Rational Recovery for alcoholics vs AA

I also wonder if AA's 12-step program is founded on any science at all. I wonder if there are any scientific studies to support their assertions. I wonder if the 12 steps are just simply a modification of the 12-steps to become a better christian programs.
 
That question can cause so much confusion and controversy, it is unbelievable. You could start an entire topic about it, and it might run forever, with all kinds of other issues thrown into the mix. Is gambling-sex-violence-internet-chocolate-smoking-foodaholism a disease? Sexaholics, chocoholics, nicoholics, gamblaholics, is internet addiction a disease? Is smoking cigs a disease?

The definition of alcoholism as a disease is, to my mind, counterproductive and incorrect. A disease is something caused by a pathogen, a foreign invading organism. Anything else would be a disorder or dysfunction. AA itself doesn't refer to alcoholism as a disease, for similar reasons.

I was never diagnosed as an alcoholic, but what's it take to be diagnosed? Is being drunk for months at a time enough?

I think the big problem is that "alcoholism" is too broad a term, and incorporates a number of different etiologies. The problem with most treatment programs, particularly those like AA, is that they treat all alcoholism the same way; when different theraputic modalities are needed.

Alcoholism is rarely, if ever, a discrete "disease" or "disorder"; but is generally a symptom of some deeper dysfunction which triggers the alcohol abuse as a self-medication or psychological coping mechanism.

Many, but certainly not all, alcoholics have an abnormal response to the drug; caused by a dysfunctioning neurochemical mechanism similar to some forms of mental illness. Indeed, self-medication with alcohol and/or other drugs is a common symptom of many mental disorders. Where programs like AA fail is that they seek to treat the symptom, the alcohol abuse, without even acknowledging, let alone treating, the disorder that led to the abuse. This is the group that I would expect to be most likely to relapse. These are also people whose best course is to avoid alcohol (and other drugs) entirely and permanently. They simply cannot drink without becoming alcoholics. In some cases, this is a genetic, inheritable trait, like many other forms of mental illness.

There are some who self-medicate with the alcohol because of some physical disorder, such as chronic pain (I know several people who do this); either because they cannot or will not find more appropriate medical treatment for their disorder. I have no idea what this group is like as a whole for recovery or recidivism, but I would think that the availability of effective medical treatment would greatly reduce alcohol/drug abuse and recidivism. Unfortunately, many of the problems that induce self-medication are chronic and not effectively or easily treatable. Like the previous groups, AA type programs don't really deal with the real physical problem.

Others have a normal physiological response to alcohol, and become alcoholics by choosing to use the drug to excess to compensate or distract from other problems. Their reaction is purely psychological, not physical. Drinking as a reaction to circumstances. Abuse, stress, ennui, etc. This would probably also include those who have "learned" to overindulge through social conditioning and peer pressure; and then go on to develop a physical dependence due to normal variations in physiological response and tolerance, as well as a psychological addiction because of the behavioural associations. Given appropriate therapy, and making effort to develop less self-destructive coping mechanisms and associations, I would expect this group to have the highest recovery rate and lowest recidivism; as well as being able to maintain moderate use of alcohol after sufficient therapy. Programs like AA can actually be counterproductive, since they overemphasize the alcohol abuse, deny the ability to change one's behaviour patterns, and don't necessarily focus on the circumstances and behaviour patterns which produced the alcoholism. It amounts to little more than trading one addiction behaviour (alcohol/drug abuse) for another (excessive dependence on AA ritual). Cognitive behavioural therapy would probably be the best option for this form.

It's telling that there are programs in existence to treat addiciton to 12-step programs.
 
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It's telling that there are programs in existence to treat addiciton to 12-step programs.

are there programs to treat addiction to the treatment of addiction to the 12 step program? :)

very interesting post.....[damn, i hate how that word has been tainted by tai chi :D ]
 
There are two things that might make it hard to trust any statistics on AA.

One, I don't think they keep any records of the people that attend do they? It is not like a rehab hospital where it might be possible to track success. If someone quits attending AA are they drinking? Did they quit for some other reason? Who would keep track of this and how would they gather accurate information.

I found some stats on the web based on how many meetings people attend on average. But that is probably skewed because, at least here in Florida, any sentence for any alcohol related crime includes mandatory attendance at AA. How fair is it to judge their success by studying people that are forced to attend?

Based solely on people I have known, the success record of any program is pretty low.
These are important points. I looked into this pretty carefully a few years ago. There are studies that break these things down by category, but the results of these studies tend to be abused by people who favor one recovery method over another. There are websites devoted to pointing out AA's low success rates. One statistic that sticks in my head is that for alcoholics over 40, AA has a lower rate of permanent recovery than spontaneous remission. IIRC, all programs have a fairly low rate of permanent recovery, "recovery" being defined as stopping drinking.

To which I say, "So what?" That doesn't mean that AA isn't a good choice for millions of people. People on this forum, and friends of mine, say that they have tried many methods of quitting, and AA was the only one that worked for them. Many people say that they'd be dead without it. I believe them.

I have a problem (beyond my atheism) with the "surrendering to a higher power" idea. I think it's a substitution of one dependency for another. I want to feel that I can gain control of myself. Some people go to AA meetings every day for decades. Again, so what? That may be exactly what they need. That dependency beats the hell out of being dead.

You are correct that there is no prescribed deity (at least in meetings that follow the official policy). However, the previous sentence is incorrect. A person may choose the universe, a philosophical principle, a minor diety, AA as a whole, a particular AA meeting, or even an inanimate object. A person, may not, however, choose him or herself as a higher power. One who asserts that "I am more powerful than myself and therefore I will turn my will over to the care of me" will quickly end up chasing one's own tail.
I think the problem people run into is thinking that there's only one kind of addiction, one kind of addict, and that one kind of treatment should work best for most people. For some addicts, the cold-turkey, pull yourself up by the bootstraps approach works. For others, the Rational Recovery method might be best.

The important thing is that anyone who wants to quit, not stop searching until they find a method that works. I had a friend visiting who was a newly recovering alcoholic, and I had the chance to go to several different AA meetings with her. One thing I learned, which has been mentioned here, is that there is a wide variety of meetings available to someone who lives in a large city. If someone here is contemplating going to AA meetings, or has been turned off by going to a particular meeting, I suggest trying several. There may be another meeting nearby that suits you much better. Even the physical location can make a big difference. Some of those church basements are downright dingy and depressing. Other locations are light and airy.

Another thing I learned is that no matter how much you think you've effed up in life, you're likely to meet many people at AA meetings who are far more advanced at demolishing their own and others' lives. Many of these people have been victimized in the past and are trying to break out of a cycle of abuse and victimization. You will hear some truly horrifying stories. This affected me in two ways. First, I thought, "Geez, my life could be a whole lot worse." Second, it is inspiring to see that, despite all they've been through and are going through, these people are walking, talking, laughing, and taking positive steps to improve their lives and the lives of their loved ones.

ETA, well, luchog covered these points better than I can.
 
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I think the problem people run into is thinking that there's only one kind of addiction, one kind of addict, and that one kind of treatment should work best for most people. For some addicts, the cold-turkey, pull yourself up by the bootstraps approach works. For others, the Rational Recovery method might be best.


I agree, which is why earlier in this thread, I said:

On the other hand, I firmly believe that A.A. does not have a monopoly on sobriety. There are a variety of paths that one can take to acheive sobriety. Many people find one path easier than others and I would never want to discourage someone who is satisfied with his or her path.
 
The definition of alcoholism as a disease is, to my mind, counterproductive and incorrect. A disease is something caused by a pathogen, a foreign invading organism. Anything else would be a disorder or dysfunction. AA itself doesn't refer to alcoholism as a disease, for similar reasons.

This is not how disease is commonly used how ever. People would include things like cancer, which is not a foreign invading organism but rather a domestic terrorist. As well as genetic diseases and so on.

Disease is a very imprecise term.
 
actually that is the only thing the higher power CANT be. You are helpless against addiction, remember? You can pick anything but yourself, which is kind of crap if you ask me. If anyone is going to stop you from doing something its YOU.

This is what really bugs me about AA, religious stuff aside. Telling people that nothing they do is their fault and that nothing they can do will help them quit seems incredibly counter-productive and is simply not true. It is like the recent case of the baby that recovered after 30 minutes of attempted resuciation had failed. The parents, and many others, praise god for this miracle, instead of thanking the medics who actually did the work. Support might help many people recover, but to claim that it was the support and not you that recovered is just silly. It is even worse to say this from the start. In the end, you are the only person that can end your own addiction, whether you have help or not.
 
I also wonder if AA's 12-step program is founded on any science at all. I wonder if there are any scientific studies to support their assertions. I wonder if the 12 steps are just simply a modification of the 12-steps to become a better christian programs.

I don't know, I haven't read the big book in a while. AA was started by white men who kept ending up in the hospital because of thier addiction.

the science says that about 30% will find effective strategies to avoid relapse. the issue about the other percent is that the program offends many (Which is where Jeanne Kirkpatrick comes in with SoS (?)) and others just don't want to quit.
 
I agree with their model of addiction. The "disease" model just seems to feed into the feeling that addicts are powerless. It's my opinion that addicts need to become empowered over their addictions in order to overcome.


Very good point and the one that Jeanne Kirkpatrick stressed, especialy for women.

The point to the powerlessness is that you have to admit you can't control (power) your use. RA says the same thing but in language I find to be better. If you are an addict: You use, you loose.

Now it would appear that some people can play in the shallow water without drowning, and I have know one or two, self confessed alcoholics who did have one or two beers after they quit. But they both survived WWII and may have been self medicating. But both of them never returned to use, they just had that one or two beers and said they didn't need it. They were committed to the idea that they would not use and wanted to prove a point.
 
This is what really bugs me about AA, religious stuff aside. Telling people that nothing they do is their fault and that nothing they can do will help them quit seems incredibly counter-productive and is simply not true. It is like the recent case of the baby that recovered after 30 minutes of attempted resuciation had failed. The parents, and many others, praise god for this miracle, instead of thanking the medics who actually did the work. Support might help many people recover, but to claim that it was the support and not you that recovered is just silly. It is even worse to say this from the start. In the end, you are the only person that can end your own addiction, whether you have help or not.

Well the main point I think that Bill W. found was that he was powerless to control his addiction, and therefore he could not use. the rest of it is windowdressing that occupies the mind while you are not using. Some things you can change and some you can't, if you are an addict you can not control your addiction, so you have to admit that and choose to not use no matter what.

That is the theory at any rate. I find the twelve step language less offensive than the patronising attitude of a small number of people in the groups who seem to glory in the suffering of others and shove in your face how they are soooo grateful to be sober. But only because your life is a mess. I can remodel the 12 steps to suit my language, but the whole things is really wierd and religous.
 
Telling people that nothing they do is their fault and that nothing they can do will help them quit seems incredibly counter-productive and is simply not true.
Substance abuse is characterized by a warped sense of self, of reality, and of personal responsibility. The degree to which the substance is cause or effect may be debated endlessly, but resolving the debate is not a prerequisite for recovery.

Active addicts and alcoholics tend to be either too easy on themselves, or too hard. When they aren't avoiding their own responsibilities and blaming others for their difficulties, they are beating themselves up for things they couldn't have done anything about. I don't like the word, "fault". Recovery is about learning to make better choices. Part of that is developing a more balanced sense of responsibility, and learning to focus on solutions rather than problems (and proper allocation of blame). It goes way beyond just not drinking.

AA's message is not that God will descend from the clouds to yank the bottle from the hands of the powerless alcoholic. On the contrary, what you hear endlessly repeated are platitudes like: "If you don't pick up the first drink, you won't get drunk". I can't offer any scientific explanation for why hearing that sort of thing is helpful. I wouldn't dismiss the theraputic value of the mere presence of others who, despite being similarly afflicted, have managed to wrest some modicum of normalcy from the wreckage of lives which were formerly not merely chaotic, but often tragically so.
 
I found A.A. helpful in getting sober, even though there were lots of completely absurd things said at meetings. I think the best part is that no one actually speaks for A.A. Still, by the time I got my life mostly straightened out, I had grown really weary of the near manic and cult-like feel of meetings. (Also, back then, there were precious few non-smoking meetings, and it was getting to be extremely unhealthy.)

I think more than the "program" itself, I benefited from the social support.

I guess the best lesson was the business about acceptance and denial: it's not about how things ought be, or what's fair or right, but about dealing with things as they actually are.

It'll be 20 years for me in April. I've been sober longer than I drank.

I can remember people telling me that the ones who quit going to meetings end up drinking again. Even then I was aware that this wasn't something they could know. Back then I wasn't "out" as an atheist, but I never was enthusiastic (ahem--note the etymology) about reciting the prayers or talking about God or higher power or any of that.

As far as the disease concept of alcoholism, I always took that mostly to mean that it's not so much about morality. In fact, I don't think I became a morally better person when I got sober (except for the drinking itself, I suppose). It's not like I was an evil sinner then, and now I'm some kind of saint--not at all. I think a lot of people in A.A. believe otherwise--that for an alcoholic to stay sober they've got to completely reform themselves on the order of a born-again Christian.
 
After I posted, I just remembered another of the A.A. slogans. "There's bad in the best of us and good in the worst of us."
 
Serious long term Meth addict clean for 17 years.

Was an NA member very active for the first two years, even got into the politics as a GSR. The group was what drove me to NA. The other addicts helping each other. Not the steps not the god crap, helping and being helped. After several years I found that it seemed to me that no one was getting better, they were just abstaining and always apparently on the brink of a relapse. I also had this odd belief that the only HP I knew was my rational self, but everyone I met insisted that the HP had to be a power greater than myself.

So when I moved to Hong Kong I did not get involved. But after a few years here I was lonely and needed a group. So I got involved for a while, same thing. people with years more than me were still talking (and doing relapse), and praying to FSM they would not. Again I left.

It is too bad really. As a guy who has found a way for 17 + years I think I may ave something to offer to others struggling. But what I know is that what I have to offer is contrary to much of the 12 steps programs.

As to disease. There is gathering evidence that 1. The brain of at least some addicts has a physical dopamine disorder. 2. Many drugs change the brain once taken, strengthening the addiction.

http://www.utexas.edu/research/asrec/dopamine.html
http://www.sciencedaily.com/releases/2007/03/070302082810.htm
http://www.physorg.com/news89575066.html
 
I drank like a fish for over twenty years. Did alot of stupid things and things that were not right. My health forced me to stop and I have not had a drink in over two years. I did it on my own. Same with smokes (though do smoke cigars). People need to take control of their lives. Do not hand that control over to anyone else. At this point I do not miss drinking but do miss the socialization that was part of the party. As to another addiction. I work out like an animal. So I guess you do trade one for another.
 

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