The Heart of Addiction

How psychology drives addictive behavior.

The Sober Truth About AA and the Rehab Industry

The science behind 12-step programs and rehabs is severely flawed. Read More

Long story short: One of the

Long story short: One of the most important subjects in our society. Drug and alcohol addiction is linked to nearly 99% of all violent crimes. And, the courts mandate a 12 step program, which may actually hurt more than help.

Long story long:

Like music to my ears! I've been saying as much for the last 10+ years, to anyone that would listen. Counting days and hanging around alcoholics, talking and thinking about alcohol constantly, is a recipe for disaster. Leads to worse relapses when you lose your precious prestigious place as a 1 -2 year know-it-all. And / or makes you just lie to gain respect of the group.

And, I've noticed things tend to gain importance and 'get bigger' the more you focus on them. Sitting around talking about drinking is analogous to a dieter stocking their fridge with big macs.

And, of course, if you give in, it's because you didn't have the moral fearlessness, or whatever cockamamie nonsense they espouse.

Personally, I (only) began truly recovering after I attended an experimental group testing Naltrexone and received in depth substance abuse counseling. They taught me to count my drinks and if I slipped, make the slip very small. Etc.

This was after 15 years of feeling like I was a failure as a human being. Because I would promise myself then a day later start having DT's and give in. I blamed myself and came very near suicide many times, thinking I had a moral weakness.

Anyways, can't wait to check out your book.
Will buy a copy and also recommend my library to acquire one as well. Thank you for writing this. Can't wait.

What was the time frame . . .

. . . in finding the 5% to 10% success rate?

Conquering an addiction takes many tries and many failures, so I believe that anything less than a 10-year time frame doesn't give a good idea of how many multiple tries are finally successful.

It IS a matter of "Rational" over "Addicted" brain

Until the "pleasure principle" in the brain is defeated by the "rational" brain, addiction gets to continue. No time frame can be put on that battle!

Sometimes a success has hidden failures

I got sober via a 12-step oriented treatment center, 12-step (along with New Age religion and the Enneagram Personality theories - i.e. BULLSHIT) oriented long term treatment center. I have been without alcohol for 21 years. Success right? Well, somewhat; during this time I struggled with serious anxiety disorders and depression, but I kept getting a definite message from AA meetings that if AA wasn't fixing everything then I wasn't doing AA right. The steps re-inforced my self-criticism, feelings of failure, and even self-hatred. I never felt "good enough", and was basically given a "spiritual" path that told me I wouldn't be, that all problems were of my own making. When a friend in the "fellowship" who always swore against psych meds gave up her fight, followed by a death in my family, I gave up my fight. I got help. Taking one little pill every day after a couple of weeks opened my eyes and made me able to actual have some positive feelings again. At that point 17 years of beating myself up with the steps had not done this. I was already in talking therapy, and now it can actually help me make progress where it could not do so before.

Not drinking was necessary for me, I self-medicated almost to death, literally. I feel that alcohol became such a go-to for me to try to fix my anxiety and depression that I can't afford to drink. That's fine, but I also needed to adress the underlying issues that I knew, no matter what kind of BS I was told to believe to the contrary in AA, that I drank over. They will help you re-write your own story in AA to make it fit with their philosophy, there's a point I reached where I didn't know what my story really was anymore, or why I had to feel so bad all the time. I just knew I'd better hide it or I would be told to work the steps that much harder. In the end I had to admit my REAL story again and seek more help. I've heard in "the rooms" that people with over 20 years who relapse often die. I can say I know why at least some of them do.

I am going to download your book on Kindle so I can read it now. Don't want to wait for a hard copy on this one.

This is a great book if for

This is a great book if for no other reason than it brings to light the unscientific dogma of AA and how most Rehab facilities use the AA template in-house and to farm out their expensive clients to free AA meetings!! That may make for a great, "Business Model," for Rehabs, but not a good therapeutic or moral model.

I speak from experience. I had a heroin addicted son who went to multiple rehabs. They all promoted and fell back on the free non educated baby sitter of AA.

many others agree we can do better

take a look at the work of Minnesota Alternatives and also Dr. Mark Willenbring. Both are working in the substance abuse field using scientific models versus AA models. With success. The "one-size fits all AA may work for some but it is a model developed in the 1950's and its not science based. Surely we can do better. 90 percent failure rate is abysmal.

re: many others agree we can do better...

Dear anonymous... I took your advice and checked out Dr. Willenbring's website and was quite astonished to see how much better he seemed to be doing when compared to the national average:

Why he scored a perfect 5 out of 5 for: Ease of scheduling urgent appointments (I guess it must be tough to book a non-urgent appointment)

Another perfect 5 out of 5 for: office environment, cleanliness, comfort etc (how does one get a 5 out of 5 for "etc?)

For Staff friendliness and courteousness? You guessed it, another 5 out out of 5 - impressive.

In fact, Dr. Mark Willenbring scored a perfect 5 out of 5 in every single category of his patient surveys, including: Level of trust in provider's decisions, how well provider explains medical conditions and of course the most important of them all: Total wait time (waiting & exam rooms) - EPIC!

We can definitely do better alright...

Heaven forbid should something created in the 30's (not the 50's; do your research, I did) still work almost a 100 years later and it's not "scientific-based" - oh the humanity!

A 90% failure rate is abysmal, but until you or someone else can show me the research that backs those numbers up then I might just as well let you know that I am a multi-miliionaire. It's not true, but if I hadn't told you that you'd be running around tomorrow telling all your friends that a multi-millionaire put you in your place on a Psychology Today Blog - simply because you read it somewhere!

AA won't just get you sober, it will transform your life and give you inner peace and happiness, if you actually work the program that is; "RARELY have we seen a person fail who has THOROUGHLY followed in our footsteps...."

But hey, if you want to wait around til science comes up with a pill that can do all that then you be my guest... in the meantime, I'm going to go about living this fabulous life I have, one day at a time - all thanks to AA...

Peace Out...

Jay K.

Not true, Jay

Jay's comment reflects the major logical error in addiction studies. He quotes Bill Wilson's Big Book that people who follow the program do well. The problem is that there are now a large number of studies that show that only a tiny percent of people who attend AA do "follow" the program. They drop out and get blamed for their "failure" when actually it is the AA approach that fails 90% of people. Most people don't "work the program" not because THEY are failures but because they've found AA is useless (or worse) for them. As for showing Jay the studies, I respectfully suggest he read The Sober Truth, which is filled with them.

12 steps

I read a lot of negative blogs/opinions about the AA program. I work in the health field and happen to be a greatful recovering alcoholic. I see the suffering that occurs to those less fortunate than myself. Those who I have come across who have managed to live sober and remain so are only those who work a 12 step program. We have learned to live and love unselfishly on lifes terms. We gain strength through fellow ship and helping others in need. Its been my observation and experience even if one is sober, without changing and working on your defects through the program you still have just as many problems as when using.
Grateful me

Life on life's terms?

If you lived "life on life's terms", you would admit that you are a RECOVERED alcoholic (or do you plan to go back to it soon?), and that there is ZERO NEED for you to EVER have to attend a bullshit 12 Step meeting EVER AGAIN! Staying sober, INDEPENDENT of "mutual support" groups-THAT is living "life on life's terms".

Exactly why humanity is struggling with addiction at a catastrophic rate!

You are completely missing the whole concept of this artile. I would expect a more rational interpretation of recovery, seeing as you work in the field. That's the problem right there. You may have found all you need through working a 12 step program, but what about the millions who still struggle with understanding, let alone the millions involved in 12 step recovery who blame themselves for not throughly doing a step 4 or 5, as a result relapsing. I understand aa/na is meant for the better good; at it's time of uprising. It's like the classic creationism vs science. Science continues to debunk myth after myth and creationsim continues to use their one point, of in this case of 12 step recovery "a power greater than yourself to restore you to sanity" Some people just need a realistic view of addiction, not spirtually guided feel good about yourself narrcissitic view. Start looking at recovery as an indivdual battle where people interpret things differently. That's what would make you an acceptable health field addiction worker. Show the individuals all avenues of treatment and long-term recovery.

WHERE ARE the OBJECTIVE studies on AA?

So Jay, where ARE the objective, peer-reviewed, scientific-journal-published studies that PROVE that A.A. has ANY sustaining effect in keeping an ex-alcoholic sober, over ANY period of time? Remember now, A.A.'s membership criteria is based in the "DESIRE TO STOP" drinking-not the ACT of actually achieving that (so those who somehow GET sober in A.A. automatically no longer meet membership criteria, and must be EXCOMMUNICATED ACCORDINGLY! As far as that "Rarely have we seen a person fail" gibberish-that may have been true in the small population (and even smaller sales!) of the "Big Book" in 1939 (that even THEN no reputeable publisher would publish!), but its 75 years later now. Welcome to the 14th year of the 21st Century! There are MANY MORE ALTERNATIVES-both in the medication, AND mutual support group realm. How come A.A. does not commission a study comparing ITS "results" to that of: Naltrexone, or SMART Recovery, or individual therapy (that Dr. Doddes is an advocate of!)? Get back to this page when you have an answer. I'll wait.

No objective studies needed

Carl Jung was one of the catalysts involved in starting AA.
He knew it worked.
He was an honest scientist who realised that he couldn't help a REAL alcoholic.
Scientists have proved that alcoholics have different chemical balances in their brains that earthlings don't have.
AA is not a religious programme.
If you don't believe that there is something more powerful than your own willpower, you have no hope, because you were powerless over alcohol when you were drinking.
Only two criteria for being an alcoholic:
1.Lack of choice, i.e. drinking when you didn't want to
2. Lack of control, i.e. when you start drinking, you cannot control how much you drink.
anything else is just symptoms, not the problem.

If you don't have either of those two, you're probably not an alcoholic.

Lies, damned lies, and AA!

In what universe (besides Planet 12 Step!), is an alleged "lack of choice" in the ingestion of an intoxicating substance made when:

1.) WILLING, KNOWING, AND VOLUNTARY HUMAN INTERVENTION is involved to acquire, and ingest that substance?, and

2.) The INGESTOR OF the substance gets to decide: a.)HOW the substance is ingested, b.) how much of the substance is ingested per each individual ingestion, c.) the location the ingestion takes place, d.) the monetary price paid to acquire the substance, e.) how the ingestor gets TO the substance, and f.) how much time goes by between "doses" of the substance ingested? WHERE IS THE ALLEGED LACK OF CONTROL IN ALL THIS? It is NOT the substance making these decisions!

And if AA is somehow NOT "religious" then WHY do 6 of the 12 steps involve a DIRECT OR IMPLIED REFERENCE to "God", or the capitalized personal pronoun of "Him"? Those are NOT declarations of atheism!

The references to God, . . .

. . . except when someone is telling his or her OWN story, are always qualified by "as we understood him." That's why many of us talk about a higher power, rather than God. It was certainly a relief for me to discover that I was not responsible for all the ills in the world.

There are quite a few atheists who feel comfortable in AA--because when others talk about God, we don't feel that THEIR belief is what WE have to believe. In fact, AA is the most tolerant organization in the universe, and I believe that's one of the main reasons for its continued existence and its continued success for many of us.

As to the choice element, people who take such insistent stands about the behavior of others are usually really worried about what they themselves are doing. Motes and beams?

So much for "rigourous honesty" . . . .

Carolyn, you are the epitomy of PROVING the pathetic mental gymnastics 12 Steppers will go through to: 1.) NEGATE THEIR OWN INDIVIDUALITY (AA is EXCELLENT AT THAT!), and 2.) allegedly "proving" that AA's own pathetically-written steps DO NOT MEAN WHAT THEY SAY, NOR SAY WHAT THEY MEAN (in which case, WHY DO THOSE WORTHLESS WORDS EVEN EXIST?). AA is, and remains ABOUT PROMOTING RELIGION (AA likes to call it "spirituality"!). It is so pathetic that it CANNOT BE HONEST WITH ITSELF, much less have "members" that postulate its false precepts as you do, and PROMOTE IT, in spite of the "tradition" against doing so!

Nope, AA is actually the most individualist-promoting organization in existence

You're free to believe what you want to believe, and to practice what works for you, and I am free to do the same.

"Most Individualistic"??

Uh, Carolyn-have you even READ those "12 Steps" that you CLEARLY PROMOTE (in violation of the tradition against doing so!) each time you make a post on here? WHICH STEP mentions the INDIVIDUALIZED PRONOUNS of "I" "YOU", or "ME"? THEY ALL have PLURALIZED PRONOUNS, and are written in the PAST TENSE no less (so how DO 12 Steppers "work" a sentence that was written for the PAST, in the PRESENT?). AA is all about its "group mentality"-the individual be damned! If AA had ANY respect for the "individual", Bill W. would have at least acknowledged them when he coughed that 12 Step verbage out in 1939! He DID NOT! An "individual" means NOTHING in A.A., only the GROUP counts! How pathetically cultish!

Your experience is not the experience of others.

No need for such hostility.

But there IS a need for such HONESTY!

Too bad you interpret HONEST as "hostility", AND that you feel you are being "attacked" for getting CALLED OUT on your selfless promotion of a "program" with its TRADTION that states it is NOT supposed to be "promoted". Stand by, why I call the WAA-mbulance!

I interpret death threats . . .

. . . as hostility.

RE: Not True Jay...

Dear Dr. Dodes,

I would be happy to purchase and read "The Sober Truth" but you will need to give me a little time to read it before I can comment on it, obviously.

Simply stated, perhaps the scientific community should be looking at why the program works for some and find ways of improving upon that instead of simply shooting it down as flawed. That's great that you've given me a resource that challenges the method and results of AA, but why don't you put forth an example of a viable alternative to AA that is having good results.

If the program works if you work it, then how can the program itself be "flawed"? If ABC company hires me to be a sales person and I don't actually go out and do my job, is the company that hired me flawed, or am I as an individual accountable for my lack of success?

If I give you a road map to my house and you don't use it and you end up lost, is that my fault? Was the map flawed? If the program works for only 10% of people the perhaps the scientific community should study the 10% of people who are successful to understand the difference between the two groups, in order to increase the odds of success for the other 90% of people?

I guess if you did that, it might hurt book sales...

I will read the book you suggested, with an open mind, and I will come back and comment - you have my word on that...

Jay K.

Update for Jay

Jay, When i referred to the model developed in the 1950's i was talking about the Rehab Industry model of 28 day stay and based upon AA. Not AA itself. We're not waiting for a pill. Just waiting for treatment that actually helps people. And yes, science and study will hopefully help to open the way for that. I'm glad that you have a fabulous life but you sound pretty snarky and angry. Maybe AA can help with that.

Anonymity in AA is a cover for predators.

Without digressing into details, my own personal experience is that anonymity in AA is often used by sexual predators to conceal and cover their true motives.I have experienced predation in institutional settings and at ordinary meetings. AA is an excellent cover for outrageous and deviant behavior. So much for accountability and responsibility!
There is one epithet which remains true in all this- Alcoholics will lie to you, then they will deny lying to you.

RE: AA is a cover for predators...

Wow! What a statement that is. Apart from being uneducated and downright ignorant, it is so blatantly inaccurate! Predators are a fact of life unfortunately. Sexual predators can be found in every walk of life including, but not limited to: teachers, Doctors, politicians and of course Catholic Priests.

Should we then put and end to schools and education and the profession of teaching? Should we condemn the entire medical community for actions like those of Dr. George Doodnaught? Should we abolish all religion, and in particular the single-largest religion in the world, Catholicism, because of the actions of a few? Come on!

Outrageous and deviant behaviour exists everywhere including in the rooms of AA. Fortunately however, most of us are aware that there are men and women out there, who despite all that they have learned, still behave badly and we do our best to protect everyone from that very kind of behaviour, but of course we can't be there all the time.

Preying on the sick and the weak, which most of us are in early recovery, is downright disgusting and reprehensible behaviour - but it occurs everywhere. To single out AA for that was both unfortunate and irresponsible on your part, so grow up and accept that you're sadly going to find predators everywhere you go and stop your infantile condemnation of entire institutions based on the actions of a few!

I can't believe I even bothered to respond to your uneducated assertion but it was after all, the elephant in the room!

Jay K.

Poor Jay, Adrian made a

Poor Jay,

Adrian made a factual observation on the topic under discussion.
I'm quite certain, as we all our that such predator behavior is not unique to AA.

The only elephant here is your anger.

excuses for predatory behavior

I've heard the same excuse from some AA members I spoke to when I asked them, "Shouldn't AA make rules against sexual harassment and other behaviors?"

I heard in response, "Rape happens everywhere, not just in AA." The question was evaded. I couldn't get a straight answer.

I don't think AA can protect anyone 100% of the time- but it sends a clear message to the members not to expect any help from AA if something should go wrong. Especially when members are a mix of court ordered violent and sexual offenders. Some people are deranged enough to think they can get away with things if there are no rules.

Schools and churches have policies in place- rules against hurting each other. Consequences are clearly outlined. Sure, a person can call the police on an AA member for hurting them. But an AA member, who wishes to remain anonymous, may not come forward as a victim or a witness in these circumstances. In addition, they might be looking for their "part in it" and making "amends." After all, they're working a good, honest program.

Without policies, it appears like AA doesn't care. Yes, that's a partially an emotional plea, but it's also a legal one. You have the inmates running the asylum at meetings, this is the result you're going to get.

You're all Wrong

I think all of you are forgetting that when AA was founded the concept of addiction as it relates to alcohol didn't exist nor did the concept of group support or self-help groups.

AA's 12 steps work if one stays sober and works the steps using the tools of the program: meetings, phone calls, helping others. The idea of going to meetings and helping others is not to dwell on alcohol but to get inspiration and knowledge on what's working for those who stay sober. Phone calls and helping others are ways to get out of your own head and focus on something other than your desire for alcohol.

Thank HP for AA and Bill Wilson - the AA Big Book is truly a work of genius. At the time it was written the medical profession didn't even know that there was a relationship between mental health problems and alcohol. Bill Wilson himself consulted several psychiatrists and psychologists and they alone couldn't help him. He had to be sober and get support from others as well as practice what he learned in therapy and from the medical profession in order to stay sober. And with all of that he remained a smoker all of his life and developed emphysema from it.

I suffer from addiction, not alcohol but food and smoking, and there is no bargaining with my substance. I quit smoking 26 years ago cold turkey (there was no patch then). It wasn't easy and I gained 50 lbs. Today I can't stand the smell of cigarettes and have no desire 99.9% of the time to have a cigarette. But once every 50 months or so I might get a thought ahh a cig would be nice now - fortunately the cost serves as a good deterrent.

The food addiction has been much harder for me to deal with but I have had long periods of abstinence. To the person who wrote that his treatment is that he drinks but tries not to drink as much is the most ridiculous thing I've ever heard. One drink like one cookie is not enough and the # that are too many changes with how strong my craving is. If a drug works to kill the addiction - great but I haven't heard that people are supposed to use the drug so they can keep drinking or use the patch so they can keep smoking.

I don't have the answer for addiction although I know that abstaining for as long as I can is better than trying to negotiate some suitable portion with my substance every day - talk about a set up for failure. AA wasn't designed to be researched in a scientific manner and there's no way to randomly assign (the gold standard of research) alcoholics to treatment or nontreatment groups. In addition, what is successful treatment - if someone is sober for a year is that failure or success - what if someone's cancer is in remission for one year was that success or failure. I say every day you can abstain is a success and everyday you can't you pick yourself up not beat yourself up and try again. That's called resilience.

Presently there is no cure for cancer and there's no cure for addiction. There are different types of treatment for both problems and as science advances we owe it to ourselves to try everything until we find the path that allows us to be productive individuals a day at a time as often as we can.

Shame on all of you who bash AA because it didn't work for you. AA was one of the great creations of the 20th century and Bill Wilson and Dr. Bob were two extraordinary people who were able to spread the message and begin a conversation that got people to look at alcoholism with a bit more compassion than they had received previously. AA is nothing like a rehab - and the failure of rehabs just means that there still isn't a cure for addiction and if someone has the 10, 20 or 30 thousand dollars to spend on treatment and it gets them some sober time, then at least they got some sober time and weren't out there drinking and driving and potentially killing someone in a car accident.

Wrong, Rhonda?!

Why the defensive attitude? We all are seeking sobriety. If you are one of a small percentage who has found success in AA, great! There are those of us that found, it did not work for us. For you to be thrusting "shame on us" is clearly evidence to me you are getting where we are coming from. I spent $17 on Frank Dodes book and I am in therapy and staying sober.


Sorry, but how much are you paying for therapy?
What happens when you stop going for a few weeks?
Are you totally honest with the therapist?
Have you and the therapist worked out what is really wrong with you?
If so, you could have had all of this for free in AA.
If not, it's no wonder that AA didn't work for you.

Post new comment

The content of this field is kept private and will not be shown publicly.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Allowed HTML tags: <a> <em> <strong> <cite> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Lines and paragraphs break automatically.
  • You may quote other posts using [quote] tags.

More information about formatting options

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


Subscribe to The Heart of Addiction

Current Issue

Love & Lust

Who says marriage is where desire goes to die?