Alcoholics Anonymous has garnered attention and popularity worldwide. From celebrities such as Demi Moore, Phillip Crosby, and Robert Downey Jr joining support groups to millions of others, it would appear that the rehabilitation program is highly successful. But does this program work in places other than the United States? Can a mutual help program with strong Protestant roots that was started by white, middle class Americans equally appeal to clients with diverse ethnic and cultural backgrounds? A closer look at the sobriety rates shows that Alcoholics Anonymous doesn’t work for everyone.
Anthropologist William Madsen, a professor at the University of California, Santa Barbara, claimed in a 1974 book that it has a “nearly miraculous” success rate, whereas others are far more skeptical. Some of the programs’ problems stem from the inconsistency of the program. For example, the fact that what occurs during AA meetings can vary considerably. Further, about 40 percent of AA members drop out during the first year (although some may return), raising the possibility that the people who remain may be the ones who are most motivated to improve. A number of experts have criticized AA’s all-or-nothing mentality, saying that it’s difficult for alcoholics to remain completely abstinent from alcohol. They’ve suggested other programs such as slowly weaning the alcoholic off the booze, or practicing moderation. Completely refraining from drinking puts unbearable pressure on people who can’t live up to so high a standard. If someone has one slip up and starts to backslide, they feel that they’re powerless to stop.
Other counselors have claimed that AA might occasionally be harmful. When a group is highly confrontational, for example, alcoholics may become resistant to change (“The Advice Trap,” by Hal Arkowitz and Scott O. Lilienfeld; Scientific American Mind, September/October 2010). Celebrities like Phillip Crosby might agree. After being arrested several times for drunken driving. In spite of the fact that he attended Alcoholics Anonymous meetings for 18 months, he told People magazine, “I don’t drink anymore — but I don’t drink any less.”
There is good reason to view with skepticism claims about the universal appeal of American movements and ideologies. Researchers Leach and Norris, publishers of a study on temperance cultures (1977) found that the number of AA groups per million people in Canada and Australia about equaled (or at times even exceeded) that of the US from 1945 to 1970. In the UK, however, the number of AA groups per capita remained much lower than in the other English-speaking regions. AA membership has also grown substantially in the Nordic countries, especially Finland. Yet even in Finland, Alcoholics Anonymous is still only one of several available forms of treatment, and it accounts for only a minority of such efforts. Most Finns with drinking problems still turn to the national health-care system, to the network of A-Clinics which use a variety of psychotherapeutic approaches, and to the indigenous Finnish self-help movement called A-Guilds (Alasuutari 1990). This is the opposite of the situation in the US where the philosophy of AA – of the twelve-step movement –dominates in-patient and out-patient treatment, therapeutic communities, and nearly all drug self help groups.
Further, alcoholism treatment in most European countries, both temperance and non-temperance, allows for moderate drinking – a notion which is still utterly heretical in the US today. Psychiatrists and other alcohol and drug treatment professionals throughout Europe also generally avoid the disease concept of alcoholism and, following the British Journal of Addiction and the World Health Organization, talk about “alcohol dependence.”
Ireland and the Netherlands, both non-temperance countries, have a relatively high number of AA groups per million. Each one deserves special study as the story of the growth and spread of AA in each place is probably different. Ireland has the highest rate of groups per million of any Western non-temperance culture. This may be due to several factors especially the impact in the early twentieth century of the Irish Protestant temperance. Tradition, and, perhaps, the influence of Irish-Americans who by all accounts seem to be the American Catholics most involved in AA in the US.
Germany, Switzerland, and Belgium are the remaining non-temperance cultures with some AA activity. Germany and Belgium have large numbers of military and corporate personnel from other temperance cultures, especially from the US, Canada, and the UK. That certainly accounts for some of the membership, perhaps for a lot of it. Switzerland (like Germany) has always had a small but steady temperance activity and AA membership there is in accord with that pattern. It appears that the pattern of native German and Swiss AA groups participation draws heavily, or primarily, from Protestants. Some evidence for that is also suggested by the case of Austria, an overwhelmingly Catholic country, with the same language as Germany and much of Switzerland; but Austria reports no AA groups at all.
A 1990 summary of five different membership surveys (from 1977 through 1989) reported that 81 percent of alcoholics who engaged in the program stopped attending within a year. And only 5% of the AA attendees surveyed had been attending meetings for more than a year. In the West, AA remains overwhelmingly a movement of the US, Canada, UK, and Australia. Indeed AA membership in the US and Canada totals 655,700 or 83.8 per cent of all AA membership in the West. And the US alone accounts for 585,800 persons or about 75 per cent of all AA membership in the West.
“When you look at people just taking themselves to a meeting, long-term abstinence is pretty low,” admits Dr. David Sack, an addiction psychiatrist and the chief executive of Promises Treatment Centers. “But the fact is it works well for the people who work it.”
One of the most illuminating reports on the topic appeared in 2005 in the online journal BMC Public Health. It analyzed data of an 8-year study that found AA, CBT and motivational enhancement therapy were all equally effective, and reported that nearly all the effect of the treatment was achieved, much like waterboarding, after attending a single session. “It was the initial decision to get better that determined a person’s chances of success,” said Dr. Bankole Johnson, chairman of psychiatry and neurobehavioral sciences at the University of Virginia, and author of The Rehab Myth: New Medications That Conquer Alcoholism. “What followed made little difference. Although AA doubtless helps some people, it is not magic.”
Another similar study was recently conducted by Marica Ferri and her co-workers at the Italian Agency for Public Health. They compared several 12-step programs for recovery from alcoholism, including “Alcoholics Anonymous.” The results, published in the journal The Cochrane Library, are clear: it makes no difference which program one enrolls in, one has about the same (not very high) chance of returning to sobriety for good.
Taken as a whole, these studies suggest that AA may not be as helpful as the program boasts. Although AA still remains a successful program for getting some drunks sober, it would be a bit naive to suggest it was the only way. In light of these studies, the conclusions suggest that it comes down to a person and whether they want change. No amount of therapy or mutual-support sessions can force someone to change their ways. Today, there are many local programs based on a variety of different ideas and methods for sobering up alcoholics, some being more successful than others.
If you have a serious issue with booze, or think you have the potential of becoming a problem drinker, then take a look at the various recovery options in your local community if the AA idea doesn’t appeal to you. But that said, it’s never a good idea to knock something before you try it, and it would be wise to at least give AA a shot first. After all, they have a fantastic fellowship of members in recovery, and there are many folks who have been successful.
For those who would sooner bypass the help of AA and try some of the newer less tested programs, the following will give some idea of what’s available. These are a few of the more popular options, but there will be others too:
Good luck. Sobriety is there for anyone who really wants to stop drinking and start a new and purposeful life!