I've had a significant amount of experience with the 12-step program in the form of Alcoholics Anonymous and Narcotics Anonymous so I chose to go to a Gamblers Anonymous (GA) meeting for a novel encounter. The meeting that I attended was held at the Providence Center three floors below an inpatient treatment program. Without a doubt this had a significant effect on the demographics of the meeting. Seven of the eleven (myself not included) members of that meeting were patients at the treatment center. Men outnumbered women nine to two; the average age was about 45. The room itself was easy to find, a rather nondescript meeting room, ample in size, and complete with the customary coffee machine and doughnuts.
Having some idea of what to expect, I was not nervous or anxious. I introduced myself to the group's facilitator and asked permission to observe. He jokingly said that I would have to sit in the corner to do so, and then offered me some coffee. At this point I thought that this was going to be a very small meeting until the people from the treatment program showed up in one big cluster. After the preliminary readings and recitation of the 12-steps I had a chance to introduce myself to the group and state that I was observing for a class at the University of Montana. There was one individual there who stated that he was there for his first GA meeting and believed that he had a gambling problem. In accordance with tradition of 12-step groups, this group had what is called a "first-step meeting" for the benefit of the newcomer. This means that the more seasoned members tell their stories of how they came to embrace the 12-step program as a device to combat the problems of a gambling addiction. The participants from the fourth floor of that same building spoke like hardened veterans of the world of recovery though, for some of them, it had only been days since their last episode of uncontrolled behavior. It seems that most of them had been through treatment before and all of them were familiar with 12-step groups in general.
Certain themes in their stories surfaced several times. One was that gambling behavior is more difficult to extinguish than consumption of drugs and alcohol (chemical) addictions. The implication is that gambling is a more robust habit. I would point to the fact that this was a Gamblers Anonymous meeting and that if I were at a Cocaine Anonymous meeting I would probably be given the impression that cocaine is the most difficult substance to quit. There was a concern that gambling addiction is not getting the attention in treatment centers that it deserves. Several of them expressed a desire to have compulsive gambling be given the `disease' status that alcoholism and drug addiction has. It seems that relapse is easier and more casual than a relapse into chemical use. The behavior of gambling cannot be detected in a test the way that the presence of alcohol and other drugs can. Gambling establishments in Missoula are open 24 hours a day so the individual can take part in his or her addiction at any time. The longest period of time abstinent from gambling that anyone at that meeting had was four years. Most of the members of this group spoke of having addictions to alcohol and other drugs in addition to gambling.
Toward the end of the meeting I was asked if I had any personal experience with gambling. I told them that my own experience with gambling is very limited and I have never had adverse consequences as a result of gambling behavior. I told them that I had never won any significant amount of money while gambling, thus not having a powerful reinforcing stimulus. All of these people had won substantial amounts of money before developing a compulsion to gamble. The meeting closed with the obligatory group prayer. I'm not one for holding hands and reciting verses to the ceiling, but out of politeness I joined the circle while they chanted the hackneyed Christian liturgy, The Serenity Prayer.
The first Gamblers Anonymous was held on September 13, 1957 in Los Angeles, California. GA was the third major offshoot from Alcoholics Anonymous, preceded by Al-anon Family Groups, which was formally assembled in 1952, and Narcotics Anonymous founded in 1956. The meetings are run in a typical 12-step style. Each member introduces her or himself as a "compulsive gambler." The structure revolves around the 12 steps, the format allows each person to speak in turn, and discussion or "cross talk" is prohibited. There is no formal study that I know of that has been conducted on the efficacy of GA. As with any 12-step organization its reputation is founded on the testimonials of its satisfied members, which amounts to the catch phrase, "it works if you work it."
There is no doubt that these groups do make some people very happy. Though limited and shallow, there is a built-in social network that goes with these organizations. The promise of camaraderie, moral support, understanding, and acceptance is very appealing to those who have traded their social life for addictive behavior. It does give some people a sense of structure and that can be helpful for those whose lives have lacked predictability. For some it provides a sense of identity and hope, and in a way I would agree that it 'works.' The question is, what does it mean to 'work,' and for whom is it working?
For the client, the individual addict, the person who seeks help the 12-step program probably does not work at all. It works for the system, the treatment industry, the court system, and the social welfare system. It serves its purpose as a place that will take troubled individuals without discrimination. It offers a set of rules that these people must follow in order to `recover' and if that individual fails it is always their fault. In addition to the parade of satisfied 12-steppers who insist that the program "saved my life" there are also a significant amount of people whose lives have been destroyed by it. I firmly believe that the latter group is also important and these people's concerns need to be heard.
The 12-step program may be popular but it is not very useful in helping people grow and develop. I would not recommend it to anyone. Instead I would direct clients to legitimate forms of therapy and alternative support groups such as Women or Men for Sobriety, Lifering, SMART Recovery, and Self-empowerment groups. The 12-step program, often referred to a religious cult (and I completely agree with that description), goes against everything that supports healthy, psychological, human development. For example, in Miller and Rollinick's Motivational Interviewing encouraging self efficacy and understanding the client without putting any labels on the person are considered primary keys to success. The anonymous groups insist that the subject admit to being powerless then label the said person unmanageable and insane. In cognitive therapy methods individual differences are accentuated; the person is seen as important and real for being who they are. Step groups are set up so that the person develops a dependence on the group rather than self-sufficiency. Although people in crisis may require outside help it is the responsibility of professionals in the helping field to encourage the subject in the direction of independence rather than helplessness.
In order to look at some of the problems with the step groups it is necessary to take a brief look at their history. It is a common misconception that the 12 steps were developed through the use of some kind of scientific method for the specific purpose of helping alcoholics to overcome obsessive drinking. No, not even close: the 12 steps are derived from principles developed by Frank Buchman and the Oxford Group, the bizarre, fascist, fundamentalist Christian cult that AA split off from in 1937. The steps are not designed to help anyone quit drinking; they are designed to invoke a religious conversion. There is nothing in the steps that actually instructs the reader to stop drinking and the end result is supposed to be "a spiritual awakening." There is nothing written about sobriety, health, or abstinence. The book Alcoholics Anonymous, commonly called "The Big Book," does not instruct the reader to stop drinking anywhere in the book, instead it insists that an alcoholic cannot stop drinking without help from God and instructs that reader to "find Him now." The book is also filled with cheap, puerile ad hominem attacks toward anyone who disagrees with the author. Those who don't blindly accept the tenets of the Big Book are accused of being constitutionally incapable of being honest, prejudiced, confused, biased, and unreasonable, to name just a few. In short AA's basic text is nothing more than a vile and offensive heap of outdated religious propaganda.
There are some complaints about the 12-step programs that keep coming up over and over and these complaints are often ignored by the addiction professionals, the very people who are supposed to be helping their clients overcome addictive behaviors. Some clients object to the religious nature of the program. This is a perfectly valid objection. Though many people insist on using the specious euphemism `spiritual,' step programs are obviously religious in nature and intended to be so. Others find that the constant talking about drinking and drug use at the meetings triggers cravings. Many who encounter the program question the wisdom of continuing to label oneself an alcoholic, addict, and the like even years after the person has stopped the behavior. The rabid anti-intellectualism and hatred of science that is prevalent in step groups and their literature is of no benefit to anyone. There are people who have been victimized by sexual predators, dangerously controlling, exploitative, and manipulative individuals in the rooms of anonymous groups; and the professionals who advocate such groups almost never address these issues.
I have provided a small sample of the things that are problematic to clients where use of the 12-step program is concerned. It causes abundant problems on the societal level as well. Most people who end up in 12-step treatment are coerced into it unconstitutionally by the court system; it is a separation of church and state issue. The 12-step program is a civil rights violation for those who do not wish to convert to the said religion. It is not a support group, it is a faith-healing scam and it has blocked legitimate forms of treatment for addictive disorders. It is fascist; most treatment centers pretend that it is the only way to overcome addiction. The clients who cannot adhere to the religion are told to "fake it `till you make it," or "take what you like and leave the rest," rather than given a viable alternative.
The GA meeting that I attended was typical and did not improve my opinion of the 12-step program. I saw the same superstitious behavior, the same dependence on the group, anti-intellectualism, and vapid slogans. I have decided to join ranks with the pioneers who are willing to speak out against the status quo, such people as Charlotte Kasl, Stanton Peele, Paul Diener, Jack Trimpey, James Christopher, Ken Ragge, and Charles Bufe to name a few. After all as Abbie said, "Sacred cows make the best hamburger."