by Lance Dodes
2. L. Kaskutas, “Alcoholics Anonymous Effectiveness: Faith Meets Science,” Journal of Addictive Diseases 28, no. 2 (2009): 145–57.
3. R. H. Moos and B. S. Moos, “Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated Individuals,” Journal of Clinical Psychology 62 (2006): 735–50.
4. Kevin Gray, “Does AA Really Work? A Round-Up of Recent Studies,” The Fix, January 29, 2012, http://www.thefix.com/.
5. J. Harris et al., “Prior Alcoholics Anonymous (AA) Affiliation and the Acceptability of the Twelve Steps to Patients Entering UK Statutory Addiction Treatment,” Journal of Studies on Alcohol 64, no. 2 (2003): 257–61.
6. Ibid.
7. Poster from the Center on Alcoholism, Substance Abuse, and Addictions, J. Scott Tonigan, Clinical Research Branch, Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico.
8. P. L. Owen et al., “Participation in Alcoholics Anonymous: Intended and Unintended Change Mechanisms,” Alcohol: Clinical and Experimental Research 27, no. 3 (March 2003): 524–32.
9. National Clergy Conference on Alcoholism, The “Blue Book” 12 (1960): 179–210, http://www.silkworth.net/religion_clergy/01052.html.
10. J. Markham, “Does Mandatory AA/NA Violate the First Amendment?” North Carolina Criminal Law (blog), October 16, 2009, http://nccriminallaw.sog.unc.edu/?p=784.
11. Griffin v. Coughlin, 88 N.Y. 2d 674 (1996), 673 N.E.2d 98, 649 N.Y.S.2d 903, June 11, 1996.
12. J. Kelly et al., “Negative Affect, Relapse, and Alcoholics Anonymous (AA): Does AA Work by Reducing Anger?” Journal of Studies on Alcohol and Drugs 71 (2010): 434–44.
13. J. Tonigan and S. Rice, “Is It Beneficial to Have an Alcoholics Anonymous Sponsor?” Psychology of Addictive Behaviors 24 (2010): 397–403.
14. P. C. Bernhardt et al., “Testosterone Changes during Vicarious Experiences of Winning and Losing Among Fans at Sporting Events,” Physiology and Behavior 65, no. 1 (August 1998): 59–62.
CHAPTER EIGHT
1. Twelve Steps and Twelve Traditions (New York: AA World Services, 1952), 42.
2. For many examples of this, see my book Breaking Addiction: A 7-Step Handbook for Ending Any Addiction (New York: HarperCollins, 2011).
3. Clarence Snyder, Going Through the Steps, AA sponsorship pamphlet, 1944.
CHAPTER NINE
1. C. Timko and A. DeBenedetti, “A Randomized Controlled Trial of Intensive Referral to 12-Step Self-Help Groups: One-Year Outcomes,” Drug and Alcohol Dependence 90 (2007): 270–79.
2. Li-Tzy Wu et al., “How Do Prescription Opioid Users Differ From Users of Heroin or Other Drugs in Psychopathology?” Journal of Addiction Medicine 5, no. 1 (March 2011): 28–35.
3. Sarah W. Yip et al., “Health/Functioning Characteristics, Gambling Behaviors, and Gambling-Related Motivations in Adolescents Stratified by Gambling Problem Severity: Findings from a High School Survey,” American Journal on Addictions 20, no. 6 (November–December 2011): 495–508.
4. Betty Ford Institute Consensus Panel, “What Is Recovery? A Working Definition from the Betty Ford Institute,” Journal of Substance Abuse Treatment 33, no. 3 (October 2007): 221–28.
5. C. Rutger et al., “Effect of Alcohol References in Music on Alcohol Consumption in Public Drinking Places,” American Journal on Addictions 20, no. 6 (November–December 2011): 530–34.
6. Igor Elman et al., “Psychosocial Stress and Its Relationship to Gambling Urges in Individuals with Pathological Gambling,” American Journal on Addictions 19, no. 4 (July–August 2010): 332–39.
7. R. B. Cutler and D. A. Fishbain, “Are Alcoholism Treatments Effective? The Project MATCH Data,” BMC Public Health 14, no. 5 (2005): 75.
8. Lance Dodes, MD, Breaking Addiction: A 7-Step Handbook for Ending Any Addiction (New York: HarperCollins, 2011).
9. J. P. A. Ioannidis, “Why Most Published Research Findings Are False,” PLOS Medicine 2, no. 8 (2005), http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020124.
10. Nate Silver, The Signal and the Noise: Why So Many Predictions Fail—But Some Don’t (New York: Penguin Press, 2012).
11. Ioannidis, “Why Most Published Research Findings Are False.”
12. Ibid.
13. P. W. Anderson, “More Is Different: Broken Symmetry and the Nature of the Hierarchical Structure of Sciences,” Science 177, no. 4047 (1972): 393–96.
14. Dodes, Breaking Addiction.
INDEX
Please note that page numbers are not accurate for the e-book edition.
abstinence: correlation with engagement,
51; counting days of, 136–137;
percentage of days abstinent (PDA),
74–75; relationship with TSF, 47;
reported rates of, 72; sponsorship
unrelated to, 126
addiction, 81–95; biological views of,
85–88, 147–148, 152, 155–156; compulsion
model of, 83–85, 89–90;
consequences of, 134–135; as failure
of morality, 5–6, 13, 98–99, 110; as
form of insanity, 144–145; geneticists’
views of, 88–89, 147, 155–156; higher
brain functions and, 87–88; as innate,
139; myths about (See addiction
myths); physical v. psychological,
81, 82–85; psychological precipitants of,
156–157; psychology of (See
psychology of addiction); soldiers
in Vietnam War, 83–84, 86–87;
studies of treatments (See addiction
treatment studies); as substitute for
helplessness, 91–92, 127; understanding,
81–82, 156–157
addiction counselors, 69–70, 142–144
addiction myths, 134–146; character
defects of addicts, 141–142, 145; counting
days of abstinence, 136–137; denial
myth, 144–145; “hitting bottom,”
134–135; insanity myth, 144; 90/90
prescription, 140–141; “one day at a
time,” 139; “one-size-fits-all” treatment,
137–138; peer group influence,
139–140; surrendering, 135–136; value
of addicts as counselors, 142–144
addiction switches, 85, 93, 108
addiction treatment studies, 29–57. See
also specific studies; claims of 12-step
programs and, 34–36; Cochrane
Collaboration review, 36–40; compliance
effect, 32–33, 39, 40, 41–42; controlled
(randomized) (See controlled studies);
definition of success, 33–34; demographics
of, 49; designing perfect
study, 150–151, 158–160; determining
actual success rates, 1–2, 52–53, 73–74;
dropout rates and, 44–50; evidence-
based studies as mirage, 151–157;
failure of, 147–160; failure to study
psychology of addiction, 152–153;
human studies, special considerations in,
29–31; of identical twins, 89;
ineffectiveness of AA, 56–57; lack of,
147–151; longitudinal, 41, 42, 43–44,
151; observational (See observational
studies); problem of spontaneous
remission, 53–55; project MATCH,
55–56, 150; publication of, limited in
scope, 148, 157–158; question of spirituality,
124–125; role of motivation,
50–52; statistics ineffectual in, 157–158
addicts: as addiction counselors, 69–70,
142–144; character defects of, 141–142,
145; demeaning treatment of, 99–100,
137–138, 143–144; need for individual
evaluation of, 132–133
“adventure therapy,” 9, 59, 64
Alcoholic Foundation
, 21, 22, 24
Alcoholics Anonymous (AA), 11–28.
See also Wilson, William Griffith
(“Bill”); actual success rates, 1–2,
122; antipathy to medical profession,
22–23; “Big Book” of (See Alcoholics
Anonymous [Wilson]); challenges to
dogma of, 131; on character defects of
addicts, 141–142, 145; claimed success
rates, 23–24, 34, 36–40; condemnation
of drug therapy, 106, 109, 117;
conditioning to guilt feelings, 118–119;
as contrived culture, 120; as cult,
100–102, 103; cult of personality in,
118; demeaning treatment of addicts,
99–100, 137–138, 143–144; dropout
rates from, 44–50; exposure to, during
hospitalization, 111, 113, 116; failures
(case studies), 7–9; failure to diagnose
depression, 99–100, 105, 115–120, 121;
as fellowship, 123–124; foundational
beliefs of, 131–132; founding of, 19–20;
inflated claims made by, 3–4; intensive
involvement with, 48, 50, 52–53;
as monopoly in treatment industry,
2–4, 131, 155; myths perpetuated by
(See addiction myths); negative effects
of, 56–57; newcomers to, 105–108;
personal safety at risk in, 107–108;
psychology of successes, 122, 127–133;
recognition by medical establishment,
24–26; within rehabilitation centers,
58, 60–61; religion and (See religion);
role of group dynamics, 123–124; roots
of, 17–19; self-promotion by, 22–24;
sexually predatory behavior in, 108,
117–118, 130; as social network, 121,
122, 132, 139–140; spirituality as factor
in, 124–127; spreading influence of,
26–28; steps in, 4–6, 128–129; studies
of (See addiction treatment studies;
specific studies); successes of, 122–133;
suicide by members, 102–103, 108–109,
110; unsound theories of treatment,
130, 132; views held by (See moralistic
views of AA)
Alcoholics Anonymous (Wilson), 3, 4, 16,
21, 27; AMA critique of, 24; moralistic
approach of, 142; on salvation
through surrender, 135–136
“Alcoholics Anonymous” (Alexander),
22–24
alcoholism: as addiction, 81; as behavior,
34; “disease theory” of, 25, 26, 100, 112,
155, 159; as disproof of neurobiological
model, 87; early “cures” for, 12–13, 14;
emotional trauma and, 112–115; family
history of, 14–15; personal relationships
ruined by, 116; spontaneous
remission rate, 54; treatments prior
to AA, 11–14; vilification as moral
weakness, 13
“alcoholism gene,” 88
Alexander, Jack, 22–24
American Journal on Addictions, 147,
149–150
American Medical Association (AMA),
11, 24
American Psychiatric Association, 64
American Public Health Association, 26
Anderson, Philip, 156
anger, reduction of, 126
apologies, 5–6
Austen Riggs Center, 77
automatic behavior, 88
Avorn, Jerry, 40
Battle Creek Sanitarium, 78
Bauer, W. W., 26
Bayes, Thomas, 153, 154
Bayesian theory, 154, 156
behavioral psychiatry, 155
“Belladonna Cure,” 18–19
Betty Ford Center, 58; AA-based treatment,
60–61; claims of, 76; costs of
treatment, 71; daily schedule, 65–66;
“enhancements” to treatment, 59, 64
“Big Book.” See Alcoholics Anonymous
(Wilson)
biochemical depression, 83
biological (biochemical) theories of
addiction: behaviors of biochemical
origin, 156; as fallacy, 152, 155–156;
flawed studies of, 147–148; neurobiology, 85–88
Bonaduce, Danny, 76
Brandsma study, 34–35, 36, 42
Breaking Addiction (Dodes), 94, 159
“Cadillac” rehabs. See rehabilitation
centers
case reports. See also individual experiences:
of failures of AA, 7–9; on
psychology of addiction, 90–91, 93;
value of, 157–158
causality, 44
Celebrity Rehab (TV series), 56, 60, 76
Census Bureau, US, 52
Chemical Dependency Recovery Program, 46–47
Churchill, Winston, 128
Cochrane Collaboration, 1–2, 36–40
Cochrane Review, 37
cognitive behavioral therapy (CBT),
158, 159
collective organizations, 57
compliance effect, in observational studies,
32–33, 39, 40, 41–42
Comprehensive Alcohol Abuse and Alcoholism
Prevention Treatment and
Rehabilitation Act of 1970, 27
compulsion model of addiction, 83–85,
89–90
compulsive behaviors: as displacement,
89–90; multiple, 15–16, 93
concordance. See correlation
confrontation as tactic, 70
control attribute of rehab centers, 63
control groups: in designing perfect
study, 159; in human studies, 29–30;
lacking in observational studies,
44, 47
controlled studies, 31; of AA and TSF,
34–36, 37; designing perfect study,
150–151, 158–160; high cost of, 36,
158–159; observational studies compared, 29–32
conversion experiences: as basis of AA,
19–20; Jung as proponent of, 18; of
Marty Mann, 24–25; of Wilson, 2,
17, 18–19; of Wilson’s grandfather,
14–15, 18
correlation(s): Bayes’ theorem applied
to, 154; in observational studies, 30–31,
38–39; in twin studies, 89
cost of controlled studies, 36, 158–159
cost of rehab programs, 9–10; effectiveness
of treatment and, 70–72; lowering
in ideal programs, 80; as scam,
114–115; set by insurance carriers,
62–63
“cures” for alcoholism, 12–13, 14
Dana-Farber Cancer Institute, 77
data: disaggregation of, 40; elided, 42–43,
72–74, 151
Dawson, Deborah, 33
decision making, psychological significance
of, 87–88, 90–91
demeaning treatment of addicts: in
AA, 99–100; all addicts as “drunks,”
137–138; insanity myth and, 144; peer-
group attitudes, 139–140; in 12-step
model, 143–144
demographics of studies, 49
denial myth, 144–145
depression: AA misdiagnosis of, 99–100,
105, 115–120, 121; causes of, 83
detoxification services, 63
“disease theory” of alcoholism, 25, 26,
100, 112, 155, 159
displacement(s): addiction as, 91–92, 127;
compulsions as, 89–90; direct action
contrasted, 92
Dr. Rogers’ Hydropathic Sanitarium and
Congenial Home, 78–79
Dowling, Fr. Edward, 16
dropouts: not inc
luded in outcome
reports, 72–74, 75; poor results for, 52;
program effectiveness and, 44–50
drugs: drug courts, 28; heroin addiction,
83–84, 86–87; prescription, AA condemnation
of, 106, 109, 117; tolerance
to, 81; withdrawal from, 82
“drunks,” all addicts treated as, 137–138
emergent behaviors, 156
Emrick study, 35
engagement with programs, 51
“equine-assisted therapy,” 9, 59, 64
“evidence-based” science: failure to
study psychology of addiction, 152–
153; problems with studies, 151–152;
researcher prejudice in, 153–154; worship of, 152
failure of treatment: by AA (See Alcoholics
Anonymous [AA]); addiction
counselors and, 69–70, 142–144;
addiction myths and (See addiction
myths); case stories of (See individual
experiences); clinical depression
undiagnosed, 99–100, 105, 115–120, 121;
coercion of patients, 97–98; confrontational
tactics, 70; consequences of,
7–9, 76–77; demeaning treatment
of addicts, 99–100, 137–138, 143–144;
dropouts, 44–50, 52, 72–74, 75; early
“cures” for alcoholism, 12–13, 14; guilt
feelings and, 99–100, 116, 118–119;
“hitting bottom” as excuse for, 135;
lack of individual treatment, 65–68,
137–138; moralistic excuses for, 5–6,
13, 98–99, 110; need for individual
evaluations, 132–133; for newcomers
to AA, 105–108; 90/90 prescription
and, 140–141; “one-size-fits-all” view
and, 137–138; problems with treatment
studies (See addiction treatment studies);
in rehabilitation centers, 9–10,
76–77; relapses, 137; suicides, 102–103,
108–109, 110; TSF as setup for failure,
103, 105–106, 114; unsound theories
and, 130, 132
federal government, 1, 13, 159
Fernside Center, 61
Fingarette, Herbert, 53
Fiorentine study, 43, 53; compliance effect
error in, 40; correlation in, 38–39;
multiple regression analysis used in,
39–40
Gamblers Anonymous, 56
Gelber, Richard, 45, 49
genetic loading, 88, 89
genetic theory of addiction, 88–89, 147,
155–156
Grapevine, 26
group therapy: general attributes of,
123–124; ideal construction of, 79; in
rehab programs, 67–68
guilt feelings, 116; AA conditioning to,
