Wednesday, October 18, 2006

Alcoholics Anonymous (A. A.) and W.S.J.

Alternatively titled, This Doc Says Thumbs Up When it Comes to A.A.

I'm going to say it. I know it sounds hokey. But some of the best people I've ever met in therapy (patients of mine) have been people who got sober in Alcoholics Anonymous.

What makes someone "best?" And what's W.S.J. got to do with A.A.?

I think of people as "best" when they give back, work hard, think of others, delay gratification, know how to appreciate and use their own gifts, and know what it means to be grateful to be alive. I could add to the list, I guess, but those are starter goals for humans.

Okay, the W.S.J. is the Wall Street Journal. W.S.J. just published in defense of A.A., Alcoholics Anonymous, since A.A. supposedly needed defending. The scientific community has been hankering for the A.A. program to be evidence-based, meaning proven effective scientifically, preferably with double-blind social science experiments.

A.A. members can't participate in double-blind studies because they're in it for the anonymity. There are no lists of members. Oh, and they want to get better, probably, not play around as guinea pigs.

Why does the scientific community have to prove interventions such as A.A. to be evidence-based (or not)? Social science research justifies spending on interventions and programs.

But Alcoholics Anonymous actually costs NOTHING, as the article points out. Revenue from books and charitable contributions last year amounted to 13.2 million. Expenses were 12.9 million (according to W.S.J.) Not particularly a high roller business, you know?

The Journal also mentions that alcoholics who go to therapy and also go to A.A. have three times the abstinence rate of people who go to therapy and don't go to A.A. Way to go, W.S.J. Substantiates what I've thought all along.

That little experiment was possible because if you pay for inpatient treatment (or your insurance pays), then you can become a participant in a double-blind study, with consent, of course. But you are captive in a hospital, so maybe you don't care at the time consent forms are placed in front of you. Your anonymity in the hospital is protected, of course, but you can still be on a list of eligible subjects of study.

Although there are 53,000 different Alcoholics Anonymous support groups in the U.S., there are no lists of attendees to randomize controls for study.

The one thing A.A. has in it's favor, besides the price tag, is 71 years of cumulative coping strategies to pass on to its members. For free.

What kind of strategies?

Many of them are so sensible you wonder how they get to take the credit.

90 meetings in 90 days. Or you can go to three meetings a day for thirty days. Any combination of 90 meetings in 90 days is okay. You have to stay sober, I'm pretty sure, during this time frame. Then you get a coin, a token, and it's very meaningful. You also get one at the end of a year's sobriety. Probably there are others, too.

You have the option of getting a sponsor, someone you can call any time of day and night to scream the following: "I can't take it, blank it, I really want a drink," and your sponsor will say something like, "So where are you, wha'cha' doin', who's with you, let's meet at such and such a place. . ." or will stay on the phone and talk you down.

You make real friends. What's a real friend? A real friend is someone who loves you even though you're not drinking together. The friends of alcoholics are usually alcoholics. They sit and drink together, perhaps grouse and talk, watch sports or soaps, but mainly drink together. That's the bond.

A real friend hangs out, talks, lets you cry on his shoulder, stops you from drinking, suggests better coping strategies, steers you away from doing stupid things, steers you toward the things he/she knows will make you happy.

And the program has all kinds of little affirmations, little sayings that give people hope. I can't think of any just now, I'm not in the program, but occasionally someone will show me a calendar or a daily affirmation book, and they're cool.

Affirmations are life affirming. People who drink too much can get pretty depressed, which usually means their world view becomes the opposite of life affirming. They are also likely to suffer from anxiety disorders. A new study at the University of Illinois in Chicago(yay) found a gene that is missing in mice (well, one of two is missing, I think) that might be associated with the link between anxiety and alcoholism.

Members of A.A. believe it's a good idea to get in touch with a Higher Power daily, or to at the very least think about the meaning in your life, one's purpose, one's place in the world. It can be meditation, prayer, whatever, but a day shouldn't go by without some attention to things outside one's self, the ol' Higher Power bit. Agnostics and atheists have their own groups, of course.

People who go to A.A. start to feel like they're a part of a community, an international community of others with shared values. Values are a very big deal, and yes, they're primarily Judeo-Christian values about loving your fellow man, helping others, getting off the pity pot and diving head first into living.

The little sayings you see on bumper stickers? It works if you work it. One day at a time. Turn it Over. Let Go, Let God. They have thousands of these little sayings that are corny but meaningful and true.

I wrote a post on Turn it Over. Perhaps worth your time, Religious Nut or Not

The 12-Steps? Sometimes they work, sometimes they confuse and obfuscate the purpose of the program, make the immediate task seem so daunting and difficult that people give up on the whole shabbang when they get stuck.

But for millions of people, working the steps can be therapeutic.

I tell people not to get too hung up on steps. Do your best to work a program, to work on steps, but work the A.A. program because it offers much more than the way to Nirvana via a bunch of challenges (steps). The socialization alone is priceless.

Those who feel A.A. won't work for them usually think they can have a drink or two, and that's just fine if it's true.

SO MANY PEOPLE, HOWEVER, CAN NOT DRINK MODERATELY, THAT IT'S GENERALLY UNWISE FOR A PROFESSIONAL TO TELL PEOPLE, GO AHEAD AND BE A "CONTROLLED DRINKER." (controlled drinking is 2 drinks or less, assuming one doesn't get into trouble under the influence of those 2 drinks.)

I'll tell people to try controlled drinking, but to expect to fail. Alcoholics aren't alcoholics because they can control they're drinking. When they find they're still making asses out of themselves, they'll go to A.A.

All of the above, by the way, applies to addictions to other substances like cocaine, heroin, meth, marijuana, etc.

There are better ways to have fun than getting stoned.

IT'S THE COPING STUFF that makes A.A. work for people.

71 years of coping strategies.

I know it's not for everyone, but believe me, one thing A.A. doesn't need is social science to back it up.

Finally a spin from the media on therapy that makes sense.

Copyright 2006, TherapyDoc


Keesha Washington said...

Nice post!

Many Blessings, Coach K!

Anonymous said...

It is fun having your own liitle code. It drives my son nuts though!:)

twodogsblogging said...

Thanks, Linda! Good post that covers a lot about AA. The AA Traditions, which were revolutionary in their time, tell us that we have no opinion on outside issues so only members, not AA as a whole, can comment on this article. That's one of the great things about AA. We know when we're in over our heads and don't go there to avoid any controversy. AA isn't the solution for everyone; but for those who work it, it works.

Judith said...

I'm glad you put this in the Carnival. I was someone in therapy for a long time before I joined AA, and my recovery did not take off until I began spending time with others like me in AA. My therapist is awesome, but even he says that it can be easy to hide in the room with my therapist too. Like you say here, the connections made with others by itself is invaluable.

I still have a long way to go in recovery, but AA and therapy have done wonders for me. Great post in defense of AA - thanks!

therapydoc said...

Vicarious, thanks for the encouragement. Taking AA seriously is half-way there (although I haven't checked the stats, honestly, the anonymity thing makes them difficult to really validate!)

Anonymous said...

A note in response to "The 12-Steps? Sometimes they work, sometimes they confuse and obfuscate the purpose of the program, make the immediate task seem so daunting and difficult that people give up on the whole shabbang when they get stuck." - the 12 step ARE the PROGRAM OF RECOVERY. This, I feel, needed to be acknowledged. Sober and free for 10 years.

Anonymous said...

AA has 3 legacies - Unity, Recovery and Service. Unity is our first tradition...recovery - well, duh. Service - passing it on so others can recover.

therapydoc said...

Way to go, anon.

Anonymous said...

My favorite AA saying is "take what you like, and leave the rest." I find myself saying that in my head all the time. There are so many good ideas out there that are right for some, but not right for all. AA helped me give myself permission to do what is right for me without making someone else wrong and vice versa.

therapydoc said...

Then that's enough, I'm quite sure. That's a lot.

Anonymous said...

The "90/90" is a rehab thing, it's not from AA.
Sponsors are not to "talk you down from a drink", the people who use sponsors like that are generally people looking to be saved or want attention, who don't stay sober very long.
The ones who call their sponsors at reasonable hours and ask questions about they handled things & how it worked out for them, that's AA.
And in particular, a sponsor doesn't stop someone else from drinking. That's called co-dependency, and it's actually tabboo in AA to claim the power to get someone drunk or get someone sober.
The 12 steps don't confuse the program - they ARE the program. Alcoholics looking for an excuse to drink can screw up a 2 step process, so sure, they can sure confuse a 12 step program if they're determined. The people who somehow stay dry without actually following the AA philosophy, are generally the predators in AA who most wise members steer clear of, and pray that the newcomers get wise to them fast enough before they get taken for money or sex or just an emotionally wrenching ride. (When I say that, this includes some people who CLAIM to be following the program philosophy, but actually are not.)

therapydoc said...

ANON, thanks so much. Please comment often.

Anonymous said...

Thanks for your defense- I appreciate it. When I got sober in 1991, some of my friends thought the disease concept was a cop or, that AA was too religious. Read my defense at:

Anonymous said...

So, the choice is therapy and AA, or therapy and not AA? I believe you are missing a choice or two there. There are other methods and peer-support groups available, and not just AA.

In terms of efficacy, AA is one of the least effective methods available. (See: Hester and Miller). Oh, sorry. That was one of those evidence-based studies you don't much like.

therapydoc said...

It's never all or none on this blog. Sorry if you got that impression.

Anonymous said...

therapy doc- interesting article, and I don't doubt your experience with patients in therapy who are also in AA. But I think you have missed the point when you claim that AA is free. Sure, actual AA meetings are 'free,' or really, self-supporting. But there are gigantic sums of public money at stake in the form of government grants and subsidies to treatment centers and programs which rigidly advocate only 12-step recovery methods. If addiction is a disease, and medicine is a science, then of course the efficacy of 12-step methods should be scientifically tested.

therapydoc said...

Thanks Anon, i think the research says, It works if you work it; all depends upon your definition of work. It's VERY hard to work a successful program, but the reward, sobriety, priceless.