A Critique of the Twelve-step Model
July 9, 2011
Shot of Whiskey
According to a 2004 report from the National Institutes of Health, an estimated 17.6 million American adults (8.5 percent) meet standard diagnostic criteria for an alcohol use disorder. The most widely known option in the world for people who want to quit drinking is Alcoholics Anonymous (AA), with an estimated membership of over 2,000,000 people in 180 countries. However, is AA the best and only option for recovery from an alcohol problem? In this four-part article, I will provide a critique of AA’s 12-Step model, and provide alternatives to AA that are not as widely known, but have been very effective in helping many people recover from an alcohol problem.
Part One: Steps 1-3
Step One: We admitted we were powerless over
alcohol—that our lives had become unmanageable.
If one is powerless over alcohol, how can one ever stop drinking? If AA means by this that a person needs to accept that alcohol is destroying his life, this makes perfect sense. But accepting that one has a problem and saying that one is powerless against that problem are two different things. In fact, those who attend AA are not powerless. They take many actions within their own power, such as attending the meetings, reading the AA literature, and eventually, refraining from drinking. As a clinician, both theoretically and clinically, I would never hold the view that a client is powerless. Even quadriplegics can accomplish many things through their own free will, even though they are paralyzed from the neck down. To communicate to a client that he or she is powerless, whether it’s to depression, anxiety, or drinking, is to communicate to them that they have no control over their lives and that they are fated to their current condition. Not only is this untrue, it would be extremely damaging to a client’s self-esteem and his ability to help himself get better. The fact is, countless people have quit drinking using AA and other approaches (including quitting on their own), which means they did exert power over their problem.
Step Two: Came to believe that a Power greater than ourselves could restore us to sanity.
AA says that you must give yourself up to a Higher Power in order to overcome your drinking problem. However, the concept “Higher Power” is not clearly defined. AA says that a Higher Power does not necessarily refer to God or religion, but it is described as a “Power greater than ourselves,” which means in essence, something non-human. This sounds like hair splitting to me, and I wonder why AA does not just say that Higher Power refers to a mystical force based on faith, instead of trying to distance itself from God and religion. Whichever way AA defines Higher Power, the idea requires one to give up his own personal power to a “power” outside himself that will stop him from drinking. How is this actually accomplished? This is not stated clearly in the AA philosophy.
Step Three: Made a decision to turn our will and our lives over to the care of God as we understood Him.
In this step, the word “God” is used explicitly, even though in the previous step, God is referred to as a “Power greater than ourselves.” Again, no matter what word you use, Higher Power refers to a mystical force that one must follow by faith. But, is this the best message to give to someone who supposedly has no control over his life? He has no power to stop drinking on his own, so he must put that control into the hands of some vaguely defined spiritual force? But, no one knows what this ‘force” is, because one must determine it for himself as he understands it. Since no one that I’m aware of communicates directly with God, whom will the AA member give up his power to? He must give it up to his peers in the AA group, since there is no defined leader of the groups. But is this the best message to give to someone who believes that he has no control over his drinking problem? You are, in essence, communicating to that person that, since he has no control over his own life, he must put the control of his life into the hands of others who represent the “Higher Power.” This would seem to do nothing to help a person gain the skills and the confidence necessary to take control of his own life and also take credit for the success of quitting or the failure of not quitting alcohol.
Step Four: Made a searching and fearless moral
inventory of ourselves.
This is a positive message in the Twelve-Step Model, because it requires a person to evaluate his or her own moral system in order to become explicitly aware of it. However, this step does not explain how to judge whether one’s moral system is healthy or unhealthy, rational or irrational, consistent or contradictory. Does AA believe in a rationally defined morality based on how a person needs to live in order to survive and thrive? Or is it based on a religious (or other mystical) morality, which requires one to blindly follow the morality of one’s chosen deity on faith? The vagueness of this step would make it difficult for someone to utilize in a practical way.
Step Five: Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
This step requires that people who are recovering from a drinking problem be honest with themselves and others about the things they’ve done wrong, or are doing wrong, in their lives. I think this is a healthy practice in general, and very helpful for someone who is trying to quit drinking and take responsibility for his life. One cannot make changes until he knows what changes to make; and in order for him to know what changes to make, he must be completely honest with himself about his own character, and then do his best to change for the better.
Step Six: Were entirely ready to have God remove all these defects of character.
Again, we are back to giving up one’s power to God and having Him take all the responsibility for change. The previous two steps were about self-responsibility: taking a moral inventory and being honest with oneself and others. It is implied that these steps are to be done by the person with the alcohol problem, not a Higher Power. But now, in Step Six, we are back to giving up control to Someone outside ourselves. How does God or a Higher Power actually remove one’s defects? Who is actually doing the changing and taking the actions? Who is attending the meetings, doing the hard thinking, controlling his or her drinking, reading the books, and sharing his or her story? It’s the individual, not God, that takes all of these actions. But in AA, God or the “Higher Power,” gets all of the credit. What does that do to a person’s self-esteem? If someone has remained sober for one, ten, or thirty years, who should get the credit for this: God or the individual person? I believe that it should be the person because he (or she) did all of the work. He may or may not have received support from others; but ultimately, he had to follow through and put in the necessary effort to make and sustain the changes, and therefore, should receive the credit. However, if he gives partial (or all) credit for his sobriety to others (God, Higher Power, his peers in AA, his sponsor, etc.), he will never fully believe that it was his achievement. Nonetheless, if he happens to later fall off the wagon, he will most likely place all of the blame on himself. This is truly damaging to his self-esteem and to his belief that he has control over his life.
SMART Recovery: One alternative to AA and other Twelve-Step programs
SMART Recover is an acronym that stands for Self-Management
and Recovery Training. It is different from traditional Twelve-Step programs
in that: “SMART Recovery has a scientific foundation, not a spiritual one.
SMART Recovery teaches increasing self-reliance, rather than powerlessness.
SMART Recovery views addictive behavior as a maladaptive habit, rather than
as a disease. SMART Recovery meetings are discussion meetings in which
individuals talk with one another, rather than to one another. SMART
Recovery encourages attendance for months to years, but probably not a
lifetime. There are no sponsors in SMART Recovery. SMART Recovery
discourages use of labels such as "alcoholic" or "addict"” (from SMART
As a special note, because of the many comments this series of articles has generated on this site and on many of the LinkedIn mental health group sites, I plan to add a part five to this series to respond to these comments. My primary purpose for writing the articles is to create better awareness of the inherent problems and contradictions within the 12-Step approach, and to provide several alternatives to AA that many people (including within the mental health field) are not aware of. The articles have generated a strong and passionate reaction both in support of the critique and in disagreement with it. Some comments suggest AA’s 12-step approach shouldn’t be criticized, as if it’s above rational analysis. However, I believe it’s only through this type of analysis that we can truly understand the benefits and/or faults of any and all treatment approaches within the mental health field.
Step Seven: Humbly asked Him to remove our shortcomings.
Like Step Six, this step requires the individual to ask God or one’s Higher Power to “remove” his problems. I assume this is to be done through prayer. But how does one’s Higher Power actually remove one’s shortcomings? Again, I see a problem with asking a mystical power to change one’s flaws for the same reasons I noted in Step Six.
Step Eight: Made a list of all persons we had harmed, and became willing to make amends to them all.
This step seems to be a very positive aspect of the twelve-step model, because it requires the individual to take responsibility for the actions he has taken that have harmed others. In order to accomplish this, he has to examine the actions he has taken while an alcoholic, and then judge which of these actions were harmful to others in his life. It also requires him to be willing to pay restitution to others for any wrongs he has done to them. What I like most about this step is the requirement of self-responsibility, which I think is vital in making any kind of change in one’s life. If one cannot take responsibility for the actions he has taken, then he can never really be in control of his life, because he can always blame something or someone else (his parents, his genes, the alcohol) for his problems. What is important, though, is for the person to make a distinction between what is and is not his responsibility, so that he is not trying to make amends for things he did not cause. Dr. Michael Hurd, in his excellent book Effective Therapy (which also includes a detailed and reasoned critique of the twelve-step approach), refers to this as distinguishing between earned and unearned guilt. “Earned guilt involves taking responsibility for something which one directly caused. Unearned guilt consists of taking responsibility for something which one did not directly cause” For example, a recovering alcoholic should take responsibility and feel guilty for beating his wife. He should not, however, take responsibility for the sobriety of his peers at AA or feel guilty if they fall off the wagon. Hurd emphasizes, “Most people, and particularly most addicts, do not distinguish between earned and unearned guilt.”
Step Nine: Made direct amends to such people wherever possible, except when to do so would injure them or others.
This step follows from the previous one and requires the person to go out and actually take action to make amends. This makes sense, since just making a list of those one has harmed and being willing to make amends is not enough. One has to actually go out and take action to make amends. This is extremely healthy because, in order to change, one has to do more than just think or analyze his past actions; he has to do something to create positive change in his life and to become a better person. This step also cautions one to be respectful of those one has harmed and to not hurt them or others in the process of making amends.
Step Ten: Continued to take personal inventory and
when we were wrong, promptly admitted it.
This positive step continues from previous steps by encouraging personal responsibility, honesty, and taking action when necessary.
Step Eleven: Sought through prayer and meditation to improve our conscious contact with God, as we understood him, praying only for knowledge of His will for us and the power to carry that out.
Again, the model returns to God, and this time it explicitly says how to communicate with the Higher Power: through prayer. I have already expressed my beliefs about the Higher Power aspect of AA’s model, so I won’t elaborate here. But, there are obvious contradictions within the AA twelve-step model, which tell you both to put your faith in a Higher Power and admit you’re helpless, while also telling you to take responsibility for your life. These contradictions must be confusing to AA members and I wonder how they are reconciled.
Step Twelve: Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
If “spiritual awakening” means a new awareness of one’s responsibility for one’s own life, and the commitment to live a productive, healthy, and happy life into the future, then I would agree wholeheartedly with this message. But, as evidenced from the previous steps, “spiritual awakening” most likely refers to giving oneself up to God or a Higher Power and admitting one is powerless to alcohol. This I would not agree with for the reasons stated in the previous articles in this series.
In summary, while AA’s 12-Step approach contains some positive aspects, such as encouraging self-responsibility and making amends; it also conveys (more predominantly) the contradictory message that problem drinkers are powerless over alcohol and dependent on an external Higher Power for attaining and maintaining sobriety. In addition, not mentioned in this critique (although somewhat implied) is AA’s view that alcoholism is a disease, which in essence means: once an alcoholic, always an alcoholic, no matter how long you’ve been sober. AA also uses an abstinence-only approach to recovery. Addressing these latter two points requires another article (or two), so I will leave it to readers to ponder these additional aspects of AA on their own (or you can go to Stanton Peele's website for in depth information on these points and many more).