Drunk with Power

The case against court-imposed 12-step treatments

Stanton Peele from the May 2001 issue

(Page 2 of 2)

Two explanations could account for such findings. One possibility is that, while treatment and non-treatment groups are equally likely to be recidivist, those who quit treatment are those who were more likely to relapse anyway. Thus, counting only those who remain in treatment and aftercare is cherry-picking those most likely to succeed in the first place. The other possibility, which would scandalize AA zealots like Keating, is that those who have a negative reaction to AA and its 12-step approach are actually driven to relapse by the experience.

For Keating, AA is singularly and extraordinarily effective: "The hard truth is that in the thousands of years before AA, there was no effective treatment for alcoholism....In 2000, as in 1935, if you're a drunk and you want to get sober, you go to AA or to a treatment program based on AA's Twelve Steps. ...It's still the only game in town...." Orange County's attorney, Richard Golden, asserted this after the Warner decision: "There are alternatives out there. Do the probation officials think they are satisfactory? Absolutely not." Indeed, New York's highest court accepted the claim that "A.A. practices and precepts have proven to be the most effective method for preventing relapse...."

In fact, in clinical trials in which alcoholics are randomly assigned to different treatments, neither 12-step treatment in general nor AA in particular has ever been found superior to a tested alternative treatment. Indeed, in most cases, the reverse has been true. In 1991, Diana Walsh and her colleagues at the Harvard School of Public Health assigned employee assistance program referrals for alcohol abuse either to a treatment program or to AA, or gave them a choice of treatments. Sixty-three percent of the AA assignees required additional treatment, compared with 38 percent of the choice group and 23 percent sent to a treatment program.

In 1997, the National Institute on Alcohol Abuse and Alcoholism completed its massive Project MATCH -- at over $30 million the largest clinical trial of psychotherapy ever conducted. Three treatments were compared: (1) skills training, which teaches alcoholics to cope with feelings and stress without drinking; (2) motivational enhancement, which leads alcoholics to balance their other values against the need for continued drinking; and (3) "12-step facilitation." Neither skills training nor motivational enhancement refers to a "higher power." In MATCH, leading clinicians wrote handbooks, trained professional counselors, and monitored videotapes of therapy sessions. Under these ideal conditions (unlike anything an inmate or drunken driver will experience), 12-step treatment merely did as well as the other two therapies. Nonetheless, since it required 12 sessions, while motivational enhancement took only four, the latter would be the most cost-effective therapy for alcoholism according to usual medical standards.

AA members often assert that these negative findings result from forcing individuals into treatment. Yet coercion -- the most common path into AA -- is exactly what Keating and many treatment advocates espouse. As Keating writes, "People rarely walk voluntarily through the door and ask for help; most of them arrive unwillingly, forced to AA and treatment by circumstances that have increasingly included orders by courts or parole officers."With drunkies and junkies, you usually need a hammer."

Although it has been adjudicated only in relation to prison and probation programs, AA coercion by state agencies and representatives extends well beyond these populations. Government-licensed professional organizations -- including pilots, attorneys, and health professionals -- public assistance programs, and family courts all regularly assign Americans to 12-step programs. Most people recognize that imposing Christianity is un-American, even if those who adopt Christianity have fewer drug and alcohol problems. Yet many people readily accept the government's imposition of AA and 12-step treatment.

Even if AA and 12-step treatment were better than available alternatives, and even if the courts found that the powerlessness that each AA member must admit to in Step 1, the higher power each has to subscribe to in Step 2, and the "decision to turn our will and our lives over to the care of God as we understood Him" in Step 3 were as nonspecific as Keating claims, forcing people into AA would still violate their personal integrity. Do Keating and other advocates of compulsory 12-step treatment really believe that the state has the right to tamper with a citizen's inner beliefs in this way?

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AA supporter|7.15.11 @ 4:20PM|#

People that chose to get behind the wheel while intoxicated, loose their rights...like a criminal who walks around with a loaded gun. We have free will to make our decisions but not free will to choose the outcome.

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