The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

This excellent and thought provoking book traces the history of AA and the 12 steps programme from inception to the present day, analyses research studies applying the standards approved (and recognised internationally) in the Cochrane Collaboration for healthcare sciences. As I finished it I let out a breath of relief : "This book needed to be written".The author(s) acknowledges that for some (a relatively small percentage) AA appears to provide support towards becoming sober. However, on analysing that group, and comparing it to the 'do nothing' option he concludes that this is not a statistically significant outcome sufficient to demonstrate the effectiveness of that particular methodology.It concludes that AA works for up to 10% of those attending but does not...or does harm...to the remaining c90%. In fact it seems that close to 90% of people attending AA do not make it past two months. (You will see AA's Big Book take on this below.). He further points out that in no other well regarded area of healthcare treatments would such an outcome be considered acceptable.Nor would a good scientist blame the patient (as the AA's manual "The Big Book" does). Particularly, he concludes, as the AA programme in fact does little to improve on the 'success' data from the 'doing nothing' option where 'spontaneous remission' levels are similar to AA 12 steps outcomes once errors in data collection and analysis in studies are corrected. In other words a sub set of people who have alcohol dependency are so committed to recovery that they do well whether or not they are in a 12 steps programme or not.However fellowship and effective social networking are helpful to people dealing with addictions. AA does provide that in one form that seems helpful to some.Unfortunately, he points out, the sense of failure and shame associated with drop out and set backs can (on the evidence of randomised trials) increase the risk of binge drinking and cause other psychological harm, which is worrying where the ethical precept of treatment is "do no harm".He is clear that the AA Big Book is remarkably unhelpful to many in that (amongst other problems) it clearly purports to suggest that those who do not do well in the 12 steps programme (which seem to be the majority) or indeed dare to disagree with the way it is packaged.. do so due to the fact that in its view (now quoting from the Big Book" ) they are"Constitutionally incapable of being honest with themselves. They are such unfortunates. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty. Their chances are less than average. There are those too who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest".One would hope that an organisation that required such honesty of its members would turn the same beam of light upon themselves in the context of research outcomes, new research, new facts and the very different social context of alcohol consumption and religious belief systems in the present day...just the reverse of the Prohibition Era in America from which AA sprang. I hope it will do so in order that the good things it offers can be retained but that it drops the unhelpful aspects of its programme with the benefitting more people and avoid doing harm.Some years ago I had read, as part of a postgrad module into effective research methodology, the Cochrane Collaboration review looking at nearly 40 years of research studies into the efficacy of 12 steps programme in the management and treatment of alcohol addiction. I was shocked at its conclusions. If they were correct : there was no conclusive evidence that the programme was effective; how could it be ethical to refer patients to such programmes in a public funded healthcare system supposedly relying on evidence based medicine?Life overtook me, the module successfully concluded and I turned my attention elsewhere, but the question has niggled me ever since.So, it was something of a relief to read this well written and well argued book, debunking thoroughly many of the rote-like claims made by various 12 steps organisation, some clearly benefitting very substantially indeed financially from their implementation of such programmes in their 'detox' and 'recovery' centres.I hope this will fuel a calm and scientifically sound debate about how public AND private money should be spent in the understanding and management of addiction and one that robustly reflects up to date research findings and result in a requirement of all privately run and NHS facilities having to provide robust, comparable and clear date onA) treatment provision (input), including details of scale (time spent doing what)B) by whom (training, qualification and experience),C) followed by consistent measures of success (eg how long AF post conclusion, how many relapses, how much drunk, etc, what post in treatment support etc) and finally unit cost.That way we may be able to judge better how to place out precious public purse spending and protect individuals who have placed life savings in the hands of such centres in the hope of a cure. After all it is in the interests of society as a whole that people are as well as can be and free of the consequences, pain and stigma of addiction.We need more and better well funded alternatives with proven and rigorously measured effectiveness.

Found this book whilst hungover, bed-ridden and surfing for alternative to 20 year old aa/rehab mantras ringing in my ears. This is frightening stuff, kicking the chairs violently over (apt cover). The author is fearless,backing his attack on the venerated bill w. and the enormous vested interests of the rehab industry with sound alternatives and bloody good sense! The stats are a bit boring for the layman but Dominic's and others experiences are incredibly moving stories. For anyone who has doubts about their 12 step experience.

This is a scientifically rigorous and extraordinarily important attempt to help the reader realise that AA is really nothing more than entrenched, and worse, ineffective dogma. Its limited successes are only correlated to its methodologies and the true relapse rates are greatly higher than much of the public assumes. People are wasting their money (rehab) and lives (always in recovery, never cured) by cleaving to the irrelevancies of the 12 steps.

Excellent book. The research was very thorough though I was more interested in the author's opinion as a psychoanalyst. Deeply insightful in terms of what addiction actually is and how it works. If you are in a 12 step fellowship and feel like something isn't quite right, read this.

Having paid through the nose for AA rehab, and attended a number of meetings, this book clearly sets out why AA doesn't work for the majority, what alternatives there are, and confirmed my experience that AA is a delightful mix of pseudo science and quasi religious cult. You'll find at many AA meetings there are disproportionately many old timers -10,15,25 years attendance - and ask yourself is this a sign of success or failure?

Very well written and lots of data. Also, some human interest stories to keep the less academic reader going.

A disappointing review of 12 Step based recovery programmes and Rehab centres. The author berates 12 Step organisations for failing to publish clear and significant data about success rates, then does no better himself. Although there are some well made points, the criticism of AA (for example) that it is an "inexact science" and "pushy" is not the experience of all members. Equally there is a self serving argument that Alcoholism is not a disease (yet recognised as such by the World Health Organisation). It makes little difference whether it is, or is not a disease: it is certainly a dangerous destructive disorder. Those hoping to learn something about treatment for Alcoholism will have learned very little. Clearly the author has an agenda-to malign 12 Step Programmes, but offers nothing in the way of alternatives, beyond therapy, which is already widely used in conjunction with them.

As a 12 step recover, I find this a fascinating read and it makes a lot of sense.

This book is great! It goes into great detail about how flawed AA is. I am very glad that I read it. I was enjoying it so much, as it was helping me to deprogram from the 12 Steps. I recommend this book to everyone who has had exposure to the 12 Steps.

The book is valuable because it speaks directly to those who, in my experience, suffer the most: 'recovering alcoholics' already in A.A. who want and need to de-program and grow beyond the limited fiction of the 12-Step Augustinian theodicy and redemption story.Reading this book not only affirms a person's choice to leave A.A. but also inspires hope and self-confidence to trust the voice within.The authors' argument that the root of addiction manifests as feelings of helplessness -- not powerlessness (the distinction merits deeper study) -- is true to human experience. No one who takes action to change is powerless.But the main thesis of this book is absolutely correct: people are complex and no one-size-fits-all approach to understanding and treating addiction will suffice. Reductive approaches to addiction, whether within the domain of the redemption from sin or the functionings of neurobiology, merely reduce the human to powerless servants of God or hosts of brain events.The authors are not 'pushing' anything, including psychology treatment. The authors are making a plea for a sane, human, and thorough understanding of addiction as a complex, human, and normal life experience, instead of as a pathology, or as a fault of character or sin upon the soul.

The book has some really good history but I was already familiar with most of that so I went through the first chapter or so, wishing for a fresh insight. Some of my favorite dirt on Bill Wilson involves his use of LSD (everyone in AA would scream that I'm not sober if I dropped a few tabs, but they roll their eyes to the sky when they say his name... you know, but no personalities except for those old dead white men from Ohio we worship) so I've always had an entertaining picture in my head of him responding to letters at HQ fried out of his mind on acid next to the lava lamp, rambling about spirituality.There's other things people don't know, like how he screwed the original investors (outright securities fraud) and then screwed AA over financially by stealing the copyright to the basic test. He was a skirt-chasing con artist. The author only touches on a few of his faults. I realize that a full dissertation on these could take up another book of their own but there's some pretty weird stuff I'd never heard about like their seances or claims of levitating the table.The author missed an extremely important part of the history of the steps and what they aimed for, namely Doc Silkworth's admonishment to Bill Wilson:"Look Bill, you're preaching at these people too much. You've got the cart before the horse. This 'white flash' experience of yours scares those drunks to death. Why don't you put the fear of God into them first? You're always talking about James and The Varieties of Religious Experiences and how you have to deflate people before they can know God, how they must have humility. So, why don't you use the tool of the medical hopelessness of alcoholism for practically all those involved. Why don't you talk to the drunk about that allergy they've got and that obsession that makes them keep on drinking and guarantees that they will die? Maybe when you punch it into them hard it will deflate them enough so that they will find what you found."This has always sounded like an inherently manipulative and deceitful ploy to me. Let's start off by saying that this misguided take on first century Christianity also happens to scare the hell out of many of those drunks and the book makes an excellent point about how failing to identify with or adapt to this "solution" leaves many people having their hopes for a new life shattered because it just didn't apply to them in one way or another, or in some cases because the attendees are dreadful and to be avoided at all costs.Not all of "those drunks" are completely stupid and need God "punched into them hard" -- to wit, I had a "white flash experience" after staying awake for 11 days on speed, snorting a gram of ketamine and dropping two hits of LSD ... so I'm not sure why my white flash experience is any less valid than a "white flash experience" on belladona in a sanitarium.Factual error: The 12 steps did not all occur to Bill W in one single insight as the author suggests. In fact there were 6 steps more or less derived from the Oxford Group's "5 C's" and these evolved into 12 steps.Slight misinterpretation of a step (9): "Amend" means to "correct", not to "apologize." If you are truly sorry for something you did, you sincerely change your behavior to the best of your ability. This is the standard for success in these affairs. It is not a world apology tour. An apology may very well be in order but that is not the point here. I've said I'm sorry more times than I'll ever know. And I am one of those people who "takes what works for me" and "leaves the rest" and for all of my overall objections, cleaning up my affairs and not carrying around shame for the dishonest things I once did, cleared my conscience and that has been a good thing in my life that has nothing to do with Christianity being shoved down my throat, to say nothing of my acceptance of that.Amusingly enough I was unfriended on Facebook recently for replying to a "tsk tsk" about this book (which the person had not read of course) by politely stating that the "success" rate was in fact proven to be abysmal (5-10%) which was well known to me before I even read the book.My response to that at the time was "Someone from the program 'unfriended' me after I responded to an article about dismal success statistics in 12-step programs and replied that they were accurate. The article wasn't referring to a book written about those fortunate enough to have a "fabulous" life, cash and prizes, and the luxury of burying their heads in the sand about the revolving door and/or those who do not recover or die. You don't have to care about any of them, just don't say they don't exist because your life is so wonderful. I have an "anecdotal" report of my own experience and I would consider it worthwhile. But as far as anyone knows, this book isn't about me either. These statistics aren't news though and I think it's refreshing that someone's actually brought something more constructive than denial to the table for a change. I can see how this might be mistaken for dissidence but it's ridiculous and it's intellectually dishonest to post about such topics and not welcome any discussion about them. "The book itself illustrates his completely uninformed / irrelevant post and his reaction to me.Many people come in and out of the revolving door, a few stay. Most don't. But it's all their fault. It has nothing to do with the program not working of course. He nailed it on the head how the default response is to blame the person for failing to work the steps properly.It gave me some new perspective on people's BS too. Just today someone was going on and on about how delusions were part of addiction, and I replied that they usually went hand in hand with using more than anything. Predictably I was told that I didnt understand the steps. So I had to ask what good being "restored to sanity" was if you were still delusional. You can't be sane and delusional, and according to 12-step programs you're "always" an addict/alcoholic. Anyway when she scolded me and told me that I just needed to work those steps harder, I told her that was the ultimate cop out for anyone who is just spouting misinformed nonsense. There is no elusive mystery to the steps. It's just how people try to win an argument.Editing to add this: "Letting someone find their bottom" is incredibly dangerous. Lots of people die before they find it, and families listen to members when they make statements like that. So I already hate and cringe at that and was VERY happy to see it on your list of AA myths.I don't agree with psychotherapy being the solution for everyone either, and the book is heavily biased in favor of that.But thank you for some really valuable insights, I can see through a lot of it now, and what a relief this has been to read.

Dr. Dodes takes a hard look at the 12-Step program, you know, the one that's the basis of Alcoholics Anonymous and all those other addiction recovery groups. And it turns out, according to the book, that this program isn't really supported by science. Like, it might not be effective for a lot of people and can even be harmful for some.The author also talks about how the rehab industry isn't all it's cracked up to be. He says that a lot of these places don't use evidence-based treatments and use unproven methods. So, it's not just about the 12-Step program, but about the whole addiction treatment industry.The book is a quick read and it's written in a way that's easy to understand, which is great for people like us who aren't experts in the field. But it's not all negative, it suggests alternative approaches to addiction treatment that are based on scientific evidence.If you're curious about addiction treatment, or know someone who is struggling, this book is definitely worth checking out. It's an informative read that makes you think about the current approach to addiction treatment and if there are better ways to help people.

Amazing book! Very helpful for those of us who have tried everything to fit into the AA 12 step process and found it lacking ..even harmful ! Dr Lance Dodes gives much information on proper analytical data collection and shows that to be severely lacking regarding any AA 12 steps etcetera . The first chapter I jumped to when I opened the book was entitled "What DOES work?".. the author is a psychotherapist and recognizes psychotherapy one on one as being the best solution . I have gone that route myself prior to reading the book and his opinions reinforced my conviction that I was taking the correct path . He also dispells the oversimplistic illusion that abstinence is the only solution. AA believes that abstinence is the only form of improvement worthwhile. To go to an AAA meeting and tell others that you're not abstinent but a mild social drinker under control...after being out of control at one time, would get you heckled as being in denial big time. It would be like going into a meeting of Mormons and telling them that Joseph Smith was nothing but a veru young storyteller with a very active imagination when writing The Book of Mormon... it would not get you very well received at all in fact you would probably be escorted out rather quickly.The author does a good analysis of the very lucrative Rehab Industry as well and it's failings and shortcomings with very little true personal individual counselling.My one concern is that the Author seems quite anti-God and anti-Christianity as a response to AA.Personally, my really big concern with AA was that they quote the Bible so much and are not direct about where the quote comes from. Seems like plagiarism to me to quote Jesus and not at least give credit for where it came from to be politically correct.In the beginning one of the three founders was a minister but they decided to take the Judeo-Christian God out of the program and yet continues to quote him in order to get much bigger numbers coming to meetings ... it seems to have worked well in terms of helping them to get very popular and large.Jesus said the way is narrow and few there be who find it.