In the first edition of this book, I came to the conclusion that AA and related 12-step groups would continue to expand indefinitely. I no longer believe that's true. I now believe that AA will, instead, begin to shrink within the next decade, and perhaps within the next five years, for reasons which I didn't cover in the 1991 edition of Cult or Cure?, even though the factors I cited in the earlier edition militating toward AA's growth are still operative.

AA is the direct spiritual descendant of Frank Buchman's Oxford Group Movement, and AA's program, the 12 steps, is a codification of the Oxford Group Movement's principles of individual powerlessness, divine guidance, confession, restitution, and continuance; as well, AA inherited many attitudes, tendencies, and stylistic features from the Oxford Groups, including anti-intellectualism, informality, wariness of formal organization (at least in communal AA), and a fondness for slogans and aphorisms. AA also inherited one other important Oxford Group Movement tendency, and one which has proven important in AA's history: expansionism.

Frank Buchman and the other members of the Oxford Groups were convinced that their "way of life" was the panacea for all of the world's ills. So, their overriding goal was to persuade everyone to adopt their it. Similarly, a great many AA members are equally convinced that the "AA way of life" (that is, following the 12 steps) is the panacea for all alcohol abusers. Many go further than that and, like their Oxford Group forebears, assert that their "way of life" is a panacea which should be adopted universally—by nonalcoholics as well as by alcoholics. One enthusiastic AA member put it like this: "I think we're talking about a revolution—ending war, people getting rid of their anger . . . I honestly think that if everyone worked the 12 steps it would change the world.ⁱ A most interesting aspect of this statement is that its author refers to 12-step programs as a "revolution," just as Oxford Group members referred to their reactionary religious program as a "revolution."

Additionally, AA members are told to "carry this message [AA's program] to alcoholics" in the 12th step, the culminating step of AA's program of "recovery." It's no surprise then, that expansionism has been one of the hallmarks of AA; and it's virtually certain that it will continue to be so.

This expansionism can easily be seen in the changing composition of AA's membership. As mentioned in the preceding chapter, the criteria defining an "alcoholic" (thus defining who is eligible for AA membership) were very restrictive in AA's early days. AA even refused to classify as alcoholic some drinkers who showed marked alcohol-related physical deterioration. At present, anyone showing any level of physical dependence, let alone deterioration, is automatically labeled "alcoholic" by AA members, and many persons who display no physical symptoms and whose drinking problems are relatively mild and of short duration are also so labeled. Thus, the pool of potential AA recruits has vastly expanded.

While the percentage of drinkers with serious drinking problems is probably no higher now than when AA was formed, the percentage of drinkers labeled "alcoholic" is far higher now than it was during AA's formative years in the late 1930s. Given the current mania for labeling nearly everyone an addict of some sort, it remains near certain that the criteria for defining someone as an "alcoholic" will remain very broad, though it's doubtful that they will expand much further; about the only way that that could happen would be to label anyone who drinks any amount of alcohol, no matter how tiny, as an "alcoholic."

Another sign of expansionism can be seen in the age of AA's members. In AA's early days, there were very few members under 30 years of age; and many members were doubtful that anyone younger than 30 could be an alcoholic, or at least doubtful that their problems were serious enough to cause them to want to stop drinking. Yet by 1989, 22% of AA's members were 30 or younger, and 3% of AA's members were teenagers.ⁱⁱ Again, the pool of potential recruits for AA has greatly expanded.

Further evidence of AA's expansionism can be found in its attitude toward coercion. In its early days, AA was proud of being an all-volunteer organization. Today, AA embraces coercion. AA willingly cooperates with courts which routinely coerce drunk drivers and others guilty of alcoholrelated offenses to attend AA meetings. As well, coerced participants make up a majority of the "clients" in 12-step treatment programs administered and overseen by AA addictions "professionals." In 1996, fully 40% of respondents to AA's triennial survey stated that a treatment center was one of the (up to) three most important factors "responsible for [their] coming to A.A.," and another 16% listed counseling as an important factor. As well, 9% listed"employer or fellow worker" (that is, EAP coercion); 8% listed "health care provider"; and those who were openly coerced made up a full 16% of the sample: 13% listed court orders; 3% listed correctional facilities.ⁱⁱⁱ As well, at least some of those who listed "family" were certainly introduced to AA as a result of coercive "interventions," though it's impossible to tell what percentage from the data supplied. Thus, because of the multiplechoice option in the survey, as well as the vagueness of its wording, it's impossible to state what percentage of AA members belong to it primarily because of treatment centers, 12-step counseling programs, coerced attendance via court mandates or correctional facilities, or other forms of coercion. But it's a certainty that it's a very high percentage. In all likelihood, the percentage of current AA members who joined AA because of coercion is at least a third, and is probably in excess of 40%.^iv

As well, a huge number, probably a large majority, of the "professionals" and "para-professionals" employed by both inpatient and outpatient alcoholism treatment programs are zealous AA members who consider AA the be-all and end-all of alcoholism treatment. In many ways, AA serves their needs very well (though not the needs of most of their clients). It provides them with a program with all the answers, a simple program which they can "utilize" and "not analyze"; and if that program doesn't work for many clients, it's the fault of the clients' "defects of character" or "lack of honesty." So, not only does AA supply a ready-made program, it also supplies a convenient excuse for treatment failures. For these reasons, for the near future AA will undoubtedly continue to be a key part of a very large majority of treatment programs, and all too many inpatient programs will continue to consist of little more than a 14- or 28-day drying out period punctuated by daily AA meetings and group "thera

py" sessions in which clients are pressured to admit that they are diseased "alcoholics" who need the intervention of a Higher Power to overcome their "alcoholism." And all this with a $20,000 bill falling due at the end of "treatment."

This is a comfortable arrangement for both AA and the 12-step treatment centers. The treatment centers provide AA with meeting space, a huge market for its literature, and a steady stream of new members, while AA provides the centers with cheap help (zealous, underpaid para-professionals) and the cheapest method of "treatment" imaginable. Given these realities, it would be very surprising if AA didn't continue to cooperate with agencies that coerce drinkers to attend its meetings, and didn't continue to be an integral part of a large majority of alcoholism treatment programs in the United States, at least for the next several years. In sum, AA's embracement of coercion is perhaps the clearest sign of AA's expansionism.

AA has also been expanding "overseas" (which, strange as it seems, includes Mexico), as well as in the United States and Canada. As of 1996, AA's overseas membership totaled 614,466—nearly 33% of AA's total membership of 1,866,281.^v One area of particularly rapid expansion has been Latin America.

Given the inherent anti-political activism bias of AA's program, with its inward focus, its total neglect of social factors involved in the production of alcohol abuse, its emphasis upon individual powerlessness, and its insistence upon divine guidance as a panacea, one can only look upon AA's Latin American expansion with trepidation. Alcohol abuse is a terrible problem in many parts of Latin America, and it's unlikely that AA will be any more effective there than it has been elsewhere; AA, in fact, will undoubtedly block progress in dealing with alcohol abuse problems there. As well, it's difficult to see the political quietism inherent in AA's ideology as being anything other than a buttress for the inequitable social systems within which alcoholism flourishes in Latin America. Given the dimensions of the alcohol abuse problem, the lack of alternative treatment programs, the presence of business-as-usual regimes that welcome a message of political quietism, and the religion-soaked atmosphere in these countries (a not-surprising reality in lands where social misery reigns), it seems likely that, for better or for worse, AA will continue to expand in Latin America.

A development related to the expansion of AA is the proliferation of non-AA 12-step groups. In 1990, there were approximately 200 non-AA 12-step organizations, with a membership estimated in excess of 2 million.^vi That might have been a rosy estimate, as a Hazelden document I obtained in 1994 stated that there were "2,700,000 12-step individuals" and that "12-step membership has been flat for the last 3 years."^vii If correct, that would yield a non-AA 12-step membership of around 1.5 million in 1994. The figure is probably about the same today, given the "flat[ness]" of 12-step membership and the slight, but noticeable, decline in popular interest in 12-step organizations over the last few years.

One indication of this decline can be found in the number of articles about AA and other 12-step groups in The Reader's Guide to Periodical Literature. In the period 1985-1987, a total of 6 articles on AA appeared in indexed periodicals. That figure jumped to 8 articles in 1988 alone, and during the period 1988-1991, a total of 22 articles appeared. But during the following five years, 1992-1996, only 8 articles on AA appeared, with none at all in 1996. The numbers are similar for other 12-step groups. The category "Twelve-Step Organizations" first appears 1988, in which year 2 articles on non-AA 12-step groups were indexed. Interest in such groups peaked in the years 1990-1992, when indexed periodicals ran 13 articles on them. But during 1993-1995, only 3 articles appeared, with none at all in 1996.

(One feature of these articles bears comment: from the late 1980s on —for the first time since the mid 1960s—articles critical of AA have been appearing in the national media. Of the 32 articles on AA listed in the period 1987-1996, 6 were critical. The proportion of critical articles on other 12-step groups was almost twice as high. Of the 18 articles listed from that same period, 6 were critical. In 1997, one national news magazine even ran a cover article headlined, "What AA Won't Tell You."^viii)

What is most surprising about the AA spinoffs is that groups having nothing to do with addictions have adopted the 12 steps as their "program," with only the most minimal alterations. Perhaps the most extreme example is Incest Survivors Anonymous. If the AA program, the 12 steps, were truly tailored to fit the needs of alcoholics (or addicts of any sort), it would seem grotesque that it be adopted as the program for victims of hideous, cruel abuse. (Should rape and molestation victims really adopt guiding principles which emphasize that they should make "amends" to those they've "harmed," take a moral inventory of themselves, and admit their "wrongs"?)^ix

But the 12 steps are not tailored to fit the needs of alcoholics and addicts. In fact, they're not tailored to fit the needs of any particular group. But for the mention of alcohol in the first step and the mention of alcoholics in the twelfth step, they are purely a set of religious principles advocated by Oxford Group Movement/Moral Re-Armament founder Frank Buchman and crystallized by AA co-founder Bill Wilson.

This fact explains a great deal. From early childhood, most persons the world over are taught that God and religious faith are the very essence of goodness; so, they're favorably inclined toward anything overtly religious, such as the 12 steps. At least in Christian countries, most are also taught, as part of their religious training, that their problems are purely their own responsibility, the results of their sins, and that only God has the power to remove those sins. So, most people are predisposed to accept 12-step religiosity with its insistence upon individual responsibility for alcoholism (or other "addictions"), individual helplessness, and the necessity of divine guidance.

But their inherent religiosity is only a partial explanation of the popularity of 12-step programs. There are many other reasons for their spread. One is loneliness. Loneliness is a terrible problem in American society, and people will flock to almost anything that relieves it—even 12-step meetings. In the case of AA, this factor is undoubtedly very important in the recruitment and retention of members. Alcohol abusers often drive off all or almost all of those close to them, and are quite socially isolated when they finally decide to quit drinking. Thus, AA, with its innumerable meetings, social functions, and opportunities for 12th-step work, becomes an important —sometimes the only—social outlet for many new members. One young AA member's comments lend support to this view of AA as a refuge from loneliness: "This is a place where I come and I don't feel alone anymore the way I used to when I was drinking and doing drugs."^x While it's uncertain whether loneliness is as potent a motivating force in drawing new members to other 12-step groups, it is undoubtedly an important factor.

Another reason for the popularity of 12-step programs is the prevalence of rampant psychological pain in contemporary America society. The problems which 12-step programs presume to address are, in many cases, all too real. Because of the absence of affordable or free alternatives (or lack of knowledge of their existence), it seems only natural that a great many people turn to 12-step programs for help. Unfortunately, it's a virtual certainty that for the foreseeable future the socioeconomic system will continue to act as a human meat grinder, churning out generation after generation of emotionally damaged people replete with "addictions" and other "dependencies." If the current trends toward regressive distribution of wealth and income, and sadistic, punitive "solutions" continue—jails rather than job training, savage drug laws rather than a socially tolerant legal code, etc., etc.—it seems likely that the social meat grinder will accelerate the pace of its grisly work. So, it's a virtual certainty that these factors in the growth of AA and other 12-step groups will continue to operate and could well be-come even more potent than they are now.

Another factor explaining the popularity and expansion of 12-step groups is AA's tremendously effective propaganda machine. Until fairly recently, the portrayal of AA in the print media was uniformly favorable, with many articles being near adulatory, and having titles such as "The drunk who helped millions get sober"^xi and "Alcoholics Anonymous: the heart of treatment for alcoholism."^xii The film industry and television have, if anything, been even worse; they've painted an unrelievedly rosy picture of the group, as in movies such as The Days of Wine and Roses and Clean and Sober. There are three reasons for this favorable portrayal of AA in the mass media: 1) AA members have set up front groups to promote the 12-step approach under the guise of professional organizations, the NCADD being the prime example; 2) most reporters are woefully ill informed about addictions, tend to believe the misinformation they've been fed over the decades by AA and its allies, and tend to regard and rely upon AA's unidentified (anonymous) spokesmen and front groups, such as the NCADD and ASAM, as disinterested experts; and 3) because of AA's anonymity provisions, many AA members in the addictions professions and in the mass media are free to issue pro-AA pronouncements and to produce pro-AA pieces (as well as to attack AA's critics) without revealing their affiliation with AA. This is unlikely to change anytime soon. Even over the last decade, magazine articles critical of AA and the 12-step movement (as listed in The Reader's Guide to Periodical Literature) have been outnumbered by pro-AA/pro-12-step pieces by a ratio of more than 3 to 1.

Yet another, and undoubtedly the most important, reason for AA's growth over the last three decades has been the systematic use of coercion by the courts, prisons, employers, and 12-step treatment industry to force people into AA. This has been tremendously important in AA's growth; as indicated in Chapters 7 and 8, at a bare minimum, a third of AA's current members were coerced into first attending, and the figure could be considerably higher.^xiii In many ways, over the last three decades AA has been in the position of a snake being force-fed mice—not that the snake was all that unwilling.

A final reason for the popularity and growth of 12-step groups is their anti-intellectualism. As Luther Burbank once remarked, "The greatest torture in the world for most people is to think." Sadly, this appears to be true, and 12-step programs, with their "utilize, don't analyze," "your best thinking got you here" philosophy, seem ideal social vehicles for those wishing to escape the "torture" of critical thought. For many members, 12-step group-think organizations form a comfortable herd in which they can submerge themselves. (This may seem extreme, but consider the cliched remarks of many members, often consisting almost entirely of time-worn AA slogans and folk sayings, at almost every meeting; consider also the many "AA successes" who have virtually no social life outside of AA.) Given the miserable state of the educational system and the smothering influence of fundamentalist Christianity and other anti-intellectual religions, it seems virtually certain that the anti-intellectualism of 12-step programs will con-tinue to be a powerful attractive force.

But there is also reason to think that the growth of AA (and the 12-step movement) will soon end, and that AA will in fact begin to shrink in size in the near future. I believe that the shrinkage will begin within the next ten years, and perhaps within the next five. There are several reasons that this seems probable.

First is the shrinkage of the inpatient treatment industry. Over the last decade, the average length of stay, and occupancy rates have both dropped, and over the last two or three years it seems as if the number of inpatient facilities has begun to decline. As insurers become even more reluctant to pay for expensive, ineffective 12-step inpatient treatment, these trends seem likely to continue.

Second, because of recent state and federal court decisions, coercion into 12-step group attendance/12-step "treatment" by the courts and penal system is on the way out. While it's still common in many parts of the country, as more and more suits against mandated attendance are filed and won, this source of members for AA will simply shrivel up, as it's already doing.

Taken together, these two factors will diminish the number of persons coerced into AA membership. Coerced persons now constitute at least a third—and probably considerably more—of AA's members, so this will be a serious blow to AA. There's some indication that at least one of these factors is already having an effect: since 1989, the percentage of teenagers in AA has fallen by two-thirds, from 3% to 1%. One likely explanation for this drop is a decline in the number of "interventions" with teenagers and their coercion into 12-step treatment. (I simply can't conceive of any significant number of teenagers being attracted to AA meetings with their bad coffee, cigarette smoke, drunkalogues, and predominance of older folks.)

A third reason for AA's probable decline is that it simply doesn't work very well. As discussed in Chapter 7, the controlled studies of AA have found that it is, quite simply, ineffective—no better than no treatment at all. And in the end the truth will out. Despite AA's well-oiled propaganda machine and its unmerited near adulation in the mass media, in the long run an organization that purports to be the answer to a serious personal and social problem, but which is utterly ineffective, cannot endure.

A fourth reason to believe that AA will begin to shrink in the near future is that the stranglehold of AA upon the mass media is loosening. Over the last decade, as indicated above, a number of articles critical of AA have appeared in the mass media (while there were none over the previous 20 years), and during the same time a spate of books critical of AA and its concepts has also appeared. Titles such as Stanton Peele's Diseasing of America, Ken Ragge's The Real AA, Jack Trimpey's The Small Book, Vince Fox's Addiction, Change and Choice, Albert Ellis's and Emmett Velten's When AA Doesn't Work for You, and the present volume come to mind. The continuing appearance of a steady stream of critical books, periodicals, and magazine articles seems a near certainly, and it thus seems almost equally certain that AA's stranglehold upon the media will be a thing of the past within the next 10 to 20 years. And with a more realistic portrayal of AA in the mass media, AA's volume of walk-in traffic will undoubtedly greatly diminish.

A related development is the appearance and endurance of the various nationwide "alternatives" to AA. In the early 1980s, there was only one such group: Women for Sobriety (WFS). Today, there are five: in addition to WFS, we have Moderation Management, Rational Recovery, Secular Organizations for Sobriety, and S.M.A.R.T. Recovery. All of these groups have now survived for at least several years, and it seems reasonable to expect that at least two or three of them will prosper in the coming years. As they do so, they'll become better known, and AA's reputation as the only game in town will disappear; and with its disappearance, AA's volume of walk-in traffic will again decline.

A final reason to believe that AA will shrink significantly over the next decade or two is AA's ideological fossilization. AA will not be able, as it has not been able, to adapt its program to changing social realities. AA's mem-bership characteristics and organizational structure ensure this.

To a great extent, AA's direction in the coming years will be determined by its members, especially those members actively involved in AA's administration. For the most part, these people are quite conservative; AA's service structure is staffed by members deeply imbued with AA tradition who love the 12-step program just the way it is, and who would fight to keep it from changing.

This is strongly related to the religious nature of AA's program. For many, probably most, AA members, the 12 steps and related beliefs are articles of faith; and it would be as unrealistic to expect AA believers to alter their central beliefs as it would be to expect Catholics to alter theirs. Additionally, as indicated in AA's Service Manual, approval by three-quarters of all registered AA groups would be required to make any changes in the heart of AA's program, the 12 steps. Anyone familiar with AA will recognize that this makes changes in the steps, AA's ideological core, utterly impossible. In spite of changes in the composition of its membership, it seems certain that as long as AA survives it will continue to be what it has been since its articles of faith were first published in 1939: a religiously oriented ideological fossil.

These six things—the shrinkage of inpatient treatment; the drying up of court/penal-mandated attendance; AA's ineffectiveness; the loosening of its stranglehold on the media; the appearance and endurance of the "alternative" self-help groups; and AA's inability to adapt its program to changing social conditions—virtually ensure that AA will begin to shrink significantly within the near future, perhaps within the next five to ten years; and they make it entirely possible that AA will cease to exist as a significant social movement by the second quarter of the 21st century.