Reddit mentions of The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

Hey man, I understand completely. I did the same. An escape is an escape.
I still have problems coping completely but being physically active can easily replace the urge.
You also might be interested in this book. It's dense and hard to get through, but he really understands addiction and what it takes to get through them.

>"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.

So, again, there's a qualitative issue here.



AA says their success rate for people who "commit" to the program is 75%, but obviously they use a weasel word to narrow the field. So it's obviously BS. Other studies suggest that 35% of people who go to AA have an increase in sober days or a decrease in alcohol use, but then you run up against lower level interventions, like the 1978 manual suggests, which compares AA broadly to things like "brief intervention by a medical professional." (If your problem is 3-5 drinks a day with dinner, do you need AA when your doctor telling you "cut it down" might be enough? what does that say about the effectiveness of 12 step programs?)

Pretty much any serious discussion of the effectiveness of AA will discuss in detail that there are significant problems in gauging the effectiveness of any alcohol treatment, and nearly all studies have serious confounding factors. Among them, that many people in AA go to a few meetings and voluntarily leave? (did it help, or did they decide they don't really have a problem? or did it fail? how do you determine?) What about a selection effect, people court ordered into AA, vs people who voluntarily seek out alcohol treatment?

To this point, all of these articles focus on the same people. Dr. Lance Dodes and Zachary Dodes. The Salon article is actually written by them, the Atlantic article is also heavily based on what they say. They're a father and son (not that it's particularly relevant, but interesting). The Antlantic article cites them as well, but goes a different direction and focuses also on Naltrexone, and the finnish program to treat alcoholism through widely dispersed clinics that distribute the drug.

The Dodes wrote a book called The Sober Truth which was specifically for the purpose of attacking AA/NA programs.

An MD writing for the New York Times called The Sober Truth "Polemical and deeply flawed" they wrote the book to promote psychodynamic treatment, which focuses on the theory that alcoholism is caused by unconscious desires.

The Dodes grossly overstate what the Cochrane Review actually said. Here's the pubmed page for the actual article. Notably, it does NOT say that there is no evidence that AA is effective, which is the claim being made. It says, in short, that AA has not been shown statistically, more or less effective than other treatment options and more study is needed.

>OBJECTIVES:To assess the effectiveness of AA or TSF programmes compared to other psychosocial interventions in reducing alcohol intake, achieving abstinence, maintaining abstinence, improving the quality of life of affected people and their families, and reducing alcohol associated accidents and health problems.

>MAIN RESULTS:
Eight trials involving 3417 people were included. AA may help patients to accept treatment and keep patients in treatment more than alternative treatments, though the evidence for this is from one small study that combined AA with other interventions and should not be regarded as conclusive. Other studies reported similar retention rates regardless of treatment group. Three studies compared AA combined with other interventions against other treatments and found few differences in the amount of drinks and percentage of drinking days. Severity of addiction and drinking consequence did not seem to be differentially influenced by TSF versus comparison treatment interventions.


What the study finds, is that AA/NA is not statistically more effective than other treatment approaches.

Which is the main point. Pretty much all drug and alcohol treatment has a terrible success rate, AA is not markedly more successful than other programs, but CBT and other similar programs are not that successful either.

The Dodes specifically choose to attack AA/NA, but there isn't any stronger evidence for their programs as well.

>But let's not compare meth to alcohol, as the addiction is much stronger with meth. People who are alcoholic need to figure out what the source of their underlying physical or emotional pain is and solve it, or they're probably never going to get and stay sober

I'll put this plainly, bullshit.

Yes, meth is very addictive and fucks up their dopamine cycle. But no mental health professional makes the distinction that you make. A significant part of my job is working with drug treatment and trying to get people clean, and I spend a lot of time listening to professionals who work on that.

Virtually all mental health professionals say that a big part of fixing any drug addiction is mental health treatment, identifying the underlying triggers for use, and resolving them. Whether it's cocaine, meth, opiates, marijuana, lots of people with drug problems (defined by causing life problems) have those problems because of some underlying issue that they're effectively self-medicating.

Standard short term rehab is 28 days, because that's all most places can get paid for. You can make someone clean in 28 days, but you can't fix the underlying problems, whether it's poverty, mental illness, bad social influences whatever.

Which is why nearly all mental health and addiction professionals talk in terms of layered treatment. if you have a drug or drinking problem, you focus on getting clean and go to substance abuse treatment (inpatient or outpatient) where, through CBT you work on thought patterns and triggers for using, and learn how to avoid using), then you continue to get treatment when you go back into the community, and nearl all recommend that going to some group support program, most commonly a 12 step group, is helpful in continuing to stay clean (SMART is an alternative, but is virtually non-existent, whereas even in the small towns I work in, there are 5-6 weekly AA/NA type meetings).

AA success rates are around 5-10% (about the same as just quitting on your own):

https://www.amazon.com/Sober-Truth-Debunking-Programs-Industry-ebook/dp/B00FIMWI1O/ref=sr_1_1?ie=UTF8&qid=1526864598&sr=8-1&keywords=dodes+aa

The Sinclair Method has success rates around 80% (by far the highest of any treatment option):

https://www.amazon.com/Cure-Alcoholism-Medically-Eliminate-Addiction-ebook/dp/B009G1TID4/ref=sr_1_2?s=digital-text&ie=UTF8&qid=1526864729&sr=1-2&keywords=the+cure+for+alcoholism