Note: This is part one of a multi-part series. You can find part two here.
I heard it often: “your worst day sober is still better than your best day drunk.” Usually uttered by folks whose worst days drunk weren’t characterized by structural oppression, and whose “rock bottoms” were mid-way points on my own descent into alcoholism, drug addiction, anorexia, bulimia, and with them, homelessness, sexual violence, and involuntary institutionalization. Men and women for whom AA’s twelve steps and twelve traditions are truisms, and whose uncritical endorsement of the program has, to put it bluntly, gotten people killed.
I have since left AA, but even after years of abstaining from “the rooms,” the rhetoric I heard there there is imprinted in my psyche. This can be attributed not just to the shame that “old timers” instilled in me when I dared challenge them, but also to the fact that mainstream society still frames addiction as a chronic, relapsing disease. It’s not, but nowhere is this myth more entrenched than among those who think they have it.
As someone whose problems neither begin nor end with addiction, and who is effectively a walking DSM, my worst days sober are no less than torturous. They include dissociation, obsessions, compulsions, voices, bipolar mania or depression, emotional and energetic erraticism, somatoform pain, and, always, insidious, unrelenting terror. This is my baseline. This is my “normal.” My best days drunk, on the other hand? Still far from great (and regularly agonizing), but, nevertheless, I have found reprieve.
I left AA for many reasons, but the most salient was its members’ staunch refusal to accommodate difference. For me this looked like being told that taking psychiatric medications was akin to a relapse, and that my mental health challenges would and should be treated with prayer. Others depart because twelve step groups can be unsafe for vulnerable women and gender non-conforming folks, or because discussing exclusion on the bases of race and culture is silenced or deemed taboo.
This is not to say that AA doesn’t confer benefits. Social support is critical for everyone, especially for those grappling with addiction, and living by spiritual principles can enhance one’s relationships. In writing this I’m not seeking to undermine that AA truly is a life — line for some, or discouraging folks for whom AA resonates to leave. However, I think it’s important to challenge the dogma that AA is one’s best and only option if they ever struggle with substance use. The advantages I’ve just listed don’t negate the harm some endure in twelve-step programs, and they are not, at least for me, sufficient motivation to stay.
Inspired by my own journey into and out of AA, as well as what I have witnessed amongst my peers, here is a list of the myths propagated in twelve step programs. I follow each with a series of evidence-based responses. Do with them what you will.
1) Myth 1: Alcoholics are allergic to alcohol.
“The action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class [of people] and never occurs in the average temperate drinkers.” — Dr. William Silkworth
Fact: Alcohol (and illicit drug) “allergies” don’t exist.
The idea that alcoholics are allergic to alcohol (and illicit drug users to drugs) is comforting. It absolves us of personal responsibility for our actions because drinking for the “real” alcoholic is a biological aberration, not a choice. It also offers a simple (not easy, but simple) solution to alcoholism — total abstinence.
There is, however, no evidence to support this theory. It reflects depression-era insights into the neurophysiology of addiction, and ample research highlights that one’s environment is more salient than genetics when determining who becomes addicted. Those who were raised in relative privilege, both in terms of demographic characteristics such as race, culture, and class, as well as those who had reasonably stable familial dynamics, are less likely to use substances problematically than those who contended with multiple, intersecting hardships.
What about those who aren’t marginalized, though? Surely these alcoholics must be different than the “normal” person, or they wouldn’t be addicted? Not so fast. First, we can’t operationalize all possible forms of trauma, isolate them as independent variables in quantitative analyses, and use these to predict one’s likelihood of addiction. Put differently, we don’t know which events will strongly affect a person throughout their life course, or how seemingly “minor” traumas may nonetheless be impactful. When it comes down to it, each of us interprets stimuli differently, and we will respond uniquely based on several, invisible factors, none of which are “allergies.”
Approaching alcoholism at the individual level, it’s been suggested that the common expression “First drink, then drunk” may trigger a self — fulfilling prophecy by influencing one’s motivational state while drinking. Another way to frame this is that alcohol creates an “expectancy response” in self — identified alcoholics who believe they can’t drink “normally.” Think about it: If you’ve been told hundreds or thousands of times that you cannot use a substance safely lest you lose control completely, and this sentiment has been reinforced by your peers for months, years, or decades, to what extent do you think you will (unconsciously) make it “true”?
Howard Becker’s classic sociological study on marijuana smoking highlighted that addiction “careers” are comprised mainly of how one self — defines in relation to a substance, with those who interpret a drug’s effects as mild or moderate less likely to become dependent. This isn’t biological, it’s societal: AA’s first step is admitting one’s “powerlessness” over alcohol, and many whose lives revolve around the fellowship would lose their point of entry without this shared foundation of helplessness. AA literature makes it abundantly clear that “real” alcoholics are different from mere “problem drinkers,” and for those arriving with limited peer networks, it’s affirming to be invited into this selective cult (er, club.) People depend on being “alcohol-dependent” because their identity is predicated on a common system of meaning for their problematic drinking. One issue with this is, of course, that and illicit drug allergies don’t actually exist.
When it comes to the specific neurophysiology of addiction, let’s first define “allergy.” Allergies are disease responses to substances (“allergens”) that evoke negative immune system reactions and cause allergic inflammation (i.e. difficulty breathing, runny nose, red eyes, and skin conditions such as eczema or hives). Allergens elicit physical effects, whereas AA claims that alcohol produces purposeful behavioural actions (i.e. the uncontrollable pursuit of alcohol). This is a false equivalence, debunked by years of “priming dose experiments.” Though unethical by today’s standards, researchers in the 1960’s and 70’s studies regularly gave detoxified alcoholics tasteless alcohol in hospital settings without letting them know. Sure enough, none of these people disclosed alcohol cravings thereafter because their expectations about cravings hadn’t been triggered. Slip someone with a severe peanut allergy a Snickers bar, on the other hand? You better have an epi — pen ready, because their body will go into anaphylaxis whether their mind is aware of having eaten the peanuts or not.
This is not to say that prolonged exposure to alcohol doesn’t cause tangible changes in the circuitry of the brain — it does. But these changes affect people in standardized, predictable ways that are then moderated by socio-cultural forces. Neuroscientist Mark Lewis, himself a former “addict,” notes for example that the longer time one spends in an addictive state, the more synaptic cues become attached to alcohol and the more dopamine (nicknamed “the feel — good chemical”) will be released upon consumption. Concurrently, we see decreased activity in the brain structures responsible for decision — making and impulse control. People mistake this as evidence of the allergy hypothesis, but identical brain changes occur through any goal-oriented activity, including language acquisition and income generation. In other words, wealthy stockbrokers on Wall Street are as neurologically “addicted” to earning money as AA members are to alcohol, but only the latter get told they are “allergic” to their pleasurable behaviour of choice.
Where alcohol drinking does diverge from other goal — oriented behaviours is in how alcohol suppresses central nervous system activity. Things slooooow down during long periods of binge — drinking, and the body undergoes compensatory adaptations to increase neuron excitability so that messages can still be transmitted to and from the brain. Once alcohol is eliminated from the body, the compensatory activation of the central nervous system remains in effect for several more days and leads to anxiety — like withdrawal symptoms that can range from agitation and the shakes to seizures and delirium tremens. Speaking personally, severe withdrawal is scary as hell, and this is where the compulsion to keep going comes from — stopping abruptly isn’t just irritating, it is also very dangerous. Once more, though, this reaction isn’t confined to alcoholics. Anyone drinking for weeks or months on end would experience withdrawal, and stopping would be difficult without the aid of medications.
The idea that alcoholics are physiologically different than average people is based on antiquated lore. Nowhere else has bad science become so deeply entrenched as in how we approach alcoholism, and this is particularly damning for those who don’t have the privilege of “just not drinking.” The allergy myth is especially problematic because its natural conclusion — abstinence — isn’t accessible for everyone, nor is it desirable. Fortunately, alcoholic drinking can be unlearned, which is what we’ll get to next.
Let me know if there are specific AA statements that you’d like to see debunked in the comments below.