Alcoholics Anonymous: Cult Lite

[Note: The following was a debate conducted with Robin Room on the CD list. Room, Vice President of Research at the Addiction Research Foundation in Toronto, has in the past declined to allow his materials to be used at this site -- for "the same reason you wouldn't want Love and Addiction used" -- as though Room's position on this matter would be a great money maker.]

Robin Room took the position that AA is not psychologically coercive because individuals are supposedly only allowed to comment on their own experiences.

Kerry Heffner supported Room's position:

But the "theory" of AA is decidedly non-totalitarian. For example, the 12 Traditions suggest that AA has no opinion on outside issues, it is a fellowship of recovered alcoholics who meet to share their experience, strength, and hope. In the "Big Book," Bill Wilson wrote that people who don't think AA is for them should be told, in essence, "Okay. Go on drinking or whatever. If you decide to return we'll be here."

Part of the difficulty is that what many people refer to as "12-Step Treatment" programs (i.e., the Minnesota model, 12-Step Facilitation) have incorporated AA as a component into their treatment program. In these treatment programs there is confrontation, denial breaking, a demand for total abstinence, lectures on the genetics of alcoholism, and a multitude of other reification tactics to "create" alcoholics. I'm not sure, but I think Robin would agree with this.

Stanton replied:

When an individual comes to AA, he/she knows some things are required for fundamental membership. Chief of these is to declare yourself an alcoholic. It may be friendly (although I have observed great hostility towards individuals who refused to declare themselves this way) but there is no backing out, and many people (especially the DWIs who quit as soon as they can) experience great anxiety around it. When people are compelled to take on a self-identification with which they disagree or about which they are unsure, when great group pressure is placed on this identification, what do you call it? Again, these tales are described in detail and at length in David Rudy's Becoming Alcoholic and Ken Ragge's More Revealed. (Room also recommended that I read Charles Bufe's book, Alcoholics Anonymous: Cult or Cure, which decided AA is not a cult. I replied: I know Bufe's book and I believe I am writing a preface to his new edition. Not being a cult -- for example not having a charismatic [living] leader or using physical coercion -- takes one out of one category, like Nazism, but leaves much room for mind control and psychological coercion.)

See Overcoming disease treatment for addiction

I can only marvel at the lack of psychological insight Robin's comments reveal -- that AA is not coercive because the rule is "no cross-talk."

One experience I have which may be unique for a "social-behaviorist" is the time I spent lecturing to AA grads going through counseling programs and attending conferences for counselors. (I did this at the UC Berkeley alcoholism counseling certificate granting program when Room was at Berkeley.) These experiences were surreal, particularly at a University, as people reviled me for even suggesting any alternative approaches to AA. Robin, you ought to try it some time. Moreover, did the regular Berkeley faculty have any obligation, do you think, to pay attention to official support UC gave to people emerging from programs like these endorsing know-nothingness?

In these programs, people showed what was either a totalitarian mind set/or a hyper psychological sensitivity to any challenge to their philosophy of sobriety for which the only previous equivalents in my experience occurred in clinical settings. At one "meeting," a woman asked me if she could could join my "group." Another walked out, saying she would have to kill me if she stayed.

Meanwhile, the horrible blood letting around controlled drinking, culminating in the Sobells' persecution, is a chapter yet to be fully plumbed in America. Of course, what is amazing vis-a-vis Room's Olympiad detachment is that Pendery et al. sharpened their teeth on the Alcohol Research Group and Cahalan and Room before turning to the Sobells.

I describe these experiences in: Denial - of Reality and of Freedom - in Addiction Research and Treatment

Of course, this has colossal policy implications, and is why American treatment remains stalled in AA and 12 steps. But it is also a commentary on the AA experience, the kind of thing for which the sociological study of brainwashing was my best academic preparation.

Kerry Heffner clarified his position:

Stanton: There may be less of a difference between us than it appears. I'm NOT suggesting that AA is this harmless little social organization where there is open expression and rational thinking -- I haven't come across one of those since the commune and--even there--there were strong pressures to conform. You characterize AA as "a m[i]nd bending experience along the lines of a cult....with major group directed influences on changing the individual's mind set and self-conception."

As if it could be anything else! I'd argue that growing up (in a family, community, society, and culture) is an experience with major group-directed influences on changing individual mind sets and identities. I think there are much better--and more productive--criticisms of AA than that it is "cult-like." The cult argument serves to distance and pathologize and I think there are more useful conversations to be had about AA.

You are free to quote me on anything I say in public. My real concern is that the context of the argument doesn't get lost or distorted. I'd hate to be known in public as being 100%, gung-ho supportive of AA--I'm not. AA serves some useful functions for some people some of the time. For the majority of problem drinkers, it is inappropriate. And for a small minority it may be harmful. (I suppose this is where we'd disagree the most--on the harmfulness of the program.)

I also discussed with John Kline of the University of Arizona on the SSCP (the scientific study of clinical psychology, Division 12 of the APA, list), in which Kline repeatedly chastised me for failing to distinguish between AA 12-steps and the commercial variety. [Kline also refused to allow me to use his material at my site, even if I quoted him verbatim, saying, "Your web site has the appearance and credibility of the National Enquirer."]

I posted SSCP with the following in answer to Kline:

National Treatment Center Study

Summary Report

A comprehensive report detailing findings from on-site interviews at 450 alcohol and drug addiction treatment programs nationwide

January 1997

The National Treatment Center Study is funded by research Grant R01-AA-10130 from the National Institute on Alcohol Abuse and Alcoholism, a component of the National Institutes of Health, U.S. Public Health Service.

National Treatment Center Study
Project Staff

Principal Investigators:
Paul M. Roman, Ph.D. - University of Georgia
Terry C. Blum, Ph.D. - Georgia Institute of Technology

FROM PAGE 4:

The National Treatment Center Study

This report summarizes data obtained during on-site interviews at a nationwide random sample of 450 private-sector alcoholism and chemical dependency treatment programs. Our research emphasizes the means by which these programs cope with a turbulent and uncertain environment, and the strategies they adopt for their long-term survival and success. Our participating centers are drawn from a stratified random sample of geographic areas throughout the United states, and constitute a random sample of all programs meeting eligibility criteria (defined below). Interviews with program administrators, clinical directors, and marketing directors (or their designated representatives) were conducted between June 1995 and September 1996. On-site visits to each facility lasted between 90 minutes and 3 hours. In all, 89% of the centers invited to participate in our study agreed to do so.

FROM PAGE 24:

12-Step Models:

419 facilities (93.1%) offer treatment programming based on a 12-step model.

375 facilities (83.3%) hold 12-step meetings on-site. These include:

AA - 81.8%
CA- 22.7%
NA - 59.6%
Other - 33.3%

339 treatment programs (75.3%) offer 12-step groups which are open to community residents.

Nearly all of the programs (98.6%) said they advocated abstinence from alcohol for all of their alcohol and/or drug dependent patients.