Sunday, January 13, 2008

Humility R Us [NOT]

It's been six years since AA Trustee Dr. George Vaillant's article in the AA Grapevine, saying that "It doesn't hurt at the level of the GSO for AA to have humility and understand that 60 per cent do it without AA." Source. He was talking about the research finding that 60 per cent of alcoholics who achieve at least five years of abstinence do it without using AA.

It's been six years, and Vaillant's plea for humility has either not been heard or already forgotten. In this months' issue of Addiction Professional, columnist Carlton Erickson reports that "fourteen experts" recently met at a "consensus conference" in Rancho Mirage CA to define "recovery," and came up with a definition that includes an implied endorsement for "peer support groups such as AA and practices consistent with the 12 Steps and 12 Traditions."

In other words, judging by Erickson's column, if you're part of the majority that are staying sober without AA you're not considered in recovery. But if you're a chain-smoking Big-Book thumper whose entire social, moral, and intellectual life is wrapped up in AA meetings, then you're a model of recovery. The mind boggles.

The panel's full report, published in the Journal of Substance Abuse Treatment, is considerably more balanced than Erickson's column makes it seem. The report says that "the founders of AA recognized that there were many paths to the same position ... and did not suggest that their specific methods were the only means to attain the overall goal." (Thanks Jason Schwartz for forwarding the full article.) The panel considered but expressly rejected the definition of recovery as "abstinence attained through adherence to 12-step principles."

That's progress. But the plug for AA and the 12 steps is highlighted in the report, and Erickson's column picked up on that highlight, as most hurried readers will.

This endorsement is completely gratuitous. It comes in the absence of any evidence cited in the report showing either (a) superior efficacy of 12-step over other paths in reaching long-term sobriety, or (b) a positive association between long-term participation in 12-step groups and measures of "personal health and citizenship."

The report admits that no validated instrument for measuring "personal health and citizenship" exists. Then what scientific ground is there for making the claim?

The implied beneficial effect of AA participation on "personal health" is indefensible given the notorious prevalence of nicotine addiction among AA members. The report takes note of the nicotine problem, including "significant rates of emphysema, cancer, and other terminal health conditions associated with these products among those otherwise in recovery" (read: in AA). But come to the bottom line, the panel tucked tail between legs and "considered it best to remain silent on tobacco use within the sobriety component of the recovery definition."

The next line is lovely: "It is admitted that there is no clinical justification for this position."

The claim that long-term AA participation enhances "citizenship" is equally dubious. The cited ground for it is the AA homilies for doing service, "giving back." But this "service," to the limited extent people actually do it, is in the nature of recruiting for the AA organization. AA has no outward-directed community service component on the order of the Masons, Shriners, Rotarians, and many other groups. So where does "citizenship" come in?

Trying to come up with a definition of recovery is a laudable project. The panel notes that recovery science (as distinct from addiction science) is a poorly developed field, and that the lack of a validated definition of 'recovery' is a significant obstacle. But when you enter the gates of science, the motto is "lasciare ogni sospetto" -- here drop all hesitation, abandon all fear. So long as recovery scientists keep genuflecting to the sacred cow in the room, little progress and considerable dung is to be expected.


Michael Walsh said...

Always enlightening Marty!

I found many people I came across in AA were still in the dark ages of everything in their life. AA will never move forward if they do not open their minds. I found many members in Victoria basically disown you if you are not "in."

The smoking at AA was a real turn-off for me. It really is astounding how many people in AA smoke.

Mike L. said...


I just came across your blog a few days ago and will continue checking in as I've enjoyed what I've read so far. While I've had a different experience within AA myself, I have no problem acknowledging that it's certainly not for everyone and it's certainly not anywhere close to perfect. Although, it's such a strange organization, I'm not sure if anyone can accurately talk about "it" as though it's an entity with a clear definition and/or scope.

Shortly after I got sober (10/20/2001) I began to sense that AA was a cult and that I was probably not going to be able to stay a member. Before walking out, I met a man who would eventually become one of my sponsors (Dr. Earle Marsh). I saw him tell a whole room of 100+ men that everything they had been spouting about that evening was bullshit. They got quiet for a few minutes and then they laughed. He simply shook his head and told them that he wasn't kidding. It was bullshit.

My world and my recovery changed that moment.

The other thing that changed my perception of AA was the pamphlet, A Member's Eye View of AA. Written in 1968 or so, it is, in my less than humble opinion, the best piece of AA sanctioned literature that's ever been written.

As to humility, I've been thinking about your post now for a couple of days. I suspect it's always hard to find good examples of humility when you look at the bottom rungs of an organization. Given AA's "inverted triangle" design, where the individuals are at the "top" of the organizational triangle and the "leaders" at the bottom, I prefer to look for paragons of humility in the meetings and outside the rooms. I've met some of the most amazing people over the last six years, many of them tremendously humble without even knowing it.

Sure, there are assholes. All too often, I'm one of them.

Take care! Feel free to peruse my blog, which I just started a couple of weeks ago:

I think I'm going to post something along the lines of humility when I have a moment.

Mike Libby
(Live in the East Bay, so I will look into attending one of the local LifeRing meetings, have never done that.)

Jack said...

Re Mike's comments...After being around AA for more years than most of the readers have been alive it astounds me that people continue to support what the doctor referred to as "Bullshit". Do most of the members not subscribe to the steps and the basics of AA or do they simply not know what they are?
Jack McNeil.

Anonymous said...

Great post, Marty. All I can say is, yup, AA is bullshit. I went to over 90 meetings, many different groups - all B.S.