Basic HTML Version
syringes, the US Congress has rescinded government
support for this policy, based on America’s
abstinence fixation.
2.
No one in the United States answers the
question, ‘How are we doing in fighting alcoholism
and addiction?’ with a wholehearted endorsement of
the success of our approach. Instead, there is great
soul-searching about every new drug and substance
use scare that comes down the road – including,
recently, off-label overuse of prescription painkillers
and ADHD medications such as Adderall, increased
drinking by young women, use of illegal drugs like
methamphetamines and heroin, and so on.
3.
No one here has great confidence in our
treatment modalities. Indeed, AA and 12-step rehab’s
greatest innovation has been to redefine failures –
up to and including death, as in the cases of Philip
Seymour Hoffman and Cory Monteith – as proof of its
underlying ‘cunning, baffling and powerful disease’
sales pitch. Yet people simultaneously endorse the
strange, religious-based self-flagellation rituals of AA
as being a medically efficacious treatment! What’s
really ‘cunning, baffling and powerful’ is AA’s hold on
the American psyche.
4.
Recently, through the work of Lance and Zachary
Dodes’
The Sober Truth: Debunking the Bad Science
Behind 12-Step Programs and the Rehab Industry
,
and my and Ilse Thompson’s
Recover! Stop Thinking
Like an Addict and Reclaim Your Life with The
PERFECT Program
, Americans have been presented
with some powerful voices rejecting the efficacy of
our most popular addiction treatment. Although our
books are, in themselves, unlikely to reverse
America’s ardour for AA and its steps, nonetheless
the simple simultaneous appearance of these books,
their wide circulation, and their coverage in the
media suggest that change is in the air.
As an answer to A’s note, let me present the five
primary reasons AA and the 12 steps should not be
supported among best practices here in the US as
well as in Europe. In a quick overview, the 12 steps’
powerlessness model distorts our understanding of
why people become addicted, downplays the great
potential for self-recovery, limits the use of effective
treatments, and syphons resources away from
pragmatic strategies that help alcoholics and
addicts. At a more basic level, it diminishes people’s
sense of their ability to manage themselves and their
worlds, and results in wasteful and often destructive
public policies that treat alcoholics/addicts as
helpless victims.
1.
AA causes us to deny the realities of recovery.
The fastest growing body of addiction research
shows that most alcoholics and addicts outgrow
addiction without treatment. In 2002, the National
Institute on Alcohol Abuse and Alcoholism studied
43,000 randomly sampled Americans’ lifetime
history of alcohol and drug abuse. Called the
National Epidemiologic Survey on Alcohol and
Related Conditions (NESARC), it concluded: ‘20 years
after the onset of alcohol dependence, three-fourths
of individuals are in full recovery; more than half of
those who have fully recovered drink at low-risk levels
without symptoms of alcohol dependence.’ Only a
quarter had treatment of any sort, and only half of
those (13 per cent) actually attended AA or rehab.
NESARC found the same to hold for drug addicts.
Gene Heyman has analysed these results and those
of three other national surveys of drug addictions:
‘Each found that most of those ever addicted to illicit
drugs were ex-addicts by about age 30. Moreover,
most of those who quit did so without professional
help. Follow-up analyses reveal that the high
remission rates were not temporary, due to missing
addicts or a function of other methodological pitfalls.’
Several longitudinal studies – those following
people in the general population – have tracked
people who developed alcoholism or drug addiction
for years, even decades, and found that ‘people
mature out of addictions at all ages’, and that
‘relapse does not appear to be as ubiquitous as one
might expect based on estimates from clinic
samples.’ All these findings lead to ‘the view that
alcoholism, at least in most cases, represents a
changeable habit rather than a brain disease.’
2.
AA exaggerates and oversells its success. Dodes
cites research indicating that AA works for 5 to 8 per
cent of those who participate in the group. But that
figure must be compared against the numbers who
recover on their own – indeed, several studies
comparing alcoholics randomly assigned to AA or left
to their own devices found the latter did better on
average! And 12-step rehab results are hardly better.
According to the Cochrane Collaboration, the
prestigious group of scientists that compiles
evidence on the effectiveness of various treatments,
in the case of the 12 steps: ‘No experimental
studies unequivocally demonstrated the
effectiveness of AA or TSF approaches for reducing
alcohol dependence or problems.’
3.
AA and 12-step treatment drive out other, often
more effective, treatments. Like carp infesting a lake
drive out other species, AA and 12-step treatment
rule out other, often more effective, approaches. A
British group, the Effectiveness Bank, compiles data
on such treatments, including motivational
interviewing, skills training, social network therapy,
community reinforcement approach (CRA) and
community reinforcement and family therapy (CRAFT),
solution-focused therapy, narrative therapy, purpose-
driven therapy – hardly any of which are known, not
only to the public, but by treatment providers in the
US. They have been thrown overboard due to the
myth of 12-step effectiveness and the 12 steps’ own
imperialistic, take-no-prisoner view of the alcoholism
treatment world.
4.
AA attacks self-efficacy. What enables people to
overcome alcoholism and addiction, particularly
considering that most people outgrow it with age and
maturity? The single factor most often found in
effective treatments is that individuals become more
confident of their own strength, sometimes called
‘self-efficacy’ or, more popularly, ‘self-empowerment’.
AA’s central message is of the individual’s
powerlessness that we all know to be the first step.
Then, there is step 3: ‘Made a decision to turn our
will and our lives over to the care of God as we
understood God.’ Sound like a sound therapy
principle to you? And are you aware of these steps?
Step 5: ‘Admitted to God, to ourselves, and to
another human being the exact nature of our
wrongs.’ Step 6: ‘Were entirely ready to have God
remove all these defects of character.’ Step 7:
‘Humbly asked God to remove our shortcomings.’
These steps do not encourage self-confidence and
acceptance of the self – they are not so subtle ways
of attacking people’s sense of themselves, just like
some therapists and group leaders tell people, ‘You
have had a deep trauma in your life which is
saddening and weakening you; what is it?’ Everyone
has a response to an intrusive question like that,
and that answer leads one to a debilitating, self-
loathing, or at least a self-pitying, place – not one
likely to lead to constructive life changes.
Stanton Peele has been at the cutting edge of
addiction theory and practice since writing, with Archie
Brodsky, Love and Addiction in 1975. He has
developed the online Life Process Program, and has
written (with Ilse Thompson), Recover! Stop Thinking
Like an Addict and Reclaim Your Life with The
PERFECT Program. He can be found online on
Google+ and Twitter.
April 2014 |
drinkanddrugsnews
| 9
www.drinkanddrugsnews.com
Cover story |
Recovery
‘After decades of
not rushing down
the American route
a number of
European countries
have been moving
steadily in the 12-
step direction.
They are often
pushed in this
direction by the US
rehab industry...’