Posted on 03/23/2014 4:04:01 PM PDT by nickcarraway
Since its founding in the 1930s, Alcoholics Anonymous has become part of the fabric of American society. AA and the many 12-step groups it inspired have become the country's go-to solution for addiction in all of its forms. These recovery programs are mandated by drug courts, prescribed by doctors and widely praised by reformed addicts.
Dr. Lance Dodes sees a big problem with that. The psychiatrist has spent more than 20 years studying and treating addiction. His latest book on the subject is The Sober Truth: Debunking The Bad Science Behind 12-Step Programs And The Rehab Industry.
Dodes tells NPR's Arun Rath that 12-step recovery simply doesn't work, despite anecdotes about success.
"We hear from the people who do well; we don't hear from the people who don't do well," he says.
Interview Highlights
On Alcoholics Anonymous' success rate
There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent. Most people don't seem to know that because it's not widely publicized. ... There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine.
It's not only that AA has a 5 to 10 percent success rate; if it was successful and was neutral the rest of the time, we'd say OK. But it's harmful to the 90 percent who don't do well. And it's harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. AA is never wrong, according to AA. If you fail in AA, it's you that's failed.
On why 12-step programs can work
The reason that the 5 to 10 percent do well in AA actually doesn't have to do with the 12 steps themselves, it has to do with the camaraderie. It's a supportive organization with people who are on the whole kind to you and it gives you a structure. Some people can make a lot of use of that. And to its credit, AA describes itself as a brotherhood, rather than a treatment.
So as you can imagine, a few people given that kind of setting are able to change their behavior at least temporarily, maybe permanently. But most people can't deal with their addiction, which is deeply driven, by just being in a brotherhood.
On a psychological approach to addiction
When people are confronted with a feeling of being trapped, of being overwhelmingly helpless, they have to do something. It isn't necessarily the "something" that actually deals with the problem ... Why addiction, though, why drink? Well, that's the "something" that they do. In psychology we call it a displacement, you could call it a substitute ...
When people can understand their addiction and what drives it, not only are they able to manage it but they can predict the next time the addictive urge will come up, because they know the kind of things that will make them feel overwhelmingly helpless. Given that forewarning, they can manage it much better.
But unlike AA, I would never claim that what I've suggested is right for everybody. But ... let's say I had nothing better to offer: It wouldn't matter — we still need to change the system as it is because we are harming 90 percent of the people.
AA is not a Christ based program, unless you want it to be that. It is a spiritual program that involves hard work. Just as therapy involves hard work when you are ready to start recovery. Addictive behavior comes from the chemical dependency, IMHO. It has worked for me for 29+ years so far.
Didn’t notice in the article anything about the success rate of any other methods. I can buy that different people will respond better to different things, but what are they and what are the criteria to choose one over the other? And I can’t see how AA would harm anyone, other than exposing sinners to God and thus stealing a few of them away from satan’s kingdom (which would constitute “harm” to a typical NPR reporter I guess).
That’s the key. You have to decide to change. I think AA at the very least can provide you with other success stories.
Lifestyle choices have consequences. Congratulations.
Most rehab programs fail. People are into them over and over again. I think AA is under attack because of its overt use of deity.
In Hollywood, Rehab is a career move.
Being sent through two re-habs by uncle sam (Bethesda and Jax dry dock) I spent another year out there before I stopped.
That was Nov 16th, 1977.
It was not the ‘treatment’ that got me sober, but the fellowship. People who shared with each other with out getting a paycheck for it.
For me, the 12 steps were a little too much for me to grasp. A friend of Clancy told me about the program before the steps;
Find God, Clean house, Help others.
Works for me
Psychiatry is largely quackery. Medication works as well as talk therapy which works as well as a good as a strong support network.
AA saved my sister’s life. That’s all that matters to me.
There is a large, ever-growing amount of evidence that contingency management is critical in the treatment of substance-abuse disorders.
Here is a link to a recent issues of the Journal of Applied Behavior Analysis, all about research on the treatment of drug abuse (http://onlinelibrary.wiley.com/doi/10.1002/jaba.2008.41.issue-4/issuetoc)
Here is a link to a recent review article on contingency management (http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2006.01581.x/full)
I was addicted to alcohol. I kicked it mostly on my own but AA did help considerably.
I was addicted to cigarettes. This I kicked by doing, IMHO, the only thing you can do to quit cigarettes, QUIT! It’s not easy.
It was after I quit smoking I realized I have an addictive personality. I have to be very careful because I can get addicted to something so easily.
I hate to admit this, but I was addicted to freezer pops. Isn’t that ridiculous? It wasn’t to me as I consumed dozens a day. Finally I realized how stupid it was and quit, just like I quit cigarettes.
Life is certainly interesting.
So what part of 12-step recovery got debunked? The whole thing about AA's Big Book is that it was written AFTER the program worked for the first 100 or so alcoholics. One cannot come after the fact 70+ years later and now deny what already happened.
From my own life experience, I may have been able to stay off alcohol and drugs due to my own self-serving stubbornness. But I didn't begin to recover until I accepted AA. It was though AA that I learned who God was and that He was really on my side. And I experienced the transformation that occurred when God did for me what I could not do for myself.
God is referred to in 7 of the 12 steps. If they were honest about it, those opposing the 12 steps are really just opposing God. But then there are those who are constitutionally incapable of being honest.
The medical establishment doesn’t like AA because they don’t encourage medication and they can’t make any money off of a purely voluntary organization. Even rehabs claim less than 20% success, and what is success? Recovery is a life-long spiritual struggle against a scourge that claims not only the victim but those around him.
Positive reinforcement works. My experience with addicts is they’re self-medicating. The ones who find a way out make a firm choice to stop. They very often redirect that energy toward helping others, including animals. They become their own therapists and prescribe dedication to service. That works and works well.
I like how they “invented” sex addiction.
I'm about the same way. I knew it early on when I was young. Just HAD to have a certain kind of candy every day after school. I think I can get hooked on virtually anything. I initially started drinking as a coping mechanism for stress. Then, it was also fun to drink while having a good time, OR while I was generally bored. I guess I was a VERY high functioning drunk. Full time job with lots of hours, a bunch of kids, ect.
Nearly died last year from Liver failure. About wished I was dead at the time. You've never known sickness until your Liver stops working as it should. Hadn't drank since. Well, except for a half a beer during our wedding anniversary. Got on the Transplant list, the doctor gave me a year to live(maybe less), and I looked like a skeleton. Weird thing is I gradually got 'better'. I've gained back about 40 lbs, mostly muscle so far, thank God. The specialist(who is literally one of the best in the world) couldn't believe it. Said that I was only the second person he's EVER seen recover to this extent. My Lab values look like that of a 'normal person', though I still generally feel like shit. Being relatively young still, it really sucks to discover mortality, the HARD way!
AA works for some people. That’s way better than nothing. Locally, there are 30 or 40 individuals, mostly men, who are no longer drunk. That’s a good thing.
You are right With G-d’ help got sober when oldest shild only two. raised six kids as sober father. Just got sixty year coin from my group. Give thanks every day,
While he charges $300/hr for his services (sorry, no sliding scale,) AA is free. No wonder he wants to sabotage the program.
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