Comment by giraffe_lady | Hacker News Reader

Comment by giraffe_lady | Hacker News Reader

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I can't speak for all of AA obviously but I've been heavily involved in it for decades now. This is definitely one of those "all models are wrong but some models are useful" situations with the allergy thing.

Most individuals either find that model sufficiently useful that they don't need to expand it. Or, they're more or less fully aware of the gaps but still find that model useful. Or they don't find it useful and quietly use another model personally. All kinds of approaches in there.

If we're talking about 'the real world' then "It is never safe for you to begin drinking again, in any context" is a highly conservative and risk-averse approach, but it has been valuable for so many, and the consequences of relapse can be so high. AA is full of people who "went back out there" after 2, 5, 10+ years of sobriety because they thought they could reintroduce it into their lives and were wrong. Also many stories of people who did and just straight died in the relapse. Often our support networks can't handle another round, plus kindling is a real thing.

AA is where I first heard about van der Kolk's research, which demonstrates very convincingly that in some very real ways there's not a meaningful difference between "biological" and "psychological" components of trauma or addiction.

The AA framework has some incredible faults don't get me wrong. But above all those people are intensely, almost pathologically sometimes focused on "the real world." You'll hear some weird shit coming out of there sometimes because of that, but it doesn't mean they're not aware of the contradictions, or unwilling to apply more "scientific" models. Just, they have a system that works for a lot of people so they keep it going.

Are you saying that AA promotes discredited scientific claims because of a belief among their members that such claims have utility in helping their members quit drinking and stay off alcohol? Why even have the quasi-scientific patina then? Just go back to purely religious-era thinking, things like 'You'll burn in hell for all eternity if you don't get off the booze right now".

The problem with groups like AA is that they seem incapable of revising their dogmatic beliefs when presented with new evidence. What if opiate addiction and alcohol addiction are not 'lifelong diseases' at all, but simply treatable conditions? Would AA revise its claims if presented with such evidence?

Yeah that's exactly what I'm saying. And if the burn-in-hell model was demonstrably more effective than a medical model I would endorse it. Wouldn't you? What's the value in pushing a scientific model if it isn't actually more practically effective at helping the people who are asking for help?

And look, I'm not saying the medical model isn't more effective. But "new evidence" isn't always easy to apply even when it is clear, and with addiction it very often is not. AA's method despite its serious serious flaws has worked for a lot of people over many decades, so yes there is some natural conservatism about updating it every decade to keep up with new research.

You're on the right track though with the dogma thing. If you're familiar with the sociological study of religions, looking at it through that lens can be very valuable. It has a cultus of belief and ritual, it has a community of believers, and yes a dogma. It doesn't never change, but it is slow to.

To understand this thing you need to try to understand what value it has to people. If you want them to switch to another approach you need to demonstrate the actual practical value of that approach to people. This is literally life and death shit, people aren't going to part with it just because some le atheist engineers don't like that they call it an allergy and ask god for help.

What I object to is religious types trying to use bad science to back up their agenda. Science is not a matter of faith, and it's a complete perversion of the basic concept of scientific inquiry to promote false claims simply because of their claimed utility. That's a dishonest and manipulative strategy at best, and I doubt any good will come of it.

Of course, science provides no ultimate answers of the type religious fundamentalists (a group which includes the dogmatic atheist IMO) seem to be seeking. For example, it's impossible to use science to test the 'simulation hypothesis', i.e. the notion that we're all living in a perfect VR sim.

Well, in this case "their agenda" is helping people out of deep addiction. What do you gain by opposing that? We aren't disinterested third parties here pushing an agenda on other people, this is US, working for ourselves. Who are you?

Expecting people to abandon a belief that they can plausibly claim has saved their life because it isn't scientifically true is a radical ideology.

Very much good has come from it, true or not. If you think you can do better then pick up a shovel man, and get to work. Because one of the other things AA provides is practical advice on how to work with people you don't understand or like, towards the shared goal of healing and sobriety.

Could it be that one of AA's goals is the creation of a population of donors to keep their organization funded, just like any other organized religious group? This would explain the reluctance to admit that alcohol addiction is not a 'lifelong disease' that requires lifetime committment to AA, wouldn't it?

Regardless, promoting bogus scientific claims in the name of social good does actual harm to people. It's one of the reasons for the whole anti-vax thing, and the resulting measles outbreaks, for example.

I think it is a stretch to think that this is a money making endeavor.

Scams to make money like MLMs and Scientology prioritize payment over adherence to the tenants of the organization. And the leaders are paid millions of dollars and live luxurious lives. AA is more like the Salvation Army. It is a group that clearly believes things that are not scientifically true, but most people join with good intentions.

I don't know much about the Salvation Army beyond hearing their name in passing, but what are their scientifically false beliefs?

I looked at the "Beliefs" section of their Wikipedia page but couldn't find, after 1 min or so of looking, a clearly stated scientifically false belief.

Are you referring to this, which sounds similar to AA? https://en.wikipedia.org/wiki/The_Salvation_Army#Adult_Rehab...

From Wikipedia: "In November 2013 it was made known that the Salvation Army was referring LGBT individuals to one of several conversion therapy groups."

The American Medical Association has never suggested there is scientific data proving this therapy to be successful at changing sexual orientation, in fact the scientific data proves the opposite, it is harmful.

Rather than engage in wild speculation why not attend some actual AA meetings?

Open meetings permit anyone to attend as a visitor.

I don't think you have much if any firsthand experience with how these orgs actually do work.

It's especially funny because I am knowledgable on this subject, sympathetic to your concerns, had time and energy this morning to go into depth on the details and problems of AA and how I have chosen to engage with them over the years, and why so many of us continue to.

If you had wanted to learn anything about the day to day fights against addiction as they are experienced, contradictions and all, this was a great opportunity. But you just couldn't get over this specific hangup of yours, and pissed it away. Good luck out there man I hope you never need us but we'll be here if you do.

there are a few layers to "AA".

first there's the philosophy itself and all the associated dogma and religious aspects. I found this pretty weird and not my cup of tea, but I have no problem with it existing and people adhering to it if it helps them.

then there's the community. thirteenth stepping aside, these are mostly people genuinely trying to help themselves and others. I noticed some odd things, like some AA meetings banning the mention of drug use (?) and the fact that people are often preaching total abstinence in between gulps of coffee and drags off a cigarette. but whatever, not a big deal. what was a big deal to me was the attitude some members take towards people who don't find success with the process. the big book is quite clear that it does not claim to have a solution for everyone, only one that worked for the writer. and yet I often heard some variation of "it works if you work it" if I voiced anything like this, the implication being that it would work for me too, if only I tried harder, surrendered more fully, etc. very toxic imo, not sure if all meetings are like this, but it was a persistent theme in the ones I went to.

but the biggest issue I have with AA is not the philosophy/organization/community, but its place in recovery in general. it's not just the default option; it's often the only one. you really have to dive deep to find any alternatives. even if you pay to see a psychiatrist or therapist, they will often just tell you to go to meetings, maybe prescribe some suboxone/naltrexone if you're lucky. rehabs (the ones that will take your insurance at least) are heavily based on the AA model. some of the lazier ones basically are just a series of AA meetings that you can't get away from. it sucks all the proverbial air out of the room. on top of all that, the relationship with ostensibly secular government (ie, court-ordered meeting attendance) is highly inappropriate.

this was a pretty negative comment, so I want to be clear that I do respect what you do. "free" and "works for some people, at least" is a pretty hard combo to beat when it comes to recovery. I don't want to pressure anyone to change something that helps them with such a serious problem. I do wish that, as a group, AA would just stay in its lane though. it should not have the relationship with government and medicine that it currently does.

Yes, your biggest issue with it is also my biggest issue with it. It holds this spot in the cultural consciousness as like, the only/best general-purpose addiction program when it absolutely is not that.

Judges and mental health professionals sending people to AA without specifically understanding its practices and how those will help that individual is terrible and I hate that it's as common as it is.

And speaking from within the US, a lot of the weird AA-isms I think are adaptions to our fucked up healthcare system and general attitudes towards personal agency and addiction. No one is picking people up off the streets and giving them top-notch medicalized in-patient addiction treatment you know? AA isn't ideal or even necessarily very good for a lot of things. But it is there and it is free, and no matter how fucked up your life is they won't turn you away. Can't really say that about many other treatment paradigms right now.

There’s shades of grey with many things. Plenty of drugs are effective at rates marginally higher than placebo.

> and I doubt any good will come of it.

You seem to express contempt without prior investigation.

I can assure you that much good has come of it.

Great post! I have been a long term member myself, and you described my feelings about AA pretty well. It was fun to read what Charlie Munger ( Warren Buffet's partner) wrote about AA. He says that AA uses a number of natural psychological tendencies together to create a "Lollapalooza effect" that helps people to stay stopped, once they quit drinking.

I really appreciate your response and respect your experience. I'm very happy for people that have been able to make positive changes in their lives and I'm not suggesting anyone stop doing AA if it works for them.

It would be great if there was a sister organization to AA that was more of a group therapy session, without the spirituality and alcohol abstinence components. But maybe that wouldn't work, since there would be no rules and groups could diverge toward unhealthy behaviors.

There's one called Smart Recovery that is more along those lines. They put a lot of effort into keeping their practice in line with the state of the art of mainstream mental health and scientific practice around addiction, and are explicitly secular.

They're based around harm reduction, so no day-counting or rigid definition of sobriety like AA which honestly is wonderful and AA could (and does!) learn a lot from it. Alcoholics already carry a lot of shame, increasing it isn't helpful imo.

It doesn't have the reach or widespread cultural awareness that AA does but they still seem pretty common. I think AA is only really a good fit for people who are already religious or are open to becoming so. Otherwise I generally do suggest people try smart recovery first.

There's all kinds of stuff like that. They don't help. The only sober people at those types of things either use it as an adjunct to their 12 step program or aren't actually alcoholic.

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