Addiction Specialist Takes Potshot at Alcoholics Anonymous
Are 12-step programs really effective against alcoholism? Dr. Lance Dodes, a psychiatrist who specializes in treatment for substance abuse, claims most emphatically that they are not. His critique appeared in written form in 2014, in a book he co-authored with his son, freelance writer Zachary Dodes, called The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. A review of the book in The New York Times by Dr. Richard A. Friedman, a professor of clinical psychiatry at Weill Cornell Medical College, called it “deeply flawed.”
When Bill Wilson and Dr. Robert Smith started Alcoholics Anonymous (AA) in 1935, no one could have anticipated it would turn into the juggernaut it eventually became. AA threw struggling alcoholics a lifeline, and over the past 80 years, tens of millions of men and women have grabbed it and held on with all of their might. AA has become so popular and well-known that courts frequently mandate attendance at its meetings for people convicted of drunk driving or other crimes related to alcohol misuse. Numerous spinoffs of AA’s 12-step program have popped up over the years (Narcotics Anonymous, Gamblers Anonymous, Overeaters Anonymous, etc.), all based on the belief that AA works and that its approach to healing and recovery from addiction is sound and universally applicable.
But sometimes popularity breeds contempt. These days it almost seems as if AA has a giant target on its back, with detractors constantly coming out of the woodwork looking to take potshots. Part of AA’s image problem stems from the fact that a disappointingly high percentage of problem drinkers have not been able to make their oaths of sobriety stick (as the team of Dodes and Dodes point out), even after seeking out the solace and advice of peers and sponsors in AA (as Dodes and Dodes take great pains to emphasize). And in the past, AA supporters did have an unfortunate tendency to exaggerate its effectiveness; most peer-reviewed research suggests 5 percent to 10 percent of those who attend organizational meetings manage to keep their drinking at bay on a long-term basis, which needless to say does not represent an astounding rate of success.
In medicine, however, success is always a relative term. Making a full and lasting recovery from a drinking problem can be a mind-bendingly difficult task, pushing people to the limit and forcing them to bounce back from failure after failure, relapse after relapse. Recovery from alcohol addiction is grueling and intense because the disease itself is grueling and intense, and there is no easy escape regardless of the strategy an addict who aspires to sobriety chooses to pursue.
Yet there are millions of recovering addicts who have left alcohol behind and changed their lives forever, and many of these people rave about the influence of AA and swear they would not have been able to stay on the straight-and-narrow without it. And despite claims to the contrary, peers, sponsors and organizers in AA don’t sugarcoat the truth—they let newcomers know the task of recovery from a drinking problem is immense and fraught with pitfalls, temptations and daunting obstacles. All they can do is share their experiences and talk about what they know will work, if it is given the chance to do so.
Some studies claim that more than 80 percent of those who attend AA meetings give up on the program in less than a year. This might signify it isn’t working for them, or it could mean they aren’t yet serious about their sobriety. Obviously, both of these statements are true in at least some cases, although there is no research that can tell us which reason is more common. But given this statistic, it is hardly surprising to discover that the majority of people who try AA—or are ordered to do so by courts—don’t emerge from the experience healthy, whole and healed in the immediate aftermath. If they do eventually get clean and sober, it is happening at a later stage in their lives.
But even in instances where AA involvement does not directly precede lasting recovery, who is to say that past learning and sharing under the AA umbrella may not have played a role in a recovering alcoholic’s ultimate success? Sometimes addicts may need to hear the same hopeful/inspirational/instructional messages over and over again until finally the wisdom behind the words sinks in. They may need to hear the testimony of dozens of people who’ve pulled themselves up from the depths of despair and climbed to the top of the mountain before they can find the strength to commit to their own process of healing. They may need to be confronted, frankly and honesty, a number of times over a multitude of years before they are finally ready to break through the walls of denial that have kept them in the dark for far too long. If this is so, then every constructive experience they had on the road to healing—all of the interventions, stints in rehab, sessions with therapists and attendance at 12-step peer group meetings—may have been necessary and vital to their cycles of healing and recovery.
Recovering Alcoholics Can’t Do It Alone, and Neither Can AA
If the claim being made by Dr. Dodes and others is that involvement in Alcoholics Anonymous is not, in and of itself, enough to ensure good odds of recovery from a drinking problem, the arguments they are making have some merit. Perhaps AA has become so famous and so synonymous with recovery from alcoholism that many problem drinkers have come to see it as a panacea, raising unrealistic expectations and putting a burden on the program that it isn’t capable of handling.
But that isn’t the fault of Alcoholics Anonymous as an organization, nor does it demonstrate that participation in AA is overrated or counterproductive. AA has helped many people overcome their alcohol addictions, and as long as participation occurs in the context of a comprehensive rehab program, it can and will continue to do so in the future.
By Nathan Falde