In Defense Of 12 Steps: What Science Really Tells Us About Addiction

The chips AA members receive to mark sobriety. (Randy Heinitz/Flickr)

The chips AA members receive to mark sobriety. (Randy Heinitz/Flickr)

Last week, Radio Boston featured an interview with Dr. Lance Dodes, author of “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.” Here, two Harvard Medical School professors of psychiatry respond, arguing that Dr. Dodes misrepresents the evidence and that 12-step programs have among the strongest scientific underpinnings of any addiction treatment.

By John F. Kelly and Gene Beresin
Guest Contributors

In a recent WBUR interview, Dr. Lance Dodes discussed his new book, which attempts to “debunk” the science related to the effectiveness of 12-step mutual-help programs, such as Alcoholics Anonymous, as well as 12-step professional treatment. He claims that these approaches are almost completely ineffective and even harmful in treating substance use disorders.

What he claims has very serious implications because hundreds of Americans are dying every day as a result of addiction. If the science really does demonstrate that the millions of people who attend AA and similar 12-step organizations each week are really deluding themselves as to any benefit they may be getting, then this surely should be stated loud and clear.

In fact, however, rather than support Dr. Dodes’ position, the science actually supports the exact opposite: AA and 12-step treatments are some of the most effective and cost-effective treatment approaches for addiction.

In his book, Dr. Dodes commits the same misguided offenses he condemns. His critique of the science behind treatment of addiction is deeply flawed, and ironically, his own psychoanalytic model of an approach to solve the “problem of addiction” has no independent scientific proof of effectiveness, particularly in comparison to other methods of treatment.

Below, we address some of the specific pronouncements he made on Radio Boston and in his book in order to convey what well-conducted science actually tells us about how to treat addiction.

What he says: 12-Step programs do not work, are not backed by science, and are probably harmful.

The evidence is overwhelming that AA, and treatments that facilitate patients’ engagement with groups like AA, are among the most effective and best studied treatments for helping change addictive behavior.

This conclusion is consistent with the views of prominent organizations such as the National Institute of Health (NIH), the Substance Abuse and Mental Health Services Administration (SAMHSA), the American Psychiatric Association (APA), and the Department of Veterans Affairs Health Care System (VAHCS), all of whom recommend patients’ participate in AA or similar groups to aid recovery.

Dr. Dodes begins his criticism of AA and related treatment by citing a 1991 study published in the prestigious New England Journal of Medicine. This paper studied the treatment of a large number of individuals with alcohol problems. Dr. Dodes notes in his book that compulsory inpatient treatment had a better outcome than AA alone. But what he fails to mention is that the inpatient unit is a 12-step-based program with AA meetings during treatment, and requirements to attend AA meetings three times a week after discharge in the year following treatment.

Importantly, too, when you compare the alcohol outcomes (average number of daily drinks, number of drinks per month, number of binges, and serious symptoms of alcohol use), AA alone was just as good as the AA-based inpatient treatment. Yet Dr. Dodes uses this study to argue that AA is poor while inpatient treatment is good — a bizarrely distorted, misleading and incorrect interpretation of the study’s findings.

Dr. Dodes then cites a review article from another prestigious entity, the Cochrane Collaboration, to condemn AA and 12-step treatment. The Cochrane group is considered by health professionals to be the “gold standard” of good scientific procedure in its series of reviews. The article reviewed 8 studies from 1991-2004, comparing AA and 12-step treatment to other approaches, such as cognitive-behavioral relapse prevention therapies.

He concludes from this important paper that AA and 12-step treatment were ineffective. However, the study actually concluded that AA and 12-step treatment were shown to be as effective as anything else to which they were compared.

Perhaps not surprisingly, given his apparent agenda, Dr. Dodes doesn’t acknowledge the more recent randomized controlled trials of addiction treatment (that is, studies in which individuals with addictions were randomly assigned to different treatment approaches, comparing outcomes. See here, here, and here. Such studies are considered the most reliable sort of research.) These studies show that 12-step treatment improves outcomes by up to 20% for as long as two years post-treatment via its ability to engage patients, and also tends to produce much higher rates of continuous abstinence than other forms of treatment.

Finally, in the largest randomized controlled study of treatment for alcohol use disorder ever undertaken (Project MATCH), which he does mention, he fails to state that compared to the cognitive-behavioral and motivational-enhancement treatments included in that study, the 12-step treatment had more than double the number of patients who were continuously abstinent at one year after treatment and about one third more at three years after treatment.

What he does not mention: cost or access to care

Dr. Dodes fails to mention cost. Unlike psychoanalysis and other treatments, AA is free, and can be accessed almost anywhere at any time in the United States and many other countries (notably at high-risk relapse times when professionals are not available like weekends, holidays, and evenings.)

In fact, studies published in prestigious peer-reviewed scientific journals have found that 12-step treatments that facilitate engagement with AA post-discharge can not only produce about one third higher continuous abstinence rates, but also 64% lower health care costs compared to cognitive-behavioral treatments.

With the current pressure to configure a leaner and more cost-effective health care system, it is these kinds of double bonus effects that we are looking for.

What he says: 12-step programs are no better than doing nothing.

In addition, Dr. Dodes then goes on to try and make the case that 12-step treatment for substance use disorder is no better than doing nothing; he’s apparently implying that if we actually just stood back and waited, people with substance use disorders would overcome addiction at the same rate as our current best efforts. Presumably, his own approach to addiction treatment would work best? Unfortunately, his own method, promoted on the air and in his book, has not a single scientific study to demonstrate its effectiveness.

What he says: 12-step programs are no more than “religious” efforts that reinforce powerlessness and helplessness

Dr. Dodes’ book and comments are so far off the track of scientific research that he doesn’t realize that for the past several years, the addiction research field has moved beyond asking whether AA and 12-step treatment works, to investigating how and why they work. We have now discovered that the reason why 12-step based interventions so often do better than others is that they engage people with groups like AA, which increase people’s ability to cope with the demands of recovery, and foster critically important social network changes within the communities in which they live every day.

For some, AA also has been shown to work by increasing spirituality, which helps people reframe and take a different viewpoint on stress, such that instead of being seen as a negative it becomes viewed as the fertilizer that fuels personal growth.

Dr. Dodes complains that AA’s focus on admitting powerlessness over one’s addiction is a step in seeking a “higher power” and he interprets this literally as seeking God. For some, this is true and helpful. For others, particularly those for whom spirituality is not appealing, it is seeking help from the AA fellowship (for some “GOD” can stand for “Group Of Drunks, or ‘Good Orderly Direction’), and acknowledging that you cannot solve the problem alone; you need what Carl Jung called “the protective wall of human community.” Strength comes from assuming personal accountability and responsibility to a group, your AA sponsor and, most importantly, to yourself. This process empowers individuals to make the changes needed for recovery.

What he says: Genetics does not play a role in addictions. They are not diseases.

In a blog on the Dodes webpage, there is an assertion that genetics has no role in addictions. This assertion once again contradicts scientific evidence. Research demonstrates that about half of the risk for addiction is conferred by genetics. But the environment is critical too. Like many diseases, the condition is caused by a personal biological vulnerability coupled with environmental exposure and experiences.

In summary, while claiming to “debunk the bad science behind 12-step programs” Dr. Dodes instead reveals a selective and superficial review of the research, at times misinterpreting the studies that he uses to support his own assertions. From a clinician who professes to care about individuals suffering from addiction, Dr. Dodes’ conclusions are not only incorrect, they may have grave consequences.

For the families who have a loved one struggling with addiction, life is beyond tragic. Nights are sleepless while many wait for the proverbial shoe to drop. Will someone be killed by your son, daughter or spouse getting behind the wheel? Will you get the often-awaited call in the middle of the night that your child was found dead in her apartment? We know these stories. We hear them on the news daily.

What can we do to prevent the scourge of addiction? And what can we do when it appears in a family member? Surely we all want a magic bullet. But we also want care that is based on sound scientific research and evidence-based treatments. There are no cures. But there is hope for recovery, sobriety, and, while AA and 12-step treatments are not cure-alls themselves, research demonstrates that they are some of the most effective and cost-effective approaches to addressing chronic diseases of addiction in our society.

John F. Kelly, PhD., is the Elizabeth R. Spallin Associate Professor of Psychiatry in Addiction Medicine at Harvard Medical School, and the President of the American Psychological Association, Society of Addiction Psychology. He is also the Director of the Recovery Research Institute at Massachusetts General Hospital.

Gene Beresin, MD, MA, is Professor of Psychiatry at Harvard Medical School and Executive Director of The Clay Center for Young Health Minds at Massachusetts General Hospital.

Dr. Lance Dodes responds in the comments section below here; please watch the comments section for further back-and-forth.  


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  • Greg Wood

    Given the progressive
    nature of addiction, the denial of an addict and the fact that the desire /
    need for the substance rarely ever fully leaves an addict are not all the
    studies cited flawed in various ways? It seems to me that a new
    longitudinal study is needed. Do things not follow along in this general
    way? non user – user – heavy users – addict in denial or unaware – addict
    aware – addict aware and attempting to stop – addict aware and seeking help
    (AA, Rehab, Outpatient, Pysch, CBT) – addict abstaining – addict continuing
    abstaining and continuing help or addict continuing abstaining and not
    continuing help – addict back to using (for most) – addict back to abstaining.
    (for many, many people it is back and forth between using and abstaining
    over and over again). Are not all these studies flawed as they start at
    seeking help and end somewhere along the path of abstaining or back to using?
    As many an addict can tell you it is a rare case regardless of treatment
    approach to go from addict aware getting help to a lifetime of never using
    again. And does it not make sense to group people into level of
    participation and then compare? It’s
    a fact in AA that “meeting makers make it.” Relapse rates
    increase dramatically as activity rate decreases. And if that is the case
    would it also not stand to follow that a program that provides free, very accessible and frequent participation options would be
    more successful than programs that cost money and are not nearly as accessible?

  • winsomeRefusenik

    Update: “MGH [Massachusetts General Hospital] to screen all patients for substance abuse”

    So you see, dear readers of John Kelly’s devious defense of AA, John Kelly has a vested interest in trashing critics of AA, because they’re like the little boy who tells the crowd, “The Emperor has no clothes!” Since Kelly is one of the tailors who’s woven such a lucrative, expansive dragnet to catch all kinds of hospital patients in his wonderful 12-Step miracle program at MGH, he gets really nasty when someone has the audacity to actually inform people about the redolent fraud in such programs. Don’t thwart John Kelly’s sweet business plans, Dr. Dodes!

    Remember that John Kelly co-authored with William L. White, who’s one of the leading 12-Step industry strategists. One of White’s clever schemes is the “Peer-based” chronic disease recovery models of treatment, which essentially means that low-cost or volunteer AA zealots can be financially exploited to staff programs such as the one Kelly and his cronies are apparently masterminding at Massachusetts General Hospital, since AA sponsors are a lot cheaper than trained medical professionals. I doubt this program will likely involve much actual medical procedures or medication, so the liability insurance will probably be kept low. Just a heavy prescription of AA meetings plus more AA meetings for life, and being told never to drink alcohol again so if the patient “relapses” they were disobeying doctor’s orders. Yet the program will likely charge hospital-level rates. Or am I just being cynical, Dr. Kelly?

    Also, by basing such programs on strict adherence to 12-Step doctrine which declares the patients to have an incurable disease, these patients are in life-long “recovery” and will forever be potential clients. By entering some unfortunate schmuck who comes in with a broken ankle from falling off a ladder, with beer on his breath, into a database as an “alcoholic,” or that’s “alcohol dependent” to sound official, they’ll be able to boost statistics and get more government funding for the skyrocketing “alcoholism” epidemic they’ll create, errr, uncover. Also, by railroading these patients into AA, they’ll pump new lifeblood into meetings with sagging attendance.

    Of course, stating these observations aloud while in MGH will probably earn someone a few extra DSM diagnoses to their chart and database records.

  • France

    “the addiction research field has moved beyond asking whether AA and 12-step treatment works”.

    Wow. How did on earth would one arrive at such a conclusion?

    I’m left somewhat perplexed at this statement. I grew up on a strict diet of hard physics, Carl Sagan and Richard Dawkins for breakfast. But I now realise they must have been misinforming me for years, because the standard technical definition of “science” within physics, chemistry and biology seems deeply estranged from the meaning Kelly and Beresin are using here.

    As a consumer of medicine myself, I would be deeply concerned if I was offered treatment where the physician tried the “don’t worry, the science is definitely in on this approach” to any treatment which had significant health outcomes for me, and where the strength of the data was as low as that available for treating alcoholism with 12 step programs. I’d definitely change physicians, there could be cause for reporting them to a professional body in my country, if this involved any treatment where there could be a real consequence to my health.

    Claiming that there is a reproducible, evidenced link – that will not be falsified in the future – between 12 step meeting attendance or participation and successful outcomes for people who have been diagnosed as substance dependent is not borne out by the facts. Maybe one day we will be able to say this, but saying this solely on the strength of current data actually does more to discredit science and the scientific method, than it does to prove that point. Because any careful reading of the data available can only result in one conclusion: that the data available suggests that 12 step meeting attendance is an extremely weak predictor for outcomes of people with addictions. The data does not rule out that in the future, could indeed find that a positive link. But there is not enough data yet. It’s a long, long way off.

    Newton’s theory of gravity could not provide a full explanation of gravity. But it was a much better predictor for what it predicts than anything we have for addiction. And it still didn’t explain the whole picture. We also know Einstein’s theories cannot be the complete story of gravity, they are incomplete, and there will be another theory – a better predictor – that one day supersedes it. Even though there has been significant orders magnitudes more research conducted and published on gravity than has been about addiction, you will still will not hear a physicist say “the science is in on gravity.” This sort of religious self-confidence is only exhibited in the psychiatry department at Harvard, apparently.

    What we need is more science. And more studies. And more criticism of orthodox thinking on addiction. The current research only asks more questions than it answers. It’s a sad day for science when we stop learning and looking at our basic ideas, because we assume we already know all we need to know on addiction.

  • Paul Cannon

    I would like to know if you are an alcoholic/addict Dr. Dodes ? I have seen many doctors who were specialists in addiction but were not addicts. They could not explain what it means to be a real alcoholic/addict. They might have many degrees on their wall but have no idea what it is like to suffer from this disease. All of them claimed that I was an alcoholic but none of them could prove it to me. I will agree that AA is not for everyone. Our literature claims that we “hold no monopoly” on business of getting people sober. I have tried every type of treat that I could find and nothing worked until I found AA. The one common aspect that I found with all my trip to medical rehabs was that they all suggested that I go to AA after I was discharged from their facility. AA was the last house on the block for me. In a few days I hope to celebrate my 8th year in sobriety and I owe that to my Higher Power which I discovered in AA.

    The twelve steps of AA are a practical prescription as a means of getting sober and staying sober. Unfortunately, over the years AA has become watered down and pulled away from the real solution that worked for me. Often newcomers will enter the rooms and listened to either war stories and/or someone complaining about their divorce, bad day at work, etc… Perhaps they might listen to someone in AA who is not a “real alcoholic” and try to follow their advice only to find themselves drunk again ? Many people today have an issue with the aspect of having a high power. The media along with the scientific community often bash God then shame those who do believe in Him. The few points that I raise are common reasons why people leave AA. That is my experience. Finding the right group, the right sponsor, and working the steps is the key to success in AA.

  • friend of bill


  • SuAnTu

    Because an acknowledged alcoholic attends AA only briefly and then finds other people and groups to bond w over the issue, does not mean that he or she is not seeking recovery elsewhere. The people sought in this case, NA members, supported the alcoholic along the way to more further recovery in a group of clean and sober motorcyclists who do charity runs. Some people must benefit from others attendance at meetings! It stil works….like a pebble in the pond.

  • seth

    In these circumstances, I am always fond of simply quoting NIDA, the forefront of addiction research, and an organization that thankfully doesn’t limit itself to AA, TSf, or other purely psychosocial modalities of recovery:

    “One of NIDA’s most important achievements has been the use of science
    to clarify central concepts in the field of drug abuse…When NIDA
    began, correct approaches to drug policy and drug treatment were often
    thought to hinge on determining whether a particular drug was
    “physically addicting” or only “psychologically addicting.” We now know
    that addiction has biological, behavioral and social components. It is
    best defined as a chronic, relapsing brain disorder characterized by
    compulsive, often uncontrollable drug craving, seeking, and use, even in
    the face of negative health and social consequences. NIDA-supported
    research has also shown that this compulsion results from specific drug
    effects in the brain. This definition opens the way for broad strategies
    and common approaches to all drug addiction.”

  • Steve L. Elliott

    I hope to have this simple question answered: Are the authors of this article paid Hazelden consultants?

  • Steve L. Elliott

    One question for the authors: Are you two paid consultants to Hazelden?

  • Elizablackwell15

    WinsomeRefusenik sees the real issues. Debate over treatment outcomes falls off the wagon in a closed system where patient autonomy, informed-consent, due process, and even civil rights are trampled by a despotic monopoly tightly run by self-proclaimed self certified “experts” in addiction who tout only one worldview. The primary directive of these prohibitionist profiteers is to impose 12-step doctrine as the Word of the Lord. Staffed by the impaired physician movement, the NAATP, ASAM, FSPHP, Like-Minded Doc industrial complex is untouchable and growing stronger. The frequent testing, contingency management, life-long brain disease and lifelong treatment model is a cash cow. Ethics, Science, Civility, Reason, Fair play, Due Process, and basic human decency play no factor. : Yes the real issue is forced 12-step imposition and indoctrination and the fact that a large percentage of those forced into 12-step do not even marginally meet diagnostic criteria for addiction or substance use disorder. Dupont and others are trying to bring the Physician Health Program model to the rest of the world as the “new paradigm” based on propaganda and deception. The PHP program is not what they claim. I encourage you to take a look at the results of the North Carolina State Physician Health Program audit which was recently completed and take a look at Dr. J. Wesley Boyd’s website and see what the future holds for addiction medicine. It is the Wild Wild West but only one gangs in control Doctors referred to State Physician Health Programs (which can be the result of a true substance abuse problem, a one-off such as a DUI, a situational issue such as depression or stress, or even malevolence (false accusations and sham peer review) are routinely forced into 3-4 months of inpatient 12-step indoctrination under threat of loss of medical licensure by physicians who are “in recovery” and granted total power over the managerial operation of the system. No regulation, no accountability, no transparency. It is killing doctors but no one is talking about it. Corruption, profiteering, fraud, coercion, and control. The ASAM = AA = FSPHP = Like Minded Docs. They control addiction medicine and they want to control you next. The science behind AA is a red herring in the larger context. It is a potential tool and if it works for you knock yourself out. Disregarding autonomy, informed consent, and the forceful imposition of a belief system on others should be anathema to the medical community but the AMA, State Medical Societies, regulatory medicine, and State agencies are looking the other way. Be it obtusity, complicity, or apathy it is inexcusable. So too is the blinkered media. More people need to take a stand.

  • Cole Shiflet

    To compare the 12-step recovery to anything else in terms of success is the same as trying to argue a pool holds more water than the ocean. It cannot be done.
    To try to argue this fact is both ignorant, and deadly.



  • realneal

    When somebody claims something to be the truth, there is a monstrous ego on the loose IMHO. Keep me safe in the company of those that seek truth and safe from the company of those who claim to have found it.

  • Jeremy Kitchen

    Lance Dodes profits off of recovery. Massive is an AA failure. Read “The Power of Habit” instead.

    • Eric Ess

      I think it’s harsh to call Massive an AA failure. She is simply trying to promote her anti-AA blog and her planned “documentary” about how AA is somehow responsible for the alleged abuse some women may have suffered at the hands of some AA participants. She’s raised about $40K, and her website has become a mecca for AA haters (and many other crazies). She’s found a way to profit from attacking a non-profit self-help program that has positively affected the lives of millions. I’d call that a success… of sorts.

      • Jeremy Kitchen

        ummmmm kay.

        • Eric Ess

          Just kidding. Trying to be sarcastic. It’s amazing how so many people are posting here claiming that AA has some sort of sinister agenda, when they clearly have their own self-serving agenda.

      • massive

        eric – a way to profit…really ….I’m using my own monies ( some 20K) along with the 25K I raised. When it’s all said and done there will be thousands who will come out and speak up. Just go on FACEBOOK and see all the anti AA blogs. There are many anti AA blogs like Stinkin- thinkin, stop13 stepinaa , and this year FACEBOOK has blown up. Change is not cheap. Making flyers is not not cheap. I give them away to current AA members who want to Make AA SAFER Workshops. I do what AA in NY should be doing. They need a hotline. They need someone to sly around to some of these clubs and put out the “fires”. Have a nice day.

    • massive

      I was not an AA failure fact they totted me around as a super AA successful geek with 36 years sober….MS GSR, MS DCM, MS AA take meetings into prision….so get the Flock off the bus with you nonsense.

  • winsomeRefusenik

    I don’t agree with absolutely everything Lance Dodes writes, but he certainly hit the nail on the head regarding the monopoly that 12-Steppers have on the rehab industry and the scientific fallacy of so much of their so-called “research.” Please, John F. Kelly, respond, if you dare, to the numerous examples I list below of fraud and corruption among 12-Steppers in the treatment industry:

    12-Step thugs and cronies like John F. Kelly and William L. White (they’ve written together) actively suppress non-12-Step alternatives. Chestnut Health Systems, for which White has worked, has refused to allow SMART Recovery meetings to substitute for A.A. if someone objects to the explicitly religious nature of A.A. Yet Chestnut was paid a $500,000 multi-year grant through NIDA to study Cognitive Behavioral Therapy! That’s like paying the Catholic Church to do a study on contraception methods! Chestnut’s Michael Dennis has also developed a GAIN database to track people’s drug usage, which I’m sure the NSA would be envious of. No wonder why Chestnut gets so much government money.

    A recent gambit of the 12-Steppers in undermining legal victories of atheists, agnostics, and Buddhists against 12-Step indoctrination (see Hazle v. Crofoot; Inouye v. Kemna; Kerr v. Farrey; Griffin v. Coughlin, Warner v. Orange County Dept. of Probation; among many others) is to throw up this so-called “Atheists and Agnostics in A.A.” movement. Considering that the overall theme of A.A. and its Big Book and 12&12 is to convert nonbelievers to surrender their lives and wills to God using their drinking problem as a pretext (see the chapter “We Agnostics” for one of many examples), that movement is comparable to “Jews for Jesus.” I’ve even been to one “S.O.S.” meeting which was not a Secular Organization for Sobriety meeting, but actually an A.A meeting using the “S.O.S.” acronym to stand for something else. I am quite sure that was just a trick for that A.A. intergroup office to claim that they offered secular alternatives. 12-Steppers are among the most deceitful people who one can ever hope to not have to deal with.

    White’s mentor Ernest Kurtz has boasted (as seen in a YouTube video with White) that he has connections in the Veterans Administration and pulled strings to promote Katherine Ketcham’s work. Keith Humphreys, protege of VA researcher Rudolf Moos, said in an interview with White that he learned a lot about 12-Step from researchers who themselves were in “recovery.” One of Moos’ VA studies comparing 12-Step to CBT actually dosed the CBT group with 12-Step. That’s like doing a drug trial with an industry darling drug that works with a high pH and pitting it against a new drug with a low pH which the industry wants to see fail, and then dosing the group receiving the new drug with some of the favored drug, thereby undermining its efficacy. So, now we can read all kinds of horror stories by persons who join the military to defend their country being forced into a fascist cult, A.A., as the only “treatment” for their alcohol problems offered by the VA. If you think guys like Kelly, Kurtz, White, or any of these other die-hard 12-Steppers (or 12-Step advocates) care about basic human rights, such as freedom from religious indoctrination, you’re severely delusional.

    Some research, such as by Audrey J. Brooks and Patricia E. Penn, (see “Comparing Treatments for Dual Diagnosis:

    Twelve-Step and Self-Management and Recovery Training”), have compared SMART Recovery and 12-Step for those with dual-diagnosis, and actually found superior outcomes of psychological functioning for the SMART group, even though the 12-Step group was slightly more abstinent. In the book “Substance Abuse: What the Science Shows and What We Should Do About It,” Stephanie O’Malley suggests that naltrexone efficacy research done by the VA was confounded by the VA’s A.A. abstinence-only orientation (naltrexone is actually more effective when the patient drinks along with taking the drug, to undermine the chemical effects of the alcohol).

    The dirty tricks and duplicity of 12-Steppers never ends. By terminating both those who “relapse” (use alcohol or other drugs) during treatment, along with those who refuse to engage in the A.A./12-Step cult, 12-Step programs like those that Kelly and William White are associated with can artificially inflate the abstinence outcomes results for 12-Step programming, since those who “complete” treatment have been screened for abstinence and 12-Step compliance. Those who might abstain but refuse A.A./12-Step involvement are not included in research results, just as those who attended A.A. but “relapsed” are also likely purged from outcomes results. White actually advocates extending the Oxford House system, where “relapsers” are thrown out of housing [treatment], thereby achieving “recovery without relapse” (see the paper he wrote with Paul Molloy, “Oxford Houses: Recovery without Relapse”). Yet White will also write papers stating that people should not be thrown out of rehab for “relapses.” Basically, White, and apparently Kelly, will resort to all kinds of rhetorical fallacies and apologetic propaganda to perpetuate the fascist fraud that is the 12-Step addiction treatment industry. They will completely contradict what they actually practice, depending on the intended audience of their writing. White often uses shibboleth such as “Peer-based recovery” or “ROSC” to repackage what is essentially institutionalized 12-Steppism.

    With a deeply imbedded network of politicians (Jim Ramstad, Patrick Kennedy, etc.) and media functionaries (William Cope Moyers’ daddy Bill), these charlatans keep plowing through controversy after controversy (such as the $90 million “Rehab Racket” CNN story in California) with the impunity of the Catholic Church in sex abuse scandals. They treat government human service budgets as slush funds for their A.A. cronies. For example, White’s mentor, A.A. apologist historian Ernest Kurtz, was paid a grant by an Illinois state agency, through a joint venture between his buddy White’s organization, Chestnut, and another 12-Step-devoted organization, the Fayette Companies, to write a paper “Alcoholics Anonymous and the Disease Concept of Alcoholism,” though Kurtz is an A.A. apologist historian with a background in Catholic theology, not medicine, and that paper had no real medically edifying content.

    In an interview with William White, Michael Boyle of the Fayette Companies spoke of how they worked with a state congressman to write law(s). They also bring in “researchers” connected with universities as business partners in ventures to help them confect research results to support their methods (Loyola and DePaul are the usual suspects). Clearly, the addiction treatment industry is a major driver of the War on [People who use] Drugs, and like any corrupt industrial complex, they have functionaries embedded throughout government and academic institutions. It sounds paranoid, but it’s absolutely true. Once again, I don’t agree with everything Lance Dodes writes, but so much of it is absolutely true. It’s no wonder that the 12-Step charlatans are freaking out in response.

    White also urges, along with Greg Skipper and Robert DuPont, for increased drug testing to catch people consuming drugs by testing their bodily fluids. Each of these authors personally profits from drug testing and/or treatment facilities to which persons’ whose pee-pee is naughty will be forced to consume their services, upon threat of incarceration or loss of job.

    It’s well known that the American Society of Addiction Medicine is chock-full of 12-Steppers. ASAM’s former president, G. Douglas Talbott was found guilty of fraud, false imprisonment, and malpractice. Hazelden’s Marvin Seppala (himself indoctrinated into 12-Steppism at Hazelden as a 17-year-old), Barb Krantz of Caron, Stuart Gitlow, DuPont, and others are in a hard-core 12-Stepper alliance called “Like Minded Docs.”

    It’s time for the U.S. to finally reform the twisted, corrupt addiction treatment industry. Don’t be distracted by the deceitful 12-Step zealot apologists and wolves in sheep’s clothing like (Tom McLellan).

    • Eric Ess

      You seem to know your stuff, so I’d like your opinion on what I said below: that the AA program as practiced in AA meetings (whether you approve of it or not) is very different from the 12 Step methodologies that are being used in treatment programs… not to mention the profit motive of professional treatment, coercion into treatment, and promotion of drugs as treatment.

      You and Dr. Dodes continue to refer to them as the same thing, saying “12 Step model” out of one side of your mouth and “AA” out the other. I don’t think anyone is disagreeing that using what is basically a spiritual practice in a professional setting is a good idea. But that has nothing to do with AA or its program, as you must know.

      Why are you attacking AA when it is not the actual problem? You use terms like “AA charlatans.” Why not “professional addiction treatment charlatans?” It seems that Dr. Dodes’ book has simply given you another excuse to express your dislike of AA, couched in what is essentially a dishonest discussion of what’s best for suffering addicts.

      It seems that if you left the AA program out of it, except for a brief acknowledgement that “some aspects of this successful spiritual practice have been misapplied by treatment professionals,” you’d have very little to say… and very few readers.

    • massive

      Great post …and thanks for some of the info as well .

  • Dw404

    With an addiction treatment industry worth billions of dollars, you can be sure people have been searching for a cure for decades. If anything could displace AA as being more effective there would be a huge financial gain. It’s kind of funny that this free service that does not promote itself or charge anything for it’s membership comes under attack for being helpful to millions. If you want to attack someone attack the medical community for not displacing AA with an alternative. Believe me, as someone who works in the addiction treatment field, if there were more effective and broadly applicable solutions to addiction they would be being exploited instantly and AA would be left in the dust.

  • Joe C

    Oh, Dr. Dodes, of all people you should not be masquerading as the truth police… You write a book that argues that AA demands obedience to gods when the fastest growing segment of AA is Agnostics and Freethinkers, you write with the hyperbolic tone of a late night infomercial pitch man and you make erroneous claims without your own peer reviewed research. You can’t honestly believe that everyone that walks into an AA meeting and leaves is an AA failure? Maybe they got what they needed and moved on; Maybe they went to NA; maybe they were not alcoholics. Your frustration might not be anyone’s fault. Unless your going to trat alkies for $2 an hour including coffee, why don’t you stop writing books untik you have a viable alternative?

  • KEL1229

    It is all so frustrating. I have found 12 step treatment to be mostly like a referral and cheerleader for AA. The AA meetings have actually been more tolerable than the treatment in many ways. I really dislike the brainwashing sessions at the beginning of the meetings and the religious daily reading focus but I have found many of the people’s stories to be very helpful. The anti-intellectual aspect turns me off and will probably lead me to stop going eventually. This anti-intellectual aspect is extremely strong in outpatient treatment. I have been called challenging so many times. Basically in treatment we are told to believe what we are told, that feelings are the source of our addiction so we need to go to AA meetings and get a sponsor and you will have a chance at sobriety. Question nothing. I go for 10 hours a week and have been going for 6 weeks and don’t recall one hour addressing any scientific aspect of addiction. Lots of talk about feelings early on in recovery when my brain is really susceptible to these stressors brought on by this leading to relapse. It doesn’t make any sense.

  • Myriam Smart-Boltwood

    there is better science on how A.A. works, I have 1 years with out booze, pills, or cock or crystal; I was giving a Medical card for the choice of 7 prescription or 3; I only take my oil at night before bed for pain relief (I was riding an 80 lbs. electric bike in 2007, I was opposing traffic, in the bike lane behind a white line (which CA dmv states is a wall) 2 months before the cell phone laws changed (which the women was on) she was looking at the traffic to make a left turn. The driver that turned in front of her, did not hit me and obeyed the law and drove safely looking for pedestrians and bikes.
    The woman turned into me and almost pulled me under her car, but looked in my eyes and braked and then i went into the hood, and dislocated my leg, tore my rotor cuff, and busted my teeth. She got out of the car and said is there anything i can do?
    I was like call 911, she had a friend call and say i was popping wheels and skipping back and forth from the bike land to the side walk; I was 45, I weighed 240 the bike weighed 80 lbs, you think i could do a wheel pop, I just got my license to drive a week before, and they wanted my SR-22 which is to report damages over 2500.00 of damage, my bike cost 350. so: 1) I was not operating a motor vehicle at the time of the accident. 2) California states that if you cross a white line it is considered a wall, since i was behind the white line; would she technology hit the wall and not me? I did not sue her for what she did for me, and she looked like she was scared that she was going to kill me. She sued me to fix her car, my home owners covered it because i was less than a mile from the house. how messed up are people? Sadly very.

    • massive

      Myriam- What a story. SO sorry to hear what happened to you. I too was hit head on my a car when I was 17 in Denver. He hit me so hard I thought he was trying to kill me. He said he didn’t see me . It was dusk. I was told I broke the Law ( 1974) because I didn t have a Bicycle license for my beach cruiser.
      I didn t ride a bike again in a street in a big city for 20 years. I rode a bike all over NYC as a kid and none of us ever got hit. I love those NY drivers. Pre 1980′s ….cell phones ….are more dangerous then … Again glad you are okay now.

  • massive

    I think its important to mention that Dr John Kelly here has been working as a consultant with Hazleton ( The AA mothership rehab) and Betty Ford ( which has been losing money for the past 4 years) and still uses a 1935 religious unvetted laypersons pods modality, for a long time.

    He is not very objective.

  • Mike Stedman

    I really do not care about “facts”. People change their lives to be successful at work and home. People change their lives to become accepted members of various communities, like school and church. Why do so many people resent and criticize a group of people that want to improve their lives one day at a time?

    I have been through detoxes and treatment centers without lasting results. I have tried churches and prayer without result. So, I go to a room with people that have been where I am and see there is a possibility that I can have a life free of drugs and booze.

    WE all go someplace where we have to work toward personal improvement. We all have little secrets that frustrate us and those that we love.

    I was in a room that had about 30 people in it. Of that group, over 1/2 had more than a year without drugs or booze. Some had over 10 years. It was not a religious service. It was a N.A. meeting, and the purpose was to help one another. Not too complicated and definitely not scientific.

    So, analyse that!

    With all the damage addicts and drunks cause, I am shocked and saddened that anyone would offer anything but whole hearted support.

    I never discuss God with anyone. Instead, I look for that time and space between what I think and what I do.

    Today I did not drink or drug. I thank those that have come before me and led me in the right direction. That is ALL a 12 step meeting is…

    • massive

      You know what.. The Catholic Church has helped millions …way more then AA or NA….and yet still they had to address phedophilia and sexual predation in the church. They got sued over and over and over again.

      I don’t care how much you or anyone else likes AA, sexual predatory behavior, Court ordering of violent and sexual offenders are being sent..needs to be exposed and the fact that if you really studied the books and literature with an open sane mind you would see the many flaws We were not born that way. We are not broken. On and on the BS that is spewed in Chapter 5 is laughable.

      • Mike Stedman

        Read the book of Romans. A mass murder (Paul) discussing how sin rears it’s ugly head, causing him to do things that make him feel unsaved. “I know not what I do for it is sin living in me”

        Claiming the perfection of man is denial, pure and simple.

        Regrettably the catholic church has become a church of many secrets, a church that treasures money and power, and many sicknesses come from that.

        There are many good people in the Catholic church. Why do they tell their friends to go to a A.A. meeting. Why does the Catholic church allow those meeting to occur in their basements, often at a financial loss?

        The Catholic church tried to hide and deny the predatory nature of some of it’s fathers. If they were more forthcoming when it occurred, your good Catholic people would have seen things much different.

        I like your new Pope. He tells his sheep to mind their own business. Are you a member of A.A., or are you ignoring what your pope asks you to do?

        Failing to follow your Pope is a serious flaw.

  • Mitch Warner

    Hard to know which is most objectionable here: Beresin’s obvious failure to read a book he’s critiquing, his serious misunderstanding of the studies he refers to, or his weirdly unprofessional, ad hominem tone. And WBUR gave him a forum? I’d be curious to know how they can justify that. For shame, Dr. Beresin.

  • suantang

    So much to say about this article and the comments, but a few points:

    1. The authors, like many, fail to discriminate between AA meetings and AA’s religious 12-step program, which AA members are often manipulated into following. Peer support can be very useful in any circumstances, but can the authors perhaps prove, with evidence, step by step, how turning one’s life and will over to God, listing all one’s sins, prayer, confession, repentance, restitution, and seeking conscious contact with God – ‘asking only of His will for us and the power to carry that out’ – leads to people stopping drinking? If they can do that, I would be grateful, and it would be a first.

    2. The assumption that those who do not buy into AA’s program are not committed enough to getting themselves sober and leave because ‘they want to drink again’ is arrogant, self-serving, and very damaging. Anyone with any kind of group or program could claim the same. The equation of ‘being in AA = remaining sober; not being in AA = an inevitable return to drinking’ might be of comfort to AA members, but is hardly helpful for anyone else seeking help with an addiction problem and the majority for whom AA is not a solution. Such people would be well advised to steer clear of 12-step groups to start with, if they are to be told there that they will inevitably fail if they ever leave.

    3. ‘Honesty’: The only thing alcoholics need to be honest about (with themselves, not necessarily anyone else) is that they would personally be far better off not drinking than drinking. If they had not realized this, they would never have gone to a support group or sought help in the first place. You can be the most dishonest, lying swindler in the universe and stay sober. Conversely, you can be a saint and struggle with addiction problems. And who is to judge or know whether another person is being ‘honest’ or not? Other AA members?

    4. Anyone who understands the English language and has read the “big book” can see quite plainly that it proposes a religious solution to addiction, even if some do prefer to call it ‘spiritual’. There is a lot of denial and sophistry about this. The contortions some 12 step people go into to say that God as represented in AA literature – a particular kind of god who has an personally-involved independent will for you, will listen to your prayers and confessions, will actively intervene to remove your faults and defects, etc. – does not mean God, get quite laughable sometimes. But there is no evidence to suggest that this approach is any more successful for those of an existing faith than to atheists. It is hugely irrelevant.
    If finding God is really the solution, as the “big book” says repeatedly, no believer
    would ever have an addiction problem, which is clearly not the case.

    5. Rehabs: 95% of rehabs impose AA’s 12 step program and attendance at 12-step meetings on their patients instead of providing treatment. Many of them require patients to study the “big book” as if it provided any advice as to how to quit drinking. Rehabs are generally staffed by AA/NA members who are completely unqualified in medicine, psychology, or addictions treatment. To pretend that the $20 bn pa recovery industry has ‘nothing to do with AA’ is disingenuous.

    As Dodes says, the stranglehold that 12-step practitioners and thinking currently
    have over ‘treatment’ means that other, non-faith-based, solutions rarely get a
    look-in, and there is no motivation for those in the very lucrative rehab business
    to explore more effective approaches. This is a scandalous state of affairs,
    and one that anyone who is genuinely concerned with the welfare of alcoholics and other addicts – AA member or not – should be actively challenging.

  • Guest

    Lance says “But the reason we wrote the book is that AA is pushed upon virtually
    100% of people suffering with addictions, and this is very harmful. It
    results in people feeling much worse about themselves when they
    cannot benefit, as many have testified.”
    Let’s take psychotherapy as a treatment. Say a person sees a therapist who understands the psychodynamic factors of addiction much like Lance writes about in his book. Say the patient spends a small fortune on this treatment and after one year, they are not able to remain sober and the therapist terminates the patient for not being able to afford their fees. This leaves the patient with a trauma of abandonment, their addiction is not addressed in a meaningful way, they have spent a small fortune on the psychotherapy and are left much like Lance states, to use his words
    “results in people feeling much worse about themselves when they cannot benefit.”
    While Lance’s public health crusade is a noble cause, I wonder why he is writing books for consumers rather than lobbying medical boards and congress and the legal system. Probably because like everyone else, he is looking to pay the bills. His solution has as much potential to harm as AA, although fewer people perhaps. For him to not acknowledge this in his books is willful ignorance disguised as public health concerns. Let’s give people all the facts Lance, not just the ones that will serve your cause.

  • Experienc3d

    The main problem w dodes work is that psychotherapy offers no better results than the method he demeans, belittles and insults. That is a serious problem. And he offers no evidence of his method because there is no evidence that it works better than AA.
    And I am no fan of AA but I am also not a fan of someone selling books
    And espousing solutions when their solution is not effective, is very costly and when it fails as it often does, results in great damage to the patient, much like the method dodes tries to take on.

  • Hal Tyler

    I have 6 years and 10 months clean and sober, and I currently work in addiction treatment. I have a Master’s degree in counseling psychology. I got sober through 12-step approaches after being unable to maintain sobriety through psychotherapy, diet, exercise, self-help books, acupuncture, life coaching, and a dozen more different treatment approaches. Here are a few thoughts:

    The kernel of truth underneath the criticism of twelve-step treatment approaches by Dr. Dodes is that compulsory practice of the 12 steps and attendance at 12 step meetings for clients with substance use disorder may not be effective. The 12 steps were designed by and for people with an extreme form of alcoholism and addiction characterized by both the inability to control use and the inability to stay stopped despite strongly compelling reasons. However, the average treatment population is a much broader population- addiction is a spectrum disease- many of whom may be that “certain type of hard drinker” (or user) described in AA’s big book that may have a bad habit that impairs him, and risks his life, but who can stop or moderate “although he may find it difficult and troublesome and may even need medical attention.” For this person, and for those who simply need it pointed out that they ought to stop, The 12 steps are often ineffective (an admission of powerlessness is impossible and illogical for those who are able to stop by themselves), and as Dr. Dodes claims, may indeed be harmful (with the unfortunate culture of shaming that can come with relapse in many 12-step communities [though certainly not part of the AA program]).

    This has been a issue brought up by many within the 12-step fellowships: those ordered into 12-step meetings or to do the 12 steps may or may not be “real alcoholics” or addicts (as defined by the Big Book) and may instead be folks for whom some form of education and psychotherapy may work much better. The central criticism of the ineffectiveness and potential harm of shipping the broad spectrum of addicts in treatment into 12-step meetings may be accurate.

    That said, Dr. Dodes seems to throw out the baby with the bathwater. To me, this information indicates that the treatment field needs more discernment about those who show up for treatment of their substance use disorder. I believe the DSM V, while flawed, offers some positive movement as a dimensional approach is clearly superior. Perhaps clients with diagnosed mild or moderate substance use disorder ought not go to 12-step meetings, which should be reserved for those with severe substance use disorder (more closely aligned with AA’s own definition of ‘real’ alcoholics/addicts.) Perhaps. However, the overall impact of this book, however unintended, is clear within these comments- there is a certain segment of the general population that is strongly against 12-step fellowships for whatever reason (anti-religious with a lack of genuine understanding of the nuances of spirituality in 12-step fellowships, those who deny that addiction is a disease, often based off the fallacy of conflating their own experience of quitting a problematic drug habit with the much more insidious mental twists of true addiction…etc). This book feeds a general attack on the 12-step process and anti-12-step sentiment, which will not accomplish its intended purpose of a specific discussion on compulsory attendance at 12-step meetings as a treatment tool. It will instead feed into a general bias and prejudice that will prevent those who would benefit from 12-step fellowships from seeking it out, and without being hyperbolic, may lead to some preventable deaths.

    This may be a needed criticism of the field of addiction and alcoholism treatment, but the medium of a book for mass consumption is a poor choice.

    I would welcome responses, particularly from Dr. Dodes.

    • massive

      AA only works for 5%. Thats great it helped you, but AA failed 95% of people who go. If Aids research was still only helping 5% they wold move on to something else. People have a right to know that there are 7 other free options. They have a right to know that AA is dangerous and that court ordering is against their 1 st amendment rights. They have a right to know that Sex offenders and violent offenders are being sent there. like…A WARNING LABEL. That would be a good idea. Safety Polices and Procedures.

      • placer

        This 5% success rate line is just that: An urban myth. There is no peer-reviewed science backing up that number. As I posted elsewhere in the thread, even the more critical scientific studies show AA having a 20% success rate. PMC2220012 shows a 67% success rate for AA.

    • massive

      That said, Dr. Dodes seems to throw out the baby with the bathwater.

      Ummm no….maybe getting some fresh water after 75 years would be a good Idea….Water might be pretty stinky after all this time….we also have new plumbing and new types of light bulbs nice 1935….How bout a new approach to Addiction. AA has stopped a lot of real research it has been so entrenched. AA and its rediculous made up religion need to get its ass out of my science! NOW ! Young people are dying. Young people are being told they are POWERLESS at 18 years old. This crap needs to go away.

  • S.B. Jordan

    AA has worked 22 years for me. I know it does not work for everyone.AA knows it does not work for everyone. So what is the point ??

    • massive

      Why do all your guys have to preface every thing with your “time”

      we and the world don’t care how much “time” you have. Yawn….Im not impressed….People with 20 years are driving their trucks into trees cause 12 step tells them “they can’t get angry. ”

      Join us in the new century. GO do some real rage work or EMDR, or CBT or MI….or treat the person like an adult and not talk down to them.

      • S.B. Jordan

        I only speak of my time to let others know it has worked for me . It may or may not work for them.The A.A. Big Book says if you need outside help you should seek it and continue to do what will help you..I talked with a social worker once a week for three years he helped me in a huge way. I’m very happy with my life and recovery of 22 years that A.A. help me attain..

  • Omar Manejwala, M.D.

    I strongly agree with Kelly and Beresin…the Dodes book greatly distorts the scientific underpinnings of 12-step approaches. These methods are not perfect, but Dodes and others who argue that 12-step programs are not scientifically based are simply ignoring the data that Kelly and Beresin (and Vaillant and so many others) have offered up. I think a reasoned debate on what works best for whom makes sense, but denying the role of genetics in addiction? That’s just silly. Someone should turn off Dodes’ microphone..playtime is over.

    • Guest

      Are you a stepper Doctor?

    • Richard Rigorolic

      Dr Manejwala,

      With all due respect to your intelligence, skill and honesty of purpose, it is apparent you are yourself contributing a distortion of fact by generalizing
      “12-step approaches” and applying a blanket label reading “scientific underpinnings”. I am entirely curious if you would maintain the same position if the scope of the assertion was focused upon the foundational literature itself: the AA basic text.

      It is certainly true that James, Jung and of course Silkworth, each hold a significant place in the history of AA and its derivatives. All three were
      competent men of science (James and Jung certainly being considerably
      more than just that). That being said, it is also simply the case the prose of the basic text are NOT a byproduct of the author rigorously applying the scientific method. Specifically, first 164 pages present a narrative (non scientific) case for & description of the program.

      Closer inspection of James, Jung and Silkworths contributions is also illuminating. In regard to James, I refer to AA scholar Dr Ernest Kurtz’s 1990 presentation at the American Psychological Associations 98th

      “Let me be clear on the point here: there is no evidence that Wilson’s understanding of the possible connections between mind-altering drugs and religious experience was drawn from James. Indeed, the bulk of evidence points in the direction of Bill being one of the few early members who did not read Varieties very thoroughly.”

      Inspecting letters of mutual correspondence between Jung and Wilson further undermines the position that the basic text has a grounding in science. The following is a portion of the initial letter from Wilson:

      “In the wake of my spiritual experience there came a vision of a society
      of alcoholics, each identifying with and transmitting his experience to the next – chain style. If each sufferer were to carry the news of the scientific hopelessness of alcoholism to each new prospect, he might be able to lay every newcomer wide open to a transforming spiritual experience. This concept proved to be the foundation of such success as Alcoholics Anonymous has since achieved. This has made conversion experiences – nearly every variety reported by James – available on an almost wholesale basis.“

      The key phrases above – “news of the scientific hopelessness” & “proved to be the foundation of such success”. Also, note the seemed discrepancy between Wilson’s claimed familiarity with James and Kurtz assessment in that regard (“the bulk of evidence points in the direction of Bill being one of the few early members who did not read Varieties very thoroughly.”).

      Jung’s response further corroborates that the basis for recovery presented in the basic text is not founded upon scientific precepts or procedures:

      “How could one formulate such an insight….You might be led to that goal
      by an act of grace or through a personal and honest contact with friends, or through a higher education of the mind beyond the confines of mere rationalism…I am strongly convinced that the evil principle prevailing in this world leads the unrecognized spiritual need into perdition……The helpful formula therefore is: spiritus contra spiritum.”

      Indeed, the phase “beyond the confines of mere rationalism” reflects the thematic framework for the entire narrative. This is conceptual underpinning of the 12 steps.

      Finally, Dr Silkworth in his own words from the basic text itself:

      “We doctors have realized for a long time that some form of moral
      psychology was of urgent importance to alcoholics, but its application presented difficulties beyond our conception. What with our ultra-modern standards, our scientific approach to everything, we are perhaps not well equipped to apply the powers of good that lie outside our synthetic knowledge.”

      Assume for the sake of argument that ‘the’ genetic components of ‘addiction’ could be accounted for with 100% accuracy and precision. In no way whatsoever would that change the that fact the underpinnings of the original 12-Step program were by design, fundamentally NOT rooted in science. You are effectively equivocating the formulation of the 12 steps with ‘scientific’ knowledge gathered a posteriori. I think a very strong case could be built along the line that this sort obfuscation of fact has potential for harm as well.

  • NICK

    I don’t know a lot about what works for most people. I think of the man in the Bible who when asked how he recovered said, “I don’t know. All I know is I was blind and now I can see!” Who, how, and when are merely inferences from experience. My life, the lives of my family, friends and coworkers were contorted by drinking and all that goes with it. Those lives are now better than I ever imagined, 14 years after I started participating in AA. I too was blind, and now I see. I cannot express my gratitude for AA.

  • A. Eden Evins

    AA is one tool in the toolbox for helping people with substance use disorders, and is as effective as other available behavioral treatments. None are as effective as we would like. In an effort to develop more effective treatments, researchers have moved beyond the question of whether AA is effective, to the important question of how it works. The more we understand about how AA works, the better we will be able to personally tailor treatments to individuals and improve outcomes. AA is effective. That some do not believe the science does not make it less true.

  • Michael Sarno

    A.A. has no monopoly on recovery. It’s just insane that after about the fifth time I came back and for the first time actually made a beginning on the the 12 steps, my desire to drink and drug was lifted. Alcohol is but a symptom of the dis-ease of Alcoholism. I feel very fortunate to have escaped the life I was living. People can show up to meetings, not talk to anyone, not work the steps, and no one is going to make them do these things. No one ever made me! WE share experience, strength, and hope with each other. There is a line that states “if you want what we have to offer and are willing to go to any lengths to get it, then you are ready to take certain steps…” I don’t think many alcoholics who work and practice the 12 steps in their everyday affairs go back to drinking or drugging. True statistics on recovery rate would have to include people working the 12 steps, why go to a 12 step program and not work the 12 steps.

  • broach

    Thank you for your thoughtful and fact-based response to the radio interview, and the book. I look forward to participating in this discussion, and in particular, I am eager to point out the 12 steps are in fact both Cognitive-Behavioral and psychoanalytic in design. As someone else posted, there is no reason for the fight that Dr. Dodes seems to be starting with his provocative, aggressive book title and content. Other than, of course, to sell his book. If indeed Dr. Dodes really cares about more alcoholics recovering, and is so confident that his approach is more effective than “5%” then I challenge him to post a link to a PDF of his book here and on his website for free.

  • Whatever

    I find it incredibly tacky and disappointing that the medical “professionals” who authored this article would prioritize the cost-effectiveness of a “treatment” over the benefit and concern of risk to their patients. Millions and millions of dollars are pumped into 12-step treatment centers yearly by vulnerable health care consumers engaging in life-threatening behavior. A 30 day stay at many treatment centers easily costs the same amount as a year or two of psychodynamic therapy. Furthermore, with new health insurance laws, expecting taxpayers to foot the bills for these snake oil promoting institutions is simply fraudulent- I would sleep much better at night knowing that insurance premiums are helping to pay for private therapy for those struggling individuals.

    As representatives of the number one medical school in the country, shame on you for attacking your colleague’s courageous book. He is doing the responsible thing and it is high time someone in the scientific community did.

  • Kelly Geistler

    An interesting read, from both perspectives. Heavy hitters on both sides of the debate. My question would be, why does there have to be one right way? Nobody has to win. I don’t disagree that the scientific conversation should remain open so growth can occur, but none of the doctors writing on either side of this issue can unequivocally state that their position is correct with PROOF (e.g. alcoholism is/isn’t a disease because there is/isn’t a visible tumor). AA works for some people; It has worked for me. I went to inpatient treatment first at Hazelden, which is a TSF program, and it worked. I’ve been sober since, 7 years, I still going to 4 or 5 meetings a month. I am not, however, one of those people who is so self-obsessed that I need my solution to be the correct solution for everyone. I could launch into the psychology of why I think it worked, but why bother? I believe that specific psychological analysis would only apply to me and my specific environmental/genetic/personality circumstances. I am highly-educated (I obtained both my BA and JD in sobriety in my late 30′s) and I don’t need a science PhD to say that this article, Dr. Dodes’ book (potentially, as I haven’t read it) and even some of these studies likely over-simplify something much to complicated to measure. Why aren’t we focusing on matching people with treatments with that work for them instead of trying to “debunk” things? The negativity is wasted time, wasted science, and wasted effort in my opinion. AA obviously works for some people. Great. For the rest, lets look for other solutions instead of trying to trash something that actually does a pretty good job of teaching those who embrace it a pretty wonderful way of embracing life.

    • Lance Dodes

      Thank you for your comment.
      I agree that there would be no point in debunking an approach if it
      simply helped people. But the reason we wrote the book is that AA is pushed upon virtually 100% of people suffering with addictions, and this is very harmful. It results in people feeling much worse about themselves when they
      cannot benefit, as many have testified.
      The second problem is that, by believing that AA is the right approach
      for everyone, we have failed to adequately use or study other approaches that may be more helpful for the majority of sufferers. Although
      some people claim that our book “bashes” AA, it is actually an effort
      to create a more sensible way to deal with this major public health problem.

      • Hal Tyler

        There is an inherent disconnect between your implicit claim that your book does not “bash” AA, and the idea of a general debunking of the AA approach. The 12-step process is clearly effective for some people, and I would argue, for those whom conventional means are ineffective. For example, I work with chronically relapsing substance use disorder (SUD) clients, who have had an average of 4 treatments. Most have tried several non-12 step approaches. These are people who require a more radical lifestyle change, and indeed outcomes are generally good- around 50% stay sober. The portion of your argument that states that referring all SUD clients to AA is an ineffective and perhaps harmful approach is compelling. The logic fails when you extend from “AA is not the right approach for everyone and is harmful to some” to “AA is harmful” in general.

        • Lance Dodes

          I agree with you; I have never said that AA is harmful in general.

          • Hal Tyler

            Perhaps I wasn’t clear- I articulated my thoughts in a more detailed way further down the comments. Contained in your argument is a valid point, also mentioned by Kelly above, that the practice of compelling people (semi- or involuntarily) to attend AA/12-step meetings as part of treatment is worth examining as it may be problematic.

            However, based on this premise, you go further to critique the efficacy of 12-step programs and AA in general as nonscientific. I would argue that 12-step approaches are extremely effective for the right population, and either neutral or perhaps slightly harmful for others.

            It is this broader critique that I take issue with. You will find no disagreement from me that 12-step approaches are not for all, and I’m open to the idea that pushing people in treatment into 12-step approaches may be counterproductive, but your book goes a good bit further than that, and conflicts both with my personal experience, with the experience of my peers, and with my reading of the research on comparative treatments for addiction.

            Let’s posit that the first premise- that compelling people (particularly those who have not tried and failed to get sober on their own) into 12-step fellowships is ineffective and perhaps harmful- is true. This does not conflict particularly with AA literature. If that is the case, then a sizeable majority of 12-step participants at any given time belong to a population for whom 12-step attendance is ineffective and possibly harmful. Would it be fair to say that this 12-step-resistant majority may mask a relatively high effect size for 12-step approaches for the minority of severe addicts/alcoholics who enter 12-step programs (AA/NA, not treatment) voluntarily?

          • Lance Dodes

            I’ve tried to address your question in responses to posts on this thread by Eric Ess and Kelly Geistler (q.v.). I think our book is clear that AA works well for the small percent who engage in it; that’s what the studies show. We don’t disagree about that. However, it is deeply harmful to many who are referred to AA or who attend voluntarily but cannot benefit from it, because they are led to feel that they have failed. The latter arises as a consequence of living in a culture that believes AA is the best treatment for addiction, from some within AA, and from friends, relatives and even professionals who believe that AA is the answer. I would certainly agree that this is not what AA officially intends, but it is true nonetheless in a vast number of AA meetings across the country, as we know from their frequent testimony. The solution isn’t to ban or bash AA, but to inform people about its severe limitations so that only those who can benefit will attend, and the rest will try something else.

          • Hal Tyler

            Fair enough, and I appreciate the reply. I suppose I disagree less with you and more with the way your book is being interpreted and summarized in these articles. I’m not sure how much responsibility you have for that, but clearly the biggest impact of your book on the public as a whole is not presenting the nuanced argument you put forth in this discussion but rather a broad-strokes “AA doesn’t work” message.

            Did you give thought to the idea of presenting this information in the form of a literature review or other academic journal article as opposed to a book for mass consumption? I’m more frustrated by the coverage of your book than what you’ve articulated of your ideas, but mass media is notorious for abbreviating nuanced ideas into a “X is good/bad for you” dichotomy. Perhaps this could have been avoided, particularly as I feel that the overall simplistic “AA doesn’t work and is bad for you” interpretation may impact some of those- like myself- who would otherwise engage in it.

          • Lance Dodes

            I think anyone who tries to publish to a general audience finds their views are misinterpreted by some. I wish there were a way around it, but I doubt that there is.

          • jrose

            How does one determine who will benefit?

          • Lance Dodes

            Thanks for your question. There is no perfect way to predict, but an evaluation from a neutral professional who is aware of the 5-10% success rate of AA is a good idea. Generally speaking, if people don’t feel comfortable going to a 12-step program/meeting, they shouldn’t. And if they’ve gone but find it unhelpful, they should leave. There are many non-12-step alternatives such as LIfeRing and other harm-reduction groups, as well as the approach I’ve described in my earlier books, The Heart of Addiction and Breaking Addiction. Nothing will be right for everybody, but the main point is that the 12-step approach does not deserve to be the first trial, nor the last, and folks suffering with addictions should never assume that when a 12-step fails it is they who have failed.

          • cuvtixo

            There is difficulty in finding alternatives, and the court system relies almost exclusively on 12-step programs. I think you are right, but inadequate funding to find and support alternative programs, and instead the virtual monopoly that is held, stands out to me as the biggest threat of 12-steps

          • squirlee

            Mr. Dodes
            AA does not EVER claim in anyway shape or form to be the “best treatment for addiction” for many reasons first of all that would be a violation of the traditions in the sense that AA is ONLY concerned with alcoholics not ANY other addiction.

            and what “frequent testimony” would you be referring to? how many meetings “across the country” (or world for that matter) have you personally been to and heard this said? after 20 yrs experience with AA I have always heard and said “aa is the only way for me but if you can find another that works for you go for it” and anytime I have ever seen anything about this matter in print it has been a similar sentence to that one. What you are forgetting to mention is the fact that AA allows each member their own opinion there is no “company line” and many members are very passionate about AA for the same reason a person suffering from diabetes is passionate about their insulin without it they die. However just like one brand of insulin does not work for all diabetics one brand of 12 steps does not work for all addicts.

            I will agree with you in the idea that AA is limited in who it can help that being only alcoholics. However the issue is just like prior to 1935 when no one knew what to do with the drunks many other addictions are within our society today and there is not always readily available help for those folks, so out of desperation they are sent to the ever prevalent AA rooms. and ideally are redirected by those in AA to a program better suited for them.

            It should be noted that there are many “AA spinoffs” using the same methods and steps AA uses and I do not see any mention of any of those other programs. Would you like to inform people of their “severe limitations”?

            I have read alot of your comments on this thread as well as articles you have published in relation to your book. My question to you is a very simple question…have you ever worked the 12 steps in any form? Because until you have had this experience you have no idea whether they will work or not.

          • massive

            Many of us ex steppers think AA is harmful to many in so many ways. Shall I list them?

            1. Sexual harassment …huge problem
            2. Assults ..very high as documented by an AA trustee
            3. Using an outdated system, the 12 steps with no proof this helps.
            4. AA members playing doctor and giving medical advice. Many suicides occur in AA
            5. Courts ordering violate offenders…women are getting murdered. ( See karla brad case.)
            6. Reading of chapter 5 at every meeting. Its just lies and telling everyone they are Broken every day is bad for everyone’s self esteem. )
            7. Lots of financial scamming at rich meetings.
            8. Court ordering too many DUI’s who don’t want to be there. Ruins the energy of the meetings how they use to be pre 1989 when drug court began
            9.Way too religious. ( over 500 times god is mentions or similar) also way to many wacko (Musts in the book that make no sense)
            10. Lots of repetition of things they are just rhetoric.

          • fllwyrrlgin

            1.You are confusing the twelve step program with the social (people) part. Sexual harassment does happen. I can’t say how often but it’s hardly a regular thing. This also has nothing to do with the steps at all. Sexual harassment is an unfortunate part of the human condition. Since AA is made up of humans it is not immune to this.

            2. Assaults? I would like to see this documentation. I have been going to meetings for many years and have only seen one fight. And the guy was drunk. I am sure it happens, but again, it’s pretty limited, far and wide in between.

            3. No proof it helps. Right tell that to me and everyone in the rooms that I see it helps. No it does not help everyone. Also when you say it doesn’t help how many of those people actually work the program as opposed to just going to meetings.But it is true even “working the program” is not effective for everyone. But to say it does not work is blatantly false.

            4.Some do, most don’t. AA should never give medical advise and it is true that some people do. It is wrong absolutely. But even in the Big book it states that we are not doctors. Those dispensing medical advise are stepping out of the bounds of AA and it’s singleness of purpose.

            5.Court ordering has nothing to do with AA. AA has not sought out judges or lawyers and told them to send people to meetings. That would be against the traditions. That is the courts decision and has nothing to do with AA. They cannot be blamed for what people outside the program do, including sending people to AA.
            6.The chapter 5 thing? I really don’t know what you are talking about. It in no way makes me or others feel broken or lowers my self esteem. I don’t like the mention of God but I can navigate myself around it and have helped other people to do so as well.
            7. I can’t speak to the financial scheming as I have never been to a rich meeting. Can you please provide and example so I can know what you mean?
            8. Again the court ordering of people to go (which I have mixed feeling about to be sure) has nothing to do with AA. The courts are ordering them to go, not AA.
            9. We totally agree on the religious aspect. I do not believe in a loving sobriety granting sky daddy. This is the one aspect of the program that I really dislike. But I, an atheist, still believe in the program. My sponsor is an atheist and he has been sober for 28 years. You can in fact be an atheist and still work a program. But I do wish they would edit all the god stuff out of the literature.

            10. Nothing wrong with repetition. I like how sometimes I get a different view on things I have heard before. Also some things need to be repeated so as not to be forgotten.
            11. I appreciate that you don’t like meetings, and I agree that they are not for everyone, but it does work for many, many, many people. Myself included. I am always interested in hearing of something that has proven to be more effective so I can supplement or supplant altogether my program. If there is something better out there I want it. Why settle for second best?

        • cuvtixo

          What qualifies in your mind as “alternative approaches?” If you are talking about trying to quit on one’s own, I agree AA and NA are much better, but for the vast majority of people they are the ONLY organized, institutional source of help, mainly because they are self-funded. 12-step is also the only method I know of that has large enough participant numbers to be scientifically studied- enough science simply does not exist for other approaches, also because of difficulties funding such efforts when 12-step monopolizes treatment.
          When you make up numbers like “good-around 50%” that doesn’t help your case. I think you don’t see your own biases on the subject.

      • Kelly Geistler

        Thanks for your rational and non-attacking response, I know this topic can really get people twisted up, as represented in other parts of this thread. Someone asked me if I “wanted people to die,” which is a pretty ridiculous question and obviously made for dramatic purposes. In reply to your response, I just want to say a few more things and than we can just agree to disagree on some points and potentially agree on others. First, I do agree with you, as a legal professional, that court ordering people to attend 12-step meetings is problematic. I understand some of the rational behind it, i.e., its potential of getting through to chronic users and offenders and its “cost-effectiveness”, especially in states that don’t have such streamlined programs like Minnesota, where Rule 25 programs can furlough offenders right into treatment within days.) Despite these benefits, requiring offenders to attend AA meetings undermines the ‘attraction not promotion’ fundamental principle of AA which is required for it to take root for most people, and therefore leaves the offender in a place of resistance and likely in a setup for failure right from the beginning. This being said, I cannot get on board with your supposition that this “results in people feeling much worse about themselves.” as the blame game ends at the place where it starts. Beating addiction is all about accountability, and no program, person, treatment center, book, 12-step program or any other theory or spiritual practice can “make” a person feel anything. This is basic psychology. Each individual person is responsible for themselves and their feelings and until they take ownership of their own actions and feelings, no matter what course of treatment they ultimately choose to take, nothing will change. We aren’t talking about babies and children here, we are talking about grown adults! Contrary to many of things that have been said, in general, and pointed directly at me, I don’t walk around like some kind of AA drone, nor do I live my days and nights attending endless meetings and preach the gospel of the program. That just isn’t how it works. There are many fallacies being promoting in this thread that for those in long term sobriety can tell you are just laughable. I live a wonderful, normal, productive, totally chemical free and vibrant life. Drinking is a complete and utter non-issue in my daily existence. I only hope the same for others, no matter how they find their way there. I have a VERY difficult time wrapping my head around any treatment that supplants a chemical addiction with another chemical (Sinclair Method, Suboxone regimens, Methadone, etc) but if over time more science could show definitive RECOVERY and not just addiction exchange then my mind is open to anything. Anyway, thank you for your thoughtful reply, I am going to read your book so I can be more informed in this ongoing debate, it is all very interesting. I may disagree with you but a appreciate your civility. Kelly G.

      • wolfemurray

        You should come to UK where doctors, judges and company bosses almost never refer people to AA

      • Alana

        I am in agreement that AA may not be for everyone, but I have read several articles by you now, and you come off confrontational. You actually don’t have your facts straight and I find it very irresponsible as a professional. You may just deter someone from going who benefit from the support because of your words and some might say purely your opinion. The professionals and the general public are so fragmented on the issue of addition or dependence. I would hope it is not because of your egos or educational level that is harming individuals who need treatment. I just finished reading your one day at a time article from psychology today. Yes, the quote “one day at a time” does speak to not drinking one day at a time, but it also about living in the present, rather the past or the future. If you live in the present life can be more manageable, especially in early recovery. AA is not just a self help group. It is a support group. It is not just about getting a staying sober. You find fault because there is not evidence to support AA is effective, but you have no evidence it does not work. I don’t believe you have evidence that supports your 5-10%. I would love to know how many AA meetings professionals attend before they speak publicly about their efficacy. I don’t think that some of these highly educated individuals understand that division expressed amongst professionals about causes and treatment is hurting people from seeking treatment. The confusion and debate of addiction actually creates distrust in treatment for the families and lowers the success of achieving sobriety. I would ask for you to be careful with your words. You must realize the impact. People at their desperate moments could be reading your words.

      • Steve L. Elliott

        I would hope you had a chance to offer a rebuttal to this article:

      • Greg Wood

        Citing studies and
        using studies to draw conclusions is responsible even if there is debate and
        discussion among experts regarding the validity of the study. Adding
        claims without hard data is where it gets dangerous. “AA is pushed
        upon virtually 100% of people suffering with addictions…” Where is
        the data to support that? That very statement and the use of the word “pushed” shows
        bias does it not? But let’s suppose there is data to support that claim.
        “It results in people feeling much worse about themselves when they cannot
        benefit, as many have testified.” Do you not take antidotal information
        and then draw universal implications? You make a leap in doing that but again,
        let’s suppose there is hard data to support that statement (and I have no doubt
        that data through a survey will support that claim). Could it be that any
        failure to abstain regardless of treatment approach will result in people
        feeling much worse about themslves? If that is the case then is not the
        entire reason for writing the book based upon faulty logic? If AA is no
        more or no less responsible for people feeling worse about themselves after
        failing to abstain than other treatment options then it comes down to success
        rate of programs. And that is where it gets confusing to me. Lastly – can anyone explain why no one has
        created a study that surveys people coming out of AA meetings, IOPs, Detox, CBT
        sessions and inpatient facilities alongside a random telephone survey? Could
        not that methodology get to some of the answers sought by so many?

  • Eric Ess

    At first glance an excellent rebuttal to Dr. Dodes’ book, which I believe deliberately attempts to shift blame to AA for the failures of the addiction treatment business.

    Then I read the rebuttal by Dr. Dodes, and I now find myself awaiting a response from the authors of the article. How can there be so much discrepancy about what is reported by these studies?

    The authors of the article fail to point out the greatest piece of (deliberate) misinformation in Dr. Dodes’ book: that the AA Program and the so-called “12 Step model” are the same. They are not. The 12 Step program as it is practiced in AA and other 12 Step meetings is COMPLETELY different than what is presented to patients in a professional treatment setting.

    First of all, AA is completely voluntary, and professional addiction treatment is very often not voluntary. Clients are often forced or urged into treatment against their will by spouses, parents, the courts, etc. They are then told that they must participate in the treatment program, which may or may not include this “12 Step model.” This is, of course, understandable, as professional treatment is expensive and the stated purpose is to “treat” the addict. But it is simply not any part of the traditional 12 Step practice.

    AA states very clearly that “the only requirement for membership is a desire to stop drinking.” In other words, if you DON’T have a desire to stop drinking (or using drugs) you are NOT a member. You are free to leave if you wish. You are also welcome to hang around, listen, even participate, but WHETHER OR NOT YOU PARTICIPATE IN THE 12 STEP PROGRAM IS ENTIRELY UP TO YOU.

    This point may sound simplistic, but this is actually a very key difference. In professional addiction treatment the client is essentially passive, there to receive treatment for his medical condition from supposed experts, regardless of whether or not he is ready or willing to take responsibility for his condition. In AA, the new member MUST take responsibility for his condition to even begin the program, and from that point on must work to help himself, supported by knowledgeable peers, but not as anything like a “client” paying experts to take care of his problem for him.

    This brings up another key point. Dr. Dodes would have you believe that the person who comes to AA and then choses not to participate is the fault of AA. And yet AA is quite clear: “IF you want what we have to offer AND you are willing to go to any lengths to get it THEN you are ready to take certain steps.” So (apparently I need to state the obvious) IF you DON’T want what AA has to offer, then you are free to NOT become a part of the program. How is a decision by an individual to not participate a failure of AA? Is the decision of an individual not to work out at the gym a failure of the gym? Absurd.

    There are many more important differences. AA is a community-based spiritual practice, it is not a treatment program. AA is not a psychological program. AA does not promote pharmacological treatment, and instead promotes “complete abstinence.” The list goes on.

    AA and the 12 Step programs should not be blamed for the poor outcomes of the professional treatment community and their misguided attempts at incorporating mutated aspects of certain 12 Step practices in their profit-based businesses.

    • broach

      Excellent commentary!

    • Sylvan

      Outstanding Eric! I have been trying not to comment as I “do not want to be drawn into public controversy”; but I have very strong feelings about AA. I have been sober for 9 years. I was an absolute low-bottom gutter drunk and “an alcoholic of the hopeless variety” (as mentioned by Jung to R Hazard). Only – and I stress ONLY when I was at the bitter end and completely ready to accept what AA was offering, did the miracle happen; BUT I had to work it. For me it was the genuine desire to stop drinking, with the AA program as a way of life, as well sponsorship and the fellowship (of men & women) – AND service (carrying the message). I am not religious, as I had it shoved down my throat for too long – but I am convinced that I was beyond human aid and the fact that the desire to drink has been removed has to come from some somewhere. I have tapped into something – I do not know who or what this is – I don’t care who or what it is. I am just eternally grateful that as long as I keep in a fit spiritual condition (like going to the gym or taking chronic medication), I need not pick up a drink EVER again. I will not criticize the book as I have not read it, and I try to refrain from become hysterical about controversy. Everyone is entitled to their own opinion, and are free to agree or disagree with me – but I do object to potentially harmful “statements of fact” that ignore the millions that have “recovered from a seemingly hopeless state of mind and body”. As to rehabs and other involuntary “treatments” – I reserve my opinion and judgement.

  • raflw

    I find it fascinating and a bit worrisome that a number of people in these comments seem to gleefully declare AA a failure. Yet for many people it does work. Of course, for others, it does not.

    Chemo extended but did not save my mother’s life. That does not mean that chemo is never the answer, or wasn’t the appropriate, limited answer for her difficult situation. Why consider the AA modality as either 100% successful or 100% failure? That’s not how any medical treatment works.

    Look, AA is a method of seeking and hopefully attaining sobriety. It is not the only method, and has limitations and is in some places and some times done poorly.
    But why try and dance on AA’s grave? That does not help the suffering alcoholic, won’t be good for those who are in successful recovery there, and in my estimation, AA is not opposing other treatment options or medical advances.

    Maybe some folks in AA zealously oppose non-AA methods. But as the Traditions would affirm, that person is not speaking for AA. Only for themselves and their own experience.

    • massive

      WOW yo are comparing chemo to AA? Faith healing made up religious dogma to CHEMO? That is crazy…

      AA is not opposing other treatment options or medical advances.

      Oh yes they do. If you go to a meeting and talk about Smart Recovery or SOS or Moderation they yell out ” why are you here then” Well maybe not in my old women’s group of nice ladies but in a mixed group I was certainly yelled at for many things including talking about safety.

      In a hospital they are all about safety. IN AA they are all about covering up the predatory behavior.

      • placer

        AA, like chemo, is a method of treating a disease which does not always work. Both have peer-reviewed scientific studies demonstrating that they sometimes, but not always, work. So the comparison is apt.

        AA’s fourth tradition states that each group is autonomous. I know a lot of members in a lot of groups have said some stupid things which are not part of the program as written in the first 164 pages of the Big Book. I have sometimes seen six-month wonders in meetings trying to tell newcomers that working the program the way they work the program is the one and only way to stay clean and sober.

        I also have seen people trying to 13-step (seducing newcomers), but that practice is discouraged in most meetings I have been to. The majority of meetings have a strong tradition of men working with men and women working with women to minimize that nonsense.

        There are a lot of AA meetings out there; if anyone doesn’t like what they see at a given meeting, I strongly suggest they go to a different meeting until they find one they like, or try something besides AA to get sober. I drive 45 minutes to go to my regular meeting because I don’t care for any of the meetings near where I live.

        • massive

          at least chemo is based on Findings a real research. There is very little unbiased AA research. AA DOES NOT DO ANY RESEARCH AT ALL!!!!
          AA members have been telling people in meetings what kind of medication they can or can not take.

          The first 164 pages is filled with utter nonsense never vetted or researched by Bill. He wrote it around 100 men’s experience and his . WOW what research that is. It was never vetted or researched….then he printed what he experienced for just 4 years. Many in that first 100 drank and again and it did not work for. That is not research and yet you and AA members recite that nonsense like its was written by GOD or Harvard Medical School.

          It too me leaving AA to see its literature for the hogwash it is. Go if you like it. I say its not a treatment. Its a fellowship and I have a serious problem with any DUI or EAP or any court co ercion. People need to know there are other options including the use of Naltrexone. NO one is BROKEN. NO One was born that way. Of is everyone in AA a sociopath which is what he is describing in CHAPTER 5 . GO listen to and us tearing up the Big Book episodes. Good Day. Driving 45 min to a good meeting….I guess things in AA are not so great anymore.

          • placer

            I see you have a lot of anger and bitterness, and I hope you find a life path that helps you let go of your anger…AA is one possible such life path.

            In terms of driving 45 minutes: The meetings near my house aren’t bad meetings. If anything, they are a victim of their own success; the meetings are a little too crowded for my taste.

          • massive

            anger is very healthy. Sad ness is very healthy. I am very healthy. I have a wide range of feelings . Without anger. there would be no change, no civil rights movement , no labor movements, no nothing. Are you a drone?

            Are you that brainwashed? AH ha …I am not. Anger is what moves people to change. AA and its lies have permeated our culture and are ruining another generation with this type of nonsensical belief system. We are going to change this.

            Empowerment is our motto. Not powerless.

          • placer

            I’m sorry, Massive, that you choose to be an angry and bitter person. You will continue to be angry and bitter until when and if such time comes that you choose to change. It is that simple.

            People who truly have found recovery outside of AA — and I know it happens — do not have a need to post to every AA-related discussion to express their anger, the way Massive seems to.

          • massive

            placer- you said “You will continue to be angry and bitter until when and if such time” ….You know nothing about me. Even Jesus got angry in the temple regarding the stupidity of mankind….Oh the arrogance of you steppers never ends…give it a rest. No good civil rights movement gets anything done with passivity.

            EVEN the freedoms riders had the right to get mad and fight for just the freedom to ride the bus! People have a right to know what is going on and to be safer!

          • placer

            So, Massive, tell me more about this noble cause you are a part of which makes your anger justified anger.

          • massive

            placer- do not placate me… do not really care…when I am done with my trailer I will post it here. You can read my story and 8,000 other comments on or watch the trailer. google The 13th Step the film. I wish you well, but I was an AA insider for 36 years. I know my AA sh**t inside and out. I know how to relax and enjoy life and I know how to fight for the under dog and the victims who are afraid to speak up. I am not afraid …but many are…

          • placer

            The fact of the matter is that AA, unlike most of society, has rules in place which limit 13th stepping. Most meetings have a strong “men work with men, women work with women” rule and dating among newcomers is discouraged. Sure, you can — and have — chosen to focus on the meetings where 13th stepping goes on. Healthy people in the program, however, when they see that, go to other meetings, and protect women in the rooms from that behavior.

            You have chosen to focus on the negative things in AA, and am now trying to make money with that focus, but the fact is that there is not a single person that movie of yours will help keep clean and sober, either inside or outside the rooms. Hopefully, the movie will simply flop and be quickly forgotten.

          • massive

            and you learned to be so loving a compassionate where? Oh yea In AA. Bye Bye.

            AA has no rules. They dont tell their members how to act. Thats there comeback line every time.

          • placer

            Monica: I was compassionate to you until it was clear that you weren’t looking for compassion, but for a fight.

            I gave you my compassion. You responded to it with nothing but resentment. I do believe there are causes worth fighting for, such as worker rights and gay rights, but trying to discredit AA just because some meetings have problems is an attempt to throw out the baby with the bath water.

            The way I and other oldtimers in the rooms handle 13th stepping is by letting newcomer women know that they need to work with women, and putting strong boundaries between myself and women in the program. Indeed, discussions like this have encouraged me to double up on doing that kind of step work in the rooms.

            AA has had a culture of “men with men and women with women” ever since the beginning. Some meetings, alas, discard that tradition, causing people to act out in sexual addictive behavior patterns in the rooms. But that’s just a case of “let’s forget the original steps that make AA work” and is no way a reflection of the culture and attitudes of people who are winners in the AA rooms.

          • Leaf

            Hi, I spent six months in a rehab for alcoholism. I had never heard of the 12 steps until day one read the 12 step posters on the wall and thought what? I won`t be doing that, nor did I as it looked like religious indoctrination to me. It was all focused on “working” the programme. Anyway, I refused to become sucked in and the staff, all AA members, soon turn against you for resisting the brainwashing and I was branded “dry drunk” as a result, still here to tell the tale guys. It made me uneasy to be honest, I am unable to accept ideas which are shaky to say the least and some of the characters who are most fervent are frankly dodgy. As for Bill W. and his Big Book, well it`s outdated dogmatic nonsensical rhetoric in my opinion. It`s interesting to note that most religions have similar patterns of unwavering loyalty in their own beliefs – no unbelievers allowed!

          • wolfemurray

            As you say…”hogwash”

    • diamondgirl

      AA and the 12 steps are absolutely Gold Standard in the treatment of alcoholism. If someone does not have the desire to stop drinking…guess what? He or she will not stop drinking. AA and the 12 steps introduce some structure in the alcoholics life, which was a life of chaos and wrong decisions due to addiction. Alcoholics need another alcoholic because they understand eachother on a level that non-alcoholics can’t. This is why AA meetings, working with a sponsor, working the steps, and the fellowship work to maintain sobriety. It is more harmful to pour prescription medications down an alcoholic’s throat and think a magic pill, or shock treatments, or any other guinea pig experiments are going to change the alcoholic. He or she will drink if not ready to stop. Sad but true. You can’t force overweight patients to exercise to lose weight can you? On another note, AA is definitely not religous. Why would there be so many atheists and agnostics in the program then?

  • Shaun Shelly

    12-step programs have no place in professional treatment settings. They are fellowships that can be helpful to some, and are often damaging to others. The supposed results are correlations, with no evidence of causation. This is called compliance bias and is common in addiction treatment – if a person is compliant they will do better due to their OWN motivation, not because of the treatment. Having said this, 12-step fellowships can be helpful because they address the relational needs of the recovering individual – they can carry the “addict” identity into the room, there is acceptance and they get a new friend they can cal 24/7 in the form of a sponsor. It also provides structure and a level of accountability.

    This all sounds good, but there are significant dangers: group think is pervasive – the same mantras are repeated time and time again, many of which are simply not true, and can be dangerous (eg 1 too many 1000 not enough can lead to Abstinence Violation Effect). The first three steps can cause all sorts of problems, and the idea that if you don’t work the program the only outcome is jails institutions or death is utter manipulation and plain hogwash.

    I have no issue with those who wish to attend these programs, or with those who facilitate those who are well informed and wanting to attend them to attend them, but to co-opt the approach into a treatment program or force people to attend them or to present them as some type of miracle cure is wrong.

  • Jeremy Kitchen

    Spiritual Atheist and sober in AA for a decade.

  • Lance Dodes

    In this post, Drs. Kelly and Beresin criticize my new book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry in a manner that is both poorly researched and flatly incorrect. The authors of the post feel that if various authorities support AA, that should suffice to end discussion. The fact that these organizations have endorsed 12-step programs is, of course, meaningless if those organizations base their conclusions on the same poor science that we described in the book. Here are some further problems with the rest of this post. To enumerate them all would require more space than I have to offer.

    1. The authors state that AA and 12-step treatments are “among the most effective … treatments for facilitating addictive behavior change,” and complain that we misinterpreted the Cochrane Collaboration report about this. This would be hard to do, given that we simply quoted the study itself. Here is what the Cochrane paper said: “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF [Twelve Step Facilitation] approaches for reducing alcohol dependence or problems.” Finding no evidence for the effectiveness of 12-step programs is difficult to reconcile with the authors’ claim about how effective they are. The post also selects a single, early paper of the many papers we reviewed (the 1991 Walsh study) and objects to citing it as evidence for the problems within 12-step treatment. Yet we did not say, as the post states, that “AA is poor while inpatient treatment was good.” An attentive reading of our book – which the authors did not appear to have done – would show that we are highly critical of inpatient treatment when it is based on the 12-step approach. Here is a direct quotation from the Walsh paper itself:

    “The hospital group fared best and that assigned to AA the least well … Even for employed problem drinkers who are not abusing drugs and who have no serious medical problems, an initial referral to AA alone … although less costly than inpatient care, involves more risk than compulsory inpatient treatment and should be accompanied by close monitoring for signs of incipient relapse.”

    There is nothing bizarre about concluding, as we did, that this paper raises serious questions about the routine practice of referring patients to AA.

    The authors also refer to Project MATCH. They write, improbably, that this expensive study somehow supported 12-step treatment. Here is a direct quote from a published scientific review of Project MATCH, which is what we included in the book:

    “Overall, a median of only 3% of the drinking outcome at follow-up could be attributed to treatment. However this effect appeared to be present at week one before most of the treatment had been delivered.. . . The results suggest that current psychosocial treatments for alcoholism are not particularly effective. … Most of the improvement which is interpreted as treatment effect is not due to treatment. Part of the remainder appears to be due to selection effects.”

    To suggest that Project MATCH provided evidence for the effectiveness of 12-step treatment is simply wrong.

    2. The authors point out that AA is free. There is actually some evidence that the decreased cost of AA has been offset by increased costs from the need for subsequent treatment. Even if this were not true, however, the book was not about cost, but about harm to the vast number of people told to attend AA who cannot make use of it.

    3. Concerning whether 12-step treatment is better than doing nothing, the authors of this post write that we are suggesting that people “just stand back and wait.” Of course, we did not say that. What we did say is that the spontaneous remission rate for alcoholism without any treatment is roughly the same as the AA success rate.

    4. The authors charge that I allegedly “don’t realize that for the past several years the addiction research field has moved beyond asking whether AA and 12-step treatment works.” Aside from the insulting nature of their comment, it is a major problem that the industry has stopped examining the science behind 12-step programs. It is precisely this failure that made it necessary to write the book.

    5. The authors of this post write that we say “genetics do not play a role in addictions.” I did not say that in the radio interview, nor in the book. Here is the exact quote from The Sober Truth: “There is probably some genetic influence on addictions, but this shouldn’t be surprising. Many human conditions, like peptic ulcer disease or hypertension, have some genetic loading.”

    It is deeply disappointing to see such a poorly considered critique of our work. We invite scholarly discussion of The Sober Truth, but these arguments must pass a higher threshold if they are to inspire useful conversation.

    • Shaun Shelly

      Well stated. In the addictions world there are so many principles/ideas that have become to be regarded as “fact”and are nothing more than theory(at best). Much of this has been at the hands of institutions that have co-opted the 12-step programs and repackaged them for sale to an unsuspecting and vulnerable public. The blind acceptance of the disease model as promulgated by AA and in a different form by NIDA has greatly held back the progress of treatment. Both may have elements of truth, but neither is the truth, and certainly the truth in 12-step programs does not lie in the steps, but rather in the relational aspects.

      We need voices like yours to create a stir and wake people up out of their collective ignorance and start thinking critically about what is being said.

      • wolfemurray

        The AA does not have the same influence ion UK and Europe as it does in the USA. On our side of the Atlantic the only form of treatment that is offered to addicts is methadone maintenance.

    • massive

      Thank you Lance Dodes for writing this book that clearly has researched the facts that drinking is not a Disease that needs a religious lay person pods for a cure that never will happen because you will need to go to meetings with strangers forever who will tell you to turn it over to a power greater then yourself.

      • John

        When Massive can find Friends instead of Strangers, he might also finds success and more joy.

      • John

        I’ve been in AA for nearly 35 years (clean and sober) and never been sexually preyed upon, but I’ve certainly been “prayed ” for!

    • placer

      Mr. Dodes,

      Thank you for taking the time to comment here. Now, as a member of AA with well over 20 years clean and sober, I have seen countless people come in and go out the doors of AA. Most people who show up at a meeting end up stop going to meetings; my experience is that most people with serious drinking and/or drug problems simply do not want to become clean and sober.

      But, of course, we’re discussing hard data here, not a single oldtimer’s experience, strength and hope. So, let’s go to those studies:

      The 1991 study (“NEJM199109123251105″) shows AA having a 20% success rate when people just go to meetings, compared to a 40% success rate when people go to meetings after a 24-day 12-step based program. Now, these aren’t the highest rates for AA success out there, but, then again, these numbers still are counter to your assertion that AA only has a 5-10% success rate.

      CD005032 (The Cochrane study) concludes that AA is neither no more or no less effective than other methods of treating alcoholism. Among other things, this study states that “AA may help patients to accept treatment and keep patients in treatment more than alternative treatments” and “Other studies reported similar retention rates regardless of treatment group”.

      Now, there are other studies that show AA as more effective than either of these studies; PMC2220012 shows AA being effective 67% of the time — which is far far higher than the 5%-10% figure your book claims.

      Now, I agree there are other ways to stay clean and sober besides going to meetings — but I have not found one single peer-reviewed study supporting that assertion that AA is no better than spontaneous remission.

      • Eric Ess

        Thanks for this. Please see my comment above (or wherever) re how Dr. Dodes conflates the 12 Step program as it is practiced in 12 Step meetings with the so-called “12 Step model” or TSF as it is presented in professional treatment situations, when it is clear that the two are very different. Do you know of any studies that differentiate between the two? Thanks.

      • Lance Dodes

        Thanks for your comment. To fully answer, I have to suggest reading The Sober Truth. Briefly, the 5-10% rate is because of the huge dropout rate from AA. Most studies ignore this, then draw conclusions from the small number who remain, We also discuss the spontaneous remission statistics in the book..

        • placer

          Mr. Dodes, thank you for your reply. I agree that AA does suffer from a serious drop out issue, and it would be good if there were more ways to help people who are not motivated to remain in AA stay clean and sober. (As per the Cochrane study and to a lesser extent Project MATCH’s findings, there are alternatives to AA that also work for some alcoholics)

          AA has the same problem gyms have. Sure, a lot of people join gyms as part of their New Year resolutions or what not. But most people who join gyms end up dropping out, instead of remaining and doing the exercise needed to lose weight.

          Same deal with AA. Most do not want to do the hard work the 12 steps entails. As we say in meetings, it’s a program for people who want it, not for those who need it.

    • Eric Ess

      Dr. Dodes, would you care to reply to my criticism: that you are conflating the 12 Step program as it is practiced in 12 Step meetings with the so-called “12 Step model” as it is presented in professional treatment situations, when they are clearly very different?

      One example among many:

      As you must know, the AA Preamble states, “the only requirement for membership is a desire to stop drinking.” While this is often quoted to express that there are no other requirements in AA, it is nonetheless a requirement. It follows, then, that if you don’t have a desire to stop drinking (using drugs, etc.) then you are not actually a member of the program.

      Do any of the studies you cite differentiate between actual members of 12 Step programs vs. clients in a treatment setting who have had the “12 Step model” given to them, possibly forced on them, usually in a reduced or modified form, whether or not they actually have a “desire to stop drinking?” Wouldn’t you agree that the outcomes of a group that has a sincere desire to stop their addictive behavior would be quite different than those of a group that wants to keep using drugs or to continue drinking, or even a group that is hoping for some sort of moderation? Whether you agree or not, certainly you will agree that AA is not responsible for any “success rate” that includes non-members.

      There are many other differences: promotion of abstinence vs. reliance on pharmaceuticals, spiritual practice among peers vs. treatment by professionals, non-profit vs. for-profit… all of which would surely affect any study of outcomes.

      My main criticism of your book and interviews is that you speak of AA and the 12 Step programs along with such aberrations as the “12 Step model” and TSF as if they are one in the same. You must know they are not, so I can only conclude that you have some other motive than presenting facts. I do agree that the programs that have been offered in professional treatment programs have proven to be fairly ineffective. The fact that they declare that they include or have some basis in the 12 Step program is not the fault of AA, and has nothing to do with how successful AA may or may not be.

      • Lance Dodes

        Thank you for your comment. I agree that there are certainly important differences between 12-step-based rehabs and AA itself, as we discuss in great detail in the book. But the main problem you raise is one of circular reasoning. There are lots of people with a sincere desire to quit who cannot benefit from AA and therefore drop out. And there are others with ambivalence (for many reasons) yet who are seeking help. To consider these people “not members” and omit them from AA’s success rate is illogical. One more point: our book doesn’t conflate AA with rehabs, it is just that our book covers both topics, which overlap.

        • Eric Ess

          I’m not sure it’s illogical, but I understand your point. I think when you consider the 12 Step Program as a “treatment modality” your logic applies: a good “treatment” helps all who have the condition, regardless of their opinion about the treatment. When you consider the 12 Step Programs as a practice rather than a treatment, more like a Buddhist practice involving acceptance of beliefs, ways of behaving, even ways of eating and sleeping, then the experience of those who do not want to practice, for whatever reason, don’t count. I know emotions run high with such a devastating health problem, so I don’t mean to be condescending at all. I just think the results of a practice should be measured on those who practice.

          • Roger H

            Eric touches on an important point that Dr. Dodes and his critics all fail to grasp: AA is NOT treatment! It never was, and has never claimed to be. It is a “fellowship” (not a “brotherhood” as Dr. Dodes incorrectly refers to it in his NPR interview — a subtle, yet important distinction) of men and women who help each other overcome their struggle with alcoholism. In its literature, AA says that it “…does not make medical or psychological diagnoses or prognoses,” nor does it “….provide detox or nursing services, hospitalization, drugs, or any medical or psychiatric treatment.” (AA World Services, Inc.) AA is often a component of a more comprehensive residential or out-patient treatment program, but it is not, and has never claimed to be, a stand-alone treatment modality unto itself. To assess AA as such and criticize it for being something that it is not is unfair, irresponsible….and wrong.

          • goldatsaside

            I’m an engineer
            with 37 years in 12 step programs, 33 of them in sobriety. I specialized in
            developing and troubleshooting complex systems and I constantly ran into people
            who approached complex situations from preconceived positions. I’ve learned the
            best quality one needs is common sense! Too many people approach addiction from
            a purely medical approach, with much right/wrong, either/or, black /white
            attitudes. I’ve learned to take something as it is and then try to figure out
            how it works, not vice versa. AA works, the 12 step approach works, but not for
            everyone. I come from 4 generations of alcoholics – both sides of my family-
            and am very grateful that my generation had an opportunity for recovery. 12
            steps have spread to those affected by others alcoholism (Al-Anon), to drug
            addiction (NA), sex, food, gambling and others. I’ve also seen it fail, even
            among some close to me. I’ve seen a lot of ego and arrogance in some of the
            replies and I see some people who had bad experiences. I’ve been to some meetings
            that I couldn’t wait for them to end too, but I have to look honestly at what
            works for me and what doesn’t, and have respect for other viewpoints. The old
            saying in AA/Al-Anon- it works if you work it (and you’re worth it- Al-Anon)!!

          • Lele

            well said!!!!!!!!!!

    • broach

      Productive AA Members Worldwide: Millions
      Lance Dodes: 1 person with a book to sell
      Absence of profit motive in AA: Priceless.

      • Happy

        hahahahaha I love that Broach. AA has no motive other than to help people get sober…….angry resentments at AA is how Rational Recovery started, read their book, it’s pretty vicious and we know how that ended! I personally do not care how people get sober and the truth really does not need to be defended, 21 years sober in AA and pretty blessed!

      • wolfemurray

        Good point, and note how Dr Dodes says in his replies that you have to buy his book in order to find the truth. Good marketing. And taking a stance like this against such an effective treatment is a good way to generate controversy and sales. He may be preaching bad science but he’s practicing damn good marketing.

      • Steve L. Elliott

        John F. Kelly is part of the rehab industry, both practicing at the center listed above and reportedly a consultant to Hazelden and Betty Ford. One guy’s selling a book. These guys are selling an idea of being diseased for a lifetime. Thinking there is an absence of profit motive in the AA model is as childish and cute as your little play on the Visa commercial. There is a statement that haunts AA to its core: more will be revealed.

    • massive

      You Are awesome !!! Thank you for your book and your speaking out !

    • wolfemurray

      I personally vote with the professors and think Dode’s approach is both wrong and malicious. Like many people he seems to have a bee in his bonnet about AA as it has a spiritual component.

    • jockmack

      Dear Dr Dodes,

      It is true that the Cochrane paper said: “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF [Twelve Step Facilitation] approaches for reducing alcohol dependence or

      However the overall findings of the review are that TSF is as good as but no better than other interventions such as CBT or MI in terms of reduction in drinking and other measures.

      As to how the authors can use findings of equivalence to claim that “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems.” is beyond me. It is a statement that does not match their findings.

      Leaving aside what ‘unequivocal’ means, this statement implies that AA is not effective even though it was not AA that was studied but TSF.

      In the Plain Language summary the authors state “The available experimental studies did not demonstrate the effectiveness of AA or
      other 12-step approaches in reducing alcohol use and achieving abstinence COMPARED with other treatments, but there were some limitations with these studies.”

      This statement is couched in negative language that almost
      seems to invite misinterpretation such as in your book but it is actually saying that the findings of the constituent studies of this review as described in the discussion section is that TSF is *no more and no less* effective than other treatments, in other words TSF works as well as but no better than standard treatments such as CBT and MI. *my emphasis*

      In the discussion section is the assessment that “there is no conclusive evidence to show that AA can help patients to achieve abstinence,
      nor is there any conclusive evidence to show that it cannot.”

      This fact in the next paragraph becomes “Yet experimental studies have on the whole failed to demonstrate their effectiveness in reducing
      alcohol dependence or drinking problems when *compared* to other interventions.” i.e. as good as but no better than.*my emphasis*

      By the time we get to the Authors’ conclusions – Implications for practice, we get the stern warning “People considering attending AA or TSF programmes should be made aware that there is a lack of experimental evidence on the effectiveness of such programmes.”

      So I don’t suppose on the one hand you can be blamed for misrepresenting the the findings of the Cochrane review given that the Cochrane authors themselves seem to misrepresent their own findings.

      On the other hand given the importance of this review I would have though that in your book, which I have open here in front of me, you would have at least investigated the findings of the constituent studies.

      Here is how the Cochrane review describes the findings *my emphasis below*

      Overall, severity of addiction *does not seem to be differentially influenced* by the interventions from studies included in this review. TSF improved scores in drinking consequences *in the same way* as other comparison treatments, though regression to the mean cannot be discounted as a factor. Similarly, there is no conclusive evidence from a number of different studies to show that AA helps patients to accept therapy and keep patients in therapy *any more or less* than other interventions. Similarly, there was no evidence that other TSF interventions impacted the number remaining in treatment *any more or less* than relapse prevention treatment.

      In terms of reduction of self-reported drinking measures, this review shows that TSF helps to reduce alcohol consumption *similarly to other comparison interventions*, though without a no treatment control group conclusions are limited. Two studies comparing TSF to other interventions showed a *similar reduction in alcohol consumption in all groups8. It was not clear whether AA specifically helps people to reduce drinking during treatment and at follow up compared with other interventions. Three studies comparing AA in different conditions with other interventions found *few differences* between interventions in reducing amount of drinks and percentage of drinking days.

      Do you still stand by your claim (p37) that “the best designed studies have all questioned AA’s effectiveness?”

      • Lance Dodes

        Thank you for your polite comment. I certainly stand by my observation in the book, which follows from the conclusion of the Cochrane authors. I understand that you question their interpretation of their own data, but I believe their conclusion is thoughtful and sound. If I understand your other point, you are saying that 12-step treatment is as effective as other interventions such as motivational interviewing, The key point, however, is that none of these treatments have shown effectiveness, as was seen in the Project Match study (see the quote in the book and in this thread).

        • jockmack

          Firstly none of these studies looked at AA, only TSF and similar interventions, very different beasts, AA is voluntarily, self-delivered by the person in question, the later a professional manualised time limited intervention design to facilitate 12-step involvement. Apples and oranges.

          I take it from your last comment that you believe that TSF and all the interventions are equally ineffective. Is that right?

          You use the Cochrane review to state that the studies it contains finds “no evidence for the effectiveness of 12-step programs ” but it that what the eight studies that make up the Cochrane review say?

          Brown (2002) says “Overall, the present findings seem consistent with the hypothesis that carefully orchestrated aftercare programs (TSF and RP) can deliver their targeted change objectives, and that these changes are important to six-month outcome.” p686 and

          “Clinical implications and shortcomings – Clinical inferences can be drawn from the present findings. Both aftercare strategies appear to offer comparable benefits to clients grappling with substance abuse. The specificity in the therapeutic gains achieved and their relationship to positive post-treatment outcomes further underscores the importance of attainment of the explicit therapeutic objectives of each approach. Thus, irrespective of which aftercare model is adopted, a clear commitment to achieving the specific intervention objectives targeted seems desirable.”

          and “Accordingly, the provision of interventions during aftercare (TSF and RP) that diminish temptations and urges to use drugs may enhance outcome, regardless of what conceptual model is in force.”

          • Lance Dodes

            The key point, I believe, is the circular logic I’ve addressed in the book and this thread. You mention the importance of “commitment” to achieving therapeutic goals. As we said in the book, those with extensive commitment, shown by devotion to the teachings of AA, do tend to do well. The problem is that those findings are not generalizable to the 90% of people who go to 12-step programs and, despite a sincere desire to be well, cannot buy into this singular program. This helps to explain the extremely poor success rate. As for the difference between TSF and free-standing AA meetings, I agree they are not the same, though the success seems to be about the same for both as shown in the many studies we examined.

          • jockmack

            The key point is the misrepresentation of evidence for 12-step which is the thrust of Kelly and Beresin’s article. I find it curious that you avoid engaging on the content of the studies which you claim back up your claim for the ineffectiveness of TSF. Brown’s (2002) study is an RCT which as you point out is a design that gets around the self-selection issue. In their sample they would have had people with a range of levels of commitment.

            So I ask you again do you believe that content of the eight studies back up your claim that they find “no evidence for the effectiveness of 12-step programs”?

            Here is another RCT from the Cochrane Review

            The abstract from Davis (2002) in full is below, can you explain why you think this study demonstrates the ineffectiveness of 12-step treatment.

            “This study sought to examine the effectiveness of a ‘‘standard’’ outpatient alcoholism treatment (ST) program. An outpatient alcoholism treatment as it is commonly practiced in the US (with group and individual therapy, and an emphasis on Alcoholics Anonymous [AA]), was
            compared with a minimal treatment (MT) approach (weekly alcohol education movies). At 6 months, ST patients surpassed those in MT in terms of complete abstinence, reduction in amount of alcohol consumed, length of sobriety at follow-up, improvement in employment status, number of AA meetings attended, and lower initial drop-out. It is concluded that a ST approach is more helpful than MT in treating severely
            alcohol-dependent individuals who have not been able to cut down drinking on their own. Those already drinking less appeared to be helped by MT.”

          • Lance Dodes

            You are arguing that the Cochrane paper misinterpreted its own data. You are entitled to your view, but in standing with the Cochrane report I am not avoiding anything. To challenge that organization’s view is an odd way to criticize my work. Our book is filled with reviews of many studies: we began with the Cochrane report then went on to look at a lot of other science. If you read the book, you will find the data presented exactly as it appears in those papers; there is no misrepresentation at all. I suggest that if your main problem is your criticism with the Cochrane authors that you write to them.

          • jockmack

            I am saying that the Cochrane paper is misrepresenting the results of the eight studies, and you are in turn doing the same by uncritically accepting their assessment. I have pointed out how their conclusions don’t match their data and I have given some evidence from two of these studies to back this up.

            I am entitled to ask you why you also claim these studies suggest TSF (not AA) is ineffective, despite the fact that none of the eight stuies actually come to this conclusion.

            I’ve given you data from two of the studies that do not support your claim (on p44 and elsewhere) that the eight Cochrane Review studies suggest that AA is ineffective.

            I think it is reasonable to ask to argue why you continue to do this yet at the same time refuse to discuss the content of these studies.

            Another thing is that you don’t actually address the findings of the eight individual studies in your book but collectively refer to them as “high-quality, controlled, randomised studies” (p37) despite that fact that several of them aren’t randomised studies at all. For example
            Zemore, S. E., Kaskutas, L. A. A., and Ammon, L. N. (2004). In 12-step groups, helping helps the helper. Addiction (Abingdon, England), 99(8):1015-1023.

            is a longitudinal treatment outcome study, the kind of study which you dismiss in your book as “bad science”.

    • Jeremy Kitchen

      Keep making that money Lance!

    • squirlee

      it seems to me from reading this thread that alot of “useful conversation” has been inspired including you cont to comment on it many times. :-)

  • Don Sheeley, MD

    Since the recovering individual is the one who has to do the work to change his life, it makes sense to utilize tools that have been shown effective to help him do so. These tools can include a personal cost-benefit analysis, how to deal with urges and cravings, how to change one’s perspective on life circumstances (CBT, REBT, DBT), and the creation of a satisfying life.

    AA has been determined to be a religious program, by our courts. In the emergency department, I see many people who will not attend AA because of AA’s religiosity and other factors such as the “AA is the only way or you are doomed” attitude. AA was designed prior to the psychological research of the 20th Century and the AA book never gets revised to reflect improved ways of creating personal change.

    It is wise for physicians to offer their patients non-religious alternatives, such as SMART Recovery, which includes all the tools above, and supports individual choice and personal development using methods based on research-proven techniques.

    AA probably helps some people because it provides them a sober community to be part of. Today, there are ways to provide a sober community without invoking religion, and while emphasizing personal strength in running one’s own life to create satisfaction.

    Donald Sheeley, MD, ABIM, ABEM

  • Guy Lamunyon

    Multiple court rulings have found AA/12 Step religious in nature. In 1985 VA Colorado was sued by a veteran for denying care because he refused the AA/12 Step religious programming. Results = out of court settlement. The AA/12 Step monopoly is over. Secular alternatives must be offered ! ! !

  • annemfletcher

    I’ve been waiting for Dr. Kelly to issue a response to the Dodes book and am so glad he did because there is much flawed thinking and reporting in it. However, it’s important to note that “12-step treatment” (what researchers call 12-step facilitation treatment or TSF) is not the same as going to AA meetings in the community. TSF as tested and shown to be effective is done a a non coercive way, according to specific research protocols and usually one-on-one with a trained therapist, not in groups. This is not the way 12-step treatment is typically done in rehabs, where most treatment is provided in groups and clients are led to believe that it’s “AA or you’re doomed.” And with studies showing that those who go to AA and get involved have better outcomes, the drop out rate tends to be high over time. That’s why clients need to be told about ways to get sober other than AA, which is seldom the case.

    • massive

      TSF – What a joke those steps are … AA and its 12 steps are dangerous …in any form.

    • suem

      I have never once heard anyone in an AA meeting say that without AA you are doomed, so I’m not sure where your clients went to have heard that. For me AA was a program of attraction, I wanted the calmness and serenity that I saw in fellow members in AA. I wanted to learn how to stay sober for 24 hours, something I had tried and tried again and failed. The most important thing I learned was to ask for help BEFORE taking a drink. And to ask for help, I needed to feel safe. And to feel safe I needed to know that those I called struggled the way I did and would do anything anytime to help me not take that first drink. (And in my case I reached out to women as I was instructed by my sponsor as this is how it’s done in AA. Men stay with men, women with women.) The drop out rate in most treatment programs is high. Many times those of us with addictions are sent to treatment by family, courts, physicians ect. If the addict is not ready to get sober or clean, it really doesn’t matter where they go because they will not hear what they need to hear. I am very curious to hear Dr. Dodes statistics in his own practice regarding sobriety vs relapse. My feeling is that whatever keeps you sober you should keep doing. For some it’s not AA but is Smart Recovery or simply court ordered screenings. The object is the same, staying away from a drink or substance and we do all a disservice by narrowing our views on one form of treatment vs another. For me it takes a village, AA meetings, a psychiatrist, a therapist and a support group, and daily meditation. I also reach my hand out to the new person to try and help them the way I was helped from my very first meeting.

      • annemfletcher


        There’s a difference between what goes on in AA meetings (and as you know they all have different practices and personalities that vary somewhat) and what goes on concerning AA and the 12 steps in treatment programs. I was referring to the latter. It’s in traditional treatment programs that I observed and/or was told about the practice of being told that you had to “get with the program” or be doomed.

        • suem

          Annemfletcher, Thank you for clarifying. It may be that some who enter treatment are “doomed” by their addiction and may misinterpret that if they don’t do the program (whatever the program is) they will fail. That unfortunately is the reality for some of us. Nobody had to tell me I was doomed, I knew it in my heart and soul and had for a long time. I couldn’t live any longer with my drinking and I was caught in a bind of being afraid to die but being afraid to live also. I have to say though that what I heard was a glimmer of hope offered by treatment. I believe that the addict has to be ready to “Hear” and in the long run if you are ready, you will learn about your addiction and with the help of others (treatment/AA/NA/Smart Recovery/psychotherapy or whatever) you can regain your life one day at a time. Rather than having long discussions on the pro’s and con’s of programs I wish we could all effect our health care system so that treatment is available for whoever needs and wants it. And they can chose what will work for them. The key is you can’t do it alone, you need a support system and they are few and far between and less than adequate. Anne thank you for this intelligent discussion. I’m appaled that others are name calling, it’s so unnecessary.

          • annemfletcher

            Yes, name calling is unproductive. But I have to say that research clearly shows that many people recover on their own. I cite the findings in my books and there isn’t time nor space to document the research here and now. If you want to explore the scientific literature on this topic, do a search for “natural recovery,” “spontaneous remission,” and you will find some of the studies. However, with more severe addictions, you’re right that it’s more likely that getting help leads to better outcomes.

    • Whatever

      I thought your book great overall but I was disappointed you didn’t seem to address any concerns about the 12 step/disease model ideology, as they are definitely a huge component of the failure rates of treatment centers, coercive, or not. After all, no treatment center is capable of forcing a client to attend meetings after discharge, nor are they able to prevent clients from ultimately seeking their own conclusions about AA.

      Essentially, why do you feel that 12 step programs are effective when they are the foundation on which these treatment centers base there therapeutic protocols? I certainly support your other points regarding why treatment centers are hardly cost-effective, but do you feel that a treatment program based on non-coercive AA is justified in charging $30,000 plus a month, or do you feel that it might be better to base these programs exclusively on SMART recovery, etc.? Why did you think Dodes’ research was flawed?

      • annemfletcher

        Thanks for the nice feedback about my book. Dr. Kelly documents the flaws you ask about, so I don’t feel a need to reiterate that. In INSIDE REHAB, I go to great lengths to explain the problems with the disease model and how rehabs use it in one-size-fits all application – giving case examples of how it hurt some people – so I’m not sure what you’re talking about. I don’t feel a rehab should base its approach on any one philosophy or program but instead should gear its treatment toward the individual client and expose clients to many different approaches for recovery as well as support groups. 12 step support groups in the community are helpful for the minority of people who get involved and stay involved with them but most people don’t, which is why we need to expose people to more alternatives.

  • ez

    The two Doctors cite the study found in The Cochrane Library . Here is the plain language summary of their source:

    “As well as AA, there are also alternative interventions based on 12-step
    type programmes, some self-help and some professionally-led. AA and
    other 12-step approaches are typically based on the assumption that
    substance dependence is a spiritual and a medical disease.

    The available experimental studies did not demonstrate the effectiveness of AA or
    other 12-step approaches in reducing alcohol use and achieving
    abstinence compared with other treatments, but there were some
    limitations with these studies.

    Furthermore, many different interventions were often compared in the same study and too many hypotheses were tested at the same time to identify factors which determine treatment success.”

    Not what I would call a rousing support for the AA aproach, is it? “did not demonstrate the effectiveness of AA or other 12-step approaches in reducing alcohol use and achieving abstinence compared with other treatments”;jsessionid=988A1865360C13843880C3F5892B3299.f01t04

    • Jeremy Kitchen

      ez also probably an AA failure…

  • Marty Harding

    Thank you so very much for this well articulated response. The information you have presented debunks a number of unfortunately widely-held beliefs. I guess we should be grateful for Dr. Dodes for giving us an opportunity to hear the facts, presented so beautifully. Again, my thanks.

  • massive

    you said AA also has been shown to work by increasing spirituality, which helps people reframe and take a different viewpoint on stress,

    SO what about those who don’t believe in any of that and are atheists! That is a horrid answer. If its genetic, if its a disease that treat it like one and use really science like we did with aids to address it. Stop sending people to a religious peer person pod that is not safe. that has not been updated since 1935 and has never been vetted or researched in any way when Bill wrote the book and and made the assumptions recited in Chapter 5 at EVERY meeting like it was gospel which it is not.

    AA is filled with many controlling sick sponsors who are bullies as well.

    • Harperandlucy

      I have been an atheist my entire life and my 18 months in recovery in AA has not changed that. Being spiritual does not make it necessary to believe in God. Finding and believing in a higher power does not equate with a belief in God. AA is absolutely not a religious program. I am so grateful for AA. After 32 years of drinking and using. After years of trying to get and stay sober, AA is the only thing that has worked for me.

      • massive

        Thats fine if it works for you. I was in it for decades sober…and sexually preyed on and brainwashed and hurt my kids with its BS lies…but don’t let them fool you. With one breath they tell you “take what you like and leave the rest” with the next breath they say…if you don’t admit powerlessness you can’t “get” the WHOLE program” I say which is it. You can’t have your cake and eat it too. Yes it is religious and deemed that way from 25 states. There are over 500 refaced to God or Him or Hp or Him or GOD in the first 164 pages of the Big Book. I know …I was once brainwashed. But hey if you like it…go ahead…its your life. I got mine back and Im free now. I have never been happier. AA never saved my life. I …..saved my life. I did it !!! for 37 years. TIME is BS too. Who gives a ……it means nothing.

        • Jeremy Kitchen

          sound like massive is an AA failure. keep coming back!

          • Lance Dodes

            This comment may have been made as a joke, but it underscores the danger of our current AA-focused treatment policy. When AA helps, it’s great. But the enormous majority who are not helped are told to keep coming back. That is deeply harmful.

          • Sheri Spillane Goldie

            It is not deeply harmful. With all due respect, you don’t know what you are talking about. Those who “go back out” and drink again are not being honest and are not willing to go to any length to get better and stay sober. It is a very simple program. If they keep coming back and want to live, they eventually become successful, work the program and stay sober. The sad truth is that 1 in 4 alcoholics in the program will die drunk.

          • Curtis Cotten

            I agree , Honesty is the first step toward recovery,if you are not honest then there is no hope for you..and Hope is that principle behind step two..And when you start to be honest then there is hope for you which will produce Faith,,,which is step 3and Faith produce courage which is 4,,,What i am getting at it works if you work it…Proof for me its been 19 yrs from some one who drank and drug everyday for years and years…I don’t have to understand why it work…just need to see that it do… I don’t understand why a brown cow that eats green grass give white milk either but i drink the milk…

          • broach

            Just how is it harmful to suggest a person continue to return? Are you suggesting it’s better to tell someone to give up, try something else, go buy your book?

          • massive

            Yea .. that would be better then going back to AA. Maybe get a good Addiction therapist and or go to a SMART Meeting, an SOS or Moderation Meeting.

          • Happy

            Addiction therapist….hahahahaha! Good one, even Dr. Carl Jung a great Psychiatrist knew that for certain Alcoholics something more than therapy was needed, note he did not say all!

          • massive

            Your arrogance is so telling….such a stepper …you think you know everything. My therapist who was and is a Phd Is the one who helped me NOT AA with childhood trauma.

          • Happy

            I’m happy for you massive. What I was referring to was that in some cases therapy does not work, which is what Dr. Jung stated, out of his experience with hard cases. I don’t know much actually, but what I do know is I have had much therapy and most of it good but AA is what lead me to being sober. I don’t claim nor does AA claim to have the answer for all, but the anger in some of these posts are disturbing to me. Why bash AA? AA as an organization is completely neutral, they only want to help and it’s free, not everyone can afford a therapist, why be such a hater on AA? People within AA are just that, people! They are not perfect and therefore to judge an organization by some of it’s members is narrow minded.

          • James Self

            Nicely said.

          • wolfemurray

            Jung said a “spiritual conversion” is needed to deal with alcoholism.

          • Happy

            why is it harmful? Reading your book could be considered harmful!

          • James Self

            Lance, I get what you’re saying and I think overall your perspective is interesting, but I don’t think telling people who are struggling to “keep coming back” is too harmful– it’s meant as encouragement (when it’s not a backhanded way of insulting someone, that is) People are free to make their own choices– I’ve been on both sides of the coin myself (eight years clean in NA at one point) and while I would agree that making people aware of their options is a great thing, and that science really should lead the charge in the fight against addiction, I don’t think “keep coming back” is really harmful. More often than not it just serves to encourage people when they’re having trouble– and people who can’t stand the program aren’t going to stick around anyway. That being said, thanks for the alternative perspective. I agree with a lot of your points.

          • Lance Dodes

            Thanks for your comment, James. I agree that “keep coming back” is usually meant in kindness, but it would be good if people were aware that this may be harmful advice.

          • massive

            This is what you learned in AA how to talk to people? Your behavior here is a perfect example of AA member arrogance.

          • James Self

            …does patronizing others really advance the conversation? Using “keep coming back” as some sort of backhanded insult always pissed me off when I was in the program, and it’s funny that it still does.

      • ez

        “AA is absolutely not a religious program”

        Courts from the 1st, 2nd, 4th, 7th, 8th, 9th and 11th Circuits disagree with you.

        • Whatever

          Yes, and anyone who has taken any Religious Studies survey course will agree that AA definitely falls under the definition of a religion.

          • suem

            I have taken the course and I don’t agree.

    • Marti Salvato

      Heh. Just for the record I’ve met more open agnostics and atheists (or non-deists) in the rooms of 12 step fellowships than anywhere else. The lack of belief in sky gods is not mutually exclusive with an embrace of spirituality. You’re confusing me with someone who cares about religion.

    • placer


      As a member with well over 20 years clean and sober, I am very sorry about how those bullies treated you. I once remember a bully (a “six-month wonder” as I call them today) trying to work my program for me. So, I went to another meeting and downright said “people who try and work my program for me can go **** themselves”. No one disagreed with me.

      I very strongly suggest that any woman in the rooms who doesn’t feel comfortable around men for any reason go only to women’s meetings. The issues you have mentioned (Bullying and 13-stepping) are a lot less prevalent in those meetings.

  • Jeff Meyer

    Look, who knows, but I am glad to have my dad back, and he went through AA. Like most things, there is no panacea, but it clearly works for some people so let’s not pretend like it’s useless.

  • Kathleen Gargan

    What Dr Dodes and his critics acknowledge is that community with others who struggle with addiction can make the difference between lifelong suffering and a meaningful life free from addiction. In addition to 12 step programs there are 3 other non-profit, abstinence based secular organizations that offer this community. LifeRing Secular Recovery, SMART Recovery and Women For Sobriety are collectively responsible for the lifelong sobriety of countless people with addictions. If 12 step programs help millions, even more will be helped when Dr Dodes and his critics acknowledge and investigate these secular options.
    Kathleen Gargan

    • AntiDenial

      Yes SMART Recovery is a great option

      I support Dr. Lance Dodes and am happy to see AA being exposed for the failure it is.

  • Kelly Knox

    I think Dr. Kelly Misrepresents what Dr. Dodes said in the interview. My question is how do you count the success rate of people who left AA. Do we assume they are drinking again? There is no other way to study what happens to those who stop attending AA. And what about people with borderline personality disorder or other mental health concerns whose very illnesses makes it nearly impossible to form healthy attachments without the support of “expensive” psychotherapy? Which brings me to the health care crisis we are dealing with in the U.S.A. Does AA work? Yes it saved my life. Do I go to meetings now. No, I do not like meetings. How is the success of my sobriety counted, and the many people I know who no longer attend AA and are living sober, extraordinary lives? I just got a call from a friend in great distress. She is having blackouts, and is lost to the disease. She is on her way to a meeting. That is where she should go. It really is duplicitous and not black and white.

    • massive

      If its a health crisis then see a doctor , a therapist and an addiction specialist. Praying to remove character defects and ones drinking is really quite harmful. Religious of not….that is not how to deal with a health or mental health issue or early childhood trauma. Also women in AA are sexually preyed on at an alarming rate as recently stated at PRAASA by high ranking AA trustee. There are many around today in 2014. Bill and his cohorts were the lone wolves in 1939 when their book came out. Now there are 7 other free options and The Sinclair Method as well. The lies repeated in AA hurt millions who are told They have failed, when its AA that has failed. Check out Claudia Christians new film soon to be out called One little Pill. She is offering a science based option that has nothing to do with character defects and prayer.

      • Happy

        To say AA is useless is as false as saying AA is the only way. Millions of people claim that AA has saved their lives, what’s wrong with that if it’s working for them. Some really angry rants here, AA is definitely not for everyone and they never claim to be. This clown is trying to sell books and all these rabid rants are really sad. AA has not failed and to say it has is pretty ignorant! Glad you found what you wanted as for me I’ll stay in AA, pretty happy there and I find no need in telling people they must stay in AA, they can do what’s best for them.

        • suem

          I wholeheartedly agree. If you stay sober that is what’s important. This is a really heated discussion with unfounded statements being hurled left and right. AA works for me too but it’s not the only thing I do.

      • Kelly Geistler

        The Sinclair Method is just plain foolish and poor science. Talk about the ultimate in obsession! To be so obsessed with drinking that you will take a pill to drink your way out of being a drunk rather than abstain. Sounds like Ultimate Alcoholism. AA is not the answer for everyone, that may be true, but the Sinclair Method is just ridiculousness. Taking drugs to get off drugs will never make sense,except to big Pharma and doctors who want to do science experiments on people. Ridiculous.

        • massive

          Really kelly- The Sinclair Method is helping hundreds of hopeless people that AA has failed. Read Claudia Christians book Babylon Confidential and see her new trailer for her upcoming film. You know….if TSM helps one I thought you spiritual steppers would be happy. Not every body has charter defects that cause them to be dependent on Alcohol. AA has single handily stopped serious scientific research.

        • Claudia Christian

          Actually Kelly, TSM is based on science and it has a nearly 80% long term success rate whilst AA has a 80-89% RELAPSE rate within the first year. Naltrexone is an FDA, safe, non addictive opiate blocker that causes pharmacological extinction in the brain so it literally undoes the learned behavior of addiction. You may not understand it or believe in it, but it works. I do not deny anyone ANY treatment that will help them, I have been on TSM for 5 years and it is quite the opposite of being obsessed with alcohol, it removes the thoughts and cravings and you no longer desire to drink. In my mind that is far healthier then spending every day of your life in a meeting talking about alcohol and alcohol dependency and calling yourself an “alcoholic” for the rest of your life. before you go attacking something I suggest you learn about it, other wise you look simply misinformed. I have a non profit website with excellent information about TSM here: .
          TSM has saved thousands of lives…iit was the number one treatment for alcohol addiciton in Finland for decades where it saved over 70,000 lives….. and tonight I am opening a TSM clinic in Beverly Hills, California….with DOCTORS….see? Doctors and scientists are who I trust my health and the health of the people I love with. Not a bunch of untrained people sitting around hoping they manage to stay sober this time around and beating themselves up if they “fail” a step. AA works for a small percentage of people, bless them, I am thrilled for them. BUT, what about the rest of the people suffering? I can knock out 80% of alcohol addiction with TSM and you’re questioning the validity of it? Do you want people to die Kelly? Is this your MO?
          I think that someday soon you will see that science will win the day.
          By the way, Bill W stated emphatically that he prayed for the day that SCIENCE would help alcoholics…..and guess what? His prayers came true.
          I will continue to save lives and you can continue to spout lies and negative conjecture…or you can be an empathetic human being and allow addicts to treat their addiction in the way THEY choose to.

      • suem

        Please share your source for the million who were lied to as I have never heard that in any meeting.