75 years of aa -time to admit we have a problem
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75 years of aa -time to admit we have a problem
Interesting article about AA, its problems and how the Affordable Care Act may help in providing alternatives.
After 75 Years of AA, It's Time to Admit We Have a Problem - Pacific Standard: The Science of Society
Challenging the 12-step hegemony.
•
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, 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.
Dodes shows that much of the research that undergirds Alcoholics Anonymous is a conflicted mess that confuses correlation with causation.
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. (If true, that would be no small problem. AA’s own surveys suggest that some 165,000 Americans and Canadians annually are court-mandated into the program—despite the fact that every court ruling on the issue has rejected such coercion as unconstitutional, given AA’s religious nature.)
Contrary to popular belief, most people recover from their addictions without any treatment—professional or self-help—regardless of whether the drug involved is alcohol, crack, methamphetamine, heroin, or cigarettes. One of the largest studies of recovery ever conducted found that, of those who had qualified for a diagnosis of alcoholism in the past year, only 25 percent still met the criteria for the disorder a year later. Despite this 75 percent recovery rate, only a quarter had gotten any type of help, including AA, and as many were now drinking in a low-risk manner as were abstinent.
Unfortunately, compared to the rehab narrative, the stories of people who get better without treatment are rarely as compelling. They tend to consist of people leaving college and realizing they can’t binge drink or take drugs and hold a job and care for a family. And since most people who straighten out on their own never show up in treatment, the worst cases congregate in rehab and make addiction recovery seem quite rare.
This is not to say that there is no benefit at all to 12-step programs: It’s clear from studies of recovery, with or without treatment, that some of the most important factors in success are having social support and a sense of meaning and purpose. Both of those can be provided by AA—at least to those who find its approach amenable. Rather than treating AA as one potentially excellent resource out of many, though, all too many people still regard 12-step programs as the only true way.
One effect of this 12-step dominance is that addiction continues to be seen by many people as a moral failing rather than a disease. This is somewhat ironic, because many 12-step advocates firmly consider addiction to be a disease, as do government agencies like the National Institute on Drug Abuse. But it is awkward to posit addiction as a disease while simultaneously promoting AA’s non-medical and moralistic course of treatment. For what other medical condition does 90 percent of the treatment consist of meetings and prayer?
Dodes is eloquent on what drives addiction, and his argument that much of it results from an attempt to counter a sense of helplessness is convincing. In his view, addiction is a compulsive disorder, an attempt to cope with anguish by engaging in ritualistic behavior that is soothing and predictable, despite ongoing negative consequences.
But Dodes stakes out dubious territory with his claim that some compulsive disorders, like obsessive-compulsive disorder (OCD), are primarily chemical in origin, while others, like drug addictions, are purely psychological. Most psychologists reject this idea—a fact Dodes fails to acknowledge.
Dodes advocates traditional treatment, such as talk therapy and medication, for what he labels “chemical” compulsive disorders (including most of what the Diagnostic and Statistical Manual of Mental Disorders calls OCD). For instance, someone who can’t stop washing his hands might receive Prozac and a specialized type of talk therapy. But Dodes recommends individual therapy for what he labels “psychological” disorders—including what we commonly think of as addiction. Specifically, he prefers psychodynamic therapy, which involves looking deeply into a patient’s past and often takes years to bear fruit.
Unfortunately, psychodynamic therapy has not been found to be any more effective than the 12-step programs Dodes so ably eviscerates. Although he admits he has his own bias in advocating psychodynamic therapy, Dodes thinks it’s an approach that hasn’t yet been studied well enough for its true effectiveness to be reflected in data. This is an unsatisfying answer. In a major review of the literature featured in The Handbook of Alcoholism Treatment Approaches, psychodynamic therapy ranked 46th out of 48 in effectiveness for treatments of alcoholism, even lower than Alcoholics Anonymous, which ranked 38th. It seems unlikely that additional study will cause a complete inversion of those numbers. (The review was notorious for finding an inverse correlation between what is most practiced in treatment and what is most effective in helping people.)
Dodes also fails to mention the success of certain approved medications for addictions—like buprenorphine and methadone for opioid problems, which have been shown to be more effective than any type of talk therapy or self-help in terms of saving lives and reducing the spread of blood-borne disease, according to the Institute of Medicine and the World Health Organization.
Still, Dodes has a deeply humane understanding of the ailments he studies, and has made an excellent case for why we need to overhaul our treatment system and provide more evidence-based options. If his book has weaknesses, they only underscore how much we still need to learn if we want to cure the multifactorial disorder we call addiction.
This post originally appeared in the March/April 2014 issue of Pacific Standard as “Kicking the Habit.”
After 75 Years of AA, It's Time to Admit We Have a Problem - Pacific Standard: The Science of Society
Challenging the 12-step hegemony.
•
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, 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.
Dodes shows that much of the research that undergirds Alcoholics Anonymous is a conflicted mess that confuses correlation with causation.
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. (If true, that would be no small problem. AA’s own surveys suggest that some 165,000 Americans and Canadians annually are court-mandated into the program—despite the fact that every court ruling on the issue has rejected such coercion as unconstitutional, given AA’s religious nature.)
Contrary to popular belief, most people recover from their addictions without any treatment—professional or self-help—regardless of whether the drug involved is alcohol, crack, methamphetamine, heroin, or cigarettes. One of the largest studies of recovery ever conducted found that, of those who had qualified for a diagnosis of alcoholism in the past year, only 25 percent still met the criteria for the disorder a year later. Despite this 75 percent recovery rate, only a quarter had gotten any type of help, including AA, and as many were now drinking in a low-risk manner as were abstinent.
Unfortunately, compared to the rehab narrative, the stories of people who get better without treatment are rarely as compelling. They tend to consist of people leaving college and realizing they can’t binge drink or take drugs and hold a job and care for a family. And since most people who straighten out on their own never show up in treatment, the worst cases congregate in rehab and make addiction recovery seem quite rare.
This is not to say that there is no benefit at all to 12-step programs: It’s clear from studies of recovery, with or without treatment, that some of the most important factors in success are having social support and a sense of meaning and purpose. Both of those can be provided by AA—at least to those who find its approach amenable. Rather than treating AA as one potentially excellent resource out of many, though, all too many people still regard 12-step programs as the only true way.
One effect of this 12-step dominance is that addiction continues to be seen by many people as a moral failing rather than a disease. This is somewhat ironic, because many 12-step advocates firmly consider addiction to be a disease, as do government agencies like the National Institute on Drug Abuse. But it is awkward to posit addiction as a disease while simultaneously promoting AA’s non-medical and moralistic course of treatment. For what other medical condition does 90 percent of the treatment consist of meetings and prayer?
Dodes is eloquent on what drives addiction, and his argument that much of it results from an attempt to counter a sense of helplessness is convincing. In his view, addiction is a compulsive disorder, an attempt to cope with anguish by engaging in ritualistic behavior that is soothing and predictable, despite ongoing negative consequences.
But Dodes stakes out dubious territory with his claim that some compulsive disorders, like obsessive-compulsive disorder (OCD), are primarily chemical in origin, while others, like drug addictions, are purely psychological. Most psychologists reject this idea—a fact Dodes fails to acknowledge.
Dodes advocates traditional treatment, such as talk therapy and medication, for what he labels “chemical” compulsive disorders (including most of what the Diagnostic and Statistical Manual of Mental Disorders calls OCD). For instance, someone who can’t stop washing his hands might receive Prozac and a specialized type of talk therapy. But Dodes recommends individual therapy for what he labels “psychological” disorders—including what we commonly think of as addiction. Specifically, he prefers psychodynamic therapy, which involves looking deeply into a patient’s past and often takes years to bear fruit.
Unfortunately, psychodynamic therapy has not been found to be any more effective than the 12-step programs Dodes so ably eviscerates. Although he admits he has his own bias in advocating psychodynamic therapy, Dodes thinks it’s an approach that hasn’t yet been studied well enough for its true effectiveness to be reflected in data. This is an unsatisfying answer. In a major review of the literature featured in The Handbook of Alcoholism Treatment Approaches, psychodynamic therapy ranked 46th out of 48 in effectiveness for treatments of alcoholism, even lower than Alcoholics Anonymous, which ranked 38th. It seems unlikely that additional study will cause a complete inversion of those numbers. (The review was notorious for finding an inverse correlation between what is most practiced in treatment and what is most effective in helping people.)
Dodes also fails to mention the success of certain approved medications for addictions—like buprenorphine and methadone for opioid problems, which have been shown to be more effective than any type of talk therapy or self-help in terms of saving lives and reducing the spread of blood-borne disease, according to the Institute of Medicine and the World Health Organization.
Still, Dodes has a deeply humane understanding of the ailments he studies, and has made an excellent case for why we need to overhaul our treatment system and provide more evidence-based options. If his book has weaknesses, they only underscore how much we still need to learn if we want to cure the multifactorial disorder we call addiction.
This post originally appeared in the March/April 2014 issue of Pacific Standard as “Kicking the Habit.”
Member
Join Date: Oct 2013
Posts: 200
"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.”
AA's 12 steps work so well because they do, that's many people's experience. It would be very difficult to gauge the success and failure rate of AA because there are so many variables and it's an anonymous program. I have seen people on the brink of death come back to life only to recover and help another person recover.
You can't mandate people into AA it doesn't work. You can't mandate willingness.
Also I hear many people in AA say if there was a better way I would leave AA. The 12 steps just work so well and transformed me.
Also I hear many people in AA say they know people who got sober through other programs.
who knows maybe there are better ways or others ways. I don't know i just know what worked for me.
AA's 12 steps work so well because they do, that's many people's experience. It would be very difficult to gauge the success and failure rate of AA because there are so many variables and it's an anonymous program. I have seen people on the brink of death come back to life only to recover and help another person recover.
You can't mandate people into AA it doesn't work. You can't mandate willingness.
Also I hear many people in AA say if there was a better way I would leave AA. The 12 steps just work so well and transformed me.
Also I hear many people in AA say they know people who got sober through other programs.
who knows maybe there are better ways or others ways. I don't know i just know what worked for me.
Recipient of Mercy
Join Date: Mar 2014
Location: Knoxville TN
Posts: 41
The article was interesting indeed. Social support is crucial. I've been sober a week without meetings, and I don't plan to attend meetings or work steps. I've placed my life in God's hands and I am receiving support from the wonderful people here. I don't have a problem with AA and I think it is wonderful for some people. I can't stand it though when people scoff at or judge me when they learn I am attempting recovery without AA... That just doesn't seem right to me... Thanks for sharing.
Member
Join Date: Mar 2014
Location: Crown Point, Indiana
Posts: 2
I definitely do not believe there is only one way to become sober. I do believe there is a difference between mere sobriety and recovery. I do not think a 12 step fellowship is the only way to find recovery, but it was the way I found it.
The history I know of the AA fellowship seems to be that its existence came about because a couple of suffering addicts could find no place where their problem was regarded as anything other than a lack of character on their part. Medicine did not recognize it as an illness yet. It was needed to fill a gap then in the system.
I will admit that it feels a bit like brain washing in the beginning as you hear all the catchy phrases and such. But my experience in the long run of it, after being a part of it for multiples of years, is that if you really do work the steps that they outline, you will do more with your life than just learn to not drink or use a drug. You will find out why you were in the first place. You will examine yourself and right many wrongs that you inflicted on others while using. You will become accountable. You will become a productive person again in the world and be capable of helping others to do the same.
It changed my life and it saved my life. For all its flaws and there are many...I am very grateful that it exists.
All that being said, my husband has been sober for near a decade and has never attended a single 12 step meeting. He seems to hit all of the same milestones that I recall coming up to in my first decade clean. Its very interesting. I wish there was more study on the subject, but most want to remain anonymous, making that very difficult at best.
Thanks for letting me share.
The history I know of the AA fellowship seems to be that its existence came about because a couple of suffering addicts could find no place where their problem was regarded as anything other than a lack of character on their part. Medicine did not recognize it as an illness yet. It was needed to fill a gap then in the system.
I will admit that it feels a bit like brain washing in the beginning as you hear all the catchy phrases and such. But my experience in the long run of it, after being a part of it for multiples of years, is that if you really do work the steps that they outline, you will do more with your life than just learn to not drink or use a drug. You will find out why you were in the first place. You will examine yourself and right many wrongs that you inflicted on others while using. You will become accountable. You will become a productive person again in the world and be capable of helping others to do the same.
It changed my life and it saved my life. For all its flaws and there are many...I am very grateful that it exists.
All that being said, my husband has been sober for near a decade and has never attended a single 12 step meeting. He seems to hit all of the same milestones that I recall coming up to in my first decade clean. Its very interesting. I wish there was more study on the subject, but most want to remain anonymous, making that very difficult at best.
Thanks for letting me share.
Member
Join Date: Oct 2013
Location: Pa
Posts: 225
All I know is that by working the 12 steps as best as I can I have experienced unworldly, unexplainable things that can only be described as supernatural. There is no doubt in my mind that there is a higher power and that there are forces at play which people can not see. Staying sober is only a minor reason I stay in AA. Seeing and experiencing God's plan as it unravels is the main reason I keep coming back. My favorite concept in AA is the Fourth Dimension of Existence. I know for a fact that it exists.
Sober Alcoholic
Join Date: Aug 2011
Posts: 3,539
Below are two phrases used in the first two paragraphs of this article.
"voicing any serious skepticism toward Alcoholics Anonymous or any other 12-step program was sacrilege"
"if you balk at these elements of the 12-step gospel"
The language used gives you an indication of the objectivity of the writer lol
I'm curious how you came to the conclusion that posting this article would provide 12 step support (as per the name of this forum) kilt?
"voicing any serious skepticism toward Alcoholics Anonymous or any other 12-step program was sacrilege"
"if you balk at these elements of the 12-step gospel"
The language used gives you an indication of the objectivity of the writer lol
I'm curious how you came to the conclusion that posting this article would provide 12 step support (as per the name of this forum) kilt?
Member
Join Date: Jul 2011
Location: Huntington Woods, Michigan
Posts: 465
Originally Posted by kilt 
Interesting article about AA, its problems and how the Affordable Care Act may help in providing alternatives. After 75 Years of AA, It's Time to Admit We Have a Problem - Pacific Standard: The Science of Society Challenging the 12-step hegemony. • 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, 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. Dodes shows that much of the research that undergirds Alcoholics Anonymous is a conflicted mess that confuses correlation with causation. 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. (If true, that would be no small problem. AA’s own surveys suggest that some 165,000 Americans and Canadians annually are court-mandated into the program—despite the fact that every court ruling on the issue has rejected such coercion as unconstitutional, given AA’s religious nature.) Contrary to popular belief, most people recover from their addictions without any treatment—professional or self-help—regardless of whether the drug involved is alcohol, crack, methamphetamine, heroin, or cigarettes. One of the largest studies of recovery ever conducted found that, of those who had qualified for a diagnosis of alcoholism in the past year, only 25 percent still met the criteria for the disorder a year later. Despite this 75 percent recovery rate, only a quarter had gotten any type of help, including AA, and as many were now drinking in a low-risk manner as were abstinent. Unfortunately, compared to the rehab narrative, the stories of people who get better without treatment are rarely as compelling. They tend to consist of people leaving college and realizing they can’t binge drink or take drugs and hold a job and care for a family. And since most people who straighten out on their own never show up in treatment, the worst cases congregate in rehab and make addiction recovery seem quite rare. This is not to say that there is no benefit at all to 12-step programs: It’s clear from studies of recovery, with or without treatment, that some of the most important factors in success are having social support and a sense of meaning and purpose. Both of those can be provided by AA—at least to those who find its approach amenable. Rather than treating AA as one potentially excellent resource out of many, though, all too many people still regard 12-step programs as the only true way. One effect of this 12-step dominance is that addiction continues to be seen by many people as a moral failing rather than a disease. This is somewhat ironic, because many 12-step advocates firmly consider addiction to be a disease, as do government agencies like the National Institute on Drug Abuse. But it is awkward to posit addiction as a disease while simultaneously promoting AA’s non-medical and moralistic course of treatment. For what other medical condition does 90 percent of the treatment consist of meetings and prayer? Dodes is eloquent on what drives addiction, and his argument that much of it results from an attempt to counter a sense of helplessness is convincing. In his view, addiction is a compulsive disorder, an attempt to cope with anguish by engaging in ritualistic behavior that is soothing and predictable, despite ongoing negative consequences. But Dodes stakes out dubious territory with his claim that some compulsive disorders, like obsessive-compulsive disorder (OCD), are primarily chemical in origin, while others, like drug addictions, are purely psychological. Most psychologists reject this idea—a fact Dodes fails to acknowledge. Dodes advocates traditional treatment, such as talk therapy and medication, for what he labels “chemical” compulsive disorders (including most of what the Diagnostic and Statistical Manual of Mental Disorders calls OCD). For instance, someone who can’t stop washing his hands might receive Prozac and a specialized type of talk therapy. But Dodes recommends individual therapy for what he labels “psychological” disorders—including what we commonly think of as addiction. Specifically, he prefers psychodynamic therapy, which involves looking deeply into a patient’s past and often takes years to bear fruit. Unfortunately, psychodynamic therapy has not been found to be any more effective than the 12-step programs Dodes so ably eviscerates. Although he admits he has his own bias in advocating psychodynamic therapy, Dodes thinks it’s an approach that hasn’t yet been studied well enough for its true effectiveness to be reflected in data. This is an unsatisfying answer. In a major review of the literature featured in The Handbook of Alcoholism Treatment Approaches, psychodynamic therapy ranked 46th out of 48 in effectiveness for treatments of alcoholism, even lower than Alcoholics Anonymous, which ranked 38th. It seems unlikely that additional study will cause a complete inversion of those numbers. (The review was notorious for finding an inverse correlation between what is most practiced in treatment and what is most effective in helping people.) Dodes also fails to mention the success of certain approved medications for addictions—like buprenorphine and methadone for opioid problems, which have been shown to be more effective than any type of talk therapy or self-help in terms of saving lives and reducing the spread of blood-borne disease, according to the Institute of Medicine and the World Health Organization. Still, Dodes has a deeply humane understanding of the ailments he studies, and has made an excellent case for why we need to overhaul our treatment system and provide more evidence-based options. If his book has weaknesses, they only underscore how much we still need to learn if we want to cure the multifactorial disorder we call addiction. This post originally appeared in the March/April 2014 issue of Pacific Standard as “Kicking the Habit.”
People feel threatened by aa's success. That's why anti twelve steppers love coming into a twelve step forum to voice their often uninformed opinions.
If you fit aa's description of alcoholism, then you are likely to see the need to do aa. If you don't, then you won't.
Member
Join Date: Apr 2012
Location: northern michigan. not the U.P.
Posts: 15,281
"Still, Dodes has a deeply humane understanding of the ailments he studies, and has made an excellent case for why we need to overhaul our treatment system and provide more evidence-based options. If his book has weaknesses, they only underscore how much we still need to learn if we want to cure the multifactorial disorder we call addiction."
i think doc silkworth, who talked with over 40,000 alcoholics in his lifetime, had a pretty good humane understanding of the ailments he studied, too.
the great thing about AA is that even in the big book, it says we realize we only know a little.
i think theres quite a few evidence based options out there, but theres always room for more.
"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.”"
who proclaimed this?
people are getting clean and sober and its the wrong path???
i think doc silkworth, who talked with over 40,000 alcoholics in his lifetime, had a pretty good humane understanding of the ailments he studied, too.
the great thing about AA is that even in the big book, it says we realize we only know a little.
i think theres quite a few evidence based options out there, but theres always room for more.
"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.”"
who proclaimed this?
people are getting clean and sober and its the wrong path???
Whatever works for ya, do it!
Fellow Traveler and Seeker
Join Date: Sep 2012
Location: Toronto, Ontario
Posts: 2,408
I know folks who were alcoholics and stopped without AA. AA isn't the only way - I have yet to see evidence of it being proclaimed that, in some "official" capacity. My old therapist had 25 years sober time at the time of me seeing him and he never touched the Big Book or went to a meeting, although for his practice and general knowledge, he has read the BB. Doesn't mean there aren't failure" rates in those other methods too. That is also what is never brought up. No method is failure proof.
Someone once mentioned in these very forums that AA is like "big oil" or "big business" - it's inevitably going to get pot shots against it. Not sure I see the correlation or the reasoning for that, but there will always be those who misunderstand or fear it. Professionals are no different.
In the end, the proof is in the (rum-free) pudding. Would an non-AA method have worked for me? i have no idea. But AA worked for me, and hence I carry the message. What works for one doesn't always work for all.
Whatever works for you, stay with it.
Someone once mentioned in these very forums that AA is like "big oil" or "big business" - it's inevitably going to get pot shots against it. Not sure I see the correlation or the reasoning for that, but there will always be those who misunderstand or fear it. Professionals are no different.
In the end, the proof is in the (rum-free) pudding. Would an non-AA method have worked for me? i have no idea. But AA worked for me, and hence I carry the message. What works for one doesn't always work for all.
Whatever works for you, stay with it.
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Originally Posted by Pokeyp1983
The history I know of the AA fellowship seems to be that its existence came about because a couple of suffering addicts could find no place where their problem was regarded as anything other than a lack of character on their part. Medicine did not recognize it as an illness yet. It was needed to fill a gap then in the system.
Thanks for letting me share.
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Originally Posted by caboblanco
AA came from the temperance movement which was a product of revival Protestantism at the turn of the century..The twelve steps are completely religious and cultural..both Christian ans American values..the temperance movement is what created prohibition. they used plays. and .literature to portray alcohol as the main reason for all the ills of society. I'm not giving an opinion on AA. revival Protestantism or the temperance movement and prohibition. this is just fact
"AA is Temperance and Prohibition repackaged. It is no accident that within two years of Repeal, Alcoholics Anonymous was created (in 1935). AA simply reframed the demon rum argument to apply only to a specific group of people - those who were born alcoholic. AA's disease concepts of loss of control, progression, irreversibility, the absolute need for abstinence, and its modus operandi of public confession, commitment to God, and making amends, were all taken over directly from the nineteenth centura Temperance movement and Protestant revivalism."
While AA certainly is aimed at alcoholics (who else would it be aimed at?) , I don't see the correlation between a semi-political / moralistic movement that started in the early 1800's to a spiritual program of action that affects change from within on an individualistic basis.
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Originally Posted by paul99
I am not sure if I agree with Dr. Peele's take on this. According to Peele:
"AA is Temperance and Prohibition repackaged. It is no accident that within two years of Repeal, Alcoholics Anonymous was created (in 1935). AA simply reframed the demon rum argument to apply only to a specific group of people - those who were born alcoholic. AA's disease concepts of loss of control, progression, irreversibility, the absolute need for abstinence, and its modus operandi of public confession, commitment to God, and making amends, were all taken over directly from the nineteenth centura Temperance movement and Protestant revivalism."
While AA certainly is aimed at alcoholics (who else would it be aimed at?) , I don't see the correlation between a semi-political / moralistic movement that started in the early 1800's to a spiritual program of action that affects change from within on an individualistic basis.
"AA is Temperance and Prohibition repackaged. It is no accident that within two years of Repeal, Alcoholics Anonymous was created (in 1935). AA simply reframed the demon rum argument to apply only to a specific group of people - those who were born alcoholic. AA's disease concepts of loss of control, progression, irreversibility, the absolute need for abstinence, and its modus operandi of public confession, commitment to God, and making amends, were all taken over directly from the nineteenth centura Temperance movement and Protestant revivalism."
While AA certainly is aimed at alcoholics (who else would it be aimed at?) , I don't see the correlation between a semi-political / moralistic movement that started in the early 1800's to a spiritual program of action that affects change from within on an individualistic basis.
The twelve steps came from the oxford group...they weren't created for alcoholics...the core philosophies behind the twelve steps anyway
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I'm not sure why we are trying to defend a program that is working so effectively for many of us here. This is the 12 step forum. This is where anyone who is interested in using a 12 step approach to recovery can come to ask questions. It is where people can share their experience or ask for help.
I totally agree there are many ways to become sober...this is just one of them. I can't see anyone disagreeing.
I worry that newcomers may be confused or put off sometimes by the anti AA sentiment that bubbles up sometimes.
I'm thinking I may take a little break from here for a while.
I totally agree there are many ways to become sober...this is just one of them. I can't see anyone disagreeing.
I worry that newcomers may be confused or put off sometimes by the anti AA sentiment that bubbles up sometimes.
I'm thinking I may take a little break from here for a while.
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Join Date: Jan 2013
Posts: 1,949
Originally Posted by Jeni26
I'm not sure why we are trying to defend a program that is working so effectively for many of us here. This is the 12 step forum. This is where anyone who is interested in using a 12 step approach to recovery can come to ask questions. It is where people can share their experience or ask for help.
I totally agree there are many ways to become sober...this is just one of them. I can't see anyone disagreeing.
I worry that newcomers may be confused or put off sometimes by the anti AA sentiment that bubbles up sometimes.
I'm thinking I may take a little break from here for a while.
I totally agree there are many ways to become sober...this is just one of them. I can't see anyone disagreeing.
I worry that newcomers may be confused or put off sometimes by the anti AA sentiment that bubbles up sometimes.
I'm thinking I may take a little break from here for a while.
Im glad we have people on here with all different opinions though..don't you? they are free to speak their mind and their experience
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Originally Posted by paul99
I know folks who were alcoholics and stopped without AA.
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Originally Posted by caboblanco
The twelve steps came from the oxford group...they weren't created for alcoholics...the core philosophies behind the twelve steps anyway
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i don't know if someone needs a powerful spiritual awakening to move on with life after alcohol abuse. That seems to be what AA is selling. there is even evidence that Billy was into LSD at gave it to some of the first clients. Enlightenment is a heavy concept. Its hard for a lot to believe that simply gong by these guidelines they will commune with God,,Allah or the divine. that if this doesn't happen you simply weren't honest and didn't do it correctly..it is very interesting that 90% of treatment centers and all courts use spiritual enlightenment as the answer for addiction in a society that plainly states seperation of church and state
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