The Sober Truth

1. AA's effectiveness is unproven and its success rate is low

Peer-reviewed studies peg the success rate of AA somewhere between 5 and 10 percent.

Lack of evidence. Despite its widespread acceptance, Alcoholics Anonymous has never been proven effective through rigorous scientific study. The Cochrane Collaboration, a prestigious research organization, concluded in 2006 that "no experimental studies unequivocally demonstrated the effectiveness of AA" in treating alcoholism.

Low success rate. While AA claims high success rates, independent studies suggest only 5-10% of those who enter AA achieve lasting sobriety. This is barely better than rates of spontaneous remission - people who recover without any treatment. Many who leave AA fare worse than if they had never attended.

Misleading statistics. AA often cites impressive statistics, but these are based on flawed methods:

• Only counting members who stay, ignoring the majority who drop out
• Relying on self-reported data from the most committed members
• Ignoring long-term outcomes beyond the first year
• Failing to use proper control groups for comparison

2. The 12-step approach lacks scientific basis and perpetuates harmful myths

If moral self-flagellation could cure addiction, we could be sure there would be precious few addicts.

Outdated model. The 12 steps are based on 1930s religious and moral concepts, not modern psychological understanding. They promote ideas like powerlessness, character defects, and moral inventory that are not supported by addiction science and may be counterproductive.

Harmful myths. AA perpetuates many myths about addiction that can impede recovery:

• You must "hit bottom" before getting better
• You must surrender your will to a higher power
• Addiction is a lifelong disease you're powerless over
• Only other addicts can treat addiction
• Counting days sober is helpful (can lead to shame cycles)
• All addicts have the same character defects

One-size-fits-all approach. AA treats all addicts the same, ignoring individual psychology and circumstances. This fails to address the underlying causes of each person's addiction.

3. Rehab centers offer luxury amenities but little evidence-based treatment

Rehab owns a special place in the American imagination.

Expensive pseudoscience. Many rehab centers charge exorbitant fees ($30,000-$90,000 per month) while offering little evidence-based treatment. They rely heavily on the 12-step model, despite its lack of proven effectiveness.

Luxury over treatment. Rehabs compete by offering amenities like:

• Equine therapy
• Adventure therapy
• Massage and acupuncture
• Yoga and meditation
• Gourmet food and beautiful settings

Limited therapy. Most rehabs provide minimal individual therapy with qualified professionals. A typical day may include only 1-2 hours of group therapy, with the rest filled by lectures, 12-step meetings, and non-therapeutic activities.

Poor outcomes. Despite high costs, rehab outcomes are poor. Studies show 40-60% of patients relapse within a year. Repeated stays are common, creating a revolving door effect.

4. Addiction is a psychological compulsion, not a disease or moral failing

Addiction seems to hold a special place in the American imagination.

Compulsion, not disease. Addiction is best understood as a psychological compulsion similar to other unwanted behaviors, not a disease or moral failing. It serves a psychological function for the individual.

Reversing helplessness. The core driver of addiction is an attempt to reverse feelings of overwhelming helplessness. Addictive acts provide a sense of empowerment and control, even if destructive.

Displacement behavior. Addiction is a substitute for more direct action to address underlying emotional issues. It's a coping mechanism, albeit a maladaptive one.

Not about pleasure. Contrary to popular belief, addiction is not primarily about seeking pleasure. It persists long after the behavior stops being enjoyable.

5. Understanding the psychology of addiction is key to effective treatment

Unlocking addiction brings it back down to earth.

Individualized approach. Effective treatment requires understanding each person's unique psychological drivers of addiction. There's no one-size-fits-all solution.

Identify triggers. Addicts must learn to recognize the specific situations, thoughts, and emotions that trigger their urges. This allows them to predict and manage cravings.

Address underlying issues. Treatment should focus on resolving the core emotional issues and traumas that fuel addictive behavior, not just abstinence.

Empower, don't surrender. Instead of promoting powerlessness, treatment should help addicts feel empowered to make changes and address their issues directly.

Psychotherapy is key. Individual talk therapy with a qualified professional is crucial for uncovering and addressing the psychological roots of addiction.

6. AA can work for some due to social support and empowerment, not the 12 steps

AA's strength lies in providing a social network where newly abstinent people can get together comfortably in mutual support.

Social benefits. AA provides valuable social support and community for some addicts, which can aid recovery. This may account for much of its limited success.

Empowerment for some. Some members find the concept of a "Higher Power" empowering, which can help reverse feelings of helplessness. However, this effect is precarious and can backfire.

Unintended matches. AA occasionally works when its approach accidentally aligns with an individual's psychology, not because of the 12 steps themselves.

Limited applicability. AA is likely only helpful for a small subset of addicts who resonate with its approach. Referring all addicts to AA is misguided and potentially harmful.

7. Current addiction research fails to address underlying psychological causes

What's missing from this literature is any study that revisits the fundamental questions once and for all: What is addiction? How should we treat it? Why does it occur in some individuals and not others?

Flawed focus. Most current addiction research focuses on genetics, neurobiology, or superficial behavioral measures. This neglects the crucial psychological aspects of addiction.

Bias towards quantification. There's an overemphasis on quantitative studies and statistics, even when qualitative approaches would be more illuminating for understanding human behavior.

Lack of controls. Many widely cited addiction studies lack proper control groups, making their conclusions unreliable.

Circular reasoning. Much addiction research starts with faulty assumptions about the nature of addiction, leading to self-reinforcing but ultimately meaningless findings.

Case studies undervalued. The field undervalues detailed case studies that could provide rich insights into the psychology of addiction.

8. A new approach to addiction treatment and research is urgently needed

A fraction of what Americans spend on rehab would cover the entire study, and then some.

Paradigm shift required. We need a fundamental shift in how we conceptualize, research, and treat addiction, moving away from the disease model and 12-step dominance.

Comprehensive study needed. A large-scale, long-term study comparing different treatment approaches (including psychodynamic therapy) is long overdue. This could revolutionize our understanding of what works.

Psychological focus. Future research and treatment must prioritize understanding the individual psychological drivers of addiction, not just its outward manifestations.

Evidence-based treatment. Addiction treatment centers should be required to offer evidence-based therapies and track long-term outcomes.

Public awareness. There's an urgent need to educate the public about the limitations of current approaches and the potential of psychologically-informed treatment.

Last updated: November 19, 2024