Twelve Steps to Nowhere: Why Twelve-Step Rehabs Fail and a Proposed Fix

By Kenneth L McElwee

Are you wondering why you haven't shed the shackles of substance addiction even though you've attended countless AA or NA chapter meetings and bank-breaking rehabs? If you're frustrated by those who insist that your relapse was entirely your fault because you supposedly (a) failed to "work the steps" sufficiently or (b) failed to learn from the

• Language: English
• Publisher: Kenneth McElwee
• Release date: Sep 15, 2022
• ISBN: 9781736641637

Book preview

Introduction

A Program in Crisis

Substance abuse is a national scourge. It’s estimated that in the United States alone, over 95,000 people die from alcoholism or alcohol-related diseases annually.¹ Moreover, according to the National Center for Disease Control, 100,306 Americans died from drug overdoses during 2021.² Every year nearly 10,000 Americans are killed in alcohol-related driving accidents and many more are left seriously injured and disabled.³ Each year, an estimated 1.4 million Americans are victims of alcohol-related violence.⁴ According to the Office of Disease Prevention and Health Promotion, the economic cost of substance abuse in the United States exceeded $600 billion in 2021.⁵ Substance addiction has reached pandemic levels and nothing seems to slow this burgeoning menace.

Since the mid-1930s, twelve step therapy, which was pioneered by Bill Wilson and Alcoholics Anonymous (AA), has held a near monopoly in substance addiction therapy and, accordingly, it has been the default solution for achieving abstinence. AA’s effectiveness was for decades celebrated as a marvel, its therapy saving the lives of alcoholics whom physicians had once written off as being terminal. Indeed, in the decades immediately following its establishment, AA reported long-term remission rates approaching an astonishing 75%.⁶ Ever since publication of the first edition of AA’s "Big Book, the organization has maintained that [r] arely have we seen a person fail who has thoroughly followed our path.⁷ Since the 1930s, millions around the world have sought recovery from twelve step programs such as AA and Narcotics Anonymous (NA").⁸ The vast majority of substance abuse rehabilitation programs are twelve-step based,⁹ and tens of thousands each year are judicially ordered to complete sobriety programs, most in the AA model. In fact, the Biden Administration intends to make drug abuse rehab mandatory for those charged criminally for possession of illicit drugs.¹⁰ In 2015 alone, $35 billion was spent on drug addiction treatment in the United States—fortunes flooding into the coffers of both for-profit and nonprofit twelve-step addiction rehabilitation facilities from insurance companies, self-insureds, and federal and state governments.¹¹ Surely, twelve-step programs have proven to be highly successful, right?

Wrong.

Today, AA’s success rate has nearly fallen through the floor. In fact, surveys indicate that its one-year sobriety rates have plummeted to between 5% and 10% of those who have entered a twelve-step program.¹² When one considers that the spontaneous remission rate (i.e., the rate at which alcoholics stop drinking without any medical intervention) stands at between 3.7% and 7.4%,¹³ AA’s real efficacy rate approaches zero.¹⁴ AA’s current abysmal success rates are consistent with the findings of the highly respected, independent Cochrane Collaboration, which concluded: No experimental studies unequivocally demonstrated the effectiveness of AA in treating alcoholism.¹⁵ AA’s questionable effectiveness was also confirmed in one scholarly paper presented to the American Society of Addiction Medicine [ASAM]. It reviewed four independent studies¹⁶ as to twelve-step effectiveness. As to the issue of whether twelve-step programs were specifically effective in achieving abstinence, the ASAM paper found as follows:

At the heart of the debate is the quality of the evidence. AA critics have argued that … rigorous experimental studies are necessary in order to convince them of AA’s effectiveness. Their concern is well-founded. As will be evident from this review, experimental studies represent the weakest of the available evidence.

* * *

What, then, is the scorecard for AA effectiveness in terms of specificity? Among the rigorous experimental studies, there were two positive findings for AA effectiveness, one null finding, and one negative finding.¹⁷

None of the four studies accounted for dropout rates, all polling trial participants upon the termination of certain time periods, such as 12 or 18 months. Accordingly, the outcome of these surveys would have been substantially worse if all persons entering a twelve-step program were polled at the end of those periods, not just the ones who stuck with the program.¹⁸ All this explains why AA and twelve-step rehab operators are loath to discuss success ratings or statistics, relying instead on the incessantly regurgitated statement made nearly a century ago, namely, rarely have we seen a person fail who has thoroughly followed our path.¹⁹

Many AA officials and twelve-step rehab operators shrug off embarrassing statistics as being unreliable or otherwise inapposite without adequately explaining why. Sometimes, they will state that they know that their effectiveness rate is substantially better, but they often conveniently fail to follow up with chapter and verse buttressing their statistical position. Even worse, without any evidence whatsoever, twelve-step facilitators and rehab operators frequently try to excuse the current low success rate for achieving sobriety by pinning the blame exclusively on the alcoholic or addict.²⁰ They often sanctimoniously and reflexively spew the assurance that the person’s relapse would not have occurred had the patient properly completed the steps. Imagine that NASA, like AA, had only a 5% success rate, meaning that 95 rockets out of 100 blew up on the pad. How do you think the public would react if on each catastrophic failure, NASA’s director shrugged off the disaster by unreflectively stating, The explosions must have occurred because the astronauts failed to complete the correct steps for launching the rocket? Wouldn’t an angry nation demand absolutely that NASA investigate its own systems, designs, materials, and manufacturing processes before dumping more billions of dollars into such a deadly program? Yet, twelve-step rehabilitation operators apparently believe the public, legislatures, and insurance companies will forever stay content to fund them regardless of countless relapse disasters.

When defending its effectiveness, AA and its proponents have traditionally relied upon surveys using dubious poling methods that generate deceptive statistics.²¹ In the past, AA has advertised sobriety statistics obtained by canvassing only members who stayed with the program for one year or more to determine the rate at which they had remained abstinent.²² Not surprisingly, AA reports significant abstinence rates of approximately 24% for those who have stayed loyal to the program for at least two years.²³ However, this methodology is very misleading, since one would naturally expect someone who has stayed with the program for the long haul would state that she experienced some level of success with it. Indeed, such surveys seem to do little more than test the nearly tautological statement that those who successfully stayed with the program experienced success with the program.²⁴ Obviously, a much more revealing test of AA’s efficacy would be to survey the abstinence and relapse rates of all persons who entered, not just stayed with, the program. Since approximately 70% of alcoholics stop attending AA meetings within the first year,²⁵ such a statistic would be depressingly elucidating, indeed. AA’s recent accomplishments appear to lie mostly in the successful spinning of a survey. It’s reminiscent of the sick patient confronting his physician about his terrible statistical success rate:

Doc, I was shocked and simply nonplussed That your patients all died and are dust.

Ah, but there’s one I’ve wall-mounted That you haven’t yet counted So, my success rate’s far more robust!

Insurance company executives are sophisticated, not stupid. Right now, insurers are compelled to recognize alcoholism and drug addiction as a disease for which benefits must be paid. They also know that currently, AA and NA run practically the entire show when it comes to addiction recovery, there being vastly fewer available therapies. This probably explains why health insurers haven’t seriously challenged indemnification demands for twelve-step rehab treatment—no medicinal or behavioral therapy has yet become available that is both cheaper and substantially more successful.

The addiction recovery industry is kidding itself if it believes (1) that health insurers will not someday demand scientifically compelling evidence as to efficacy and (2) that poorly conceived abstinence surveys and anecdotal testimonies will suffice to justify the expenditure of even more billions. Money will stop flowing into twelve-step rehabilitation facilities and the addicted will stop attending AA and NA chapter meetings as soon as a new medicine or protocol is developed that is demonstrated to be just marginally more effective. Insurance companies have a duty to their shareholders to be profitable, and they routinely implement cost-saving measures despite public consternation. It’s simply inconceivable that twelve step addiction programs have much of a future unless they start achieving demonstrably superior success rates.

Yet, AA’s death would truly be tragic. AA’s spiritual approach to healing really does work. In fact, it saved my life. However, I embraced those spiritual truths despite, not because of, how AA currently teaches them. Many twelve-step organizations now give only passing lip service to their core values and spiritual principles,²⁶ and its failure to deliver the founders’ original message lies at the heart of current twelve-step ineffectiveness. More often than not, they ignore the obvious, looming barrier that blocks the alcoholic’s path to sobriety, i.e., her pathological, deeply held conviction that she is worthless and unloved. Alcoholics and addicts suffer from a spiritual deficit, taking it for granted that their lives have no more transcendent significance than those of toiling ants.

My Own Path to Sobriety

I began abusing alcohol to cope with physical and emotional pain following serious surgeries that negatively affected the quality of my life. My drinking soon caused me to self-isolate, and my emotional anguish snowballed. On seven occasions over the course of as many years, I binge drank myself to the brink of death. My life fell into the toilet. After each detox, I attended an AA-based rehabilitation program, procured a sponsor, worked the steps, read the Big Book and attended AA meetings. Every time I returned home, I was determined not to drink, being reasonably confident that all I had to do was to learn how to exist without alcohol. However, each time I fell off the wagon harder than the time before, drinking more and more booze to assuage chronic pain and to numb raw emotions.

During my eighth and last addiction rehabilitation enrollment, I finally decided to take the Big Book’s message seriously—that addiction naturally withers and dies upon the alcoholic’s spiritual awakening. However, I also realized that I could no longer rely upon the advice and instruction that I had been receiving from AA chapters and rehabs. Many twelve-step operators don’t appear to really believe in the Big Book’s core principles and values. I knew that my recovery was going nowhere if I listened to the steady stream of nonsense, cult talk, irrationality, and weird moonshine that many twelve-step facilitators now attempt to pass off as spiritual advice.

I immersed myself in the Big Book as well as other philosophical, inspirational, and spiritual discourses. Through my own efforts and God’s help, the proverbial scales dropped from my eyes. I had been led to a spiritual awakening and felt the power and desire to remain sober grow from strength to strength. In retrospect, I wish I had received intelligent, serious spiritual guidance from chapters and rehabs well before my eighth rehab experience. Not only did those twelve-step rehabs and local AA chapters fail to deliver a philosophically sound spiritual message, but they also projected timidity and even embarrassment in advocating reliance on a transcendent, personal spiritual Power.

Once having immersed myself in spiritual thinking in a serious way, I quickly realized that AA’s founders had always known that developing a relationship with our higher Power and reaching a spiritual awakening was a prerequisite for many if they really wanted to achieve long-term sobriety. AA’s founders had the profound, correct insight that sobriety was not likely achieved if conceived as a life-long, white-knuckled struggle to accept a life deprived of alcohol or drugs. The thrill of living spiritually awake and energized to change the world eclipses the allure of addictive substances. The truly awakened don’t agonize about whether they’ll relapse because they’re riveted to a new way of life. AA’s founders knew that sobriety was the inevitable, natural fallout from having a spiritual awakening and then living by it. They also knew that sobriety without such an awakening was a Pyrrhic victory. Afterall, sobriety means little if, after the process, you remain resentful, depressed, demoralized, resigned to a meaningless, purposeless existence, or suicidal. A medical or behavioral alternative to twelve-step programs that simply sobers up the desperate and despondent does little more than remove the alcoholic’s anesthesia. Although such a cheaper, new recovery protocol would be cruel to those suffering from substance addictions, it would, nevertheless, likely constitute a substantial financial victory for health insurers.

The Root of the Addiction Crisis

Because my own spiritual awakening finally gave me victory over addiction, AA’s precarious future became an issue of great personal concern. The organization’s previous successes could not have been a myth since millions of alcoholics and addicts have testified to the twelve-step solution, not to mention millions of persons around the globe who have seen their sick loved ones transformed by it. Something must have happened but what?

At first, I concluded that the answer lay in the expanded availability of alcohol and drugs since the 1930s. More stores sell liquor throughout the country than ever before, and in many States, it’s difficult to find a restaurant that doesn’t serve alcoholic beverages. As to drugs, it was then an even deeper underground market, but now, pills and dope can be easily procured in the suburbs and even rural areas. Surely, I thought, this must account for why it is harder for the recovering alcoholic and addict to stay clean.

However, on reflection, I concluded my theory was fatally flawed. It’s true that with respect to the sale of most legitimate goods, reduced access to supply results in decreased consumption, but the use of addictive substances is nowhere near as sensitive to supply availability as are legitimate products. Addicts and alcoholics are notorious for going to extraordinary lengths to satisfy their cravings, and closer suppliers only make meeting the non-elastic demand for addictive substances a little more convenient.

For example, while attending a rehab in Pennsylvania, I met a woman who resided in Philadelphia who told me that on a Christmas morning, while suffering through withdrawal, she left her house dazed while wearing just pajamas and slippers in order to walk over the Benjamin Franklin Bridge to Camden, New Jersey. (Unlike Pennsylvania, New Jersey permits the sale of liquor on Christmas). Anyone familiar with that bridge, its length, and the area into which it terminates in beautiful Camden knows what a harrowing experience that must have been.

At another rehab, which happened to be located on a body of water, the gates leading into the facility from the outside were both closed and guarded, and it was exceedingly difficult to escape from the campus in order to purchase drugs or alcohol without being caught. Nevertheless, a heroin addict in his early twenties solved the problem by swimming almost two hundred yards in cold fall weather to make a drug score on the opposite bank.

I realize these stories constitute only anecdotal evidence and that I have no data from an Ivy League economist graphing out the sensitivity of (a) illegal drug sales to (b) the addition of dope outlets, but common sense compels the conclusion that a withdrawing boozer or dope-sick junkie will go to incredible lengths to satisfy his addiction’s pitiless demand to be satiated. In other words, greater availability of illegal drugs and alcohol did not explain pathetic twelve-step success rates.

I then considered the possibility that AA’s spiritual philosophy no longer has traction in modern society. When pondering that possibility, I researched polling data on the percentage of Americans claiming religious/ spiritual affiliation since AA’s founding in 1935. I discovered that during this time, the percentages of Americans who claimed membership in traditional religions such as Roman Catholicism and mainline Protestantism have fallen dramatically.²⁷ However, this decline was largely offset by the huge increase in the percentage of people who now claim affiliations with so-called emerging faiths.²⁸

At first, I concluded that a mere transfer of affiliation from one spiritual or religious worldview to another should not in principle make the twelve-steps less effective. Afterall, neither AA nor NA has ever been a Roman Catholic or Protestant-based organization. These programs have always respected non-Christians as members, and the steps expressly state that the higher Power on which the alcoholic should rely must be based upon the member’s own individual understanding of God. Alcoholics Anonymous literature is, and always has been, non-reliant on quotations from scriptures, and the idea that AA is just re-worked Christianity is patently false. People of many faiths around the globe have accepted the spiritual principles on which the twelve steps are based, and there is simply no reason to believe that reduced efficacy statistics tightly correlate to diminishing mainstream church attendance.

I initially thought the transfer of religious affiliations to non-traditional spiritualities should have no impact on the popularity of either AA or NA. Neither organization cared about the differences among the world’s many practiced theistic faiths because most either expressly embrace twelve-step principles or are otherwise compatible with them. To AA’s founders, spirituality was a praxis, being a disciplined philosophy or structured worldview that was based upon a transcendent Power and certain objective, eternal truths. For them, virtually all the world’s theistic religions functioned as such, and it was the responsibility of the alcoholic to find and then trust in that higher Power. The specifics of the alcoholic’s spiritual worldview or religious orientation was his own business, and AA and its members were obliged to respect it.²⁹ Recovery was based on the application of a sort of redemptive formula (i.e., the twelve steps) that could easily be incorporated into most spiritual worldviews or religious ways of life.³⁰ I tentatively concluded that since polls have shown that most Americans identify themselves as being spiritual (as opposed to religious), AA’s spiritual therapy should still be effective.

The Evil Hiding in Plain View

Before giving up my attempt to discover the reasons for pathetic twelve-step success rates, I began to recall and analyze the specific statements touching upon spirituality made by many AA and NA attendees and instructors. I also recalled and reviewed my mountain of class notes memorializing the lessons taught by twelve-step instructors and speakers, particularly at rehabs. Shortly into that investigation, the reason for the current failure of AA and NA hit me like a dropped anvil. I had been like a fish that is unaware it lives in water—the problem was both ubiquitous and systemic to twelve-step institutions. The two causes for pathetic sobriety rates are:

The modern, widely held belief that humans (a) are nothing but aggregates of organic matter destined to decay, (b) that they are unloved, (c) that their lives are meaningless, and (d) that no good, loving Creator exists to rescue them from spiritual oblivion; and

AA’s and NA’s failure to meet their members’ spiritual needs [i.e., by refuting (1), above] by peddling a fad, anything goes, sham spiritual philosophy that is cynically designed to maximize the orga-nizations’ popularity at the expense of efficacy.

Both AA and NA are uniquely equipped to teach the spiritual principles that empower the hopeless to wrestle freedom from addiction. However, in recent times, too many within twelve-step organizations have grown afraid to promote them for fear that they might offend atheists, agnostics, and moral relativists. To be pluralistic and culturally relevant, some twelve-step advocates proclaim that AA has always been divorced from spiritual doctrines. This assertion is plainly false, and those who promote it to maximize institutional membership are disingenuous. Saying that there’s no spirituality in AA’s literature is like saying there’s no sugar in Twizzlers®. People who utter such things suffer from a common disability–willful blindness. Even the most cursory reading of the Big Book reveals the organization’s core spiritual principles, i.e., its simple doctrine.³¹ The twelve steps themselves expressly discuss the goal of a spiritual awakening, and God, whose very essence is spiritual, is expressly cited eight times therein.³² The human need to shed moral shortcomings as part and parcel of doing God’s will is unambiguously stated. Moreover, the imperative that people should act from love, both as to others and themselves, is unmistakably implied. These core principles, among others discussed below, are also shared by the overwhelming majority of the world’s faiths.

It’s this book’s thesis that if AA and NA are to survive, then they must return to their original spiritual principles, teach them, and insist that the addicted start living by them. Unless AA and NA embrace their historic roots, twelve-step therapy will lead the addicted to nowhere—the isolated last stop where drunks and addicts numbly await oblivion’s arrival.

This Book’s Structure

This book is divided into two sections. In chapter one of the first section, I describe the modern attitudes that have sickened our society and fueled our addiction crisis. In chapter two, I show how AA and NA not only fail to fight these diseased attitudes, but also, how they tolerate and even promote them. In chapter three, I relate real-life stories of the systemic dysfunctionality within twelve-step rehabs that I have personally witnessed. By retelling these accounts, I hope to describe current institutional infection in such a way as to suggest its logical cure.

Section II explains what must be done to revitalize AA and NA and restore them to preeminence as the most powerful weapons against addiction that have ever been conceived.

It’s a hold-no-punches presentation which simultaneously emphasizes the seriousness of twelve-step institutional sickness and lays out a hopeful, exciting plan to revitalize both organizations. That plan includes practical ways in which twelve-step leaders, sponsors, instructors, and therapists can motivate the recovering alcoholic or addict to take active steps towards a spiritual awakening instead of passively waiting for it to occur. It explains how the open-hearted alcoholic or addict can obtain knowledge of, and trusting faith in, a personal, loving God who will empower her to crush addiction.

³³

_______________________

¹ Centers for Disease Control and Prevention (CDC). Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI). Annual Average for United States 2011-2015 Alcohol Attributable Deaths Due to Excessive Use, All Ages. Available at: https://nccd.cdc.gov/DPH_ ARDI/Default/Default.aspx. Accessed March 27, 2022.

² See official website of the National Center for Disease Control and Prevention, https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm. Accessed March 27, 2022.

³ Ibid.

⁴ Ibid.

⁵ See official website of the Office of Disease Prevention and Health Promotion at https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Substance-Abuse. Accessed March 27, 2022.

⁶ Alcoholics Anonymous Big Book. 1955. 2nd ed. New York, NY: Alcoholics Anonymous World Services; see also Alcoholics Anonymous Recovery Outcome Rates, Jan. 1, 2008; see also A. H. Thurstin et al., The Efficacy of AA Attendance for Aftercare of Inpatient Alcoholics: Some Follow-up Data, International Journal of the Addictions 22 (1987): 1083–90.

⁷ Alcoholics Anonymous Big Book. 2002. 4th ed. New York, NY: Alcoholics Anonymous World Services, p. 58. [Hereinafter, Big Book shall refer to the 4th edition unless otherwise stated].

⁸ For the sake of concision, I have, throughout this book, referred primarily to AA, but my analysis in all cases is equally applicable to NA and all other twelve-step substance addiction recovery programs. Any reference herein to AA shall mean and refer to all twelve-step addiction programs.

⁹ Joe Biden’s ‘Mandatory Rehab’ for Drug Users Are Rebranded Jail that Don’t Work and Cause Overdoses, Forbes, Sept. 10, 2020

¹⁰ Ibid.

¹¹ Inside the $35 Billion Drug Treatment Industry, Forbes, April 27, 2015, found at https://www.forbes.com/sites/danmunro/2015/04/27/inside-the-35-billion-addiction-treatment-industry. Accessed March 27, 2022.

¹² AA abstinence studies usually don’t include the rate at which its members drop out of the program. By omitting it, AA disingenuously exaggerates its successfulness. In those few studies where dropout rates are reported, AA’s overall effectiveness rate is very poor. [See nn. 13, 16, 18, 21, 23 & 24, infra.]. For example, University of California professor Herbert Fingarette reported on a sobriety survey in which only 25% of the survey participants remained with an AA program eighteen months after its commencement. [The percentage of remaining participants will be referred to as the Remainder Rate.] Given the nature of the disease when left untreated, it is overwhelmingly likely that all of those who dropped out failed to achieve consistent sobriety. As to this smaller, remaining group, only 22% had achieved consistent sobriety at the end of the eighteen months. [I will refer to effectiveness rates that fail to account for dropouts as an Unadjusted Effectiveness Rate.] To extrapolate AA’s overall Adjusted Effectiveness Rate, we must multiply the 25% Remainder Rate by the 22% Unadjusted Effectiveness Rate, arriving at an Adjusted Success Rate of only 5.5%. In other words, only 5.5% of those who entered a twelve-step program achieved consistent sobriety at the end of eighteen months. H. Fingarette, Heavy Drinking: The Myth of Alcoholism as a Disease (Berkeley: University of California Press, 1988) at 35. The Adjusted Effectiveness Rates extrapolated from other studies is likewise poor. See, e.g., R. Fiorentine, After Drug Treatment: Are 12-Step Programs Effective in Maintaining Abstinence? American Journal of Drug and Alcohol Abuse 25, no. 1 (Feb. 25, 1999) at 93–116. (When the Remainder Rate of 23.8% [as calculated in note 18, infra.] is multiplied by the Unadjusted Effectiveness Rate of 40%, the study’s Adjusted Effectiveness Rate was only 9.52%). For a discussion as to the requirement to calculate an Adjusted Effectiveness Rate, see With Sobering Science, Doctor Debunks 12-Step Recovery, The Atlantic (March 23, 2014) Available at https://www.npr.org/2014/03/23/291405829/with-sobering-science-doctor-debunks-12-step-recover. Accessed March 27, 2022.

¹³ R. G. Smart, Spontaneous Recovery in Alcoholics: A Review and Analysis of the Available Research, Drug and Alcohol Dependence 1 (1975–1976) at 284. It would be interesting to know the correlation between (a) those who experienced spontaneous remission in addictive behaviors and (b) secondary diagnoses of emotional and psychological disorders. I suspect that those in remission might not have really been afflicted with the genetic physiological predisposition to alcohol but were, rather, medicating themselves to cope with other painful mental illnesses.

¹⁴ Few rehabs rigorously track their graduates, so meaningful, scientific efficacy measurements aren’t available in that clinical setting. Of the two oldest and most recognized national rehabs, i.e., Hazelden-Betty Ford, and Sierra Tucson Clinics, only Hazelton published follow up success statistics based on 1998 data, reporting that approximately 50% of its clients remained sober after one year. R. Stitchfield and P. Owen, Hazelden’s Model of Treatment and Its Outcome, Journal of Addictive Behaviors 23, no. 5 (1998): 669–83.

¹⁵ Alcoholics Anonymous and Other 12-Step Programmes for Alcohol Dependence, Cochrane Database Systems Review 3 [July 2006]: CD005032).

¹⁶ Those studies are (1) Walsh D.C., et al. A randomized trial of treatment options for alcohol-abusing workers. New England Journal of Medicine. 1991 at 775–782; (2) Project MATCH Research Group. Matching alcoholism treatment to client heterogeneity: Project MATCH posttreatment drinking outcomes. Journal of Studies on Alcohol. 1997;58(1):7–29, (3) Timko C, Debenedetti A. A randomized controlled trial of intensive referral to 12-step self-help groups: one-year outcomes. Drug & Alcohol Dependence. 2007; 90:270–279 & (4) Brandsma JM, Maultsby MC, Jr, Welsh RJ. Outpatient Treatment of Alcoholism: A review and comparative study. Baltimore, MD: University Park Press; 1980.

¹⁷ Kaskutas, Lee Ann, Alcoholic Anonymous Effectiveness: Faith Meets Science, presented to the American Society for Addiction Medicine (2009) (emphasis supplied) Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746426/. Accessed March 27, 2022.

¹⁸ In the few studies that captured this information, the rate at which AA members remained with the program after one year or more has shown to be very low. [I will refer to this percentage as the Remainder Rate]. The following studies are illustrative: J. Harris et al., Prior Alcoholics Anonymous (AA) Affiliation and the Acceptability of the Twelve Steps to Patients Entering UK Statutory Addiction Treatment, Journal of Studies on Alcohol 64, no. 2 (2003): 257–61 (21% Remainder Rate); Fingarette, Herbert Heavy Drinking: The Myth of Alcoholism as a Disease (25% Remainder Rate); Comments on AA’s Triennial Surveys (New York: AA World Services Dec. 1990) (26% Remainder Rate); M. Ferri et al., Alcoholics Anonymous and Other 12-Step Programmes for Alcohol Dependence, Cochrane Database Systems Review 3 (July 2006): CD005032 (31% Remainder Rate); Fingarette (1988) (citing typical remainder rates between 14% and 18% for an averaged Remainder Rate of 16%). Based on the average of these five Remainder Rates, only 23.8% of those who enter an AA program remain with it after one or more years.

¹⁹ Big Book at 58; see also Keller, M. The Old and the New in the Treatment of Alcoholism, in Alcohol Interventions: Historical and Sociocultural Approaches (supplement to Alcoholism Treatment Quarterly), ed. B. Carruth et al. (New York: Routledge, 1986) (Discussing the addiction recovery industry’s endemic reluctance to provide statistical data to journalists, leading to the probable conclusion either that they don’t publicize their findings, or worse, dispense with conducting outcome studies all together).

²⁰ In fact, the organization’s modus operandi of pinning its failures on its members instead of the organization is built into the Big Book itself:

Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. They are such unfortunates. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty. Their chances are less than average. There are those, too, who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest.

Big Book at 58-60.

²¹ Substandard polling and faulty statistical analysis have made most efficacy studies either meaningless, or worse, deceptive. They include such things as inadequate study periods, absence of proper study controls, capricious and preferential treatment of favorable statistics while ignoring unfavorable results, baselessly extrapolating data from laboratory rats to human beings, and dubious attempts to retroactively account for missing or skewed data instead of reconducting the prior flawed surveys and tests. See Dodes, Lance & Dodes, Zachary, The Sober Truth, Beacon Press. Kindle Edition at 151.

²² D. Dawson et al., Recovery from DSM-IV Alcohol Dependence: United States, 2001–2002, Addiction 100, no. 3 (2005): 281–92.

²³ AA’s 2014 Membership Survey, which does not comply with appropriate methodological standards, reports that 27% of its members stayed sober for less than one year, 24% stayed sober between one and five years, 13% stayed sober between five and 10 years, and 14% stayed sober between 10 and 20 years. See Alcoholics Anonymous 2014 Survey at https://www.aa.org/alcoholics-anonymous-2014-membership-survey. Accessed March 27, 2022.

²⁴ Harvard biostatistics professor Richard Gelber observed, The main problem is the self-fulfilling prophesy: the longer people stick with AA the better they are; hence AA must be working. It is like saying the longer you live, the older you will be when you die. See Dodes, Lance & Dodes, Zachary, The Sober Truth Beacon Press. Kindle Edition at 45.

²⁵ M. Ferri et al., Alcoholics Anonymous and Other 12-Step Programmes for Alcohol Dependence, Cochrane Database Systems Review 3 (July 2006): CD005032.

²⁶ See Appendix II (author’s summary of twelve-step spiritual principles).

²⁷ Smith, Gregory, About Three-in-Ten U.S. Adults Are Now Religiously Unaffiliated, Pew Research Center (Dec. 14, 2021) Available at: https://www.pewforum.org/2021/12/14/about-three-in-ten-u-s-adults-are-now-religiously-unaffiliated/ Accessed March 27, 2022.

²⁸ See generally Oliver, Paul, New Religious Movements: A Guide of the Perplexed, Bloomsbury (2013).

²⁹ See Appendix I, step three (a member proceeds through the program based upon his own individual understanding of God).

³⁰ See Frequently Asked Questions of Alcoholics Anonymous Available at: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/viewer.html?pdfurl=https%3A%2F%2Fwww.aa.org%2Fsites%2Fdefault%2Ffiles%2Fliterature%2Fassets%2Fp-2_faqAboutAA.pdf&clen=510716. Accessed March 27, 2022.

³¹ See Appendix II.

³² See Appendix II (God is referenced directly or as a capitalized pronoun eight times after the term higher Power which is thereafter not repeated in the remainder of the text of the Twelve Steps); The Big Book itself expressly confirms this fact. Specifically, in Bill’s Story we read:

To some people we need not, and probably should not, emphasize the spiritual feature on our first approach. We might prejudice them. At the moment we are trying to put our lives in order. But this is not an end in itself. Our real purpose is to fit ourselves to be of maximum service to God.

See Big Book at 77.

³³ This book will not address what is known by theologians as special revelation as might be contained in the world’s various religious scriptures. My decision not to discuss sacred texts should in no way suggest that I oppose organized religions. In fact, the opposite is true. Discussing the various doctrines of organized theistic faiths