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US of AAReview - US of AA
How the Twelve Steps Hijacked the Science of Alcoholism
by Joe Miller
Chicago Review Press, 2019
Review by Christian Perring
Jun 11th 2019 (Volume 23, Issue 24)

The thesis of US of AA is that Alcoholic Anonymous is not based on credible scientific theories and it does not provide the only or even the best treatment for alcoholism. It gained its dominance in the US not through scientific and medical evidence but through chance and politics. The forces that keep it in its predominant position are also political and social rather than scientific. The subtitle of the book uses the emotive word "hijacked" which is also misleading in implying that there was a plan to carry all this out. Indeed, it is reminiscent of those who say that in addiction, the substance that the person is taking hijacks the brain or their self-control. Some careful thought shows that this is not an enlightening metaphor, precisely because it obscures the agency of the addicted person. In the case of the rise of the twelve steps, there is no real planning on the part of AA at all to achieve its domination. Rather, what happened was that people who wanted to help alcoholics used a powerful rhetoric to achieve their ends, and various social forces worked together to push AA to its position of power. Indeed, that's what Miller himself shows in his history of the rise of AA in the twentieth century United States.

The debunking of AA is hardly new. Indeed, as Miller documents, it had its critics right from the start. In recent years, there has been a flurry of books on the topic includingThe Sober Truth (2014) by Lance and Zachary Dodes, and psychologist Stanton Peele has devoted his whole career to providing an alternative to AA. Many books provide theories about the nature of alcoholism that don't fit a simplistic disease model and there are evidence-based treatments that do have documented success, which don't require abstinence. Philosophers have spent a good deal of time trying to provide a definition of disease and have discussed whether substance addiction should count as a disease (usefully set out in The Routledge Handbook of Philosophy and Science of Addiction, 2018.) What is distinctive about US of AA is that it provides a history of what happened. Most historical accounts of AA have been by true believers, and thus have lacked objectivity. One of the main precedents for Miller's book is William White's valuable history Slaying the Dragon: The History of Addiction Treatment and Recovery in America, which came out in a second edition ins 2014, and that's a very different sort of book, being dauntingly comprehensive and without having a central thesis to defend.

Miller's book is modest in size -- about 155 pages of main text, in a font that won't strain your eyes (unlike quite a lot of academic books). While the author's prologue makes clear that he is very skeptical about AA and its methods, starting with his own experience of it, the book is written in the third person and adopts a neutral tone. There are five main chapters, organized historically. Miller sets out the history in a way that certainly advances the case that AA did not have a coherent scientific basis at the start and advanced through a process of confusion and obfuscation, with some people advancing their own personal agendas.

Does the book prove its claims? Not really. It has a significant bibliography but there are no footnotes, and so it is hard to verify all the claims it makes. It does not aim to be a scholarly book. Rather, it aims to give a version of events in a readable story, and it does that well. It is possible that events did not occur exactly as Miller says or that he is leaving out major portions of the story -- presumably this is what defenders of AA would say in criticism. Is Miller more objective than the true believers who defend AA? Since I agree with his thesis, I'm inclined to believe that he is, and his lengthy bibliography of scholarly work also helps his case. But I'm not an expert in the history of the social position of addiction treatment myself, so I can't directly speak to the historical claims. Nevertheless, since the poor scientific status of the claims of AA is basically incontrovertible, we can know ahead of time that Miller's thesis has to be right, since there was never strong scientific evidence for the effectiveness of twelve steps approaches. That means that we should be skeptical of enthusiastic histories of AA and more ready to accept at face value critical histories such as Miller's.


© 2019 Christian Perring


Christian Perring teaches in NYC.


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