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Alcoholics Anonymous: Its Effectiveness, Its Cultural Assumptions, and a Problem (Part 1 of Series)

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May 11, 2013 by Dr. Bob Weathers

Alcoholics Anonymous:

Its Effectiveness, Its Cultural Assumptions, and a Problem

Part 1 of Series on

“Cross-Cultural Integration of Spiritual Resources in Recovery”

A.A.’s Effectiveness

There is an abundance of literature (from empirical research to anecdotal, clinicians’ accounts) to support the fact that Alcoholics Anonymous (A.A.) has saved and transformed the lives of countless alcoholics (Governors State University, 2000; Johnson, 2012; Kelly, Stout, Magill, Tonigan, & Pagana, 2011; Robinson, Krentzman, Webb, & Brower, 2011).  Over the course of nearly 75 years, A.A. has provided a clearly delineated, 12-step program of spiritually based recovery.  The focus has been on treating the compulsive behaviors associated with addiction to alcohol (which will be our focus here).  This same methodology, it should be noted, has been applied with equally impressive results to addictions to other drugs and also “process” or behavioral addictions.  The latter addictions include sex, gambling, work, compulsive buying, and food (Anonymous, 2005; Anonymous, 2009b; Johnson, 2012; Veach, Rogers, & Essic, 2012).

Cultural Assumptions

The founders of A.A. were not primarily concerned about how the 12 steps seemed to work.  Theirs was chiefly a pragmatic, not theoretical, focus.  Having said that: these same founders did at least initially attempt to address various mechanisms of healing in A.A.  In particular, the reader is recommended to review the A.A. volume entitled Twelve Steps and Twelve Traditions (Anonymous, 2005).

What become clear when one reads this core A.A. text are A.A.’s foundational assumptions about what heals the alcoholic. Included in such cultural assumptions is the A.A. movement’s historical and philosophical rootedness in a traditional Christian worldview.  There is surely nothing wrong about such cultural beliefs and language preferences.  They have obviously been of great service to so many individuals in search of recovery from alcoholism.  However, those same theistic, Christianity-based assertions about religious worldview have provided a not insignificant stumbling-block to many recovery-seeking alcoholics. Such individuals have found themselves less comfortable, or even familiar, with just such a profoundly theistic worldview (right down to God as a Him).  This cultural perspective is replete throughout the literature of A.A. (Johnson, 2012).

A Problem

It may be difficult to even detect this bias, insofar as we in America are all fairly immersed in Christianized language and culture from birth (Hillman, 1998).  Unfortunately, many seekers of healing have turned away from A.A., owing specifically to its particular cultural form of theism-laced language.  In addition, they have found difficulty connecting from their own cultural perspective to A.A.’s most commonly practiced rituals.  Such rituals include repeating traditional and overtly Christian prayers found in meetings every day (Johnson, 2012).

This author recalls his years working as the founding clinical director of a now highly successful and internationally recognized substance abuse rehabilitation facility in Malibu, California.  Many of that rehab’s client referrals came from other, nationally known rehabs.  Many of those clients’ most common complaints related to their previous rehab experiences having been too infused with 12-Step principles and practices.  Upon further inquiry, the complaint appeared to be about such clients’ feeling forced to believe in something in which they had never, or no longer, believed: namely, a personal God.

Unfortunately, it was not atypical for staff members, e.g., chemical dependency counselors, at this aforementioned Malibu rehab facility to confront such client complaints with some variation of: “That’s just your resistance to recovery speaking.”  In other words, genuine complaints about the religious stumbling blocks inherent to A.A. were often reduced to being nothing more than “smoke screens.”  The assumption was that such complaints were an expression of defensiveness, behind which clients were hiding from truly dealing with their addictions.  The course of inpatient treatment for these clients, predictably, did not often go well.

Next Up:

Evaluating A.A. for Its Capacities to Change and to Communicate

References

Anonymous (2005).  Twelve steps and twelve traditions (Electronic .pdf version).  Retrieved from http://www.aa.org/twelveandtwelve/

Anonymous (2009b). Alcoholics Anonymous (Kindle edition). Retrieved from http://www.amazon.com/Alcoholics-Press-ebook/dp/B002LLNN82

Governors State University. (Producer). (2000). Integrating therapy with 12-step programs [DVD]. Needham Heights, MA: Allyn & Bacon.

Hillman, J. (1998). American soul. Putnam, CT: Spring.

Johnson, A. L. (2012). 12-step facilitation of treatment. In Capuzzi, D., & Stauffer, M. (Eds.), Foundations of addictions counseling (2nd ed., pp. 240-259).  Upper Saddle River, New Jersey.

Kelly, J. F., Stout, R. L., Magill, M., Tonigan, J. S., & Pagana, M. E. (2011). Spirituality in recovery: A lagged meditational analysis of Alcoholics Anonymous’ principal theoretical mechanism of behavioral change. Alcoholism: Clinical and Experimental Research, 35(3), 454-463.  Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117904

Robinson, E. A. R., Krentzman, A. R., Webb, J. R., & Brower, K. J. (2011). Six-month changes in spirituality and religiousness in alcoholics predict drinking outcomes at nine months. Journal of Studies on Alcohol and Drugs, 72(4), 660-668. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125889

Veach, L. J., Rogers, J. L., & Essic, E. J. (2012). Process addictions. In Capuzzi, D., & Stauffer, M. (Eds.), Foundations of addictions counseling (2nd ed., pp. 41-54).  Upper Saddle River, NJ: Pearson.

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2 thoughts on “Alcoholics Anonymous: Its Effectiveness, Its Cultural Assumptions, and a Problem (Part 1 of Series)

  1. Joshua says:

    Baby, bathwater… I think it is undeniable that AA helps many people recover from addiction and regain control over their lives. That is not in question. However, I agree that AA also turns off many who they could help if AA was able to utilize a more “skillful” approach. Their aggressive, Christian doctrine is one size fits all. It surely alienates many people who might otherwise benefit from the program if it just had a little more agility, flexibility, and subtly built in.

    • Dear Joshua,

      Thank you for your thoughtful reply: very well-articulated and concisely so!

      I join you in being interested, very interested, in what you call “a more ‘skillful’ approach” within A.A.

      In fact, I had a rich conversation just this morning with a fellow A.A. member in which I asserted that I cannot feel morally OK simply ignoring the sizable number of A.A. attendees who drop out quickly (50% within 3 months!). Nor is it ethically defensible, to me, to then agree to reduce these individuals’ discontinuing to nothing but denial or resistance to recovery.

      Some percentage of that group, I am increasingly convinced, yearns for a different language, one more inclusive, or more “skillful,” to aid toward sobriety and healing.

      Sure, it’s possible to go elsewhere than A.A. But I’m not inclined to suggest that (for a number of reasons, which I am happy to discuss at another time).

      Why not, as I shared with my friend today, serve rather as a positive change agent within A.A.? The practical aim here is toward a broader (dare I say deeper?) embrace and inclusion of non-traditional (translate: non-Christian) spiritualities. The overall impetus is to be of service to A.A. as we move into the 21st century, where traditional solutions no longer are effective in communicating to younger, more educated, less traditional, and more pluralistic audiences of alcoholics and addicts?

      Thanks again, Joshua. I would love to hear your further thoughts (as well as those from others who share a similar interest).

      Bob

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