The Ineffectiveness of Alcoholics Anonymous: Unconstitutional Treatment

 

Originally published in 2010 on Associated Content, this article was the first of many attacking AA as a cult religion.  This article also touched off huge debate and I believe is important in that it highlights how religion can infiltrate medicine, law, and public organizations. Thanks for reading please enjoy. 

Van Noir

 

     Alcoholics Anonymous (AA) is the largest self help organization in the world.  AA provides free support for individuals recovering from alcoholism.  AA methodology is used in 97% of all treatment facilities for the treatment of substance abuse. AA is routinely court mandated for drug and alcohol offenders. But in contrast to the widespread use and popularly held belief that AA is an effective program, there is an abundance of research that shows that AA is a complete failure (Peele, 2001).

     Research has shown that AA has a 95% failure rate.  Studies have shown that in many instances no treatment would have been preferable to the AA program. AA has shown through its own research that the program raises the death rate amongst group participants by 3% (Vaillant, 1995).

     As well as having no benefit in reducing alcoholism, courts have determined that AA is a religious organization.  Because AA is a religious organization courts cannot force offenders to participate in the AA program.  Courts that coerce AA participation are in violation of the first amendment, which guarantees freedom of religion.   

     AA can be viewed as useless, dangerous, and often illegal. There exists very little evidence to support continued use of AA by the judiciary system.  For these reasons, AA participation should not be court mandated because it is counterproductive to achieving sobriety, harmful to participants, and a violation of a person’s freedom to choose religion.

     When courts sentence individuals to AA, the mandate is intended to provide aid for a substance abuse problem.  The common belief in the judiciary system is that AA is an effective means for helping people achieve abstinence from alcohol or drugs.  To the contrary the failure rate of AA is somewhere between 95% and 100%.

     Many studies have been performed to study the efficacy of the AA program, but many of these studies have been flawed.  In fact in the case of almost every study of AA, in which AA was found to be effective, the study either lacked a control group, or the data was interpreted incorrectly.  For instance, in the study “The impact of self-help group attendance on relapse rates after alcohol detoxification in a controlled study”; the researchers compare rates of relapse amongst alcoholics who used AA as aftercare and alcoholics who did not use AA.  At the end of one year the study showed that there was no difference between rates of relapse between these groups of alcoholics (Mueller, et al, 2007).

     The researchers interpreted the lack of difference between rates of relapse as somehow being significant of AA being effective. The researchers argue that because AA did not increase relapse rates then AA treatment is useful.  Their logic is skewed, what should have been concluded from this study is that AA did nothing to curb relapse rates (Mueller, et al, 2007).

     Another example of this type of misinterpretation of data can be seen in the study, “The long-term course of treated alcoholism: Mortality, relapse, and remission rates and comparisons with community controls.” In this study researchers found that AA was effective at creating better 16 year outcomes than individuals who had no AA treatment (Finney, J. Moos, R., 1991).

     These results would be compelling evidence to support the effectiveness of AA, but there is a flaw in the way the study was conducted.  The AA-treatment that was used in this study was not actual AA participation but was instead one-on-one sessions between a doctor and a client (Finney, J. et al, 1991).  During these sessions the doctor employed the use of 12 step methods as treatment.  This form of treatment is not representative of true AA meetings in which there is no clinical supervision and no one-on-one therapy.

     Beyond faulty data and misinterpretation, there are studies that definitively exhibit the inefficacy of the AA program.  The most compelling of these studies was undertaken by Professor George Vaillant.  Professor Vaillant is the Director of Research for the Department of Psychiatry at Harvard Medical School.  Professor Vaillant also sits on the board of AA World Services.

     In an effort to prove that AA was effective, Professor Vaillant proved that AA was a complete failure. After an eight year study of AA, Professor Vaillant candidly admits that AA is ineffective at treating alcoholism.  “Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling (Vaillant, 1995).” Worse than not being effective, AA also raised the mortality rate amongst alcoholics by 3%.

Each year that passes the number of alcoholics that recover diminishes with the size of the original alcoholic population.  This is just a simple method of viewing the natural history of alcoholism and does not take into account the death rate of alcoholics. 

     What Vaillant is stating in the preceding quote is important to understanding the rate of failure in AA.  When he speaks of the natural history of alcoholism, he is referring to what would have happened had the alcoholics not been treated.  The natural history of alcoholism is very significant because what most people do not realize is that 50% of alcoholics will recover on their own without any form of intervention at a rate of about 5% per year.  This is 5% of the remaining sum after subtracting the prior year’s 5%.

First year-100 alcoholics        

                  -5%

 

2nd year    95.   alcoholics 

 


                  -5%

3rd year    90.25 alcoholics

 

     Essentially, if AA treatment has a success rate of 5% per year then AA is doing nothing to curb the rate of alcoholism since alcoholics cure themselves at the same rate.  But beyond just doing nothing, AA increased the death rate amongst alcoholics by 3%.  This means that not only did AA not work but was detrimental to alcoholics.  

     These numbers albeit startling, do not represent the true failure of AA.  By AA’s own statistics most individuals leave AA very quickly and never return.   According to AA’s own results from five surveys completed from 1977 to 1989, AA yielded a 5% rate of attendance (Hodgins, 2009). The following charts show the percentages of people who stay and leave AA over the course of a year in accordance with these surveys.

As one can see, just after one month, 81% of those attending AA leave.  AA members will argue that those individuals who leave were not alcoholics to begin with.  But out of thousands of people, of which many are forced by courts to attend, it is difficult to believe that 81% of these individuals attended AA by accident. The attendance by accident theory seems illogical when one considers the fact that many of the individuals who are forced to attend AA are guilty of some form of substance abuse violation.  Their guilt provides evidence that these individuals may have a drinking or drug problem.

 

 

After three months there remain only 10% of the original attendees.  These are not just court ordered individuals these are also people who walked into AA unforced.  These are persons who may have been seeking help on their own for their drinking problems.

 

 

 

 

 

 

At the end of one year there are only 5% of the original attendees remaining.  According to AA’s own surveys, only 5% of all attendees remain for a year.  But there is a far worse side to these numbers.  This 5% only measures the number of attendees that stay in AA for one year.  The percentage does not distinguish between individuals who are sober and those who are still drinking. 

     When one applies the natural history of alcoholism rate, one is left with 5% of 5%.  This means that of all the people who attended AA, .25% benefitted from the program. If 1000 people go to AA for one year, only 2 to 3 persons will benefit from the program. But as stated previously AA has been shown to increase the death rate amongst alcoholics by 3%.  These charts do not factor in that percentage; if one factors in the 3% death rate, the effectiveness rate of .25% will become zero or less than zero percent.

     The ineffectiveness of AA is indisputable when one views these statistics.   Many proponents of AA argue that since AA is not harmful to individuals then there is no reason not to send people to AA (Vaillant, 1995).  But, this reasoning is not true since AA raises the death rate by three percent.

     Besides the three percent increased mortality there are other factors that show that AA participation may be harmful.  In a 20 year study of 4585 participants, researchers found that 80% of those who had received AA treatment were either sober or drinking normally.  The clients who had never received any treatment, 90% were either abstinent, or drinking non-problematically. The treatment group showed that exposure to AA caused higher rates of alcoholism after 20 years (Dawson, 1996).  

     In 1999 a study of Texas' correctional substance abuse treatment programs discovered that participation in AA meetings had no more effect on substance abusers than no treatment. In follow-ups to this study the rate of relapse was larger in the treatment group than in the non-treatment group. Researchers claimed that there might be some individuals who have a negative reaction to AA and this reaction causes relapses (Peele, 2001).

     There is much evidence to support that AA is harmful to participants.  But ineffectiveness and harmfulness notwithstanding, the main reason that AA should not be court enforced is because AA is a religion.  Because AA is a religion, court coerced participation is a violation of the first amendment.

     Bill Wilson, one of the founders of AA, at the Shrine Auditorium in Los Angeles announced, "Divine Aid was A.A.'s greatest asset. An alcoholic is a fellow who is 'trying to get his religion out of a bottle,' when what he really wants is unity within himself, unity with God. There is a definite religious element here (Hodgins, 2009).”

     AA continuously defines itself as a spiritual program not a religion.  But to the contrary legal decisions have constantly been upheld in which the verdict has been that AA is a religious body. In Grandberg v. Ashland County, a 1984 Federal 7th Circuit Court ruling concerning judicially-mandated A.A. attendance, Judge Shabaz stated, “Alcoholics Anonymous materials and the testimony of the witness established beyond a doubt that religious activities, as defined in constitutional law, were a part of the treatment program. The distinction between religion and spirituality is meaningless, and serves merely to confuse the issue (Hodgins, 2009).”

     In the case of Inouye v. Kemna, a parolee was violated for not wishing to attend AA meetings on the grounds that the meetings were a violation of his freedom of religion.  The court ruled that parolees could not be forced to attend AA meetings. Judge Marsha Berzon, writing for the court, stated, “While we in no way denigrate the fine work of AA/NA, attendance in their programs may not be coerced by the state (Mullins, 2007).”

     In Griffin v. Coughlin, a prisoner sued the state because his right to freedom of religion was violated when the prison tried to force him to attend AA meetings. Judge Levine ruled, "While it is of course true that the primary objective of A.A. is to enable its adherents to achieve sobriety, its doctrine unmistakably urges that the path to staying sober and to becoming happily and usefully whole is by wholeheartedly embracing traditional theistic beliefs (Conlon, 1997).”

     AA is a religious organization.  When somebody is requesting for someone to, “turn their will and life over to the care of God,” there is an implicit religious connotation.  AA simply uses the word God and Higher Power interchangeably.  Basically, AA is redefining their religion as a spiritual program (Wilson, 2001).  Regardless of how AA defines itself the law has judged AA to be a religious group and therefore unconstitutional to mandate attendance.

     There exists unfairness in the quality of care given to substance abusers.  The FDA would never approve a method of treatment that had less than 5% effectiveness at curing a particular ailment.  Yet in the case of substance abuse, thousands of individuals are routinely sent to AA for help.  For some of these individuals, being sent to AA will be a death sentence.

     Many supporters of AA argue that continued use of AA may at least be helping some of the people who attend.  This reasoning begs the obvious question, at what cost?   A rational person would not use a medicine that fails 95% of the time and increases their chance of dying. 

     The larger implication from continued AA use is that substance abusers are constantly being lied to and placed in harm’s way.  Doctors prescribe AA for substance abusers and unknowingly lie to their clients because they believe that AA is effective.   If these clients were diagnosed with any other illness and prescribed a treatment with the same rate of success as AA there would be massive malpractice lawsuits enacted.  Yet substance abusers have no recourse. 

     Substance abuse is a terrible problem.  An estimated 20 million Americans are substance abusers and many of these individuals are chronic addicts and alcoholics.  This number has steadily grown since the creation of AA, 80 years ago. There is very little hope of remedying this problem when the treatment being used is ineffective.  Perhaps if a different mode of therapy was used the number of chronic substance abusers would begin to decrease.



References 

Conlon, L,S (1997).Griffin v. Coughlin: mandated AA meetings and the establishment clause. Journal of Church & State, Vol. 39 , p427-428.

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     Research. Vol. 20, 773-790.

Finney, J. Moos, R. (1991).The long-term course of treated alcoholism: Mortality, relapse, and

     remission rates and comparisons with community controls. Journal of Studies on Alcohol. 52,

     44-54.

Galanter, M.  (2008). Spirituality, Evidence-Based Medicine, and Alcoholics Anonymous. The American Journal of Psychiatry. Vol. 165, 1514.

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     site: http://www.orange-papers.org/orange-spirrel.html

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     http://www.digitaljournal.com/article/229810/AA_Can_Not_Be_Forced_O...

Peele, S (2001).Drunk with power. Reason. Vol. 33, 34.

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