By Mark Flanagan
Of the 23 million people who struggle with alcohol or drug abuse on a yearly basis, roughly 1.2 million regularly attend Alcoholics Anonymous (AA) meetings as a way to stop drinking. AA was the first 12-step program to be created. Founded on December 14, 1934 by Bill Wilson and Robert or “Dr. Bob” Smith, AA combines self-assessment, reconciliation, group therapy, and surrendering control to a “higher power” in a progressive plan consisting of 12 distinct steps to combat impulsive cravings to use.
“Secret of AA: After 75 Years, We Don’t Know How It Works”, written by Brendan Koerner for Wired, does a thorough job explaining the history and approach of Alcoholics Anonymous in the United States. Koerner writes that, “There’s no doubt that when AA works, it can be transformative. But what aspect of the program deserves most of the credit?… Stunningly, even the most highly regarded AA experts have no idea.”
Koerner then examines how research in the behavioral sciences and neurology can provide insights to AA’s intermittent success. Here we learn that it’s not just the twelve steps but also the power of the group, from the commitment the individual feels to forming close relationships that can provide a sense of security to the opportunity to relearn how to connect to others without alcohol. Koerner also argues that the experience of public confession, both doing it and seeing it, helps individuals strengthen the regulatory powers of their prefrontal cortex, weakened after years of drinking.
However, in trying to account for the modest but significant beneficial effects AA can have for many individuals, Koerner leaves out important “soft sciences”, such as anthropology. Why do people attend AA? It’s not just to strengthen their prefrontal cortices.
In this post I will outline some societal forces that have led to AA’s popularity. I will also argue that the social sciences are integral for crafting new and effective addiction treatments. The ideas and data presented here come in large part from my comparative research on alcohol use and abuse among homeless men, college students, and veterans struggling with post-traumatic stress disorder.
Societal Forces at Play in Biomedicine
AA has been the subject of countless studies, yet reported success rates vary enormously: between 5 and 75 percent. This may be due to AA’s shunning of individual identification and the ease with which members enter and leave the program. However, several studies indicate that AA does not work for everyone and that, for most people, does not work at all.
While scientific support for AA or other 12-step programs is inconclusive, most medical practitioners strongly recommend it as a primary means to treat addiction. In Wired, addiction-medicine specialist Drew Pinsky states: “In my 20 years of treating addicts, I’ve never seen anything that comes close to the 12-steps. In my world, if someone says they don’t want to do the 12-steps, I know they aren’t going to get better.”
This contradiction between the little if any definitive scientific proof that AA reliably treats those suffering from addiction and the wide-spread endorsement of AA by medical and governmental officials raises an important sociological question:
Why do so many science-based medical providers recommend AA?
Neuroanthropology 