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.
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.
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!”
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.”
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.
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.
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