Finding myself deeply inspired by Lance Dodes’s theory that a feeling of helplessness underlies addiction in Breaking Addiction: A 7-Step Handbook for Ending Any Addiction – the first part of which I excerpted here and applied to my own life here – Lance and Zachary Dodes’s 2014 book The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
I felt shaken by The Sober Truth, both as a counselor and as person recovering from alcoholism. (I am still pondering and will share when I have insights.)
The Sober Truth has been extensively reviewed. Jake Flanagan offered brilliant commentary in The Atlantic. It was reviewed negatively in The New York Times; co-author Lance Dodes was featured on NPR. The book was challenged here by some heavyweights in the addictions field. Dodes replies to each charge with calm erudition.
When I read the extensive comments to Dodes’s replies, so many thoughtful and rational, others dogmatic and shrill, including distressing personal attacks of Dodes and other commenters, I felt as if were observing a microcosm of the very state of disrepair in the addictions field that Dodes criticizes.
After reading features and reviews and hundreds of comments, interlaced with Dodes’s rather heroic attempts to converse respectfully and reasonably with commenters, eventually I found his voice missing among the increasingly frantic and repetitive comments. Did he feel helpless and give up?
When I thought of entering a room full of commenters and commentators on The Sober Truth and attempting to find common ground among them – necessary to derive a vision and plan for the future of addictions treatment – I felt helpless. So helpless, in fact – as Dodes might predict – I wanted a drink.
“[B]y believing that AA [Alcoholics Anonymous] is the right approach for everyone, we have failed to adequately use or study other approaches that may be more helpful for the majority of sufferers. Although some people claim that our book ‘bashes’ AA, it is actually an effort to create a more sensible way to deal with this major public health problem.”
– Lance Dodes, comment
Excerpts from The Sober Truth follow.
[All text is quoted directly except when in brackets. Bracketed text is added for clarity. Page numbers are at ends of sections.]
Peer-reviewed studies peg the success rate of AA somewhere between 5 and 10 percent. That is, about one of every fifteen people who enter these programs is able to become and stay sober. 1
While it’s praiseworthy that some do well in AA, the problem is that our society has followed AA’s lead in presuming that 12-step treatment is good for the other 90 percent of people with addictions. 2
A treatment for alcoholism may be called successful if an individual no longer drinks in a way that is harmful in his or her life. 34
An objective calculation puts AA’s [Alcoholic Anonymous’s] success rate at 5 to 8 percent. Controlled, randomized studies, on the other hand, have revealed an even more discouraging picture: no such study to date has been able to prove that AA is effective at all. 56
Is this industry [the addiction rehab industry] actually helping people? 60
All this begs the questions: given that virtually every rehab is an elaborate expansion of 12-step meetings, why do people spend a fortune for programs that aren’t fundamentally different from what they could find for free in a church basement? 61
How does anyone know that thirty days is the right number of days to treat addiction? 62
How did standardized, education-like group therapy become the predominant mode of treatment at rehab centers…? 69
“Any serious treatment center would study its own outcomes to modify and improve its approach. But rehabs generally don’t do this. For example, only one of the three best-known facilities has ever published outcome studies (Hazelden); neither Betty Ford nor Sierra Tucson has checked to see if their treatment…” 39% on Kindle
What can we conclude from this [research on the success of rehabs in achieving abstinence for those they treat]? At minimum, as the researchers themselves write…”There appears to be a loss of treatment effect over time.” It appears that the benefits of being away…do not last long…[T]he single foundational treatment offered by Hazelden and most other rehab centers is the 12-step program, whose success rate we know. Rehab’s poor outcomes in light of these limitations are, therefore, not surprising. 75
[Lady MacBeth’s] compulsive behavior is universally comprehensible in human terms: a symbolic gesture to undo her guilt. 90
Once addictive behavior is defined through the prism of compulsive behavior, it can be treated just as pychotherapists would treat any emotionally driven compulsion, using talk therapy to root out the deeper meanings and purposes behind the behavior. 90
[Excerpt from case story on Marion:] By deciding to take a pill, Marion has chosen to do something within her own control, something that would make her feel better. Gone was the unbearable sense of powerlessness, replaced by a liberating sense of control. 91
[Three pieces of the addiction puzzle:]
[1] The psychological function of addiction is to reverse the sense of overwhelming helplessness. 91
[2] If reversal of helplessness is the function of addiction, then the powerful drive behind addiction is rage at that helplessness. 92
[3] Every addictive act is a substitute for a more direct behavior. 92
The drive to reverse utter helplessness is an explosive force, the natural human rage to fight against being trapped. 91-92
If addicts can learn to address their rage at helplessness directly, then it [rage] manifests simply as an assertive act. When people act directly, there can be no addiction. 92
[Addiction] becomes ordinary, no more or less manageable than any psychological challenge; it needs no special category; it is a psychological problem and can be managed as such. 93-94
People who have this symptom [the psychological symptom of addiction] can learn how it works within them and develop the agility to solve the issues that lie behind it. For instance, once people view their addiction as a mechanism to solve feelings of overwhelming helplessness, then it becomes critical to identify what is overwhelming for them – what sort of events or feelings carry powerful emotional significance. Being stuck on a call with the bank is frustrating for everybody, but for someone who used to spend hours every week as a child wait to speak to his estranged father by phone, it carries a particular resonance and power. 94
[A]ddiction can be understood, managed, and ended through learning about oneself. 94
Programs that apply community-based encouragement and little or no individualized care are poorly designed to treat emotional symptoms, including addictive behaviors…12-step treatments are trying their best to solve a problem whose fundamental essence they do not understand. 95
[S]elf-understanding is the key to treating all psychological symptoms. 121
[The] goal of therapy is to help people recognize feelings and thoughts that lie beyond their awareness. 121
[G]ains made throughout sobriety can quickly evaporate as the addict discovers that the very same feelings of intolerable helplessness have returned. 130
Insight is a form of empowerment that cannot be wrested from your grasp. 131
[C]urrent members [of Alcoholics Anonymous] respond with rage when pressed to consider different viewpoints or countermanding data. The visceral power of these responses should be a clue to the psychology behind them: we save our fiercest defenses for an attack on that which keeps us whole. 131
What can be done to make use of that which is useful in the program [of Alcoholics Anonymous]? Since AA is helpful for a small minority of people with alcoholism, and often neutral or detrimental to others, it should be prescribed carefully. The current practice of referring addicts wholesale to a 12-step group is unwise and dangerous. 132
People who make it clear they find 12-step meetings and ideas to be offensive, stupid or wrong should not be encouraged to ignore their feelings. They are telling us in clear language that they are simply not candidates for this particular approach. Conversely, those who like 12-step programs and benefit from them are telling us they may belong in that small group of committed and helped members. 132
Directing people toward the best approach for them is one of the most basic forms of medical care. We have generally failed at applying thoughtful triage like this to addiction in this country. 133
[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. 135
Asking them [addicts] to surrender their free will in response to this problem is diametrically opposed to what they need to do: feel empowered. 136
Yet slips [from abstinence] are hardly rare and not remotely apocalyptic. Most people will experience some lapses as they grapple with their addiction. This is completely predictable, given the fact that addictions arise from deeply personal emotions and experiences that can take months and years to work through. 137
The word “drunks” also defines addicts by their addiction, further reinforcing the notion that addicts are somehow different from the rest of us, as if addiction is an innate quality rather than an acquired behavior…[it says] addiction is not something you do, it’s something you are… Addiction appears within every possible socioeconomic level and in people who run the gamut of emotional health… The core issues [and underlying distress] that lead to feelings of overwhelming helplessness, and thence to addiction, are as varied as the people who experience them. 138
The idea that having an addiction makes people so different from others that only other addicts could possibly understand them is demeaning. Nobody would ever suggest that a doctor must have had cancer to treat cancer, yet in the 12-step model, addiction is accorded this special designation of “otherness.” 145
Addictive thoughts are never random. 94
[A]ddiction itself isn’t a remotely insane thing to do. Addiction has its own logic and its own purpose…[A]lthough addicts may engage in deeply destructive behavior, crazy they are not. 144
[A]ddiction works psychologically – as a fundamentally healthy drive to feel empowered when it seems like there is no other choice… 145
“It turns out that AA’s emphasis on denial is misplaced; denial itself isn’t the problem – it’s shame, coupled with a lack of understanding of the nature of addiction that makes ‘denial’ necessary.” 145
But they [who judge addicts’ problem to be denial] do terrible harm to the very addicts whose recovery depends on understanding themselves without judgment. 145
Most people who do good work in education or the humanities know that deeply significant truths cannot be measured…Most good, worthy, and verifiable ideas don’t belong in a spreadsheet. 148
What’s missing from this literature [published research on addictions] is any study that revisits the fundamental questions once and for all: What is addiction? How should we treat it? Why does it occur in some individuals and not in others? 150
The addiction field has been dominated by two colossal institutions, neither of which is trained or interested in looking beneath the surface of any behavior to its underlying causes. One of these forces is AA. The other is [a shift in research and thinking in the field of psychology that includes] …the very popular notion that addiction is a disease. 155
Image: Screenshot from lancedodes.com
I am not a religious person and don’t believe in any doctrine. When I first went to AA I was also put off by AA reference to god. I do however believe in different levels of consciousness and the energy of life and the universe and that is my higher power. AA recognises that to tackle addiction you can’t do it with the same mind that got you into the problem to start with. We need to tap into a higher level of consciousness and become less egotistical and stop seeking contentment from external sources and realise happiness comes from within. AA also provides connection to people trying to deal with the same issue and an antidote for addiction is connection. I started with a skeptical mind towards AA but I having looked past the archaic language I do see a logical solution and find that following AA is helping me immensely. Like it or not our lives are a spiritual journey and alcoholism like materialism is a side effect of low spirituality. Spirituality is not doctrine or religion.
Thank you for an excellent blog and series of posts. I’ve been in AA for around 15 months having come through a Hazelden model rehab in Ireland. I did find it slightly disconcerting that a treatment centre charging the kind of fees that it does had no metrics in place for measuring success. Having relapsed three months after treatment I threw myself into AA at the beginning of this year as I had – fairly much – nowhere left to turn. I find AA can vex and inspire me in equal measure but I think you summed it up perfectly, Anne, when you mentioned “support” and “structure” as this is what it has most given me. I do my best to ignore the grand, sweeping statements that the old timers proclaim as fact and I try not to bristle too much any time I hear mention of the phrase “this disease of the mind” (a big favourite in this part of the world!) But it has helped me stay sober for 12 months – my longest period in 25 years – and I am very grateful for that. For the moment I intend to keep going.
“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…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.”
– Lance Dodes, NPR interview, 3/23/14
http://www.npr.org/2014/03/23/291405829/with-sobering-science-doctor-debunks-12-step-reco
Fantastic clarifying interview with Lance Dodes at The Fix from 5/30/14. I didn’t find it when I was studying reviews of the book:
http://www.thefix.com/content/14-questions-dr-lance-dodes
Anne:
I am, and have been, of the opinion that when anybody says, “My way is the only way,” we need to turn around and walk away. There are very few instances where that is true. I got sober in AA. It took a long time and a lot of work, but eventually it worked for me. But I will never say it is for everybody because it is not.
Will it work for you, or anybody else? I don’t know. We are all different and we respond differently to various stiumli. When I finally figured out how a higher power would and could work for me, the rest was relatively easy, but that took 23 years. Some never figure it out.
I stopped going to AA a few years ago because there were so many “sober” people in the program with long sobriety dates who were anything but sober. It was discouraging to see the negativity, the doctrinaire attitudes, the resistence to any other type of treatment (including, and maybe especially, treatment for depression, which plagues so many alcoholics and addicts). “Don’t drink and go to meetings” is a good mantra for the first year. After that, there needs to be some “there” there. Often, there is not. We, as individuals and as a group, must make our own “there.” This is, indeed, a designer program, designed by the individual after a while.
I have no experience with the sobriety “industry,” except for the stories I have heard over the years. My old friend Bill Hollandsworth (who knew Bill Wilson, the founder of AA and died with more than 50 years of sobriety) called those in the industry “charlatans” and strongly recommended avoiding them. I know other people who have benefitted greatly from good and sensitive care. It’s out there. Often it is expensive and always it’s a roll of the dice at this point.
In my estimation–and for myself only–getting sober was a simple act. I came to a point in my life when I wanted to be sober more than I wanted to drink. Cessation of smoking happened a year earlier for the same reason, and it was easy. I smoked 3 1/2 packs a day for more than 30 years, but quitting was simple when I decided that’s what I wanted to do.
Putting away the bottle was a bit more difficult, but it could not be accomplished in those 23 years before it it happened because I was not ready to completely change my life, to get rid of the drink, the friends, all the influences that promoted that lifestyle. I asked for and got help. AA was there and for that I am eternally grateful. But AA is not for everybody; it’s not even for me any longer.
Dan Smith
Dear Dan, again and always, I am grateful to you for sharing your thoughts and experiences and insights with me. They continue to be invaluable, pushing me deeper into self-understanding – which is where I want to go.
Where I’m up to on the Dodes book, so far, is this: my training, experience and own literature reviews corroborate Dodes’s findings and assertions. To the best of my ability to discern it at this time, Dodes’s explanations don’t fully correlate with my own experience recovering from alcoholism, nor with that of some people with whom I work who are attempting to address their addictions. I finished the book a few days ago and am still seeing what fits for me and what doesn’t and why.
Dodes has an M.D. and 30 years of experience treating those with addictions. I’ve got a master’s, an 8-month internship, an 8-month volunteer stint as a weekly group counselor, 4 months as a part-time group addictions counselor, and 19 months of sobriety. I give weight to his words. I’m still pondering.
I so appreciate, Dan, your explanation of your path. I loved reading your beautifully worded and reasoned points and not having to cringe and shield myself from, well, the craziness of some of the anti-AA and anti-anti-AA commentary I see out there.
And I so appreciate hearing, for you, “getting sober was a simple act.” It is imperative for me to continue to address why that is not true for me.
With heartfelt gratitude,
Anne
Anne:
“Dodes’s explanations don’t fully correlate with my own experience recovering from alcoholism,” and they never will. Your experience is and will be unique. There will be similarities, but your sobriety is stamped “Anne Giles.”
One element strongly in your favor: You’re working your sobriety with intelligence, enthusiasm and the kind of bulldog intensity you require. The sweat and tears will wash away the pain eventually. I promise that. That beautiful smile will be your trademark.
Dan
Your support means the world to me, Dan! Thank you!
Thank you for your story, so much of it has helped me know the truth of where I am! I’ve been dealing with a lot of negative thoughts that older AAs have said if I don’t do it their way I will get drunk/die and their own life is so negative and have not even cleaned up their mouth in 30 years of being sober.