The Heart of Addiction

How psychology drives addictive behavior.

A Poor Critique

Our scientific examination of AA has led to heated, poorly thought-out responses from both some AA members and a few academics whose careers have involved supporting AA. Challenges to accepted wisdom are always met with resistance, but it would be better to have a less personal, more reasoned discussion. Read More

Having read Sober Truth and

Having read Sober Truth and after reading Beresin's malarkey, I felt that he had not even read the book!

http://www.psychologytoday.com/blog/inside-out-outside-in/201404/what-sc...

I read the critique

He seems to say that since mutual aid groups can be helpful that means that AA is wonderful and can never be criticized. No one ever asks the question why a support group has to be based around the remains of a fundamentalist religious movement from over 75 years ago (the Oxford Group)? Why can't today's professionals in addiction support mutual aid groups that do not? Why does a person who has a problem with addiction need to become "accountable" to another addict, in the form of a sponsor? Can't support groups be there for each other without religious rules and rank?

The steps limit the aid that people in AA could be giving each other because the steps are viewed as such a requirement to get sober that it is self-limiting. I remember a woman who could not face step 4, yet sponsor's hands were tied in giving her much support until she did so. She vanished from AA. Wouldn't professional help along with an actually supportive group have more success than this?

Psychology Today should have

Psychology Today should have higher standards for their posts. Any half-wit could have seen how weak Beresin's critique was, and that it could only have done a disservice to the readers for the reasons stated by Dodes.

Stop with the partisanship!

Both the article and the rebuttal mirror what's going on in the larger public arena - it's pro-AA versus anti-AA. Either-or. Black-and-white. We've got to move beyond this type of debate and towards a choice-based future for addiction treatment. As a psychologist and a person in recovery, I urge both writers to work together to create a future that doesn't include the following:

- Trying to unGod AA. Let's move past this. AA involves God, which for most people in AA is the Christian God. Meetings end with the Lord's Prayer. I've seen groups refuse to end with the Serenity Prayer when asked in a very respectful way to do that. Recovery mediation books lay it on even thicker. God can't be a doorknob, a group of drunks, or good orderely direction, at least for very long. Rather than attempting to reverse-engineer AA to make it seem like it isn't a God-infused program, we should ask ourselves why there is even a need to do that.
- Forcing people (through treatment or the court system) to adopt a program of recovery that has failed them on numerous occassions and in which they do not believe.
- Processing people through the same tired inpatient programs over and over again - individuals with different profiles need different programs - we at least need programs that differentiate first-timers from chronic relapsers. Yes, many programs now have "relapse prevention" tracks, which would be a step in the right direction if those programs weren't just Cliff Notes versions of the full 12-step programs.
- Blaming the victim to avoid examining program effectiveness and getting defensive about the need for robust program evaluation.
- Using the ineffective "confrontation" style of therapy and demanding higher standards and better training for substance abuse counselors.
- Treating adults like children in programs heavy on therapist-as-parent/client-as-child dynamics.
- Forcing patients into high-drama residential settings that stress already overstressed clients. I understand the need for residential treatment. I don't understand the positive contribution made by playing up the inherent drama among residents, therapists, and staff members through 1970's-style confrontational program elements.

I am glad to see this subject finally being debated. Now we need to move past the debate and start the reconciliation.

Reply

Thank you for your comment; we made virtually all of these points ourselves in "The Sober Truth." I would only differ on two matters. Trying to "unGod" AA has its merits. Studies suggest that many people who do find AA helpful are responding to its group support, not its official religiously-based teaching. For them, it would be helpful to have a specifically secular version of AA, and of course some such groups do now exist (LifeRing, Smart Recovery, etc.). The other matter is that I am not "anti-AA"; anything that is helpful to anybody is good. The problem with AA is that we collectively believe that AA is the best, first, and last treatment for addiction, which is a massive error that has been harmful to the vast majority who cannot benefit from it.

I am a successfully sober AA

I am a successfully sober AA memeber who is agnostic. From my understanding of AAs history, AA was developed from the Oxford groups beliefs but that is where the religeous affiliation ends. I am constantly reminded by my sober connections and other AA members that this is not a religeous but spiritual program. I disagree with the implication that AA is a covert religeous organization. The fact remains that there are some alcoholics who must have a spiritual awakening in order to get and remain sober. That does not mean it has to be a religeous awakening and definetly does not have to be a belief in a christian based deity. My GOD is Good Orderly Direction and that works great fo me and many other AAs that I know. I might agree that in treatment centers the 12 step model is overused and should not be the 1 trick pony it has become. AA is not for everyone and I don't believe Bill W. ever thought it was. I heard Dr. Dodes speak on MPR recently and felt he completely misrepresented AA. I suggest you study the traditions, sit through some AA meetings then talk to some recovering alcoholics. I think you will find a wide variety of beliefs and open minds by most. And if not, you are hitting the wrong meetings!

Reply

As you may know, AA has been deemed a religious organization by 25 states in this country; the religious quality of the organization certainly has never ceased. I am aware that not all groups are equally focused on AA's religious foundation. But I believe you make my point when you acknowledge that AA is a "spiritual" program and that some people must have a spiritual awakening to get and remain sober. That is, of course, AA's view, and indicates a mystical, moral, spiritual or religious view of addiction. This baseless idea has caused a great deal of harm to people suffering with addictions because it suggests they have moral imperfections that must be purged (Step 4).

Since AA is intentionally unregulated, you must appreciate that meetings run the gamut from mature, open-minded groups to rigid, punitive ones. Your good experience is not universal and should not be generalized. Indeed, this is another version of the "sampling error" that leads people to assume from the 5-10% who do well that everyone should attend 12-step groups.

I agree that for most who do well, the structure, comaraderie, and support of AA, rather than its spiritual ideas, explain why it is helpful. A smaller group benefits from the concept of spiritual betterment. None of these things address the underlying source of addiction, however. If you are interested in a more thorough discussion of all of this, I would respectfully suggest that you read any of the 3 books I've written rather than relying on the radio interview.

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

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