folks keep bringing this to my attention: the irrationality of alcoholics anonymous. what i want to say is this: i have seen 12-step programs work for many people, and i have never seen anything else work. i believe that total abstinence is the only possibility for people like me; i believe i know that as well as anyone can know anything. and i have a funny feeling that some brief therapeutic intervention and drugs drugs drugs are going to have an even more impressive rate of failure. also i will say say that most doctors, neuro-obsessives, and gabrielle glazer do not understand what addiction is. also aa is spiritually profound. also perhaps rationality will kill you in the end.
now this is not to say that the whole aa thing is well thought-out on the philosophical or scientific levels. it originates basically among non-scientists of the 1930s; really it was founded by desperate alcoholics, ok? smart people but not harvard profs. this is also why it does work, when it does. now the big book asserts flatly that alcoholism is a disease. then again, it doesn't say what 'disease' means, exactly. at one point it even tries 'allergy'. but actually it's apparently an early version and one of the fundamental sources of the flat medicalization of addiction that now takes the form of genetics and neurotransmitters. but then 'made a list of all the people we had harmed and became willing to make amends to them all' (for example) is an odd therapy for a genetic or neurological disorder.
so i don't think that aa or 12 step really has a coherent notion of addiction. also i think the disease model of addiction is really very half-assed and ill-thought-out, though people sort of insist on its literal truth, whatever that would mean exactly. what 12-step programs have is the insight - not really compatible with the notion of alcoholism as an organic disorder - that really you've got to undergo a kind of spiritual transformation, however you want to think about that. that the transformation begins with surrender is one of the profound bits. now, what the scientists and docs that glazer recommends don't have is any sort of connection to the phenomenology of addiction: what it's like to be an addict. you really really do not want to turn the matter over to them.
but honestly, no one has a clear conception of addiction, i believe. it is a great puzzle in ethical theory, especially as it bears on free will and responsibility. we are poised between all sorts of medical, moral, and spiritual models that are not nearly as distinct as people think. the brainboys have no more sense of what they're looking for than did jung, and there have been few more primitive stabs at the thing than the whole 'lights up your pleasure pathways' or 'dopamine' route: really, pathetic. but however, no one is doing much good here. you'd have to know what you're looking for to find it in someone's brain, yes? but it's not in a brain: it's in a brain embedded in a social and physical world.