At the beginning of every Twelve-Step meeting, someone reads a plastic-laminated document that says, among other things, that this Twelve-Step program has never been known to fail, except for a few unfortunate people who are "constitutionally incapable of being honest with themselves." Nothing could be further from the truth. Even the most ardent true believers who will be honest about it recognize that AA and NA have at least 90% failure rates. And the real numbers are more like 95% or 98% failure rates. It depends on who is doing the counting, and what they are counting. A 5% success rate is nothing more than the rate of spontaneous remission in alcoholics and drug addicts. That is, out of any given group of alcoholics or drug addicts, approximately 5% per year will just wise up, and quit killing themselves. They just get sick and tired of being sick and tired, and of watching their friends die. (And about 3% of their friends do die annually, so that is a big incentive.) They often quit with little or no official treatment or help. Some actually detox themselves on their couch, or locked in their closet. Often, they don't go to a lot of meetings. They just quit, all on their own. Fanatical AA and NA true believers insist that it can't happen, but it does, every day.

When one of those people who is going to quit anyway, or who did just quit, walks into an AA meeting, AA is happy to take credit for the success, while disavowing any responsibility for all of those other people who walk in, walk out, and relapse. That is grossly dishonest.

AA is also more than happy to convince the person who just quit that it is all due to AA and the Twelve Steps. And many of them will believe it. At meetings, you will hear many testimonials like "I tried everything, the VA program, the Christian Brotherhood, and finally, AA is what worked." This ignores one of the famous corollaries to Murphy's Law: "The thing you seek is always in the last place you look."

That is, many people require one or many relapses to convince themselves that they really can't drink any more. They think that they can just nibble, or "just have one", and that it will be okay. They will go through a lot of programs while they experiment and fail. In the end, some of them will finally quit, rather than die, and they will usually give the credit to whichever program they happened to be in when they quit. Thus the Christian sects have a bunch of totally-convinced true believers who say that Jesus saved them, and the VA has some veterans who believe that the VA program is the best, and AA has a bunch of people who insist that AA and the Twelve Steps are the only answer.

When you are at an AA meeting, you are in a self-selecting group. You won't hear from the Jesus-freak Christians or the gung-ho VA guys, because they aren't there. You will only hear from the AA true believers, who will be happily reassuring each other that they are doing the only thing that really works.

At one university, a dozen years ago, a bunch of doctors and professors were puzzling over the fact that all alcohol and drug rehabilitation programs seemed to have about the same rates of success and failure, no matter what the treatment was. All of the programs that they were studying had about a 93% failure rate (by their counting methods), which left about a 7% success rate. Those professors and doctors were trying to find what treatment methods worked best, and what would save the most lives, but with all of the treatments getting about the same scores, it didn't seem to matter what the treatment was.

So, for an experiment with a wacky sense of humor, the doctors and professors designed a new treatment program for drugs and alcohol, and put it to the test. The treatment program consisted of getting a bunch of alcoholics and drug addicts together for a weekly meeting, which started with playing patty-cake with each other. You know, the children's nursery rhyme where you pat your hands together: "Patty-cake, patty-cake, baker man. Bake a cake as fast as you can..." Then the participants spent the rest of the hour talking about whatever they felt like talking about: sports, television, and news, or drugs, sex, and rock and roll, or wine, women, and song, or whatever. There was no counselor to make them talk about the "right" stuff, or to say the "right" things, or to come to the "right" conclusions. Nevertheless, at the end of the year, the patty-cake treatment program had the same success rate as all of the other treatment programs, including Alcoholics Anonymous.

Now, to be fair, all of the treatment programs did score a couple of percentage points better than the control group which got no treatment at all, which seems to indicate that just getting the alcoholics and drug addicts together in a room and letting them talk helped a little. The groups provided a sense of community and gave members some moral support, and encouragement to "make it", and succeed in abstaining. But the inescapable conclusion was that all of the treatment programs were basically just taking credit for the spontaneous remissions that were occurring anyway. The treatment programs were taking credit for the peoples' own hard work to save themselves.

We do not have nearly enough properly-done scientific tests of the various popular alcoholism treatment programs. Alcoholics Anonymous has a reputation for not liking scientists poking too deeply into its affairs. The very nature of the AA organization makes measurement of success very difficult. Everyone is anonymous; people are members if they say they are, and aren't if they say they aren't. Also, when someone relapses and disappears, he is then assumed to not be a member. Thus any casual glance at AA will be biased by cherry-picking: only the success stories are around to be counted. So we must be very careful about statistics and surveys, and ask who is doing the counting, and what they are counting, and how they are defining success. But there are some tests and studies which are fairly good.

In 1996, The National Longitudinal Alcoholism Epidemiological Survey was designed by the NIAAA and conducted by the US Bureau of the Census. The survey was large, both in terms of people, tens of thousands, and in terms of time, 20 years. Deborah A. Dawson, of the NIAAA, filtered out 4585 subjects who had displayed standard DSM-IV Alcohol Abuse and Dependency symptoms, and analyzed those people. There were populations of people who had not received any treatment, and those who had. The commonest treatment modality by far was the AA Twelve-Step "therapy." The treatments were a cross-section of all of the standard treatments used in the USA, which means that about 85% of the treatment programs were based on the AA 12-step-program. The results were: 20 years after the onset of alcoholism symptoms, 80% of those who had undergone treatment were either abstinent, or "drinking without abuse or dependence." But, of those who had never received treatment, 90% were either abstinent or drinking non-problematically.

When we flip those numbers around, expressing them as a failure rate, rather than a success rate, we get: After 20 years, 10% of the untreated people still had drinking problems, while 20% of the treated people still had drinking problems. It would appear that the treatments actually had a negative effect, with twice as many treated people as untreated people still having drinking problems after 20 years. But there is one mitigating factor: the people who got treatment were in worse condition than the others, to start with. That's why they got treated. And after treatment, they were still in worse condition. So rather than saying that the treatment had a negative effect, the most reasonable analysis of the effectiveness of treatment of alcoholism is to say that the treatment had no effect (especially in light of the following study by Vaillant). It didn't work, it didn't fix the alcoholics.

Both groups -- the treated and the untreated people -- were slowly but steadily improving as time passed. That was the spontaneous remission at work.

Remember this the next time you hear someone say, "Nobody can do it alone." The truth is, more people do it alone than do it in any group therapy treatment program, or any treatment program of any kind.

(See "Correlates of Past-Year Status Among Treated and Untreated Persons with Former Alcohol Dependence: United States, 1992," by Deborah A. Dawson. Alcoholism: Clinical and Experimental Research, Vol. 20, No. 4, June 1996, p. 773.)

In addition, Stanton Peale has argued, in an article in The Sciences, that the most widely used alcoholism treatments (12-step) are the least effective. "This is seen in Deborah Dawson's (1996) analysis of data from the 1992 National Longitudinal Alcohol Epidemiologic Survey." Peele suggests that the "brief intervention" and "motivational enhancement" treatments are more successful alternatives.
(Peele, Stanton. The Sciences, 1998, vol. 38, no. 2, Mar-Apr, pp. 17-21.)

In 1983, Professor George Vaillant of Harvard University, an enthusiastic advocate of 12-step treatment, published his 1983 landmark book The Natural History of Alcoholism. In it, Vaillant describes the natural healing process associated with individuals addicted to alcohol -- "spontaneous remission" -- where some of the population addicted to alcohol will simply quit, and choose to stay abstinent of their own volition, without any AA, therapy, or any other outside intervention.

Vaillant's question was: does the AA program improve on the percentage of spontaneous remission?

Vaillant compiled forty years of clinical studies, including an eight-year longitudinal study of his own where he reported having followed 100 patients who had undergone 12-step treatment. He compared these people to another group of several hundred untreated alcohol abusers. The treated patients did no better than the untreated people. Fully 95% of the treated patients relapsed sometime during the eight-year period that Vaillant followed them. He concluded, "There is compelling evidence that the results of our treatment were no better than the natural course of the disease." And, "Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent per year was appalling."

Remember this the next time you hear somebody say "Keep coming back! It works!"

(See The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, by George Vaillant. Cambridge, MA: Harvard University Press, 1983, p. 285.)

Stanton Peele writes:

A 1999 study of Texas' correctional substance abuse treatment programs found that those who participated in an in-prison [12-step] program had the same recidivism rates as non-participants. Although those who completed the program did better than untreated offenders, those who entered but did not complete the program did worse. Moreover, probationers enrolled in treatment in Texas had an overall higher recidivism rate than non-participants.

Two explanations could account for such findings. One possibility is that, while treatment and non-treatment groups are equally likely to be recidivist, those who quit treatment are those who were more likely to relapse anyway. Thus, counting only those who remain in treatment and aftercare is cherry-picking those most likely to succeed in the first place. The other possibility, which would scandalize AA zealots like [Oklahoma Governor] Keating, is that those who have a negative reaction to AA and its 12-step approach are actually driven to relapse by the experience.
Stanton Peele, "Drunk with Power", Reason, May 2001, Vol. 33, Issue 1, p34, 5pp.

We have developed a new alcohol treatment program: the Cheech'n'chong Treatment Program. It works like this: whenever you get cravings for alcohol, you put on a ballerina's tutu and slippers, and Mickey Mouse ears, just like Cheech and Chong in the movie "Up in Smoke." Then you jump up and down on one foot, while juggling five tennis balls, and reciting Shakespeare sonnets. Continue this procedure for as long as the cravings last.

This simple program has never been known to fail, except for a few unfortunates who are constitutionally incapable of being honest with themselves while wearing a tutu.

As long as you believe in the AA Step 7, that God must remove all of your defects of character and shortcomings, you are in great danger of relapse. What if you find that God hasn't bothered to fix you? Then you are dead meat. You are helpless, because you already confessed in Step 1 that you are powerless over your problem. And in Step 2, you confessed that you are insane, and in Step 3 you turned your will over to God. You have left yourself no escape route, no way to save yourself. And sure enough, sooner or later, you will find that you are still just you, and you have the same cravings and temptations as before, and you still want to feel good, just like before.

The only way I can see to save myself is to assume that I will have to do all of the heavy lifting myself. Pardon me if I offend someone's religious beliefs, but I don't believe that God will take away all of my problems, and neither will Santa Claus, the Easter Bunny, or the Tooth Fairy. And Cinderella's Fairy Godmother has been AWOL lately, too. So forget about Steps 1, 2, and 3, and forget about Step 7. Forget about all twelve of them, in fact.

Make up some new steps, like:

1. I admit that drinking and drugging has gotten to be a real drag, and I am suffering so much that it isn't any fun any more.
2. I quit, and I'm staying quit forever.
3. Some of my friends may help me, but I'm mainly going to have to count on myself.
4. Whenever I am really tempted to relapse, I will think about step one again, and remember why I quit in the first place. I will also remember what happened the last time I relapsed.

I think that might do it for starters. Maybe we will make up some more steps later, but those four will certainly be a good start. They work for me.

DSM-IV: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Essentially, the Bible of the American Psychiatric Association. This book describes all of the various mental illnesses that the Association recognizes. If you want to decide what kinds of crazy people your friends are, read this book.

Last updated 29 May 2001.

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