AA’s Dominance in the US is Harmful
by A. Tom Horvath, PhD., ABPP
It would be easy to misunderstand the title of this article. I’m not saying that AA (Alcoholics Anonymous) is harmful. On the contrary, many people attend AA and report it to be helpful. In the US there may be one million individuals or more active in AA at any one time. A significant percentage may attend under court order, but the rest are free to quit anytime. Although some individuals hate AA and speak their hatred loudly, it appears reasonable to believe that individuals who freely attend AA are not experiencing it as harmful.
In most other countries AA also has meetings, but does not dominate the recovery environment. In these countries there is a much greater opportunity to choose from an array of recovery approaches (including the DIY—do it yourself—approach).
The reason AA’s dominance is harmful is that this dominance reduces choice. Unfortunately what most people who have addiction problems are told is that is “AA is the only successful approach.”
From a scientific perspective, there isn’t even sufficient evidence to confirm that AA is a successful approach. This fact may surprise you, given how much you may have heard about AA’s success. AA is clearly successful as an organization. Its success as an approach to recovery remains to be verified, and may never be.
Every three years the U.S. Secretary of Health and Human Services sends a report to Congress entitled Alcohol and Health. The 1990 report states: “The effectiveness of AA has not been scientifically documented, and methodological problems make such an evaluation difficult” (pg. 265). The National Academy of Sciences published in 1990 a massive report entitled Broadening the Base of Treatment for Alcohol Problems. The National Academy of Sciences was established in 1863 by Congress as its advisory body on the application of scientific knowledge to public policy, and in the United States there is no higher authority on such applications. This report (commissioned by Congress in 1986) states: “AA is considered by many lay persons and professionals to be the most successful treatment for persons with alcohol problems, despite the lack of well-designed and well-executed studies that can be cited to support or negate the validity of this perception” (pg. 111).
Although the above quotations may seem ancient in the internet age, the conclusions they report have not changed. Addiction scientists have moved on to other issues.
When professionals and AA members keep saying that AA is the only way, it discourages the tens of millions of Americans, who may want to consider changes in their behavior, from considering the range of options available. Instead of thinking “there must be alternative approaches out there, I’ll look for them” many people get discouraged and delay doing anything. In fact there are scientifically validated non-AA-based treatments, as well as free support groups (including SMART Recovery, Moderation Management, Women for Sobriety, LifeRing Secular Recovery and Secular Organizations for Sobriety). However, when you hear “AA is the only way” it may not occur to you to look for alternatives.
I believe, therefore, that AA’s dominance is harmful to the millions who are discouraged from considering all their options. Because there are so many of these individuals, the harm to them outweighs the benefits AA provides to its participants. AA could continue to do its helpful work without people being misled that AA is the only or best way to recover.
As alternative approaches gain more prominence this situation in the US will gradually change. In the meantime you can be helpful by clearly stating whenever relevant that there are many approaches to change, and that AA is only one among many.