Sorry, Bill W. Your 12 Steps Need Revising

Image courtesy of 20th Century Fox
Image courtesy of 20th Century Fox

I’d like to kick off this post by talking about one of my favorite movies, Fight Club. I’m a big fan; I have a Tyler Durden leather jacket and I’ve read the book. I’ve gone on to read other books by the author of the book, Chuck Palahniuk. There’s a lot of decay in Fight Club, despite only a single fatality. We ultimately see the decay of the city’s financial district (which happened very rapidly), preceded by the decay of civilization among a population of men, which all began with a single man’s descent into madness. When he lost his ability to sleep, he went to various support groups to get a sort of cheap therapy. Along the way the narrator encounters a woman named Marla Singer, a drug-addicted loner. (I admit, it was never directly indicated that Marla was an addict, but just trust me on this one. This isn’t the science part.) Marla was someone who was hitting bottom, as told by Tyler Durden.

I believe the support groups in Fight Club were much like Alcoholics Anonymous, and, by extension, Narcotics Anonymous, and possibly every other Anonymous (perhaps even Anonymous themselves). We see groups of people who have lost everything (RIP Robert Paulson) and come together to help each other. The groups are moderated by others who have already had the experience of drug addiction, disease, etc. To hit bottom and then climb back up with the help of the group is heroic. It is noble.

Being part of AA is akin to brotherhood, sort of like serving in the Armed Forces. But it’s also highly spiritual; spirituality and some idea of God comprise almost all of AA’s treatment doctrines. You’ve likely heard of the Twelve Steps, and if you don’t know what they are, here you go:

  1. Admit to being powerless over alcohol and that your life has become unmanageable.
  2. Believe that a higher power (God) greater than yourself can restore you to sanity.
  3. Make a decision to turn your will and your life over to the care of God as you understand him.
  4. Take an objective and honest moral inventory of yourself.
  5. Admit to God, to yourself and to another person the exact nature of the things you’ve done wrong.
  6. Be entirely ready for God to remove your defects of character.
  7. Humbly ask God to remove your shortcomings.
  8. Make a list of the people you’ve done harm. Be willing to make amends to all of them.
  9. Make direct amends to those people whenever you can, except if it would harm them or others.
  10. Continue to take personal inventory; when you’re wrong, admit it promptly.
  11. Improve your conscious contact with God (as you understand him) through meditation and prayer for knowledge of God’s will and the power to carry it out.
  12. Give these steps to alcoholics and practice them in all your affairs.

The problem here is that there are no medical approaches in these steps. The steps cannot be refined through new research and evidence. While alcoholics can (and do) hurt people with their lifestyles, addiction is more than just some simple choice. It is a health problem, and health problems require actual medicine.

The conclusion reached through AA treatment is that you must forever abstain from drinking any alcohol. This may not be true for everyone.  The evidence regarding the success of AA is controversial; some studies conclude that it is successful overall, while others conclude that it brings no greater benefit than other types of interventions. If I can make a comparison here: if you were diagnosed with cancer, would you want such a controversial treatment to be your only option? Or would you want to see other options? What about moderation? What if totally abstaining just makes the craving worse until you go on a binge? This is the sort of thing you would face with shame in the AA community. (I’m sure that last point is arguable.)

For people who are not physically dependent on alcohol, moderation has been shown as an effective approach. This study says that the web-based protocols of Moderate Drinking and Moderation Management are effective for “problem drinkers,” or people who consume alcohol excessively while not physically addicted. The goal with moderation is to return to a lifestyle of light-to-moderate alcohol consumption, without the risk of dependency;  believe it or not, there are people for whom this works.

Surveys show that  60% of AA members who have abstained from alcohol for less than a year will either begin drinking again or stop participating (or both) in AA during the next year. Twenty percent of those who have lasted in the program for one to five years will stop participating in the program/begin drinking again/both. You can figure out the total failure rate based on your assumptions about the outcomes of those who left the program, but even conservative estimates regarding returning to alcohol call into question the effectiveness of AA’s program.

The point is, the twelve-step program does not work for everyone. It may not even work for the majority or a large minority. Obviously, someone who has entered Alcoholics Anonymous (or any kind of addiction treatment program) want help. They want to stop abusing alcohol. With millions of people with addiction problems in this country, we have to stop treating the recovery process as a test of character.

And don’t take my word for it. I hope you’ll check out the links below, or examine other sources. A little knowledge goes a long way!

Related Links:

2 thoughts on “Sorry, Bill W. Your 12 Steps Need Revising

  1. It works for some to keep fighting with abuse. I stopped wanting to drink when I finally got help for my depression and PTSD. That’s a problem with 12- step. It is a support group but leaves underlying problems unaddressed. I think it may be more useful when/if the underlying problems are managed. There’s a reason people drink to the point it’s a problem- it’s a form of self medication and numbing,


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