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.
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