Definition of chronic alcoholism. Outcome of Alcoholism? Not Jails, Institutions or Death

Alcoholics Anonymous founder Bill Wilson was quite fond of threatening atheists and people who didn’,t go to AA with death. In Chapter 4 of the AA Big Book, he says on page 44 that drinkers are “,doomed to an alcoholic death or to live on a spiritual basis.”, On page 53 of this same chapter he says, “,When we became alcoholics…,we had to fearlessly face the proposition that either God is everything or else He is nothing.”, In Chapter 9 the Twelve Steps and Twelve Traditions on page 174 Bill says, “,Unless each A.A. member follows to the best of his ability our suggested Twelve Steps to recovery, he almost certainly signs his own death warrant.”, Define chronic alcoholism.

All of these statements gave rise to the popular 12-step slogan: “,The only alternative to AA is jails, institutions, or death.”, But do these statements have any basis in scientific fact, or are they merely rhetoric by means of which a charismatic leader held the reins of his flock?

Let’,s see what the scientific evidence has to say.

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was conducted 2001 to 2002, surveyed a total of 43,093 adults, and was the largest and most comprehensive study of alcohol problems ever conducted in the Unites States. NESARC found the past year prevalence of Alcohol Dependence in the U.S. is 3.8 percent. The population of the U.S. at this time was about 285 million people, with about 210 million adults over the age of 18. That means there were about 8 million active alcoholics in the U.S. in 2001. Since the size of the U.S. population has increased only slightly from 2001 to today, there are about the same number of active alcoholics today.

…,although alcohol is responsible for about 88,000 deaths per year in the U.S., only about 3,700 of these deaths are due to Alcohol Dependence…,

The CDC tells us that although alcohol is responsible for about 88,000 deaths per year in the U.S., only about 3,700 of these deaths are due to Alcohol Dependence, aka alcoholism. Moreover, an analysis of the NESARC data by Dr. Gene Heyman showed that approximately 5 percent of people with Alcohol Dependence recover each year – about 400,000 Americans. What this tells us is that for every one person who dies of Alcohol Dependence each year there are roughly 100 who recover, as is illustrated in Figure 1.

According to a study of the NESARC data by Cohen, et al., only about 11 percent of people with an Alcohol Use Disorder ever attend AA in spite of the fact that NESARC shows that the lifetime remission rate for Alcohol Dependence is over 90 percent. Even when we include those people who seek other forms of help – such as rehab, seeing a therapist, talking to a clergyman, etc. – together with those who go to AA, only 14.6 percent ever seek any form of help, the other 85.6 percent go it alone without AA, rehab, or anything.

…,about 90 percent of people who recover from Alcohol Dependence do so without AA and only about 10 percent who recover utilize AA to do so.

Other studies also suggest that about 90 percent of people who recover from Alcohol Dependence do so without AA and only about 10 percent who recover utilize AA to do so. For example, a joint study by OASAS and found that 23.5 million Americans are in recovery from drug or alcohol addiction, whereas AA’,s membership in the U.S. is only 1.3 million , even if we add in other 12-step groups such as NA, CA, MA, etc. we are unlikely to get a total of 2 million: less than 10 percent of those in recovery. Moreover, NESARC tells us that roughly half of all people who recover from Alcohol Dependence do so by cutting back on alcohol and half by abstaining. We will make the generous assumption that 11 percent of those in recovery are in AA and will further assume that those in AA are abstaining. NESARC also tells us that the lifetime remission rate for Alcohol Dependence is roughly 90 percent, when we put this together we get the results in Figure 2.

The final question which remains is what would happen to those 11 percent who currently recover via AA if AA had never existed.

People considering attending AA or TSF programmes should be made aware that there is a lack of experimental evidence on the effectiveness of such programmes.

Would they all have drunk themselves to death as AA dogma suggests? Or would they all have recovered on their own as the fans of spontaneous remission would like to believe? A meta-analysis of studies of 12-step programs conducted by the prestigious Cochrane Review found that extremely few properly controlled studies of 12-step programs had ever been conducted and that given the dearth of adequate studies it was impossible to conclude whether 12-step programs were superior to any other form of treatment, in fact there was not sufficient evidence to conclude that 12-step programs were superior to no treatment at all. In the words of the study, “,People considering attending AA or TSF programmes should be made aware that there is a lack of experimental evidence on the effectiveness of such programmes.”,

Maybe now that 80 years have passed since the founding of AA and untold billions have been poured into the promotion of the 12 steps, someone will finally conduct a properly controlled experiment to show whether the 12 steps are effective or not.

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of We do believe in healthy dialogue on all topics and we welcome the opinions of our professional contributors.

What Are Your Thoughts on this Topic? AddictionMyth

Thank you for debunking AA doctrine. It’,s not just that AA says you’,re going to self-destruct. They also say you’,re ‘,in denial’, if you think you won’,t, and that your ‘,resentments’, will kill you. (“,Resentments are a deathly business for the alcoholic.”,) This brainwashing can actually kill people who mistakenly believe one day that they were ‘,powerless’, to their ‘,cravings’, and take every drug and drink every bottle in the house. But it’,s a suicide attempt, not a ‘,symptom’, of ‘,addiction’,. Of course, AA cult members claim that “,AA saved my life and millions of others.”, But this is just a lie to defend the cult, and the reality is that it kills many more than it ‘,helps’,. Don’,t believe it? Go to your local AA meeting and see for yourself!

This is the crowd u attract the lone wolf at addiction myth who told me that shortly (I think he said by 2015) the world would drop addiction and alcoholism as a mental disease and would see it as a will power issue AddictionMyth

I said the world would see it as a lie.

Ur site says in one place that alcoholism is “,demonic possession”, then another that it’,s a “,choice”, then say that aa is a “,cult”, and that alcoholics should “,moderate”,…, it’,s confusing as hell AddictionMyth

No I said that AA thinks it’,s demonic possession. Right out of Alastair Crowley’,s diary of a drug fiend –, “,Self will run riot.”,

I guess I would believe all this if all my old drinking friends who didn’,t stop drinking when I did with the help of AA but two are now dead. The last two are the one’,s that kept going to jail all the time. One is dying from drinking health reason and the other is 5 yrs younger then me who looks many yrs older then me who is have crasy and close to death also. You keep believing your studies and I’,ll keep watching real people. AddictionMyth

Mischief and lies. And demonic possession like I just said. No one believes a word you guys say anymore. You’,re probably drunk right now.

Believe as you wish. 27 yrs and counting! Thanks AA &, Bill W!

u literally just said that u never said it was demonic posession and that aa said it

Soneone must have really messed you up!!!

If steppers were ACTUALLY ‘,happy, joyous and free’,, they would have no need to attend mind-fuck, disempowering, thought-stopping meetings for the rest of their lives. They would also have no need to defend their dangerous cult religion whenever someone pointed to the truth. Unfortunately, they are miserable, depressed and shackled …, To a cult religion that labels them with horrible negative labels for all eternity. What a waste of a life.

Totally agree with what you said so very true

Thank you Kenneth for keeping up the good fight!

Diagram pictures works best for imagination of many people. I have friends who are drinking very often. Some of them could say stop to this, but not all. I’,ve got also friends who can’,t normally stop drinking and they are starting the day from beer. Two of my friend won with addiction and Jack send me a link to little review of guide which helped him.

Where else could alcoholism lead but jails institutions and death? Are u confusing hard drinkers with alcoholism? Also bill w made it very apparent that aa has “,no monopoly on recovery”, and that you can have “,any conception”, of a higher power to work the aa 12 steps, this could be nature, the universe, a dead relative, etc. For people like me who once went from institution to institution and jails and almost ODd on a daily basis then heard the aa message identified it with our own experience did what they said and now have years of recovery u sound ridiculous especially due to the fact that u blatantly ignore passages and twist others taking them out of context

Also ur pie chart.. the definition of an alcoholic is one who cannot moderate.. so to say that “,this many alcoholics moderate use”, is contradictory

The definition of alcohol dependence comes from the NIAAA and the American Psychiatric Association. Get a copy of the DSM IV, which was the edition used for the study, and read it yourself.

I don’,t care what the dsm says a huge problem with the recovery industry and aa is the hard drinker or problem drinker being classified with the chronic alcoholic, it harms both groups Juliet.roxspin

But doesn’,t the AA literature, even the blue book, state that some are hard drinkers who are becoming alcoholics and are lower bottoms? So the fact is they are welcome in AA since they are on track with a progressive disease…, hence, they are welcome in AA the minute they declare themselves a member? Right? AddictionMyth

Your mischief took you to jails and institutions. Or as you call it, ‘,addiction’,. Of course, you insist you had a disease that made you do it, and hold the public hostage to your threat of drinking again. Or as you call it, ‘,sobriety’,. Now you try to brainwash vulnerable people into powerless to their cravings and suicide. Or as you call it, ‘,AA’,. AddictionMyth

And anyone who challenges sacred cult doctrine is called ‘,idiot’, and ‘,insane’,. Or as you call it, ’,12th Step’,. Juliet.roxspin

Step 2…, you are insane…, find a Higher Power…, a loving God as you understand Him (which can also be a potato, if you prefer)…, it’,s spiritual not religious. Doorknobs are deities it’,s as ancient as Rome when the Romans prayed to doorways, steps, etc…, which didn’,t cure their alcoholism if anything I think the ancients prayer rituals were drunken orgies almost? I do intend to do more research though…,

ah name you learn that in AA. I thought you are all loving and tolerant …,.

The definition of alcohol dependence used in the NESARC study comes from the American Psychiatric Association and is published in the DSM IV, the edition which was current when this study was carried out. It clearly distinguishes alcohol dependence from alcohol abuse and also clearly distinguishes these two categories from that of heavy drinking.

I’,ve known plenty with the symptoms of alcohol use disorder and alcohol dependence who were not alcoholics.. they were able to stop or moderate on will power or self knowledge

This study specifically states that the subjects meet the criteria for alcohol dependence. Not alcohol abuse. The “,word “,alcoholic”, is a folk term with no scientific definition. If you have developed more accurate means of diagnosis than those found in the DSM then perhaps you should inform the APA about them.

“,Alcoholism”, is hardly a folk term, but is rather a medical term. It was very well defined in a 1992 JAMA article. link to

We use the term “,alcoholism”, regularly in the field of addiction medicine.

In medicine “,alcoholism”, is used by (older) doctors in place in of “,alcohol dependence”,.

It nearly always refers to the DSM classification. They’,re trying to educate professionals who work in medicine to stop using the term purely because of the reasons Kenneth Anderson brought up, and stick to “,alcohol dependence”,.

When a doctor diagnoses alcoholism they will be referring to the DSM-IV or DSM-IV classification of “,alcohol dependence”,. There is no actual technical diagnosis available to give of “,alcoholism”, because such a diagnosis isn’,t available to give.

The DSM-V classification of alcohol dependence is a spectrum, and people can be diagnosed along this in order of severity.

Interesting. In my experience, “,alcoholism”, almost never refers to the DSM classification, which is largely used primarily by psychiatrists and not addiction specialists. The big difference between the definitions is that alcoholism refers to addictive use of any drug cross-tolerant with alcohol, and the reason the term was used instead of sedativism was simply because alcohol was the prototypical drug within the class. Alcohol dependence, and now, alcohol use disorder, have always been defined separate and apart from sedative disorders, therefore the literature for alcoholism is quite different from the literature for the use disorders. We teach our students regularly the differences between alcoholism and alcohol use disorders as defined in the DSM, just as we do the differences between addictive illness as defined by ASAM and the various addiction entities as defined by the APA. There are enormous terminology differences among the various fields here, but since it IS terminology, there is no correct perspective, just different ones.

Psychiatrists are addiction specialists in the field of medicine. Only a doctor or psychiatrist can actually diagnose alcohol dependence. It’,s these diagnostic capabilities which allows studies to yield data.

Secondly, there is much variation about the term “,alcoholic”, around the world: that’,s why a standard classification of “,alcohol dependence”, is needed. DSM classification is the same around the world from Saudi Arabia to the United States, the word “,alcoholic”, carries remarkably different baggage depending geographic location or even demography.

It’,s not my definition. It’,s the published definition in the peer reviewed literature. And while some psychiatrists have addiction specialization, most addiction specialist physicians aren’,t psychiatrists. Psychiatrists came relatively late to the addiction treatment circle, with their addition to the field largely coming in the 1970s and later. The field of addiction medicine has welcomed physicians of all backgrounds since the 50s. Alcoholism as defined is very much a medical definition.

Alcoholism as defined is very much a medical definition.

Alcoholism as you define it fits in a subset of the DSM classification. Therefore it’,s already defined by the DSM. This is why scholarly discourse often takes note of the classification subset of alcohol dependence diagnoses (moderate, severe, etc).

There’,s no need for extra definitions. This is parlly why the spectra diagnosis of alcoholism was introduced –, to eliminate this exact discussion we’,re here.

The DSM-V classification didn’,t exist when the article you cited was written.

Let’,s face it, NCADD and ASAM are both front groups for AA and have no interest in science–,their sole purpose for existence is the promulgation of AA religious dogma and the suppression of scientific information about addiction and the suppression of science-based addiction treatment in favor of faith healing, i. e. surrender to a “,Higher Power.”,

ASAM has no relationship with AA, Ken. Its entire existence is based upon the evidence in the medical literature. In fact, there is a vocal group of physicians who are distressed that ASAM is not more aligned with twelve-step programs. But in fact the medical literature has always demonstrated the value of twelve-step programming and I think most of the members of ASAM would suggest that participation in such programming is a valuable if not a necessary component of recovery. That is certainly consistent with the findings of the majority of research that has taken place over the decades. Might I suggest that you attend ASAM’,s upcoming national meeting in April? I think you’,d be surprised.

ASAM was founded by Dr. Ruth Fox in 1954, it was originally called the New York City Medical Society on Alcoholism (NYCMSA). Fox was a close personal friend of NCA founder Marty Mann and in fact served as medical director for NCA from 1958 to 1969. NCA is AA’,s PR arm, it was founded by AA member Marty Man for the sole purpose of selling the public on the notion that AA was the only successful treatment for alcoholism. ASAM was founded for the purpose of selling the same notion to the medical community, an unfortunate occurance which has caused MD’,s to reject evidence-based science in favor of referring clients to an organization, AA, which c,aims to arrest the “,disease”, of “,alcoholism”, through its special relationship with “,God.”,

Front groups never have official relationships with the groups they proselytize for, that is the definition of a front group. It would be very helpful to the public if ASAM would publish its annual reports on the web like the AMA does–,I could not find a trace of them there.

When Ruth was placed into the position of Medical Advisor at NCA, Marty felt that a local and formal medical recognition of alcoholism as a disease was desirable. The New York State Medical Society was asked to bring together a group of physicians to discuss this as a committee. From December 1952 and over the next two years, this group became gradually more formal and in 1954 my father arranged for what would eventually become ASAM to be set up as a formal entity. Ruth was the first President of the organization, and my father followed. The original mission of the group does not even mention AA, nor was twelve-step an underlying reason for the organization to have been set up. The primary purpose was to ensure that alcoholism was recognized as a disease entity and to further ensure that alcoholics would be able to be admitted for treatment and provided with medical services. At the time, admission for alcoholism was not widely available. Your comments are inconsistent with everything I heard as a child growing up with frequent visits from Ruth, Marvin Block, and other physicians involved in this activity, and with all the paperwork that my father and I have involving ASAM’,s creation.

I have a copy of Ruth Fox’,s book “,Alcoholism: its scope, cause and treatment.”, It reads like a 200 page ad for AA.

Show me how its a disease? Read Dr Carl Hart’,s work. Its not a disease. You can’,t get a disease form drinking a beverage from a bottle. Read The Sober Truth by Dr Lance Dodes.

Precisely, and if its a disease then why is it a moral spiritual failing? You cannot have your cake and eat it too. Juliet.roxspin

The medical recognition was desirable for AA in order to teach the 12 Steps outside of AA and have it produce money for these non-AA rehabs…, the same system is alive and well today. It would be foolish and naive to believe that Marty Mann and Ruth Fox were involved with NCA/ASAM and were interested in solutions other than AA—, why would they be? They created this system to promote AA without using the AA name on the buildings. The fact that your father followed Ruth would indicate you are well aware what I say is true. Of course these front groups do not mention AA by name—, that would be too obvious. Doesn’,t the AA literature instruct AA’,s working in the field not to use the AA name at their work? It does! The only reason they wanted to have alcoholism treated as a disease was to carry the AA message into treatment. If that wasn’,t the purpose then AA would not be there at all. But AA is in rehabs—, somewhere between 75% or 90% of all rehabs demand a patient must go to 12 Step meetings…, Ken would know more than I do, I’,m sure.

Actually, Ruth was one of the first physicians to bring Antabuse to the US when it was available only in Europe. She kept a large bottle on her desk and gave handfuls to her alcoholic patients. She was a firm believer in multiple approaches to the treatment of addiction. I can’,t speak for NCA but I can state without question that ASAM had nothing to do with AA, even from the beginning. While I wasn’,t there at the beginning, I did know all the early participants while they were alive and have all of the handwritten notes and letters documenting the founding of ASAM. AA is certainly mentioned from time to time, just as other approaches were mentioned. The primary reason ASAM was started, if you go back to the very start, was that hospitals would not admit patients with addiction so that they would receive proper treatment. The physicians felt that organizing themselves and working as a team, they might be able to change that. Almost all of ASAM’,s early efforts and energies were spent to change, successfully, that one issue. Juliet.roxspin

Medication not withstanding, it is the recommendation or notion that AA has any therapeutic value and can be a part of professional treatment centers just alludes and confuses me. AA is religious just for starters…, how do professionals explain this to clients? What does ASAM recommend a doctor say about God and the 3rd Step Prayer? What are ASAM’,s recommendations for women when they read a chapter called “,To Wives”, at the AA meeting b/c the book presumes the alcoholic in the family is the husband? I mean, ASAM shouldn’,t recommend anything it doesn’,t publicly explain THOROUGHLY so there is no confusion when someone arrives at “,Stepping Stone Rehab”, (made up name maybe it does exist) and is shocked it’,s religious…, right?

Juliet: There is a residential program for women named Stepping Stone in San Francisco. See: link to They say they are not affiliated with AA, but that their philosophy is based on AA’,s 12 steps and 12 traditions. I think I went to some women’,s meetings there in the 80s, lol!

Stewart, you do know that you are dealing with a group who’,s sole purpose in commenting is to bash AA. France, Juliet and a slew others spend a great deal of time frequenting sites with an agenda that comes from a bad experience in AA. These folks choose to spend their days attacking what they perceive as the problem, AA, when their time COULD be spent on creating an alternative based on their experience. Most of these individuals use the same methodology as conspiracy theorists and so called truthers. Rather than agreeing to disagree they bait you into a spiral to distract from the real issue and give themselves a platform in which to give their “,mission”, the grandiose appearance of saving alcoholics from the evils of AA when in fact they are only attempting to validate that AA was their problem not the issues and circumstances that took them to AA in the first place. So long as the focus is on how bad AA is the real issues can be obscured. The real issue being that choose to spend their time on belittling a proven program rather than spending their time on developing and work toward an alternative. If the groups of individuals that spend their days trolling these forums got together and put their time toward an alternative solution we may see a sucessful alternative take shape and flourish. But instead what happens is this endless cycle of debate that in the end does nothing for the alcoholic that needs to heal.

Thank you. My impression is that there is a vocal minority who feel that twelve step programs are inappropriate, overly religious, lack efficacy, and/or are potentially hazardous. My goal here has been to gain a greater understanding of these perspectives so that I might better serve my patients, some of whom undoubtedly have these same concerns. I don’,t have addictive disease, and while I attended many AA meetings as part of my medical training, I surely have a different perspective on the format than those who attend as a way of addressing their own issues. So this dialogue has been helpful for me, will hopefully have some application for my patients, and I hope I’,ve been able to shed some light on the medical perspective for those with whom I’,ve been having the discussion. Juliet.roxspin

No, Stuart, there is an oppressed majority that comes across as a vocal minority. 95% of people who try AA leave AA. Some stay long enough (like myself) to be damaged by the experience. There is absolutely nothing psychologically wrong with sharing one’,s personal experience in AA—, whether it’,s positive or negative does not matter. Denying a person’,s truth is not therapeutic. I am not an “,AA basher”, as Cyndy said—, that is an example of name calling. I heard this at meetings, too. I also heard in meetings when I spoke of sexism or other “,problems”, in AA that I had a vendetta. This to me sounds like paranoia in AA members. How on earth could a small “,army?”, of people topple or attempt to topple the giant AA? Why are they so intent on shutting us down or ridiculing us for sharing negative AA experiences. We are attempting to help other programs gain traction but part of that effort includes pointing out that AA doesn’,t always work. If we said “,AA works!”, and *smile”, all the time about AA how does that honestly convey the need for alternatives? If AA was so great there’,d be no need for alternatives. Not everyone needs a support group, either, some people do not heal better in groups. Cyndy is actually an example of someone who attempts to disgrace, demean, and silence anti-AA speech. I personally have no problem with her in the past, but the above comment reflects exactly what kind of bullying by AA members that hurts and harms people in meetings. As though I should say, “,Oh, ok Cyndy, you’,re right. I’,ll just shut up now and never say another bad word about AA again.”, That is what I had to do at meetings…, I couldn’,t share how I really felt. Even reading her comment has triggered that same feeling (on a smaller scale) of hurt and fear for saying anything at all. Don’,t you see how how this is harmful and should be talked of openly?

That’,s right, Juliet. I also think that a lot of us have so much anger and hurt surrounding AA because we did stay long enough to get damaged, and we could never say anything while we were there. Anger builds up even more when we’,re not allowed to talk about it. And I feel the same way, almost as if I was back at an AA meeting and being told again to just shut up. It also reminds me of my abusive family of origin, where I was not allowed to express anger over any of the abuse, even about getting hit, because then I would just get it worse. Juliet.roxspin

AA replaced my dysfunctional family and told me what I felt instead of asking me how I felt and listening to me, validating my experiences…, I thought I was just imagining things and resisting help for a long time…, I didn’,t understand for years why I felt “,crazy”, around AA meetings. I had to abstain from AA to heal from attending meetings…,. sort of like people need to abstain from alcohol/drugs b/c it’,s harming them. Having therapists tell me to use “,coping skills”, at meetings was the last straw…, why should I have to use coping skills, walk on eggshells, feel like shit for over an hour several days a week and not be able to speak openly at meetings and not have the support supposedly AA was there to give to me? The snide remarks after the meeting, during the meeting, judging me if I didn’,t pray, for saying anything they didn’,t like, it just got to me. I never went outside a meeting and told them I didn’,t like their comment, or that they were stupid for believing in X, Y, or Z…,. why did they feel they could talk to me like that? I don’,t know…, I was actually working those damn steps…, I was practicing treating others with respect…, it seemed to me no one at these meetings were practicing the same steps I was! Sometimes that’,s what it felt like…,

Juliet, the way you started this post is exactly how my family life was! I was told what to think, how to feel, and what to believe in (God, etc). On the flip-side I was criticized if I displayed anything other than respectfully agreeing and playing a “,role”, of my parents dreams. Honestly, reading brought a tear to my eyes because I got into the program just a few years after fleeing the “,coop”, and fighting, learning, to be an individual and speak/think for myself. Thanks for some great posts! *Know that you have helped some people with them:) Juliet.roxspin

I thought that was normal—, I thought my parents were almost god-like when I was little. I wondered why I consistently made them unhappy and learned to hold thoughts inside, not speak, people thought for a long time I was shy. Sure, alcohol at first made me open up and talk and that did attract me to drinking—, too much and too often. I hadn’,t felt that freedom before. But it became self-medicating, it replaced other bad coping skills. At times I could socially drink, other times I would binge. I’,m an emotional drinker not much different than an emotional eater—, but obviously the consequences of my behavior are punishable by law like DUIs. I have a behavioral disorder then, not a disease…, but I wouldn’,t even say disorder—, it’,s a behavioral issue.

I was scared to stop going to church with my dad, but my mom had stopped going b/c she didn’,t have friends there (her behavior and her actions kept her from connecting with others)…, she was paranoid and delusional. I had to play the role of pretending everything was ok. I was told not to tell the truth and also told to always tell the truth at the same time. I had to keep secrets, in other words. Sort of like being honest in AA but being anonymous and keeping my membership a secret at the same time.

Sorry didn’,t mean to bring a tear to your eyes…, I was very much flight not fight when I ran off with a guy who raped me I was at my lowest—, I would rather choose his abuse over my mom’,s abuse. That landed me in AA…, but perhaps everything happens for a reason? Thanks for what you wrote it helps me reading that, almost got a tear in my eye too. I don’,t like being labeled an AA-basher, by all means I truly believe I work an “,honest program”, and try hard not to treat others in any way I wouldn’,t want to be treated. I’,m not perfect, I fail often, but I get back up. I don’,t think there’,s some rock bottom below the rock bottom below the rock bottom—, there’,s only one rock bottom and the rest is up, up, up…,

Juliet: You’,re right, why should you have to learn how to “,cope”, with something that’,s supposed to be a support group? I also have to stay away from my family of origin now, because I felt crazy around them too.

Indeed. There were things that I’,d hear or that would happen in AA that were so very unhealthy it would stun me for days wondering how this or that was in any way, shape or form, therapeutic like they presented it as.

AA/TSF isn’,t the dominant modality used or incorporated into addiction treatment in my country, I’,ve certainly enjoyed hearing your perspective, which is different in parts but similar in others to official policy here.

I certainly don’,t deny that 12 step programs seem to be beneficial for some people. We probably disagree on the size of that group, however I live in a country with much less respect for religious and spiritual approaches to mental and physical well-being than the United States. While I think some trends in the studies you cite might be replicated here, I doubt –, due to sociological conditions being different –, that the results will track in a linear manner. I’,m all for using what data we have on local populations where possible.

As a “,recovering alcoholic”,, a trained scientist, and a medical professional, I have also worked professionally in advocacy for people with mental health issues. I have some personal and professional experience in this area. I can assure you there is a minority who object to the methods used in 12 step programs. These can be for religious or cultural reasons, even an objection to the unregulated nature of the programming and safety issues. Where I live sex offenders and violent criminals cannot be mandated to AA by law, and there has been robust debate around these sorts of issues. There are many valid, or plausible objections people can have. Some people with specific mental health issues also do not feel that these groups are a good fit for them. As someone who has suffered considerable personal problems with anxiety, I’,ve found that there are certain times when going to a public meeting is not always the best advice in specific instances.

I’,m quite critical of clinicians who ignore these issues, and insist that the fault lies with the patient.

However, that’,s just my personal experience.

The dialogue I’,ve had with you has been helpful to me also, as it’,s broadened my perspective somewhat –, so I appreciate your efforts here and certainly do not think this has been a fruitless or futile exercise.

France: I wish I could afford to move there! To France, that is.

I live in the island paradise of New Zealand ,) Most Americans which visit prefer it to France, to be honest. But I’,m biased

Earth Quakes, it does have earthquakes.

It also has one of my early favourite resources, a professional area and a public one…,either of which is available for use link to

I was in an AA meeting when a very large quake struck which took out significant portions of the city. A lot of AA members relapsed after that. Many pious old trouts without and ounce of compassion and too much Time had to reset their sobriety clocks to zero. I shouldn’,t say this, but I stayed around to watch them come crawling back, pretending to be humbled, much to My chagrin. It was a spectacle which will probably never be repeated

Wow, that was a bad one with a lot of after shocks. It’,s well after the fact now, but the NZ REBT site has a list of resources for professionals working with patients effected by the quakes. You may find it interesting link to

We had a chance to be posted to ‘,Windy’, Wellington, but sadly it fell through. I still have hopes though.

Dr. Gitlow, behind the vocal minority there are thousands who aren’,t so vocal who join communities of others who have had real, and often very serious, problems with the 12-step philosophy. Many come seeking help from others who have been through the same thing and the list of grievances are far too long to list. Considering the fact that somewhere around 95% of people who ever go to AA don’,t stick around long, (you can sit in a meeting for a year and see this for yourself as I did) I’,m betting there are millions who have had problems but are unaware that such communities exist. There are many ways that AA shames people out of speaking their minds or telling the truth and make them blame themselves and make them feel marginalized. You won’,t very often get the truth from people who have been shamed this way.

When anybody suggests that AA is helpful to most people I simply don’,t believe it and that’,s not because of anecdotes. I’,ve done a lot of research on the issue of it’,s efficacy and I know better.

I’,m glad you are open to other perspectives, Steve.

Stewart, I applaud you taking the time to research and share your thoughts here, as well as for the benefit of your patients. I would like to share I found AA to be a great help in my desire to stop drinking. I used a combination of treatments which included long term therapy with a psychologist, a domestic violence shelter, sessions with a psychiatrist, spiritual practice (Buhhdism), getting fit, eating well, the list goes on and on. My healing also took years and required complete abstinence from drugs/alcohol. I do not need statistical research to prove the benefit of AA since it helped me and has helped countless others. Is it the only way to stop drinking? Is if for everyone…, surely not!

Perhaps next time you engage in spiritual pursuits or or self reflection on your own behavior you might be so kind as explore why you feel the need to publicly comment in online media and attribute what my aims are, whether I’,m involved in alternative treatment options, or what work I’,ve been personally involved in pertaining to addiction treatment.

Another spiritual angle you could perhaps explore is and when I was wrong, promptly admitted it.

As you have absolutely no idea what my views on AA, 12 step orthodoxy, or my personal involvement in formal treatment in the country where I live, I’,d appreciate if in future you discontinue such behavior. Juliet.roxspin

I think I’,ve told you before, a long time ago on a different thread, that it’,s great you found a combination of therapies that worked for you and “,countless others…,”, presumably…, So it’,s fair to ask, what about those who were harmed by AA, myself and “,countless others”, also? I’,m speaking form my own experience also. Recovery has a broad definition—, AA’,s definition may be what some need, and benefit from, and the number still stands around 5-8% will benefit from AA. I wouldn’,t presume to know or claim to speak for you and what you really need—, what you really think—, or what your motives really are. I accept your experiences as being yours—, accept mine for being mine.

Juliet-no where here today or at any other time have I questioned your “,experiences”,. I do, however, question you motives and your methods. In essence, as it stands today, you are a professional whinner.

You once said that you started an alternative meeting “,but gave it up”,. If the first AA’,s gave up on a solution like you did you would you would have to find another line of work. You spend your days bashing AA. If the first AA’,s did everything else wrong they have given you a full time job. Explain to me how any of what I have said is in accurate. Explain to me how any of what you do truly benefits the alcoholic. Do you spend an equal amount of time going to AA meetings and taking the vulnerable woman such as you were aside and telling that if they find AA to be as offensive as you did there are other programs. Do you go to jails and institutions and spread the word about alternatives to AA. Your passion and energy could be used in so many positive ways…,but here you are complaining…,.still.

Anytime an individual spends more time fighting a negative than they spend on a postive solution they run the risk of becoming a negative themselves. You have crossed that line. You are not a crusader for the rights of the disenfranchised you are merely complainer. What you do here shows that.

You really need to stop these blanket attempts to silence criticism of AA. Criticism of AA exists because there is plenty to criticize. If AA doesn’,t want criticism, there are steps it can take to avoid it.

You continually engage in personal attacks, including to myself, rather than addressing the issues at hand. The kind of tactics you employ routinely smack of Scientology-esque approaches to attacking the individual rather than the point of disagreement raised.

Questioning people’,s motivations is a choice you’,re making to not answer the criticism on the table. I spent quite some time explaining to you how a point you raised could be interpreted differently by others, but you never replied to anything I said. Instead you came back several weeks later fuelled by ad-hominem attacks accusing me of all sorts of things you had absolutely no evidence for

This is exactly what you’,re doing here, and you do it to a few others too. It’,s entirely unprofessional and not constructive. I believe those who spend the amount of time that you do attacking others may not have any real desire to contribute anything to the field of addiction at all.

There’,s plenty you’,ve posted today which you really should apologize for. All of it concerns your behavior, and none of it concerns addiction treatment in any capacity.

Those were spiritual giant ad homs and I’,m kind of glad she’,s doing it so Dr. Gitlow can see what often really takes place in AA Juliet.roxspin

Huh, my motives? To share my experience in hope that someone else doesn’,t feel alone if they relate to what I went through? My methods? Writing to a fairly small audience? A professional whiner? I disagree with that one. I started an SOS meeting during probation because I was required/mandated to AA and decided to fulfill the requirements with a secular group.

After the requirements were met, probation ended, that group spawned 2 groups and the original group folded. (I was running that group each week, it was far more commitment than most would give to AA just by showing up and sitting there and getting a paper signed. I’,m far from being a whiner. I’,m pro-active.) The meeting turned into an online page with over 800 participants now reading posts and thoughts I share when I blog/write as well as other topics that pertain to alcohol abuse/addiction topics.

Running a meeting for 14 months was a good run and I am proud of it. I spend my days bashing AA? What does bashing mean? Do I call AA names, like “,stupid”, or something? Nope, I don’,t do that. Just because my experiences seem negative (they were) in AA doesn’,t mean I’,m complaining for no reason—, it’,s called telling the truth. Sometimes the truth hurts–, or in this case it bothers you Cyndy even though it shouldn’,t bother you. If you are happy with AA my experience should not affect your happiness…, but maybe you are questioning how AA can be so harmful and if so I am at least making you think. After all, you are the one choosing to read what I write and I have never forced you to do so.

Actually, sharing a negative experience out loud brings much closure and peace for me. It was in AA, where I would bite my tongue, and not share things that would bother others (such as it now bothers you) where I suffered greatly. You see, I couldn’,t express myself. My life experiences were not “,AA”, enough for AA—, abuse was an “,outside issue”, and rejecting the religious parts of AA was “,wrong”, of me…, The only one complaining here is you complaining about me—, do you see that? I have nothing to do with your happiness and well-being in AA. I have not personally attacked you nor do I follow you around online harassing you. I am more than happy to debate issues with you that we both seem to care about in recovery—, but you apparently are Juliet-bashing right now and I don’,t know what I did to you cause you to bash me.

You know what you did, Juliet. You told the truth, which some people can’,t bear to hear.

I personally don’,t feel the need to “,qualify”, what I have or have not done for someone who tells me that my facts and opinions aren’,t valid or that I should not be allowed to speak them unless I’,ve done X, Y and Z.

Cyndy: I’,m glad you find AA helpful and also sought other forms of help. I know AA helped me at one time and know others who have been going there a long time who are still sober. But please recognize that some of us also feel harmed by AA and that criticizing some aspects of it and sharing our negative experiences is a necessary part of OUR healing. I would never say that because your husband abused you (which I am sorry about), that you shouldn’,t criticize him or express anger toward him, even though he may have supported you or done nice things for you too. Ditto for family of origin issues. I can say of my own family that they did many positive things such as supporting me, buying me presents, complimenting me sometimes, etc. Does that mean I don’,t have the right to ever get angry about my father punching me in the face? Don’,t forget that some of us were forced to suppress our anger in AA for years before finding this board. Juliet.roxspin

Cyndy that is really an unfair characterization of my mission and work with recovery issues. I am a former, active AA member. I am also an abuse survivor. I also write of how those criticize and ask questions are labeled “,AA bashers”, I am sure you probably read that piece? We are accused of having some kind of “,conspiracy”, against AA. Our questions are mocked. Our experiences are put down and laughed at. Your comment is an indication of that. There are suicides in AA. I knew of them. I felt suicidal as a practicing sober member of the fellowship. Denying the problems in AA won’,t correct them, Cyndy. Your comment reflects that you deny my experience right off—, what brought me into AA? I was hanging out with my abusive rapist and court ordered to AA. You might have read about that one, also. The real issue is AA is not supportive—, it demeans, it ridicules, it oppresses opinions that don’,t agree with AA. Your comment also reflects this. The agencies—, the powers that be—, are controlled by where the money is and the money is in AA/12 Step rehab. That is not a conspiracy that is a reality. Just because AA’,s name is not on those rehabs does not mean they are not AA rehabs. Hazelden is an example of this. Denying reality is a problem. I wish you would be honest but I’,m not sure how to change you so I’,ll just keep working on myself, thanks.

I’,d appreciate it if you didn’,t speak on my behalf as to what my aims are, whether I’,m involved in alternative treatment options, or similar.

The truth is you most likely don’,t know where I live, what I do for a job, or what my views on AA are. I’,ve quite clearly said in the past I have no problem with AA being a voluntary association of individuals.

In the future, please ask before you speak on my behalf. I think the fair thing to do here is for you to retract your attribution of me to this bizarre characterization of my clinical and civil objections to 12 step groups.

Cyndy: I would appreciate it if you don’,t speak for me either. You don’,t know me and I am not part of any group whose purpose is to bash AA, though some individuals in any group certainly can criticize or “,bash”, it if they wish. In fact, I am only currently a member-at-large of one group, Secular Organizations for Sobriety. I am not an “,Oranger,”, though I have corresponded with Orange, and I am not a member of any group on this forum. I went to AA for 13 years. I will still always credit it for helping me get and stay sober in the beginning. I will still always recall with fondness many of the people there. But there were problems too, and it wasn’,t just “,one”, bad experience. You accuse us of trying to obscure the issues, but it is largely AA which does this. You make a good point about putting our time working toward alternative solutions. Actually, some of us have and/or do. The same could be said for you. Why are you not setting up chairs at some AA meeting instead of “,trolling”, this forum as you accuse some of us of doing? We have has much right to share our opinions and experiences here as you do. Part of my criticism of AA is in response to comments by people in AA. In other words, people wouldn’,t criticize AA so much here if there weren’,t comments by AA members to criticize, and if YOU weren’,t criticizing US. Then I guess there wouldn’,t as much for either “,side”, to talk about, though some people go to both 12-step and alternative groups. Also, I do agree with some AAers about some things, and disagree with some things said by the alternates. I at least try to think for myself and I am mostly supported here for doing so, which I certainly wasn’,t in AA. You accuse most of us of using the methods of conspiracy theorists, which ironically makes YOU sound like a conspiracy theorist. You say we can’,t just agree to disagree. The same can be said of you. We have just as much right to be here as you.

Cyndy, I would appreciate it if you didn’t try

to armchair psychoanalyze me over the internet and presume to know whether my issues

with AA were the “issues and circumstances that took them to AA in the first

place” because they are not. Not even close. You don’t know anything about me and it’s very

presumptuous of you to make statements about what my problems with AA actually

I see what you are saying Amythist, France, and Juliet. Good Lord, it is sad. Cyndy writes like she knows you personally but without any concern for your personal feeling and putting you down, trying to discredit you. Very sophomoric:

“,Rather than agreeing to disagree THEY”,.

I’,ve read some horrible things about what has happened to AA members. My experience showed me that the AA structure would support occurrences like this. Some of it was similar to what I experienced.

Instead of any compassion, wonder, or concern about how this happened and why, I see AA members only become defensive and retort with ad hom attacks. “,You guys…,. those people…, they are…,”,

What about what AA has done!?!? It’,s scary to think that there are people so committed to an organization they do not care about their peers which not only do not find benefit, but have get hurt in various ways. Juliet.roxspin

In theory, since I left participating in AA, what I have to say shouldn’,t effect their opinions at all since my opinion is an “,outside issue.”, Thanks for saying all that…, I appreciate it.

It’,s really simple. If AA hasn’,t worked, go somewhere else. Try Smart, MM, Women for Sobriety, Lifering, SOS or whatever. Has anyone considered that the 12 steps in their numerous variations have helped millions of people? If you don’,t like it, leave it alone. What I’,m seeing through these anecdotes is some people went to meetings where there were some assholes. You’,re gonna have that. Go to a different meeting or don’,t go at all, but don’,t classify all of the 12 step fellowships with such a broad cloth. What’,s the big deal?

Large numbers of people are mandated to AA meetings, who do not have this choice.

Yes, this is true. The fault is on the courts and legal systems who mandate the people, not on AA. It is a silly notion to mandate someone, there is no way to verify that someone has attended an AA meeting. In the days when I was one of those mandated clients I had to get a signature on a piece of paper. Easily obtained from a friend, or I’,d sign it myself. Second, mandated clients are often a distraction, they don’,t want to be there and often don’,t abide by the request for anonymity. Some people in 12 step fellowships resent this, others see it as a way for mandated clients to see what AA (or other) meetings are all about. The reaction to these mandated clients thus varies.

It’,s part of the problem. The fact it’,s not part of AA policy is not in dispute here. The courts and rehabs have clearly co-opted AA, and this is a major problem.

If AA was a strictly groups of people who freely associated, articles like this wouldn’,t exist. Ken Ragge

AA worked to establish coercion and are still encouraging members to go to courts to get more coercees. Of course the courts are at fault but so is AA, especially considering how many court officials are two-hatters and use their influence on behalf of AA.

Now you really are out of your mind. AA encourages it’,s member to go to court to get “,coercees”,? In all my 26 years I have never seen anything even close to that. And if there are as many two hatters running rampant through the world forcing people to think AA is treatment and coercing people to go, I guess it really does work, eh? Not for nothing, but in NY you can’,t be forced to attend AA, so I don’,t where all this is happening. Personally, I don’,t believe it for a second. Ken Ragge

I am on the other side of the country (California) but I’,ve been hearing ever since the 2nd Circuit ruled coercion to AA legal, the court have gotten around it by coercing to AA-based treatment and the “,treatment center”, then coerces to AA.

I can understand your surprise at all the coercion going on. When I was going to AA back before any of the Circuit Court rulings against AA on religious grounds, I sort of didn’,t notice all the coercion going on around me. I had no involvement with the Intergroups.

Here is the url of the AA pamphlet, titled “,Cooperating with Court, D.W.I. and Similar Programs”, that instructs members on how to go about getting people coerced to the courts:

While it takes more effort for two-hatter in the criminal justice system to coerce in the courts, I’,m not sure that the Circuit Courts’, rulings against coercion have any effect on licensing bodies of professional organizations, medicine, or EAPs.

My assumption that two-hatters participating in coercion has more to do with their religious beliefs. Step 12 which calls for proselyting and AA and the other Step groups have been very clever in recruiting new members without simply and honestly knocking on doors and honestly and openly “,sharing the message”, like the JWs do.

I almost missed on point. The two hatters have been very busy over the last 10 or 20 years convincing people that AA is not “,treatment”, because they’,ve been challenged so much on the failure of AA to be able to show success. They’,ve decided to call what two hatters in the treatment industry do “,Twelve Step Facilitation,”, TSF for short. Ken Ragge

I believe it was here that I posted the url of AA’,s guidelines telling how to get coercees from the courts. Just googling

on the AA website will get you the official AA pamphlet.

First of all, I’,d like proof that AA has helped millions of people, as you say it has. The only stats available show that it is likely that millions of people have attended AA, but that doesn’,t it mean it works or as helped that many. In fact, since most people leave AA and likely due to the guilt inducing steps/cultish atmosphere, it is probable that AA has failed millions.

Anyway, I have moved on. The time I spent participating in the program and the misery I endured because of it gives me the right to express myself regarding my negative experience. It obviously doesn’,t matter to you that others suffered in AA, most members become defensive of it. People deserve to hear about both kinds of experiences and know it’,s quite alright to leave. That death and drinking are not waiting for those that decide it wasn’,t for them. It was those specific threats which came from members and two-hatters that kept me “,coming back”, in fear.

I’,m sorry you had a bad experience, but I won’,t apologize for AA or the 12 steps. I haven’,t attended a meeting for years, and I feel no guilt about it. I haven’,t used or had a drink in 26 years, thanks in good measure to the 12 steps and my involvement in AA and NA. You can say you had a horrible experience and it has harmed millions. I had a positive experience and say it helps millions. AA’,s own literature says the 12 steps are a bridge back to life. I took that bridge and enjoy my life sober. I’,d guess you had a bad experience because of the people in the meetings you attended. Of course your mileage may vary when you have a bunch of plumbers, carpenters, mechanics, doctors, lawyers, rich poor black white Hispanic, in other words, people, gathering for a common purpose. No two meetings are alike. But again, there’,s no need to paint all 12 step fellowshiips with such a broad brush. I don’,t know why you stayed if it was so horrible. To me that’,s on you, not on AA. It ain’,t Jonestown, although you seem to want others to think it is.

Good luck to you in your future endeavors. You say tomahto, I say tomato. Ken Ragge

Do you have any evidence for the efficacy of AA beyond personal witness more appropriate in Wednesday-night prayer meetings or television infomercials?

oh your father helped create the ASAM. Are you a stepper? or just a stepper lover?

Nice, massive. What the heck is a “,stepper,”, anyway.

Stuart: Obviously a stepper is someone who is in a 12-step program and who practices and/or defends the 12 steps. Did you really not know that?

It sounds like a pejorative and nasty expression similar to racist terms that some might use in politically incorrect conversation. In fact, the way the question was asked –, if you replace the term “,stepper”, with any of a number of racial epithets –, made it clear that the meaning was in fact both pejorative and nasty. I never heard the term prior to my presence on this web page, so was asking just to confirm my guess as to the meaning and overall intent.

Stuart: I looked at it again and think you may be right, as least as far as the definition I gave. I didn’,t see that before. Maybe I even misinterpreted what Massive meant, maybe she meant it as someone who sees “,stepping”, as the only way and tries to push it on everyone else. I guess you’,ll have to wait to see if she answers you to know for sure.

Also, I would be happy to attend the ASAM national meeting if you wish to invite me as a guest speaker to explain how harm reduction for alcohol works, what its science base is, and why all MDs should refer their alcohol dependent, abusing, or problem drinking clients to the HAMS Harm Reduction support group as the first line of defense rather than sending them to AA for faith healing.

That statement is highly irresponsible. Anyone in their right mind can search PHP’,s, ASAM and the 12 steps and see that these ‘,like minded-doctors’, are steppers of the highest criminal order and are coercing, threatening and abusing others into the cult religion commonly known as AA. The ASAM is nothing but a scam. They have caused more physician suicides than any illness or disorder in history. These ‘,doctors’, are a group of people who would never be able to practice ‘,medicine’, ever again had they not formed this group of brainwashed steppers, also known as ‘,doctors.’,

They are a pack of AA cult wolves with them all acting as pack leader …, Without any ethics whatsoever. The gaul! The forced indoctrination! The subterfuge!

Appalling. Stuart should be ashamed of himself. Truth is, he is ONE of these people, hence his vitriolic responses here. Shameful. Better pray some more. 12 step programs are cult religion disguised as medicine. Disgraceful.

The “,Like Minded Doctors”, are not ASAM. They are a group of physicians, some of whom are ASAM members. Counselorchick, I’,d invite you to attend ASAM’,s annual meeting in April in Austin. I suspect you’,ll find it to be different from your current notion. Michael L. Langan

Saying the “,like minded docs”, are not ASAM is like saying the “,tea party”, is not part of the GOP.

ASAM is a membership based professional organization. You either are or are not a member. The like minded docs have no connection to ASAM. Some are members. Some are not. Just as tea party members do not represent the gop, the lmds do not represent ASAM. Michael L. Langan

Perhaps I should clarify,

The increasingly rapid growth and complexity of medical knowledge in twentieth century American medicine resulted in the creation of specialties and subspecialties.

A related development was the creation of “boards” to “certify” physicians as knowledgeable and competent in the specialties and subspecialties in which they claimed to have expertise. The American Board of Ophthalmology, organized in 1917, was the first of these.

As the number of medical specialties proliferated an umbrella organization was formed to accomplish this task. The Advisory Board for Medical Specialties was created in 1933 and reorganized as the American Board of Medical Specialties (ABMS) in 1970. This non-profit organization oversees board certification of all physician specialists and sub-specialists in the United States.

The ABMS recognizes 24 medical specialties in which physicians can pursue additional training and education to pursue Board Certification.

In 1991 the American Board of Medical Geneticswas approved as the 24th ABMS board and these 24 boards grant the 37 general certificates and 88 subspecialty certificates available to medical specialists today.

The ABMS Member Boards are responsible for developing and implementing the educational and professional standards for quality practice in a particular medical specialty or subspecialty and evaluate physician candidates for Board Certification. They set the bar of knowledge and competence for their given area of expertise.

All of the ABMS Member Boards are:

“committed to the principle of examining doctors based on six general competencies designed to encompass quality care: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.”

These areas have been collectively identified by the ABMS, the American College of Graduate Medical Education (ACGME) and the Institute of Medicine (IOM) in order to standardize graduate medical education in any specialty from medical school graduation through retirement.

One of the 24 medical specialties ABMS recognizes in which physicians can pursue additional training and education and pursue Board Certification is Psychiatry.

Founded in 1934, The American Board of Psychiatry and Neurology (ABPN) is one of the 24 ABMS specialty boards. In 1959, the ABPN issued its first subspecialty certificate inChild and Adolescent Psychiatry and was the only ABNP subspecialty until 1991 when the first examination in Geriatric Psychiatry was administered. Addiction Psychiatry became a subspecialty of ABPN in 1993.

The ABPN governs the specialty of Psychiatry, of which Addiction Psychiatry is a subspecialty. Board Certification in Addiction Psychiatry requires a four-year psychiatric-residency program for training in the prevention, diagnosis and treatment of mood, anxiety, substance-abuse as well as other psychological and interpersonal problems followed by an additional year of training in one of the 40 accredited Addiction Psychiatry Fellowship programs. The Accreditation Council for Graduate Medical Education (ACGME) is the professional organization responsible for the accreditation residency education programs in the US for ABMS specialty and subspecialty areas of medicine. Addiction Psychiatry training programs are governed by the ACGME and graduates are eligible for ABPN Certification in Addiction Psychiatry.

When this rigorous education and training is complete a candidate is Board Eligible and can then take the subspecialty certification exam. The exam assesses competency in diagnosis and treatment, consultation, pharmacotherapy, pharmacology of drugs, psychosocial treatment and behavioral basis of practice to be Board Certified in the subspecialty of Addiction Psychiatry by the ABPN.

Candidates must then be assessed in a number of areas including psychiatric evaluation and consultation, pharmacotherapy, pharmacology, toxicology, psychosocial treatment, behavioral basis of practice, and many other areas in which for the past half-decade they where taught and apprenticed.

The current structure of residency training is little changed from when it was conceived originally by William Stewart Halsted in the late 19th Century. Physicians acquire knowledge and skills necessary to safely and competently manage patients through apprenticeship.

Training in a specialty area provides a comprehensive platform that allows medical school graduates to apply a body of knowledge to patient care and the treatment of disease. This forms the foundation of our Guild–undifferentiated and general but pluripotential.

The American Academy of Addiction Psychiatry (AAAP) is the only professional organization in the US focused on the subspecialty of Addiction Psychiatry. The AAAP Mission Statements are to:








“,addiction medicine”, is a self-designated practice specialty (SDPS)

The American Medical Association records a physician’s Self-Designated Practice Specialty(SDPS) in response to an annual credentialing survey. According to the AMA, SDPS are “historically related to the record-keeping needs of the American Medical Association and do not imply ‘recognition’ or ‘endorsement’ of any field of medical practice by the Association. SDPS refers to a self-designated specialty and this is not equivalent nor does it imply ABMS [American Board of Medical Specialties] Board Certification.

“The fact that a physician chooses to designate a given specialty/area of practice on our records does not necessarily mean that the physician has been trained or has special competence to practice the SDPS.”

Physicians have been able to list addiction medicine as a self-designated area of practice using the specialty code “ADM” since 1990.

In contrast to ABMS accepted board credentials, American Board of Addiction Medicine(ABAM) certification requires only a medical degree, a valid license to practice medicine, completion of a residency training in ANY specialty, and one year‘s full time involvement plus 50 additional hours of medical education in the field of alcoholism and other drug dependencies. The majority of American Society of Addiction Medicine(ASAM) physicians meet these requirements by “working in a chemical dependency treatment facility, taking continuing medical education courses in addiction, or participating in research.

The American Society of Addiction Medicine’s mission is to “establish addiction medicine as a specialty recognized by professional organizations, governments,, physicians, purchasers, and consumers of health care products, and the general public.’ They have succeeded in doing this as many consider them to be the experts in addiction medicine including regulatory agencies.

The goal of the American Board of Addiction Medicine (ABAM) Foundation is to “gain recognition of Addiction Medicine as a medical specialty by the American Board of Medical Specialties (ABMS).”

But Addiction Medicine is currently not recognized by the ABMS. It is still a a Self-Designated Practice Specialty and the ABAM is a Self-Designated Board.

Two questions you can answer please?

What percentage of ASAM doctors are in recovery themselves? And of those in recovery how many did so via 12-step methodology at a “,PHP-approved”, assessment and treatment center?

One thing is for certain. When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model. The birth of Addiction Medicine as an ABMS accepted discipline is sure to be a success for the drug and alcohol testing and 12-step treatment industry, but its spawn is sure to be an inauspicious mark on the Profession and Guild of Medicine and a bane of society for years to come.

Stevens RA. In: Stevens R, Rosenberg C, Burns L, eds. History and Health Policy in the United States: Putting the Past Back in: Rutgers University Press, 2006:49-83.

American Association of Addiction Psychiatry Website link to (accessed 4/2/2014).

American Medical Association. List &, Definitions of Self-Designated Practice Specialties. August 21, 2012 link to

Juul D, Scheiber SC, Kramer TA. Subspecialty certification by the American Board of Psychiatry and Neurology. Academic psychiatry: the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry.Spring 2004,28(1):12-17.

Tontchev GV, Housel TR, Callahan JF, Kunz KB, Miller MM, Blondell RD. Specialized training on addictions for physicians in the United States. Substance abuse: official publication of the Association for Medical Education and Research in Substance Abuse. Apr 2011,32(2):84-92.

You’,re absolutely correct that AAAP is the only medical professional organization in the US that focuses on addiction psychiatry. ASAM focuses on the broader realm of addiction medicine. They differ, though they are similar in most respects. ASAM and AAAP memberships overlap considerably though AAAP’,s membership is significantly smaller. AAAP is not a democratic association in that its members do not elect its leadership. ASAM is set up as a democratic association. As you noted, addiction psychiatry was set up in 1993, about 40 years after addiction medicine began as a specialty. Specialization in addiction medicine was available for far longer. Whether a board is part of ABMS or not was, for many years, not considered important. In fact, until this century, a significant number of practicing physicians weren’,t board certified at all, let alone ABMS board certified. These days, it has become more important politically, and so ABAM is following all the steps necessary to become part of ABMS.

Your questions about ASAM could also be asked of AAAP. That is, what percentage of ASAM docs are in recovery. Given the percentage of docs who come into this field mid-career, I would guess that it is somewhere around one-quarter, and that the same percentage would apply in AAAP. But I don’,t believe anyone has ever asked or cared, comparable to asking how many endocrinologists have been treated for diabetes. Your second question as to how those members who are in recovery achieved their recovery is even more of an unknown.

What really puzzles me about your note above is your apparent distinction between ASAM and AAAP, which as I’,ve noted are largely made up of a similar population of physicians. We’,ve had several people over the years, I think, who have been Presidents of both groups, or who served simultaneously on both Boards. Both groups are trained similarly, both groups appear to have similar demographics, and much of the policy and positions of the two groups are identical. ASAM and AAAP have worked together many times over the years, and in fact, since AAAP does not participate in the medical federation through the AMA House of Delegates, ASAM has always been the voice of addiction there, whether in the House itself or in the Psychiatry Section Council. So when you pummel ASAM, you must also have the same feelings about AAAP, and yet it is clear that you don’,t. I can assure you, as an ABMS board certified addiction psychiatrist myself, that there is no or little significant difference in perspective with respect to the major issues you’,ve raised between addiction psychiatry and addiction medicine. Sure, we may lack consensus from time to time, or bicker about minutiae, but to say that addiction medicine’,s ABMS approval would change anything at all related to industry is absurd. It would simply add the potential for a greater number of physicians to receive ABMS certification in the field of addiction, something badly needed by a society which has a huge number of addicts and insufficient sources of treatment.

In any case, I appreciate the opportunity to discuss this with you but I get the sense that you have an unstated agenda.

I think it’s a very valid question as to how many of these physicians are AA or NA members, especially considering that the whole purpose of the 12th step is to proselytize with the belief that their sobriety, professions, and their very lives depend upon it. And what I’m seeing in that regard is very alarming. It seems even some doctors can be susceptible to this kind of thinking that God is going to provide them a daily miracle by removing their compulsion to drink or drug and remove their character defects, among other promises. And it’s apparent they seem to think that should be the case for everyone. However, you can’t really expect all people, much less all physicians, to believe that as some people just by their nature are going to be more rational thinkers. Coercing them to be involved in religious activities for the rest of their lives with the threat of removing their licenses if they don’t comply is unconscionable to me. So is telling any human being—physician or not–,that they can never again have a single drink for the rest of their professional lives just because they might have gotten into a little too much at one point, especially considering the fact that most dependence is actually short-lived. What I think is being conflated here is the idea that the steps are effective, rather than the threat of losing their professions these physicians are living under which is a horrible and unnecessary threat. Most people fully recover without any of that.

These are just a couple of reasons why religious indoctrination should never, ever shape policies. The rest of what I’m seeing is just a little too alarming to even begin to address. I’m really shocked and horrified at the idea of people routinely getting drug tested by their doctors as a matter of policy. That’s just such an invasion of such unbelievable depth, I just don’t have the words… Juliet.roxspin

So are they carrying the message only with the selfish desire to stay sober if they do what AA says—, so it’,s not really about caring if the other person gets it or not—, as long as the person carrying the message stays sober. The AA literature also makes it clear they can’,t endorse other programs so individuals in addiction treatment professions who are in AA/NA would probably fear losing their sobriety if they break the AA traditions? They seem to bring too much bias into their careers, huh? The steps are not effective, the minute one person tries and fails at them that’,s proof. Threats and drug testing keep participants in line but that’,s not proof the steps work.

Amythist: Last August I was tested for drugs for the first time in my life without my knowledge or consent. I found out it is perfectly legal as long as they have another reason or excuse for the blood testing besides drug testing. They had just taken a blood test 2 months before. I can’,t tell you how violated I felt. Also, I have been honest about my past alcohol use and told them I was sober a long time. I feel they should have taken my word. Furthermore, if I wanted to do crack, smoke grass, or whatever, I feel I should have been able to do so without being tricked by a medical clinic into getting caught.. If I wanted help for any of those issues, I would know where to go to get it, and if I didn’,t want help, it would be my business and my right. On top of that, eating something with poppy seeds can cause you to test for positive for cannabis, and if I had eaten poppyseeds, it would have falsely shown in my records that I smoke grass. Now even though they said I have kidney disease, I don’,t want to ever go back, because I don’,t trust them or any doctors. If they would do that, how do I know they wouldn’,t inject me with HIV or something else without telling me? On top of that, even though I tested negative for everything, they then violated my confidentiality by giving my name and phone number to a nearby drug &, alcohol clinic. I know, because the clinic called me, trying to scrounge around for more business, and I don’,t see where else they could have gotten my information from. I may drop dead from kidney disease (which my last idiot doctor didn’,t find in 12 years) if I even really have it, but I will never give these idiots a blood or urine sample again. Ironically, the same asshole who ordered the blood test also tried to get me on anti-anxiety medication, which I didn’,t want and don’,t feel I need. On top of that, the clinic couldn’,t accurately measure my blood glucose, because they didn’,t give me a chance to fast first. Michael L. Langan

Confusing ideological opinions with professional knowledge is unacceptable. Presenting it as textbook science is not only dangerous but fosters negligence, abuse of power, self-interest and prejudice on the part of the medical community with respect to the treatment of all patients.

Addiction psychiatry follows the standard and acceptable rules, regulations and even mores of the profession. To become an “,addiction medicine”, specialist only requires an ABMS board certification in ANY specialty. The truth is that any radiologist, pathologist or proctologist could become “,board certified”, in addiction medicine. Even more concerning is the fact that you don’,t even need to meet anyone to do so. One can simply apply, pay the fee and take the test. When I was board certified in Internal Medicine and Geriatric Medicine the process required letters from my Chief Resident, Chief, supervisors and others who could vouch for my integrity and character. No such process exists for addiction medicine. Some would even go so far as to deem the process a “,diploma mill”, to certify enough doctors to staff the ASAM and

“,PHP-approved”,assessment and treatment centers. “,Addiction Medicine”, does outnumber “,Addiction psychiatry”, by about 3.2 to 1 correct? Michael L. Langan

Dr. Gitlow, I have nothing against the ASAM per se. In fact one of my top ten favorite physicians in the history of medicine, LeClair Bissell, MD was not only board certified in “,addiction medicine”, but also the President of the ASAM. She was a doctor with a good heart who cared about patients and the greater good of medicine and society. Many ASAM physicians are. Both your father and Bissell combined good intentions with good works.

However, ABAM Board certification is not commensurate with the common goals of the ABMS, ACGME or IOM. The educational and apprenticeship requirements fall short by a long-shot. I have absolutely no training in addiction medicine or psychiatry and took the test in 2012 without any studying or preparation and got a score of 459 with a passing score of 394. I am not expert (and I don’,t claim to be) I took the test without even meeting one person. The point being neither is 4000 of me and this needs to be addressed.

This “,lower bar”, has enabled a number of physicians to be board certified in “,addiction medicine”, who have a history of manipulating the system (including many felons and even some double felons). These include doctors who stole IV pain medication from dying patients, pedophiles and even one physician who was caught selling the “,date-rape”, drug to DEA agents. Some of these doctors have committed unconscionable acts and should have never gotten their licenses back. Not only did they get their licenses back but many have been put in charge of other physicians by joining their state PHPs –,which are unregulated, opaque and accountable to no one.

You yourself argued against regulation by claiming an 80% “,success”, rate based on a methodologically flawed and biased study with false endpoints to hide all the suicides.

And by “,unstated agenda”, you are probably referring to the fact that I was a victim of some of these sociopaths. But my agenda is not unstated –,it’,s stated everywhere.

Take a look at what some of your ASAM “,addiction medicine”, specialists do. In fact this guy is another “,like-minded”, doc. An ex-alcoholic with a history of malpractice who, like so many other ASAM doctors, joined his state PHP and gained power over other doctors where he previously had none. Unfortunately good doctors like John Knight and J Wesley Boyd have been “,let go”, from state PHPs so that most states are left with doctors similar to this one in charge. He is supposed to be an MRO.

I’,ll tell you what -if you can defend him either procedurally, ethically or legally I’,ll make this my last post ever. On top of that I’,ll give you my entire collection of The Classics of Medicine as outlined in the contest. Just one of these will suffice. In fact I’,ll go even further–,if you can give me any argument that would even make what this guy did procedurally, ethically or legally defensible the books are yours.

My bet is you cannot. And if you cannot then as President of ASAM you need to do something about it!

You raise some very interesting points, but I don’,t know to whom you’,re referring in your final ¶’,s. I’,ll be the first to accept as fact that some physicians should not be in practice. I’,ll also accept as fact that it is sometimes a judgment call as to how or whether to get an individual back into practice after difficulties such as those you’,ve described. There are addiction psychiatrists just as there are addiction medicine specialists who have significant histories of addiction-related difficulties.

Your points about the differences in the exam and process between ADP and ADM are well taken. The ADM process began many decades ago, and was quite consistent with the board approaches at that time. ABAM has been instrumental in updating it and bringing MOC into play as well. We are in a difficult position, of course, in terms of needing to simultaneously bring more people into the field of addiction treatment while also ensuring that educational standards are up to par. At the same time that you are upset about addiction medicine having apprenticeships, physicians overall are largely being replaced in many locations by nurse specialists, who have only a fraction of the requirements that ABMS imposes, and a fraction of the requirements that ABAM imposes. It remains unclear that all of the ABMS requirements are necessary in order to retain quality of care. Studies of physicians with ABMS requirements met vs nurses who do not even have a medical school background have not been conducted with outcomes as an overall measure of quality.

You have described in depth your concern that ABMS/ACGME requirements are necessary, but there aren’,t even any studies demonstrating that, and I’,m sure you’,re aware that there have been many published articles recently suggesting that perhaps these requirements are far in excess of what’,s necessary.

LeClair and I were close friends for many years, and I’,m glad to hear of your warm thoughts toward her. I’,ve strived at ASAM to ensure that our work follows in her footsteps as much of what I learned about alcoholism I learned from her. As I said earlier, many of us in ASAM are addiction psychiatrists. But as an addiction psychiatrist, almost all of my addiction education came from internists like LeClair, Max Schneider, and Marvin Block. The internists were instrumental in starting the field, with psychiatrists simply setting up an educational pathway for themselves within the ABMS system that was separate from the rest of addiction medicine –, all quite a few decades later.

Oh, oh, oh. Prizes! It’,s like a game show. Stuart goes home with parting gifts of a life’,s supply of SPAM. Yum.

In the new game show, Who’,s Got Your Mind Anyway …, The winner is?

Congratulations. You are truly ‘,happy, joyous and free’, and you get the grand prize. A healthy mind. (And you get to keep your books.)

The bad egg shoot now opens and Gitlow slides down the poop dumbwaiter. Bad Egg. Michael L. Langan

There are no winners if egregious ethical misconduct and crimes are overlooked, dismissed or deflected by any group. Perhaps Dr. Gitlow has not seen my question yet. This is an “,addiction medicine”, specialist who is also a “,like-minded doc”, and my claim is that he (along with his cohorts) is engaging in gross negligence and fraud, violating all ethical norms of the profession and committing crimes. If this is not the case then I would welcome a counter-argument to any of these allegations. If there is no counter-argument that can be given then may I ask how the ASAM holds bad eggs like this accountable? I think most people outside of the ASAM would concur that people like this should not be practicing medicine.

This so called “,addiction specialist”, and “,medical review officer”, is violating everything from the Hippocratic Oath to the AMA Code of Ethics to MRO Codes of Conduct and essentially every other virtue of the medical profession. Does the ASAM just tolerate this type of misconduct of its members? One measure of integrity is accountability and if the ASAM does not hold individual members of its group accountable then how can those members as a whole be trusted by outside groups including the general public.

Tis true but Sir Stu can claim to be the winner due to the financial and psychological extortion inflicted on members of his beloved 12 step cult. They have to justify if somehow!

Do the ‘,bad eggs’, test themselves with EtG? Michael L. Langan

Rumor has it that the first order of business when the FSPHP was formed wast that they took a vote whether or not to continue testing themselves and voted to not do so.

I’,d invite you to stop making excuses for this group of criminals and cult recruiters.

That ‘,I’,d invite you …,’, Is condescending drivel and you know it. You protest too much. I suspect you are brainwashed and indoctrinated and therefore cannot accept the truth. I’,d invite you to wake up. That’,s ‘,how it works.’,

Condescending steppers know no truths. Read the research. Defending a dangerous cult religion is unethical to the extreme. Stop it.

Counselorchick, what group of criminals and cult recruiters are you talking about? If you’,re referring to the roughly 5000 addiction medicine specialists in the country, then I suppose we will simply have to agree to disagree. If there are indeed criminals and cult recruiters among that group, call them out. Speak clearly.

I speak and think clearly and precisely. If you understand it not, that is your responsibility. Is that the best you’,ve got?

Stop being a condescending prick. That clear enough for ya?

It’,s clear. Pity you don’,t think your comment important enough to attach your actual name to it. Without that, I don’,t give you a great deal of (e.g. any) credibility.

Of course not, you’,re a stepper and desperate to make any claim to discount the truth. You have no credibility whether you attach your ‘,actual’, name to your BILLshit or not. Also, you’,re a liar. If you didn’,t give the truth-tellers credibility, you would have no need to defend your cult religion as you continue to do. Pathetic.

Also, you did not address that last attempt to discard the truth to anyone in particular. Coward. You have less than zero credibility.

Ad hominem attacks are for the weak and desperate. Stop it Stuart. Respond to Dr. Langan. He’,s even offering prizes!

So let me get this straight, she-who-has-no-name: you are assuming that I am an addict who has gone to a twelve step program to gain recovery, that I follow a twelve step program with religious fervor, and that I am attempting to defend that program with my statements. Do I understand your assumption correctly?

OMFG. You are truly not well. Please seek professional help immediately.

In the meantime, for those following along …, here’,s a link to my brilliant blog. Enjoy!

Laura, I see from your about page on your blog that you are a certified addiction specialist and you have a private practice in Pacific Palisades. I know someone who might be interested. What is the name of your private practice so that I might look it up? Do you do other types of counseling as well?

Thank you. I’,ll pass that email on to my friend. He can email you himself, if and when he’,s ready.

Yes. When he is ready. You’,re a good friend.

Ahh, there you are, Laura. Good. You have a name. And I see you hold yourself out as an addiction counselor. So in the past day, you’,ve called me a “,stepper,”, “,condescending prick,”, and have concluded after brief comments on both sides that I am “,truly not well.”, You’,ve further raised suspicion that I am “,brainwashed”, and “,indoctrinated.”, Nice. Is this the way you act in your role as a counselor as well? Jorge H. R.

I do sign this question with my name: Why you people proclaim to be: “The Voice of Addiction Medicine.”? —, link to

ASAM has the only delegation focused on the medical specialty of addiction medicine within the federation of medicine. It is the largest group of physicians specializing in the field of addiction in the world. It builds policy and positions through a democratic process involving any member who is interested in participating in the process. As such, ASAM’,s voice represents its membership and therefore is the voice of the field of addiction medicine.

And I’,m quite relieved to live in a country where the official positions of the ASAM are completely disregarded when it comes to policy formation.

Do you feel differently about ISAM, France?

Where I live policy formation is an internal process where the data most closely looked at is the stuff which pertains to the local population, documentation from ISAM or ASAM hardly feature in this discourse. Juliet.roxspin

Does this democratic process serve to silence non 12 Step methods from its inflated sense of importance although there is evidence SMART Recovery, for example, uses scientifically proven techniques and offers trained facilitators at meetings? Or that SOS is not religious but provides a similar meeting format as AA without the steps? What is it about non-12 Step groups that makes pro 12 Step members/promoters disinterested, as if they don’,t even care to know what other groups exist? Jorge H. R.

Stuart:That’,s easy for you to say. You are not a counselor “,chick.”, Don’,t you realize how dangerous it can be for women especially to give our full actual names in a forum like this? From what you’,ve said so far, probably not. Twelve steppers do gang stalk people. Not all 12-steppers do it, but some do.

Some of us have been stalked by AA members. That’,s a fact. Then they turn around and accuse us of it. It’,s just another way of ruining our credibility.

Amythist: I have been a victim of organized gang stalking for years. I didn’,t even know that’,s what was going on at first. I don’,t know who’,s behind it or if it’,s AA, but I have started to suspect AA or NA could be involved.

Counselorchick: That depends. Define what you mean by the word “,prick.”, To some people it might mean a penis, but to other people it might mean a doorknob. Michael L. Langan

I call one out right here Dr. Gitlow. I posit that this “,addiction medicine”, specialist is a criminal. Please prove me otherwise.

My offering of “,prizes”, is rhetorical of course. One of the “,logical fallacies”, used by groups such as the FSPHP is to “,move the goalpost.”, When confronted with procedural irregularities, ethical violations and even criminal acts the individuals involved will often claim “,special circumstances”, or that they follow different rules according to their “,experts.”, The problem is that this logical fallacy often works as justification and this superficial blather placates non-inquiring minds. It suffices in keeping those who should know better blinkered and they just accept the “,appeal to authority”, fallacy claims at face-value, complacent that these are just benevolent doctors helping sick doctors and protecting the public. Accountability is not enforced. There is no negative reinforcement and no consequences to those who engage in the misconduct.

Well if these special circumstances actually exist or expert opinion can in fact support what was done by this ASAM physician then positive reinforcement in the form of almost $10,000.00 worth of books should be able to provoke someone to substantiate that this doctor is not in fact an unethical criminal.

But that is not going to happen. I could offer my house, my car or my very soul and no one is going to be able to disprove that Dr. Wayne Gavryck is not what the documents show he is.

And if you can disprove this on any level I will remove my posts and my blog and fade into the woodwork.

If you cannot disprove it then I ask what is going to be done about it? I am hoping silence is not the answer to my question. And I too attach my name.

you mean like the re-invented ASAM addiction specialists who did my initial evaluation? This lasted an hour and cost $1700 dollars. He is the guy that was caught stealing morphine from dying cancer patients.

ASAM is a professional organization of over 3000 clinicians specializing in addictive disease. As in any group of that size, there will be occasional individuals who fall outside societally acceptable norms. I don’,t believe you’,ll find any group, or any medical association, without such issues arising from time to time.

Question: Do you find it ‘,falls outside societal acceptable norms’, to coerce professionals into a religious cult as a pretext to regaining their respective professional certifications? Does it ‘,fall outside of societal acceptable norms’, to charge money for said indoctrination?

It’,s way outside societal norms, in my opinion. I think most people would strongly object if they knew what the various PHPs do.

Jonathan: OMG! Or should I say OMHP?! Juliet.roxspin

Is anyone from SMART Recovery or SOS in ASAM? I mean, ASAM is open to all recovery methods that help end this horrible disease that has ravaged our country —, a disease that despite 80 years of AA has not been cured! ASAM—, if you’,re reading this, please don’,t lose hope. You’,re not affiliated with AA therefore you can use all sorts of different programs and methods to help end this disease once and for all!

Juliet: I know someone in ASAM who supports SOS. Juliet.roxspin

Any support group focused on recovery issues should be treated as equally as AA gets attention…, Of course there is support of SOS and SMART in ASAM but there is not enough attention or light shined on those programs. Ask for a secular meeting and you still hear people saying “,there are atheists in AA”, but that’,s not the answer to the question…, AA may have atheists but that doesn’,t make AA secular. If ASAM can be unbiased and ignore the status quo and the rhetoric out there, I’,d love to see that. I’,d love to see ASAM promote all recovery meetings equally instead of just saying there are more AA meetings, it’,s lazy and convenient to try to sell more AA but is that helping others? Nope. The public perception is shifting but the reason there are not a lot of these other meetings is because professionals from boards such as ASAM speak of AA as if there is no other program…, or that the others don’,t need as much promotion as AA does…, this is ridiculous to me.

There’,s never been one scientifically validated trial ever conducted in the annals of human history which has concluded upon the preponderance of evidence that specific mutual aid groups such as Alcoholics Anonymous are “,necessary”, or “,beneficial”, for all people.

Such conclusions are currently not possible to draw from any study which has ever been conducted. Such an interpretation as yours is not an honest appraisal of the available data, but a representation which has pulled through hoops and contortions to meld to your preconceived ideas.

What preconceived ideas? And who are “,alcohol dependent people?”, That term isn’,t even used anymore. And no study has ever shown that any intervention is necessary or beneficial for ALL of any one group. Those weren’,t my words. What the studies have shown is that of those patients with addictive disease who participate in ongoing care with their addiction specialist physician, who are subject to random drug tests, and who participate in twelve step programming, 80-90% have long term recovery. It’,s not right for everyone, and there’,s no question that for some of the 80-90%, one or more of those interventions might not have been necessary, but there’,s no evidence that it does any harm to participate in each of those forms of intervention.

I was referring specifically to what you did say:

…, I think most of the members of ASAM would suggest that participation in such programming is a valuable if not a necessary component of recovery.

If that’,s the case, then these members need to go back over the available evidence available and actually read it, because this is not supported by the empirical evidence available.

Your statement that “,there’,s no evidence that it does any harm to participate in each of those forms of intervention”, is also factually incorrect. Many people object to the religious or unregulated nature of such programming, or find it harmful in other ways. Doctors who specialize in addiction medicine should be made aware of this, because it seems at present to be something the “,addiction specialists”, community in the United States seems largely uneducated about, even while it remains their specialty.

The purpose of scientific studies is to control for as many variables as possible. If you’,re referring to studies covering Pilots and Physicians, socio-economic factors and many other variables cannot be controlled for. There are many inputs which factor into why people make decisions –, too many for one RCT to firmly cover. Non-professionals may likely not respond to the same carrot-and-stick approach as you are suggesting, neither will the explosion of heroin addicts in Afghanistan, or the opium addicts in Egypt, or the drunken vagrant on a Sevastopol street. This is because there are other inputs in all these cases which are not addressed in the study in question. The extrapolation error which is occurring here is severe, and at a fairly basic level.

Define chronic alcoholism

The problem here is not the data, but the way the results are interpreted.

We could be having the exact same discussion about statins for cholesterol control, or about taking an aspirin a day. Many people object to them or find them harmful. That’,s independent of what the studies demonstrate, though, as applying to a broad population.

The studies do not demonstrate what you’,re asserting on a broad population. They demonstrate very specific outcomes in very specific circumstances under specific healthcare conditions not generally present elsewhere in the First, Second or Third World. The target group here is a controlled population who are all very likely to be in –, or already heading for the richest “,1%”, of the world’,s population, who can access healthcare freely, and probably have a more fulfilling vocation than many –, and more to lose. You’,re essentially making sweeping claims about the natures of such studies which are not substantiated.

Doctor’,s (if you’,ll excuse me for using that word in place of physician, I’,m not an American) routinely screen patients for contraindications in the analog you mentioned, which is not really analogous. Where I live so do pharmacists, and nearly all other health professionals where they can. The entire system is designed this way, people wear medic-alert bracelets specifically for this reason, certain criteria for these issues are taught at fundamental first aid courses, etc. I’,m slightly alarmed the same sort of screening doesn’,t occur in the United States when it comes to addiction treatment.

I agree with you entirely on the need for improved screening, not to mention improved education of clinicians. I also agree that differing populations may well have differing responses to various approaches. Juliet.roxspin

I somehow don’,t see someone being driven to suicide for being prescribed aspirin daily…, How can you compare a minor annoyance (if that) with the layer upon layer of complaints made against the 12 Step programs? Shouldn’,t all patients be treated with dignity, respect, and not harmed by the treatment given? If a treatment is making a patient worse, not better, a doctor switches the treatment and doesn’,t give more of the stuff that is making someone sicker. That 80% success rate seems to come from a strict testing policy not AA attendance alone. What success would the 12 Step program have on them if there wasn’,t a testing policy with it? How well would it work if they were given their licenses back AND then told to attend meetings…, It’,s coerced attendance to one organization that in my understanding is financially gaining from this source of membership. Isn’,t this a monopoly? Why hasn’,t SMART Recovery been used as an alternative secular support and then also tested to see the success outcomes?

You raise excellent questions. It is entirely unknown whether the success rate comes from strict testing, from regular appointments with a specialist, or from AA, or from some combination of these. No one has done the study necessary to determine that. Your points are well taken. Juliet.roxspin

Add some other programs besides 12 Steps to that and allow someone a choice between Religious and Secular treatment…, I have never heard of prayer-based group support being the only thing available for ANY other “,disease”, or behavioral problem or condition…, Let alone the FIRST choice of treatment and not the LAST …, at best AA should ONLY be by choice not FORCED on anyone. (Think of how the US public schools don’,t have prayer—, that’,s why—, you CHOOSE to go to a religious school not the other way around!)

We are in agreement here too…,no approach to disease should involve coercion.

I have to say that I’,ve always looked at twelve step as being secular in nature. The patients I’,ve spoken with generally view higher power as being different from “,God”, or anything religious. Rather, they simply look at it as being like gravity. Gravity is a power that we can not, without something like an airplane or other device, overcome. It is therefore a higher power, and clearly a secular power rather than a religious one. I know very well that there are some highly religious twelve-step groups and I’,m happy that in my geographic area, patients can avoid those should they desire. Juliet.roxspin

The steps are religious…, let that sink in for a moment. I know you’,re a psychiatrist but even psychiatrists can be wrong sometimes. They are not secular. The concept of Gravity does not involve God being mentioned in order to study it. You can choose to involve God in that discussion but it would not be science. People invented airplanes, helium balloons take flight…, we have proven we are not victims of Gravity or ruled by Gravity. The steps are not secular. Stop lying about them, please. Every 12 Step group is religious—, some more than others—, but the steps are religious. You’,ve read them right? We couldn’,t read those steps in a public school. Because they are religious. How is it beneficial if patients have to avoid certain meetings that disturb them? You’,re just further illustrating my point that AA meetings are ineffective…, people may want a nice support group but the content of AA if it is irrelevant to recovery means why not recommend Women for Sobriety or SMART Recovery? If ASAM recommended these other organizations as fervently as AA then perhaps people would start more alternative meetings. But people won’,t start more alternative meetings if the rehabs won’,t recommend them. And rehabs will point to ASAM and say, well ASAM recommends the steps and ASAM says AA is the best so that is what we use—, and there is NO basis for saying AA is the best if only 5% stay with AA…,. Why can’,t ASAM do better than this? You do realize that this AA or nothing approach is actually killing people who may have lived, right? Don’,t you have a conscience as a doctor?

Juliet: Even psychiatrists can be wrong sometimes, lol! The American Psychiatric Association votes new disorders in and out every year. Some current “,disorders”, are Oppositional Defiant Disorder (which means you don’,t like being told what to do and is found mainly in women and children), Math Disorder (trouble with math), and Reading Disorder (trouble with reading). The APA once said that homosexuality was a disease, but now say it’,s not. In addition, a former president of the APA once said that all retarded children over the age of 5 who couldn’,t work should be killed. During slavery, there was a “,disease”, called “,drapetomania.”, It was found only in black slaves, and was characterized primarily by the desire to run away. The “,treatment”, of this “,disorder”, was beating the hell out of the slave when caught. Also, anyone who criticized the government was “,diagnosed”, with a “,disease”, called “,Anarchia.”, Also, we should never forget that the Holocaust in Nazi Germany didn’,t begin with Jews, but with “,feeble minded”, children. The killings of the feeble-minded were encouraged and carried out mostly by psychiatrists, with the support of some medical doctors. In fact, 3 hospitals for feeble-minded people in Germany actually had a contest to see who could kill the most. When a total of 10,000 were killed, the psychiatrists, nurses and secretaries at the 3 hospitals had a party to celebrate! Another interesting fact is that they lied to these people’,s relatives about their cause of death. These “,doctors”, would have loved the passive, non-questioning attitude encouraged by AA. This doesn’,t mean that all doctors and psychiatrists are bad, of course, just that it pays to think critically, regardless of anyone’,s title. But of course you already know that. Juliet.roxspin

I think when I refused to accept the sexist AA Big Book I was Oppositional Defiant…, But yes, homosexuality for instance is a well-known example of when psychiatrists have retracted a disorder. AA to me is a remnant of those rehabs created to cure gays/lesbians. It’,s this treatment out of all treatments for all “,diseases”, that doesn’,t seem to make sense…, Being told to “,not think”, in AA was a red flag to me this wasn’,t healthy—, at least it was the wrong treatment for me! I’,m still unlearning, and deprogramming today and part of that is thinking and speaking for myself—, about what I experienced and felt. Any psychiatrist who would rather me not think or problem solve for myself (go to AA! You’,ll like it! Stop resisting!)…, well, I would have to fire my psychiatrist.

Dr. Gitlow, AA is very religious in nature. Are you aware that between the big book and the 12&,12 the word ‘,God’, is mentioned over 500 times? That doesn’,t even include ‘,His’, or ‘,Him’, or ‘,Creator of the Universe’, or ‘,Higher Power’,. It has been deemed religious by every Court the issue has been tried in. People say it’,s “,spiritual not religious”, but that’,s just denial and a bait and switch. It’,s very religious. Try replacing the words for Higher Power or God in the steps with the word Gravity and you’,ll see how nonsensical it is to claim this Higher Power is not a deity and a micromanaging miracle producing one, at that. The literature makes it clear that the whole program is about God, not some force of nature or inanimate object because this Higher Power has to have the ability to take actions and cause miracles. The literature makes it clear you cannot stay sober without God.

I would personally go so far as to say AA is a religion in itself. But it being religious isn’,t even the worst part of it.

I suppose it’,s religious if you think of “,God”, within AA as being the same as “,God”, as spoken of in a church, synagogue, or other house of worship. I’,ve never looked at it that way. To me, “,God”, in AA is simply a metaphor for a power outside one’,s own self. For some of my patients, they think of “,God”, in AA as being the same as “,God”, in their church or synagogue. In that case, AA becomes religious. Other patients see it as I do, and for them, AA is secular. One of the best parts of AA is that it is what any one participant makes of it, though I suppose someone might say the same about houses of worship.

I really can’,t understand the claim that AA can be secular when it makes over 500 references to a deity and the claim is the deity will remove your desire to drink, That’,s the opposite of secular.

secular = denoting attitudes, activities, or other things that have no religious or spiritual basis.

Amythist, if that is the definition of secular, I stand corrected. I believe AA to contain spiritual tenets rather than religious ones. So using your definition, it isn’,t secular. But using mine, it isn’,t religious because I don’,t interpret the Big Book’,s reference to “,God”, as being any more than a higher power as opposed to “,God”, as worshipped in a religious context.

Well, the Courts have deemed it religious and I’,ll go with their definition because it’,s the way I see it. I understand that you can name your God anything you want, but that God has to have very specific characteristics, making it a religion of its own. That God has to be willing to listen to and remove your character defects (this doesn’,t happen) and communicate his will to you. He has to remove your compulsion to drink (but only one day at a time because he isn’,t powerful enough to miracle you into moderation). He also has to fulfill the promises. Are these extravagent promises? We think so!

Amythist: He also has to be a He, not a She, an It, or a Them. And you still have to believe in Him, or some kind of higher power, because if you don’,t believe in a higher power, you can’,t be helped, just like if you were on a sailboat you couldn’,t sail unless you “,believed”, in wind. And since you’,re supposed to confess the exact nature of your wrongs to God in Step 5, he apparently isn’,t all knowing either. Juliet.roxspin

Him is a metaphor. Duh. The Catholic and Jewish God(s) can’,t help you quit drinking—, it is the God of AA that can help you. Otherwise, if it was a matter of God helping you quit drinking AA would not be necessary—, doctors would recommend going to church. But doctors don’,t recommend church, because churches don’,t have the “,program.”, God won’,t help you unless you are in AA, obviously, and I’,m supposed to believe it’,s not even really God just a metaphor that can help? If metaphors can help then just send me to an English class…, but that won’,t work either…, Because it’,s not just a metaphor…, it’,s a belief that the metaphor can do for you what you can’,t do for yourself. Plus, you can’,t get a sponsor in English class, so you must go to AA because it’,s not just about metaphors it’,s about having a sponsor and making coffee. But if it was about making coffee, why not make patients get jobs at a coffee house then? But it isn’,t just about coffee, it’,s about giving back to others. So why not work at a charity of one’,s choice? Nope, it has to be AA…, Juliet.roxspin

Oddly enough “,He”, isn’,t powerful enough to help you unless you are practicing AA member…,

Stuart: That IS the definition of secular, the dictionary definition, at least. Now you are using your own definition, and then trying to say that because YOU define secular differently, AA can be “,secular”, if you want it to be. Well, perhaps I should define gravity as pulling objects upward toward the sky instead of downward to earth, and then decide that when I trip I will fall upward instead of down because that’,s how I interpret it. You can interpret and reinterpret things all you want, but the facts remain. The “,God”, mentioned in the blue book means exactly the concept of the male humanoid “,God”, worshipped in some religions. That’,s exactly what it means. Juliet.roxspin

Perhaps the problem is one’,s interpretation, or perception, of what “,religious”, means…, I am sure some would feel AA isn’,t religious enough, and others find it overwhelmingly too religious. For most of us—, and anyone can correct me for speaking on their behalf—, who object to AA being too religious it is simply the inclusion of God and prayer and the instruction to believe in those things—, and the chapter “,We Agnostics”, cinches the deal. What else could that chapter mean other than either you get some faith in God or you fail the AA program. Have you read the Big Book? Consider again what is a public school in the USA? Can they instruct students about God and how to pray? No! You are well-educated, I find it hard to believe secular never was taught in the schools you attended and graduated from…, Or that you’,d be unaware of ethics guidelines–, each hospital I’,ve ever had to be in has asked me if I have a faith or religious practice. Upon saying no they didn’,t just say, “,How about some spirituality then? How about some non-religious prayer and talk of God then?”, No—, spiritual matters are religious matters. Can they be practiced outside of a church? Yes, of course, but they are still religious matters.

Dr. Gitlow: Why should anyone in AA even be asked to consider a power outside themselves? It is not that there aren’,t things that aren’,t more powerful than any one of us individually. But even though a tornado could literally blow me away, I would never think of it as “,a power greater than myself,”, or pray to it or worship it, or confess to it “,the exact nature of my wrongs”, as in AA’,s Step 5. Who outside of 12-step groups thinks or talks this way? If other people don’,t see it as religious, which I didn’,t use to myself, I frankly think they are in denial. And many, if not all, secular people DO see AA as religious, NOT secular. What about us? Do none of your secular patients see AA as religious, or do you just conveniently neglect to mention them? Plus, if AA really is only religious for religious people who believe in a God of their church or synagogue, then: 1) Some people are encouraged or forced to attend something they find religious, even though while having come from a religious background, they may no longer believe in that religion or have problems with it. 2) If they are traditionally religious and see other people in meetings having gravity, a doorknob, or whatever as their “,higher power,”, and see them saying the Lord’,s Prayer even if they may not believe it, they are seeing their religion or religion in general being mocked. At the very least, the religion of their church or synagogue which they may really believe in, is being diluted. Therefore, why not keep religion in churches, synagogues, mosques, temples, etc.? Also, whether you consider it religious or not, praying to a “,higher power”, probably won’,t keep you sober. If it does, it can just as easily do so by praying in a religious institution or privately, not by holding hands and saying The Lord’,s Prayer to a singular male deity in “,Heaven”, in an AA meeting while simultaneously picturing your own personal idea of a “,higher power”, and trying not to let it be drowned out by the chanting of the Lord’,s Prayer. Juliet.roxspin

If God were a metaphor then why is God the term used…, since it is obviously going to remind someone of other Gods they’,ve learned about—, right? Then to close meetings with the Lord’,s Prayer—, a prayer historically believed, religiously believed to have been taught by Jesus Christ to his disciples…, But seems to me it’,s an incredible stretch of the imagination to tell someone—, a patient or client—, that God is a metaphor for something else. An invisible friend? A doorknob that takes away your defects of character? All I hear when I heard this “,God is a metaphor”, line is a big excuse for something that is obviously meant to mean God—, a God the steps instruct you to pray to. Is “,pray”, also a metaphor? If God isn’,t important to the steps why use God in them? And how insulting is this to those who truly believe in God to tell them the God of AA is not real, it’,s just a metaphor, it’,s meaningless and can mean anything. Have you read the Big Book? The author(s) clearly state that those who come to scoff will stay to pray and believe in God, the Father, and this is not a metaphor. The chapter “,We Agnostics”, is not a metaphor. Do any of your patients disagree with you on this matter? Furthermore, as a psychiatrist, you cannot conduct yourself as a practicing AA member instructing patients in AA—, as I understand it. AA literature clearly states AA members cannot conduct themselves as “,AA”, psychiatrists or teach patients AA—, that’,s what meetings are for. It is in my impression psychiatrists must be educated in all available treatments and not favor one organization (AA) over another—, because it’,s bias? It’,s the opposite of helpful in my opinion. Why is the treatment of alcoholism/addiction even have to mention prayer/God…, what other disease/condition warrants this kind of bizarre confusing debate-instigating treatment that just incites confusion and distortions of beliefs of a religious nature? If we presented the 12 Steps as a treatment for diabetes we’,d have millions of diabetics calling foul! It would be obvious that the treatment was odd at the least. And it wouldn’,t be the first order of “,things”,…, it would be presented only as an auxiliary method of a patient’,s choosing.

Psychiatrists are educated in all available treatments and modalities, AA included. They receive a limited amount of attention to addictive disease. Addiction specialists receive significantly more training within this realm. All the survey data I’,ve seen indicates that the majority of psychiatrists and addiction specialist physicians do not have addictive illness and therefore are rather unlikely to be “,practicing AA members.”, Just as you don’,t have to have diabetes to treat a diabetic, you don’,t have to have addiction to treat a patient with addictive illness. Juliet.roxspin

Yes, hence my confusion—, I know psychiatrists are knowledgeable of all treatments available. However, I fail to see in particular your willingness to inform others of these other treatments available. Please don’,t take this the wrong way but I hear high praise for AA from you and absolutely nothing else about other programs (SMART, SOS)…, I also don’,t see much transparency or forthcoming from the information you do provide about AA—, an obviously religious program and a very sexist, demeaning program to women. I also don’,t see any knowledge about how AA, being such a large and oft used organization, having no safety policies while it openly invites court orders who may not be in court for alcohol related offenses. (I.E. rapists)…, I would prefer those who are addiction specialists to be well informed on matters involved in the recovery world—, including how the meetings operate in communities and may present unintended dangers—, “,13 Stepping.”, Many come into AA after suffering abuse issues—, not just myself—, and is it appropriate to have someone who survived sexual assault perhaps sit alongside and hold hands with a convicted rapist who doesn’,t even have to reveal why they are at the meeting or provide any background information? Perhaps a lot of people in addiction services are not practicing addicts they may be in recovery and not disclosing it because they are “,anonymous.”, And AA literature instructs AA members not to disclose their membership in public—, or as professionals. Do you recommend other programs or just AA?

My specific recommendation to patients is generally that in addition to the medical care I provide they receive support from peers within a structured group setting. I inform them that AA is one widely utilized approach but also tell them that there are other options should they not find AA to be acceptable for any reason. I also inform them that finding the right AA group for them can take some time. If the patient is a 20 year old woman, she will likely not find a group of 50-something steelworkers to be the right group.

ASAM has conducted a variety of anonymous surveys of its members to determine the percentage of membership with addictive disease. This would likely be markedly different from results of social workers or other clinicians in the field, and I wouldn’,t try to extrapolate ASAM’,s results to other clinicians or other countries.

I don’,t typically mention other programs (such as SMART or SOS) by name because there is a paucity of scientific literature describing the results of these other programs. Physicians have been pushed into providing what is called “,evidence-based care”, over the past decade or so, and while we can still speak our mind and provide opinion, it has become increasingly important that treatment recommendations be supported by what the literature describes. This is probably due, in our field, to liability concerns and an increasing number of malpractice actions in the mental health field overall. I believe that many of the groups other than AA might well provide an excellent service to individuals with addiction. For me to recommend them rather than simply mention them, I’,d need to see an appropriately conducted scientific study revealing their value.

Dr. Gitlow: You sound clearly biased toward AA. You say that you can’,t specifically mention other groups without seeing an appropriately conducted scientific study revealing their value. But what such study has proven AA’,s value? The best you seem to be able to say about it is that while there’,s no proof it works, it probably (supposedly) doesn’,t do any harm. You recommend your clients, whom you are giving medical treatment, to AA. Then you say that your clients are sober and in AA, and seem to see that as proof that AA helps. You do not see patients that are staying sober with medical help going to other groups, because you don’,t mention those groups to them by name. Therefore you don’,t have enough evidence of their effectiveness to mention them by name. This reflects the typical circular logic of AA.

I posted a note last night here with a series of citations from the scientific literature with respect to AA’,s value. Let me know if you can’,t find it and I’,ll repost.

Dr. Gitlow, I looked at your citations. You cited Chappel, who incidentally is a Fellow of ASAM. He cites a study of only 20 people, which is, with all due respect, laughable. Furthermore the study had absolutely nothing to do with abstinence or any other form of recovery, like moderation. It was all about how to promote attendance in AA meetings and Alanon, and nothing else. The piece by him you cited is an opinion piece and has no citations. That anybody could cite such a thing is deeply disturbing and I have to worry about the kind of empirical evidence ASAM takes seriously. You also cited Humphreys who is a well known AA proponent who conducts studies that are highly criticized and not methodologically sound. He starts with the assumption AA works and works back from there to prove it. That’,s not the way it should be done. The same hold true of Moos and Moos and if you look really hard at such studies, the bias and the methods, such as the tools they use to assess, are quite shocking. These “,researchers”, really know how to load the dice and they rely on the fact most people can’,t be bothered to read a study so as to impress them with how great AA is.

About the best thing that can possibly be said about AA is it is a support group if you can stomach the literature, religiosity, pressures of conformity and trite slogans etc. Other than that, it’,s nothing but pure superstitious faith healing and any scientist can tell you that does not work. Even intercessory prayer has been disproved, but I’,m sure you know that.

Although SMART hasn’,t been studied, the elements of it are evidence-based and have been repeatedly proven. To ignore a program which does have elements that have been repeatedly proven in favor of faith healing is, to me, a big problem. Juliet.roxspin

Dr. Gitlow you claimed previously you simply can’,t mention something like SMART by name b/c there isn’,t enough evidence…, but ASAM recognizes SMART and SMART recognizes ASAM on its website—, AA’,s website does not even mention ASAM as ASAM would be an “,outside issue”, and it can’,t look connected to ASAM, can it?

It would seem the wires are crossed—, AA mentions one agency that supports a brain disease theory and mainly 12 Step treatment (NCADD) And the NIAAA defines recovery as any remission from alcoholism including moderation…, Wheras ASAM’,s policy is abstinence only is recovery yet ASAM recognizes SMART and AA really doesn’,t seem to care less …, why should they? It’,s strange anyone would recommend AA on the basis alone that AA doesn’,t seem to care at all what science says and doesn’,t inform its members about other forms of treatment only it’,s own program. If you’,re concerned so much with science, SMART is where the science is…, not AA.

Like I said, I don’,t know enough about SMART from the literature. I do know that some of my peers are recommending it. I appreciate what you’,ve said to me and will find a local meeting of SMART, attend, and learn more about it first-hand. I will also review their website to see what I can learn there. Juliet.roxspin

That is awesome and I’,m so glad to hear that! I think when you learn more about SMART you may find it at least as beneficial a support system as you believe AA is in terms of support at least. I had a gentleman from SMART guest speak at the SOS meeting we used to run—, so another woman in the SOS meeting decided to start a SMART meeting and went through the training. Another woman started a LifeRing meeting in Akron, Ohio. I had a young woman travel 3 hours from Columbus, Ohio to attend SOS. Do you see that level of desire, and willingness, to recover from many AA members? Sometimes, but the interest was amazing. People were also scared their AA friends would find out and ostracize them…, which is why I bring up the bullying by AA members…, some are still afraid to go public online because of the harassment by AA members. Although there is increasing support for alternative meetings there is a lot of fear from some to leave AA.

But I do hope you become more interested in the alternatives, which I believe in my opinion is part of your role as a professional. It is hard to recommend something you aren’,t familiar with but I feel one is a recovery specialist unless they are familiar with all modes of recovery—, not just one. And if you are willing to go a step further, if you haven’,t already, checked out HAMS which may be a more effective option than SMART or SOS or AA for some…, or it may be used in combination with something else. Many do better at least knowing there are more options in my opinion. And I know I’,d appreciate having a doctor who was knowledgeable in more than one treatment and could explain the pro’,s and con’,s of each one.

That’,s fantastic! I’,m thrilled to hear it! Thanks Dr. Gitlow!

Dr, Gitlow I feel that I should clarify ahead of time that you may not find old-timers in SMART the way you find in AA meetings. The reason for this is that SMART does not subscribe to the idea that you need meetings for life. I know it’,s true for myself and many others. People go as long as they feel they need to.

People who go into SMART holding the same expectations they have for AA meetings may come away disappointed and feeling it doesn’,t work. I just hope you judge it by its content. I think you will be very pleased.

Dr. Gitlow, I was just wondering if you’,ve had a chance to go to a SMART meeting yet, or had a chance to look at their literature? I was wondering what you thought about it.

Thanks, Dr. Gitlow. I will look later and see if I can find it. I still don’,t want to go back though. Juliet.roxspin

AA doesn’,t cite any science at all- in fact, it is the opposite—, science cites AA as though AA was a form of treatment…, now, SOS uses a similar structure. it’,s a support group. Support is support—, according to you it’,s not a higher power or the steps or God it’,s the support right? So therefore SOS is interchangeable now with AA in terms of support—, plus it’,s darn hard to study SOS if you aren’,t recommending it. AA was recommended for years without any scientific “,evidence”, and today the evidence you claim doesn’,t prove AA works—, unless 5% of the time is great to you? Any study where AA does work it is in conjunction with other treatments—, and it doesn’,t bode better than no treatment. So now we can SOS is as good as no treatment, at least, since you say it lacks evidence. You claim ASAM backs other programs—, SMART actually has ASAM’,s support but you yourself won’,t mention SMART by name when SMART uses scientifically based proven effective approaches and TRAINS their leaders. You have got to be kidding me—, not enough evidence? You won’,t mention them by name…, this is what I mean with the excuses. How can we SHOW these other programs work if people in your position don’,t recommend them! You name AA by name but you don’,t work for AA but you won’,t name SOS by name? This is why AA members harass us as they sit on their golden pedestals laughing in these online comments at our anger and outrage. AA gets all these special privileges when it is not the best program in the world and there is not evidence it works better than SOS or SMART. Can you bring that up to your board? Because not recommending these groups by name is NOT HELPING your patients…, must they do their own research? Is AA paying you not to mention SOS? This really does upset me, if you can’,t tell. But I’,m going to take some deep breaths now and await a reply, which I hope you do reply, and I’,d like to talk more with you about this.

First, AA is not paying me. I’,ve never even spoken to anyone who works for the AA General Service Office or other administrative branch of AA.

Second, regarding SMART, I have to admit that I did a cursory literature search on PubMed when you brought that up. My search terms were “,SMART addiction recovery.”, The search did brought up 3 irrelevant cites, though a similar search for AA brought up nearly 200 mostly-relevant cites. If you have a citation to which you can refer me, I’,d very much like to read it.

You indicate that AA works 5% of the time, you’,re basing that on your earlier statement that 95% of people who attend AA do not persist in attending. That logic doesn’,t follow, however. Your data might simply mean that 95% of people chose to not pursue this form of intervention, AA may have worked for them had they pursued it, but they chose to leave. That’,s very different than saying that of those who continued to attend, AA worked for only 5%. Where does your 95% figure come from, by the way? I’,m not saying it’,s wrong, but I have not heard that particular point before.

Dr. Gitlow: If you searched a little further by going to SMART’,s website,, and then looked up meeting locations, you would see they have meetings all over. Granted, they still don’,t have nearly as many as AA does, but this 3 “,irrelevant”, cities you cite is nonsense. The fact that they are not appropriately listed on PubMed means nothing. PubMed could be biased toward 12-step groups too.

You also say: “,Your data might simply mean that 95% of people chose to not pursue this

form of intervention, AA may have worked for them had they pursued it, but they chose to leave.”, Did it occur to you that some of those who left did so because AA didn’,t work for them and they went back to drinking, or committed suicide, or found another way to stay sober, or in some cases, learned to moderate? Many people also choose to leave AA because they can’,t stand it. But you don’,t seem too concerned to find out why. You call us a “,vocal minority.”, The fact that not everyone who has or has had complaints about AA doesn’,t post on this blog doesn’,t prove we’,re a minority. But I guess the ones who don’,t speak out don’,t count. Some of them CAN’,T speak out because they are dead. They were lead to believe that their only choices were drinking alcoholically, AA, or death. And they chose death.

Basically, you’,re assuming people who are still in AA after a year are still sober, which is often not even true, and then assuming it’,s because AA works for them, and therefore “,AA works if you work it,”, which is just what AA says. You’,re not bothering to follow up with those who have left or died. But then AA doesn’,t care, because those people are just incapable of being honest with themselves, don’,t really want to stay sober, or if they are sober they are just on a “,dry drunk”, not “,really”, sober, or they weren’,t really alcoholics to begin with, etc.

If you or AA really want to help alcoholics, why don’,t you consider that there are legitimate reasons so many people leave instead of just always blaming the individual Why won’,t AA even consider changing to accommodate more people? Why do they refuse to implement even a rudimentary sexual harassment safety policy? Why won’,t you recommend other groups like Secular Organizations for Sobriety, Women for Sobriety/Men for Sobriety, SMART Recovery, etc. by name to your patients? And even if there aren’,t many meetings, these groups do have literature, and some have online meetings. One time when there were no SOS meetings where I lived, I got an SOS pen pal.

It seems to be AA or the highway. Like it or lump it. You seem very clearly biased toward AA. Why don’,t you go to an AA meeting every day yourself for a year, or at least 90 days, and see how much you like it then?

Following this logic Dr. Gitlow, should a client, coerced into TSF, pray to Gravity to remove character defects or compulsion to drink? Can gravity act as a catalyst for a spiritual awakening? Does gravity require confession of sin? The research shows that TSF originated in an errant, heretical, Lutheran cult of confession that has little to do with substance mis-use.

Stuart: AA is absolutely NOT secular. Meetings usually start with the Serenity Prayer and usually end with the Lord’,s Prayer, a distinctly Christian prayer addressed to a distinctly male deity. God is distinctly mentioned in some of the steps as well as in the blue book. If someone says they are an atheist or agnostic, or believe in a female deity, or in multiple goddesses and/or gods, you can bet they will be hated, ridiculed and shunned by many people in AA. The same is true if you won’,t say the Lord’,s Prayer. I personally had hot coffee poured on my hands after saying that I didn’,t think meditation had to be religious in order to be helpful. Is this not harmful? If meditation is even going to be a topic in addiction therapy or support groups, why not discuss it in a rational manner and mention scientific studies that show its benefits, like the one by Yale that shows meditation can increase brain cells? In AA you are repeatedly forced to listen to things you don’,t believe or say things you don’,t believe if you are asked to read “,How It Works”, or the steps at meetings. If you refuse to do so, you will be criticized for not participating. This causes cognitive dissonance which over time, I believe, causes or aggravates mental illness. It is the same as being abused by your family of origin and then having it denied and being told to hide it and pretend everything is okay when it’,s not. Why should religious belief or lack thereof even be an issue in alcohol treatment? Shouldn’,t that be something that’,s best kept in one’,s church, temple, mosque or whatever, if one has one? And what about people who believe in a Christian God being told to substitute it with a vague “,higher power”, whom some people “,choose to call God?”, Couldn’,t that also create cognitive dissonance? On top of that, the program and blue book are very sexist. You are also discouraged in meetings from questioning anything. As for gravity being a “,power greater than myself”,, that’,s true. But so what? Jim Christopher, founder of Secular Order for Sobriety, says in his book How to Stay Sober: Recovery Without Religion: “,A large dog could make short order of yours truly.”, I would never think of either gravity or a large dog as a “,power greater than myself,”, nor would I worship or pray to gravity or a large dog, or ask gravity or a large dog to “,restore me to sanity.”, (Though I would be scared of a large dog if it was unfriendly and try to appease it with dog biscuits if I had any, lol! Then I’,d run like hell!) Juliet.roxspin

Not to mention why would I turn my will and life over to the care of Gravity. And you’,re right—, I didn’,t even think of that how many times I recited things I myself didn’,t believe in using the “,we”, statements of the steps—, and calling God “,Him”, which to me repulsed me just like it did in Catholic school where only the boys could aspire to be priests! I had gotten away successfully from church only to find myself in AA where if I didn’,t accept and speak of this male Christian God not only was I “,against AA”, I was “,resisting recovery”,!! This is why I use the term now “,religious abuse”, because it was using religion to offend, hurt, and upset others…, Say “,he/she/it”, in a meeting to refer to God and the whole room chuckles! What is so funny about calling God a “,she”,? I could admit without any reservation at a point in my life I had drinking problems—, but step 2 simply states I was insane. I was not insane. Every addictions professional must read the AA literature and attend the meetings and report objectively not just parrot or “,pick at”, it and report it seems to be “,just fine!”, …, Self-reporting from AA members also needs to be scrutinized—, how many are “,afraid”, to admit AA has problems or what they dislike about AA? Many are afraid to criticize AA! Just glimpse some recovery articles for how many times anti-AA people are bullied, harassed, criticized and wished harm upon by those claiming to be in AA. Michael L. Langan

In addition many of the doctors and pilots do not even remotely have addiction or even the all encompassing new substance use disorder (a boon to the ASAM and the NAATM “,treatment”, providers). If you look at the methodologically flawed “,PHP-blueprint”, which can be seen here in its entirety thanks to the recently archived Journal of Regulatory Medicine. link to The paper states the following: “,A sample of 904 physicians consecutively admitted to 16 state Physicians’ Health

Programs (PHPs) was studied for 5 years or longer to characterize the outcomes of this episode of care

and to explore the elements of these programs that could improve the care of other addicted populations.

The study consisted of two phases: the first characterized the PHPs and their system of care management,

while the second described the outcomes of the study sample as revealed in the PHP records. The

programs were abstinence-based, requiring physicians to abstain from any use of alcohol or other drugs

of abuse as assessed by frequent random tests typically lasting for 5 years. Tests rapidly identified any return

to substance use, leading to swift and significant consequences. Remarkably, 78% of participants had

no positive test for either alcohol or drugs over the 5-year period of intensive monitoring. At post-treatment

follow-up 72% of the physicians were continuing to practice medicine. The unique PHP care management

included close linkages to the 12-step programs of Alcoholics Anonymous and Narcotics Anonymous and

the use of residential and outpatient treatment programs that were selected for their excellence.”,

What happened to the 1/5 who were “,lost.”, Most of these doctors had a single DUI or other situational factors, one-off and even sham peer review for which they were referred. My understanding is the lost to follow-up endpoint was used to hide all of the suicides of which there were many. Perhaps Dr. Gitlow could comment on this?? Michael L. Langan

Note the “,unique PHP care management

included close linkages to the 12-step programs of Alcoholics Anonymous and Narcotics Anonymous and

the use of residential and outpatient treatment programs that were selected for their excellence.”, The NC PHP Audit found absolutely no basis for how these out of state treatment programs were “,selected for their excellence.”,

In fact the audit pointed out they could not find any criteria for the selection of these out of state assessment and treatment centers at all.

The 80% success rate touted has far more to do with holding a licensed professional hostage. What of the 30% who do not respond well to twelve step facilitation? I know of at least a few pilots who have become seriously depressed and one who attempted suicide during the course of their indoctrination and the financial ruin that this modality causes. These are largely people who made a mistake, got a DUI, or had other serious medical ‘,real’, diseases.

We use alcohol and drug over use issues. Thats the way we speak about it now. Juliet.roxspin

I was harmed tremendously by the teachings of AA and can single it out as the part of a wide variety of treatments that harmed me —, not the drug testing not the non-AA therapy—, but AA and the 12 Step rehab harmed me. I was forced to participate and listen to religious instruction, which is religious abuse, and threatened w/ consequences for not participating. I was exposed to demeaning, sexist AA literature that further eroded my self-esteem and was criticized if I dared mention it—, by other women no less. The steps echoed the abuse (mental, emotional) of my childhood—, admit powerlessness, depend on others for validation, admit wrongs constantly, list my defects, shortcomings, and apologize and own up to “,my part in it”, for being abused even raped. If you want evidence AA harms, I’,m evidence of that. AA just added to the emotional disturbance I suffered from before AA and didn’,t give me coping skills to work through it—, just “,take the cotton out of your ears and stick it in your mouth.”, The steps are negative, and if you hold them up to the red flags for what abusers tell victims they echo them it’,s scary. And the creepy part is the last step told me to carry these abusive, negative steps to everyone else…, I would never do that.

Juliet, I’,m sorry to hear about what you’,ve gone through and hope you have found yourself in a better place. I have no doubt that any strategy, for any disease, will never work universally. And while I can tell you that twelve step programs are very effective and helpful for many of my patients, they are not effective and helpful for all. Juliet.roxspin

No they are not very effective. My 12 Step rehab claimed there was only a 1 in 6 chance a patient would fully recover. I wish you’,d stop lying—, or whitewashing it—, yes, your patients may love the steps. But that doesn’,t mean they are always effective. Nor do I feel you actually care because you start by telling me you are sorry to hear what I’,ve gone through and then nationalistically claim “,many”, of you patients are helped. So what else do you recommend? Also, alcoholism to me is not a disease. Asthma is a disease. Can I buy a 6 pack of asthma? Can I work some steps and turn my asthma over to God?

I don’,t know whether my patients “,love”, the steps. I haven’,t asked them that. I do know whether my patients achieve sobriety and a long lasting recovery, and I do know whether they are participating in a twelve step program as part of their recovery. The 1 in 6 statistic that you quote is true for individuals who don’,t receive proper medical care from an addiction specialist physician. The statistics are far better when patients get proper care. Again, the same is true for multiple other disease states. I wouldn’,t send an asthmatic or diabetic to a support group without also giving them medical care. Yet for some reason, in this country, that is done with addicts all the time. Twelve-step is a useful adjunct to appropriate medical care –, for most patients, though as you’,ve pointed out, not for all.

And while you can’,t buy a six pack of asthma, you can live in a polluted area, smoke, or walk out into the freezing cold, all of which will lead to symptoms that might not be present otherwise. Alcoholism can be symptom free if a person doesn’,t also have the six-pack as you mentioned. Both are diseases, both involve genetics, both involve lifestyle choices, and both are potentially life threatening. Juliet.roxspin

Why go to AA if they don’,t “,love”, the steps? Do any of you patients recover in other programs or no program? Why is not accepting or succeeding AA be a failure of the patient? Isn’,t it a failure of AA? I was in rehab to get “,proper care”, so I fail to understand why only 1-6 would succeed. Other diseases have multiple treatment methods if one fails we don’,t blame the patient. If someone is allergic to penicillin we don’,t give them more of it or go “,oh well, there’,s nothing else to give you.”, I have already told you the 12 Steps are not a useful adjunct to medical care for me but you keep repeating that. And you say “,for most”, when only 25% of alcoholics will ever go to AA and only 5% will stay in AA if they do check it out. So yes, of course, this isn’,t true for all people—, AA doesn’,t work for MOST people. Why can’,t you be honest with me? Or your patients? Yes but we don’,t call the polluted area a person lives in the disease, we call the disease of asthma a disease. Alcohol can cause disease but the act of drinking constantly is not a disease. I have only one relative distant from me who is an “,alcoholic”, and she quit without AA. Genetic? These are lifestyle choices—, that is the most honest true thing you’,ve said to me. Choices not diseases.

Stuart: I do think that alcoholism can be triggered by alcohol, just as asthma can be triggered by pollution. I have long considered it a disease, whether it can be proven officially to be so or not. I also agree it can be life-threatening. However, as you said, most addicts just go or get sent to AA or NA without getting medical care. Twelve-step programs are considered to be the main if not the only “,treatment.”, You say that 12-step groups can be a useful adjunct to medical care. But would you send a diabetic or an asthmatic to a support group where they were told they must pray to a deity or a higher power to remove their “,defects of character”, in order to get healed of their diabetes or asthma?

You also say: “,I don’,t know whether my patients “,love”, the steps. I haven’,t asked them

that. I do know whether my patients achieve sobriety and a long lasting

recovery, and I do know whether they are participating in a twelve step

program as part of their recovery.”, For alcoholics sobriety is certainly the main hallmark of recovery, but it’,s not the only one. I stayed sober in AA for a long time. But my self esteem kept going down and I was increasingly miserable, even suicidal much of the time. Part of it was AA, but part of it was also from a head injury that my “,higher power”, kindly let me have in early sobriety. AA would never have recommended medical treatment, not that it would have done any good anyway, because when I went to the ER I was screamed at for wasting space, and I was told by another doctor that I was still drinking when I wasn’,t. But AA was definitely part of the problem, because when I finally left I felt better. The point is that maybe you should ask your patients who are sober and going to AA how the AA meetings and program make them feel. They may be staying sober, which is good, but they may also be miserable. AA would call that being on a dry drunk, but I don’,t. It’,s better to be sober and not miserable, though.

And very often people are discouraged from taking meds their doctors have prescribed for them and it happened to me. I came very close to suicide and I would never have tried such a stunt if I didn’,t feel so indebted to the person who sternly made that request.

They can deny it all they want to because AA has a pamphlet on medication that even admits suicides have occurred because of it. Most people don’,t read those pamphlets at all and the whole idea that you don’,t need medications came from something that is read before each and every meeting. “,There are those, too, who suffer

from grave emotional and mental disorders, but many of them do recover

if they have the capacity to be honest.”, See? All you need is to be honest and your mental illness magically just goes away. There are meetings where nobody will sponsor you if you are on ANY kind of medication. Yet they are threatened they will die if they don’,t work the program. Damned if you do and damned if you don’,t.

I’,m glad you’,re still here in spite of them, Amythist! When I had severe problems for a long period of time I was resistant to taking medication. I don’,t remember being specifically told not to take it by anyone in AA, but I might have subconsciously gotten the idea from there that I shouldn’,t. I knew 5 people in AA who killed themselves. Five!

I’,m glad you survived it too, Liz. I’,ve enjoyed talking with you, as well.

Up until I went to AA, I only knew one person who had intentionally killed himself and he didn’,t have any kind of alcohol or drug problem. To have so many in AA who do so tells us very clearly there is something very wrong at work there. The stories range from people going back out and killing themselves to people who have decades of sobriety that hang themselves when they are stone cold sober.

Reading an interview with Dr. Chappel alarmed me that he is fully aware that people are often advised to quit taking medications but he recommends AA anyway. They seem to think that little piece of paper called a pamphlet is going to protect against people doing this. I can assure you it does not. This fact alone

should be enough to prevent professionals from recommending it, but it’,s not. I find that very dangerous.

In fact there is a group out of the UK who are very concerned about other groups doing this and these groups have been contacted by mental health professionals telling them that if they continue to advise people to stop their meds they would have to stop recommending their duel-diagnosed clients go to AA. This group flat out refused to do so. It’,s shameful and deadly. Juliet.roxspin

So there was this guy who went by the nickname “,Doc”, at meetings (I’,ve been corrected by AAs that “,Doc”, was just an old-fashioned affectionate nickname, btw, it never implied doctor!) Anyhow, “,Doc”, would say in meetings meds were a crutch even anti-depressants. That newcomers would rather think they were depressed and go on meds than face their alcoholic problem. I finally had the guts to approach “,Doc”, one night and tell him what he was saying at meetings was dangerous—, some may take meds as a crutch but how dare he suggest all of them are copping out of recovery? Anti-depressants are for the most part non-habit forming and don’,t get a person high. At the time I was depressed and taking Zoloft. At the time, I was also practicing a very negative program and didn’,t realize it was contributing to my depression and anxiety. A guy named “,Doc”, might come across as knowing something medically…, I didn’,t think it was just an affectionate nickname when he went on and on about medications…,

What’,s the matter Juliet? Can’,t you read minds? You’,re supposed to automatically know that people who are called Doc and talk about medicines aren’,t doctors. And you’,re supposed to know that those who are being coerced by the legal system and getting their papers signed aren’,t just DUIs but sometimes rapists and pedophiles and violent criminals.

I’,ve seen the AA’,s repeatedly rake you over the coals for not reading minds. Juliet.roxspin

I knew he was a coin collector, not a doctor, but I noticed some newcomers that night and it occurred to me not everyone would know he wasn’,t a doctor…, just like I didn’,t know my first meeting. I thought he was a doctor until I got to know him. He laughed, of course, he wasn’,t a doctor…, haha…, I didn’,t get the joke. Unfortunately, because I got in trouble with my rapist/thief knew too well the courts were sentencing at least thieves. “,Liars, cheats, and thieves”,…, right? The rapists part though alluded me…, I thought rapists went to prison. My rapist got at least 6 months in prison. Not enough if you ask me. But that was some vindication…, even though I couldn’,t get him convicted of rape my police testimonies and letter to the judge made sure of reporting it. I’,m sorting through how to do clemency in Ohio, now. But yes, I was an idiot for not knowing “,Doc”, was not a doctor. I was an idiot for not knowing who the “,winners”, were even though I was told to stick with them…, sometimes a “,loser”, might tell you they are a “,winner”, but you should know who they were liars. I mean, if they are in AA they can’,t all be “,winners”, …,. ugh…, I should have been a mind reader…, but my stinking thinking probably got in the way of that. Juliet.roxspin

I am so glad you’,re here, too. Autonomous meetings boast they can do whatever they like which loosely translates to they can ignore the medication pamphlet for one example. Their choices are of course only limited to what AA literature they want to use—, they can’,t use SMART literature b/c it’,s not AA literature. But most meetings aren’,t punished for using Hazelden literature—, although it’,s not AA and they’,d be excommunicated if there was an SOS or WFS pamphlet anywhere in sight! Lol.

That medication pamphlet was one attempt on AA to avoid lawsuits I am sure of it…, but meetings are not required to carry it—, there are no rules in AA. Except that the steps words must not be changed—, change the steps even change Him to God or God to Being of Light and you are not AA anymore. So there are rules. AA is the most dishonest organization I know of—, but I am open to learning that other organizations are also dishonest. As Ken’,s article points out AA’,s literature dishonestly tells members they are sure to die. AA is dishonest. AA ignores facts. More is never revealed…, they wish to learn nothing that contradicts their fairy tale.

Very true. You can never speak about anything that isn’,t in AA conference approved literature. Some meetings would allow Hazelden literature because it’,s very 12-step geared but in some meetings that would be very taboo because Bill Wilson didn’,t write it.

I’,ve heard people being instantaneously shut down because they mentioned that they read exercise is good in early sobriety to increase endorphins. You would think he had suggested sacrificing babies the way the old timer reacted to it. I’,ve heard other people say they had read something that had really helped them but they couldn’,t say what it was and if anyone wanted to know about it they would have to catch them after the meeting. Juliet.roxspin

Living Sober mentions exercise…, something I guess AA didn’,t discover until the 70s maybe the 80s? But that book isn’,t at a lot of meetings and is not replacing the Big Book. The BB is still the Bible and the 12×,12 is like the New Testament…, the longer, more in depth explanation of the steps and of course the tedious, obnoxious, rules …, errr…, traditions.

Living Sober is a book they just don’,t use around here. A shame because it’,s the only book that has half way sensible advice, imo. Juliet.roxspin

If the steps/program stuff weren’,t in there it makes a lot more sense than the other books. I think it was an attempt by AA to show professionals how normal it all was, etc…, how it gels with other self-help books out there. But this book never replaced the Big Book. Even though AA learned sexist language was “,bad”, they couldn’,t apply that to their other books. Why bother? Even though “,half measures avail us nothing”, all I see in AA are half measures, or quarter measures, or tenth measures…,

Stuart: Twelve step “,programming”, is an interesting choice of words. As for not having any evidence that 12-step participation can cause harm, have any studies actually been done on the subject? If not, you could start by interviewing some of the people here about some of the harm done to us, or that we have witnessed done to others. Juliet.roxspin

I filled out a survey leaving rehab…, of my honest thoughts/feelings about the treatment I received. Do you think they took my complaints seriously? Nope…, it would be great to have more voices heard not just those who “,liked”, AA.

Yea ASAM as started by a stepper lover.

has no relationship with AA”, is

precisely the very point and nature of a front group –, this was an attempted

equivocation that never quite made it way out of the barn –, therein actually affirming

the intended point of repudiation. No

official affiliation at all. None. More over, the frame of reference in which –,

“,…, members of ASAM would suggest that participation in such programming

is a valuable if not a necessary component of recovery”, is one without

relationship to the subject at hand –, how is it possible to support

something that one has no relationship

with? This must be a demonstration

of that (non terminally) unique variant of honesty which is contingent upon

Other than imposing 12 step treatment and AA/NA participation what else would these “,vocal group of physicians who are distressed that ASAM is not more aligned with twelve-step programs”, want? How can they be more aligned than that?

ASAM is not aligned at all with twelve step programs, any more than it is aligned with inpatient treatment, methadone, or any other approach or modality to the treatment of addictive disease. I’,d urge you to read through the ASAM Criteria, 3d Edition, to see what ASAM’,s position is regarding treatment. I’,d also welcome your attendance at ASAM’,s annual meeting in April so that you can see for yourself what ASAM stands for.

I’,m sorry Stu, but when you say, “,not more aligned”, you are admitting to at least some degree of alignment. So my question still holds: What would these vocal doctors want that’,s “,more aligned”, than what it already is? Are you denying that 12 step is an integral part of what ASAM advocates? Because I think you’,ve already admitted to that.

Now you’,re putting words in my mouth. AA is one approach to recovery. There are many approaches. ASAM pays attention to all of them. Read the Criteria. It’,s widely available. Read ASAM’,s policy compendium. It’,s posted on the ASAM website.

Thank you so much for the kind invitation. Do I just mention your name to get in?

I’,d have to know your name to alert the staff that you’,ll be there.

Thank you so much! Can you just tell them my name is Amythist, just Amythist? Michael L. Langan

Regarding the ASAM criteria:

II. ASAM patient placement criteria

Question: How many articles regarding the ASAM patient placement criteria have been published by peer-review medical journals?

Answer: “asam criteria” or “asam patient placement” or “American Society of Addiction Medicine criteria”

–, 47 PubMed articles discussing a common coercive practice is a surprising evidence of insufficient academic discussion about this matter.

–, These articles are not a reliable source of high-quality medical evidence to support the ASAM patient placement criteria.

Dr. Gitlow, I don’,t feel that I got an answer to my question, so let me ask again. Since ASAM already requires physicians to attend 12-step treatment, and attend 12-step meetings, what more would the

ASAM does not require physicians to attend 12-step treatment or to attend 12-step meetings. Perhaps there is another group you’,re thinking of?

Thank you for responding. Perhaps you’,re only looking at this page through Disqus. There have been numerous posts to you that you might be missing. Perhaps you should just have a look at the page so you can respond to Michael Langan. You can follow the discussion right here.

That’,s where I’,m looking, but I don’,t see that there’,s anything here that I can help with. I’,m not sure what group it is that is being referenced here, but I’,m certain it isn’,t ASAM. ASAM has no policy of the sort that you’,re describing. We’,ve certainly never required physicians to attend 12 step treatment nor to attend 12 step meetings. Perhaps this is why I’,ve been unable to figure out why there is such animus toward ASAM here, I’,ve never encountered that in my nearly 20 years of work with ASAM members.

So what you’,re saying is that ASAM and PHPs are completely different entities? And that ASAM does not effect PHPs in any way, shape or form? I must be mistaken then. So I’,d actually prefer to see you address Michael Langan’,s posts to you.

Correct. Asam doesn’,t have any oversight or other relationship with any PHP. I don’,t see that I missed any question from Michael though. Michael L. Langan

Dr. Gitlow is correct that “,ASAM doesn’,t have any oversight of PHPs. There is no oversight of PHPs and this is a major problem. In an age of transparency and accountability the PHPs are a real medical boards and medical societies have no oversight or regulation of their state PHPs.

With no oversight, regulation or accountability PHPs can do whatever they want with no consequences. Malpractice and fraud, violations of ethical codes of conduct and even crimes can be committed with impunity and immunity. This is by design.

The relationship of the ASAM with state PHPs is more complex. Although the ASAM does not have any official relationship with state PHPs there is a connection between the ASAM and the state PHPs through the Federation of State Physician Health Programs.

By 1988 membership in the ASAM was over 2,800 with 1,275 certified. The formation of state chapters began with California, Florida, Georgia and Maryland submitting requests.

By 1993 ASAM had a membership of 3,500 with a total of 2,619 certifications in addiction medicine.

Many of these physicians joined state PHPs and over time the ASAM groupthink has taken over many state. Those who did not agree with the groupthink, such as John Knight and Wes Boyd in Massachusetts, were removed. The FSPHP is the umbrella organization of the state PHPs.

Many of these ASAM doctors also became involved in addiction assessment and treatment centers such as

Hazelden, Marworth and Talbott.

In fact there is a disturbing relationship between state PHPs and ASAM. If the ASAM has no relationship with state PHPs then why are they issuing public policy statements mandating that doctors only be evaluated at “,PHP-approved”, assessment and treatment centers. What is a “,PHP-approved”, assessment and treatment center? An ASAM facility with a medical director who can be found on the list of like-minded docs.

The FSPHP was formed by ASAM doctors through their state chapters. FSPHP is ASAM.

In 2011 the ASAM issued a Public Policy Statement on Coordination between Treatment Providers, Professionals Health Programs, and Regulatory Agencies recommending physicians in need of assessment and treatment be referred only to “PHP approved” facilities and also that PHPs need the full cooperation of the board if they deem a monitored physician noncompliant as “criticism or doubt could unintentionally undermine the PHP” In addition the ASAM wants regulatory agencies to recognize the PHP their expert in all matters relating to licensed professionals with “potentially impairing illness.” You read that right, “potentially impairing illness.” The Federation of State Medical Boards House of Delegates adopted an updated Policy on Physician Impairment at their 2011 annual meeting and approved the concept of “potentially impairing illness” and “relapse without use.”

Michael, you made several statements with which I have comments:

1) First, you note that many of our ASAM members have “,joined state PHPs.”, Physician Health Programs aren’,t membership organizations, so one can’,t join a PHP as one might pay dues to join an organization, but a physician might certainly be employed by a state PHP, either as medical director or perhaps as an outside consultant. Physicians might also be part of the state PHP board of directors. Even if we were to assume that there were 50 PHPs (there are actually fewer) and then assumed that each employed three physicians (I don’,t know of any that employ that many), and then assumed that all of these physicians were ASAM members, that would be 150 MD’,s out of thousands of members. I don’,t believe ASAM has as members anywhere close to 150 who are employees or consultants of state PHPs. In my last four years as President-Elect and President, there has not been a single event that came to my attention in which any physician has taken issue with anything happening with PHPs.

2) You note that “,Many of these ASAM doctors also became involved in addiction assessment and treatment centers such as Hazelden, Marworth and Talbott.”, There are obviously many addiction assessment and treatment centers. They employ addiction specialist physicians, who are sometimes members of AAAP, sometimes of ASAM, sometimes both, and sometimes neither. I’,ve no knowledge of there being any difference nor of these physicians holding substantially different perspectives than those who are not involved in addiction assessment and treatment centers.

3) You note that in 2011, ASAM issued a Public Policy Statement on Coordination between Treatment Providers, Professionals Health Programs, and Regulatory Agencies. The entire document is here: link to

This passed ASAM’,s Board before my term as Board Chair, but I will investigate what led to its composition, given your suggestion of connections here.

4) You state: The FSPHP was formed by ASAM doctors through their state chapters. FSPHP is ASAM.

That is not at all the case. The FSPHP began as a result of activities conducted by the AMA, not by ASAM. Individual state PHPs also participated in the launch of FSPHP. State chapters of ASAM were not involved routinely and I do not recall any of them specifically being involved (some of this happened long before my arrival at the ASAM Board, however). PHP docs are members of many organizations, including the AMA, ASAM, and AAAP. The fact that these physicians are members of professional organizations does not mean that the professional organization has anything to do with what these physicians do. ASAM and FSPHP are entirely separate organizations. FSPHP does not even have a liaison to the ASAM Board. FSPHP is not ASAM. Michael L. Langan

You are right Dr. Gitlow. The actions of a few bad apples do not represent the entire orchard. The percentage of bad apples in ASAM is small. I would argue that the percentage of bad apples in the FSPHP, however, is much higher.

The 2011 Public Policy statements that were introduced by the FSPHP and approved by ASAM is an example of how they remove themselves from accountability. On the surface these public policy statements seem innocuous. In reality they provide absolute power to an organization with no oversight, transparency or regulation.

The FSPHP requested and ASAM public policy recommends:

Doctors only be evaluated at “,PHP-approved”, assessment and treatment centers.

Medical Boards not “,second guess”, PHPs diagnoses of “,relapse”, in a physician as “criticism or doubt could unintentionally undermine the PHP.”, This “,relapse”, does not even require substance use as the FSPHP got the FSMB to accept “,relapse without use”, and “,potentially impairing illness”, as applicable concepts to PHPs.

PHPs be recognized as “,experts”, in all things physician health (behavioral, aging, etc ).

On the surface these may seem benign and appropriate policies but keep in mind that the FSPHP has no regulation, oversight or meaningful accountability.

If all involved were in it for the right reasons then the consequences would not be significant. It is becoming evident, however, that many involved in the FSPHP are not in it for the right reasons. Ethical violations, misconduct and even criminal activity is taking place. In some states they have removed competent and ethical doctors from the PHPs and the organizational culture has become corrupt.

In these cases the ASAM public policy statements listed above can foster corruption as it gives the PHP essentially absolute power and protection.

Accountability requires both the provision of information and justification for actions. Accountability also requires that outside actors be able to punish those who commit wrongdoing.

State PHPs are currently without oversight or regulation. Recommending that any organization not be second guessed or questioned is a red-flag. Making it public policy that an unregulated and unaccountable organization not be questioned is unjust, removes all due process for doctors and fosters corruption and abuse.

And making PHPs judge, jury and executioner creates an unfair and unpredictable system of “,institutional injustice. And although only a few are talking about it it is this institutional injustice that is contributing to the marked increase in physician suicide of late. Although they have been trying to deflect and hide this association it is nevertheless true. I can give you the names of some of the deceased. The majority of them were not even addicts but got caught up in the PHP programs due to a one-off, situational factors and in a few cases political.

Using laboratory developed tests of unknown validity and vague and ill-defined “,potentially impairing”, diagnoses promotes sham peer review.

And how can ASAM and the FSMB support “,relapse without use”, in the REGULATORY MEDICINE paradigm. Whether the concept is valid is not the point–,the point is that this public policy endorses the FSPHP and state PHPs telling doctors how to THINK. Last I checked the state is limited to regulating behavior. Telling individuals how to think is tyranny.

This is only going to get worse. Oversight, transparency and accountability are universally accepted as necessary barriers in preventing corruption and abuse. The FSPHP is no exception and the public policy of those groups who work with the FSPHP need to support these concepts. Instead, the FSMB and ASAM have been bamboozled into supporting policies that give the FSPHP and state PHPs more power, opacity and scope while removing accountability. This needs to be recognized and addressed.

Holding any organization accountable for their actions is generally reasonable. You haven’,t asked that ASAM explore these points to determine what next steps might be taken, but if you’,d like I could pass along your comments to the ASAM Board for their consideration. Juliet.roxspin

But what if the democratic process votes down making changes to something shown to be dangerously flawed? That doesn’,t seem to make any sense to me…,

If the evidence shows something to be dangerously flawed and yet physicians still follow the old procedure, that’,s a problem. We certainly have that today with the outmoded use and prescribing of opioid pain relievers for extended periods. Change can come from a variety of sources –, it can be political, it can be scientific, or it can be groundswell of public opinion. Juliet.roxspin

We have that today with forced/mandated 12 Step meetings too. My addictions counselor would not even let me criticize AA in group sessions. I was censored. I couldn’,t mention alternative groups in group sessions. The other women were not as informed as I was about options. That is absurd. The 12 Steps are hardly the best or the most effective strategy out there and should only be by choice. Michael L. Langan

Dr. Gitlow, I would like the ASAM to explore these points and determine what steps might be taken as this is an important issue that must be addressed sooner or later. Drs. John Knight and Wes Boyd wrote an article regarding concerns of ethical and managerial issues in Physician Health Programs (PHPs). The final edit was a very watered down version done under the watchful eye of the FSPHP. It essentially went from a R to G rating under threats of breach of peer review and confidentiality issues. Although I was surprised they got the comment that if a PHP finds a physician particularly problematic the “,PHP-approved”, assessment facility will “,tailor a diagnosis and recommendations”, according to the impression of the PHP past editorial review. To “,tailor”, a diagnosis is fraud. The reality is much worse. In fact it will hopefully soon be revealed that the PHPs are in large part responsible for the markedly high increase in physician suicide. I know of many. These suicides had nothing to do with their “,disease”, as most of them did not even have a substance abuse problem but were referred to the PHP for a one-off, situational factors, a DUI and so forth.

The truth is many of the physicians involved in the PHP programs are sociopaths. And I have documentary proof that they are fabricating neuropsychological tests and colluding with labs to fabricate positive tests. Both of these are documented by outside agencies. They are violating every ethical code from Hippocrates to the AMA code of ethics, engaging in procedural regularities that constitute fraud and breaking state, federal and HIPPA law. They are able to do it because they have removed themselves from accountability. No oversight, regulation or meaningful consequences.

As you know LeClair Bissel wrote the first textbook on ethics in addiction medicine. She would be appalled with what is going on. These doctors represent the worst of the worst in medicine and humanity.

Accountability requires both the provision of information and justification for one’,s actions. The PHPs have removed themselves from accountability by removing both. While most drug testing is transparent the PHPs do not allow doctors to get copies of their drug tests under threat of punishment. They block the information. Even if a doctor does get the information and discovers an error there is no one to report it to. The medial boards and medical societies have no oversight. The departments of health have no avenue for complaint. And when doctors go to law enforcement they are turned back over to the PHP.

In addition to the provision of information and justification accountability requires the ability of an outside agent to punish misconduct. No such outside agency exists.

As an inevitable result many of the PHPs have become corrupt.

But I have documents showing the fraud and exactly how they do it.

These are ASAM physicians and when it is exposed what they are doing and how it is linked to physician suicide it will reflect badly on the ASAM.

After Knight and Boyd published their paper it generated a lot of reaction from the FSPHP. They do not want any oversight or exposure.

And everything I say is fact not opinion and I have the documents to prove it. The actions of these doctors are indefensible, undeniable and unconscionable.

And if you want to talk to some of the spouses, kids or parents of the doctors who died by suicide I will give you their phone numbers. These were good doctors who were put into a system of institutional injustice who became helpless, hopeless and could find no help.

I went to a high school of 300 and a classmate a couple of years ahead of me got a DUI in 2009. He was pulled over for speeding and had had a couple beers at a barbecue and was just over the legal limit. A mistake that he would have learned from and not let happen again. As a result he was referred and monitored by the WA PHP. As is often the case, just before he was about to complete his 5 year contract they gave him a positive EtG. He was referred to a “,PHP-approved”, facility where they told him he needed to be admitted for a 2 month relapse prevention inpatient stay. He went home and hanged himself.

3 doctors killed themselves in Oklahoma in one month alone. The stories are horrendous. These are not suicides but murders.

So in the spirit of Leclair Bissel please address this head on. If you do you will go down in history with the likes of her. That would make you a hero. Remaining silent and allowing this to continue will not.

What the documents reveal the MA PHP is doing is the same method of operation that is killing these doctors. They need to be expose and addressed. Where do I present them?

Michael, I have passed your message along to the chairs of our legislative advocacy and public policy committees for discussion. Obviously, any documentary evidence you might have would be useful for our committee deliberations and discussions. I’,d be happy to receive this privately or it could be sent directly to ASAM’,s Executive Director.

You refer to certain physicians as being ASAM physicians. They are probably also AMA physicians as well as members of their primary specialty societies. As with nearly all professional medical organizations, any physician with a medical license in good standing can join ASAM. ASAM has no control over its members, no ethical body that supervises them, and no requirements of them –, again identical to all other specialty-related professional medical societies of which I’,m aware. The AMA, however, does have a judicial and ethical council, which does serve the purpose that I believe you are discussing. Michael L. Langan

Thank you Dr. Gitlow. How can I get it to you?

You can mail it to me at ASAM.

American Society of Addiction Medicine

Chevy Chase, MD 20815-4520

ASAM and the FAA certainly do require physicians and pilots to attend 12-step treatment and meetings. If they do not, they will never practice medicine or fly airplanes again. Who do I have to thank for this? My career is trashed because I see AA for what it is. I exercised rigorous honesty from the start. Question the appropriateness, efficacy, or patently ludicrous dogma of TSF and you are assigned the pathology of delusion, denial, free will, anger, intellectual pride, the pejorative ‘,dry drunk’,, and relapse without drinking Those who are profiting from this coercion, extortion, fraud, malpractice, and abuse would do well to cease and desist.

Jonathan, you are confusing ASAM with a regulatory body. Yes, the FAA requires pilots to attend 12 step treatment in certain cases. ASAM, however, has no regulatory oversight and couldn’,t require anything from physicians even if the organization wanted to. ASAM is simply a professional organization –, a group of physicians specializing in addictive disease. Although we have policies and opinions, we have no ability whatsoever to require anything from anyone, least of all directing treatment strategies for physicians, whether members of the organization or not.

Taking off my ASAM hat for a moment, I’,ve seen many pilots, both general and commercial, who have safely and effectively returned to their aviation activities as a result of following the FAA protocols. The FAA and commercial airlines have had enormous success with such pilots over many decades. Some pilots fail to get a special issuance even with ongoing treatment, but the majority not only gain the special issuance but have no further related issues.

As I’,ve said before, the approach used by the FAA or other regulatory bodies will not work for everyone. But the approach used has been demonstrated to be most effective for the most individuals.

“,Yes, the FAA requires pilots to attend 12 step treatment in certain cases.”, All cases

“,As I’,ve said before, the approach used by the FAA or other regulatory

bodies will not work for everyone. But the approach used has been

demonstrated to be most effective for the most individuals.”, because you hold their credentials hostage whilst extorting large sums of money. Perhaps you can address the suicides, financial ruin, the depression, and relapse. They are a direct result of ASAM policy. When agents of the state, such as Lynn Hankes, Greg Skipper et al, state sponsor participation in religion and hold licensed professionals hostage, we have an enormous problem.

Why is a secular alternative such as psychotherapy and monitoring or just simply monitoring not provided as an option?

Jonathan, you keep referring to ASAM policy as causing certain actions. ASAM policies are opinion statements by an organization composed of over 3000 physicians. I’,m aware of no situation in which any ASAM policy involves regulatory action, and the FAA developed their regulatory policies without any input from ASAM.

The FAA, by the way, does not require pilots to attend 12 step treatment in all cases. Each case is considered individually and the case is considered within the framework of the applicable regulation under Part 67 of the Federal Air Regulations. You’,d be interested in 67.107,.207, and.307. The Federal Air Surgeon is the individual responsible for determining what the required process will be for any given pilot.

I’,m very puzzled by your statement regarding holding credentials hostage while extorting large sums of money. The FAA, I assume, is the agency you feel that holds credentials hostage, but they reap no financial gain from that. Who is it that is extorting anything?

Your final point also puzzles me. AA has no associated costs. It is free to attend by patients and no clinician earns money from recommending it. Your argument would carry weight if physicians recommended psychotherapy and monitoring instead of AA, there, they would stand to gain revenue as a result of such a recommendation. The fact that they are recommending a free service strongly suggests that money is not the relevant issue. Juliet.roxspin

So physicians are unpaid volunteers? If say, funding was cut off if a physician/rehab didn’,t recommend AA…, let’,s say funding by a local drug/alcohol board that was staffed by AA members…, who controlled who got funding…, then yes…, there would be money made by recommending AA b/c there would be money lost if they didn’,t. In theory. What capacity does ASAM operate upon then…, their public statement of what constitutes recovery is limited to abstinence and “,sobriety.”, Which are AA’,s goals also. This outcome is so limited that it leaves out moderate drinking altogether. And this set up for failure or …, let’,s say a “,relapse”, even 3-6-9 years later…, is guaranteed “,repeat customers”, for rehabs and doctors.

No, physicians are professionals. We aren’,t told what to recommend or what not to recommend. That is for us individually to determine based upon our interpretation of any given case. If anyone employing me ever saw fit to tell me how I should treat my patient, I’,d tell him to stick it and walk out, taking my patient with me.

You are correct, however, that ASAM’,s definition of recovery presumes abstinence. Drinking in moderation has never been an accepted part of recovery by any professional medical group in the field. There is, in the literature, a newer definition of recovery than ASAM’,s –, one that the Betty Ford clinic worked on a few years ago. Juliet.roxspin

Actually moderation appears in the AA literature it just isn’,t the basis of the program …, it just kinda leaves that idea hanging out there and presumes anyone who enters AA is an alcoholic thru and thru…, But you would know that is not true of everyone experience alcohol abuse or dependency…, that there is a primary condition that is being masked by the alcohol use. Which is why even Moderation Management and HAMS recommend abstinence as a basis for recovery–, however individualized treatment (and the NIAAA would back this up) insists on patient oriented goal setting. I.E. a patient is more likely to succeed a treatment they are working alongside a doctor with. It may be abstinence, it may be moderation, it maybe decreased harm…, the goal may change at any time. ASAM’,s definition (perhaps it’,s not ASAM’,s intention) has been used by 12 Step rehabs to “,back up”, their claims that AA works—, even though they are making this connection perhaps without ASAM’,s blessing it is something rehabs do to convince a client AA is scientific–, when it’,s not. Betty Ford uses the Minnesota Model which is based on AA b/c it was invented by AA members…, the history can’,t be rewritten. A lot has changed, it’,s 2015.

First, we can’,t treat every problem drinker as an alcoholic—, many are alcohol abusers. Some will want to quit others won’,t. So perhaps the diagnosis of addiction/alcoholism is being overused…, as is the prescription of AA as the first and the best method. It clearly comes across as bias—, and public perception is AA is just a support group they don’,t know what the steps are—, do you ever hear about the 12 Steps in drug prevention courses in DARE for example? A ten year old learning of drug dangers is not learning of the drug addiction treatment—, but they are aware of treatments for cancer and diabetes…, chemo/insulin…, etc…, Why do we shield kids from the 12 Steps until they are prescribed them after the fact? I’,ve always wondered the secrecy around this supposed solution…,. I didn’,t know what the steps read until I was 21 at my first AA meeting.

Every problem drinker is not an alcoholic. I agree entirely. There are many people who drink substantial quantities of alcohol, do not have alcoholism (or alcohol use disorder), and yet have significant potential for morbidity due to their alcohol intake. Most people who drink to excess don’,t fall within the addiction category at all, a fairly recent study pointed out. The addiction definition does not consider quantity or frequency of substance use. The use of a substance is merely a marker for the existence of an underlying addictive illness. So when we talk about alcohol USE, we are talking about something very different from ADDICTION, even when use is, by any measure, excessive. And you’,re right that if someone doesn’,t have addiction, but is simply drinking too much and by doing so is placing him or herself at risk, there’,s no need for long term addiction treatment, AA attendance, or even abstinence. The important component is to ensure that such an individual is examined to determine whether addictive disease is present.

Stuart, do you disagree that ‘,like minded docs’, are influencing federal policy? I call this input from ‘,like minded’, docs.

“,The FAA, by the way, does not require pilots to attend 12 step treatment

in all cases. Each case is considered individually and the case is

considered within the framework of the applicable regulation under Part

67 of the Federal Air Regulations.”, So statements from HIMS medical providers (coincidentally also Like Minded Docs) and peer monitors such as: “,you are making life difficult for yourself”, “,you are not working a program in accordance with the FAA’,s expectations”, “,do what you are told”, “,you can have a job and your medical if you work the steps and attend meetings”, “,AA is optional but if you do not comply, the FAA will deny your application”, “,good luck getting the FAA to approve your medical if you aren’,t attending AA”, “,your aftercare must include AA”,

“,I’,m very puzzled by your statement regarding holding credentials hostage while extorting large sums of money.”, This refers to 28 day TSF reahab (it ain’,t free)

There is a group called Like Minded Docs. Like AAAP, it is a group entirely separate from ASAM. Like Minded Docs include a group of eight individuals who help run the group. In a communication with one of these leaders last year, he happened to mention to me his support of SMART and RR. I have no knowledge of the LMD’,s doing anything to influence federal policy, but you’,d have to ask their leadership directly about that.

Now I see what you mean about the FAA. The FAA will not, in some cases of addictive disease, issue an SI unless a pilot goes through a 28 day program, attends meetings, and so forth. Some parts of those requirements cost the pilot money. The same is true, by the way, for pilots with retinal detachments, sleep apnea, head injuries, and so forth. In each case, the pilot is required, at his or her expense, to obtain significant medical care and records to demonstrate reduced risk for compromise within the aviation environment. I agree these costs can be quite significant, across the board. But I’,ve also seen many pilots who are not required to go through such a process in the case of a substance use disorder. It very much depends upon the specific case, whether an EAP is involved at a commercial airline, how recent the history of addiction was, and so forth. Ultimately, though, the FAA develops its own regulations, largely internally, and industry responds by making available the treatments which the FAA requires.

…,and they are influenced by Skipper, Hankes, Hudson, the like acting as agents of state influencing policy.

I believe you are correct in that the FAA relies in part upon external experts in developing their procedures and process. I wouldn’,t say that these external experts are acting as agents of the state, however, but would agree that they have volunteered their efforts in helping the FAA to arrive at a reasonable policy. As in any political activity, sometimes the regulatory body follows the suggestion of experts, and sometimes it does not. I don’,t know in this specific case where the influence led to beneficial change and where it did not.

I call this influencing policy with profit as a motive.

Roughly 10-15% of the American population has addictive disease. There are only about 3000, give or take, addiction specialists in the nation, far fewer than are necessary to address the needs of this population. All the docs in this specialty that I know, myself included, are booked up months in advance. Adding one patient, or 100, simply means one or 100 other patients aren’,t seen. Because our revenue is limited by time, not by volume, any additional source of patients does little or nothing to add to revenue. So while addiction docs may influence federal policy, profit isn’,t the motive.

We disagree. Kindly reverse my diagnosis. Seriously, could I pee in a cup sans involvement in the cult of Bill Wilson’,s personality? The man was a delusional psychopath and I was certainly capable of discerning between a viable systematic theology and one that fails the cult test miserably.

I lacked coping skills but I am in no way powerless over alcohol, insane, or morally defective. My spirit was alive and well. Fleecing a person who was already financially ravaged does not help them get better. There has not been a single thing about HIMS that has ‘,helped’, me and it should not be referred to as help. Its not help. Its psychological abuse.

Here are a few interviews you might find interesting.

you will have to scroll down on the second one.

I have enjoyed this debate. I believe we will be on the right side of history. Our numbers are growing.

You mean pilots don’,t get insurance? Seriously?

Insurance covers only “,medically necessary”, treatment, where medically necessary is defined by the insurer. It never covers directed treatment unless such treatment meets the medical necessity definition. So if the FAA says to a pilot that the pilot must obtain a CogScreen as part of a workup for taking an SSRI for depression, while that is considered aeromedically important by the FAA, it would not represent a standard part of treatment for depressive disease. Insurance therefore would not cover it. Similarly, if a pilot sees an aviation medical examiner for a physical exam for medical certification, this is not covered by insurance. The pilot is generally out of pocket the $75 or so that such a certification exam usually costs.

If a pilot has addictive disease and meets medical necessity criteria for a 28 day treatment program, insurance would be applicable. If, however, the pilot has addictive disease and does not meet the insurer’,s definition of medical necessity, then the insurer would not cover the costs of the treatment program. The latter situation is far more common as 28 day inpatient programs are not generally considered medically necessary unless an individual has fairly advanced disease, which would typically be present long after the pilot has come to the FAA’,s attention.

Well, here’,s where there’,s a problem because the PHPs are demanding they go to treatment or lose their license even when it’,s not necessary, Most people recover on their own. That was what this article said in the first place.

Is this true for all the PHP’,s? Or just some of them? Juliet.roxspin

So if it’,s not a medical necessity that just means they don’,t have the disease and it’,s medically unnecessary than why should they even to go this 28 day treatment? The diagnosis is wrong and the FAA should not mandate unnecessary treatment.

And if it is medically necessary why is religious indoctrination the treatment?

No, I’,m afraid there are two issues there:

The first is that medical necessity is not tied directly to whether someone has a disease state. For instance, let’,s say that you and I agree Mr. Smith has opioid addiction. Mr. Smith, if he withdraws gradually from opioids in the context of ambulatory observation by a physician, will be highly unlikely to suffer any significant risk. He therefore would not meet medical necessity criteria for any inpatient stay. However, an inpatient stay could increase his odds of a successful recovery. Because the number of available beds is limited, the simple increase in odds does not result in his meeting medical necessity (otherwise everyone with the illness would go for an inpatient stay). Only those who have significant risk meet medical necessity criteria. The FAA uses a different standard based upon aeromedical safety. Just as you might expect tractor-trailer drivers or school bus drivers to have a different standard, the public expects pilots to be held to a higher standard. Mr. Smith, therefore, if he were a pilot, might be required to have the inpatient stay even if not medically necessary because it was judged to be aeromedically necessary.

The second issue is that the diagnosis differs. The FAA uses regulatory language to determine whether a pilot has “,abuse”, or “,dependence.”, The way these terms are defined in the regulations differs from the way addictive disease is defined medically. An individual can have “,abuse”, or “,dependence”, as defined within the Federal Air Regulations (FAR) while not having addictive disease as defined medically. Again, this is due to the differing standard for aeromedical safety. The public demands that pilots have a lower bar, both for defined illness and for treatment for such illness, than the general population has.

Given the two standards, it is not at all unusual to have a pilot defined as having “,abuse”, or “,dependence”, under the FAR’,s, then being required to obtain treatment for same, all while neither meeting the medical definition of addiction and not having medical necessity for specific types of treatment. Insurance therefore doesn’,t pay. Juliet.roxspin

People with retinal detachments, sleep apnea, head injuries…, they aren’,t required to go to AA…, this is the bizarre part—, not the drug testing, not the option for therapy …, it’,s the insistence on one program/organization that is religious and known to be harmful to some as much as it may help a a few…, Substance abuse is the only condition requiring a God/prayer based treatment and this is unconstitutional and strange and cruel punishment…,. You said you were against mandating or coerced or forced AA attendance…, and AA is supposed to be all voluntary by the way…, it seems this kind of forced AA attendance is not in keeping with AA’,s traditions. How can one practice an honest AA program if they feel their traditions are violated?…,. Right? See my point here? AA will tell someone to be honest in order to recover—, but if one says AA is harming them and the FAA says “,well, we don’,t care”,—, then a person can’,t even practice the solution they were ordered to practice!

I can’,t wait to show you the film. You did a great interview Ken!

Psychiatrists are not, by nature of being a psychiatrist, addiction specialists, no doctor is who is not trained in addiction. Further, dependence is very different from addiction. If you go into a hospital and are on a morphine drip for a few days you will become physically dependent on opiates, it may only be a chippy, but you’,ll be dependent, but you won’,t be addicted, as in when you withdraw you won’,t steal your mothers purse for a fix. Addiction is too complex to classify as easily as the DSMV tries, although it is the best we have. The DSMV also classifies gambling disorder, which indicates to me and many others that addiction has less to do with substances and more to do with reactions in the brain.

Where I live (which is outside the United States), only a doctor or Psychiatrist can diagnose alcohol dependence by the DSM-V, if a doctor doesn’,t feel comfortable doing this they refer to any psychiatrist, which all require addiction training to be certified in my country. I guess all you’,re saying here is that the USA operates differently. I agree the DSM-V is imprecise, but it is the best we have.

It would be great if psychiatrists here (USA) required addiction training. Most doctors here get very little addiction specific training. You don’,t know how many times clients have come back from their doctors with a script for tramadol or ultram, saying that their doctors told them it was ok to take because it’,s not an opiate, or how many GP will prescribe anti-anxiety drugs like Xanax to our clients instead of trying something else like buspar first, or letting us work on natural anxiety relief like meditation, relaxation etc

Are you aware that young people have been labeled this and how detrimental this is. No one who is a teenager can be an Alcoholics…, like Bill Wilson was…,Hollywood sold this nonsense to 3 generations now. We will undo it along with Ken Anderson, Lance Dodes, Stanton Peele, Gabrielle Glaser, Tom Horvath, Dee Dee Stout, Claudia Christian, Donna Cornnett, Dr Marc Kern, Dr Adi Jaffe, Jeff Foote, Emily Cavell, The Center for Motivation and Change. The St Judes Retreat, Steven Slate, Hank Hayes, Amy Lee Coy, and non 12 step help, and Practical Recovery and Smart Recovery and MM and SOS, and Jim Christopher. Michael L. Langan

I’,m sorry “,used primarily by psychiatrists and not addiction specialists.”, Last I looked psychiatrists are the ONLY recognized specialists in addiction medicine. Although they are trying to robber baron their way into ABMS acceptance “,addiction medicine”, is not currently recognized by the American Board of Medical Specialties (ABMS). It is a “,self-designated practice specialty”, or SDPS, an AMA census term which just means it is what a group of doctors is calling themselves. Board “,certification”, is currently self-certification and does not represent knowledge, experience or competence. Addiction psychiatrists are the ONLY recognized specialists in the field today. Just because the ASAM put forth a public policy statement on “,how to recognize an addiction specialist”, and named themselves does not make it so. LOL

I’,m afraid the psychiatrists (of whom I’,m one) were very late to the addiction treatment world, arriving long after addiction medicine had been formed as a medical specialty. The terminological differences between a board specialty as recognized by ABMS and otherwise are not necessarily significant. Addiction Medicine specialists are recognized in all states and the AMA itself has addiction medicine on its specialty list. I’,m not sure what you mean by “,robber baron their way into ABMS acceptance.”, Could you explain what you’,re referring to? Michael L. Langan

Happy to. Addiction Medicine is currently not recognized by the American Board of Medical Specialties (ABMS). It is still a a Self-Designated Practice Specialty and the American Board of Addiction Medicine is a Self-Designated Board. So too is the American Academy of Ringside Medicine and Surgery, the American Academy of Bloodless Medicine and Surgery and the Council of Non-Board Certified Physicians. But these Self-Designated Boards do not have the multi-billion dollar drug and alcohol testing and treatment industry supporting them. Addiction Medicine has deep pockets, and if the November 2014 issue of the Journal of the American Medical Association (JAMA) is a harbinger of what’s to come, this self-designated practice specialty currently being certified by a self-designated Board and bereft of anything resembling the educational and professional standards for quality practice in a particular medical specialty or subspecialty as defined by the ABMS, the American Council on Graduate Medical Education (ACGME) and the Institute of Medicine (IOM) may soon robber baron its way into acceptance by the Medical Profession.

You are correct that Addiction Medicine is not recognized by ABMS. It is, however, recognized by multiple other parties and as such has participated in the AMA House of Delegates as a specialty society for several decades. I don’,t believe the other organizations you mentioned have had the same validation. I wish there were some money in the addiction industry for ASAM –, in fact, there is almost no support for a field which addresses a chronic life-threatening illness that impacts 10-15% of our population –, a crime that is unequaled in any other branch of medicine. ABAM’,s professional standards for quality practice, and ABAM’,s certification examination both, have followed ABMS guidelines to the letter. That’,s one of the reasons why ABAM’,s certification in Addiction Medicine is widely accepted nationally as an equivalent certification to that of Addiction Psychiatry.

Does that allow someone to practice Addiction Psychiatry without training in actual psychiatry? That’,s frightening, too.

Does the ABMS usually recognize forms of faith healing and appealing to a higher power to resolve any other kind of “,chronic life-threatening illness”,?

No. Addiction psychiatry certification requires initial certification in general psychiatry. Both addiction psychiatry and addiction medicine are credentials that generally sit atop an initial prior certification. Michael L. Langan

Recognition does not necessarily comport with expertise and knowledge. The validity and reliability of opinions lie in their underlying methodology and evidence base. Reliance on the personal authority of any expert or group of experts is the fallacy of appeal to authority.

The American Society of Addiction Medicine’s stated mission is to “establish addiction medicine as a specialty recognized by professional organizations, governments,, physicians, purchasers, and consumers of health care products, and the general public.’ They have succeeded in doing this through loopholes, misinformation and propaganda with the unfortunate reality being that many do consider the “,addiction medicine”, specialty as a credible authority. But swaying opinion does not equate with true expertise and knowledge.

So Michael, let me make sure I understand this. They’,ve made up their own Board? Does that mean professionally as “,addiction specialists”, they are not accountable to anybody but themselves? And their higher power, of course. Michael L. Langan

Yes -and everything I state below is well documented and can be fact-checked.

The ASAM arose out of the “,impaired physician movement”, which the British sociologist G.V. Stimson characterized as “,a number of evangelical recovered alcoholic and addict physicians, whose recovery has been accompanied by an involvement in medical society and treatment programs. Their ability to make authoritative pronouncements on physician impairment is based on their own claim to insider’s knowledge.”

The impaired physician movement emphasizes disease and therapy rather than discipline and punishment and believes that addiction is a chronic relapsing brain disease requiring lifelong abstinence and 12-step spiritual recovery. The drug or alcohol abuser or addict is a person lacking adequate internal controls over his or her behavior, for his own protection as well as the protection of society external restraints are required including involuntary treatment.

The American Society of Addiction Medicine can trace its roots to the 1954 founding of the New York City Medical Society on Alcoholism (NYCMSA) by Ruth Fox, M.D whose husband died from alcoholism. Finding that alcoholics in her psychoanalytic practice did not recover when she used conventional analytic approaches, she taught her patients about alcoholism as a disease and introduced “them to AA meetings held in her living room.” A number of physicians in the New York Medical Society were themselves recovering alcoholics who turned to Alcoholics Anonymous for care.

The society, numbering about 100 members, established itself as a national organization in 1967, the American Medical Society on Alcoholism (AMSA).

The group promoted the concept of alcoholism as a chronic relapsing disease requiring lifelong spiritual recovery through the 12-steps of AA.

By 1970 membership was nearly 500.

n 1973 AMSA became a component of the National Council on Alcoholism (NCA), now the National Council on Alcoholism and Drug Dependence (NCADD) in a medical advisory capacity until 1983.

“Abstinence from alcohol is necessary for recovery from the disease of alcoholism” became the first AMSA Position Statement in1974.

n 1985 ASAM’s first certification exam was announced. According to Dr. Bean-Bayog, chair of the Credentialing Committee:

“A lot of people in the alcoholism field have long wanted physicians in the field to have a high level of skills and scientific credibility and for this body of knowledge to be accredited.”

nd in 1986 662 physicians took the first ASAM Certification Exam.

Definition of chronic alcoholic liver disease

By 1988 membership was over 2,800 with 1,275 of these physicians “certified” as: “having demonstrated knowledge and expertise in alcoholism and other drug dependencies commensurate with the standards set forth by the society.”“While certification does not certify clinical skill or competence,” the Board explained, “it does identify physicians who have demonstrated knowledge in diagnosis and treatment of alcoholism and other drug dependencies.”5

Achieving “recognized board status for chemical dependence” and fellowships in “chemical dependency” are among the five-year objectives identified by the group. These are to come to fruition by “careful discussion, deliberation, and consultation” to “determine its form and structure and how best to bring it about.”5

The formation of ASAM State Chapters begins with California, Florida, Georgia, and Maryland submitting requests.6

In 1988 the AMA House of Delegates votes to admit ASAM to the House. According to ASAM News this “legitimizes the society within the halls of organized medicine.”

In 1989 the organization changes its name to the American Society of Addiction Medicine (ASAM).

Since 1990, physicians have been able to list addiction medicine as a self-designated area of practice using the specialty code “ADM.”

By 1993 ASAM has a membership of 3,500 with a total of 2,619 certifications in Addiction Medicine.

The Membership Campaign Task Force sets a goal to double its membership of 3,500 to7,000 by the year 2000 to assure “the future of treatment for patients with chemicals. It represents a blueprint for establishing addiction medicine as a viable entity.”

The American Board of Addiction Medicine (ABAM) is formed in 2007 as a non-profit 501(C)(6) organization “following conferences of committees appointed by the American Society of Addiction Medicine” to “examine and certify Diplomats.” It was done to give the veneer of legitimacy.

In 2009 National Institute on Drug Abuse (NIDA) Director Nora Volkow, M.D., gives the keynote address at the first ABAM board certification diploma ceremony.10

According to an article in Addiction Professional“Board certification is the highest level of practice recognition given to physicians.”

“A Physician membership society such as ASAM, however, cannot confer ‘Board Certification,’ ” but a“ “Medical Board such as ABAM has a separate and distinct purpose and mission: to promote and improve the quality of medical care through establishing and maintaining standards and procedures for credentialing and re-credentialing medical specialties.”

The majority of ASAM physicians meet these requirements by “working in a chemical dependency treatment facility, taking continuing medical education courses in addiction, or participating in research.”

“…addiction is a chronic relapsing brain disease requiring lifelong abstinence and 12-step spiritual recovery.”

That’s interesting that they take that position considering how much research that has been out for decades that has shown the exact opposite. In fact, I’ve personally been abstinent without any 12-step recovery or spirituality far longer than the vast majority who go to AA. So how is it that they are allowed to practice under such antiquated ideas of addiction? Michael L. Langan

They are essentially unaccountable and this is by design. The bogus non-FDA approved tests that Dupont and Skipper have introduced via a loophole renders their drug-testing unaccountable. As it bypasses the FDA approval process there is no regulation in the marketing of these tests. The American Medical Association (AMA) and American Psychiatric Association (APA) provide avenues for patients to file complaints against physicians and investigate breaches of ethical codes of conduct. The ASAM does not provide a complaint process against their doctors. Likewise the Federation of State Physician Health Programs (which was organized by ASAM physicians) is unregulated, opaque, and has no outside auditing or oversight.

Yes. Yes. Oh …,.. yes. Their HP is their lies and subterfuge. Diabolical liars. Juliet.roxspin

How is a psychiatrist not an addiction specialist? They must learn of addiction to get their psychiatry degree—, and in order to know which medications they prescribe that may be addictive. Alcoholism is not a diagnosis it is a label, a term to describe someone or to affix to one’,s self and it is a deadly belief system that one can’,t stop drinking so must drink to death. That’,s alcoholism.

I think we covered this. A psychiatrist (I’,m one, by the way) has some training in addiction, just as a family physician has some training in endocrinology. But the former training does not make the psychiatrist an addiction specialist any more than the latter training makes the family physician an endocrinologist. One is a specialist while the other a sub-specialist. They’,re quite different, in both cases.

Alcoholism has been a diagnosis for many years. It is also a lay term, as you note, and in that realm may carry other meanings beyond those established in medical practice. Juliet.roxspin

As a psychiatrist have you ever read the AA literature? It’,s damaging psychologically. I would think reading comprehension is a critical area a psychiatrist should be strong in. Also, good listening skills. And empathy. A psychiatrist would and should be hard-pressed to recommend anyone lists all of their defects and shortcomings or blames themselves for everything that has ever gone wrong in their lives. This is where I get worried/concerned why professionals would recommend 12 Step programs. ASAM should read the Big Book at their convention and find one “,fact”, in the book—, there are no facts in that book. Juliet.roxspin

I’,ve read the Big Book and agree that it is not a scientific text. 12 step programs are recommended because they work for the vast majority of those so referred. They do not work for everyone, just as any approach does not work for everyone. I was asked earlier about psychiatry and what we are taught. A big piece of what psychiatrists are taught about addiction is that twelve step programs are the heart and soul of a good treatment strategy for addiction. That has nothing to do with ASAM, and I’,m puzzled as to why ASAM keeps coming up in this manner. Psychiatric training guidelines are developed by groups entirely separate from ASAM. Juliet.roxspin

Why not just sit around and read The Wizard of Oz then? Why that AA book? Or any 12 Step book? If it’,s not about the literature (and I sense some deflection from the issue here from you)…, then it’,s not about the steps or the AA program. So any fellowship or support group of a client’,s choice would work. And ASAM needs to make this loud and clear because ASAM’,s history is directly tied to AA and AA members creating ASAM. Perhaps it is time ASAM disassociated itself from “,looking”, like it’,s part of AA. The majority of my non-recovery friends think AA is a government agency. Or a medical organization. Groups like ASAM present this false image to people. Some actually think AA runs rehabs. America doesn’,t know the “,truth”, or maybe they know it better than the lie AA spreads?

ASAM was not created by AA members. Of the founders of ASAM, I note only one was in recovery at the time of the founding. The others did not have addictive illness. The first time in my recollection, as President of ASAM, that I’,ve ever mentioned AA in any public setting, is right here on this board. If you feel ASAM looks like it’,s part of AA, please tell me specifically what I should ask my Board of Directors to do to alter that. In looking at our current organizational priorities and strategies, I don’,t see anything that would lead someone to believe that we have any relationship, direct or indirect. As for what the majority of your non-recovery friends think, none of those beliefs are a result of anything ASAM has said as far as I can tell. Juliet.roxspin

One of the founders was an AA member at the time of the founding…, hence let me correct myself, at least one founder was in AA. (I admit I am not the ASAM history expert here, lol)…, I am sorry if it came across I’,m jumping hard on AA’,s effectiveness here, I am just frustrated because I am a former rehab patient and have gone through this process of being denied alternative forms of treatment that I know exist because the rehab “,liked”, AA and claimed it was the “,best.”, I feel this situation is wrong. My non-recovery friends, I ask them what they think AA is if they have never been to it…, and they give me answers like “,I think it’,s a support group, you go there to talk about current stuff, or join a softball team…,”, Or they think it’,s government supported. I think more doctors like yourself should ask someone what they think AA is and then go into what it actually is…, you’,ll discover most have no idea what AA is. I think it’,s public perception. If ASAM or any non-AA agency/organization gives this impression the 12 Steps are the only method —, or the best one—, it is limiting options that may help others who do not benefit from AA. That is what is not happening here—, it gives the impression all these groups are connected—, which they deny. AA and ASAM and my former rehab the list goes on…, they seemed to be all “,AA”, …, that’,s a public perception. So even if you say ASAM is not all about AA, when you quote that your own clients “,most”, find AA helpful…, few don’,t…, this seems to indicate that you (as part of ASAM) are a part of an organization that only endorses AA (which you say ASAM does not)…,.

I don’,t know that the ASAM founder who was in recovery was actually an AA member. There has been discussion about this over the years internally, somewhat out of curiosity from what I can tell from the notes, but no statement that would allow a historian to draw conclusions.

I can say that I as an individual physician hold a number of views some of which differ from ASAM’,s positions. In the case of our AA discussion, ASAM does not have a position, which leaves me free to provide my own anecdotal experience. I didn’,t say I believe or don’,t believe, but merely stated that my patients have by and large found AA helpful. They go not as a matter of coercion but because I offer it to them as one potential source of help. They then choose whether to attend initially and/or to continue attending.

Many of ASAM’,s positions revolve around use of medication, use of various forms of therapy, and so forth. In fact, ASAM has a policy stating that twelve step programs are not, and should not be viewed as, medical treatment for addictive disease. That’,s not the same as saying twelve step programs are not a useful adjunct to treatment for patients in general. But I think ASAM is fairly clear on the matter…,please read ASAM’,s policies regarding twelve step, available at the website, and let me know if you find anything that you feel needs to be addressed. Juliet.roxspin

I find Google points me in the direction of any “,search”, someone looking up ASAM &, AA may read—, and these searches should concern people in addictions medicine—, and ASAM. And in AA. Dr. Ruth Fox did not seem to have a good reputation overall to many who investigate her works.

I appreciate you being a good sport, keeping the discourse professional, and engaging with both professionals and the commentariat here. In this spirit, I do have to take you up on one statement you made here:

12 step programs are recommended because they work for the vast majority of those so referred.

Across the board, I’,m not aware of anything that “,works”, (in the broad sense of the word, ie results in significant improvement) for the majority of people. Perhaps you mean specific groups again here?

I’,d have said that nothing really comes close to crossing the 50% (majority) line, because there are too many other factors which contribute to addiction which cannot be controlled for.

Project MATCH demonstrated that patient outcomes from AA were comparable to those of CBT and motivation enhancement. Humphreys et al in 1997 demonstrated that otherwise untreated alcoholics who attended AA showed greater improvement than those who did not, with a higher number of AA visits leading to a higher likelihood of improvement. Emrick in 1993 showed that patients who were receiving medical treatment AND who attended AA were more likely to show improvement than those who did not attend AA. I would also refer you to Chappel’,s 1999 article in Psych Clin North Am that concludes that the preponderance of the research data indicate 12 step programs to be the most helpful for addicts as they seek long term abstinence.

Similarly, Witbrodt concluded in 2005 (Am J Drug Alcohol Abuse) that 12 step participation predicts abstinence, in fact of all the models studied, 12 step participation was the best predictor of abstinence.

I could go on, based upon the medical literature, but these cites also provide a wide range of bibliographies all of which appear to support my original statement that twelve step participation is helpful to the majority of patients. I’,m certain it doesn’,t work for everyone, and might even present risks to some, but my anecdotal experience that patients do well within that framework appears largely supported by the literature.

By the way, the Witbrodt article provides specifics that are widely taught to medical students: “,Early on, those who are drug-dependent-only especially need to become connected with 12-step programs to the extent that they consider themselves a member, and, later, saturate themselves in a highly supportive and predominantly nondrinking environment. Alcohol and drug dependent clients need more intense ongoing 12-step involvement (sponsor and meetings) as well as having nondrinking individuals and people supportive of abstinence in their network. For all clients, doing service is especially important at the longer 12-month posttreatment timeframe.”, Juliet.roxspin

Comparable would mean use of any one of them would suffice…, but people aren’,t mandated to CBT meetings from courts, employers, rehabs etc. If 3 are comparable why is only 1 being the most used? I think clients who voice a complaint 12 Step meetings should be given a different treatment.

I never said I believed that anyone should be mandated to do anything. I agree that if an individual finds any approach to their medical treatment to be unacceptable, alternatives should be considered. That said, there are certainly times when individuals will make a choice that isn’,t in their best interest. As a result, our political and legal systems often lands at the point where individuals are not given a choice that would ethically be appropriate.

“,12 step programs are recommended because they work for the vast majority of those so referred.”, Juliet.roxspin

What if they don’,t work? Why are the 12 Step programs the “,heart and soul”, of a “,good treatment strategy”, in the first place—, historically I am sure you are familiar with the first treatment centers using the Minnesota Model—, a model developed by AA members? Right? Has anyone fought this system or have they just allowed it to continue without any oversight or concern for whomever isn’,t helped by it? ASAM has an ethical obligation not to endorse something that may potentially harm or abuse someone else, right? Can you help me or send me a link to ASAM’,s ethics policies or something similar? The criteria used in deciding if a program is effective, beneficial, and worthy to be exploited onto every person who seeks help for alcohol use disorders?

ASAM’,s policies are all available to the public at:

No major epidemiological study has used the term “,alcoholism”, or the definition you cite, Stuart. All, including ECA, NCS, NCS-R, NLAES, and NESARC have used DSM criteria for Alcohol Dependence and Alcohol Abuse. So I will stick with these two well-defined terms and avoid the term “,alcoholism”, which has not been studied in any major epidemiological study and which is not defined by the APA.

Ken, multiple studies have used the term alcoholism, incorporating the definition as published. It looks like you’,ve been focused on the psychiatric literature, which almost always utilizes the psychiatric definitions as published by the APA. As I noted in an earlier post, the majority of physicians specializing in addictive illness are not psychiatrists. So while the APA definitions certainly have validity in their own domain, the terminology framework there is not the primary one utilized by the addiction medicine field.

I am focusing on epidemiological studies–,please name one major government funded epidemiological study which uses the definition which you cited. I named 5 which use the APA definitions

Ahh, you gave the keyword away that time…,not particularly interested in the government funded epidemiological studies. They generally have a variety of errors associated with their methodology, largely in terms of definition and terminological approaches.

What I hear you saying Stuart, is that you have made up your mind to follow your preconceived ideas and wish no one to upset your prejudices with scientific facts. If psychiatrists, who all have MDs, are not qualified to treat addiction, then which MDs in your opinion are? Rectal surgeons?

No, what I’,m saying is that the scientific facts must be interpreted by those with expertise in study methodology. We’,ve all seen studies which demonstrate x to be a superior drug over y, but which further analysis then indicates to be inaccurate due to a methodological error. I have no preconceived ideas but simply follow the science. The MDs who are certified to treat addiction are those who have addiction certification, either from the ABPN as addiction psychiatrists or from ABAM as addiction medicine specialists. Those MDs are trained, generally, to recognize that AA and related groups are not treatment but that rather they are an adjunct to treatment, one which the literature has demonstrated to be an important component in the overall treatment plan.

Of course. It is because I have expertise in these study methodologies that I am interpreting them. NESARC is a more accurate picture of the scientific realities of alcohol dependence than were Bil Wilson’,s divine revelations. Just as Galileo’,s scientific heliocentric picture of the universe was more accurate than the divinely revealed geocentric picture presented by the Spanish Inquisition which tortured him to make him recant. Much like ASAM does with its PHP programs it seems

Why hasn’,t ASAM done a major government funded epidemiological study to prove that its definition of “,alcoholism”, is superior to the APA’,s definition of “,alcohol dependence?”, Is it not true that ASAM cannot get the government grants because of its lack of scientific rigor and the fact that it is pushing Bill Wilson’,s religious agenda as a replacement for scientific knowledge?

Actually, I wish to correct my above statement. Science speaks for itself. It does not need to be interpreted by an “,authority”, with “,expertise”, in the methodology. This is the logical fallacy of appeal to authority and it is a favorite technique of charlatans and quacks to obscure the issue and ignore scientific facts which speak for themselves link to

ASAM is not a research organization, and the definition of alcoholism was not composed by ASAM. I urge you to look through ASAM’,s policy compendium to rest your mind and confirm that ASAM does not and has never pushed any religious agenda.

ASAM is a bunch of steppers. AA members. Doctors who screwed up and now are in control of the looney bin. Controlling mean, arrogant, …,.interesting…,.after they themselves got into control Doctors and…,

that world, they send them all to 12 Step rehabs and play games with good men that no one in their right mind would join AA,. Forcing them to go to stepper ville Hazelton rehab at $40K a pop…,. No one needs rehab for 30 –, 60 days, Thats is all a money making scheme. There is no science at these crap hole places.

Actually Stuart…,its called extortion. and many who are forcing Doctors into Religious AA is going to get sued big time. Everyone who has a license has been forced into this BS AA game. Its disgusting.

Massive, I’,m not sure why you’,re saying that ASAM is made up of AA participants. Do you think that the American Academy of Pediatrics is made up of children? Or that all the members of the American Neurological Association have dementia? As with other specialties of medicine, ASAM has a higher percentage of members with the disease of interest than one would expect in a similar number drawn from the general population, but that group does not represent a majority of the organization. As I said originally, one of the biggest internal discussions at ASAM over the past few years has been based upon distress by some members that ASAM does not pay sufficient attention to twelve step related activity. ASAM does attend to it, but always consistent with what the science demonstrates.

They are steppers. AA members, AA lovers, They are brainwashed and they are not based in Science. They are extorted.

You seem to have a fixed set of ideas here that, unfortunately, is not based in reality.

I could say the same about you and the men at the ASAM who are extorting Doctors to follow a rigid cult like AA program when they get drug tested and forced to attend AA meetings, AA rehab etc.:) Juliet.roxspin

At least the American Academy of Pediatrics doesn’,t sentence children to 12 Step fellowships where they will sit next to child molesters. At least the American Academy of Pediatrics doesn’,t assume all children are the same and must accept “,spirituality”, and God, etc. I know of no other specialty in medicine that evokes the name of God, prayer, or spirituality as specifically or explicitly necessary for a person’,s recovery from any other disease or disorder, can you name another similar treatment for non-addiction diseases that require “,spiritual”, steps and meetings?

Correct. AAP does not sentence children to anyplace, nor does AAP assume all children are the same. ASAM is the same. We do not coerce anyone, nor do we assume all patients are the same. ASAM does not consider AA to be medical treatment. Juliet.roxspin

I just am observing only from your comments that your practice seems not to match up with what ASAM purports to be…, I understand it’,s a diverse team on ASAM…, But I don’,t have a breakdown of what that means…, of 3,000 professionals how many are mainly pro-12 Step, how many recommend moderation if at all, how many favor SMART or SOS…, that’,s what I don’,t know. When someone w/ a private practice like yourself is also in ASAM it does give the impression you speak for ASAM when you say that AA is the best and then…, to not mention other programs by name to patients it gives the impression of bias to me. (By the way, let me know what you learn about SMART and what you discover—, the pro’,s and the con’,s. I know other readers here will want to know also…, if you write on another site or forum I’,d like to learn more about you &, your work as well.) Juliet.roxspin

I’,ve heard Brand “,X”, chewing gum is recommended by 4 out of 5 dentists but should I buy that gum? McDonald’,s is on every corner, that must mean their food is most nutritious because billions and billions served can’,t be wrong? Right? You’,ve mentioned that this belief in a higher power has helped “,most”, patients you’,ve worked with…, do you have supporting data or is this just a rough estimate “,most”,? I am sure you have made some errors in your work as well or you would not be human. ASAM does in fact inform of medications and alternative treatments but it seems you are closed off to accepting them yourself. IF AA is not treatment I don’,t know why psychiatrists are recommending it at all. Might as well recommend a synchronized swimming class. Or an hour a day playing mini golf. I’,ve pointed out also (I realize this is an older comment though) the literature is one of the worst components of AA—, demeaning to women, demeaning to atheists/freethinkers. Horrible fear tactics abound in it. False claims of Utopia are made, for christ’,s sake, how is this psychologically sound as an adjunct to treatment? How many have to suffer before they are taken seriously? Juliet.roxspin

Most studies have a margin of error if the researchers conduct their investigation correctly…, in AA it’,s “,it works if you work it”, with absolutely no data, evidence, or scientific study included in any of the AA literature. Yet this is the basis for accepting AA works generally without any evidence at all…, how is that better?

Alcoholism was seriously coined and used by AA and its members. Its really passé. aka 1930’,s like smoking cigarettes, women in the workplace, sexual harassment was in the 1950’,s.

Alcohol and drug overuse issues is how I like to put it. The upcoming film The 13th Step will expose much of the nonsense that has been promoted in our society from way back in 1944 when AA got its little tentacles into Harvard and Mass General.

The gig is up. The truth is coming.

See CBS 48 hours episode THE SOBER TRUTH.

You are not right. Your language is so dated. The AA paradigm is based on Cult and religious tenants. Google is AA a cult. Google is AA dangerous for women. Google is AA filled with sexual predators.

One more thing, Why would our government send someone to a lay person unregulated religious self help group for ANYTHING?

Why would a judge send a sex offender and a pedophile to AA and then another judge send a 16 year old girl with one beer to AA meetings?

David and war against the 12 step machine has begun. Juliet.roxspin

Prior to AA “,alcoholic”, described a practicing alcoholic drinking alcoholically…, “,ex-alcoholic”, was the term used to describe a former alcoholic. AA made “,alcoholic”, mean an AA member in recovery…, as well as a practicing “,alcoholic”, which means—, in AA you are calling yourself a name that denotes you are drinking excessively/addicted style even if you are 20 years sober. It simply doesn’,t make sense. If you beat diabetes you can say former diabetic, not diabetic…, right?

Thank you for all your hard work. Many who are leaving AA in droves are drinking agains successfully and using your HAMS program. Thank you. Moderation is very popular again in the ex stepper movement.

Stuart, When you assessed/diagnosed pilots for this condition for the federal government as an Aviation Medical Examiner for the FAA did you report that they were “,alcoholic”,/”,suffering from alcoholism”, OR that they had a “,substance use disorder”,, i.e., “,substance abuse”,/”,alcohol abuse”, or “,substance dependence”,/”,alcohol dependence”,?

I’,m just wondering what term the federal government prefers to describe this condition.

Depends on the scenario. Different branches of the federal government use different terminology. The FAA’,s terminology is based on the Federal Air Regulations, not on DSM. And the FAA defines abuse and dependence quite differently from the way DSM-IV used to define it. Thus a pilot may have alcohol abuse or alcohol dependence per the Federal Regulation while simultaneously not having such a condition per the DSM. You can reference the relevant FAA regs here: link to

Typically, an AME will utilize the diagnostic approach as defined by the Federal Air Regulations rather than as defined by any other guideline or professional body.

I’,ll answer. They reported I was alcoholic and opiate dependent. Nothing could be further from the truth. They were also in the process of diagnosing me with Borderline Personality Disorder. Good thing I got kicked out for demanding to use my cell phone. Sickening. Juliet.roxspin

Alcoholism is alcohol dependence. Anyone can stop with will power and self knowledge–, AA pretty much allows a person to do that very same thing if a person chooses (their power) to work AA…, tada, they have stopped because they made the choice to in AA. They had to make the choice—, that’,s will power.

Indeed they can and do. When TSF takes away self knowledge and will power and replaces these with powerlessness and cult dogma, you get depression and relapse. Along came AA to re-enforce the very shame based dogma I could not relate to in my youth. Revisiting the abuse did not help.

This Dan Carr stepper considers himself a ‘,mental health professional!’, These stepper-pusher ‘,experts’, are the worst kind of abusers. He just tried to correct me on my blog siting project MATCH.!!!! How these people practice by sending people vulnerable people to the faith healing disguised as medicine is beyond explanation. The power of ‘,powerlessness.’, What a sham and extremely unethical.

exactly Dan. as you can see by my profile pic, i found my serenity in another 12 step…,..6yrs sofar…,congrats to you. Juliet.roxspin

Bill W. died of emphysema he hid his smoking at the end and also was too stubborn to admit to the AA fellowship he was an addict and unable to stop smoking. He maintained he could quit smoking on his own with his own willpower and it was not an addiction. In actuality, many quit smoking each year without a 12 Step program. But it is an addiction, isn’,t it? You wouldn’,t say they weren’,t addicted then if they can stop on their own, would we? No way. Same with people addicted to alcohol (and alcoholism is addiction!)…, they stop on their own everyday…, and they were alcoholics. It is a spectrum. AA teaches a pessimistic self-fulfilling prophecy—, there’,s rock bottom, then another rock bottom, and a further rock bottom…, But logic states that once a person hits a real rock bottom there is no where to go but up. AA teaches powerlessness not empowerment. I can’,t conceive of a more negative psychology than AA other than people who are verbally abusive and AA to me was verbally abusive. And religiously abusive. Not to mention incredibly sexist.

precisely, TSF contributed to my depression, relapse, thoughts of suicide, re-enforced negative self image, self loathing, fear, and anxiety. Of course these are all cleverly packaged as ‘,re-activation of disease’,, stinkin-thinkin, denial, delusion, self will, and intellectual pride. Juliet.roxspin

I am a daughter of a narcissist who projected her symptoms on to me…, AA re-enforced that abuse by assigning her symptoms to me. The AA description of an alcoholic described my primary abuser in childhood—, self-centered, self-will run riot, egocentric, unable to see right &, wrong…, No wonder my mom loved AA &, Al Anon although she didn’,t practice any steps—, why would she? She couldn’,t admit being powerless no more could she admit her defects—, but I grew up constantly repeating a list of defects in my mind…, I grew up apologizing constantly and even seeing my part in things I didn’,t even do. Any practicing psychiatrist would be able to distinguish AA’,s steps as being a hallmark “,road map”, for an abuser to entrap a would-be victim. 1.) Render the person helpless (powerless) 2.) Get them dependent on you 3.) Encourage them to see where they have been wrong 4.) Remind them how defective they are 5.) Make them apologize for what you did wrong 6.) Encourage them to spread this message to others (repeat the abuse)…,

These steps “,would be”, effective on a real narcissist unfortunately narcissists would typically never want to look honestly at themselves…, but they know the “,right things”, to say…, Which is why many in AA talk a good game but don’,t walk the walk.

I think the steps were designed by a narcissist for narcissists but I’,m not sure they would be effective, even if one did honestly work them. Juliet.roxspin

It sounds nice but when you step back what humble person sits around talking about how humble they are? “,I’,m a humble person, I list my defects, I pray…,”, Whoa…, I can’,t compete with that kind of awesomeness. This person is a good person today because they tell me they are a good person today…, and they tell me I’,m a belligerent jerk who’,s still sick and that’,s how good people talk to other people—, they go around calling them unwilling, dishonest, and incapable, belligerent and self-centered, and diseased. In the 12×,12 they point out that they don’,t get angry or fight with others not to appear superior—, why point out specifically it is not to feel superior? Why make a point of explaining why they are doing things to seem so respectable? Seems fishy to me. How about be good and do good because it feels good—, in the AA literature it definitely appears to be “,do good because it feels uncomfortable to do good things…,”, I don’,t understand it.

Yes, Juliet, the 12&,12 talks about how some of us just thought we were good people but we just had selfish motives for being good therefore we were actually bad people attempting to appear good, but that’,s what AA is all about: a pretense of being good, Fake it til you make it, after all. Juliet.roxspin

Even fake believe in God until you really do…, I know…, I read some AA literature now and it’,s like some mad ramblings of a sociopath desperate to sound like they’,ve changed and know how to be good now…, and then it back pedals…, like where Bill W. writes the wife need not know about the other women…, or the wife mustn’,t nag or be angry…, and we don’,t be good to look superior…, Having to write books explaining/ teaching others how to be good is strange…, if it’,s a disease not a moral failing why is there a moral inventory…, what is a “,spiritual disease”,? I can’,t find any other spiritual disease out there…,

I can’,t either. There’,s no other “,spiritual disease”, that I’,m aware of and no physical diseases that I’,m aware of that requires a spiritual solution. It’,s just absurd on the face of it. It makes no sense either way you look at it.

No dues or fees, it’,s for the ones who want it, not for the ones who need it, it takes a drunk to help a drunk, as this becomes a Godless society, of course they will try to defame AA, it’,s free, how are you going to make money off of that,

Not true. Addiction therapists who have a PhD are helping many more then AA. Juliet.roxspin

Have you read the AA literature “,Where Money and Spirituality Mix”, it makes it clear AA is not free and is self-supporting through members’, own contributions…, or we are to believe it is free…, but it seems it is both free and funded by members’, contributions at the exact same time. The tax forms show AA makes at least millions—, not Bill Gates rich but that’,s where the non-AA 12 Step rehabs come in. Any outside AA group that makes money promoting AA is basically AA making money off of AA…, The fact that perhaps only 1 in 6 will succeed at treatment means it is a system that thrives on its failure rate. Repeat customers. And AA gets new membership via these non-AA enterprises. It’,s a well-oiled machine.

Kenneth there are literally HUNDREDS of empirical articles and controlled experiements showing whether 12 step fellowship are effective or not.. here is a few for you …,.

Spirituality and Sobriety During a Behavioral Spirituality

Intervention for Twelve Step (TS) Recovery. American Journal Of Drug &, Alcohol Abuse, 33(4), 611-617

Hoeppner, B. , Hoeppner, Susanne S. , Kelly, John F. (2014).

Do young people benefit from AA as

much, and in the same ways, as adult aged 30? A moderated multiple mediation analysis. Drug and Alcohol Dependence,

Brown, A. (2013). Spirituality and confidence to resist

substance use among celebrate recovery participants.

Journal of Religion and Health, (1), 107.

one of the most popular.. project MATCH …,

Longabaugh, Richard, Wirtz, Phillip W., Zweben, Allen, and Stout,

Robert L. (1998). Network support for drinking, Alcoholics Anonymous

and long-term matching effects. Addiction. Vol. 93. No. 9.

…,. it almost seems as if you have never actually researched it to see if there was, perhaps read a book or article telling you there wasn’,t and took them at their word ,) AddictionMyth

Spirituality is fabulous for people who want to pray to their dead relatives or local boneyard goblins for ‘,relief’, from their ‘,cravings’, caused by ‘,resentments’, caused by ‘,character defects’, that make them drink until good and drunk and have anonymous sex and shoplift makeup from the local pharmacy. Such techniques have been scientifically proven in controlled experiments to work great on Halloween. But what about the other 364 days of the year? And what about those unfortunates who still prefer barroom belligerence and local correctional facilities to AA’,s ‘,peace and serenity’,? Or do you have a special higher power in mind for such rascals? Ken Ragge

Dan, There are tens of thousands of studies that claim that AA works. The problems with these studies are many. They are generally not methodologically sound. The second Brown study above is about Celebrate Recovery, not AA. Project MATCH mentioned above showed no difference between the three groups tested and that Motivational Interviewing was considered the best from a public police perspective since it cost the least, was the least time consuming, and had the same results. Unfortunately, Project MATCH failed to use a non-treatment control group so it showed nothing about treatment effectiveness.

I’,ve not read the other studies mentioned above but from reading a lot of similar studies over the last 30 years, the first Brown study above probably counted meeting attendance (not continuing to drink) as successful as well as the Longabaugh et al study.

In any case, measuring religious beliefs (and even requiring them in what is supposed to be science-based treatment is not only unethical but only gives a measure of how frightened the new recruits to your religion have been made. Requiring only abstinence as having solved a drinking problem is exluding all those who would have moderated on their own.

Having 5 people staying abstinent for 5 years is not “,more successful”, than people quitting on their own and having 10 people who are abstinent or drinking non-problematically after 10 years.

If you remember the brouhaha over the Sobell’,s controlled drinking experiment you will see that they were lambasted to the point of leaving the country for “,killing alcoholics”, when the abstinence group had almost all the deaths and the “,controlled drinkers”, did best overall.

Furthermore, all three groups of Project Match went to AA. I had always wondered why there was little differences between the groups until I found this little fact out. Imagine being told in one setting that you alone have the power to abstain, and being told in another setting that you’,re powerless. No wonder it didn’,t work any better than it did. I have to wonder if “,free to attend”, actually means encouraged.

“,Along with the treatment approaches being tested in Project MATCH – cognitive behavioral therapy, motivational enhancement therapy, and a 12-step therapy – participants were free to attend AA meetings.”, Ken Ragge

It is my understanding that some of the two non-12-Step group members attended AA as it wasn’,t forbidden. I looked at the Massachusetts General article and that is nothing new or unusual to be said. What it does say, however, is simply silly when they say explain how AA is supposed to have helped people “,recover.”, One measure efficacy by measuring how well people are doing with their drinking. Normally, a large percentage drinks or moderates on their own. About 90% of those who “,qualify”, as alcoholics at some point in the past resolve their drinking problems without any “,help”, (meaning AA or treatment).

With AA “,treatment”, it isn’,t so much how well it works to help people recover but how well it works to break people down and convert them to the 12 Step religious world view.

Match was a huge failure to prove anything. If you were studying the effectiveness of, for instance a particular statin, would you tell the study participants they were free to take additional statins? Of course not. It would skew your results.

Among other reasons, I liked the NESARC because it did show moderation as a viable result which backs up other previous studies. Of course, we’,re already getting the “,if you can abstain without AA or moderate, you were never an alcoholic to begin with”, dogma. One could easily turn that around and say “,if faith healing is all that it takes for you to abstain, you must have never been an alcoholic to begin with.”, , ) Ken Ragge

Amythist, Totally in agreement on the fact that Project MATCH didn’,t prove anything except maybe that no matter how poorly a study is designed or what the results are, the 12-Step treatment industry will not be deterred from claiming that it proved that treatment/the Steps “,really work.”,

The 12-Step definitions of alcoholism are essentially, “,a disease one dies from be a wretched sinner if one doesn’,t turn over his will and life and dedicate themselves to converting others to the 12-Step religion/world view.

Did you see this analysis of Project MATCH data? The authors found an accidental control group –, those who went through intake but didn’,t show up for the treatment sessions. They did almost as well as those who did 12 weeks of treatment: link to Ken Ragge

Thanks for pointing out the Project MATCH data. I’,d not seen it before.

I particularly like the “,empirical”, studies with no control groups, and the controlled studies which control for nearly nothing.

The problem here is that you have drawn a conclusion that they “,show”, whether AA works or not. There’,s not been one study which can control for enough variables to conclude anything of the sort. The body of evidence you have presented is weak, and quite far from accepted adherence to the scientific method. Many of these studies are also conducted by people who lack an even basic understanding of elementary statistics, and confuse correlation with causation in the same sentence they claim to be trained scientists.

An honest look at the studies would simply conclude that there is at best a weak correlation between participation in mutual aid groups and better outcomes for addiction.There’,s many other formal studies in medicine which measure much larger placebo effects than what you’,ve cited here. It would be advisable to just leave it at that.

The biggest problem –, not just with the studies you’,ve cited here, but with many others which focus on alcoholism –, is that people read far too much into the results and draw causal links where none are presented. This seems to be what you have established here in your comment.

Can’,t convince people like me, who went from jail to jai, institution to institution, and could not stop, that aa doesn’,t work…,. I actually agree with the belief that there are many, many ways to recover…,none of them worked for me…, I am not a theist, more an agnostic, but don’,t give a damn what anyone believes in, or doesnt…,. believe in science…,. anyway, my empirical study? I haven’,t used any type of mind or mood altering substance in well over a decade…, works for me…,hope anyone seeking any recovery finds what works for them…,even if it’,s dancing with voodoo dolls, right on…,who the hell cares if it’,s scientifically sound, or spritually it works, do it…,..peace

I’,m more than happy for you if AA/spirituality worked for you. However it’,s a completely different question whether it’,s a good fit for most alcoholics.

All you’,re concluding here is that what worked for you is the only appropriate method for everyone else. That’,s a very dangerous position to have, and hinders, rather than helps other alcoholics.

You’,re not trying to convince anyone of anything. You are simple pointing out the ugly truth. That a stepper takes this personally only further proves the power of the extreme indoctrination.

For most people, when they are informed of the truth, they say something like, “,wow I had no idea.”, When a stepper hears the truth, they fight back, name-call, rant, threaten and deny everything presented …, I able to hear one word of truth regarding their beloved cult religion. They become unglued and rather than take this as a warning sign, they run to their meetings and get in the phone with their sponsor and AA fellow disciples and gang up. Their thugs and their ‘,program’, encouraged group-think which inspires rage when compromised.

“,…,dancing with voodoo dolls, right on…,”, Interesting you would say that as it’,s quite a good comparison. AA is faith healing, pure and simple, and would be just about as effective as dancing with voodoo dolls.

I find it absolutely hilarious that they think they can measure an accurate number of people involved in an ANONYMOUS program

BILLshit. You most certainly do not find it ‘,hilarious.’, You are dismissng the research findings outright …, Because you’,ve been brainwashed to believe this dangerous cult religion has ‘,saved your life.’, You’,re lying to everyone, mostly yourself. But that’,s what this ‘,program’, does —, makes every member a liar. Fake it till you make it! Too bad there is NO ‘,making it.’,

I am a recovering addict I went to aa for a year. It helped in the beginning but these people live in the past it’,s sad. I don’,t like the conformity of aa either you do as they tell you believe as they tell you preform the meeting as they tell you or your not accepted. I have never relapsed I refuse to go to aa meetings and I am doing great. Everyday these people go to aa and tell the same story they are living in the past I on the other hand live in the now. Aa should be re vamped to say the least. I will go once a year to get my coin but that’,s it and even that one time a year I go, same people same story it’,s like they are stuck in the past. But when I do go once a year they tell me I’,ll never make it because I don’,t go to aa everyday I say bullcrap. Very judgmental people there

Times are different now since aa first started and it’,s time to throw out bills idea and come up with something new and helpful. They say yes don’,t make you choose a higher power but they do! Everything is God this and God that. If I had stayed in aa I would be messed up in the head. CULT

The “,science”, of this article is questionable. Ken Ragge

Heh, someone’,s trying to sell a book. ,)

Of course there are ‘,heavy drinkers’, who meet the DSM 4 criteria for alcohol dependence. College students come to mind. DSM 5 is an attempt to make the diagnostic criteria more specific, as is the change in language.

Question for you, Mr. Anderson, when someone comes to one of your HAMS groups, would it be beneficial for them to acknowledge that they are there because their drinking has caused them problems, or is in itself a problem? Or do they just come to your HAMS meetings because they’,re bored?

I will admit a bias here. I am in long term recovery through the 12 steps, although I no longer attend meetings. Like anything there are going to be variations on how the meetings are run depending on the population in the area. I attended a meeting where people spoke about jesus and told me I needed to be saved to be sober. I thanked them and never went back. That doesn’,t mean AA wants me to be saved, just that meeting based on that population in that geographic area.

I am an atheist. My ‘,higher power’, was a group of people who could maintain abstinence where I was unable.

Addiction is so complex that there is no one answer. If someone can go to a 12 step meeting and find their answer, great. If someone can go to Smart recovery, Women in recovery, one of your harm reduction meetings, great. As addiction professionals we should be trying to work together to find an answer, not trying to get one up on the various offers of help out there.

Finally, the 12 steps are not treatment. Ken Ragge

Even worse, someone is trying to sell a book that isn’,t AA approved literature like The Big Book. Doesn’,t Mr. Anderson understand that God has only granted to those who promote His program, AA, have any right to write and sell books about destructive drinking?

That is the REAL problem now isn’,t it. Brainwashed and sad.

AA approved literature should come with a warning label. “,Read and embrace at your own risk. The material herein is about as reliable as project MATCH …, In other words, a scam and a lie. Any personal consequences from this indoctrination is the member’,s responsibility. Either that, or you are not of the REAL alcoholic/accict variety. Our hats are off to you.”,

Apparently you didn’,t read my entire post. You just want to continue your rant against AA. How many posts have you made in your anti-AA rant? Dozens? Hundreds? Happy trails, dude…, may the force be with you in your never ending quest to get back at AA for whatever it did, or for whatever you think it did, to you. Ken Ragge

What are you upset about? That I didn’,t point out that for a Grouper to say the 12 Steps are not “,treatment”, after they have been pushing the Steps as treatment for decades takes brass balls?

Just because some two-hatters came up with the term “,TSF”, doesn’,t mean that all of a sudden a Step “,fellowship”, isn’,t an attempt to “,treat the disease”, just as they have been describing themselves since the days of Bill W and Dr. Bob.

Who’,s they? AA is not treatment, never has been, never will be. Neither has AA classified itself as treatment. “,Treat the disease”, as you put it, is semantics. In 1935 alcoholics were placed in asylums, there was no known “,treatment”, for alcoholics. When AA began to prove successful others called it alcohol treatment, AA called it an answer consisting of one alcoholic talking to another. Treatment professionals have been pushing the 12 steps as treatment for decades, courts and probation/parole have been pushing AA for decades. AA has not. AA will go so far as to go into treatment facilities, but they’,ve been doing this since Bob met Bill. AA World Service states, regarding AA bringing meetings into treatment centers, “,Do not talk about medication, psychiatry,

or scientific theories of alcoholism. This is

the territory for professionals. Our own personal

spiritual life does not make us experts on religion”,

If some treatment professionals choose to develop a treatment modality based on the 12 steps of AA, that is their prerogative. AA’,s 12 steps are open for anyone to use however they wish. Treatment facilities can use the 12 steps, hang them on the wall even, that doesn’,t indicate approval or agreement from AA.

Alcoholics Anonymous is a fellowship of men and women who

share their experience, strength and hope with each other that

they may solve their common problem and help others to recover

The only requirement for membership is a desire to stop drinking.

There are no dues or fees for A.A. membership, we are selfsupporting

through our own contributions. A.A. is not allied with

any sect, denomination, politics, organization or institution, does

not wish to engage in any controversy, neither endorses nor

opposes any causes. Our primary purpose is to stay sober and

help other alcoholics to achieve sobriety.

If AA works for someone, fine, If not, go somewhere else. It’,s not that deep. But you go ahead with this ax you have to grind. Ken Ragge

Am I reading you right? Are you saying that AA is not treatment for alcoholism? Are you also going to excommunicate Marty Mann who sold AA as treatment for alcoholism through the NCAE (now the NCADD) since the 40s?

Or do a group of high ranking early AAs promoting AA as the treatment for the disease of alcoholism “,not AA.”,

Yes, I am saying AA is not treatment for alcoholism. I’,ve said it several times, and I’,ll keep saying it. AA is not treatment for alcoholism. Treatment for addiction is carried out by professionals. No one in AA is a professional addiction treatment provider. Try getting your insurance to pay for AA.

Marty Mann? Marty Mann and others, E.M. Jellinick, Howard Haggard, Selden D. Bacon, all the way back to Benjamin Rush, the first person to call overuse of hard liquor a distinct disease, lived in a time when there was no treatment for alcoholism or any other addiction. It was seen as a moral failing or other weakness. Marty Mann, along with others, worked to lift the stigma and show that there is hope for the hopeless addict. Mann’,s goal was to raise awareness of alcoholism and other addictions as a public health issue. At the beginning of her efforts there was nothing but AA. You can’,t just throw out a name without the context.

As far as the NCADD, their website has a neat section you might like, Definition of Recovery. On it you’,ll find no mention of AA or the 12 steps. You will find, “,There are many pathways to recovery.”, Ken Ragge

AA is treatment for alcoholism in spite of the fact that AA may regret promoting that idea for many decades.

You can repeat what you say a million times but that does not make it true.

As can you. It may be true that for many years, not decades, AA was the only thing available for alcoholics, and professionals, psychiatrists, doctors etc tried to figure out how it worked and put it to use as treatment, it still isn’,t treatment and never was. Mann and her contemporaries didn’,t consider it treatment, but worked to relieve the stigma and show that there was found a way for hopeless alcoholics to stop drinking, that it was possible. Before 6/10/35 it wasn’,t possible and hopeless alcoholics ended up in asylums with wet-brain.

I don’,t think you know what treatment is. Would you go to an electrician for your mental health treatment? That’,s what calling AA treatment is, because that’,s what AA is, a bunch of drunks getting sober, some carpenters, plumbers, salesmen…, but very few actual treatment professionals who, while at the meetings, are just like the lawyers, in other words, just another drunk. Why not call AA a Legal Aid Society, there are a lot of lawyers there. And you can probably find a few used car salesmen there, so how about calling it a Used Car Dealership.

I don’,t see how a bunch of untrained non professionals can be considered treatment. I suppose then it must also be treatment for depression, anxiety, schizoaffective disorder, OCD, borderline personality disorder and any and all other mental health maladies. Like I said, try to get your insurance to pay for it. Let me know how that works out for you. Otherwise, this is getting ridiculous. Ken Ragge

If a doctor, psychiatrist prescibes a drug, bed rest, or taking up exercise, that is treatment.

If a psychiatrist or psychologist suggests one does to resolve a problem, that is treatment.

Whatever is prescribed by a doctor, psychiatrist, or psychologist is treatment. Many if not most prescribe AA so that is treatment too.

Now when AA was the “,Alcoholic Squad”, of the Oxford Group, there was, as far as I know, no one calling them “,treatment”, even if they liked sequestering away potential recruits in hospital rooms for “,oxfordizing.”, However, just ahead a few decades after AA started meetings separate from the Oxford Group, doctors, psychiatrists, and psychologists are all prescribing meeting attendance and institutionalization in treatment.

The idea in these institutions is to indoctrinate them so they will continue with meetings after they leave. AA meetings, both in house and in the community required. That makes AA meetings treatment.

The big question is, whose fault is it? Among other places, the answer can be found in the AA official Guidelines at: link to

Whether Marty Mann considered AA meetings treatment or not is irrelevant. She was a publicity hack. Her job was publicizing and lobbying for AA. Her work was all about getting people to “,come to believe.”, Mann’,s NCAE “,educated”, America on the “,fact”, that alcoholism is a disease and that, because it is a disease, treatment is required. Guess what the treatment for the “,disease”, as she described it was?

You said, “,I don’,t think you know what treatment is. Would you go to an electrician for your mental health treatment? That’,s what calling AA treatment is...”,

Of course it is crazy to go to an electrician for psychological treatment. But no more crazy than to go to a church for “,the disease of alcoholism.”,

Actually, the accepted treatment for alcoholism for decades has been AA. It is what MDs, psychiatrists and psychologists have been prescribing for decades. It doesn’,t matter if it is very much like a Society of Friends Church meeting in fornat and not at all like an antibiotic.

You said, “,I don’,t see how a bunch of untrained non professionals can be considered treatment.”,

I think it is a disgrace that AA has gotten professionals to use it as treatment. That is how come it has been considered treatment. No other religious group, as far as I know, has lobbied for people with “,diseases”, whether they believed the disease spiritual or not.

You said, “,I suppose then it must also be treatment for depression, anxiety, schizoaffective disorder, OCD, borderline personality disorder and any and all other mental health maladies.”,

Twelve-Step “,fellowships”, are used as treatment for many mental health problems, although I can only imagine the efficacy is even less than in AA. Ever heard of Emotions Anonymous? Of course AA is not the same as EA but it is merely a leaf on the neo-Buchmanistic twig.

And finally you said, “,Like I said, try to get your insurance to pay for it. Let me know how that works out for you. Otherwise, this is getting ridiculous.”,

Do you not understand that is what inpatient treatment is for? It is to get money for working Step 12. It is Higher Power’,s way of rewarding the loyal Grouper. It is essential to the financial soundness of probably most all if not all “,two-hatters.”,

1) After 80 yrs. we still can’,t have a study like that which is suggested. We are ANONYMOUS, therefore an accurate way of tracking both the ppl that stayed and recovered and those that tried the 12-steps and failed/left, just doesn’,t exist.

2) don’,t recall the big book, defining that death would befall anyone who left the programs dying from dependence ONLY. Add Suicide, Auto Accidents, and other DRUG/ALCOHOL related deaths. Add these factors in, and that percentage will jump sharply

I think it is all up to the individual and if they want to stop drinking. AA has helped millions of people and if so, let that happen. Please do not disregard a program that effects millions of people’,s lives. I personally chose to remain sober and rely on my faith in God to get me through my daily battles. I will randomly attend a meeting but I do not need to go every day or every week. Other people do need it that much and if that is the case, leave it alone. Drinking can lead to JAIL. Drinking has killed so many people in auto accidents, Drinking has put people in institutions, check out your local ER…,you will find a few in there on any given weekend, being labeled a 5150 was due to drinking alcohol daily. Suicide was the next step. Each bender leads to another step closer to death. It’,s the way God intended it to be. Read the Bible, it’,s all in there. When one evil leaves an empty man and the man allows the evil to come back, it brings with it seven more even more evil spirits that will ruin that soul. Alcohol is the evil, it will eventually kill you if you let it back in. That is how it is for this wicked generation.

Great article, Kenneth. I love the pie chart, with just a sliver that die from alcoholism. One question I have about the other chart is the “,remittance via AA.”, Does that mean people who have EVER been to AA? Like if you went to AA for a week five years ago and didn’,t quit drinking, but you are now abstinent on your own for 2 years, wouldn’,t you be still included in that percentage?

The study done do not take the fact that more than half the number are people who are problem drinkers, who have probably suffer some life tragedy who use alcohol to cover it up and become heavy drinker who have some difficulty in stopping or cutting back,, but with a true, or real alcoholic, there is no such thing,,, which was also cover in the big book that was not mention is this article. If your a real alcoholic, than you will find that being alive is not the same as living,,, and only a real one will understand the meaning of that,, yea I will still agree with Bill Wilson that for the real alcoholic,, there only jail lnstitutions or death,,, or a new way to live, so you just got to find the path for you.

I am in recovery. I am an atheist. I am also on probation and living in a halfway house. I am required to go to 4 meetings a week. Meetings where I have been verbally attacked and disrespected because of my lack of belief. I chose to get sober, I choose to stay sober, I choose to work CBT because the maladaptive ways I learned to deal with emotions caused my addictions. A higher power does not keep me out of bars, I choose not to go. Being forced to attend faith based 12 step meetings only leads me to feeling alienated and resentful. Its a struggle I have to deal with everyday. However I will take dealing with small minded zealots over going back to the piece of garbage I was anyday. AA is perfect for god fearing hypocrites who claim “,a desire to stop drinking is the only requirement for membership”, but then sneer and turn their backs when a person takes responsibility and credit for their addiction and recovery.

Catfish- I really like what you are saying here.

They can not force you. You can sue them. They are in violation of your 1st amendment rights. Listen to this radio show with Barry Hazle who sued his probation officer, the state of CA and the 12 step rehab. link to

If I had the money I would. This is a long term goal I intend to pursue Juliet.roxspin

I wish there was a class-action lawsuit—, I couldn’,t find a local attorney or afford to fight either…, lawsuits take money. In Ohio there doesn’,t seem to be a lawyer who thinks fighting forced AA attendance is a “,real issue.”, I wish anyone harmed by AA/ forced to go to AA gets rewarded…, of course I do.

Ohio is bad. Its like California …,but worse. Someday it will happen. AN ACLU lawyer for starters is a great idea. Juliet.roxspin

I think I attempted to contact them back in 2011 but now I probably don’,t have much of a case. But if they can help someone else I will find out.

Good for you!. There is a law firm that is helping pilots if you want to check out their site.

I just got done sending an email to my local ACLU chapter.

Good. Im glad you did. I have contacted my local chapter about DUI coercion to AA and how that is in violation of our 1st amendment rights. Let me know how it goes. Ken Ragge

The ACLU in one anti-coercion case sent a secret 12 Stepper as the attorney for the coercee. Anonymity is indeed a miracle from God (or perhaps Satan). I don’,t have time to look it up, but remember that Jeffrey Schaler, Ph.D. “,Addiction is a Choice”, originally reported it.

Ken –, WOW, thats fucked up. I have called them 3 times now. Just to get them involved and show them my film. I am not giving up yet.:) Ken Ragge

I don’,t know if anything has changed, but where ACLU has taken coercion cases, it seems they settle things out of courts. At least not much can be found out about them.

Ken, Thanks for the tip and the warning. Juliet.roxspin

I feel AA cancels out the rewards of CBT if it’,s practiced at the same time…, in actuality I had to practice coping skills to survive in AA meetings. I had to talk about AA harming me in therapy. I listed AA as an emotional “,trigger”, on my harms list for rehab. (I was not allowed to share that in group though…, I was told to keep my issues out of group sessions.) I couldn’,t be honest in groups and was shut down and told to censor myself by the counselors. Stay true to yourself, though, because only you have to be you. And you’,ll thank yourself for that later.

I don’,t practice any tenet of aa. I simply go because I’,m required to. I use it as a way to strengthen my views. I enjoy countering every argument they give for a higher power being solely responsible for their sobriety. However I usually do it in my head so I’,m not completely ostracized. I do have friends in the program who have watched me change, as a result they no longer question my methods. Atheists are a minority, and any minority faces unique challenges. The key is to use it as motivation, and refuse to fall into a victim stance. I was once a victim, now I survive to prove them wrong, everyday sober is a refutation of their cult like claims…,…,.

True internet garbage at its finest…, I can tell you as a recovering heroin, cocaine, alcohol, anything addict with over 4 years clean- that I experienced jails and institutions…, Next was death Im certain. Alcohol, and drugs, are a symptom. The true danger is the disease of addiction which is obsession, compulsion, and total self centeredness. Obsession- the overwhelming thought to use (drugs, alcohol, porn, gambling, food, sex, money, women). Compulsion- the inability to control ones self physically once using. Total self obsession –, total disregard and for anyone and everything only, concerned with satisfying ones needs at any cost. The 12 steps treat the obsession, compulsion, and self centeredness that lead to using. And they work. Im currently working the 12 steps with a sponsor and Ive been clean for over four years. Im an Iraq veteran and I used to be on the streets. I tried everything from church, to counseling, to will power, to women, to work, substituting one drug for another- and nothing worked. The 12 step program of recovery goes much much deeper then the three or four sentences introduced here. And the program is very clear on the freedom to choose the Higher Power that works for the addict. It doesnt have to be religion or God, it can be spiritual principles like love, honesty, and service- or the group as a whole. It only has to be loving and caring. This article is ignorant and dangerous to the addict who is trying to justify getting high and drinking- THIS article might sign a death warrant for an addict trying to find a reason NOT to go to a meeting. The program has given me a life worth living. Juliet.roxspin

I understand the 12 Steps worked for you and I would never say stop doing what works. Yet I’,d want the same understanding and respect in return that those same steps could harm someone else like me. That is all I am ever trying to say. I could easily say telling everyone the steps work all the time could be harmful to someone else. Any treatment has pros and cons. Step 3 clearly states God if it meant something else it would say something else—, I am a stickler for words because words typically mean exactly what they mean. I don’,t personally read the steps as being loving &, caring. Listing my defects, shortcomings, being powerless, insane…, those were negative to me. I needed empowerment. I needed to climb out of a mental, emotional gutter and live a life that was worth living…, not keep beating myself up. This article is helpful to me. It reminds me I am not alone, my observations and my experiences are not weird, and the science backs it up. At the same time this article backs you up, Ryan, it backs up that the 12 Steps work about 10% (I’,m paraphrasing here) of the time. About 1.3 million people will do great in AA, About 2 million will benefit total from 12 Step meetings. There are a variety of methods available to recover but it is far more harmful to say one method works ALL of the time. The 12 Steps can hurt or they can help.

The only garbage here is the expectation that your own personal experience is the necessary route for everyone else. That’,s arrogance, not humility.

If you’,re able to stop drinking or getting high on your own- you’,re not a true addict or alcoholic who is suffering from obsession, compulsion, and total self centeredness. Its that simple.

Ryan, do you go to AA or NA or both?

LOL @ the histrionic Steppers declaring that people will DIE!!!! if someone criticizes their precious quasi-cult.

I can only speak for myself.I am an alcoholic. I tried on my own countless times to quit drinking.Nothing worked. I was what is called a lost cause. I would have died from drinking if I did not stop. AA saved my life and continues to do so. For me AA works! For that I am greatful!

My thoughts are that Wilson was wrong.

My other thought is that if the premise is that God is everything or He is nothing, and believing in a Higher Power=God is quintessential to resolution of drinking, noting that in the 12 &, 12 it is stated that the grace of God removes the drinking obsession then why is it the world had to wait 2000 years for a bunch of Congregationalists to pattern their belief system after a Lutheran and if the Grace of God is sufficient in this paradigm then is AA the only place the grace of God is obtainable?

Along that same line of thinking is God only found in AA? Michael L. Langan

“With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world.”—Twelve Steps and Twelve Traditions, AA World Services, Inc (1953).

Notwithstanding the efficacy or lack of efficacy of AA, the line needs to be drawn at mandated participation. The ASAM is largely responsible for “,AA facilitation”, which is just a euphemism for “,AA coercion”, and this is a much larger problem. If A.A. works for you and you think it is effective then go for it–,more power to you-spend all day and night there if you wish. But when you start telling other people how to think it crosses the line. Right now this coercion is isolated to the criminal justice system (drug-courts, parolees, probationers and certain professional monitoring programs for doctors, nurses, pilots and other occupations where a license can be held as ransom. They call this “,contingency-management”, using a license (which is a privilege not a right) as “,leverage.”, Leverage sounds a lot better than extortion. The problem is a large percentage of the people in these programs are not even remotely “,addicts”, and some are not even substance abusers. (and the new DSM-V definition of Substance Use Disorder which ASAM heavily pushed for made it a helluva lot easier to make these over-diagnoses and false diagnoses possible). In this system people are pushed into a revolving door of drug testing, assessment and treatment and this is a cash cow for the drug and alcohol testing, assessment and treatment industry.

Everyone needs to look at the ASAM white paper on Drug Testing. The ASAM wants to bring this same “,contingency management”, system to essentially everyone using regulatory agencies as the enforcers. Like it or not we all depend on regulatory agencies whether we are nurses, doctors, cut hair, receive state benefits or even drive. The ASAM is proposing widespread suspicion-less drug testing of all of us by using the healthcare system as a urine collection agency. A positive test will result in an “,assessment”, and the ASAM wants to limit this assessment to an ASAM approved facility (i.e. a 12-step facility with a medical director who is an “,addiction medicine”, specialist) where they will continue to over-diagnose and and “,treat”, people for substance abuse who don’,t need it while those who really do need it (but can’,t afford it or don’,t have the insurance) remain untreated. Moreover, they want to use non-FDA approved “,laboratory developed tests “,LDTs.”, The LDT pathway was designed for “,clinical”, tests of low risk not forensic test but ASAM physicians (particularly Greg Skipper and Robert Dupont) introduced a whole panoply of these tests for hair, nail, breath, blood and urine and want to use them to drug test all of us. And what does a positive test mean? An assessment at an ASAM center followed by more testing, assessments and treatment. Perhaps Dr. Gitlow could enlighten us a bit on the ASAM White Paper and the “,New Paradigm.”,

That is really, really frightening. That’,s the most “,big brother”, thing I’,ve heard in a very long time. Michael L. Langan Michael L. Langan

Before the 2012 Drug and Alcohol Testing Industry Association (DATIA) annual conference, Dr. Robert Dupont delivered a speech entitled “Drug Testing and the Future of American Drug Policy.” He describes a “New Paradigm” for substance abuse treatment that enforces “zero tolerance for alcohol and drug use” that is enforced by monitoring with frequent random drug and alcohol tests in which positive tests are “met with swift, certain, but not draconian, consequences” including lifelong abstinence with forced 12-step and frequent testing. The system is based on the Physician Health Programs blueprint (which is basically Straight, inc. for doctors). Dupont states:

“…physician health programs, have set the standard for effective use of drug testing. These pioneering state programs provide services to health care professionals with substance use disorders. The programs are run by physicians, some of whom in recovery themselves. PHPs feature relatively brief but highly focused treatment followed by active lifelong participation in the 12-step fellowships of Alcoholics Anonymous and Narcotics Anonymous. The key to the success of the PHP system of care management is the enforcement of the standard of zero tolerance for any alcohol or other drug use by intensive long-term random testing for both alcohol and drugs with swift and certain consequences for even a single use of alcohol or any other drugs of abuse. PHPs use drug panels of 20 or more drugs. The PHPs commonly use EtG and EtS tests to detect recent alcohol use. Similar comprehensive programs have been developed for commercial pilots and attorneys. These innovative programs of care management produce unprecedented long-term, outcomes.”

President Dr. Gitlow, please speak to conflicts of interests you have

as medical director of a pharmaceutical company while being President of

Pharmaceutical company Orexo. Michael L. Langan

Perhaps Dr. Gitlow did not see my question from 5 days ago so I am reposting it again.

Many of the doctors and pilots who are being forced into AA and 12-step by ASAM physicians in what appears to be a rigged game do not even remotely have substance use disorders. Why are non “,alcoholics”, ( by the very definition promulgated by A.A. and used to defend AA –, i.e. the “,true Scottsman”, fallacy) being FORCED into lifelong abstinence and 12-step?

The new Substance Use Disorder funnel is certainly a boon to the ASAM and the NAATM “,treatment”, providers but it is not to those who the label is being misused on.

If you look at the methodologically flawed “,PHP-blueprint”, which can be seen here in its entirety thanks to the recently archived Journal of Regulatory Medicine it amounts to nothing more than biased expert opinion yet the ASAM is claiming it the “,gold standard”, and “,New Paradigm”, in order to sell it to other EAPs. After all, Robert Dupont is one of its authors as is Greg Skipper who we can thank with introducing forensic tests of unknown validity through the laboratory developed test (LDT) loophole that avoids FDA approval and oversight-a multibillion dollar industry.

The PHP blueprint states the following: “,A sample of 904 physicians consecutively admitted to 16 state Physicians’ Health Programs (PHPs) was studied for 5 years or longer to characterize the outcomes of this episode of care and to explore the elements of these programs that could improve the care of other addicted populations. The study consisted of two phases: the first characterized the PHPs and their system of care management, while the second described the outcomes of the study sample as revealed in the PHP records. The programs were abstinence-based, requiring physicians to abstain from any use of alcohol or other drugs of abuse as assessed by frequent random tests typically lasting for 5 years. Tests rapidly identified any return to substance use, leading to swift and significant consequences. Remarkably, 78% of participants had no positive test for either alcohol or drugs over the 5-year period of intensive monitoring. At post-treatment

follow-up 72% of the physicians were continuing to practice medicine. The unique PHP care management included close linkages to the 12-step programs of Alcoholics Anonymous and Narcotics Anonymous and the use of residential and outpatient treatment programs that were selected for their excellence.”,

What happened to the 1/5 who were “,lost Dr. Gitlow”,??? These are doctors with unique identifiers and not that hard to track. Most of these doctors had a single DUI or other situational factors, one-off and even sham peer review for which they were referred. My understanding is the lost to follow-up endpoint was used to hide all of the suicides of which there were many. In fact the elephant in the room is that PHPs (which have been taken over by ASAM “,addiction medicine”, specialists state by state) are the biggest factor in the marked rise in physician suicide of late. Please comment.

Off topic I know, but why do some of these articles use pale gray print? It is hard for some of us to read!

As Shakespeare noted ”, a rose is a rose by any other name “,. You have drank yourself into a rehab or worse but you don’,t want to suffer the indignity of being called an alcoholic. How dare they label YOU. Oh the shame.

I feel like the lost voice in the wilderness. So let me say this for the millionth time. If you think that your going to do a study on alcoholics and get results that are empirical you have been spending too much time in your cubicle or lab. Come out on the streets with me. Ask an ”, alcohol dependent ”, person how many drinks they have a day and I guarantee you’,ll get an estimate that’,s several short to say the least. We are notorious liars, cheats and obfusticators.

If you can moderate your intake then your not ”, alcohol dependent “,. And God bless you, have fun. It doesn’,t work that way for us. If I have to count my drinks every night well then it must be a problem…,.. just like the calorie counter. The obvious difference is we don’,t need alcohol to live as with food.

To be religious you must be part of a Religion or sect of that Religion …, so I ask, what Religion is AA associated with? If you have been mandated to go to AA meetings ( which I am at odds with ) it is probably because you were arrested for something and if probation and AA meetings are too much for you I suggest we do what JT Morgan would do …,…,. throw your ass in jail!

“,We are notorious liars, cheats and obfusticators.”, That’,s simply not true but it is what Bill Wilson was and he tried to make us all in his image. Bill Wilson was indeed a very dishonest man, even in his sobriety and so-called spirituality. These kinds of characterizations are part and parcel of what is so damaging about AA. It’,s these beliefs that people internalize that does them harm. Sometime people don’,t take on these kinds of characteristics until they get to AA and start to believe these things about themselves because you are what you believe you are. This coming from addiction professionals who repeat this myth is especially damaging because we look to professionals to know such things.

The idea that we always lie about our drinking and are in denial is utterly false and it has been known for a long time that self report is generally pretty good. It comes from the practice of confronting people which has been proven to increase resistance against quitting drinking. That’,s not just alcoholics, most everybody will dig their heels in when they are being brutally confronted.

The idea that there’,s a consistent alcoholic personality has been debunked by research for decades now but people still repeat these abusive ideas as though they are truth. Juliet.roxspin

So true Amythist…, it would be like me designing a program where everyone must agree they were previously abused, had terribly low self-esteem, were abusing themselves with alcohol or other drugs, were doormats, were constantly putting others before themselves, were self-destructive, too forgiving, inviting more harm upon themselves…, etc…,. And if you don’,t agree you must not be ready or willing to accept my program for recovery. —,- In some weird twisted way in AA I actually came to believe I was asking people to hurt me, to rape me, that my egocentric self-centered all-powerful stance in life was inviting abuse onto me…,. I began to believe this. I must have this “,come rape me”, look or something and that’,s why it happened. And that’,s why AA can kill someone—, I was really depressed and I wanted to die thinking I was somehow causing the abuse I had suffered to happen to me. AA just drove that home for me…, it distorted my reality. It got in the way of my healing.

Exactly Juliet and telling people that they aren’,t honest if they don’,t admit to having the exact same problems you have, they must be constitutionally incapable and will probably die.

Not that it’,s OK under for alcoholics to be falsely labeled and pushed to accept it (or be falsely labeled again as in denial), the same “,personality”, traits are placed onto other addicts as well. Are pill poppers liars? Do sex addicts notoriously lie about their sexual zeal? Are pot heads as spiritually unfit? The more this subject gets defended and debated, the more sinful the recovery program actually seems. Juliet.roxspin

How can accepting, wanting help be “,denial”, …, showing up in the first place denotes some acknowledgement of some kind of problem…, Accepting “,treatment”, is not denial. Now, if a pot head goes into a doctor’,s office and says their problem is LSD but the tests keep showing pot and not LSD…, then that’,s denial…, but is it addiction? Or just pathological lying? Those 2 don’,t necessarily go hand in hand.

What has been found is that most alcoholics are aware of what they’,re doing and will be honest if they are approached in a non-judgmental and empathetic manner.

It was Bill Wilson’,s psychiatrist who thought that alcoholics needed extreme confrontation and their defenses broken down. He was wrong. Dead wrong. That doesn’,t work for MOST people. What it actually does is make them drink more. He was deadly wrong and you have to wonder how many people have died needlessly.

I see how confrontational therapy would fail and/or hurt someone. A victim of any form of abuse that gets humiliated by way of having to entirely focus on their own faults can feel betrayed and further suffer by the very people supposed to help them. It’,s like getting kicked by the very officer you called to assist you in defense of a victimization –, when already down and suffering. It’,s bad enough to get blamed for the disease they say you have no control of.

Unbound, it’,s funny how with addiction, for decades people have been doing the wrong things and they ignore the failures and blame the “,disease”, but they cling to the few “,successes”, that happen despite the horrible treatment as validating the treatment works. This can only happen in addiction where we are so stereotyped. Juliet.roxspin

The only way the 12 Step treatment would work is if you re-interpret it and don’,t work it the way it is written—, which is what many members do. Or, you just say you worked the steps and you just don’,t do them. If you actually work them…, now…, that can go either way…, Juliet.roxspin

Yes the police laughed and arrested me after the guy was beating me up…, made a sexual innuendo when I wanted to use my chapstick…, some are naive enough to assume all police protect and serve. Or, you’,re me…, lol…, I laugh because I really should change this blue wig photo but…, my whiny victimhood is pretending me from moving forward with my life…, Yes, confrontational therapy fails…, scared straight fails…, calling people stupid also fails. Juliet.roxspin

William Miller…, Motivational Interviewing…, ranks number 1…, AA/12 Steps rank 37/38…,. That’,s what I’,m saying…, There are scientific methods proven better than AA…, MI is the opposite of confrontation and yields better results. HAMS kind of uses this I believe—, Kenneth would correct me if I’,m wrong—, but it’,s client focused in that the client helps create the goal and is more likely to achieve it that way.

As a “,professional”, I can tell you unequivocally that yes we are good liars, cheats and obfusticators …,. having said that it doesn’,t make me a bad person. I had been lying because my substance trumped everything including the truth. Once I stopped I saw my patterns ans was able to confront myself and be honest and do the right thing. Trust me when I tell you that they had taken on these characteristics long before they walked through those doors. How you can say ”, utterly false ”, just tells me a) you haven’,t gone to an AA meeting b) your not an alcoholic or c) you have no experience in this field.

Whose “,research”, has debunked a consistent alky personality? Where it is true we are all different in our own ways we have certain patterns and behaviors that are universal. Alcohol reshapes your brain and your character and recovery can do the same in a positive way.

This is the problem with using an 80 year old modality that has rigid beliefs embedded as irrefutable truths that will not be changed when competing actual facts come to light. But even more so for those who work in the field. They tend to confront the alcoholic until they admit to fitting the professional’,s preconceived assumptions about them (much like the ones you have expressed about me, JTM). The patients must rewrite their own histories for approval and that’,s rigorously dishonest and a huge disservice to the client. This is why everyone in AA’,s stories match each others so closely, but it’,s dishonest. If you’,re finding your clients to be dishonest with you, the problem is more likely to be in the assumptions you’,re going by as well as the approach you’,re using than a problem in your client’,s honesty.

“,Fifty years of both psychological (Miller, 1976) and longitudinal studies (Jones, 1968, Vaillant, 1983) have failed to reveal a consistent “,alcoholic personality.”, Attempts to derive a set of alcoholic psychometric personality subtypes have yielded profiles similar to those found when subtyping a general population (e.g., Loberg &, Miller, 1968). That is, alcoholics appear to be as variable in personality as are nonalcoholics. Studies of character defense mechanisms among alcoholics have yielded a similar picture. Denial and other defense mechanisms have been found to be no more nor less frequent among alcoholics than among people in general. (Chess, Neuringer, &, Goldstein, 1971, Donovan, Rohsenow, Schau, &, O’,Leary, 1977, Skinner &, Allen, 1983). There was simply no support for the view that alcoholics in general come into treatment with a consistent set of personality traits and defenses. (p. 90)”,

And I double-dog dare you to read this whole article.

”, There never has been a scientific basis for believing that people with substance use disorders, let alone their family members, possess a unique personality or character disorder. Quite to the contrary, research on virtually any measure reflects wide diversity of personal characteristics among people with addictions, who are about as diverse as the general population, or as snowflakes. Studies of defense mechanisms among people in alcohol treatment have found no characteristic defensive structure, and higher denial was specifically found in a clinical sample to be associated not with worse, but with better treatment retentionand outcomes (Donovan, Hague, &, O’,Leary, 1975).”,

You might also want to look that this: Juliet.roxspin

I only take offense that you as a professional would us the word “,we”, and have it seem every person with drinking problems is in that “,we”, group—, where are the “,I”, statements? You may have been—, many others were not the same as you. And to say people had those characteristics before what…, before they even picked up a drink? That is not true—, but AA teaches that so it may just be your “,belief”, but it doesn’,t apply to everyone else in AA or outside of AA. Read AA’,s description of an alcoholic then read the symptoms of narcissistic personality disorder—, they are pretty darn close to be the same. Then read up on the percentage of previously abused individuals who self-medicate with alcohol. Not every “,alky”, has the same personality. That’,s like saying every diabetic or depressive or arthritis sufferer has the same personality. Professionals typically don’,t speak like this—, they speak of individuals as individuals…,.

Define chronic alcoholism

There’,s plenty to unpack here, but I’,ll address one or two issues:

If you can moderate your intake then your not ”, alcohol dependent “,.

what Religion is AA associated with

Many people find AA religious, this is beyond dispute, and supported by the courts in the United States. The criticism here you’,ve obviously missed is that AA is criticized as in a legal capacity as being religious in its own right, not of being affiliated with another religion.

As such, legal rulings have included wording regarding AA:

…,the fundamental A.A. doctrinal writings…, [are] unequivocally religious in theme and proselytizing in content.

.. is at least as offensive as many people would find forced attendance of services at a Mosque, a Jewish Temple, or a meeting of Pentecostals (sic) to be.

If you are suggesting that people should be thrown in jail if they reject AA, this is in fact supporting State coercion, which is a violation of civil rights. State coercion, when it occurs in other countries, is also routinely criticized by the U.S. government.

As a “,sober coach”, I’,m quite concerned you seem to be uneducated in these areas, which have been the subject of robust debate over the years and there is plenty of information on. Juliet.roxspin

Who teaches alcohol dependent people to lie? I’,ve never had to lie about how much I drank. Even when it was wayyy too much why lie about it? I didn’,t learn what alcoholics did, or acted, or behaved like until I was in AA. And it was not how I behaved. It was just some more put downs on top of put downs I already heard my whole life growing up. And if you can’,t beat ’,em, join ’,em right? If you treat people like crap they start to act like crap and it’,s a self-fulfilling prophecy…, AA doesn’,t even attempt to teach a person to moderate why would they? Carry this negative message to others, ask others to list their defects and confess them to me? Who am I? Their judge? Their sponsor? Their God? I would never carry the AA message to others. Because I can’,t in good conscience abuse another human being. I’,ve seen suicide happen in AA and it wasn’,t because they weren’,t working a good program or relapsing…, AA uses Christian elements but what religion is AA? AA is the religion of AA, with it’,s own rituals (program/steps) and belief system (if you pray to God, God will remove your defects)…,. If you don’,t believe in AA or God you will suffer an alcoholic death (hell?)…, No other “,disease”, is punishable with jail…, wow, either accept AA’,s help or suddenly it’,s not a disease anymore and doesn’,t deserve “,treatment”,…, this just doesn’,t make any sense. That sounds kinda conceited—, AA or else? Public schools don’,t permit prayer. Doctors in all other areas of medicine don’,t recommend prayer. If you can’,t see this being a problem something else is wrong with a person—, not just alcoholism.

If you are not activity working, in a meaningdul way, towards a sucessful alternative to AA, you are by default only attacking.

Does that mean you’,er attacking too? You are just arguing with people and not offering a solution.

I put my time, money and resources towards many, many solutions…,.daily as a matter of fact. Funny by all the responses to my original post I must have really touched a nerve. If the shoe fits?

The reason you got the response you did was clearly spelled out to you in plain English: you made unfounded allegations which you still have yet to provide evidence for, but seem unwilling to retract.

When you take some personal responsibility and actually read the replies –, and and retract what you wrote, then I will view you as being to engage constructively.

Until then, it’,s clear you are only interested in attacking people you personally disagree with in an unfounded manner, rather than working constructively towards anything.

I view your behavior as being unprofessional –, and any organizations you work for –, if you do –, for should be alerted to this fact.

I have in fact read and followed many of your’,s and Juliet’,s posts on many forums. You both have an axe to grind. None of what either of you do furthers a solution in any way, shape or form. If you, in fact, have posted solutions direct me there via a link. I have read lots of whining and outlandish accusations but have yet to read any solutions. I am not the one hiding behind a a fake name. Show me the money.

Fact is that your posts show you as a butt hurt whinner with an axe to grind. Name a fact just the same. Again quit complaining and tell us about your solution.

Firstly, I am not Juliet. Please take up any personal grievances you have with her directly, instead of via proxy.

You both have an axe to grind. None of what either of you do furthers a solution in any way,

As I previously have stated and clearly outlined, I am not responsible for the behavior of Juliet. So let’,s keep it specific to me please. You have no way of knowing what I’,m involved in or not, as I don’,t discuss everything pertaining to it also have no way of knowing if my professional work “,furthers a solution in any way”,. If you’,d actually read the entirety of my comments, which you haven’,t, you’,d be aware that what you’,re saying is factually incorrect. So somewhere here you’,ve made a decision to essentially lie outright, and claim something you don’,t know is true as being factual.

I’,ve also responded to you before at length concerning Alcoholics Anonymous, in a manner which was neither abrasive or dismissive of your position.

What I’,m interested in, is given the fact you cannot have known what work I am in fact involved in, you are prepared to state that nothing I do “,furthers a solution in any way, shape or form”, in a public forum, when you are well aware that this may not in fact be correct. This is completely unprofessional on your part.

Can you please inform me exactly how my work doesn’,t further alternatives to AA? If you cannot, can you please retract that statement.

Until then, I stand by my statement that I believe you are only interested in attacking people you personally disagree with in an unfounded manner, rather than working constructively towards anything.

Tell us about your work and the solution it provides. I will be the first to applaud you.

I venture to say with the amount of time you spend posting in forums you have time for little else but complaining. Are you an author that writes self help books, to do hold alternative groups, what alternatives to you support with your time and money?

Why is your activity on DISQUS private? Why do you use a pseudonym?

As for linking you with Juliet where she is posting there you are. Massive too. There is a group of whiners that follow this topic and you can not deny the black and white. Like I said if the shoe fits!

Can you please respond to this, which you skipped:

What I’,m interested in, is given the fact you cannot have known what work I am in fact involved in, you are prepared to state that nothing I do “,furthers a solution in any way, shape or form”, in a public forum, when you are well aware that this may not in fact be correct. This is completely unprofessional on your part.

Secondly, I am married to a social worker who is very active in assisting those who suffer from mental illness professionally. I do not work in addiction or mental health, but am involved in primary healthcare. I’,ve experienced personal addiction problems, she hasn’,t (well, not in nearly the same capacity as myself), Between us, in a professional but voluntary capacity, we commit a large amount of our free time working in mental health advocacy. Very little of this often pertains to addiction, but the issues do come up from time to time and I like to explore them here. In terms of addiction, Individually, I volunteer for “,peer support”, programs run by the government, which involve people who have had personal experience of addiction sharing with others what they have found helpful. These programs are larger than AA is in my country. I do a few more things than this, and I’,m also involved in the bureaucratic side of several charities. If you need to know more, I can elaborate, but that will have to cover it for now.

Being involved in advocacy often means being familiar with common complaints people have. This is how I’,m familiar with common complaints about AA. They actually come from real people I deal with.

Why is your activity on DISQUS private? Why do you use a pseudonym?

There are many good reasons I have for this, but not everyone has employment which leaves them in a position to comment using their real name. You’,ll just have to respect that.

I find that refreshing! My hands are in fact clapping applause! I have based my opinion of you based on your posts which are mainly negative and it is wonderful to hear the solutution side of what you do!

Have you ever consider writing a blog on the benefits of alternatives? Not a blog bashing a program but a blog praising the alternatives. A blog that shares sucess stories of those that have been helped by the alternatives. You do have a gift for expressing your views and it could be used to get the word out that there are good alternatives out there.

Argh, I just wrote you something much more nasty and now I feel aggrieved about it, since we’,ve reached a more positive place in this comment thread.

If we can put he past behind us, that would be my preferred option now.

Yes, I’,ve thought of starting a blog. The problem is I live in a small country, and professionally I’,m involved in work which I don’,t want to disclose my mental health history to.

I’,d probably struggle to keep the tone neutral, but if I could, yes I agree, there’,s a gap in the market for it.

No need to feel aggrieved! If I can dish it out I had better be able to handle a come back.: )

I am just saying you can catch more flys with honey than with vinegar. AA happened to work for me but I am well aware that for some it does not. I am a big believer in options and not discounting one option because it did not work for me. I, for one, I am an AA’,r that believes we are not the only way. I personally know of many people that have other programs that work. I just get sooooooo very tired of all the negative in many of these forums.

The “,blame game”, and constant negativity is counter productive to what I think we all want which is to be better, be more and share it.

Why is it that stating facts is considered negative and bashing? France you are always very logical in your debate and simply stating facts.

I got some personal benefit from AA, but have outgrown it. As an atheist I am aware there are objections from other people with religious views like my own. There are a real lack of options in my country, Lifering and SMART do not exist, and AA seems to be the default recommendation for everyone.

I’,ve got no problem with AA existing as a voluntary group, I’,m just aware there’,s a need for alternatives for people whom AA is never going to be a good fit. While AA is set up to function as a voluntary association of individuals, the reality is that this is abused by powers greater than itself to dump people on.

There’,s a high collision rate (or co-morbidity, in technical parlance) of alcoholism and other forms of mental illness. It’,s complex, and messy, and I don’,t think there’,s every going to be “,one true way”, which works for everyone.

Alcoholism is hard work, and I wouldn’,t wish it on anyone.

Edit: I admit I do like to criticize for criticisms sake, this is partly because I’,m a product of my environment and have spent far too much time on the receiving end of an endless tertiary education and associating with elite sectors of society.

Same here. I grew past what the groups had to offer and have not been to more than two meetings in three years. At this point I am more concerned that some that could be helped may not. So long at the negativity is perpetuated the real message gets lost.

The real message in all of these forums should not be AA is bad but that that there are good, proven alternatives available. By saying that I am not dismissing that AA could and maybe should alter it’,s program since it is often the most available.

We should be shouting at every opportunity that if one program is not working there other programs with a different method that may work. The whole point should be get the word out about options.

I also STRONGLY disagreed with mandating AA. Juliet.roxspin

Yes but we must build a solid foundation built on honesty—, there are reasons why AA doesn’,t help all people and what are those reasons? We must face the reality that some are harmed by AA—, ok, fine, so let’,s stop sending all to AA. I’,ve made comments on here urging agencies like ASAM to be more vocal about the alternatives. It is not just up to me and these commenters to make it happen—, these agencies have helped maintain the AA monopoly and it’,s a big bureaucracy issue. If a treatment expert cannot even bother to look up SMART and learn about it how can their patients learn about it? This is also an educational gap in addiction fields. There is a healthy component in venting though and 4 years ago there were few “,AA harmed me”, stories out there or “,13 Stepping”, stories…, people harmed by AA have felt very much alone and we can’,t just brush them off and tell them they can’,t talk about it. We wouldn’,t tell any other abuse survivors that, right? Juliet.roxspin

Look I must interject here because there seems to be some disconnect about something. A bad experience in AA (i.e. the mental abuse it did to me…, mirroring the abuse I had before AA) is something I must talk about…, I will not just let that go because it bothers you, Cyndy. Not because I want to be rude to you but because it’,s rude to me to completely discount what happened to me by working the AA program. Next of all, why is it not good to share how AA can be harmful? If everyone suddenly stopped saying something bad about AA would it change the fact AA is harming others? That being said, there are pro’,s and con’,s to any program—, in order to be honest we must take the good reviews along with the bad.

Yet I don’,t think you’,re seeing the good that I do that comes out of it. Those who can relate to me speaking out publicly about the abuse of AA are thanking me for coming forward. They were afraid to speak out. They were suffering. These messages are heart breaking but powerful. They are getting empowered because others are coming forward. I used to be quite a coward. I am not today. Well, not as much. What you call a blame game really hurts my feelings—, I only blame anything if it is something that actually happened…, it’,s called assigning blame accordingly. Not everyone shows up to AA and just leaves…, even if that were the case…, the steps clearly mirror abusive patterns and I urge you to research that because I am not making that up.

Anyone who’,s been harmed by AA should speak up…, some medications that help people also harm others and those people speak up why can’,t I? Zoloft comes with a warning. Tylenol comes with a warning. Does this mean it’,s Zoloft bashing? Tylenol bashing? Nope.

Abusive patterns, just one of them but an obvious one: “,If you leave me you will die.”, Juliet.roxspin

The other one is rendering the victim powerless…, you’,re stupid…, you know you want this…, take it…, “,Keep it simple stupid”,??? “,Don’,t think”,??? The more you fight it the worse it will be…, Abuse.

You just did it again. You took a postive disscussion and turned it negative. Who made you the “,Godess of did you wrong…,GET OVER IT!

Juliet…,the perpetual victim. Glad you are, as you say healing, from your posts. Get it out girl again, and again, and again, and again, and again, and again, and again, and again, and again, on to infinity.

You don’,t like negative posts about AA. GET OVER IT!

How does hearing that make you feel?

I’,d like to mention that this blog is a perfect place to discuss such matters as it pertains to the negativity of the AA message. Many of Juliet’,s posts have ended with a positive statement of feeling good for expressing herself. Juliet.roxspin

That actually really hurt to read it…, I’,m not joking. But I can turn that negative into a positive because it helps me remember why I do this…, a person with that temperament could be an AA sponsor for example—, the women who sponsored me would tell me to GET OVER IT also…, it really hurt. It didn’,t help. Juliet.roxspin

You really don’,t like anything negative do you? I’,m not a goddess of anything but this projection is getting bothersome seriously—, I will not get over it, no thank you. You can’,t just stay silent about abuse and expect it to get better—, for the next person who may be abused in AA—, Seriously. You do know AA recruits court ordered sex offenders and you do know alcoholism/alcohol abuse is a symptom/coping pattern for abuse victims—, right? And you do know AA recruits minors. Have some respect for abuse survivors or get over it yourself…, because abuse survivors have the right to speak up about it. Could you kindly stop bashing me?

You are a lot like the guy who’,s girl friend cheated on him still hating on the old relationship 5 years into a new relationship. At what point do you start enjoying the new relationship, if in fact it is so much better, and talking about that.

Have you ever considered that you may actually be hurting someone that needs help. You offer yourself up as an authority on alternatives yet most of your post just bash AA. Consider balancing your caustic hatred AA with a healthy dose of what the alternatives are and how they work.

I think those that need help will probably be better off doing anything but AA which is pretty much a failure. Even those who do nothing seem to do really well on their own.

Do you really believe telling the truth is causing harm? I’,m glad you’,re showing up like this as an example of what we are talking about. The things you are saying and your attacks and attempts to silence the truth are all too familiar from AA. Juliet.roxspin

Hahaha that’,s almost funny…, now you are confusing abuse for a bad relationship? Do I have to explain what abuse is again when you don’,t seem fond of that topic? OMG I’,ve heard that a billion times in AA—, don’,t talk about what really happened to you, Juliet, because you might hurt someone if you do. That is another classic manipulation of trying to silence an abuse story…, Do you know how many messages I’,ve received in the past year thanking me for coming forward because it helped them open up too? Leave it alone, Cyndy, you aren’,t convincing me to shut up about it. You obviously hate abuse victims or something and don’,t want them to talk about their past…, but maybe hate is the wrong word…, it annoys you? When did this begin? Who taught you to shame abuse survivors and tell them to shut up?

For what I hope is the last time this is the solution—, talking about it! Duh! Lol—, it’,s that simple. The worst thing an abuse survivor can do is not talk about it…, deny it…, yes I can talk about it and still be moving forward. Can you talk about first grade and still live in the present?

Maybe she doesn’,t believe in abuse victims, Juliet. After all the big book does not allow for being a victim. It’,s only allows for being the abuser.

seemingly without provocation, but we invariably find that at

some time in the past we have

made decisions based on self which later placed us in a position to be hurt.”,

Alcoholics are not allowed to be victims in AA. They are only allowed to be victimizers and that’,s why they sneer the word ‘,victim’,. “,Oh you poor little victim”,, they say.

As a Catholic I’,ve never even thought to criticize a victim of clergy abusive. My heart has only gone out to them and my mind has at time raced trying to come up with ideas that might help them. At least I can be thankful that clergy abuse is common knowledge these days, there is support for victims, and that the Church has finally acknowledge it –, making change, some getting punished for their crimes.

I don’,t see how, why, AA should get a pass when history has shown us that non action and denial only result in more tragedy.

I know a man in his 60’,s who is still traumatized by what a priest did to him. In addition, he had a mother who was a classic narcissist and very abusive. He still struggles and has reached out for help from so many different avenues. It’,s cruel and unfair to heap more abuse on someone who has suffered. I think it’,s one of those “,If you can’,t say anything nice, don’,t say anything at all.”,

I guess some people will never understand what being abused is like.

For a similar example, would a random commentator be applauded for suggesting the victim “,hush up”, after getting abused by a priest? Would there be posts countering such complaints due to possible converts not getting all the benefits of becoming a Catholic?

I dunno, guess it’,s possible. I’,d like to believe that more people than not would offer compassion, rather than criticism. Surely there would not be many more concerned with discussion of optional religions.

I’,m sure that there are some from the Catholic church who have a ‘,shut up and don’,t make waves’, attitude towards that situation, but most would not. Change never comes about by people being silent. Name one important positive change in society that was accomplished by people being silent about any kind of social injustice.

AA presenting itself as the only way, without which you will die, is a social injustice indeed. I’,m sure many have died needlessly because they never knew there was anything else to try.

Cyndee says Juliet doesn’,t talk enough about the alternatives but in fact she very often does. Very often. Juliet.roxspin

Yes, of course they can do this and they used to do this before the social tide changed. Not all priests are bad people. Why don’,t you just go to a different church? You are trying to get people to leave the church because you are filled with hate. Can’,t you see that what you are saying about priests abusing others is hurting others chances of finding love and hope in church today? If the abuse happened years ago, then why are you still talking about? Move on and let it go already. Why don’,t you talk about solutions rather than the problems? Juliet.roxspin

I think to use my own mom as an example, she didn’,t like knowing her only brother was abused. She was taught, or learned, somewhere that it was his fault. She was angry at him for not getting better and blaming the abuser. But knowing this first hand as allowed me to understand why some do hate hearing abuse stories. They feel in some way if they admit others can be weak, or can be victims, it will somehow put a crack in their own armor…, they would have admit they have weaknesses too. And a narcissist does not admit they have weaknesses. They can’,t be abused. They know exactly how to avoid it. They can’,t understand how stupid you must be to let someone else abuse you. They think you are whining and they think you are evil and perhaps an alcoholic because you are drinking to conceal your pain. They’,d rather you be a bad person than an abuse victim. They’,d rather put you down, ridicule you, and ruin your life than admit you have ever been hurt.

Oddly enough, they are likely to have learned this from their own parents and this is the narcissist’,s coping mechanism. They reacted by passing down the illogical life lessons and they resent you for having feelings and weaknesses. Why can’,t you stuff it down like they did? Juliet.roxspin

I went to Catholic school 1st –, 8th grade. I grew up learning of the abuse and even in my own church (my mom and her brother attended the same school) had abuse issues in the 1950s. My uncle was also abused by a co-worker of his dad’,s…, Abuse issues back then were handled with punishing the child…, telling them to shut up.. or accusing them of being sexual deviants. My uncle didn’,t want to talk about the abuse or risk being labeled “,gay”, and this was how boys who were molested were treated in the 50s through the 70s and I imagine some people still hold this deep hatred of abuse victims. But today that is rare because we are educated more.

Oddly enough, my mother held these disturbed beliefs and even tried to blame her brother for abusing me…, she cut off her family from me for 23 years until her death when I contacted her brother, my uncle. Today he is a great support to me. My mother was abusive to him and to me, verbally, mentally and emotionally. I don’,t talk about it because I’,m stuck in the past but because it is the truth.

And even though I’,m no longer in AA my heart goes out to any other abuse victim who can’,t move on, who feels stuck in the cycle. Or who can’,t even recognize the abuse or blame themselves for it. The Catholic church is a great example. The last 2 Popes have openly apologized on behalf of the church even though they personally didn’,t create the abuse. This is what I’,d love to see in AA. But AA makes no comments. They offer no condolences for those who have died or sympathy for those abused in AA. AA doesn’,t get a pass on their flaws…, AA cannot claim exemption from being responsible. You are right—, it does show non action and denial and that leads to more tragedy. Juliet.roxspin

Yes my decisions led me to be abused…, is kind of how I feel her comments are reading like. I believed that, and AA backed that up, but it was wrong to think like that. If anything, if I seemed to have a walking target on my head, it was because I believed I was inviting this abuse. There is some truth to that—, but it becomes true if you believe it’,s your fault and stay in that low-self esteem mindset. AA re-enforces that mindset. I made my rapist rape me! It’,s my fault! Omg that is so wrong! Might as well walk around dark alley drunk as a skunk with a neon light above me saying “,Rape Me”,…, I’,m not worthy of real love just getting abused…, I have to re-blog something I wrote at an AA meeting years ago. I used to take notes sometimes at meetings when I was “,triggered”, I’,d write it down to get it out of my head. (Had to practice coping skills at meetings per the therapist’,s recommendation!) Lol…, if you need to practice coping skills at a support group there is a problem with your support group.

Juliet when I hear you talk about alcohol 12 step programs I don’,t recognize it. What meetings do you go to? We talk about abuse, trauma, and a host of other things that are not particularly alcohol related. No one ever talks religion or a certain set of tenets they’,ll talk of spirituality and their connection with it. We laugh we cry we get each other through one more day.

There is annoying saying ( annoying because it’,s true ) you have probably heard which says ”, it’,s a simple program for complicated people ”, and you are a complicated person. And that is a good thing. We are free thinkers. No one has ever told me I have to do what they say and if they did I would just ignore them because as you may or may not know it’,s a program of suggestions. Yes there can be many Bozos on the bus but the bus is the vehicle that will get me to where I want to be. I have also found that it has given me the patience and TRUE tolerance to listen to those that I don’,t agree with, don’,t like or are so debilitated that they barely make sense. IT IS NOT PERFECT.

I tell folks all the time if you don’,t like it go to SMART or better yet spend all that time and energy you spend here disputing the 12 steps to start your own group, but to talk of class action suits etc is just a negative pull in the direction of relapse. If you ever make it to NYC come check out the over 500 meetings we have and perhaps you’,ll see it a little differently. It is very diverse, open and growing. I’,d love to take you to one. …, Love&,Light Juliet.roxspin

I went to Alcoholics Anonymous meetings. I found them to be complicated meetings with a complicated program and sayings that didn’,t even match up—, “,a program of contradictions”, they also called it. A freethinker in AA is an oxymoron to me—, “,We Agnostics”, is still published by AA today. AA is a religious program that welcomes atheists, it is not a secular program that welcomes people of all faiths.

Please read over the steps and then read over the abuse cycle of how an abuser renders a victim powerless…, they line up as though an abuser wrote the steps—, trigger alert for anyone who has been abused. Another trigger alert is telling someone “,that’,s not what we meant, the first step is about empowerment”,—, that is also how abusers talk. They say one thing and tell you it means another. I agree with you, AA is not perfect. But I would rather someone actually heard the voices (not just mine) of those who have been harmed instead of trying to convince them it’,s not that bad…, it’,s not validating or listening to the person telling you they were harmed by AA.

The day an AA meeting can run without the AA literature is the day I’,ll go back to an AA meeting—, so if the steps are posted in the 500 rooms and the Big Book is present in all its sexist, women-degrading glory—, I just refuse to represent or participate in a group that I cannot be proud of being a member of…,. I can’,t carry that message. To each their own, but don’,t shoot the messenger I always say.

I think you need to accept things you can’,t change. The flood gate is open of people finally being honest about AA. Even if Juliet and those of us you have a problem with were to shut up and go away as you wish, there would be more to fill the spot.

I personally think you are so bugged by this because all this scrutiny makes you feel foolish. That’,s just natural when it starts to dawn on you that you engaged in magical thinking. The problem is something you need to examine, not Juliet.

Now how does it feel to be armchair psychoanalyzed by a stranger?

I don’,t understand the logic or fairness behind “,must have, or be working, on a solution”, or “,otherwise the comments are just bashing”, (paraphrase). Sure, alternatives are a good thing and that is something I’,d very much like to see. As a former addict in search of help, I wasn’,t offered an alternative and was actually punished for objecting to and for not continuing to blindly accept AA as my personal solution. Long story, and it was as similarly illogical as the exclamation that “,all discussion need be solution based”,. I am not a professional in the field of addiction and do not pretend to be, so other than my own personally, I don’,t see as how my working on a solution would benefit anyone. I support having options and support alternatives to recovery as far as actually having a choice. I am like any member that wants to share their experience in an effort to help someone else. With my voice and that of others, people will have an opportunity to hear of AA failures along with the positives. If I had read of what I fought so hard to uncover and had to learn of my own, it would have saved me years of a stagnant life, miserable as a member of the program. Like France said in this thread, it’,s fine for those that want it and like it, but people shouldn’,t be pushed and coerced into AA or any 12 step group. Juliet.roxspin

There’,s my name again, you also seem to have an axe to grind with me and I have no clue why because I don’,t even know you. You are whining that others cannot criticize AA and calling us bashers…, which is name-calling. I have difficulty believing you are active in the AA or any other 12 Step program because those programs demand that you do not become angry or hostile with others—, you must cease fighting everyone and everything. And not to mention, steps 9 and step 10. You’,ve offered no amends for your actions and to me that doesn’,t indicate active involvement in the AA program. Yes, I don’,t work the AA program, but I do practice making amends where I have been wrong. That’,s just something people tend to do …, I’,ve written part of my solution was identifying my issues in life—, the abuse issues—, self-medicating with alcohol was how I dealt with abuse among other ways…, AA added to that abuse. I deprogram today and share my story today because that is my healing process…, That is how I stay healthy and grow as a person able to express herself and make healthier decisions and set healthier boundaries. I take what I learned in therapy—, basic CBT techniques. I read a lot. That’,s my solution. And I won’,t let anyone tell me I can’,t talk negatively about AA—, that is also part of my solution.

Yes and I know that your solution has helped many who have had similar problems to you. Telling the truth is a positive thing even if you have to say negative things to do it. Other people who don’,t like it are the ones who can stand to hear the truth. That’,s what is negative. Keep speaking your truth because you are great at it and you help people. Juliet.roxspin

Exactly and going public with my story wasn’,t some easy cake walk thing where I was like pumping my fists and jumping up and down…, it was scary and I wasn’,t sure I could do it and the mean comments were f**king with my head. It hurt a lot. It was re-traumatizing…, I hadn’,t been away from AA very long…, I stopped attending in 2012. I get this weird impression others think these horrible stories are done for sport…, like we tell these stories for fun? I don’,t…, but there wasn’,t a lot of stories like mine out there and it was frustrating feeling alone. So…, I’,m not alone anymore.

Sorry to correct you but WE are not alone any more. We, as well as many others, have both been bullied and stalked by AA menbers and called every name in the book just for talking honestly about our experiences and the way AA affected us by these people who believe that you have to be rigorously honest.

After awhile being attacked and insulted in either crude ways like calling us whiners or more verbose ways, you just get immune to it. Juliet.roxspin

It is exactly the same pattern of conversation I had at AA meetings…, exactly…, Not really immune to it but kind of expect it from an AA member…, few respond to my experiences with kindness or genuine concern…, like…, “,Wow, I didn’,t realize AA could harm someone…, how can I help you? What could AA do better? Damn…,.”, No, it’,s just absolute lack of empathy. Juliet.roxspin

Also thank you Amythist and keep on doing what you are doing because it’,s helping me too! I think if I waited any longer to talk about the bad experiences and just pretended I was ok and over it I wouldn’,t have improved like I have. adding this…, We all help each other by validating the truth each person’,s life experience holds…, it’,s very important.

Sorry it took me awhile to post a reply to your many comments directed at me. Iwas was having a postive discussion about the many alternatives to AA with another poster on this forum.

You can and do speak negatively at every opportunity. That is your main focus, which, is my point. Ninety nine percent of your focus is how AA did you wrong.

There are dozens of programs out there that offer alternative methods but that is not, as your rants show, your focus. Your focus is to point out that AA did you wrong.

You have the right to bash AA all you want but you frequently add in that you are just trying to save others from your experience. If that were the case you would use at least as many words on alternative solutions. I do, however, have a problem with you attempting to portray your self as a crusader for the disenfranchised which you are, in fact, NOT.

Not attacking…,just letting Stewart and others know, if they had not already figured it out themselves, that discussing a solution with you would not be possible as your main focus is not to educate but to hate.

No everyone is looking for solutions for their addiction, Cyndy. Former AA’,s are also looking for others that experienced the same negative experience so that they don’,t feel so alone. There is helpful, therapeutic validation to hearing that others experienced the same as you did. This gives people an opportunity to learn from and heal from those experiences. Leaving AA doesn’,t just mean losing a support for addiction recovery, but a hole for what was lost. Sometimes it’,s filled with pain from what you went through in the name of recovery. Why this insistence that’,s a greedy, unrighteous crusade despite the painful admissions you read about? Honestly said, it shouldn’,t be taken personally. Many of us were active AA too. Having a good experience doesn’,t make it less valuable or make you guilty for the harm others endured.

What I am saying is that at some point everyone of us that does not move past hurt done to us stays stuck in the hurt. Purge yourself and move on. If AA did not work find something that does and move one. I first started reading some of these forums 5 months ago and the same people are rehashing the same hurts over and over again here tonight.

If you scrape your knee you clean it out, put on some ointment, put on a band aide and allow it to heal…,but some might choose to pick at it until it is infected, heals very slowly and leaves a scar.

There is a big difference between acknowledged shared pain and wallowing in it.

You seem to keep missing the point. If you scrape your knee and clean it up, etc. in order to heal, but that doesn’,t help you…,.yes, move on and fine something that does. BUT if you scrape your knee and clean it up, etc. however find out the medication you used actually cause you more harm than originally had –, that would make for good reason to warn others and work on patching the second wound. I get what you’,re saying, but also think that this more of an attempt to quiet down ANY negativity regarding AA in order to protect it.

What’,s the most aggravating all of this is that AA doesn’,t acknowledge anyone’,s pain, try to help them, or deter it from happening to others. They just continually allow more people to get hurt. Some even die. It’,s almost as if I have no choice but to keep at it until either AA’,s harmful attributes are either common knowledge or AA just vanishes. It’,s not out of hate and revenge, but AA’,s flat out refusal to do anything at all to prevent harm to others. The organization is in complete denial and unwilling to offer anyone anything. They only take from their members. If AA would start making changes then people wouldn’,t feel the need to keep at raising awareness themselves.

Read back through all my comments here tonight. I have not espoused the singular healing properties of AA. It worked for me but than I love Lima beans and many people hate them. Does not make lima beans poisonous except maybe if you only eat lima beans. (Just trying to lighten things up)

What I have pointed out is the lack of conversation about what does work for those of you for which AA failed. What I have pointed out is that many of the posters here seem solely focused on the evils of AA and not on how another program did for them what AA could not. Juliet.roxspin

OK, I see there is a lack of positive conversation on here and I understand you do not like that—, however, you entered into conversations on here already in progress and decided you didn’,t like them …, When no one else was pointing fingers you felt compelled to. That is your right to an opinion. If AA was as dangerous a lima bean you wouldn’,t see me complaining, Cyndy! I leave well enough alone. I criticize abuse—, oh no there goes the world! How dare I criticize abuse. Right? What’,s next, I criticize murders? The shame of it all (humor attempt also)…, We can’,t always get what we want and we can’,t always control the conversation—, even if we want to.

Come on Juliet I know you know what I mean. I had to pry what your solution to your problems were months ago on another forum.

You are in a position to share your solution with others that have and are experiencing the hopeless you found in AA. I had to read through tons of words of yours on this forum to find a tid bit here and there about how you healed. I can not control what others post but I can control what I post and so can you.

Her solutions might not fit the next person. What business is it of yours to dictate to someone what they can and cannot communicate? Sponsor much?

I have a solution. Perhaps you can help Cyndy? Notify AA of the problems and make suggestions for the betterment of all. Maybe a long-timer member like yourself will have more credibility than a former member.

I have done that part in AA. When I still attended AA we formed a committee for our area to address issues such as many of you have voiced here. I speared headed what is now policy of not signing court cards we got sick of law enforment and the judicial system using AA as a dumping ground to save a buck. I have not attended meetings more than twice in three years and my decision was supported my my core group of friend in AA. We also suggest at every meeting that woman and men attend same sex meetings as often as possible. As far as weeding out any criminal element that is just not possible statics as stated by the the US justice department show that one in eleven adults in the US are criminals. You come in contact with convicted felons everywhere daily and just don’,t know it more in AA but given what brings most people to AA it does not take a rocket scientist to calculate that the percentage is at least double that. I have written my state and federal representives asking that the courts no longer mandate AA. I serve on the Drug and Alcohol Advisory Board in our county and we also work toward doing away with mandating AA. I have also asked in my letters to government officials that sex offenders be prohibited from attending AA and our areas committee monitors the sex offender site so that we have a better chance of knowing if one is attending meetings. We also did not hesitate to speak up at any hint of inappropriate behavior but I do that in my everyday life. Since I am still close with the friends I made while attending AA I know that locally we still have a committee dedicated to safety in meetings.

That’,s great, Cyndy but I wouldn’,t hold my breath on some of those. I’,ve talked with a man who was very high up in AA who only stuck around with the hopes that he could change some things. And mostly it failed. You may know massive has tried the same and met with very little success. You may be able to get some minor local changes but don’,t expect AA as an organization to change, because they won’,t.

I know we have discussed your 1 in 11 theory and how the way you’,re conceiving it is a logical fallacy before.

1 out of 11 is not my theory. That is a statistic as sited my the US Department of justice. I would venture to say since the government wants us to believe we are winning the war on crime that the ratio is an understatement.

I do not recall discussing with “,Amythist”, in a forum related to another article. We’,re younposting under one of your alts or have you changed your name with your DISQUS account.

What solution based actions have you taken other that complaining in forums. How much time and effort do you put forth to solve the issues you have with AA besides frequenting these forums? Juliet.roxspin

America has 25% of the world prison population and only 5% of the world’,s entire population. We make more felons than ever! The solution is not banning felons or segregating felons in AA—, because there are dangerous people who don’,t have criminal records and that’,s a “,duh”, moment there. The key is making members aware that telling on someone else is ok in terms of if crimes are committed—, we can’,t use the AA “,what’,s your part in it”, for example against a crime victim. A lof of conversations I’,ve had with those hurt by other AA members is that they felt they were breaking the AA program’,s steps or someone’,s anonymity, they felt too intimidated by a more powerful member, to report the crime. And the other group members were bystanders who didn’,t want to take the criminal or victim’,s “,inventory.

In other words, the AA suggestions in the literature have been used to block reports of crime—, hence a real need for a safety statement read at meetings. Remember, many hardcore AA members who follow the “,AA or die”, approach of teaching newcomers can make it seem like “,you can’,t report SoNSo, he’,s a long term AA member, you’,ll ruin him!”, It’,s intimidating. Newcomers don’,t have the power of old timers no matter what anyone says. Juliet.roxspin

Yet this isn’,t just about convicted felons (not all of which are violent or sex offenders) Cyndy, it’,s about those who have never been caught either who use AA meetings as playground to prey on newcomers. Same sex meetings would never, and have never, replaced a need for an official AA safety statement. The obvious place I would look at is what does AAWS print regarding court mandates—, and this is on AA’,s website. AA instructs how to work with inmates in prison, or in court, and how to get them to meetings. How to cooperate with the judge and probation officers. I think everything you said is great however it’,s passed down only word of mouth regarding safety—, there should be something read perhaps with the Preamble? Would it solve everything? No way. But since we can’,t control that each member will be trained to follow the same word of mouth safety instructions having it in writing seems to be taken more seriously in AA. My opinion. Juliet.roxspin

I e-mailed AA and they wrote back that the rest of the members liked the program and the book and didn’,t want to make any changes. That was their response to my hurt, pain, testimonial …, So in my opinion AA doesn’,t want to hear the negativity either.

The data would suggest most alcoholics “,mature out”, of alcoholic drinking, some to moderation, some to moderation after a period of abstinence, and some to abstinence.

This “,maturing out”, process is obviously personal for many people. It doesn’,t necessarily work in the way you’,re implying: that if not AA, there has to be some other “,group”, or “,medication”, or external “,thing”, that recovery hinges on.

Insisting that there has to be something that helped someone and that the person should be obligated to talk about it is pretty demanding and it’,s very often not that simple. Especially if AA exacerbated their drinking and leaving is what helped them gain control but they’,re not allowed to talk about leaving or why AA made it worse. Another catch 22.

For many people, talking about AA is exactly what helps them heal.

For many people, talking about AA is exactly what helps them heal.

I agree. While I don’,t comment often about my own negative experiences within AA (one man I picked up for a meeting had murdered a fellow AA, kept her corpse in the basement and had sex with it until the police came around a few days later –, and I walked “,over”, it under the floor a couple of times, oblivious), I think places like this can serve an extremely useful function for letting people let off steam.

It seems to be a necessary phase many people who feel they’,ve been harmed by AA go through. I don’,t see the point in “,requiring”, people to immediately offer a worldwide solution to alcoholism just after they’,ve left AA. Some people need time to process everything, and part of that is being honest about “,negative”, emotions like anger and not pretending harmful events didn’,t happen.

Many people who comment here and air their frustrations are still in a more positive space of action than those who are in denial.

For many people, talking about AA is exactly what helps them heal.

I agree. While I don’,t comment often about my own negative experiences within AA (one man I picked up for a meeting twice had murdered a fellow AA, kept her corpse in the basement and had sex with it until the police came around a few days later –, and I walked “,over”, it under the floorboards a couple of times, oblivious), I think places like this can serve an extremely useful function for letting people let off steam.

It seems to be a necessary phase many people who feel they’,ve been harmed by AA go through. I don’,t see the point in “,requiring”, people to immediately offer a worldwide solution to alcoholism just after they’,ve left AA. Some people need time to process everything, and part of that is being honest about “,negative”, emotions like anger and not pretending harmful events didn’,t happen.

Many people who comment here and air their frustrations are still in a more positive space of action than those who are in denial.

Gasp! Oh how horrible! There was a similar case here.

Talking about it is helpful to ourselves and to others. Personally, speaking out helped me far more than AA ever did. I have learned, though, to not put out any personal information unless you want these AA members to pick you apart and personally ridicule you for anything and everything. Juliet.roxspin

Yes, France, it seems to be a disconnect to assume if one feels AA harmed them the solution is to latch onto another program and promote it. I feel this is a continuation of step 12—, carrying the message to others.

I feel I’,ve said almost all I could say on how AA harmed me but in conversations with others, I realize something new constantly. Such as yesterday, I read how reading the steps or books aloud at meetings with the word “,We”, in the words…, made it seem like I agreed with AA when I didn’,t. I just couldn’,t not read the steps if asked to at a meeting.

One thing I do agree with (why wouldn’,t I?) with AA is being honest with ourselves and others—, because that to me is a universal truth I believed in before AA. And yes, negative things are part of the truth. And sometimes talking about them is part of healing…, So it’,s actually a positive thing. Believe me, if I was still whining I’,d be at the bar today, drinking down my misery and resentments. That’,s how I handled keeping my mouth shut while AA was in my head. The fact that I’,m successfully moderating today is a testament to my own recovery. And I am not perfect and if I ever see my goals needing to change, they will change. But I’,m not powerless today. That’,s the best part.

They dangle these high ideals such as honesty and tolerance when you can actually find very little of it in the rooms. If some people are honest they tend to be shunned because their experiences don’,t match those defined by Bill Wilson. That’,s not honest or tolerant. Juliet.roxspin

It made me question if I actually understood the meaning of honesty or tolerance because it didn’,t seem to match up with the majority of AA members’, behaviors…, and actions. Definitely it reminded me of growing up and my family’,s perception of being “,honest.”, Tolerance meant tolerating them…, while making fun of others…, it was all distorted. I was learning how to hate others growing up for no reason while being told I was loved no matter what—, and then having that love dangled in front of me like a carrot and removed if I did something wrong (even if I had done nothing wrong and it was invented out of thin air I did!)…, It was scary. I couldn’,t feel relaxed. I still have issues relaxing and falling asleep—, I can be on edge a lot. As though there is an impending war about to strike…, the anxiety issues remain long after the abuse is over.

Precisely, that’,s worshiping a dead man’,s ego.

I agree with you France. I would say personal growth and the maturing process are the most contributing factors. For me it was and is a continuos path of of refining how I think and behave. As for finding a way of recovery my father in law just up and quit after years of drinking causing havoc in his life and has not had a drink in 25 years. I have friends that have succeeded using everything from moderation programs to hypnotism.

I will say that, for me, the self examination and owning the results of my choices was the real kicker. If I want things to be better I have make choices and take actions that make me better. Juliet.roxspin

Lol Cyndy…, and I’,ve said talking about the abuse is part of the solution and you didn’,t want to believe that or accept that. I guess we’,re confused what the problem is and the solution is…, the problem for me was abuse (I drank to cope) and the solution is getting away from abusive people, places, things (bullies, AA meetings, the Big Book)…, Don’,t like my solutions? Maybe because you didn’,t have the same problems.

Sorry Cyndy, I keep accidentally hitting the vote button rather than the reply button, I don’,t want to mislead you with votes.

We have every right to express ourselves and IS helpful to others. You can object to that, but don’,t expect your objections to do anything more than fuel the fire, because telling people who have been harmed to shut up and attacking them is not going to help anything.

In AA they say, “,We are powerless over people, places and things.”, That’,s only partly true and this is one of those cases for you. Nobody is going to shut up for you, Cyndee. Nor should they have to,

You can vote on here…,who knew. Is that what this is about?

I have not asked anyone to shut up. Live in the problem all you like but I will point out the fact that you are living in the problem. What was your it with AA bashing if need be…,but do tell us how you got well.

Why? So you can ridicule me for it? No thank you. I’,ve seen how you react and how you bully people Juliet.roxspin

Can you quit it, please, with accusing others of “,AA bashing”, which makes it seem as though people are bashing AA w/ no cause or reason—, seriously. It’,s like the word “,bashing”, implies someone is [[sticking out their tongue, going “,na na na na na”, I hate AA…, AA is a buncha stupid-heads…, I hate it it’,s sooo stupid…, ]]

(That is my impression of a basher…, I don’,t do that!) Want solutions? Stop calling people with criticisms “,bashers”, because it is not a proper portrayal of what’,s going on. How did we get well—, we vented—, but you don’,t want to hear the venting…, And you don’,t agree with the solution (talking about it.) People’,s recovery needs are different. Alcohol was not my primary problem—, so I have to center recovery on emotional/abuse issues and whatever may have not helped will be mentioned—, AA did not help. Having said that, will you say the phrase “,AA did not help”, is bashing?

You are in fact, as your words here and in other forums show, a basher, hater and whinner. You may use grown up words but you are, whether you like it or not, a professional, full time whinner, hater and complainer.

I accept and whole heartedly accept that AA did not help you as it is apparent that you are still living in the problem. Chemo therapy almost killed me along with the cancer it cured but I focus on the fact that I was cured not the fact that chemo is a form of poison. Juliet.roxspin

So your solution is to bash me by calling me a whiner and complain and invent that I hate AA…, how is this solving anything for you? I just want to know. I appreciate your acceptance that AA did not help me. I am also emphatic towards you that chemo therapy almost killed you for that is horrible and also clearly a reason why they offer more than one kind of therapy to treat cancer. (But isn’,t calling chemo a form of poison bashing chemo? Can’,t do that now, can we? Lol.) Anyway, you and I deal with life differently. I don’,t feel a pressing need to denigrate you for your choices in life. Juliet.roxspin

I think you’,re confusing reporting my history for me currently living in my past—, that would be like criticizing someone for writing about JFK and telling them—, JFK’,s dead, get over it, Obama’,s president now…, I don’,t live in the past, if that helps you understand where I am coming from.

I have purged myself, Cyndy, and I continue to help others purge themselves too. I don’,t tell them to GET OVER IT. That’,s not how this works—, and I’,m all about solutions too.

You’,re comparing severe trauma in people’,s life to a scraped knee—, that isn’,t how it works. Putting a band-aid on abuse is going to infect it and make it fester and get worse. Some injuries need to air out…, for a longgg time. Healing isn’,t as fast as you may want it to be—, but again if you haven’,t been abused may be you can’,t relate to that.

Telling others when to heal, how fast to heal, is not healthy and if you are about solutions maybe listening to others will help you help them, Cyndy. That’,s my advice.

It’,s interesting that you seem to want to have so much control over other people, Cyndee, Perhaps a 4th and 5th step would be helpful and 100 serenity prayers. Juliet.roxspin

This is a good bad example of an AA member helping another person out…, telling them to shut up, don’,t be so negative…, I hope Stuart is reading this so he can see how well AA works…, those who actually work the steps become doormats who constantly apologize and the rest use the literature against others…, they are bullies. And this is why it isn’,t a supportive environment. These aren’,t short term support groups—, they are life long, with cliques, with hierarchies and leaders and followers…, And if you come into AA with abuse in your past those who are abusive will pounce on you…, I’,ve been there, done that…, Part of my solution is no longer going to AA.

Been there, done that too. I hope Dr. Gitlow is reading and taking notes. I bet he never knew that saying “,GET OVER IT”, was supposed to work so well. I bet he never knew calling patients who have abuse issues “,whiners”, was therapeutic, as well.

Thanks Cyndee. I’,m sure the field of Psychiatry will benefit greatly from the insight you learned in AA. Wow, it’,s a whole new revolution in treating people. “,GET OVER IT, WHINER!…, NEXT!”,

Cyndy she is a crusader and a great one who helps many people. It seems you have missed some of the progress made here and that’,s a shame that you want to see those harmed by a process, and an unnecessary one that that, as haters. It’,s your right to be wrong, Juliet.roxspin

Comparing abuse to a scraped knee is minimizing it…, it wasn’,t that bad ya know…, you must be exaggerating it…, you are making it into a problem by talking about it (this is what abusive language sounds like)…, This is why many people in AA go out in drink because they are making cravings a problem by constantly talking about it…, see my point here? Juliet.roxspin

Yes you’,re rather obsessed with positive-only comments and censoring abuse stories. The point is—, your reaction to abuse stories is part of the problem. That is why I talk about it. To warn others. The women in AA spoke to me the same way you have commented to me. GET OVER IT is not how a person emphatically responds to issues of abuse. You keep repeating the word “,bash”, or “,bashing”, and seriously I am not bashing anything…, except abuse. Yes, I bash abuse. I’,ve chatted with Stuart on here and he did not tell me to get over it…, I also mentioned ASAM does recommend SMART Recovery…, and he should look into HAMS as well. I am not the one obsessed with negativity—, you are. You look for it, you comment about it, you ridicule it. If you don’,t like what I have to say about abuse—, ignore it.

So replace the word bashing with talking about little else besides how AA did you wrong. You are an AA hater which is fine. You were hurt and you have a right to say so but if that is all you are going to focus on you leave your audience, which maybe much like you, in a void. A new reader of your posts, looking for an alternative, would have to read an awful lot of complaining to find anything about how you healed. In fact when I first read your posts several months ago I had to pin you down and ask you directly what you found that worked for you in the ways AA failed you.

You do occasionally pepper your comments with alternatives but your main focus is always how AA did you wrong. I have not asked for all negative comments to cease. I have suggested, since you claim to be on a mission to save others the pain you experienced, that you talk about the alternatives and how they worked for you and countless others at least as much as you talk about how AA did you wrong. Focusing predominately on the pain you experienced paints a very hopeless picture for anyone looking for an alternative.

Scratching my head. Are you looking for an alternative?

I remember discussing what helped me after being questioned by an AA member. She ridiculed and laughed at me, lol. My “,personal”, program wasn’,t as funny as much as my getting laughed at for it. I really found that humorous. I wasn’,t suggesting that anyone else do the same. Thing is, I’,ve found that it doesn’,t matter what I say when an AA sympathizer knows that I’,ve left.

Vice Verse for you, Cyndy. Nothing you said was regarding what AA has to offer, just a firm stance against those that speak against it…, “,Lets all talk about the you first!”,

Great point, Avo. Cyndee is not practicing what she’,s preaching but just wants to control and dictate Juliet’,s behavior. She needs to chant the serenity prayer.

I used long term therapy as my main healing mechanism. I used a domestic violence shelter to get out of my abusive relationship. I still donate my time, money and resources to this facility 12 years later. I used AA as my method to quit drinking. I have close friends that attend SMART and Harm Reduction with great sucess. I have not drank or used for coming up on 14 years. I quit attending meetings three years ago. I am still close friends with my core group of friends and they supported my choice to no longer attend meetings. Had a woman’,s luch out with them yesterday. I began practicing Buhhdism about 4 years ago, which, for me was the greatest help of all my tools. I volunteer regularly at homeless shelters and other community healing organization. I meditate daily. I have a core group of friends that love me and I them. I speak my mind, tell my truth and try to find a positve in every negative. I am sure I have left out something but that is my high lights. Juliet.roxspin

I’,m doing similar things. I was asked to join a drug/alcohol board last year in fact, we were in discussions to promote the SMART meeting in the area. However, turns out the board is ran by AA members (well, they don’,t say they are in AA while at board meetings) and demanded proof SMART works. We supplied that proof and they stopped talking to us, returning e-mails. It is simple to start a meeting but there is a problem with promoting and support from the powers that be. It affects supply/demand issues. Which is why I promote online meetings because it goes around the red tape of local preferences by A/D boards and what is available nearby. One doesn’,t necessarily have to start a face-to-face meeting to promote the alternatives—, online meetings are 24/7 and also they supply proof for rehab mandated meetings or court mandated meetings.

The main issue is we need the support of rule-makers, policy makers, in order to promote every kind of support —, whether it’,s SOS, SMART, whichever—, it has been a relative monopoly where AA/NA is just “,given”, this support without ever having to supply proof from the get-go. The meetings today are entering a 12 Step arena and being asked to jump through hoops AA never had to jump through. Online meetings are a great way to increase promotion of alternatives…, we simply can’,t re-invent the wheel right now in terms of expecting meetings to snowball the way AA did back in the 40s…, when they were the only game in town.

And the other programs will continue to take a back seat as long as forums such as thes keep the focus on the ills of AA. The bulk of what is said in these forums focuses on the evils if AA rather than the benefit of the alternatives and activism such as you outlined above.

You and I began this this debate, here, 12 hours ago and you just now start talking about the solutions rather than how AA did you wrong. If your reason for being was truly to help those suffering at the hands of AA what you posted above would have been your first reply to my initial posts. It took 12 hours of my badgering you.

Solution to what? If it’,s addiction and you want to stop abusing substances, focus on that. If it’,s overcoming emotional difficulty, addiction related or not, focus on that. AA teaches people that they can’,t do it alone and without AA’,s help. People need to know that it isn’,t true. They may not need a program. You follow? If they decide that they do, the individual needs to evaluate what for and in what ways they can get help. Individual people, individual problems. They are unique. They know themselves best. Giving people options are nice, but figuring what options are best is up to them. It may not be group therapy. It may be medicinal or single therapy, or couples therapy. This is where people see a doctor, get evaluated, and with a professional figure out how to get their needs met. Juliet.roxspin

Actually I strongly disagree. For too long people not voicing their criticisms of AA have made it easier for professionals to wrongly assume people were ok with AA and AA was not harmful in anyway. Negative reviews of 12 Step programs combined with sharing negative experiences is opening the doors to look for solutions to the problem. One cannot see a problem exists if the problem is not talked about.

I see nothing wrong with repeatedly hammering it home there are flaws in AA and how damaging AA’,s program can be. I began commenting on here a couple days ago before you commented back to me, so I’,m unsure what this is all about. I definitely felt like you sought out my comment on purpose and are now criticizing me for replying to you. I don’,t assume or pretend to assume how someone wants me to reply to them—, that is a strange way to conduct one’,s self. I’,ll reply on my terms not yours. This is, I imagine, how you also conduct yourself. I don’,t tell you what I wish you would say or how I want you to respond. In other words—, it is pointless trying to control other’,s responses to ourselves. Isn’,t it? Juliet.roxspin

I was told in AA meetings there were no alternatives “,this is it!”, And by professionals in rehab that AA is the best so why look for anything else. So right off the bat I get blamed for not finding alternatives in 2003/2004 when I asked people in AA and rehab for them, lol…, that happens quite frequently. I try to warn others if they ask AA for alternatives they are in the wrong place. I learned of alternatives first of all through the book “,Cult or Cure”, but it was that book, and one social worker, against the hundreds of AA members who successfully convinced me to give AA a real try. The running joke, very egocentric and conceited joke, was if those “,alternative”, groups were any good there’,d be more of them! Well, this excuse is still given today. So I did some investigating and it’,s the drug and alcohol boards—, the local ones—, who decide how state funding is spent in rehabs.

I contacted the local A/D board and of course there were AA members on the board who demanded “,proof”, SMART worked in order to use it in rehabs. And then they stopped returning calls and e-mails suddenly. This is the obstacle in the way and it is a huge one. The local boards will pick and choose what “,larger”, agencies define as recovery. The states will look at SAMHSA or ASAM etc and use that to validate the state curriculum. I don’,t have this all sorted out yet but it’,s a chain of command that has very little to do with one man or woman starting a meeting and having it catch on like the domino effect.

There is also supply and demand. It is hard to keep SOS/SMART meetings running in our area because when rehabs and courts don’,t recognize these groups who is going to go? AA has thrived on it’,s outside public reputation…, even if it isn’,t well-earned. There is a need for a meeting everyday because of the demand from courts and rehabs. In all actuality, if forced AA attendance were to disappear, there’,d be less of a need for all these AA meetings.

My theory is if the forced AA meetings were to go away, they’,d shrink to about the same size as SOS and SMART are today. But there is a false demand created and a false supply in place. What is the solution? I’,m looking for them for sure but right now it’,s an AA monopoly—, and I’,m not a legal/business/ expert and a lot of the problems lies with boards and agencies that make the rules.

You bring up a very interesting point, Juliet. How small would AA actually be if there was no coercion? I think you’,re right about that. Juliet.roxspin

I’,m not an AA hater I kindly request you stop saying that. Hate is a real strong word…, I don’,t like that word—, it denotes random, unfeeling, emotionless rage towards something. I am not a puppet for spreading alternative programs and don’,t support one group over another. There is a need for ex-AA member stories and they don’,t involve just listing alternatives, joining alternatives…, Yet…, anyway, I have other areas where I write constantly about alternatives and seemingly you have just conveniently missed those posts. So you’,re saying something about me that is inaccurate and someone reading this might assume you know me and this is true—, I want to say it’,s not true. Your’,e focused only things you find negative and somehow attempting to project this unto me is how I am seeing this. Juliet.roxspin

Sorry just read that last part—, Hate? Now you are accusing me of hate —, which doesn’,t even address anything at all about the abuses AA projects onto people…, I already told you part of the solution is speaking about it. Educating others because if we censor the abuse stories we only hear stories like yours—, everything is wonderful—, everything is fine—, nothing to see here…, but that isn’,t honest. Is it? Are people leaving AA because they had a wonderful time there and it was the best thing ever and now they are wondering where the alternatives are? Seriously, tell me how I should approach this? Edit out the bad stuff and only speak of the good? Ok…, one time I made a pasta salad for the AA anniversary meeting. I made dozens of friends—, ok, well only 2-3 of them still talk to me the rest of them want me to get over it—, and today I feel great and am not censoring myself to keep others happy.

I am NOT suggesting you speak well of AA as it hurt you. I have acknowledged that fact in prior forums and I will acknowledge that here and now.

I am suggesting that you talk about how you healed far more than you do. You have a platform and an audience that could really be helped by hearing your solution over and over, as much as they hear about the failure of AA over and over again.

Telling others how AA failed you is a perfect way to garner the power of identification via a shared bad experience. I am suggesting that your posts are biased and focus on your hatred of AA. But instead you abuse your platform, claim to be a crusader, and stop short of offering the other side of the healing side. Juliet.roxspin

I have explained this numerous times—, part of that process is speaking with others about what happened. Don’,t people sit around AA meetings for years still talking about how they used to get drunk? Isn’,t that kind of defeating the purpose? And then labeling one’,s self an “,alcoholic”, for life…, that is extremely negative…, but seems after 10-20 years in the rooms people still sitting around talking about the same things is ok—, I don’,t think so. A lot of people graduate out of their need to attend a support group. As it is, AA meetings were not support groups for me.

There is a serious need to combat “,AA works if you work it”, with “,AA doesn’,t work.”, The more people hear the opposing opinions the more fair, and balanced the information regarding AA will be. Again—, this is part of the solution. Part of the problem is telling others to only say kind things about AA and shut up about what happened to you in AA and how much it hurt- get over it, move on, no one wants to hear it.

That’,s ridiculous. That’,s like me saying, no one wants to hear how supportive AA was for you early on–, that was the past—, get over it. Why go to meetings longer than 6 months or a year…, you “,had”, a drinking problem but it’,s over…, get over it! Move on! I don’,t hate AA. My posts are biased b/c they speak from my first hand experience—, other than that I look at data that are facts I can’,t move around to fit my opinion. Unlike in AA, where facts are discarded if they don’,t fit one’,s opinion—, and one can’,t find facts in AA literature…, sadly. Part of the solution though is informing people AA is not medical or scientific—, if you are looking for facts it’,s the wrong place to be! I’,ve saved someone a lot of grief if they don’,t have to waste their time in a prayer group, if that’,s not what they need.

I never claimed to be a crusader, but I am an advocate that everyone out there in the world practices better listening skills…, too many like to put words in others’, mouths. I think there are better things to worry about out there other than my personal abuse story—, because I’,m not the only one getting abused in AA or before they get to AA…, Those people are hurting and it’,s hurting them to silence others who survived AA’,s abuse. Thankfully, I’,m not silent and part of the problem anymore, today I’,m part of solutions.

My point was that you are making regulations and I wondered if they applied to you as well.

Do you/we/they have to be discussing the solutions? The ones you say people need to be actively working on (or are otherwise “,by default only attacking”, AA).

I put lots of time and money into solving my problems after leaving AA. Does that count?

I you took my statement to have the power of a regulation you need to invest some more in your own healing as you are not there yet. My statement is a simple opinion. If you only complain and do not act toward a positive alternative your complaints are just a form of whining.

More arm-chair psychoanalysis by a Stepper, without invitation or any knowledge personally.

See my more recent post for my reply regarding your opinion. About wining, you should find something original to complain about instead of picking on me for complaining. At least I have something substantial to base it on.

I made a general state to the forum. I did not single you out…,you replied to my comment. Obviously something about the word whining in my general post caught you. So the picking would be you pciking up on my statement. You could have easily posted an opposing statement as a general post. Do not reply to me you have that option. Juliet.roxspin

Everything is whining to you…, I get this weird impression your parents or some other authority figure growing up didn’,t allow you to complain or voice criticism without calling you a whiner, perhaps? I’,m just speculating. Constructive criticism is like…, a movie review. Some movie reviews are scathing…, should we like every movie we see though? Should we praise every film ever made? No, we wouldn’,t do that. I also have read from you on other article comments that you really don’,t’, like abuse survivors sharing their abuse stories—, I don’,t know what abuse survivors are supposed to do as an alternative to that…, pretend it never happened? Never bring it up again, ever? I didn’,t learn that in therapy.

I didn’,t learn that in therapy either. Abuse survivors can’,t talk about their abuse or they are whining? Yet people can tell the same drunkologue ad nauseam. That doesn’,t make sense to me. This is the kind of attitude these armchair psychologists have all to often in AA and people wonder why we complain. This is damaging stuff and this is what we have to expect if we turn to AA for recovery. Now there are some nice people in AA. That’,s a fact. But there are some abusive ones and there are nice ones who are misled to believe that certain kinds of abuse is actually doing you a favor. Juliet.roxspin

It’,s a bit abusive to call anyone talking of their abuse a whiner…, actually…, I know it’,s an unpleasant topic and I know a lot of people want to avoid discussing it…, but that doesn’,t mean telling people to shut up…, just don’,t read about it then…, don’,t comment back that I’,m a whiner then. Even if I did present a solution like I did to many AA members they’,d tell me I can’,t change AA so…, but that is one solution. Step 1—, You are a capable person…, Step 2—, You can trust yourself…,. That wouldn’,t be AA so again, my solution would be shot down…, can’,t win…, There are some very nice people in AA but I honestly don’,t think their 4th steps were as detailed as mine…, I blamed myself for crying when my gymnastics instructor yelled at me when I was 4…, I listed anything that may be a resentment and everything…,So I can understand if someone has a list that’,s like a dozen people and they’,d be like…, that wasn’,t abusive…, it wasn’,t so bad…, but again I took AA very seriously! I was afraid if I wasn’,t very thorough I’,d die.

Sorry Juliet it was the opposite. Lots of complaining and little action were how I was raised. I learned in my home it was always someone or something that was to blame. Mom complained about being the victim of Dad’,s drinking. Dad complained that he drank because Mom was always complaining. We all complained and blamed each other. I found myself as a young adult wondering why I could not cope in life. I floundered for years, suffered from chronic, debilitating depression. I was in a violent relationship with one man, separated from another man, slamming heroine, drinking like a fish, blaming everyone and everything and complaining profusely about it constantly to anyone and everyone. My days were filled with complaining, blaming and very little else.

It was only when I took responsibility for my choices and the results that my choices reaped did I seek a solution. I learned that blaming and complaining were the key factor in where I found myself. I learned to be teachable. My perspective began to change. I learned if what I was doing was not giving me what I wanted out of life I had better do something different. I learned that even if it was wrong I would a least learn one more thing not to do. I found that focusing more on what went wrong than finding a better way of doing it was holding me back. I learned if I think and talk more about was is working than thinking and talking about what was not working I found better solutions faster. I implemented the 80/20 rule for myself. For every 20% I focus on the problem I will focus 80% on a solution. That was about 7 years ago. Today I rarely come across a situation that drags me down or holds be back and I attribute it to where I choose to focus. I try to always say that did not work but this does, or might. Juliet.roxspin

Ok, that’,s exactly what I’,ve been doing. I sat around in 12 Step meetings unable to speak or open up for about 8 years. (Because it was a non-AA discussion topic to discuss family dynamics, etc.) In therapy, I avoided talking about abuse issues because AA told me to shut up and move on—, it wasn’,t important to talk about. So this lasted til about 2011. I made a decision that I could no longer afford for my own sake to stay silent another year.

Given that I’,d spent my entire life groomed to be silent this was a huge step in a different direction for me. Part of this recovery process involved standing up for myself—, even telling my probation officer I would not go back to AA meetings because it was defeating the purpose of recovery. This was difficult and scary to do—, it risked my freedom but it made me gain confidence—, something I lacked completely.

I can only take responsibility for my choices not those of others—, I used to blame myself for others’, actions and took on their wrongs or they’,d twist it or project it onto me. AA allowed me to keep that cycle going in step 4…, etc. Another reason I have to say, like it or not, AA was a part of the abuse cycle I had to break.

Today, I share my story, despite being criticized for sharing it, because it helps me and it does help others. Recovery was impossible for me until I left AA behind, and without AA I can actually see where did I go wrong, what did I do right, and what was never my fault to begin with that I can let go of taking on other people’,s problems. This would be only my 4th year into this decision to leave AA behind for good. That is the solution for many who feel trapped in the rooms, afraid to leave. But there is hope, and a light at the end of the tunnel. Too many will stay in AA until they actually kill themselves—, that is not the only other way out. There is too much negativity in 12 Step programs. “,AA or die”, is negative as all get out. “,AA or live”, sounds much better.

Once again you you attempt to paint yourself as a martyr for the masses that have been wounded by AA by sharing your story but your story consistently and predominently focuses on how you were done wrong. You spend very, very little time sharing how you overcame. So in essence you spend a great deal of your time explaining how and why you were a victim but very, very little time sharing any sort of hope. I know the kind of time doing what you do here takes and I would venture to say it takes up the bulk of the hours in any given day. So the bulk of your time is spent living in the past, rehashing a bad experience. AA may have hurt you but here you are, years later, still immersed in it, a good portion of every day.

That is not my idea of healing.

Cyndy, there is a huge message of hope within Juliet’,s and the message of others. Bottom line is this:

For anyone in AA and suffering, either haunted by abuses past or present (AA related or not), there is nothing to fear by leaving AA. For people that feel stuck in a 12 Step Program and are scared to leave, they will know that others just like them have left and not only survived, but have also gotten well. For so many members struggling, THAT is the biggest step –, getting out and knowing that jails, institutions, and death aren’,t waiting for them.

AA’,s message can debilitate people and keep them in a position of suffering. Abuses are common in the program, even for those that are lucky enough to find themselves surrounded by good people. It’,s not that every member is bad, it’,s the messages those good people push.

The program is loaded with people that are emotionally distraught upon arriving. No, they aren’,t saints, nobody is a saint. But Step programs instruct members to focus on their negative attributes (demons), their sins which only weakens one’,s resolve and love for themselves. How does that help anyone overcome past emotional trauma or help them overcome addiction. It makes them feel like crap with nothing to help pull them back. Anything that does that consistently is like self abuse.

It’,s OK to leave and focus on your strong attributes. Loving and respecting one’,s self works if you work it too! Juliet.roxspin

I love how you phrased that—, it’,s not that every member is bad, it’,s the messages those good people push. Damn, that should go on a t-shirt!

I am constantly trying to illustrate the steps mirror abusive language and that is simply stating a fact—, I know how others may feel. I’,ve been there too. I worked those steps, correctly, and gave it my all. And because I put those steps to use I continued the same cycle of abuse others taught me as a child.

And I didn’,t think I could just walk away and leave AA—, just like I didn’,t think I was being abused as a kid. AA members and the literature taught me to leave AA was to die. I was seriously afraid to death of leaving AA…, and thought I was pure evil incarnate or something for thinking I could leave—, how dare I question AA?! How dare I doubt such a great program that’,s helped millions. I bashed myself long before other bashed me for leaving AA.

I was supposed to love AA more than myself and love the program more than me and I seriously did put AA first. I share these thoughts and experiences because back when I was there no one shared them with me.

Thank you, Juliet!, I love you, and I do not even have to know you. You are so on point within your words. I knew of people who have left AA came back, and was shunned by quote unquote AA members in good standing. (Some never came back, and guess what?!?!? They commited suicide!!! In my many years of attending AA meetings, I have seen such a click in AA, as if I was still in highschool. If you are not a follower, (as they) you get judged or shunned by many. I was also told, “,You should not be sharing that or this.”, Who died and left anyone to become, The AA Presidential Martyr?!? I have also witnessed, quote unquote lustful old timers, (just as sick, if not sicker) thinking it is alright to prey on newcommers. (On already wounded weak ones.) Sick, huh!?! Guess what? After many years I got out. Best thing I have ever done for my spiritually! (My sanity.) I have heard of the word used, in association of AA. The word is, “,CULT.”, I used to think, “,No way is AA a cult, you can get out at anytime.”, In hindsight, now I wonder? If you do not follow what everyone else does, you then get judged as if you have the plague. Let me tell you, that is no kind of group I’,d want to remain in for the rest of my life! Being sober and in AA almost killed me! (The guilt ridden crap some instill in you.) As if, I was still that abused child again. I have a voice, and not a one of its AA members, (addicted to meetings and coffee LoL!) will ever shut me up!! Oh!, I am so sorry AA’,s, I am not being as positive as you’,d like for me to be. I will not spologize for being honest and being my authentic self. God Luck!, leaders and followers. P.S. It is said, “,No one is a leader”, but, ones, “,TRY”, to be. Again, their are Martyrs in AA. Unfortunately, newcommers don’,t know better. Juliet.roxspin

Interesting the only one painting me as a martyr is this comment…, Cyndy, many have been wounded by AA I hear from them every day. Some are still scared (why would they be scared?) of sharing their stories publicly or even in therapy. The reactions to abuse stories from AA members are vicious and nasty. It is one thing to have the courage to share these experience and another thing to hear such negative backlash for it. If you are sick of my story, skim past it. I am certainly not living the past as much as you seem to be currently living in my past and taking the time to tell me about how much it bothers you. Perhaps I am not the right person for you to talk to about it. If I wasn’,t doing this, think about it, I could still be sitting in AA meetings unable to say anything at all out of fear. That was the way I was doing things…, over and over again…, expecting different results…, the very definition of insanity right? Juliet.roxspin

Yes, but how is putting me, and others down, helping you out? I’,m just asking…, because I’,m not familiar with this from AA literature or therapy…, Juliet.roxspin

Attacking what? I didn’,t know asking questions was attacking. I didn’,t know sharing experiences one has had was attacking…, the issues is people who need help. The answers are diverse and the people commenting are diverse. To each their own. To thine own self be true.

If I’,m not doing what Cyndy thinks I should be doing, I’,m not allowed to have a voice? My opinion doesn’,t count? Sure it does.

:Yes, this is very useful. Thank you. I’,m going to forward it to a few people as well as post it on my wall. Factual, to the point and very clearly written.

this is not a factual article, you manipulate statistics to make your point, you cite a study that says 5% recover(magical information from NUMEROUS 12 step programs that use the 12 steps and are ANONYMOUS, that is a pure guestimate yet you use it as fact. also the slogan involves 3 possible end results and you offer manipulated stats for only 1 of the 3 possibilities and in only 1 12 step program AA. At this point it is safe to say you have a book knowledge ONLY and NO personal experience and you also prove the old saying “,you can prove anything with statistics”, I’,m sure you and Betty Ford have a commonality, “,just say no”,. My question is, are you here to actually help the alcoholic who suffers or just to make money. Please note Bill Wilson said the AA doesn’,t hold a monopoly in helping those that suffer in recovering from alcoholism.

Maybe 80 years from now if your beliefs are still around and working then you might have a leg to stand on and if your book stays around and sells as many copies as the Big Book of Alcoholics Anonymous has and you have had millions follow your path (successfully) then you have credibility. You tear down what has worked for millions of people all around the world, seemingly to promote you as being the authority, good luck with that!!

With the 12 steps and a loving God and the fellowships I have over 23 years and if you knew where I came from you too would know tha it is a miracle for me to be alive never mind the not in jail or some mental institution aspect,

Currently there are 35 programs based on the 12 steps and traditions, true not all deal with alcohol but the fact that all these other groups are based on the 12 steps and the 12 traditions this is a testament to that processes effectiveness. I have been in recovery process for almost 25 years and I have never heard of you, your book of you concepts until tonight

Lastly you use the comment untold millions go into promotion of the 12 steps, first where on earth did you divine this figure? secondly the 11th tradition states. “,Our public relations policy is based on attraction rather than promotion, we need always maintain personal anonymity at the level of press, radio, and films”,.

this seems to refute the untold millions comment you made.

I truly hope that people who need help to find a way out, that come to you and follow your concepts find their way out too, if not you know where to refer them as we have a chair waiting for them, we’,re the last house on the block.

I’,ve only been sober for 29 1/2 years, free from alcohol, cocain, narcotics, etc and I have been a member of AA since that time. My sponsor has 40 years and his sponsor has over 60 years. I have seen time and time and time again the results of ‘,going it on your own’, and it is always a train wreck for the individual with only a handful of exceptions I have seen. I live a full life, am an active freediver, a blackbelt in Karate, go to crossfit regularily and write and play music. I have raised 4 state adopted kids to adulthood, all of whom had major issues, and am the director on a non profit agency. I have remained married for over 33 years. I am a active and grateful recovering alcoholic.

AA was never really intended for the mild to moderate substance abuser. The Big Book is clear on this. It’,s for the more or less hopeless drinker who does not age out or improve on his/her own. If the courts and rehabs have misused AA, that’,s on them…,other than carrying the message to rehabs and jails, AA does not recruit members, does not charge any fees. It’,s just a certain kind of addict helping another. If you don’,t like AA, don’,t go. Also, there is a bit of a straw man attack in many of these posts…,the most ardently Christian, AA-or death type members are not really typical. The small town southern and western AA groups are hard core Christian, but in any city of size (say, 50K or more), it’,s easy to find groups and members who are not particularly religious and in bigger cities, there are groups that specialize in applying a 12 step, nontheistic approach. As to the steps themselves, they are mainly rooted in ancient wisdom…,they have a Stoic vibe and I remember talking to a Tibetan Buddhist who said the steps are wonderful, though they would prefer a different wording for higher power…,finally, AA does not program anyone to relapse…,people relapse because they choose to get to get drunk…,any real AA member knows that after 90 days or so, most addicts don’,t have drinking/drug problems anymore…,they have living problems…,they need to learn to live without using substances to cope…,and if someone says, hey, I am now able to drink moderately, I quote the Big Book: it says “,our hats are off to you.”, But AA keeps the doors open for people like me who really lose control when they drink.

PS. I attend AA about weekly…,went a lot more during the first year when I was unsteady…,I am a straight up pure atheist and don,t think addiction is disease…,but there was enough good stuff in AA to keep me coming back, plus I was attracted to a certain kind of altruism I don,t see often elsewhere…,

Alcoholics are substantially more likely to be jailed and they are substantially more likely to need institutionalization. Statistically alcoholism shortens your life by 10 to 12 years. These are facts. That’,s the essence of what the AA slogan means.

If you don’,t believe alcoholism kills, your an idiot. As someone who watched it destroy my uncle, someone who watched my wife’,s grandfather be killed by a third offense dui, I’,ve witnessed it first hand. But let’,s look at it from the most practical standpoint, go apply for life insurance. Tell them you have 3 drinks or more daily. Tell them that you have had a dui. Tell them you’,ve been to rehab in the last year. You will be uninsurable.

What I find entertaining about this article is how the author is hung up on this in the first place. What’,s he trying to say? Is it that he believes Alcoholism is nothing to worry about? Being an alcoholic is miserable. It puts you in a state of spiritual, physical, and emotional bankruptcy. It devastates everyone around the alcoholic. In many ways it’,s worse than being dead. So why is this author so hung up on this?

Here’,s my guess. He has a financial interest in selling an alternative program to AA. He stands to make money if people follow his approach rather than attending AA meetings which are free.

So there’,s no real credibility here as far as I’,m concerned.

Kenneth Anderson, M.A. is the author of the book How to Change Your Drinking: a Harm Reduction Guide to Alcohol – a self-help manual for safer drinking, reduced drinking, or quitting alcohol altogether. Mr. Anderson is also the founder and CEO of The HAMS Harm Reduction Network. The acronym HAMS stands for Harm Reduction, Abstinence, and Moderation Support. HAMS is the first world-wide, harm reduction-based support group specifically for people who drink alcohol. HAMS is lay-led and free-of-charge. Mr. Anderson has worked in the field of harm reduction since 2002. His wide range of experience includes serving as Director of Online Services at Moderation Management, working "in the trenches" of harm reduction doing needle exchange in Minneapolis, and serving as Director of Development at the Lower East Side Harm Reduction Center in New York City. He has been a regular presenter at the National Harm Reduction Conference since 2008 and has been a guest speaker at the Harlem Hospital Harm Reduction Program, New York University, The New School for Social Research, and many other venues. Mr. Anderson is a member of The International Center for Clinical Excellence and the International Harm Reduction Association. He holds a masters degree in psychology and substance abuse counseling from the New School for Social Research as well as a masters degree in linguistics from the University of Minnesota.

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