Brendan Koerner has a really fantastic article in the latest Wired on Alcoholics Anonymous (AA). It's a fascinating exploration of the organization, from its hallucinogen inspired birth (Bill Wilson was tripping on belladonna when he found God in a hospital room) to the difficulty of accurately measuring the effectiveness of AA:

The group's "cure rate" has been estimated at anywhere from 75 percent to 5 percent, extremes that seem far-fetched. Even the most widely cited (and carefully conducted) studies are often marred by obvious flaws. A 1999 meta-analysis of 21 existing studies, for example, concluded that AA members actually fared worse than drinkers who received no treatment at all. The authors acknowledged, however, that many of the subjects were coerced into attending AA by court order. Such forced attendees have little shot at benefiting from any sort of therapy--it's widely agreed that a sincere desire to stop drinking is a mandatory prerequisite for getting sober.

Yet a growing body of evidence suggests that while AA is certainly no miracle cure, people who become deeply involved in the program usually do well over the long haul. In a 2006 study, for example, two Stanford psychiatrists chronicled the fates of 628 alcoholics they managed to track over a 16-year period. They concluded that subjects who attended AA meetings frequently were more likely to be sober than those who merely dabbled in the organization. The University of New Mexico's Tonigan says the relationship between first-year attendance and long-term sobriety is small but valid: In the language of statistics, the correlation is around 0.3, which is right on the borderline between weak and modest (0 meaning no relationship, and 1.0 being a perfect one-to-one relationship).

Koerner also investigates AA from the perspective of the brain. He focuses on the prefrontal cortex, that chunk of tissue behind the forehead that allows us to exert self-control, to order club soda instead of whiskey:

As dependence grows, alcoholics also lose the ability to properly regulate their behavior. This regulation is the responsibility of the prefrontal cortex, which is charged with keeping the rest of the brain apprised of the consequences of harmful actions. But mind-altering substances slowly rob the cortex of so-called synaptic plasticity, which makes it harder for neurons to communicate with one another. When this happens, alcoholics become less likely to stop drinking, since their prefrontal cortex cannot effectively warn of the dangers of bad habits.

This is why even though some people may be fully cognizant of the problems that result from drinking, they don't do anything to avoid them. "They'll say, 'Oh, my family is falling apart, I've been arrested twice,'" says Peter Kalivas, a neuroscientist at the Medical University of South Carolina in Charleston. "They can list all of these negative consequences, but they can't take that information and manhandle their habits."The loss of synaptic plasticity is thought to be a major reason why more than 90 percent of recovering alcoholics relapse at some point.

It's now possible to see these changes in the prefrontal cortex at an extremely precise level. Interestingly, one of the most important changes has to do with how alcoholics (and addicts in general) process "prediction error" signals. In essence, a prediction error signal occurs when we expect to get a reward - and it doesn't matter if the reward is money, sex, praise or drugs - and we instead get nothing (or maybe even a negative outcome). The brain processes this disappointment as a prediction error. As Wolfram Schultz and others have demonstrated, such prediction errors are an incredibly efficient way to learn about the world, allowing us to update our internal models (all those predictions of good stuff) in light of our mistakes.

This is an essential aspect of decision-making, as it allows us to avoid the mindless repetition of mistakes. Just look at what happens to monkeys when their prediction error pathway is surgically disrupted. The experiment went like this: monkeys were given a joystick that moved in two different directions. At any given moment, only one of the movements would trigger a reward (a pellet of food). To make things more interesting, the scientists switched the direction every twenty-five trials. If the monkeys had previously gotten in the habit of lifting the joystick in order to get a food pellet, they now had to shift their strategy.

So what did the monkeys do? Animals with an intact prediction error pathway had no problem with the task. As soon as they stopped receiving rewards for lifting the joystick - this generated a prediction error - they started turning it in the other direction, which meant they continued to receive their pellets of food. However, monkeys that were missing their prediction error machinery demonstrated a telling defect. When they stopped being rewarded for moving the joystick in a certain direction, they were still able (most of the time) to change directions, just like a normal monkey. However, they were unable to persist in this successful strategy, and soon went back to moving the joystick in the direction that garnered no reward. They never learned how to consistently find the food, to turn a mistake into an enduring lesson.

What do prediction errors have to do with addiction? One way to think about addiction is the abuse of a substance despite serious adverse consequences. We think the alcohol will make us happy - and it does, for a few minutes - but the drug will also lead to withdrawal, hangovers, ruined relationships, an empty wallet, etc. In other words, the costs of the drink far exceed its fleeting rewards. Why, then, do addicts keep on drinking? One possible explanation is that addicts can't properly process their prediction errors, so that all those negative outcomes get ignored. (In other words, we're like those monkeys who keep on pressing the joystick in the wrong direction.) The end result is that we never learn from our very costly decision-making mistakes.

A new paper in the Journal of Neuroscience by Soyoung Q Park, et. al. provides compelling support for this hypothesis. The scientists began by giving twenty "abstinent alcohol-dependent patients" a simple reinforcement learning task featuring green smiling faces (positive feedback) and red frowning faces (negative feedback).

The first thing to note is that it took the alcoholic patients significantly longer to figure out the game than a group of control subjects. Because the game was played inside an fMRI machine, the scientists were able to analyze the neural differences that led to the learning problems. Interestingly, the alcoholic patients didn't have a problem generating prediction errors in the striatum, the dopaminergic source of the prediction error signal. When they made a bad guess and saw the red frowning face, their addicted brains looked identical to brains of control subjects. Both groups instantly and automatically recognized their mistakes.

It's what happened next that begins to explain the errant behavior of addicts. In the control group, this prediction error signal was quickly passed along to the prefrontal cortex, which used this new information to modulate future decisions. As a result, the control brain was able to quickly learn from its mistakes and minimize the number of red frowning faces.

The alcoholic brain wasn't nearly as adept. Park et. al. found that, at least in this small group of addicted patients, there appeared to a connectivity problem between the striatum and the prefrontal cortex. As a result, when these subjects made a mistake, their prefrontal cortex wasn't fully informed - there was a reduced amount of "feedback-related modulation" - and this lack of modulation correlated with 1) an inability to succeed at the simple learning task and 2) the magnitude of their alcohol craving. (This data extends similar results observed in smokers.) In other words, the addicts who couldn't internalize their prediction errors were the most addicted. This suggests that it is the inability to learn from mistakes - even when these mistakes are destroying our life - that makes addiction so damn hard to escape.

Now here's some blatant speculation. I think one reason AA is successful, at least for many of those who commit to the program, is that it's designed to force people to confront their prediction errors. Just look at the twelve steps, many of which are all about the admission of mistakes, from step number 1 ("We admitted we were powerless over alcohol--that our lives had become unmanageable") to step number 8 ("Made a list of all persons we had harmed, and became willing to make amends to them all") to step number 10 ("Continued to take personal inventory and when we were wrong promptly admitted it"). I'd suggest that the presence of these steps helps people break through the neuromodulatory problem of addiction, as the prefrontal cortex is forced to grapple with its massive failings and flaws. Because unless we accept our mistakes we will keep on making them.


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I agree with your blatant speculation. Sobriety is something of a mind game; booze is a groove.

Interesting research ... however ...

I think one reason AA is successful, at least when compared to many other addiction programs

Where is the data that suggests that AA is more successful than non-AA programs? The story suggests that alternatives have the same success rate (which to say low).

This statement in particular jumped out at me from the article.

AA doesnât work for everybody. In fact, it doesnât work for the vast majority of people who try it.

This always bothered me - why do we keep pushing a program that fails the "vast majority" of time? And not do more research and testing with programs that may have a higher success rate? The article touches on some of that aspect but I can't see how anyone can call AA a success.

The use of Baclofen to reduce cravings appears to have had success for addicts who had not been able to quit using other means. "The End of My Addiction," by Olivier Ameisen, M.D., covers his personal treatment and provides additional information in the comprehensive bibliography. The book is worth reading.

By OftenWrongTed (not verified) on 01 Jul 2010 #permalink

Interesting Blatant Speculation.

Makes sense, though. You might be on to something!

You're right, Tim. I've changed that sentence. Given the contradictions in the data, I think it's better to not talk about the relative success rate of various treatment approaches. I've changed the sentence. Thanks.


As always, informative, highly readable and insightful. Have the recent (print) issue of Wired on the coffee tableâlooking forward to digging into this article.

-Tom B.

I think that the "confronting of mistakes" in AA is more like wallowing in the pain of the past and not moving on, a prime reason why many people start drinking in the first place.

People with serious problems as a result of alcoholism deal with the consequences every single day. It isn't something that can be escaped. All the self pitying nonsense is totally encouraged. I mean, they give people a space to talk about this stuff but not any real way to deal with those mistakes AND retain/build self esteem. It smacks of the freaky unhealthy boundaries and inappropriate confessions that mormons/other cults expect of their members so often. Both make it seem like their members are hopelessly broken individuals, and that the group is the One True Hope at getting better. It keeps people coming back but I don't know how much anyone is helped by that brand of confession.

Outside of the blatant speculation I found this article to be extremely interesting and informative. Thanks.

It would be useful, perhaps, to research and discuss how the big dopamine payoff, which those who are addicted to anything experience when they partake of their addictions, affects prediction. My guess is, if I had a strong reward from doing something that wound up hurting me, my brain would most likely 'forget' the prediction, or not bother to create that useful pathway (that is, I would not learn from my mistake), and just go for the pleasure (or release from anxiety, or whatever the substance or activity was providing).

By zephyr haversack (not verified) on 01 Jul 2010 #permalink

This makes me wonder if more addicted alcoholics (those who could be said to be more alcoholic) have correspondingly severe disconnects between the striatum and the prefrontal cortex.

If so, could an fMRI test like the one described be used to diagnose persons as to the extent of their alcoholism? Maybe someone drinks regularly, but doesn't think they have a "drinking problem", so they and/or their friends/family sign them up for one of these tests to determine a presence of absence of alcoholism...

skeptifem, in my experience, the average active alcoholic an amazing ability both to blame their drinking on their circumstances and to rationalize away the negative consequences of their drinking. The brief period of remorse following a binge can be wiped away by starting a new round of drinking. IMO, AA is decidedly anti-wallowing. Getting stuck beating yourself up for past mistakes is not going to help the adddict. The steps do in fact provide a way for people to work through their past in such a way as to get freedom from it, and its nothing more than common sense-if you've screwed up, acknowledge it, apologize/make restitution to the harmed party, and don't repeat the behavior. As a member of a different 12 step program, I have found that process to be challenging, but liberating.

I think AA works very well for some (a minority, IMO) people, but is not at all a cure-all. I do know they don't like getting sent by the courts a bunch of people who don't want to be there any more than the people getting sent there do-its generally a waste of time for everyone.

Nice article Jonah, though it's important to note that prediction errors also occur, and in fact are much more substantial in important reward circuits, when one DOESN'T expect a reward and one is received (a positive prediction error). It's this type of error that drives learning guiding behavior TOWARDS specific cues and situations, versus the one you discuss which directs behavior away from circumstances.
Both are very important for learning, but when we're talking about aversive stimuli, which you mention in the negative consequences of drinking discussion, the learning actually takes place in very different brain regions.
If you have a chance, check out a recent article on our site about white matter dysfunction, and problems in LTD, an important process in learning, among addicted, versus non-addicted, animals. I think it touches on the same themes you brought up here.
Good work.

- We favor the medical model of addiction as inherited, incurable dopamine receptor deficits that drive compulsive dopamine triggering in an attempt to make up for chronic, acute "under" stimulation of seeking impulses - not reward/"feel-good" states (this distinction deserves its own post)
- While certainly frontal/cortical structures play a role, we stay focused on brain-stem and increasingly mid-brain processes. The evidence we seen suggests that any (likely largely post-hoc, observational) cortical role is exaggerated in human research commentary as a pop/humanistic defense of free-will and conscious control. Good headlines - weak science. If there isn't a correlate in rat brains we don't think it controls much human behavior - except verbal/largely self-talk behavior.

Finally, self-help programs like AA/religion/rehab are quaint but unprofessional and, at best palliative.

Self-help, without professional medical care, likely works as well for addiction as other inherited and structural organ illnesses. If there isn't a solid evidence-basis, why waste the time?

Note: On the heroic stories about and by people suffering with alcoholism, it's worthwhile to remember that classic symptoms of the illness include grandiosity, non-stop drama and hyper-self-centeredness. In the addict's brain-stem, very little cortex here!, it really is all about their immediate impulses - all the time.

These have proven to be very effective ways to distract attention from their brain-stem's prime direct 24/7/365: Get drunk now! That "seeking," not "reward," drive again.

We're not saying they're "bad" people but but the brain impairments drive them to say or do anything in service of getting blind drunk -- all the time. It's a horrible curse. Like any disease there are different degrees of illness.


I work with adult students at the basic skills level and know that many of them are recovering alcoholics or addicts. The other teachers and I know that they tend to have excellent attitudes and are often a bit sharper than other students, but they also become incredibly frustrated when they run into problems. Their frustration is not something that is just a part of their personality since many of the students have quite calm and deliberate demeanors. And their frustration does not show up when they are dealing with complicated tasks.

Instead it shows up when they make mistakes and need to developed a different way to solve a writing issue. We know that they often deal with their frustrations by just giving up and walking away. Adding the emotional baggage of giving up on an education just adds to the emotional baggage they are already carrying.

I imagine a similar issues with the prefrontal cortex is contributing to the issues in my classroom. I just wish I had an fMRI machine to test whether these two issues are one in the same.

By Gopherus Agassizii (not verified) on 01 Jul 2010 #permalink

Great article, Jonah! As a long time (20 years) recovering alcoholic,and an avid reader of brain research (on a lay level), this is fascinating stuff to me. If the communication to the prefrontal cortex is impaired in addicts, that impairment could still affect other parts of their decision making processes, once they are sober, no? The prediction error response applies to all manner of reward type situations, as shown in the rat experiment. Do you know of any research done on long term sober folk to see if the communication pathways get better with no substance abuse?

My daughter has been clean now for 3 years thanks to NA (Narcotics Anonymous). She is very involved and heavily committed to the program; attends 3 meetings a week and also runs meetings in hospitals and institutions.

I also held the belief that the program consisted of wallowing in self-pity about the "disease" in a form of group navel gazing. I questioned whether they had simply replaced one addiction with another; meetings.

I still think there is some of this in play, but what I see from my daughter very much jives with Jonah's article. My daughter tells me that the people in the program realize their judgement of consequences is impaired. They use the group to help analyze situations and determine the possible outcomes from various actions. Eventually, they learn to do this on their own, but stay with the group to reinforce the learning which they know can quickly be challenged through new experiences and/or stress. It's as if they - as a group - rewire their brains.

So, my layman's view of AA is that it works from a psychological perspective (support) and neurological perspective (relearning).

I would be interested to learn if there are any heriditary issues in play in regards to diminished prefrontal cortex/synaptic plasticity and addictive behavior. My daughter comes from several generations of addicts of some substance or another...

Most of the above comments disparaging AA seem to be made by people who have no clue as to what it is all about. It is very common for outsiders to compare AA and other 12 step programs to religion and/or cults. The best way to summarize AA is in one of it's slogans... "It works if you work it". Period.

AA has a long track record of success, and in a world of ever increasing health care costs, and reduced health insurance coverage benefits, AA has one major benefit... it is free. It is completely self supporting and "off the grid" of the medical establishment. (If we want to discuss failure rates, let's look at the current ultra expensive re-hab system)

As a 16 year sober person I can vouch for the successful side of AA and other 12 step programs, and I can't explain it better than the "promises" of AA...

"If we are painstaking about this phase of our development, we will be amazed before we are half way through. We are going to know a new freedom and a new happiness. We will not regret the past nor wish to shut the door on it. We will comprehend the word serenity and we will know peace. No matter how far down the scale we have gone, we will see how our experience can benefit others. That feeling of uselessness and selfpity will disappear. We will lose interest in selfish things and gain interest in our fellows. Self-seeking will slip away. Our whole attitude and outlook upon life will change. Fear of people and of economic insecurity will leave us. We will intuitively know how to handle situations which used to baffle us. We will suddenly realize that God is doing for us what we could not do for ourselves.Are these extravagant promises? We think not. They are being fulfilled among usâsometimes quickly, sometimes slowly. They will always materialize if we work for them." (from the AA Big Book)

So, if it's a connectivity issue, I wonder if you could improve connectivity between striatum and prefrontal somehow through innocuous prediction-error learning (i.e., run a series of similar prediction error tests and reward positive prediction error learning) - and if that 'learning' / increased neural pathways could improve addicts ability to properly recognize the harm of their own addictions?


Your blatant speculation fits my experience. Take a step back and consider the steps you describe without alcohol. What you have is a process for continuous improvement. Not a bad deal.

CH Paquette highlights the way AA works. Sure the social support within the AA group and the complete absence of profit motive makes it available to everyone.
The success of AA, and every other 12 step group, is achieved by actually doing the 12 steps. Most alcoholics eventually find themselves in an AA meeting. When it's court-mandated or to get a loved-one or employer off his back, the likely hood of recovery is nil. Even a seemingly motivated and remorseful sufferer will struggle with relapses if they balk at doing the steps. The program's success cannot accurately be evaluated unless we stick with studying just those who go through all the steps.
This new discovery in brain function validates the 1st step empirically. Unless one accepts they are powerless over alcohol (just like Michael Jackson was powerless over propofol), he will pursue the illusion that he can somehow manage drinking and find a way to avoid the negative consequences. Once any amount of alcohol (or drug) enters his system, the phenomenon of craving kicks in like a primal instinct so strong that it completely overcomes any rational thought. That's why total abstinence is crucial. The hypothesis presented here provides a scientific explanation for why alcoholics/addicts who by all other accounts quite intelligent, still fail. Understanding the disease inside and out, is not sufficient to avoid that first drink/drug. The excuses, if any, for picking up the first one seem nonsensical in light of the consequences.

Another common mistake that non-affected critics make is not actually reading the AA Big Book. Otherwise they could easily identify that nearly every example of failure correlates with failure to work through the steps, just as the book states. "Rarely have we seen a person fail who has thoroughly followed our path." A dedicated professional or researcher in the field, ought to at least read "The Doctor's Opinion" in the introduction written by the most prominent medical expert at the time. This non-alcoholic's description of the disease remains remarkably accurate today.
Alcoholics Anonymous acknowledges that it is not the only way. Nor do they claim expertise on the medical or psychological aspects of the disease. But this statement is still true 75 years later. "Physicians who are familiar with alcoholism agree that there is no such thing as making a normal drinker out of an alcoholic. Science may someday accomplish this, but so far it has not."

Whenever I run across discussion of AA in scientific blogs or articles, someone always denounces AA for not fixing everyone, and bemoans the fact that modern medicine has woefully failed to discover a more effective approach. Given the prevalence of addiction/alcoholism in society,it is highly unlikely that the issue has been neglected. Still today, nothing can replace AA.

By laursaurus (not verified) on 02 Jul 2010 #permalink

This always bothered me - why do we keep pushing a program that fails the "vast majority" of time? And not do more research and testing with programs that may have a higher success rate? The article touches on some of that aspect but I can't see how anyone can call AA a success.

Because SOME success is better than NO success? Look at IVF as a perfect example. For these people it's the choice of NO BABY of their own geneset contribution versus at least a low-chance of having a baby from their geneset contribution.

Jonah, Your article is right on target with my alcoholically wired brain and the experience of trying to deal with it's inability to think differently. Just like the mice, I was unable to change how I mentally reacted to things that occured in my day to day life. Hense my life resembled the "Groundhog Day" movie. Even though I was long time sober I felt like I was living the same day over and over and was powerless to change what I was doing in the relationships in my life. The part in the movie where Bill Murrey was killing himself to stop living the same day over again was were my brain was headed. My brain began to look at suicide as a solution. The solution found in AA for me was the 12 step process. It is an experiential process that takes apart the defective thinking and patterns that are hard wired into my brain. Repairing the harms done to others shuts down the brain from constantly reviewing the past and projecting about the future. For the first time I was able to experience my brain in the moment. Hense the ablility to work a 10th step that deals with what is currently going on in my brain. I learned to see the thinking by writing my thoughts on paper. Then, once I'm aware of the defective thinking, instead of returning back to my defective brain for an answer AA taught me to ask for guidance, and this is the 11th step in the program. New ways of living happen when I shut down the old hardwired brain patterns. The 12th step increases my awareness of my thinking by passing on what I have learned to others who want what I have. It is still a mystery to me as to how I can use a brain that is wired to kill me and use it to save my life and others lives, but it works. I'm living proof. My brain no longer sees suicide as a solution. I'm a life saved and there are others around me alive today because of the 12 step process. As another one of your readers wrote, the process is only for those who want it. Someone who is not determined to get sober is not going to go to these lengths. Like the mice that went back to pushing the joystick in a direction that didn't get them a pellet I have watched many a drunk choose insanity or an alcoholic death over working the steps. The good news is that this process when worked on a daily basis accelerates. My experience is that it becomes a working part of the mind.

Interesting, Jonah, but I think your "blatant speculation" is off. People start getting better as a result of not drinking, period. If they happen to be working the steps at the time, they will attribute their success to that busy work. Correlation is not causation.

In AA, one is told to pray even if they don't believe, then when they start to do better because they have not been drinking, they're supposed to realize that God has answered those prayers:
"You can, if you wish, make AA itself your 'higher power.' Here's a very large group of people who have solved their alcohol problem. In this respect they are certainly a power greater than you, who have not even come close to a solution. Surely you can have faith in them. Even this minimum of faith will be enough. You will find many members who have crossed the threshold just this way. All of them will tell you that, once across, their faith broadened and deepened. Relieved of the alcohol obsession, their lives unaccountably transformed, they came to believe in a Higher Power, and most of them began to talk of God." (Twelve and Twelve, Step Two, pg. 29)

AA is, at best, a placebo. Attempting to figure out how it works is an exercise in futility since AA's success rate is the same as the rate of natural remission. Studies that talk about AA attendance and long-term sobriety are flawed from the start because they ignore the dropouts. Attendance in a sobriety group is associated with sobriety?

I've been sober for 12 years, and in my experience, "working steps" is useless. The social support available in AA is nice, but the program itself is too flawed to be helpful. The plain fact is that the steps are not geared toward healthy thinking or behavior: instead, they are geared toward turning oneself over to God and having a spiritual experience.

I was in therapy during my early years of recovery, and the exercise of working the steps was continually at odds with what I was discovering about myself and life with my therapist. Yet when I mentioned this to my AA friends, I was told that I was "too smart for the program" and needed to pray more. Eventually, the uselessness of the steps and the lack of intelligent discourse at the meetings led me to leave the program entirely.

I am always amazed when I run across intelligent, science-minded people tripping over themselves attempting to figure out "why AA works", in the face of the concrete reality that its efficacy has never been proven. If treatment for any other condition was involved, the scientific and medical communities would be actively trying to come up with something better, rather than trying to come up with reasons to cling to past failure.

By Mona Lisa (not verified) on 03 Jul 2010 #permalink

People who believe that AA helps them should definitely go to AA. I just can't stomach it anymore. There are other methods for changing thinking and repairing the damage that alcohol has caused to the brain.

Far be it for me to call B.S. on an fMRI, but as a recovering alcoholic, the assertion that the risks of drinking far outweigh the benefits doesn't ring true. I mean, clearly that's inherently true, but at the time I was hitting the drink hard, the last thing I wanted was to have my family around, I didn't give a crap about work, etc. So, in fact, I was making an informed, fully rationalized decision; the small reward of drinking was actually very worth it within the framework of that distorted reality. Because it wasn't just the body buzz/pressure release; it was feeling like I had the potential to be someone entirely different from who I was. That's pretty compelling stuff. Sign me up!

I think the truly intractable part about drinking is the chemical feedback loop your brain's been on for years...the brain is awash in self-administered circuitry, and has physiologically been remapped to shortcut to the reward....and while this could obviously interrupt the conveyance of prediction errors, I think it's incidental, not the core thing responsible for producing sustained, compulsive behavior.

As for demystifying AA, I think i know why it works. It gives people a place to chill while the brain returns to an approximation of its normal patterns long enough to take root. This can happen anywhere safe and supportive. I credit my boyfriend and Netflix.

Thanks all for the conversation, and Jonah for the terrific article.

So we have a lot of non-professional comments and users on here...oh well. Not much interesting or enlightening. Personal venting doesn't help the cause. If it did...

Science can.

I left drinking about 18 years ago after about the same amount of years with having the drinking problem. I didn't go to AA, but through reading and examining myself I used the rational way to leave alcohol...I took responsibility, didn't trust myself to a "higher authority", etc.

However, when I told people how I quit without AA I was told "Oh, you didn't really have a problem." So, I just stopped talking about it unless I was asked by a sincere person. Leaving alcohol was hard but simple work...and very satisfying.

By Joe Robinson (not verified) on 03 Jul 2010 #permalink

laursaurus writes:
"someone always denounces AA for not fixing everyone, and bemoans the fact that modern medicine has woefully failed to discover a more effective approach"

It's not that AA doesn't fix anyone, it's that AA fails to improve upon the rate of natural remission, judged to be about 5%. George Vaillant, former Harvard professor, researcher, and AA Trustee, set out to prove that AA works. He said of his findings, "Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling."
"The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery"

Modern medicine has found more effective methods than AA, 37 of them can be found here:
"What works? A summary of alcohol treatment research" in R. K. Hester & W.R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives (3rd ed.), 2003, Allyn & Bacon.

"AA doesnât work for everybody. In fact, it doesnât work for the vast majority of people who try it."

No, AA works for 100% of the people who try it. When you stop trying, that's when it stops working. AA isn't a "cure." It is a process, and as they say, "it works if you work it."

Raysny writes:

"What works? A summary of alcohol treatment research" in R. K. Hester & W.R. Miller (Eds.)..."

This absurdity of this list is frank - the list topper is 'brief interventions'. Really... brief interventions with your trusted physician cures alcoholism...

I posit another blatant speculation - if you're not an alcoholic you brain literally cannot understand why AA works. If you are an alcoholic, you literally have no difficulty understanding why aa works. I would be interesting in seeing some brain research on that one.

Interesting variation on the absurd argument that "if you don't get AA, you were never an alcoholic in the first place", Mark. It's so strange. When I presented for treatment, nobody had any difficulty diagnosing me as a chronic alcoholic. Drank for 25 years...every day...blackouts...couldn't troubles...yep, alcoholic. But it's amazing how my alcoholism suddenly disappears when I'm critical of AA! "If you can stay sober without the program, you were never an alcoholic in the first place." Oh, how I wish.

By Mona Lisa (not verified) on 04 Jul 2010 #permalink

Mona; if you have gone to AA you certainly understand why it works - it didn't work for you, but you understand why it works for others.


Spoken like a true believer. I attended AA on and off for about twenty years, never managing more than a few months sobriety. It wasn't until I turned my back on AA, took responsibility for my addiction that I could take responsibility for my recovery. I've been sober since, 9 years next month.

Brief interventions do work, but not after someone has been taught that they are incapable of changing on their own.

Luckily, most people who realize they have a problem with alcohol quit before ever going to AA. The NIAAAâs 2001â2002 National Epidemiologic Survey on Alcohol and Related Conditions interviewed over 43,000 people. Based on the criteria for alcohol dependence found in the DSM-IV:
"About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol (rehab) programs and AA. Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment."

"In a 2006 study, for example, two Stanford psychiatrists chronicled the fates of 628 alcoholics they managed to track over a 16-year period. They concluded that subjects who attended AA meetings frequently were more likely to be sober than those who merely dabbled in the organization."

This data doesn't show AA specifically is effective because those who are most committed and conscientious - i.e. those who will be more likely to stick to *any* program - are also likely the ones most likely to stick to AA.

Mark: Why do you suppose that my years in AA resulted in my "knowing how it works for others"? To the contrary, my years in AA gave me a ringside seat to watch it repeatedly not work for anyone. Probably the first person to clue me into this (albeit unwittingly) was my sponsor, who was comforting me after my first sponsee relapsed. She said: "Mona, if somebody doesn't want to get sober, there is nothing we can say or do to help them. And if they do want to get sober, there is nothing we can say or do to make them keep drinking." Which renders the program a recent meta-analysis of the research confirms:…

By Mona Lisa (not verified) on 05 Jul 2010 #permalink

The 12 Step, God-based treatment methods have an unacceptable failure rate. Even those in the industry know it and they are looking for alternatives. AA's basic approach is that you are powerless over alcohol, people, places and things, you must give your life to a God ( who is the only one that can give you the power you need), then you document your negative aspects, make amends for your wrongs, continue to seek God and help others( to find God). Now does this sound like an acceptable, modern treatment regimen? Would you use it on yourself to cure cancer, diabetes, heart disease ? If you went to a real doctor for a real problem and they told you to do this for anything, what would you say? So, why do we accept it as a plausible treatment for alcoholism today? Especially when the real success rate investigations all point to massive problems. like a higher death rate, a higher severity of relapse binge drinking and a higher rearrest rate than other methods - including no "treatment" at all. AA will always be defended by the faithful, because that is what they are - faith-filled, not fact accepting. The 12-step treatment monopoly must be broken and replaced with modern treatment methods that have real, provable results. AA needs to be pushed aside and put in the class of medical solutions that include faith healing, leeches and blood letting.

I agree lets close AA down and tell 3 million people to go figure it out themselves. Maybe they could read some scientific mumbo-jumbo. Or you experts could host non-drinking classes at your houses. OR we could leave them alone and let what is working work.

By Fred Rogers (not verified) on 05 Jul 2010 #permalink

Fred: I wish I could easily pass off this issue with a sarcastic remark, like you've done. To me, though, it is a real problem when sick and desperate people reach out to the medical community for help with a problem, and get recruited into a statistically unproven faith healing group while their medical insurance (or our tax dollars) pay for it.

By Mona Lisa (not verified) on 05 Jul 2010 #permalink

I am curious about Mona's comment that medical insurance and tax dollars pay for AA. Surely, as a former member, you know that AA is completely self-supporting through member donations. Where and how do you believe medical insurance and tax dollars fund AA?

Anna: Because medical insurance and tax dollars (Medicaid) fund 12 step based treatment centers. I'll use myself as an example of what goes on every single day in the "medical" treatment industry. I decided to quit drinking and I showed up at a local hospital for treatment. I was placed in outpatient rehab, where (1) my counselor was in AA, gave me a meeting list, circled the meetings I was to attend, and laughed when I mentioned I was interested in using Rational Recovery instead of AA; (2) the 12 steps were posted on the wall and we were expected to do them up to step 5; and (3) part of my treatment plan was to attend AA meetings and get a home group and a sponsor. My health care insurance paid for this. My experience was not unusual; in fact, it is the standard way things go in the treatment industry today. Of course, AA claims that there is actually no relationship between it and treatment centers...which is strange, since it actually provides instructions on how to go about partnering with treatment centers (it calls this partnership "cooperation" in an effort to avoid acknowledging what is really going on, but the truth is pretty transparent to anyone who has actually been to 12 step based treatment center).

Here are links AA's website there it provides these materials:

Treatment Facilities Workbook (for AA members who work in treatment centers):

Cooperation with the Professional Community Workbook (for AA members who want to âcarry the messageâ to the treatment community):

By Mona Lisa (not verified) on 06 Jul 2010 #permalink

AA is, in my opinion, the opposite of a self-help group. The point of it is that we are incapable of helping ourselves, by ourselves. The admission of powerless is not intended to humiliate, but to gain a sense of humility - a realistic sense of our limitations as well as our strength. I (by myself) am powerless over the craving and effects of alcohol, but I can remain sober as long as I turn my recovery over to the care of others (a power greater than myself). This I choose to call God - even though it doesn't fit any traditional definition of such. And this is more than what AA requires of me in terms of believing in a higher power.

The reason I need to turn my recovery over to a group of people in my same situation is implied in Jonah's speculation. The type of thinking that will lead me to relapse is like a gravitational pull that eventually will lead to very bad decisions (and a return to drinking). The meetings counteract this tendency by either giving me the opportunity to confront the truth about myself, or to identify my own behavior in someone else's story. While this may look like wallowing and self-abasement from the outside, in practice it is quite the opposite. The key to this is the making of amends to those that I have harmed. Once I begun that process, my past mistakes are transformed from being a source of shame into being a tool that can be used to help others.

When I tell the gory details of my past, the goal is not to self-flagellate and seek pity (because I no longer need either), but to seek to connect with others who have had similar experiences - to help reconnect the action-to-consequence part of their mind in the hopes that the identification will counteract their own gravitational pull and help to keep them sober for another day.

As for the steps, they are a plan for dispelling delusion - such as the idea that I am the center of the universe, the lies that I tell to others and myself, the shame/anger/fear about my past, and the sense that I cannot help or be helped by other people.

Is it scientific? Frankly, I don't care. I don't need to care. All I need to do is compare my life to the life I led before going to AA to realize that to give it up for the sake of someone's statistics is folly bordering on insanity.

You don't have to give it up, Tim. You can think whatever you want. The problem is that as long as 12 step maintains its monopoly on treatment, the rest of us don't have the same right that you enjoy. Instead, we typically get told that if we don't like 12 step, we aren't serious about recovery. When we get sober without utilizing 12 step, we are accused of being "dry drunks" or of never being alcoholics in the first place. I know it may be hard to see this from the majority perspective, much as it is hard to see racism in the US when one is white. But the reality is that when it comes to addictions, many of us are ignored or outright mistreated simply because we don't care for the 12 step approach...which, to repeat, has NEVER been shown to actually work.

By Mona Lisa (not verified) on 06 Jul 2010 #permalink

This discussion could be about mindfulness-awareness meditation which addresses all bad habits rather than just one. A lot more people come and receive instruction (for free) than stick around and do it. One must have strong motivation to stick to making it a habit and for those who do, they continue with the practice because they find it of benefit. As with AA it is helpful to have a personal guide who has actually done what is purposed and it is helpful to be around other people who are studying the same teachings and doing the same practice.

As an experienced AA man, I'd say those who commit to the AA program are switching addictions.

By vadar, darth (not verified) on 06 Jul 2010 #permalink

Mona -

I'm not a spokesperson for AA, and fortunately it is designed not to have a spokesperson. I can only speak for my experience with the program. In the meetings that I attend it is regarded as against our principles to 'accuse' someone else of being a dry drunk or claim that they are/aren't an alcoholic. As our preamble states, the only requirement for membership is a desire to stop drinking. People should be allowed to implement the program however they choose.

Should treatment centers try using other approaches as they are discovered? Sure. I'm neither a doctor nor a scientist and am not qualified to judge whether something else would be equally or more effective. I'm also against the idea of 'mandating' that a person attend meetings, since that would imply an affiliation between AA and an outside agency. It should only be for those who want it, and we should not be evangelical in our approach, but rather rely on what we call 'attraction rather than promotion' - tell our individual experiences and be willing to help those that want to do what we did. But if a person manages to overcome an addiction in some other fashion, what right do I have to say that they're wrong?

As for the statement that it has 'never been shown to actually work', the only evidence I have to counter it is myself and the people I know that have had years, even decades, of sobriety in AA. It may be a coincidence, or even a placebo, but my (anecdotal) experience tells me something else.

Same with meditation, Darth. Some addictions are more helpful than others.

Getting back to the article I do think Jonah is right; the goal of AA is to force one to confront their prediction errors and the program does this in several clever ways - drunkalogs, sponsorship, belief in a higher power, etc.

AA is not as dogmatic as these chats suggest; the individual meeting chemistry is very different. Commenters who are listing a bunch of AA dogma are way off base and probably should have just found another meeting if they tried the program.

There are some things that must be grasped; one is that as an alcoholic you cannot drink socially (step 1). A lot of alcoholics try and evade this one for years, even decades, concocting elaborate plans and rationale, and the medical profession pretends they can help out by proferring pills to alkies into social drinkers. Brain-wise, this is almost certainly a big waste of time.

The second is that it is hard for many to white-knuckle it and do it alone - this is where HALT (hungry, angry, lonely, tired) comes from. A lot of alcoholics, and even more non-alcoholics that write articles about alcoholism, think that willpower should be sufficient - just stop drinking. The problem, as every alcoholic know and Roger Ebert said so well, is that willpower only works until your willpower tells you that you are strong enough to have a drink. But you only get to take the first drink; the second drink will take itself.

And this is where the higher power thing come it - you can't do it yourself, even though your your brain is telling you it can; you're essentially being lied to, by yourself. The 'higher power' will get you way out of that box you have put yourself in.

Finally, and for all the comments to the contrary, many alcoholics do not want to be cured, preferring to probe the proverbial bottom to see where its hardest to bounce off of it.

My personal experience with AA was not so positive as that of some and I found a major flaw in its program. The reason it seems so successful is that those who are still going are the ones who have dumped their baggage on others who are out paying for it by getting drunk again.

The transferences that go on is mind boggling to say the least and I attended AA for 10 years. The 5th does say admitted to another human being, the nature of our wrongs. Mind melding with someone who can handle it is one thing, mind melding with someone who is new in the program is another. My first sponsor did this to me, I ended up acting out his baggage and going to prison, he was a Vietnam Vet who was somewhat involved in the My Lai Massacre. Psychologists might call it dissociation. He needed professional help, I was blind to all of this then, being a pigeon (carrier and newcomer to the game).

I have to agree with those who find that it can be abusive. I have done better being away from AA, than when I was attending AA. Taking techinques from Maxwell Maltz and others, looking in the mirror, admitting my mistakes and forgiving myself seems to be the most affective, because in the end, it is ourselves we have harmed the most, by damaging our own health.

I ahve also been an avid television viewer and what a brew in the mind that can conjure up. You can feel guilty for something you didn't even do. Alcohol was so heavily advertised once that I am surprised that the entire Country isn't alcoholic. Finding and separating the sources of my problem has been eye opening to say the least. I didn't have to forgive myself for being manipulated into drinking or feeling guilty about my behavior when so much more of it was influenced by the environment, My father drank, my uncles drank, my aunts drank occasionally, my cousins drank, my peers drank,some of my favorite movie stars drank and smoked cigarettes. I hated the stuff when I was a teenager, but then I linked it to having been given paregoric as an infant and I was off and running, it became less and less blissful and more and more a problem. I admitted myself into a treatment facility twice and was an outpatient twice. Only one Doctor of all that I had seen, introduced me to the effects of alcohol in my BRAIN. That was the beginning of my journey into getting off it. The more about my brain I learned, having witnessed the effects of alcohol on so many people in my family and in AA, believing it was not a problem. You can lead a horse to water but making him drink it another matter. There was never a time that I did not want to stop abusing my body and brain, but nor did I want to relinquish that pleasure. It just wasn't like the paregoric that made me feel better, the alcohol started making me sick.

I have weaned myself from the grips of the influences that kept me drinking. Maintaining conscious awareness of the ill effects of alcohol rather than pummeling myself with the pleasures was a step in the right direction.

"And this is where the higher power thing comes in - you can't do it yourself, even though your your brain is telling you it can; you're essentially being lied to, by yourself. The 'higher power' will get you way out of that box you have put yourself in."

This comment, I submit, reveals the basic fallacy of AA: the notion that "you can't do it yourself", that the power to quit comes from God, from a doorknob, from the meetings. Sure, some meetings are better than others in the sense that they are less abusive and bizarre; but they ALL share this essentially absurd philosophy.

By Mona Lisa (not verified) on 06 Jul 2010 #permalink

Mark writes:
"There are some things that must be grasped; one is that as an alcoholic you cannot drink socially (step 1)."

No Mark, step one reads, "We admitted we were powerless over alcoholâthat our lives had become unmanageable." You're attempting to shift the meaning into something that you can defend.

You claim that AA isn't as dogmatic as we claim, and attempt to prove by pulling out the old slogan about going to "better meetings". The stock answer to that is, "That's like telling a person who doesn't like the food at one McDonald's to try a better one."

Mark also writes:
"And this is where the higher power thing come it - you can't do it yourself, even though your your brain is telling you it can; you're essentially being lied to, by yourself. The 'higher power' will get you way out of that box you have put yourself in."

So how do 75% of people stop on their own then? How can atheists ever possibly get sober? Take me for example, I've been sober almost 9 years. My "higher power" certainly didn't do it for me, I don't have one, especially not one that I pray to who answers those prayers.

All you're doing is reciting dogma. You're talking in circles thinking you're profound; you may dazzle 'em in the rooms with it, but out here you're dealing with adults and some of us come armed with FACTS.

Tim writes:
"But if a person manages to overcome an addiction in some other fashion, what right do I have to say that they're wrong?"

OK, Tim, what if I say my program is that you can stay sober by wearing green socks on Thursdays. I started wearing green socks on Thursdays and I've been sober for years. Since it works for me, it must work for everyone else.

Let's bump it up a notch. Anyone who claims to be sober that doesn't wear green socks on Thursdays is a dry drunk or never had a problem with alcohol in the first place, because everybody knows the only way to be truly sober is by wearing green socks on Thursdays.

So now the courts are sending people to me and telling them to wear green socks on Thursdays and even though they did, they relapsed. They must not have wanted sobriety. They were secretly wishing they had black socks on.

And as you claim:
"As for the statement that it has 'never been shown to actually work', the only evidence I have to counter it is myself and the people I know that have had years, even decades, of sobriety in AA. It may be a coincidence, or even a placebo, but my (anecdotal) experience tells me something else."

There's a subtle irony in aa, in that everyone does in fact stop on their own... with their selective choice of the tools provided to them. Barring those alcoholics that are hooked up to an ethanol IV, 100% of alcoholics do stop on your own... through death or hopefully before then.

Obviously I'm not sure why aa didn't work for some of the commenters and did for others; in fact, ironically, I'm not even sure why it worked for me! I never had a sponsor, never joined a subgroup for support; perhaps I took advantage of the flexibility of aa where others didn't or couldn't. Something happened though - after drinking daily for 20 years, one day I got up and just realized that I would never drink again.

Again, the higher power thing for me was just a trope, an illusion. One may believe in The One or not but changing your reference point is the key - it is, I believe, almost a pure mind game. In fact, I'm confident (and serious) that certain individuals could probably use a doorknob as the higher power and it can work wonders. This gets you out of the 'willpower' trap which fails, utterly, for many.

From step 1, I have never been to an aa that promulgates turning alcoholics into social drinkers - the language is "powerlessness over alcohol", the corollary is "abstinence for life". The policy is clever as it encapsulates the 'black swan' effect - one day you might wake up, get drunk, then change your life forever by running someone down. Indeed, this is reinforced by the countless drunkalogs of people that actually did this sort of thing.

I am an alcoholic who has been sober for 11 years, and I have participated in AA for most of that time. I have a couple of comments in response to your observations:

1) Regarding prediction errors and the steps. I agree that the steps are a useful tools to help an alcoholic see through his delusions and confront his "prediction errors," but something else happens before a sober person does the steps. (Most participants in AA do not get to steps 1, 8 and 10 until they have been sober for quite a while, years even.) The "psychic change", as they say in AA literature, that allows an alcoholic to decline the first drink comes before stepwork, often almost immediately upon encountering another alcoholic's honest witness. It is something that alcoholics have a hard time explaining. It's as if the exercise of will were no longer the necessary solution to their problem. The compulsion is simply removed. My own experience was that another alcoholic told me that I could choose not to pick up a drink one day, and I believed him. All kinds of people had told me that before, people who I loved and trusted, and I knew it was true. But something that I understood only abstractly became immediate and actual when it was conveyed by a fellow sufferer.

2) Most non-alcoholics can't imagine the dishonesty, shame, duplicity and confusion that torment an active alcoholic. It is profound and isolating. Active alcoholics mostly feel that nobody lives the way they do, sick with shame and condemned to lie. To go to AA and witness that other people have lived that way and no longer do, it's a revelation and it's why AA works. In AA you get see and hear somebody tell your story and then go on through the chapter of your life that comes next, the frightening and confusing next chapter you have not yet got to.

3) AA is a fellowship of honest people -- honest in difficult, searching, half-understood ways. This is why it works, and this is why it doesn't work for people lacking the capacity to be honest. The AA Big Book says "their chances are less than average." True that.

4) When I was new to AA, sometimes I was frustrated with the limits of the program, and my sponsor would say, "'s just AA." Its a finite program that offers a solution to alcoholics who want to stop drinking, That's all it is, a solution for people who want it. Many alcoholics don't. Many alcoholics with ruined lives don't want to stop. They haven't finished drinking, or they want to bargain with it, or they want to buy off the complaints of their family or boss or a judge. They are welcome in AA, and sometimes they eventually get it. But you can't hurry an alcoholic's progress, I'm sad to say. You really can't. And the dream of modifying AA to make it work for alcoholics who aren't finished drinking is mistaken, I think.

5) In AA they suggest you don't pick up a drink today. If you go to bed sober, you have fully succeeded. No one ever, ever, works with you on what you can do to be sober five years from now. It's not their concern.

To t h... There is just soooo much to work with there, but let me comment on one area-

"3) AA is a fellowship of honest people -- honest in difficult, searching, half-understood ways. This is why it works, and this is why it doesn't work for people lacking the capacity to be honest. The AA Big Book says "their chances are less than average." True that."

Wow! So, the sexual predators that roam the rooms of AA- including Bill Wilson, when he was practicing his brand of honesty- are some kind of half-understood, honest sexual predators? Or, those that hire other people and don't pay them? Or, those that run off with the Groups funds? Or, sponsees that cheat with a sponsors wife? Those difficult, searching, half-understood, honest people?

If you really think through what is being said with the "their chances are less than average." The chances he is talking about the chances to "recover from a hopeless state of mind and body". So, chances less than average can be less than 50%. So, does it follow that 49% of the people in AA that have "recovered" are those that are constitutionally incapable of being honest with themselves? They are still dishonest as hell, but not drinking. And they permeate AA and all the other 12 Step programs. I have seen and been the direct recipient of dishonest acts from "friends" in my 16 years in the rooms and stories about dishonest and unethical people in AA groups have even made national news!

Oh, silly me. You were being sarcastic and I just missed it, right? No body could be that blind to the truth. Right?

Regarding the Belladona-induced hallucination at the beginning of all this. AA ers seem to perceive the story of Bill Wilsons spiritual epiphany as some God-given, spiritual event that kick-started the movement.

The truth is the guy was jacked out of his gourd! It wasn't just Belladona - which would probably be enough - but there were a lot of other drugs too.

Belladonna, morphine, chloral hydrate, paraldehyde, hyoscyamine, strychnine, and apomorphine. This is in addition to withdrawing from alcohol. He had been taking this combination for two or three days straight.

He was high as a kite! And quite the story teller."The room instantly lit up,lit up in a blinding glare of white, white light" (He was really high and Lois opened the curtains :-)

Check this out on youtube

Watch for the dramatic looks toward the sky for affect. The boy was quite an actor too! As you are watching this, keep in mind the guy was a known sexual predator in meetings and he took LSD for several years with one of his mistresses. Oh, what a frisky cad he was. Just the kind of guy you need to start a program of rigorous honesty that would maintain the natural course of remission from alcohol.

And, for the list of drugs he was on, check out -

The list of compounds in the treatment is towards the bottom of a very long page, although the whole page is an interesting read.

"Bill Wilson was tripping on belladonna when he found God in a hospital room""

There is nothing that I can find on any medical site online that says that belladonna is a hallucinogenic. Here is what it says, "Belladonna produces many effects in the body, including relief from spasms of the gastrointestinal tract (stomach and intestines), the bladder, and the biliary tract. This is helpful in controlling conditions such as colitis, spastic bladder, diverticulitis, infant colic, renal and biliary colic, peptic ulcer, and irritable bowel syndrome.Belladonna also reduces the secretions of many organs, thereby helping to control conditions such as excessive stomach acid production. Belladonna is used to treat the rigidity, tremor, excessive salivation, and sweating caused by Parkinson's disease."

I don't see any sort of reference to belladonna producing hallucinogenic effects. Your use of the word "tripping" implies that Wilson was experiencing the type of state brought on by psychedelic drugs (of which I have had a lot of experience so I know of what I speak). Detoxing from alcohol is not same thing as tripping, trust me.

If you, or Mr. Koerner, actually took the time to do a little research on Mr. Wilson's experience at the Towne's Hospital, you would have discovered that Mr. Wilson had been advised by his friend Ebby prior to his entering the hospital to seek a spiritual solution to his problem through a "practical program of action" which would result in a "spiritual experience".

Wilson also had in his possession while at the hospital the book, "Varieties of Religious Experiences" by William James. Wilson saw his "experience" in the hospital room as just another variety of the kind of religious experiences that James wrote about. These occurrences occur after such life changing events such as a brush with death, combat experience or other trauma. The writers implication that Wilson's experience was brought about by his taking a hallucinogenic drug is misleading and down right lazy journalism. I am sure this guy has a great scientific mind, too bad his editor never finished community college.

My very first Google hit on Belladona Hallucinogen brought up a site that contains - "WARNING: Belladonna is an atropine based plant and is a severe hallucinogen, actually more like a deterrent. It is not recommended for stupid high schoolers looking for a buzz. All concepts of reality are lost under the affects of belladonna. Belladonna trips are a billion times more real than anything you've ever seen under the influence of any other hallucinogen."

And there were many more similar references. It is well known that Belladona is a hallucinogen. And, while digging further on the spiritual experience of Bill Wilson, I found this little tidbit.

From Orange -

"As if things weren't complicated enough already, another critic pointed out a very funny complication in Bill's story about his religious experience. Bill claimed that this happened to him:

"Oh, God," he cried, and it was the sound not of a man, but of a trapped and crippled animal. "If there is a God, show me. Show me. Give me some sign." As he formed the words, in that very instant he was aware first of a light, a great white light that filled the room, then he suddenly seemed caught up in a kind of joy, an ecstasy such as he would never find words to describe. It was as though he were standing high on a mountaintop and a strong clear wind
blew against him, around him, through him â but it seemed a wind not of air, but of spirit â and as this happened he had the feeling that he was stepping into another world, a new world of consciousness, and everywhere now there was a
wondrous feeling of Presence which all his life he had been seeking.
-- Robert Thomsen, Bill W., 1975, pp. 222-223.

But in the biography of Bill that was written by Lois Wilson's personal secretary, Francis Hartigan, we learn that Bill's paternal grandfather, who was also named William Wilson, also had a bad drinking problem. In desperation, he climbed a mountain and had a religious experience of a wind of Spirit blowing through him, and he never drank again:

William Wilson may have preferred inn keeping to quarrying, but inn keeping is seldom the right occupation for a hard-drinking man. His attempts to control his drinking led him to try Temperance pledges and the services of revival-tent
preachers. Then, in a desperate state one Sunday morning, he climbed to the top of Mount Aeolus. There, after beseeching God to help him, he saw a blinding light and felt the wind of the Spirit. It was a conversion experience that left him feeling so transformed that he practically ran down the mountain and into town. When he reached the East Dorset Congregation Church, which is across the
street from the Wilson House, the Sunday service was in progress. Bill's grandfather stormed into the church and demanded that the minister get down from the pulpit. Then, taking his place, he proceeded to relate his experience to the shocked congregation. Wilson's grandfather never drank again. He was to live another eight years, sober.
Bill W.; A Biography of Alcoholics Anonymous Cofounder Bill Wilson, Francis Hartigan, page 11.

What are the odds that both Bill's grandfather and Bill would have exactly the same dramatic religious experience, almost word-for-word identical, both beseeching God for help, both seeing a blinding White Light,both feeling that they were on a mountaintop with a wind of Spirit blowing
through them,and both being so overwhelmed by the experience that they never drank again?

Or did Bill Wilson just appropriate his grandfather's story to embellish his own experience?

Did Bill's grand vision of God really happen at all?

We are still left wondering just what this statement in the Hazelden "autobiography" of Bill Wilson really means:

"There will be future historical revelations about Bill's character and behavior in recovery that will be interpreted, by some, as direct attacks on the very
foundation of AA."
Bill W., My First 40 Years, William G. Wilson, Hazelden, page 170."

The whole thing is really suspect to me and a growing population of others. However, it seems the faithful have no problem coming up with rationalizations when items like this are brought up.

There are so many outright lies, half-truths and distortions in and around AA that many, including myself, are beginning to entertain the thought that AA is simply a religious con, brought into this world by a narcissistic, philandering, lunatic of a con man.

If a true AA believer has the constitution, read from front to back. It will take a while, but it will change your belief - in one direction or another.

It is little wonder that many of the comments here are ignorant of the actual AA message - most of the people who are in AA don't understand it either.

The AA message is laid out in the first 164 pages of the book, "Alcoholics Anonymous" plus the eight pages of the Doctors Opinion which in the first edition of the books printing started on page one.

The book is laid out very specifically - it provides information on what makes a person a "real alcoholic" and allows the reader to make a self diagnosis based upon that information. There are two, and ONLY TWO, criteria which make you an alcoholic according to the book: 1. once you start to drink, you are unable to control how much or for how long you will drink and 2. you are unable to manage your decision to give up alcohol completely once you have made up your mind to quit.

Comments like those made by Mona Lisa, "When I presented for treatment, nobody had any difficulty diagnosing me as a chronic alcoholic. Drank for 25 years...every day...blackouts...couldn't troubles...yep, alcoholic." show that this person is ignorant of the actual AA message. According to AA, the drama that happens AFTER you drink, has got nothing to do with whether or not you are a alcoholic.

One of the tragedies of contemporary AA is that most of the people sitting in the rooms don't understand this either. You would clear out half the place if people were aware of this basic information and then they looked at their actual experience to assess their condition. If your "problem" is due to circumstances or trauma in your life then you can, and should get the psychological help that you need from the medical community - they are good at that.

I have worked with a lot of guys over the years and I never told any of them that they were an alcoholic. I simply gave them the information as presented in the book and allowed them to make their own assessment based upon their experience. If they conclude that they are, then I explain to them that in AA we have a spiritual solution to their problem which is realized through the program of action, the twelve steps. If they are willing to make the effort, I can help them with the process but I can't do it for them. It is up to each individual to choose if they want to do the work and continue to do the work on a daily basis to transform their life. Sobriety, freedom from alcohol, is a by product of living a life based upon spiritual principles. That is the way it is laid out in the book and it works for me.

By CelticGreen (not verified) on 07 Jul 2010 #permalink

SoberPJ writes, "My very first Google hit on Belladona Hallucinogen brought up a site that contains - "WARNING: Belladonna is an atropine based plant and is a severe hallucinogen, actually more like a deterrent. It is not recommended for stupid high schoolers looking for a buzz. All concepts of reality are lost under the affects of belladonna. Belladonna trips are a billion times more real than anything you've ever seen under the influence of any other hallucinogen."

Wow! That sounds like quite a reputable source! I particularly like the "stupid high schoolers looking for a buzz" part and "Belladonna trips are a BILLION times more real...".

If that is indicative of your research gravitas, everything else on your post is suspect as well.

Sorry sw fla,
I think if you just do a Wikipedia search for Belladonna Alkaloids you will find in the first paragraph it states that they cause hallucinations in high doses. Not scholarly enough,try "Goodman& Gilman's The Pharmacological Basis for Therapeutics" 13th edition page pages 191-192 where they discuss how atropine(an alkaloid of belladonna)has direct CNS effects including euphoria, delirium and hallucinations. That is why scopalamine(another belladonna alkaloid)is more suitable therapeutically because it has less CNS effects. Still in high doses, scopalamine can cause hallucinations.
Also if you ever read any Carlos Castaneda,one of the drugs they trip balls on is jimson weed-chock full of belladonna alkaloids. Sw fla, you are wrong,promptly admit it.

By Ben Franklin (not verified) on 07 Jul 2010 #permalink

As a relatively bright guy with maybe too much of a taste for drink, I found this post really interesting. Especially when I play poker, I find that my raw ability is probably above average, but I inevitably fail to appropriately process "prediction errors" at some point in the game (especially after a drink or two), despite the fact that I can explicitly acknowledge my mistake beforehand.

I wonder if you didn't underestimate the chicken/egg problem a bit, though, because the prefrontal cortex dysfunction that you claim is a consequence of alcoholism seems likely to lead to it in the first place. This seems particularly compelling when you look at the behavioral traits of many young, future alcoholics.

Yep, I'm suspect, and so are my opinions and I implore everyone to thoroughly investigate any and all of my claims. Because, through investigation you will assuredly learn new things. For example, if someone incorrectly thought that Belladona is not a hallcinogen, they might investigate further and find that is actually is. Or, if one didn't know that Bill's paternal grandfather had a nearly identical spiritual ephiphany to the one that Bill W claimed to have, it could broaden their awareness of how Bill W might have been a fraud. Investigation is a great tool for learning new things.

Investigate deeply at -

Sw fla.,
Here is a list of people you need to make amends to:Brendan Koerner,Jonah Lehrer,Jonah Lehrer's editor(you know the one you assumed didn't finish community college) and SoberPJ. What's wrong cat got your tongue? Can't admit you're wrong? Especially to someone you perceive to be the enemy? Oh,I am sorry I am taking your inventory. But,I am not in the program so I don't care.

By Ben Franklin (not verified) on 07 Jul 2010 #permalink

Thanks Ben, probably won't get one though. I do understand the staunch position. It is one that I would have taken many years ago. I was an AA bigot. It felt good. Smug, sanctimonious and always right because there is an answer for everything in AA. Then things changed. I began to wonder about the real history of AA. Not the AA archives history, but what came before that. Who exactly was this Bill Wilson guy? How successful is AA really? In 16 years, so many people just disappeared and many seemingly healthy people killed themselves - why? Then I found Orange, and others. I dug in and read and read and read. It seemed harsh at first, really anti-AA, and I was annoyed by those who would dare criticize the wonderful and successful institution that is AA. Then the evidence started to add up and I found myself agreeing with the vast majority of the alternative observations. The web of deceit and faith healing nonsense became abundantly clear and I soon felt like a tragic con job was being played on the world. I don't have a "spiritual malady", nor am I powerless over people, places and things, or "of the hopeless variety". No one has a spiritual malady, nor are they powerless or hopeless. Believing these things does not appear to be healthy. The approach to helping people with substance abuse problems has to evolve away from ineffective faith-based 12 Step regimens to more effective, science-based approaches and we need to have vibrant and lively discussions about all of it. These discussions, regardless of how difficult and vitriolic they may seem, make people think and hopefully investigate other perspectives which can lead to effective change.

CelticGreen writes:

"Comments like those made by Mona Lisa, "When I presented for treatment, nobody had any difficulty diagnosing me as a chronic alcoholic. Drank for 25 years...every day...blackouts...couldn't troubles...yep, alcoholic." show that this person is ignorant of the actual AA message. According to AA, the drama that happens AFTER you drink, has got nothing to do with whether or not you are a alcoholic."

This comment is downright astonishing. I just pulled my step 1 out of mothballs and re-read it (I wrote out my steps). For those who don't know, step 1 is: "we admitted we were powerless over alcohol, that our lives had become unmanageable." And right there, under "unmanageability" is list of things like blackouts, not being able to work, family troubles, etc.

If this material was part of the process of doing step one, it can hardly be "ignorant" to mention it as having once been used to diagnose me with alcoholism!

But of course, this comment was really nothing more than the standard stepper argument that those who don't "get it" were never alcoholics in the first place.

My point, which I'll make again, is that NO ONE EVER suggested I wasn't an alcoholic until I left AA and started talking. NOW I'm not an alcoholic. How convenient.

By Mona Lisa (not verified) on 08 Jul 2010 #permalink

Hi Jonah, Interesting, but can we extend it downward? What if we do a (simplified) version of the task with an fMRI on the four-year olds who pass and fail the marshmallow task? Might we be able to predict future addicts based on possibly hard-wired prefrontal differences? Kathleen

By kathleen mcnellis (not verified) on 08 Jul 2010 #permalink

Mona Lisa said,"And this is where the higher power thing comes in - you can't do it yourself, even though your your brain is telling you it can; you're essentially being lied to, by yourself. The 'higher power' will get you way out of that box you have put yourself in."

This comment, I submit, reveals the basic fallacy of AA: the notion that "you can't do it yourself", that the power to quit comes from God, from a doorknob, from the meetings. Sure, some meetings are better than others in the sense that they are less abusive and bizarre; but they ALL share this essentially absurd philosophy.

I couldn't agree with you more Mona Lisa. Some alcoholics are hard core and have been drinking for years. I was 25 years old when I found AA and I was snagged by a young woman who was even younger when she joined. We shared the same sponsor and she had tried to run herself off a bridge while intoxicated. Needless to say he was suicidal. Why he didn't go to the VA I will never know.

I didn't stop with reading the Big Book, which I think puts more drinking ideas into the mind, I read everything I could and when I had the time. Born to Win was most helpful as was Psycho-cybernetics, Magic of Believing, The Power of Your Subconscious Mind, Co-dependent No More, Choices, Repeat After Me and others. I also attended Al-Anon. In all honesty I have to admit that the therapy I received was the most helpful, though the books gave me insight into my difficulties, while I also must admit that at no time did any of the counselors or therapists admit that the television and advertising were part of the problem that I had not stopped using at that time. In the 10 years I attended AA I went every night in the beginning and maintained 3 years of sobriety. After a break-up I started drinking again and so I read Co-Dependent No More. I slipped every year at about the same time. It wasn't until the past 10 years that I was able to recall having been given the paregoric as a child. I think my first confession was something I did when I was 12 and that was really a re-enactment of someone else's act. I used to watch alot of police shows too and that certainly compounded my problem, I was forever feeling persecuted for something I did not do, even though most of the shows had a resolution in the end. The more I have delved into my history, the less I have discovered I am to blame but to stay sober I had to clean it up or die a drunk.

A speaker at a meeting one night said, "I am a recovering alcoholic". Most of the people I was around were saying, "I am an alcoholic". That set the thinker ticking. Neurolinguistic programming, that is what it's called and anyone can do it. We do it all the time. I also read Tony Robbins' book, Ultimate Power. I started thinking like a sober person. The television and believing what they sell you influenced my habit, I had to get myself out of it. I still drink coffee, "good to the last drop".

I read Dean Radin's, Entangled Minds and Dream Telepathy by Ullman Krippner and Vaughn, a few years ago. Seems we may even be affected by what others are thinking and feeling or viewing.

I have also found some subliminal messaging cd's to be very helpful such as those by Barrie Konicov at Potentials Unlimited and I have created my own based on principles I learned from Brian Tracy and The Psychology of Achievement and the other books I have read. Konicov's Stop SMoking program was powerful and I stopped smoking in 1990. I recently learned about "memes", another stumbling block in the process of sobriety. Meme yourself!

I will add that I was employed during most of this and also add that my mother was an avid listener of country music and alot of it is about being down o your luck and drinking your problems away. Not good for one trying to recover.

One more thing, my first therapist taught me about THIQ. Some supposedly produce this chemical while others do not. I think it is a familial thing and how one is programmed to behave socially or to solve one's problems, I think we all would eventually become addicted.

One more thing and I am done here. I think basically the Steps are what works in AA and support from others, you don't necessarily have to get that from AA.

The one slogan I found to be truest, is that one must change playmates and play-pens. Needless to say I put this to the test. I wasn't aware of transferences, in the form of memes. I associated with a man who drinks and loves it, and has no intentions of stopping. He does it every night, wine or beer, sometimes liquor. Needless to say, like memes, he was infectious and his jubilance bled into my thinking and so I once again slipped into drinking. I was able to distance myself long enough to stop drinking and sadly, have since terminated the relationship, as he was a likeable person. This I see is a necessity if I want to stay way from alcohol.

This included distancing myself from AA and those who are too lazy to do the work. I even avoid walking down the beer isle in the supermarket as much as possible.

I started drinking alcohol when I was 17, it has been a struggle, I am 55 now.

I evetually grew aware of the system and how it was feeding itself on the minds and bodies of those of us who are its victims, alcohol is just the tip of the iceberg.

One has to become, Thick as a Brick.

Now here's some blatant speculation. I think one reason AA is successful, at least for many of those who commit to the program, is that it's designed to force people to confront their prediction errors.

I want to make this distinction: AA is "successful" as an organization. It's successful, but it is not effective as treatment for alcoholism or addiction.

What's effective is one's desire to quit drinking and commitment to quitting. And if working the steps gives one a touchstone, or a ritual, that helps one focus on one's commitment, then anything one feels is legitimate will work -- as long as the desire and commitment is there.

It's true that AA works if you work it. That's a little logical loop right there. Your car works if you work it, too. And if you take your cold medicine, you will get better in about a week.

It could be that it is just the right thing for the people who have been able to quit on the program, for just the reasons you speculate about. Of all things, perhaps this is the one thing that makes sense and seems do-able. And then, of course, it could be that the people for whom it works would have been able to make anything work, as long as they believed in its legitimacy -- because they were willing to do whatever it takes.

It is too bad that AA will not allow itself to be subject to scientific scrutiny, especially since it is held in such high esteem by doctors and substance abuse counselors, and the dang TV.

For an illustration of how entrenched the AA nonsense is in treatment centers, visit the Betty Ford Center…\t-make-it-in-aa.php

Wow, I can hardly believe my eyes. Someone is having trouble staying sober using a faith-based healing regimen and a DOCTOR at Betty Ford Center is recommending a reading from the textbook that is the basis to achieve the AA religious conversion and thereby receive the faith-based healing.

Before this completely disrupts my confidence in medicine, I have to assume the doctor is simply uninformed. There is no way he can know that the opening sentence of that chapter is, at best, patently false and still recommend it and the text that follows. Why would a doctor recommend the reading of false text to a person in a potentially life and death situation? Is that the state of modern medicine at the Betty Ford Center?

The opening sentence to chapter 5 is suspect for several reasons. But first, we have to decompose the sentence. âRarely have we seen a person fail who has thoroughly followed our pathâ , can be condensed to ârarely fail if thoroughly follow path.â Or further, follow path = rare failure. My initial observation is that someone can supposedly follow the path and still fail. So, the doctor is recommending text that says even if you do everything you are told, you can still die a drunk. Not very reassuring. Next, what did the author mean by ârarelyâ? Rarely could be 10%, or less, or more. No one knows. And rare over what period of time? Surely there are some statistics behind this grand claim of success? Sadly, no. The anecdotal evidence is not good however. In the book Alcoholics Anonymous, there are stories written by some of the members of the original group. These stories extolled the life saving virtues of the program of AA. The unfortunate part of this is that half of those authors got drunk and some died drunk. There is no reason to assume that the general population of the early religious converts had any better luck at staying sober with the âpathâ. So, the âRarely failâ statement is highly suspect, if not patently false.
Further, what path was being referred to? What statistically proven regime was being proposed here? One that a Doctor at Betty Ford Center would be proud to recommend and endorse as a life saving methodology for relieving the horrendous symptoms of relapse in the program of AA? No one can really agree. The 12 Steps were written for the Big Book, they didnât exist before the book was being written. There were six steps that were supplied by a religious organization called the Oxford Group, but they worked so poorly that Bill Wilson, the main author of the Big Book, expanded them. He turned the six steps of the Oxford Group into the 12 Steps of AA. The six steps of the Oxford Group were the âpathâ prior to the Big Book and probably the one he claimed had rare failures. Which was patently untrue and the early poor success rate is well known.

Now we come back to the doctor and his professional recommendation. My lay person examination of the opening sentence of Chapter 5 of the book, Alcoholics Anonymous, hopefully shows that, at best, there is reason to doubt the accuracy of the claims made in the sentence. At worst, it is pure nebulous fabrication designed to make the religious faith-based healing approach look more successful than it is. On a spectrum with truth at one end and blatant deceit at the other, the sentence surely falls closer to the end with deceit than it does to truth. So, knowing all this, why would a doctor of medicine recommend the reading of a deceitful text as a solution to the very real problem of recurrent drinking in a faith-based abstinence program of recovery? Surely, modern medicine contains helpful alternatives for this type of situation? The best possible medical answer canât be, to paraphrase, â It would be too bad if you died drunk, others like you have made it, just read some text that begins with a sentence of dubious truth that contains unsupported claims and focus on rigorous honesty.â

Is that medicine? Let me venture an answer, âNO!â

SW Fla @57 says:
There is nothing that I can find on any medical site online that says that belladonna is a hallucinogenic.

The hallucinatory activity of belladonna is highly documented in current scientific literature and as far back as the Middle Ages. Rather than using Google, you can search NCBI's PubMed. More search returns will be found by using the names of the alkaloids in Atropa belladonna, such as atropine and hyoscine.

But a really nice source for an educated lay explanation of belladonna, and many other drugs of abuse, can be found in a superb book called, Buzzed: The Straight Facts About the Most Used and Abused Drugs from Alcohol. It's written by Dr. Cynthia Kuhn, a neuropharmacologist at Duke University, and several of her colleagues who put together a couple of other books as well to guide parents and teens through the years of the temptations of recreational drug experimentation.

You can read the passage on belladonna at this link in Google Books.

I couldn't agree more with Mona Lisa.

AA is not a harmless organisation. I have been forced to submit to this cult and when I refused, I was told I was in denial. This just put me under more pressure. Now, years later, when I am clearly healthy and well and not getting progressively worse, I am told that I was never an alcoholic. This organisational is dangerous and unaccountable.

Are people who frequently watch/listen to right-wing shows, Beck and Limbaugh, addicted? The stroking and conspiratorial tone, telling the audience they are smarter than liberals and adopting a conspiratorial tone that suggest that you are being let in on a secret are certainly rewards.

But at the same time regular listeners/watchers seem to have lost their ability to notice when the bloviator gets it wrong on their predictions. Regular watchers never seem to connect the claims and predictions that are time and again proven wrong, negative stimulus, to the people who made the predictions.

It reminds me of the relationship of addict to dealer. The addict always associates the dealer with the high. Not the hangover or other negative consequences.

I read this article in Wired with great interest and a large amount of pride in my brother who continues to overcome his substance addictions.

I think Jonah, you make a good point about way the Twelve Steps help addicts make sense of their prediction errors.

Many people still feel that addicts are just weak and lack self-control and responsibility, but articles like these demonstrate that it's more complex than that. MANY thanks for sharing.

AA has worked for me. Booze started wrecking my life in my early teens and continued in wrecking my life till I quit with the help of AA over 2 years ago
Today living sober is awesome and life is better than I expected. I still have dramas going on but I seem to be able to respond to them way better, thanks to what I learn in AA.
Thank You to AA

#76 Angelica I agree, it is cultish and I was certainly told the same thing many times, even after standing up in front of a room of more than 100 people and admitting I was an alcoholic. It's an abusive cult and the long way around getting sober.

What I discovered was that I was being used to clean up after the idiots before me that had trashed themselves with ignorant jargons and remarks (why they say what you hear here let it stay here), instead of working on my own sobriety, that has now taken me ten years to work on.

I have a lot of rage and resentment towards those people, I lost 10 years of my life associating with them, ending up in prison to boot.

You will never find me recommending AA as a fix for alcohol or drug abuse. There are better ways of getting support as well, starting with your own family, if they are so inclined, mine are still stuck in their diseases. A Psyciatrist tried to get me to get involved in DBT (dialectical behavior training), after my AA expereinces I told her falt out NO. I have been more successful on my own and until I am able to defend myself from those people like my x friend I will stay a loner.

I have been sober for almost 16 months, and I know for a fact that I couldn't have done it with out A.A. I work the 12 steps to the best of my ability. I want to make one thing perfectly clear about the A.A program. It never promises me a liftime of sobriety. At best it gives me a 24 hour reprieve from my condition, based on my spiritual condition, and how honestly I work the 12 steps.

So for almost 16 months I have managed to not only stay sober, but to improve my life. I tried it on my own before and I always failed. At least now thanks to A.A. I now have hope in my life.

If you can find another way to stay sober then my hat is off to you, but for me A.A. works and it has worked for many others.

No program is perfect and A.A. doesn't claim to be perfect, but for those of us who have found it and worked the program it has worked.

For the many friends and family who couldn't and cannot stop drinking even with AA, I hope for a cure. Baclofen and Adavan both have helped with cravings. Tweak one or both of these drugs to be specific for reducing cravings and lots of people will have a chance at life.

By Narda Pitkethly (not verified) on 11 Jun 2011 #permalink

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