12-Step Coercion

Quailfeather · Jun 22, 2004

Somehow this thread has veered from the original topic, the legality of mandated 12-step treatment, to a discussion of the efficacy of treatment [AA in particular]. Yet, no one has offered any valid research-based statistics to support their claims that AA works. While I wish to remain neutral on the subject of AA effectiveness, I do have some statistics that may be of interest to those who are curious about addiction/alcoholism and treatment outcomes. As I have stated on previous posts, more alcoholics recover without AA than do with it. One article published by the Harvard Medical School in their Harvard Mental Health Letter addresses this phenomenon:

"There is a high rate of recovery among alcoholics and addicts, treated and untreated. According to one estimate, heroin addicts break the habit in an average of 11 years. Another estimate is that at least 50% of alcoholics eventually free themselves although only 10% are ever treated. One recent study found that 80% of all alcoholics who recover for a year or more do so on their own, some after being unsuccessfully treated. When a group of these self-treated alcoholics was interviewed, 57% said they simply decided that alcohol was bad for them. Twenty-nine percent said health problems, frightening experiences, accidents, or blackouts persuaded them to quit. Others used such phrases as "Things were building up" or "I was sick and tired of it." Support from a husband or wife was important in sustaining the resolution."

Treatment of Drug Abuse and Addiction -- Part III, The Harvard Mental Health Letter, Volume 12, Number 4, October 1995, page 3.

As for the effectiveness of AA, there are a few studies that have addressed this. One is an informal survey conducted by Alcoholics Anonymous. For many years in the 1970s and 1980s, the AA GSO (Alcoholics Anonymous General Service Organization) conducted triennial surveys where they counted their members and asked questions like how long members had been sober. Around 1990, they published a commentary on the surveys: Comments on A.A.'s Triennial Surveys [no author listed, published by Alcoholics Anonymous World Services, Inc., New York, no date (probably 1990)]. The document has an A.A. identification number of "5M/12-90/TC". This document was produced for A.A. internal use only. A compilation and averaging of the results from the five surveys from 1977 to 1989 yielded these numbers:

Of all of the newcomers to AA,

81% are gone (19% remain) after 1 month;

90% are gone (10% remain) after 3 months,

93% are gone (7% remain) after 6 months,

and 95% are gone (5% remain) at the end of one year.

The above survey does not address whether those 5% remaining achieve continuous sobriety.

A more formal and valid study was performed in the 1980's by a Harvard physician who is also a member of the AA Board of Trustees. George E. Vaillant, M.D., joined AA's General Service Board as a Class A (nonalcoholic) trustee in 1998. He is professor of psychiatry, Harvard Medical School, director of the Study of Adult Development, Harvard University Health Services, and director of research in the Division of Psychiatry, Brigham and Women's Hospital. The author of The Natural History of Alcoholism Revisited, a comprehensive study of alcoholism, George lectures widely on alcoholism and addiction and is one of the foremost researchers in the field. While working at the Cambridge-Sommerville [Massachusetts] Program for Alcohol Rehabilitation (CASPAR) back in the 1970s and 1980s, Dr. Vaillant conducted an 8-year-long clinical test of A.A. treatment of alcoholics, enthusiastically trying to prove that A.A. works and is a good, effective treatment for alcoholism. Much to his dismay, Dr. Vaillant instead clearly showed that A.A. was no more effective than no treatment at all. Dr. Vaillant candidly reported those results in his book The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, in 1984:

"To me, alcoholism became a fascinating disease. It seemed perfectly clear that ... by turning to recovering alcoholics [A.A. members] rather than to Ph.D.'s for lessons in breaking self-detrimental and more or less involuntary habits, and by inexorably moving patients from dependence upon the general hospital into the treatment system of A.A., I was working for the most exciting alcohol program in the world.

But then came the rub. Fueled by our enthusiasm, I and the director, William Clark, tried to prove our efficacy. ... After initial discharge, only five patients in the Clinic sample [100 subjects] never relapsed to alcoholic drinking, and there is compelling evidence that the results of our treatment were no better than the natural history of the disease. ...Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling."

The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, George E. Vaillant, Harvard University Press, Cambridge, MA, 1983, pages 283-285.

I, for one, would love to see more current statistics comparing and contrasting the efficacy of all of the addiction treatment modalities. In the meantime, I would strongly urge anyone who is finding success in their chosen program to stick with it, regardless of the numbers. However, I would caution anyone against claiming that their program is the best, or that it works for everyone. The numbers speak for themselves. And yes, I still advocate against mandating anyone into any program that may violate their constitutional right to religious freedom. After all, we are human beings with human rights, in spite of our differing beliefs or dysfunctional compulsions.

Dixiedi · Jun 22, 2004

I don't think it is important wether AA works or not. The original discussion was wether or not a state BON has the right to require AA so that nurses with a problem can keep their license.

Yes, they do have that right. If you are required to provide proof of treatment and the BON chooses AA as that form, no amount of complaint, proof it doesn't work, proof it is illegal to force an atheist to be exposed to Christianity or anything else can change that.

The states have developed their BON and given the responsibility to them to ensure safe nurses for that state. It's their game, we choose to play it. Play by there rules or get the heck out!

If you don't lilke the rule they have established, at the next open meeting, engage in an effort to get them to change the ruling. Provide suggestions for alternatives that will be readily available throughout the state. Provide proof that these alternatives are available, are effective and anything else you can think of. I wuold suggest that a spych nurse, one without an addiction prepare and present this to them.

Legal in your mind or not, it is the boards choice!

Quailfeather · Jun 22, 2004

I don't think it is important wether AA works or not. The original discussion was wether or not a state BON has the right to require AA so that nurses with a problem can keep their license.
Yes, they do have that right. If you are required to provide proof of treatment and the BON chooses AA as that form, no amount of complaint, proof it doesn't work, proof it is illegal to force an atheist to be exposed to Christianity or anything else can change that.

What part of "Any state or governmental agency that mandates or coerces a citizen to participate in A.A. or any other 12-step program is acting in direct opposition to the principle set forth in the Establishment Clause of the First Amendment of the United States Constitution" do you not understand? Several courts at the state and federal levels have made this ruling. As a state agency, the Board of Nursing, does not have the right to supercede any court ruling. Period.

If you don't lilke the rule they have established, at the next open meeting, engage in an effort to get them to change the ruling.

That is exactly what Tommy Perkins did (please refer to the original post).

Big Bab's · Jun 22, 2004

Amen to that Quailfeather!!!....and for the record Dixiedi, treatment "Porgrams" choose the 12 steps NOT because it does or does not work, they choose it because its FREE.

What part of "Any state or governmental agency that mandates or coerces a citizen to participate in A.A. or any other 12-step program is acting in direct opposition to the principle set forth in the Establishment Clause of the First Amendment of the United States Constitution" do you not understand? Several courts at the state and federal levels have made this ruling. As a state agency, the Board of Nursing, does not have the right to supercede any court ruling. Period.
That is exactly what Tommy Perkins did (please refer to the original post).

Big Bab's · Jun 22, 2004

Just to clear something up, when nurses are mandated to these Alt. programs, they are supposedly there to recieve TREATMENT not punishment....so when we are coerced into meetings, the BON does it in the name of TREATMENT.....these programs are supposed to get the nurse treatment and help maintain and prove their sobriety, they are also to help facilitate the nurse rejoining the nursing profession NOT try to break us down, treat us like garbage, and keep our licenses and livlihood, which IS what happens in many programs.....It seems that there are a few in this discussion that are unaware of this, so here it is.

Dixiedi · Jun 22, 2004

What part of "Any state or governmental agency that mandates or coerces a citizen to participate in A.A. or any other 12-step program is acting in direct opposition to the principle set forth in the Establishment Clause of the First Amendment of the United States Constitution" do you not understand? Several courts at the state and federal levels have made this ruling. As a state agency, the Board of Nursing, does not have the right to supercede any court ruling. Period.
That is exactly what Tommy Perkins did (please refer to the original post).

If you examine the constitution a little more closely, you will find the criminals have no rights under the constitution.

Anyone abusing their nursing license is guilty of criminal activity just the same as any other person abusing their license no matter what kind it is. You enter into an agreement with the state concerning behavior, break it and well it's criminal.

Dixiedi · Jun 22, 2004

Just to clear something up when nurses are mandated to these Alt. programs, they are supposedly there to recieve TREATMENT not punishment....so when we are coerced into meetings, the BON does it in the name of TREATMENT.....these programs are supposed to get the nurse treatment and help maintain and prove their sobriety, they are also to help facilitate the nurse rejoining the nursing profession NOT try to break us down, treat us like garbage, and keep our licenses and livlihood, which IS what happens in many programs.....It seems that there are a few in this discussion that are unaware of this, so here it is.[/quote']
Call it what you want but we all know in reality forced treatment is little more than punishment that will hopefully correct the problem.
People who abuse their driver license might be sent to driving school. Is this piddly little treatment gong to teach folks, many with years of poor driving habits, how to drive safely? NO. It's little more than punishment that the system has labeled treatment.
The hope, I think, being that the treatment will be so disagreeable that it will serve the purpose and on paper look like the treatment was successful!

donnar232 · Jun 23, 2004

For one, I do not feel bad that you have to attend these meetings and that there is a mixed crowd as you wordedit strippers, street people. Well those strippers and street people are there to let you know that you can be there too. They could have been a nurse before they started using alcohol, or drugs. It can happen to you. Also if I was told to go to meetings, I would be in my glory beacause I am not in jail or have lost my liscence for good. Where is your humbleness. Be glad someone like the board gave you a second chance. Also even celebrities use AA or NA meeting beacuse they work and lord knows they can afford any type of professional treatment and are in the halls. Be grateful that being mandated to a 12 step program is all you received. Any treatment will work if you are ready and have had enough.:rotfl:

serene992 · Jun 23, 2004

Sounds like you found the same kind of AA that worked for me. And you said it very well. Denial is not something one does in a conscious state, it is part of the protection of self, based on beliefs and values. The 3 biggest tools of denial are 1) Rationalization 2) justification 3) Intellectualization. I can only speak to what my life was like, what happened, what my life is like now and what has worked for me. It is a program of progress rather than perfection. You are invited to take from the meetings only what you want and leave the rest there. I was one of those who only attended meetings because it was part of the aftercare plan and was mandated by the place I worked. I went to meetings 60 miles from where I lived for about a year. Finally as my attitutes, values and beliefs were restored to reality, I was able to attend meetings in my home town. I keep hearing that loosing your license because one does not attend 12 step meetings is not a choice. Not all choices are those we want to choose but they are choices irregardless.

I adopted the name Serene in 1991 while attending Codependents Anonymous, trying to find myself and heal the horrendous inner wounds and the destroyed spirit from a decade of marriage to an abuser. I had gone to several counselors of varying degrees over the years trying to fix myself and fix my mate. The denial of the events occuring in my life including the fear and the desperate need for love were numbed by my pain killer - alcohol. After getting out of the marriage and still alive physically, I spent lots of money of further codependency therapy. I'd attend group sessions trying to heal the hole in my soul and the memories and then go home and have a drink or 2 to numb myself into sleep. Alcohol became my best and only friend. It allowed me to maintain and heal the wounds - or so I thought. I do not know the day I crossed the line and my pain reliever became my pain killer. But that line was crossed. All of the high priced therapists never picked up on the fact that I was using and abusing alcohol. I knew of the main AA meeting place in town because my ex rebuilt it after a fire a few years before. I had thought of going there to a meeting but No Way would I want anyone to see this proud professional RN going into a place like THAT! I was lucky that I had not gone to a meeting when the thought first began seeping in. Instead I waited and drank and numbed some more. September 24, 1992 I was spiritually dead with a hole straight through my chest that I thought was visible to the world, with the wind rushing through it. All of that false pride went out the window as a gift of desperation led me to opening that door to my first AA meeting rather than taking my life. Slowly but surely the gorilla on my back that kept my shamed head looking at the ground began to leave due to the unconditional love and acceptance I felt in those rooms. I no longer care who sees me go into a room of alcoholics. I have no dirty secrets that I worked hard to hide from the world. For the first time in 4 decades they taught me to love and honor myself.

I have been rescued by a life raft twice in my life. Once was in 1980 after a boating accident in which my husband and 6 year old son died. The second life raft that saved my life was the program of Alcoholics Anonymous. I am eternally greatful for living happy joyous and free today. Thank you Bill W. and Dr. Bob and thank you everyone that continues the basics of AA so that the program will be there when my son is ready to learn to live one day at a time rather than die piece by piece, drink by drink. It is not how much you drank or what you drank it's what happens to you when you drank. I love life, I love AA and I love being a nurse. The spiritual gifts I received through the program have given me all I ever wanted -serenity.

Big Bab's · Jun 23, 2004

For one, I do not feel bad that you have to attend these meetings and that there is a mixed crowd as you wordedit strippers, street people. Well those strippers and street people are there to let you know that you can be there too. They could have been a nurse before they started using alcohol, or drugs.
--------UUUmmm..FYI.....They can be nurses even AFTER alcohol and drugs......and for the record, most of us are NOT criminals, we didn't break laws, were never charged with breaking laws and we never convicted of breaking laws.....some of us made only 1 mistake, which was unknowingly asking for help in the wrong place.
It can happen to you. Also if I was told to go to meetings, I would be in my glory beacause I am not in jail or have lost my liscence for good. Where is your humbleness.
--------My humbleness??....what you're talking about is NOT humbleness, its rolling over and giving up all my rights as a U.S. citizen and NO, I'm not willing to do that.
Be glad someone like the board gave you a second chance.
--------I AM truly greatful for the second chance, BUT I do still have some rights according to the constitution and the courts that uphold it, and as such I WILL exercise them, like it or not.
Also even celebrities use AA or NA meeting beacuse they work and lord knows they can afford any type of professional treatment and are in the halls.
--------I frankly don't care how "the stars" handle their issues, I do however care about and know what is best for me, and its not AA/NA.
Be grateful that being mandated to a 12 step program is all you received.
---------Being mandated to meetings is by far NOT all we receive, their are sooooo many things that we are required to do and not all of them are bad, I named alot of them in an earlier post on this thread so I won't go thru it all again (unless you would like me to.)...I've said this before too, but I'll say it again...I personally only have issues with the meetings, the rest of the program that I am involved in is pretty damn good, I've learned alot, I feel supported by my peers in the program and by the staff and director of the program, but I am in a very small minority, my state has good and progressive program that GENUINELY cares for us and advocates for us with the BON, and is always working toward the goal of its nurses reentering the workplace as safe and excellent nurses, but again most all other programs are NOT like this.
Any treatment will work if you are ready and have had enough.
---------Now once again here I'll use an analogy and then tell me if the above statement is still as good as you thought....the next time I've got a cancer patient in the office who's having to restart treatment, when the Dr. says "lets start the chemo" and the patient replys "chemo has never worked for me, but radiation does.", I'll tell them "the chemo will work "if you are ready and have had enough."'......Remember!!...ALL of these programs work with adamant belief in the "disease theory" of addiction.....How many other "diseases" do you know of that are "treated" with punishment??:rotfl:

...............See my replies above, Thanks!.............................

Big Bab's · Jun 23, 2004

Call it what you want but we all know in reality forced treatment is little more than punishment that will hopefully correct the problem.
People who abuse their driver license might be sent to driving school. Is this piddly little treatment gong to teach folks, many with years of poor driving habits, how to drive safely? NO. It's little more than punishment that the system has labeled treatment.
The hope, I think, being that the treatment will be so disagreeable that it will serve the purpose and on paper look like the treatment was successful!

Why does it have to be "little more than punishment that will hopefully correct the problem."??.......We (the people in the programs) PAY MONEY (lots of it!) to be in these programs to get good "treatment", so why CAN'T they help us to find an individualized program, one that works best for each person, and a plan that takes each persons belief systems, lifstyle, one that takes everything into account, why ONE program for everyone?!!.....We would NEVER let people get away with this kind of thing in other service sectors, we would NEVER allow teachers or Dr's to practice this way, so WHY should we let the BON's and Alt. programs do this??....we pay them huge amounts of money for 3 to 5 YEARS to be in it!!!....Why shouldn't we expect better "treatment" and more individualization!??!....I would truly LOVE a legitimate answer for this. :angryfire

Big Bab's · Jun 23, 2004

I adopted the name Serene in 1991 while attending Codependents Anonymous, trying to find myself and heal the horrendous inner wounds and the destroyed spirit from a decade of marriage to an abuser. I had gone to several counselors of varying degrees over the years trying to fix myself and fix my mate. The denial of the events occuring in my life including the fear and the desperate need for love were numbed by my pain killer - alcohol. After getting out of the marriage and still alive physically, I spent lots of money of further codependency therapy. I'd attend group sessions trying to heal the hole in my soul and the memories and then go home and have a drink or 2 to numb myself into sleep. Alcohol became my best and only friend. It allowed me to maintain and heal the wounds - or so I thought. I do not know the day I crossed the line and my pain reliever became my pain killer. But that line was crossed. All of the high priced therapists never picked up on the fact that I was using and abusing alcohol. I knew of the main AA meeting place in town because my ex rebuilt it after a fire a few years before. I had thought of going there to a meeting but No Way would I want anyone to see this proud professional RN going into a place like THAT! I was lucky that I had not gone to a meeting when the thought first began seeping in. Instead I waited and drank and numbed some more. September 24, 1992 I was spiritually dead with a hole straight through my chest that I thought was visible to the world, with the wind rushing through it. All of that false pride went out the window as a gift of desperation led me to opening that door to my first AA meeting rather than taking my life. Slowly but surely the gorilla on my back that kept my shamed head looking at the ground began to leave due to the unconditional love and acceptance I felt in those rooms. I no longer care who sees me go into a room of alcoholics. I have no dirty secrets that I worked hard to hide from the world. For the first time in 4 decades they taught me to love and honor myself.
I have been rescued by a life raft twice in my life. Once was in 1980 after a boating accident in which my husband and 6 year old son died. The second life raft that saved my life was the program of Alcoholics Anonymous. I am eternally greatful for living happy joyous and free today. Thank you Bill W. and Dr. Bob and thank you everyone that continues the basics of AA so that the program will be there when my son is ready to learn to live one day at a time rather than die piece by piece, drink by drink. It is not how much you drank or what you drank it's what happens to you when you drank. I love life, I love AA and I love being a nurse. The spiritual gifts I received through the program have given me all I ever wanted -serenity.

I am soooo sorry that you had to go thru so much to get where you are today, but I am truly glad that you got here....congrats!!...How much clean/sober time do you have?....I am just shy of 3 years and am very proud of that fact!...it feels great. :)