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12-step-program

After 75 years of AA, it’s time to admit we have a problem

 

FOR much of the past 50 years or so, voicing any serious skepticism toward Alcoholics Anonymous or any other 12-step program was sacrilege…the equivalent, in polite company, of questioning the virtue of American mothers or the patriotism of our troops. If your problem was drink, AA was the answer; if drugs, Narcotics Anonymous.

And if those programs didn’t work, it was your fault: You weren’t “working the steps.” The only alternative, as the 12-step slogan has it, was “jails, institutions, or death.” By 2000, 90 percent of American addiction treatment programs employed the 12-step approach.

In any other area of medicine, if your doctor told you that the cure for your disease involved surrendering to a “higher power”, praying to have your “defects of character” lifted, and accepting your “powerlessness”, as outlined in the original 12 steps, you’d probably seek a second opinion.

But, even today, if you balk at these elements of the 12-step gospel, you’ll often get accused of being “in denial”. And if you should succeed in quitting drinking without 12-step support, you might get dismissed as a “dry drunk”.

Fortunately — just in time for the implementation of the Affordable Care Act (Obamacare), which mandates that substance misuse be covered in a way that is equivalent to coverage for physical illnesses—a spate of new books is challenging the 12-step hegemony.

Last year, the bestselling author David Sheff published Clean: Overcoming Addiction and Ending America’s Greatest Tragedy, which includes a chapter aimed at debunking the idea that AA is the only way.

The author Anne Fletcher released Inside Rehab: The Surprising Truth About Addiction Treatment and How To Get Help That Works, a deeply reported exposé on the poor results and exorbitant prices of upscale rehab centers.

And the journalist Gabrielle Glaser came out with Her Best Kept Secret, which illustrates, among other things, how forcing AA attendance on women makes them easy prey for sexual predators.

The latest salvo comes from Dr Lance Dodes, the former director of Harvard’s substance abuse treatment unit at McLean Hospital, who weighs in with a book called The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.

While much of Dodes’ diagnosis of the problems with rehab and 12-step programs was originally made by maverick psychologist Stanton Peele in books like The Meaning of Addiction (1985), Dodes benefits from several decades of additional data, and he covers complicated scientific issues lucidly. The results are largely persuasive.

Dodes doesn’t pull his punches. “Alcoholics Anonymous was proclaimed the correct treatment for alcoholism over seventy-five years ago despite the absence of any scientific evidence of the approach’s efficacy,” he writes in his introduction, “and we have been on the wrong path ever since.”

Dodes shows that much of the research that undergirds AA is a conflicted mess that confuses correlation with causation. It’s true that people with alcoholism who choose to attend AA regularly drink less than those who do not—but it’s not proven that making people attend works better than other options, including doing nothing.

In fact, some studies find that people mandated into AA do worse than those who are simply left alone…..

Pacific Standard: Read the full article

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