In an earlier post (The Myth of Anti-AA & AA- Bashing), I argued (effectively I hope) two points:

  1. That the terms ‘anti-AA’ & ‘AA-bashing’ were largely fabricated by the AA/12X12 community so as to purposefully derail any useful inquiry into or discussion of the institution itself (i.e., simply stating that a large body of scientific research as well as AA’s own documentation shows that the ‘program’ is roughly as effective as quitting on one’s own is ‘AA-bashing’); these terms serve to marginalize critique as counter-productive, or, in the more outlandish responses, responsible for the deaths of alcoholics
  2. That the terms were pure hyperbole — there is no organized ‘anti-AA’ movement actively ‘bashing’ & trying to destroy AA/12X12; further, utilizing these terms positioned AA/12X12 proponents as martyrs, victims of unwarranted persecution from a narrow-minded, blindly hateful ‘anti’ conspiracy movement

In my post I implored those who might approach AA/12X12 with a skeptical eye (& further comment on it in that spirit) to actively fight against accepting those labels.  Taking my cue from the often very heated, highly ideological ‘Pro-Life’ / ‘Pro-Choice’ debate, I suggested that we impose our own label or labels & that those labels be couched in positive rhetoric (e.g., ‘Pro-[fill-in-the-blank]’).

As George Orwell illustrated rather deftly in his novel “1984”, language can be power: Controlling the language, controlling the public message (e.g., “Freedom Is Slavery”, etc.) meant controlling the populace & individual thought.  While I don’t want to suggest 12X12 proponents’ ultimate goals are nefarious, they do certainly appear (to these eyes, at least) disingenuous — more concerned with maintaining a ‘one-way conversation’ than actually honestly discussing larger issues.

In more contemporary terms, the theory of ‘memes’ (self-replicating ideas that emerge, evolve, & introduce action within socio-cultural contexts often times despite their lack of benefit [or even outright harm] to individuals) is also worth noting in this discussion.  The “AA has saved millions” meme has been repeated by everyone from the newest of newcomers at an AA meeting to US Congressmen (Jim Ramstad) & medical directors at major treatment facilities (e.g., Hazelden, Betty Ford, etc.).  While I won’t try to counter that argument, it is worth noting that not a shred of empirical evidence supports it & it’s highly unlikely that any empirical evidence supporting the claim will ever emerge.  It’s simply a string of words that once uttered, proliferated & is now accepted unquestioningly by most — at least here in the United States.  A common ‘truth’ that rests on a bed of no real evidence — anecdotal testimony aside.

(For more on memes see: wikipedia, Philosopher Daniel Dennett’s fascinating discussion on the topic www.youtube.com, or Psychologist Susan Blackmore’s discussion www.youtube.com.)

I bring these points up because I’ve come to believe that the language of treating & researching alcohol/drug abuse or dependence problems has largely hijacked the actual practice of science, therapy & medicine.  That’s no small point.  That’s not an issue of one side screaming “Pro” with the other side screaming “Anti”.  It’s a matter of maintaining objectivity in the pursuit of better treatment & methodology.  It’s a matter of allowing discussion & debate to emerge organically, rather than within the severe restrictions of an antiquated lexicon.

For instance, the semantic utility of ‘powerlessness’ in treating a person’s abuse issues is at least arguable (as Steven Orma’s series on the 12 Steps impressively displays; see: www.examiner.com). Remaining absolutely wedded to the notion of ‘personal powerlessness’ as a complete & irrefutable concept (as AA/12X12 does) or as the foremost scientifically sound analogy (as many ‘therapists’ & ‘recovery professionals’ appear to), suggests a certain dogmatic inflexibility.

Issues of choice, free-will, powerlessness are all still largely philosophical concepts (although advances in neuroscience suggest the topic is more slippery than previously thought; see: Boston Globe Health and here: www.secularhumanism.org) .  Denying an individual’s personal agency (within any situational context) is absurd.  That the field is mired in mudslinging about ‘powerlessness’ & other dubious terminology rather than theories of agency & causal context speaks volumes to the time-warp in which it’s allowed itself to become trapped.

Powerful personal experiences aside, the creation of public health policy should not proceed from a point of retro-fitting itself to dovetail with a 70-plus year old model that has no time for science, textual revision, or the incorporation of complimentary methodologies.  And, yes, I am talking about the 12 Step model here.

AA/12X12 has done an exemplary job of creating its own lexicon & promulgating it into the larger culture (e.g., powerless, spiritual not religious, a program that’s saved millions, recovery, alcoholism is a disease, etc.).  To the extent that the program is ‘successful’ is more a triumph of public relations (and memetics) than proven scientific efficacy.  Let me be clear, though, that is not an argument against an individual’s embrace of AA nor should it be construed as a personal insult to anyone who has had (or continues to have) a positive experience with AA/12X12.  That said, until AA/12X12 proves itself empirically, it’s a more than reasonable inference to make.

What’s most important is that discussion, debate, critique, research & representation be done in plain, simple, honest language.  Loading the language so that it conceals an agenda (see: wiredin.org.uk) or that it is imbued with ‘insider’ sub-text serves only to promote singular interests.  That is not “helping others”; that is perpetuating a false ‘us & them’ duality.

Leaning on antiquated notions (e.g., ‘powerlessness’) simply because they’ve successfully entered the public imagination doesn’t serve progress either.  If ‘disease’ needs to become ‘brain-based disease’ so that clinicians or researchers can talk about it with a straight face, how valuable could the initial concept be?  Again, for clarity’s sake I am not definitively arguing for or against the ‘disease’ concept.  I am simply illustrating how modern science seems to be going out of its way to retro-fit its findings into a model that’s been problematic for more than 200 years (see: en.wikipedia.org and the CDC’s own reluctance to use the term: www.cdc.gov).

If alcoholism & substance abuse are indeed important matters of public health, then they should be addressed via language easily understood by the public — not jargon that furthers the agenda of a single organization.

The most important step in ‘recovery’ is recovering the language.