Not long ago there was a blog post in Psychology Today titled “Does Alcoholics Anonymous Work Because it’s a Form of Cognitive Behavioral Therapy?” (Lazarus, 2010). This is an odd title because it assumes that AA is more effective than a placebo in spite of the fact that all studies (e. g. Brandsma, et al 1980) have shown AA to be no more effective than a placebo. And it is an odd article because it ignores the fact that all of the core practices of AA found in the twelve steps and in AA tradition are the exact opposite of what one finds in Cognitive Behavioral Therapy.
The research demonstrates that cognitive behavioral approaches to treating alcohol dependence are about twice as effective as either AA or a placebo (Brandsma, et al 1980). It is the thesis of our paper that CBT is successful in treating alcohol dependence because CBT empowers the individual to take charge of his or her life and solve problems, hence CBT is therapeutic. AA, on the other hand, disempowers individuals in order to empower itself as a group. This is why many AA members are fanatically loyal to AA even while relapsing. AA is highly successful at self-promotion and gaining new members, but not successful at all in treating alcohol problems. It is also the thesis of this paper that AA empowers itself at the expense of the individual because the 12 steps and other aspects of the AA program work to lower self-esteem and self-efficacy and to increase self-stigmatization, as well as working to increase anxiety and depression.
What follows are examples of how AA empowers itself by disempowering individuals and of how AA is the diametric opposite of CBT.
Labeling
AA asks people to label themselves “alcoholics”. Here is what CBT therapist David Burns (1990) has to say about labeling: “Labeling is an extreme form of all-or-nothing thinking. Instead of saying “I made a mistake,” you attach a negative label to yourself: “I’m a loser.” You might also label yourself a “fool” or a “failure” or a “jerk.” Labeling is quite irrational because you are not the same as what you do. Human beings exist, but “fools,” “losers,” and “jerks” do not. These labels are just useless abstractions that lead to anger, anxiety, frustration, and low self-esteem. ” According to CBT labels are harmful and serve to perpetuate the problem. The purpose of labeling in AA is not to empower the person to stop drinking, but to disempower the individual so that the individual will be forced to be dependent on AA.
All-or-nothing-thinking:
AA slogans such as “One drink means one drunk” are a perfect example of all or nothing thinking, which often turns a small lapse into a major relapse according to Alan Marlatt. David Burns says this about all or nothing thinking: “You see things in black-or-white categories. If a situation falls short of perfect, you see it as a total failure. When a young woman on a diet ate a spoonful of ice cream, she told herself, “I’ve blown my diet completely.” This thought upset her so much that she gobbled down an entire quart of ice cream!”
Self-stigmatization
AA lowers self-esteem and self efficacy and increases self-stigmatization through slogans such as the following:
“No one is too dumb to get this program but a lot of people are too smart to get it.”
“The ones who don’t recover are too smart, too rich, or too good looking.”
AA also encourages self-stigmatization by forcing people to label themselves as alcoholics and insane (see step two).
Equating AA with God
AA promotes dependence on AA by telling its members that AA can be their “higher power”. AA cofounder Bill Wilson states in The Twelve Steps and Twelve Traditions (Wilson, 1953), “You can, if you wish, make AA itself your ‘higher power’.” A common AA slogan is “G.O.D. stands for Group of Drunks.” It is the fact that AA is highly successful at erasing the distinction between itself and God in the minds of its members which gives it such great power over its members. This is key to the empowerment of AA at the expense of its members and key to explaining their loyalty to AA even while they relapse and sometimes even drink themselves to death.
The 12 steps Dissected:
Now let us walk through the steps one by one. Since AA says that AA itself is a higher power–we will also interpolate this into the steps:
1) We admitted we were powerless over alcohol-that our lives had become unmanageable.
CBT works to increase self-efficacy and self-esteem, CBT builds up people’s beliefs that they have the power to change for the better and that they can learn to manage their lives, AA works to destroy these beliefs and to destroy people’s self-esteem and self-efficacy.
2) Came to believe that a Power greater than ourselves (i. e. AA) could restore us to sanity.
Whereas CBT teaches people to learn to rely on themselves, AA teaches dependence on an outside force to solve problems and specifically instructs people to be dependent on AA itself for rescue from their addictions. AA teaches self-stigmatization by forcing people to admit that they are insane.
3) Made a decision to turn our will and our lives over to the care of (AA) God as we understood Him.
CBT does not tell you to turn your life and will over to the therapist. It teaches you to change your thoughts so that you can take charge of your life for yourself. AA wants you to turn your life and will over to AA and not take charge for yourself. This step creates dependency on AA.
4) Made a searching and fearless moral inventory of ourselves. 5)Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
Steps 4 and 5 go together since step 4 is writing out a confession on paper and step 5 is confessing it out loud to someone–usually an AA sponsor. This sort of confession is a part of the Catholic Church as well as a part of Communist brainwashing (Lifton, 1961), but it is not a part of CBT.
6) Were entirely ready to have God (i. e. AA) remove all these defects of character. 7) Humbly asked Him (i. e. AA) to remove our shortcomings.
CBT concentrates on people’s strengths to help give them good self-esteem and the power to fix what is wrong in their lives. AA keeps people focused on negativity and character defects to disempower them and to keep them dependent on AA. These two steps work together to destroy self-esteem and self-efficacy.
8 ) Made a list of all persons we had harmed, and became willing to make amends to them all. 9) Made direct amends to such people wherever possible, except when to do so would injure them or others.
Making amends is usually the only step that non-AA members can list of the twelve. This step actually makes sense and can be helpful and seems compatible with CBT.
10) Continued to take personal inventory and when we were wrong promptly admitted it.
Once again there is a focus on wrongs instead of strengths. People need to build up their strengths to overcome addictions and other personal and mental problems. Having people tear themselves down is a way to empower the group at the expense of disempowering the individual.
11) Sought through prayer and meditation to improve our conscious contact with God as we understood Him (AA), praying only for knowledge of His (AA’s) will for us and the power to carry that out.
Step 11 is pretty clearly all about empowering the group at the expense of disempowering the individual. Members are to pray to AA for the knowledge of AA’s will and the power to carry it out. Terrorists who fly airplanes into buildings also believe that they are doing the will of God which they have been given knowledge of through prayer and meditation. CBT does not teach you this.
12) Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
This is about proselytizing for more AA members–all religions do this. Although it may be therapeutic to help others by doing volunteer work–step 12 does not say to go out and work in a soup kitchen. It says to get more AA members. And as the AA saying goes, “Work the steps or die.”
CONCLUSION
What this analysis of the 12 steps and other AA practices shows us is that AA is focused on making individuals dependent on and subservient to the AA group at the expense of their own self-efficacy and self-reliance. AA is not focused on changing people’s drinking habits.
What the research shows us is that AA is no more successful than nothing when it comes to helping people to stop drinking. Moreover, much research suggests that AA is beneficial to people with a dependent personality type but harmful to people with an independent personality type (Poldrugo and Forti 1988, Karno and Longabaugh 2005).
Since CBT has been demonstrated in clinical studies to be about twice as effective as AA regardless of personality type it seems clear that it is time to abandon AA as a treatment modality. And since harm reduction has proven of great efficacy in helping those who are unable, unwilling, or not yet ready to abstain, the only rational future of addiction treatment must be a combination of harm reduction and CBT.
Simply saying that something produces changes in behavior and action does not equate it to CBT. To be regarded as similar to CBT it must also be therapeutic. Jim Jones was highly successful at changing the thinking and behaviors of members of The People’s Temple, but few would argue that drinking the Guyana, Jonestown Kool Aid was therapeutic.
If you find AA helpful, then more power to you! But if you find that it is making you drink more or suffer anxiety, depression, and other problems, then you may need AA Deprogramming. Let this article be a first step.
REFERENCES:
Brandsma JM, Maultsby MC, Welsh RJ. (1980). Outpatient treatment of alcoholism: A review and comparative study. Baltimore: University Park Press.
Burns D. (1990). The Feeling Good Handbook. Plume.
Karno MP, Longabaugh R. (2005). An examination of how therapist directiveness interacts with patient anger and reactance to predict alcohol use. J Stud Alcohol. 66(6), 825-32.
PubMed Abstract: http://www.ncbi.nlm.nih.gov/pubmed/16459944
Lazarus CN. (2010). Does Alcoholics Anonymous Work Because it’s a Form of Cognitive Behavioral Therapy?
Lifton RJ (1961). Thought Reform and the Psychology of Totalism, The University of North Carolina Press/Chapel Hill and London
Marlatt GA, Gordon JR. (1985). Relapse prevention : maintenance strategies in the treatment of addictive behaviors. New York, Guilford Press
Poldrugo F, Forti B. (1988). Personality disorders and alcoholism treatment outcome. Drug Alcohol Depend. 21(3):171-6.
http://www.ncbi.nlm.nih.gov/pubmed/3168759
Copyright © 2010, The HAMS Harm Reduction Network
How Effective Is AA and 12 Step Treatment?
12 Step Programs Are The Opposite Of CBT
Not long ago there was a blog post in Psychology Today titled “Does Alcoholics Anonymous Work Because it’s a Form of Cognitive Behavioral Therapy?” (Lazarus, 2010). This is an odd title because it assumes that AA is more effective than a placebo in spite of the fact that all studies (e. g. Brandsma, et al 1980) have shown AA to be no more effective than a placebo. And it is an odd article because it ignores the fact that all of the core practices of AA found in the twelve steps and in AA tradition are the exact opposite of what one finds in cognitive Behavioral Therapy.
The research demonstrates that cognitive behavioral approaches to treating alcohol dependence are about twice as effective as either AA or a placebo (Brandsma, et al 1980). It is the thesis of our paper that CBT is successful in treating alcohol dependence because CBT empowers the individual to take charge of his or her life and solve problems, hence CBT is therapeutic. AA, on the other hand, disempowers individuals in order to empower itself as a group. This is why many AA members are fanatically loyal to AA even while. AA is highly successful at self-promotion and gaining new members, but not successful at all in treating alcohol problems. It is also the thesis of this paper that AA empowers itself at the expense of the individual because the 12 steps and other aspects of the AA program work to lower self-esteem and self-efficacy and to increase self-stigmatization, as well as working to increase anxiety and depression.
What follows are examples of how AA empowers itself by disempowering individuals and of how AA is the diametric opposite of CBT.
Labeling
AA asks people to label themselves “alcoholics”. Here is what CBT therapist David Burns (1990) has to say about labeling: “Labeling is an extreme form of all-or-nothing thinking. Instead of saying “I made a mistake,” you attach a negative label to yourself: “I’m a loser.” You might also label yourself a “fool” or a “failure” or a “jerk.” Labeling is quite irrational because you are not the same as what you do. Human beings exist, but “fools,” “losers,” and “jerks” do not. These labels are just useless abstractions that lead to anger, anxiety, frustration, and low self-esteem. ” According to CBT labels are harmful and serve to perpetuate the problem. The purpose of labeling in AA is not to empower the person to stop drinking, but to disempower the individual so that the individual will be forced to be dependent on AA.
All-or-nothing-thinking:
AA slogans such as “One drink means one drunk” are a perfect example of all or nothing thinking, which often turns a small lapse into a major relapse according to Alan Marlatt. David Burns says this about all or nothing thinking: “You see things in black-or-white categories. If a situation falls short of perfect, you see it as a total failure. When a young woman on a diet ate a spoonful of ice cream, she told herself, “I’ve blown my diet completely.” This thought upset her so much that she gobbled down an entire quart of ice cream!”
Self-stigmatization
AA lowers self-esteem and self efficacy and increases self-stigmatization through slogans such as the following:
“No one is too dumb to get this program but a lot of people are too smart to get it.”
“The ones who don’t recover are too smart, too rich, or too good looking.”
AA also encourages self-stigamatization by forcing people to label themselves as alcoholics and insane (see step two).
Equating AA with God
AA promotes dependence on AA by telling its members that AA can be their “higher power”. AA cofounder Bill Wilson states in The Twelve Steps and Twelve Traditions (Wilson, 1953), “You can, if you wish, make AA itself your ‘higher power’.” A common AA slogan is “G.O.D. stands for Group of Drunks.” It is the fact that AA is highly successful at erasing the distinction between itself and God in the minds of its members which gives it such great power over its members. This is key to the empowerment of AA at the expense of its members and key to explaining their loyalty to AA even while they relapse and sometimes even drink themselves to death.
The 12 steps Dissected:
Now let us walk through the steps one by one. Since AA says that AA itself is a higher power–we will also interpolate this into the steps:
1) We admitted we were powerless over alcohol-that our lives had become unmanageable.
CBT works to increase self-efficacy and self-esteem, CBT builds up people’s beliefs that they have the power to change for the better and that they can learn to manage their lives, AA works to destroy these beliefs and to destroy people’s self-esteem and self-efficacy.
2) Came to believe that a Power greater than ourselves (i. e. AA) could restore us to sanity.
Whereas CBT teaches people to learn to rely on themselves, AA teaches dependence on an outside force to solve problems and specifically instructs people to be dependent on AA itself for rescue from their addictions. AA teaches self-stigmatization by forcing people to admit that they are insane.
3) Made a decision to turn our will and our lives over to the care of (AA) God as we understood Him.
CBT does not tell you to turn your life and will over to the therapist. It teaches you to change your thoughts so that you can take charge of your life for yourself. AA wants you to turn your life and will over to AA and not take charge for yourself. This step creates dependency on AA.
4) Made a searching and fearless moral inventory of ourselves. 5)Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
Steps 4 and 5 go together since step 4 is writing out a confession on paper and step 5 is confessing it out loud to someone–usually an AA sponsor. This sort of confession is a part of the Catholic Church as well as a part of Communist brainwashing (Lifton, 1961), but it is not a part of CBT.
6) Were entirely ready to have God (i. e. AA) remove all these defects of character. 7) Humbly asked Him (i. e. AA) to remove our shortcomings.
CBT concentrates on people’s strengths to help give them good self-esteem and the power to fix what is wrong in their lives. AA keeps people focused on negativity and character defects to disempower them and to keep them dependent on AA. These two steps work together to destroy self-esteem and self-efficacy.
8) Made a list of all persons we had harmed, and became willing to make amends to them all. 9) Made direct amends to such people wherever possible, except when to do so would injure them or others.
Making amends is usually the only step that non-AA members can list of the twelve. This step actually makes sense and can be helpful and seems compatible with CBT.
10) Continued to take personal inventory and when we were wrong promptly admitted it.
Once again there is a focus on wrongs instead of strengths. People need to build up their strengths to overcome addictions and other personal and mental problems. Having people tear themselves down is a way to empower the group at the expense of disempowering the individual.
11) Sought through prayer and meditation to improve our conscious contact with God as we understood Him (AA), praying only for knowledge of His (AA’s) will for us and the power to carry that out.
Step 11 is pretty clearly all about empowering the group at the expense of disempowering the individual. Members are to pray to AA for the knowledge of AA’s will and the power to carry it out. Terrorists who fly airplanes into buildings also believe that they are doing the will of god which they have been given knowledge of through prayer and meditation. CBT does not teach you this.
12) Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
This is about proselytizing for more AA members–all religions do this. Although it may be therapeutic to help others by doing volunteer work–step 12 does not say to go out and work in a soup kitchen. It says to get more AA members. And as the AA saying goes, “Work the steps or die.”
CONCLUSION
What this analysis of the 12 steps and other AA practices shows us is that AA is focused on making individuals dependent on and subservient to the AA group at the expense of their own self-efficacy and self-reliance. AA is not focused on changing people’s drinking habits.
What the research shows us is that AA is no more successful than nothing when it comes to helping people to stop drinking. Moreover, much research suggests that AA is beneficial to people with a dependent personality type but harmful to people with an independent personality type (Poldrugo and Forti 1988, Karno and Longabaugh 2005).
Since CBT has been demonstrated in clinical studies to be about twice as effective as AA regardless of personality type it seems clear that it is time to abandon AA as a treatment modality. And since harm reduction has proven of great efficacy in helping those who are unable, unwilling, or not yet ready to abstain, the only rational future of addiction treatment must be a combination of harm reduction and CBT.
Simply saying that something produces changes in behavior and action does not equate it to CBT. To be regarded as similar to CBT it must also be therapeutic. Jim Jones was highly successful at changing the thinking and behaviors of members of The People’s Temple, but few would argue that drinking the Guyana, Jonestown Kool Aid was therapeutic.
If you find AA helpful, then more power to you! But if you find that it is making you drink more or suffer anxiety, depression, and other problems, then you may need AA Deprogramming. Let this article be a first step.
REFERENCES:
Brandsma JM, Maultsby MC, Welsh RJ. (1980). Outpatient treatment of alcoholism: A review and comparative study. Baltimore: University Park Press.
Burns D. (1990). The Feeling Good Handbook. Plume.
Karno MP, Longabaugh R. (2005). An examination of how therapist directiveness interacts with patient anger and reactance to predict alcohol use. J Stud Alcohol. 66(6), 825-32.
PubMed Abstract: http://www.ncbi.nlm.nih.gov/pubmed/16459944
Lazarus CN. (2010). Does Alcoholics Anonymous Work Because it’s a Form of Cognitive Behavioral Therapy?
Lifton RJ (1961). Thought Reform and the Psychology of Totalism, The University of North Carolina Press/Chapel Hill and London
Poldrugo F, Forti B. (1988). Personality disorders and alcoholism treatment outcome. Drug Alcohol Depend. 21(3):171-6.
http://www.ncbi.nlm.nih.gov/pubmed/3168759
The Alcohol Harm Reduction Blog 
Thank you for your article. I have family that believes strongly in AA. When I first started battling Alcoholism, it was suggested that I go to AA. I went once and while I found it was OK, I didn’t really care for it. I could never pinpoint why, I just knew that I didn’t really care for it.
I’ve been actively working at recoving for several months now. I’ve been in counseling and using medication. While the medication helps, I’d say that the counseling is what helps the most. There has been times when I relapsed. I never beat myself up, I just started over. Counseling has helped me get to the root of my problems…they why’s of why I drink.
AA seems more like a chatty support group. I can spill my heart out, but it doesn’t help me understand my behavior or the best way to treat it. I think I picked the right course of action for me. Not saying that AA doesn’t work, but counseling and medication are most helpful for me. Not only that, but I believe in God and I have gone where he lead me: to counseling.
P.S. I’d probably be an undercover alcoholic if I left my recovery efforts up to AA.
I practice both the 12 steps and CBT. I do not find that they compete with one another. I was sober a number of years by working the steps before I began CBT work with my psychiatrist. CBT helped my depression a great deal.
Without meaning to be confrontational, I am constantly curious as to why other methods of achieving sobriety are not as widely practiced or available as 12-step?
We hear lots of studies and stories and cited studies disproving the effectiveness of AA. Yet AA seems to work for many of us and is readily available in most communities on a weekly, if not, multiple-time-daily basis.
Why would you imagine that CBT or other methods do not appear as frequently used by those seeking to get or remain sober?
Ciao.
Chaz
There was a large chemical dependency treatment boom from the 1960s to the 1990s where 12 step treatments moved in and monopolized the field because the alternative modalities were not yet invented. At present in the US 12 step treatment programs comprise about 95 % of treatments in the US and have a funding in the area of tens of billions of dollars. Alternative programs have nothing like that in terms of capital for PR. Ask a room ful of 100 people to name a treatment for alcoholism and 100 people can name the 12 steps–but you will be lucky if one has heard of SMART Recovery.
However, the economic equation is changing. Since the 1990s insurance companies have greatly limited the amounts which they will pay for 12 step treatments because of their extremely low efficacy. There is a growing demand for evidence based treatments and I believe that eventually there will be more CBT treatments for alcohol than 12 step.
Again, if 12 step works for you then good. I have many friends in needle exchange who do the 12 steps and I wish them all the best. A voluntary fellowship is not the same as a treatment modality.
Ken… Thanks for the clarifications.
Interestingly, in my area of Canada, government-funded treatment programs are less and less supportive of 12-step seemingly due to the profession of God. Public health bodies offer many alternatives other than 12-step… in fact, the last program I did in the public-funded system conspicuously excluded 12-step. Private treatment centres on the other hand are mainly 12-step focused.
Yet there are no other programs other than 12-step that have any visible presence in our area. And we have a notorious drug area with a notorious reputation all across the country and probably known in many parts of yours.
My psychiatrist, interestingly, is a sober alcoholic and practices the 12-steps. He’s the one who introduced me to and worked with me in CBT.
I think we can never lose sight of the fact that when 12-step recovery was first discovered and developed, there were no comparable treatment programs to speak of. Many seem to have believed that chronic alcoholics were lost causes, which in function, many were. 12-step at least, I feel, can be credited with providing hope that recovery was possible for many for whom it previously had not been. And perhaps this hope was the seed from which grew other programs of recovery.
Not unlike the Sir Roger Bannister being the first to run a mile in less than 4 minutes giving rise to hundreds of others who would exceed this achievement in the decades to follow. It may have been the belief that it were possible that Bannister provided that then fueled further achievements. How Bannister did it may not have been as important as the fact that he did.
Although distasteful to some, it is hard to argue that 12-step recovery has at the very least created belief that something other than chronic alcoholism, suffering, and eventual death is possible.
Personally, I am more interested in sobriety and recovery than I am in the preference of one philosophy over another. I know what worked for me and what didn’t. 12-step was the last program I tried and happened to he the one that did work. Not to say that had I tried another, that another wouldn’t have worked. Who knows.
All I can say is that I have found great value in and relate strongly to the community of 12-step recovery in my area. At the same time, I seem to be less than typical in the fact I look to and practice additional avenues of personal growth and recovery that many steppers seem to minimize in favour of their professed all-sufficient, all-providing steps (as they suck on their cigarettes, get fat and unfit, and bounce from relationship to relationship with the “frequency of a cheap ham radio”, to borrow a line from Dan Akroyd).
So call me a cautious stepper perhaps. And one who has not plugged into the 12-step matrix.
Thanks for adding to my experiences of broader discoveries. I’ll cruise by more often.
Ciao.
Chaz
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