Recently, an article published in The Atlantic that turned heads by criticizing Alcoholics Anonymous (AA) and its ineffectiveness. In a rather scathing piece titled The Irrationality of Alcoholics Anonymous, journalist Gabrielle Glaser claims that 12–step programs, particularly AA, are "irrational" and pseudoscientific . I, hereby, want to give a rebuttal.
Before diving into my argument though, it is important to consider the source—in this case, the author. Glaser is an award-winning journalist who writes quite a bit about addiction. She also has a Master’s degree in history. However, Glaser is not a scientist, clinician or, to my knowledge, has any formal training in science, research methods, addiction and recovery, counseling, clinical psychology, psychiatry, etc. As such, Glaser is best considered an informed layperson when it comes to determining whether something is scientific or not. She must rely on the viewpoints of others when describing her case and is unable to weigh in the evidence from an expert viewpoint herself.
Not to be mistaken, many of Glaser’s criticisms about AA are valid. Now before any AA supporters get too upset, let me state that I happen to attend AA meetings fairly regularly and enjoy going to them. However, I certainly take a lot of the cherished beliefs of AA with a large grain of salt. Glaser does not look at both sides of the issue but instead engages in something known as a confirmation bias to make her point. So while some of Glaser's criticisms of AA are actually valid criticisms, they fail to consider some other elements of AA that make it attractive to certain groups of people. In this way, her statement that AA programs are “irrational” is made without true understanding of both the strengths and weaknesses of AA.
Criticisms of Glaser's Approach
My first criticism of Glaser's article is that she does not understand the research that she attempts to cite. For instance, Glaser spends quite a bit of time discussing medications used to treat addiction, particularly naltrexone, which I have discussed in a previous article. The claims that Glaser makes for naltrexone are largely based on anecdotal and not research-based evidence while research on naltrexone indicates that it is about as effective as psychotherapy is in treating alcohol use problems. In fact, while Glaser makes a point to state that AA’s success rate in treating alcoholism is probably very low, she fails to mention that the success rate for nearly any addiction treatment program is actually very low compared to treatment for most other mental health issues. An interesting contradiction that Glaser unwittingly makes in her article is her frequent discussion on how unprepared physicians are in treating addiction all the while giving her support to medical treatments for addiction.
My next criticism is that while Glaser repeatedly criticizes AA’s claims as being anecdotal (subjective and untrustworthy) she relies primarily on anecdotal stories herself to support her own points (in the form of self-reports from addicts, personal self-reports and claims from researchers who have an agenda in promoting their own programs). This tendency belies Glaser's inexperience in understanding how to formulate a criticism based on the scientific method. So while Glaser tries to make a case that AA is unscientific, her case is primarily itself composed of unscientific evidence and anecdotal explanations. However, even given these observations I do agree with several of her primary criticisms of AA.
Abstinence: No Empirical Foundation
Glaser asserts that the principles of AA are not supported by empirical research. For example, AA supports the notion that alcoholism is a chronic disease and the only way to cope with alcoholism is by engaging in total abstinence from alcohol. This is one of the myths that AA continues to support. The idea that total abstinence should be the only goal in addiction treatment has been refuted over and over again in both clinical and epidemiological studies, some of which are discussed by Glaser.
There is no truth to the idea that the only way to recover from addiction is total abstinence; however, there is a good reason why many addicts try and remain abstinent. Just as total abstinence does not appear to work for everyone, neither does a return to moderate use. So while Glaser discusses programs and cases that support continued use of alcohol in moderation, she fails to discuss the many cases where an addict attempted moderate use but failed miserably. This is an example of her confirmation bias; Glaser only presents information that confirms her own belief. She does not investigate information that disconfirms it. The scientific method, which Glaser pretends to support, actually is more concerned with trying to disconfirm its theories and beliefs as opposed to simply trying to confirm them. By failing to disconfirm a belief or theory in the scientific method, scientists add more support to the theory. The fact that Glaser is not a scientist or has no training in research methods leads to this biased style of reporting. Even most programs and sites devoted to moderation in recovery warn that this approach is not be effective for everyone.
The Jellinek Model
It is also true that AA still relies heavily on the notions of E. M. Jellinek in describing the course of alcoholism. Glaser makes a point of pointing out how unscientific Jellinek's model really is. This may surprise many hard-core 12 steppers, but Jellinek's model has been refuted over and over by empirical research. Moreover, Jellinek's method of data collection used in developing his model was extremely biased and would most likely not get even minor consideration by most peer-reviewed journals today. I, for one, actually cringe every time I hear someone mention the Jellinek model in an AA meeting. The Jellinek model is frankly not valid and does not apply to the vast majority of people that suffer from addiction.
Another issue that Glaser directly and indirectly refers to several times in her paper is the idea that AA members are not trained professionals (interestingly she also makes a good point that even trained addiction professionals are not very well-trained in the field of addiction and recovery). Though it’s true that most of the members and sponsors in AA are not trained mental health professionals, that is not something that AA tries to hide. In fact, AA readily states that its programs are run by addicts and recovering addicts. Moreover, AA does not charge for its services so it would not fall under the umbrella of clinical treatments for alcohol use disorders. With that, the program is not ethically bound to include treatment professionals or to follow any clinical treatment guidelines.
In addition, AA makes a point to assert that it is not affiliated with any particular professional organization or political philosophy. The bottom line here is that AA is simply a support group that attempts to help individuals with alcohol problems. Certainly Glaser would not deny that someone who has successfully recovered from a serious problem like addiction has a lot to offer other people trying to recover from the same issue. I personally know of no instance where AA has formally come out and certified its members as "professional addiction counselors." Again, AA is simply a support group for alcoholics run by alcoholics where the mere purpose is to get together, discuss issues related to recovery and try to learn from and help each another.
The 12 Steps
Of course Glaser makes a lot of critical remarks about the 12 steps of AA—criticism that will draw the ire of nearly any devoted AA member. It is true that the 12 steps have no sound empirical basis on its effectiveness in treating alcoholism. It is also true that really committed AA members may exert peer pressure on other members or new members to follow the 12 steps. I realize this is anecdotal, but personally I attempted to follow the steps at one time and found no benefit or significant disadvantage in them. However, I do not give them much credence as being essential for recovery based on my understanding of the research and personal experience. Anyone who attends AA meetings is free to follow them or not follow them. It really is a personal choice and one cannot be denied attendance to AA meetings because they do not complete the steps. I never completed them, attend meetings regularly and am still accepted as someone seriously addressing my recovery by the group.
While I do agree that it is not necessary to follow these 12 steps in order to successfully recover from alcohol abuse, I have seen cases where following the 12 steps has been beneficial to some. Following the 12 steps may instill structure in some people’s lives, which can be important in recovery. However, it can also be that any strong form of structure that an individual buys into will produce the same results. AA has never tested this idea and one of the real problems the program has in being nonscientific is that it does not revise its foundations (in this case the 12 steps) based on empirical research findings. So the 12 steps are the same 12 steps that AA used in the beginning and will be the same 12 steps 50 years from now unless they change this policy. Still, unlike medication that always has the potential for serious side effects, it is highly doubtful that following the 12 steps has significantly harmed anyone.
As a trained mental health professional, my advice regarding the 12 steps to anyone entering AA would be to try them and use them if they’re relevant to your situation. However, if they’re not, you can still attend AA meetings and receive the support you’re looking for without adhering to them.
Glaser also offers criticisms of AA's ties to Christianity and its spiritual-based approach. However, AA is not the only available recovery program for alcoholics and any atheist is free to ignore the faith-based references or opt out of meetings altogether. If someone does not want to attend AA for this reason or does not want to believe in God they certainly don't have to. There are several recovery groups that do not have the spiritual foundations of AA like Smart Recovery and Secular Organizations for Sobriety that anyone can look up and get involved in. The fact that many courts mandate attendance to AA, a spiritually-based program, as part of the requirements for rehabilitation or probation for those with alcohol use problems is a criticism of the court system, not AA.
Glaser also makes a point that the notion that alcoholics must "hit bottom," meaning they must sink to the most extreme low they can possibly reach before seriously attempting to recover from their alcoholism, is fantasy. That is certainly true and many AA members have experience with other recovering alcoholics who never hit their absolute bottom. Moreover, hitting bottom is a subjective term in that even if a person were to recover from an extremely impoverished state they would still never know if they actually hit their absolute worst because, theoretically: things can always get worse.
This criticism actually applies to a general misconception in the treatment of addiction and not specifically to AA as many lay people and even therapists, addiction counselors, etc. have been known to support this notion. What is true, and what Glaser never fully touches upon in her article, is that in order for someone to recover from an addiction they must realize that they have some kind of a problem and also want to change. If a person has no commitment to change their situation or behavior then it becomes extremely difficult if not impossible for them to stop drinking, no matter what method is forced upon them. I often think the “hitting bottom” term should rather explain the period when an alcoholic or other addict realizes that they have an addiction, that the situation is serious, that they’re acting in a self-destructive manner and that they need to change themselves or their life will be ruined (if it isn’t already) as opposed to a literal maximum level of depravity and hopelessness.
Glaser does provide some valid criticisms of AA; however, she is not the first to provide these very same criticisms and certainly will not be the last. Despite the attention that her article has generated, there is nothing new in her criticism. These criticisms have been stated and formally written by many other individuals—those who are much more qualified to criticize AA than Glaser as well.[3, 4, 5] The Atlantic article is simply a case of old wine in new bottles.
Regardless, criticisms like Glaser’s do point out that certain widely accepted tenets of programs like AA actually have very little empirical support to substantiate them. This includes the highly-valued 12 steps, the Jellinek model and other aforementioned traditions that 12 step programs adhere to. However, this does not mean that positive results do not come out of these meetings. Even if AA is no better than any other treatment program out there, it does have a large number of individuals who claim to have attained sobriety by attending meetings. So like it or not, there is something about AA that, in spite of its flaws, continues to work for a substantial number of people.
 Glaser G. (2015). The irrationality of alcoholics anonymous. http://www.theatlantic.com/features/archive/2015/03/the-irrationality-of-alcoholics-anonymous/386255/.
 Hatfield, R. C. (2015). Medications to curb drinking behavior. Internetbrands.com
 Schaler, J. A. (2000). Addiction is a choice. Open Court Publishing.
 Peele, S. (2000). What addiction is and is not: The impact of mistaken notions of addiction. Addiction Research & Theory, 8(6), 599-607.
 Peele, S. (1990). What works in addiction treatment and what doesn't: Is the best therapy no therapy? Substance Use & Misuse, 25(S12), 1409-1419.