Debunking the Bad Science Behind 12-Step Programs and The Rehab Industry
By: Lance Dodes, MD, and Zachary Dodes
Publisher: Beacon Press
Alcoholics Anonymous is an all-American staple, so closely tethered to addiction recovery it’s come to represent the process itself, much in the same way “Kleenex” is synonymous with facial tissue. Annual attendance for twelve-step programs within the U.S. totals to over five million individuals, with no indications of future decrease. But there remains to be no definitive collection of data on these individuals or their success rates: in fact, peer reviewed studies arrive at a dismal figure, estimating that just five to ten percent of AA participants are able to maintain sobriety.
The Sober Truth is not an unmitigated attack on the ever-popular Alcoholics Anonymous, nor is it a rebuke of the program’s millions of past and present disciples. Instead, using AA as a model, Dr. Lance Dodes delivers a systematic criticism of the entire rehab industry, and the disconcerting lack of transparency that perseveres, despite advancing medical research.
In some light, Alcoholics Anonymous is a miraculous success story, worthy of envy from every corner of the self-help industry. Creator and author of Alcoholics Anonymous (and former addict) Bill Wilson found a hole, an untapped market, and filled it with his methodology, a methodology that eighty years after its inception, still knows no formidable rival. AA’s unchallenged monopoly is a stronghold for the century—no other program is so lauded by individual, church, and state. Despite the unparalleled popularity of AA and similar twelve-step programs, there is very little research to merit their abject supremacy, as The Sober Truth’s Dr. Lance Dodes is quick to note.
Formerly the substance abuse treatment director at Harvard’s McLean Hospital, Dodes has been researching and writing about addiction and methods of healing for over two decades. Among his numerous complaints concerning modern addiction recovery are the following tenets, which Dodes explores and expands upon throughout the text:
-AA and other similarly modeled twelve-step programs are exclusionary and inflexible, promoting a dangerous all-or-nothing mentality. Any blunder, from a slight slip-up to a total relapse incurs the ultimate penalty: to begin again, at Step One. If you find that the path AA has laid isn’t leading you to lasting recovery, it’s because you’re not doing it “right.” In a one-size-fits-all program, the program doesn’t need alteration. You do.
-Many of those employed as “addiction counselors” in the rehabilitation industry have questionable qualifications. Some are merely current or former addicts (as are “sponsors” within AA). The amount of time addicts will spend with these addiction counselors in any recovery program or rehabilitation facility greatly exceeds time spent with an accredited physician.
-There is no blanket method to treat, cure, or repel addiction, yet individuals with substance addictions are routinely grouped together for recovery purposes: by the court systems, the rehab industry, and former addicts.
His objective is not the abolishment of AA or to necessarily deter future subscribers. Instead, The Sober Truth acts as a plea, stressing the need for more alternatives, and for a more comprehensive system of research into the nature of addiction.
The Sober Truth is accessible while remaining intelligent; it requires no prior knowledge about addiction or recovery, only active interest. The chapters read as stand-alone articles encompassing their assigned topics chronologically (Chapter One “The Problem”, Chapter Two “The Rise of AA”, Chapter Three “Does AA Work?” etc.), ideal for lunch break research.
However, those looking for a textbook analysis of the strengths and foibles of Alcoholics Anonymous will not find them in Dr. Dodes’s 160 pages of Truth. It is the lazy-Sunday-morning equivalent to an in-depth examination; conversational, and almost casual in some of its overviews and inferences. A reader gets the impression that everything has been researched and worked out backstage, but we’re never afforded a peek behind that curtain. Chapter Six, “What the Addicts Say,” features a block of essays and interviews from the perspective of former AA members, a section that severely alters the rhythm of the text without adding any new information. If Dodes was seeking additional credibility in their inclusion, he should have been more discerning. By his own admission, “There was no selection process in choosing the narratives in this chapter; they are simply the reports of the first ten people who responded…” (Dodes, 96). This indiscriminate inclusion may be a play for objectivity, but it reads as carelessness at best, disingenuousness at worst.
While Dodes’s critique of the AA machine will trigger a predictable amount of backlash from those who’ve benefited from the program, certainly a certain amount of probing is paramount to the success of any institution. The text is not going to convert passionate adherents, and it isn’t meant to. The Sober Truth is light reading on a heavy subject, ideal for field novices and readers seeking inquiry without much commitment. The advocacy for alternate routes of addiction recovery is admirable. In any industry concerned with human health and wellness, there is room for alternatives. The Sober Truth makes a case for their necessity.
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