AA有效吗？

大家好。

Hey, everybody.

欢迎来到《开放辩论》。

Welcome to Open to Debate.

我是约翰·多万。

I'm John Donvan.

我只是短暂出现一下，把本集的主持权交给我们的常驻嘉宾主持人娜伊拉·雷扎。

Just dropping in very briefly to hand off the reins for this episode to our frequent guest moderator, Naima Reza.

娜伊拉，你来主持吧。

Naima, take it away.

我是娜伊拉·雷扎。

I'm Naima Reza.

欢迎来到《开放辩论》。

Welcome Welcome to Open to Debate.

一月通常很冷，也通常很干燥。

January is a month that is often cold and often one that is dry.

我说的不是气候。

And by that, I don't mean the climate.

每到新年，许多人会立下戒酒的决心，有的目标是一个月，有的则是永久戒酒。

Every new year, many people make a resolution to stop drinking, some with the goal of a month and others with the goal of forever.

因此，审视这一领域的主要运动——匿名戒酒会（AA），并辩论‘AA有效吗？’这个问题显得恰逢其时。

So it seemed timely to examine the leading movement in this space, Alcoholics Anonymous, and debate the question, does AA work?

全球有超过12万个AA小组，其中50%位于美国，该组织的全球会员人数估计约为200万人。

There are over a 120,000 AA groups worldwide, 50% of them are in The United States, and the organization's worldwide membership is estimated at around 2,000,000 people.

尽管AA在康复过程中常被赞誉和推崇，这并不令人意外。

Though it's no surprise that AA is often credited and lauded for its role in recovery.

然而，该组织也面临不少批评，主要围绕其宗教根源、有效性，甚至其对其他潜在替代方案的主导地位。

Yet the organization also gets its fair share of criticism with complaints around AA's religious roots, its effectiveness, and even its dominance over other potential alternatives.

那么，AA有效吗？

So does AA work?

为回答这个问题，让我介绍一下我们的辩手。

To answer that, let me introduce our debaters.

支持AA确实有效的论点由丹·格里芬提出。

Arguing yes that AA does work is Dan Griffin.

他拥有社会学硕士学位，拥有三十年作为AA康复领域演讲者和专家的经验，尤其以著作《男性如何走完十二步》而闻名。

He has a master's in sociology with three decades of experience as a speaker and expert on recovery in AA, and he's notably the author of A Man's Way Through the 12 Steps.

丹，非常感谢你来到这里。

Dan, thanks so much for being here.

很高兴能来到这里。

It's great to be here.

而反对‘AA是否有效’这一问题的是阿迪·贾菲。

And here to argue no to the question, does AA work?

我们有阿迪·贾菲。

We have Adi Jaffe.

阿迪拥有心理学博士学位，是Ignited的创始人，也是即将出版的书籍《永远摆脱成瘾》的作者。

Adi holds a PhD in psychology and he's the founder of Ignited, as well as the author of the forthcoming book, Free Yourself from Addiction Forever.

阿迪，欢迎你。

Adee, welcome.

非常感谢你们邀请我。

Thanks so much for having me.

感谢你们两位今天到场并参与这场辩论。

Thank you both for being here today and for debating this.

我真的很想了解是什么让你们来到这里。

I really want to get to what brought you here.

但在那之前，先听听你们的开场陈述。

But first, let's hear your opening statements.

我们希望你们每人花几分钟时间阐述自己的立场，为讨论奠定基础。

We want each of you to take a few minutes to explain your position and set the table here.

那么，丹，你先来。

So, Dan, you're up first.

你主张戒酒互助会确实有效。

You're arguing that, yes, AA does work.

告诉我们为什么。

Tell us why.

好的。

Alright.

能来到这里并与贾夫医生进行这场对话，我感到非常荣幸。

Well, it's true pleasure to be here and having this conversation with doctor Jaffe.

让我明确说明一下。

And let me be very clear.

我并不代表匿名戒酒会，也不为其发言。

I do not represent AA or speak for AA.

我是匿名戒酒会的朋友。

I'm a friend of AA.

核心问题似乎是：匿名戒酒会有效吗？

The fundamental question appears to be, does AA work?

首先，匿名戒酒会只有一个主要目的，那就是帮助仍在受苦的酗酒者。

And so first, AA has one primary purpose, and that's to help the alcoholic who is still suffering.

它在过去九十年里尽其所能做到了这一点，因此它实际上对这个问题没有立场。

It's done that as best it can for ninety years, So it really doesn't have an opinion on this issue.

下一个问题是，当我们说AA时，我们指的是什么？

The next point is, what are we referring to when we say AA?

有AA这个组织。

There's the AA organization.

还有人们参与的AA康复计划。

There's the AA program of recovery that people participate in.

还有那些会议，正如你所说，遍布全球，人们根据团体良知实践这一计划，而这种良知可能因国家不同甚至因州不同而有所差异。

And then there are the meetings that, as you said, all over the world where people practice the program according to a group conscience that can differ from one country to the next and even from one state to the next.

AA是治疗酗酒的唯一有效方案吗？

Is AA the only effective program for alcoholism?

绝对不是。

Absolutely not.

AA从未声称自己是唯一有效的方案。

And AA has never purported to be that.

它的文献中多次明确指出这一点。

It states clearly in its literature numerous times that it is not.

AA适合每个人吗？

Is AA for everybody?

绝对不适合。

Absolutely not.

因为那些不是酗酒者的人——但需要明确的是，AA关于项目成员资格的说法是，它真正面向的是那些有戒酒愿望的人。

Because those who are not alcoholic, though to be clear, what AA says about membership in the program is that it's really for those who have a desire to stop drinking.

而这唯一的条件。

And that's the only requirement.

患有成瘾障碍的人通常并不会主动前来寻求帮助。

People with addictive disorders do not come into AA usually ready for help.

很多时候，他们是被强迫来的。

A lot of the times they've come after being forced.

而且很多时候，是在尝试过控制和节制饮酒之后才来的，因为事实上，很多人最不想去的地方就是AA。

And certainly a lot of the time after having tried to control and moderate their drinking because the truth is the last place that a lot of people want to end up is AA.

也已经有很多重要的研究提出了同样的问题，即AA是否有效。

There's also been a lot of significant research asking the same question as to whether or not AA works.

一些研究认为不行。

And some of the research has said no.

一些研究则认为可以。

And some of the research has says yes.

我找到的最新研究是凯利·汉弗莱斯和费里进行的一项全面的元分析研究。

The most recent research that I could find was a comprehensive meta analytical study by Kelly Humphries and Ferry.

该研究分析了27项研究，涉及超过一万名参与者。

It looked at 27 studies with over 10,000 participants.

研究明确发现，与诸如四步疗法等个体心理干预相比，匿名戒酒会（AA）的效果明显优于单独的个体治疗。

And it found unequivocally that compared to individual therapeutic interventions like four, it looked at that AA was unequivocally more effective than individual therapy alone.

好消息是，不一定非得只靠AA本身。

The good news is it doesn't have to be just AA by itself.

还有大量研究证明，人际联结在超越成瘾的康复过程中具有强大作用。

There's also extensive research showing the power of connection in healing far beyond addiction.

许多疾病和其他社会问题都采用了十二步疗法，更不用说还有数十种不同类型的十二步项目，它们都在试图应对和治愈正在困扰我们国家和世界的巨大 Disconnect 与孤独流行病。

Numerous illnesses and other social issues have adopted the 12 Step approach, not including the fact that there are dozens of different types of 12 Step programs, all of which are trying to address and heal this massive epidemic of disconnection and loneliness that's plaguing our country and our world.

那么它完美吗？

So is it perfect?

当然不完美。

Of course not.

医生。

Doctor.

贾菲医生，我知道他是帮助那些受苦者这一更大事业的盟友，可能会告诉你，匿名戒酒会已经过时了，它完成了自己的使命。

Jaffe, who I know is an ally in a much larger cause of helping those suffering, is likely to tell you that AA is behind the times or it's antiquated and it served its purpose.

这确实有一定道理，但匿名戒酒会正在变化，这种变化是由匿名戒酒会成员自身推动的，比如将有效的精神健康治疗与药物结合、理解创伤的影响，以及更加开放地审视性别歧视或性别偏见的语言，为所有性取向和性别认同者提供一个安全的环境。

There's some truth to that, but it is changing as driven by the members of AA itself, whether it's effective mental health treatment and the use medication paired with AA involvement, understanding the impact of trauma or being more open to looking at sexist or gender biased language and being a safe place for all sexual and gender identities.

所有这些变化都在匿名戒酒会中发生，尽管并非由组织本身推动，而是由成员推动的。

All of that is happening in AA, though it's not being driven by the organization itself, but the membership.

所以匿名戒酒会是有效的。

So AA works.

它确实不完美，毫无疑问。

It works imperfectly, no doubt.

但在近九十年的历史中，明年就满九十年了，它已经改变了数百万人的生活，并对我们的社会产生了不可磨灭的积极影响。

But in its almost ninety years, next year is ninety years, it has transformed the lives of millions of people and has had an indelible and positive impact on our society.

谢谢。

Thank you.

非常感谢你，丹。

Thank you so much, Dan.

阿迪，你不同意。

Adi, you disagree.

你认为匿名戒酒会无效。

You are arguing that AA does not work.

你有四分钟时间来阐述你的观点。

You have four minutes to make your case.

谢谢，也感谢丹的开场。

Thank you and thank you Dan for starting us off.

非常兴奋能参与这场辩论。

Very, very excited to be part of this debate.

在我们为这场辩论做准备时，原本计划的一些重点，可能发生了轻微甚至更显著的调整。

And you know, as we were preparing for this debate, there were some slight, maybe more substantial changes in the focus that were looking to have.

起初，问题是：戒酒互助会是不是最好的治疗方法？

Know, it started off with, is AA the best treatment there is?

丹对此已经讲了不少。

Dan spoke about that a good bit.

戒酒互助会是否兑现了它的承诺？

Does AA deliver on its promises?

如果你对戒酒互助会不太了解，你甚至可能不知道它的承诺是什么。

Which if you're not really familiar with AA, you may not even know what the promises are.

然后是戒酒互助会是否有效，这最终成了我们讨论的核心。

And then does AA work, which is where we landed in the end.

因此，对我个人而言，在收集证据、思考我要讲什么的时候，我必须明确我的核心问题。

And so me, for myself, as I was collecting evidence and trying to figure out what I was going to talk about, I had to understand my primary question.

我在准备这场辩论时提出的核心问题是：如果你把有成瘾问题的人推荐给戒酒互助会这个组织、体系和聚会，你能否依赖它带来积极的效果？甚至连‘戒酒互助会’具体指什么，都显得模糊不清。

And the primary question that I was asking as I was preparing for this was, can you rely on AA to provide positive results for people with addiction if you refer them to the organization, the system, the meetings is then talked about, it's even nebulous what exactly you mean by AA.

因此，在这场辩论中，我必须提出一个实用的定义。

And so in this debate I had to come up with a working definition.

对我来说，'实用'意味着这种治疗方法或方式能够可靠且有效地解决这个问题，同时不会带来额外的伤害。

And to me working means that that treatment, that approach will provide reliable and effective resolution of the problem while causing no additional harm.

而我今天所要呈现的是，根据这一定义，匿名戒酒会（AA）并不能作为治疗成瘾的有效方法。

And what I'm presenting here today is that by that definition AA does not work as a treatment for addiction.

首先，正如丹已经指出的，它只适用于非常小的一部分人群，即那些希望永久戒酒的人，这立即排除了至少一半，甚至超过一半的饮酒问题者。

First of all, as Dan already pointed out, it is only meant for a very small subset of people, people looking to stop drinking forever, which immediately rules out at least by some measures, at least half, if not more than half of people who struggle with drinking.

所以，它甚至都不适用于至少一半的人，更不用说更多了。

So it's not even meant for at least half of the people, not more.

即使对于那些主动选择它并声称希望永久戒酒的人，它的长期成功率也非常低。

It also has very low long term success rates, even among the people who do choose it and say that they want to stop forever.

对吧？

Right?

我们谈论的是长期成功率只有百分之五、六，或者百分之八。

We're talking five, six, 8% success rate long term.

它并没有被可靠地实施，丹已经谈过了，对吧？

It is not reliably applied, Dan already talked about it, right?

每次会议都不同，甚至不受主要组织的控制。

Every meeting is different, it's not even controlled by the primary organization.

因此，无论你走进世界上哪个房间，治疗方式都不同，这是因为其过程缺乏科学严谨性和验证。

So the treatment is even different depending on which room you walk into all over the world, and that's because its process lacks scientific rigor and validation.

还有一个非常重要的事实：参与其中可能通过羞耻感、污名化和语言使用造成心理伤害。

And then a really, really other important fact, engagement in it can cause psychological harm through shame and stigma and use of language.

也许现在正在改变，但历史上它完全抵制基于证据的其他方法，比如冥想、药物治疗和创伤干预。

Maybe it's changing right now, but historically complete resistance to evidence based other practices like meditation, medication and trauma approaches.

有些人甚至因为不够戒酒，或正在使用整个医学界公认的医学治疗方法，而被赶出会议或禁止入内。

Literally some people being kicked out or not allowed into meetings because they are not sober, taking what is considered by the entire medical community, a medically recognized treatment.

所以，如果一种治疗方法无法持续产生积极效果，反而还会造成伤害，我就不能认为它是有效的。

So if a treatment can't consistently produce positive outcomes and then also produce some harm, I can't consider it to be working.

现在，丹提到了这一点，我想对此谈谈：毫无疑问，有许多人——其中一些是我的好朋友——说他们从AA中受益，并热情地谈论AA的奇妙之处以及它如何对他们有效。

Now, Dan pointed this out and I want to speak to it, there's no doubt that there are many people, some of them great friends of mine, who say that they were helped by AA and who avidly talk about the wonders of AA and how it worked for them.

但在这里，我认为重要的是要真正理解，无论有多少人提供，轶事证据都无法构成一种有效的治疗方法。

But here, I think it's important to really understand that anecdotal evidence, no matter from how many people doesn't create an effective treatment.

我们在医学和心理健康领域已经多次遇到过这种情况。

And we've had this happen a number of times, many times before in the medical and mental health community.

在古希腊，放血被认为是一种循证疗法，成百上千的人都曾接受过这种治疗，通过放血让体液排出，以预防精神疾病。

Bloodletting in Greece was considered an evidence based practice that works for hundreds, if not thousands of people, where people had blood let out of them for humors to be able to escape, to prevent mental illness.

这已经被彻底驳斥了，对吧？

That's been heavily debunked, right?

和放血一样，匿名戒酒会基于一种非常过时的模式，虽然它已经存在了九十年，但我们在这九十年里学到了很多。

Like bloodletting, AA is based on really outdated model and it's great that it's been around for ninety years, but we've learned a lot in ninety years.

甚至医学上的做法，比如在20世纪30年代和50年代，脑叶白质切除术曾广泛流行，特别是用于治疗精神分裂症。

Even medical approaches, lobotomies for were massively popular in the '30s and '50s, specifically, let's say for schizophrenia.

这种做法是将锋利或钝的器械插入大脑，直接破坏前额叶皮层区域。

This was the practice of putting in sharp instrument, blunt instruments and literally disrupting prefrontal cortical parts of the brain.

到20世纪60年代，这种做法已被彻底否定，因为它会导致严重的认知和情感损伤。

By the 1960s, this was completely debunked in showing that it caused severe cognitive and emotional damage.

当时，人们因为这种疗法效果出众而获得诺贝尔奖，并受到赞誉。

People won Nobel prizes and were recognized and lauded for how great of a treatment it was at the time.

仅仅因为某事物在某一时刻看起来非常好，并不意味着它真的有效。

Just because something looks really, really good at one point in time doesn't mean it's actually effective.

或许更贴近我们当前讨论和丹的观点的是，胰岛素休克疗法和电休克疗法，这些方法虽然经过了时间的调整，但它们需要严格的科学研究来确定如何调整，因为最初使用这些方法的方式实际上非常有害。

And maybe much more relevant to our discussion here and to Dan's point, insulin shock therapy, electroconvulsive shock therapy were other approaches that had been adjusted over time, but they needed rigorous scientific study to know what to adjust because the way they were being used originally in treatment were really, really harmful.

因此，从所有这些角度来看，我想说的是，一百年前，匿名戒酒会可能是我们当时最好的选择。

And so by all of those measures, what I want to say is this, AA was potentially the best option that we had a hundred years ago.

我不会反驳这一点，这很好。

I'm not going to argue against that, that's great.

但我们已经取得了长足的进步。

But we have come a long way.

而当你对其进行检验时，根据我们目前所知，很明显，匿名戒酒会整体上并不有效，它需要进行重大更新，才能被视为一流的方法。

And when you put it to the test, again, everything we know right now, it's clear that AA as a whole doesn't work, and it would need some substantial updating to be considered a best in class approach.

感谢两位的开场陈述。

Thank you both for those opening arguments.

稍后，我们将短暂休息一下。

In a moment, we're gonna take a quick break.

但在那之前，我想问你们一个问题：是什么促使你们今天来到这里讨论这个话题？

But before we get there, I just want to ask you the question of what motivated you to come here and talk about this topic today?

当然。

Sure.

我曾经深受成瘾困扰。

I used to struggle with addiction.

我从14岁就开始，但到25、26岁的时候，我已经严重依赖冰毒六七年了。

I had a very, I mean it started at the age of 14, but by the time I was 25, 26, I had been heavily addicted to meth for six or seven years at that point.

我当时体重只有124磅，比现在轻了四五十磅。

I was one hundred and twenty four pounds, which forty, forty five pounds lighter than I am right now.

我现在就站在你们面前。

I'm standing in front of you.

我曾深陷毒品交易，冰毒是我使用的一种毒品，我什么都用。

I had gotten involved in heavy drug dealing and meth was one of the drugs I used, I used everything.

我与家人完全断绝了联系，最终被 SWAT 特警队逮捕。

I'd just been completely disconnected from my family and ended up going through a SWAT team arrest.

你提到了即将出版的书，这正是我打开这本书的方式。

You mentioned the upcoming book, that's how I opened the book.

12 名警员在周六早上 8 点撞开了我的门。

12 officers knocking down my door, 08:00 in the morning on a Saturday.

在过去十五六年里，我经历了这一切——自从那件事以来已经过去了二十二年，我不得不入狱，不得不去康复中心，我靠自己做了很多事才走出困境。

And I've spent the last fifteen, sixteen years of my life, it's been twenty two years since that, I had to go to jail, had to go to rehab, I did a lot of things myself to get through that problem.

当这一切结束时，我必须弄清楚：到底发生了什么？

And when I was done with all that, I had to figure out, first of all, what the heck happened to me?

其次，在深入投入研究后，我真正将帮助他人作为自己的使命。

And then secondly, once I got heavily involved in the research, I really made it my mission to go help so many other people.

数以千万计的人，SAMHSA 刚刚更新了数据，超过四千万人正在挣扎。

Are millions and millions, SAMHSA just updated the number, over 40,000,000 people who struggle.

正如丹所指出的，我已经将帮助尽可能多的人作为自己的目标，我知道这也是他的目标。

I've made it my point as Dan pointed out, I know it's his as well, to help as many people out there as possible.

谢谢你分享这些，阿迪。

Thank you for sharing that, Adee.

听起来你一路走来经历了许多。

It sounds like you've had quite a journey to where you are now.

你有以个人经历尝试过匿名戒酒会吗？

Did you experiment with AA as a personal experience?

你可以称之为实验，但那是当时唯一提供给我的选择。

You can call it experiment, it was the only option that was presented to me.

我连续三年参加了匿名戒酒会。

I was an a for three years.

非常感谢。

Thanks very much.

好的，丹。

Alright, Dan.

是什么让你今天来到这里？

What brought you here today?

当然。

Sure.

恭喜你保持清醒，无论你用什么方式做到的。

So congrats on your sobriety, however you're doing it.

更重要的是，我父亲是一位长期酗酒者，他曾参加戒酒互助会。

Perhaps most importantly, my father was a chronic alcoholic who went to AA.

他拼命试图控制和节制饮酒，直到这最终夺去了他的生命。

He tried desperately to control and moderate his drinking until it literally killed him.

我不认为这是戒酒互助会的失败。

I do not see that as AA's failure.

在我看来，这恰恰证明了这种疾病的残酷性。

I see it as evidence of the brutality of this disease, frankly.

正是戒酒互助会成员在他去世后对我和我家人的回应，让我真正认识到这个组织有多么特别。

It was the people of AA's response to him and my family when he died that helped me see actually how special of an organization it is.

非常感谢你，丹，分享了这些。

Thank you very much, Dan, for sharing that.

现在是短暂的休息时间。

It's time for a quick break.

回来后，我们将更深入地探讨这个问题：戒酒互助会有效吗？

And when we're back, we're gonna dig deeper into the question, does AA work?

我是纳玛·拉扎，欢迎收看《开放辩论》。

I'm Naima Raza, and this is Open To Debate.

欢迎回到《开放辩论》。

Welcome back to Open to Debate.

我是主持人纳伊玛·雷扎，今天我们辩论的问题是：戒酒互助会有效吗？

I'm your moderator, Naeema Reza, and we're debating the question, does Alcoholics Anonymous work?

我身边有两位辩手：丹·格里芬，著有《男性如何走完十二步》；以及阿迪·贾夫，即将出版《永远摆脱成瘾》。

I'm here with debaters Dan Griffin, author of A Man's Way Through the 12 Steps, and Adi Jaffe, author of the forthcoming book, Free Yourself from Addiction Forever.

在正式展开辩论之前，我想简要总结一下你们的开场观点，因为你们对戒酒互助会是否根本有效存在分歧。

So before we dive in to the debate in true form, I want to try and summarize your opening arguments briefly because you disagree on whether or not AA fundamentally works.

丹，你的观点是：是的，它确实有效。

And Dan, you're you're arguing that, yes, it does work.

为了证明这一点，你引用了数据，指出数以百万计的人从戒酒互助会中受益，以及最近一些研究考察了其效果，表明戒酒互助会的效果是有益的。

And to point to that, you you point to the data, the millions of people who have been helped by Alcoholics Anonymous, as well as recent research looking at the the outcomes and showing that the outcomes from AA are beneficial.

尽管它们可以与其他疗法结合使用，但根据你所引用的研究，它们确实是有益的。

And and while they can become they can be complemented by other therapies, but they are indeed beneficial according to the research you're citing.

我认为，你还提出了一个关于社区的重要观点：戒酒互助会的核心功能之一就是这种社区感、联结和支持结构，以及它所建立的责任机制。

And you also, I think, made a really important point about community, that a core function of Alcoholics Anonymous is this community and the bonding and the support structure that that allows and also the accountability structure that that allows, I think.

阿迪，你的看法则不同。

Adi, you see things differently.

看起来，你从根本上认为，尽管戒酒互助会很流行，但并不总是正确的。

It seems like fundamentally, you think that while AA is popular, it's not always correct.

你引用了一系列历史案例，比如放血疗法、脑叶切除术等，这些比喻我怀疑戒酒互助会并不乐见——你指出，当前流行、主流的治疗方法，未来可能会被淘汰，或者根本就是错误的。

And you cited a a bunch of historical examples from bloodletting to lobotomy to other examples, metaphors that I'm not sure AA would look kindly upon to say, hey, what works right now, what's popular, and what's the modality of treatment right now actually might be phased out over time or it might be the wrong one.

或者说，你认为戒酒本身似乎并不一定是最佳目标。

Or, you know and so you you think sobriety is a goal, it seems, is not necessarily the best goal.

正如你所指出的，这显然不是每个人的目标，数据也反映了这一点。

It's certainly, as you cited, not the goal for everyone, and and the data reflects that.

你还指出，它并不能提供一致的结果，甚至可能对参与匿名戒酒会的人造成伤害，比如这种参与可能带来更多羞耻感，或者戒酒标准过高以及其他原因。

And you went out to say that it doesn't provide consistent outcomes and it also can provide harm, can actually create harm for people going through AA, whether that engagement creates more shame, whether that standard of sobriety is too high and other means.

所以我认为他们很好地总结了你的两种观点。

So I think they fundamentally stated your two perspectives.

这样概括公平吗，各位？

Is that fair, gentlemen?

这是一次很好的总结。

It was a nice summary.

非常好。

That was great.

好的。

Okay.

很好。

Great.

所以我想先探讨一下目标这个问题，因为匿名戒酒会的大部分内容都是围绕戒酒和对戒酒的承诺展开的。

So I want to get to this first question of the goal because so much of AA is designed around abstinence and this commitment to abstinence.

所以，丹，你能告诉我，为什么在你看来，这个组织应该以完全且终身戒酒为目标吗？

So, Dan, tell me why total and lifelong sobriety is the right goal in your opinion for this organization to have.

我想说的是，在AA的文献中，你永远不会听到有人声称你必须永远戒酒。

So I would say there's nowhere in the literature where you're gonna hear somebody say in AA that you have to stop drinking forever.

这种观念被灌输给了人们：继续饮酒可能会导致你生命的巨大损失或对生活造成严重影响。

The idea is implanted for people that to continue drinking could lead to incredible loss of your, you know, your life or impact on your life.

但正如我所说，真正的要求是拥有停止饮酒的愿望，而不是永远戒酒。

But really, like I said, the requirement is a desire to stop drinking, then not stop drinking forever.

事实上，那句流行的‘一天一天来’的说法正是源于此。

In fact, that's where the popular saying one day at a time comes from.

这也暗示着，如果你不戒酒，就不受欢迎，但这绝对不是事实。

It also implies that if you're not abstaining from alcohol, you're not welcome, which is definitely not the case.

坦率地说，目标是让人们找到最适合自己的饮酒方式。

The the goal, quite frankly, is for people to find a relationship to alcohol that works best for them.

在AA中，从未有过任何声明说：如果你想继续饮酒，就不欢迎你。

And there is never a statement in AA that says, if you wanna continue drinking, you're not welcome here.

这对你来说效果如何？它如何帮助了你？

It's just how is that working for you and how is that helping you?

这确实是文献中的一些原话。

That literally is some language in the literature.

如果你能继续饮酒并适度社交，我们向你脱帽致敬。

If you can continue to drink and drink socially, our hats are off to you.

这是一句引述。

That's one of the quotes.

所以，这听起来确实比阿迪你之前描述的伤害要平和得多。

So, that certainly sounds kind of more peaceful than, Adi, the kind of harm that you were laying out.

斯坦福大学的心理学博士基思·汉弗莱斯有一句引述，他进行了一项关于戒酒会有效性的高水平元分析，指出戒酒会确实有效。

There there is a quote from Keith Humphries, a PhD in psychologist at Stanford who conducted a high level kind of meta study on AA's effectiveness, saying that AA absolutely does work.

参与这些团体的人，其戒酒成功率比接受其他治疗的人高出20%到60%。

That people who are in these groups have 20 to 60% better abstinence than people in other treatments.

在任何情况下，他们的结果都没有更差。

In no case did they come out worse.

我想知道你对这个发现怎么看。

I'm curious what you make of this finding.

嗯。

Yeah.

好吧，我再给你介绍一位研究者，罗伯特·阿什福德，如果你想查阅更多学术分析，他专门建立了一整套研究，探讨人们在参与后情况反而更糟的现象。

So look, I'll give you another researcher, Robert Ashford, if you want to look up more academic analysis, who specifically has created an entire body of research talking about how people come out worse.

顺便说一句，基思·汉弗莱斯的一位合著者约翰·凯利也亲自表示，使用‘酒鬼’、‘瘾君子’等带有污名化的语言——这些正是匿名戒酒会（AA）中常见的术语——会制造污名、造成伤害，并阻止人们寻求帮助。

By the way, one of Keith Humphrey's co authors, John Kelly, has also said himself that using stigmatizing language to which alcoholic, addict, etcetera, terms that are part and parcel to AA, create stigma and harm and keep people out of getting help.

所以，虽然基思的观点很有价值，他所关注的内容也很重要，但我还是要回到他所参考的那些研究本身，对吧？

So while Keith's point is great what he's looking at, I'll just go to the research that he examined, right?

所以，丹引用了这项具体的研究。

So Dan quoted this specific study.

这是一项最近完成的元分析。

This is a recent meta analysis that was completed.

我此刻正看着面前的数据，一边说一边看。

I'm literally looking at the data in front of me right now as we're saying it.

唯一显示出显著效果、具有高证据确信度的指标是持续或长期戒酒，这很合理，因为AA体系本身就倡导长期戒酒。

The only measure that was seen to be substantial, like high certainty of evidence that AA was better was in continuous or long term sobriety, which makes sense because it is the system that espouses long term sobriety.

所以那些决定参与并长期留在AA的人，已经认同了这一点。

So the people who decide to participate and stay long term in AA have bought into that.

但我们必须明白，说‘当然，对我们长期留下的7%到10%的人，我们取得了成功’，和说‘70%的人通常在三个月内离开，超过90%的人在一年内失败’，是完全不同的。

But here's what we have to understand, there's a difference between saying, yeah sure, for the seven to ten percent of people who stay with us long term, we find success versus the seventy percent who typically leave within three months and the upwards of ninety percent who fail within a year.

所以你看，如果你不知道有多少人会回来，

So look, if this But you don't know how

而这些人是否返回其实并没有被追踪记录。

many of those people return and that's not something that's actually tracked.

因为我们是匿名的，所以无法追踪。

Well, we can't track it because it's anonymous.

我知道。

I know.

但在AA内部，人们能感受到那些离开又回来、再离开再回来的人，他们正在努力寻找解决办法。

But within AA, people have a sense of people who leave and come back and leave and come back as they're trying to figure these things out.

这一点你必须加以考虑。

And that's something you have to take into consideration.

但感觉并不能构成学术证据。

But but a sense is not gonna make academic evidence.

戒酒这一点是明确无误的。

The the abstinence is the one that's unequivocal.

对吧？

Right?

但它还进一步指出，在其他方面也表现得相当或略优。

But it also goes on to say, and it showed to be equal to or slightly better in other areas as well.

可能表现得同样好。

Potentially may perform as well.

是的。

Yes.

是的。

Yes.

但你没提到那部分。

But you didn't mention that part.

但关键是这样。

But here here's the thing.

我认为，阿迪的论点是，成功的衡量标准是组织的使命，因此，该组织也证实了这种成功。

I I think that, you know, the argument Adi is making is that the, you know, the the litmus test for success is the, mission of the organization, and therefore, the organization, you know, corroborates that success.

这在某种程度上是一种自我实现的预言。

And and that's kind of a self fulfilling prophecy in some way.

不过，阿迪，如果戒酒不是目标，那目标应该是什么？

I do wonder though, Adi, if if sobriety isn't the goal, what should be the goal?

我知道，我在《脱钩》之前写过第一本书，叫《戒酒神话》。

I, you know, I wrote the first book before Unhooked called The Abstinence Myth.

匿名戒酒会当然可以帮助人们减少饮酒。

AA can certainly help people cut down.

我参加过很多很多次匿名戒酒会，见过许多人在三十天内反复复发，连三十天的纪念币都拿不到，还被会里的人排斥。

I've sat in many, many, many AA meetings and I've seen many, many people who relapsed chronically before thirty days and just couldn't get their thirty day chip and were shunned in meetings.

所以对我来说，重点是，如果匿名戒酒会能稍微放宽一点，说：我们理解戒酒这个标准很高。

So the point for me is more of this, if AA could relax a little bit and say, look, we understand that the bar of abstinence is a high one.

如果你来这里是为了应对饮酒问题，我们欢迎你加入。

If you're here to address your drinking, we welcome you in.

如果组织上的语言能更宽泛一些，并且他们愿意衡量的成果之一是改善，我会成为更坚定的支持者。

If the language organizationally widened, and then if one of the outcomes that they were willing to measure is improvement, I would be a much, much bigger supporter

但我猜你还不熟悉刚刚出版的通俗版《大书》，Adi。

of But I'm the guessing you're not familiar with the plain language big book that's just come out, Adi.

通俗语言。

Plain language.

这正是你所说的，而且它让很多匿名戒酒会成员和专业人士都非常兴奋，因为这是九十年来他们首次用更易懂、更包容的语言重写了《大书》，取代了1930年代的语言。

It's precisely what you're talking about, and it's got a lot of people in AA very, very excited and professionals very excited because it's the very first time in those ninety years that they have rewritten the big book with language intentionally done so that it's more accessible and more welcoming than the 1930s language.

这里有一个核心问题：治疗的目的是针对症状，还是针对根本原因？

There's this kind of core question of is the point of treatment to treat the symptom or the underlying cause?

我认为，Adi，如果我理解你的论点，部分在于：匿名戒酒会是否只是在治疗症状？

I think part of, Adi, if I'm understanding your argument, is that is AA treating a symptom?

它是否试图提供一种一刀切的、可衡量的戒酒解决方案，而不是具备足够细致的结构来真正解决根本原因？

Is it trying to provide a measurable solution that's like a one size fits all in terms of sobriety versus having the nuance and infrastructure to really get to underlying causes?

我将从几个方面来回答这个问题。

So I'm gonna answer that in a couple of ways.

首先，我们在九十年间学到了很多。

First, we've learned a lot in ninety years.

我的意思是，如果没有戒酒互助会，现在的成瘾治疗领域可能根本不会存在。

I mean, we could argue that there wouldn't be the current addiction field if there hadn't been AA.

而且这个领域一直在发展。

And there's been an evolution.

在成瘾治疗领域内，我们对心理健康、创伤、羞耻感与成瘾之间复杂相互关系的理解取得了重大而显著的进展。

And within that addiction field, there's been advances in understanding of the intricacies of the interrelationship of mental health and trauma and shame and addiction in major significant ways.

这些进展已经融入了治疗体系和治疗实践中。

And that has come into the treatment complex and the treatment world.

同时，随着这些人在参加聚会，这些理念也逐渐进入了戒酒互助会。

And then it's been coming into AA as well as those people are coming into meetings.

所以这是其中一点。

So that's one thing.

第二，AA从未说过AA项目仅仅是参加会议和完成十二步。

Two, AA has never said the AA program is solely meetings and working the steps.

另外，我认为即使AA本身的项目，以及通过十二步和我们所谓的“执行步骤”实现的康复过程，也是一个能触及许多根本问题的过程。

Then the other is that I think even the program of AA itself and the program of recovery through the 12 steps and what we, you know, what they call working the steps, that is a process that gets to a lot of the underlying things.

有几点要说。

Couple of things.

首先，十二步促进是一种标准化的方法。

First of all, 12 step facilitation is a manualized approach.

而我对于AA的整个问题在于，每次会议都是完全不同的世界。

And part of my entire problem with AA is every meeting is an entirely different universe.

是的。

Yeah.

想象一下，假如有人给你开了一种抗抑郁药，但一个药瓶里的药和另一个完全不一样，我们还能说这种抗抑郁药有效吗？

Which makes it imagine, imagine for a second if when somebody prescribed you an antidepressant, one pill bottle was completely different than another, would we be able to say that that antidepressant is effective?

我们不会，因为你根本不知道自己吃的是什么。

We wouldn't, because you literally wouldn't know what you're taking.

因此，AA的实施方式缺乏控制，这是一种极其糟糕的护理提供方式。

So the way AA is delivered is not controlled, which is a horrible, horrible way to then provide care.

从一个房间到另一个房间，情况真的完全不同。

It's different literally from one room to another room.

现在，12步辅导旨在消除其中一些差异。

Now 12 step facilitation seeks to eliminate some of that.

现在，我愿意这么说：如果你遇到一个具有心理健康意识、理解创伤并了解其他方法、且对这些方法持开放态度的人，他们能以标准化的方式引导你进行任何护理，当然也包括12步辅导，那么你或许能触及到深层问题。

Now, here's what I'm willing to say, If you land on somebody who is mental health aware and understands trauma and understands other approaches and is open to those, and they walk you through a manualized way of doing any care, but sure, also 12 step facilitation, then you may get to underlying issues.

但这并不是AA通常的做法。

But that is not what AA does as a rule.

不过，它并没有你描述得那么随意，因为AA会议中确实有一条贯穿始终的指导原则。

It's not as freewheeling though as you're presenting it because there really is a guidance in AA meetings as a thread that runs throughout.

我的意思是，那就是会议的结构。

I mean and that is the the structure of meetings.

也许并不总是完全相同，但结构非常相似。

There's maybe that's not always the exact same, but there's some very similar structure.

但毫无疑问，文献和十二步法的核心线索是始终如一的，无论你去哪里，我敢保证你都能找到它。

But certainly, the thread, the core thread of the literature and the 12 steps, that is something that consistently wherever you go, I guarantee you, you're gonna find it.

我可以告诉你，通过非轶事证据，通过走进那些未遵循这些步骤的房间。

I can tell you wrong by not anecdotal evidence, by walking into rooms where those were not followed.

在美国各地的小城镇，当你走进一个会议时，他们可能会选择遵循自己的传统。

Small Where towns all over America, when you walk into a meeting, they may choose to have their own traditions.

总组织没有任何控制。

There is no control by the general organization.

总组织完全没有任何控制。

There is zero control by the general organization.

好的。

Okay.

没有任何控制。

There's no control.

我承认，由于每个小组的集体良知，这实际上是非常有趣的一点。

I grant you that because of the individual group conscience, which is actually something that's very fascinating.

我的意思是，人们确实研究过指导匿名戒酒会的组织原则，包括十二项传统、十二项概念以及所有相关文献。

Mean, people have actually studied the organizational principles that guide AA through the 12 traditions and the 12 concepts and all the writings that have been done.

几位社会学家得出结论，这是我们在社会中见过的最接近民主的制度。

And several sociologists have concluded that it's the closest thing to democracy that's ever been established in our societies.

阿迪，我想暂时撇开民主不谈，思考一下：有什么比匿名戒酒会更好的替代方案吗？

Adee, I wanna take a moment, democracy aside, I want to take a moment to think, well, what is a better alternative to AA?

首先，我关于成瘾的主要观点是：这与匿名戒酒会反复强调的观点完全相反——那些与成瘾斗争的人并非同一种人。

So first of all, my main argument around addiction is that completely contrary to the thing that the notion that is repeated over and over in AA, people who struggle with addiction are not the same.

我想避免使用他们反复使用的术语，因为已被证明具有污名化倾向。

I want to avoid using the term that they use over and over and over because it's been shown to be stigmatizing.

与酒精斗争的人并不是同一种人，那种认为因为人们 compulsively 喝酒，他们就是同一类人的想法，实在太荒谬了。

People who struggle with alcohol are not the same, it's this ridiculous notion that we have that because people drink compulsively, they are all the same kind of a person.

书里不就明明白白写着这一点吗？

It literally says that in the book, right?

他们都被称为酒鬼。

That they're all alcoholics.

我的观点是，有些人有生理功能障碍，有些人有心理健康问题，有些人有创伤和创伤后应激障碍。

Now my point is, some of them have biological dysfunction, some of them have mental health issues, some of them have trauma and PTSD.

不同的治疗方法实际上需要个性化，并针对每个人的特定困境进行定制。

The different approaches actually need to customize and be specifically directed to the individual struggle.

这种认为你可以把十二步写在一张纸上，然后适用于所有人的方式。

This idea that you can have 12 steps that are written on a piece of paper and they would blanket apply.

我想再提出一个非常重要的一点，因为丹说了一个正确的观点，即AA文献中的主张是：它并非唯一的治疗方法，但事实上，在我们国家的这个行业里，它已经成为了事实上的标准疗法。

And I want to make another really, really important point because Dan made a correct point, which is the assertion in the AA literature is that it is not the only treatment, but the de facto reality in our industry in this country is that it has become the de facto treatment.

原因很简单，这些团体是免费的。

There's a very simple reason, groups are free.

作为一名从事这个行业的人，我可以告诉你，作为治疗中心，每天把你的患者送去两到三次免费会议当然很好，但不幸的是，并不是每个人都能找到合适的匹配。

And as somebody who works in the industry, I can tell you that of course, as a treatment center, it's nice to send your people to two to three free meetings every single day, but unfortunately not everybody has a good fit.

丹，我承认这一点，AA的初衷确实不是这样，但你已经说过，AA是一种模糊的架构。

And Dan, I will give you this, that that is not the point of AA, but you already said that AA is this nebulous architecture.

结果就是，那些不该去的人反而去了。

What ends up happening is people who shouldn't be going, end up going.

那些对这种方法无效的人，最终被强迫参加这些会议。

People for whom it's not effective, they end up essentially being forced to go to these meetings.

但他们该去哪里呢，阿迪？尤其是如果他们负担不起的话？

But where should they go instead, Adi, especially if they can't afford it?

嗯，这应该是我们医疗体系的责任。

Well, that's the responsibility of our healthcare system.

我的意思是，如果放血疗法是免费的，现在在座的各位会跑去免费接受放血治疗吗？

I mean, look, if bloodletting was free, is anybody on this call right now running to get some free bloodletting because it's free?

我得走了。

Gotta go.

我真得走了，各位。

Gotta go, guys.

开玩笑的。

Just kidding.

我背上有一些。

I got some on my back

现在。

right now.

是的。

Yeah.

然后，我想让丹来回应这个问题。

And so and then I want Dan, you to respond to this question.

丹，阿迪的核心观点是，主导地位是个问题，这实际上是个经济论点：戒酒互助会规模庞大、进入新市场容易、成本低廉，挤占了其他竞争者的空间，抑制了创新。

Dan, Adi is fundamentally making this argument that dominance is a problem, that, like, it's a bit of an economic argument actually, that the size and scale of AA, that it's ease and it's like low cost of entry into new markets, that it's crowding out entry, that it's stumping innovation.

对此做出回应。

Respond to that.

所以，让我们说清楚一点。

So, yeah, let's be really clear.

好吗？

Okay?

AA并没有做这些事。

AA isn't doing any of this.

是治疗行业在做这些事。

The treatment industry is doing this.

我实际上看到的和阿迪所说的恰恰相反。

I've actually seen the opposite of what Adi's talking about.

再说一遍，我在这一行已经工作了三十年。

Again, I've worked in the field for thirty years.

我记得以前人们根本没有选择。

I remember when people didn't have options offered to them.

他们只能去参加AA会议，别无他选。

They they they could go to an AA meeting and that was it.

现在则提供了各种各样的选择，包括非会议形式的选项。

Now it's like all kinds of options that they're being offered, including not meetings.

如果你想的话，也可以去教堂。

You could go to church if you wanna go to church.

重点在于强调治疗后的支持的重要性。

The idea is to emphasize the importance of the support after treatment.

需要某种持续性的支持，因为如果你像许多人那样认为成瘾是一种慢性病，那么当你审视科学和研究中关于慢性病最有效治疗方式时，就会明白，参与某种形式的支持服务三到五年才是最佳方案。

Some kind of ongoing support because, I mean, like if you believe that addiction is a chronic illness as many people do, when you look at the science and the research behind chronic illnesses and how to treat them most effectively, then you understand that engagement in services of some kind of support for like three to five years is kind of optimal.

对于成瘾来说，似乎更是如此。

For addiction, it seems to be even even more so.

所以，人们只把患者送去参加AA会议，是因为它免费。

So the idea that people are only sending people in treatment to AA meetings is because it's free.

我认为这是一种误解。

I think that's really a misstatement.

我不是说它免费，但我请你回应这一点。

I'm not saying it's free, but I'm asking you to respond to this.

不，不，他确实这么做了。

No, no, he did.

阿迪确实这么做了。

Adi did.

我并没有说这是唯一的原因。

I didn't say the only reason.

你强调了它是免费的，并暗示这就是他们送人去的原因。

You emphasized the fact that it was free and implied that that's why they send them.

我会说，他们送人去是因为AA非常有支持性，能帮助他们为治疗后的生活做好准备。

And I would say they send them because it's very supportive, it helps set them up for after treatment.

而且，它确实有效。

And again, it works.

我只是想非常快速地指出一点。

I just want to point out really, really quickly.

这很有趣，因为我同意你的观点，丹，确实出现了一种回归更多选择的趋势。

So it's interesting because I agree with you, Dan, that there has been a shift to reverting to more options.

我认为部分原因在于，如果我能回到我们为何展开这场辩论的源头，是因为太多人抗拒参加AA，治疗中心才不得不提供其他选择。

And I think part of the reason, if I can go back to why we're having this debate, is because too many people were so resistant to go into AA, the treatment center had to offer other options.

所以再次说明，AA至少曾经占据主导地位，只是因为当时别无选择。

And so again, it is just showing that AA at least it was only dominant because of the offerings.