Alcoholics Anonymous: Part 2: The good, the bad, and why I didn’t join.

pexels-photo-924004.jpegA quick note before I begin: I have received feedback that the science can be a bit hard to follow in this blog. From now on I will signal the sciencey bits with *Warning Sciencey bit” and signal the end of it with *End Sciencey bit* and if you choose to skip these bits, the rest of it should still make sense. Hope that helps, but open to more feedback if anyone has better suggestsions.

The Scientific Perspective on AA
For the most part (although this is not a consensus by any means) scientists do not particularly rate AA. To them it is a program that was made up by a guy a long time ago (1935) without being based on any kind of scientific evidence, and due to its anonymous nature is difficult to study in a systematic manner. What this means is, that the studies that have been done are largely observational, and do not involve participants being randomly assigned to AA vs. other treatments and control groups to infer outcomes in a more causal manner. And then there’s the God thing. For those who don’t know, a large part of the AA program involves putting faith into a ‘higher power’ – defined as a ‘God of your choosing’ which doesn’t necessarily HAVE to be God Himself, but often is.

*Warning Sciencey bit*
The notion of a higher power is inherently non-scientific. This is because it is non-falsifiable. What this means is that, because it can never be proven wrong, it can never really be tested. In other words, the concept of a higher power can be altered to fit any situation. For example, if someone prays for something, and subsequently receives what they asked for, a believer will assume that their higher power has answered their prayers. On the other hand, if someone prays but doesn’t get what they ask for, this doesn’t change the beliefs of that individual. Instead, a believer will assume that their higher power has a different plan or destiny for them. In this way, a person’s faith can be used to justify any outcome, and therefore can never be proven wrong. And although things are never proven ‘right’ in science, if something is non-falsifiable then we also cannot provide solid scientific evidence suggesting its existence. So at least within the realm of our capabilities right now, the concept of a higher power can never be proven or disproven.
*End Sciencey bit*

What the Soberverse thinks of AA
It is worth mentioning that this view of AA and other anonymous programs by scientists is far from a consensus, and some do have a positive view on it. But the soberverse (my made up name for the online recovery world) has a different perspective altogether: anonymous programs are still by far and away the most popular treatments for addiction. They are the most accessible as there are many such meetings at convenient times, all over the world, and all you need to attend is to give a gold coin donation. Even without that, you will not be turned away. Furthermore, within the soberverse you will find many people who have gotten sober using these programs, who swear by their efficacy, and become very attached to the ’12-step program’.

As for my point of view, as a ‘Neuroscientist in recovery’, I suspect the truth lies somewhere in between these two points of view. Whilst it is not the panacea that some people believe it to be (although it can be for many individuals), it is not completely useless either.

The Positives
The biggest ‘pro’, in my opinion, is that AA provides a way for people in recovery to connect. Furthermore, it provides an opportunity to connect with active and ex-addicts, and other people who generally understand what an individual might be going through. It gets people out of the isolation they might have been suffering, which even in basic neuroscience we know to be important because of studies such as the famous ‘rat park’ experiment.

*Warning Sciencey bit*
In brief, rats who were kept in isolation without enrichment were easy to train to self-administer cocaine or opioids and to became ‘addicts’, whereas rats that were given access to other animals in an enriched environment (i.e. rat park) were not. The implication, of course, is that individuals with good social connections and opportunities are less likely to become drug addicts than isolated individuals with little opportunity. I should mention that this finding hasn’t always been well replicated since the original, something else I will touch on in future posts.
*End Sciencey bit*

I think most people in recovery will tell you, and from my personal experience I totally agree, that connections are vital to recovery. So in this respect, AA does a good job. It is often said within the soberverse that “connection is the opposite of addiction” and I agree, although most of my connection has been achieved online.

Another thing AA gets right is that it provides a program of positive reinforcement of ‘good’ or productive actions that are learned in sobriety, such as paying bills, cleaning your house, getting a job and generally getting your shit together. That is, when good things start happening to the addict in recovery (because they are sober, no longer isolated, have help etc), not only do they feel the intrinsic happiness of getting their shit together, but they have the added feeling of a spiritual guide, a ‘higher power’ that helps the addict feel like they are not alone, and that they are being guided on the right path. Moreover, addicts often feel like the higher power affords them a strength to get better that they didn’t have alone. Over the months I have spent in recovery, I have really begun to appreciate the positives people get out of having a higher power. Although my beliefs prevent me not only from believing in a higher power, but really in any type of spirituality, over time I have honestly come to see this as a bit of a shame, because I see how much contentment such beliefs can provide.

These are not the only benefits of AA by any means. It provides a program of accountability, allows a person to address the issues in their past or in their current life with a new perspective (in particular changing from seeing themselves as as a helpless victim), and eventually provides a way for addicts to help others. Therefore I believe the AA program provides many things that even a scientist or skeptically-minded individual can appreciate.

The Negatives
So, given all those positives, why haven’t I been back to AA? In all honesty, I’m not really sure. For a long time I told myself I’m too busy as my job can be very demanding. But I’m sitting here writing this blog when I could be at a meeting, so I guess I would have time right now! Also as I mentioned, as much as I can see the benefits of believing in a higher power, I just can’t. As far as I can tell, even the agnostic or atheist alternatives involve some kind of higher power or spirituality – just not one based on God. This is just a 100% no from me.

I think that another reason for not attending is that I don’t think I need to. Whilst I have no problem admitting that I am an alcoholic, my life is not ‘unmanageable’ and never really has been. I have a family, I have a good job, I have a lot of friends and happiness, and I am relatively fit and healthy. I also have expert knowledge of the neural circuitry of decision-making, and that helps a lot. Further, if I’m going to be totally honest, the idea of walking into a room of people I don’t know to talk about being an alcoholic is terrifying, even if I have done it once before. I know that this is a weak reason, but I’d be lying if I said it wasn’t a factor.

So there’s all my excuses. I recognise that they are all excuses. If I really needed a program like AA, none of these excuses would get in my way – just as they didn’t when I was in Bali. However, my last and most important reason for not attending, I feel is not just an excuse, and this reason is the rigidity/inflexibility of thinking I see it produce in people. Although of course it is possible that it is the addiction that produces such rigidity, not the program, but there does at least seem to be a correlation even if the link is not causal. And of course I should mention that this does not go for everyone who attends AA, there’s plenty of people with their own take on things

*Warning Sciencey bit*
There is evidence in the lab, that even in animals that have been trained to be alcoholics or drug addicts, then their ability to make decisions is impaired. Specifically, if rats learn to press a left lever for sugar water, and a right lever for pellets, when later given a choice between levers a normal rat will choose the one that earns whichever (pellets or sugar water) is most valuable to them at the time. An alcoholic/drug-addicted rat, on the other hand, will choose both levers equally. This demonstrates that on a fundamental level, drug addiction impairs the capacity to make decisions. This impairment appears to be accompanied by alterations in neural activation and other structural changes in the striatum, which is part of the brain’s hub of action selection. Similarly, human drug addicts show reduced activity in prefrontal cortices and striatal regions associated with decision-making (see the figure below for a highly simplified diagram of this pathway, taken from http://addictionpathology.wikia.com/wiki/The_Reward_Pathway). I know for me personally, when I was drinking, a lot of the time my decisions were impaired because I just didn’t really care. All I cared about was my next drink.

The_reward_pathway_3.png
*End Sciencey bit*

So it is possible that the rigidity of thinking was there prior to attending AA. Alternatively, it is possible that because of the alcoholic’s impairment in their ability to make good decisions, it makes sense for them to ‘surrender’ this process to others, and to ‘take the cotton out of their ears and put it in their mouth’ as a common saying goes. Suddenly, when the program works for them like nothing ever has before, they start to believe that this is the only way to get sober.

It is this rigid attachment to the ideas and traditions of AA is that keeps me away. I am sure there is wisdom in the twelve steps, and as mentioned the higher power provides an important service. But the rigidity is very difficult to accept for people like myself, whose entire world view is built around scepticism, questioning, and the necessity of empirical evidence. I have had an MD in recovery say to me that he had to suspend his scientific thinking in order to go through the program, but I just don’t think this is possible (or necessary) for me.

So if not AA then what?
There are a number of alternatives. If you are looking for face-to-face meetings, there’s SMART recovery which is a research-based program. I was quite drawn to the idea of SMART but I couldn’t find a convenient meeting. This is one area in which AA beats SMART hands down, there are far more AA meetings than SMART meetings. Other than that, there are also medications such as the Sinclair method (an opioid receptor antagonist [i.e. blocker] taken in pill form that blocks the pleasurable effects of alcohol). I haven’t had personal experience with these, but the science suggests they are relatively effective.

For me personally to stay sober, I haven’t tried medication, SMART recovery or AA (other than that one time in Bali). But that doesn’t mean I haven’t worked hard on recovery, and I am still working hard. Online connection has been a big part of it. Of course I should acknowledge that, being a functional alcoholic, I was not too isolated already a close family, a good job, and a pretty good social network which already included some sober people. Perhaps if I were missing just one of these factors I would have needed face-to-face meetings to get sober. Perhaps I still will need such meetings one day, I certainly wouldn’t rule it out. As mentioned previously, I have also read every sobriety memoir going, listened to recovery podcasts (especially the Shair podcast), and joined recovery groups on facebook and elsewhere. I also do regular sessions with a recovery coach.

This blog is the next step on my journey. Writing here will keep me accountable, will allow me a way to express my feelings and thoughts. I am not doing this alone by any means. “Connection is the opposite of addiction” indeed. So welcome on my journey, let’s see where it takes us.

12 thoughts on “Alcoholics Anonymous: Part 2: The good, the bad, and why I didn’t join.

    1. Thanks Vivian! It’s very nice to hear. I’ve been causing a bit of controversy with this post and it’s tough when my aim was to bring people together, not pull them apart. But I suppose upsetting some people is inevitable!

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  1. I am loving your blog. I have attended AA for 8 or so years. I have relapsed several times, only for a week or so at a time, then I would get right back in the saddle. I am not being critical, or I don’t profess to mean it that way, but AA seems a bit hypocritical to me. All the “we are family” etc. is not generally true. I love my group, but if one falters, I don’t find them there for you unless it is convenient….just like in everything really. There are other things…..like rigidity. It is not supposed to be rigid, but in reality, it is quite rigid. You MUST have a sponsor, they MUST be of the same sex, you MUST attend umpteen meetings or you will fail, on and on. I have started to go online and read and chat with other alcoholics and I am finding it really suits me! Some one has a problem…many will pitch in at all hours to help and give suggestions, including me. I don’t particularly need face to face. And I can communicate at any time. I feel helpful and I am making new friends that are a little different from the rank and file (including me…haha). I love your blog and will continue to keep up. Oh, I am going to go to a Smart meeting this week if possible. You are right, they are hard to find. But I’m going to give it a whirl! I will keep in touch. Go on my facebook page and you can learn more about me in my credentials. I think my past career has a lot to do with my independence. Don’t know if that is a good or bad thing, but I am doing just fine.

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    1. I forgot to mention that I have been a certified recovery coach for two years now. I work pro bono and most of whom I counsel are lawyers and court personnel, as that is where I worked for so long and I am comfortable with those people and they are comfortable with me.

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    2. Thank you! I totally agree, and if you dare question something about AA you can be accused of being a ‘resistant alcoholic’. I’m sure it’s true that many people were like that in early recovery, and I’m sure I am being arrogant. But I’m arrogant and sober and happy so I think that’s OK? I also should say that I’m sure that there is a lot of variation in meetings around the world, some may be more rigid than others etc. As mentioned above, I do think AA gets a lot of things right, and is a great support system for many. But for me personally it wasn’t what I wanted to do, so I just wanted to get the message out there that it isn’t the only way to get sober.

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  2. I think alot of people just practice prayer and try to cultivate their ‘belief’ similar to any other cognitive/behavioural technique. (Fake it to make it as AA says).

    As a sort of fellow Neuroscientist (in an out of recovery) I look forward to reading your posts. Btw probably the least controversial thing I ever read regarding AA! lol.

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    1. Hey Ric, yes that exact thought has crossed my mind also. Surely by praying over and over, the individual is forming and strengthening synaptic connections that provide resistance, distraction, or alternatives to using. So in that sense it might very well work, and there might very well be an underlying scientific reason as to why.

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  3. I enjoyed your article and although I am a spiritual person understand your point. It is my child who has struggled with addiction but I have also wondered why if people become what they tell themselves they are why do you introduce yourself as alcoholic or addict? It’s not who you are it is one issue in a complex person with other abilities and talents. It seems to put a person in a box.

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    1. Hey Robin, it’s a good point you make. Probably people who are in AA would have a better answer for you, but my assumption would be that it’s to do with Step 1 and admitting you’re powerless over alcohol. Then I would say it might help people resist complacency as they achieve stretches of sobriety – to remind them that they are an alcoholic and so shouldn’t go out and drink again? But like I said I’m not 100% sure. I’m sorry to hear about your child, I’m not sure what part of the world you are in but if you need to be pointed in the direction of help please let me know and I’ll see what I can come up with.

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  4. Putting up an intellectual defense is commonplace behavior. Contempt prior to investigation is normal behavior as well. We’re all experts and have an answer for everything when we arrive. Don’t be too proud to strong! Summon the courage to work the program and change yourself for the better.

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      1. In the WP blog feed, neuroscientist caught my eye. I read a few of your posts and it took me back to the beginning. I understand the neurobiological component well. That aside, I’m more interested today in the individual and their life journey.

        I have learned a few things on my sober journey. Every child deserves a sober parent! They grow up fast and leave the home. The quicker we can move from “not drinking” and into “sobriety”, all the better. Addiction is a response to emotional pain. Identify and work through that pain and your life and the life of your loved ones will be enriched immeasurably.

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