Breaking free of addictions such as alcohol, drugs, and smoking is hard and very often people who seek to do so enroll in the many 12-step programs modeled on the one made famous by Alcoholics Anonymous. Some judges even use such programs as part of their sentencing requirements.
But Lance Dodes, a psychiatrist who treats addictions and has studied the various programs, says that not only are these popular programs unsuccessful, they actually cause more harm than good. He is extremely harsh in his judgment about their effectiveness.
[P]eople 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, and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine.
It’s not only that AA has a five to 10 percent success rate. If it was successful and was neutral the rest of the time, we’d say OK. But it’s harmful to the 90 percent who don’t do well. And it’s harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. 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.
He says that these and similar 12-step programs have created such an aura of success that if a person does not succeed after trying them, then it is that person’s own fault and is urged to try over and over again.
And if you don’t do well in a rehab, the rehab says you’ve failed, come back again, and come back again and again for the same failed treatment. Whenever we hear about these celebrities who go in and out of the same rehabs, we blame them. We say, what’s the matter with them? They’re falling out of the treatment. No one says the treatment is no good.
He says that there is no sure-fire way to treat addiction but that it is important for addicts to realize that their habit arises as a substitution for something and that it is important to get them to understand what it is they are missing in their lives and deal with that root problem if they are to kick the addiction.
One thing that I have not been clear about is what constitutes a ‘success’ in such rehabilitation efforts. Does it mean that the person kicks the habit entirely forever? Is it considered a failure if an addict replaces the addition with a more harmless substitute (like chewing gum) that they never get rid of? What if they stop being severely addicted to alcohol (say) but end up drinking the occasional beer or at socially acceptable levels? Or if they find that they are totally dependent on a support group for their entire lives to stay sober?
I see all of these things as successes because people have replaced a practice that was harming their lives with one that is under control. But maybe that is because I have no experience with such extreme addictions and that there is no escape from them unless you make a total break.