Ep. 342 The Truth About the Rehab Industry and 12-Step

That alcoholics and drug addicts need rehab and a 12-step program is one of those things everyone knows, but isn't true. Scroll down for the show notes and mp3 of today's provocative episode!

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Everyone thinks “rehab” and/or 12-step programs are indispensable for recovery from addiction. But according to my guest, their success rates are abysmal and the science behind them is either bogus or nonexistent.

About the Guest

Dr. Lance Dodes recently retired as assistant clinical professor of psychiatry at Harvard Medical School. He is a Training and Supervising Analyst Emeritus with the Boston Psychoanalytic Society and Institute. He has also served as director of the substance abuse treatment unit of Harvard’s McLean Hospital, director of the alcoholism treatment unit at Spaulding Rehabilitation Hospital (now part of Massachusetts General Hospital), and director of the Boston Center for Problem Gambling.

Book Discussed

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

Other Books by the Guest

The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors

Breaking Addiction: A 7-Step Handbook for Ending Any Addiction (also available in audiobook)

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Guest’s Website

LanceDodes.com

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  • Duff_McClintock

    Um, no it emphatically does not work. Show up to an average AA meeting and listen to all the stories of the people who have been giving it a try … dozens of times over and over again. Courts force it upon weak, marginal people and they do this because (as pointed out time and yet time again) AA enjoys an incestuous relationship with the treatment industry. Judges rely on people who are perceived as experts in other subject areas. In the area of addiction, psychiatrists and “treatment professionals” (read: professional AA proselytizers) are deferred to. This is how AA has become embedded in society.

  • Duff_McClintock

    You make many assumptions. Let me pose a question to you: If I have no experience with this sort of problem, why do you suppose I take such an interest and hold such strong viewpoints?

    As far as your “war stories” go – I am glad you found your way out of that lifestyle. Many others with similar – or worse – circumstances are able to find their way out without joining the cult-like organization of AA. Many more are probably made worse by internalizing AA’s belief (shared by many, if not most psychiatrists and mental health professionals) that addiction is a “life-long brain disease.” It is not. You mentioned schizophrenia, which I also have a deep, personal interest in (I’ll let you do some guesswork on that too). I don’t want to get too far along into another tangential argument, but most of what is in the DSM V, including schizophrenia, is not disease. More specific to your point, a diagnosis of schizophrenia – and virtually every other “mental illness” is subjective. As a matter of fact, the concept of the disease itself was subjectively determined. I’ve encountered all the hullabaloo about “brain scans…” as well. It is unconvincing to those with a rigorous mind.

  • Augustus Gustavius Salvatore C

    I followed what Tom was saying quite easily. Mary … what have you done to make the world a better place ? I look forward to the list. 99guspuppet

  • Augustus Gustavius Salvatore C

    Do you bother to consider Tom’s presentation ?

  • Augustus Gustavius Salvatore C

    AA is not free. There are opportunity costs at the very least.

  • Augustus Gustavius Salvatore C

    Mary Are you an expert on AA ? I look forward to your credentials.

  • Augustus Gustavius Salvatore C

    Jewish ….. Beverly Hills …….A great example of a logical fallacy.

  • Augustus Gustavius Salvatore C

    antidote ? If I say that I am here today because of Unicorns and Karaoke …….. is that a good enough antidote ?

  • Augustus Gustavius Salvatore C

    I would love to discuss what “scientific” means.

  • Dennis

    I would assume by your response that you work in the field devoted to the study of mental disorders. I understand that people who work in this field do change the names and or definitions of what they consider to be mental diseases or disorders. Case in point, schizophrenia, which was considered and called a mental disease back in my childhood days is now called a mental disorder. So….?
    My definition, your definition aside, my point is that I will and do defend 12 step programs like AA. If there are suffering people who find sobriety outside of the AA 12 step program, good for them, I commend them and God bless them.
    The difference is I do not put them down or call them names (cult) or spout out to the world on the internet that they do not work. What would I accomplish by doing so? Hubris? Bravado? If I were to say, “Look at me world, I am not an addict, I have never been an addict. I like to dismiss some forms of addiction treatment and I call them derogatory names because they are not the kind of treatments I agree with.”
    Really? That would be the pinnacle of self aggrandizement. In my childhood it was called false pride. To call a group of people who come together to help one another with God’s love and understanding a cult? You might as well call every Christian church a cult or any self help group a cult. Jesus said, “Wherever 2 or more are gathered in my name, there I am also.” That is well enough for me.
    I

  • Eric Von Mises

    Credentials? Paul Krugman has credentials including a nobel prize and he is wrong and causes a lot of harm. I love Tom Woods but if this was the first podcast I listened to, I would have never listened again based on the lack of understanding of guest. This guest bastardized the AA program and the history of AA. He even has the gall to talk ill about Bill W. who had Delirium Tremens and was told he would soon have a “wet brain” and complains about his cigarette smoking and womanizing. Like they say, “One miracle at a time, Tom.” Bill was a hope to die drunk and gave the world a beautiful course of action for those afflicted with alcoholism.
    Tom if you did your research on AA, you would have found out the structure of AA is one of the most brilliant, libertarian type of organization there can be. All groups are autonomous except matters affecting other groups or AA as a whole. I can start my own group and report to nobody. AA is self supporting through its own contributions (no gov $) and was bullied by the government into signing court cards for DUI convictions. Your guest spoke of the people that run the meetings. “The group leaders are but trusted servants, they do not govern.”
    Tom you are a brilliant man and I appreciate all the hard work you do for our movement. AA is a spiritual program and I have never seen anyone fail who has worked the program rigorously. The beauty of AA is that it brings you closer to God. The number of Catholics in AA would knock your socks off Tom. AA has no defense because our traditions suggest that we stay anonymous at the level of press, radio and film. Even me posting this could give others the idea that “AA’s” are pompous and intolerant.

    Tom, I encourage you to learn more of the structure, it is beautiful sight to see, nobody in charge/we are “self-governed” and yet we are peaceful and get along great without any rulers or the help of government or any treatment centers.

  • Eric Von Mises

    Last thing, the guest snickers at the fact that AA hasn’t changed since the founding and the original (first 164 pages) text has not changed. Wow, they left a great document alone and the society of sober alcoholics flourished. Imagine if our government leaders had taken that same attitude with constitution. Tom, you are a good dude, us alkies are just a bit defensive over the program that saved our lives.

  • TK

    I love the above comment. This was my 1st podcast and 1st comment. it was extremely dissapointing to hear so much misinformation about AA including its factual history and the actual program. Mainly though because I felt assured that Tom Woods would never be this ignorant of the US constitution. The constitution works if I can understand it and take action. so it is with AA.

  • TK

    If you can ‘just stop’, you are not a real alcoholic.

  • TK

    excellent!

  • TK

    If you want to bake a cake, it takes effort but you have to follow all directions on the box. If you do not, you will probably not have a cake. So it is with taking action via the 12 Steps of AA..

  • TK

    Love you Mary. Love you Tom. I know you both care :-)

  • Eric Von Mises

    Tom Woods really does a phenomenal job with his podcasts and this one was an outlier. Although Tom will probably not circle back to this thread nor want to debate me on his show, this is the only topic I would love to debate Tom on but I would not be able to due to the traditions of AA. How could I, as a recovering alcoholic speak on behalf of the AA program, who delegated me the authority? Nobody, so this is where it ends. Isn’t it funny how the “establishment” of AA as the guest calls it, has no spokes-person like every other organization. It is one of the only true examples of bottom up governing I have seen. In a perfect world, I wish Tom would read the book “Alcoholics Anonymous” and ask sober members about the structure of the society. Tom would love it. I am surprised no libertarians have done a case study on the autonomy of the groups. It’s probably better that AA flies under the radar as it does so well. After someone who is suffering tries the guests “magic pill” approach (the easier softer way) and hopefully they are still alive, they will hopefully find their way to the rooms and they can be greeted with love, tolerance and acceptance. The funniest part is that it even says in “how it works” half measures availed us nothing.

  • Eric Von Mises

    How could AA have an incestuous relationship with the treatment centers? Treatment centers are often for profit, AA is not. “AA is not allied with any sect, denomination, politics, organization or institution, neither endorses nor opposes any causes. Our primary purposes is to stay sober and help other alcoholics to achieve sobriety”. Treatment centers are a completely different discussion. If they want to send patients to AA to attend meetings, they can do that as AA has no dues or fees. They can even claim it as there own as there is no one in AA who could or would stop them.

  • Gabriel1

    If you want arguments they aren’t terribly hard to provide. Quoting statistics is meaningless when there is no scientific method being followed, and it’s impossible to gather accurate data about a group where people are anonymous and don’t want to admit they are in the group due to social pressure. About the only thing I agreed with the guest on is there should be less stigma, because then actual data would be easy to gather.

    Your guest presents some interesting ideas about the origin of addiction. But his critique of AA is not convincing. When quoting the 5-8% number he didn’t even compare it to the success rate for the general population, which would also be difficult to measure. The only really meaningful evidence he could bring forth is Bill W’s death from emphysema, but that’s not enough to convict AA beyond a reasonable doubt. I think you should take a less biased approach when discussing the painful and complex subject of addiction.

    Finally, you didn’t mention any of the anarchistic aspects of AA. For example, the lack of central leaders yet still managing to organize clubs and meetings. If you talked to some of the people in it you might be able to appreciate the ways they have developed to deal with sociopaths trying to take over and rule their decentralized, informal society.

  • Kirk Jaco

    Hold on Mary, Did you even give the discussion above the time of day? At no point in time did this Dr. say AA will not work, he said AA only works if there is the correct group of people guiding recovers, it has nothing to do with the 12 steps and even when there is the correct group there still is a good chance it wont help. Addiction is a disease, do you go to a 12 step group when you have cancer, no. Prayer and discussions don’t cure cancer just like 12 steps and talking doesn’t cure addiction. You go to someone who understands your disease and they help address and explain the issue.

  • Joe L.

    “Unscientific, outdated, unregulated”, don’t these sound eerily like the arguments Keynesians raise against the Austrian School?
    I would think that 12-step groups would be of particular interest to any Libertarian because they are perhaps the best working blueprint available for studying the effectiveness of a stateless society. 12-step groups are founded on spiritual principles, they are not governed and members are only disciplined by the natural consequences of their individual actions.
    Although I am disappointed by the way this subject was handled, I am not surprised that you are not well informed about 12-step groups. Very few people will take an interest in them unless they need one; but I would recommend learning what you can about them before commenting on their effectiveness.
    I would strongly suggest reading the literature of Alcoholics Anonymous or other 12-step groups directly instead of relying on biased interpretations of anecdotal evidence. In particular I would suggest the book Twelve Steps & Twelve Traditions. It is clear, concise, and reads like a collection of Leonard Read essays.

  • Jeffey

    Dennis you are acting like a big baby. If you are gonna be offended then why are you listening to academic discussions? I am gonna refer to you as Denise now. Don’t ever try to silence a man with god or christianity again. You are clearly a self centered and self loathing person.

  • menloman

    Dr. Dodes would seem to have his own issues worthy of discussion. Anyone who accepted the claims of psychoanalysis (the short term for what Sigmund Freud was peddling) has much to answer for. Psychoanalysis has no scientific basis. It seems to be based on a handful of very questionable cases that Freud seemed will into existence and promulgate to a gullible Jewish community.

  • 2nephi32

    Different things work for different people. My entire family has been plagued with self-inflicted addictions, and the 12 Step program has been a God-send. I attend a class for families of loved ones with addictions, and I can’t begin to express what a help it has been. My brother-in-law has been drug free for 4 years, my uncle for 6, my brother, who’s addicted to porn is getting an enormous amount of help through this program, and the eating disorder I struggled with is a distant memory (I know, kind of a crazy family). I cannot even begin to express what a blessing this program has been for myself and my loved ones.

  • ProfessionalOut

    Thank you Tom Woods for this podcast with Dr. Dodes. My story is in this book, and the most important thing to walk away with is that we need to focus on and help people, in other ways, that were harmed by the proselytization by AAers(and staunch supporters) and people the program failed and stand up for them in that journey without AA 12 step etc.
    .