How AA Hijacked Addiction Science and Came to Dominate Treatment: An Interview with Joe Miller

By John McMillian 05/22/19

The scientists at Yale liked what AA did, but they did not by any stretch think that AA was a cure-all for alcoholism. Neither, by the way, did Bill Wilson.

A group of people sit while one member stands, talking, AA meeting
Bill Wilson: Just because something works for us, that doesn’t mean it will work for everyone.

Back when he was struggling to control his drinking, Joe Miller failed on a nightly basis. He would get stumbling drunk every evening, and suffer through every day. His treatment providers all delivered the same message:

“Go to Alcoholics Anonymous.”

That was hardly surprising advice — AA has long dominated alcoholism treatment in the United States. But Miller, an English professor at Columbus State University in Georgia, eventually learned that numerous other options were available to him at the time, such as Naltrexone, SMART Recovery, and Moderation Management. Why hadn’t anybody mentioned them?

That is the question that Miller sets out to answer in The Us of AA, a slender, provocative book that tells the story of how Alcoholics Anonymous grew into the gargantuan organization that we know today, even though some evidence suggests that other treatments may be more effective.

Miller is not “anti-AA.” He believes that there is little to be lost — and perhaps much to be gained — by trying 12-step solutions. But he adds that alcoholism is more complex than the AA model suggests. Miller holds that problem drinkers should explore an array of potential strategies, not just one. Though he writes with powerful indignation, The US of AA is not a tendentious or overly polemical book; it is based on careful analysis of a huge and diverse range of sources.

I had the pleasure of speaking to Joe by phone on May 11, 2019. This interview is lightly edited for length and clarity.

Many people know a bit about how Bill Wilson helped start Alcoholics Anonymous, but you argue that Marty Mann may have played a more pivotal role in building AA. What do we need to know about her?

Absolutely, I think she is largely responsible for our nationwide concept of alcoholism as a disease, and our idea that AA is the go-to cure for alcoholism. She ran one of the most brilliant PR campaigns of the 20th century. She helped build a huge network with local chapters across the country, which distributed information at the individual level and the community level, [then progressed] to lobbying in state houses, and eventually, the federal government.

Alcoholics Anonymous has the 11th Tradition, which states, “Our public relations policy is based on attraction rather than promotion.” But Mann started out being a spokesperson for AA in the New York area — she was an excellent public speaker — and during that process, she developed a vision for a national campaign that would bring about a new understanding of alcoholism.

You say in the book Marty Mann, and others in AA, were adamant that alcoholism should be understood as a disease.

Yes. From the beginning, that was part of AA’s cure mechanism. AA said that alcoholism is not a moral failing. Rather, it’s an indication that something is wrong with you physiologically or psychologically (or some combination of the two). It’s beyond your control. You need to believe this is a disease.

One thing Marty Mann did was reach out to a scientist at Yale, named Bunky Jellinek, who was kind of an odd character. (There’s some mystery about whether he had even earned a college degree.) But, by all accounts, he was an extremely energetic person, really passionate about the problem of alcoholism, and he seized upon Mann’s idea. He says, “Okay, we can have this PR campaign and it will help shore up our scientific research. We’ll sell the public on alcoholism as a medical problem and not a moral failing, and this will help us.”

To boil this whole story down, the scientists got the cart before the horse. They didn’t have the money to research their theory that alcoholism was a physiological disease, but they got behind that idea, so the money would come. Then, when the money came, they learned that alcoholism was far more complex than the model they were using. The scientists at Yale liked what AA did, but they did not by any stretch think that AA was a cure-all for alcoholism. Neither, by the way, did Bill Wilson.

That was something I learned in your book. I was surprised by Bill Wilson’s intellectual humility.

All throughout his career, he could see that AA was not working for everybody. He worried about AA beliefs hardening into dogma, and he said “Just because something works for us, that doesn’t mean it will work for everyone.” Some of his later work was devoted to trying to find ways to get people other types of help.

All along, the folks who were not beholden to AA’s story — i.e., the scientists who weren’t — had the sense that alcoholism is this really complex problem, which could be approached in numerous ways. At Yale, when Marty Mann was doing her campaign, researchers were developing treatment programs in Connecticut — some pilot programs. And AA was just one small part of them. It was very much like what science nowadays says is the way to go: You’ve got to use an array of different approaches to tackle alcoholism. It’s different for everybody.

Today, many treatment programs are rooted in AA doctrine. And you say in the book that some forces in the treatment industry actively tried to suppress other approaches to helping people.

It actually goes back to the 1960s. This psychiatrist in England, named D. L. Davies, found that a significant number of patients who went through alcoholic treatment programs later resumed drinking at levels he described as “normal.” He wrote a paper on his findings, and a number of big players in the AA movement disputed the study. One of them was Marvin Block, a doctor from Buffalo who had spearheaded the AMA’s (American Medical Association) campaign to recognize alcohol as an illness. Block said, “Well, the [people who learned to drink normally] must not be real alcoholics,” even though these men had been hospitalized for severe drinking problems.

Another example is Mark and Linda Sobell. They did a study where they trained people in moderate drinking, and they found that a significantly higher number of them fared better [after practicing controlled drinking] than those in AA. Afterward, there was a fierce attack against them, which was publicized on 60 Minutes. It almost cost them their jobs, and it really set back any work in the area.

My pet theory is that sobriety spreads in AA through “social contagion.” If a person who is discouraged about their drinking walks into an AA meeting, they’re likely to find a large group of people who have enjoyed substantial periods of sobriety, and who are willing to help them. I think people in AA are mimicking each other’s behaviors and attitudes – just like we do in other phases of life.

I’ve had two quite long stretches of sobriety in AA, one when I was in college, in Boulder, Colorado, and another for about seven years in the 2000s, in Kansas City. In both cases, it was because I had strong social connections, and healthy routines. In Boulder, the meetings were almost a pretext for us to go out and socialize afterward. For the most part, I found the AA meetings in Kansas City to be insufferable. But there was a meditation house nearby, and after meditating, we’d go out for Mexican food afterwards. And that was enough to help me stay sober.

But AA itself did not work for me. Especially after going through the steps, and really working them hard — and I really freaking worked them hard! — and hearing people say, “After you do that fourth, boy, it really changes your life.” And hearing them say that, over and over again. I just thought, “No. I do not believe this. It’s fine for you, but I just don’t believe in it.”

In a recent New York Post article, you talked a bit about your drinking habits now. You practice moderation, but you say it takes some effort. Can you explain?

It’s going well. I don’t take Naltrexone anymore, but that drug really helped disrupt my drinking patterns. I would take it and almost magically, I would drink about 50 percent less in a night.

I combined that with that an app called CheckUp & Choices, which was developed by a psychologist, Reid Hester. That’s a kind of cognitive behavioral therapy app, where you do a very extensive questionnaire that gets you thinking about the situations in which you get triggered, and when you drink, and how much you drink. It helps you keep track of your frame of mind about drinking. Exercise is also a key part of my program. Having my spouse on board with this is also huge — evidence suggests this can make a difference, if you have spousal support.

If you were to find out down the road that this approach does not work for you — if, heaven forbid, you fall back into full-blown alcoholism — are you confident you’ll be willing to revisit your approach?

Yes. But I don’t see that happening. I see the opposite. I see, down the road, no drinking at all. That’s the direction we’re going. The direction is continually toward drinking less.

I share many of your thoughts about AA. Sometimes I even have doubts about its strict emphasis on total abstinence and continuous sobriety. I heard a segment on NPR last week suggesting that AA's chip system may even be counterproductive, because it can cause people who slip up in the program — or who drink very occasionally — to feel demoralized and ashamed. And as any treatment provider will tell you, those are precisely the feelings that may lead to even more drinking.

That said, I think AA's line about alcoholism being "cunning, baffling and powerful" is spot-on. People who struggle with addiction or alcoholism are prone to rationalization and self-deception. Everyone is a bit different, but it is obvious that some people should simply never drink under any circumstances whatsoever. If they do drink, the consequences can be devastating. This seems to me a difficult and tricky subject.

I think the best answer to this is something one of the psychologists I interviewed said to me: if AA works for you, that’s the easiest and most effective solution. Similarly, with moderation, many people find in time that it’s much simpler to just stay away from that first drink than it is to try to control drinking.

But if you look at large-scale statistics on drinking and recovery, most problem drinkers do not follow the traditional AA path of complete abstinence forever. Even those who are in AA for a while, working the steps and staying sober — statistics show that many will one day have another drink. What’s most dangerous in these cases, I think, is the belief that one drink will lead automatically to alcoholic behavior. That might be true for any given individual, but it’s not the truth for all, and studies have shown that believing it’s true tends to make it true.

Purchase US of AA: How the Twelve Steps Hijacked the Science of Alcoholism on Amazon. For more about the book and its author, check out Joe Miller's website.

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John McMillian is an associate professor of history at Georgia State University, in Atlanta. His most recent book is Beatles Vs. Stones (Simon & Schuster, 2013).