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Concerning Problems Within AA

Mark Dombeck, Ph.D.

cocktail umbrella tilted on its sideIt's time for a follow-up on my AA is a Cult? Essay of about a year ago. Two reasons for this. First, Newsweek recently published a three page article profiling an AA group in the Washington DC area which has been accused of cult-like and abusive behavior. And of course, as AA is by design an open organization at the ground level, there are not really mechanisms in place to keep predatory sorts of folks from joining and then manipulating the organization. Some words on how to identify and avoid predatory behaviors and characteristics are perhaps in order. Second, because the comments on my original AA article keep on coming, and there are distinct patterns emerging therein which are worth commenting on.

The Newsweek article first. The article concerns meetings held at Midtown, which is represented as one of the oldest and largest meetings in the DC area. According to Newsweek, Midtown members pressured a recent attendee, a young woman named "May", to cut off ties with anyone outside the group, to stop taking doctor-prescribed medications for her bipolar disorder, and to date and become sexually involved with other group members. Apparently, newer group members were also pressured to do chores for more established group members, as though they were pledging for a fraternity. There are other accusations as well, but these listed here capture the tone of the complaints.

Some of these behaviors, such as encouraging members to go off prescribed medications, become sexually involved with other members, and do chores for other members seem simply abusive, controlling and arrogant. They are against established AA guidelines as I understand them. Other behaviors such as the group's efforts to socially isolate members may have started out with good intentions. Some social control can be a good thing when dealing with addictions. Addicts build up habit chains, which are series of linked behaviors that lead them down a path towards becoming intoxicated. For instance, seeing a friend with whom you used to drink can set off a chain of behaviors which culminates in you drinking again. The best way to cope with these sorts of habit chains is to avoid getting them triggered. It makes sense, therefore, for newly recovering alcoholics to avoid the people, places and things associated with their drinking habits which get the habit chains started. It similarly makes sense for an organization designed to promote sobriety to encourage newly sober members to avoid those triggering people, places and things as well. There is a line that can be crossed into abuse here as well. You can certainly attempt to control people too much. However, the bar is higher for calling this sort of social control abusive than for some of the other behaviors Midtown is accused of perpetrating.

A little more on the social control complaint. A frequent criticism of AA groups is that members are not allowed to grow out of AA. In the case of the Midtown group, a member alleges that when she tried to leave her sponsor told her that she would die without the group to support her. There may be some merit to this behavior too, despite its seemingly sinister bent. Alcoholics are typically psychologically vulnerable in early recovery. Their minds and behaviors have been compromised by those addictive habit chains I spoke of earlier. Their judgment is typically crappy by which I mean that they may believe that they can go out with their old drinking friends, go to the bar, etc. and not end up drinking. It is as though they believe they are immune to their entrenched habits if they want to be. People who are more experienced with overcoming negative habits know better and do what they can to avoid triggering their habits in the first place. Understood in this light, a sponsor getting angry with a sponsee who wants to leave what seems to be shelter for a return to old habits makes sense. It is a helpless feeling watching someone who seems determined to hurt themselves and will not listen to warnings.

To take the other side of this argument for a moment, I have long been troubled by the idea that AA doesn't seem to provide a clear path for maturing out of the group for those people who over time cease to require it anymore. Or if there is such a path, it is not widely discussed. I have seen people whose entire social lives revolve around AA decades after their initial involvement and last drink and I have to wonder (from my non-addicted point of view) if that is necessary or entirely healthy. I don't question that there are people out there who will continue to need the constant support of AA for the rest of their lives. I don't question that people who have become addicted will remain vulnerable for the rest of their lives. I also don't question that it is a good idea for addicted people to remain sober for the rest of their lives. Better safe than sorry is a good policy. However, I also know that there is a larger world than AA out there, and it seems like it would be a good idea for experienced and long-time-sober AA members to expand their social horizons outside AA, even as it is also a good idea to keep their connection to AA alive.

I've said this before and it bears repeating. AA is not necessarily the best available treatment for alcoholism, and it is certainly not the only one. I'm partial to the scientifically derived treatments myself. Relapse prevention and motivational interviewing approaches are what I'm most comfortable promoting. However, these sorts of interventions are administered by professionals and cost a lot of money to obtain. They cannot be frequently administered to large amounts of people, or at least people cannot typically afford them in any frequent format. Also these scientifically derived interventions don't do a very good job of providing available sober social support; a sort of support that is absolutely critical for early recovery to progress in most cases. AA provides frequently available social support and promotes sobriety every night and every morning and in many places at lunchtime too. AA is free. AA helps people who are open to its message. AA makes an excellent adjunctive treatment for those who can afford to take advantage of the scientifically derived therapies. It is what is available to those who cannot afford those therapies.

There is a baby in with the bathwater, is what I've been saying, and what many people who have commented on the AA essays have been saying too. There are really some treasures within AA if you can get to them. In order to get to them you have to find a good AA group in the first place (which is not guaranteed to be available to you, apparently (but what in life is?), and you also have to be open to the idea that your judgment is faulty; that you need to submit yourself to a "higher" judgment; the judgment of people who have struggled with alcoholism and learned how to live sober.

The thing is, even though an alcoholics' judgment is generally crappy, they still need to keep their wits about them. They still need to be making judgments about the motives of the people in the AA group they're attached to. They need to be satisfying themselves that they are in a group of people who are not trying to take advantage of them but rather who are trying to do something altruistic (and self-preservative too). Both con artist and saint will need to be giving explicit and somewhat controlling directions to the newly recovering alcoholic, and because it is hard to take directions; because there is generally so much pride at stake, these two efforts to control may appear to be indistinguishable. Nevertheless, it is important for the newly recovering alcoholic to be able to reject the one and embrace the other. This is one of the harder things to do in AA, I suspect.

For what they are worth, here are some pointers for what to avoid in a support group and in AA. Stay away from groups that encourage you to:

 

  • Avoid your friends and family (unless there is a clear and logical rational for why you should avoid your friends and family (e.g., there is concrete evidence that they will undermine your sobriety or mental health). When this is the case (and it really is the case sometimes), it is reasonable that the avoidance should be temporary rather than permanent and something that can be attempted again in the future if that becomes a reasonable thing to do.
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  • Discourage engaging in leisure or daily activities that don't involve group members. It's okay if alcoholic or drug-involved activities are discouraged, but that is where the line should be drawn.
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  • Discourage using other forms of treatment besides the group. Any group member that tells you to not take prescribed medication should not be listened to. Any group member who tells you to not attend psychotherapy should not be listened to.
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  • Rely on group decision making processes for making your important decisions. There will be times when it will be wisest to delegate decisions to others (e.g., when you are intoxicated, when you are in very early recovery and you can't seem to keep yourself sober), but such delegation should always be done on a temporary basis, and it should be limited in scope. Allow the group to help you troubleshoot difficult situations (e.g., what do I do when I go to the office party and everyone else is drinking!). Allow a more experienced person to help you find a sponsor. Do not allow a more experienced person to tell you to stay with a sponsor you know to be abusive. Do not give your life savings to a support group. Do not let the group dictate who you must date or become sexual with, etc. On the other hand, it is a good idea to follow the general AA rule to not date during the first year of sobriety. It can be tricky figuring this out.
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  • Take up an us/them mentality. Your membership in the support group should not become your only and sole identity, or if it must (because otherwise you know you will drink), then let that be only on a temporary basis, until you've built up the coping skills necessary to have outside relationships. In other words, support and understanding within the group is good. Suggesting that no one else outside the group will ever understand or care about you is not.

A variety of people have shared their experience with AA and there is an interesting pattern than has emerged. The positive comments are not unrelentingly positive. However, the negative comments are very and unrelentingly negative. What I mean by this is that most people who've written in defense of AA say something to the effect that AA helped them but they recognize that there are some difficulties with the organization. They promote and support AA very much but do not pretend that it is not a human institution with human problems. You might think that those saying negative things about AA would have a little something positive to say, but by and large they don't. Our negative comments are very polarized; very black and white. Very absolutist in nature. The positive comments are a lot less demanding too. They offer an opinion and an experience and do not pretend that they have the whole picture. On the other hand, some of the negative comments demand that any mention of the positive be removed. They actively try to shame. Here are some examples of comments by way of an illustration.

Here is a positive one:

As an M.D., Ph.D. and AA member, I see that AA has a lot of glaring problems. First and foremost, AA presents addiction and alcoholism as a spiritual defect. This notion is absurd. Is any disease related to a spiritual defect? If I have high blood pressure, is it due to a spiritual defect? The answer is NO!! In this regard AA must move into the year 2007. With the vast amount of solid medical evidence and research, the causes of addiction are now understood better than ever. Treatments are improving and new medications are on the horizon that promise to dramatically improve recovery rates from this disease/disorder.

I am honestly disgusted when AA members fail to recognize that change is needed. They fail to see that program fails for 95% of the people that come in the doors of the program. They DENY that anything may be wrong with the program at all. If a person fails to say sober, the contention is that they were not spiritually fit, or they didn't want help bad enough, or they didn't hit rock bottom. This is a load of crap. People relapse because addiction is a nuero-biochemical brain disease, end of subject.

I realize that AA was formed when little was known about addiction so the God concept worked for Bill & Dr. Bob. Hell, it was once widely believed that the black plague was due to spiritual defects and sin; however, as we now know, the plague was simply a disease caused by bacteria. Again, I implore AA to grow up and live in the present.(2007)

Why do I remain in AA? The answer is simple, the people. I have met some absolutely wonderful and amazing people in the program who love to help others. Sure I have met a lot of egotistical cult members, but I cannot abandon the people who come into the program because they have no where else to go. Believe me, not all AAs are wacko occultists. Many are just like me in that they suffer from addiction and want to be around others that understand their plight.

Here is a negative one:

Read and heed sir. AA is, in fact, a haven for socio paths. And, you know it. I know that you know it. Full stop.

Your credibility is at stake, sir. As is, your honor.

The world is watching: when will you end your referrals to AA?

And:

either the editors can legitimately dispute rays' arguments or they can't. the "your mileage may vary" comment manages to sarcastically skirt the issue while also being downright unhelpful.

there are plenty of problematic things about AA's methods (as both a program and an organization), and its efficacy as a manner for treating alcoholism is debatable at best. there are no shortage of articles and comments on this website that speak poignantly and directly to those very issues.

i think the general consensus is that alcoholism (in the united states, at least) is a public health concern. starting from that premise, then, it's the only public health concern i know of where the most identifiable and widely applied approach to treatment is the prescription of a "spiritual solution". on its face, that is just absurd.

ray uses the statistical numbers rightly to show that a lot of very needy people walk away from the AA prescription (however dubiously it may be "suggested") in large numbers often disgusted and despondent. because the AA brand has so permeated the public consciousness -- thanks largely to an intellectually incurious (or, worse, 12 step adhering) therapeutic community -- those people who walk away are left to find solutions on their own or, all too often, to return to self-destructive behaviors.

characterizing that kind of failure at the organizational level (and there's no other way to characterize it -- if AA's primary purpose is "to help other alcoholics achieve sobriety" the numbers suggest that it is not getting the job done) as an individual experience of 'varying mileage' is as smarmy and despicable as the hot air one might get from any other used car salesman.

you ought to be ashamed to have even thought about posting it as a response.

I don't doubt that there are reasons and personally terrible experiences behind such unrelentingly negative comments. I suspect that these are people who have been hurt in some fashion by AA members and who are trying to warn others to avoid that fate. And to the extent that there are sociopaths and the like at meetings taking advantage of people, that warning is useful and appreciated. I can't help thinking, however, that such an unrelentingly negative message - one so at odds with the AA I know through personal acquaintances and through the more positive comments made – is negatively biased and overgeneralized in its fundamental assumptions. There is a truth there at the bottom of it, I know, but they've magnified that truth until it becomes their whole world, and it now obscures their vision of the other more positive elements AA has to offer.

There is a psychodynamic defense mechanism known as splitting, which is often seen to occur in borderline personality disordered individuals and other dramatic-erratic personality disordered individuals. Splitting occurs when individuals fail to be able to integrate opposed points of view and instead pick a single point of view and deny the other's existence. In other words, when someone cannot bear to think of something as having both positive and negative qualities, that person may simply deny that there are negative qualities, or that there are positive qualities present. For instance, a child abuse victim may report that he deserves the treatment that daddy dishes out to him and that daddy is a great man. He does this because it is vital to him that daddy love him and in the interest of keeping this love alive the negatives of being beaten are overlooked. As another example, a woman who has caught her man looking at internet porn may feel as though he is an absolutely negative being with no redeeming qualities, even though she did not feel this way prior to her discovery. Splitting is considered to be a "primitive" defense mechanism, mostly because in its operation it takes the individual who is doing the splitting away from a shared vision of reality into a more private and skewed one. As I look at the negative comments I'm getting regarding my relatively positive position towards AA, I can't help but see splitting in action. I know I'll get flack for pointing this out (it will likely come across like a judgment rather than a description), but it is useful to know the state of mind that some of the critics are coming from. It's not that their concerns are unfounded. Rather, its that they are not seeing the whole picture very well.

"Caveat Emptor" is the old Latin phrase we're all familiar with meaning, "Let the buyer beware". AA is a positive force for sobriety around the world, but it is not without its problems. People seeking to become sober should avail themselves of a range of treatment options including rehabs, relapse prevention and motivational interviewing approaches and related therapies as well as AA to the extent that these can be afforded and accessed. AA should be used for the good it can provide. There is much wisdom therein. At the same time, people should not abandon their street smarts upon entering AA. They should be careful to avoid the more abusively controlling and immature sorts of members and rather associate themselves with those other members who are working towards a more straightforward and sincere recovery. Not an easy task, I know. One that becomes harder if you allow yourself to become isolated and unable to check in with other people about the validity of your perception. So, to the extent that you can avoid it, don't allow that to happen. Listen to your gut and check your perceptions with others who care about you. Do what you can do to not be taken advantage of. At the same time, don't be so paranoid that you fail to take advantage of what help is available.