Skip to comments.With Sobering Science, Doctor Debunks 12-Step Recovery
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.
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.
If that’s true then it’s been “not working” for me for almost 18 years.
It’s also a program of want, not need. It is not a panacea.
NPR staff. Bah
Sour grapes. His “program” probably costs money. AA does not. It has helped millions of people. Nothing’s perfect, except in the imagination of a liberal.
The main reason that is “doesn’t work” for the NPR crowd is that is based on a belief in a higher power than man. That is something they just can’t stand.
Look at the picture of the guy in the article. Typical hippy dippy know it all. He doesn’t like it because it brings people to God instead of knocking on his door. I’m okay with some stats that say it doesn’t work for everyone but the idea that its actually harmful is cr*p. No way that they can prove that. The people in the 12 step programs are damaged but the addict is going to hang out with damaged people whether he/she is in the program or not. 90 meetings in 90 days works. I was a grateful member of Al-anon for eight years. It got me through a lot. I’m now very busy with Church and I’m sure Dr. Dode thinks that’s a bad thing.
camraderie?...that's a bad thing?....
those same principles are used in weight loss groups, in study groups, in the miltary, etc...
I cheer AA for helping those they can....even if its ONE person, that's one person not on a perpetual binge...
It doesn’t work for everyone.
All it did for me was provide me with a new bunch of drinking buddies. What eventually worked for me was making a conscious decision to quit and toughing it out. Its been 12 or 13 years since I quit.
I am truly bothered when mental health officials are critical of AA. Treating addiction is amazingly difficult. God bless AA and any other program that can heal the addict.
Good for you, man. It’s definitely a softer way of life, isn’t it?
A person close to me once said “First I lost my mother to alcoholism, then I lost her to AA”. In a way it is a substitution for an addiction. But if it works for some I accept that.
“Not working” for me for 38 years. Continuous sobriety, nights and weekends included.
The article seems to equate fellowship (”brotherhood”) with the 12 step process. I currently see about 30% of the fellowship actually doing the 12 steps. Most stay try to stay abstinent on fear and fellowship.
I will look for some raw data from one of the medical insurance companies about the percentages for people who do the process through step nine. Those people show much higher success. “Anecdotally”, I see >50% for those people who do that.
AA works for those who work AA.
AA claims it works for everybody? This guy is full of chit.
Welcome to the 10%..........
Alcohol abusers (”heavy drinkers” who still have the power of choice) can quit. Many do. I quit smoking the way you quit drinking.
As a recovered, it depends on the individual and their willingness to accept and change on their own honor.
It works...but it is only successful for those who actually try. If the alcoholic puts in the minimum, then they will fail and end up using again. It’s a lifelong activity/commitment, you’re never cured, only in remission.
Its definitely made me stronger and led me to much more productive pursuits and interests. Its nice not sitting at the gas pump figuring if I can squeeze the miles I need out of a gallon of gas and get a 12 pack.
I tortured myself when I quit. I carried an unopened can of beer around with me for months figuring that if I opened it, I had failed. Finally I ditched it.
Placebos work too. Self-hypnosis works. Got to believe. For skeptics, programs of this type will never work.
The low success rate of AA is known. The varying ways people respond to AA is also known. Indeed, I have observed it myself.
It is notable to me that there seems to be no mention of the success rate of other approaches. What is there that works better? The anti-AA psychology disagreement has been going on for more then 3 decades. Surely is there IS data showing something that works better than AA the writer could mention it.
It seems likely that addictive behavior has several causes. Therefore it seems likely that one therapy will not work for all who display such behavior. Further those who stop displaying addictive behavior with respect to things like alcohol or medication may still show compulsive behaviors in other ways.
Some people who go to AA seem to get really better, a LOT better. Others, to mention just one imperfect outcome, just become addicted to going to AA — which still beats being addicted to a substance which in sufficient doses is a poison.
Not only that, but the proposed approach involving insight may well be insufficient in many cases. The inner state which leads to the displacement or compulsive behavior could be organic in origin, for example. The “talking cure” can only go so far with organic illness.
My conclusion is that, as it is, this is a pretty vapid article which seems to be self-serving somehow.
I know Robert Downey Jr still goes to weekly meetings.
On the other hand, Megadeth frontman Dave Mustaine said nothing worked for years till he picked up a bible and started reading.
If you can quit in twelve steps, great. I did it in one step, 38 years ago. Just don’t drink.
I think it is just one more step in the progressive plan to completely erradicate the concept of a Higher Power from the public eye. “Don’t ask God for help, as his bosses (psychiatrists).”
Those whom cannot afford a psychiatrist? Ignore them
Those who are helped by programs like these? They are unimportant
I think he is laying the groundwork for legal challenges to funding a la Boy Scouts.
I'll tell you what this is all about. God. They hate that many people seek help from a higher power. Liberals attacked Teen Challenge who has a 70% success rate, because their strength comes from depending on God. The left hates anything that has to do with God. They called teen challenges help child abuse. These people would rather their own loved ones, continue in their addiction if it meant believing in God. Government success rate is in 20s.
Thank goodness it worked for my brother. Without it I would have no brother.
Because of it he has been a model husband, father and completed a lifelong Navy career.
He now, after retirement from the Navy, been working for the state of Virginia in Social Work, for years.
He could have done none of this.
You have to do it on your honor. Either to yourself, or to god and it goes on for a lifetime.
It’s been close to 17 years for me and while not as intense as it once was, I still go to meetings once in a while. I need to see the newbies as a reminder to keep the faith.
Doc we will hold your seat for you until you are ready...
Well, it requires “rigorous honesty”. That takes a lot of liberals out of the picture.
I was just talking to some recovered addicts (and drinkers) regarding that program. One of them is in a ministry program At Oral Roberts University.
He said that without the power of God to change on’s life - it just isn’t going to work; they’ll just fall back. But, if it’s a Christ-based program, then you have the power of the Holy Spirit working in the person’s life.
The problem with that? Well ... I guess it leaves out the atheists, Buddhists, Muslims, Mormons, Jehovah’s Witnesses, Hindus ... etc ... :-) ...
I’ve got a relative that we’re trying to work on ... in that regard.
they don’t say it doesn’t work for everyone. but i am sure you know of people in aa that have fallen off the wagon one or more times. ithink admitting the fact that it’s a program that doesn’t work for everyone is true, just like not every medicine works for everyone.
AA has helped countless people live one day at a time by the grace of God.
wht you say is true. the persone truly inside has to want to quit, consciously. maybe their life hasn’t hit rock bottom or the ‘what the hell am i doing?!?’ moment yet.
I read through it waiting for the argument against relying on a Higher Power. Surprised that was not in there.
I have had 2 close relatives who were helped by AA.
i have two friends that i KNOW would NOT BE HERE TODAY without AA.
Im now very busy with Church and Im sure Dr. Dode thinks thats a bad thing.
I am betting you are correct about that.
12 Steps have made my Wife and I better by getting over Addictions. We are now continuing our recovery via Celebrate Recovery.
Thank you Bill and God.
“It doesnt work for everyone.
All it did for me was provide me with a new bunch of drinking buddies. What eventually worked for me was making a conscious decision to quit and toughing it out. Its been 12 or 13 years since I quit.”
I have known almost no one who beats an addiction permanently.
Kudos to you for doing it.
Regarding AA failing. My psych professor said that traditional psychiatry also has about a 90 percent failure rate. He said drugs were about the only thing that worked and even then it was about 50%.
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.
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