“The only requirement for A.A. membership is a desire to stop drinking" - That's awesome and very inviting for those who qualify but what about the millions of people out there who have an alcohol or drug issue of some kind but have little or no desire to stop? Someone might reason that it is just too bad for those unfortunate individuals who don't want to stop using and there is nothing any of us can do for them. That may very well be true theoretically speaking as most of us know that it is extremely difficult if not impossible to help someone to change who does not want to change.
Realistically speaking, however, if you ask just about any substance abuse treatment provider (such as myself) which types of situations dominate our treatment programs and they will tell you that treatment consists of a huge mandated and coerced population. The truth is that a huge proportion of people in treatment have little or no desire to stop using rather they have to stop to avoid consequences (for example, someone on parole who enters a program to avoid returning to prison, or a man who is going to lose his job if he doesn't complete a program because he gave a random dirty urine on the job) Let's not forget the countless adolescents and young people in treatment, most of whom will openly state that the only reason that they are in treatment is to get someone like their parents or probation officer off of their back and the minute that the smoke clears (no pun intended) they intend to go right back to getting high because they have no desire to stop!
When we consider these and other similar examples and look at all of the people who end up in treatment programs who have little or no motivation or desire to stop using other than to avoid consequences, then obvious next question is: "Why are so many treatment programs strictly using 12 step methodology if these people don't even meet the basic minimum requirement for the 12 steps (a desire to stop?)
The reality is the such a huge percentage of people who have substance use issues who are in treatment are actually on Step Zero. These people are clearly not ready for the 12 steps so it does not make sense to try to force it on someone who does not qualify. Rather an alternative approach and perspective is so desperately needed that starts from the point of building motivation and insigt where those qualities may be lacking.