The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry Hardcover – March 25, 2014

I am 34 years old and have struggled with addiction for the past 15 years. It culminated with the loss of job, home, large retirement savings, many friends and family. I studied extensively to try to figure this stuff out on my own but continued to fail. Mind you i have numerous professional accreditations, degrees, and am of very high intelligence.

Many of my friends referred to me as the "smartest and dumbest person they'd ever met." It was a weird statement to take pride in but I did as I knew it to be true. I simply could not abstain from drunken or drug induced outrageous behaviors including arrests, wild sexual parties, expensive damage to professional and personal reputation. It plagued every relationship I entered to the point where I became infamous.

I entered a 90 day treatment facility and benefitted from some of the stuff we did there but if i ran the cost/benefit analysis or measured it based on the time commitment the results were pathetic. Most of this was due to the sheer insanity of the 12 step mentality, and the bogus "disease model of addiction" which i knew going into treatment was based on faulty reasoning and industry profits.

This book walks you through all the stages of addiction studies and why they are inaccurate and then targets the true underlying causes of addiction. It tells the merits of rehab and 12 step based groups then provides valuable insight as to what these groups lack. An absolute must read for anyone serious about beating addiction.

When I read the first chapter, I had the feeling like I could have written it. I am a psychologist who worked with parolees, and when I'd get a referral involving a substance abuser, it would be as a last resort, after traditional AA programming had failed. The philosophy in this book works, & I have seen it work many times.

This book is of course, correct. It rightfully debunks the myth that god-programs of the 12 steps come even close to qualifying as "treatment." But people have been debunking this myth for decades now, and I've seen nothing change. The U.S. "treatment" centers are still overwhelmingly based in faith-healing, even though faith-healing has long since fallen out of fashion as a type of legitimate treatment. For every other medical issue, we do not tell people to get better by praying to the skydaddy to rescue them, yet this is what the 12 steps are based upon. I'm frustrated reading the same work over and over again, and seeing nothing change.

The Sober Truth is accurate, full of explanations as to why god-programs and faith-healing do not work (what a shocker!) and contains some interesting personal stories. But this book is not ground-breaking or full of particularly new information; indeed, the most sober truth about the matter is the sad fact that a book like this still needs to be written and read, because the U.S. is so stubbornly steadfast in its make-believe ideas that addiction is a moral failing marked by "character defects" and the solution is a-higher-power-god-skydaddy-rescuer. No wonder addiction is an epidemic in this country.

In 160 pages of text, don’t expect this book to be a literature review of studies relating AA to treatment receptivity and treatment outcome, although it does offer some representative examples. I found The Sober Truth less of a polemic against AA than Rational Recovery. Both books seriously undermine AA claims to effectiveness and minimization of its religious underpinnings. The Sober Truth further overviews the marketing of AA by its proponents to the front lines of popular treatment without much empirical evidence to support its efficacy.

Until I read this book I did not know that AA took its famous twelve steps directly from a fundamentalist religious organization founded in the early twentieth century. I did not know that Bill W. even after he stopped drinking was a heavy consumer of cigarettes and coffee, was serially unfaithful to his marital partner and experimented with hallucinogenics. I did not know E.M. Jellinek, the originator of the disease model of alcoholism, eventually distanced himself from the conceptualization. I did not know that five US circuit Courts of Appeals ruled against mandatory referral to twelve-step-based treatment on the basis that there is “no doubt” that AA meetings are “intensely religious events.”

As a practicing psychologist with over thirty years of experience, I’ve certainly seen AA proponents and detractors along the way, including a subgroup of proponents who recoil at the religious infrastructure. Moreover, I am attuned to the paucity of adequately designed research published in peer-reviewed journals after the 70+ years AA has been around that demonstrates utility much above chance levels. Even the COMBINE study published by JAMA in 2006 comparing medical management (e.g., naltrexone) with “combined behavioral intervention” lumps “twelve-step facilitation” with cognitive behavioral therapy, motivational interviewing and support system involvement rather than as a stand-alone treatment. If it is so effective, why is it not considered as an independent variable? The fact is it is not very effective as a stand alone intervention with success rates estimated between 5-10%. Even “success” is variously defined. Is it percentage of days abstinent from baseline? Is it the reduction of drinks per day?

The authors propose an alternative approach to understanding and treating alcoholism. They assert the psychological function of addiction is to reverse a sense of overwhelming helplessness and that every addictive act is a substitute for more direct behavior. The reversal of helplessness is a function of addiction and the powerful drive behind addiction is rage at that helplessness. Alcoholism is treated as a displacement (substitute behavior) that can be reversed through psychodynamic psychotherapy aimed at understanding, managing, and learning about oneself so the direct action can be undertaken without being seen as either impossible or forbidden. Addiction as a misguided quest for empowerment is possible, even plausible. However, these assertions are offered without proof, without citations from peer-reviewed journals – suffering from the same weaknesses with which the authors indict AA. Anecdotal data is weak data prone to selection bias, accuracy limitations of self-report, mistaking correlation for causation, among many other things that limit its utility. Maybe that is in one of their other books. In this book, case study method offered (P. 157) as “the only way to describe [psychodynamic] treatment” would be anecdotal as well.

I quibble with the authors’ contention (P. 124) that any AA group should be interchangeable with another AA group if the twelve steps were the active treatment components for addiction. Any psychotherapist who has done theme-based groups (e.g., divorce groups) or treatment-based groups (e.g., cognitive behavioral therapy) understands each group has its own “personality” regardless of conceptual constancy because of the different personalities involved.
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Any treatment of alcoholism and other addictions may be considered successful if the individual lives a life in which there are no longer negative consequences, broadly defined, as a result of the behavior whether abstinence or temperance is achieved.
Would you take a medicine wherein ~69% discontinued use due to unacceptable side effects within a year and only 5 to 10% of those who used the medication found relief from symptoms – a rate not appreciably different from spontaneous remission (those who discontinue substance abuse without treatment)? That is the analog to AA as well as the question posed by this book.