Thursday, June 23, 2011

The AA Debate: Life Saving Healing Community or Dangerous Cult?

I have been in the field for over 30 years, primarily offer psychotherapy to people with drug and alcohol problems and supervise and train professionals in this area. I think we as a field need to get to the bottom of this debate about AA. We as a community, zealots and nay sayers unite!

AA has been wonderful, life saving and growth enhancing for many of my patients, colleagues and family members. AA has been irrelevant, damaging or silly to many of my patients, colleagues and family members. Both true. Lets all face these facts that we know to be true. I am anti-dogma. The problem with AA is not AA but the idea that AA is the only way. It kind of was when the founders of AA got together while they were drinking to hang out and talk. It is no longer as we all know.

As people who are all concerned about and wish to be of help/service to people who struggle with substance use, we need to consider that AA may be useful to some people and may be dangerous to others when we consider making a referral to AA.

We need to gather the research! Can we all commit to working together as a team to gather and examine the data? If not we are not really interested in truth, rather interested in promoting our dynamically driven narcissistically invested agendas.

Foisting these agendas on each other and our patients is not interesting and potentially traumatizing to patients. If the therapeutic alliance is paramount, we must put our agendas at the door when we go to work. This radical stance enables us to meet our patients open to creating a space in which they can be themselves, invite us into their experience as unique individuals and collaborate on the project of clarifying the nature of their struggles so we can decide together what goals and positive change plan is right for them.

I call this Integrative Harm Reduction Psychotherapy. and think it is essential to any effective treatment. This emphasis on a radical non-ideological therapeutic stance with the patient enables a space in which all self-help and evidence-based practices can be considered together in the search for an integrative whole person plan that is uniquely suited to each individual.

I am committed to gathering the research and will make the database available to the community. Please share your thoughts, research and citations for us to consider together.



Sheila Vakharia said...

Hi Andrew,

Thought you may be interested in the results of a systematic review of the literature on the efficacy of AA/Twelve Step work:

It's a good starting point and I'll be sure to send you more as I gather it.



jjeff said...

Oh boy... speaking truth to power. It may bring you unpopularity but it's admirable and some people, some of the time, will get it. I for one do.

christopher said...

Hi Andrew,
I am myself a grateful recovering addict who uses AA as a spiritual grounding, and like so many before me, have dedicated time in sobriety to try to make sense of my addictions, I've a Bsc in psychology and am presently studying a master in cog behavioural therapy. As a profesional I cant limit myself to what worked for me as every client is an island. The same as I am not a "behavioural or cognitive taliban" I would try to avoid being guided by dogma or my own belief structures. I also am very infavour of harm reduction policy believing taht any sort of drug intervention must have four basic pilars. Harm reduction, treatment, prevention and policy and law. I have just discovered your blog through LinkedIn, so am off to investigate. Keep up the good work. Chris