Alcoholics Anonymous is part of the nation’s conflict between puritanism and libertinism.

This June, millions of recovering alcoholics will not raise a glass to celebrate the 80th anniversary of Alcoholics Anonymous (AA). The centrality of toasting in our culture reflects AA’s near-impossible task. Founded in June 1935, two years after Prohibition ended, this organization has valiantly combatted alcohol abuse even as modern mores glamorize binge drinking. But like Santa Claus, AA and its Twelve-Step program is famous and makes people feel good—but fails to deliver in reality.

The fight between Alcoholics Anonymous and the many forces peddling the “evil drink” reflects a classic American clash pitting puritanism versus libertinism, our tendency toward self-discipline versus our desire to indulge, our zeal for protecting life and liberty versus our zest in pursuing happiness—or at least what feels fleetingly like happiness, until the hangover. Clearly, AA is on the side of the angels. But with a success rate in peer reviewed scientific studies hovering between 5 and 10 percent, it may be no more effective than the old West’s alcohol-laced, snake oil miracle cures.

In fairness, becoming sober can be torturous in our culture of indulgence. Mixed messages about alcohol abound. A classic American joke has one congressman, asked his stand on whiskey, responding: “If you mean the demon drink that poisons the mind, pollutes the body, desecrates family life and inflames sinners, then I’m against it. But if you mean the elixir of Christmas cheer, the shield against winter chill, the taxable potion that puts needed funds into public coffers to comfort little children, then I’m for it.” Today, moderate drinkers, let alone teetotalers, face intense peer pressure reinforced by a $2 billion-a-year alcohol-advertising barrage insisting that the way to be cool, relaxed, and fun, is to drink, and drink profusely.

America’s attempt to eradicate liquor, starting with the Temperance movement and culminating with the 18th Amendment imposing Prohibition in 1919, failed miserably. But alcohol’s allure in American history, from George Washington’sMount Vernon distillery and fondness for Madeira to today’s single malt craze, has only made imbibing more ubiquitous and dangerous. The Center for Disease Control estimates that drunkenness kills 88,000 Americans annually, generating $223.5 billion in damages—averaging about $1.90 per drink—and alcohol abuse is often a key factor in car accidents, child abuse, handgun murders, rape and sexual abuse, including the problem of date rape on campus. With 44 percent of studentsbinge drinking regularly, experts estimate that alcohol is a factor in the more than 97,000 sexual assaults that occur every year.

We throw around phrases like “Twelve Step Program to recover” and “one day at a time,” as if we were medical experts—or Oprah herself.

Alcoholics Anonymous traces its origins to June 10, 1935, when Dr. Bob Smith had his last drink, handed to him by his AA cofounder, Bill Wilson. Wilson would define the Twelve Steps three years later. These two “recovering alcoholics,” as they would be called, popularized the teachings of the Oxford Group, an evangelical Puritan network that emphasized acknowledging your weakness, making amends to those you have harmed, and trusting God for salvation.

AA soared, much like another behemoth founded five years later, McDonald’s. Today, AA has more than 90,000 groups in 141 countries, with approximately 5 million individuals attending at least one meeting in a given year. In the United States, approximately 60,000 groups host over 1 million Americans annually. Even many who never attended a meeting can mimic the rituals of first-name self-introductions, with the name echoed as everyone says “Hi,” followed by affirming applause after the ritualized confessions. We throw around phrases like “Twelve Step Program to recover” and “one day at a time,” as if we were medical experts—or Oprah herself.

Like McDonald’s, AA franchised its operation, offering a standardized formula providing spiritual comfort food globally. Although rooted in the sensibilities of the Great Depression and what we nostalgically hail as the Greatest Generation, AA suited the Baby Boomers and their progeny. The Twelve Step approach anticipated two of the 1960s counterculture’s enduring assumptions. First, treating alcoholism as a disease, not a moral failing, confirmed the nonjudgmental, amoral, I’m OK you’re OK approach more and more Americans embraced. Second, the universalistic, just short of generic, approach to religion rejected the particularism of the Bible, the richness and idiosyncrasies of Christianity, Judaism, and Islam. Instead, AA’s one-size-fits-all, mass-produced we-are-the-worldism intends to make recovery accessible to all, if not necessarily easy. By the 1990s, four in 10 Americans belonged to support groups to help control all kinds of bad habits which we now label “addictions,” choosing fromover 300 Twelve Step groups including Overeaters Anonymous and Pills Anonymous, Workaholics Anonymous, and Love Addicts Anonymous.

AA’s positioning at this comfortable intersection of easy-listening psychology and denatured religion works because that’s how many Americans now talk about their inner lives. America’s Oprahfied popular culture seeks cathartic confessionals, with therapists quietly encouraging troubled clients in an office, facilitators inviting twelve-steppers to “share with the group,” and audiences lustily baiting distressed guests in a studio. People are told that “sharing,” what hippies called “letting it all hang out,” is essential for exorcising your demons, and building your all-important self-esteem. One New Yorker cartoon has one inmate explaining to another that it is OK to plead guilty—but not to feel guilty.

I mean no disrespect for the millions who have benefited from AA. But, despite its apparent openness, AA is doctrinaire in its own way, often making those who fail not only feel badly about themselves but feel truly broken and deviant, given how successful the program claims to be. Acknowledging the shockingly low success rate may free millions of AA dropouts to seek other solutions. Note that drunk driving dropped due to a more behavioral approach by imposing greater penalties and encouraging Designated Drivers. And maybe, just maybe, an approach emphasizing right and wrong might work with some people too.

Good doctors understand that every complex medical case is unique; healing often requires mixing methods. Unfortunately, pop healers and therapists, dealing with humans at our most idiosyncratic, often end up being particularly fanatic. On its 80th anniversary, let us celebrate AA’s many achievements, fighting our mass addiction to alcohol while affirming spirituality’s humbling, healing powers. Hopefully, such humility will open its practitioners to the broader arsenal needed to combat alcohol abuse and to find deeper discipline with greater meaning in our lives.