It is not that addicts don't get better - the vast majority do.
But the disease theory actually does damage by conveying the image of addiction
as an alien force that medical experts can remove. In fact, recovery is a natural process
that helpers can encourage by building on existing forces in the addict's life.
George Vaillant is a world renown alcoholism expert who identified this truth, then became a spokesperson for Alcoholics Anonymous and the disease theory. When he determined that his 12-step treatment program did no good, Vaillant intoned, "the best that can be said for our exciting treatment effort at Cambridge Hospital is that we were certainly not interfering with the normal recovery process." Chew on that! But, even this ridiculously modest claim is wrong.
George Vaillant is a remarkable figure in American addictionology. A Harvard psychiatrist who made his name tracking people's life trajectories, he joined a hospital alcoholism treatment program and bought the twelve steps hook, line, and sinker. Along with relying on 12-step treatment, Vaillant required patients to attend AA. When he found the treatment he provided did no good, Vaillant endeared himself in the field by endorsing Alcoholics Anonymous as the only solution for alcoholism.
Vaillant first gained attention with his 1977 book, Adaptation to Life, which traced the life courses of a group of Harvard graduates over decades. He took a neutral, humanistic view of men whose coping styles and defense mechanisms led them to better and worse life outcomes, which Vaillant scrupulously examined.
Vaillant described the next phase of his career in his 1983 book, The Natural History of Alcoholism (revised in 1995):
When I joined the staff at Cambridge Hospital, I learned about the disease of alcoholism for the first time. . . . It seemed perfectly clear that. . .by turning to recovering alcoholics rather than to Ph.D.'s for lessons in breaking self-detrimental habits, and by inexorably moving patients from dependence upon the general hospital into the treatment system of AA, I was working for the most exciting alcohol program in the world.
But then came the rub. Fuel by our enthusiasm, I tried to prove our efficacy [but found]. . . . after initial discharge, only 5 percent never relapsed to alcoholic drinking, and there is compelling evidence that the results of our treatment were no better than the natural history of the disease.
In a separate non-clinical sample he studied, Vaillant found that the substantial majority achieved remission without entering AA. Yet Vaillant failed to cite a single case of natural recovery in his book! Every single case is of an AA success, or else of failures like "Tom Reardon," who foolishly "never learned to pick up the telephone" to call AA. The discrepancy between his data and his case studies is not very reassuring about Dr. Vaillant's mission.
In a summary to his book that deserves to be studied as a clinical document on its own, Vaillant recited all the bromides about the disease of alcoholism, listed the 12 steps, and intoned that "alcoholism is a disease that is highly treatable." He then takes our breath away by reporting that a would-be helper is "as powerless over another's alcoholism as he is over another's measles" and by his admonition that such a helper does best by "not interfering with the normal recovery process."
I need to counterbalance my emphasis on the intellectual perfidy of George Vaillant by referring to the remarkable Harold Mulford, who identified both the descent into alcoholism and recovery from it as natural processes, leading to my own development of the Life Process Program. Based on Mulford's example, I actually took seriously Vaillant's proclamation that, "if treatment as we currently understand it does not seem more effective than natural healing processes, then we need to understand these natural healing processes."
Disclosure: I reviewed Vaillant's book for the New York Times Book Review in 1983, and I shared a cab with him to the Victoria, BC (Canada) airport after we each received a lifetime achievement award from the International Network of Personal Meaning. (George: I apologize for stealing your cab.)