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59 of 75 people found the following review helpful
3.0 out of 5 stars Arguments Against 12-Step Programs, February 16, 2014
This review is from: The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry (Hardcover)
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I was curious about this book because I have read many books derived from the 12-Step movement and found them helpful. I also have had friends who benefited from attending 12-Step programs. However, I have long had questions about various aspects of the 12-Step movement which 12-Step books didn't address.

This book is a sustained attack on the 12-Step movement. It reads like a reaction to the many books praising the 12-Step movement.

The co-authors argue that there is no real scientific proof for the 12-Step movement's effectiveness, that it is in some ways a religion rather than a recovery system, that in some instances 12-Step groups may do more harm than good, that some segments of the rehab industry are fraudulent, and that current theories of addiction need to be reviewed from a scientific standpoint.

I think the co-authors' critique of the fraud and malpractice in the rehab industry warrants close attention.

I believe that anyone considering joining a 12-Step group or simply reading 12-Step literature should have a look at his book to give them the other side of the story. They may then wish to review 12-Step literature and perhaps attend a few meetings to see the positive qualities of the 12-Step movement. Then they can decide for themselves if the 12-Step movement is personally useful for them.

I hope this book will contribute to the development of more treatment methods for people dealing with addiction beyond the 12-Step movement. It is obvious that the 12-Step movement meets some recovering addicts' needs -- and those of people suffering from other problems -- beautifully, but it is also obvious that closer scientific scrutiny of the movement's claims would be useful, so that people who are not comfortable with the 12-Step movement can have more options.

The book's co-authors apparently feel that psychotherapy would fix most addicts' problems. I am uncertain about this, as some cases of addiction and other emotional problems are deeply rooted.

While I personally benefited from the 12-Step books I read, I can see from "The Sober Truth" how aspects of the 12-Step movement that helped me would irritate or alienate other people, who need different pathways to recovery.
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Showing 1-10 of 12 posts in this discussion
Initial post: Mar 23, 2014, 12:43:21 PM PDT
Hello, there -

I'm a sober alcoholic (30 years), and I stopped going to AA meetings about a year after I stopped drinking. I will credit AA with helping me realize I needed more help, and I went into a "medical model" rehab at Suburban Hospital in Bethesda, Maryland. It was like a 21-day college about how not to drink. The essential text was "Under the Influence: the Myths and Realities of Alcoholsim", by Milam and Ketcham, which posits that alcoholism is first and foremost a physiological disease with psycho-social consequences. My rehab encouraged AA attendance, but also educated us about AA's limitations and contradictions.

I'll be reading this book, and think the authors are onto something. Like you, however, I am uncertain about the efficacy of psychotherapy as a treatment for addiction. My own post-sobriety therapy dealt with the psycho-social effects of my alcoholism, and was very helpful in that regard.

I appreciate your thoughtful review of this book. I'm sure the book itself will anger or annoy many AA apostles, as well as those making scads of money in the rehab business.


In reply to an earlier post on Mar 23, 2014, 5:44:38 PM PDT
Cometkazie says:
Mr. Parkes, I really appreciate your contributions here.

I will purchase "Under the Influence: the Myths and Realities of Alcoholsim" instead.

In reply to an earlier post on Mar 24, 2014, 6:07:31 PM PDT
I wish you the best.

In reply to an earlier post on Mar 28, 2014, 9:45:23 PM PDT
Dear Mr. Parkes:

It is always good to hear from someone who has in-depth personal experience!


In reply to an earlier post on Apr 6, 2014, 6:05:41 PM PDT
Last edited by the author on Apr 6, 2014, 6:07:31 PM PDT
R.E. Burke says:
Mr. Parker, it's very helpful to have contributions from people with your experience. A favorite dictum in many AA meetings is that those who leave will end up dead, insane, or in jail. And there is no shortage of people who leave, relapse, and return in shame. Very few people ever report back on a successful departure.

Whether psychotherapy works depends a lot on the etiology of the disease. One major flaw in AA thinking is its one size fits all philosophy. Treatment modalities in AA invariably lead back to going to meetings, getting a sponsor, and calling people. Substituting psychotherapy may not be much of an improvement.

This bias in AA seems both misleading and potentially destructive. I'm familiar with cases where alcoholics were driven by mood disorders, hormone disorders, etc. Get them on a course of anti-depressants, or give them a hormone shot, and the temptation to drink disappears. Going to meetings and getting sponsors might be a nice adjunct to that, but it doesn't address the core problem.

It's not clear to me if AA can or should deal with such considerations. However, it is incumbent on any AA member to recognize the limits of what is said in AA. Even when ideas have enthusiastic support, they may still be bad ideas for some people.

Posted on Apr 8, 2014, 6:09:49 AM PDT
I am one of the lucky 5 - 10% of people for whom AA has so far (for 17 years) offered a successful path to recovery from addiction to alcohol. While far from a perfect program or a complete solution to the problem, it DOES work for some of us. I, like the authors, am dismayed at how many people come into the rooms and subsequently disappear. We like to say that AA is a program of attraction rather than promotion. Most of us don't openly promote what we have; we attract people to the program by offering a solution to those who want to follow the AA way of life.

The premise of this book reminds me of the Republican party's attacks on Obamacare. There is lots of criticism about the program, but it is a cowardly attack because there is no alternative, better solution recommended. Why go to all of the trouble of attacking the flaws of AA when you offer nothing as an alternative solution? The last chapter, where I expected some concrete alternative solutions, offers nothing but excuses as to why research and a psychotheraputic approach to recovery cannot be attained.

In reply to an earlier post on Apr 8, 2014, 8:10:36 AM PDT
Last edited by the author on Apr 8, 2014, 5:14:15 PM PDT
R.E. Burke says:
Whether AA should be replaced or transformed is an open question. Is AA capable of reforming itself? In many places, AA groups have a very traditional and fundamentalist bent that perpetuates a very formulaic approach. The constant repetition of a limited set of catch-phrases is one example of this. The implicit dominance of oldtimers is another. The tendency in meetings to preach and give speeches rather than offer authentic personal testimony is a third example.

I have known any number of young people who refuse to have anything to do with AA because of the above tendencies. While many members are, as individuals, very highly educated, thoughtful, and openminded, these qualities tend to be muted and sometimes put down in meetings. That's not a recipe for future success.

One significant problem inherent in AA's structure is the lack of professionalism. This can be a strength in that many AA members do not want and cannot afford professional involvement. There is also an underlying resentment and fear that professionals might take over a grassroots recovery effort.

At the same time, this has opened the door to very harmful and ignorant statements by AA members. It was once the case that oldtimers decried the use of anti-depressants because they are "mind-altering chemicals." This has mostly, but not entirely, stopped. Depending on the specific group, I'm sure it's just been replaced by something else. The ethos of AA practically guarantees this.

Yet some kind of professional involvement seems advisable. The most recent addiction studies I've seen suggest that 12-step programs are not the most effective approach. It's hard to tell for sure, because the drop-out rates from the "12-step only" groups are so high in controlled studies (this in itself should be grounds for concern). Instead, the most effective approach appears to be a 12-step approach combined with professional 12-step facilitation.

I have known AA members, mostly older ones, who would rather die than allow such a synthesis. But the choice shouldn't belong to just them. Does AA really want that much to lose the younger generation? I know a lot of young people walk out of AA. Do you see many of them walking back in?

By the way, the last three decades are littered with efforts to debunk AA. It's pointless for AA members to get too worked up about them. They rarely have much effect.

In reply to an earlier post on Apr 8, 2014, 3:03:46 PM PDT
Cometkazie says:
Who exactly is going to "replace" A.A. and what are they going to replace it with?

Do the authors give any figures for the "success rate" for psychotherapy?

In reply to an earlier post on Apr 8, 2014, 5:10:10 PM PDT
Last edited by the author on Apr 8, 2014, 5:33:25 PM PDT
R.E. Burke says:
There are millions of alcohol dependent people, and they vote with their feet. Epidemiological studies suggest that the majority stop on their own without further treatment or support. Of the remainder, AA seems like the majority solution, but there are competing organizations and solutions which have gained some attention in the past 20 years. I'm guessing, but a lot of people go elsewhere because they want (1) a more Christian solution, (2) a more secular solution, (3) a Muslim, Jewish, or Buddhist solution, or (4) a rational psychotherapeutic solution.

By the way, it's virtually impossible to measure success rates outside of a controlled study. It's hard to even define what success is supposed to mean. And AA's dictum that anyone leaving AA is doomed to an awful fate (prison, insanity, death, etc.) is an unfortunate bit of folklore. There is a network of support groups designed to help people who do just that.

In reply to an earlier post on Apr 8, 2014, 5:21:38 PM PDT
Cometkazie says:
If the authors are able to come up with a success rate for A.A., why can't they come up with one for psychotherapy? Which controlled studies are you quoting?

I agree in general with what you are getting at but would like specifics.

I know many who have left A.A. w/o the dire consequences predicted. I suspect their problem was physiological and not psychological. Just a guess.
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