In a book that’s getting plenty of discussion around the Internet, including multiple reviews, “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry,” is one of the hardest-hitting and most direct critiques yet of the 12-step ideas, structure and model for sobriety support. Per the subtitle, it’s about more than just Alcoholics Anonymous and Narcotics Anonymous. Authors Lance Dodes and Zachary Dodes, the former with  35 years of psychiatric experience, tackle how the 12-step model has become accepted by the rehab industry, and also the courts, including noting, of additional importance to LifeRing, legal rulings that 12-step programs are a religion in terms of First Amendment views. and therefore mandatory  orders to AA or NA meetings are not allowed.

From the review on Amazon:

In The Sober Truth, acclaimed addiction specialist Dr. Lance Dodes exposes the deeply flawed science that the 12-step industry has used to support its programs. Dr. Dodes analyzes dozens of studies to reveal a startling pattern of errors, misjudgments, and biases. He also pores over the research to highlight the best peer-reviewed studies available and discovers that they reach a grim consensus on the program’s overall success.

But The Sober Truth is more than a book about addiction. It is also a book about science and how and why AA and rehab became so popular, despite the discouraging data. Dr. Dodes explores the entire story of AA’s rise, from its origins in early fundamentalist religious and mystical beliefs to its present-day place of privilege in politics and media.

The Sober Truth includes true stories from Dr. Dodes’s thirty-five years of clinical practice, as well as firsthand accounts submitted by addicts through an open invitation on the Psychology Today website. These stories vividly reveal the experience of walking the steps and attending some of the nation’s most famous rehabilitation centers.

The Sober Truth builds a powerful response to the monopoly of the 12-step program and explodes the myth that these programs offer an acceptable or universal solution to the deeply personal problem of addiction. This book offers new and actionable information for addicts, their families, and medical providers, and lays out better ways to understand addiction for those seeking a more effective and compassionate approach to this treatable problem.

To many LifeRingers who came to LifeRing from 12-step programs, these critiques may already be known. But, as Dr. Dodes notes, they’re still not well known in either the court system or his own profession.

Some, based on the first major media review of the book, in Salon, an excerpt from the book by the authors, may fear this book engages in “AA bashing.” However, Dodes does note that the 12-step methodology does work for some people. Rather, to me, the book seems to be what flows from his observations of “medical best practice” based on his 35 years as a psychiatrist.

In one earlier book, per a review on Amazon, he labels as “myth”:

  • Addictions are fundamentally a physical problem.
  • People with addictions are different from other people.
  • You have to hit bottom before you can get well.
  • You are wasting your time if you ask “why” you have an addiction.

In other words, he seems to discuss issues of addiction from a variety of medically and psychologically informed angles. In that book, these issues seem to be related to what he presents in his current book, namely that addiction is a psychological issue as much as anything, and that while addictive substances affect brain chemicals, that’s not the most productive way, or the right level of approach, to address this situation. I do know that neuroscientist Carl Hart, in his new book, “High Price,” is more explicit about ideas about how addiction boils down to dopamine problems are more and more panning out as not true. (I’ll have a review of that book in a couple of days.)

Per the informational angle, this book is gaining “traction” nationally, and aside from any possible concerns about “tone” on Dodes’ discussion of 12-step methodology, raises important issues from a medical stance. Besides Salon, it’s now also been reviewed in The Atlantic and at NPR, as part of an author interview.

There is one thing that is a bit eyebrow-raising, that I noticed most at his NPR interview. He talks about “managing” addiction. I don’t know if “moderation” is under his “management” ideas or not.

You can learn more about Dodes, including a blog he maintains on addiction issues, at his website.

Note: This post h as been lightly edited since its original posting to drop most references to other Liferingers’ opinions and to add a reference to another new book about addiction, that of Hart.