What’s The Best Way To Get Clean?

Andrew Sullivan —  Feb 12 2014 @ 10:29am

Maia Szalavitz profiles Dr. Lance Dodes, who considers the primacy of 12-step programs like Alcoholics Anonymous an impediment to more scientifically supported methods of addiction recovery:

Dodes shows that much of the research that undergirds AA is a conflicted mess that confuses correlation with causation. It’s true that people with alcoholism who choose to attend AA regularly drink less than those who do not—but it’s not proven that making people attend works better than other options, including doing nothing.

In fact, some studies find that people mandated into AA do worse than those who are simply left alone. … Contrary to popular belief, most people recover from their addictions without any treatment—professional or self-help—regardless of whether the drug involved is alcohol, crack, methamphetamine, heroin, or cigarettes. One of the largest studies of recovery ever conducted found that, of those who had qualified for a diagnosis of alcoholism in the past year, only 25 percent still met the criteria for the disorder a year later. Despite this 75 percent recovery rate, only a quarter had gotten any type of help, including AA, and as many were now drinking in a low-risk manner as were abstinent.

Last week, Dish readers offered impassioned defenses of the AA/NA approach. Another reader, who got sober without a 12-step program, pushes back:

Your reader’s contention that AA “works 100 percent of the time for people who are 100-percent committed to the program, while they maintain that level of commitment” is utter and total horseshit. AA’s effectiveness in promoting sobriety is hotly debated, but it’s far, far less than 100 percent, and blaming addicts for the failures of AA and related programs is delusional and cruel. Maybe all those dead friends and acquaintances should tip the reader that AA may not be a wonderfully successful treatment, as is often claimed.

I don’t believe that a full-blown addiction currently be “cured” in most instances, but it is certainly treatable. And that treatment needs to be personalized. Access to qualified medical professionals in developing a treatment plan is a necessity for most addicts. If AA meeting attendance provides some value or is appealing to the patient, then fine, but using a church basement full of old drunks as the first line of treatment in 2014 is just an appallingly bad idea. There is wisdom to be gained in the AA rooms but addicts have too many interrelated issues for a group of strangers to fully address.

I have just over ten months of complete sobriety, and my life is seriously better because I’m clean. It didn’t happen because I “bottomed out” or had some spiritual awakening. It happened because three years ago I owned the fuck up to my disease and started to address it as such. I didn’t get a good draw in this round of the genetic lottery but there are people who drew far worse maladies than “ethanol turns me into an asshole.”

Another:

From my experience, you would have a hard time convincing me AA helps anyone. My housemate was mandated to go to AA after getting a DUI. He says he was told at AA meetings that smoking and eating sugary foods would help him control his alcohol cravings. He now starts every day with two cigarettes, coffee and a pop tart. He smokes a pack of cigarettes a day (I saw all the empty cartons when I took out the recycling last week), and eats candy, ice cream and other sweets for breakfast, lunch and dinner, and snacks in between. He would often come back from meetings with package of cinnamon rolls or some other sugary sweet that a fellow AA attendee encouraged him to try. Our panty is now full of pop tarts, candy, cookies and other sweets, and our freezer has five cartons of ice cream in it. He has easily put on 30 pounds in the last year. I fail to see how hanging out and learning of people with bad lifestyles and bad personal habits is going to help anyone. Surely there must be a better way.

Update from an earlier emailer:

Well, since you’ve published my letter and one of your other readers has decided to attack me for it, I feel it’s only fair to respond. Clearly, this individual isn’t reading what I wrote: “AA works 100 percent of the time for people who are 100 percent committed to the program, while they maintain that level of commitment.” Someone who relapses is, by definition, committed to getting drunk over getting sober. It’s not delusional and cruel to point that out; it’s an empirical fact. If I go out and drink right now, it’s because I chose to abandon the program that lifts the desire to drink from me – but only lifts it conditionally, as I work the program and as I focus myself on spiritual recovery, and stops working when I stop doing those things. I’d retort that what’s delusional and cruel is to tell someone whom that program is keeping alive that they don’t need it anymore, especially if their use of the program isn’t adversely affecting you in the slightest.

I’m an alcoholic. I’m not supposed to be sober. I’m supposed to be drunk. Science and my own proclivities indicate I should be drunk right now. But when I go into a church basement and talk with a bunch of other drunks, a miracle happens – a miracle that science has never explained in any study I’ve read. The desire to drink is lifted from me.

Sociological studies of AA’s effectiveness have nothing to do with the fact that it works 100 percent of the time for people who work it 100 percent of the time. I don’t understand why your reader has so much difficulty understanding that, although given the eyeball-popping, vituperous rage of his or her response, I suspect an underlying bitterness toward recovery programs. No one is forcing AA on anyone (except for courts). If your reader found an easier, softer way, good for them. Me, I’d be dead doing it their way. So why do they begrudge me my success?

Recent Dish on AA and its alternatives here and here.