By Lance Dodes and Zachary Dodes, authors of The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry (Beacon Press, 2015)
The major current interventions for alcoholism and other addictions are based on some terribly flawed science, and have startlingly poor success rates. These are the key findings within our 2014 book, The Sober Truth.
My co-author and I reviewed every major scientific study examining outcomes for AA and 12-step-based rehabilitation programs, and found that the most likely success rate for these programs falls somewhere between 5% and 10%. This wasn’t our finding alone; an exhaustive scientific review by the prestigious Cochrane Collection which examined all AA studies over 40 years came to an even more damning conclusion, disclosing that “No experimental studies unequivocally demonstrated the effectiveness of AA” at all.
We found that virtually all of the studies that are commonly cited in support of AA fail to meet ordinary scientific standards. Many of them examine only a short window of this lifelong condition, and most fail to account for widely known statistical issues such as selection bias, compliance bias, and subjective self-reporting without independent verification. Perhaps most egregiously, many of the authors of these papers simply discarded data that did not fit their conclusions.
Nearly all of the research in support of AA concludes that those who stay in the program the longest do best, as if this were a meaningful statement of proof. In fact it is a tautology. The people who stay, do so because they are already doing well. Everyone else drops out. Because most studies ignore the vast majority of people who leave the program, their widely-touted results only reflect a small, self-selected group that remains.
Sadly, the widespread cultural cachet of 12 Step programs and rehab facilities has led many people to a destructive myth: that if you can’t make use of AA, it’s your problem, and not a weakness of the program. In fact the reverse is true, which suggests that the 90% of addicts we are scolding to “stick with the program” are at best wasting their time, and at worst compounding a debilitating sense of helplessness and despair.
The book also undertakes a clear-eyed review of the rehab industry. Pastoral retreats such as The Betty Ford Center and Promises Malibu typically charge tens of thousands of dollars for the same 12-step program you can get for free in a church basement, so they must they compete with each other by offering irrelevant extras such as horse therapy, Reiki massage and ocean adventuring. That the data is scarce on these programs is no accident: it turns out hardly any of them have studied their own outcomes. (If they have, they refuse to publish their findings.) This hasn’t stopped many of them from trumpeting dubiously high success rates, a PR effort they can pursue with impunity, as the rehab industry is entirely unregulated.
There is no question that 12-step programs have saved some people’s lives. But sending everyone with an addiction to AA or its cousins is simply poor practice, not to mention a calamitous waste of time and resources. It is time to turn the page and change the national discussion on what is the appropriate treatment for addiction.
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.
ZACHARY DODES is a freelance writer based in Southern California. He earned a BA from Yale University and an MFA from the University of Southern California.