In this Edition of Critical Links:

December Dates of Interest

CFIC News and Events
  • The Cost of Religion
  • Branch Updates

Think Check
  • The Tragedy of the Commons
  • Y2K: 20/20 Hindsight 20 Years Later
  • Keith’s Conundrums: Joan and the single string

Science Check
  • Vaccine Roundup

Secular Check
  • Book Review: Unveiled: How Western Liberals Empower Radical Islam, by Yasmine Mohammed
  • Sobriety, Addiction Treatment, and Secular Exclusion (Part Two)

December Dates of Interest
December 1 is World AIDS Day . There have been many medical advances in the area of AIDS prevention and treatment since the disease was first identified in the 1980s. Yet according to the WHO, the HIV epidemic is not over .

December 6 marks 30 years since the tragic mass shooting at l'École Polytechnique de Montréal, which saw the promising lives of 14 young women cut violently short. This senseless act of targeted violence shook our country and led Parliament to designate December 6 as the National Day of Remembrance and Action on Violence Against Women.

December 8 is Pretend to be a Time Traveler Day . Whether you are Marty McFly, Martha Jones, or the man in H.G. Wells’ time machine, here are some tips .

December 10 marks the end of the 70 th anniversary of the Universal Declaration of Human Rights .

December 12 and 13 , the Geminid meteor shower returns . (Unlike most other meteor showers, the Geminids are not associated with a comet but with the asteroid 3200 Phaethon.)

Though the coldest days of winter will still be to come, the days start getting longer as of 11:19 pm on December 21 .

If you celebrate any of these, or have suggestions for upcoming celebrations or observances, please drop us a line or send a picture to .

CFIC News & Events
The Cost of Religion

In November, CFIC issued the first of a series of reports on the cost of religion. These reports are intended to create an important dialogue. We certainly achieved that. Thanks to everyone who engaged in this conversation on our website and through social media, and especially those who took the time to write us thought-provoking letters.

In this first report, we explored the cost of tax credits for people who donated to charities that self-identified as being in the category “Advancement of Religion.” If you missed it, you can download the report and add your comments here .

Here’s what you have to look forward to in 2020:
  • A more detailed look at the activities (religious and public benefit) carried out by religious charities
  • A review of government transfers to religious charities
  • An assessment of the cost of tax incentives (permissive tax exemptions, GST/HST exemptions, income tax, clergy residence deductions)
  • Exploration into the social costs of including advancement of religion as a charitable purpose
Ottawa Evolution Pub Quiz

Do you know what a batologist studies? Or a chiroptologist? Or who said “Nothing in biology makes sense except in the light of evolution”? On November 24, CFIC Ottawa celebrated the 160 th anniversary of Charles Darwin’s publication of On the Origin of Species with a science- and evolution-themed pub quiz. Five teams competed for prizes and bragging rights, and accumulated yet more useful (?) facts to store away for next time.
Upcoming Montreal Event

Skeptics in the Pub: Saturday, December 28

Montreal West Island Skeptics in the Pub is a fun and friendly casual social event that welcomes all local science enthusiasts who value critical thinking, reason, and skepticism. This is a great opportunity to discuss current events, share ideas, and meet new people, in a relaxed atmosphere.

Our next meeting is Saturday, December 28, 5:00pm — more information here.

Upcoming Ottawa Events

Making Sense of Medical Research Reporting: Sunday, December 1

This hands-on workshop will cover the common types of health research methods that deal with therapies, and how that research is used to develop national guideline recommendations. Our presenter, Dr. Michael Allen, has an MSc in Community Health and Epidemiology and has taught evidence-based medicine to physicians and medical students through his work for Dalhousie University Faculty of Medicine. (More information here . )

Living Without Religion Holiday Brunch: Sunday, December 22

CFIC Ottawa’s Living Without Religion group will have a secular holiday brunch on December 22 . Come celebrate the holiday season, the first morning of the winter solstice, the end of Saturnalia, and the eve of both HumanLight and Festivus with free-thinkers, atheists, agnostics, secular humanists, those questioning their faith, and others who are no longer part of a religious community. This won't be a traditional Christmas party — nor a celebration of Hanukkah, Yule, Mawlid, Kwanzaa, or Noël. EVERYONE IS WELCOME!
Volunteers Needed!

If you are interested in becoming a part of the CFIC volunteer team, please complete a volunteer application .

Think Check      /by-sa/2.0/deed.en
The Tragedy of the Commons
Sandra Dunham

I have enjoyed the dramatic sound of this term since I first heard it studying undergraduate economics in the 1980s. Throughout the ensuing 30+ years, I have seen this tragedy play out many times and I am currently witnessing it firsthand with CFIC.

The tragedy of the commons is a concept that was popularized by biologist Garret Hardin in 1968. He defines it as “a situation in a shared-resource system where individual users, acting independently according to their own self-interest, behave contrary to the common good of all users, by depleting or spoiling that resource through their collective action.”

The example that resonates with me is of a neighbourhood with joint parkland. If all the neighbours pitch in to keep the parkland clean, everyone can enjoy it. However, if everyone assumes someone else looks after the parkland, eventually the parkland is ruined because no one is actually taking care of it, because they assume everyone else is. Now no one can enjoy the park, a tragedy for all.

Why am I seeing this with CFIC? Our readers all (I presume) recognize the crisis of fake news. People and institutions are spreading false information and pseudoscience to serve their self-interest at the expense of others. Our readers recognize that the common good is served by promoting the values of secularism, science, and critical thinking. However, too many leave this work for others to do, while still reaping the benefits.

Because of apathy, we see a current instantiation of the tragedy of the commons with fake news and pseudoscience gaining ever greater prominence. We need critical thinkers like you to help create a more just society by dispelling the lies from the many purveyors of fake news and rebutting deceitful, self-interested propaganda from anti-scientific purveyors of climate denial, for example. Whether you represent an organization, an informal group of like-minded people, or simply yourself — we need you to get involved.

Organizations and informal groups are invited to reach out to us at to explore how we can collaborate to find better ways to promote critical thinking and defeat pseudoscience and fake news.

If you are not already supporting CFIC, now is the time to do so. Without you, we cannot continue to fight for this important cause. Please don’t let CFIC wither due to the tragedy of the commons . Please join , donate , and volunteer . We need you.
Y2K: 20/20 Hindsight 20 Years Later
Seanna Watson

Twenty years ago, we were on the cusp of a new millennium. (Yes, I know that there are pedants who assert that the actual start of this millennium was January 1st, 2001, since there was no year “zero.” But I think most people were on the side of the “odometerists.” What they really cared about was watching all those number 9s roll over to 0s.)

In any case, January 1, 2000, came — the calendar turned, and not much happened. Power stations did not suddenly spin up or spin down their turbines, sewers did not back up, planes did not fall out of the sky, billionaires’ bank balances did not suddenly appear in the accounts of the 1 percent. In other words, the world continued pretty much as usual.

There are two possible explanations for this. Some have said that all the concern about Y2K was a trumped-up hoax — perhaps a money-making scheme for out-of-work Cobol programmers (or for people who want to make a quick buck selling silly plush toys like that fuzzy Y2K bug). But others would argue that the reason nothing much happened was because of all the work that was done — we really did avert potential disaster.

What was the Y2K problem, anyway? Well, memory for early computers was very expensive. Rather than use four digits to denote a year, programmers usually just used the last two digits. Which is fine until you cross a century boundary — at which point the person born in 1975 turns -75 on their 25 th birthday. (It gets even more complicated when considering the fact that because of the way computers represent negative numbers, a result that is not expected to be negative is likely to appear as a very large positive number instead.)

Of course, programmers were well aware of this. But the end of the century seemed so far away that no one thought critically about it. They thought that their code would likely be replaced long before it would cause trouble. But as it turned out, a lot of code lasted far longer than anyone expected. “If it ain’t broke, don’t fix it” is generally considered good practice in software design, since even minor changes have the risk of introducing unexpected consequences.

So, let’s take a trip back two decades, to 1999. At the time, I was leading a team of people responsible for IT and security for the computers and networks used by Nortel’s hardware and software designers. The computers we used were running various flavours of Unix (an operating system which very few non-techies had even heard of at the time, but which, these days, most of us are carrying around in our pockets).

As with pretty much all of the rest of the industry, Nortel’s phone system software, written in the 1970s, ‘80s, and ‘90s had two-digit dates, and we had teams of people working on making products Y2K compliant.

By the end of 1999, the work was considered pretty much complete, but of course it would be arrogant to discount Murphy’s Law, ever the bane of engineers. So on December 31 of that year, teams of Nortel software designers stood ready to jump in and make last-minute fixes (since everyone needs to be able to call up their grandma to wish her happy New Year). And so my internal tech-support team needed to be available in case the designers’ workstations had Y2K problems of their own. So I was not drinking champagne on the cusp of the millennium, just in case I had to drive to work and fix some servers.

(As it turns out, we did have a server failure related to Y2K. We had decided to reboot all our servers on January 1, 2000, to give us a chance to fix any issues that might come up before work resumed after the Xmas break. And, in fact, one of our servers failed to come up after reboot. It was getting on in years, and one of its disks did not survive the ordeal of powering down and back up again.)

It has been estimated that the government and private expenditure to fix the Y2K bug was about $100 billion. When the year 2000 rolled around, nothing much happened. Which has resulted in a lot of cynicism about whether it was really a hoax after all. But as skeptics, we can look at the evidence. Though companies were reluctant to provide specifics, it was pretty clear that there was a significant number of potential issues found and fixed. Y2K hype might have fed into the hysteria of “preppers,” but perhaps having a bit of that trickle down to the general public is a good thing. *

People who work in IT and computer security will tell you that it’s one of those jobs where you are either invisible or in trouble. Invisible is better. Though it’s probably a good thing to have a bit of skepticism to keep us on our toes, there is always a balancing act. People are not very good at addressing “invisible or in trouble.”

A topical example is vaccines. As fewer people remember deaths and disabilities caused by so-called normal childhood illnesses, the tendency is to minimize the risk. Now we are starting to see outbreaks of measles, which had been on the verge of eradication. And of course there is the looming existential threat of climate change. It’s no longer quite so invisible as it once was , but it remains to be seen how far we need to get “in trouble” before it is taken sufficiently seriously.

* PSA: Emergency Preparedness Canada recommends that people keep 72 hours’ worth of household supplies — medications, food, water, flashlights, etc.
Keith’s Conundrums: Joan and the single string
Keith Douglas

In this column I will pose “funny problems.” Some will be paradoxes; some will be weird things to think through. Generally they will have a popular science and philosophy feel, though some are taken from undergraduate-level discussions as well. Feel free to write back with comments, questions, and any feedback you wish. You can email me at , or post a comment on the CFIC website . In each column, I will discuss the feedback and more details about the previous problem and introduce a new one. 

Last issue , I asked about the fable of Buridan’s Ass, a donkey that is so indecisive that it starves to death. Before I analyze the problem, a historical note first, if I may:

The name “Buridan” is the name of a medieval French philosopher, but as far as we can tell he did not address the problem as we have stated it (though versions are found in the works of many other thinkers from many places and times). The erroneous naming seems to be due to Spinoza, for what that’s worth.

The lesson seems to be one about the nature of choice. I personally draw the lesson that sometimes it is good to be random, or rather to introduce a factor independent of a choice that seems otherwise arbitrary. This is actually used formally in some distributed systems in computing: If we have two processes competing for a resource, we do not want them to retry at the same time and repeatedly go into contention. So, they each select a random “back-off time” and then hopefully do not need to compete when they try again.

Some people go further in the realm of choice and ask if the situation of the hapless donkey suggests something about freedom of the will. Philosophers generally do not buy the idea that randomizers are how we are free (so no, quantum mechanics or other sources of randomness do not make one free). Yet here there does seem to be a case for their use — to avoid will at all! (Or so one might say.) Hume laughs, and we move on.

Before we get to this month’s conundrum, I would like to also report I eventually received a note about a previous conundrum. Steve Watson wrote about “ A puzzle about measurements ,” where we asked ourselves if all properties are actually lengths. He suggested that the lengths are analogs, which is what I was on about when I suggested indicator hypotheses — instead an engineering use which is a bit more pragmatic (maybe).

Both are interesting areas of study, but again only open to the realist. Those seeking an interesting area to study could investigate how these work. I for one would have liked to have them addressed in the science curriculum in high school even if in a simple way. The problem is that many instruments have a more complicated theory of operation than the simple systems that they can be used to analyze. For example, a simple theory of the ammeter requires understanding the tangent function from trigonometry (and perhaps even the integral calculus), whereas one can understand simple DC circuits with grade school arithmetic (sums and products of fractions).

On to the next conundrum.

Joan and the Single String

A good friend of mine is a cellist. We talk from time to time about the nature of her instrument, and as I don’t know much about music and she doesn’t know much physics we have a hard time understanding each other in these conversations.

In order to understand the cello, I started by the usual (second- or third-semester physics) simplest understanding of a vibrating string fixed at both ends. This gives a very simple equation for the frequency of the string’s vibration when it is plucked.

Joan and I both agreed that this was an oversimplification. It did not predict much of the cellist’s experiences, nor, we agreed, was it meant to. Yet we obviously cannot capture everything about even the simplest of systems. Where should we stop? Here are some features of the cello we left out by pretending it was a single plucked string:

  • The body of the cello, which seems to amplify some sound waves and deaden others
  • The fact that the bow does seem to do more than pluck the string (otherwise, why isn’t it plucked? It sure sounds different!)
  • The fact that one can in fact use the bow several different ways to different effect
  • The rosin on the string, which seems to work by increasing friction between the bow and the string (this isn’t even in the model the equation proposes)
  • The temperature dependence of the length of the strings and (perhaps) the body shape
  • The multiple strings influencing each other (“sympathetic vibrations” are, in a way, real, but not mysterious)

There are no doubt more, which is precisely the point. I have also ignored the psychological aspects for the time being (how the sound waves affect a human — or other — ear and nervous system).

So what goes into a good model of a physical system? How do we know when to stop? Does it matter that we are attempting to understand something used for aesthetic rather than (say) commercial purpose? (But of course Joan earns money by playing in concerts, and so on — so maybe that’s a false dichotomy.)

Fields to consider: scientific realism, metaphysics and epistemology of approximations and idealizations, physics, music, differential equations, the relation between an aesthetic understanding and a scientific one.

P.S.: If you have any good references for the physics of stringed instruments that go beyond the infinitely thick monochord attached at two ends and plucked at a single point, etc., let me know!

Science Check
Vaccine Roundup
Seanna Watson

The first vaccine, a preventive treatment for smallpox, was developed in the late 1700s. Over the years, vaccines have revolutionized medicine, saving millions of lives . Yet in the past few years, we have seen an increase of people who are opposed to vaccines.

The rate of philosophical exe mptions for children in alternative public schools both in Ottawa and in Toronto is alarmingly high (over 10 percent in some cases). This decrease in herd immunity presents a serious risk to people who are immunocompromised, or those too young to receive vaccines themselves.

Meanwhile, a group of Ontario parents has launched a lawsuit, challenging the requirement that in order to qualify for conscientious objection to vaccines, they must sign a form to acknowledge that they are accepting responsibility for putting their child’s “health and even life at risk.”

National Geographic Magazine discusses the Catch-22 of vaccines — the better they work, the more we are inclined to forget about how important they are.

Some anti-vaccination activists have adopted a new strategy that is similar to political propaganda campaigns — find out more about “ firehosing ” and how to combat it .

Many anti-vaxxers claim that measles is a benign disease, and that it is beneficial to acquire “natural immunity” (i.e., as opposed to the “artificial immunity” that results from vaccines). But the results of a recent study show that the measles virus can actually damage the body’s entire immune system , with effects lasting up to five years in some cases!

While Facebook claims to be clamping down on anti-vaccine ads, the same cannot be said for Google and Twitter , both of which have allowed ads saying “Don’t get vaccinated” and “Vaccines aren’t safe.”

A few years ago, CFIC reported on the tragic case of Ezekiel Stephan , whose death (after his parents had attempted to treat him with various natural remedies including those sold by the family business) was likely the result of a vaccine-preventable illness. Ezekiel Stephan’s father is now speaking out against the Canadian Medical Association .

While people worry about Ebola, a much more serious threat in the Democratic Republic of the Congo is measles. This disease has killed nearly 5,000 people in 2019 — more than twice the number who have died of Ebola in the last 15 months. Meanwhile, in Samoa, where the measles vaccination rate is estimated at between 28 and 40 percent, a measles outbreak has killed 22 people , nearly all children under five.

Secular Check
Book Review: Unveiled: How Western Liberals Empower Radical Islam , by Yasmine Mohammed
Gus Lyn-Piluso
All those interested in how humans overcome adversity must read this book. Yasmine is one of the bravest people of our time. She is a shining example to all of us.”  
— Ayaan Hirsi Ali

First-generation Canadian children often complain about feeling trapped between two worlds. At home, they live in the world of their parents’ traditions. These traditions come with beliefs and practices that have been around for so long that they are self-evident to those from back home. Yet their children only know “back home” to be the confines of family life. When these children are out and away from familial pressures, they encounter the complexity of Canadian life, which is at once liberating in its potential and terrifying in its lack of clarity. It would be easier to simply observe the age-old practices of home. The problem is that, once exposed to other possibilities, the yearning to explore and to see what else is out there is difficult to satisfy.

As a young Canadian, Yasmine Mohammed was caught between these worlds. She grew up in a fundamentalist Muslim family and, for the most part, assumed that this was just the way families were. But once she started to venture out, she soon found herself in conflict. Unveiled: How Western Liberals Empower Radical Islam is the story of how she dealt with this internal conflict and how it led her to courageous and selfless social and political activism.

Unveiled tells the story of how Yasmine became one of the most important human rights activists in Canada. Her work challenges Canadians of all stripes. She confronts Islamic cultural norms by asking hard questions about terrorism, female genital mutilation, and the subjugation of women, while also asking liberals like me why we go out of our way to make allowances for illiberal practices simply because of our desire to be supportive of new Canadians. She doesn’t tell us what to believe, but asks the uncomfortable questions that leave few stones unturned. As a result, we learn about our own blind spots and are transformed — and that is what a great book should do.

This is not an easy book to read, but it is also not an easy book to put down. It is at once personal and political, powerful and gentle, distressful and yet — in the end — hopeful.

Yasmine says that she “wrote this book to expose the dangerous blind spot many well-intentioned liberals have toward Islam. They give an outdated religious patriarchy a free pass when it comes to oppressing women. As someone who has lived through it, I want to speak up and insist that women’s rights are indeed universal.”

As one of the well-intentioned liberals this book is intended for, I know that many of my blind spots are no more. I have Yasmine to thank for this. Challenge yourself. Read this book.
Issues covered in  Unveiled: How Western Liberals Empower Radical Islam include :
  • Growing up Muslim in the West
  • Fundamentalist Islam and children
  • Being married to an Al Qaeda operative
  • Forced marriage
  • Surviving abuse
  • Failure of Western institutions to protect children in minority communities
  • Forced hijab
  • Feminism in the Muslim world
Unveiled : How Western Liberals Empower Radical Islam
Publisher : Free Hearts Free Minds (September 25, 2019)
ISBN : 978-1999240509
Sobriety, Addiction Treatment, and Secular Exclusion (Part Two)
Christjahn Beck

Let’s start with my second point, that AA (which I will focus on as a case study rather than try to individually address all 12-step programs) just doesn’t work. I want to begin here because I know that this claim will strike some people as hard to believe, given AA’s supremacy on the substance abuse treatment scene, and the longevity of its reign. I’ll start by saying this: When I say that AA “just doesn’t work,” I do not mean that it has never worked. It has worked for many people, full stop. What I do mean when I say it “just doesn’t work” is that it does not have nearly the success rate that you would expect from a program that presumably specializes in helping individuals to achieve sobriety.

How do I know this?

In recent years (very recent years, as a lot of this research has come out since I quit drinking), there has been an increased amount of attention paid to the efficacy of 12-step programs in treating addiction. This research can be quite difficult due to the anonymous nature of most 12-step programs. What we do know is that Alcoholics Anonymous ( otherwise known as “The Big Book” ), AA’s primary guidance tool for helping individuals achieve sobriety, states in the forward to the second edition that 50 percent of individuals who join AA achieve sobriety “at once” and 25 percent more struggle at first but eventually achieve sobriety. According to this document, 75 percent of those who “really tried” found the AA 12-step method to be effective long term.

Sounds pretty good, right?

There are two problems to note here. First, there is no information provided to indicate where AA actually gets these numbers. Second, and far more problematic, AA is only reporting numbers for those considered to be “really trying.” Individuals who are “really trying,” by AA’s programmatic definition, means individuals who are attending meetings, staying in contact with their sponsor, and abstaining from alcohol. If you stop attending meetings, fall out of contact with your sponsor, or start drinking, AA considers you to have left the program, thus not “really trying.” This means they do not take your outcome into consideration when self-reporting their success rates. Put more simply, a program that claims to help people achieve sobriety excludes from its self-reported success rate individuals who fail to achieve sobriety. Which seems to me to be... well… kind of missing the point?

This is a problem beyond just AA’s self-reported numbers. A series of academic studies that have purported to demonstrate the effectiveness of AA’s treatment model have come under scrutiny in recent years for not including in their final reporting the outcomes of patients who started drinking and stopped responding to their surveys. For a famous example of these analyses, see this comparison of treatment outcomes for problem drinkers seeking help.

So what is the real success rate of AA?

Lance Dodes, the Harvard addictions researcher I quoted earlier, wrote a book along with his son Zachary entitled The Sober Truth , in which they studied the 12-step program industry . According to the Dodes’ research, the actual long-term success rate of AA, taking into account relapses and dropouts, is somewhere between 5 to 9 percent. While such a percent recovery rate is certainly well below the 50 to 75 percent self-reported rate that AA publishes, it is also nothing to scoff at.

It is worth taking a moment, however, to put this into perspective. One study that Dodes cites in his research places the rate of “spontaneous remission” of alcohol abuse disorder (i.e., cessation of alcohol-related substance abuse without any intervention at all) between 3.7 and 7.4 percent. Another study places the success rate between 4 and 18 percent. The fact that AA’s actual success rate is well within the measured range of individuals achieving sobriety without any treatment at all is, needless to say, not encouraging.

What makes this even more troubling, given the lack of evidence for efficacy, is AA’s popularity with the U.S. criminal justice system as a referral for those struggling with addiction. AA reports that they have somewhere in the neighborhood of 1.5 million active members in the U.S. alone. From public records, we know that around 12 percent of all AA participants in the U.S. are court ordered. This means that at any given time, over 150,000 individuals in the U.S. are attending AA as a requirement of their parole/probation, with little evidence that this will ultimately lead to a recovery from addiction.

(It should be noted that several court cases have challenged the constitutionality of requiring AA/NA attendance as part of a plea/parole/probation mandate on First Amendment grounds, arguing that AA is sufficiently religious to qualify as a violation of an individual’s rights. For an example of this see the case of Barry Hazle Jr . )

The Moralizing of Addiction

Another major problem with the AA 12-step model is the moralizing of addiction. According to AA’s 12-step guide to recovery, addiction isn’t a medical or psychological issue, but rather it is a moral defect. AA’s steps 4 through 7:

4. Made a searching and fearless moral inventory of ourselves
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs
6. Were entirely ready to have God remove all these defects of character
7. Humbly asked Him to remove our shortcomings

(The capital H in “Him” is not a typo. It appears in the literature. More on that later.)

Additionally, the very first paragraph of chapter 5 of The Big Book contains this rather ignominious quote: “Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty.”

This quote demonstrates exactly what I mean when I talk about the moralization of addiction within 12-step programs. If you “fail,” with failure being defined narrowly as encompassing essentially anything other than complete and permanent abstinence, it is not thought to be because you simply made a mistake while trying to beat one hell of a disease. It is certainly not thought to be because the program itself is flawed. This failure is thought to be because you are “constitutionally incapable of being honest” with yourself. Not only is this false, but it is counter-productive to effective recovery. Nearly EVERYONE stumbles at some point in their road to sobriety.

The problem with our societal tendency to view addiction as a moral failing rather than a treatable psychological or medical condition extends beyond the unfortunate overlooking or non-use of empirically supported treatments like therapy or medication. This moralized view of addiction is so prevalent in the U.S. that, according to the Center on Addiction and Substance Abuse at Columbia University (CASA), American medical professionals routinely fail to diagnose alcoholism as a potential cause for a given set of symptoms common to alcohol dependency.

In a survey conducted by CASA , the authors noted that “94% of primary care physicians (excluding pediatricians) failed to identify addiction as a possible diagnosis when asked to offer five possible diagnoses of a patient with symptoms of risky alcohol use.” Viewing addiction/alcoholism as a moral failing is so persistent in the U.S. that even medical professionals may be less likely to consider alcohol dependency as a medical diagnosis, and thus many doctors are potentially misdiagnosing and mistreating patients suffering from addiction.

Perhaps not surprisingly, given the incredibly low diagnostic rates among American doctors, a shockingly low percentage of the overall referrals for addictions treatment in the U.S. come from healthcare providers. The CASA study mentioned above found that only 5.7 percent of all referrals to publicly funded addiction treatment programs in the U.S. came from healthcare providers.

Accentuating the point, in this same study the single largest source of referrals for individuals to publicly funded substance abuse treatment programs came from the criminal justice system, which accounted for nearly half of all referrals and significantly more than community resources, addiction treatment providers, healthcare providers, schools and employers combined.
Consider the implications of this, both for addicts and for those tasked with treating addiction. Addicts are often being forced to seek treatment, which is not conducive to recovery, and the treatment counsellors are often first encountering their clients in an adversarial setting. Yikes...

The Exclusion of Secular Individuals

Before I knew anything about the inefficacy of the 12-step model, I already knew that AA was not for me. This wasn’t because I didn’t take sobriety seriously. I absolutely did and still do. Rather, many of the steps already struck me as excluding non-secular individuals like me, an atheist.

Over half of the 12 steps directly implicate God or a higher power. Reading on, in Chapter 6 of Alcoholics Anonymous , during a discussion of how to approach those that one may have harmed during the course of their addiction, there is this not so subtle hint that AA might not be for secular folks.

To some people we need not, and probably should not, emphasize the spiritual feature on our first approach. We might prejudice them. At the moment we are trying to put our lives in order. But this is not an end in itself. Our real purpose is to fit ourselves to be of maximum service to God and the people around us.

My decision to quit drinking had nothing to do with fitting myself to be of maximum service to God, turning my life over to a power greater than myself, or believing that I needed any external intervention in order to “restore me to sanity.” Instead, sobriety was about reestablishing control over my life and proving to myself that I had the strength and the willpower to improve on my own. The very idea of turning my will and my life over to “the care of God” ran entirely contrary to what sobriety represented in my mind, not just from a spiritual perspective (or lack thereof), but from a philosophical approach as well.

In the interest of fairness, I should mention that there are thriving agnostic AA groups throughout the world. (See, for example, here and here .) As with the melding of any two beliefs or philosophies, it is possible to adapt one’s own approach to an overarching philosophy in such a way that no contradiction is to be found, just like it is similarly possible to accept that you are operating within a contradiction and go on functioning in spite of that. There is nothing inherently wrong with this (in fact, we all likely do it without realizing it). If creating a secular version of AA helps some agnostics manage their life, I am all for it. I would never tell someone in recovery they are doing it wrong, just because I happen to find that their approach doesn’t work for me.

While it is undeniable that AA is rooted in Christianity — as was the Oxford Group , which both of AA’s founders belonged to prior to forming AA — it is noteworthy that " as they understand Him" is a core part of the original 12 steps. While the capitalization of H, as I’ve noted above, leaves a not-so-subtle clue about the Christian roots AA is founded upon (Christians always capitalize the H in “Him” or “His” when talking about God), not all participants choose to read this passage as overtly Christian or even spiritual, and thus non-Christians are still able to follow the steps in a way that makes sense to them.

AA members will tell you that even if you are secular you are just as welcome as anyone else, and my experience has led me to believe that this is absolutely true. I’ve never met someone from AA or any other 12-step program who even hinted that my atheism would preclude me from involvement in their group. Even so, the language itself is so fundamentally at odds with my worldview that I have simply never found it useful to try and manage my recovery from within this philosophical structure. I now go into conversations about 12-step programs fully prepared to discuss the information that I know about the efficacy of this method, if the situation calls for it, while simultaneously being sincerely ready to tell anyone that if they think a 12-step program is what they need in order to get their life in order that I hope they do it. This, however, brings me to my final point.

The Implications of Failure

Because of the legacy of 12-step programs, there is often an all-or-nothing approach to recovery. Once you are an alcoholic you are always an alcoholic, and you either abstain from alcohol completely or you are still an active addict. I know this is true because I find that I have internalized it myself, even though I think it is a load of garbage. Due to the history of moralizing addiction, where any slip-up in recovery is treated as a moral failure and an abandonment of treatment altogether, we continue to believe that once someone has demonstrated that they are unable to handle alcohol for even a short period of their life that this necessarily means that they are permanently damaged and will never be able to drink responsibly again.

While it seems to be true that some people are genetically predisposed to a lack of impulse control which can contribute to addiction, and some may metabolize alcohol differently from others putting them at increased risk of abuse, it is also true that many (perhaps most) people who may go through a period of time where they struggle with unhealthy levels of drinking do not fall into these risk categories. With more empirically rooted approaches to treating addiction/alcoholism, for instance, it is common that addicts work with their doctor or therapist to set their own goals for managing their addiction. For some this may mean voluntary long-term/permanent abstinence, while for others this can just mean taking some time to change their patterns of behavior or addressing underlying triggers, then returning to drinking in moderation at safe levels.

Many factors such as stressful personal circumstances, social groups/habits, geographical isolation, or even simultaneously occurring mental health issues affect a person’s desire to drink, especially in excess. If, for example, someone has gone through their life drinking in moderation at safe levels, but then a divorce serves as a trigger that results in them self-medicating their anxiety/depression for a period of time (even a prolonged period of time), it is not necessarily the case that when this individual’s period of personal turmoil has passed that they would suddenly be incapable of returning to the safe level of alcohol consumption that they had previously maintained throughout their life. With the all-or-nothing 12-step approach, though, individuals are convinced that if they have struggled with alcoholism for any period of time during their life, they are therefore damaged and defective, lack control over their own life, are reliant upon a higher power in order to maintain sobriety, and should consider themselves to be an active alcoholic for the rest of their life.

Personally, I think that this approach is bogus and that it flies in the face of just about everything that we know about human nature. I think that people ARE capable of change and I think that just because you made a mistake (or even a series of them) during one point in your life does not mean that you are doomed to repeat it ad infinitum. BUT , I still don’t drink.

I think I probably could, but I have thus far chosen not to. I’ve made this decision because I saw just how badly my life can go when I over-indulge. I’ve decided that the benefits of drinking (occasional fun, ease of social interaction, the taste of whisky… because yum!) are far outweighed by even a slight chance that I return to my previous unhealthy level of consumption. I'm hyper-aware, though, that this fear that I'm only one slip up away from returning to alcoholism is, at least in part, based on the internalized terror that I have had pounded into my head for years: Once you are an alcoholic you are always an alcoholic. To individuals who were raised in the church and have gone through the often painful process of de-conversion, this internalized guilt, fear, and self-doubt will sound quite familiar.

Wrapping Up

When I quit drinking, I spent the first several nights staying at my mother’s house, in order to change my routine and have someone to talk to. I went to a doctor in order to determine how much damage I had done to myself physically. After talking to my doctor, I was given two options. The first was a very expensive in-patient facility that reports costs on average $16,800 for a 14-day stay. The second was to attend a free 12-step program that would take place entirely separate from medical/psychological supervision. I was uninsured at the time and certainly could not afford $16,800 for two weeks of treatment. I went with the 12-step program. However, put off by the innate spirituality, and deeply concerned by the obvious lack of expertise present in my group, I soon made the decision to leave this program as well and pursue my sobriety entirely on my own.

The lack of expertise in 12-step programs is a real problem. According to an April 2015 article in The Atlantic , there is no mandatory national certification exam for addiction counselors (in the U.S.). The 2012 Columbia University report on addiction medicine found that only six states required alcohol- and substance-abuse counsellors to have at least a bachelor’s degree and that only one state, Vermont, required a master’s degree. Fourteen states had no license requirements whatsoever — not even a GED or an introductory training course was necessary — and yet counsellors are often called on by the judicial system and medical boards to give expert opinions on their clients’ prospects for recovery.

For some perspective on this lack of a licensing requirement, in the U.S. all 50 states currently require training and licensing in order to be certified as a cosmetologist. Now, please do not interpret this as me denigrating cosmetologists. I am not. I am glad that individuals whose profession includes the application of potentially harmful chemicals onto the skin of their fellow citizens are required to have training and be licensed. I simply wish that the U.S. had at least the same standard for individuals who are going to be responsible for their client’s recovery from a deadly disease.

The entire 12-step model, sometimes referred to as the “mutual support model,” is predicated upon surrounding yourself with fellow addicts who have been through the same thing. While this support system is undeniably useful and has its place in recovery, it should be seen as a supplement to treatment rather than being conflated with treatment itself. Imagine if we treated any other mental health or medical problem this way. Imagine an individual struggling with suicidal thoughts working up the courage to go to a hospital and ask for help, but instead of being admitted and referred to a mental health professional they were just given a physical, discharged, and told to go to the basement of the local Methodist church every Monday and Thursday so that they could have coffee and donuts with a room full of other suicidal people, none of whom have any training or mental health credentials. We would justifiably be incensed if this were happening.

Twelve-step programs are to substance abuse treatment what abstinence-only curricula are to sex education. That is the level of empiricism and regressiveness that we are talking about. If you know someone who is struggling with addiction, particularly if they are struggling alone, be there for them. Secular support systems are few and far between, and I know all too well how hard it is to try to recover alone. But, also, if you know someone going through this, help them begin looking into more foundationally empirical addiction treatment programs. Programs like this do exist, and there are ways to get help with costs. By being there for someone struggling with addiction you might literally be saving their life.

You may now return to your regularly scheduled guilt-free cocktail.

(Check out CFIC’s previous takes on 12-step programs here and here .)
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