Beyond 12-steps

In another article, we highlight the research that supports 12-step recovery. However, noted clinicians and researchers emphasize that 12-step recovery doesn't help everyone, and its dominant role in addiction treatment is causing harm to many.

Lance Dodes, MD, is a retired professor of psychiatry from Harvard Medical School and a former director of the substance abuse treatment unit at McLean Hospital. He is known for his critical analysis of traditional addiction treatment models, particularly 12-step programs, and has authored several books on the subject, including The Sober Truth. Dodes advocates for evidence-based, individualized approaches to addiction recovery, challenging prevailing notions in the field.

Dodes critically examines the effectiveness and scientific basis of Alcoholics Anonymous (AA) and other 12-step programs. Dodes, a retired psychiatry professor, argues that the success rates of 12-step programs are significantly lower than widely believed, citing studies that suggest these programs help only a small fraction of those who participate. He contends that the prevailing belief in the universal efficacy of AA is based more on anecdotal success stories and cultural acceptance than on rigorous scientific evidence. Dodes also critiques the broader addiction treatment industry, highlighting its reliance on the 12-step model despite the availability of alternative, evidence-based approaches.

Dodes emphasizes that 12-step programs can be particularly harmful to individuals who do not succeed within their framework. The programs often propagate the idea that failure to achieve sobriety is due to a personal or moral failing, rather than a potential mismatch between the individual and the treatment method. This can lead to feelings of shame, guilt, and hopelessness among participants who struggle to adhere to the program’s principles. Additionally, the spiritual and surrender-oriented aspects of 12-step programs may not resonate with everyone, particularly those who do not share the same beliefs or who prefer a more secular or individualized approach to recovery. This misalignment can exacerbate the sense of isolation and inadequacy, potentially worsening the individual's addiction issues.

To improve outcomes for individuals struggling with addiction, Dodes advocates for significant changes in the recovery treatment industry. He calls for a shift towards evidence-based treatments that are tailored to the individual needs of patients. This includes greater emphasis on approaches such as cognitive-behavioral therapy (CBT), motivational interviewing, and medication-assisted treatment (MAT), which have shown higher efficacy rates in clinical studies. Dodes also highlights the importance of addressing underlying psychological issues, such as trauma and mental health disorders, which often co-occur with addiction. Moreover, he suggests that treatment programs should be more flexible and inclusive, allowing for a variety of pathways to recovery that respect individual differences in beliefs, experiences, and needs. By prioritizing scientific evidence and personalized care, the recovery industry can better support individuals on their path to sobriety.

This is a list of some of the experts and data sources cited by Lance Dodes in his book The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. This list includes notable researchers and studies referenced to support his arguments.

George E. Vaillant:

• Vaillant is a psychiatrist and a prominent researcher in the field of addiction. He conducted the Harvard Grant Study, which is one of the longest longitudinal studies of adult development. His research is often cited regarding the natural history of alcoholism and recovery.

William R. Miller:

• Miller is a professor of psychology and psychiatry, known for his work on motivational interviewing and the stages of change model. His research includes a critical analysis of the efficacy of various addiction treatments.

Keith Humphreys:

• Humphreys is a professor of psychiatry and behavioral sciences at Stanford University. His work focuses on addiction treatment policy and the effectiveness of mutual-help organizations like Alcoholics Anonymous (AA).

H. Westley Clark:

• Clark is the former director of the Center for Substance Abuse Treatment (CSAT) at SAMHSA. His insights into addiction treatment policies and practices are frequently cited in discussions about the effectiveness of various treatment modalities.

Robert M. Morse and Daniel K. Flavin:

• Morse and Flavin co-authored a study titled "The Definition of Alcoholism," published in The Journal of the American Medical Association (JAMA), which provides a comprehensive definition and understanding of alcoholism as a medical condition.

Mick Cooper:

• Cooper is a psychologist who has researched and written extensively about therapeutic relationships and the effectiveness of different psychotherapeutic approaches, including those used in addiction treatment.

Charles P. O'Brien:

• O'Brien is a professor of psychiatry at the University of Pennsylvania, known for his research on the neurobiology of addiction and the development of medications for addiction treatment.

Thomas Babor:

• Babor is a professor in the Department of Community Medicine and Health Care at the University of Connecticut, with significant contributions to the field of addiction research, particularly in the area of alcohol use disorders.

Marc Galanter:

• Galanter is a professor of psychiatry at New York University, whose research includes studies on self-help approaches to addiction treatment and the effectiveness of 12-step programs.

Harvard Grant Study:

• A longitudinal study conducted by George E. Vaillant, which tracked the lives of 268 Harvard sophomores over 75 years to understand the factors contributing to healthy aging and the natural history of alcoholism.

Project MATCH:

• A large-scale study funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) that compared the effectiveness of three different types of therapy for alcohol use disorder: cognitive-behavioral therapy (CBT), motivational enhancement therapy (MET), and 12-step facilitation therapy.

Cochrane Review on Alcoholics Anonymous and Other 12-Step Programs:

• A systematic review that evaluates the evidence on the effectiveness of AA and other 12-step programs in treating alcohol use disorder.

NIAAA's National Epidemiologic Survey on Alcohol and Related Conditions (NESARC):

• A large, nationally representative survey that collects data on the prevalence, treatment, and correlates of alcohol use disorders and related conditions in the United States.

The JAMA Study by Morse and Flavin:

• "The Definition of Alcoholism" by Robert M. Morse and Daniel K. Flavin, which provides a medical and clinical definition of alcoholism, often cited in discussions about the nature and treatment of alcohol use disorders.

These experts and studies provide a broad and critical perspective on the efficacy of various addiction treatments and the scientific understanding of addiction, as presented in Dodes' book.