>Addicts and alcoholics can turn their lives around, even though they remain addicts for life.

The "addicts for life" is an American puritan view (by AA and other such groups) -- not some scientific fact. Certainly not the view everywhere in the world. You can have an alcoholic of 5-10 years that recovered and can still enjoy the occasional drink just fine without getting back to regular drinking.

Neal Stephenson does a good job of presenting that sort of attitude in Cryptonomicon:

"I don't like the word 'addict' because it has terrible connotations," Root says one day, as they are sunning themselves on the afterdeck. "Instead of slapping a label on you, the Germans would describe you as 'Morphiumsüchtig.' The verb suchen means to seek. So that might be translated, loosely, as 'morphine seeky' or even more loosely as 'morphine seeking.' I prefer 'seeky' because it means that you have an inclination to seek morphine."

"What the fuck are you talking about?" Shaftoe says.

"Well, suppose you have a roof with a hole in it. That means it is a leaky roof. It's leaky all the time--even if it's not raining at the moment. But it's only leaking when it happens to be raining. In the same way, morphine-seeky means that you always have this tendency to look for morphine, even if you are not looking for it at the moment. But I prefer both of them to 'addict,' because they are adjectives modifying Bobby Shaftoe instead of a noun that obliterates Bobby Shaftoe."

Stephenson is great, but just for the record, the claim that Germans understand "süchtig" as "seeking" goes too far.

Süchtig is the adjective to Sucht (addiction), not to Suche (search), and although the etymological link is clear, there's nothing romantic or compassionate about the word.

Thanks: I'm sure I would have gone a long ways before discovering anything more about the context of that statement. However, I note that Stephenson does seem to have described this as a loose translation. Is the German word used as an adjective, or is that also an issue of translation?

Süchtig is an adjective, yes, and 'seeky' is actually a sensible literal translation. But just like the word addicted, it carries the connotation of a destructive obsession, not just a tendency-to-seek-out, and it is just as obliterating a word as its English equivalent.

The more specific statements about addicts become, the more cautious I tend to be.

That said, I do at least agree that your quote is rather particular to AA, and not shared by other programs, like SMART.

The reason I hesitate to dismiss the AA view is that it strikes me as quite possible that, for a subset of addicts, any kind of hope of moderation can be disastrous.

The way I see it, a less dichotomous perspective such as that of SMART is a better starting point than the 'once an alcoholic, always an alcoholic' approach of AA. And if SMART doesn't work, AA might very well be the only solution left.

> The reason I hesitate to dismiss the AA view is that it strikes me as quite possible that, for a subset of addicts, any kind of hope of moderation can be disastrous.

This, absolutely this. And since it is impossible to know in advance if moderation is possible for a given person, AA optimizes for the worst case scenario and assumes that no one can handle moderation, which has the greatest likelihood of success for all who use this strategy.

Although different substance, I'm a heavy smoker and moderation has always proved impossible.

I've kicked the habit once by NRT and once cold turkey. I'd gone well long enough for any physical withdrawal symptoms (many months).

Both times, I thought just one wouldn't hurt, socially. Both times I started right back up again.

There was a time I could smoke socially. I know people who did that and then went on to live a smoke free life. On the flip side, I've known smokers go years without and just one "oh go on then" hooked them right back on it.

So if nicotine addiction is anything to go by, it would be possible in other addictions too. Unfortunately, the only alcoholics I knew lost their battle and never achieved any semblance of sobriety. They were both at a point where the withdrawal would kill them without clinical supervision.

Not necessarily. The AA model is then unforgiving. This can create tremendous pressure, with the consequences of non-compliance being infinitely greater.

When it works, it works the best. When it doesn’t work, it’s a cliff. E.g. “20 years out the window”.

AA isn't so much a recovery program as a submarine Christian conversion program; it's seldom better than nothing, and often worse. Very consistently and well-marketed, though.

https://www.theatlantic.com/magazine/archive/2015/04/the-irr...

(Fun fact: when it started, it wasn't anonymous -- except one of the founders kept showing up drunk in public, and they realized this itself was pretty quickly debunking their success claims!)

I think this is a rather unfair distortion of AA. I know many who have been tremendously helped by the program. It does work for many. It's explicitly unreligious -- they have a notion of a higher power, but make the conscious effort to allow each member to have their own definition of this higher power. It's not a religious process in the sense most would think of it. I also don't think it's fair to mention any one particular person's success or lack thereof with AA when making sweeping generalizations about the program (including the founder, which I don't know if what you say is actually correct or not -- it just doesn't matter).

The other important thing that AA does, which is quite critical, is get individuals with problems frequent, implicit counseling from others who have been through the same thing. This is very hard to get in modern life in most other ways. It's possible, but AA makes it the default process. You can throw away all the other stuff about AA and dismiss it, and you are still left with the fact social therapy in any form is very effective, and AA promotes that.

When it's been studied for effectiveness, it turns out AA works for between 5% and 10% of the people in it; as it also turns out, that's about the same percentage of people for whom any group support program would work.

This isn't a distortion, this is the empirical view of AA.

As for explicitly unreligious, I would like to include the twelve steps here:

1) We admitted we were powerless over alcohol—that our lives had become unmanageable.

2) Came to believe that a power greater than ourselves could restore us to sanity.

3) Made a decision to turn our will and our lives over to the care of God as we understood Him.

4) Made a searching and fearless moral inventory of ourselves.

5) Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6) Were entirely ready to have God remove all these defects of character.

7) Humbly asked Him to remove our shortcomings.

8) Made a list of all persons we had harmed, and became willing to make amends to them all.

9) Made direct amends to such people wherever possible, except when to do so would injure them or others.

10) Continued to take personal inventory, and when we were wrong, promptly admitted it.

11) Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12) Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

I am struggling to find an unreligious interpretation for steps 3, 5, 6, 7, 11, and 12, even if the "higher power" isn't an Abrahamic religion "God".

What's a spiritual awakening to an atheist?

I think the key here is that people function better, and break addictions better, when they realize and submit to the concept that they do not (and can't) have complete power and control over their own lives. The notion of a "higher power" or "God" can help people get into that posture of "letting go", which helps them find real support outside of themselves (and their addictions).

Being a Christian myself, I know I function much better when I'm consciously in an attitude of trusting God -- it lets me relax and simply be who I am and do what I need to do, without worrying about "fixing things" outside of my control. (And yes, I do take an intellectually rigorous approach to my faith, but that's a different topic.)

I'm not a religious man myself, but I think your perspective is wiser than most of those who call themselves Christians, and frankly, I think what you have expressed here runs deeper than the particulars of any specific religion.

>It's explicitly unreligious -- they have a notion of a higher power, but make the conscious effort to allow each member to have their own definition of this higher power.

Very magnanimous of them. But why would a rehabilitation program have a notion "of a higher power", and especially it's own notion of it?

Probably because it helps people? If it is useful in helping people to not harm themselves and others then I don't see anything wrong with that.

> If it is useful in helping people to not harm themselves and others

this is a big if. the way AA is structured (they don't themselves collect any statistics about efficacy whatsoever) makes it extremely difficult to draw any conclusions about how helpful it is.

as other people have said, AA essentially provides free group therapy, which is likely to be at least slightly helpful. i'm not sure there's any evidence to suggest that the 12 steps or higher power aspect yield any benefits over generic group drug counseling.

There is some evidence that the higher power business works[1]. Anyway, it will always be difficult to directly judge a particular organization rather than its methods.

[1] The Power of Habit, by Charles Duhigg : while not scientifically spotless, the book directly addresses the methods of AA. To successfully establish a change in habit, one needs a belief that I can change : there is some sound evidence presented in the book.

Smart Change, by Art Marckman : he is literally a scientist and I can't find anything scientifically incorrect in this book. He also mentions and gives evidence for the advantage of belief in one's ability to change : here the context is not directly AA.

> It's explicitly unreligious -- they have a notion of a higher power, but make the conscious effort to allow each member to have their own definition of this higher power.

I knew about this 'misunderstanding' that most people have about AA and its 'higher power' thing.

I actually attended meetings though, and their 'unreligious process' is actually anything but.

As someone who attended AA meetings for a few months when my depression/anxiety/substance abuse was getting out of control I have to agree with this.

A couple of the chapters were fine, and listening to people tell stories of their experiences was great, but there is a heavy cult-like vibe pushed on you relentlessly at most.

They parrot on about the fact that you are helpless to effect change in your own life and without the group, you will inevitably drink again.

That turned me off completely and I never went back. Still haven't had a drink in a year since either.

AA is sometimes jokingly referred to as the last house on the block (NA is the last room in that house).

I know a great many recovered individuals that tried everything to get clean and only found success (and more importantly satisfaction) in 12 step.

Most institutions don’t want to let their clients go—why should AA be any different.

i think you have it backwards- institutions that don’t self sustain, don’t survive.

That's an explanation for the observed phenomenon, not him getting it backwards.

IDK. There’s no shortage of alcoholics, so they could deal with people exiting after 2y or so, without dissolving. Instead, they are like boy/girlscouts for grownups without the age limit.

> It's also revealing how the unique ability of humans to overcome their fundamental biological nature can be quite impressive and inspiring.

That ability is itself part of the fundamental biological nature of humans, or whatever. The way you phrased it suggests a Cartesian dualistic interpretation.

I have heard it frequently mentioned by interesting scientists (most recently, by Neil DeGrasse Tyson) that this ability to live against natural biological tendencies is unique for humans among the rest of the animal kingdom. So while it may be fundamental to humans, it is not apparently fundamental to the general biology of the world, and humans appear to be an interesting exception.

Color me skeptical of the idea that humans can really go against the grain of their evolved instincts. What seems much more likely is:

1) A large subset of people possess instincts that were successful for reproduction in the ancestral environment, but are no longer so. See also plummeting birth rates despite being at the historical peak in terms of access to resources for the average person (in the developed world, at least).

2) Some people's evolved instincts are to play a long game based on building reputation and then leveraging that reputation over the long term, rather than pursuing immediate wants and desires. Such an instinct will produce a lot of behavior that seems out of line with a naive interpretation of how we "should" be evolved to behave.

Dogs do it, albeit with human help. Considering that humans that grew up alone, ie. feral, seem to have no self control either I would think that dogs get to count too

Can you give an example of dog behavior that does this? I'm curious.

Here’s that behavior on display: https://www.reddit.com/r/rarepuppers/comments/9ime34/heckin_...

Not sure why you are being downvoted. This link is one of the recent examples I was thinking of. The dog has been taught to not eat the food even when a human isn't around protecting the food. That requires ignoring one part of its biology for other benefits.

Just read about ibogaine if you'd like to learn about how possible and easy "curing" addiction can be. :)