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This is a GREAT question and I have many thoughts, but I'll start with an overarching principle - DO NOT try to eliminate bad habits. Instead, either replace them (or crowd them out) with habits you'd like to take on instead OR identify the role they play (what they help with) and neutralize their power by actually addressing the underlying issues!

You can do both of these in parallel!


I'm a big supporter of "whatever works," so I think AA is great for the people for whom it works. The problem is that, to some extent due to its length of existence and its religious origins and connections, it's been seen as "THE" approach for addiction... and this is where things fall apart.

Overall success in AA is very small (5%-15% is the estimate range for success among all those who try/enter) and the vast majority of people (over 95%) will simply not meet long-term, let alone lifelong, sobriety goals. So, if our hope is to actually help people and not to shame/judge/relegate them to failure, we need to support additional and alternative approaches that have either similar/better success rates OR that succeed for different groups of people who are unhelped by AA.


AA groups use Christian prayers exclusively and the word god is repeated hundreds of times in the text, so religion is intimately connected there. And research always uses anonymous members and there have been literally hundreds of studies assessing AA efficacy - the findings are simple (and easy to understand): AA works great for people who are committed to it and stick with it and terribly for those who do not. The only issue is that we send people there who are not interested and it destroys the entire operation (but grew AA to mammoth proportions). The outcome measure for AA seems pretty clear - long-term abstinence and if we start actually listening to people and giving them choice in the approach they get to pursue we may identify helpful factors in determining fit. But as of now, that is a very hard thing to study and the most recent and largest study to try found about the same success rate for all available interventions (but very few identifying factors that predicted success).


Wow. Great Question. I'd love to know more specific about the area, etc.

My guess is that this comes along with some stress and struggle specific to the region and that perhaps the "fatigue" is also a reaction to the impact of that stress AND the judgement regarding the users reliance on drugs for dealing with the pain and struggle (versus those who feel like they have to hold their own and take up the slack)...

Am I right at all?


I'm saying that the evidence tells us we should stop sending people to AA (even AA says that in the book). And if AA wants to alter the religious overtones, it's really easy to edit the book... By keeping it bible-like they're choosing to continue the religious narrative... IMO