The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

by Lance Dodes, Zachary Dodes

A powerful exposé of Alcoholics Anonymous, 12-step programs, and the rehab industry—and how a failed addiction treatment model came to dominate America.“A humane, science-based, global view of addiction . . . an essential, bracing critique of the rehab industry and its ideological foundations that we have much to learn from.” —Gabor Maté M.D., author of In The Realm of Hungry Ghosts Alcoholics Anonymous has become so infused in our society that it is practically synonymous with addiction recovery. Yet the evidence shows that AA has only a 5–10 percent success rate—hardly better than no treatment at all. Despite this, doctors, employers, and judges regularly refer addicted people to treatment programs and rehab facilities based on the 12-step model. In The Sober Truth, acclaimed addiction specialist Dr. Lance Dodes exposes the deeply flawed science that the 12-step industry has used to support its programs. Dr. Dodes analyzes dozens of studies to reveal a startling pattern of errors, misjudgments, and biases. He also pores over the research to highlight the best peer-reviewed studies available and discovers that they reach a grim consensus on the program’s overall success. But The Sober Truth is more than a book about addiction. It is also a book about science and how and why AA and rehab became so popular, despite the discouraging data. Drawing from thirty-five years of clinical practice and firsthand accounts submitted by addicts, Dr. Dodes explores the entire story of AA’s rise—from its origins in early fundamentalist religious and mystical beliefs to its present-day place of privilege in politics and media.  A powerful response to the monopoly of the 12-step program and the myth that they are a universal solution to addiction, The Sober Truth offers new and actionable information for addicts, their families, and medical providers, and lays out better ways to understand addiction for those seeking a more effective and compassionate approach to this treatable problem.

Genres: Nonfiction, Psychology, Addiction, Science, Mental Health, Health, Drugs

193 pages, Kindle Edition

First published March 25, 2014

About the author

Lance Dodes, MD, has been treating people with addictions for more than three decades. He is the author of The Heart of Addiction and Breaking Addiction. He is a Training and Supervising analyst emeritus with the Boston Psychoanalytic Society and Institute and recently retired assistant clinical professor of psychiatry at Harvard Medical School. He lives in Southern California.

Reviews

[Carmen · Rating 3 out of 5]

"You're sick. And you'll always BE sick."
- Darla, BtVS, Episode 1.7


This book is a case of very interesting subject matter, but boring execution.

I'm going to break down this book for you so you don't have to read it. Let me explain the author's views to you:

- AA programs blame, humiliate and shame addicts.

- AA has too much emphasis on religion and a higher power.

- AA promotes the incorrect and untrue statement that only addicts can treat other addicts.

- AA says alcoholism is a disease; the author states it is a behavior or set of behaviors.

- AA says you can NEVER cure your alcoholism, you are an alcoholic for LIFE. Author says you can cure yourself from addiction, you do not have to be an alcoholic for life, you can get better.

- AA can't deal with the fact that stopping drinking doesn't always make people's lives magically better. People who are still depressed and have shitty lives and/or kill themselves are NOT accepted by the AA community, they are shut down when they try to share their stories.

- Some people in AA are bad people, predators who prey on the vulnerable, and/or people who enjoy shaming and humiliating other people. People are sometimes sexually and financially preyed on by predators they are exposed to at meetings. And AA's culture of encouraging the shaming and humiliation of others can be like a fun buffet for sadists.
"..like the Catholic Church. Some parishes may be really, really great and strong and wonderful with a great priest. And others can be really, really corrupt with a pedophile [priest]. Who knows what you are going to get? That's the bad thing about therapists just telling people to go to AA. They have no idea what they're going to get."

- AA treats only the symptom (drinking) not it's cause(s).

- AA does not offer individual programs, instead it's a mass treatment that's supposed to work for everyone. This is a bad idea.

- AA often shames and discourages people from using prescription anti-depressants or other psychiatric medicine because they see it as another "addiction." Members are often shamed and scolded for taking pills prescribed by a psychiatrist.

- The author promotes psychotherapy in the place of AA. It's individual, it's compassionate, and it treats the cause of the problem not just the symptom. Of course, the author IS a psychiatrist.



Okay, that sums up the book. My personal thoughts:

- No one is going to get better unless they want to get better. You can go to AA, you can go to psychotherapy, but no one can force you to get better against your will.

- AA does push religion, sometimes to a frightening extent.

- AA does teach helplessness and eternal sickness. I can't say I think this is the best attitude.

- I hate shaming and humiliating people, I can hardly believe that would be a good idea.

- AA is a great social (and FREE) program that gives people friends and support. Much like church. However, I think if you are going to be someone who goes to AA, you should also get therapy. I understand not everyone can afford this and thus AA's appeal to a lot of people.

- It's rather scary that AA is often seen as The Only Way to treat alcoholics.

- AA works for some people, it doesn't for others - and it should be OKAY if you are creeped out by AA and its philosophies. There should be some other widely known option for treatment for people who don't want to be in AA. However, tons of people are "ordered" to go to AA, and this isn't always the best thing.


Tl;dr - Is AA really the only choice for alcoholics' recovery? Does AA even work? AA is unregulated and ungoverned, and this can lead to some shitty AA groups run by some shitty people. This author stresses that psychotherapy is a much better option for people for a wide range of reasons. However, AA is free. What's the answer? Is there an answer?

UPDATE 03/12/2020 https://nyti.ms/2IPqktL
"Alcoholic Anonymous vs. Other Approaches: The Evidence Is Now In"

[Sarah · Rating 4 out of 5]

As a therapist who frequently works with clients struggling with substance abuse, I’m baffled that I’ve never considered the fundamental question of whether the AA model is actually effective, and under what circumstances it may be contraindicated. How have I gone so long taking such care to provide individualized treatment in relation to mental health issues, but blindly relied on a cookie-cutter approach to substance abuse? One-size-fits-all thinking and treatment represents the direct opposite of my values as a helping professional.

So where does this seemingly incontestable reverence for the 12-steps come from? The outlandish claims of AA’s overwhelming success, as Dodes points out in this book, are based almost wholly on bad science and flat out unsubstantiated propaganda. In fact, from the data that is available (admittedly limited), AA has only a 5-10% success rate for those who join.

This is particularly disconcerting as I contemplate my training as a therapist and the fact that, of all the mentors and teachers I’ve had (undoubtedly good, caring people), not one has questioned the validity of universal AA referrals. Moreover, lack of “success” in recovery (the definition of which being a whole other can of worms) is commonly perceived as “not being ready” or “not being committed” to addressing unhealthy behaviors.

What an outrageous assumption! And a demeaning, unhelpful assumption at that! Making that judgement is comparable to claiming that someone who isn’t successfully losing weight via jogging is fundamentally “not ready” to adopt a healthier lifestyle. What about swimming? Dancing? Tennis? The idea that you’re somehow failing because you’ve not been presented with interventions that suit your own individual preferences and personality is absurd and destructive.

While it’s true that there are limited alternatives at this point, and that our understanding of addiction is far from complete, in my mind that is no excuse for not exploring the full spectrum of a client’s options and thinking outside the box for interventions that offer more individually effective solutions.

Of course the argument that AA is entirely ineffective for everyone is clearly false. That said, as a culture we’ve somehow become brainwashed into the belief that 12-step programs are the be-all end-all of substance abuse treatment. Considering that there’s no substantive evidence supporting this claim, and that the 12-step approach has been demonstrably harmful for some, the belief that AA is the one and only way is incredibly dangerous and clinically reckless.

I wholeheartedly recommend this book for anyone who is actively engaged in treating, researching, or otherwise curious about substance abuse issues. It brings up insightful questions and concerns that should be obvious, but somehow aren’t, and encourages critical thinking about a problem that has plagued and puzzled people for centuries.

[Leigh Sewell]

I became a heroin addict after witnessing my fiances murder. In and out of in patient and out patient rehabs as well as countless NA and AA programs, the 12 step program never worked for me. I congratulate those it did work for but being out spoken about it not working for me in this community, well, I may as well have shouted hail Satan in church. I'm really looking forward to reading this. Fingers crossed to win the giveaway.

Oh PS I'll have five years clean in a couple months. :)

[Rick Wilson · Rating 4 out of 5]

I’ve been sober coming up on five years now. It is one of the few unquestionably good decisions I’ve made in my life.

This book does a good job talking about some of the negatives of Alcoholics Anonymous. I would say it’s worth a read if you’re involved in the community. I’ll start the caveat that I don’t think I’d be sober without having gone to a lot of AA meetings in the first six months or so. But I’m definitely drifted from the community the longer I’ve been sober, for many of the reasons discussed in this book. Over reliance on religion, shame based focus, heavy denial of the self.

There’s a bit of a “ostrich with its head in the sand“ approach to some of the negatives in the aa community and unfortunately, what ends up happening is that people (me) who are dissenting often times find it easier to kind of fade away. I don’t see anything productive in trying to change something that’s helped a lot of people over decades, and I don’t think if I tried, it would result in much of anything other than a lot of frustration for all parties. But because of that, you’re left with just the sort of heavily traditional, highly invested folks who stick around long term. If you’ve been any meetings, it’s usually the old guy who looks like a bit of chewed up shoe leather sitting in the back talking about how “ it used to be this way” So I guess maybe i’m here to tell you you do not have to listen that guy to stay sober.

Only thing you have to do is not drink, and if you do that long enough, the rest of it’ll start to work itself out. I found that there was a combination of forcing myself to do step work early on and just hanging on by the tips of my fingers, but what I did manage lead to positive experiences and improved quality of living. That got me more excited about continuing to do it. It’s really relieving to not carry around the baggage of things you’ve done at some point. But there is this sort of dehumanized route advice to just blindly “find a sponsor to the step work“ without any sort of exploration of the individual.

If you’re really wrestling with it, go to some different meetings. There’s a lot of different types and usually similar. People are attracted to similar stuff. I spent the first three months only going to “atheist“ meetings, which now I don’t really connect with.

If you’re reading this random review on the Internet and find yourself struggling with overview of it, maybe check out some other books about sobriety. That helped me a lot. Books are safe, you take the parts that hit close to home and seem truthful and you just ignore out the rest of it.

I think if you’re looking at this review and saying, oh yeah, fuck those guys, maybe check out like SMART sobriety, I thought Russell Brand’s book was really good without being preachy. And for me, exploring trauma, and things related to that were really helpful. YMMV

Good luck out there

[Kara · Rating 5 out of 5]

The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, co-authored by brothers Lance and Zachary Dodes, is a far less dry and more radically change-oriented book than its title might suggest. What makes this read so compelling and its ideas so unusual, IMHO, is the primacy of individual human beings who struggle with addiction issues -- their personal thoughts, feelings, experiences -- in its assessment of the value of treatment options for those . Because of this fresh, humanistic perspective I believe the book is likely to be of great value to both readers drawn to this topic for reasons of personal experience (broadly speaking -- I’m not just talking about the addicts themselves) and/or those interested in the problem more generally because of its impact on society as a whole and the grievous damage it does to so many human lives and human relationships.

In my view, The Sober Truth successfully discredits the popular assumption that 12-step programs such as Alcoholics Anonymous (AA), its various affiliates focused on other types of addiction, and the great many other rehabilitation programs that incorporate significant components of the 12-step method into their own methodology not only are unnecessary for successful recovery, but that these programs can set individuals back in their attempts to curtail their substance abuse (or other targeted behavior) and sustainably change their lives.

You may imagine, as I did, that the book’s attack on the legitimacy of the 12-step treatment modality created by AA would rely on the deployment of in-depth analysis of a variety of scientific research studies on these programs’ (as well as other forms of treatments’) ability to provide their respective participants with successful coping methods and effect sustainable life change. While some observational studies (necessarily of less value than randomized treatment trial studies) are reviewed in the book, science is not the weapon the book uses in its argument. First of all, there is a dearth of reliable research available on the efficacy of 12-step and other addiction treatments, either individually or comparatively. Summing up the reasons for the lack of “good science” available on this topic, the authors state:

“A poor understanding of these issues--the need for randomization, the difference between correlation and causation, and the power of the compliance effect--has colored much of the research that has been conducted to date about the effectiveness of 12-step membership and attendance” (p. 33).

Existing research is surveyed in greater detail with applicable limitations set forth straightforwardly and specifically in the book’s chapter: “Does AA work?”

However, the authors make clear their belief that numerical data would not be the most effective fodder for an attack on ineffective treatment modalities. In Chapter Nine, “The Failure of Addiction Research and Designing the Perfect Study,” they explain the foundation of their approach:

“These days, virtually every addiction journal assigns far more value to statistical studies than to clinical findings. The primary claim is that words are not rigorous; number are. Yet this perspective fails to account for the complexity of human beings, who are, let’s face it...more complex than any number could possibly assimilate” (p. 157).

Accordingly, most of the argument involves straightforward discussion of the particular history and practice of the 12-step programs, which highlights their origins in ideology rather than science and experience , and more critically, their rigidity and dogmatism. The 12-step programs hold themselves out as the only likely effective -- approach to addiction problems of manifold particularities experiences by a diverse cross-section of people in our society.

This book is at its best when it points out the poor reasoning behind some of AA’s cherished dogma and the very real threat some of its bad ideas pose to participants’ chances of recovery. If you only read one chapter of this book, make it “The Myths of AA” in which the authors quickly and powerfully expose the contradictions between people’s experiences of addiction and the one-size-fits-all narrative of addiction and recovery that underlies the 12-step system.

All this said, The Sober Truth as Dr. and Mr. Dodes tell it is not hopeless. While AA’s 12-step model is knocked down, psychotherapy is held up as an alternative that can meet people’s individual needs with a depth of empathy and flexibility of response unavailable in the former modality. What is powerfully persuasive about this and all the ideas propounded in the book is the openness to change and an implicit expectation of dialogue among treatment participants (before, during, after), clinicians, loved ones and other people with relevant experience in a continuing public discourse about how best to fight the problem of addiction and ameliorate affected lives. This openness is communicated in various ways throughout the book.

Most explicitly, a long chapter includes extended narrative accounts by people with 12-step program experience. Some positive views are expressed; most assessments are mixed or largely negative. The relative range of viewpoints presented, and especially the lack of heavy editing of these narratives, demonstrated to me the value of the personal particulars of these stories to the authors. They didn’t cherry pick for useful quotations, or ones that clearly and succinctly set forth particular views, or ones particularly expressive of the full spectrum of positive and negative experiences with 12-step treatment. I got the sense that the authors took these contributors’ ideas as they found them, more or less, and that spoke volumes to me. I think this book is really worthwhile reading.

Please be advised I received a free copy of this book from the LibraryThing Early Reviewer program in return for a promise to publish an honest review. Thank you for reading my ideas; I hope they prove helpful to some of you.

[Chris · Rating 4 out of 5]

This is a curious book. I picked it up for a book club that I'm going to soon, but I wanted to get some thoughts down while it's still fresh in my mind.

A little backstory, I have a history of substance abuse primarily with alcohol, and have been to a few AA meetings myself. I've been sober for almost three years now. I went to AA as part of a rehab program that was mildly 12 step based, but really was just group and education based. Rehab really helped me, but the actual AA meetings themselves really put me off for reasons that the authors get into in detail.

What most people don't know is that there is no evidence that AA actually does any good for most people. AA took off and became what it is today for the most American of reasons, good marketing. As the authors of the book go through in detail, AA for most people doesn't work. In detailed studies with control groups it often does worse than doing nothing at all. Both the spontaneous cure rate (doing nothing) and AA have a success rate of about 5-10%. Why does AA have a such a terrible record? There a bunch of theories that the authors get into. The reason most people are put off by AA is the overtly religious and "moral" aspects of the program. AA is a deeply religious organization, and is run pretty much as a religion. It maintains a disease based theory of addiction even while just about all the experts now dismiss this as wrong. It maintains if AA doesn't work for you it's your fault, not AA's fault. As the authors note, if you were taking a cure for cancer and it didn't work, would you blame yourself or the cure?

So why 4 stars instead of 5? Because the authors themselves have some rather strange biases that creep into the narrative. They spend the entire book railing against AA for not using evidence based medicine, then at the end they have a strange rant against evidence based medicine. This is mainly just a medical turf war, the authors prefer psychological based treatments rather than pharmaceutical ones. It's mainly turf war stuff.

That being said, if you've ever been to a 12 step meeting or know someone who has our think should be going to one, pick this up. It's a great overview of the huge flaws in the methodology of those systems while at the same time pointing out the good that they can do.

[Scott Helms · Rating 4 out of 5]

AA works...about 5% of the time.
rehab isn't much better and is EXPENSIVE!
this is tragic.
we need real medical AND psychological solutions to help with substance abuse problems in our world.

[Stefano · Rating 3 out of 5]

Not a bad book per se, but there is some misleading and deceptive bias in this book if you look at the cover!
The book addresses mainly the scientific-medical ratio of success of AA program put in relationship with the legal court-orders to follow a 12-steps program and its reliability from a scientific-medical point of view. Fair enough! This is what part of the title states. THEN, the book starts to address the rehab industry which is based on the 12-steps program (with the brouhaha of money, frauds, non professionalism ...) ... more than fair, but this point is against the “industry”. So why transform it in an attack to 12-steps programs? It is like to criticize the industry related to pseudo-therapists, psychologists, psychiatrists ... to demolish Psychology as such???
THEN it starts to address the problems of therapy related to addictions and SURPRISE ... the 12-steps program works for a range of addicts (and surprise ...) LIKE EVERY OTHER APPROACH!!! So the book says at the end that the major skill is to identify the better approach for every individual, and the 12- steps programs can really help some patterns ... like every other method or approach.

Now ... you see why the Cover of the book is so misleading?

[Lauren Mcarthur · Rating 3 out of 5]

So, I thought this was an interesting book. I agree kind of with it, though I never have had to face a drug/alcohol problem I know many who did. I don't want to discount the 12 step process completely because I know it is a long hard process to become sober, and it has worked for some people I know. However, I was shocked to see some statistics in the book. Now, I don't know if they are all reliable because this book is written subjectively against the 12 step program, and I'm sure if AA were to release statistics it would be somewhere in the middle. Over all however I came out of this book with a new perspective on AA. I believe in therapy and that can help many people, but that is not a one way path, and it is tailored to the client. The 12 step process is just that, steps. Not tailored to individual needs, and obviously not everyone fallows recovery in the same way.
So why 3 stars? While I liked the book, it was not really attention grabbing at some parts. This could have been because the topic does not pertain to me, and I couldn't directly relate. I do want to be a therapist, so it did peek my interest in substance abuse. I would recommend this book for professionals in the field, people who like direct facts or are extremely interested in this topic, and people who thought AA didn't work for them. If AA worked for you, I wouldn't read this book. It was a (mostly) quick read, which I liked because I have read a lot of these type books, and some of them get very tedious, repetitive, and repeat themselves too much.
I was glad I won the giveaway, so I greatly thank the author for sending me the book. I would just like to say to those who have an addiction, I bet it is scary, and daunting to give recovery a chance.I'm guessing a lot of people reading this book, have been through AA and relapsed, and there are many other way's to get better. But I promise you it can change, so please keep trying and don't give up.

[Kathleen · Rating 3 out of 5]

"The program works if you work it," is one of the least rigorous statements ever made. Any evidence of the efficacy of twelve step programs is entirely anecdotal, and proponents of the programs openly admit that there is a high recidivism rate. Yet there have been very few studies about the long term efficacy of twelve step programs and those that have been done suggest that rehabilitation isn't nearly as successful as the common lore would have it.

I could have done without the testimonial chapter in a book that is all about looking at the problem of addiction in a deeper, more scientific way. As heartbreaking as the family that misread the signs of an imminent suicide as making amends, I don't think an emotional appeal is necessary to make the point. Real medical and psychiatric treatment by professionals would be superior to encouraging laypeople to take control of care.

Overall, I found this argument persuasive, though there is a lot to be said for AA as a freely accessible service available anywhere in the country. As expensive as rehab might be and as unpalatable as the religious aspect of twelve step programs might feel, the cost of better treatment might make AA the only option for a lot of people.

This book is definitely worth a read, as the subject is one that deserves serious consideration.

[Holly Whitaker · Rating 3 out of 5]

good, but ultimately biased towards psychotherapy

I thought this book was ripe with relative and valuable points why as doesn't work. But completely biased towards the authors own profession and yet just one more account I "do it my way".

[Zoe · Rating 4 out of 5]

Important book. People need to be more aware of the failings of the 12 step model in order to start funding research into alternative methods to beat addiction.

[Joseph M. O'Connor · Rating 3 out of 5]

Eye-opening.

I'm in AA. I've been sober for over 13 years. Throughout that time I have made my own interpretation of what The 12 Steps actually mean, and how to work them. My "renegade" attitude fits very closely with what Dr. Dodes is talking about in his more meaningful chapters.

Take note! Dr. Dodes has meaningful chapters in his book and chapters in which he just seems to vent his anger at the AA process. That really isn't productive; indeed, his invective nearly prevented me from reading further and getting to the meat of his argument. But I forgive him his rant. He's right in many respects. The most important things being that AA will NOT result in a cure; AA will NEVER "get anyone sober;" going to AA meetings will NOT help anyone stop drinking.

UNLESS THEY REALLY WANT TO STOP!

And I dare say the same is true for any other drug/drink/gambling/over-eating/over-working/sex-addicted behaviour out there. Sigmund Freud himself ain't gonna help someone who doesn't want to change.

That single factor - effecting a change in one's behaviour - is, in the final analysis exactly what Dr. Dodes prescribes as the solution to alcoholism. Find, through analysis, what the problem is, look at the behaviour it causes, and effect a change in that behaviour. In his "MD-speak" this becomes "determine what helpless feeling leads to the displacement behaviour, deal with the feeling, and find that you are able to stop drinking/doing drugs/gambling/over-enthusiastic sexual behaviour, etc., etc."

Note that Dr. Dodes does not seem to know anyone for whom AA, with all its warts and foibles, was a positive influence and led to a happier healthier life. I guess that am here to say that for some people like me, AA has helped to work wonders. It's true that I was really done with drinking. It's true that I wanted, desperately, to stop. But... aren't people like me exactly those for whom AA was created?

The AA that works for me encourages its members to seek psychiatric care. I do. It encourages its members to obtain medical treatment for depression. I do. It encourages its members to think about and study and try ANY alternative treatment; and to use that treatment if it helps. I do. And my AA - the San Francisco Fellowship - does not put down alternative treatments. It suggests them. I do, too.

And if any AA hardliner reads this review and sees my name and chooses to chastise me for "breaking anonymity," well... the Big Book was written between 1935 and 1939. Almost 80 years ago. Things change. Society evolves. Get over it.

[Lane Willson · Rating 1 out of 5]

If this is what passes for science, then addicts are doomed. Dr. Dodes starts by declaring AA a "fundamentalist" sect. I've never known a group that includes Catholics, Baptist, Atheists, Buddhists, Protestants of all description, Agnostics, and folks just searching to be considered "fundamentalist". Of course I'm not a Harvard scientist like Dr. Dodes. For those of you with children smart enough to consider Harvard, Dr. Dodes is reason enough to choose Stanford or Yale.

[Lynn Kearney · Rating 3 out of 5]

It certainly debunks 12-step programs but I'm not completely convinced by the alternatives suggested for addiction treatment.

[Travis English · Rating 4 out of 5]

Highly informative and well supported by citations. Unfortunately, it comes across as self serving, given the author’s career.

The author is a psychologist, and he’s arguing that therapy with a psychologist is more effective than AA. While that may be true (the case made here seems sound), it certainly comes across as a bit self-serving. It almost would have been better to have the same book written by someone less invested in the alternative. Even saying this, as a critique of the book, is a little sad. The author is saying “the 12 step success rate is 5%-8%, and I can beat that”. That means If we were to send the next 100 cases to him, we’d save at least a few lives. But, it still feels oddly self-serving.

This is the first full-on critique of the 12-step approach that I’ve read, aside from the “orange papers”. And, while “orange papers” always came across as a passionate OCD conspiracy theorist being right the same twice per day as a broken clock, this critique is organized, concise, and well supported in every step. So, what’s the critique? Essentially: (1) The vast majority of medical and clinical addiction treatment in the US today is 12-step based. (2) The success rate, as an industry, is poor. The author estimates it at 5%-8%, which may be worse than the rate of spontaneous remission. (3) 12-step based therapy works for some: those who do well in it do well in it. (4) The rehabilitation industry is expensive in addition to being ineffective. (5) The religiosity of the 12 step model is unscientific (unsupportable) and a significant barrier to expanded success. (6) there are a number of ‘myths” and inaccuracies spread within the groups, which have unintended negative consequences.

[MonumentToDecency · Rating 5 out of 5]

Before I existed, my grandmother had a good friend who was an alcoholic. My grandmother accompanied the friend to to a couple of AA meetings. At one of the meetings my grandmother picked up a fridge magnet featuring the AA version of the serenity prayer:

God grant me the serenity to accept the things I cannot change
Courage to change the things I can
and the Wisdom to know the difference

As I kid I would read that prayer and think how nice it sounded. To be able to just deal with not being able to deal with stuff - so simple. I got my hands on the NA book (5th Ed.) when I was maybe 15. It was full of stories about people using drugs and/or alcohol, and their path to abstinence through the 12 Steps, and a lot of talk about god and higher powers.

As an adult, I've watched so many friends and acquaintances struggle through their addictions, many dying in the process, addiction has featured in my family, and at one point in time nearly everyone I knew had some kind of link to addiction. I know what it is, how it behaves, how it saves, and how it ruins. As an adult, I am firmly opposed to the incredibly simplistic, idealistic, guilt-laden, bible bashing of the 12 Step program. I have a large collection of ancient books on diagnosis and treatment of 'deviance' and addiction, comprised of theories and ideas spanning the last century. The so-called science behind the whole of AA fits firmly in there right next to Dr. Kellogg and his enemas for aneurysms - i.e. it is bogus and causes more harm than good.

The 12 Step program is based on stripping away a persons identity, leaving them as nothing but 'addict,' in mind, body and name. It tells people they will forever be their addiction, that there is no true recovery, only a lifelong battle against the weakness of your 'disease' which you willfully give in to (addiction is not a disease, it is a behaviour). Each time someone relapses, the NA/AA program strips away all their hard work, shaming and shunning anyone for simply becoming overwhelmed on their journey. AA ignores that relapses can increase a persons knowledge of their addiction, can help to reaffirm willpower, and help with subsequent attempts to get clean.

The Sober Truth is a brilliant, full scale examination of what precisely is wrong with the AA approach. Lance Dodes M.D. is a psychiatrist and psychoanalyst, an associate clinical professor of psychiatry at Harvard Med School. He has a very impressive resume and his career spans 30 odd years. If anyone is going to write a book on this stuff, it had to be him. The book collects research results and methodology to show why AA doesn't work, why it won't and can't work, and how the major US rehab centres use the lure of prestige to up-sell the AA program even though they know it doesn't work. The irony is, even using research conducted by AA and the rehabs, the success rate of the 12 Step program is fucking embarrassing.

The Sober Truth is presented in a very easy to read format, and while it covers a lot of research and stats you by no means need to be anything like a scientist to read and understand it. A ten year old could consume this with no problems. The Sober Truth importantly also offers solutions based in science with proven, replicable results - what does work and why it works. And the best bit: alternatives to AA programs are a heckload easier than the 12 Steps.

Success:
Why does the 12 Step program seem like a resounding success, all we ever hear about it is good news. Even the justice system refers people into the program, so it can't be all that bad, right? Wrong. The success rate is somewhere around 5% but it seems much higher "because most of us hear only from the people who succeeded in the program, it is natural to conclude that they represent the whole".

Failure:
The AA approach is that they give you the tools and you 'work the steps'. According to AA, if you fail, it wasn't the program, it was you. "Imagine if similar claims were made in defense of an ineffective antibiotic". We gave you the treatment, we know it works, so if it failed, it must be that you're just a failure. "In professional medicine, if a treatment doesn’t work, it’s the treatment that must be scrutinized, not the patient. Not so for Alcoholics Anonymous."

Religion:
When you've had a particularly hard time and you relapse or things are just really really shit and you feel like you are falling apart, it's nice and reassuring to have someone there to comfort you. And AA, like church, does lend a sense of community to people who need that. But a sense of community is not a treatment for addiction. At the end of the day you still have to live with yourself, trapped inside your mind with the knowledge that drives you to self-medicate. All the comfort and community in the universe can't change what's happening inside us. According to AA, sitting in a circle, pretending to be positive ('fake it til you make it'), hanging out with other people also struggling like fuck to not use today (mentors), not talking about anything that actually matters (they forbid talking about negative emotional issues), will help fix you. They believe that depression is caused by a lack of faith. They believe taking any prescribed medication to help with anxiety, depression, etc is toxic.

You have to completely strip away the last vestiges of power you have within and instead give yourself up to a 'higher power' because you literally cannot be trusted to be an adult. If you felt weak before, prepare to feel completely useless because according to AA: you are, you just haven't realised it yet. That one thing, giving yourself up to a higher power because you are weak and useless, goes against absolutely everything we know about treating addiction. To treat addiction we build people up, show them they are functional. We give people back their power.

I'm just going to do some quotes with headings now because if I comment on all the quotes I have in my notes we'll be here for longer than it takes to succeed at AA. (1 hour later... And of course I wrote a whole bunch more stuff because I just can't not. But it's interesting, so read away. It won't kill you.)

Morality:
"The notion that people with addictions suffer from a failure of morality to be indexed and removed is fundamental to Alcoholics Anonymous. Yet addiction is not a moral defect, and to suggest that does a great disservice to people suffering with this disorder..."

Degradation:
The degradation woven through these steps also seems unwittingly designed to exacerbate, rather than relieve, the humiliating feelings so common in addiction. If moral self-flagellation could cure addiction, we could be sure there would be precious few addicts.

On Step 5: admitting to god, yourself and others, the wrongs you have committed:
"People suffering with addictions as a rule tend to be well aware of the many “wrongs” they have committed. Awareness of this fact doesn’t help the problem". Indeed, awareness of wrongs committed during addiction are often a trigger for addictive behaviours. No wonder 95% of people don't get through the program.

Rehabs:
"[I]n rehab, one feels that one is doing something, taking on a life-changing intervention whose exorbitant expense ironically reinforces the impression that epochal changes must be just around the corner." Then you have to go home, to the house where you used, to the people that use with you or that were a trigger for using, to a job or no job which drives your using, to a town where every place you look reminds you of using. And suddenly you wish you were back at rehab patting that nice horse, but you're not, you're here in hell.

Repeating Rehab:
"What’s especially shocking is how the rehab industry responds to these individuals: they simply repeat their failed treatments, sometimes dozens of times. Repeat stays in rehab are very common, and readmission is almost always granted without any special consideration or review. On second and subsequent stays, the same program is offered, including lectures previously attended". What's that thing about the definition of insanity? Yeah, you know the one.

Bill Wilson, the guy who thought up this AA nonsense was an addict, an alcoholic to be precise. He invented the steps to treat himself. And he was successful, kind of. He didn't end up treating the cause of his addiction, just the addiction. So when he was free of alcohol he switched to a slew of other addictions:
"Bill was compulsive, given to emotional extremes. . . . Even after he stopped drinking, he was still a heavy consumer of cigarettes and coffee. He had a sweet tooth, a large appetite for sex, and a major enthusiasm for LSD and, later, for niacin, a B-complex vitamin.” In the end, Bill, basically a chain smoker, died of emphysema.

One of the biggest issues with AA is that they base their success rate on how many people remain in the program. They don't count people who leave. People who leave (for whatever reasons) are considered failures, 'they didn't do the steps properly,' therefore the program didn't fail, the person did. When I started uni, there were around 1000 people in my psych degree. By graduation around 150 were left. Proper figures would show 15% of students graduated (that's those 150 students). But AA would say that 100% graduated because they do not count people who leave. Saying 100% succeeded makes it look like 100% followed the program to completion, but they didn't. In the case of AA 95% don't follow to completion. Most cease attendance before 3 months.

"AA claims; namely, that the program “works if you work it.” Which is another way of saying that people who do well, do well. What does this mean about whether AA itself “works”?" "Harvard biostatistics professor Richard Gelber said, “The main problem is the self-fulfilling prophesy: the longer people stick with AA the better they are, hence AA must be working. It is like saying the longer you live, the older you will be when you die.”"
See how that doesn't work, it's not even remotely logical. Are you better because you stuck with AA or did you stick with AA because you were better? There's a valid point there that people who stick with AA are already more inclined toward recovery (and god). Research shows that people who are more involved in their healthcare attend healthcare appointments (doctors/specialists/gym membership/etc) more regularly. Are they healthy because they go to the doctor or do they go to the doctor because they're healthy? Hint: they go to the doctor because they're healthy. People who go to AA likely do so because they're already that way inclined. Those AA attendees very likely fit into the fucking big cohort that undergo spontaneous recovery regardless of treatment.

Bombshell:
"A higher percentage of alcoholics get better without any treatment than with AA, suggesting that some of AA’s success rate may simply be nature taking its course." That 'higher percentage' is around 35% of alcoholics. As opposed to AAs still questionable 5% success rate. Furthermore, research shows that people who join AA and then leave due to relapse/guilt/struggle tend to have much, much worse outcomes that people who never join at all.

I can't rate this book highly enough. Dodes explores AA and addiction in depth, he remains objective throughout and always backs his statements and claims with valid methodologically sound research. Yet, what I value even more highly than the AA take down is the 'So What Does Work to Treat Addiction' chapter. Lots of therapists and specialists understand addiction from a chemical point of view. Addiction happens because not because of drugs or alcohol but because of what is going on in the mind. Dodes really fucking gets it. If you want to read a really, really good book about treating what drives addiction, about how to predict when you're going to next use, about how to see psychological triggers you didn't even know existed, then pick up a copy of Breaking Addiction: A 7-Step Handbook for Ending Any Addiction

My Rating: 10 illogical bible bashers out of 5

[Rob Dinsmoor · Rating 5 out of 5]

Dr. Dodes takes on the claims made about Alcoholics Anonymous, arguing convincingly that there is scant scientific background to supports its effectiveness and highlighting the downside of buying into AA's philosophy and approach. With this, I have no problem with. My only objection is that he appears to very casually dismiss the idea that there is a biological component to long-term addiction. He argues something to the effect, "If exposure to alcohol were enough to cause addiction, then everyone who ever took a drink would be an alcoholic." This type of argument is a tad facile, dismissing the idea of a genetic component as carelessly as he dismisses a biological component. Nonetheless, I found it great reading and would highly recommend it to anyone who is considering (or has already been disappointed by) a 12-step program.

[Ray · Rating 5 out of 5]

This is a life-changing book for me. I even plan to buy it, and that's saying something.

It is significantly flawed, however. The author, a psychoanalyst, stops his ideas for effective treatment at the door of American individualized psychology models, most notably psychoanalysis, and also supports psychoactive medication. Although both those tools have helped me, I was disappointed that he paid no attention to systems of power and oppression, and the role of community in mental health and substance abuse prevention.

Still, his careful pulling apart of AA had me nodding and nearly in tears. Finally.

[Darina · Rating 5 out of 5]

This book saved my life. It helped me see that being subservient to narrsastic cult members who were only contributing to my self-esteem issues was more harmful than if I had sought no help at all. I was able to get licensed thearpy, and figure out that my drinking and depression had gotten progressively worse (to the point of multiple suicide attempts) BECAUSE of the insane teachings of AA. If you are in and out of the revolving door of AA, and cannot figure out why it's not working, stop blaming yourself for not working it, and read this book.

[Maggie · Rating 4 out of 5]

The premise is great. Why is AA the go-to recommendation for addicts? Although it sifts through data and explains research methods ad nauseum, it puts forth a great argument that there's no scientific reason that AA should be the only treatment method for addiction. I wish they would have spent more time going into detail about their recommended alternative. But, it's a great read that's quite thought-provoking.

[Savannah · Rating 3 out of 5]

Read this book for class. Had some good points that made me think and consider the opposing view to AA. Authors write with clear bias in passionate opposition of AA. An example of this is in the chapter on personal stories from AA, the authors state that they interviewed both success stories and failure stories of people who went through AA, but then fail to include any of the stories of success. The authors have a clear bias against religion as well, therefore impacting their views on AA which has a clearly religious/spiritual component. The authors also emphasize the fact that AA encourages submission to the individual’s own helplessness toward their addiction, but the authors disagree with this premise, claiming that the addict needs to find the power within themselves/self-reliance. But what the authors fail to consider is that by accepting their own helplessness toward their addiction, they gain power over it instead of continuing to white knuckle it on their own. This counterintuitive notion is pertinent and saturated in Christianity, the largest religion in the world. So there must be something to that. Overall a compelling read.

[micaela · Rating 2 out of 5]

1.5. i hate ending a year with a dud but here we are. this book started so strong - but should have stopped after its first few chapters. those were essentially a thorough literature review on AA and 12-step treatments, which revealed significant gaps in popular understanding of AA and major problems in the united states’ reliance on AA/12-step. then dodes started to talk about rehabs and it all went to shit. put another way: Noo don’t ruin all credibility your too sexy aha

dodes makes many good points about the questionable expenditure of money, the weak clinical work in these retreats, the prioritization of bangs and whistles over research-based treatment. but he shoots himself in the foot with his derision towards any treatment at all that isn’t just therapy. by constantly declaring that one thing or another has “nothing to do with treatment,” he is advocating for what amounts to institutionalization. mindfulness is advocated by MANY THERAPIES AND THERAPISTS. considering that addiction is often comorbid with other mental illnesses, entirely discarding very common recommendations for mental health treatment is ridiculous. DBT has a strong focus on mindfulness, and exercise is one of its key skills. why shouldn’t yoga, exercise, meditation, etc be part of a rehab experience? i agree that the balance of time in therapy vs. these activities is off-kilter, and that a profit-driven model means those perks drive prices up and make rehabs inaccessible… but having “nothing to do with treatment”? give me a break. grand vistas may not be as huge an asset to treatment that hazelden sells it as, but addiction is often a product of environment. advocating that addicts spend all day in intensive therapy in what? a hospital? is good for no one.

his crusade against rehab is also just fucking WRONG. his focus on his version of “treatment” is so myopic that it barely covers medication-assisted treatment in the first place, but the FACT is that hazelden introduced MAT as part of their work in 2003. TWO THOUSAND AND THREE! and this doesn’t merit a single mention in his polemic against them? btw, serious trials of MAT began in 2006, eight years before this book was published; these include medications specifically targeting alcohol use. dopesick went into detail about MAT for opioids and it’s absurd that this book - with a purported specific focus on science-based treatment - basically glosses over it, avoiding discussing the controlled clinical trials he advocates for earlier in the book. this feels somewhere between ignorant and straight-up dishonest.

dodes’ myopia extends to the therapy he advocates for as well. he exclusively pushes psychodynamic therapy, which i’ve done. i loved my therapist and got a lot out of it but i can tell you it did little for my obsessive or addictive tendencies. i don’t think cbt is helpful in all cases, but it’s extremely effective for ocd (which he parallels to addiction, more on that later), as is erp; dbt has elements that specifically focus on addiction. taking a swipe at the idea of using a workbook is frankly unprofessional. worse, while discussing one of the myths surrounding AA, that only addicts can treat addicts, his defensiveness essentially claims that addicts have no special knowledge to aid in treatment. what bullshit. of course they do! i agree that not only addicts can treat addicts but personal lived experience will always give you valuable insight that anyone outside simply can’t have. want to know how i know? because i have more fucking insight into half the stuff in this book than he does.

i also am simply hard pressed to believe him when he starts talking about anything else mental health related. i have been in a lot of therapies with a lot of therapists and shrinks and have never heard ANYONE claim there’s “true” depression which requires psychotherapy and “chemical” depression which is treatable by medication. what a fucking horrible attitude to take towards your patients. he states the same thing about ocd: “chemical ocd” vs “psychological compulsions.” i have experience in this area too. i learned a hell of a lot about the parasympathetic nervous system and the vegas nerve and the ocd cycle and blah blah, and also about trauma, and NOT ONCE did anyone say that some ocd is just chemistry and other ocd is caused by trauma and meds can’t help, or even that removing the root cause of an obsession is a cure. he also says that all ocd compulsions are irrational; i am tired of this stereotype, especially from therapists. some certainly are, but some feel absolutely rational. you cannot treat ocd without understanding this. everything i do because of my phobia feels like a good idea and there is solid internal logic. this is irresponsible bullshit. i would fucking hate being this guy’s patient. fuck that noise.

the problem is that drawing a parallel between ocd and addiction is actually a compelling argument. i can get behind this - it makes sense that in an effort to exert control over one’s environment or obsessions, one might turn to substances or rituals respectively. then, as with many things in this book, he tears down any goodwill he builds up by showing disdain for anything beyond his fairly narrow views. to add insult to injury, there is no research cited whatsoever for this conclusion. the entire book is about how little science there is behind AA - fine. but where is the research behind this? it appears to be in dodes’ head alone.

the science he cites behind addiction is questionable at best. his dismissal of a study of rats producing dopamine when presented with drugs runs counter to his anecdote of his patient’s reaction to drugs. another example: he claims overuse of painkillers can cause dependence but not addiction, and that it doesn’t permanently change brain chemistry. WHAT??? opioid addiction is classified as a disorder because of its effect on brain chemistry. his argument SEEMS to imply that victims of the opioid epidemic, for example, were just addicts in waiting, as opposed to people who followed medical instruction and were tossed into addiction by chemical dependency. as any heavy cannabis user can tell you, there is absolutely a difference between psychological addiction and chemical dependency - but that doesn’t mean that they can’t exist in concert or that one can’t lead to the other.

he claims at one point that he can “only” include 10 first-person anecdotes because of his deadline and page count. this is stupid. his book is, according to goodreads, 190 pages. this is short as hell; he could easily have included more. and claiming deadlines got in the way is insulting - all you need to do is edit them. what takes so long? and he should have included more - these stories are the most important and valuable part of the book outside his lit review chapter. dodes is not an addict. he should have been looking from moment one for personal accounts of people - NOT his patients - especially as they would probably self-select as ones who feel unheard under the onslaught of pro-AA voices. this is exclusionary, irresponsible writing.

it’s made especially exclusionary because this is the ONLY section of the book that actually interrogates what “success” is. these narratives do mention that moderate drinking can be success. this is fantastic to hear; i am a big advocate for this. in the atlantic article i cited above there are a number of examples of doctors who push for moderate drinking as opposed to total abstinence (backed, by the way, by science). while the latter definitely works for some people, it’s not the be-all and end-all… sort of like how AA isn’t the be-all and end-all of total sobriety either. that he doesn’t make this point himself is a glaring oversight.

there is much in this book that is good. the numbers challenging the popular narrative around AA’s effectiveness are striking. highlighting its stranglehold over rehab thinking and treatment in the united states is vitally important. facts like rehab counseling only requires a year of training (what?!) are important and terrifying. discussing the origins of AA, its unscientific approach - even, yes, the questionable methods in some rehabs. it’s all good stuff. it would make a great article. (as i’ve linked to repeatedly now, it did!) but instead of actually writing a book about AA, dodes writes a book defensive of his particular brand of therapy and throws science to the wind. the fact is that while there are merits to this book i am left with such a sour taste in my mouth that i can only state it was a waste of my time.

recommended reading:
frrobins' review
the atlantic article i keep linking: the irrationality of alcoholics anonymous
this new york times review by a doctor: taking aim at 12-step programs

[Frrobins · Rating 2 out of 5]

Dodes debunks the bad science behind AA meetings and traces the origins of AA and details how it became the powerhouse it is in the US. As a therapist who has worked with addiction, I am not a fan of AA or 12 step meetings. That said, Dodes really undermined his worked by first demonstrating that AA essentially only has anecdotal evidence to support it, and then positing his own "theory" on what addiction is, admits that there is no evidence other than his clinical observation (essentially, anecdotes), and asks us to trust him that he has it right and everyone else has it wrong.

I felt the sections detailing the origins of 12 step meetings, discussing how they research shows that they aren't effective, debunking some of the myths of AA, and describing how AA can be harmful were good and they match up with my experience as well as evidence I had read. Dodes concludes that while some people can benefit (and he explains why some people do benefit), using AA as a one sized fits all approach and courts mandating treatment has had disastrous consequences for how substance use disorders are treated in the US, a conclusion I have no problem with. If AA works for Person A, Person A should do it. But if its not working for Person B, Person B should not be forced to do it and feel guilty for not doing it.

Further, a lot of the problems he describes in the rehab industry and with 12 step meetings are real, and it was frustrating as while I worked for a small nonprofit we had freedom to provide a good treatment program that was not based on the 12 steps, but we still had to refer people to AA/NA per state requirements even though it was not evidence based and could be harmful to some clients.

I also thought some of the stories of people committing suicide while in AA alarming, and felt it warranted some investigation if people doing 12 step meetings were more likely to commit suicide.

Where I thought Dodes shot himself in the foot is where he talked about his own concept of addiction. He lambasted all addiction research, and then put forth his own hypothesis (which he deemed theory) of what addiction is, admitted there was no research supporting it, and said it was his observation. Basically anecdotes, and basically anecdotes are what people have for the effectiveness of AA and what he'd spent the rest of the book debunking. I felt the book would have been a lot stronger if he had admitted that there is a lot of controversy about what addiction is and that more studies need to be done rather than, after shredding AA for not having the right answer, he went on to write, "but I have the right answer!"

Further, some of his assertions were baffling, such as only depressants have withdrawal symptoms. People withdrawal from stimulants such as meth and cocaine, though it's not lethal like it can be with alcohol, and there are even withdrawal symptoms with marijuana, a hallucinogen. And while he used the Vietnam study of heroin users as proof that the disease model is debunked, I've seen the study interpreted as that the influence of location and the triggering things we see in a location play a role in addiction, not debunking the disease model so much. Further, he said that the NIDA has only done studies on rats, and this is not the case. They have done studies on humans showing that drug use affect human brains.

I do agree with his final call for a research study to look into the effectiveness of CBT, 12 Steps, therapy and no treatment. And I do think his idea that addiction stems from learned helplessness is interesting and deserves further research. That said, considering how many people there are in the world and how complex life is, I can see there being multiple causes of addiction, some biological (10% of people in the Vietnam study continued using heroin when they got back to the US afterall), some of it learned behavior, some of it something else we don't know yet. Overall I think if finding the cause of addiction was simple we would have done it already.

Overall, much as I want to take a swipe at 12 step meetings and the rehab industry, I can't recommend this book because the self inflicted wounds undermine the good parts of it.

[Kelly McCubbin · Rating 3 out of 5]

Coming from the point of view of an A.A. member, I find it hard to argue with Dodes assessment of the effectiveness of A.A.. He's right, it's got about a 5% success rate. And the studies that try to enhance and elevate that rate are hopelessly flawed. He also points out, very fairly, that folks who are driven to stick with it and stay in the program for a long time, have a much better success rate than those who are lacksidasical about it. He also, very fairly, implies that A.A. is often used by the Courts as well as medical professionals as a one size fits all solution to not have to really deal with adddiction in a larger sense and that we might be better off doing some actual good research.
Can't argue it.
That all said, if you can't stop and your life is falling apart and you are, perhaps, getting very ill, do what the doctor says, get some help. Go see a therapist. Go to A.A.. Find an alternative program. One of the arguments of this book is the very sound idea that we should encourage alternative addiction therapy. A.A. really does work for some people and makes them happy. Other things might work for you instead. Do everything you can think of until something, or several things, fit, because none of us want to see you die.

In the meantime, let's do more research. And let's lean on one of the really glorious arguments of this book. "When networked pieces of anything come together, be they ants in a colony or neurons in a brain, the network exhibits emergent behaviors that are far more strange and complex than anyone could predict from looking at their consituent parts."
In other words, use your tools, your 12 steps or your therapy or your meditation or whatever helps, but recognize that we are far more complex and deeply fascinating than what those tools can describe.
Isn't that neat?

[Tegan · Rating 4 out of 5]

I checked out this book because I have an unpleasant history with twelve-step treatment programs, and wanted to prove to my family and care providers that there are other, better ways. For that purpose, it did not disappoint. The Sober Truth does exactly what it says on the tin: debunks the unscientific claims to success of AA/NA, rehab, and myriad other twelve-step-based programs. In fact, it goes a step farther in taking a wrecking ball to AA's cherished disease model, in which addicts are seen as incurable victims of physiological dependence.

To me, the cherry on top was Chapter 5, about what does work to treat addiction. There, Dodes sets forth a scientifically based non-disease model of addiction as a behavioral compulsion best treated through.

All in all, the writing is clear, though somewhat lacking in style. I give the book four stars because about halfway through it began to feel a bit tedious, as though he was reiterating the same basic ideas in numerous ways. Perhaps this was simply unnecessary to me since I was already inclined to agree with him, or perhaps he needed to pad the text to book length, but I felt that either a little more concision, or enough style to keep my interest piqued, would have gone a long way.

I hope this doesn't discourage others from reading the book-- twelve-stepping is a big part of our culture and doesn't deserve it's angelic reputation, so it really is worth reading, even if you have to force yourself to keep going at times.

[David Ward · Rating 3 out of 5]

The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry by Lance Dodes (Beacon Press 2014) (616.8606). Premise: Alcoholics Anonymous (AA), a twelve-step program for alcoholics, is only effective in overcoming addiction about 5% or 10% of the time. That's the claim on this book's dust jacket. And that's not good enough, says the author, who is a physician.
Even more pointless than the AA program are “rehab centers,” which combine the Alcoholics Anonymous principles with in-house medical care. These are no more effective, and a typical twenty-eight day stay costs $30,000, says the author, but the alternative seems to be madness and death.
So what's the solution? The author fails to identify one. It sure sounds like the AA model is the best on offer. At least the one alcoholic in ten or one in twenty acknowledged by the author as having been helped by AA is better off, and attendance at AA meetings costs nothing! Maybe all AA provides is positive peer pressure, but it's better than nothing. Right? My rating: 7/10, finished 5/26/16.

[victor harris · Rating 5 out of 5]

As the title indicates, it takes the 12-step programs based on AA to task for spreading myths about the effectiveness of that approach for treating addiction. As he correctly argues, AA is nothing more than conservative religion cloaked in different jargon and it's founding was based on Christian beliefs. It also addresses the harmful "disease" mantra concerning alcohol addiction when there is no clinical support for such contentions. The rehab industry became lucrative selling such a proposition and most using the 12-step model often do more harm than good. Unless of course, one goes to the " celebrity" rehabs where riding on yacht is supposedly a good cure for addiction. While worth reading for anyone suspicious of the claims of AA or turned off by their zealous religiosity. Which by the way, the best studies done, show a success rate for 12-step treatments as between 4-8 %, though they deceptively make outrageous claims boasting of much higher success rates.

[Kate · Rating 3 out of 5]

I really didn't love or hate The Sober Truth. I thought this book had some limitations. Dodes' major criticism of 12-step programs is the ineffective research, and low success rate. Yet, Dodes advocates his use of psychodynamic therapy to be a better solution to treating addiction, but doesn't provide adequate research to substantiate this argument. I do agree that 12-step programs are not a one size fits all solution to overcoming addiction. However, some people simply cannot afford 1 hour a week of psychotherapy. While, psychodynamic therapy may have worked for some of Dodes patients, I do not believe that all patients will have the same success rate by a practitioner using only a psychodynamic theoretical orientation. People are too complex to be reduced to any one size fits all approach whether it be psychodynamic therapy or attending 12-step programs.

[Matthew Lawrence · Rating 4 out of 5]

It's not the most compellingly written book-actually, it feels like the authors went to a great lengths to stretch it to 160 pages at all-but it's a really interesting subject. I didn't realize that AA success rates are as low as they are (10% on the high end) but ultimately the book argues the greater point of how psychology is now taking a backseat to biology in addiction studies, largely because pharmaceutical companies are better equipped to fund studies these days. There is also a lot bat the God parts of 12-step programs and how various courts have ruled it unconstitutional for judges to mandate 12-step programs.