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Copyright ©️ JAAllison, 2019
In the Western world, nothing is safe from being commodified a prevailing monopoly exists. There are a select few groups and corporations that own the majority of enterprises and entities, extending their dominance even to the field of substance abuse treatment, where Alcoholics Anonymous (AA) has gained prominence in the mainstream treatment system. Despite assertions made by AA regarding its unique efficacy, it still yields a mere 7-10% success rate due to many misleading claims. Meanwhile, other alternative treatments are demonstrably more effective than AA, yet remain unknown in the substance abuse treatment industry.
During my schooling, I encountered an individual named Alex, who exhibited introverted tendencies and a propensity for overthinking. Unbeknownst to him, his heightened sensitivity predisposed him to absorb the emotions of others, leading to heightened anxiety. Subsequently, the discovery of the effects of alcohol provided him with a newfound sense of ease and self-assurance, facilitating his integration into social settings and enabling him to express his authentic self among peers.
Embracing a routine of alcohol consumption before classes, Alex transformed reticence into confidence, gaining popularity within both his immediate peer group and the wider school community. However, the prolonged consumption of alcohol eventually resulted in adverse effects on his physical well-being.
In light of Alex’s history of alcohol and drug abuse, mostly receiving two DWIs along with two previous DUIs, a judge recommended that he see a therapist, particularly one who specializes in substance abuse. Alex, however, had trained himself to believe that liquor was necessary for him to feel comfortable enough to speak his mind. Before he was able to be open with his therapist, he had to finish a pint of Irish whiskey.
He found himself in treatment two months later with a black eye following an incident that occurred the night before. He spent a month at the center attending meetings of Alcoholics Anonymous as part of his treatment. E mom
He felt utterly defeated. And according to AA doctrine, the failure was his alone. When the 12 steps don’t work for someone like Alex, Alcoholics Anonymous doesn’t have the individual take responsibility for his fault, but instead he is deeply flawed. The (“Big”) Book of Alcoholics Anonymous states:
Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.
This is read at the beginning of every meeting. The instruction comes from “How it Works,” the fifth chapter of the Big Book. Even though it remains in the back of your mind like a subliminal message, the effect is far greater if one is conscious of it, especially if one chooses to follow such detrimental words.
Alex’s despair was only heightened by his seemingly lack of options. “Everybody I talked to told me there was no other way,” he said.
The 12 steps are so deeply ingrained in the United States that many people, including doctors and therapists, believe attending meetings, earning sobriety chips, and never taking another sip of alcohol is the only way to get better. Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment. Doctors have a hard time understanding that there is no one-size-fits-all treatment for addicts (or anything, for that matter). Despite this, there are alternatives, including prescription drugs, therapies, and realistic programs that aim to help patients learn to drink in moderation. Unlike Alcoholics Anonymous, these methods are based on modern science and have been proven, in randomized, controlled studies, to work.
For Alex, it took years of trying to “work the program,” pulling himself back onto the wagon only to fall off again, before he finally realized that Alcoholics Anonymous was not his only or even his best, hope for recovery. But in a sense, he was lucky, for many others never made that discovery at all. Until, a “rehab-fling” had introduced him to a whole other world of addiction, one that had stuck a heroin-filled needle in his arm…
The discussion surrounding the effectiveness of 12-step programs has persisted quietly among addiction experts for decades. However, it has gained newfound significance following the enactment of the Affordable Care Act. This legislation mandates that all insurers and state Medicaid programs cover alcohol and substance abuse treatment, thereby extending coverage to 32 million previously uninsured Americans and offering enhanced coverage to an additional 30 million individuals.
In the realm of medicine, few treatments are as inadequately supported by modern scientific evidence as those for addiction. A 2012 report by the National Center on Addiction and Substance Abuse at Columbia University drew parallels between the current state of addiction medicine and the early 1900s era of general medicine when unqualified practitioners operated alongside formally trained physicians. According to the American Medical Association, out of one million physicians in the United States, only 582 identified themselves as addiction specialists. (It is worth noting, as highlighted in the Columbia Report, that there may be additional physicians with a subspecialty in addiction.)
The majority of treatment providers hold credentials as addiction counselors or substance abuse counselors, for which many states impose minimal educational requirements such as a high school diploma or a GED. Furthermore, many counselors are individuals in recovery themselves, a topic that will be explored further. The report stated, “The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.”
Alcoholics Anonymous was established in 1935 when knowledge of the brain was in its infancy. It offers a single path to recovery: lifelong abstinence from alcohol. The program instructs members to surrender their ego, accept that they are “powerless” over alcohol, make amends to those they’ve wronged, and pray and meditate—much like a religion or cult.
Alcoholics Anonymous is famously difficult to keep tabs on, in that it keeps no records of who attends meetings; members come and go, and of course, remain anonymous. So if a judge orders you to attend AA meetings, any forged signature will do and the judge will be none the wiser.
No conclusive data exists on how well the program works. In 2006, the Cochrane Collaboration, a health-care research group, reviewed studies going back to the 1960s and found that “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.”
The Big Book includes an assertion first made in the second edition, which was published in 1955: that AA has worked for 75 percent of people who have gone to meetings and “really tried.” It says that 50 percent got sober right away, and another 25 percent struggled for a while but eventually recovered. I’ll say it again, due to its anonymity, there can’t be any conclusive evidence. According to AA, these figures are based on members’ experiences.
In his book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, Lance Dodes, a retired psychiatry professor from Harvard Medical School, looked at Alcoholics Anonymous’s retention rates along with studies on sobriety and rates of active involvement (attending meetings regularly and working the program) among AA members. Based on his data, he put AA’s actual success rate somewhere between 5 and 8 percent. That is just a rough estimate, but it’s the most precise one you will find.
We’ve grown so accustomed to testimonials from those who say AA saved their life that we take the program’s efficacy as an article of faith. Rarely do we hear from those for whom 12-step treatment doesn’t work. But think about it: How many celebrities can you name who bounced in and out of rehab without ever getting better? Why do we assume they failed the program, rather than the program had failed them?
Amy Lee Coy, the author of the memoir From Death Do I Part: How I Freed Myself From Addiction, told about her eight trips to rehab, starting at age 13. “It’s like getting the same antibiotic for a resistant infection—eight times.”
She and countless others had put their faith in a system they had been led to believe was effective—even though finding treatment centers’ success rates is next to impossible: facilities rarely publish their data or even track their patients after discharging them. “Many will tell you that those who complete the program have a ‘great success rate,’ meaning that most are abstaining from drugs and alcohol while enrolled there,” says Bankole Johnson, an alcohol researcher and the chair of the psychiatry department at the University of Maryland School of Medicine.
Well, no kidding.
Alcoholics Anonymous has more than 2 million members worldwide, and the structure and support it offers have helped many people. But it is not enough for everyone. The history of AA is the story of how one approach to treatment took root before other options existed, inscribing itself on the national consciousness and crowding out dozens of newer methods that have since been shown to work better.
A meticulous analysis of treatments published more than a decade ago in The Handbook of Alcoholism Treatment Approaches but still considered one of the most comprehensive comparisons, ranks AA 38th out of 48 methods. At the top of the list are brief interventions by a medical professional; motivational enhancement, a form of counseling that aims to help people see the need to change; and acamprosate, a drug that eases cravings.
An oft-cited 1996 study found 12-step facilitation—a form of individual therapy that aims to get the patient to attend AA meetings—as effective as cognitive behavioral therapy and motivational interviewing. But that study, called Project Match, was widely criticized for scientific failings, including the lack of a control group.
People with alcohol problems also suffer from higher-than-normal rates of mental health issues, and research has shown that treating depression and anxiety with medication can reduce drinking. However AA is not equipped to address these issues—it is a support group whose leaders lack professional training—and some meetings are more accepting than others of the idea that members may need therapy and/or medication in addition to the group’s help.
AA truisms have so infiltrated our culture that many people believe heavy drinkers cannot recover before they “hit bottom.” Researchers compare it to only offering antidepressants to those who have attempted suicide, or prescribing insulin only after a patient has lapsed into a diabetic coma. “You might as well tell a guy who weighs 250 pounds and has untreated hypertension and cholesterol of 300, ‘Don’t exercise, keep eating fast food, and we’ll give you a triple bypass when you have a heart attack,’ ” says Mark Willenbring, a psychiatrist in St. Paul and a former director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism.
Part of the problem is the one-size-fits-all approach. Alcoholics Anonymous was originally intended for chronic, severe drinkers—those who may, indeed, be powerless over alcohol—but its program has since been applied much more broadly. Today, for instance, judges routinely require people to attend meetings after a DUI arrest; in all, 12 percent of AA members are there by court order. (These aren’t the brightest crayons in the box either, seeing that the signatures required for court can easily be forged, with AA’s anonymity.)
Whereas AA teaches that alcoholism is a progressive disease that follows an inevitable trajectory, data from a federally funded survey called the National Epidemiological Survey on Alcohol and Related Conditions show that nearly one-fifth of those who have had alcohol dependence go on to drink at low-risk levels with no symptoms of abuse. A recent survey of nearly 140,000 adults by the Centers for Disease Control (CDC) and Prevention found that nine out of 10 heavy drinkers are not dependent on alcohol and, with the help of a medical professional’s brief intervention, can change unhealthy habits.
The United States already spends about $35 billion a year on alcohol- and substance abuse treatment, yet heavy drinking causes 88,000 deaths a year —including deaths from car accidents and diseases linked to alcohol. It also costs the country hundreds of billions of dollars in expenses related to health care, criminal justice, motor vehicle crashes, and lost workplace productivity, according to the CDC.
With the Affordable Care Act’s expansion of coverage, it’s time to ask some important questions: Which treatments should we be willing to pay for? Have they been proven effective? And for whom—only those at the end of the spectrum? Or also those in the vast, long-overlooked middle?
work treatment model is based in large on the work of an American neuroscientist named John David Sinclair.
Sinclair has researched alcohol’s effects on the brain since his days as an undergraduate at the University of Cincinnati, where he experimented with rats that had been given alcohol for an extended period. Sinclair expected that after several weeks without booze, the rats would lose their desire for it. Instead, when he gave them alcohol again, they went on week-long benders, drinking far morue than thoooo oooooo ey ever had before—more, he says, than any rat had ever been shown to drink.
Sinclair ioooooo pppPpppPpppopppp popp the alcohol-deprivation effect, and his laboratory results, which have since been confirmed by right other studiellpp popp s, suggested a fundamental flaw in abstinence-based treatment: going cold turkey only intensifies cravings. This discovhissery helped explain why relapses are common.
Sinclair published findings in a handful of journals and the early 1970s moved to Finland, drawn by the chance to work in what he considered the best alcohol research lab in the world, complete with special rats that had been bred to prefer alcohol to water. He spent the next decade researching alcohol and the brain.
Sinclair came to believe that people develop drinking problems through a chemical process: each time they drink, the endorphins released in the brain strengthen certain synapses. The stronger these synapses grow, the more likely the person is to think about, and eventually crave, alcohol— until almost anything can trigger a thirst for booze, and drinking becomes compulsive.
Sinclair theorized that if you could stop the endorphins from reaching their target, the brain’s opiate receptors, you could gradually weaken the synapses, and the cravings would subside. To test this hypothesis, he administered opioid antagonists—drugs that block opiate receptors—to the specially bred alcohol-loving rats. He found that if the rats took the medication each time they were given alcohol, they gradually drank less and less. He published his findings in peer-reviewed journals beginning in the 1980s.
Subsequent studies found that an opioid antagonist called Naltrexone was safe and effective for humans, and Sinclair began working with clinicians in Finland. He suggested prescribing Naltrexone for patients to take an hour before drinking. As their cravings subsided, they could then learn to control their consumption. Numerous clinical trials have confirmed that the method is effective, and in 2001 Sinclair published a paper in the journal, Alcohol and Alcoholism, reporting a 78 percent success rate in helping patients reduce their drinking to about 10 drinks a week. Some stopped drinking entirely.
The most common course of treatment involves six months of cognitive behavioral therapy, a goal-oriented form of therapy, with a clinical psychologist. Treatment typically also includes a physical exam, blood work, and a prescription for naltrexone or nalmefene, a newer opioid antagonist approved in more than two dozen countries.
When looking at how much all of this costs, it comes out at about $2,500—a fraction of the cost of inpatient rehabs in the United States, which routinely runs in the tens of thousands of dollars for a 28-day stay.
Some of the treatments offered at top-of-the-line rehab centers include equine therapy, art therapy, and mindfulness mazes in the desert. None of these have any scientific proof of aiding in recovery from addiction. Yet, even at some of the bare-bones facilities, they charge as much as $40,000 a month and offer no treatment beyond AA sessions led by minimally qualified counselors.
Still, AA is painted as a lily-white, all-volunteer group offering its “spiritual” program on a take-it-or-leave-it basis, and it operates on the principle of “attraction, rather than promotion.” This is about as true as maintaining that people “voluntarily” pay taxes.
AA’s sixth tradition states that “AA ought never to endorse, finance, or lend the AA name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.” This is contradicted by one of AA’s methods of coercion for “attracting” new members: AA’s promotional “Alcoholics Anonymous Membership Survey” brochure.
The brochure describing the 1996 survey, for instance, reveals that 16 percent of AA members were originally introduced to AA by the courts or penal system. Taking other avenues of coercion into account, such as threats of job loss and coercion by treatment centers, the statistics published in AA’s Membership Survey brochures strongly suggest that the total percentage of AA’s active members who were originally coerced into attendance exceeds 40 percent.
The majority of newcomers are coerced into attendance—and then leave as quickly as they can through AA’s “revolving door.” It is routine for the courts to sentence DUI defendants to attend AA (and often 12-step treatment as well).
Does it kinda seem as if all of this could have been made by design? That would be ludicrous… right? Let’s find out…
So, how exactly did AA start?
In 1934, just after Prohibition’s repeal, a failed stockbroker named Bill Wilson staggered into a Manhattan hospital. Wilson was known to drink two quarts of whiskey a day, a habit he’d attempted to kick many times. He was given the hallucinogen Belladonna, an experimental treatment for addictions, and from his hospital bed he called out to God to loosen alcohol’s grip. He reported seeing a flash of light and feeling a serenity he had never before experienced. He quit booze for good.
The next year, he co-founded Alcoholics Anonymous. He based its principles on the beliefs of the evangelical Oxford Group, which taught that people were sinners who, through confession and God’s help, could right their paths.
AA filled a vacuum in the medical world, which at the time had few answers for heavy drinkers. In 1956, the American Medical Association named alcoholism a disease, but doctors continued to offer little beyond the standard treatment that had been around for decades: detoxification in state psychiatric wards or private sanatoriums.
As Alcoholics Anonymous grew, hospitals began creating “alcoholism wards,” where patients detoxed but were given no other medical treatment. Instead, AA members—who, as part of the 12 steps, pledge to help other alcoholics—appeared at bedsides and invited the newly sober to meetings.
A public relations specialist and early AA member named Marty Mann worked to disseminate the group’s main tenet: that alcoholics had an illness that rendered them powerless over booze. Their drinking was a disease, in other words, not a moral failing. Paradoxically, the prescription for this medical condition was a set of spiritual steps that required accepting a higher power, taking a “fearless moral inventory,” admitting “the exact nature of our wrongs,” and asking God to remove all character defects. Mann helped ensure that these ideas made their way to Hollywood.
In 1945’s The Lost Weekend, a struggling novelist tries to loosen his writer’s block with booze, to devastating effect. In Days of Wine and Roses, released in 1962, Jack Lemmon slides into alcoholism along with his wife, played by Lee Remick. He finds help through AA, but she rejects the group and loses her family.
Mann also collaborated with a physiologist named E. M. Jellinek. Mann was eager to bolster the scientific claims behind AA, and Jellinek wanted to make a name for himself in the growing field of alcohol research.
In 1946, Jellinek published the results of a survey mailed to 1,600 AA members. Only 158 were returned. Jellinek and Mann jettisoned 45 that had been improperly completed and another 15 filled out by women, whose responses were so unlike the men’s that they risked complicating the results. From this small sample—98 men—Jellinek drew sweeping conclusions about the “phases of alcoholism,” which included an unavoidable succession of binges that led to blackouts, “indefinable fears,” and hitting bottom.
Though the paper was filled with caveats about its lack of scientific rigor, it became AA gospel. Jellinek, however, later tried to distance himself from this work, and from Alcoholics Anonymous. His ideas came to be illustrated by a chart showing how alcoholics progressed from occasionally drinking for relief, to sneaking drinks, to guilt, and so on, until they “hit bottom” and then recovered.
In 1952, Jellinek noted that the word alcoholic had been adopted to describe anyone who drank excessively. He warned that overuse of that word would undermine the disease concept. He later beseeched AA to stay out of the way of scientists trying to do objective research.
But AA supporters worked to make sure their approach remained central. Marty Mann joined prominent Americans including Susan Anthony, the grandniece of Susan B. Anthony; Jan Clayton, the mom from Lassie; and decorated military officers in testifying before Congress. John D. Rockefeller Jr., a lifelong nondrinker, was an early booster of the group, along with the eugenics movement and other Malthusian efforts.
In 1970, Senator Harold Hughes of Iowa, a member of AA, persuaded Congress to pass the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act. It called for the establishment of the National Institute on Alcohol Abuse and Alcoholism, and dedicated funding for the study and treatment of alcoholism. The NIAAA, in turn, funded Marty Mann’s nonprofit advocacy group, the National Council on Alcoholism, to educate the public. The nonprofit became a mouthpiece for AA’s beliefs, especially the importance of abstinence, and has at times worked to squash research that challenged those beliefs.
In 1976, for instance, the Rand Corporation released a study of more than 2,000 men who had been patients at 44 different NIAAA-funded treatment centers. The report noted that 18 months after treatment, 22 percent of the men were drinking moderately. The authors concluded that some alcohol-dependent men could return to controlled drinking. Researchers at the National Council on Alcoholism charged that the news would lead alcoholics to falsely believe they could drink safely. The NIAAA, which had funded the research, repudiated it. Rand repeated the study, this time looking over four years. The results were similar.
After the Hughes Act was passed, insurers began to recognize alcoholism as a disease and pay for treatment. For-profit rehab facilities sprouted across the country, the beginnings of what would become a multibillion-dollar industry. (Hughes became a treatment entrepreneur himself, after retiring from the Senate.) If Betty Ford and Elizabeth Taylor could declare that they were alcoholics and seek help, so too could ordinary people who struggled with drinking.
Today there are more than 13,000 rehab facilities in the United States, and about 90 percent of them follow the 12 steps. The problem is that nothing about the 12-step approach draws on modern science: not the character building, not the tough love, not even the standard 28-day rehab stay.
Marvin D. Seppala, the chief medical officer at the Hazelden Betty Ford Foundation in Minnesota, one of the oldest inpatient rehab facilities in the country, describes how 28 days became the norm: “In 1949, the founders found that it took about a week to get detoxed, another week to come around so [the patients] knew what they were up to, and after a couple of weeks they were doing well, and stable. That’s how it turned out to be 28 days. There’s no magic in it.”
Tom McLellan, a psychology professor at the University of Pennsylvania School of Medicine who has served as a deputy U.S. drug czar and is an adviser to the World Health Organization, says that while AA and other programs that focus on behavioral change have value, they don’t address what we now know about the biology of drinking.
Alcohol acts on many parts of the brain, making it in some ways more complex than drugs like cocaine and heroin, which target just one area of the brain. Among other effects, alcohol increases the amount of GABA (gamma-aminobutyric acid), a chemical that slows down activity in the nervous system and decreases the flow of glutamate, which activates the nervous system. (This is why drinking can make you relax, shed inhibitions, and forget your worries.) Alcohol also prompts the brain to release dopamine, a chemical associated with pleasure.
Over time, though, the brain of a heavy drinker adjusts to the steady flow of alcohol by producing less GABA and more glutamate, resulting in anxiety and irritability. Dopamine production also slows, and the person gets less pleasure out of everyday things. Combined, these changes gradually bring about a crucial shift: instead of drinking to feel good, the person ends up drinking to avoid feeling bad. Alcohol also damages the prefrontal cortex, which is responsible for judging risks and regulating behavior—one reason some people keep drinking even as they realize that the habit is destroying their lives. The good news is that the damage can be undone if they’re able to get their consumption under control.
Studies of twins and adopted children suggest that about half of a person’s vulnerability to alcohol-use disorder is hereditary and that anxiety, depression, and environment—all considered “outside issues” by many in Alcoholics Anonymous and the rehab industry—also play a role. Still, science can’t yet fully explain why some heavy drinkers become physiologically dependent on alcohol and others don’t, or why some recover while others flounder.
We don’t know how much drinking it takes to cause major changes in the brain, or whether the brains of alcohol-dependent people are in some ways different from “normal” brains to begin with. What we do know, McLellan says, is that “the brains of the alcohol-addicted aren’t like those of the non-alcohol-dependent.”
Eighty years ago, Bill Wilson, AA’s founding father, had insisted that alcohol dependence is an illness, not a moral failing. Why, then, do we so rarely treat it medically? It’s a question that’s been asked many times by researchers and clinicians. “Alcohol- and substance-use disorders are the realm of medicine,” McLellan says. “This is not the realm of priests.”
As the rehab industry began expanding in the 1970s, its profit motives dovetailed nicely with AA’s view that counseling could be delivered by people who had themselves struggled with addiction, rather than by highly trained (and highly paid) doctors and mental-health professionals. No other area of medicine or counseling makes such allowances.
There is no mandatory national certification exam for addiction counselors. The 2012 Columbia University report on addiction medicine found that only six states required alcohol- and substance-abuse counselors to have at least a bachelor’s degree and that only one state, Vermont, required a master’s degree. Fourteen states had no license requirements whatsoever—not even a GED or an introductory training course was necessary—and yet counselors are often called on by the judicial system and medical boards to give expert opinions on their clients’ prospects for recovery.
Perhaps even worse is the pace of research on drugs to treat alcohol-use disorders. The FDA has approved just three: Antabuse, the drug that induces nausea and dizziness when taken with alcohol; acamprosate, which is helpful in quelling cravings; and naltrexone. (There is also Vivitrol, the injectable form of naltrexone.)
There has been some progress: the Hazelden Center began prescribing naltrexone and acamprosate to patients in 2003. This makes Hazelden a pioneer among rehab centers. There was never any campaign for this medication that said, ‘Ask your doctor,’ nor was there ever any attempt to reach consumers. Few doctors accepted that it was possible to treat alcohol-use disorder with a pill. And now that naltrexone is available in an inexpensive generic form, pharmaceutical companies have little incentive to promote it.
In one study, Naltrexone was found to be effective in limiting consumption among college-age drinkers. The drug helped subjects keep from going over the legal threshold for intoxication, a blood alcohol content of 0.08 percent.
Moderate drinking is not a possibility for every patient, and doctors should weigh many factors when deciding whether to recommend lifelong abstinence. It is unlikely for a doctor to consider moderation as a goal for patients with severe alcohol-use disorder. (According to the DSM-5, patients in the severe range have six or more symptoms of the disorder, such as frequently drinking more than intended, increased tolerance, unsuccessful attempts to cut back, cravings, missing obligations due to drinking, and continuing to drink despite negative personal or social consequences.) Other factors to be taken into account are whether the patient has mood, anxiety, or personality disorders; chronic pain; or a lack of social support. Doctors then can provide treatment based on the stage where patients are, which is a radical departure from issuing the same prescription to everyone.
The difficulty of determining which patients are good candidates for moderation is an important cautionary note. However, promoting abstinence as the only valid goal of treatment likely deters people with mild or moderate alcohol-use disorder from seeking help. The prospect of never taking another sip is daunting, to say the least. It comes with social costs and may even be worse for one’s health than moderate drinking: research has found that having a drink or two a day could reduce the risk of heart disease, dementia, and diabetes.
We cling to this one-size-fits-all theory even when a person has a small problem. The idea is ‘Well, this may be the person you are now, but this is where this is going, and there’s only one way to fix it.’ In reality, however, we have 50 years of research saying that, chances are, that’s not the way it’s going. We can change the course.
Returning to the story of Alex, the dingy rooms of 12-step meetings didn’t work. But they were not the only answer. After ten years of a nasty heroin addiction, he discovered something different. Something that worked and had opened his eyes to himself and the world. I know this to be true because Alex’s story is my story.
Alcoholics Anonymous may appear to work for some people—if relying on sitting in a smoke-filled room surrounded by suffering works for you. But after years spent in meetings and seeing how contradicting members of the fellowship were, I began to do some research; which became what you’d just read. But it didn’t come without my thoughts and observations…
If addiction is a disease, then anyone with a functioning brain can and most likely is already “diseased.” The stigma that tails the dreaded word of ‘addiction’—especially when followed by the word ‘drug’—has become so demonized that those who suffer as a result of the lack of research in brain chemistry, are seldom met with the love and compassion (which initially drove them to escape or dull the emotional or physical pain) they desperately need.
Rather, they’re met with insensitivity, and harsh judgment, and no longer regarded as functioning members of society—a society that is hardly without a flaw. And it’s down, below our feet where we keep them, underneath our own self-deception of living a “non-addictive” life. This, however, doesn’t begin with any stigma, but is the result of something else—a particular program, perhaps?
While drug addicts are left living on the outskirts of an already broken society, those who keep them there are also glued to their phones and computer screens, waiting for their fix. They wait in anticipation for their next shot of dopamine from receiving a ‘Like’ on their Facebook or Instagram page.
Social media has become the new “opiate of the masses.” It works no different from that of a drug. We receive the same effect when snorting a bump of cocaine:
The brain uses the same neurotransmitters and receptors when one receives a ‘Like,’ comment, ‘thumbs up,’ share, or any indicator that someone has acknowledged your digital presence. I say acknowledged because seldom does anyone actually like what you’ve posted if it doesn’t benefit them in any way. Rather, it’s more of an acknowledgment, like saying, “Hey, we’re still friends, so I care about this too!”
Why have more people succumbed to narcissistic tendencies?
Social media.
Rene Descartes had claimed the most famous philosophical quote up to about ten years ago, known to many intellectuals as the “Cogito, after its Latin phrasing Cogito Ergo Sum,” meaning, I think, therefore I am (which he later changed to “I am, I exist,” in his Meditations on First Philosophy.) However, in the past ten years, Descartes’ “claim-to-fame” has become something more innately known and considered ‘common sense’ to the millennial generation and younger, who could relate more by giving it a piece of what makes them stand out from previous generations: more individuality—a makeover, if you will. And thus, we have the defining quote of the early twenty-first century: I tweet, therefore I am. (I’ll go ahead and, like Descartes, change it up to be more accurate: I tweet, I suck.)
The self-acclaimed “philanthropist” and first president of Facebook, Sean Parker, has blatantly stated that “Facebook was developed to get people addicted.” The avaricious Mr. Parker still claims this title and is paradoxically still known as a philanthropist. Even with consideration of his charitable donations, it’s no amount to suffice for the damages to society and human welfare for which his company is responsible.
For those who truly wish to understand what addiction is and how to recover from it, I will say that it’s not your fault for misunderstanding. It’s no fault of any person. But if you want to point the finger, you can start by discovering the hidden agendas for having television shows reveal these sometimes obvious fallacies. Shows such as Intervention and Celebrity Rehab use a “tough-love” approach to recovery. While such television programs don’t reveal the entire truth, such as Celebrity Rehab, painting a highly misleading picture of how long it truly takes to recover, others can be downright appalling.
In Intervention, an addict’s loved ones, the only people he/she has left in the world, read letters that remind, or inform, how their lives had negatively been affected because of actions and behaviors solely of the addict. The parents, guardians, siblings, friends, and whoever is involved, take zero responsibility for playing a part in the enablement of their addicted “loved” one.
That “dear friend” or family member at the moment is feeling the lowest they’ve ever felt in their overwhelmingly dark and experienced lives, while everyone around them points the finger. It’s not that the family members don’t care, they’ve been misguided by the advice given by television producers and one of two paid addiction ‘experts.’ However, nobody is as lied to as the star of the show—the Addict.
Here is an obvious example of how family members enable their loved one’s addiction: They do this by participating in their loved one’s televised addiction, where not only is the addict misled about what the documentary is, but they reveal every everyhorrible thing the addict has done. Much of the family’s personal, private matters then become displayed to be viewed all over the world.
At the end of every letter is an ultimatum, that of “an offer they can’t refuse.” If the addict decides on going to treatment, they immediately hop on a plane to spend the next 3-6 months living with other unknown drug addicts at an inpatient treatment facility in an unfamiliar place usually across the country.
The treatment centers used in shows like Intervention and Addicted are always based within a 12-step program—that of/or affiliated with the failed ruins of an ancient program known as Alcoholics Anonymous.
Okay, maybe it’s not ancient, but it still uses the same steps and traditions that haven’t been updated to fit any other addiction other than alcohol. Even Narcotics Anonymous, HA, CA, etc., all still use the same 12-step doctrine—which probably hasn’t been changed since its founding in 1935.
One person speaks about a bunch of things you’ve already heard millions of times, or if no speaker, you hear these same things but from various people, who raise their hand and identify themselves with, “Hi, I’m Bobby, and I’m an alcoholic/drug addict.” This is also sometimes followed by their “clean time”—how long they’ve been sober—which for a small minority can be years, yet they still consider themselves “addicted.”
“I’m Clarence,” a voice struggled to climb out from the back of the room. “And I’m a recovered alcoholic.”
I thought to myself, “Well if you’ve recovered then… what the fuck are you doing here?“
It’s not the best example, but it shows how they stay sober by merely replacing their addiction to drugs and alcohol by attending meetings. If you want to live a life of attending meetings until you die, be my guest.
People truly believe in the lies and manipulation of the 12-step program. It’s referred to as “working the program”—it’s right there in your face and used every day, programming millions of people. The sad thing is, if you relapse after they’ve “programmed” you to cut ties with everyone you know who isn’t in your program, they’re the first ones to turn on you. You’re left suffering alone until you walk back into a meeting and face more humiliation.
Rehabs based on the 12-step program of AA have the lowest rates of success within the world of recovery—with a whopping 5-10% of people staying clean. They also have a firm belief that their program is the only way to achieve sobriety. This alone should tell you something is wrong.
You don’t need a higher power to recover; although, based on personal experience, it can help. It is not mandatory though. However, an addict should learn to become more open-minded to new beliefs anyway, for their own good. The same goes for making amends. I can’t think of a quicker way toward relapse. Why would you put yourself in a high-stress situation when you are still becoming accustomed to the vulnerable state experiencing everything over again like a child with a clear but experienced brain? You’re just getting back on your feet and making amends only throws you straight into the lion’s den.
If those people whom you think need amends aren’t there right now for you in your recovery, supporting you, then they are not a friend and don’t deserve a damn thing from you.
An addict needs to be surrounded by people who love and care for them. They must truly understand that they are loved no matter what—with or without drugs and alcohol. When you know who your real friends are, keep a mindful distance from those other people; until, you are strong enough in your recovery to properly do what you feel you need to do.
The addict must also reestablish themselves in their community, or a new one. This can be done by getting a job that has nothing to do with anything or anyone that will remind him of using. It’s always good to meet and befriend other addicts. But not anyone belonging to AA. Sure, they’ll tell you the program works if you work it correctly, but inside they are miserable. You can see it when they yell their phony cliches at you. They will see you improving and how truly happy you are and will want to give up AA and join you. I promise.
Another misconception groups such as Alcoholics Anonymous have hammered into America’s mind is that recovery means complete and total abstinence. Everyone in the world, whether they know it or not, has an addiction to something. It could be exercising, working, diets, video games, TV shows, social media, the news, anything someone uses to wind down, escape, and look forward to, helping them get through the day. Addiction has become a part of our biological makeup now with technology. However, through strong will and self-discipline, one can learn moderation and even complete abstinence, if one chooses.
Though I don’t condone smoking marijuana, if one wants to use it to wind down after a hard day, they have that right and should not be judged by anyone. If one can use drugs, alcohol, or whatever and still function in society without hurting themselves, their job, or anyone else, nobody has the right to take away that escape or joy from that person. You’ll never hear that in an AA meeting.
In the past, while on Suboxone to help recover from a nasty heroin addiction, a member of AA tried to tell me I wasn’t truly “sober” because of the Suboxone. This person knew nothing of opiates, opiate addiction, or anything for that matter. Because Suboxone can be overridden by using a greater amount of heroin, which I explained, I managed to argue that not only was I “sober” but that I had greater willpower than they, since a tiny bit of a synthetic version of my drug of choice was still in my body—though not enough to feel high—which, based on their science, should have made me susceptible to more cravings. False.
I’m going to end this with a story from the last 12-step meeting I attended four years ago. It was Heroin Anonymous.
A kid in his early to mid-twenties kept going on and on about how his god had gotten him a job. They had to ring the bell on him for taking too long. Now, according to his story, this wasn’t his first job ever, nor did he speak of any hardships that would keep him from getting a job besides his heroin use.
“If it wasn’t for God, I wouldn’t have this job. He got it for me.” These words were repeated several times.
I wanted to smack him off of his pink cloud, bringing him back to reality, by telling him, “Dude, I highly doubt any god is responsible for getting you that job. God didn’t fill out any application. God didn’t give a solid interview. God didn’t even get you sober to be able to do all this. You did. You did all of this. So, give yourself some fucking credit, for God’s sake!”
An addict doesn’t need the tough-love attitude to be sober. They don’t need to think about “sobriety” or complete abstinence. Rather, they need to feel love and support, to be able to work on the inner issues within themselves that drove them to use and abuse the addictive substances. The same substances are pushed by cartels working with corporate elitists and political figures involved in drug and human trafficking. These very people are also the ones responsible for keeping the failing 12-step program of AA in 92% of America’s 13,000 rehabs. It’s a billion-dollar operation run by the greedy scum of the power elite.
Today, I choose not to drink or do heroin, but I can now use drugs without becoming powerless to them. Thank you. I’m Josh and I no longer consider myself a drug addict or alcoholic
J. A. Allison 