Almost every Sunday night, I walk to this one restaurant in my neighborhood for some comfort food (we’re creatures of habit aren’t we?).

I pass a church on my way where an Alcoholics Anonymous meeting is held almost every night. As I walk through the crowd of smokers, I look at them and they look at me. They don’t know that I know they’re recovering addicts. And they put a smile on my face. They’ve taken the initiative to change their lives, restructure their lifestyle, and improve their health. They’ve realized that overcoming bad lifestyle takes friends, family, and professionals. What does the social science community know about AA?

Not much:

Alcoholics Anonymous and its steps have become ubiquitous despite the fact that no one is quite sure how—or, for that matter, how well—they work. The organization is notoriously difficult to study, thanks to its insistence on anonymity and its fluid membership. And AA’s method, which requires “surrender” to a vaguely defined “higher power,” involves the kind of spiritual revelations that neuroscientists have only begun to explore.

What we do know, however, is that despite all we’ve learned over the past few decades about psychology, neurology, and human behavior, contemporary medicine has yet to devise anything that works markedly better. “In my 20 years of treating addicts, I’ve never seen anything else that comes close to the 12 steps,” says Drew Pinsky, the addiction-medicine specialist who hosts VH1’s Celebrity Rehab. “In my world, if someone says they don’t want to do the 12 steps, I know they aren’t going to get better.”

Overcoming addiction doesn’t happen in silos. Health is social. Lifestyle change is social change.

Positive change is about you, your friends, your family, and the physical environment of your home and neighborhood — that is where health happens. That is not where medical care happens. Bad lifestyle isn’t a medical issue, it’s a social one, hence the reason why “contemporary medicine has yet to devise anything that works markedly better.” Doctors are just so bad at lifestyle and behavior modification. Or maybe they’re just uninterested, or ill-prepared, or not reimbursed for social change? Maybe individual physicians think fixing these big hairy problems is too big of an issue for them to exert any effort? Medical care has pills and scalpels– not urban design, portion size, influential friends, walkability, and the complexities of the modern family structure. I should know. I got about 4 lectures in medical school on topics other than sickness. I had to seek out, on my own, solutions for the real problems our modern culture face– hyperlocal relationships with other people and with our environment that make choosing health difficult.

AA is one of those hyperlocal solutions because it fundamentally understands that alcoholism doesn’t happen in silos, nor does it happen in institutions– it takes a restructuring of your lifestyle in your own neighborhood to kick the habit. How do we change our lifestyle? Good question. There’s not as much research happening on this topic compared to medical interventions. You can’t bottle up and sell “lifestyle change” and turn it into a multi-billion dollar market, so who’s going to do it? And how does patient privacy fit with solutions that require your friends, family, and acquaintances? Can you do meaningful outcomes research on these kinds of social solutions? Are there technology solutions to lifestyle change? Or can we simply design things that people use and want? Is it good enough to just have a 1.2 million person following like AA? Or must we have to put numbers on its effectiveness? Social solutions are notoriously difficult to measure. AA has been going strong for 75 years and it’s still an enigma, but it’s the kind of solution that will save us from the deadliest disease we know– unhealthy lifestyle.

Do we need more AA-like solutions? We’d say yes. We can chase our tails for 75 years looking for a +/- 5% difference or we can design engaging solutions that people enjoy. Should we care about measurability? Good question.

Jay Parkinson is a pediatrician and preventive medicine specialist and founder of The Future Well. He blogs at his self-titled site, Jay Parkinson + MD + MPH.

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