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Conflict between 12-Step Anonymous Groups and Science: A Historical Perspective

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

Historically, there has been considerable controversy about the causes of addiction and the solutions for recovery. We can simplify this controversy and say it has resulted in two polarized groups: 1) people who turn to medicine and science for solutions, and 2) people who turn to the spiritual realm for solutions (for instance, 12-step groups like AA). As we have emphasized throughout, there are many effective solutions for any given problem. These different solutions need not be mutually exclusive. Ultimately, each person must pick the set of problem-solving strategies that best fit their own needs and circumstances.

From this unified perspective, it becomes clear that the conflict surrounding addictions treatment and recovery is unnecessary. However, a powerful, historical undercurrent forms the basis of this conflict. When we examine the historical context from which this conflict has emerged, we more easily understand the polarization between these two groups. Perhaps such an understanding will help to close the chasm between these rival factions. We have found these unproductive, philosophical debates are not helpful for people in recovery.

The problem of alcoholism has been with us for quite some time. Certainly, we have attempted various solutions. One attempted solution was to ban alcohol. In 1919, the United States passed a prohibition law. It remained in effect from 1920 to 1933. Prohibition began with the hope that by eliminating alcohol, we would eliminate the problem of alcoholism. As Prohibition unfolded, voters gradually decided that Prohibition was more trouble than it was worth. It also became clear that Prohibition could not end alcoholism. Therefore, it was an ineffective solution. Although there may have been a modest reduction in alcohol consumption, organized crime and disrespect for law increased. The decrease in one set of problems was offset by an increase in a different set of problems.

Compared to Prohibition, The Harrison Narcotics Act of 1914 was more effective at reducing the supply of illicit drugs. By 1933 when Prohibition ended, the primary addiction problem was alcohol. Yet, there remained no solution for the perplexing problem of alcoholism. Prior to this time, there are few records to suggest people with alcoholism became well. Some became homeless, some were institutionalized, and some found religion. Most went without treatment of any sort. Although mental health professionals are widely available today, this was certainly not the case in the 1930s. Moreover, during the Great Depression of the 1930s, very few people could afford even routine medical care. Specialty care, like psychiatrists, was beyond reach for most people. Psychiatry's solution to the problem of addiction rested almost entirely upon the psychopathological model of addiction. Like all theories, this was only helpful to some.

Into this vacuum, emerged Alcoholics Anonymous (AA) in 1935. The AA co-founders ("Bill W" and "Dr. Bob") self-describe multiple failed attempts by various medical professionals to "cure" their alcoholism. The two met as they became involved with a religious group called the Oxford Group. Together they stumbled upon a method that enabled them to recover. The AA founders based their program upon many of the religious principles of the Oxford Group. Although its initial growth was slow, by the early 1950s AA's membership approached 100,000. It quickly became the dominant approach to addiction recovery in the United States. Although AA meetings are available worldwide, AA's role in other countries is significantly smaller. Thus, the success of AA would appear to be a phenomenon of the United States.