The Sober Truth by Lance Dodes: Is Alcoholics Anonymous Effective?

The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry was published earlier this year and created quite a controversy. The authors, Lance Dodes and Zachary Dodes, go to great length to criticise AA groups and the 12 Step approach to treating addiction.

In an interview for the American station NPR (National Public Radio), the presenter asked Dr. Dodes: “Does AA work?” Dodes replies categorically: “No…the success rate for the AA is between 5 and 10%…People stop drinking on their own at about the same rate as they get better in AA. There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors…probably AA has the worst success rate in all medicine.”

He went on to claim that AA  is “harmful to the 90% who don’t do well…AA is never wrong according to AA. If you fail in AA it’s you that’s failed…People leave feeling much more depressed and discouraged and worse about themselves.” The only reason AA works for the few, Dodes believes, has to do with “camaraderie”.

A few experts replied to him via articles:

Robert DuPont, president of Institute for Behavior and Health and former director of United States’ National Institute on Drug Abuse (NIDA) points out in an opinion article that “AA and NA do not replace treatment; they enhance it. I see this daily in my own practice. Some addicts do get well without AA or NA, but far more of them fail. I encourage my patients to join the fellowships, and I rejoice with them when they do, confident that they have a better chance at lifelong recovery.”

He also argues against the idea that AA is “harmful” for those who relapse: “no one judges you if you relapse. No one makes you feel as if you’ve failed. Rather, you receive unconditional support. I know of no other programs like these. They are not treatment, nor are they religion. The only requirement is a desire to stop drinking and using drugs.”

In the article Defense Of 12 Steps: What Science Really Tells Us About Addiction, Gene Beresin, professor of Psychiatry at Harvard Medical School writes that: “In his book, Dr. Dodes commits the same misguided offenses he condemns. His critique of the science behind treatment of addiction is deeply flawed, and ironically, his own psychoanalytic model of an approach to solve the “problem of addiction” has no independent scientific proof of effectiveness, particularly in comparison to other methods of treatment.”

Dr. Beresin exposes one of the errors from The Sober Truth:

“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.”

Richard Friedman, professor of psychiatry at Weill Cornell Medical College describes The Sober Truth in New York Times  as a “polemical and deeply flawed book about the nature and treatment of addiction”.

Dr. Friedman thinks that “the authors’ blanket claim of efficacy for their own cherished treatment, in the absence of credible data, is the very flaw for which they harshly criticize AA.”

The biggest issue, Friedman notes, is “the authors’ dismissive attitude and misunderstanding about the role of neuroscience in addiction.” Dr. Dodes view on addiction is that it is merely a “psychological symptom” — not a disease with physical and mental symptoms.

Dr. Friedman believes that addiction is “one of the most puzzling and fascinating human behaviors, one that reflects a complex interplay among genes, biology, psychology and environment. Those looking for a scientifically accurate and nuanced understanding of addiction and its treatment will not find it in this book.”

Claudiu Revnic also contributed to this article.

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