A.A. and Science

March 30, 2015 | David Whitesock, Addiction Informatics Officer Featured

In many industries there are passionate factions, often with strongly held ideas about which way the profession should be. Many times these ideas are completely at odds.

The addiction recovery industry is no different.

Over the last couple weeks, a spotlight was put on the industry thanks to a lengthy piece in The Atlantic (“The Irrationality of Alcoholics Anonymous”) that excoriated the reliance on the Alcoholics Anonymous model of addiction care and recovery despite a lack of science behind this particular model. Essentially, Gabrielle Glaser, the article’s author, suggests that very little scientific evidence supports the efficacy of Alcoholics Anonymous or the treatment industry, which largely relies on the 12-step facilitation method (clinical counseling supported by the introduction and infusion of the 12-steps).

At the present time, there are over 12,000 comments on The Atlantic article.

Numerous retorts were spawned, most notably, one that appeared in New York Magazine (“Why Alcoholics Anonymous Works”). The essential argument here was that a major scientific study has been done (see the Cochrane Collaboration) that demonstrated positive outcomes from A.A. or 12-step facilitation treatment.

The major response from the masses goes something like this:

Of course, A.A. works, I’m living proof, as are millions of others who have surrendered to the steps of A.A. and have followed the program.

As Glaser points out, this expression is not science, but anecdote.

And this is where the factions devolve into the he said, she said world of addiction recovery.

For about a week this topic grabbed the public attention. Many major news sources waded in and did their own reporting. The most notable mainstream media coverage was by Chris Hayes of MSNBC.

Even after all this attention, the public is worse off. The general public, which already holds a stereotyped and misunderstood view of addiction and those that suffer, witnessed a collective group of survivors (estimated at 23 million) who essentially had 23 million stories to tell about how they got well.

Glaser is right, this is not science.

Just like cancer, diabetes, depression, and other chronic illnesses, there is a singularly personal experience as the individual moves through suffering, diagnosis, treatment, recovery, and wellness. Yet, many share similar physical, mental, emotional, and spiritual manifestations of their disease. We see this all the time in the stories of cancer survivors.

Addiction is no different in that respect.

But with addiction, society says the sufferer only gets treatment when they’ve “hit rock bottom.” No other medical condition demands that you climb atop your death bed before getting care. No other medical condition demands that the sufferer repent.

Granted, and science is beginning to prove this point, most chronic illnesses that have genetic, behavioral, and environmental elements require some acceptance on the part of the sick to commit to the treatment and see it through. Yet, when a diabetic stops taking their insulin we don’t kick them out of the house, fire them from their job, or lock them up in jail.

Maybe instead of bickering back and forth over a set of treatments and support groups that have been around and used for 70 plus years, we own our place in the 21st century and develop care based on the best science, medicine, and technology have to offer.

How about instead of saying, “It worked for me, if you just work it, it will work for you,” we say, “Okay, that did not work for you, let’s try this.” And have the data and science to back up such a change in treatment. Then, over time, we’ll have population data that will immediately tell us what treatments have the highest probability for certain people.

This is where we must get to with addiction. The most severe form of the disease includes (as estimated) 23 million sufferers. No other disease reaches such individual suffering. That portion of the disease exacts a nearly |half a trillion dollar negative economic drain on the U.S. Our cities are ravaged by the illness. Families and schools are torn at the seams. Yet, when someone wants to apply science to this cunning and baffling disease -- to make it less cunning and baffling -- the factions raise up and shoot them down.

The problem remains a problem not because of external societal stigma; but because of our own internal prejudices.

As Glaser suggests in her piece, the new frontier for addiction care is the health care system. One look around our website shows that we agree. One look at the work we are doing with Sanford Health to mainstream addiction care into health care should tell you that we see a solutions-oriented future.

We also see a future where the sufferer never needs to see what rock bottom looks like. Too many of us have been there. Why are we standing back and waiting for our loved ones to fall?

Society, science, and medicine are not going to jettison A.A. It has helped and will help many. But A.A., among many other modes of support and modalities of clinical care need to be connected to a continuum of care rooted in an integrated health care system.

There will always be factions of people who think their way is the better way. But when tens of thousands die every year, countless numbers of families torn apart, and communities restricted from reaching their  full potential, the in-fighting simply makes solving the problem we all want to solve worse.