The Heart of Addiction

How psychology drives addictive behavior.

The Sober Truth About AA and the Rehab Industry

12-step programs and rehabs fail almost all the time.

I am pleased to announce the release today of my new book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.

In it, I describe the stunning facts about the current national treatment approach for addiction. AA has a success rate between 5% and 10%. An exhaustive scientific review by the prestigious Cochrane Collection, of all AA studies over 40 years, found even worse results, concluding that, "No experimental studies unequivocally demonstrated the effectiveness of AA" in treating alcoholism.

Practically no studies that support AA meet ordinary scientific standards, and all suffer from serious scientific errors. Most cover only a short time for this lifelong condition, or they are spoiled by a failure to account for "selection bias,” or they base their data on self-reports without independent verification, or they commit the grave error of discarding data that does not fit the authors' conclusions. (Invariably people who are happy and sober are glad to let the researchers know how they're doing, whereas people who have resumed heavy drinking are far less likely to respond to researchers' questionnaires or phone calls. Yet in reaching the statistical conclusion that AA (and rehabs) are successful, these people are regularly ignored.)

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A logical error arises from these acrobatics with the data: studies tend to show that the people who remain in AA longest are the most likely to succeed. Pro-AA researchers conclude from this that everyone should stay with AA. Of course this is basic, flawed circular reasoning. The people who stay are precisely the 5% to 10% who are doing well. Their success says absolutely nothing about the 90% who cannot make use of the program and have therefore dropped out.

This book also undertakes a clear-eyed review of the rehab industry. These pastoral retreats typically charge exorbitant amounts for the same 12-step program you can get for free in a church basement, adding irrelevant extras such as horse therapy, reiki massage and ocean adventuring to justify the cost. The data is scarce on these programs by design: it turns out that practically none of them have studied their own outcomes or, if they have, refuse to publish their findings. This has not stopped many of them from claiming fantastic success rates. The rehab industry is unregulated and can claim whatever it wants.

There’s no question that 12-step programs have saved people’s lives. But sending everyone with an addiction to AA or its cousins is simply bad treatment that does harm to the 90% who cannot make use of such programs, and are led to believe they are the ones who are failures, because the program is never wrong. It is time to change the national discussion about what is appropriate treatment for addiction, and I hope this book will provide a starting place.

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

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