Nayeema Raza
I am Nayeema Raza. Welcome to Open to Debate. January is a month that is often cold and often one that is dry. And by that I don’t mean the climate. Every new year, many people make a resolution to stop drinking, some with the goal of a month and others with the goal of forever. So it seemed timely to examine the leading movement in the space, Alcoholics Anonymous, and debate the question does AA work?

There are over 120,000 AA groups worldwide. 50% of them are in the United States, and the organization’s worldwide membership is estimated at around 2 million people. Though it’s no surprise that AA is often credited and lauded for its role in recovery, yet the organization also gets its fair share of criticism with complaints around AA’s religious roots, its effectiveness, and even its dominance over other potential alternatives. So does AA work?

To answer that, let me introduce our debaters. Arguing yes, that AA does work, is Dan Griffin. He has a master’s in sociology with three decades of experience as a speaker and expert on recovery in AA, and he’s notably the author of A Man’s Way Through the Twelve Steps. Dan, thanks so much for being here.

Dan Griffin
It’s great to be here.

Nayeema Raza
And here to argue no to the question does AA work, we have Adi Jaffe. Adi holds a PhD in psychology, and he’s the founder of IGNTD as well as the author of the forthcoming book, Unhooked: Free Yourself from Addiction Forever. Adi, welcome.

Adi Jaffe
Thanks so much for having me.

Nayeema Raza
Thank you both for being here today and for debating this. I really wanna get to what brought you here, but first, let’s hear your opening statements. We want each of you to take a few minutes to explain your position and set the table here. So Dan, you’re up first. You’re arguing that yes, AA does work. Tell us why.

Dan Griffin
All right, well, it’s a true pleasure to be here having this conversation with Dr. Jaffe. And let me be very clear, I do not represent AA or speak for AA. I’m a friend of AA. The fundamental question appears to be, does AA work? And so first, AA has one primary purpose, and that’s to help the alcoholic who is still suffering. It’s done that as best it can for 90 years. And so it really doesn’t have an opinion on this issue.

The next point is what are we referring to when we say AA? There’s the AA organization, there’s the AA program of recovery that people participate in, and then there are the meetings that, as you said, all over the world, uh, where people practice the program according to a group conscience that can differ from one country to the next and even from one state to the next.

Is AA the only effective program for alcoholism? Absolutely not. And AA has never purported to be that. It states clearly in its literature numerous times that it is not.

[NEW_PARAGRAPH]Is AA for everybody? Absolutely not, because those who are not alcoholic, though, to be clear, what AA says about membership in the program is that it’s really for those who have a desire to stop drinking, and that’s the only requirement. People with addictive disorders do not come into AA usually ready for help. A lot of the times they’ve come after being forced, and certainly a lot of the time after having tried to control and moderate their drinking, because the truth is the last place that a lot of people want to end up is AA.

There’s also been a lot of significant research asking the same question as to whether or not AA works, and some of the research has said no, and some of the research has says yes. The most recent research that I could find was a comprehensive meta-analytical study by, uh, Kelly Humphreys and Ferry. It looked at 27 studies with over 10,000 participants, and it found unequivocally that compared to individual therapeutic interventions, like four it looked at, that AA was unequivocally more effective than individual therapy alone.

The good news is doesn’t have to be just AA by itself. There’s also extensive research showing the power of connection in healing far beyond addiction, right? Numerous illnesses and other social issues have adopted the 12-step approach, not including the fact that there are dozens of different types of 12-step programs, all of which are trying to address and heal this massive epidemic of disconnection and loneliness that’s plaguing our country and our world.

So is it perfect? Of course not. Dr. Jaffe, who I know is an ally in a much larger cause of helping those suffering, is likely to tell you that AA is behind the times or it’s antiquated and it’s served a purpose. There’s some truth to that, but it is changing as driven by the members of AA itself, whether it’s effective mental health treatment and the use of medication paired with AA involvement, understanding the impact of trauma or being more open to looking at sexist or gender-biased language, and being a safe place for all sexual and gender identities, all of that is happening in AA, though it’s not being driven by the organization itself, but the membership.

So AA works. It works imperfectly, no doubt, but in its almost 90 years, next year’s 90 years, it has transformed the lives of millions of people, and has had an indelible and positive impact on our society. Thank you.

Nayeema Raza
Thank you so much, Dan. Adi, you disagree. You are arguing that AA does not work. Uh, you have four minutes to make your case.

Adi Jaffe
Thank you. And, uh, thank you, Dan, for starting us off. Very, very excited to be part of this debate. And you know, as we were preparing for this debate, there was some slight and maybe more substantial changes in the focus that we, we were looking to have. You know, it started off with, is AA the best treatment there is? Dan spoke about that a good bit. Uh, does AA deliver on its promises? Which if you’re not really familiar with AA, you may not even know what the promises are. Uh, and then does AA work, which is where we landed in the end. And so me, I, for myself, I was, as I was collecting evidence and trying to figure out what I was gonna talk about, I had to understand my primary question. And the primary question that I was asking as I was preparing for this, was, can you rely on AA to provide positive results for people with addiction if you refer them to the organization, the system, the meetings as Dan talked about where it’s even nebulous what exactly you mean by AA?

And so in this debate, I had to come up with a working definition. And to me, working means that that treatment, that approach, will provide reliable and effective resolution of the problem while causing no additional harm. And what I’m gonna present here today is that by that definition, AA does not work as a treatment for addiction. First of all, as Dan already pointed out, it is only meant for a very small subset of people, people looking to stop drinking forever, which immediately rules out, at least by some measures, at least half, if not more than half, of people who struggle with drinking. So it’s not even meant for at least half of the people, if not more.

It also has very low long-term success rates, even among the people who do choose it and say that they wanna stop forever. Right? We’re talking 5, 6, 7, 8% success rate long term.

It is not reliably applied. Dan already talked about it, right? Every meeting is different. It’s not even controlled by the primary organization. So the treatment is even different depending on which room you walk into all over the world. And that’s because its process lacks scientific rigor and validation.

And then a really, really other important fact, you know, engagement in it can cause psychological harm through shame and stigma and use of language. Uh, maybe it’s changing right now, but historically, complete resistance to evidence-based other practices like meditation, medication, and trauma approaches. You know, literally some people being kicked out or not allowed into meetings because they are not sober, taking what is considered by the entire medical community a medically recognized treatment.

So if a treatment can’t consistently produce positive outcomes and then also produce some harm, I can’t consider it to be working. Now, Dan pointed this out and, and I wanna speak to it. There’s no doubt that there are many people, some of them great friends of mine, who say that they were helped by AA and who avidly talk about the wonders of AA and how it worked for them. But here, I think it’s important to really understand that anecdotal evidence, no matter from how many people, doesn’t create an effective treatment. And we’ve had this happen a number of times, many, many times before in the medical and, uh, mental health community. Bloodletting in Greece was considered an evidence-based practice that works for hundreds, if not thousands of people, where people were, had bloodlet out of them for, uh, humors to be, to be able to escape, to prevent mental illness. That’s been heavily debunked, right? Like bloodletting, AA is based on really outdated model, and it’s great that it’s been around for 90 years, but we’ve learned a lot in 90 years.

Even medical approaches, lobotomies, for instance, were massively popular in the ’30s and ’50, specifically let’s say for schizophrenia. This was the practice of putting in sharp instrument, blunt instruments in, uh, and literally disrupting prefrontal cortical parts of the brain. By the 1960s, this was completely debunked and showing that it caused severe cognitive and emotional damage. People won Nobel Prizes and were recognized and lauded for how great of a treatment it was at the time. Just because something looks really, really good at one point in time doesn’t mean it’s actually effective.

And maybe much more relevant to our discussion here, and to Dan’s point, insulin shock therapy, electroconvulsive shock therapy were other approaches that had been adjusted over time, but they needed rigorous scientific study to know what to adjust because the way they were being used originally in treatment were really, really harmful. And so, by all of those measures, what I wanna say is this: AA was potentially the best option that we had a hundred years ago. I’m not gonna argue against that, that’s great. But we have come a long way. And when you put it to the test, again, everything we know right now, it’s clear that AA as a whole doesn’t work, and it would need some substantial updating to be considered a best-in-class approach.

Nayeema Raza
Thank you both for those opening arguments. In a moment we’re gonna take a quick break, but before we get there, I just want to ask you the question of what motivated you to come here and talk about this topic today?

Adi Jaffe
Sure. Um, I used to struggle with addiction. Um, I had a very, I mean, it started at the age of 14, but by the time I was 25, 26, I had been heavily addicted to meth for, you know, six or seven years at that point. I was 124 pounds, which was about 40, 45 pounds lighter than I am right now, I’m standing in front of you. Uh, I had gotten involved in heavy drug dealing and meth was one of the drugs I used, but I used everything. I’d just been com- completely disconnected from my family and ended up going through a SWAT team arrest. You mentioned the upcoming book; that’s how I open the book. Uh, 12 officers knocking down my door eight o’clock in the morning on a Saturday.

Uh, and I’ve spent the last 15, 16 years of my life, it’s been 22 years since that. I had to go to jail, I had to go to rehab.,I did a lot of things myself to get through that problem. And when I was done with all that, I had to figure out, first of all, what the heck happened to me? And then secondly, once I got heavily involved in the research, I really made it my mission to go help so many other people. There are millions and millions, SAMHSA just updated the number, over 40 million people who struggle. I’ve made it my point, as Dan pointed out, and I know it’s his as well, to help as many people out there as possible.

Nayeema Raza
Thank you for sharing that, Adi. It sounds like you’ve had quite a journey to where you are now. Uh, did you, uh, experiment with AA as a personal experience?

Adi Jaffe
You can call it experiment; it was the only option that was presented to me, so I was in AA for three years.

Nayeema Raza
Thanks very much. All right, Dan, what brought you here today?

Dan Griffin
Sure. So congrats on your sobriety, however you’re doing it. Perhaps most importantly, my father was a chronic alcoholic who went to AA. He tried desperately to control and moderate his drinking until it literally killed him. I do not see that as AA’s failure; I see it as evidence of the brutality of this disease, frankly. It was the people of AA’s response to him and my family when he died that helped me see actually how special of an organization it is.

Nayeema Raza
Thank you very much, Dan, for sharing that. It’s time for a quick break, and when we’re back, we’re gonna dig deeper into the question, does AA work? I’m Nayeema Raza, and this is Open to Debate.

Welcome back to Open to Debate. I’m your moderator, Nayeema Raza, and we’re debating the question, does Alcoholics Anonymous work? I’m here with debaters Dan Griffin, author of A Man’s Way Through the Twelve Steps, and Adi Jaffe, author of the forthcoming book, Unhooked: Free Yourself From Addiction Forever.

So, before we dive into the debate in, in true form, I wanna try and summarize your opening arguments briefly because you disagree on whether or not AA fundamentally works. And Dan, you’re, you’re arguing that yes, it does work. And to point to that, you, you point to the data, the millions of people who have been helped by Alcoholics Anonymous as well as recent research looking at the, the outcomes and showing that the outcomes from AA are beneficial. And, and while they can be com- they can be complemented by other therapies, but they are indeed beneficial according to the research you’re citing. Um, and you also I think made a really important point about community, that a core function of Alcoholics Anonymous is this community and the bonding and the support structure that allows, and also the accountability structure that allows, I think.

Adi, you see things differently. It seems like fundamentally, you think that while AA is popular, it’s not always correct. And you cited a ci- a bunch of hor- historical examples from bloodletting to lobotomy to other examples, uh, metaphors that I’m not sure AA would, uh, look kindly upon, um, to say, hey, what works right now, what’s popular and what’s the modality of treatment right now actually might be phased out over time. It might be the wrong one. Um, or, you know, and so you, you think sobriety is a goal, it seems, is not necessarily the best goal. It’s certainly, as you cited, not the goal for everyone. And, and the data reflects that. And you went out to say that it doesn’t provide consistent outcomes, and it also can provide harm, can actually create harm for people going through AA, whether that engagement creates more shame, whether that standard of sobriety is too high and other means. So I think I’ve fundamentally stated you- your two perspectives. Is that fair, gentlemen?

Dan Griffin
That was a nice summary.

Adi Jaffe
That was great.

Nayeema Raza
Okay, great. So I wanna get to this first question of the goal because so much of AA is designed around abstinence and this commitment to abstinence. So Dan, tell me why total and lifelong sobriety is the right goal in your opinion, for this organization to have?

Dan Griffin
So, I, I would say there’s nowhere in the literature where you’re gonna hear somebody say in AA that you have to stop drinking forever. The idea is im- implanted for people that to continue drinking could lead to incredible loss of your, you know, your life or impact on your life. But really, like I said, the requirement is a desire to stop drinking, th- not stop drinking forever. In fact, that’s where the popular saying “one day at a time” comes from.

It also implies that if you’re not abstaining from alcohol, you’re not welcome, which is definitely not the case. But the goal, quite frankly, is for people to find a relationship to alcohol that works best for them. And there is never a statement in AA that says, “If you wanna continue drinking, you’re not welcome here.” It’s just how is that working for you and how is that helping you? There literally is some language in the literature: “If you can continue to drink and drink socially, our hats are off to you.” That’s one of the quotes.

Nayeema Raza
So, um, that certainly sounds, uh, kind of more peaceful than, Adi, the kind of harm that you were laying out. There, there is a quote from Keith Humphreys, a PhD and psychologist at Stanford, who conducted, uh, high level kind of meta study on AA’s effectiveness, saying that AA absolutely does work, that people who are in these groups have 20 to 60% better abstinence than people in other treatments. In no case did they come out worse. I’m curious what you make of this finding.

Adi Jaffe
Yeah, so look, I’ll give you another researcher, Robert Ashford, if you want to look up more, uh, more academic analysis, who specifically has created an entire body of research talking about how people come out worse. Um, by the way, one of the Keith Humphreys’ co-authors, John Kelly, has also said himself that using stigmatizing language to which alcoholic, addict, etc, terms that are, uh, you know, part and parcel to AA, create stigma and harm and key people out of getting help. So while Keith’s point is great by, by what he’s looking at, I’ll just go to the research that he, uh, that he examined, right?

So, um, Dan quoted this specific study. This is a, a recent meta-analysis that was completed. I just wanna, I’m literally looking at the data in front of me right now as we’re saying it. The only measure that was sh- seemed to be substantial, like high certainty of evidence that AA was better, was in continuous or long-term sobriety, which makes sense because it is the system that espouses long-term sobriety. So the people who decide to participate and stay long term in AA have bought into that. But here’s what we have to understand. There’s a difference between saying, yeah, sure, for the 7 to 10% of people who stay with us long term, we find success versus the 70% who typically leave within three months, and the upwards of 90% who fail within a year. So, look, uh, if this, if this debate-

Dan Griffin
But you don’t know how many of those people return, and that’s not something that’s actually tracked.

Adi Jaffe
Well, we can’t track it because it’s anonymous.

Dan Griffin
I know, but within AA, people have a sense of people who leave and come back and leave and come back as they’re trying to figure these things out. And that’s something you have to take into consideration.

Adi Jaffe
But, but a sense is not gonna make academic evidence.

Dan Griffin
The, the abstinence is the one that’s unequivocal, right? But it also goes on to say in it showed to be equal to or slightly better in other areas as well.

Adi Jaffe
Potentially may perform as well.

Dan Griffin
Yes, yes. But you didn’t mention that part.

Nayeema Raza
But here, here’s the thing. I, I think that, uh, you know, the argument Adi is making is that the, you know, the, the litmus test for success is the, uh, mission of the organization, and therefore the organization, you know, corroborates that success. And, and that’s kind of a self-fulfilling prophecy in some way. I do wonder though, Adi, if, if sobriety isn’t the goal, what should be the goal?

Adi Jaffe
I, you know, I wrote a first book before on hook called The Abstinence Myth. AA can certainly help people cut down. I’ve sat in many, many, many AA meetings, and I’ve seen many, many people who relapse chronically with before 30 days and just couldn’t get their 30-day chipped and were shunned in meetings. So the point for me is, is more of this: if AA could relax a little bit and say, “Look, we understand that the bar of abstinence is a high one. If you’re here to address your drinking, we welcome you in.” If the language organizationally widened, and then if one of the outcomes that they were willing to measure is improvement, I would be a much, much bigger supporter of AA.

Dan Griffin
But I’m, I’m guessing you’re not familiar with the Plain Language Big Book that’s just come out, Adi.

Adi Jaffe
Plain Language-

Dan Griffin
It’s precisely what you’re talking about, and it’s got a lot of people in AA very, very excited and professionals very excited because it’s the very first time in those 90 years that they have rewritten the Big Book with language intentionally done so that it’s more accessible and more welcoming than the 1930s language.

Nayeema Raza
There’s this kind of core question of, is the point of treatment to treat the symptom or the underlying cause? I think part of, Adi, if I’m understanding your argument, is that, and i- i- i- is AA treating a symptom? Is it trying to provide a measurable solution that’s like a one size fits all in terms of sobriety versus having the nuance and infrastructure to really get to underlying causes?

Dan Griffin
So I’m gonna answer that in a couple of ways. Um, first, we’ve learned a lot in 90 years. I mean, we could argue that there wouldn’t be the current addiction field if there hadn’t been AA. And there’s been an evolution. And within that addiction field, there’s been in advances in understanding of the intricacies of the interrelationship of mental health and trauma and shame and addiction in major significant ways. And that has come into the treatment complex and the treatment world. And then it’s been coming into AA as well as those people are coming into the meetings. So that’s one thing.

Two, AA has never said the AA program is solely meetings and working the steps.

Then the other is that I think even the program of AA itself and the program of recovery through the 12 Steps and what we, you know, what they call working the steps, that is a process that gets to a lot of the underlying things.

Adi Jaffe
Couple things. First of all, 12 Step Facilitation is a manualized approach, and part of my entire problem with AA is every meeting is an entirely different universe.

Dan Griffin
Yeah.

Adi Jaffe
Which makes it, imagine, imagine for a second if, when somebody prescribed you an antidepressant, one pill bottle was complete- one pill was completely different than another, would we be able to say that that antidepressant is effective? We wouldn’t because you literally wouldn’t know what you’re taking. So the way AA is delivered is not controlled, which is a horrible, horrible way to then provide care. It’s different literally from one room to another room.

Now, 12 Step Facilitation seeks to eliminate some of that. Now if, here, here’s what I’m willing to say, right? If you land on somebody who is mental health aware and understands trauma and understands other approaches and is open to those, and they walk you through a manualized way of doing, uh, any care, but sure, also 12 Step Facilitation, then you may get to underlying issues. But that is not what AA does, as a rule.

Dan Griffin
I- it’s not as freewheeling though, as you’re presenting it, because there really is a guidance in AA meetings that’s a thread that runs throughout. I mean, and that is the, the structure of meetings. There’s, maybe that’s not always the exact same, but there’s some very similar structure. But certainly the thread, the core thread of the literature and the 12 Steps, that is something that consistently, wherever you go, I guarantee you, you’re gonna find it.

Adi Jaffe
I can tell you you’re wrong by, by not anecdotal evidence, by walking into rooms where those were not-

Dan Griffin
So what-

Adi Jaffe
… not followed.

Dan Griffin
[inaudible

]

Adi Jaffe
Where in small towns all over, in small towns all over America, when you walk into a meeting, they may, they may choose to have their own traditions, they can, there is no control by the general organization. There is zero control by the general organization.

Dan Griffin
Okay. There’s no control, I grant you that because of the individual group conscience, which is actually something that’s very fascinating. I mean, people have actually studied the organizational principles that guide AA through the 12 Traditions and the 12 Concepts in all the writings that have been done. And several sociologists (laughs) have concluded that it’s the closest thing to democracy that’s ever been established in our societies.

Nayeema Raza
Adi, I wanna take a moment, um, d- democracy aside, I wanna take a moment to think-

Dan Griffin
(laughs)

Nayeema Raza
… well, what is a better alternative to AA?

Adi Jaffe
So first of all, my main argument around addiction is that completely contrary to the thing that the notion that is repeated over and over in AA, people who struggle with addiction are not the same. I, I don’t even, I wanna avoid using the term that they use over and over and over ’cause it’s been shown to be stigmatizing. People who struggle with alcohol are not the same. It’s this ridiculous notion that we have that because people drink, uh, compulsively, they are all the same kind of a person. It literally says that in the book, right? That they’re all alcoholics.

Now my point is some of them have biological dysfunction, some of them have mental health issues, some of them have trauma and PTSD. The different approaches actually need to customize and be, uh, specifically directed to the individual struggle. This idea that you can have 12 steps that are written on a piece of paper and they would blanket apply …

And I wanna make another really, really important point ’cause Dan made a correct point, which is the assertion in the AA literature is that it is not the only treatment, but the de facto reality in our industry, in this country, is that it has become the de facto treatment. And there’s a very simple reason: groups are free. And as somebody who works in the industry, I can tell you that of course, as a, as a treatment center, it’s nice to send your people to two to three, uh, free meetings every single day, but unfortunately, not everybody has a good fit. And Dan, I will give you this, that that is not the point of AA. But you already said that AA is this nebulous architecture. What ends up happening is people who shouldn’t be going end up going, people for whom it’s not effective, they end up essentially being forced to go to these meetings.

Nayeema Raza
But where should they go instead, uh, Adi, especially if they can’t afford it?

Adi Jaffe
Well, that’s the responsibility of our healthcare system. I mean, look, if bloodletting was free, is anybody on this call right now running to get some free bloodletting ’cause it’s free? No.

Nayeema Raza
Gotta go, gotta go, guys. Just kidding.

Adi Jaffe
(laughs)

Dan Griffin
I got some on my back right now.

Nayeema Raza
(laughs) Yeah. And so, and then I want, Dan, you to respond to this question. And Dan, Adi is fundamentally making this argument that dominance is a problem. That like, it’s a bit of an economic argument actually, that the size and scale of AA, that its ease and its like low cost of entry into new markets, that it’s crowding out entry, that it’s stumping innovation. Respond to that.

Dan Griffin
So yeah, let’s be really clear, okay, AA (laughs) isn’t doing any of this. The treatment industry is doing this. I’ve actually seen the opposite of what Adi is talking about. Again, I’ve worked in the field for 30 years. I remember when people didn’t have options, um, offered to them. They, they, they could go to an AA meeting and that was it. Now it’s like all kinds of options that they’re being offered, including not meetings. You could go to church if you want to go to church.

The idea is to emphasize the importance of the support after treatment. Some kind of ongoing support. Because I mean, like, if you believe that addiction is a chronic illness, as many people do, and you look at the science and the research behind chronic illnesses and how to treat them most effectively, then you understand that engagement in services of some kind of support for like three to five years is kind of optimal. For addiction, it seems to be even, even more so.

So the idea that people are only sending people, uh, in treatment to AA meetings is because it’s free, I think that’s really a misstatement.

Nayeema Raza
I, I, I’m not saying it’s free, but I’m asking you to respond to this.

Dan Griffin
No, no, he did. A- Adi did.

Adi Jaffe
I didn’t say, I didn’t say the only reason.

Dan Griffin
You said what, you, you emphasized the fact that it was free and implied that that’s why they send them. And I would say they send them because it’s, it’s very supportive, it helps set them up for after treatment. And again, it works.

Adi Jaffe
I, I, I just wanna point out really, really quickly. So it’s, you know, it’s interesting ’cause I, I agree with you, Dan, that, um, there has been a shift to revert, reverting to more options. And I think part of the reason, if I can go back to why we’re having this debate, is because too many people were so resistant to going to AA, the treatment center had to offer other options. And so again, it is just showing that AA, at least it was only dominant because of the offerings. And now that there are other offerings, there are other things being offered. And I think what we’ll see over time is a substantial moderation in this push to pretend that AA could work for everybody. And again-

Nayeema Raza
One thing, and thank you for saying that. One point I really wanna get to is this point Dan made earlier about community, and you’re getting to it too, these structures, these meetings, everything. I think that is a, and certainly I’m sure some of the alternatives that are being offered, Dharma, et cetera, that you’re talking about, might have a communal element. Is that true, Adi?

Adi Jaffe
Yep. Very similar to the 12-Step meetings.

Dan Griffin
Absolutely.

Nayeema Raza
They do? Okay. But how do you think, Adi, how do you look at the communal aspect of Alcoholics Anonymous, of AA? Do you think that part is helpful or do you think that part also is dangerous?

Adi Jaffe
Look, I said at the outset that I think if AA did some retooling, uh, I would be a much bigger supporter of it. Uh, the AA emerged from the Oxford Group, so very religious initial organization. I think if they soften this whole massive dependence on specifically, um, Christian religion, right? Because everybody would always tell me, “Well, it’s, you know, it’s not about religion specifically, it’s about any religion.” I’m like, I’m Jewish, I literally never heard a Jewish prayer in a single AA meeting. They’re all Christian prayers.

So if we, if we reduce that to some extent, that would be a-

Dan Griffin
Agreed. (laughs)

Adi Jaffe
… huge initial point. I absolutely agree on two points. The fellowship is probably the thing that AA got the most right in the first place. And, and I said this in my opening statement, you go back 90 to a hundred years, the level of stigma around alcohol use issues was much, much greater than it is now, and AA provided a refuge for people in those rooms. We just come a long way since. And so I absolutely agree that having supportive environments is great, not in all meetings and not by, uh, you know, not by decree, but I’ve been in rooms over and over and over with people who actually have the biggest problems and may need that support the most, get shunned because they’re having the biggest, um, obstacles meeting the long-term abstinence, which is a defined goal.

Nayeema Raza
Dan, I’m gonna give you literally 30 seconds to respond to that. Why is it better for those people to be in the room regardless, or for that room to exist?

Dan Griffin
Well, it, it’s like I said, I mean, literally just yesterday on NPR there was a radio show about the epidemic of loneliness that is plaguing our country, loneliness and disconnection. Like, anything we can do to help heal that and put it in a place where people can be open and honest and kind of share what’s really going in their lives, ’cause we live in still such a phony, artificial world of people not really being truthful, like, who doesn’t really want that if you can have it in a safe and loving way?

Nayeema Raza
All right, we’re gonna wrap our discussion there. When we come back, we’re gonna continue the conversation around this question: does AA work? I’m Nayeema Raza. This is Open to Debate, and we’ll be right back.

Welcome back to Open to Debate, where we’re delving into the question, does Alcoholics Anonymous work? I’m your moderator, Nayeema Raza, and I’m joined by our debaters Dan Griffin and Adi Jaffe. We’re having a very lively debate here. We found a few areas where you guys agree, uh, most importantly that AA is not a monolith, that people who, um, are struggling with, you know, challenges with alcohol are not a monolith themselves, and that you both have a shared enemy in the, in the, uh-

Dan Griffin
(laughs)

Nayeema Raza
… recovery treatment industrial complex, but-

Dan Griffin
Enemy is a bit strong, but (laughs).

Nayeema Raza
(laughs) But there’s a lot that you also disagree on. Um, and we’re gonna bring in some other voices right now, members of the audience, journalists, to help probe at that. Uh, first I’d like to welcome in David Ovalle. David is a has- health and science reporter at the Washington Post who covers opioids and addiction. David, welcome.

David Ovalle
Thank you. Thank you very much. Um, it’s my, my main question is what, what do you guys think about the role of the criminal courts and AA? Should they be more disentangled? Is it an appropriate level of intermeshing where so many people, um, that go to drug courts or get, uh, or get DUIs end up having to go to AA? I’d love to get you guys’ takes on that role. And should it be, is, is it appropriate the way it is now?

Dan Griffin
Well, I mean, I’ll, I’ll just jump in because I worked in drug courts for 10 years in Minnesota, and I, I, I think that combined element of basically public health and criminal justice is necessary as far as we know for the structures of addiction and dealing with addiction effectively. Because, you know, some people are like, “Well, you know, you criminalize addiction, you gotta criminalize diabetes and heart disease because there’s similar diseases.” It’s like, yeah, but people don’t drive the wrong way down the highway, you know, when they’re having too many donuts. And so it’s like that balance that drug courts have established is absolutely wonderful.

In drug courts, what we would talk about is we want to treat the ones that, um, are not well and we want to put in prison the ones, you know, that are causing crimes. And so you need to distinguish between those and try to help in different ways. Um, I think criminal justice infrastructure has its role in this. It’s all in how it’s done. In the way that drug courts have evolved and continue to evolve with therapeutic jurisprudence in the different topics, I think it’s the, the right direction. I think it’s what we want. Um, and I think they’re very effective.

Nayeema Raza
Adi, I wanna give you a moment to respond.

Adi Jaffe
Yeah, absolutely. So I’ve only visited drug courts, uh, but I’ve been to jail and the statistics are that 85% of people who are criminal justice involved either struggle with drugs or are in for a drug-related offense. So there’s no question that there’s, it’s essentially they’re, they’re married problems, right? They’re one and the same in, in a way.

Um, I will say this, I think drug court used to be far, far too punitive and has come a long way. Uh, your harm reduction is starting to make its way into criminal drug courts. And I think there’s a reason for that. The stick-only approach doesn’t work for people who struggle with a compulsive habit. It just doesn’t fix things.

So to answer the question really, really directly, it’s this: I think we have to become more trauma-informed. We have to become more mental health forward in our criminal justice engagement. There’s no question that there are some people whose criminal- criminogenic factor involvement is just so high that they may just not be ready to get mental health, health and support. I, for sure, always err on the side of giving too much mental health and support before we kick them to the curb, if you will. Uh, I’m a big, big supporter of as many carrots as we can offer in the process.

Nayeema Raza
Thanks, Adi. And thanks, David, for your question. Um, next I’d like to bring in Sally Satel. Sally is a psychiatrist, a lecturer at Yale University School of Medicine, and a visiting professor at Columbia University. Sally, uh, welcome.

Sally Satel
Thanks. Um, this question is for Adi. I know you see patients. Uh, what would you do with a patient who came to you, um, just beginning to, you know, get help? And since that, uh, you know, in addition to coming to see you in a more formal way, that he also started an AA meeting. What would you say to him because he, he is already, you know, sort of positively predisposed to, uh, to this engagement?

Adi Jaffe
Yeah, absolutely. I, I’ve dealt with this many, many a time. Uh, I am a big supporter of every person finding the specific approach that works for them. So my recommendation will be to continue engaging in whatever’s working in the moment. Uh, I’ll, I’ve, actually even tell you that I’ve supported and helped people who are in AA but dissatisfied. And I, my first recommendation is not, “Well, leave the meetings and never go to another one,” right? It’s to implore and ask what is it that is working and what is not? Because to the point that we were making earlier, I need to understand the underlying reasons, the motivations, the, uh, the mental health factors that are driving the behavior in the first place. Structure and a sponsor may actually be the right thing for a subset of people.

Nayeema Raza
Thank you, Sally, for your question. Next up we have Jamie Marich. Jamie is a speaker, a clinical trauma specialist, an expressive artist and author of Trauma and the Twelve Steps: A Complete Guide to Enhancing Recovery. Jamie, welcome.

Jamie Marich
Thank you. My thoughts towards Dr. Jaffe are, I’m wondering if you have looked into those of us who have updated language, even if it’s not part of, I mean the organization Alcoholics Anonymous, because there are a lot of us who work in professional treatment, um, who have been doing that. But this is really for both of you, whoever wants to to answer it. Is there a shaming that happens? ‘Cause, you know, Dr. Jaffe talked a lot about the shaming language that can and does happen in AA, I’m the first to admit that, but I also feel a lot of shame from the other side, like, “Oh, you’re so backward for still promoting AA.” Does that happen whether it’s a person benefiting from AA, the meetings or the treatment approaches, or those of us who still say, “Hey, it’s an option”?

Nayeema Raza
Thank you very much for, Jamie, for sharing that. Maybe, Dan, I’ll start with you. How do you take Jamie’s question?

Dan Griffin
Well, I have a lot of respect for Jamie. I’ve known her, uh, and them a long time. Uh, and you know, the work that Jamie has done for years is pushing us (laughs) to look at really difficult things that we don’t necessarily wanna look at. And so I appreciate that.

I mean, look, is there shaming in AA meetings? You bet. Is there shaming outside of AA (laughs) meetings? You bet. Absolutely. I mean, look, to Adi’s point, a lot of treatment programs have gone to the other extreme where it’s like, there’s, there’s no option for 12 Steps even when people want ’em, because they’re, they’re not 12 Step either friendly or they have like their own ideas about it.

So I think we’re in a disruptive period, quite frankly. And I think it’s a positive because I think it’s a result of the evolution. I think it’s this groundswell in the grassroots of recovery and 12-Step recovery culture that’s basically saying like, we can do better or some of this stuff it doesn’t, you know, and then there’s, so there’s the folks like Adi who see that and leave. And then there are the folks like others who see that and they stay. And one’s not right or wrong. But the truth is, I think we’re at a point where the more we can have conversations like this and really talk, you know about it and, and understand what’s happening, I think the more we can really kind of grasp the fact that nobody should be shaming anybody for just trying to get well. (laughs)

Adi Jaffe
I wanna, I wanna touch, I really wanna be able to touch on this. First of all, thank you for, uh, for what you just said, Jamie. And, uh, you know, for me AA couldn’t have worked long term because I’m not sober. Um, and, and so I, I just wanna call that out. So there are some versions of recovery that are just not acceptable in the rooms. Jamie, to your point, I think it is, it’s a, it miss-services and represents what recovery should mean when we shame anybody for any approach that they took on.

Nayeema Raza
Thank you, guys, for this conversation, and thank you, Jamie, for joining us. Um, we have one more questioner. Uh, next up is Maia Szalavitz. Um, Maia is a reporter who focuses on science, on public policy and addiction treatment. Uh, she’s the author of Undoing Drugs: How Harm Reduction is Changing the Future of Drugs and Addiction. Maia, welcome.

Maia Szalavitz
Thank you so much for having me. Um, what I would like to ask is about the connection between AA and the treatment field. Because I’ve asked online, “Can you find me 10 rehabs in which the content is not primarily 12 Step?” Like when you go to treatment, what happens most of the time in your treatment hours is being indoctrinated into “12 Steps are the best way.” There have been some changes, and yet if I want to help somebody find treatment, I get people sent to what is the equivalent of insurer and taxpayer paid 12 Step meetings as sold as treatment. And to me, you know, the question isn’t does AA work or not? It’s why are we as taxpayers and people who pay into insurance, paying people to provide treatment that you can get for free in a church basement and that does not work for everybody?

Dan Griffin
Maia, thanks for your question. I’ve, I’ve followed your work for a long time. Well, the truth is, I, I could easily quickly find you the names of 10 programs that don’t do any 12 Step connection whatsoever. There, there, there’s many out there, but they are for sure not the dominant model.

The other thing is that, again, distinguishing from AA, very different. The majority of 12-Step focused treatment programs now have, they are trauma-informed, they have mental health interventions, they have, uh, EMDR or brain spotting, they have comprehensive care, they use CBT, they use, uh, DBT, they use all these different modalities. They are far-

Maia Szalavitz
In my experience, they say that they use those things, and then when the patients actually talk to me after going to those places, what they have gotten is “Don’t drink and go to meetings.”

Dan Griffin
That’s not my experience in the last 10 years of visiting numerous programs and working with them and seeing what they were doing. To the point, Maia, where I was sometimes like, “It doesn’t even seem like you’re doing anything to actually teach them about the 12 Steps, even though you say you’re connected to it, other than just sending them to meetings and not talking about it.”

Nayeema Raza
It’s a really interesting conversation ’cause it’s like one, one of you thinks the 12 Steps is a, is, you know, a boon and another one thinks it’s being used lightly. But I-

Dan Griffin
(laughs)

Nayeema Raza
… I think that, Adi, I, I’m curious how you respond to this idea, this commercialization of AA and, you know, packaged and sold as an alternative to AA.

Adi Jaffe
Yeah, it’s probably not a big surprise that I’m relatively aligned with Maia on this, but, um, (laughs) but I will say this, 10, 15 years ago, 10, 10 would’ve been a hard number to pick, the number has grown. Many of them are smaller and boutique. The big, the big standard kind of Goliaths in our industry are still primarily traditional. And to speak to, to Dan’s point, many of them do purport to offer a whole slew of adjunct therapies, but then to support part of Maia’s having talked to patients who’ve been in them, I’ll say the majority of the actual therapeutic support that they get is 12-Step aligned. Now again, you know, we only get to pick a black and a white, uh, side in a debate ’cause that’s just what ends up happening here.

I just, I do wanna say this, Maia, you know, I think we’re moving in the right direction. By the way, you’re one of the reasons why that’s happened, right? Uh, you know, Stanton Peele, who’s not here right now, he’s a staunch, hardcore anti AA, uh, representative. And I think we also need voices all the way on that extreme to push for people to open facilities that are not there. There’s no question the dominance is still 12-Step.

Nayeema Raza
Thank you very much. Thank you, Adi, and thank you, Maia, for that question. Um, that’s it for our questioners and it’s time. We, we’re running outta time here. We have so much to talk about. This has been a really fascinating conversation. So thank you both for, um, for taking black and white positions in an area where it seems like neither of you really quite want to. Um, but it’s time to bring it home with closing remarks. So, Dan, you have the first opportunity for a closing remark. Give us one last reason why you believe AA does work.

Adi Jaffe
The majority of the actual therapeutic support that they get is 12-Step aligned.

Nayeema Raza
Thank you very much. Thank you, Adi, and thank you, Maia, for that question. Um, it’s time to bring it home with closing remarks. So, Dan, you have the first opportunity for a closing remark. Give us one last reason why you believe AA does work.

Dan Griffin
All right, so does AA work? Yes, of course it does. Is it perfect? Of course it’s not. Is it the best intervention for alcoholism? Maybe. Is it the only one? Of course not. There’s a joke in AA. The newcomer asks in a meeting, “How does it work?” And the old timer in a quiet voice responds, “Just fine, thank you.”

Will AA evolve to meet the needs of its members and our changing culture? I have every confidence it will to the slightest degree necessary because AA protects itself as much as possible against the vagaries of change. One organization is a more closed system, a multi-million member worldwide organization that will accept anyone in its doors with open arms and that’s free, versus a primary relationship with one therapist or two and an individual that you have to pay.

So what does it mean for AA to work? Is it true that 3 to 5% of those who attend AA stay and gets sober? Possibly. How do you measure the impact of a chronic alcoholic on our society? Medical emergencies, job productivity, criminal activity, violence, impact on children and other family members, to name only some. And what is the impact on our society when all of those things go away for just one person, not to mention all of the pluses that occur as a result of their sobriety? Families restored, loving relationships with kids, productivity, giving back to the community.

As we’ve talked about, AA estimates about 2 million people in 180 countries worldwide. So take that one person that I just described and multiply it by 2 million plus people and then tell me what is the impact. And then ask me again if AA really worked.

Nayeema Raza
Thank you, Dan, for that. And now, Adi, you’ll have the final word here in this debate. Convince us again why AA does not work.

Adi Jaffe
Well, so first of all, it has been pointed out numerous times, certainly if you were asking whether AA is an effective treatment or if it works as a treatment for addiction, uh, the answer is no by its own definition, right? And so I would say that one of the main reasons we should say AA does not work is when you look at all the people who enter AA, the vast majority of them are not helped by it. We’ve also identified that there’s at least a good amount of evidence that says that people can actually be harmed by it. And you know, last but not least, the idea that AA itself doesn’t really mean all that much (laughs) because it’s being applied in so many different ways.

What people need when they struggle with something like addiction is certainty. They need reliability. And as it stands right now, AA doesn’t offer that. Add to this the fact that we use outdated terms like alcoholic and addict, people like myself, by the way I was addicted to meth, as I mentioned earlier on. Uh, when I walked into a rehab, they didn’t send people to um, you know, Meth Addicts Anonymous ’cause there’s now anonymous meetings for everything, so they sent me to Alcoholic Anonymous meetings and I was told over and over and over that it doesn’t matter that my addiction was one thing, I have to identify as an alcoholic every single day. I literally looked at people and said, “But I don’t drink.” They couldn’t care less.

They’re dogmatic. They have an idea of my way or the highway. And it says it literally in one of the main readings in AA called How It Works, which Dan just alluded to, by the way, “Rarely have we seen a person fail.” I don’t know about a much more delusional language to say that “rarely have we seen a person fail” when 70% of people who try you out can’t even make it three months.

We have evidence that the language is outdated. We’ve been told here before that much of it needs to change and get updated. It is great to hear that that is starting, but starting is not in existence. What we need to do at best for AA to be considered working is a pretty major overhaul, removing the massive dogma around, um, around, um, religion, potentially also around abstinence, and reducing much of the dependence on this incredibly outdated 100-year-old language.

Nayeema Raza
Thank you so much, Adi, for that closing argument. That concludes our debate. I’d really like to thank our debaters, Dan Griffin and Adi Jaffe. We so appreciate you showing up, your approaching this debate with an open mind, and your bringing your thoughtful disagreement to the table. In short, your being open to debate. Thank you for being here.

Dan Griffin
Thank you.

Adi Jaffe
Thank you.

Nayeema Raza
Thank you. I’d also like to thank my fellow journalists and interrogators for being here and bringing their expert questions to the table. Thank you, David, Sally, Jamie, and Maia. And finally, a big thank you to you, our audience, for tuning into this episode of Open To Debate. We know that this is a topic that could hit close to home for many people listening and watching, and so we hope that this program offers something helpful to anyone who is or knows somebody who is facing alcoholism, addiction, or any kind of challenge with alcohol. Thank you so much for listening to this show and we hope you’ll tune in again.

Thank you for listening to Open To Debate. As a nonprofit working to combat extreme polarization through civil debate, our work is made possible by listeners like you, the Rosenkranz Foundation and supporters of Open to Debate. Robert Rosenkranz is our chairman. Our CEO is Clea Conner. Lia Matthow is our Chief Content Officer, and Elizabeth Kitzenberg is our Chief Advancement Officer. This episode was produced by Jessica Glazer and Marlette Sandoval. Editorial and Research by Gabriella Mayer and Tom Bunting. Andrew Lipson and Max Fulton provided production support. And the Open to Debate team also includes Gabrielle Iannucelli, Annalisa Cochrane, Rachel Kemp, Erik Gross, Mary Ragus, and Linda Lee. Damon Whittemore mixed this episode. And our theme music is by Alex Clement, and I’m your host, Nayeema Raza. We’ll see you next time on Open To Debate.