What Can We Learn from A.A.'s Success (and Failure)?

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According to a recent piece in Wired magazine, 75 years after the founding of Alcoholics Anonymous, it's still not clear how and why the group works. Reporter Brendan Koerner goes through the complexities of the program's mysterious failure and success rates, and examines possible mechanisms for breaking through addiction, evidence of selection bias among members, and more. A thoughtful conversation has now sprung up around the topic.

  • AA: 'Transformative,' When It Works  It doesn't always work, Koerner hastens to add. But when the transformation does occur, "what aspect of the program deserves most of the credit?" And could the program be made better? The "power of the group," it turns out, may be more important than the actual 12-step program. The lack of professionals can be a handicap, but also an asset, "help[ing] foster a sense of intimacy between members." There's also "evidence that the act of public confession ... plays an especially crucial role" by increasing self-awareness and "reinvigorat[ing] the prefrontal cortex, a part of the brain that is gravely weakened by alcohol abuse." But on the other hand, it's also possible AA success has to do with its members: it's "known for doing a better job of retaining drinkers who've hit rock bottom," who may be so desperate they're headed for sobriety anyway. Koerner identifies a few areas--figuring out how to deal with unhelpful members, increasing openness to medication--where AA might also improve.
  • One Idea: Addiction and the Ability to Predict  Jonah Lehrer's got another possible answer to the mystery of AA's success. In our brains, he explains at The Frontal Cortex, "a prediction error signal occurs when we expect to get a reward--and it doesn't matter if the reward is money, sex, praise or drugs--and we instead get nothing." We expect happiness from alcohol and only get it for a few minutes. "Why, then, do addicts keep on drinking? One possible explanation is that addicts can't properly process their prediction errors, so that all those negative outcomes get ignored." Thus (and he admits this is "blatant speculation"), AA might succeed because it's "designed to force people to confront their prediction errors." Many of the twelve steps are "all about the admission of mistakes."
  • A Pre-modern Approach to 'Changing Lives'  The New York Times' David Brooks looks at the broader public policy interests in "get[ting] people to behave in their own long-term interests--to finish school, get married, avoid gangs, lose weight, save money. Because the soul is so complicated, much of what we do fails." Koerner's piece, he argues, teaches us "that we should get used to the idea that we will fail most of the time." But Brooks is also fascinated by the ways in which AA culture adopt some of the best practices not always present in our current society: "In a culture that generally celebrates empowerment and self-esteem, A.A. begins with disempowerment ... In a world in which gurus try to carefully design and impose their ideas, Wilson surrendered control."His conclusion:
In the business of changing lives, the straight path is rarely the best one. A.A. illustrates that even in an age of scientific advance, it is still ancient insights into human nature that work best. Wilson built a remarkable organization on a nighttime spiritual epiphany.

This article is from the archive of our partner The Wire.