The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
By Lance Dodes & Zachary Dodes (Boston: Beacon Press, 2014)
Review by John M.
In this recently published book by psychiatrist Dr. Lance Dodes and Zachary Dodes, one would hope that new and refreshing insight might be revealed given the advances made in scientific addiction recovery research over the past few years in checking some of the more tenuous claims made by Alcoholics Anonymous, as well as treatment centres that adhere closely to a 12-Step recovery model. Instead, the authors have produced a hugely disappointing, highly one-dimensional, and fundamentally flawed work.
Lance Dodes is currently on a book promoting tour that finds him on radio or on television and featured in magazine interviews, and he was initially in Canada’s weekly news magazine, Maclean’s, where I found him and I was intrigued enough to order the electronic version of his book. In the U.S., The Atlantic has an interview with Dr. Dodes, and excerpts of the book appeared the week of March 16th in Salon. I haven’t seen anything yet in Time Magazine or Newsweek but I mention these media outlets because the book will get widespread coverage for yet again another unnuanced, clichéd, and stereotypical version of AA, the 12 Steps, and treatment centres.
In purporting to debunk the myths of 12-Step influences in our culture, the authors offer nothing new.
This is not to say there is no merit in what they have written (I will outline a few legitimate points in a moment), but for every step forward in contributing to current debates, the authors take two steps back. The authors, in effect, nullify any advances they make and we end with a work that has been produced many times before, by other authors. You might as well save a few dollars and dust off your old copies of Charles Bufe’s 1998 Alcoholics Anonymous: Cult or Cure or Stanton Peele’s 1999 The Diseasing of America or Ken Ragge’s 1998 The Real AA: Behind the Myth of 12-Step Recovery, among others. It’s déjà vu all over again!
Apart from yet another work that will reinforce AA stereotypes in the public domain, the work fundamentally leaves the status quo of the treatment and recovery debate in place. William White put this succinctly in his 2000 book review of Bufe’s and Peele’s Resisting 12-Step Coercion: How to Fight Forced Participation in AA, NA, or 12-Step Treatment: “Those who are hostile to AA and to addiction treatment will have their animosity affirmed by this book; those with affection for AA and treatment will not likely read this book. In the end, the polarization continues.”
For the sake of brevity I will list and briefly comment on the main points of interest starting with some discussion by the authors which are important but which one wishes could be found consistently throughout its 192 pages.
1. Chapters 3 & 7 are good and, if the entire book were made up of only these two chapters, we might actually have quite a nice little contribution here on a few levels: a study of 12-Step efficacy and its limitations; a comparison of other recovery modules; what in AA works best when it serves those who are comfortable with its philosophy; and what kind of alcoholics and drug addicts should not be recommended for participation in AA (NA) or 12-Step treatment.
2. Chapter 3, “Does AA Work?” probably gathers together the most recent and most diverse body of studies, showing each study’s research and statistical strengths and weaknesses which, though containing no thorough-going consensus among researchers, certainly helps further delineate what we currently do and do not know about addiction and recovery.
3. Chapter 7, “Why Does AA Work When it Does?” is a well balanced and a reasonably fair look at Alcoholics Anonymous (perhaps for the first time in the book, apart from chapter 3) although the authors place greater emphasis on the efficacy of the fellowship — “One of the principle ways AA helps people is in its capacity as a community” — than on working through the 12 Steps.
This last point is not intended to imply a criticism of the author’s views since there are certainly a number of readers of AA Agnostica who would agree entirely with them. Nor would every member of “traditional” AA groups think that “the fellowship” and the 12 Steps must be inextricably linked; others of course insist on it.
4. The authors provide a reasonable and well argued case for rejecting the common claim that alcoholism is a disease and instead argue that it bears every similarity to obsessional behaviour. I will not get into the “Is alcoholism a disease?” debate here, since not all AAs are in agreement on this either. Bill Wilson, of course, was wary of calling alcoholism anything other than an “illness” or a “malady.” In the Big Book, disease is mentioned only once in a metaphorical way as a “spiritual disease,” and the 12 step essays in the Twelve & Twelve not once refer to alcoholism as a disease. (None of this, by the way, is pointed out by the authors.)
5. What the authors say about court mandated attendance at AA meetings, the high cost of so many of the extravagant Rehab centres, and the Hollywoodization of addiction, treatment, relapse, and re-treatment is pretty standard fare and readers of AA Agnostica have long been familiar with, and written about, the shortsightedness of mandating court-ordered attendance at AA.
6. In general, Lance and Zachary Dodes make use of multiple studies that call into question the efficacy of 12-Step recovery and the various treatment facilities that base their programs of recovery on the 12 Steps. They are all found wanting and the authors warn their readers to approach them with extreme caution.
Now we begin to get into what falters so badly in The Sober Truth.
7. Taken as whole, excluding these two chapters, the rest of the book simply undermines itself. The authors are long on criticism (some justified as noted) but short on offering any proposals that realistically meet the challenges of addiction in our diverse communities today apart from a recurring, almost mantra-like evocation scattered throughout the work that every alcoholic or addict should seek out a good psychotherapist — Dr. Lance Dodes’ profession, as one would hardly need to guess.
Replying to their imagined AA interlocutor who rhetorically asks —“AA isn’t perfect, have you got anything better?” — the one constructive piece of advice they offer the alcoholic or addict is to find a psychotherapist or a “good” psychiatric hospital. Yet the authors provide no criteria for what would constitute a good therapist or hospital except that one will find a “professionally trained expert” there: “…I will simply say that addiction can be understood, managed, and ended through learning about oneself….For working out these issues permanently, a good psychotherapy is the best approach.”
But how would we know (how do they know) that this is the “best approach?” Dr. Dodes offers no studies, no statistics on the success rates in his field of psychotherapy. If the success rate of AA, for instance, is between 5 – 10% as the authors freely admit, one waits throughout reading the book for the authors to tell us the success rates of psychotherapy, either at “good” hospitals or in private practices. None are given.
Dr. Dodes never tells us what his success rates are in his years of private practice. Do we take all of this on faith? Are we expected to believe that a “professionally trained” therapist eo ipso equates with successful outcomes? What are the percentages in his field? We are still left wondering this at the end of the book.
On a personal note, my psychiatrist agreed to take me on as a client on the condition that I continued to attend AA meetings or any other peer support groups like SOS, LifeRing, Smart Recovery, etc., since he said that the psychiatric profession has less than a 4% success rate in treating alcoholism when psychiatry is used on its own.
Assuming that my doctor low-balled the success rate in his profession, are we to assume that he was pretty much 96% off the mark? Lance Dodes’ inference is that, with a good therapist, it is inevitable that “addiction can be understood, managed, and ended….” Yet one wonders why he is not forthcoming about statistics in his own profession given that this is the one constructive proposal that he offers his alcoholic and addict readers. Given that it is research and statistical studies that are the basis — he admits not the be-all and end-all, however — for arguing that bad science is behind 12-Step treatment’s continued popularity, where are the studies to assure the reader that psychotherapy offers far greater success? Here is how the authors end the book:
For the time being, until a critical mass is reached on pursuing the question of addiction treatment from a fuller perspective, the very best contribution individuals can make is to seek out therapists with good general psychological training (and without 12-step bias), and to apply pressure where it is needed to mount a public campaign in support of enlightenment in addiction research.
Yet when the authors talk about addiction and recovery research from a “fuller perspective,” this seems to remain within the parameters of professionally trained doctors and therapists in “good” hospitals or in private practices. As for a “public campaign” to support better addiction research, does this mean, once again, for the use of only therapists employed by hospitals as well as self-employed private practitioners? We are never quite sure.
What is so perplexing about this book is that the authors argue that if there is any merit to AA (or other peer support groups, one supposes), it is the idea of fellowship or community. Yet they have no interest in commenting further about this. They seem totally divorced from the exciting work in the recovery movement that is growing at the grass roots level across North America.
In reading The Sober Truth one becomes ever more appreciative of the work of writers like Ernest Kurtz and William White. It is White who reminds us that Ernie Kurtz was the first to coin the term “communities of recovery” and both Kurtz and White give a much more realistic and comprehensive assessment of the present state of community-oriented addiction and recovery initiatives operating in some of our cities today. Here are a couple of examples of what is taking place:
Recovery Management (RM), “is a philosophy of organizing addiction treatment and recovery support services to enhance pre-recovery engagement, recovery initiation, long-term recovery maintenance, and the quality of personal/family life in long-term recovery.”
And on a larger, macro level, Recovery Oriented Systems of Care (ROSC),
are the networks of indigenous and professional services and relationships that can support the long-term addiction recovery of individuals and families and that embody the values and policies in the larger cultural and policy environment that are supportive of these recovery processes. The ‘system’ in ROSC is not a federal, state or local agency, but a macro level organization of the larger cultural and community environment in which long-term recovery is nested.
Lance and Zachary Dodes’ failure to acknowledge how their own professional services could fit into current recovery initiatives means that the authors have outdated themselves; their contribution neutralizes itself. If I can risk my own use of a cliche here: if you are not a part of the solution, you are a part of the problem.
Without the larger community support, access to recovery simply means that those who can afford private or hospital therapists will get help. The Dodes’ prescription for recovery falls under the same criticisms that they level against expensive, “Cadillac” (their term) Rehab centres. (Will ObamaCare somewhat ameliorate this inequity in the U.S.?)
The authors might defend their silence about current community initiatives in the area of addiction treatment, however, by claiming that the intent of their book was limited to detailing the inadequacies of AA and 12-Step based treatment centres. Yet given their acknowledgement of the strength of community in AA itself, they do not at all draw our attention to initiatives like RM and ROSC (or Faces and Voices in Recovery, for that matter) even by way of one single reference in the endnotes of their book.
This is simply not part of their agenda and the reader is given more than enough clues throughout The Sober Truth that the book’s underlying presupposition is the authors’ absolute faith in the positivistic expertise of professional elites.
If I can offer a suggestion at this point, I’d say to my readers at AA Agnostica: save your money but, more importantly, save the time it would take to read the Dodes’ book by investing your time in the 4 1/2 hours it takes to view William White’s ROSC Symposium where you will get a better, fuller, far more sophisticated critique of the treatment industry in North America. At the same time you will get a rich array of current recovery initiatives and suggestions on how modern addiction treatment can be improved and made part of the public policy agenda.
You can read a preview of the William White’s ROSC Symposium here, All Paths to Recovery are Cause for Celebration, where you will also find a link to a video of the symposium itself: Recovery Oriented Systems of Care (ROSC) Symposium. Or, you can read about RM and ROSC in a PDF at White’s website: Recovery Management.
8.Turning to the authors’ specific focus on AA and 12-Step recovery, I’ll point out that their book suffers from a number of blatant falsifications of AA which can be attributed to 1.) an ignorance of or an unwillingness to discuss certain segments of AA literature (i.e., they haven’t done their research); 2.) a misreading of the literature they indeed quote; 3.) interpretations that are caricatures of the actual reality of AA practice; and 4.) perhaps the most blatant and oldest of canards, they take the “horror stories” which many of us in AA — “traditional” or WAFT members — are all too familiar with, universalize these and other “rigidities,” and then claim that these are normative and common practices of AA.
I do not have space here to discuss the plethora of errors and misreadings contained in this book but, if you decide to buy The Sober Truth, you will find plenty for yourself. Chapter 8, for instance, “The Myths of AA,” is replete with distortions and falsifications. Here is just one representative sample from this chapter. (Again, I do not have space to go through the arguments they provide in each of the 11 myths that make up this chapter, but their criticisms, for the most part, are unoriginal.)
“Myth #1: You Have To ‘Hit Bottom’ Before You Can Get Well”
In the substantial number of “traditional” and WAFT meetings I have attended since joining AA, a large number of members have spoken about how they did not have to go through some of the pain and suffering others did because of the examples laid out for them by being introduced to AA before things could “get worse.” Here is what the Twelve & Twelve says early in Step I, clearly indicating that “hitting rock bottom” has a context and is not a hard-fast maxim of AA:
In AA’s pioneering time, none but the most desperate cases could swallow and digest this unpalatable truth (admitting alcohol’s all-consuming hold over their lives). Even these “last-gaspers” often had difficulty in realizing how hopeless they actually were. But a few did, and when these laid hold of A.A. principles with all the fervour with which the drowning seize life preservers, they almost invariably got well. That is why the first edition of the book “Alcoholics Anonymous,” published when our membership was small, dealt with low-bottom cases only. Many less desperate alcoholics tried AA, but did not succeed because they could not make the admission of hopelessness.
It is a tremendous satisfaction to record that in the following years this changed. Alcoholics who still had their health, their families, their jobs, and even two cars in the garage, began to recognize their alcoholism. As this trend grew, they were joined by young people who were scarcely more than potential alcoholics. They were spared that last ten or fifteen years of literal hell the rest of us had gone through. (p. 22)
Myth #1 is simply one example from this chapter, and one among many throughout the book, where the authors universalize a particular AA idea, ignore its context (or have no idea that something like the above quotation is in AA literature), and present it to their readers as if it were a normative tenet for all of AA.
Either through ignorance (i.e., a lack of appropriate research into AA) or through careless reading, if not willful distortion, the falsifications abound throughout the text.
9. The authors’ gloss of AA history in Chapter 2, “The Rise of AA,” is superficial at best and furthers the distortions presented to the reader. AA is represented in its beginnings as a homogeneous group of pioneering alcoholics who reflect Bill Wilson’s and Dr. Bob’s protestant Christianity and religious commitment to recovery. While acknowledging Bill Wilson’s own interest in finding an identity through various religious or spiritual avenues — “(Wilson) once famously described himself as a ‘shopper at the theological pie counter’” — the organization even today, the authors’ maintain, “is clearly permeated with Wilson’s religious beliefs.”
We all know, especially here at AA Agnostica, that much of this is true. Still, the authors seem to be oblivious to, or unwilling to talk about, the dissenters of this religious paradigm in AA. There is no mention of Jim Burwell’s atheism or of others —“our atheists and agnostics widened our gateway so that all who suffer might pass through, regardless of belief or lack of belief,” as Bill Wilson would acknowledge — and nothing is said by the authors about agnostics and atheists in AA’s subsequent history leading up to today.
Chapter 6 gives the accounts of alcoholics and addicts who were invited to respond to Lance Dodes’ blog on Psychology Today; they represent the first ten people who responded so there was no selection process other than this. The accounts by and large reflect the complaints about AA (and NA) that one would find here at AA Agnostica or across the internet. I mention this chapter because one of the ten respondents remarks in passing that she believes that agnostics and atheists have their own separate AA meetings. The authors cannot, therefore, be unaware of the existence of those of us in AA who do not reflect Bill Wilson’s or others’ religious (spiritual) beliefs.
Yet nothing is said by the authors acknowledging that AA is not a homogeneous entity. Readers of this book or those who will read and listen to Lance Dodes in the media will continue to get a one-dimensional, stereotypical version of AA.
Nor do the authors seem to be interested in secular organizations — like SOS, LifeRing, Smart Recovery, Women for Sobriety, etc. Again, the reader may very well suspect that the authors consciously or unconsciously believe that addiction will be solved only by professional therapists operating out of “good” hospitals or in their private practices.
Finally, a word to my fellow AA Agnostica readers. Military historians have long warned that, whenever possible, one should not fight a war or any battle on two fronts. It seems, however, that we agnostics, atheists, and free thinkers have no choice but to do so.
On one side, we have the supporters of a vision of an Alcoholics Anonymous that is set in stone, as it were, where the early days are nostalgically revered as a golden age, as if the good old days were frozen in time as sacred days marked by an equally unalterable sacred text – The Big Book. If we could only go back to the way the old timer’s designed the program, we are told - mostly by AA dogmatists of today who were not alive “back then” – then we would have the better results they enjoyed in the 30s and 40s.
We must be on guard, however, against these kinds of mythic musings and remember what William Faulkner had one of his characters observe with uncommon awareness — “the way it was, was never the way it was.”
On the other, we have AA’s skeptics and critics who are at times justified in being wary of an uncritical and dogmatic vision of AA (and practice in some groups) and, in this, they are no different than those of us at AA Agnostica who continue to battle with our more fundamentalist members . But many of AA’s critics, like Lance and Zachary Dodes, would like to believe that their “AA prey” is an entire homogeneous and uniform organization that fully accepts and operates within rigid, ossified beliefs and practices.
So, the “good fight” for us continues to be against the dogmatists on one side and the skeptics on the other. Our fight here at AA Agnostica is not just the struggle for recognition within AA as a whole or, for some of us as well, with our local Intergroups, but also with the critics who distort the very structural and historical dynamism in AA that in fact exists, though all too often unobserved.
As people in long term recovery who also happen to be members of AA, and who are exceedingly grateful to the fellowship despite our quarrels among ourselves, we cannot be silent and let others define us.
Week in and week out, AA Agnostica lets our voices be heard on behalf of all AA, even if the more traditionalists among us are unwilling to understand and appreciate this. Each week we stand guard against those in AA who would put barriers in the way of people who are just trying to get sober and stay sober.
But surely we can be no less vigilant when it comes to defending this fellowship against the kinds of distortions, hackneyed analysis, and half-hearted research presented to the recovery community and to the public at large by authors such as Lance and Zachary Dodes.