William Miller and Reid Hester, editors of the most comprehensive and most methodologically sound evaluation of treatment methods ever published, state that, "We were pleased to see that a number of treatment methods were consistently supported by controlled scientific research." But they continue, "On the other hand, we were dismayed to realize that virtually none of these treatment methods was in common use within alcohol treatment programs in the United States." (Source.)
I've previously written positive things about some aspects of twelve-step programs. However, despite some things they do right, twelve-step programs in America may serve as the prime example of the danger involved with religion and religious thinking.
What separates religious thinking from scientific thinking?
1) The reliance on faith.
2) The trusting of authority.
3) The reliance on anecdotal data.
For example, Christianity places great emphasis on faith, while Catholicism maintains that the Pope is infallible, and Orthodox Judaism maintains that the great sages of previous generations were closer to the truth than we can be today. Anecdotal data is used quite often in support of religion, describing personal visions, near-death experiences, unlikely coincidences, faith healings, and alleged conversations with God Himself.
Scientific thinking recognizes none of these methods of argument. With regard to faith, science doesn't ask us to believe anything because it "feels" a certain way. (The closest thing is the assumption that empiricism is rational, but even that is somewhat self-evident.) Regarding authority, no-one is infallible, nor is anyone trusted on their word alone. Although Einstein was a luminary, he was wrong about quantum mechanics, and science moved on without him. Although Newton was a scientific giant, he also believed in all sorts of bizarre alchemy, which science has since rejected. Finally, science completely rejects anecdotal data, which is why most scientific thinkers still disbelieve in UFO abductions, telekinesis, and faith healings.
Instead of faith, authority, and anecdote, science relies on testable, repeatable experimentation. It is this experimentation which has led us to discover many of the secrets of gravity, relativity, intertia, medicine, and astronomy. Science's record of success is unparalleled by any other system of thought or investigation.
As Carl Sagan asked,
Think of how many religions attempt to validate themselves with prophecy... Yet has there ever been a religion with the prophetic accuracy and reliability of science?
So how does this all tie in with Twelve-Step Programs (TSPs?)
Well, I argue that the phenomenal popularity of TSPs despite evidence that they are ineffective is due to the prevalence of religious, rather than scientific, thinking.
First, the evidence against TSPs' efficacy. Here are a few sources:
The National Longitudinal Alcoholism Epidemiological Survey was designed and sponsored by the NIAAA and was conducted by the U.S. Bureau of the Census. It was notable both for its size (4,585 subjects) and its study period (20 years). Its subjects were divided into a treated group and an untreated group. All of the study’s subjects “had to have satisfied the criteria for prior-to-past year DSM-IV alcohol dependence by meeting at least 3 of the 7 DSM-IV criteria for dependence: tolerance; withdrawal (including relief or avoidance of withdrawal); persistent desire or unsuccessful attempts to cut down on or stop drinking; much time spent drinking, obtaining alcohol or recovering from its effects; reduction or cessation of important activities in favor of drinking; impaired control over drinking; and continued use despite physical or psychological problems caused by drinking.”xxxiv
The study’s findings were surprising: At 20 years after onset of symptoms, 80% of those who had undergone treatment were either abstinent or “drinking without abuse or dependence.” But those who had never undergone treatment were doing even better: 90% of them were either abstinent or drinking nonproblematically. That is, 10% of those who had never been treated were still drinking abusively 20 years after the onset of symptoms, as were 20% of those who had been treated. In other words, twice as many of those who had undergone treatment were drinking abusively as those who had never been treated. (Source.)
There have been at least three randomized clinical trials that studied the effectiveness of AA. Specifically: Ditman et al. 1967; Brandsma et al. 1980; Walsh et al. 1991.
* Dr. Ditman found that participation in A.A. increased the alcoholics' rate of rearrest for public drunkenness.
* Dr. Brandsma found that A.A. increased the rate of binge drinking. After several months of indoctrination with A.A. 12-Step dogma, the alcoholics in A.A. were doing five times as much binge drinking as a control group that got no treatment at all, and nine times as much binge drinking as another group that got Rational Behavior Therapy. Brandsma alleges that teaching people that they are alcoholics who are powerless over alcohol yields very bad results and that it becomes a self-fulfilling prediction -- they relapse and binge drink as if they really were powerless over alcohol.
* And Dr. Walsh found that the so-called "free" A.A. program was actually very expensive -- it messed up patients so that they required longer periods of costly hospitalization later on.
While AA acknowledged in the foreword to the second edition of the Big Book that "we surely have no monopoly", one of the stories following the main text of the book still claims that AA is "the only remedy" to alcohol abuse (BB, pg. 259. Emphasis added.), despite some current research which shows that high percentages of alcohol abusers recover without medical treatment (Treatment of Drug Abuse and Addiction -- Part III, The Harvard Mental Health Letter, Volume 12, Number 4, October 1995, page 3.). Another study suggests that AA may be "no better than the natural history of the disease" in keeping people alive and sober (The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, George E. Vaillant, pgs. 283-286.)(Source.)
So why is AA so popular? Because most Americans put their trust in faith ("Came to believe that a Power greater than ourselves could restore us to sanity," "Made a decision to turn our will and our lives over to the care of God as we understood Him") authority (the Big Book of Alcoholics Anonymous is treated as a Bible,) and anecdotal data ("but these people are sober and they've done it through AA!")
I wonder how many lives we could save, of alcoholics, of victims of drunk drivers, of victims of the War on Drugs, if we were more scientific than religious.
Some theists fear an atheistic world without meaning. I fear a theistic one without knowledge.