Are 12 Steps Necessary?

A new book by Lance and Zachary Dodes suggests there might be better alternatives to Alcoholics Anonymous:

Peer-reviewed studies peg the success rate of AA somewhere between 5 and 10 percent. That is, about one of every fifteen people who enter these programs is able to become and stay sober. In 2006, one of the most prestigious scientific research organizations in the world, the Cochrane Collaboration, conducted a review of the many studies conducted between 1966 and 2005 and reached a stunning conclusion: “No experimental studies unequivocally demonstrated the effectiveness of AA” in treating alcoholism. This group reached the same conclusion about professional AA-oriented treatment (12-step facilitation therapy, or TSF), which is the core of virtually every alcoholism-rehabilitation program in the country.

Many people greet this finding with open hostility. After all, walk down any street in any city and you are likely to run into a dozen people who swear by AA—either from personal experience or because they know someone whose life was saved by the program. Even people who have no experience with AA may still have heard that it works or protest that 5 to 10 percent is a significant number when we’re talking about millions of people. So AA isn’t perfect, runs this thread of reasoning. Have you got anything better? 

In a review of the Dodes’ book, Jake Flanagin considers how AA took hold:

According to Dodes, when the Big Book [AA’s founding literature] was first published in 1939, it was met with wide skepticism in the medical community. The AMA called it “a curious combination of organizing propaganda and religious exhortation.” A year later, the Journal of Nervous and Mental Diseases described it as “a rambling sort of camp-meeting confession of experiences … Of the inner meaning of alcoholism there is hardly a word. It is all surface material.”

That perception has since radically changed, albeit gradually, thanks in no small part to the concerted efforts of AA’s early pioneers. They “realized early on that to establish true legitimacy, they would eventually need to earn the imprimatur of the scientific community,” writes Dodes. Which they did, with aplomb, largely by manufacturing an establishment for addiction scholarship and advocacy that did not previously exist. They created a space for AA to dictate the conversation.

Meanwhile, Mano Singham questions how we define rehabilitation:

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.

Previous Dish on AA and its alternatives here, here, and here.