rethink addiction AA 12 stepsWe’re over halfway through National Recovery Month, and we should remember that the month isn’t just about celebrating those who have recovered; it’s also about encouraging discourse and educating people about addiction. When I think about alcohol addiction recovery, I always see chairs in a circle, people recounting their stories: Alcoholics Anonymous and the 12 steps.

To me, the 12 Steps concept has always seemed illogical and potentially dangerous: Addiction is a life-threatening disease, and to treat it with willpower and faith seemed irresponsible at best. Time and time again, doctors have reported that addiction is simply not a choice; like any other debilitating disease, it cannot be overcome by sheer power of will.

The National Institute on Drug Abuse, along with other leading authorities, agree that addiction is a chronic disease, like cancer, type II diabetes or heart disease. You wouldn’t treat a tumor by speaking to another cancer patient about your shared disease, hoping to rid your body of cancer through prayer and support. Like cancer, addiction is treatable under the right circumstances. It seemed logical to me, then, that addiction should be treated as such.

So why isn’t that the national consensus, and why is AA such a powerful force in addiction recovery? I decided to dig into the oft-lauded 12 steps. My first stop was a chat with Dr. Lance Dodes, a recently retired professor of psychiatry at Harvard Medical School and author of the much-cited book “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.” He got right to the point.

“The statistics for 12-step programs are extremely bad,” Dr. Dodes said. “Of all the people who go to AA, only five to eight percent become sober members of AA. It’s a very, very poor success rate.”

The numbers surprised me in light of AA’s prestige, not to mention its own self-reported numbers. According to the Atlantic, “AA reported that 33% of its members said they’d been sober for over ten years.” However, as the magazine points out, those numbers only count the number of alcoholics who make it through their first year of meetings. That’s a serious misrepresentation, yet the program persists as a cornerstone of addiction recovery.

Dr. Dodes explained the reason the program has such a great reputation is because the people who do well have a tendency to proselytize.

“It’s actually part of the 12 steps.”

The 12th step reads, “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics.” 

Dodes continued, “The people who don’t do well—which is the vast majority—aren’t going to write a book called, ‘How I Failed in AA.’”

Makes sense. Then I asked him what makes AA and its 12 steps a failure.

“The more interesting question,” he retorted, “is why AA works at all.” Dr. Dodes explained that addiction is what psychiatrists call a displacement, or a substitution. Instead of dealing with the real psychological issue, whether it’s trauma or depression or anxiety, a person ineffectively and harmfully displaces her problem with an addiction. In the case of the 12 steps, the addict substitutes her addiction with other compulsive behaviors. Simply put, she continues to gloss over the real issue, like a traumatic event or mental illness, by going to a meeting every day or mentoring other addicts.

That sounded like a very smart—and highly exploitative—marketing strategy on the part of AA, a centrally Christian organization. (To those who doubt its overtly Christian affiliation, look no further than the Big Book, which reads, “Our real purpose is to fit ourselves to be of maximum service to God.”) As I’d find out, the history of the organization goes a long way in further explaining its ubiquity.

Shortly after the U.S. repealed Prohibition in the early 1930’s, a sick yet enterprising man named Bill Wilson checked himself into a hospital. This was his fourth visit for alcoholism, which doctors treated with belladonna, a powerful hallucinogen that was thought to “inspire” alcoholics out of their destructive patterns. And inspire it did. Wilson said that he was visited by God, he was filled with peace, and until the time of his death, Wilson didn’t touch another drop of alcohol.

But when that history is repeated today, the part about hallucinogens is usually left out.

Wilson founded AA and the 12 steps soon after in 1935, long before neuroscience had made strides beyond phrenology. At the time, AA was among the only option available for addicts, and Wilson was an excellent salesman. Doctors and scientists cheered the program as a scientific development, and Wilson even convinced Congress to include the 12 steps in the United States’ first act to establish a national institute on alcohol abuse.

Starting in 1989, but eventually being overturned as unconstitutional because of the program’s religious affiliation, America’s drug courts sentenced offenders to 12-step programs. According to Dr. Dodes, however, some judges still refer people to AA as part of probation, and according to the Atlantic, 12 percent of AA members are at meetings by a court order, despite the orders’ illegality.

So it’s no wonder that AA is such a prominent figure in the realm of addiction recovery; it’s practically a religion in and of itself. As the organization grew to an immense size, it stomped out any other programs that threatened to steal the spotlight, simultaneously dismissing doubt. And that’s why it’s taken so long for people like Dr. Dodes to probe AA’s claims. We’ve finally begun to uncover the danger in the 12 steps.

To me, that’s the most important aspect of the argument against AA and the 12 steps: The program isn’t just fruitless, it’s also dangerous.

“The harm caused by AA is enormous,” Dr. Dodes told me. “No one objects to having 5 percent of the people be helped by it. That’s great. But the problem is that AA tells you that if you’re not doing well, it’s your fault.”

That’s especially clear in AA’s famous saying, “It works if you work it,” but the idea of moral failing also crops up in other parts of the program. Take for example the idea that an addict must hit rock bottom before she can begin proper recovery.

“The notion that addicts have to hit bottom suggests that they are too selfish to quit until they have paid a steep enough personal price,” Dr. Dodes wrote in his book. Not only that, but waiting around for an addict to hit rock bottom is, obviously, extremely dangerous.

Then there’s the importance of abstinence and counting days with chips. The tradition is meant to discourage relapse and to encourage abstinence with a token of accomplishment.

“The dark side of this practice,” Dr. Dodes wrote, “is what happens when addicts take a drink or slip in some way: they must go back to zero and lose everything they’ve gained.”

It’s not just emotionally crushing; scientists have discovered that alcohol cravings actually intensify after periods of withdrawal. Abstinence works for some, but moderation shouldn’t be immediately ruled out.

Finally, there’s the all-important tenet of surrendering to a higher power.

“Surrendering,” Dr. Dodes wrote, “is tantamount to agreeing that one is incapable of managing one’s own life.”

The tenet takes away an addict’s free will and selfhood at a time when what an addict often needs most is to “feel empowered.”

I’m not trying to tell people to leave AA if it works for them, and I’m not trying to belittle or dismiss anyone; rather, I want to reach those 95 percent of people for whom the program has failed. There are other options out there, groups like Smart Recovery and LifeRing, that don’t use the 12 steps. Therapy—by a licensed professional, not a fellow recovering addict—is also a powerful tool, and something I can attest to personally.

This month, as we openly and actively discuss addiction recovery, part of the conversation should be about the inefficacy and harm that so often accompanies a traditional 12-step program. If you have failed in your recovery, don’t immediately see the failure in yourself; instead, consider that the fault may lie in your program.

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20 COMMENTS

  1. Great piece. My niece is 12 years sober using the AA method and my daughter also attends AA meeting 4 times a week WITH therapy from two different therapists. Many of her friends have not recovered and I have other friends who got well not using AA. I am thrilled my girl is succeeding- so far- and hope it takes because the alternative is grim. Thanks for this.

  2. Kate, while encouraging addicts to seek a form of recovery that works for them is intelligent, citing only one source to “debunk ” 12 Step Programs isn’t an intelligent argument, it is an advertisement for that doctor’s book. Drug court programs have a different success rate than 12 Step Programs which you neglect to research and by the way, Drug Court Offenders have AGREED to avoid jail and abide by a set of rules that upon completion can reduce or even dismiss felony criminal charges essentially giving the recovering criminal drug addict a second chance, if he chooses to take the program. He can still choose jail as a sentence for criminal behavior. 12 step programs have no “Religious affiliation.” Religious origin and direction, yes but affiliation defined as partnership with or member of, NO. It asks that you seek a Higher Power that is not yourself even if that power is a Drug Court Judge. I believe that most things in life can be retooled or updated but the evidence and research process for articles ? No. Next time you write an article cite more than one doctor, don’t allow someone who has written a book do your research for you, and find actual examples (often called evidence ) of the danger you threaten. While you cite a 5% rate for recovery using 12 steps you have no rate for the programs you mention, none for Dr. Hodes alternatives, and only yourself as a statistic for therapy. Congratulations on seeking and finding a program that works for you.

  3. Kate,
    I’d like to know how many successful, recovered alcoholics you interviewed, when writing this article?
    Perhaps they could have contributed as to the context of some of your “big book” quotes.

    Not everyone who stumble through the doors of an AA meeting want to remain sober; this program works for those that have lost the willpower to abstain. Any path to a “higher power” is accepted, and brutal honesty is essential, when dealing with a relapse. If the individual has relapsed, and returned, they are welcomed back. If you are searching for someone to coddle a chronic relapser, I would question both parties motives….
    Your purported Dr. Dodes claims a low success rate, where are the sources to support this? I feel they are exaggerated.

    And to further put this in perspective, CPR is considered successful only 6% of the time, should we scrap the entire practice?
    Tell that to the families and the lives that have been restored by “… This simple program” of Alcoholics Anonymous.

    It sounds to me like you have a biased opinion, perhaps because a loved one turned to AA, but lacked the constitution to remain sober?

    Your article smells more of conjecture, than well rounded journalism. But I lack the peer reviewed sources to accurately pigeon hole you as a successful writer….

    • Great comment!!! You hit this right on the top of the head. This is the most inaccurate, and biased article I have ever read. It makes me so angry!!!!!!

    • My name is William Tillahash, I am a recovered Alcoholic/Addict. You talk like you have a few character defects of your own. Taking someones Inventory is something I leave up to my “Higher Power,” my “Creator,” the white people call him “God”. I’ve learned in this program or programs, of AA/NA, that you truly do have to have a spiritual awakening. The only way to do that is pray to a Power Greater than yourself. I myself have lived a terrible life, yes I have a lot of Drs. who know the truth. The Doctors opinion will explain the truth, that your will didn’t get you anywhere, why not ask a Power Greater than Yourself for some sort of “Solution”. Yes, I was directed to Drug Court, my Higher Power has a plan for me. I was waiting to go back to Prison, no biggy, my mentality was ready for the big house and to do some chaos. Without the 12 steps of AA, I would still be lost, the program works, I’m living proof. But I had to have the faith and the “WANT,” to be Sober. Also, the connection, to love God, Myself and many others. Without the 12 steps, I would be in Prison, finding that Higher Power was the answer. Please open the book with a clear conscience and read, then if your serious, PRAY.

  4. Well, fortunately this is cast as an opinion piece. These opinions are quite pertinent. Let us not forget this is opinion. It is unfortunate that there are people in St. George that will be affected by opinion. I really can’t say more. Quite amazing.

  5. Kate,
    Alcoholism and Drug Addiction is a life or death topic. You may want to consider research and other viable options when tackling such topics. I think you have a bright future writing posts on Facebook…

  6. Kate,

    THANK YOU! I know many claim the 12 step groups helped them, but they nearly killed me. Fortunately, I found SMART Recovery and individual therapy. Together, they did not save me, but rather helped me save myself. Don’t let the negative comments and ad hominem attacks above dissuade you; keep spreading the word about the choice in recovery.

  7. This piece honestly frightens me and makes me a little angry. Having an extensive knowledge of AA and knowing intimately how the program works I honestly have to agree with others that very little research went into this article nor was anyone in AA or from AA spoken to. And while this is an opinion piece and not a news article research should have been done and both sides talked to prior to providing the above argument.

    As others have said this reads much more like an advertisement for the doctor’s book. The author herself also shows her bias against AA in her unwillingness to even consider that there is a whole other side to the issue that she did not even touch on.

    There are also a couple of other things I feel are important enough to set the record straight. Not only does AA have absolutely no religious affiliation, the big book talks about not being the only answer to recovery or having a monopoly on God. In addition, AA has absolutely nothing to do with will power, in fact just the opposite.

    Finally you talk about carrying the message and say that that’s somehow alcoholics promoting and selling the program but what you fail to do is read and tell the reader about the traditions that clearly point out that alcoholics do not push AA on anyone nor do they promote it. It’s there and if people want it then that’s great and if they don’t no one is going to come after them, knock on their door with literature and books nor is anyone going to try and sell them the idea. Any alcoholic with recovery behind them knows and understands this.

    The thing that really concerns me is this doctor and the author claim to have some understanding about the disease of alcoholism, yet their ignorance is revealed in the statement that suggests alcoholics may be able to drink in moderation. This is very dangerous and honestly shows that the good doctor has no more understanding about the disease than I do on how to fly to the moon. A disease is a disease and using the similar example as the author: you would not tell someone allergic to gluten that they can eat wheat and flour in moderation or someone allergic to peanuts that they can eat peanut butter in moderation so why would you tell an alcoholic who has a similar allergy and disease that they might be able to drink in moderation? And if the doctor and the author understood the disease they would understand that there is a physical component to the disease of alcoholism that reacts with the body as an allergy and drinking in moderation is absolutely as out of the question for the alcoholic as it is in the above examples.

    Kate I’m sorry that the program didn’t work for you and while I know many that it has worked for, I also know some who it hasn’t worked for and that’s okay. I wish you the best and a long recovery ahead.

    I will stop here with one caveat, I really hope The Independent will be true to their mission and allow someone else who has a background and working knowledge of AA to write an opinion piece providing readers with an alternative viewpoint from this one.

    • Sorry for the errors. I posted on my phone so everything is not as correct nor does it all read the way I wish it should.

    • I think you did a fine job! I too, find this piece to be ignorant and light on facts. I can’t even begin to count the number of people I know personally that have thrived and continue to thrive while working the program. I’m glad to see others on here that see that as well. There is hope in recovery, and I’ve seen many embrace that hope thanks to AA and the desire to get and stay clean.

  8. I loved this piece and found it very cohesive and well rounded. I think there needs to be a change in how we treat addiction and recovery and you did a very good job at exploring that. I hope you keep writing! This was really refreshing and touched on some things I’ve thought about before but didn’t quite know how to articulate. Thank you!

  9. I always welcome other opinions and ideas and this is no different. I just happen to not agree with this one. I think the author is a good writer and in no way was I putting her down personally as a writer, I just happen to not agree with her opinion. I also feel that a little harder look should have been given to what AA is really about. I also feel the doctor is very biased and honestly, I question his motives because to me it appears he has his own agenda and that while accusing the organization of not telling the truth or the whole story, he himself is guilty of doing the very same.

    I’ll be honest this piece is personal to me and I’ll admit I absolutely have a bias. But, with that said, I’m also the first one to remind people in AA and outside that the program is not the only answer to recovery. This is one area where I do agree with the author that there are other alternatives that work for people. AA does not work for everyone and I will be the first one to admit that. I’m not arguing that point. My only argument with the article is again, I just feel that there is another side and that more research into AA and talking with recovering alcoholics who have succeeded in using AA would prove that much of what the doctor argues is not credible or even truthful for that matter. I can point out over and over again in the big book of AA where what the doctor says has been taken out of context and misrepresented.

    At the same time I want to commend The Independent for supporting different opinions and for not censoring their writers and this is no different. The beauty of the first amendment is we don’t have to all agree and The Independent will be one of the first papers to cheer free speech and encourage open discussion on varying opinions and ideas. When I said I hoped they would allow another opinion to be written, I wasn’t suggesting they wouldn’t let one be written, I was only hoping to encourage them to do so because I think it’s an important topic and one that I think does need more honest communication. And Sky I don’t disagree in looking at how we treat addiction and recovery. I think we should always be looking for a better solution and for anyone to suggest that we shouldn’t and that any way is the only way is also very dangerous because it can eliminate possible solutions before we ever even start the discussion. 🙂

    • All your points were great!!! This article is absolutely not supported by any really facts…. And the fact is Alcoholics Anonynous saves lives, many many lives. Alcoholism is skid row of the soul and the 12 steps bring Alcoholics back to life.the Big Book states “those who do not recover, are men and women who are constitutionally incapable of getting honest with themselves and others”. AA is a program of action… And many who do not recover do not want to do the work it takes to get rigorously honest with themselves and others. It is a simple program… The 3 legacies of Alcoholics Anonymous are honesty, open-mindedness and willingness to get honest with yourself, another human being and God (a God of your understanding- you are free to chose any God), set right the wrongs of your past, make amends to those you have harmed, and carry the message to another alcoholic. It is that simple. As for stating that the 12th step about carrying the message is to in large AA. That is false. The point of carrying the message, is that Alcoholics suffer from a disease of selfishness. They are selfish and self centered by nature and do anything to get their way, by carrying the message of Alcoholics Anonymous they are doing service work, getting out of themselves and giving freely what has been given to them, which in essence is LIFE… Because most Alcoholics were on the verge of death! Alcoholism and Addiction are very serious… It is a matter of life and death. It destroys anything in. It’s path, wives, husbands, families, children, careers, goals, dreams, love, life, happiness, and the list goes on . It leaves wounds far greater than what shows on the body. Unless one suffers from Alcoholism there is no way to sufficiently understand something so painful and dehabilitating as this disease. This article could tarnish another’s chance at finding recovery, and giving it a chance. They could die!!!!! This is one of the only programs that shows any kind of success rate, and it may be small but at least it has one. Alcoholics Anonymous is a international world wide program with MILLIONS of sober members across the world. This woman has obviously NEVER been to an AA convention, read any AA literature, or done her research. This article is obserd and VERY, VERY DANGEROUS!!!!! I am appalled and angered it was even ran!!!
      Sachet

  10. I am a Smart Recovery Facilitator I obviously believe in the Smart programme. Saying this I believe that whatever works for you in your recovery is fantastic being the most important thing is to take control of your life and live again.If you need every option open for you then take it. What I or others believe in is of no matter,what matters is that you feel hope and motivation towards your future

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