Should People with Addictions Be Forced to Attend AA?

Should people be forced to attend AA? - image of AA logo

A nurse that I used to work with developed an addiction a number of years back. When it came out, in order to have any hope of getting his job and his nursing license back, he was required to see an addictions specialist and adhere to the treatment plan that was set out. One of the elements of the treatment plan this doctor came up with was attending Alcoholics Anonymous (AA) meetings.

This nurse is an atheist. He tried AA but didn’t find it helpful at all, as it just didn’t mesh with his personal brief system, so he refused to continue going to meetings. Despite being keen to engage in other forms of treatment, he was fired by the health authority for not following his treatment plan. He ended up taking the issue to the provincial Human Rights Tribunal, complaining that he was discriminated against on religious grounds because he was an atheist. According to an article on the CBC website a couple of months ago, a settlement was reached between the nurse and the health authority. As a result, the health authority will no longer require health professionals to attend 12-step groups if it goes against their religious beliefs.

AA and the higher power

While AA is Christian-influenced, it isn’t associated with any particular religion or denomination. Still, a higher power plays a major role in the 12 steps.

The 12 steps of Alcoholics Anonymous

It’s possible to substitute some non-deity form of higher power, but it requires some mental and spiritual acrobatics, although there certainly are atheists in AA. If God isn’t your thing, it’s hard to avoid given how enshrined God is in the AA program. For myself, as an atheist, what I wouldn’t be comfortable with is the shift in locus of control from self to higher power; that’s just not the way I look at the world. Whether that higher power is a deity or not, with the lens through which I view the world, it’s not up to a high power to remove defects of character or shortcomings or restore me to sanity; it’s up to me (granted, I don’t have an addiction, so it’s kind of a moot point).

Other options

While AA (and its other 12-step variations like Narcotics Anonymous, etc.) works for some people, it doesn’t work for everybody. It’s generally not considered an evidence-based treatment for substance use disorder, as there isn’t solid research to show that it works. That being said, it absolutely is effective for some people.

While a self-help fellowship isn’t a bad thing, it seems strange for an addictions doctor to insist on it as a non-negotiable part of a treatment plan.  It’s not as though there aren’t other treatments available. There are other group-based programs available, such as SMART Recovery; it’s based on a form of psychotherapy called rational emotive behaviour therapy. My former colleague was highly motivated to participate in secular groups like SMART Recovery, but the addictions doctor wouldn’t accept that as a substitute for AA. The CBC news story also mentions that for this particular nurse, the game-changer in really moving forward with his recovery was the medication naltrexone, which blocks the effects of opioids and alcohol.

The right fit for the individual

I can see that an addictions physician who treats healthcare professionals would be in a difficult position. They need to make sure someone isn’t going to go back to work and put patients at risk. But insisting on AA when someone says that it’s just not the right fit for them seems inappropriate. A person isn’t necessarily lacking commitment to recovery if a specific treatment isn’t a good fit for them; if they show motivation to engage in treatment, it doesn’t make sense that one particular type of treatment should be considered the be-all and end-all.

I’ve never had a substance use disorder, but if I did, I can say with certainty that AA would not be a good fit for me; it’s just very different from my way of looking at the world. If I wasn’t interested in treatment at all I’d probably be trying to say no to a lot of different things, but I think someone can be fully committed to recovery and still not want to do AA. For me, SMART Recovery sounds like it would be right up my alley.

Just because someone is a health professional doesn’t mean they shouldn’t have the right to patient-centred care with evidence-based treatment tailored to what’s suitable and effective for them. I’m really impressed with this nurse for fighting this fight, even though it’s taken years.

No single treatment works for everyone

When it comes to any form of addictions treatment, what works for one person won’t work for another, and it’s hard to know which it will be until someone tries the particular form of treatment.

If addictions treatment providers are so rigid that they want to adhere to their own plan rather than go with what’s most effective for the patient with the addiction, that’s really not accomplishing much of anything. It’s just like if a doctor was trying to treat me with their antidepressant of choice; if it wasn’t working, I would expect them to switch me to their second choice antidepressant rather than keep me on the first because they were so confident that it was the only one that would work.

Do you think AA should ever be forced on people who don’t believe in God in any form?

52 thoughts on “Should People with Addictions Be Forced to Attend AA?”

  1. I’m against forcing someone towards a particular treatment. But when it comes to treatment in general I’m not so sure. People who suffer from addiction often don’t realize they need help until it’s too late – or even when they are aware of it, they lack the abilities to seek help themselves. It’s always a tough call to “force people for their own good” but there might be cases in which it is the humane thing to do.

    1. I agree, there are times when it would make sense to impose short-term treatment so the person has a chance to make a decision from a clearer state of mind.

  2. I’m three years sober from alcohol. I’ve never attended an AA meeting. I do attend a weekly yoga for recovery class.

    I’ve also been on the other side of this- I was an addiction counselor for a couple of years at an outpatient substance abuse facility. Many patients were there bc they were mandated.

  3. I would have to say no. Whether it is NA or AA you really can’t force people. Success with either of these programs really revolves around the person wanting to be there.

  4. Being in recovery 17 months, I can say AA/NA did not work for me and I actually am spiritual. It was the reiterating my past over and over again that kept me stagnant. I can’t say I ever did the steps but I do see way more clean time in those rooms than I have ever seen come out of an inpatient or outpatient facility. Also, “not wanting to go” is typical addict ego and self-pity behavior. EGO. EGO. EGO. Part of recovery is realizing everyone has to do shit they just don’t want to do. Period. If you want to get clean, do the uncomfortable work. Simple as that. If you want to keep your job, just suck it up and go and get whatever you can out of it. There’s a ton of wisdom in those rooms so find the positive instead of focusing on the negative. If you don’t give a shit about your job and want to stay stagnant, then whine about going and face the consequences. And to whoever mentioned that AA is a Bible based meeting… false. I once had someone at a meeting tell me my higher power could be the tree outside.

    1. I don’t think it’s ego, self-pitying, or stagnant for someone to say form of treatment A doesn’t work for me as an individual, so I’d like to actively pursue form treatment B, C, and/or D instead. No one form of treatment is going to be the be-all and end-all for every individual.

      1. I absolutely agree. Me, personally, I felt stagnant which is why it didn’t work for me. Sometimes I just think we have to do what we have to do. Being atheist was more important to him than his job so only he can decide if he made the right decision. I was court mandated outpatient at one point which did nothing for me but I did it anyways. Looking back I suppose I wasn’t ready to get clean anyways so nothing would have worked. If you’re truly ready, physical addiction aside, you can get clean on a street full of dope. I do appreciate you bringing light to this. Often we are made to believe AA is the ONLY way, which simply isn’t true.

  5. once in awhile the court card people who got a nudge from the judge actually stick around longer than mandated. So I think it’s worth a shot. Hi there. I am going around the neighborhood introducing myself. My name is Marc. My blog contains excerpts from my book The Driveway Rules. It contains memoirs about growing up with undiagnosed autism. I hope you stop by.

  6. I am not one that particularly should speak on this or maybe I am. I have been clean of heroin over 4 years. I don’t go to meetings. I still sometimes have trouble with other vices. However when I have gone to meetings, you can find things of a higher power that have nothing to do with a deity human based or not. In example…your higher power is human kindness. Through human kindness you can restore yourself to sanity. Or through human togetherness/fellowship you can restore yourself to sanity. It basically means you yourself alone are powerless. But with a deity or in my examples with a human assembly based on the principles of wholeness through togetherness you can restore yourself to sanity. Just my opinion, I’ve gone through treatment centers, been to dozens of meetings, the reasons I don’t go to meetings is because I still partake in drinking occasionally and I don’t take light of the work others have done to get sober. I have merely just gotten clean of heroin and opiates.

  7. I dont think it should be forced, I do believe there can be much gained, but as in my case…people go to meetings high and they are only there to dig up dirt to use against those recovering. That said, if yo uh can find a good online group one may find it worthwhile.
    Tha is for the food for thought.

    1. I agree, it can definitely be helpful for some people, but as with anything else, no single form of treatment is going to be the right fit for everyone.

      1. And court ordered or forced goes against the very basic issue. You can lead a horse to water but cant make him drink. An addict not ready to ask or accept the help takes seats away from those that WANT to attend

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