Do 12-Step Programs Deserve to Be So Popular?

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20 Aug 1967 photo from seventh annual AA convention in Colorado.
Photo: Duane Howell/The Denver Post via Getty Images

On this week’s “On the Media,” Brooke Gladstone interviewed Gabrielle Glaser, author of Her Best-Kept Secret: Why Women Drink — And How They Can Regain Control and a forthcoming piece in The Atlantic on Alcoholics Anonymous, about the singular place AA and other “12-step” programs have in the American cultural consciousness when it comes to addiction.

Glaser, citing an upcoming book called The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry by Lance and Zachary Dodes, noted that research suggests that these programs only help about 5 to 8 percent of the people who enter them. When Gladstone expressed surprise at that low figure, mentioning that she knows people who have found 12-step programs effective, Glaser responded, “Exactly, but you also know a lot of people for whom yoga works really well or for whom Catholicism works really well. But that’s not science — that’s anecdote, that’s narrative.”

It’s compelling, though. “We in this country adore redemption narratives,” Glaser explained. And the 12-step model, with its slow process toward redemption, its adherents’ inevitable setbacks, and its common reliance on abstinence, offers good stories — so it’s no wonder that 12-step programs show up so frequently in films.

The problem, as Glaser sees it, is that it’s taken for granted that these programs work, or that they outperform other alternatives (say, cognitive-behavioral therapy), despite a serious lack of evidence. In fact, society holds them in such high regard that, in many cases, a promise to join AA or another group can get a convict out of jail time or another punishment for addiction-related offenses.

AA sent Gladstone an interesting statement when she asked the group to comment: “AA has no opinion regarding scientific studies or research. As a nonprofessional fellowship, AA neither gathers nor distributes this information, nor do we express any opinions about it.” It’s not a good sign that an organization that claims, when its tenets are followed closely, to be able to help people whose lives have been devastated by alcohol doesn’t appear particularly interested in research that could help inform its approach.

Anyway, Glaser does a really nice, interesting job laying out the history of America’s cultural fixation with 12-step programs, and the segment is definitely worth a listen. I’m looking forward to reading her Atlantic article.