Does AA Work?

An image of Jamie Marich with friends, overlayed text reads: "Like many issues on which I'm asked to give me opinion, the answer is an emphatic...it depends."
Jamie with Chintan (left) and Mike L. (right)

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A program called Open to Debate recently invited me to debate the topic of whether or not Alcoholics Anonymous (AA), as a program of recovery, works. I declined the offer because I do not have a position that can be argued in a simple yes/no, positive/negative, does/doesn’t format. My long-time friend and colleague Dan Griffin took up the mantle of the “Yes” side and Dr. Adi Jaffe, a clinical psychologist whose work I’ve followed on social media for years made the “No” argument. You can listen to the debate HERE. The program producers graciously invited me to be a guest commentator at the end of the program. This role felt most fitting since I describe myself as both the biggest fan and biggest critic of AA and other 12-step programs. That tone comes through in my Trauma and the 12 Steps work and it’s how I’ve described my professional and personal opinion of 12 step programs in the years that I’ve taught on the intersections of trauma and addiction/substance use disorders. 

Despite my middle of the road positionality, as Dan and Dr. Jaffe debated, I wanted to jump in so many times with my opinion. Because of course I have opinions; lots of them! And what I offer you in this article are my opinions only, based on both my professional position and years of lived experience as a person in long-term recovery from a substance use disorder and a dissociative disorder. 

So, does AA work? Like with many issues on which I’m asked to give my opinion, the answer is an emphatic… it depends. To even explain the it depends, we must consider the meaning and operational definitions behind the two main concepts in the question. What are we talking about when we say AA? And what does it mean for something to work? 

While I go into much more detail on this topic in Trauma and the 12 Steps, I will briefly summarize what AA is and how it is important to distinguish the AA and 12 step meetings that are freely offered in the community from the scores of professional treatment centers (especially in the United States in Canada) that are grounded in 12-step concepts. The official founding of Alcoholics Anonymous is traced to 1935 when Bill Wilson, a disgraced stockbroker with about 5 months of sobriety obtained through his involvement in the Christian-based Oxford groups found himself on a business trip in Akron, Ohio. Trying to prove himself, he was awaiting the outcome of a proxy battle and found himself tempted to drink. A principle he learned during his Oxford group involvement is that reaching out and attempting to talk to another alcoholic was critical to his own sobriety. So Wilson started calling around to churches and a minister’s network eventually connected him with Dr. Bob Smith, a disgraced medical doctor. The two talked for hours in what would become the establishing groundwork for AA: the importance of one alcoholic helping another. 

To make a very long story short for the purposes of this article, Alcoholics Anonymous officially received that name in 1939 when the first edition of its text, colloquially called “the Big Book” debuted. While the early days were fraught with disagreement and the pains that come with a good thing evolving, AA eventually became an organization that committed itself to being non-professional. The various groups with the desire to stop drinking established throughout the country and later the world were to be autonomous. Although AA maintains World Services offices and holds regular conferences to determine which literature is and isn’t officially approved by the core organization, the autonomy of the groups is what, as Dan points out during the debate, what many sociologists see as true democracy. As Dr. Jaffe expresses during the debate, and I agree with him on this one, the lack of central positionality on many critical issues can be problematic. And World Services making statements to promote greater inclusion is not unheard of, like when it recently changed the Preamble statement of AA from “Alcoholics Anonymous is a fellowship of men and women,” to “Alcoholics Anonymous is a fellowship of people.” Needless to say, many of the autonomous groups in more conservative areas took issue with the change. 

It is important to distinguish, and this is one area I felt the debate could have better highlighted, that the AA meetings that one can find in a church or social hall basement in most American towns weekly are not intended to be professional treatment. Yet there is a tricky and, as I point out in the book, sometimes unhealthy relationship between AA and the hundreds of fellowships that spun off of it and use the same 12 steps (e.g., Narcotics Anonymous, Al-Anon Family Groups, etc.) and professional treatment centers. Although the AA organization itself committed in its early and still in-tact traditions to remain non-professional, the existence of the professional treatment industry and its leaders being 12-step members themselves (or having been helped by the 12-steps at one point in time) is responsible for this connection. A resulting problem, which I heartily acknowledge in Trauma and the 12 Steps, is that many 12-step principles and problematic slogans (such as “Take the cotton out of your ears and put it in your mouth”) can get passed off as psychological interventions. While I do not think there is a problem with exposing people to 12-step ideas in treatment settings, they need to be given as one of many choices for follow-up services that people can access after treatment. Ideally treatment ought to be a place where people receive psychologically sound interventions, which can include dialectical behavior therapy (DBT), the various flavors of cognitive-behavioral therapy (CBT), Internal Family Systems (IFS), Eye Movement Desensitization and Reprocessing (EMDR), among others. 

As the debate discussed, too often, sending people to AA in the community is seen as the cheap alternative to actually giving people quality treatment. AA itself was never meant to be a replacement for professional treatment, and the opinions about psychological and psychiatric interventions amongst AA members can be inconsistent. Although the official position of the AA’s conference-approved Twelve Steps and Twelve Traditions (originally published in 1952) is that outside psychological and psychiatric help might be needed, problems abound when individual AA members and sometimes the autonomous groups discourage folks from taking medications or seeking counseling. Of course this practice is problematic. And when clients or people who have had bad experiences in AA or other 12-step groups mention it to me, I feel it is my duty to explain that the program as described in the literature does not officially support this position. Yet this brings up an important point: there are a lot of toxic ideas being peddled in 12-step spaces by wounded people that inevitably cause harm. Some would see this as an inexcusable potential side effect of coming into contact with 12-step spaces. 

One of the reasons that I wrote Trauma and the 12 Steps is that I found AA helpful, even life-saving. If the wrong person or treatment center introduced it to me, I may have the same negative feelings about the fellowship and its steps that many of my colleagues in trauma-informed circles like Dr. Jaffe espouse.  I had a good experience because my first sponsor, Janet L. was beautifully trauma-informed, which she learned how to be as a clinical social worker in inner city Cleveland. Moreover, I find the AA steps to be spiritually inclusive when they are presented in non-fundamentalist ways, helping people to embrace concepts like surrender and letting go of the need to control (which are also core ideas in Buddhist psychology). A few tweaks to some of the arcane language in the steps can also make a tremendous difference. I make suggestions for how to do this in Trauma and the 12 Steps. Many other rebel 12-steppers have done the same over the years. As Dan points out in the debate, even AA World Services recently published a Plain Language Big Book (2024).

Some of the slogans and folksaying of 12-step recovery, like the aforementioned take the cotton out of your ears and put it in your mouth can be used abusively. Many of these are not even a part of the official literature. And I point that out when people in meetings or other professionals who blindly follow a 12-step path use such sayings to shut people down. However, other 12-step ideas outside of the steps such as acceptance is the answer to all of my problems today pre-date much of what we in the psychological professions teach now within modalities such as acceptance and commitment therapy (ACT) and the dialectical behavior therapy (DBT). For a piece that I wrote on how much the acceptance concept helped me to stay sober, click HERE. I wrote Trauma and the 12 Steps and its supporting workbook and meditation reader to help people exposed to 12-step programs and the professionals who support them wade through the bullshit; also, to help sponsors and 12-step leaders do better around issues with trauma.

I take some flack from trauma therapy professionals for believing that the 12-steps can work for people or at least be a part of getting them started on the path of recovery as they define it. These feelings are not unlike my sentiments about Christianity. Even as a survivor of conservative, fundamentalist Christianity (which you can read more about in my memoir if interested), I am still not opposed to Christianity as a spiritual path. I’m the first to call out what I see as the problems, yet I also see and have experienced where following the teachings of Christ through a non-dogmatic lens can be nourishing. I do credit both Dan and Dr. Jaffe for touching on the philosophical concept of dialectics, often expressed as the notion of both/and or two things can be true at the same time in the debate. For me, looking at all spiritual paths and programs through this both/and lens is critical. Which is why in answering the question does AA work, we must approach it with this both/and delicateness. Just as people have a right to be critical of AA and other 12-step approaches, we must also be careful not to mock and shame people who find them helpful in some way. 

So what does it mean for something to work? In the debate, Dr. Jaffe uses the standards of academic, peer-reviewed research as a benchmark and often makes comparisons to medical model standards of whether or not something works. For instance, if someone is prescribed an antidepressant to treat depression, research and clinical data can predict rather well what kind of an effect that medication will have. I believe that this comparison is rather unfair since, in my clinical experience, how people respond to all psychotropic medications can radically differ from person-to-person based on a variety of variables. And as I’ve called out in many other articles, including my 2024 year in review, I fear that those of us offering therapy can get so caught up in validating what we do as scientific, we fail to see that what we do is an art. And the ways of art, not to mention the ways of spirituality, cannot be easily measured by quantitative scientific methodology. I make this assertion as a qualitatively trained researcher and thinker who must emphasize in modern times that I am not anti-quantitative science. I do not, however, believe that it paints a complete picture of the human experience. 

Perhaps I am biased in saying that AA and other 12-step methods can still work because the people I’ve come into contact with seem to be helped by it, at least in the early stages of developing necessary lifestyle change. I have kept an open-mind, more than most 12-steppers do, about approaches like psychedelics in recovery, medically assisted treatment, harm reduction, and other programs for recovery that exist either as 12-step modifications or as their own separate entities. And I’ve seen these work for people too depending on how they are defining their goals for healing and recovery. Naturally, as a trauma therapist, I am the first to admit that as a treatment field we must help people get to the root causes of their substance use or other addictive disorders. Yet I’ve also seen disasters happen when people go digging for the root causes as excuses and don’t lay the necessary groundwork for daily practice or commitment to change first or in concert with the deeper trauma work. 

I intended to close this article in the spirit of there are no simple answers, let’s all keep our minds open and our shaming of others in check. However, in the weeks between taping the debate and writing this article, one of the greatest men I ever knew in the rooms of recovery passed away after a short time in Hospice care. Mike L. was an gay atheist with over thirty five years in recovery at the time of his death who credited his recovery to AA. Many people who argue against AA will contend that the program is too spiritual, and in most parts of the United States, too Christian to be effective for people of other religions or for those who are agnostic or atheist. Mike, the spouse of my own sponsor, allowed me to interview him for the revised and expanded edition of Trauma and the 12 Steps in 2020 on the topic of how an atheist could be helped by AA. He had two simple responses. First, was that his own recovery sponsor (mentor) “couldn’t care less” if Mike believed in God or not. This resonates with my own experience of what made 12-step recovery effective for me: having the person who initially mentored me through the program be open-minded and flexible instead of rigid and dogmatic. Secondly, Mike took great encouragement from the idea in the Big Book: “And we have ceased fighting everything and everyone–even alcohol.” By letting go of his need to be right and always win the debate, he learned about the power of surrender in the rooms of AA, even though he had to filter out a lot of other people’s ideas about God in the process. 

Personally, I am a rebel member of various 12-step fellowships (who clearly has broken traditions by outing myself so much in my work, so yeah…not dogmatic). And I needed to learn about the power of surrender and not taking myself too seriously, while also honoring my pain, in order to get well. Connecting with the right people and positive experiences in 12-step spaces helped me to do this, and then later receiving trauma therapy and learning meditation, yoga, and mindfulness practices enhanced my healing. So it worked for me, or can at least be described as a significant aspect in what worked at the beginning and what helps with maintenance. I have many other friends, loved ones, clients, and colleagues who testify that 12-step recovery didn’t work for them, whereas other things have. If such folks are living a life that they find to be personally rewarding while treating others around them with dignity and respect, I take no issue with how they obtain recovery or healing as they define it. I even celebrate it. I am not here to debate you, to fight you. I hope that we all make it. And I hope that people seeking help in the days and years to come are met with a greater sense of accessible choice in how they heal and pursue their intentions for changing their lives. 

Resources

I am happy to share some resources for recovery support that were initially started by AA/other 12-step members but have flourished to be more inclusive and offer other styles of meetings either in place of or in addition to 12-step groups.

She Recovers Foundation

www.sherecovers.org

Friendly Circle Berlin Online Workshops

https://friendlycircleberlin.org

InTheRooms Online Meetings

www.intherooms.com 

Secular AA Resources 

https://www.aasecular.org

The Secular Recovery Group

https://srgrecovery.org/

A.A. Agnostica

https://aaagnostica.org

FreeThinkers Recovery (Tus Nua)

https://tusnua.eu/

Various Resources for Jewish Folks in Recovery 

https://www.chabad.org/library/article_cdo/aid/714731/jewish/On-The-Net.html https://jewishboard.org/how-we-can-help/jewish-community-services/jacs/

Recovery Dharma

https://recoverydharma.org/

Yoga of 12-Step Recovery

https://www.y12sr.com

Recovery Yoga Nidra

https://numind.org/

Choices in Healing and Recovery

https://choicesihar.org/index.html

Seeking Safety

https://www.treatment-innovations.org/seeking-safety.html

METTA Protocol (EMDR)

http://www.mettaprotocol.com/metta-protocol-introduction 

And… it you are local to Summit County (Ohio), where AA’s birthplace of Akron, Ohio is located, I want to give a hearty shout-out to this newer resource, a drop-in center that is harm reduction friendly and hosts meetings of all kinds:

Summit Recovery Hub

https://www.summitrco.org

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Warrior Queens

I do not call myself a dysregulated survivor of sexual assault, molestation, betrayal, physical abuse or psychological trauma. I won’t even call myself a thriver.