The Atlantic magazine just published a lengthy piece by author Gabrielle Glaser that challenges the efficacy of Alcoholics Anonymous. Entitled, "The Irrationality of Alcoholics Anonymous," the article takes aim at the organization and never lets up, and on Wednesday night's All In with Chris Hayes, the author continued an assault that's based on a fundamentally flawed premise, and some really bad journalism. The normally excellent, intellectually trustworthy Hayes went along for the ride, and made the same mistakes.
To be clear, this is not a defense of AA; you can like it or not like it, go or don't go, believe in it or don't. This is about journalism, which is supposed to be fair and accurate. This piece, and this interview, were neither of those things.
Hayes did get a lot right about AA, pointing out important facts like the low success rate for almost any form of alcohol treatment, and rightly lauding it as "genuinely one of the most remarkable institutions human beings have ever built."
Unfortunately, he undoes much of that by interviewing two people who obviously know nothing about it. Psychotherapist Dr. Robi Ludwig gives it a decent shot, but is kneecapped by the fundamentally flawed premise. You can watch the full, lengthy segment here, but I've put together some highlights of what they got wrong:
Hayes: "We just don't know as empirical testing what the success rate is, and how the success rate might stack up against alternative forms of treatment."
This is the fundamental flaw that makes Glaser's entire article (and this interview) null and void, because Alcoholics Anonymous is not a treatment, it's a support group for recovery. Asking if AA is as effective as "other treatments" is like asking if eating apples is as effective as "other antibiotics." Here's where Hayes and Glaser failed most miserably in their journalism, because neither of them bothered to get their subject's side of the story. Glaser didn't go to any meetings or speak to any current AA members, Hayes didn't invite anyone on the show, and neither of them bothered to see what AA says about "other" treatment methods:
A.A. is in competition with no one. Our ability to help other alcoholics is not based on scientific or professional expertise. As A.A.s, we are limited to sharing our own firsthand knowledge of the suffering of an alcoholic, and of recovery.
They don't claim to be a replacement for treatment, and indeed, have a detailed policy regarding cooperation with treatment professionals. That policy includes this note:
Some of us need different kinds of help, and it may come best from non-A.A. sources, as pointed out in Alcoholics Anonymous (p. 74) and Twelve Steps and Twelve Traditions (p. 61).
That doesn't sound like a group that thinks it's the only way.
Glaser: "The best guess is that it's in the single digits, under 10%."
Actually, no, this is a guess, one that Glaser cites in her article without much detail as "just a rough estimate, but it’s the most precise one I’ve been able to find."
While Glaser and Hayes are right that the anonymous nature of the organization makes it difficult to study, they could have looked at the most recent Alcoholics Anonymous Membership Survey (2011), and discovered that 73% of members report being sober for a year or more. That's the metric used in many of the studies that Glaser cites, and while it's not the perfect measurement, it's better than Glaser's bad guess, and certainly worthy of inclusion.
Glaser: "Traditionally within AA, you don't go to an outside source. you see your sponsor, your sponsor tells you how to do the steps. Medicine is, in many cases, hundreds of people have written to me to say that they were ordered off their meds by their sponsor for their mood disorder."
Funny Glaser should mention that, because AA does have an actual list of its traditions, and they don't include keeping members away from professional help. In addition to its policy about cooperating with treatment professionals, AA literature also includes this note (repeatedly) about sponsors:
"An A.A. sponsor does not offer professional services such as those provided by counselors, the legal, medical or social work communities, but may sometimes help the newcomer to access professional help if assistance outside the scope of A.A. is needed."
Now, individual sponsors can do all sorts of crazy things. Anecdotally, they sometimes end up falling off the wagon with their sponsees, and as Glaser noted in her book, the role can be exploited for sexual purposes. It's called the "13th Step," but what Glaser and Hayes could have learned from attending a meeting is that AA is very good at self-policing these problems. The term "13th Step" exists as a warning that's also codified in the sponsorship literature, which recommends same-gender-or-preference pairings. The sponsor relationship is a pivotal, yet much-misunderstood part of AA. Glaser's right about the implicit power sponsors can have over members, but because it is so important, the groups are very watchful of those relationships. Bad sponsors, especially "13th-Steppers," are quickly and thoroughly called out.
Hayes: "Courts say, you are sentenced to go to a 12-step recovery. or we pay sometimes, whether it's health insurance, or it's for Medicaid, right, a recovery program, a treatment program is 28 days of this specific type of treatment."
To be clear, no insurance body or government agency, nor anyone anywhere ever, pays a fee for Alcoholics Anonymous. Meetings at treatment facilities are no different, and are an example of cooperation, not affiliation, with professional treatment.
Glaser: "By the way, that's illegal. To be sentenced to AA is against the law. It's a violation of the First Amendment."
That's not entirely true. While there are court cases about this, even those jurisdictions allow AA as an option as long as a "secular" option is also available. One powerful substrata of opposition to AA is among atheists who feel the group features too many religious overtones. Penn and Teller devoted a good portion of their showBullshit! to this idea, and Glaser brings it up, too. The word "God" is mentioned in five of the 12 steps, although with the caveat "as we understand Him," and every meeting closes with a hand-holding recitation of The Lord's Prayer. Members are free to skip any of that, and warned not to push matters of faith (or atheism) on others.
In practice, many members replace "God" with "Higher Power," and often consider the group as a whole to fulfill that role. Still, it's a fair point in a legal sense, but that's really not AA's problem. They don't recruit from the courts, but neither will they turn anyone away:
We cannot discriminate against any prospective A.A. member, even if he or she comes to us under pressure from a court, an employer, or any other agency.
Here's hoping that Hayes will correct the record that was so badly distorted on his show.
As for Glaser, her piece is actually not completely useless, as it does make a somewhat compelling case that the medical establishment and the government are farming out too much responsibility to a recovery support group. If doctors were sending cancer patients to a support group and calling it "treatment," no one would attack the support groups, yet this is what Glaser has done.
It should also be noted that while Glaser criticizes AA for its lack of scientific backing, she shifts deftly between vague scientific citations and anecdotal evidence, and even conducts a medical experiment on herself against the advice of her doctor. The only "irrationality" she's proven, beyond any doubt, is her own, and The Atlantic's editors.