This is the third part of a consideration of Lance and Zachary Dodes' critique of AA. In the first part, I called into question their claim that AA helps only about 10% of those who pursue it, and is damaging to the other 90%. In the second part, I consider how they mischaracterize AA's twelve steps--in a way that parallels the distortion of Christian theologies of grace.
For the final installment in this series, I want to (briefly, for me) consider how the Dodes' suspicion of AA may be linked to the deeper science/religion wars. The Dodes' make claims about the ineffectiveness of AA that are far more confident than is warranted, and they impose an uncharitable interpretation of the twelve steps when a more charitable one is available. But why? What lies behind these kinds of errors?
My answer is admittedly speculative--a bit of an exercise in "psychologizing." But I think there are clues in what the Dodes' say that point towards a diagnosis
Let's begin with the title of the Dodes' essay: "The pseudoscience of Alcoholics Anonymous." This title is ambiguous. It might refer to pseudoscience in the study of AA, or it might be accusing AA itself of being a pseudoscience.
While concern about the former seems appropriate, calling AA pseudoscience is a category mistake. AA isn't an empirical study of the world, but a way of life and an underlying way of thinking about life that aims to help those who participate in it overcome addiction and live clean and sober lives.
Unfortunately, the Dodes appear to have more than just the former in mind. This comes out especially when they walk through the twelve steps. As they begin to examine the steps one by one, they set up their discussion by asserting, "Twelve steps sounds like science." That is, they begin their walk-through of the twelve steps by setting up a kind of straw man: AA should be considered a science and evaluated in those terms. But then it's found to be more like religion in its language and aims. And this becomes the basis for a kind of condescending dismissal.
Let's think about what's going on here in a broader context. A common feature of the modern culture wars is the tendency to pit science against religion as if the two were essentially opposed. I think this tendency is a disservice both to science and to religion--and it is, unfortunately, fueled by agendas on both sides.
It's a disservice to both because treating them as competitors leads to distortion: On the one side, it leads to a "scientism" that unjustifiably treats scientific descriptions of the physical world as if they were offering a metaphysical worldview--that is, a view about the fundamental nature of reality and the meaning of life. This happens when it is assumed without warrant that the limits of what science is suited to investigate are identical to the limits of what is real.
On the other side, the conflation of science and religion leads to a superstitious fundamentalism wherein something meant to provide a way of seeing and responding to the world of physical facts is instead reduced to a set of dubious factual claims. When religion sets itself up as offering the best path to answering empirical questions, it has lost touch with what religion is for. It is attempting to do the sort of thing that science does, except badly. In other words, it has devolved into pseudoscience.
For example, instead of offering a religious worldview that invites us to see and respond to the world (the one described by science) as a reality that springs from a vast and creative intelligence, we get the Young Earth Creationist claim that the best way to decide the age of the earth is to deduce it from clues left in the Bible. The creationist then has to scramble for some semblance of scientific credibility in the hopeless attempt to compete with the results of sober and objective research.
Some Young Earth Creationists even find themselves driven to say that their God has systematically deceived us by planting an overwhelming body of evidence for an ancient universe...as a test of our faith in what the Bible "teaches" (as if we should trust God after accepting their assertion that God is the perpetrator of the greatest hoax in history).
This is what happens when religion pretends to be science. And there's plenty of it going on out there. But some overreaching critics of religion have taken this distortion of religion for religion's essence, as if there could be no religion without pseudoscience. And this mistake leads to the prejudicial dismissal of ideas and approaches to life that smack of religion. Even those who pay lip service to the social value of religion will often fall prey to this unconscious prejudice.
Such prejudicial dismissal, when it happens, is rarely spelled out explicitly. But if you read through the Dodes' treatment of the twelve steps, what you find is a critique that relies extensively on invoking the labels of "unscientific" and "religious" as if they were equivalent--as if, in establishing that AA is pseudoscience, it is sufficient to show that the twelve steps retain much of their religious origins.
It's not sufficient. And one reason it's not sufficient is precisely this: In an effort to be ecumenical and welcoming to the diverse array of alcoholics within its fold, AA has needed to treat as inessential the very things that are at risk of turning religion into pseudoscience when treated as essential.
Consider: AA has seen the need to set aside specific doctrinal claims, including in the interpretation of its own twelve steps. In the same stroke, it has lost the need to be "right." It is that need that leads so often to assertions that a specific text or institution or prophetic leader is an inerrant authority. And it is the need to stick by this supposedly inerrant authority, to preserve its inerrancy even when that authority makes claims that are about empirical facts rather than transcendent meaning, that so often paves the way to pseudoscience.
Put another way, AA offers a good model of what religion can look like when it is freed from the propensity towards pseudoscience. Focusing on a general way of approaching life and responding to its challenges, but without the demand for doctrinal conformity that prevails in fundamentalistic religion, AA offers a broadly religious way of life that is resistant to the pseudoscience that springs from the insistence on inerrant authority (and the concomitant cries of heresy).
This is not to say that no such fundamentalistic leanings ever infect isolated AA meetings. It is not to say that individual AA members never bring their pseudoscientific ideas into their home groups. Rather, it is to say that AA overall is not a source of pseudoscience in the way that fundamentalistic religion has proven itself to be.
Of course, the same can be said for many progressive expressions of traditional religious faith, which are friendly to good science and its conclusions (even if they are not friendly to a scientism in which invalid inferences from science underwrite metaphysical claims). But too often, those who have been burned in one way or another by fundamentalistic religion see all religion through the lens of this species, and are prone to dismiss progressive faith as some kind of bad-faith attempt to cling to comforting ideas while throwing off religion's irrationality. "Real" religion is the stuff that stands in opposition to science.
My speculative hypothesis, then, is this: The Dodes' critique of AA, riddled as it is with the errors discussed in previous posts, is colored by an underlying prejudice (perhaps a quite unconscious one). That prejudice is born out of two things: first, the fact that AA is not only historically rooted in religion but retains religious and spiritual language and aims; and second, a derisive attitude towards religion springing from (a) the scientist's wholly appropriate disdain for pseudoscience, and (b) the unfortunate prevalence of pseudoscience in fundamentalist religion.
The problem, of course, is that not all religion is the same. And to the extent that AA is religious, it is (largely) a form of religion that can live happily alongside science done with integrity.
Of course, if that is true, then AA members should be willing to engage seriously with careful scientific study of the efficacy of AA's methods relative to alternatives. While I don't think the Dodes' have offered anything critical of AA that would qualify as such a study, should there be serious academic research that demonstrates ways of improving the outcomes of AA's efforts, the AA community ought to be willing to engage with that research.
But, of course, most AA members are not researchers qualified to assess the merits of such research. And they aren't in AA to do research, but to stay sober. To say that the AA community should be open to seriously engaging with such research is not to say that AA members should be skeptical of a way of life that has worked well for them personally.
If you've become a brilliant pianist through a distinct method, a study suggesting an alternative method works better for most people who learn to play piano shouldn't inspire you to jeopardize your achievement by switching to an approach that may not be suited to you. It might, however, mean that if other methods are available and comparably accessible to your students, and some of those students aren't flourishing with you, you might suggest that they try one of the alternatives.
But AA members routinely say, "If you find something that works better for you, go for it." AA is a way of engaging with and thinking about the world, not a scientific study of the relative efficacy of such ways. Furthermore, because of the interpretive flexibility built into AA, there is not a single monolithic approach that falls under AA's rubric. Even within AA, there is room for asking which approach works better, and for whom.
More often than not, the answer to that question comes from personal discovery rather than scientific study. This is not to say that the latter should not be attempted despite the range of practical difficulties discussed in my first post. But it is to say that AA isn't a science. And it is to say that personal decisions about the path to sobriety typically need to be made based on something other than the outcomes of scientific research. Sometimes that path with adopt the forms and language of religion, extracting from religious traditions the fruits of centuries of collective practical experience, fruits which have yet to be scientifically assessed.
And none of these facts imply that AA is pseudoscience.
Showing posts with label AA. Show all posts
Showing posts with label AA. Show all posts
Monday, June 16, 2014
Wednesday, June 11, 2014
AA's Critics and the Mangling of Theologies of Grace: Considering a Recent Challenge to AA. (Part 2)
In a post last week, I began to consider a recent Salon piece by Lance and Zachary Dodes, in which the Dodes argue that Alcoholics Anonymous's 12-step programs are a poor method for treating addiction. In the earlier post, I considered their contention that AA works for only a very small percentage of people (5-10%) and is "harmful to the 90% who don't do well." I explained why I find these claims less than compelling.
In this post and the next one, I want to consider something I think may be going on beneath the surface of the Dodes' essay, something that may help explain why they make such dubious assertions with disproportionate confidence. Although anti-religious bias might not be the best term for it, it's related to the kind of prejudice one finds among many well-meaning humanists--a prejudice that fixates on a distinctive (mis)construal of religion that's widespread among believers and nonbelievers alike, but which is opposed to a more reasonable and beneficial construal.
Mangling the Twelve Steps
My suspicion that some kind of prejudice is in play is elevated by several tensions and confusions in the Dodes' critique of AA. These come out especially as they walk through the twelve steps.
For example, one recurring feature of the Dodes' critique is their charge that AA creates the illusion of control by giving the addict a series of steps to follow: "AA offers a comforting veneer of actionable change: it is something you can do." They raise this concern in their lead-in to examining the twelve steps, and in the very next paragraph consider the first of those steps: “We admitted we were powerless over alcohol, that our lives had become unmanageable.” They dismiss the value of this step on the grounds that "it lacks any clinical merit or scientific backing."
The tension here lies in the fact that the first step is about admitting that recovery requires letting go of the idea that you can do it on your own. So which is it? Should the twelve steps be accused of inculcating a false sense of control in the addict? Or should they be accused of encouraging addicts to give up the illusion of control even though such an act of release has no "clinical merit or scientific backing"? Maybe the charge here is that the twelve steps contradict themselves.
If so, the problem may be that the Dodes haven't really understood what the twelve steps are about. They haven't found the interpretation that makes sense. What they are targeting is an interpretation that doesn't make sense at all. Doing that is worthwhile, of course: If AA is going to work, it's the version that makes sense which will work, not the version that doesn't. And so it's beneficial to expose incoherent interpretations and warn addicts against working them.
But if there is a version of the steps that isn't contradictory, assuming that the steps are essentially confused does a disservice to addicts who would benefit from AA if they only got past their mangled understanding. It's exactly similar to the kind of attack on religion that we find in the New Atheists: They treat the mangled fundamentalist understanding of religion as the very essence of religion, never considering the possibility that there exists a more promising and life-enriching understanding.
And there can be little doubt that the Dodes are attacking a mangled understanding of the twelve steps.
The Dodes excoriate the twelve steps for inspiring "self-flagellation," as if the twelve steps were about beating yourself up about your failings: "The degradation woven through these steps also seems unwittingly designed to exacerbate, rather than relieve, the humiliating feelings so common in addiction." And they make this charge despite recognizing that the first step "is intended to evoke a sense of surrender that might give way to spiritual rebirth."
It doesn't occur to them that this first step sets the tone for understanding the rest: addiction is an illness, not a fault, and from the perspective that concedes something greater than ourselves, the guilt and shame that comes from clinging to a vaunted sense of control can be released. The idea is that, from the right perspective, we can honestly recognize our inescapable imperfections without beating ourselves up over them, and so can seek the kind of help and support required to become better than we could be on our own (something we can't do so long as we are hiding from our imperfections in order to avoid the guilt that we attach to them).
The Dodes deride the fourth step's call to make "a searching and fearless moral inventory of ourselves" and the tenth step's call to continue taking "personal inventory," while extolling the capacity of competent therapy to promote the kind of honest self-awareness that can lead to positive change. That the twelve steps are about cultivating the kind of inner honesty essential to therapeutic breakthroughs doesn't even enter the Dodes' radar screen, because they link AA's call to acknowledge our "shortcomings" and hand them over to our higher power with "the fundamentalist religious principle...that the path to recovery is to cleanse oneself of sin."
It doesn't occur to them that this funamentalist religious principle, which drives people to fixate on their sins in an effort to purge themselves, is the very opposite of what is intended when AA calls on its members to hand their shortcomings over to their higher power. It's not accidental that steps six and seven don't say "we are entirely ready to make ourselves responsible for overcoming our defects of character" and "arrogantly take charge of the effort to overcome our own shortcomings." The steps don't call for this because "cleansing oneself of sin" is the very opposite of what the twelve steps are about.
Here's the idea: One crucial barrier to genuine self-understanding is that people are afraid of what they will find when they honestly introspect. They are afraid because (a) they know they will find serious imperfections, and (b) they have a habit of beating themselves up ruthlessly about their imperfections. You could avoid this fear of introspection, of course, by convincing yourself in advance that there aren't any imperfections to be found. But that, of course, is going to be a lie. Every human being has imperfections. You can't begin a project of honest introspection by telling yourself a lie. The alternative solution is to stop beating yourself up about your inevitable human limitations.
That is what the twelve steps are about: leaving behind the perspective from which you deserve to be beaten up for your shortcomings, so that you can look inward without fear of those shortcomings. The promise of a perspective greater than our own from which our shortcomings are already set aside, a perspective from which we can hand our failings over to something greater than ourselves as opposed to beating ourselves up over them--these are the defining features of the twelve steps.
With such a perspective in place, a crucial impediment to instrospective self-understanding--namely, one's propensity for self-flagellation--can be set aside. The addict is able to engage in the kind of internal inventory and honest self-discovery that the Dodes think the best therapy can help facilitate--and which, thankfully (since not everyone can afford therapy), can also be facilitated with the help of talented AA sponsors and peer counselors.
In short, the Dodes have an understanding of the twelve steps that is almost exactly backwards. Sadly, their confusion is entirely predictable.
Works vs Grace
The Dodes display a classic confusion about the nature of the twelve steps. I say the confusion is classic because the twelve steps have their origins in the Christian theology of grace. But in the history of Christianity, the theology of grace has been repeatedly misconstrued and misappropriated by people who can't let go of "works theology." The result is that good news is twisted into bad news, a message of hope is turned into a threat, and a liberating idea is reframed as a call to self-flagellation.
That the Dodes misconstrue the twelve steps as they do is no surprise, because even those who explicitly endorse the theology of grace have had a long tradition of finding ways to subvert its meaning.
According to the Christian theology of grace, we are saved, not by what we do, but by what God does for us when we get out of the way. And the first thing that God does for us is forgive us--a forgiveness that liberates us from the weight of our offenses, from guilt and shame, precisely because it springs from the author of our very being. If the infinite creator of all does not hold our offenses against us, who are we to do so? This is what traditional Christian theology has called "justification."
The second thing God does is provide spiritual resources for becoming better than we can be on our own. By releasing ourselves to something greater than ourselves, giving our wills over to a good that transcends us, we transcend ourselves. That is, we become better than we could be on our own. This is what traditional Christian theology has called "sanctification."
AA has extracted this theology from its Christian context, offering its practical dimensions purged of specific doctrines and creeds. The way in which releasing yourself to a higher power opens doors to self-improvement can be viewed, within AA, as the result of a metaphysical infusion of divine grace. But it needn't be. There's no cry of heresy if you think of it as a shift in perspective that erases self-imposed limits. Contrary to what the Dodes say, there is nothing preventing you, in AA, from conceiving of your higher power as your best self, the self you could become were you to let go of the narratives and habits that are constraining you.
A friend told me of one person who decided, cynically, to make a doorknob his higher power. What he discovered is that when he went through the twelve steps earnestly, the doorknob became a functional focus for the steps. He released his shortcomings to the doorknob, and they didn't weight him down anymore. The doorknob was transformed into a symbol of something else.
Others less cynical but equally skeptical of supernatural powers have envisioned that their higher power is the support network of love and community, within AA and elsewhere, that encourages them to be more than they thought they could be and offers resources greater than a single person can hope to possess alone.
What AA seeks to preserve is the practical dimension of this theology of grace: the release and openness to transformation, the reaching out for support and strength, the giving up on stubborn reliance on one's own willpower, the attitude of self-forgiveness that makes honesty possible and turns the act of making amends into an exercise of responsible relationship-building instead of an exercise in self-recrimination. AA thereby also affirms the distinction between using moral principles as a map and and using them as a bludgeon--that is, using them as a guide to a better life instead of using them as a tool of judgment and condemnation.
By contrast, we have the theology of works: The idea that it all rests on our own shoulders, that we are to blame for every imperfection, that we can achieve perfection on our own, save ourselves...and that our failure to do so is our own fault. In a theology of works, everything depends on our own willpower--and so, if we fail to live up to moral principles, we are blameworthy. Morality is thus twisted so that it becomes about guilt and blame instead of guidance.
I should point out that a theology of grace does not hold that humans aren't called to good works, or that they don't have responsibilities, etc. What a theology of grace says is that our salvation does not depend on our own works. Instead, our good works depend on our salvation: We live up to our responsibilities because we have opened ourselves up to that which makes it possible to do so--what Christianity calls the grace of God. We don't overcome our flaws by "will power" and personal effort, but by a connection to something that gives us more strength than we can ever muster alone. If we want to transcend our limits we don't do so by relying on our limited self but by reaching out to something that is not limited in the ways that we are. Our "salvation" is found in making the connection to that something--and we make that connection not by an effort of personal will but by an act of release.
Again, AA is open to wholly secular conceptualizations of this process: You might conceive of your higher power as a community that is greater than the sum of its parts, which can offer to you the resources for being better than you could be alone. Whether this works as well as conceiving of your higher power as the infinite creator of the universe is a different matter, and one I think it would be very hard to assess (for reasons mentioned in the earlier post). But even in its secularized understandings, it remains a kind of theology of grace.
In the history of Christianity, the theology of grace has prevailed in theory...but in practice, the theology of works has continued to operate behind the scenes, twisting and distorting the message of grace.
This happens in all sorts of ways. The idea that our salvation comes from divine grace through the channel of faith is converted into the idea that we are saved by the work of our own faith. And so we focus in on our faith, struggling to make sure it is pure enough, fixating on it and beating ourselves up if we fail to show sufficient faith. People say "let go and let God"...and then beat themselves up for failing to do this work for which they see themselves as wholly responsible. The "good news" of Christianity--that humanity has been saved by God's saving work in Christ--is transformed into the terrible news that if you fail to get your beliefs about Christ just right and then perform the act of making Him your Lord and Savior, you will writhe in eternal anguish in the fiery pits of everlasting hell.
At every turn, Christians have found ways to twist and distort the core message of divine grace, making it all about what we do. Paradoxically, what really requires work is resisting the urge to make it all about our own works. We're saved by our own faith, or by getting our beliefs right, or by believing the Bible, or by saying a prayer in which we accept Jesus as Lord and Savior, or by saying such a prayer with the right degree of earnestness--anything but our salvation depending on something greater than ourselves.
The Dodes' utter inversion of the twelve steps--getting AA's core message completely backwards--falls cleanly into this pattern. It's as if they've seen the connection between AA and Christian theology, but have experienced Christianity largely in terms of these historic distortions. They transfer the distortions to AA, and condemn the program based on a distorted understanding of it.
But as understandable as this may be, it remains a mistake. The theology of grace should not be judged by the flaws in theologies that wear grace as a cloak. Instead, we should assess the theology of grace and the theology of works on their own terms--and if we decide that there is something problematic about the latter that the former avoids (as the Dodes seem to think, albeit in wholly secular terms), we should look for ways to encourage the former despite the seductiveness of the latter.
Instead, the Dodes treat the mangled variant of AA as the proper way--perhaps the only way--to understand it. In so doing, they are not just unfair to AA. More seriously, they help to perpetuate the misconstrual and the harms that it can do.
If they really want to help addicts recover, it would seem far better to give AA an honest and careful assessment that recognizes both the harmful misconstruals of its methodologies and the more promising understandings--and then encourage those who pursue AA to approach the steps as they were meant to be approached, in a spirit of grace.
I suspect that one reason the Dodes don't approach things this way lies in a common tendency among those who display an anti-religious bias: the tendency to see all of religion through the lens of its most pernicious expressions. The religion of fear and hellfire, the religion of hate-yourself-because-you're-a-sinner, is their model of religion. When they see the religious roots of AA and the persistence of religious language and forms, their stereotype of religion rises up and offers a template for interpreting the twelve steps that admits of no more humanistic rivals.
Such stereotyping of religion can be resisted. And if we want to be honest in our engagement with the diversity of religious communities and those influenced by them, we need to resist such stereotyping.
In my next and final post in this series, I will consider another way in which I see anti-religious bias at work in the Dodes' essay--in a way that reflects the false opposition between science and religion.
In this post and the next one, I want to consider something I think may be going on beneath the surface of the Dodes' essay, something that may help explain why they make such dubious assertions with disproportionate confidence. Although anti-religious bias might not be the best term for it, it's related to the kind of prejudice one finds among many well-meaning humanists--a prejudice that fixates on a distinctive (mis)construal of religion that's widespread among believers and nonbelievers alike, but which is opposed to a more reasonable and beneficial construal.
Mangling the Twelve Steps
My suspicion that some kind of prejudice is in play is elevated by several tensions and confusions in the Dodes' critique of AA. These come out especially as they walk through the twelve steps.
For example, one recurring feature of the Dodes' critique is their charge that AA creates the illusion of control by giving the addict a series of steps to follow: "AA offers a comforting veneer of actionable change: it is something you can do." They raise this concern in their lead-in to examining the twelve steps, and in the very next paragraph consider the first of those steps: “We admitted we were powerless over alcohol, that our lives had become unmanageable.” They dismiss the value of this step on the grounds that "it lacks any clinical merit or scientific backing."
The tension here lies in the fact that the first step is about admitting that recovery requires letting go of the idea that you can do it on your own. So which is it? Should the twelve steps be accused of inculcating a false sense of control in the addict? Or should they be accused of encouraging addicts to give up the illusion of control even though such an act of release has no "clinical merit or scientific backing"? Maybe the charge here is that the twelve steps contradict themselves.
If so, the problem may be that the Dodes haven't really understood what the twelve steps are about. They haven't found the interpretation that makes sense. What they are targeting is an interpretation that doesn't make sense at all. Doing that is worthwhile, of course: If AA is going to work, it's the version that makes sense which will work, not the version that doesn't. And so it's beneficial to expose incoherent interpretations and warn addicts against working them.
But if there is a version of the steps that isn't contradictory, assuming that the steps are essentially confused does a disservice to addicts who would benefit from AA if they only got past their mangled understanding. It's exactly similar to the kind of attack on religion that we find in the New Atheists: They treat the mangled fundamentalist understanding of religion as the very essence of religion, never considering the possibility that there exists a more promising and life-enriching understanding.
And there can be little doubt that the Dodes are attacking a mangled understanding of the twelve steps.
The Dodes excoriate the twelve steps for inspiring "self-flagellation," as if the twelve steps were about beating yourself up about your failings: "The degradation woven through these steps also seems unwittingly designed to exacerbate, rather than relieve, the humiliating feelings so common in addiction." And they make this charge despite recognizing that the first step "is intended to evoke a sense of surrender that might give way to spiritual rebirth."
It doesn't occur to them that this first step sets the tone for understanding the rest: addiction is an illness, not a fault, and from the perspective that concedes something greater than ourselves, the guilt and shame that comes from clinging to a vaunted sense of control can be released. The idea is that, from the right perspective, we can honestly recognize our inescapable imperfections without beating ourselves up over them, and so can seek the kind of help and support required to become better than we could be on our own (something we can't do so long as we are hiding from our imperfections in order to avoid the guilt that we attach to them).
The Dodes deride the fourth step's call to make "a searching and fearless moral inventory of ourselves" and the tenth step's call to continue taking "personal inventory," while extolling the capacity of competent therapy to promote the kind of honest self-awareness that can lead to positive change. That the twelve steps are about cultivating the kind of inner honesty essential to therapeutic breakthroughs doesn't even enter the Dodes' radar screen, because they link AA's call to acknowledge our "shortcomings" and hand them over to our higher power with "the fundamentalist religious principle...that the path to recovery is to cleanse oneself of sin."
It doesn't occur to them that this funamentalist religious principle, which drives people to fixate on their sins in an effort to purge themselves, is the very opposite of what is intended when AA calls on its members to hand their shortcomings over to their higher power. It's not accidental that steps six and seven don't say "we are entirely ready to make ourselves responsible for overcoming our defects of character" and "arrogantly take charge of the effort to overcome our own shortcomings." The steps don't call for this because "cleansing oneself of sin" is the very opposite of what the twelve steps are about.
Here's the idea: One crucial barrier to genuine self-understanding is that people are afraid of what they will find when they honestly introspect. They are afraid because (a) they know they will find serious imperfections, and (b) they have a habit of beating themselves up ruthlessly about their imperfections. You could avoid this fear of introspection, of course, by convincing yourself in advance that there aren't any imperfections to be found. But that, of course, is going to be a lie. Every human being has imperfections. You can't begin a project of honest introspection by telling yourself a lie. The alternative solution is to stop beating yourself up about your inevitable human limitations.
That is what the twelve steps are about: leaving behind the perspective from which you deserve to be beaten up for your shortcomings, so that you can look inward without fear of those shortcomings. The promise of a perspective greater than our own from which our shortcomings are already set aside, a perspective from which we can hand our failings over to something greater than ourselves as opposed to beating ourselves up over them--these are the defining features of the twelve steps.
With such a perspective in place, a crucial impediment to instrospective self-understanding--namely, one's propensity for self-flagellation--can be set aside. The addict is able to engage in the kind of internal inventory and honest self-discovery that the Dodes think the best therapy can help facilitate--and which, thankfully (since not everyone can afford therapy), can also be facilitated with the help of talented AA sponsors and peer counselors.
In short, the Dodes have an understanding of the twelve steps that is almost exactly backwards. Sadly, their confusion is entirely predictable.
Works vs Grace
The Dodes display a classic confusion about the nature of the twelve steps. I say the confusion is classic because the twelve steps have their origins in the Christian theology of grace. But in the history of Christianity, the theology of grace has been repeatedly misconstrued and misappropriated by people who can't let go of "works theology." The result is that good news is twisted into bad news, a message of hope is turned into a threat, and a liberating idea is reframed as a call to self-flagellation.
That the Dodes misconstrue the twelve steps as they do is no surprise, because even those who explicitly endorse the theology of grace have had a long tradition of finding ways to subvert its meaning.
According to the Christian theology of grace, we are saved, not by what we do, but by what God does for us when we get out of the way. And the first thing that God does for us is forgive us--a forgiveness that liberates us from the weight of our offenses, from guilt and shame, precisely because it springs from the author of our very being. If the infinite creator of all does not hold our offenses against us, who are we to do so? This is what traditional Christian theology has called "justification."
The second thing God does is provide spiritual resources for becoming better than we can be on our own. By releasing ourselves to something greater than ourselves, giving our wills over to a good that transcends us, we transcend ourselves. That is, we become better than we could be on our own. This is what traditional Christian theology has called "sanctification."
AA has extracted this theology from its Christian context, offering its practical dimensions purged of specific doctrines and creeds. The way in which releasing yourself to a higher power opens doors to self-improvement can be viewed, within AA, as the result of a metaphysical infusion of divine grace. But it needn't be. There's no cry of heresy if you think of it as a shift in perspective that erases self-imposed limits. Contrary to what the Dodes say, there is nothing preventing you, in AA, from conceiving of your higher power as your best self, the self you could become were you to let go of the narratives and habits that are constraining you.
A friend told me of one person who decided, cynically, to make a doorknob his higher power. What he discovered is that when he went through the twelve steps earnestly, the doorknob became a functional focus for the steps. He released his shortcomings to the doorknob, and they didn't weight him down anymore. The doorknob was transformed into a symbol of something else.
Others less cynical but equally skeptical of supernatural powers have envisioned that their higher power is the support network of love and community, within AA and elsewhere, that encourages them to be more than they thought they could be and offers resources greater than a single person can hope to possess alone.
What AA seeks to preserve is the practical dimension of this theology of grace: the release and openness to transformation, the reaching out for support and strength, the giving up on stubborn reliance on one's own willpower, the attitude of self-forgiveness that makes honesty possible and turns the act of making amends into an exercise of responsible relationship-building instead of an exercise in self-recrimination. AA thereby also affirms the distinction between using moral principles as a map and and using them as a bludgeon--that is, using them as a guide to a better life instead of using them as a tool of judgment and condemnation.
By contrast, we have the theology of works: The idea that it all rests on our own shoulders, that we are to blame for every imperfection, that we can achieve perfection on our own, save ourselves...and that our failure to do so is our own fault. In a theology of works, everything depends on our own willpower--and so, if we fail to live up to moral principles, we are blameworthy. Morality is thus twisted so that it becomes about guilt and blame instead of guidance.
I should point out that a theology of grace does not hold that humans aren't called to good works, or that they don't have responsibilities, etc. What a theology of grace says is that our salvation does not depend on our own works. Instead, our good works depend on our salvation: We live up to our responsibilities because we have opened ourselves up to that which makes it possible to do so--what Christianity calls the grace of God. We don't overcome our flaws by "will power" and personal effort, but by a connection to something that gives us more strength than we can ever muster alone. If we want to transcend our limits we don't do so by relying on our limited self but by reaching out to something that is not limited in the ways that we are. Our "salvation" is found in making the connection to that something--and we make that connection not by an effort of personal will but by an act of release.
Again, AA is open to wholly secular conceptualizations of this process: You might conceive of your higher power as a community that is greater than the sum of its parts, which can offer to you the resources for being better than you could be alone. Whether this works as well as conceiving of your higher power as the infinite creator of the universe is a different matter, and one I think it would be very hard to assess (for reasons mentioned in the earlier post). But even in its secularized understandings, it remains a kind of theology of grace.
In the history of Christianity, the theology of grace has prevailed in theory...but in practice, the theology of works has continued to operate behind the scenes, twisting and distorting the message of grace.
This happens in all sorts of ways. The idea that our salvation comes from divine grace through the channel of faith is converted into the idea that we are saved by the work of our own faith. And so we focus in on our faith, struggling to make sure it is pure enough, fixating on it and beating ourselves up if we fail to show sufficient faith. People say "let go and let God"...and then beat themselves up for failing to do this work for which they see themselves as wholly responsible. The "good news" of Christianity--that humanity has been saved by God's saving work in Christ--is transformed into the terrible news that if you fail to get your beliefs about Christ just right and then perform the act of making Him your Lord and Savior, you will writhe in eternal anguish in the fiery pits of everlasting hell.
At every turn, Christians have found ways to twist and distort the core message of divine grace, making it all about what we do. Paradoxically, what really requires work is resisting the urge to make it all about our own works. We're saved by our own faith, or by getting our beliefs right, or by believing the Bible, or by saying a prayer in which we accept Jesus as Lord and Savior, or by saying such a prayer with the right degree of earnestness--anything but our salvation depending on something greater than ourselves.
The Dodes' utter inversion of the twelve steps--getting AA's core message completely backwards--falls cleanly into this pattern. It's as if they've seen the connection between AA and Christian theology, but have experienced Christianity largely in terms of these historic distortions. They transfer the distortions to AA, and condemn the program based on a distorted understanding of it.
But as understandable as this may be, it remains a mistake. The theology of grace should not be judged by the flaws in theologies that wear grace as a cloak. Instead, we should assess the theology of grace and the theology of works on their own terms--and if we decide that there is something problematic about the latter that the former avoids (as the Dodes seem to think, albeit in wholly secular terms), we should look for ways to encourage the former despite the seductiveness of the latter.
Instead, the Dodes treat the mangled variant of AA as the proper way--perhaps the only way--to understand it. In so doing, they are not just unfair to AA. More seriously, they help to perpetuate the misconstrual and the harms that it can do.
If they really want to help addicts recover, it would seem far better to give AA an honest and careful assessment that recognizes both the harmful misconstruals of its methodologies and the more promising understandings--and then encourage those who pursue AA to approach the steps as they were meant to be approached, in a spirit of grace.
I suspect that one reason the Dodes don't approach things this way lies in a common tendency among those who display an anti-religious bias: the tendency to see all of religion through the lens of its most pernicious expressions. The religion of fear and hellfire, the religion of hate-yourself-because-you're-a-sinner, is their model of religion. When they see the religious roots of AA and the persistence of religious language and forms, their stereotype of religion rises up and offers a template for interpreting the twelve steps that admits of no more humanistic rivals.
Such stereotyping of religion can be resisted. And if we want to be honest in our engagement with the diversity of religious communities and those influenced by them, we need to resist such stereotyping.
In my next and final post in this series, I will consider another way in which I see anti-religious bias at work in the Dodes' essay--in a way that reflects the false opposition between science and religion.
Sunday, June 1, 2014
Is "the Sober Truth" about AA sober and true? Considering a recent challenge to AA. (Part 1)
Is Alcoholics Anonymous being subjected to unfair criticism--perhaps partly rooted in unconscious anti-religious bias against AA's Christian roots?
This was the question I found myself asking after reading a recent Salon piece by Lance Dodes and Zachary Dodes, authors of the recent book, The Sober Truth. The primary author, Lance Dodes, is a clinical psychiatrist who's been treating addiction for decades--and he seems to be on something of a crusade. In a recent NPR interview, he asserted that "AA has probably the worst success rate in all of medicine" and is "harmful to the 90 percent who don't do well."
This is quite a scathing indictment of one of the most respected and venerable organizations for fighting alcoholism and addiction. And as I read the Salon piece (an excerpt from the recent book), I started out skeptical, became irritated, and ended up a bit angry. Dodes does make a number of good points about the way our culture has appropriated AA's 12-step model--making it the heart of for-profit rehab centers, and endorsing it to the exclusion of other approaches to promoting sobriety. But when it comes to Dodes' direct challenge to the value of AA, the argument in the Salon piece amounts to little but sophistry.
In fact, it reminded me a bit of Richard Dawkins' rhetorically excessive and intellectually sloppy "take-down"of religion in The God Delusion. Which might, I suppose, mean that Dodes and Dodes have a bestseller on their hands. But it doesn't mean that the millions who benefit from AA should pay much attention to them.
In the next couple of posts on this blog, I want to consider some of the problems I found with the Dodes' supposed take-down of AA, at least as laid out in the Salon piece. While it's possible that some of these problems are resolved in their book, my decisions about what books to spend time on need to made in the light of the information available prior to investing those resources. And the Salon piece leads me to be very skeptical that the investment would be worth it.
Here's why.
1. Inconsistent Approach to Anecdotes
Part of my initial skepticism when I started reading the piece was based on my experience: the people I know who've made a sincere effort to work the program have had great success with it, which is not what I'd expect if Dodes' 5-10% success rate were accurate. This is "anecdotal" evidence, of course--specific personal experiences used to assess a general claim.
But anecdotal evidence is not always bad. If a general claim is at odds with one's personal experience, this doesn't mean the general claim is false. But it does give one reason to be skeptical--especially if one's body of personal experiences would be very surprising or unlikely were the general claim true.
But while Dodes is happy to sweepingly dismiss the anecdotal evidence in support of AA with a few gestures (pointing out that the general public only hears from the AA success stories), when it comes to his own astonishing claim that AA is "harmful to the 90% who don't do well," Dodes resorts to...anecdotal evidence.
He tells the story of "Dominic," a patient of his who got out of AA the same mangled understanding that Dodes puts forward as if it were the only one (more on this in the next post). Dominic wasn't able to achieve sobriety when he tried to follow his mangled understanding of AA's principles, but he did manage to uncover what was really triggering his drinking after eight months of (potentially expensive) therapy. Apparently, since pursuing the AA path kept Dominic from getting the therapy he needed (as if pursuing therapy and AA were mutually exclusive, as if there aren't tons of people who do both), AA delayed his enlightenment--and may even have triggered him (when, for example, he misinterpeted AA's tradition of giving out tokens to celebrate milestones in sobriety as a tally system that played into his fears of failure).
I'm sorry. When you make a claim to the effect that AA is bad for 90% of people who pursue it, you need more than a dubious anecdote or two. An anecdotal experience might lead you to be suspicious of a program--but to decide whether that suspicion is justified, you need more than anecdotes. In the Salon piece, that's all we get.
2. Dubious Statistics
But what about Dodes' assertion that AA has a low success rate, of only 5-10%? In the Salon piece, Dodes assures us that this figure comes from peer-reviewed studies. I'm sure there are such studies. But what exactly are these studies measuring? What is their definition of "success"? According to a Scientific American article, a 16-year study of problem drinkers published in 2006 found the following:
Dodes' figure, without the proper context and qualifications, is likely to be similarly misleading. (From what I gather here, one common source of the 5% success figure is that it's a measure of retention in the program after a year, and has its roots in a misconstrual of an internal AA study--with at least two studies indicating a substantially higher retention rate. But are retention rates really the best way to measure success? How many show up at a meeting or two well before they're ready to commit to the challenge of getting sober?)
Even if we can settle on a useful definition of success, another problem is this: In measuring the success of a twelve-step program, you need to distinguish between the success of those who actually work the steps from the success of those who just show up. It's like the difference between measuring how many of those using an antibiotic properly are cured of their infection, and measuring how many of those sent home with a prescription for the antibiotic are cured. If many of those prescribed the antibiotic don't actually use it or use it properly, it's hard to assess the antibiotic's efficacy under proper use--unless we have some way to determine who is using it properly and only count their cure-rate.
Dodes actually invokes the antibiotic analogy at one point in the Salon piece, in response to AA's claims that those who really work the steps are very successful at remaining sober. Dodes takes this to imply that if AA doesn't work for you, the fault is yours. He finds this an irresponsible assertion that would be dismissed out of hand were it made with respect to an antibiotic or new chemotherapy treatment. "In professional medicine, if a treatment doesn’t work, it’s the treatment that must be scrutinized, not the patient."
Here, Dodes has failed to pay any attention to the crucial distinction made above. In professional medicine, if prescribing a course of treatment isn't working, good doctors would first ask why. Are the patients actually following through on the treatment plan as prescribed? If not, then that may be the problem. In other words, in professional medicine you do need to "scrutinize" the patient: Is the patient skipping doses or stopping treatment before the course of antibiotics has been completed? If you don't, you are in danger of dismissing a valuable treatment based on patient error.
Likewise, when it comes to AA, we need to focus on the success-rate of those who actually follow the 12 steps properly if we want to know how successful they are in helping alcoholics stay sober.
But doing that is going to be difficult in the case of AA for a couple of reasons. And this leads to my third concern about Dodes' Salon piece.
3. Treating Absence of Evidence as Evidence of Absence.
In the case of AA, the nature of the beast makes it very difficult, if not impossible, to come up with definitive conclusions concerning the success rate of those who actually work the program. One reason for this is that AA's "treatment plan" is very different from a course of antibiotics. When it comes to antibiotics, all you need to do is swallow the pills on schedule until they're gone. While your attitude might have some placebo effect, it's going to be relatively minor.
But working the steps in AA is more like following the practice guidelines of your music teacher: commitment and focus matter at least as much as plodding through all the assigned etudes and scales and practice pieces. Put simply, difficult-to-measure subjective phenomena play a much bigger role when it comes to making proper use of what AA offers than they do when it comes to making proper use of antibiotics. In AA, there's a difference between working the program and going through the motions, and it's a difference that matters a lot for one's chances of success. It's also a difference that's difficult to take into account in a study.
That difficulty is compounded by the "anonymous" feature of AA. Here's how one overview of studies into AA puts the problem:
Finally, there's the problem of accounting for variation in understanding and approach among AA groups. Just as with religious communities, there are different ways of understanding the 12 steps, different attitudes towards the Big Book, and different attitudes towards alternative, non-AA approaches to sobriety. Some AA groups are similar to fundamentalist exclusivists, and some are more like religious progressives. With that kind of variability, does it even make sense to ask about the success of AA as a single, monolithic entity?
What does all of this mean? It means that it would be very difficult, given the limitations of the real world, to come up with a reliable scientific way to measure the success rate of committed participation in AA. That doesn't mean no measures can be taken. But it does mean that they will typically fail to account for all the important variables, may not measure the right things all the time, etc.
But Dodes seems to treat this limitation of science as if it were the failure of AA. In this respect, he reminds me of those among the New Atheists who, under the influence of logical positivism, dismiss as unbelievable any assertion that resists scientific testing.
In the Salon piece, Dodes notes the following:
This is logical positivism on steroids: if it resists unequivocal proof in an experimental study, don't believe it--even if eighty years of human experience give reason to think it has considerable merit.
Let's be clear: there are lots of truths that we have yet to demonstrate are true. There are lots of truths that we will never be able to demonstrate are true. And there are some things that we have reason to think are true based on collective wisdom and a rich body of anecdotal evidence, but which we haven't been able to unequivocally demonstrate as true using experimental studies.
The rigor of science is wonderful when it can be applied--but there are some questions that fall in principle outside the scope of scientific inquiry and others where a scientific approach faces formidable practical hurdles. The question of AA's success rate falls into the latter category. And so, even if AA is the most successful addiction-recovery program around, we shouldn't be surprised if, to this point, "no experimental studies unequivocally demonstrated the effectiveness of AA."
We should, however, be very surprised when someone who quotes this conclusion then asserts--in the same paragraph--that AA has a 5-10% success rate, as if some experimental studies have been able to unequivocally demonstrate the ineffectiveness of AA.
Rather than quoting dubious numbers out of context, what we should do is wrestle with what to do when we have to make a decision but don't have precise "scientific" answers. Looking into better ways to find those answers makes sense--but in the meantime, should you check out AA if you or a loved one is struggling with addiction?
The Dodes, at least in their Salon piece, don't offer much reason not to. The best they offer are some anecdotes, dubious statistics out of context, and the fallacious insinuation that absence of clear scientific evidence of success is evidence of failure. While they are surely right that therapy can often provide useful insights in the pursuit of sobriety, there is nothing preventing those who attend AA from pursuing therapy as well--unless they are prevented by financial constraints, in which case it's a good thing that they at least have AA, which is free.
In the next post in this series (which I may not get to for a few days), I will look at how the Dodes walk through the 12-steps, focusing on how their understanding of those steps seems to be distorted by (perhaps unconscious) anti-religious bias and a tendency to read the steps through the lens of fundamentalist theology.
This was the question I found myself asking after reading a recent Salon piece by Lance Dodes and Zachary Dodes, authors of the recent book, The Sober Truth. The primary author, Lance Dodes, is a clinical psychiatrist who's been treating addiction for decades--and he seems to be on something of a crusade. In a recent NPR interview, he asserted that "AA has probably the worst success rate in all of medicine" and is "harmful to the 90 percent who don't do well."
This is quite a scathing indictment of one of the most respected and venerable organizations for fighting alcoholism and addiction. And as I read the Salon piece (an excerpt from the recent book), I started out skeptical, became irritated, and ended up a bit angry. Dodes does make a number of good points about the way our culture has appropriated AA's 12-step model--making it the heart of for-profit rehab centers, and endorsing it to the exclusion of other approaches to promoting sobriety. But when it comes to Dodes' direct challenge to the value of AA, the argument in the Salon piece amounts to little but sophistry.
In fact, it reminded me a bit of Richard Dawkins' rhetorically excessive and intellectually sloppy "take-down"of religion in The God Delusion. Which might, I suppose, mean that Dodes and Dodes have a bestseller on their hands. But it doesn't mean that the millions who benefit from AA should pay much attention to them.
In the next couple of posts on this blog, I want to consider some of the problems I found with the Dodes' supposed take-down of AA, at least as laid out in the Salon piece. While it's possible that some of these problems are resolved in their book, my decisions about what books to spend time on need to made in the light of the information available prior to investing those resources. And the Salon piece leads me to be very skeptical that the investment would be worth it.
Here's why.
1. Inconsistent Approach to Anecdotes
Part of my initial skepticism when I started reading the piece was based on my experience: the people I know who've made a sincere effort to work the program have had great success with it, which is not what I'd expect if Dodes' 5-10% success rate were accurate. This is "anecdotal" evidence, of course--specific personal experiences used to assess a general claim.
But anecdotal evidence is not always bad. If a general claim is at odds with one's personal experience, this doesn't mean the general claim is false. But it does give one reason to be skeptical--especially if one's body of personal experiences would be very surprising or unlikely were the general claim true.
But while Dodes is happy to sweepingly dismiss the anecdotal evidence in support of AA with a few gestures (pointing out that the general public only hears from the AA success stories), when it comes to his own astonishing claim that AA is "harmful to the 90% who don't do well," Dodes resorts to...anecdotal evidence.
He tells the story of "Dominic," a patient of his who got out of AA the same mangled understanding that Dodes puts forward as if it were the only one (more on this in the next post). Dominic wasn't able to achieve sobriety when he tried to follow his mangled understanding of AA's principles, but he did manage to uncover what was really triggering his drinking after eight months of (potentially expensive) therapy. Apparently, since pursuing the AA path kept Dominic from getting the therapy he needed (as if pursuing therapy and AA were mutually exclusive, as if there aren't tons of people who do both), AA delayed his enlightenment--and may even have triggered him (when, for example, he misinterpeted AA's tradition of giving out tokens to celebrate milestones in sobriety as a tally system that played into his fears of failure).
I'm sorry. When you make a claim to the effect that AA is bad for 90% of people who pursue it, you need more than a dubious anecdote or two. An anecdotal experience might lead you to be suspicious of a program--but to decide whether that suspicion is justified, you need more than anecdotes. In the Salon piece, that's all we get.
2. Dubious Statistics
But what about Dodes' assertion that AA has a low success rate, of only 5-10%? In the Salon piece, Dodes assures us that this figure comes from peer-reviewed studies. I'm sure there are such studies. But what exactly are these studies measuring? What is their definition of "success"? According to a Scientific American article, a 16-year study of problem drinkers published in 2006 found the following:
Of those who attended at least 27 weeks of AA meetings during the first year, 67 percent were abstinent at the 16-year follow-up, compared with 34 percent of those who did not participate in AA. Of the subjects who got therapy for the same time period, 56 percent were abstinent versus 39 percent of those who did not see a therapist—an indication that seeing a professional is also beneficial.At least on one reading of "success rates," this could be taken to mean that AA has a 67% success rate. But, of course, to simply assert that AA has been shown to have an almost 70% success rate based on this study would be seriously misleading--especially since not participating in AA has, by this study, a 34% success rate.
Dodes' figure, without the proper context and qualifications, is likely to be similarly misleading. (From what I gather here, one common source of the 5% success figure is that it's a measure of retention in the program after a year, and has its roots in a misconstrual of an internal AA study--with at least two studies indicating a substantially higher retention rate. But are retention rates really the best way to measure success? How many show up at a meeting or two well before they're ready to commit to the challenge of getting sober?)
Even if we can settle on a useful definition of success, another problem is this: In measuring the success of a twelve-step program, you need to distinguish between the success of those who actually work the steps from the success of those who just show up. It's like the difference between measuring how many of those using an antibiotic properly are cured of their infection, and measuring how many of those sent home with a prescription for the antibiotic are cured. If many of those prescribed the antibiotic don't actually use it or use it properly, it's hard to assess the antibiotic's efficacy under proper use--unless we have some way to determine who is using it properly and only count their cure-rate.
Dodes actually invokes the antibiotic analogy at one point in the Salon piece, in response to AA's claims that those who really work the steps are very successful at remaining sober. Dodes takes this to imply that if AA doesn't work for you, the fault is yours. He finds this an irresponsible assertion that would be dismissed out of hand were it made with respect to an antibiotic or new chemotherapy treatment. "In professional medicine, if a treatment doesn’t work, it’s the treatment that must be scrutinized, not the patient."
Here, Dodes has failed to pay any attention to the crucial distinction made above. In professional medicine, if prescribing a course of treatment isn't working, good doctors would first ask why. Are the patients actually following through on the treatment plan as prescribed? If not, then that may be the problem. In other words, in professional medicine you do need to "scrutinize" the patient: Is the patient skipping doses or stopping treatment before the course of antibiotics has been completed? If you don't, you are in danger of dismissing a valuable treatment based on patient error.
Likewise, when it comes to AA, we need to focus on the success-rate of those who actually follow the 12 steps properly if we want to know how successful they are in helping alcoholics stay sober.
But doing that is going to be difficult in the case of AA for a couple of reasons. And this leads to my third concern about Dodes' Salon piece.
3. Treating Absence of Evidence as Evidence of Absence.
In the case of AA, the nature of the beast makes it very difficult, if not impossible, to come up with definitive conclusions concerning the success rate of those who actually work the program. One reason for this is that AA's "treatment plan" is very different from a course of antibiotics. When it comes to antibiotics, all you need to do is swallow the pills on schedule until they're gone. While your attitude might have some placebo effect, it's going to be relatively minor.
But working the steps in AA is more like following the practice guidelines of your music teacher: commitment and focus matter at least as much as plodding through all the assigned etudes and scales and practice pieces. Put simply, difficult-to-measure subjective phenomena play a much bigger role when it comes to making proper use of what AA offers than they do when it comes to making proper use of antibiotics. In AA, there's a difference between working the program and going through the motions, and it's a difference that matters a lot for one's chances of success. It's also a difference that's difficult to take into account in a study.
That difficulty is compounded by the "anonymous" feature of AA. Here's how one overview of studies into AA puts the problem:
Accurate reports about the success rates of 12-step programs like AA and NA are notoriously difficult to obtain. The few studies that have attempted to measure the effectiveness of the program have often been contradictory. Fiercely protective of their anonymity, AA forbids researchers from conducting clinical studies of its millions of members.In the face of that commitment to anonymity, it is hard to do any kind of study that takes into account the distinction between the committed twelve-stepper and the guy who's going through the motions. Because if you want to take that distinction into account you're going to need inside information about each person in your study--the kind of qualitative information that humans use to determine who is really committed and who is just floating along. And I can't see how you could get that kind of information without violating the confidentiality of the AA model.
Finally, there's the problem of accounting for variation in understanding and approach among AA groups. Just as with religious communities, there are different ways of understanding the 12 steps, different attitudes towards the Big Book, and different attitudes towards alternative, non-AA approaches to sobriety. Some AA groups are similar to fundamentalist exclusivists, and some are more like religious progressives. With that kind of variability, does it even make sense to ask about the success of AA as a single, monolithic entity?
What does all of this mean? It means that it would be very difficult, given the limitations of the real world, to come up with a reliable scientific way to measure the success rate of committed participation in AA. That doesn't mean no measures can be taken. But it does mean that they will typically fail to account for all the important variables, may not measure the right things all the time, etc.
But Dodes seems to treat this limitation of science as if it were the failure of AA. In this respect, he reminds me of those among the New Atheists who, under the influence of logical positivism, dismiss as unbelievable any assertion that resists scientific testing.
In the Salon piece, Dodes notes the following:
In 2006, one of the most prestigious scientific research organizations in the world, the Cochrane Collaboration, conducted a review of the many studies conducted between 1966 and 2005 and reached a stunning conclusion: “No experimental studies unequivocally demonstrated the effectiveness of AA” in treating alcoholism.This, of course, is the very conclusion one would expect given what I've said above--but Dodes presents the conclusion of the Cochrane Collaboration as if the failure to unequivocally demonstrate AA's effectiveness were reason to suppose that it's ineffective.
This is logical positivism on steroids: if it resists unequivocal proof in an experimental study, don't believe it--even if eighty years of human experience give reason to think it has considerable merit.
Let's be clear: there are lots of truths that we have yet to demonstrate are true. There are lots of truths that we will never be able to demonstrate are true. And there are some things that we have reason to think are true based on collective wisdom and a rich body of anecdotal evidence, but which we haven't been able to unequivocally demonstrate as true using experimental studies.
The rigor of science is wonderful when it can be applied--but there are some questions that fall in principle outside the scope of scientific inquiry and others where a scientific approach faces formidable practical hurdles. The question of AA's success rate falls into the latter category. And so, even if AA is the most successful addiction-recovery program around, we shouldn't be surprised if, to this point, "no experimental studies unequivocally demonstrated the effectiveness of AA."
We should, however, be very surprised when someone who quotes this conclusion then asserts--in the same paragraph--that AA has a 5-10% success rate, as if some experimental studies have been able to unequivocally demonstrate the ineffectiveness of AA.
Rather than quoting dubious numbers out of context, what we should do is wrestle with what to do when we have to make a decision but don't have precise "scientific" answers. Looking into better ways to find those answers makes sense--but in the meantime, should you check out AA if you or a loved one is struggling with addiction?
The Dodes, at least in their Salon piece, don't offer much reason not to. The best they offer are some anecdotes, dubious statistics out of context, and the fallacious insinuation that absence of clear scientific evidence of success is evidence of failure. While they are surely right that therapy can often provide useful insights in the pursuit of sobriety, there is nothing preventing those who attend AA from pursuing therapy as well--unless they are prevented by financial constraints, in which case it's a good thing that they at least have AA, which is free.
In the next post in this series (which I may not get to for a few days), I will look at how the Dodes walk through the 12-steps, focusing on how their understanding of those steps seems to be distorted by (perhaps unconscious) anti-religious bias and a tendency to read the steps through the lens of fundamentalist theology.
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