AA: Is It Only Way Alcoholics Can Go?

Group's spiritual element troubles atheists, agnostics.

By Melissa Fletcher Stoeltje, [email protected]

January 1, 2012

Michael is a recovering alcoholic. Though he attends Alcoholics Anonymous, Michael struggles with the program's spiritual element. He would prefer to join a support group without the religious overtones but one does not seem to exist in San Antonio.

As is tradition on this day, people are busy forming resolutions to make 2012 better than the year now receding in the rearview mirror.

For people with alcohol and drug problems, this might entail joining a group like Alcoholics Anonymous. According to AA doctrine and its 12-step program, redemption from the disease comes not from willpower but from reliance on a “higher power” — as Step Three puts it, “God as we understood him.”

This is where things get dicey for some alcoholics and addicts who are atheist or agnostic, especially if they've been mandated to attend 12-step groups by the courts. Why should they be forced to sit through meetings that violate their own secular beliefs?

In recent decades, mutual-help groups such as Smart Recovery, LifeRing and Secular Organization for Sobriety have formed across the nation to offer support without spiritual concepts, but they've yet to make their way to San Antonio.

Members of AA say their program isn't religious — it's spiritual. A member's higher power can be anything they choose — God, Jesus, Buddha, the power of love, even AA membership itself, which exceeds more than 1 million people in the U.S. alone.

At free meetings throughout San Antonio each week, there are generally no sectarian references, which are considered taboo since it violates AA's big-tent approach.Still, most meetings end with a group recitation of the Lord's Prayer, the provenance of which is Christian.

This practice alienates some nonreligious members and potential members, as does the whole higher-power concept and what can sometimes be a preponderance of generic “God talk” at meetings.

“It's a bit of a problem,” said Michael, 53, who is gay and an atheist. (In keeping with AA's tradition of anonymity, only first names are being used.) He attended his first AA meeting here in 1999, one aimed at gay and lesbian alcoholics. His drinking had become daily, which worried him.

“But people were talking about going to jail, having blackouts,” he said. “I thought, ‘I don't have these kinds of problems.'”

Still concerned about his drinking six years later, he returned to the meeting. When it ended with the Lord's Prayer, Michael vowed to never go back.

But then some mornings, he found he needed a drink to soften a hangover. Eventually, Michael returned to his old group but still felt out of place.

Recently, he found an AA group he likes, which he uses as his higher power. So far, though, he's only been able to go four months before relapsing. He admits he hasn't followed AA protocol, such as getting a sponsor, someone who guides a newcomer through the steps.

“If there were secular options, I think I absolutely would stick with it, and I believe a large number of people would as well,” he said. “But somebody has to start it.”

A different approach

In the 1980s, secular alternatives did begin to form. Smart Recovery, the most well-known with 2,000 members, is based largely on cognitive-behavioral therapy, a counseling approach that seeks to change maladaptive thoughts and behaviors. In the free SR support groups, which take place in person and online, members are taught ways to cope with cravings, stay motivated and live a balanced life.

Unlike at AA, they're told they can conquer alcohol or other addictions without help from above.

“Some people aren't comfortable with the idea of powerlessness,” said executive director Shari Allwood.

“Addiction can be overcome,” she said. “We don't expect you to attend meetings for the rest of your life. You can put these tools to use in your life and move on.”

Some SR members don't believe alcoholism is a disease — the prevailing medical view, given the role genetics plays in some, but not all, cases of alcoholism and for the physical changes in the brain that happen during addiction that never fully go away and make it hard to quit and stay sober. Personal choice plays a role as well.

Groups like Smart Recovery are minuscule compared with the mammoth AA. “It's a Catch-22,” said Dr. John F. Kelly, assistant professor of psychiatry at Harvard Medical School. “Because the alternatives to AA are so small, clinicians are reluctant to refer patients there. And most of the evidence so far (regarding effectiveness) has been about AA.”

Contrary to AA's critics, a growing body of research shows that for many people with alcohol use disorders, AA is effective. One study found that of patients who regularly attended AA after alcoholism treatment, about half remained abstinent after one year. Many who weren't at least cut their consumption.

“For those who want to change their drinking behavior, AA can be an important resource, as can other mutual-help organizations,” said Dr. Robert Huebner, acting director of the National Institute on Alcohol Abuse and Alcoholism Division of Treatment and Recovery Research.

At this point, there are few studies showing the efficacy of AA alternatives. Existing ones are of poor quality, mainly due to small sample sizes, Huebner said. But new studies are under way, including an NIAAA-funded one of Smart Recovery.

‘How it works'

Dedicated 12-step members don't need studies to convince them the philosophy works: Their redeemed lives are proof enough.

Still, AA may not be suitable for everyone, some experts believe.

“The single best predictor of whether or not someone will go to AA is the severity of their drinking problem,” said J. Scott Tonigan, a researcher at the University of New Mexico. “The more you've lost control of your life, the more the 12-step message resonates.”

But in the last 20 years, researchers have found that alcoholism — once considered an “all or nothing” disease that invariably worsens over time — actually lies along a continuum.

“People with alcohol use disorders have mild, moderate and severe forms of the disorder, with the majority of people experiencing problems in the mild-to-moderate range,” Huebner said. “This finding has major implications for our treatment system, because the focus traditionally has been on people with disorders at the most severe end of the continuum.”

So it's not a question of AA or Smart Recovery being better or worse, said Keith Humphreys, professor of psychiatry at Stanford School of Medicine. It's a question of fit.

“People in Smart Recovery tend to have more education, better jobs, less severe (drinking) problems,” he said. “The narrative of self-control resonates with them: They haven't been lying in the street. They go to an AA meeting and think, ‘That's way worse than anything that's happened to me!' This is true for a lot of people, particularly high-bottom drunks. They may be happier in Smart Recovery.”

A “bottom” refers to an incident, usually dramatic, that prompts an alcoholic to accept he or she must stop drinking.

But how does AA, which has its roots in religion, psychology and medicine, “work?”

Many recovering alcoholics say their higher power played the main role. Cathy, 61, a retired business executive, said she was a “hopeless” alcoholic who tried willpower, traditional psychotherapy and self-help books for years to no avail.

“I couldn't live without alcohol, period,” she said. “I didn't lose my house or my husband, I didn't have DUIs. But there was a complete emptiness inside, a spiritual malady. I had lost my soul. And only my relationship with my higher power, whom I choose to call God, was able to fill that hole.”

Scientists theorize that AA works mainly by using a layman's version of cognitive-behavioral therapy, complemented by social connection. They note the many parallels between AA's approach and the psychological one.

“(Members) say prayer and meditation help them; scientists call that a cognitive exercise in coping mechanisms,” Tonigan said. “You say the Serenity Prayer when you're angry; in cognitive-behavioral therapy we call that rehearsal training. Changing ‘playmates and playpens' in AA is called avoiding triggers in CBT.”

One large study found it is the social component of AA — going to meetings, having a sponsor — that is most beneficial to most alcoholics, more so than the spiritual practices, said Harvard's Kelly.

“Prayer and meditation only seemed to be an explanatory effect among the most severe members, although they also benefited from the social network,” he said.

The law has gotten involved in the debate. Federal courts across the country have ruled that judges can't mandate DUI or drug offenders to attend AA or related 12-step programs as part of probation if they object on religious grounds — a suitable secular alternative must be provided. It's a church-state thing.

Lisa Graybill, director of the ACLU of Texas, said her office regularly gets complaints from nonbelievers ticked off because they've been ordered to 12-step programs, but so far none have resulted in litigation.

In his 23 years at the Bexar County probation office, assistant chief Abel Salinas said he hasn't heard of a single probationer objecting to a 12-step mandate on religious grounds. When asked to provide a list of local secular alternatives, he offered fee-based drug-education classes at driving schools.

But 12-step waivers are rarely granted, said Salinas, and only to defendants who can prove beyond doubt they cannot attend meetings for legitimate reasons, such as work schedules. A defendant must ask for alternatives to 12-step; it's not offered by the courts.

“Everyone would try to get out of going,” he said.

The Center for Health Care Services offers nonspiritually-based support groups, but they're open only to clients enrolled in its addiction-treatment programs.

One local criminal defense attorney who wished to remain nameless because he regularly appears before judges here, said those who object to AA on religious grounds are aware of the risk in voicing such concerns.

“The problem is judges hold so much power,” he said. “Are you going to tell the person who holds your fate in his hands that you don't want to go to AA? (Judges) can make your life really hard, and the goal of most people is to stay out of ... jail, no matter the cost.”

Interestingly, studies show atheists — if they commit to AA — tend to fare as well sobriety-wise as believers.

That's the tack Suzanne, 75, took four years ago, when she joined an AA group in Austin geared to atheists and agnostics. She said she keeps her focus on working the steps and practicing the AA principles — humility, rigorous honesty, service to others — and lets the spiritual stuff work itself out.

“I realized that maybe my definition of spiritual was too narrow,” she said. “One meaning of spirituality is the immaterial. I mean, you can't see love.”

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