There Has To Be a Better Way Than Alcoholics Anonymous

We, ironically, depend on Alcoholics Anonymous in this country rather than allowing for more progressive and scientific treatments and remedies for addiction. Our judicial system depends on it. Pop culture has made it iconic. We aren't willing to truly consider the possibility that there are ways to save even more lives and help people overcome alcohol abuse and addiction even more effectively than what we've been doing for nearly a century. We just take it for granted now that A.A. is how you get sober, when maybe it's not and maybe some who abuse alcohol don't need to get sober at all.
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Chez Pazienza
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We, ironically, depend on Alcoholics Anonymous in this country rather than allowing for more progressive and scientific treatments and remedies for addiction. Our judicial system depends on it. Pop culture has made it iconic. We aren't willing to truly consider the possibility that there are ways to save even more lives and help people overcome alcohol abuse and addiction even more effectively than what we've been doing for nearly a century. We just take it for granted now that A.A. is how you get sober, when maybe it's not and maybe some who abuse alcohol don't need to get sober at all.
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Doing almost $200-a-day in heroin probably qualifies as rock bottom, which is why in July of 2001, at the advice of a psychologist, I checked myself into a well-known rehab facility here in Los Angeles. The plan wasn't to stay for a full rotation, only to undergo a five day detox program aimed at re-acclimating my body to the concept of running on air, water and blood again instead of opiates. The medical unit that acted in conjunction with the facility sat atop a hospital next door and as such looked like you'd expect. There were nurses, mechanical beds with uncomfortable plastic pillows and shiny tile floors that reflected the squares of fluorescent lights that broke up the pattern in the drop ceiling. They gave me drugs right off the bat: Depakote, Klonopin, Phenobarbital, basically a cocktail designed to turn me into an old school shambling zombie so withdrawal wouldn't turn me into a 28 Days Later-style rage zombie running up and down the halls, threatening to kill anyone and everyone if somebody didn't get me some fucking drugs. It worked. I was barely conscious of the heroin draining out of my system, feeling most of the time as if I were submerged in dark water, my arms moving languidly around me trying to grasp and hold on to thoughts as they glided past me in all directions.

In addition to that experience being the first time in the better part of a year that I wasn't doing heroin, it was also my first experience ever with something that would in very short order become a major part of my life: the 12 Steps of Alcoholics Anonymous. This place, which by any measure was a hospital ward with all the resources and medical advancements that designation would imply, based its recovery model on a program started in the 1930s by a hyper-religious alcoholic who believed that it was divine providence that intervened in his life to help him kick booze. Several times a day, we gathered in a circle to discuss our small victories and giant catastrophes, admit that we were "powerless" over alcohol and drugs and that our lives had become "unmanageable.” (In between nodding off from the barbiturates, I remember mumbling "no shit" under my breath on that latter point.) Those of us detoxing were looked after by the nurses, but those in the full Program or the alumni, the people who'd come and gone and were returning for any of their 90 meetings in 90s days, joined in the same little series of empowering/depressing pow-wows. Even doped up to the point where I could've created a hallway-long Slip-n-Slide on the drool I was leaving on the floor, it seemed odd to me. It was the year 2001 and this was the best anybody could do: holding hands in a circle and desperately calling on God to give you serenity and acceptance and strength and wisdom while knowing that for the rest of you're life you'll always at best be recovering but never actually recovered.

I left that facility early, as soon as I was cognizant enough to understand that I was never going to get better until I actually got away from L.A. Driving off into the night was probably a bad idea, but it wasn't exactly the worst thing I'd done recently.

A few days later I was on a plane to South Florida and as soon as I landed I checked myself again into rehab, this time for a full 28-day program. 28 days of the 12 Steps, the Big Book, the Serenity Prayer chanted over and over again, silly trust exercises and being told that it works if I worked it. (So work it -- I'm worth it!) My counselors were good people and they indulged my misanthropy, made slightly less palatable and amusing than usual because while I was trying to get myself better my wife was moving out of our lovely two-story apartment in Beverly Grove and trying to position my things into the shape of a giant middle finger for whenever I returned to claim them. I'd been a prick to begin with; I was absolutely a prick in rehab. Knowing there's nothing waiting for you when you get out but the scorched earth you created while on drugs will do that to you. But the staff at the county-funded recovery center that I'd resigned myself to somehow put up with my shit. My main counselor, in fact, was even willing to affix a smirk to his face and entertain lengthy discussions with me about the very nature of Alcoholics Anonymous and its famous 12 Steps. That's a very nice way of saying that he listened to me and sometimes even responded respectfully while I questioned a good portion of the very program that was supposedly going to help get me clean -- particularly the part about how, if I asked too many questions, it meant to some that I was arrogant and unwilling to admit my powerlessness and therefore was doomed to probably get back on drugs again.

Put simply, I didn't like A.A. or the concept of the 12 Steps, which hadn't changed in decades, relied on the notion that alcoholics and addicts would never be able to lead normal lives and would always be slaves to drugs or alcohol or the Program itself, and seemed to be free of any actual science. Maybe the meetings you went to when you got out of rehab acted more as support than treatment, per se, but the treatment you received in rehab -- treatment designed to help you kick drugs and alcohol as best you could -- was all based on the tenets of A.A., and for many that treatment is court-ordered so somebody must think it's the best thing going in terms of getting people clean. I understand the idea that a singular approach to treatment is necessary for most rehab facilities, simply because -- as I was told during one of my many back-and-forths -- a center like the one I went to just sees too many people to provide a truly personalized experience. (If you want one that does, be prepared for a "significant financial commitment," and even then the philosophy likely stays the same.) But something about it feels all wrong. It felt like, in the year 2001, there should be a better way than calling out to God or your "higher power" and hoping for the best as you prepare for a life of calling yourself an alcoholic or addict. Because that's what you always were. That's what you introduced yourself as at every single meeting: "I'm (your name here) and I'm an alcoholic and an addict," someone for whom one drop of alcohol or one relapse could represent catastrophe. Every time I heard that I remember thinking, "No, I don't want myself to be defined by this disaster. I want to be more than an addict. I want to be an ex-heroin addict, otherwise why the hell am I doing this?"

There's a lengthy article currently published at The Atlantic that dissects A.A.'s 12 Steps (and the corresponding 12 Traditions) and asks how exactly they became the foundation of drug and alcohol treatment and recovery in the United States, seemingly to the exclusion of all other methods. "The history of AA is the story of how one approach to treatment took root before other options existed," writes Glaser, "inscribing itself on the national consciousness and crowding out dozens of newer methods that have since been shown to work better." Glaser traveled to Finland to speak to a researcher who's using the opioid antagonist Naltrexone to slowly wean alcohol abuse patients off booze to the point where many can ultimately resume drinking in moderation, something that runs completely anathema to A.A.'s policy of abstinence and helplessness. She also examines the efficacy of behavior modification and other forms of legitimate psychotherapy on those who believe they consume too much alcohol, placing them up against an admittedly antiquated program that seems to rely on little more than talking your problems out with strangers and which almost serves as its own religion. An argument for the lattermost point can be made given that not only does Alcoholics Anonymous speak of surrender to a higher power, it also acts as a self-reinforcing belief system, one which holds that when you convince yourself you've become powerful enough to drink again, you've lost and need to seek redemption.

Glaser throws out quite a few numbers she says could be the actual success and recidivism rate of A.A., but it's true that those figures are difficult to confirm or debunk. I can tell you that my primary counselor in rehab told me that their success rate was probably only about 30%, but when I explained to him by way of a couple of colorful metaphors how not-at-all-reassuring that was he reminded me the part of town our little paradise was located in. Many of those who were beside me during my stint had been ordered there by the court system -- quite a few had been through more than once -- and once they were done they'd be out onto the streets again, right back into the fire that burned them before.

But that brings us to maybe the most unsettling fact about the 12 Steps: They're so "inscribed on the national consciousness," to use Gabrielle Glaser's words, that our judicial system actually sentences drug and alcohol offenders to both treatment in facilities that use the A.A. model and independent A.A. meetings. Here in Los Angeles County, a misdemeanor DUI comes with mandatory attendance at A.A., which means that you're not only being sentenced by the state to a program that has faith built into its DNA -- although some will twist themselves into tautological pretzels to make "God as we know him" less than divine or will simply suggest that religion and prayer be disregarded altogether -- but the state obviously considers the 12 Steps to be integral in helping the person abusing alcohol to get sober. It's not possible that you just went out and got drunk and were dumb enough to get behind the wheel, you apparently have to have an alcohol problem. (Either that or the court system just considers sitting in a room full of tragedy for hours on end part of the punishment.)

There's a line in Chapter 5 of the Alcoholics Anonymous Big Book that a lot of the Program's detractors have latched onto, and it's easy to see why because of how accusatory it is and how well it proves what I just said about A.A. being a self-reinforcing religion. "Rarely have we seen a person fail who has thoroughly followed our path," the declaration goes. "Those who do not recover are those who cannot or will not give themselves completely 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." So it's not your fault, but it kind of is. And it's all or nothing, which is how A.A. is supposed to work if you truly follow its Bible word-for-word. Admittedly, many people don't do that; as something other than rock-bottom drunks whose lives have spiraled into oblivion, they don't live by every single rule of A.A., but they can't get around the fact that 100% abstinence is the goal of the 12 Steps, because, again, the very first step is the admission that you can't handle that one drink -- that you're powerless against it. The treatment/support group with a stranglehold on recovery in the United States is all-or-nothing. There's no gray area. There's no wiggle room. There's do, or do not -- there is no try. If you do, great. If you don't, then you either call your sponsor and begin working the steps again or, according to the Big Book, you're "constitutionally incapable of being honest with yourself." You can't admit that you're not you -- you're an alcoholic, consumed by your disease.

Maybe what's most interesting about the 12 Steps is that they can supposedly be -- and often are -- applied to every kind of addiction, whether it be drinking or drugs or gambling. They're all purpose. I was addicted to heroin but I was in a rehab facility that adhered to the A.A. philosophy -- twice. Heroin is a vicious, physically addictive drug, the kind of thing that once it has hold of you you can't stop doing because if you do you'll get violently sick. The drive to do heroin when you're addicted to it is like nothing I can describe. The need is involuntary; the drug simply becomes you and nothing else matters anymore. There were people in rehab with me who were addicted to heroin and far worse and some of them got quite a bit out of the Program, and I have no doubt that A.A. has been responsible for saving many, many lives. Like faith, if it does some good it feels like it's easy to avoid critically examining it. But that's the thing: We, ironically, depend on it in this country rather than allowing for more progressive and scientific treatments and remedies for addiction. Our judicial system depends on it. Pop culture has made it iconic. We aren't willing to truly consider the possibility that there are ways to save even more lives and help people overcome alcohol abuse and addiction even more effectively than what we've been doing for nearly a century. We just take it for granted now that A.A. is how you get sober, when maybe it's not and maybe some who abuse alcohol don't need to get sober at all.

Is there a better way? It sure as hell seems that way. But we won't know if we don't try.

At the end of July, 2001 I got out of rehab. I was, at last, healthy and clear-minded. I still drank on occasion, which I was told not to do because drinking and drugs are all one thing according to the wisdom of the Program. But I knew myself -- and I knew that I never had a problem with drinking. Heroin was my killer and I was determined not to do it again.

I eventually tried going to a couple of meetings in New York City, where I had moved less than two weeks out of rehab to be part of MSNBC's 9/11 coverage. I'm glad I went but I gave it up quickly, realizing that the thing most likely to keep me off smack was the overwhelming desire to never see another A.A. meeting again. I wasn't an addict. I'm not an addict. I'm just Chez.

I wrote a book about my descent into addiction, time in rehab and attempt at recovery while living in New York City and covering 9/11. Here's where you can read it if you're so inclined.