Myths and misconceptions of Alcoholic Anonymous
Book: The Sober Truth: Debunking The Bad Science Behind 12-Step Programs and The Rehab Industry
Authors: Lance Dodes, MD and Zachary Dodes
Critic: Glenville Ashby, PhD
The Sober Truth is a direct challenge to Alcoholic Anonymous’ 12 Step Program, a system widely considered the Holy Grail for treating addiction. According to authors Lance Dodes and Zachary Dodes, high monetary stakes mask the verisimilitude of AA. While it is presumptuous to argue that a conspiracy exists to ensure AA’s survivability, the reluctance to explore alternative treatments in the face of convincing evidence of its failure begs the question: Why faithfully continue to endorse an unproven treatment?
No doubt, AA has its fair share of defenders on the front line, proselytisers in a battle against intemperance.
However, what was once a genuine attempt at salvaging victims of the bottle has turned into a utilitarian movement hijacked by dogma and anecdotal confessions. But of scientific data to support the effectiveness of AA, there is none, not unlike the spurious 19th-century Keeley Remedy for the hopeless drunk.
To this day, “efforts by journalists to solicit data from rehabs have been met with resistance, making an independent audit of [AA] results almost impossible, leading to the inevitable conclusion that the rest of the programs either do not study their own outcomes or refuse to publish what they find”.
That dipsomania is curable through fate is thoroughly debunked by the authors.
Confluence of factors
How then did AA become the salve, the go-to solution endorsed by government and medical agencies? The authors trace the history of the movement, revealing a confluence of factors, from universal despair to evangelisation and perceptive marketing.
The authors detail the movement’s unsettling beginnings.
“In 1939, the American Medical Association called AA “a curious combination of organising propaganda and religious exhortation”, and that the one valid thing about [its Big Book] is the recognition of the seriousness of addiction. Other than this, this book has no scientific merit or interest.”
A year later, The Journal of Nervous and Mental Diseases called it “a regressive mass psychological method”, and “a religious fervour”.
However, Bill Wilson (fondly referred to as Bill W.), the founding member of AA and now synonymous with the movement, never capitulated, such was his absolute faith. Unbowed, he recruited believers with financial and political reach – figures like Dr William Silkworth, who was so “impressed by Wilson’s conversion that he gave him free rein to circulate among patients”, and Marty Mann, a wealthy Chicago debutante who later formed the National Council on Alcoholism and Drug Dependence.
E.M. Jellinek, who authored the “disease theory” of alcoholism, a model that was later disowned by Jellinek himself, was also critical to resuscitating a fledgling movement.
Interesting is the picture presented of Bill W. He was a man torn by the impulsive forces of service and self-destruction, a man, not unlike many members of AA today, who simply substituted one addiction for another – his being chronic womanising and cigarette smoking, with the latter finally leading to his demise. Abandoned as a child and influenced by his once wretched grandfather who boasted of a spiritual conversion that cured him from alcoholism, Bill W.’s worldview was rooted in fervent religiosity.
Despite its tottering beginnings, “AA managed to survive, in part, because members who became and remained sober, spoke and wrote about it regularly.” This is no accident, the authors remind us. “AA’s twelfth step expressly tells members to proselytise for the organisation.”
They add, “Even people who have no experience with AA may still have heard that it works or protest that 5 to 10 per cent is a significant number when we’re talking about millions of people.” They continue, “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 per cent of people with addictions.”
Clearly, AA has dismissed the psychology behind addiction, labelling it a disease while offering the Twelve Steps as the only solution.
Throughout, the authors decry the overriding culture of treating addiction.
“Rehab,” they write, “owns a special place in the American imagination.”
They elaborate, “Unfortunately, nearly all these programs use an adaptation of the same AA approach that has been shown repeatedly to be highly ineffective. Where they differ from traditional AA dogma is actually more alarming. Many top rehab programs include extra features such as horseback riding, Reiki massage, and “adventure therapy” to help their clients exorcise the demons of addiction … Sadly, there is no evidence that these additional treatments serve any purpose other than to provide momentary comfort to their clientele and cover for the programs’ astronomical fees, which can exceed $90,000 a month.”
Further, the authors pen, “Patients begin using again soon after they emerge from rehab, often suffering repeat relapses … What’s especially shocking is how the rehab industry responds to these individuals: they simply repeat their failed treatments, sometimes dozens of times.”
Convincingly, the authors argue that the Higher Power of AA, central to recovery, places the addict in a potential quandary. “The relief [the addict is] afforded by the notion of a higher power is commensurate with the great disappointment one feels when the higher power turns out to be an illusion …”
Moreover, they assert that the movement is based on the false premise that members that have achieved sobriety are clinicians with the capability to help others. On the contrary, “these people are typically as fallible as anyone else, and even long-standing members can lapse or even withdraw from the program”. For the spondee, inextricably bound to his or her sponsor, such a fall can prove catastrophic, “leading to the return of addictive behaviour”.
The authors present the case for understanding addiction through psychological lens.
The impulse to drink is symptomatic of a psychoanalytic problem that AA fails to address, hence, the astronomical rate of recidivism.
Addictive acts, they note, are nothing more than psychological displacements and such issues are best explored and treated under the care of a psychotherapist and not by faith-based movements or programmes that “apply community-based encouragement and little or no individualised care to treat emotional symptoms, including addiction.”
Hence, the failure of AA is understandable given its endeavour to address a psychological issue that it does not understand.
The Sober Truth is not merely an indictment on AA. It is a study in groupthink and the sheepish nature of man, indolent and obdurate enough to shun reason in the face of compelling evidence. Surely, five to ten per cent of AA members have triumphed over a presumable disease; but why, the authors reason, should we insist that the majority be enslaved to a treatment that just does not work for them?
The Sober Truth: Debunking The Bad Science Behind 12-Step Programs and The Rehab Industry by Lance Dodes, MD and Zachary Dodes
Publisher: Beacon Press. Boston, Massachusetts
Available at Amazon