Addiction Treatment, Coercion, and Alcoholics Anonymous

By Steve K.

I attend a weekly AA meeting which I consider to be my “home group”, and have done so for a long period of time. I value the group and in general it has had a good balance of people experienced in recovery, as well as newer members. Recently a local residential treatment provider (I live in the UK) has started sending its clients to the meeting. As many as twenty treatment residents all turn up at once and most don’t seem very keen to be there. As the meeting is relatively small the treatment residents are a dominant presence and the atmosphere has been dramatically altered. They can at times also be disruptive and seem to need to separate themselves by not joining the circle, despite being encouraged to do so.

As a result some long-term members of the group have started avoiding the meeting and going elsewhere. I personally feel that the large number of treatment residents attending the meeting has been harmful to the overall welfare of the group. I’m also aware that many of the treatment residents identify themselves as drug addicts and often don’t believe that they have a problem with alcohol. 

The treatment provider requires its residents to attend several 12-Step meetings weekly (even though it’s not a 12-Step treatment facility), which I consider to be coercive. It seems to me that coerced meeting attendance is against some of the values inherent within the AA ‘traditions’, as well as the general liberal principles that underpin 12-Step philosophy.

When considering the AA ‘traditions’ in relation to this issue several principles come to mind.  Firstly, tradition one clearly expresses that no individual should be compelled to do or believe anything, and that the 12 Steps are only “suggestions.” These principles must also apply to attendance surely?

Tradition one promotes group unity. The mass invasion of coerced treatment clients, many of whom don’t identify as alcoholic, seems to create division instead.  Treatment clients are often not interested in becoming a ‘group member’ and actually participating in group activity. Unity is about working together to help each other and the still suffering alcoholic, and therefore the welfare of the group as a whole is of primary importance in order to do so.

Tradition three expresses AA’s only requirement…..“a desire to stop drinking”.  Many treatment clients don’t identify as having a problem with alcohol and will often admit this during their shares. Drug addicts who’ve also had difficulties with alcohol and express a desire to stop drinking are welcome in AA meetings, but this criteria is often not met by treatment clients.

Identification is an important aspect of tradition five – the group’s primary purpose is to carry a message of recovery “to the alcoholic who still suffers.”  It’s difficult to carry a message of recovery when some group members don’t identify with the problem.  I was dependent upon both alcohol and other drugs and so have attended NA meetings as well as AA. If I hadn’t had a history of using drugs other than alcohol and didn’t consider that I had a dependency issue with them, I don’t think going to NA meetings would have been that helpful personally. I would have found it difficult to feel a part of the group and probably wouldn’t have been motivated to share. Although the principles for recovery from addiction to any substance are the same, identification is an important aspect of communicating our experience to each other.

Tradition eleven advocates for a principle of attraction rather than promotion, and certainly not coercion when dealing in public relations. Treatment centres who coerce their clients to attend 12-Step meetings are imposing their rules as an outside agency upon AA and NA groups, which don’t require anyone to attend their meetings. In order to avoid controversy, in accordance with tradition ten, 12-Step fellowships are generally reluctant to defend their principles and philosophy where outside matters are concerned. However, I believe the above issue is a legitimate problem for each individual group’s welfare and may require diplomatic, although direct, negotiation with the relevant treatment provider concerned.

12-Step fellowships also value the principles of personal and group autonomy, as well as individual willingness and surrender, which are considered the foundational principles of recovery. These principles are often absent in treatment centre clients in my observations and experience.

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Keeping in mind that 12-Step groups practice a spiritual program of recovery – coercion to attend groups and participate seems incompatible with the original liberal and spiritual values in my view. Psychologist Fred Rotgers, Psy.D., past president of the American Psychological Association’s Society of Addiction Psychology, said, “If you read the Big Book carefully, you will see that AA as originally conceived, but now sorely corrupted by the treatment industry, was purely a self-directed, self-elected program—no pressure to attend, no pressure to admit being an alcoholic. The only approach was an invitation, not a prescription. All the prescriptive stuff came from treatment providers who decided that if something was good, it should be required as a part of treatment. And, of course, they ‘knew’ it was good because they got sober while they were doing it. And if it worked for them, it would work for everyone. But AA makes no prescriptions about how it should be used, or even that it should be used.”

Does Coercion in Relation to AA Work?

Treatment centres seem to make the assumption that coerced or required attendance at 12-Step meetings is beneficial for their clients’ recovery, with seemingly no consideration for the impact upon the groups involved. My brief research into this assumed benefit has found very little evidence for this belief. In fact, there seems to be more evidence that coercion to attend 12-Step groups by treatment centres is potentially harmful to their clients, and in particular to the recovery culture of 12-Step fellowships.

In regard to my inquiry into this issue I emailed the eminent addiction treatment and recovery historian and researcher, William L White. His response was as follows:

More research has been done on the effects of coercion to addiction treatment than coercion to AA in terms of effects on recovery outcomes.  In general, outcomes are similar for coerced and non-coerced treatment, but less clear on coerced AA attendance with still many researchers concluding that coerced AA attendance is not a good idea in terms of potential negative effects on the coerced individual and its negative effects on AA groups.  I think the latter can be particularly destructive in situations where groups of coerced clients are forced into relatively small AA or other recovery support meetings……I’ve been observing this for nearly half a century and generally recommend meetings between local groups and treatment centres to discuss how to best manage such issues.  Mass invasions can destroy the fabric of a recovery culture and there may be far more effective ways to handle linkage to recovery support groups.”

Bill White.

It seems to me that there is often a clash in principles and beliefs between treatment providers (particularly in the UK, where many don’t adhere to 12-Step philosophy) and 12-Step fellowships. This can be harmful to treatment centre clients who are potentially being force fed beliefs they are opposed to, as well as the recovery groups they are being made to attend. Large groups of treatment clients descending upon relatively small AA groups is often detrimental to the group, which then becomes dominated by coerced people in very early recovery who often lack self-discipline, respect for others, interest, and a willingness to participate.

If given the choice, many treatment clients wouldn’t attend AA meetings voluntarily in my experience, choosing instead other sources of support they consider themselves more suited to.  If so, then maybe in the best interests of all concerned this is how it should be? Treatment clients that are voluntarily willing to attend 12-Step groups should be encouraged to do so, and in my experience the few that are willing tend to be a positive influence on the recover meetings they attend. This approach is in line with client-centred values, which seem a more respectful and humane way of relating to people, their problems and wishes.

 

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One thought on “Addiction Treatment, Coercion, and Alcoholics Anonymous

  1. I never thought coercion was a good idea. I am in the US and got sober in 1988. At that time, there were a lot of people ordered by the courts to attend AA, and I remember then not thinking it was a good idea. They used to tell me that “I had to want it for myself”, but many of these people were just there to get their ticket punched and could care less about AA.

    I used to tell the court ordered people that they could sign their slip on their own if they wanted and nobody would know because we are anonymous and not affiliated with the courts. I used to be surprised at how many of them did not realize this, they thought AA was somehow cooperating with the judges to make sure they were attending meetings.

    This doesn’t happen so much anymore because so many courts have ruled AA as a religion. What happens now is the courts require them to seek some sort of outside help and AA counts. This is good in that they at least have a choice, but the truth is that there are not that many options around here other than AA, though more are becoming available all the time.

    It would seem to me that the advice that I was given early on was spot on. You need to do this for yourself and you need to want it for yourself. Don’t do it for any other reason.

    Liked by 1 person

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