AA Unmasked: “For 66 years, AA has been the refuge of last resort for millions of desperate alcoholics who have hit
bottom. AA has always been free for the taking, and as testament to its revolutionary Twelve Steps,
its program has been successfully adapted over the years to over 40 12-step fellowships. But
throughout AA’s 66 years runs a history of mistreatment of non-alcoholic addicts and dually addicted
alcoholics that is not in keeping with AA’s own criteria for membership and the spiritual principles the
program espouses.” The Village Voice I’m not sure I agree with this essay that AA ought to embrace drug abusers’ problems. The central importance of identification to the self-help process, the vastly different societal attitude toward alcohol use as opposed to drug addiction, and often the demographic differences between the drug-addicted and the alcoholic all argue for ‘separate but equal’ programs. A drug abuser can attend AA — the ‘steps’, which include acknowledging powerlessness, asking for help, taking things one day at a time, etc., are the same — especially if the more suitable NA meetings are not available enough, but I advise those who do to listen to the alcohol recovery talk as analogy, rather than attempt to explicitly engage the group around their drug abuse issues. The dually-addicted (alcohol and drugs) are the losers in this process, of course.

But I’m even more concerned with the plight of another ‘dual-diagnosis’ clientele, those dually diagnosed with alcohol and a major mental illness. AA groups have usually proven themselves undiscriminating about the differences between self-administered drugs of abuse and therapeutic drugs used for major mental illnesses under a doctor’s supervision. Countless patients have reported to me that, needing appropriate treatment both for their alcoholism and their psychiatric illness, they are caught between a rock and a hard place, needing to attend AA but slammed by its blanket condemnation of ‘mood-altering drugs’. Different AA groups have diferent degrees of enlightenment on this issue, and I’ve given patients permission to be choosy in this regard. I suppose I shouldn’t be surprised about this attitude within AA, since it is reflective of a general societal attitude that the psychiatrically ill rely on drugs to feel better because they lack the willpower or resolve to get over their difficulties on their own.

By the way, if you’re interested in how AA works (or doesn’t), think about trying to find a copy of visionary Gregory Bateson’s 1971 essay ‘The Cybernetics of “Self”: A Theory of Alcoholism’, which appeared in his now-out-of-print Steps to an Ecology of Mind (1972) and was reprinted in the exhaustive 1992 The Restoration of Dialogue: Readings in the Philosophy of Clinical Psychology edited by Ronald B. Miller.