US of AA: How the Twelve Steps Hijacked the Science of Alcoholism

By Joe Miller

In US of AA, Miller shares the never-before-told story of how in the aftermath of prohibition America's top scientists helped launch a movement that would give rise to a multi-million-dollar treatment industry and a new government agency devoted to alcoholism that has made available millions of dollars for research. Despite the fact that this research showed that alcoholism is a complex disease requiring an array of treatment strategies, among which Alcoholics Anonymous (AA) is one of the least effective, money continued to flow to treatment facilities using approaches similar to AA. Five years in the making, his brilliant, in-depth investigative reporting into the history, politics and science of alcoholism will show how AA became our nation's de facto treatment policy, even as evidence for more effective remedies accumulated. US of AA is a character-driven, beautifully written expos, full of secrecy, irony, liquor industry money, the shrillest of scare tactics and, at its center, a grand deception. In the tradition of Crazy by Pete Earley, and David Goldhill's Catastrophic Care, US of AA shines a much-needed spotlight on the addiction treatment industry. It will forever change the way we think about the entire enterprise.

• Language: English
• Publisher: Chicago Review Press
• Release date: Apr 2, 2019
• ISBN: 9781613739280

Joe Miller

Joe Miller is an outdoors and fitness writer based in Cary, N.C. He produces the outdoor recreation blog http://www.getgoingnc.com/ and is author of 100 Classic Hikes in North Carolina.

Reviews for US of AA

[jennynau10 · Rating: 3 out of 5 stars]

I'm the only member of my nuclear family that is not an alcoholic and this book put the entire AA program into a new light for me. It didn't really work for any of my family and we spent years trying to help them to succeed within the parameters of that program. We could have been addressing the addiction scientifically and that may have improved their quality of life- we'll never know now. Highly recommended if you have been affected by alcoholism.

[davidwineberg · Rating: 4 out of 5 stars]

The history of alcoholism is colored by the fact it has spent almost the entire 20th century trying to be recognized as a disease. In Joe Miller’s brief but more than sufficient history of Alcoholics Anonymous, US of AA, doctors play almost no positive role until the 2000s. Ordinary Americans, suffering the effects, tried to figure out the extent, the how, and the why of alcoholism. They had their successes and plenty of setbacks, and by the 1960s were at the level of the Supreme Court, arguing it was a disease, not a crime.Alcoholism was finally declared a disease in the late 1960s, not by doctors or the AMA, but by President Lyndon Johnson, who by then had been part of the organization for 20 years. Funding in the millions began to flow from federal coffers to agencies and commissions led by AA supporters. The focus was almost entirely on total abstinence as the only treatment. But as the rest of the world knew, that’s not true, not what it looks like, and not how it works.Alcoholics Anonymous (AA) is one of the strongest brands in US history. Everyone knows it means constant meetings of verbal self-flagellation and obeisance to God, to ward off the temptation to drink. That members monitor each other with the sole intent of preventing the consumption of a single drop of alcohol by other members. Doctors all but automatically send patients to AA rather than any other course of treatment. It is an astonishing branding achievement by a small group of alcoholics. Even more astonishing is their failure rate – 90 to 95%. AA is far from a proven cure. There are 25-40 million Americans who have recovered from alcoholism and addiction, and less than 20% did it by total abstinence. And even fewer are lifelong AA members. The vast majority learns to manage and control it, and can drink socially without getting blind drunk or go on weeklong binges.AA chapters pop up all over the country, mostly thanks to the efforts of alcoholics who were saved by AA. They become evangelicals, who can’t wait to share with others. AA members are quick to work intensely with any alcoholic (above age 40) and get them on the path. Their method is to point out it is a disease, not a moral failing of theirs, that it can be overcome, that they are proof of it, and that a whole fruitful life lies ahead. But they avoid people in their 30s, because they haven’t yet hit bottom, and so have more trials and suffering to endure before they capitulate for real. A very odd disease, indeed.Even stranger is the medical establishment’s avoidance of it all, despite the evidently huge market for treatment. Miller tells the story of the end of Prohibition, when drunkenness became so pervasive, the New York Times was certain the constitutional amendment would be repealed and Prohibition would return forever. Few clinical studies, less research, and nothing in the way of political will mark the journey from the AA founding until about 60 years ago, when public relations efforts finally brought the public, at least, to believe it was a physical disease. To AA, alcoholism is like an allergy – a systemic physical defect that causes the alcoholic to crave the stuff if even one sip is imbibed. That’s sensitivity in the extreme.The story Joe Miller has researched is one of constant conflict – getting alcoholics to admit they are, getting doctors to take AA seriously, getting governments to acknowledge alcoholism as a clinical disease. And it’s not just medical doctors who are a problem; psychiatrists play an important role in the fog of alcoholism. Miller himself had to go to numerous psychiatrists before he could find one to prescribe a most useful medication to reduce his own alcohol cravings.With no small irony, Bill Wilson, the founder of AA, spent his dying days in bed with emphysema, begging for and demanding whiskey. His wife and medical team refused. Some alcoholism just doesn’t go away.David Wineberg