This is actually one of the things that many psychologists are dubious about. It's entirely possible that self-labeling as an alcoholic forever makes it harder, not easier, for some people to remain abstinent.

To the extent that it keeps you vigilant and involved in a supportive community, it can be good. But it could also make it harder to get back on the wagon if you have a single drink if you think you're "an alcoholic", and not "a sober person who made a mistake".

Due to the anonymous and heterogeneous nature of AA, good data and studies of its efficacy are very hard to come by, so we have little idea if it's actually better than non-AA or pharmaceutical alternatives.

I also believe you've misunderstood how we view ourselves (and each other) when we fall of the wagon/bust/slip. I'm not a "sober person who made a mistake". I'm an addict who made a mistake.

Most of us in 12-step programs have tried psychology (and counselling and hypnotherapy and...) before the despair was enough that we'd admit defeat and join *A. Admittedly, there's a cohort of people mandated to turn up. It should surprise no one that this cohort sees very high rates of recidivism. But I'd suspect the same to be the case for people mandated to attend psychotherapy. If you don't want to change, nothing can make you.

Pharmaceuticals are interesting. I believe that LSD has been trialled to help those with substance addictions but I'm not sure of the state of research regarding behavioural addictions.

Fundamentally though, the evidence is pretty clear that there's a neurological basis to most addictions including the behavioural ones. e.g. check the research of Mira Fauth-Buhler.

https://www.researchgate.net/profile/Mira-Fauth-Buehler

I totally understand why it's a helpful framing for some people, but it really isn't for others.

Another form allows participants to drink but uses a medicine which induces unpleasant effects from alcohol. Thus participants self train an avoidance pattern and break the positive feedback loop.

These should not be seen as contrary to the AA abstinance approach. For some people that appears to be the most effective means. For many other people, AA is not.

I suspect as we advance our understanding we'll come to find distinct subdiagnoses in alcoholism and alcohol abuse that suggest different treatment strategies. Right now our understanding feels very rudimentary.

Actually, the successful medical method doesn't introduce unpleasant effects, but removes the pleasant ones and introduces 'extinction'.

The medication is naltraxone. Look up 'Sinclair method'.

If you take one or two drinks, yeah it will just be not good. If you binge, you be puking your guts out.

What I think is still up for debate is whether AA's framings are a net benefit, due to the lack of good research.

Your comment brings up standard AA doctrine, and I'm glad it's worked for you. But by your own admission, a lot of people fall off the wagon. You blame it on being court-mandated, but it doesn't seem to occur to you that another program may have worked better, court-ordered or not.

There's no consideration in your comment for survivorship bias in who remains in AA. Perhaps AA works great for a small subset of people, who stick with it, but is worse for a larger majority, who would be better served in a different program.

> Fundamentally though, the evidence is pretty clear that there's a neurological basis to most addictions

Uh, I'm not disagreeing. Not sure why you think I was? I used to chat about this stuff with Dr. Carl Hart, who studied meth addiction, when I was in grad school. He was also of the opinion that AA's efficacy was a black box, and said that he'd recommend Scandinavian outpatient facilities over AA, based on the research he'd seen.

If you don't want what we have ... no worries. You won't get it.

The problem is when we make decisions for other people. Things look very, very different, when it's our own butt on the line.

Which is precisely what this article is complaining about. AA both as a program and as cultural push "abstinence first" is harming addicts for which the AA method is not successful. Which is most people. For instance drug therapies are slow to be given approval, people are sent to AA programs through court orders, etc.

As an individual if it works for you that's wonderful. But governmental policy and cultural norms should be based on what's effective.

Also, AA and NA don't collect much, in the way of data. It's actually hard to tell how truly effective they are. Something to do with the second "A," I would guess...

That brings up another point that people have been avoiding, here: Desperate people can be squeezed hard. A lot of folks are making a lot of money, from people with their lives in tatters.

Some of the therapies are effective, but a lot of them are definitely not.

Since people like to cast addiction (and alcoholism is simply addiction to the sedative-hypnotic drug ethyl alcohol) as a moral failing on the part of the addict, it's easy to blame them, and say that "they got what they deserved."

It's really pretty hard to feel sorry for many addicts. Pick up the paper, on any given day, and you'll likely see some horrific stories of crimes committed by addicts.

That's why programs like AA and NA work. The only people that actually care about addicts, are other addicts. It's also important that they not be in a position to profit from their treatment. 12-Step programs live on a regimen of enforced poverty. They love to fight about money, but the amounts are chicken feed, compared to what the for-profit orgs make.

Which begs the question: If someone makes money by selling treatment to desperate, ostracized, people, is it surprising that they don't like organizations that provide highly effective treatment for free?