The Sober Truth
Page 21
118–119; self-demeaning statements,
99–100
Harris study, 52–53, 124–125
“hazardous” drinking, 49, 75–76
Hazelden Treatment Center, 9, 10;
costs of treatment, 71; daily schedule,
66–67; history of, 58; “Minnesota
Model” of treatment, 60; outcomes
reported by, 72, 74
The Heart of Addiction (Dodes), 89,
90–91, 156
helplessness: addiction as reversal of,
91–92, 127; admission of, 4, 5; combating
feelings of, 7–9; direct response to,
94–95; in “disease theory” of alcoholism,
25; in psychology of addiction,
145; rage at, 92; surrender to “higher
power” and, 136
heroin addiction, 83–84, 86–87
higher brain functions, 87–88
“higher power,” 127–131; in AA steps,
128–129; consequences of identifying
with, 130–131; identification with powerful
figures, 127–128; illusory nature
of, 129–130; surrendering to, 135–136
“hitting bottom,” 134–135
Horvath, Arthur, 26–27
hospitalization: exposure to AA during,
111, 113, 116; inebriate hospitals, 13; as
part of “rehab,” 60–67
humility, 130
identical-twin studies of addiction, 89
impaired physician programs, 28
independent testing, 43
individual experiences, 96–121; AA as
cult, 100–102, 103; AA misdiagnosis of
depression, 99–100, 105, 115–120; alcoholism
and emotional trauma, 112–115;
demeaning treatment in AA, 99–100;
dissatisfaction with 12-step philosophy,
98–99; feelings of coercion, 97–98;
negativity of AA, 105–107; psychology
of addiction, 90–91, 93; rigidity of AA,
109–110; “13th-stepping,” 108, 117–118,
130; 12-step based rehab, 103–104;
warning signs for suicide, 102–103
individual therapy: in ideal rehab,
79; missing from rehab programs,
65–68; “one-size-fits-all” treatment
contrasted, 137–138; in psychiatric
centers, 68
inebriate hospitals, 13
“Inquiry into the Effects of Ardent Spirits
on the Human Mind and Body”
(Rush), 11–12
insanity myth, 144
insurance carriers, 62–63
intensive involvement with program, 48,
50, 52–53
Intervention (TV series), 1, 60
Ioannidis, John, 153, 154, 155
James, William, 18
Jellinek, E. M., 25–26
Johnson, Lyndon B., 27
Journal of Addiction Medicine, 148
Journal of Addictive Behaviors, 72, 74–75
Journal of Consulting and Clinical Psychology, 47
Journal of Drug and Alcohol Dependence,
147
Journal of Inebriety, 14
Journal of Nervous and Mental Diseases,
24
Journal of Substance Abuse Treatment,
147, 149
Jung, Carl, 18
Kaiser Permanente Chemical Dependency
Recovery Program, 61
Kaskutas, L. A., 50, 123
Keeley, Leslie, 12–13
Keeley Institutes, 12–13
Kennedy, Foster, 24
Ladies’ Home Journal, 24
Lasker Award, 26
legal issues: court-mandated 12-step
attendance, 26–27, 111, 125–126; drug
courts, 28; Prohibition, 13
Liberty magazine, 21
longitudinal studies: punctuated nature
of, 43–44, 151; surveys in, 41, 42
Los Angeles Times, 69, 71
Macbeth (Shakespeare), 89–90
Majer study, 51
Mann, Marty, 24–25, 26, 27
“March of Time” newsreels, 24
Markey, Morris, 21–22
McClellan, A. Thomas, 71
McCrady study, 39
McKellar studies, 45, 47–50, 56, 75–76,
123
medical profession, AA antipathy toward, 22–23
Menninger Clinic, 59
“Mighty Destroyer Destroyed” (essay),
11
“Minnesota Model” of treatment, 60
Moore’s Brook Sanitarium, 78
Moos study, 40–44; compliance effect
in, 41–42; on dropouts, 52; group
dynamics, 123; lack of data on treatment,
40–41; objectionable methods
of, 43–44
moralistic views of AA: addiction as
failure of morality, 5–6, 13, 98–99, 110;
character defects of addicts, 141–142,
145; salvation through surrender,
135–136; tally system and, 136–137
motivation, studies of, 50–52
“motivational enhancement therapy,” 41
multiple regression analysis (MRA),
39–40
mutual support, 57
Narcotics Anonymous, 56
National Council on Alcoholism and
Drug Dependence, 25
National Institute on Alcohol Abuse
and Alcoholism (NIAAA), 27, 33, 52,
55, 150
National Institute on Drug Abuse
(NIDA), 85–86, 159
National Institutes of Health (NIH), 30,
150
National Longitudinal Alcohol
Epidemiologic Survey, 52
neurobiology of addiction, 85–88
newcomers to AA: demands made of,
107–108; lack of support for, 105–107
New York Times, 71–72
New York Times Magazine, 30–31
90/90 prescription, 140–141
Nixon, Richard M., 27
noise (statistical turbulence), 42, 54, 151
observational studies: compliance effect
in, 32–33, 39, 40, 41–42; controlled
studies compared, 29–32; correlations
in, 30–31, 38–39; selection effect in,
31–32, 46
obsessive-compulsive disorder (OCD),
83, 90, 115
“Ocean Therapy,” 64–65
“one day at a time” myth, 139
“one-size-fits-all” treatment, 137–138
Oursler, Fulton, 21
Owen study, 125
Oxford Group, 2, 4; moralistic approach
of, 135, 142; Wilson as member of,
17–18, 19
Passages Malibu, 64–65, 69, 71
peer group influence, 139–140
percentage of days abstinent (PDA),
74–75
personal relationships: in AA, 105, 119,
123; ruined by alcoholism, 116;
“13th-stepping,” 108, 117–118, 130
physical addiction, 81, 82–85
Pinsky, Drew (“Dr. Drew”), 56, 57, 76
placebo effect, 33
platform agnostic networks, 156
powerful figures, identification with,
127–128, 129
powerlessness. See helplessness
prediction of addictive urges, 139
prefrontal lobotomy, 13
probability, 154
Project MATCH, 55–56, 150
Promises Malibu, 61, 69, 76; claims of,
77; costs of treatment, 71; duration
of residence, 62; “enhancements”
to treatment, 59–60; extra features
of program, 64
Promises Treatment Centers, 123
proselytizing, 3
psychiatri
c centers, 68–69
psychodynamic therapy, 158, 159
psychological addiction, 81, 82–85
psychological depression, 83
psychological insights, 130–131
psychological precipitants of addiction,
156–157
psychological significance of decision
making, 87–88
psychological testing, 68–69
psychology of addiction, 89–95; case
reports, 90–91, 93; failure to study,
152–153, 155; forms of helplessness, 127;
as map for treatment, 93–95; physical
addiction contrasted, 82–85; reversing
helplessness, 145; self-medication
hypothesis, 82–83
Psychology Today, 62, 96
psychotherapy: “addiction counselors”
unfit to provide, 143; difficulty of
quantifying results, 157–158; long
follow-ups required in, 159; personal
empowerment due to, 7–9; success in
breaking addiction, 94–95; in understanding
addiction, 156–157
public relations, 21–24, 60, 78
“qigong therapy,” 63–64
rage at helplessness, 92
randomized studies. See controlled
studies
rational behavioral therapy (RBT), 34–35
Rational Emotive Therapy (RET), 67–68
rehabilitation centers. See also specific
treatment centers: AA and, 58,
60–61; aggressive marketing by,
60; “Cadillac” rehabs, 9–10, 59–60;
coercion in, 97–98; in competitive
market, 78–79; consequences of
failure in, 76–77; costs of (See cost of
rehab programs); exorbitant costs
of (See cost of rehab programs);
extra features of, 59, 63–70; history
of, 58–60; ideal design of, 79–80;
lack of individual therapy in, 65–68;
negative experiences with, 112–115;
non 12-step based, 61; outcome data
of, 72–76; repeated failures of, 9–10;
role of hospitalization, 62–63; stress-
relieving settings of, 122; 12-step
based, 58–80, 103–104
Reiki treatments, 64
relapses, 137
religion: in AA steps, 104, 112, 125,
128–129; close bond with AA, 4–5, 17,
27; court rulings on AA and, 125–126;
fundamentalist groups, 2, 121; preaching
salvation through surrender to
God, 135–136; 12-step obsession with,
98–99, 104, 106–107, 120
Robins study, 83–84, 86–87
Rockefeller family, 11
Rush, Benjamin, 11–12
Sack, David, 62, 123–124
Sacket, David, 37
St. Jude Retreats, 61
sanitaria, history of, 78–79
Sanitarium at Dansville (NY), 78
Saturday Evening Post, 11, 22, 24
scientific method, 29, 43–44, 48
seeking behavior, 88
selection effect (bias): compliance effect
of, 32–33; in observational studies,
31–32, 46
self-examination, 121, 142
self-fulfilling prophecy, 45
self-medication concept, 85
self-reporting: anecdotal (See individual
experiences); as questionable
metric, 35, 43; through surveys, 41, 42;
underreporting bad outcomes, 72–74;
unverified, 49–50
self-selection, 51
sexually predatory behavior in AA, 108,
117–118, 130
Shakespeare, William, 89–90
Shoemaker, Sam, 19
Sierra Tucson, 9, 10, 58; claims of, 76–77;
costs of treatment, 71; extra features
of program, 63–64; “Individualized
Treatment Plans,” 68; “Sierra Model”
of treatment, 61
Silkworth, William, 21, 22
Silver, Nate, 153
SLIP (sobriety loses its priority), 137
Smith, Bob, 19–20
smoking, 85
spas, rehabilitation centers as, 59–60
SPECT brain imaging, 64
spirituality. See religion
sponsorship: failure of, 129; fear of, 118;
fitness of sponsors, 143; negative experiences
with, 106, 108, 110; unrelated
to abstinence, 126
spontaneous remission: study of, 55–56,
150; treatment efficacy and, 53–55, 56
statistical methodology, 43, 48–49, 151–152
statistical turbulence (noise), 42, 54, 151
structural modeling, 47–48
successful treatment: cost of rehab
programs and, 70–72; defined, 33–34;
involvement with program and, 48,
50, 52–53; loss of efficacy over time,
75; spontaneous remission and, 53–55,
56; through psychotherapy, 93–95
success rates: of AA, actual, 1–2, 122;
of AA, claimed, 23–24, 34; of rehab
centers, claimed, 72–74
suicide, AA and, 102–103, 108–109, 110
surveys: in longitudinal studies, 41, 42;
questionable size of, 43; triviality of,
148–150
susceptibility to addiction, 88–89
“tally system,” 7, 136–137
Taubes, Gary, 30–31
temperance movement, 12
Thacher, Ebby, 18
“13th-stepping,” 108, 117–118, 130
Tiebout, Harry, 26
Timko study, 45, 147
tolerance to drugs, 81
Tonigan study, 125, 126
treatment industry: AA as monopoly
in, 2–4, 131, 155; rehabilitation centers
(See rehabilitation centers)
treatment of addiction/alcoholism:
failure of (See failure of treatment);
“one-size-fits-all,” 137–138; psychology
of addiction as map for, 93–95; by
psychotherapy (See psychotherapy);
studies of (See addiction treatment
studies); successful (See successful
treatment); TSF (See twelve-step
facilitation therapy)
Treatment Research Center, 71
twelve-step facilitation therapy (TSF),
1–10. See also specific programs;
AA monopoly, 2–4, 131, 155; ability
of addict to respond to, 132–133;
claims of, 34–36; court-mandated
attendance, 26–27, 111, 125–126; critiques
of, 1–2; demeaning treatment
of addicts in, 143–144; designing
study of, 158, 159; devotion to, 95;
impaired physician programs, 28;
obsession with religion, 98–99, 104,
106–107, 120; rehabilitation centers
based on, 58–80, 103–104; relationship
with abstinence, 47; as setup
for failure, 103, 105–106, 114; studies
of, 50–51
Vaillant, George, 54–55
Varieties of Religious Experience
(James), 18
Vederhus study, 45–46
Walsh study, 36, 39
Weiss study, 50–51
Wilson, Lois, 17, 24
Wilson, William Griffith (“Bill”), 11,
120; alcoholism in family of, 14–15;
conversion experience of, 2, 17, 18–19;
emotional struggles of, 15, 16, 17–18;
founding of AA, 19–20; multiple
compulsive behaviors of, 15–16, 93; on
religion in AA, 4, 125; relig
ious faith
of, 16–17; spreading influence of AA
and, 24, 25, 27
Winehouse, Amy, 76
Wired magazine, 56
Witbrodt study, 46, 47
withdrawal syndrome, 82
Yale University, 11, 25–26
Zimburg study, 54
BEACON PRESS
Boston, Massachusetts
www.beacon.org
Beacon Press books
are published under the auspices of
the Unitarian Universalist Association of Congregations.
© 2014 by Lance Dodes and Zachary Dodes
All rights reserved
Printed in the United States of America
Many names and identifying characteristics of the patients
mentioned in this work have been changed to protect their identities.
This book is printed on acid-free paper that meets the uncoated paper
ANSI/NISO specifications for permanence as revised in 1992.
Text design and composition by Kim Arney
Library of Congress Cataloging-in-Publication Data
Dodes, Lance M.
The sober truth : debunking the bad science behind 12-step programs
and the rehab industry / Lance Dodes, MD and Zachary Dodes.
pages cm
Includes bibliographical references.
e-ISBN 978-0-8070-3316-6 (ebook)
ISBN 978-0-8070-3315-9 (hardcover : alk. paper)
1. Twelve-step programs. 2. Addicts—Rehabilitation.
3. Substance abuse—Treatment. I. Dodes, Zachary, 1976– II. Title.
HV4998.D634 2014
616.86ˊ06—dc23
2013043331