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by William H. Benson

April 10, 2014

     Charlie Sheen, Lindsay Lohan, Robert Downey, Jr., Britney Spears, the late Whitney Houston, and countless numbers of other celebrities have gone through rehab at least once, and each experienced far less than a full cure. The actor Danny Bonaduce—the red-headed middle son on The Partridge Family—said, “They charged me more than $40,000 for my stay, and I drank on the way home.”

     Treatment centers, such as Betty Ford, Sierra Tucson, and Promises Malibu, offer hope to an individual who suffers from a compulsive addiction, but often those who pay and stay for the required twenty-eight or thirty days regress to the same addictive behavior once they leave and return home.

     The guilt and shame those people feel for failing to stop the drinking or drug use overwhelms them, and so they and their families feel devastated. They accuse each other, or they drown in self-recrimination. Few question the treatment itself, to say, “that treatment was inappropriate for me.”

     The expensive treatment centers can offer exotic forms of therapy, such as riding horses or daily swims in the ocean, but at their base, for the actual treatment, most use principles espoused by Alcoholics Anonymous, the Twelve-Step Program. So entrenched is AA in the social and judicial system that no one dares to question its premises, its methods, or its success rate.

     One person who has taken on AA is Dr. Lance Dodes, who has written a new book, The Sober Truth: Debunking the Bad Science Behind the Twelve-Step Programs and the Rehab Industry. Last week Dr. Dodes spoke on National Public Radio and said that “AA’s success rate is between five and ten percent, which is about the same as if there was no treatment.” On their own, without any professional assistance, some five to ten percent of addicts quit their alcohol consumption or drug use.

     Why is AA’s failure rate so high? Dodes says that some people dislike the emphasis on religion: surrendering the will, admitting that life is unmanageable, and recognizing a higher power. Many who are first exposed to AA “resist these ideas because they exacerbate the powerful sense of helplessness that most addicts struggle with every day.” Dodes also says that “increased spiritual endorsement is not predictive of increased abstinence.”

     Dodes disapproves of the phrases that AA drills into those seeking help: “You have to hit bottom before you can get well.” “One day at a time.” “Stick with the winners—those already in AA.” “90 meetings in 90 days.” “People with addictions have character defects.” “Only an addict can treat an addict.” Dodes says that these “myths” cause more harm than help, that “folklore and anecdote are elevated to equal standing with a data and evidence.” Instead, Dodes pleads for a scientific approach.         

     Of the twelve steps, Dodes says that only one is beneficial, the fourth one, the one on self-examination: “Make a searching and fearless moral inventory of ourselves.”

     Why do some succeed with AA? Dodes says that it is because of the camaraderie and the sense of brotherhood that surfaces at the meetings, and that some appreciate that feeling of being included.

     The primary reason Dodes frowns on AA is because it fails to address the underlying psychological issues that create the compulsive behavior. Instead, he believes that treatment should focus on helping individuals recognize the feeling that triggers the compulsion. Dodes argues that that feeling is usually profound “helplessness.” Once the addict recognizes that emotion, he or she can then predict when the urge to swallow a drink or a pill will arrive, and he or she can then manage it.

     Dodes writes, “There is always a more direct response to helplessness; this is the lesson to be learned from understanding addictive acts as displacements. Addiction can be understood, managed, and tended through learning about oneself. Addicts must focus on when the addictive thought first appears. This is the key moment, the pivot point on which everything else turns.”

     Dodes is not without his critics. In his book he devotes more time bashing AA than revealing his own therapy’s details. He lists testimonials from those who have tried and failed at AA, and he assumes that people drink or use drugs for the same reason, that sense of helplessness, whereas others would argue that other reasons lie below the surface, rather than just that one.

     Addiction is a complex and very human issue, controversy surrounds it, but therapists and counselors should investigate other forms of treatment, not rely just upon AA’s twelve-steps. Alcohol consumption and rampant drug use has enormous consequences for individuals and for society: broken lives, disrupted families, hopelessness, and an overwhelmed judicial and social support system.

     Dr. Dodes writes, “The failure of addiction treatment in our country is especially discouraging since there are better ways to both understand addiction and treat it.”