Let's argue about Step 1

A Critique of the Twelve-step Model

July 9, 2011

Steven Orma

Shot of Whiskey

According to a 2004 report from the National Institutes of Health, an estimated 17.6 million American adults (8.5 percent) meet standard diagnostic criteria for an alcohol use disorder. The most widely known option in the world for people who want to quit drinking is Alcoholics Anonymous (AA), with an estimated membership of over 2,000,000 people in 180 countries. However, is AA the best and only option for recovery from an alcohol problem? In this four-part article, I will provide a critique of AA’s 12-Step model, and provide alternatives to AA that are not as widely known, but have been very effective in helping many people recover from an alcohol problem.

Part One: Step 1

Step One: We admitted we were powerless over alcohol—that our lives had become unmanageable.

If one is powerless over alcohol, how can one ever stop drinking? If AA means by this that a person needs to accept that alcohol is destroying his life, this makes perfect sense. But accepting that one has a problem and saying that one is powerless against that problem are two different things. In fact, those who attend AA are not powerless. They take many actions within their own power, such as attending the meetings, reading the AA literature, and eventually, refraining from drinking. As a clinician, both theoretically and clinically, I would never hold the view that a client is powerless. Even quadriplegics can accomplish many things through their own free will, even though they are paralyzed from the neck down. To communicate to a client that he or she is powerless, whether it’s to depression, anxiety, or drinking, is to communicate to them that they have no control over their lives and that they are fated to their current condition. Not only is this untrue, it would be extremely damaging to a client’s self-esteem and his ability to help himself get better. The fact is, countless people have quit drinking using AA and other approaches (including quitting on their own), which means they did exert power over their problem.