Mental Health

Should People with Addictions Be Forced to Attend AA?

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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.  He refused to continue going to meetings, and 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.

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.

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 give 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 he 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).

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 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.

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.  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.

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.

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

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

  1. No, I don’t think AA should be forced on anyone. If you don’t believe in its approach you are not going to be able to commit wholeheartedly to the program. That means its effectiveness is likely to be limited at best. It would be better to be in some other kind of supportive, professionally led self-help group with other participants who also want to get free of their addiction. (Supplemented with individual counselling.)

  2. Forced therapy doesn’t work (most of the time). You have the choice to chose the approach best suited for you. Imagine someone would ‘find out’ that only psychoanalysis works for OCD. Could we force all the people with OCD on Freud’s couch? Or maybe psychodynamic therapy? Or maybe Jung? Or Klein?
    If I was forced to go to AA it wouldn’t help me and it wouldn’t help them either. It is in no ones interest to be ‘treated’ against their will. Ooops that is a whole other discussion! 😉

    1. I think it’s pretty par for the course for health professionals with addictions to be required to get treatment if they want to continue on with their careers, but using a form of treatment that doesn’t work for someone makes no sense,.

      1. Yes that was what I was trying to explain. (long day….sorry)
        With forced treatment I was thinking more in terms of forensic psychiatry, what does work but where timing is also important.
        When you’re not functioning on the job as you should (and it’s not solely the jobs fault) I understand fully that it can be acquired that you take action towards resolving the problem at hand. Only you should be free to chose in what way you do that. What if a ‘sweat hut’ became acquired? I have too many fantasies about which ‘treatment’ ‘should/could’ be proposed to a certain problem, of course without any science to it!

        1. Health professionals with addictions are dealt with pretty strictly, and I can see why that would be, but If any treatment should be required, it should be evidence-based, which AA is not. And also based on what works for that specific person.

  3. I have learnt something new today about AA groups. I didn’t know that. I myself don’t believe in God. When ticking forms on paperwork for religion, I tick none. If none is not available, tick other. So if AA was enforced on me, I would kick up a stink. Where as a supportive group without the religion bit, I would find acceptable.

  4. Wethinks the root of addiction is relevant to treatment modality efficacy. What are we trying to “cure”?

    We had a hospital-met friend who was kicked out of a world-renowned alcohol treatment facility after friend’s x-th time (10, 12?) through their rehab program. Why? The root of friend’s addiction was trauma. They said friend was not recovering because the addiction was a symptom of friend’s problem, not the core problem.

    Friend went to residential trauma program for 5 weeks. They also used AA at the hospital.

    It was just too late. Friend said the 46-year alcohol addiction (begun age 6 😭) was too ingrained.

    Friend passed away one year after trauma therapy.

    “Low-dose” Naltrexone is being touted as a wonder drug: maybe some cancers, Crohn’s, auto immune, etc. It was recommended to us for our DID, because it blocks endogenous opioid craving, which is ostensibly the reward system for dissociation!

    We opted no because dissociation is often how we stay alive. If we can’t dissociate, would we get better or worse? Still something for us to consider. Maybe you’ll someday write about this wonder drug?

    1. A pattern of dissociation probably would never get started in the first place if it didn’t serve a useful purpose at the time. ❤️

      And yes, I’ll do a post about naltrexone. 🙂

  5. Hard to say. From a legal perspective, you do need to do SOMETHING with addicts besides just throw them in jail and forget about them. Is AA that thing though? Probably not… everyone I’ve only ever met one person who was court ordered to attend AA who stayed sober and at least 15 people who just came to get their sheet signed and then left to go drink or do whatever else. You can’t force somebody to get help.

    I think we need to attack addiction from both sides, both preemptively trying to keep people from becoming addicts and in revolutionary treatment methods. I don’t know what those methods should be, myself. I only offer help to people who ask for it, personally. Medications like Naltrexone never did anything for me (except help me lose weight!) but I understand they have some benefit for some people.

    It’s a tough issue. People have been trying to crack addiction since the ancient world. It’s not for lack of trying… it’s just hard to force someone to stop being a loser if he doesn’t want to.

    1. I agree, trying to force treatment on people who don’t want it doesn’t work, except in perhaps a few cases where enforced clean time allows another underlying disorder to be treated properly, and that allows them to get motivated,

  6. Fortunately, I do not suffer from either mental health issues or addictions, but I have a lot of friends who have been there. Yes, I do believe people with addictions NEED help, especially before resuming their jobs. AA specifically may not be the answer, however, they now have programs with a proven track record that are not set with religious overtones and the Bible as their guide. .

  7. Forced into the AA program? No. Forced into rehab for a short time? Maybe. I can see the benefit in getting someone sober to at least then have them make a rational choice about whether they want treatment. Can someone who is high and still under the influence of drugs even make a rational choice or think things through? I think a short forced rehab stint is better than jail time anyway for just simple usage of drugs. Once someone is sober, they may be able to think about the things their addiction is stealing from them and maybe they would be more likely to accept further treatment.

  8. No….

    AA doesn’t work for everyone. In fact, I can imagine that for some people, it might even lead to relapse. As with mental illness, treating addiction should be individualized, rather than the “one size fits all” approach

  9. Very much so agree that forcing any type of anything on anyone will never work!! I can understand an employer requiring someone to meet standards for continuing the work but it shouldn’t be specified which kind they have to do as long as they’re not putting themselves or others in harms way.

  10. Wow, interesting story. I think a treatment plan for any kind of illness whether it’s addiction-related or not should be between a person and his/her doctor. Because as you summed it up perfectly – what works for one person may not work for another!

  11. Very thought-provoking! I don’t think it should be forced on anyone, but haven’t there been some newer groups that are atheist-based that could work instead? However, I think AA has some benefits even if you don’t buy into the religious stuff, like the community aspects and having a sponsor on-call. Granted, if you’re offended or just turned off by the God stuff, then it wouldn’t be a good fit, end of story. It probably wouldn’t work for me, either, because my beliefs are so weird and esoteric as to not match any group’s. I don’t like the idea of forced therapy, but I do think that people should have some sort of treatment plan of their own choosing rather than being out there driving drunk, etc. But I think the best treatment plans have to come from the patient who’s given options, ya know?

  12. Hmmm. In general, I don’t think therapies (AA, rehabilitation, talk therapy) are as effective when they are forced on people; it’s much more effective when people WANT to change. But I also think that forced therapy is better than forced jail time. In the case that you mentioned, I think your colleague should have had the option to seek a different recovery program, as he was receptive to the idea of recovering. And like you said, recovery plans will differ from person to person!

  13. I didn’t go to NA when I got sober. Or rehab. When I did research, I came across SMART & if there had been meetings here I woulda went. But it’s a small town & some are dedicated to AA/NA. It’s not for me. I also don’t like how they tell you all medication is bad. They judge opiate addicts if they use medication to get through withdrawals & cut cravings. Some even judge people for taking antidepressants. Not all but some.

  14. Being in a 12 step fellowship myself, no one should ever have to be forced to do anything let alone go to a recovery program. in Any form of recovery the person has to be willing and make the choice for him/herself, otherwise it doesn’t work. the 12 step program is a spiritual program and not a religious one. Using the term God has many, but many connotations in the program. What God means for some, doesn’t mean for another. The good thing about this program is that You don’t have to believe in anything. You can make Elvis your HP if you want. As long as you define what your HP is for yourself. The 12 step program works, and that is because of the HP element. It only works if you work it. Its a flawless program. And to understand and grasp this concept one has to experience it. No, its not for everybody, and its not for those who need it. Its only for those who want it. when it comes to addiction, its the only program that brings long term sobriety. one can debate all they want, this is the truth. IF you understand addiction, you understand this. I enjoy reading your blog, interesting topics.

    1. “It’s the only program that brings long term sobriety.” I think I’ll have to disagree with this. Maybe you see it that way because it’s what worked for you, but I work my own program and it’s worked so much better for me than sitting in a room repeating “I’m an addict.” To me, that kind of introduction is contradictory to the label we want society to drop. We can’t expect the world not to see us as ONLY addicts, if we’re constantly calling ourselves one behind closed doors. To each his own I suppose, but to say it’s the only program that brings long term sobriety is a bold statement. I’ve made amends, I’ve worked on resentment, forgiveness, cutting out negative influences, setting boundaries, being present, letting go and letting God, made connections with people in recovery, and I’ve done it all on my own. It’s not easy, but it’s not impossible. It takes work, dedication and and incredible amount of self awareness to maintain sobriety. In the end, I would probably say it was ultimately my faith that saved me and keeps me going.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  21. 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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