Salon.com lands a harsh critique of Alcoholics Anonymous as the prevailing model of drug and alcohol counseling, referring to the 80-year old, peer-led program as a “monopoly” that has “made it impossible to have real debate about addiction.” The article, which is worth a read, is long on empirics: Salon points out that “Peer-reviewed studies peg the success rate of AA somewhere between 5 and 10 percent” and walks through the ubiquitous 12-steps criticizing the lack of evidence supporting each as an effective intervention strategy for drug and alcohol counseling.
An honest look at any institution with such influence over the area in which it trades, as AA has held in the world of drug and alcohol counseling is critical. The practice and science of drug and alcohol counseling have changed significantly since AA’s founding in 1935, and many of its cherished beliefs about drug and alcohol counseling have spilled over into the culture more broadly, applied not just in conversations related drugs and alcohol counseling but in dieting, so-called pornography or sex addiction, and innumerable other habits found to be undesirable.
Many get serious help with drug and alcohol counseling with AA
Still, it’s hard to look at the intense devotion that many have to AA and its many offshoots and disregard its significance not just as a context for drug and alcohol counseling but for creating community and supporting emotional development. Many people insist that AA saved their lives, rescuing them from drugs and alcohol, and I’m disinclined to dismiss those claims as the product of a monopolistic, misguided enterprise.
We need to end the dogma in drug and alcohol counseling
It’s important to take note of just how revolutionary AA was in its founding. AA was significant for acknowledging the seriousness of the problems many experienced with alcohol but also in its belief that a peer-led group (i.e. not those trained in professional drug and alcohol counseling) could, through community and collective regard, help people make drastic changes in their relationships with drugs and alcohol. But as with all innovations, when what is first radical becomes dogma it’s time for a new revolution. A 5-10% success rate is abysmal. Drugs and alcohol are not and should not be a death sentence. My wish is that we can celebrate the best of AA, honor the wonderful drug and alcohol counseling so many of its devotees have received, and learn from its 80-year experience as well as the innovations in our understanding of drug and alcohol counseling to create better outcomes.
Ending the separation between therapy and drug and alcohol counseling
A critical area of interest is in giving up the phony dichotomy between drug and alcohol counseling and counseling/ therapy more broadly. Too often we relate to issues related to drugs and alcohol as a separate sort of matter from anxiety and sadness and trauma. In practice, they are as integrated as can be. Often therapists refuse to work with patients with drug and alcohol problems, referring them elsewhere for categorical “drug and alcohol counseling.” We need to better understand that human beings are emotional, that those emotions cannot be dissected into categories in the manner of medicine’s sorting of the body’s systems into categories of specialization.
We need to better understand that there are not discrete categories of development. Perhaps the biggest failing in drug and alcohol counseling is insistence on sorting people into categories at all.