Now for an update of Friday’s blog about a blogger who was shut down by WordPress for being critical of a quack in Maine who is practicing homeopathic medicine. It turns out that the whistle blower who complained is one of the doctor’s* peers named Andreas Moritz, who refers to himself as a “medical intuitive“, which is a type of quack who uses his intuition to treat various ailments.

This jackass has written a number of books, among them being The Amazing Liver and Gallbladder Flush, where he wrote, among other things, “Alcohol is liquefied, refined sugar….” This is false, and somebody advising people their health treatments should know this. Alcohol does not contain, and is not converted into sugar. The myth that alcohol converts to sugar is perpetuated in the rooms of AA, which is not surprising, considering the typical AA has the same qualifications, as well as the same inclination to rely on their intuition on questions of science, as this nut.

One of the most common questions we are asked is why we write this blog. The answer is because, like this quack, AA is not a benign organization. Andreas Moritz’ advice to cancer patients is no different than AA’s advice is to alcoholics, and that is that both conditions are consequence of a person’s mental attitude and spiritual deficiencies. Most people can see the absurdity of this advice as it relates to cancer, as well the tragic consequences to those following the advice of this jackass. Still, there are some who believe this nonsense, not because their rational self tells them it makes sense, but because they want to believe.

A typical newcomer to AA or a 12-Step rehab clinic is not unlike a patient seeking alternative treatment in a Mexican cancer clinic, where they feel they have exhausted all other possibilities, and in desperation head across the border. A desperate person is willing to believe just about anything. Wrap the snake oil up in lab coats and medical jargon, and it makes the sale that much easier.

As with AA, Andreas Moritz has a following of true believers, most of whom genuinely believe they were helped by their respective program or treatment. Look on his website or the jacket of his books, and you find no shortage of testimonials, many sounding like the testimonials one will hear from an AA. They are not being disingenuous — they are just being manipulated, and no matter how much they want to believe, it does not make their beliefs anything more than delusions. For some, there is little or no harm done, aside from the money and time they may have lost. For others, the consequences are tragic.

AA, like Andreas Moritz, does not highlight their failures, and it is those failures who make up the vast majority those seeking treatment from a faith healing placebo. For every person who feels AA has helped them, there are many more who have left feeling victimized. Some of the consequences to them are fairly mild, like the realization AA is nothing more than a long dose of religious snake oil. There might even be some mild embarrassment at the thought that they actually bought into the dogma. For others, the consequences are far worse, as they leave the program feeling they themselves failed, and that they did not have the moral fiber to properly work the only program that could help them.

There is a broader consequence to AA that we have not talked about much here on this blog, and that is the consequence to shutting out science, and hindering the advancement of our understanding of alcohol addiction. AA is more than a bunch of independent groups of alcoholics getting together to help each other solve their spiritual deficiencies. AA represents the core approach to the treatment of alcohol addiction, and like all pseudoscience, they have successfully cloaked the program in a lab coat, and presented it to the masses in the form of Twelve-Step Facilitation (TSF).

Some AAs are quick to say that TSF is not AA, but that is as disingenuous as saying AA is not a religious organization. It may not be your brand of AA (there are so many), but it is definitely is AA, as many of the counselors are themselves AAs, AA literature is used, and the steps are taught directly from the ‘Big Book’. AA is also used as the after-care for TSF, with each participant being told to begin attending a local AA group, and being encouraged to do 90 meetings in 90 days. The largest purchasers of AA-approved literature, and the largest distributor of 12-Step publications is from the World’s substance abuse treatment centers. The constant flow of new AAs sent from rehabs help maintain the flow of new recruits into the room.

The very fact that it is AA, is a reason why we have made virtually no progress in addiction therapy in the past seventy years. Unlike the treatment of any other disease, twelve-step treatment is stagnant, and not interested in improving upon itself. Real medical treatment is the product of science, and real science is constantly challenged, refined and improved upon. 12-Step treatment is religious faith healing, and religions do not change. Imagine if our accepted course of treatment for heart disease or diabetes remained unchanged, and those in charge of treating it fought against any advancement in the status quo. That could never happen, but it does happen with addiction treatment, and the reason it does is because AA is so ingrained in treatment.

To understand why this is so, one has to look at the origins and growth of the treatment industry. What we have today is the result of organic growth over the past seventy years, with the origins of TSF dating back to the 1940s. I recently read Slaying the Dragon by William L White, which chronicles the history of the treatment industry, including AA’s part in its establishment. I found a really good book review over at Life Ring, in which  there is a good description of AA’s role in treatment industry:

White touches all the bases of AA’s early history in a readable and useful if not novel way. The real reason to read White is in his extended discussion of the historic interplay between AA and the treatment industry. White has worked as an addiction treatment counselor or in related capacities for the past thirty years, and lived through this history himself. At the core of the dialectic is AA’s tradition of anonymity. As the early AA members became involved in the worthy cause of helping to set up hospital facilities for drying out, there developed what White calls the “Knickerbocker Paradox.” This refers to a small hospital wing of the 1940s which was set up with AA money, staffed by AA members, whose patients came in entirely via AA referrals, and who could only leave if checked out by AA sponsors. Yet it was forbidden to refer to Knickerbocker as an AA institution. In the public eye, it was completely independent and no AA connection was ever publicly admitted.

Now take this microcosm and fast forward twenty years to the election of Lyndon Baines Johnson and the commencement of the “War on Poverty.” LBJ, since 1948 a member of the National Council on Alcoholism (another Knickerbocker-style “independent” body), shepherded through Congress a number of huge appropriation bills and set up a triad of major federal agencies devoted to alcoholism and drug addiction research, policy formulation, and treatment (NIAAA, NIMH and NIDA). With boomlike suddenness, there emerged on the scene what even its benevolent godfather, recovered alcoholic (and undoubtedly AA member) Sen. Harold Hughes later referred to as “the alcoholism and drug abuse industrial complex.” In the same political climate, the insurance industry (led by James Kemper, a recovered alcoholic and head of Kemper Insurance) gradually dropped its systematic discrimination against alcoholics and, prodded by the AMA’s proclamation of alcoholism as a disease, began underwriting alcoholism and addiction treatment. White quite rightly calls this the “critical center upon which the entire modern industry of addiction treatment has turned.” This sudden opening of the public and private purses for alcoholism and addiction treatment led to an “explosive growth” in the treatment industry in the 1960s and 70s. This was a historic victory, as White rightly points out, for the “invisible army” — the legions of anonymous foot soldiers (and, we should add, many of much higher rank) who had been trained to do the work of AA without using the AA name. It was Knickerbocker writ huge.

Rich in significant detail, White’s work affords insights into nonprofit mega-institutes like Hazelden and Lutheran General and others, where millions in public funds went to subsidize and disseminate a treatment philosophy (the Minnesota Model) that has religious conversion and referral to AA as one of its components. And his light also illuminates the for-profit recovery industry, in which the higher operatives pocketed and pocket millions, processing alcoholics as a crop to be harvested for profit; and this, too, although White refrains from saying so, is just another variant of the Knickerbocker paradigm.

But this was not the end of the dialectic of anonymity. The “Knickerbocker Paradox” plainly required the participants to wear two hats, their “AA” hat and their “independent” hat. To put it less charitably, it required them to deny who and what they really were. Massive and widespread role confusion was the result. White speaks in vivid detail of the institutional leaders who attempted, strenuously but often in vain, to clarify for the counseling staff what was “AA work” and what was “counseling work,” what they were supposed to give away and what they were being paid for. Numerous and tragic have been the relapses among the army of confused, unsupervised, overworked and underpaid 12-Step “professionals by experience” who were inducted as the corporals and sergeants of the new treatment juggernaut.

The inexorable demand for an institutional program that was definable and replicable (hence insurable and bankable) meant that the 12 Steps, initially sketched as a suggested path of personal spiritual transformation, became transmogrified and blenderized into a compulsory top-down treatment protocol. It was a great victory for the invisible army, but it turned the legions of America’s alcoholics and addicts, and many who were neither but happened to be caught in a urine test, into dispirited prisoners of war.

When Knickerbocker was just a small wing of a single hospital, it must have seemed clever to the small guerrilla band of inspired volunteers that all the patients were channeled straight to AA meetings on their release. Today, when virtually every hospital, treatment center, court and prison mandates AA referral, the result is that many AA meetings are overrun “by a growing assortment of sullen, recalcitrant men and women mandated to attend AA meetings by their employers, judges and probation and parole officers,” who outnumber the core members by two or three to one on a given night (p. 278). I have heard other informal estimates that put the number of what I am calling “POW members” of AA at more than 70 per cent of the current AA membership. It is not uncommon to hear AA members complain that AA has lost its soul. White cites one such effort, by the widely respected AA historian Ernest Kurtz, to recover “the real AA.”

And the story continues. For just as the burgeoning “inebriate asylums” of the 1870s were suddenly swept away by the advent of Prohibition, the “recovery boom” of the 60s and 70s gave way, around the middle 80s, to the Reagan backlash. Where LBJ had publicly pronounced addiction a disease, the Reagan rhetoric returned the pendulum toward criminalization. Fueled by popular works that challenged the central assumptions of the recovery boom (Fingarette, Peele), and by law-and-order rhetoric, and by the excesses of the movement itself, the right-wing ascendancy began tightening the public purse strings. The “managed care” movement effected the same constriction in the private sector. After taking a cold hard look at what was really being accomplished, insurance companies virtually stopped paying for inpatient treatment, the most lucrative sector of the industry. Today, the recovery boom has gone, or is going, bust. Just as the anonymous footsoldiers of the modern Knickerbocker juggernaut were achieving a measure of professional status and salary, many of them received their pink slips. In 1998, the number of treatment opportunities of any kind available to alcoholics, other than those with private means, is much smaller than two decades ago and continues to constrict. Poorer addicts and minorities, especially, are much more likely today than two decades ago to be sent to jail rather than to any kind of treatment.

Highly worth reading also are White’s chapters on the origins of what is called the “modern alcoholism movement.” I will just sketch this briefly. After the repeal of Prohibition in 1933, the bloodied and beaten “Drys” sought for a new paradigm. Out of their severe financial crisis emerged what is called “Bowman’s compromise,” which dropped the traditional barrage against “alcohol” in favor of concern with “alcoholism.” The problem was redefined; it no longer lay in the bottle but in the man. White fearlessly cites mounting evidence that alcohol industry money was one of the inducements and one of the rewards for this paradigm shift. One of the most influential institutions in shaping and disseminating what became the Minnesota Model, the summer schools of the Yale Institute of Alcohol Studies, was funded by liquor industry money. In White’s words, “The industry saw Alcoholics Anonymous as a potential ally because the organization focused on a small percentage of late-stage drinkers and had little to say about the drinking habits of most Americans. … AA located the problem of alcohol in the person, not in the bottle.” (p. 195). White notes that liquor industry representatives sat on national and local alcoholism councils across the country — bodies that were typically “Knickerbocker”-style extensions of AA. A careful historian, White notes that evidence about the extent of liquor industry involvement in the modern alcoholism movement is still very scanty. His discussion of the problem is nuanced, detailed, cautious, and never degenerates into sloganeering. There is an illuminating discussion of the ethical and credibility issues involved in liquor industry sponsorship of alcoholism research, although more could be said.

Aficionados of the “disease theory” debate will find this work an invaluable reference. I pointed earlier to the revolutionary doctor Benjamin Rush’s pioneering insights, and touched on the first wave of institutional efforts to treat alcoholism as a disease, namely the turn-of-the-century inebriate asylums and the Keeley Institutes. White’s well-documented history absolutely obliterates the fallacy that the disease theory was invented by AA. White also quotes both William Miller and Ernest Kurtz, surely authorities on the history of AA, as categorically rejecting any claim that the origin of the disease concept is to be found in AA. According to White, the original AA conceptualization of alcoholism is “emotional and spiritual maladjustment.” When AA did use medical terminology, it was “primarily for their metaphoric value — more for sense-making than for science.”

That having been said, however, there is no doubt that AA later became, and is today, perhaps inextricably interwoven with the disease concept in the public mind and perhaps in its own mind as well. The principal weaver of these threads was the indomitable Marty Mann, the first woman to attribute her recovery to AA. Sponsored by the Yale Institute and promoted by AA, she tirelessly crisscrossed the country making thousands of speeches popularizing the disease concept. She portrayed the alcoholic not as a bad person who should be punished but as a good person who was sick and could be helped. What White adds to this story is strong evidence that Mann’s presentation ran far ahead of anything that scientific research at that time could support; indeed Dr. Tiebout, one of the seminal thinkers of AA, reflected in 1955 that he trembled to think “how little we have to back up our claims. We are all skating on pretty thin ice.” There is much other material as well on several sides of the question in White’s account; one comes to the disease debate only half-armed if one has not read this volume.

The “knickerbocker paradox” referred to in the book is alive and well today. Hospitals and treatment centers are staffed exclusively by those who have been trained in AA and TSF, many of whom are AAs themselves — not by objective health care providers who see AA as one of many treatment options, and not by researchers looking to objectively advance our understanding of alcoholism. Government agencies like  NIAAA  have their origins in AA, and have been staffed by AAs and AA proponents, and although there has finally been a tug of progress made with some of these agencies, there has been virtually none in the treatment facilities who have a symbiotic relationship with AA. AA might not lend its name to these facilities, but they lend their people, all the way up the board members of Hazelden, who also sit on the board of AA. From this, AA gets their inflow of new recruits and payment for AA literature, and Hazelden and company rake in billions of dollars of insurance premiums, all for treatment shown to be no more effective than doing nothing.

At the time AA was formed, we knew little about alcohol addiction. Dr Silkworth was actually on the right track by hypothesizing that alcoholism was an allergy. That was in 1937, a time when we believed masturbation causes blindness, and mental health conditions were treated with lobotomies. Alcoholism was largely considered a moral failing, so the idea that it could be physiological was not widely accepted. AA took advantage of this ignorance, and had a window of opportunity to establish the idea that alcoholism was a disease of the spirit, which could be treated with a spiritual awakening. From that point on, the normal rules of research, treatment and the scientific method no longer applied to alcoholism. AA ran the show, and AA set the rules. In the last seventy years, the death rates from virtually every common disease has dropped, and we have found cures and effective treatments for most. A glaring exception to this is alcoholism, and it is sadly ironic that the same group who advocates the idea of alcoholism being a disease, is the very one preventing it from being treated as such.

It is easy for us to see the absurdity and danger of a quack like Andreas Moritz, because we live in the 21st century, and we have the advantage of looking at cancer treatment through the lens created by decades of research and treatment. If he could take a time a time machine back to the 1930s, he would most likely be more successful at selling his brand of snake oil. Our understanding of cancer was simply not what it is today. Imagine the consequences of his ideas actually taking hold, and having the treatment of illness being addressed spiritually, and not physically. Today, most people see addiction treatment as we did in 1937, because not much has changed. AA is complicate in this, because they are happy with the way things are. As with Andreas Moritz, ignorance is the life blood AA and TSF. I would like to see alcohol addiction treatment step out from the ignorance and quackery of the 1930s, and into the world of modern medicine, where it belongs.

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*Somehow the state of Maine allows these jackasses to refer to themselves as “doctor”. I’d rather be treated by Dr. J.