Wednesday, March 25, 2015

12-step programs are not great

The April 2015 issue of The Atlantic has an article called The Irrationality of Alcoholics Anonymous. In the article Gabrielle Glaser, author of Her Best Kept Secret: Why Women Drink - And How They Can Regain Control, discusses the ways that Alcoholics Anonymous (AA) falls short of helping people control their drinking. Her article asserts that it's past time to consider more medical approaches to treating alcohol abuse besides AA's outdated methods.

This blog post won't be about that, athough I'm sure it's true. Glaser's article made me think about how I haven't had very good experiences with twelve-step programs. That's how people commonly refer to Alcoholics Anonymous, Narcotics Anonymous, Gamblers Anonymous and all the other programs that use the same format as the original organization. When I first realized I had a problem with food, specifically sweets, I tried a few Overeaters Anonymous meetings back in 1994. People brought so much pain to those meetings that I actually wanted to eat more afterwards. I found the stories emotionally disturbing and felt like I picked up more baggage than I had walked in with. I stopped going after just a short while.

I tried another twelve-step program in my second year of marriage. I attended Al-Anon meetings (for the family/partners/friends of alcoholics) for a few months because I felt concerned about my husband's drinking. This time the meetings were less scary and I met some great people who felt like they could turn into real friends. But the meetings still didn't feel like a good fit. People described drinking parents with erratic behavior and stormy emotions. They described feeling trapped and helpless in the face of their alcoholic spouses. Many of them had already moved on from these relationships, but were managing the aftermath of their own pain. Again, I felt more upset leaving the meetings than when I arrived.

This time the problem was that the stories of violence and abuse didn't sound like my husband. They sounded like my mother. I found this very confusing because my mother didn't drink; her emotional abuse was driven by mental illness. It was my husband who drank, replacing the Jack Daniels whiskey that he kept in the kitchen with surprising regularity. Yet his moods never got anywhere close to what my Al-Anon peers described in their drinking spouses. What the hell was going on?

When I found myself returning from meetings expecting my husband to be raging and driving the car into walls, I decided to stop going to them. Once again, the twelve-step participants felt like they were carrying much heavier burdens than I, and I was taking on their anxiety. I finally concluded that twelve-step programs were just not for me

I add this point to Glaser's critique of Alcoholics Anonymous: AA and Al-Anon use a very limited model of alcoholic behavior. They focus on drinkers who destroy things and abuse others, who lose jobs and "hit bottom" (sink to the lowest point in your life you can possibly reach). But there are actually different kinds of alcoholism. Sure, there are drinkers who will tear through relationships, insurance policies and careers, but there are also drinkers who hold their lives together quite well while they slowly drink themselves sick. "Highly functional alcoholics" need to drink every day, but hold jobs, raise families and are rarely suspected of having a problem with alcohol. They're in danger of destroying their livers before any external consequences force them to examine their habits. They don't tend to rage or destroy things. But highly functional alcoholics aren't even mentioned in AA or Al-Anon literature because they don't "hit bottom." They just float along until their health gives out.

AA and Al-Anon also leave out the wide range of drinkers who are now described as having alcohol use disorder. Alcohol use disorder refers to having a dependence on alcohol and can include many symptoms such as depressed mood, generalized anxiety, anger, social withdrawal and marital discord/neglect. Without including the various shades of problem drinking, AA and Al-Anon fail to serve many people whose lives are affected by alcohol.

Glaser's article is well-researched and points out the blinders we've been wearing with regards to treating alcohol problems. Twelve-step programs, for the most part, don't work for alcohol abuse and it's time we stop thinking of them as the be-all-and-end-all of alcohol addiction treatment. I'd add that twelve-step programs probably don't work for a lot of people, alcoholic or not. At least, that's my experience.

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