An exposé of Alcoholics Anonymous, 12-step programs, and the rehab industry—and how a failed addiction-treatment model came to dominate America.
AA has become so infused in our society that it is practically synonymous with addiction recovery. Yet the evidence shows that AA has only a 5–10 percent success rate—hardly better than no treatment at all. Despite this, doctors, employers, and judges regularly refer addicted people to treatment programs and rehab facilities based on the 12-step model.
In The Sober Truth, acclaimed addiction specialist Dr. Lance Dodes exposes the deeply flawed science that the 12-step industry has used to support its programs. Dr. Dodes analyzes dozens of studies to reveal a startling pattern of errors, misjudgments, and biases. He also pores over the research to highlight the best peer-reviewed studies available and discovers that they reach a grim consensus on the program’s overall success.
But The Sober Truth is more than a book about addiction. It is also a book about science and how and why AA and rehab became so popular, despite the discouraging data. Dr. Dodes explores the entire story of AA’s rise, from its origins in early fundamentalist religious and mystical beliefs to its present-day place of privilege in politics and media.
The Sober Truth includes true stories from Dr. Dodes’s thirty-five years of clinical practice, as well as firsthand accounts submitted by addicts through an open invitation on the Psychology Today website. These stories vividly reveal the experience of walking the steps and attending some of the nation’s most famous rehabilitation centers.
The Sober Truth builds a powerful response to the monopoly of the 12-step program and explodes the myth that these programs offer an acceptable or universal solution to the deeply personal problem of addiction. This book offers new and actionable information for addicts, their families, and medical providers, and lays out better ways to understand addiction for those seeking a more effective and compassionate approach to this treatable problem.
“A searing critique of the rehab industry.”
—Psychotherapy Networker
“As always, Dr. Dodes offers a humane, science-based, global view of addiction. The Sober Truth is an essential, bracing critique of the rehab industry and its ideological foundations that we have much to learn from.”
—Gabor Maté M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
“Like Breaking Addiction and The Heart of Addiction, The Sober Truth makes an important contribution to the field by raising central questions about how treatment and self-help programs operate and whether commonly used treatments for addiction are effective. Dodes and Dodes thoughtfully and rigorously trace the history of alcohol treatment and the role of such treatment within the “rehab” setting. Perhaps most importantly, The Sober Truth examines the failure of science to provide answers to fundamental questions about addiction treatment. People struggling with addiction deserve more than science has provided, and The Sober Truth should stimulate a fundamental dialogue that can move the field forward. Finally, and not to be missed, this book also serves as a treatment guide for anyone seeking help with their own or a loved one’s alcohol use.”
—Howard J. Shaffer, Ph.D., Associate Professor, Harvard Medical School; Director, Division on Addiction, The Cambridge Health Alliance
“Lance Dodes and Zachary Dodes have the guts to take on clearly, perceptively, and with solid scientific grounding the nude king of American addiction treatment: AA and the 12 steps. Not only do these shibboleths yield no benefit for the mass of alcoholics and addicts in America, they leave cold—even harm—far more people than they help. Read this book!”
—Stanton Peele, Ph.D., author of Recover!
“Provocative, illuminating, persuasive, and lucid, The Sober Truth will enrage some, reassure others, but inform all. The Dodes's write beautifully (so rare in this field), and they also hold fast to common sense (also rare) while backing up their contrarian statements with utterly convincing evidence. Read this book before committing to any 12-step course of treatment, then decide for yourself.”
—Edward Hallowell, M.D., author of Answers to Distraction and Superparenting for ADD
CHAPTER EIGHT: THE MYTHS OF AA
MYTHS HAVE A WAY of coming to resemble facts through repetition alone. This is as true in science and psychology as in politics and history. Today few areas of public health are more riven with unsubstantiated claims than the field of addiction.
Alcoholics Anonymous has been instrumental in the widespread adoption of many such myths. The organization’s Twelve Steps, its expressions, and unique lexicon have found their way into the public discourse in a way that few other “brands” could ever match. So ingrained are these ideas, in fact, that many Americans would be hard-pressed to identify which came from AA and which from scientific investigation.
The unfortunate part of this cultural penetration is that many addiction myths are harmful or even destructive, perpetuating false ideas about who addicts are, what addiction is, and what is needed to quit for good. In this chapter, I’d like to take a look at a few of these myths and examine some of the ways they impair efforts at adopting a more effective approach.
MYTH #1: YOU HAVE TO “HIT BOTTOM” BEFORE YOU CAN GET WELL
This common myth essentially says that an addict needs to reach a point of absolute loss or despair before he or she can begin to climb back toward a safe and productive life.
The most common objection to this myth is simple logic: nobody can possibly know where their “bottom” is until they identify it in retrospect. One person’s lowest point could be a night on the street, while another’s could be a bad day at work or even a small personal humiliation. It’s not unusual for one “bottom” to make way for another following a relapse. Without a clear definition, this is a concept that could be useful only in hindsight, if it is useful at all.
A bigger problem with this notion is the idea that addiction is in some fundamental way just a matter of stubbornness or stupidity-- that is, addicts cannot recover until they are shown the consequences of their actions in a forceful enough way. This is a dressed-up version of the idea that addiction is a conscious choice and that stopping is a matter of recognizing the damage it causes. I have said it before, but it bears repeating: if consequences alone were enough to make someone stop repeating an addictive behavior, there would be no addicts. One of the defining agonies of addiction is that people can’t stop despite being well aware of the devastating consequences. That millions of people who have lost their jobs, marriages, and families are still unable to quit should be a clear indication that loss and despair, even in overwhelming quantities, aren’t enough to cure addiction. Conversely, many addicts stop their behavior at a point where they have not hit bottom in any sense.
There is a moralistic subtext at work here as well. The notion that addicts have to hit bottom suggests that they are too selfish to quit until they have paid a steep enough personal price. Once again we get an echo of the medieval notion of penance here: through suffering comes purity. Addicts no more need to experience devastating personal loss than does anyone else with a problem. Yes, it can be useful when a single moment helps to crystallize that one has a problem, but the fantasy that this moment must be especially painful is simply nonsensical.
Finally, the dogmatic insistence that addicts hit bottom is often used to excuse poor treatment. Treaters who are unable to help often scold addicts by telling them that they just aren’t ready yet and that they should come back once they’ve hit bottom and become ready to do the work. This is little more than a convenient dodge for ineffectual care, and a needless burden to place on the shoulders of addicts.
MYTH #2: YOU MUST “SURRENDER” YOUR WILL TO GET WELL
Here we have another pillar of the Oxford Group, AA’s theological forerunner, which preached salvation through surrender to God. In Alcoholics Anonymous, this idea is implied, if not expressly stated, in steps 1 and 3, which respectively recommend admitting powerlessness and making a decision “to turn our will and our lives over to the care of God as we understood God.”
The first problem with this idea is its overt religious flavor. I have covered the many ways that addiction is a problem of the mind and not of the spiritual soul. “Surrendering,” in the sense that addiction organizations commonly understand it, means abdicating power to a presence greater than oneself to attain guidance. It’s not surprising that many addicts chafe at this notion, not least because it requires a belief system that may not jibe with their own.
A bigger problem is that surrendering is tantamount to agreeing that one is incapable of managing one’s own life. AA’s literature ties this idea once again to a moralistic adage: “Our whole trouble had been the misuse of will power.”1 Surrendering becomes a way to toss out a useful sense of selfhood or agency precisely when it’s needed most.
And of course the very notion of surrender is problematic when viewed through the prism of a more psychologically sophisticated understanding of addiction. As I outlined in chapter 5, the emotion that precipitates addiction is helplessness. Addicts find certain forms of helplessness utterly intolerable, and the addiction is an effort to reverse that. Asking them to surrender their free will in response to this problem is diametrically opposed to what they need to do: feel empowered. As we saw in the first-person accounts in chapter 6, the dissonance created by this emphasis on surrender is one of the big reasons so many addicts don’t get better in AA.
CONTENTS
PREFACE
CHAPTER ONE
The Problem
CHAPTER TWO
The Rise of AA
CHAPTER THREE
Does AA Work?
CHAPTER FOUR
The Business of Rehab and the
Broken Promise of AA-Plus
CHAPTER FIVE
So, What Does Work to Treat Addiction?
CHAPTER FIVE
What the Addicts Say
CHAPTER SEVEN
Why Does AA Work When It Does?
CHAPTER EIGHT
The Myths of AA
CHAPTER NINE
The Failure of Addiction Research
and Designing the Perfect Study
ACKNOWLEDGMENTS
NOTES
INDEX