We’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.