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Author’s Note: This post is part of a larger sequence on addiction, and sampled from an appendix post of mine. For more background on the appendix format I used, read this.
If you are in, suspect you are in, or have struggled in the past with some sort of addiction, feel free to join this Discord server. It is a recovery group I set up focused on helping EAs struggling, in case they think they would benefit from having a space where they can discuss more unique struggles with a group of people who are more likely to understand them. It is currently relatively inactive, but I am trying to change this. If you are uncomfortable with this for any reason, but still want help, feel free to get in touch via DMs, and I can try to help you in some other way.
Photo I took, with lots of filters and effects to disguise my poor photography skills
In my original post, I didn’t discuss recovery groups. I hadn’t been to any other than one my school’s health center ran, but now I’ve been to a ton of meetings. I think meetings like this are generally a good idea, Lorien Psychiatry has a pretty good broad overview on them, but not as thorough an accounting of their differences.
There are four big categories I’ve run into. One is just general, unaffiliated. I’ve gone to a bunch of these but they’re harder to find unless you fall into a particular niche or treatment plan that refers you to one (like the one focused on Effective Altruists, linked at the top of this post). You also have less of an idea of what you’re getting in advance, though even the more affiliated ones have a huge variety in local culture and things that turn different people off or make them feel more at home (much like EA groups).
The three big affiliated groups are Alcoholics Anonymous, Recovery Dharma, and SMART Recovery. Out of these, I find SMART to be the best personal fit, and sort of suspect this will be true for most EAs. That said I think AA has some surprising resonances with EA despite its reputation for being the less “rational” of the groups. Scott Alexander (writing as his Scott Siskind persona for the Lorien page) for instance describes them as a bit like a religious cult. Now, part of me reflexively looks at overbroad cult accusations like this and gets quite defensive…but some of the biggest problems I have with AA relative to other groups are things that are either more religious, or more culty than the other groups to some degree.
In terms of cultishness, AA has a sort of self-serving broad approach in a way none of the others have to remotely the same degree. If you go to a SMART or Dharma or unaffiliated meeting, typically there will be much more humility about the program’s effectiveness, and what other things members should try. AA people tend to insist that AA is what works, getting a sponsor is what works, working the steps is what works. Sure fine fine you can do some of the other stuff if you want to, but the actual important thing is always doing AA. This tends to come with a sort of smug “oh I once was like you” tone when you raise objections or talk about things you plan to do differently from the AA norm.
There is also a very shabby epistemology when it comes to justifying their effectiveness. If you claim the 12 steps work, then can’t we just check how often people get sober after working them? Well, obviously many people get sober without AA, but they aren’t speaking at meetings. Many people also fail to get sober after working the steps. Some of them do get sober eventually, and then they will just say they weren’t really working the steps the first time. They weren’t ready, they weren’t serious, they weren’t thorough enough. Of course, when they finally do get sober, obviously that’s when they were doing them right. Others never get sober, but the program concedes that people who aren’t honest with themselves often fail. So someone dies a drunk who tried AA over and over again? Guess they were never “self-honest” enough.
The 12th step is also a little cultish like this, in that it specifically tells the person doing it to try to get other people to work the program. In order to work all the steps, you need to try to rope other people into them. Obviously it’s more benevolent than this, but it has a slight unsavory MLM taste to it.
The religious element is also a major sticking point, probably the most common one people have. You can just sort of shrug off the self-serving stuff and try out the program, but the issue is working some of the steps requires “God”. Mind you, AA evangelists don’t tend to be too narrow-minded about what you choose for this role, but my impression is still that the alternatives that work in the same way require something with pretty religiony elements, like it being a power that is not you and is greater than you, one that is with you and guiding you in your worst moments, one that you can confess things to and ask things of in a fairly anthropomorphic way, one that cares about you, and one that is strongly related to morality in some way. If you do not believe in something sufficiently like this, it is very hard to get the full program.
The most plausible “higher power” candidates I’ve heard of that soooort of mostly fit these things and which don’t require any spooky religiony beliefs are the AA group itself (the refrain I hear for this one is GOD: Group Of Drunks), or your moral conscience (Good Orderly Direction), but I remain unpersuaded that you get all the same benefits with just one of these. This isn’t something I consider a general problem with the program, none of them will work for everyone, and many people are religious, but my impression is that most EAs are not, which will make it a bit less appealing.
That said, one of the elements that I like most about it is very related to EA, and that is the interest in morality. Many of the steps are in some way focused on reviewing your character flaws and past moral transgressions, and confronting, atoning for, and moving past them. I think this is very important, because many addicts find themselves engaging in many behaviors they would have, in a different state of mind or earlier in life, considered huge transgressions. And eventually get used to this just being their new normal. This can both be a source of moral injury which leads to broader mental health problems, and something that further erodes someone’s self esteem and prior identity, such that they are no longer as invested in sobriety. Feel that drinking is who they now are and that they aren’t worth the huge effort required by them to save.
Heck, I criticized the 12th step earlier, but you can strip it of the AA-centered elements to make it less cultish, and then it is just genuinely great advice. One of the best ways to maintain sobriety is to build back up a sense of identity and self esteem through moral service which would be predictably compromised by drinking again. If that identity is built not only on moral good, but also helping others with sobriety, it becomes even more effective, something more new about your identity that doesn’t just try to wipe the slate clean, and something that will be especially compromised if you relapse.
A final advantage of the AA program that I think most people in AA would be somewhat offended by, but which can be a genuine strength in my opinion, is the gamification of recovery. You count days, and then say them at the meetings (and eventually months or years instead), and keeping track isn’t just useful for logistics, but also for the part of your lizard brain that gets dopamine from winning “points”. Recovery is also generally a bit of a boring and inactive process by default since the key success criterion is just continuing to not do something[1]. The 12 steps give you different “levels” you are working on, a project you are doing, rather than just not doing something for a while. You can feel accomplished, get a dopamine hit when you win a level (finish a step). Relapse is game over, you lose all your points, start the day counter back up, have to redo the steps.
In the initial draft I more or less left things there when discussing the “gamification”, in no small part because I was worried the AA stuff was getting too long. Further thinking as well as subsequent feedback on the draft has made it clear to me that I should also talk about the not-inconsiderable downside of this.
The gamification helps with avoiding relapse in important ways, but boy does it put you at risk if you do relapse. If someone loses all their progress when they lapse, then they might as well go in for a full blown relapse. Part of this can be the blow to their self-confidence or self esteem, but part of it is also that you lose all of your days in one day when you are counting days, and after you lose all of your days, you aren’t losing any days again until you stop drinking. It’s easier to justify drinking more, in part because of the sense that you have less to lose now, in part out of fear that if you don’t get it out of your system now, you’ll drink again when it really counts (you know, when you’re counting days), and in part because of the blow to your confidence in the sense that you are right back where you started.
Not only do you need to start counting days all over again, you have to start the steps all over again. This, speaking of ways AA can exaggerate its effectiveness to itself, means that having more steps isn’t just a proxy for how committed to the program you are, but also for just how long you have made it sober so far (which improves your odds of making it further still). Things like this are a big part of the reason SMART recovery is much warier of day counting and concrete sequential steps.
In fact SMART does almost the opposite thing to all of the stuff AA does. This includes on sort of irrelevant issues such as the word “alcoholic” itself. AA really likes people calling themselves alcoholics, SMART really doesn’t. If you investigate why, there are some practical differences in their programs this can be a vague proxy for (AA starts out with admitting you have no power over alcohol, SMART focuses on personally developing self-discipline and coping tactics. AA wants people to view alcoholism as like a lifelong allergy, SMART defines alcoholism as purely behavioral, and so something you can permanently overcome), but mostly they just use the word in different ways. Both programs want alcoholics (yes, I am going to keep using the word for convenience) to be more humanized, and for them to view themselves as distinct from, and able to rise above the bad actions they have taken in the past. They just view the word as symbolizing basically opposite positions about this.
There are also more functional differences in just how meetings are run, where I typically side with SMART. AA is opposed to “cross-talk”, where people respond to or react to the statements of other people in the group. SMART is for it, and as a result feels a bit less procedural and more conversational (there is still a facilitator to moderate if the cross-talk gets counter-productive). AA is very strict about sobriety, whereas SMART will often allow you in meetings even if you are under the influence so long as you don’t talk or cause trouble. SMART also lacks the “religious cult” elements. It is much more humble about its methodology, and less self-serving. It also doesn’t require any version of religion, and that’s one of the most common motives people have for seeking it out as opposed to the much more widespread AA meetings.
It is designed based on CBT, and as opposed to AA which is focused on the 12 steps, has both much more minimal and much more maximal versions. Instead of 12 steps there are “four points”, that represent very broad things that recovering addicts ought to try to pay attention to in sustainable recovery, “Building and Maintaining Motivation”, “Coping with Urges”, “Managing Thoughts, Feelings, and Behaviors”, and “Living a Balanced Life”. In addition to the broad elements, there are tons of more specific exercises. Rather than prose books of the kind AA has, SMART has a workbook you can practice a bunch of different tailored CBT exercises from (and many SMART meetings do a sheet from it during the meeting time). Because it is less prescriptive about the specific ways to go through each point, people can wind up with a wide range of different strategies that wind up being local favorites at specific locations (whereas with AA, there is a feeling that for every situation there is some sort of obscure lore that the deep AA-heads can quote from like the fifth-most-famous AA book). I do want to mention one such local favorite that I heard of in a SMART meeting I went to while at rehab, which many people swore by as extremely helpful to them. It’s simple. First, give your addiction a name. Second, when you get urges, scream at it (in your head mostly, but you know, go bananas). Something like “well it wouldn’t be so bad if--” “shut up Frank! Shut up shut up SHUT UP!”
I have tried this a little and it hasn’t felt right to me. I think the most basic reason is that I’m not normally an angry person, and the angriest person I have been was the resentful alcoholic lashing out at my family, so trying to be angry in my recovery feels inherently sort of triggering and identity eroding. More complicatedly, I feel like the intrusive thoughts in my head aren’t some malicious external demon, the most anthropomorphic version of them is like a scared little kid that only knows how to do one thing and needs to be convinced that everything will be alright and is terrified if it isn’t allowed to do the thing. This is sort of connected to the idea that making it long-term is not just about learning not to drink, but learning how to be sober, to prove to this part of yourself that everything will be fine. Of course thinking more bluntly about addiction it’s hard to see as either a demon or scared little kid, it’s more like a magnet in your head pulling towards one set of thoughts/solutions, which it takes active effort to move away from and is still there when you tire out. Not something anthropomorphic enough to effectively get angry at.
That said, again, a bunch of people swear by this method, and I think it is useful for squaring the circle between two conflicting attitudes: “you are not at fault, you are worth fighting for, this is not you acting” and “you got this, you can make the choice to be sober and make it out”. To make these things compatible, just name the different sides different things. You are the victim, Frank is the abuser, you have power and so does Frank, and recovery is finally being done with the abuse and screaming down Frank’s manipulations.
Finally there’s Dharma. Unfortunately I have very little to say about it because I haven’t been to many meetings. It’s in that unhappy middle where I like it less than SMART meetings, and it’s harder to find than AA. That said, the ones I attended had many similar advantages over AA to SMART. Despite its name it is merely “Buddhist inspired” in the sort of Western, self-help program sense that doesn’t involve very bold metaphysical claims. As far as I can tell, none of its program requires any form of religion to do effectively. It is also not very culty in the ways I described for AA. My big complaint with it is that it basically always involves meditation, which I don’t have any belief which contradicts, but which just never works for me.
That said, it’s a kind of chill environment where you can meditate and share your feelings, and get some decent advice without the AA dogmatism, so if that sounds good to you, try it out. Again, I just haven’t been to enough meetings to give more ringing endorsement or more damning critiques of Dharma recovery. My own recommendation is mostly to try multiple different ones, especially early on.
Sometimes I have found it useful to really lean into my laziness to avoid drinking too though. “Grooooan, I’m all cozy under the covers, do I have to get up to get a drink?” “Grooooan, I don’t want to have to stay up to drink all this water, but I hate headaches so much, wouldn’t it just be easier to do nothing?” “Just let me sleep/scroll a bit longer, maybe I’ll do it tomorrow” I’ve been told by a friend who has struggled with suicide ideation that something like this worked well for them as well. Nothing wrong (short term) with the lazy strategy if it helps. ↩︎
