The Heart of Addiction

How psychology drives addictive behavior.

"Stuck" Treatment in Addiction

Old and ineffective treatments for addiction are still around, at great cost to people suffering with the problem. Holding on to old ideas is common in human history, but it is especially wrong when taking care of others. Read More

How much twelve step literature have you read?

Have you read any of the twelve step literature? Alanon is all about taking personal responsibility for your own helplessness. Buy How Alanon How Works and read it. Also, buy and read From Survival To Recovery.You seem to have little understanding of it. As for AA, do you know what working a four step is? You go through and look at the behaviors that caused you to drink. These are all done with a sponsor and a supportive sober twelve step community. Many people cannot afford psychotherapy. I suggest you read some more of the twelve step literature before you paint it with such a broad brush. The first Book is the ACA big red book for a adult children of alcoholics. It is a phenomenal book. It is very focuses on taking personal responsibility. I would love to hear your opinion of it. If you are truly intellectually curious take the time to buy and read it and then critique. Peace

Alanon and step 4

"Alanon is all about taking personal responsibility for your own helplessness."

Complete nonsense. Alanon is about convincing anyone who has any kind of relationship at all with a person who has or develops addiction problems that they are spiritually defective, powerless, insane, suffering from the incurable, chronic, mythical “disease” of codependency, and need to buy into the religious program of the 12 steps in order to keep this mythical disease at bay. It pathologizes any normal human feelings or behaviours such as love, loyalty, compassion, caring, self-preservation or anger, and twists these into labels of (on the one hand) ‘enabling’ or (on the other hand) ‘controlling’.

Like AA, it is an amateur religious group that preys on people seeking help with a very real problem in their lives, and seeks to impose an extremely dubious and potentially destructive philosophy and set of practices on these people.

Step 4 is the listing of all one’s bad deeds and thoughts and character defects. The “moral inventory” doesn’t include listing any of your good points – the whole idea is to make the addict or their relatives feel even worse about themselves than they no doubt already do. It has absolutely nothing to do with looking at ‘the behaviours that caused you to drink’. It presupposes that addicts are basically morally ‘bad’ people and this is what made them drink (or take drugs, or, presumably, smoke), and if they become morally ‘good’ and find God through the practices laid out in the 12 steps their addiction problems will be solved.

In step 5, the person is required to make a confession of ‘the exact nature of their wrongs’ to a 12 step believer, someone who almost inevitably is not trained in psychology or in dealing with another person’s confessions or innermost secrets in any appropriate way.

If people want to go to 12 step groups and practise a religion invented in the 1930s, that’s up to them. But please can we kick the 12 step program out of anything that purports to be any kind of serious help or "treatment" for addicts and their families. It is a wholly irrelevant distraction that IMO does a lot more harm than good. It should certainly never be promoted as any kind of substitute for proper therapeutic counselling or treatment.


Your comment emphasizes taking personal responsibility, and AA's Step Four. They have little to do with understanding oneself psychologically. Taking a "fearless moral inventory" is a purely conscious reflection upon one's behavior; it does not touch the unconscious motivations within people. Correspondingly, untrained sponsors and others in the 12-step community may be supportive but cannot do the job of people who are professionally trained to understand and treat emotional issues. Indeed, for many, the AA emphasis on "personal responsibility" has a moralistic quality, which is the last thing needed by people suffering with addictions. Since you have an interest in reading material about addiction, I would respectfully suggest that you move beyond the 12-step literature and take a look at views presented from a different perspective.

Thank you!

And thank you for writing this article. A few years ago, after almost 18 years sober IN AA, I hit a wall with my initial problems pre-drinking days; anxiety and depression. I did not drink but became willing to seek medical help. AA gave me a group of people that did not hate me for drinking, and I had to have that to survive initially, but I have done mental gymnastics for 2 decades to read the steps in a way that doesn't put me right back into the old habits of putting myself down and fearing doing something wrong and then drinking.

When I entered "treatment" my long time difficulties of depression and anxiety disorders were graced over as by-products of the all consuming alcoholism. To have argued with anyone would have been to be told I was in denial. I realize I cannot drink successfully, after all that time of self-medicating, but I can't be depressed, anxious, active in debilitating OCD successfully either. The rubber had to hit the road or suicide, I realized, could easily become an option.

If a person self-medicates with alcohol, they are at great risk of any psychological issues that they drank over to begin with NEVER being addressed. And after years of clawing your way through that, bad things can happen.

been there, done that

Eight years ago, my drinking became a serious problem and, on the advice of my church, sought help through AA.

It was awful.

I REALLY tried to embrace the whole thing, but found the very first step I needed to take -- admitting I was powerless over my addiction -- to be incredibly disempowering. If I was powerless, why was I here? It just didn't compute with me at all.

I kept at it, on and off the wagon, for several years before entering therapy for severe clinical depression. I began to get to the root of the addiction problem in therapy, and began to think of it less as dependance and more as a faulty coping mechanism. As I learned new ways to cope, I didn't need to drink.

I drink very moderately now, with no problem. I don't believe I'm an "alcoholic," I just had some major hangups in life that I was trying to cope with.

Thank goodness my therapist didn't insist I attend 12-step meetings -- no doubt I would have given up on therapy too!!


thanks for a useful article. doubtless there should be more options than AA available to people struggling with alcoholism or addiction.

Some questions on this approach -

What's your stance on abstinence? you say it's better to be abstinent than not. do you think it's possible, to paraphrase AA, 'to make a normal drinker out of an abnormal one?

if AA success rate is around 5% what is the success rate of your method?

Thanks for your comment. The

Thanks for your comment. The abstinence issue is complex, for reasons having to do with humans in general, not addiction specifically. We are all at risk of returning to old symptoms in times of stress, whether that is compulsive/addictive behavior or something else. For that reason, it is generally safer to be abstinent than not. Many people also find that it is easier to be completely abstinent than to have to decide every day whether it's safe to drink (or repeat any addictive behavior) However, it is better to reduce the harm from addiction than strive for complete abstinence in a way that will never achieve it. This is why harm reduction programs are so valuable.

As for the success of my method, as a psychotherapist I am not in position to run large-scale statistical studies. I have heard from a large number of both therapists and addiction sufferers around the country that my approach has been helpful. But more important, we need to understand the way addiction works as a psychological symptom in order to have any rational approach to treating it. Through understanding the psychological nature of addiction, we can finally stop wasting people's time and making them feel worse by expecting them to get better with approaches that cannot help them.

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Lance Dodes, M.D., is an assistant clinical professor of psychiatry at Harvard Medical School.


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