Points Bookshelf: “US of AA” by Joe Miller

Editor’s Note: Today’s post comes from Dr. Jeremy Milloy, the W. P. Bell Postdoctoral Fellow at Mount Allison University. In it, he adds to our Points Bookshelf series, where we examine and review recent books about alcohol and drug history. More than a traditional review, however, Milloy also interviews Miller. Enjoy! 

Screenshot 2019-10-22 at 6.26.31 AMAlcoholics Anonymous is one of the most successful social movements in history. It has exercised more influence over treatment of substance use disorder than probably any other non-state organization in history. AA programming is the foundation of upscale private rehabs and prison programs alike. Today almost two million people are believed to be AA members, with many more in the myriad of other 12-step fellowships created in its image. But for the great majority of people who go to AA, it doesn’t work. 

Why then, did AA become the first, and often, the last treatment option? Why does it remain so today? These are some of the questions journalist and English professor Joe Miller tackles in his timely and trenchant new history US Of AA: How The Twelve Steps Hijacked The Science of Alcoholism. In it, Miller deftly combines a personal narrative about his struggles with alcohol and journey through AA to stable program of moderation with the larger history of AA itself. 

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Joe Miller

The moderation, or harm reduction, techniques so useful to him are not widely known. Miller skillfully narrates how AAers, spearheaded by Marty Mann’s resourceful public relations work, successfully defined alcohol in the medical profession and public discourse as a disease that could only be arrested by total abstention and AA membership. Miller shows how AA members successfully lobbied the federal government to create an agency, the NIAAA, and devote resources to addiction treatment.

Perhaps most troubling among Miler’s findings, AAers, not actively identifying themselves as such in accordance with their commitment to anonymity, pushed to advance AA within and without NIAAA as the standard addiction treatment while attacking the research of heretical scholars like Mark and Linda Sobell, who published research in the 1970s that found that controlled drinking was more effective than total abstention. Today, despite research showing AA is not effective for many people, and that other interventions are of benefit–and despite AA founder Bill W.’s own statements disavowing AA as the only option, and his personal experimentation with psychedelic therapies–AA remains dominant. 

Miller’s achievement here is considerable. US of AA is extremely well-researched, and a masterpiece of organization and concision, balanced by a compelling personal story. It features capsule biographies of important figures like Bill W., Marty Mann, and Audrey Kishline, and a well-researched history of AA in just over 200 pages. It is strongly recommended to drug and alcohol historians, 12-step members past and present, and those working in the treatment of substance use disorder.

I spoke with Dr. Miller for Points:

What’s your book about?

It’s the story of how AA became the de facto alcohol treatment policy in the US, despite evidence that it only works for a small percentage of people who suffer from alcoholism. It begins in the early years after Prohibition and spans more than 80 years to the present, and it shows how the science community, in an effort to raise funds for research into alcoholism and alcohol, backed a PR campaign launched by one of AA’s first female members, Marty Mann, to convince Americans that problem drinking is a disease, not a moral failing, and that AA is the most effective cure. It worked. After several decades, the research money started flowing in from the federal government, and the research revealed that alcohol use disorders are much more complex than the AA doctrine says it is. In fact, much like depression, it’s a range of disorders, for which a variety of treatment strategies are needed. AA is one of those strategies, and works for many people, but by no means for the majority of people who struggle.

Why did you write it?

It started with personal experience. I struggled with drinking and was in and out of AA. I worked the program diligently, but it didn’t work for me. Despite this, doctors and psychologists kept telling me my only choice was AA. Eventually, after a lot of looking, I found other alternatives. The journalist in me was intrigued. Why would I keep being told to do something I knew didn’t work? Why wasn’t I made aware of other options? I started digging into it and found a fascinating stories filled with very interesting characters. 

What does your book have to say to drug and alcohol historians?

That when it comes to alcoholism treatment and AA, it’s hard to write a history that actually tells it like it was. Well, not hard to write, but hard to get people to take seriously. The story of AA as a miraculous cure-all is deeply entrenched and sacrosanct.

What does your book reveal about some of the crucial figures in the history of AA, like Bill W. and Marty Mann?

It reveals both as fascinating, complex characters. Especially Bill Wilson. He knew AA had limited power, and he spent much of his life trying to find ways to help those for whom AA didn’t work, and a lot of his efforts were rebuffed and outright condemned by members of AA.

AA has been chronicled by many a great writer and filmmaker. Does AA have a cultural appeal and resonance that helps explain its success and endurance in the absence of verifiable success?

AA is based in storytelling, and stories are powerful. Throughout AA’s history, journalists, authors and filmmakers have told and retold the AA story until it has become a kind of indelible truth in our society. Also, I think the religious and spiritual aspects of it contribute to its appeal. It’s like a religion, with its own dogma, and there’s a lot of comfort to be found in religion and dogma. It can explain away uncomfortable mysteries. Another part of its appeal is that it’s free, and it’s everywhere.

AA has often been described as a working anarchy, but it also has elements that strongly appeal to social conservatives. Does the latter also help to explain its reach and influence?

I think so. There’s comfort in fundamentalism, in thinking, “I’m on a righteous path.”

How has your book been received inside and outside the 12-step community?

I’d say the response has been tepid. It’s received very few reviews, none from any of the big, mainstream book forums such as Publisher’s Weekly, Kirkus and the New York Times. The reviews online have been mostly positive, by people who’ve read the book, and stridently negative, by AA defenders who clearly haven’t.