The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry Hardcover – March 25, 2014

Lance Dodes brings a psychoanalytic approach to this work and, no surprise given the title, finds much wrong with AA and similar twelve-step programs and the parts of the rehab community that recommend them, are based on them, or refer people to them.Central to the objection is the claim, which the authors support well, that, at best, twelve-step programs are effective 10% of the time (they claim 5-10%), and that the programs are not likely any better than spontaneous remission (doing nothing), which seems to work about 5-7% of the time. The authors support their claim by reference to peer-reviewed controlled studies, observational studies, and meta-analysis of controlled and observational studies. They also point out that no controlled or randomized peer-reviewed study has ever shown twelve-step programs to have any efficacy at all. This is a much more serious accusation than the common observation that programs like AA work for whom they work. Rather, in multiple places in the book, the authors advance the claim that such programs likely are pernicious and do more harm than good, and that practitioners who routinely send clients to such programs are, to be kind, misguided.Two well-documented chapters in the book compile the statistical evidence for their claims, and are easily readable by anyone who has only a fundamental understanding of basic statistics. I have not followed all the notes to their sources to evaluate the honesty of the authors' claims, but am predisposed to give at least initial credibility to those who unflinchingly offer the sources of their claims. Many of the authors' complaints about research are based on the objection that such research is rigidly quantitative, avoiding psychological research on people, case studies, for example, and relying purely upon reductionist claims in behavioral research and similarly reductionist appeals to research in biochemistry.We should note here, also, that the primary author is a psychoanalyst who also finds that other forms of therapy, he specifically cites CBT, are less effective than psychodynamic therapy that gets at the roots of individual addictions in the growth and development of the patient.The authors single out for special ridicule the popularly respected and expensive in-patient twelve-step recovery systems like the Betty Ford Center and the various Hazelden programs. Only the latter publishes any studies of results (not peer-reviewed, and, as the Dodeses note, often flawed). Other programs have refused to submit for review and publication any claims for effectiveness beyond vague assertions on their websites. Such programs offer activities unproved to help with recovery such as labyrinths, rock climbing, yachting, meditation, Reiki, "adventure therapy", and psychodrama. One center, "Sierra Tucson also offers its guests 'equine therapy,' noting that the process 'involves establishing a relationship with a horse...[that] evolves into the nurturing of that relationship, which may or may not culminate in actual riding.... Horses are typically non-judgmental and have no expectations or motives. Therefore, a patient can practice congruency without the perceived fear of rejection.'" [Dodes and Dodes, also quoting Sierra Tucson, Kindle location 1086]. Fees for such centers range from $28,300 for a month (Hazelden) to $90,000 for a month in a private room at Promises Malibu. The authors also object to the routine 28-day or one-month stays that appear based not on medical wisdom but on the payment limitations of insurance providers.A particularly helpful chapter disposes of eleven myths that have percolated into popular culture via AA. I'll not recount them all, but especially dangerous, the authors suggest, is the notion that "You must 'surrender' your will to get well." [Dodes and Dodes, Kindle location 2269] Since addiction is, as the authors argue elsewhere, a response to perceived powerlessness over an uncomfortable life or developmental experience, encouraging powerlessness or surrender only works to make recovery or shedding of addiction all the more difficult. They also dismiss the importance of counting days of abstinence, of peer support as the only means to recovery, and of labeling people with addiction problems as permanent drunks. Many of the slogans that come from AA infantilize people or otherwise rain down disrespect upon the individual. Others (90 meeting in 90 days, for example) are arbitrary and unsupported by science or even by common sense.To their credit, the Dodeses do not simply disassemble the unwarranted respect of twelve-step programs and the flawed research that supports it. They also describe what a long-term, psychology-based, randomized, peer-reviewed study would look like and note that the pharmaceutical industry, for example, is unlikely to support such an endeavor, that only a well-funded university or a government could undertake the 25-year longitudinal research that would be required.There is more than a measure of anger and frustration in the book and a powerful bias for psychoanalysis that might be off-putting to those who prefer other therapeutic modes. Nevertheless, there are good challenges here, and also good reasons to call into question the respect our culture gives to twelve-step programs and to the disease model of addiction. I will, provisionally, forgive the authors their unmasked disdain for multivariate regressions and advanced statistics.

The book has some really good history but I was already familiar with most of that so I went through the first chapter or so, wishing for a fresh insight. Some of my favorite dirt on Bill Wilson involves his use of LSD (everyone in AA would scream that I'm not sober if I dropped a few tabs, but they roll their eyes to the sky when they say his name... you know, but no personalities except for those old dead white men from Ohio we worship) so I've always had an entertaining picture in my head of him responding to letters at HQ fried out of his mind on acid next to the lava lamp, rambling about spirituality.There's other things people don't know, like how he screwed the original investors (outright securities fraud) and then screwed AA over financially by stealing the copyright to the basic test. He was a skirt-chasing con artist. The author only touches on a few of his faults. I realize that a full dissertation on these could take up another book of their own but there's some pretty weird stuff I'd never heard about like their seances or claims of levitating the table.The author missed an extremely important part of the history of the steps and what they aimed for, namely Doc Silkworth's admonishment to Bill Wilson:"Look Bill, you're preaching at these people too much. You've got the cart before the horse. This 'white flash' experience of yours scares those drunks to death. Why don't you put the fear of God into them first? You're always talking about James and The Varieties of Religious Experiences and how you have to deflate people before they can know God, how they must have humility. So, why don't you use the tool of the medical hopelessness of alcoholism for practically all those involved. Why don't you talk to the drunk about that allergy they've got and that obsession that makes them keep on drinking and guarantees that they will die? Maybe when you punch it into them hard it will deflate them enough so that they will find what you found."This has always sounded like an inherently manipulative and deceitful ploy to me. Let's start off by saying that this misguided take on first century Christianity also happens to scare the hell out of many of those drunks and the book makes an excellent point about how failing to identify with or adapt to this "solution" leaves many people having their hopes for a new life shattered because it just didn't apply to them in one way or another, or in some cases because the attendees are dreadful and to be avoided at all costs.Not all of "those drunks" are completely stupid and need God "punched into them hard" -- to wit, I had a "white flash experience" after staying awake for 11 days on speed, snorting a gram of ketamine and dropping two hits of LSD ... so I'm not sure why my white flash experience is any less valid than a "white flash experience" on belladona in a sanitarium.Factual error: The 12 steps did not all occur to Bill W in one single insight as the author suggests. In fact there were 6 steps more or less derived from the Oxford Group's "5 C's" and these evolved into 12 steps.Slight misinterpretation of a step (9): "Amend" means to "correct", not to "apologize." If you are truly sorry for something you did, you sincerely change your behavior to the best of your ability. This is the standard for success in these affairs. It is not a world apology tour. An apology may very well be in order but that is not the point here. I've said I'm sorry more times than I'll ever know. And I am one of those people who "takes what works for me" and "leaves the rest" and for all of my overall objections, cleaning up my affairs and not carrying around shame for the dishonest things I once did, cleared my conscience and that has been a good thing in my life that has nothing to do with Christianity being shoved down my throat, to say nothing of my acceptance of that.Amusingly enough I was unfriended on Facebook recently for replying to a "tsk tsk" about this book (which the person had not read of course) by politely stating that the "success" rate was in fact proven to be abysmal (5-10%) which was well known to me before I even read the book.My response to that at the time was "Someone from the program 'unfriended' me after I responded to an article about dismal success statistics in 12-step programs and replied that they were accurate. The article wasn't referring to a book written about those fortunate enough to have a "fabulous" life, cash and prizes, and the luxury of burying their heads in the sand about the revolving door and/or those who do not recover or die. You don't have to care about any of them, just don't say they don't exist because your life is so wonderful. I have an "anecdotal" report of my own experience and I would consider it worthwhile. But as far as anyone knows, this book isn't about me either. These statistics aren't news though and I think it's refreshing that someone's actually brought something more constructive than denial to the table for a change. I can see how this might be mistaken for dissidence but it's ridiculous and it's intellectually dishonest to post about such topics and not welcome any discussion about them. "The book itself illustrates his completely uninformed / irrelevant post and his reaction to me.Many people come in and out of the revolving door, a few stay. Most don't. But it's all their fault. It has nothing to do with the program not working of course. He nailed it on the head how the default response is to blame the person for failing to work the steps properly.It gave me some new perspective on people's BS too. Just today someone was going on and on about how delusions were part of addiction, and I replied that they usually went hand in hand with using more than anything. Predictably I was told that I didnt understand the steps. So I had to ask what good being "restored to sanity" was if you were still delusional. You can't be sane and delusional, and according to 12-step programs you're "always" an addict/alcoholic. Anyway when she scolded me and told me that I just needed to work those steps harder, I told her that was the ultimate cop out for anyone who is just spouting misinformed nonsense. There is no elusive mystery to the steps. It's just how people try to win an argument.Editing to add this: "Letting someone find their bottom" is incredibly dangerous. Lots of people die before they find it, and families listen to members when they make statements like that. So I already hate and cringe at that and was VERY happy to see it on your list of AA myths.I don't agree with psychotherapy being the solution for everyone either, and the book is heavily biased in favor of that.But thank you for some really valuable insights, I can see through a lot of it now, and what a relief this has been to read.

This book is great! It goes into great detail about how flawed AA is. I am very glad that I read it. I was enjoying it so much, as it was helping me to deprogram from the 12 Steps. I recommend this book to everyone who has had exposure to the 12 Steps.

Having paid through the nose for AA rehab, and attended a number of meetings, this book clearly sets out why AA doesn't work for the majority, what alternatives there are, and confirmed my experience that AA is a delightful mix of pseudo science and quasi religious cult. You'll find at many AA meetings there are disproportionately many old timers -10,15,25 years attendance - and ask yourself is this a sign of success or failure?

Excellent book. The research was very thorough though I was more interested in the author's opinion as a psychoanalyst. Deeply insightful in terms of what addiction actually is and how it works. If you are in a 12 step fellowship and feel like something isn't quite right, read this.

Found this book whilst hungover, bed-ridden and surfing for alternative to 20 year old aa/rehab mantras ringing in my ears. This is frightening stuff, kicking the chairs violently over (apt cover). The author is fearless,backing his attack on the venerated bill w. and the enormous vested interests of the rehab industry with sound alternatives and bloody good sense! The stats are a bit boring for the layman but Dominic's and others experiences are incredibly moving stories. For anyone who has doubts about their 12 step experience.

Very well written and lots of data. Also, some human interest stories to keep the less academic reader going.