STAT recently posted a series on the public health costs associated with alcohol. It’s a welcome subject of focus. Opioids have overwhelmed media and professional attention, despite far greater death tolls from alcohol and tobacco.
…the number of alcohol deaths occurring in the U.S. each year exceeds the number of opioid deaths at any point in that epidemic. The alcohol epidemic’s hidden nature obscures its true scope. Take Massachusetts, where 10,000 residents were hospitalized in 2024 for opioid-related problems. For alcohol, that number was 85,000.
Cueto, I. (2026, May 12). Alcohol is wreaking havoc on U.S. public health. American society looks the other way. STAT. https://www.statnews.com/2026/05/12/america-alcohol-epidemic-plain-sight-deadliest-drug-series-part-1/
Alcohol is an interesting subject because of the scale of the public health costs, but also because of its legal and regulatory status, its cultural status as a celebrated drug, and because, while it’s widely used, a small but significant minority develops severe and chronic problems with it. It challenges a lot of the assumptions embedded in discussions about drug policy and public health.
It looks like it’s intended to be a 7-part series, with already published articles on: the public health toll associated with alcohol and our failure to address it; barriers to screening for alcohol problems in primary care; the emergence of MetALD (metabolic dysfunction and alcohol-associated liver disease); AA as a barrier to resolving alcohol problems; and drinking during pregnancy. Upcoming installments will address Trump administration policies and the influence of the alcohol lobby.
This post is about the article framing AA as a barrier to problem resolution and a source of harm for many people seeking help for severe alcohol problems. (Treatment for alcohol addiction is undergoing a seismic shift. Many say it’s overdue.)
I’ve previously written about STAT’s misrepresentation of 12-step mutual aid, questioned the framing of 12-step as having hegemonic influence over American addiction treatment, questioned paid professionals’ insistence that 12-step groups change to meet the needs of treatment providers and people outside of their scope, we’ve also highlighted research on AA, and research on multiple mutual-aid pathways.
In the case of this new STAT article, what bothered me most was the use of “weasel words” to advance a narrative that AA and AA-based treatment dominate and harm in ways that didn’t even really align with the case presented in the story.
When I refer to “weasel words”, the most prominent example is the article’s frequent use of the word “many” to give the statement vague authority. Here are 9 examples:
- “Treatment for alcohol addiction is undergoing a seismic shift. Many say it’s overdue”
- “Alcoholics Anonymous has helped millions but for many others proved too rigid on medication and moderation.”
- “Many treatment programs operate with little oversight and do not conform to basic standards of medicine or science.”
- “Moreover, though most Americans with alcohol use disorder experience only mild or moderate symptoms, many treatment modes still oppose any form of harm reduction, insisting instead that all patients achieve total abstinence from alcohol and refusing to concede that two drinks per day is better than 10.”
- “Many programs do not adapt to the severity of their patients’ drinking problems, leading would-be participants to either not seek treatment at all — or to attend a 12-step meeting, declare themselves an “alcoholic,” and endeavor to never consume alcohol again.”
- “Many onetime participants have reported sexual abuse at the hands of other meeting attendees, or emotional manipulation and excessively controlling behavior from sponsors, who are assigned mentors meant to guide and oversee a new participant’s recovery.”
- “Many AA participants have historically reported being discriminated against for disclosing that they take antidepressants or antipsychotics.”
- “In retrospect, many onetime Alcoholics Anonymous participants describe their 12-step experience as cult-like.”
- “The medications are shunned in many 12-step communities and are often unknown even to physicians.”
Is there some truth to statements like these? Yes.
Let me first note that it can be hard to make definitive statements about AA (to criticize it or defend it) because it often reflects the community it’s nested in and because of what we might call the “varieties of AA experiences” from group to group, and sometimes within groups. For this reason, it’s the responsibility of any decent SUD professional to know the cultures and subcultures of their region’s recovering community and mutual aid groups so that they can match patients to the communities most likely to be helpful to them — where atheists can find affirmation, where women can feel safe, where seniors, young people, or minorities will see people like themselves, where people pursuing moderation can feel supported in their goals, etc.
- Treatment for alcohol addiction, like the rest of behavioral health and medicine, nearly always needs to evolve. And, addiction treatment has always had a chorus of vocal critics. And, the shift in focus toward Substance Use Disorders (SUDs), which includes mild and moderate severity problems, has increased the emphasis on the needs of people with lower severity problems. To be sure, there are some one-size-fits-all programs out there.
- However, moderation-oriented services are not rare. I worked in a pretty conservative treatment program that started a track supporting non-abstinence goals nearly 25 years ago.
- 12-step groups are not for everyone and are certainly not an appropriate referral for people with mild to moderate problems.
- However, AA itself encourages people to try moderation to see if they are “an alcoholic of our type” for whom moderation is not possible.
- While AA has no official opinion on medications, there are AA members with anti-medication attitudes.
- However, the use of psychiatric medications is common and not controversial.
- Medications for Alcohol Use Disorder, like disulfiram, acamprosate, and naltrexone, are generally not controversial within AA. This is not like the question of agonist treatments (buprenorphine and methadone) within NA.
- There are some bad 12-step sponsors and groups that might be experienced as cult-like. It’s a hard thing to quantify, but they are definitely not the norm and, where they exist, they represent an outlier subculture.
Of course, it’s also important to note that over the last few decades, we’ve witnessed rapid growth in mutual aid options, including:
- SMART Recovery (not abstinence-oriented and widely referred to),
- Recovery Dharma,
- Women for Sobriety,
- The Phoenix (events are sober, but only require 48 hours of continuous abstinence),
- Secular Organization for Sobriety (SOS),
- Moderation Management (as the name implies, moderation-oriented),
- atheist groups within AA (with AA Agnostica as a touchstone),
- religion-specific groups for Christians, Jews, and Muslims, and
- many more 12-step anonymous fellowships.
When I say the narrative didn’t even align with the story presented, I mean that:
- The article’s subject was seeing a therapist who used a harm reduction approach, undermining the suggestion that non-12-step and non-abstinence approaches are not available. Further, one might imagine that a therapist using a harm reduction approach could recommend non-AA mutual aid options.
- The article’s subject appears to end up finding the recovery support she seeks in an AA group. It’s not totally clear in the story that it is an AA group, but it appears to be a well-organized but pretty standard online AA group.
- The group’s website has a lot of information, but most is published by the AA General Service Conference. There’s nothing particularly novel about it.
- One nice touch that is not from the AA General Service Conference is the Personal Safety in Online Meetings guide.
- Further, the article acknowledges the rapid growth of mutual aid options over the last couple of decades, including secular and non-abstinence options for support. He mentioned some, but not all, of these options:
- SMART Recovery (not abstinence-oriented and widely referred to),
- Recovery Dharma,
- Women for Sobriety,
- The Phoenix (events are sober, but only require 48 hours of continuous abstinence),
- Secular Organization for Sobriety (SOS),
- Moderation Management (as the name implies, moderation-oriented),
- atheist groups within AA (with AA Agnostica as a touchstone),
- religion-specific groups for Christians, Jews, and Muslims, and
- several more 12-step anonymous fellowships.
There’s a lot that could be said about the limitations of AA and the failures of treatment systems, and all of that can be said without painting AA as a cult full of anti-science religious zealots and predators who are the key barrier to improvements in public health and treatment systems. To me, it always feels like punching down toward regular people who come together to support each other in finding and maintaining recovery without profit, without a lobby, and without much formal organization.
I’ve been hearing these kinds of characterizations my entire professional life, from social work classrooms to a steady stream of articles in respected publications to various professional spaces. I’ve written multiple responses over the years and was reluctant to write another in response to this article, but I kept ruminating on the persistence and consistency of these messages.
To be sure, there is no single reason for the persistence and consistency of these messages, but a talk by Trysh Travis offers a potentially important framework for thinking about it.
Trysh Travis is a cultural and literary historian who teaches in the Center for Women’s Studies and Gender Research at the University of Florida. She also wrote The Language of the Heart: A Cultural History of the Recovery Movement from Alcoholics Anonymous to Oprah Winfrey.
In a 2024 talk on “AA in the Age of Polarization,” she provides the framework I referred to above. In this talk, she describes a “right-leaning” critique and a “left-leaning” critique. I’m sharing a summary of the critiques because I believe the left-leaning critique offers an explanation for the seemingly outsized and steady stream of criticism/skepticism of AA from journalists, researchers, public health, academics, etc.
The “right-leaning” critique
The right-leaning critique argues that AA was once great and has lost its way. Its membership has grown to include too many people bringing problems other than alcohol into the fellowship, it’s integrated too many concepts from treatment, it’s being changed by broader currents, etc.
She talks about the elements of this critique as common in a lot of spaces — arguing that a favorite band’s early albums are their best stuff and people who came to their fandom later and favor the newer releases are poseurs.
With occasional exceptions, usually spotlighting some aberrant event within AA to score points in broader culture wars, the right-leaning critique is overwhelmingly internal to AA itself. It’s people who believe in AA arguing about the attributes of “true” AA.
This critique is simple, and its solution is to make AA great again by getting the fellowship back to basics.
The “left-leaning” critique
According to Travis, the left-leaning critique is much more complicated, more far-reaching, and harder to resolve.
The argument isn’t that AA lost its way; it’s that AA was fatally flawed from the start. It was a group of straight, white, Christian, middle and upper-class men who encoded their own values and arrogantly universalized their experience while presenting themselves as admirably open-minded because they are willing to embrace anyone who is willing to become just like them.
She puts her finger on a few key elements of that argument:
- Respectability politics – AA’s emphasis and universalization of norms around abstinence, gainful employment, health, sexual continence, and the stable nuclear family are exclusionary and delegitimize people who live outside those norms.
- Powerlessness – AA’s emphasis on powerlessness over alcohol may be good for straight, white, Christian, middle-class men, but it’s harmful to women and minorities who are already culturally disempowered.
- Personal responsibility – AA’s emphasis on personal responsibility, personal inventory, and rejecting justified anger colludes with existing power structures to ignore the material and structural causes of the difficulties people face (e.g., poverty, racism, sexism, trauma, etc.).
Within the left-leaning critique, it would be bad enough if these issues were confined to AA itself, but they aren’t. Within this critique, AA’s reach extends well beyond the rooms where AA members meet. AA members recover their way into positions of institutional power and/or made friends with people who make policy. This part of the argument asserts that AA’s values have influenced, provided justifications for, and been entangled with deeply flawed policies in criminal justice, mental health, public health, and social welfare systems that harm marginalized people.
This critique overwhelmingly comes from outside of AA, and there’s no obvious remedy, because it asserts AA is “poisoned at the root.” Within the critique, even AA’s supposed virtues — like AA’s ability to cut through social difference — are illusions because everything is conditioned on conformance to a set of normative values.
Of course, there are responses to these critiques (like the emphasis on personal responsibility is pragmatic), but that’s not really what this post is about. I also don’t have any responses that could satisfy critics. However, I think Travis’s left-leaning critique helps explain why different versions of the same argument keep coming up over decades in different spaces. For me, maybe the most helpful takeaway is a better understanding of the rationale for the frequent framing of AA (or 12-step) as a hegemonic force.
Maybe a future post will respond to the left-leaning critique.
