AA, Al-anon, all those other 12 step programs are *not* group therapy. There is no licensed or trained social worker, psychiatrists, psychologist, etc., to supervise and lead the group. Group members do not comment on what other people say, it is not interactive. No one gets called on their b.s. like they do in group. The 2 Al-anon groups I attended were shocking in that all I wanted to say to people was, "you need therapy. you don't have a "disease," you have issues. your (mother/father) was a lousy parent and they hurt you. work through it an move on." I saw people wallowing in their dysfunction, going on and on about their "disease" which seems to be no more than being somehow related to or involved with an alcoholic. It seemed like everyone was just being reinforced in their dysfunction; maybe they were comforted by being with others going through the same thing, but there was nothing resembling therapy. AA is free, that is why our court system pushes it over things like Cognitive Behavioral Therapy that have a better track record of success. Maybe someone after sitting in Al-anon or AA can have some sort of breakthrough, but they'd get there a lot faster with a trained therapist helping them adjust their thinking and behavioral patterns.

If there are pharmacological treatments that can help people stay off drugs and alcohol, or stop engaging in other destructive behaviors, I'm all for it. We often describe addicts as "self-medicating." Why the idea of pharmacological treatment for addiction is so controversial is beyond me. I've met several alcoholics where I really felt that, like the author of one of the books, they had serious anxiety issues and used alcohol cope. There was no way they could stay sober if they couldn't eliminate or manage the anxiety. It was a vicious cycle; they couldn't deal whith what was causing the anxiety while they were drinking, they couldn't stop drinking until they could control the anxiety. If there is a drug that can break that cycle, even if someone still needs talk therapy to work through underlying issues, it is criminal to withhold it. It seems to be another example of American puritanism, that addiction is a moral failure, not a biochemical one. It is a false dichotomy to view addiction as either bio-chemical or the result of life experiences. Environment and trauma can alter brain chemistry, look at PTSD.

Given the abyssmal success rate of most addiction treatment in this country, you'd think the 12 step model would be long gone but somehow, with no evidentiary support for its effectiveness, courts order people into AA, the government spends millions of dollars on 12 step rehab programs, and families spend tens, if not hundreds of thousands of dollars putting relatives into the same type of program over and over again. There is a lot of money to be made selling a treatment that people have to keep repeating over and over again. There is little motivation to come up with something new and those that do are held to a much higher standard to demonstrate effectiveness than any 12 step program ever is.

We're a country of whining children. By calling an otherwise boring, everday weakness an addiction and therefore an illness, we get to claim the sympathy and attention that people naturally extend to us when we're sick. (Hypochondriacs learned this long ago.) Also, we get to foist responsibility for our failings onto our genetics, our surroundings, our physiological conditioning--anything except our own sorry decisions.

It's a cliche, and therefore probably true, that addicts are trying to fill an inner emptiness. Usually, however, the best way to go about filling that inner emptiness is to stop being so goddamn self-absorbed, get up off your ass, and do something to make another person's life better.

Toxic social expectations and norms are the source of many people's anguish.

I think a lot of people would be more liberated with some philosophical enlightenment then mea culpas and therapy.

In the book "Alcholics Anonymous", the basic text for recovering alcholics, there is a section that urges the alcoholic in recovery to "be quick to see where religious people are right" and to make use of the physicians, psychiatrists and therapists that are outside of the 12-Step world. In other words, A.A. urges its members to seek help enlarging their spritual life and working out deep-rooted psychological problems. It also tells its members to get off their asses and help others. A.A. does not claim to have the monopoly on recovery or on God. It just has a program that works.

A.A. was a spin-off from the Oxford Groups, a recovery program that was in fashion during the 1930's, they did not survive. However, A.A. has lasted for over 70 years. Just a thought.

If you really want to read a thoughtful, intelligent book on addiction and recovery forget about these books and get _In_Realm_of_Hungry_Ghosts_ by Dr. Gabor Mate. In it he brings together a wealth of knowledge, drawing upon science, research, his own experience working with addicts as well as a compassionate and mature perspective. He acknowledges the many and varied factors that contribute to (not 'cause') addiction. He proposes no one 'cure', which may disappoint an audience looking for easy answers, but he does offer a remarkably nuanced understanding and hope.

I can't speak for any other 12 step fellowship but Narcotics Anonymous is very international and very fast growing. In the Middle East, for example, e.g. Iran. The new Basic Text (NA equivalent of AA's Big Book) has stories from all over the world.

it cedes deeper understanding by accepting the false frame of a “dilemma” posed by a question of “treating” addictive behaviors psychopharmacologically versus by the traditional 12-Step, AA/NA model. In fact neither is a type of treatment for addiction.

Psychotropic medications are not treatment for behavioral disorders or mental illness. They are used to mask or dampen symptoms; they bring symptomatic relief. That dampening can be useful in bringing individuals into functional spaces in which they can take advantage of therapeutic interventions that can lead to long-term gains by addressing maladaptive behaviors, internal models, early experiences, environmental stressors, and other factors. Such relief can be critical in acute care for dangerously disordered behavior, e.g. as associated with psychosis. Addictive behaviors are maladaptive attempts to lessen inner distress, and are almost certain to recur until the source of that inner distress is addressed in therapy.

The 12-Step/AA/NA system is not intended to provide treatment for addictive behaviors, which is why it has no therapeutic value. Its principles and beliefs run directly counter to factors known to have therapeutic value in clinical treatment of mental health disorders. Its actual purpose, transparently so, is to keep addicted individuals comfortably addicted and to avoid the discomfort of emotional and behavioral change. It’s participants are encouraged to remain addicted by substituting addictive use of food or especially nicotine, one of the most lethal and addictive substances known (also a gateway drug), while being patted on the back for being “clean and sober”. As such, it constitutes a well-developed system of denial and other ego defenses used to maintain addiction. About 90 percent relapse. Those who stay clean do so in spite of the countertherapeutic factors they are exposed to in AA/NA.

It’s a symbiosis. The relapsing addict coming into AA receives praise, supported denial, and encouragement for doing what the addict wants more than anything to do - staying addicted and avoiding the distress of change and of inner growth. There is a huge payoff for the “old-timers” in meetings and for treatment providers (almost always individuals “in recovery”) in the 12-Step-run treatment industry – by focusing attention on the rapidly turning-over and relapsing newcomers and aggressively labeling them “addicts”, “in denial”, etc., they utilize the ego defense of projection - projecting away their own continuing addictive behaviors. The worldwide organization creates an illusion of legitimacy by claiming “millions” of adherents, “millions helped”. In that way, some sheen of legitimacy is provided the medical “disease” model of addiction and the religion-based precepts embedded in 12-Step, both representations of patriarchal control. Turf is protected, addicts kept addicted. The alliance of medicine, religion, and 12-Step gains the illusion of legitimacy by providing for continued addiction, remarkably under the constructed guise of “treatment”. With those kinds of payoffs, change is an uphill battle.