An article on Salon recently went viral. Thousands of social shares later, and I’m sure at least some people with substance abuse disorders have died because of it. Perhaps that view is a little extreme. But if you’re in recovery, you know that alcoholism and addiction are life and death matters. Not just for the substance abuser either.
Alcoholics tend to have issues with anger and resentment. This wasn’t any secret over 70 years ago when the Big Book of Alcoholics Anonymouswas published. It’s no secret today. Imagine this scenario: a recovering alcoholic reads about how the 12 steps are actually detrimental to recovery. Even worse, the article is written by a guy with seemingly legitimate credentials.
I’m using myself as an example in this scenario. Life gets tough, and I start to slack off on my 12 step program of recovery. One day, on Facebook, someone shares an article called The Pseudo-Science of Alcoholics Anonymous: There’s a Better Way to Treat Addiction.
I read the article. Because I’m in a vulnerable condition, I get a case of the fuck-its. I knew my little brother was right, AA was a cult. Never mind the fact I’ve been sober for 2 years. They were lying to me. All I need is talk therapy.
I’ll make an appointment with a therapist tomorrow. Before I do, I might as well get good and drunk tonight. Since I’m not going to see any of my friends in recovery anymore, or take pride in the chips I receive for my sobriety, I’ll have one last hurrah.
Little do I know that on the way home, since I enjoy drinking and driving and speeding, I’ll hit someone head on in a haze of booze and blurry vision. The impact instantly kills the other vehicle’s occupant, a young lady on her way home from a second job.
Two lives are lost, all because some self-aggrandizing doctor wanted to sell some books.
Sound far-fetched? It’s not.
WHY DID TWO HARVARD PROFESSORS DEFEND THE 12 STEPS?
Anyone who has been to a 12 step meeting knows men and women get drunk for reasons far less believable. I think I speak for everyone in the recovery community when I say the author of this article, Dr. Lance Dodes, is a complete donkey.
Who is Dr. Lance Dodes? If you read the biography on his website, he sounds like the Jesus Christ of substance abuse recovery.
Here’s what it says:
- “Lance Dodes, M.D. is a Training and Supervising Analyst Emeritus with the Boston Psychoanalytic Society and Institute and was assistant clinical professor of psychiatry at Harvard Medical School (retired). He has been the Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the Alcoholism Treatment Unit at Spaulding Rehabilitation Hospital (now part of Massachusetts General Hospital) and Director of the Boston Center for Problem Gambling. He annually chairs the discussion group The Patient with Addiction in Psychotherapy and Psychoanalysis at the fall meeting of the American Psychoanalytic Association. He is the author or co-author of a number of journal articles and book chapters about addiction. His books, The Heart of Addiction (HarperCollins, 2002) and Breaking Addiction: A 7-Step Handbook for Ending Any Addiction (HarperCollins, 2011) have been described as revolutionary advances in understanding how addictions work. Dr. Dodes has been honored by the Division on Addictions at Harvard Medical School for “Distinguished Contribution” to the study and treatment of addictive behavior, and has been elected a Distinguished Fellow of the American Academy of Addiction Psychiatry. He has been invited to speak about the treatment of addiction at symposia around the country.”
I haven’t read Dr. Dodes’ book. I’m sure he does an excellent job of decimating the 12 step program. The only issue I agree with him on is his critique of modern addiction treatment programs.
- “…many top rehab programs include extra features such as horseback riding, Reiki massage, and “adventure therapy” to help their clients exorcise the demons of addiction. Some renowned programs even have “equine therapists” available to treat addiction—a fairly novel credential in this context, to put it kindly. Sadly, there is no evidence that these additional “treatments” serve any purpose other than to provide momentary comfort to their clientele—and cover for the programs’ astronomical fees, which can exceed $90,000 a month.”
As someone who is in long-term recovery from alcoholism and opiate/heroin addiction, I know this all too well. Trying to saddle a horse was a bit of a challenge. Yet it taught me precisely nothing about staying sober.
Adventure therapy? Seems like most modern addiction treatment programs slap a therapy stamp on anything they offer, making it sound legit. It’s not. It’s a joke.
These offerings are designed to lure substance abusers who are notoriously resistant to the idea of getting help. Or getting sober.
So maybe the Dr. Dodes isn’t all that bad. At least some of his points merit further discussion.
ENTER HARVARD'S JOHN F. KELLY AND GENE BERESIN
Two Harvard Medical School professors of Psychiatry wrote a response entitled In Defense of 12 Steps: What Science Really Tells Us about Addiction.
John F. Kelly and Gene Beresin don’t share Dr. Dodes’ opinion. At all.
Here’s a snippet from the opening of their article:
“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.”
Let’s see if they offer studies to back up their claims, which Dr. Dodes conveniently left out of his article. It also seems Dr. Dodes likes to use research that actually supports the 12 steps by presenting it as if it doesn’t.
“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.”
12 Steps: 1 Dr. Dodes: 0
“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.”
12 Steps: 2 Dr. Dodes: 0
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.
12 Steps: 3 Dr. Dodes: 0
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.
12 Steps: 4 Dr. Dodes: 0
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.
DR. DONK...ERR...DR. DODES KO’D! 12 STEPS WINNER BY KNOCKOUT IN THE 5TH ROUND
“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.”
And Dr. Lance Dodes is officially dead. Any person interested in recovery should not take this doctor seriously. He’s a quack who’s pushing financially motivated recovery – his own unique addiction solution. There’s even books you can buy too.
I almost want to invite him to speak at Discovery Place and have our staff troll him the entire lecture.
Oh look at me, I think I need to do a 4th step inventory.
If you care about the 12 steps, please share this article via your favorite social media platform. Let’s see if we can outshare the article Dr. Dodes published!