The 12 Step Debate

Last month, The Atlantic magazine published an article entitled “The Irrationality of Alcoholics Anonymous” written by Gabrielle Glaser. It generated over 137,755 comments, on that site alone. It has brought attention to an ongoing debate that has become the center of much polarity. Either you are “with AA” or “not with AA.”  The article, and others before it, seem to have a one sided and motivated agenda that does not take into consideration a lot of varying factors.

The reason for my blogging on this issue is not to enter the fray of the debate.  Rather, I believe it is important to examine, at an objective level, what AA is really all about; and what the alternatives are that Glaser and her supporters are suggesting.

Most people I talk with about AA who are either in early recovery, or not in need of recovery, are not aware of how AA came to be.  Making a very long story short:  Bill Wilson, a chronic alcoholic who had finally put together some sober time, was on a business trip and found himself in a hotel that had a lobby bar.  The pull was instant.  But he knew that if he went in for a drink his marriage would be over, and everything he had worked hard for to reach this point of achieving even a minimal amount of sobriety, would be over.  Instead of walking in to the bar, he walked into the phone booth.  This was back in the day when there were phone booths, and when you picked up a phone, there was a human being on the other end called “an operator.”  The operators back then knew all, heard all, and therefore were a font of information.

Bill Wilson spoke to the operator and asked if there were any alcoholics in town who were having a hard time of it.  “Why yes,” replied the operator, “there is – our local doctor has just tied one on and he’s home nursing a hangover.”  Bill Wilson got his address, went over to Dr. Bob’s house, and announced himself as a fellow alcoholic.

What happened next is what most believe to be “the miracle” of AA.

Bill and Bob sat together and talked.  For hours.  One alcoholic to another, sharing their stories, their experience, strength and hope.  One thing led to another, and together, they created Alcoholics Anonymous. That was back in 1935, and today in 2015, it continues to work its magic on many alcoholics.

How could two drunks, one only sober for a short amount of time, achieve this?  Many would say “it was an act of God” – and that proposal is valid, if one believes in God.  Most who have a problem with God might accept that this was one of those moments when the universe was in alignment for something to take place.  Others might speak of karma.  Still others might say that it was a random act, with nothing spiritual or religious or mysterious attached to the relationship.

Knowing what we know today of neuroscience and addiction, there is another point of view. Interpersonal neurobiology and the effects of mirror neurons.

Mirror neurons was a term coined in the 1990’s by Italian researcher Giacomo Rizzolatti who posited that our brains contain a series of neurons in the pre-motor cortex which mirrors the “behavior of the other, as though the observer were itself acting.”  Researchers have proposed that these neurons are responsible for our learning, our understanding the actions of others, and one UCLA researcher Marco Iacoboni has proposed that mirror neurons may explain  the “human capacity for emotions such as empathy.”

In the most simplistic terms, Bill W and Dr. Bob may well have been experiencing the exchange of mirror neurons between themselves that led to a broader understanding of their condition, and experience. In this particular case, of the suffering of alcoholism.

Daniel Siegel, MD has written a prolific amount on the topic of Interpersonal Neurobiology, Interpersonal Resonance and Mirror Neurons that offers a scientific basis for much of what we might otherwise find “mysterious” in an organization such as AA.  He defines Interpersonal Neurobiology as

“a consilient field that embraces all branches of science as it seeks the common, universal findings across independent ways of knowing in order to expand our understanding of the mind and well-being.”

Further, he defines Interpersonal Resonance as:

“The way two or more minds align their states and becomes mutually influenced by one another.”

There is something rather extraordinary that takes place in an AA meeting.  Once everyone settles down, there is usually a moment of silence, and  a collective prayer. These several minutes allow for our bodies and our minds to shift from the “outside” experience of workdays, parenting, relationships, struggles, etc., to the “inside” experience of the 1 hour group. The shift, according to Siegel’s definition, is the process of the minds in the room aligning their states and becoming mutually influenced by one another.

The meeting begins, and people share.  Or there might be a speaker, and people share. Or a topic. Or a reading.  The energy in an AA meeting may move slowly,  but the collective attention comes together for a purpose:  healing, recovery, wellness, well-being.

No matter the format of an AA meeting most people sitting in chairs around a table or in a circle experience something. That something has been virtually impossible to define. Some call it energy; some call it a spiritual experience of God; some call it the “miracle” of the program.

All this may be true.  And there may be another dimension the interpersonal neurobiology and resonance of those attending.  Collectively, an AA group begins to experience the hope, strength, and faith that they can overcome their addiction just by being in a room with others who have a similar experience.

Admittedly, AA is not for everyone.  A lot of people have trouble with the “God thing.” My first experience of AA included someone telling me that unless I accepted Jesus as my Savior, I wasn’t going to make it.  I didn’t know better, but as a Buddhist, I figured I was in the wrong place.  The fact that I was in the Bible Belt didn’t help either.  It took another 7 years to figure out that AA is indeed, for everyone.  Including Atheists, Agnostics, and yes, Buddhists.

Someone told me over 20 years ago at one of my earliest meetings during my second go-around, that you can substitute “GOD” for “Good Orderly Direction.” That fit me perfectly, and fit my world and spiritual view.  I took the suggestion, and did not find it necessary to have another drink. I have been attending meetings on a regular basis ever since.

One of the arguments that Glaser sets forth in her article which misses a point is that taking medication supplants the need for AA.  The medication that is available indeed does help enormously – I have worked with many a client who has benefited from the plethora of drugs now available to curb cravings.  But medication alone misses a critical mark – other people.

Recovering alcoholics need other people for support.  Isolation is one of the most damaging symptoms of the disease of addiction; popping a pill and going at it alone just doesn’t make good sense. Which is why AA suggests sponsorship as a means to help a newcomer (or an old-timer) navigate the program.

Like so much in life, connectivity and relationship is the glue of the human condition.  While AA may not be for everyone, there other group supports for those struggling with addiction that are equally as beneficial. Many have found recovery through the Church, or through therapy with a psychologist; many have found Rational Recovery.

There are dozens of other paths leading to the same end goal; but to suggest that the only “cure” is medication, is in my opinion, a very narrow view.

Glaser also puts forth that the disease model of addiction is misplaced. With that I have to disagree. A visit to the National Institute of Drug Abuse (NIDA) at will give the visitor an enormous amount of data regarding addiction to drugs and alcohol. Glaser conveniently never included this information in her article.

Controlled drinking is another hallmark of this piece.  In my years as a substance abuse counselor and addiction therapist, I have never encountered anyone who struggled with alcoholism or drug addiction to be able to “control” their use.  Tell that to a heroin addict.  Tell that to a binge drinker, or alcoholic.  It just doesn’t happen.

I have to wonder if Atlantic Monthly magazine didn’t publish this article just to get “buzz” and I also have to wonder if pharmaceutical companies such as the ones producing Naltrexone, aren’t primary advertisers. (My cynical side.) Not that there is anything wrong with “buzz” – or pandering to those paying large sums for page space reaching millions of viewers.  What I do have a problem with is that the choice of topic and the way it was treated is so one sided, and ultimately detrimental to the overall issue of recovery.

Glaser does make one valid point: That treatment centers charging $40,000 a month for nothing more than AA meetings is wrong.  I agree.

Save the $40k and go to an AA meeting for $1.  (Or $2-5 if you are of a mind, given that they serve coffee.)  Who knows, you might just get something out of it.



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