Friday, July 27, 2007

Can you spot the real national tragedy?

For most of the seven-plus decades since its founding in 1935, little in this country has been so mythologized as Alcoholics Anonymous and its special place in American society. Certainly during its first three decades, before other mainstream alternatives began appearing (and differentiating themselves by questioning AA's methods, albeit still with some delicacy), perhaps nothing in our culture was so untouchable, so off-limits as a topic for serious debate, as AA. This attitude is still largely intact, and I encountered it in spades during the 2005 media push for SHAM. Those of you who've read the book know that I was pretty hard on AA—as hard as I was on any single facet of the SHAMscape. As a result, in almost every phone-in show I did, and I did dozens, I received a call that began with some version of the following: "How dare you! All I know is, my [father, mother, brother, uncle, etc.] wouldn't be alive today, if it weren't for Alcoholics Anonymous...." Others simply called in to defend the organization on principle, even though they claimed no familial connection to AA or any related success story.

Several good reasons underlie such entrenched feelings. AA's intentions were always seen as honorable, especially during its first half-century. There are also the organization's strong religious underpinnings, which are bound to resonate in a faith-based nation like the U.S. (In the fabled 12 Steps to recovery, five of the first seven make some reference to God's central role in the process.) Plus, "treatment" is free. Ergo, the snarky, money-based accusations I make against other gurus and their regimens don't apply. And then, of course, you have all the anecdotal testimonials, like the ones I'd hear about when I did talk shows.

I do not doubt that AA has helped people. As I often reply when contentious interviewers ask, "Are you suggesting that self-help never helped anyone?", AA now has about 1.9 million members worldwide; it'd be hard not to help somebody, even just by accident. And if AA enables only a small percentage of those 2 million people to kick the sauce, that's still a fair number of lives affected.

But do we have any real idea how "fair" that "fair number" is? And is it enough?

That's what brings us—much belatedly—to the real topic of this post: a new study out* from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a branch of the National Institutes of Health. Among other things, the study quotes experts who peg AA's "success rate" at around 20 percent. That's actually not as dour a prognosis as I surmised in crunching the numbers, or trying to, while researching my book. (Because of AA's veil of secrecy, reliable data can be hard to find and authenticate.) But 20 percent is a long, long way from the 40 to 75 percent success rate AA has historically bandied about. And, of course, it's nowhere near the famous, blatantly misleading promise that some of the more aggressive AA chapters still use: "We will help 75 to 90 percent of those who are ready to embrace change." As I've pointed out on talk shows, that's like a surgeon telling you before an operation, "Don't worry, I cure 75 to 90 percent of the people who don't die on my table." Your first question is going to be, OK, but doc, what percentage of people die on your table??

The ambiguity and purposeful overstatement of AA's success rate** takes on added meaning when you consider the meta-analysis featured in the October 1995 Harvard Mental Health Letter (see SHAM page 143), which suggested that alcoholics have at least a 43 percent chance of kicking the habit by going cold turkey on their own. Sounds implausible? Think about it. First of all, AA's highly structured, claustrophobic, spiritually tinged format just doesn't work for some people; they drop out right off the bat. (Though the dropout rate, too, is controversial, and by its nature almost impossible to quantify, even AA admits it's high: that, for example, half of those who show up for their first meeting drop out within a month.) Also think about the overall climate of an AA meeting: a room full of people, self-admitted "failures" (see step 1 of the 12) who are constantly swapping horror stories about their slavish dependency on booze and the hold it has—will always have***—on their lives. Is it not possible that such a climate might reinforce and perpetuate that dependency, laying the groundwork for future "stumbles"?

There are further aspects of the NIAAA study, as recounted in the AP story (linked above), that will not only surprise you, but lend credence to several other against-the-grain ideas I broached in SHAM (and for which I also took a lot of heat during my media work). I won't cover them at length here because, 1, this post is quite long enough already, and 2, this is a complex subject where you're best served by using the AP story as a road map to your own independent investigation, should you be so inclined. However, the overarching point is this: So many of our suppositions about drinking and the very nature of addiction were based on...nothing. They were ideas that got pulled out of a hat by two men, a salesman and a proctologist, who couldn't find satisfying answers to the riddle of alcoholism, so they basically made up their own.

That was the genesis and "theoretical foundation" of the program that—for seven decades—has been America's first line of defense against a national catastrophe with a total economic impact of $185 billion a year****.

If my math is corect, that's about the same as the total economic impact of 9/11 and Hurricane Katrina. Combined.

* which, predictably, got very little media play, perhaps because the larger news outlets had to devote all that time and space to Lindsay Lohan's latest tumble from the wagon. Ironic, no?
** This is armchair sniping, but fairly well documented, and interesting reading nonetheless.
*** The notion of lifelong addiction is part and parcel of the AA liturgy. You're never "cured"; you just do your best to battle the malaise "one day at a time." There are eye-opening insights into this theory, too, in the NIAAA material.
**** See SHAM, pp. 224-229.
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A WORD ABOUT THE TITLE I CHOSE FOR THIS POST: I am using it "for effect," to be purposely provocative. I intend no offense to people who suffered losses of any kind on 9/11, which was, of course, a national tragedy of unspeakable dimensions. I would offer the same apology to victims of Hurricane Katrina.

14 comments:

Anonymous said...

i've read some outrageous things before on your blog, which i try to avoid, but this is a class by itself. i don't care how you try to twist things to make AA into a negative, to me it's a just another symptom of how you approach everything, tearing down the things that people put their faith in. kudos to you steve, for living up to the low standards you set for yourself. nothing with you surprises me anymore.

Steve Salerno said...

It's so nice to be loved and, especially, understood. Am I still on the radio...?

a/good/lysstener said...

This hits close to home, Steve. There are people I need to show this to. And then I'll get back to you. Or, hopefully, encourage them to.

Steve Salerno said...

I hope that you're successful in that effort, Alyssa...but tread carefully. You don't want to invite the backlash that typically has greeted me.

I will gladly read and respond to anything (civil) that anyone wishes to send me on this topic, either on-blog or off.

RevRon's Rants said...

I try to avoid your blog too, Steve. Every day. But I have to admit that I am powerless... Oh, never mind. If I really wanted to avoid your blog, I guess I'd manage. It's not like I have to pass through your place just to get to Google. :-)

I once went with a woman who went through the 12 steps... every 6 months. I left when I realized she'd never find that 13th step (And I don't mean the one where you hit on all the newbies, either!). Kind of an emotional "Groundhog Day."

Anonymous said...

You should check out the Agent Orange papers site. He thorougly debunks AA's stats, history, founders, everything. Very eye-opening.

Steve Salerno said...

Ron, it's bizarre how many people lately have been using variants of that construction--"emotional [fill in the blank]"--in comments and/or emails to me. Yesterday one of our regulars recounted his efforts to actually USE some of the methods I critique in SHAM to find his clients' "emotional G-spot," which I deemed a particularly good one (leaving aside my natural questions about the legitimacy of his strategy itself). Your Groundhog Day reference now joins that one at the top of the heap.

Steve Salerno said...

Anon, maybe I'm just a little tipsy, but I think I actually link to A. Orange's site in this very post, where I talk about the dubious "success rate."

Cosmic Connie said...

I relied on AA in my early non-drinking days. (Stop me if you've heard this before. And anyone who's been here a while probably has.) But AA helped me since I had no real "support" for my choice to stop being a drunk. All of my friends drank, some heavily, and most indulged in various illegal recreational substances as well.

I was turned off by a lot of the God talk in AA but I suspended disbelief and went along with it. I made a few friends who helped me. And at first I did try diligently to work "the steps." But I have a short attention span and I think I maybe got to the fifth or sixth step.

Early on, however, I think I did sort of a "twelfth step." Some folks who believed in doing AA by the book would have said it was too early. Be that as it may, I accompanied an AA old-timer on a "rescue" call, because she didn't have anyone else handy to call on. And it was an emergency. I went, and saw firsthand the sort of person I could have become if I'd kept drinking. I guess that helped me.

But there were numerous other factors in my life -- by far most of them positive -- that reinforced my decision to not drink. I went to AA fairly steadily for about five months, but nothing close to the "90 meetings in 90 days" that the fundamentalists recommended. I haven't been to an AA meeting in many years but I am still not drinking. AA gave me a push I needed, but in my short time there I saw just as many folks who were completely turned off and dropped out.

I'm glad AA is there because it is a tool that is useful to some. But it has many shortcomings. I think that addictive tendencies are rooted in biochemistry and genetics, and to a certain degree the "disease" model is helpful. But as you and others have pointed out on numerous occasions, Steve, the disease model is misused. One of the ways it is misused is the ongoing efforts by PR hacks to get the public -- and the legal system -- to cut some slack for the Hollywood stars and the athletes who "make poor choices."

Then these spoiled, overpaid jokers get to go to their expensive rehab places, whereas your average drunk who gets caught driving or whatever under the influence just gets to go to jail. What state-of-the-art treatments do the elite receive in those expensive rehab joints? Why, mostly AA, of course!

A few weeks later they're out drinking again and getting in more trouble.

Don't get me wrong; I generally think rehab is a better choice than jail. But repeat offenders pose a danger to society, no matter how cute and perky they are.

Steve, I think that your post "hit close to home" in more ways than that alluded to by Alyssa. It sounds as if your first Anon has a deep attachment to 12-step programs. I would never discourage anyone from utilizing a 12-step program like AA, but as I said, it's just one tool, and a flawed one at that. AA apologists would say it's people who are flawed -- it doesn't work if you don't "work it" -- but maybe the reason so many people don't "work it" is that it just doesn't "resonate" with them (sorry about the New-Agey term).

There's just gotta be a better solution for addiction.

Anonymous said...

I wish people would at least stop and think about some of the staunch beliefs they hold - whether it's about AA or anything else. Alcoholism has never been a personal struggle of mine, but over the years I've gone from believing that AA was pretty much the answer to the problem (and referring clients to it - I was a social worker) to doing a complete 180 and now thinking it's not just ineffective, but potentially harmful in some of the beliefs it fosters (you can't stop drinking on your own, for instance). I know it can be difficult to let go of something you've sworn by, but what's the harm in keeping an open mind and revisiting things from time to time? I don't understand the animosity with which some people receive opposing points of view.

In response to the first comment, about "tearing down the things people put their faith in": are all things we put our faith in inherently equal? If someone you cared about chose to put their faith in something you believed was harmful, wouldn't you want to say something?

Anonymous said...

Steve - Sam here:

You know my criticism is the lack of the c-word ("cult") in this post, which can be found all over The Orange Papers. I wish more thought would go into that aspect of things ("highly structured, claustrophobic, spiritually tinged format") as well as, specifically, what's going on in the heads of supporters of these ideas - like when the horror story truck driver described his wife's eyes-wide-shut reaction to the Course In Miracles.

Like in the recent story of the Scientology double-suicide, there's a serious denial factor - by the rest of us - to admit there are cultish forces at work on our society:

http://www.calendarlive.com/galleriesandmuseums/cl-et-blake25jul25,0,5067221.story?coll=la-home-center

Things, like Heaven's Gate, etc., don't just pop out of nowhere. We are currently awash in a sea of bad ideas and occult ("hidden") symbols, that very few seem to notice - except around the edges or in part - but those who have been touched directly. You, Steve, deal with SHAM, Connie deals with the "hustle", The Orange Papers deal with AA, James Randi deals with pseudo-science, etc. Very few, if any, are dealing with the idea that we're being, collectively, led down a "path" that's organized around attaining certain goals - which is exactly where my own "studies" have led me. I mean, why is Mr. Sexual Cigar - a politician - talking about bringing about a "higher level of conscienceness" and what's he "really" mean by that?

http://www.youtube.com/watch?v=GEjKr2gA8Wk

What? Is it The Harmonic Convergence time, again, kids?

I can't go into my thinking in depth, now, but we know - along with Hillary - Bill has been thoroughly worked-over by these gurus/motivational speakers/whack jobs/ "cult" people - he's been very open about that. And, we also know, he has been very busy (along with many organizations) setting an agenda - specifically, for the rest of us. But I would posit that it's not HIS agenda, but the secretive cultish types he's involved with, that's being carried out.

I gotta go.

Rev,

You provided the best laugh I had all day,...

Anonymous said...

Sam again:

The Orange Papers opens with a quote:

"There is a principle which is a bar against all information, which is proof against all arguments and which cannot fail to keep a man in everlasting ignorance -- that principle is contempt prior to investigation."

http://www.orange-papers.org/

This is exactly what I've been guilty of in my marriage - and what I've faced, constantly, since trying to understand, and relate information to others - regarding cults in society. I've discovered so much through, finally, investigating the beliefs and behavior of my french ex-wife (the self-proclaimed "student of the occult" and "Level III Reiki Master") but, until the damage was done, I never thought to ask (my wife or myself) where she was getting these crazy ideas from. I thought it was only individuals in San Francisco (her "friends") talking to her - that's all I saw - and believed I could handle their influence myself. The idea these various people were hooked up to world-wide occult groups just never occured to me. But, as new agers like to say, "They're all connected." How I started paying attention to cults and occult ("hidden") symbolism is worth telling:

During the AIDS hysteria, we felt we should do our part and - along with AIDS Walks, etc. - my ex became "friends" with a gay man who was sexually reckless and had an obnoxiously giggly maharishi-type personality. She also started working with him, at a hospice called "Maitri", which I drove her to regularly.

Looking for answers, after my divorce, I found Chris Locke's brilliant Mystic Bourgeoisie site, and started reading it obsessively. At this time, I still wasn't sure if I trusted Chris's cult information (we've since become pen pals, etc.) so I looked up his friend, Chögyam Trungpa - David Bowie's "crazy wisdom" guru - and discovered he was the promoter of "Maitri, a therapeutic program that works with different styles of neurosis":

http://mysticbourgeoisie.blogspot.com/

http://en.wikipedia.org/wiki/Chögyam_Trungpa

As we say in Hip-Hop: Boo-yah! "Maitri" is where my ex learned to do TT, Reiki, etc., without ever saying a word to me about the many bizarre rituals, etc., she had been participating in for years (I learned about those from reading her journals on the experience). Since then, I've wanted to know the basis for all the new age beliefs/words/symbols that are popular in society but are "behind the veil": in other words, have no meaning to the average American.

The Orange Papers has a chapter entitled "The Cult Test, and Alchoholics Anonymous as a Cult". For our purposes, let's say The Orange Papers are correct, and AA is a cult. That means (using Steve's numbers) American society, with the help of various state governments, has been assisting the growth of a cult, currently with 1.9 million world-wide members, since 1935. (And many, if not most, of those members are as vehement as the anonymous poster who wrote in to castigate Steve.) Couple that with all the other groups out there and you start to see the scope of the problem.

Therapeutic Touch, Reiki, and Pranic Healing, are in most of our better healthcare facilities - but without scientific support - and even though they have their underpinnings in the cultish (and mystical) Theosophy Society - an "occult" organization started by a con woman, Helena P. Blavatsky.

http://www.theosociety.org/

http://www.randi.org/encyclopedia/Blavatsky,%20Helena%20Petrovna.html

All of these nonsensical beliefs follow the same cult pattern: they have a leader or leaders (living or dead) vehement followers; a slogan or symbol; a belief that rebuffs reality and, of course, some way to make money. Look at Homeopathy:

Leader: Dr.Samuel Hahnemann

Followers: Melanie Hahnemann, Past and Present Practitioners.

Slogan or symbol: Similia Similibus Curentur, "like cures like", etc.

Belief: Dynamization - Potentization - "energy".

Money-making: Selling Medicines and Training for a fee.

Am I making sense, so far, to you guys?

Anonymous said...

Actually, referring to the one of AA's founders who was not a proctologist a salesman is putting it kindly - even in AA's Big Book, he mentions talking money from his wife's purse while she was working to support them.

There is no science to any of AAs claims - that there is a "real physical disease like diabetes or cancer" that causes some people to turn into some kind of helpless yet manipulative monsters when they imbibe alcohol, and that hanging around with a bunch of other people talking about how much one can't control one's behavior because of this "disease" actually causes any measureable change, or that this lack of control runs in families.

I also have a big problem with the way AA is sold to society: if your spouse, family member or employee likes to party and is obnoxious, they must be an alcoholic [or more recently an addict], and must attend AA to become a more palatable spouse/relative/employee. But if you read the Big Book, it's telling them that the meetings are more important than spouses, family or jobs.

I also suspect that Robert Blake was not convicted of murdering his wife because the defense managed to convince the jury that, since the two main witnesses against Blake weren't "in recovery" and were "in their addiction" during the times that Blake acquired the gun and was shopping for a hit man to kill the woman, that their reports of things that happened even during episodes when they were not under the influence of drugs had to be discounted. By that logic, we'd have to let the Manson murderers go, since the main witness against them did a lot of drugs and no AA.

Finally, I think that the idea of "intervention" and that it is the duty of people to pry into whether people they know use alcohol or drugs, and pressure them into treatment, has dangerous implications for a free society.. As does the idea that people can evade responsibility for their bad or criminal behavior by claiming that his disease has made them less than responsible for their own acts.

[sorry this is so long]

Steve Salerno said...

Length is never a problem when the comment is good.