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12 Steps: An Outsider's Look at Alcoholics Anonymous

It’s Thursday night in downtown Tempe. The weekend has begun for many students at ASU, and the bars up and down Mill Avenue are opening their doors to accept the night’s first patrons. Soon, the alcohol will begin to flow, and there will be revelry. There will be 21st birthday celebrations, there will be high fives, there will be shots. There will be stumbling and drunk driving, and at some point, someone will likely vomit.

One block away, in the balmy lobby of a small church, close to 100 people are taking part in this night’s meeting of “The Doctor’s Nightmare,” a speaker-based gathering of young people and an offshoot of Alcoholics Anonymous.

Founded in 1939, A.A. is the world’s largest recovery program, providing fellowship and opportunities for recovery from alcoholism and other addictions for more than 1.2 million people in the U.S. and more than 2 million worldwide.

Most of the people here aren’t just alcoholics. They’re drug addicts. They have personality problems that span far beyond the realm of a simple problem of alcohol abuse, and they attribute their experiences in A.A. to the reconciliation of all of them.

It’s why the 12-step program has been adopted by so many disparate organizations attempting to help members overcome a variety of diseases and disorders. There are 12-step programs to help gamblers, workaholics, cocaine users, over-eaters, rape victims, schizophrenics and sex addicts, to name a few. They meet in every city, in every state, all subscribing to the same mantra.

The meeting in the church begins with announcements of gatherings in the coming weeks. People who speak say their names and whether they’re an alcoholic, an addict or both. The people around repeat the names, as an affirmation.

The people here are as diverse as you’ll find: tattooed and clean cut, beautiful and ugly, tall, fat, thin, bald. But they have a certain sameness, too — a certain tired look behind their eyes. These people have wounds. What’s scary is that you’ve seen this look in people you’ve known all your life. These people could be your friends, your family. They could be you.

The group leaders move to the distribution of chips and medallions to mark sobriety, a practice that began at an A.A. group in Indianapolis in 1942. Some are given to those who have achieved a certain number of days without alcohol; others are passed throughout the group as inspiration. The man in a bandanna next to me holds the token I pass to him like a piece of treasure, rubbing it between his hands as if for luck before sending it along.

Next, tin coffee cans are passed around for donations. Alcoholics Anonymous has a firm belief in being self-supporting, and thus doesn’t seek subsidies from outside organizations. The group doesn’t even accept contributions from non-members — if an outside contribution is received at A.A’s General Service Office, they send it right back. There are no dues or fees; everything is entirely voluntary and donation-based. A.A. funds its meetings by passing a bucket for contributions from members at each meeting. Individual members are limited to a total donation of $3,000 per year.

This particular A.A. group is speaker-based. Members who have achieved sobriety visit each week to tell their stories and inspire others. Tonight’s speaker is a man named Jake. He looks young, his black hair is slicked back and accents already razor-sharp facial features. Tattoos cover his arms and creep up his neck. His sobriety began Sept. 26, 2003, he says, but it was hard at first.

“I didn’t love A.A. when I got here, but I love it now. I meet on Saturday nights with people who are still shaky, and I come and I tell them how great my life is, and I can see it in their eyes: ‘What the fuck is this guy talking about? God? The steps? Staying sober?’ But that’s the one thing I know how to describe my life today," Jake says. "I didn’t know how to describe happiness or contentment before.”
He goes on: “I think it’s very important for me to tell the people who are new here today that I was just like you. I am just like you. I just have a solution to my problem today.”

His solution, he says, came from following the 12 steps prescribed by Alcoholics Anonymous. A large poster hangs beside me, a simple white scroll with red and black lettering. These dozen stages are the actual program for recovering alcoholics to follow. Designed by Bill W., one of A.A.'s founders, the program draws on teachings gleaned from several spiritual leaders. The steps range from creating a moral inventory of yourself to making amends to all those you have wronged to asking a higher power to take control of your life.

You’ll notice that references to the Christian God today contain the major caveat God as we understood him. Because today’s A.A. isn’t a religious group, members are encouraged to believe in a power greater than themselves and submit to it — whatever they may understand that power to be.

Jake is talking about doing drugs with his friends now. “They would go on a bender and spend a weekend doing cocaine, but then when the time came they would put it away, they’d say, ‘I’m saving that for later,’ and go back to their lives. I had no idea how they could do that. That’s how I knew I was different.”

A major tenant of A.A. is the belief that alcoholism, rather than an addiction, is a “progressive disease.” Many peoples’ major misgivings about the organization stems from its reliance on this line of thought. They see it as a way to absolve guilty drinkers of blame that should be their own.

Dr. Craig Nagoshi is a psychology professor at ASU whose research involves alcohol and drug use among ASU students, how alcohol changes one’s social and emotional responses and the genetics of alcohol use and abuse. He’s dealt with scores of alcoholics involved in A.A. and has formed his own opinions about the group.

“Disease is a loaded word,” Nagoshi says. “I’m not one of those that believes it’s a useful term. Basically, my point of view is any kind of addiction is a psychological problem. It might have some kind of neurological basis, but the disease metaphor gets in the way of understanding what’s going on.”

The problem with alcohol is less genetic and more behavioral, Nagoshi says.

“Because it is a legal drug, and one that one is often exposed to early in life, you develop lots and lots of habits over a long period of time that tend to be very difficult to extinguish,” he says.
Jake is talking about how he finally got involved in A.A. He wasn’t fond of the 12 steps, he said, but he was motivated by the success of others.

“I don’t like listening to other people. I don’t like this idea of praying to some god that I’ve despised my entire life. I didn’t like making amends to people I didn’t like," he says. "I didn’t want to say, ‘I was wrong. What can I do to make it right?’ That’s not stuff that I enjoy doing. But, I knew that it worked for you guys. I knew that it worked. And that was attractive to me, what those people had.”

It may be that those who succeed at A.A. are simply more motivated than others to begin with.

“The contradiction about addiction is that motivation is the best predictor,” Nagoshi says. “Even a therapist can’t make you want to change.”

This is an idea the leaders of Alcoholics Anonymous would likely agree with. A.A. has a lot of faith in the efficacy of its program — but only for those who are willing to put forth the effort. Indeed, page 58 of the Big Book, the informal name of the Alcoholics Anonymous handbook, states:

“Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are those who cannot or will not give themselves completely to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.”

But many studies have been carried out that find A.A. isn’t nearly as effective as it would seem. In the mid-1960s, a group of doctors and researchers in San Diego conducted a controlled study of the benefits of Alcoholics Anonymous.

In the study, 301 public drunkenness offenders were randomly sentenced by the court to one of three "treatment programs”: one in which offenders were sent to a professional alcoholism treatment clinic, one in which they were sent to Alcoholics Anonymous and one that received no treatment at all. After following each subject for at least a full year following his or her conviction, the researchers came to a surprising result: The group that received no treatment had the highest rate of sobriety success. The worst group? The ones sent to A.A., and by a wide margin.

Another study found similar results. In 1996, The U.S. Census Bureau conducted The National Longitudinal Alcoholism Epidemiological Survey, designed by the National Institute on Alcohol Abuse and Alcoholism.

Large both in terms of people (thousands) and in terms of time (20 years), the study analyzed 4,585 subjects who had displayed standard alcohol abuse and dependency symptoms and filtered them based on whether they received treatment for their symptoms. The treatments were a cross-section of all of the standard treatments used in the USA, 85 percent of which were based on the A.A. 12 step program.

The results: 20 years after the onset of alcoholism symptoms, 80 percent of those who had undergone treatment were either abstinent, or "drinking without abuse or dependence." But of those who had never received any treatment, 90 percent were either abstinent or drinking without problems.

If you flip those numbers around and express them as failure rates rather than rate of success, after 20 years, 10 percent of the untreated people still had drinking problems, while 20 percent of the treated people still had drinking problems.

But according to "Alcoholics Anonymous, Cult or Cure?" by Charles Bufe, the most persuasive evidence for the ineffectiveness of A.A. comes from statistics the organization itself provides.

Since 1977, A.A. has conducted an extensive survey of its members every three years (though the survey scheduled for 1995 was conducted in 1996), measuring such variables as length of membership, age distribution, male-female ratio, employment categories and length of sobriety.

Following the 1989 survey, A.A. produced "Comments on A.A.'s Triennial Surveys," a document that analyzed the results of all five surveys done to that point. According to the document, the "percentage of those coming to A.A. within the first year that have remained the indicated number of months" is 19 percent after one month, 10 percent after three months and 5 percent after 12 months. In other words, 95 percent of people who begin attending A.A. on Jan. 1 will have dropped out before the next new year.

Rampant criticism prompted A.A. in 2008 to distribute a pamphlet in response. The report, “AA Recovery Outcome Rates: Contemporary Myth and Misinterpretation,” makes many assertions, including:

  • Of those in their first month of A.A. meeting attendance, 26 percent will still be attending A.A. at the end of that year.
  • Of those in their fourth month of A.A. meeting attendance (i.e. have stayed beyond 90-days) 56 percent will still be attending A.A. at the end of that year.
  • The 2004 Survey showed an increase in the length of sobriety over the 2001 Survey (as has every triennial survey since 1983).
However, the very nature of most of its members — anonymous — makes it difficult to accurately discern whether, statistically, A.A. is helping or hurting.

Jake is wrapping it up now. He says he’s happily married. He has a house, a job, and a 1-year-old daughter.

“It’s an amazing gift to be able to be a responsible, providing, stand-up, respectable, look-people-in-the-eye type of person, because that’s not who I was. That’s what Alcoholics Anonymous made me.”

As the meeting nears its close, I notice a girl sitting on the floor. She’s small, dark and delicate. She chews gum absentmindedly. She looks as though she doesn’t belong here. But here she is.

I watch her as the circle of people mumbles the final prayer:

“God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

The girl looks up and hugs her friend. They hold hands, they smile. They make plans for the week. This is fellowship. This is support. Whatever the statistics say — good or bad —it’s hard to argue with that.

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