This post was originally a letter to a friend who had asked why there suddenly seemed to be so much criticism of AA, not just in social media but also in recovery literature and the mainstream press. I consider the post, not a full explanation, but a start on an explanation.

The backlash against AA is complicated, like all cultural phenomena, but here are the bones, as I see them. AA and the other 12-step programs are fundamentally two things: fellowships and blueprints for recovery. The fellowships are simply communities that offer understanding, peer support, and a respite from the shame that accompanies substance-use disorders and process addictions—all for free. Even AA’s harshest critics acknowledge the value of such communities. 

The blueprints are a different story. They all derive from AA, and AA derives from a short-lived evangelical movement called the Oxford Group, which aimed to change the world, not through collective action, but through individual moral reform and subjection to God’s will. Its members practiced absolute surrender to God, public confession, restitution to those wronged, and an ongoing commitment to seek divine guidance in all things, which is basically a precis of the 12 steps. Twelve-step programs insist they’re not fundamentally religious because the “higher power” to which members must “surrender” can be something other than God—say, Planet Earth or other people in recovery (the famous G.O.D., which stands for “Group of Drunks). But all you have to do is read a few pages of the “big book” Alcoholics Anonymous to see how disingenuous the secular option is; you can’t actually swap in anything but another Abrahamic deity and have the program remain coherent, and God is mentioned on every page. Moreover, most meetings open and close with Christian prayers. 

It is true that a few explicitly atheistic and agnostic meetings exist, but the issue is not just prayers and God-talk; it’s the religious DNA expressed in the AA program’s structure. I’ll get to that in a minute; first, a few historical notes about AA. 

From its founding in 1935, AA spread quickly, aided by influential supporters. Also helpful was the full-throated encouragement of the alcohol industry, which loved the idea that there was nothing wrong with its products, just with a small subset of users suffering from a “disease.” And the alcohol industry funds a lot of alcohol-related science and policy, so, ironic as it may seem, its approval mattered. By the 1970s, AA completely dominated research to the point where scientists whose work didn’t conform to 12-step principles had trouble getting funded or published—and were publicly attacked for considering questions such as “How can heavy drinkers reduce their alcohol consumption?” 

(I briefly volunteered in the lab of one of these scientists, Alan Marlatt, who ran the UW’s Addictive Behaviors Research Center. He would eventually be recognized as a great pioneer, but he was a voice crying in the wilderness for many years, including when I knew him. So I do know whereof I speak—and there’s some reporting on the issue as well, if you’re interested.) 

Anyway, this dominance of organizations such as the National Institute on Alcohol Abuse and Alcoholism (NIAAA) by practitioners of AA-based “recovery science” stifled other kinds of treatment research for a good 40 years, which is one reason the US lags behind Europe in developing medications for alcohol use disorders—or even understanding the medications already developed. Yes, there was excellent research into the pathology of alcohol-related illness throughout these decades, but, when it came to research on how to help people suffering from alcohol use disorders, AA orthodoxy ruled until the turn of the century and remained a force to be reckoned with for another 10-15 years. 

This dominance is even more pronounced in the treatment industry, where 90 percent of US programs, even posh rehabs offering spa amenities and equine therapy, are basically just the first five steps of AA plus a lot of AA meetings, regardless of whether patients are addicted to alcohol or opioids or sex. Rehabs love AA-based treatment because it’s cheap; you don’t need doctors or mental health professionals, just “substance abuse counselors,” who, in some states, can treat patients with no college or psychological training, just a year or two of sobriety in AA. And few states mandate professional development; counselors can move up the licensing ranks solely with hours on the job, though an associate’s degree is sometimes necessary at the higher pay grades. As a result, many rehabs are staffed by people who know little about addiction science and instead rely exclusively on their own personal histories, anecdotes heard in AA meetings, and the “big book” I mentioned a moment ago, which was published in 1939. These people run therapy groups and deliver lectures, in addition to counseling one-on-one, and nowhere else in the entire US healthcare system are providers less qualified for the work they do, though there are, of course, some excellent practitioners among them. 

Partly for these reasons, partly because of organized PR campaigns, partly because celebrities began coming out of rehab and speaking about their own experience in its language, 12-step soon dominated the media and therefore what “everybody knows” about addiction and recovery. TV was particularly keen, contributing series specifically devoted to addiction, such as Intervention, but also going full 12-step in less obvious places, such as the Sherlock Holmes update Elementary, where Holmes becomes a recovering heroin addict and Watson his sober companion. Then there’s Mom, Bojack Horseman, Recovery Road, Love, Flaked, The Cleaner, and hundreds of individual episodes of series from soapy dramas to police procedurals, very different shows all conveying similar ideas about what addiction is and how to deal with it. Only in print media and only very recently have I started to see divergent ideas taken seriously, but they haven’t had much real influence yet. 

In short, the first—and most important—reason for the emerging backlash against 12-step is the hegemony of 12-step; it has been, for too long, the only game in town, despite a success record estimated at 5-8 percent. Its adherents, in the way of many true believers, have been too certain that theirs was the only path to recovery, and some went to great lengths to sideline alternatives. I do understand that they weren’t trying to do harm; in fact, I’m sure most believed they were merely protecting a program that had saved their lives and spreading the word about it so that it could save the lives of others. But the practical result of their efforts is an orthodoxy that alienates a lot of people and resists change, and now those chickens are coming home to roost. 

The second contributor to the backlash is a growing body of research into alternative ways of understanding and treating addiction, fostered by breakthroughs such as fMRI and the ACE Study in the 1990s. Though the “recovery science” folks fought some of this progress—for example, in 2012, they joined alcohol industry lobbyists to block the NIH’s proposed merger of the NIAAA and NIDA into a single addiction institute—there was now too much happening in fields such as neuroscience and psychotraumatology for any interest group to suppress it. That said, I don’t want to be too celebratory here; a recent analysis described progress in addiction science as “mixed, despite ample government and private funding,” but there’s definitely more published research available for people to read, absorb, and share with others. 

The third contributor is the internet, which disseminates some of this new information and amplifies people’s dissatisfaction with AA. And where the critics are, so are the defenders of 12-step, producing a lot of debate, mostly just people shouting past one another. The internet has also facilitated the spread of AA alternatives, not just old-school groups such as SMART and Rational Recovery, but a whole slate of new programs and organizations, some online, some real-world, some both. And, though American doctors remain reluctant to use medication (or use it productively), there’s now a lot of European pharmacological research available online, as well as social-media communities where people share links to those studies and report their own experiences. 

The fourth contributor is a shift in the values of young people toward self-care and away from excessive risk-taking. In the past, many Americans in their late teens and twenties enjoyed binge drinking, drug use, sexual experimentation, driving too fast, and other expressions of youthful exuberance, but the current cohort seems less interested, and no one really knows why, though the media have lots of theories, as I’m sure you’ve seen in articles decrying “puriteens” and “generation zero tolerance.” At any rate, many in Gen Z are getting off the party train far earlier in life than previous generations, and even those struggling with real dependency are often turned off by 12-step. 

As to what’s turning them off, the first should be obvious already: the dominance of specifically Evangelical ideas and practices, which is not just a problem for the 37 percent of Americans who aren’t Christian—though it is that, especially as AA and the rehabs using it don’t advertise how religious their method is. Equally problematic is that the program’s religiosity undermines the agency of people with substance use disorders, telling them over and over that they’re “powerless” and can recover only if God relieves them of their addiction. 

A lot of people, from addiction scientists to social media denizens, think that AA’s insistence on individual powerlessness is both wrong and dangerous. Sure, placebo effect is real, and some people can stop drinking by believing that God has freed them from the compulsion. But placebo effect isn’t stable over the long term. Lapses, full relapses, or even just periods of intense craving—all so typical of addiction that they’re named as symptoms—can breed doubt in God’s gift of recovery. Moreover, there’s a psychological price to pay for withholding credit for sobriety from people who could use a bit more belief in themselves and confidence in their own abilities. 

Now’s a good time to pause and make another historical point: AA was devised by a small group of well-off white male professionals used to having their way in the world. Because they thought that the unchecked exercise of their own will had contributed to their alcohol dependency, they embraced humility and created a program designed to foster it, a program that deliberately sought to deflate members’ egos and undermine their self-reliance so they’d turn to God for direction. The result of this deflation, in AA’s original demographic, was probably a pretty healthy midpoint between swagger and meekness, if my memory of midcentury white professional men is any indication. 

But what happens when humility is pushed on people who are already way too humble? Recent studies show that a large majority of alcohol dependents drink to medicate trauma, mental illness, or both. Moreover, though the prevalence of alcohol use rises with income and education, the prevalence of alcohol use disorders rises as you go down the economic ladder. So there are a lot of people in recovery who are pretty beaten-down, not just by their addictions, but by poverty or depression or prejudice, and the last thing many of them need is another serving of humble pie. 

Unfortunately, there are heaping plates of that pie in Steps Four through Ten, or seven of the twelve steps. Yes, humble pie can encourage healthy modesty and other virtues in people with reasonable standing in the world and relatively intact personalities. But in people who drink to medicate complex trauma or mental illness, it may be unhealthy to repeatedly inventory, confess, and do penance for “character defects” that may have very little to do with their addictions. Doing so can encourage global shame and self-blame in a population already beset by them. And shame is a major relapse trigger. 

The next problem is viewing recovery as a kind of conversion. Go to any AA speaker meeting, and you will hear some version of “I once was lost but now am found,” a formula that obviously predates the Oxford Group and even the Puritans who raised the “conversion relation” to an art form. The “lost” part may be funny or dramatic or both, but the upshot is always “when I was drinking/using, everything was bad, though it may have looked okay on the outside.” Usually, there’s a crisis (“hitting bottom”), followed by introduction to AA, followed by recovery to a point beyond where the speaker was before the addiction began, inspiring gratitude for being a drunk in the first place. There are variations within this larger formula—for example, some speakers report having fought AA (or parts of the program) at the beginning before completely surrendering—but the overall shape of the narrative is not negotiable. 

The problem with this narrative formula is that it doesn’t map well onto everybody’s experience of addiction and recovery. Many people don’t “hit bottom” or experience a crisis followed by conversion. Instead, they may, at any point in an addiction, begin practicing harm reduction, gradually reducing their substance use as they gain knowledge of themselves and mastery of new coping skills. They may use medication, which for years AA condemned as “just another addiction,” though some fellowships have backed off this absolutist position in recent years, especially NA groups, which have always been less doctrinaire than their elder sibling. 

Anyway, this more gradual learning-based model of recovery makes for a far less dramatic story, and, worse (from AA’s perspective), it contradicts AA’s doctrine of “powerlessness” by demonstrating that people with substance use disorders can take small but significant steps to help themselves, reaching sobriety incrementally, rather than “surrendering” all at once. So this kind of story is a rarity at speaker meetings, decreasing support for people following this path and keeping newcomers who might benefit from it in the dark. 

Another problem with the conversion model is that it doesn’t handle relapses well. A few at the beginning are okay—the formula can accommodate a rough start—but, once underway, abstinence is supposed to be continuous; that’s why AA makes such a big deal about birthdays and other rituals marking sober time. There is preventive power in this emphasis, to be sure; if members know that one drink will reset their sober clocks to zero, effectively wiping out any status they’ve accumulated, then maybe they won’t take that drink. 

But some will; in fact, many will, simply because of what addiction does to the brain. At this point, the ideal response is: (1) to see a drinking episode as a regrettable but minor lapse, (2) stop as quickly as possible without damage to health, (3) try to understand why the lapse happened, and (4) recommit to sobriety. But AA’s all-or-nothing philosophy encourages global shame and the transformation of a lapse into a major relapse. When the social penalty for having a few beers is the same as for a month-long bender that ends in jail, then some people will conclude that, as long as they’ve already “destroyed” their 30 days or their year or their ten years of sobriety, they might as well go to town. 

Finally, the conversion model is a problem for people who are still drinking. Schooled on media, especially TV series such as Intervention, they buy into the idea that someday they’ll “hit bottom,” which will usher in a recovery they’re convinced is not possible now. So they wait for that mythical bottom—and sometimes even try to bring it about—rather than looking for help now. 

Another controversial model AA embraces is the disease model of alcoholism, but it would take me ten pages to run through all the arguments on that one, five of them devoted to the definition of “disease.” Anyone with sense can see that saying “alcoholics have a disease” is more humane than saying “drunkards are hopeless degenerates,” but the former does tend to undermine the dependent drinker’s agency. And it completely exonerates the alcohol industry, which does everything it legally can to foster the addiction responsible for 74 percent of its profits. And alcoholism-as-disease is inconsistent with the AA program’s penitential emphasis anyway, since we generally don’t treat illnesses by telling people to inventory, confess, and atone for their moral failings. So the disease concept contributes to an overall impression that AA is incoherent.

A problem related to the disease model is AA’s insistence on members’ self-labeling as “alcoholics” every time they speak, reaffirming a stigmatized identity based on addiction and a binary way of thinking about alcohol problems. Almost all scientists and policy-makers now reject the term and talk instead about a wide spectrum of alcohol use disorders, rather than a single population afflicted with a lifetime disease. Accordingly, the question “Does drinking interfere with my life?” is replacing the traditional “Am I an alcoholic?” as a way of thinking about one’s own drinking. This substitution is particularly marked among younger people. 

Finally, AA can foster some unhealthy interpersonal dynamics. For example, thirteenth-stepping, or the sexual exploitation of new members, is far too common an occurrence, especially for young women. Fundamentalists quote the “big book” to shut down discussions (and people) they don’t like, and some hard-liners shame those who use any psychoactive medication, over-the-counter or prescription, even anesthesia during surgery. Sponsors overstep, acting like therapists, priests, parents, or life coaches, rather than encouraging sponsees to seek out appropriate professional help. Cliques dominate meetings so that the same people tell the same stories over and over while others sit silent. Members gossip after meetings and “take other people’s inventory.”

All of that said, there are meetings with a critical mass of honest, enlightened folks who don’t do any of those things, who just want to help one another and reach out to people still suffering from alcohol dependency. There’s no trick to finding such a fellowship; you just have to get yourself an AA meeting schedule (or an equivalent app) and visit some promising-looking groups—which is easier post-pandemic than it has ever been, as many meetings have migrated online.