The cliche you’re bound to hear an oldtimer repeat in meetings, sometimes, is, “The Chapter is called How it Works, not Why it Works!”
I get it, haha. This laughter is typically followed up with another worn cliche, “Why it Works falls under the category of none-of-your-business!”
It kind of makes you feel warm and fuzzy, doesn’t it?
If you’re new to the AA culture which at times is blunt, well, maybe not.
Regardless, if you’re sincere about understanding your options for recovery and where AA might fit into them, this is not particularly helpful information.
Legitimate Question
“Why it works” is a legitimate question for someone exploring AA and there should be a clear answer.
And, since AA has been around for 85 years, one would think the answer would include data and facts. Unfortunately, that is not how AA rolls. Data is hard to track in an organization that is decentralized to the extreme and holds anonymity foundational.
Specifically, are there elements of a program that has 72 “official” publications to explain itself that one should prioritize? Attending countless meetings to explain that someone should focus on? It seems like that information would be helpful.
But, with AA literature, if you look for up-to-date data with attributions from peer-reviewed research on alcoholism, you’re a bit out of luck. AA doesn’t provide much, if any, of that information. AA seems to be mainly interested in preserving its legacy of what has worked in the past. Refining the program to make it more effective and accessible to the newcomer of the 21st century does not seem to be AA’s goal.
This is because AA’s “folksy” (aka non-scientific) approach to addiction recovery that requires “finding God” is deep in AA’s DNA and unlikely to change. If you’re sober through AA and are not a zealot for God, prayer, and “working the steps as written in the book,” you best keep that opinion to yourself. Any meaningful discussion for change is typically gridlocked. “If it ain’t broke, don’t fix it,” they will say. Hence, no material changes to the first 164 pages of the Big Book for almost 80 years.
This is all unfortunate, as there are many studies about addiction, alcoholism, and the AA program published in the last thirty years with interesting findings that could help people who want to get and stay sober. Some simple ideas here. It is this growing canon of research that provides some insight into “Why it Works.”
What the Research Says
The Harvard Health Newsletter cites three elements that are the most important program for a good outcome looking across several academic peer-reviewed studies.
They are:
- Staying the Course – People who, in AA terms, “keep coming back” and keep at it are most likely to both obtain and sustain sobriety than those who stop.
- Helping Others – “Carrying the message” is a core component of AA, and studies do corroborate this works. Studies also indicate “helping” someone in ways beyond just working the twelve steps (working through problems like finding a job or getting housing) will contribute to staying sober.
- Absence of Other Problems that Require Treatment – Other “problems” whose treatment requires medication (bipolar, schizophrenia, depression, and borderline disorder, to name a few) complicate getting and staying sober.
Good to know, right? Shouldn’t this be on a pamphlet? Or, mentioned in meetings?
So for the newcomers, stick with it, even if you fail initially. While you’re there in the program, try to be helpful in all ways to others. And, don’t look to AA to solve other problems that may require medication for treatment. Get professional help for that. And by all means, be suspicious of anyone in AA who offers “opinions” about those other problems that require medical attention.
More Controversy From Data
Another truth is much of what is shared at meetings does not align with data.
For example, attending a specific number of meetings is not an indicator of success with abstinence. The data shows that fewer meetings over a longer period are preferable to an initial flurry of many meetings. Often you’ll hear, “I drank every day, so I go to meetings every day!” Sounds great, but going to a meeting every day is not an indicator of success with sobriety. More important is losing the desire to stay sober and stop going altogether.
It’s also reported that AA’s emphasis on “spiritual awakening” is not a corollary to success with abstinence. As beloved as the “spiritual angle” of AA is, many get and stay sober without any real spiritual belief. There is little evidence to support “finding God” is a guarantee of success with obtaining sobriety. It is more of a nice-to-have and a preference rather than the must-have many old-timers insist it is.
Professionally Guided Recovery
Finally, a recent literature review of all AA studies indicated that the most initially successful AAs combined therapy with the AA program. This may be the best approach to take from a data perspective. This dual approach makes intuitive sense as many coming into the program are confused about where to start and what to do. A professional could be of enormous help to someone new and earnest. While some claim this is the role of the sponsor, the efficacy of sponsors is all over the place.
Plus, many newcomers have problems other than alcohol, where guidance from a therapist rather than the untrained voluntary help given through AA’s sponsorship could really help speed things along. Many old-timers insist that therapy can be more a distraction than anything and, “working the steps” is all that one should focus on. Again, simply not true according to the data.
Data Doesn’t Change Minds.
I get it that many in AA cling to the twelve-step’s power to solve not only the drink problem but many other issues newcomers and members face. Providing untested, mostly qualitatively based solutions to newcomers and members is potentially dangerous in they won’t work.
I say look at the data – there is a lot. I also say it is time for AA to grow up and embrace the science and research of recovery facts rather than continuing with the well-worn folksy anecdotal solution.
But, since when has data changed minds.
A Small Sampling of AA, alcoholism, and addiction research.
