Often AA members state that if people were not forced or coerced to attend AA, that it would solve lots of the problems that detractors or ex-members complain about. I think this answer is, however, far too simplistic. Part of the issue – it seems to me – is the fact that lots of 12 steppers go and train as addiction counsellors or work as programme assistants (with no training) in treatment centres, clinics, detox units, or regular counselling practices and doctors surgeries etc. There is currently no requirement for AA members to declare their involvement when it would point to a conflict of interest (I’m thinking police officers, judges, teachers, drug and alcohol counsellors, doctors etc who are in AA but because of ‘anonymity’ don’t say so). Therefore, a lot of the time, this mysterious ‘they’ who are coercing people to attend, are actually AA members who believe that their approach is the only or most effective way. If really pushed, they will declare defensively and adamantly, ‘it saved my life’ (and I usually keep quiet on my view that this is about as verifiable as declaring ‘I was abducted by aliens’).
Certainly when both my brother, and I, were in rehab (different centres, he for ‘anxiety’ as a manifestion of his spiritual disease – his step one was ‘I admitted I was powerless over fear’ – and me for ‘codependency’) no other alternatives were mentioned at all, and nearly ALL staff were 12 steppers (although there was no requirement for them to declare it as part of professional transparency). Also there doesn’t seem to be much of a mechanism within AA to provide people with a list of options signposting other methods if the AA method doesn’t fit or feel right to that person. I appreciate that people are free to walk out (and 95% do) but I think the dynamics of the process for people worried about their drinking is not helpful.
Also as AA relies quite heavily on self-diagnosis (they say that no one can tell you you are an alcoholic but they provide the 20 questions booklet that has contradicitory questions in it – do you find your tolerance has increased?, and also do you find your tolerance has decreased? so either provides one of the magic ‘three’ yeses). New members, who’ve looked in the phone book and turn up to their first meeting are told (and I was told): ‘no one ends up in an AA meeting by accident, there are no coincidences’.
So, it doesn’t leave a lot of room for doubt or exploring whether the person really does have alcohol dependence syndrome. I know for myself, I was given a great deal of well-intentioned pressure and warnings about ‘denial’ being a major component of my own thinking and I was heartily recommended to ‘identify don’t compare’ when in my case some comparison would have been helpful. I was told I was a ‘high bottom’ case and to be grateful that I’d arrived ‘just in time’. These people weren’t being malicious, I have no doubt they were sincere, but they were in fact wrong!
I know a therapist here in the UK who runs two largely 12 step based nationally respected treatment centres – he’s holistic in his approach so uses a raft of different treatments and techniques tailored to the individual – and prior to his training as a therapist he worked in psychiatric services. Part of my leaving AA (laying aside my own philosophical and moral concerns with it) was as a result of the long standing discussions he and I had over two years – I also finally, after more than a decade in AA – was assessed by a psychiatrist specialising in addiction (maddeningly, it is nearly impossible to see an addictions psychiatrist any more on the NHS). My own, my counsellor’s and the shrink’s conclusion was that I never met the criteria for dependent drinking, and I did not belong in AA (I have a long history of misdiagnosed endocrine problems that prompted this exploration). Indeed the shrink told me that, when it comes to addiction, ‘there is simply no such thing as a lifelong diagnosis’.
My therapist said that, his words: ‘AA is packed to the rafters with people who are not really alcoholics, they have issues for sure [often mental health / trauma problems], they may have been drinking abusively for a while to self medicate, but they are not addicts’ – the AA big book talks about this in detail, I think it’s in the chapter, ‘The Family Afterward’ and lists four types of drinking. The trouble is, of course, these not-really-alcoholic people openly ‘identify’ as alcoholics, which further adds to the confusion for new people who might also be ‘like them’ – they hear similarities in these stories which convinces them that they too, must be an ‘alcoholic’ ….
Unfortunately, in my naivete I took to heart AA’s advice to ‘be honest with your doctor’ which created a great deal of problems for me later down the line when trying to get a diagnosis for cancer and the endocrine stuff. I’ll give just one example here, part of my illness means I had very low levels of vitamin B12 and abnormal GGT readings and my GP for months kept saying, ‘we see this in people who drink too much’ – by that point I was 9 years sober!!! He wouldn’t do other tests and kept focusing on psychological issues due to this misguided confession I’d made years earlier. In the end I had to quote the NHS guidelines on alcohol dependence to him (ie I never met them!) but he still wouldn’t help me. Finally, I had to pay for a private second opinion. Fortunately I had the funds to do so, many don’t. Also as it was on my care summary when I got to hospital any discussion of pain relief (e.g. double strabismus surgery and discharged with no pain relief) was treated as if I was ‘drug seeking’. It has been an unholy nightmare from start to finish and to some extent is still ongoing.
So whilst I agree wholeheartedly with the more liberal AA members that there do need to be options, and people need to be made aware of their choices and the different approaches at their disposal, it does seem that many AA members – in their enthusiasm – seem to scupper this actually happening. I met many good people in AA (although as been said elsewhere, they were still unquestioning of the AA rhetoric) and many sincerely did try to help me with an open heart (although I met far more messed up ‘serenity hornets’ and big book nazis).
I also agree that people are indeed told to ‘stick with the winners’ but this is quite hard to figure out, particularly if you are new, as (as we all know), many people talk a better recovery than they practice. Further, given the reverence for ‘time’ as a measure of recovery in AA, the concept of ‘winner’ can be misleading.
AAs maintain that if these coerced referrals were to cease, then 13th stepping would be drastically reduced. They then usually also insist that there is a great deal of focus in AA that the men stick with the men and the women with the women.
They are of course right, this does happen, but this leaves out the well documented patterns exhibited by people stuck in the ‘cycle of abuse’ – poor and damaged sexual and physical boundaries and unresolved trauma (for example approximately 80% of prostitutes were sexually abused as children). We all know that dealing with a damaged person in the throws of addcition can be deeply frustrating, but these people bring a whole raft of issues with them through the door, not least a dependent approach to life, a desire to get parented, an ‘other directed’ orientation, damaged self image, and no internal locus of control. It’s hard to feel sympathy for people sometimes, but that does not mean that sympathy is not warranted. More importantly professional help is needed.
Therefore, it seems to me, given the above point about ‘winners’ with ‘time’, newcomers are still easy pickings, especially by established members who offer understanding and companionship, and there appears to be an inadequate understanding of what ‘abuse’ or the consequences of abuse (‘acting out’) actually looks like to AA members, and even then, even more confusion about what to do about it given the whole anonymity issue. This seems to result, even with the best will in the world, in those who have been hurt being hurt all over again.
Any therapist who manages a group counselling session has to have rigorous training and ongoing supervision to learn to spot and manage powerful group dynamics, transference and counter transference (i.e. projection of their own and others unconscious issues in the true sense of the word) and from my experience (having had extensive therapy outside AA) people in AA are not qualified to handle it – even if they are sincerely trying to help. This creates lots of situations where people are hurt emotionally and psychologically, and often – maybe inadvertently – blamed or scapegoated (their poor ’emotional sobriety’ is pointed out for instance) in a way that is counter productive to the stated aim of ‘recovery’.
This is why I have such a hard time with ‘To Wives’ and ‘The Family Afterward’ as many of the ideas therein are really out of place in a modern understanding of gender and sexual politics, and the social and economic forces that cause people to be and to feel disempowered. I also feel that AA’s line on ‘acceptance is the answer to all my problems today’ can be totally invalidating for abuse survivors, (it is, even for mentally well people going through life’s problems like divorce or bereavement or facing things like racism), and leaves out these important factors. It also breeds a sort of passive acceptance of the status quo, when in fact data shows that addiction is vastly concentrated in these disadvantaged groups, and in fact is not ‘an equal opportunities disease’ – it very much is an ‘UNequal opportunities’ problem instead.
Disempowered people need to learn to own their power and pay attention to the things they cannot accept. Even the most mild mannered, loving and kind delivery of the 12 step ‘message’ doesn’t address this, and good and decent members of AA – who surely DO have the right intentions – are unwittingly perpetuating a system that sets addiction and abuse up in the first place. Recovering from abuse or trauma is not for the faint of heart, it requires the marshalling of all of our resources, (it’s incredibly hard work!), along with unwavering and abundant affirmation of our reality. It also requires (often, but not always, some folk seem to be naturally resilient), skilled professional help. A skilled professional can also help to place the alcohol abuse in its rightful context (usually a complete disregard for our value, and an attempt to control symptoms) and clarify next steps.