Author Interviews
1:43 pm
Sun March 23, 2014

With Sobering Science, Doctor Debunks 12-Step Recovery

Originally published on Mon March 24, 2014 12:27 pm

Since its founding in the 1930s, Alcoholics Anonymous has become part of the fabric of American society. AA and the many 12-step groups it inspired have become the country's go-to solution for addiction in all of its forms. These recovery programs are mandated by drug courts, prescribed by doctors and widely praised by reformed addicts.

Dr. Lance Dodes sees a big problem with that. The psychiatrist has spent more than 20 years studying and treating addiction. His latest book on the subject is The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.

Dodes tells NPR's Arun Rath that 12-step recovery simply doesn't work, despite anecdotes about success.

"We hear from the people who do well; we don't hear from the people who don't do well," he says.


Interview Highlights

On Alcoholics Anonymous' success rate

There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent. Most people don't seem to know that because it's not widely publicized. ... There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine.

It's not only that AA has a 5 to 10 percent success rate; if it was successful and was neutral the rest of the time, we'd say OK. But it's harmful to the 90 percent who don't do well. And it's harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. AA is never wrong, according to AA. If you fail in AA, it's you that's failed.

On why 12-step programs can work

The reason that the 5 to 10 percent do well in AA actually doesn't have to do with the 12 steps themselves; it has to do with the camaraderie. It's a supportive organization with people who are on the whole kind to you, and it gives you a structure. Some people can make a lot of use of that. And to its credit, AA describes itself as a brotherhood rather than a treatment.

So as you can imagine, a few people given that kind of setting are able to change their behavior at least temporarily, maybe permanently. But most people can't deal with their addiction, which is deeply driven, by just being in a brotherhood.

On a psychological approach to addiction

When people are confronted with a feeling of being trapped, of being overwhelmingly helpless, they have to do something. It isn't necessarily the "something" that actually deals with the problem. ... Why addiction, though — why drink? Well, that's the "something" that they do. In psychology we call it a displacement; you could call it a substitute ...

When people can understand their addiction and what drives it, not only are they able to manage it but they can predict the next time the addictive urge will come up, because they know the kind of things that will make them feel overwhelmingly helpless. Given that forewarning, they can manage it much better.

But unlike AA, I would never claim that what I've suggested is right for everybody. But ... let's say I had nothing better to offer: It wouldn't matter — we still need to change the system as it is because we are harming 90 percent of the people.

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Transcript

ARUN RATH, HOST:

This is ALL THINGS CONSIDERED from NPR West. I'm Arun Rath.

Since its founding in the 1930s, Alcoholics Anonymous has become the go-to treatment program for alcoholism, and it's spawned 12-step programs for every kind of addiction. These recovery groups are part of the fabric of society. They're mandated by courts, prescribed by health care professionals and widely praised by reformed addicts. But not everyone is convinced such programs are effective.

That's the idea behind the book "The Sober Truth: Debunking The Bad Science Behind 12-Step Programs And The Rehab Industry." I asked author Lance Dodes, does AA work?

DR. LANCE DODES: No. There is a large body of evidence now looking at AA success rate, and the success rate of AA is between five and 10 percent. Most people don't seem to know that because it's not widely publicized.

RATH: And for a baseline, if someone were just trying on their own, what would be the percentages that you think would be a success?

DODES: Well, actually, it's an interesting question because people stop drinking on their own at about the same rate as they get better in AA. There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors, and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine.

It's not only that AA has a five to 10 percent success rate. If it was successful and was neutral the rest of the time, we'd say OK. But it's harmful to the 90 percent who don't do well. And it's harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. AA is never wrong, according to AA. If you fail in AA, it's you that's failed.

RATH: And you hear that from your patients?

DODES: Absolutely. People leave feeling much more depressed and discouraged and worse about themselves. Even the tally system that AA uses where you get a chip for 24 hours of sobriety. It's supposed to work by encouraging you to stay sober because you lose your chip. But the dark side of it is if you have a beer after six months of sobriety, you're back to zero in AA. That makes no sense. It's unscientific. It's simply crazy. If you have only a beer in six months, you're doing beautifully

RATH: Now, it's not scientific, but anecdotally, we've heard all of these stories, all of these people who say AA saved my life.

DODES: They're not lying. But we have what's called a sampling bias error. We hear from the people who do well. We don't hear from the people who don't do well. All the people, the 90 percent who go to AA who do not become sober members, don't write books about their experience.

RATH: Is there anything positive, are any of these 12 steps worthwhile therapeutically?

DODES: The reason that the five to 10 percent of people do well in AA actually doesn't have much to do with the 12 steps themselves. It has to do with the camaraderie. It's a supportive organization with people who are on the whole kind to you, and it gives you a structure. Some people can make a lot of use of that. And to its credit, AA describes itself as a brotherhood rather than a treatment.

So as you can imagine, a few people given that kind of setting are able to change their behavior at least temporarily, maybe permanently. But most people can't deal with their addiction, which is deeply driven, by just being in a brotherhood.

RATH: There have been other rehabilitation programs that have come up over the decades. How do other rehab systems compare?

DODES: Almost all the rehabs in this country are 12-step based, which tells you something right away. It raises the question of what are you getting for your 30 to $90,000 a month. And the answer is that they have added on a lot of other quote treatments, which have absolutely no scientific basis, like horse therapy, Reiki therapy, which is a mystical idea. Adventure therapy is part of the program. There's ocean therapy, which means you go out on a yacht.

None of these things have anything to do with treating addiction, but they're all part of the program. And they developed because since all of these programs are based on the same unsuccessful 12-step model and they're in competition with each other, they've become like spas, so they try to outdo each other in the extra frills that they put in.

And if you don't do well in a rehab, the rehab says you've failed, come back again, and come back again and again for the same failed treatment. Whenever we hear about these celebrities who go in and out of the same rehabs, we blame them. We say, what's the matter with them? They're falling out of the treatment. No one says the treatment is no good.

RATH: So how do you kick alcoholism?

DODES: Well, I've been writing about this for 20-plus years. Let me - I'll give you a brief summary. When people are confronted with a feeling of being trapped, of being overwhelmingly helpless, they have to do something. It isn't necessarily the something that actually deals with the problem; they do something.

Why addiction, though? Why drink? Well, that's the something that they do. In psychology, we call it a displacement. You could call it a substitute. So what happens is when people can understand their addiction and what drives it, not only are they able to manage it, but they can predict the next time the addictive urge will come up because they know the kind of things that will make them feel overwhelmingly helpless. Given that forewarning, they can manage it much better.

But unlike AA, I would never claim that what I've suggested is right for everybody. But I do want to emphasize that let's say I had nothing better to offer. It wouldn't matter. We still need to change the system as it is because we are harming 90 percent of the people.

RATH: Lance Dodes is a physician and the author of "The Sober Truth: Debunking The Bad Science Behind 12-Step Programs And The Rehab Industry." Dr. Dodes, thank you so much.

DODES: Thank you for having me. Transcript provided by NPR, Copyright NPR.