May. 20th, 2017

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

My rating: 2 of 5 stars

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.

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