Members of Alcoholics Anonymous commonly state that the reason why they are staying sober and happy is due to their participation in the program of AA. They might state that they stay sober due to service work, because of the steps, because of fellowship outside of meetings, because they go to many meetings, or other aspects of the AA program. If you were to go to AA meetings you would hear these “truths” repeated over and over again. One thing I’ve wondered though, is, could a member’s sobriety and well being actually be due to the placebo effect rather than AA itself?
The placebo effect occurs when a person is told that a treatment works or may work, and the person feels or experiences the expected effects of the treatment even though the treatment itself is actually a placebo (meaning that it has no effect on the person). The existence of the placebo effect has been established in studies with patients who have depression. Kirsch (2014) reviewed a number of studies on antidepressant use and the placebo effect. A common method that researchers have used to understand the placebo effect is to split a group of patients/participants into two groups: a treatment and control group. In the control group, patients are given a placebo pill, while patients in the treatment group are given an antidepressant. Neither the experimenters nor the participants know whether they are on placebo or an antidepressant, but participants do know that they could be taking an antidepressant that is could lift their depression and/or is known to do so. The results are usually that both the placebo and antidepressant groups show an improvement in depression symptoms, and that this improvement is not statistically different between the two groups. In other words, patients in these studies responded similarly to both the placebo and the treatment itself due to suggestion, expectations, and possibly just hope. This phenomena is termed the placebo effect. Because of these studies, some researchers and clinicians question whether or not antidepressants are effective at all, and some actually believe that they could lead to worsening depression over time due to the dynamics of the placebo effect.
The placebo effect has been established across a variety of settings and with a variety of treatments. When it comes to questioning if there could be a placebo effect in AA, we simply need to listen to the many people in meetings who are suggesting that AA and the suggestions in it will keep you sober. These suggestions can be communicated both directly or indirectly, meaning that people in AA don’t have to tell each other that xyz will work for you in order to establish a pattern of suggestion and possible placebo effect. Sharing about personal successes in AA without directly telling people “it will work for you” is still a form of suggestion. Thus a person doesn’t need to specifically be told “You will stay sober if you do xyz” to believe that doing xyz will lead to sobriety when they attend AA. Because of these group dynamics and the frequency and strength of suggestion that one hears when he or she participates in AA, there is a strong possibility that a placebo effect is occurring in AA.
When we consider the possibility of a placebo effect in AA, we must consider that the group dynamics and suggestions in AA could lead to a placebo effects that can quickly spread from one person to the next. And the truth is that if there is placebo effect in AA, that an individual member can easily spread this effect to hundreds of people within a short time. When you take into account that there are claims of millions of members in AA who are devoted to spreading the AA message, you begin to wonder about not just the possibilities but the dangers of so many people relying on a possible placebo effect or simply on suggestion itself to stay sober.
In order to explore what happens in AA, let me give you an example of what AA is like for an individual member who finds success within the program. Let’s imagine for a moment that a woman enters AA, and is told or hears that if she follows a program of “action” that she will stay sober. So she takes action and works the steps, does service work, goes to fellowship activities, gets a sponsor, and goes to many meetings, and soon she finds that she has been sober for six months! She excitedly tells of her story at meetings and to other members and lets people know, either directly or indirectly, that AA does work! This woman then gets one year of sobriety, then, five years of sobriety, and soon she has dedicated her life to “sharing the AA message” and goes on to “help” many people stay sober by carrying the message of AA. In turn, other members reinforce the idea to her that AA really works, which only leads the woman to more devotion and beliefs about the effectiveness of AA in keeping people sober. This woman alone, then, spreads the AA word to hundreds if not thousands of people within a short time with the use of suggestion. This is a very typical story of what happens in AA and the phrases that are used to spread suggestion, Groupthink, social persuasion, peer pressure, and other dynamics that cast doubt on the validity of the claims by members in AA.
If we think about this woman’s story we realize that there is no way of knowing whether she stayed sober due to AA or because it was suggested to her repeatedly that AA would keep her sober. There is no way yet to know if the steps influences one’s sobriety, or if suggestion and the placebo effect causes one to stay sober when they work the steps. Thus a person might spend a lifetime in AA believing that it is keeping them sober when it really isn’t. This leads one to ask: Are millions of people in this world relying upon a placebo to stay sober? While many people in AA and around the world would scoff at this question, it really is a very necessary question because of the damage that addiction and alcohol use disorders can cause. And when you think about it, the act of devoting one’s life to a placebo doesn’t sound like a great thing, even if it does make you feel good. In fact, it sounds like a recipe for disaster to me. One might wonder how long AA will continue to exist as it does today.
Thanks for reading! Stay tuned as I write more about AA, mental health, trauma, and cats.
Kirsch, M. (2014). Antidepressants and the placebo effect. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/