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

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Lance Dodes

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“Unsurprisingly, they found that the people who stuck with either treatment—AA or professional treatment—did significantly better than those who did not. These were the compliers.”

AddictionRecoverySobrietyRehabGamblers AnonymousGam AnonAlcoholics Anonymous12 Step ProgramAaAl Anon
Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“People who stayed in AA for fewer than six months had worse outcomes than people who never entered AA at all. This finding seems to mirror the Brandsma data: AA attendees seem to get worse before they get better. One theory is that the finding is nothing but noise—the standard statistical turbulence that can foul any short-term study. But if the data are real and repeatable, then they suggest something the Moos researchers perhaps did not consider: that AA might do more harm than good for the people who choose to attend but do not buy into the program.”

AddictionRecoverySobrietyRehabGamblers AnonymousGam AnonAlcoholics Anonymous12 Step ProgramAaAl Anon
Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“Why do large observational studies such as that of Fiorentine and Moos seem to suggest that AA is effective, while smaller controlled studies like those of the Brandsma, Walsh, and others included in the Cochrane Review do not? The likely explanation is simple: people stay in AA if they’re getting better and leave if they aren’t. This is understandable. If you are able to stop drinking, then continuing to attend AA is a comfortable and affirming choice. If you struggle with drinking and can’t make use of the AA approach, then you are less likely to keep attending. Over the long term, the people who remain in AA are, by definition, the success stories. But they represent a very small slice of the people who start there; as we will see shortly, the dropout rate from AA is extremely high. These facts—that AA works for the diehards and fails for the dropouts—are perennially misunderstood by the press and even by some researchers. Proponents of the program proudly point to the fact that people who stay in AA tend to be sober, ignoring the tautological nature of this claim. Reviewing this logic, Harvard biostatistics professor Richard Gelber said, “The main problem is the self-fulfilling prophesy: the longer people stick with AA the better they are, hence AA must be working. It is like saying the longer you live, the older you will be when you die.” As we will soon see, this fundamental error in logic undergirds nearly every claim of AA’s efficacy.”

AddictionRecoverySobrietyRehabGamblers AnonymousGam AnonAlcoholics Anonymous12 Step ProgramAaAl Anon
Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“In 2008, J. McKellar (writing as lead author, with Ilgen, Moos, and Moos as coauthors) concluded that “clinicians should focus on keeping patients engaged in AA.” This recommendation is even more dogmatic than Moos and Moos suggested in their original paper. In fact, this paper itself notes that pressuring people to attend AA is usually unhelpful: “a significant number of substance abuse patients never attend self-help groups after discharge,” that is, when no longer mandated to attend.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“AA began as a nonprofessional attempt to grapple with the alcoholism of its founders. It arose and took its famous twelve steps directly from the Oxford Group, a fundamentalist religious organization founded in the early twentieth century.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“AA has managed to survive, in part, because members who become and remain sober speak and write about it regularly. This is no accident: AA’s twelfth step expressly tells members to proselytize for the organization: “Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.” Adherence to this step has created a classic sampling error: because most of us hear only from the people who succeeded in the program, it is natural to conclude that they represent the whole. In reality, these members speak for an exceptionally small percentage of addicts.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“AA makes inflated claims about itself. Its foundational document, Alcoholics Anonymous (commonly referred to as the “Big Book” and a perennial best seller), spells out a confident ethos regularly endorsed by AA members: "Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There 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." In other words, the program doesn’t fail; you fail. Imagine if similar claims were made in defense of an ineffective antibiotic. Imagine dismissing millions of people who did not respond to a new form of chemotherapy as “constitutionally incapable” of properly receiving the drug. Of course, no researchers would make such claims in scientific circles—if they did, they would risk losing their standing. In professional medicine, if a treatment doesn’t work, it’s the treatment that must be scrutinized, not the patient. Not so for Alcoholics Anonymous.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“For an organization that has expressly denied religious standing and publicly claims a secular—even scientific—approach, it is curious that AA retains these explicit references to a spiritual power whose care might help light the way toward recovery. Even for addicts who opt to interpret this step secularly, the problem persists: why can’t this ultimate power lie within the addict?”

AddictionRecoverySobrietyRehabGamblers AnonymousGam AnonAlcoholics Anonymous12 Step ProgramAaAl Anon
Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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