it doesn't work the way you are asking about. Some addictions are just too powerful. It is not a matter of having failed to treat the root cause. It's a matter of acknowledging that, for some people, the only solution to alcohol is not to consume any. It doesn't mean they don't also try to treat and understand deeper emotional reasons for their drinking.

magicalhippo 10mo ago
There's lots of research that points to that the brain after addiction just isn't the same as before addiction[1][2]. So while there might have been a root cause before, the effects of addiction is still present even if the root cause isn't an issue anymore. [1]: https://med.stanford.edu/news/insights/2025/08/addiction-science-human-brain-ancient-wiring.html https://med.stanford.edu/news/insights/2025/08/addiction-sci... [2]: https://www.rockefeller.edu/news/35742-newly-discovered-brain-pathway-sheds-light-on-addiction/ https://www.rockefeller.edu/news/35742-newly-discovered-brai...

chiefalchemist 10mo ago

I recently exited an LTR with someone who was in The Program and 6 - 9 yrs sober. The daily meetings routine was certainly help but, to your point, it never addressed the root problem. Tho to be fair, I’m not sure AA was designed for that as the spectrum of underlying problems is many. In short, my key takeaway (as an outsider) is that with AA it’s helpful to get people sober and there’s value and comfort in that. Unfortunately that comfort has diminishing return. People (e.g., my ex) put in the time (in a comfortable sorta way), but then don’t put in the work (read: progress to address the root problem). Finally, as an unrelated / random side note, my theory is that if you evaluated late in life alcoholics (read: 30 yo and up) most would test positive for NPD. In the hands of someone suffering from NPD, alcoholism is one hell of a weapon (e.g., manipulation, avoid accountability, etc). Also, within the context of The Program you will never be encouraged to seek help for your NPD.

fn-mote 10mo ago
> test positive for NPD NPD = Narcissistic Personality Disorder ? >> overblown levels of self-importance, arrogance, and selfishness, as well as a lack of empathy for others. Googled the term, but couldn't exactly see the connection. Fortunately, I currently only interact with a few people I consider alcoholics. AA definitely addressed the lack of empathy, at least.
- chiefalchemist 10mo ago
  Look deeper. There are two types of NPD. You found the typical / cliche version. Either way, NPD is ultimately a defense mechanism, which leads to a control mechanism. If you suffer from NPD then “alcoholic” is a great cover and a great weapon. In fact, “alcoholism” is known to correlate with those with NPD.

celeries 10mo ago

If you've ever tried to stop doing something, going 90% of the way (e.g "I'll drink one soda per week") is often much harder than quitting entirely. This is particularly true with addiction where neural pathways need to be changed.

samsolomon 10mo ago

12-step programs do treat the underlying illness—fear, resentment and negative coping mechanisms for dealing with those things. That’s why basically all 12-step and addiction-recovery programs are the same. Life is hard. People fall back on bad habits and many won’t even realize that it’s happening until it their life is in ruins. If that has happened to you there are often no more second chances. So for some they may be able to recover and have a drink every now and then. However, if your life has become upside down enough to enter a 12-step program, it’s often because there were no other options.

colechristensen 10mo ago

>The thing that has always bothered me about the 12-step program is that the end goal seems to always be abstinence, at least in the context of alcoholism. It seems very strange to me that we treat the symptom, here, not the underlying disease. Abstaining from alcohol certainly does have positive affects on the life of an alcoholic, but the abuse of alcohol is a symptom, not the root issue. For some people the root problem is simply that their biological reward/motivation system with regards to a substance is just too much. If they drink they can't stop drinking and there's no deeper issue to solve and no cure besides abstinence. Very few people can get high on heroin or meth and not have it be a permanent problem. When you do it you get addicted and when you get addicted there's no deeper problem than using the substance and needing to stop. The only advice for people is to never touch these things. Different people have different reactions to different substances. For many, they just need to never do things and that's that. Alcohol is a "never touch" substance for some people.

fragmede 10mo ago
> Very few people can get high on heroin or meth and not have it be a permanent problem. Why do you think that's true?
- colechristensen 10mo ago
  >Why do you think that's true? Medical literature and talking with people who have done these things and knowing about their usage afterwards. Particularly people who have done lots of different drugs and isolate a few things as just different. One of the disservices done to young people being taught about drugs is the misrepresentation of the addictive quality of various drugs and lumping everything together.
- port11 10mo ago
  Sibling comment explains it well enough, but from my own experience: you don’t mess with a few, select drugs. You just don’t. There’s potent synthetics that you can rid yourself of despite their addictive nature. But I don’t know anyone that wasn’t messed up by CM. Honestly, there’s a few drugs you simply shouldn’t bundle with the rest, they’re not even drugs anymore, but pure brain hijacking material.

BurningFrog 10mo ago

> the abuse of alcohol is a symptom, not the root issue You say that as if it's obviously true. Not even a hint at an argument for it. Nor a mention of what you consider the actual root issue.

PaulDavisThe1st 10mo ago

I've read articles that suggest that the GLP-1 (Ozempic et al.) drug class tends to drastically diminish addictive desire. The problem is that is reduces all desire (including that for food), which can be a bit of an issue. I would imagine that if there was a drug that removed the addictive desire for alcohol (and/or some other drugs, perhaps), all of us would know its name. We certainly have drugs that can almost immediately terminate the effect of, for example, opiates, but that has nothing to do with ending addiction to them.

kelipso 10mo ago
Naltrexone reduces cravings by blocking the reward effect of drugs. Pretty well known I think.
- Rendello 10mo ago
  There's also disulfiram (branded as Antabuse), which impedes your body's ability to fully break down alcohol. If you drink, you basically get an instant and devastating hangover (which can even kill you). Apparently it's proscribed in conjunction with naltrexone. https://en.wikipedia.org/wiki/Disulfiram https://en.wikipedia.org/wiki/Disulfiram I learned about it on Reddit while clicking the (now removed) "random subreddit" button. I believe it was this subreddit: https://old.reddit.com/r/Alcoholism_Medication/ https://old.reddit.com/r/Alcoholism_Medication/

jalapenos 10mo ago

I think there are treatments too though. I think there's some drug that can be prescribed that blunts the pleasure of it for those predisposed.