Ever found yourself saying “I hate AA”?
Alcoholics Anonymous is the world’s largest alcohol addiction recovery support group, with more than 115,000 chapters worldwide. Many people have credited the group for saving their lives and it’s even endorsed by the National Institute of Drug Abuse (NIDA) as an accepted evidence-based behavioral therapy.
On the other hand, there are doubters, critics, and even addiction experts who believe the AA program shouldn’t be considered a viable therapy. Despite the AA’s obvious success, why do so many people find themselves loathing AA meetings? To answer that, let’s start with a bit of history.
Alcoholics Anonymous’s Higher Power
In addition to the clinical naysayers mentioned above, there is a significant number who question the very fundamental belief behind the “12 Steps” program – both the concept of a spiritual “Higher Power” that oversees everything and even more so, the actual use of the word “God” in the organization’s fabled “Big Book.”
The Religious Roots of AA
History has shown that the founding members of AA were closely related to a Christian evangelical group during the 1930s, known as the “Oxford Group.” Bill, our NYC stockbroker, attended their meetings in an attempt to beat his alcohol addiction.
The historic meeting between Bill, in recovery from his alcoholism, who firmly believed that alcoholism was a disease, and Bob, still actively drinking, and a medical man who’d never thought of his addiction as a medical condition – led immediately to the beginning of Bob’s own recovery from his alcoholism…
As the story goes, Bob “found himself face to face with a fellow sufferer who had made good. Bill emphasized that alcoholism was a malady of mind, emotions, and body. This all-important fact he had learned from Dr. William D. Silkworth of Towns Hospital in New York, where Bill had often been a patient. Though a physician, Dr. Bob had not known alcoholism to be a disease.”
AA as a concept, where recovering alcoholics directly help other alcoholics who are struggling with their own recovery, was born.
The program of the Oxford Group did involve a belief in God, as well as other tenets that were to become part of the later 12-Step program, eg. to make amends and to openly admit personal faults.
However, the Christian concept of God was deliberately replaced (but not fully) by AA’s founders with the focus centered on a “higher power” – admittedly done in the hope it would be found more acceptable to more people. Regardless, the phrase is often seen as highly ambiguous.
Higher Power in the 21st Century
This ambiguity of the phrase “higher power” has clearly lasted as long as AA has done. Nowadays, many active alcoholics, who, despite their families and loved ones begging and pleading with them to find help for their drinking, will often refuse to attend a no-obligation, totally anonymous, free AA meeting, citing the simple two-word phrase – “Higher Power” – as their valid reason:
- “It won’t work – I don’t believe in God.”
- “I don’t go to church, so why should I go to an AA meeting?”
- “Simple. I’m an atheist.”
For many, it’s a real stumbling block.
In response to this, there is an entire chapter in the Big Book, entitled “We Agnostics,” which does attempt to encourage those who are not religious that they can still, in fact, work the 12-Step program. The reason being?
There is no obligation to accept the theist idea of a higher power at all. People are free to view their “higher power” as anything they choose it to be – the power of community, a natural force, whatever. The only actual “requirement” is that they believe that this power is greater than they are.
Unsurprisingly, many people still have a problem, even with a simple statement like this. However, Alcoholics Anonymous has traditionally made it clear that their only real requirement for membership and meeting attendance is the desire to stop drinking.
Higher Power, God “as you perceive Him to be” & The 12 Steps
The phrase does, indeed, imply a belief in some type of “unseen, all-powerful being” or a kind of “supernatural agent.” In reality, the members of AA themselves interpret the term as they see fit. It would be fairer to say, then, that AA is not a religious movement, but a spiritual one, and members do include people of varying religious belief systems, as well as atheists, too.
However, the fact remains. The ambiguity of the phrase “higher power,” seen as a decided benefit back in 1935, has actually proved to be a distinct disadvantage in some respects, too. Of course, it’s not helped by the fact that the word “God” is even directly used in the 12 Steps…
6 out of 12 of the steps that comprise the fundamental teachings of AA’s program use the word “God” or the phrase “higher power.” There’s certainly no ambiguity about that. The terms are also used interchangeably, as you can see here:
- Step 2: We came to believe that a Power greater than ourselves could restore us to sanity.
- Step 3: We made a decision to turn our will and our lives over to the care of God as we understood Him.
- Step 5: We admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
- Step 6: We were entirely ready to have God remove all these defects of character.
- Step 7: We humbly asked Him to remove our shortcomings.
- Step 11: We sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
Unfortunately, for many people who actually do believe in a Christian God, or have no issue with the concept of a “higher power,“ and although AA might seem like the perfect fit to pull them from the grasp of alcoholism, they are often left deeply disappointed as it may not be the level of treatment they truly need.
Alcoholics Anonymous: Our Way or The Highway
In the view of many recovered alcoholics who have previously used AA as part of their treatment, or who have relied on it as their path to recovery success, the 12-Step fellowship is often touted as “the one path to sobriety.”
With far more than an estimated 2 million members worldwide, it’s easy to see how the organization could view itself, its philosophy, and its “success.” However, this 12-Step approach to alcohol rehab doesn’t have the internal structure (or even an acknowledgment) to consider and value the unique situations of its many members.
AA & Dual Diagnosis
The clearest example of this is the estimated 50-70% of those people who suffer from dual diagnosis, also known as a co-occurring disorder, where their alcohol use disorder (AUD) is comorbid with a mental health disorder, like depression, anxiety, PTSD, or bipolar disorder.
AA is certainly not staffed with mental health professionals at every meeting, and their firm belief that prescription drugs can harm recovery chances will actually cause harm to those individuals where these medications could make a positive difference to their mental health. Even with AA, if a member suffers from a mental health disorder and doesn’t independently seek counseling or medication, they run a much greater risk of staying dependent on alcohol.
Furthermore, the judicial system in the U.S. is still highly dependent on AA. In many state courts, those convicted of a DUI or another drug or alcohol-related crime can be forced to attend AA meetings. It is estimated that 1 in 8 people attending their local AA meeting is there solely at the direction of the U.S. legal courts.
It’s vitally important for those struggling with alcohol or drug addiction to realize there is absolutely more than one path to sobriety – especially if an individual has concerns about their own mental health.
AA: The Positive & Proven Aspects of The 12-Step Program
To balance the books, as it were, it is only right and fair to look at the positive and proven aspects of Alcoholics Anonymous as an evidence-based substance addiction treatment, formally acknowledged by the NIDA, among other federal addiction treatment agencies. In fact, maybe we should retitle this section to read:
“Why Do Some People Love AA’s 12-Step & Higher Power Approach?”
Proven Cost-Effective, Evidence-Based Addiction Treatment
Regardless of what the addiction experts and clinical naysayers say about the efficacy of the 12-Step approach, it does work – and that can now be stated with a strong degree of clinical, medical, and analytical certainty.
The professionally peer-reviewed proof comes from an ongoing review study, “Alcoholics Anonymous & Other 12-Step Programs for Alcohol Use Disorder,” which is continuously being conducted through the esteemed Cochrane Library’s program of systematic clinical reviews, now considered the gold standard in scientific rigor for medical research.
This particular report, produced in 2020 by the Recovery Research Institute, a leading nonprofit research institute of Massachusetts General Hospital, and an affiliate of Harvard Medical School, represents the most comprehensive and up-to-date review and analysis of the medical research community’s current and historical scientific literature on the effectiveness of Alcoholics Anonymous.
The most important finding from this ongoing study is a simple one:
Active involvement in AA’s 12-Step program is as good as any other form of addiction treatment.
Based upon the clinical results of 27 peer-reviewed studies, representing over 10,000 participants, and in the first analysis of its kind, active involvement in the AA’s 12-Step program (including the use of TSF therapy as used by Modern Recovery and described previously) performed as well as first-line clinical interventions at the end of treatment for keeping people abstinent from alcohol – and, therefore, sober.
Furthermore, in the majority of these 27 studies, which went through rigorous selection criteria for inclusion, an individual’s full participation in AA and TSF even performed better over timed follow-ups – specifically at 6, 12, 24, and 36 monthly intervals – after the end of first-line clinical treatment for ensuring sobriety.
Furthermore, in addition to the overall effectiveness of AA/TSF as an addiction treatment in its own right, the Recovery Research Institute researchers also assessed the different costs of the 12-Step program and traditionally recognized therapies, like cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET).
Here’s what they found:
In a 3-year follow-up study of individuals with severe AUD, the researchers found that AA participants had alcohol-related outcomes comparable to outpatients receiving clinical addiction treatment, yet their alcohol-related healthcare costs associated with AA participation were significantly lower – 45% lower, in fact, representing a cost-saving of $2,856 per participant.
Can the “Higher Power” Aspect of AA Be a Positive to Non-Believers?
Believing 100% in an all-powerful, all-seeing God can literally be a leap of faith too great for many people. However, to believe in the concept that there is something else that guides our lives and has a bearing on our futures rather than only ourselves… Well, that may be a lot easier for some to accept.
Simply acknowledging this as a scientific possibility may make you see AA’s “higher power” in a different light. It’s also true that when people believe in a power far greater than themselves – whatever that may be; for example, fate, Karma, the universe, and so on, it can make a life of recovery and in recovery far easier too.
- People who are attempting to recover from addiction can feel completely overwhelmed by their past. The acceptance of a higher power makes it easier to forgive other people and let go of long-held resentments.
- One tenet of the AA fellowship is that if the power of addiction becomes too great, too much to handle, the person can hand it over to their higher power, providing the sense of a weight being lifted off their shoulders.
- In AA, you are encouraged to learn how to let go and accept a new way of life, specifically in the belief that if you do the right things, then the right things will keep on happening for you in return.
- Belief in a higher power can provide a sense of purpose in their life, and a valuable sense of spirituality, which can strengthen recovery and reduce the possible risk of relapse.
- Drug addicts and alcoholics tend to be utterly self-absorbed; however, a sense of spirituality can combat this.
- Alcoholics Anonymous homepage. June 2021. Available at AA.org.
- National Institute of Drug Abuse (NIDA): Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) – “Evidence-Based Approaches to Drug Addiction Treatment.” January 2018. Available at DrugAbuse.gov.
- Alcoholics Anonymous: 2014 Membership Survey. 2014. Available at AA.org.
- National Institute of Drug Abuse (NIDA): Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) – “12-Step Facilitation Therapy (Alcohol, Stimulants, Opiates).” January 2018. Available at DrugAbuse.gov.
- Springer Link: “Comorbidity Between Psychiatric Diseases and Alcohol Use Disorders: Impact of Adolescent Alcohol Consumption.” September 2015. Available at Link.Springer.com.
- Cochrane Library: “Alcoholics Anonymous & Other 12-Step Programs for Alcohol Use Disorder.” March 2020. Available at CochraneLibrary.com.
- Recovery Research Institute homepage. 2021. Available at RecoveryAnswers.org/.
U.S. National Library of Medicine: “Reduced Substance Abuse-Related Health Care Costs among Voluntary Participants in Alcoholics Anonymous.” July 1996. Available at NLM.NIH.gov.