Recovery is Not Synonymous with AA
As National Recovery Month comes to a close, there is no better time to challenge a long-held and systemic belief about recovery: that recovery is synonymous with AA. Yet, the ideological lens through which we, as a society and institutionally, view recovery — our medical profession, judicial system, and medical boards — is that the doctrine of AA is the only solution to substance use disorders. However, it is an option that doesn’t meet the needs of those disproportionately affected by substance use disorders.
Our drug courts direct people to a 12-step program as an alternative to jail. Doctors and nurses refer people to AA for help, and professional regulators can stipulate that a recovering medical professional can keep their license but it is contingent upon their attendance at a 12-step program.
I’m not suggesting that we overlook the historical contribution of AA for people with substance use disorders. AA developed a solution for people with desperate alcohol use disorders that had never been available, and it has helped millions of people recover. However, we’ve come a long way from 1939, substance use disorder is increasingly seen as cutting across many socio-cultural demographics — race, gender, sexual orientation, and class — and there is now a plethora of recovery options available. Just as people carry Narcan, we can also educate ourselves in the range of recovery pathways available and acknowledge the realities and complexities of how people recover.
I’m not anti-AA. I believe that, like many other programs, it is a valid pathway of recovery. What I oppose is the institutionalized attitude that if you’re not in AA, you’re not really in long-term recovery. I suggest that societally, we stop believing that recovery is synonymous with AA and instead open our eyes to just how patriarchal and heteronormative “the rooms” are and that they are unsafe for many marginalized groups, like LGBTQIA+ folx and BIPOC.
In my experience, of attending AA and NA for five years in the UK, US, and Europe, I have consistently seen cis-gendered, straight white men dominating the rooms, not only in terms of male members but also in terms of speaking first. Even in queer meetings, then men spoke first and most often.
As an activist, people give me some stick for challenging these dominant and unhelpful paradigms. Unsurprisingly, the critique is mostly from white and cisgendered male 12-steppers. I’ve been called “tone deaf,” told by a friend that they’re “not feeling this crusading part” of me, and informed that I seem “very angry.” I’m going to overlook the unhelpful comments and instead say this: Instead of taking issue with my statements as insensitive to the current epidemic, or trying to deny that has been your experience, I challenge you to ask yourself: How am I supporting the people who the 12-step program doesn’t work for? Because shaming them as being “constitutionally incapable of being honest” with themselves isn’t a solution. I’m fighting for better solutions for all, not one narrow option that works for some. I am not bashing AA — I am clarifying that it isn’t suitable for everyone and that it’s about time we challenged the dominant norms within the rooms.
Why forcing people into AA isn’t working
We no longer have the luxury of forcing people — through drug courts, treatment programs, the recommendations of a physician, or the dogmatic AA evangelist — into a 12-step recovery that doesn’t work for everybody. And isn’t reflective of the landscape of recovery for 22 million Americans who have resolved an alcohol or drug problem.
We don’t have that luxury, because the number of people affected by addiction are increasing every year. In 2018, nearly 21 million Americans had substance use disorders, and less than 10 percent got treatment. We also know that for the past three decades, drug-related deaths have continued to rise each year. While there was a brief reprieve in 2018, this country still saw 88,000 alcohol-related deaths and nearly 70,000 drug-related deaths.
And this year, those figures are increasing. In a recent CDC survey, 13 percent of respondents reported that they were increasingly using substances to cope with stress related to the Covid-19 pandemic. According to Nielsen data the national increase of alcohol sales rose by 55 percent for the week ending March 21.
We have to ask ourselves: Why is healing so inaccessible for so many? Is it because we believe AA is the only option and that we will be stigmatized if we seek other forms of help? Is the systemic and institutional oppression perpetrated in the rooms a contributing factor? Or is it a combination of all of these factors?
Why recovery is a question of social justice
“While 12-step programs have helped countless people recover from substance use disorder, the rigidity of what parts of the self that people are encouraged to bring to the rooms makes the 12-step community unwelcoming and inaccessible to many others,” says Kristine De Jesus, PsyD and founder of The Wellness Cooperative.
Privilege lurks at the heart of recovery movements. The inequality is clear on social media as the majority of “influencers” are white and have the privilege of taking extended periods of time off work to focus on their recovery, that marginalized groups just don’t have. We know that substance use disorders disproportionately affect people of color and LGBTQIA+ folx who don’t always have the financial privilege to stay home while they recover.
Studies show:
The risk of developing substance use disorder is estimated to be 30 percent higher for LGBTQIA+ people, compared to 9 percent of the general population.
Black women over 45 are the fastest-growing population with alcohol use disorder.
Black and Latinx people are far less likely than white people to complete outpatient treatment.
The consequences of the so-called drug epidemic have been framed as disproportionately affecting white people, but that isn’t true. Yet white people are 35 times more likely to access medication-assisted treatment even though death rates among people of color were rising faster than white people.
People of color have less access to treatment and are more likely to be arrested and receive harsher punishments, including incarceration, for drug-related offenses.
Mentioning marginalization and oppression in 12-step programs is often met with the response that recovery has nothing to do with politics or social justice — “We don’t talk about those things in the rooms.” I have had countless debates, and written many articles, about recovery being very much an issue of social justice.
Despite these inequalities, the dominant discourse within 12-step rooms comes from from the perspective of a white, cisgendered, heterosexual male. Recovery activist Brooke Feldman wrote about heterosexism within addiction recovery spaces, stating: “With the risk of developing a substance use disorder as much as 20–30 percent higher for individuals who identify as LGBTQ+, it is baffling to me that heterosexism still pervades large pockets of the recovery communities,” she says.
Many recovery slogans are geared towards heterosexism and the gender binary and overlook safety for those who identify outside the dominant norm. “Heterosexual individuals are often unaware of the privilege they hold and what life is like for those without it,” Feldman says.
“While for many folks, the idea of suggesting that ‘men stick with the men and women stick with the women’ seems to be sound advice, this suggestion totally discounts the reality of gender identity being far more than a binary of male or female. It also ignores the fact that sexual orientation actually exists on a vast and fluid spectrum that includes so much more than just a firm heterosexual.”
The reason why you’re supposed to pick same-sex sponsors is to avoid attraction and muddying the relationship. I’m not saying this happens to everyone, but it can happen. However, the assumption that everyone is straight can be problematic for gay, trans, and non-binary people, who may feel it is difficult to openly identify in such a way as it may feel unsafe and different to the dominant norm. Second, it can cause a lot of confusion because it overlooks the queer experience. In some cases it might be more appropriate to pick a sponsor where attraction won’t occur.
I have experienced first-hand the assumption that I’m straight as many members have given me relationship advice over the years, geared towards men. The dominant shares about relationships are also heterosexual relationships, not queer ones. And I made the mistake of picking my first sponsor based on my attraction to her, rather than what she had to offer in terms of her experience (although, I didn’t realize that was the basis of my decision until later in my recovery).
The concept of privilege, or what some call “outside issues,” says De Jesus, is that they “often create a hostile environment for those who identify as anything other than white, straight, or cisgender. By disregarding the impact of systemic oppression and the trauma associated with it, 12-step communities gaslight people from marginalized groups by demanding they comply with the dominant culture or risk further alienation.” In other words, “the group is your higher power” — so you have to do what the group says.
Holly Whitaker, founder of Tempest — a feminist approach to recovery — and author of Quit Like a Woman, and the controversial New York Times article “The Patriarchy of Alcoholics Anonymous,” has been challenging the recovery community for some time to think about the inequality and exclusivity that is pervasive within recovery, in that recovery is more available to those with privilege and that it has historically been oriented towards white men.
This exclusivity — i.e. the notion that recovery is available to everyone because anyone can access the free resource of AA — however, overlooks one’s privilege and separates the paradigm of recovery from issues of social justice, like how substance use disorders disproportionately affect marginalized groups and that these environments may not be a safe place to recover.
“I didn’t go to Alcoholics Anonymous. I didn’t go to 90 meetings in 90 days. I didn’t have a sponsor. I didn’t work the steps. Most important: I wasn’t required to enumerate my character defects and work to eliminate them, or to buy into the idea that an outsized ego and lack of humility were the causes of my need to numb myself with alcohol,” says Whitaker.
She faced heavy criticism for not attending AA and was questioned about whether she was taking her recovery seriously. In response, she says, “AA may be the foundation of global recovery, but it wasn’t made with everyone in mind. It’s a framework created in the 1930s by upper-middle-class white Protestant men to help people like them overcome addiction. Its founders believed the root of alcoholism was a mammoth ego resulting from an entitled sense of unquestioned authority.”
Like many other activists in this space speaking about inequality, we are frequently dismissed and told that recovery is not a political or social justice issue. Example: I was recently called a “Di Angelo groupie” for responding to an Instagram account that promotes recovery being separate to social justice and openly mocks anyone who suggests the two are linked.
Whitaker says this, “For those people who don’t want to ‘dirty up’ or confuse recovery spaces with talk of racism, classism, transphobia, homophobia, ableism, classism, etc. — remember that recovery is about awareness, and that this path is about inclusion, love, and acknowledging wrongs and injustices. If we aren’t talking about the way the system works, and who gets crushed by the system, we aren’t actually talking about recovery. We’re still just talking about our comfort zones, and using our privilege to deny other experiences.”
How do people recover?
I’m living proof against the universal perspective that assumes recovery is synonymous with AA. Like hundreds of others I know, I left AA years ago and have continued — against the cultural dogma that tells me otherwise — my own process of long-term recovery. I’m not a dry drunk, or destined for jails, institutions and death, like 12-step fellowships conditioned me to believe. In fact, I’m thriving. I relocated to the US from the UK, have an established writing career, and am just starting to study for my Master of Social Work degree.
Ann Dowsett Johnston, MSW and author of Drink: The Intimate Relationship Between Women and Alcohol, shared her experiences of outgrowing AA, too.
“It’s no secret that I got sober sitting on a tough wooden chair in an anonymous 12-step group — and I broke my own anonymity by writing my book,” she said. “I believe in recovering out loud: I grew up the daughter of a beautiful female alcoholic, cross-addicted to Valium and cocktails, and I know our secrets kept us sick. But many 12-step group members shunned me after I wrote and spoke publicly about my own recovery, and I grew tired of their averted eyes.”
As I did, Dowsett Johnston continued her own process of long-term recovery by leaning on other resources. “Today, I am aware that I got — and stayed — sober for the past 11 years in a multitude of ways: reading Pema Chodron and listening to Van Morrison (in my first year), staying close to my serenity sisters, practicing self-care.”
What I particularly love about Ann’s book is the frank acknowledgement that AA isn’t for everyone. While it can be a great stepping stone — and it was for me, allowing me to maintain a period of sobriety — it can become uncomfortable, and quickly. I began to notice that individuals’ vocal contributions during meetings were mostly a regurgitation of literature. I’d receive texts from members that were AA slogans. I felt a great sense of disconnection from my fellow AA members and my communication started to feel inorganic and disingenuous.
[QUOTE FROM DRINK] “On those early dark days, one of my few comforts was reading. Wilfrid Sheed’s recovery memoir, In Love with Daylight, was a favorite. Sheed, who suffered from depression as well, wrote, ‘Giving up booze felt at first like nothing so much as sitting in a great art gallery and watching the paintings being removed one by one until there was nothing left up there but bare white walls.’ He also said, ‘Booze is like an exit door painted on the wall for which alcoholics and other optimists manage to fall every time.’ That helped me stay sober. Like me, Sheed had a very tough early sobriety. For him, AA was little comfort — a place where ‘parrots’ lecture to ‘sheep,’ and people talked ‘in bumper stickers.’”
Kelly Fitzgerald Junco, the Sober Señorita, recovered outside of AA initially but joined for support then realized it wasn’t for her. “I got sober by myself in Cancun with no real program or support, but I craved community. When I moved back to the US I ended up trying AA because I knew there was a community there, even though I didn’t think it was for me. I went for about two-and-a-half years before leaving. There were positives and negatives about it, but ultimately I felt like I outgrew the program and I was ready to try other recovery pathways and a community where I felt like I truly belonged,” she says.
Kelly experienced first-hand the assumption that recovery is synonymous with AA, which she finds limited in scope — and annoying.
“I’ve always found it irritating. Every time I even said I was sober, people just always assumed I was a ‘friend of Bill’ and ‘working a program’ or they immediately asked which meetings I go to. It was always really awkward after I stopped going to AA to explain that I didn’t go to meetings. I think it limits the scope of recovery and makes people feel bad for not being a part of 12-step recovery.”
She contends that this assumption “upholds the thought that if you don’t go to AA, you’re not really in recovery, which is a dangerous fallacy.”
However, even though the reality is that we all recover in a variety of ways — not always AA — the unfortunate reality is that systemically we haven’t caught on. Shauntelle Hammonds thinks we equate recovery with AA.
“The structure of recovery organizations and treatment facilities either push AA or have the unspoken expectation that you are in 12-step recovery. The structure of these organizations are heavily 12-step-based and 12-step is seen as the norm. 12-step recovery is deemed as superior in recovery spaces. So the majority of the individuals who are in recovery and work in recovery that are at the top. Usually are cisgender white individuals who are members of 12 step programs.”
While the system hasn’t caught on, the recovery landscape speaks for itself.
A leading study showed that 22 million Americans — 1 in 10 people — have resolved an alcohol or drug problem using a range of clinical and non-clinical means. The key findings of this study were that:
Around half of those who recover use some form of professional or informal assistance
The most common were mutual-help groups (45.1 percent, with AA being the most popular)
Formal treatment (27.6 percent)
Recovery support services (21.8 percent)
Just under half of those who did not report an assisted pathway recovered without the use of formal treatment and recovery supports.
Alternatives to AA
There are many alternative mutual-aid meetings, including clinical treatment (addiction treatment centers and therapy), and alternative supports (yoga, meditation).
Alternative meetings include:
SHE RECOVERS TOGETHER Online (they also hold weekly meetings for BIWOC)
Jewish Alcoholics, Chemically Dependent Persons, and Significant Others
A recent study showed that other support groups, like SMART, LifeRing, and Women for Sobriety, were just as successful as AA. For a more complete list of all pathways, you may find this blog helpful.
There is a solution
Refreshingly, some members of AA acknowledge that they don’t have a monopoly on recovery like many others believe. Kelly Thompson says, “12-step recovery is based on universal principles found in all wisdom traditions. So it may not be synonymous with recovery.”
As for personalities, Kelly says, “AA can be dogmatic and rigid, but that’s people, not the program of recovery as laid out in its literature. It is definitely not the only pathway to freedom from dependency. But for me, it was and is the one that works and has given me a way of life based on true autonomy and community, as well as a solution and freedom from the deep wounds that otherwise threaten to destroy me and harm others. With the 12 steps, I’ve been led to the ability and awareness to contribute to humanity, rather than contaminate it and add to the suffering. That said, I repeat — 12-step recovery is not for everyone.”
Veronica Valli, in her blog post The Misinformation about Alcoholics Anonymous and Sobriety, disagreed with many of Whitaker’s points in her Times op-ed. She highlights, from her experience, the misinformation about the program perpetuated in this article and as a whole within the fellowship, while still acknowledging the flaws inherent in the program. Valli attributes the misinformation to the fellowship — and outside of it — not to the spiritual program itself. She explains, “The AA ‘fellowship’ and the AA ‘program’ are two entirely separate entities. The fellowship is simply the people who attend meetings and consider themselves members. The program is the 12 steps, which are laid out in the basic text (commonly referred to as ‘the Big Book’) of Alcoholics Anonymous.”
“I also recognize that there is, of course, no one path to recovery. I know that any body of thought and organization has its flaws, and that AA is no exception. I have seen people in the program misinterpret the text as justification for abuse of other members; I have come across unhealthy practices and people; I understand where things can go and have gone awry.”
Valli also acknowledges that AA can be patriarchal, “like most things in our culture,” she says. It is unfortunate that the only way to access the spiritual program Valli describes is by participating in the fellowship. She advises that individuals seek the path of recovery that fits them best.
What’s clear from the science, and the experience of those who have shared their stories with me for this piece, is that AA is not the only way to recover and it certainly does not mean that recovery is only contingent upon attendance at AA meetings. There are numerous pathways to recovery, and we can all benefit from acknowledging that fact and supporting people with this deadly disease in finding a solution that works for them, rather than shaming people who don’t attend AA or those who speak up about it not working for them.
Dowsett Johnston again: “Really, I believe that we live in an alcogenic world, and our job is to push back — not as prohibitionists but as feminists, as whistleblowers, saying that what I call the ‘pinking’ of the alcohol market has got to stop. I am not a victim; I am a protester in a movement that is growing — a recovery movement that is real and compelling.”