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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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“Examining this history, it is clear that AA has been extraordinarily effective at influencing public opinion and policy toward a favorable view of its ideas. What is missing from this account is notable as well: these strides were achieved without any triggering event, such as a well-designed study, that might support the organization’s claims of efficacy. Most of AA’s claims were simply grandfathered in, collecting legitimacy in a sort of echo chamber of reciprocal mentions that often featured the same handful of names.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“Human research tends to cleave into two major “kingdoms”: observational studies and controlled studies. Observational studies observe and compare groups of people. This research is conducted passively; in other words, without interventions or controls. Any significant differences that emerge between the populations studied—say, finding that people who drink more diet soda tend to have a higher incidence of depression than people who don’t—can’t prove anything but may be used to generate hypotheses about what is causing this difference. Yet people still assume the obvious when confronted with a correlation of this sort. In the diet soda study, which was actually run by the National Institute of Health and widely reported, many people jumped to the conclusion that depression must be caused by something in the soda. But a moment of creative consideration turns up several other plausible possibilities. What if the people who drink diet soda are simply more judgmental about their body appearance and generally more prone to self-criticism? What if, since drinking more diet soda correlates with a history of being overweight, the depression arises physiologically from the effects of obesity, or as a result of the cluster of health problems that go along with it, such as obstructive sleep apnea and diabetes? What if people who are depressed simply crave sweet things, as evidence suggests? And what of the fact that diet soda drinkers tend to cluster more in urban areas: is there something about this environment that promotes depression? Strong correlation is tantalizing, a just-so homily that satisfies our need for simple explanations. It feels definitive and self-apparent, especially given the huge number of subjects typically involved in such studies. The NIH study that produced the diet soda finding, for instance, had 260,000 subjects. Headlines are driven and public health advice administered whenever a major observational study unearths a provocative new correlation. But it turns out that the record of observational studies like these for generating accurate medical advice is, in a word, abysmal.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“Why do purely observational studies fail so often despite finding such clear associations? The diet soda example tells the tale. All of those alternative theories I mentioned can be boiled down to a single, devastating possibility: what if diet soda drinkers are just fundamentally different from regular soda drinkers, in any of the ways I mentioned, and this difference colors everything about the way they live and behave? Scientists call this the selection effect, or selection bias. When human beings are free to behave as they always have—free to willfully choose their behavior—there is no meaningful way to find a control group of comparable subjects.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“A growing body of evidence strongly suggests that people who do things faithfully and regularly for their own well-being, such as taking a multivitamin, exercising daily, or eating a certain diet, are, in fact, fundamentally different from people who don’t. People who adhere to, or comply with, medical advice are more likely to take care of themselves in numerous other ways as well: "Quite simply, people who comply with their doctors’ orders when given a prescription are different and healthier than people who don’t. This difference may be ultimately unquantifiable.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“The compliance effect can lead researchers and reporters who study interventions to falsely credit a pill or diet with improving our health—“Look, people who take fish oil pills live longer than the rest of us!”—when the truth may be far more subtle: the kind of people who take supplements in a disciplined way are already healthier to begin with, with a better prognosis for every disease.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“The compliance effect has led to some famously strange epidemiological results. One long-term study showed that people who took a placebo were half as likely to die as those who did not. Was the placebo protecting them in some way the researchers had failed to anticipate? Hardly. It turned out that simply taking the placebo regularly was a signpost for a wholly different lifestyle. The pill takers were simply more actively engaged in their health across the board.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“A poor understanding of these issues—the need for randomization, the difference between correlation and causation, and the power of the compliance effect—has colored much of the research that has been conducted to date about the effectiveness of 12-step membership and attendance.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“Deborah Dawson of the National Institute on Alcohol Abuse and Alcoholism, Division of Biometry and Epidemiology, once lamented the lack of credible data in the study of addiction treatment: “Few, if any, studies have assessed the impact of different types of treatment on both the probability and rapidity of recovery, i.e. on person-years of dependence averted.”5 Her principal complaint: the lack of controls in most AA studies.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“Analyzing the available data about AA requires that we begin with a clear definition of success. Success, after all, can mean any number of things. Should one measure it in days of sobriety? Weeks without a binge episode? What if people who are making substantive progress slip and have one drink during an otherwise successful period of time: Should they “go back to zero,” as is the practice in many AA chapters? What if they stop drinking but acquire a gambling problem instead?”

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