I’ve just read a report on the NPR website discussing a new book purporting to debunk the ‘bad science behind 12-step programs and the Rehab industry’. The article, 'With Sobering Science, Doctor Debunks 12-step Recovery' reports the findings of psychiatrist Lance Dodes, who purports to expose the misleading claims of AA and its related addiction groups with respect to recovery. Focusing specifically on alcoholism and the growth of Alcoholics Anonymous as the primary means of helping people recover from their addiction to alcohol, Dr. Dodes concludes that 12-step programs simply do not work, despite anecdotal evidence to the contrary. ‘We hear from the people who do well,’ says Dodes; ‘we don’t hear from the people who don’t do well.’ The book cites studies that indicate that AA has only a 5-10% success rate. The reason it works for some people has to do more with the supportive structure of the program than with the 12 steps themselves, according to the authors.
Alternatively, Dr. Dodes and his coauthor Zachary Dodes suggest a more nuanced ‘psychological’ approach to treating 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.’
So far, so good.
But Dr. Dodes goes on to claim that groups like AA do actual harm to the vast majority of their participants, 90% by his reckoning. It’s the 90% who ‘don’t do well’. And it’s harmful because ‘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.’
This has not been my experience of recovery programs in the AA mold. And the AA/NA/SA/SAA/SLAA literature itself makes no claim to universal applicability or efficacy, stating only that this is something that ‘we’ have found effective for us. I dare say that AA and related programs are not for everybody, and that many people find themselves forced to attend by the courts or by spouses or in last-ditch efforts to save jobs/families/reputations. The 12-step program requires serious commitment and serious change. And not everyone is willing or able to go there. But the 12-step programs that I am aware of are all upfront about these things. And what makes the program both realistic and powerful is that it was devised by addicts for addicts, not by courts for addicts, nor by psychologists for addicts. And while the AA program values the insights that can come through counseling, and encourages addicts to make use of whatever means they can to help themselves, they have through experience a pretty good idea of what addiction is and what needs to happen to escape it.
Moreover, the great problem Dr. Dodes fails to admit (at least in the article) is that there is no ‘successful’ treatment for addiction. There are, instead, a host of tools that can be used to help someone out of the pit of whatever addiction they find themselves in. Any one of these tools, or any combination of them, may or may not work. But every person is different, every circumstance is different, every pathway into the addiction is different. Which might suggest that every pathway out may be different as well. To their credit, the authors acknowledge that AA does not claim to be a ‘treatment’ per se, but rather a fellowship or ‘brotherhood’ of addicts who realize they have come to the end of their rope. Those whom I know involved in AA, NA, SA SAA and SLAA have often come to the conclusion that their addiction is beyond the power of a meeting or two a week to handle, and are themselves seeking further help through counseling, seminars, and residential treatment. If addiction were easy to resolve, there would be a lot more whole and healthy people walking around. But the roots often go very deep. And attempts to deal with symptoms only end up seeing the addictive behavior pop up again and/or elsewhere in short order.
It’s one thing to criticize an organization that has provided relief to many, many addicts as being ultimately ineffective for the vast majority of women and men who attend its meetings. It’s another thing entirely to suggest that their own method is the holy grail, when the same criticism they level at others could just as easily be leveled at their own methodology. If a better method could be demonstrated, I for one would be first in line.
12 step programs – what do you think? Are they useless? Do they work?