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Why Doesn’t AA Work for Everyone?

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Alcoholics Anonymous (AA) is not synonymous with recovery. While I wrote about this at length nearly four years ago, my opinion hasn’t changed. If anything, I’ve witnessed more people coming to the same point of view. And here’s why: I’ve run a group called Life After 12-Step Recovery for over five years now and there are 1,754 members who, just like me, felt like AA no longer worked for them.

Why I’m not an AA-basher

Before I explain why I feel this way, I want to be clear: I am not an AA-basher. AA can and does help many people. But too often people who leave AA are classified as outliers or people on their way to “jails, institutions, or death,” as they say in the NA program. And there certainly are those who leave these programs because they resume substance use. But I’m here to say that I’m thriving after leaving AA, just like the many others I know who have left 12-step fellowships. My point is, there is nothing wrong with leaving AA. It doesn’t mean something terrible has happened to us, nor does it equate to hating AA. Sure, I can’t speak for every single person. But I can say the rules of our community are to be able to safely express what didn’t work but also what did. And so this article is to expand on that concept of sharing, through the lens of shared experience, why AA doesn’t work for everyone.

A partial list of reasons why AA doesn’t work for some

I just celebrated 12 years of recovery, and seven of those years have been outside of AA. That very statement tells you that the fear-mongering about leaving isn’t accurate. Again, I can’t speak for everyone, but I can tell you that since leaving AA my life has become substantially more expansive: I moved to the US, I became a full-time writer, and I completed a Master’s degree in clinical social work, got married (and divorced), and experienced the sudden loss of my mother during a pandemic. I didn’t drink because, even in desperate times, my life and my coping skills are bigger than something I used to do 12 years ago.

In those seven years, I’ve found there to be several reasons why AA doesn’t work for everyone:

Character defect or human emotion?

Humans experience a range of emotions. Psychologist Robert Plutchik defined a human emotions wheel that includes anger, fear, sadness, disgust, surprise, anticipation, trust, and joy. Yet in AA it has been my experience—and that of others—that emotions are often categorized into good and bad categories. Rather than allowing space to process the “bad” emotions, they are instead labeled as character defects.

“I found that 12 Step didn’t address or make space for grief, rage, shame, or trauma,” says Fox, an LA12 member for the last year. “The ‘pull yourself up by your bootstraps’ is so trickle down from puritanical thinking, and left no space for compassionate inquiry, or modern mental health technologies,” he explained. Not that Fox needs my validation, but I couldn’t agree more. I’d also add that emotions are messengers. For example, anger and rage tell us something, like someone has violated a personal boundary. We cannot pray away a valuable message that helps us grow as humans by implementing boundaries that protect our values and safety.

A binary concept of a multifaceted problem

I first want to acknowledge that back in 1935 when AA came to be, we didn’t have the research that we do today. At that time, AA was revolutionary and it had (and continues to have for millions of people) a place as a pathway of recovery. However, we now know that substance use disorders, as Fox alluded to, are a multifaceted problem, often involving trauma, and I’d add neurodivergence, gender, and race paint a multifaceted picture:

  • 75 percent of individuals with substance use disorder have experienced trauma at some point in their lives
  • Autism and ADHD are associated with increased substance use and vulnerability to alcohol dependence. Further studies show substance use disorder occurs at twice the rate for autistic people than neurotypical peers (between 20 and 30 percent)
  • National evaluations of substance use disorders include the use of alcohol and alcohol use disorder. When AA was founded, alcohol use was often a primary substance, whereas today, folks increasingly use multiple substances

Conceptualizing substance use disorders as just needing a 12-step solution to a spiritual malady, and this idea that if AA doesn’t work for you it’s because you need to ‘go back out there and do more research’ are ill-conceived and, frankly, outdated.

Substance use disorders exist on a spectrum

“The idea that alcohol use disorder is a binary ‘you are one of us or not’ did not resonate with me,” said another member of LA12, who works as a professional researcher and wishes to remain anonymous. They went on to explain “nor is it supported in modern science, which has an evidence base to show people are on a spectrum of alcohol-use/misuse.”

It is well known and supported by the National Institute on Alcohol Abuse and Alcoholism that alcohol use disorder exists on a spectrum from mild to moderate to severe. Most people with AUD “can benefit from treatment with behavioral therapies, medications, or both.”

The practices in AA may not be suited to the trauma many folks are dealing with

Given the prevalence of trauma co-occurring or preceding substance use disorders, it can be retraumatizing for some to go to AA. “The shame and the trauma associated with doing the steps when you have PTSD and low self-esteem already,” said Trina. Oftentimes people drink to blot out or cope with the symptoms of trauma, so it is virtually impossible to detangle the two without the help of a professional. Yet, many members of AA think they are qualified to ‘help.’ “Sponsors acting like therapists without training. Violation of boundaries. Assumptions about why you don’t go to meetings. The false notion of spirituality using the name of God,” exclaimed Trina.

The steps don’t always work for neurodivergent people

In my recovery—and I’ve heard this many times from others, as well—I discovered that I am, in fact, neurodivergent. Neurodivergence and trauma were the reasons I used substances to regulate my nervous system. Yet, being told by sponsors ‘go to a meeting’ as the solution to autistic burnout, made me more burned out. What I needed was tools for self-regulation, low-stimulation environments, and people who validated rather than shamed me into working harder.

Developed primarily by men in the 1930s, AA can be regressive about gender and sexuality

When we talk about alcohol and substance use disorders among gender we have another issue with AA. “AA and NA need to move with the times,” says Ed. “Any recovery model whose guiding document has a chapter entitled ‘To Wives’ is seriously out of date.” I agree, and so does science.

Alcohol use affects all genders. While more “men” have alcohol use disorder, male substance use is declining and “female” alcohol use is on the rise. I’ve used quotations because, sadly, NIDA is still binary in their conceptualization of gender and the exclusion of race, but research shows alcohol use disproportionately impacts sexual and gender minorities:

  • Some studies show that 47 percent of trans adults binge drink compared to 17 percent of the general population
  • LGBTQIA folks are at a 30 percent higher risk of developing substance use disorder compared to 9 percent of the general population
  • 78 percent of bisexual women drink compared to 64 percent of heterosexual women

Outside issues that exist within the Rooms

Perhaps the most impactful of our experiences in AA is this notion that issues of racism and social injustice are ‘outside issues’ that shouldn’t be brought into meetings. Yet studies show that substance use disorders disproportionately impact people of color and their access to recovery:

Outside issues are a hot topic among many, and I’ve experienced countless debates in the rooms and conversations outside, an experience echoed by others.

“There was no talk allowed of ‘outside issues’ also known as ‘systems of oppression,’” says Fox. “I personally feel a lot of ‘addiction’ or just wanting to escape the human experience comes from capitalism and the cultural and generational trauma created by a money-first society. Even more so if you aren’t a straight, white male, though it decimates their souls as well.”

Dr. Kristine De Jesus, PsyD, and founder of Students Recover explained: “While 12-step programs have helped countless people recover from substance use disorder, the rigidity of what parts of the self that people are encouraged to bring to the rooms makes the 12-step community unwelcoming and inaccessible to many others,” says De Jesus.

“The concept of privilege, or what some call ‘outside issues’ is that they often create a hostile environment for those who identify as anything other than white, straight, or cisgender,” says De Jesus. “By disregarding the impact of systemic oppression and the trauma associated with it, 12-step communities gaslight people from marginalized groups by demanding they comply with the dominant culture or risk further alienation. In other words, ‘the group is your higher power’ so you have to do what the group says,” she concludes.

The reality of how we recover

Despite some common rhetoric I’ve alluded to, AA is not the only pathway of recovery. I am living proof that AA can work and that it is outgrown by many. Evidence shows there are many pathways to recovery that don’t even involve AA, even though I acknowledge (and respect) that it is a pathway for many. The Recovery Research Institute published a study showing that of 22 million Americans who resolved an alcohol or drug problem, over half did so without any formal treatment or recovery support.

Of the remaining (just under) half that used professional or informal assistance, they did so in the following ways:

  • 45 percent in a mutual aid group (AA is part of this number, along with many other fellowships)
  • 27.6 percent in treatment
  • 21.8 percent in recovery support services

If AA works well for you, that’s great! I’m not here to dissuade you. My hope for us all in recovery is that we make the space welcoming to everyone, understanding substance use disorder affects us all in different ways and is more challenging for some to get the help they need. I believe that when someone shares their experience—even if it includes uncomfortable things we don’t want to hear—it should be met with warmth, understanding, and compassion. And that everyone deserves the right to self-direct and access their recovery.

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Olivia Pennelle (Liv) has a masters in clinical social work from Portland State University. She is a mental health therapist, writer, and human activist. Her writing has appeared in STAT News, Insider, Filter Magazine, Ravishly, The Temper, and Shondaland. She is the founder of Liv’s Recovery Kitchen, Life After 12-Step Recovery, and Tera Collaborations. She lives near Portland, Oregon. Follow her on Instagram @Livwritesrecovery and @teracollaborations

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