Alcoholics Anonymous has a terrible success rate, addiction expert finds

[politicat]

145. Anecdotal from my years in public mental health

I don't have hard numbers to back this, but when I worked for the county, about 85% of my caseload was court-ordered, and most of those had substance abuse problems. Most of those were on mandatory daily meetings (or mandatory dailies were a possible escalation if they had a violation). I also worked in the county that is home to the heaviest concentration of fundamentalist, evangelical Christian organizations in the US.

A significant proportion of my clients had underlying mental health or mental injury scars that we were just starting to heal, but one of the instruments that had been used to inflict abuse on quite a lot of them (especially the women) was what we're now starting to call spiritual abuse -- the use of religious attitudes or practices to cause harm. Spiritual abuse takes a lot of forms and we're only now starting to talk about it, but things like complimentarianism, purity culture, demonism, intellectual suppression, religiously influenced corporal punishment and social isolation all cause enormous harm.

When these clients were required to attend *A meetings with a more strongly religious flavor (some meetings are more overtly religious than others) due to scheduling or proximity, we had significantly higher non-compliance issues from those clients who had difficult religious/spiritual experiences in their past. We never had sufficient data for a study (mostly because confidentiality) but we had enough to go to parole/probation/DA and make a strong case for not requiring *A, and making non *A programs equivalent. We also managed to get a *A variant running that specifically did not criticize psychotropic and neuroleptic meds because when the abused substance was abused to provide (temporary and insufficient) respite from symptoms of mental illness/injury, the *A error that all drugs are bad is actively harmful. (People with panic disorders do in fact need anxiolytics; people with bipolar disorders need mood regulators; telling them that their meds are a crutch doesn't help. People with broken ankles need crutches; just because the injury is all in one's head doesn't mean it's not real.)

The religious/spiritual component of *A can be comforting for some people, but for others, it is traumatic and an unnecessary retraumatization that makes recovery and therapy less effective, if not impossible. Many people who have experienced spiritual abuse are not even aware that what they experienced was abusive (until it's pointed out), or don't have the skills to articulate how they were damaged, but they can still be re-triggered and re-traumatized. That's why making it required is a huge problem. It's mandating a one-size solution to a far more complicated problem and makes the other parts of the recovery process harder (and more expensive and more prone to failure.)

Of course, given that county, and that community, those with the political and financial power wanted those without TO fail, so it might not have been an innocent and well-meaning error.