Mittwoch, 6. Januar 2016

The Sober Truth

"Although the fledgling organization lacked any scientific backing, research or clinical experience to support its method, AA spread like wildwire through a country desperate for hope at the end of Prohibition and in the midst of the Great Depression. It soon became immaterial whether AA worked well or worked at all: it had claimed its place as the last best hope for beating the mighty specter of addiction. It had become the indispensable treatment, the sine qua non of addiction recovery in the United States. And science looked away."

In AA meetings, the following passage is often read aloud:
"Rarely have we see a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple programme, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault, they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty. Their chances are less than average. There are those, too, who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest."

"In other words, the program doesn’t fail; you fail", comments Lance Dodes. And, he adds: "In professional medicine, if a treatment doesn’t work, it’s the treatment that must be scrutinized, not the patient. Not so for Alcoholics Anonymous." Pretty devastating, isn't it?!

What Mr. Dodes, MD, implicitly means but does not say is: professional medicine is much better suited to treat addiction than some anonymous guys and girls without proper scientific training. In other words: he argues for his own scientific training in which he obviously believes. I must say that I do find his belief in science rather alarming. When it comes to addiction, that is. Differently put: science is based on a cause-and-effect logic and addiction, in my view (we are dealing here with the unconscious), defies such logic.

Nevertheless, in many respects I consider The Sober Truth spot on. True, it cannot be proven that AA works. True, for quite some it does clearly not work.

There are however also the ones who are for years in AA, who do not drink and who are convinced that AA keeps them sober. Can they prove it that it is because of AA that they are staying sober? Of course not. And, why should they? Isn't it enough that before they joined AA they drank and after they joined AA they didn't?

There is no way to prove that the 12 steps cause drunks to stop drinking. Maybe they had anyway been ready to quit, maybe they simply like to hang out with other alcoholics who do not drink anymore, maybe they had experienced what is known as spontaneous remission and erroneously attributed it to the 12 steps?

If you happen to believe in the 12 steps, the 12 steps might be helpful. If you happen to believe in psychotherapy, psychotherapy might be helpful. Young Dominic, for instance, for whom AA didn't work was eventually being helped by Dr Dodes. "It took eight months of psychotherapy before Dominic stopped drinking for good. Although he remained in therapy for several years after that, the key that unlocked his addiction was nothing more complex or ethereal than an understanding of what his addiction really was and how it really worked."

Debunking the bad science behind 12-step programs and the rehab industry promises the subtitle and does indeed live up to it yet, in regards to the 12-steps, misses (to be fair: Dodes mentions it) the point for, at least to my knowledge, nobody has ever claimed that there is scientific proof that the steps work. Moreover, it is not needed for the ones who practise the AA principles and stay sober. As I've stated before, for the ones who could not stay stopped before they joined AA but were able to stay stopped after they joined it is pretty obvious that being sober has something to do with AA.

Mr Dodes also addresses what he calls "The Myths of AA". For instance: "One Day at a Time" that he judges as "also rather infantilizing, as it suggests that addicts cannot bear the burden of considering weeks or months without addiction." Well, "One Day at a Time" suggests something completely different, namely, that the best preparation for things to come is to take care of the things in front of us.

Lance Dodes also explains what in his opinion does work to treat addiction. He doesn't think that alcoholism is a disease but "a behavior, or perhaps a collection of behaviors". To him, addictive behavior is "a response to feelings of overwhelming helplessness. It's what people do to 'fight back' against this unbearable feeling" and so "every addictive act is a substitute for a more direct behavior". In addition: "Although different 'addictions' may appear to be wholly separate problems, they are, in fact, just different outward manifestations of the same mechanism."

As much as I do agree on this, I think Dr Dodes conclusion to be mistaken. "Programs that apply community-based encouragement and little or no individualized care are poorly designed to treat emotional symptoms, including addictive behaviors." To me, addiction is basically an ego-problem, a phenomenon of "self-will run riot". And so, nurturing the ego (and this is what individualized-care is also about) shouldn't be encouraged. At the same time (I do have no problems with contradictions, they only exist in the mind) there clearly are situations in which the ego should indeed be encouraged, constructively, that is.

The Sober Truth provides lots of food for thought. And, since I'm a fan of the "whatever works"-approach, this is a most helpful book.

Lance Dodes, MD
and Zachary Dodes
The Sober Truth
Beacon Press, Boston 2014

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